The Pennant Group, Inc. (PNTG) Earnings Call Transcript & Summary

Good day and thank you for standing by. Welcome to the Pennant Group Second Quarter 2026 Earnings Conference Call. [Operator Instructions] Please note that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Kirk Cheney. Please go ahead.

Thank you, Olivia. Welcome, everyone, and thank you for joining us today. Here with me today, I have Brent Guerisoli, our CEO; John Gochnour, our President and COO; Lynette Walbom, our CFO; and Andy Rider, our Senior Living President. Before we begin, I have a few housekeeping matters. We filed our earnings press release and 10-Q yesterday. This announcement is available on the Investor Relations section of our website at www.pennantgroup.com. A replay of this call will also be available on our website until 5:00 p.m. Mountain on August 6, 2027. We want to remind anyone who may be listening to a replay of this call that all statements made are as of today, August 6, 2026, and these statements will not be updated after today's call. Also any forward-looking statements made today are based on management's current expectations about our business and the environment in which we operate. These statements are subject to risks and uncertainties that could cause our actual results to materially differ from those expressed or implied on today's call. Listeners should not place undue reliance on forward-looking statements and are encouraged to review our SEC filings for a more complete discussion of factors that could impact our results. Except as required by federal securities laws, we do not publicly update or revise any forward-looking statements where changes arise from new information or for any other reason. In addition, the Pennant Group, Inc. is a holding company with no direct operating assets, employees or revenues. Certain of our independent subsidiaries, collectively referred to as the Service Center, provide administrative services to the operating companies through contractual relationships. The words Pennant, company, we, our and us refer to the Pennant Group, Inc. and its consolidated subsidiaries. Our operating subsidiaries and the Service Center are operated by separate independent companies that have their own management, employees and assets. References herein to the consolidated company and its assets and activities as well as use of the terms we, us, our and similar terms do not imply that the Pennant Group, Inc. has direct operating assets, employees or revenues or that any of the subsidiaries are operated by the Pennant Group. Also, we supplement our GAAP reporting with non-GAAP metrics. When viewed together with our GAAP results, we believe that these measures can provide a more complete understanding of our business, but they should not be relied upon to the exclusion of GAAP reports. A GAAP to non-GAAP reconciliation is available in yesterday's press release and is available in our 10-Q. And with that, I'll turn the call over to Brent Guerisoli, our CEO. Brent?

Thanks, Kirk, and welcome, everyone, to our second quarter 2026 earnings call. We are pleased to report another strong quarter, which put us on pace to surpass the top end of our original guidance range. Our momentum is a product of diligent focus on operational excellence, along with effective transitions at recently acquired operations. In Q2, we generated revenue of $298 million, an increase of $78.5 million or 35.8% over the prior year quarter; adjusted EBITDA of $24.3 million, an increase of $7.9 million or 48.2% over the prior year quarter; adjusted EBITDA prior to NCI of $26.1 million, an increase of $8.8 million or 51% over the prior year quarter, and adjusted diluted earnings per share of $0.36, an increase of $0.09 or 33.3% over the prior year quarter. I'm incredibly proud of our local leaders and teams. Heading into this year, we outlined 2 critical initiatives that would create success in 2026. First, we would rigorously pursue operational excellence across all of our business lines, looking at every lever to increase efficiencies, and improve results. Second, after a period of significant investment, we would focus sufficient resources and attention on integrating those operations, especially our sizable recent acquisition in the Southeast to ensure that they were transitioned quickly and effectively. As a testament to the strength of our operating model, we have experienced remarkable progress in organic growth across our core operations even as we have outperformed internal expectations thus far in the transition of the largest acquisition in our history. This has been the story of Pennant's year thus far. Before the recent announcement of the 2027 proposed Home Health rule, home health reimbursement had been in a down cycle with annual base rate cuts for 4 consecutive years. We made the best of this challenging environment by rigorously innovating and optimizing our operations and delivering exceptional clinical care more efficiently. Throughout this period, we continue to invest in home health at attractive valuation and reaffirmed our bullish view and long-term commitment to these services even as we have expanded our hospice and senior living businesses. We know and we believe the government also knows that home health services are a vital component of America's health care strategy, and their importance will only increase as more seniors age into the services, and governmental leaders look for solutions to reduce the nation's overall health care spend. The silver wave will continue to unfold over the next decade and beyond. Each year, more than 4 million Americans turn 65. As the share of the U.S. population over 65 increases and life expectancy continues to expand, we anticipate growing demand for our services. Our home health and hospice services will continue to be critical, lowest cost solutions to address these demographic changes. Health care reimbursement is cyclical. It appears now that the payment pendulum is moving in a better direction with a 2.4% increase in the 2027 proposed rule, which we're modeling as a 1.7% increase as applied to our operations. We see this as a positive signal and welcome the opportunity to collaborate with CMS and Congress on a more stable home health rate environment that aligns reimbursement with the increasing costs of delivering high-quality care. As payers and CMS increasingly focus on rewarding quality outcomes and value-based care, we are well positioned to be a solution in the health care continuum. As announced in yesterday's press release, we are raising annual guidance based on the momentum in the business, the progress we have made in transitioning new acquisitions in the Southeast and the significant upside that remains in our existing operations. We anticipate full year revenue in the range of $1.17 billion to $1.19 billion, adjusted EBITDA prior to NCI of $101.5 million to $105.1 million and adjusted earnings per share in the range of $1.34 to $1.41. With solid performance across the portfolio, a pipeline of potential growth opportunities and a robust balance sheet, we are excited for the remainder of 2026 and beyond. With that, I'll turn the call over to John to provide more details on our second quarter operational results.

Thank you, Brent, and good morning, everyone. Pennant's local leaders continue to drive inspiring clinical and operational results in their communities. We are pleased to see strong performance in our mature operations even as we are onboarding these new acquisitions. In our home health and hospice segment, exemplary clinical and cultural performance continues to create financial momentum. Top line segment revenue in the second quarter was $237.8 million, an increase of $71.8 million or 43.2%. Adjusted EBITDA was $37.7 million, an increase of $12.3 million or 48.2% and adjusted EBITDA prior to NCI of $39.6 million, an increase of $13.2 million or 50% each over the prior year quarter. Our growth in adjusted EBITDA prior to NCI reflects not only the addition of new operations, but also our focus on operational excellence as same-store margin improved 70 basis points year-over-year. Our hospice business continues to excel. Hospice revenue in Q2 was $103.6 million, an increase of $29.8 million or 40.4% over the prior year quarter. Hospice admits increased 38.4% and average daily census increased 40.1%. While this increase reflects the impact of our investment in the Southeast, our same-store trends reflect that the community is responding to our locally driven approach and clinical excellence. For the second quarter, same-store hospice admissions increased 8.8% and ADC grew 10.8%, each over the prior year quarter. In July, CMS released the 2027 hospice final payment rule, which includes a 2.3% increase in revenue per day, along with several program integrity measures primarily intended to increase rigor relating to hospice enrollment. The hospice industry is currently the subject of intense scrutiny because of the significant fraud and abuse issues perpetrated by bad actors in California and elsewhere. While they have created new administrative costs, we understand and support the need for program integrity measures that will help lawmakers and regulators pinpoint and punish fraudsters. We are working closely with regulators to narrowly tailor regulations and enforcement in ways that improve patient care and increase trust in the industry. By identifying and isolating bad actors, funds can be redirected to providers like Pennant who deliver great care in a compliant manner. In short, we are well equipped to thrive through this dynamic regulatory environment. On the home health side, our operations continue to grow and perform well. Home health revenue increased to $119.4 million, an increase of $40.3 million or 50.8% over the prior year quarter. Total home health admissions increased 62.3% and Medicare admissions increased 70.7%, each over the prior year quarter. Revenue per episode decreased by 1.9% over the prior year as we anticipated based on our significant growth in the Southeast. These markets have lower CMS wage indexes and thus lower revenue per episode, offset by lower actual wages and overall cost of service. Consistent with our hospice results, our same-store strength illustrates our foundation of quality care with total same-store home health admissions increasing 9.7% and same-store Medicare admissions increasing 13.6%. The transition of new operations in the Southeast continues to roll forward on schedule, but we see significant variability and much opportunity to improve individual operations. We are pleased with our overall performance and transition progress to date. Financially, margins in these businesses are trending ahead of internal expectations. Clinically, where we have successfully transitioned to Pennant's EMR instance and implemented our technology stack and clinical best practices, we are seeing outcomes improve, including star ratings and potentially preventable hospitalization scores. That said, we are currently in the thick of our largest transition waves, which will continue through October. This will naturally cause some ongoing disruption. In the long term, we see so much potential in these operations and the local leaders and teams. We expect them to thrive in Pennant's unique operating model for many years to come. Clinical excellence is the foundation of all we do. Our quality scores remain excellent with an average CMS star rating of 4.1 compared to the national average of 3.0, and a potentially preventable hospitalization rate of 10%, which compares favorably to the national average of 10.8%. We also continue to benefit from CMS' home health value-based purchasing program, in which our mature operations have experienced positive revenue impacts on average. These favorable adjustments helped our same-store revenue per episode increase by 40 basis points over the prior year quarter despite the impact of Medicare base rate cuts. Our senior living segment continued its significant growth in the second quarter as revenue improved to $60.2 million, an increase of $6.7 million or 12.6% over the prior year quarter. Segment adjusted EBITDA increased to $5.8 million, a $0.7 million or 13.2% increase over the prior year quarter. In Q2, average all-store monthly revenue per occupied unit rose to $5,392, an increase of $204 or 3.9% over the prior year quarter, and same-store monthly revenue per occupied unit rose to $5,413, an increase of $282 or 5.5% over the prior year quarter. Same-store occupancy ticked up 150 basis points versus the prior year quarter to 81.6%, even as we have consistently strengthened our revenue quality year after year. We are pleased with the broad-based stability and leadership in our senior living business which has enabled us to be active acquirers with 7 deals closed year-to-date. As we have discussed previously, in Q3 and Q4, we anticipate some lumpiness in senior living margin as we integrate these newly acquired communities, many of which have low occupancy but compelling long-term potential that we are excited to unlock. Turning to acquisitions more specifically, Q2 produced a steady stream of senior living deals. On our Q1 call, we discussed our April and May acquisitions of 2 communities in Arizona and 2 in Wisconsin, constituting 262 units. Later in May, we acquired the operations and real estate of Copper Canyon Memory Care, a 40-unit community in Tucson, Arizona. On June 1st, Pennant assumed operations of a senior living community in Pleasant Hill, California, known as Memory Care of Contra Costa, including 46 memory care units. These acquisitions reflect Pennant's commitment to high acuity senior living care, which is embedded in our DNA as a clinical company. We believe that our ability to accept and serve more clinically complex residents positions us well for the demographic trends ahead. On August 1st, we acquired the operations and real estate associated with River Center Assisted Living, a 63-unit community in Tucson, Arizona. The addition of River Center and Copper Canyon increases our growing real estate portfolio to 9 properties, including 5 acquired in the last 12 months. It also strengthens our robust care continuum in Tucson, which includes multiple home health, hospice and senior living operations. On the home health and hospice side, we made an investment in Hartford HealthCare at Home that we are excited to discuss. On June 4, we announced the next evolution of our partnership with Hartford HealthCare, which began more than 2 years ago. In 2024, we commenced management of Hartford HealthCare at Home, which now provides home health and hospice services to more than 30,000 patients annually from 9 locations throughout the State of Connecticut. In June, we made an investment in the future of Hartford HealthCare at Home that allows us to share in the profits or losses recognized in connection with our management of the business. These now appear as income from equity method investments in our financial statements and more details are available in our 10-Q. We are pleased that since we began working with Hartford, we have expanded patient access, improved clinical outcomes and brought financial stability to Hartford HealthCare at Home. We have also established a service center in Connecticut, invested in strong operational and resource leaders and created a foundation from which we can grow in the Northeast. With that, I'll hand it over to Lynette for a review of the financials. Lynette?

Thank you, John, and good morning, everyone. Detailed financial results for the 3 months ended June 30, 2026, are contained in our 10-Q and press release filed yesterday. For the quarter ended June 30, 2026, we reported total GAAP revenue of $298 million, an increase of $78.5 million or 35.8% over the prior year quarter; adjusted EBITDA of $24.3 million, an increase of $7.9 million or 48.2% over the prior year quarter; adjusted EBITDA prior to NCI of $26.1 million, an increase of $8.8 million or 51% over the prior year quarter; GAAP diluted earnings per share of $0.25; and adjusted diluted earnings per share of $0.36. Our year-to-date results put us on pace to exceed the top end of our full year guidance. Accordingly, we are revising and raising our full year 2026 guidance as follows: full year total revenue is anticipated to be between $1.17 billion and $1.19 billion. Full year adjusted diluted earnings per share is anticipated to be between $1.34 and $1.41, and full year adjusted EBITDA is anticipated to be between $94.4 million and $98 million, and full year adjusted EBITDA prior to NCI is anticipated to be between $101.5 million and $105.1 million. This updated guidance incorporates current operations and organic growth, diluted weighted average shares outstanding of approximately 37 million and a 26% effective tax rate. It anticipates continued strong operating performance through the end of the year, hospice reimbursement rate adjustments, elevated interest expense and the contributions from our joint ventures and management agreements. It excludes unannounced acquisitions, start-ups, share-based compensation, acquisition-related costs and one-time implementation and unusual items. Key metrics as of June 30, 2026, include $201.9 million outstanding under our credit facility and $15.3 million cash on hand at quarter end, 1.96x net debt to adjusted EBITDA and cash flows provided from operations of $18.4 million year-to-date. I would now like to spotlight a few leaders in our organization who have achieved exceptional results. Their stories demonstrate the remarkable progress that can occur when local leaders build strong culture and develop high-performing teams of C-level leaders in their operations. At Emblem Hospice in Tucson, Arizona, CEO, Tobias Emms; CCO, Adriana Chrite; future CCO, Itzel Eriksen; and future CMO, Chelsey Kahn, have created a culture that makes Emblem a vital contributor to the Tucson market. Emblem's leaders have intently focused on cultural excellence, creating a supportive environment where employees feel aligned with the organization's goals and ownership over results. This has resulted in a caregiver satisfaction score of 95%. This alignment has also allowed Emblem to become a consistent provider of choice in the Tucson market as the team works collaboratively to respond quickly and communicate effectively with referral sources and families. Emblem has developed an outstanding clinical reputation, highlighted by their strong scores for visiting patients in the last days of their life. As a result of these efforts, average daily hospice census has grown 43% year-over-year. Financial results have followed suit as Emblem's revenue has increased 75% and EBITDA has increased 315%, each over the prior year. Emblem is a valued partner in the robust care continuum that Pennant has developed to serve Tucson and the surrounding community. At Signature Healthcare at Home in Eugene, Oregon, CEO Samantha Monroe; CCO, Lucy Arbow; and future CMO, Milly Sage, have demonstrated how local leaders and teams can transition and thrive in Pennant's unique operating model, adding tremendous value to their local communities. Since its acquisition by Pennant in January 2025, Samantha and Lucy have embraced CAPLICO and our unique locally driven model. Signature's rigorous focus on operational excellence has resulted in exceptional clinical and cultural outcomes, including a real-time star rating of 4.5, a potentially preventable hospitalization score of 7.2%, single-digit turnover and home health value-based purchasing score significantly better than the national and state average. As a result of this clinical excellence and workforce stability, census has increased nearly 30% since acquisition and EBITDA has doubled versus the prior year. Samantha, Lucy and team are helping to set the bar and elevate care in Oregon. On the senior living side, CEO, Ryan Weaver; CWO, Abigail Santos; and CMO, Charlie Wolfe, have created a community of choice at Desert View Senior Living in Las Vegas, Nevada. With a special focus on caring for our nation's military veterans Desert View benefits the lives of a deserving elderly population. Desert View's occupancy has consistently been above 95% over the past 4 years, demonstrating that it is an in-demand community. By creating a comfortable and caring environment, Desert View has grown revenue 10% year-over-year and EBITDA 29% year-over-year. Desert View's story exemplifies how established leaders in a stable, mature operation can drive steady organic growth year after year and benefit the lives of a vulnerable population. With that, I'll turn the call back over to Brent for concluding comments.

Thanks, Lynette. Before we transition to questions, I want to thank our employees whose daily efforts create the results we share on these calls. With that, we'll open it up for questions. Olivia, can you please instruct the audience on the Q&A procedure?

[Operator Instructions] Our first question coming from the line of Raj Kumar with Stephens.

Maybe kind of focusing on home health and the strong organic growth that you guys are seeing there. Fee-for-service pretty healthy and MA kind of right behind it. So as I kind of think about some of the dynamics underlying that this year, MA has kind of been tempered from a growth perspective, might kind of rebound next year. How should we kind of be thinking about just the kind of profile of the business and the underlying stability if there are certain population shifts across the fee-for-service or MA kind of insurance backdrop?

Yes. Thank you for the question. I think one thing that is unique about our business is our locally driven models impact on how we make referral and acceptance of referral decisions. So each of those decisions is made at the local level by leaders and teams who understand sort of both sides of the equation. They understand what their staffing looks like. They understand what their reimbursement looks like. And so they're really well positioned to make those decisions in a way that benefits patients and the community and the organization as a whole. And so I think one of the things that your question highlights is we've had incredible success in driving organic growth across the platform. 13.6% increase in Medicare referrals, a 9.9% increase in total admissions sort of reflects that the communities that we serve are choosing us. And because we've been able to staff, because we've been able to take volume in those more in-demand communities, it's positioned us to sort of choose which referrals to accept. I think we believe that there will continue to be growth on both sides of the ledger. I think as Brent highlighted, there's just going to be more patients that need services and more demand for the services we provide. But certainly, we expect that there's going to be more growth in Medicare Advantage and commercial plans. And so we're investing strategically within the service center to make sure that we have the best team possible to present the compelling tenant story from a clinical outcome standpoint, from an efficiency of care delivery standpoint so that we can make sure that we have the rate that's necessary to take that volume. And so I think you'll continue to see growth in both fee-for-service patients and in MA patients. We believe that being a solution to the community is critical to our overall success as a company. And so that's how we're intending to approach it.

Got it. And then maybe following up on thinking about senior living and I think the kind of uniqueness of your portfolio with the Medicaid exposure. Just kind of curious on the waiver programs there, the sustainability that just underlying the backdrop around constrained Medicaid funding overall under this administration. So curious on what offers advantage or stability from that standpoint with your Medicaid weighted business as you kind of think about the senior living business long term?

Thanks, Raj. This is Andy. Yes, we have developed really meaningful relationships with the managed payers in the states where we serve higher density on the Medicaid population side. We're pretty particular about the states where we're expanding that offering versus not, and we're thoughtful about how we grow that business. In the case of those specific programs, we see stability where we have that density and believe that we need to create an offering for all, but also it has to be in a way that protects margin in those states where we have those relationships. Because we're providing a lot of value and we're working with those managed care payers, we continue to be able to negotiate and work with them to create not just an offering from kind of a community standpoint, but one that does have a viable margin and gives us hope for the future. In terms of the rate pressure, we continue to monitor that situation, but haven't felt large effects in any of our major density areas.

Our next question in queue coming from the line of David MacDonald with Truist. Your line is now open. David, your line is now open. Please check your mute button. Alright, we'll go to the next person in queue. David, join the queue again, if you can. Our next question coming from the line of Brian Tanquilut with Jefferies.

Congrats on a solid quarter. Maybe my first question, as I think about the Amedisys assets, if you can share with us just the progress in that integration. It seems like there's still waves to be done, but any color you can share with us in terms of the strength in that business that you're seeing as you evaluate the new market in Tennessee?

Yes, Brian, thanks for the question. I would start with the people. There's amazing people that we inherited in these operations. And it's been fun to see them embrace our unique operating model. Anytime you go into a new community with 46 new assets in Tennessee, multiple assets in Alabama and Georgia, there's that question of how people are going to respond. And it's been really exciting to see them embrace the Pennant model and how quickly and effectively they've worked through the difficulties that are inherent in any transition. We're currently -- we've completed 3 waves. We are approaching the end of Wave 4, which was one of the larger waves. And then we've still got one of the largest waves, which is Wave 5 that just started August 1. And so as I mentioned in the call, I think we are on schedule from a timing standpoint. Our service center team and our operations teams that have been supporting these assets have done a remarkable job of working through the implementation of new brands, training and developing the existing leaders and some new leaders to step in and lead these operations in our model. And then, of course, implementing our instance of Homecare Homebase, our technology stack and ultimately -- and this process will take longer, the implementation of our clinical best practices. But all of that is proceeding on schedule, and we're excited about it. I think Brent mentioned we feel like we're a little bit ahead of schedule with regard to how the assets are performing. We've seen volumes sort of stay well and really above where we expected it to be through the transition, through the brand change, through the leadership change. And I think that's a sign of the need in these communities for high-quality providers. And that's exactly what we have in these assets. And so we're just really excited about the future of what we can build in the Southeast in the quality of these assets and most importantly, in the quality of the people and the way that they can impact the remainder of the year, but more importantly, how they impact the future of Pennant.

That's good. And then when I think about the same-store performance for the quarter, I mean, really strong, right? And when I think through the drivers of that, obviously, the market for home health and post-acute as a whole is growing. But how are you thinking about market share gains and the ability to sustain that level of same-store performance?

I think there's a couple of things I would highlight with regard to our same-store home health and hospice performance. One of them, obviously, is the strong organic growth numbers, which really play into your question about market share. And that comes back to what I stated in responding to Raj's question. I think our local approach allows us to diversify our offering based on the needs of the community. And that includes everything from the clinical programs we design, which -- some of which are designed at the service center, but then implemented according to the needs of the local community. It also allows us to be super responsive to referral sources because decision-makers are housed there in the local community. And so we've just seen that resonate with people. I also think that it's resonating with staff. And that's a big -- the big question of the future. There is so much demand. The big question is who will be the best at recruiting, retaining and creating a life-changing opportunity for clinicians. And I think our leaders are doing a good job of that. I think our turnover shows it that as that has declined, I think our headcount growth shows that our recruiting has improved. And overall, we're better meeting that need. And so when you look out and say, is this sustainable, I think we have traditionally sort of cited that mid- to high single digits as where we think our mature organic growth is going to lie. We've been performing above that for a number of quarters in a row. And I think that reflects the increasing demand and our ability to take market share. The other thing that I would highlight is just in, and I called it out on the call, even as we've been going through this growth, we improved margin at our same-store operations by 50 basis points year-over-year -- actually 70 basis points year-over-year. And when you think about that, I think that reflects sort of this element of our model where owners are supporting other owners and cluster partners are supporting other cluster partners in driving improved operational outcomes. And I think that is sustainable because it's such a focus and because the way our model ties people together to support each other.

I see David MacDonald is back in queue.

Can you guys hear me?

Yes, we can hear you.

Okay. Sorry about that. So guys, just 2 quick questions. One, we hear a lot in terms of providers talk about automation, talking about AI, talking about a lot of the things that are changing the market a little bit. Can you guys just talk about -- obviously, you've got a staff that deals with a lot of clinical paperwork, a lot of things where there is potentially an opportunity to drive some efficiencies. Just kind of how you're thinking about that relative to your employee base and any opportunities there over the next, let's say, 12 to 24 months?

Yes, David, I appreciate the question. And it's certainly something we haven't spent a lot of time talking about on past calls. But I will say this, it is a key focus area for us. We recognize and acknowledge that moving forward, technology advancements and specifically related to using AI and the tools available there are going to be critical to delivering more effective, more efficient care. And so we've spent a significant amount of money and investment in driving and elevating the performance from a technology standpoint. And a lot of this stuff is in development. There's a huge opportunity to do a few things. First of all, we think a lot about our clinicians and the experience that they have in patient homes and just the work that they do. A lot of that is tied into documentation time. And so we're really focused on coming up with solutions and piloting different solutions that will allow our clinicians to be more efficient and effective in the care that they provide and frankly, just provide a better experience for them in general because we know if they can do that, they will be more productive. We'll be able to increase the number of patients that we can care for. And it should also ensure that the care that the patients are getting is increasing and improving. The other side of this is on the back-office automation piece. And there's a lot of procedures or manual processes that currently is just part of what we do. But a lot of these AI tools are going to allow us to eliminate many of those processes and really reduce the indirect spend. And so I could elaborate for an extended period of time on all of this, but I'll just say this, we are very focused on this. We believe it's a part of our future. We look forward to maybe speaking about it more as some of these pilot programs and these trials continue to show progress. And ultimately, we would expect to see improved quality outcomes and improved financial outcomes as a result of the investments that we're making on the technology front.