DALLAS -- Tenet Healthcare Corporation (NYSE:THC) today reported net income of $70 million, or $0.15 per share, for its first quarter ended March 31, 2006. This compares to a net loss of $4 million, or $0.01 per share, in the first quarter of 2005. The net income for the first quarter of 2006 includes
"We improved our pricing and maintained tight control of costs while reducing our bad debt expense in the first quarter, which contributed to positive earnings," said Trevor Fetter, president and chief executive officer. "But we continue to struggle with declining patient volumes in a number of our hospitals, and rebuilding those volumes is our top priority."
"We continued to strengthen our relationships with our managed care payors in the first quarter," said Reynold Jennings, chief operating officer. "This strengthening is evident not only in our pricing, but also in the continued growth in the number of our hospitals which are earning center of excellence designations from the major, national managed care payors. In the first quarter, Cigna awarded 149 Center of Excellence designations to individual service lines in Tenet's hospitals."
"The improvement in the first quarter's operating performance included a decline in bad debt expense on a sequential quarter basis," said Timothy Pullen, executive vice president and interim chief financial officer. "It is also important to point out that our first quarter results included favorable pre-tax net adjustments of $23 million for prior year cost report settlements and cost report valuation allowances. Cash used by operating activities and capital expenditures was $438 million in the first quarter, including capital expenditures of $117 million, interest payments of $123 million, and payments for restructuring charges, litigation costs and settlements, and discontinued operations of $183 million. This is compared to the first quarter of 2005 when cash provided from operating activities, net of capital expenditures of $96 million, was $420 million, including net income tax refunds of $537 million, net cash provided from discontinued operations of $45 million, and interest payments of $94 million. It should be noted that we made a decision to change the timing of funding the company's 401(k) plan match to once a year, in order to reduce costs. Due to this change, an additional $44 million in 401(k) funding took place in the first quarter of 2006 compared to 2005. The company also incurred additional interest payments in the first quarter of 2006 compared to the first quarter of 2005 of $29 million due to the timing of scheduled interest payments and new debt issuances in 2005."
Continuing Operations
Income from continuing operations for the first quarter of 2006 was $15 million, or $0.03 per share, including the following five items with an aggregate favorable net after-tax impact totaling approximately $1 million or zero cents per share:
(1) litigation and investigation costs of $16 million pre-tax, $10
million after-tax before the impact of the valuation
allowance, or $0.02 per share;
(2) net impairment and restructuring charges of $1 million
pre-tax, with no net after-tax or per share impact before the
impact of the valuation allowance;
(3) costs related to Hurricane Katrina of $5 million pre-tax and
post-hurricane operating losses related to our Gulf Coast
operations of approximately $13 million pre-tax, totaling $18
million pre-tax, $11 million after-tax before the impact of
the valuation allowance, or $0.03 per share;
(4) a favorable, non-cash adjustment to decrease the company's
total valuation allowance for deferred tax assets related to
continuing operations of $7 million, or $0.02 per share,
associated with a decrease in our deferred tax assets; and,
(5) favorable net adjustments for prior year cost report
settlements and cost report valuation allowances, primarily
related to Medicare and Medicaid, of $23 million pre-tax, $15
million after-tax before the impact of the tax valuation
allowance, or $0.03 per share, Included in these adjustments
is a favorable adjustment of $17 million pre-tax, $11 million
after-tax, or $0.02 per share, as a result of a change in
estimate of the valuation allowances necessary for prior year
cost report periods not yet audited and settled by our fiscal
intermediary, based on updated historical cost report
settlement trends and refinements to estimate such trends.
See Explanatory Notes for additional information regarding certain
of these items.
In addition, the company incurred stock compensation expense, included in salaries, wages and benefits, of $11 million pre-tax, $7 million after-tax, or approximately $0.02 per share in the first quarter of 2006 as compared to $13 million pre-tax, $8 million after-tax, or approximately $0.02 per share in the first quarter of 2005.
The company also recorded a $2 million credit, with zero per share impact, as a cumulative effect of a change in accounting principle, net of tax expense and related valuation allowance, due to the requirement under SFAS 123(R) to estimate the amount of stock-based awards expected to be forfeited rather than recognizing the effect of forfeitures only as they occur.
Definition of Same-Hospital Data
Same-hospital data for all periods presented excludes our six hospitals and imaging centers in the Gulf Coast Area that were impacted by Hurricane Katrina.
Admissions
Continuing General Hospitals
Admissions, Patient Days and ------------------------------
Surgeries Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Admissions - Total 166,426 178,458 (6.7)
--------------------------------------- -------- ---------- ----------
Uninsured Admissions 6,240 6,226 0.2
--------------------------------------- -------- ---------- ----------
Uninsured Admissions/Total Admits (%) 3.7 3.5 0.2 (1)
--------------------------------------- -------- ---------- ----------
Charity Care Admissions 2,945 2,366 24.5
--------------------------------------- -------- ---------- ----------
Charity Care admissions as % of total 1.8 1.3 0.5 (1)
--------------------------------------- -------- ---------- ----------
Commercial Managed Care Admissions 46,768 50,930 (8.2)
--------------------------------------- -------- ---------- ----------
Admissions through Emergency Dept. (ED) 91,208 97,380 (6.3)
--------------------------------------- -------- ---------- ----------
ED Admits as % of Total 54.8 54.6 0.2 (1)
--------------------------------------- -------- ---------- ----------
Surgeries (inpatient and outpatient) 117,838 123,101 (4.3)
--------------------------------------- -------- ---------- ----------
Patient Days - Total 855,620 934,203 (8.4)
--------------------------------------- -------- ---------- ----------
Equivalent Admissions 233,356 248,225 (6.0)
--------------------------------------- -------- ---------- ----------
Equivalent Patient Days 1,191,546 1,291,165 (7.7)
--------------------------------------- -------- ---------- ----------
Same-Hospital
Admissions, Patient Days and ------------------------------
Surgeries Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Admissions - Total 161,756 167,253 (3.3)
--------------------------------------- -------- ---------- ----------
Uninsured Admissions 6,033 6,040 (0.1)
--------------------------------------- -------- ---------- ----------
Uninsured Admissions/Total Admits (%) 3.7 3.6 0.1 (1)
--------------------------------------- -------- ---------- ----------
Charity Care Admissions 2,849 2,194 29.9
--------------------------------------- -------- ---------- ----------
Charity Care admissions as % of total 1.8 1.3 0.5 (1)
--------------------------------------- -------- ---------- ----------
Commercial Managed Care Admissions 45,962 48,537 (5.3)
--------------------------------------- -------- ---------- ----------
Admissions through Emergency Dept. (ED) 88,483 91,421 (3.2)
--------------------------------------- -------- ---------- ----------
ED Admits as % of Total 54.7 54.7 -
--------------------------------------- -------- ---------- ----------
Surgeries (inpatient and outpatient) 113,746 114,665 (0.8)
--------------------------------------- -------- ---------- ----------
Patient Days - Total 830,002 869,095 (4.5)
--------------------------------------- -------- ---------- ----------
Equivalent Admissions 226,638 232,518 (2.5)
--------------------------------------- -------- ---------- ----------
Equivalent Patient Days 1,154,543 1,199,890 (3.8)
--------------------------------------- -------- ---------- ----------
(1) This change is the difference between the 2006 and 2005
amounts shown.
----------------------------------------------------------------------
Same-hospital admissions in the first quarter of 2006 were 161,756, a decline of 5,497 admissions, or 3.3 percent, compared to same-hospital admissions of 167,253 in the first quarter of 2005. Approximately 27 percent of this decline, or 1,529 admissions, is attributable to the loss of admissions from business units or service lines that were closed during 2005, including the loss of 694 admissions in our rehabilitation facilities as a result of recent regulatory changes regarding the 75 percent rule. These lost rehabilitation admissions accounted for 41 basis points of the 330 basis point decline in same-hospital admissions. We believe the remaining portion of the decline is primarily the result of (1) competition, (2) challenges in physician recruitment, retention and attrition, (3) contentious managed care contract negotiations and/or terminations, and (4) unfavorable publicity resulting from lawsuits and government investigations.
Same-hospital commercial managed care admissions declined by 5.3 percent during the first quarter of 2006 compared to the first quarter of 2005, while managed Medicare and managed Medicaid admissions increased by approximately 5.8 percent in the aggregate. We continue to experience a shift in our managed care patient mix towards plans with lower levels of reimbursement including managed Medicare and managed Medicaid insurance plans.
Outpatient Visits
Continuing General Hospitals
------------------------------
Outpatient Visits Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Total Visits 1,228,199 1,376,156 (10.8)
--------------------------------------- -------- ---------- ----------
Uninsured Visits 125,338 131,621 (4.8)
--------------------------------------- -------- ---------- ----------
Uninsured/ Total Visits (%) 10.2 9.6 0.6 (1)
--------------------------------------- -------- ---------- ----------
Charity Care Visits 5,366 4,713 13.9
--------------------------------------- -------- ---------- ----------
Charity Care / Total Visits (%) 0.4 0.3 0.1 (1)
--------------------------------------- -------- ---------- ----------
Same-Hospital
------------------------------
Outpatient Visits Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Total Visits 1,180,821 1,280,991 (7.8)
--------------------------------------- -------- ---------- ----------
Uninsured Visits 117,825 121,824 (3.3)
--------------------------------------- -------- ---------- ----------
Uninsured/ Total Visits (%) 10.0 9.5 0.5 (1)
--------------------------------------- -------- ---------- ----------
Charity Care Visits 5,376 4,622 16.3
--------------------------------------- -------- ---------- ----------
Charity Care / Total Visits (%) 0.5 0.4 0.1 (1)
--------------------------------------- -------- ---------- ----------
(1) This percentage change is the difference between the 2006 and
2005 amounts shown
----------------------------------------------------------------------
Same-hospital outpatient visits in the first quarter of 2006 declined to 1,180,821, a decline of 100,170, or 7.8 percent, compared to 1,280,991 visits in the first quarter of 2005. Approximately 22 percent of this decline was the result of the sale or closure of certain home health agencies, hospices and clinics. The company believes the same factors cited as contributing to the decline in our inpatient volumes are also having a similar effect on our outpatient volumes.
Revenues
Continuing Operations
------------------------------
Revenues ($ in Millions) Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Net Operating Revenues 2,414 2,501 (3.5)
--------------------------------------- -------- ---------- ----------
Compact discounts 230 155 48.4
--------------------------------------- -------- ---------- ----------
Compact-adjusted Net Operating
Revenue (1) 2,644 2,656 (0.5)
--------------------------------------- -------- ---------- ----------
Charity care 172 155 11.0
--------------------------------------- -------- ---------- ----------
Provision for Doubtful Accounts 138 167 (17.4)
--------------------------------------- -------- ---------- ----------
Total uncompensated care (1) (2) 540 477 13.2
--------------------------------------- -------- ---------- ----------
Uncompensated care/(Net Operating Rev +
Charity + Compact) (%) (1) 19.2 17.0 2.2 (3)
--------------------------------------- -------- ---------- ----------
Same-Hospital Operations
------------------------------
Revenues ($ in Millions) Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Net Operating Revenues 2,357 2,352 0.2
--------------------------------------- -------- ---------- ----------
Compact discounts 217 144 50.7
--------------------------------------- -------- ---------- ----------
Compact-adjusted Net Operating
Revenue (1) 2,574 2,496 3.1
--------------------------------------- -------- ---------- ----------
Charity care 167 143 16.8
--------------------------------------- -------- ---------- ----------
Provision for Doubtful Accounts 132 163 (19.0)
--------------------------------------- -------- ---------- ----------
Total uncompensated care (1) (2) 516 450 14.7
--------------------------------------- -------- ---------- ----------
Uncompensated care/(Net Operating Rev +
Charity + Compact) (%) (1) 18.8 17.1 1.7 (3)
--------------------------------------- -------- ---------- ----------
(1) Non-GAAP measure
(2) Defined as Compact discounts plus charity care plus provision
for doubtful accounts
(3) This percentage change is the difference between the 2006 and
2005 amounts shown
----------------------------------------------------------------------
Net operating revenues for same-hospital operations were $2.357 billion in the first quarter of 2006, an increase of $5 million, or 0.2 percent, as compared to $2.352 billion in the first quarter of 2005. Patient discounts provided under the Compact with Uninsured Patients ("Compact") reduced same-hospital net operating revenues in the first quarter of 2006 and 2005 by $217 million and $144 million, respectively. If the discounts under the Compact were added back to net operating revenues, it would have produced a non-GAAP measure of Compact-adjusted net operating revenues for the first quarter of 2006 of $2.574 billion, which would then have resulted in an increase of $78 million or 3.1 percent compared to same-hospital Compact-adjusted net operating revenues of $2.496 billion for the first quarter of 2005. (A reconciliation of net operating revenue to Compact-adjusted net operating revenue, how the company uses the measures, and why the company believes these measures are useful, are provided in the tables below entitled "Additional Supplemental Non-GAAP Disclosures." The foregoing also applies to all non-GAAP measures described below.)
Tenet initiated the implementation of the Compact in June, 2004. The Compact was fully implemented in all the hospitals with the initiation of Compact discounts in Texas on September 1, 2005.
Under the Compact, discounts are provided to uninsured patients at managed care-style rates established by each hospital. The Compact discount offered to an uninsured patient is recognized as a contractual allowance, which reduces net operating revenues at the time the account is recorded. Prior to implementing these discounting provisions under the Compact, the vast majority of these discounts was ultimately recognized to be uncollectible and, as a result, was then recorded in our provision for doubtful accounts.
Pricing
Continuing Operations
------------------------------
Pricing Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Net inpatient revenue per admission ($) 10,077 9,532 5.7
--------------------------------------- -------- ---------- ----------
Compact-adjusted net inpatient revenue
per admission ($) (1) 10,768 9,980 7.9
--------------------------------------- -------- ---------- ----------
Net inpatient revenue per patient
day ($) 1,960 1,821 7.6
--------------------------------------- -------- ---------- ----------
Compact-adjusted net inpatient revenue
per patient day ($) (1) 2,094 1,906 9.9
--------------------------------------- -------- ---------- ----------
Net outpatient revenue per visit ($) 541 515 5.0
--------------------------------------- -------- ---------- ----------
Compact-adjusted net outpatient revenue
per visit ($) (1) 634 570 11.2
--------------------------------------- -------- ---------- ----------
Net patient revenue from managed care
payers ($mm) 1,197 1,219 (1.8)
--------------------------------------- -------- ---------- ----------
Stop loss payments from managed care
payers ($mm) 91 120 (24.2)
--------------------------------------- -------- ---------- ----------
Same-Hospital Operations
------------------------------
Pricing Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Net inpatient revenue per admission ($) 10,151 9,596 5.8
--------------------------------------- -------- ---------- ----------
Compact-adjusted net inpatient revenue
per admission ($) (1) 10,831 10,056 7.7
--------------------------------------- -------- ---------- ----------
Net inpatient revenue per patient
day ($) 1,978 1,847 7.1
--------------------------------------- -------- ---------- ----------
Compact-adjusted net inpatient revenue
per patient day ($) (1) 2,111 1,935 9.1
--------------------------------------- -------- ---------- ----------
Net outpatient revenue per visit ($) 548 519 5.6
--------------------------------------- -------- ---------- ----------
Compact-adjusted net outpatient revenue
per visit ($) (1) 639 571 11.9
--------------------------------------- -------- ---------- ----------
Net patient revenue from managed care
payers ($mm) 1,168 1,139 2.5
--------------------------------------- -------- ---------- ----------
Stop loss payments from managed care
payers ($mm) 89 110 (19.1)
--------------------------------------- -------- ---------- ----------
(1) Non-GAAP measure
----------------------------------------------------------------------
Same-hospital net inpatient revenue per admission for the first quarter of 2006 was $10,151 compared to $9,596 in the first quarter of 2005. However, this unit measurement has been reduced by the Compact. If the discounts under the Compact are added back to net inpatient revenue, it produces a non-GAAP measure of same-hospital Compact-adjusted net inpatient revenue per admission of $10,831 for the first quarter of 2006, an increase of $775, or 7.7 percent, compared to $10,056 for the first quarter of 2005.
Same-hospital net outpatient revenue per visit was $548 in the first quarter of 2006 compared to $519 in the first quarter of 2005. This unit measurement is also reduced by the Compact. If the discounts under the Compact are added back to net outpatient revenue, it produces a non-GAAP measure of $639 in same-hospital Compact-adjusted net outpatient revenue per visit in the first quarter of 2006, an increase of $68, or 11.9 percent, compared to $571 in the first quarter of 2005.
The company disaggregates its total managed care business into two categories: commercial managed care, and managed Medicare and managed Medicaid. In the first quarter of 2006, approximately 79 percent of total managed care net revenues are from Tenet's commercial managed care business and 21 percent from managed Medicare and managed Medicaid. Managed care admissions in the first quarter of 2006 were 64 percent commercial, and 36 percent from managed Medicare and managed Medicaid. Managed care outpatient visits in the first quarter of 2006 were 75 percent commercial and 25 percent managed Medicare and managed Medicaid. These same-hospital statistics are consistent with the comparable total hospital statistics.
Same-hospital inpatient managed care base rates in the first quarter of 2006 increased by 10.6 percent for our total managed care portfolio and 11.0 percent for the commercial segment of the managed care portfolio as compared to the first quarter of 2005. Same-hospital net inpatient revenue per admission increased by 11.8 percent in the commercial segment of our managed care business. On an aggregate portfolio yield basis, which includes managed Medicare and managed Medicaid in addition to our commercial managed care business, same-hospital net inpatient revenue per admission increased by 6.1 percent as compared to the first quarter of 2005. These pricing increases contributed to same-hospital net inpatient revenue from managed care payers increasing by 4.5 percent in the first quarter of 2006 compared to the first quarter of 2005 despite the decline in managed care patient volumes.
Same-hospital stop-loss payments were $89 million in the first quarter of 2006, a decrease of $21 million from the $110 million received in the first quarter of 2005. Same-hospital stop-loss payments on a sequential quarter basis also decreased showing a decline of $9 million compared to the fourth quarter of 2005 when stop-loss payments were $98 million. Stop-loss payments were received on 3.8 percent of aggregate managed care admissions in the first quarter of 2006, and on 5.1 percent of commercial managed care admissions.
Controllable Operating Expenses
Continuing Operations
Controllable Operating Expense ------------------------------
($ millions) Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Salaries, Wages & Benefits 1,075 1,124 (4.4)
--------------------------------------- -------- ---------- ----------
Supplies 449 457 (1.8)
--------------------------------------- -------- ---------- ----------
Other Operating Expenses 536 527 1.7
--------------------------------------- -------- ---------- ----------
Total Controllable Operating Exp 2,060 2,108 (2.3)
--------------------------------------- -------- ---------- ----------
Same-Hospital Operations
Controllable Operating Expense ------------------------------
($ millions) Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Salaries, Wages & Benefits 1,048 1,060 (1.1)
--------------------------------------- -------- ---------- ----------
Supplies 436 426 2.3
--------------------------------------- -------- ---------- ----------
Other Operating Expenses 516 490 5.3
--------------------------------------- -------- ---------- ----------
Total Controllable Operating Exp 2,000 1,976 1.2
--------------------------------------- -------- ---------- ----------
Same-hospital controllable operating expenses (consisting of salaries, wages and benefits, supplies, and other operating expenses) were $2.000 billion and $1.976 billion in the first quarters of 2006 and 2005, respectively. Same-hospital controllable operating expenses per equivalent patient day were $1,732 in the first quarter of 2006 compared to $1,647 in the first quarter of 2005, an increase of $85 or 5.2 percent. Contributing to this increase are certain fixed costs that do not fluctuate with the changes in our patient volumes, such as utilities, property taxes, rent and information technology costs.
Malpractice expense of $47 million and $52 million for the first quarters of 2006 and 2005, respectively, is included in "Other Operating Expenses." This decrease is due in part to lower patient volumes, a reduction in the frequency of claims, and an increase in the interest rate used to discount our malpractice liabilities.
Provision for Doubtful Accounts
Continuing Operations
------------------------------
Bad Debt Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Provision for Doubtful Accounts
("Bad Debt") ($mm) 138 167 (17.4)
--------------------------------------- -------- ---------- ----------
Bad Debt/Net Operating Revenues (%) 5.7 6.7 (1.0)(2)
--------------------------------------- -------- ---------- ----------
Compact-related reduction in bad
debt ($mm) 211 143 47.6
--------------------------------------- -------- ---------- ----------
Bad Debt + Compact-related Reduction
(1) ($mm) 349 310 12.6
--------------------------------------- -------- ---------- ----------
Compact Adjusted Bad Debt/(Net operating
revenues + Compact discounts) (%) (1) 13.2 11.7 1.5 (2)
--------------------------------------- -------- ---------- ----------
Same-Hospital Operations
------------------------------
Bad Debt Q1'06 Q1'05 Change (%)
--------------------------------------- -------- ---------- ----------
Provision for Doubtful Accounts
("Bad Debt") ($mm) 132 163 (19.0)
--------------------------------------- -------- ---------- ----------
Bad Debt/Net Operating Revenues (%) 5.6 6.9 (1.3)(2)
--------------------------------------- -------- ---------- ----------
Compact-related reduction in bad
debt ($mm) 199 132 50.8
--------------------------------------- -------- ---------- ----------
Bad Debt + Compact-related Reduction
(1) ($mm) 331 295 12.2
--------------------------------------- -------- ---------- ----------
Compact Adjusted Bad Debt/(Net operating
revenues + Compact discounts) (%) (1) 12.9 11.8 1.1 (2)
--------------------------------------- -------- ---------- ----------
(1) Non-GAAP measure
(2) This change is the difference between the 2006 and 2005
amounts shown
----------------------------------------------------------------------
Same-hospital provision for doubtful accounts, or bad debt expense, was $132 million in the first quarter of 2006, a decrease of $31 million from bad debt expense of $163 million in the first quarter of 2005. Same-hospital bad debt expense was 5.6 percent of net operating revenues in the first quarter of 2006, compared to 6.9 percent of net operating revenues in the first quarter of 2005. After adding back the Compact-related reduction to bad debt to bad debt expense and Compact discounts to net operating revenues in both quarters, it produces a non-GAAP measure of 12.9 percent for same-hospital Compact-adjusted bad debt expense to Compact-adjusted net operating revenue for the first quarter of 2006 as compared to 11.8 percent for the first quarter of 2005.
Accounts Receivable
Accounts receivable were $1.584 billion at March 31, 2006, and $1.525 billion at December 31, 2005. Accounts receivable days outstanding for continuing operations decreased to 57 days at March 31, 2006 from 59 days at December 31, 2005.
Cash Flow
Unrestricted cash was $975 million at March 31, 2006, down $398 million from $1.373 billion at December 31, 2005. Unrestricted cash at March 31, 2006, as well as at December 31, 2005, excludes $263 million of cash restricted as collateral for standby letters of credit under the letter of credit facility that we entered into in December 2004.
Cash used in operating activities for the first quarter of 2006 was $321 million, including our net shareholder settlement payment of $145 million, other litigation and restructuring costs of $30 million, $97 million of annual 401(k) matching contributions and cash used in operating activities from discontinued operations of $8 million.
Capital expenditures in the first quarter of 2006 were $117 million. Substantially all capital expenditures in the first quarter of 2006 were for continuing operations including $24 million relating to our Gulf Coast operations.
Liquidity
Total debt was $4.8 billion at March 31, 2006, unchanged from total debt on December 31, 2005. Net debt, a non-GAAP measure defined as total debt less unrestricted cash and cash equivalents, was $3.8 billion at March 31, 2006, compared to $3.4 billion at December 31, 2005.
Income Taxes
The income tax expense of $5 million in the first quarter of 2006 on pre-tax income of $20 million from continuing operations includes a $7 million income tax benefit to decrease the valuation allowance for deferred tax assets.
Discontinued Operations
Income from discontinued operations for the first quarter of 2006 was $53 million after-tax, or $0.12 per share, and includes the following four items with an aggregate positive net after-tax impact of approximately $55 million, or $0.12 per share:
(1) favorable non-cash adjustment to decrease the valuation
allowance for deferred tax assets of approximately $20
million, or $0.04 per share;
(2) favorable adjustment of $45 million pre-tax, $28 million
after-tax, or $0.06 per share for an insurance recovery
related to the December 2004 settlement of patient litigation
at Redding Medical Center;
(3) favorable net adjustments for prior year cost report
settlements and cost report valuation allowances of $14
million pre-tax, $9 million after-tax before the impact of the
tax valuation allowance, or $0.02 per share. Included in these
adjustments is a favorable adjustment of $6 million pre-tax,
$4 million after-tax, or $0.01 per share, as a result of a
change in estimate of the valuation allowances necessary for
prior year cost report periods not yet audited and settled by
our fiscal intermediary based on updated historical cost
report settlement trends and refinements to estimate such
trends, and;
(4) impairment and restructuring charges of $3 million pre-tax, $2
million after-tax, or zero cents per share.
See Explanatory Notes for additional information regarding certain
of these items.
Management's Web Cast Review of First Quarter Results
Tenet management will discuss first quarter 2006 results on a webcast event scheduled to begin at 11:00 AM (ET) on May 9, 2006. This webcast may be accessed through Tenet's website at www.tenethealth.com
Tenet Healthcare Corporation, through its subsidiaries, owns and operates acute care hospitals and related health care services. Tenet's hospitals aim to provide the best possible care to every patient who comes through their doors, with a clear focus on quality and service. Tenet can be found on the World Wide Web at www.tenethealth.com.
Some of the statements in this release may constitute forward-looking statements. Such statements are based on our current expectations and could be affected by numerous factors and are subject to various risks and uncertainties discussed in our filings with the Securities and Exchange Commission, including our annual report on Form 10-K for the fiscal year ended Dec. 31, 2005, our quarterly reports on Form 10-Q and periodic reports on Form 8-K. Do not rely on any forward-looking statement, as we cannot predict or control many of the factors that ultimately may affect our ability to achieve the results estimated. We make no promise to update any forward-looking statement, whether as a result of changes in underlying factors, new information, future events or otherwise.
TENET HEALTHCARE CORPORATION
CONSOLIDATED STATEMENTS OF OPERATIONS DATA
(Unaudited)
--------------------------------------
(Dollars in millions except per Three Months Ended March 31
share amounts) --------------------------------------
2006 % 2005 % Change
-------- ------ ------- ------ -------
Net operating revenues (1) $2,414 100.0% $2,501 100.0% (3.5%)
Operating expenses:
Salaries, wages and benefits (1,075) 44.5% (1,124) 44.9% (4.4%)
Supplies (449) 18.6% (457) 18.3% (1.8%)
Provision for doubtful
accounts (138) 5.7% (167) 6.7% (17.4%)
Other operating expenses (2) (536) 22.2% (527) 21.1% 1.7%
Depreciation (83) 3.4% (90) 3.6% (7.8%)
Amortization (7) 0.3% (6) 0.2% 16.7%
Impairment of long-lived
assets and restructuring
charges (3) (1) 0.1% (9) 0.4%
Loss from hurricanes and
related costs (4) (5) 0.2% -- --
Costs of litigation and
investigations (5) (16) 0.7% (8) 0.3%
Loss from early
extinguishment of debt (6) -- -- (15) 0.6%
------------------------------- -------- ------ ------- ------ -------
Operating income 104 4.3% 98 3.9%
------------------------------- -------- ------ ------- ------ -------
Interest expense (102) (101)
Investment earnings 17 9
Minority interests (1) (3)
Net gains on sales of
investments 2 --
------------------------------- -------- ------ ------- ------ -------
Income from continuing
operations before income taxes 20 3
------------------------------- -------- ------ ------- ------ -------
Income tax (expense) benefit (8) (5) 17
------------------------------- -------- ------ ------- ------ -------
Income from continuing
operations 15 20
------------------------------- -------- ------ ------- ------ -------
Discontinued operations:
Income (loss) from operations
of asset group 13 (39)
Impairment of long-lived
assets and restructuring
charges (7) (3) (7)
Insurance recovery (9) 45 --
Net gains on sales of asset
group -- 22
Income tax expense (8) (2) --
------------------------------- -------- ------ ------- ------ -------
Income (loss) from discontinued
operations 53 (24)
------------------------------- -------- ------ ------- ------ -------
------------------------------- -------- ------ ------- ------ -------
Income (loss) before cumulative
effect of change in accounting
principle 68 (4)
------------------------------- -------- ------ ------- ------ -------
------------------------------- -------- ------ ------- ------ -------
Cumulative effect of change in
accounting principle, net of
tax 2 --
------------------------------- -------- ------ ------- ------ -------
------------------------------- -------- ------ ------- ------ -------
Net income (loss) $70 $(4)
------------------------------- -------- ------ ------- ------ -------
Diluted earnings (loss) per
common share and common
equivalent share:
Continuing operations $0.03 $0.04
Discontinued operations 0.12 (0.05)
Cumulative effect of
change in accounting
principle, net -- --
-------- -------
$0.15 $(0.01)
======== =======
------------------------------- -------- ------ ------- ------ -------
Weighted average shares and
dilutive securities (if
applicable) outstanding
(in thousands): 470,745 468,947
------------------------------- -------- ------ ------- ------ -------
TENET HEALTHCARE CORPORATION
BALANCE SHEET DATA
Dollars in millions
(Unaudited)
----------------------------------
March 31, 2006 December 31, 2005
--------------- ------------------
Cash and cash equivalents $975 $1,373
Net accounts receivable 1,584 1,525
Assets held for sale 9 11
Other current assets 510 599
--------------- ------------------
Current assets 3,078 3,508
Current liabilities (1,809) (2,292)
--------------- ------------------
Net working capital 1,269 1,216
Investments and other assets 364 380
Restricted cash 263 263
Net property and equipment 4,601 4,620
Goodwill 800 800
Net intangible assets 231 241
Long-term debt, net of current
portion (4,785) (4,784)
Other long-term liabilities and
minority interests (1,644) (1,715)
Total shareholders' equity (1,099) (1,021)
CASH FLOW DATA
Dollars in millions
(Unaudited)
----------------------------------
3 Months Ended 3 Months Ended
March 31, 2006 March 31, 2005
--------------- ------------------
Net cash provided by (used in)
operating activities $(321) $516
Cash flows from investing activities:
Purchases of property and equipment (117) (96)
Proceeds from sales of facilities,
investments and other assets 29 76
Insurance recoveries 10 --
Other items -- (2)
Cash flows from financing activities:
Payments of borrowings -- (22)
Sale of new senior notes -- 773
Repurchases of senior notes -- (413)
Other items 1 11
--------------- ------------------
Net increase (decrease) in cash and
cash equivalents $(398) $843
=============== ==================
Supplemental disclosures:
Interest paid, net of capitalized
interest $(123) $(94)
Income tax refunds received
(payments made), net (3) 537
TENET HEALTHCARE CORPORATION
GENERAL HOSPITALS
SELECTED STATISTICS - CONTINUING OPERATIONS
Quarter Ended March 31, 2006
(Unaudited)
(Dollar amounts in millions except for net inpatient revenue per
patient day and per admission, and net outpatient revenue per visit)
-----------------------------------
Three Months Ended March 31
-----------------------------------
2006 2005 Change
----------- ---------- ------------
Net inpatient revenues $ 1,677 $ 1,701 (1.3%)
Net outpatient revenues $ 664 $ 709 (6.3%)
Number of hospitals (at end of
period) 69 69 -- (a)
Licensed beds (at end of period) 17,851 17,941 (0.5%)
Average licensed beds 17,851 17,924 (0.4%)
Utilization of licensed beds 53.3% 57.9% (4.6%) (a)
Patient days 855,620 934,203 (8.4%)
Equivalent patient days 1,191,546 1,291,165 (7.7%)
Net inpatient revenue per patient
day $ 1,960 $ 1,821 7.6%
Admissions 166,426 178,458 (6.7%)
Equivalent admissions 233,356 248,225 (6.0%)
Net inpatient revenue per admission$ 10,077 $ 9,532 5.7%
Average length of stay (days) 5.1 5.2 (0.1) (a)
Surgeries 117,838 123,101 (4.3%)
Net outpatient revenue per visit $ 541 $ 515 5.0%
Outpatient visits 1,228,199 1,376,156 (10.8%)
Sources of net patient revenue
Medicare 28.3% 28.2% 0.1% (a)
Medicaid 8.5% 8.1% 0.4% (a)
Managed care 51.1% 50.6% 0.5% (a)
Indemnity, self-pay and other 12.1% 13.1% (1.0%) (a)
Same-hospital (b)
Net inpatient revenues $ 1,642 $ 1,605 2.3%
Net outpatient revenues $ 647 $ 665 (2.7%)
Number of hospitals (at end of
period) 63 63 -- (a)
Average licensed beds 16,583 16,646 (0.4%)
Utilization of licensed beds 55.6% 58.0% (2.4%) (a)
Patient days 830,002 869,095 (4.5%)
Net inpatient revenue per patient
day $ 1,978 $ 1,847 7.1%
Admissions 161,756 167,253 (3.3%)
Net inpatient revenue per
admission $ 10,151 $ 9,596 5.8%
Average length of stay (days) 5.1 5.2 (0.1) (a)
Net outpatient revenue per visit $ 548 $ 519 5.6%
Outpatient visits 1,180,821 1,280,991 (7.8%)
(a) This change is the difference between the 2006 and 2005
amounts shown.
(b) Excludes six hospitals and imaging centers in the Gulf Coast
area that were impacted by Hurricane Katrina for all periods
presented.
TENET HEALTHCARE CORPORATION
CONSOLIDATED STATEMENTS OF OPERATIONS DATA
Fiscal 2005 by Calendar Quarter
(Unaudited)
-------------------------------------------------
(Dollars in millions Three Months Ended Year Ended
except per share -------------------------------------- ----------
amounts) 3/31/05 6/30/05 9/30/05 12/31/05 12/31/05
--------- --------- --------- -------- ----------
Net operating
revenues $ 2,501 $ 2,420 $ 2,394 $ 2,299 $ 9,614
Operating expenses:
Salaries, wages
and benefits (1,124) (1,114) (1,099) (1,051) (4,388)
Supplies (457) (447) (446) (424) (1,774)
Provision for
doubtful accounts (167) (153) (206) (172) (698)
Other operating
expenses (527) (547) (554) (555) (2,183)
Depreciation (90) (86) (95) (81) (352)
Amortization (6) (6) (10) (8) (30)
Impairment and
restructuring
charges (9) 4 (205) (56) (266)
Loss from
hurricanes and
related costs -- -- (40) (15) (55)
Costs of litigation
and investigations (8) (11) (28) (165) (212)
Loss from early
extinguishment
of debt (15) -- -- -- (15)
--------------------- -------- --------- --------- -------- ----------
Operating income
(loss) 98 60 (289) (228) (359)
--------------------- -------- --------- --------- -------- ----------
Interest expense (101) (102) (102) (100) (405)
Investment earnings 9 15 17 18 59
Minority interests (3) (3) -- (1) (7)
Net gain on sales of
facilities and long-
term investments -- -- -- 4 4
--------------------- -------- --------- --------- -------- ----------
Income (loss) from
continuing
operations
before income taxes 3 (30) (374) (307) (708)
--------------------- -------- --------- --------- -------- ----------
Income tax (expense)
benefit 17 18 (4) 56 87
--------------------- -------- --------- --------- -------- ----------
Income (loss) from
continuing
operations
before discontinued
operations and
cumulative effect of
change in accounting
principle 20 (12) (378) (251) (621)
--------------------- -------- --------- --------- -------- ----------
Discontinued
operations:
Income (loss) from
operations of
asset group (39) (20) 7 5 (47)
Impairment of long-
lived assets and
goodwill, and
restructuring
charges (7) (1) (27) (21) (56)
Net gain (loss) on
sales of asset
group 22 -- (2) (1) 19
Income tax expense -- -- (1) (2) (3)
--------------------- -------- --------- --------- -------- ----------
Loss from
discontinued
operations (24) (21) (23) (19) (87)
--------------------- -------- --------- --------- -------- ----------
--------------------- -------- --------- --------- -------- ----------
Loss before
cumulative effect of
change in accounting
principle (4) (33) (401) (270) (708)
--------------------- -------- --------- --------- -------- ----------
--------------------- -------- --------- --------- -------- ----------
Cumulative effect of
change in accounting
principle, net of
tax -- -- -- (16) (16)
--------------------- -------- --------- --------- -------- ----------
--------------------- -------- --------- --------- -------- ----------
Net loss $ (4) $ (33) $ (401) $ (286) $ (724)
--------------------- -------- --------- --------- -------- ----------
Diluted earnings
(loss) per common
share and common
equivalent share:
Continuing
operations $ 0.04 $ (0.03) $ (0.80) $ (0.53) $ (1.32)
Discontinued
operations (0.05) (0.04) (0.05) (0.05) (0.19)
Cumulative
effect of change
in accounting
principle, net -- -- -- (0.03) (0.03)
-------- --------- --------- -------- ----------
$ (0.01) $ (0.07) $ (0.85) $ (0.61) $ (1.54)
======== ========= ========= ======== ==========
--------------------- -------- --------- --------- -------- ----------
Weighted average
shares and dilutive
securities
(if applicable)
outstanding
(in thousands): 468,947 468,758 469,179 469,607 468,898
--------------------- -------- --------- --------- -------- ----------
TENET HEALTHCARE CORPORATION
GENERAL HOSPITALS
SELECTED STATISTICS - CONTINUING OPERATIONS
Fiscal 2005 by Calendar Quarter
(Unaudited)
(Dollar amounts in millions except for net inpatient revenue per
patient day and per admission, and net outpatient revenue per visit)
-------------------------------------------------
Three Months Ended Year Ended
-------------------------------------- ----------
3/31/05 6/30/05 9/30/05 12/31/05 12/31/05
--------- --------- --------- -------- ----------
Net inpatient
revenues $ 1,701 $ 1,598 $ 1,603 $ 1,590 $ 6,492
Net outpatient
revenues $ 709 $ 727 $ 708 $ 641 $ 2,785
Number of hospitals
(at end of period) 69 69 69 69 69
Licensed beds at
end of period 17,941 17,897 17,859 17,863 17,863
Average licensed beds 17,924 17,930 17,859 17,842 17,889
Utilization
of licensed beds 57.9% 53.0% 50.8% 49.3% 52.7%
Patient days 934,203 865,396 834,601 809,577 3,443,777
Equivalent
patient days 1,291,165 1,222,322 1,179,032 1,134,196 4,826,715
Net inpatient
revenue per
patient day $ 1,821 $ 1,847 $ 1,921 $ 1,964 $ 1,885
Admissions 178,458 168,526 163,707 157,896 668,587
Equivalent admissions 248,225 239,747 233,272 223,084 944,328
Net inpatient revenue
per admission $ 9,532 $ 9,482 $ 9,792 $ 10,070 $ 9,710
Average length of
stay (days) 5.2 5.1 5.1 5.1 5.2
Surgeries 123,101 125,907 120,871 114,226 484,105
Net outpatient
revenue per visit $ 515 $ 542 $ 568 $ 534 $ 539
Outpatient visits 1,376,156 1,341,793 1,246,170 1,200,682 5,164,801
Sources of net
patient revenue
Medicare 28.2% 27.2% 26.5% 28.2% 27.5%
Medicaid 8.1% 8.3% 8.8% 8.0% 8.3%
Managed care 50.6% 50.2% 51.1% 51.3% 50.8%
Indemnity,
self-pay and other 13.1% 14.3% 13.6% 12.5% 13.4%
Same-hospital
Net inpatient
revenues $ 1,605 $ 1,504 $ 1,533 $ 1,563 $ 6,205
Net outpatient
revenues $ 665 $ 688 $ 678 $ 625 $ 2,656
Number of hospitals
(at end of period) 63 63 63 63 63
Average licensed
beds 16,646 16,652 16,582 16,565 16,612
Utilization
of licensed beds 58.0% 53.1% 52.0% 52.0% 53.8%
Patient days 869,095 804,167 793,309 792,962 3,259,533
Net inpatient
revenue per
patient day $ 1,847 $ 1,870 $ 1,932 $ 1,971 $ 1,904
Admissions 167,253 157,924 156,682 154,625 636,484
Net inpatient
revenue per
admission $ 9,596 $ 9,524 $ 9,784 $ 10,108 $ 9,749
Average length of
stay (days) 5.2 5.1 5.1 5.1 5.1
Net outpatient
revenue per visit $ 519 $ 553 $ 573 $ 536 $ 545
Outpatient
visits 1,280,991 1,244,435 1,182,418 1,165,366 4,873,210
Additional Supplemental Non-GAAP Disclosures
In March 2004, we announced that we would be implementing managed care-style pricing for most of our uninsured patients under our Compact with Uninsured Patients ("Compact"). The discounts for uninsured patients began to be phased in during the second quarter of 2004 and were in effect at 40 of our hospitals by December 31, 2004, at 57 of our hospitals on March 31, 2005, and at all 69 of our hospitals by December 31, 2005. Our Compact is designed to offer managed care-style discounts to most uninsured patients, which enables us to offer lower rates to those patients who historically have been charged standard gross charges. A significant portion of those accounts had often been written down as provision for doubtful accounts if the accounts were not collected. Under the Compact, the discount offered to uninsured patients is recognized as a contractual allowance, which reduces net operating revenues at the time the self-pay accounts are recorded and also reduces our provision for doubtful accounts.
In light of the phase-in of the discounts for uninsured patients under the Compact, the Company is providing supplemental data in addition to data required in accordance with generally accepted accounting principles ("GAAP"). It does so to show the effect that the discounts under the Compact have had on the Company's historical results of operations, without estimating or suggesting the effect on future results of operations. This supplemental information has inherent limitations because discounts under the Compact during the periods presented are not indicative of future periods. In spite of the limitations, the Company finds the information useful to the extent it better enables it and users of its financial statements to evaluate net operating revenue trends and measure certain operating expense categories, which are largely influenced by volumes and generally are analyzed as a percent of net operating revenues.
The tables below illustrate certain operating expense categories as a percent of net operating revenues excluding discounts under the Compact, as described above, for the three-month periods ended March 31, 2006 and March 31, 2005. The tables also illustrate same-hospital net inpatient revenue per admission and same-hospital net outpatient revenue per visit excluding the discounts under the Compact, as described above, for the three-month periods ended March 31, 2006 and March 31, 2005. For all non-GAAP measures provided, the tables below present the comparable GAAP measures and a reconciliation of the different measures. The Company believes the consistent use of this supplemental information provides it and users of its financial statements with reliable period-to-period comparisons. Investors are encouraged, however, to use GAAP measures when evaluating the Company's financial performance.
TENET HEALTHCARE CORPORATION
Additional Supplemental Non-GAAP Disclosures
Operating Measures Adjusted for the Impact of the Compact
(Unaudited)
-------------------------------------------------
Quarter Ended March 31, 2006
-------------------------------------------------
Non-GAAP
% of
GAAP % of Adjusted
Actual Compact Non-GAAP Net Net
GAAP Adjust- Adjusted Operating Operating
Amounts ments Amounts Revenues Revenues
-------------------------------------------------
(Dollars in millions except net inpatient revenue
per admission and net outpatient revenue per visit)
Net operating
revenues $ 2,414 $ 230 $ 2,644 100.0% 100.0%
Operating expenses:
Salaries and
benefits (1,075) -- (1,075) 44.5% 40.7%
Supplies (449) -- (449) 18.6% 17.0%
Provision for
doubtful accounts (138) (211) (349) 5.7% 13.2%
Other operating
expenses (536) -- (536) 22.2% 20.3%
Same-hospital
Net inpatient
revenue $ 1,642 $ 110 $ 1,752
Net outpatient
revenue $ 647 $ 107 $ 754
Admissions 161,756 161,756
Outpatient Visits 1,180,821 1,180,821
Net inpatient
revenue per
admission $ 10,151 $ 10,831
Net outpatient
revenue per visit $ 548 $ 639
-------------------------------------------------
Quarter Ended March 31, 2005
-------------------------------------------------
Non-GAAP
% of
GAAP % of Adjusted
Actual Compact Non-GAAP Net Net
GAAP Adjust- Adjusted Operating Operating
Amounts ments Amounts Revenues Revenues
-------------------------------------------------
(Dollars in millions except net inpatient revenue
per admission and net outpatient revenue per visit)
Net operating
revenues $ 2,501 $ 155 $ 2,656 100.0% 100.0%
Operating expenses:
Salaries and
benefits (1,124) -- (1,124) 44.9% 42.3%
Supplies (457) -- (457) 18.3% 17.2%
Provision for
doubtful
accounts (167) (143) (310) 6.7% 11.7%
Other operating
expenses (527) -- (527) 21.1% 19.8%
Same-hospital
Net inpatient
revenue $ 1,605 $ 77 $ 1,682
Net outpatient
revenue $ 665 $ 67 $ 732
Admissions 167,253 167,253
Outpatient Visits 1,280,991 1,280,991
Net inpatient
revenue per
admission $ 9,596 $ 10,056
Net outpatient
revenue per visit $ 519 $ 571
TENET HEALTHCARE CORPORATION
Explanatory Notes
1. Net operating revenues for the quarter ended March 31, 2006
include favorable net adjustments for prior year cost report
settlements and cost report valuation allowances, primarily
related to Medicare and Medicaid, of $23 million pre-tax, $15
million after-tax, or $0.03 per share. Included in these
adjustments is a favorable adjustment of $17 million pre-tax,
$11 million after-tax, or $0.02 per share as a result of a
change in estimate of the valuation allowances necessary for
prior year cost report periods not yet audited and settled by
our fiscal intermediary based on updated historical cost
report settlement trends and refinements to estimate such
trends.
2. Other operating expenses include malpractice expense of $47
million and $52 million for the quarters ended March 31, 2006
and 2005, respectively. Also included is a net gain of $6
million in the quarter ended March 31, 2005 from the sale of
certain home health agencies.
3. During the quarter ended March 31, 2006, we recorded
impairment and restructuring charges of $1 million consisting
of a $36 million write down of long-lived assets to their
estimated fair values, primarily due to the adverse current
and anticipated future financial trends at three of our
hospitals, approximately $1 million in employee severance and
related costs and $2 million in lease termination costs,
offset by a $2 million reduction in restructuring reserves
recorded in prior periods and $36 million of insurance
proceeds for property damage caused by Hurricane Katrina.
During the quarter ended March 31, 2005, we recorded
restructuring charges of $9 million consisting of $6 million
in employee severance, benefits and relocation costs and $3
million in non-cash stock option modification costs related to
terminated employees.
4. Loss from hurricanes and related costs were $5 million for the
quarter ended March 31, 2006 and were comprised of $2 million
of relief pay and other employee-related expenses and
approximately $3 million in repair costs.
5. Costs of litigation and investigations in continuing
operations were $16 million and $8 million for the quarters
ended March 31, 2006 and 2005, respectively. These expenses
consisted primarily of costs to defend ourselves in various
lawsuits and legal fees related to settlements.
6. In January 2005, we sold $800 million of senior notes with
registration rights in a private placement and received net
proceeds of approximately $773 million after deducting
discounts and related expenses. We used a portion of the
proceeds from the offering for the early redemption of our
remaining outstanding senior notes due in 2006 and 2007,
resulting in a $15 million loss from early extinguishment of
debt.
7. During the quarter ended March 31, 2006, we recorded
impairment and restructuring charges of $3 million in
discontinued operations consisting primarily of $2 million for
the write-down of long-lived assets to their estimated fair
values, less estimated costs to sell, $1 million in employee
severance and retention costs, $1 million in lease termination
and other costs, and a $1 million reduction in reserves
recorded in prior periods.
8. Income tax expense of $5 million in continuing operations for
the three months ended March 31, 2006 includes a $7 million
income tax benefit to decrease the valuation allowance for our
deferred tax assets. Income tax expense of $2 million in
discontinued operations for the three months ended March 31,
2006 includes a $20 million income tax benefit to decrease the
valuation allowance for our deferred tax assets.
Income taxes for the three months ended March 31, 2005
included a $22 million income tax benefit in continuing
operations to reduce the valuation allowance for our deferred
tax assets and income tax expense of $7 million in
discontinued operations to increase the valuation allowance.
9. During the quarter ended March 31, 2006, we recorded an
insurance recovery of $45 million based on a recent agreement
in principle with one of the insurance carriers for which we
sought recovery under our excess professional and general
liability insurance policies for the December 2004 settlement
of substantially all patient litigation related to Redding
Medical Center.