Tenet Healthcare. Credit Suisse 21 st Annual Healthcare Conference
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1 Tenet Healthcare Credit Suisse 21 st Annual Healthcare Conference November 15, 2012
2 Forward-looking Statements Certain statements contained in this presentation constitute forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of Such forward-looking statements are based on management's current expectations and involve known and unknown risks, uncertainties and other factors that may cause the Company s actual results to be materially different from those expressed or implied by such forward-looking statements. Such factors include, among others, the following: the passage of heath care reform legislation and the enactment of additional federal and state health care reform; other changes in federal, state and local laws and regulations affecting the health care industry; general economic and business conditions, both nationally and regionally; demographic changes; changes in, or the failure to comply with, laws and governmental regulations; the ability to enter into managed care provider arrangements on acceptable terms; changes in Medicare and Medicaid payments or reimbursement; liability and other claims asserted against the Company; competition, including the Company s ability to attract patients to its hospitals; technological and pharmaceutical improvements that increase the cost of providing, or reduce the demand for, health care; changes in business strategy or development plans; the ability to attract and retain qualified personnel, including physicians, nurses and other health care professionals, and the impact on the Company s labor expenses resulting from a shortage of nurses or other health care professionals; the significant indebtedness of the Company; the Company's ability to integrate new businesses with its existing operations; the availability and terms of capital to fund the expansion of the Company's business, including the acquisition of additional facilities; the creditworthiness of counterparties to the Company s business transactions; adverse fluctuations in interest rates and other risks related to interest rate swaps or any other hedging activities the Company undertakes; the ability to continue to expand and realize earnings contributions from the revenue cycle management, health care information management, capitation management, and patient communications services businesses under our Conifer Health Solutions ( Conifer ) subsidiary by marketing these services to third party hospitals and other health care-related entities; and its ability to identify and execute on measures designed to save or control costs or streamline operations. Such factors also include the positive and negative effects of health reform legislation on reimbursement and utilization and the future designs of provider networks and insurance plans, including pricing, provider participation, coverage and co-pays and deductibles, all of which contain significant uncertainty, and for which multiple models exist which may differ materially from the company's expectations. Certain additional risks and uncertainties are discussed in the Company s filings with the Securities and Exchange Commission, including the Company s annual report on Form 10-K and quarterly reports on Form 10-Q. The information contained in this presentation is as of November 7, The Company specifically disclaims any obligation to update any forward-looking statement, whether as a result of changes in underlying factors, new information, future events or otherwise. Non-GAAP Information This presentation includes certain financial measures such as Adjusted EBITDA, which are not calculated in accordance with generally accepted accounting principles (GAAP). Management recommends that you focus on the GAAP numbers as the best indicator of financial performance. These alternative measures are provided only as a supplement to aid in analysis of the Company. Reconciliation between non-gaap measures and related GAAP measures can be found in the Company s third quarter earnings release issued on November 7,
3 Tenet profile Acute care hospitals (1) 49 Beds (1) 13,200 Employees (1) 58,000 U.S. coverage (1) 10 states Inpatient admissions (2) 507,000 Outpatient visits (2) 4.1 million Babies delivered annually (2) 66,800 Projected December 31, 2012 Acute Care Hospitals.. 49 Diagnostic Imaging Centers. 68 Ambulatory Surgery Centers Urgent Care Centers Freestanding Emergency Rooms... 4 OP Centers in Development... 7 (1) Continuing operations as of September 30, (2) LTM continuing operations as of September 30,
4 Leading market positions Acute Care Hospitals and Outpatient Presence Market Information Of the 24 markets in which we operate: North Central CA Philadelphia (Pediatric) We negotiate our health plan contracts on a state- or nationwide basis to maximize the relevance of Tenet hospitals to the payers Tenet hospitals have an average market share of 21% San Luis Obispo County Coachella Valley Hickory York County Spalding County Sanford Hilton Head Tenet holds the number 1 position in 11 markets Tenet holds the number 1 or 2 position in 14 of its markets El Paso Nacogdoches NW Houston Palm Beach County In 2 markets Tenet operates one of the only two Level 1 trauma centers Market in which Tenet holds the #1 or #2 position Miami In 1 market Tenet operates one of only two pediatric Level 1 trauma centers Tenet operates the only hospitals in 3 of its markets 4
5 Diversified Business Model Tenet Healthcare Providing Value through Sustainable Growth Acute Care Hospitals 49 hospitals More than 500,000 admissions (LTM) #1 or #2 in 14 of 24 markets 21% market share (average) Outpatient Centers 124 free-standing outpatient centers 68 imaging centers 36 ambulatory surgery centers 16 urgent care centers 4 free-standing EDs More than 4 million visits (LTM) Built or acquired 31 in in in 2010 (1) Conifer Health Solutions Revenue Cycle Services Patient Communications Capitation Management of 3 million + managed lives Serving more than 500 healthcare entities (2) CHI partnership initiated July 1, 2012 InforMed Dell s Revenue Cycle Management Business (1) Projected December 31, 2012 (2) Includes 56 hospitals with Catholic Health Initiatives; integration of CHI launched July 1,
6 Adjusted EBITDA shows attractive growth trend $1, % $ Millions $1,250 $1,000 $750 $500 $ ,036 1,126 1,200 Outlook Mid-point Outlook Mid-point 13% 11% 9% 7% 5% Adjusted EBITDA Margin (1) Adjusted EBITDA Adjusted EBITDA Margin (1) (1) EBITDA as a percent of net operating revenues net of provision for doubtful accounts. 6
7 Volume Growth Resumes... Adjusted Admissions Growth (Same Hospital) Improving growth trend through mid-2009 Recession effects Growth resumes 5.0% 2.5% 0.0% -2.5% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3-5.0%
8 Strong YTD 2012 Performance Key Performance Metrics Evidence Strength Performance Metrics Q YTD Volume Growth Resumes Volumes Adjusted Admissions (Growth %) Emergency Dept Visits (Total - Growth %) Surgeries (Growth %) Solid Pricing Growth Excellent Cost Control Bad Debt Controlled Costs Pricing Bad Debt Net Patient Revenue per Adjusted Patient Day (Increase %) Selected Operating Expenses /AA (Increase %) Supplies Expense / AA (Change %) (2.2) (2.1) Bad Debt Expense Ratio (Change basis points) 20bp 30bp Collection Rates (Self Pay Change basis points) 110bp 110bp 8
9 Approx. 75% of Tenet hospitals expect higher covered lives growth than the U.S. average Expansion of insurance coverage in Tenet facility markets with PPACA Government (1) covered lives (CAGR: ) Des Peres Brookwood Tenet without ACA USA without ACA Los Alamitos San Ramon Park Plaza Cypress Fairbanks Houston Northwest Hilton Head Sierra Med Ctr Piedmont Lake Pointe Providence Memorial Doctors at WRL Sierra Providence East North Fulton South Fulton Coral Gables Atlanta Med Ctr Twin Cities North Shore Med Ctr Sierra Vista East Cooper Hialeah Palm Beach Gardens Palmetto Desert Nacogdoches Good Samaritan Tenet JFK Memorial St. Mary s Spalding Placentia-Linda Coastal Carolina Delray West Boca Fountain Valley Manteca Lakewood Central Carolina USA North Shore - Florida St. Louis Univ Modesto St. Francis Bartlett St. Francis Frye Hahnemann St. Christopher s USA Tenet system Tenet hospitals Commercial covered lives (CAGR: ) (1) Medicare and Medicaid (2) Centennial growth not shown (4% Commercial CAGR, 11% Government CAGR) 9
10 Improving Quality: CMS Core Measures (1) 99% 97% 95% 93% 91% 89% 87% 85% 83% 81% 79% 84.7% 82.8% 83.3% 81.5% 82.3% 80.5% 81.1% 80.0% 87.2% 84.7% 88.8% 85.9% 89.7% 88.5% 89.6% 87.0% 86.7% 86.2% 91.2% 90.8% 90.4% 89.3% 88.6% 88.0% 92.2% 90.3% 93.1% 91.3% 97.0% 96.6% 96.2% 95.7% 95.1% 94.7% 94.4% 93.8% 92.2% 95.3% 95.5% 95.0% 94.6% 94.1% 93.2% 93.5% 98.0% 98.2% 98.3% 98.4%98.5% 97.2% 97.5% 96.9% 97.1% 96.6% 95.7% 96.0% Tenet National Average 77% Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q (1) Core measures for four quarters ended in the indicated quarter. 10
11 Tenet Quality Is Recognized By Insurers Centers of Excellence and Other Quality Designations for Tenet Hospitals and Service Lines
12 Quality is increasingly being measured by patient outcomes The Affordable Care Act directed Medicare to impose financial penalties on hospitals with excessive readmissions beginning in FFY 2013 % US Hospitals Subject to Readmission Penalty * Other Penalty 54% No Penalty 37% Max Penalty 9% 25% 20% 15% 10% 5% 0% 23.5% % of Hospitals Subject to Maximum Readmission Penalty * 20.6% 15.8% 13.1% 9.5% 4.3% 2.2% LPNT HMA VHS CYH UHS THC HCA * Readmission penalty includes pneumonia, heart failure, heart attacks 12
13 Tenet s Medicare Performance Initiative Reducing Costs and Improving Quality Practice Sharing Across Hospitals MPI Cost Savings ($MM) $305 $ $ Analytical Tools to Focus Actions $30 $30 30 $ E 2013E Sustained Incremental 13
14 Sierra Providence Health Network (El Paso, Texas) Providence Sierra Sierra Providence East 14
15 Sierra Providence Health Network (El Paso, Texas) ASC = ambulatory surgery center ASC Providence Sierra Sierra Providence East 15
16 Sierra Providence Health Network (El Paso, Texas) ASC = ambulatory surgery center DIC (Las Cruces, NM) DIC DIC = diagnostic imaging center DIC DIC ASC DIC DIC Providence Sierra DIC Sierra Providence East 16
17 Sierra Providence Health Network (El Paso, Texas) ASC = ambulatory surgery center DIC (Las Cruces, NM) UCC DIC DIC = diagnostic imaging center UCC = urgent care center FED = freestanding emergency room UCC DIC DIC ASC DIC UCC (In-Progress) FED DIC Providence Sierra DIC Sierra Providence East 17
18 Conifer Health Solutions Service Lines Conifer Solves Emerging Needs Health Insurance Exchanges Risk Based Payment Models Population Management Payment Bundling Clinical Integration Cash Flow Improvement Pay for Performance Revenue Compliance 18
19 Conifer with recent transactions (CHI, InforMed and DELL) Conifer Health Solutions (Prior to CHI Agreement) Conifer Health Solutions (with CHI and DELL)* *Map does not reflect 200 healthcare entities for InforMed Conifer (3/31/12) Key Metrics Conifer with CHI, InforMed & DELL 4,100 Employees 9, Healthcare Entity Clients 500+ $11 billion Net Revenue Processed Annually $21 billion 5mm Patient Accounts Processed Annually 10 mm Key Conifer Centers of Excellence Revenue Cycle Management Client Locations Patient Communications Client Locations Cap Management Systems Client Locations CHI Client Locations Dell Client Locations 19
20 Conifer Partnership with Catholic Health Initiatives Transformative Partnership Operating Economics & Capabilities Scale economics Technologydriven Leverages $250mm revenue cycle infrastructure investment Marketing Power Establishes Conifer as a market leader Attracts other early adopter clients Positions Conifer favorably among faith-based NFPs Shareholder Value Expands earnings in a higher multiple business Accelerates aggregate earnings growth 20
21 High Degree Of Experimentation With A Variety Of Reimbursement And Risk-sharing Models Tenet Examples Upside and downside risk Full risk Risk sharing Payor-led integrated network Provider-led integrated network ACO Episodes of care Acquisition of Golden State Medicare Health Plan provides opportunity to expand and also consider Exchange products Launched coordinated care model in Modesto on January 1, 2012 with AllCare IPA and Blue Shield of California Implemented ACO model in South Florida with CIGNA for Tenet employees in 2012 Other projects in development in additional markets Nine hospitals in five markets have submitted proposals to Medicare for total joint and EP/PCI* bundling projects Upside only Gain sharing Incentive * Electrophysiological/percutaneous cardiac interventions Patient-centered medical home Pay for value Basic P4P New agreement with Cigna provides for participation by Tenet s Clinically Integrated Organizations in Cigna s Collaborative Accountable Care model Pursuing narrow network arrangements with selfinsured employers, both directly and through third parties (e.g., Imagine Health) Included in 9 of our top 20 payer contracts Incentives represent $18-20mm in net annual revenue 21
22 New Conifer Acquisition: InforMed, LLC Health information management and services company with a robust population health management service offering 230 clients, including strong presence in the employer sector Complements Conifer Capitation Management strength with providers and health plans 2.5 million members on proprietary report application provides data intelligence on population health management 1 million members under medical management 22
23 Tenet s leverage is in-line with competitors 5.0x 4.5x 4.8x (1) Leverage Ratio 4.0x 3.5x 3.0x 2.5x 2.0x 1.5x CHS 4.1x HCA (2) 4.0x HMA 4.0x VHS 3.7x 2.9x 2.8x UHS 1.0x 0.5x 0.0x (3) (2) CHS VHS HCA THC HMA LPNT UHS (1) Total debt less Cash and Cash Equivalents / last twelve months EBITDA as of September 30, 2012 (2) The October 2012 financing activity had no impact to the ratio above: Issuance of $500M 4.75% Sr. Secured Debt and $300M 6.75% Sr. Unsecured Debt maturing in 2020, repayment of $175M outstanding revolver balance as of 09/30/2012, and repurchase of $161M 7.375% Sr. Unsecured Debt Maturing in 2013 (3) Leverage ratio before dividend payment 23
24 Near-term debt maturities extended and reduced (millions) $1,200 October 31, 2012 (1) $1,000 Weighted Average Maturity of 7.1 years 6.25% (1) 8.875% (1) $800 $600 $ % 10.0% (1) 8.0% 4.75% (1) 6.75% 6.875% $200 $ % 9.875% Unsecured Debt Secured Debt (1) Q Pro forma including the following October 2012 financing activity: Issuance of $500M % sr. secured debt and $300M 6.75% sr. unsecured debt maturing in 2020, repayment of $175M outstanding revolver balance as of 09/30/2012 and repurchase of $161M % sr. unsecured debt maturing in
25 Compelling Investment Value Track Record of Superior Growth Strong Cash Flow Growth Expectation NOL Enhances Cash Flow $1.7 Billion (12/31/11 balance) Upside from Affordable Care Act Investment Value Proven Strategies for Further Growth Upside Potential from Economic Cycle Diversified Earnings Streams Transparent Disclosures 25
26 Reconciliation of EBITDA Adjusted EBITDA, a non-gaap term, is defined by the Company as net income (loss) attributable to Tenet Healthcare Corporation common shareholders before (1) cumulative effect of changes in accounting principle, net of tax, (2) net income attributable to noncontrolling interests, (3) preferred stock dividends, (4) income (loss) from discontinued operations, net of tax, (5) income tax (expense) benefit, (6) net gain (loss) on sales of investments, (7) investment earnings (loss), (8) interest expense, (9) gain (loss) from early extinguishment of debt, (10) litigation and investigation (costs) benefit, net of insurance recoveries, (11) hurricane insurance recoveries, net of costs, (12) impairment of long-lived assets and goodwill and restructuring charges, net of insurance recoveries, and (13) depreciation and amortization. The Company s Adjusted EBITDA may not be comparable to EBITDA reported by other companies. The Company provides this information as a supplement to GAAP information to assist itself and investors in understanding the impact of various items on its financial statements, some of which are recurring or involve cash payments. The Company uses this information in its analysis of the performance of its business excluding items that it does not consider as relevant in the performance of its hospitals in continuing operations. Adjusted EBITDA is not a measure of liquidity, but is a measure of operating performance that management uses in its business as an alternative to net income (loss) attributable to Tenet Healthcare Corporation common shareholders. Because Adjusted EBITDA excludes many items that are included in our financial statements, it does not provide a complete measure of our operating performance. Accordingly, investors are encouraged to use GAAP measures when evaluating the Company s financial performance. The reconciliation of net income (loss) attributable to Tenet Healthcare Corporation common shareholders, the most comparable GAAP term, to Adjusted EBITDA, is set forth below. Outlook Outlook Dollars in Millions Low High Low High Net Income (Loss) Attributable to Common Shareholders $ (2,806) $ (724) $ (803) $ (89) $ 25 $ 181 $ 1,119 $ 58 $ 134 $ 175 $ 258 $ 335 Less: Net income (loss) from noncontrolling interests 3 (2) (7) (4) (7) (10) (9) (12) (15) (10) Preferred stock dividends (6) (24) (24) (12) (12) 0 0 Income (loss) from cumulative effect of accounting change 0 (16) Income (loss) from discontinued operations, net of tax (1,024) (422) 52 (39) (36) (17) 17 (9) (75) (70) (5) 0 Income (loss) from continuing operations (1,785) (284) (850) (46) , Income tax benefit (expense) (300) (61) (129) (148) (177) (220) Income (loss) from continuing operations, before income taxes (1,485) (366) (1,108) (105) Net gain on sales of investments Investment earnings Interest expense (333) (403) (408) (419) (418) (445) (424) (375) (410) (390) (460) (420) Net gain (loss) from extinguishment of long-term debt (13) (15) (57) (117) Operating income (loss) (1,167) (11) (767) Litigation and investigation costs (74) (212) (766) (12) (41) (31) (12) (55) (10) (5) 0 0 Hurricane insurance recoveries, net of costs 0 (7) Impairment of long-lived assets and goodwill, and restructuring charges (1,208) (26) (312) (36) (16) (27) (10) (20) (20) (15) 0 0 Depreciation and amortization (281) (291) (301) (324) (357) (373) (380) (398) (410) (430) (410) (440) Adjusted EBITDA $ 396 $ 525 $ 598 $ 636 $ 714 $ 955 $ 1,036 $ 1,126 $ 1,180 $ 1,220 $ 1,325 $ 1,425 EPS - Continuing Ops - reported ($15.32) ($2.57) ($7.20) ($0.41) $0.54 $1.63 $8.03 $0.56 $1.65 $1.99 $2.66 $3.38 EPS - Continuing Ops - normalized* ($1.15) ($0.89) ($0.57) ($0.57) ($0.34) $0.58 $0.87 $1.49 $1.83 $2.10 $2.66 $3.38 Fully diluted weighted average shares outstanding (in millions) Fully diluted weighted average shares outstanding with preferred conversion (in millions) *Excludes impairment and restructuring charges, litigation and investigation costs, net gain (losses) from early extinguishment of debt, and net gain (losses) from discontinued operations. 26
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