EMSC Company Overview JP Morgan Investor Conference January 2009

Transcription

1 EMSC Company Overview JP Morgan Investor Conference January

2 2 Cautionary Statement Regarding Forward-Looking Statements Certain statements and information in this presentation may be deemed to be forward-looking statements within the meaning of the Federal Private Securities Litigation Reform Act of Forward-looking statements may include, but are not limited to, statements relating to our objectives, plans and strategies, and all statements (other than statements of historical facts) that address activities, events or developments that we intend, expect, project, believe or anticipate will or may occur in the future are forward-looking statements. These statements are often characterized by terminology such as believe, hope, may, anticipate, should, intend, plan, will, expect, estimate, project, positioned, strategy and similar expressions, and are based on assumptions and assessments made by EMSC management in light of their experience and their perception of historical trends, current conditions, expected future developments, and other factors they believe to be appropriate. Any forward-looking statements in this presentation are made as of the date hereof, and EMSC undertakes no duty to update or revise any such statements, whether as a result of new information, future events or otherwise. Forwardlooking statements are not guarantees of future performance and are subject to risks and uncertainties. Important factors that could cause actual results, developments and business decisions to differ materially from forward-looking statements are described in EMSC s filings with the SEC from time to time, including the section entitled Risk Factors in the most recent Annual Report on Form 10-K and Quarterly Report on Form 10-Q. Non-GAAP Financial Measures Reconciliation This overview includes presentations of Adjusted EBITDA, which is defined as net income before equity in earnings of unconsolidated subsidiary, income tax expense, interest and other income, realized gain on investments, interest expense, and depreciation and amortization. It also includes presentations of free cash flow, which is defined as cash flow from operations less cash used in nonacquisition related investment activities. Adjusted EBITDA and free cash flow are commonly used by management and investors as performance measures and liquidity indicators. Adjusted EBITDA and free cash flow are not considered measures of financial performance under U.S. generally accepted accounting principles (GAAP), and the items excluded therefrom are significant components in understanding and assessing our financial performance. Adjusted EBITDA and free cash flow should not be considered in isolation or as an alternative to GAAP measures such as net income, cash flows provided by or used in operating, investing or financing activities or other financial statement data presented in our consolidated financial statements as an indicator of financial performance or liquidity. Reconciliations of non-gaap financial measures are provided on our website at under Investor Relations in Financial Reports. Since Adjusted EBITDA and free cash flow are not measures determined in accordance with GAAP and are susceptible to varying calculations, these measures, as presented, may not be comparable to other similarly titled measures of other companies.

3 Investment Highlights Dominant player in the medical transport and emergency department and hospital based physician outsourcing industry Large, growing and highly fragmented market Leading market share with less than 10% of the market (a) Continued trends toward outsourcing Multiple growth opportunities Organic Acquisition Adjacent/Complimentary businesses Stable reimbursement environment Strong financial performance 3 (a) Management estimates

4 EMSC Service Offerings Pre-Hospital Transportation & Other Services 911 emergency Non-emergency (IFT) Fixed wing air ambulance International EMS operations Managed transportation Disaster response 4 Hospital Based Physician Services Emergency dept Hospitalist/inpatient Radiology Anesthesia

5 AMR Industry Overview & Drivers Ambulance Market - $13B (a) Rural Metro, 3% Hospitalbased, 5% AMR 8% 34% outsourced communities in 1999 has grown to 44% today (a) Private, 30% Fire Department/ Government, 54% Cost pressures leading to increased privatization of medical transportation Technology & clinical expertise Favorable demographic trends 5 (a) Management estimates

6 AMR Industry Overview & Drivers Air Ambulance Market - $3.5B (a) AASI <1% Air Methods 14% Managed Transportation - $ 1B (b) Logisticare 38% MTM 10% Other Local 47% Other 85% AMR 5% The number of trauma centers has declined over the past 10 years 54% of all air medical transports are hospital to hospital 550,000 annual transports 73% Rotor / 27% Fixed Wing Growing international opportunities Non-emergency Medical Transportation Services highly fragmented Reimbursement of medical transportation is expensive and ineffective All Payors seeking opportunities to direct utilization and control costs States continue to outsource their Medicaid population Highly fragmented market 6 (a) (b) GAO Report number GAO Providence Service Corporation Annual Report

7 EmCare Industry Overview and Drivers Outsourced ED Market - $10B (a) Team Health, 5% Other National Groups, 6% Regional Groups, 13% EmCare 8% Non-Outsourced, 35% Local Groups, 33% 55% of hospitals outsourced contracts in 1999; 64% today (a) Approximately 40% of admits from ED Shortage of qualified physicians Renewed focus on operational improvement/ patient satisfaction Management complexity of ED 7 (a) Management estimates

8 EmCare Industry Overview and Drivers Hospitalist - $50.8B (b) Radiology Market - $10B (a) Anesthesia Market - $ 15B (c) Team Health, 3% IPC, 5% Apogee, 2% RadCare <1% MEDNAX (Pediatrix) 2% AnesthesiaCare <1% EmCare (EIS) <1% Self-Op, 20% Local Groups, 69% Local Group 45% Self-Op 54% Non- Outsourced 50% Local Groups 47% Almost 40 percent of hospitals nationwide employ hospitalists Number of hospitals with hospitalists grew 17% between 2003 and 2004 Growing need by all sized hospitals Improved resource utilization Technology & clinical expertise Renewed focus on operational improvement/ physician satisfaction Teleradiology widely accepted as standard of practice Shortage of qualified physicians Shortage of qualified physicians Renewed focus on operational improvement/ surgeon satisfaction Management complexity of OR Increased acceptance of CRNA delivery model 8 (a) Management estimates (b) Society of Hospital Medicine-A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction- AHA Surveys (c) Global Market Research Company 18 Oct 2007

9 Stable reimbursement characteristics and trends AMR Communities/municipalities generally do not pay but set rates Discounts not provided for 911 services Rate increases to offset reimbursement changes/payor mix/fuel costs 2008 EMSC Payor Mix Profile 1,3 Medicare/ Medicaid 37% Commercial / Managed Care 42% EmCare Strong payor mix visibility prior to contract Subsidy increases to offset reimbursement/payor mix changes Self-Pay 21% 1 Percentage of total volume 2008 EMSC Payor Mix Profile 2,3 Self-pay volume mix has been fairly stable over past four years Physician bill reversed scheduled cuts with small increases Medicare/ Medicaid 28% Self-Pay 4% Commercial / Managed Care 47% 9 Ambulance fee schedule set through 2010 recent 2% urban/3% rural increase in ambulance rates 3 For the nine months ended Sept 30, 2008 Subsidies / Fees 21% 2 Percentage of net revenue

10 AMR Services Net revenue of $1.22 billion; 3.4 million transports in 37 states Emergency transports 911 (56% of Net Revenue) 167 Exclusive contracts Governmental procurement process Historically 2-3 new large RFPs / year Non-emergency / inter-facility transports IFT (31% of Net Revenue) Non-exclusive contracts and non-contracted services Retail orientation Fragmented; over 10,000 mom and pops Other services (13% of Net Revenue) Air Ambulance Managed Transportation International, Dispatch, Standby, Disaster Response 10 (a) Data as of the year ended December 31, 2007.

11 EmCare Services Net revenue of $888 million; 7.2 million visits in 40 states 395 Hospital contracts YTD September 08 net contract adds of 58 (b) Emergency Department Physician/mid-level services Hospitals responsible for nursing, facilities and equipment Hospitalist Physician management of hospital in-patients Specialty inpatient service coverage Radiology Hospital based professional services Tele-radiology and locums services Anesthesiology Recent acquisition of anesthesia management company Hospital based professional services 11 (a) Data as of the year ended December 31, (b) 45 contracts from anesthesia acquisition.

12 EMSC Highlights for 2008 (a) Industry / Regulatory Environment Continued increase in outsourcing No material legislative or regulatory action in 2008 Stable reimbursement environment Strong year over year financial performance Continued improvement in revenue growth and Adjusted EBITDA margins Business Highlights Organic growth supplemented by recent acquisitions River Medical (02/08), CPPA (07/08), Templeton (10/08) Annualized revenue of $40 million Significant FEMA deployment for hurricanes Gustav and Ike ($90M revenue + $11M expense pass through) 12 (a) As of Sept 30, 2008

13 13 Growth Strategies

14 AMR Key Growth Strategies Organic Growth Organic Revenue Growth Win Additional 911 contracts Public/private partnerships Increase non-emergency transport share National/Regional contracting Expand Managed Transportation Business International opportunities Management services Margin Improvement Compensation Improve resource deployment with technology Operating Expense Fleet management Billing system automation Insurance Leveraging G&A/support costs through growth Cross selling of Air Ambulance & other key services 14

15 EmCare Key Growth Strategies Organic Growth Organic Revenue Growth Margin Improvement Winning of new outsourced ED contracts Flexible contracting models National Contracting Recent agreements include HMA, UHS, CYH Hospitalist Value to hospitals with respect to LOS and utilization mgmt Radiology Tele-radiology and inpatient physician services New Anesthesia service Compensation Physician productivity comp models Predictive staffing models Insurance Fail safes Risk assessments of providers and hospitals Leveraging G&A/support costs through growth 15

16 EMSC Acquisition Strategies Supplement organic growth with additional revenue from acquisitions Fragmented market provides acquisition opportunities Regional players with attractive scale / scope Local players with entrenched position Rational EBITDA multiples AMR New/adjacent markets Complimentary services EmCare Focus on other hospital based physician services 16

17 17 Financial Overview

18 Solid organic revenue growth and significant margin expansion Net Revenue (in millions) Adjusted EBITDA (in millions) Diluted EPS CAGR = 8% $1,934 $2,107 $147 CAGR = 20% $174 $210 CAGR = 62% $0.92 $1.39 $1,799 $ (a) Growth 10.6% 7.5% 8.9% 2005(a)(b) Margin 8.2% 9.0% 10.0% 2005(c) Growth % 51.1% (a) Pro-forma combined 1-month predecessor with 11-month successor, year ended December 31, (b) Adjusted EBITDA has been further adjusted to exclude Laidlaw-related compensation, restructuring and other charges (c) Consolidated 11-months ended December 31,

19 Continued year over year growth in 2008 Net Revenue (in millions) Adjusted EBITDA (in millions) Diluted EPS $1,557 $1,816 $152 $183 $0.97 $1.49 YTD 07(a) YTD 08 Growth 8.7% 16.6% YTD 07(b) YTD 08 Margin 9.8% 10.1% YTD 07(b) YTD 08 Growth 44.8% 53.6% 19 (a) (b) Excludes $13M positive revenue adjustment in 2007 as discussed in our 2008 earnings releases. Excludes approximately $10M positive EBITDA impact of revenue adjustment and $2.2M of restructuring charges in 2007 as discussed in our 2008 earnings releases.

20 Other financial highlights Strong Q net revenue YOY growth in both segments AMR net revenue growth of 7.6% (excl. the change in FEMA deployment revenue) EmCare net revenue growth of 16.1% Strong earnings growth metrics even when excluding favorable impacts of prior period insurance reserve adjustments Adjusted EBITDA margin improvements 30 bps in 2006; 80 bps in 2007; 110 bps for the 9 months ended September 30, 2008 Adjusted EBITDA CAGR of 16% between 2005 and 2007 EPS CAGR of 62% between 2005 and 2007 Net debt of $344 million at September 30, 2008 Total net leverage at 1.5x (1) Debt of $480M; Cash of $136M; $65M revolver capacity no borrowings Market Cap of $1.46 billion (2) 20 (1) Calculated using net debt at 9/30/08 divided by Adjusted EBITDA for the 12 months ended September 30, (2) As of January 8, 2009

21 Free Cash Flow (a) (in millions) $128 DSO increase in 2007 related to AMR system conversion and industry enrollment issue at EmCare DSO reduction of 7 days during 9 months ended September 30, 2008 (b) $76 $73 Lower capital expenditures 9 months ended September 30, 2008 compared to same period 2007 Reduction in insurance collateral requirements in YTD (a) (b) Cash flows from operations net of non-acquisition related investing activities. Excludes the impact of FEMA.

22 Summary Favorable industry and reimbursement trends Nation s largest provider of pre-hospital and hospital based emergency services serving over 2,000 communities American Medical Response and EmCare #1 market position in core segments with single digit market share National presence results in significant competitive advantages Track record of revenue and earnings growth 22

23 23 Questions?