Document and Entity Information
Document and Entity Information - shares | 3 Months Ended | |
Mar. 31, 2017 | Apr. 28, 2017 | |
Document Information [Line Items] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Mar. 31, 2017 | |
Document Fiscal Year Focus | 2,017 | |
Document Fiscal Period Focus | Q1 | |
Trading Symbol | AMED | |
Entity Registrant Name | AMEDISYS INC | |
Entity Central Index Key | 896,262 | |
Current Fiscal Year End Date | --12-31 | |
Entity Filer Category | Large Accelerated Filer | |
Entity Common Stock, Shares Outstanding | 33,728,276 | |
Entity Voluntary Filers | No | |
Entity Current Reporting Status | Yes | |
Entity Well-known Seasoned Issuer | Yes |
CONSOLIDATED BALANCE SHEETS
CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands | Mar. 31, 2017 | Dec. 31, 2016 |
Current assets: | ||
Cash and cash equivalents | $ 48,334 | $ 30,197 |
Patient accounts receivable, net of allowance for doubtful accounts of $19,249, and $17,716 | 172,707 | 166,056 |
Prepaid expenses | 10,097 | 7,397 |
Other current assets | 11,964 | 11,260 |
Total current assets | 243,102 | 214,910 |
Property and equipment, net of accumulated depreciation of $142,185 and $138,650 | 36,676 | 36,999 |
Goodwill | 292,793 | 288,957 |
Intangible assets, net of accumulated amortization of $28,557 and $27,864 | 46,220 | 46,755 |
Deferred income taxes | 98,943 | 107,940 |
Other assets, net | 38,894 | 38,468 |
Total assets | 756,628 | 734,029 |
Current liabilities: | ||
Accounts payable | 29,444 | 30,358 |
Payroll and employee benefits | 81,909 | 82,480 |
Accrued expenses | 65,663 | 63,290 |
Current portion of long-term obligations | 6,888 | 5,220 |
Total current liabilities | 183,904 | 181,348 |
Long-term obligations, less current portion | 85,472 | 87,809 |
Other long-term obligations | 4,306 | 3,730 |
Total liabilities | 273,682 | 272,887 |
Commitments and Contingencies - Note 5 | ||
Equity: | ||
Preferred stock, $0.001 par value, 5,000,000 shares authorized; none issued or outstanding | 0 | 0 |
Common Stock, $0.001 par value, 60,000,000 shares authorized; 35,364,752, and 35,253,577 shares issued; and 33,693,027 and 33,597,215 shares outstanding | 35 | 35 |
Additional paid-in capital | 544,428 | 537,472 |
Treasury Stock at cost 1,671,725 and 1,656,362 shares of common stock | (47,531) | (46,774) |
Accumulated other comprehensive income | 15 | 15 |
Retained earnings | (14,967) | (30,545) |
Total Amedisys, Inc. stockholders' equity | 481,980 | 460,203 |
Noncontrolling interests | 966 | 939 |
Total equity | 482,946 | 461,142 |
Total liabilities and equity | $ 756,628 | $ 734,029 |
CONSOLIDATED BALANCE SHEETS (Pa
CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands | Mar. 31, 2017 | Dec. 31, 2016 |
Patient accounts receivable, allowance for doubtful accounts | $ 19,249 | $ 17,716 |
Property and equipment, accumulated depreciation | 142,185 | 138,650 |
Intangible assets, accumulated amortization | $ 28,557 | $ 27,864 |
Preferred stock, par value | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized | 5,000,000 | 5,000,000 |
Preferred stock, issued | 0 | 0 |
Preferred stock, outstanding | 0 | 0 |
Common Stock, par value | $ 0.001 | $ 0.001 |
Common Stock, shares authorized | 60,000,000 | 60,000,000 |
Common Stock, shares issued | 35,364,752 | 35,253,577 |
Common Stock, shares outstanding | 33,693,027 | 33,597,215 |
Treasury Stock at cost, shares | 1,671,725 | 1,656,362 |
CONSOLIDATED STATEMENTS OF OPER
CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands | 3 Months Ended | |
Mar. 31, 2017 | Mar. 31, 2016 | |
Net service revenue | $ 370,458 | $ 348,817 |
Cost of service, excluding depreciation and amortization | 215,785 | 201,837 |
General and administrative expenses: | ||
Salaries and benefits | 74,459 | 76,717 |
Non-cash compensation | 3,874 | 4,070 |
Other | 40,417 | 46,717 |
Provision for doubtful accounts | 6,341 | 3,940 |
Depreciation and amortization | 4,417 | 4,473 |
Operating expenses | 345,293 | 337,754 |
Operating income | 25,165 | 11,063 |
Other expense: | ||
Interest income | 19 | 22 |
Interest expense | (1,068) | (1,112) |
Equity in loss from equity method investments | (106) | (5) |
Miscellaneous, net | 1,112 | 735 |
Total other expense, net | (43) | (360) |
Income before income taxes | 25,122 | 10,703 |
Income tax expense | (9,923) | (4,388) |
Net income | 15,199 | 6,315 |
Net income attributable to noncontrolling interests | (69) | (102) |
Net income attributable to Amedisys, Inc. | $ 15,130 | $ 6,213 |
Basic earnings per common share: | ||
Net income attributable to Amedisys, Inc. common stockholders | $ 0.45 | $ 0.19 |
Weighted average shares outstanding | 33,443 | 32,920 |
Diluted earnings per common share: | ||
Net income attributable to Amedisys, Inc. common stockholders | $ 0.44 | $ 0.19 |
Weighted average shares outstanding | 34,073 | 33,508 |
Income Amounts Attributable To Reporting Entity Disclosures [Abstract] | ||
Net income attributable to Amedisys, Inc. | $ 15,130 | $ 6,213 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2017 | Mar. 31, 2016 | |
Cash Flows from Operating Activities: | ||
Net income | $ 15,199 | $ 6,315 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||
Depreciation and amortization | 4,417 | 4,473 |
Provision for doubtful accounts | 6,341 | 3,940 |
Non-cash compensation | 3,874 | 4,070 |
401(k) employer match | 2,227 | 1,737 |
(Gain) loss on disposal of property and equipment | (16) | 360 |
Deferred income taxes | 9,445 | 4,038 |
Equity in loss of equity method investments | 106 | 5 |
Amortization of deferred debt issuance costs | 185 | 185 |
Return on equity investment | 150 | 362 |
Changes in operating assets and liabilities, net of impact of acquisitions: | ||
Patient accounts receivable | (12,493) | (27,689) |
Other current assets | (3,403) | 7,845 |
Other assets | (990) | (2,775) |
Accounts payable | 93 | 9,098 |
Accrued expenses | 1,386 | 801 |
Other long-term obligations | 576 | (521) |
Net cash provided by operating activities | 27,097 | 12,244 |
Cash Flows from Investing Activities: | ||
Proceeds from sale of deferred compensation plan assets | 565 | 230 |
Purchase of investment | (256) | 0 |
Purchases of property and equipment | (4,385) | (6,702) |
Acquisitions of businesses, net of cash acquired | (4,099) | (27,682) |
Net cash used in investing activities | (8,175) | (34,154) |
Cash Flows from Financing Activities: | ||
Proceeds from issuance of stock upon exercise of stock options and warrants | 653 | 0 |
Proceeds from issuance of stock to employee stock purchase plan | 612 | 638 |
Shares withheld upon stock vesting | (758) | 0 |
Tax benefit from stock options exercised and restricted stock vesting | 0 | 159 |
Non-controlling interest distribution | (42) | 0 |
Proceeds from revolving line of credit | 0 | 40,500 |
Repayments of revolving line of credit | 0 | (25,500) |
Principal payments of long-term obligations | (1,250) | (1,250) |
Purchase of company stock | 0 | (12,315) |
Net cash (used in) provided by financing activities | (785) | 2,232 |
Net increase (decrease) in cash and cash equivalents | 18,137 | (19,678) |
Cash and cash equivalents at beginning of period | 30,197 | 27,502 |
Cash and cash equivalents at end of period | 48,334 | 7,824 |
Supplemental Disclosures of Cash Flow Information: | ||
Cash paid for interest | 706 | 648 |
Cash paid for income taxes, net of refunds received | $ 284 | $ (7) |
NATURE OF OPERATIONS, CONSOLIDA
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS | 3 Months Ended |
Mar. 31, 2017 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS | 1 . NATURE OF OPERATIONS , CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS Amedisys, Inc., a Delaware corporation, and its consolidated subsidiaries (“Amedisys,” “we,” “us,” or “our”) are a multi-state provider of home health , hospice and personal care services with approximately 7 5 % and 79 % of our revenue derived from Medicare for the three -month period s ended March 31, 2017 and 2016 , respectively . As of March 31, 2017 , we owned and operated 326 Medicare-certified home health care centers , 79 Medicare-certified hospice care centers and 1 6 personal - care care centers in 34 states within the United St ates and the District of Columbia . Basis of Presentation In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting solely of normal recurring adjustments) necessary to present fairly our financial position, our results of operations and our cash flows in accordance with U.S. Generally Accepted Accounting Principles (“U.S. GAAP”). Our results of operations for the interim periods presented are not necessarily indicative of results of our operations for the entire year and have not been audited by our independent auditors. Certain information and footnote disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted from the interim financial information presented. This report should be read in conjunction with our consolidated finan cial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 2016 , as filed with the Securities and Exchange Commission (“SEC”) on March 1, 201 7 (the “Form 10-K”), which includes information and disclosures not included herein. Use of Estimates Our accounting and reporting policies conform with U.S. GAAP. In preparing the unaudited condensed consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates. Reclassifications and Comparability Certain reclassifications have been made to prior periods' financial statements in order to conform to the current period' s presentation . Principles of Consolidation These unaudited condensed c onsolidated financial statements include the accounts of Amedisys, Inc. , and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying unaudited condensed consolidated financial statements, and business combinations accounted for as purchases have been included in our unaudited condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain equity investments that are accounted for as set forth below . Equity Investments We consolidate investments when the entity is a variable interest entity and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50 %. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our condensed consolidated financial statements. We account for investments in entities in which we have the ability to exercise significant influence under the equity method if we hold 50 % or less of the voting stock and the entity is not a variable interest entity in which we are the primary beneficiary. The book value of investments that we accounted for under the equity method of accounting was $ 2 7 . 8 million as of March 31 , 201 7 and December 31, 201 6 . We account for investments in entities in which we have less than a 20 % ownership interest under the cost method of accounting if we do not have the ability to exercise significant influence over the investee . |
SUMMARY OF SIGNIFICANT ACCOUNTI
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES | 3 Months Ended |
Mar. 31, 2017 | |
Accounting Policies [Abstract] | |
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES | 2 . Summary of Significant Accounting Policies Revenue Recognition We earn net service revenue through our home health , hospice and personal-care care center s by providing a variety of services almost exclusively in the homes of our patients. This net service revenue is earned and billed either on an episode of care basis, on a per visit basis or on a daily basis depending upon the payment terms and conditions established with each payor for services provided. We refer to home health revenue earned and billed on a 60 -day episode of care as episodic-based revenue. When we record our service revenue, we record it net of estimated revenue adjustments and contractual adjustments to reflect amounts we estimate to be realizable for services provided, as discussed below. We believe, based on information currently available to us and based on our judgment, that changes to one or more factors that impact the accounting estimates (such as our estimates related to revenue adjustments, contractual adjustments and episodes in progress) we make in determining net service revenue, which changes are likely to occur from period to period, will not materially impact our reported consolidated financial condition, results of operations, cash flows or our future financial results. Home Health Revenue Recognition Medicare Revenue Net service revenue is recorded under the Medicare prospective payment system (“PPS”) based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if our patient's care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits was fewer than five; (c) a partial payment if our patient transferred to another provider or we received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required (with various incremental adjustments made for additional visits, with larger payment increases associated with the sixth, fourteenth and twentieth visit thresholds); (e) adjustments to payments if we are unable to perform periodic therapy assessments; (f) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (g) changes in the base episode payments established by the Medicare Program; (h) adjustments to the base episode payments for case mix and geographic wages; and (i) recoveries of overpayments. In addition, we make adjustments to Medicare revenue if we find that we are unable to produce appropriate documentation of a face to face encounter between the patient and physician. We make adjustments to Medicare revenue to reflect differences between estimated and actual payment amounts, our discovered inability to obtain appropriate billing documentation or authorizations and other reasons unrelated to credit risk. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99 % on Medicare claims, and record this estimate during the period in which services are rendered as an estimated revenue adjustment and a corresponding reduction to patient accounts receivable. Therefore, we believe that our reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. In addition to revenue recognized on completed episodes, we also recognize a portion of revenue associated with episodes in progress. Episodes in progress are 60 -day episodes of care that begin during the reporting period, but were not completed as of the end of the period. We estimate this revenue on a monthly basis based upon historical trends. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and our estimate of the average percentage complete based on the number of days elapsed during an episode of care . As of March 31, 2017 and 2016 , the difference between the cash received from Medicare for a request for anticipated payment (“RAP”) on episodes in progress and the associated estimated revenue was immaterial and, therefore, the resulting credits were recorded as a reduction to our outstanding pa tient accounts receivable in our condensed consolidated balance sheets for such periods. Non-Medicare Revenue Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. Non-episodic b ased Revenue. Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates, as applicable. Contractual adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue and are also recorded as a reduction to our outstanding patient accounts receivable. In addition, we receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment. Hospice Revenue Recognition Hospice Medicare Revenue Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily or hourly rates for each of the four levels of care we deliver. The four levels of care are routine care, general inpatient care, continu ous home care and respite care. Routine care accounts for 98 % of our total net Medic are hospice service revenue for each of the three - month period s ended March 31, 2017 , and 2016 . Beginning January 1, 2016, the Centers for Medicare and Medicaid Services (“ CMS ”) has provided for two separate payment rates for routine care: payments for the first 60 days of care and care beyond 60 days. In addition to the two routine rates, beginning January 1, 2016, Medicare is also reimbursing for a service intensity add-on (“SIA”). The SIA is based on visits made in the last seven days of life by a registered nurse (“RN”) or medical social worker (“MSW”) for patients in a routine level of care. We make adjustments to Medicare revenue for an inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record it during the period services are rendered as an estimated revenue adjustment and as a reduction to our outstanding patient accounts receivable. Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap for each provider number, we monitor these caps and estimate amounts due back to Medicare if we estimate a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in other accrued liabilities. Beginning for the cap year ending October 31, 2014, providers are required to self-report and pay their estimated cap liability by March 31 st of the following year. As of March 31, 201 7 , w e have settled our Medicare hospice reimbursements for all fiscal years through October 31, 20 12 . As of March 31, 201 7 , we have recorded $ 0.9 million f or estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2013 through October 31, 201 7 . As of December 31, 2016, we had recorded $0.8 million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2013 through October 31, 2016. Hospice Non-Medicare Revenue We record gross revenue on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per day rates, as applicable. Contractual adjustments are recorded for the difference between our established rates and the amounts estimated to be realizable from patients, third parties and others for services provided and are deducted from gross revenue to determine our net service revenue and patient accounts receiv able . Personal Care Revenue Recognition Personal Care Revenue We generate net service revenues by providing our services directly to patients primarily on a per hour, visit or unit basis. We receive payment for providing such services from our payor clients, including state and local governmental agencies, managed care organizations, commercial insurers and private consumers. Net service revenues are principally provided based on authorized hours, visits or units determined by the relevant agency, at a rate that is either contractual or fixed by legislation, which are recognized as net service revenue at the time services are rendered . Patient Accounts Receivable Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. As of March 31, 2017 , t here is only one single payor , other than Medicare, that accounts for more than 10 % of our total outstanding patient receivables ( approximately 1 3 . 2 %). T hus we believe there are no other significant concentrations of receivables that would subject us to any significant credit risk in the collection of our patient accounts receivable. We fully reserve for accounts which are aged at 36 5 days or greater. We write off accounts on a monthly basis once we have exhausted our collection efforts and deem an account to be uncollectible. We believe the credit risk associated with our Medicare accounts , which represent 58 % and 6 1 % of our net patient accounts receivable at March 31, 201 7 and December 31, 2016 , respectively, is limited due to our historical collection rate of over 99 % from Medicare and the fact that Medicare is a U.S. government payor . Accordingly, we do not record an allowance for doubtful accounts for our Medicare patient accounts receivable, which are recorded at their net realizable value after recording estimated revenue adjustments as discussed above . During the three - month periods ended March 31, 2017 and 2016 , we recorded $ 3 . 4 million and $ 1 .7 million, respectively , in estimated revenue adjustments to Medicare revenue. We believe there is a certain level of credit risk associated with non-Medicare payors . To provide for our non-Medicare patient accounts receivable that could become uncollectible in the future, we establish an allowance for doubtful accounts to reduce the carrying amount to its estimated net realizable value. Medicare Home Health For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for 60 % of our estimated payment for the initial episode at the start of care or 50 % of the estimated payment for any subsequent episodes of care contiguous with the first episode for a particular patient. The full amount of the episode is billed after the episode has been completed (“final billed”). The RAP received for that particular episode is then deducted from our final payment. If a final bill is not submitted within the greater of 120 days from the start of the episode, or 60 days from the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare from any other claims in process for that particular provider number. The RAP and final claim must then be resubmitted. Medicare Hospice For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services t hat we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. W e bill Medicare on a monthly basis for the services provided to the patient . Non-Medicare Home Health, Hospice and Personal Care For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient's eligibility for services with the applicable payor . Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor . Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk. We estimate an allowance for doubtful accounts based upon our assessment of historical and expected net collections, business and economic conditions, trends in payment and an evaluation of collectability based upon the date that the service was provided. Based upon our best judgment, we believe the allowance for doubtful accounts adequately provides for accounts that will not be collected due to credit risk . Fair Value of Financial Instruments The following details our financial instruments where the carrying value and the fair value differ (amounts in millions): Fair Value at Reporting Date Using Financial Instrument Carrying Value as of March 31, 2017 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Long-term obligations $ 94.8 $ 0 $ 96.4 $ 0 The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows: Level 1 – Quoted prices in active markets for identical assets and liabilities. Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities. Our deferred compensation plan assets are recorded at fair value and are considered a level 2 measurement. For our other financial instruments, including our cash and cash equivalents, patient accounts receivable, accounts payable , payroll and employee benefits and accrued expenses , we estimate the carrying amounts' approximate fair value . Weighted-Average Shares Outstanding Net income per share attributable to Amedisys , Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calc ulate our basic and diluted net income attributable to Amedisys , Inc. common stockholders (amounts in thousands): For the Three-Month Periods Ended March 31 2017 2016 Weighted average number of shares outstanding - basic 33,443 32,920 Effect of dilutive securities: Stock options 239 82 Non-vested stock and stock units 391 506 Weighted average number of shares outstanding - diluted 34,073 33,508 Anti-dilutive securities 332 319 Recently Issued Accounting Pronouncements In May 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2014-09, Revenue from Contracts with Customers (Topic 606) , which requires an entity to recognize the amount of revenue for which it expects to be entitled for the transfer of promised goods or services to customers. The ASU will replace most existing revenue recognition guidance in U.S. GAAP. In August 2015, the FASB issued ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date , to defer the effective date of the standard from January 1, 2017 to January 1, 2018, with an option that permits companies to adopt the standard as early as the original effective date. The new ASU reflects the decisions reached by the FASB at its meeting in July 2015. Early application prior to the original effective date is not permitted. The standard permits the use of either the retrospective or cumulative effect transition method. The Company does not expect an impact on its consolidated financial statements upon implementation of ASU 2014-09 and ASU 2015-14 on January 1, 2018, but is still evaluating the effect the standard will have on its related disclosures . In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842) , which will require lessees to recognize a lease liability and right-of-use asset for all leases (with the exception of short-term leases) at the commencement date. The ASU is effective for annual and interim periods beginning on or after December 15, 2018. Early adoption is permitted. The standard requires a modified retrospective transition method which requires application of the new guid ance for all periods presented. While the Company expects adoption of this standard to lead to a material increase in the assets and liabilities recorded on our balance sheet, we are still evaluating the overall impact on our consolidated financial statements and related disclosures and the effect of the standard on our ongoing financial reporting. In March 2016, the FASB issued ASU 2016-09, Compensation – Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting , which will simplify the accounting for share-based payment award transactions , including income tax consequences, classification of awards as either equity or liability and classification on the statement of cash flows. The ASU is effective for annual and interim periods beginning after December 15, 2016. We adopted this ASU effective Ja nuary 1, 2017, and as a result, we recorded a $ 0. 4 million increase to our non-current deferred tax asset and retained earnings for tax benefits that were not previously recognized under the prior rules. Additionally, on a prospective basis, we recorded excess tax benefits as a discrete item in our income tax provision within our condensed consolidated statement of operations for the three-mo nth period ended March 31, 2017. Historically these amounts were recorded as addition al paid-in capital in our condensed consolidated balance sheet . We also elected to prospectively apply the change to the presentation of cash payments made to taxing authorities on the employees' behalf for shares withheld upon stock vesting on our condensed consolidated statements of cash flows for the three-month period ended March 31, 2017. We have also elected to continue our current policy of estimating forfeitures of stock-based compensation awards at grant date and revising in subsequent periods to reflect actual forfeitures . In A ugust 2016, the FASB issued ASU 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments , which provides specific guidance on eight cash flow classification issues not specifically addressed by U.S. GAAP. The ASU is effective for annual and interim periods beginning after December 15, 2017. Early adoption is permitted. The standard should be applied using a retrospective transition method unless it is impractical to do so for some of the issues. In such case, the amendments for those issues would be applied prospectively as of the earliest date practicable. The Company is evaluating the effect that ASU 2016-15 will have on its consolidated financial statements and related disclosures and the effect of the standard on its ongoing financial reporting . In January 2017, the FASB issued ASU 2017-01, Business Combinations (Topic 805): Clarifying the Definition of a Business , which provides guidance to assist entities with evaluating whether transactions should be accounted for as acquisitions or disposals of assets or businesses. The ASU is effective for annual and interim periods beginning after December 15, 2017. The impact on our consolidated financial statements and related disclosures will depend on the facts and circumstances of any specific future transactions . In January 2017, the FASB issued ASU 2017-04, Intangibles - Goodwill and Other (Topic 350) - Simplifying the Test for Goodwill Impairment , which eliminates the requirement to calculate the implied fair value of goodwill to measure a goodwill impairment charge (Step 2 of the goodwill impairment test). Instead, impairment will be measured using the difference of the carrying amount to the fair value of the reporting unit. The ASU is effective for annual and interim periods beginning after December 15, 2019. Early adoption is permitted. The Company is evaluating the effect that ASU 2017-04 will have on its consolidated financial statements and related disclosures and the effect of the standard on its ongoing financial reporting . |
ACQUISITIONS
ACQUISITIONS | 3 Months Ended |
Mar. 31, 2017 | |
Business Combinations [Abstract] | |
ACQUISITIONS | 3 . ACQUISITIONS We complete acquisitions from time to time in order to pursue our strategy of increasing our market presence by expanding our service base and enhancing our position in certain geographic areas as a leading provider of home health , hospice and personal care services. The purchase price paid for acquisitions is negotiated through arm's length transactions, with consideration based on our analysis of, among other things, comparable acquisitions and expected cash flows. Acquisitions are accounted for as purchases and are included in our consolidated financial statements from their respective acquisition dates. Goodwill generated from acquisitions is recognized for the excess of the purchase price over tangible and identifiable intangible assets because of the expected contributions of the acquisitions to our overall corporate strategy . We typically engage outside appraisal firms to assist in the fair value determination of identifiable intangible assets. Preliminary purchase price allocation is adjusted, as necessary, up to one year after the acquisition closing date if management obtains more information regarding asset valuations and liabilities assumed. On February 1, 201 7 , we acquired the assets of Home Staff, L.L.C. which owns and operates three personal-care care centers servicing the state of Massachusetts for a total purchase price of $4.0 million (subject to certain adjustments), of which $0.4 million was placed in a promissory note to be paid over 24 months, subject to any offsets or withhold s for indemnification purposes. The purchase price was paid with cash on hand on the date of the transaction. During the three-month period ended March 31, 2017, we recorded goodwill ($3.8 million), other intangibles – non-compete agreements ($0.2 million) and other assets and liabilities, net ($0.5 million) in connection with the acquisition . The non-compete agreements will be amortized over a weighted-average period of 2.8 years . |
LONG-TERM OBLIGATIONS
LONG-TERM OBLIGATIONS | 3 Months Ended |
Mar. 31, 2017 | |
Debt Disclosure [Abstract] | |
LONG-TERM OBLIGATIONS | 4. LONG-TERM OBLIGATIONS Long-term debt consisted of the following for the periods indicated (amounts in millions): March 31, 2017 December 31, 2016 $100.0 million Term Loan; principal payments plus accrued interest payable quarterly; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (2.98% at March 31, 2017); due August 28, 2020 $ 93.7 $ 95.0 $200.0 million Revolving Credit Facility; interest only payments; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage; due August 28, 2020 0.0 0.0 Promissory notes 1.1 0.7 Deferred debt issuance costs (2.4) (2.7) 92.4 93.0 Current portion of long-term obligations (6.9) (5.2) Total $ 85.5 $ 87.8 Our weighted average interest rate for our $100.0 million Term Loan, under our Credit Agreement, was 2. 8 % and 2.4% for the three-month period s ended March 31, 201 7 and 2016, respectively . Our weighted average interest rate for our $200.0 millio n Revolving Credit Facility was 2.7 % for the three-month period ended March 31, 2016 . As of March 31, 201 7 , our consolidated leverage ratio was 0 . 9 , our consolidated fixed charge coverage ratio was 4 . 1 and we are in compliance with our Credit Agreement. In the event we are not in compliance with our debt covenants in the future, we would pursue various alternatives in an attempt to successfully resolve the non-compliance, which might include, among other things, seeking debt covenant waivers or amendments. As of March 31, 201 7 , our availability under our $2 00.0 million Revolving Credit Facility was $ 17 0. 4 million as we had $ 29 . 6 million outstanding letters of credit. |
COMMITMENTS AND CONTINGENCIES
COMMITMENTS AND CONTINGENCIES | 3 Months Ended |
Mar. 31, 2017 | |
Commitments and Contingencies Disclosure [Abstract] | |
COMMITMENTS AND CONTINGENCIES | 5 . COMMITMENTS AND CONTINGENCIES Legal Proceedings - Ongoing We are involved in the following legal actions: Securities Class Action Lawsuits As previously disclosed, between June 10 and July 28, 2010, several putative securities class action complaint s were filed in the United States District Court for the Middle District of Louisiana (the “District Court”) against the Company and certain of our former senior executives. The cases were consolidated into the first-filed action Bach, et al. v. Amedisys , Inc., et al. Case No. 3:10-cv-00395, and the District Court appointed as co-lead plaintiffs the Public Employees' Retirement System of Mississippi and the Puerto Rico Teachers' Retirement System (the “Co-Lead Plaintiffs”). They filed a consolidated, amended complaint which all defendants moved to dismiss. The District Court granted the defendants' motions to dismiss on June 28, 20 1 2, and the Co-Lead Plaintiffs appealed that ruling to the United States Court of Appeals for the Fifth Circuit (the “Fifth Circuit”). On October 2, 2014, a three-judge panel of the Fifth Circuit reversed the District Court's dismissal and remanded the case to the District Court for further proceedings. The defendants request for an en banc review was denied on December 29, 2014 and their Petition for a Writ of Certiorari from the United States Supreme Court was denied on June 29, 2015. After remand to the District Court, the Plaintiffs were granted leave to file a First Amended Consolidated Complaint (the “First Amended Securities Complaint”) on behalf of all purchasers or acquirers of Amedisys ' securities between August 2, 2005 and September 30, 2011. The First Amended Securities Complaint alleges that the Company and seven individual defendants violated Section 10(b), Section 20(a), and Rule 10b-5 of the Securities Exchange Act of 1934 by materially misrepresenting the Company's financial results and concealing a scheme to obtain higher Medicare reimbursements and additional patient referrals by (1) providing medically unnecessary care to patients, including certifying and re-certifying patients for medically unnecessary 60-day treatment episodes; (2) implementing clinical tracks such as “Balanced for Life” and wound care programs that provided a pre-set number of therapy visits irrespective of medical need; (3) “ upcoding ” patients' Medicare forms to attribute a “primary diagnosis” to a medical condition associated with higher billing rates; and (4) providing improper and illegal remuneration to physicians to obtain patient certifications or re-certifications. The First Amended Securities Complaint seeks certification of the case as a class action and an unspecified amount of damages, as well as interest and an award of attorneys' fees. All defendants moved to dismiss the First Amended Securities Complaint on December 15, 2015. While that motion was pending the parties agreed to mediate the case. This mediation was not successful. On August 19, 2016, the District Court issued its ruling on the defendants' motions to dismiss, dismissing with prejudice all claims against two former officers, dismissing all except Section 20(a) claims against three former officers, and denying all other relief. The Company and four individual defendants then filed their answers to the First Amended Securities Complaint on October 20, 2016. The independent executrix of the estate of William F. Borne, who was substituted as a defendant in the case after Mr. Borne's death, filed her answer on February 6, 2017. The case is currently in the early stages of discovery. The parties have agreed to mediate the case again on June 12, 2017. Because the case is in the early stages of litigation, w e are unable to assess the probable outcome or reasonably estimate the potential liability, if any, arising from the securities litigation described above. The Company intends to continue to vigorously defend itself in the securities litigation matter but, if decided adverse to the Company, its impact could be material. No assurances can be given as to the timing or outcome of the securities matter described above or the impact of any of the inquiry or litigation matters on the Company, its consolidated financial condition, results of operations or cash flows, which could be material, individually or in the aggregate. Subpoena Duces Tecum Issued by the U.S. Department of Justice On May 21, 2015, we received a Subpoena Duces Tecum (“Subpoena”) issued by the U.S. Department of Justice. The Subpoena requests the delivery of information regarding 53 identified hospice patients to the United States Attorney's Office for the District of Massachusetts. It also requests the delivery of documents relating to our hospice clinical and business operations and related compliance activities. The Subpoena generally covers the period from January 1, 2011, through May 21, 2015 . We are fully cooperating with the U.S. Department of Justice with respect to this investigation. Based on the information currently available to us, we cannot predict the timing or outcome of this investigation or reasonably estimate the amount or range of potential losses, if any, which may arise from this matter. Civil Investigative Demand Issued by the U.S. Department of Justice On November 3, 2015, we received a civil investigative demand (“CID”) issued by the U.S. Department of Justice pursuant to the federal False Claims Act relating to claims submitted to Medicare and/or Medicaid for hospice services provided through designated facilities in the Morgantown, West Virginia area. The CID requests the delivery of information to the United States Attorney's Office for the Northern District of West Virginia regarding 66 identified hospice patients, as well as documents relating to our hospice clinical and business operations in the Morgantown area. The CID generally covers the period from January 1, 2009 through August 31, 2015. We are fully cooperating with the U.S. Department of Justice with respect to this investigation. Based on the information currently available to us, we cannot predict the timing or outcome of this investigation or reasonably estimate the amount or range of potential losses, if any, which may arise from this matter . On June 27, 2016, we received a CID issued by the U.S. Department of Justice pursuant to the federal False Claims Act relating to claims submitted to Medicare and/or Medicaid for hospice services provided through designated facilities in the Parkersburg, West Virginia area. The CID requests the delivery of information to the United States Attorney's Office for the Southern District of West Virginia regarding 68 identified hospice patients, as well as documents relating to our hospice clinical and business operations in the Parkersburg area. The CID generally covers the period from January 1, 2011 through June 20, 2016. We are fully cooperating with the U.S. Department of Justice with respect to this investigation. Based on the information currently available to us, we cannot predict the timing or outcome of this investigation or reasonably estimate the amount or range of potential losses, if any, which may arise from this matter. In addition to the matters referenced in this note, we are involved in legal actions in the normal course of business, some of which seek monetary damages, including claims for punitive damages. We do not believe that these normal course actions, when finally concluded and determined, will have a material impact on our consolidated financial condition, results of operations or cash flows. Other Investigative Matters - Ongoing Corporate Integrity Agreement On April 23, 2014, with no admissions of liability on our part, we entered into a settlement agreement with the U.S. Department of Justice relating to certain of our clinical and business operations. Concurrently with our entry into this agreement, we entered into a corporate integrity agreement (“CIA”) with the Office of Inspector General-HHS (“OIG”). The CIA formalizes various aspects of our already existing ethics and compliance programs and contains other requirements designed to help ensure our ongoing compliance with federal health care program requirements. Among other things, the CIA requires us to maintain our existing compliance program, executive compliance committee and compliance committee of the Board of Directors; provide certain compliance training; continue screening new and current employees to ensure they are eligible to participate in federal health care programs; engage an independent review organization to perform certain auditing and reviews and prepare certain reports regarding our compliance with federal health care programs, our billing submissions to federal health care programs and our compliance and risk mitigation programs; and provide certain reports and management certifications to the OIG. Additionally, the CIA specifically requires that we report substantial overpayments that we discover we have received from federal health care programs, as well as probable violations of federal health care laws. Upon breach of the CIA, we could become liable for payment of certain stipulated penalties, or could be excluded from participation in federal health care programs. The corporate integrity agreement has a term of five years. Computer Inventory and Data Security Reporting On March 1 and March 2, 2015, we provided official notice under federal and state data privacy laws concerning the outcome of an extensive risk management process to locate and verify our large computer inventory. The process identified approximately 142 encrypted computers and laptops for which reports were required under federal and state data privacy laws. The devices at issue were originally assigned to Company clinicians and other team members who left the Company between 2011 and 2014. We reported these devices to the U.S. Department of Health and Human Services, state agencies, and individuals whose information may be involved, as required under applicable law because we could not rule out unauthorized access to patient data on the devices. The Office of Civil Rights, U.S. Department of Health and Human Services (“OCR”) is reviewing our compliance with applicable laws, as is typical for any data breach involving more than 500 individuals. We are cooperating with OCR in its review and if any other regulatory reviews are formally commenced, will cooperate with applicable regulatory authorities. In accordance with our CIA, we have notified the OIG of this matter. Idaho and Wyoming Self-Report During 2016, the Company engaged an independent auditing firm to perform a clinical audit of the hospice care centers acquired by Frontier Home Health and Hospice in April 2014. No assurances can be given as to the timing or outcome of the audit on the Company, its consolidated financial condition, results of operations or cash flows, which could be material, individually or in the aggregate. Third Party Audits - Ongoing From time to time, in the ordinary course of business, we are subject to audits under various governmental programs in whic h third party firms engaged by the Centers for Medicare and Medicaid Services (“CMS”) conduct extensive review of claims data to identify potential improper payments under the Medicare program. In July 2010, our subsidiary that provides hospice services in Florence, South Carolina received from a Zone Program Integrity Contractor (“ZPIC”) a request for records regarding a sample of 30 beneficiaries who received services from the subsidiary during the period of January 1, 2008 through March 31, 2010 (the “Review Period”) to determine whether the underlying services met pertinent Medicare payment requirements. We acquired the hospice operations subject to this review on August 1, 2009; the Review Period covers time periods both before and after our ownership of these hospice operations. Based on the ZPIC's findings for 16 beneficiaries, which were extrapolated to all claims for hospice services provided by the Florence subsidiary billed during the Review Period, on June 6, 2011, the Medicare Administrative Contractor (“ MAC ”) for the subsidiary issued a notice of overpayment seeking recovery from our subsidiary of an alleged overpayment. We dispute these findings, and our Florence subsidiary has filed appeals through the Original Medicare Standard Appeals Process, in which we are seeking to have those findings overturned. An ALJ hearing was held in early January 2015. On January 18, 2016 , we received a letter dated January 6, 2016 referencing the ALJ hearing decision for the overpayment issued on June 6, 2011. The decision was partially favorable with a new overpayment amount of $3.7 million with a balance owed of $5.6 million including interest based on 9 disputed claims (originally 16). We filed an appeal to the Medicare Appeals Council on the remaining 9 disputed claims and also argued that the statistical method used to select the sample was not valid. No assurances can be given as to the timing or outcome of the Me dicare Appeals Council decision. As of June 30, 2016, Medicare has withheld payments of $5.7 million (including additional interest) as part of their standard procedures once this level of the appeal process has been reached. In the event we are not able to recoup this alleged overpayment, we are indemnified by the prior owners of the hospice operations for amounts relating to the period prior to August 1, 2009. As of March 31, 2017 , we have an indemnity receivable for the amount withheld related to the period prior to August 1, 2009. In July 2016, the Company received a request for medical records from SafeGuard Services, L.L.C (“ SafeGuard ”), a ZPIC related to services provided by some of the care cente rs that the Company acquired fro m Infinity Home Care, L.L.C. The review period covers time periods both before and after our ownership of the care centers, which were acquired on December 31, 2015. Subsequent to the initial ZPIC letter, the Company received additional requests for information regarding its care centers in Florida including post payment claims reviews, communications regarding suspensions of payment, and letters notifying the Company that various care centers have been placed on prepayment review. As these matters continue to develop, the Company is cooperating with SafeGuard , responding to all requests for information, and working to resolve these matters. Based on the information currently available to the Company and the uncertainty regarding the scope of this audit , the Company cannot predict the timing or outcome of this audit or reasonably estimate the amount or range of potential losses, which may arise from this matter . Insurance We are obligated for certain costs associated with our insurance programs, including employee health, workers' compensation and professional liability. While we maintain various insurance programs to cover these risks, we are self-insured for a substantial portion of our potential claims. We recognize our obligations associated with these costs , up to specified deductible limits in the period in which a claim is incurred, including with respect to both reported claims and claims incurred but not reported . These costs have generally been estimated based on historical data of our claims experience. Such estimates, and the resulting reserves, are reviewed and updated by us on a quarterly basis. Our health insurance has a retention limit of $ 0.9 million, our workers' compensation insurance has a retention limit of $ 0.5 million and our professional liability insurance has a retention limit of $ 0.3 million. |
SEGMENT INFORMATION
SEGMENT INFORMATION | 3 Months Ended |
Mar. 31, 2017 | |
Segment Reporting [Abstract] | |
SEGMENT INFORMATION | 6 . Segment Information Our operations involve servicing patients through our three reportable business segments: home health , hospice and personal care . Our home health segment delivers a wide range of services in the homes of individuals who may be recovering from surgery, have a chronic disability or terminal illness or need assistance with completing important personal tasks . Our hospice segment provides palliative care and comfort to terminally ill patients and their families. Our personal ca re segment , which was established with the acquisition of Associated Home Care during the three-month period ended March 31, 2016, provides patients with assistance with the esse ntial activities of daily living . The “other” column in the following tables consist s of costs relating to executive management and administrative support functions, primarily information services, accounting, finance, billing and collections, legal, compliance, risk management, procurement, marketing, clinical administration, training, human resources and administration . M anagement evaluates performance and allocates resources based on the operating income of the reportable segments, which includes an allocation of corporate expenses directly attribu table to the specific segment and includes revenues and all other costs directly attributable to the specific segment . Segment assets are not reviewed by the company's chief operating decision maker and therefore are not disclosed below (amounts in millions). For the Three-Month Period Ended March 31, 2017 Home Health Hospice Personal Care Other Total Net service revenue $ 271.3 $ 85.6 $ 13.6 $ 0.0 $ 370.5 Cost of service, excluding depreciation and amortization 163.0 42.4 10.4 0.0 215.8 General and administrative expenses 68.0 18.0 3.3 29.5 118.8 Provision for doubtful accounts 3.7 2.5 0.1 0.0 6.3 Depreciation and amortization 0.9 0.3 0.0 3.2 4.4 Operating expenses 235.6 63.2 13.8 32.7 345.3 Operating income (loss) $ 35.7 $ 22.4 $ (0.2) $ (32.7) $ 25.2 For the Three-Month Period Ended March 31, 2016 Home Health Hospice Personal Care (1) Other Total Net service revenue $ 272.7 $ 73.0 $ 3.1 $ 0.0 $ 348.8 Cost of service, excluding depreciation and amortization 160.8 38.8 2.2 0.0 201.8 General and administrative expenses 71.2 16.9 0.4 39.0 127.5 Provision for doubtful accounts 3.2 0.7 0.0 0.0 3.9 Depreciation and amortization 1.3 0.3 0.0 2.9 4.5 Operating expenses 236.5 56.7 2.6 41.9 337.7 Operating income (loss) $ 36.2 $ 16.3 $ 0.5 $ (41.9) $ 11.1 (1) Acquired March 1, 2016. |
SUBSEQUENT EVENT
SUBSEQUENT EVENT | 3 Months Ended |
Mar. 31, 2017 | |
Subsequent Event [Abstract] | |
SUBSEQUENT EVENT | 7. SUBSEQUENT EVENT On May 1, 2017, we acquired certain home health and hospice operations from Tenet Healthcare in Arizona, Illinois, Massachusetts, and Texas for a purchase price of $ 2 0 . 5 million . |
NATURE OF OPERATIONS, CONSOLI13
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS (Policies) | 3 Months Ended |
Mar. 31, 2017 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Basis of Presentation | Basis of Presentation In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting solely of normal recurring adjustments) necessary to present fairly our financial position, our results of operations and our cash flows in accordance with U.S. Generally Accepted Accounting Principles (“U.S. GAAP”). Our results of operations for the interim periods presented are not necessarily indicative of results of our operations for the entire year and have not been audited by our independent auditors. Certain information and footnote disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted from the interim financial information presented. This report should be read in conjunction with our consolidated finan cial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 2016 , as filed with the Securities and Exchange Commission (“SEC”) on March 1, 201 7 (the “Form 10-K”), which includes information and disclosures not included herein. |
Use of Estimates | Use of Estimates Our accounting and reporting policies conform with U.S. GAAP. In preparing the unaudited condensed consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates. |
Reclassifications and Comparability | Reclassifications and Comparability Certain reclassifications have been made to prior periods' financial statements in order to conform to the current period' s presentation . |
Principles of Consolidation | Principles of Consolidation These unaudited condensed c onsolidated financial statements include the accounts of Amedisys, Inc. , and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying unaudited condensed consolidated financial statements, and business combinations accounted for as purchases have been included in our unaudited condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain equity investments that are accounted for as set forth below . |
Equity Investments | Equity Investments We consolidate investments when the entity is a variable interest entity and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50 %. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our condensed consolidated financial statements. We account for investments in entities in which we have the ability to exercise significant influence under the equity method if we hold 50 % or less of the voting stock and the entity is not a variable interest entity in which we are the primary beneficiary. The book value of investments that we accounted for under the equity method of accounting was $ 2 7 . 8 million as of March 31 , 201 7 and December 31, 201 6 . We account for investments in entities in which we have less than a 20 % ownership interest under the cost method of accounting if we do not have the ability to exercise significant influence over the investee . |
Revenue Recognition | 2 . Summary of Significant Accounting Policies Revenue Recognition We earn net service revenue through our home health , hospice and personal-care care center s by providing a variety of services almost exclusively in the homes of our patients. This net service revenue is earned and billed either on an episode of care basis, on a per visit basis or on a daily basis depending upon the payment terms and conditions established with each payor for services provided. We refer to home health revenue earned and billed on a 60 -day episode of care as episodic-based revenue. When we record our service revenue, we record it net of estimated revenue adjustments and contractual adjustments to reflect amounts we estimate to be realizable for services provided, as discussed below. We believe, based on information currently available to us and based on our judgment, that changes to one or more factors that impact the accounting estimates (such as our estimates related to revenue adjustments, contractual adjustments and episodes in progress) we make in determining net service revenue, which changes are likely to occur from period to period, will not materially impact our reported consolidated financial condition, results of operations, cash flows or our future financial results. Home Health Revenue Recognition Medicare Revenue Net service revenue is recorded under the Medicare prospective payment system (“PPS”) based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if our patient's care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits was fewer than five; (c) a partial payment if our patient transferred to another provider or we received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required (with various incremental adjustments made for additional visits, with larger payment increases associated with the sixth, fourteenth and twentieth visit thresholds); (e) adjustments to payments if we are unable to perform periodic therapy assessments; (f) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (g) changes in the base episode payments established by the Medicare Program; (h) adjustments to the base episode payments for case mix and geographic wages; and (i) recoveries of overpayments. In addition, we make adjustments to Medicare revenue if we find that we are unable to produce appropriate documentation of a face to face encounter between the patient and physician. We make adjustments to Medicare revenue to reflect differences between estimated and actual payment amounts, our discovered inability to obtain appropriate billing documentation or authorizations and other reasons unrelated to credit risk. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99 % on Medicare claims, and record this estimate during the period in which services are rendered as an estimated revenue adjustment and a corresponding reduction to patient accounts receivable. Therefore, we believe that our reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. In addition to revenue recognized on completed episodes, we also recognize a portion of revenue associated with episodes in progress. Episodes in progress are 60 -day episodes of care that begin during the reporting period, but were not completed as of the end of the period. We estimate this revenue on a monthly basis based upon historical trends. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and our estimate of the average percentage complete based on the number of days elapsed during an episode of care . As of March 31, 2017 and 2016 , the difference between the cash received from Medicare for a request for anticipated payment (“RAP”) on episodes in progress and the associated estimated revenue was immaterial and, therefore, the resulting credits were recorded as a reduction to our outstanding pa tient accounts receivable in our condensed consolidated balance sheets for such periods. Non-Medicare Revenue Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. Non-episodic b ased Revenue. Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates, as applicable. Contractual adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue and are also recorded as a reduction to our outstanding patient accounts receivable. In addition, we receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment. Hospice Revenue Recognition Hospice Medicare Revenue Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily or hourly rates for each of the four levels of care we deliver. The four levels of care are routine care, general inpatient care, continu ous home care and respite care. Routine care accounts for 98 % of our total net Medic are hospice service revenue for each of the three - month period s ended March 31, 2017 , and 2016 . Beginning January 1, 2016, the Centers for Medicare and Medicaid Services (“ CMS ”) has provided for two separate payment rates for routine care: payments for the first 60 days of care and care beyond 60 days. In addition to the two routine rates, beginning January 1, 2016, Medicare is also reimbursing for a service intensity add-on (“SIA”). The SIA is based on visits made in the last seven days of life by a registered nurse (“RN”) or medical social worker (“MSW”) for patients in a routine level of care. We make adjustments to Medicare revenue for an inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record it during the period services are rendered as an estimated revenue adjustment and as a reduction to our outstanding patient accounts receivable. Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap for each provider number, we monitor these caps and estimate amounts due back to Medicare if we estimate a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in other accrued liabilities. Beginning for the cap year ending October 31, 2014, providers are required to self-report and pay their estimated cap liability by March 31 st of the following year. As of March 31, 201 7 , w e have settled our Medicare hospice reimbursements for all fiscal years through October 31, 20 12 . As of March 31, 201 7 , we have recorded $ 0.9 million f or estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2013 through October 31, 201 7 . As of December 31, 2016, we had recorded $0.8 million for estimated amounts due back to Medicare in other accrued liabilities for the Federal cap years ended October 31, 2013 through October 31, 2016. Hospice Non-Medicare Revenue We record gross revenue on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per day rates, as applicable. Contractual adjustments are recorded for the difference between our established rates and the amounts estimated to be realizable from patients, third parties and others for services provided and are deducted from gross revenue to determine our net service revenue and patient accounts receiv able . Personal Care Revenue Recognition Personal Care Revenue We generate net service revenues by providing our services directly to patients primarily on a per hour, visit or unit basis. We receive payment for providing such services from our payor clients, including state and local governmental agencies, managed care organizations, commercial insurers and private consumers. Net service revenues are principally provided based on authorized hours, visits or units determined by the relevant agency, at a rate that is either contractual or fixed by legislation, which are recognized as net service revenue at the time services are rendered . |
Patient Accounts Receivable | Patient Accounts Receivable Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. As of March 31, 2017 , t here is only one single payor , other than Medicare, that accounts for more than 10 % of our total outstanding patient receivables ( approximately 1 3 . 2 %). T hus we believe there are no other significant concentrations of receivables that would subject us to any significant credit risk in the collection of our patient accounts receivable. We fully reserve for accounts which are aged at 36 5 days or greater. We write off accounts on a monthly basis once we have exhausted our collection efforts and deem an account to be uncollectible. We believe the credit risk associated with our Medicare accounts , which represent 58 % and 6 1 % of our net patient accounts receivable at March 31, 201 7 and December 31, 2016 , respectively, is limited due to our historical collection rate of over 99 % from Medicare and the fact that Medicare is a U.S. government payor . Accordingly, we do not record an allowance for doubtful accounts for our Medicare patient accounts receivable, which are recorded at their net realizable value after recording estimated revenue adjustments as discussed above . During the three - month periods ended March 31, 2017 and 2016 , we recorded $ 3 . 4 million and $ 1 .7 million, respectively , in estimated revenue adjustments to Medicare revenue. We believe there is a certain level of credit risk associated with non-Medicare payors . To provide for our non-Medicare patient accounts receivable that could become uncollectible in the future, we establish an allowance for doubtful accounts to reduce the carrying amount to its estimated net realizable value. Medicare Home Health For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for 60 % of our estimated payment for the initial episode at the start of care or 50 % of the estimated payment for any subsequent episodes of care contiguous with the first episode for a particular patient. The full amount of the episode is billed after the episode has been completed (“final billed”). The RAP received for that particular episode is then deducted from our final payment. If a final bill is not submitted within the greater of 120 days from the start of the episode, or 60 days from the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare from any other claims in process for that particular provider number. The RAP and final claim must then be resubmitted. Medicare Hospice For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services t hat we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. W e bill Medicare on a monthly basis for the services provided to the patient . Non-Medicare Home Health, Hospice and Personal Care For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient's eligibility for services with the applicable payor . Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor . Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk. We estimate an allowance for doubtful accounts based upon our assessment of historical and expected net collections, business and economic conditions, trends in payment and an evaluation of collectability based upon the date that the service was provided. Based upon our best judgment, we believe the allowance for doubtful accounts adequately provides for accounts that will not be collected due to credit risk . |
Fair Value of Financial Instruments | Fair Value of Financial Instruments The following details our financial instruments where the carrying value and the fair value differ (amounts in millions): Fair Value at Reporting Date Using Financial Instrument Carrying Value as of March 31, 2017 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Long-term obligations $ 94.8 $ 0 $ 96.4 $ 0 The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows: Level 1 – Quoted prices in active markets for identical assets and liabilities. Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities. Our deferred compensation plan assets are recorded at fair value and are considered a level 2 measurement. For our other financial instruments, including our cash and cash equivalents, patient accounts receivable, accounts payable , payroll and employee benefits and accrued expenses , we estimate the carrying amounts' approximate fair value . |
Weighted-Average Shares Outstanding | Weighted-Average Shares Outstanding Net income per share attributable to Amedisys , Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calc ulate our basic and diluted net income attributable to Amedisys , Inc. common stockholders (amounts in thousands): For the Three-Month Periods Ended March 31 2017 2016 Weighted average number of shares outstanding - basic 33,443 32,920 Effect of dilutive securities: Stock options 239 82 Non-vested stock and stock units 391 506 Weighted average number of shares outstanding - diluted 34,073 33,508 Anti-dilutive securities 332 319 |
Recently Issued Accounting Pronouncements | Recently Issued Accounting Pronouncements In May 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2014-09, Revenue from Contracts with Customers (Topic 606) , which requires an entity to recognize the amount of revenue for which it expects to be entitled for the transfer of promised goods or services to customers. The ASU will replace most existing revenue recognition guidance in U.S. GAAP. In August 2015, the FASB issued ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date , to defer the effective date of the standard from January 1, 2017 to January 1, 2018, with an option that permits companies to adopt the standard as early as the original effective date. The new ASU reflects the decisions reached by the FASB at its meeting in July 2015. Early application prior to the original effective date is not permitted. The standard permits the use of either the retrospective or cumulative effect transition method. The Company does not expect an impact on its consolidated financial statements upon implementation of ASU 2014-09 and ASU 2015-14 on January 1, 2018, but is still evaluating the effect the standard will have on its related disclosures . In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842) , which will require lessees to recognize a lease liability and right-of-use asset for all leases (with the exception of short-term leases) at the commencement date. The ASU is effective for annual and interim periods beginning on or after December 15, 2018. Early adoption is permitted. The standard requires a modified retrospective transition method which requires application of the new guid ance for all periods presented. While the Company expects adoption of this standard to lead to a material increase in the assets and liabilities recorded on our balance sheet, we are still evaluating the overall impact on our consolidated financial statements and related disclosures and the effect of the standard on our ongoing financial reporting. In March 2016, the FASB issued ASU 2016-09, Compensation – Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting , which will simplify the accounting for share-based payment award transactions , including income tax consequences, classification of awards as either equity or liability and classification on the statement of cash flows. The ASU is effective for annual and interim periods beginning after December 15, 2016. We adopted this ASU effective Ja nuary 1, 2017, and as a result, we recorded a $ 0. 4 million increase to our non-current deferred tax asset and retained earnings for tax benefits that were not previously recognized under the prior rules. Additionally, on a prospective basis, we recorded excess tax benefits as a discrete item in our income tax provision within our condensed consolidated statement of operations for the three-mo nth period ended March 31, 2017. Historically these amounts were recorded as addition al paid-in capital in our condensed consolidated balance sheet . We also elected to prospectively apply the change to the presentation of cash payments made to taxing authorities on the employees' behalf for shares withheld upon stock vesting on our condensed consolidated statements of cash flows for the three-month period ended March 31, 2017. We have also elected to continue our current policy of estimating forfeitures of stock-based compensation awards at grant date and revising in subsequent periods to reflect actual forfeitures . In A ugust 2016, the FASB issued ASU 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments , which provides specific guidance on eight cash flow classification issues not specifically addressed by U.S. GAAP. The ASU is effective for annual and interim periods beginning after December 15, 2017. Early adoption is permitted. The standard should be applied using a retrospective transition method unless it is impractical to do so for some of the issues. In such case, the amendments for those issues would be applied prospectively as of the earliest date practicable. The Company is evaluating the effect that ASU 2016-15 will have on its consolidated financial statements and related disclosures and the effect of the standard on its ongoing financial reporting . In January 2017, the FASB issued ASU 2017-01, Business Combinations (Topic 805): Clarifying the Definition of a Business , which provides guidance to assist entities with evaluating whether transactions should be accounted for as acquisitions or disposals of assets or businesses. The ASU is effective for annual and interim periods beginning after December 15, 2017. The impact on our consolidated financial statements and related disclosures will depend on the facts and circumstances of any specific future transactions . In January 2017, the FASB issued ASU 2017-04, Intangibles - Goodwill and Other (Topic 350) - Simplifying the Test for Goodwill Impairment , which eliminates the requirement to calculate the implied fair value of goodwill to measure a goodwill impairment charge (Step 2 of the goodwill impairment test). Instead, impairment will be measured using the difference of the carrying amount to the fair value of the reporting unit. The ASU is effective for annual and interim periods beginning after December 15, 2019. Early adoption is permitted. The Company is evaluating the effect that ASU 2017-04 will have on its consolidated financial statements and related disclosures and the effect of the standard on its ongoing financial reporting . |
SUMMARY OF SIGNIFICANT ACCOUN14
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables) | 3 Months Ended |
Mar. 31, 2017 | |
Accounting Policies [Abstract] | |
Financial Instruments Where Carrying Value and Fair Value Differ | Fair Value of Financial Instruments The following details our financial instruments where the carrying value and the fair value differ (amounts in millions): Fair Value at Reporting Date Using Financial Instrument Carrying Value as of March 31, 2017 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Long-term obligations $ 94.8 $ 0 $ 96.4 $ 0 |
Weighted-Average Shares Outstanding | For the Three-Month Periods Ended March 31 2017 2016 Weighted average number of shares outstanding - basic 33,443 32,920 Effect of dilutive securities: Stock options 239 82 Non-vested stock and stock units 391 506 Weighted average number of shares outstanding - diluted 34,073 33,508 Anti-dilutive securities 332 319 |
LONG-TERM OBLIGATIONS (Tables)
LONG-TERM OBLIGATIONS (Tables) | 3 Months Ended |
Mar. 31, 2017 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | 4. LONG-TERM OBLIGATIONS Long-term debt consisted of the following for the periods indicated (amounts in millions): March 31, 2017 December 31, 2016 $100.0 million Term Loan; principal payments plus accrued interest payable quarterly; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (2.98% at March 31, 2017); due August 28, 2020 $ 93.7 $ 95.0 $200.0 million Revolving Credit Facility; interest only payments; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage; due August 28, 2020 0.0 0.0 Promissory notes 1.1 0.7 Deferred debt issuance costs (2.4) (2.7) 92.4 93.0 Current portion of long-term obligations (6.9) (5.2) Total $ 85.5 $ 87.8 |
SEGMENT INFORMATION (Tables)
SEGMENT INFORMATION (Tables) | 3 Months Ended |
Mar. 31, 2017 | |
Segment Reporting [Abstract] | |
Operating Income of Reportable Segments | For the Three-Month Period Ended March 31, 2017 Home Health Hospice Personal Care Other Total Net service revenue $ 271.3 $ 85.6 $ 13.6 $ 0.0 $ 370.5 Cost of service, excluding depreciation and amortization 163.0 42.4 10.4 0.0 215.8 General and administrative expenses 68.0 18.0 3.3 29.5 118.8 Provision for doubtful accounts 3.7 2.5 0.1 0.0 6.3 Depreciation and amortization 0.9 0.3 0.0 3.2 4.4 Operating expenses 235.6 63.2 13.8 32.7 345.3 Operating income (loss) $ 35.7 $ 22.4 $ (0.2) $ (32.7) $ 25.2 For the Three-Month Period Ended March 31, 2016 Home Health Hospice Personal Care (1) Other Total Net service revenue $ 272.7 $ 73.0 $ 3.1 $ 0.0 $ 348.8 Cost of service, excluding depreciation and amortization 160.8 38.8 2.2 0.0 201.8 General and administrative expenses 71.2 16.9 0.4 39.0 127.5 Provision for doubtful accounts 3.2 0.7 0.0 0.0 3.9 Depreciation and amortization 1.3 0.3 0.0 2.9 4.5 Operating expenses 236.5 56.7 2.6 41.9 337.7 Operating income (loss) $ 36.2 $ 16.3 $ 0.5 $ (41.9) $ 11.1 (1) Acquired March 1, 2016. |
Nature of Operations Consolidat
Nature of Operations Consolidation and Presentation of Financial Statements - Additional Information (Detail) $ in Millions | 3 Months Ended | ||
Mar. 31, 2017USD ($)Agencies | Mar. 31, 2016 | Dec. 31, 2016USD ($) | |
Organization And Nature Of Operations [Line Items] | |||
Number Of States With Facilities | 34 | ||
Minimum percent ownership for controlling interest percent | 50.00% | ||
Equity Method Investment Aggregate Cost | $ | $ 27.8 | $ 27.8 | |
Maximum Percent Ownership For Equity Method Percent | 50.00% | ||
Maximum Percent Ownership For Cost Method Percent | 20.00% | ||
Medicare Revenue [Member] | |||
Organization And Nature Of Operations [Line Items] | |||
Percent Of Net Services Revenue Provided By Medicare | 75.00% | 79.00% | |
Home Health [Member] | |||
Organization And Nature Of Operations [Line Items] | |||
Operating Care Centers | 326 | ||
Hospice [Member] | |||
Organization And Nature Of Operations [Line Items] | |||
Operating Care Centers | 79 | ||
Personal Care [Member] | |||
Organization And Nature Of Operations [Line Items] | |||
Operating Care Centers | 16 |
Summary of Significant Accoun18
Summary of Significant Accounting Policies - Additional Information (Detail) $ in Thousands | 3 Months Ended | 12 Months Ended | |
Mar. 31, 2017USD ($)DNumber_of_Visits | Mar. 31, 2016USD ($) | Dec. 31, 2016USD ($) | |
Revenue Recognition Multiple Deliverable Arrangements [Line Items] | |||
Episode of care as episodic-based revenue, days | D | 60 | ||
Percentage of total reimbursement of outlier payment | 10.00% | ||
Low utilization payment adjustment, maximum number of visits | Number_of_Visits | 5 | ||
First threshold of therapy services required, visits | Number_of_Visits | 6 | ||
Second threshold of services required, visits | Number_of_Visits | 14 | ||
Third threshold of therapy services required, visits | Number_of_Visits | 20 | ||
Historical collection rate from Medicare | 99.00% | ||
Episodes in progress that begin during reporting period, days | D | 60 | ||
Hospice Medicare revenue rate accounted for routine care | 98.00% | 98.00% | |
Percentage of patient receivables outstanding | 10.00% | ||
Minimum days for accounts receivable outstanding to be fully reserved | D | 365 | ||
Portion of accounts receivable derived from Medicare | 58.00% | 61.00% | |
Revenue adjustment to Medicare revenue | $ | $ 3,400 | $ 1,700 | |
Rate of request for anticipated payment submitted for the initial episode of care | 60.00% | ||
Rate of request for anticipated payment submitted for subsequent episodes of care | 50.00% | ||
Maximum days to submit final bill from the start of episode | D | 120 | ||
Maximum days to submit final bill from the date the request for anticipated payment was paid | D | 60 | ||
Percentage Of Patient Receivables Outstanding Over Ten Percent | 13.20% | ||
Stockholders Equity Including Portion Attributable To Noncontrolling Interest | $ | $ 482,946 | $ 461,142 | |
Accounting Standards Update 2016-09 [Member] | Retained Earnings [Member] | |||
Revenue Recognition Multiple Deliverable Arrangements [Line Items] | |||
Stockholders Equity Including Portion Attributable To Noncontrolling Interest | $ | $ 400 | ||
Home Health [Member] | |||
Revenue Recognition Multiple Deliverable Arrangements [Line Items] | |||
Historical collection rate from Medicare | 99.00% | ||
Hospice [Member] | |||
Revenue Recognition Multiple Deliverable Arrangements [Line Items] | |||
Historical collection rate from Medicare | 99.00% | ||
Cap Year Two Thousand Thirteen Through Two Thousand Sixteen [Member] | |||
Revenue Recognition Multiple Deliverable Arrangements [Line Items] | |||
Estimated amounts due back to Medicare | $ | $ 800 | ||
Cap Year Two Thousand Thirteen Through Two Thousand Seventeen [Member] | |||
Revenue Recognition Multiple Deliverable Arrangements [Line Items] | |||
Estimated amounts due back to Medicare | $ | $ 900 |
Schedule of Financial Instrumen
Schedule of Financial Instruments Where Carrying Value and Fair Value Differ (Detail) $ in Millions | Mar. 31, 2017USD ($) |
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items] | |
Long-term obligations, excluding capital leases | $ 94.8 |
Fair Value, Inputs, Level 1 [Member] | |
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items] | |
Long-term obligations, excluding capital leases | 0 |
Fair Value Inputs Level 2 [Member] | |
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items] | |
Long-term obligations, excluding capital leases | 96.4 |
Fair Value, Inputs, Level 3 [Member] | |
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items] | |
Long-term obligations, excluding capital leases | $ 0 |
Schedule of Weighted Average Sh
Schedule of Weighted Average Shares Outstanding (Detail) - shares shares in Thousands | 3 Months Ended | |
Mar. 31, 2017 | Mar. 31, 2016 | |
Accounting Policies [Abstract] | ||
Weighted average number of shares outstanding - basic | 33,443 | 32,920 |
Stock options | 239 | 82 |
Non-vested stock and stock units | 391 | 506 |
Weighted average number of shares outstanding - diluted | 34,073 | 33,508 |
Anti-dilutive securities | 332 | 319 |
Acquisitions (Detail)
Acquisitions (Detail) $ in Millions | 1 Months Ended | 3 Months Ended | |
Feb. 01, 2017USD ($)Agencies | Mar. 31, 2017USD ($) | Dec. 31, 2016USD ($) | |
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items] | |||
Long Term Debt | $ 92.4 | $ 93 | |
Promissory Notes [Member] | |||
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items] | |||
Long Term Debt | 1.1 | $ 0.7 | |
Massachusetts [Member] | Home Staff, L.L.C. [Member] | Personal Care [Member] | |||
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items] | |||
Acquisition, total purchase price | $ 4 | ||
Acquisition, number of care centers acquired | Agencies | 3 | ||
Acquisition, recorded other assets and liabilities | 0.5 | ||
Additions | 3.8 | ||
Massachusetts [Member] | Home Staff, L.L.C. [Member] | Personal Care [Member] | Promissory Notes [Member] | |||
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items] | |||
Long Term Debt | $ 0.4 | ||
Massachusetts [Member] | Home Staff, L.L.C. [Member] | Personal Care [Member] | Noncompete Agreements [Member] | |||
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items] | |||
Acquisition, other intangibles recorded | $ 0.2 | ||
Weighted-average amortization period | 2 years 9 months 18 days |
Long Term Debt (Detail)
Long Term Debt (Detail) - USD ($) $ in Thousands | Mar. 31, 2017 | Dec. 31, 2016 |
Debt Instrument [Line Items] | ||
Deferred debt issuance costs | $ (2,400) | $ (2,700) |
Long-term debt including current portion | 92,400 | 93,000 |
Current portion of long-term obligations | (6,888) | (5,220) |
Total | 85,500 | 87,800 |
Promissory Notes [Member] | ||
Debt Instrument [Line Items] | ||
Long-term debt including current portion | 1,100 | 700 |
One Hundred Million Term Loan [Member] | ||
Debt Instrument [Line Items] | ||
Long-term debt including current portion | 93,700 | 95,000 |
Two Hundred Million Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term debt including current portion | $ 0 | $ 0 |
Long Term Debt - Additional Inf
Long Term Debt - Additional Information (Detail) $ in Millions | 3 Months Ended | ||
Mar. 31, 2017USD ($) | Mar. 31, 2016 | Dec. 31, 2016USD ($) | |
Debt Instrument [Line Items] | |||
Total leverage ratio | 0.9 | ||
Fixed charge coverage ratio | 4.1 | ||
Long-term debt including current portion | $ 92.4 | $ 93 | |
Deferred debt issuance costs | (2.4) | (2.7) | |
Promissory Notes [Member] | |||
Debt Instrument [Line Items] | |||
Long-term debt including current portion | $ 1.1 | 0.7 | |
One Hundred Million Term Loan [Member] | |||
Debt Instrument [Line Items] | |||
Weighted-average interest rate for five year Term Loan | 2.80% | 2.40% | |
Principal amount | $ 100 | ||
Maturity date | Aug. 28, 2020 | ||
Long-term debt including current portion | $ 93.7 | 95 | |
Two Hundred Million Revolving Credit Facility [Member] | |||
Debt Instrument [Line Items] | |||
Weighted-average interest rate for five year Term Loan | 2.70% | ||
Principal amount | 200 | ||
Availability under the revolving credit facility | 170.4 | ||
Outstanding letters of credit | $ 29.6 | ||
Maturity date | Aug. 28, 2020 | ||
Long-term debt including current portion | $ 0 | $ 0 |
Long Term Debt (Parenthetical)
Long Term Debt (Parenthetical) (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2017USD ($) | |
One Hundred Million Term Loan [Member] | |
Debt Instrument [Line Items] | |
Principal amount | $ 100 |
Eurodollar Rate plus the applicable percentage | 2.98% |
Maturity date | Aug. 28, 2020 |
Two Hundred Million Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Principal amount | $ 200 |
Maturity date | Aug. 28, 2020 |
Commitments and Contingencies (
Commitments and Contingencies (Detail) $ in Millions | Mar. 02, 2015ComputersResidents | Jan. 18, 2016USD ($)Claims | Mar. 31, 2017USD ($)AgenciesD | May 21, 2015 | Jun. 06, 2011Beneficiary | Jun. 27, 2016 | Aug. 19, 2016 | Nov. 03, 2015 | Mar. 31, 2010Beneficiary | Sep. 30, 2011D | Jun. 30, 2016USD ($) |
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Health insurance retention limit | $ 0.9 | ||||||||||
Workers' compensation insurance retention limit | 0.5 | ||||||||||
Professional liability insurance retention limit | $ 0.3 | ||||||||||
Corporate Integrity Agreement Term | 5 years | ||||||||||
Number Of States With Facilities | Agencies | 34 | ||||||||||
Episode Of Care As Episodic Based Revenue | D | 60 | ||||||||||
Computer Inventory And Data Security Reporting [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Number of Missing Computers and Laptops | Computers | 142 | ||||||||||
Threshold of Individuals in Data Breach | Residents | 500 | ||||||||||
Computer Inventory And Data Security Reporting [Member] | Minimum [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Year of Departure | 2,011 | ||||||||||
Computer Inventory And Data Security Reporting [Member] | Maximum [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Year of Departure | 2,014 | ||||||||||
Securities Class Action Lawsuit [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Loss Contingency Number Of Defendants | 7 | ||||||||||
Episode Of Care As Episodic Based Revenue | D | 60 | ||||||||||
Securities Class Action Lawsuit [Member] | Favorable [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Loss Contingency Number Of Defendants | 2 | ||||||||||
Securities Class Action Lawsuit [Member] | Unfavorable [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Loss Contingency Number Of Defendants | 4 | ||||||||||
Securities Class Action Lawsuit [Member] | Favorable In Part [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Loss Contingency Number Of Defendants | 3 | ||||||||||
Home Health [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Operating Care Centers | Agencies | 326 | ||||||||||
Hospice [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Operating Care Centers | Agencies | 79 | ||||||||||
Hospice [Member] | South Carolina [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Number of beneficiaries | Beneficiary | 30 | ||||||||||
Hospice [Member] | Extrapolated [Member] | South Carolina [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Number of beneficiaries | Beneficiary | 16 | ||||||||||
Hospice [Member] | Unfavorable [Member] | South Carolina [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Number of claims submitted by subsidiary | Claims | 9 | ||||||||||
Recovery amount of the overpayment made to the subsidiary | $ 3.7 | ||||||||||
Recovery Amount Of Over Payment Made To Subsidiary Including Interest | $ 5.6 | ||||||||||
Recovery amount of over payment made to subsidiary including interest withheld | $ 5.7 | ||||||||||
Hospice [Member] | U.S. Department of Justice [Member] | Massachusetts [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Number of patients | 53 | ||||||||||
Hospice [Member] | U.S. Department of Justice [Member] | Morgantown, West Virginia [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Number of patients | 66 | ||||||||||
Hospice [Member] | U.S. Department of Justice [Member] | Parkersburg, West Virginia [Member] | |||||||||||
Commitments And Contingencies Disclosure [Line Items] | |||||||||||
Number of patients | 68 |
Segment Information - Additiona
Segment Information - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2017Segments | |
Segment Reporting [Abstract] | |
Number of reportable business segments | 3 |
Operating Income of Reportable
Operating Income of Reportable Segments (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2017 | Mar. 31, 2016 | |
Segment Reporting Information [Line Items] | ||
Net service revenue | $ 370,458 | $ 348,817 |
Cost of service, excluding depreciation and amortization | 215,785 | 201,837 |
General and administrative expenses | 118,800 | 127,500 |
Provision for doubtful accounts | 6,341 | 3,940 |
Depreciation and amortization | 4,417 | 4,473 |
Operating expenses | 345,293 | 337,754 |
Operating income | 25,165 | 11,063 |
Home Health [Member] | ||
Segment Reporting Information [Line Items] | ||
Net service revenue | 271,300 | 272,700 |
Cost of service, excluding depreciation and amortization | 163,000 | 160,800 |
General and administrative expenses | 68,000 | 71,200 |
Provision for doubtful accounts | 3,700 | 3,200 |
Depreciation and amortization | 900 | 1,300 |
Operating expenses | 235,600 | 236,500 |
Operating income | 35,700 | 36,200 |
Hospice [Member] | ||
Segment Reporting Information [Line Items] | ||
Net service revenue | 85,600 | 73,000 |
Cost of service, excluding depreciation and amortization | 42,400 | 38,800 |
General and administrative expenses | 18,000 | 16,900 |
Provision for doubtful accounts | 2,500 | 700 |
Depreciation and amortization | 300 | 300 |
Operating expenses | 63,200 | 56,700 |
Operating income | 22,400 | 16,300 |
Personal Care [Member] | ||
Segment Reporting Information [Line Items] | ||
Net service revenue | 13,600 | 3,100 |
Cost of service, excluding depreciation and amortization | 10,400 | 2,200 |
General and administrative expenses | 3,300 | 400 |
Provision for doubtful accounts | 100 | 0 |
Depreciation and amortization | 0 | 0 |
Operating expenses | 13,800 | 2,600 |
Operating income | (200) | 500 |
All Other Segments [Member] | ||
Segment Reporting Information [Line Items] | ||
Net service revenue | 0 | 0 |
Cost of service, excluding depreciation and amortization | 0 | 0 |
General and administrative expenses | 29,500 | 39,000 |
Provision for doubtful accounts | 0 | 0 |
Depreciation and amortization | 3,200 | 2,900 |
Operating expenses | 32,700 | 41,900 |
Operating income | $ (32,700) | $ (41,900) |
Subsequent Event (Detail)
Subsequent Event (Detail) $ in Millions | 4 Months Ended |
May 01, 2017USD ($) | |
Tenet Healthcare [Member] | |
Subsequent Event [Line Items] | |
Acquisition, total purchase price | $ 20.5 |