Nutex Health Q1 2025 Earnings Call Transcript

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Provided by Quartr
May 14, 2025

Key Takeaways

  • Q1 revenue of $211.8 million represented a 214% year-over-year increase, with Adjusted EBITDA reaching $72.8 million compared to a $0.4 million loss in Q1 2024.
  • The arbitration process covered 60–70% of billable visits, achieved an over 80% win rate, and boosted facility collections by 200–300% above initial insurance payments.
  • Net cash from operating activities surged to $51 million, cash on hand rose to $87.7 million, and long-term debt was reduced to $20.7 million, strengthening the balance sheet.
  • Newtek plans to open three additional micro hospitals in Texas during Q3 and Q4 2025, with a development pipeline of over 10 projects extending through 2028.
  • Supply costs decreased 28% through GPO and vendor realignment, while labor expenses remained a lean 16.4% of net revenue, underscoring the company’s operational efficiency.
AI Generated. May Contain Errors.
Earnings Conference Call
Nutex Health Q1 2025
00:00 / 00:00

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Operator

Greetings. Welcome to Nutex Health's first quarter 2025 financial results conference call. At this time, all participants are in listen-only mode. A question-and-answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero from your telephone keypad. Please note the conference is being recorded. At this time, I'll turn the floor over to your host, Jennifer Rodriguez, Investor Relations for Nutex. Jennifer, you may begin.

Jennifer Rodriguez
Jennifer Rodriguez
Head of Investor Relations at Nutex Health

Good morning, everyone, and welcome to Nutex Health's first quarter 2025 earnings call. I'm Jennifer Rodriguez, and I'm pleased to moderate today's discussion. Thank you for joining us as we review our performance and outline our plans for the future. This call is being recorded for future reference. With me today are our key leaders, Dr. Tom Vo, Chairman and CEO; Jon Bates, Chief Financial Officer; Dr. Warren Hosseinion, President; and Josh DeTillio, Chief Operating Officer. They will provide insights into our financial results, operational progress, and strategic direction, followed by a Q&A session. Before we begin, a few reminders. Today's discussion may include forward-looking statements based on management's current expectations. These are subject to risks and uncertainties that could cause actual results to differ. For details, please refer to our press release and Form 10Q filed yesterday and our other SEC filings.

Jennifer Rodriguez
Jennifer Rodriguez
Head of Investor Relations at Nutex Health

We'll also discuss non-GAAP measures like adjusted EBITDA, with reconciliations available in our press release and Form 10Q. With that, I'm pleased to turn the call over to Dr. Tom Vo, our Founder and CEO. Dr. Vo, the floor is yours.

Tom Vo
Tom Vo
CEO at Nutex Health

Thank you, Jennifer, and good morning, everyone. I am pleased to present Nutex Health's results for the first quarter of 2025, which reflect continued progress following a strong 2024. Our mission of delivering accessibility with high-quality care and a patient-first approach has driven consistent growth and operational stability. Operationally, Q1 2025 shows steady progress, with total patient visits reaching 48,269 patients, a 20.5% increase from 40,068 in Q1 2024. Mature hospitals achieved a 5.3% increase in visits, demonstrating sustained demand for our services. Financially, Q1 2025 delivered solid results. Total revenue reached $211.8 million, a 214% increase from $67.5 million in Q1 2024. Adjusted EBITDA was $72.8 million, up from a negative $400,000 from the same quarter last year. Net income attributable to Nutex Health.

Tom Vo
Tom Vo
CEO at Nutex Health

was $14.6 million, or $2.65 per basic share, compared to a negative $400 million loss or a negative $0.008 per basic share in Q1 2024. Our balance sheet remained stable, with long-term debt actually slightly reduced to $20.7 million from $22.5 million at year-end 2024, and cash in the bank at $87.7 million, up from $43.5 million from year-end 2024. Our net cash flow from operating activities in the first quarter of 2025 was $51 million, compared to just $3.1 million in the same period in 2024, and surpassing the cash flow for the entire year of 2024. These impressive growth metrics reflect our company-wide efforts to enhance patient volume, increase inpatient admissions, cost streamlining and optimization, and improve revenue per patient through effective revenue cycle management, particularly via the arbitration process.

Tom Vo
Tom Vo
CEO at Nutex Health

Every month, we are gathering more data collections and arbitration wins, which help us refine our tools, and we believe we are getting closer to a steady state. While there's a lot of work that needs to be done, we are very encouraged by the positive progress. Let me take a few moments to discuss the arbitration process that we first implemented in July of 2024. Overall, it is a small but very important part of our operation. In the first quarter of 2025, we submitted between 60%-70% of billable visits through the arbitration portal. We achieved an 80% plus win rate of these submissions, resulting in facility collections increasing by between 200%-300% compared to the initial insurance payments.

Tom Vo
Tom Vo
CEO at Nutex Health

This means that an independent arbitrator has legally determined that the insurance companies are paying us initial payments that are much lower than fair and reasonable rates over 50% of the time. So far, even with these winning percentages, we have not seen any significant behavioral changes. We are constantly monitoring legislative and legal developments at both CNS and in Congress to make sure we are on top of any potential changes. However, from all our research and discussions with subject matter experts, it appears that the No Surprises Act and the associated arbitration process is here to stay. One main reason for this is the fact that very few of the charts that are eligible for arbitration actually get arbitrated. In fact, public data shows that only about 5% of eligible charts are actually arbitrated.

Tom Vo
Tom Vo
CEO at Nutex Health

The reasons for this include the reasons for this low level of arbitration participation include the high monetary costs, as well as the extended length of time to get paid once a chart goes through the arbitration process. In terms of the arbitration process itself, it is constantly getting more refined day by day. We are seeing some improvements to the arbitration process, including more IDREs or arbitrators being added to the list of available arbitrators, as well as new guidelines to provide safeguard to the integrity of the system.

Tom Vo
Tom Vo
CEO at Nutex Health

In fact, one legislative development that may be germane to our industry will be Bill HR 9572, being introduced by Representative Greg Murphy of North Carolina, that proposes a penalty of three times the difference between the insurer's initial payments and the IDR award amount, plus interest if the insurers do not pay in 30 days, as required by rules in the No Surprises Act. This bill will only help us get paid faster and in a more reasonable manner. Looking ahead, we are well positioned for 2025. We continue to expand our micro-hospital model in high-demand markets. There is no lack of demand for our innovative micro-hospital model, as we still receive requests to build these hospitals monthly from all over the country. For 2025, we have plans to open three additional hospitals.

Tom Vo
Tom Vo
CEO at Nutex Health

Our pipeline currently extends from 2025 to 2028 and has 10-plus projects in various stages of development, targeting markets where our high-quality care is needed. Each facility is designed to reduce emergency wait room times, increase accessibility, and provide tailored medical services. Our company growth strategy emphasizes four priorities: increasing patient volume, expanding services to provide care to more observation and inpatient admissions, optimizing revenue through efficient revenue cycle management and arbitration, maintaining disciplined costs, and aggressive debt management. We feel that as long as we receive fair and reasonable payments from either the arbitration process or from changes in payer behavior, our lower-cost model will be sustainable and repeatable. Because of our experience of having been through multiple cycles and our ability to pivot and adapt to any market conditions, and with a balance sheet and a clear pipeline, Nutex is well positioned for continued sustained growth.

Tom Vo
Tom Vo
CEO at Nutex Health

Now I'll turn the call over to Jon Bates, our CFO. Jon?

Jon Bates
CFO at Nutex Health

I think.

Jon Bates
CFO at Nutex Health

Financial performance for the first quarter of 2025, which reflects another solid quarter with consistent growth. I'll compare some key financial metrics for Q1 of 2025 versus the same period in 2024, highlighting percentage changes across areas such as revenue, adjusted EBITDA, net income, EPS, and other indicators as detailed in our Form 10Q filed yesterday. Starting off with total revenue. Total revenue for Q1 of 2024, as Tom indicated, did reach $211.8 million, a 214% increase from $67.5 million in quarter one of 2024. The hospital division drove most of this growth, generating $203.9 million, which is up 240% from $60 million in the first quarter of 2024, with $105 million tied to arbitration efforts through the independent dispute resolution process.

Jon Bates
CFO at Nutex Health

Of that $105 million in arbitration revenue, $60 million related to dates of service for the first quarter of 2025, $26 million related to dates of service for the fourth quarter of 2024, and $12 million related to dates of service for the third quarter of 2024, following the remaining $7 million relating to periods prior to the third quarter. Of the total hospital division revenue, mature hospitals, which are hospitals operational before December 31st, 2022, it saw a 186.5% revenue increase for the first quarter of 2025 versus the same period in 2024.

Jon Bates
CFO at Nutex Health

For the hospital division visits, we did see growth as well during the quarter, as they increased by 20.5%, or 8,201 visits, up to 48,269 visits in the first quarter of 2025 versus 40,068 visits in the same period in 2024, with mature hospitals growing at 5.3%, as Tom indicated before, in the first quarter of 2025 versus the same period in 2024. Additionally, the population health division revenue did increase by roughly $400,000, or 5.4%, up to $7.8 million in the first quarter of 2025 from $7.4 million in the same period in 2024. Now let's discuss the overall facility and corporate costs and the continued improvement in that area.

Jon Bates
CFO at Nutex Health

Total facility-level operating costs and expenses increased $36.2 million during the period, but only represented 44.1%, or $93.5 million of total revenue for the first quarter of 2025, versus 84.9%, or $57.3 million of total revenue for the same period of 2024. Of the $36.2 million increase in these facility operating costs and expenses, $26.3 million related to arbitration costs for the additional arbitration revenue recorded during this period, which approximated 25% of that incremental addition of revenue I mentioned previously. As a result of the revenue and facility cost improvements, our 2025 first quarter gross profit was $118.3 million, or 55.9% of total revenue, as compared to $10.2 million, or only 15.1% of total revenue in the same period of 2024, which represented a 1,065% improvement.

Jon Bates
CFO at Nutex Health

From a corporate and other cost perspective, the general and administrative expenses, as a percentage of total revenue for the first quarter of 2025, decreased down to 4.7% compared to 12.8% for the first quarter of 2024, showing our continued focus on controlling costs while improving revenue. Additionally, on our first quarter 2025 income statement, you will see a line item for stock-based compensation expense, and it's been there this year and last year and before, but with the amount for the first quarter of 2025 being $36.1 million.

Jon Bates
CFO at Nutex Health

Most of that expense is explained in our first quarter 2025 10Q within Note 10, but within that note, we explain that under the terms of four separate contribution agreements for hospitals that were deemed to be underdevelopment hospitals when Nutex went public back in April of 2024, at the point at which each of the hospitals had been open for two full years, they are eligible to receive a one-time additional issuance of company common stock based upon the earnings of the hospital in the second year of their operations, and that second year is which we denote to be the period of what the earn-out period is. With four of these hospitals in the earn-out period currently, we are accruing for the potential earn-out for each.

Jon Bates
CFO at Nutex Health

In the first quarter of 2025, that accrual amounted to $36 million that will be trued up each quarter until we get to the end of year two of each hospital after opening, and at which time a final calculation will be done and payment will be made 100% in common stock and recorded as non-cash stock compensation expense in our financials, which is how it is presented currently. In the first quarter of 2025, one of these four facilities did reach the end of the earn-out period, leaving the other three to complete their earn-out period by the early part of the third quarter of 2025. The good news is that after these limited number of legacy hospitals have matured, there will not be significant non-cash earn-outs in the future. Now let's talk about operating income.

Jon Bates
CFO at Nutex Health

Operating income, including the negative impact of this same $36.1 million in non-cash stock-based compensation expense for the first quarter of 2025, was $72.2 million compared to $1.5 million in Q1 of 2024, representing a $70.7 million improvement quarter over quarter. Net income attributable to Nutex Health was $14.6 million for the first quarter of 2025, again also including the negative impact of that $36.1 million non-cash stock-based compensation expense that we talked about previously. The comparative net loss attributable to Nutex was $400,000 for the first quarter of 2024, showing a $15 million improvement period over period. From an earnings per share perspective, our diluted EPS for the first quarter of 2025 was $2.56 a share compared to a loss of $0.08 per share in the first quarter of 2024, showing a $2.64 per share price increase period over period.

Jon Bates
CFO at Nutex Health

Now, adjusted EBITDA attributable to Nutex increased $73.2 million from a loss of $400,000 in the first quarter of 2024 to $72.8 million in the first quarter of 2025. One small change in our calculation of adjusted EBITDA this quarter, which we will continue using as we go forward, was that we now include in our calculation the impact of cash rents paid that fall under our right-of-use asset financing accounting treatment for our building leases for all periods presented. In our previous treatment of these rent payments within our calculation, the rent paid, the cash rent paid impact was not being reflected as a reduction in this calculation, so we felt it appropriate to include it.

Jon Bates
CFO at Nutex Health

Finally, our balance sheet remains very strong with cash and cash equivalents at March 31, 2025, at a record high of $87.7 million, up $44.1 million, or 101.1%, from $43.6 million as of December of 2024. Our continued success with the collection efforts related to the arbitration process is allowing us to get paid more fairly for the services we provide, and was obviously a big part of this success. With regard to the accounts receivable, our balance at March 31, 2025, was $295 million, an increase of just under $63 million from $232 million at the end of the year of 2024. To give you some perspective of that $295 million AR, $199.3 million, or roughly 68%, relates to visits in the arbitration process, which was similar to our position at the end of 2024.

Jon Bates
CFO at Nutex Health

During the first quarter of 2025, the company collected around $140.4 million in cash, of which $103.7 million, or approximately 45% of that, related to AR as of December 31, 2024. Regarding cash flow, Tom mentioned this earlier, but net cash from operating activities is very strong this quarter at $51 million, which was an increase of $47.3 million from the same period in 2024. On the liability side, our total bank and equipment type debt increased by merely $1.8 million to $43.2 million at March 31, 2025 from $41.4 million at December 31, 2024, with the majority of this debt, as we talked about before, relating to equipment loans at our hospitals for such items as the MRIs, X-rays, ultrasounds, and items like CT machines.

Jon Bates
CFO at Nutex Health

Outside of this normal $40-plus million of bank equipment type debt, the only other items of materiality that look like debt on the balance sheet are the liabilities related to financing and operating lease liabilities, which are just the future lease payments due to our landlords on our hospitals.

Jon Bates
CFO at Nutex Health

We have discussed this in previous periods, but I just wanted to walk through again so that we remind people how this and what this really means, because these are reflected on the balance sheet because the accounting rules require us to aggregate all lease payments that we pay the landlord for the entirety of each lease term, which might be 15 to 20 years of payments, and then present value that total lease payment back for each all the way from inception of that lease and record both the right-of-use asset and a corresponding right-of-use liability on the balance sheet for that result. As a result, on our balance sheet at March 31, 2025, the net asset balance for the operating and financial right-of-use assets amounted to $243.7 million, which is about 32% of our total assets.

Jon Bates
CFO at Nutex Health

The net liability balance for the operating and financing right-of-use liabilities amounted to $288.7 million, which is 61.2% of total liabilities. I just wanted to provide some of this perspective, as most investors and analysts do not view these right-of-use asset liabilities as real operating debt, so I wanted to kind of clarify that for you. With all this said, our balance sheet remains very solid, and we continue to strengthen it with our positive operating performance. Our current financial position has put us in a great position to execute on all of our initiatives in our 2025 operating plan, including the opening of three new hospitals later this year, as Tom mentioned earlier. With that, I'll now turn it over to Warren Hosseinion. Warren?

Warren Hosseinion
Warren Hosseinion
President at Nutex Health

Thank you, Jon, and good morning, everyone. Thank you all for joining us today.

Warren Hosseinion
Warren Hosseinion
President at Nutex Health

I'm pleased to provide an update on Nutex Health population health division, which supports our commitment to value-based care. As a reminder, our overarching strategy at Nutex Health is to build an integrated healthcare delivery system combining hospitals and medical groups, also referred to as IPAs. Our IPAs are comprised of networks of primary care physicians and specialists located around our facilities. The IPAs enroll patients from different health plans and are responsible for the total care of these patients. By combining hospitals and IPAs, we believe we will be able to deliver care that is more coordinated, cost-effective, and with better outcomes for our patients. Our IPAs send patients to our hospitals, and our hospitals deliver more efficient and cost-effective care, reducing the medical loss ratios in our IPAs.

Warren Hosseinion
Warren Hosseinion
President at Nutex Health

This is a long-term strategy that will take several years to bear fruit, but we are in this for the long run at Nutex Health. We are pleased to report a strong start to the year with first quarter results that reflect the continued momentum behind our strategy. We currently have over 40,000 patients enrolled in our IPAs in various risk-based arrangements. Of note, I am happy to report that we now have almost 1,400 Medicare Advantage members in our Houston Physicians IPA. In Q1, our IPAs generated $7.8 million in revenue, a 5.4% increase from $7.4 million in Q1 2024. This is despite the fact that we divested two non-core assets in mid-2024 that were generating revenues but had operating losses. Operating income improved to $0.1 million from a $0.3 million loss in Q1 2024.

Warren Hosseinion
Warren Hosseinion
President at Nutex Health

Margins continue to be moderated by ongoing investments in new markets such as Houston, Phoenix, and Dallas. With that, I will now turn it over to Josh DeTillio, our Chief Operating Officer.

Josh DeTillio
Josh DeTillio
COO at Nutex Health

Thank you, Warren, and good morning, everyone. I'm pleased to share Nutex Health's operational results for Q1 2025, which demonstrate our ability to deliver high-quality care while achieving steady growth and cost discipline. Our micro-hospital model, centered on patient needs, continues to perform very well, and I'll discuss some volume trends, cost management, patient acuity, and the advantages of our approach. Total patient visits, as Tom mentioned, reached 48,269, a 20.5% increase from the 40,068 in Quarter 1, 2024, which reflects growth in both new and mature hospitals. Mature hospitals grew by 5.6% in the first quarter.

Josh DeTillio
Josh DeTillio
COO at Nutex Health

This growth reflects our leadership team's efforts in community engagement, business development, and adding specialists to manage more complex cases by increasing observation and inpatient stays to meet the community need. Our capacity to provide observation and inpatient is a key strength. Observation stays help avoid unnecessary admissions, while inpatient services ensure comprehensive care for appropriate cases. This approach improves outcomes and patient satisfaction by offering efficient, high-quality care. Our model reduces emergency room wait times and provides personalized services, positioning Nutex as a trusted provider in the communities we serve. Cost discipline for us remains a priority. Excluding arbitration costs, operating costs remain stable despite higher volumes and new hospitals this year. Labor costs increased 29% from $27 million to $34.9 million, which was comprised of increased payroll and benefits for opening four new hospitals, our higher volumes, and an increased volume of higher acuity observation and inpatients.

Josh DeTillio
Josh DeTillio
COO at Nutex Health

Overall, labor costs continue to be a much smaller percentage of net revenue than most hospital companies, at 16.4% for the first quarter, which exemplifies our lean, high-quality model. Supply costs continue to be a very good story for us. Supply costs decreased 28% from $5.3 million to $3.8 million in the quarter due to our 2024 GPO and vendor realignment, even while we opened four new hospitals in the year. We will continue to see supply cost savings throughout 2025, as stated in the third quarter 2024 earnings call. We're continuing to explore technology investments, including AI for patient check-ins, staffing optimization, provider note writing, and coding accuracy to improve productivity and efficiency. These tools will help further streamline operations and enhance care delivery and productivity this year and going forward. We continue to believe our micro-hospital model is the future of healthcare.

Josh DeTillio
Josh DeTillio
COO at Nutex Health

This model provides efficient access, high-quality concierge care, a lower-cost structure in a more intimate and personalized setting versus the large general hospitals. We believe the micro-hospital model will continue to grow rapidly over the next few years and in the industry. As we've seen in our existing hospitals, when patients have a choice, they prefer fast, high-quality, personalized care. With our model and profitability, we are well-positioned to continue our growth and progress in the coming years. Back to you, Jen.

Jennifer Rodriguez
Jennifer Rodriguez
Head of Investor Relations at Nutex Health

Thank you, Josh, and thank you to Tom, Jon, and Warren for those updates. We'll now move to the Q&A. Operator, please provide instructions.

Operator

Thank you. If you'd like to ask a question at this time, you may press Star 1 from your telephone keypad, and a confirmation tone will indicate your line is in the question queue.

Operator

You may press Star 2 if you'd like to withdraw your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the Star keys. One moment, please. We'll be polling for questions, and that's Star 1. Thank you. Thank you. Our first question comes from the line of Bill Sutherland with The Benchmark Company. Please just use your questions.

Bill Sutherland
Bill Sutherland
Analyst at Benchmark Company

Thanks. Hey, everybody, and congrats on all the progress. I guess, Jon, I wanted to think about you said you're getting a lot more clarity on the arbitration process as far as how the cash comes in, and it looks like your metrics are holding steady in terms of the submissions and the success rate. Should we think about Q1 as something that is essentially repeatable in the following quarters this year?

Bill Sutherland
Bill Sutherland
Analyst at Benchmark Company

I mean, you do have a viewpoint here at the midpoint of 2Q. Thanks.

Jon Bates
CFO at Nutex Health

Yeah. No, great question. Obviously, we're still in the middle of the second quarter. We're not going to speak much to that. What I can tell you is, and I mentioned this at year-end when we went through this first discussion around what was going on with arbitration, and it was sort of early stage. We felt like we had an understanding of the early-on payments that were coming in, the realization of what was happening because we had a little more time to hold off as we were going through year-end, going into the early March time period to see how the true realization was happening. That is when we created the receivable we had at the end of the year.

Jon Bates
CFO at Nutex Health

I think what you can see from this, while it's going to take time to get to the point of normalizing, after one quarter, we're starting to see a little more of what we would expect. I think I mentioned then that I think it's really going to be two quarters till we're going to really prove this out. If you look at the raw numbers and think about how we talked about at the end of last year compared to now when we were looking at where the reimbursement rates were. You saw back then, at the end of 2024, if you looked at a full year, it was in the $2,700 mark, but that was really only with six months of arbitration in it.

Jon Bates
CFO at Nutex Health

Now we're moving forward, and you can kind of continue and think about, okay, for the quarter of 2025, where the reimbursement, if you looked at it kind of per visit, was a little over $4,000, over $4,200. That's a guide, but I think you need to look back at more, I believe, let's say the last nine months from July through the first quarter. If you look at the nine-month number, it's in the $3,800 area. I think when you're talking about normalization of revenue, it's starting to work its way down based on assuming similar acuity, certainly similar level of volume, which we've had some improvement there. I think it's starting to work itself out, but to predict and say that this quarter is representative of what would happen in the next four, there's seasonality.

Jon Bates
CFO at Nutex Health

I think that we're still kind of getting the complete information now that we've been in this. We started in July, but really we didn't see activity until middle of the fourth quarter. We've really only had about four, four and a half months of cash coming in. I think as we see the second quarter and add another quarter to it, we'll really define that. Generally, it's trending in that direction, but I still think we're not at a steady state yet. We're going to have to watch that closely over the next quarter or so.

Bill Sutherland
Bill Sutherland
Analyst at Benchmark Company

Yeah, I was kind of thinking about it in terms of how it laid out with what you realized in terms of claims that were actually in the first quarter and then what came in from fourth quarter and third quarter, etc., and whether that sort of pattern feels like it's something that is going to follow, in other words. Repeatable.

Jon Bates
CFO at Nutex Health

Yeah.

Bill Sutherland
Bill Sutherland
Analyst at Benchmark Company

Yeah, repeatable. And you can't say, obviously, no one's looking for—we understand the vagaries of all this, but that's kind of a pattern to think about in terms of the trail, if you will.

Jon Bates
CFO at Nutex Health

Yeah, absolutely. That's all. Yeah. I mean, it's a good point. The trending, as you mentioned about the pattern, what we can say is we put out numbers at the end of the year, just like we put out numbers here.

Jon Bates
CFO at Nutex Health

I can tell you that the numbers at the end of the year, I feel like they were representative of what was happening and what is expected to happen. We've continued that into the first quarter. Barring major changes other than the other independent variables that affect revenue, I think the trending is solid. I mean, this engine, the process that we go through, has been in place since even before when we went public. We set up just the regular accrual process of our revenue. All we did was add on this feature, and the engine is there, and we're feeding, as we talked about, 60%-70% of our visits are rolling through this process. It's on a consistent basis still happening in that fashion, and we're still seeing the same level of success, over 80% or more.

Jon Bates
CFO at Nutex Health

Based on that, the trending has been solid, and we hope to watch that continue to move forward.

Bill Sutherland
Bill Sutherland
Analyst at Benchmark Company

Great. Just to reaffirm something, I want to make sure I understood, the three remaining underdeveloped hospitals receiving income on their model, that is going to run through third quarter, and then they'll be done?

Jon Bates
CFO at Nutex Health

Correct. Yeah. Okay. That's what I'm assuming. They're mainly rear-faced by the early part of the third quarter.

Bill Sutherland
Bill Sutherland
Analyst at Benchmark Company

Okay. With the cash growing the way it is, I'm just curious as you guys think about your capital deployment plans and how you may be prioritizing going forward.

Jon Bates
CFO at Nutex Health

Yeah. That's a great question. I know Tom can speak more to that too as well. I mean, cash has been strong.

Jon Bates
CFO at Nutex Health

We actually have sort of an investment approach internally in the short term as we look at the different opportunities that are out there. In particular, I mean, certainly, we're always looking for continued growth and opening up facilities, which does take, as he's talked about, he's got several in the pipeline. That's a big piece of potentially opportunities for us. We could increase that rate if we wanted to. I know as Warren mentioned on the population health side, there's opportunities to invest in that side of the business as well, as well as potentially even looking at other similar smaller hospitals that would fit our layout to basically potentially add existing businesses that maybe aren't performing as well and then adding the features of functionality that we have to it and getting off the ground a little bit quicker.

Jon Bates
CFO at Nutex Health

There's opportunities in kind of those three areas. Tom, you can talk more about others.

Tom Vo
Tom Vo
CEO at Nutex Health

Yeah. No, thank you, Bill. Thank you for following us, and thank you for covering us. Like Jon said, we're very fortunate to be in a position to have a lot of cash in the books. Obviously, we're going to be very conservative with our cash and use it to maximize shareholder value. We have a lot of options. The good news, though, is that opening one of these hospitals, as you know, is not that capital-intensive. Even if we open these three hospitals this year, we should still have a lot of cash left over. We're still discussing internally on how to best deploy that cash and to maximize shareholder value.

Bill Sutherland
Bill Sutherland
Analyst at Benchmark Company

Great. I'll jump back in too if I have other people get a question.

Bill Sutherland
Bill Sutherland
Analyst at Benchmark Company

Thanks, guys.

Jon Bates
CFO at Nutex Health

Thanks, Bill.

Operator

Our next question is from the line of Thomas McGovern with Maxim Group. Please proceed to your question.

Thomas McGovern
Thomas McGovern
Equity Research Associate at Maxim Group

Hey, guys. Congrats on the quarter. Another strong performance, especially underscored by the collections and arbitration. That's going to be my first question related to during the quarter, a little bit over 40% of the arbitration-related revenue was related to data service prior to the first quarter, right? If we look back between the fourth quarter and this quarter, you recognized around $95 million in 4Qs. What I'm getting at is, how have you guys started to look at working through prior quarter data service revenue? Have you guys worked through most of what you'll recognize for the fourth quarter? Can we expect the first quarter to be similar to the fourth quarter as of the end of the second quarter?

Thomas McGovern
Thomas McGovern
Equity Research Associate at Maxim Group

You guys recognized $60 million prior to, kind of clarify this. You guys recognized $60 million from 1Q. Would it be reasonable for us to assume you guys would be able to recognize somewhere around another $35 million in the second quarter, kind of consistent with what you did in 4Q?

Jon Bates
CFO at Nutex Health

I mean, it's a great question, Thomas. The reality is, I think we don't know as we watch the process. I can tell you that, as I mentioned before, I think the ironing out of the realization piece, assuming steady state, is starting to become clearer and clearer, which allows us to, in the period that we're in, improve kind of the accuracy of the revenue that we're recording, right? I think we've done a really, really good job.

Jon Bates
CFO at Nutex Health

Quite frankly, even prior, as I mentioned before, prior to arbitration, this is the way we've captured revenue to the best recent historical data, assuming things remain consistent for similar acuity, similar insurance payer, similar location, right? We're doing it down to the granular level. What happens is, as you see things like, okay, maybe there was an additional amount in a current quarter or current month that may be related to a previous month or a previous quarter, what that does is it helps us update the model. It could be up or down. In this case, clearly, it's a little bit higher. I think it's helping us to better align, better identify, and better predict really what's going to happen. I think we've done a really good job up to this point, and we're continuing to get better and better.

Jon Bates
CFO at Nutex Health

A lot of it depends on the timing of cash coming in. Each of the different payers, right, we have different situations with each one. Some might pay slightly quicker, some slower, and there are all sorts of individual situations one by one. On a consistent trend basis, I think that previous period component should continue to work its way down. That is always going to be there because you are taking someone who is walking in the door today, and potentially, if it goes through the arbitration process, it could be five months before you ultimately get final payment. You are anticipating, well, you might get a piece of that in 30-45 days, which is how it works. Then you go into the process, and you have to wait four months after that to potentially get paid.

Jon Bates
CFO at Nutex Health

It'll just be watching that and managing that and each of the different watching it closely with different payers and the different levels of acuity and also the different locations and different states that we're in. Long answer to your short question is, I can't predict exactly what we'll be to expect, say, in the second and third quarter, but I can tell you that I feel like we're getting tighter and tighter on the realization based on the more data that now we're getting that we've now had a solid if you think about the first payment coming in in September, October of last year, now we've got six, seven months of payments. By the time we close out second quarter, it'll be up to close to nine months of payments on this process. I think we'll have a much better feel for it.

Jon Bates
CFO at Nutex Health

I think you see the trending, and I think you have an idea of kind of where it's heading, and I think you're on target with your thought process.

Thomas McGovern
Thomas McGovern
Equity Research Associate at Maxim Group

Understood. I appreciate that, Color. How should we be looking at the addition of new eligible arbitrators? Do you think this could accelerate the arbitration process or in any way shift your strategy for submitting plans?

Jon Bates
CFO at Nutex Health

Yeah, that's a great question. We believe ultimately that will only help us, right? Because I think one of the things that we've been made known, we've been to a couple of different seminars speaking at some and listening to other groups, including a couple of these IDREs, in particular, a couple of the larger ones along with the government.

Jon Bates
CFO at Nutex Health

They all indicate that the most important thing that needs to happen is that they need to find some additional arbitrating groups that can be certified and come in and help with some of the backlog because there is no doubt that the backlog is there, and you can see it in industry data as well. We see it too. They have been picking that pace up a little bit. Several of them have done a great job. There are a couple that have lagged, and they are actually being communicated with to try to help them get resources and improve on that. Plus, they have added, potentially, as you mentioned, adding a couple more. I think adding a couple more will only help the situation.

Jon Bates
CFO at Nutex Health

We will have to watch their impact and their communication in the process as we start using them because each one is a little bit distinct and different. We have to kind of watch their approach to how they handle the information that we provide them when it comes to their resolution of who wins or who loses. We think it will only be a positive as we move down the road as they add more and more of these. They are getting better at it, which is good. Most of them are adding resources as we speak.

Thomas McGovern
Thomas McGovern
Equity Research Associate at Maxim Group

Understood. Thanks for that. Last question, then I'll hop back in queue. Just looking at the acuity, making one of the largest drivers of mature hospital growth as well as the increase in patient and observation visits.

Thomas McGovern
Thomas McGovern
Equity Research Associate at Maxim Group

You guys have added specialists to kind of facilitate this and continue to drive growth in that regard. I'm just curious, do you think that you're now operating at kind of a steady run rate in terms of acuity mix and inpatient volume? Would you expect that to continue to ramp as we move through 2025? If you do expect it to continue to ramp, maybe just touch on some of the key points that you expect to drive continued growth in acuity or high-level acuities and inpatient and observation visits. Thanks.

Tom Vo
Tom Vo
CEO at Nutex Health

Yeah. Hi, Thomas. This is Tom. First of all, thank you for following us, and thank you for covering us. I'll elaborate a little bit on that question, and then I'll pass it over to Josh.

Tom Vo
Tom Vo
CEO at Nutex Health

The way to think about this is that we still have a very high capacity in our inpatient capacity. In other words, as we ramp up these hospitals to be able to admit more patients, and that includes getting more specialists on, getting the proper equipment, getting the proper software technology, so on and so forth, we feel that there's room to grow, not just on the volume side, but also on the inpatient side. Josh, do you have anything else to add from that standpoint?

Josh DeTillio
Josh DeTillio
COO at Nutex Health

No, not much on what I've said. I would just add that, as Tom said, we do have bed capacity, and we are increasing our reputation in the care as being prepared to take care of most patients. The specialist component is a big component.

Josh DeTillio
Josh DeTillio
COO at Nutex Health

Adding cardiologists, adding neurologists, and other specialties has helped us take care of more patients, more observation and inpatient. So we expect that to grow. We have not put out guidance on that yet, but that will continue to grow over the next coming quarters.

Thomas McGovern
Thomas McGovern
Equity Research Associate at Maxim Group

Understood. I appreciate that clarity. I will hop back in queue.

Operator

Thank you. Next question is from the line of Gene Manheimer with Freedom Capital. Please use your questions.

Gene Mannheimer
Gene Mannheimer
Managing Director of Senior Research Analyst at Freedom Capital

Thanks. Good morning. Congratulations, guys. Another above-average quarter. Appreciate it. Thank you.

Jon Bates
CFO at Nutex Health

Thank you, Gene.

Gene Mannheimer
Gene Mannheimer
Managing Director of Senior Research Analyst at Freedom Capital

You are welcome. The arbitration payments, right, that we have been discussing, when you get those in a successful dispute, is there a penalty payment that you are receiving in that that you would not otherwise receive if the bill was paid right the first time?

Gene Mannheimer
Gene Mannheimer
Managing Director of Senior Research Analyst at Freedom Capital

I guess where I'm going with that question is, over time, right, as arbitration revenue moderates and perhaps it's offset by higher base reimbursement, does that make year-over-year comps tougher, right, when we get out to, say, 2026?

Jon Bates
CFO at Nutex Health

Yeah. Gene, great question. On the first piece, in the arbitration concept and how that process works, right now there is no "penalty" for them to pay timely or not pay timely. I know Tom indicated one of the acts earlier, the Murphy Act, and one of the components of that listed and has in there a somewhat punitive penalty concept that I think is important and something that if and when that gets put in will significantly improve the timeliness of payments. First question, or answer to your first question is it should not have in our numbers.

Jon Bates
CFO at Nutex Health

It's basically us providing the support for each component of the visit itself, supporting the value of the services that we're providing. That's what's going on to the arbitrator now. There is the ability, you'll see in the NSA specifically says this, you can include cost to collect because you have to go through this process, and you potentially have to get lawyers or just spend time and effort. You are able to include some type of cost component in addition to the services that you have, which in a lot of cases, that is included in the ultimate argument that ultimately goes to that arbitrator and part of the 80%+ win that we do get. There is no "penalty," as you asked at this point, for them not paying or not paying timely.

Jon Bates
CFO at Nutex Health

I guess the answer based on that, then you asked about how that would affect 2026, I do not think there would be any necessarily impact, say, in future periods based on that changing other than certainly if they do put in place the action for a punitive measure for the payers if they do not pay timely, then that certainly will increase the ability to have additional revenue. At this point, that is not the case in the way we do our current process.

Gene Mannheimer
Gene Mannheimer
Managing Director of Senior Research Analyst at Freedom Capital

Okay. Thank you, Jon, for that color. My follow-on is really more in the core business. You cited a 5.3% increase in mature hospital visits, which is strong. I am just wondering if there was any element of outsized seasonality there. In other words, was the flu season worse this Q1 than last Q1 and therefore maybe played a bigger factor?

Tom Vo
Tom Vo
CEO at Nutex Health

Yeah. Hi, Gene.

Tom Vo
Tom Vo
CEO at Nutex Health

I can answer that and maybe Josh can chime in. By the way, Gene, thank you once again for following us and covering us. This year's flu season was quite interesting. What we saw was that the flu season started later, I would say mid-December, and it progressed through February and maybe even early March. It was not just the flu, but there was RSV. There was obviously COVID also and some GI bugs that were also involved. The point is that, yes, this flu season was a little bit longer than last year. Even then, if you compare it quarter to quarter, year over year, and that successive quarter, we still achieve a 5% increase. I think that is basically to Josh's point that the communities are more aware of our services. We still provide fantastic services to the community.

Tom Vo
Tom Vo
CEO at Nutex Health

I mean, if you take a look at any of our, say, Google review, we have consistent four and a half to five stars, which is very unusual in healthcare. As the further we continue to operate in each community, the more the word gets out of how great our hospitals are so that more patients continue to come. Josh, any more color on that?

Josh DeTillio
Josh DeTillio
COO at Nutex Health

Yeah, Tom. Well said. A couple of things. One, about a year and a half ago, we really—and I give credit to our team—really started a big business development effort, which continues to bear fruit. Our challenge really is getting the word out on our hospitals. We feel that we have the best service in the industry.

Josh DeTillio
Josh DeTillio
COO at Nutex Health

Once a patient comes in, they see how great it is, they get the concierge care, they're going to come back, they're going to bring their family back. We continue to try and get the word out to educate the community on all the services we provide. I think that's why you're seeing the continued mature hospital growth, as well as increased observation and inpatient.

Gene Mannheimer
Gene Mannheimer
Managing Director of Senior Research Analyst at Freedom Capital

Yep. That's great. Congratulations on that progress. If I could just squeeze one more in, the three new hospitals planned this year, can you just share maybe the timing of when you think those will open? Thanks.

Jon Bates
CFO at Nutex Health

Yeah. Hi, Gene. I could elaborate on that. All three hospitals this year will be third and fourth quarter. All three of them are going to be in Texas.

Jon Bates
CFO at Nutex Health

One of them is going to be in Houston, where our corporate office is. It is essentially our backyard. The second hospital is going to be in San Antonio. The third hospital is going to be in Sherman, Texas, which is located north of Dallas on the Texas and Oklahoma border. All three are very fast-growing areas with very good job growth for each of the communities. We think that we could make a difference by bringing our brand of medicine to all three of those areas this year.

Gene Mannheimer
Gene Mannheimer
Managing Director of Senior Research Analyst at Freedom Capital

Oh, that's great. Thanks, everybody, and congrats again.

Jon Bates
CFO at Nutex Health

Thank you, Gene.

Operator

Our next question is from the line of Joshua Cohen with Westbury Capital. Please proceed with your questions.

Joshua Cohen
Managing Partner at Westbury Capital

Hi. Good morning. Thanks for taking my questions and congrats on the strong quarter.

Joshua Cohen
Managing Partner at Westbury Capital

Going back to the discussion around the excess cash, could you talk through the options you guys are considering and whether capital returns could be in the cards?

Jon Bates
CFO at Nutex Health

Yep. Absolutely. In addition to the things that we talked about earlier—thanks, Josh, for the question—we're always looking at whatever is going to make sense from a shareholder perspective to add value. We have discussions about whether there be a share buyback could certainly happen. We've talked about things like dividends at some point down the road, whether that would happen anytime soon. Certainly, along with those, as we mentioned earlier, certainly the investments in our current hospitals and maybe growing that pipeline a little bit quicker, the population health side, which I think is a great opportunity there to take on some situations that will help us really add value quickly. Those are a couple of different areas.

Jon Bates
CFO at Nutex Health

Tom, you can add to that.

Tom Vo
Tom Vo
CEO at Nutex Health

Yeah. No, thank you, Josh, for following us. To Jon's point, we have a lot of options. Obviously, we need to be very cautious with our cash and maximize shareholder value. The way that I see it, I mean, obviously, we could talk about dividends, share buyback, and all those are on the table. A more interesting way of looking at this is maybe to increase more in our development pipeline and increase growth. There are several levels for that. I mean, the first lever is adding more de novo hospitals. The problem with that is that it is all development and construction. By what I mean is that even if you want to grow faster today, it still takes about two years to build these hospitals from ground up because these hospitals do not exist.

Tom Vo
Tom Vo
CEO at Nutex Health

We're the pioneer in the country in building these hospitals. Unless we want to build a hospital, we can't operate the hospital. You have to build it from the ground up. As you can tell, building these, developing these is challenging. Not that we can't do it, it's just that there's only a certain amount that you could do, even if you want to start now. The second question is, is there M&A activities, or is there acquisition opportunities? Once again, from a hospital standpoint, there's just no hospitals out there to be bought. Even if you want to buy a hospital, they don't exist unless you buy these very massive, big traditional hospitals.

Tom Vo
Tom Vo
CEO at Nutex Health

A lot of these hospitals may have failed for some reason, and they do not have the same sort of model that we do with smaller and less number of beds and more cost-efficient. That is a little bit of a limitation. The third lever is to maybe increase our number of IPAs as to what Warren was talking about. That is a possibility. Currently, we have four IPAs in Houston, Phoenix, Los Angeles, and Miami, and we have 24 hospitals. The idea is that if we could put an IPA around each of the hospitals, that may be doable. Once again, we do not want to—we need to be very prudent in our spending and only look at certain businesses that will have a good correlation as well as benefit our current hospital.

Tom Vo
Tom Vo
CEO at Nutex Health

At this point, we're looking at all options at this point.

Joshua Cohen
Managing Partner at Westbury Capital

Okay. Yeah. Thanks for that. Just one additional follow-up. I appreciate that you guys are only halfway through the quarter here. On the accounts receivable, curious if you could provide any additional color on both the confidence for collection and then also the expectations for pacing there.

Jon Bates
CFO at Nutex Health

Yeah. I mean, good question, Josh.

Jon Bates
CFO at Nutex Health

As I kind of talked about earlier on one of the previous questions, when I think about AR and I think about where we were at the end of the year and doing based on early information on how realizability was happening through then and then now watching it after first quarter, I'm pretty confident, much more confident in what we had at that year-end, which is fantastic, and that it's continuing into the first quarter because I think the trending has been pretty consistent. As we watch it, of course, payers can change their behavior or situations can happen. I think the timelines that it takes to collect in the current environment that we're in, somewhere on average, all in, it's four months, but you get the piece that doesn't go through arbitration coming in just like it did before.

Jon Bates
CFO at Nutex Health

That normally would come in in the 60-70 day mark. If you remember back in 2023 or even early 2024, most of our collection time period for a lot of it was in that 60-75 day. That was pre-arbitration. Now the arbitration clearly has extended that because it can take from day of walking in the door up to five-plus months for the final payment to come in. You still get the first payment after that 30-45 days, and then you just have to wait from there. Long answer to your short question is the average of that comes to somewhere in the 120-day mark is what we're seeing overall blended.

Jon Bates
CFO at Nutex Health

We will watch it closely with some of that coming in in that normal 60-75 day period and a larger chunk through arbitration coming on the back end between the four, five, and sometimes slightly longer than five month process to get paid from day one. Hopefully, that helps. I think what we were anticipating at the end of the year, which we were sort of seeing that early on with limited numbers, continued into the first quarter. I think that is substantiated, kind of where we had finished the year. I feel pretty confident that what we have sitting at the end of March is continuing on that run rate and, barring any major changes, that the time period to collect all of this will continue to stay on the kind of period timeline that I have described.

Joshua Cohen
Managing Partner at Westbury Capital

Got it. Thanks for that.

Joshua Cohen
Managing Partner at Westbury Capital

And congrats again on the strong quarter.

Jon Bates
CFO at Nutex Health

Thanks, Josh.

Tom Vo
Tom Vo
CEO at Nutex Health

Thank you, Josh.

Operator

Thank you. This now concludes the question-and-answer session. I'd like to turn the floor back over to Jennifer Rodriguez for closing comments.

Jennifer Rodriguez
Jennifer Rodriguez
Head of Investor Relations at Nutex Health

Thank you all for those valuable questions and answers. For all those joining us today, if you have more questions, please email us at investors@nutexhealth.com, and we'll get back to you promptly. On behalf of the Nutex Management Team, thank you all for joining us for our first quarter 2025 earnings call. We've covered a lot: growth, strategy, challenges, and our vision. We appreciate your time and interest. A recording of this call will be available on our website for a limited time, so feel free to revisit it. Take care, everyone, and we look forward to keeping you updated on our journey.

Operator

Ladies and gentlemen, thank you for your participation.

Operator

This does conclude today's teleconference.

Executives
    • Warren Hosseinion
      Warren Hosseinion
      President
    • Jennifer Rodriguez
      Jennifer Rodriguez
      Head of Investor Relations
    • Josh DeTillio
      Josh DeTillio
      COO
    • Tom Vo
      Tom Vo
      CEO
Analysts
    • Bill Sutherland
      Analyst at Benchmark Company
    • Joshua Cohen
      Managing Partner at Westbury Capital
    • Gene Mannheimer
      Managing Director of Senior Research Analyst at Freedom Capital
    • Jon Bates
      CFO at Nutex Health
    • Thomas McGovern
      Equity Research Associate at Maxim Group
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