Q1 2024 Ensign Group Inc Earnings Call
Operator: Thanks for standing by. My name is Mandeep, and I'll be your conference operator today. At this time, I would like to welcome everyone to the Ensign Group Inc. First Quarter Fiscal Year 2024 Earnings Conference. All participants want to be placed on mute to prevent any background noise.
Thanks for standing by my name is Martin deep and I'll be your conference operator today at this time I would like to welcome everyone to the Ensign Group, Inc. First quarter fiscal year 2024 earnings conference call. All lines have been placed on mute to prevent any background noise.
Operator: After the speaker's remarks, there will be a question and answer session. If you'd like to ask a question during this time, simply press star followed by the number one on your telephone keypad. If you'd like to withdraw your question, press star 1 again. Thank you. I would now like to turn the conference over to Mr. Keetch. You may begin.
Operator: The Speakers' remarks, there'll be a question and answer session if you'd like to ask a question. During this time simply press star followed by the number one on your telephone keypad if.
Chad A. Keetch: If you'd like to withdraw your question Press Star one again. Thank you I would now like to turn the conference over to Mr. Keetch you may begin.
Chad A. Keetch: Thank you, operator, and welcome, everyone. We filed our earnings press release yesterday, and it is available in the investor relations section of our website at ensigngroup.net. A replay of this call will also be available on our website until 5 p.m. Pacific on Friday, May 31st, 2024. We want to remind anyone that may be listening to a replay of this call that all statements made are as of today, May 2nd, 2024, and these statements have not been or will not be updated subsequent to today's call.
Keetch: Thank you operator and welcome everyone.
Chad A. Keetch: Filed our earnings press release yesterday, and it is available on the Investor Relations section of our website at Ensign group Dot net.
Chad A. Keetch: A replay of this call will also be available on our website until five P. M Pacific on Friday May 31 2024.
Chad A. Keetch: We want to remind anyone that may be listening to a replay of this call that all statements made are as of today <unk> 2024, and these statements have not been nor will be updated subsequent to today's call.
Chad A. Keetch: Also, any forward-looking statements made today are based on management's current expectations, assumptions, and beliefs about our business and the environment in which we operate. These statements are subject to risks and uncertainties that could cause our actual results to materially differ from those expressed or implied on today's call.
Chad A. Keetch: Also any forward looking statements made today are based on management's current expectations assumptions and beliefs about our business and the environment in which we operate these statements are subject to risks and uncertainties that could cause our actual results to materially differ from those expressed or implied on today's call.
Chad A. Keetch: Listeners should not place undue reliance on forward-looking statements and are encouraged to review our SEC filings for a more complete discussion of factors that could impact our results. Except as required by federal security laws, Ensign and its independent subsidiaries do not undertake to publicly update or revise any forward-looking statements where changes arise as a result of new information, future events, changing circumstances, or for any other reason. In addition, Ensign Group Inc. is a holding company with no direct operating assets, employees, or revenues.
Chad A. Keetch: Listeners should not place undue reliance on forward looking statements and are encouraged to review our SEC filings for a more complete discussion of factors that could impact our results.
Chad A. Keetch: As required by federal Securities laws, Ensign and its independent subsidiaries do not undertake to publicly update or revise any forward looking statements where changes arise as a result of new information future events changing circumstances or for any other reason. In addition, the Ensign Group, Inc. Is a holding company with no direct.
Chad A. Keetch: Operating assets employees or revenues.
Chad A. Keetch: Certain of our independent subsidiaries, collectively referred to as the service center, provide accounting, payroll, human resources, information technology, legal, risk management, and other services to other independent subsidiaries through contractual relationships with such subsidiaries. In addition, our captive insurance subsidiary, which we refer to as the insurance captive, provides certain claims-made coverage to our operating companies for general and professional liability as well as for workers' compensation insurance liability. Ensign also owns Standard Bear Healthcare REIT, Inc., which is a captive real estate investment trust that invests in healthcare properties and enters into lease agreements with certain independent subsidiaries of Ensign, as well as third-party tenants that are unaffiliated with the Ensign Group.
Chad A. Keetch: Certain of our independent subsidiaries collectively referred to as the service center provide accounting payroll human resources information technology legal risk management and other services to the other independent subsidiaries through contractual relationships with such subsidiaries and.
Chad A. Keetch: In addition, our captive insurance subsidiary, which we refer to as the insurance captive provides certain claims made coverage to our operating companies for general and professional liability as well as for workers' compensation insurance liabilities.
Chad A. Keetch: <unk> also own standard bearer health care REIT, Inc, which is a captive real estate investment trust that invest in health care properties and entered into a lease agreement with certain independent subsidiaries of enzyme as well as third party tenants that are unaffiliated with the Ensign group.
Chad A. Keetch: The words Ensign, Company, We, Our, and Us refer to the Ensign Group and its consolidated subsidiaries. All of our independent subsidiaries, the Service Center, Standard Bearer Healthcare REIT, and the Insurance Captive, are operated by separate, independent companies that have their own management employees and assets.
Chad A. Keetch: The words enzyme company, we our and us refer to the Ensign group and its consolidated subsidiaries.
Chad A. Keetch: All of our independent subsidiaries the service Center Standard-bearer healthcare REIT and the insurance captive are operated by a separate independent companies that have their own management employees and assets references here end of the consolidated company and its assets and activities as well as use of the words, we us our and similar terms are not.
Chad A. Keetch: References herein to the consolidated company and its assets and activities, as well as use of the words we, us, our, and similar terms, are not meant to imply nor should be construed as meaning that the Ensign Group has direct operating assets, employees, or revenue, or that any of the subsidiaries are operated by the Ensign Group. Also, we supplement our GAAP reporting with non-GAAP metrics. When viewed together with our GAAP results, we believe that these measures can provide a more complete understanding of our business.
Chad A. Keetch: Meant to imply nor should it be construed as meaning that the Ensign group has direct operating assets employees or revenue or that any of the subsidiaries are operated by the Ensign group.
Chad A. Keetch: Also we supplement our GAAP reporting with non-GAAP metrics when viewed together with our GAAP results. We believe that these measures can provide a more complete understanding of our business. They should not be relied upon funding exclusion of GAAP reports a GAAP to non-GAAP reconciliation is available in yesterday's press release and is available in our Form 10-Q.
Chad A. Keetch: They should not be relied upon to the exclusion of GAAP reports. A gap to non-gap reconciliation is available in yesterday's press release and is available in our Form 10-2. And with that, I'll turn the call over to Barry Port, our CEO.
Chad A. Keetch: And with that I'll turn the call over to Barry Port Our CEO Barry Thanks, Shannon and thank you everyone for joining US today, we're pleased with the continued consistent performance that our local teams achieved again.
Barry R. Port: Thanks Chad, and thank you everyone for joining us today. We're pleased with the continued and consistent performance that our local teams achieved again. After another record quarter, we're excited about the remarkable momentum our teams have created across our entire portfolio and look forward to seeing that continue throughout the year. As strong as our performance has been, we continue to see enormous opportunities inherent in our portfolio, both in existing operations and the growing number of new acquisitions.
Barry R. Port: After another record quarter, we're excited about the remarkable momentum our teams have created across our entire portfolio and look forward to seeing that continue throughout the year.
Barry R. Port: As strong as our performance has been we continue to see enormous opportunities inherent in our portfolio both in existing operations and the growing number of new acquisitions.
Barry R. Port: We were encouraged to see an increase in skilled mix during the quarter with an increase in same-store skilled mix days of 5.6% and an increase in same-store skilled mix revenue of 1.9% sequentially during the fourth quarter. This continued strength in our skilled mix demonstrates the ongoing trend of increasing demand for skilled post-acute services. We were also excited to see same-store occupancy for the quarter reach 81%, which grew by 2.7% over the prior year quarter and surpassed pre-pandemic same-store occupancies for the first time since the first quarter of 2020.
Barry R. Port: We were encouraged to see an increase in skilled mix during the quarter with an increase in same store skilled mix days of five 6%.
Barry R. Port: We had an increase in same store skilled mix revenue of one 9% sequentially over the fourth quarter.
Barry R. Port: This continued strength in our skilled mix demonstrates the ongoing trend of increasing demand for skilled post acute services.
Barry R. Port: We're also excited to see same store occupancy for the quarter reached 81%.
Barry R. Port: Which grew by two 7% over the prior year quarter and surpassed pre pandemic same store occupancies for the first time since first quarter of 2020.
Barry R. Port: While we celebrate this milestone, our SaneStore portfolio still has an incredible amount of built-in upside, as dozens of our most mature SaneStore operations operate in the 90-plus percent occupancy range. As our operators continue to build on a solid foundation of strong clinical results, cultural excellence, and sustainable real estate costs, they will continue to realize the occupancy and skilled mix growth potential inherent in our same-store portfolio, which will allow us to continue achieving the consistent financial results that we have delivered over time without depending solely on acquiring new operations.
Barry R. Port: While we celebrate this milestone our same store portfolio still has an incredible amount of built in upside as dozens of our most mature same store operations operate in the 90 plus percent occupancy range.
Barry R. Port: As our operators continue to build on our solid foundation of strong clinical results cultural excellence and sustainable real estate costs. They will continue to realize the occupancy and skilled mix growth potential inherent in our same store portfolio, which will allow us to continue achieving the consistent financial results that we have.
Barry R. Port: <unk> delivered over time without depending solely on acquiring new operations.
Barry R. Port: That said, as you saw in our press release yesterday, we have been busy acquiring new operations, and our transitioning and newly acquired buckets now represent over 25% of our total operational beds. We have enormous organic growth potential within those growing buckets.
Barry R. Port: That said as you saw in our press release yesterday, we have been busy acquiring new operations and our transitioning and newly acquired buckets now represent over 25% of our total operational beds, we have enormous organic growth potential within those growing buckets to give us some perspective, our occupancy in <unk>.
Barry R. Port: To give some perspective, our occupancy and skilled mix days for the skilled nursing operations in the transitioning bucket were 74% and 22% respectively, while our same-shore occupancy and skilled mix days were 81% and 32% respectively. As we've shown over two decades, we expect our teams to unlock significant upside in each of these new operations as they mature. As most of you know, CMS issued a final minimum staffing rule last week.
Barry R. Port: <unk> days for the skilled nursing operations in the transitioning bucket, where 74% and 22% respectively. While our same store occupancy and skilled mix days were 81% and 32% respectively.
Barry R. Port: As we've shown over two decades, we expect our teams to unlock significant upside in each of these new operations as they mature.
Barry R. Port: As most of you know CMS issued a final minimum staffing rule last week as expected. The final rule is very much in line with the proposed rule. They issued last year with a few minor differences. Despite the overwhelming amount of feedback CMS received from various stakeholders, including operators of all sizes and in all geographies.
Barry R. Port: As expected, the final rule was very much in line with the proposed rule they issued last year with a few minor differences, despite the overwhelming amount of feedback CMS received from various stakeholders, including operators of all sizes and in all geographies. While we are deeply committed to increasing access to quality care for our seniors, We strongly disagree with this rule and believe, especially in light of the nationwide shortage of nursing labor, that the rule only exacerbates an already precarious staffing problem and, if it survives as is, would severely limit the ability of the skilled nursing industry to serve the growing long-term care population. We believe it would be much more constructive to focus policy on rewarding quality outcomes and assisting providers to increase the supply of caregivers. Unfortunately, this rule will have its largest impact on smaller and more thinly capitalized operators, many of which are quality providers, and will ultimately result in limiting quality care options for the senior population.
Barry R. Port: While we are deeply committed to increasing access to quality care for our seniors we strongly disagree with this rule and believe especially in light of the nationwide shortage of nursing labor, that's a rule only exacerbates and already for carrier staffing problem and if it survives as is would severely limit the ability.
Barry R. Port: Of the skilled nursing industry to serve the growing long term care population.
Barry R. Port: We believe it would be much more constructed to focus policy on rewarding quality outcomes and assisting providers to increase the supply of caregivers.
Barry R. Port: Unfortunately, this rule will have its largest impact on smaller and more thinly capitalized operators many of which are quality providers and will ultimately result in limiting quality care options for the senior population.
Barry R. Port: However, we are optimistic that this rule will be either eliminated entirely, or its effects will be mitigated long before the rule takes effect in two to three years. We're encouraged to see bipartisan support in the legislature that can result in this rule being overturned or significantly altered. In addition, our industry representatives and their legal experts have been preparing to challenge this rule in the courts on several grounds and believe this rule is highly likely to be overturned in federal court. Lastly, because this rule is being driven by political ideology, its survival also depends on the outcome of several elections that will take place before the rule is implemented.
Barry R. Port: However, we are optimistic that this rule will be either eliminated entirely or its effects will be mitigated long before the rule takes effect in two to three years.
Barry R. Port: We're encouraged to see bipartisan support in the legislature that can result in this rule being overturned or significantly altered.
Barry R. Port: In addition, our industry representatives and their legal experts have been preparing to challenge. This rule in the courts on several grounds.
Barry R. Port: And believe this rule is highly likely to be overturned in federal court.
Barry R. Port: Lastly, because this rule is being driven by political ideologies. Its survival also depends on the outcome of several elections that will take place before the rule would be implemented in.
Barry R. Port: In the meantime, our locally driven operational model is built to respond to changes like these. As we've shown over and over again, when change comes, our leaders respond. Whether you look back on seismic changes and reimbursement like RUGS 4 in 2011 and 2012, or PDPM in 2019, or the frequent regulatory changes imposed on our business during the COVID pandemic, our local CEOs and COOs have been able to adjust their individual operations strategy and rapidly respond to any shift in market dynamics in a very thoughtful and specific way. In addition, when the industry is out of favor, or regulatory uncertainty leads to less capital being invested in our space.
Barry R. Port: In the meantime, our locally driven operational model is built to respond to changes like these.
Barry R. Port: As we've shown over and over again when change comes our leaders respond.
Barry R. Port: Whether you look back to seismic changes in reimbursement like rugs, four in 2011 and 2012 or.
Barry R. Port: <unk> in 2019.
Barry R. Port: Or the frequent regulatory changes imposed on our business during the Covid pandemic, our local Ceos and cfos have been able to adjust their individual operation strategy and.
Barry R. Port: And rapidly respond to any shift in market dynamics in a very thoughtful and specific way.
Barry R. Port: In addition, when the industry is out of favor or regulatory uncertainty leads to less capital being invested in our space are local acquisition approach has allowed us to continue to add new operations at attractive prices.
Barry R. Port: Our local acquisition approach has allowed us to continue to add new operations at attractive prices, as our local teams have done so. They have demonstrated their capabilities to their healthcare partners and have grown market share. It's ultimately because of them that we have so much confidence that no matter what happens with minimum staffing or other unforeseeable regulatory changes in the future, we are built not only to survive but to thrive and grow with change.
Barry R. Port: As our local teams have done so.
Barry R. Port: They have demonstrated their capabilities to their health care partners and have grown market share it's.
Barry R. Port: It's ultimately because of them that we have so much confidence that no matter, what happens with minimum staffing or other unforeseeable regulatory changes in the future. We are built not only to survive, but to thrive and grow with change.
Barry R. Port: Our focus over the coming months and years is to continue the strategy that has always been paramount to our success, regardless of staffing mandates or any other change. Good care depends entirely on attracting and training great talent.
Barry R. Port: Our focus over the coming months and years is to continue the strategy that has always been paramount to our success, regardless of staffing mandates or any other change.
Barry R. Port: Good care depends entirely on attracting and training great talent.
Barry R. Port: Becoming the employer of choice in each of our markets has been and will be a relentless focus. We've seen evidence of the fruits of these efforts during the quarter and are encouraged by the reduction in the use of third-party nursing agencies, which improved again for the fifth consecutive quarter, representing a reduction in agency usage of 59% since its peak in December of 2022. We're also thrilled to continue to see lower turnover for the 10th quarter in a row, which is a result of our local leader's focus on a customer-first philosophy.
Barry R. Port: Becoming the employer of choice in each of our markets has been and will be a relentless focus.
Barry R. Port: We've seen evidence of the fruits of these efforts during the quarter and are encouraged by the reduction in the use of third party nursing agencies, which improved again for the fifth quarter in a row, representing a reduction in agency usage of 59% since its peak in December of 2022.
Barry R. Port: We're also thrilled to continue to see lower turnover for the 10th quarter in a row, which is a result of our local leaders focus on our customers second philosophy like.
Barry R. Port: Likewise, we continue to see the pace of wage inflation slowing while we simultaneously successfully recruit new talent. As of the end of the quarter, we saw net new hires increase yet again. We are confident that by being true to our cultural values, strong clinical results, and proven operating principles, our ability to attract talent to our organization will shine through. We're affirming our annual 2024 earnings guidance of 529 to 547 per dilute share, and an annual revenue guidance of $4.13 billion to $4.17 billion.
Barry R. Port: Likewise, we continue to see the pace of wage inflation slowing while we simultaneously successfully recruit new talent.
Barry R. Port: As of the end of the quarter, we saw net new hires increased yet again we.
Barry R. Port: We are confident that by being true to our cultural values strong clinical results and proven operating principles, our ability to attract talent to our organization will shine through.
Barry R. Port: We're affirming our annual 2024 earnings guidance of 529% to $5 47 per diluted share and.
Barry R. Port: And annual revenue guidance of $4 $3 billion to $4 $1 $7 billion the.
Barry R. Port: The midpoint of this 2024 earnings guidance represents an increase of 13% over our 2023 results and is 30% higher than our 2022 results. This annual guidance comes on top of the extraordinary growth we've experienced in the last few years. Put this performance in perspective.
Barry R. Port: The midpoint of this 2024 earnings guidance represents an increase of 13% over our 2023 results and is 30% higher than our 2022 results.
Barry R. Port: This annual guidance comes on top of the extraordinary growth we've experienced in the last few years.
Barry R. Port: Put this performance in perspective since we've spun out the pennant group in 2019, the midpoint of our 2024 guidance represents growth in adjusted EPS of 201, 1% with a compound annual growth rate of 24, 4%.
Chad A. Keetch: Since we spun out the Pennant Group in 2019, the midpoint of our 2024 guidance represents growth and adjusted EPS of 201.1%, with a compound annual growth rate of 24.4%. This performance is not due to some large event or a single transformative transaction but instead as a result of consistent growth and performance quarter after quarter, which comes from following proven ensign principles. All these achievements are entirely due to the efforts and commitment of our local leadership teams, caregivers, field resources, and service center partners.
Chad A. Keetch: This performance is not due to some large event or a single transformative transaction.
Chad A. Keetch: But instead as a result of consistent growth and performance quarter after quarter, which comes from following proven ensign principles.
Chad A. Keetch: All of these achievements are entirely due to the efforts and commitment of our local leadership teams caregivers field resources and service Center partners.
Chad A. Keetch: There are so many opportunities in front of us to improve and expense management and drive occupancy and skilled mix as we continue to successfully unlock value in all of our operations. We remain poised to again showcase our ability to find, acquire, and transition performing and underperforming operations by applying proven leasing principles developed over two decades. Next, I'll ask Chad to add some additional insights regarding our recent growth.
Chad A. Keetch: There are so many opportunities in front of us to improve and expense management and drive occupancy and skilled mix as we continue to successfully unlock value in all of our operations.
Chad: We remain poised to again showcase our ability to find acquire and transitioned performing and underperforming operations by applying proven ensign principles developed over two decades.
Chad A. Keetch: Next I'll ask Chad to add some additional insights regarding our recent growth Chad.
Chad A. Keetch: Thank you, Barry. As we expected, we continue to add to our growing portfolio, and we are very excited about the 13 new operations and six real estate assets we added during the quarter and since, bringing the number of operations acquired since January 2023 to 39. These acquisitions span eight of our 14 states and represent a significant opportunity to either strengthen our current clusters or to establish new clusters and new markets. These new acquisitions include the following new operations: three in Tennessee, one in Iowa, two in Kansas, one in Texas, two in Colorado, two in Utah, one in Arizona, and one in Nevada, totaling 1,216 new skilled nursing beds, 202 senior living units, and 43 new LTAC beds. Of these 13 new operations, six of them include real estate assets which were acquired by Standard Bearer and will be leased to an Ensign-affiliated operator.
Chad: Thank you Barry as we expected we continue to add to our growing portfolio and we are very excited about the 13, new operations and six real estate assets, we added during the quarter and.
Chad A. Keetch: Bringing the number of operations acquired since January 2023 to 39.
Chad A. Keetch: These acquisitions spend eight of our 14 states and represent a significant opportunity to either strengthen our current clusters or to establish new clusters in new markets.
Chad A. Keetch: These new acquisitions include the following new operations three in Tennessee, one in Iowa to in Kansas, One in Texas, two in Colorado two.
Chad A. Keetch: In Utah.
Chad A. Keetch: One in Arizona, and one in Nevada, totaling 1216, new skilled nursing beds, and 202 senior living units and 43, new <unk> beds.
Chad A. Keetch: Of these 13, new operations six of them included the real estate assets, which were acquired by standard bear and will be leased to an enzyme affiliated operator. Each of these additions were all carefully selected amongst the many opportunities available to us and were chosen because of the huge clinical and financial potential.
Chad A. Keetch: Each of these additions was carefully selected from the many opportunities available to us and was chosen because of the huge clinical and financial potential. We continue to prioritize growth in our established geographies as it allows our clusters to work together with their acute care partners and to provide a comprehensive solution to their health care needs. However, we are also excited to build clusters in new states or in markets where we have significant room to add more density.
Chad A. Keetch: We continue to prioritize growth in our established geographies as it allows our clusters to work together with their acute care partners and to provide a comprehensive solution to their health care needs.
Chad A. Keetch: However, we are also excited to build clusters in new states or in markets, where we have significant room to add more density.
Chad A. Keetch: In particular, we are very excited to grow Nevada and to add our second and third operations in Tennessee, which, along with the acquisition we completed earlier this year, creates our first Tennessee cluster. We are very optimistic about our ability to continue growing in Nevada, Tennessee, and the surrounding regions. We are also pleased to see some growth in the Midwest with the additions of Iowa and Kansas. We've already seen the benefits of our recent growth in Kansas and look forward to a similar boost in Iowa.
Chad A. Keetch: In particular, we are very excited to grow in Nevada and to add our second and third operations in Tennessee, which along with the acquisition. We completed earlier this year creates our first Tennessee cluster we.
Chad A. Keetch: We are very optimistic about our ability to continue growing in Nevada, Tennessee and the surrounding regions.
Chad A. Keetch: We're also pleased to see some growth in the Midwest with the additions in Iowa, and Kansas and we've already seen the benefits from our recent growth in Kansas and look forward to a similar boost in Iowa.
Chad A. Keetch: We were also excited to add a dynamic healthcare campus in northern Utah that includes a skilled nursing operation and a long-term acute care hospital, or an LTAC. As those of you who have followed us over time will note, we often make small investments in new lines of business. Once we've proven the model works, we will expand from there. While the LTAC operation will remain a very small part of what we do in Utah, we are pleased to be adding another service offering to our acute care partners in Utah, all of which rely very heavily on us for a variety of post-acute services for some of their most complex patients.
Chad A. Keetch: We were also excited to add a dynamic health care campus in northern Utah that includes the skilled nursing operation and our long term acute care hospital or an <unk> of <unk>.
Chad A. Keetch: Those of you who have followed us over time will note, we often make small investments in new lines of business. Once we've proven the model works, we expand from there while the <unk> operation will remain a very small part of what we do in Utah. We are pleased to be adding another service offering to our acute care partners in Utah all.
Chad A. Keetch: All of which rely very heavily on us for a variety of post acute services for some of their most complex patients.
Spencer W. Burton: We continue to see a very healthy pipeline of new acquisition opportunities and are lining up some exciting new additions that we expect to close in the second and third quarters. Our decentralized growth model is driven by leadership in each market who have a built-in incentive to attract talent, train them, and then acquire operations that will be accretive to their clusters and ultimately the entire organization. As co-owners of the organization, our team's bandwidth to acquire expands as they grow, and the model is not dependent on a centralized team of deal experts.
Chad A. Keetch: We continue to see a very healthy pipeline of new acquisition opportunities and are lining up some exciting new additions that we expect to close in the second and third quarters are decentralized growth model is driven by leadership in each market, who have a built in incentive to attract talent train them and then acquire operations that will be accretive to their clusters and.
Spencer W. Burton: Ultimately the entire organization.
Spencer W. Burton: As co owners of the organization our teams bandwidth to acquire expands as they grow and the model is not dependent on a centralized team of deal experts.
Spencer W. Burton: This scalable approach to growth has allowed us to continue to acquire or lease new operations at disciplined prices, which has led to a cost structure that has allowed us to drive consistent organic growth over time at healthy margins. However, we don't grow just for the sake of growth, or acquire revenue, or buy earnings. We have grown and will continue to grow when we see deals that will be accretive to our shareholders in both the near term and over time.
Spencer W. Burton: This scalable approach to growth has allowed us to continue to acquire or lease new operations at disciplined prices, which has led to a cost structure that has allowed us to drive consistent organic growth over time at healthy margins.
Spencer W. Burton: However, we don't grow just for the sake of growth or acquire revenue or by earnings we have and will continue to grow when we see deals that will be accretive to our shareholders in both the near term and over time.
Spencer W. Burton: We continue to provide additional disclosure on Standard Bear, which is now comprised of 114 properties owned by the company and leased to 85 affiliated skilled nursing and senior living operations, and 30 operations that are leased to third-party operators. Each of these properties is subject to triple-net long-term leases and together generated rental revenue of $22.2 million for the quarter, of which $18 million was derived from Ensign Affiliated Operations. Also for the quarter, we reported $14.1 million in FFO and, as of the end of the quarter, had an EBITDAR to rent coverage ratio of 2.5 times. And with that, I'll turn the call over to Spencer, our COO, to add more color around operations. Spencer?
Spencer W. Burton: We continue to provide additional disclosure on standard bearer, which is now comprised of 114 properties owned by the company and leased to 85 affiliated skilled nursing and senior living operations and 30 operations that are leased to third party operators.
Spencer: Each of these properties are subject to triple net long term leases and together generated rental revenue of $22 2 million for the quarter of which $18 million was derived from ensign affiliated operations.
Spencer: Also for the quarter, we reported $14 1 million and <unk> and as of the end of the quarter had an EBITDAR to rent coverage ratio of two five times.
Spencer W. Burton: Thank you, Chad. And hello, everyone.
Spencer W. Burton: And with that I'll turn the call over to Spencer, our COO to add more color around operations Spencer.
Spencer W. Burton: Today, I'd like to share two examples that demonstrate how frontline teams throughout the organization are continuing to grow earnings, improve culture, and elevate clinical outcomes. The first facility is Olympia Transitional Care in Washington, currently led by Director of Nursing, Jenica Kautz, and Executive Director, Mindy Bradley. When it was acquired back in 2015, Olympia Transitional had low star ratings and a poor clinical reputation with state regulators and with the local health care community.
Spencer: Thank you Chad and Hello, everyone.
Spencer W. Burton: Today, I would like to share two examples demonstrate how frontline teams throughout the organization are continuing to grow earnings improved culture and elevate their clinical outcomes.
Spencer W. Burton: As a result, occupancy, especially skilled payers, was low, and the facility consistently lost money. Nevertheless, despite the enormous challenges, local operators who make acquisition decisions recognize the latent potential that the facility has, especially given its discounted purchase price. And over the course of the past nine years, the Olympia team has pushed relentlessly, transforming the culture of the facility and methodically adding clinical capacity. Today, Olympia Transitional is completely transformed, as evident in its CMS 5-star rating for quality measures and overall.
Spencer W. Burton: The first facility is Olympia transitional care in Washington.
Spencer W. Burton: Led by director of Nursing, <unk> accounts, and executive director Middleby brands.
Spencer W. Burton: The local hospital and health system have embraced the change, and today the facility actively participates in their ACO and is a preferred provider for numerous managed care plans. As you'd expect, skilled mix has improved by 227% since acquisition, with a 37% increase since the prior year quarter. Since acquisition, revenues have grown by 87%, and the facility has become one of the top EBIT producers in the state of Washington. The second facility example is Birthed Care and Rehabilitation in Colorado.
Spencer W. Burton: When it was acquired back in 2015, Olympia transitional had most star ratings.
Spencer W. Burton: Clinical reputation.
Spencer W. Burton: <unk> and with the local health care community.
Spencer W. Burton: As a result occupancy, especially skilled players was low <unk>.
Spencer W. Burton: <unk> consistently lost money.
Spencer W. Burton: Despite the enormous challenges the local operators make acquisition decisions recognize the latent potential with the facility.
Spencer W. Burton: Especially given the discounted purchase price.
Spencer W. Burton: And over the course of the past nine years. The Olympia team has pushed relentlessly transforming the culture of the facility and methodically, adding clinical capacity.
Spencer W. Burton: Today, Olympia transitional has completely transformed as evident in its CMS five star ratings for quality measures and overall.
Spencer W. Burton: The local hospital and health system have embraced the change and to data facility actively participates in their ACO and as a preferred provider for numerous managed care plans.
Spencer W. Burton: As you would expect skilled mix has improved by 227% since acquisition.
Spencer W. Burton: With a 37% increase since the prior year quarter.
Spencer W. Burton: Since acquisition revenues have grown by 87%.
Spencer W. Burton: The facility has become one of the top EBIT producers in the state of Washington.
Spencer W. Burton: The second facility example, birth that Karen rehabilitation and Colorado.
Spencer W. Burton: This operation, currently led by COO Emily McDonough and Executive Director Andy LaFomme, was acquired in 2021 and exemplifies what typically happens in our transitioning category. Notably, this acquisition occurred in the midst of the COVID pandemic and staffing crisis. Yet during the past three years, enormous strides have been made. For example, the birth of a leadership team created and implemented a unique incentive system that rewarded existing staff for recruiting and retaining additional caregivers. And as a result, turnover among caregivers has been cut by over 50%.
Spencer W. Burton: This operation currently led by our COO, Emily Mcdonough and executive Director Andy Lasalle.
Spencer W. Burton: <unk> was acquired in 2021 and exemplifies what typically happens in our transitioning category.
Spencer W. Burton: Notably this acquisition occurred in the midst of the Covid pandemic and staffing crisis, yes.
Spencer W. Burton: During the past three years enormous strides have been made.
Spencer W. Burton: For example, the birth of the leadership team created and implemented a unique incentive system that rewarded existing staff, we're recruiting and retaining additional caregivers.
Spencer W. Burton: And as a result turnover among caregivers has been cut by over 50% and contract staffing has now sold and used.
Spencer W. Burton: And contract staffing is now sold in use. The facility has developed a fun, yet results-driven culture where the whole team pushes for admissions, and occupancy has grown from 70% at acquisition to 95% in Q1 of this year. They have simultaneously expanded their ability to care for clinically complex patients, and as a result, rates for both long-term and short-stay residents have increased substantially. As a result, revenues continue to rise, increasing by 24% in Q1 from the prior year quarter, and EBIT has soared by 155% during that same period.
Spencer W. Burton: The facility has developed a fund yet results driven culture, where the whole team pushes for admissions and occupancy has grown from 70% at acquisition to 95% in Q1 of this year.
Spencer W. Burton: We have simultaneously expanded their ability to care for clinically complex patients and as a result rates for both long term and short stay residents have increased substantially.
Spencer W. Burton: As a result revenues continue to rise increasing by 24% in Q1 from prior year quarter.
Spencer W. Burton: And the EBIT has soared by 155% during that same period.
Spencer W. Burton: Before I turn it over to Suzanne, I want to highlight one more principle that is essential to the ongoing health of our organization and that is illustrated perfectly by these two facilities. That principle is diligent succession planning.
Speaker Change: Before I turn it over to Suzanne I wanted to highlight one more principle that is essential to the ongoing health of our organization and that is illustrated perfectly by these two facilities.
Spencer W. Burton: That principle is diligent succession planning.
Spencer W. Burton: In the case of both Olympia and Berthoud, the CEOs who were instrumental in transforming the facilities post-acquisition have both recently moved into new roles. In the case of Olympia, CEO Vivian Curie transferred to a recently acquired sister facility and is applying her skills and experience to elevate quality and results. In the case of Berthoud, CEO Joey Graham recently took on the role of market leader and is helping accelerate quality and acquisition growth for the northern half of the state.
Spencer W. Burton: In the case of both Olympia and boosted the Ceos, who are instrumental in transforming the facilities post acquisition have both recently moved into new roles in the case of Olympia.
Spencer W. Burton: Joe Bigler Kerry transferred to our recently acquired sister facility and as a player skills and experience to elevate quality and results.
Spencer W. Burton: In the case of birthday.
Spencer W. Burton: So Joey Graham recently took on the role of market leader and is helping accelerate quality and acquisition growth for the northern half of the state.
Spencer W. Burton: We can't thank these leaders enough for their sacrifices made in order to continue to elevate their markets while also honoring the teams who are onboarding new leaders and continuing to drive exceptional results at both Olympia and Berthoud. With that, I'll turn the time over to Suzanne to provide more detail on the company's financial performance.
Spencer W. Burton: We can't thank these leaders enough for their sacrifices made in order to continue to elevate their markets. While also honoring the teams, we're onboarding new meters and continuing to drive exceptional results at both Olympia and versa.
Spencer W. Burton: With that I will turn the time over to Suzanne to provide more detail on the company's financial performance and our guidance.
Spencer W. Burton: And then we'll open it up for questions Suzanne. Thank you Sara and good morning, everyone detailed financials for the quarter are contained in our 10-Q and press release filed yesterday, some additional highlights for the quarter compared to the prior year quarter include the following GAAP diluted earnings per share was $1 19, an increase at 13, 3%.
Suzanne D. Snapper: Thank you, Spencer, and good morning, everyone. Detailed financials for the quarter are contained in our 10Q and press release filed yesterday. Some additional highlights for the quarter compared to the prior year quarter include the following. Gap's diluted earnings per share was $1.19, an increase of 13.3%. Adjusted diluted earnings per share was $1.30, an increase of 15%. Consolidated gap revenue and adjusted revenues were both $1 billion, an increase of 13.9%. Gap net income was $68.8 million, an increase of 15%, and adjusted net income was $75.4 million, an increase of 16.6%.
Suzanne D. Snapper: Adjusted diluted earnings per share was $1 30, an increase of 15%.
Suzanne D. Snapper: Validated GAAP revenue and adjusted revenue.
Suzanne D. Snapper: $1 billion, an increase of 13, 9% GAAP.
Suzanne D. Snapper: GAAP net income was $68 8 million, an increase of 15% and adjusted net income was $75 4 million an increase of 16, 6%.
Suzanne D. Snapper: Other key metrics as of March 31st, 2024 include cash and cash equivalents of $512 million and cash flows from operations of $35.3 million. We also continue to de-lever our portfolio, achieving a least-adjusted net debt-to-EBITR ratio of 1.98 times. This de-leverage in a period of growth is particularly noteworthy and demonstrates our commitment to disciplined growth, as well as our belief that we can continue to achieve sustainable growth in the long run. In addition, we continue to have approximately $594 million of availability on our line of credit, which when combined with cash on hand on our balance sheet, gives us over a billion dollars in dry powder for future investment. We also own 119 assets, of which 114 are held by Standard Bear, and 95 of which are owned completely debt-free and are gaining significant value over time, adding even more liquidity to help with future growth.
Suzanne D. Snapper: Other key metrics as of March 31st 2024 included cash and cash equivalents of $512 million in cash flow from operations of $35 3 million.
Suzanne D. Snapper: We also continued to delever our portfolio, achieving our lease adjusted net debt to EBITDA ratio of 198 times. This deleverage in a period of growth is particularly noteworthy and demonstrates our commitment our disciplined growth as well as our belief that we can continue to achieve sustainable growth in the long run.
Suzanne D. Snapper: In addition, we continue to have approximately $594 million of availability on our line of credit, which when combined with cash on hand on our balance sheet. It is over a $1 billion in dry powder for future investment.
Suzanne D. Snapper: Also our <unk>.
Suzanne D. Snapper: <unk> 19 asset.
Suzanne D. Snapper: 114 or help us Canterbury.
Suzanne D. Snapper: And 95 of which are completely debt free and are gaining significant value over time, adding even more liquidity to help with future growth.
Suzanne D. Snapper: In order to give you insight into our transformation of acquisitions, we have presented our skilled nursing operations in three buckets: SANE, Transitioning, and Recently Acquired Facilities. You heard Barry refer to these different buckets earlier, and I thought it would be helpful to further explain what we mean when we are referencing two buckets and how we treat them for comparison purposes. Same facility represents all facilities purchased more than three years ago. Transitioning includes all facilities acquired between two and three years.
Suzanne D. Snapper: In order to give you insight into our transformation of acquisitions, we have presented our skilled nursing operations into three buckets same transitioning in a recently acquired facility.
Suzanne D. Snapper: Recently acquired facilities represents facilities acquired within the last two years. For the same and transitioning facilities buckets, we include the exact same facilities in the applicable bucket for the comparison time period. Meaning the same operations and the same number of facilities are included in these buckets for an identical duration, whether it's on a yearly or quarterly basis in the prior accounting period. For comparison purposes, we show service revenue, field revenue, occupancy, and skilled days. The purpose of doing it this way is twofold.
Suzanne D. Snapper: Yes.
Suzanne D. Snapper: Prior to the different buckets earlier, and I thought it'd be helpful to further explain what we.
Suzanne D. Snapper: Ah referencing two bucket and how we treat them for comparison purposes.
Suzanne D. Snapper: Same facility represents all facilities purchased more than three years ago.
Suzanne D. Snapper: Transitioning all facilities acquired between two and three years recent.
Suzanne D. Snapper: Recently acquired facilities represents facility acquired within the last two years.
Suzanne D. Snapper: For the same and transitioning facilities bucket. We include the exact same facility and the applicable.
Suzanne D. Snapper: For the comparison period.
Suzanne D. Snapper: The same operation and the same number of facility are included in the packet for an identical duration, whether it's on a yearly or quarterly basis in the prior accounting period for.
Suzanne D. Snapper: For comparison purposes, we show service revenue build revenue occupancy and still gain the <unk>.
Suzanne D. Snapper: First, to show the organic growth produced by the same group of facilities over a comparable period of time on an apples-to-apples basis, rather than showing growth that would come from simply adding new acquisitions into a bucket that weren't included in the bucket in the prior period, making it impossible to see the true organic growth of that group of facilities. The second is to demonstrate that, historically, our recently acquired and transitioning buckets have substantial organic growth potential.
Suzanne D. Snapper: Purpose of doing it this way is twofold first to show that organic growth produced by the same group of facilities over a comparable period of time on an apples to apples basis.
Suzanne D. Snapper: Rather than showing growth that would come from simply adding new acquisitions and share buybacks that were included in that bucket in a prior period.
Suzanne D. Snapper: Impossible.
Suzanne D. Snapper: Through organic growth of that group with Adobe.
Suzanne D. Snapper: Second is to demonstrate that historically, our recently acquired and transitioning buckets have substantial organic growth potential. We hope that this extra disclosure is helpful and to show the progress that our operations make overtime, but we also wanted to make sure. We emphasize that Chesapeake has an operation is in the same store bucket does not mean, that's fully matured.
Suzanne D. Snapper: We hope that this extra disclosure is helpful and shows the progress that our operations make over time. But we also want to make sure we emphasize that just because an operation is in the same store bucket does not mean it's fully matured and operating at maximum capacity, as we continue to see enormous upside within our same facilities. As Barry mentioned, we are reaffirming our annual earnings guidance of $5.29 to $5.47 per diluted share and annual revenue guidance of $4.13 billion to $4.17 billion.
Suzanne D. Snapper: Operating at maximum capacity as we continue to see enormous upside within our thing.
Suzanne D. Snapper: As Barry mentioned, we are reaffirming our annual earnings guidance of $5 29 to $5.47 per diluted share.
Suzanne D. Snapper: <unk> revenue guidance.
Suzanne D. Snapper: One 3 billion to $4 7 billion.
Suzanne D. Snapper: We've evaluated multiple scenarios, and based upon the strength in our performance and positive momentum we've seen in occupancy and the skilled mix, as well as continued progress on agency management and other operational initiatives, we have confidence that we can achieve these results. Our 2024 guidance is based on diluted weighted average common shares outstanding of approximately $58.5 million, a tax rate of 25%, the inclusion of acquisitions closed in the first half of 2024, and management expectations for Medicare and Medicaid reimbursement net of provider tax with a primary exclusion coming from stock-based compensation.
Suzanne D. Snapper: Evaluating multiple scenarios and based upon that strengthen our performance and positive momentum leasing and occupancy in skilled mix as well as continued progress on agency management and other operational initiatives. We have confidence that we can achieve these results. Our 2024, our guidance is based on diluted weighted average common shares outstanding.
Suzanne D. Snapper: Of approximately $58 5 million.
Suzanne D. Snapper: Tax rate at 25%.
Suzanne D. Snapper: Christian of acquisitions closed in the first half of 2020 for the inclusion of management's expectations for Medicare and Medicaid reimbursement net of <unk>.
Suzanne D. Snapper: Provider tax with the primary exclusion coming from stock based compensation.
Suzanne D. Snapper: Additionally, other factors that could impact quarterly performance include variations in reimbursement systems, delays and changes in state budgets, seasonality and occupancy and skilled mix, the influence of the general economy on census and staffing, the short-term impact of acquisition activities, variations in insurance controls, and other factors. Also, as Barry explained, CMS issued the final federal staffing rule last week. Given the rule's phase and period, the rule will have no material effect on us in 2024. And with that, I'll turn it back over to Barry.
Suzanne D. Snapper: Additionally, other factors that could impact quarterly performance include variations in reimbursement systems delays and changes in state budgets seasonality in occupancy and skilled mix.
Suzanne D. Snapper: Influence of the general economy on census, and staffing the short term impact of acquisition activities variations in insurance costs and other factors.
Barry: Also as Gary explained CNS issue.
Suzanne D. Snapper: Final federal staffing rule the athlete.
Suzanne D. Snapper: The phase in period, they're willing to have no material effect on us in 2024, and with that I'll turn it back over to Barry Barry.
Barry: Thanks Suzanne.
Barry R. Port: As we wrap up, I need to reiterate again how incredibly honored and grateful we are to work alongside our facility leaders, field resources, clinical partners, and service center team that are behind these record-setting results. We're always impressed by their incredible resilience as they focus on supporting this mission in new and innovative ways. This commitment has blessed the lives of so many, including our own, and we're excited about our future because of these amazing partners.
Barry: As we as we wrap up I I need to reiterate again, how incredibly honored and grateful correct.
Barry R. Port: We are to work alongside our facility leaders field resources clinical partners and service Center team that are behind these record setting results were always impressed by their incredible resilient resiliency as they focus on supporting this mission in new and innovative ways.
Barry R. Port: This commitment has blessed the lives of so many including our own and we're excited about our future because of these amazing partners, we have complete faith in them and the culture. They have collectively built and continued to improve so thank you to all of our field leaders and service Center partners and with that we'll now turn it over to our Q&A portion of the call.
Barry R. Port: We have complete faith in them and the culture they have collectively built and continue to improve. So thank you to all of our field leaders and service center partners. And with that, we'll now turn it over to our Q&A portion of the call.
Operator: Thank you. We will now begin the question and answer session. If you've dialed in and would like to ask a question, please press star 1 on your telephone keypad, raise your hand, and join the queue. If you'd like to withdraw your question, simply press star 1 again. If you are called upon to ask your question and are listening via loudspeaker on your device, please pick up your handset and ensure that your phone is not on mute when asking your question. Again, press star 1 to join the queue. Our first question comes from the line of Ben Hendrix with RBC Capital Markets. Please go ahead.
Speaker Change: Thank you we will now begin the question and answer session.
Benjamin Hendrix: And we'd like to ask a question. Please press star one on your telephone keypad to raise your hand and join the queue if you'd like to withdraw your question simply press Star one again.
Operator: You are called upon to ask your question and Theyre listening via loud speaker on your device. Please pickup your handset in the short at your phone is on mute when asking your question.
Operator: Again, Chris.
Benjamin Hendrix: <unk> wanted to join the queue.
Benjamin Hendrix: Thank you very much, guys. Congratulations on the quarter.
Operator: Our first question comes from the line of Ben Hendrix with RBC capital markets. Please go ahead.
Benjamin Hendrix: I appreciate all the color around the minimum staffing rule and appreciate that you're not expecting any impact, assuming it goes through in 2024, but next year, it seems like the bit associated with the nurse aid minimum goes into effect, and I know there would be opportunities there to shuffle some staffing mix, especially with your LPN utilization, to kind of help offset that. Just wondering, you know, mechanically what that looks like, and how feasible that is. Is it something that could be done on a financial neutral basis and on a star ratings neutral basis? Thanks. Thanks Ben, that's a good question.
Benjamin Hendrix: Thank you very much guys congratulations on the quarter.
Benjamin Hendrix: <unk> all of the color around the minimum staffing rule and appreciate that you are not expecting any impact assuming it goes through on 2024, but next year. It seems like the bit associated with the nurse aide minimum goes into effect.
Ben: It seems like there would be opportunities there to shuffle, some staffing mix too, especially with your LPN utilization to kind of help offset that just wondering.
Benjamin Hendrix: <unk>, what that looks like how feasible that is is it something that could be done on a financial neutral basis and on a star ratings neutral basis. Thanks.
Barry R. Port: Thanks, Ben. That's a good question. Just to be very clear, the staffing ratios that are specific to overall RNs and CNAs wouldn't go into effect for three years from when the rule is registered in the federal register. So, by 2025, there would really be no need for us to do anything different. But that's a year we'd probably start gearing up or preparing and doing a little bit more. You'd probably hear a little bit more from us on what we'd be doing in preparation for that to go into effect in 2027.
Speaker Change: Yes. Thanks.
Benjamin Hendrix: Ben It's a good question just to be very clear.
Barry R. Port: The staffing ratios that are specific to overall our ends in CNS.
Barry R. Port: Wouldn't go into effect for three years from when the rule is registered in the Federal Register. So 2025, there would be really no no need for us to do any shuffling.
Barry R. Port: Quite yet either.
Barry R. Port: 2026.
Barry R. Port: Really the same but thats year, we'd probably start gearing up and preparing and doing doing a little bit more you probably hear a little bit more from us on what we'd be doing.
Barry R. Port: In preparation for that to go into effect.
Barry R. Port: In 2027.
Barry R. Port: So we don't anticipate doing a whole lot different operationally in the next couple of years, other than focusing on the things that we know we can control and get better at, which really include all the different dynamics around labor control and also being employee-centric, you know. [inaudible] and also focus on eliminating the registry as universally as we can, making sure that we're not relying on third-party staffing agencies for any staffing And those are things that we can do a whole lot around to make sure that we're in a really strong and healthy place when and if those staffing ratios come into play.
Barry R. Port: So.
Barry R. Port: We don't anticipate doing a whole lot different operationally in the next couple of years other than focusing on the things that we know we can control and get better at which really include all of the different dynamics around labor labor control and also being.
Barry R. Port: And employee centric.
Barry R. Port: Kind of customer second environment, where we focus relentlessly on people systems and making sure we've got.
Barry R. Port: World class orientation, and training and support for our employees.
Barry R. Port: And also focus on eliminating registry is universally as we can making sure that we're not relying on 33rd party staffing agencies for any staffing needs and those are things that we can do a whole lot around to make sure that we're in a really strong and healthy place.
Barry R. Port: When a nurse.
Barry R. Port: Those staffing ratios come into play.
Speaker Change: Thank you.
Scott J. Fidel: Our next question comes from a line from Scott Fidel with Stevens. Please go ahead.
Barry R. Port: Our next question comes from the line of Scott Fidel with Stephens. Please go ahead.
Scott J. Fidel: Thanks. Hi everyone. First question, just wanted to talk about the deals you just announced and one nuance about them, and then put it in a longer-term perspective, which was that it was interesting how there was a bit of a higher mix of non-SNF beds that you acquired with some IL and AL and then even the LTAC, as Chad talked about. But that could have just been a coincidence as well around some of the campuses that you acquired as part of this package.
Scott J. Fidel: Thanks, Hi, everyone.
Scott J. Fidel: First question just wanted to talk about the deals you just announced and one nuance a band and then putting it in a longer term perspective.
Scott J. Fidel: Why is it was interesting there was a bit of a higher <unk>.
Scott J. Fidel: Mix.
Scott J. Fidel: Non Smith.
Scott J. Fidel: Our beds that you acquire with some IL and al and then even the outback as Chad talked about.
Scott J. Fidel: So, my question is whether that was more of a coincidence or whether you are now looking to do more expansion in some of those adjacent lines of business outside of just SNF. And then if we do end up in a scenario where the staffing regs actually go into effect in 3 years, whether that may further sort of influence your thinking on diversifying more beyond skilled nursing into some of those adjacent areas, like IL, AL, LTACs, and even, theoretically, IRFs down the road.
Scott J. Fidel: But that could have just been coincidence as well around some of the campuses that you you acquired as part of this package. So my question is whether that was more of a coincidence or whether you are now looking to do more expansion in some of those adjacent lines of business outside.
Scott J. Fidel: It just snaps and then if we do end up in a scenario, where the staffing rags actually would go into effect.
Scott J. Fidel: Three years.
Scott J. Fidel: Whether that may further sort of influenced your thinking God diversifying more beyond skilled nursing.
Scott J. Fidel: Some of those adjacent areas like IL al al tax and even theoretically arps.
Scott J. Fidel: Down the road.
Chad A. Keetch: Yeah, thanks for that question. So I would say that it certainly wasn't something we set out to do this quarter, acquiring more senior living or independent living beds. We are always looking for what we consider health care campuses, which are primarily skilled nursing operations that happen to have those other offerings on the campus. And I think in every case, that was what was going on. And so from that point of view, no, our strategy really hasn't changed. We've always liked those.
Speaker Change: Yes, Thanks, Scott for that question, so I would say.
Chad A. Keetch: Certainly wasn't something we set out to do this this quarter in acquiring more senior living or independent living beds.
Chad A. Keetch: We are always looking for.
Chad A. Keetch: We call consider health care campuses.
Chad A. Keetch: Which are primarily skilled nursing operations that happened to have those other offerings on the campus and I think in every case that was that was what was going on and so from that point of view no our strategy really hasn't changed.
Chad A. Keetch: We'll continue to seek those out. It just happened to be that we had more of those kinds of deals this particular quarter. So I don't think you'll see us look to acquire lots of standalone assisted living and independent living, as again, our focus would be on primarily SNFs that have those service offerings on the campus. As for the LTAC, I mean, you know, as I said, we're really excited about that service offering. You know, it's only 43 beds.
Chad A. Keetch: We've always liked those will continue to seek those it just happened to be that we had more of those kinds of deals this particular quarter.
Chad A. Keetch: Yes.
Chad A. Keetch: I don't think Youll see us.
Chad A. Keetch: Look to go acquire lots of Standalone assisted living and independent living.
Chad A. Keetch: Again, our focus would be on primarily sniff that has those those service offerings on the campus.
Chad A. Keetch: As for the <unk> I mean.
Chad A. Keetch: As I said, we're really excited about that service offering.
Chad A. Keetch: It's only 43 43 beds.
Chad A. Keetch: But operationally, we already operate sub-acute and very high-acuity skilled nursing facilities in many states, and so it doesn't feel very different from a lot of what we already do. There are clear differences, though, in the regulatory environment.
Chad A. Keetch: But.
Chad A. Keetch: Operationally, we already operate sub acute some very high acuity.
Chad A. Keetch: Skilled nursing facilities in many states and so it doesn't feel very different from from a lot of what we already do there are clear differences, though in the regulatory environment some of the the technical.
Chad A. Keetch: Some of the technical aspects of billing with the DRG kind of coding system and those sorts of things will be new to us. But this is what we call a small bullet type of investment that is again part of a larger skilled nursing campus. And certainly hope that it goes really well and to the extent that we can learn that business and show that Ensign operating principles apply and work, which we think they will in a beautiful way.
Chad A. Keetch: Aspects of billing with the DRG coding system and those sorts of things will be new to us.
Chad A. Keetch: But this is what we.
Chad A. Keetch: We call them small bullet type of investment that that again is part of a larger skilled nursing campus.
Chad A. Keetch: Certainly.
Chad A. Keetch: Hope that it goes really well and to the extent, we can learn that business.
Chad A. Keetch: Show that enzyme operating principles apply and work, which we think they will in a beautiful way. That's certainly something we like we've done in other cases right in other lines of business.
Chad A. Keetch: That's certainly something we, like we've done in other cases, right? In other lines of business, we certainly could expand it, both LTAC and IRF. But I'm not saying that that's like, comprise a big chunk of our investment dollar, but it is something that as we learn and get good at, we certainly can expand into. As for the diversification question, again, I would say that the staffing stuff really, if anything, it probably just creates even more opportunities for us to continue doing what we've done.
Chad A. Keetch: Certainly could expand it.
Chad A. Keetch: Both El <unk> and Earth.
Chad A. Keetch: But I'm not saying that that's like.
Chad A. Keetch: Comprise a big chunk of our investment dollar, but it is something that as we learn and get good at that we certainly can expand into.
Chad A. Keetch: As for the diversification question.
Chad A. Keetch: Again, I would say that.
Chad A. Keetch: The staffing stuff.
Chad A. Keetch: Really.
Chad A. Keetch: If anything it probably just creates even more opportunities for for us to continue doing what we've done.
Chad A. Keetch: And so I don't think that that will impact our overall strategy. To the extent we do decide to go down some of these other paths, it will be much more driven by sort of the operational dynamics and the local dynamics in those healthcare markets, responding to the needs of our Q partners in those areas. That'll drive it much more than any sort of regulation would.
Chad A. Keetch: And.
Chad A. Keetch: So I don't think that that will impact our overall strategy.
Chad A. Keetch: To the extent, we do decide to go down some of these other pass it will be much more driven by sort of the operational dynamics.
Chad A. Keetch: And the local dynamics in those health care markets.
Chad A. Keetch: <unk>.
Chad A. Keetch: Responding to the needs of our of our acute partners in those areas that.
Chad A. Keetch: That will drive it much more than than any sort of regulation.
Chad A. Keetch: Okay.
Scott J. Fidel: Okay, I got it. Thanks, Chad.
Speaker Change: Okay got it thanks Chad.
Speaker Change: Next question just.
Speaker Change: Wanted to get I guess sort of in the updated guidance, which is obviously reaffirm but now you have visibility into the first quarter.
Speaker Change: How youre thinking about.
Scott J. Fidel: Both occupancy and skilled mix.
Barry R. Port: Next question, just, you know, wanted to get, I guess, sort of in the updated guidance, which is obviously reaffirmed, but now you have visibility into the 1st quarter, how you're thinking about both occupancy and skilled mix. You know, it's sort of thinking about trends in the 2nd quarter and then in the back half of the year, just when considering things like historical seasonality. The fact that you now, you know, eclipse the pre-pandemic same store occupancy, but then you also have over 25% of operational beds in the transitional and new buckets, where there's obviously a lot of opportunity to harvest improvements there.
Speaker Change: Sort of thinking about trending in the second quarter and then in the back half of the year, just when considering things like historical.
Barry R. Port: Historical seasonality.
Barry R. Port: The fact that you have now.
Barry R. Port: Clips the pre pandemic same store occupancy, but then you also have over 25% of operational beds.
Barry R. Port: And the transitional and new bucket, where theres, obviously, a lot of opportunity after harvest improvements there.
Barry R. Port: Yeah, great question, Scott. I mean, we obviously feel pretty bullish about our occupancy trends as they've been really strong lately, certainly in the times we'd expect them to be, but even as we are looking at trends now, we feel like demand is really, really strong, and we feel like we've got, we're poised to, in spite of seasonality, have a pretty strong summer. Certainly, that can change, and as we get deep into the summer months, we can see a little bit more of a drop-off, which is usually more evident in our skilled mix.
Speaker Change: Yes, great Great question, Scott I mean, we we obviously feel pretty bullish about our occupancy trends as they have been really strong lately certainly in the times, we would expect them to be but even as we.
Barry R. Port: Looking at trends.
Barry R. Port: Now, we we feel like demand is really really strong and we feel like we've got.
Barry R. Port: We're poised to.
Barry R. Port: In spite of seasonality have a pretty strong summer.
Barry R. Port: Certainly and that can change and as we get into the deep into the summer months, we could see a little bit more of a drop off which is usually more evidenced.
Barry R. Port: Our skilled mix and I think if there if there is some seasonality to be seen it will probably be more evident. There then it will be in our overall occupancy which might just go sideways for a little while.
Barry R. Port: And I think if there is some seasonality to be seen, it'll probably be more evident there than it will be in our overall occupancy, which might just go sideways for a little while. But, as is typical, that should start picking up as we get it leased into the third quarter and start into the fourth quarter. But, you know, we don't anticipate anything unusual or abnormal, and nor do we feel like getting to pre-pandemic occupancy is some kind of artificial Sealing or Target. You know, our expectation is that we continue to grow, and the trends that we've seen are great indications of that.
Barry R. Port: But as is typical that should start picking up.
Barry R. Port: As we get it later late into the third quarter and into starting into the fourth quarter.
Barry R. Port: But we don't we don't anticipate anything unusual or abnormal and nor do we feel like getting to pre pandemic occupancy as some.
Barry R. Port: Kind of artificial ceiling or target or expectation is that is that we continue.
Barry R. Port: <unk> to grow in the.
Barry R. Port: The trends that we've seen are great indications of that.
Barry R. Port: And I would add, Scott, that when you take a look at the guide, really on the low end of the guide, we've factored in a higher level of seasonality. And then, kind of moving up the guide, there would be less seasonality, as Barry was talking about. And so, as we continue to have the year play out, you know, that seasonality aspect of historically having lower occupancy, lower skilled mix, and Q2, Q3 would really play into that lower end of the guide.
Speaker Change: And I would add Scott that you know when you have a look at the guide really on the low end of the guide we've factored in higher level of seasonality.
Barry R. Port: Then kind of moving up the guide would be less and less seasonality as Barry was talking about and SaaS as we continue to have the year play out now that seasonality aspect as well.
Barry R. Port: Historically, having lower occupancy lower skilled mix in Q2, Q3, but really play into that lower end of the guidance as well.
Barry R. Port: And as, you know, if we end up experiencing better seasonality, you know, less seasonality, in other words, we would kind of guide to the high end of the guide with that. And it's, you know, right now we feel pretty strong about where we're at on the season, less seasonality than we've experienced historically right now in the quarter.
Barry R. Port: If we end up experiencing better seasonality less seasonality in other words, we would kind of guide to the high end of the guide with that and it's right.
Barry R. Port: Right now we saw a pretty strong about where we're at in the season less seasonality than we've experienced historically.
Barry R. Port: Right now in the quarter.
Barry R. Port: Okay.
Scott J. Fidel: Okay, great. And then I'm going to just sneak one more question in here.
Speaker Change: Okay, Great and then I'm going to just start sneak one more question here and that would be around.
Scott J. Fidel: And that would be around, if you could update us on the visibility that you feel you have now into rates over the course of the full year. It seems like the rate backdrop has developed pretty favorably for 24 months when we think about the rebasings that have gone on in Medicaid and a number of key states. And then we already do have visibility into the proposed FY25 rates for Medicare coming in at a little bit over 4%.
Scott J. Fidel: If you could update us on the visibility that you feel you have dow it into rates over the course of the full year. It seems like the rate backdrop has developed.
Scott J. Fidel: Develop pretty pretty favorably for 24, when we think about the re basing that have gone on.
Scott J. Fidel: Medicaid and a number of key states and we already do you have visibility into the proposed FY 'twenty five rates for Medicare coming in a little bit over 4%, but maybe just sort of help us fill us in in terms of the overall picture.
Scott J. Fidel: But maybe just sort of fill us in on the overall picture and any sort of emerging insight that you have into FY25 Medicaid rates. I know it's early here, but just any visibility would be helpful. Thanks. And that's it for me. So just one reminder.
Scott J. Fidel: Any sort of emerging insight that you have into FY 'twenty five Medicaid rates I know, it's early here, but just any visibility would be helpful. Thanks, that's it for me.
Suzanne D. Snapper: Thanks, Scott. So just one reminder when you're looking at the numbers in our rate tables, remember that if you're doing a comparison last year to this year, last year's numbers would not include FMAP dollars. And so you're going to see some pretty big increases in those rate tables that might not look like they're translating into the overall impact. But what we feel about the current year's rates is that they're very strong, very solid.
Speaker Change: Thanks Scott.
Speaker Change: Just one reminder, when youre looking at the numbers in our rate tables are men.
Suzanne D. Snapper: And Brian that if youre getting a compare last year. This year last year's number does not include the snap dollars and so youre going to see some pretty big increases in those rate tables.
Suzanne D. Snapper: That might not look like or transplanting into their overall impact, but what we feel about the current year's ranked.
Scott: Very strong very solid as you mentioned the Medicare rate came out we're very pleased with where that came out as a preview I'm excited to have that come in but doesn't come in until the beginning of Q4. So October 1st everything else is really panning out to be pretty nice overall.
Suzanne D. Snapper: As you mentioned, the Medicare rate came out. We're very pleased with where that came out as a preview. I'm excited to have that come in. It doesn't come in until the beginning of Q4, so October 1st. Everything else is really panning out to be pretty nice overall. Really, having all of those states, as we were talking about through all of 2023, really roll those FMAP dollars into the underlying rates. States did it in a very different way.
Suzanne D. Snapper: Having all of those states as we were talking about through all of 2023 roll of those asked Matt dollars into the underlying rates states did in a very different way from delta into the base rate some put into supplemental and put it into a supplemental programs, including quality programs, but we're very very pleased with where everything.
Suzanne D. Snapper: Some built it into the base rate. Some put it into supplemental programs, including quality programs. But we're very, very pleased with where everything landed. And that's why you see those large jumps when you look at our rate table is because now they're included in the base rate, which is way more stable for us and creates long-term visibility for us to continue to be successful.
Speaker Change: Randy I am that's why you see those large jobs when you look at our rate table. Because now they are included in base rates, which is way more stable for us and creates long term visibility for us to continue to be successful.
Speaker Change: Okay, great. Thank you.
Operator: That concludes today's Q&A session and today's conference. You may now disconnect.
Speaker Change: That concludes today's Q&A session.
Speaker Change: And today's conference you may now disconnect.
Operator: Okay.
Operator: Yeah.
Operator: Yeah.