Seeking Alpha: LHC Group Looking For M&A And Hospice Growth To Offset Reimbursement

Six months after I last wrote on LHC Group (LHCG), not all that much has changed in the home health provider world. While the industry got a partial reprieve in a one-year delay in Sustainable Growth Rate (or SGR) cuts, rebasing is still going to lead to significant revenue and margin pressure for many players. LHC Group is likely to fare relatively better due to its focus on rural locations and states that require Certificates of Need (or CONs), as well as its growing hospice business and desire to act as a consolidator in the space. LHC Group shares do still look undervalued on a long-term cash flow basis, but this remains a tough, tough industry right now.

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LHC Group Looking For M&A And Hospice Growth To Offset Reimbursement

Seeking Alpha: Weak Performance Continues To Plague Amedisys

If you can't beat 'em, give up. After several quarters where Amedisys (AMED) has missed analyst expectations, interim management has chosen to stop providing guidance for the timing being. Seeing as how the company needs to hire a new CEO (who likely will come in with a set of ideas about how to run/change the business) and is still in the midst of efforts to reduce costs and respond to reimbursement cuts, that's a reasonable move. Still, in the absence of information investors may choose to assume the worst.

It is difficult to feel all that cheerful or optimistic about this business. Costs per visit have been rising steadily, while revenue is pressured by reimbursement cuts and sluggish admissions. Amedisys is one of the largest operators in a fragmented industry likely to consolidate in response to ongoing reimbursement pressures, but a settlement with the government will stress the balance sheet and margins are very weak at present. The stock has been surprisingly strong for all of the company's travails, but I'd be hesitant to pay almost double the valuation (on a forward EV/EBITDA basis) for Amedisys over its peers even if this is a low period for the industry.

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Weak Performance Continues To Plague Amedisys

Seeking Alpha: LHC Group Appears Undervalued, But Times Are Getting Tougher

Having recently written about the significant headwinds pushing against Amedisys (AMED), I now turn to its smaller but more profitable rival LHC Group (LHCG). Like Amedisys, LHC Group is looking at an operating environment dominated by further cuts in Medicare reimbursement. Unlike Amedisys, though, I believe LHC Group may be able to leverage its strong network of hospital joint ventures and benefit from its exposure to rural locations and growing hospice revenue to offset this pressure.

Make no mistake, the next few years will not be easy ones for LHC Group. Although I believe that LHCG is likely to do better than most in terms of admissions and margins, the next couple of years could be quite challenging. I do also believe, though, that LHC Group is in a good position to take advantage of increasing stresses upon this industry and grow faster than many of its peers. These shares do appear to be undervalued today, but investors buying into the story need to appreciate that, outside of a takeover or go-private transaction, this one could take some time to work.

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LHC Group Appears Undervalued, But Times Are Getting Tougher

Seeking Alpha: Amedisys Still Facing Significant Headwinds

It has been about a year and a half since I last wrote on Amedisys (AMED). In that time, a lot of the bad news I feared (namely ongoing Medicare pressure) materialized, and the company has struggled to offset weak reimbursement and volume with cost cuts. While my bullish call on the stock has technically worked out (the shares are up about 55% since February 7, 2012), the stock really didn't go anywhere before August of this year and I'm not really calling this a successful pick.

Looking ahead, I see Amedisys broadly the same as I did before, only with a higher valuation. I believe the Street still underestimates the long term potential of this business, but that "potential" has to be set against some very real challenges from reimbursement and in executing additional cost cuts. I'm reasonably confident that Amedisys can improve its margins from here, and I think the KKR investment supports that basic idea, but it's hard to really pound the table for a company that has to always stay a step ahead of government price cuts.

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Amedisys Still Facing Significant Headwinds

Investopedia: Lincare Shows That You Can Go Home Again

If I had to guess the sort of healthcare company that would get a premium acquisition offer, Lincare (Nasdaq:LNCR) would be low on my list, as relatively few buyers would want to pay a premium to get into a business that is beset by constant reimbursement pressures. But, as the old saying goes, you only need one buyer to make a deal and Lincare found that one.

In a deal that reverses a spin-out from nearly 25 years ago, German industrial gases company Linde will be acquiring Lincare for $4.6 billion in total considerations. That works out to $41.50 per share for Lincare's shareholders; a 22% premium to Friday's closing price (which had been moving up on takeover rumors) and a whopping 67% premium to the stock's three-month average price.

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Seeking Alpha: Lincare's Short-Term Pain Can Become Long-Term Gain?

Some investors love to parrot the thesis that the aging of America will be a boon to health care companies of all stripes. What these investors aren't always able to explain, though, is who is going to pay for all of that growth. That's a key issue with home oxygen therapy provider Lincare (LNCR). While efforts to diversify the business are pressuring margins and cash flow in the near-term, long-term investors should support these as moves towards better long-term sustainability.

First Quarter Results Not Bad On Balance
Revenue growth of 16% looks pretty flashy, but organic growth was a more modest 6%. Lincare saw a 1% negative impact from Medicare rate changes, with about 11% growth coming from various acquisitions. Interestingly, patient growth was the slowest it has been in some time (up about 2%), while revenue per patient rose by double-digits.

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Lincare's Short-Term Pain Can Become Long-Term Gain

Seeking Alpha: LHC Group - Beaten Up, But Addressing A Huge Growth Market

The graying of America has been a theme in healthcare for at least the last 15 years, and I've seen analysts and investors apply it to med-tech companies like Johnson & Johnson (JNJ), insurance companies like UnitedHealth (UNH), and a host of other facility operators and service providers. It may be a trite theme at this point, but there is still an element of truth to it and patient investors may be able to ride LHC Group (LHCG) to its fruition.

A Growth Play In A Bad Neighborhood
It would be an understatement to say that home healthcare providers like LHC Group, Amedisys (AMED), Gentiva (GTIV), and Almost Family (AFAM) have been beaten up since 2010. Not only has the industry had to absorb cuts in reimbursement, but the entire industry has been under a regulatory cloud caused by accusations that these companies have fraudulently and illegally billed for unnecessary treatments.

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LHC Group - Beaten Up, But Addressing A Huge Growth Market

Seeking Alpha: A Battered Healthcare Play With Favorable Long-Term Demographics

There is no point in sugar-coating it - 2011 was a disastrous year for home health providers following a terrible 2010. The entire industry is under pressure as Congress cuts Medicare reimbursement and looks to implement new rules and regulations to address and punish prior wrong-doing, while the overall economy applies its own pressures. Although Amedisys (AMED) has been hit hard, patient investors willing to take on the risk may see a multi-year turnaround story unfold here.

What Amedisys Does
Amedisys is the largest publicly-traded provider of home health care and hospice services. Active in 45 states (but focused on the East/Southeast), Amedisys operates over 500 facilities offering skilled nursing, home health aides, physical/occupational therapy, and specialty nursing services.

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A Battered Healthcare Play With Favorable Long-Term Demographics

Seeking Alpha: Can The Government Afford To Let Skilled Healthcare Prosper?

In some respects it may seem like a good thing to have the government as a major customer for your healthcare services. After all, hospitals like HCA (NYSE: HCA) and Health Management Associates (NYSE: HMA) have to wrangle with the fact that they must treat all comers irrespective of ability to pay and bad debt expense is a major issue here. Unfortunately, Medicare and Medicaid are looming as major problem areas in the U.S. federal budget and reimbursement cutbacks threaten to limit Skilled Healthcare's (NYSE: SKH) ability to grow and prosper.

A Deceptively Good Third Quarter
Skilled Healthcare's third quarter results hint at what the company can do. Revenue was up a little less than 4% on flat occupancy. The company's core business, long term care, was down very slightly this quarter, while therapy services and hospice revenue were both up better than 20%. While Skilled Healthcare has stood out a bit from rivals like Kindred (NYSE: KND) and Sun Healthcare (Nasdaq: SUNH) on the basis of a higher mix of skilled services, the skilled mix was a little disappointing this quarter at less than 23%.


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Seeking Alpha: Lincare - Unreasonably Cheap For A Good Reason

On first blush, Lincare LNCR) would look like one of those great undervalued GARP companies that famous investors like Peter Lynch gush about in their memoirs. The thing is, while Lincare may well have a lot of value in it, that value is a little like a bag of gold resting atop a pedestal … in a minefield … surrounded by razorwire … and on fire. Lincare management has indeed done a great job over the years of running this business, but it seems like government price cuts are going to be an unrelenting drag on the company.

A Pretty Mixed Third Quarter
Lincare's third quarter highlights some of the challenges that the company has to deal with now and in the near future. Reported revenue growth of over 13% sounds great, as does the little note that growth would have been nearly 16% without the impact of negative Medicare changes. Unfortunately, the organic growth was more on the order of 6% and that growth was not especially profitable.

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Lincare: Unreasonably Cheap For A Good Reason

Investigators Send Home Health Care To The Hospital

If you take care of sick people, and particularly sick people whose treatment is paid for by the government, it is almost a given that you are going to be the subject of an investigation sooner or later. Whether it is nursing homes, dialysis centers, orthopedic device makers or blood-derived drug companies, they have all had their time under the magnifying glass. 

Home Health Care
Now it is home health care's turn. Amedisys (Nasdaq:AMED), Almost Family (Nasdaq:AFAM), Gentiva (Nasdaq:GTIV) and LHC Group (Nasdaq:LHCG) have all announced that they are party to investigations underway by the SEC and the Senate Finance Committee.

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