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Text: I'm joined by Steve Rusckowski, our Chairman, CEO and President; and Mark Guinan, our Chief Financial Officer.
Actual results may differ materially from those projected.
Risks and uncertainties, including the impact of the COVID-19 pandemic that may affect Quest Diagnostics' future results include, but are not limited to, those described in our most recent Annual Report on Form 10-K and subsequently filed quarterly reports on Form 10-Q and current reports on Form 8-K.
The company continues to believe that the impact of the COVID-19 pandemic on future operating results, cash flows and/or its financial condition will be primarily driven by the pandemic's severity and duration; healthcare insurer, government and client payer reimbursement rates for COVID-19 molecular tests; the pandemic's impact on the US healthcare system and the US economy; and the timing, scope and effectiveness of federal, state and local governmental responses to the pandemic, including the impact of vaccination efforts, which are drivers beyond the company's knowledge and control.
Any references to base business, testing, revenues or volumes refer to the performance of our business excluding COVID-19 testing.
Growth rates associated with our long-term outlook projections, including total revenue growth, revenue growth from acquisitions, organic revenue growth and adjusted earnings growth are compound annual growth rates.
Finally, revenue growth rates from acquisitions will be measured against our base business.
Now, here is Steve Rusckowski.
Well, we had a strong third quarter as COVID-19 molecular volumes increased throughout the summer.
While our base business continued to deliver solid volume growth versus the prior year and 2019.
In late summer, we experienced some softness in the base business across the country, but saw a rebound in September.
Importantly, our base business continued to improve sequentially in the third quarter, which speaks to the ongoing recovery.
We have raised our outlook for the remainder of the year based on higher than anticipated COVID-19 volumes as well as continued progress we expect to see in our base business despite rising labor costs and inflationary pressures.
The momentum of our base business positions us to deliver the 2022 outlook we shared at our March Investor Day.
But before turning to our results into the third quarter, I'd like to update you on our progress we've made in our Quest for Health Equity initiative, a more than $100 million initiative aimed at reducing healthcare disparities in underserved neighborhoods.
Since we've established just over a year ago, we have launched 18 programs across the United States and Puerto Rico ranging from supporting COVID-19 testing of vaccination events, to educating young students on healthy nutritional choices, to providing funding support for a long-haul COVID-19 clinic in Puerto Rico.
Recently, we announced a collaboration with the American Heart Association that will expand research and mentorship opportunities for Black and Hispanic scholars and drive hypertension management and COVID-19 relief.
We're off to a good start and I look forward to updating you on our continued progress as Quest for Health Equity enters its second year.
Now turning to our results for the third quarter.
Total revenue of $2.77 billion, down 40 basis points versus the prior year; earnings per share were $4.02 on a reported basis, down approximately 3% versus the prior year; and $3.96 on an adjusted basis, down 8% versus the prior year.
The revenue and earnings declines in the third quarter reflect lower COVID-19 testing in 2021 versus the prior year, partially offset by continued recovery in our base business.
Cash provided by operations increased by nearly 20% year-to-date through September to approximately $1.75 billion.
Now, starting with COVID-19 testing, our COVID-19 molecular volumes increased in the third quarter versus the second quarter due to the spread of the Delta variant over the course of the summer.
Testing began to increase meaningfully in mid-July and peaked in early mid-September.
Our observed positivity rate peaked in mid-August and has steadily been declining across much of the country in recent weeks.
We performed an average of 83,000 COVID-19 molecular tests today in the third quarter and maintain strong average turnaround times of approximately one day for most specimens throughout the surge.
As clinical COVID-19 volumes declined, we are expanding our non-clinical COVID-19 testing to support the return to school, office, travel and entertainment.
We're making testing easy, fast and affordable for school systems and other group settings across the country.
We are currently performing K through 12 school testing in approximately 20 states with five additional states ready to come online.
We're testing passengers on Carnival Cruise Lines and Quest exclusively provided testing at the Boston Marathon earlier this month.
In the base business, we continue to make progress on our two-point strategy to accelerate growth and drive operational excellence.
Now, here are some highlights from the third quarter.
Our M&A pipeline remained strong.
In the third quarter, we completed a small tuck-in acquisition of an independent lab in Florida.
We continue to build on our exceptional health plan access of approximately 90% of all commercially insured lives in the United States.
At our Investor Day, we discussed how we have fundamentally changed our relationship with health plans and we continue to see the promise of value-based relationships come to life.
So here is a couple of examples.
We are working with National Health Plans to help their self-insured employers, employer customers improve quality outcomes and lower the cost of care for both the employers and their employees.
Also, effective October 1, we gained access to 1 billion Managed Medicaid members in Florida as their coverage transitions to Centene's Sunshine Health Plan.
We're getting good feedback from the provider community in our growing testing volumes through this expanded access opportunity.
Our hospital health system revenue continues to track well above 2019 levels, driven largely by the strength of our professional laboratory services contracts.
As we highlighted previously, 2021 performance is benefiting from two of our largest PLS contracts to-date, Hackensack Meridian Health and Memorial Hermann.
Altogether, our PLS business is expected to exceed $500 million in annual revenue this year.
Trends in our hospital reference business also remained steady with third quarter base testing volumes above 2019 levels.
We also generated record consumer-initiated testing revenue through QuestDirect in the third quarter.
While COVID testing has been the strong contributor to growth, we expect our base direct-to-consumer testing revenue to more than double this year.
Recently, we soft-launched a comprehensive health profile on QuestDirect, similar to our Blueprint for Wellness offering for employers.
This expanded health plan panel offers a deep dive into consumers' health profile with a battery of test and biometric measurements to provide a personalized Health Quotient Score that can be used to track health progress over time.
And then finally, our MyQuest app and patient portal now has almost 20 million users.
In advanced diagnostics, we continue to ramp investments and see strong momentum in key growth drivers.
We're seeing strong growth in non-invasive prenatal testing significantly above 2019 levels and saw solid contribution in our specialty genetics portfolio from Blueprint Genetics.
We continue to work closely with the CDC to sequence positive COVID specimens in an ongoing effort to track emerging variants, expanding the -- of the work that we performed in the quarter.
And then finally, we plan to introduce a test service based on a new FDA-approved companion diagnostic from Agilent for a therapy from Eli Lilly for a certain type of high-risk early breast cancer.
Quest will be the first laboratory to offer it to physicians nationally at the end of the month.
Turning to our second strategy, driving operational excellence, we made progress and remain on track to deliver at our targeted 3% annual efficiencies across the business.
Last week, we announced that we completed the integration and consolidation of our Northeast regional operations into our new 250,000 square foot next-generation lab in Clifton, New Jersey.
This state-of-the art highly automated facility services more than 40 million people across seven states.
In patient services, we are seeing all-time high numbers of patients making appointments to visit our patient service centers.
Now, more than 50% of patient service center visits are now by appointment versus walk-ins and this enables patients to be very satisfied and also improves our ability to drive productivity of our phlebotomists.
Similar to our immunoassay platform consolidation, we recently procured a highly automated urinalysis platform that is expected to generate millions in annual savings once these new systems are standardized across our laboratory network.
As a demonstration of our gratitude, we're assisting our employees with a one-time payment of up to $500 designed to reimburse cost they incurred during the pandemic.
Additionally, another year of pandemic pressures and travel restrictions have made it very difficult for many employees to take their hard-earned time off.
Therefore, we are providing a payout of most unused paid time off for our hourly employees to ensure they don't forfeit their earned unused time at year-end.
For the third quarter, consolidated revenues were $2.77 billion, down 0.4% versus the prior year.
Revenues for Diagnostic Information Services were essentially flat compared to the prior year, which is reflected by lower revenue from COVID-19 testing services versus the third quarter of last year, largely offset by the strong ongoing recovery in our base testing revenues.
Compared to 2019, our base DIS revenue grew approximately 6% in the third quarter and it was up nearly 2% excluding acquisitions.
Volume, measured by the number of requisitions, increased 5.3% versus the prior year with acquisitions contributing approximately 2%.
Compared to our third quarter 2019 baseline, total base testing volumes increased 9%.
Excluding acquisitions, total base testing volumes grew approximately 4% and benefited from new PLS contracts that have ramped over the last year.
We saw a rebound in our base business volumes in September following a modest softening in August that we believe was at least partially caused by the rise of the Delta variant and the timing of summer vacations.
Importantly, our base business revenue and volume grew sequentially in the third quarter.
This helps illustrate the ongoing recovery as historically total revenue and volumes typically step down in Q3 versus Q2 due to summer seasonality.
As most of you know, COVID-19 testing volumes grew in the third quarter versus Q2, which was in line with broader COVID-19 testing trends across the country.
We resulted approximately 7.6 million molecular tests and nearly 700,000 serology tests in the third quarter.
So far in October, average COVID-19 molecular volumes have declined approximately 10% from where we exited Q3 but are still above the levels we expected prior to the surge of the Delta variant, while the base business continues to improve since September.
Revenue per requisition declined 5.4% versus the prior year, driven primarily by lower COVID-19 molecular volume and, to a lesser extent, recent PLS wins.
Unit price headwinds remained modest and in line with our expectations.
Reported operating income in the third quarter was $652 million or 23.5% of revenues compared to $718 million or 25.8% of revenues last year.
On an adjusted basis, operating income in Q3 was $694 million or 25% of revenues compared to $831 million or 29.8% of revenues last year.
The year-over-year decline in operating margin was driven by lower COVID-19 testing revenue, partially offset by the recovery in our base business.
Reported earnings per share was $4.02 in the quarter compared to $4.14 a year ago.
Adjusted earnings per share was $3.96 compared to $4.31 last year.
Cash provided by operations was $1.75 billion through September year-to-date versus $1.46 billion in the same period last year.
Turning to guidance, we have raised our full-year 2021 outlook as follows.
Revenue is expected to be between $10.45 billion and $10.6 billion, an increase of approximately 11% to 12% versus the prior year.
Reported earnings per share is expected to be in the range of $14.69 [Phonetic] and $15.09 and adjusted earnings per share to be in the range of $13.50 and $13.90.
Cash provided by operations is expected to be approximately $2.2 billion and capital expenditures are expected to be approximately $400 million.
Before concluding, I'll touch on some assumptions embedded in our updated outlook.
We expect COVID-19 molecular volumes to continue to decline from Q3 levels throughout the remainder of the year.
At the low end of our outlook, we assume approximately 50,000 molecular tests per day in Q4 and serology volumes to hold relatively steady at approximately 5,000 tests per day.
As you may know, late last week, the public health emergency was again extended another 90 days through late January.
We expect reimbursement for clinical COVID-19 molecular testing to hold relatively steady through the remainder of the year.
However, we continue to assume average reimbursements to trend lower in Q4 as our mix of COVID-19 molecular volumes potentially shift from clinical diagnostic testing to more return-to-life surveillance testing.
Finally, we continue to assume low single-digit revenue growth in our base business in Q4 versus 2019.
Getting to the midpoint or higher end of our outlook ranges assumes stronger COVID-19 molecular testing volumes and/or stronger growth in our base business.
Well, to summarize, we had a strong third quarter.
We have raised our outlook for the remainder of the year based on higher than anticipated COVID-19 volumes as well as our continued progress we expect to see in our base business.
And finally, the momentum of our base business positions us to deliver the 2022 outlook we shared at our March Investor Day.

user
compname posts qtrly adjusted diluted earnings per share of $3.96.
quest diagnostics inc - raises full year 2021 outlook to reflect higher than anticipated covid-19 testing volumes.
quest diagnostics inc - q3 reported diluted earnings per share (eps) of $4.02.
quest diagnostics inc - qtrly adjusted diluted earnings per share of $3.96.
quest diagnostics inc - had a strong q3, as covid-19 molecular volumes increased throughout summer.
quest diagnostics inc - in late summer we experienced some softness in base business across country, but saw an overall rebound in september.
quest diagnostics inc - base business continued to improve sequentially in q3 which speaks to ongoing recovery.
quest diagnostics inc - q3 revenues of $2.77 billion, down 0.4% from 2020.
quest diagnostics inc - sees fy net revenues $10.45 billion to $10.60 billion.
quest diagnostics inc - sees fy adjusted diluted earnings per share $13.50 - $13.90.
quest diagnostics inc - sees fy reported diluted earnings per share $14.69 - $15.09.

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