Amedisys Reports Third Quarter 2021 Financial Results Updates 2021 Guidance


BATON ROUGE, La., Nov. 02, 2021 (GLOBE NEWSWIRE) -- Amedisys, Inc. (NASDAQ: AMED) today reported its financial results for the three and nine-month periods ended September 30, 2021.

Three-Month Periods Ended September 30, 2021 and 2020

  • Net service revenue increased $9.4 million to $553.5 million compared to $544.1 million in 2020.
  • Net income attributable to Amedisys, Inc. of $45.0 million compared to $72.0 million (inclusive of a $24.0 million income tax benefit related to executive stock option exercise) in 2020.
  • Net income attributable to Amedisys, Inc. per diluted share of $1.37 compared to $2.16 (inclusive of $0.72 income tax benefit related to executive stock option exercise) in 2020.

Adjusted Quarterly Results*

  • Adjusted EBITDA of $72.4 million compared to $75.7 million in 2020.
  • Adjusted net service revenue of $553.5 million compared to $544.1 million in 2020.
  • Adjusted net income attributable to Amedisys, Inc. of $50.5 million compared to $74.6 million (inclusive of a $24.0 million income tax benefit related to executive stock option exercise) in 2020.
  • Adjusted net income attributable to Amedisys, Inc. per diluted share of $1.53 compared to $2.24 (inclusive of $0.72 income tax benefit related to executive stock option exercise) in 2020.

Nine-Month Periods Ended September 30, 2021 and 2020

  • Net service revenue increased $134.0 million to $1,654.8 million compared to $1,520.8 million in 2020.
  • Net income attributable to Amedisys, Inc. of $175.0 million compared to $138.5 million (inclusive of a $24.0 million income tax benefit related to executive stock option exercise) in 2020.
  • Net income attributable to Amedisys, Inc. per diluted share of $5.30 compared to $4.16 (inclusive of $0.72 income tax benefit related to executive stock option exercise) in 2020.

Adjusted Year to Date Results*

  • Adjusted EBITDA of $234.8 million compared to $195.4 million in 2020.
  • Adjusted net service revenue of $1,648.3 million compared to $1,520.8 million in 2020.
  • Adjusted net income attributable to Amedisys, Inc. of $157.5 million compared to $153.9 million (inclusive of a $24.0 million income tax benefit related to executive stock option exercise) in 2020.
  • Adjusted net income attributable to Amedisys, Inc. per diluted share of $4.77 compared to $4.63 (inclusive of $0.72 income tax benefit related to executive stock option exercise) in 2020.

* See pages 3 and 16 - 18 for the definition and reconciliations of non-GAAP financial measures to GAAP measures.

Updated 2021 Guidance

COVID-19 has continued to impact the operating metrics typically used to forecast both growth and cost assumptions for both core Amedisys and Contessa. We are basing our guidance on our current operating environment. COVID-19 continues to evolve in both the disease itself as well as disruptions to the healthcare systems and the economy. Any future regulations or government interventions, spike in clinicians and business development staff on quarantine, staffing shortages due to current and proposed federal, state and local vaccine mandates, reduction in elective procedures, change in patient behavior and further decline in senior living occupancy could impact our ability to achieve this guidance.

Based upon the above discussion, our updated 2021 guidance is as follows:

  • Adjusted net service revenue is anticipated to be in the range of $2.200 billion to $2.205 billion.
  • Adjusted EBITDA is anticipated to be in the range of $296 million to $298 million.
  • Adjusted diluted earnings per share is anticipated to be in the range of $5.88 to $5.93 based on an estimated 33.0 million shares outstanding.

This guidance excludes the effects of any future acquisitions, if any are made.

Paul B. Kusserow, Chairman and Chief Executive Officer stated, “Though COVID-19 continues to impact all of our lines of business, I am very proud of the efforts of the nearly 21,000 Amedisys employees and thank them for their continued dedication and tireless work throughout this quarter and for the results their work produced. Our operating environment continues to change in real-time and yet we have been able to grow Home Health and Hospice admissions. We have made significant progress on recovering our Hospice Business Development staff and remain very confident in our ability to continue to expand this group, translating into further admissions growth. Though it is hard to predict when the impacts of COVID-19 will truly subside, we remain very excited about all of the opportunity ahead of us. We are well positioned to capitalize on the aging demographics of the U.S. population; our industry leading quality scores make us a provider of choice for those that want to be cared for in their homes; and via our acquisition of Contessa, we have assembled a group of assets that truly differentiate Amedisys from our peers. It is a time unlike any other to be in our spaces and tackling the challenges of COVID-19 has, and continues to, energize our entire organization. My enthusiasm for the future of Amedisys has never been stronger.”

We urge caution in considering the current trends and 2021 guidance disclosed in this press release. The home health, hospice, personal care and high acuity care industries are highly competitive and subject to intensive regulations, and trends are subject to numerous factors, risks, and uncertainties, some of which are referenced in the cautionary language below and others that are described more fully in our reports filed with the Securities and Exchange Commission (“SEC”) including our Annual Report on Form 10-K for the fiscal year ended December 31, 2020, subsequent Quarterly Reports on Form 10-Q, and current reports on Form 8-K which can be found on the SEC’s internet website, http://www.sec.gov, and our internet website, http://www.amedisys.com

Earnings Call and Webcast Information

Amedisys will host a conference call on Wednesday, November 3, 2021, at 11:00 a.m. ET to discuss its third quarter results. To participate on the conference call, please call before 11:00 a.m. ET to either (877) 524-8416 (Toll-Free) or (412) 902-1028 (Toll). A replay of the conference call will be available through December 3, 2021 by dialing (877) 660-6853 (Toll-Free) or (201) 612-7415 (Toll) and entering conference ID #13724253.

A live webcast of the call will be accessible through our website on our Investor Relations section at the following web address: http://investors.amedisys.com.

Non-GAAP Financial Measures

This press release includes reconciliations of the most comparable financial measures calculated and presented in accordance with accounting principles generally accepted in the U.S. (“GAAP”) to non-GAAP financial measures. The non-GAAP financial measures as defined under SEC rules are as follows: (1) adjusted EBITDA, defined as net income attributable to Amedisys, Inc. before net interest expense, provision for income taxes and depreciation and amortization, excluding certain items; (2) adjusted net service revenue, defined as net service revenue excluding certain items; (3) adjusted other operating income, defined as other operating income excluding certain items; (4) adjusted net income attributable to Amedisys, Inc., defined as net income attributable to Amedisys, Inc. excluding certain items; and (5) adjusted net income attributable to Amedisys, Inc. per diluted share, defined as net income attributable to Amedisys, Inc. common stockholders per diluted share excluding certain items. Management believes that these non-GAAP financial measures, when reviewed in conjunction with GAAP financial measures, are useful gauges of our current performance and are also included in internal management reporting. These non-GAAP financial measures should be considered in addition to, and not more meaningful than or as an alternative to the GAAP financial measures presented in this earnings release and the company’s financial statements. Non-GAAP measures as presented herein may not be comparable to similarly titled measures reported by other companies since not all companies calculate these non-GAAP measures consistently.

Additional Information

Amedisys, Inc. (the “Company”) is a leading healthcare at home company delivering personalized home health, hospice, personal care and high acuity care services. Amedisys is focused on delivering the care that is best for our patients, whether that is home-based personal care; recovery and rehabilitation after an operation or injury; care focused on empowering our patients to manage a chronic disease; or hospice care at the end of life. More than 2,900 hospitals and 78,000 physicians nationwide have chosen Amedisys as a partner in post-acute care. Founded in 1982, headquartered in Baton Rouge, LA with an executive office in Nashville, TN, Amedisys is a publicly held company. With approximately 21,000 employees in 527 care centers within 38 states and the District of Columbia, Amedisys is dedicated to delivering the highest quality of care to the doorsteps of more than 418,000 patients and clients in need every year. For more information about the Company, please visit: www.amedisys.com

We use our website as a channel of distribution for important company information. Important information, including press releases, investor presentations and financial information regarding our company, is routinely posted on and accessible on the Investor Relations subpage of our website, which is accessible by clicking on the tab labeled “Investors” on our website home page. Visitors to our website can also register to receive automatic e-mail and other notifications alerting them when new information is made available on the Investor Relations subpage of our website.

Forward-Looking Statements

When included in this press release, words like “believes,” “belief,” “expects,” “strategy,” “plans,” “anticipates,” “intends,” “projects,” “estimates,” “may,” “might,” “will,” “could,” “would,” “should” and similar expressions are intended to identify forward-looking statements as defined by the Private Securities Litigation Reform Act of 1995. These forward-looking statements involve a variety of risks and uncertainties that could cause actual results to differ materially from those described therein. These risks and uncertainties include, but are not limited to the following: the impact of the novel coronavirus pandemic (“COVID-19”), including the measures that have been and may be taken by governmental authorities to mitigate it, on our business, financial condition and results of operations, the impact of current and proposed federal, state and local vaccine mandates, including potential staff shortages, changes in or our failure to comply with existing federal and state laws or regulations or the inability to comply with new government regulations on a timely basis, changes in Medicare and other medical payment levels, our ability to open care centers, acquire additional care centers and integrate and operate these care centers effectively, competition in the healthcare industry, changes in the case mix of patients and payment methodologies, changes in estimates and judgments associated with critical accounting policies, our ability to maintain or establish new patient referral sources, our ability to consistently provide high-quality care, our ability to attract and retain qualified personnel, our ability to keep our patients and employees safe, changes in payments and covered services by federal and state governments, future cost containment initiatives undertaken by third-party payors, our access to financing, our ability to meet debt service requirements and comply with covenants in debt agreements, business disruptions due to natural disasters or acts of terrorism, widespread protests or civil unrest, our ability to integrate, manage and keep our information systems secure, our ability to realize the anticipated benefits of acquisitions, changes in law or developments with respect to any litigation relating to the Company, including various other matters, many of which are beyond our control.

Because forward-looking statements are inherently subject to risks and uncertainties, some of which cannot be predicted or quantified, you should not rely on any forward-looking statement as a prediction of future events. We expressly disclaim any obligation or undertaking and we do not intend to release publicly any updates or changes in our expectations concerning the forward-looking statements or any changes in events, conditions or circumstances upon which any forward-looking statement may be based, except as required by law.

   
Contact:Investor Contact:Media Contact:
 Amedisys, Inc.Amedisys, Inc.
 Nick MuscatoKendra Kimmons
 Senior Vice President, FinanceVice President, Marketing & Communications
 (615) 928- 5452(225) 299-3720
 IR@amedisys.comkendra.kimmons@amedisys.com


AMEDISYS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(Amounts in thousands, except per share data)
(Unaudited)

     
 For the Three-Month
Periods Ended September 30,
 For the Nine-Month
Periods Ended September 30, 
     
  2021   2020   2021   2020 
     
Net service revenue$553,485  $544,070  $1,654,795  $1,520,814 
Other operating income (4)  4,812   13,300   27,592 
Cost of service, excluding depreciation and amortization 310,294   297,668   916,188   878,633 
General and administrative expenses:    
Salaries and benefits 119,373   123,146   349,533   330,329 
Non-cash compensation 4,397   7,124   17,860   19,758 
Other 55,158   49,348   158,995   142,616 
Depreciation and amortization 7,487   8,283   21,763   19,955 
     
Operating expenses 496,709   485,569   1,464,339   1,391,291 
     
Operating income 56,772   63,313   203,756   157,115 
Other income (expense):    
Interest income    31   49   258 
Interest expense (2,730)  (2,692)  (6,734)  (8,675)
Equity in earnings from equity method investments 1,444   1,435   3,932   2,399 
Gain (loss) on equity method investments       31,092   (2,980)
Miscellaneous, net 490   122   1,253   662 
     
     Total other (expense) income, net (796)  (1,104)  29,592   (8,336)
     
Income before income taxes 55,976   62,209   233,348   148,779 
Income tax (expense) benefit (10,731)  10,202   (57,192)  (9,175)
     
Net income 45,245   72,411   176,156   139,604 
Net income attributable to noncontrolling interests (239)  (430)  (1,131)  (1,147)
     
Net income attributable to Amedisys, Inc.$45,006  $71,981  $175,025  $138,457 
     
Basic earnings per common share:    
Net income attributable to Amedisys, Inc. common stockholders$1.38  $2.20  $5.36  $4.26 
Weighted average shares outstanding 32,607   32,662   32,658   32,469 
Diluted earnings per common share:    
Net income attributable to Amedisys, Inc. common stockholders$1.37  $2.16  $5.30  $4.16 
Weighted average shares outstanding 32,899   33,260   33,021   33,267 


AMEDISYS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
(Amounts in thousands, except share data)

   
 September 30,
2021
(unaudited)
 December 31,
2020
   
ASSETS  
Current assets:  
Cash and cash equivalents$124,458  $81,808 
Restricted cash 3,750   1,549 
Patient accounts receivable 274,570   255,145 
Prepaid expenses 16,080   10,217 
Other current assets 14,024   13,265 
   
     Total current assets 432,882   361,984 
Property and equipment, net of accumulated depreciation of $100,407 and $95,024 20,381   23,719 
Operating lease right of use assets 100,028   93,440 
Goodwill 1,188,054   932,685 
Intangible assets, net of accumulated amortization of $20,309 and $22,973 118,084   74,183 
Deferred income taxes 10,111   47,987 
Other assets 68,105   33,200 
   
     Total assets$1,937,645  $1,567,198 
   
LIABILITIES AND EQUITY  
Current liabilities:  
Accounts payable$41,649  $42,674 
Payroll and employee benefits 155,123   146,929 
Accrued expenses 154,264   166,192 
Provider relief fund advance 58,535   60,000 
Current portion of long-term obligations 13,225   10,496 
Current portion of operating lease liabilities 31,553   30,046 
   
     Total current liabilities 454,349   456,337 
Long-term obligations, less current portion 434,781   204,511 
Operating lease liabilities, less current portion 67,723   61,987 
Other long-term obligations 31,991   33,622 
   
     Total liabilities 988,844   756,457 
   
Equity:  
Preferred stock, $0.001 par value, 5,000,000 shares authorized; none issued or outstanding     
Common stock, $0.001 par value, 60,000,000 shares authorized; 37,659,284 and 37,470,212 shares issued; and 32,590,775 and 32,814,278 shares outstanding 38   38 
Additional paid-in capital 720,875   698,287 
Treasury stock, at cost 5,068,509 and 4,655,934 shares of common stock (420,665)  (319,092)
Retained earnings 605,016   429,991 
   
     Total Amedisys, Inc. stockholders’ equity 905,264   809,224 
Noncontrolling interests 43,537   1,517 
   
     Total equity 948,801   810,741 
   
     Total liabilities and equity$1,937,645  $1,567,198 
   


AMEDISYS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS AND DAYS REVENUE OUTSTANDING
(Amounts in thousands, except statistical information)
(Unaudited)

     
 For the Three-Month
Periods Ended September 30,
 For the Nine-Month
Periods Ended September 30,
     
  2021   2020   2021   2020 
     
Cash Flows from Operating Activities:    
Net income$45,245  $72,411  $176,156  $139,604 
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 7,487   8,283   21,763   19,955 
Non-cash compensation 4,397   7,124   17,860   19,758 
Amortization and impairment of operating lease right of use assets 10,479   10,591   30,181   29,149 
(Gain) loss on disposal of property and equipment (72)  17   (64)  (77)
(Gain) loss on equity method investments       (31,092)  2,980 
Write-off of other comprehensive income          (15)
Deferred income taxes 12,013   1,274   34,729   (2,762)
Equity in earnings from equity method investments (1,444)  (1,435)  (3,932)  (2,399)
Amortization of deferred debt issuance costs/debt discount 237   216   669   653 
Return on equity method investments 1,585   1,175   4,268   3,919 
Changes in operating assets and liabilities, net of impact of acquisitions:    
Patient accounts receivable 5,149   (2,511)  (17,638)  6,486 
Other current assets (9,779)  (24,748)  (6,219)  (28,217)
Other assets (886)  584   (938)  (91)
Accounts payable 5,338   4,825   (1,192)  (1,627)
Accrued expenses (7,736)  (2,396)  (9,363)  25,594 
Other long-term obligations (49)  17,735   (1,785)  38,481 
Operating lease liabilities (9,417)  (9,211)  (27,372)  (25,576)
Operating lease right of use assets (780)  (851)  (2,304)  (2,775)
     
Net cash provided by operating activities 61,767   83,083   183,727   223,040 
     
Cash Flows from Investing Activities:    
Proceeds from sale of deferred compensation plan assets 101   73   126   94 
Proceeds from sale of property and equipment 98      140   80 
Purchases of property and equipment (2,244)  (1,294)  (5,187)  (2,995)
Investments in technology assets (147)     (147)   
Investments in equity method investees          (875)
Proceeds from sale of equity method investment          17,876 
Acquisitions of businesses, net of cash acquired (262,369)     (264,872)  (299,723)
     
Net cash used in investing activities (264,561)  (1,221)  (269,940)  (285,543)
     
Cash Flows from Financing Activities:    
Proceeds from issuance of stock upon exercise of stock options 1,083   3,123   1,706   6,070 
Proceeds from issuance of stock to employee stock purchase plan 1,061   914   3,022   2,600 
Shares withheld to pay taxes on non-cash compensation (9,750)  (47,788)  (16,694)  (54,172)
Noncontrolling interest distribution (459)  (300)  (1,253)  (672)
Proceeds from borrowings under term loan 290,312      290,312    
Proceeds from borrowings under revolving line of credit 111,500   7,500   500,700   432,000 
Repayments of borrowings under revolving line of credit (141,500)  (97,500)  (551,700)  (357,000)
Principal payments of long-term obligations (501)  (2,685)  (5,893)  (7,360)
Debt issuance costs (2,792)     (2,792)   
Purchase of company stock (10,805)     (84,879)   
Provider relief fund advance 207   (10,000)  (1,465)  60,000 
     
Net cash provided by (used in) financing activities 238,356   (146,736)  131,064   81,466 
Net increase (decrease) in cash, cash equivalents and restricted cash 35,562   (64,874)  44,851   18,963 
Cash, cash equivalents and restricted cash at beginning of period 92,646   180,327   83,357   96,490 
     
Cash, cash equivalents and restricted cash at end of period$128,208  $115,453  $128,208  $115,453 
     
Supplemental Disclosures of Cash Flow Information:    
Cash paid for interest$1,565  $1,610  $3,479  $4,902 
     
Cash paid for income taxes, net of refunds received$16,815  $22,137  $25,482  $30,290 
     
Cash paid for operating lease liabilities$10,197  $10,062  $29,676  $28,351 
     
Cash paid for finance lease liabilities$492  $497  $1,509  $1,483 
     
Supplemental Disclosures of Non-Cash Activity:    
Right of use assets obtained in exchange for operating lease liabilities$14,192  $10,982  $34,881  $29,876 
     
Right of use assets obtained in exchange for finance lease liabilities$287  $335  $814  $822 
     
Reductions to right of use assets resulting from reductions to operating lease liabilities$279  $360  $1,183  $767 
     
Days revenue outstanding 43.5   40.0   43.5   40.0 

(1) Our calculation of days revenue outstanding, net is derived by dividing our ending patient accounts receivable at September 30, 2021 and 2020 by our average daily net patient service revenue for the three-month periods ended September 30, 2021 and 2020, respectively.


AMEDISYS, INC. AND SUBSIDIARIES
SEGMENT INFORMATION
(Amounts in millions, except statistical information)
(Unaudited)

Segment Information - Home Health

   
 For the Three-Month Periods
Ended September 30,
   
  2021   2020 
   
Financial Information (in millions):  
Medicare$228.2  $222.2 
Non-Medicare 110.4   103.8 
   
Net service revenue 338.6   326.0 
Other operating income    2.6 
Cost of service 190.1   180.0 
   
Gross margin 148.5   148.6 
Other operating expenses 82.4   78.8 
Depreciation and amortization 1.1   1.0 
   
Operating income$65.0  $68.8 
   
Same Store Growth (1):  
Medicare revenue 2%  5%
Non-Medicare revenue 6%  4%
Total admissions 1%  5%
Total volume (2) (6) 1%  6%
Key Statistical Data - Total (3):  
Admissions 86,732   85,578 
Recertifications (6) 46,919   46,186 
   
Total volume (6) 133,651   131,764 
   
Medicare completed episodes 78,318   77,552 
Average Medicare revenue per completed
episode (4)
$2,969  $2,886 
Medicare visits per completed episode (5) 13.8   14.4 
   
Visiting Clinician Cost per Visit$94.24  $89.10 
Clinical Manager Cost per Visit$9.85  $8.91 
   
Total Cost per Visit$104.09  $98.01 
Visits 1,826,505   1,836,895 
        
        
 For the Nine-Month Periods
Ended September 30, 
   
  2021   2020 
   
Financial Information (in millions):  
Medicare$684.4  $619.0 
Non-Medicare 332.1   300.8 
   
Net service revenue 1,016.5   919.8 
Other operating income 7.3   17.7 
Cost of service 563.5   543.8 
   
Gross margin 460.3   393.7 
Other operating expenses 243.8   226.7 
Depreciation and amortization 3.3   2.9 
   
Operating income$213.2  $164.1 
   
Same Store Growth (1):  
Medicare revenue 10%  (4%)
Non-Medicare revenue 10%  2%
Total admissions 8%  (1%)
Total volume (2)(6) 6%  1%
Key Statistical Data - Total (3):  
Admissions 265,933   245,880 
Recertifications (6) 136,744   132,811 
   
Total volume (6) 402,677   378,691 
   
Medicare completed episodes 232,838   221,848 
Average Medicare revenue per completed
episode (4)
$2,962  $2,811 
Medicare visits per completed episode (5) 14.0   15.2 
   
Visiting Clinician Cost per Visit$91.94  $88.64 
Clinical Manager Cost per Visit$9.54  $9.10 
   
Total Cost per Visit$101.48  $97.74 
Visits 5,553,423   5,563,992 

(1) Same store information represents the percent change in our Medicare, Non-Medicare and Total revenue, admissions or volume for the period as a percent of the Medicare, Non-Medicare and Total revenue, admissions or volume of the prior period. Same store is defined as care centers that we have operated for at least the last twelve months and startups that are an expansion of a same store care center.
(2) Total volume includes all admissions and recertifications.
(3) Total includes acquisitions, start-ups and denovos.
(4) Average Medicare revenue per completed episode is the average Medicare revenue earned for each Medicare completed episode of care. Average Medicare revenue per completed episode reflects the transition to PDGM effective January 1, 2020 and the suspension of sequestration effective May 1, 2020.
(5) Medicare visits per completed episode are the home health Medicare visits on completed episodes divided by the home health Medicare episodes completed during the period.
(6) Prior year amounts have been recast to conform to the current year calculation.


Segment Information - Hospice

   
 For the Three-Month Periods
Ended September 30,
   
  2021   2020 
   
Financial Information (in millions):  
Medicare        $187.8  $189.0 
Non-Medicare         9.7   10.7 
   
Net service revenue         197.5   199.7 
Other operating income            1.7 
Cost of service         107.6   104.1 
   
Gross margin         89.9   97.3 
Other operating expenses         49.5   47.8 
Depreciation and amortization         0.7   0.6 
   
Operating income        $39.7  $48.9 
   
Same Store Growth (1):  
Medicare revenue         (1%)  3%
Hospice admissions         1%  9%
Average daily census         (5%)  %
Key Statistical Data - Total (2):  
Hospice admissions         13,292   13,026 
Average daily census         13,272   13,953 
Revenue per day, net        $161.74  $155.57 
Cost of service per day        $88.06  $81.05 
Average discharge length of stay         94   101 
        
        
 For the Nine-Month Periods
Ended September 30,
        
  2021   2020 
        
Financial Information (in millions):  
Medicare        $556.2  $516.5 
Non-Medicare         30.7   29.7 
   
Net service revenue         586.9   546.2 
Other operating income         6.0   8.9 
Cost of service         314.4   293.1 
   
Gross margin         278.5   262.0 
Other operating expenses         144.4   127.4 
Depreciation and amortization         2.0   1.7 
   
Operating income        $132.1  $132.9 
   
Same Store Growth (1):  
Medicare revenue         %  4%
Hospice admissions         3%  3%
Average daily census         (4%)  1%
Key Statistical Data - Total (2):  
Hospice admissions         39,650   35,755 
Average daily census         13,282   12,841 
Revenue per day, net        $161.87  $155.23 
Cost of service per day        $86.68  $83.29 
Average discharge length of stay         95   98 

(1) Same store information represents the percent change in our Medicare revenue, Hospice admissions or average daily census for the period as a percent of the Medicare revenue, Hospice admissions or average daily census of the prior period. Same store is defined as care centers that we have operated for at least the last twelve months and startups that are an expansion of a same store care center.
(2) Total includes acquisitions, start-ups and denovos.


Segment Information - Personal Care

   
 For the Three-Month Periods
Ended September 30,
   
  2021  2020
   
Financial Information (in millions):  
Medicare        $ $
Non-Medicare         15.9  18.4
   
Net service revenue         15.9  18.4
Other operating income           0.5
Cost of service         11.7  13.5
   
Gross margin         4.2  5.4
Other operating expenses         2.6  3.2
Depreciation and amortization         0.1  
   
Operating income        $1.5 $2.2
   
Key Statistical Data - Total:  
Billable hours         558,227  673,161
Clients served         8,697  10,153
Shifts         240,736  280,470
Revenue per hour        $28.44 $27.33
Revenue per shift        $65.95 $65.59
Hours per shift         2.3  2.4


   
 For the Nine-Month Periods
Ended September 30,
   
  2021  2020
   
Financial Information (in millions):  
Medicare        $ $
Non-Medicare         49.9  54.8
   
Net service revenue         49.9  54.8
Other operating income           1.0
Cost of service         37.4  41.7
   
Gross margin         12.5  14.1
Other operating expenses         8.8  9.5
Depreciation and amortization         0.2  0.1
   
Operating income        $3.5 $4.5
   
Key Statistical Data - Total:  
Billable hours         1,774,965  2,067,958
Clients served         11,597  14,057
Shifts         759,242  896,141
Revenue per hour        $28.11 $26.51
Revenue per shift        $65.71 $61.18
Hours per shift         2.3  2.3


Segment Information - High Acuity Care

   
 For the Three-Month Periods
Ended September 30,
   
  2021   2020
   
Financial Information (in millions):  
Medicare        $  $
Non-Medicare         1.5   
   
Net service revenue         1.5   
Other operating income            
Cost of service         0.9   
   
Gross margin         0.6   
Other operating expenses         3.9   
Depreciation and amortization         0.5   
   
Operating income        $(3.8) $
   
Key Statistical Data - Total:  
Full risk admissions         46   
Limited risk admissions         188   
   
Total admissions         234   
Direct medical loss ratio         52.6%  
Number of joint ventures         8   
Market penetration         31%  
Patient satisfaction         92%  
       
       
 For the Nine-Month Periods
Ended September 30,
       
  2021   2020
   
Financial Information (in millions):  
Medicare        $  $
Non-Medicare         1.5   
   
Net service revenue         1.5   
Other operating income            
Cost of service         0.9   
   
Gross margin         0.6   
Other operating expenses         3.9   
Depreciation and amortization         0.5   
   
Operating income        $(3.8) $
   
Key Statistical Data - Total:  
Full risk admissions         46   
Limited risk admissions         188   
   
Total admissions         234   
Direct medical loss ratio         52.6%  
Number of joint ventures         8   
Market penetration         31%  
Patient satisfaction         92%  


Segment Information - Corporate

   
 For the Three-Month Periods
Ended September 30,
   
  2021  2020
   
Financial Information (in millions):  
Other operating expenses        $40.5 $49.9
Depreciation and amortization         5.1  6.7
   
Total operating expenses        $45.6 $56.6
   


   
 For the Nine-Month Periods
Ended September 30,
   
  2021  2020
   
Financial Information (in millions):  
Other operating expenses        $125.5 $129.2
Depreciation and amortization         15.8  15.2
   
Total operating expenses        $141.3 $144.4
   


AMEDISYS, INC. AND SUBSIDIARIES
RECONCILIATION OF NON-GAAP FINANCIAL MEASURES TO GAAP MEASURES
(Amounts in thousands)
(Unaudited)

Adjusted Earnings Before Interest, Taxes, Depreciation and Amortization (“Adjusted EBITDA”) Reconciliation:

     
 For the Three-
Month Periods
Ended September 30,
 For the Nine-
Month Periods
Ended September 30,
     
  2021   2020   2021   2020 
     
Net income attributable to Amedisys, Inc.        $45,006  $71,981  $175,025  $138,457 
Add:    
Income tax expense (benefit)         10,731   (10,202)  57,192   9,175 
Interest expense, net         2,730   2,661   6,685   8,417 
Depreciation and amortization         7,487   8,283   21,763   19,955 
Certain items (1)         6,858   3,494   (24,440)  20,843 
Interest component of certain items (1)         (451)  (558)  (1,437)  (1,450)
     
Adjusted EBITDA (2) (7)        $72,361  $75,659  $234,788  $195,397 
     


Adjusted Net Service Revenue Reconciliation:

     
 For the Three-
Month Periods
Ended September 30,
 For the Nine-
Month Periods
Ended September 30,
     
  2021  2020  2021   2020
     
Net service revenue        $553,485 $544,070 $1,654,795  $1,520,814
Add:    
Certain items (1)             (6,541)  
     
Adjusted net service revenue (3) (7)        $553,485 $544,070 $1,648,254  $1,520,814
     


Adjusted Other Operating Income Reconciliation:

     
 For the Three-
Month Periods
Ended September 30, 
 For the Nine-
Month Periods
Ended September 30,
     
  2021   2020   2021   2020 
     
Other operating income$(4) $4,812  $13,300  $27,592 
Add:    
Certain items (1) 4   (4,812)  (13,300)  (27,592)
     
Adjusted other operating income (4) (7)$  $  $  $ 
     


Adjusted Net Income Attributable to Amedisys, Inc Reconciliation:

     
 For the Three-
Month Periods
Ended September 30,
 For the Nine-
Month Periods
Ended September 30,
     
  2021  2020  2021   2020
     
Net income attributable to Amedisys, Inc.        $45,006 $71,981 $175,025  $138,457
Add:    
Certain items (1)         5,474  2,585  (17,495)  15,424
     
Adjusted net income attributable to Amedisys, Inc. (5) (7)        $50,480 $74,566 $157,530  $153,881
     


Adjusted Net Income Attributable to Amedisys, Inc. per Diluted Share Reconciliation:

     
 For the Three-
Month Periods
Ended September 30, 
 For the Nine-
Month Periods
Ended September 30,
     
  2021  2020  2021   2020
     
Net income attributable to Amedisys, Inc. common stockholders per diluted share        $1.37 $2.16 $5.30  $4.16
Add:    
Certain items (1)         0.17  0.08  (0.53)  0.46
     
Adjusted net income attributable to Amedisys, Inc. common stockholders per diluted share (6) (7)        $1.53 $2.24 $4.77  $4.63
     

(1) The following details the certain items for the three and nine-month periods ended September 30, 2021 and 2020:


Certain Items:

   
 For the Three-Month Period
Ended September 30, 2021
 For the Nine-Month Period
Ended September 30, 2021
 (Income) Expense(Income) Expense
Certain Items Impacting Net Service Revenue:  
Contingency accrual        $   (6,541)
Certain Items Impacting Other Operating Income:  
CARES Act & State COVID-19 grants         4   (13,300)
Certain Items Impacting Cost of Service:  
COVID-19 costs         3,513   16,457 
Certain Items Impacting Operating Expenses:  
Acquisition and integration costs         2,757   6,249 
COVID-19 costs         199   576 
Pre-acquisition legal settlement            1,825 
Certain Items Impacting Total Other Income (Expense):  
Interest component of certain items         451   1,437 
Other (income) expense, net         (66)  (31,143)
   
Total        $6,858  $(24,440)
   
Net of tax        $5,474  $(17,495)
   
Diluted EPS        $0.17  $(0.53)
   


   
 For the Three-Month Period
Ended September 30, 2020
 For the Nine-Month Period
Ended September 30, 2020
 (Income) Expense
 (Income) Expense
Certain Items Impacting Other Operating Income:  
CARES Act & State COVID-19 grants        $(4,812) $(27,592)
Certain Items Impacting Cost of Service:  
COVID-19 costs         4,389   27,399 
Severance - reductions in staffing levels         (550)  4,633 
Certain Items Impacting Operating Expenses:  
Acquisition and integration costs         3,626   9,561 
COVID-19 costs         322   1,385 
Severance - reductions in staffing levels            271 
Certain Items Impacting Total Other Income (Expense):  
Interest component of certain items         558   1,450 
Other (income) expense, net         (39)  3,736 
   
Total        $3,494  $20,843 
   
Net of tax        $2,585  $15,424 
   
Diluted EPS        $0.08  $0.46 
   

(2) Adjusted EBITDA is defined as net income attributable to Amedisys, Inc. before net interest expense, provision for income taxes and depreciation and amortization, excluding certain items as described in footnote 1.
(3) Adjusted net service revenue is defined as net service revenue excluding certain items as described in footnote 1.
(4) Adjusted other operating income is defined as other operating income excluding certain items as described in footnote 1.
(5) Adjusted net income attributable to Amedisys, Inc. is defined as net income attributable to Amedisys, Inc. calculated in accordance with GAAP excluding certain items as described in footnote 1.
(6) Adjusted net income attributable to Amedisys, Inc. common stockholders per diluted share is defined as diluted income per share calculated in accordance with GAAP excluding the earnings per share effect of certain items as described in footnote 1.
(7) Adjusted EBITDA, adjusted net service revenue, adjusted other operating income, adjusted net income attributable to Amedisys, Inc. and adjusted net income attributable to Amedisys, Inc. common stockholders per diluted share should not be considered as an alternative to, or more meaningful than, income before income taxes or other measures calculated in accordance with GAAP. These calculations may not be comparable to a similarly titled measure reported by other companies, since not all companies calculate these non-GAAP financial measures in the same manner.