Medical Facilities Corp
TSX:DR
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Good morning, everyone. Welcome to Medical Facilities Corporation's 2022 First Quarter Earnings Call. [Operator Instructions]
Before turning the call over to management, listeners are reminded that today's call may contain forward-looking statements within the meaning of the safe harbor provisions of Canadian provincial securities laws. Forward-looking statements involve risks and uncertainties, and undue reliance should not be placed on such statements. Certain material factors or assumptions are applied in making forward-looking statements, and actual results may differ materially from those expressed or implied in such statements.
For additional information, please consult the MD&A for this quarter, the Risk Factors section of the Annual Information Form and Medical Facilities or other filings with Canadian security regulators. Medical Facilities does not undertake to update any forward-looking statements. Such statements speak only as of the date made. Today's conference is being recorded.
I would now like to turn the meeting over to Mr. Rob Horrar, President and CEO of Medical Facilities. Please go ahead, Mr. Horrar.
Thank you, operator. Good morning, and welcome to our first quarter earnings call. Joining me today is David Watson, our Chief Financial Officer.
Earlier this morning, we released our first quarter results. Our news release, financial statements and MD&A may be accessed through our website at www.medicalfacilitiescorp.ca and have been filed with SEDAR today.
Our first quarter results demonstrated once again our ability to respond in the face of ongoing challenges posed by the pandemic. Surgical case volumes and facility revenue increased 6.1% and 7.2%, respectively, for the quarter. However, the quarter began with the Omicron variant surging across North America, driving higher cancellation rates and significantly impacting our operations in the month of January. As the Omicron surge began to subside, our case volumes improved dramatically in the second half of the quarter, particularly in the month of March.
For some context, in January of this year, our surgical case volumes were down 2% from January of last year, which was also a month that was particularly impacted by the pandemic. Our volume -- January '22 volumes were 17.4% less than those in the same period of 2019. For February, our surgical case volumes were up 11.9% over last year but were still 3.8% off the pace from 2019. In March, our volumes were up 8% over prior year, a month that also saw a strong rebound in case volumes. Importantly, March '22 volumes were 11.9% higher than they were in March of '19.
We exited Q1 with significant momentum. However, given recent global events, continued supply chain issues around the world and inflationary pressures that the whole industry is facing, we do expect pressures on supply and labor costs to remain a headwind in the near future. We remain confident in our ability to navigate challenges that may lie ahead. We have a strong balance sheet and remain in a good position to execute on potential growth opportunities, and we continue to have a robust pipeline of de novo and acquisition opportunities in the ASC space.
With that, I'd like to turn the call over to David to review our financial results for the quarter. David?
Thanks, Rob, and good morning, everyone. As usual, I will discuss our financial performance for the quarter, then provide an update on our balance sheet and liquidity. I would also like to remind everyone that all dollar amounts in today's call are in U.S. dollars, unless stated otherwise.
Our higher surgical case volumes for the quarter contributed to a 7.2% increase in facility service revenue, which came in at $100.8 million for the quarter. Also contributing to the increase was the impact of Arkansas Surgical Hospital bringing its anesthesia service and related billings in-house in the current year. Total revenue and other income, including government stimulus income of $1.8 million, was $102.6 million, an increase of 4.6% compared to the first quarter of last year.
Looking at expenses. Our consolidated salaries and benefits were up 2.9% compared to the first quarter of last year, primarily due to annual salary increases and staff retention premiums due to industry-wide labor pressure. However, as a percentage of total revenue and other income, consolidated salaries and benefits were down to 29.1% from 29.6% in Q1 of last year.
Consolidated drugs and supplies increased 12.2%, primarily driven by case mix and higher surgical case volumes. As a percentage of total revenue and other income, the consolidated cost of drugs and supplies increased to 32.9% or 30.7% a year earlier. Our general and administrative expenses were up 38.1% in the quarter. The largest components of this increase were share-based contestation costs driven by the 21% appreciation in our share price during the quarter and the impact of ASH bringing its anesthesia service and related billing in-house. As a percentage of total revenue and other income, consolidated G&A increased to 18.6% from 14.1% a year earlier.
With the higher operating expenses and decrease in government stimulus income during the quarter, our income from operations decreased 20% to $14.7 million. EBITDA for the quarter was $19.8 million or 19.3% of revenue and other income, compared to $25.1 million or 25.6% of revenue and other income in Q1 of last year.
During the quarter, we generated cash available for distribution totaling CAD 5.5 million, resulting in a payout ratio of 44.4% versus 27.6% in Q1 of 2021. Our balance sheet remains strong with consolidated net working capital of $61.4 million, including $50.3 million of cash and equivalents at the end of the quarter. This compares to working capital of $67.4 million including cash and equivalents of $61 million at the end of 2021. Total cash includes $11.7 million of Medicare advances, which will be recouped by year-end.
During the quarter, we purchased 391,000 shares for $2.95 million under our NCIB program. This brings total shares purchased to $701,000 as of March 31, and a cost of $5 million since the reauthorization of the program in the fourth quarter of 2021. At the end of the quarter, we had $21 million outstanding on our corporate credit facility. Inclusive of lease liabilities, our net debt to equity stands at 0.49, which is well below that of our U.S. listed peers. We remain well resourced to capitalize on both growth opportunities and the return of capital to shareholders via our dividend and NCIB program.
This concludes my financial review for the quarter. For additional detail on our financial results, including specific results for each facility, please refer to our MD&A.
With that, we would now like to open the line for questions. Operator?
[Operator Instructions] We will now take our first question from Paul Stewardson from iA Capital Markets.
Just calling in for Chelsea. Could you give a little more color on, sort of the outlook, both short term but also more medium term in terms of these labor shortages. Is this something that is really foreseeable that it's just going to keep happening? Or is it something that will wash out as, sort of, salaries normalize and so forth across the back?
Yes. Thanks, Paul. So I do think that for the most part, we're going to see continued pressure. It is ripe not only in the nursing but in the labor market in general, so there will be a continued pressure there.
Now we're not immune to that, but our facilities have of a pretty good environment, working environment, typically not a lot of weekend or call types of schedules. So -- but we do have some challenges around, really, all the labor, the pressure and inflationary pressures. And in the near term, we expect that to continue.
And we have seen a little bit of improvement around pressure for clinical folks to work in contract labor, which is more expensive. That seems to be normalizing a little bit. But we will expect that, I think at least in the near term, to continue much like the rest of the economy, the pressures there.
Okay, okay. And maybe just any more color you can give on how you're looking at over the balance of the year, potentially de novo development or acquisitions? Any recent developments in your sort of growth pipeline from that perspective?
Yes. So a couple of things. Organically, we've seen -- it had been up -- or called that out in the first quarter, recovery in the volumes are coming back to pre-COVID levels, so that's very positive going forward. We expect that will continue.
On the pipeline side, we've got a robust pipeline of opportunities, especially in the ASC space, and we continue to diligence those and find the right fit for the company. So there's certainly a robust activity in that sector.
And is anything near term? Or is that just sort of ongoing?
Ongoing.
[Operator Instructions] We will now take our next question from Endri Leno from National Bank.
This is Eduardo Garcia talking on behalf of Andre. I have a couple here. The first one is on high -- higher G&A. I was wondering if you can give it more color. How did it -- how do you see these expenses going forward besides HR-based compensation increases?
Sure. And we detail -- provide a little more detail on the G&A expenses and the MD&A. But for the quarter, we included about $1.5 million of share-based compensation. That fluctuates based on changes in the share price. So with a 21% increase in share price for the quarter, there's a commensurate increase in those expenses that are accrued.
But I'd point out, those are noncash expenses, and that accrual will fluctuate based on those market changes. There's also $1.2 million of anesthesia-related expenses for Arkansas. Those are -- that's new as they brought those services in-house, but they're largely offset by increases in revenue, but they're now providing billing for those services.
There was a reclassification of about $800,000 of expenses for Sioux Falls as ACO. Those were previously recorded in drugs and supplies on a comparative basis. Again not new expenses, just a reclassification. And then the balance of the increase is largely administrative and facility costs and professional and billing fees. So as revenue increases, the billing fees also increased commensurately based on collections.
Okay. And a follow-up question on the ACA, was there a onetime cost out of that $1.2 million that you refer in the MD&A? Or should I see it as a run rate, $1.2 million, or can I adjust it?
So those will be continuing costs as will the corresponding revenues.
Okay. And how do you reconcile it with the revenues of $1 million that it is bringing to the company?
Yes. So there's a net expense component. You got $1 million of revenue, $1.2 million of related expenses, there's effectively a net cost of $200,000.
Okay. And now moving to the BAFH, you mentioned that there were a fewer ortho and spine cases. What drove the decrease in these cases? And I was wondering what's the current status, how are they performing right now?
So the decrease in spine cases were really just driven by fewer cases coming to those surgeons. And the surgeons, It's primarily COVID-related. It's a great timing issue. We would expect to see increases in those types of cases later in the year.
That's right.
Okay. And I have one last one, if I may. For -- I was wondering what was the FDA recently for denying the forgiveness of the FPP fee loan? And if you can appeal that decision?
It was really based on technical matters related to qualifying for the loan. So the facility believes that they've met the qualifications and we'll be appealing that decision.
Okay. And how long do you think it's going to take, the oral appeal?
It's a fairly lengthy process. I would say it's at least 7 to 8 months.
And do you expect the remaining 6.4 to be at risk? Or that would not be the case?
Yes, we've mentioned that those are under review. They were forgiven, but there's continued review. So we can't really opine on what the outcome of that process may be.
It appears there are no further questions. At this time, I would like to turn the conference back to Mr. Horrar for any additional or closing remarks.
Thank you, operator. In closing, we thank our physician partners, our nurses and all team members who deliver outstanding care to patients each and every day. We look forward to reporting on our progress throughout the rest of the year. Thank you.
This concludes today's call. Thank you for your participation. You may now disconnect.