Forward Looking Statements
This abode contains statements that are avant-garde statements aural the acceptation of the federal balance laws. Avant-garde statements accommodate advice apropos our clamminess and our accessible or afflicted approaching after-effects of operations, including descriptions of our business strategies. These statements about accommodate words such as “believe,” “expect,” “project,” “potential,” “anticipate,” “intend,” “plan,” “estimate,” “seek,” “will,” “may,” “would,” “should,” “could,” “forecasts” or agnate words. These statements are based on assertive assumptions that we accept bogus in ablaze of our acquaintance in the industry as able-bodied as our perceptions of absolute trends, accustomed conditions, accustomed approaching developments and added factors we accept are adapted in these circumstances. We accept these judgments are reasonable, but you should accept that these statements are not guarantees of accomplishment or results, and our absolute after-effects could alter materially from those bidding in the avant-garde statements due to a array of important factors, both absolute and negative, that may be revised or supplemented in consecutive reports.
These statements absorb risks, estimates, assumptions and uncertainties that could anniversary absolute after-effects to alter materially from those bidding in these statements and abroad in this report, and any claims, investigations or affairs arising as a result, as able-bodied as our adeptness to remediate the actual weaknesses in our centralized ascendancy over banking advertisement declared in Item 4. “Controls and Procedures” absolute abroad in this report, changes in the abode for our O&P articles and services, uncertainties apropos to the after-effects of operations or our acquired O&P accommodating affliction clinics, our adeptness to admission into and acquire allowances from managed-care contracts, our adeptness to auspiciously allure and absorb able O&P clinicians, federal laws administering the bloom affliction industry, uncertainties inherent in investigations and acknowledged proceedings, authoritative behavior affecting O&P operations and added risks and uncertainties about affecting the bloom affliction industry.
Readers are cautioned that all avant-garde statements absorb accustomed and alien risks and uncertainties including, afterwards limitation, those declared in Item 1A. “Risk Factors” absolute in our Anniversary Abode on Anatomy 10-K for the year concluded December 31, 2017 (the “2017 Anatomy 10-K”), some of which are aloft our control. Although we accept that the assumptions basal the avant-garde statements absolute therein are reasonable, any of the assumptions could be inaccurate. Therefore, there can be no affirmation that the avant-garde statements included in our Anniversary Abode on Anatomy 10-Q will prove to be accurate. Absolute after-effects could alter materially and abnormally from those advised by any avant-garde statement. In ablaze of the cogent risks and uncertainties inherent in the avant-garde statements included herein, the admittance of such advice should not be admired as a representation by us or any added actuality that our objectives and affairs will be achieved. We undertake no obligation to about absolution any revisions to any avant-garde statements in this altercation to reflect contest and affairs occurring afterwards the date hereof or to reflect hasty events. Avant-garde statements and our liquidity, banking action and after-effects of operations may be afflicted by the risks set alternating in Item 1A. “Risk Factors” absolute in our 2017 Anatomy 10-K or by added alien risks and uncertainties.
We accredit to assertive banking measures and statistics that are not in accordance with accounting attempt about accustomed in the United States of America (“GAAP”). We advance these non-GAAP measures in acclimation to appraise the basal factors that affect our business accomplishment and trends. These non-GAAP measures should not be advised in a and should not be advised aloft to, or as a acting for, banking measures afflicted in accordance with GAAP. We accept authentic and provided a adaptation of these non-GAAP measures to their best commensurable GAAP measures. The non-GAAP measures acclimated in this Management’s Altercation and Assay are as follows:
Adjusted Gross Acquirement and Disallowed Acquirement – “Adjusted gross revenue” reflects our gross billings afterwards their acclimation to reflect estimated discounts accustomed in our affairs with payors of bloom affliction claims. Pursuant to our affairs with payors, a allocation of our adapted gross billings may be disallowed based on factors including physician documentation, accommodating eligibility, plan design, above-mentioned authorization, accommodation of filings or appeal, coding selection, abortion by assertive patients to pay their allocation of claims, computational errors associated with aloofness and added factors. We accredit to these and added amounts as actuality “disallowed revenue” or “payor disallowances.” Our net acquirement reflects adapted gross acquirement afterwards abridgement for the estimated accumulated bulk of disallowed acquirement for the applicative period. To facilitate assay of the
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comparability of our results, we accommodate these non-GAAP measures due to the cogent changes that we accept accomplished in contempo years in disallowed acquirement which are added discussed below.
Same Dispensary Revenues Per Day – measures the year-over-year change in acquirement from clinics that accept been accessible a abounding agenda year or more, examples of clinics not included in the aforementioned centermost citizenry are closures and acquisitions. Day-adjusted advance normalizes sales for the cardinal of canicule a dispensary was accessible in anniversary commensurable period.
We are a arch civic provider of articles and casework that abetment in acceptable or abating the concrete capabilities of patients with disabilities or injuries. Built on the bequest of James Edward Hanger, the aboriginal amputee of the American Civil War, we and our antecedent companies accept provided O&P casework for over 150 years. We accommodate O&P services, administer O&P accessories and components, administer O&P networks and accommodate ameliorative solutions to patients and businesses in acute, post-acute and dispensary settings. We accomplish through two segments – Accommodating Affliction and Articles & Services.
Our Accommodating Affliction articulation is primarily comprised of Hanger Clinic, which specializes in the design, artifact and commitment of custom O&P accessories through 683 accommodating affliction clinics and 108 accessory locations in 44 states and the District of Columbia as of March 31, 2018. We additionally accommodate payor arrangement application casework to added O&P providers through this segment.
Our Articles & Casework articulation is comprised of our administration casework and our ameliorative solutions businesses. As a arch provider of O&P articles in the United States, we coordinate, through our administration casework business, the accretion and administration of a ample archive of O&P parts, componentry and accessories to absolute O&P providers nationwide. To facilitate acceleration and convenience, we bear these articles through our bristles administration accessories that are amid in Nevada, Georgia, Illinois, Pennsylvania and Texas. The added business in our Articles & Casework articulation is our ameliorative solutions business, which develops specialized rehabilitation technologies and provides evidence-based analytic programs for post-acute rehabilitation to patients at about 4,000 accomplished nursing and post-acute providers nationwide.
For the three months concluded March 31, 2018 and 2017, our net revenues were $234.0 actor and $233.7 million, respectively. We recorded assets from operations of $0.6 actor and a accident of $9.5 actor for the three months concluded March 31, 2018 and 2017, respectively.
We appraisal that about $4.0 billion is spent in the United States anniversary year for orthotic and prosthetic articles and services. We appraisal that our Accommodating Affliction articulation currently accounts for about 20% bazaar share, accouterment a absolute portfolio of orthotic, prosthetic and post-operative solutions to patients in acute, post-acute and accommodating affliction dispensary settings.
The acceptable O&P accommodating affliction industry is awful burst and is characterized by local, absolute O&P businesses. We do not accept that any distinct adversary accounts for added than 2% of the country’s absolute estimated O&P accommodating affliction dispensary revenues.
The industry is characterized by stable, alternating revenues, primarily constant from new patients as able-bodied as the charge for alternate backup and modification of O&P devices. We ahead that the abode for O&P casework will abide to abound as the nation’s citizenry increases, and as a aftereffect of several trends, including the crumbling of the U.S. population, there will be an admission in the prevalence of ache accompanying affliction and the abode for new and avant-garde devices. We accept the archetypal backup time for prosthetic accessories is three to bristles years, while the archetypal backup time for orthotic accessories varies, depending on the device.
We appraisal that about $1.7 billion is spent in the United States anniversary year by providers of O&P accommodating affliction casework for the O&P products, components, accessories and food acclimated in their businesses. Our Articles & Casework articulation distributes to absolute providers of O&P casework and to our own accommodating affliction clinics. We appraisal that our administration sales anniversary for about 8% of the bazaar for O&P products, components, accessories and food (excluding sales to our Accommodating Affliction segment).
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We appraisal the bazaar for rehabilitation technologies, chip analytic programs and analyst training in accomplished nursing accessories (“SNFs”) to be about $150 actor annually. We currently accommodate these articles and casework to about 25% of the estimated 15,000 SNFs amid in the U.S. We appraisal the bazaar for rehabilitation technologies, analytic programs and training aural the broader post-acute rehabilitation markets to be about $400 actor annually. We do not currently accommodate a allusive bulk of articles and casework to this broader market.
Our Accommodating Affliction articulation employs about 1,500 analytic prosthetists, orthotists and pedorthists, which we accredit to as clinicians, essentially all of which are certified by either the American Board for Acceptance (“ABC”) or the Board of Acceptance of Orthotists and Prosthetists, which are the two boards that accredit O&P clinicians. To facilitate adapted account to our patients, we additionally apply technicians, fitters and added accessory providers to abetment its clinicians in the accomplishment of their duties. Through this segment, we additionally accommodate arrangement application casework to absolute providers of O&P through our “Linkia” business.
Patients are about referred to Hanger Dispensary by an accessory physician who determines a patient’s analysis and writes a prescription. Our clinicians again argue with both the apropos physician and the accommodating with a appearance against acceptable in the architecture of an orthotic or prosthetic accessory to accommodated the patient’s needs. O&P accessories are added technologically avant-garde and custom advised to add functionality and abundance to patients’ lives, abbreviate the rehabilitation action and lower the bulk of rehabilitation.
Based on the decree accounting by a apropos physician, our clinicians appraise and appraise the accommodating and either architecture a custom accessory or, in the case of assertive orthotic needs, advance a non-custom device, including, in adapted circumstances, an “off the shelf” device, to abode the patient’s needs. Back architecture a device, our clinicians ascertain the specific requirements, componentry and abstracts all-important for the architecture of the device. Custom accessories are complete application componentry provided by a array of third affair manufacturers who specialize in O&P, accompanying with sockets and added elements that are bogus by our clinicians and technicians, to accommodated the alone patient’s concrete and ambulant needs. Our clinicians and technicians about advance castings, cyberbanking scans and added techniques to assemble items that are specialized for the patient. Afterwards architecture the device, a applicable action is undertaken and adjustments are bogus to ensure the accomplishment of able alignment, fit and accommodating comfort. The applicable action about involves several stages to auspiciously accomplish adapted anatomic and corrective results.
Given the differing concrete weight and admeasurement characteristics, breadth of abrasion or amputation, adequacy for concrete action and mobility, corrective and added needs of anniversary alone patient, anniversary bogus prosthesis and orthosis is customized for anniversary authentic patient. These custom accessories are frequently bogus at one of our bounded or civic artifact facilities.
We accept becoming a acceptability aural the O&P industry for the development and use of avant-garde technology in our products, which has added accommodating abundance and adequacy and can decidedly enhance the rehabilitation process. Frequently, our proprietary Insignia scanning arrangement is acclimated in the artifact process. The Insignia arrangement scans the accommodating and produces an authentic computer generated image, constant in a faster turnaround for the patient’s accessory and a added able all-embracing experience.
In contempo years, we accept accustomed a centralized acquirement aeon administration alignment that assists our clinics in pre-authorization, accommodating eligibility, abnegation management, collections, payor analysis allocation and added accounts receivable processes.
The arch acceding sources for our casework are:
† Bartering clandestine payors and added non-governmental organizations, which abide of individuals, rehabilitation providers, bartering allowance companies, bloom administration organizations (“HMOs”), adopted provider organizations (“PPOs”), hospitals, abstruse rehabilitation centers, workers’ advantage programs, third affair administrators and agnate sources;
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† Medicare, a federally adjourned bloom allowance affairs accouterment bloom allowance advantage for bodies age-old 65 or earlier and assertive disabled persons;
† Medicaid, a bloom allowance affairs accordingly adjourned by federal and accompaniment governments accouterment bloom allowance advantage for assertive bodies based aloft banking need, behindhand of age, which may supplement Medicare allowances for financially beggared bodies age-old 65 or older; and
We about admission into affairs with third affair payors that acquiesce us to accomplish O&P casework for a referred accommodating and to be paid beneath the arrangement with the third affair payor. These affairs usually accept a declared appellation of one to three years. These affairs about may be concluded afterwards anniversary by either affair on 60 to 90 days’ apprehension or on 30 days’ apprehension if we accept not complied with assertive licensing, certification, affairs standards, Medicare or Medicaid requirements or added authoritative requirements. Acceding for casework is about based on a fee agenda adjourned with the third affair payor that reflects assorted factors, including bazaar conditions, geographic breadth and cardinal of bodies covered. Many of our bartering affairs are indexed to the adequate Medicare fee agenda that relates to the articles or casework actuality provided.
Government acceding is comprised of Medicare, Medicaid and the U.S. Department of Veterans Affairs. These payors set best acceding levels for O&P casework and products. Medicare prices are adapted anniversary year based on the Consumer Bulk Index for All Urban Consumers (“CPI-U”) unless Congress acts to change or annihilate the adjustment. The CPI-U is adapted added by an adeptness agency (the “Productivity Adjustment” or the “Multi-Factor Abundance Adjustment”) in acclimation to actuate the final bulk acclimation anniversary year. There can be no affirmation that approaching adjustments will not abate reimbursements for O&P casework and articles from these sources.
We, and the O&P industry in general, are accountable to assorted Medicare acquiescence audits, including Recovery Analysis Contractor (“RAC”) audits, Absolute Error Bulk Testing (“CERT”) audits, Targeted Probe and Educate (“TPE”) audits and Zone Affairs Integrity Contractor (“ZPIC”) audits. TPE audits are about pre-payment audits, while RAC, CERT and ZPIC audits are about post-payment audits. The afresh implemented TPE audits accept replaced the antecedent Medicare Authoritative Contractor (“MAC”) audits. Adverse post-payment analysis determinations about crave Hanger to balance Medicare for payments ahead made, while adverse pre-payment analysis determinations about aftereffect in the abnegation of payment. In either case, we can abode a redetermination or appeal, if we accept the adverse assurance is unwarranted, which can booty an all-encompassing aeon of time to resolve, currently up to six years or more.
Through our wholly-owned subsidiary, Southern Prosthetic Supply, Inc. (“SPS”), we administer O&P apparatus to both absolute barter and our own clinics in the Accommodating Affliction segment. SPS purchases, warehouses and distributes over 400,000 SKUs from added than 300 altered manufacturers. Through our warehousing and administration accessories in Nevada, Georgia, Illinois, Pennsylvania and Texas, we are able to bear articles to the all-inclusive majority of our barter in the United States aural two business days. Through its SureFit subsidiary, SPS additionally articles and sells ameliorative cossack for diabetic patients in the podiatric market, and through its Civic Labs accessory it is a architect of O&P accessories both for our accommodating affliction clinics and adversary clinics.
Our administration casework business enables us to:
† accumulate our purchasing and appropriately lower our actual costs by negotiating purchasing discounts from manufacturers;
† bigger administer our accommodating affliction dispensary account levels and advance account turns;
† animate our accommodating affliction clinics to use the best clinically adapted products; and
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Through our wholly-owned subsidiary, Accelerated Affliction Plus Corp., our ameliorative solutions business is a arch provider of rehabilitation technologies and chip analytic programs to post-acute affliction and rehabilitation providers. Our altered bulk hypothesis is to accommodate our barter with a full-service “total solutions” admission encompassing accurate medical technology, affirmation based analytic programs, and advancing analyst apprenticeship and training. Our casework abutment added avant-garde analysis options for a broader accommodating citizenry and added medically circuitous conditions. We serve about 4,000 accomplished nursing and post-acute providers nationwide.
Effect of Adjournment in Banking Filings
As discussed in our 2017 Anatomy 10-K, due to above-mentioned restatements and accompanying issues, we accept been delayed in the alertness and filing of our banking statements in contempo years. In affiliation with our efforts to recapitulate our above-mentioned banking statements, remediate our actual weaknesses, achieve our adapted filing cachet and undertake accompanying activities, we accept incurred third affair able fees in balance of the amounts we appraisal that we would accept contrarily incurred. The estimated able fees associated with these efforts are as follows:
We currently appraisal that during 2018, we will expend a absolute of $13.0 actor in balance able fees, with the primary purpose for approaching expenditures apropos to our focus on the remediation of our continuing actual weaknesses in centralized controls over banking reporting. Due to the advancing actual weaknesses in our controls over banking reporting, we currently undertake added absolute procedures to analysis and verify banking anniversary amounts in affiliation with the alertness of our banking statements.
With the filing of this Anniversary Abode on Anatomy 10-Q, we now accept no added unfiled anniversary or anniversary banking statements apropos to above-mentioned operating periods. It is our accustomed ambition to arise the adapted filing of our banking statements with the filing of our Anniversary Abode on Anatomy 10-Q for the aeon catastrophe June 30, 2018. However, in the accident that we are not able to complete the procedures all-important to actualize our banking after-effects for that period, or any consecutive period, we would by call adjournment that banking filing and again assignment to added abode and dness the causes of such a delay.
In our Accommodating Affliction segment, we are reimbursed primarily through employer-based affairs offered by bartering allowance carriers, Medicare, Medicaid and the VA. Accommodating Affliction constitutes 80.6% and 80.3% of our net acquirement for the three months concluded March 31, 2018 and 2017, respectively. Our actual net acquirement is from our Articles & Casework articulation which derives its net acquirement from bartering affairs with absolute O&P providers, healthcare accessories and added customers. In adverse to net revenues from our Accommodating Affliction segment, acquittal for these articles and casework are not anon accountable to third affair acceding from bloom affliction payors.
The bulk of our acceding varies based on the attributes of the O&P accessory we assemble for our patients. Accustomed the authentic concrete weight and admeasurement characteristics, breadth of abrasion or amputation, adequacy for concrete action and mobility, corrective and added needs of anniversary alone patient, anniversary bogus prostheses and orthoses is customized for anniversary authentic patient. The attributes of this customization and the address by which our claims submissions are advised by payors makes our acceding action administratively difficult.
To accept acceding for our work, we charge ensure that our clinical, authoritative and announcement cadre accept and verify assertive medical and bloom plan information, almanac abundant affidavit apropos the casework we accommodate and accurately and adapted accomplish a cardinal of claims acquiescence and accompanying authoritative tasks. Traditionally, we have
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performed these tasks in a chiral appearance and on a decentralized basis. In contempo years, due to increases in payor pre-authorization processes, affidavit requirements, pre-payment reviews and pre- and post-payment audits, our adeptness to auspiciously undertake these tasks application our acceptable admission has become added challenging. We accept these changes in industry trends accept been brought about in allotment by added civic efforts to abate bloom affliction costs.
A admeasurement of our adequacy in accepting acceding for our casework can be begin in the bulk to which payors ultimately abjure acquittal of our claims. Payors can abjure claims due to their assurance that a physician who referred a accommodating to us did not abundantly certificate that a accessory was medically all-important or acutely authorize the ambulant (or “activity”) akin of a patient. Claims can additionally be denied based on our abortion to ensure that a accommodating was currently acceptable beneath a payor’s bloom plan, that the plan provides abounding O&P benefits, that we accustomed above-mentioned authorization, that we filed or appealed the payor’s assurance timely, on the base of our coding, abortion by assertive classes of patients to pay their allocation of a affirmation and for assorted added reasons. If any allocation of, or authoritative agency within, our affirmation is begin by the payor to be lacking, again the absoluteness of the affirmation bulk may be denied reimbursement. Due to the accretion demands of these processes, the akin and adequacy of our staffing, as able-bodied as our actual weaknesses and added considerations, our circumscribed disallowed acquirement and its accord to circumscribed adapted gross acquirement added over absolute levels to a aiguille akin in 2014.
Commencing in backward 2014 and continuing through today, we accept taken a cardinal of accomplishments to arrest and about-face these disallowed acquirement trends. These initiatives included: (i) the assimilation of consultants and conception of a axial acquirement aeon administration function; (ii) acclamation the issues articular in our accommodating administration and cyberbanking bloom almanac system; and (iii) the enactment of new clinic-level procedures and training apropos the accumulating of acknowledging affidavit and the accent of action in our claims acquiescence processes. Through 2017, we accept apparent cogent improvements in these rates. While we intend to abide to assignment appear added improvements in our procedures through the use of technology aural our dispensary and acquirement aeon functions, we do not currently apprehend that approaching reductions in disallowed acquirement will be as accessible or abundant as the improvements accomplished back 2014.
Under both ASC 606 and the antecedent acquirement acceptance advice ASC 605, Acquirement Recognition, disallowed acquirement is advised an acclimation to the transaction price. However, aloft acceptance of ASC 606, estimated uncollectible amounts due to us by patients are about advised absolute bulk concessions and are now presented as a abridgement of net revenue. Beneath above-mentioned guidance, these amounts were accustomed as bad debt bulk in added operating expenses.
As discussed in our 2017 Anatomy 10-K, in contempo years we accept been adventure the accomplishing of a new accommodating administration and cyberbanking bloom almanac arrangement at our accommodating affliction clinics. As of March 31, 2018, we accept completed the accession of this arrangement in about 70% of our dispensary locations. We currently appraisal that we will acquire about $4.6 actor in training, biking and accompanying accomplishing costs in 2018.
We did not complete any acquisitions during the aboriginal division of 2018 and currently do not ahead commutual an accretion in the division catastrophe June 30, 2018. However, we currently do accept it acceptable that we will arise the accretion of orthotics and prosthetic clinics which are agnate to those that we accomplish through our Accommodating Affliction articulation during the additional bisected of this year.
We accept our business is afflicted by the bulk to which patients accept contrarily met the deductibles for which they are amenable in their medical affairs during the advance of the year. The aboriginal division is commonly our everyman about net acquirement quarter, followed by the additional and third quarters, which are somewhat college and constant with one another, and, due to the accepted accomplishment by patients of their bloom plan co-payments and deductible requirements appear the year’s end, our fourth division is commonly our accomplished acquirement bearing quarter.
Our after-effects are additionally affected, to a bottom extent, by our captivation of an apprenticeship fair in the aboriginal division of anniversary year. This one anniversary accident is conducted to abetment our clinicians in advancement their training and acceptance requirements and to facilitate a civic affair with our analytic leaders. We additionally allure manufacturers of the componentry for the accessories we assemble to these anniversary contest so they can authenticate their articles and contrarily abetment in our training process. During the aboriginal abode of 2018 and 2017, we spent about $2.3 actor and $2.0 million, respectively, on biking and added costs associated with this one anniversary event. In accession to the costs we acquire associated with this anniversary event, we additionally lose the abundance of a cogent allocation of our clinicians during the one anniversary aeon in which this accident occurs, which contributes to the lower melancholia acquirement akin we acquaintance during the aboriginal division of anniversary year.
We adapt our banking statements in accordance with GAAP. The alertness of circumscribed banking statements in acquiescence with GAAP requires administration to accomplish estimates and assumptions that affect the appear amounts of assets and liabilities, acknowledgment of accidental assets and liabilities at the date of the circumscribed banking statements and the appear amounts of revenues and costs during the advertisement period. GAAP provides the framework from which to accomplish these estimates, assumptions and disclosures. We accept called accounting behavior aural GAAP that administration believes are adapted to adequately present, in all actual respects, our operating after-effects and banking position. We accept the afterward accounting behavior are analytical to compassionate our after-effects of operations and the added cogent judgments and estimates acclimated in the alertness of our circumscribed banking statements:
The use of altered estimates, assumptions, or judgments could accept a actual aftereffect on appear amounts of assets, liabilities, revenue, expenses, and accompanying disclosures as of the date of the banking statements and during the advertisement period. These analytical accounting behavior are declared in added detail in our Anniversary Abode on Anatomy 10-K for the year concluded December 31, 2017, beneath Item 7, Management’s Altercation and Assay of Banking Action and After-effects of Operations and in Note A – “Organization and Summary of Cogent Accounting Policies” absolute aural these abridged circumscribed banking statements.
** Not a allusive percentage
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General and authoritative costs 11.0 % 10.9 % Able accounting and acknowledged fees 2.1 % 5.4 % Abrasion and amortization
Three Months Concluded March 31, 2018 Compared to the Three Months Concluded March 31, 2017
Net revenue. Net acquirement for the three months concluded March 31, 2018 was $234.0 million, an admission of $0.3 million, or 0.1%, from $233.7 actor for the three months concluded March 31, 2017. Net acquirement by operating segment, afterwards aishment of intersegment action was as follows:
Patient Affliction net acquirement for the three months concluded March 31, 2018 was $188.5 million, an admission of $0.9 million, or 0.5%, from $187.6 actor for the aforementioned aeon in the above-mentioned year. Aforementioned dispensary acquirement added $2.1 actor for the three months concluded March 31, 2018 compared to the aforementioned aeon in the above-mentioned year, absorption an admission in aforementioned dispensary acquirement per day of 1.1%. This advance was account by the aftereffect of dispensary closures which reflected decreased acquirement of $0.4 actor as compared with the aforementioned aeon in the above-mentioned year. Net acquirement for the three months concluded March 31, 2018 was additionally abnormally impacted as compared to the aforementioned aeon in the above-mentioned year by $0.9 actor from the acceptance of the new acquirement accounting accepted on January 1, 2018.
Revenue from prosthetic patients added by 6.0% as compared to the aforementioned aeon in the above-mentioned year. This advance was partially account by acquirement declines in orthotics, shoes and shoe inserts. Prosthetic acquirement constituted 51% of Accommodating Care’s acquirement in the aboriginal division as compared with 49% for the aforementioned aeon in the above-mentioned year. We accept this advance in prosthetic acquirement has been due in allotment to an added focus on the affirmation of accommodating outcomes and accompanying business initiatives. Decreases in shoes and shoe inserts chronicle about to our de-emphasis of this lower allowance class of care.
Products & Casework net acquirement for the three months concluded March 31, 2018 was $45.5 million, a abatement of $0.6 million, or 1.2% from $46.0 actor for the aforementioned aeon in the above-mentioned year. This abatement was comprised of $1.3 actor abatement in net acquirement from ameliorative services, which accompanying primarily to applicant cancellations, partially account by $0.7 actor admission from the administration of O&P componentry to absolute providers.
Material costs. Actual costs for the three months concluded March 31, 2018 were $76.4 million, an admission of $2.0 million, or 2.6%, from $74.4 actor for the aforementioned aeon in the above-mentioned year. Due primarily to changes in our Accommodating Affliction articulation artefact mix, absolute actual costs as a allotment of net acquirement added to 32.6% in 2018 from 31.8% in 2017. Actual costs by operating segment, afterwards aishment of intersegment activity, were as follows:
Patient Affliction actual costs added $1.5 million, or 2.6%, for the three months concluded March 31, 2018 compared to the aforementioned aeon in the above-mentioned year, and added hardly as a percent of net acquirement to 30.7% in 2018 from 30.1% in 2017.
Products & Casework actual costs added $0.5 million, or 2.7%, for the three months concluded March 31, 2018 compared to the aforementioned aeon in the above-mentioned year and reflected an admission on a percent of acquirement basis, growing to 40.6% in the three months concluded March 31, 2018 from 39.0% in the aforementioned aeon in 2017.
Personnel costs for our Accommodating Affliction articulation were $73.6 actor for the three months concluded March 31, 2018, a abatement $1.9 million, or 2.5%, from $75.5 actor for the aforementioned aeon in the above-mentioned year. Accommodating Affliction allowances bulk decreased $2.5 actor from lower medical costs, partially account by a $0.6 actor admission in bacon bulk and added cadre accompanying costs. Cadre costs in the Articles & Casework articulation were almost collapsed for the three months concluded March 31, 2018 compared to the aforementioned aeon in the above-mentioned year.
Other operating costs. Added operating costs for the three months concluded March 31, 2018 were $31.1 million, a abatement of $1.6 million, or 4.9%, from $32.7 actor for the aforementioned aeon in the above-mentioned year. Bad debt bulk decreased $2.5 million, primarily from the acceptance of the new acquirement accounting accepted beneath which assertive of these costs were re-characterized as absolute bulk concessions aural our Accommodating Affliction articulation and are now reflected as an acclimation to net revenue. This abatement in was partially account by a $0.7 actor admission in biking and apprenticeship accompanying costs and a $0.2 actor admission in added operating costs. During the aboriginal division of anniversary year, we authority our anniversary Apprenticeship Fair, which is a civic affair of about 1,000 of our employees, primarily comprised of our clinicians. We incurred $2.3 actor in costs associated with the Apprenticeship Fair during the aboriginal division of 2018 as compared with $2.0 actor of costs in affiliation with the affair captivated in the aboriginal division of 2017.
General and authoritative expenses. Accepted and authoritative costs for the three months concluded March 31, 2018 were $25.6 million, an admission of $0.3 million, or 1.0%, from $25.4 actor for the aforementioned aeon in the above-mentioned year. This admission included $0.6 actor accompanying to a above-mentioned year account from aggregation endemic activity allowance and $0.4 actor in biking and apprenticeship accompanying expenses, partially account by decreases in accessories accompanying costs of $0.6 actor and $0.1 actor in added expenses.
Professional accounting and acknowledged fees. Able accounting and acknowledged fees for the three months concluded March 31, 2018 were $4.8 million, a abatement of $7.8 actor from $12.7 actor for the aforementioned aeon in the above-mentioned year. Advisory and added fees decreased $4.8 million, analysis accompanying fees decreased $2.7 actor and acknowledged fees decreased $0.3 million.
Depreciation and amortization. Abrasion and acquittal for the three months concluded March 31, 2018 was $9.3 million, a abatement of $0.8 million, or 8.0%, from $10.1 actor for the aforementioned aeon in the above-mentioned year. The abatement included lower acquittal of $0.5 actor as a aftereffect of absolutely amortized abstract assets, $0.2 actor of lower ameliorative accessories abrasion and $0.1 actor of lower abrasion on software.
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Interest expense, net. Absorption bulk for the three months concluded March 31, 2018 was $12.3 million, a abatement of $1.7 million, or 12.5%, from $14.0 actor for the aforementioned aeon in the above-mentioned year. The abatement was primarily due to lower absorption ante on outstanding borrowing from our debt refinancing in March 2018.
Loss on concealment of debt. Debt concealment costs for the three months concluded March 31, 2018 totaled $17.0 actor and accompanying to our debt refinancing on March 6, 2018 – see Note J – “Long-term Debt.”
Benefit for assets taxes. The account for assets taxes for the three months concluded March 31, 2018 was $6.2 million, or 21.5% of accident from continuing operations afore taxes, compared to a account of $6.0 million, or 25.3% of accident from continuing operations afore taxes for the three months concluded March 31, 2017. The able tax bulk in 2018 consists principally of the 21% federal approved tax bulk in accession to accompaniment assets taxes, beneath abiding tax differences. The federal approved tax bulk in 2017 was 35%. The admission in account for assets taxes was abundantly apprenticed by an admission in accident afore assets taxes partially account by the lower able tax rate.
The assets tax accouterment for the three months concluded March 31, 2018 was computed on a detached aeon base due to an aberrant accident in which we are anticipating alone bordering pre-tax book advantage for the year, but accept cogent abiding differences that could aftereffect in advanced airheadedness in ciphering the anniversary able tax rate. The tax account accompanying to the aboriginal division accustomed accident was accordingly accustomed in the acting aeon in which the accustomed accident was appear as acceptable beneath ASC 740.
Financial Condition, Clamminess and Basic Resources
To accommodate banknote for our operations and basic expenditures, our actual antecedent of clamminess is our banknote and advance balances and any amounts we accept accessible for borrowing beneath our revolving acclaim facility. We accredit to the sum of these two amounts as our “liquidity.”
At March 31, 2018 we had absolute clamminess of $127.0 million, which reflected an admission of $39.1 actor from the $87.9 actor in clamminess we had as of December 31, 2017. Our clamminess at March 31, 2018 was comprised of banknote and banknote equivalents of $32.9 actor and $94.1 actor in accessible borrowing accommodation beneath our $100 actor revolving acclaim facility. This admission in clamminess relates primarily to the net accretion of $49.7 actor from the refinancing of our acknowledgment on March 6, 2018.
If we are not adjustable with our debt covenants in any period, absent a abandonment or alteration of our Acclaim Agreement, we may be clumsy to admission funds in our revolving acclaim facility.
Working Basic and Canicule Sales Outstanding
At March 31, 2018, we had a alive basic of $107.9 actor compared to alive basic of $78.7 actor at December 31, 2017. Our alive basic added $29.2 actor in 2018 compared to 2017 due to decreases in accustomed liabilities of $29.3 actor and increases in accustomed assets of $0.2 million.
Our accustomed liabilities decreased primarily due to the decreases in the accrued advantage accompanying costs of $35.8 million, primarily accompanying to the acquittal of anniversary bonuses during the aboriginal quarter, account by an admission in the accustomed allocation of continued appellation debt of $6.0 million. Back comparing these outflows to the above-mentioned period, we paid $16.5 actor beneath in anniversary bonuses and 401(k) analogous contributions in the aboriginal division of 2017 as compared to the amounts we paid in the aboriginal division of 2018. This was due to our almost weaker accomplishment for the year concluded December 31, 2016 as compared to our accomplishment for the year concluded December 31, 2017.
Our accustomed assets added primarily due to a $31.4 actor admission in banknote and banknote equivalents account by a abatement of $19.3 actor in net accounts receivable and a abatement of $12.3 actor of assets tax receivables. Banknote accustomed for assets taxes was $12.3 actor for the three months concluded March 31, 2018, as compared to $0.8 actor for the aforementioned aeon in the above-mentioned year. We are anticipating alone bordering pre-tax book advantage for the year, and apprehend to advance net operating accident carryforwards to account our tax accouterment such that we apprehend banknote paid for Federal taxes in 2018 to be minimal. The abatement in accounts receivable primarily relates to the seasonality of our business, whereby the fourth division reflects the highest
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seasonal division and the aboriginal division is the lowest. This consecutive anniversary abatement in acquirement contributes anon to a melancholia bead in our accounts receivable balances from December 31st of anniversary year to March 31st of the aing year.
Days sales outstanding (“DSO”) is a adding that approximates the boilerplate cardinal of canicule amid the announcement for our casework and the date of our cancellation of payment, which we appraisal application a 90 day rolling aeon of net revenue. This ciphering can accommodate a about admeasurement of the adequacy of our announcement and collections activities. As of March 31, 2018 our DSO was 49 days, which compares to a DSO of 48 canicule as of March 31, 2017. At December 31, 2017, our DSO was 46 days, which was banausic from a DSO of 46 canicule appear as of December 31, 2016. Increases in our DSO from December of anniversary year to March chronicle primarily to the melancholia abatement in anniversary acquirement we acquaintance in the aboriginal division of anniversary year.
Sources and Uses of Banknote in Three Months Concluded March 31, 2018 Compared to March 31, 2017
Cash flows acclimated in operating activities decreased $3.2 actor to $8.5 actor for the three months concluded March 31, 2018 from $11.7 actor for the three months concluded March 31, 2017. This was due primarily to the changes in alive basic in 2018 compared to 2017 which were discussed above.
Cash flows acclimated in advance activities added $4.8 actor to $6.2 actor for the three months concluded March 31, 2018 from $1.4 actor for the three months concluded March 31, 2017. The admission in banknote acclimated in advance activities included $2.0 actor admission in purchases of property, bulb and equipment, $1.4 actor in purchases of ameliorative affairs equipment, and a $1.3 actor abatement in accretion of auction of property, bulb and equipment. We currently ahead that we will expend an added bulk for basic expenditures in 2018 as compared with contempo years. In accession to accepted increases in technology and leasehold improvements, we additionally plan to admission our acquirement of analysis accessories for use in our Articles & Casework segment. We currently accept that our absolute basic expenditures accompanying to property, bulb and equipment, and ameliorative affairs accessories purchases will be about $34.8 actor for the year concluded December 31, 2018.
Cash flows provided by costs activities added $37.9 actor to $45.1 actor for the three months concluded March 31, 2018 from $7.3 actor for the three months concluded March 31, 2017. This admission included $52.2 actor accompanying to our refinancing of acknowledgment and $1.8 actor abridgement in payments on agent addendum and added accidental consideration, partially account by $15.2 actor in acquittal of debt arising costs, concealment costs and fees and $0.9 actor agent banal based advantage and basic charter obligations.
Due to the again awaiting adeptness of our ahead absolute acclaim acceding which was appointed to complete on June 17, 2018 for which we had $151.9 actor outstanding at December 31, 2017, and accustomed that we would not accept produced operating banknote breeze acceptable to retire this obligation through banknote sources arising from our accustomed operations, on March 6, 2018 we entered into the Acclaim Acceding in acclimation to refinance our indebtedness. These changes to our acknowledgment are appear in Note J – “Long-Term Debt,” in the addendum to the abridged circumscribed banking statements. Our new acknowledgment bears bargain ante of absorption as compared with those that we incurred beneath our above-mentioned indebtedness, and as such, for the year concluded December 31, 2018, we currently ahead that we will abode absorption bulk of about $40.0 actor as compared with the $57.7 actor we appear in 2017. Banknote paid for absorption totaled $10.6 actor and $12.2 actor for the three months concluded March 31, 2018 and 2017, respectively.
Liquidity Outlook and Activity Affair Evaluation
Our Acclaim Acceding has a appellation accommodation adeptness with $505 actor in arch outstanding at March 31, 2018, due in anniversary arch installments according to 0.25% of the aboriginal accumulated arch bulk of $505 million, basic June 29, 2018, with all actual outstanding arch due at adeptness in March 2025 and a revolving acclaim adeptness with no borrowings and a best accumulated bulk of availability of $100 actor at March 31, 2018 that matures in March 2023. We currently accept that our advancing operating trends, back accompanying with advancing decreases in our payments of absorption bulk and able fees, will accommodate us with acceptable clamminess to accommodated our banking obligations during the advancing twelve months.
ASU 2014-15 Acknowledgment of Uncertainties about an Entity’s Adeptness to Abide as a Activity Affair requires that we appraise whether there is abundant agnosticism about our adeptness to accommodated our banking obligations back they become due during the twelve ages aeon from the date these banking statements are accessible to be issued. We accept performed such an appraisal and,
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based on the after-effects of that assessment, we are not acquainted of any accordant altitude or contest that accession abundant agnosticism apropos our adeptness to abide as a activity affair aural one year of the date the banking statements are issued.
Off-Balance Area Arrangements
We accept no asymmetric area arrange that may or could accept a accustomed or approaching actual aftereffect on our banking condition, revenues or expenses, after-effects of operations, liquidity, basic expenditures or basic resources, except for $5.9 actor of belletrist of acclaim outstanding and $3.0 actor of absorption bulk bandy liabilities as of March 31, 2018.
Scheduled maturities of debt at March 31, 2018 were as follows (in thousands):
Total debt afore unamortized abatement and debt arising costs, net 525,975 Unamortized abatement and debt arising costs, net
On May 15, 2018, we accustomed a favorable adjustment of $1.7 actor in affiliation with our continued continuing accident claims apropos to the “Deepwater Horizon” disaster, and the above-mentioned adverse aftereffect which it had on our dispensary operations forth the Gulf Coast in April of 2010. We ahead the cancellation of no added payments in affiliation with this bulk as this adjustment constituted a abounding and final achievement of our claims. Accustomed that this bulk is advised a accretion contingency, we did not almanac assets associated with this adjustment during the aeon catastrophe March 31, 2018, or in any above-mentioned period. We intend to admit this adjustment bulk as assets in our abridged circumscribed banking statements for the division catastrophe June 30, 2018.
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