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AmSurg Corporation (NASDAQ:AMSG)

Q4 2013 Earnings Conference Call

February 26, 2014 9:00 AM ET

Executives

Chris Holden – President and CEO

Claire Gulmi – EVP and CFO

Analysts

Joanna Gajuk – Bank of America

Kevin Ellich – Piper Jaffray

Josh Raskin – Barclays

Josh Raskin – Barclays Capital

Darren Lehrich – Deutsche Bank

Whit Mayo – Robert Baird

Steve O’Neil – Hilliard Lyons

Operator

Please stand by. Good day everyone and welcome to today’s AmSurg Corporation fourth quarter conference call. Today’s call is being recorded and a replay will be available starting today through March 9, 2014. The number for the replay is 7194570820 and the code is 2067702. At this time for opening remarks I would like to turn the call over to Chris Holden, President and Chief Executive Officer. Please go ahead sir.

Chris Holden

Thank you very much. Welcome everyone to the AmSurg’s fourth quarter 2013 and year end investor call. Joining me today is Claire Gulmi, Executive Vice President and Chief Financial Officer and also I’d like to welcome any one who’s participating via the webcast.

With that I’ll turn it over to Claire to read our disclaimer.

Claire Gulmi

Certain statements in the conference call constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These forward-looking statements reflect management expectations and are based upon currently available information.

These forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause actual results, performance or achievements of AmSurg to differ materially from those that are expressed in or implied by the forward-looking statements.

To the extent any non-GAAP financial measure discussed in today’s call, you will also find a reconciliation of that measure to the most directly comparable financial measure calculated according to GAAP in today’s news release, which is posted on the company’s website. These factors are discussed in more detail in the company’s reports that are filed with the Securities and Exchange Commission, including without limitation, AmSurg’s Annual Report on Form 10-K for the year ended December 2012 and other filings with the SEC. Copies of these filings are available from AmSurg upon request.

I’ll now turn it back over to Chris for opening comments.

Chris Holden

Thanks, Claire. Let me just jump in with the view of the highlights for the quarter and for the year. Just overall we feel very good about the revenue, cash flow and EPS growth for both the quarter and the year. Specifically revenues increased 17% for the quarter and 17% for the year. Net earnings increased 24% for the quarter and 17% for the year. Operating cash flows increased 12% to $149 million. EPS grew by 22% for the quarter. We ended the quarter with $0.60 which was above guidance and also $2.23 for the year also above guidance.

Our same store revenue increased 2% for quarter and brought us up for the 1% – to 1% for the year. Our leverage decreased from 3.2x at the end of 2012 to 3x at the end of 2013. And we ended the year with 151 GI centers, 55 ophthalmology centers – excuse me, 36 ophthalmology centers and 55 multispecialty and orthopedic centers.

In the fourth quarter, we completed one acquisition. We also completed one acquisition on January 2, 2014 subsequent to the quarter. So for the year we closed on seven acquisitions. Today we have five letters of intent, although we close as I mentioned earlier on one of those transactions already in January.

I would say despite having a very strong pipeline entering into Q4, the closing rate was a bit more choppy than we expected. We concluded the year with $20 million of required earnings which was below our guidance of $25 million to $29 million. I will say in our view there are really no systemic cost utilization [ph] or weakness which drove those results. The pipeline is robust. We feel very confident about the future and we remain bullish on the development contracts prospects going forward.

With did have two of the best tiers in the quarter, and Claire will provide additional color on those in her comments. Market multiples remain in the six to seven range. We end the year with 242 centers in the portfolio. Revenue mix of 51% GI, 12% ophthalmology and 37% from – generated from the multispecialty.

I’m going to turn it over shortly to Claire to provide guidance and color on the quarter and year, just two quick observations going into her comments. One, our same store revenue does what we believe will be the – reflect what we believe will be impact of the multiple snow storms that we’ve seen across the country. It’s not often that we have a snow day in Belmont, Texas. However, we did this year, in New Orleans as well.

And our development guidance is also, we’ll give more color on this, it really reflects what we see from our historical trends and I know that there will be several questions on that and we will be happy to answer those as we go through the Q&A.

So with that, I will turn it over to Claire.

Claire Gulmi

Thanks, Chris. Good morning everyone. As Chris said, we’re pleased to report our fourth quarter results that showed strong growth across all category. Highlight of the fourth quarter include the following; same center revenue increased 2%. Our net revenue per procedure increased to $663 driven by a combination of mix change due to the increase in the number of multispecialty centers and by rate increases. Our EBITDA increased 25% over the prior year to $48.3 million and our growth EBITDA margin for the quarter was 34.2% and net EBITDA margin was 17%, a 100 basis points increased over the prior year.

As Chris said, we acquired one center during the quarter and closed on another one effective January 2. We dispose the two centers during the quarter. One was a multispecialty center which was sold with third party. And the second one was the GI center which was closed at the exploration of its lease [ph].

Capital expenditure totaled $22 million which included $14 million for acquisitions and $8 million for maintenance CapEx. And our long-term debt decreased to $583 million. We continue to have strong operating cash flow in the fourth quarter. Net operating cash flow, net distribution to non-controlling interest was [ph] $36.8 million.

Our full year 2013 results exceeded our guidance and showed double digit growth in revenues, EBITDA and earnings per share. Revenues increased 17% to $1.08 billion. Same center revenues increased 1% for the year. Our EBITDA increased 21% to $183 million. And our operating cash flow excluding distributions to non-controlling interest increased 12%. Excluding a 4% gain from deconsolidation, earnings per share increased 13% to $2.23.

And today we are establishing 2014 guidance as follows; revenues in the range of $1.12 billion to $1.15 billion. Same center revenue increase of 1% to 2%. Center acquisition that generate annualized operating income in a range of $25 million to $29 million. And net cash flow provided by operating activities less [ph] distributions to non-controlling interest in the range of $150 million to $160 million. Net earnings per diluted share of $2.45 to $2.49 for the full year, and net earnings per diluted share for the first quarter of $0.53 to $0.57.

And at this time, operator I will open it up for questions.

Question-and-Answer Session

Operator

Thank you. (Operator instructions) We’ll take our first question from Kevin Fischbeck with Bank of America.

Joanna Gajuk – Bank of America

Good morning. Actually this is Joanna Gajuk in for Kevin today. Thank you for taking the question. Question on the same store revenue for the quarter, can you break this for us in terms of volume versus price?

Claire Gulmi

Volume, they were very similar, very similar, a very little difference between the two.

Joanna Gajuk – Bank of America

Okay. So each 1% volume and pricing? All right, and then – and then as a follow up, you mentioned on the rate increases this quarter, the impact of the mix and also rate increases. So what the level of rate increases are you seeing on your commercial book?

Chris Holden

Which – Tennessee [ph] around 1%.

Joanna Gajuk – Bank of America

Okay. So it’s still pretty much unchanged from what we heard before. And just lastly on the acquisition front [ph], if you can just give us more color in terms of what’s causing those delays. I mean, you mentioned in the release and the prepared remarks that those still – that did not [ph] close where maybe larger than average. So any color there in terms of – any details you can give us in terms of what happen and when do you expect this to close. Thank you.

Chris Holden

The – as I mentioned in the comments, there’s really nothing systemic. There was substantial number of deals in the pipeline headed into the fourth quarter, they all – obviously we only close on two in that – on that list and the others all had different reasons. The one reason that really didn’t bubble up was we went out to repeat it [ph] anywhere. It was really a function of complexity and issues in that have bubbled up as we went to the closing process. We have some other theories about what’s happening and I could lay all those out, but it would be – it would be an exercise in art [ph] and not science because the truth is there was probably eight different reasons along the way. So probably it would be easier for this conversation if it had been one reason but it really wasn’t.

Joanna Gajuk – Bank of America

All right. Thank you.

Operator

(Operator instructions) Our next question comes from Kevin Ellich with Piper Jaffray.

Kevin Ellich – Piper Jaffray

Good morning. Just wondering Chris if you could provide the weather impact on same center revenue growth.

Chris Holden

Kevin, we kind of struggle with that since we’re talking about the fourth quarter and that’s more about the first quarter and we think about how it factors into the guidance.

Kevin Ellich – Piper Jaffray

Yes. That’s what I meant. On the same center revenue growth guidance I guess if excluding weather what do you think same center growth would be?

Claire Gulmi

I’m trying – I’m trying to answer that question. I think it’s a – I don’t know that it would change dramatically. It’s probably going to affect the first quarter more than anything. But the 1% to 2% for the year I think we would have meet that without the weather. I think it’s really affecting more earnings per share for the year and what the same center for the [ph] first quarter will be.

We think we’ve lost 4,000 to 5,000 procedures in the first quarter from the –

Chris Holden

And I wonder it’s not over.

Claire Gulmi

Yes, right. And so, it will have a pretty dramatic impact on that.

Kevin Ellich – Piper Jaffray

And typically did those procedures get rescheduled or are they just gone?

Claire Gulmi

You know that’s a question we ask ourselves all the time. They’re probably do get rescheduled but the question – so you push everybody out and you really never catch up, unless you’re opening hours that you’re not opened before. It’s hard to believe that you really actually get those procedures back.

Kevin Ellich – Piper Jaffray

Okay. That’s helpful. And then –

Claire Gulmi

That’s our – that’s our assumption as we’re making these projections that we really don’t ever get those procedures back.

Kevin Ellich – Piper Jaffray

Yes. No, that make sense, that make sense and it’s affected every one. So going back to the acquisitions, Chris, you made a comment about – I think it’s not so much that you are competed but level of complexity. Can you give us more color kind of dig in to that a little bit is it complexity and the deal arrangements, complexity in – I guess just one more detail as to what you mean by that?

Chris Holden

Yes. I mean, Kevin, actually what I said was complexity would be one of the seven or eight rational reasons [ph] for some of those, it’s not the – it’s not the characterization of what happened systemically at all. There was literally – it’s more – I think what you tend to find in the development process, you can have a year where it’s choppy. It’s just the law of averages.

We’ve been very successful over a long period of time. And I think everyone has gotten used to us having a strong fourth quarter. This particular group of prospects that we had going into the fourth quarter look very strong. And again, for a wide variety of reasons it didn’t materialize as we had expected even as late as November. So they’re just the law of average I’m afraid this time.

Kevin Ellich – Piper Jaffray

Nope, I understand. Yes, you guys do have a long track record. But that choppiness that you saw late in the year, did that continue – we’ve got two months under your belt now, has that pretty much continued into this year?

Chris Holden

Well, it’s a different task [ph]. No, we’re continuing to – we didn’t lose several of those transactions. So we continue to work with the – they’re still working through the issues. This being guidance and this being subject to I think a very strict test on how we communicate with the shareholders. Until I’m sure they’re done, until their NLOI [ph] form. We’re going to represent it the way we’re representing it here today.

But I go back to the pipeline, it is very strong, we feel very good. We had just as many conversations if not more than we’ve ever had. So I don’t know – we don’t sense any weakness in the store here bound the [ph] space and the opportunity to continue to grow and consolidate.

Kevin Ellich – Piper Jaffray

Got you. And then can you just remind us should you see any benefit or do you expect to see a benefit from healthcare reform and expanded coverage, will that show up in your volume growth?

Chris Holden

I think we’ve seen a slight benefit on the GI side from the waver of the co-pays and deductibles for colon cancer screening. And that’s about the only metric I could point to with some certainty right now, Kevin. As far as expanded coverage on the $30 million, I think we’re one website short of making that work actually [ph], but they’re gaining on it, I understand.

Kevin Ellich – Piper Jaffray

Sure. That makes sense. Two last quick one for Claire. One, the acquisition that close in January 2, was that funded in Q4 or will that be actually shown up in Q1 in the cash flows?

Claire Gulmi

It will show up in Q1 cash flows.

Kevin Ellich – Piper Jaffray

Okay. And then the salaries and benefits as a percent of revenue, we saw a little tick down sequentially and it was lower than we expected. Is that kind of run rate or is there something behind that or just kind of normal population [ph]?

Claire Gulmi

I think it’s really just a function of that we had really strong revenue in the fourth quarter with good same center. And so, it’s really just operating leverage. And I think that it will depend on what we do on things at a quarter-by-quarter in 2014.

So we’ll move around a little bit. Obviously it will be much lower in the first quarter of 2000 or a much higher – salaries and benefits much higher as a percent of revenue in the first quarter with lower volumes and the weather impact.

Kevin Ellich – Piper Jaffray

Okay, excellent. Thanks guys.

Chris Holden

Thanks, Kevin.

Operator

Our next question comes from Josh Raskin with Barclays.

Josh Raskin – Barclays

Hi. Thanks. Good morning. Just on the acquisition and I appreciate the commentary you’ve already given Kevin around the eight reasons. But I’m just curious were any of these lost to competition or any of these disagreements on price or anything like that?

Chris Holden

We – it was almost any reason you can think of, there will be at least one of them in that pipeline, it was a combination. I don’t know if we had the same reason twice.

Josh Raskin – Barclays Capital

Got you. And are you looking at multi-center acquisitions, with that – some of the complexity to it, was it you were looking in that sort of one [indiscernible] but maybe a couple of them together, was that part of it?

Chris Holden

No, actually for the guidance and even going into the – after the last callers [ph], we’re all single center transactions.

Josh Raskin – Barclays Capital

Okay, those will – think of that. Any –

Chris Holden

And then broader geography [ph], there was – we really – we did a deep dive just to make sure there was nothing systemic or no change in the – in our feeling about where the – about the level of opportunity that’s out there and it really didn’t change our mind at all.

Josh Raskin – Barclays Capital

Got you, and when you guys include the 25 to 29 million of acquired earnings in 2014, is that some sort of just probability weighted expectation of deals that you think will come up through the year or is that more based on a bottoms up pipeline analysis of what you think is going to close?

Chris Holden

It’s a combination, it’s a function of a percentage of the free cash flow and our historical performance and an assessment of what percentage of the space turns over and our ability to penetrate that.

Josh Raskin – Barclays Capital

Got you. Maybe moving away from that, just – are you guys seeing any increased impact from seasonality, I’m just thinking about deductible, the fourth quarter was pretty strong and I just – I’m just curious if you’re seeing sort of a commercial product surging in the fourth quarter as people get to their deductibles. Is that becoming more evident or not really necessarily big difference year-over-year?

Chris Holden

I was hoping you do the answer to that. We obviously had a strong quarter and I think as I read other companies’ reports so I think everyone enjoyed the fourth quarter, maybe a bit more than I expected. I don’t know that I can, with certainty point to the causation for that. We don’t see a rebound in any particular line of business or range of type of procedure, you would expect that if you’re thesis is correct and the more expensive, the bigger ticket type cases would have rebounded.

Josh Raskin – Barclays Capital

Yes.

Chris Holden

Then a higher percentage than the other is going to – I don’t think we saw that.

Josh Raskin – Barclays Capital

Okay. And then just last question, it’s the – I think it’s the revenue mix, but you have the procedure mix for 4Q?

Claire Gulmi

The procedure mix for the fourth quarter was 68% GI, 9% ophthalmology and 23% multi.

Josh Raskin – Barclays Capital

Okay. Perfect, thanks Claire.

Operator

(Operator instructions) We’ll take our next question from Darren Lehrich with Deutsche Bank.

Darren Lehrich – Deutsche Bank

Thanks, good morning everybody. We’ll it is snowing in New York so weather is still a factor. All right, so I guess I wanted just to go back to one of the questions, Claire, about the fourth quarter, roll it to the deposit of variance versus what your internal expectation was, is it safe to say that it was just better revenue growth and so the operating leverage or was there – is there anything else that came through from the expense perspective that we ought to be thinking about?

Claire Gulmi

No, there was really nothing meaningful in the expense category, it was really just better revenue than we expected and better leverage of that revenue.

Darren Lehrich – Deutsche Bank

Okay, that seems straightforward. The non-controlling interest percentage, just looking at our model and how it’s trended over time and it’s obviously come down as percentage of revenue and I just want to confirm if that’s a function of the economics of your partnerships and if so, can you just, maybe give us a sense for the number of your centers that are not in the 51, 49; I just want to make sure that we’re thinking about that relationship to revenue and operating – come at the NCI word [ph].

Claire Gulmi

Well, I’m not seeing a change that much, for 2012 that was 17.2% and for 2013 it was 17.2%. So I’m not seeing a lot change, we do have – when we bought the NSC centers, they had a little bit higher ownership probably average of 55% to 57%. So I think there was a jump in ‘11 when we bought those but I think it’s been pretty steady for the last two years at about that level; varies a little bit quarter to quarter but I think that’s a good number going forward.

Darren Lehrich – Deutsche Bank

Okay, got it. And then just on the topic of maybe three-way deals or non-51, 49 deals, Chris, any updates there on how you’re thinking about your opportunity set and what this year might look like compared to last year, are you feeling any better or worse about the prospects in that arena?

Chris Holden

Very pleased with the pipeline and the number of discussions that are in process right now and I feel like we’ll continue to build on that. I’m not really guiding to a particular number of those types of relationships but I think we’re definitely be adding as we go through another there [ph].

Darren Lehrich – Deutsche Bank

Okay, and the five LOIs that you have disclosed here wouldn’t include any of those, is that correct or would it?

Chris Holden

There would be some in there.

Darren Lehrich – Deutsche Bank

Okay, so the five LOIs, how many centers does that relate to?

Chris Holden

It’s five.

Darren Lehrich – Deutsche Bank

It’s five, okay.

Chris Holden

Oh remember, as we’ve already closed on, Darren.

Darren Lehrich – Deutsche Bank

Right, okay. All right, and then on – I guess the – couple other things here. Just as it relates to your acquisition guidance and your acquired EBIT, given that you got 20 million of that done and you’re guiding to the same number, I guess you’re just not building any of that that slipped into 2014 and to a higher number because you just want to keep it about the same or is it just the fact that a number of things really did fall off the table and just won’t be opportunities for you this year?

Chris Holden

Well, now is that the – the philosophy around how we guided it there was this – a long topic of conversation here and we’ve landed on a decision to stick with our traditional methodology as a – I think I’ll walked through this a second ago and how we come to that, we debated on a blending methodology and I think in terms of shareholder expectation, that we do like this is more of the right way to do it, stick to how we’ve done it historically and not try to blend that with – combining with the gap on 2013.

Darren Lehrich – Deutsche Bank

Got it. Okay, last question here, will 2014 be a year where we see any international revenue recognized?

Chris Holden

I don’t think so. We refined our approach, we continue to keep our ears at the ground and explore the ability. It’s really defined platforms versus any kind of de novo activity. So that’s opportunistic.

Darren Lehrich – Deutsche Bank

Okay. Thanks guys.

Operator

Our next question comes from Whit Mayo with Robert Baird.

Whit Mayo – Robert Baird

Hey, thanks. But first maybe just an update on industry advocacy efforts and anything new to note from the industry in terms of communications with policy makers?

Chris Holden

We really have unified our advocacy to target not only Washington but payers and physicians and consumers on the advantage of the cost savings available to the space. We just want to keep hammering on the point that we’re half the price from the Medicare patient and often a greater differential versus the commercial patients. And it’s head scratcher summation why [ph] we haven’t taken more advantage of that. And we’re trying to actually tie that advocacy whether it’s in Washington or with the payers with some internal efforts focused on taking greater advantage of transparency engines and other tools to help really with that shopping process and making that awareness more top of mind, I mean that’s – it’s a simple message, it’s a – and that’s what we spend our time in Washington doing.

And we are still focused on trying to unify the insulator between the hospitals and the ASCs so we’re both using the same metric there. And we think – we still believe we have a good shot at that, you just have – it will be a rider on some other type of legislation.

Whit Mayo – Robert Baird

Got it, and last year if I recall, I think there was a slight headwind in California with workers comp, is there anything to note there as – is that worsening or getting better in any states?

Chris Holden

Oh that – last year, we had both sequestration in California workers comp, meeting our overall same store growth rate. The California workers comp now is a reset so that won’t repeat and going in to this year and there’s a quarter tail of sequestration this year. I think some forecast in our consensus assume that sequestration would have gone away which would have had than others, $0.05 to $0.07 to our performance this year and everything that – for guidance but obviously the sequestration is expected to continue through ‘14.

Whit Mayo – Robert Baird

Just the first quarter?

Chris Holden

Well, you don’t get the benefit of having it go away.

Whit Mayo – Robert Baird

That’s fair. But net with the California – lapping the California workers comp headwind, lapping somewhat the sequester and also looking at the Medicare rate update for ASCs, it does seem that pricing should be a net tailwind versus 2013. Is that a fair statement?

Chris Holden

The slight tailwind correct.

Whit Mayo – Robert Baird

Okay.

Chris Holden

We spotted – the only a visibility we have is the quarter tail.

Whit Mayo – Robert Baird

Yes.

Chris Holden

Sequestration.

Whit Mayo – Robert Baird

And maybe anything on the supply front, are there any new implants or IOLs, is there anything to talk about it in terms of inflationary pressure on your call structure at this point?

Chris Holden

The only thing I’m aware off in the short term is that IV solution has been in shortage in some places, not – it’s not material to our supply cost but just generally that’s the hot spot right now.

Whit Mayo – Robert Baird

Okay, that’s helpful. And Claire, maybe one last, I may have just completely missed this but just commentary on the margin performance in the quarter was really strong and what you attribute the majority of this trade to?

Claire Gulmi

I think it was just revenue driven. I think our expenses we’re pretty much in line with what we had forecasted, it was just – our revenues were a little bit better than what we had forecasted.

Whit Mayo – Robert Baird

Got it. Thanks a lot.

Chris Holden

Thanks Whit.

Operator

And next we have a follow question from Kevin Ellich with Piper Jaffray.

Kevin Ellich – Piper Jaffray

I was on mute, sorry. So I just wanted to go back to kind of your overall growth strategy Chris. Are you looking at anything kind of outside of the traditional ASC business, I know we kind of talked about that in the past but just wondering what you guys are looking at and what you’re seeing, what opportunities are coming across your desk?

Chris Holden

That’s a great question Kevin. Actually, there’s a lot of stuff coming across the desk right now. I don’t know if it’s a function of the – six or seven years since coming up on – I guess six years since the beginning of the recession but seems to be a lot of chatter out there right now and a lot of innovative combinations that are being presented.

So a lot of analysis at this point in time but nothing to speak of at this point, just – I would say that that kind of activity is a little bit higher paced than we’ve seen in the last two years.

Kevin Ellich – Piper Jaffray

Got it. I mean, when we think about AmSurg over the next three to five years, I guess what strategically could you guys add or kind of expand into that would kind of help boost that next leg of growth given the size of the company now?

Chris Holden

We’ve always and an eye towards diversification and that could take a lot of different forms. The last few years, through ‘12 and – ‘11, ‘12 especially there was – the core was so strong, a lot of the consolidation there and there’s still a long way to go on that front.

We feel like we have competencies that would be a fit for any number of ambulatory sub-sectors and we’ve studied, done a deep dive on nearly everyone and continue to keep that as a possibility as we think about our five, 10 or 20-year horizon where would that all take us.

Kevin Ellich – Piper Jaffray

Sure.

Chris Holden

But like, we have a lot of competencies that would be a good fit for that.

Kevin Ellich – Piper Jaffray

Okay and then Claire, could you go over the procedure mix and the percent and procedures as percent of revenues again? I don’t think I got those down correctly because they weren’t adding up to 100%.

Claire Gulmi

Oh, let’s check, they do. Let’s say – did you want it for the quarter, is that – which one is –

Kevin Ellich – Piper Jaffray

Yes.

Claire Gulmi

On a procedure basis, it was 68, nine and 23. Does that add up?

Kevin Ellich – Piper Jaffray

Okay, yes, that does; and then as a percent of revenues?

Claire Gulmi

And the percent or revenues, it was 51, 12 and 37 for the quarter.

Kevin Ellich – Piper Jaffray

Okay, didn’t change very much. Got it, that’s all I had. Thank you.

Operator

And our next question comes from Steve O’Neil with Hilliard Lyons.

Steve O’Neil – Hilliard Lyons

Good morning and you just answered my question. Thank you.

Claire Gulmi

Okay.

Operator

At this time, I’d like to turn the conference over to Mr. Chris Holden for any additional or closing remarks.

Chris Holden

I appreciate everyone being on the call today and the great questions, also thanks to the AmSurg team and all the partners for a great fourth quarter and a great 2013. We look forward for warm weather and hope everyone is able to thaw out soon. All right, thanks for joining us.

Operator

This concludes today’s conference, thank you for your participation.

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