KENNETT SQUARE, PA — Genesis Healthcare, Inc. (NYSE: GEN), one of the largest post-acute care providers in the United States, recently announced operating results for the second quarter ended June 30, 2020 and provided an update regarding the impact of the 2019 novel coronavirus (COVID-19) pandemic on its business.
“As the effects of COVID-19 persist in the United States, the Company’s primary focus continues to be on the health and safety of its patients, residents, employees and their respective families,” stated George V. Hager, Jr., Chief Executive Officer of Genesis. “I am extremely grateful for the heroism, resolve and sacrifice of our frontline caregivers and workers fighting the pandemic, along with our dedicated regional and corporate staff who are supporting their efforts on the ground. I am also very proud of the leadership role Genesis is playing in the fight against COVID-19 in partnership with the Administration, public health officials at the federal, state and local levels, and our peers and partners in the industry, as well as the academic community.”
“The virus is having a significant adverse impact on the Company’s revenues and expenses, particularly given the Company’s concentration in hard-hit Mid-Atlantic and Northeastern states. Before considering funds recognized under the CARES Act and various state Medicaid programs, we estimate the impact of incremental expenses and lost revenue caused by COVID-19 in the second quarter of 2020 was approximately $213 million. While we are grateful for federal and state financial support received and committed to date, the persistence of COVID-19 outbreaks across the country, the slow pace of top line recovery in our portfolio and the elevation of operating expenses caused by COVID-19 highlight the Company’s reliance on and need for additional government sponsored financial support which is essential to meeting our responsibilities to patients, residents and caregivers. We will continue to work closely with industry advocates, elected officials and the Administration to articulate thoughtfully the resource needs of our Company and the industry in the fight against COVID-19.”
Second Quarter 2020 Results
- US GAAP revenue in the second quarter of 2020 was $0.96 billion compared to $1.15 billion in the second quarter of 2019;
- US GAAP net loss attributable to Genesis Healthcare, Inc. in the second quarter of 2020 was $22.0 million compared to $4.8 million in the second quarter of 2019;
- Adjusted EBITDA in the second quarter of 2020 was $59.4 million compared to $61.4 million in the second quarter of 2019; and
- Adjusted EBITDAR in the second quarter of 2020 was $155.8 million.
The Company recognized $188 million of federal relief grants and other support under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and $40 million of additional funding provided by certain states. The recognition of these funds in the Company’s operating results served to offset the estimated $213 million impact of COVID-19 related to lost revenue and incremental expenses incurred in the second quarter of 2020.
COVID-19 Update and Outlook
The Company’s first report of a positive case of COVID-19 in one of its facilities occurred on March 16, 2020. Since that time 241 of its 361 facilities have experienced one or more positive cases of COVID-19 among patients and residents. Over 77% of patient and resident positive COVID-19 cases have occurred in its facilities located in the states of New Jersey, Connecticut, Massachusetts, Pennsylvania and Maryland, which correspond to many of the largest initial community outbreak areas across the country. Genesis facilities in these five states represent 45% of its total operating beds.
Despite the unprecedented challenges facing the Company’s operations, Genesis reported that of the 897 focused infection control surveys conducted during the pandemic by state and federal officials at its centers, 94% achieved a “zero deficiency rate”.
The Company’s net revenues for the three and six months ended June 30, 2020 were materially impacted by a significant decline in occupancy as a result of COVID-19. The Company’s skilled nursing facility operating occupancy decreased from 88.2% for the three months ended March 31, 2020 to 77% for the three months ended June 30, 2020. The Company’s operating occupancy in the month of July 2020 of 74.8% grew approximately 60 basis points from operating occupancy of 74.2% in the month of June 2020.
The Company’s occupancy decreased in the early months of the pandemic following the efforts of referring hospitals to cancel or reschedule elective procedures in anticipation of an increasing number of COVID-19 cases in their communities. As the pandemic progressed, occupancy was further decreased by, among other things, implementation of self-imposed admission holds in those Genesis facilities having exposure to positive cases of COVID-19 among patients, residents and employees. These self-imposed restrictions on admissions were instituted to limit risks of potential spread of the virus by individuals who either tested positive for COVID-19, exhibited symptoms of COVID-19 but had not yet been tested positive due to a severe shortage of testing materials, or were asymptomatic of COVID-19 but potentially positive and contagious.
After considering a commensurate reduction in operating expenses, the Company estimates lost revenue caused by COVID-19 reduced earnings by approximately $67 million and $74 million for the three and six months ended June 30, 2020, respectively. The impact of COVID-19 on the Company’s occupancy and net revenues for the remainder of 2020 will depend on future developments, which are highly uncertain and cannot be predicted, including the pace of recovery in occupancy, the future scope and severity of COVID-19, and the actions taken by public and private entities in response to the pandemic.
The Company’s operating expenses for the three and six months ended June 30, 2020 were materially and adversely impacted due to increases in costs as a result of the pandemic, with more dramatic increases occurring at facilities with positive COVID-19 cases among patients, residents and employees. During the three months and six months ended June 30, 2020, the Company estimates it incurred approximately $145 million and $152 million, respectively, of incremental operating expenses to prepare for and respond to the pandemic. Increases in cost primarily stemmed from higher labor costs, including increased use of overtime and bonus pay, as well as a significant increase in both the cost and usage of personal protective equipment, medical equipment, food service supplies for staff, enhanced cleaning and environmental sanitation costs, the impact of utilizing less efficient modes of providing therapy in order to avoid the grouping of patients and workers compensation expense.
Government-Sponsored Relief Programs.
Since March 31, 2020, the Company’s usual sources of liquidity have been supplemented by grants and advanced Medicare payments under programs expanded or created under the CARES Act. Specifically, in April 2020, the Company applied for and received $157 million of advanced Medicare payments, and in April and May 2020, received approximately $186 million of relief grants. In addition, the Company has elected to implement the CARES Act payroll tax deferral program, which is expected to preserve, on an interest-free basis, approximately $90 million of cash representing the employer portion of payroll taxes estimated to be incurred between March 27, 2020 and December 31, 2020, of which approximately $36 million was realized through June 30, 2020. The advance Medicare payments of $157 million, which are also interest-free, are scheduled to be recouped between August 2020 and November 2020, while one-half of the payroll tax deferral amount will become due on each of December 31, 2021 and December 31, 2022. In addition to relief funding under the CARES Act, funding has been committed by a number of states in which the Company operates, currently estimated at $56 million, of which approximately $46 million was recognized in net revenue through June 30, 2020.
Liquidity and Going Concern Considerations
A significant number of the Company’s facilities and operations are geographically located and highly concentrated in markets with close proximity to areas of the United States that have experienced widespread and severe COVID-19 outbreaks. As previously noted, COVID-19 is having and will likely continue to have a material and adverse affect on the Company’s operations and supply chains, resulting in a reduction in its operating occupancy and related revenues, and an increase in its expenditures.
The Company performed an assessment to determine whether there are conditions or events, considered in the aggregate, that raise substantial doubt about its ability to continue as a going concern within one year after the date the financial statements are issued. Initially, this assessment does not consider the potential mitigating effect of management’s plans that have not been fully implemented. When substantial doubt exists, management assesses the mitigating effect of its plans to determine if it is probable that (1) the plans will be effectively implemented within one year after the date the financial statements are issued, and (2) when implemented, the plans will mitigate the relevant conditions or events that raise substantial doubt about the entity’s ability to continue as a going concern.
In completing its going concern assessment, the Company considered the uncertainties around the impact of COVID-19 on its future results of operations as well as its current financial condition and liquidity sources, including current funds available, forecasted future cash flows and the Company’s conditional and unconditional obligations due within 12 months following the date its financial statements were issued. Without giving effect to the prospect, timing and adequacy of future governmental funding support and other mitigating plans, many of which are beyond the Company’s control, it is unlikely that the Company will be able to generate sufficient cash flows to meet its required financial obligations, including its rent obligations, its debt service obligations and other obligations due to third parties. The existence of these conditions raises substantial doubt about the Company’s ability to continue as a going concern for the twelve-month period following the date the financial statements are issued.
In response to COVID-19, the Company has taken the following measures to improve its liquidity position:
- The Company applied for and received government-sponsored financial relief related to the pandemic;
- The Company is utilizing the CARES Act payroll tax deferral program to delay payment of a portion of payroll taxes incurred through December 2020, 50% to be repaid by December 31, 2021 and 50% to be repaid by December 31, 2022;
- While it vigorously advocates, for itself and the skilled nursing industry, regarding the need for additional government-sponsored funding, the Company continues to explore and take advantage of existing government-sponsored funding programs implemented to support businesses impacted by COVID-19;
- The Company continues to implement measures to adapt successfully its operational model to function for the long-term in a COVID-19 environment; and
- The Company has pursued, and will continue to pursue, creative and accretive opportunities to sell assets and enter into joint venture structures in order to provide liquidity.
These measures and other plans and initiatives of the Company are designed to provide it with adequate liquidity to meet its obligations for at least the twelve-month period following the date its financial statements are issued. However, such plans and initiatives are dependent on factors that are beyond the Company’s control or may not be available on terms acceptable to the Company, or at all. Accordingly, management determined it could not be certain that the plans and initiatives would be effectively implemented within one year after the date the financial statements are issued. Further, even if the Company receives additional funding support from government sources and/or is able to execute successfully all of its these plans and initiatives, given the current challenging environment the Company’s operating plans and resulting cash flows along with its cash and cash equivalents and other sources of liquidity may not be sufficient to fund operations for the twelve-month period following the date the financial statements are issued, which could force the Company to seek reorganization under the U.S. Bankruptcy Code.
Genesis continues to exit challenged facilities and certain low density markets in order to focus on investment and growth in core markets. During the second quarter of 2020, Genesis divested, exited or closed the operations of 19 facilities.
The 19 divested facilities this quarter generated approximate annual net revenue of $191 million, Adjusted EBITDA of $6 million and a pre-tax net loss of $2 million. These transactions resulted in the reduction of approximately $14 million of annual cash lease payments and the repayment of over $13 million of indebtedness.
The Company exited operations of one additional facility thus far during the third quarter of 2020. This facility generated approximate annual net revenue of $10 million, Adjusted EBITDA of $1 million and a pre-tax net income of $2 million.
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