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Text: In today's remarks by management, we will be discussing non-GAAP financial metrics.
I'm, of course, pleased with our results for the quarter, which were ahead of what we could have foreseen when we talked to you in February.
Our patient volume strengthened through the quarter, ramping up to March and into April.
I'm sure most of you saw the statistics published this week by the CDC, which indicated a sharp downturn in nationwide births in the fourth quarter of 2020.
As you know, we experienced the same trajectory at the end of last year, but to a significantly lesser degree.
We believe this reflects the typical profile of the hospitals where we provide neonatology services, which tend to be larger and bigger markets and with extensive labor and delivery services, including robust neonatal ICUs.
It may also reflect our geographic footprint, which has a heavier weighting in faster-growing states and markets.
Now through into the first quarter and the roughly 400 hospitals that make up our own births statistics, this downward trajectory on price did not continue.
Adjusting for the leap year, total births at the hospitals where we provide NICU services were essentially unchanged in Q1, which is better than what we reported in late 2020.
Lastly, while it's too early to make a final call, the improvement in our payer mix so far suggests that the volatility we experienced in November and December could have been more of an anomaly.
To give me one quick insight into how this rebound in trends impacted our results, our revenue for the quarter, excluding the CARES money we recorded, was over $30 million ahead of our internal expectations, which translated into meaningful year-over-year growth in adjusted EBITDA versus the expectation we shared with you in February that it could easily be down versus 2020.
Looking ahead to our full year 2021 expectations, we expect that our 2021 adjusted EBITDA will be at or above $220 million.
I said last quarter that we'll listen closely at our 2019 adjusted EBITDA of $265 million before the pandemic as the best available benchmark for how our business is recovering as well as backing out our estimate that the 2020 impact of the pandemic was roughly $40 million to $50 million.
If you look at the first quarter of 2021, our adjusted EBITDA of $45 million was still below the first quarter of 2019.
And when we reported -- and that's when we also reported $50 million in adjusted EBITDA.
And when you exclude the roughly $4 million in contribution from the CARES fund we recorded this quarter, we were roughly 18% below Q1 2019.
So while I'm certainly pleased with our results, it's still clear that we're not back to normal and, in fact, that our first quarter results reflect a similar run rate of COVID impact to what we experienced last year.
I don't think this should be surprising, given the unique nature of the services we provide and the time led of this COVID impact and since much of our patient volume is based on pregnancies and trial birth timing.
Lastly, I'll add that our operating results for the past two quarters have been unusually volatile.
So we're also mindful of the still uncertain nature of how fast or consistently we'll see things recover.
Now I've talked for a couple of quarters about my confidence that we can achieve a run rate of $270 million in adjusted EBITDA once we move past the impact of COVID-19 pandemic.
Our results bolster our confidence that we will reach and exceed that run rate.
But I'm not confident just because we saw better trends over the past couple of months.
I'm confident because we continue to push our operating plans and because we are reshaping how we do things here.
Our singular focus at MEDNAX is to reinforce our position as the formal provider of women's and children's healthcare in the markets we serve and to do so efficiently and as the best partner we can be to the patients we serve as well as to the payers and health systems we work with.
So let me talk about what we've been focused on and speak to you about our core Pediatrix and Obstetrix.
It's all about the patient.
Since MEDNAX first began caring for mothers and babies in their most challenging times about 40 years ago, the only absolute imperative that our founder and Board member, Dr. Medel, prescribed has been take great care of the patient.
Much of my time is spent with our clinicians, hospital partners, prospective partners, and of course, with my team.
And I can attest to this unwavering commitment.
There's an unshakable conviction at MEDNAX that we always take great care of the patients, everything else will follow.
Now that's easier said than done.
To take the best care of the patients, the mothers, babies and children required a lot of work and investment.
First, we have to recruit and retain the finest physicians and clinicians.
Second, to do this, we try to provide more support for our affiliated clinicians than anyone else in our field.
Third, we have a foremost independent research organization in our field of medicine, including complex newborn screenings.
one in four babies in the U.S. are patients of ours.
We have more knowledge and data in these areas than anyone else.
And since our care is provided, of course, at a very local level, we have to provide more support for our affiliated clinicians in each market where we are than anyone else.
Finally, we must always lead in our field.
For example, one of the most critical and active parts of our organization is our clinical support group.
This grew along with our full support team, make sure that we can continue to advance our skill and knowledge for the sake of our patients.
In two weeks, as we did even during the depth of the pandemic last year, we will be holding our Annual Medical Directors Meeting, where over 2,000 clinicians will actively participate and will learn from research, quality and clinical experts.
On top of these areas, we provide system support, recruiting support and every other kind of health to allow our clinicians to, again, take great care of the patients.
This long-winded tour of what we do is what I believe makes a de-choice among our nation's hospitals.
This is what makes us a lead employee, a partner to great medical brands.
This is what makes us the leading referral choice of physicians who want their patients to be in our care during their most difficult minutes, days and weeks.
I've spoken about our drive to employ our practice data and dashboards to improve patient access.
This has and continues to be a paramount importance to us.
It's a steady drumbeat.
We want to be certain that a patient who needs care from one of our affiliated physicians gets that care as soon as possible.
And we know as business leaders and owners the effect that this can have on volume.
So we're working with all of our practices to help them make scheduling as driven and efficient as we can, making sure their appointments are kept and immediately rescheduling no-shows, backfilling cancellations, using our scheduling tools to open additional slots staggering staff, outreach and referral management.
They're all part of this necessary equation.
We've already seen improvements in many practices, particularly in terms of higher percentages of kept appointments and reductions in no-shows.
This focus is also helping us to share best practices and create benchmarking capabilities so we can measure how effective our data has on practice scheduling in every measurable factor beyond just the post COVID recoveries we've recently seen.
We all know that a physical visit is not always needed or possible.
And we will make our telehealth process fluid to help our patients and attract new patients.
This efficiency and effectiveness also applied to our growth plans.
Our sales and business development team has reengineered a focused market-by-market approach that's driven by local intelligence and relationships.
We've also added resources to this team to make sure that we're highly integrated, not just in intensifying and winning new business but providing services quickly and seamlessly to the partners who put their trust in us and in pediatrics affiliated physicians.
In my view, we've lapped until now two other major ingredients to propel us forward.
First, our patient relationships have not extended path to our subspecialty practices.
We need to make sure as well as we can that when a patient needs to see a physician in our network, they can do so as quickly as easily as possible.
We're moving forward in pediatric urgent care to develop plans for expansion of their business in markets where we have a significant presence, and we will expand with our brand name pediatrics.
We believe that providing pediatric primary and urgent care and patient-friendly dedicated clinics will allow us to give patients easier access to the exceptional specialists across our organization when they need it and will also help strengthen our relationships with the communities where we provide services and with our hospital partners.
And maybe most significantly, we believe nobody knows how to care for babies, children and mothers like we do.
And we want to fully extend the types of relationships we currently have.
When a mother on trial want to find the best primary and urgent care practice, our answer should be and will be right here with us at Pediatrix.
Second, our brands, Pediatrix and Obstetrix, are not widely known.
We do believe our hospital partners know our name very well.
And more importantly, they know that they can rely on us for what we can do for their patients.
But patients learn about us and count on us at their most challenging times, and then they move on.
Our prospective practices and clinicians do not always think of who we are and what we provide as they cross their career paths.
To address this, and all of our work, we've launched a marketing campaign and its obvious key theme is trust.
Our ads are going to be widespread, and they're completely authentic.
They feature only our own doctors who speak about why people should trust them and trust us.
We will continue to reach out to reinforce the very unique importance of Pediatrix and Obstetrix.
In hospitals, Pediatrix and Obstetrix mean trust, life saving, world-class clinicians.
Our brand will be known to that.
We're working to ensure that MEDNAX can be the best possible partner to the patients we serve and to the physicians, payers and health systems we work with, all driven by our mission to take great care of the patient while, at the same time, taking great care of the business.
This isn't always easy, but we have a long track record of working hard to the best solution when we need to.
I'll add some detail for our first quarter results, including some of the bench making versus 2019 that Mark mentioned and touch on some of our G&A expectations as we move through the second quarter.
Lastly, I'll touch on our financial position as it stands today.
Turning to the quarter.
At the top line, our net revenue grew by $5.5 million or just over 1% year-over-year.
We recorded about $8 million in revenue from the provided relief fund established by the CARES Act during the quarter.
Overall, same unit revenue increased by 2.5% year-over-year, or 3.6% after excluding the additional calendar day in February 2020 for the 2020 leap year.
Same unit volumes declined 2.5% year-over-year or 1.4% adjusted for the leap year, compared to a 6.6% year-over-year decline in the 2020 fourth quarter.
First, as Mark mentioned, patient volumes improved throughout the quarter, such that we saw same unit growth in March across all of our service lines with the exception of PICU and pediatric hospitalist services.
Second, our NICU days for the quarter as a whole were down slightly more than total births at the hospitals where we provide NICU coverage.
This reflects a modest year-over-year decline in average length of stay, partially offset by a year-over-year increase in the rate of admission.
I know that the rate of admission was an area of interest for many of you following our fourth quarter release.
So I'll point out that in Q1, our admit rate reverted to its historical level after being modestly lower through the latter part of 2020.
Lastly, I'd like to address our 2021 volume relative to 2019.
Our first quarter same unit volume was down approximately 3% as compared to the same period in 2019, with hospital-based volume down to a greater degree than office-based volume.
We'll continue to look at this two year comparison throughout this year since it's likely that comparisons to 2020 will not be relevant based on the pandemic-related disruptions we experienced last year.
On the pricing side, we had a couple of favorable items in addition to our usual rate growth, which has been typically in the 1% to 2% range based on managed care and administrative fee revenues.
First, the cares revenue we recorded added little under 2% to our pricing growth.
On the expense side, our practice level, salary, wage and benefit expense was up by $2.7 million or about 85 basis points year-over-year.
This increase mostly reflects variable incentive compensation tied to practice level revenues, partially offset by a decrease in malpractice expense, which was higher in 2020.
Our G&A expense was down nearly $1 million year-over-year, despite incurring approximately $5 million of costs related to transitional services we provided to the buyers of our anesthesia and radiology medical groups.
The reimbursement for those expenses is reflected in our investment and other income line item.
So there's minimal impact to our adjusted EBITDA, but those costs do inflate our reported G&A expense.
In the near term, I'll note that while the radiology PSA arrangement has concluded, we do anticipate that we'll continue providing services under our anesthesiology PSA, at least through the second quarter of this year.
So you should expect a similar expense and reimbursement dynamic in the second quarter.
We expect to wind down the Anesthesiology PSA services sometime after the second quarter, at which point we'll also be able to begin winding down the expenses we're incurring and move toward that future state expectation for G&A.
Again, there may be some period of time when we're still incurring some of those expenses but not being reimbursed for them.
Lastly, our balance sheet reflects our reduced leverage profile and strong liquidity position.
We ended the quarter with $270 million in cash and net debt of $730 million, implying leverage just north of three times.
And I think we are ready to take questions.

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q1 same store sales rose 2.5 percent.
during 2021 q1, mednax's operations were negatively impacted by reductions in patient volumes and revenue from covid-19 pandemic.

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