Acadia Healthcare Q1 2025 Earnings Report

Acadia Healthcare EPS Results

• Actual EPS: $0.40
• Consensus EPS: $0.35
• Beat/Miss: Beat by +$0.05
• One Year Ago EPS: $0.84

Acadia Healthcare Revenue Results

• Actual Revenue: $770.51 million
• Expected Revenue: $769.90 million
• Beat/Miss: Beat by +$601.00 thousand
• YoY Revenue Growth: +0.30%

Acadia Healthcare Announcement Details

• Quarter: Q1 2025
• Date: 5/12/2025
• Time: After Market Closes
• Conference Call Date: Tuesday, May 13, 2025
• Conference Call Time: 8:30AM ET

Acadia Healthcare (NASDAQ:ACHC) provides behavioral healthcare services in the United States and Puerto Rico. The company develops and operates acute inpatient psychiatric facilities, specialty treatment facilities comprising residential recovery facilities and eating disorder facilities, comprehensive treatment centers, and residential treatment centers, as well as facilities offering outpatient behavioral healthcare services for the behavioral healthcare and recovery needs of communities. Acadia Healthcare Company, Inc. was founded in 2005 and is headquartered in Franklin, Tennessee.

Acadia Healthcare Q1 2025 Earnings Call Transcript

Presentation

[Operator]

After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star then 1 on your telephone keypad. To withdraw your question, please press star then 2.

[Operator]

On today's call, we ask that you please limit yourself to one question and one follow-up during q and a. Also, please be aware that today's call is being recorded. I would now like to turn the call over to Brian Farley, General Counsel. Please go ahead.

[Brian Farley, EVP - General Counsel & Secretary at Acadia Healthcare Company]

Thank you, and good morning. Yesterday, after the market closed, we issued a press release announcing our first quarter twenty twenty five financial results. This press release can be found in the investor relations section of the AcadiaHealthCare.com web site. Here with me today to discuss the results are Chris Hunter, chief executive officer, and Heather Dixon, chief financial officer. To the extent any non GAAP financial measure is discussed in today's call, you will find in the press release that is posted on our website a reconciliation of that measure to the most directly comparable financial measure calculated according to GAAP.

[Brian Farley, EVP - General Counsel & Secretary at Acadia Healthcare Company]

This conference call may contain forward looking statements within the meaning of Private Securities Litigation Reform Act of 1995, including statements, among others, regarding Acadia's expected quarterly and annual financial performance for 2025 and beyond. These statements may be affected by the important factors, among others, set forth in Acadia's filings with the Securities and Exchange Commission and in the company's first quarter news release. And consequently, actual operations and results may differ materially from the results discussed in the forward looking statements. At this time, I would like to turn the conference call over to Chris.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

Thank you, Brian, and good morning, everyone.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

Thank you for being with us for Acadia's first quarter twenty twenty five conference call. We are pleased with our start to 2025 with both first quarter revenue and EBITDA landing in line with our expectations while we made continued progress against our strategic growth initiatives. First quarter revenue of $770,500,000 came in just above the midpoint of our outlook range of $765,000,000 to $775,000,000 while adjusted EBITDA of $134,200,000 was near the high end of our outlook range of $130,000,000 to $135,000,000 We also reaffirmed our previously issued full year financial guidance ranges for both revenue and adjusted EBITDA, which Heather will provide further detail on later in the call. Moving to volumes. Same facility patient days grew 2.2% in the first quarter, which included an unfavorable leap year impact of roughly 110 basis points over the first quarter of twenty twenty four.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

The strong relationships we've built with our referral sources and our 21 joint venture partners continue to be an important part of our strategy for success. Acadia continues to be the preferred partner for leading health systems with both local and national brand recognition across the country to better serve patients by bridging the gap between physical and behavioral health care. Along those lines, I'd like to provide a progress update on our strategic initiatives. In the first quarter, we added three seventy eight new beds comprised of 90 beds to existing facilities and 288 beds from two new facilities that were opened in the quarter, which includes a joint venture hospital in partnership with Henry Ford Health in West Bloomfield, Michigan and a de novo facility in Northport, Florida. In addition, Acadia added seven new comprehensive treatment centers in the first quarter, extending the company's market reach to 170 CTCs across 33 states.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

For the full year 2025, we expect to add between 801,000 total beds. Looking forward, we have a solid pipeline of potential opportunities in attractive markets and expect to add between 608 beds annually over 2026 to 2028. Before I turn the call over to Heather, I would like to spend a few minutes discussing the numerous efforts this company continues undertaking to support our quality initiatives and share a few thoughts on the policy landscape. At Acadia, our commitment to quality and safety is a foundational element of our strategy. Our facilities are licensed, accredited, and regularly inspected to uphold high regulatory and quality standards, including rigorous requirements for employee training and patient safety.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

We employ a multilayered approach to patient protection that often exceeds industry and regulatory standards. These measures, such as twenty four seven patient monitoring systems, mandatory de escalation training, and regular safety rounds, are designed to meet the specific needs of the patients and staff at each Acadia facility. Our ability to use data has continued to advance significantly. Our hospital CEOs and leadership teams also use a variety of sophisticated cloud based systems with deep data capabilities to monitor care quality. Further, our integrated quality dashboard now provides real time visibility into over 50 distinct safety patient experience and regulatory compliance related key performance indicators.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

At the corporate level, our team supports this work with weekly, monthly, and quarterly operational and quality performance reviews. We believe the supportive, multidisciplinary relationship between the field and the corporate teams ensures we find and eliminate sources of operational and clinical variation and helps us translate behavioral science to practice with consistency. Behavioral health is complex, but it is clear the need has never been greater for high quality behavioral health care given the severe mental health crisis that our nation faces. Our strategy at Acadia remains centered on high quality care and clinical health outcomes, and we will continue to prioritize our quality initiatives and expand them when necessary. Turning to labor.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

We believe our differentiated quality initiatives are having a positive impact on our ability to recruit and retain our staff. These efforts are directly connected to our emphasis on employee engagement and talent acquisition, ensuring we have appropriately staffed facilities with trained employees, which have improved underlying labor trends for our company. This is further reinforced by our premium pay, which declined on both a sequential and year over year basis in the first quarter. We are extremely proud of the commitment of Acadia's nearly 26,000 employees that have chosen to join our mission to provide compassionate care that improves the lives of patients and their families. Now I would like to briefly touch on the policy landscape.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

First, let me say that we believe government policy has an important role to play in continuing to strengthen the behavioral health care system, and we remain highly engaged on the policy front so that we can continue advocating strongly on behalf of patients in need. While the situation in Washington is fluid, we believe that the essential care we provide to underserved and vulnerable patient populations will continue to be recognized and supported. To cite one example, supplemental payment programs have been a key enabling force behind not only our ability to serve high acuity behavioral health patients, but also patients in many other essential parts of the health care system, including rural hospitals, children's hospitals, and nursing homes. With this in mind, we expect these programs to remain an important funding mechanism for Medicaid populations. We remain focused on providing programs and facilities that provide these patients with the best possible care, and we'll provide updates to the investment community as we receive clarity on any potential policy related impacts to our business.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

With that, I would now like to turn the call over to Heather to discuss our financial results for the quarter.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Thanks, Chris, and good morning, everyone. Our first quarter financial performance for both revenue and adjusted EBITDA fell within our guidance ranges, with adjusted EBITDA performing at the high end of the range. We reported $770,500,000 in revenue for the quarter, representing a slight increase over the first quarter of last year. Recall, we had expected Medicaid supplemental payments to be down ten to fifteen million dollars year over year in q one, and these came in near the midpoint of that range. Same facility revenue grew 2.1% compared with the first quarter of twenty twenty four, driven by patient day growth of 2.2%.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

As Chris mentioned, both same facility revenue and patient day growth included an unfavorable impact of approximately 110 basis points from the leap year. Q one same facility revenue per patient day growth was roughly flat on a year on year basis, primarily due to the timing of supplemental payments. Adjusted EBITDA for the first quarter of twenty twenty five was $134,200,000 reflecting an adjusted EBITDA margin of 17.4%. As reflected in our prior guidance, these quarterly results included an approximate $5,000,000 year on year EBITDA impact due to the decision to close the facility in the first quarter as a part of our ongoing portfolio management efforts. Also included in our results were start up losses related to new facilities, which were higher on both a year over year basis and a sequential basis, reflecting a step up in the number of newly constructed facilities.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

On a same facility basis, adjusted EBITDA was $191,600,000 and adjusted EBITDA margin was 25.2% in the first quarter of this year. Our same facility results continued to be affected by a small group of underperforming facilities that you will recall started to have a material impact on our results near the end of the third quarter of twenty twenty four. To date, these facilities have performed in line with our expectations. While we continue to work diligently to improve performance of these facilities, we acknowledge that it will take time, and our 2025 guidance continues to reflect no material improvement at these underperforming facilities as we move throughout the year. We continue to maintain a strong financial position, providing us the ability to make the right strategic investments to enhance our operations and support our growth strategy.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

As of 03/31/2025, we had $91,200,000 in cash and cash equivalents and approximately $900,000,000 under our $1,000,000,000 revolving credit facility with a net leverage ratio of approximately 3.2 times. The company repurchased approximately 1,600,000.0 shares during the first quarter for a total of $47,300,000 Moving on to our outlook for 2025. As noted in our press release, we are reaffirming our full year guidance ranges for revenue, adjusted EBITDA and adjusted earnings per share. As a reminder, our 2025 guidance includes the following considerations. For 2025, we expect to add between 801,000 total beds.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

As I just mentioned, we expected that a small subset of underperforming facilities would result in an approximate $20,000,000 year over year headwind to our 2025 adjusted EBITDA. As I mentioned, to date, these facilities have performed in line with our expectations and negatively impacted our same facility patient day growth by approximately 90 basis points in the first quarter. We expect to begin to comp over this headwind to volumes in the fourth quarter of twenty twenty five. We continue to expect Medicaid supplemental payments to be flat to up $15,000,000 in 2025 on a net basis, inclusive of the new Tennessee program once approved. We continue to expect $50,000,000 to $55,000,000 in start up losses for full year 2025, of which we anticipate approximately $15,000,000 in the second quarter.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Before we move to Q and A, I would like to offer some additional color on our bed additions and growth plans. Since last quarter, some of you have asked us questions about our long term EBITDA growth guidance. So we want to take a moment to clarify some of the assumptions that are contemplated in that guidance range. The previously announced expected revenue growth of seven to 9% and EBITDA growth of eight to 10% over 2026 to 2028 is underpinned by annual bed additions of 600 to 800 beds beginning in 2026 as well as the roughly 1,600 to 1,800 beds being added over 2024 and 2025. First, we want to highlight that most of these bed additions come in the form of brand new facilities, which on average typically ramp to run rate occupancy and EBITDA margin within a five year period.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

As a result, we expect to recognize incremental EBITDA for majority of this cohort beyond 2028 as these beds continue to ramp to mature occupancy and margin levels. Keep in mind, our three year outlook also contemplates the inherent uncertainty that always exists with regards to construction timing, licensing timing, and time to ramp, and we will remain cognizant of this uncertainty as we continue execute on the largest expansion of bed capacity in our company's history over the next several years. Accordingly, our three year outlook assumes that the occupancy and EBITDA ramp for new hospitals will trend towards a five year ramp period, which is at the upper end of our historical ramp model and leads to significant amount of inherent earnings power beyond 2028. Second, with regards to payer rates, we included an element of conservatism in our assumptions as it relates to revenue per patient day and rate growth given some of the uncertainty surrounding the policy and macro environment. We see embedded upside in these projections if the next few years updates from government and commercial payers more closely resembles that of the last few years versus what is currently contemplated in our three year outlook.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

This base of new behavioral health hospitals we are currently building will provide a multiyear runway for growth, not only as occupancy ramps over the next few years, but also as we're able to add expansion beds to these facilities over time. As we decrease the accelerated pace of bed additions in 2026 to a rate of six to 800 per year, we expect start up losses to ease in the back half of '20 '20 '6, helping to fuel strong and self sustaining free cash flow generation as we exit 2026. Note that Fed growth is still well above the historical pace prior to 2024, which will contribute meaningfully to our performance in the outer years, including in 2028 and beyond. With that, we're ready to open the call for questions.

[Operator]

We will now begin the question and answer session. To ask a question, you may press star then 1 on your telephone keypad. If you're using a speakerphone, please pick up your handset before pressing the keys. And to withdraw a question, you may press star then 2. And our first question here will come from AJ Rice with UBS.

[Operator]

Please go ahead.

[A.J. Rice, Managing Director at UBS Group]

Hi, everybody. Just maybe first, there are a lot of moving parts in this year's numbers. I know you got the supplemental timing on different supplemental payment programs. You got the pacing of startup losses on the bed additions and then the annualizing of the Q4 challenges from last year start to make the comps easier later in the year. Can you just give us some perspective on how you see the progression of EBITDA from here, maybe a little bit of more color on how to think about the seasonality of the business this year given some of those dynamics?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yes, sure. Hi, A. J. Good morning. Thanks for the question.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

So I'll just kinda walk through a little bit of the phasing. You know, if we if we think about q one versus the rest of the year, you're right. There are several moving parts, and we had talked about, you you know, a few things that will specifically impact q one a little bit more predominantly. And so if you factor those in or normalize them, then you can see the normal cadence that we would expect. The first thing I would say to you, nothing's changed since, you know, we talked last time and where we we set our guidance and all of the the multiple factors we went through.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

And I I think the most obvious piece is that from a timing perspective, the Tennessee DPP is is clearly gonna be the biggest swing factor thinking about the cadence throughout the balance of the year, AJ, as as we look at it depending on which quarter that will be recorded in. I mean, beyond that, there's just, you a couple other things that I would I would would talk about that would really lead to the improved EBITDA performance as we move throughout the year. I mean, first, you know, q one had the highest level of start up costs and the lowest contribution from the new beds just because of the timing of when we added them. So that alone implies a steeper ramp as we work our way through the year. And then, you know, as we assumed in our guidance, you know, supplemental payments were down year over year in q one.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

We had said those would be down $10,000,000 to $15,000,000 and we landed sort of right in the middle of that for q one. But we expect that those supplemental payments will actually be flat to up $15,000,000 on a net basis for the full year. So that's a pretty big swing between q one and the balance of the year. And, you know, as I mentioned, obviously, Tennessee is the largest piece of that. From you know, if I think about the other swing factors from a volume perspective, we will have a growing contribution from the new beds as we move throughout the year.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

And then we're also gonna comp over a headwind that we started to see from some of those underperforming facilities as we move into fourth quarter of the year. So that's another piece as you think about comping last year's fourth quarter. Maybe just one more thing to point out is is rates. Again, the timing of the supplemental payments and Medicaid mix shift in the specialty business were impacting q one, and those should start to moderate as we head into q two and then, you know, further on throughout the year. And that that means that low single digit rate growth for the full year, you know, really, really moves throughout the year, and and it's, you know, there where we expect it to be for the full year versus where it was for q one where it was slightly down.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

So I I think that covers the highlights, the big points. Again, I pointed out a lot of different moving parts with the full year guide for EBITDA on the on the year end call, but I think those are the highlights, and and, hopefully, that helps.

[A.J. Rice, Managing Director at UBS Group]

Yeah. No. That's very helpful. Maybe just my follow-up question is, I know you've got a cautious view on rates this year, but, technically, what are you actually seeing in your Medicaid rate updates? I assume a lot of states updated January 1, and you'll have some more update July 1.

[A.J. Rice, Managing Director at UBS Group]

And then you probably also got your Medicare rate update, which we pretty much know, but if there's any variance there for you specifically. And then any comment on commercial and what you're seeing there?

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

AJ, this is Chris. I'll go ahead and take that one. You know, I would just say overall that we continue to have very good discussions with, you know, our payer partners, and, you know, we remain very optimistic that they're gonna continue to recognize our focus on providing high quality care. I wouldn't call anything out with respect to to Medicaid versus commercial or Medicare. You know, our our outlook, as Heather has discussed, always assumed a low single digit same facility revenue per day growth.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

And historically, we've talked about that in kind of a low to mid single digit range. We decided, just given the noise on the policy front, that it was prudent to just incorporate a more conservative approach in our thinking about rates just given the broader environment. But there's nothing specific on the horizon that we see is concerning. And I would say underlying rate growth has been relatively stable and in line with our expectation as we've, you know, gotten into the year.

[A.J. Rice, Managing Director at UBS Group]

Okay. Thanks a lot.

[Operator]

And

[Operator]

our next question will come from Brian Tanquilut with Jefferies. Please go ahead.

[Brian Tanquilut, Equity Research Analyst - Healthcare Services at Jefferies & Company Inc]

Hey, good morning, guys. Chris, maybe take a step back. As think about, obviously, 2% same store volume performance in the quarter despite some of the headwinds you're facing with the units that are dealing with the headlines. How are you thinking about what the broader demand environment looks like right now? I mean, obviously, you're one of our data points and your peer that's public.

[Brian Tanquilut, Equity Research Analyst - Healthcare Services at Jefferies & Company Inc]

But outside of that, if you can share with us what the demand environment looks like for behavioral health today.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

Yeah. I would say, Brian, thanks for the question that, you know, our expectation is that it just continues to be consistent with what we're with what we're seeing. I mean, I think particularly given our strategy of focusing on the higher acuity patients, when you look across our various lines of business, whether it's, you know, on the acute front, you know, CTC, specialty, RTC. We just continue to see, you know, increasing demand. And I think, you know, we've done a very good job of pointing out our commitment to quality.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

We have obviously invested heavily in being able to quantify outcomes, and we've shared that with our payer partners. And I think all of that has led to a consistent demand environment. I mean, Heather, anything that that you would wanna add?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

No. I I think that's right. I think, you know, the demand environment remains, and we are, you know, doing doing our part to meet that demand. And we're working hard to to look at new facilities and bed additions where those are necessary. So nothing to add there.

[Brian Tanquilut, Equity Research Analyst - Healthcare Services at Jefferies & Company Inc]

I appreciate that. And maybe, Heather, you know, thank you for all the color on the five year ramp to maturity. So just curious, as you think about the cohort of beds added in '24 and '25, maybe even into '26, has your view on the path to breakeven changed, or is it still the same, you know, kind of laying out that five year, you know, kinda, like, ramp up to kinda, like, mature levels of margins and and occupancy?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yeah. Thanks for the question. I I our view has not changed. Let me just walk through a little bit of how we're thinking about it and specifically how we thought about it whenever we thought of it the long term guide, the three year guide that that we put out. I mean, first of all, you know, you mentioned the three to five year ramp period that we've experienced historically.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

That is that's our average. Now keep in mind, there's multiple factors that impact how how those those ramp, and we've seen some really good success in recent facilities as they've been ramping. You know, one of the factors that impacts it pretty significantly is whether it's a bed addition to an existing facility or whether it's a newly constructed bed. Obviously, those take much longer to ramp. In our longer term guide, we have assumed a higher mix of new facilities constructed and new beds from construction than what has historically over the last few years been contemplated and what's actually played out.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

And so that shifts a bit towards the higher end between the three to five range. Those obviously will be at the higher end of that range versus others. So that's that's part of it. And, you know, what that means actually is that there's incremental EBITDA that's beyond 2028 because those beds you know, you just mentioned the the years that are ramping. All of those would continue to be ramping and really hitting their stride in in in what we've modeled out post 2028.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

There's a couple of other things that I would think about. You know, there's always uncertainty with construction timing, and that's you know, it's not just construction. Construction licensing timing, how long does it take to ramp, you know, all of those different things. And we're just very cognizant of all of that uncertainty. So as we're executing and continuing to execute on what's clearly the largest expansion that the company's had, we've been in that position for the past several years, and we're gonna continue.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

We're just very cognizant that, and we wanna make sure that we factor that uncertainty inappropriately into the guide. You know, if I if I think about how far our outlook goes, you know, we think about four years from now effectively will be when that outlook, you know, when those things are actually happening. And that means the EBITDA growth that's included in the the end, sort of, the longer tail of that '28. We haven't even started construction on those beds yet, so we feel like it's, it's more prudent to just assume the higher end of the ramp range between that three to five years just because it's further out into the future. And so, you know, I talked about on the prior call that that that's some conservatism that's built in.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

So, hopefully, that helps you understand a a little bit of of what we're thinking about with conservatism whenever I say that. I mean, again, what that points to is that, you know, the occupancy and the EBITDA ramp for those hospitals, there will be certainly incremental amounts of inherent earnings that are, again, showing up beyond 2028 there. So, you know, that all that said, you know, we are still experiencing strong performance. I just mentioned that we had, you know, some in our recent cohorts, 2023 cohorts specifically that we're watching because of of where it is now and sort of the the ramp. And we're seeing some really good outcome and results, but we just thought it was more prudent for the reasons I just walked to to assume sort of the higher end of that ramp period.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

But back to your that was a long winded answer to your question, but back to your original point, our our view hasn't shifted. We've just factored in some conservatism, and, that helps you understand why and how we factored it in.

[Brian Tanquilut, Equity Research Analyst - Healthcare Services at Jefferies & Company Inc]

Very helpful. Thank you.

[Operator]

And our next question will come from Whit Mayo with Leerink Partners. Please go ahead.

[Whit Mayo, Senior Managing Director at Leerink Partners]

Hey. Thanks. Anything when you just look at the first quarter and your performance, was there anything better or worse in the quarter versus your original expectations? Just wondering if there was any, you know, favorability on any of the key assumptions or expense items. Thanks.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yeah. Hi, Whit. Sure. Let me I'll I'll talk about two things. I mean, the first thing I would talk about is is labor.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

We saw, you know, the continuation of those favorable labor trends that we have been seeing, and our base wage inflation continued to trend lower. And, you know, contract and premium labor expenses both fell year over year and sequentially, so, you know, that's that's the first thing that I would point to. The second thing I would point to are start up losses. You know, those came in a couple of million dollars better than our expectations for the first quarter, and that's just timing. That's just, you know, all things I just marked through in regards to construction and some of the uncertainty.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

That's just some timing differential. And, you know, we still expect that those will continue to, you know, be in the range of 50 to 55 for the full year, just to be clear. But they were around $16,000,000 in q one, and that's that's a little lower than what our expectations were. But that's really the, I think, the only two things that I would point out from a quarterly perspective.

[Whit Mayo, Senior Managing Director at Leerink Partners]

Okay. So a couple million dollars of favorability, on the expense side, and you were still within the range that you targeted. Is that I mean, is that the way that you're you're looking at the performance? I'm just trying to figure out, like, how you perform versus the internal plan versus the guidance that you provided.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yeah. I mean, we were up, you know, towards the the higher end of our guide with and that is, you know, very I you know, the things I just walked through, I I think, you know, specifically the start up losses, those were what contributed us being at the high end of the guide, but we were, you know, performing right in line with our internal plan.

[Whit Mayo, Senior Managing Director at Leerink Partners]

Okay. I know this isn't a metric that you talk about, but when I look at the revenue per average CTC, it's been declining for several quarters now, and, just trying to maybe better understand why that metric would would look like that.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

You know, I'll I'll start, and, Chris, you may wanna jump in. But from a revenue perspective for CTC, I mean, as you know, there the CTC business has experienced just, you know, significant growth. I'm very, very pleased with the growth over the the past few years. There was, you know, a lot that we could do to apply some muscle behind it and really, really, get get the most out of that business. The other thing that I would point out is if you if you look at the CTC business, we have found a very capital friendly way to add facilities to to to the lineup, and those are effectively acquiring subscale, you know, sort of ramping CTC facilities that we can buy for, you know, very good price.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

And then we can put those in, you know, put those in, apply the Acadia methodology for running the operations, and and really ramp those pretty quickly. So as we add those in, and they are in, you know, similarly in the ramp position, you'll see that those will kinda pull down the average overall as we're ramping them. In the first quarter, we opened three new CTCs, and then we acquired an additional four, excuse me, that would fall under that category that that I just mentioned. And so when you think about that, that really is part of the timing of what you're seeing impact the revenue to to clinic. I think, you know, just generally speaking, the the revenue can can clearly vary based on the size of the clinic maturity, all those things.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

But I think what you're seeing, Whit, and to your question is is those different nuances I just walked through.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

Yeah. I would just add one thing, Heather, and I think that's that so frequently, the CTC market continues to be highly fragmented. And so as a result, when we do find these subscale acquisition opportunities that we can tuck in, they have frequently underinvested across the board, and they very, very frequently have a limited digital presence, frequently don't even have a a website, and they certainly have not invested in the capabilities that we're able to bring in. So all of that enables us to buy these subscale assets and ramp them more quickly. And I think that ties into your question in terms of the revenue per average CTC.

[Whit Mayo, Senior Managing Director at Leerink Partners]

Okay. Thanks.

[Operator]

And our next question will come from John Ransom with Raymond James.

[John Ransom, Managing Director, Director of Healthcare Research at Raymond James Financial]

I'm just wondering on the new facilities, not the badass, but the new facilities, what sort of return target do you look at once the facility is fully ramped? And maybe it'd helpful to kind of put that as an EBITDA as a numerator and total investment as a denominator. Kind of as a car layer, are you sharpening your pencil on new opportunities to try to drive higher returns? Or are you still kind of sticking with the historical?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

John, thanks for the You know, if I think about, you know, just in general, the first part of your question, you know, what do we do? We look at typically couple things first. As you can imagine, we look at our our cost of capital, and we make sure that we understand all the moving parts. We also then ensure that we are applying sort of margin or a cushion on top of that to make sure that we have returns that are, you know, well above that cost of capital. And that you know, one of the primary measures, obviously, that we use is is return on invested capital, and and we typically look at that on a very detailed basis for every project consistently, whether it's a denot, a bed addition, an m and a potential transaction, etcetera.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

So we look at all those in the same way and and just sort of apply very disciplined approach across the board from a capital perspective. And so that is that is certainly something that we look at. Sort of to the to the second part of your question, you know, what are we doing now and sort of, you know, are we I think you asked for rethinking what we have done. I'll just a little bit of detail on the process. You know, first, we have multiple check-in points as we go throughout any project.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

As you can imagine, it's it's quite a large undertaking to to make sure that we have all of the the the right pieces in place before we move forward with the decision. We check-in multiple times before we ultimately move forward as we gather more information, and so those checkpoints have always been there. Very disciplined approach we have. Second, you know, we've gone through a couple of pieces. First, everything that we had currently had in our pipeline, we've gone back, and we have made sure that when we rerun sensitivities and we look at, you know, any perspectives that we think we need to have a different lens on, that those still meet the thresholds that we originally set out to meet whenever we think about capital deployment and ensure that those are still sort of all viable projects that we would like to do.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

You know, fortunately, we have a lot of different opportunities to deploy capital. And so if we find something that, you know, no longer meets, you know, what what we think we should have as a a required return, then we can move to the next thing. The the maybe what the other thing that I would point out is for future projects, we have obviously incorporated some sensitivity analysis both on a rate and a construction cost side so that we can ensure we have a flexible view, and we can sensitize those and ensure that we have the right perspective as we move forward. So, you know, maybe if I just sum all that up, I think we would we would say very, very disciplined approach. We're very careful with how we select investments.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

We have a very thorough conversation, over multiple periods.

[John Ransom, Managing Director, Director of Healthcare Research at Raymond James Financial]

Second question is when we think about the future of yet a pretty sizable legal accrual in the first quarter, how do we think about is that the high watermark? Or how should we think about that number for the rest of the year?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yeah.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

I you're the I think you're referring to the legal costs and and not a legal accrual, I'm assuming.

[John Ransom, Managing Director, Director of Healthcare Research at Raymond James Financial]

Yep.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yeah. Okay. Good.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Just wanna make sure I'm answering the right question. So if I think about that, you know, we have obviously, you know, we're working through multiple things right now. We have the both the DOJ and the SEC that we are working very cooperatively and diligently with. You know, we have engaged, you know, an excellent, you know, law firm to help us with this so that we can continue to work and participate with them. We've undertaken significant efforts to respond as quickly as possible to all of the inquiries that we have.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

And what you're seeing, I think, know, John, is is the goal with the that's being done in order to respond to and participate with all of those questions. So that is really what's driving that. From a cadence perspective, you know, it's hard to say and to predict the future, but, certainly, what I would say is, you know, that at the earlier stages of the investigation, certainly, there is a lot of preliminary work to do and and certainly a large amount of work that needs to get done and, again, working as quickly as we possibly can. So hope hopefully, that's helpful.

[John Ransom, Managing Director, Director of Healthcare Research at Raymond James Financial]

Thank you.

[Operator]

Our next question will come from Pito Chickering with Deutsche Bank. Please go ahead.

[Pito Chickering, Analyst at Deutsche Bank]

Hey, guys. Just two quick questions. I I can confirm that the webcast is down getting about dozen reports of that right now, so people are unable to join right now. It falls to AJ's question, just can you give us sort of guidance of how we should think about sort of 2Qs percentage of annual guidance and bridges for how you can get to that number. I believe that you talked about $50,000,000 beneficial supplement payment coming in 2Q, but any bridge would be helpful as you think about the ramp from the first quarter results.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yeah. Sure. Hi hi, Pito. You know, I'll I'll start by saying I'm I'm I'm not gonna get into q two guidance, but but let me just, you know, point out a couple of things. I mean, very clearly, the biggest swing factor is sort of the supplemental payments and specifically the Tennessee program.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

So that is certainly one that that we are that we're watching and, you know, thinking about timing. To the extent that that is approved, there would, you know, be a a significant impact to whichever quarter that that is approved in. From our perspective, we have you know, we pointed this out in the fourth quarter call. And just to reiterate for for our perspective, we've assumed that that comes in the second half of the year. And so to the extent that that comes in earlier in q two, that would be a swing factor for what we have for what we have thought through.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

And, you know, the rest of the things, you know, that I that I talked through a little bit earlier in regards to how you can think about the ramping, you know, there's the the the bed additions and the new beds. You know, those are gonna continue to steadily improve. Again, supplemental, very much the largest swing factor here. And just thinking about how we move throughout the balance of the year, you know, q four is when we're gonna lap things. And so if you think about the balance of q one versus q two, q '3, q '4, there will be some, you know, significant differences between q four and the rest of the year.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

I I that's probably the the best guidance I can give you. I talked about a little bit earlier that we expect start up losses still to be in the 50 to 55 range for the full year. I think Q2 will look fairly similar to Q1, maybe a little bit less, but that's probably about the only things that I could point to.

[Pito Chickering, Analyst at Deutsche Bank]

Okay. Fair enough. And then a follow-up to which question on CBC would ask a different direction. CBC revenues were flat sequentially. The number of patients grew, I think it was like 2,000 or almost sort of 3%.

[Pito Chickering, Analyst at Deutsche Bank]

So can you talk about what you're seeing on CBCs from a pricing perspective? Just I'm trying to sort of look at the flat revenues while patients are growing to figure out is pricing under pressure? What are seeing there? Thanks so much.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

Peter, this is Chris. Let me take that one. I would say CTC revenue grew 3.6% year over year in Q1, and that was generally in line with the growth rate that we reported in the second half of twenty four. The service line, as we've discussed before, it's stepping over some pretty tough comps in the first half of twenty four. And there was also some modest unfavorable impact from weather that we also saw in q one.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

But, you know, as we discussed in the first quarter, we opened the three new facilities, the three new CTCs. We acquired an additional four, as Heather said earlier, and those are progressing well. There isn't anything that we would call out with respect to pricing, though, on CTC.

[Pito Chickering, Analyst at Deutsche Bank]

So, I mean, just to I mean, just to follow-up there, you know, because you're disclosing the patients in CTC, you know, you know, the December is 72,000, now it's 74,000. That implies you have 2,000 more patients, but revenues are flat sequentially. So, I guess, how would growing census by 2,000 from four q to one q not impact revenues increasing sequentially? Thank you.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Let me just understand your question. You're saying how if we grew the volume of patients, why did revenue not grow sequentially? Is that your question?

[Pito Chickering, Analyst at Deutsche Bank]

Correct.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

You know, I think I think there's some timing factors in there from a payment perspective there, you know, not not nearly to the extent of the acute side of the business, but there can be some supplemental payment streams much, much smaller that can that can that can really impact some of the timing of the revenue. You know, we have different rates in different states. And as those rate updates come through, that can can add a little bit of what seems like supplemental lumpiness, but that's really just rate changes that come through. You know, we closed a few facilities as well, and so that will affect those are obviously we're not gonna close them, but they're high volume facilities, but they could have been facilities that were contributing some revenue, but really on a scale basis weren't the right weren't the right mix for our business on an EBITDA contribution perspective. And so that can certainly affect the revenue and the top line, but would not impact the EBITDA contribution.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

So that's probably the only, you know, couple of things that I would would point to. Hopefully, that helps a little bit.

[Pito Chickering, Analyst at Deutsche Bank]

Great. Thanks so much.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

No problem.

[Operator]

And our next question will come from Matthew Gillmor of KeyBanc. Please go ahead with your question.

[Matthew Gillmor, Director & Equity Research Analyst at KeyBanc Capital Markets]

Hey. Thanks for the question. I I wanted to follow-up on some of the policy comments and ask about work requirements. I know there's normally exceptions for people with substance abuse and psychiatric issues, but I just wanted to get your thinking in terms of that proposal and and if that would have any impact on Acadia.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

Yeah. Thanks, Matt. This is Chris. I'll take that one. You know, I would say, overall, we're we're still from have far from having a clear view of what potential Medicaid adjustments will be.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

Obviously, the energy and commerce draft, we have been scrutinizing, and it's over a hundred pages and a lot of nuance language in there. But overall, I think we continue to believe that the patient populations that we serve, including some of the highest acuity mental health issues in the country, are gonna be relatively less impacted in terms of the risk of losing Medicaid access. I would say as it with as as it refers to work requirements specifically, I would just iterate that while the the language may change, we remain really optimistic that a good portion of our population could be exempt both based on existing structures that are in place and based on our initial interpretation of what we're seeing there. We have just seen in the past that if you remove access to high acuity mental health care for these populations, you tend to get exploding costs in other parts of the system. And we've seen examples of that in the past where the populations have been carved out and things like work requirements.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

And I think what you're seeing in the bill appears to to have some significant carve outs related, but we're just gonna have to continue to to work through it and obviously continue to to to lobby, you know, with the the broader NABH and, you know, broader industry groups.

[Matthew Gillmor, Director & Equity Research Analyst at KeyBanc Capital Markets]

Got it. And then I wanted to see if Heather had any comments on the the cash flow from operations in the quarter. I I think the the legal expenses probably had an impact there, but were there any other sort of timing things to think through and and when those would normalize?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yeah. The the only thing I I would point to is, obviously, as we've talked about, we are clearly at the peak from a CapEx perspective as we are in the middle of the highest, you know, number of new beds that the company has experienced, you know, both with the the the end of last year, the significant number of beds coming on. You know, some of those costs continue to flow through related to those in q one. CapEx and, you know, cash is obviously cash based. It's not accrual.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

So even though we opened the beds in q four, the costs are still gonna come through in q one. So that's part of it. And, you know, incrementally, just to to add on to that, you know, obviously, we have added a large number of beds already this year. With q one, we've added, you know, almost 400 new beds already, so that's a piece of it as well. Keep in mind that start up losses are also part of that, and those are clearly at a peak in q one of what we expect for the full year as we've talked about as we move through the year.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

You know, 50 to 55,000,000 for the year, but there was a predominance in q one. And so that's that's also a piece of of what you're seeing. You're you're correct. You know, obviously, the legal costs, you know, those come through, and that's part of what is is coming through from a legal perspective and impacting cash flow. I think, you know, those are the primary moving parts.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Hopefully, that's helpful and and answers your question.

[Matthew Gillmor, Director & Equity Research Analyst at KeyBanc Capital Markets]

Got it. Thank you.

[Operator]

And our next question will come from Andrew Mock with Barclays. Please go ahead.

[Andrew Mok, Director at Barclays]

Hi, good morning. There's been a year over year decline in specialty revenue, it looks like, for five quarters in a row now, which has contributed to the broader deceleration in same store revenue. Can you help us understand what's going on with that line specifically and when you expect to get back on track for growth?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yes.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yes, I'll jump in. Hi, Andrew. So a couple of things I would point to, you know, first is we have we have closed some specialty facilities over the past several quarters. And, obviously, we closed one in q one of this year, and then there were, you know, a few others that we've closed over the past, you know, handful of quarters. And so that's part of what is contributing to that.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

It was it was about 5% down in the first quarter, and that's, you know, really mostly driven by the facility closures. You know, over the past, I would say, a year and a half, we've wound down four specialty facilities, and that includes the one that I just mentioned in the fourth quarter. So that's part of it. The other part is if you think about just from a a revenue perspective, we have seen some some nice growth in the Medicaid specialty inpatient business. Obviously, that has a a differential from just a year over year perspective on the overall revenue contribution for that depending on the type of the type of treatment that those patients need.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

But but, really, I think it's mostly driven by the closures.

[Andrew Mok, Director at Barclays]

Got it. That's helpful. And as we contemplate the recognition of state supplementals, supplemental payments from Tennessee, Is that mostly an acute inpatient item that would hit that revenue line?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yes.

[Andrew Mok, Director at Barclays]

Okay. Understood. Thank you. Thanks for all the color.

[Operator]

And our next question will come from Sarah James with Cantor Fitzgerald. Please go ahead.

[Gabrielle Ingoglia, Equity Research Associate at Cantor Fitzgerald]

Hi, guys. This is Gabby on for Sarah. I just have a quick one. Could you elaborate if there was any weather impact on your facilities in the Southeastern States when your peers had seen that? And then maybe if you could just elaborate on how trends are going on some of the underperforming facilities spoken to last quarter?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yes, I'll start. And then, Chris, if you I'm sure you want you wanna say some things about some of the operations of the facilities. You know, from a weather perspective, nothing material for us to call out. You know, obviously, it's seasonal, and every year we see some some sorts of weather in different parts of the business, but but nothing I would really call out and point to. Chris, do you want to give some color on those facilities, the underperforming facilities?

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

Sure. And thanks for the question, Sarah. As we discussed in the prepared remarks, our 25,000,000 guidance had assumed a roughly $20,000,000 EBITDA headwind for the full year from this group of underperforming facilities that we had first called out in the fourth quarter, which you're asking about. And so I would say those facilities have performed overall in line with our expectations. They had a negative impact on our same facility patient growth of about 90 basis points in the first quarter, and we'd expect to begin to comp over that headwind to volumes in the fourth quarter of twenty twenty five.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

You know, the underperformance has tended to be correlated more with, you know, local media coverage that's more intensive. Health care is obviously local rather than any news at the national level. And it's just it's difficult to to put an estimate on the timing. But, you know, we continue, as we had said at the the outset, to be prudent and taking a more conservative approach when we set guidance, and I think this is an example of that. We continue to execute and, just feel very good about the path that we're on, but nothing additional that I would call out.

[Gabrielle Ingoglia, Equity Research Associate at Cantor Fitzgerald]

Okay. Great. Thank you, guys.

[Operator]

And

[Operator]

our next question will come from Joanna Gaju with Bank of America. Please go ahead.

[Joanna Gajuk, Analyst at Bank of America]

Hi. Good morning. Thanks for taking the question. So I guess first follow-up on the Tennessee DPP. Did I miss it?

[Joanna Gajuk, Analyst at Bank of America]

I I know you said that you ex you assume, you know, second half of this year, but did you say how much you expect from that program?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Hi there. No. We did we did not say how much we expect from that program in particular. We have said historically not historically since since our earnings call for q four, we said that we expect total supplemental payments on a net basis to be up flat to up 15,000,000 for the full year inclusive of Tennessee, but we haven't called out any numbers for Tennessee specifically or or for any other states for that matter.

[Joanna Gajuk, Analyst at Bank of America]

Okay. And, I guess, would you remind us, was there any out of period payments last year in '24? So when we think about the numbers flat to up 15, is there something we should adjust out from last year?

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

Yeah. No. That's that's a great question, and and thanks for the reminder. We did call out last year 10,000,000, approximately 10,000,000 payments that that we saw predominantly in q one. About 7,000,000 of those were in q one, and then the rest were in the balance of the year.

[Heather Dixon, Chief Financial Officer at Acadia Healthcare Company]

But, yes, we did.

[Joanna Gajuk, Analyst at Bank of America]

Alright. Thank you. And if I may, another follow-up on different topic on these handful problem facility. So I understand you're saying, you know, things performing in line there. But is there anything you continue to do there to try to improve the situation as in, like, you know, can you give us an update on these referral sources, you know, outreach that you've had and, you know, any any traction, I guess, you're getting there?

[Joanna Gajuk, Analyst at Bank of America]

Thank you.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

Yeah. I would say there's a number of things that we can continue to do. I mean, obviously, we have been very deliberate about meeting with our referral sources, particularly in person, and also inviting them to these facilities as well, which we, you know, do all the time, but we've tried to be, you know, even more intentional about making that happen since the fourth quarter. We've obviously done everything from talent reviews and taking a look at the existing staffing, making sure that we don't have key positions that are unfilled, working with our talent acquisition team very closely on that. And then, obviously, working with our other corporate functions, including our quality team to make sure that, you know, we have everything in place that we need to continue to provide high quality services.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

And so we're just we're looking at a range of things in any given facility. There isn't one, step that I would call out. But just in totality, you know, we're just very, very much cognizant of making sure that we're continuing to deliver high quality care and that we have the right staffing in place and that we're continuing to focus on the right referral sources and that we're able to provide, you know, a great patient experience when the opportunity avails itself. And we'll continue executing on that plan.

[Operator]

This concludes our question and answer session. I'd like to turn the conference back over to Chris Hunter for any closing remarks.

[Christopher H. Hunter, CEO at Acadia Healthcare Company]

Thank you. In closing, I just want to again thank our committed facility leaders, clinicians, and approximately 26,000 dedicated employees across the country who've continued to work tirelessly to meet the needs of our patients in a safe and effective manner. We are together doing incredibly important work for our patients across the country and remain committed to serving them with care, compassion, and excellence. Thank you all for being with us this morning and for your interest in Acadia. Have a great day.

[Operator]

The conference has now concluded. Thank you for attending today's presentation. You may now disconnect your lines.

Participants

Executives

• Brian Farley, EVP - General Counsel & Secretary
• Christopher H. Hunter, CEO
• Heather Dixon, Chief Financial Officer

Analysts

• A.J. Rice, Managing Director at UBS Group
• Brian Tanquilut, Equity Research Analyst - Healthcare Services at Jefferies & Company Inc
• Whit Mayo, Senior Managing Director at Leerink Partners
• John Ransom, Managing Director, Director of Healthcare Research at Raymond James Financial
• Pito Chickering, Analyst at Deutsche Bank
• Matthew Gillmor, Director & Equity Research Analyst at KeyBanc Capital Markets
• Andrew Mok, Director at Barclays
• Gabrielle Ingoglia, Equity Research Associate at Cantor Fitzgerald
• Joanna Gajuk, Analyst at Bank of America