14.09.2009 11:30:00

Tenet Raises Outlook for 2009

Tenet Healthcare Corporation (NYSE: THC) today announced revisions to its outlook for 2009 Adjusted EBITDA to a new range of $900 million to $950 million. The prior outlook range was $810 million to $875 million. This new range corresponds to an outlook for net income attributable to shareholders in a range of $76 million to $141 million. Adjusted EBITDA is a non-GAAP term defined and reconciled to GAAP net income below.

"Our third quarter results through August were stronger than anticipated and extended the improving trend evident in our second quarter,” said Trevor Fetter, president and chief executive officer. "Since the summer months typically represent a seasonal slowdown in our business, this strength warrants raising our outlook for the balance of the year. In the last few months we have seen trends in payer and patient mix, bad debt expense, and volume growth that are favorable relative to our prior expectations. Our pricing trends remain positive and consistent with prior expectations.”

Adjusted EBITDA in the third and fourth quarters of 2009 is expected to be approximately equal. The Company’s revised 2009 outlook continues to make allowances for potential deterioration in bad debt expense and adverse trends in business mix in the remaining months of 2009. Additional details on revised 2009 outlook assumptions are provided in Table #1 below.

The Company also provided interim admissions statistics for the period July 1 to September 8, a time period which represents the first complete 10 weeks, or 70 days, of the third quarter. Comparing volumes in 2009 to the same 70-day period of 2008: admissions grew by 0.2 percent, paying admissions were flat, and commercial managed care admissions declined by 4.1 percent. Charity and uninsured admissions grew by 3.5 percent.

For the period July 1 to August 31, total same-hospital outpatient visits grew by 3.8 percent, paying outpatient visits grew by 4.4 percent, and commercial managed care outpatient visits increased by 0.8 percent. Charity and uninsured outpatient visits declined by 1.0 percent. The July 1 to August 31 time period included 44 weekdays and 18 weekend days in both 2008 and 2009. The reporting period for outpatient visits differs from the time period for inpatient data due to the complexity of assembling interim outpatient volume data related to our various non-hospital outpatient businesses.

The Company expects Adjusted Free Cash Flow from Continuing Operations to be in the range of negative $45 million to positive $40 million and Adjusted Net Cash Provided by Operating Activities from Continuing Operations of $380 million to $440 million for the full year 2009. The Company’s year end cash balance is expected to be in the range of $500 million to $635 million. Adjusted Free Cash Flow from Continuing Operations and Adjusted Net Cash Provided by Operating Activities from Continuing Operations are non-GAAP terms defined and reconciled to GAAP net cash provided by operating activities in Table # 7 below.

Tenet Healthcare Corporation, through its subsidiaries, owns and operates acute care hospitals and related ancillary health care businesses, which include ambulatory surgery centers and diagnostic imaging centers. Tenet’s hospitals and related health care facilities are committed to providing high quality care to patients in the communities we serve. For more information, please visit www.tenethealth.com.

Some of the statements in this release may constitute forward-looking statements. Such statements are based on our current expectations and could be affected by numerous factors and are subject to various risks and uncertainties discussed in our filings with the Securities and Exchange Commission, including our annual report on Form 10-K for the year ended Dec. 31, 2008, our quarterly reports on Form 10-Q and periodic reports on Form 8-K. Do not rely on any forward-looking statement, as we cannot predict or control many of the factors that ultimately may affect our ability to achieve the results estimated. We make no promise to update any forward-looking statement, whether as a result of changes in underlying factors, new information, future events or otherwise.

TABLES and EXHIBITS

Table #1     Revised   Prior
2009 Outlook Assumptions Assumptions Assumptions
            (8/4/09)

Admissions - growth (a)

 

(%)

  (0.5) - 0.5   (1.0) - 0.0

Outpatient visits - growth (a)

 

(%)

  2.5 - 4.0   1.5 - 3.0

Net operating revenues - growth

 

(%)

  4.5 - 6.0   3.0 - 5.0

Net operating revenues

 

($Bil)

  9.0 – 9.1   8.9 - 9.1

Controllable operating expenses

 

($Bil)

  7.35 - 7.45   7.3 - 7.4

Bad debt ratio

 

(%)

  7.8 - 8.3   7.8 - 8.5

Bad debt expense

 

($mm)

  n/c   700 - 750

Adjusted EBITDA (b)

 

($mm)

  900 - 950   810 - 875

Depreciation and amortization

 

($mm)

  n/c   400 - 420

Interest expense, net

 

($mm)

  n/c   460 - 445

Income (loss) from continuing operations before income taxes (b)

 

($mm)

  40 - 85   (50) - 10

Net income (loss) from cont. ops. (normalized at 37.1% tax rate) (b)

 

($mm)

  25 - 53   (31) - 6

Net income attributable to non-controlling interests

 

($mm)

  n/c   (8) - (13)

Net income (loss) attributable to shareholders (b)

 

($mm)

  17 - 40   (39) - (7)

E.P.S. (normalized at 37.1% tax rate, continuing operations) (b)

 

($)

  0.04 - 0.08   (0.08) - (0.01)
 
        (a)   Growth versus 2008 (same-hospital)
(b) Excludes impairment of long-lived assets and goodwill, and restructuring charges, litigation and investigation costs, loss from early extinguishment of debt, and net gain on sales of investments.
"n/c” indicates "no change”
 
Table #2 –  

 

  Bad  

 

 

 

 

 

  Prior
Adjusted EBITDA Walk-Forward

Revenue

Debt

Controllable

Adjusted

Change

Outlook
        Exp  

Costs

 

EBITDA

      (8/4/09)

2008 (a)

  8,585   (628)   (7,218)   739   -   739

Volume

 

 

assuming constant mix (b)

  65   (5)   (35)   25   16   9
   

-

 

impact from adverse mix shift

  (37)   (2)   -   (39)   34   (73)

Pricing

 

 

Base line increase (c)

  292   (28)   -   264   -   264
   

-

 

Managed care (d)

  49   -   -   49   -   49

Costs

 

 

base line inflation (e)

  -   -   (253)   (253)   -   (253)
   

-

 

cost reduction initiatives (f)

  -   -   188   188   -   188

Bad Debt

 

 

impact of rate differential only (g)

  -   (50)   -   (50)   25   (75)
Other (h)   57   (7)   (23)   27   -   27

Total

 

 

Upper end of Adjusted EBITDA

  9,011   (720)   (7,341)   950   75   875
Allowance for risk (i)               (50)   15   (65)

Total

 

 

Lower end of Adjusted EBITDA

              900   90   810
   
      (a)   2008 restated for NorthShore Regional Medical Center reclassification to discontinued operations.
(b) Assumes admissions growth of positive 0.2% and outpatient visit growth of positive 3.7%, using 2008 average pricing. Margin assumption on incremental revenues is 40%.
(c) Base line pricing increases of approximately 3.5%. This assumption is before discrete initiatives valued in this analysis.
(d) Rate parity price increases in existing contracts and anticipated future increases plus $7mm from pay-for-performance payments.
(e) Inflation rate of 3.5% reflects normal merit increases, union contract adjustments, supply cost increases and other items before discrete initiatives valued in this analysis.
(f) Full-year impact of cost initiatives initiated in late 2008 and malpractice reductions.
(g) Assumes 2009 bad debt ratio of approximately 8.0%, a 40 basis point increase over our Q4’08 bad debt ratio of 7.6%. Bad debt ratio was 7.3% in 2008.
(h) Includes impact of Sierra Providence East Medical Center (El Paso) and Coastal Carolina Hospital.
(i) Various risks including volume growth, volume mix, and bad debt create at least $50 million in uncertainties for 2009 performance.

This schedule is not intended to provide a series of spot estimates or line item guidance. Other combinations of line item performance could produce the same or higher or lower results.

 

Table #3

Cash Walk-Forward: 12/31/08 to 12/31/09

 

Revised Outlook

      Prior Outlook

(8/4/09)

  Low   High   Change   Low   High
2009 Adjusted EBITDA   900   950   90 - 75   810   875
Add back: Stock compensation charges   20   25   -   20   25
Changes in Cash from Operating Assets and Liabilities   (120)   (100)   -   (120)   (100)
Interest Payments, net   (420)   (435)   -   (420)   (435)
Adjusted Net Cash Provided by Operating Activities from Continuing Operations   380   440   90 - 75   290   365
Capital Expenditures – Continuing Operations   (425)   (400)   (25) - 50   (400)   (450)
Adjusted Free Cash Flow from Continuing Operations   (45)   40   65 - 125   (110)   (85)
Income Tax Refunds (payments)   15   25   -   15   25
Payments against Reserves for Restructuring Charges, Litigation Costs and Settlements   (195)   (185)   -   (195)   (185)
Net Cash Provided by (used in) Operating Activities from Discontinued Operations   28   38   -   28   38
Investing Activities, Reserve Fund, Divestitures and Other   320   330   20 - (5)   300   335
Net Financing Activities   (130)   (120)   -   (130)   (120)
Net Increase (Decrease) in Cash and Cash Equivalents   (7)   128   85 - 120   (92)   8
Cash and Cash Equivalents December 31, 2008   507   -   507
Cash and Cash Equivalents December 31, 2009   500   635   85 - 120   415   515
       
 
Table #4 Revised Outlook Prior Outlook
Cash Walk-Forward: 6/30/09 to 12/31/09         (8/4/09)
    Low   High Change   Low   High
2009 Adjusted EBITDA   376   426 90 - 75   286   351
Add back: Stock compensation charges   7   12 -   7   12
Changes in Cash from Operating Assets and Liabilities   12   32     12   32
Interest Payments, net   (185)   (200) -   (185)   (200)
Adjusted Net Cash Provided by Operating Activities from Continuing Operations   210   270 90 - 75   120   195
Capital Expenditures – Continuing Operations   (252)   (227) (25) - 50   (227)   (277)
Adjusted Free Cash Flow from Continuing Operations   (42)   43 65 - 125   (107)   (82)
Income Tax Refunds (Payments)   (7)   3 -   (7)   3
Payments against Reserves for Restructuring Charges, Litigation Costs and Settlements   (139)   (129) -   (139)   (129)
Net Cash Provided by (used in) Operating Activities from Discontinued Operations   -   10 -   -   10
Investing Activities, Reserve Fund, Divestitures and Other   (3)   7 20 - (5)   (23)   12
Net Financing Activities   (67)   (57) -   (67)   (57)
Net Decrease in Cash and Cash Equivalents   (258)   (123) 85 - 120   (343)   (243)
Cash and Cash Equivalents June 30, 2009   758 -   758
Cash and Cash Equivalents December 31, 2009   500 635 85 - 120   415   515
 

Exhibit 1: Non-GAAP Measures

The following provides definitions of the non-GAAP measures used in this press release and the reconciliation to the most closely related GAAP measures.

Adjusted EBITDA

Adjusted EBITDA, a non-GAAP term, is defined by the Company as net income (loss) attributable to Tenet Healthcare Corporation shareholders before (1) cumulative effect of change in accounting principle, net of tax, (2) net income attributable to noncontrolling interests, (3) income (loss) from discontinued operations, net of tax, (4) income tax (expense) benefit, (5) net gains (losses) on sales of investments, (6) investment earnings (loss), (7) gain (loss) from early extinguishment of debt, (8) interest expense, (9) litigation and investigation (costs) benefit, net of insurance recoveries, (10) hurricane insurance recoveries, net of costs, (11) impairment of long-lived assets and goodwill and restructuring charges, net of insurance recoveries, (12) amortization, and (13) depreciation. The Company’s Adjusted EBITDA may not be comparable to EBITDA reported by other companies.

The reconciliation of net income (loss) attributable to shareholders, the most comparable GAAP term, to Adjusted EBITDA, is set forth in Table #5 below:

Additional Supplemental Non-GAAP Disclosures
Table #5 - Reconciliation of Outlook Adjusted EBITDA to

Outlook Net Income (Loss) Attributable to Tenet Healthcare Corporation Shareholders for

Year Ending December 31, 2009

(Unaudited)
 
(Dollars in Millions)   Low   High
 
Net income attributable to Tenet Healthcare Corporation shareholders $ 76 $ 141
Less:
Net income attributable to noncontrolling interests (8 ) (13 )
Loss from discontinued operations, net of tax   (60 )   (40 )
Income from continuing operations 144 194
Income tax benefit (expense)   5     (5 )
Income from continuing operations, before income taxes 139 199
Net gains on sales of investments (a) 15 15
Interest expense, net (460 ) (445 )
Net gain from early extinguishment of debt (a)   119     119  
Operating income 465 510
Litigation and investigation costs (25 ) (15 )
Impairment of long-lived assets and goodwill, and restructuring charges (10 ) (5 )
Depreciation and amortization   (400 )   (420 )
Adjusted EBITDA $ 900   $ 950  
 
Net operating revenues $ 9,000 $ 9,100
Adjusted EBITDA as % of net operating revenues

(Adjusted EBITDA margin)

10.0 % 10.4 %
(a) Management is not providing a forecast of these items for the remainder of 2009.
 
Additional Supplemental Non-GAAP Disclosures
Table #6 - Reconciliation of Outlook Adjusted EBITDA to

Outlook Normalized Net Income (Loss) Attributable to Tenet Healthcare Corporation

Shareholders for Year Ending December 31, 2009

(Unaudited)
 
(Dollars in Millions except per share amounts)   Low   High
 
Adjusted EBITDA (from Table #2, above) $ 900 $ 950
 
Depreciation and amortization (400 ) (420 )
Interest expense, net   (460 )   (445 )
Normalized income from continuing operations before income taxes 40 85
Normalized income tax expense (a)   (15 )   (32 )
Income from continuing operations 25 53
Net income attributable to noncontrolling interests   (8 )   (13 )
Normalized net income attributable to Tenet Healthcare Corporation shareholders (a) $ 17   $ 40  
 
Weighted average shares outstanding (in millions) 484 484
 
Normalized income per share – continuing operations (a) $ 0.04 $ 0.08
(a) Uses normalized tax rate of 37.1 percent.
 

The Company provides this information as a supplement to GAAP information to assist itself and investors in understanding the impact of various items on its financial statements, some of which are recurring or involve cash payments. The Company uses this information in its analysis of the performance of its business excluding items that it does not consider as relevant in the performance of its hospitals in continuing operations. Adjusted EBITDA is not a measure of liquidity, but is a measure of operating performance that management uses in its business as an alternative to net income (loss) attributable to Tenet Healthcare Corporation shareholders. Because Adjusted EBITDA excludes many items that are included in our financial statements, it does not provide a complete measure of our operating performance. Accordingly, investors are encouraged to use GAAP measures when evaluating the Company’s financial performance.

Adjusted Free Cash Flow from Continuing Operations

Adjusted Free Cash Flow from Continuing Operations, a non-GAAP term, is defined by the Company as cash provided by (used in) operating activities less income tax refunds (payments), payments against reserves for restructuring charges and litigation costs and settlements, net cash provided by (used in) operating activities from discontinued operations, capital expenditures in continuing operations, and new and replacement hospital construction expenditures. The Company believes the use of Adjusted Free Cash Flow from Continuing Operations is meaningful as the use of this financial measure provides the Company and the users of its financial statements with supplemental information about the impact on the Company’s cash flows from the items specified above. The Company provides this information as a supplement to GAAP information to assist itself and investors in understanding the impact of various items on its cash flows, some of which are recurring. The Company uses this information in its analysis of its cash flows excluding items that it does not consider relevant to the liquidity of its hospitals in continuing operations. Adjusted Free Cash Flow from Continuing Operations is a measure of liquidity that management uses in its business as an alternative to net cash provided by (used in) operating activities. Because Adjusted Free Cash Flow from Continuing Operations excludes many items that are included in our financial statements, it does not provide a complete measure of our liquidity. Accordingly, investors are encouraged to use GAAP measures when evaluating the Company’s financial performance or liquidity. The reconciliation of net cash provided by (used in) operating activities, the most comparable GAAP term, to Adjusted Free Cash Flow from Continuing Operations is set forth in Table #7 below.

Additional Supplemental Non-GAAP Disclosures
Table #7 - Reconciliation of Outlook Adjusted Free Cash Flow
from Continuing Operations for the Year Ending December 31, 2009
(Unaudited)
(Dollars in Millions)  
Low   High
Net cash provided by operating activities $ 228 $ 318
Less:
Income tax refunds, net 15 25
Payments against reserves for restructuring charges and litigation costs and settlements (195 ) (185 )
Net cash provided by operating activities from discontinued operations   28     38  
Adjusted Net Cash Provided by Operating Activities from Continuing Operations 380 440
Purchases of property and equipment – continuing operations (345 ) (310 )
Construction of new and replacement hospitals   (80 )   (90 )
Adjusted Free Cash Flow from Continuing Operations $ (45 ) $ 40  
 

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