2021-10-24-瑞士信贷集团-第三季度急性期后预览_关于家庭健康和临终关怀的问题_38页_1mb

Post-Acute Healthcare Providers Summary

Core Content

This document provides a detailed analysis of the performance and expectations for key post-acute healthcare providers in the third quarter of 2021 (3Q21), focusing on challenges such as labor shortages, volume pressures, and pricing trends. It also includes financial expectations, valuations, and target prices for each company based on Credit Suisse Research.

Main Points

Labor Shortage and Impact

• Labor Constraints: The entire post-acute sector is facing labor shortages, particularly in home health and hospice services.
• Contract Labor: Companies are increasingly relying on contract labor due to limited clinical capacity. For example, AMED has 4.5% contract utilization, with a peak of 4.9% in some markets.
• Delta Variant Impact: The delta variant has increased the percentage of clinicians on quarantine, particularly in the Southeastern U.S., which has spiked contract labor usage.
• Staffing Challenges: All companies report challenges in both recruitment and retention, with some noting higher turnover in hospice services due to the lower length of stay (LOS) associated with COVID patients.

Volume and Pricing Trends

• Home Health (HH):
  • AMED and LHCG face volume pressure due to labor shortages and the delta variant.
  • AMED expects a 7.2% sequential growth in hospice admissions, while a 6.9% decline is anticipated for Q3.
  • EHC has seen a rebound in IRF volumes, with 16.9% Y/Y growth in SS discharge and 18.7% in total discharge.
• Hospice:
  • Occupancy challenges in skilled nursing facilities (SNFs) have impacted hospice referral volumes.
  • AMED and LHCG report declining hospice admissions and ADC (Average Daily Census), with AMED expecting a 9.4% Y/Y decline.
• IRFs (Inpatient Rehabilitation Facilities):
  • EHC reports strong recovery in elective procedures, with SS discharge growth of 16.9% Y/Y.
  • EHC expects continued recovery in 2H21, with a 4.9% sequential increase in total discharges.

Financial Expectations

• ACHC:
  • Expected revenue growth of 7.9% Y/Y to $591.4 mln.
  • Adj. EBITDA growth of 8.4% Y/Y to $145.4 mln.
  • 2021 revenue guidance of $2.31 bln, EBITDA of $541 mln, and EPS of $2.57 - $2.61.
• AMED:
  • Expected revenue growth of 4.0% Y/Y to $565.8 mln.
  • Adj. EBITDA growth of 12.0% Y/Y to $306 mln.
  • 2021 revenue guidance of $2.25 bln, EBITDA of $301 - $308 mln, and EPS of $6.03 - $6.18.
• AVAH:
  • Expected revenue growth of 10.5% Y/Y in HH.
  • Adj. EBITDA growth of 12.0% Y/Y to $306 mln.
  • 2021 revenue guidance of $1.75 bln, EBITDA of $187.7 mln, and EPS of $0.40.
• EHC:
  • Expected revenue growth of 4.0% Y/Y to $1.31 bln.
  • Adj. EBITDA growth of 12.0% Y/Y to $255.4 mln.
  • 2021 revenue guidance of $5.175 bln, EBITDA of $1.06 bln, and EPS of $4.37.
• LHCG:
  • Expected revenue growth of 4.0% Y/Y to $566 mln.
  • Adj. EBITDA growth of 12.0% Y/Y to $68.4 mln.
  • 2021 revenue guidance of $2.202 bln, EBITDA of $269 mln, and EPS of $5.83.
• SEM:
  • Expected revenue growth of 4.0% Y/Y to $1,445 mln.
  • Adj. EBITDA growth of 12.0% Y/Y to $996 mln.
  • 2021 revenue guidance of $5,999 mln, EBITDA of $996 mln, and EPS of $3.04.

Valuations and Target Prices

• Target Prices:

  • ACHC: $68.00 (Outperform), 13.0x 2022 EBITDA.
  • AMED: $192.00 (Outperform), 20.5x 2022 EBITDA.
  • AVAH: $12.00 (Outperform), 14.2x 2022 EBITDA.
  • EHC: $82.00 (Outperform), 10.6x 2022 EBITDA.
  • LHCG: $191.00 (Outperform), 20.3x 2022 EBITDA.
  • SEM: $39.00 (Neutral), 9.5x 2022 EBITDA.

• Valuation Multiples:

  • ACHC: Current P/E of 23.6x, EV/EBITDA of 13.3x.
  • AMED: Current P/E of 27.7x, EV/EBITDA of 18.1x.
  • AVAH: Current P/E of 25.8x, EV/EBITDA of 10.1x.
  • EHC: Current P/E of 24.5x, EV/EBITDA of 9.5x.
  • LHCG: Current P/E of 28.9x, EV/EBITDA of 15.6x.
  • SEM: Current P/E of 17.8x, EV/EBITDA of 8.7x.

Key Information

• Labor Shortage: A significant challenge across the post-acute sector, particularly in home health and hospice, with elevated contract labor usage and increasing clinician quarantines due to the delta variant.
• Volume Pressures: Reduced hospice admissions and ADC growth due to lower SNF referrals and increased patient churn.
• Recovery in IRFs: EHC is showing signs of recovery with increased elective procedures and SS discharge growth.
• Financial Outlook: All companies are expected to see some level of growth in revenue and EBITDA, though some face headwinds from staffing issues and volume declines.
• Risk Factors: Staffing challenges, volume pressures, and the impact of the delta variant on elective procedures and patient confidence.

Summary of Financial Expectations

Conclusion

The post-acute healthcare sector is navigating through a period of recovery and challenges, with labor shortages and volume pressures being the most pressing issues. While some companies like EHC are showing signs of recovery, others such as AMED and LHCG are experiencing declines in hospice admissions and ADC growth. Financial expectations for 2021 are generally positive, with revenue and EBITDA growth anticipated, though these are tempered by the ongoing impact of the pandemic and labor constraints. The document highlights the importance of strategic expansion and the management of staffing issues for sustained growth.