Encompass Health Corporation (EHC) Earnings Call Transcript & Summary

May 19, 2020

New York Stock Exchange US Health Care Health Care Providers and Services conference_presentation 41 min

Earnings Call Speaker Segments

Benjamin Mayo

analyst
#1

Okay, great. I think we're going to go ahead and get started. It's 10 a.m. This is Whit Mayo, UBS' health care facilities and managed care analyst. It's my pleasure to have the management team from Encompass Health Care with us today. Joining the company, we have Doug Coltharp, the Chief Financial Officer; Mark Tarr, Chief Executive Officer; and of course, Crissy Carlisle that runs the Investor Relations effort.

Benjamin Mayo

analyst
#2

Maybe just to get started, guys, I think you put out an 8-K this morning giving a real-time update on some of the business trends. Maybe Doug or Mark, if you care to elaborate on some of the numbers that you put out this morning, that might be just a good place to start.

Mark Tarr

executive
#3

Yes. Good morning, and welcome, everyone. This is Mark. I'll take a first shot at this. And yes, we filed the 8-K this morning that shows our volume trends in our operating segments. And I think if you had a chance to take a look at it, you've seen that where we certainly ended February strong, went into March strong. Second half of March started to decline. We saw a bottoming, the downward trend in both of our segments in April. And then we've had a nice trajectory coming back up through April and then so far into May. So we feel very positive about the way the trends are growing now and the fundamentals of our business going forward.

Benjamin Mayo

analyst
#4

Great. Sorry, I was trying to hit my mute button. Helpful. Let's just start also on the CARES Act. You certainly have had a different view on some of the terms and conditions of the program. I think that we all sensed that you were a little bit hesitant to take the funds. You've now returned the funds. Just maybe walk us through some of the elements of the program that left you just a little uncomfortable with the program in general.

Mark Tarr

executive
#5

Well, once again, this is Mark. And first of all, we want to make sure and recognize the fact that we're very appreciative of HHS and Congress wanting to make sure to help support the providers out there. Certainly, it's been a challenging time for everyone in the health care segment. But we did some due diligence on it. We received $237 million that was quickly atomized in accounts and not spent or dispersed in any way. We used the next 2 to 3 weeks after receipt to these funds to do a fair amount of due diligence on the terms and conditions and whatever information we could gather on that. And at the end of the day, we just felt as a well-capitalized company, we had access to a variety of funding resources. We just thought it was the best decision for Encompass Health to return the funds.

Douglas Coltharp

executive
#6

And Whit, let me give you some more -- this is Doug. Let me give you some more specifics on things that were specific to us. And so the first was the allocation methodologies. So as you know, the $237 million, $238 million that we received came in 2 tranches. The first tranche was substantially larger than the second. But the allocation methodology that was utilized by HHS to distribute those funds to various providers differed from the first tranche to the second tranche. And it was language in the second distribution that led us to believe that it was the methodology for the second tranche that should be applied to both. When we applied the methodology from the second tranche, it suggested that the amount that we should have been due was closer to $80 million than it was to the $237 million. The second was an issue of aggregation. We received the funds at 209 separate legal entities under the Encompass Health corporate umbrella. And as we researched this and even as we tried to seek clarification from HHS, we could get -- not get any assurances that there would not be a continuing requirement to utilize the funds, report on the funds, be audited on the funds, et cetera, at that entity level at which it was received. And that would have both limited our ability to fully utilize the now $80 million because not every one of those entities was equally impacted by COVID-19. And it also would have imposed a very significant administrative burden and potential risk on us. Third thing is our interpretation was that any utilization of the funds would be subject to federal income taxes, and so that would also reduce the amount of dollars that was really available to us. Fourth was the concept of alternative reimbursement sources that is embedded in the language. And so we believe that at least a portion of the damage that we have suffered from COVID-19 might be subject to a business interruption insurance claim. Now that's going to be a controversial topic and likely will take years to process a claim like that. But if -- to the extent we were pursuing any such claim that would preclude us from using at least a portion of whatever funds we have retained. And the last one is an item that we've talked about before and that is attestation. And that is the form of the attestation associated with the acceptance of these funds remains very open-ended and includes provisions that allows HHS and other governmental entities and committees of Congress to add terms and conditions unilaterally post the acceptance of these funds, and we found that aspect to be problematic. Beyond that, we also believe that once the COVID-19 pandemic passes, that there is potentially going to be substantial congressional remorse about how various aid programs were distributed to various companies. And you may find yourself, as a publicly traded company with, as Mark stated, access to other sources of capital to be on a public shaming list. And that was just a risk that given a now substantially whittled down allocation of the CARE funds that we did not believe was in the best interest of our shareholders.

Benjamin Mayo

analyst
#7

Yes. No, all helpful. Definitely, I think, saved yourselves a trip to D.C. for a congressional hearing for sure. Maybe just back to just the impact on the business from COVID-19. I mean when you look at your different patient categories across both the inpatient rehab and the home health businesses, I mean, does anything stand out as being a type of patient that was more impacted? Obviously, I think the elective orthopedic musculoskeletal business is one, stroke business, neuro. Just kind of curious if you've seen any meaningful impact in different patient categories.

Mark Tarr

executive
#8

Whit, in general, if you look at it, just from a broad brush stroke, it was the lower acuity patients that we saw a decline in, and that would include orthopedic patients, hip fractures, low extremity joint placements. That was consistent. Even though it's not a large portion of our discharges on our hospital side, it does make up a material amount on the home health side through the -- particularly the elective procedures, about 20% of our overall business on the home health side. We saw actual increase of the percentage of discharges from our hospitals falling in the stroke category. So we maintained the patients that were of the higher acuity levels, which would include stroke. And we saw a decrease in any of those that could be either elective or termed as being low acuity in nature.

Douglas Coltharp

executive
#9

Whit, the other thing that we have observed is that we took a bigger volume hit on the inpatient rehabilitation side in Medicare fee-for-service patients than we did in Medicare Advantage. As a matter of fact, we saw a tremendous surge in Medicare Advantage patients. And we think that, that has something to do with both the average age and the relative health of that population of patients versus the fee-for-service with SKUs older and tends to have a different array of debilities. It also, no doubt, was positively influenced by the waiver of most of the managed CARE plans of post-acute pre-authorization requirements beginning in April.

Benjamin Mayo

analyst
#10

Yes. So just to be clear, it's not that you saw an overall increase in your Medicare Advantage volumes but as a percentage of your total, it went up as the fee-for-service volumes went down, correct?

Douglas Coltharp

executive
#11

Actually, in more recent weeks, it's been both. It's been year-over-year growth in the Medicare Advantage discharges. And as a result, it is increasing as a percentage of our payer mix.

Benjamin Mayo

analyst
#12

CMS, as you alluded to -- well, you really were alluding more towards the payers and their response efforts to, I think, try to keep the pipes flowing. But CMS came out and made a number of modifications to a lot of the rules around post-acute for inpatient rehab eliminating the 3-hour therapy rule, I think, waiving the 60% rule, home health, there's a number of modifications. Can you maybe speak a little bit to some of those changes and how that's been helpful? And do you think there are any longer-term implications from those relief efforts just on the rules?

Mark Tarr

executive
#13

Well, I think that has been helpful. Certainly, in terms of our ability to work with referral sources as they were looking to place patients into post-acute from the acute care hospitals, it gave us an opportunity to accept some patients that -- into our IRFs that were still rehab patients but maybe in the past would not have been able to tolerate the 3 hours a day of therapy or would have been restricted by the 60% rule. So both of those opportunities gave us a chance to what I would consider to be better service our acute care referring sources at a time that, quite frankly, they were looking for opportunities to reduce their capacity to prepare for this influx of COVID patients, in some cases, it never eventually happened. You had telemedicine that was also impactful in both of our segments. I think that, that, while not impactful in a material way, I do think that telemedicine in general is going to be something that CMS is going to be trying to implement as a complementary component of CARE going forward. And then I think just the enhanced use of nurse practitioners and PAs, particularly on the home health side, gives us an additional opportunity to go out and market and have our sales force communicate and market to the nurse practitioners and PAs that are out there, too. So overall, I think it's been helpful. I don't think it's been a huge influence, but I think it has been helpful.

Douglas Coltharp

executive
#14

I would say specifically, just to add to Mark's comments, the impact on the business related to the relaxation of the regulations regarding both patient criteria and requirements of CARE, just taking a little bit of time to work its way through the system. It requires broad-based communication by us to all of our hospitals, and they have a communication to our clinical marketing liaisons about what those new criteria mean and what is and what is not acceptable and how that might be applied to the patient flow from the acute care hospitals. And although we have great partnerships with the acute care hospitals, recognize that they have had a tremendous amount thrown at them in terms of regulatory changes and payment model changes and everything. They're very, very preoccupied right now with some of those. And at the end of the day, only about 3.5% of the patients who flow through an acute care hospital in a normalized environment ultimately wind up in an inpatient rehabilitation facility. So it took us a little while to get their attention. Those things are now completely in place. And not only are they helping with the recovery of volume, but an important component of this is those changes allow us now to treat patients who are recovering from COVID-19. Because if you've got an elderly patient who spent a period of time in an ICU in an acute care hospital, particularly if a portion of that time was on intubation, they really need the kind of post-acute care that we can provide in our facilities but they don't come after that kind of experience. They don't come into one of our facilities, able to tolerate the normal therapy regime that were required by law to administer.

Benjamin Mayo

analyst
#15

Yes. I mean your model's unique in a sense that you have true partnerships with acute care hospitals, I think, across, what, maybe 30% of your inpatient rehab hospitals. And I'm just sort of curious how you're engaging with those -- I mean, you sort of alluded to this a bit, but you're engaging with your hospital partners to work around what post-acute solutions they need. Does this, in some way, strengthen the relationships that you think you have and provide you an opportunity to reengage about a full post-acute solution across rehab and home health? Is this something that you're pursuing at this point? Wasn't cure -- wasn't sure exactly how that conversation is evolving.

Mark Tarr

executive
#16

Whit, it absolutely -- this period has absolutely given us a chance to strengthen our relationships, not only with our JV partners but also just as -- just to our referring partners, maybe where we don't even have a JV partnership. They -- all acute care hospitals are looking for post-acute providers that can provide great care, that had a smooth transition from the discharge acute care hospital to the mission and the post-acute facility or into the home health agency. And so I think this period has really given us an opportunity to strengthen our relationships. As I mentioned earlier, we were certainly trying and make sure we were a positive influence when it came to working with hospitals as they were trying to discharge and open up their beds for the COVID patients. Throughout this period, we admitted COVID patients into our hospitals. We had 80 of our hospitals admitted COVID patients where we could successfully treat these patients in our settings in a very positive manner. So I think we have continued to strengthen our relationship, show the fact that we are a quality provider in the marketplace, get great outcomes and can truly be a post-acute partner in a larger continuum.

Douglas Coltharp

executive
#17

Yes. Whit, I think that this is an opportunity, and we're taking full advantage of it, to really highlight the clinical efficacy of both of our business segments and to do that with key constituencies that range from the acute care hospitals to the Medicare Advantage plans that we referenced before to attending physicians and so forth. And they're really understanding just how differentiated we are and how helpful we can be in terms of treating patients more effectively if they're in need of post-acute inpatient care in an IRF versus a SNF or being able to bypass the SNF visit all together when coming out of the acute care hospital for the lower acuity patients and receive high-quality and effective care in the home setting.

Benjamin Mayo

analyst
#18

Yes. Maybe just to stay on this point. I mean as I reflect back on the Analyst Day that you had in early March, you had a slide where you, I think, provided some empirical data around, let's call it, the low-cost advantage of inpatient rehab versus other post-acute alternatives. I think you cited some 90-day episodic costs that were materially lower than skilled nursing. Doug, can you maybe revisit some of those numbers and that analysis and how you've been in -- obviously engaging with a lot of hospitals to drive home that message?

Douglas Coltharp

executive
#19

Yes, I'll start. I know Mark is going to want to add some on this. But first is, as you attempt to compare across the sites of care, it's important to recognize that the results are going to be market provider and DRG-specific, and that it's important to evaluate these on an episodic basis to capture both the stay-in-the-pack setting and some reasonable period post-discharge from that inpatient pack setting. So we focused in the Investor Day and we focused internally on 60- and 90-day episodes, and that was the specific methodology we used with the examples that we shared as part of our Investor Day materials. And so generally speaking, when you look at higher-acuity, more medically complex patients who are eligible for CARE in either SNF or an IRF, our company outperforms the SNF in both outcomes and cost effectiveness, primarily due to shorter length of stay and lower acute care readmissions. And so many times, our IRFs are more costly on the front end compared to a SNF if you're just comparing them on a per diem basis. And also then, if you look at kind of that even times a typical length of stay. But you might, for instance, have an example where a stay in an IRF was $15,000 per an episode as compared to, say, $12,000 for a SNF. But then when you add in the very costly impact of the readmission that would occur within a 60- or 90-day period, it flip-flops dramatically and creates a pretty wide delta between the episodic cost.

Mark Tarr

executive
#20

Well, I think it's -- it also goes to show how the clinical collaboration is working for us. So we have 89 markets now where we have both an IRF and home health service in those marketplaces. And you start to look at some of the quality metrics that come out in these overlap markets. And it's clearly showing that we have an opportunity, in our overlap markets, to return a higher percentage of patients back to the community and also have an opportunity to score higher on the patient satisfaction with regard to the overall satisfaction with CARE as well as satisfaction with the discharge process. So yes, it's just something that health care, in general, whenever you have a discharge and transition from one health care setting to the next, it's imperative that there's strong communication and collaboration. And it's difficult to do that unless you're vested in the process. And having these overlap markets where we have a both facility-based presence and a home-based presence, we're able to provide that level of care in a more collaborative manner that ultimately responds and results in higher quality of care.

Douglas Coltharp

executive
#21

And, Whit, one of the specific examples we used demonstrating the results from one of the larger acute care hospital networks within our marketplace was around strokes. And in that Investor Day material, we showed that the 90-day average spend for a patient that went into our IRF and then stayed with us through home health was just about $60,000. And on average, the same 90-day spend for one of those acute care patients who went into a SNF setting instead was almost $94,000. So that was about a 37% differential right there. And we have numerous other examples like that.

Benjamin Mayo

analyst
#22

Yes. All super helpful. I want to transition a second to the FIM to CARE Tool change this past year. It started, I believe, in the fourth quarter of last year. And how has that transition been relative to your initial expectation? My impression is that you were tracking better than I expected to see. It felt like you were overcoming it by a pretty wide margin, but I may be off. So just any early comments around that transition would be helpful.

Mark Tarr

executive
#23

Yes, you're right. That transition has gone well. We're very pleased with the way our hospitals have responded to that. As you pointed out, it did start in the fourth quarter of 2019. That was after over 1 year of preparation, actually a couple of years of preparation. In 2019, I think we spent some $5 million in overall education as part of this. And it's shown that, that was money well spent. Our hospitals transitioned very smoothly into the CARE Tool, the level of differentiation between 1 hospital and another. If you recall, we were trying to have a portfolio that was consistent across the same types of patients in 1 hospital with another hospitals in terms of the score. So we've not seen a lot of variation across our portfolio, which is good. That was the whole intent of the overall education with our staff and nurses. And so we've been very pleased with the transition.

Douglas Coltharp

executive
#24

And Whit, you may recall that we began providing estimates of the potential impact of the full transition to CARE Tool that would take place on October 1, 2019, in the first quarter of last year. And then we updated that on a quarterly basis by looking at the prior 3 months, and we were essentially running the CARE Tool against the FIM that was still in place at that time. And through the course of last year, we kept bringing in the estimated impact, starting initially with an anticipation that we would have a negative pricing impact in fiscal year 2020 to -- by the time we actually entered the fiscal year and dropped FIM and focused solely on CARE, our estimate of the 2020 impact was flat to up 50 basis points. We did outperform that marginally in the first quarter of the transition, which was Q4 of last year. And so as we entered calendar year 2020, we raised the estimate for the first 3 quarters to flat to up 75 basis points. And as we said in the first quarter, we believe that we landed right smack in the middle of it when you adjust out some of the prior period pricing implications. It's going to be increasingly difficult as we move forward to try to isolate the impact of this transition versus FIM because we no longer are running FIM simultaneously and so with all these other factors that are impacting it. But generally, we feel like, as Mark has suggested, we have successfully made the transition across our hospital portfolio to the CARE Tool. We'll continue to reinforce training and look for the consistent application. But we feel like we've landed in the middle, if not to the high end of the range that we had previously provided.

Benjamin Mayo

analyst
#25

Got it. So if you just isolate the revenue headwind from the CARE Tool, I think originally, we had sort of estimated it around $55 million, give or take. Is there a way to frame how you look at just the CARE Tool revenue impact versus netting it against all the market basket factors and everything else?

Douglas Coltharp

executive
#26

Well, I think what you would need to do is pick your point in terms of where we land in that 0 to 75 basis points and then compare that to what would have been a beginning rate of 2.4% and it's the delta between the two. What becomes difficult is you have to apply that against some kind of volume and patient mix. And one of the reasons that we withdrew our guidance in April is that those two things, although they're recovering nicely, as indicated in our 8-K, remain very much in flux.

Benjamin Mayo

analyst
#27

Yes. I'll figure something out. I had a question...

Douglas Coltharp

executive
#28

I know you would.

Benjamin Mayo

analyst
#29

Yes. Let's just talk about the recession for a second and the impact on your overall business. I mean, I think it's generally a topic that we get a lot of inbound questions on, and your business is certainly over-indexed towards Medicare. And generally, historically, we think about these being more recession resistant-like businesses. Does anything change going forward? How do you think about demand? How do you think about your cost structure? I mean, presumably, with unemployment going up, that might create a little bit of not deflation but something like that on your clinical cost structure. So I don't know, just any thoughts would be great.

Mark Tarr

executive
#30

Yes. If you look back, recession has not really impacted our business at all. As you noted, I mean, there might be certain pockets where you might see a little bit of benefit on the labor side, really kind of test, put your finger just on that. It's certainly easier to hire, particularly the support staff in marketplaces that maybe have a little bit more pressure, from a recession standpoint, on jobs than others. But it's not been much, if any, of an influence on our overall business. I think we're well positioned going forward. As we always try to note and point towards the demographic trends and the aging population and the fact that as the population grows older, the likelihood of meeting our services increases. I think that positions us very well for whether it's a recession or nonrecession marketplace.

Douglas Coltharp

executive
#31

And it's -- we don't want this to sound in any way morbid but to the extent that COVID-19 stays with us perhaps indefinitely, albeit at a substantially reduced rate, the likelihood that it is still disproportionately impacting the elderly population, as the flu does today, I think, is high, and there are going to be a percentage of those patients who are not only going to survive it but are going to require the services that we provide, both in the inpatient setting and at home. So there's another factor that I think would contribute to demand. And as a result, we're not pulling back on any of our capacity expansion plans. To the contrary, we're plowing forward with those.

Benjamin Mayo

analyst
#32

Yes, that's helpful. And maybe thinking longer term, I mean, another sort of inbound question that I receive from a number of investors is thinking about certain asset classes that may benefit long term from COVID-19. And there seems to be sort of this, I don't know, this inertia towards the home model, home infusion, home dialysis, home health, of course. Do you -- how do you think long term this may impact how the delivery system, the ecosystem sort of looks at home health?

Mark Tarr

executive
#33

I think it's going to continue to increase the demand. I think more and more people already had chosen the home setting as a preferred setting to receive care, if available to them. So I think this only -- this COVID-19 only pushes that trend forward. And so I think it's very sound for home health and the outlook there.

Douglas Coltharp

executive
#34

Albeit subject to the continued reduction in anxiety and we're seeing progress in this, but it's not resolved yet with regard to both patient anxiety and caregiver anxiety.

Benjamin Mayo

analyst
#35

Yes. Well, why don't we just transition there? I think this is a good segue to talk about PDGM and what the pre-COVID experience was, how you were tracking versus your original plans. You had a much different view, I think, of the slope of the curve coming into this than maybe some of your peers. And then obviously, COVID has created a lot of missed visits and some challenges around LUPA. So any initial impressions of how your operators have responded pre-COVID and post-COVID in light of the transition in PDGM?

Douglas Coltharp

executive
#36

Unfortunately, there just wasn't really an opportunity to get a read on that. If you think about it, we had a hybrid pricing model coming into the year because we were implementing PDGM effective January 1, but you still had many episodes that started in the second half of December. They were carrying over and being priced into the old system that really carried through until February, almost to March. So we had about maybe 2 weeks to get -- start to get a view on the PDGM impact, and that's not even enough to cover an initial 30-day payment period. What we can say, and it's something that we've talked about quite a bit on the first quarter call, is that for us, the impact of COVID-19 was spreading gasoline on fire that already existed. We knew that we were going to have challenges based on our referral source mix and our patient mix, giving the negative impact of PDGM based on the program design for reimbursements related to patients that come out of the community, for therapy patients versus nursing patients and for the LUPA designation. And things that are directly attributable to the COVID-19 negatively impacted the progress that we were making on getting more patients referred to us out of an institutional setting. So that was a negative in terms of a pricing impact, and they had a pretty substantial increase in the number of payment periods that were falling under the LUPA threshold. We've started to see that mitigate to some extent and we think the trend line is positive. But that's what led to that really significant decline in revenue per episode that we had in the first quarter. And it made it very difficult for us to get a real assessment as to how PDGM was tracking. We feel good about all of the training that we've done, about the programs that we have in place, about the systems capabilities that we have in place. We're just going to need a more normalized operating environment, whatever that may be moving forward, to truly assess the impact of PDGM on our business.

Mark Tarr

executive
#37

But as you know, our home health team has a very strong track record of making whatever adjustments and adaptability to regulatory changes and have really done well in the past. So we're very confident that we'll have that same trend going forward.

Benjamin Mayo

analyst
#38

That's great. Something I wanted to talk about that I've been thinking a lot about lately is Medicare Advantage. And you've noted more recently that you've successfully narrowed the payment gap between MA and fee-for-service on inpatient rehab. I don't think you've had the same experience with home health. And obviously, MA is going to continue to grow, we presume, as a percent of the overall Medicare population. And maybe just talk about the experience on inpatient rehab, how you narrowed that gap, what the gap is, what the gap was. And any comments on home health or hospice?

Douglas Coltharp

executive
#39

Yes. So Whit, this is Doug. In terms of -- on the IRF side, if you roll the clock back probably 5 years ago, the payment gap between fee-for-service and Medicare Advantage would have been as high as 25%. And that was due to the fact that a large percentage of our contracts remained on a per diem basis and were managed very aggressively by the Medicare Advantage plans such that the length of stay was lower. Over time, we were able to demonstrate, through our value proposition, our ability to effectively treat a higher-acuity patient, ultimately reducing the cost of an episode. But it was important, as we explained to the MA plans there, that our clinicians being able to manage the plan of CARE, including the length of stay and to not have this aggressive management of the per diem rate. And so the primary way that we did that was we converted the contracts from a per diem to a case rate basis so that we were sharing effectively in some of the risk. And those rates were very much tied to fee-for-service. At the same time, where we really demonstrated our efficacy was around the more medically complex, higher-acuity patients. And as we've talked about before, when you look at our Medicare Advantage book of business, it skews very highly into those categories. We're up at around 35% in a more normalized environment of our MA book of business are stroke patients and those carry a higher reimbursement. So it's both the conversion of contracts from a per diem to a case rate basis. And the higher acuity overall, it's found in an MA population for our patients versus fee-for-service that has narrowed the rate differential. And in the first quarter, that was at its lowest level ever at 6%.

Mark Tarr

executive
#40

Whit, I think this is where the increased amount of outcomes data plays to our advantage. And it's one of the things we've really used on the IRF side is this value proposition and starting to have the MA plan start thinking longer term and not just short term in terms of overall cost. I think that, too, will also resonate eventually in the home health sector as well. And that ultimately, the value and the outcomes will matter and not all providers are the same.

Douglas Coltharp

executive
#41

And we really believe that for both of our business segments, the MA plans have been enormously constructive to work with through this pandemic. And we're hopeful that we're going to be able to demonstrate, during this period of time, just how differentiated we are from our peers and that the value proposition for both of our business segments is really there, and that, that will change the nature of the relationship in a favorable way with the MA plans for both business segments as ultimately we overcome the pandemic.

Benjamin Mayo

analyst
#42

Yes. I think they're certainly looking for ways to spend money right now. On the stroke opportunity, since you referenced the patient population a little bit earlier, you've -- the American Stroke and Heart Associations came out endorsing inpatient rehab as the preferred setting of treatment for stroke. But where do we go with the next campaign? Do you think about a national branding campaign? I'm just trying to think about like what the internal initiatives are to continue to keep the momentum building around the awareness of stroke and how to treat it.

Mark Tarr

executive
#43

We have continued with American Heart, American Stroke Association on our national branding opportunity. We felt like the first 1.5 years of that had nice results in terms of just getting exposure to portions of the public or the referring clinicians that we did not have access to or a chance to get exposure to in the past. So we continue to move forward with that. We continue to publish our outcomes. We think this pandemic has given an even clearer insight in terms of the separation of the settings of CARE, IRF versus SNF. And we'll take full advantage of that going forward to continue to make sure that the outcomes that we're able to get with the stroke population are paramount when compared to other settings. So we've got a nice foothold into that. We think that there continues to be opportunities for growth in the future. I think, overall, we're just a little bit over 5% of overall market share of the stroke opportunity. So we hope to continue to build that platform.

Douglas Coltharp

executive
#44

I think there's going to be both an opportunity and a need, as we work through this pandemic, to engage in those kinds of awareness campaign. In addition to the factors that Mark just cited, there have been widespread reports. Granted this is anecdotal but I'm sure you've read some of the same articles, about patients who've simply elected not to go to an acute care hospital, not to go to an emergency room when they're having clear symptoms of a stroke. And the impact that it is having, particularly within the elderly population in these instances, is pretty catastrophic, and I think it's going to become much more widely known as we continue to move through the pandemic. And I think it's going to be incumbent upon providers and caregivers to really reinforce the need within the elderly population to seek treatment for stroke in the most efficient setting as possible. I really believe that there's an opportunity for us to increase the education and awareness and to fully demonstrate our effectiveness in treating stroke patients.

Mark Tarr

executive
#45

Whit, that would take a couple of years to play out in terms of the data. But this deferred care that has occurred over the last couple of months, it's going to have some longer-term impacts.

Benjamin Mayo

analyst
#46

No, certainly. Well, with that, I think we are just out of time. So why don't we leave it there? Doug, Mark, thanks again, and Crissy, thanks for joining us. Really appreciate your time and insight, incredibly helpful. As always, if anyone has questions, please reach out to myself. My team will get back to you as soon as we can. I think we've got Acadia presenting in about 10 minutes so we'll take a quick break. Thanks again, guys. Enjoyed that, and we will hopefully see you soon, talk soon. Bye.

Mark Tarr

executive
#47

Thanks, Whit.

Douglas Coltharp

executive
#48

Thank you, Whit.

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