Cover Page
Cover Page - shares | 6 Months Ended | |
Jun. 30, 2023 | Aug. 07, 2023 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Jun. 30, 2023 | |
Document Transition Report | false | |
Entity File Number | 001-39479 | |
Entity Registrant Name | AKUMIN INC. | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 88-4139425 | |
Entity Address, Address Line One | 8300 W. Sunrise Boulevard | |
Entity Address, City or Town | Plantation | |
Entity Address, State or Province | FL | |
Entity Address, Postal Zip Code | 33322 | |
City Area Code | 844 | |
Local Phone Number | 730-0050 | |
Title of 12(b) Security | Common Stock, $0.01 par value per share | |
Trading Symbol | AKU | |
Security Exchange Name | NASDAQ | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Non-accelerated Filer | |
Entity Small Business | true | |
Entity Emerging Growth Company | true | |
Entity Ex Transition Period | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 90,998,491 | |
Entity Central Index Key | 0001776197 | |
Current Fiscal Year End Date | --12-31 | |
Document Fiscal Year Focus | 2023 | |
Document Fiscal Period Focus | Q2 | |
Amendment Flag | false |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Current assets: | ||
Cash and cash equivalents | $ 37,968 | $ 59,424 |
Accounts receivable | 115,790 | 114,166 |
Prepaid expenses | 8,477 | 8,003 |
Other current assets | 10,309 | 10,352 |
Total current assets | 172,544 | 191,945 |
Property and equipment, net | 197,559 | 221,214 |
Operating lease right-of-use assets | 156,778 | 166,823 |
Goodwill | 715,269 | 769,110 |
Other intangible assets, net | 370,512 | 392,095 |
Other assets | 23,080 | 23,928 |
Total assets | 1,635,742 | 1,765,115 |
Current liabilities: | ||
Accounts payable | 43,575 | 36,618 |
Current portion of long-term debt | 19,282 | 19,961 |
Current portion of obligations under finance leases | 7,837 | 7,800 |
Current portion of obligations under operating leases | 15,744 | 17,223 |
Accrued liabilities | 88,339 | 86,916 |
Total current liabilities | 174,777 | 168,518 |
Long-term debt, net of current portion | 1,273,077 | 1,254,652 |
Obligations under finance leases, net of current portion | 15,991 | 19,505 |
Obligations under operating leases, net of current portion | 151,957 | 160,475 |
Other liabilities | 19,384 | 20,674 |
Total liabilities | 1,635,186 | 1,623,824 |
Redeemable noncontrolling interests | 26,800 | 30,337 |
Stockholders’ deficit: | ||
Preferred stock, $0.01 par value; 50,000,000 shares authorized; no shares issued and outstanding at June 30, 2023 and December 31, 2022 | 0 | 0 |
Common stock, $0.01 par value; 300,000,000 shares authorized; 90,998,491 shares issued and outstanding at June 30, 2023; 89,811,513 shares issued and outstanding at December 31, 2022 | 910 | 898 |
Additional paid-in capital | 231,842 | 231,014 |
Accumulated other comprehensive income | 24 | 73 |
Accumulated deficit | (411,985) | (280,185) |
Total stockholders’ deficit | (179,209) | (48,200) |
Noncontrolling interests | 152,965 | 159,154 |
Total equity (deficit) | (26,244) | 110,954 |
Total liabilities, redeemable noncontrolling interests and equity | $ 1,635,742 | $ 1,765,115 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares | Jun. 30, 2023 | Dec. 31, 2022 |
Statement of Financial Position [Abstract] | ||
Preferred stock, par or stated value per share (in USD per share) | $ 0.01 | $ 0.01 |
Preferred stock, shares authorized (in shares) | 50,000,000 | 50,000,000 |
Preferred stock, shares issued (in shares) | 0 | 0 |
Preferred stock, shares outstanding (in shares) | 0 | 0 |
Common stock, par or stated value per share (in USD per share) | $ 0.01 | $ 0.01 |
Common stock, shares authorized (in shares) | 300,000,000 | 300,000,000 |
Common stock issued (in shares) | 90,998,491 | 89,811,513 |
Common stock outstanding (in shares) | 90,998,491 | 89,811,513 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Income Statement [Abstract] | ||||
Revenues | $ 184,840 | $ 192,128 | $ 372,432 | $ 378,391 |
Operating expenses: | ||||
Cost of operations, excluding depreciation and amortization | 158,495 | 154,574 | 314,062 | 309,735 |
Depreciation and amortization | 35,015 | 25,200 | 58,008 | 49,931 |
Impairment charges | 53,460 | 0 | 53,460 | 0 |
Restructuring charges | 944 | 7,244 | 6,680 | 7,324 |
Severance and related costs | 22 | 5,559 | (27) | 7,797 |
Settlements, recoveries and related costs | 465 | 814 | 1,913 | 677 |
Stock-based compensation | 441 | 758 | 840 | 1,819 |
Other operating expense (income), net | 477 | 586 | (274) | 579 |
Total operating expenses | 249,319 | 194,735 | 434,662 | 377,862 |
Income (loss) from operations | (64,479) | (2,607) | (62,230) | 529 |
Other expense (income): | ||||
Interest expense | 31,164 | 29,290 | 61,861 | 57,971 |
Other non-operating expense (income), net | 2,346 | (2,335) | 2,214 | (2,011) |
Total other expense, net | 33,510 | 26,955 | 64,075 | 55,960 |
Loss before income taxes | (97,989) | (29,562) | (126,305) | (55,431) |
Income tax benefit | (1,578) | (3,483) | (704) | (2,920) |
Net loss | (96,411) | (26,079) | (125,601) | (52,511) |
Less: Net income attributable to noncontrolling interests | 241 | 4,390 | 6,199 | 8,769 |
Net loss attributable to common stockholders | (96,652) | (30,469) | (131,800) | (61,280) |
Comprehensive loss, net of taxes: | ||||
Net loss | (96,411) | (26,079) | (125,601) | (52,511) |
Other comprehensive income (loss): | ||||
Unrealized gain (loss) on hedging transactions, net of taxes | (7) | 7 | (21) | 36 |
Reclassification adjustment for gains (losses) included in net loss, net of taxes | (14) | 9 | (28) | 26 |
Other comprehensive income (loss) | (21) | 16 | (49) | 62 |
Comprehensive loss, net of taxes | (96,432) | (26,063) | (125,650) | (52,449) |
Less: Comprehensive income attributable to noncontrolling interests | 241 | 4,390 | 6,199 | 8,769 |
Comprehensive loss attributable to common stockholders | $ (96,673) | $ (30,453) | $ (131,849) | $ (61,218) |
Earnings Per Share [Abstract] | ||||
Basic (in USD per share) | $ (1.07) | $ (0.34) | $ (1.46) | $ (0.69) |
Diluted (in USD per share) | $ (1.07) | $ (0.34) | $ (1.46) | $ (0.69) |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Equity - USD ($) $ in Thousands | Total | Total Stockholders’ Equity (Deficit) | Common Stock | Additional Paid-In Capital | Accumulated Other Comprehensive Income (Loss) | Accumulated Deficit | Noncontrolling Interests |
Beginning balance (in shares) at Dec. 31, 2021 | 89,026,997 | ||||||
Beginning balance at Dec. 31, 2021 | $ 283,679 | $ 105,189 | $ 890 | $ 227,705 | $ 18 | $ (123,424) | $ 178,490 |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||
Net income (loss), net of the net income (loss) attributable to redeemable noncontrolling interests | (53,625) | (61,280) | (61,280) | 7,655 | |||
Settlement of restricted share units (in shares) | 489,516 | ||||||
Settlement of restricted share units | 0 | $ 5 | (5) | ||||
Stock-based compensation | 1,819 | 1,819 | 1,819 | ||||
Other comprehensive income (loss) | 62 | 62 | 62 | ||||
Distributions paid to noncontrolling interests | (11,604) | (11,604) | |||||
Purchase accounting adjustments | 161 | 161 | |||||
Ending balance (in shares) at Jun. 30, 2022 | 89,516,513 | ||||||
Ending Balance at Jun. 30, 2022 | 220,492 | 45,790 | $ 895 | 229,519 | 80 | (184,704) | 174,702 |
Beginning balance (in shares) at Mar. 31, 2022 | 89,516,513 | ||||||
Beginning balance at Mar. 31, 2022 | 252,209 | 75,485 | $ 895 | 228,761 | 64 | (154,235) | 176,724 |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||
Net income (loss), net of the net income (loss) attributable to redeemable noncontrolling interests | (26,613) | (30,469) | (30,469) | 3,856 | |||
Stock-based compensation | 758 | 758 | 758 | ||||
Other comprehensive income (loss) | 16 | 16 | 16 | ||||
Distributions paid to noncontrolling interests | (5,878) | (5,878) | |||||
Ending balance (in shares) at Jun. 30, 2022 | 89,516,513 | ||||||
Ending Balance at Jun. 30, 2022 | 220,492 | 45,790 | $ 895 | 229,519 | 80 | (184,704) | 174,702 |
Beginning balance (in shares) at Dec. 31, 2022 | 89,811,513 | ||||||
Beginning balance at Dec. 31, 2022 | 110,954 | (48,200) | $ 898 | 231,014 | 73 | (280,185) | 159,154 |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||
Net income (loss), net of the net income (loss) attributable to redeemable noncontrolling interests | (126,212) | (131,800) | (131,800) | 5,588 | |||
Settlement of restricted share units (in shares) | 1,186,978 | ||||||
Settlement of restricted share units | 0 | $ 12 | (12) | ||||
Stock-based compensation | 840 | 840 | 840 | ||||
Other comprehensive income (loss) | (49) | (49) | (49) | ||||
Distributions paid to noncontrolling interests | (11,777) | (11,777) | |||||
Ending balance (in shares) at Jun. 30, 2023 | 90,998,491 | ||||||
Ending Balance at Jun. 30, 2023 | (26,244) | (179,209) | $ 910 | 231,842 | 24 | (411,985) | 152,965 |
Beginning balance (in shares) at Mar. 31, 2023 | 90,498,491 | ||||||
Beginning balance at Mar. 31, 2023 | 75,202 | (82,977) | $ 905 | 231,406 | 45 | (315,333) | 158,179 |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||
Net income (loss), net of the net income (loss) attributable to redeemable noncontrolling interests | (95,876) | (96,652) | (96,652) | 776 | |||
Settlement of restricted share units (in shares) | 500,000 | ||||||
Settlement of restricted share units | 0 | $ 5 | (5) | ||||
Stock-based compensation | 441 | 441 | 441 | ||||
Other comprehensive income (loss) | (21) | (21) | (21) | ||||
Distributions paid to noncontrolling interests | (5,990) | (5,990) | |||||
Ending balance (in shares) at Jun. 30, 2023 | 90,998,491 | ||||||
Ending Balance at Jun. 30, 2023 | $ (26,244) | $ (179,209) | $ 910 | $ 231,842 | $ 24 | $ (411,985) | $ 152,965 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
Operating activities: | ||
Net loss | $ (125,601) | $ (52,511) |
Adjustments to reconcile net loss to net cash provided by operating activities: | ||
Depreciation and amortization | 58,008 | 49,931 |
Impairment charges | 53,460 | 0 |
Stock-based compensation | 840 | 1,819 |
Non-cash interest expense | 27,962 | 24,604 |
Amortization of deferred financing costs and accretion of discount/premium on long-term debt | 1 | 54 |
Deferred income taxes | (914) | (3,368) |
Distributions from unconsolidated investees | 305 | 915 |
Earnings from unconsolidated investees | (279) | (488) |
Other non-cash items, net | 1,380 | (498) |
Changes in operating assets and liabilities: | ||
Accounts receivable | (2,326) | (4,547) |
Prepaid expenses and other assets | (1,181) | (1,919) |
Accounts payable and other liabilities | 6,171 | 6,502 |
Operating lease liabilities and right-of-use assets | 129 | 585 |
Net cash provided by operating activities | 17,955 | 21,079 |
Investing activities: | ||
Purchases of property and equipment | (11,460) | (15,466) |
Other investing activities | 823 | 963 |
Net cash used in investing activities | (10,637) | (14,503) |
Financing activities: | ||
Proceeds from revolving loan | 14,000 | 20,000 |
Principal payments on revolving loan | (14,000) | (20,000) |
Proceeds from long-term debt | 1,706 | 10,292 |
Principal payments on long-term debt | (10,618) | (8,365) |
Principal payments on finance leases | (3,937) | (4,330) |
Contributions received from redeemable noncontrolling interests | 107 | 0 |
Distributions paid to noncontrolling and redeemable noncontrolling interests | (16,032) | (14,145) |
Net cash used in financing activities | (28,774) | (16,548) |
Net decrease in cash and cash equivalents | (21,456) | (9,972) |
Cash and cash equivalents, beginning of period | 59,424 | 48,419 |
Cash and cash equivalents, beginning of period | 37,968 | 38,447 |
Cash and cash equivalents, end of period | ||
Interest paid | 33,986 | 32,439 |
Income taxes paid, net of refunds | 929 | 502 |
Supplemental disclosure of non-cash investing and financing activities: | ||
Property and equipment purchases in accounts payable and accrued liabilities | 3,551 | 4,852 |
Derecognition of operating lease right-of-use assets and lease liabilities associated with lease terminations | 3,656 | 3,635 |
Equipment acquired in exchange for finance lease obligations | 460 | 1,433 |
Operating lease right-of-use assets obtained in exchange for operating lease liabilities | $ 3,500 | $ 668 |
Basis of Presentation
Basis of Presentation | 6 Months Ended |
Jun. 30, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Basis of Presentation | Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared by Akumin Inc. (the “Company” or “Akumin”) and do not include all of the information and disclosures required by accounting principles generally accepted in the U.S. (“GAAP”). In the opinion of management, all normal recurring accruals and adjustments considered necessary for a fair presentation have been included. The results for the three and six months ended June 30, 2023 are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. The accompanying condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and notes to the consolidated financial statements for the year ended December 31, 2022. The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could differ from those estimates. |
New Accounting Standards
New Accounting Standards | 6 Months Ended |
Jun. 30, 2023 | |
Accounting Standards Update and Change in Accounting Principle [Abstract] | |
New Accounting Standards | New Accounting Standards Recently Adopted Accounting Standards ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments , and related clarifying standards, which replaces the incurred loss impairment methodology in current GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to assess credit loss estimates. This ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2022. The Company is considered an Emerging Growth Company as classified by the Securities and Exchange Commission (“SEC”), which gave the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company adopted this standard on January 1, 2023 using the modified retrospective approach and it did not have a material impact on the Company's condensed consolidated financial statements, resulting in no adjustments to prior year earnings. Recently Issued Accounting Standards Not Yet Effective ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805) In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers , creating an exception to the recognition and measurement principles in ASC 805, Business Combinations . The amendments require an acquirer to use the guidance in ASC 606, Revenue from Contracts with Customers , rather than using fair value, when recognizing and measuring contract assets and contract liabilities related to customer contracts assumed in a business combination. In addition, the amendments clarify that all contracts requiring the recognition of assets and liabilities in accordance with the guidance in ASC 606, such as contract liabilities derived from the sale of nonfinancial assets within the scope of ASC 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets , fall within the scope of the amended guidance in ASC 805. The amendments do not affect the accounting for other assets or liabilities arising from revenue contracts with customers in a business combination, such as customer-related intangible assets and contract-based intangible assets, including off-market contract terms. This ASU is effective for public entities for fiscal years beginning after December 15, 2022, with early adoption permitted. For |
Variable Interest Entities
Variable Interest Entities | 6 Months Ended |
Jun. 30, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Variable Interest Entities | Variable Interest Entities In accordance with consolidation guidance, a reporting entity with a variable interest in another entity is required to include the assets and liabilities and revenues and expenses of that separate entity (i.e., consolidate with the financial statements of the reporting entity) when the variable interest is determined to be a controlling financial interest. A reporting entity is considered to have a controlling financial interest in a variable interest entity (“VIE”) if (i) the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (ii) the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE. As a result of the financial relationship established between the Company and certain entities (the “Revenue Practices”) through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenues and expenses of the Revenue Practices are included in the condensed consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. As of June 30, 2023 and December 31, 2022, the Revenue Practices’ assets included in the Company’s condensed consolidated balance sheets were $39.6 million and $36.0 million, respectively, and liabilities included in the Company’s condensed consolidated balance sheets were $2.9 million and $1.4 million, respectively. The assets of the Revenue Practices can only be used to settle their obligations. During the six months ended June 30, 2023 and 2022, the Revenue Practices’ revenues were $85.7 million and $92.8 million, respectively, and the net cash provided by operating activities was $77.9 million and $93.2 million, respectively. |
Property and Equipment
Property and Equipment | 6 Months Ended |
Jun. 30, 2023 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | Property and Equipment Property and equipment consists of the following: (in thousands) June 30, December 31, Medical equipment $ 254,247 $ 244,517 Leasehold improvements 44,000 43,382 Equipment under finance leases 45,348 44,845 Office and computer equipment 19,151 17,742 Transportation and service equipment 11,542 11,672 Furniture and fixtures 3,439 3,362 Construction in progress 3,550 4,636 381,277 370,156 Less accumulated depreciation 183,718 148,942 $ 197,559 $ 221,214 Depreciation expense was $18.2 million and $20.2 million for the three months ended June 30, 2023 and 2022, respectively, and $36.4 million and $39.9 million for the six months ended June 30, 2023 and 2022, respectively. |
Goodwill
Goodwill | 6 Months Ended |
Jun. 30, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill | Goodwill Changes in the carrying amount of goodwill are as follows: (in thousands) Radiology Oncology Total Balance, December 31, 2022 $ 682,725 $ 86,385 $ 769,110 Impairment (53,460) — (53,460) Goodwill written off in connection with site closure — (381) (381) Balance, June 30, 2023 $ 629,265 $ 86,004 $ 715,269 The Company tests its goodwill and indefinite-lived intangible assets annually or more frequently depending on certain impairment indicators. Such indicators include a significant decline in expected future cash flows due to changes in company-specific factors or the broader business climate. During the second quarter of 2023, the Company determined that potential indicators of impairment existed and thus performed a quantitative test for impairment at the reporting unit level as of May 31, 2023. In estimating fair values, the Company gave equal weight to an income approach (the DCF method) and a market approach (the GPC method). Specifically, the Company utilized the following Level 3 estimates and assumptions in its analysis: Discount rate 9.5% to 10.0% Perpetual growth rate 3.0% Tax rate 26.0% Risk-free interest rate 3.5% Revenue multiple 1.8 to 2.2 EBITDA multiple 7.5 to 9.5 The impairment test yielded a fair value for the Oncology reporting unit that exceeded its carrying value; therefore, this reporting unit was not considered at risk of impairment. In connection with the impairment test for the Radiology reporting unit, the Company concluded that the carrying value exceeded its estimated fair value based on management's assessment of the outlook and long-term business plans for this division. Consequently, the Company recorded an impairment charge of $53.5 million related to goodwill for the Radiology reporting unit, which was recorded in the condensed consolidated statements of operations and comprehensive loss for the three and six months ended June 30, 2023. |
Other Intangible Assets
Other Intangible Assets | 6 Months Ended |
Jun. 30, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Other Intangible Assets | Other Intangible Assets Other intangible assets consist of the following: (dollars in thousands) Weighted June 30, 2023 December 31, 2022 Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 250,733 $ (23,057) $ 227,676 $ 263,388 $ (17,588) $ 245,800 Trade names 18 76,391 (13,324) 63,067 77,135 (11,063) 66,072 Management agreements 17 10,200 (1,100) 9,100 10,200 (800) 9,400 Other 5 5,739 (4,628) 1,111 5,719 (4,454) 1,265 Total $ 343,063 $ (42,109) 300,954 $ 356,442 $ (33,905) 322,537 Certificates of Need 69,558 69,558 Total other intangible assets $ 370,512 $ 392,095 The Company performs an impairment test when indicators of impairment are present. As of June 30, 2023, there were no indications of impairment of the Company's other intangible assets balances. |
Long-Term Debt
Long-Term Debt | 6 Months Ended |
Jun. 30, 2023 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | Long-Term Debt Long-term debt consists of the following: (in thousands) June 30, December 31, 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 451,265 423,303 Equipment Debt 63,842 72,754 1,365,107 1,346,057 Debt discount/premium and deferred issuance costs (72,748) (71,444) 1,292,359 1,274,613 Less current portion 19,282 19,961 Long-term debt, net of current portion $ 1,273,077 $ 1,254,652 During the six months ended June 30, 2023, the Company elected to pay interest in-kind on the Subordinated Notes pursuant to the original agreement and, accordingly, $28.0 million of accrued interest was added to the principal balance of the Subordinated Notes. |
Accrued Liabilities
Accrued Liabilities | 6 Months Ended |
Jun. 30, 2023 | |
Payables and Accruals [Abstract] | |
Accrued Liabilities | Accrued Liabilities Accrued liabilities consist of the following: (in thousands) June 30, December 31, Accrued compensation and related expenses $ 21,743 $ 25,655 Accrued interest expense 18,267 18,183 Other 48,329 43,078 $ 88,339 $ 86,916 |
Redeemable Noncontrolling Inter
Redeemable Noncontrolling Interests | 6 Months Ended |
Jun. 30, 2023 | |
Noncontrolling Interest [Abstract] | |
Redeemable Noncontrolling Interests | Redeemable Noncontrolling Interests The Company has noncontrolling interests with redemption features. These redemption features could require the Company to make an offer to purchase the noncontrolling interests in the case of certain events, including (i) the expiration or termination of certain operating agreements of the joint venture, or (ii) the noncontrolling interests’ tax-exempt status is jeopardized by the joint venture. As of June 30, 2023, the Company holds redeemable noncontrolling interests of $26.8 million, which are not currently redeemable or probable of becoming redeemable. The redemption of these noncontrolling interests is not solely within the Company’s control, therefore, they are presented in the temporary equity section of the Company’s condensed consolidated balance sheets. The Company does not believe it is probable the redemption features related to these noncontrolling interest will be triggered as the triggering events are generally not probable until they occur. As such, these noncontrolling interests have not been remeasured to redemption value. The following is a rollforward of the activity in the redeemable noncontrolling interests for the six months ended June 30, 2023: (in thousands) Balance, December 31, 2022 $ 30,337 Net income attributable to redeemable noncontrolling interests 611 Contributions received from redeemable noncontrolling interests 107 Distributions paid to redeemable noncontrolling interests (4,255) Balance, June 30, 2023 $ 26,800 |
Financial Instruments
Financial Instruments | 6 Months Ended |
Jun. 30, 2023 | |
Financial Instruments [Abstract] | |
Financial Instruments | Financial Instruments Assets and Liabilities that are Measured at Fair Value on a Recurring Basis The following table summarizes the valuation of the Company’s financial instruments that are reported at fair value on a recurring basis: Fair Value as of June 30, 2023 Fair Value as of December 31, 2022 (in thousands) Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total Current and long-term assets: Interest rate and fuel option contracts $ — $ 64 $ — $ 64 $ — $ 52 $ — $ 52 Long-term liabilities: Derivative in subordinated notes $ — $ — $ 5,831 $ 5,831 $ — $ — $ 6,132 $ 6,132 The derivative in subordinated notes relates to the Change of Control Redemption Election included in the Subordinated Notes (see Note 7). The fair value of the Change of Control Redemption Election liability was determined using a probability weighted scenario analysis regarding a potential change of control during the seven years from initiation date. The estimated fair values of the Change of Control Redemption Election as of June 30, 2023 and December 31, 2022 use unobservable inputs for probability weighted time until an exit event of 3.2 years and 3.5 years, respectively, and an exit event probability weighting of 21.7% and 22.9%, respectively. The following is a reconciliation of the opening and closing balances for the derivative in subordinated notes liability measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the six months ended June 30, 2023: (in thousands) Balance, December 31, 2022 $ 6,132 Change in fair value (301) Balance, June 30, 2023 $ 5,831 The decrease in the fair value of the derivative in subordinated notes liability was recorded as a gain and included in other non-operating expense (income), net in the Company's condensed consolidated statements of operations and comprehensive loss for the six months ended June 30, 2023. The Company’s interest rate contracts are primarily pay-fixed, receive-variable interest rate swaps related to certain of the Company’s equipment debt. The amount that the Company expects to reclassify from accumulated other comprehensive income to interest expense over the next twelve months is immaterial. During the second quarter of 2023, the Company entered into a fuel call option contract to hedge against fluctuations in fuel prices through April 2024. Assets and Liabilities for which Fair Value is only Disclosed The estimated fair values of other current and non-current liabilities are as follows: (in thousands) June 30, December 31, 2028 Senior Notes $ 247,705 $ 228,894 2025 Senior Notes 390,814 339,385 Subordinated Notes 294,380 254,951 Equipment Debt 53,272 58,698 $ 986,171 $ 881,928 As of June 30, 2023 and December 31, 2022, the estimated fair values of the 2028 Senior Notes and 2025 Senior Notes were determined using Level 2 inputs and the estimated fair values of the Subordinated Notes and Equipment Debt were determined using Level 3 inputs. The carrying value of cash and cash equivalents, accounts receivable, accounts payable, accrued liabilities, and the current portion of lease liabilities approximates their fair value given their short-term nature. The carrying value of the non-current portion of lease liabilities approximates their fair value given the difference between the discount rates used to recognize the liabilities in the condensed consolidated balance sheets and the normalized expected market rates of interest is insignificant. Financial instruments are classified into one of the following categories: amortized cost, fair value through earnings and fair value through other comprehensive income. The following table summarizes information regarding the carrying value of the Company’s financial instruments: (in thousands) June 30, December 31, Financial assets measured at amortized cost: Cash and cash equivalents $ 37,968 $ 59,424 Accounts receivable 115,790 114,166 $ 153,758 $ 173,590 Financial liabilities measured at amortized cost: Accounts payable $ 43,575 $ 36,618 Current portion of long-term debt 19,282 19,961 Current portion of leases 23,581 25,023 Non-current portion of long-term debt 1,273,077 1,254,652 Non-current portion of leases 167,948 179,980 Accrued liabilities 88,339 86,916 $ 1,615,802 $ 1,603,150 Financial assets measured at fair value through earnings: Fuel option contract $ 36 $ — Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 5,831 $ 6,132 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 28 $ 52 Assets and Liabilities that are Measured at Fair Value on a Nonrecurring Basis The Company measures certain non-financial assets at fair value on a nonrecurring basis, primarily intangible assets, goodwill and long-lived assets in connection with acquisitions and periodic evaluations for potential impairment. The Company estimates the fair value of these assets using primarily unobservable inputs; therefore, these are considered Level 3 fair value measurements. See disclosure of Level 3 measurements related to the goodwill impairment analysis in Note 5. Interest Rate Risk Interest rate risk is the risk the fair value or future cash flows of a financial instrument will fluctuate because of changes in market interest rates. Changes in lending rates can cause fluctuations in interest payments and cash flows. Certain of the Company’s equipment debt arrangements have interest rate swap agreements to hedge the future variable cash interest payments in order to avoid volatility in operating results due to fluctuations in interest rates. As of June 30, 2023 and December 31, 2022, the Company had $0.3 million and $0.4 million, respectively, of variable interest rate equipment debt that is not hedged. In addition, the Company is exposed to variable interest rates related to the 2020 Revolving Facility, which had no outstanding balance as of June 30, 2023 or December 31, 2022. The Company’s exposure to interest rate risk from a 1% increase or decrease in the variable interest rates is not material. |
Stockholders' Equity
Stockholders' Equity | 6 Months Ended |
Jun. 30, 2023 | |
Equity [Abstract] | |
Stockholders' Equity | Stockholders' Equity In connection with the Company's change of jurisdiction of incorporation from the province of Ontario, Canada, to the State of Delaware (the "Domestication") in 2022, the Company amended its Certificate of Incorporation to provide for the issuance of up to 300,000,000 shares of common stock, par value $0.01 per share, and 50,000,000 shares of undesignated preferred stock, par value $0.01 per share. The effect of the change in the common stock from no par value to $0.01 par value per share has been reflected in the condensed consolidated financial statements on a retroactive basis for all periods presented. Stock-Based Awards The Company may grant stock-based awards to employees, directors and consultants under the Amended and Restated Restricted Share Unit Plan, adopted as of April 18, 2023 (the “RSU Plan”) and the Amended and Restated Stock Option Plan, adopted as of April 18, 2023 (the “Stock Option Plan” and together with the RSU Plan, the “2023 Stock Plans”). Under the 2023 Stock Plans, the collective maximum number of shares reserved for issuance is equal to 10% of the number of capital shares of the Company that are outstanding from time to time. As of June 30, 2023 and December 31, 2022, shares of common stock reserved for issuance under the 2023 Stock Plans were 9,099,849 and 8,981,151, respectively. The 2023 Stock Plans are administered by the Board of Directors, which has authority to select eligible persons to receive awards and to determine the terms and conditions of the awards. Restricted Share Units Restricted share units (“RSUs”) represent a right to receive a share of common stock at a future vesting date with no cash payment from the holder. RSUs granted vest over two years from the date of grant. A summary of RSU activity is as follows: Number of Weighted- Aggregate Outstanding and unvested at December 31, 2022 2,143,601 $ 1.77 Granted 2,217,213 0.67 $ 1,479 Vested (1,186,978) 2.06 $ 2,450 Cancelled (57,078) 1.10 $ (63) Outstanding and unvested at June 30, 2023 3,116,758 $ 0.89 $ 2,761 Stock Options Stock options are awarded as consideration in exchange for services rendered to the Company. Stock options granted generally have terms of 7 years, but in no event more than 10 years after the date of grant, and vest over 3 years. A summary of the stock option activity is as follows: Number of Weighted- Weighted- Aggregate Outstanding at December 31, 2022 5,348,120 $ 2.56 3.3 $ 378 Outstanding at June 30, 2023 5,348,120 $ 2.56 2.8 $ — Exercisable at June 30, 2023 5,325,020 $ 2.55 2.8 $ — Aggregate intrinsic value for outstanding and exercisable stock options in the table above represents the difference between the closing stock price on June 30, 2023 and the exercise price multiplied by the number of in-the-money options. No stock options were granted during the six months ended June 30, 2023. |
Commitments and Contingencies
Commitments and Contingencies | 6 Months Ended |
Jun. 30, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | Commitments and Contingencies Purchase Commitments The Company has certain binding purchase commitments primarily for the purchase of equipment from various suppliers. As of June 30, 2023, the obligations for these future purchase commitments totaled $38.4 million, of which $32.5 million is expected to be paid during the remaining six months of 2023 and $6.0 million is expected to be paid thereafter. Guarantees and Indemnities In the normal course of business, the Company has made certain guarantees and indemnities, under which it may be required to make payments to a guaranteed or indemnified party, in relation to certain transactions. The Company indemnifies other parties, including customers, lessors, and parties to other transactions with the Company, with respect to certain matters. The Company has agreed to hold the other party harmless against losses arising from certain events as defined within the particular contract, which may include, for example, litigation or claims arising from a breach of representations or covenants. In addition, the Company has entered into indemnification agreements with its executive officers and directors and the Company’s bylaws contain similar indemnification obligations. Under these arrangements, the Company is obligated to indemnify, to the fullest extent permitted under applicable law, its current or former officers and directors for various amounts incurred with respect to actions, suits or proceedings in which they were made, or threatened to be made, a party as a result of acting as an officer or director. It is not possible to determine the maximum potential amount under these indemnification agreements due to the limited history of prior indemnification claims and the unique facts and circumstances involved in each particular agreement. Historically, payments made related to these indemnifications have been immaterial. As of June 30, 2023, the Company has determined that no liability is necessary related to these guarantees and indemnities. Legal Matters On December 20, 2021, an alleged shareholder of the Company filed a putative class action claim with the Ontario Superior Court of Justice against the Company and certain of its directors and officers alleging violations of Securities Act (Ontario), negligent misrepresentation and other related claims relating to the restatement of the Company’s financial statements that were filed in 2021. On February 17, 2023, the plaintiff delivered a motion record for certification and for leave to commence action under Part XXIII.1 of the Securities Act (Ontario). The Company plans to defend the claim and the motion. Other Matters |
Supplemental Revenue Informatio
Supplemental Revenue Information | 6 Months Ended |
Jun. 30, 2023 | |
Revenue from Contract with Customer [Abstract] | |
Supplemental Revenue Information | Supplemental Revenue Information Revenues consist primarily of net patient fees received from various payors and patients based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. Revenues are also derived directly from hospitals and healthcare providers. Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third-party payors, management fees, government grants and fees for other services provided to third parties. The following table summarizes the components of the Company’s revenues by payor category: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Patient fee payors: Commercial $ 65,066 $ 71,609 $ 130,588 $ 140,710 Medicare 20,082 21,002 41,502 42,174 Medicaid 3,256 3,347 6,661 6,449 Other patient revenue 2,729 3,213 5,324 6,487 91,133 99,171 184,075 195,820 Hospitals and healthcare providers 91,513 90,651 183,975 178,110 Other revenue 2,194 2,306 4,382 4,461 $ 184,840 $ 192,128 $ 372,432 $ 378,391 |
Cost of Operations, excluding D
Cost of Operations, excluding Depreciation and Amortization | 6 Months Ended |
Jun. 30, 2023 | |
Cost Of Operations Excluding Depreciation And Amortization [Abstract] | |
Cost of Operations, excluding Depreciation and Amortization | Cost of Operations, excluding Depreciation and Amortization The following table summarizes the components of the Company’s cost of operations, excluding depreciation and amortization: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Employee compensation $ 68,302 $ 72,021 $ 139,829 $ 147,148 Third-party services and professional fees 32,091 29,919 62,920 59,096 Rent and utilities 12,780 12,742 25,121 25,219 Reading fees 11,953 11,788 23,552 23,286 Administrative 12,944 11,467 23,365 23,091 Medical supplies and other 20,425 16,637 39,275 31,895 $ 158,495 $ 154,574 $ 314,062 $ 309,735 |
Supplemental Statement of Opera
Supplemental Statement of Operations Information | 6 Months Ended |
Jun. 30, 2023 | |
Other Income and Expenses [Abstract] | |
Supplemental Statement of Operations Information | Supplemental Statement of Operations Information Restructuring Charges Restructuring charges consist of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Transformation costs $ 939 $ 4,025 $ 6,659 $ 4,025 Lease termination costs 7 1,840 7 1,840 Domestication and related costs — 1,063 — 1,063 Other (2) 316 14 396 $ 944 $ 7,244 $ 6,680 $ 7,324 Transformation costs consist of third-party consulting fees associated with a significant project to identify, plan, and implement various business improvement initiatives designed to enhance growth opportunities and improve operations. The project is expected to continue into 2024. The consulting agreement provides for fixed fees totaling $12.5 million, milestone fees totaling up to $7.0 million that are earned upon the achievement of certain milestones, and performance fees totaling up to $15.0 million that are earned based on the achievement of certain performance results during the period of the contract. The Company recognizes the fixed fees over the contract period as the services are rendered. Milestone and performance fees that are probable of ultimately being paid are recognized based on a percentage of achievement of the related milestone or performance result. As of June 30, 2023, the accounts payable and accrued liability balance for unpaid transformation consulting costs was $3.4 million and $4.5 million, respectively. Severance and Related Costs Severance and related costs represent costs associated with employees whose employment with the Company has been terminated and are generally paid in the year recorded. In connection with certain terminated employees, severance benefits are being paid over periods of 12 to 18 months. As of June 30, 2023, the unpaid balance of severance and related costs totaled $1.5 million, which will be paid during the next twelve months. Other Operating and Non-Operating Expense (Income) Other operating expense (income), net consists of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Loss on sale of accounts receivable $ 922 $ — $ 1,046 $ — Gain from insurance proceeds — — (776) — Loss (gain) on disposal of property and equipment, net (348) 170 (417) 372 Other, net (97) 416 (127) 207 $ 477 $ 586 $ (274) $ 579 Other non-operating expense (income), net consists of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Capital structure initiatives $ 1,912 $ — $ 1,912 $ — Acquisition-related costs 155 86 298 468 Fair value adjustment on derivative in subordinated notes (258) (1,009) (301) (839) Earnings from unconsolidated investees (128) (248) (279) (488) Other, net 665 (1,164) 584 (1,152) $ 2,346 $ (2,335) $ 2,214 $ (2,011) Capital structure initiatives represent costs associated with the Company’s initiative to restructure its long-term debt. Impairment Charges Impairment charges relate to the following assets: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Goodwill (Note 5) $ 53,460 $ — $ 53,460 $ — $ 53,460 $ — $ 53,460 $ — |
Investments in Unconsolidated I
Investments in Unconsolidated Investees | 6 Months Ended |
Jun. 30, 2023 | |
Other Investments [Abstract] | |
Investments in Unconsolidated Investees | Investments in Unconsolidated Investees Effective March 1, 2021, the Company completed a common equity investment in an artificial intelligence business (“AI business”) as part of a private placement offering for $4.6 million. The AI business develops artificial intelligence aided software programs for use in medical businesses, including outpatient imaging services provided by the Company. As a result of the investment, a previous investment in a convertible note instrument issued by the AI business to the Company in May 2020 converted to common equity. The Company’s total common equity investment has a carrying value of $7.9 million as of June 30, 2023 and represents a 34.5% interest in the AI business on a non-diluted basis. In addition, the Company holds share purchase warrants which, subject to the occurrence of certain events and certain assumptions, and the payment of $0.4 million, would entitle the Company to acquire an additional 2.4% ownership interest in the AI business common equity. The Company has a 15% direct ownership in an unconsolidated investee and provides management services under a management agreement with the investee. The Company provides services as part of its ongoing operations for and on behalf of the unconsolidated investee, which reimburses the Company for the actual amount of the expenses incurred. The Company records the expenses in cost of operations and the reimbursement as revenue in the condensed consolidated statements of operations and comprehensive loss. |
Income Taxes
Income Taxes | 6 Months Ended |
Jun. 30, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income Taxes The Company is subject to U.S. federal income tax as well as income tax of multiple state jurisdictions. The Company is no longer subject to Canadian tax after the Domestication on September 30, 2022.The effective tax rate for the three and six months ended June 30, 2023 differs from the U.S. federal statutory rate of 21.0% primarily due to the impact of valuation allowances applied against losses in jurisdictions for which no tax benefit is recognized. |
Basic and Diluted Loss per Shar
Basic and Diluted Loss per Share | 6 Months Ended |
Jun. 30, 2023 | |
Earnings Per Share [Abstract] | |
Basic and Diluted Loss per Share | Basic and Diluted Loss per Share The loss per share is calculated by dividing the net loss attributable to common stockholders by the weighted average common shares outstanding during the period. Three Months Ended June 30, Six Months Ended June 30, (in thousands, except share and per share amounts) 2023 2022 2023 2022 Net loss attributable to common stockholders $ (96,652) $ (30,469) $ (131,800) $ (61,280) Weighted average common shares outstanding: Basic and diluted 90,503,986 89,516,513 90,163,458 89,296,619 Net loss per share attributable to common stockholders: Basic and diluted $ (1.07) $ (0.34) $ (1.46) $ (0.69) Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,478,978 2,042,461 2,006,143 2,207,983 |
Segment Information
Segment Information | 6 Months Ended |
Jun. 30, 2023 | |
Segment Reporting [Abstract] | |
Segment Information | Segment Information Operating segments are reported in a manner consistent with the internal reporting provided to the chief operating decision maker. The chief operating decision maker, who is responsible for allocating resources and assessing performance of the operating segments, has been identified as the Chief Executive Officer. The Company operates in two reportable segments: Radiology and Oncology. All intercompany revenues, expenses, receivables and payables are eliminated in consolidation and are not reviewed when evaluating segment performance. Each segment’s performance is evaluated based on revenue and adjusted earnings before interest, taxes, depreciation and amortization ("Adjusted EBITDA"). The following table summarizes the Company’s revenues by segment: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Radiology $ 156,291 $ 160,867 $ 313,692 $ 316,207 Oncology 28,549 31,261 58,740 62,184 $ 184,840 $ 192,128 $ 372,432 $ 378,391 Adjusted EBITDA is defined as net loss before interest expense, income tax benefit, depreciation and amortization, impairment charges, restructuring charges, severance and related costs, settlements and related costs, stock-based compensation, loss on sale of accounts receivable, capital structure initiatives, fair value adjustment on derivative, deferred rent expense, and items that we do not consider to be indicative of our core/ongoing operations. Adjusted EBITDA should not be considered a measure of financial performance under GAAP, and it should not be considered in isolation or as an alternative to net income, cash flows generated by operating, investing or financing activities, or other financial statement data presented in the condensed consolidated financial statements as indicators of financial performance or liquidity. Adjusted EBITDA is not a measurement determined in accordance with GAAP and is therefore susceptible to varying methods of calculation and may not be comparable to other similarly titled measures of other companies. Adjusted EBITDA is the most frequently used measure of each segment’s performance and is commonly used in setting performance goals. The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Adjusted EBITDA: Radiology $ 25,449 $ 35,692 $ 55,775 $ 64,281 Oncology 8,072 10,302 17,920 20,335 Corporate (6,994) (7,810) (14,027) (14,414) $ 26,527 $ 38,184 $ 59,668 $ 70,202 A reconciliation of the net loss to total Adjusted EBITDA is shown below: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Net loss $ (96,411) $ (26,079) $ (125,601) $ (52,511) Interest expense 31,164 29,290 61,861 57,971 Income tax benefit (1,578) (3,483) (704) (2,920) Depreciation and amortization 35,015 25,200 58,008 49,931 Impairment charges 53,460 — 53,460 — Restructuring charges 944 7,244 6,680 7,324 Severance and related costs 22 5,559 (27) 7,797 Settlements, recoveries and related costs 465 814 1,913 677 Stock-based compensation 441 758 840 1,819 Loss on sale of accounts receivable 922 — 1,046 — Loss (gain) on disposal of property and equipment, net (348) 170 (417) 372 Capital structure initiatives 1,912 — 1,912 — Acquisition-related costs 155 86 298 468 Fair value adjustment on derivative (258) (1,009) (301) (839) Deferred rent expense (43) 247 142 579 Other, net 665 (613) 558 (466) Adjusted EBITDA $ 26,527 $ 38,184 $ 59,668 $ 70,202 The following table summarizes the Company’s total assets by segment: (in thousands) June 30, December 31, Identifiable assets: Radiology $ 1,304,358 $ 1,400,938 Oncology 312,992 346,337 Corporate 18,392 17,840 $ 1,635,742 $ 1,765,115 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Capital expenditures: Radiology $ 7,093 $ 4,648 $ 9,069 $ 13,460 Oncology 500 858 1,000 1,834 Corporate 1,359 82 1,391 172 $ 8,952 $ 5,588 $ 11,460 $ 15,466 |
New Accounting Standards (Polic
New Accounting Standards (Policies) | 6 Months Ended |
Jun. 30, 2023 | |
Accounting Standards Update and Change in Accounting Principle [Abstract] | |
Recently Adopted Accounting Standards and Standards Not Yet Effective | Recently Adopted Accounting Standards ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments , and related clarifying standards, which replaces the incurred loss impairment methodology in current GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to assess credit loss estimates. This ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2022. The Company is considered an Emerging Growth Company as classified by the Securities and Exchange Commission (“SEC”), which gave the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company adopted this standard on January 1, 2023 using the modified retrospective approach and it did not have a material impact on the Company's condensed consolidated financial statements, resulting in no adjustments to prior year earnings. Recently Issued Accounting Standards Not Yet Effective ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805) In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers , creating an exception to the recognition and measurement principles in ASC 805, Business Combinations . The amendments require an acquirer to use the guidance in ASC 606, Revenue from Contracts with Customers , rather than using fair value, when recognizing and measuring contract assets and contract liabilities related to customer contracts assumed in a business combination. In addition, the amendments clarify that all contracts requiring the recognition of assets and liabilities in accordance with the guidance in ASC 606, such as contract liabilities derived from the sale of nonfinancial assets within the scope of ASC 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets , fall within the scope of the amended guidance in ASC 805. The amendments do not affect the accounting for other assets or liabilities arising from revenue contracts with customers in a business combination, such as customer-related intangible assets and contract-based intangible assets, including off-market contract terms. This ASU is effective for public entities for fiscal years beginning after December 15, 2022, with early adoption permitted. For |
Property and Equipment (Tables)
Property and Equipment (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Property, Plant and Equipment [Abstract] | |
Schedule of Detailed Information of Property and Equipment | Property and equipment consists of the following: (in thousands) June 30, December 31, Medical equipment $ 254,247 $ 244,517 Leasehold improvements 44,000 43,382 Equipment under finance leases 45,348 44,845 Office and computer equipment 19,151 17,742 Transportation and service equipment 11,542 11,672 Furniture and fixtures 3,439 3,362 Construction in progress 3,550 4,636 381,277 370,156 Less accumulated depreciation 183,718 148,942 $ 197,559 $ 221,214 |
Goodwill (Tables)
Goodwill (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Goodwill | Changes in the carrying amount of goodwill are as follows: (in thousands) Radiology Oncology Total Balance, December 31, 2022 $ 682,725 $ 86,385 $ 769,110 Impairment (53,460) — (53,460) Goodwill written off in connection with site closure — (381) (381) Balance, June 30, 2023 $ 629,265 $ 86,004 $ 715,269 |
Schedule Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill | Specifically, the Company utilized the following Level 3 estimates and assumptions in its analysis: Discount rate 9.5% to 10.0% Perpetual growth rate 3.0% Tax rate 26.0% Risk-free interest rate 3.5% Revenue multiple 1.8 to 2.2 EBITDA multiple 7.5 to 9.5 |
Other Intangible Assets - (Tabl
Other Intangible Assets - (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Intangible Assets Excluding Goodwill | Other intangible assets consist of the following: (dollars in thousands) Weighted June 30, 2023 December 31, 2022 Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 250,733 $ (23,057) $ 227,676 $ 263,388 $ (17,588) $ 245,800 Trade names 18 76,391 (13,324) 63,067 77,135 (11,063) 66,072 Management agreements 17 10,200 (1,100) 9,100 10,200 (800) 9,400 Other 5 5,739 (4,628) 1,111 5,719 (4,454) 1,265 Total $ 343,063 $ (42,109) 300,954 $ 356,442 $ (33,905) 322,537 Certificates of Need 69,558 69,558 Total other intangible assets $ 370,512 $ 392,095 The Company performs an impairment test when indicators of impairment are present. As of June 30, 2023, there were no indications of impairment of the Company's other intangible assets balances. |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Debt Disclosure [Abstract] | |
Schedule of Long-term Debt Instruments | Long-term debt consists of the following: (in thousands) June 30, December 31, 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 451,265 423,303 Equipment Debt 63,842 72,754 1,365,107 1,346,057 Debt discount/premium and deferred issuance costs (72,748) (71,444) 1,292,359 1,274,613 Less current portion 19,282 19,961 Long-term debt, net of current portion $ 1,273,077 $ 1,254,652 |
Accrued Liabilities (Tables)
Accrued Liabilities (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Payables and Accruals [Abstract] | |
Schedule of Other Accrued Liabilities | Accrued liabilities consist of the following: (in thousands) June 30, December 31, Accrued compensation and related expenses $ 21,743 $ 25,655 Accrued interest expense 18,267 18,183 Other 48,329 43,078 $ 88,339 $ 86,916 |
Redeemable Noncontrolling Int_2
Redeemable Noncontrolling Interests (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Noncontrolling Interest [Abstract] | |
Schedule of Redeemable Noncontrolling Interests | The following is a rollforward of the activity in the redeemable noncontrolling interests for the six months ended June 30, 2023: (in thousands) Balance, December 31, 2022 $ 30,337 Net income attributable to redeemable noncontrolling interests 611 Contributions received from redeemable noncontrolling interests 107 Distributions paid to redeemable noncontrolling interests (4,255) Balance, June 30, 2023 $ 26,800 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Financial Instruments [Abstract] | |
Schedule of Fair Value Measurements, Recurring and Nonrecurring | The following table summarizes the valuation of the Company’s financial instruments that are reported at fair value on a recurring basis: Fair Value as of June 30, 2023 Fair Value as of December 31, 2022 (in thousands) Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total Current and long-term assets: Interest rate and fuel option contracts $ — $ 64 $ — $ 64 $ — $ 52 $ — $ 52 Long-term liabilities: Derivative in subordinated notes $ — $ — $ 5,831 $ 5,831 $ — $ — $ 6,132 $ 6,132 |
Schedule of Reconciliation of Liability Related to the Embedded Derivative | The following is a reconciliation of the opening and closing balances for the derivative in subordinated notes liability measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the six months ended June 30, 2023: (in thousands) Balance, December 31, 2022 $ 6,132 Change in fair value (301) Balance, June 30, 2023 $ 5,831 |
Schedule of Fair Value Of Other Current And Non Current Liabilities | The estimated fair values of other current and non-current liabilities are as follows: (in thousands) June 30, December 31, 2028 Senior Notes $ 247,705 $ 228,894 2025 Senior Notes 390,814 339,385 Subordinated Notes 294,380 254,951 Equipment Debt 53,272 58,698 $ 986,171 $ 881,928 |
Schedule of Information Regarding The Carrying Value Of Financial Instruments | The following table summarizes information regarding the carrying value of the Company’s financial instruments: (in thousands) June 30, December 31, Financial assets measured at amortized cost: Cash and cash equivalents $ 37,968 $ 59,424 Accounts receivable 115,790 114,166 $ 153,758 $ 173,590 Financial liabilities measured at amortized cost: Accounts payable $ 43,575 $ 36,618 Current portion of long-term debt 19,282 19,961 Current portion of leases 23,581 25,023 Non-current portion of long-term debt 1,273,077 1,254,652 Non-current portion of leases 167,948 179,980 Accrued liabilities 88,339 86,916 $ 1,615,802 $ 1,603,150 Financial assets measured at fair value through earnings: Fuel option contract $ 36 $ — Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 5,831 $ 6,132 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 28 $ 52 |
Stockholders' Equity (Tables)
Stockholders' Equity (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Equity [Abstract] | |
Schedule of RSU Activity | A summary of RSU activity is as follows: Number of Weighted- Aggregate Outstanding and unvested at December 31, 2022 2,143,601 $ 1.77 Granted 2,217,213 0.67 $ 1,479 Vested (1,186,978) 2.06 $ 2,450 Cancelled (57,078) 1.10 $ (63) Outstanding and unvested at June 30, 2023 3,116,758 $ 0.89 $ 2,761 |
Schedule of the Stock Option Activity | A summary of the stock option activity is as follows: Number of Weighted- Weighted- Aggregate Outstanding at December 31, 2022 5,348,120 $ 2.56 3.3 $ 378 Outstanding at June 30, 2023 5,348,120 $ 2.56 2.8 $ — Exercisable at June 30, 2023 5,325,020 $ 2.55 2.8 $ — |
Supplemental Revenue Informat_2
Supplemental Revenue Information (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Revenue from Contract with Customer [Abstract] | |
Schedule of Revenue Information | The following table summarizes the components of the Company’s revenues by payor category: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Patient fee payors: Commercial $ 65,066 $ 71,609 $ 130,588 $ 140,710 Medicare 20,082 21,002 41,502 42,174 Medicaid 3,256 3,347 6,661 6,449 Other patient revenue 2,729 3,213 5,324 6,487 91,133 99,171 184,075 195,820 Hospitals and healthcare providers 91,513 90,651 183,975 178,110 Other revenue 2,194 2,306 4,382 4,461 $ 184,840 $ 192,128 $ 372,432 $ 378,391 |
Cost of Operations, excluding_2
Cost of Operations, excluding Depreciation and Amortization (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Cost Of Operations Excluding Depreciation And Amortization [Abstract] | |
Schedule of Cost of Goods and Service Excluding Depletion Depreciation and Amortization | The following table summarizes the components of the Company’s cost of operations, excluding depreciation and amortization: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Employee compensation $ 68,302 $ 72,021 $ 139,829 $ 147,148 Third-party services and professional fees 32,091 29,919 62,920 59,096 Rent and utilities 12,780 12,742 25,121 25,219 Reading fees 11,953 11,788 23,552 23,286 Administrative 12,944 11,467 23,365 23,091 Medical supplies and other 20,425 16,637 39,275 31,895 $ 158,495 $ 154,574 $ 314,062 $ 309,735 |
Supplemental Statement of Ope_2
Supplemental Statement of Operations Information (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Other Income and Expenses [Abstract] | |
Schedule of Restructuring Charges | Restructuring charges consist of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Transformation costs $ 939 $ 4,025 $ 6,659 $ 4,025 Lease termination costs 7 1,840 7 1,840 Domestication and related costs — 1,063 — 1,063 Other (2) 316 14 396 $ 944 $ 7,244 $ 6,680 $ 7,324 |
Schedule of Other Operating Expense (Income) | Other operating expense (income), net consists of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Loss on sale of accounts receivable $ 922 $ — $ 1,046 $ — Gain from insurance proceeds — — (776) — Loss (gain) on disposal of property and equipment, net (348) 170 (417) 372 Other, net (97) 416 (127) 207 $ 477 $ 586 $ (274) $ 579 |
Schedule Of Other Non-operating Losses (gains) | Other non-operating expense (income), net consists of the following: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Capital structure initiatives $ 1,912 $ — $ 1,912 $ — Acquisition-related costs 155 86 298 468 Fair value adjustment on derivative in subordinated notes (258) (1,009) (301) (839) Earnings from unconsolidated investees (128) (248) (279) (488) Other, net 665 (1,164) 584 (1,152) $ 2,346 $ (2,335) $ 2,214 $ (2,011) |
Schedule of Impairment of Assets | Impairment charges relate to the following assets: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Goodwill (Note 5) $ 53,460 $ — $ 53,460 $ — $ 53,460 $ — $ 53,460 $ — |
Basic and Diluted Loss per Sh_2
Basic and Diluted Loss per Share (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Earnings Per Share [Abstract] | |
Schedule of Earnings Per Share Basic and Diluted | The loss per share is calculated by dividing the net loss attributable to common stockholders by the weighted average common shares outstanding during the period. Three Months Ended June 30, Six Months Ended June 30, (in thousands, except share and per share amounts) 2023 2022 2023 2022 Net loss attributable to common stockholders $ (96,652) $ (30,469) $ (131,800) $ (61,280) Weighted average common shares outstanding: Basic and diluted 90,503,986 89,516,513 90,163,458 89,296,619 Net loss per share attributable to common stockholders: Basic and diluted $ (1.07) $ (0.34) $ (1.46) $ (0.69) Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,478,978 2,042,461 2,006,143 2,207,983 |
Segment Information (Tables)
Segment Information (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Segment Reporting [Abstract] | |
Schedule of Revenue By Segment | The following table summarizes the Company’s revenues by segment: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Radiology $ 156,291 $ 160,867 $ 313,692 $ 316,207 Oncology 28,549 31,261 58,740 62,184 $ 184,840 $ 192,128 $ 372,432 $ 378,391 |
Schedule of Company's Adjusted EBITDA | The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Adjusted EBITDA: Radiology $ 25,449 $ 35,692 $ 55,775 $ 64,281 Oncology 8,072 10,302 17,920 20,335 Corporate (6,994) (7,810) (14,027) (14,414) $ 26,527 $ 38,184 $ 59,668 $ 70,202 |
Schedule of Net Income (Loss) to Total Adjusted EBITDA | A reconciliation of the net loss to total Adjusted EBITDA is shown below: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Net loss $ (96,411) $ (26,079) $ (125,601) $ (52,511) Interest expense 31,164 29,290 61,861 57,971 Income tax benefit (1,578) (3,483) (704) (2,920) Depreciation and amortization 35,015 25,200 58,008 49,931 Impairment charges 53,460 — 53,460 — Restructuring charges 944 7,244 6,680 7,324 Severance and related costs 22 5,559 (27) 7,797 Settlements, recoveries and related costs 465 814 1,913 677 Stock-based compensation 441 758 840 1,819 Loss on sale of accounts receivable 922 — 1,046 — Loss (gain) on disposal of property and equipment, net (348) 170 (417) 372 Capital structure initiatives 1,912 — 1,912 — Acquisition-related costs 155 86 298 468 Fair value adjustment on derivative (258) (1,009) (301) (839) Deferred rent expense (43) 247 142 579 Other, net 665 (613) 558 (466) Adjusted EBITDA $ 26,527 $ 38,184 $ 59,668 $ 70,202 |
Schedule of Segment Reporting Information By Segment | The following table summarizes the Company’s total assets by segment: (in thousands) June 30, December 31, Identifiable assets: Radiology $ 1,304,358 $ 1,400,938 Oncology 312,992 346,337 Corporate 18,392 17,840 $ 1,635,742 $ 1,765,115 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Capital expenditures: Radiology $ 7,093 $ 4,648 $ 9,069 $ 13,460 Oncology 500 858 1,000 1,834 Corporate 1,359 82 1,391 172 $ 8,952 $ 5,588 $ 11,460 $ 15,466 |
Variable Interest Entities (Det
Variable Interest Entities (Details) - USD ($) $ in Thousands | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Dec. 31, 2022 | |
Variable Interest Entity [Line Items] | |||
Assets | $ 1,635,742 | $ 1,765,115 | |
Liabilities | 1,635,186 | 1,623,824 | |
Net cash provided by operating activities | 17,955 | $ 21,079 | |
Variable Interest Entity, Primary Beneficiary | |||
Variable Interest Entity [Line Items] | |||
Assets | 39,600 | 36,000 | |
Liabilities | 2,900 | $ 1,400 | |
Revenues | 85,700 | 92,800 | |
Net cash provided by operating activities | $ 77,900 | $ 93,200 |
Property and Equipment - Summar
Property and Equipment - Summary of Detailed Information of Property and Equipment (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Property, Plant and Equipment [Line Items] | ||
Equipment under finance leases | $ 45,348 | $ 44,845 |
Total property and equipment, gross | 381,277 | 370,156 |
Less accumulated depreciation | 183,718 | 148,942 |
Property and equipment, net | 197,559 | 221,214 |
Medical equipment | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 254,247 | 244,517 |
Leasehold improvements | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 44,000 | 43,382 |
Office and computer equipment | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 19,151 | 17,742 |
Transportation and service equipment | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 11,542 | 11,672 |
Furniture and fixtures | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 3,439 | 3,362 |
Construction in progress | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | $ 3,550 | $ 4,636 |
Property and Equipment - Additi
Property and Equipment - Additional Information (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | |||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | Dec. 31, 2022 | |
Property, Plant and Equipment [Abstract] | |||||
Depreciation expense | $ 18.2 | $ 20.2 | $ 36.4 | $ 39.9 | |
Net book value of equipment under finance leases | $ 25.4 | $ 25.4 | $ 26.3 |
Goodwill - Changes in the Carry
Goodwill - Changes in the Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Goodwill [Roll Forward] | ||||
Balance - Beginning of period | $ 769,110 | |||
Impairment | $ (53,460) | $ 0 | (53,460) | $ 0 |
Goodwill written off in connection with site closure | (381) | |||
Balance - End of period | 715,269 | 715,269 | ||
Radiology | ||||
Goodwill [Roll Forward] | ||||
Balance - Beginning of period | 682,725 | |||
Impairment | (53,500) | (53,460) | ||
Goodwill written off in connection with site closure | 0 | |||
Balance - End of period | 629,265 | 629,265 | ||
Oncology | ||||
Goodwill [Roll Forward] | ||||
Balance - Beginning of period | 86,385 | |||
Impairment | 0 | |||
Goodwill written off in connection with site closure | (381) | |||
Balance - End of period | $ 86,004 | $ 86,004 |
Goodwill - Schedule Of Signific
Goodwill - Schedule Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill (Details) | Jun. 30, 2023 |
Discount rate | Minimum | |
Goodwill [Line Items] | |
Goodwill measurement input | 0.095 |
Discount rate | Maximum | |
Goodwill [Line Items] | |
Goodwill measurement input | 0.100 |
Perpetual growth rate | |
Goodwill [Line Items] | |
Goodwill measurement input | 0.030 |
Tax rate | |
Goodwill [Line Items] | |
Goodwill measurement input | 0.260 |
Risk-free interest rate | |
Goodwill [Line Items] | |
Goodwill measurement input | 0.035 |
Revenue multiple | Minimum | |
Goodwill [Line Items] | |
Goodwill measurement input | 1.8 |
Revenue multiple | Maximum | |
Goodwill [Line Items] | |
Goodwill measurement input | 2.2 |
EBITDA multiple | Minimum | |
Goodwill [Line Items] | |
Goodwill measurement input | 7.5 |
EBITDA multiple | Maximum | |
Goodwill [Line Items] | |
Goodwill measurement input | 9.5 |
Goodwill - Additional Informati
Goodwill - Additional Information (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Goodwill [Line Items] | ||||
Impairment | $ 53,460 | $ 0 | $ 53,460 | $ 0 |
Radiology | ||||
Goodwill [Line Items] | ||||
Impairment | $ 53,500 | $ 53,460 |
Other Intangible Assets - Sched
Other Intangible Assets - Schedule Of Intangible Assets Excluding Goodwill (Details) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2023 | Dec. 31, 2022 | |
Finite-Lived Intangible Assets [Line Items] | ||
Gross Carrying Amount | $ 343,063 | $ 356,442 |
Accumulated Amortization | (42,109) | (33,905) |
Other Intangible Assets, Net | 300,954 | 322,537 |
Certificates of Need | 69,558 | 69,558 |
Total other intangible assets | $ 370,512 | 392,095 |
Customer contracts | ||
Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Useful Life (in years) | 20 years | |
Gross Carrying Amount | $ 250,733 | 263,388 |
Accumulated Amortization | (23,057) | (17,588) |
Other Intangible Assets, Net | $ 227,676 | 245,800 |
Trade names | ||
Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Useful Life (in years) | 18 years | |
Gross Carrying Amount | $ 76,391 | 77,135 |
Accumulated Amortization | (13,324) | (11,063) |
Other Intangible Assets, Net | $ 63,067 | 66,072 |
Management agreements | ||
Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Useful Life (in years) | 17 years | |
Gross Carrying Amount | $ 10,200 | 10,200 |
Accumulated Amortization | (1,100) | (800) |
Other Intangible Assets, Net | $ 9,100 | 9,400 |
Other | ||
Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Useful Life (in years) | 5 years | |
Gross Carrying Amount | $ 5,739 | 5,719 |
Accumulated Amortization | (4,628) | (4,454) |
Other Intangible Assets, Net | $ 1,111 | $ 1,265 |
Other Intangible Assets - Addit
Other Intangible Assets - Additional Information (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Finite-Lived Intangible Assets [Line Items] | ||||
Amortization of Intangible Assets | $ 16.8 | $ 5 | $ 21.6 | $ 10 |
Oncology | ||||
Finite-Lived Intangible Assets [Line Items] | ||||
Amortization of Intangible Assets | $ 12.1 | $ 12.1 |
Long-Term Debt - Summary of Lon
Long-Term Debt - Summary of Long-term debt (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term debt | $ 1,365,107 | $ 1,346,057 |
Debt discount/premium and deferred issuance costs | (72,748) | (71,444) |
Total long-term debt | 1,292,359 | 1,274,613 |
Less current portion | 19,282 | 19,961 |
Long-term debt, net of current portion | 1,273,077 | 1,254,652 |
2028 Senior Notes | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term debt | 375,000 | 375,000 |
2025 Senior Notes | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term debt | 475,000 | 475,000 |
Subordinated Notes | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term debt | 451,265 | 423,303 |
Equipment Debt | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term debt | $ 63,842 | $ 72,754 |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Details) $ in Millions | 6 Months Ended |
Jun. 30, 2023 USD ($) | |
Subordinated Notes | |
Debt Instrument [Line Items] | |
Accrued interest added to the principal balance | $ 28 |
Accrued Liabilities (Details)
Accrued Liabilities (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Payables and Accruals [Abstract] | ||
Accrued compensation and related expenses | $ 21,743 | $ 25,655 |
Accrued interest expense | 18,267 | 18,183 |
Other | 48,329 | 43,078 |
Total accrued liabilities | $ 88,339 | $ 86,916 |
Redeemable Noncontrolling Int_3
Redeemable Noncontrolling Interests - Additional Information (Detail) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Noncontrolling Interest [Abstract] | ||
Redeemable noncontrolling interests | $ 26,800 | $ 30,337 |
Redeemable Noncontrolling Int_4
Redeemable Noncontrolling Interest - Summary of Redeemable Noncontrolling Interests (Detail) $ in Thousands | 6 Months Ended |
Jun. 30, 2023 USD ($) | |
Stockholders' Equity Attributable to Noncontrolling Interest [Roll Forward] | |
Balance, December 31, 2022 | $ 30,337 |
Net income attributable to redeemable noncontrolling interests | 611 |
Contributions received from redeemable noncontrolling interests | 107 |
Distributions paid to redeemable noncontrolling interests | (4,255) |
Balance, June 30, 2023 | $ 26,800 |
Financial Instruments - Schedul
Financial Instruments - Schedule of Fair Value Measurements, Recurring and Nonrecurring (Details) - Fair Value, Recurring - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Interest rate and fuel option contracts | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term assets: | $ 64 | $ 52 |
Interest rate and fuel option contracts | Level 1 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term assets: | 0 | 0 |
Interest rate and fuel option contracts | Level 2 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term assets: | 64 | 52 |
Interest rate and fuel option contracts | Level 3 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term assets: | 0 | 0 |
Derivative in subordinated notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Long-term liabilities: | 5,831 | 6,132 |
Derivative in subordinated notes | Level 1 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Long-term liabilities: | 0 | 0 |
Derivative in subordinated notes | Level 2 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Long-term liabilities: | 0 | 0 |
Derivative in subordinated notes | Level 3 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Long-term liabilities: | $ 5,831 | $ 6,132 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Details) $ in Millions | Sep. 01, 2021 | Jun. 30, 2023 USD ($) yr | Dec. 31, 2022 USD ($) yr |
Revolving Credit Facility | Interest Rate Contract | |||
Financial Instruments [Line Items] | |||
Increase decrease in the variable rate of interest | 1% | 1% | |
Equipment Debt | |||
Financial Instruments [Line Items] | |||
Long term debt unhedged | $ | $ 0.3 | $ 0.4 | |
Subordinated Notes | Stone Peak Magnet | |||
Financial Instruments [Line Items] | |||
Debt covenant, redemption option, change of control period (in years) | 7 years | ||
Level 3 | Measurement Input Probability Weighted Time | |||
Financial Instruments [Line Items] | |||
Embedded derivative liability measurement input | yr | 3.2 | 3.5 | |
Level 3 | Measurement Input Probability Of Exit Event Percentage | |||
Financial Instruments [Line Items] | |||
Embedded derivative liability measurement input | 0.217 | 0.229 |
Financial Instruments - Summary
Financial Instruments - Summary of Reconciliation of Liability Related to the Embedded Derivative (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Disclosure Of Movement In Embedded Derivative Liabilities [Roll Forward] | ||||
Change in fair value | $ 258 | $ 1,009 | $ 301 | $ 839 |
Subordinated Notes | Stone Peak Magnet | Level 3 | ||||
Disclosure Of Movement In Embedded Derivative Liabilities [Roll Forward] | ||||
Balance, December 31, 2022 | 6,132 | |||
Change in fair value | (301) | |||
Balance, June 30, 2023 | $ 5,831 | $ 5,831 |
Financial Instruments - Sched_2
Financial Instruments - Schedule Of Fair Value Of Other Current And Non Current Liabilities (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | $ 986,171 | $ 881,928 |
2028 Senior Notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | 247,705 | 228,894 |
2025 Senior Notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | 390,814 | 339,385 |
Subordinated Notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | 294,380 | 254,951 |
Equipment Debt | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | $ 53,272 | $ 58,698 |
Financial Instruments - Sched_3
Financial Instruments - Schedule of Information Regarding The Carrying Value Of Financial Instruments (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Cash and cash equivalents | $ 37,968 | $ 59,424 |
Accounts receivable | 115,790 | 114,166 |
Current portion of long-term debt | 19,282 | 19,961 |
Non-current portion of long-term debt | 1,273,077 | 1,254,652 |
Accrued liabilities | 88,339 | 86,916 |
Financial assets measured at fair value through earnings: | ||
Fuel option contract | 36 | 0 |
Reported Value Measurement | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Cash and cash equivalents | 37,968 | 59,424 |
Accounts receivable | 115,790 | 114,166 |
Financial assets measured at amortized cost | 153,758 | 173,590 |
Accounts payable | 43,575 | 36,618 |
Current portion of long-term debt | 19,282 | 19,961 |
Current portion of leases | 23,581 | 25,023 |
Non-current portion of long-term debt | 1,273,077 | 1,254,652 |
Non-current portion of leases | 167,948 | 179,980 |
Accrued liabilities | 88,339 | 86,916 |
Financial liabilities measured at amortized cost | 1,615,802 | 1,603,150 |
Financial liabilities measured at fair value through earnings: | ||
Derivative in subordinated notes | 5,831 | 6,132 |
Financial assets measured at fair value through other comprehensive income: | ||
Interest rate contracts | $ 28 | $ 52 |
Stockholders' Equity - Addition
Stockholders' Equity - Additional Information (Detail) | 6 Months Ended | ||
Apr. 18, 2023 | Jun. 30, 2023 $ / shares shares | Dec. 31, 2022 $ / shares shares | |
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | |||
Common stock, shares authorized (in shares) | 300,000,000 | 300,000,000 | |
Common stock, par or stated value per share (in USD per share) | $ / shares | $ 0.01 | $ 0.01 | |
Preferred stock, shares authorized (in shares) | 50,000,000 | 50,000,000 | |
Preferred stock, par or stated value per share (in USD per share) | $ / shares | $ 0.01 | $ 0.01 | |
Restricted Stock Units (RSUs) | |||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | |||
Vesting period | 2 years | ||
Employee Stock Option | |||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | |||
Vesting period | 3 years | ||
Options granted (in shares) | 0 | ||
Employee Stock Option | Minimum | |||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | |||
Term of award | 7 years | ||
Employee Stock Option | Maximum | |||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | |||
Term of award | 10 years | ||
Domestication | |||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | |||
Common stock, shares authorized (in shares) | 300,000,000 | ||
Common stock, par or stated value per share (in USD per share) | $ / shares | $ 0.01 | ||
Preferred stock, shares authorized (in shares) | 50,000,000 | ||
Preferred stock, par or stated value per share (in USD per share) | $ / shares | $ 0.01 | ||
2023 Stock Plans | |||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | |||
Common stock options reserved for issuance (as a percent) | 0.10 | ||
Common stock options reserved for issuance (in shares) | 9,099,849 | 8,981,151 |
Stockholders' Equity - Summary
Stockholders' Equity - Summary of RSU Activity (Detail) $ / shares in Units, $ in Thousands | 6 Months Ended |
Jun. 30, 2023 USD ($) $ / shares shares | |
Number of RSUs | |
Beginning balance (in shares) | shares | 2,143,601 |
Granted (in shares) | shares | 2,217,213 |
Vested (in shares) | shares | (1,186,978) |
Cancelled (in shares) | shares | (57,078) |
Ending balance (in shares) | shares | 3,116,758 |
Weighted- Average Grant Date Fair Value | |
Beginning balance (in dollars per share) | $ / shares | $ 1.77 |
Granted (in dollars per share) | $ / shares | 0.67 |
Vested (in dollars per share) | $ / shares | 2.06 |
Cancelled (in dollars per share) | $ / shares | 1.10 |
Ending balance (in dollars per share) | $ / shares | $ 0.89 |
Aggregate Grant Date Fair Value, Granted | $ | $ 1,479 |
Aggregate Grant Date Fair Value, Vested | $ | 2,450 |
Aggregate Grant Date Fair Value, Cancelled | $ | (63) |
Aggregate Grant Date Fair Value, Outstanding and unvested | $ | $ 2,761 |
Stockholders' Equity - Summar_2
Stockholders' Equity - Summary of the Stock Option Activity (Detail) - Stock Options - USD ($) $ / shares in Units, $ in Thousands | 6 Months Ended | 12 Months Ended |
Jun. 30, 2023 | Dec. 31, 2022 | |
Number of Options | ||
Beginning balance (in share) | 5,348,120 | |
Ending balance (in share) | 5,348,120 | 5,348,120 |
Weighted- Average Exercise price | ||
Beginning balance (in USD per share) | $ 2.56 | |
Ending balance (in USD per share) | $ 2.56 | $ 2.56 |
Stock Options Additional Disclosures | ||
Number of Options, Exercisable (in shares) | 5,325,020 | |
Weighted-Average Exercise price, Exercisable (in dollars per share) | $ 2.55 | |
Weighted- Average Remaining Contractual Term (Years) | 2 years 9 months 18 days | 3 years 3 months 18 days |
Weighted-Average Remaining Contractual Term, Exercisable | 2 years 9 months 18 days | |
Aggregate Intrinsic Value (in thousands) | $ 0 | $ 378 |
Aggregate Intrinsic Value, Exercisable | $ 0 |
Commitments and Contingencies (
Commitments and Contingencies (Details) - Commitement For The Purchase Of Equipment $ in Millions | Jun. 30, 2023 USD ($) |
Loss Contingencies [Line Items] | |
Purchase commitments | $ 38.4 |
Greater Than Six Months | |
Loss Contingencies [Line Items] | |
Purchase commitments | 6 |
Within the Remaining Six Months | |
Loss Contingencies [Line Items] | |
Purchase commitments | $ 32.5 |
Supplemental Revenue Informat_3
Supplemental Revenue Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Disaggregation of Revenue [Line Items] | ||||
Other revenue | $ 2,194 | $ 2,306 | $ 4,382 | $ 4,461 |
Total revenue | 184,840 | 192,128 | 372,432 | 378,391 |
Sales Channel, Directly to Consumer | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | 91,133 | 99,171 | 184,075 | 195,820 |
Commercial | Sales Channel, Directly to Consumer | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | 65,066 | 71,609 | 130,588 | 140,710 |
Medicare | Sales Channel, Directly to Consumer | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | 20,082 | 21,002 | 41,502 | 42,174 |
Medicaid | Sales Channel, Directly to Consumer | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | 3,256 | 3,347 | 6,661 | 6,449 |
Other patient revenue | Sales Channel, Directly to Consumer | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | 2,729 | 3,213 | 5,324 | 6,487 |
Hospitals and healthcare providers | Sales Channel, Through Intermediary | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | $ 91,513 | $ 90,651 | $ 183,975 | $ 178,110 |
Cost of Operations, excluding_3
Cost of Operations, excluding Depreciation and Amortization (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | $ 158,495 | $ 154,574 | $ 314,062 | $ 309,735 |
Employee compensation | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | 68,302 | 72,021 | 139,829 | 147,148 |
Third-party services and professional fees | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | 32,091 | 29,919 | 62,920 | 59,096 |
Rent and utilities | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | 12,780 | 12,742 | 25,121 | 25,219 |
Reading fees | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | 11,953 | 11,788 | 23,552 | 23,286 |
Administrative | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | 12,944 | 11,467 | 23,365 | 23,091 |
Medical supplies and other | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | $ 20,425 | $ 16,637 | $ 39,275 | $ 31,895 |
Supplemental Statement of Ope_3
Supplemental Statement of Operations Information - Schedule of Restructuring Charges (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Restructuring Cost and Reserve [Line Items] | ||||
Restructuring charges | $ 944 | $ 7,244 | $ 6,680 | $ 7,324 |
Transformation costs | ||||
Restructuring Cost and Reserve [Line Items] | ||||
Restructuring charges | 939 | 4,025 | 6,659 | 4,025 |
Lease termination costs | ||||
Restructuring Cost and Reserve [Line Items] | ||||
Restructuring charges | 7 | 1,840 | 7 | 1,840 |
Domestication and related costs | ||||
Restructuring Cost and Reserve [Line Items] | ||||
Restructuring charges | 0 | 1,063 | 0 | 1,063 |
Other | ||||
Restructuring Cost and Reserve [Line Items] | ||||
Restructuring charges | $ (2) | $ 316 | $ 14 | $ 396 |
Supplemental Statement of Ope_4
Supplemental Statement of Operations Information - Additional Information (Details) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2023 | Dec. 31, 2022 | |
Restructuring Cost and Reserve [Line Items] | ||
Accounts payable | $ 43,575 | $ 36,618 |
Minimum | ||
Restructuring Cost and Reserve [Line Items] | ||
Severance benefits, payment period | 12 months | |
Maximum | ||
Restructuring Cost and Reserve [Line Items] | ||
Severance benefits, payment period | 18 months | |
Transformation costs | ||
Restructuring Cost and Reserve [Line Items] | ||
Accounts payable | $ 3,400 | $ 4,500 |
Transformation Costs, Fixed Fees | ||
Restructuring Cost and Reserve [Line Items] | ||
Remaining transformation costs | 12,500 | |
Transformation Costs, Milestone Fees | ||
Restructuring Cost and Reserve [Line Items] | ||
Remaining transformation costs | 7,000 | |
Transformation Costs, Performance Fees | ||
Restructuring Cost and Reserve [Line Items] | ||
Remaining transformation costs | 15,000 | |
Employee Severance | ||
Restructuring Cost and Reserve [Line Items] | ||
Accrued liability for unpaid transformation consulting costs | $ 1,500 |
Supplemental Statement of Ope_5
Supplemental Statement of Operations Information - Schedule of Other Operating Expense (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Other Income and Expenses [Abstract] | ||||
Loss on sale of accounts receivable | $ 922 | $ 0 | $ 1,046 | $ 0 |
Gain from insurance proceeds | 0 | 0 | (776) | 0 |
Loss (gain) on disposal of property and equipment, net | (348) | 170 | (417) | 372 |
Other, net | (97) | 416 | (127) | 207 |
Other operating expense (income), net | $ 477 | $ 586 | $ (274) | $ 579 |
Supplemental Statement of Ope_6
Supplemental Statement of Operations Information - Schedule of Other Non-operating Losses (gains) (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Other Income and Expenses [Abstract] | ||||
Capital structure initiatives | $ 1,912 | $ 0 | $ 1,912 | $ 0 |
Acquisition-related costs | 155 | 86 | 298 | 468 |
Fair value adjustment on derivative | (258) | (1,009) | (301) | (839) |
Earnings from unconsolidated investees | (128) | (248) | (279) | (488) |
Other, net | 665 | (1,164) | 584 | (1,152) |
Other non-operating expense (income), net | $ 2,346 | $ (2,335) | $ 2,214 | $ (2,011) |
Supplemental Statement of Ope_7
Supplemental Statement of Operations Information - Schedule of Impairment of Assets (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Other Income and Expenses [Abstract] | ||||
Goodwill | $ 53,460 | $ 0 | $ 53,460 | $ 0 |
Impairment charges | $ 53,460 | $ 0 | $ 53,460 | $ 0 |
Investments in Unconsolidated_2
Investments in Unconsolidated Investees (Detail) - USD ($) $ in Millions | Mar. 01, 2021 | Jun. 30, 2023 |
Other Investments [Line Items] | ||
Payments to acquire Investments | $ 4.6 | |
Equity method investments | $ 7.9 | |
Common Equity | Share Purchase Warrants | ||
Other Investments [Line Items] | ||
Payments to acquire Investments | $ 0.4 | |
AI Business | ||
Other Investments [Line Items] | ||
Equity method investment, ownership percentage | 34.50% | 15% |
AI Business | Common Equity | Share Purchase Warrants | ||
Other Investments [Line Items] | ||
Equity method investment, ownership percentage | 2.40% |
Basic and Diluted Loss per Sh_3
Basic and Diluted Loss per Share (Detail) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Earnings Per Share [Abstract] | ||||
Net loss attributable to common stockholders | $ (96,652) | $ (30,469) | $ (131,800) | $ (61,280) |
Weighted average common shares outstanding: | ||||
Basic (in shares) | 90,503,986 | 89,516,513 | 90,163,458 | 89,296,619 |
Diluted (in shares) | 90,503,986 | 89,516,513 | 90,163,458 | 89,296,619 |
Net loss per share attributable to common stockholders: | ||||
Basic (in USD per share) | $ (1.07) | $ (0.34) | $ (1.46) | $ (0.69) |
Diluted (in USD per share) | $ (1.07) | $ (0.34) | $ (1.46) | $ (0.69) |
Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive (in shares) | 1,478,978 | 2,042,461 | 2,006,143 | 2,207,983 |
Segment Information - Additiona
Segment Information - Additional Information (Details) | 22 Months Ended |
Jun. 30, 2023 segment | |
Segment Reporting [Abstract] | |
Number of reportable segments | 2 |
Segment Information - Summary o
Segment Information - Summary of Company's Revenues By Segment (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenues | $ 184,840 | $ 192,128 | $ 372,432 | $ 378,391 |
Radiology | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenues | 156,291 | 160,867 | 313,692 | 316,207 |
Oncology | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenues | $ 28,549 | $ 31,261 | $ 58,740 | $ 62,184 |
Segment Information - Summary_2
Segment Information - Summary of Company's Adjusted EBITDA (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | $ 26,527 | $ 38,184 | $ 59,668 | $ 70,202 |
Corporate | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | (6,994) | (7,810) | (14,027) | (14,414) |
Radiology | Operating Segments | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | 25,449 | 35,692 | 55,775 | 64,281 |
Oncology | Operating Segments | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | $ 8,072 | $ 10,302 | $ 17,920 | $ 20,335 |
Segment Information - Summary_3
Segment Information - Summary of Net Income (Loss) to Total Adjusted EBITDA (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Segment Reporting [Abstract] | ||||
Net loss | $ (96,411) | $ (26,079) | $ (125,601) | $ (52,511) |
Interest expense | 31,164 | 29,290 | 61,861 | 57,971 |
Income tax benefit | (1,578) | (3,483) | (704) | (2,920) |
Depreciation and amortization | 35,015 | 25,200 | 58,008 | 49,931 |
Impairment charges | 53,460 | 0 | 53,460 | 0 |
Restructuring charges | 944 | 7,244 | 6,680 | 7,324 |
Severance and related costs | 22 | 5,559 | (27) | 7,797 |
Settlements, recoveries and related costs | 465 | 814 | 1,913 | 677 |
Stock-based compensation | 441 | 758 | 840 | 1,819 |
Loss on sale of accounts receivable | 922 | 0 | 1,046 | 0 |
Loss (gain) on disposal of property and equipment, net | (348) | 170 | (417) | 372 |
Capital structure initiatives | 1,912 | 0 | 1,912 | 0 |
Acquisition-related costs | 155 | 86 | 298 | 468 |
Fair value adjustment on derivative | (258) | (1,009) | (301) | (839) |
Deferred rent expense | (43) | 247 | 142 | 579 |
Other, net | 665 | (613) | 558 | (466) |
Adjusted EBITDA | $ 26,527 | $ 38,184 | $ 59,668 | $ 70,202 |
Segment Information - Schedule
Segment Information - Schedule Of Segment Reporting Information By Segment (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | |||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | Dec. 31, 2022 | |
Segment Reporting Information [Line Items] | |||||
Identifiable assets | $ 1,635,742 | $ 1,635,742 | $ 1,765,115 | ||
Capital expenditures | 8,952 | $ 5,588 | 11,460 | $ 15,466 | |
Corporate | |||||
Segment Reporting Information [Line Items] | |||||
Identifiable assets | 18,392 | 18,392 | 17,840 | ||
Capital expenditures | 1,359 | 82 | 1,391 | 172 | |
Radiology | Operating Segments | |||||
Segment Reporting Information [Line Items] | |||||
Identifiable assets | 1,304,358 | 1,304,358 | 1,400,938 | ||
Capital expenditures | 7,093 | 4,648 | 9,069 | 13,460 | |
Oncology | Operating Segments | |||||
Segment Reporting Information [Line Items] | |||||
Identifiable assets | 312,992 | 312,992 | $ 346,337 | ||
Capital expenditures | $ 500 | $ 858 | $ 1,000 | $ 1,834 |