TruBridge Inc (TBRG) 2015 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by.

And welcome to the CPSI second quarter 2015 earnings conference call.

(Operator Instructions)

As a reminder, today's call is being recorded Thursday, July 30th, 2015.

Now, I'd like to turn the conference over to Mr. Boyd Douglas, President and Chief Executive Officer.

Please go ahead, sir.

Thank you, Tommy.

Good afternoon, everyone, and thank you for joining us.

During this conference call, we may make statements regarding future operating plans, expectations, and performance that constitute forward-looking statements made pursuant to the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995.

We caution you that any such forward-looking statements only reflect management expectations and predictions based upon currently available information and are not guarantees of future results or performance.

Actual results might differ materially from those expressed or implied by such forward-looking statements as a result of known and unknown risks, uncertainties, and other factors, including those described in our public releases and reports filed with the Securities and Exchange Commission, including, but not limited to, our most recent annual report on Form 10-K.

We also caution investors that the forward-looking information provided in this call represents our outlook only as of this date, and we undertake no obligation to update or revise any forward-looking statements to reflect events or developments after the date of this call.

Joining me on the call is David Dye, our Chief Financial Officer.

David and I have a few minutes of prepared comments, and then we'll be happy to take your questions.

We continue to see weakness in the inpatient EHR market as hospitals catch their breath from the financial and operational drain of meeting meaningful use.

I think it is fair to say that the resource impact of a full EHR implementation and subsequently meeting MU standards in a relatively short timeframe is felt more deeply at rural and community hospitals than at their urban counterparts.

As a result, our new system sales continue to be impacted, and we are certain our competitors are experiencing similar effect.

I want to emphasize we are 100% confident that this is a market condition, not a lack of execution on our part.

In fact, our win ratio in new business deals continues to track at its highest level ever.

The fact of the matter is there are very few decisions to rip and replace an incumbent EHR being made right now, even among those hospitals that are dissatisfied with their current vendor.

We believe this hesitancy to make a change is probably attributable to several factors -- the desire to take a pause from EHR implementation that I just described, the fact that CMS has still not officially adopted its announced intention from earlier this year to change the required stage 2 reporting period for 2015 from 365 days to 90 days, though this still could happen in time to have a positive impact.

And finally, there's the ICD-10 adoption date of October 1st that is only two months away.

Any combination of these factors is going to most likely prevent most hospitals from taking on a new system search and replacement right now.

With that being said, we are more than positive about where we are today with regard to sales growth.

First, we believe the market softness is a short-term condition.

Meaningful use stage 3 is coming, ICD-10 adoption will pass, and hospitals will begin to recover from stage 1 and stage 2 and evaluate their options.

In fact, the number of potential clients we term either a suspect or a prospect is up appreciably over the last couple months.

And while we believe the market is already showing signs of turning, we started back in 2014 taking steps to identify other potential sources of revenue and act on those opportunities.

In our current client base, sales of our ED information system continued to meet our projections of 10 to 15 new installs per quarter.

We are gaining increasing traction with our client hospitals with our Thrive Provider EHR ambulatory solution, as hospitals and providers more and more realize the necessity of a single patient record in the face of upcoming reimbursement changes.

Thrive UX, our new user experience application, has been very well received since its release at our National Users Conference in April.

And reports from initial adopters have been excellent.

A second new product, and our first iPad app, Mobile Rounding, is out in the field as well and likewise has gotten positive reviews.

We expect sales of these two applications to increase throughout the remainder of the year.

As you all know, we started an intensive rebranding effort with the formation of Evident as our customer-facing EHR company in April.

One of the primary objectives driving that effort has been to change the perception regarding our ability to compete in hospitals between 100 and 300 beds.

As I've said before, we have been compartmentalized by our success in the under-100-bed market for some time, even though we have a number of hospitals effectively using our system in the 100- to 300-bed range.

Now that we are well into establishing our identify as Evident, we are in the process of assigning dedicated sales staff to address these larger facilities.

We have invested heavily in this effort and have high expectations with regard to increased penetration into these hospitals.

The two opportunities we are most excited about, though, are the Canadian market and data analytics.

We gained a great deal of valuable insight around the immediate opportunities in data analytics when we met with those hospitals that participated in our pilot project at our National Users Conference.

Since then, we have been moving forward with our development around business intelligence dashboards before moving into predictive and prescriptive areas.

As I've said previously, we expect to bring this to market by the end of the year.

We have spent a great amount of time in evaluating the Canadian market and have no doubt a significant opportunity exists there for us.

There are numerous rural and community hospitals.

And with one exception, none of our traditional competitors in the US are engaged in Canada.

Our EHR already meets the vast majority of requirements there, especially with regard to clinical applications.

We have already hired sales staff with Canadian market experience, and they're in the process of localizing our Thrive EHR platform to meet Canadian requirements.

While the fact that Canada having a nationalized health care system impacts the sales cycle, as opposed to the US market, we are confident we will see results in Canada within a year and expect it to be a substantial part of our growth in new hospital sales for an extended time to come.

With the formation of Evident, we initiated a renewed emphasis on our customer experience.

We have always considered implementation and support to be our strong suit and have continually stressed its importance to our success as a company.

Our track record to date shows that we have exceed very well here.

That being said, the opportunity exists for us to take our customer experience to an even higher level, as we believe this will take on even greater importance as a differentiating factor between us and our competitors.

We're instituting several programs as part of this initiative, which is known as LikeMind.

One aspect of LikeMind involves a significant restructuring of how support requests are processed, as well as moving clients to having specific support personnel, including management-level individuals dedicated to their sites.

We started piloting this program the first of the year and announced it to our customers at our National Users Conference, and to date have moved 70 of our clients over to the new model and are on track to have the remainder of our customer base transitioned by the end of the year.

The response of the customers on the program has been overwhelmingly positive.

We are resolving support requests quicker, with fewer transfers among support staff.

And the fact that we have dedicated management responsible for specific sites allows us a great level of familiarity with each hospital structure, users, and system implementation.

This lets us be more proactive in supporting our clients.

As I have said before, the formation of Evident was not just a name change, and the LikeMind customer support experience is just one key aspect of who our company is now as Evident.

At this time, I'd like to turn the call over to David for a few comments on the financials.

Thanks, Boyd, and good afternoon, everyone.

In the second quarter, we installed the Thrive Financial and Patient Accounting System in six hospitals, and our core clinical departmental applications at four facilities.

Additionally, four hospitals implemented Thrive point-of-care documentation, 13 installed our Thrive Emergency Department Information System, and five customers went live with physician applications.

Thrive Provider EHR was installed at 16 facilities.

Add-on sales to existing clients were $7.5 million or 16% of total revenue for the quarter.

At this time, we expect to install Thrive Financial and Patient Accounting Systems in four new client facilities in the third quarter.

We anticipate four installations of our core clinical departmental modules, four point-of-care documentation implementations, eight installations of physician applications, and 13 ED implementations.

Additionally, we expect to install Thrive Provider EHR in 14 facilities.

Our employee headcount as of June 30th was 1,375.

And CapEx for the quarter was $125,000.

Our second quarter G&A expense includes approximately $525,000 in one-time nonrecurring legal expense.

Our year-to-date G&A expense also includes approximately $500,000 in costs associated with our corporate rebranding project, of which about half was expensed in the first quarter and half in the second.

As of June 30th, the rebranding project was essentially complete and fully expensed.

TruBridge continues to perform exceptionally well.

Our record year-over-year revenue growth of 17% and gross margin performance of 39% are ahead of plan.

TruBridge's sales results for the quarter were impressive as well, with eight new contracts for full business office management services and nine new customer agreements for private-pay collection services.

Sales from medical record coding services ahead of the ICD-10 requirement continued to be strong, with 12 new customers coming onboard during the quarter.

Finally, as stated in the press release, we are lowering our previously issued 2015 full-year revenue guidance to a range of $188 million to $192 million, and net income guidance to $23.2 million to $24.5 million.

This is reflective of our lower-than-expected system sales performance year to date and anticipated continued weak system sales for the remainder of 2015.

As Boyd detailed in his comments, we expect the system sales environment to remain challenging through the first half of 2016, at which point we believe both the replacement market and add-on sales market will improve substantially.

And Tommy, if you could please open the call for questions.

(Operator Instructions) Jamie Stockton, Wells Fargo.

I guess maybe the first one, Boyd -- you talked about how the pipeline of suspects and prospects is better than you've seen it in a while.

Can you just -- and I think you've done this before, but I've forgotten -- can you go back and help us understand how you define those categories, and if there's anything quantitative that you can give us on the number of hospitals that you see in those categories?

Sure.

I want to recap around the quantitative part of the question.

But as far as defining it -- suspects are hospitals that we expect to start a sales process within the next 12 months.

And really, most of them probably start within six months.

But those are people that aren't in process yet but have begun with preliminary questions ,and we expect to be a part of that process.

And it should start again, certainly, within 12 months.

A prospect is someone that -- in most cases, the way the sales process would get started was with an RFP.

And you're a prospect once an RFP is issued and we've responded to it, and we know we're being included in the process.

Then you're a prospect.

And the only color I want to add around those numbers -- just for the last two quarters now, those numbers have increased.

So that number went up a little bit in the first quarter, and it went up even more the second quarter.

So it's showing signs of life in the market that it will come back.

Okay.

And then, David, on the TruBridge business -- eight full back-office outsourcing clients is a very healthy quarter.

I know that business seems to be humming fairly well.

Can you talk about -- is it ICD-10 that's really driving a lot of that?

Hospitals are kind of panicking ahead of the deadline and feeling they have to do something?

I think Med Assets talked about on their call last night that that was helping their revenue cycle business --

Yes.

I --

Go ahead.

I'm sorry, Jamie.

I think with regard to the full business office outsourcing, where we run the entire operation, I don't know if ICD-10's much of a contributor there.

It certainly is with the coding and, I would say, is probably the primary reason that we have so many hospitals that have signed up recently and continue to be actively engaged in looking at us potentially taking over that service for them.

I think with regard to both the private-pay and the full business office outsourcing, it has more with us to do with the fact that we're really now getting some major traction in the non-Evident EHR customers, those that are using competitive systems.

We started this, as you know, almost two and a half years ago now, where we went out with the TruBridge brand with the goal of trying to be successful, not just within Evident customers but all small hospitals.

And we're really starting to see success there.

Which is why we're optimistic that success can continue for a while.

Okay.

My last question is just on the cash, with taking the guidance down.

Is there any update on where your expectation is as far as where the cash will end the year?

I think before, you guys had said that you thought you'd probably generate some cash this year.

Is that still the case?

Yes, we still do, based on the status of our AR and what's left in the Gen2 contracts.

We still expect to end the year with roughly a little more than $40 million in cash.

And I think in looking at cash as well, one of the things we look at as a positive is that, while paying the dividend that we paid for the second half of 2014 and the first half of 2015, our cash and investment balance is up about $13 million year over year.

So we feel very good about it.

Okay.

Thank you.

Thanks, Jamie.

George Hill, Deutsche Bank.

I know you guys don't like to give guidance beyond the one-year.

But you mentioned kind of a longer-term 2019 outlook in the release.

I guess, would you be willing to give any guidance around what you think the longer-term growth expectations are for the business services business?

And what do we think the steady-state or the normalized system sales -- whether it's a number or whether it's a growth rate -- looks like?

Or maybe just -- you guys put the line in there about the recurring revenue being 80% of the business.

Just kind of talk us through the thought process on that.

Yes.

On the TruBridge side, I think we're comfortable with mid-teen growth.

I think on the system sales side -- and I'll get back to the reason why that was in the release -- there's really two reasons.

One is we do, because of stage 3 -- we're not 100% sure of the timing.

As I'm sure you're aware, there's some chatter about extending it a little bit.

But there is a -- will be a definite increase in demand, certainly with our customers.

That's a given for add-on sales.

But then, in the replacement market as well, we are aware of some sunsets, and I'm sure you are as well, that are going to occur that'll stir up that market.

We are now, as a company and as a management team, thinking a lot about 2019.

Because we feel as though the second half of 2016 through the first half of 2018 should be really good from a system sales standpoint.

But we feel like in 2019 we're likely to be in a situation similar to what we're in right now.

So another reason why is that we think -- and this has been something that we've been talking about for about a decade -- it's called ASPs, and then SaaS, and now cloud.

And the technology's a little different, but it's still the same concept of a monthly recurring payment for access to a system.

But we feel like that percentage of new client business that's going to go in that direction is increasing and will continue to increase, and that it's probably here to stay this time.

And so that's why by 2019 we feel that a much greater percentage of our overall revenue will be occurring than has been historically.

So I think -- hopefully that answers your question.

No, that's good color.

I guess maybe, then, one other thing I'd ask -- could you just remind us the ASP on the ambulatory product?

And is there an ASP that goes with the app product?

And I guess what I'm trying to just figure out is -- do you guys feel like you sell enough of them to move the needle from a revenue or an earnings perspective?

Yes.

I mean, the ASP is about a hundred grand each on average, maybe a little bit higher than that.

And certainly, 10 to 15 a quarter is enough to move the needle for us.

If we get back to where -- with stage 3, where we've got some significant add-on sales in some other areas, and some more new system sales as well, and then you throw that on top of it, we would have some significant system sales growth at that time.

Okay.

I'll hop back in the queue.

Thanks, guys.

Thanks, George.

David Larsen^, Leerink Partners.

Can you just talk about who you're seeing in the market?

I mean, who are you competing with?

Is it still sort of the same cast of characters, like MEDITECH and a couple other vendors?

And just sort of the competitive environment -- description would be great, thanks.

Sure.

Certainly, the traditional competitors are all still there.

So haven't seen significant change there.

Probably the only change we've seen -- we are seeing Cerner again more.

If you all remember back several quarters ago, we saw them.

That seemed to kind of be a one-time thing.

But we definitely run into them more recently than we have historically.

Okay.

And then, can you talk about sort of the competitive advantages that TruBridge brings to your hospital customers?

Just remind us sort of the value prop that TruBridge brings, and how they can basically improve cash flows or rev cycle operations with you guys -- maybe they can't do [with] themselves.

Thanks.

Yes.

With our most popular revenue cycle services, private-pay collections and -- I think most community hospitals admittedly would say that they do either something between a nonexistent and a poor job at that.

It's very cumbersome and labor-intensive to go after relatively small balances.

And they don't necessarily have the staff to be there after hours to do the dialing for dollars that we're able to do with our efficient call centers and our software.

So that, I would think, would be the easiest one, and the one that we have -- therefore we have the most customers.

On the full business office outsourcing service -- generally speaking as well, there's a lot of hospitals out there that struggle to keep good people in rural areas and to do a good job keeping their AR days down and keeping up with the regulations and so forth.

The biggest thing that we struggle with competitively there still is competing with the concept of the hospitals keeping in-house.

Because those jobs are valuable to the community.

And they can be anywhere from -- two to 12 FTEs in a rural community is very important.

So they're very hesitant to let go of those jobs in order to let us take over that for them.

And we do have competition out there, too, Dave.

But generally speaking, there still isn't a national competitor that focuses on the rural hospital market.

Great, thanks very much.

And then, just one last quick one -- I think there was $400,000 of meaningful use Gen1 revenue still outstanding.

Did you collect that?

I think it was the end of the last quarter, the number was $300,000.

And we are collecting $15,000 a month.

So the number was no longer material, so we removed it from the press release.

Great.

Thanks a lot.

Thank you, Dave.

Jeff Garro, William Blair & Company.

I wanted to ask a little bit more about systems bookings, and in particular the ambulatory and EDIS products.

You've talked about the number of installs the last couple quarters.

But as we look out the next six to 12 months, do you still see a robust demand environment for those products given that they're not tied to specific meaningful use mandates?

I don't see a big change in the demand.

I think it's still there.

And we're still targeting 10 to 15 per quarter for both of those applications.

Great.

And then, looking at some other newer products that you've discussed -- I was hoping you could frame the revenue opportunity around the mobile rounding product and the new Thrive UX.

Yes.

The rounding product is on a per-seat basis.

So if a hospital wants to do it for just a couple docs, it can be as low as about $5,000 initially plus support.

And the idea being that a couple docs will start using it, and the other docs will see it, and then it'll take off from there.

It can go as high as, say, $50,000 if you have a hospital that rolls it out to the majority of their docs.

So that one -- a lot of this just remains to be seen.

But that's the range that that can be.

On the Thrive user experience -- we think the average there will be about $70,000 per site.

Great.

And then, one final question -- I noticed the tax rates seemed to come in a little bit lower again in the quarter, and want to see if there's any change to your expectations for tax rate for the remainder of the year.

No, it's not.

Our expectation is about 35% for the remainder of the year.

We had an additional reversal of some previous FIN 48 reserves for R&D tax credits that based on new information were reversed.

Great.

Thanks again, guys.

Thanks, Jeff.

Donald Hooker, KeyBanc.

I guess my question -- trying to understand some of the revenue lines, just so we can sort of level-set as we start thinking about 2016.

So the support and maintenance was flat sequentially, it looks like, and flat year over year.

I think there were some catch-up payments from prior installations that were coming through.

Should we still expect that in the second half of 2015?

Yes, there were some catch-up payments at the end of last year.

A lot of that is attributable to our weak system sales.

And as the Gen2 contracts pay off in full, that increases our support and maintenance a little bit as well.

Additionally, we had gone through a period of a couple years without increasing the support and maintenance going up on our normal rates.

And we started to do that again in the spring of this year, so that'll impact it positively as well.

Got you.

So that'll increase in the second half, I guess?

Yes.

And the -- okay, got you.

And then the other -- I guess also, I'll just ask one more and jump off.

Again, kind of trying to level-set here on the gross margin for TruBridge -- is this sort of a -- pretty sizeable bounce-back there, and is this sort of a normal level?

And again, I realize this is an area you want to grow, so you might choose to have that go down.

But just wanted to get in your head in terms of where we should plan for that margin to go forward, the level-set expectation.

I think going forward over any 12-month period at this point, I would say between 38% and 39%.

(Multiple speakers) it can vary by quarter.

But on an annual basis, going forward from here, that's what we're looking at.

Got you.

I will leave it to that.

Thank you.

Thanks, Don.

Garen Sarafian, Citi Research.

First, a quick follow-up to Don's question -- what's the average price increase pass-through in support and maintenance in the spring?

About 4%.

Got it.

And then, on visibility, just curious -- is there a specific catalyst mid-2016 related to incentive, or any catalyst that you're thinking of?

Or is it more just on how your pipeline is shaping up now?

It's a combination of the fact that the new prospects that we have now would convert into revenue conservatively in the second half 2016, and the fact that the more aggressive hospitals, if you will, in the community hospital market space will be reacting to stage 3 in the second half of 2016.

Those that wait till the last minute will be reacting to it in the very first half of 2018.

The full year that looks to benefit the most from stage 3, obviously, is 2017.

So it's a combination of those two things.

Got it.

And then, results -- in your prepared remarks, you mentioned results in Canada within a year.

Could you elaborate on that a little bit more?

Is that having one pilot?

Or is it more of a meaningful contribution to financials?

I think it would probably be more than one pilot.

But I don't think it'd be meaningful at that point.

But ideally, my goals would be to have two or three by then.

Got it.

And just lastly, if you could just repeat -- is your success rate in displacements increasing?

And if you could elaborate a little bit on the RFP flow for the quarter?

Thank you.

On the win rates -- basically, the way we calculate win rate -- because that can be a funny thing to do -- I think I've gone through this before, but just to make sure that we're all on the same page -- the way we calculate win rate is if we get to demonstrate our software.

And then, if there's a decision made by the hospital, whether it's for Evident or not for Evident, then we count that as either a win or a loss.

And that rate is at an all-time high right now.

I think the second part of your question, in terms of the number of actual prospects since the last quarter, is up about 50%.

50%.

Okay.

Great, I'll hop off.

Thank you.

Thanks, Garen.

Matthew Gillmor, Robert Baird.

I wanted to ask a follow-up about the Canadian opportunity -- can you give us a sense for how that market is structured?

Is this more replacement or greenfield?

And then, is the ownership structure similar to the US, where it's mostly nonprofit and government hospitals?

Yes.

It's mostly replacement of an existing financial and patient accounting piece, along with some clinicals.

We would equate it to the US market five to seven years ago, where there's not a full EHR, but they've got financial patient accounting plus lab radiology, maybe nursing order entry.

But not nursing point-of-care and CPOE, and that type of thing.

I mean, of course, I'm generalizing here.

And yes, it is very similar.

A lot of the hospitals operate in what are called LENs -- local hospital networks.

And so there are more that are -- and some LENs are in a situation where a decision is made for all the community hospitals and is dictated.

And some allow for more independence, and each individual hospital can make a decision.

So there are some traditional US companies that you'd be very familiar with that have approximately 75% of the market now, at least in terms of financial patient accounting.

And then, about 25% have some Canadian-based software for their core.

And we're primarily targeting Ontario at this point, primarily English-speaking and has the most community hospitals.

Yes.

And then, just one other quick one -- I know the backlog conversion for system sales can bounce around.

But it seems like that ratio has come down a little bit.

Is there anything to call out?

Has there been any delays in implementation?

Just kind of curious about that ratio.

Yes, we had one new install push from the second quarter.

[Perfect].

But other than that, nothing.

Okay.

Thanks a lot.

Thank you, Matthew.

Mohan Naidu, Oppenheimer.

This is actually Mike Ott, on for Mohan.

Just to follow up on Canada for a minute here -- could you help us quantify, maybe, the number of small hospitals in English-speaking Canada and how that might compare to the US market here?

There are about 450 hospitals that we feel like are in our sweet spot, in our target market, in Canada.

All right, thanks.

And then, to follow up on TruBridge a bit -- do you have a number for roughly how penetrated you are in your CPSI customer base, either in terms of number of clients or number of solutions that they're taking?

Probably the number I can give you that's the best is 90% of Evident customers utilize TruBridge for at least one service.

But that could be anything from statement outsourcing, where we print and mail the statements, to full business office.

So by particular service, it's a little bit harder to come at, and I don't have those numbers right here in front of me.

But 90% of the Evident base is utilizing TruBridge for at least one service.

That's helpful, thanks.

And then, just lastly, on the Like Minded initiative you mentioned, with customer service -- is that something that you can quantify as having any kind of impact on your new 2015 guidance here, or not really a needle-mover in terms of --

It's not a needle-mover, it's just really a change in the way we're delivering support.

Okay.

Thanks very much.

Thank you very much.

And Mr. Douglas, we have no further questions on the line.

I'll turn it back to you.

We appreciate everyone's time this afternoon.

Thanks for joining us on the call.

Thank you for your interest in CPSI.

Hope everyone has a great weekend.

Thank you.

Thank you very much.

And ladies and gentlemen, this concludes the conference call for today.

We thank you for your participation and ask you to disconnect your lines.