Encompass Health Q3 2024 Earnings Results & Report

Encompass Health EPS Results

• Actual EPS: $1.03
• Consensus EPS: $0.94
• Beat/Miss: Beat by +$0.09
• One Year Ago EPS: $0.86
• EPS Beat Rate: 8 of last 8 quarters

Encompass Health Revenue Results

• Actual Revenue: $1.35 billion
• Expected Revenue: $1.33 billion
• Beat/Miss: Beat by +$22.81 million
• YoY Revenue Growth: +11.90%

Encompass Health (NYSE:EHC) (NYSE:EHC) is a healthcare services company focused on inpatient rehabilitation. Through its network of rehabilitation hospitals, the company provides intensive medical and therapeutic care to patients recovering from conditions such as strokes, brain and spinal cord injuries, hip fractures, amputations, neurological disorders, and other disabling illnesses or injuries.

Its rehabilitation hospitals offer coordinated care from physicians, nurses, therapists, and other healthcare professionals. Services generally include physical, occupational, and speech therapy, along with rehabilitation nursing, medical management, and patient education designed to help individuals regain function and return to independent living.

Encompass Health operates rehabilitation hospitals across numerous U.S. states and also serves patients in Puerto Rico. The company was formerly known as HealthSouth Corporation and adopted the Encompass Health name as it concentrated on inpatient rehabilitation following the separation of its home health and hospice operations. Mark Tarr serves as the company’s president and chief executive officer.

Encompass Health Q3 2024 Earnings Call Transcript

Key Takeaways

• Strong Q3 performance: Revenue rose 11.9% year-over-year to $1.35 billion and adjusted EBITDA increased 13.4%, with total discharges up 8.8% (6.8% same-store).
• Raised full-year guidance: Encompass now expects $5.325–$5.375 billion in net operating revenue, $1.07–$1.09 billion in adjusted EBITDA, and $4.19–$4.33 in adjusted EPS for 2024.
• Capacity expansion: Added 99 beds in Q3 via two de novo hospitals and ten bed additions, and will open a 61-bed fully prefabricated hospital in Houston to accelerate build times and lower costs.
• Infrastructure resilience: Despite hurricanes Helene and Milton, 25 hospitals—10 using prefabrication elements—suffered only minor damage (<$1 million in repairs) and all facilities quickly resumed operations.
• Robust cash flow and leverage: Adjusted free cash flow rose 27.1% to $189.7 million in Q3 (YTD ~$500 million), with full-year FCF guidance of $560–$620 million and net leverage improving to 2.3x.

Presentation

[Operator]

Good morning, everyone, and welcome to Encompass Health's third quarter 2024 earnings conference call. At this time, I would like to inform all participants that their lines will be in a listen-only mode. After the speaker's remarks, there will be a question-and-answer period. If you would like to ask a question during this time, please press star one on your telephone keypad. You will be limited to one question and one follow-up question. Today's conference call is being recorded. If you have any objections, you may disconnect at this time. I will now turn the call over to Mark Miller, Encompass Health's Chief Investor Relations Officer. Please go ahead.

[Mark Miller, Chief Investor Relations Officer at Encompass Health]

Thank you, Operator, and good morning, everyone. Thank you for joining Encompass Health's third quarter 2024 earnings call. Before we begin, if you do not already have a copy, the third quarter earnings release supplemental information and related Form 8-K filed with the SEC are available on our website at encompasshealth.com. On page two of the supplemental information, you will find the safe harbor statements, which are also set forth in greater detail on the last page of the earnings release. During the call, we will make forward-looking statements, which are subject to risks and uncertainties, many of which are beyond our control.

[Mark Miller, Chief Investor Relations Officer at Encompass Health]

Certain risks and uncertainties, like those relating to regulatory developments as well as volume, bad debt, and labor cost trends that could cause actual results to differ materially from our projections, estimates, and expectations, are discussed in the company's SEC filings, including the earnings release and related Form 8-K, the Form 10-K for the year ended December 31st, 2023, and the Form 10-Q for the quarters ended March 31st, 2024, June 30th, 2024, and September 30th, 2024, when filed. We encourage you to read them. You are cautioned not to place undue reliance on the estimates, projections, guidance, and other forward-looking information presented, which are based on current estimates of future events and speak only as of today. We do not undertake a duty to update these forward-looking statements. Our supplemental information and discussion on this call will include certain Non-GAAP financial measures.

[Mark Miller, Chief Investor Relations Officer at Encompass Health]

For such measures, reconciliation to the most directly comparable GAAP measure is available at the end of the supplemental information, at the end of the earnings release, and as part of the Form 8-K filed yesterday with the SEC, all of which are available on our website. I would like to remind everyone that we will adhere to the one question and one follow-up rule to allow everyone to submit a question. If you have additional questions, please feel free to put yourself back in the queue. With that, I'll turn the call over to Mark Tarr, Encompass Health's President and Chief Executive Officer.

[Mark Tarr, President and CEO at Encompass Health]

Thank you, Mark, and good morning, everyone. We're very pleased with our third quarter performance, highlighted by an increase of 11.9% in revenue and 13.4% in Adjusted EBITDA. Q3 total discharges increased 8.8%, including 6.8% in same store. Once again, discharge growth was broad-based across geographies, payers, and patient type. Neurological and stroke, our two most common primary conditions treated, grew 9% and 9.7%, respectively. Within our payer mix, Medicare discharges increased 8.8% for the quarter, while Medicare Advantage discharges grew 12.6%. Owing largely to our Q3 results, we are again increasing our 2024 guidance. Doug will cover the details of the quarter and guidance in his comments. The demand for inpatient rehabilitation care is underserved and growing.

[Mark Tarr, President and CEO at Encompass Health]

For more than a decade, the age cohort most in need of these services has grown at a 4%-5% CAGR, while the total supply of licensed IRF beds has been essentially static. It is estimated that by 2030, one in five Americans, more than 70 million people, will be aged 65 or older. Older adults disproportionately experience chronic health conditions, which is likely to continue to drive strong demand for inpatient rehabilitation services. We are continuing to invest in capacity additions to meet the needs of patients requiring such services. During Q3, we added 99 beds to our capacity, comprised of two de novo hospitals with a total of 89 beds and the addition of 10 beds to existing hospitals.

[Mark Tarr, President and CEO at Encompass Health]

We expect to open one additional de novo in 2024, a 61-bed hospital in Houston that will be our first fully prefabricated hospital, and add approximately 22 more beds to existing hospitals. The Houston project marks an important milestone in our de novo construction strategy. Full prefabrication will facilitate lower costs and shorter design and construction times, but the process is not without complexities. Together with our primary prefab partner, BLOX, we have learned a great deal on the Houston project, paving the way for efficiencies on future de novos. These efficiencies are starting to materialize on our Athens, Georgia de novo scheduled to open in the first quarter of 2025. We currently anticipate that at least two de novos per annum will be built with full prefabrication. With 15 development projects beyond 2024 already announced and underway, our pipeline remains robust and balanced between wholly owned and joint ventures.

[Mark Tarr, President and CEO at Encompass Health]

Many areas in the Southeast and Mid-Atlantic regions of the U.S. were significantly impacted by Hurricanes Helene and Milton. We operate numerous hospitals within these geographies. We are very proud of our leadership and how they prepared for and performed during and in the aftermath of these hurricanes. We are humbled by the resiliency of our dedicated employees, some of whom experienced damage to their homes and personal property, as well as electricity and water outages. Given our presence in hurricane-prone markets, we have well-defined protocols for dealing with large storms. These protocols prioritize the safety and well-being of our patients and employees. Our physical plants withstood the hurricanes very well.

[Mark Tarr, President and CEO at Encompass Health]

Twenty-five of our hospitals, including ten that incorporated at least one element of prefabrication as part of either the initial build or bed addition, were in some way impacted by the hurricanes, yet in total experienced only relatively minor damage. This is a testament to the quality and strength of our hospitals. We are still gathering estimates on required repairs, which we currently believe will amount to less than $1 million of expenses to be incurred in Q4. For the safety of our patients and staff, we chose to evacuate our Largo and Cape Coral, Florida hospitals ahead of Hurricane Milton, with our Largo Hospital closing for five days and Cape Coral for six days. Many patients from these two hospitals were evacuated safely to other Encompass Health hospitals and were accompanied by members of our clinical staff as needed. Again, a testament to our hospital staff.

[Mark Tarr, President and CEO at Encompass Health]

Four additional Florida locations did not admit patients prior to and immediately after Hurricane Milton passed through Florida on October 9th and 10th. By Saturday, October 12th, all of our hospitals had resumed normal operations and were admitting patients. Although our operations are back to normal, some of the communities we serve are still in recovery mode. Disruptions to the healthcare systems in those communities may impact our volumes and length of stay in Q4, and we have attempted to account for that as well as the aforementioned facility repairs in our updated guidance. Now I'll turn it over to Doug.

[Doug Coltharp, CFO at Encompass Health]

Thank you, Mark, and good morning, everyone. As Mark stated, Q3 was another strong quarter, with revenue increasing 11.9% to $1.35 billion and Adjusted EBITDA increasing 13.4% to $269.3 million. Total discharges increased 8.8%, and net revenue per discharge increased 2.5%. As we saw in Q2, discharge growth in Q3 was skewed somewhat more toward same store based primarily on the timing of de novo openings. Revenue growth in Q3 included a $7.9 million increase in provider tax revenues, partially offset by a $4.5 million increase in associated expense, netting to a $3.4 million Adjusted EBITDA benefit. Bad debt expense as a percent of revenue was 1.9%, down 30 basis points from Q3 2023 and 100 basis points from Q2 2024. Recall that in Q2, we had a substantial increase in claims requested for review by our primary MAC.

[Doug Coltharp, CFO at Encompass Health]

Consistent with our historical practice, we established a reserve against those claims in Q2 as the review was still pending. During Q3, a substantial majority of those claims was resolved favorably, contributing to strong collections. We had a relatively small number of new claims selected for review under TPE in Q3. Moving on to Review Choice Demonstration, or RCD. As a reminder, Alabama was the first state to implement RCD inclusive of seven Encompass Health hospitals. RCD began with cycle one, which ran from August 2023 until February 2024, and had a minimum required affirmation rate of 80%. Cycle one participants were given an option of 100% prepayment claims review or 100% postpayment claims review for all Medicare claims. We elected 100% prepayment claims review, and all seven of our hospitals completed cycle one with an affirmation rate of approximately 89%, exceeding the 80% required threshold.

[Doug Coltharp, CFO at Encompass Health]

Accordingly, we were given the option for cycle two of remaining on 100% prepayment claims review, changing to 100% postpayment claims review, or being subject to a 5% spot audit. Given the processes we had established and the success we had achieved in cycle one, we elected to remain on 100% prepayment claims review. Cycle two began in May 2024 and concludes on October 31st. The required affirmation rate in cycle two increased from 80% to 85%. We do not expect any of our seven hospitals to achieve that target by October 31st. Many of our RCD non-affirmations are based on the application of improper standards or requirements that directly conflict with the Medicare coverage criteria for inpatient rehabilitation facilities. We are appealing incorrect determinations, and we are working directly with CMS to address our concerns related to these improper standards.

[Doug Coltharp, CFO at Encompass Health]

We are still early in this process, but we believe our approval rates of approximately 90% in cycle one better reflect our long-term affirmation rates than the lower initial approval rates we have thus far experienced in cycle two. There is no financial penalty for not meeting the affirmation rate in cycle two. Rather, as we enter cycle three, we will remain at 100% prepayment claim review. The required affirmation rate in cycle three increases to 90%. SWB per FTE increased 4.1% in Q3, inclusive of a 3.5% increase in salaries and wages per FTE and a 14% increase in benefits per FTE. The large increase in benefits per FTE in Q3 was driven by group medical costs, which included several large-dollar claims and an increase in prescription costs. The incurrence of large claims is sporadic, and the frequency of such claims tends to be mean-reverting.

[Doug Coltharp, CFO at Encompass Health]

Total premium labor expense for Q3 was $32.6 million, down 2% from Q3 2023 and flat sequentially. Q3 contract labor FTEs were 1.5% of total FTEs. These metrics are consistent with our expectations of a stable labor market. Net pre-opening and ramp-up costs were $5.4 million in Q3 2024, as compared to an Adjusted EBITDA contribution of $900,000 from the 2023 openings in Q3 2023. We continue to generate significant free cash flow. Adjusted free cash flow increased 27.1% to $189.7 million, bringing our year-to-date total to approximately $500 million. We now expect full-year adjusted free cash flow of $560 million to $620 million. Our leverage and liquidity remain very favorable. Net leverage at quarter-end was 2.3 times compared to 2.7 times at year-end 2023. We ended the third quarter with approximately $148 million in unrestricted cash and no amounts drawn on our $1 billion-dollar revolving credit facility.

[Doug Coltharp, CFO at Encompass Health]

On October 22nd, we issued a notice of redemption for an incremental $100 million of our 5.75% senior notes due in September 2025. This redemption will settle next month, following which we will have a remaining balance of $100 million on these notes. We are again raising our 2024 guidance, and we now assume net operating revenue of $5.325-$5.375 billion, Adjusted EBITDA of $1.07-$1.09 billion, and adjusted earnings per share of $4.19-$4.33. The key considerations underlying our guidance can be found on page 12 of the supplemental slides. There are a number of factors to keep in mind as you contemplate year-over-year comparisons for Q4. Q4 of 2023 included a $22 million revenue reserve related to bad debt stemming from the write-off of older claims, predominantly pre-2018.

[Doug Coltharp, CFO at Encompass Health]

After giving effect to minority interest, the impact of this revenue reserve on Q4 2023 Adjusted EBITDA was $16 million. Q4 2023 also included $6.8 million in favorable reserve adjustments for workers' comp and general professional liability insurance. We are anticipating net pre-opening and ramp-up costs of $3-$3.5 million in Q4 2024 as compared to $1 million in Adjusted EBITDA contribution from 2023 openings in Q4 2023. And we anticipate a Q4 Adjusted EBITDA impact of $3 million-$3.5 million related to the addition of our Augusta Hospital to the Piedmont Joint Venture, together with Oracle Fusion implementation costs. With that, we'll open the lines for Q&A.

[Operator]

Thank you. At this time, the floor is now open for your questions. If you would like to signal to ask a question, please press star one on your telephone keypad. If at any point your question has been answered, you may remove yourself from the queue by pressing star two. Once again, that is star one to signal for a question and star two to remove yourself. We'll pause for just a moment to assemble the question queue. We'll go first to the line of Joanna Gajuk with Bank of America Securities. Please go ahead.

[Mark Tarr, President and CEO at Encompass Health]

Morning, Joanna.

[Christian Porter, Analyst at Bank of America]

Hi. Hi. This is Christian Porter on the line for Joanna. Thank you guys so much for taking our question. I was wondering, because same store volumes were very strong and accelerated quarter-over-quarter, just wondering what drove that strength and how much of this was from the addition of new beds. Thank you.

[Mark Tarr, President and CEO at Encompass Health]

Christian, this is Mark Tarr, as I noted in my comments. It was very broad across geographies. All of our eight geographic operating regions had nice growth. We saw nice growth in our stroke and other neurological categories. We saw the continued ramp-up of the facilities we brought on for the past couple of years. So we believe that we continue to take market share. We believe that our value proposition continues to be out there relative to the quality outcomes that we're able to achieve and is recognized as our ability to get patients back home and not readmitted back to the acute care hospital.

[Doug Coltharp, CFO at Encompass Health]

I do think the bed additions had a favorable impact. Prior to Q3, on a year-to-date basis, we had added 115 beds, including 40 beds in a satellite location, and so those are counted in same store. It's also the case that in the first half of the year, the 23 de novo openings were rolling into same store, and those are still in ramp-up mode, so that provides a little bit of a tailwind to the same store number as well.

[Operator]

We'll hear next from Andrew Mok with Barclays. Please go ahead.

[Andrew Mok, Analyst at Barclays]

Hi, good morning.

[Andrew Mok, Analyst at Barclays]

Hi, how are you? Total FTEs have been up about 7%-8% for the last year or so. Should we expect that to continue to increase in that ballpark to keep up with the discharge growth, or should we expect that to moderate as we distance ourselves from some of the severe labor issues of 2021 and 2022? And then relatedly, it sounded like there were some additional group medical expenses hitting the SWB line in the quarter. What was the underlying wage inflation, and what's the outlook for that going forward? Thanks.

[Doug Coltharp, CFO at Encompass Health]

Yeah, I'll take the second part of the question first. And SWB per FTE was up 3.5%. So pretty consistent with what we saw in Q1 and Q2. With regard to the total FTEs, we're pretty much at a stabilized EPOB of about 3.4 now. You'll have some noise from quarter to quarter based on the timing of new openings, but generally speaking, we would expect that the growth in total FTEs will be pretty highly correlated to discharge growth.

[Mark Tarr, President and CEO at Encompass Health]

As we've noted in the past, at this EPOB level, we feel like it's at a level that is conducive with us being able to continue to retain staff and also produce the outstanding outcomes. We have put a lot of focus on that in the past couple of years as well.

[Doug Coltharp, CFO at Encompass Health]

We do believe that we're seeing tangible evidence of the impact of EPOB, as well as a number of the other initiatives we've been pursuing on our turnover rates. The Q3 annualized turnover rate for RNs was 20.7%, and for therapists, 7.6%. Those are very strong numbers.

[Andrew Mok, Analyst at Barclays]

Great. Thanks for all the color.

[Operator]

Next, we'll hear from the line of Ben Hendrix with RBC Capital Markets. Please go ahead.

[Mark Tarr, President and CEO at Encompass Health]

Hello, Ben.

[Mike Murray, Analyst at RBC Capital Markets]

Hi. This is Mike Murray on for Ben. Congrats on the quarter, and I appreciate all the commentary you gave on the hurricanes. Just given your expectations for lower volumes, could you provide a ballpark estimate for revenue impact in the fourth quarter?

[Doug Coltharp, CFO at Encompass Health]

We really can't because, as we said, our hospitals resumed normal operations very quickly. So the impact to discharge growth and to revenue from those disruptions would have been relatively minor. What we're still evaluating is whether or not the systems in the communities in which we operate hospitals have been impacted in any way that might cause us, for instance, to see a longer length of stay because there aren't available places for patients who have been treated in our facilities to be discharged. We are confident that the updated guidance ranges for revenue and Adjusted EBITDA incorporate any impact that we're going to see from the hurricanes, whether it's to volume, whether it's to length of stay, or making the repairs to the facilities that will be expensed in Q4.

[Mike Murray, Analyst at RBC Capital Markets]

Okay. And just to follow on, so you had some de novos in development in areas that were impacted by the hurricanes. And sorry if I missed this, but are you expecting any delays in construction as a result? Thanks.

[Doug Coltharp, CFO at Encompass Health]

We are not. And you're right. We're scheduled to open five hospitals in the state of Florida next year. And those sites were all secured in advance of the storm and came through very well. So any of the relatively minor disruptions that we may have experienced there, we believe we will be able to make up and stick with the timeframe that is depicted on the schedule in the supplemental slides.

[Mike Murray, Analyst at RBC Capital Markets]

Awesome. Thank you.

[Operator]

And now we'll turn to the line of Brian Tanquilut with Jefferies. Please go ahead.

[Mark Tarr, President and CEO at Encompass Health]

Morning.

[Doug Coltharp, CFO at Encompass Health]

Morning, Brian.

[Meghan Holtz, Analyst at Jefferies]

Morning, guys. This is Megan Holtz for Brian. Congrats on the quarter. Just going back to your bad debt really quick, we noticed that you're guiding for Q bad debt reserves to a midpoint of $22.25. Is that a step up from Q3? Is that just conservatism, or is that attributed to the small new audit claims that you guys mentioned in 3Q?

[Doug Coltharp, CFO at Encompass Health]

You know, before Q3, that was kind of before Q2 and Q3, where you had some noise in each one of those, that was kind of the run rate that we were at, and so we don't think it's reflecting anything other than what we suggest is a normalized level of activity. In Q3, we benefited from a decrease in our aging-based reserve, and some of that was attributable to processing some previously denied claims.

[Meghan Holtz, Analyst at Jefferies]

Got it. Thank you so much.

[Operator]

Next, we'll hear from the line of Pito Chickering with Deutsche Bank. Please go ahead.

[Mark Tarr, President and CEO at Encompass Health]

Hey, Pito.

[Kieran Ryan, Analyst at Deutsche Bank]

Hey, good morning, everyone. This is Kieran Ryan on for Pito. Thanks for taking the question. It looks like 4Q EBITDA margin guidance is maybe down somewhere about 50 basis points from 3Q, excluding the provider taxes. I don't think there's any negative seasonality from 3Q to 4Q on margins or EBITDA dollars. So just wanted to confirm, is that kind of just the opening costs and any potential impact from the hurricane headwinds, or is there anything else we should be thinking about sequentially?

[Doug Coltharp, CFO at Encompass Health]

Yeah, I think it's really that series of year-over-year considerations that I reviewed at the end of my prepared comments, and those are laid out in the guidance considerations.

[Kieran Ryan, Analyst at Deutsche Bank]

Okay. And then on free cash flow, it looks like the working capital tailwind came down pretty significantly, but you still raised your guidance quite a bit in free cash flow dynamics in the quarter. And if there's anything we should pay attention to there for 2025? Thanks.

[Doug Coltharp, CFO at Encompass Health]

You know, I think probably the most significant item in Q3 was just the strong collections of AR we had, and a lot of that was moving through that bulge of claims that had been selected for review under TPE at the end of Q2.

[Kieran Ryan, Analyst at Deutsche Bank]

Thanks.

[Operator]

And next, we'll go to the line of Scott Fidel with Stephens. Please go ahead.

[Doug Coltharp, CFO at Encompass Health]

Morning.

[Scott Fidel, Analyst at Stephens]

Good morning. I'll find out, but close enough. Good morning. Wanted to, first question, just ask about just an understanding that you're not providing guidance at this point, but you wanted to maybe frame the key headwinds and tailwinds for 2025. And just from, I guess, the bigger picture, any modeling considerations at this vantage point that you think it is important to call out for analysts and investors?

[Doug Coltharp, CFO at Encompass Health]

As we head into 2025, our starting assumption, and we've got a better part of another quarter to continue to flush this out, is that we'll see SWB per FTE inflation of somewhere in the 3%-3.5% range. We think it's kind of settling down there. We have not yet put a fine pencil to what pre-opening and ramp-up costs will be on a year-over-year basis, but it's probably not going to be too distinct from the impact that we're seeing this year. The last thing I'd call to attention is, already on a year-to-date basis for Q3, we've had a favorable EBITDA impact from net provider taxes of $13 million.

[Doug Coltharp, CFO at Encompass Health]

As we've mentioned previously, it's difficult to have a lot of confidence in the visibility of those provider taxes on a go-forward basis because those programs vary from state to state, and they're typically implemented on an annual basis. We know of the $13 million that's been included in EBITDA on a year-to-date basis. That approximately $4 million-$5 million relates to out-of-period. So I think it's a fair assumption that that portion is not likely to repeat going into 2025. Some portion of the balance, maybe even a substantial portion of the balance, probably will. Those are the things that come immediately to mind, Scott.

[Scott Fidel, Analyst at Stephens]

Okay. Thanks, Mark. That's helpful. And then just my follow-up question, wanted to circle back just on some of the comments that Mark had made around the sort of lessons learned on the prefabs and then starting to see efficiencies realized more on the Athens facility. Was hoping maybe you can sort of frame if there's any type of quantitative figures you can share with us in terms of maybe in the initial process, how much maybe additional costs you had just as you were sort of working your way through this new format. And then as you sort of move towards the efficiencies, how much you think you could bring down those costs, for example, on the Athens facility, and then as you continue to launch more of the prefabs?

[Doug Coltharp, CFO at Encompass Health]

Yeah. So you've got two primary advantages that we're trying to achieve. One is shortening the actual construction process because that obviously connotes speed to market. And the faster we get these things open, the faster we can start to generate cash flow from those. If we look specifically at Houston, and again, this was a learning exercise for us because it was the first fully prefabricated facility we did, we laid the first module in Houston in June, in the early part of June. And we got all of the final permitting and licensing. Final inspection will happen in the first week in November. So that's really fast, right? You're talking about a little over five months there or just about five months. And that compares to conventional construction, which would be 11-12 months.

[Doug Coltharp, CFO at Encompass Health]

We think we're going to be even a little bit faster than that for Athens. From an expense perspective, and so ultimately what we're looking at, because the elements of the timeframe that you're not really able to impact much with prefabricated construction, you get some savings with regard to the design process because we're using a lot of replication from project to project. Permitting and site work are going to continue to vary pretty significantly from location to location. So there's not really an opportunity there. Again, from laying the first module to when the door opens, it's a pretty substantial time improvement. On the cost side, Houston, because we were still on the learning curve, was essentially a break even with conventional costs.

[Doug Coltharp, CFO at Encompass Health]

We do expect that as we hone the process further, and we'll see a little bit of the impact on Athens, it's really going to be for future projects where we'll get there, that we'll move towards an estimated 15% cost savings versus conventional construction.

[Mark Tarr, President and CEO at Encompass Health]

Scott asked Mark, so I'll just pitch in there. We've been at this now for a number of years on an incremental basis, first starting with bathrooms and head walls and then working our way up to our modules, and it has really turned out to be a nice, what we consider to be a competitive advantage in terms of building our hospitals. I also commented on the fact that these have been tested in a number of severe storms in terms of their quality and soundness of construction, so we just couldn't be happier in terms of the success and the way this is working its way through our implementation phase.

[Scott Fidel, Analyst at Stephens]

Okay. Great. Thanks for the caller.

[Operator]

Now we'll hear from the line of Jared Haase with William Blair. Please go ahead.

[Mark Tarr, President and CEO at Encompass Health]

Hey, Jared. Morning.

[Jared Haase, Analyst at William Blair]

Hey, good morning, and congrats on a solid quarter. Maybe just taking a step back and kind of really thinking about sort of the durability of growth again as we look out to 2025. I'm curious, do you feel like the same sort of growth trends, is that largely reflecting sort of the underlying demand environment for IRF services, or do you feel like you are taking, I guess, more than your fair share as you capture market share from other care settings like SNFs, which I know has been kind of a focus area from recent years? Just any thoughts around that?

[Mark Tarr, President and CEO at Encompass Health]

I think it's both. It's hard to put an exact number on what is taking additional market share versus just organic growth from a demographic tailwind. But it's some of both. Some marketplaces, it's more evident than others in terms of where we're taking it from, in terms of whether they're nursing homes or other providers in the marketplace. As I noted in my general comments, the aging demographics and the increased demand just by the aging population for inpatient rehab services is certainly playing its way out and can be seen in our same-store growth.

[Doug Coltharp, CFO at Encompass Health]

As we've stated on a number of occasions, we believe that the conditional measure of looking at market share in the IRF space, which is to look at the number of discharges we have over the total industry discharges, grossly underrepresents the total addressable market for IRF Services. One of the primary reasons we think that is that we can look upstream at the number of annual discharges coming out of all of the acute care hospitals in the U.S. that are prima facie CMS 13 compliant. Obviously, only 60% of the patients treated in any particular IRF during the course of a year have to be CMS 13 compliant. Only 14% of that total population of acute care hospital discharges that are CMS 13 compliant are winding up in an IRF bed.

[Doug Coltharp, CFO at Encompass Health]

Now, we recognize that the number shouldn't be 100% for various reasons, including the fact that a portion of that population would not meet medical necessity criteria, but the potential for that number to be a lot higher than 14% is out there. It's important to note too that that 14% that winds up in an IRF bed includes existing Encompass Health facilities, and in virtually all of the markets in which we operate, we convert higher than 14% of the CMS 13 eligible discharges in that market into the IRF bed. If you strip us out, that number on a national basis is probably at a high single digit, and we know in more mature markets where we've been operating for a period of time, it's not unusual for us to see that conversion rate at 30% or higher.

[Jared Haase, Analyst at William Blair]

Okay. Great. I think that's super helpful. And then maybe I'll just ask a quick follow-up on the quarter. It sounded like the Medicare Advantage discharge growth was solid. I think that was running a couple of points higher than the Medicare, traditional Medicare discharge growth. It does look like in the revenue mix for the quarter, MA declined a little bit sequentially just as a percentage of total revenue. So I'm curious. I assume that's related to sort of a mixed dynamic in terms of the conditions that were treated in the quarter. Is there something else you should be thinking about from a revenue mix perspective?

[Doug Coltharp, CFO at Encompass Health]

No, as Mark cited, the growth has been broad-based across the payers. So if you look at Q3 specifically, Medicare up 8.8%, Medicare Advantage 12.6%, and managed care saw solid growth at 9.1%. On a year-to-date basis through Q3, Medicare up 9.3%, Medicare Advantage 11.1%, and managed care up 8.5%. Looking at a three-year CAGR from 2020 through 2023, again, it reflects very balanced growth. Medicare over that period of time up 7.4%, Medicare Advantage 8.9%, and managed care 11.3%. I think what this really demonstrates is that our value proposition really extends well across all payer classes. We ought to talk to the case that we create more value for our referral sources when we're not trying to cherry-pick patients between payers.

[Jared Haase, Analyst at William Blair]

Absolutely. Makes sense. And thanks for all the color.

[Operator]

As a reminder, ladies and gentlemen, if you would like to signal for a question, simply press star one on your telephone keypad. We'll turn to the line of Matthew Gilmore with KeyBanc. Please go ahead.

[Mark Tarr, President and CEO at Encompass Health]

Good morning.

[Zach Haggerty, Analyst at KeyBanc Capital Markets]

Hey, good morning, guys. This is Haggerty on for Matt. Appreciate you taking our question. So we've been getting questions on election implications for hospitals, especially on the exchange subsidies and Medicaid supplemental payments. I guess, could you remind us maybe what your exposure is to these programs or if you see any other election-related items that we should be aware of?

[Doug Coltharp, CFO at Encompass Health]

Yeah. I think from our perspective, the program that seems to be getting the most airplay because of its size is Tennessee. And it's really not a factor for us in the state of Tennessee. So we've talked quite a bit about our net provider tax numbers. For us, the numbers are substantially smaller than they are for acute care hospitals or some other settings. They've been challenging to predict. If you look at the last two years preceding this year, the EBITDA impact from our net provider taxes was nominal. It was give or take a couple million bucks. On a year-to-date basis, this year has been $13 million, but four to five of that relates to out-of-period. So as I stated in my earlier comment, is it reasonable to believe that some amount of that continues into 2025? Yeah, I think it probably is.

[Doug Coltharp, CFO at Encompass Health]

We just don't have a good estimate because of the lack of visibility.

[Mark Tarr, President and CEO at Encompass Health]

Relative to your question just around the whole presidential election and if there's one preference over another, we really don't see a threat from either one. If you look back historically, whether it's been Republican or Democrat, it doesn't seem to have had a significant impact one way or the other.

[Zach Haggerty, Analyst at KeyBanc Capital Markets]

Okay. That's helpful. And then just as my follow-up, as you guys continue to reduce leverage in the business, is there a leverage ratio that you guys are targeting?

[Doug Coltharp, CFO at Encompass Health]

There's not. We're obviously very comfortable kind of in the current range. We used to say that we felt like a run rate leverage of about three times was appropriate. Obviously, we're substantially below that right now. It feels like just based on some of the macro factors that are out there that the market is appreciating 2.5 as the new 3.0. We recognize that if we get much below the current level of leverage, there's an inefficiency that kind of creeps in from a cost of capital perspective. We continue to think that we have good opportunities to deploy cash towards capacity expansions, and that will be our top priority, and I think our board of directors signaled some of the other potential utilizations of cash with the increase in the dividend that occurred in Q2, as well as the increase in the share repurchase authorization.

[Zach Haggerty, Analyst at KeyBanc Capital Markets]

Great. Appreciate the time, guys.

[Operator]

As there are no further questions in queue at this time, I'd like to turn the floor back over to Mr. Mark Miller for any additional or closing comments.

[Mark Miller, Chief Investor Relations Officer at Encompass Health]

Thank you, operator. If anyone has additional questions, please call me at 205-970-5860. Thank you again for joining today's call.

[Operator]

Ladies and gentlemen, that will conclude the Encompass Health Third Quarter 2024 earnings conference call. Thank you for your participation. You may disconnect at this time and have a wonderful day.

Participants

Executives

• Mark Tarr, President and CEO
• Doug Coltharp, CFO
• Mark Miller, Chief Investor Relations Officer

Analysts

• Christian Porter, Analyst at Bank of America
• Kieran Ryan, Analyst at Deutsche Bank
• Mike Murray, Analyst at RBC Capital Markets
• Zach Haggerty, Analyst at KeyBanc Capital Markets
• Scott Fidel, Analyst at Stephens
• Meghan Holtz, Analyst at Jefferies
• Jared Haase, Analyst at William Blair
• Andrew Mok, Analyst at Barclays