Second Quarter 2013 Highlights:
- Total revenues of $178.1 million
- ICC and Physician Liaison programs and same market corporate development drove domestic, same-market treatments per day growth of 3.2% year-over-year
- Prostate treatment volumes declined 1.6% year-over-year but have stabilized, with volumes up 4% sequentially
- International revenues of $22.5 million, up 10.8% year-over-year
- Pro Forma Adjusted EBITDA of $24.8 million
Recent Business Highlights:
- Entered into "stalking horse" investment agreement to acquire OnCure Holdings, Inc., which would add 34 additional centers in Florida, California and Indiana
- Acquired Premiere Radiation Oncology/Specialists in Urology, an integrated group of urologists and radiation oncologists with 5 centers strategically located in Southwest FL, for $17.7M plus assumption of capital leases and a seller financing note
- Acquired a majority interest in a newly formed joint venture with Casa Grande Regional Medical Center and Cancer Treatment Services of Arizona
- Joint venture with Our Lady of Lourdes Health System, part of Catholic Health East, is progressing
- In July, closed acquisition of facility in Tijuana, Mexico and began refurbishment for planned re-launch in 1Q 2014
FORT MYERS, Fla., Aug. 7, 2013 (GLOBE NEWSWIRE) -- Radiation Therapy Services Holdings, Inc ("Radiation Therapy" or "the Company"), a leading operator of radiation therapy centers, announced today its financial results for the second quarter ending June 30, 2013.
Dr. Daniel Dosoretz, President and Chief Executive Officer, commented, "During the second quarter we experienced improved financial performance driven by our organic growth initiatives. We also made significant progress on the corporate development front which we believe will yield immediate positive and accretive results. We achieved this financial performance despite continued headwinds from both roughly 9% CMS RVU cuts for 2013 and industry wide declines in prostate treatment volumes. We were very encouraged to see prostate treatment levels stabilize in our business on a year-over-year basis and increase by roughly 4% on a sequential basis. Furthermore, our integrated cancer care and Physician Liaison initiatives have made meaningful contributions to organic volume growth. This resulted in approximately 2% growth of both total treatments and domestic same practice treatments per day, as well as growth in non-prostate treatments. When we include results from our recent same market acquisition of Premiere/SIU, treatments grew by 3.2% year-over-year. We also continued to make progress on commercial payor negotiations. The success of these programs continues to strengthen our leading position as an integrated cancer care provider, producing attractive and sustainable returns for our business."
He continued, "Our team worked tirelessly and effectively during the quarter on some of the most significant corporate development transactions in our history. We announced a potentially transformational acquisition and expansion with the signing of a stalking horse investment agreement to acquire OnCure, one of the largest comprehensive radiation oncology treatment networks in the United States. OnCure has partnerships with some of the most highly respected physicians in the industry and whom we believe will broaden and deepen our ability to provide world-class treatment and expand our ICC model in their markets. We have met with many of OnCure's physicians and are encouraged by the alignment of their expertise and culture with ours. During the quarter, we completed the acquisition of Premiere Radiation Oncology/Specialists in Urology, a 14 physician, 5 center practice in the Southwest Florida market that offers significant synergy opportunities. We also closed the acquisition of a majority interest in a newly formed strategic joint venture in Casa Grande, Arizona, which will enable us to combine resources for improved patient care, better efficiency and to leverage a partnership with a local hospital. Internationally, we purchased a center in Tijuana, Mexico in July which we have closed and after refurbishing will re-open in early 2014 as this large geography's premier source for advanced radiation therapy."
Dr. Dosoretz concluded, "We have and will continue to take significant steps in the remainder of 2013 to further strengthen our model to ensure long term clinical leadership and treatment growth. Our leadership position in the industry continues to attract top physicians, strategic partnerships and attractive corporate development opportunities, all of which we believe positions us well for the opportunities presented by today's dynamic healthcare services market and will lead to the continued expansion of our business for many years to come."
Second Quarter 2013 Results
Total revenues for the second quarter of 2013 were $178.1 million, compared to $180.3 million in revenues in the same quarter of 2012. The decrease in revenue was principally due to lower reimbursement rates and the volume declines in the treatment of prostate cancer, offset by meaningful increases in non-prostate treatments, newly established ICC practices, and international revenue growth.
Domestic total treatments per day increased 3.2% in the second quarter of 2013, which includes treatment volume from our same market acquisition of SIU. This was driven by the expansion of our ICC model, increased referrals from the Company's physician liaison program, growth in non-prostate treatments and the impact of previously acquired centers. Domestic same practice therapy revenue per treatment decreased 7.6% from the second quarter of 2012, primarily due to reductions in the reimbursement rate announced in the CMS 2013 Physician Fee Schedule, partially offset by continued improvements in managed care pricing.
Total RVUs per day at same practice domestic freestanding centers decreased 4.7% in the second quarter versus the same period of the prior year due to reductions in the reimbursement rate included in the CMS 2013 Physician Fee Schedule, in conjunction with volume declines in the treatment of prostate cancer.
Adjusted earnings before interest, taxes, depreciation, amortization, stock-based compensation and other non-cash and pro forma items ("Pro Forma Adjusted EBITDA") in the second quarter of 2013 was $24.8 million, or 13.0% of total pro forma revenues, compared to $28.1 million, or 15.6% of total pro forma revenues, in the second quarter of 2012. Pro Forma Adjusted EBITDA margins declined in the current quarter versus the prior year period primarily due to reductions in the Medicare reimbursement rate, volume declines in the treatment of prostate cancer, the growth and expanded development activity in establishing ICC practices, and investments made in key personnel. A reconciliation of net loss attributable to Radiation Therapy Services Holdings, Inc., determined in accordance with generally accepted accounting principles to Pro Forma Adjusted EBITDA and total revenues, determined in accordance with generally accepted accounting principles, to total pro forma revenues for the quarters ended June 30, 2013 and 2012 is included in the attached supplemental financial information.
Income tax expense in the second quarter of 2013 was $1.4 million, compared to an income tax expense of $1.4 million in the second quarter of 2012. The net loss for the second quarter of 2013 was $19.5 million, compared to a net loss of $19.0 million in the second quarter of 2012.
Recent Developments
In May, the Company acquired Premiere Radiation Oncology/Specialists in Urology, an integrated group of urologists and radiation oncologists with 5 centers strategically located from Naples, FL to Ft. Myers FL, for $17.7 million plus assumption of capital leases and a seller financing note. The transaction enhanced the Company's presence in Lee and Collier County markets, providing opportunities to expand the Company's ICC model in the region, maximize efficiencies of our physician resources across a larger footprint, and achieve important operating synergies.
In May, the Company acquired a majority interest in a newly formed joint venture with Casa Grande Regional Medical Center and Cancer Treatment Services of Arizona in Casa Grande, AZ., enhancing the Company's provider network in the region, strengthening its competitive positioning and providing an opportunity to expand service offerings in the region.
In June, the Company entered into a "stalking horse" investment agreement to acquire OnCure Holdings, Inc. (together with its subsidiaries, "OnCure") upon effectiveness of its plan of reorganization under Chapter 11 of the U.S. Bankruptcy Code for approximately $125.0 million, including $42.5 million in cash (plus covering certain expenses and subject to working capital adjustments) and up to $82.5 million in assumed debt. OnCure currently provides services to a network of 11 medical groups that treat cancer patients at its 34 radiation oncology treatment centers, making it one of the largest strategically located networks of radiation oncology service providers. The Company believes the acquisition will broaden and deepen its ability to provide world-class treatment to patients and establish its integrated cancer care model in key markets across the United States. The investment agreement constitutes a lead or "stalking horse" bid in a sale process being conducted in conjunction with OnCure's reorganization. As such, the acquisition of OnCure by the Company remains subject to approval by the United States Bankruptcy Court for the District of Delaware and a subsequent auction process in which other interested buyers may submit competing bids for OnCure. Completion of the transaction, which is expected to occur prior to the end of October 2013, remains subject to competing offers, approval by the United States Bankruptcy Court, and customary closing conditions.
In July, the Company closed the acquisition of a single facility in Tijuana, Mexico. The Company is currently upgrading the facility and installing advanced radiation oncology technology ahead of its planned re-opening in early 2014. The Company expects the facility to be the most advanced cancer care center in a geographic area serving approximately 4 million people and expects it to operate at full capacity rapidly after opening.
Conference Call
Management will host a conference call on Thursday, August 8, 2013 at 10:00 a.m. ET to discuss its financial results. The dial-in numbers are (877) 407-0789 for domestic callers and (201) 689-8562 for international callers. In addition, a telephonic replay of the call will be available until August 22, 2013. The replay dial-in numbers are (877) 870-5176 for domestic callers and (858) 384-5517 for international callers. Please use the conference ID number 418681 to access the replay.
A live webcast and webcast replay of the call will also be available from the Events section on the corporate web site at www.rtsx.com.
About Radiation Therapy Services Holdings, Inc.
Radiation Therapy is a leading provider of advanced radiation therapy and other services to cancer patients in the United States and Latin America. The Company offers a comprehensive range of radiation treatment alternatives, focused on delivering academic quality, cost-effective patient care in a personal and convenient setting. In total, the Company operates 131 treatment centers, including 100 centers located in 15 U.S. states, strategically clustered in 28 local markets. The Company also operates 31 centers located in six countries in Latin America. The Company holds market leading positions in most of its domestic local markets and abroad. RTSX.
Forward-Looking Statements
This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Act of 1934, as amended. Statements preceded by, followed by or that otherwise include the words "believes", "expects", "anticipates", "intends", "projects", "estimates", "plans", "may increase", "forecast" and similar expressions or future or conditional verbs such as "will", "should", "would", "may" and "could" are generally forward-looking in nature and not historical facts. Forward-looking statements are based on management's current expectations or beliefs about the Company's future plans, expectations and objectives, including, but not limited to, the Company's expected financial results and estimates for 2013 and the effects of the CMS's Final Rule for the 2013 Physician Fee Schedule on its results. These forward-looking statements are not historical facts and are subject to risks and uncertainties that could cause the actual results to differ materially from those projected in these forward-looking statements including, but not limited to reductions in Medicare reimbursement, healthcare reform, decreases in payments by managed care organizations and other commercial payers and other risk factors that may be described from time to time in the Company's filings with the Securities and Exchange Commission. Readers of this release are cautioned not to place undue reliance on forward-looking statements contained herein, which speak only as of the date stated, or if no date is stated, as of the date of this press release. The Company undertakes no obligation to publicly update or revise the forward-looking statements contained herein to reflect changed events or circumstances after the date of this release, unless required by law.
| RADIATION THERAPY SERVICES HOLDINGS, INC. | ||
| CONDENSED CONSOLIDATED BALANCE SHEETS | ||
| (in thousands, except share amounts) | ||
|
June 30, 2013 |
December 31, 2012 |
|
| (unaudited) | ||
| ASSETS | ||
| Current assets: | ||
| Cash and cash equivalents | $ 11,759 | $ 15,410 |
| Restricted cash | 5,001 | -- |
| Accounts receivable, net | 90,869 | 86,869 |
| Prepaid expenses | 7,383 | 6,043 |
| Inventories | 4,365 | 3,897 |
| Deferred income taxes | 810 | 540 |
| Other | 5,834 | 7,429 |
| Total current assets | 126,021 | 120,188 |
| Equity investments in joint ventures | 781 | 575 |
| Property and equipment, net | 224,714 | 221,050 |
| Real estate subject to finance obligation | 20,465 | 16,204 |
| Goodwill | 504,302 | 485,859 |
| Intangible assets, net | 33,797 | 35,044 |
| Other assets | 40,695 | 43,381 |
| Total assets | $ 950,775 | $ 922,301 |
| LIABILITIES AND EQUITY | ||
| Current liabilities: | ||
| Accounts payable | $ 35,261 | $ 27,538 |
| Accrued expenses | 50,883 | 46,401 |
| Income taxes payable | 2,327 | 2,951 |
| Current portion of long-term debt | 12,907 | 11,065 |
| Current portion of finance obligation | 283 | 287 |
| Other current liabilities | 8,625 | 7,684 |
| Total current liabilities | 110,286 | 95,926 |
| Long-term debt, less current portion | 799,028 | 751,303 |
| Finance obligation, less current portion | 21,839 | 16,905 |
| Other long-term liabilities | 23,950 | 22,130 |
| Deferred income taxes | 5,593 | 6,202 |
| Total liabilities | 960,696 | 892,466 |
| Noncontrolling interests - redeemable | 16,350 | 11,368 |
| Commitments and Contingencies | ||
| Equity: | ||
| Common stock, $0.01 par value, 1,025 shares authorized, issued and outstanding | -- | -- |
| Additional paid-in capital | 652,252 | 651,907 |
| Retained deficit | (677,903) | (638,023) |
| Accumulated other comprehensive loss, net of tax | (16,526) | (11,464) |
| Total Radiation Therapy Services Holdings, Inc. shareholder's (deficit) equity | (42,177) | 2,420 |
| Noncontrolling interests - nonredeemable | 15,906 | 16,047 |
| Total (deficit) equity | (26,271) | 18,467 |
| Total liabilities and equity | $ 950,775 | $ 922,301 |
| RADIATION THERAPY SERVICES HOLDINGS, INC. | ||||
| CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS | ||||
| (in thousands) | ||||
| (unaudited) | ||||
|
Three Months Ended June 30, |
Six Months Ended June 30, |
|||
| 2013 | 2012 | 2013 | 2012 | |
| Revenues: | ||||
| Net patient service revenue | $ 175,847 | $ 178,499 | $ 347,820 | $ 354,047 |
| Other revenue | 2,262 | 1,755 | 4,266 | 3,652 |
| Total revenues | 178,109 | 180,254 | 352,086 | 357,699 |
| Expenses: | ||||
| Salaries and benefits | 99,687 | 95,166 | 195,940 | 189,009 |
| Medical supplies | 14,407 | 16,639 | 30,249 | 32,099 |
| Facility rent expense | 10,675 | 9,925 | 20,858 | 19,515 |
| Other operating expenses | 10,997 | 9,961 | 21,273 | 18,662 |
| General and administrative expenses | 23,161 | 21,301 | 43,896 | 40,983 |
| Depreciation and amortization | 15,320 | 16,247 | 30,491 | 31,443 |
| Provision for doubtful accounts | 2,015 | 4,800 | 5,090 | 9,861 |
| Interest expense, net | 20,473 | 19,600 | 40,417 | 37,155 |
| Gain on the sale of an interest in a joint venture | (1,460) | -- | (1,460) | -- |
| Early extinguishment of debt | -- | 4,473 | -- | 4,473 |
| Loss on foreign currency transactions | 758 | 45 | 802 | 94 |
| Loss (gain) on foreign currency derivative contracts | 190 | (374) | 242 | 220 |
| Total expenses | 196,223 | 197,783 | 387,798 | 383,514 |
| Loss before income taxes | (18,114) | (17,529) | (35,712) | (25,815) |
| Income tax expense | 1,371 | 1,439 | 3,150 | 1,549 |
| Net loss | (19,485) | (18,968) | (38,862) | (27,364) |
| Net income attributable to noncontrolling interests- redeemable and non-redeemable | (654) | (1,236) | (1,018) | (2,389) |
| Net loss attributable to Radiation Therapy Services Holdings, Inc. shareholder | (20,139) | (20,204) | (39,880) | (29,753) |
| Other comprehensive loss: | ||||
| Unrealized loss on derivative interest rate swap agreements | -- | -- | -- | (333) |
| Unrealized loss on foreign currency translation | (3,408) | (2,492) | (5,589) | (3,020) |
| Other comprehensive loss: | (3,408) | (2,492) | (5,589) | (3,353) |
| Comprehensive loss: | (22,893) | (21,460) | (44,451) | (30,717) |
| Comprehensive loss attributable to noncontrolling interests- redeemable and non-redeemable | (294) | (903) | (491) | (2,080) |
| Comprehensive loss attributable to Radiation Therapy Services Holdings, Inc. shareholder | $ (23,187) | $ (22,363) | $ (44,942) | $ (32,797) |
| RADIATION THERAPY SERVICES HOLDINGS, INC. | ||
| CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS | ||
| (in thousands) | ||
| (unaudited) | ||
|
Six Months Ended June 30, |
||
| 2013 | 2012 | |
| Cash flows from operating activities | ||
| Net loss | $ (38,862) | $ (27,364) |
| Adjustments to reconcile net loss to net cash provided by operating activities: | ||
| Depreciation | 26,222 | 25,637 |
| Amortization | 4,269 | 5,806 |
| Deferred rent expense | 422 | 549 |
| Deferred income taxes | (1,138) | (702) |
| Stock-based compensation | 345 | 3,012 |
| Provision for doubtful accounts | 5,090 | 9,861 |
| Loss on the sale/disposal of property and equipment | 76 | 22 |
| Gain on the sale of an interest in a joint venture | (1,460) | -- |
| Amortization of termination of interest rate swap | -- | 958 |
| Write-off of loan costs | -- | 525 |
| Early extinguishment of debt | -- | 4,473 |
| Termination of derivative interest rate swap agreements | -- | (972) |
| Loss on foreign currency transactions | 34 | 18 |
| Loss on foreign currency derivative contracts | 242 | 220 |
| Amortization of debt discount | 391 | 417 |
| Amortization of loan costs | 2,731 | 2,609 |
| Equity interest in net loss of joint ventures | 332 | 539 |
| Distribution received from unconsolidated joint ventures | -- | 9 |
| Changes in operating assets and liabilities: | ||
| Accounts receivable and other current assets | (9,677) | (18,102) |
| Income taxes payable | (261) | (441) |
| Inventories | (461) | (713) |
| Prepaid expenses | 46 | 1,111 |
| Accounts payable and other current liabilities | 8,822 | (2,701) |
| Accrued deferred compensation | 656 | 602 |
| Accrued expenses / other current liabilities | 5,795 | 6,314 |
| Net cash provided by operating activities | 3,614 | 11,687 |
| Cash flows from investing activities | ||
| Purchase of property and equipment | (17,769) | (16,298) |
| Acquisition of medical practices | (22,848) | (23,742) |
| Restricted cash associated with initial deposit in the potential acquisition of medical practices | (5,001) | -- |
| Proceeds from the sale of property and equipment | 4 | 27 |
| Loans to employees | (153) | (115) |
| Contribution of capital to joint venture entities | (542) | (225) |
| Proceeds from the sale of equity interest in a joint venture | 1,460 | -- |
| Payment of foreign currency derivative contracts | (171) | (432) |
| Premiums on life insurance policies | (626) | (518) |
| Change in other assets and other liabilities | 5 | 7 |
| Net cash used in investing activities | (45,641) | (41,296) |
| Cash flows from financing activities | ||
| Proceeds from issuance of debt | 83,880 | 434,061 |
| Principal repayments of debt | (45,501) | (369,903) |
| Repayments of finance obligation | (99) | (53) |
| Proceeds from noncontrolling interest holders - redeemable and non-redeemable | 765 | -- |
| Cash distributions to noncontrolling interest holders - redeemable and non-redeemable | (650) | (2,018) |
| Payments of loan costs | -- | (14,225) |
| Net cash provided by financing activities | 38,395 | 47,862 |
| Effect of exchange rate changes on cash and cash equivalents | (19) | (5) |
| Net (decrease) increase in cash and cash equivalents | (3,651) | 18,248 |
| Cash and cash equivalents, beginning of period | 15,410 | 10,177 |
| Cash and cash equivalents, end of period | $ 11,759 | $ 28,425 |
| Supplemental disclosure of noncash transactions | ||
| Recorded finance obligation related to real estate projects | $ 5,029 | $ 1,457 |
| Recorded capital lease obligations related to the purchase of equipment | $ 78 | $ 696 |
| Recorded property and equipment related to the North Broward Hospital District license agreement | $ -- | $ 4,260 |
| Recorded capital lease obligations related to the acquisition of medical practices | $ 8,748 | $ 5,726 |
| Recorded seller financing promissory note related to the acquisition of medical practices | $ 2,097 | $ -- |
| Recorded noncash contribution of capital by noncontrolling interest holders | $ 4,235 | $ -- |
| RADIATION THERAPY SERVICES HOLDINGS, INC. | ||||
| Supplemental Financial Information (Unaudited) | ||||
| Reconciliation of Total Pro-forma Revenue and Pro-forma Adjusted EBITDA to Net Loss Attributable | ||||
| to Radiation Therapy Services Holdings, Inc. Shareholder | ||||
|
Three Months Ended June 30, |
Six Months Ended June 30, |
|||
| 2013 | 2012 | 2013 | 2012 | |
| (in thousands): | ||||
| Total revenues | $ 178,109 | $ 180,254 | $ 352,086 | $ 357,699 |
| Pro-forma full period effect of acquisitions (a) | 12,729 | -- | 28,185 | 7,557 |
| Total pro-forma revenues | $ 190,838 | $ 180,254 | $ 380,271 | $ 365,256 |
| Net loss attributable to Radiation Therapy Services Holdings, Inc. shareholder | $ (20,139) | $ (20,204) | $ (39,880) | $ (29,753) |
| Income tax expense (benefit) | 1,371 | 1,439 | 3,150 | 1,549 |
| Interest expense, net | 20,473 | 19,600 | 40,417 | 37,155 |
| Depreciation and amortization | 15,320 | 16,247 | 30,491 | 31,443 |
| Gain on the sale of an interest in a joint venture | (1,460) | -- | (1,460) | -- |
| Early extinguishment of debt | -- | 4,473 | -- | 4,473 |
| Loss (gain) on foreign currency derivative contracts | 190 | (374) | 242 | 220 |
| Management fees (b) | 223 | 328 | 481 | 541 |
| Non-cash expenses (c) | 1,033 | 3,323 | 2,151 | 3,925 |
| Sale-lease back adjustments (d) | (355) | (246) | (660) | (490) |
| Acquisition-related costs (e) | 2,745 | 1,101 | 3,804 | 1,744 |
| Other expenses (f) | 1,246 | 437 | 2,355 | 894 |
| Litigation settlement (g) | 888 | 590 | 1,520 | 1,100 |
| Costs associated with the provision for income taxes (h) | -- | 532 | -- | 532 |
| Tradename / rebranding initiative (i) | 169 | 317 | 340 | 317 |
| Expenses associated with idle / closed treatment facilities (j) | 499 | 529 | 978 | 1,478 |
| Pro-forma full period effect of acquisition EBITDA (a) | 2,626 | -- | 5,595 | 2,433 |
| Pro-forma Adjusted EBITDA (1) | $ 24,829 | $ 28,092 | $ 49,524 | $ 57,561 |
| Pro-forma Adjusted EBITDA as a percentage of total pro-forma revenues | 13.0% | 15.6% | 13.0% | 15.8% |
| (1) Pro-forma Adjusted EBITDA is defined as income (loss) before interest expense (net of interest income), income taxes, depreciation and amortization, gain on the sale of an interest in a joint venture, early extinguishment of debt, foreign currency derivative contract loss (gain), management fees accrued to our sponsor, non-cash expenses including costs relating to stock compensation, amortization of straight-line rent and amortization of capital expenditures relating to repairs and maintenance, non-cash equipment rent, sale-lease back adjustments, acquisition-related costs, other expenses including loss on sale of assets, severance payments related to termination of employee staff reductions, tail premiums on termed physicians, franchise taxes, costs relating to consulting services on Medicare reimbursement, litigation settlements with physicians, expenses associated with the provision for income taxes, costs associated with tradename and rebranding initiatives, expenses associated with idle / closed radiation therapy treatment facilities and pro-forma full period effect of acquisition EBITDA | ||||
| (a) Pro-forma amounts related to adjustments to total revenues and Pro-forma Adjusted EBITDA to reflect the full period effect of our acquisitions and Value Added Services contracts completed during 2012. The adjustments reflect the impact to our total revenues and Pro-forma Adjusted EBITDA as if the acquisitions and Value Added Services contracts had occurred at the beginning of the year. | ||||
| (b) Management fees are fees accrued to our sponsor, Vestar Capital Partners. | ||||
| (c) Non-cash expenses including costs relating to stock compensation, amortization of straight-line rent, amortization of capital expenditures relating to warranty arrangements amortized to repairs and maintenance and non-cash equipment rent. | ||||
| (d) Sale-lease back adjustments relates to the adjustment of benefit derived from the classification of operating leases as finance obligations reflecting a reclassification of interest expense and depreciation and amortization expense as rent expense. | ||||
| (e) Acquisition related costs associated with ASC 805, Business Combinations, including professional fees and due diligence costs relating to the acquisition of medical practices. | ||||
| (f) Other expenses include loss on sale of assets, severance payments related to termination of employee staff reductions, tail premiums paid on terminated physicians, franchise taxes and costs relating to consulting services on Medicare reimbursement. | ||||
| (g) Litigation settlement relates to costs associated with the termination of physicians during 2012 and 2013. | ||||
| (h) Expenses related to the costs associated with process improvements in the provision for income taxes. | ||||
| (i) Expenses related to the costs associated with the Company's tradename and rebranding initiatives. | ||||
| (j) Expenses associated with idle / closed radiation therapy treatment facilities. | ||||
| We believe the Pro-forma Adjusted EBITDA provides useful information about our financial performance to investors, lenders, financial analysts and rating agencies since these groups have historically used EBITDA-related measures in the healthcare industry, along with other measures, to estimate the value of a company, to make informed investment decisions, to evaluate a company's leverage capacity and its ability to meet its debt service requirements. Pro-forma Adjusted EBITDA eliminates the uneven effect of non-cash depreciation of tangibles assets and amortization of intangible assets, much of which results from acquisitions accounted for under the purchase method of accounting. Pro-forma Adjusted EBITDA is also used by us to measure individual performance for incentive compensation purposes and as an analytical indicator for purposes of allocating resources to our operating business and assessing their performance, both internally and relative to our peers, as well as to evaluate the performance of our operating management teams, and for purposes in the calculation of debt covenants and related disclosures. | ||||
| Pro-forma Adjusted EBITDA is not intended as a substitute for net income (loss) attributable to Radiation Therapy Services Holdings, Inc. shareholder, operating cash flows or other cash flow data determined in accordance with accounting principles generally accepted in the United States. Due to varying methods of calculation, Pro-forma Adjusted EBITDA as presented may not be comparable to similarly titled measures of other companies. | ||||
| RADIATION THERAPY SERVICES HOLDINGS, INC. | ||||||||||||
| KEY OPERATING STATISTICS | ||||||||||||
| (unaudited) | ||||||||||||
|
Three Months Ended June 30, |
Six Months Ended June 30, |
|||||||||||
| Domestic U.S. | 2013 | 2012 |
% Change |
2013 | 2012 |
% Change |
||||||
| Number of treatment days | 64 | 64 | 0.0% | 127 | 128 | -0.8% | ||||||
| Total RVU's - freestanding centers | 2,828,004 | 2,969,204 | -4.8% | 5,546,897 | 5,902,036 | -6.0% | ||||||
| RVU's per day - freestanding centers | 44,188 | 46,394 | -4.8% | 43,676 | 46,110 | -5.3% | ||||||
| Percentage change in RVU's per day -- freestanding centers - same market basis | -4.7% | -4.8% | -6.1% | -5.1% | ||||||||
| Total treatments - freestanding centers | 132,139 | 128,005 | 3.2% | 257,809 | 253,321 | 1.8% | ||||||
| Treatments per day - freestanding centers | 2,065 | 2,000 | 3.2% | 2,030 | 1,979 | 2.6% | ||||||
| Percentage change in revenue per treatment -- freestanding centers - same market basis | -7.6% | -3.5% | -6.6% | -3.0% | ||||||||
| Percentage change in treatments per day -- freestanding centers - same market basis | 3.2% | 4.1% | 1.6% | 3.1% | ||||||||
| Number of regions at period end (global) | 9 | 9 | ||||||||||
| Number of local markets at period end | 28 | 28 | ||||||||||
| Treatment centers - freestanding (global) | 126 | 121 | 4.1% | |||||||||
| Treatment centers - hospital / other groups (global) | 5 | 5 | 0.0% | |||||||||
| 131 | 126 | 4.0% | ||||||||||
| Days sales outstanding at quarter end | 35 | 40 | ||||||||||
| Percentage change in freestanding revenues - same market basis | -4.7% | 0.5% | -5.8% | 0.0% | ||||||||
| Net patient service revenue - professional services only (in thousands) | $ 52,574 | $ 52,293 | $ 105,479 | $ 101,827 | ||||||||
|
Three Months Ended June 30, |
Six Months Ended June 30, |
|||||||||||
| International | 2013 | 2012 |
% Change |
2013 | 2012 |
% Change |
||||||
| Number of new cases | ||||||||||||
| 2-D cases | 947 | 1,091 | 1,937 | 2,450 | ||||||||
| 3-D cases | 2,539 | 2,304 | 4,784 | 4,327 | ||||||||
| IMRT / IGRT cases | 434 | 343 | 806 | 779 | ||||||||
| Total | 3,920 | 3,738 | 4.9% | 7,527 | 7,556 | -0.4% | ||||||