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Operator
Welcome to the Greenbrook TMS Inc. first-quarter 2021 results conference call and webcast. (Operator Instructions) I would like to remind you that this conference call is being recorded today and is also being webcast on the company's website at www.greenbrooktms.com under the Investors section event. (Operator Instructions) Analysts and investors are reminded that any additional questions can be directed to the company at investorrelations@greenbrooktms.com.
This call contains forward-looking statements, which reflect the current expectations or beliefs of the company based on currently available information. Forward-looking statements are subject to a number of risks and uncertainties that may cause the actual results of the company to differ materially from those discussed in the forward-looking statements.
Factors that could cause actual results or events to differ materially from current expectations are disclosed under the heading Risk Factors in the company's annual information form dated March 30, 2021, and in the company's MD&A for the period ended March 31, 2021, which are available on own SEDAR, EDGAR, and on the company's website. Any forward-looking statement speaks only as of the date on which it is made, and the company disclaims any intent or obligation to update any forward-looking statements, unless required by law.
I would now like to turn the meeting over to Mr. Bill Leonard, President and Chief Executive Officer of Greenbrook TMS; and Erns Loubser, Chief Financial Officer.
Go ahead, please, Mr. Leonard.
Bill Leonard - President & CEO
Thank you, Cara, and thank you to everyone for joining our conference call and webcast today.
We are very excited about our Q1 2020 results, which continues to demonstrate our ability to navigate through a challenging operating environment imposed by COVID-19, and especially during the harsh winter weather events in parts of the US, which resulted in the temporary closure of some of our TMS Centers during the first part of the quarter. Despite these operational challenges, we continue to grow our business, achieving records for new patient starts and treatment volumes in March 2021.
For the quarter, with new patient starts increasing by 19% as compared to the first quarter of 2020, and 11% compared to the fourth quarter of 2020, and treatment revenues grew at 9% year over year. We also saw a strong bounce back in revenue, which increased by 14% to $11.3 million as compared to Q4 2020, seeing a return to pre-COVID levels.
According to the CDC, after the onset of COVID-19 pandemic, approximately 40% of the US adults reported struggling with mental health or substance abuse making access to TMS therapy and other treatment modalities for mental health more essential than ever. We believe the improved operational performance, especially late in Q1 '21 positions us well for Q2 2021. Consultations performed an important performance indicator for the company increase by 52% as compared to Q1 2020, what points towards encouraging prospects for the remainder of 2021.
From a development perspective, we added three new active TMS Centers during Q1 '21, with an additional nine TMS Centers in development, bringing the total company network to 128 TMS Centers as of March 31, 2021, increasing from 124 in Q1 2020. We expect an acceleration development through 2021, as we begin to move forward with opportunities that were previously paused or delayed by the COVID-19 pandemic. We are also particularly pleased with several other milestones for the company and in the industry.
We successfully rolled out the Spravato pilot program, building on our long-term business plan of utilizing our TMS Centers as platforms for delivery of innovative treatments to patients suffering from MDD and other mental health disorders. A key part of our strategy is to take advantage of our network of TMS Centers and affiliated physicians, as a service delivery platform providing a community-based approach to mental health services.
We are also very pleased with the progress made in this strategy through the Spravato pilot and are excited to continue to develop this program. Through this Spravato pilot, our Greenbrook-affiliated physicians found the treatment to be clinically useful, with some patients who were not responsive to other treatments, responding well to Spravato. No adverse patient events were experienced during the pilot. And operationally, the administration of Spravato did not disrupt TMS operations, and the observation period was extremely well tolerated. And we are already collected a significant portion of the expected revenue from treatments performed during Q1 2021.
The administration of Spravato complements TMS therapy as an additional modality for treatment failures with some patients preferring to be referred to TMS therapy once stabilized. Patients who previously did not respond to TMS therapy made up the largest portion of patients during the Spravato pilot program, illustrating the potential for previous TMS therapy patients to receive Spravato therapy and vice versa. We believe that offering Spravato treatments will enable us to serve a wider range of patients suffering treatment-resistant depression.
Based on those promising findings, we expect to expand our offering to Spravato to an additional five to six TMS Centers, bring our total to 10 to 12 TMS Greenbrook Centers offering Spravato.
We will also explore opportunities to, first, utilize the buy-and-bill method, where profitable from a regulatory perspective which could potentially enhance the economics associated with delivery of Spravato; and second, explore offering Spravato using mid-level practitioners, such as nurse practitioners or physician assistants. At the same time, continue to collaborate with device manufacturers to expand a range of indications for TMS.
On April 29, 2021, our Richmond Heights, Missouri TMS Center was named as one of the participating centers in BrainsWay's rollout of its smoking cessation TMS therapy. BrainsWay recently received FDA clearance for the use of their H4 coil TMS device in aiding short-term smoking cessation.
From a financing perspective, due to the market conditions, we have decided to temporarily delay pricing for the previous announced equity offering. However, we continue to experience strong interest in our company and a strong base of support of existing shareholders. We expect to move forward with an appropriate structure as conditions stabilize.
And now, for a more detailed review of the company's financial and operating performance, I will turn it over to CFO, Erns Loubser.
Erns Loubser - CFO & Treasurer
Thank you, Bill. As Bill mentioned, despite the impact of COVID-19 and adverse weather events, which caused the closure of some of our centers during the quarter, revenue bounced back strongly from Q4 2020, increasing by 14% to $11.3 million. Revenue remained flat year over year, which represents a return to pre-COVID levels with treatment volumes exceeding Q1 2020 by 9%. Average revenue per treatment for Q1 2021 was $217, representing a 19% quarter-over-quarter increase, compared to Q4 2020; Q4 2020 at $182.
This was primarily attributable to a reduction in the provision for adjustment to variable consideration, as billing enhancements and the recredentialing process started to yield results. Year over year, average revenue per treatment decreased by 9% to $217 in Q1 2021 as compared to Q1 2020, largely due to the provision for adjustment to variable consideration, saved with a lower contribution from the higher reimbursement jurisdictions.
To be very clear, there has been no changes in reimbursement levels, and we expect this metric to continue to normalize through 2021. Same region sales growth was negative 6%, largely as a result of adverse weather events experienced in some of our more established regions.
Moving to regional operating income, Q1 2021 resulted in entry-wide regional operating loss of $1.5 million as compared to an entry-wide regional operating loss of $2.1 million in Q4 2020, and an entry-wide regional operating income of $700,000 in Q1 2020. This is largely associated with lower revenue per treatment as a result of provisions against revenue and strategic marketing spend to take advantage of the leading integrated momentum, as Bill alluded to earlier, we experienced in the latter part of Q1 2021.
In addition, the inclusion of nine newly active TMS Centers and nine TMS Centers in development impacted the loss position.
Year-over-year aggregate corporate costs increased by 22% to $4.7 million for Q1 2021 as compared to Q1 2020. This is primarily as a result of costs associated with the deferral payment in respect to achieve TMS earn-out consideration, and one-time NASDAQ listing-related professional and legal fees. On a normalized basis, year-over-year corporate costs increased by only 8%.
The business continues to scale into its cost structure with treatment growth eclipsing the rate of corporate G&A growth. The loss for the period in comparison, loss increased by 85% to $7.8 million during Q1 2021, compared to Q1 2020 of $4.2 million. This was predominantly due to lower revenue per treatment, as previously mentioned, and increased marketing spend. In addition, the inclusion of nine newly active TMS Centers and nine TMS Centers in development impacted loss position.
From a balance sheet perspective, the accounts receivable balance remains stable. As of March 31, 2021, we had approximately $5.9 million in cash on hand. As Bill mentioned earlier, we're in the process of securing additional financing to manage our liquidity position.
Moving to our core operating metrics. As Bill mentioned earlier, we continue to show record growth in all our key operating metrics with record highs in new patient starts and consultation performance towards the end of Q1 2021, indicating a positive upward momentum into Q2.
As of the end of Q1 2021, the active TMS Centers increased by 8% to 119 from 110 a year ago. Total number of TMS Centers grew by 3% year over year. We experienced lower growth in this metric as a result of a temporary pause in development in response to the pandemic.
The year-over-year number of consultations performed increased by 52% to a record 3,591 as compared to Q1 2020. We increased the number of TMS treatments performed by 9% to 52,126 as compared to Q1 2020. New patient starts increased to a record of 1,583 in Q1 2021, an 11% increase compared to Q4 2020, and a 19% increase compared to Q1 2020. The strong upward trend in all leading indicators speaks to our firm business fundamentals and positions us very well for future growth.
Back to you, Bill.
Bill Leonard - President & CEO
Thanks, Erns. As you heard from Erns, we produced strong growth in key operating metrics during what has been a challenging quarter in terms of the resurgence of COVID-19 and adverse weather events. We are particularly proud of our exit run rate in all metrics for Q1 2021, which demonstrates our ability to reach new patients during this difficult time.
We are also very pleased with the results of the Spravato pilot and look forward to expanding that program. Our business is positioned stronger than ever to take advantage of new TMS indications, new treatment modalities, and new expansion opportunities, both through organic TMS growth and M&A.
The need for mental health support is at an all-time high, and we are well positioned to support patients suffering from treatment-resistant depression and OCD. We have now treated over 17,000 patients with over 620,000 treatments performed, a significant positive impact on the lives of so many patients suffering from mental health disorders.
We look forward to keeping you updated on the progress of the company throughout 2021. Thank you for your time today. And with that, operator, we will now take questions.
Operator
(Operator Instructions) Noel Atkinson, Clarus Securities.
Noel Atkinson - Analyst
Well done overall in Q1. Just a few questions for me. So first, you mentioned in the prepared remarks that March was really strong in terms of revenue. Can you give us a sense of how strong it was relative to the rest of Q1 and how much of that was sort of catch-up from the severe weather?
Bill Leonard - President & CEO
Yeah. Noel, thanks for the question. Good to hear from you. March, itself, was a record-breaking month in all key metrics in terms of consultations, new patient starts, treatments, and really high revenue. There was a slow start to the quarter, as we've talked about caused by COVID pandemic. And more importantly, the weather issues, which included a shutdown of Texas due to the power grid outage. But March was, from our end, significantly one of the best months we've ever had.
Noel Atkinson - Analyst
Okay, great. And in terms of the procedure volumes, what are you seeing in terms of people coming back from maintenance and booster sessions? How important is that to the growth right now?
Erns Loubser - CFO & Treasurer
In terms of -- we typically see a 20% return rate from a maintenance and retreatment perspective. As we've mentioned before, retreatment is covered by insurance and we see about 20% of our patients coming back for retreatment. So that's 20% of the respondents coming back for retreatment. And as we've mentioned before, there's a significant efficacy as it relates to the retreatment for patients. So we'll continue to see that as an element of growth.
Noel Atkinson - Analyst
Okay, great. On the Spravato side, have you started formally marketing now, as a service provision rather than -- so you can move beyond the pilot? And then also, is 10 clinics the next -- the culmination of your next stage of the rollout or is that what you think is appropriate for your overall national footprint?
Bill Leonard - President & CEO
Hey, Noel. I would tell you that we continue to expand on that. 10 to 12 centers will not be our typical rollout across the country. I think with Spravato, you have to -- it's a little bit different to TMS because those patients do not have to come on a daily basis. So therefore, as a convenience factor, they're willing to travel a little further.
So I think from our end, developing that service platform, you're going to look to have, as a number, somewhere in the neighborhood of 30-plus centers, eventually, there are centers of excellence, if not more, that can handle both the Spravato and expanded service platform at those locations.
So we'll continue to ramp up. In this next phase, what I'll tell you, it's still part of a pilot, although we'll continue to expand, and that is, we'll like to learn more things such as the potential to utilize nurse practitioners or even moving towards buy-and-bill methodology from a regulatory standpoint. But we will limit the marketing, but we will start opening up the gates a little bit on that marketing, including our boots on the ground and potential DTC
Noel Atkinson - Analyst
Okay. And then just the last one for me here. Are you still targeting 140 centers, either opened for business or in developments this year?
Bill Leonard - President & CEO
Yes.
Noel Atkinson - Analyst
Okay, all right. Great. Thanks very much.
Operator
David Newman, Desjardins.
Bill Leonard - President & CEO
Hey, David.
David Newman - Analyst
And welcome back. It's good to see you back on your feet.
Erns Loubser - CFO & Treasurer
Thanks, David. Appreciate that.
David Newman - Analyst
So I guess, in terms of just the capital, you noted in the release that you have about two months of capital overall. So I'm sure you can't actually disclose what your plans are. But I guess you're looking at a range of alternatives? Is that a glean at how you're looking at things? Also, markets and all?
Bill Leonard - President & CEO
Yeah. I think we're in the process of addressing our cash requirements, really to fuel our ongoing operations and growth. As you know, the market was quite turbulent last week, which obviously isn't conducive to pricing a deal. As such, we decided not to price a financing last week and we will be discussing a more appropriate time with our Board and banking advisers. Good thing for us is we're fortunate to have strong shareholder support from investors that are partnered with us for long-term success. So we're reviewing all of our options as we speak.
David Newman - Analyst
Okay. And then in terms of the milestones that your lender was looking for access to the delayed drop, any indications of what they were looking for? Because it seems like a fairly short turnover. The financing was the end of last year and then these milestones to get access to it. Anything that you can disclose or is it just confidential
Bill Leonard - President & CEO
It is confidential. And quite frankly, we weren't expecting to hit those milestones in 2022. So I would tell you at this point, no need to discuss them.
David Newman - Analyst
Okay. And in terms of -- you're pretty -- sounds pretty confident, Bill, that things could be sorted out here, you can hit your 140. I think the 140 target was for midyear, right, if I'm not mistaken? And any other calls in cash that you've got other than the earn-out, which is, I think, $4.4 million due on June 30? Any other calls in cash for the first part of the year?
Erns Loubser - CFO & Treasurer
No, that's the main short-term obligation we have for the first time. You're correct in that.
David Newman - Analyst
Okay. And I did notice, guys, that in the provision for adjustment for variable consideration did decline Q over Q from $3.2 million to $1.2 million. So it seems like the taps are beginning to reverse here, or it's beginning a reversal of provision. So it seems like you're getting through the statewide credentialing and COVID repair processing and communications and things like that. Maybe just a status update on the credentialing and when do you expect that adjustment to wane, or, obviously, reverse in total?
Bill Leonard - President & CEO
Hey, Dave, thanks for pointing that out. Yeah, as we said on the last call, we expected that the work we had done in 2020 would start to show -- start to trend downwards. We're really pleased that what happened in Q1 in terms of seeing some of that focus we put on in the billing area really come to fruition, significant decline compared to where we were in Q4.
And we do expect that to continue to level out during the course of the year, which gets us back to normalized rates. And as we've said, there's been no change in any reimbursement rates. It's still strong and as expected.
David Newman - Analyst
Okay. So it sounds to me like if you're getting great indicators coming out right now and you can get your payer situation all straightened out, that the cash conversion should start to look quite good as we get into the back half of the year. Am I reading the TVs wrong?
Erns Loubser - CFO & Treasurer
No, that's absolutely correct. As Bill alluded to, we have over 20% adjustment for variable consideration in Q4 that came down to about 9% in Q1. We expect that to level off as we go through 2021. And also the improvements that we made in our billing procedures would increase or shorten the cash conversion cycle. So absolutely, we expect that to really yield results as we -- in the latter half of the year.
David Newman - Analyst
Excellent. And last one for me, guys. Just on the marketing spend, it came in around $2 million. What's your view -- is this the new level of marketing spend that we should expect or should that decline and normalize through time? What's your kind of marketing -- I mean, great that you're putting it on because, obviously, you want to monetize the environment, which is, obviously, not great for mental health but great for you guys in terms of the outlook. So what's your view on the marketing?
Erns Loubser - CFO & Treasurer
So that's a very good question. As I mentioned, we pulled forward a little bit of marketing to take -- I wouldn't say take advantage, but to capitalize on the momentum that we had going into March 2021. So you'd see that normalize through the -- our budget wasn't outsized. We just pulled forward a bit of marketing to really get the momentum going into Q2 2021.
David Newman - Analyst
Excellent. Thanks, guys, I will jump back on the queue.
Erns Loubser - CFO & Treasurer
Thanks, David.
Operator
Marie Thibault, BTIG.
Marie Thibault - Analyst
Good morning, Bill and Erns, thanks for taking the questions.
A question here on looking forward, maybe a two-parter question. March was a near-record month. Would love to hear what you were seeing in the early part of this quarter, April, particularly given some of the reopening that's been happening here in the states. And then, as you look forward, you mentioned some opportunities to expand -- opportunities that has been previously paused and delayed. Are there specific regions where you're looking to expand? Tell us how you're thinking about the opportunities there.
Bill Leonard - President & CEO
Great. Thanks, Marie. And great to hear you on the call. A couple of things. Let's start with number one, what we're seeing. As we alluded to, when you have a consultation number like we did, that really gives you a chance to see that there's been a lot more momentum built up from the patients and our marketing efforts, whether that's from the vaccine now in play, whether that's a little bit of the pent-up demand from people getting out of the house, it was a trend line, it was a record milestone for us. So we're excited about that as it leads into Q2.
In terms of how we look in development, obviously, two key areas for us, both on the M&A front and on an organic basis. What we like to do is look for markets that we need to add density in. So some of our growth that we will move forward with this year will be on areas that were new regions that we'll add density to. And then the area with potential opportunities at new regions that we really like, higher reimbursement areas.
So in 2019, we had a wonderful acquisition with the Achieve Partners. There's plenty of rooms to expand in that marketplace that has some gaps in our current centers, but also higher reimbursement rates. So I would say to you, majority of our development will come from newer regions or brand-new locations that we currently aren't in that have a higher reimbursement area, such as the California, the Northeast, areas like that we would focus on.
Marie Thibault - Analyst
All right. That's very helpful, Bill, thank you. And then, I guess, a follow-up here on maybe Spravato and some of the new indications. First on Spravato, what were you seeing in those first five or six pilot centers in terms of patient volume? And maybe, what competitors in the region were doing in response to you being able to offer Spravato. Just curious whether that can be extrapolated as you add more centers. And then on new indications, what are you seeing so far with the smoking cessation? I know it's very early days. Thank you.
Bill Leonard - President & CEO
Yeah. I'll go backwards with that. The smoking -- look, we love when the manufacturers, Neuronetics and BrainsWay, come out with new indications, it kind of proves the science of TMS therapy and potentially expands the scope until the reimbursement codes attach to it, a little bit less of demand. But smoking just got rolled out on April 29, limited rollout of 10 centers, we're thrilled to be part of it in St. Louis, but nothing to report yet. It's too early in the process in terms of any feedback to provide on this call.
In terms of Spravato, we're not getting pushed back from our rollout, specifically in markets where we have a large supporting community-based physicians that are using Greenbrook as an extension of their own practice.
And what we really did like in the findings was, it allowed us to capture a more sick patient suffering from depression. It also allowed us to take non-responding patients from previous TMS therapy experiences who really love their experience at Greenbrook but did not respond well. We saw a majority of our patients come from that particular pipeline. So it was a great chance for us to increase the revenue for that patient and keep them in the Greenbrook family.
So right now, we like the fact that our patients and our staff handled that Spravato patient in our centers. We'll continue to see patients come in for Spravato that may end up in TMS. So there was a cross-referral type situation. And we like the fact that it allows us to expand on our platform, especially in the world of TRD. So [I'm excited] to expand that out even further, and we'll continue to do so throughout the year.
Marie Thibault - Analyst
All right. Thank you for the time. I will jump back in queue.
Operator
Justin Keywood, Stifel GMP.
Justin Keywood - Analyst
Good morning, thanks for taking my calls. On the patient consultations that were up 52% from last year, are you able to characterize the mix of the patients if they're coming from GTMS's referral network or direct efforts? And I'm also wondering if you're seeing any new types of patients compared to -- prior to the pandemic or any key observations in what's driving that higher activity?
Bill Leonard - President & CEO
Sure, Jus. In terms of where that patient's coming from, I would say to you that the patients that come from the physician offices that we've worked with in the past continues to be at a high rate. We're also doing a really strong job in the marketing area creating -- casting a wider net on our direct consumer, especially that digital emphasis.
And in terms of like, what that demographic looks like or that patient pipeline, I think with the positive momentum from the payers in terms of -- in some cases, reducing the criteria to get into TMS therapy, we are starting to see a younger group to get in. Normally, our typical patient is somewhere between 37 to 54, I would look at that as a Facebook crowd.
But due to that criteria lowering our hurdles to get in, we're starting to see more of that 22 to 33 reach out. That patient's been on less medication, so they are starting to get interest in TMS exploring options. That generation also tends to explore other potential health care treatment modalities more so than that older generation. So we're starting to see a pickup in that younger demographic.
Justin Keywood - Analyst
Thank you. Interesting trend there. And then for Spravato, on the buy and bill versus administer and observe, just so I can clarify, would the buy and bill be part of the expanded pilot? And also, what would be the relative economics? I assume there's an expanded billing option there.
Bill Leonard - President & CEO
Yeah. So where possible, from a regulatory perspective, we will explore buy-and-bill methodology. And this could enhance the economics associated with the delivery of Spravato. Administer and observe is your entry point into that billing area and that is probably the most conservative approach in terms of it. So you will see more favorable economics when appropriate from a regulatory perspective with buy and bill.
Justin Keywood - Analyst
Okay. And then just finally, in expanding the network from 128 clinics to 140, I assume that could be accomplished organically. But are you seeing any acquisition opportunities out there? Or any indication on what some of our target valuation multiples could be?
Bill Leonard - President & CEO
Yes. We've talked about -- in terms of our expansion, it will be a combination of both organic and M&A. In our last disclosures, we did report that we've set aside roughly $10.5 million in terms of potential acquisition or two, so from a valuation standpoint, that's where we are.
Our last one was done at a combination with a multiple of EBITDA and also a cash-stock deal. So there's opportunities there. I think the pandemic has increased that opportunity for us. And obviously, we're thrilled to be back in the game and heading back on that growth trajectory that we're normally used to.
Erns Loubser - CFO & Treasurer
I think, adding to Bill there, in terms of we're going to land, as we've said at press con of our previous acquisition, we're going to land between that six and seven times EBITDA multiple, hopefully closer to the six.
Justin Keywood - Analyst
Okay. That's helpful. Thank you for taking my questions.
Bill Leonard - President & CEO
Thanks, Jus.
Operator
Tania Gonsalves, Canaccord Genuity.
Tania Gonsalves - Analyst
Good morning, gentlemen. I think most of my questions have been asked already. So just a couple for me here.
First is for Spravato pilot. So as you're building this out now, I'm wondering if, I think to my knowledge, there were certain restrictions on what parts of that patient dosing and experience you could actually control and what were left to the patients based on regulatory hurdles. As you expand this pilot, will you be taking on any more of that patient administration session in terms of responsibility?
Bill Leonard - President & CEO
Yeah. In that area, Tania, that's where we'd look at the regulatory perspective in terms of the buy-and-bill methodology versus administer-observe. You're still going to have to have oversight there from a physician. But we would look to expand out when appropriate at some of our centers.
Tania Gonsalves - Analyst
Okay. And then secondly, the marketing spend line item. Are you shifting where these dollars are going? I think there was a bit of a transition earlier in 2020, away from music, radio to more news, radio, TV. Are you coming back to spending on those normalized channels?
Bill Leonard - President & CEO
From our actual spend standpoint, it continues to be a mix of both the digital and direct consumer via radio, or, in some cases, when appropriate, TV in certain marketplaces. But really, we leave that in the hands of our Chief Marketing Officer to determine what is best.
Obviously, our dollars go a little bit further from a digital spend, that allows us to capture a wider range of patients and spread that net up further. But the good thing is, being or having a live database, we're able to see the results from those programs in real time and we adjust accordingly based on what we're seeing in the marketplace and our results.
Tania Gonsalves - Analyst
Okay. Great. And then correct me if I'm wrong, but I think Neuronetics is rolling out some customer programs where they come in and help train the personnel at these delivery centers to better manage how these patients are captured and taken through the treatment process up until follow-up. Are any Neuronetics personnel working in any, or working with any, of the personnel at your centers today?
Bill Leonard - President & CEO
We work closely with Neuronetics. I love what Keith and the team are doing in terms of expanding the awareness by spending more dollars in the marketplace. Obviously, we believe we'll benefit from that based on where our centers are and our number of devices installed throughout the US. We do work closely with the Neuronetics teams both on customized programs and utilize their new program in place for marketing.
Value add there for us, we do a great job of it. But obviously, with the two leaders that can enhance a program, then we'll take all the support we can from them. But we're thrilled to be working closely with them as we expand the marketplace.
Tania Gonsalves - Analyst
Perfect. And that's broad. That's -- they're helping you across every center that you have? Or are there just specific centers that it gets rolled out in?
Bill Leonard - President & CEO
Yeah. I think from our standpoint, we love their help in new marketplaces to expand that awareness that hasn't already been there. So for example, in DC, we have established roughly 15 to 18 centers. That DC-Baltimore marketplace, we've created some awareness ourselves, with Greenbrook awareness, probably less needed in that area versus somewhere where we roll out a new program and new centers like in the Florida market. So I would tell you if we're going to work together, it's going to be on marketplaces that are relatively new with less awareness, specifically for TMS and Greenbrook.
Tania Gonsalves - Analyst
Excellent. Thanks, Bill. And then just last one for me here. I think you touched already on M&A valuations and what you're seeing in terms of landscape. Could you talk to how the differential between public and private valuations has changed over the course of the last couple of months?
Erns Loubser - CFO & Treasurer
Okay. Yeah. I think from my end --
Bill Leonard - President & CEO
I'll take that. Hold on. I think from my end, obviously, we're comfortable in terms of what we acquired, Achieve TMS for. I think there is some private equity looking in the mental health space. Obviously, it's a marketplace that continues to grow, continues to be underserved. I think there can be aggressive valuations in that in play.
But the reality, we've competed against the private equity before and we're successful in our first acquisition out in California. I think that will continue to be a competitor to us in terms of not just other competitors looked in, but in terms of the price point as well. I think it sometimes it's not just providing a higher valuation, it's what additional services can you bring and what expertise you already have in place that makes it more valuable to work with a Greenbrook versus someone that's just coming into the marketplace.
Erns Loubser - CFO & Treasurer
Good. I think adding to Bill, so when we positioned ourselves very well to be a consolidator of the market and there's the significant benefit for us to be the acquirer, especially if stuff like in the Achieve West continues to stay in the business. So they like working with a bigger platform. So we do compete against private equity, but we'll continue a very disciplined acquisition strategy. And as I mentioned to Justin, I think we're comfortable where that valuation came in for the Achieve West deal.
Tania Gonsalves - Analyst
Okay, perfect. Thank you, Bill, thank you, Erns. That's all for me.
Bill Leonard - President & CEO
Thank you.
Operator
And there are no further questions at this time.
Bill Leonard - President & CEO
Thank you to everyone for joining today. We look forward to update you in the future. And obviously, we're excited about how the quarter ended and how we exited out. Look forward to the next call coming up in a couple of months. Have a great day.
Operator
This concludes today's conference call. You may now disconnect.