Individualized Education Programs; Services, supports, and accommodations; functional behavioral assessments; behavioral intervention plans; early intervening services.
law that works to ensure that all
children with disabilities are able to access a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and
prepare them for further education, employment, and independent living.
ESSA Title I Part A
counseling and mental health services; MTSS; PBIS; community mental health partnerships; mentoring; professional development.
Funds can be utilized as mental health services are an allowable school improvement strategy.
ESSA Title I Part D
Coordination of health and social services (childcare, substance abuse counseling, and mental health services)
Funds can be utilized if there is a likelihood that providing allowable services will help children complete their education.
ESSA Title II
developing programs and activities that increase the
ability of teachers to effectively teach children with
disabilities, including children with significant cognitive
disabilities, and English learners.
formula-based funding to each state education agency for improving teacher quality overall and “provid[ing] low-income and minority students greater access to effective teachers.”
ESSA Title IV Part A
Districts must use at least 20{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of these funds on efforts to improve student mental and behavioral health, school climate, or school safety, which could include:
comprehensive school mental and behavioral health service delivery systems,
trauma informed policies and practices,
bullying and harassment prevention,
social–emotional learning,
improving school safety and school climate,
mental health first aid training, and
professional development activities.
Funds will be allocated to states using the Title I funding formula; states will then allocate funds to LEAs using the same formula. Specialized instructional support personnel must be involved in the development of district plans and applications for these funds, which must include a needs assessment that examines the needs for improvement in three key areas: (a) access to and opportunities for a well-rounded education, (b) safe and supportive conditions for learning, and (c) access to personalized learning experiences supported by technology.
One state has utlitized funds to launch a Mental Heralth First Aid training that teaches participants about mental health and substance use issues.
School-Based Mental Health Services Grant Program
Increasing the number of credentialed school-based mental health service providers; promote the respecialization and certification of existing menal health service providers; increasing the diversity, and cultural and linguistic competency, of school-based mental health providers.
The purpose of the SBMH grant program is to provide competitive grants to State educational agencies (SEAs), local educational agencies (LEAs), and consortia of LEAs to increase the number of credentialed mental health services providers providing school-based mental health services to students in LEAs with demonstrated need.
One district proposes to offer a multi-tiered approach to K-12 mental healthcare by providing clinical programs, professional learning, and telehealth services to promote mental health best practices and build a mental health continuum that supports the needs of every student.
Mental Health Service Professional Demonstration Grant Program
Innovative partnerships to train school-based mental health services providers; increase the number and diversity of high-quality providers; develop mental health career pathways.
The Mental Health Service Professional Demonstration Grant Program provides competitive grants to support and demonstrate innovative partnerships to train school-based mental health service providers for employment in schools and local educational agencies (LEAs).
One university intends to utilize grant funds to provide financial support to students who are recruited and accepted to the Ed.S program.
Project AWARE
Building collaborative partnerships; implement mental health related promotion, awareness, prevention, intervention, and resilience; ensure students have access to appropriate and effective behavioral health services.
Project AWARE is a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) spread over five years to both build and grow mental health services and behavioral health education within the awarded districts.
One state will utilize funds by partnering with 3 LEAs and 2 behavioral health partners to deliver care through telehealth. This state intends to outfit 1 room per school to deliver telehealth services.
Project Prevent Grant Program
Offer affected students mental health services; support conflict management programs; implement other community- and school-based strategies to help prevent community violence and to mitigate the impacts of exposure to community violence.
This program provides grants to local educational agencies (LEAs) impacted by community violence and to expand the capacity of LEAs to implement community- and school-based strategies to help prevent community violence and mitigate the impacts of exposure to community violence.
One state will utilize funds to develop a comprehensive program that leverages the
expertise of both LEAs and community based mental health staff to meet the needs of all
students. The project will have LEA and community health staff receive professional
development through multiple frameworks, as well as MTSS and TBRI training for school staff,
community partners, students, and families. The project will also create calming and play
therapy rooms and implement group interventions to better target services to students as well
as hosting family university and summer camp to create linkages with community-based
organizations.
Elementary and Secondary School Emergency Relief
Providing mental health services and supports, including through the implementation of evidencebased full-service community schools.
The American Rescue Plan Act’s (ARPA) Elementary and Secondary School Emergency Relief (ESSER) provides more than $122 billion to help pre-K through grade12 students recover from lost time in schools by supporting their mental health, as well as their social, emotional, and academic needs.
One state is partnering with the Center for Disease Control and Prevention to expand school health clinics and is requiring clinics to provide behavioral health screenings, counseling, and crisis response.
Medicaid
States can expand their school-based Medicaid programs, which will allow them to reimburse for school-based mental health staff who work with students covered by Medicaid.
Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. The federal government has general rules that all state Medicaid programs must follow, but each state runs its own program.
Some state Medicaid programs partner with LEAs to help promote school-based behavorial health services; 4 states take advantage of the reversal of the free care policy by expanding Medicaid reimbursements for school-based services provided to children without IEPs. Several states have increased reimbursements for school-based providers.
Bipartisan Safer Communities Act Stronger Connections Grant Program
Implementing comprehensive, evidence-based strategies that meet student social, emotional, and mental well-being needs; create positive, inclusive, and supportive school environments; and increase access to place-based interventions and services; Engaging students, families, educators, staff, and community organizations in the selection and implementation of strategies and interventions to create safe, inclusive, and supportive learning environments; Designing and implementing policies and practices that are responsive to underserved students, protect student rights, and demonstrate respect for student dignity and potential.
Provides $1 billion in funding to SEAs to be distributed under Title IV, Part A of the ESEA. The BSCA specifies that SEAs must make competitive subgrants to high-need LEAs), foractivities to support safe and healthy students under section 4108 of the ESEA. The Department has designated BSCA section 4108 funds as the Stronger Connections grant program to distinguish it from the regular Title IV, Part A, Student Support and Academic Enrichment Grants program, which funds a broader range of activities, including activities to support well-rounded educational opportunities and the effective use of educational technology.
Built-in Measurement Provides Actionable, Privateness-Secure Patient Insights for Serious-Time Organizing, Activation, and Optimization
NEW YORK, Feb. 27, 2023 /PRNewswire/ — PulsePoint, a technological innovation corporation revolutionizing wellbeing choice-making in genuine time, right now declared the launch of integrated direct-to-shopper (DTC) measurement methods in partnership with Komodo Wellbeing, a major health care technology organization that has designed the industry’s most full and linked watch of affected individual encounters. PulsePoint consumers utilizing the Lifestyle system can now leverage Komodo Health’s superior analytic capabilities and insights visualization resources for initially-bash viewers profiling and measurement, in addition to PulsePoint’s initially-occasion and proprietary collection of intelligence tools.
Knowledge what influences individuals to just take medical action with a manufacturer has become increasingly difficult. Models need to have true-time visibility into their steps to fully have an understanding of how to influence what they might do next along the affected person journey. People that are not measuring properly are most probable performing on insights that you should not validate if messaging essentially arrived at a patient in the 1st location. An impartial solution to measurement is essential to making sure marketers have a complete and accurate being familiar with of what’s working so they’re in the greatest situation to boost campaigns that are underperforming.
Combining PulsePoint information with the Komodo Health care Map and configurable measurement answers supplies impartial, 3rd-celebration DTC marketing campaign measurement on uncovered and unexposed audiences. This enables PulsePoint customers to harness actionable, privacy-secure audiences with Komodo’s scientific and digital intelligence to rapidly respond to evolving patient behaviors driven by true-time campaign outcomes planned, activated, and optimized on Lifetime. Serious-time measurement will allow for real-time optimizations to better access clients inside the targeted wellbeing ailment and generate improved results.
Realize what methods to prioritize to enhance viewers good quality and improve certified viewers effect.
Drill down into important demographic and scientific insights about the audience arrived at, this kind of as geo-locale, age, and gender, being aware of who initiated, refilled, or stopped an Rx, or switched to or from a competitor.
Identify campaign-driven script elevate for exposed and unexposed patients primarily based on a check and control methodology operate dynamically, in actual time.
“PulsePoint has a sizeable competitive gain as it relates to fidelity, flexibility, and accessibility, which permits us to provide a much better, 1st-party stage of perspective of the client with actionable outcomes to optimize campaigns and strategy that other DTC measurement remedies cannot,” stated Andrew Stark, Chief Income Officer at PulsePoint. “Our one of a kind solution to shut-loop measurement and wide range of remedies allow for PulsePoint to deliver the greatest attainable HCP and DTC viewers achieve result in in the vicinity of real time.”
“This partnership fuels a unique opportunity for PulsePoint purchasers to gain a additional comprehensive and representative perspective of their affected individual audience, and hook up the dots in between personal affected individual journeys and large-scale medical results,” reported Aswin Chandrakantan, MD, Main Operating Officer at Komodo Wellbeing. “As life sciences groups goal to choose a far more data-pushed tactic to DTC general performance measurement, these new options can support give a window into serious-time campaign changes that can be designed to fortify engagement.”
This announcement furthers PulsePoint’s focus on setting up a smarter, much more scalable, far more efficient way for manufacturers to target, achieve, comprehend, and activate health care audiences via upcoming-era know-how that is run by confirmed well being audience knowledge in actual time.
About PulsePoint
PulsePoint is a foremost technological innovation firm that utilizes authentic-globe knowledge in real time to improve campaign performance and revolutionize well being selection-generating. Leveraging proprietary datasets and methodology, PulsePoint targets health care experts and individuals with an unprecedented stage of accuracy—delivering unparalleled effects to the purchasers we provide. The organization is now a portion of Internet Manufacturers, a KKR portfolio company and proprietor of WebMD Well being Corp. For far more info, take a look at pulsepoint.com.
This story contains conversations of suicide. If you or an individual you know is in disaster, you can get enable from the Suicide and Crisis lifeline by calling or texting 988.
It is really a relatable emotion. You might be emotion unwell, have several indicators, and you come to a decision to Google what could ail you. Occasionally doom will take keep and you self-diagnose with the worst-case circumstance. But it’s not just bodily ailments. CBS News identified that as the mental well being disaster amid American teens deepens, they look for out alternative sorts of guidance and information. More and more young people today transform to social media platforms like TikTok and diagnose them selves with severe psychological overall health challenges.
With qualified therapists highly-priced and significantly really hard to uncover numerous youthful people lookup for answers on social media platforms wherever the answers are plentiful and cost-free but not essentially accurate.
According to a the latest Pew Investigation study, 1 in 6 Gen Zers use TikTok as a search motor — a position not only to look at dance videos and lip synching, but to discover bite-sized chunks of informational material.
“If I’m trying to determine out how to do something, I come to feel like it is really a lot easier to go on TikTok,” mentioned Alexis Diomino, a third-yr psychology student.
Study additional: Inside America’s youth mental health and fitness disaster
It is not just a look for motor. It is really a put to give tips, share feelings and experiences and speak about severe mental overall health conditions.
“Social media treatment”
At an early age, 19-12 months-aged Samantha Fridley was identified with nervousness and depression. By the time she was in fifth quality she started possessing suicidal views. Even with treatment her struggles with panic and ideas about self-hurt designed her sense on your own.
“I felt like there was no one that could assistance me. And I felt mainly because I had been by way of so a lot that there is just no treatment method for me,” said Fridley. “I started on the lookout for other men and women by means of social media. Then I looked as a result of Instagram — any social media I could. And then Tik Tok.”
It was on TikTok that Fridley claimed she commenced exploring for mental wellness advocacy and enthusiasm. It’s not uncommon. On TikTok the hashtag “mental wellbeing” has been searched much more than 67 billion moments.
The phenomenon now gaining traction is referred to as social media treatment.
“What they are performing is they are heading into the interactive media area to soothe on their own, to make on their own come to feel much better, to make them selves the grasp of that surroundings when they don’t truly feel that they have mastered the atmosphere of the exterior globe,” explained Dr. Michael Prosperous, director of the Digital Wellness Lab at Boston Kid’s Healthcare facility.
“There is a demand from customers which is getting crammed by individuals now. The question genuinely is, is how perfectly and how safely is it getting crammed?”
Industry experts like Prosperous say that open up conversation about mental wellness can provide support and cut down stigma. But there are worries that turning to social media influencers as de facto therapists is risky.
How the social media “echo chamber” can hurt teens’ psychological health
12:18
“I think that we require to understand why individuals are coming to these influencers for aid. But we also have to have some sort of high-quality manage,” stated Loaded. “However, when these youthful persons, normally young persons, are untrained and with the finest of intentions, are trying to be there for their peers, they are, initially of all, not able to always detect how significantly distress another person is in or how much how shut somebody is to actually harming on their own. And so, I believe there is a actual challenge listed here of the demand significantly outstripping the need to have.”
The algorithm feeding frenzy
Fridley suggests her research for psychological wellbeing connected information led her down a risky rabbit gap. She was now observing a therapist for her diagnosed stress and anxiety and depression but begun seeing innumerable movies of influencers sharing feelings on critical mental wellness situations — and claims TikTok flooded her feed with hundreds far more.
“As you glimpse through TikTok and as the algorithm strengthens, it turned into analysis and turned into other items like ADHD and borderline temperament condition and a lot more despair and stress,” claimed Fridley.
The articles showing in her “For You” feed was the result of TikTok’s special algorithm which sends recommended video clips centered on what you’ve searched, shared or liked. Fridley claims becoming bombarded with imprecise signs or symptoms of numerous psychological conditions led to her diagnosing herself.
“It just got to a level exactly where I was losing sleep for the reason that of it. I would be up until like 3 a.m. on TikTok, just like investigating,” she claimed. But Fridley was in no way skillfully identified with any of individuals issues.
In an email to CBS News TikTok stated the “For You” feed “…reflects choices one of a kind to each individual consumer. The procedure recommends material by rating movies dependent on a mix of elements, including movies you like or share, accounts you observe, remarks you post, and content material you create.”
TikTok told CBS Information it began tests means to stay away from recommending a sequence of equivalent written content on matters to buyers and is examining to see if their program inadvertently feeds a narrower vary of information to its viewers.
But there are worries about what the unintended repercussions of providing a regular stream of psychological health and fitness information can direct to — specially, when it truly is inaccurate or misinformed.
In a person recent research by the Centre for Countering Digital Hate, researchers posed as 13-calendar year-previous buyers and searched and “liked” mental well being films. They found that TikTok pushed likely harmful information to these end users on average every single 39 seconds. Some customers received tips for written content about suicide inside of 2.6 minutes of joining the application.
“What is actually on-line is a cost-free-for-all. There really is no accountability for this and there is no duty taken,” stated Wealthy.
In accordance to 1 evaluation revealed in The Canadian Journal of Psychiatry of common TikTok videos about ADHD, 52{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} had been considered deceptive.
TikTok would not concur to an job interview but in a statement to CBS News a spokesperson wrote: “We will get rid of misinformation that leads to considerable hurt to folks, our neighborhood, or the much larger public regardless of intent.”
The company also wrote: “We care deeply about the well-getting of our neighborhood, which is why we keep on to make investments in digital literacy training aimed at aiding individuals assess and understand written content they interact with on the internet. We strongly motivate persons to seek out specialist medical suggestions if they are in need of assist.”
Debunking misinformation
“I have talked even to persons at TikTok, and I retained saying, ‘you know, at some place, I know you only treatment about misinformation if it’s COVID, or politics. You you should not treatment about misinformation, about psychology, but you have to understand this is mental health and fitness,'” stated Dr. Inna Kanevsky, a professor of psychology at San Diego Mesa College or university.
For the last number of decades, Kanevsky has been battling psychological misinformation on TikTok, debunking faulty mental well being facts a single online video at a time.
“You can give people today advice based on your working experience as prolonged as you happen to be clear that that is wherever you’re coming from,” mentioned Kanevsky.
With a million followers and far more than 36 million views, Kanevsy has grow to be a TikTok star and reverse influencer herself. But her candid takes on mental overall health misinformation is not always effectively obtained — primarily from all those users who come across on their own on the acquiring stop of a debunking video.
“If I right people… men and women get pretty mad at me for the reason that they [say] they are just speaking about their private practical experience. They’re not performing anyone any damage.”
But Kanevsky says there can be actual hurt which is why she actions in.
“Men and women believe that all sorts of issues that are not really accurate due to the fact somebody they come across relatable claimed it, and they obtain this particular person a lot more relatable than some health-related medical doctor or some Ph.D. with science posts. And they want to benefit the individual experience.”
Social media professionals say that is at the coronary heart of the problem.
“There are content creators who are qualified physicians, educated clinicians men and women doing work in disinformation in this house striving to counter it. But it can be virtually like currently being a salmon and swimming upstream,” reported Robin Stevens, an associate professor of communications at the College of Southern California in Los Angeles.
“To see true improve, it definitely does have to come at the system level and requires pretty a little bit of content moderation,” she claimed.
Stevens runs the Overall health Equity and Media Lab at USC. She generally will work with Black and Latinx youth and reports how they are working with social media to come across alternatives to the community wellbeing issues they confront — including psychological ailment.
For most of her occupation, Stevens studied and critiqued social media platforms. But this previous calendar year she started functioning with Instagram’s Effectively-being Creator Collective — a pilot program aimed at influencers and articles creators to teach and practice them on how to produce accountable mental health and fitness content.
Meta, the father or mother business of Fb and Instagram, a short while ago held a two-day summit with these articles creators in Los Angeles. Stevens is one particular of their specialist advisers.
“As they designed Reels, we written content-analyzed them to see what the amount of disinformation was. What was the level of how a lot the teens react to it? What was the written content that teens have been viewing in excess of and around?” she said. “And then we would feed that again to them to help them produce improved Reels.”
“I was a minor skeptical to see what they would genuinely be accomplishing. Was this just PR? And I will say that doing the job in the Wellness Collective, they truly had a amazing method of how to deliver much more supportive material that showed they comprehended how youth use media,” stated Stevens.
But right up until a lot more content moderation comes about at the platform-amount how youth use media suggests people will have to be conscious of the approaches in which their feeds are populated.
Samantha Fridley suggests it took a whole detox for her to finally cost-free herself from the grips of psychological health and fitness influencers and self-diagnosis. She put in 56 times in residential rehab absent from her cellular phone and TikTok. And although she nevertheless takes advantage of the app, the way she uses it has modified considerably. She stopped viewing mental health and fitness video clips and searched for written content that would reset her feed, like K-pop and comedy.
“It really is a good useful resource for funny movies,” said Fridley. “But it truly is not a great source for diagnosing oneself. And if you get started diagnosing yourself, you might be likely to slide into a spiral that you will actually have a tricky time having out of.”
Advice for teens and mothers and fathers
Both equally Dr. Kanevsky and Dr. Rich say dad and mom have to have to play an active aspect in how their small children are partaking with psychological wellbeing-related social media posts. Dr. Wealthy suggests it is really like a ability device — employing it safely and securely need to be taught.
A pair of techniques teens can use if their feeds are flooded with damaging posts is to try and reset the algorithm by modifying the varieties of videos they observe, like and remark on. Observing beneficial posts can support displace the destructive information. They can even delete their accounts and get started from scratch.
TikTok, Snapchat, YouTube and Meta are named in a federal lawsuit joined by households about the country proclaiming the platforms’ algorithms have brought about depression, having problems and suicide in young people. Statements from Snapchat, YouTube owner Google and Meta to CBS Information can be found right here.
Company Provides 2023 Guidance and Raises Dividend
HOUSTON, February 23, 2023–(BUSINESS WIRE)–U.S. Physical Therapy, Inc. (“USPH” or the “Company”) (NYSE: USPH), a national operator of outpatient physical therapy clinics and provider of industrial injury prevention (“IIP”) services, today reported results for the three months and year ended December 31, 2022 (“2022 Fourth Quarter” and “2022 Year”, respectively).
FULL YEAR AND QUARTER HIGHLIGHTS **The Company is still completing its evaluation of the income tax expense for the 2022 Fourth Quarter and 2022 Year. As a result, the Company’s presentation of earnings per share, operating results per share and its provision for income taxes may change as a result of this evaluation. Set forth below are the Company’s current estimates for these amounts. The Company will promptly announce any changes upon the completion of the evaluation.
Adjusted EBITDA, a non-GAAP measure, was $17.9 million for the 2022 Fourth Quarter, an increase of $0.5 million, or 2.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, from $17.4 million, excluding Relief Funds, for the three months ended December 31, 2021 (“2021 Fourth Quarter”). See definition, explanation and calculation of Adjusted EBITDA, a non-GAAP measure, in the schedules on pages 16 and 17.
Adjusted EBITDA was $73.7 million for the 2022 Year, a decrease of $0.1 million, or 0.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, from $73.8 million, excluding Relief Funds, for the year ended December 31, 2021 (“2021 Year”).
For the 2022 Fourth Quarter, USPH’s net income attributable to its shareholders, a GAAP measure, was $2.6 million as compared to $10.2 million for the 2021 Fourth Quarter. The 2022 Fourth Quarter included a goodwill impairment charge, further described below, of $4.8 million, net of taxes and allocation to non-controlling interest. For GAAP purposes, a charge for the revaluation of redeemable non-controlling interest, net of taxes, is included in the computation of earnings or loss per diluted share. Loss per diluted share on a GAAP basis, net of taxes, was $0.01 for the 2022 Fourth Quarter as compared to earnings per share of $0.73 for the 2021 Fourth Quarter.
For the 2022 Year, USPH’s net income attributable to its shareholders, a GAAP measure, was $32.2 million as compared to $40.8 million for the 2021 Year. Earnings per diluted share, which includes a charge for revaluation of redeemable non-controlling interest, was $2.25 for the 2022 Year, as compared to $2.41 for the 2021 Year.
Operating Results, a non-GAAP measure, was $0.58 per diluted share for the 2022 Fourth Quarter compared to $0.72 per diluted share, excluding Relief Funds (defined under “Impact of COVID-19/Relief Funds” below), for the 2021 Fourth Quarter. See definition, explanation and calculation of Operating Results, a non-GAAP measure, in the schedules on pages 16 and 17.
Operating Results was $2.70 per diluted share for the 2022 Year. For the 2021 Year, Operating Results, excluding Relief Funds, was $3.17 per diluted share.
Average visits per clinic per day were 29.1 for the 2022 Fourth Quarter and 28.7 for the 2022 Year, the second highest average visits per day for each period in the Company’s history, surpassed only by 29.8 average visits per day in the Fourth Quarter 2021 and 29.1 in the 2021 Year.
Net patient revenue from physical therapy operations was $120.1 million for the 2022 Fourth Quarter, an increase of 5.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $113.5 million for the 2021 Fourth Quarter. Net patient revenue from physical therapy operations was $464.6 million for the 2022 Year, an increase of 6.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $438.3 million for the 2021 Year.
For the 2022 Fourth Quarter, total patient visits were 1,152,139, an increase of 5.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from 1,096,389 for the 2021 Fourth Quarter. For the 2022 Year, total patient visits were 4,483,282, an increase of 6.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from 4,219,576 for the 2021 Year.
The net rate per patient visit was $104.28 in the 2022 Fourth Quarter, a $0.75 per visit increase from $103.53 in the 2021 Fourth Quarter. For the 2022 Year, the net rate per patient visit was $103.63 as compared $103.88 in the 2021 Year. The net rate per patient visit increased throughout 2022, from $103.00 in the first quarter of 2022 to $103.18 in the second quarter, $104.01 in the third quarter and $104.28 in the fourth quarter.
Physical therapy total operating costs were $84.05 per visit in the 2022 Fourth Quarter, a decrease of 1.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $85.14 in the third quarter of 2022, and an increase of 2.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $82.30 per visit in the Fourth Quarter 2021. Physical therapy salaries and related costs were $60.04 per visit in the Fourth Quarter 2022, a decrease of 1.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $60.99 in the third quarter of 2022, and an increase of 1.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $59.20 in the Fourth Quarter 2021.
For the 2022 Year, physical therapy total operating costs were $83.34 per visit, an increase of 4.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $79.71 for the 2021 Year. Total salaries and related costs were $59.52 per visit, an increase of 4.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as compared to $57.20 for the 2021 Year.
IIP services revenue increased 37.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} to $18.4 million in the 2022 Fourth Quarter as compared to $13.4 million in the 2021 Fourth Quarter. For the full year, IIP services revenue increased 75.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} to $77.1 million in the 2022 Year as compared to $43.9 million for the 2021 Year. Excluding the Company’s IIP Acquisition in November 2021 (“IIP Acquisition”), IIP services revenue increased 9.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in the 2022 Fourth Quarter and 20.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in the 2022 Full Year as compared to the same periods in 2021.
The Company completed two acquisitions in the 2022 Fourth Quarter, resulting in five total acquisitions in the 2022 Year. On October 31, 2022, the Company acquired 60{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the equity interest in a fourteen-clinic physical therapy practice with approximately $9.2 million in annual revenue and approximately 84,000 patient visits per year. On November 30, 2022, the Company acquired 80{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the equity interest in a thirteen-clinic physical therapy practice with approximately $12.0 million in annual revenue and approximately 120,000 patient visits per year.
The Company’s Board of Directors raised the Company’s quarterly dividend from $0.41 per share to $0.43 per share, an increase of 4.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, effectively immediately, and declared a quarterly dividend for the first quarter of 2023 at the higher rate.
Management currently expects the Company’s Adjusted EBITDA for 2023 to be in the range of $75.0 million to $80.0 million. The guidance represents projected Adjusted EBITDA from existing operations and excludes future acquisitions. See “Management Provides 2023 Guidance” below for more information.
Management’s Comments
Chris Reading, Chief Executive Officer, said, “I am proud of the work by our partners, clinicians, and leadership team despite significant macroeconomic headwinds present in the second half of 2022. We are making good progress around contract renegotiations, development has been strong, and staffing has begun to improve. Volumes to start the new year have been ahead of our initial expectations. Our team will continue to work on all these important items as we go forward in 2023.”
Carey Hendrickson, Chief Financial Officer, said, “We are pleased to raise our quarterly dividend rate once again in the first quarter of 2023, which we have raised each year since the inception of our dividend in 2011. While we again have some Medicare rate headwinds as we enter 2023, we have tremendous confidence in our team to produce EBITDA growth this year through increased volumes, continued momentum in rate renegotiations and an ongoing focus on making our operations as efficient as possible.”
Fourth Quarter 2022 As Compared to Fourth Quarter 2021 **As noted above, the Company is still completing its evaluation of the income tax expense for the 2022 Fourth Quarter and 2022 Year. As a result, the Company’s presentation of earnings per share, operating results per share and its provision for income taxes may change as a result of this evaluation. Set forth below are the Company’s current estimates for these amounts. The Company will promptly announce any changes upon the completion of the evaluation.
Reported total revenue for the 2022 Fourth Quarter was $141.2 million, an increase of 8.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as compared to $129.8 million for the 2021 Fourth Quarter. See table below for a detail of reported total revenue (in thousands):
Three Months Ended
December 31, 2022
December 31, 2021
Revenue related to Mature Clinics
$
105,655
$
106,955
Revenue related to 2022 Clinic Additions
7,759
–
Revenue related to 2021 Clinic Additions
6,383
5,304
Revenue from clinics sold or closed in 2022
349
1,252
Net patient revenue from physical therapy operations
120,146
113,511
Other revenue
883
717
Revenue from physical therapy operations
121,029
114,228
Revenue from management contracts
1,761
2,242
Revenue from industrial injury prevention services
18,392
13,363
Total revenue
$
141,182
$
129,833
Revenue from physical therapy operations increased $6.8 million, or 6.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, to $121.0 million for the 2022 Fourth Quarter from $114.2 million for the 2021 Fourth Quarter. The average net patient revenue per visit was $104.28 for the 2022 Fourth Quarter as compared to $103.53 for the 2021 Fourth Quarter. Total patient visits increased 5.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} to 1,152,139 for the 2022 Fourth Quarter from 1,096,389 for the 2021 Fourth Quarter.
Net patient revenue related to clinics opened or acquired prior to 2021 and still in operation on December 31, 2022 (“Mature Clinics”) decreased slightly. Visits for Mature Clinics (same store) for the 2022 Fourth Quarter decreased by 2.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as compared to the 2021 Fourth Quarter while net patient revenue per visit increased by 1.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} over the comparable period.
Total operating cost was $113.4 million for the 2022 Fourth Quarter, or 80.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue, as compared to $102.7 million, or 79.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue, for the 2021 Fourth Quarter. Operating cost related to Mature Clinics increased $0.3 million, or 0.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, for the 2022 Fourth Quarter as compared to the 2021 Fourth Quarter. Operating cost related to the IIP services business increased by $4.5 million for the 2022 Fourth Quarter as compared to the 2021 Fourth Quarter, of which $3.5 million related to the IIP Acquisition. See table below for a detail of operating cost (in thousands):
Three Months Ended
December 31, 2022
December 31, 2021
Operating cost related to Mature Clinics
$
84,846
$
84,539
Operating cost related to 2022 Clinic Additions
6,136
59
Operating cost related to 2021 Clinic Additions
5,399
4,437
Operating cost related to clinics sold or closed in 2022
455
1,191
Operating cost related to physical therapy operations
96,836
90,226
Operating cost related to management contracts
1,411
1,814
Operating cost related to industrial injury prevention services
15,104
10,610
Total operating cost
$
113,351
$
102,650
Total salaries and related costs, including all operations, were 58.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue for the 2022 Fourth Quarter versus 58.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. Rent, supplies, contract labor and other costs as a percentage of total revenue were 21.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter versus 20.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. The provision for credit losses as a percentage of total revenue was 1.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for 2022 Fourth Quarter and 1.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for 2021 Fourth Quarter.
Gross profit for the 2022 Fourth Quarter was $27.8 million as compared to $27.2 million for the 2021 Fourth Quarter. The gross profit percentage was 19.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue for the 2022 Fourth Quarter as compared to 20.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. The gross profit percentage for the Company’s physical therapy operations was 20.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter as compared to 21.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. The gross profit percentage on management contracts was 19.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter as compared to 19.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. The gross profit percentage for industrial injury prevention services was 17.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter as compared to 20.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. The table below details the gross profit (in thousands):
Three Months Ended
December 31, 2022
December 31, 2021
Physical therapy operations
$
24,193
$
24,002
Management contracts
350
428
Industrial injury prevention services
3,288
2,753
Gross profit
$
27,831
$
27,183
During the 2022 Fourth Quarter, the Company recorded a charge for goodwill impairment of $9.1 million related to the IIP Acquisition. The impairment is related to a change in the IIP Acquisition’s current and projected operating income as well as various inputs based on current market conditions, including the higher interest rate environment.
The change in revaluation of put-right liability was $0.8 million for the 2022 Fourth Quarter. The put right relates to the potential future purchase of a company that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area. The owners have the right to put this transaction to the Company in approximately five years from November 2021. The value of this right will continue to be adjusted in future periods, as appropriate.
Interest expense on debt and other, primarily from the Company’s $150 million term loan entered into in June 2022 and to a lesser extent the funds drawn on the Company’s revolving credit facility, amounted to $2.2 million for the 2022 Fourth Quarter. The effective interest rate on the Company’s debt was 5.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter. See discussion of Other Comprehensive Income below for information related to the Company’s interest rate swap agreement. For the 2021 Fourth Quarter, interest expense, primarily from the Company’s revolving line of credit, was $0.2 million.
The provision for income tax was $1.2 million for the 2022 Fourth Quarter and $3.9 million for the 2021 Fourth Quarter. The provision for income tax, as a percentage of income before taxes less net income attributable to non-controlling interest (effective tax rate), was 31.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter and 27.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. Excluding the impact of the impairment charge discussed above, the effective tax in the Fourth Quarter 2022 was 27.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} See computation of 2022 Year tax rate in next section. See table below ($ in thousands):
Three Months Ended
December 31, 2022
December 31, 2021
Income before taxes
$
4,560
$
18,389
Less: net loss (income) attributable to non-controlling interest:
The net loss attributable to redeemable non-controlling interest (temporary equity) was $0.3 million for the 2022 Fourth Quarter as compared to net income attributable to redeemable non-controlling interest of $2.7 million for the 2021 Fourth Quarter. Net income attributable to non-controlling interest (permanent equity) was $1.1 million for the 2022 Fourth Quarter and $1.5 million for the 2021 Fourth Quarter. During the 2022 Fourth Quarter, $2.7 million of the goodwill impairment charge related to redeemable non-controlling interest (temporary equity).
For the 2022 Fourth Quarter, the Company’s net income attributable to its shareholders was $2.6 million as compared to $10.2 million for the 2021 Fourth Quarter. In accordance with GAAP, the revaluation of redeemable non-controlling interest, net of taxes, is not included in net income but charged directly to retained earnings; however, the charge for this change is included in the earnings per basic and diluted share calculation. Inclusive of the charge for revaluation of noncontrolling interest, net of taxes, the amount is a loss of $0.1 million, or $0.01 per diluted share, for the 2022 Fourth Quarter, and income of $9.4 million, or $0.73 per diluted share, for the 2021 Fourth Quarter.
For the 2022 Fourth Quarter, the Company’s Adjusted EBITDA, a non-GAAP measure, was $17.9 million as compared to $17.4 million (excluding Relief Funds) in the 2021 Fourth Quarter. See definition, explanation and calculation of Adjusted EBITDA, a non-GAAP measure, in the schedules on pages 16 and 17.
For the 2022 Fourth Quarter, the Company’s Operating Results, a non-GAAP measure, was $7.5 million, or $0.58 per diluted share as compared to $9.3 million (excluding Relief Funds), or $0.72 per diluted share, for the 2021 Fourth Quarter. See definition, explanation and calculation of Operating Results, a non-GAAP measure, in the schedules on pages 16 and 17.
2022 Year As Compared to 2021 Year **As noted above, the Company is still completing its evaluation of the income tax expense for the 2022 Fourth Quarter and 2022 Year. As a result, the Company’s presentation of earnings per share, operating results per share and its provision for income taxes may change as a result of this evaluation. Set forth below are the Company’s current estimates for these amounts. The Company will promptly announce any changes upon the completion of the evaluation.
Reported total revenue for the 2022 Year was $553.1 million, an increase of 11.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as compared to $495.0 million for the 2021 Year. See table below for a detail of reported total revenue (in thousands):
For the Year Ended
December 31, 2022
December 31, 2021
Revenue related to Mature Clinics
$
421,806
$
420,093
Revenue related to 2022 Clinic Additions
14,779
–
Revenue related to 2021 Clinic Additions
25,211
12,638
Revenue from clinics sold or closed in 2022
2,794
5,143
Revenue from clinics sold or closed in 2021
–
456
Net patient revenue from physical therapy operations
464,590
438,330
Other revenue
3,407
2,939
Revenue from physical therapy operations
467,997
441,269
Revenue – Management contracts
8,095
9,853
Revenue – Industrial injury prevention services
77,052
43,900
Total revenue
$
553,144
$
495,022
Revenue from physical therapy operations increased $26.7 million, or 6.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, to $468.0 million for the 2022 Year from $441.3 million in the 2021 Year. The average net patient revenue per visit was $103.63 for the 2022 Year as compared to $103.88 for the 2021 Year. Total patient visits were 4,483,282 for the 2022 Year and 4,219,576 for the 2021 Year, an increase of 6.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}.
Net patient revenue related to Mature Clinics increased $1.7 million, or 0.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, to $421.8 million for the 2022 Year, as compared to $420.1 million for the 2021 Year. Visits for Mature Clinics (same store) for the 2022 Year increased 0.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as compared to the 2021 Year. The increase in visits was partially offset by a 0.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} reduction in the net patient revenue per visit.
Total operating cost was $441.1 million for the 2022 Year, or 79.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue, as compared to $377.8 million, or 76.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue, for the 2021 Year. Operating cost related to Mature Clinics increased by $16.7 million for the 2022 Year as compared to the 2021 Year. Operating cost related to the IIP services business increased by $27.9 million for the 2022 Year as compared to the 2021 Year, of which $22.4 million related to the IIP Acquisition. See table below for a detail of operating cost (in thousands):
For the Year Ended
December 31, 2022
December 31, 2021
Operating cost related to Mature Clinics
$
337,606
$
320,882
Operating cost related to 2022 Clinic Additions
12,425
74
Operating cost related to 2021 Clinic Additions
20,792
10,299
Operating cost related to clinics sold or closed in 2022
2,810
4,561
Operating cost related to clinics sold or closed in 2021
Total salaries and related costs, including all operations, were 57.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue for the 2022 Year versus 56.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. Rent, supplies, contract labor and other costs as a percentage of total revenue were 21.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year versus 19.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. The provision for credit losses as a percentage of total revenue was 1.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for 2022 Year and 1.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for 2021 Year. The Company experienced pressure on labor rates and other costs in 2022 due to the inflationary economic environment.
Gross profit for the 2022 Year was $112.0 million, a decrease of $5.2 million, or 4.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, as compared to $117.2 million for the 2021 Year. The gross profit percentage was 20.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue for the 2022 Year as compared to 23.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. The gross profit percentage for the Company’s physical therapy operations was 20.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year as compared to 23.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. The gross profit percentage on management contracts was 20.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year as compared to 15.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. The gross profit percentage for industrial injury prevention services was 20.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year as compared to 24.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. Gross profit in the 2022 Year was affected by pressure on labor rates and other costs due to the inflationary economic environment. The IIP margin in 2022 was impacted by the lower margin profile of the IIP Acquisition. The table below details the gross profit (in thousands):
For the Year Ended
December 31, 2022
December 31, 2021
Physical therapy operations
$
94,364
$
104,941
Management contracts
1,693
1,547
Industrial injury prevention services
15,967
10,694
Gross profit
$
112,024
$
117,182
Corporate office costs were $46.1 million for the 2022 Year as compared to $46.5 million for the 2021 Year. Corporate office costs were 8.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue for the 2022 Year as compared to 9.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. The decrease was primarily due to lower estimated bonus expense in the 2022 Year than the 2021 Year.
For the 2022 Year, the valuation of the put-right liability remained relatively the same. The put right relates to the potential future purchase of a company that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area. The owners have the right to put this transaction to the Company in approximately five years from November 2021.
Interest expense on debt and other, primarily from the $150 million term loan and revolving credit facility entered into in June 2022, amounted to $5.8 million for the 2022 Year. The effective interest rate on the Company’s debt was 3.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year. See discussion of Other Comprehensive Income below for information related to the Company’s interest rate swap agreement. For the 2021 Year, interest expense, primarily from the Company’s revolving line of credit, was $0.9 million.
The provision for income tax was $12.2 million for the 2022 Year and $15.3 million for the 2021 Year. The provision for income tax as a percentage of income before taxes less net income attributable to non-controlling interest (effective tax rate) was 27.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year and 27.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. See table below ($ in thousands):
For the Year Ended
December 31, 2022
December 31, 2021
Income before taxes
$
55,571
$
73,196
Less: net income attributable to non-controlling interest:
Net income attributable to redeemable non-controlling interest (temporary equity) was $6.9 million for the 2022 Year as compared to net income attributable to redeemable non-controlling interest (temporary equity) of $11.4 million for the 2021 Year. Net income attributable to non-controlling interest (permanent equity) was $4.3 million for the 2022 Year and $5.7 million for the 2021 Year. During the 2022 Year, $2.7 million of the goodwill impairment charge related to redeemable non-controlling interest (temporary equity).
The Company’s net income attributable to its shareholders was $32.2 million for the 2022 Year, and $40.8 million for the 2021 Year. Inclusive of the charge for revaluation of non-controlling interest, net of taxes, the amount is $29.3 million, or $2.25 per diluted share, for the 2022 Year, and $31.1 million, or $2.41 per diluted share for the 2021 Year. See table on page 17.
For the 2022 Year, the Company’s Operating Results, a non-GAAP measure, was $35.0 million, or $2.70 per diluted share, as compared to $40.8 million (excluding Relief Funds), or $3.17 per diluted share, for the 2021 Year. For the 2021 Year, the Company’s Operating Results including Relief Funds was $43.7 million, or $3.39 per diluted share. See table on page 18.
For the 2022 Year, the Company’s Adjusted EBITDA, a non-GAAP measure, was $73.7 million, as compared to $73.8 million, excluding Relief Funds, for the 2021 Year. See definition, explanation and calculation of Adjusted EBITDA, a non-GAAP measure, in the schedule on pages 16 and 17.
Other Comprehensive Income
The Company entered into an interest rate swap agreement in May 2022, which became effective on June 30, 2022. The maturity date of the swap agreement is June 30, 2027. It has a $150 million notional value adjusted concurrently with scheduled principal payments made on the term loan. Beginning in July 2022, the Company pays a fixed one-month SOFR rate of interest of 2.815{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}. The total interest rate in any period also includes an applicable margin based on the Company’s consolidated leverage ratio. In the 2022 Fourth Quarter and 2022 Full Year, the Company’s interest rate including the applicable margin was 4.665{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}. Unrealized gains and losses related to the fair value of the interest rate swap are recorded to accumulated other comprehensive income (loss), net of tax. The fair value of the interest rate swap at December 31, 2022, was $5.4 million, which has been included within Other assets (current and long term) in the accompanying Consolidated Balance Sheet. The impact of the interest rate swap on the accompanying Consolidated Statements of Comprehensive Income was an unrealized loss of $0.4 million, net of tax, for the 2022 Fourth Quarter, and an unrealized gain of $4.0 million, net of tax, for the 2022 Year.
Quarterly Dividend
The Company’s Board of Directors increased the Company’s quarterly dividend on February 21, 2023, from $0.41 per share to $0.43 per share, an increase of 4.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}. The Board of Directors subsequently declared a quarterly dividend of $0.43 per share payable on April 7, 2023, to shareholders of record on March 10, 2023.
Impact of COVID-19
Relief Funds In March 2020 in response to the COVID-19 pandemic, the federal government approved the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”). The CARES Act provided additional waivers, reimbursement, grants and other funds to assist health care providers during the COVID-19 pandemic, including $100.0 billion in appropriations for the Public Health and Social Services Emergency Fund, also referred to as the Provider Relief Fund, to be used for preventing, preparing, and responding to the coronavirus, and for reimbursing eligible health care providers for lost revenues and health care related expenses that are attributable to COVID-19. For the 2021 Year, the Company recorded income of approximately $4.6 million of payments under the CARES Act (“Relief Funds”). Under the Company’s accounting policy, these payments were recorded as Other income – Relief Funds. These funds are not required to be repaid upon attestation and compliance with certain terms and conditions, which could change materially based on evolving grant compliance provisions and guidance provided by the U.S. Department of Health and Human Services. Currently, the Company can attest and comply with the terms and conditions. The Company will continue to monitor the evolving guidelines and may record adjustments as additional information is released.
Medicare Accelerated and Advance Payment Program (“MAAPP Funds”) The CARES Act allowed for qualified healthcare providers to receive advanced payments under the existing MAAPP funds during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. The Company applied for and received approval to receive MAAPP Funds from Centers for Medicare & Medicaid Services in April 2020. The Company recorded the $14.1 million in advance payments received as a liability. During the quarter ended March 31, 2021, the Company repaid the MAAPP funds of $14.1 million rather than applying them to future services performed.
Management Provides 2023 Earnings Guidance
Management currently expects the Company’s Adjusted EBITDA for 2023 to be in the range of $75.0 million to $80.0 million. The range considers that the previously announced 2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} reduction in the Medicare rate, which we estimate to impact our revenues by $3.1 million, as well as the 2023 impact of the phase-out of sequestration relief during 2022, which we estimate to be $1.2 million, are expected to be offset by increases in commercial rates from renegotiations completed in 2022 and those anticipated to be accomplished in 2023.
Please note that the earnings guidance represents projected Adjusted EBITDA from existing operations and excludes future acquisitions. The annual guidance figures will not be updated unless there is a material development that causes management to believe that Adjusted EBITDA will be significantly outside the given range.
Fourth Quarter and Year Ended 2022 Conference Call
U.S. Physical Therapy’s management will host a conference call at 10:30 a.m. Eastern Time, 9:30 a.m. Central Time, on February 23, 2023, to discuss results for the Company’s 2022 Fourth Quarter and Year ended December 31, 2022. Interested parties may participate in the call by dialing (866) 952-8559 Primary or (785) 424-1743 Alternate and entering reservation number USPHQ422 approximately 10 minutes before the call is scheduled to begin. To listen to the live call via webcast, go to the Company’s website at www.usph.com at least 15 minutes early to register, download and install any necessary audio software. The conference call will be archived and can be accessed until May 23, 2023, at U.S. Physical Therapy’s website.
Forward-Looking Statements
This press release contains statements that are considered to be forward-looking within the meaning under Section 21E of the Securities Exchange Act of 1934, as amended. These statements contain forward-looking information relating to the financial condition, results of operations, plans, objectives, future performance and business of our Company. These statements (often using words such as “believes”, “expects”, “intends”, “plans”, “appear”, “should” and similar words) involve risks and uncertainties that could cause actual results to differ materially from those we expect. Included among such statements may be those relating to new clinics, availability of personnel and the reimbursement environment. The forward-looking statements are based on our current views and assumptions and actual results could differ materially from those anticipated in such forward-looking statements as a result of certain risks, uncertainties, and factors, which include, but are not limited to:
the multiple effects of the impact of public health crises and epidemics/pandemics, such as the novel strain of COVID-19 and its variants, for which the total financial magnitude cannot be currently estimated;
changes in Medicare rules and guidelines and reimbursement or failure of our clinics to maintain their Medicare certification and/or enrollment status;
revenue we receive from Medicare and Medicaid being subject to potential retroactive reduction;
changes in reimbursement rates or payment methods from third party payors including government agencies, and changes in the deductibles and co-pays owed by patients;
compliance with federal and state laws and regulations relating to the privacy of individually identifiable patient information, and associated fines and penalties for failure to comply;
competitive, economic or reimbursement conditions in our markets which may require us to reorganize or close certain clinics and thereby incur losses and/or closure costs including the possible write-down or write-off of goodwill and other intangible assets;
the impact of COVID-19 related vaccination and/or testing mandates at the federal, state and/or local level, which could have an adverse impact on staffing, revenue, costs and the results of operations;
changes as the result of government enacted national healthcare reform;
business and regulatory conditions including federal and state regulations;
governmental and other third party payor inspections, reviews, investigations and audits, which may result in sanctions or reputational harm and increased costs;
revenue and earnings expectations;
some of our acquisition agreements contain contingent consideration, the value of which may impact future financial results;
one of our acquisition agreements includes a Put Right for a potential purchase of a company and we may or may not have the capital necessary to satisfy this obligation;
legal actions, which could subject us to increased operating costs and uninsured liabilities;
general economic conditions, including but not limited to inflationary and recessionary periods;
availability and cost of qualified physical therapists;
personnel productivity and hiring, training and retaining qualified personnel;
competitive environment in the industrial injury prevention services business, which could result in the termination or nonrenewal of contractual service arrangements and other adverse financial consequences for that service line;
acquisitions, and the successful integration of the operations of the acquired businesses;
impact on the business and cash reserves resulting from retirement or resignation of key partners and resulting purchase of their non-controlling interest (minority interests);
maintaining our information technology systems with adequate safeguards to protect against cyber-attacks;
a security breach of our or our third party vendors’ information technology systems may subject us to potential legal action and reputational harm and may result in a violation of the Health Insurance Portability and Accountability Act of 1996 of the Health Information Technology for Economic and Clinical Health Act;
maintaining clients for which we perform management, industrial injury prevention related services, and other services, as a breach or termination of those contractual arrangements by such clients could cause operating results to be less than expected;
maintaining adequate internal controls;
maintaining necessary insurance coverage;
availability, terms, and use of capital; and
weather and other seasonal factors.
In addition to the above, see Risk Factors in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2021 and the additional risk factors below:
Our debt and financial obligations could adversely affect our financial condition, our ability to obtain future financing, and our ability to operate our business.
We have outstanding debt obligations that could adversely affect our financial condition and limit our ability to successfully implement our business strategy. Furthermore, from time to time, we may need additional financing to support our business and pursue our business strategy, including strategic acquisitions. Our ability to obtain additional financing, if and when required, will depend on investor demand, our operating performance, the condition of the capital markets, and other factors. We cannot assure that additional financing will be available to us on favorable terms when required, or at all.
Our loan agreements contain certain restrictions and requirements that among other things:
require us to maintain a quarterly fixed charge coverage ratio and minimum working capital ratio;
limit our ability to obtain additional financing in the future for working capital, capital expenditures and acquisitions, to fund growth or for general corporate purposes;
limit our future ability to refinance our indebtedness on terms acceptable to us or at all;
limit our flexibility in planning for or reacting to changes in our business and market conditions or in funding our strategic growth plan; and
impose on us financial and operational restrictions.
Our ability to meet our debt service obligations will depend on our future performance, which will be affected by the other risk factors described in our Annual Report on Form 10-K for the year ended December 31, 2021, filed on March 1, 2022. If we do not generate enough cash flow to pay our debt service obligations, we may be required to refinance all or part of our existing debt, sell our assets, borrow more money or raise equity. There is no guarantee that we will be able to take any of these actions on a timely basis, on terms satisfactory to us, or at all.
If we fail to satisfy our debt service obligations or the other restrictions and requirements in our loan agreements, we could be in default. Unless cured or waived, a default would permit lenders to accelerate the maturity of the debt under the credit agreement and to foreclose upon the collateral securing the debt.
Our outstanding loans bear interest at variable rates. We are exposed to certain market risks during the ordinary course of business due to adverse changes in interest rates. The exposure to interest rate risk primarily results from our variable-rate borrowing. Fluctuations in interest rates can be volatile and the Company’s risk management activities do not eliminate these risks. In May 2022, we entered into an interest rate swap agreement to manage these risks. While intended to reduce the effects of fluctuations in these prices and rates, these transactions may limit our potential gains or expose us to losses. If our counterparties to such transactions or the sponsors fail to honor their obligations due to financial distress, we would be exposed to potential losses or the inability to recover anticipated gains from these transactions. Some of our acquisition agreements contain contingent consideration, the value of which may impact future financial results.
Some of our acquisition agreements include contingent earn-out consideration, the fair value of which is estimated as of the acquisition date based on the present value of the expected contingent payments as determined using weighted probabilities of possible future payments. These fair value estimates contain unobservable inputs and estimates that could materially differ from the actual future results. The fair value of the contingent earn out consideration could increase or decrease, as applicable. Changes in the fair value of contingent earn-outs will be reflected in our results of operations in the period in which they are recognized, the amount of which may be material and cause volatility in our financial results.
Our business depends upon hiring, training and retaining qualified employees.
Our workforce costs represent our largest operating expense, and our ability to meet our labor needs while controlling labor costs is subject to numerous external factors, including market pressures with respect to prevailing wage rates and unemployment levels. We compete with rehabilitation companies and other businesses for many of our clinical and non-clinical employees, and turnover in these positions can lead to increased training and retention costs, particularly in a competitive labor market. We cannot be assured that we can continue to hire, train and retain qualified employees at current wage rates since we operate in a competitive labor market, and there are currently significant inflationary and other pressures on wages. If we are unable to hire, properly train and retain qualified employees, we could experience higher employment costs and reduced revenues, which could adversely affect our earnings.
One of our acquisition agreements contains a Put Right related to a potential future purchase of a majority interest in a separate company.
One of our acquisition agreements includes a Put Right for the potential future purchase of a majority interest in a separate company at a purchase price which is derived based on a specified multiple of the separate company’s historical earnings. The exercise of the Put Right is outside of our control. In the event the Put Right is triggered, we are required to purchase the aforementioned equity interest at the calculated purchase price described above. The resulting purchase price may be greater than the fair value of such equity interests at the time, and we may or may not have the capital necessary to satisfy such contractual purchase obligation, in which case we could be in breach.
Many factors are beyond our control. Given these uncertainties, you should not place undue reliance on our forward-looking statements. Please see the other sections of this report and our other periodic reports filed with the Securities and Exchange Commission (the “SEC”) for more information on these factors. Our forward-looking statements represent our estimates and assumptions only as of the date of this report. Except as required by law, we are under no obligation to update any forward-looking statement, regardless of the reason the statement may no longer be accurate.
About U.S. Physical Therapy, Inc.
Founded in 1990, U.S. Physical Therapy, Inc. currently operates 640 outpatient physical therapy clinics in 40 states. The Company’s clinics provide preventative and post-operative care for a variety of orthopedic-related disorders and sports-related injuries, treatment for neurologically-related injuries and rehabilitation of injured workers. In addition to owning and operating clinics, the Company manages 40 physical therapy facilities for unaffiliated third parties, including hospitals and physician groups. The Company also has an industrial injury prevention services business which provides onsite services for clients’ employees including injury prevention and rehabilitation, performance optimization, post-offer employment testing, functional capacity evaluations, and ergonomic assessments.
More information about U.S. Physical Therapy, Inc. is available at www.usph.com. The information included on that website is not incorporated into this press release.
U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF INCOME
(IN THOUSANDS, EXCEPT PER SHARE DATA)
(unaudited)
Three Months Ended
For the Year Ended
December 31, 2022
December 31, 2021
December 31, 2022
December 31, 2021
Net patient revenue
$
120,146
$
113,511
$
464,590
$
438,330
Other revenue
21,036
16,322
88,554
56,692
Net revenue
141,182
129,833
553,144
495,022
Operating cost:
Salaries and related costs
82,317
75,296
319,191
278,469
Rent, supplies, contract labor and other
29,678
25,971
116,381
94,066
Provision for credit losses
1,356
1,383
5,548
5,305
Total operating cost
113,351
102,650
441,120
377,840
Gross profit
27,831
27,183
112,024
117,182
Goodwill Impairment
9,112
–
9,112
–
Corporate office costs
11,925
10,718
46,111
46,533
Operating income
6,794
16,465
56,801
70,649
Other income and expense
Relief Funds
–
4,597
–
4,597
Resolution of a payor matter
–
–
–
1,216
Settlement of a legal matter
–
(2,635
)
–
(2,635
)
Change in fair value of contingent earn-out consideration
520
–
2,520
–
Equity in earnings of unconsolidated affiliate
192
112
1,175
112
Other and interest income
69
41
859
199
Change in revaluation of put-right liability
(776
)
–
(5
)
–
Interest expense – debt and other, net
(2,239
)
(191
)
(5,779
)
(942
)
Total other income and expense
(2,234
)
1,924
(1,230
)
2,547
Income before taxes
4,560
18,389
55,571
73,196
Provision for income taxes
1,212
3,946
12,164
15,272
Net income
3,348
14,443
43,407
57,924
Less: net loss (income) attributable to non-controlling interest:
A 7.8-magnitude earthquake struck Turkey and Syria on 6 February, killing extra than 47,000 individuals.Credit score: Salwan Georges/The Washington Article through Getty
The 7.8-magnitude earthquake that struck Turkey and Syria on 6 February has killed a lot more than 50,000 persons and flattened numerous cities. A lot more than 4,500 of those who died, and 8,500 wounded, are in northwest Syria, a region with no unified govt that has been slash off from the globe for extra than 12 years amid a devastating war. Its now-depleted wellness-treatment program — 4.7 million people today share just just one MRI device — is on its knees. A lot more than 10,000 buildings are totally or partially ruined, leaving 11,000 people today homeless, in accordance to the United Nations humanitarian company, OCHA. The earthquake also ruined warehouses that retail store medicines. Nature spoke to physicians, engineers and other experts on the ground, as very well as those people encouraging remotely from Europe and elsewhere in the Center East. This is what they have explained.
Credits: Earthquake intensity data: US Geological Study. Waterways: Humanitarian OpenStreetMap Team. Buildup: AtlasAI. Administrative boundaries: UN Office for the Coordination of Humanitarian Affairs.
Right after the 2011 Arab Spring, Syria’s federal government utilized navy force versus all opposition. All over 60{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of northwest Syria’s 4.7 million folks are internally-displaced, acquiring fled bombing assaults from the federal government of Bashar al-Assad with military services backing from Russia.
The United Nations and help agencies are battling to get materials and skills to earthquake-affected locations, due to the fact there are only a few short term crossing factors together the 911-kilometre border with Turkey.
Medical unexpected emergency
Hospitals in this area have been overwhelmed as they try to accommodate thousands of hurt persons in spaces with severely restricted beds, health care materials, surgical gear and intense-treatment amenities.
Much more than 8,500 injured people have to have to be accommodated in only 66 purposeful hospitals furnishing 1,245 beds for quick medical center stays, according to the WHO. What’s more, all of northwest Syria has just 86 orthopaedic surgeons, 64 X-ray machines, 7 computerized tomography (CT) scanners and a person magnetic resonance imaging (MRI) device throughout the region, in accordance to WHO-compiled details released in direction of the finish of 2022. Gynaecologist Ikram Haboush, director of Idleb city’s sole community maternity-medical center, suggests “the medical predicament in northwest Syria is catastrophic”.
“The provide of antibiotics ran out from day three” immediately after the earthquake, says Abdulkarim Ekzayez, an epidemiologist at King’s College London, who now fears widespread bacterial infections. “We have used the medications and serums that would have lasted us for four to 6 months in two to a few days,” adds Haboush. The WHO has started off airlifting medications and health care materials, but claims northwest Syria also needs essential diagnostic machines such as X-ray equipment.
The region’s significant deficiency of health and fitness care is partly induced by hospitals and medical employees being qualified through the war, clarifies Ekzayez, who is a co-investigator on a Uk-funded challenge known as Study for Health Process Strengthening in Syria. In a separate review, Ekzayez estimated that as of June 2021, 350 clinical amenities experienced been attacked and 930 wellbeing-care personnel killed.
“People are working all above the place to make use of any current resources, which includes basic ambulances,” Ekzayez says. “The professional medical staff members have been doing work non-prevent,” provides Haboush, who was doing the job at the maternity clinic in Idleb when the initial earthquake hit at 01:17 common time. The hospital occupies the fifth and sixth flooring of a setting up. “We experienced to evacuate the incubators and go all the infants to the floor floor,” Haboush recalls.
In accordance to 3 medical professionals who Nature spoke to in northwest Syria, the most common accidents are limb fractures, trauma injuries, crush accidents which include ‘crush syndrome’ (damages that result in organ dysfunction like kidney failure) and bleeding.
Individuals with crush syndrome have to have intense treatment and dialysis, claims cardiologist Jawad Abu Hatab, who is dean of medicine at Cost-free Aleppo College in northwest Syria. Having said that, the region has only 73 renal dialysis equipment, in accordance to the WHO-compiled details.
“There ended up also conditions of cardiac arrests from the shock and horror of the catastrophe,” Abu Hatab provides. The health-related local community is also planning to deal with more situations of write-up-earthquake trauma, specifically amid children and women of all ages.
Physicians say that they urgently want much more dialysis machines and orthopaedic-surgical treatment devices, alongside with painkillers and antibiotics. “These materials had been not plentiful ahead of the earthquake,” and will now operate out, claims Haboush.
Rescuers searched for survivors in the rubble of collapsed properties in Harim, 1 of the towns with the maximum variety of fatalities and accidents.Credit history: Omar Haj Kadour/AFP by using Getty
Bare-eye injury assessments
Volunteer engineers are going property-to-property examining which of some 8,500 earthquake-harmed buildings are safe ample for individuals to return to. But lacking in the important instruments and safety gear, they are resorting to tapping partitions with home implements this kind of as simple hammers and generating decisions working with the naked eye.
It is painstaking do the job. As of 25 February, all over 2,644 of the damaged properties experienced been assessed, in accordance to the Association of Absolutely free Syrian Engineers , a voluntary group centered in A’zaz, in close proximity to Aleppo, that is coordinating the effort and hard work.
At the very same time, industry experts from the Syrian diaspora are supporting with digital assessments in places inaccessible to neighborhood engineers. Inhabitants of weakened buildings are taking photos and video clips of the interiors and sending them to customers of the Syrian Engineers Association in Qatar, based mostly in Doha.
“Assessing the structural status of buildings is as urgent as the medical situation and should not be underestimated simply because aftershocks are however on-likely suggests Muhammad Azmie Tawackol, a civil engineer and the association’s president. But in northwest Syria, persons are owning to use whatsoever approaches are obtainable, he provides.
The engineers are making an attempt to estimate no matter whether buildings are inhabitable (risk-free with slight cracks), quickly unusable (needing reinforcement) or unsafe — in which circumstance occupants must evacuate right away.
Properties in threat of collapsing are getting strengthened with whichever products are out there, irrespective of regardless of whether they are ideal. Carbon-fibre-bolstered polymers would function far better for seismic reinforcement, Mohammad Khear Hayek, an engineer with the volunteers association, advised Nature. Instead, they are owning to use brittle industrial iron. “We are in an unexpected emergency circumstance, so we have to respond rapidly using the methods that we have,” Hayek claims.
The engineers association centered in northwest Syria is collating information daily and “the following phase is to analyse the experiences and produce statistical studies, which will be essential in the reconstruction phase”, suggests affiliation member Ali Hallak, a personal computer engineer.
Several properties will want to be rebuilt, but there is a scarcity of engineers in northwest Syria, claims Hayek. Right before the earthquake, “we talked about a will need to practice engineers on reconstruction according to suitable safety specifications”, Hayek suggests. “Now this has develop into a requirement,” he provides.
Online education and learning has come to be a well-liked selection for people wanting to further more their education and learning or receive new skills. Learners may well now attend education and learning from any place in the globe and at their have speed because of the relieve and flexibility it delivers.
According to Allied Marketplace Research, the worldwide e-learning marketplace was predicted to be $197.00 billion in 2020 and is predicted to boost at a 17.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} CAGR in between 2021 and 2030, achieving $840.11 billion by 2030.
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