Alliance HealthCare Services' (AIQ) CEO Tom Tomlinson on Q2 2014 Results - Earnings Call Transcript | Seeking Alpha 9/7/2014

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Tomlinson on Q2 2014 Results - Earnings Call AIQ

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Aug. 7, 2014 8:55 PM ET | About: Alliance Healthcare Services, Inc. (AIQ) IRY 0.2% 0.5% 21.6% 9.6%
EES 0.2% -1.0% 14.5% -0.7%
Start Time: 17:00 SLY 0.2% 0% 12.9% 1.2%
RWJ 0.1% 0.1% 19.7% 3.0%
End Time: 17:28

Alliance HealthCare Services, Inc. (NASDAQ:AIQ) SEARCH TRANSCRIPT

This Transcript e.g. "this quarter" Find

Q2 2014 Earnings Conference Call
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August 07, 2014, 17:00 PM ET

Executives COMPARE TO:

All AIQ Transcripts
Tom C. Tomlinson - CEO Other Companies in this sector

Howard K. Aihara - EVP and CFO

Richard W . Johns - EVP, General Counsel and Secretary

Richard W. Johns - EVP, General Counsel and Secretary

Good afternoon, ladies and gentlemen, and welcome to the Alliance
HealthCare Services Second Quarter 2014 Earnings Call. My name is Rick
Johns, and I am the company's Executive Vice President and General
Counsel. This conference is being recorded for rebroadcast and all lines have
been placed on mute. As is customary, we will open the conference up for
questions and answers after the presentation.

This conference call will contain forward-looking statements, which are based
on the company's current expectations, forecasts and assumptions, including
statements related to our business strategy, growth opportunities, the
impact of the Affordable Care Act, the 2014 Medicare fees schedule, our
2014 guidance, our expected capital expenditures for 2014, expected cost
reduction and the company's effective tax rate.

As most of you know, forward-looking statements involve risks and

uncertainties, which could cause actual outcomes and results to differ
material from the company's expectations, forecasts and assumptions. These
risks and uncertainties are described in the 2013 guidance release under the
heading Forward-Looking Statements, as well as in the Risk Factors section
of the company's annual report on Form 10-K for the year ended, December
31, 2013, as such report may be modified.

The company disclaims any intention or obligation to update or revise any

forward-looking statements, whether as a result of new information, future
events or otherwise. Financial and other statistical information presented on
this conference call, or information required by the SEC's Regulation G,
maybe accessed through the Investor Relations section of the company's
website. And please visit our website for replay information of this call.

On today's call, our CEO, Tom Tomlinson, will provide a brief overview of our
business, our second quarter 2014 results, the progress of our strategic

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Alliance HealthCare Services' (AIQ) CEO Tom Tomlinson on Q2 2014 Results - Earnings Call Transcript | Seeking Alpha 9/7/2014

transformation and growth strategies initiatives and our priorities for 2014
and beyond. Our Chief Financial Officer, Howard Aihara, will follow with the
details of the second quarter 2014 results and confirm our 2014 guidance.

W ith that, I will now turn the conference over to Tom. Tom, please go
ahead.

T om C. T omlinson - CEO
Thank you, Rick, and good afternoon, everyone. W elcome to Alliance's
second quarter 2014 earnings call. As always, we appreciate your time and
participation. W e’re pleased with our second quarter results and the progress
we have made in transforming Alliance into the outsource partner of choice
for the radiology and radiation oncology service lines.

As we’ve discussed on previously calls, hospitals continue to seek

outsourced partners who can bring deep expertise and the powerful value
proposition to specific areas of their business. The investments we’re making
in Alliance this year, our transformation year, are beginning to yield results.

On our last call, we highlighted an important win for our Alliance Oncology
Division with the closing of our agreement with the Medical University of
South Carolina or MUSC. This quarter I’d like to highlight a similar
partnership win in our Alliance Radiology Division where we have acquired
two existing diagnostic radiology clinics and merged them into a newly
formed joint venture with the major for-profit operator of hospitals. W e
expect this single market joint venture to be the model for executing on
outsourced radiology operations in additional markets with this customer.

From a revenue perspective, I’m encouraged by the performance of our

oncology business which is up 21% over the prior year period. In our
radiology business, second quarter revenues rebounded as expected after
severe weather in the first quarter impacted volumes for MRI and PET/CT. As
Howard will discuss in greater detail, revenue for the second quarter of 111.2
million and adjusted EBITDA of 36.7 million is consistent with the 2014 full
year guidance ranges we’ve communicated.

It’s worth noting that overall, Alliance HealthCare revenues increased

slightly in the second quarter, up 60 basis points from the same quarter last
year after adjusting for the sale of our professional radiology service
businesses and the pruning of unprofitable accounts. This is a positive
milestone in our story as we move through the three stages of our plan from
turnaround to transformation to traction.

Like many in the healthcare sector, we’ve been keenly focused on the rollout
of the Affordable Care Act. During the second quarter, there was clear
evidence that expanding coverage is lifting utilization in decisionable
services like MRI. W hen we examined same-store results for MRI and
Medicaid expansion states versus non-Medicaid expansion states, we’re
seeing 100 to 200 basis point differential. W hile there are always many
factors involved, our sample population covers nearly every state in the
country and we believe at least a portion of this increase is a result of the
Affordable Care Act.

Moreover, we note that many of the large hospitals and health systems have
guided towards increased volumes from the ACA in the current calendar year
and a number of these hospitals and health systems are our customers. W e
continue to see evidence that our growth strategy is sound and both
divisions are pipelined of opportunities and strategic outsourced services
continues to grow and, like the example of our new radiology joint venture,
is starting to come to fruition.

W e’re focused on building upon the success of these projects through the
investments we have made this year in additional sales and business
development talent. Of course, a part of this transformation is also
operational. Our new growth strategy in radiology called RAD360 in which we
provide an enhanced value proposition to our customers enabling us to be a

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Alliance HealthCare Services' (AIQ) CEO Tom Tomlinson on Q2 2014 Results - Earnings Call Transcript | Seeking Alpha 9/7/2014

full service radiology outsourced partner for them. Fundamental to this

strategy in radiology are operational competencies that drive clinical quality
with best-in-class efficiency.

In the last call, we touched on the improvements we have made in patient

scheduling and that service is now at a best-in-class level. A few months
ago, we announced our seventh year as an avatar award winner in patient
care. And all sites across our radiology division and hospital-based radiation
oncology sites are joint commission accredited, the same accreditation
agency that supports quality in the majority of hospitals. These are just a
few of the operational elements that we bring to our hospital customers
when we engage with them to improve the performance of their radiology
and radiation oncology service lines.

W e remain confident that our strategy to transform Alliance into the

outsource partner of choice to hospitals and providers remains on track. Our
EBITDA results for the quarter included approximately 1.5 million of
incremental spending to support growth and build our RAD360 capabilities,
including consulting, sales, marketing and strategic development. W e also
invested about $1 million this quarter in the acquisition of OnPoint Medical
Diagnostics within our Radiology Division.

Second quarter revenue results in Alliance Radiology were down slightly from
the prior year due largely to the impact of our pruning of unprofitable
accounts and challenging dynamics in the PET/CT market. Same-store
volumes rebounded from the first quarter’s inclement weather slowdown with
sequential improvements of 5.9% for MRI and 1.2% for PET/CT. Y es-over-
year MRI same-store volumes were up by 0.3% this quarter but PET/CT was
down 4.9% due in large part to payor changes and tighter RBM utilization
management.

As a reminder, our dual mandate in radiology is to increase competitive

intensity in our core business while also transforming in a comprehensive
radiology outsource provider to our 1,000 plus hospital customers. The
strength and execution in the first of these imperatives, we continue to
focus on several key drivers; improved physician facing sales and marketing
to drive volume at existing sites and on behalf of our hospital customers,
new leadership in our sales team that’s focused on the hospital segment
both retention of existing and acquisition of new customers, targeted
investment in our equipment to ensure we are providing high quality
competitive technology, and leveraging differential advantages such as the
RAD360 diagnostic tool and related consultative services and the OnPoint
data analytics technology offering in order to win business in a competitive
environment.

The second element of this dual mandate driving to a position as the clear
partner of choice for a hospital or provider looking to outsource their
radiology service line is progressing well. The recent win noted earlier is
exactly the type of outcome we’re looking to create and becoming the long-
term strategic partner. Operating an outpatient radiology service line
strategy for a hospital, we can make our partners more successful.

As we’re currently doing with many hospital customers, we begin this

opportunity through the use of our proprietary RAD360 diagnostic tool
accessing key factors and strategies within the market area. Once this
market strategy was embraced by all partners, the Alliance team executed
the plan which included negotiating an acquisition, finalizing the joint
venture and operationally integrating the acquired centers into the care
network of both Alliance and our hospital partner.

Going forward we’re focused on delivering results across a number of key

success drivers including demand generation and market share capture
through sales and marketing, highly efficient operations that also deliver
excellence in clinical care, utilizing some of the tools that have made us a
seven-time award winner and sustain our [JV] (ph) accreditation, response of

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Alliance HealthCare Services' (AIQ) CEO Tom Tomlinson on Q2 2014 Results - Earnings Call Transcript | Seeking Alpha 9/7/2014

patient scheduling and insurance management and the deployment of data

analytics through our OnPoint offering to manage quality control and drive
efficiency.

W e’ve noted our increased investment in a number of key areas to drive

growth in our outsourcing solution and I’m encouraged that our pipeline of
new opportunities is continuing to grow. As we move into the second half of
the year, I expect to see additional RAD360 contracts signed.

In our Alliance Oncology business, second quarter revenues of 23.9 million

grew by 21% when compared to the prior year. A combination of strong
same-store performance and revenue driven by our new strategic partnership
with MUSC were the major factors driving these strong results.

Our Linac centers delivered same-store volume growth of 4.2% and our
stereotactic radiosurgery centers generated growth of 4.1%. One element of
our radiation oncology outsourced value proposition to prospective hospital
customers is our ability to drive exceptional volume results at our sites. Our
industry-leading demand capabilities result in average SRS case volumes
that are 80% higher than peers.

One of the investments we’ve made this year has been to bring in a senior
VP of sales strategy to support physician facing sales and marketing,
building upon our strength in direct marketing tactics, our team’s focus on
effective engagement with physicians is driving even greater results and
further strengthening our outsourced value proposition.

Initiated on March 1 of this year, our partnership with MUSC continues to

track ahead of expectations financially and most importantly for our partners
we’re hitting our milestones. First, we just installed the first new TrueBeam
STx and plan to begin treating patients in mid-August. Second, we’re
currently in a process of reloading the radiation source for the Gamma Knife
to improve its treatment times.

Finally, we plan to start construction for the installation of a second

TrueBeam at the Mount Pleasant location in the fourth quarter. In short,
we’re making the necessary technology investments in MUSC now that will
further drive growth in the program in 2015 as we’re able to expand our
service offerings.

As I mentioned on our last call, as part of our planned investment strategy

we added business development resources to build our pipeline of
opportunities and accelerate new contract activity. I’m pleased to say the
hard work of our team is paying off and we have a robust pipeline of new
opportunities.

In fact we have one transaction in final negotiation of definitive documents

and several transactions currently under Letter of Intent and we expect
these to move forward into definitive documents in the second half of the
year. Now, of course, we’ll share more details of these once they’re fully
executed.

W e’ve also moved into the construction phase on the Dignity Health facility
in San Francisco and we expect it to be operational no later than the first
quarter of 2015. These deals and pipeline activities illustrate the success of
both our business development and sales investments and overall
outsourced partner strategy.

Additionally, we’re also seeing growing interest from new hospital partners
and expanding our oncology relationship and service line offering to their
other sites and markets. Hospital and health systems value our expertise
and are looking to leverage our strengths, including the ability to develop
and execute sales and marketing strategies, rapidly deploy cutting-edge
clinical equipment, drive efficiencies through operational expertise and
leverage a national network of clinicians to rapidly expand treatment into
new disease states, all for the purpose of growing and optimizing their

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oncology service line.

In summary, we’ve made important material progress in our transformation

of Alliance during the second quarter. W e’ve made incremental investments
and we’re driving solid same center volumes across both divisions with the
exception of PET/CT. Success in business development activity and a growing
pipeline of new opportunities mean we’re well positioned to execute on our
plans for the second half of the year. W e’re confident the steps we’ve taken
to build and expand our offering better positions us to capitalize on growth
opportunities and support growth initiatives of our hospital customers.

To illustrate this point, a recent industry survey of hospital CEOs by

HealthLeaders Media showed that 72% plan to invest in patient experience
improvement, 50% said they would invest in facility expansions or
renovations and 42% said investment in service line redesign or realignment
would begin or increase over the next three years. As a result of our
hospital-centric business model, industry expertise, comprehensive services
and disciplined operational execution, we believe we’ll continue to grow and
deliver long-term value to our hospital partners and shareholders.

I’ll now hand the call over to Howard to provide the financial details of our
second quarter. Howard?

Howard K. Aihara - EVP and CFO

Thanks, Tom, and good afternoon. Today, I’ll review the highlights of our
second quarter 2014 financial performance, discuss the impact of the
proposed 2015 CMS reimbursement fee schedule changes which are not
significant to Alliance and then affirm our full year 2014 guidance ranges.

On the highlights from Q2, revenue in the second quarter of 2014 totaled
$111.2 million compared to $114.4 million last year. After adjusting for the
sale of our professional radiology service business line in December of 2013
and to a much lesser degree some pruning in Alliance Radiology totaling
$3.8 million in the aggregate, we posted Q2 revenue growth of 60 basis
points over last year’s second quarter.

As Tom mentioned, our Alliance Oncology revenue grew robustly in the

second quarter with strong same-store volumes across both Linac and SRS
and a full quarter contribution of MUSC revenue. Alliance Oncology revenue
totaled $23.9 million in the quarter or a 21% increase over Q2 of last year.

Both Linac and SRS same-store volume growth exceeded 4% in the second
quarter and our MUSC radiation oncology outsourcing hospital relationship
contributed significantly to this quarter’s results. Also, as expected, our
second quarter Alliance Radiology revenue bounced back after severe winter
storms experienced in many parts of the country during January and
February. Sequentially, radiology revenue increased 3% to $87.3 million in
Q2 over Q1.

In the second quarter, on a same-store basis, radiology MRI volumes were a

positive 5.3% and PET/CT volumes were a negative 4.9%. This positive
same-store volume trend for MRI is related to both our increased marketing
efforts for the referring physician community as well as a positive impact for
patients that are now insured through the ACA. W e continue to see pressure
in our PET/CT business as payors update policies to require CTs and other
less expensive diagnostic tests as well as continued pressure from radiology
benefit managers.

Second quarter adjusted EBITDA was $36.7 million and totaled almost $70
million for the first half of 2014. W e invested $1.5 million in the second
quarter to build our sales, business development and marketing capabilities
in our Alliance RAD360 program and have invested $2.5 million in the first
half of this year. After adjusting for our RAD360 investments, we have
produced stable adjusted EBITDA compared to Q2 of last year.

Another highlight from the same quarter is our bottom line profitability. Pro
forma of diluted EPS was a profit of $0.52 in the second quarter of 2014

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forma of diluted EPS was a profit of $0.52 in the second quarter of 2014
compared to $0.23 in last year’s second quarter. As reported, diluted EPS for
the second quarter was a profit of $0.26 compared to a loss of $1.22 a year
ago.

Included in the as reported diluted EPS with a $0.26 charge in the second
quarter of 2014 and a $1.45 charge in the second quarter of 2013 due to the
following items; restructuring, severance related to costs, legal costs,
impairment, extinguishment of debt and differences in the GAAP income tax
rate from our historical rate of 42.5%.

In terms of CapEx, we continue to invest in solid capital projects and

efficient upgrade of our assets. For the second quarter of 2014, our CapEx
spend totaled $7.5 million compared to $4.8 million a year ago. Our first half
of 2014 CapEx totaled $13.3 million. W e expect to spend a greater amount
of our CapEx in the second half of this year as our MUSC radiation oncology
project will incur approximately $11 million of CapEx in Q3.

W e also expect to incur capital expenditures of approximately $6 million for

the two radiology centers we acquired in partnership with a large for-profit
health system in Q2 and an additional multimodality center we opened in
July, all of which are part of our RAD360 growth initiative.

W e also continue to generate strong free cash flow. W e define free cash
flow as a change in net debt before investments and acquisitions and debt
financing fees. W e generate free cash flow by focusing on organic growth
and adjusted EBITDA, efficient CapEx spending and effective pricing of our
debt structure. This focus has resulted in Alliance generating $10.4 million of
free cash flow in the second quarter of 2014.

In the LTM period ended this June, we generated $44.4 million of free cash
flow or $4.08 per share. This strong free cash flow generation continues to
strengthen our balance sheet. As of the end of June, total leverage is 3.6
times and net leverage is 3.3 times. At the end of the quarter, Alliance had
cash balances of $31 million, long-term debt totaled $508 million and net
debt was $477 million.

Now I’ll make a few comments on CMS’ proposed 2015 fee schedules.
Alliance is largely shielded from proposed reductions in the Medicare
physician fee schedule through the vast majority of our revenue as
generated from hospital relationships. Only 6% of our total revenue is
directly reimbursed by Medicare.

The proposed 2015 Medicare reimbursement changes make the assumption

that Congress waives implementation of the 21% proposed reduction related
to the SGR formula which is not waived would be affected beginning in April
of 2015. The 2015 proposed Medicare physician fee schedule reimbursement
changes would decrease our MRI revenue by $300,000 or 11%.

The 2015 proposed Medicare physician fee schedule does not address PET/CT
services. PET/CT reimbursement is proposed to be governed by the individual
Medicare intermediaries and no impact is expected.

Additionally, Medicare physician fee schedule reimbursement related to our

Linear Accelerator revenue is proposed to be reduced by 5%. This proposed
reduction in reimbursement is expected to impact us by $600,000, rebuild
our stereotactic radiosurgery business under an arrangement with our
hospital joint venture partners or under a traditional wholesale arrangement.
Under CMS’ proposal, our analysis indicate that there is a 0.5% increase
under the HOPPS reschedule which would translate into a $250,000 increase
in reimbursement.

In the aggregate, the proposed 2015 CMS fee schedule changes will reduce
Alliance’s Medicare reimbursement by a total of $700,000 or 0.5% of our
2014 adjusted EBITDA guidance range. These proposed changes, if enacted,
are manageable.

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Alliance HealthCare Services' (AIQ) CEO Tom Tomlinson on Q2 2014 Results - Earnings Call Transcript | Seeking Alpha 9/7/2014

Now I’ll reaffirm our 2014 guidance ranges which remain unchanged. For full
year 2014, Alliance expects revenue to range from $437 million to $462
million. As Tom mentioned, 2014 is a foundational year for the
transformation phase of Alliance. W e believe that 2014 will be a pivotal year
in terms of growing our capabilities in a meaningful and significant way as
we look into 2015 and beyond.

Our 2014 revenue guidance range also assumed a negative impact of $15
million, almost all of which is related to the sale of our professional
radiology services business in December 2013. Our 2014 adjusted EBITDA
guidance range is $140 million to $160 million, which includes incremental
investments on our sales business development and marketing teams of $5
million to grow Alliance into the premier hospital partner for radiology and
radiation oncology services. W e’ll continue to remain cost disciplined
throughout the organization.

Our 2014 capital expenditure guidance is $52 million to $62 million.

Approximately $30 million is expected for maintenance CapEx while the
remaining $22 million to $32 million is for growth projects, including Alliance
Oncology MUSC project and our radiology RAD360 projects. W e’ll continue to
allocate sufficient resources through targeted investments designed to
support long-term growth.

Our free cash flow guidance range is a range from $27 million to $37 million.
Impacting our 2014 free cash flow guidance range, our cash income tax
payments for full year 2014 are $14 million to $17 million, which increased
from $2 million of cash income taxes paid in 2013.

At year end 2013, we had $22 million of federal NOLs and $12 million of
state NOLs, all of which are expected be used during 2014, as Alliance
transitions into becoming a regular cash taxpayer during 2014. W e expect to
pay $24 million to $25 million of cash interest payments in full year 2014.

Thank you for your interest in Alliance. W e look forward to answering your
questions. I'll now turn it back over to the operator to begin the Q&A
session. Operator, we’re ready to begin the Q&A session.

Question-and-Answer Session

Operator

Y es, sir. (Operator Instructions). There are no questions at this time, sir.

T om C. T omlinson - CEO
Okay. Thank you. Thank you everyone for listening in today and look forward
to talking to you again at the end of our next quarter. Thank you.

Operator

This concludes today’s conference call. Y ou may now disconnect your lines.

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