Bob Carfagno, President & CEO Management Presentation June 2008

Transcription

1 American Radiology Services Bob Carfagno, President & CEO Management Presentation June 2008

2 American Radiology Services Vision ARS will continue to be a leader in fullyintegrated diagnostic imaging services, designed to delight patients, clients and colleagues alike. Mission ARS is a team of professionals dedicated to providing superior, integrated management and support services to the medical practices with which we are affiliated for the purpose of providing optimal patient care and diagnostic services. We successfully serve by placing quality and value first in all that we do. 1

3 Experienced Management Executive Office Position Tenure Industry Exp. Practice Management Susan H. Wyatt, M.D. ARA President Bolivia Davis, M.D. Director of American Radiology Solutions 6 13 Kate Smith Director, Practice Management ARA Board of Directors Seven members ARS Management Bob Carfagno President and CEO John Rodgers CFO Meyer J. Tollen Chief Information Officer Sherrie Friedman VP, Billing and Managed Care Mary Jones Director, Marketing & Sales 2 15 Mary Johnson Director of Support & Ancillary Services Betsy Varnedoe Regional Director, Operations for the N. Region 5 23 Carolyn Frye Regional Director, Operations for the S. Region Keith Penn-Jones Development 9 20 Mike Boylan Development

4 Regional Leader in High Quality Imaging Services Owns and operates 17 fixed-site outpatient centers ( offices ) and staffs 11 hospital contracts, as well as 27 teleradiology contracts Leading market position in Mid-Atlantic region Reputation for medical excellence Driven by strong partnership with Johns Hopkins and American Radiology Associates ( ARA ) State-of-the-art equipment base and facilities Teleradiology and sub-specialization commitment Excellent medical claims history; participant in captive insurance program with Johns Hopkins Centralized operational and marketing infrastructure built over last seven years Robust management information systems (provide realtime data) Outside auditors regard ARS as having one of the single best billing operations in the country Sophisticated scheduling capabilities Sales and marketing innovation 3

5 Company History For more than a decade, ARS has been a leading diagnostic imaging provider 1997 March Four radiology practices merge to form ARS Johns Hopkins becomes a shareholder and strategic partner Current ARS senior management team hired Advent becomes capital partner Expand in contiguous markets Open four new outpatient centers in 10 months Further penetration in existing local markets Deficit Reduction Act enacted Advent decides to exit from ARS May 1998 Consolidate 32 outpatient centers into Introduction of PET systems Add RIS/PACS Introduce teleradiology capabilities 2004 Sales and marketing emphasis Develop additional senior management in marketing and operations Technology advances in CT and PET/CT Invest in facility, equipment and technology 4

6 Revenue and EBITDA Growth Since inception, ARS has a consistent track record of strong revenue and EBITDA growth Net Revenue Adjusted EBITDA E E 5

7 Established Regional Platform ARS geographic concentration provides strong foundation for growth Operational leverage Cost savings opportunities Established platform for roll-up acquisitions Hospital relationships favorably impact patient referrals O f f ice Locat ion Imaging Units High-Tech Imaging Units Locat ion No Location No Location No Location No Location No Location No Location No Location No Location No Location No Location No Location No Locat ion No Locat ion No Locat ion No Location No Locat ion No Total

8 American Radiology Services Business Model & Competitive Strengths John Rodgers, CFO

9 Outpatient Imaging Centers Compensation formula aligns ARS and physicians Referring Physicians Managed Care Organization (MCO) Referrals Patients ARS receives 100% of the associated technical fee ARS Operational Support ARS Operational Support Imaging Imaging Equipment Equipment and and technology Scheduling Scheduling Administration Administration Billing and Collection Billing and Collection Sales and Marketing Sales and Marketing Tech and clerical staff Tech and clerical staff ARS Imaging Centers ARA receives portion the professional fee ARS receives portion of the professional fee ARA Medical Support Practice of Medicine Supervise Technologists Radiological Interpretations 8

10 Contracted Hospital Services Hospital contracts increase the ARS footprint in the Mid-Atlantic ARS familiarity working with hospitals Referring Physicians High return on invested capital Enhance interaction with referring physicians In Patient Referrals Patients ARS receives portion of the associated professional fee ARS Operational Support Billing and Collection Information Technology Equipment Consulting Workflow Recommendations Hospital Radiology Department ARA receives portion of the associated professional fee ARA Medical Support Practice of Medicine Radiological Interpretations 9

11 Revenue Mix Outpatient Centers Two-thirds of revenues from high tech modalities PET/CT 6% Other 5% DEXA 2% Nuclear Medicine 2% X-Ray/Fluroscopy 6% MRI 36% Mammography 10% Ultrasound 11% CT 22% 10

12 Company Strengths By focusing on core competencies, management has established a platform for sustained growth Robust Internal Controls with Real- Time Information Reporting / Image Management Systems Revenue and EBITDA Growth with Continued Focus on High Tech Modalities Affiliation with Johns Hopkins and a Prominent Physician Group Focus on Quality Care with State-of-the-Art Equipment Experienced Management Team Consistent History of Volume Growth Best-in-Class Billing and Collection Coupled with Strong Payor Group Relations Significant Growth Potential from Current Facilities High Degree of Employee Commitment and Morale Superior Customer Service and Centralized Scheduling Capability Sophisticated Sales and Marketing Effort 11

13 Johns Hopkins Affiliation ARS affiliation with Johns Hopkins provides it with several competitive advantages Benefit to ARS Co-branding opportunity Access to faculty and sub-specialists Improved purchasing power Cooperative training programs and studies Radiologist interaction and staffing Reduced insurance costs Expansion opportunities Benefit to Johns Hopkins Johns Hopkins intends to continue growing its relationship with ARS Clinical work complements academic programs Economic incentives Recruitment and retention Johns Hopkins Percent of Total Reads 25% 20% 15% 13% 13% 13% 14% 14% 15% 10% 8% 5% 4% 0% 1997A 2001A 2002A 2003A 2004A 2005A 2006A 2007E 2007PF 12

14 Commitment to Quality A reputation for quality service Best Practice radiology Company built on a platform of quality and service Board certified radiologists All radiologists are board certified and meet CME requirements Cutting-Edge technology Significant competitive advantage in the marketplace Early deployment of teleradiology and RIS/PACS Conversion to multi-slice CT and digital equipment Equipment certification and accreditation Fully accredited by all appropriate agencies and 3 rd party payors Four 64-Slice CT units Model Facilities Most facilities are in newly constructed, highly efficient space Modality leadership Modality specialists lead operations and marketing efforts Highly trained technologists Supported by modality leadership and in-house training Hospital and outpatient orientation Access to community referring physicians 13

15 Driving Utilization Through Dedicated Sales and Marketing Strategy ARS 12 person field team to supports its 11,000 physician referral base, while constantly targeting additional referral opportunities to drive growth Targeting and Conversion Differentiation Value Sub-specialty physician practice profitability Convert splitters/minimalists Physician and marketer contact Quality/service at sites Patient marketing High tech modalities Unique offerings Full modality/women s services Digital Mammography offering Referral based reading On-line scheduling ARA/Hopkins access Pre-authorization On-line report/image access Use of real-time marketing data to develop target list for physicians and practices 14

16 Customer Service ARS goal is to become the radiology provider of choice for patients and referring physicians by continually improving its already robust customer focus Centralized Scheduling Centralized in two locations Staff of ~40 FTE Phone monitoring Schedule optimization Support Services Comprehensive Disney training Central management of clerical functions Engage field staff in continuous process improvement On-line scheduling platform 15

17 Billing Division and Cash Collection ARS independently recognized, best-in-class billing system is extremely efficient at converting invoices into cash 85% of claims billed electronically and 80% paid electronically Low bad debt percentage ARS bills approximately 2.2mm procedures per year Ability to scale billing platform Bill approximately 500,000 procedures for third-party providers AMICAS s SENTINEL billing system Staff of ~90 FTE 15,000 square foot facility (Owings Mills, MD) 16

18 American Radiology Services Regulatory Update

19 Deficit Reduction Act of 2005 Through a series of cost cutting measures and new revenue initiatives, ARS has mitigated the impact of DRA Impact of DRA fully reflected in 2007 results Technical component reimbursement capped at lesser of Medicare Part B and Hospital Outpatient Prospective Payment System (HOPPS) rate 25% 50% reduction in reimbursement for scan of contiguous body parts Effect of rate cuts: ~ 10% reduction in MRI reimbursement rate ~ 7% reduction in CT reimbursement rate ~ 26% reduction in PET reimbursement rate 18

20 Recent Pressure on Self Referral National Pressure Study published in 2007, links higher rates of imaging with self-referring physicians Use imaging x times more often Industry lobbying groups creating focus on impact of self referrals Likely to lead to restrictions Physicians are already prohibited from self-profiting referrals As a result, non-radiologists have begun shutting down their self-referred imaging businesses Local Pressure & Recent Developments Maryland self-referral laws similar to Federal Maryland already prohibited referrals to physician-owned equipment In 2006, the Maryland Board of Physicians issued a ruling supporting this enforcement A 2007 appeal upheld the existing MD laws (ruling has been re-appealed) This ruling, combined with the ONI relationship, will make ARS the preferred partner of specialist practices 19

21 Opportunity to Grow Orthopedic Scan Volume Recent legislative and regulatory changes have provided ARS with a significant opportunity to take market share from smaller imaging practices Rationale Potential Upside Opportunity to gain volume fallout DRA rate cut MD Stark Law enforcement Added CMS scrutiny of selfreferral Opportunity to offer incremental services to orthopedic practices Leverage sales and marketing expertise to promote dedicated referral relationships There are ~20 large orthopedic groups in the MD region that operate their own imaging equipment These sites perform approximately 30,000 40,000 scans per year These practices have fewer and less sophisticated modalities than ARS sites 20

22 Regulatory Issues Today Lobbyists fighting to prevent further cuts AQI Federal Access to Medical Imaging Coalition (AMIC) State Awaiting action on court case appeal Summer study session on self-referral law Current Senate Proposal Excludes any new cuts Accreditation requirements included 21

23 American Radiology Services Growth Opportunities Bob Carfagno, President & CEO

24 Growth Strategy With a strong brand name and scalable initiatives, the ARS platform is well positioned to drive margin improvement at a regional or national level Transition to Digital Mammography Improved patient care, productivity and increased billing rate To be completed in 2008 New RIS/PACS Modern technology will enhance efficiency and improve patient care Being evaluated with CML Expand Teleradiology Business Organic Growth Program High growth potential, low CapEx requirement Enhanced penetration in the Orthopedic market Establishment of dedicated women s imaging centers Expanded marketing of alternative procedures with high tech equipment Acquisition and JVs Growth through acquisitions and partnerships 23

25 Projected Impact of Digital Mammography ARS is in the process of rolling out digital mammography in 14 clinics and transitioning its current volume at a favorable reimbursement rate Faster throughput will help reduce existing backlog Demand for superior technology will increase scan volumes Improved customer satisfaction, especially among women, may encourage greater brand loyalty 24

26 Increased Focus on Women-Specific Care One of the Company s largest facilities doubled revenue and increased EBITDA margins in the first three full years after expanded service offering Leverage existing infrastructure Opportunity to significantly increase volumes Management has identified three additional sites that could particularly benefit from women s centers Opening additional women s centers could capitalize on excess demand at a number of ARS office locations, while growing overall volumes and increasing patient satisfaction Maximizes referrals across specialists and modalities 25

27 ONI Strategic Relationship An exclusive distribution agreement with ONI Medical will supply ARS with next generation MRI systems and drive referrals ARS has the exclusive right to distribute ONI extremity MRI systems in Maryland and Delaware Systems can increase efficiency by 20-25% ONI systems keep the majority of a patient s entire body outside the imaging magnet Increases comfort and decreases involuntary movement Compact and less expensive than traditional MRIs Still exceeds current ACR guidelines for knee MRI tests Well suited for small outpatient centers, especially orthopedic practices Opportunity to increase referrals from orthopedic specialists ARS can even enter orthopedic practices to perform imaging services 26

28 Significant Acquisition Opportunities Medical imaging expenditures in the U.S. are estimated at US$100 billion and expected to grow to US$110 billion in 2009 Out-patient medical imaging market represents approx. US$45 billion of total expenditures NE U.S. comprises US$10 billion of out-patient market U.S. medical imaging market is highly fragmented and undercapitalized, primarily consisting of small group practices and regional providers Approx. 6,000 out-patient diagnostic testing facilities DRA is driving consolidation of "mom and pop" imaging operators ARS has a strong, scaleable platform to pursue acquisition opportunities NE U.S. presents an attractive market into which to expand Strong demand for medical imaging Favorable demographics (dense population) 6 of the 10 wealthiest U.S. states by income 27