May 1st Update

The Stoneridge Partners Home Health Index (HH Index) is updated monthly and measures the performance of these three publicly traded home health companies, all listed on the NASDAQ:

  • Almost Family (AFAM)
  • LHC Group (LHCG)
  • Amedisys (AMED)

Quote of the Month:

“The final two years of re-basing of Medicare rates and the current stability in the Federal political environment provide better reimbursement visibility and predictability than we’ve had for some time.” Steve Guenthner, President, Almost Family

The Stoneridge Partners Home Health Index (HH Index) drops 1.7%.

After four straight months of increases, the Stoneridge Partners Home Health Index (HH Index) took a bit of a rest in April. While the S&P 500 increased 1.2%, the HH Index dropped 1.7%.

Again we had mixed results:  Almost Family down, Amedisys up, LHC Group down and Addus up nicely.  However when looking back one year the results have been impressive with our HH Index up 84%.

The first quarter earnings reports are coming in, and, as we look at the numbers, we continue to be very optimistic about these companies.

Note that the all-time high for our HH Index was set in September, 2008 at 41.75. Our low since then was set in October, 2011 at 11.65. Two years ago we were at 17.68. We now rest at 34.25.

Here are the results for the past two years:

Company 4/30/15 1 mos change YTD change 1 yr change 2 yr change
Almost Family 43.28 -3.2% +49.50% +101.58% +119.25%
Amedisys 27.81 +3.85% -5.25% +104.04% +176.99%
LHC Group 31.66 -4.15% +1.54% +52.36% +45.76%
HH Index** 34.25 -1.69% +14.83% +83.88 +99.51%
S&P 500 2,085.51 +1.23% +1.29% +10.70% +30.54%
Addus 26.84 +16.59% +10.59% +24.14% +126.69%

Although we track the performance of Addus, they  are not included in our HH Index because most of their revenue does not come from Medicare reimbursement.

See It to Believe It

This first graph compares the percentage change of the HH Index to the percentage change in the S&P 500 Index for over 13 years, going back to November, 2002. It has been quite a ride. And what a great two year trend.

This second graph compares our HH Index to the price of Addus stock (non-Medicare).

This third graph is a 12 month trailing chart of the HH Index compared to the actual prices of the individual companies that make up the chart, through April, 2015.  Look at Almost Family take off.

Enterprise Value (EV)

EV (000s) 5/1/15
Almost Family 463.6
Amedisys 1,010
LHC Group 678.8
Addus 301.3

Enterprise Value (EV), aka Selling Price,  as a Percent of Revenue.

Company 5/1/15 5/1/14
Almost Family 94% 69%
Amedisys 85% 39%
LHC Group 95% 58%
HH Index Average 91% 55%
Addus 96% 84%

Multiples of EV/EBITDA.

Think of this as selling price as a multiple of EBITDA.

Company 5/1/15 5/1/14
Almost Family 16.71 14.17
Amedisys 15.26 10.63
LHC Group 11.38 6.68
HH Index Average 14.45 10.49
Addus 13.14 12.60

The above calculations are based on selling price being defined as Enterprise Value (EV), with data provided by Capital IQ.   EV has been calculated based on stock prices May 1. Enterprise value is defined as market cap plus debt, minority interest and preferred shares, minus total cash and cash equivalents. EBITDA is calculated using methodology that may differ from that used by a company it is reporting.

IN THE NEWS!

Quarterly earnings reports are coming out.  We will have a complete update in next month’s newsletter.  For now here are a few highlights:

AMEDISYS

  • Paul Kusserow, President and CEO, introduced his new executive team including, COO Dan McCoy, HR Larry Pernosky from Humana, and IT Marty Howard.
  • The selection of Homecare Homebase for their software platform
  • Revenue for the first quarter of $302 million vs 2014 revenue of $299 million
  • Adjusted EBITDA of 8.7% or $26 million

To read the complete transcript courtesy of Seeking Alpha:  Amedisys Earnings Call

ADDUS: 

  • Double digit census growth
  • Revenue increase of 14.3% to $81.9 million
  • Adjusted EBITDA increases 21.3% to $5.4 million
  • Announced a definitive agreement to purchase New York’s South Shore Health Services, see below for more details.

Addus Earnings call transcript courtesy of Seeking Alpha:  Addus Earnings Call

ALMOST FAMILY:

  • Investing up to 2 million in NavHealth, a development-stage enterprise that seeks to develop technology based tools and analytics to improve patient experiences and lower the overall costs of care.
  • A new credit facility providing up to $175 million in borrowing
  • Net revenues of $128 million vs 2014 revenue of $120 million
  • Net quarterly income of $4 million vs 2014 of $1.1 million

LHC GROUP

  • Revenue increased 18% to $193.1 million
  • Net income increased 62.5% to $6.8 million
  • Organic growth in home health Medicare admissions was up 6.5%

Merger & Acquisition Activity:

Burnsville, NC – PruittHealth Home Health announced today that it has officially acquired Toe River Home Health Agency in Burnsville, North Carolina.

Kennett Square, PA – Genesis HealthCare, one of the nation’s largest providers of post-acute care services, today announced that it has signed a definitive agreement to combine with Skilled Healthcare Group, Inc., based in Foothill Ranch, California. The combined company will be able to expand its core business lines and enhance its collective ability to provide the highest quality patient care while meeting the current challenges facing the healthcare industry. The combined company will provide scale and resources to continue investment for the future.

Markham, Ontario – Extendicare Inc. (“Extendicare” or the “Company”) (EXE) is pleased to announce that the Company has completed the acquisition of the Revera Home Health business from Revera Inc. (the “Vendor”), for $83 million in cash, before working capital adjustments.

Downers Grove, IL – Addus HomeCare (ADUS) has agreed to acquire South Shore Home Health Services for an undisclosed amount.  South Shore currently serves Suffolk, Nassau, Queens and Westchester counties. For 2014, South Shore produced revenue of approximately $47 million. Addus expects that, assuming satisfaction of all closing conditions (as to which no assurances can be made), including customary closing conditions for a transaction of this type (including New York regulatory approval), the purchase of South Shore is expected to be completed before year end or in early 2016 and that the purchase will be accretive to the Company’s 2016 financial results.

Exclusively Listed for Sale by Stoneridge:

  • Minnesota & Wisconsin – $2 million Medicaid & Medicare certified home health agency in MN and WI. Primarily Medicaid with great opportunity for Medicare growth. Well-run with excellent clinical. Stoneridge file S-3002
  • Florida– Clearwater/St. Pete area – $4 million Medicare home health agency. Excellent outcomes, strong clinical programs, excellent management team in place. $700K in adjusted EBITDA. Stoneridge file S-4109.
  • Texas – $5 million East Texas Medicare certified home health agency with diverse payor sources, including Medicare, Medicaid, pediatric and private pay.  Stoneridge file S-3665
  • Washington State – $2 million revenue. This agency has a long history of profitability. Diverse payor sources includes Medicaid programs and private pay. Great reputation in a unique service area. Stoneridge file S-7010
  • New Mexico – $4.4 million Medicaid and Medicare agency & hospice with a pediatric component. Excellent clinical results and financial records. Stoneridge file S-9160
  • Texas $1.2 million Medicare certified home health care agency in the Galveston area. Stoneridge file S-9015
  • Colorado – $3.7 million Medicare certified home health agency in SW Colorado. Large service territory. Clean surveys and good clinical operations. Stoneridge file S-4161
  • Texas – $1.5 million East Texas Medicare certified home health agency, providing skilled care, approx 75% from traditional PPS Medicare.  Last survey was deficiency free. Stoneridge file S-4088
  • Virginia- $4 million Medicare agency located in Northern Virginia. 78% Traditional Medicare. Accredited. Stoneridge file S-6001
  • Texas – $2.3 million Medicare certified home health agency in Houston, Texas. 92% Traditional Medicare. Stoneridge file S-1542
  • North Carolina – $2.2 million Medicaid provider with two locations serving Charlotte, NC and surrounding areas. Service waiver programs include: PCS, PDN, and CAP. Accredited. Professionally run company with outstanding clinical. Great tuck-in opportunity. Stoneridge file S-2999
  • Texas – $3.3 million accredited Medicare home health agency. Profitable and still growing with approximately 87% of revenue coming from traditional Medicare. Strong marketing team in place with diversified referral sources. Stoneridge file S-1500
  • California – $2.2 million revenue, JCAHO accredited, Medicare certified home health care agency serving Southern California. Stoneridge file S-1050
  • Texas – $2 million plus Medicare certified home health agency providing service to Region 2.  88% of revenue is from traditional Medicare. Stoneridge file S-3650
  • Pennsylvania – $7 million plus, Medicaid provider with multiple locations in southeastern Pennsylvania. Well-run, profitable agency with great year over year growth and reputation for quality services.  Stoneridge file S-8000
  • Texas – $2 million Fort Worth Medicare agency, approx 90% traditional Medicare.Stoneridge file S-2650
  • Utah – Approximately $3.5 million home health and hospice provider with multiple office locations. Good platform or add-on opportunity, motivated seller.  Stoneridge file S-2262
  • Florida – Stable $1 million Florida district 4 Medicare home health agency, management team in place and accredited. Stoneridge file S-5542 On Contract
  • New Jersey – $4 million hospice serving southern New Jersey, well-established with a great reputation for quality care.  Stoneridge file S-1070 On Contract
  • Florida – $2.8 million Medicare certified agency serving District 3. Solid operational team in place. 95% Medicare.  Stoneridge file S-9000
  • New Mexico – $2.3 million Medicare provider serving the Roswell area. Clean surveys.  Stoneridge file S-5295
  • Oklahoma –  $6 million revenue Oklahoma City Medicare certified home health agency.   90% of revenue from traditional Medicare. Stoneridge file S-3200
  • Ohio – $2.5 million Medicare agency in Columbus area, 75% traditional Medicare, long history of quality care.  Stoneridge file S-5232.
  • Florida – Orlando area Medicare agency with about $900,000 revenue.  Stoneridge file S-2540.  On Contract

To see more home care agencies and hospices exclusively listed for sale by Stoneridge Partners go to the following link: Agencies for Sale

Do you know of any acquisitions that have taken place?  We would be interested in your comments.  At the top of this column is a “Contact Tab” with a section for comments.  These can be sent anonymously. The return email address can be left blank.  We are interested in what you have to say, or acquisitions that you know about.

Another favorite from The New Yorker

TouchAnywhere

More

For more cartoons and additional musings on the state of homecare and what’s going on at Stoneridge Partners, visit our blog, which is updated regularly: http://stoneridgepartners.com/category/blog/.
From Don Cummins, Publisher of “The Home Health Index” don@stoneridgepartners.com – 800-218-3944

Previous editions of this monthly newsletter can be searched for at the bottom of the home page of the Home Health Index. Links to Google Finance: Almost Family | Amedisys | LHC Group