Cover
Cover - shares | 3 Months Ended | |
Mar. 31, 2024 | Apr. 30, 2024 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Mar. 31, 2024 | |
Document Transition Report | false | |
Entity File Number | 001-34465 | |
Entity Registrant Name | SELECT MEDICAL HOLDINGS CORP | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 20-1764048 | |
Entity Address, Address Line One | 4714 Gettysburg Road | |
Entity Address, Address Line Two | P.O. Box 2034 | |
Entity Address, City or Town | Mechanicsburg | |
Entity Address, State or Province | PA | |
Entity Address, Postal Zip Code | 17055 | |
City Area Code | 717 | |
Local Phone Number | 972-1100 | |
Title of 12(b) Security | Common Stock, par value $0.001 per share | |
Trading Symbol | SEM | |
Security Exchange Name | NYSE | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 130,031,562 | |
Current Fiscal Year End Date | --12-31 | |
Amendment Flag | false | |
Document Fiscal Year Focus | 2024 | |
Document Fiscal Period Focus | Q1 | |
Entity Central Index Key | 0001320414 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets (unaudited) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Current Assets: | ||
Cash and cash equivalents | $ 92,620 | $ 84,006 |
Accounts receivable | 1,134,788 | 940,335 |
Prepaid income taxes | 9,034 | 22,726 |
Current portion of interest rate cap contract | 42,660 | 58,962 |
Other current assets | 161,238 | 151,617 |
Total Current Assets | 1,440,340 | 1,257,646 |
Operating lease right-of-use assets | 1,176,713 | 1,188,616 |
Property and equipment, net | 1,024,626 | 1,023,561 |
Goodwill | 3,517,071 | 3,513,170 |
Identifiable intangible assets, net | 324,125 | 329,916 |
Other assets | 375,388 | 376,722 |
Total Assets | 7,858,263 | 7,689,631 |
Current Liabilities: | ||
Overdrafts | 28,534 | 30,274 |
Current operating lease liabilities | 245,617 | 245,400 |
Current portion of long-term debt and notes payable | 60,184 | 70,329 |
Accounts payable | 163,551 | 174,312 |
Accrued and other liabilities | 686,491 | 728,150 |
Total Current Liabilities | 1,184,377 | 1,248,465 |
Non-current operating lease liabilities | 1,015,160 | 1,025,867 |
Long-term debt, net of current portion | 3,758,631 | 3,587,675 |
Non-current deferred tax liability | 133,987 | 143,306 |
Other non-current liabilities | 100,175 | 110,303 |
Total Liabilities | 6,192,330 | 6,115,616 |
Commitments and contingencies (Note 14) | ||
Redeemable non-controlling interests | 28,290 | 26,297 |
Stockholders’ Equity: | ||
Common stock, $0.001 par value, 700,000,000 shares authorized, 128,369,492 and 128,357,832 shares issued and outstanding at 2023 and 2024, respectively | 128 | 128 |
Capital in excess of par | 505,403 | 493,413 |
Retained earnings | 830,821 | 751,856 |
Accumulated other comprehensive income | 30,930 | 42,907 |
Total Stockholders’ Equity | 1,367,282 | 1,288,304 |
Non-controlling interests | 270,361 | 259,414 |
Total Equity | 1,637,643 | 1,547,718 |
Total Liabilities and Equity | $ 7,858,263 | $ 7,689,631 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (unaudited) (Parenthetical) - $ / shares | Mar. 31, 2024 | Dec. 31, 2023 |
Statement of Financial Position [Abstract] | ||
Common stock, par value (in dollars per share) | $ 0.001 | $ 0.001 |
Common stock, shares authorized (in shares) | 700,000,000 | 700,000,000 |
Common stock, shares issued (in shares) | 128,357,832 | 128,369,492 |
Common stock, shares outstanding (in shares) | 128,357,832 | 128,369,492 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations (unaudited) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Income Statement [Abstract] | ||
Revenue | $ 1,788,809 | $ 1,664,980 |
Costs and expenses: | ||
Cost of services, exclusive of depreciation and amortization | 1,494,610 | 1,418,819 |
General and administrative | 48,447 | 42,279 |
Depreciation and amortization | 54,069 | 52,425 |
Total costs and expenses | 1,597,126 | 1,513,523 |
Other operating income | 2,284 | 0 |
Income from operations | 193,967 | 151,457 |
Other income and expense: | ||
Equity in earnings of unconsolidated subsidiaries | 10,421 | 8,556 |
Interest expense | (50,763) | (48,571) |
Income before income taxes | 153,625 | 111,442 |
Income tax expense | 36,458 | 26,185 |
Net income | 117,167 | 85,257 |
Less: Net income attributable to non-controlling interests | 20,270 | 14,452 |
Net income attributable to Select Medical Holdings Corporation | $ 96,897 | $ 70,805 |
Earnings per common share (Note 13): | ||
Basic (in dollars per share) | $ 0.75 | $ 0.56 |
Diluted (in dollars per share) | $ 0.75 | $ 0.56 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Comprehensive Income (unaudited) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Statement of Comprehensive Income [Abstract] | ||
Net income | $ 117,167 | $ 85,257 |
Other comprehensive loss, net of tax: | ||
Gain (loss) on interest rate cap contract | 4,370 | (2,696) |
Reclassification adjustment for gains included in net income | (16,347) | (13,252) |
Net change, net of tax benefit of $5,175, and $3,782 | (11,977) | (15,948) |
Comprehensive income | 105,190 | 69,309 |
Less: Comprehensive income attributable to non-controlling interests | 20,270 | 14,452 |
Comprehensive income attributable to Select Medical Holdings Corporation | $ 84,920 | $ 54,857 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Comprehensive Income (unaudited) (Parenthetical) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Statement of Comprehensive Income [Abstract] | ||
Tax benefit (expense) on components of other comprehensive income | $ 3,782 | $ 5,175 |
Condensed Consolidated Statem_4
Condensed Consolidated Statements of Changes in Equity and Income (unaudited) - USD ($) $ in Thousands | Total | Total Stockholders’ Equity | Common Stock | Capital in Excess of Par | Retained Earnings | Accumulated Other Comprehensive Income | Non-controlling Interests |
Beginning balance (in shares) at Dec. 31, 2022 | 127,173,000 | ||||||
Beginning balance at Dec. 31, 2022 | $ 1,356,564 | $ 1,121,922 | $ 127 | $ 452,183 | $ 581,010 | $ 88,602 | $ 234,642 |
Increase (Decrease) in Stockholders' Equity | |||||||
Net income attributable to Select Medical Holdings Corporation | 70,805 | 70,805 | 70,805 | ||||
Net income attributable to non-controlling interests | 12,811 | 0 | 12,811 | ||||
Cash dividends declared for common stockholders ($0.125 per share) | (15,897) | (15,897) | (15,897) | ||||
Issuance of restricted stock (in shares) | 3,000 | ||||||
Issuance of restricted stock | 0 | 0 | $ 0 | 0 | |||
Vesting of restricted stock | 10,003 | 10,003 | 10,003 | ||||
Issuance of non-controlling interests | 2,731 | 0 | 2,731 | ||||
Non-controlling interests acquired in business combination | 3,877 | 0 | 3,877 | ||||
Distributions to and purchases of non-controlling interests | (6,069) | 0 | (6,069) | ||||
Redemption value adjustment on non-controlling interests | (436) | (436) | (436) | ||||
Other comprehensive loss | (15,948) | (15,948) | (15,948) | ||||
Other | 0 | 0 | (1) | 1 | |||
Ending balance (in shares) at Mar. 31, 2023 | 127,176,000 | ||||||
Ending balance at Mar. 31, 2023 | $ 1,418,441 | 1,170,449 | $ 127 | 462,185 | 635,483 | 72,654 | 247,992 |
Beginning balance (in shares) at Dec. 31, 2023 | 128,369,492 | 128,369,000 | |||||
Beginning balance at Dec. 31, 2023 | $ 1,547,718 | 1,288,304 | $ 128 | 493,413 | 751,856 | 42,907 | 259,414 |
Increase (Decrease) in Stockholders' Equity | |||||||
Net income attributable to Select Medical Holdings Corporation | 96,897 | 96,897 | 96,897 | ||||
Net income attributable to non-controlling interests | 17,845 | 0 | 17,845 | ||||
Cash dividends declared for common stockholders ($0.125 per share) | (16,045) | (16,045) | (16,045) | ||||
Issuance of restricted stock (in shares) | 1,000 | ||||||
Issuance of restricted stock | 0 | 0 | $ 0 | 0 | |||
Forfeitures of unvested restricted stock (in shares) | (12,000) | ||||||
Forfeitures of unvested restricted stock | 14 | 14 | $ 0 | 0 | 14 | ||
Vesting of restricted stock | 11,596 | 11,596 | 11,596 | ||||
Issuance of non-controlling interests | 4,002 | 0 | 4,002 | ||||
Distributions to and purchases of non-controlling interests | (10,506) | 394 | 394 | (10,900) | |||
Redemption value adjustment on non-controlling interests | (1,901) | (1,901) | (1,901) | ||||
Other comprehensive loss | $ (11,977) | (11,977) | (11,977) | ||||
Ending balance (in shares) at Mar. 31, 2024 | 128,357,832 | 128,358,000 | |||||
Ending balance at Mar. 31, 2024 | $ 1,637,643 | $ 1,367,282 | $ 128 | $ 505,403 | $ 830,821 | $ 30,930 | $ 270,361 |
Condensed Consolidated Statem_5
Condensed Consolidated Statements of Changes in Equity and Income (unaudited) (Parenthetical) - $ / shares | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Statement of Stockholders' Equity [Abstract] | ||
Cash dividend declared (in dollars per share) | $ 0.125 | $ 0.125 |
Condensed Consolidated Statem_6
Condensed Consolidated Statements of Cash Flows (unaudited) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Operating activities | ||
Net income | $ 117,167 | $ 85,257 |
Adjustments to reconcile net income to net cash provided by (used in) operating activities: | ||
Distributions from unconsolidated subsidiaries | 12,374 | 2,566 |
Depreciation and amortization | 54,069 | 52,425 |
Provision for expected credit losses | 854 | 429 |
Equity in earnings of unconsolidated subsidiaries | (10,421) | (8,556) |
(Gain) loss on sale or disposal of assets | 44 | (7) |
Stock compensation expense | 11,610 | 10,181 |
Amortization of debt discount, premium, and issuance costs | 750 | 565 |
Deferred income taxes | (6,891) | (2,601) |
Changes in operating assets and liabilities, net of effects of business combinations: | ||
Accounts receivable | (195,308) | (55,397) |
Other current assets | (9,611) | (11,742) |
Other assets | 2,363 | 3,659 |
Accounts payable | (5,718) | (4,564) |
Accrued expenses | (37,971) | (20,775) |
Net cash provided by (used in) operating activities | (66,689) | 51,440 |
Investing activities | ||
Business combinations, net of cash acquired | (5,405) | (397) |
Purchases of property, equipment, and other assets | (52,517) | (58,885) |
Investment in businesses | 0 | (9,800) |
Proceeds from sale of assets and businesses | 265 | 20 |
Net cash used in investing activities | (57,657) | (69,062) |
Financing activities | ||
Borrowings on revolving facilities | 495,000 | 225,000 |
Payments on revolving facilities | (265,000) | (210,000) |
Payments on term loans | (79,085) | 0 |
Borrowings of other debt | 17,728 | 21,448 |
Principal payments on other debt | (9,061) | (11,170) |
Dividends paid to common stockholders | (16,045) | (15,897) |
Decrease in overdrafts | (1,740) | (724) |
Proceeds from issuance of non-controlling interests | 4,002 | 2,731 |
Distributions to and purchases of non-controlling interests | (12,839) | (7,969) |
Net cash provided by financing activities | 132,960 | 3,419 |
Net increase (decrease) in cash and cash equivalents | 8,614 | (14,203) |
Cash and cash equivalents at beginning of period | 84,006 | 97,906 |
Cash and cash equivalents at end of period | 92,620 | 83,703 |
Supplemental information | ||
Cash paid for interest, excluding amounts received of $17,828 and $22,515 under the interest rate cap contract | 88,834 | 84,531 |
Cash paid for taxes | $ 604 | $ 336 |
Condensed Consolidated Statem_7
Condensed Consolidated Statements of Cash Flows (unaudited) (Parenthetical) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Statement of Cash Flows [Abstract] | ||
Interest received under interest rate cash flow hedge | $ 22,515 | $ 17,828 |
Basis of Presentation
Basis of Presentation | 3 Months Ended |
Mar. 31, 2024 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Basis of Presentation | Basis of Presentation The unaudited condensed consolidated financial statements of Select Medical Holdings Corporation (“Holdings”) include the accounts of its wholly owned subsidiary, Select Medical Corporation (“Select”). Holdings conducts substantially all of its business through Select and its subsidiaries. Holdings, Select, and Select’s subsidiaries are collectively referred to as the “Company.” The unaudited condensed consolidated financial statements of the Company as of March 31, 2024, and for the three month periods ended March 31, 2023 and 2024, have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (the “SEC”) for interim reporting and the accounting principles generally accepted in the United States of America (“GAAP”). Accordingly, certain information and disclosures required by GAAP, which are normally included in the notes to the consolidated financial statements, have been condensed or omitted pursuant to those rules and regulations, although the Company believes the disclosure is adequate to make the information presented not misleading. In the opinion of management, such information contains all adjustments, which are normal and recurring in nature, necessary for a fair statement of the financial position, results of operations and cash flow for such periods. All significant intercompany transactions and balances have been eliminated. The results of operations for the three months ended March 31, 2024, are not necessarily indicative of the results to be expected for the full fiscal year ending December 31, 2024. These unaudited condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto for the year ended December 31, 2023, contained in the Company’s Annual Report on Form 10-K filed with the SEC on February 22, 2024. |
Accounting Policies
Accounting Policies | 3 Months Ended |
Mar. 31, 2024 | |
Accounting Policies [Abstract] | |
Accounting Policies | Accounting Policies Recent Accounting Guidance Not Yet Adopted Segment Reporting In November 2023, FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures , which is intended to improve disclosure of segment information so that investors can better understand an entity’s overall performance. The ASU requires entities to quantitatively disclose significant segment expenses that are regularly provided to the chief operating decision maker for each reportable segment, as well as the amount of other segment items for each reportable segment and a description of what the other segment items are comprised. Disclosure of multiple measures of profit or loss will be permitted by the ASU. The ASU is effective for annual reporting periods beginning on or after December 15, 2023, and interim periods with fiscal years beginning after December 15, 2024; however, early adoption is permitted. The ASU is required to be applied retrospectively to all periods presented in the financial statements. The Company is currently reviewing the impact that ASU 2023-07 will have on the disclosures in our consolidated financial statements. Income Taxes In December 2023, FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, which is intended to improve the transparency and decision usefulness of income tax disclosures. The ASU includes enhanced requirements on the rate reconciliation, including specific categories that must be disclosed, and provides a threshold over which reconciling items must be disclosed. The amendments in the update also require annual disclosure of income taxes paid, disaggregated by federal, state, and foreign taxes, as well as any individual jurisdictions in which income taxes paid is greater than 5% of total income taxes paid. The ASU is effective for annual periods beginning after December 15, 2024; however early adoption is permitted. The ASU can be applied either prospectively or retrospectively. The Company is currently reviewing the impact that ASU 2023-09 will have to the disclosures in our consolidated financial statements. Recently Adopted Accounting Guidance Leases In March 2023, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2023-01, Leases (Topic 842): Common Control Arrangements , which requires companies to amortize leasehold improvements associated with related party leases under common control over the useful life of the leasehold improvement to the common control group. The ASU is effective for annual reporting periods beginning on or after December 15, 2023; however, early adoption is permitted. The ASU can either be applied prospectively or retrospectively. The Company adopted this ASU using the prospective method of transition on January 1, 2024. There was not a material impact on the Company’s consolidated financial statements upon adoption. Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, and expenses. Actual results could differ from those estimates. |
Credit Risk Concentrations
Credit Risk Concentrations | 3 Months Ended |
Mar. 31, 2024 | |
Credit Loss [Abstract] | |
Credit Risk Concentrations | Credit Risk Concentrations Financial instruments that potentially subject the Company to concentrations of credit risk consist primarily of cash balances and accounts receivable. The Company’s excess cash is held with large financial institutions. The Company grants unsecured credit to its patients, most of whom reside in the service area of the Company’s facilities and are insured under third-party payor agreements. Because of the diversity in the Company’s non-governmental third-party payor base, as well as their geographic dispersion, accounts receivable due from the Medicare program represent the Company’s only significant concentration of credit risk. Approximately 17% and 20% of the Company’s accounts receivable is due from Medicare at both December 31, 2023, and March 31, 2024, respectively. |
Redeemable Non-Controlling Inte
Redeemable Non-Controlling Interests | 3 Months Ended |
Mar. 31, 2024 | |
Noncontrolling Interest [Abstract] | |
Redeemable Non-Controlling Interests | Redeemable Non-Controlling Interests The ownership interests held by outside parties in subsidiaries, which include limited liability companies and limited partnerships, controlled by the Company are classified as non-controlling interests. Some of the Company’s non-controlling ownership interests consist of outside parties that have certain redemption rights that, if exercised, require the Company to purchase the parties’ ownership interests. These interests are classified and reported as redeemable non-controlling interests and have been adjusted to their redemption values, after the attribution of net income or loss. The changes in redeemable non-controlling interests are as follows: Three Months Ended March 31, 2023 2024 (in thousands) Balance as of January 1 $ 34,043 $ 26,297 Net income attributable to redeemable non-controlling interests 1,641 2,425 Distributions to redeemable non-controlling interests (1,900) (2,333) Redemption value adjustment on redeemable non-controlling interests 436 1,901 Other 179 — Balance as of March 31 $ 34,399 $ 28,290 |
Variable Interest Entities
Variable Interest Entities | 3 Months Ended |
Mar. 31, 2024 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Variable Interest Entities | Variable Interest Entities Certain states prohibit the “corporate practice of medicine,” which restricts the Company from owning medical practices which directly employ physicians or therapists and from exercising control over medical decisions by physicians and therapists. In these states, the Company enters into long-term management agreements with medical practices that are owned by licensed physicians or therapists, which, in turn, employ or contract with physicians or therapists who provide professional medical services. The management agreements provide for the Company to direct the transfer of ownership of the medical practices. Based on the provisions of the management agreements, the medical practices are variable interest entities for which the Company is the primary beneficiary. As of December 31, 2023, and March 31, 2024, the total assets of the Company’s variable interest entities were $246.4 million and $263.7 million, respectively, and are principally comprised of accounts receivable. As of December 31, 2023, and March 31, 2024, the total liabilities of the Company’s variable interest entities were $84.3 million and $85.4 million, respectively, and are principally comprised of accounts payable and accrued expenses. These variable interest entities have obligations payable for services received under their management agreements with the Company of $161.8 million and $179.5 million as of December 31, 2023, and March 31, 2024, respectively. These intercompany balances are eliminated in consolidation. |
Leases
Leases | 3 Months Ended |
Mar. 31, 2024 | |
Leases [Abstract] | |
Leases | Leases The Company’s total lease cost is as follows: Three Months Ended March 31, 2023 Three Months Ended March 31, 2024 Unrelated Parties Related Parties Total Unrelated Parties Related Parties Total (in thousands) Operating lease cost $ 76,632 $ 1,834 $ 78,466 $ 79,055 $ 1,834 $ 80,889 Finance lease cost: Amortization of right-of-use assets 394 — 394 354 — 354 Interest on lease liabilities 320 — 320 304 — 304 Variable lease cost 15,761 84 15,845 17,076 — 17,076 Sublease income (1,678) — (1,678) (1,760) — (1,760) Total lease cost $ 91,429 $ 1,918 $ 93,347 $ 95,029 $ 1,834 $ 96,863 |
Leases | Leases The Company’s total lease cost is as follows: Three Months Ended March 31, 2023 Three Months Ended March 31, 2024 Unrelated Parties Related Parties Total Unrelated Parties Related Parties Total (in thousands) Operating lease cost $ 76,632 $ 1,834 $ 78,466 $ 79,055 $ 1,834 $ 80,889 Finance lease cost: Amortization of right-of-use assets 394 — 394 354 — 354 Interest on lease liabilities 320 — 320 304 — 304 Variable lease cost 15,761 84 15,845 17,076 — 17,076 Sublease income (1,678) — (1,678) (1,760) — (1,760) Total lease cost $ 91,429 $ 1,918 $ 93,347 $ 95,029 $ 1,834 $ 96,863 |
Long-Term Debt and Notes Payabl
Long-Term Debt and Notes Payable | 3 Months Ended |
Mar. 31, 2024 | |
Debt Disclosure [Abstract] | |
Long-Term Debt and Notes Payable | Long-Term Debt and Notes Payable As of March 31, 2024, the Company’s long-term debt and notes payable are as follows: Principal Unamortized Premium (Discount) Unamortized Carrying Value Fair Value (in thousands) 6.250% senior notes $ 1,225,000 $ 14,041 $ (7,186) $ 1,231,855 $ 1,226,531 Credit facilities: Revolving facility 510,000 — — 510,000 506,175 Term loan 2,013,400 (11,088) (2,973) 1,999,339 2,015,917 Other debt, including finance leases 77,667 — (46) 77,621 77,621 Total debt $ 3,826,067 $ 2,953 $ (10,205) $ 3,818,815 $ 3,826,244 Principal maturities of the Company’s long-term debt and notes payable are approximately as follows: 2024 2025 2026 2027 2028 Thereafter Total (in thousands) 6.250% senior notes $ — $ — $ 1,225,000 $ — $ — $ — $ 1,225,000 Credit facilities: Revolving facility — — — 510,000 — — 510,000 Term loan — — — 2,013,400 — — 2,013,400 Other debt, including finance leases 58,155 3,151 2,461 1,941 1,620 10,339 77,667 Total debt $ 58,155 $ 3,151 $ 1,227,461 $ 2,525,341 $ 1,620 $ 10,339 $ 3,826,067 As of December 31, 2023, the Company’s long-term debt and notes payable are as follows: Principal Unamortized Premium (Discount) Unamortized Carrying Value Fair Value (in thousands) 6.250% senior notes $ 1,225,000 $ 15,533 $ (7,937) $ 1,232,596 $ 1,228,063 Credit facilities: Revolving facility 280,000 — — 280,000 278,600 Term loan 2,092,485 (12,040) (3,229) 2,077,216 2,092,485 Other debt, including finance leases 68,255 — (63) 68,192 68,192 Total debt $ 3,665,740 $ 3,493 $ (11,229) $ 3,658,004 $ 3,667,340 |
Accrued and other liabilities
Accrued and other liabilities | 3 Months Ended |
Mar. 31, 2024 | |
Payables and Accruals [Abstract] | |
Accrued and other liabilities | Accrued and other liabilities The following table sets forth the components of accrued and other liabilities on the Condensed Consolidated Balance Sheets: December 31, 2023 March 31, 2024 Accrued payroll $ 238,768 $ 184,801 Accrued vacation 157,748 164,113 Accrued interest 32,472 14,438 Accrued other 297,663 292,587 Income taxes payable 1,499 30,552 Accrued and other liabilities $ 728,150 $ 686,491 |
Interest Rate Cap
Interest Rate Cap | 3 Months Ended |
Mar. 31, 2024 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Interest Rate Cap | Interest Rate Cap The Company is subject to market risk exposure arising from changes in interest rates on its term loan, which bears interest at a rate which is indexed to one-month Term SOFR. The Company’s objective in using an interest rate derivative is to mitigate its exposure to increases in interest rates. The interest rate cap limits the Company’s exposure to increases in the variable rate index to 1.0% on $2.0 billion of principal outstanding under the term loan, as the interest rate cap provides for payments from the counterparty when interest rates rise above 1.0%. The interest rate cap has a $2.0 billion notional amount and is effective through September 30, 2024. The Company will pay a monthly premium for the interest rate cap over the term of the agreement. The annual premium is equal to 0.0916% of the notional amount, or approximately $1.8 million. The interest rate cap has been designated as a cash flow hedge and is highly effective at offsetting the changes in cash outflows when the variable rate index exceeds 1.0%. Changes in the fair value of the interest rate cap, net of tax, are recognized in other comprehensive income and are reclassified out of accumulated other comprehensive income and into interest expense when the hedged interest obligations affect earnings. The following table outlines the changes in accumulated other comprehensive income (loss), net of tax, during the periods presented: Three Months Ended March 31, 2023 2024 (in thousands) Balance as of January 1 $ 88,602 $ 42,907 Gain (loss) on interest rate cap cash flow hedge (2,696) 4,370 Amounts reclassified from accumulated other comprehensive income (13,252) (16,347) Balance as of March 31 $ 72,654 $ 30,930 The effects on net income of amounts reclassified from accumulated other comprehensive income are as follows: Three Months Ended March 31, Statement of Operations 2023 2024 (in thousands) Gains included in interest expense $ 17,552 $ 21,509 Income tax expense (4,300) (5,162) Amounts reclassified from accumulated other comprehensive income $ 13,252 $ 16,347 The Company expects that approximately $40.7 million of estimated pre-tax gains will be reclassified from accumulated other comprehensive income into interest expense through the expiration of the interest rate cap on September 30, 2024. |
Fair Value of Financial Instrum
Fair Value of Financial Instruments | 3 Months Ended |
Mar. 31, 2024 | |
Fair Value Disclosures [Abstract] | |
Fair Value of Financial Instruments | Fair Value of Financial Instruments Financial instruments which are measured at fair value, or for which a fair value is disclosed, are classified in the fair value hierarchy, as outlined below, on the basis of the observability of the inputs used in the fair value measurement: • Level 1 – inputs are based upon quoted prices for identical instruments in active markets. • Level 2 – inputs are based upon quoted prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active, and model-based valuation techniques for which all significant inputs are observable in the market or can be corroborated by observable market data. • Level 3 – inputs are generally unobservable and typically reflect management’s estimates of assumptions that market participants would use in pricing the instrument. The Company’s interest rate cap contract is recorded at its fair value in the condensed consolidated balance sheets on a recurring basis. The fair value of the interest rate cap contract is based upon a model-derived valuation using observable market inputs, such as interest rates and interest rate volatility, and the strike price. Financial Instrument Balance Sheet Classification Level December 31, 2023 March 31, 2024 Asset: (in thousands) Interest rate cap contract, current portion Current portion of interest rate cap contract Level 2 $ 58,962 $ 42,660 The Company does not measure its indebtedness at fair value in its condensed consolidated balance sheets. The fair value of the credit facilities is based on quoted market prices for this debt in the syndicated loan market. The fair value of the senior notes is based on quoted market prices. The carrying value of the Company’s other debt, as disclosed in Note 7 – Long-Term Debt and Notes Payable, approximates fair value. December 31, 2023 March 31, 2024 Financial Instrument Level Carrying Value Fair Value Carrying Value Fair Value (in thousands) 6.250% senior notes Level 2 $ 1,232,596 $ 1,228,063 $ 1,231,855 $ 1,226,531 Credit facilities: Revolving facility Level 2 280,000 278,600 510,000 506,175 Term loan Level 2 2,077,216 2,092,485 1,999,339 2,015,917 |
Segment Information
Segment Information | 3 Months Ended |
Mar. 31, 2024 | |
Segment Reporting [Abstract] | |
Segment Information | Segment Information The Company’s reportable segments consist of the critical illness recovery hospital segment, rehabilitation hospital segment, outpatient rehabilitation segment, and Concentra segment. Other activities include the Company’s corporate shared services, certain investments, and employee leasing services with non-consolidating subsidiaries. The Company evaluates the performance of its segments based on Adjusted EBITDA. Adjusted EBITDA is defined as earnings excluding interest, income taxes, depreciation and amortization, gain (loss) on early retirement of debt, stock compensation expense, transaction costs associated with the Concentra separation, gain (loss) on sale of businesses, and equity in earnings (losses) of unconsolidated subsidiaries. The Company has provided additional information regarding its reportable segments, such as total assets, which contributes to the understanding of the Company and provides useful information to the users of the consolidated financial statements. The following tables summarize selected financial data for the Company’s reportable segments. Three Months Ended March 31, 2023 2024 (in thousands) Revenue: Critical illness recovery hospital $ 593,926 $ 655,880 Rehabilitation hospital 231,462 265,700 Outpatient rehabilitation 295,903 303,158 Concentra 456,298 467,598 Other 87,391 96,473 Total Company $ 1,664,980 $ 1,788,809 Adjusted EBITDA: Critical illness recovery hospital $ 76,773 $ 115,940 Rehabilitation hospital 47,216 61,400 Outpatient rehabilitation 30,199 24,928 Concentra 93,748 96,142 Other (33,873) (36,493) Total Company $ 214,063 $ 261,917 Total assets: Critical illness recovery hospital $ 2,507,265 $ 2,608,979 Rehabilitation hospital 1,203,069 1,233,828 Outpatient rehabilitation 1,397,823 1,423,740 Concentra 2,300,632 2,362,848 Other 290,947 228,868 Total Company $ 7,699,736 $ 7,858,263 Purchases of property, equipment, and other assets: Critical illness recovery hospital $ 23,658 $ 15,941 Rehabilitation hospital 8,582 7,101 Outpatient rehabilitation 9,932 9,500 Concentra 14,400 17,231 Other 2,313 2,744 Total Company $ 58,885 $ 52,517 A reconciliation of Adjusted EBITDA to income before income taxes is as follows: Three Months Ended March 31, 2023 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Adjusted EBITDA $ 76,773 $ 47,216 $ 30,199 $ 93,748 $ (33,873) Depreciation and amortization (16,637) (6,888) (8,457) (18,310) (2,133) Stock compensation expense — — — (178) (10,003) Income (loss) from operations $ 60,136 $ 40,328 $ 21,742 $ 75,260 $ (46,009) $ 151,457 Equity in earnings of unconsolidated subsidiaries 8,556 Interest expense (48,571) Income before income taxes $ 111,442 Three Months Ended March 31, 2024 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Adjusted EBITDA $ 115,940 $ 61,400 $ 24,928 $ 96,142 $ (36,493) Depreciation and amortization (17,157) (7,135) (9,181) (18,485) (2,111) Stock compensation expense — — — (166) (11,444) Concentra separation transaction costs (1) — — — (1,993) (278) Income (loss) from operations $ 98,783 $ 54,265 $ 15,747 $ 75,498 $ (50,326) $ 193,967 Equity in earnings of unconsolidated subsidiaries 10,421 Interest expense (50,763) Income before income taxes $ 153,625 _______________________________________________________________________________ |
Revenue from Contracts with Cus
Revenue from Contracts with Customers | 3 Months Ended |
Mar. 31, 2024 | |
Revenue from Contract with Customer [Abstract] | |
Revenue from Contracts with Customers | Revenue from Contracts with Customers The following tables disaggregate the Company’s revenue for the three months ended March 31, 2023 and 2024: Three Months Ended March 31, 2023 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Patient service revenue: Medicare $ 229,383 $ 110,055 $ 45,801 $ 243 $ — $ 385,482 Non-Medicare 363,305 109,925 231,985 454,598 — 1,159,813 Total patient services revenues 592,688 219,980 277,786 454,841 — 1,545,295 Other revenue 1,238 11,482 18,117 1,457 87,391 119,685 Total revenue $ 593,926 $ 231,462 $ 295,903 $ 456,298 $ 87,391 $ 1,664,980 Three Months Ended March 31, 2024 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Patient service revenue: Medicare $ 226,261 $ 126,386 $ 45,841 $ 266 $ — $ 398,754 Non-Medicare 428,666 126,577 239,613 465,601 — 1,260,457 Total patient services revenues 654,927 252,963 285,454 465,867 — 1,659,211 Other revenue 953 12,737 17,704 1,731 96,473 129,598 Total revenue $ 655,880 $ 265,700 $ 303,158 $ 467,598 $ 96,473 $ 1,788,809 |
Earnings per Share
Earnings per Share | 3 Months Ended |
Mar. 31, 2024 | |
Earnings Per Share [Abstract] | |
Earnings per Share | Earnings per Share The Company’s capital structure includes common stock and unvested restricted stock awards. To compute earnings per share (“EPS”), the Company applies the two-class method because the Company’s unvested restricted stock awards are participating securities which are entitled to participate equally with the Company’s common stock in undistributed earnings. Application of the Company’s two-class method is as follows: (i) Net income attributable to the Company is reduced by the amount of dividends declared and by the contractual amount of dividends that must be paid for the current period for each class of stock. There were no contractual dividends paid for the three months ended March 31, 2023 and 2024. (ii) The remaining undistributed net income of the Company is then equally allocated to its common stock and unvested restricted stock awards, as if all of the earnings for the period had been distributed. The total net income allocated to each security is determined by adding both distributed and undistributed net income for the period. (iii) The net income allocated to each security is then divided by the weighted average number of outstanding shares for the period to determine the EPS for each security considered in the two-class method. The following table sets forth the net income attributable to the Company, its common shares outstanding, and its participating securities outstanding. Basic and Diluted EPS Three Months Ended March 31, 2023 2024 (in thousands) Net income $ 85,257 $ 117,167 Less: net income attributable to non-controlling interests 14,452 20,270 Net income attributable to the Company 70,805 96,897 Less: Distributed and undistributed income attributable to participating securities 2,573 3,398 Distributed and undistributed income attributable to common shares $ 68,232 $ 93,499 The following tables set forth the computation of EPS under the two-class method: Three Months Ended March 31, 2023 2024 Net Income Allocation Shares (1) Basic and Diluted EPS Net Income Allocation Shares (1) Basic and Diluted EPS (in thousands, except for per share amounts) Common shares $ 68,232 122,553 $ 0.56 $ 93,499 123,859 $ 0.75 Participating securities 2,573 4,622 $ 0.56 3,398 4,501 $ 0.75 Total Company $ 70,805 $ 96,897 _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ (1) Represents the weighted average share count outstanding during the period. |
Commitments and Contingencies
Commitments and Contingencies | 3 Months Ended |
Mar. 31, 2024 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | Commitments and Contingencies Litigation The Company is a party to various legal actions, proceedings, and claims (some of which are not insured), and regulatory and other governmental audits and investigations in the ordinary course of its business. The Company cannot predict the ultimate outcome of pending litigation, proceedings, and regulatory and other governmental audits and investigations. These matters could potentially subject the Company to sanctions, damages, recoupments, fines, and other penalties. The Department of Justice, Centers for Medicare & Medicaid Services (“CMS”), or other federal and state enforcement and regulatory agencies may conduct additional investigations related to the Company’s businesses in the future that may, either individually or in the aggregate, have a material adverse effect on the Company’s business, financial position, results of operations, and liquidity. To address claims arising out of the Company’s operations, the Company maintains professional malpractice liability insurance and general liability insurance coverages through a number of different programs that are dependent upon such factors as the state where the Company is operating and whether the operations are wholly owned or are operated through a joint venture. For the Company’s wholly owned hospital and outpatient clinic operations, the Company currently maintains insurance coverages under a combination of policies with a total annual aggregate limit of up to $37.0 million for professional malpractice liability insurance and $40.0 million for general liability insurance. For the Company’s Concentra center operations, the Company currently maintains insurance coverages under a combination of policies with a total annual aggregate limit of up to $29.0 million for professional malpractice liability insurance and $29.0 million for general liability insurance. The Company’s insurance for the professional liability coverage is written on a “claims-made” basis, and its commercial general liability coverage is maintained on an “occurrence” basis. These coverages apply after a self-insured retention limit is exceeded. For the Company’s joint venture operations, the Company has designed a separate insurance program that responds to the risks of specific joint ventures. Most of the Company’s joint ventures are insured under a master program with an annual aggregate limit of up to $80.0 million, subject to a sublimit aggregate ranging from $23.0 million to $33.0 million. The policies are generally written on a “claims-made” basis. Each of these programs has either a deductible or self-insured retention limit. The Company also maintains additional types of liability insurance covering claims which, due to their nature or amount, are not covered by or not fully covered by the applicable professional malpractice and general liability insurance policies, including workers compensation, property and casualty, directors and officers, cyber liability insurance, and employment practices liability insurance coverages. Our insurance policies generally are silent with respect to punitive damages so coverage is available to the extent insurable under the law of any applicable jurisdiction, and are subject to various deductibles and policy limits. The Company reviews its insurance program annually and may make adjustments to the amount of insurance coverage and self-insured retentions in future years. Significant legal actions, as well as the cost and possible lack of available insurance, could subject the Company to substantial uninsured liabilities. Healthcare providers are subject to lawsuits under the qui tam provisions of the federal False Claims Act. Qui tam lawsuits typically remain under seal (hence, usually unknown to the defendant) for some time while the government decides whether or not to intervene on behalf of a private qui tam plaintiff (known as a relator) and take the lead in the litigation. These lawsuits can involve significant monetary damages and penalties and award bounties to private plaintiffs who successfully bring the suits. The Company is and has been a defendant in these cases in the past, and may be named as a defendant in similar cases from time to time in the future. Oklahoma City Investigation. On August 24, 2020, the Company and Select Specialty Hospital – Oklahoma City, Inc. (“SSH–Oklahoma City”) received civil investigative demands (“CIDs”) from the U.S. Attorney’s Office for the Western District of Oklahoma seeking responses to interrogatories and the production of various documents principally relating to the documentation, billing and reviews of medical services furnished to patients at SSH-Oklahoma City. The Company understands that the investigation arose from a qui tam lawsuit alleging billing fraud related to charges for respiratory therapy services at SSH–Oklahoma City and Select Specialty Hospital – Wichita, Inc. The Company has produced documents in response to the CIDs and is fully cooperating with this investigation. At this time, the Company is unable to predict the timing and outcome of this matter. Physical Therapy Billing. On October 7, 2021, the Company received a letter from a Trial Attorney at the U.S. Department of Justice, Civil Division, Commercial Litigation Branch, Fraud Section (“DOJ”) stating that the DOJ, in conjunction with the U.S. Department of Health and Human Services (“HHS”), is investigating the Company in connection with potential violations of the False Claims Act, 31 U.S.C. § 3729, et seq . The letter specified that the investigation relates to the Company’s billing for physical therapy services, and indicated that the DOJ would be requesting certain records from the Company. In October and December 2021, the DOJ requested, and the Company furnished, records relating to six of the Company’s outpatient therapy clinics in Florida. In 2022 and 2023, the DOJ requested certain data relating to all of the Company’s outpatient therapy clinics nationwide, and sought information about the Company’s ability to produce additional data relating to the physical therapy services furnished by the Company’s outpatient therapy clinics and Concentra. The Company has produced data and other documents requested by the DOJ and is fully cooperating on this investigation. At this time, the Company is unable to predict the timing and outcome of this matter. California Department of Insurance Investigation . On February 5, 2024, Concentra received a subpoena from the California Department of Insurance relating to an investigation under the California Insurance Frauds Prevention Act (“IFPA”), Cal. Ins. Code § 1871.7 et seq ., which allows a whistleblower to file a false claims lawsuit based on the submission of false or fraudulent claims to insurance companies. The subpoena seeks documentation relating mainly to Concentra’s billing and coding for physical therapy claims submitted to commercial insurers and workers compensation carriers located or doing business in California. The Company has produced data and other documents requested by the California Department of Insurance and is fully cooperating on this investigation. At this time, the Company is unable to predict the timing and outcome of this matter. Perry Johnson & Associates, Inc. Data Breach . On November 10, 2023, Perry Johnson & Associates, Inc., a third-party vendor of health information technology solutions that provides medical transcription services (“PJ&A”), notified Concentra Health Services, Inc. (“Concentra”) that certain information related to particular Concentra patients was potentially affected by a cybersecurity event. In February 2024, Concentra sent notices to almost four million patients who may have been impacted by the data breach. During the first quarter of 2024, Concentra became aware of six putative class action lawsuits files against PJ&A and Concentra related to the data breach. The first was filed in the U.S. District Court for the Eastern District of Michigan on February 19, 2024 by Elliot Curry, individually and on behalf of all others similarly situated. Plaintiff alleged, among other things, that he became the victim of identity theft as a result of the PJ&A data breach and that Concentra had lax data security policies. The second was filed in the U.S. District Court for the Eastern District of New York on February 21, 2024 by Tiffany Williams and Jo Joaquim, individually and on behalf of all others similarly situated. Plaintiffs alleged, among other things, that they face an immediate and heightened risk of identity theft as a result of the data breach and that the defendants failed to take measures to properly safeguard their private information. The third was filed in the U.S. District Court for the Eastern District of Missouri on February 26, 2024 by Stephen Tate, a.k.a. Steven Tate, individually and on behalf of all others similarly situated. Plaintiff alleged, among other things, that he faces a heightened and imminent risk of identity theft as a result of the data breach and that the defendants failed to take measures to properly safeguard his private information. The fourth was filed in the U.S. District Court for the Eastern District of Michigan on February 26, 2024 by Eric Franczak, individually and on behalf of all others similarly situated. Plaintiff alleged, among other things, that he faces a substantially increased risk of fraud and identity theft as a result of the data breach and that the defendants failed to take measures to properly safeguard his private information. The fifth was filed in the U.S. District Court for the Eastern District of Michigan on March 6, 2024 by Lazema Johnson, individually and on behalf of all others similarly situated. Plaintiff alleged, among other things, that she faces a substantially increased risk of fraud and identity theft as a result of the data breach and that the defendants failed to take measures to properly safeguard her private information. The sixth was filed in the Superior Court of California, County of Los Angeles, on April 8, 2024 by Robert Valencia, individually and on behalf of all others similarly situated. Plaintiff alleged, among other things, that he faces a substantially increased risk of fraud and identity theft as a result of the data breach and that the defendants failed to take measures to properly safeguard his private information. The Company is working with its cybersecurity risk insurance policy carrier and does not believe that the data breach or the lawsuits will have a material impact on its operations or financial performance. However, at this time, the Company is unable to predict the timing and outcome of these matters. |
Subsequent Events
Subsequent Events | 3 Months Ended |
Mar. 31, 2024 | |
Subsequent Events [Abstract] | |
Subsequent Events | Subsequent Events On May 1, 2024, the Company’s Board of Directors declared a cash dividend of $0.125 per share. The dividend will be payable on or about May 30, 2024, to stockholders of record as of the close of business on May 16, 2024. |
Pay vs Performance Disclosure
Pay vs Performance Disclosure - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Pay vs Performance Disclosure | ||
Net income attributable to Select Medical Holdings Corporation | $ 96,897 | $ 70,805 |
Insider Trading Arrangements
Insider Trading Arrangements | 3 Months Ended |
Mar. 31, 2024 | |
Trading Arrangements, by Individual | |
Rule 10b5-1 Arrangement Adopted | false |
Non-Rule 10b5-1 Arrangement Adopted | false |
Rule 10b5-1 Arrangement Terminated | false |
Non-Rule 10b5-1 Arrangement Terminated | false |
Accounting Policies (Policies)
Accounting Policies (Policies) | 3 Months Ended |
Mar. 31, 2024 | |
Accounting Policies [Abstract] | |
Recent Accounting Guidance Not Yet Adopted and Recently Adopted Accounting Guidance | Recent Accounting Guidance Not Yet Adopted Segment Reporting In November 2023, FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures , which is intended to improve disclosure of segment information so that investors can better understand an entity’s overall performance. The ASU requires entities to quantitatively disclose significant segment expenses that are regularly provided to the chief operating decision maker for each reportable segment, as well as the amount of other segment items for each reportable segment and a description of what the other segment items are comprised. Disclosure of multiple measures of profit or loss will be permitted by the ASU. The ASU is effective for annual reporting periods beginning on or after December 15, 2023, and interim periods with fiscal years beginning after December 15, 2024; however, early adoption is permitted. The ASU is required to be applied retrospectively to all periods presented in the financial statements. The Company is currently reviewing the impact that ASU 2023-07 will have on the disclosures in our consolidated financial statements. Income Taxes In December 2023, FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, which is intended to improve the transparency and decision usefulness of income tax disclosures. The ASU includes enhanced requirements on the rate reconciliation, including specific categories that must be disclosed, and provides a threshold over which reconciling items must be disclosed. The amendments in the update also require annual disclosure of income taxes paid, disaggregated by federal, state, and foreign taxes, as well as any individual jurisdictions in which income taxes paid is greater than 5% of total income taxes paid. The ASU is effective for annual periods beginning after December 15, 2024; however early adoption is permitted. The ASU can be applied either prospectively or retrospectively. The Company is currently reviewing the impact that ASU 2023-09 will have to the disclosures in our consolidated financial statements. Recently Adopted Accounting Guidance Leases In March 2023, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2023-01, Leases (Topic 842): Common Control Arrangements , which requires companies to amortize leasehold improvements associated with related party leases under common control over the useful life of the leasehold improvement to the common control group. The ASU is effective for annual reporting periods beginning on or after December 15, 2023; however, early adoption is permitted. The ASU can either be applied prospectively or retrospectively. The Company adopted this ASU using the prospective method of transition on January 1, 2024. There was not a material impact on the Company’s consolidated financial statements upon adoption. |
Use of Estimates | Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, and expenses. Actual results could differ from those estimates. |
Credit Risk Concentrations | Credit Risk Concentrations Financial instruments that potentially subject the Company to concentrations of credit risk consist primarily of cash balances and accounts receivable. The Company’s excess cash is held with large financial institutions. The Company grants unsecured credit to its patients, most of whom reside in the service area of the Company’s facilities and are insured under third-party payor agreements. |
Redeemable Non-Controlling Interests | Redeemable Non-Controlling Interests The ownership interests held by outside parties in subsidiaries, which include limited liability companies and limited partnerships, controlled by the Company are classified as non-controlling interests. Some of the Company’s non-controlling ownership interests consist of outside parties that have certain redemption rights that, if exercised, require the Company to purchase the parties’ ownership interests. These interests are classified and reported as redeemable non-controlling interests and have been adjusted to their redemption values, after the attribution of net income or loss. |
Variable Interest Entities | Variable Interest Entities Certain states prohibit the “corporate practice of medicine,” which restricts the Company from owning medical practices which directly employ physicians or therapists and from exercising control over medical decisions by physicians and therapists. In these states, the Company enters into long-term management agreements with medical practices that are owned by licensed physicians or therapists, which, in turn, employ or contract with physicians or therapists who provide professional medical services. The management agreements provide for the Company to direct the transfer of ownership of the medical practices. Based on the provisions of the management agreements, the medical practices are variable interest entities for which the Company is the primary beneficiary. |
Redeemable Non-Controlling In_2
Redeemable Non-Controlling Interests (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Noncontrolling Interest [Abstract] | |
Schedule of redeemable non-controlling interests | The changes in redeemable non-controlling interests are as follows: Three Months Ended March 31, 2023 2024 (in thousands) Balance as of January 1 $ 34,043 $ 26,297 Net income attributable to redeemable non-controlling interests 1,641 2,425 Distributions to redeemable non-controlling interests (1,900) (2,333) Redemption value adjustment on redeemable non-controlling interests 436 1,901 Other 179 — Balance as of March 31 $ 34,399 $ 28,290 |
Leases (Tables)
Leases (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Leases [Abstract] | |
Schedule of lease cost | The Company’s total lease cost is as follows: Three Months Ended March 31, 2023 Three Months Ended March 31, 2024 Unrelated Parties Related Parties Total Unrelated Parties Related Parties Total (in thousands) Operating lease cost $ 76,632 $ 1,834 $ 78,466 $ 79,055 $ 1,834 $ 80,889 Finance lease cost: Amortization of right-of-use assets 394 — 394 354 — 354 Interest on lease liabilities 320 — 320 304 — 304 Variable lease cost 15,761 84 15,845 17,076 — 17,076 Sublease income (1,678) — (1,678) (1,760) — (1,760) Total lease cost $ 91,429 $ 1,918 $ 93,347 $ 95,029 $ 1,834 $ 96,863 |
Long-Term Debt and Notes Paya_2
Long-Term Debt and Notes Payable (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Debt Disclosure [Abstract] | |
Schedule of long-term debt and notes payable | As of March 31, 2024, the Company’s long-term debt and notes payable are as follows: Principal Unamortized Premium (Discount) Unamortized Carrying Value Fair Value (in thousands) 6.250% senior notes $ 1,225,000 $ 14,041 $ (7,186) $ 1,231,855 $ 1,226,531 Credit facilities: Revolving facility 510,000 — — 510,000 506,175 Term loan 2,013,400 (11,088) (2,973) 1,999,339 2,015,917 Other debt, including finance leases 77,667 — (46) 77,621 77,621 Total debt $ 3,826,067 $ 2,953 $ (10,205) $ 3,818,815 $ 3,826,244 As of December 31, 2023, the Company’s long-term debt and notes payable are as follows: Principal Unamortized Premium (Discount) Unamortized Carrying Value Fair Value (in thousands) 6.250% senior notes $ 1,225,000 $ 15,533 $ (7,937) $ 1,232,596 $ 1,228,063 Credit facilities: Revolving facility 280,000 — — 280,000 278,600 Term loan 2,092,485 (12,040) (3,229) 2,077,216 2,092,485 Other debt, including finance leases 68,255 — (63) 68,192 68,192 Total debt $ 3,665,740 $ 3,493 $ (11,229) $ 3,658,004 $ 3,667,340 |
Schedule of principal maturities of long-term debt and notes payable | Principal maturities of the Company’s long-term debt and notes payable are approximately as follows: 2024 2025 2026 2027 2028 Thereafter Total (in thousands) 6.250% senior notes $ — $ — $ 1,225,000 $ — $ — $ — $ 1,225,000 Credit facilities: Revolving facility — — — 510,000 — — 510,000 Term loan — — — 2,013,400 — — 2,013,400 Other debt, including finance leases 58,155 3,151 2,461 1,941 1,620 10,339 77,667 Total debt $ 58,155 $ 3,151 $ 1,227,461 $ 2,525,341 $ 1,620 $ 10,339 $ 3,826,067 |
Accrued and other liabilities (
Accrued and other liabilities (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Payables and Accruals [Abstract] | |
Components of accrued and other liabilities | The following table sets forth the components of accrued and other liabilities on the Condensed Consolidated Balance Sheets: December 31, 2023 March 31, 2024 Accrued payroll $ 238,768 $ 184,801 Accrued vacation 157,748 164,113 Accrued interest 32,472 14,438 Accrued other 297,663 292,587 Income taxes payable 1,499 30,552 Accrued and other liabilities $ 728,150 $ 686,491 |
Interest Rate Cap (Tables)
Interest Rate Cap (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Schedule of accumulated other comprehensive income (loss) | The following table outlines the changes in accumulated other comprehensive income (loss), net of tax, during the periods presented: Three Months Ended March 31, 2023 2024 (in thousands) Balance as of January 1 $ 88,602 $ 42,907 Gain (loss) on interest rate cap cash flow hedge (2,696) 4,370 Amounts reclassified from accumulated other comprehensive income (13,252) (16,347) Balance as of March 31 $ 72,654 $ 30,930 |
Schedule of reclassification out of accumulated other comprehensive income | The effects on net income of amounts reclassified from accumulated other comprehensive income are as follows: Three Months Ended March 31, Statement of Operations 2023 2024 (in thousands) Gains included in interest expense $ 17,552 $ 21,509 Income tax expense (4,300) (5,162) Amounts reclassified from accumulated other comprehensive income $ 13,252 $ 16,347 |
Fair Value of Financial Instr_2
Fair Value of Financial Instruments (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Fair Value Disclosures [Abstract] | |
Schedule of interest rate cap | Financial Instrument Balance Sheet Classification Level December 31, 2023 March 31, 2024 Asset: (in thousands) Interest rate cap contract, current portion Current portion of interest rate cap contract Level 2 $ 58,962 $ 42,660 |
Schedule of long-term debt | December 31, 2023 March 31, 2024 Financial Instrument Level Carrying Value Fair Value Carrying Value Fair Value (in thousands) 6.250% senior notes Level 2 $ 1,232,596 $ 1,228,063 $ 1,231,855 $ 1,226,531 Credit facilities: Revolving facility Level 2 280,000 278,600 510,000 506,175 Term loan Level 2 2,077,216 2,092,485 1,999,339 2,015,917 |
Segment Information (Tables)
Segment Information (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Segment Reporting [Abstract] | |
Schedule of selected financial data for reportable segments | The following tables summarize selected financial data for the Company’s reportable segments. Three Months Ended March 31, 2023 2024 (in thousands) Revenue: Critical illness recovery hospital $ 593,926 $ 655,880 Rehabilitation hospital 231,462 265,700 Outpatient rehabilitation 295,903 303,158 Concentra 456,298 467,598 Other 87,391 96,473 Total Company $ 1,664,980 $ 1,788,809 Adjusted EBITDA: Critical illness recovery hospital $ 76,773 $ 115,940 Rehabilitation hospital 47,216 61,400 Outpatient rehabilitation 30,199 24,928 Concentra 93,748 96,142 Other (33,873) (36,493) Total Company $ 214,063 $ 261,917 Total assets: Critical illness recovery hospital $ 2,507,265 $ 2,608,979 Rehabilitation hospital 1,203,069 1,233,828 Outpatient rehabilitation 1,397,823 1,423,740 Concentra 2,300,632 2,362,848 Other 290,947 228,868 Total Company $ 7,699,736 $ 7,858,263 Purchases of property, equipment, and other assets: Critical illness recovery hospital $ 23,658 $ 15,941 Rehabilitation hospital 8,582 7,101 Outpatient rehabilitation 9,932 9,500 Concentra 14,400 17,231 Other 2,313 2,744 Total Company $ 58,885 $ 52,517 |
Schedule of reconciliation of Adjusted EBITDA to income before income taxes | A reconciliation of Adjusted EBITDA to income before income taxes is as follows: Three Months Ended March 31, 2023 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Adjusted EBITDA $ 76,773 $ 47,216 $ 30,199 $ 93,748 $ (33,873) Depreciation and amortization (16,637) (6,888) (8,457) (18,310) (2,133) Stock compensation expense — — — (178) (10,003) Income (loss) from operations $ 60,136 $ 40,328 $ 21,742 $ 75,260 $ (46,009) $ 151,457 Equity in earnings of unconsolidated subsidiaries 8,556 Interest expense (48,571) Income before income taxes $ 111,442 Three Months Ended March 31, 2024 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Adjusted EBITDA $ 115,940 $ 61,400 $ 24,928 $ 96,142 $ (36,493) Depreciation and amortization (17,157) (7,135) (9,181) (18,485) (2,111) Stock compensation expense — — — (166) (11,444) Concentra separation transaction costs (1) — — — (1,993) (278) Income (loss) from operations $ 98,783 $ 54,265 $ 15,747 $ 75,498 $ (50,326) $ 193,967 Equity in earnings of unconsolidated subsidiaries 10,421 Interest expense (50,763) Income before income taxes $ 153,625 _______________________________________________________________________________ |
Revenue from Contracts with C_2
Revenue from Contracts with Customers (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Revenue from Contract with Customer [Abstract] | |
Schedule of disaggregation of revenue | The following tables disaggregate the Company’s revenue for the three months ended March 31, 2023 and 2024: Three Months Ended March 31, 2023 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Patient service revenue: Medicare $ 229,383 $ 110,055 $ 45,801 $ 243 $ — $ 385,482 Non-Medicare 363,305 109,925 231,985 454,598 — 1,159,813 Total patient services revenues 592,688 219,980 277,786 454,841 — 1,545,295 Other revenue 1,238 11,482 18,117 1,457 87,391 119,685 Total revenue $ 593,926 $ 231,462 $ 295,903 $ 456,298 $ 87,391 $ 1,664,980 Three Months Ended March 31, 2024 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Patient service revenue: Medicare $ 226,261 $ 126,386 $ 45,841 $ 266 $ — $ 398,754 Non-Medicare 428,666 126,577 239,613 465,601 — 1,260,457 Total patient services revenues 654,927 252,963 285,454 465,867 — 1,659,211 Other revenue 953 12,737 17,704 1,731 96,473 129,598 Total revenue $ 655,880 $ 265,700 $ 303,158 $ 467,598 $ 96,473 $ 1,788,809 |
Earnings per Share (Tables)
Earnings per Share (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Earnings Per Share [Abstract] | |
Schedule of computation of basic and diluted earnings per share | The following table sets forth the net income attributable to the Company, its common shares outstanding, and its participating securities outstanding. Basic and Diluted EPS Three Months Ended March 31, 2023 2024 (in thousands) Net income $ 85,257 $ 117,167 Less: net income attributable to non-controlling interests 14,452 20,270 Net income attributable to the Company 70,805 96,897 Less: Distributed and undistributed income attributable to participating securities 2,573 3,398 Distributed and undistributed income attributable to common shares $ 68,232 $ 93,499 The following tables set forth the computation of EPS under the two-class method: Three Months Ended March 31, 2023 2024 Net Income Allocation Shares (1) Basic and Diluted EPS Net Income Allocation Shares (1) Basic and Diluted EPS (in thousands, except for per share amounts) Common shares $ 68,232 122,553 $ 0.56 $ 93,499 123,859 $ 0.75 Participating securities 2,573 4,622 $ 0.56 3,398 4,501 $ 0.75 Total Company $ 70,805 $ 96,897 _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ (1) Represents the weighted average share count outstanding during the period. |
Credit Risk Concentrations (Det
Credit Risk Concentrations (Details) | 3 Months Ended | 12 Months Ended |
Mar. 31, 2024 | Dec. 31, 2023 | |
Medicare Receivable | Credit Concentration Risk | Accounts Receivable | ||
Concentration Risk [Line Items] | ||
Percentage of concentration risk | 20% | 17% |
Redeemable Non-Controlling In_3
Redeemable Non-Controlling Interests (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Increase (Decrease) in Temporary Equity [Roll Forward] | ||
Balance, beginning | $ 26,297 | $ 34,043 |
Net income attributable to redeemable non-controlling interests | 2,425 | 1,641 |
Distributions to redeemable non-controlling interests | (2,333) | (1,900) |
Redemption value adjustment on redeemable non-controlling interests | 1,901 | 436 |
Other | 0 | 179 |
Balance, ending | $ 28,290 | $ 34,399 |
Variable Interest Entities (Det
Variable Interest Entities (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 | Mar. 31, 2023 |
Variable Interest Entity [Line Items] | |||
Assets | $ 7,858,263 | $ 7,689,631 | $ 7,699,736 |
Liabilities | 6,192,330 | 6,115,616 | |
Variable Interest Entity, Primary Beneficiary | |||
Variable Interest Entity [Line Items] | |||
Assets | 263,700 | 246,400 | |
Liabilities | 85,400 | 84,300 | |
Variable Interest Entity, Primary Beneficiary | Related Party | |||
Variable Interest Entity [Line Items] | |||
Obligations payable | $ 179,500 | $ 161,800 |
Leases (Details)
Leases (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Operating lease cost | ||
Unrelated Parties | $ 79,055 | $ 76,632 |
Related Parties | 1,834 | 1,834 |
Total | 80,889 | 78,466 |
Amortization of right-of-use assets | ||
Unrelated Parties | 354 | 394 |
Related Parties | 0 | 0 |
Total | 354 | 394 |
Interest on lease liabilities | ||
Unrelated Parties | 304 | 320 |
Related Parties | 0 | 0 |
Total | 304 | 320 |
Variable lease cost | ||
Unrelated Parties | 17,076 | 15,761 |
Related Parties | 0 | 84 |
Total | 17,076 | 15,845 |
Sublease income | ||
Unrelated Parties | (1,760) | (1,678) |
Related Parties | 0 | 0 |
Total | (1,760) | (1,678) |
Total lease cost | ||
Unrelated Parties | 95,029 | 91,429 |
Related Parties | 1,834 | 1,918 |
Total | $ 96,863 | $ 93,347 |
Long-Term Debt and Notes Paya_3
Long-Term Debt and Notes Payable - Components of Long-Term Debt And Notes Payable (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Debt Instrument [Line Items] | ||
Principal Outstanding | $ 3,826,067 | $ 3,665,740 |
Unamortized Premium (Discount) | 2,953 | 3,493 |
Unamortized Issuance Costs | (10,205) | (11,229) |
Carrying Value | 3,818,815 | 3,658,004 |
Fair Value | $ 3,826,244 | $ 3,667,340 |
Senior notes | 6.250% senior notes | ||
Debt Instrument [Line Items] | ||
Interest rate of debt (as a percent) | 6.25% | 6.25% |
Principal Outstanding | $ 1,225,000 | $ 1,225,000 |
Unamortized Premium (Discount) | 14,041 | 15,533 |
Unamortized Issuance Costs | (7,186) | (7,937) |
Carrying Value | 1,231,855 | 1,232,596 |
Fair Value | 1,226,531 | 1,228,063 |
Term loan | ||
Debt Instrument [Line Items] | ||
Principal Outstanding | 2,013,400 | 2,092,485 |
Unamortized Premium (Discount) | (11,088) | (12,040) |
Unamortized Issuance Costs | (2,973) | (3,229) |
Carrying Value | 1,999,339 | 2,077,216 |
Fair Value | 2,015,917 | 2,092,485 |
Other debt, including finance leases | ||
Debt Instrument [Line Items] | ||
Principal Outstanding | 77,667 | 68,255 |
Unamortized Premium (Discount) | 0 | 0 |
Unamortized Issuance Costs | (46) | (63) |
Carrying Value | 77,621 | 68,192 |
Fair Value | 77,621 | 68,192 |
Revolving facility | Revolving facility | ||
Debt Instrument [Line Items] | ||
Principal Outstanding | 510,000 | 280,000 |
Unamortized Premium (Discount) | 0 | 0 |
Unamortized Issuance Costs | 0 | 0 |
Carrying Value | 510,000 | 280,000 |
Fair Value | $ 506,175 | $ 278,600 |
Long-Term Debt and Notes Paya_4
Long-Term Debt and Notes Payable - Principal Maturities Of Long-Term Debt (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Debt Instrument [Line Items] | ||
2024 | $ 58,155 | |
2025 | 3,151 | |
2026 | 1,227,461 | |
2027 | 2,525,341 | |
2028 | 1,620 | |
Thereafter | 10,339 | |
Total | $ 3,826,067 | $ 3,665,740 |
Senior notes | 6.250% senior notes | ||
Debt Instrument [Line Items] | ||
Interest rate of debt (as a percent) | 6.25% | 6.25% |
2024 | $ 0 | |
2025 | 0 | |
2026 | 1,225,000 | |
2027 | 0 | |
2028 | 0 | |
Thereafter | 0 | |
Total | 1,225,000 | $ 1,225,000 |
Revolving facility | Revolving facility | ||
Debt Instrument [Line Items] | ||
2024 | 0 | |
2025 | 0 | |
2026 | 0 | |
2027 | 510,000 | |
2028 | 0 | |
Thereafter | 0 | |
Total | 510,000 | 280,000 |
Term loan | ||
Debt Instrument [Line Items] | ||
2024 | 0 | |
2025 | 0 | |
2026 | 0 | |
2027 | 2,013,400 | |
2028 | 0 | |
Thereafter | 0 | |
Total | 2,013,400 | 2,092,485 |
Other debt, including finance leases | ||
Debt Instrument [Line Items] | ||
2024 | 58,155 | |
2025 | 3,151 | |
2026 | 2,461 | |
2027 | 1,941 | |
2028 | 1,620 | |
Thereafter | 10,339 | |
Total | $ 77,667 | $ 68,255 |
Accrued and other liabilities_2
Accrued and other liabilities (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Payables and Accruals [Abstract] | ||
Accrued payroll | $ 184,801 | $ 238,768 |
Accrued vacation | 164,113 | 157,748 |
Accrued interest | 14,438 | 32,472 |
Accrued other | 292,587 | 297,663 |
Income taxes payable | 30,552 | 1,499 |
Accrued and other liabilities | $ 686,491 | $ 728,150 |
Interest Rate Cap - Narrative (
Interest Rate Cap - Narrative (Details) - Interest Rate Cap $ in Millions | 3 Months Ended |
Mar. 31, 2024 USD ($) | |
Derivative [Line Items] | |
Derivative cap interest rate (as a percent) | 1% |
Notional amount | $ 2,000 |
Annual premium (in percent) | 0.000916 |
Annual premium amount | $ 1.8 |
Estimated pre-tax gain expected to be reclassified through expiration | $ 40.7 |
Interest Rate Cap - Schedule of
Interest Rate Cap - Schedule of Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward] | ||
Beginning balance | $ 1,547,718 | $ 1,356,564 |
Ending balance | 1,637,643 | 1,418,441 |
Accumulated Gain (Loss), Net, Cash Flow Hedge, Parent | Interest Rate Cap | ||
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward] | ||
Beginning balance | 42,907 | 88,602 |
Gain (loss) on interest rate cap cash flow hedge | 4,370 | (2,696) |
Amounts reclassified from accumulated other comprehensive income | (16,347) | (13,252) |
Ending balance | $ 30,930 | $ 72,654 |
Interest Rate Cap - Schedule _2
Interest Rate Cap - Schedule of Reclassification out of Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Reclassification Adjustment out of Accumulated Other Comprehensive Income on Derivatives [Line Items] | ||
Gains included in interest expense | $ (50,763) | $ (48,571) |
Income tax expense | (36,458) | (26,185) |
Amounts reclassified from accumulated other comprehensive income | 96,897 | 70,805 |
Reclassification out of Accumulated Other Comprehensive Income | Accumulated Gain (Loss), Net, Cash Flow Hedge, Parent | Interest Rate Cap | ||
Reclassification Adjustment out of Accumulated Other Comprehensive Income on Derivatives [Line Items] | ||
Gains included in interest expense | 21,509 | 17,552 |
Income tax expense | (5,162) | (4,300) |
Amounts reclassified from accumulated other comprehensive income | $ 16,347 | $ 13,252 |
Fair Value of Financial Instr_3
Fair Value of Financial Instruments - Schedule of Interest Rate Cap (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Interest rate cap contract, current portion | $ 42,660 | $ 58,962 |
Interest Rate Cap | Fair Value, Inputs, Level 2 | Fair Value, Recurring | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Interest rate cap contract, current portion | $ 42,660 | $ 58,962 |
Fair Value of Financial Instr_4
Fair Value of Financial Instruments - Schedule of Long-Term Debt (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Fair Value | $ 3,826,244 | $ 3,667,340 |
Senior notes | 6.250% senior notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Interest rate of debt (as a percent) | 6.25% | 6.25% |
Carrying Value | $ 1,231,855 | $ 1,232,596 |
Fair Value | 1,226,531 | 1,228,063 |
Senior notes | Fair Value, Inputs, Level 2 | 6.250% senior notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Carrying Value | 1,231,855 | 1,232,596 |
Fair Value | 1,226,531 | 1,228,063 |
Revolving facility | Fair Value, Inputs, Level 2 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Carrying Value | 510,000 | 280,000 |
Fair Value | 506,175 | 278,600 |
Term loan | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Carrying Value | 1,999,339 | 2,077,216 |
Fair Value | 2,015,917 | 2,092,485 |
Term loan | Fair Value, Inputs, Level 2 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Carrying Value | 1,999,339 | 2,077,216 |
Fair Value | $ 2,015,917 | $ 2,092,485 |
Segment Information - Selected
Segment Information - Selected Financial Data (Details) - USD ($) $ in Thousands | 3 Months Ended | ||
Mar. 31, 2024 | Mar. 31, 2023 | Dec. 31, 2023 | |
Segment Reporting Information [Line Items] | |||
Revenue | $ 1,788,809 | $ 1,664,980 | |
Adjusted EBITDA | 261,917 | 214,063 | |
Total assets | 7,858,263 | 7,699,736 | $ 7,689,631 |
Purchases of property, equipment, and other assets | 52,517 | 58,885 | |
Operating Segments | Critical Illness Recovery Hospital | |||
Segment Reporting Information [Line Items] | |||
Revenue | 655,880 | 593,926 | |
Adjusted EBITDA | 115,940 | 76,773 | |
Total assets | 2,608,979 | 2,507,265 | |
Purchases of property, equipment, and other assets | 15,941 | 23,658 | |
Operating Segments | Rehabilitation Hospital | |||
Segment Reporting Information [Line Items] | |||
Revenue | 265,700 | 231,462 | |
Adjusted EBITDA | 61,400 | 47,216 | |
Total assets | 1,233,828 | 1,203,069 | |
Purchases of property, equipment, and other assets | 7,101 | 8,582 | |
Operating Segments | Outpatient Rehabilitation | |||
Segment Reporting Information [Line Items] | |||
Revenue | 303,158 | 295,903 | |
Adjusted EBITDA | 24,928 | 30,199 | |
Total assets | 1,423,740 | 1,397,823 | |
Purchases of property, equipment, and other assets | 9,500 | 9,932 | |
Operating Segments | Concentra | |||
Segment Reporting Information [Line Items] | |||
Revenue | 467,598 | 456,298 | |
Adjusted EBITDA | 96,142 | 93,748 | |
Total assets | 2,362,848 | 2,300,632 | |
Purchases of property, equipment, and other assets | 17,231 | 14,400 | |
Other | |||
Segment Reporting Information [Line Items] | |||
Revenue | 96,473 | 87,391 | |
Adjusted EBITDA | (36,493) | (33,873) | |
Total assets | 228,868 | 290,947 | |
Purchases of property, equipment, and other assets | $ 2,744 | $ 2,313 |
Segment Information - Reconcili
Segment Information - Reconciliation of Adjusted EBITDA to Income Before Taxes (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Segment Reporting Information [Line Items] | ||
Adjusted EBITDA | $ 261,917 | $ 214,063 |
Depreciation and amortization | (54,069) | (52,425) |
Income from operations | 193,967 | 151,457 |
Equity in earnings of unconsolidated subsidiaries | 10,421 | 8,556 |
Interest expense | (50,763) | (48,571) |
Income before income taxes | 153,625 | 111,442 |
Operating Segments | Critical Illness Recovery Hospital | ||
Segment Reporting Information [Line Items] | ||
Adjusted EBITDA | 115,940 | 76,773 |
Depreciation and amortization | (17,157) | (16,637) |
Stock compensation expense | 0 | 0 |
Concentra separation transaction costs | 0 | |
Income from operations | 98,783 | 60,136 |
Operating Segments | Rehabilitation Hospital | ||
Segment Reporting Information [Line Items] | ||
Adjusted EBITDA | 61,400 | 47,216 |
Depreciation and amortization | (7,135) | (6,888) |
Stock compensation expense | 0 | 0 |
Concentra separation transaction costs | 0 | |
Income from operations | 54,265 | 40,328 |
Operating Segments | Outpatient Rehabilitation | ||
Segment Reporting Information [Line Items] | ||
Adjusted EBITDA | 24,928 | 30,199 |
Depreciation and amortization | (9,181) | (8,457) |
Stock compensation expense | 0 | 0 |
Concentra separation transaction costs | 0 | |
Income from operations | 15,747 | 21,742 |
Operating Segments | Concentra | ||
Segment Reporting Information [Line Items] | ||
Adjusted EBITDA | 96,142 | 93,748 |
Depreciation and amortization | (18,485) | (18,310) |
Stock compensation expense | (166) | (178) |
Concentra separation transaction costs | (1,993) | |
Income from operations | 75,498 | 75,260 |
Other | ||
Segment Reporting Information [Line Items] | ||
Adjusted EBITDA | (36,493) | (33,873) |
Depreciation and amortization | (2,111) | (2,133) |
Stock compensation expense | (11,444) | (10,003) |
Concentra separation transaction costs | (278) | |
Income from operations | $ (50,326) | $ (46,009) |
Revenue from Contracts with C_3
Revenue from Contracts with Customers (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Disaggregation of Revenue [Line Items] | ||
Total revenue | $ 1,788,809 | $ 1,664,980 |
Total patient services revenues | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 1,659,211 | 1,545,295 |
Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 398,754 | 385,482 |
Non-Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 1,260,457 | 1,159,813 |
Other revenue | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 129,598 | 119,685 |
Operating Segments | Critical Illness Recovery Hospital | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 655,880 | 593,926 |
Operating Segments | Critical Illness Recovery Hospital | Total patient services revenues | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 654,927 | 592,688 |
Operating Segments | Critical Illness Recovery Hospital | Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 226,261 | 229,383 |
Operating Segments | Critical Illness Recovery Hospital | Non-Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 428,666 | 363,305 |
Operating Segments | Critical Illness Recovery Hospital | Other revenue | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 953 | 1,238 |
Operating Segments | Rehabilitation Hospital | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 265,700 | 231,462 |
Operating Segments | Rehabilitation Hospital | Total patient services revenues | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 252,963 | 219,980 |
Operating Segments | Rehabilitation Hospital | Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 126,386 | 110,055 |
Operating Segments | Rehabilitation Hospital | Non-Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 126,577 | 109,925 |
Operating Segments | Rehabilitation Hospital | Other revenue | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 12,737 | 11,482 |
Operating Segments | Outpatient Rehabilitation | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 303,158 | 295,903 |
Operating Segments | Outpatient Rehabilitation | Total patient services revenues | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 285,454 | 277,786 |
Operating Segments | Outpatient Rehabilitation | Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 45,841 | 45,801 |
Operating Segments | Outpatient Rehabilitation | Non-Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 239,613 | 231,985 |
Operating Segments | Outpatient Rehabilitation | Other revenue | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 17,704 | 18,117 |
Operating Segments | Concentra | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 467,598 | 456,298 |
Operating Segments | Concentra | Total patient services revenues | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 465,867 | 454,841 |
Operating Segments | Concentra | Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 266 | 243 |
Operating Segments | Concentra | Non-Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 465,601 | 454,598 |
Operating Segments | Concentra | Other revenue | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 1,731 | 1,457 |
Other | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 96,473 | 87,391 |
Other | Total patient services revenues | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 0 | 0 |
Other | Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 0 | 0 |
Other | Non-Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | 0 | 0 |
Other | Other revenue | ||
Disaggregation of Revenue [Line Items] | ||
Total revenue | $ 96,473 | $ 87,391 |
Earnings per Share - Narrative
Earnings per Share - Narrative (Details) - USD ($) | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Earnings Per Share [Abstract] | ||
Contractual dividends paid | $ 0 | $ 0 |
Earnings per Share - Net Income
Earnings per Share - Net Income Attributable to the Company, Common Shares Outstanding, and Participating Securities Outstanding (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Earnings Per Share [Abstract] | ||
Net income | $ 117,167 | $ 85,257 |
Less: Net income attributable to non-controlling interests | 20,270 | 14,452 |
Net income attributable to Select Medical Holdings Corporation | 96,897 | 70,805 |
Basic EPS | ||
Less: Distributed and undistributed income attributable to participating securities - Basic EPS | 3,398 | 2,573 |
Distributed and undistributed income attributable to common shares | 93,499 | 68,232 |
Diluted EPS | ||
Less: Distributed and undistributed income attributable to participating securities - Diluted EPS | 3,398 | 2,573 |
Distributed and undistributed income attributable to common shares | $ 93,499 | $ 68,232 |
Earnings per Share - Computatio
Earnings per Share - Computation of EPS Under the Two-Class Method (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Net Income Allocation | ||
Net income allocated to common shares - basic | $ 93,499 | $ 68,232 |
Participating securities - basic | 3,398 | 2,573 |
Net income allocated to common shares - diluted | 93,499 | 68,232 |
Participating securities - diluted | 3,398 | 2,573 |
Net income attributable to Select Medical Holdings Corporation | $ 96,897 | $ 70,805 |
Weighted average common shares outstanding, basic (in shares) | 123,859 | 122,553 |
Weighted average common shares outstanding, diluted (in shares) | 123,859 | 122,553 |
Weighted average participating securities outstanding (in shares) | 4,501 | 4,622 |
Basic EPS | ||
Basic EPS (in dollars per share) | $ 0.75 | $ 0.56 |
Diluted EPS | ||
Diluted EPS (in dollars per share) | $ 0.75 | $ 0.56 |
Commitments and Contingencies (
Commitments and Contingencies (Details) $ in Millions | 1 Months Ended | 3 Months Ended |
Feb. 29, 2024 class_action_lawsuit patient | Mar. 31, 2024 USD ($) | |
Commitments and Contingencies | ||
Number of patients | patient | 4,000,000 | |
Number of class action lawsuits | class_action_lawsuit | 6 | |
Professional liability claims | Critical Illness Recovery Hospitals, Rehabilitation Hospitals And Outpatient Rehabilitiation | ||
Commitments and Contingencies | ||
Total annual aggregate limit of insurance coverage | $ 37 | |
Professional liability claims | Concentra | ||
Commitments and Contingencies | ||
Total annual aggregate limit of insurance coverage | 29 | |
Professional liability claims | Joint Venture Operations | ||
Commitments and Contingencies | ||
Total annual aggregate limit of insurance coverage | 80 | |
Professional liability claims | Joint Venture Operations | Minimum | ||
Commitments and Contingencies | ||
Total annual aggregate limit of insurance coverage | 23 | |
Professional liability claims | Joint Venture Operations | Maximum | ||
Commitments and Contingencies | ||
Total annual aggregate limit of insurance coverage | 33 | |
General Liability | Critical Illness Recovery Hospitals, Rehabilitation Hospitals And Outpatient Rehabilitiation | ||
Commitments and Contingencies | ||
Total annual aggregate limit of insurance coverage | 40 | |
General Liability | Concentra | ||
Commitments and Contingencies | ||
Total annual aggregate limit of insurance coverage | $ 29 |
Subsequent Events (Details)
Subsequent Events (Details) | May 01, 2024 $ / shares |
Subsequent Event | |
Subsequent Event [Line Items] | |
Cash dividend declared (in dollars per share) | $ 0.125 |