We build partnerships.
LHC Group Inc.
420 West Pinhook Road
Lafayette, LA 70503
1.866.LHC.GROUP
LHCgroup.com
2 0 1 2 An nU A L ReP O Rt
Our Purpose
It’s all about helping people.
Our Mission
We provide exceptional care and unparalleled
service to patients and families who have
placed their trust in us.
Our Vision
We will improve the quality of life in the
United States by transforming the delivery
of healthcare services.
To Our Valued Stakeholders
In the earliest days of our company’s history, the business that would one day become LHC Group was
a single home health agency in rural Louisiana. My wife, Ginger, was our first nurse, and I can still
remember countless late nights and early mornings when our phone would ring – one of our patients
was sick or hurting and needed help.
Today, LHC Group
supports physicians,
hospitals, patients
and families in 23
states as we deliver
home health, hospice,
long-term acute care
and community-
based services to
more than 90,000
patients each year.
Ginger would leave our home in the dark of night and go to her patient’s side.
An hour or two later, she’d crawl back into bed, her patient’s needs met and a
trip to the hospital avoided.
What we didn’t know then — what we couldn’t have known — is that the work
we were doing in St. Landry Parish, La., nearly 20 years ago was a precursor to
the care delivery model that is now widely recognized as an effective, efficient
way to promote patient healing and control healthcare costs. Post-acute care
is a powerful part of the care continuum, empowering patients to recover at
home and dramatically reducing avoidable hospital readmissions.
Today, LHC Group supports physicians, hospitals, patients and families in
23 states as we deliver home health, hospice, long-term acute care and
community-based services to more than 90,000 patients each year. We value
these vital relationships — these partnerships with purpose. You see, even as
we’ve grown from one location to more than 300, we’ve never lost sight of our shared purpose. Just as
it was in 1994, it’s all about helping people.
In recent months, we’ve asked our 8,500 employees to tell us their own unique purpose. And, because
“it’s all about helping people” sums up our company purpose in just five words, we’ve challenged
our employees to write their purpose statements in five words as well. The response has been
Keith G. Myers
Chairman and
Chief Executive Officer
overwhelming. Their words are equal parts compelling and sincere — not only inspirational but also
aspirational. Our employees’ responses, more than anything else could, clearly demonstrate why LHC
Group is not only an industry leader but also the partner of choice for hospitals and patients nationwide.
1
“Optimal care for our patients”
— Tracie Parrish
Lifeline Health Care of Russell, Russell Springs, Ky.
For everyone at LHC Group, it all begins with quality. Every decision — whether at the bedside or in the
boardroom — is considered through the lens of quality patient care. You see our commitment to quality
in the Joint Commission accreditation seal now proudly displayed by 95 percent of our home health
and hospice locations across the country. Accreditation drives quality outcomes, and
research has shown Joint Commission-accredited home health providers have fewer
29,646
33,414
33,351
34,371
readmissions after an episode of care than do non-accredited organizations.
You see our quality commitment, too, in our HomeCare Elite recognition. In 2012,
nearly 60 percent of LHC Group home health agencies achieved HomeCare Elite
status, an independent ranking of the nation’s top home health agencies based on
2009
2010
2011
2012
as of 12/31
quality and performance.
Perhaps most significantly, our commitment to quality care is evidenced in our 30-day
readmission rate, which is consistently better than the national average. Through our
($ in millions)
$529.2
$631.6
$633.9
$637.6
industry-leading T3 disease management strategy, we’re successfully managing patient
care through appropriate care transitions, triage and training. Around the country, we
encourage our patients to “call us first” when a health concern arises. These robust
triage efforts are resolving an impressive 90 percent of patient calls without the need
for physician intervention or a trip to the emergency department.
2009
2010
2011
2012
as of 12/31
2
Average Daily CensusNet Service Revenue “Being a positive team player!”
— Amy Breaux
LHC Group Home Office, Lafayette, La.
We entered into our first joint venture with a hospital partner in 1998. In the 15 years since, LHC Group
has emerged as the premier post-acute care partner for hospitals and health systems around the
country. We operated more than 100 joint-ventured locations in 2012, working hand in hand with our
hospital partners to seamlessly transition patients from the hospital to home.
Our extensive partnership experience has given us a unique and in-depth understanding of the post-
acute care challenges facing hospitals. We understand seniors ages 65 and older account for 60 percent
of potentially preventable hospitalizations. And we know that proper care transitions and management
are key to keeping these seniors out of the hospital and in the comfort of home.
We’ve aligned our efforts with those of our hospital partners as we work together to reduce avoidable
readmissions, and the results have been compelling. While in excess of 2,000 hospitals around the
We operated more than 100 joint-ventured
locations in 2012, working hand in hand
with our hospital partners to seamlessly
transition patients from the hospital to home.
3
310
301
285
277
country are being penalized by the government for high readmission rates, more
than eight in 10 of our partner hospitals are paying either no readmission penalty
or a penalty less than 1 percent in 2013.
Our proven record of clinical excellence continues to open the door for new
partnerships. In 2012, we were honored to become the post-acute care partner
of choice for both Texas Health Resources and Methodist Health System in North
2009
2010
2011
2012
Texas — healthcare systems recognized nationwide for their commitment to
as of 12/31
quality and innovation.
We’re also pioneering new ways to add value to long-time partners. Working collaboratively with
Ochsner Health System in New Orleans, for example, we were part of Ochsner Clinic Foundation’s
successful effort to secure a $3.8 million Health Care Innovation Award from the U.S. Department of
Health and Human Services. Through this innovation award, our clinicians are working with Ochsner
to manage the continuing care of stroke patients as they transition from the acute to the post-acute
setting. The program is expected to reduce readmissions and save an estimated $5 million over the
next three years.
“Our family loving your family”
— Peggy Posey
Access Hospice Care, Branson, Mo.
At LHC Group, we recognize our company is only as strong as the 8,500 employees who carry
out our mission of patient care each day. To that end, we invest heavily in the development of our
work force. In 2012, we launched a new and comprehensive learning management system to support
employee development. In addition, we created and implemented a robust internal credentialing
4
Locations program for our clinicians. Through this voluntary program, our team members have the opportunity
to complete 12 in-depth clinical modules to earn credentials in chronic disease management. Already,
employees representing more than two-thirds of our 23 states have completed or are enrolled in the
credentialing program.
We’ve also empowered our employees to assist each other in times of need. The Purpose Fund, a newly
launched employee hardship relief fund, provides financial assistance to LHC Group employees facing
economic hardship due to emergency situations. Grants from The Purpose Fund are made possible
through the financial support of LHC Group and our employees, many of whom provide voluntary
donations to support the fund.
“We can always be better!”
— Kate Lyon
Mississippi HomeCare of Hattiesburg, Miss.
Our company is guided by a vision to improve the quality of life in the United States by transforming
the delivery of healthcare services. We fulfill this vision through our commitment to clinical excellence,
our effective stewardship of our resources and our continued growth to serve new patients, families
and communities across the country.
We enjoyed solid organic growth in 2012, posting a 5.1 percent increase in home
health admissions, and we expect this strong performance to continue going
forward. As the realities of healthcare reform become more fully realized, we
80,883
109,316
116,161
98,363
are uniquely positioned to seize growth opportunities in both new markets and
existing ones. Propelled by our proven partnership model, our ongoing investment
in point-of-care technology, our demonstrated clinical results and our thriving
culture of caring, we will continue to implement care models that deliver both
2009
2010
2011
2012
as of 12/31
quality and efficiency despite reimbursement cuts and an increasingly complex
regulatory environment.
Our financial performance bears out the strength of our operating model. In 2012,
we saw our net service revenue climb to $637.6 million, up from $633.9 million
6,998
7,973
7,571
7,903
the prior year. Net income for the year was $27.4 million, which translated into
diluted earnings per share of $1.53 for the year. In fact, following a review of
strategic alternatives in 2012, our board of directors unanimously affirmed the
continued execution of our operating plan provides the greatest opportunity for our
2009
2010
2011
2012
as of 12/31
company’s long-term success.
5
AdmissionsEmployees The recent acquisition of Addus HomeCare Corp.’s home health service line expands our geographic
footprint to include California, Illinois, Nevada and South Carolina and positions us for significant
growth. In total, 19 home health agencies, one hospice agency and more than 500 employees joined
our LHC Group family as part of the Addus transaction.
“ Do the right thing - always!”
— Dana Godwin
Infirmary HomeCare of Saraland, Ala.
Even as we grow, helping more hospitals, patients and communities than ever before, we continue
to be guided by the same purpose that defined us when we were but one small home health agency
serving one small community in Louisiana.
It’s all about helping people.
This is the litmus test that directs our every action and shapes our every endeavor. It links us to our
past and illuminates our journey forward — a journey rooted in patient service, defined by clinical
quality and, above all else, governed by an unfailing commitment to do the right thing, always, for
those we serve.
Sincerely,
Keith G. Myers
Chairman and CEO
6
People
Service
Quality
Finance
Growth
Ethics
Ours is a business of people helping people.
We are here to serve patients, families and
communities.
In all we do, our focus is quality above all else.
We operate with discipline and efficiency to
remain strong.
It is our obligation to care for as many as we can.
We conduct ourselves with the highest standards
of ethics, integrity and professionalism.
Financial Highlights
(in thousands, except for per share data)
Net service revenue
Cost of service revenue
Gross margin
Provision for bad debts
Settlement with government agencies
General and administrative expenses
Operating income (loss)
Interest expense
Gain (loss) on the sale of assets and entities
Non-operating (loss) income
Income (loss) from continuing operations before income taxes and noncontrolling interest
Income tax expense (benefit)
Net income (loss)
Less net income attributable to noncontrolling interest
Year Ended December 31
2012
2011
$ 637,569
365,752
271,817
11,875
—
205,637
54,305
(1,550 )
(105 )
289
52,939
17,511
35,428
7,988
$ 633,872
352,346
281,526
12,320
65,000
210,588
(6,382 )
(1,018 )
59
1,722
(5,619 )
(1,968 )
(3,651 )
9,593
Net income (loss) available to LHC Group Inc.’s common stockholders
$
27,440
$
(13,244 )
Earnings per share — basic:
Net income (loss) attributable to LHC Group Inc.’s common stockholders
$
1.54
$
(0.73)
Earnings per share — diluted:
Net income (loss) attributable to LHC Group Inc.’s common stockholders
$
1.53
$
(0.73)
Weighted average shares outstanding:
Basic
Diluted
17,853,321
17,899,195
18,265,118
18,265,118
8
We build partnerships.
2 0 1 2 f o r m 1 0 - k
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-K
3 ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
l
For the fiscal year ended December 31, 2012
or
l TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from ___________________ to ___________________
Commission file number: 001-33989
LHC GROUP, INC.
(Exact name of registrant as specified in its charter)
Delaware
(State or other jurisdiction of incorporation or organization)
71-0918189
(I.R.S. Employer Identification No.)
420 West Pinhook Rd, Suite A
Lafayette, Louisiana 70503
(Address of principal executive offices)
(337) 233-1307
(Registrant’s telephone number, including area code)
Securities registered pursuant to Section 12(b) of the Exchange Act:
Common Stock, par value $.01 per share
(Title of each class)
NASDAQ Global Select Market
(Name of each exchange on which registered)
Securities registered pursuant to Section 12(g) of the Exchange Act:
None
3
Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes l No l
3
Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes l No l
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange
Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has
3
been subject to such filing requirements for the past 90 days. Yes l
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive
Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter
3
period that the registrant was required to submit and post such files). Yes l
Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K (117 CFR 229.405) is not contained
herein, and will not be contained, to the best of registrant’s knowledge, in definitive proxy or information statements incorporated by
3
reference in Part III of this Form 10-K or any amendment to this Form 10-K. l
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller
reporting company. See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of
the Exchange Act.
No l
No l
3
Large accelerated filer l Accelerated filer l
3
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act). Yes l No l
As of June 30, 2012, the aggregate market value of the registrant’s common stock held by non-affiliates of the registrant was $273.9
million based on the closing sale price as reported on the NASDAQ Global Select Market. For purposes of this determination shares
beneficially owned by officers, directors and ten percent stockholders have been excluded, which does not constitute a determination
that such persons are affiliates.
Non-accelerated filer l Smaller reporting company l
There were 17,584,303 shares of common stock, $0.01 par value, issued and outstanding as of March 11, 2013.
DOCUMENTS INCORPORATED BY REFERENCE
Portions of the Registrant’s Annual Report to stockholders for the fiscal year ended December 31, 2012 are incorporated by reference in
Part II of this Annual Report on Form 10-K. Portions of the Registrant’s Proxy Statement for its 2013 Annual Meeting of Stockholders are
incorporated by reference in Part III of this Annual Report on Form 10-K.
LHC GROUP, INC.
Table of Contents
PART I.
Cautionary Statement Regarding Forward-Looking Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
Item 1.
Item 1A.
Item 1B.
Item 2.
Item 3.
Item 4.
PART II.
Item 5.
Item 6.
Item 7.
Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
Unresolved Staff Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
Properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Legal Proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Mine Safety Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Market for Registrant’s Common Equity, Related Stockholder Matters and
Issuer Purchases of Equity Securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Selected Financial Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40
Management’s Discussion and Analysis of Financial Condition and Results of Operations . . . . . . . . . . . . . . . . . . .
41
Item 7A.
Quantitative and Qualitative Disclosures About Market Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60
Item 8.
Item 9.
Financial Statements and Supplementary Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
61
Changes In and Disagreements with Accountants on Accounting and Financial Disclosure . . . . . . . . . . . . . . . . . .
61
Item 9A.
Controls and Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
PART III.
Item 10.
Item 11.
Item 12.
Item 13.
Item 14.
PART IV.
Item 15.
Directors, Executive Officers and Corporate Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
63
Executive Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
63
Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters . . . . . . .
63
Certain Relationships and Related Transactions, and Director Independence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Principal Accounting Fees and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
63
Exhibits, and Financial Statement Schedules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
64
Signatures
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Exhibit Index
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 10-K
We build partnerships. With purpose.
PART I
Cautionary Statement Regarding Forward-Looking Statements
This Annual Report on Form 10-K and the information incorporated by reference herein contain certain statements and information that
may constitute “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the
Securities Exchange Act of 1934 (the “Exchange Act”). Forward-looking statements relate to future plans and strategies, anticipated
events or trends, future financial performance and expectations and beliefs concerning matters that are not historical facts or that
necessarily depend upon future events. The words “may,” “should,” “could,” “would,” “expect,” “plan,” “anticipate,” “believe,” “foresee,”
“estimate,” “predict,” “potential,” “intend” and similar expressions are intended to identify forward-looking statements. Specifically, this
Annual Report on Form 10-K contains, among others, forward-looking statements about:
• our expectations regarding financial condition or results of operations for periods after December 31, 2012;
• our critical accounting policies;
• our business strategies and our ability to grow our business;
• our participation in the Medicare and Medicaid programs;
• the reimbursement levels of Medicare and other third-party payors;
• the prompt receipt of payments from Medicare and other third-party payors;
• our future sources of and needs for liquidity and capital resources;
• the effect of any changes in market rates on our operating and cash flows;
• our ability to obtain financing;
• our ability to make payments as they become due;
• the outcomes of various routine and non-routine governmental reviews, audits and investigations;
• our expansion strategy, the successful integration of recent acquisitions and, if necessary, the ability to relocate or restructure our
current facilities;
• the value of our proprietary technology;
• the impact of legal proceedings;
• our insurance coverage;
• the costs of medical supplies;
• our competitors and our competitive advantages;
• our ability to attract and retain valuable employees;
• the price of our stock;
• our compliance with environmental, health and safety laws and regulations;
• our compliance with health care laws and regulations;
• our compliance with Securities and Exchange Commission laws and regulations and Sarbanes-Oxley requirements;
• the impact of federal and state government regulation on our business; and
• the impact of changes in or future interpretations of fraud, anti-kickback or other laws.
The forward-looking statements included in this report reflect our current views and assumptions only as of the date this report is filed with
the Securities and Exchange Commission. Except as required by law, we assume no responsibility and do not intend to release updates or
revisions to forward-looking statements after the date they are made, whether as a result of new information, future events or otherwise. The
occurrence of any of the events described in Part I, Item 1A. Risk Factors in this Annual Report on Form 10-K or incorporated by reference
into this Annual Report on Form 10-K, and other events that we have not predicted or assessed could have a material adverse effect on our
earnings, financial condition and business, and any such forward-looking statements should not be relied on as a prediction of future events.
We qualify all of our forward-looking statements by these cautionary statements. In addition, with respect to all of our forward-looking
statements, we claim the protection of the safe harbor for forward-looking statements contained in the Private Securities Litigation Reform
Act of 1995.
You should read this Annual Report on Form 10-K, the information incorporated by reference into this Annual Report on Form 10-K and
the documents filed as exhibits to this Annual Report on Form 10-K completely and with the understanding that our actual future results or
achievements may differ materially from what we expect or anticipate.
Unless otherwise indicated, “LHC Group,” “we,” “us,” “our” and “the Company” refer to LHC Group, Inc. and its consolidated subsidiaries.
Form 10-K Part I
3
LHC GROUP
Item 1. Business.
Overview
We provide post-acute health care services to patients through our home nursing agencies, hospices and long-term acute care hospitals
(“LTACHs”). As of December 31, 2012, through our wholly- and majority-owned subsidiaries, equity joint ventures and controlled affiliates,
we operated in Alabama, Arkansas, Florida, Georgia, Idaho, Kentucky, Louisiana, Maryland, Mississippi, Missouri, North Carolina, Ohio,
Oklahoma, Oregon, Tennessee, Texas, Virginia, West Virginia and Washington. We operate in two segments: home-based services and
facility-based services. As of December 31, 2012, we owned and operated 274 home-based service locations, with 232 home nursing
agency locations, 32 hospices, three specialty agencies and four private duty agencies. As of December 31, 2012, we also managed the
operations of three home nursing agencies in which we do not have an ownership interest. Our facility-based services included six
long-term acute care hospitals with nine locations, a pharmacy, and a family health center.
We provide home-based post-acute health care services through our home nursing agencies and hospices. Our home nursing locations
offer a wide range of services, including skilled nursing, medically-oriented social services and physical, occupational and speech therapy.
The nurses, home health aides and therapists in our home nursing agencies work closely with patients and their families to design and
implement individualized treatments in accordance with a physician-prescribed plan of care. Our hospices provide end-of-life care to
patients with terminal illnesses through interdisciplinary teams of physicians, nurses, home health aides, counselors and volunteers. Of the
274 home-based services locations, 140 are wholly-owned by us, 124 are majority-owned or controlled by us through joint ventures,
seven are operated through license lease arrangements, and we manage the operations of three home nursing agencies in which we have
no ownership interest.
Our LTACH locations provide services primarily to patients with complex medical conditions who have transitioned out of a hospital
intensive care unit but whose conditions remain too severe for treatment in a non-acute setting. As of December 31, 2012, our LTACHs
had 220 licensed beds. Of our 11 facility-based services locations, six are wholly-owned by us and five are majority-owned or controlled
by us through joint ventures.
Our net service revenue by segment for the years ended December 31, 2012, 2011 and 2010 was as follows (amounts in thousands):
Year Ended December 31,
Home-Based Services
Facility-Based Services
Consolidated Net Service Revenue
2012
2011
2010
$ 563,741
73,828
$ 557,901
75,971
$ 555,110
76,457
$ 637,569
$ 633,872
$ 631,567
Our founders began operations in September 1994 as St. Landry Home Health, Inc. in Palmetto, Louisiana. After several years of
expansion, our founders reorganized their business and began operating as Louisiana Healthcare Group, Inc. in June 2000. In March 2001,
Louisiana Healthcare Group, Inc. reorganized and became a wholly owned subsidiary of The Healthcare Group, Inc., a Louisiana
business corporation. In December 2002, The Healthcare Group, Inc. merged into LHC Group, LLC, a Louisiana limited liability company,
with LHC Group, LLC being the surviving entity. In January 2005, LHC Group, LLC established a wholly owned Delaware subsidiary,
LHC Group, Inc. and on February 9, 2005, LHC Group, LLC merged into LHC Group, Inc., a Delaware corporation. Our principal
executive offices are located at 420 West Pinhook Road, Suite A, Lafayette, Louisiana, 70503. Our telephone number is (337) 233-1307.
Our website is www.lhcgroup.com. Information contained on our website is not part of or incorporated by reference into this Annual
Report on Form 10-K.
Business Strategy
Our objective is to become the leading provider of post-acute services to Medicare beneficiaries in the United States. To achieve this
objective, we intend to:
Drive internal growth in existing markets. We intend to drive internal growth in our current markets by increasing the number of health
care providers in each market from whom we receive referrals and by expanding the breadth of our services. We intend to achieve this
growth by: (1) continuing to educate health care providers about the benefits of our services; (2) reinforcing the position of our agencies
and facilities as community assets; (3) maintaining our emphasis on high-quality medical care for our patients; (4) indentifying related
products and services needed by our patients and their communities; and (5) providing a superior work environment for our employees.
4
Form 10-K Part I
We build partnerships. With purpose.
Achieve margin improvement through the active management of costs. The majority of our net service revenue is generated under
Medicare prospective payment systems (“PPS”) through which we are paid pre-determined rates based upon the clinical condition and
severity of the patients in our care. Because our profitability in a fixed payment system depends upon our ability to manage the costs of
providing care, we continue to pursue initiatives to improve our margins and net income.
Expand into new markets. We intend to continue expanding into new markets by utilizing our point of care technology, developing de
novo locations and by acquiring existing Medicare-certified home nursing agencies in attractive markets throughout the United States.
We will continue our unique strategy of partnering with non-profit hospitals in home health services, as these ventures provide significant
return on investment. We also plan to acquire larger freestanding agencies that can serve as growth platforms in markets we do not
currently serve in order to support our growth into new markets.
Pursue strategic acquisitions and develop joint ventures. We will continue to identify and evaluate opportunities for strategic
acquisitions in new and existing markets that will enhance our market position, increase our referral base and expand the breadth of
services we offer. We endeavor to joint venture with hospitals to provide post-acute services, such as home health and hospice
services, in communities served by hospitals already operating Medicare-certified home health agencies.
Services
We provide post-acute care services in the United States by providing quality cost-effective health care services to patients within the
comfort and privacy of their home or place of residence. Our services can be broadly classified into two principal categories:
(1) home-based services offered through our home nursing agencies and hospices; and (2) facility-based services offered through our
long-term acute care hospitals.
Home-Based Services
Home Nursing. Our registered and licensed practical nurses provide a variety of medically necessary services to homebound patients
who are suffering from acute or chronic illness, recovering from injury or surgery, or who otherwise require care, teaching or monitoring.
These services include:
• wound care and dressing changes;
• cardiac rehabilitation;
• infusion therapy;
• pain management;
• pharmaceutical administration;
• skilled observation and assessment; and
• patient education.
We have also designed guidelines to treat chronic diseases and conditions, including diabetes, hypertension, arthritis, Alzheimer’s disease,
low vision, spinal stenosis, Parkinson’s disease, osteoporosis, complex wound care and chronic pain. Our home health aides provide
assistance with daily living activities such as light housekeeping, simple meal preparation, medication management, bathing and walking.
Through our medical social workers, we counsel patients and their families with regard to financial, personal and social concerns
that arise from a patient’s health-related problems. We provide skilled nursing, ventilator and tracheotomy services, extended care
specialties, medication administration and management, and patient and family assistance and education. We also provide management
services to third-party home nursing agencies, often as an interim solution until proper state and regulatory approvals for an acquisition
can be obtained.
Our physical, occupational and speech therapists provide therapy services to patients in their home. Our therapists coordinate
multi-disciplinary treatment plans with physicians, nurses and social workers to restore basic mobility skills such as getting out of bed and
walking safely with crutches or a walker. As part of the treatment and rehabilitation process, a therapist will stretch and strengthen
muscles, test balance and coordination abilities and teach home exercise programs. Our therapists assist patients and their
families with improving and maintaining a patient’s ability to perform functional activities of daily living, such as the ability to dress, cook,
clean and manage other activities safely in the home environment. Our speech and language therapists provide corrective and
rehabilitative treatment to patients who suffer from physical or cognitive deficits or disorders that create difficulty with verbal
communication or swallowing.
Form 10-K Part I
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LHC GROUP
All of our home nursing agencies offer 24-hour personal emergency response and support services through Philips Lifeline (“Lifeline”) for
qualified patients who require close medical monitoring but who want to maintain an independent lifestyle. These services consist
principally of a communicator that connects to the telephone line in the subscriber’s home and a personal help button that is worn or
carried by the individual subscriber which, when activated, initiates a telephone call from the subscriber’s communicator to Lifeline’s
central monitoring facilities. Lifeline’s trained personnel identify the nature and extent of the subscriber’s particular need and notify the
subscriber’s family members, neighbors and/or emergency personnel, as needed. We believe our use of the Lifeline system increases
patient satisfaction and loyalty by providing our patients a point of contact between scheduled nursing visits. As a result, we provide a
more complete regimen of care management than our competitors in the markets in which we operate by offering this service to qualified
patients as part of their home health plan of care.
Hospice. Our Medicare-certified hospice operations provide a full range of hospice services designed to meet the individual physical,
spiritual and psychosocial needs of terminally ill patients and their families. Our hospice services are primarily provided in a patient’s home
but can also be provided in a nursing home, assisted living facility or hospital. Key services provided include pain and symptom
management accompanied by palliative medication, emotional and spiritual support, inpatient and respite care, homemaker services,
dietary counseling, and family bereavement counseling and social worker visits for up to 13 months after a patient’s death.
Facility-Based Services
Long-term Acute Care Hospitals. Our LTACHs treat patients with severe medical conditions who require a high-level of care and
frequent monitoring by physicians and other clinical personnel. Patients who receive our services in an LTACH are too medically unstable
to be treated in a non-acute setting. Examples of these medical conditions include respiratory failure, neuromuscular disorders, cardiac
disorders, non-healing wounds, renal disorders, cancer, head and neck injuries and mental disorders. We also treat patients diagnosed
with musculoskeletal impairments that restrict their ability to perform normal activities of daily living. As part of our facility-based services,
we operate an institutional pharmacy, which focuses on providing a full array of services to our long-term acute care hospitals.
Operations
Financial information relating to the home- and facility-based operating segments of our business including their contributions to our total
net service revenue, operating income and total assets for each of the three years in the period ended December 31, 2012, 2011 and
2010, respectively, is found in Note 11 to the Consolidated Financial Statements included in this Annual Report on Form 10-K.
Home-Based Services
Our home nursing agencies are operated in one division that is separated into five geographical regions and further separated into
individual operating areas. Each agency is staffed with experienced clinical home health and administrative professionals who provide a
wide range of patient care services. Each of our home nursing agencies is licensed and certified by the state and federal governments. As
of December 31, 2012, 266 of our 274 agencies were accredited by the Joint Commission, a nationwide commission that establishes
standards relating to the physical plant, administration, quality of patient care and operation of medical staffs of hospitals. Those not yet
accredited are working towards achieving this accreditation, a process which can take up to six months. As we acquire companies, we
apply for accreditation 12 to 18 months after acquisition.
Our home nursing agencies use our Service Value Point system, a proprietary clinical resource allocation model and cost management
system. The system is a quantitative tool that assigns a target level of resource units to a group of patients based upon their initial
assessment and estimated skilled nursing and therapy needs. The Service Value Point system allows the Director of Nursing or Branch
Manager to allocate adequate resources throughout the group of patients assigned to his or her care, rather than focusing on the
profitability of an individual patient.
Patient care is handled at the home nursing agency level. Centralized functions that are provided by the home office include payroll,
accounting, financial reporting, billing, collections, regulatory and legal compliance, risk management, pharmacy, information technology
and general clinical oversight accomplished by periodic on-site surveys.
Facility-Based Services
Our LTACHs are operated in one division within one geographic region. Our facility-based services follow a clinical approach under which
each patient is discussed in weekly, multidisciplinary team meetings. In these meetings, patient progress is assessed and compared to
goals and future goals are set. We believe that this model results in higher quality care, predictable discharge patterns and the avoidance
of unnecessary delays.
6
Form 10-K Part I
We build partnerships. With purpose.
All coding, medical records, case management, utilization review and medical staff credentialing are provided at the hospital level. Centralized
functions that are provided by the home office include payroll, accounting, financial reporting, billing, collections, regulatory and legal
compliance, risk management, pharmacy, information technology and general clinical oversight accomplished by periodic on-site surveys.
Joint Ventures
As of December 31, 2012, we had 70 equity joint ventures including 62 with hospitals, five with physicians, and three with other parties.
We also operate three agency license leasing agreements.
Equity Joint Ventures
A majority of our equity joint ventures are structured as limited liability companies in which we own a majority equity interest and our
partners own a minority equity interest. At the time of formation, we and our partners each contribute capital to the equity joint venture in
the form of cash or property. We believe that the amount contributed by each party to the equity joint venture represents their pro-rata
portion of the fair market value of the equity joint venture. None of our partners are required to make or influence referrals to our equity
joint ventures. In fact, each of our hospital joint venture partners must follow the same Medicare discharge planning regulations, which,
among other things, requires them to offer each Medicare patient a list of available Medicare-certified home nursing agency options and to
allow the patient to choose his or her own provider.
We serve as the manager for our equity joint ventures and oversee their day-to-day operations. From a governance perspective, our
equity joint ventures are either manager-managed or board-managed. In our manager-managed joint ventures, we are designated as the
manager, and, in our board-managed joint ventures, we hold a majority of the votes required to take action, although a majority of our joint
ventures require super majority approvals of certain actions. We possess a majority of the total votes available to be cast by the members
of the management committee. However, in three of these joint ventures where we have partnered with not-for-profit hospitals, the
hospitals control a majority of the total management committee votes. In such instances we possess the right to withdraw from the equity
joint venture at any time upon notice to our partner in exchange for the receipt of a payment in an amount calculated in accordance with a
predetermined formula. The members of our equity joint ventures participate in profits and losses in proportion to their equity interests.
Distributions from our equity joint ventures are made pro-rata based on percentage ownership interests and are not based on referrals
made to the equity joint venture by any of the members.
The 70 equity joint ventures individually contribute between 0.02% and 3.88% of our consolidated net service revenue with only two of
the equity joint ventures accounting for greater than 3% of our total net service revenue for the twelve months ended December 31, 2012.
LA Extended Care of Lafayette, in which we have a 87.23% ownership interest, contributed 3.77% and Mississippi HomeCare of
Jackson, LLC, in which we have a 66.67% ownership interest, contributed 3.88% to our consolidated net service revenue for the year
ended December 31, 2012.
Most of our equity joint ventures include a buy/sell option that grants to us and our joint venture partners the right to require the other joint
venture party to either purchase all of the exercising member’s membership interests or sell to the exercising member all of the non-
exercising member’s membership interests, at the non-exercising member’s option, within 30 days of the receipt of notice of the exercise
of the buy/sell option. In some instances, the purchase price under these buy/sell provisions is based on a multiple of the historical or
future earnings before income taxes, depreciation and amortization of the equity joint venture at the time the buy/sell option is exercised.
In other instances, the buy/sell purchase price will be negotiated by the partners but will be subject to a fair market valuation process.
License Leasing Agreements
As of December 31, 2012, we had three agreements to lease, through our wholly-owned subsidiaries, the right to use the home health
licenses necessary to operate our home nursing agencies and hospice agencies. These leases are entered into when state law would
otherwise prohibit the alienation and sale of home nursing agencies. The table below details the monthly fees and termination dates of the
leasing agreements. Two of the agreements are based on net quarterly projections with a cap of $180,000 per year.
Form 10-K Part I
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LHC GROUP
Number of Agreements
2012 Current Monthly Fee
Increase in Monthly Fee
Initial Term Dates
1
2
$17,500
Based on net quarterly projections
with a cap of $180,000
5% increase every three years
None
2017 with a 2 year automatic renewal
2010 with a 5 year automatic renewal
In all three leasing arrangements, we have a right of first refusal in the event that the lessor intends to sell the leased agency to a third party.
Management Services Agreements
As of December 31, 2012, we had three management services agreements under which we manage the operations of home nursing
agencies. We do not have ownership interest in the agencies subject to these management services agreements. We provide billing,
management and other consulting services suited to and designed for the efficient operation of the applicable home nursing agency.
We are responsible for the costs associated with the locations and personnel required for the provision of services. We are
compensated based on a percentage of cash collections for one agreement and reimbursed for operating expenses plus a percentage
of operating net income for the remaining two agreements. The term of these arrangements is typically five years, with an option to
renew for an additional five-year term. All management services agreements will automatically renew annually unless either party gives
written notice of termination.
We record management services revenue as services are provided in accordance with the various management services agreements.
Competition
The home health care market is highly fragmented. According to MedPac, there were approximately 11,654 Medicare-certified home
nursing agencies in the United States in 2010. In 2009 MedPac estimated that approximately 32% of Medicare-certified home health
agencies were hospital-based or not-for-profit, freestanding agencies and 19% of home nursing agencies were located in rural markets.
We believe we are well positioned to build and maintain long-term relationships with local hospitals, physicians and other health care
providers and to become the highest quality post-acute provider in our markets. In our experience, because most rural areas have the
population size to support only one or two general acute care hospitals, the local hospital often plays a significant role in rural market
health care delivery systems. Rural patients who require home nursing frequently receive care from a small home care agency or an
agency that, while owned and run by the hospital, is not an area of focus for that hospital. Similarly, patients in these markets who require
services typically offered by long-term acute care hospitals are more likely to remain in the community hospital because it is often
the only local facility equipped to deal with severe, complex medical conditions. By entering these markets through affiliations with local
hospitals, competition for the services we provide is minimal.
As we expand into new markets, we may encounter public companies that have greater resources or greater access to capital.
Competition in our markets comes primarily from small local and regional providers. These providers include facility- and hospital-based
providers, visiting nurse associations and nurse registries. We are unaware of any competitor offering our breadth of services and
focusing on the needs of rural markets.
We have also entered into various joint ventures with non-profit hospitals for the ownership and management of home nursing agencies
and LTACHs. We are unaware of any competitor with this type of ownership mix.
Although several public and private national and regional companies own or manage long-term acute care hospitals, they generally do not
operate in the rural markets that we serve. Generally, the competition in our markets comes from local health care providers. We believe
our principal competitive advantages over these local providers are our diverse service offerings, our collaborative approach to working
with health care providers, our focus on rural markets and our patient-oriented operating model.
8
Form 10-K Part I
Quality Control
The LHC Group Quality Council (“The Council”) is responsible for formulating quality of care indicators, identifying performance
improvement priorities, and facilitating best-practices for quality care. As part of this council, we adopted the Plan, Do, Check, Act
methodology. We also set forth a quality platform for home care that reviews the following:
We build partnerships. With purpose.
• performance improvement audits;
• Joint Commission accreditation;
• state and regulatory surveys;
• Home Health Compare scores; and
• patient perception of care.
The Council also has the responsibility to ensure that the infrastructure of the quality initiatives throughout the Company is appropriate,
to oversee and evaluate the effectiveness of the quality plans and initiatives and to recommend appropriate quality and performance
improvement initiatives.
The Clinical Quality Committee of the Board of Directors (“The Committee”) is responsible for advising the Company’s clinical leadership,
monitoring the performance of our locations based on internal and external benchmarks, overseeing and evaluating the effectiveness
of the performance improvement and quality plans, facilitating best practices based on internal and external comparisons and fostering
enhanced awareness of clinical performance by the Board of Directors.
As part of our ongoing quality control, internal auditing and monitoring programs, we conduct internal regulatory audits and mock surveys
at each of our agencies and facilities at least once a year. If an agency or facility does not achieve a satisfactory rating, we require that
it prepare and implement a plan of correction. We then follow-up to verify that all deficiencies identified in the initial audit and survey have
been corrected.
As required under the Medicare conditions of participation, we have a continuous quality improvement program, which involves:
• ongoing education of staff and quarterly continuous quality improvement meetings at each of our agencies, facilities and home office;
• monthly comprehensive audits of patient charts performed at each of our agencies and facilities;
• at least annually, a comprehensive audit of patient charts is performed on each of our agencies and facilities;
• review of Home Health Compare scores;
• assessment of patient’s and/or family member’s perception of care using Press Ganey, Deyton or Thomson Reuters; and
• assessment of infection control practices and risk events.
We continually expand and refine our quality improvement programs. Specific written policies, procedures, training and educational
materials and programs, as well as auditing and monitoring activities, have been prepared and implemented to address the functional and
operational aspects of our business. Our programs also address specific problem areas identified through regulatory interpretation
and enforcement activities. We believe our consistent focus on continuous quality improvement programs provide us with a competitive
advantage in the market.
Compliance
We have established and continually maintain a comprehensive compliance and ethics program that is designed to assist all of our
employees to meet or exceed applicable standards established by federal and state laws and regulations and industry practice.
Our goal is to foster and maintain the highest standards of compliance, ethics, integrity and professionalism in every aspect of our
business dealings.
The purpose of our compliance and ethics program is to focus on compliance with applicable legal and regulatory requirements; the
requirements of the Medicare and Medicaid programs and other government healthcare programs; industry standards; our Code
of Conduct and Ethics; and our policies and procedures that support and enhance overall compliance within our Company. The primary
focus of our compliance and ethics program is on regulations related to the federal False Claims Act, Stark Law, Anti-Kickback Law,
billing and overall adherence to health care regulations.
Form 10-K Part I
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LHC GROUP
To ensure the independence of our compliance department staff, the following measures have been implemented:
• our Chief Compliance Officer reports to and has direct oversight by the Audit Committee of our Board of Directors;
• the compliance department has its own operating budget; and
• the compliance department has the authority to independently investigate any compliance or ethical concerns, including, when deemed
necessary, the authority to interview any company personnel, access any company property (including electronic communications) and
engage counsel to assist in any investigation.
Among other activities, our compliance department staff is responsible for the following activities:
• drafting and revising the Company’s policies and procedures related to compliance and ethics issues;
• reviewing, making recommended revisions, disseminating and tracking attestations to our Code of Conduct and Ethics;
• measuring compliance with our policies and procedures, Code of Conduct and Ethics and legal and regulatory requirements related to
the Medicare and Medicaid programs and other government healthcare programs, laws and regulations;
• developing and providing compliance-related training and education to all of our employees and, as appropriate, directors, contractors
and other representatives and agents, including new-hire compliance training for all new employees, annual compliance training for
all employees, sales compliance training to all members of our sales team, billing compliance training to all members of our billing and
revenue cycle team and other job-specific and role-based compliance training of certain employees;
• performing an annual company-wide risk assessment;
• implementing an annual compliance auditing and monitoring work plan and performing and following up on various risk-based
auditing and monitoring activities, including both clinical and non-clinical auditing and monitoring activities at the corporate level and at
the local agency/facility level;
• developing, implementing and overseeing our Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) privacy and security
compliance program;
• monitoring, responding to and overseeing the resolution of issues and concerns raised through our anonymous compliance hotline;
• monitoring, responding to and resolving all compliance and ethics-related issues and concerns raised through any other form of
communication; and
• ensuring that we take appropriate corrective and disciplinary action when noncompliant or improper conduct is identified.
All employees are required to report incidents, issues or other concerns that they believe in good faith may be in violation of our Code of
Conduct and Ethics, our policies and procedures, applicable legal and regulatory requirements or the requirements of the Medicare and
Medicaid programs and other government healthcare programs. All employees are encouraged to either contact our Chief Compliance
Officer directly or to contact our 24-hour toll-free compliance hotline when they have questions or concerns about any compliance or
ethics issues. All reports to our compliance hotline are kept confidential to the extent allowed by law, and employees have the option to
remain anonymous. In cases reported to our compliance hotline that involve a compliance or ethics issue or any possible violation of law
or regulation, the matter is referred to the compliance department for investigation. Retaliation against employees in connection with
reporting compliance or ethical concerns is considered a serious violation of our Code of Conduct and Ethics, and, if it occurs, will result
in discipline, up to and including termination of employment.
We continually expand and refine our compliance and ethics programs. We promote a culture of compliance, ethics, integrity and
professionalism within our company through persistent messages from our senior leadership concerning the necessity of strict compliance
with legal requirements and company policies and procedures. We believe our consistent focus on our compliance and ethics programs
provides us with a competitive advantage in the markets we serve.
Technology and Intellectual Property
Our Service Value Point system is a proprietary information system that assists us in, among other things, monitoring clinical utilization
and other cost factors, supporting our health care management techniques, internal benchmarking, clinical analysis, outcomes monitoring
and claims generation, revenue cycle management and revenue reporting.
10
Form 10-K Part I
We build partnerships. With purpose.
Our patent for our Service Value Point system was finalized during 2009 by the U.S. Patent and Trademark Office. This proprietary home
nursing clinical resource and cost management system is a quantitative tool that assigns a target level of resource units to each patient
based upon his or her initial assessment and estimated skilled nursing and therapy needs. We designed this system to empower our
direct care employees to make appropriate day-to-day clinical care decisions while also allowing us to manage the quality and delivery of
care across our system and to monitor the cost of providing that care both on a patient-specific and agency-specific basis.
In addition to our Service Value Point system, our business is substantially dependent on non-proprietary software. We utilize a third-party
software information system for billing and maintaining patient claim receivables for our LTACHs. As of December 31, 2012, our home
nursing agencies primarily utilized two billing and patient claim systems.
We continue to implement, evaluate and refine our point of care (“POC”) roll out strategy. POC allows a visiting clinician access to records
and other information from the patient’s home or at the point of care. This access also allows the clinician to complete required
documentation at the point of care and submit it electronically into our patient record. As of December 31, 2012, we had 125 locations
(home health and hospice) on POC. We plan to continue converting our locations to POC and expect to be completed by 2014.
Technology plays a key role in our organization’s ability to expand operations and maintain effective managerial control. The software we
use is based on client-server technology and is highly scalable. We believe our software and systems are flexible, easy-to-use and allow
us to accommodate growth without difficulty. We believe that building and enhancing our information and software systems provides us
with a competitive advantage that allows us to grow our business in a more cost-efficient manner and results in better patient care.
Reimbursement
Medicare
The federal government’s Medicare program, governed by the Social Security Act of 1965, reimburses health care providers for services
furnished to Medicare beneficiaries. These beneficiaries generally include persons age 65 and older and those who are chronically
disabled. The program is primarily administered by the Department of Health and Human Services (“HHS”) and the Centers for Medicare &
Medicaid Services (“CMS”). Medicare payments accounted for 77.9%, 79.7% and 80.5% of our net service revenue for the years ended
December 31, 2012, 2011 and 2010, respectively. Medicare reimburses us based upon the setting in which we provide our services or
the Medicare category in which those services fall.
In 2011, sequestration was used in the Budget Control Act of 2011(BCA, P.L. 112-25) as a tool in federal budget control. Sequestration is
a procedure in United States law that limits the size of the federal budget. Sequestration involves setting a hard cap on the amount of
government spending within broadly-defined categories; if Congress enacts annual appropriations legislation that exceeds these caps, an
across-the-board spending cut is automatically imposed on these categories, affecting all departments and programs by an equal
percentage. This 2011 act authorized an increase in the debt ceiling in exchange for $2.4 trillion in deficit reduction over the following ten
years. This total included $1.2 trillion in spending cuts identified specifically in the legislation, with an additional $1.2 trillion in cuts that
were to be determined by a bipartisan group of Senators and Representatives known as the “Super Committee” or officially as the United
States Congress Joint Select Committee on Deficit Reduction. The Super Committee failed to reach an agreement. In that event, a trigger
mechanism in the bill was activated to implement across-the-board reductions in the rate of increase in spending known as sequestration.
Sequestration was triggered on March 1, 2013 for non-exempted spending other than Medicare. Due to the Congressional Budget Act,
sequestration’s impact on Medicare spending is triggered on the first day of the first month after the order is put into effect. The
sequestration cut to Medicare will begin on April 1, 2013 and will reduce Medicare payments for patients whose service dates end on or
after April 1, 2013 by 2%.
Home Nursing. The Medicare home nursing benefit is available to patients who need care following discharge from a hospital, as well
as patients who suffer from chronic conditions that require ongoing but intermittent care. The services received need not be rehabilitative
or of a finite duration; however, patients who require full-time skilled nursing for an extended period of time generally do not qualify for
Medicare home nursing benefits. As a condition of coverage under Medicare, beneficiaries must: (1) be homebound in that they are
unable to leave their home without considerable effort; (2) require intermittent skilled nursing, physical therapy, or speech therapy services
that are covered by Medicare; and (3) receive treatment under a plan of care that is established and periodically reviewed by a
physician. Qualifying patients also may receive reimbursement for occupational therapy, medical social services and home health aide
services if these additional services are part of a plan of care prescribed by a physician.
Form 10-K Part I
11
LHC GROUP
We receive a standard prospective Medicare payment for delivering care over a base 60-day period, referred to as an episode of care.
There is no limit to the number of episodes a beneficiary may receive as long as he or she remains eligible. Most patients complete
treatment within two payment episodes. The base episode payment, established through federal legislation, is a flat rate that is adjusted
upward or downward based upon differences in the expected resource needs of individual patients as indicated by clinical severity,
functional severity and service utilization. The magnitude of the adjustment is determined by each patient’s categorization into one of
153 payment groups, known as Home Health Resource Groups and the costliness of care for patients in each group relative to the
average patient. Our payment is further adjusted for differences in local labor costs using the hospital wage index. We bill and are
reimbursed for services in two stages: an initial request for advance payment when the episode commences and a final claim when it is
completed. We submit all Medicare claims through the Medicare Administrative Contractors for the federal government. We receive 60%
of the estimated payment for a patient’s initial episode up-front (after the initial assessment is completed and upon initial billing) and the
remaining 40% upon completion of the episode and after all final treatment orders are signed by the physician. In the event of subsequent
episodes, reimbursement timing is 50% up-front and 50% upon completion of the episode. Final payments may reflect one of four
retroactive adjustments to ensure the adequacy and effectiveness of the total reimbursement: (1) an outlier payment if the patient’s care
was unusually costly; (2) a low utilization adjustment if the number of visits was fewer than five; (3) a partial payment if the patient
transferred to another provider before completing the episode; or (4) a payment adjustment based upon the level of therapy services
required in the population base. Because such adjustments are determined upon the completion date of the episode, retroactive
adjustments could impact our financial results.
In 2011, CMS finalized two provisions of the Patient Protection and Affordable Care Act (“the PPACA”): (1) a face-to-face encounter
requirement for home health and hospice; and (2) changes in the therapy assessment schedule. As a condition for Medicare payment, the
PPACA mandates that prior to certifying a patient’s eligibility for home health services, the certifying physician must document that he or
she, or a non-physician practitioner that meets the requirements of the rule, has had a face-to-face encounter with the patient that relates
to the condition for which the patient receives home health services. The encounter must occur within 90 days prior to the start of care
or 30 days after the start of care. Documentation regarding these encounters must be present on certifications.
In addition to the face-to-face encounter requirements, CMS made important changes to therapy assessment requirements.
A professional qualified therapist assessment must take place at least once every 30 days during a therapy patient’s course of treatment.
For those eligible patients needing 13 or 19 therapy visits, a qualified therapist must perform the therapy service required, assess
the patient, and measure and document effectiveness of the 13th visit and the 19th visit for all therapy disciplines caring for the patient.
We verify a patient’s eligibility for home health benefits at the time of admission. Through the verification process we are able to determine
the payor source and eligibility for reimbursement of each patient. Accordingly, we do not have any material reimbursement amounts
that are pending approval based on the eligibility of a patient to receive reimbursement from the applicable payor program. Further, we
provide only limited services to patients who are ineligible for reimbursement from a third party payor. Therefore, we do not have any
material reimbursement from patients who are self-pay.
The base payment rate for Medicare home nursing was $2,138.52, $2,192.07 and $2,312.94 per 60 day episode for the calendar years
of 2012, 2011 and 2010, respectively. In 2013, the base payment rate for Medicare home nursing per 60 day episode is $2,137.73.
The base payment rate does not include the 2% reduction to Medicare payment through sequestration as mandated by the Congressional
Budget Act.
The standard federal rate is increased or decreased based on each Medicare patient’s case mix index which measures the severity of
the patient’s condition. Since the inception of the prospective payment system in October 2000, the base episode payment rate has
varied due to both the impact of annual market-basket based increases and Medicare-related legislation. Home health payment rates are
updated annually by either the full home health market basket percentage, or by the home health market basket percentage as
adjusted by Congress. CMS establishes the home health market basket index, which measures inflation in the prices of an appropriate
mix of goods and services included in home health services.
The Office of Inspector General (“OIG”) of HHS has a responsibility to report both to the Secretary of HHS and to Congress any program
or management problems related to programs such as Medicare. The OIG’s duties are carried out through a nationwide network of audits,
investigations and inspections. The OIG has undertaken a study with respect to Medicare reimbursement for home health services.
No estimate can be made at this time regarding the impact, if any, of the OIG’s findings.
12
Form 10-K Part I
We build partnerships. With purpose.
Hospice. In order for a Medicare beneficiary to qualify for the Medicare hospice benefit, two physicians must certify that, in the best
judgment of the physician or medical director, the beneficiary has less than six months to live, assuming the beneficiary’s disease runs its
normal course. In addition, the Medicare beneficiary must affirmatively elect hospice care and waive any rights to other Medicare benefits
related to his or her terminal illness. For each benefit period, a physician must recertify that the Medicare beneficiary’s life expectancy is
six months or less in order for the beneficiary to continue to qualify for and to receive the Medicare hospice benefit. The first two benefit
periods are measured at 90-day intervals and subsequent benefit periods are measured at 60-day intervals. A Medicare beneficiary may
revoke his or her election at any time and resume receiving traditional Medicare benefits. There is no limit on how long a Medicare
beneficiary can receive hospice benefits and services, provided that the beneficiary continues to meet Medicare hospice eligibility criteria.
Medicare reimburses for hospice care using a prospective payment system. Under that system, we receive one of four predetermined
daily or hourly rates based upon the level of care we furnish to the beneficiary. These rates are subject to annual adjustments based on
inflation and geographic wage considerations. Our base Medicare rates depend upon which of the following four levels of care we provide:
• Routine Care. This level of care includes care that is not classified under any of the other levels of care, such as the work of social
workers or home health aides.
• General Inpatient Care. This level of care is available for pain control or acute or chronic symptom management that cannot be managed
in a setting other than an inpatient Medicare certified facility, such as a hospital, skilled nursing facility or hospice inpatient facility.
• Continuous Home Care. This level of care is provided when a patient is experiencing a medical crisis and requires nursing services to
achieve palliation and symptom control. For services to qualify for this level of care, the agency must provide a minimum of eight hours of
care within a 24-hour period.
• Respite Care. This level of care is provided on a short-term, inpatient basis to give temporary relief to the person who regularly
provides care to the patient.
Medicare limits the reimbursement we may receive for inpatient care services of hospice patients. Under the “80-20 rule,” if the number
of inpatient care days furnished by us to Medicare beneficiaries exceeds 20% of the total days of hospice care furnished by us to
Medicare beneficiaries, Medicare payments to us for inpatient care days exceeding the inpatient cap will be reduced to the routine home
care rate. This determination is made annually based on the 12-month period beginning on November 1st each year. This limit is
computed on a program-by-program basis. Our hospices did not exceed the cap on inpatient care services during 2011 or 2010. We
have not received notification that any of our hospices have exceeded the cap on inpatient care services during 2012.
Our Medicare hospice reimbursement is also subject to a cap amount calculated by the Medicare fiscal intermediary at the end of the
hospice cap period, which runs from November 1 through October 31 of the following year. We have not received notification that any of
our hospices have exceeded the cap on per beneficiary limits during 2012.
The two caps include an inpatient cap and overall payment cap, detailed below:
• Inpatient Cap. This cap limits the number of days of inpatient care (both respite and general) under a provider number to 20% of the
total number of days of hospice care (both inpatient and in-home) furnished to all patients served. The daily payment rate for any
inpatient days of service in excess of the cap amount is calculated at the routine home care rate, with excess amounts due back to
Medicare; and
• Overall Payment Cap. This cap is calculated by the Medicare fiscal intermediary at the end of each hospice cap period to determine
the maximum allowable payments per provider number.
On a monthly and quarterly basis, we estimate our potential cap exposure using information available for both inpatient day limits as
well as per beneficiary cap amounts. The total cap amount for each provider is calculated by multiplying the number of beneficiaries
electing hospice care from September 28, 2011 to September 27, 2012 by a statutory amount that is indexed for inflation. The per
beneficiary cap amount was $25,377 for the twelve-month period ended October 31, 2012 and $24,528 for the twelve month period
ended October 31, 2011. There will be a cap liability if actual payments per the Provider Statistical and Reimbursement report for the
period of November 1, 2011 to October 31, 2012 exceed the beneficiary cap amount.
Form 10-K Part I
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In 2011, CMS finalized a face-to-face encounter requirement applicable to hospice. This requirement mandated that a physician or nurse
practitioner must have a face-to-face encounter with the patient no later than the 30 day period prior to the 180th-day recertification
(third benefit period) and each subsequent recertification in order to gather clinical findings that support continued hospice care, and that
the certifying hospice physician must attest that such a visit took place.
Long-Term Acute Care Hospitals. All Medicare payments to our LTACHs are made in accordance with a prospective payment system
specifically applicable to long-term acute care hospitals, referred to as “LTACH-PPS.” There have been significant regulatory changes
over the last few years, including reimbursement changes, which have affected our net operating revenues and, in some cases, caused us
to change our operating model and business strategies.
The LTACH-PPS is based on a prospective payment system specifically applicable to LTACHs. It was established by CMS final regulations
published on August 30, 2002, and applies to LTACHs for cost reporting periods beginning on or after October 1, 2002. Under the
LTACH-PPS, each patient discharged from an LTACH was assigned a distinct LTC-DRG and an LTACH is generally paid a pre-determined
fixed amount applicable to the assigned LTC-DRG (adjusted for area wage differences), subject to exceptions for short stay and high
cost outlier patients (described below). Beginning with discharges on or after October 1, 2007, CMS implemented a new patient
classification system with categories referred to as “MS-LTC-DRGs.” The new classification categories take into account the severity of
the patient’s condition. The payment amount for each MS-LTC-DRG is intended to reflect the average cost of treating a Medicare
patient assigned to that MS-LTC-DRG in an LTACH.
Standard Federal Rate
Payment under the LTACH-PPS is dependent on determining the patient classification, that is, the assignment of the case to a particular
MS-LTC-DRG, the weight of the MS-LTC-DRG and the standard federal payment rate. There is a single standard federal rate that
encompasses both the inpatient operating costs, which includes a labor and non-labor component, and capital-related costs that CMS
updates on an annual basis. LTACH-PPS also includes special payment policies that adjust the payments for some patients based on
the patient’s length of stay, the facility’s costs, whether the patient was discharged and readmitted and other factors.
Short Stay Outlier Policy
CMS established a different payment methodology for Medicare patients with a length of stay less than or equal to five-sixths of the
geometric average length of stay for that particular MS-LTC-DRG, referred to as a short stay outlier, or “SSO.” When LTACH-PPS was
established, SSO cases were paid based on the lesser of (1) 120% of the average cost of the case; (2) 120% of the LTC-DRG specific
per diem amount multiplied by the patient’s length of stay; or (3) the full LTC-DRG payment. CMS modified the payment methodology for
discharges occurring on or after July 1, 2006, which changed the limitation in clause (1) above to reduce payment for SSO cases to
100% (rather than 120%) of the average cost of the case, and also added a fourth limitation, potentially further limiting payment for SSO
cases at a per diem rate derived from blending 120% of the MS-LTC-DRG specific per diem amount with a per diem rate based on
the general acute care hospital inpatient prospective payment system, or “IPPS”. Under this methodology, as a patient’s length of stay
increases, the percentage of the per diem amount based upon the IPPS component will decrease and the percentage based on the
MS-LTC-DRG component will increase.
Modification of Short Stay Outlier Policy
Effective December 29, 2012, the SSO rule was further revised adding a category referred to as a “very short stay outlier” for discharges.
For cases with a length of stay that is less than the average length of stay plus one standard deviation for the same MS-DRG under IPPS,
referred to as the so-called “IPPS comparable threshold,” the rule lowers the LTACH payment to a rate based on the general acute care
hospital IPPS per diem. SSO cases with covered lengths of stay that exceed the IPPS comparable threshold would continue to be paid
under the SSO payment policy.
High Cost Outliers
Some cases are extraordinarily costly, producing losses that may be too large for hospitals to offset. Cases with unusually high costs,
referred to as “high cost outliers,” receive a payment adjustment to reflect the additional resources utilized. CMS provides an additional
payment if the estimated costs for the patient exceed the adjusted MS-LTC-DRG payment plus a fixed-loss amount that is established
in the annual payment rate update.
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Form 10-K Part I
We build partnerships. With purpose.
Interrupted Stays
An interrupted stay is defined as a case in which an LTACH patient is admitted upon discharge to a general acute care hospital, IRF, skilled
nursing facility or a swing-bed hospital and returns to the same LTACH within a specified period of time. If the length of stay at the
receiving provider is equal to or less than the applicable fixed period of time, it is considered to be an interrupted stay case and is treated
as a single discharge for the purposes of payment to the LTACH.
Freestanding, HwH and Satellite LTACHs
LTACHs may be organized and operated as freestanding facilities or as a hospital within a hospital, or “HwH”. An HwH is an LTACH that is
located on the campus of another hospital. In this case, “campus” means the physical area immediately adjacent to a hospital’s main
buildings, other areas and structures that are not strictly contiguous to a hospital’s main buildings but are located within 250 yards of its
main buildings, and any other areas determined, on an individual case basis by the applicable CMS regional office, to be part of a
hospital’s campus. An LTACH, whether freestanding or an HwH, that uses the same Medicare provider number of an affiliated “primary
site” LTACH is known as a “satellite.” Under Medicare policy, a satellite LTACH must be located within 35 miles of its primary site
LTACH and be administered by such primary site LTACH. A primary site LTACH may have more than one satellite LTACH. CMS sometimes
refers to a satellite LTACH that is freestanding as a “remote location.” As of December 31, 2012, we had a total of nine LTACH facilities,
with 220 licensed beds. Eight of our LTACH facilities were classified as HwHs and one as freestanding. Of the eight HwH facilities, three
were located in Metropolitan Statistical Area (“MSA”) or urban areas and five were located in non-MSA or rural areas. One of our HwH
facilities was a satellite location of a parent hospital located in an MSA and one was a satellite location of a parent hospital located in a
non-MSA. Our single freestanding location was a freestanding remote site of a parent located in an MSA.
LTACH Certification Criteria
The LTACH-PPS regulations define the criteria that must be met in order for a hospital to be certified as an LTACH. To be eligible for
payment under the LTACH-PPS, a hospital must be primarily engaged in providing inpatient services to Medicare beneficiaries with
medically complex conditions that require a long hospital stay. In addition, by definition, LTACHs must meet certain facility criteria,
including (1) instituting a review process that screens patients for appropriateness of an admission and validates the patient criteria within
48 hours of each patient’s admission, evaluates regularly their patients for continuation of care and assesses the available discharge
options; (2) having active physician involvement with patient care that includes a physician available on-site daily and additional consulting
physicians on call; and (3) having an interdisciplinary team of healthcare professionals to prepare and carry out an individualized
treatment plan for each patient.
An LTACH must have an average inpatient length of stay for Medicare patients (including both Medicare covered and non-covered days)
of greater than 25 days. LTACHs that fail to exceed an average length of stay of 25 days during any cost reporting period may be paid
under the general acute care hospital IPPS if not corrected within established timeframes. CMS, through its contractors, determines
whether an LTACH has maintained an average length of stay of greater than 25 days during each annual cost reporting period. In the
preamble to the final rule for fiscal year 2012, CMS clarified its policy on the calculation of the average length of stay by specifying that all
data on all Medicare inpatient days, including Medicare Advantage days, must be included in the average length of stay calculation
effective for cost reporting periods beginning on or after January 1, 2012.
25 Percent Rule
The 25 Percent Rule is a downward payment adjustment that applies to Medicare patients discharged from LTACHs who were admitted
from a co-located hospital or a non-co-located hospital and caused the LTACH to exceed the applicable percentage thresholds of
discharged Medicare patients. To the extent that any LTACH’s or LTACH satellite facility’s discharges that are admitted from an individual
hospital (regardless of whether the referring hospital is co-located with the LTACH or LTACH satellite) exceed the applicable percentage
threshold during a particular cost reporting period, the payment rate for those discharges would be subject to a downward payment
adjustment. Cases admitted in excess of the applicable threshold are reimbursed at a rate comparable to that under general acute care
IPPS, which is generally lower than LTACH-PPS rates. Cases that reach outlier status in the referring hospital do not count toward the
limit and are paid under LTACH-PPS.
Form 10-K Part I
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For HwHs that meet specified criteria and were in existence as of October 1, 2004, the Medicare percentage thresholds were phased in
over a four year period starting with hospital cost reporting periods that began on or after October 1, 2004. For HwHs opened after
October 1, 2004, the Medicare percentage threshold has been established at 25% except for HwHs located in rural areas or co-located
with an MSA dominant hospital or single urban hospital (as defined by current regulations) where the percentage is no more than 50%,
nor less than 25%. All of our LTACH’s are in rural areas or are collocated with an MSA dominant hospital.
The SCHIP Extension Act (as amended by the American Recovery and Reinvestment Act, or the “ARRA,” see below) and the PPACA has
limited the application of the Medicare percentage threshold to HwHs in existence on October 1, 2004 and subject to the four year phase
in described above. For these HwHs, the percentage threshold is no lower than 50% for a five year period to commence on an LTACH’s
first cost reporting period to begin on or after October 1, 2007, except for HwHs located in rural areas and those which receive referrals
from MSA dominant hospitals or single urban hospitals, in which cases the percentage threshold is no more than 75% during the
same five cost reporting years.
For cost reporting periods beginning on or after July 1, 2007, CMS expanded the 25 Percent Rule to apply a payment adjustment to
Medicare patients admitted from any individual hospital in excess of the specified percentage threshold. Previously, the percentage
threshold payment adjustment was applicable only to Medicare admissions from hospitals co-located with an LTACH or satellite of an
LTACH. The expanded 25 Percent Rule subjects free-standing LTACHs, grandfathered HwHs and grandfathered satellites to the
Medicare percentage threshold payment adjustment, as well as HwHs that admit Medicare patients from non-co-located hospitals.
Two of our LTACH facilities are grandfathered HwH’s.
The SCHIP Extension Act, as amended by the ARRA, postponed the application of the percentage threshold to all free-standing and
grandfathered HwHs for a three year period commencing on an LTACH’s first cost reporting period on or after July 1, 2007. However, the
SCHIP Extension Act did not postpone the application of the percentage threshold, or the transition period, to those Medicare patients
discharged from an LTACH HwH or satellite that were admitted from a non-co-located hospital. The ARRA limits application of the
percentage threshold to no more than 50% of Medicare admissions to grandfathered satellites from a co-located hospital for a three year
period commencing on the first cost reporting period beginning on or after July 1, 2007. The PPACA included a two-year extension of
the limits placed on the 25 Percent Rule by the SCHIP Extension Act, as amended by the ARRA.
The 25 Percent Rule is highly complex and CMS has issued only limited guidance. Based on our discussions with CMS, we believe
each of our satellite and remote locations will be viewed as being located in a non-MSA regardless of the location of its parent hospital
and will be treated independently from its parent for purposes of calculating its compliance with the admissions limitations. If the
25 Percent Rule is extended, as planned, to freestanding LTACHs after the three-year delay (established in the MMSEA), our current
freestanding facility would not likely be affected because we currently do not receive more than 25% of our Medicare admissions
from any single referring hospital.
For the 12 months ended December 31, 2012, on an individual basis, our LTACH admissions were under the proper threshold as of the
current cost report year date of August 31, 2012. We acquired LTACHs in 2010 and 2009 both of which were grandfathered LTACHs
and, therefore, have no limitations under MMSEA with respect to the number of patients that can be admitted from the host hospital.
One LTACH is not subject to these limits on host hospital referrals because it is not an HwH. All of our LTACHs maintain compliance
with non-co-located hospital referral thresholds.
After the expiration of the regulatory relief provided by the SCHIP Extension Act, the ARRA and the PPACA, as described above, our
LTACHs (whether freestanding, HwH or satellite) will be subject to a downward payment adjustment for any Medicare patients who were
admitted from a co-located or a non-co-located hospital and that exceed the applicable percentage threshold of all Medicare patients
discharged from the LTACH during the cost reporting period. If the 25 Percent Rule, as originally adopted by CMS, becomes effective after
the expiration of the applicable provisions of the SCHIP Extension Act, the ARRA and the PPACA, these regulatory changes will
collectively cause an adverse effect on our operating revenues and profitability in 2013 and beyond. However, this adverse effect could be
partially mitigated if we are able to implement certain operational changes.
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Form 10-K Part I
We build partnerships. With purpose.
Extension of Changes Made by the Medicare, Medicaid, and SCHIP Extension Act of 2007
On March 23, 2010, President Obama signed into law the PPACA. The PPACA adopts significant changes to the Medicare program that
are particularly relevant to our LTACHs. Among other changes, the PPACA applies a market basket payment adjustment to LTACHs.
In addition, the PPACA includes a two-year extension to sections of the SCHIP Extension Act, as amended by the ARRA. The two-year
extension applies the relief granted to the 25 Percent Rule payment adjustment, the one-time budget neutrality adjustment and the
very short stay outlier payment adjustment. The two-year extension also applies to the moratorium on new LTACHs and new LTACH beds
adopted in the SCHIP Extension Act.
Medicare Market Basket Adjustments
The PPACA instituted a market basket payment adjustment to LTACHs. In fiscal year 2010, LTACHs were subject to a market basket
reduction of 0.25% for discharges occurring after April 1, 2010 through September 30, 2010. In fiscal year 2011, LTACHs were subject to
a market basket reduction of 0.5%. There will be a slightly smaller 0.1% market basket reduction for LTACHs in fiscal years 2012 and
2013. In fiscal year 2014, the market basket update will be reduced by 0.3%. Fiscal years 2015 and 2016 the market basket update will
be reduced by 0.2%. Finally, in fiscal years 2017 through 2019, the market basket update will be reduced by 0.75%. The PPACA
specifically allows these market basket reductions to result in less than a 0% payment update and payment rates that are less than the
prior year.
Hospital Wage Index
The PPACA calls for CMS to abandon the current system of calculating the hospital wage index based on data submitted in hospital cost
reports, which currently has a four year lag in data. In its place, CMS is required to develop and present to Congress a comprehensive
reform plan using Bureau of Labor Statistics data, or other data or methodologies, to calculate relative wages for each geographic area
involved. Although the PPACA addresses the hospital wage index generally, this change presumably applies to LTACHs given that the
LTACH-PPS wage index is computed using wage data from general acute care hospitals.
Recent Changes to the LTACH Prospective Pay System
Proposed rules specifically related to LTACHs are generally published in January, finalized in May and effective on July 1st of each year.
Additionally, LTACHs are subject to annual updates to the rules related to the IPPS, which are typically proposed in May, finalized in
August and effective on October 1st of each year. In the annual payment rate update for the 2010 fiscal year, CMS consolidated the two
historical annual updates into one annual update. The final rule adopted a 15-month rate update for fiscal year 2009 and moved the
LTACH-PPS from a July-June update cycle to an October-September cycle. Beginning fiscal year 2010 the LTACH rate year will begin
October 1, coinciding with the start of the federal fiscal year.
The following is a summary of significant changes to the Medicare LTACH-PPS that has occurred during several years.
The American Recovery and Reinvestment Act of 2009. On February 17, 2009, President Obama signed into law the American
Recovery and Reinvestment Act of 2009, the “ARRA.” The ARRA makes several technical corrections to the SCHIP Extension Act,
including a clarification that, during the moratorium period established by the SCHIP Extension Act, the percentage threshold for
grandfathered satellites is set at 50% and not phased in to the 25% level for admissions from a co-located hospital. In addition, the ARRA
clarifies that the application of the percentage threshold is postponed for a LTACH HwH or satellite that was co-located with a provider-
based, off-campus location of an IPPS hospital that did not deliver services payable under IPPS. The ARRA also provides that the
postponement of the percentage threshold established in the SCHIP Extension Act will be effective for cost reporting periods beginning on
or after July 1, 2007 for freestanding LTACHs and grandfathered HwHs and satellites and on or after October 1, 2007 for other LTACH
HwHs and satellites.
June 3, 2009 Interim Final Rule. On June 3, 2009, CMS published an interim final rule in which CMS adopted a new table of MS-LTC-DRG
relative weights that applied to the remainder of fiscal year 2009 (through September 30, 2009). This interim final rule revises the
MS-LTC-DRG relative weights for payment under the LTACH-PPS for fiscal year 2009 due to CMS’s misapplication of its established
methodology in the calculation of the budget neutrality factor. This error resulted in relative weights that are higher, by approximately
3.9% for all of fiscal year 2009 (October 1, 2008 through September 30, 2009) which has the effect of reducing reimbursement by
approximately 3.9%. However, CMS only applied the corrected weights to the period from June 3, 2009 through September 30, 2009.
Form 10-K Part I
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LHC GROUP
July 31, 2009 Final Rule. On July 31, 2009, CMS released its annual payment rate update for the LTACH-PPS for “fiscal year 2010”
(affecting discharges and cost reporting periods beginning on or after October 1, 2009 and before September 30, 2010). For fiscal
year 2010 CMS adopted a 2.5% increase in payments under the LTACH-PPS. As a result, the standard federal rate for fiscal year
2010 is set at $39,897, an increase from $39,114 in fiscal year 2009. The increase in the standard federal rate uses a 2.0% update
factor based on the market basket update of 2.5% less an adjustment of 0.5% to account for changes in documentation and
coding practices. The fixed loss amount for high cost outlier cases is set at $18,425. This is a decrease from the fixed loss amount in
the 2009 rate year of $22,960.
The July 31, 2009 annual payment rate update also included an interim final rule with comment period implementing provisions of the
ARRA discussed above, including amendments to provisions of the SCHIP Extension Act relating to payments to LTACHs and LTACH
satellite facilities and increases in beds in existing LTACHs and LTACH satellite facilities under the LTACH-PPS.
In the same federal register, CMS finalized three interim final rules. First, CMS finalized the June 3, 2009 interim final rule that adopted a
new table of MS-LTC-DRG relative weights for the period between June 3, 2009 and September 30, 2009. Second, CMS finalized the
May 6, 2008 interim final rule that implemented changes to LTACH-PPS mandated by the SCHIP Extension Act addressing: (1) payment
adjustments for certain short-stay outliers, (2) the federal standard rate for the last three months of rate year 2008, and (3) adjustment
of the high cost outlier fixed-loss amount. Finally, CMS finalized the May 22, 2008 interim final rule that implemented changes to
LTACH-PPS mandated by the SCHIP Extension Act modifying the percentage threshold policy for certain LTACHs and addressing the
three-year moratorium on the establishment of new LTACHs and bed increases at existing LTACHs and LTACH satellites.
On June 2, 2010, CMS published a notice of changes to the payment rates for LTACH-PPS during the portion of fiscal year 2010
occurring on or after April 1, 2010. The standard federal rate for discharges occurring on or after April 1, 2010 was revised downward to
$39,795 from $39,897 established in the original final rule for fiscal year 2010. This change to the LTACH-PPS standard federal rate
for the remainder of fiscal year 2010 was based on an additional market basket reduction of 0.25% as mandated by the PPACA. The
notice revised the fixed-loss amount for high cost outlier cases for fiscal year 2010 discharges occurring on or after April 1, 2010 to
$18,615, which was higher than the fixed-loss amount of $18,425 in effect from October 1, 2009 to March 31, 2010.
Fiscal Year 2011. On August 16, 2010, CMS published the policies and payment rates for LTACH-PPS for fiscal year 2011 (affecting
discharges and cost reporting periods beginning on or after October 1, 2010 through September 30, 2011). The standard federal rate for
fiscal year 2011 is $39,600, which is a decrease from the fiscal year 2010 standard federal rate of $39,897 in effect from October 1, 2009
to March 31, 2010 and the fiscal year 2010 standard federal rate of $39,795 that went into effect on April 1, 2010. This update to the
LTACH-PPS standard federal rate for fiscal year 2011 is based on a market basket increase of 2.5% less a reduction of 2.5% to account
for what CMS attributes as an increase in case-mix in prior periods that resulted from changes in documentation and coding practices
less an additional reduction of 0.5% as mandated by the PPACA. The final rule establishes a fixed-loss amount for high cost outlier cases
for fiscal year 2011 of $18,785, which is higher than the fiscal year 2010 fixed-loss amount of $18,425 in effect from October 1, 2009
to March 31, 2010 and the $18,615 that went into effect on April 1, 2010. The final rule also included revisions to the relative weights for
each of the MS-LTC-DRGs for fiscal year 2011.
Fiscal Year 2012. On August 18, 2011, CMS published the policies and payment rates for LTACH-PPS for fiscal year 2012 (affecting
discharges and cost reporting periods beginning on or after October 1, 2011 through September 30, 2012). The standard federal rate for
fiscal year 2012 was $40,222, an increase from the fiscal year 2011 standard federal rate of $39,600. The final rule established a
fixed-loss amount for high cost outlier cases for fiscal year 2012 of $17,931, which is a decrease from the fixed loss amount in the 2011
fiscal year of $18,785.
Fiscal Year 2013. On August 1, 2012 CMS released its final rule for LTACH Medicare reimbursement for fiscal year 2013 which spans
from October 1, 2012 through September 30, 2013. In aggregate, payments for fiscal year 2013 will increase by 1.8% over fiscal year
2012 rates. The 1.8% increase consists of a 2.6% inflationary market basket update offset by a 0.7% reduction for the productivity
adjustment, a 0.1% reduction to the market basket as defined by the PPACA. LTACH payment rates will also be reduced by approximately
1.3% to 0.5% for the “one-time” budget neutrality adjustment for discharges on or after December 29, 2012. The 0.5% does not include
the 2% reduction to Medicare payments caused by sequestration.
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Form 10-K Part I
We build partnerships. With purpose.
The fiscal year 2013 rule also includes:
• A one-year extension of the existing moratorium on the “25 percent threshold” policy, pending results of an on-going research initiative
to re-define the role of LTACHs in the Medicare program.
• A reduction to Medicare payments for very short stay cases in LTACHs to the Inpatient Prospective Payment System comparable per
diem amount payment option for discharges occurring on or after December 29, 2012 and an increase to the high cost outlier payment.
The labor-related share of the LTACH-PPS standard federal rate is adjusted annually to account for geographic differences in area wage
levels by applying the applicable LTACH-PPS wage index. CMS adopted a decrease in the labor-related share from 75.271% to 70.199%
under the LTACH-PPS for fiscal year 2012.
In addition, CMS applied an area wage level budget neutrality factor to the standard federal rate to make annual changes to the area
wage level adjustment budget neutral. Previously, there was no statutory or regulatory requirement that these adjustments to the area
wage level be made in a budget neutral manner. The final rule creates a regulatory requirement that any adjustments or updates to the
area wage level adjustment be made in a budget neutral manner such that estimated aggregate LTACH-PPS payments are not affected.
An LTACH must have an average inpatient length of stay for Medicare patients (including both Medicare covered and non-covered days)
of greater than 25 days. In the preamble to the final rule for fiscal year 2012, CMS clarified its policy on the calculation of the average
length of stay by specifying that all data on all Medicare inpatient days, including Medicare Advantage days, must be included in the
average length of stay calculation effective for cost reporting periods beginning on or after January 1, 2012.
Medicaid
Medicaid is a joint federal and state funded health insurance program for certain low-income individuals. Medicaid reimburses health
care providers using a number of different systems, including cost-based, prospective payment and negotiated rate systems. Rates are
also subject to adjustment based on statutory and regulatory changes, administrative rulings, government funding limitations and
interpretations of policy by individual state agencies.
Non-Governmental Payors
Payments from non-governmental payor sources are based on episodic-based rates or per visit basis depending upon the terms
and conditions of the payor. Examples of non-governmental payor sources are insurance companies, workers’ compensation
programs, health maintenance organizations, preferred provider organizations, other managed care companies and employers, as
well as patients directly.
Patients are generally not responsible for any difference between customary charges for our services and amounts paid by Medicare and
Medicaid programs and the non-governmental payors, but are responsible for services not covered by these programs or plans, as well
as for deductibles and co-insurance obligations of their coverage. The amount of these deductibles and co-insurance obligations on
patients has increased in recent years. Collection of amounts due from individuals is typically more difficult than collection of amounts due
from government or business payors. Because the majority of our billed services are paid in full by Medicare, Medicaid or private
insurance, co-payments from patients do not represent a material portion of our billed revenue and corresponding accounts receivable.
To further reduce their health care costs, most insurance companies, health maintenance organizations, preferred provider organizations
and other managed care companies have negotiated discounted fee structures or fixed amounts for services performed, rather than
paying health care providers the amounts billed.
In response to the challenges associated with collecting from commercial payors we began negotiating higher reimbursement rates with a
majority of our commercial payors. As of December 31, 2012, our Managed Care contracts included 93 different payors between all our
divisions, six of those were national contracts, 19 were regional contracts and 68 were state and local contracts/standing letters of
agreement. However, if we are unable to continue negotiating higher reimbursement rates with commercial payors or if commercial payors
continue to reduce health care costs through reduction in home health reimbursement, it could have a material adverse impact on our
financial results.
Form 10-K Part I
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LHC GROUP
Government Regulations
General
The health care industry is highly regulated and we are required to comply with federal, state and local laws which significantly affect our
business. These laws and regulations are extremely complex and, in many instances, the industry does not have the benefit of significant
regulatory or judicial interpretation. Regulations and policies frequently change, and we monitor these changes through trade and
governmental publications and associations. The significant areas of federal and state regulatory laws that could affect our ability to
conduct our business include the following:
• Medicare and Medicaid participation and reimbursement;
• the federal Anti-Kickback Statute and similar state laws;
• the federal Stark Law and similar state laws;
• false and other improper claims;
• the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”);
• civil monetary penalties;
• environmental health and safety laws;
• licensing; and
• certificates of need and permits of approval.
If we fail to comply with these applicable laws and regulations, we could suffer civil or criminal penalties, including the loss of our licenses
to operate and our ability to participate in federal and state health care programs, which would materially adversely affect our financial
condition and results of operations. Although we believe we are in material compliance with all applicable laws, these laws are complex
and a review of our practices by a court or law enforcement or regulatory authority could result in an adverse determination that could
harm our business. Furthermore, the laws applicable to us are subject to change, interpretation and amendment, which could adversely
affect our ability to conduct our business.
Office of Inspector General
The Department of Health and Human Services OIG has a responsibility to report any program or management problems related to
programs such as Medicare to the Secretary of HHS and Congress. The OIG’s duties are carried out through a nationwide network of
audits, investigations and inspections. Each year, the OIG outlines areas it intends to review relating to a wide range of providers.
As part of its annual process, the OIG describes topics relating to, among others, home health, hospice and long-term care hospitals.
No estimate can be made at this time regarding the impact, if any, of the OIG’s findings.
Medicare Participation
During the years ended December 31, 2012, 2011 and 2010, we received 77.9, 79.7% and 80.5%, respectively, of our consolidated net
service revenue from Medicare. We expect to continue to receive the majority of our consolidated net service revenue from serving
Medicare beneficiaries. Medicare is a federally funded and administered health insurance program, primarily for individuals who are 65 or
older or who are disabled. To participate in the Medicare program and receive Medicare payments, our agencies and facilities must
comply with regulations promulgated by CMS. Among other things, these requirements, known as “conditions of participation,” relate to
the type of facility, its personnel and its standards of medical care. Although we intend to continue to participate in the Medicare
reimbursement programs, we cannot guarantee that our agencies, facilities and programs will continue to qualify for participation.
Under Medicare rules, the designation “provider-based” refers to circumstances in which a subordinate facility (e.g., a separately-certified
Medicare provider, a department of a provider or a satellite facility) is treated as part of another provider, called the “main” provider,
for Medicare payment purposes. In these cases, the services of the subordinate facility are included in the “main” provider’s cost report
and overhead costs of the main provider can be allocated to the subordinate facility, to the extent that such costs are shared. We
operate LTACHs that are treated as provider-based satellites of certain of our other facilities. We also provide contract rehabilitation and
management services to hospital rehabilitation departments that may be treated as provider-based. These facilities are required
to satisfy certain operational standards in order to retain their provider-based status. Although we intend to continue to operate these
facilities as provider-based, we cannot guarantee that they will continue to qualify as provider-based entities.
20
Form 10-K Part I
We build partnerships. With purpose.
Anti-Kickback Statute
Provisions of the Social Security Act of 1965, commonly referred to as the Anti-Kickback Statute, prohibit the payment or receipt of
anything of value in return for the referral of patients or arranging for the referral of patients, or in return for the recommendation,
arrangement, purchase, lease or order of items or services that are covered by a federal health care program such as Medicare and
Medicaid. Violation of the Anti-Kickback Statute is a felony and sanctions include imprisonment of up to five years, criminal fines of up
to $25,000, civil monetary penalties of up to $50,000 per act plus three times the amount claimed or three times the remuneration offered
and exclusion from federal health care programs (including the Medicare and Medicaid programs). Many states have adopted similar
prohibitions against payments intended to induce referrals of Medicaid and other third-party payor patients.
The OIG has published numerous “safe harbors” that exempt some practices from enforcement action under the federal Anti-Kickback
Statute. These safe harbors exempt specified activities, including bona-fide employment relationships, contracts for the rental of space or
equipment, personal service arrangements and management contracts, so long as all of the requirements of the safe harbor are met.
The OIG has recognized that the failure of an arrangement to satisfy all of the requirements of a particular safe harbor does not necessarily
mean that the arrangement violates the Anti-Kickback Statute. Instead, each arrangement is analyzed on a case-by-case basis, which
is very fact specific. We cannot guarantee that all our arrangements will satisfy a safe harbor or will ultimately be viewed as being compliant
with the Anti-Kickback Statute.
We are required under the Medicare conditions of participation and some state licensing laws to contract with numerous health care
providers and practitioners, including physicians, hospitals and nursing homes and to arrange for these individuals or entities to
provide services to our patients. In addition, we have contracts with other suppliers, including pharmacies, ambulance services and
medical equipment companies. We have also entered into various joint ventures with hospitals and physicians for the ownership
and management of home nursing agencies and LTACHs. Some of these individuals or entities may refer, or be in a position to refer,
patients to us and we may refer, or be in a position to refer, patients to these individuals or entities. We attempt to structure these
arrangements in a manner that meets the requirements of a safe harbor. However, some of these arrangements may not meet all of
the requirements of a safe harbor. We believe that our contracts and arrangements with providers, practitioners and suppliers do
not violate the Anti-Kickback Statute or similar state laws. We cannot guarantee, however, that governmental agencies and bodies will
interpret these laws in the same manner as we do.
From time to time, various federal and state agencies, such as CMS and DHHS, issue pronouncements, including fraud alerts, that identify
practices that may be subject to heightened scrutiny. For example, the OIG’s fiscal year 2013 Work Plan describes, among other things,
he government’s intention to examine the compliance with Face to Face requirements, monitor the employment of home health aides with
criminal convictions, Medicare oversight for timeliness of recertification and complaint surveys conducted by the state, review the
OASIS data to ensure submitted accurately and that billing codes on the claim are consistent with the OASIS data, review compliance
with documentation required in support of the claims paid by Medicare, and review cost report data to analyze home health agency
revenue and expense trends against PPS to determine whether the payment methodology should be adjusted.
In June 1995, the OIG issued a special fraud alert that focused on the home nursing industry and identified some of the illegal practices
the OIG has uncovered. In March 1998, the OIG issued a special fraud alert titled, Fraud and Abuse in Nursing Home Arrangements with
Hospices. This special fraud alert focused on payments received by nursing homes from hospices. We believe, but cannot assure, that our
operations comply with the principles expressed by the OIG in these special fraud alerts.
We endeavor to conduct our operations in compliance with federal and state health care fraud and abuse laws, including the Anti-Kickback
Statute and similar state laws. However, our practices may be challenged in the future and the fraud and abuse laws may be
interpreted in a way that finds us in violation of these laws. If we are found to be in violation of the Anti-Kickback Statute, we could be
subject to civil and criminal penalties and we could be excluded from participating in federal health care programs such as Medicare
and Medicaid. The occurrence of any of these events could significantly harm our business and financial condition.
Stark Law
Congress has passed significant prohibitions against physician referrals of patients for certain health care services. These prohibitions
are commonly known as the Stark Law. The Stark Law prohibits a physician from making referrals for particular health care
services (called designated health services) to entities with which the physician, or an immediate family member of the physician, has
a financial relationship.
Form 10-K Part I
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LHC GROUP
The term “financial relationship” is defined very broadly to include most types of ownership or compensation relationships. The Stark Law
also prohibits the entity receiving the referral from seeking payment under the Medicare and Medicaid programs for services rendered
pursuant to a prohibited referral. If an entity is paid for services rendered pursuant to a prohibited referral, it may incur civil penalties and
could be excluded from participating in the Medicare or Medicaid programs. If an arrangement is covered by the Stark Law, the
requirements of a Stark Law exception must be met for the physician to be able to make referrals to the entity for designated health
services and for the entity to be able to bill for these services.
“Designated health services” under the Stark Law is defined to include clinical laboratory services; physical therapy services; occupational
therapy services; radiology services, including magnetic resonance imaging, computerized axial tomography scans and ultrasound
services; radiation therapy services and supplies; durable medical equipment and supplies; parenteral and enteral nutrients, equipment
and supplies; prosthetics, orthotics and prosthetic devices and supplies; home health services; outpatient prescription drugs; and
inpatient and outpatient hospital services. The Stark Law defines a financial relationship to include: (1) a physician’s ownership or
investment interest in an entity and (2) a compensation relationship between a physician and an entity. Under the Stark Law, financial
relationships include both direct and indirect relationships.
Physicians refer patients to us for several Stark Law designated health services, including home health services, inpatient and outpatient
hospital services and physical therapy services. We have compensation arrangements with some of these physicians or their professional
practices in the form of medical director and consulting agreements. We also have operations owned by joint ventures in which physicians
have an investment interest. In addition, other physicians who refer patients to our agencies and facilities may own our stock. As a result
of these relationships, we could be deemed to have a financial relationship with physicians who refer patients to our facilities and agencies
for designated health services. If so, the Stark Law would prohibit the physicians from making those referrals and would prohibit us from
billing for the services unless a Stark Law exception applies.
The Stark Law contains exceptions for certain physician ownership or investment interests in and certain physician compensation
arrangements with entities. If a compensation arrangement or investment relationship between a physician, or a physician’s immediate
family member, and an entity satisfies all requirements for a Stark Law exception, the Stark Law will not prohibit the physician from
referring patients to the entity for designated health services. The exceptions for compensation arrangements cover employment
relationships, personal services contracts and space and equipment leases, among others. The exceptions for a physician investment
relationship include ownership in an entire hospital and ownership in rural providers. We believe our compensation arrangements with
referring physicians and our physician investment relationships meet the requirements for an exception under the Stark Law and that our
operations comply with the Stark Law.
The Stark Law also includes an exception for a physician’s ownership or investment interest in certain entities through the ownership
of stock. If a physician owns stock in an entity and the stock is listed on a national exchange or is quoted on NASDAQ and the ownership
meets certain other requirements, the Stark Law will not apply to prohibit the physician from referring to the entity for designated health
services. The requirements for this Stark Law exception include a requirement that the entity issuing the stock have at least $75.0 million
in stockholders’ equity at the end of its most recent fiscal year or on average during the previous three fiscal years. As of December 31,
2012, 2011 and 2010, we have exceeded $75.0 million in stockholders’ equity.
If an entity violates the Stark Law, it could be subject to civil penalties of up to $15,000 per prohibited claim and up to $100,000 for knowingly
entering into certain prohibited referral schemes. The entity also may be excluded from participating in federal health care programs
(including Medicare and Medicaid). There are no criminal penalties for violations of Stark Law. If the Stark Law was found to apply to our
relationships with referring physicians and those relationships did not meet the requirement of an exception under the Stark Law, we would
be required to restructure these relationships or refuse to accept referrals for designated health services from these physicians. If we were found
to have submitted claims to Medicare or Medicaid for services provided pursuant to a referral prohibited by the Stark Law, we would be
required to repay any amounts we received from Medicare for those services and could be subject to civil monetary penalties. Further, we
could be excluded from participating in Medicare and Medicaid. If we were required to repay any amounts to Medicare, subjected to fines,
or excluded from the Medicare and Medicaid Programs, our business and financial condition would be harmed significantly.
Many states have physician relationship and referral statutes that are similar to the Stark Law. Some of these laws generally apply regardless
of payor. We believe that our operations are structured to comply with applicable state laws with respect to physician relationships
and referrals. However, any finding that we are not in compliance with these state laws could require us to change our operations or could
subject us to penalties. This, in turn, could have a negative impact on our operations.
22
Form 10-K Part I
We build partnerships. With purpose.
False and Improper Claims
The submission of claims to a federal or state health care program for items and services that are “not provided as claimed” may lead to
the imposition of civil monetary penalties, criminal fines and imprisonment and/or exclusion from participation in state and federally funded
health care programs, including the Medicare and Medicaid programs. These false claims statutes include the Federal False Claims Act.
Under the Federal False Claims Act, actions against a provider can be initiated by the federal government or by a private party on behalf of
the federal government. These private parties are often referred to as qui tam relators, and relators are entitled to share in any amounts
recovered by the government. Both direct enforcement activity by the government and qui tam actions have increased significantly in
recent years. This development has increased the risk that a health care company like us will have to defend a false claims action, pay
fines or be excluded from the Medicare and Medicaid programs as a result of an investigation arising out of false claims laws. Many states
have enacted similar laws providing for the imposition of civil and criminal penalties for the filing of fraudulent claims. Because of the
complexity of the government regulations applicable to our industry, we cannot assure that we will not be the subject of an action under
the Federal False Claims Act or similar state law.
Anti-fraud Provisions of the HIPAA
In an effort to combat health care fraud, Congress included several anti-fraud measures in HIPAA. Among other things, HIPAA broadened
the scope of certain fraud and abuse laws, extended criminal penalties for Medicare and Medicaid fraud to other federal health care
programs and expanded the authority of the OIG to exclude persons and entities from participating in the Medicare and Medicaid programs.
HIPAA also extended the Medicare and Medicaid civil monetary penalty provisions to other federal health care programs, increased the
amounts of civil monetary penalties and established a criminal health care fraud statute.
Federal health care offenses under HIPAA include health care fraud and making false statements relating to health care matters. Under
HIPAA, among other things, any person or entity that knowingly and willfully defrauds or attempts to defraud a health care benefit program
is subject to a fine, imprisonment or both. Also under HIPAA, any person or entity that knowingly and willfully falsifies or conceals or
covers up a material fact or makes any materially false or fraudulent statements in connection with the delivery of or payment of health
care services by a health care benefit plan is subject to a fine, imprisonment or both. HIPAA applies not only to governmental plans but
also to private payors.
Administrative Simplification Provisions of HIPAA
HHS’s final regulations governing electronic transactions involving health information are part of the administrative simplification provisions
of HIPAA, commonly referred to as the Transaction Standards rule. The rule establishes standards for eight of the most common health
care transactions by reference to technical standards promulgated by recognized standards publishing organizations. Under the
standards, any party transmitting or receiving health transactions electronically must send and receive data in a single format, rather than
the large number of different data formats currently used. This rule applies to us in connection with submitting and processing health
claims. The Transaction Standards rule also applies to many of our payors and to our relationships with those payors. We believe that our
operations materially comply with the Transaction Standards rule.
HHS also has final regulations implementing HIPAA that set forth standards for the privacy of individually-identifiable health information,
referred to as protected health information. These regulations cover health care providers, health care clearinghouses and health plans.
The privacy regulations require companies covered by the regulations to use and disclose protected health information only as allowed by
the privacy regulations. Specifically, the privacy regulations require companies, including us, to do the following, among other things:
• obtain patient authorization prior to certain uses or disclosures of protected health information;
• provide notice of privacy practices to patients and obtain an acknowledgement that the patient has received the notice;
• respond to requests from patients for access to or to obtain a copy of their protected health information;
• respond to patient requests for amendments of their protected health information;
• provide an accounting to patients of certain disclosure of their protected health information;
• enter into agreements with the companies’ business associates through which the business associates agree to use and disclose
protected health information only as permitted by the agreement and the requirements of the privacy regulations;
• train the companies’ workforce in privacy compliance;
• designate a privacy officer;
• use and disclose only the minimum necessary information to accomplish a particular purpose; and
• establish policies and procedures with respect to uses and disclosures of protected health information.
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These regulatory requirements impose significant administrative and financial obligations on companies that use or disclose individually
identifiable health information relating to the health of a patient. We have implemented policies and procedures to maintain patient privacy
and comply with HIPAA’s privacy regulations. However, the privacy regulations are extensive, and we may need to change some of our
practices to comply with them as they are interpreted.
In February 2003, HHS published the final security regulations implementing HIPAA that govern the security of health information.
The compliance date for the security regulations was April 21, 2005. The security regulations require the implementation of policies and
procedures that establish administrative, physical and technical safeguards for electronic protected health information. Companies
covered by the security regulations are required to ensure the confidentiality, integrity and availability of electronic protected health
information. Specifically, among others things, companies subject to the security regulations, including us, are required to:
• conduct a thorough assessment of the potential risks and vulnerabilities to confidentiality, integrity and availability of electronic
protected health information and to reduce the risks and vulnerabilities to a reasonable and appropriate level as required by the
security regulations;
• designate a security officer;
• establish policies relating to access by the companies’ workforce to electronic protected health information;
• enter into agreements with the companies’ business associates whereby business associates agree to establish administrative,
physical and technical safeguards for electronic protected health information received from or on behalf of the companies;
• create a disaster and contingency plan to ensure the availability of electronic protected health information;
• train the companies’ workforce in security compliance;
• establish physical controls for electronic devices and media containing or transmitting electronic protected health information;
• establish policies and procedures regarding the use of workstations with access to electronic protected health information; and
• establish technical controls for the information systems maintaining or transmitting electronic protected health information.
In addition, in 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act (enacted as part of the
American Reinvestment and Recovery Act of 2009) expanded some of our obligations under the existing HIPAA privacy and security
provisions, including:
• requirements to notify individuals and governmental agencies when security breaches occur with respect to unsecured information;
• limitations on our ability to use or disclose protected health information for marketing or soliciting charitable contributions;
• expansion of certain privacy and security requirements to our vendors and business associates; and
• requirements for providing an accounting of disclosures of electronic health records.
In January 2013, HHS published a Final Rule implementing provisions of the HITECH Act addressing the privacy and security requirements
for health information established under HIPAA.
The significant changes in the Final Rule include:
• expansion of the HIPAA privacy and security regulations to business associates (contractors and subcontractors) of providers that
receive protected health information, and provides a timeline for amendment of existing contracts to ensure compliance;
• increased penalties for noncompliance based on four levels of negligence with a maximum penalty of $1.5 million per violation;
• clarification of the circumstances under which breaches of unsecured health information must be reported to HHS;
• expansion of individual rights to request copies of electronic records in electronic form;
• modifies authorization requirements for specific records relating to research, immunizations and decedents;
• limiting use and disclosure of information for marketing and fundraising purposes;
• prohibiting the sale of individuals’ health information without their permission; and
• extends privacy rule protections to genetic information, and prohibits most health plans from using or disclosing genetic information for
underwriting purposes.
These regulatory requirements impose significant administrative and financial obligations on companies like us that use or disclose electronic
health information. We are modifying our existing HIPAA privacy and security policies and procedures to comply with the new regulations.
24
Form 10-K Part I
We build partnerships. With purpose.
Civil Monetary Penalties
The Secretary of HHS may impose civil monetary penalties on any person or entity that presents, or causes to be presented, certain
ineligible claims for medical items or services. The amount of penalties varies depending on the offense, from $2,000 to $50,000 per
violation, plus treble damages for the amount at issue and may include exclusion from federal health care programs (including Medicare
and Medicaid).
HHS also can impose penalties on a person or entity who offers inducements to beneficiaries for program services, who violates rules
regarding the assignment of payments, or who knowingly gives false or misleading information that could reasonably influence the
discharge of patients from a hospital. Persons who have been excluded from a federal health care program and who retain ownership in
a participating entity and persons who contract with excluded persons may be penalized.
HHS also can impose penalties for false or fraudulent claims and those that include services not provided as claimed. In addition, HHS
may impose penalties on claims:
• for physician services that the person or entity knew or should have known were rendered by a person who was unlicensed, or
by a person who misrepresented either (1) his or her qualifications in obtaining his or her license or (2) his or her certification in a
medical specialty;
• for services furnished by a person who was, at the time the claim was made, excluded from the program to which the claim was
made; or
• that show a pattern of medically unnecessary items or services.
Penalties also are applicable in certain other cases, including violations of the federal Anti-Kickback Statute, payments to limit certain
patient services and improper execution of statements of medical necessity.
Environmental Health and Safety Laws
We are subject to federal, state and local regulations governing the storage, use and disposal of materials and waste products. Although
we believe that our safety procedures for storing, handling and disposing of these hazardous materials comply with the standards
prescribed by law and regulation, we cannot completely eliminate the risk of accidental contamination or injury from those hazardous
materials. In the event of an accident, we could be held liable for any damages that result and any liability could exceed the limits or fall
outside the coverage of our insurance. We may not be able to maintain insurance on acceptable terms, or at all. We could incur significant
costs and the diversion of our management’s attention to comply with current or future environmental laws and regulations. We do not
have any violations related to compliance with environmental, health and safety laws through 2012.
Licensing
Our agencies and facilities are subject to state and local licensing regulations ranging from the adequacy of medical care to compliance
with building codes and environmental protection laws. To assure continued compliance with these various regulations, governmental and
other authorities periodically inspect our agencies and facilities. Additionally, health care professionals at our agencies and facilities are
required to be individually licensed or certified under applicable state law. We take steps to ensure that our employees and agents
possess all necessary licenses and certifications.
The institutional pharmacy operations within our facility-based services segment are also subject to regulation by the various states in
which we conduct the pharmacy business, as well as by the federal government. The pharmacies are regulated under the Food, Drug
and Cosmetic Act and the Prescription Drug Marketing Act, which are administered by the United States Food and Drug Administration.
Under the Comprehensive Drug Abuse Prevention and Control Act of 1970, administered by the United States Drug Enforcement
Administration, dispensers of controlled substances must register with the Drug Enforcement Administration, file reports of inventories and
transactions and provide adequate security measures. Failure to comply with such requirements could result in civil or criminal penalties.
We do not have any violations related to the Comprehensive Drug Abuse Prevention and Control Act of 1970 through 2012.
Certificate of Need and Permit of Approval Laws
In addition to state licensing laws, some states require a provider to obtain a certificate of need or permit of approval prior to establishing
or expanding certain health services or facilities. States with certificate of need or permit of approval laws place limits on both the
construction and acquisition of health care facilities and operations and the expansion of existing facilities and services. In these states,
approvals are required for capital expenditures exceeding certain amounts that involve certain facilities or services, including home nursing
Form 10-K Part I
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LHC GROUP
agencies. The certificate of need or permit of approval issued by the state determines the service areas for the applicable agency or
program. The following states issue certificates of need or permits of approval: Alabama, Alaska, Arkansas, Georgia, Hawaii, Kentucky,
Maryland, Mississippi, Montana, New Jersey, New York, North Carolina, South Carolina, Tennessee, Vermont, Washington, West Virginia
and the District of Columbia. In addition, the state of Louisiana has imposed a moratorium on the issuance of new licenses for home nursing
agencies that we expect to remain in effect for 2013.
State certificate of need and permit of approval laws generally provide that, prior to the addition of new capacity, the construction of new
facilities or the introduction of new services, a designated state health planning agency must determine that a need exists for those beds,
facilities or services. The process is intended to promote comprehensive health care planning, assist in providing high quality health care at
the lowest possible cost and avoid unnecessary duplication by ensuring that only needed health care facilities and operations will be built
and opened.
Accreditations
The Joint Commission is a nationwide commission that establishes standards relating to the physical plant, administration, quality of
patient care and operation of medical staffs of health care organizations. Currently, Joint Commission accreditation of home nursing and
hospice agencies is voluntary. However, some managed care organizations use Joint Commission accreditation as a credentialing
standard for regional and state contracts. As of December 31, 2012, the Joint Commission had accredited 266 of our 274 agencies.
Those not yet accredited are working towards achieving this accreditation. As we acquire companies, we apply for accreditation
12 to 18 months after acquisition.
Employees
As of December 31, 2012, we had 7,903 employees, of which 5,201 were full-time. None of our employees are subject to a collective
bargaining agreement. We consider our relationships with our employees and independent contractors to be good.
Insurance
We are subject to claims and legal actions in the ordinary course of our business. To cover claims that may arise, we maintain professional
malpractice liability insurance, general liability insurance, automobile liability insurance and workers’ compensation/employer’s liability
insurance in amounts that we believe are appropriate and sufficient for our operations. We maintain professional malpractice and general
liability insurance that provide primary coverage on a claims-made basis of $1.0 million per incident and $3.0 million in annual aggregate
amounts. We maintain workers’ compensation insurance that meets state statutory requirements with a primary employer liability limit of
$1.0 million for Alabama, Arkansas, Florida, Georgia, Idaho, Kentucky, Louisiana, Maryland, Mississippi, Missouri, North Carolina,
Oklahoma, Oregon, Tennessee, Texas, Virginia, and West Virginia. There are no limits to employer liability in Ohio and Washington. The
Company is self-insured for the first $350,000 in workers compensation liability. We maintain automobile liability insurance for all
owned, hired and non-owned autos with a primary limit of $1.0 million. In addition, we currently maintain multiple layers of umbrella
coverage in the aggregate amount of $40.0 million that provides excess coverage for professional malpractice, general liability,
automobile liability and employer’s liability. We maintain directors and officers liability insurance in the aggregate amount of $45.0 million,
with an additional $10.0 million of Side A coverage. The cost and availability of insurance coverage has varied widely in recent years.
While we believe that our insurance policies and coverage are adequate for a business enterprise of our type, we cannot guarantee
that our insurance coverage is sufficient to cover all future claims or that it will continue to be available in adequate amounts or at
a reasonable cost.
Available Information
Our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, proxy statements and amendments
to those reports are available free of charge on our internet website at www.lhcgroup.com as soon as reasonably practicable after such
reports are electronically filed with or furnished to the Securities and Exchange Commission (“SEC”). The SEC also maintains an internet
site at www.sec.gov that contains such reports, proxy and information statements and other information regarding issuers that file
electronically with the SEC. These reports may also be obtained at the SEC’s Public Reference Room at 100 F Street NE, Washington, D.C.
20549. Information on the operation of the Public Reference Room is available by calling the SEC at (800) SEC-0330. Information
contained on our website is not part of or incorporated by reference into this Annual Report on Form 10-K.
26
Form 10-K Part I
We build partnerships. With purpose.
Item 1A. Risk Factors.
The risks and uncertainties described below and elsewhere in this Annual Report on Form 10-K could cause our actual results to differ
materially from past or expected results and are not the only ones we face. Other risks and uncertainties that we have not predicted or
assessed may also adversely affect us.
If any of the following risks occur, our earnings, financial condition or business could be materially harmed and the trading price of our
common stock could decline, resulting in the loss of all or part of stockholders’ investments.
Risk Factors Related to Reimbursement and Government Regulation
We cannot predict the effect that health care reform and other changes in government programs may have on our business, financial
condition or results of operations.
The PPACA and the Health Care Education Reconciliation Act of 2010 (collectively, the “Acts”) were signed into law by President Obama
on March 23, 2010, and March 30, 2010, respectively. The Acts dramatically alter the United States health care system and are intended
to decrease the number of uninsured Americans and reduce overall health care costs. The Acts attempt to achieve these goals by, among
other things, requiring most Americans to obtain health insurance, expanding Medicare and Medicaid eligibility, reducing Medicare and
Medicaid payments, and tying reimbursement to the satisfaction of certain quality criteria. The Acts also contain a number of measures
that are intended to reduce fraud and abuse in the Medicare and Medicaid programs. Because a majority of the measures contained
in the Acts have not yet taken effect, it is difficult to predict the impact the Acts will have on our operations. However, depending on how
they are ultimately interpreted and implemented, the Acts could have an adverse effect on our business and its financial condition and
results of operations.
We derive a majority of our consolidated net service revenue from Medicare. If there are changes in Medicare rates or methods
governing Medicare payments for our services, or if we are unable to control our costs, our results of operations and cash flows could
decline materially.
For the years ended December 31, 2012, 2011 and 2010, we received 77.9%, 79.7% and 80.5%, respectively, of our net service revenue
from Medicare. Reductions in Medicare rates or changes in the way Medicare pays for services could cause our net service revenue
and net income to decline, perhaps materially. Reductions in Medicare reimbursement could be caused by many factors, including:
• administrative or legislative changes to the base rates under the applicable prospective payment systems;
• the reduction or elimination of annual rate increases;
• the imposition or increase by Medicare of mechanisms, such as co-payments, shifting more responsibility for a portion of payment to
beneficiaries;
• adjustments to the relative components of the wage index used in determining reimbursement rates;
• changes to case mix or therapy thresholds;
• the reclassification of home health resource groups or long-term care diagnosis-related groups; or
• further limitations on referrals to long-term acute care hospitals from host hospitals.
We receive fixed payments from Medicare for our services based on the level of care provided to our patients. Consequently, our
profitability largely depends upon our ability to manage the cost of providing these services. Medicare currently provides for an annual
adjustment of the various payment rates, such as the base episode rate for our home nursing services, based upon the increase or
decrease of the medical care expenditure category of the Consumer Price Index, which may be less than actual inflation. This adjustment
could be eliminated or reduced in any given year. In 2012 we experienced an approximate 2.4% cut in home health reimbursement for
our Medicare patients and expect an additional 1.1% cut in 2013. Also beginning on April 1, 2013 Medicare reimbursement will be cut an
additional 2% through sequestration as mandated by the Congressional Budget Act. Further, Medicare routinely reclassifies home health
resource groups and long-term care diagnosis-related groups. As a result of those reclassifications, we could receive lower reimbursement
rates depending on the case mix of the patients we service. If our cost of providing services increases by more than the annual
Medicare price adjustment, or if these reclassifications result in lower reimbursement rates, our results of operations, net income and cash
flows could be adversely impacted.
Form 10-K Part I
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LHC GROUP
We are subject to extensive government regulation. Any changes in the laws and regulations governing our business, or the interpretation
and enforcement of those laws or regulations, could require us to modify our operations and could negatively impact our operating results
and cash flows.
As a provider of health care services, we are subject to extensive regulation on the federal, state and local levels, including with regard to:
• licensure and certificates of need and permits of approval;
• coding and billing for services;
• conduct of operations, including financial relationships among health care providers, Medicare fraud and abuse and physician self-referral;
• maintenance and protection of records, including HIPAA;
• environmental protection, health and safety;
• certification of additional agencies or facilities by the Medicare program; and
• payment for services.
The laws and regulations governing our operations, along with the terms of participation in various government programs, regulate how
we do business, the services we offer and our interactions with patients and other providers. These laws and regulations, and their
interpretations, are subject to frequent change. Changes in existing laws, regulations, their interpretations or the enactment of new laws or
regulations could increase our costs of doing business and cause our net income to decline. If we fail to comply with these applicable
laws and regulations, we could suffer civil or criminal penalties, including the loss of our licenses to operate and our ability to participate in
federal and state reimbursement programs.
We are also subject to various routine and non-routine governmental reviews, audits and investigations. These audits include those
conducted through the recovery audit contractor program, in which third party firms engaged by CMS conduct extensive reviews of claims
data and non-medical and other records to identify potential improper payments under the Medicare Program. In recent years, federal
and state civil and criminal enforcement agencies have heightened and coordinated their oversight efforts related to the health care
industry, including with respect to referral practices, cost reporting, billing practices, joint ventures and other financial relationships among
health care providers. Although we have invested substantial time and effort in implementing policies and procedures to comply with
laws and regulations, we could be subject to liabilities arising from violations. A violation of the laws governing our operations, or changes
in the interpretation of those laws, could result in the imposition of fines, civil or criminal penalties, the termination of our rights to
participate in federal and state-sponsored programs or the suspension or revocation of our licenses to operate. If we become subject to
material fines or if other sanctions or other corrective actions are imposed upon us, we may suffer a substantial reduction in net income.
Current economic conditions and continued decline in spending by the Federal and State governments could adversely affect our results
of operations and cash flows.
Worldwide economic conditions have significantly declined and will likely remain depressed for the foreseeable future. While our services
are not typically sensitive to general declines in the federal and state economies, the erosion in the tax base caused by the general
economic downturn has caused, and will likely continue to cause, restrictions on the federal and state governments’ ability to obtain
financing and a decline in spending. As a result, we may face reimbursement rate cuts or reimbursement delays from Medicare and
Medicaid and other governmental payors, which could adversely impact our results of operations and cash flows.
If any of our agencies or facilities fail to comply with the conditions of participation in the Medicare program, that agency or facility could
be terminated from Medicare, which could adversely affect our net service revenue and net income.
Our agencies and facilities must comply with the extensive conditions of participation in the Medicare program. These conditions of
participation vary depending on the type of agency or facility, but, in general, require our agencies and facilities to meet specified standards
relating to personnel, patient rights, patient care, patient records, administrative reporting and legal compliance. If an agency or facility
fails to meet any of the Medicare conditions of participation, that agency or facility may receive a notice of deficiency from the applicable state
surveyor. If that agency or facility then fails to institute and comply with a plan of correction to correct the deficiency within the time period
provided by the state surveyor, that agency or facility could be terminated from the Medicare program. We respond in the ordinary course to
deficiency notices issued by state surveyors and none of our facilities or agencies have ever been terminated from the Medicare program
for failure to comply with the conditions of participation. Any termination of one or more of our agencies or facilities from the Medicare program
for failure to satisfy the Medicare conditions of participation could adversely affect our net service revenue and net income.
28
Form 10-K Part I
We build partnerships. With purpose.
The inability of our long-term acute care hospitals to maintain their certification as long-term acute care hospitals could have an adverse
affect on our results of operations and cash flows.
If our LTACHs fail to meet or maintain the standards for Medicare certification as LTACHs, such as for average minimum length of patient
stay, they will receive reimbursement under the prospective payment system applicable to general acute care hospitals rather than the
system applicable to long-term acute care hospitals. Payments at rates applicable to general acute care hospitals would likely result in our
LTACHs receiving less Medicare reimbursement than they currently receive for their patient services. Moreover, all but one of our
LTACHs are subject to additional Medicare criteria because they operate as separate hospitals located in space leased from and located
in a general acute care hospital, known as a host hospital. This is known as a “hospital within a hospital” model. These additional criteria
include requirements concerning financial and operational separateness from the host hospital. If any of our LTACHs were subject to
payment as general acute care hospitals or failed to comply with the separateness requirements, our net service revenue and net income
would decline.
CMS has adopted regulations that could materially and adversely affect the results of operations and cash flows of our long-term acute
care hospitals.
In a final rule released on May 1, 2007, CMS expanded the Medicare admissions threshold to apply not only to long-term acute care
HwHs and satellites but also to freestanding LTACHs and grandfathered LTACHs. The policy also applies to HwHs and satellites that admit
Medicare patients from non-co-located hospitals. While this policy change was supposed to take effect for cost reporting periods
beginning on or after July 1, 2007, the MMSEA delayed the implementation of the policy initially for three years and then for an additional
two years with respect to freestanding LTACHs and grandfathered LTACHs. Further, the MMSEA set the percentage threshold at 50%
for three years for HwHs and satellites located in urban areas that would otherwise be subject to a transition period and it established a
75% ceiling for HwHs and satellite facilities located in rural areas and those that receive referrals from MSA dominant hospitals or
urban single hospitals. The fiscal year 2013 IPPS/LTACH-PPS final rule extended the 25% thresholds established under MMSEA for cost
reporting periods beginning on or after October 1, 2012 and before October 1, 2013.
As of December 31, 2012, we had a total of nine LTACH locations; eight of our LTACHs were classified as HwHs and one was
freestanding. Of the eight HwH facilities, five were located in rural or non-MSAs and were, therefore, subject to a final admission
percentage of 50% at the end of the phase-in period. Three of our HwH facilities were located in MSA or urban areas and will be subject
to a final admission percentage of 25% at the end of the phase-in period. Of the eight locations classified as HwHs, one facility was a
satellite location of a parent hospital located in an MSA and one was a satellite location of a parent hospital located in a non-MSA. Based
on our discussions with CMS, we believe each of these satellite locations will be viewed as being located in a non-MSA regardless of the
location of its parent hospital and will be treated independently from its parent for purposes of calculating its compliance with the
admissions limitations. If the “25 Percent Rule” is extended, as planned, to freestanding LTACHs after the implementation delay
established in the MMSEA, our current freestanding facility would not likely be affected because we currently do not receive more than
25% of our Medicare admissions from any single referring hospital.
For the 12 months ended December 31, 2012, on an individual basis, all of our LTACHs that are classified as HwHs admitted between
56% and 72% of their patients from their host hospitals. These hospitals came under the proper thresholds as of their respective cost
report year end date in 2012. Our new LTACHs acquired in 2010 and 2009 are grandfathered and, consequently, have no limitations
under MMSEA with respect to the number of patients that can be admitted from the host hospital. Our remaining LTACH is not an HwH;
therefore, it is not subject to these limits on host hospital referrals.
Our ability to quantify the potential reduction in our reimbursement rates resulting from the implementation of these new regulations is
contingent upon a variety of factors, such as our ability to reduce the percentage of admissions that are derived from our host hospitals
and, if necessary, our ability to relocate our existing long-term acute care hospitals to freestanding locations. We may not be able
to successfully restructure or relocate these operations without incurring significant expense or in a manner that avoids reimbursement
reductions. If these new regulations result in lower reimbursement rates, our net service revenue and net income could decline. As a
result of these new rules, we do not intend to expand the number of HwH long-term acute care hospitals that we operate.
Form 10-K Part I
29
LHC GROUP
We are reimbursed by Medicare for services we provide in our long-term acute care hospitals based on the long-term care diagnosis-
related group assigned to each patient. CMS establishes these long-term care diagnosis-related groups by grouping diseases by diagnosis
to reflect the amount of resources needed to treat a given disease. The May 2007 CMS final rules reclassifies certain long-term care
diagnosis-related groups, which could result in a decrease in reimbursement rates. Further, the rule kept in place the financial penalties
associated with the failure to limit the total number of Medicare patients discharged from a host hospital and subsequently readmitted
to a long-term acute care hospital located within the host hospital to no greater than 5.0%. If we fail to comply with these readmission
rates or if our reimbursement rates decline due to the reclassification of certain long-term care diagnosis-related groups, our net service
revenue and net income could decline.
If the structures or operations of our joint ventures are found to violate the law, it could have a material adverse impact on our financial
condition and consolidated results of operations.
Several of our joint ventures are with hospitals and physicians, which are governed by the Anti-Kickback Statute and similar state laws.
These anti-kickback statutes prohibit the payment or receipt of anything of value in return for referrals of patients or services
covered by governmental health care programs, such as Medicare. The OIG has published numerous safe harbors that exempt qualifying
arrangements from enforcement under the Anti-Kickback Statute. We have sought to satisfy as many safe harbor requirements as
possible in structuring our joint ventures. For example, each of our equity joint ventures with hospitals and physicians is structured in
accordance with the following principles:
• the investment interest offered is not based upon actual or expected referrals by the hospital or physician;
• our joint venture partners are not required to make or influence referrals to the joint venture;
• at the time the joint venture is formed, each hospital or physician joint venture partner is required to make an actual capital contribution
to the joint venture equal to the fair market value of his or her investment interest and is at risk to lose its investment;
• neither we nor the joint venture entity lends funds to or guarantees a loan to acquire interests in the joint venture for a hospital or
physician; and
• distributions to our joint venture partners are based solely on their equity interests and are not affected by referrals from the hospital
or physician.
Despite our efforts to meet the safe harbor requirements where possible, our joint ventures may not satisfy all elements of the safe harbor
requirements.
If any of our joint ventures were found to be in violation of federal or state anti-kickback or physician referral laws, we could be required to
restructure them or refuse to accept referrals from the physicians or hospitals with which we have entered into a joint venture. We also
could be required to repay to Medicare amounts we have received pursuant to any prohibited referrals, and we could suffer civil or criminal
penalties, including the loss of our licenses to operate and our ability to participate in federal and state health care programs. If any of
our joint ventures were subject to any of these penalties, our business could be materially adversely affected. If the structure of any of our
joint ventures were found to violate federal or state anti-kickback statutes or physician referral laws, we may be unable to implement
our growth strategy, which could have an adverse impact on our future net income and consolidated results of operations.
The application of state certificate of need and permit of approval regulations and compliance with federal and state licensing
requirements could substantially limit our ability to operate and grow our business.
Our ability to expand operations in a state will depend on our ability to obtain a state license to operate. States may have a limit on the
number of licenses they issue. For example, Louisiana currently has a moratorium on the issuance of new home nursing agency licenses.
We cannot predict whether this moratorium will be extended beyond this date or whether any other states in which we operate, or may
wish to operate in the future, may adopt a similar moratorium.
As of December 31, 2012, we operated in 10 states that require health care providers to obtain prior approval, known as a certificate of
need or a permit of approval, for the purchase, construction or expansion of health care facilities, to make certain capital expenditures
or to make changes in services or bed capacity. The states that currently issue certificates of need or permits of approval are: Alabama,
Alaska, Arkansas, Georgia, Hawaii, Kentucky, Maryland, Mississippi, Montana, New Jersey, New York, North Carolina, South Carolina,
Tennessee, Vermont, Washington, West Virginia and the District of Columbia. In granting approval, these states consider the need in the
service area for additional or expanded health care facilities or services. The failure to obtain any requested certificate of need, permit
of approval or other license could impair our ability to operate or expand our business.
30
Form 10-K Part I
We build partnerships. With purpose.
Risk Factors Related to Capital and Liquidity
The condition of the financial markets, including volatility and weakness in the equity, capital and credit markets could limit the availability
and terms of debt and equity financing sources to fund the capital and liquidity requirements of our business.
Financial markets experienced significant disruptions over the past few years. These disruptions have impacted liquidity in the debt
markets, making financing terms for borrowers less attractive and, in certain cases, significantly reducing the availability of certain types
of debt financing. Despite the instability over the past few years within the financial markets nationally and globally, we have not
experienced any individual lender limitations to extend credit under our revolving credit facility. However, the obligations of each of the
lending institutions in our revolving credit facility are separate and the availability of future borrowings under our revolving credit facility
could be impacted by further volatility and disruptions in the financial credit markets or other events. Our inability to access our revolving
credit facility or refinance the revolving credit facility would have a material adverse effect on our business, financial positions, results of
operations and liquidity.
Based on our current plan of operations, including acquisitions, we believe our existing cash balance, when combined with expected cash
flows from operations and amounts available under our revolving line of credit, will be sufficient to fund our growth strategy and to
meet our anticipated operating expenses, capital expenditures and debt service obligations for at least the next 12 months. If our future
net service revenue or cash flow from operations is less than we currently anticipate, we may not have sufficient funds to implement
our growth strategy. Further, we cannot readily predict the timing, size and success of our acquisition and internal development efforts and
the associated capital commitments. If we do not have sufficient cash resources, our growth could be limited unless we are able to
obtain additional equity or debt financing.
The agreement governing our credit facility contains, and future debt agreements may contain, various covenants that limit our discretion
in the operation of our business.
The agreement and instruments governing our outstanding credit facility, and the agreements and instruments governing future debt
agreements may contain various restrictive covenants that, among other things, require us to comply with or maintain certain financial
tests and ratios that may restrict our ability to:
• incur more debt;
• redeem or repurchase stock, pay dividends or make other distributions;
• make certain investments;
• create liens;
• enter into transactions with affiliates;
• make unapproved acquisitions;
• merge or consolidate;
• transfer or sell assets; and
• make fundamental changes in our corporate existence and principal business.
In addition, events beyond our control could affect our ability to comply with and maintain such financial tests and ratios. Any failure by us
to comply with or maintain all applicable financial tests and ratios and to comply with all applicable covenants could result in an event
of default with respect to our credit facility or any other future debt agreements. An event of default could lead to the acceleration of the
maturity of any outstanding loans and the termination of the commitments to make further extensions of credit. Even if we are able to
comply with all applicable covenants, the restrictions on our ability to operate our business at our sole discretion could harm our business
by, among other things, limiting our ability to take advantage of financing, mergers, acquisitions and other corporate opportunities.
Our net service revenue is concentrated in a small number of states, which makes us sensitive to regulatory and economic changes in
those states.
As of December 31, 2012, the Company’s facilities in Louisiana, Alabama, Mississippi, Tennessee, and Kentucky accounted for approximately
64.9% of net service revenue. Accordingly, any changes in the current demographic, economic, competitive, or regulatory conditions
in these states could have an adverse effect on our business, financial condition, results of operations and cash flows. Medicaid changes
in these states could also have a material adverse effect on our results of operations or cash flows.
Form 10-K Part I
31
LHC GROUP
Hurricanes or other adverse weather events could negatively affect the local economies in which we operate or disrupt our operations,
which could have an adverse effect on our business or results of operations.
Our operations along coastal areas in the southern United States are particularly susceptible to hurricanes. Such weather events can
disrupt our operations, result in damage to our properties and negatively affect the local economies in which we operate. Future hurricanes
could affect our operations or the economies in those market areas and result in damage to certain of our facilities, the equipment
located at such facilities or equipment rented to patients in those areas. Our business or results of operations may be adversely affected
by these and other negative effects of future hurricanes. Although we maintain insurance coverage, we cannot guarantee that our
insurance coverage will be adequate to cover any losses or that we will be able to maintain insurance at a reasonable cost in the future. If
our losses from business interruption or property damage exceed the amount for which we are insured, our results of operations and
financial condition would be adversely affected.
Delays in reimbursement may cause liquidity problems.
Our business is characterized by delays in reimbursement from the time we request payment for our services to the time we receive
reimbursement or payment. A portion of our estimated reimbursement (60.0% for an initial episode of care and 50.0% for subsequent
episodes of care) for each Medicare episode is billed at the commencement of the episode and, we typically receive payment within
approximately seven days. The remaining reimbursement is billed upon completion of the episode and is typically paid within 14 to 17 days
from the billing date. If we have information system problems or issues arise with Medicare or other payors, we may encounter further
delays in our payment cycle. For example, in the past we have experienced delays resulting from problems arising out of the
implementation by Medicare of new or modified reimbursement methodologies or as a result of natural disasters, such as hurricanes. We
have also experienced delays in reimbursement resulting from our implementation of new information systems related to our accounts
receivable and billing functions. Any future timing delay may cause working capital shortages. As a result, working capital management,
including prompt and diligent billing and collection, is an important factor in our consolidated results of operations and liquidity. Our
working capital management procedures may not successfully negate this risk. Significant delays in payment or reimbursement could
have an adverse impact on our liquidity and financial condition.
Risk Factors Related to Operations and Our Growth Strategy
We could be required to record a material non-cash charge to income if our recorded goodwill or intangible assets are impaired.
Goodwill and other intangibles represent a significant portion of the assets on our balance sheet and are assessed for impairment annually.
The goodwill assessment includes comparing the fair value of each reporting unit to the carrying value of the assets assigned to the
reporting unit. If the carrying value of the reporting unit were to exceed our estimate of fair value of the reporting unit, we would be required
to estimate the fair value of the individual assets and liabilities within the reporting unit to ascertain the fair value of goodwill. If we
determine that the fair value is less than our book value, we could be required to record a non-cash impairment charge to our consolidated
statements of operations, which could have a material adverse effect on our earnings, debt covenants and ability to access capital.
We assess other intangible assets, such as trade names and licenses, individually based on expected revenue and cash flows to be
generated by those assets. Specific economic factors and conditions attributed to local agencies could cause these expected revenue
and cash flows to decrease. If we determine that the fair value is less than the carrying value, we could be required to record material
non-cash impairment charges, which could have a material adverse effect on our earnings, debt covenants and ability to access capital.
Our allowance for contractual adjustments and doubtful accounts may not be sufficient to cover uncollectible amounts.
On an ongoing basis, we estimate the amount of Medicare, Medicaid and private insurance receivables that we will not be able to
collect. This allows us to calculate the expected loss on our receivables for the period we are reporting. Our allowance for contractual
adjustments and doubtful accounts may underestimate actual unpaid receivables for various reasons, including:
• adverse changes in our estimates as a result of changes in payor mix and related collection rates;
• inability to collect funds due to missed filing deadlines or inability to prove that timely filings were made;
• adverse changes in the economy generally exceeding our expectations; or
• unanticipated changes in reimbursement from Medicare, Medicaid and private insurance companies.
32
Form 10-K Part I
We build partnerships. With purpose.
If our allowance for contractual adjustments and doubtful accounts is insufficient to cover losses on our receivables, our business, financial
position and results of operations could be materially adversely affected.
Changes in the case mix of patients, as well as payor mix and payment methodologies, may have a material adverse effect on our results
of operations and cash flows.
The sources and amounts of our patient revenue are determined by a number of factors, including the mix of patients and the rates
of reimbursement among payors. Generally, we receive higher reimbursement for services rendered under Medicare. Changes in the case
mix of the patients, payment methodologies or payor mix among private pay, Medicare and Medicaid may significantly affect our results
of operations and cash flows.
Shortages in qualified nurses and other health care professionals could increase our operating costs significantly or constrain our ability
to grow.
We rely on our ability to attract and retain qualified nurses and other health care professionals. The availability of qualified nurses
nationwide has declined in recent years and competition for these and other health care professionals has increased, while salary and
benefit costs have risen accordingly. Our ability to attract and retain nurses and other health care professionals depends on several
factors, including our ability to provide desirable assignments and competitive benefits and salaries. We may not be able to attract and
retain qualified nurses or other health care professionals in the future. In addition, the cost of attracting and retaining these professionals
and providing them with attractive benefit packages may be higher than anticipated which could cause our net income to decline.
Moreover, if we are unable to attract and retain qualified professionals, the quality of services offered to our patients may decline or our
ability to grow may be constrained.
If we are required to either repurchase or sell a substantial portion of the equity interests in our joint ventures, our capital resources and
financial condition could be materially adversely impacted.
Upon the occurrence of fundamental changes to the laws and regulations applicable to our joint ventures, or if a substantial number of our
joint venture partners were to exercise the buy/sell provisions contained in many of our joint venture agreements, we may be obligated
to purchase or sell the equity interests held by us or our joint venture partners. In some instances, the purchase price under these buy/sell
provisions is based on a multiple of the historical or future earnings before income taxes, depreciation and amortization of the equity
joint venture at the time the buy/sell option is exercised. In other instances, the buy/sell purchase price will be negotiated by the partners
but will be subject to a fair market valuation process. In the event the buy/sell provisions are exercised and we lack sufficient capital to
purchase the interest of our joint venture partners, we may be obligated to sell our equity interest in these joint ventures. If we are forced to
sell our equity interest, we will lose the benefit of those particular joint venture operations. If these buy/sell provisions are exercised and
we choose to purchase the interest of our joint venture partners, we may be obligated to expend significant capital in order to complete
such acquisitions. If either of these events occurs, our net service revenue and net income could decline or we may not have sufficient
capital necessary to implement our growth strategy.
If we are unable to maintain relationships with existing referral sources or establish new referral sources, our growth and net income could
be adversely affected.
Our success depends significantly on referrals from physicians, hospitals and other health care providers in the communities in which we
deliver our services. Our referral sources are not obligated to refer business to us and may refer business to other health care providers.
We believe many of our referral sources refer business to us as a result of the quality of patient care provided by our local employees in the
communities in which our agencies and facilities are located. If we are unable to retain these employees, our referral sources may refer
business to other health care providers. Our loss of, or failure to maintain, existing relationships or our failure to develop new relationships
could affect adversely our ability to expand our operations and operate profitably.
We face competition, including from competitors with greater resources, which may make it difficult for us to compete effectively as a
provider of post-acute health care services.
We compete with local and regional home nursing and hospice companies, hospitals and other businesses that provide post-acute
health care services, some of which are large established companies that have significantly greater resources than we do. Our primary
competition comes from local operators in each of our markets. We expect our competitors to develop joint ventures with providers,
referral sources and payors, which could result in increased competition. The introduction by our competitors of new and enhanced
Form 10-K Part I
33
LHC GROUP
service offerings, in combination with industry consolidation and the development of competitive joint ventures, could cause a decline in
net service revenue, loss of market acceptance of our services or make our services less attractive. Future increases in competition
from existing competitors or new entrants may limit our ability to maintain or increase our market share. We may not be able to compete
successfully against current or future competitors and competitive pressures may have a material adverse impact on our business,
financial condition and results of operations.
Future acquisitions may be unsuccessful and could expose us to unforeseen liabilities. Further, our acquisition and internal development
activity may impose strains on our existing resources.
Our growth strategy involves the acquisition of home nursing agencies and facilities throughout the United States. These acquisitions
involve significant risks and uncertainties, including difficulties integrating acquired personnel and other corporate cultures into our
business, the potential loss of key employees or patients of acquired agencies and the assumption of liabilities and exposure to unforeseen
liabilities of acquired agencies. We may not be able to fully integrate the operations of the acquired businesses with our current
business structure in an efficient and cost-effective manner. The failure to effectively integrate any of these businesses could have a
material adverse effect on our operations.
We generally structure our acquisitions as asset purchase transactions in which we expressly state that we are not assuming any
pre-existing liabilities of the seller and obtain indemnification rights from the previous owners for acts or omissions arising prior to the date
of such acquisitions. However, the allocation of liability arising from such acts or omissions between the parties could involve the
expenditure of a significant amount of time, manpower and capital. Further, the former owners of the agencies and facilities we acquire
may not have the financial resources necessary to satisfy our indemnification claims relating to pre-existing liabilities. If we were
unsuccessful in a claim for indemnification from a seller, the liability imposed could materially adversely affect our operations.
In addition, as we continue to expand our markets, our growth could strain our resources, including management, information and
accounting systems, regulatory compliance, logistics and other internal controls. Our resources may not keep pace with our anticipated
growth. If we do not manage our expected growth effectively, our future prospects could be affected adversely.
We may face increased competition for attractive acquisition and joint venture candidates.
We intend to continue growing through the acquisition of additional home nursing agencies and the formation of joint ventures with
hospitals for the operation of home nursing agencies. We face competition for acquisition and joint venture candidates, which may limit
the number of acquisition and joint venture opportunities available to us or lead to the payment of higher prices for our acquisitions
and joint ventures. We cannot guarantee that we will be able to identify suitable acquisition or joint venture opportunities in the future or
that any such opportunities, if identified, will be consummated on favorable terms, if at all. Without successful acquisitions or joint ventures,
our future growth rate could decline. In addition, we cannot guarantee that any future acquisitions or joint ventures, if consummated,
will result in further growth.
Federal regulation may impair our ability to consummate acquisitions or open new agencies.
Changes in Federal laws or regulations may materially adversely impact our ability to acquire agencies or open new start-up agencies.
For example, CMS recently adopted a regulation known as the “36 Month Rule” that is applicable to home health agency acquisitions.
Subject to certain exceptions, the 36 Month Rule prohibits buyers of certain home health agencies – those that either enrolled in Medicare
or underwent a change in ownership fewer than 36 months prior to the acquisitions – from assuming the Medicare billing privileges
of the acquired agency. Instead, the acquired agencies must enroll as new providers with Medicare. As a result, the 36 Month Rule may
further increase competition for acquisition targets that are not subject to the rule, and may cause significant Medicare billing delays for
the purchases of agencies that are subject to the rule.
We are the subject of an inquiry by the federal government, which could have an adverse impact on our financial condition and operations.
We operate in a highly regulated industry and are the subject of an inquiry by the federal government. We are cooperating with the
government agency with respect to the inquiry and producing the requested records. Any negative findings could have a material adverse
impact on our operations and financial condition. Although we cannot predict when this matter may be resolved, it is not unusual
for an investigation such as this one to continue for a considerable period of time. Responding to this inquiry will continue to require
management’s attention and significant legal expense. See Part I. Item 3. Legal Proceedings in this Annual Report on Form 10-K for
additional information regarding these inquiries.
34
Form 10-K Part I
We build partnerships. With purpose.
We are subject to a corporate integrity agreement and could be subject to substantial monetary penalties or suspension of participation
in Federal health care programs for noncompliance.
On September 29, 2011, we entered into a corporate integrity agreement (“CIA”) with the Office of Inspector General of the Department of
Health and Human Services. The CIA imposes certain auditing, self-reporting and training requirements that we must comply with. Failure
to comply with certain obligations may lead to the imposition of monetary penalties and/or exclusion from participation in the Federal
health care programs. The imposition of monetary penalties would adversely affect our profitability. An exclusion from participation in the
Federal health care programs would have a material adverse effect on our financial condition as substantially all of our net service revenue
is attributable to payments received under the Medicare and Medicaid programs.
If we are subject to substantial malpractice or other similar claims, it could materially adversely impact our results of operations and
financial condition.
The services we offer have an inherent risk of professional liability and substantial damage awards. We, and the nurses and other health
care professionals who provide services on our behalf, may be the subject of medical malpractice claims. These nurses and other health
care professionals could be considered our agents and, as a result, we could be held liable for their medical negligence. We cannot
predict the effect that any claims of this nature, regardless of their ultimate outcome, could have on our business or reputation or on our
ability to attract and retain patients and employees. We maintain malpractice liability insurance that provides primary coverage on a
claims-made basis of $1.0 million per incident and $3.0 million in annual aggregate amounts. In addition, we maintain multiple layers of
umbrella coverage in the aggregate amount of $40.0 million that provide excess coverage for professional malpractice and other
liabilities. We are responsible for deductibles and amounts in excess of the limits of our coverage. Claims that could be made in the future
in excess of the limits of such insurance, if successful, could materially adversely affect our financial condition. In addition, our insurance
coverage may not continue to be available to us at commercially reasonable rates, in adequate amounts or on satisfactory terms.
Failure of, or problems with, our critical software or information systems could harm our business and operating results.
In addition to our Service Value Point system, our business is also substantially dependent on non-proprietary software. We utilize a
third-party software information system for billing and maintaining patient claim receivables for our LTACHs. Our various home nursing
agency databases are fully consolidated into an enterprise-wide system. Problems with, or the failure of, these systems could negatively
impact our clinical performance and our management and reporting capabilities. Any such problems or failure could materially and
adversely affect our operations and reputation, result in significant costs to us, cause delays in our ability to bill Medicare or other payors
for our services, or impair our ability to provide our services in the future. The costs incurred in correcting any errors or problems with
regard to our proprietary and non-proprietary software may be substantial and could adversely affect our net income.
Our information systems are networked via public network infrastructure and standards based encryption tools that meet regulatory
requirements for transmission of protected health care information over such networks. However, threats from computer viruses, instability
of the public network on which our data transit relies, or other instances that might render those networks unstable or disabled would
create operational difficulties for us, including difficulties effectively transmitting claims and maintaining efficient clinical oversight of our
patients, as well as disrupting revenue reporting and billing and collections management, which could adversely affect our business or
operations. If personal or protected information of our patients, employees or others with whom we do business is tampered with, stolen
or otherwise improperly accessed, we may incur additional fines and penalties associated with the breach of security or take other
action with respect to judicial or regulatory actions arising out of the incident, including under HIPAA or other judicial acts, as applicable.
Risk Factors Related to Our Ownership and Management
Start-up agencies can be delayed from opening in a timely manner due to processing or regulatory approvals.
There can be delays associated with opening a de novo agency. These delays are the result of processing delays with the state regulatory
bodies as well as processing delays by the associated fiscal intermediaries that serve as billing liaisons between the agency and CMS.
To initiate operations at a de novo agency, we must submit the necessary applications along with the required documentation to the
appropriate state and Federal regulatory bodies. However, CMS has issued a memorandum which prioritizes the initial surveys for new
Medicare providers as lowest priority for the state regulatory bodies. Moreover, depending on state requirements, the fiscal intermediary
may need to receive the state license before the approval process can move forward. Once the necessary application and documentation
has been submitted to the state and Federal regulatory bodies, there is a testing period of transmitting data from the applicant to CMS.
Form 10-K Part I
35
LHC GROUP
Once complete, the agency receives a provider agreement and corresponding number and can begin billing. If we are unable to obtain
regulatory approval for our de novo agencies in a timely manner, such delays could have a material adverse effect on our business and our
consolidated financial condition, results of operations and cash flows.
As a holding company, we have no material assets or operations of our own.
We are a holding company with no material assets or operations of our own. Accordingly, our ability to service our debt and pay dividends,
if any, is dependent upon the earnings from the business conducted by our subsidiaries. The distributions of those earnings or advances
or other distributions of funds by these subsidiaries to us are contingent upon the subsidiaries’ earnings and are subject to various business
considerations. In addition, distributions by subsidiaries could be subject to statutory restrictions, including state laws requiring that the
subsidiary be solvent, or contractual restrictions. If our subsidiaries are unable to make sufficient distributions or advances to us, we may
not have the cash resources necessary to service our debt or pay dividends.
The loss of certain executive management or key employees could have a material adverse effect on our operations and financial
performance.
Our success depends upon the continued employment of our executive management team and key employees and our ability to retain
and motivate these individuals. If we lose the services of one or more of our executive officers or key employees, we may not be able
to successfully manage our business, achieve our business goals or replace them with equally qualified personnel. The loss of any of our
executive officers or key employees could have a material adverse effect on our operations and financial performance.
Our executive officers and directors and their affiliates hold a substantial portion of our stock and could exercise significant influence over
matters requiring stockholder approval, regardless of the wishes of other stockholders.
Our executive officers and directors and individuals or entities affiliated with them, beneficially own an aggregate of approximately 31.8%
of our outstanding common stock as of December 31, 2012. The interests of these stockholders may differ from other stockholders’
interests. If they were to act together, these affiliated stockholders would be able to significantly influence all matters that our stockholders
vote upon, including the election of directors, business combinations, the amendment of our certificate of incorporation and other
significant corporate actions.
Certain provisions of our charter, bylaws, and Delaware law may delay or prevent a change in control of the Company.
Delaware law and our corporate documents contain provisions that may enable our Board of Directors to resist a change in control of the
Company. These provisions include:
• a staggered Board of Directors;
• limitations on persons authorized to call a special meeting of stockholders;
• the authorization of undesignated preferred stock, the terms of which may be established and shares of which may be issued without
stockholder approval; and
• advance notice procedures required for stockholders to nominate candidates for election as directors or to bring matters before an
annual meeting of stockholders.
These anti-takeover defenses could discourage, delay or prevent a transaction involving a change in control of the Company. These
provisions could also discourage proxy contests and make it more difficult for stockholders to elect directors or cause us to take other
corporate actions.
We have implemented other anti-takeover provisions or provisions that could have an anti-takeover effect. These provisions and others
that our Board of Directors may adopt hereafter, may discourage offers to acquire us and may permit our Board of Directors to choose not
to entertain offers to purchase us, even if such offers include a substantial premium to the market price of our common stock. Therefore,
our stockholders may be deprived of opportunities to profit from a sale of control.
Our common stock is thinly traded, which may cause volatility in our stock price, including a decline in value.
We have a relatively low volume of daily trades in our common stock on the NASDAQ Global Select Market (“NASDAQ”). For example, the
average daily trading volume of our common stock on NASDAQ over the three-month trading period ending March 13, 2013 was
approximately 57,710 shares per day. Because our common stock is traded infrequently, the price per share of our common stock can
36
Form 10-K Part I
We build partnerships. With purpose.
fluctuate more significantly from day-to-day than a widely held stock that is actively traded on a daily basis. For example, trading of a large
volume of our common stock may have a significant impact on the trading price of our stock. In addition, future issuances of our
common stock, including the exercise of any options or the vesting of any restricted stock that we may grant to directors, executive
officers and other employees in the future and the issuance of common stock in connection with acquisitions, could have an adverse
effect on the market price of our common stock.
If we identify deficiencies in our internal control over financial reporting, our business and our stock price could be adversely affected.
We are required to report on the effectiveness of our internal control over financial reporting as required by Section 404 of Sarbanes-Oxley.
Under Section 404, we are required to assess the effectiveness of our internal control over financial reporting and report our conclusion
in our annual report. Our independent registered public accounting firm is also required to report its conclusion regarding the effectiveness
of our internal control over financial reporting. The existence of one or more material weaknesses would require us and our auditor
to conclude that our internal control over financial reporting is not effective. If material weaknesses in our internal control over financial
reporting are identified, we could be subject to regulatory scrutiny and a loss of public confidence in our financial reporting, which
could have an adverse effect on our business and our stock price.
Item 1B. Unresolved Staff Comments.
We have no unresolved written comments from the staff of the SEC regarding our periodic or current reports filed under the
Exchange Act.
Item 2. Properties.
Our home office facilities are located in two properties in Lafayette, Louisiana. One property is 22,571 square feet of leased office space
under a lease that commenced on March 1, 2004 and expires on December 31, 2021. The second property is 25,849 square feet of
leased office space under a lease that commenced on December 27, 2008 and expires on February 28, 2014.
Of our 274 owned home-based service locations, five are owned by us and the remaining locations are in leased facilities. Generally, the
leases for our home-based service locations have initial terms of one year, but range from one to five years. Most of the leases either
contain multiple options to extend the lease period in one-year increments or convert to a month-to-month lease upon the expiration of
the initial term. Eight of our LTACHs are hospitals within a hospital, meaning we have a lease or sublease for space with the host hospital.
Generally, our leases or subleases for LTACHs have initial terms of five years, but range from three to ten years. Most of our leases and
subleases for our LTACHs contain multiple options to extend the term in one-year increments. The following table shows our locations of
our home-based and facility-based facilities:
Home-Based Services
Facility-Based Services
Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mississippi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Kentucky. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
West Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
47
32
29
27
26
21
17
12
11
9
9
9
7
5
4
4
2
2
1
274
11
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
11
Form 10-K Part I
37
LHC GROUP
Item 3. Legal Proceedings.
The Company is involved in various legal proceedings arising in the ordinary course of business. Although the results of litigation cannot
be predicted with certainty, management believes the outcome of pending litigation will not have a material adverse effect, after
considering the effect of the Company’s insurance coverage, on the Company’s consolidated financial statements.
On July 16, 2010, the Company received a subpoena from the Securities and Exchange Commission (“SEC”) that included a request for
documents related to the Company’s participation in the Medicare Home Health Prospective Payment System. The Company produced
the documents requested by the initial subpoena, produced additional documents requested by the SEC as part of its review, and
cooperated fully with the SEC’s review. On December 3, 2012, the Company was advised by the SEC that its investigation was complete
and that it did not intend to recommend any enforcement action against the Company.
On October 17, 2011, the Company received a subpoena from the Department of Health and Human Services Office of Inspector General
(the “OIG”). The subpoena requested documents related to the Company’s agencies in Oregon, Washington and Idaho. The Company
has produced all documents requested by the OIG and has fully cooperated with the OIG’s review. The Company cannot predict the
outcome or effect of this review, if any, on the Company’s business.
On June 13, 2012, a putative shareholder securities class action was filed against the Company and its Chairman/CEO in the United
States District Court for the Western District of Louisiana, styled City of Omaha Police & Fire Retirement System v. LHC Group, Inc., et al.,
Case No. 6:12-cv-01609-JTT-CMH. The action was filed on behalf of LHC shareholders who purchased shares between July 30, 2008
and October 26, 2011. Plaintiff generally alleges that the defendants caused false and misleading statements to be issued in violation of
Section 10(b) of the Securities Exchange Act of 1934 (“Exchange Act”) and Rule 10b-5 promulgated thereunder and that the Company’s
Chairman/CEO is a control person under Section 20(a) of the Exchange Act. On November 2, 2012, Lead Plaintiff City of Omaha Police &
Fire Retirement System filed an Amended Complaint for Violations of the Federal Securities Laws (“Amended Complaint”) on behalf of
the same putative class of LHC shareholders as the original Complaint. In addition to claims under Sections 10(b) and 20(a) of the
Exchange Act, the Amended Complaint added a claim against the Chairman/CEO for violation of Section 20A of the Exchange Act. The
Company believes these claims are without merit and intends to defend this lawsuit vigorously. On December 17, 2012, the Company
and the Chairman/CEO filed a motion to dismiss the Amended Complaint, which was denied by Order dated March 15, 2013. The Company
cannot predict the outcome or effect of this lawsuit, if any, on the Company’s business.
Except as discussed above, the Company is not aware of any pending or threatened investigations involving allegations of
potential wrongdoing.
Item 4. Mine Safety Disclosures.
Not applicable.
38
Form 10-K Part I
We build partnerships. With purpose.
PART II
Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and
Issuer Purchases of Equity Securities.
Sales of Unregistered Common Stock
None.
Market Information and Holders
Our common stock trades on the NASDAQ Global Select Market (“NASDAQ”) under the symbol “LHCG.” As of March 13, 2013, there
were approximately 364 registered holders of record of our common stock.
Dividend Policy
We have not paid any dividends on our common stock since our initial public offering in 2005 and do not anticipate paying dividends in
the foreseeable future. We currently intend to retain future earnings, if any, to support the development and growth of our business.
Payment of future dividends, if any, will be at the discretion of our Board of Directors and subject to any requirements under our Credit
Facility or any future credit facility.
Price Range of Common Stock
The following table provides the high and low prices of our common stock during 2012 and 2011 as quoted by NASDAQ:
2012
Fourth Quarter
Third Quarter
Second Quarter
First Quarter
2011
Fourth Quarter
Third Quarter
Second Quarter
First Quarter
High
Low
$ 22.12
18.70
18.87
19.71
$ 18.84
23.90
30.39
31.52
$ 16.33
16.86
16.45
12.57
$ 12.35
16.15
22.48
26.33
The closing price of our common stock as reported by NASDAQ on March 12, 2013 was $20.09.
Performance Graph
This item is incorporated by reference from our annual report to stockholders for the fiscal year ended December 31, 2012.
Issuer Purchases of Equity Securities
In October 2010, our Board of Directors authorized a program to repurchase shares of our common stock, par value $0.01 per share,
from time to time, in an amount not to exceed $50.0 million (“Stock Repurchase Program”). We anticipate that we will finance the
Stock Repurchase Program with cash from general corporate funds or draws under our Credit Facility, the terms of which allow us to
purchase up to $50.0 million of our common stock without obtaining approval from the bank group. We may repurchase shares of our
common stock in open market purchases or in privately negotiated transactions in accordance with applicable securities laws, rules and
regulations. The timing and extent to which we repurchase our shares will depend upon market conditions and other corporate considerations.
We account for the repurchase of our common stock under the cost method. We use the average cost method upon the subsequent
reissuance of treasury shares. During the twelve months ended December 31, 2012, we repurchased 1,540,813 shares of common stock
at an aggregate cost of $27.0 million, including commissions, or an average cost per share of $17.52. During the twelve months ended
December 31, 2011, we repurchased 24,159 shares of common stock at an aggregate cost of $577,000, including commissions, or an
average cost per share of $23.93. The remaining dollar value of shares authorized to be purchased under the share repurchase program
is $22.5 million at December 31, 2012.
Form 10-K Part I I
39
LHC GROUP
The following table summarizes the Company’s repurchase activity during the three month period ended December 31, 2012:
(a)
(b)
Total Number
of Shares
(or Units Purchased)
Average Price
Paid per Share
(or Unit)
238,416
208,738
—
447,154
$ 18.10
$ 17.37
—
—
(c)
Total Number of Shares
(or Units) Purchased
as Part of Publicly
Announced Plans
or Programs
(d)
Maximum Number
(or Approximate Dollar Value)
of Shares (or Units) that
May Yet Be Purchased
Under the Plans or Programs
238,416
208,738
—
—
$ 26,090,000
$ 22,465,000
$ 22,465,000
$ 22,465,000
Period
October 1 – October 31
November 1 – November 30
December 1 – December 31
Total for the fourth quarter of 2012
Item 6. Selected Financial Data.
The selected consolidated financial data presented below is derived from our audited consolidated financial statements included in this
Annual Report on Form 10-K as of and for each of the years ended December 31, 2012, 2011 and 2010. The selected consolidated
financial data presented below as of and for each of the years ended December 31, 2009 and 2008 is derived from our audited
consolidated financial statements not included in this Annual Report on Form 10-K. The financial data for the years ended December 31,
2012, 2011 and 2010 should be read together with our consolidated financial statements and related notes included in Part II, Item 7.
Management’s Discussion and Analysis of Financial Condition and Consolidated Results of Operations and Item 8. Financial Statements
and Supplementary Data included herein.
Year Ended December 31,
2012
2011
2010
2009
2008
(In thousands, except share and per share data)
Consolidated Statements of Operations Data:
Net service revenue
Gross margin
Operating income (loss)
Income (loss) from continuing operations
Net income (loss) attributable to LHC Group, Inc.
Change in the redemption value of redeemable
noncontrolling interests
Net income (loss) available to LHC Group, Inc.’s
common stockholders
Net income (loss) attributable to LHC Group Inc.’s
common stockholders per basic share:
Net income (loss) attributable to LHC Group Inc.’s
common stockholders per diluted share:
Weighted average shares outstanding:
Basic
Diluted
$ 637,569
271,817
54,305
35,428
27,440
$ 633,872
281,526
(6,382)
(3,651)
(13,244)
$ 631,567
305,046
95,602
64,546
48,759
$ 529,246
261,465
85,046
57,900
43,841
$ 381,278
196,337
60,492
42,654
30,202
—
—
41
45
31
27,440
(13,244)
$ 48,800
$ 43,886
$ 30,233
$
1.54
$
(0.73)
$
2.69
$
2.44
$
1.69
$
1.53
$
(0.73)
$
2.68
$
2.43
$
1.69
17,853,321
17,899,195
18,265,118
18,265,118
18,119,183
18,226,091
17,960,376
18,069,897
17,855,634
17,899,087
As of December 31,
2012
2011
2010
2009
2008
(In Thousands)
Consolidated Balance Sheet Data:
Cash
Total assets
Total debt
Total LHC Group, Inc. stockholders’ equity
$ 9,720
386,894
19,500
$ 268,181
$
256
396,376
34,820
$ 263,683
$
288
357,305
—
$ 273,741
$
394
307,615
11,802
$ 221,172
$ 3,511
243,400
5,116
$ 176,821
40
Form 10-K Part I I
We build partnerships. With purpose.
Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations.
The following discussion and analysis contains forward-looking statements about our future revenues, operating results, plans and
expectations. Forward-looking statements are based on a number of assumptions and estimates that are inherently subject to significant
risks and uncertainties and our results could differ materially from the results anticipated by our forward-looking statements as a result
of many known or unknown factors, including, but not limited to, those factors discussed in Part I, Item 1A. Risk Factors. Also, please read
the “Cautionary Statements Regarding Forward-Looking Statements” set forth at the beginning of this Annual Report on Form 10-K.
Please read the following discussion in conjunction with Part 1 of this Annual Report on Form 10-K as well as our Consolidated Financial
Statements and the related notes contained elsewhere in this Annual Report on Form 10-K.
Overview
We provide post-acute health care services primarily to Medicare beneficiaries throughout the United States, through our home nursing
agencies, hospices and LTACHs. Our net service revenue increased $3.7 million to $637.6 million for the year ending December 31, 2012
from $633.9 million for the year ending December 31, 2011. During 2012, we acquired three home nursing agencies. As of December 31,
2012, we operated 285 locations in the following 19 states: Alabama, Arkansas, Florida, Georgia, Idaho, Kentucky, Louisiana, Maryland,
Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Oregon, Tennessee, Texas, Virginia, West Virginia and Washington.
Segments
We operate in two segments for financial reporting purposes: home-based services and facility-based services. We derived 88.4%,
88.0%, and 87.9% of our net service revenue during the years ended December 31, 2012, 2011 and 2010, respectively, from our
home-based services segment and derived the balance from our facility-based services segment.
Through our home-based services segment we offer a wide range of services, including skilled nursing, private duty nursing, physical,
occupational and speech therapy, medically-oriented social services and hospice care. As of December 31, 2012, the home-based
services segment was comprised of the following locations:
Type of Service
Home Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hospice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Private Duty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Specialty Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Management Companies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
232
32
4
3
3
274
Of our 274 home-based services locations, 140 are wholly-owned by us, 124 are majority-owned or controlled by us through joint
ventures, seven are controlled by us through license lease arrangements and the remaining three are management companies in which
we have no ownership interest. We intend to increase the number of home nursing agencies that we operate through continued
acquisitions and organic development. As we acquire and develop home nursing agencies, we anticipate the percentage of our net
service revenue and operating income derived from our home-based services segment will continue to increase.
We provide facility-based services principally through our LTACHs. As of December 31, 2012, we owned and operated six LTACHs with
nine locations, of which all but one are located within host hospitals. We also owned and operated a pharmacy and a health and fitness
center. Of these 11 facility-based services locations, six are wholly-owned by us and five are majority-owned or controlled by us through
joint ventures.
Development Activities
The following table provides a summary of our acquisitions, divestitures and internal development activities from January 1, 2010
through December 31, 2012. This table does not include the three management services agreements under which we manage the
operations of three home nursing agencies, through our home-based services segment.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
41
LHC GROUP
Year
Total at January 1, 2010
Developed
Acquired
Divested/Merged
Total at January 1, 2011
Developed
Acquired
Divested/Merged
Total at January 1, 2012
Developed
Acquired
Divested/Merged
Total at December 31, 2012
Recent Developments
Home-Based Services
Home-Based Services
Facility-Based Services
Home Nursing
Agencies
Hospice
Agencies
Specialty and
Private Duty
Long-Term Acute
Care Hospitals
Specialty
230
12
20
(5)
257
6
5
(21)
247
—
3
(18)
232
21
—
6
(1)
26
—
8
(2)
32
—
—
—
32
9
—
1
—
10
—
—
(3)
7
—
—
—
7
8
—
1
—
9
—
—
—
9
—
—
—
9
3
—
—
—
3
—
—
—
3
—
—
(1)
2
Home Nursing. In 2010, the PPACA was enacted, which made a number of changes to Medicare payment rates, including the
reinstatement of the 3% home health rural add-on, which began on April 1, 2010 (expiring January 1, 2016). Other changes from the
PPACA that began on or after January 1, 2011 are:
• a reduction in the market basket adjustment to be determined by CMS for the calendar years 2011, 2012 and 2013 by 1%;
• a full productivity adjustment beginning in 2015; and
• rebasing of the base payment rate for Medicare beginning in 2014 and phasing in over a four year period – the amount of the rebasing
is uncertain at this time.
On October 31, 2011, CMS issued the final rule covering payment rates for home health services in Calendar Year (“CY”) 2012. CMS set
the base payment rate for Medicare home nursing at $2,138.52 per 60-day episode for CY 2012, a decrease of 2.4% from the CY 2011
base payment rate of $2,192.07. The decrease for CY 2012 includes the following adjustments to the base rate, as compared to the
CY 2011 base rate, in accordance with the PPACA: a reduction of 1% to the 2.4% inflation update increase to the market basket and a
3.79% case-mix weight adjustment decrease. These changes are effective for all episodes completed during 2012.
The case-mix weight adjustment reduced Home Health Prospective Payment System (“HH PPS”) rates 3.79% for CY 2012 and an
additional 1.32% reduction for CY 2013.
This rule also finalizes structural changes to the HH PPS by removing two hypertension codes from the case-mix system, lowering
payments for high therapy episodes, and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same
amount of total aggregate payments.
Under current Medicare policy, a certifying physician or an allowed non-physician practitioner must see a patient prior to certifying a
patient as eligible for the home health benefit. The rule also finalizes added flexibility to allow physicians who cared for the patient in
an acute or post-acute facility to inform the certifying physician of their encounters with the patient in order to satisfy the requirement.
42
Form 10-K Part I I
Management’s Discussion and Analysis of Financial Condition and Results of Operations
We build partnerships. With purpose.
On November 2, 2012, CMS issued the final rule effective January 1, 2013 regarding payment rates for home health services in CY 2013.
In the CY 2013 issue, CMS is:
• Decreasing the base payment rate to $2,137.73 in 2013 as compared to $2,138.52 in 2012. The decrease is made up of a market
basket increase of 2.3% less a reduction of 1% to the market basket as defined by the PPACA and less a 1.32% case mix adjustment
carried over from 2012.
• Rebasing of the wage index and increasing the labor related portion of the base payment rate from 77.082% to 78.535% which
decreases payments to the home health industry an aggregate of 0.37%.
• The estimated 0.1% reduction to home health payments does not include the deficit reduction sequester approved earlier by Congress.
The sequestration cut to Medicare will begin on April 1, 2013 and will reduce Medicare payments for patients whose service dates end
on or after April 1, 2013 by 2%.
• Face to Face – CMS will allow non-physician practitioners in an acute or post-acute setting to perform the encounter and inform the
certifying physician.
• Therapy – CMS will also revise the regulation to state that in cases where multiple therapy disciplines are involved, if the required
reassessment visit was missed for any one of the therapy disciplines for which therapy services were being provided, therapy coverage
would cease only for that particular therapy discipline. Therefore, as long as the required therapy reassessments were completed timely
for the remaining therapy disciplines, therapy services would continue to be covered for those therapy disciplines.
Finally, with respect to the therapy assessments timing, CMS revises the regulations to clarify that in cases where the patient is receiving
more than one type of therapy, qualified therapists could complete their reassessment visits during the 11th, 12th, or 13th visit for the
required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment.
• Sanctions – CMS will have additional sanctions for enforcement of survey deficiencies that will include the following:
(These are not mutually exclusive. CMS can impose any or all of the following, including termination.) Each of these sanctions requires
a prior 15 day notice:
(a) Civil money penalties;
(b) Suspension of payment for all new admissions and new payment episodes;
(c) Temporary management of the HHA;
(d) Directed plan of correction;
(e) Directed in-service training.
Hospice. The following table shows the hospice Medicare payment rates for fiscal year 2012, which began on October 1, 2011 and
ended September 30, 2012:
Description
Routine Home Care
Continuous Home Care
Full Rate = 24 hours of care
$36.73 = hourly rate
Inpatient Respite Care
General Inpatient Care
Rate Per Patient Day
$ 151.03
$ 881.46
$ 156.22
$ 671.84
On July 29, 2011, CMS issued its final rule for hospice for fiscal year 2012 which increased Medicare reimbursement payments by 2.5%.
The 2.5% increase consisted of a 3.0% inflationary market basket update offset by a 0.5% reduction for the third year of CMS’ seven-year
phase-out of its wage index budget neutrality adjustment factor. The final rule also:
• Changed the way CMS counts hospice patients for the 2012 cap accounting year and beyond. The final policy for counting the
number of Medicare hospice beneficiaries in care for a given cap year calculates the cap based on the number of days of care the
patient received in that cap year for each hospice. This rule also finalized that the new counting method be applied to past cap years
in certain instances.
• Allowed hospice providers who do not want a change in their patient counting method to elect to continue using the current method.
• Allowed any hospice physician to perform the face-to-face encounter regardless of whether that same physician recertifies the patient’s
terminal illness and composes the recertification narrative.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
43
LHC GROUP
• Implemented a hospice quality reporting program, which includes a timeframe for reporting, as required by section 3004 of the PPACA.
The measures that are being adopted in this final rule for the fiscal year 2014 program are one measure endorsed by the National
Quality Forum related to pain management and one structural measure that assesses whether a hospice administers a Quality Assessment
and Performance Improvement (QAPI) program that contains at least three indicators related to patient care.
On July 24, 2012, CMS issued its final rule for hospice for fiscal year 2013, which increases Medicare reimbursement payments by 0.9%
over fiscal year 2012 rates. The 0.9% increase consists of a 2.6% inflationary market basket update offset by a 0.6% reduction for the
fourth year of CMS’ seven-year phase-out of its wage index budget neutrality adjustment factor, a 0.7% reduction for the productivity
adjustment, a 0.3% reduction to the market basket as defined by the PPACA, and a 0.1% reduction related to the wage index changes.
The 0.9% does not include the deficit reduction sequester approved earlier by Congress. The sequestration cut to Medicare will begin on
April 1, 2013 and will reduce Medicare payments for patients whose service dates end on or after April 1, 2013 by 2%.
The final rule also provides:
• Clarification regarding diagnosis reporting on hospice claims:
CMS is concerned that hospices reporting a single diagnosis on claims are not providing an accurate description of the patients’
conditions, and believes that providers should code and report coexisting or additional diagnoses in order to more fully describe the
Medicare patients they are treating.
• Hospice payment reform update:
CMS indicates that it is moving forward with hospice payment reform efforts and will continue to investigate Medicare Payment Advisory
Commission, Office of the Inspector General, and Government Accountability Office recommendations, as well as other payment
options, as part of this comprehensive effort. CMS does not, however, provide an anticipated timeline for public release of information
about proposals to alter the current hospice payment system.
The following table shows the hospice Medicare payment rates for fiscal year 2013, which began on October 1, 2012 and will end
September 30, 2013 (the payment rates do not reflect the 2% sequestration cut):
Description
Routine Home Care
Continuous Home Care
Full Rate = 24 hours of care
$37.32 = hourly rate
Inpatient Respite Care
General Inpatient Care
Facility-Based Services
Rate Per Patient Day
$ 153.45
$ 895.56
$ 158.72
$ 682.59
LTACHs. On August 1, 2011, CMS released its rule for LTACH Medicare reimbursement for fiscal year 2012, which spans from October 1,
2011 through September 30, 2012. In aggregate, payments for fiscal year 2012 increased 2.5% from fiscal year 2011. Included in the
final regulations was (1) a 2.9% market basket increase to the standard payment rate; (2) an aggregate reduction in the standard payment
rate of 1.1% mandated by the PPACA; and (3) a reduction in the high cost outlier threshold per discharge from $18,785 in fiscal year
2011 to $17,931 in fiscal year 2012. The final rule resulted in a 1.8% increase in average Medicare payments to LTACHs. Some of the
other changes in the final rule included:
• Three quality measures to begin reporting October 1, 2012 that will affect payment in fiscal year 2014.
• Clarification that the 25-day average length of stay (“ALOS”) calculation includes both traditional Medicare Fee-For-Service and
Medicare Advantage stays but this calculation began January 1, 2012.
On August 1, 2012 CMS released its final rule for LTACH Medicare reimbursement for fiscal year 2013 which spans from October 1, 2012
through September 30, 2013. In aggregate, payments for fiscal year 2013 will increase by 1.8% over fiscal year 2012 rates. The 1.8%
increase consists of a 2.6% inflationary market basket update offset by a 0.7% reduction for the productivity adjustment, a 0.1% reduction
to the market basket as defined by the PPACA. LTACH payment rates will also be reduced by approximately 1.3% to 0.5% for the
“one-time” budget neutrality adjustment for discharges on or after December 29, 2012. The 0.5% does not include the deficit reduction
sequester approved earlier by Congress. The sequestration cut to Medicare will begin on April 1, 2013 and will reduce Medicare
payments for patients whose service dates end on or after April 1, 2013.
44
Form 10-K Part I I
Management’s Discussion and Analysis of Financial Condition and Results of Operations
We build partnerships. With purpose.
The fiscal year 2013 rule also includes:
• A one-year extension of the existing moratorium on the “25 Percent threshold” policy, pending results of an on-going research initiative
to re-define the role of LTACHs in the Medicare program.
• A reduction to Medicare payments for very short stay cases in LTACHs to the Inpatient Prospective Payment System comparable per
diem amount payment option for discharges occurring on or after December 29, 2012 and an increase to the high cost outlier payment.
2012 and 2011 Operational Data
The following table sets forth, for the period indicated, data regarding aggregate admissions and Medicare admissions to our home health
agencies and patient days for our LTACHs. Certain historical data has been included in order to present a more comparative analysis of
the statistical data.
Home Health Agencies:
Average census
Average Medicare census
Admissions
Medicare admissions
LTACHs:
Patient days
Home Health Agencies:
Average census
Average Medicare census
Admissions
Medicare admissions
LTACHs:
Patient days
Three Months
Three Months
Ended March 31, Ended June 30, Ended Sept. 30,
2012
Three Months
2012
2012
Three Months
Ended Dec. 31,
2012
32,608
24,689
27,696
19,046
32,988
24,858
26,498
17,837
32,605
24,279
27,301
18,415
33,103
24,765
27,443
18,665
16,191
15,822
15,335
15,552
Three Months
Three Months
Ended March 31, Ended June 30, Ended Sept. 30,
2011
Three Months
2011
2011
Three Months
Ended Dec. 31,
2011
34,466
26,570
26,194
18,589
33,937
26,192
24,935
17,477
31,311
24,076
25,787
18,445
31,692
24,301
25,410
17,803
15,333
15,268
15,385
15,953
Consolidated Results of Operations
The following table sets forth, for the periods indicated, the consolidated results of our Company (amounts in thousands):
Year Ended December 31,
Consolidated Services Data:
Net service revenue
Cost of service revenue
Gross margin
Provision for bad debts
Settlement with government agencies
General and administrative expenses
Operating income (loss)
Interest expense
Non-operating income , including gain on sales of entities and assets, net
Income tax expense (benefit)
Income attributable to noncontrolling interests
Redeemable noncontrolling interests
2012
2011
2010
$ 637,569
365,752
271,817
11,875
—
205,637
$ 54,305
(1,550)
184
17,511
7,988
—
$ 633,872
352,346
281,526
12,320
65,000
210,588
$
(6,382)
(1,018)
1,781
(1,968)
9,593
—
$ 631,567
326,521
305,046
7,607
—
201,837
$ 95,602
(134)
805
31,727
15,787
41
Net income (loss) available to LHC Group, Inc.’s common stockholders
$ 27,440
$ (13,244)
$ 48,800
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
45
LHC GROUP
The following table sets forth the consolidated results of our Company as a percentage of net service revenue, except income tax expense
(benefit), which is presented as a percentage of income from continuing operations available to LHC Group, Inc:
Year Ended December 31,
2012
2011
2010
Consolidated Services Data:
Cost of service revenue
Gross margin
Provision for bad debts
Settlement with government agencies
General and administrative expenses
Operating income (loss)
Interest expense
Non-operating income (loss), including gain on sales of entities and assets
Income tax expense (benefit)
Income attributable to noncontrolling interests
Net income (loss) available to LHC Group, Inc.’s common stockholders
57.4%
42.6%
1.9%
—
32.3%
8.5%
0.2%
0.0%
39.0%
1.3%
4.3%
55.6%
44.4%
1.9%
10.3%
33.2%
(1.0)%
0.2%
0.3%
(12.9)%
1.5%
(2.1)%
51.7%
48.3%
1.2%
—
32.0%
15.1%
0.0%
0.1%
39.4%
2.5%
7.7%
Year Ended December 31, 2012 Compared to Year Ended December 31, 2011
Net Service Revenue
Consolidated net service revenue for the year ended December 31, 2012 was $637.6 million compared to $633.9 million in 2011. Net
service revenue growth in 2012 was primarily due to an increase in census and increase in admits. Net service revenue was comprised of
the following for the periods ending December 31:
Home-Based Services
Facility-Based Services
2012
88.4%
11.6
2011
88.0%
12.0
100.0%
100.0%
Revenue derived from Medicare represented 77.9% and 79.7% of consolidated net service revenue for the years ended December 31,
2012 and 2011, respectively.
Cost of Service Revenue
Consolidated cost of service revenue for the year ended December 31, 2012 was $365.8 million compared to $352.3 million in 2011.
The increase in cost of service revenue was related to the following factors:
• an increase of costs related to 2012 acquisitions;
• cost of living increases;
• an increase in insurance; and
• additional field staff included in our existing home based agencies.
Provision for Bad Debts
Consolidated provision for bad debts for the year ended December 31, 2012 was $11.9 million compared to $12.3 million in 2011.
Beginning January 1, 2011, the period allowed to file Medicare claims was reduced to twelve months from the end of episode date. This
change resulted in a greater number of Medicare claims being denied for timely filing requirements in 2011.
General and Administrative Expenses
Consolidated general and administrative expenses for the year ended December 31, 2012 was $205.6 million compared to $210.6 million
in 2011. The decrease was primarily due to our incurring higher legal fees in 2011 associated with the settlement with the United States
of America. In addition, we eliminated salaries and benefits, consulting, travel and hotel costs incurred in 2011 related to the conversion of
four legacy billing systems to our point of care platform. We accelerated this transition in order to replace the legacy billing systems
which remained from previous acquisitions. The accelerated transition was completed in the first quarter of 2011. We also entered into
46
Form 10-K Part I I
Management’s Discussion and Analysis of Financial Condition and Results of Operations
fewer acquisitions and incurred lower acquisition related costs during the twelve months ended December 30, 2012. Finally, cost
reduction initiatives begun last year reduced personnel costs and other corporate costs in the twelve months ended December 31, 2012
as compared to the twelve months ended December 31, 2011.
General and administrative expenses consist primarily of the following expenses incurred by our home office and administrative
We build partnerships. With purpose.
field personnel:
• Home office and field administration:
• salaries and related benefits;
• insurance;
• costs associated with advertising and other marketing activities; and
• rent and utilities.
• Supplies and services:
• accounting, legal and other professional services; and
• office supplies.
• Depreciation;
• Other:
• advertising and marketing expenses;
• recruitment;
• operating locations rent; and
• taxes.
Non-Operating Income
Consolidated non-operating income for the year ended December 31, 2012 was $184,000 compared to $1.8 million in 2011. In 2011,
non-operating income was primarily due to the Medicare Home Health Pay for Performance program. We received $1.2 million in 2011.
The program was not available during 2012.
Interest Expense
Consolidated interest expense for the year ended December 31, 2012 was $1.6 million compared to $1.0 million in 2011 and related to
balances outstanding on our Credit Facility in each year.
Income Tax Expense
Consolidated income tax expense (benefit) for the year ended December 31, 2012 was $17.5 million compared to $(1.9) million in 2011.
In 2011, we recognized a tax benefit on our settlement with the United States of America, reduced by $3.4 million to recognize the
uncertainty of deducting the full settlement.
Net Income Attributable to Noncontrolling Interest
Consolidated net income attributable to noncontrolling interest for the year ended December 31, 2012 was $8.0 million compared to
$9.6 million in 2011. The overall decrease was due to our purchasing the outstanding membership interest of three joint venture partners,
and an overall decrease of operating results of the joint ventures themselves.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
47
LHC GROUP
Home-Based Services Segment Results of Operations
Year Ended December 31,
Home-Based Services Data:
Net service revenue
Cost of service revenue
Gross margin
Provision for bad debts
Settlement with government agencies
General and administrative expenses
Operating income (loss)
Average census
Average Medicare census
Total admissions
Total Medicare admissions
2012
2011
2010
(amounts in thousands, except for statistical data)
$ 563,741
322,189
241,552
10,593
—
184,125
$ 46,834
33,834
25,544
113,362
77,969
$ 557,901
307,744
250,157
11,680
65,000
190,264
$ 555,110
281,013
274,097
7,078
—
182,750
$ (16,787)
$ 84,269
33,062
25,713
106,323
75,944
32,997
26,107
95,688
69,490
Net service revenue from home-based services for the year ended December 31, 2012 was $563.7 million compared to $557.9 million in
2011. Total admissions increased 6.6% to 113,362 during the year ended December 31, 2012, compared to 106,323 for the same period
ended December 31, 2011. Average home-based patient census for the year ended December 31, 2012 increased 2.3% to 33,834
patients as compared with 33,062 patients for the year ended December 31, 2011.
Organic growth includes growth in “same store” locations, or those locations owned for greater than 12 months, and growth from
“de novo” locations. We calculate organic growth by dividing organic growth generated in a period by total revenue generated in the same
period of the prior year. Revenue from acquired agencies contributes to organic growth beginning with the thirteenth month after acquisition.
The following tables detail the home-based services revenue growth and home health agencies’ census, admissions and episodes
growth (amounts in thousands, except statistical data):
Revenue
Revenue Medicare
Average Census
Average Medicare Census
Admissions
Medicare Admissions
Episodes
Year Ending December 31, 2012
Same Store (1)
De Novo (2)
Organic (3)
$ 560,165
$ 437,117
32,671
24,563
107,556
73,375
166,457
$ —
$ —
—
—
—
—
—
$ 560,165
$ 437,117
32,671
24,563
107,556
73,375
166,457
Organic
Growth %
0.4%
(2.4)%
1.6%
(1.3)%
5.1%
1.5%
(1.6)%
Acquired (4)
Total
Total
Growth %
$ 3,576
$ 2,012
163
76
1,382
588
572
$ 563,741
$ 439,129
32,834
24,639
108,938
73,963
167,029
1.0%
(2.0)%
2.1%
(1.0)%
6.5%
2.3%
(1.3)%
(1) Same store – location that has been in service with the Company for greater than 12 months.
(2) De Novo – internally developed location that has been in service with the Company for 12 months or less.
(3) Organic – combination of same store and de novo.
(4) Acquired – purchased location that has been in service with the Company for 12 months or less.
Revenue
Revenue Medicare
Average Census
Average Medicare Census
Admissions
Medicare Admissions
Episodes
Year Ending December 31, 2011
Same Store (1)
De Novo (2)
Organic (3)
$ 538,135
$ 431,101
31,514
24,383
99,434
70,195
166,100
$ 3,191
$ 2,793
129
106
310
238
518
$ 541,326
$ 433,894
31,643
24,489
99,744
70,433
166,618
Organic
Growth %
(2.5)%
(4.3)%
(2.3)%
(4.1)%
7.5%
5.4%
(0.1)%
Acquired (4)
Total
Total
Growth %
$ 16,575
$ 14,120
522
410
2,582
1,827
2,571
$ 557,901
$ 448,014
32,165
24,899
102,326
72,260
169,189
0.5%
(1.2)%
(0.6)%
(2.5)%
10.3%
8.1%
1.4%
(1) Same store – location that has been in service with the Company for greater than 12 months.
(2) De Novo – internally developed location that has been in service with the Company for 12 months or less.
(3) Organic – combination of same store and de novo.
(4) Acquired – purchased location that has been in service with the Company for 12 months or less.
48
Form 10-K Part I I
Management’s Discussion and Analysis of Financial Condition and Results of Operations
We build partnerships. With purpose.
Organic growth for total new admissions was 5.1% in 2012 compared to 7.5% in 2011. Organic growth is primarily generated by
population growth in areas covered by mature agencies, agencies five years old or older, and by increased market share in acquired and
developing agencies. Historically, acquired agencies have the highest growth in admissions and average census in the first 24 months
after acquisition, and have the highest contribution to organic growth, measured as a percentage, in the second full year of operation
after acquisition.
The primary strategies to increase organic growth include differentiating ourselves from our competitors through our care services and
quality outcomes, focusing our sales efforts on our agencies, in particular agencies acquired in the last three years, which have not fully
developed their coverage in secondary markets and developing “Greenfield” opportunities. Greenfield opportunities exist in secondary
markets with three service delivery alternatives:
1. Utilizing point of care technology;
2. Drop site or virtual office; or
3. Traditional branch or de novo locations.
Cost of Service Revenue
Cost of service revenue from home-based services for the year ended December 31, 2012 was $322.2 million compared to $307.7 million
in 2011. The factors associated with the change in cost of service revenue were primarily driven by:
• increase in salaries, wages and benefits associated with an increase in admissions and visits, and an increase in field clinicians training
costs associated with continued roll out of our Point of Care system; and
• decrease in supplies and services due to a contract renegotiation associated with the Lifeline product.
The following table summarizes cost of service revenue (amounts in thousands).
Year Ended December 31,
2012
2011
Salaries, wages and benefits
Transportation, primarily mileage reimbursement
Supplies and services
Total
(1) Percentage of home-based net service revenue
Facility-Based Services Segment Results of Operations
Year Ended December 31,
Facility-Based Services Data:
Net service revenue
Cost of service revenue
Gross margin
Provision for bad debts
General and administrative expenses
Operating income
Patient days
$ 278,559
24,815
18,815
49.4%(1)
4.4
3.3
$ 265,372
24,221
18,151
47.6%(1)
4.3
3.3
$ 322,189
57.1%
$ 307,744
55.2%
2012
2011
2010
(amounts in thousands, except for statistical data)
$ 73,828
43,563
30,265
1,282
21,512
$ 7,471
62,900
$ 75,971
44,602
31,369
640
20,324
$ 10,405
61,939
$ 76,457
45,508
30,949
529
19,087
$ 11,333
61,658
Net service revenue from facility-based services for the year ended December 31, 2012 was $73.8 million compared with $76.0 million in
2011. The decrease was primarily due to a reduction in pharmacy revenue related to the loss of a third party contract as well as a
decrease in revenue per patient day caused by a decrease in case mix and a higher number of patient days provided in excess of a
patient’s maximum benefit. Also, $1.0 million of adjustments from facility cost reports were recorded during the twelve months ended
December 31, 2012.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
49
LHC GROUP
Cost of service revenue from facility-based services for the year ended December 31, 2012 was $43.6 million compared to $44.6 million
in 2011, as detailed in the following table (amounts in thousands).
Year Ended December 31,
Salaries, wages and benefits
Transportation
Supplies and services
Total
(1) Percentage of facility-based net service revenue.
2012
2011
$ 27,732
257
15,574
38.1%(1)
0.3
21.4
$ 43,563
59.8%
$ 26,926
189
17,487
$ 44,602
35.4%(1)
0.3
23.0
58.7%
Year Ended December 31, 2011 Compared to Year Ended December 31, 2010
Net Service Revenue
Consolidated net service revenue for the year ended December 31, 2011 was $633.9 million compared to $631.6 million in 2010.
Net service revenue growth in 2011 was primarily due to an increase in census, increase in admits, and additions of 2010 acquisitions that
occurred late in the year. This increase was offset by the effect of the CMS rule for 2011 that reduced home health Medicare rates by
5.2%. Net service revenue was comprised of the following for the periods ending December 31:
Home-Based Services
Facility-Based Services
2012
88.0%
12.0
2011
87.9%
12.1
100.0%
100.0%
Revenue derived from Medicare represented 79.7% and 80.5% of consolidated net service revenue for the years ended December 31,
2011 and 2010, respectively.
Cost of Service Revenue
Consolidated cost of service revenue for the year ended December 31, 2011 was $352.3 million compared to $326.5 million in 2010. The
increase in cost of service revenue was related to the following factors:
• an increase of costs related to 2010 acquisitions that were acquired during the latter part of 2010;
• an increase of costs related to 2011 acquisitions;
• cost of living increases;
• an increase in insurance, retirement and employee benefits; and
• additional field staff included in our existing home based agencies.
Provision for Bad Debts
Consolidated provision for bad debts for the year ended December 31, 2011 was $12.3 million compared to $7.6 million in 2010.
The increase in provision for bad debts was due to the increase in commercial receivables both in dollars and as a percentage of total
receivables. Commercial claims are not collected as efficiently as Medicare or Medicaid claims, and as our commercial payor revenue
increases, these claims will continue to increase in significance in the aging of accounts receivable. In addition, bad debt reserves for Medicare
have increased due to the changes in the timely filing regulations. Beginning January 1, 2011, the period allowed to file Medicare
claims was reduced to twelve months from the end of episode date. Previously, episodes ending on or before September 30 of any year
could be filed through December 31 of the following year.
Settlement with Government Agencies
On September 29, 2011, we entered into a settlement agreement which resolved the issue with the United States of America. Pursuant
to the settlement agreement, we paid the United States of America $65 million (“settlement amount”) in a single lump sum payment. For
additional information see Part I, Item 3. Legal Proceedings of the 2011 Annual Report on Form 10-K.
50
Form 10-K Part I I
Management’s Discussion and Analysis of Financial Condition and Results of Operations
We build partnerships. With purpose.
General and Administrative Expenses
Consolidated general and administrative expenses for the year ended December 31, 2011 was $210.6 million compared to $201.8 million
in 2010. The increase was primarily driven by additional costs incurred in 2011 such as:
• $2.1 million for our legal expenses and those of the relator associated with our settlement with the United States of America;
• $1 million for settlement of non-intervened claims with the relator;
• $1.1 million of expenses due to our conversion to point of care technology; and
• overall increase in costs related to acquisitions.
Non-Operating Income
Consolidated non-operating income for the year ended December 31, 2011 was $1.8 million compared to $805,000 in 2010. In both
years, non-operating income was primarily due to the Medicare Home Health Pay for Performance program. A two year demonstration
was done in 2008-2009 to initiate improvement in the quality and efficiency of care furnished to Medicare beneficiaries. Agencies were
measured using seven home health quality measures. For each measure, the agencies that ranked by performance in the top 20% of their
state, were eligible to receive a share in the Medicare savings generated in their region. We received $1.2 million and $437,000 in 2011
and 2010, respectively.
Interest Expense
Consolidated interest expense for the year ended December 31, 2011 was $1.0 million compared to $134,000 in 2010 and related to
balances outstanding on our Credit Facility in each year.
Income Tax Expense
Consolidated income tax expense (benefit) for the year ended December 31, 2011 was $(1.9) million compared to $31.7 million in 2010.
We recognized a tax benefit on our settlement with the United States of America, reduced by $3.4 million to recognize the uncertainty of
deducting the full settlement.
Net Income Attributable to Noncontrolling Interest
Consolidated net income attributable to noncontrolling interest for the year ended December 31, 2011 was $9.6 million compared to
$15.8 million in 2010. The overall decrease was due to our purchasing the outstanding membership interest of four joint venture partners,
a decrease in noncontrolling interest ownership in 2011 acquisitions and an overall decrease of operating results of the joint ventures
themselves.
Home-Based Services Segment Results of Operations
Net service revenue from home-based services for the year ended December 31, 2011 was $557.9 million compared to $555.1 million
in 2010. Total admissions increased 11.1% to 106,323 during the year ended December 31, 2011, compared to 95,688 for the same
period ended December 31, 2010. Average home-based patient census for the year ended December 31, 2011 increased 0.2% to
33,062 patients as compared with 32,997 patients for the year ended December 31, 2010.
As detailed in the tables below, the increase in revenue in 2011 resulted from both organic growth and the growth from our acquisitions
during the year ended December 31, 2011.
Organic growth includes growth in “same store” locations, or those locations owned for greater than 12 months, and growth from
“de novo” locations. We calculate organic growth by dividing organic growth generated in a period by total revenue generated in
the same period of the prior year. Revenue from acquired agencies contributes to organic growth beginning with the thirteenth month
after acquisition.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
51
LHC GROUP
The following tables detail the home-based services revenue growth and home health agencies’ census, admissions and episodes growth
(amounts in thousands, except statistical data):
Revenue
Revenue Medicare
Average Census
Average Medicare Census
Admissions
Medicare Admissions
Episodes
Year Ending December 31, 2011
Same Store (1)
De Novo (2)
Organic (3)
$ 538,135
$ 431,101
31,514
24,383
99,434
70,195
166,100
$ 3,191
$ 2,793
129
106
310
238
518
$ 541,326
$ 433,894
31,643
24,489
99,744
70,433
166,618
Organic
Growth %
(2.5)%
(4.3)%
(2.3)%
(4.1)%
7.5%
5.4%
(0.1)%
Acquired (4)
Total
Total
Growth %
$ 16,575
$ 14,120
522
410
2,582
1,827
2,571
$ 557,901
$ 448,014
32,165
24,899
102,326
72,260
169,189
0.5%
(1.2)%
(0.6)%
(2.5)%
10.3%
8.1%
1.4%
(1) Same store – location that has been in service with the Company for greater than 12 months.
(2) De Novo – internally developed location that has been in service with the Company for 12 months or less.
(3) Organic – combination of same store and de novo.
(4) Acquired – purchased location that has been in service with the Company for 12 months or less.
Revenue
Revenue Medicare
Average Census
Average Medicare Census
Admissions
Medicare Admissions
Episodes
Year Ending December 31, 2010
Same Store (1)
De Novo (2)
Organic (3)
$ 524,022
$ 431,296
29,797
23,883
85,961
63,146
159,618
$ 1,372
$ 1,090
205
171
355
265
371
$ 525,394
$ 432,386
30,002
24,054
86,316
63,411
159,989
Organic
Growth %
12.6%
11.4%
4.5%
4.6%
13.1%
13.5%
8.6%
Acquired (4)
Total
Total
Growth %
$ 29,716
$ 20,941
2,373
1,487
6,448
3,415
6,814
$ 555,110
$ 453,327
32,375
25,541
92,764
66,826
166,803
18.9%
16.8%
12.7%
11.1%
21.6%
19.6%
13.2%
(1) Same store – location that has been in service with the Company for greater than 12 months.
(2) De Novo – internally developed location that has been in service with the Company for 12 months or less.
(3) Organic – combination of same store and de novo.
(4) Acquired – purchased location that has been in service with the Company for 12 months or less.
Organic growth for total new admissions was 7.5% in 2011 compared to 13.1% in 2010. Organic growth is primarily generated by population
growth in areas covered by mature agencies, agencies five years old or older, and by increased market share in acquired and developing
agencies. Historically, acquired agencies have the highest growth in admissions and average census in the first 24 months after acquisition,
and have the highest contribution to organic growth, measured as a percentage, in the second full year of operation after acquisition.
The primary strategies to increase organic growth include differentiating ourselves from our competitors through our care services and
quality outcomes, focusing our sales efforts on our agencies, in particular agencies acquired in the last three years, which have not fully
developed their coverage in secondary markets and developing “Greenfield” opportunities. Greenfield opportunities exist in secondary
markets with three service delivery alternatives:
1. Utilizing point of care technology;
2. Drop site or virtual office; or
3. Traditional branch or de novo locations.
52
Form 10-K Part I I
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Cost of Service Revenue
Cost of service revenue from home-based services for the year ended December 31, 2011 was $307.7 million compared to $281.0 million
in 2010. As a percentage of home-based net service revenue, cost of service revenue increased to 55.2% for the year ending
December 31, 2011 compared to 50.6% for the year ending December 31, 2010. The factors associated with the change in cost of
service revenue were primarily driven by:
We build partnerships. With purpose.
• increase in salaries, wages and benefits associated with an increase in admissions and episodes;
• increase in mileage reimbursement due to the rise in fuel prices;
• increase in overall costs associated with acquisitions; and
• decrease in supplies and services due to a contract renegotiation associated with the Lifeline product.
The following table summarizes cost of service revenue (amounts in thousands).
Year Ended December 31,
2011
2010
Salaries, wages and benefits
Transportation, primarily mileage reimbursement
Supplies and services
Total
(1) Percentage of home-based net service revenue
$ 265,372
24,221
18,151
47.6%(1)
4.3
3.3
$ 240,281
20,118
20,614
43.3%(1)
3.6
3.7
$ 307,744
55.2%
$ 281,013
50.6%
Facility-Based Services Segment Results of Operations
Net service revenue from facility-based services for the year ended December 31, 2011 was $76.0 million compared with $76.5 million
in 2010.
Cost of service revenue from facility-based services for the year ended December 31, 2011 was $44.6 million compared to $45.5 million
in 2010, as detailed in the following table (amounts in thousands).
Year Ended December 31,
Salaries, wages and benefits
Transportation
Supplies and services
Total
(1) Percentage of facility-based net service revenue
Liquidity and Capital Resources
2011
2010
$ 26,926
189
17,487
35.4%(1)
0.3
23.0
$ 44,602
58.7%
$ 27,084
146
18,278
$ 45,508
35.4%(1)
0.2
23.9
59.5%
Cash at December 31, 2012 was $9.7 million compared to $256,000 at December 31, 2011. Based on our current plan of operations,
including acquisitions, we believe this amount, when combined with expected cash flows from operations and amounts available under our
revolving line of credit will be sufficient to fund our growth strategy and to meet our anticipated operating expenses, capital expenditures
and debt service obligations for at least the next 12 months.
Liquidity
Our principal source of liquidity for our operating activities is the collection of our accounts receivable, most of which are collected from
governmental and third-party commercial payors. Our reported cash flows from operating activities are impacted by various external and
internal factors, including the following:
• Operating Results – Our net income has a significant impact on our operating cash flows. Any significant increase or decrease in our
net income could have a material impact on our operating cash flows.
• Timing of Acquisitions – We use our operating cash flows to purchase home health agencies, hospice agencies and LTACHs. When
the acquisitions occur at or near the end of a period, our cash outflows significantly increase.
• Timing of Payroll – Our employees are paid bi-weekly on Fridays; therefore, operating cash flows decline in reporting periods that
end on a Friday. Conversely, for those reporting periods ending on a day other than Friday, our cash flows are higher because we have
not yet paid our payroll.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
53
LHC GROUP
• Medical Insurance Plan Funding – We are self-funded for medical insurance purposes. Any significant changes in the amount of
insurance claims submitted could have a direct impact on our operating cash flows.
• Medical Supplies – A significant expense associated with our business is the cost of medical supplies. Any increase in the cost of
medical supplies, or in the use of medical supplies by our patients, could have a material impact on our operating cash flows.
Cash used in investing activities is primarily for acquisitions of home nursing and hospice agencies, while cash used by financing activities
relates to payments on outstanding debt agreements and payments to our noncontrolling interest partners.
The following table summarizes changes in cash flows (amounts in thousands):
Year Ended December 31,
2012
2011
Cash provided by (used in) operating activities
Cash used in investing activities
Cash provided by (used in) financing activities
Change in cash
Cash and cash equivalents at beginning of period
Cash and cash equivalents at end of period
$ 74,772
(15,140)
(50,168)
9,464
256
$ 9,720
$
$ (3,376)
(19,625)
22,969
(32)
288
256
Operating activities during the year ended December 31, 2012 provided $74.7 million in cash compared to $3.4 million used during the
year ended December 31, 2011. Operating cash flow increased in 2012 due to the payment of the legal settlement with the United States
of America that occurred in 2011. In addition, we carried back tax losses related to our settlement with the United States of America
executed in 2011 and received refunds of tax payments in 2011. Finally, better collections of receivables generated operating cash flow.
At December 31, 2012, working capital was $65.5 million compared to $80.7 million at December 31, 2011, a decrease of $13.4 million.
The decrease in working capital was primarily due to a decrease in patient accounts receivable and prepaid income taxes partially offset
by a decrease in accounts payable and accrued liabilities.
Investing activities used $15.1 million and $19.6 million in cash for the years ended December 31, 2012 and 2011, respectively. Cash
outflows for the year ended December 31, 2012 included $8.4 million for purchases of property, building and equipment compared
to $8.0 million for the year ended December 31, 2011. Cash outflows for the year ending December 31, 2012 included $6.8 million for
acquisitions, compared to $11.7 million for acquisitions for the year ending December 31, 2011.
Financing activities used $50.2 million in the year ended December 31, 2012 compared to $23.0 million provided in the year ended
December 31, 2011. We paid $15.3 million on our line of credit, net of draws, and $27.0 million to repurchase our common stock during
2012. In 2011 we drew $34.8 million, net of payments, on our line of credit primarily to fund our settlement with the United States of
America. Additionally, in 2012 distributions to noncontrolling interests were lower as a result of lower operating results in our joint ventures.
Days sales outstanding (“DSO”) for the year ended December 31, 2012 was 48 days compared to 53 days for the same period in 2011.
Credit Facility
On August 31, 2012 we entered into a Third Amended and Restated Credit Agreement (the “Credit Facility”). The Credit Facility is
unsecured and provides for a maximum aggregate principal borrowing of $100 million (with a letter of credit sub-limit equal to $15 million).
The Credit Facility is scheduled to expire on August 31, 2015. A fee of 0.5% is charged for any unused amounts. A letter of credit fee
equal to the applicable London Interbank Offered Rate (“LIBOR”) margin times the face amount of the letter of credit is charged upon the
issuance and on each anniversary date while the letter of credit is outstanding. The agent’s standard up-front fee and other customary
administrative charges will also be due upon issuance of the letter of credit along with a renewal fee on each anniversary date of such
issuance while the letter of credit is outstanding. The interest rate for borrowings under the Credit Facility is a function of the prime rate (base
rate) or LIBOR rate, as elected by the Company, plus the applicable margin based on the Leverage Ratio, as defined in the agreement.
We paid $1.0 million of credit fees on the Credit Facility during 2012. At December 31, 2012 and 2011, outstanding letters of credit were
$6.0 million and $3.8 million, respectively, which are issued as collateral on our workers’ compensation insurance.
54
Form 10-K Part I I
Management’s Discussion and Analysis of Financial Condition and Results of Operations
We build partnerships. With purpose.
The interest rate for borrowings under the Credit Facility is a function of the prime rate (Base Rate) or the Eurodollar rate (Eurodollar), as
elected by the Company, plus the applicable margin as set forth below:
Leverage Ration
< 1.00 : 1.00
1.00 : 1.00 < 1.50:100
1.50 : 1.00 ≤ 2.00:1.00
Eurodollar Margin
Base Rate Margin
2.25%
2.50%
2.75%
1.00%
1.25%
1.50%
Our Credit Facility contains customary affirmative, negative and financial covenants. For example, the Company is restricted in incurring
additional debt, disposing of assets, making investments, allowing fundamental changes to the Company’s business or organization, and
making certain payments in respect of stock or other ownership interests, such as dividends and stock repurchases. Under the Credit
Facility, we are also required to meet certain financial covenants with respect to minimum fixed charge coverage, consolidated net worth,
leverage and minimum asset coverage ratios. At December 31, 2012, we were in compliance with all covenants and we expect to be in
compliance with all covenants throughout 2013.
The Credit Facility also contains customary events of default, including bankruptcy and other insolvency events, cross-defaults to other
debt agreements, a change in control involving the Company or any subsidiary guarantor, and the failure to comply with covenants.
Commitments
The following table discloses aggregate information about our contractual obligations and the periods in which payments are due as of
December 31, 2012:
Contractual Cash Obligation
Total
Less Than 1 Year
1-3 Years
3-5 Years
More Than
5 Years
Payment Due by Period
Long-term debt
Operating leases
Total contractual cash obligations
Off-Balance Sheet Arrangements
$ 19,500
31,433
$ 50,933
—
13,332
$ 13,332
(In thousands)
$ 19,500
13,459
$ 32,959
—
3,205
$ 3,205
—
1,437
$ 1,437
We currently do not have any off-balance sheet arrangements with unconsolidated entities, financial partnerships or entities often referred
to as structured finance or special purpose entities, which would have been established for the purpose of facilitating off-balance sheet
arrangements or other contractually narrow or limited purposes. In addition, we do not engage in trading activities involving non-exchange
traded contracts. As such, we are not materially exposed to any financing, liquidity, market or credit risk that could arise if we had
engaged in these relationships.
Critical Accounting Policies
The following discussions describe our critical accounting policies, which we believe require the most significant judgments and estimates
used in the preparation of our consolidated financial statements.
The preparation of financial statements in conformity with U.S. generally accepted accounting principles requires management to make
estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at
the date of the financial statements and the reported revenue and expenses during the reporting period. Actual results could differ from
those estimates. Changes in the accounting estimates are reasonably likely to occur from period to period. Accordingly, actual results could
differ materially from our estimates. To the extent that there are material differences between these estimates and actual results, our
financial condition or results of operations will be affected. We base our estimates on past experience and other assumptions that we
believe are reasonable under the circumstances and we evaluate these estimates on an ongoing basis.
Principles of Consolidation
The consolidated financial statements include all subsidiaries and entities controlled by us. We define control as ownership of a majority of
the voting interest of an entity. The consolidated financial statements include entities in which we have the obligation to absorb losses
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
55
LHC GROUP
of the entities or the right to receive benefits from the entities and have voting control over the entities or both, as a result of ownership,
contractual or other financial interests in the entities.
The following table summarizes the percentage of net service revenue earned by type of ownership or relationship we had with the
operating entity:
Wholly owned subsidiaries
Equity joint ventures
License leasing arrangements
Management services
2012
48.1%
49.1
1.9
0.9
2011
2010
49.5%
47.1
2.4
1.0
49.5%
47.4
1.7
1.4
100.0%
100.0%
100.0%
All significant inter-company accounts and transactions have been eliminated in consolidation. Business combinations accounted for as
purchases have been included in the consolidated financial statements from the respective dates of acquisition.
The following describes the Company’s consolidation policy with respect to its various ventures excluding wholly owned subsidiaries:
Equity Joint Ventures
Our joint ventures are structured as limited liability companies in which we typically own a majority equity interest ranging from 51% to
90%. Each member of all but one of our equity joint ventures participates in profits and losses in proportion to their equity interests. We
have one joint venture partner whose participation in losses is limited. We consolidate these entities as we have the obligation to absorb
losses of the entities and the right to receive benefits from the entities and have voting control over the entities.
License Leasing Arrangements
We, through wholly owned subsidiaries, lease home health licenses necessary to operate certain of our home nursing agencies. As with
wholly owned subsidiaries, we own 100% of the equity of these entities and consolidate them based on such ownership, as well as our
obligation to absorb losses of the entities and the right to receive benefits from the entities.
Management Services
We have various management services agreements under which we manage certain operations of agencies and facilities. We do not
consolidate these agencies or facilities, as we do not have an ownership interest and do not have an obligation to absorb losses of the
entities or the right to receive the benefits from the entities.
Revenue Recognition
We report net service revenue at the estimated net realizable amount due from Medicare, Medicaid, commercial insurance, managed care
payors, patients and others for services rendered. All payors contribute to both the home-based services and facility-based services.
The following table sets forth the percentage of net service revenue earned by category of payor for the years ending December 31:
Payor:
Medicare
Medicaid
Other
2012
2011
2010
77.9%
1.8
20.3
79.7%
2.3
18.0
80.5%
2.7
16.8
100.0%
100.0%
100.0%
The percentage of net service revenue contributed from each reporting segment was as follows for the years ending December 31:
Home-Based Services
Facility-Based Services
2012
88.4%
11.6
2011
88.0%
12.0
2010
87.9%
12.1
100.0%
100.0%
100.0%
56
Form 10-K Part I I
Management’s Discussion and Analysis of Financial Condition and Results of Operations
We build partnerships. With purpose.
Medicare
Home-Based Services
Home Nursing Services. Our home nursing Medicare patients are classified into one of 153 home health resource groups prior to
receiving services. Based on this home health resource group, we are entitled to receive a standard prospective Medicare payment for
delivering care over a 60-day period referred to as an episode. We recognize revenue based on the number of days elapsed during an
episode of care within the reporting period.
Final payments from Medicare may reflect one of four retroactive adjustments to ensure the adequacy and effectiveness of the total
reimbursement: (a) an outlier payment if the patient’s care was unusually costly; (b) a low utilization adjustment if the number of visits was
fewer than five; (c) a partial payment if the patient transferred to another provider before completing the episode; or (d) a payment
adjustment based upon the level of therapy services required in the population base. Management estimates the impact of these payment
adjustments based on historical experience and records this estimate during the period the services are rendered. Our payment is
also adjusted for geographic wage differences. In calculating our reported net service revenue from home nursing services, we adjust the
prospective Medicare payments by an estimate of the adjustments.
Hospice Services. We are paid by Medicare under a per diem payment system. We receive one of four predetermined daily or hourly
rates based upon the level of care we furnished. We record net service revenue from hospice services based on the daily or hourly rate
and recognize revenue as hospice services are provided.
Hospice payments are also subject to an inpatient cap and an overall payment cap. Inpatient cap relates to individual programs receiving
more than 20% of its total Medicare reimbursement from inpatient care services and the overall payment cap relates to individual
programs receiving reimbursements in excess of a “cap amount,” calculated by multiplying the number of beneficiaries during the period
by a statutory amount that is indexed for inflation. The determination for each cap is made annually based on the 12-month period
ending on October 31 of each year. We monitor our limits on a provider-by-provider basis and record a liability when program payments
exceed the cap. To date we have not received notification that any of our hospices have exceeded the cap on inpatient care services or
overall payments during 2012 or 2013 to date.
Facility-Based Services
Long-Term Acute Care Services. We are reimbursed by Medicare for services provided under the LTACH prospective payment system,
which was implemented on October 1, 2002. Each patient is assigned a long-term care diagnosis-related group. We are paid a
predetermined fixed amount intended to reflect the average cost of treating a Medicare patient classified in that particular long-term care
diagnosis-related group. For selected patients, the amount may be further adjusted based on length of stay and facility-specific costs,
as well as in instances where a patient is discharged and subsequently re-admitted, among other factors. We calculate the adjustment
based on a historical average of these types of adjustments for claims paid. Similar to other Medicare prospective payment systems,
the rate is also adjusted for geographic wage differences. Revenue is recognized for our LTACHs as services are provided.
Medicaid, Managed Care and Other Payors
Our Medicaid reimbursement is based on a predetermined fee schedule applied to each service provided. Therefore, revenue is recognized
for Medicaid services as services are provided based on this fee schedule. Our managed care payors and other payors reimburse us
in a manner similar to either Medicare or Medicaid. Accordingly, we recognize revenue from managed care payors and other payors in the
same manner as we recognize revenue from Medicare or Medicaid.
Management Services
We record management services revenue as services are provided in accordance with the various management services agreements to
which we are a party. As described in the agreements, we provide billing, management and other consulting services suited to and
designed for the efficient operation of the applicable home nursing agency or inpatient rehabilitation facility. We are responsible for the
costs associated with the locations and personnel required for the provision of services. We are compensated based on a percentage
of cash collections and reimbursed for operating expenses and compensated based on a percentage of operating net income.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
57
LHC GROUP
Income Tax
We operate in several tax jurisdictions and recognize income tax expense based on the revenue and income earned in those jurisdictions
which requires us to make estimates on the appropriations of revenue and income in those jurisdictions. During 2011, we entered into a
settlement with the United States of America which we believe is fully deductible for income tax purposes. In compliance with the
provisions of Accounting Standards Codification 740 and based on our assessment of probable outcomes, we recorded an unrecognized
tax position which increased income tax expense for 2011 by $3.2 million.
Accounts Receivable and Allowances for Uncollectible Accounts
We report accounts receivable net of estimated allowances for uncollectible accounts and adjustments. Accounts receivable are
uncollateralized and primarily consist of amounts due from Medicare, other third-party payors, and patients. To provide for accounts
receivable that could become uncollectible in the future, we establish an allowance for uncollectible accounts to reduce the carrying
amount of such receivables to their estimated net realizable value. Because Medicare is our primary payor, the credit risk associated with
receivables from other payors is limited. We believe the credit risk associated with our Medicare accounts, which represent 63.6% and
65.6% of our patient accounts receivable at December 31, 2012 and 2011, respectively, is limited due to (i) the historical collections from
Medicare and (ii) the fact that Medicare is a U.S. government payor. We do not believe that there are any other significant concentrations
of receivables from any particular payor that would subject it to any significant credit risk in the collection of accounts receivable.
The amount of the provision for bad debts is based upon our assessment of historical and expected net collections, business and
economic conditions and trends in government reimbursement. Uncollectible accounts are written off after exhausting collection efforts
and we have concluded the account will not be collected.
A portion of the estimated Medicare prospective payment system reimbursement from each submitted home nursing episode is received
in the form of a request for anticipated payment (“RAP”). We submit a RAP for 60% of the estimated reimbursement for the initial
episode at the start of care. The full amount of the episode is billed after the episode has been completed. The RAP received for
that particular episode is deducted from the final payment. If a final bill is not submitted within the greater of 120 days from the
start of the episode, or 60 days from the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare
from any other Medicare claims in process for that particular provider. The RAP and final claim must then be resubmitted. For
subsequent episodes of care contiguous with the first episode for a particular patient, we submit a RAP for 50% instead of 60% of
the estimated reimbursement.
Our Medicare population is paid at a prospectively set amount that can be determined at the time services are rendered. Our Medicaid
reimbursement is based on a predetermined fee schedule applied to each individual service we provide. Our managed care contracts
are structured similar to either the Medicare or Medicaid payment methodologies. Because of our payor mix, we are able to calculate our
actual amount due at the patient level and adjust the gross charges down to the actual amount at the time of billing. This negates the
need to record an estimated contractual allowance when reporting net service revenue for each reporting period.
At December 31, 2012, our allowance for uncollectible accounts, as a percentage of patient accounts receivable, was approximately
12.4%, or $11.9 million, compared to 10.5%, or $10.7 million, at December 31, 2011.
The following table sets forth, as of December 31, 2012, the aging of accounts receivable (based on the end of episode date) and the
total allowance for uncollectible accounts, expressed as a percentage of the related aged accounts receivable (amounts in thousands):
Payor
Medicare
Medicaid
Other
Total
0-90
91-180
181-365
Over 365
Total
$ 48,219
2,067
18,688
$ 68,974
$ 7,955
531
4,695
$ 13,181
$ 4,114
696
5,536
$ 10,346
$ 672
300
2,341
$ 3,313
$ 60,960
3,594
31,260
$ 95,814
Allowance as a percentage of receivables
4.3%
15.1%
40.1%
83.2%
12.4%
For home-based services, we calculate the allowance for uncollectible accounts as a percentage of total patient receivables. The
percentage changes depending on the payor and increases as the patient receivables age. For facility-based services, we calculate the
allowance for uncollectible accounts based on a claim by claim review. As a result, the allowance percentages presented in the table
above vary between the aging categories because of the mix of claims in each category.
58
Form 10-K Part I I
Management’s Discussion and Analysis of Financial Condition and Results of Operations
We build partnerships. With purpose.
The following table sets forth, as of December 31, 2011, the aging of accounts receivable (based on the billing date) and the total
allowance for uncollectible accounts, expressed as a percentage of the related aged accounts receivable (amounts in thousands):
Payor
Medicare
Medicaid
Other
Total
0-90
91-180
181-365
Over 365
Total
$ 48,656
2,609
18,346
$ 69,611
$ 10,358
770
5,425
$ 16,553
$ 6,732
642
5,860
$ 13,234
$ 1,110
160
1,240
$ 2,510
$ 66,856
4,181
30,838
$ 101,875
Allowance as a percentage of receivables
3.7%
9.9%
30.0%
98.8%
10.5%
The following table summarizes the activity and ending balances in the allowance for uncollectible accounts (amounts in thousands):
Year ended December 31:
2012
2011
2010
Goodwill and Intangible Assets
Beginning of
Year Balance
Additions and
Expenses
Deductions
End of
Year Balance
$ 10,692
9,769
8,262
$ 11,875
12,320
7,607
$ 10,704
11,397
6,100
$ 11,863
10,692
9,769
We have a significant amount of goodwill on our balance sheet from the numerous business acquisitions we have made each year. We
review goodwill and other intangible assets with indefinite lives annually for impairment or more frequently if circumstances indicate
impairment may have occurred. We evaluate goodwill for impairment by comparing the current fair value of each of our reporting units to
their carrying value, including goodwill. To the extent the carrying value of a reporting unit exceeds the fair value of the reporting unit,
the Company would be required to perform the second step of the impairment test. Components of our home-based services operating
segment are generally represented by individual subsidiaries or joint ventures with individual licenses to conduct homecare or hospice
operations within geographic markets as limited by the terms of each license. Our segment managers review discreet financial information
for our homecare and hospice businesses and we believe that they represent two reporting units for the purposes of evaluating goodwill.
Components of our facility-based services operating segment are represented by individual operating entities. For the purposes of
evaluating goodwill, we believe it is appropriate to aggregate these operating components. Our impairment analysis is performed on
September 30th of each year.
We estimate the fair value of our identified reporting units using the discounted cash flow method and the market multiple analysis
method. These valuations require us to make estimates and assumptions regarding industry economic factors and the profitability of future
business strategies. We consider historical experience and all available information at the time the fair values of its reporting units are
estimated. For each of the reporting units, the estimated fair value is determined based on a formula that considers 50% of the estimated
value based on a multiple of earnings before interest, taxes, depreciation and amortization plus 50% of the estimated value using
discounted cash flow method.
The fair value of net assets including goodwill exceeded the carrying value by 67.3% for the homecare reporting unit, 165.6% for the
hospice reporting unit and 111.5% for the facility based services reporting unit.
The discount rate and projected revenue and earnings before interest, tax, depreciation and amortization (EBITDA) growth rates are
significant assumptions utilized when applying the discounted cash flow method. We applied a discount rate of 9.8%, which is derived
from our weighted average cost of capital. The future cash flows of the homecare reporting unit is based on six percent annual organic
census growth, known reimbursement changes, an estimate of normal annual cost increases and our ability to control costs. In developing
our forecast assumptions, we considered our historical performance and the current reimbursement and utilization trends, and market
share assumptions in the markets where we operate. These assumptions could be adversely impacted by unanticipated changes in risks
or other economic factors including deterioration of general economic and industry conditions.
We also compared our equity book value to our market capitalization as of September 30, 2012. Our stock price on September 30,
2012 was $18.47. The implied fair value of our Company based on the market capitalization exceeded the carrying value as of
September 30, 2012, although that does not individually validate the fair value of each reporting unit discussed above. However, we
believe the calculations of fair value discussed above are reasonable in relation to the overall market capitalization of our Company.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
59
LHC GROUP
A change in the weight assigned to each methodology would not have changed the conclusion that no impairment charge is necessary
during the year ended December 31, 2012. We have not recognized goodwill impairment charges in 2012, 2011 or 2010.
Included in intangible assets, net are definite-lived assets subject to amortization such as software licenses and non-compete agreements.
Amortization of the definite-lived intangible assets is calculated on a straight-line basis over the estimated useful lives of the related
assets. Software licenses are amortized over a three year period and non-compete agreements are amortized over the life of the agreement,
usually ranging from three to five years.
We also have indefinite-lived assets that are not subject to amortization expense such as trade names, certificates of need and licenses to
conduct specific operations within geographic markets. Trade names, certificates of need and licenses have indefinite lives because
there are no legal, regulatory, contractual, economic or other factors that would limit the useful life of these intangible assets and we intend
to renew and operate the certificates of need and licenses and use these trade names indefinitely. These indefinite-lived intangibles are
reviewed annually for impairment or more frequently if circumstances indicate impairment may have occurred. To determine whether an
indefinite-lived intangible asset is impaired, we perform a qualitative assessment to support the conclusion that the indefinite-lived
intangible asset is not impaired. Based on the results of that qualitative assessment, we may perform a quantitative test. The quantitative
impairment test on trade names uses the relief-from royalty method. Under this method, the fair value of the intangible asset is determined
by calculating the present value of the after-tax cost savings associated with owning the trade names and, therefore, not having to pay
royalties for use over their estimated useful lives. The quantitative impairment test for certificates of need and licenses applies the cost
approach. Under this method, assumptions are made about the cost to replace the certificates of need. Lower revenue expectations
caused primarily by projected Medicare reimbursement cuts reduced the fair values of certain intangible assets below their carrying values.
Based on that analysis, we recorded an impairment charge of $650,000 during the twelve months ended December 31, 2012.
As a result of the impairment charge, the carrying values of the related intangible assets were adjusted to their estimated fair values as
of September 30, 2012. Any further decline in the estimated fair values of these intangibles could result in additional impairment charges
being recorded. The Company determined that except for the impairment charges described above, there were no indicators that the
other intangible assets were impaired at September 30, 2012.
Recent Accounting Pronouncements
In July 2012, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update 2012-02, Intangibles – Goodwill
and Other (Topic 350): Testing Indefinite-Lived Intangible Assets for Impairment allowing an entity to have the option to not calculate the fair
value of an indefinite-lived intangible asset if the entity determines that it is not more likely than not that the asset is impaired. The
guidance is effective for all interim and annual reporting periods after September 15, 2012. The adoption of the guidance did not have a
material impact on our operating results, financial position or liquidity.
Item 7A. Quantitative and Qualitative Disclosures About Market Risk.
As of December 31, 2012, we had $9.7 million in cash. Cash in excess of requirements are deposited in highly liquid money market
instruments with maturities less than 90 days. Because of the short maturities of these instruments, we would not expect our operating
results or cash flows to be materially affected by the effect of a sudden change in market interest rates on our portfolio. The FDIC
reinstated coverage on all non interest bearing checking accounts through December 31, 2012, in which all non interest bearing accounts
were fully insured, regardless of the balance on the account. Beginning January 1, 2013, the FDIC will insure each depositor up to
$250,000 in coverage at each separately chartered insured depository institution. We do not expect any loss as a result of cash deposits
in excess of FDIC insurance limit.
Our exposure to market risk relates to changes in interest rates for borrowings under the Credit Facility we amended and restated on
August 31, 2012. A hypothetical 100 basis point increase in interest rates on the average daily amounts outstanding under the Credit Facility
would have increased interest expense by $137,000 for the year ended December 31, 2012.
Item 8. Financial Statements and Supplementary Data.
The consolidated financial statements and financial statement schedules in Part IV, Item 15 of this Annual Report on Form 10-K are
incorporated by reference into this Item 8.
60
Form 10-K Part I I
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Item 9. Changes In and Disagreements with Accountants on Accounting and Financial Disclosure.
We build partnerships. With purpose.
None.
Item 9A. Controls and Procedures.
Evaluation of Disclosure Control and Procedures
The Company maintains disclosure controls and procedures that are designed to ensure that information required to be disclosed by
the Company in the reports it files or submits under the Exchange Act of 1934 is recorded, processed, summarized and reported
within the time periods specified in the SEC’s rules and forms, and that such information is accumulated and communicated to the
Company’s management, including its Chief Executive Officer and Chief Financial Officer, as appropriate to allow timely decisions
regarding required disclosure.
Under the supervision and with the participation of the Company’s management, including its Chief Executive Officer and Chief Financial
Officer, management evaluated the effectiveness of the Company’s disclosure controls and procedures as of December 31, 2012.
Based on that evaluation, the Company’s Chief Executive Officer and its Chief Financial Officer concluded that the Company’s disclosure
controls and procedures (as such term is defined under Rule 13a-15(e) promulgated under the Securities Exchange Act of 1934, as
amended) were effective as of December 31, 2012.
Management’s Report on Internal Control Over Financial Reporting
The Company’s management is responsible for establishing and maintaining adequate internal control over financial reporting, as that term
is defined in Exchange Act Rule 13a-15(f). Under the supervision and with the participation of the Company’s management, including
the Chief Executive Officer and Chief Financial Officer, the Company conducted an evaluation of its internal control over financial reporting
based on the framework in Internal Control – Integrated Framework issued by the Committee of Sponsoring Organizations of the
Treadway Commission. Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements.
Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate
because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.
Based on management’s testing and evaluation under the framework in Internal Control – Integrated Framework, management concluded
that our internal control over financial reporting was effective as of December 31, 2012.
The attestation report of KPMG LLP, independent registered public accounting firm, is included herein.
Changes in Internal Control Over Financial Reporting
There have not been any changes in the Company’s internal control over financial reporting, as such term is defined in Rule 13a-15(f)
under the Exchange Act, during the Company’s fiscal quarter ended December 31, 2012 that have materially affected, or are reasonably
likely to materially affect, the Company’s internal control over financial reporting.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Form 10-K Part I I
61
LHC GROUP
Report of Independent Registered Public Accounting Firm
The Board of Directors and Stockholders
LHC Group, Inc.:
We have audited LHC Group, Inc.’s internal control over financial reporting as of December 31, 2012, based on criteria established in
Internal Control – Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO).
LHC Group, Inc.’s management is responsible for maintaining effective internal control over financial reporting and for its assessment of
the effectiveness of internal control over financial reporting, included in the accompanying Management’s Report on Internal Control
over Financial Reporting. Our responsibility is to express an opinion on the Company’s internal control over financial reporting based on
our audit.
We conducted our audit in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those
standards require that we plan and perform the audit to obtain reasonable assurance about whether effective internal control over financial
reporting was maintained in all material respects. Our audit included obtaining an understanding of internal control over financial reporting,
assessing the risk that a material weakness exists, and testing and evaluating the design and operating effectiveness of internal control
based on the assessed risk. Our audit also included performing such other procedures as we considered necessary in the circumstances.
We believe that our audit provides a reasonable basis for our opinion.
A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of
financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting
principles. A company’s internal control over financial reporting includes those policies and procedures that (1) pertain to the
maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the
company; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements
in accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only
in accordance with authorizations of management and directors of the company; and (3) provide reasonable assurance regarding
prevention or timely detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect
on the financial statements.
Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of
any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in
conditions, or that the degree of compliance with the policies or procedures may deteriorate.
In our opinion, LHC Group, Inc. maintained, in all material respects, effective internal control over financial reporting as of December 31,
2012, based on criteria established in Internal Control – Integrated Framework issued by the Committee of Sponsoring Organizations of
the Treadway Commission.
We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States), the
consolidated balance sheets of LHC Group, Inc. and subsidiaries as of December 31, 2012 and 2011, and the related consolidated
statements of operations, changes in equity, and cash flows for each of the years in the three-year period ended December 31, 2012,
and our report dated March 18, 2013 expressed an unqualified opinion on those consolidated financial statements.
/s/ KPMG LLP
Baton Rouge, Louisiana
March 18, 2013
62
Form 10-K Part I I
Report of Independent Registered Public Accounting Firm
We build partnerships. With purpose.
PART III
Item 10. Directors, Executive Officers and Corporate Governance.
The information required by this Item with respect to directors and executive officers is incorporated by reference from the information
contained under the heading “Information About Directors, Nominees and Management” in the definitive Proxy Statement relating to the
Company’s 2013 Annual Meeting of Stockholders.
The information required by this Item regarding compliance with Section 16(a) of the Exchange Act is incorporated by reference from the
information contained under the heading “Section 16(a) Beneficial Ownership Reporting Compliance” in the definitive Proxy Statement
relating to the Company’s 2013 Annual Meeting of Stockholders.
The information required by this Item with respect to corporate governance is incorporated by reference from the information contained
under the heading “The Board of Directors and Corporate Governance” in the definitive Proxy Statement relating to the Company’s 2013
Annual Meeting of Stockholders.
Code of Conduct and Ethics
We have adopted a code of ethics that applies to all of our directors, officers and employees. This code is publicly available in the investor
relations area of our website at www.lhcgroup.com. Any substantive amendments to this code, or any waivers granted for any directors or
executive officers, including our principal executive officer, principal financial officer, principal accounting officer or controller, will be
disclosed on our website and remain available there for at least 12 months. This code of ethics is not incorporated in this report by
reference. Copies of our code of ethics may also be requested in print by writing to Investor Relations at LHC Group, Inc., 420 West
Pinhook Road, Suite A, Lafayette, Louisiana, 70503.
Item 11. Executive Compensation.
The information required by this Item is incorporated by reference from the information contained under the heading “Executive Officer
Compensation” in the definitive Proxy Statement relating to the Company’s 2013 Annual Meeting of Stockholders.
Item 12. Security Ownership of Certain Beneficial Owners and Management
and Related Stockholder Matters.
The information required by this Item is incorporated by reference to the information contained under the headings “Security Ownership of
Certain Beneficial Owners and Management” in the definitive Proxy Statement relating to the Company’s 2013 Annual Meeting of Stockholders.
Equity Compensation Plan Information
(a)
(b)
Number of Shares
to be Issued
Upon Exercise of
Outstanding Options,
Warrants and Rights
Weighted-Average
Exercise Price of
Outstanding Price of
Outstanding Rights
(c)
Number of Shares
Remaining Available for
Future Issuance Under
Equity Compensation Plans
(Excluding Securities
Reflected in Column a)
Equity compensation plans approved by Stockholders:
Equity compensation plans not approved by Stockholders:
Total
15,000
—
15,000
$ 16.88
—
$ 16.88
1,112,090
—
1,112,090
Item 13. Certain Relationships and Related Transactions, and Director Independence.
The information required by this Item is incorporated by reference from the information contained under the heading “Certain Relationships
and Related Transactions” in the definitive Proxy Statement relating to the Company’s 2013 Annual Meeting of Stockholders.
Item 14. Principal Accounting Fees and Services.
The information required by this Item is incorporated by reference from the information contained under the heading “Principal Accounting
Fees and Services” in the definitive Proxy Statement relating to the Company’s 2013 Annual Meeting of Stockholders.
Form 10-K Part I I I
63
LHC GROUP
PART IV
Item 15. Exhibits, Financial Statement Schedules.
(a) Documents to be filed with Form 10-K:
(1) Financial Statements
Report of Independent Registered Public Accounting Firm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Consolidated Balance Sheets as of December 31, 2012 and 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
For each of the years in the three-year period ended December 31, 2012
Consolidated Statements of Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Consolidated Statements of Changes in Equity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Consolidated Statements of Cash Flows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Notes to the Consolidated Financial Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
F-1
F-2
F-3
F-4
F-5
F-6
(2) Financial Statement Schedules
There are no financial statement schedules included in this report.
(3) Exhibits
The Exhibits are listed in the Index of Exhibits required by Item 601 of Regulation S-K included herewith, which is incorporated
by reference.
64
Form 10-K Part IV
We build partnerships. With purpose.
Report of Independent Registered Public Accounting Firm
The Board of Directors and Stockholders
LHC Group, Inc.:
We have audited the accompanying consolidated balance sheets of LHC Group, Inc. and subsidiaries as of December 31, 2012 and
2011, and the related consolidated statements of operations, changes in equity, and cash flows for each of the years in three-year period
ended December 31, 2012. These consolidated financial statements are the responsibility of the Company’s management. Our
responsibility is to express an opinion on these consolidated financial statements based on our audits.
We conducted our audits in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those
standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of
material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial
statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as
evaluating the overall financial statement presentation. We believe that our audits provide a reasonable basis for our opinion.
In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the financial position of LHC
Group, Inc. and subsidiaries as of December 31, 2012 and 2011, and the results of their operations and their cash flows for each of the
years in three-year period ended December 31, 2012, in conformity with U.S. generally accepted accounting principles.
We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States), LHC Group,
Inc.’s internal control over financial reporting as of December 31, 2012, based on criteria established in Internal Control – Integrated
Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO), and our report dated March 18,
2013 expressed an unqualified opinion on the effectiveness of the LHC Group, Inc.’s internal control over financial reporting.
/s/ KPMG LLP
Baton Rouge, Louisiana
March 18, 2013
Report of Independent Registered Public Accounting Firm
Form 10-K Part IV
65
LHC GROUP
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEETS
(Amounts in thousands, except share data)
As of December 31,
2012
2011
ASSETS
Current assets:
Cash
Receivables:
Patient accounts receivable, less allowance for uncollectible accounts of $11,863
and $10,692, respectively
Other receivables
Amounts due from governmental entities
Total receivables, net
Deferred income taxes
Prepaid income taxes
Prepaid expenses
Other current assets
Total current assets
Property, building and equipment, net of accumulated depreciation of $34,331 and $28,073
Goodwill
Intangible assets, net of accumulated amortization of $2,985 and $2,325
Other assets
Total assets
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Accounts payable and other accrued liabilities
Salaries, wages and benefits payable
Self insurance reserve
Amounts due to governmental entities
Total current liabilities
Deferred income taxes
Income tax payable
Revolving credit facility
Total liabilities
Noncontrolling interest-redeemable
Stockholders’ equity:
Common stock – $0.01 par value: 40,000,000 shares authorized; 21,578,772 and 21,374,264 shares
issued and 16,925,733 and 18,298,659 shares outstanding, respectively
Treasury stock – 4,653,039 and 3,075,605 shares at cost, respectively
Additional paid-in capital
Retained earnings
Total LHC Group, Inc. stockholders’ equity
Noncontrolling interest – non-redeemable
Total equity
Total liabilities and stockholders’ equity
See accompanying Notes to the Consolidated Financial Statements
$ 9,720
$
256
83,951
589
1,596
86,136
7,671
7,436
6,818
2,949
120,730
29,531
169,150
62,042
5,441
$ 386,894
$ 14,897
29,890
5,444
4,979
55,210
25,129
3,415
19,500
103,254
11,426
216
(33,846)
100,619
201,192
268,181
4,033
272,214
$ 386,894
91,183
1,636
315
93,134
7,269
26,667
6,576
4,363
138,265
28,182
164,731
59,389
5,809
$ 396,376
$ 23,119
25,571
5,612
3,234
57,536
22,523
3,415
34,820
118,294
11,348
183
(6,216)
95,964
173,752
263,683
3,051
266,734
$ 396,376
66
Form 10-K Part IV
Consolidated Balance Sheets
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF OPERATIONS
(Amounts in thousands, except share and per share data)
For the Year Ended of December 31,
2012
2011
2010
We build partnerships. With purpose.
305,046
7,607
—
201,837
95,602
(134)
(7)
812
96,273
31,727
64,546
64,546
15,787
48,759
41
48,800
2.69
2.68
$ 633,872
352,346
$ 631,567
326,521
Net service revenue
Cost of service revenue
Gross margin
Provision for bad debts
Settlement with government agencies
General and administrative expenses
Operating income (loss)
Interest expense
Gain (loss) on the sale of assets and entities
Non-operating income
Income (loss) from continuing operations before income taxes and
noncontrolling interests
Income tax expense (benefit)
Income (loss) from continuing operations
Net income (loss)
Less net income attributable to noncontrolling interest
Net income (loss) attributable to LHC Group, Inc.
Redeemable noncontrolling interests
$
637,569
365,752
271,817
11,875
—
205,637
54,305
(1,550)
(105)
289
52,939
17,511
35,428
35,428
7,988
27,440
—
281,526
12,320
65,000
210,588
(6,382)
(1,018)
59
1,722
(5,619)
(1,968)
(3,651)
(3,651)
9,593
(13,244)
—
Net income (loss) available to LHC Group, Inc.’s common stockholders
$
27,440
$
(13,244)
Earnings per share-basic:
Net income (loss) attributable to LHC Group, Inc.’s common stockholders
Earnings per share-diluted:
Net income (loss) attributable to LHC Group, Inc.’s common stockholders
$
$
1.54
1.53
$
$
(0.73)
(0.73)
$
$
$
Weighted average shares outstanding:
Basic
Diluted
See accompanying Notes to the Consolidated Financial Statements
17,853,321
18,265,118
18,119,183
17,899,195
18,265,118
18,226,091
Consolidated Statements Of Operations
Form 10-K Part IV
67
LHC GROUP
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY
(Amounts in thousands, except share data)
LHC Group, Inc.
Common Stock
Issued
Treasury
Amount
Shares
Amount
Shares
Additional
Paid-In
Capital
Non-Controlling
Interest –
Total
Retained
Earnings Non-redeemable Equity
Non-Controlling Net
Interest –
Redeemable
Income
(Loss)
$ 179
—
—
20,967,418
—
—
$ (3,513)
—
—
2,976,733
—
—
$ 86,310
—
—
$ 138,196
48,759
—
$ 388
1,824
684
$ 221,560
50,583
684
$ 13,823
13,963
(684)
64,546
Balances at December 31, 2009
Net income
Transfer of noncontrolling interest
Purchase of additional
interest
Acquired noncontrolling interest
Noncontrolling interest distributions
Stock issued for acquisitions
Stock option exercise
Nonvested stock compensation
Issuance of vested restricted stock
Treasury shares redeemed to pay
income tax
Excess tax benefits-vesting
nonvested stock
Issuance of common stock
under Employee Stock
Purchase Plan
Recording noncontrolling interest in
joint venture at redemption value
Balances at December 31, 2010
Net income (loss)
Transfer of noncontrolling interest
Acquired noncontrolling interest
Noncontrolling interest distributions
Purchase of additional controlling
interest
Sale of noncontrolling interest
Nonvested stock compensation
Issuance of vested restricted stock
Treasury shares redeemed to pay
income tax
Repurchase of common stock
Excess tax benefits-vesting
nonvested stock
Issuance of common stock under
Employee Stock Purchase Plan
Balances at December 31, 2011
Net income
Acquired noncontrolling interest
Noncontrolling interest distributions
Purchase of additional controlling
interest
Sale of noncontrolling interest
Nonvested stock compensation
Issuance of vested restricted stock
Treasury shares redeemed to pay
income tax
Repurchase of common stock
Excess tax benefits-vesting
nonvested stock
Issuance of common stock under
Employee Stock Purchase Plan
Reclassification of common stock
at par value
Balances at December 31, 2012
—
—
—
2
—
—
—
—
—
—
—
—
50,150
4,000
—
130,211
—
—
—
—
—
—
—
—
—
—
—
—
—
—
(1,914)
—
—
1,548
91
3,742
—
—
(940)
31,531
—
—
—
—
459
—
—
—
—
—
—
—
—
—
—
612
(1,761)
—
—
—
—
(1,914)
612
(1,761)
1,550
91
3,742
—
—
338
(13,905)
—
—
—
—
—
(940)
—
459
—
—
—
—
28,508
—
—
781
—
—
781
—
$ 181
—
21,180,286
—
$ (4,453)
—
3,008,264
—
$ 91,017
41
$ 186,996
—
$ 1,747
41
$ 275,488
—
$ 13,535
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
155,687
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
205
—
—
(641)
212
4,092
—
—
—
(1,186)
(577)
43,182
24,159
—
—
—
—
—
221
(13,244)
—
—
—
—
—
—
—
—
—
—
1,075
163
1,372
(1,402)
—
96
—
—
—
—
(12,169)
368
1,372
(1,402)
(641)
308
4,092
—
(1,186)
(577)
—
221
(3,651)
8,518
—
—
(10,455)
(250)
—
—
—
—
—
—
2
$ 183
38,291
21,374,264
—
$ (6,216)
—
3,075,605
858
$ 95,964
—
$ 173,752
—
$ 3,051
860
$ 266,734
—
$ 11,348
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
154,323
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
(189)
80
4,390
—
—
—
(672)
(26,958)
36,621
1,540,813
—
—
—
—
1
50,185
—
—
—
(376)
782
27,440
—
—
595
1,636
(1,249)
28,035
1,636
(1,249)
7,393
—
(7,195)
35,428
—
—
—
—
—
—
—
—
—
—
—
—
(189)
80
4,390
—
—
—
(672)
(26,958)
—
(376)
—
783
(120)
—
—
—
—
—
—
—
32
$ 216
—
21,578,772
—
$ (33,846)
—
4,653,039
(32)
—
$ 100,619 $ 201,192
—
$ 4,033
—
$ 272,214
—
$ 11,426
See accompanying Notes to the Consolidated Financial Statements
68
Form 10-K Part IV
Consolidated Statements Of Changes In Equity
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
(Amounts in thousands)
For the Year Ended December 31,
2012
2011
2010
We build partnerships. With purpose.
Operating activities
Net income (loss)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Depreciation and amortization expense
Provision for bad debts
Stock based compensation expense
Deferred income taxes
(Gain) loss on sale of assets
Loss on impairment of intangible assets
Changes in operating assets and liabilities, net of acquisitions:
Receivables
Prepaid expenses, other assets
Prepaid taxes
Accounts payable and accrued expenses
Net amounts due from governmental entities
Net cash provided by (used in) operating activities
Investing activities
Cash paid for acquisitions, primarily goodwill, intangible assets and advance payment
on acquisitions
Proceeds from sale of assets
Purchases of property, building and equipment
Net cash used in investing activities
Financing activities
Proceeds from line of credit
Payments on line of credit
Principal payments on debt
Payments on capital leases
Payment of contingent consideration
Excess tax benefits from vesting of restricted stock
Proceeds from issuance of common stock under ESPP
Proceeds from exercise of stock options
Noncontrolling interest distributions
Purchase of additional controlling interest
Sale of noncontrolling interest
Payment of deferred financing fees
Repurchase of common stock
Net cash provided by (used in) financing activities
Change in cash
Cash at beginning of period
Cash at end of period
Supplemental disclosures of cash flow information
Interest paid
Income taxes paid
$ 35,428
$
(3,651)
$ 64,546
7,806
11,875
4,390
2,204
105
650
(4,497)
1,780
18,855
(4,288)
464
74,772
(6,758)
33
(8,415)
(15,140)
188,561
(203,881)
—
—
—
—
783
—
(8,444)
(309)
80
—
(26,958)
(50,168)
9,464
256
$ 9,720
7,521
12,320
4,092
4,378
—
—
(21,024)
6,247
(17,926)
4,478
189
(3,376)
(11,680)
—
(7,945)
(19,625)
142,995
(108,175)
—
(14)
—
320
860
—
(11,857)
(891)
308
—
(577)
22,969
(32)
288
256
$
$ 1,550
$ 8,645
$ 1,018
$ 11,363
7,496
7,607
3,742
2,771
—
—
(16,195)
(2,319)
(2,194)
5,777
706
71,937
(31,747)
—
(11,586)
(43,333)
9,023
(14,746)
(4,483)
(31)
(1,726)
476
781
74
(15,666)
(1,914)
—
(498)
—
(28,710)
(106)
394
288
$
$
134
$ 30,605
Supplemental disclosure of non-cash transactions:
2012 non-cash transactions. In conjunction with the vesting of non-vested shares of stock, recipients incur personal income tax obligations. The Company
allows the recipients to turn in shares of common stock to satisfy those personal tax obligations. During 2012, the Company obtained $672,000 of treasury
shares for tax payments on stock vesting.
2011 non-cash transactions. Consideration for one of the Company’s acquisitions during 2011 was a transfer of a 26.32% ownership interest in one of the
Company’s wholly owned home health agencies. The transfer of the noncontrolling interest in the Company’s existing home health agency was accounted for
as an equity transaction, resulting in the Company recognizing additional paid in capital of $206,000 and additional noncontrolling interest of $294,000.
Additionally, the Company acquired a majority ownership in four entities and recorded $1.3 million of noncontrolling interest related to the acquisitions.
During 2011, the Company obtained $1.2 million of treasury shares for tax payments on stock vesting.
The Company recorded $3.4 million as an unrecognized tax position during 2011.
2010 non-cash transactions. During 2010, the Company acquired a majority ownership in six entities and recorded $950,000 of noncontrolling interest
related to the acquisitions.
During 2010, the Company issued 29,988 shares of the Company’s common stock, valued at $950,000, as settlement of contingent consideration on one of the
Company’s 2008 acquisitions. The shares were contingent upon the acquired company achieving certain financial measurements in the year after acquisition.
The acquired company achieved the financial measurements and, therefore, the Company remitted the remaining contingent consideration to the seller.
The Company also issued 20,162 shares, valued at $600,000, during 2010 as consideration for one of the Company’s 2010 acquisitions.
During 2010, the Company obtained $940,000 of treasury shares for tax payments on stock vesting.
See accompanying Notes to the Consolidated Financial Statements
Consolidated Statements Of Cash Flows
Form 10-K Part IV
69
LHC GROUP
LHC GROUP, INC. AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
1. Organization
LHC Group, Inc. (the “Company”) is a health care provider specializing in the post-acute continuum of care primarily for Medicare
beneficiaries. The Company provides home-based services, primarily through home nursing agencies and hospices, and facility-based
services, primarily through long-term acute care hospitals. As of December 31, 2012, the Company, through its wholly and majority-
owned subsidiaries, equity joint ventures and controlled affiliates, operated in Alabama, Arkansas, Florida, Georgia, Idaho, Kentucky,
Louisiana, Maryland, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Oregon, Tennessee, Texas, Virginia, West Virginia and
Washington.
2. Summary of Significant Accounting Policies
Use of Estimates
The preparation of financial statements in conformity with U.S. generally accepted accounting principles (“US GAAP”) requires
management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent
assets and liabilities at the date of the financial statements and the reported revenue and expenses during the reporting period. Actual
results could differ from those estimates.
Principles of Consolidation
The consolidated financial statements include all subsidiaries and entities controlled by the Company. Control is defined by the Company
as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which the Company
has the obligation to absorb losses of the entities or the right to receive benefits from the entities and generally has voting control over
the entities or both, as a result of ownership, contractual or other financial interests in the entities. Third party equity interests in the
consolidated joint ventures are reflected as noncontrolling interests in the Company’s consolidated financial statements.
The following table summarizes the percentage of net service revenue earned by type of ownership or relationship the Company had with
the operating entity for the periods presented:
Wholly owned subsidiaries
Equity joint ventures
License leasing arrangements
Management services
2012
48.1%
49.1
1.9
0.9
2011
2010
49.5%
47.1
2.4
1.0
49.5%
47.4
1.7
1.4
100.0%
100.0%
100.0%
All significant inter-company accounts and transactions have been eliminated in consolidation. Business combinations accounted for as
purchases have been included in the consolidated financial statements from the respective dates of acquisition.
The following discussion describes the Company’s consolidation policy with respect to its various ventures excluding wholly owned
subsidiaries:
Equity Joint Ventures
A majority of the Company’s joint ventures are structured as limited liability companies in which the Company typically owns a majority
equity interest ranging from 51% to 90%. Each member of all but one of the Company’s equity joint ventures participates in profits and
losses in proportion to their equity interests. The Company has one joint venture partner whose participation in losses is limited. The
Company consolidates these entities as the Company has the obligation to absorb losses of the entities and the right to receive benefits
from the entities and generally has voting control over the entities.
70
Form 10-K Part IV
Notes to Consolidated Financial Statements
We build partnerships. With purpose.
License Leasing Arrangements
The Company, through wholly owned subsidiaries, leases home health licenses necessary to operate certain of its home nursing
agencies. As with wholly owned subsidiaries, the Company owns 100% of the equity of these entities and consolidates them based on
such ownership, as well as the Company’s obligation to absorb losses of the entities and the right to receive benefits from the entities.
Management Services
The Company has various management services agreements under which the Company manages certain operations of agencies and
facilities. The Company does not consolidate these agencies or facilities, as the Company does not have an ownership interest and does
not have an obligation to absorb losses of the entities or the right to receive the benefits from the entities.
Revenue Recognition
The Company reports net service revenue at the estimated net realizable amount due from Medicare, Medicaid, commercial insurance,
managed care payors, patients and others for services rendered. All payors contribute to both the home-based services and facility-
based services.
The following table sets forth the percentage of net service revenue earned by category of payor for the years ending December 31:
Payor:
Medicare
Medicaid
Other
2012
2011
2010
77.9%
1.8
20.3
79.7%
2.3
18.0
80.5%
2.7
16.8
100.0%
100.0%
100.0%
The percentage of net service revenue contributed from each reporting segment was as follows for the years ending December 31:
Home-Based Services
Facility-Based Services
Medicare
Home-Based Services
2012
88.4%
11.6
2011
88.0%
12.0
2010
87.9%
12.1
100.0%
100.0%
100.0%
Home Nursing Services. The Company’s home nursing Medicare patients are classified into one of 153 home health resource groups
prior to receiving services. Based on this home health resource group, the Company is entitled to receive a standard prospective Medicare
payment for delivering care over a 60-day period referred to as an episode. The Company recognizes revenue based on the number of
days elapsed during an episode of care within the reporting period.
Final payments from Medicare may reflect one of four retroactive adjustments to ensure the adequacy and effectiveness of the total
reimbursement: (a) an outlier payment if the patient’s care was unusually costly; (b) a low utilization adjustment if the number of visits was
fewer than five; (c) a partial payment if the patient transferred to another provider before completing the episode; or (d) a payment
adjustment based upon the level of therapy services required in the population base. Management estimates the impact of these payment
adjustments based on historical experience and records this estimate during the period the services are rendered. The Company’s
payment is also adjusted for geographic wage differences. In calculating the Company’s reported net service revenue from home nursing
services, the Company adjusts the prospective Medicare payments by an estimate of the adjustments.
Hospice Services. The Company is paid by Medicare under a per diem payment system. The Company receives one of four
predetermined daily or hourly rates based upon the level of care the Company furnished. The Company records net service revenue from
hospice services based on the daily or hourly rate and recognizes revenue as hospice services are provided.
Hospice payments are also subject to an inpatient cap and an overall payment cap. Inpatient cap relates to individual programs receiving
more than 20% of its total Medicare reimbursement from inpatient care services and the overall payment cap relates to individual
programs receiving reimbursements in excess of a “cap amount,” calculated by multiplying the number of beneficiaries during the period
Notes to Consolidated Financial Statements
Form 10-K Part IV
71
LHC GROUP
by a statutory amount that is indexed for inflation. The determination for each cap is made annually based on the 12-month period
ending on October 31 of each year. The Company monitors its limits on a provider-by-provider basis. The Company has not received
notification that any of its hospices have exceeded the cap on inpatient care services or overall payments during 2012 or 2013 to date.
Facility-Based Services
Long-Term Acute Care Services. The Company is reimbursed by Medicare for services provided under the long-term acute care hospital
(“LTACH”) prospective payment system, which was implemented on October 1, 2002. Each patient is assigned a long-term care
diagnosis-related group. The Company is paid a predetermined fixed amount intended to reflect the average cost of treating a Medicare
patient classified in that particular long-term care diagnosis-related group. For selected patients, the amount may be further adjusted
based on length of stay and facility-specific costs, as well as in instances where a patient is discharged and subsequently re-admitted,
among other factors. The Company calculates the adjustment based on a historical average of these types of adjustments for claims
paid. Similar to other Medicare prospective payment systems, the rate is also adjusted for geographic wage differences. Revenue is
recognized for the Company’s LTACHs as services are provided.
Medicaid, managed care and other payors
The Company’s Medicaid reimbursement is based on a predetermined fee schedule applied to each service provided. Therefore, revenue
is recognized for Medicaid services as services are provided based on this fee schedule. The Company’s managed care and other
payors reimburse the Company in a manner similar to either Medicare or Medicaid. Accordingly, the Company recognizes revenue from
managed care and other payors in the same manner as the Company recognizes revenue from Medicare or Medicaid.
Management Services
The Company records management services revenue as services are provided in accordance with the various management services
agreements to which the Company is a party. As described in the agreements, the Company provides billing, management and other
consulting services suited to and designed for the efficient operation of the applicable home nursing agency or inpatient rehabilitation
facility. The Company is responsible for the costs associated with the locations and personnel required for the provision of services. The
Company is compensated based on a percentage of cash collections and is reimbursed for operating expenses and compensated
based on a percentage of operating net income.
Accounts Receivable and Allowances for Uncollectible Accounts
The Company reports accounts receivable net of estimated allowances for uncollectible accounts and adjustments. Accounts receivable
are uncollateralized and primarily consist of amounts due from Medicare, other third-party payors, and patients. To provide for accounts
receivable that could become uncollectible in the future, the Company establishes an allowance for uncollectible accounts to reduce the
carrying amount of such receivables to their estimated net realizable value. Because Medicare is the Company’s primary payor, the
credit risk associated with receivables from other payors is limited. The Company believes the credit risk associated with its Medicare
accounts, which represent 63.6% and 65.6% of its patient accounts receivable at December 31, 2012 and December 31, 2011,
respectively, is limited due to (i) the historical collection rate from Medicare and (ii) the fact that Medicare is a U.S. government payor. The
Company does not believe that there are any other significant concentrations of receivables from any particular payor that would
subject it to any significant credit risk in the collection of accounts receivable.
The amount of the provision for bad debts is based upon the Company’s assessment of historical and expected net collections, business
and economic conditions and trends in government reimbursement. Uncollectible accounts are written off when the Company has
determined the account will not be collected.
A portion of the estimated Medicare prospective payment system reimbursement from each submitted home nursing episode is received
in the form of a request for anticipated payment (“RAP”). The Company submits a RAP for 60% of the estimated reimbursement for
the initial episode at the start of care. The full amount of the episode is billed after the episode has been completed. The RAP received
for that particular episode is deducted from the final payment. If a final bill is not submitted within the greater of 120 days from the
start of the episode, or 60 days from the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare from
any other Medicare claims in process for that particular provider. The RAP and final claim must then be resubmitted. For subsequent
episodes of care contiguous with the first episode for a particular patient, the Company submits a RAP for 50% instead of 60% of the
estimated reimbursement.
72
Form 10-K Part IV
Notes to Consolidated Financial Statements
The Company’s Medicare population is paid at a prospectively set amount that can be determined at the time services are rendered.
The Company’s Medicaid reimbursement is based on a predetermined fee schedule applied to each individual service we provide. The
Company’s managed care contracts are structured similar to either the Medicare or Medicaid payment methodologies. Because of its
payor mix, the Company is able to calculate our actual amount due at the patient level and adjust the gross charges down to the actual
amount at the time of billing. This negates the need to record an estimated contractual allowance when reporting net service revenue for
We build partnerships. With purpose.
each reporting period.
Business Combination
The Company accounts for business combinations using the acquisition method. The assets acquired consist primarily of a Medicare
license, certificate of need and/or a noncompete agreement. The assets acquired and liabilities assumed, if any, are measured at fair value
on the acquisition date using the appropriate valuation method. The noncontrolling interest associated with joint venture acquisitions is
also measured and recorded at fair value as of the acquisition date. The residual purchase price is recorded as goodwill. The operations of
the acquisitions are included in the consolidated financial statements from their respective dates of acquisition.
Goodwill and Intangible Assets
Goodwill is reviewed annually for impairment or more frequently if circumstances indicate impairment may have occurred. To determine
whether goodwill is impaired, a two step impairment test is performed. Goodwill is evaluated for impairment by comparing the current fair
value of each of the Company’s reporting units to their recorded value, including goodwill. If the fair value of the reporting units exceeds
the carrying value, no impairment is indicated. If the fair value of a reporting unit exceeds the carrying value, the second step of the
goodwill impairment test is performed to measure the amount of impairment loss, if any. The Company has determined that its homecare
and hospice businesses, which together make up its home-based services segment, each represent individual reporting units. The
operating components of the Company’s home-based services segment are the subsidiaries or joint ventures with individual licenses to
conduct homecare or hospice operations within geographic markets as limited by the terms of each license. The operating components
of the Company’s facility-based services segment are individual operating entities and the facility-based services segment is the reporting
unit. For purposes of evaluating goodwill for impairment, the Company aggregates the operating components that make up each
reporting unit.
The Company estimates the fair value of its identified reporting units using the discounted cash flow method and the market multiple
analysis method. These valuations require management to make estimates and assumptions regarding industry economic factors and the
profitability of future business strategies. Management considers historical experience and all available information at the time the fair
values of its reporting units are estimated. For each of the reporting units, the estimated fair value is determined based on a formula that
considers 50% of the estimated value based on a multiple of earnings before interest, taxes, depreciation and amortization plus 50%
of the estimated value using recent sales of comparable facilities. A change in the weight assigned to each methodology would not have
changed the conclusion that no impairment charge is necessary during the year ending December 31, 2012. The Company has not
recognized goodwill impairment charges in 2012, 2011 or 2010.
Included in intangible assets, net, are definite-lived assets subject to amortization such as non-compete agreements. Amortization of
definite-lived intangible assets is calculated on a straight-line basis over the estimated useful lives of the related assets.
The Company also has indefinite-lived assets that are not subject to amortization expense such as trade names, certificates of need and
licenses to conduct specific operations within geographic markets. The Company has concluded that trade names, certificates of need and
licenses have indefinite lives, because there are no legal, regulatory, contractual, economic or other factors that would limit the
useful life of these intangible assets and the Company intends to renew and operate the certificates of need, licenses and use these trade
names indefinitely. These indefinite-lived intangible assets are reviewed annually for impairment or more frequently if circumstances
indicate impairment may have occurred. To determine whether an indefinite-lived intangible asset is impaired, the Company performs a
qualitative assessment to support the conclusion that the indefinite-lived intangible asset is not impaired. Based on the results of that
qualitative assessment, the Company may perform a quantitative test. The quantitative impairment test on the trade names uses the
relief-from royalty method. Under this method, the fair value of the intangible asset is determined by calculating the present value of
the after-tax cost savings associated with owning the trade names and, therefore, not having to pay royalties for use over their estimated
Notes to Consolidated Financial Statements
Form 10-K Part IV
73
LHC GROUP
useful lives. The quantitative impairment test for certificates of need and licenses applies the cost approach. Under this method
assumptions are made about the cost to replace the certificates of need. During the twelve months ended December 31, 2012, the
Company recorded an impairment charge related to indefinite-lived intangible assets of $650,000. There were no impairment charges
recorded in 2011 or 2010.
Due to/from Governmental Entities
The Company’s LTACHs are reimbursed for certain activities based on tentative rates. The amounts recorded in due to/from governmental
entities on the Company’s consolidated balance sheets relate to settled and open cost reports that are subject to the completion of
audits and the issuance of final assessments. Final reimbursement is determined based on submission of annual cost reports and audits
by the fiscal intermediary. Adjustments are accrued on an estimated basis in the period the related services were rendered and further
adjusted as final settlements are determined. These adjustments are accounted for as changes in estimates. During the twelve months
ended December 31, 2012, the Company recorded adjustments related to cost report settlements and anticipated settlements which
reduced revenue in the facility-based segment by $1.0 million. There were no significant adjustments related to cost report settlements
recorded in 2011 or 2010.
Property, Building and Equipment
Property, building and equipment are stated at cost. Depreciation is computed using the straight-line method over the estimated useful
lives of the individual assets. Estimated useful lives for buildings is 39 years and ranges from 3 to 10 years for transportation equipment
and furniture and other equipment. The useful life for leasehold improvements is the lesser of the lease term or the expected life of the
leasehold improvement. Routine repairs and maintenance are expensed when incurred.
Property, building and equipment is reviewed whenever events or changes in circumstances occur that indicate possible impairment.
There were no impairments recognized during the periods ended December 31, 2012, 2011 or 2010.
The following table describes the Company’s components of property, building and equipment:
December 31,
Land
Building and improvements
Transportation equipment
Fixed equipment
Office furniture and medical equipment
Less accumulated depreciation
2012
2011
(In thousands)
$
673
6,109
6,232
3,516
47,332
63,862
34,331
$ 29,531
$
673
6,275
5,664
3,630
40,013
56,255
28,073
$ 28,182
Depreciation expense for the years ended December 31, 2012, 2011 and 2010 was $6.9 million, $6.6 million and $6.7 million, respectively.
The Company writes off assets that are fully depreciated and no longer in use.
Noncontrolling Interest
The nonredeemable interest held by third parties in subsidiaries owned or controlled by the Company is reported on the consolidated
balance sheets as noncontrolling interest as a component of stockholders’ equity. Redeemable interest held by third parties in subsidiaries
owned or controlled by the Company is reported on the consolidated balance sheets outside permanent equity. All noncontrolling
interest reported in the consolidated statements of operations reflects the respective interests in the income or loss after income taxes of
the subsidiaries attributable to the other parties, the effect of which is removed from the net income (loss) available to LHC Group, Inc.
74
Form 10-K Part IV
Notes to Consolidated Financial Statements
We build partnerships. With purpose.
Stock-Based Employee Compensation
The Company grants restricted stock or restricted stock units to employees and members of its Board of Directors as a form of
compensation. The expense for such awards is based on the grant date fair value of the award and is recognized on a straight-line basis
over the requisite service period. See Note 7 to these consolidated financial statements.
Earnings Per Share
Basic per share information is computed by dividing the item by the weighted-average number of shares outstanding during the period,
under the treasury stock method. Diluted per share information is computed by dividing the item by the weighted-average number of shares
outstanding plus dilutive potential shares.
The following table sets forth shares used in the computation of basic and diluted per share information for the years ended December 31,
2012, 2011 and 2010:
Weighted average number of shares outstanding for basic per share calculation
Effect of dilutive potential shares:
Options
Nonvested restricted stock
Adjusted weighted average shares for diluted per share calculation
Antidilutive shares
2012
2011
2010
17,853,321
18,265,118
18,119,183
1,909
43,965
17,899,195
—
—
18,265,118
5,368
101,540
18,226,091
345,122
316,928
153,290
Recent Accounting Pronouncements
In July 2012, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update 2012-02, Intangibles – Goodwill
and Other (Topic 350): Testing Indefinite-Lived Intangible Assets for Impairment allowing an entity to have the option to not calculate the fair
value of an indefinite-lived intangible asset if the entity determines that it is not more likely than not that the asset is impaired. The guidance
is effective for all interim and annual reporting periods after September 15, 2012. The adoption of the guidance did not have a material
impact on the Company’s operating results, financial position or liquidity.
3. Acquisitions and Disposals
2012 Acquisitions
Pursuant to its strategy for becoming the leading provider of post-acute health care services in the United States, the Company
acquired three home health entities during the twelve months ended December 31, 2012, and maintains an ownership interest in the
entities as set forth below:
Acquired Entity
Ownership Percentage
State of Operations
Acquisition Date
LHCG XXXIII, LLC
Methodist HomeCare
Acadian Homecare of New Iberia, LLC
70%
70%
100%
Texas
Texas
Louisiana
07/01/2012
07/01/2012
11/01/2012
Each of the acquisitions was accounted for under the acquisition method of accounting, and accordingly, the accompanying consolidated
financial statements include the results of operations of each acquired entity from the date of acquisition.
The total aggregate purchase price for the Company’s acquisitions was $5.1 million, which was paid primarily in cash. Purchase prices are
determined based on an analysis of comparable acquisitions and the target market’s potential future cash flows.
The Company’s home-based segment recognized aggregate goodwill of $4.4 million, including $902,000 of noncontrolling goodwill.
Goodwill generated from the acquisitions was recognized based on the expected contributions of each acquisition to the overall corporate
strategy. The Company expects its portion of goodwill to be fully tax deductible. The following table summarizes the aggregate
Notes to Consolidated Financial Statements
Form 10-K Part IV
75
LHC GROUP
consideration paid for the acquisitions and the amounts of the assets acquired and liabilities assumed at the acquisition dates, as well as
the fair value at the acquisition dates of the noncontrolling interest acquired (all amounts are in thousands):
Consideration
Cash
Fair value of total consideration transferred
Acquisition-related costs (included in general and administrative expenses)
Recognized amounts of identifiable assets acquired and liabilities assumed
Trade name
Certificates of need/license
Other identifiable intangible assets
Other assets and (liabilities)
Total identifiable assets
Noncontrolling interest
Goodwill, including noncontrolling interest of $902,000
$ 5,058
$ 5,058
$ 182
$ 1,895
519
63
(202)
$ 2,275
$ 1,636
$ 4,419
Trade names, certificates of need and licenses are indefinite-lived assets and, therefore, not subject to amortization. The other identifiable
assets include non-compete agreements that are amortized over the life of the agreements, ranging from two to five years.
Noncontrolling interest is valued at fair value by applying a discount to the value of the acquired entity for lack of control. The fair value of
the acquired intangible assets is preliminary pending the final valuations of those assets.
The following table contains unaudited pro forma consolidated income statement information assuming the 2012 acquisitions closed
January 1, 2011 (amount in thousands, except earnings per share):
Net service revenue
Operating income (loss)
Net income (loss)
Basic earnings per share
Diluted earnings per share
2012
2011
$ 641,911
52,909
26,246
1.47
1.47
$ 646,678
(6,030)
(14,102)
(0.77)
(0.77)
The pro forma disclosure in the table above includes adjustments for depreciation expense, amortization of intangible assets, income
tax expense and an estimate of additional costs to provide administrative services for these locations as if the acquisition had
occurred on January 1, 2011. This pro forma information is presented for illustrative purposes only and may not be indicative of the
results of operations that would have actually occurred. In addition, future results may vary significantly from the results reflected in
the pro forma information.
Sale of Membership Interest in Company’s Subsidiary
During the twelve months ended December 31, 2012, the Company sold membership interests in one of its wholly owned subsidiaries.
The total sales price was $80,000 for the sale of 40% membership interests and was accounted for as an equity transaction, resulting in
the Company increasing additional paid in capital by $80,000.
Purchase of Membership Interest in Company’s Subsidiary
During the twelve months ended December 31, 2012, the Company purchased additional membership interests in three of its joint
ventures. The total purchase price for the additional ownership from these equity transactions was $309,000, resulting in the Company
reducing noncontrolling interest-redeemable by $120,000 and additional paid in capital by $189,000.
2011 Acquisitions
The total purchase price for the Company’s acquisitions was $12.3 million, which was paid primarily in cash. Purchase prices were
determined based on an analysis of comparable acquisitions and the target market’s potential future cash flows. Consideration for one of
the acquisitions was a transfer of a 26.32% ownership interest in one of the Company’s wholly owned home health agencies. The transfer
of the noncontrolling interest in the Company’s existing home health agency was accounted for as an equity transaction, resulting in the
Company recognizing additional paid in capital of $206,000.
76
Form 10-K Part IV
Notes to Consolidated Financial Statements
We build partnerships. With purpose.
The Company’s home-based segment recognized goodwill of $7.4 million, including $658,000 of noncontrolling goodwill. Goodwill
generated from the acquisitions was recognized based on the expected contributions of each acquisition to the overall corporate strategy.
The Company expects its portion of goodwill to be fully tax deductible.
During the twelve months ended December 31, 2011, the Company purchased additional ownership interests in three of its joint ventures.
The total purchase price for the additional ownership was $891,000 and was accounted for as an equity transaction, resulting in the
Company reducing additional paid in capital by $641,000.
During the twelve months ended December 31, 2011, the Company sold membership interests in three of its wholly owned subsidiaries.
The total sales price was $308,000 for the sale of 26% membership interests and was accounted for as equity transactions, resulting in
the Company increasing additional paid in capital by $212,000.
During the twelve months ended December 31, 2011, the Company settled the working capital amounts acquired on a 2011 acquisition
paying $155,000 in cash related to the settlements.
2010 Acquisitions
Home-Based
The total purchase price of home-based acquisitions was $18.4 million, which was paid primarily in cash. The purchase prices were
determined based on the Company’s analysis of comparable acquisitions and the target market’s potential future cash flows.
The Company recognized goodwill of $11.2 million, including $663,000 of goodwill attributable to noncontrolling interests, related to
acquisitions made in 2010. The Company expects its portion of goodwill to be fully tax deductible.
During 2010, the Company purchased certain noncontrolling interest holders’ assigned interests in one of the Company’s joint ventures,
resulting in cash payments of $1.9 million and a decrease in additional paid in capital of $1.9 million.
On December 30, 2010, the Company paid $6.9 million in cash for three acquisitions with January 1, 2011 acquisition dates. Control was
not assumed until January 1, 2011; therefore, the $6.9 million cash payments were recorded as advance payment on acquisitions at
December 31, 2010.
One of the Company’s 2009 acquisitions provided for up to $2.5 million in contingent consideration to be paid to the seller if certain
financial measurements are achieved. The fair value of the contingent consideration recognized on the acquisition date was $1.7 million.
The fair value of the contingent consideration was estimated using the income approach based on financial projections of the acquired
company. The projected cash flows were discounted using a discount rate of London Interbank Offered Rate plus 100 basis points, which
the Company believes is appropriate and is representative of a market participant assumption. During the fourth quarter of 2010, the
Company paid $1.7 million to satisfy the contingent consideration obligation.
Facility-Based
The total purchase price of the facility-based acquisitions was $7.2 million, which was paid primarily in cash. The purchase price was
determined based on the Company’s analysis of comparable acquisitions and the target market’s potential future cash flows.
The Company recognized goodwill of $6.0 million related to the acquisitions, which is fully tax deductible.
During 2010, certain noncontrolling interest holders redeemed their interest in one of the Company’s joint ventures, resulting in a cash
payment of approximately $36,000. In connection with the partial redemption, the Company decreased noncontrolling interest
redeemable by approximately $41,000 and increased retained earnings by the same amount, representing the fair value at December 31,
2009 of the shares converted during the first quarter of 2010. Simultaneously, the Company recorded goodwill of $36,000, which
is not deductible for income tax purposes, to represent the value of the noncontrolling interest redeemed. As of December 31, 2010,
all noncontrolling interest associated with this joint venture had been redeemed.
Notes to Consolidated Financial Statements
Form 10-K Part IV
77
LHC GROUP
4. Goodwill and Other Intangibles, Net
In accordance with applicable accounting standards, the Company performed an impairment analysis on its indefinite-lived intangible
assets related to the Company’s trade names, licenses and certificates of need to determine the fair values as of September 30, 2012.
Lower revenue expectations caused primarily by projected Medicare reimbursement cuts reduced the fair values of certain intangible
assets below their carrying values. Based on that analysis, the Company recorded an impairment charge of $650,000 for the year ended
December 31, 2012 which is included in general and administrative expenses.
As a result of the impairment charge, the carrying values of the related intangible assets were adjusted to their estimated fair values as
of September 30, 2012. Any further decline in the estimated fair values of these intangibles could result in additional impairment charges
being recorded. The Company determined that except for the impairment charges described above, no other intangible assets were
impaired at December 31, 2012.
The Company determined that there was no impairment for the goodwill of any reporting units as of December 31, 2012.
The following table summarizes the changes in goodwill by segment during the twelve months ended December 31, 2012 (amounts
in thousands):
Home-based services segment:
Balances at beginning of period
Goodwill from acquisitions
Goodwill related to noncontrolling interest
Home-based balance at end of period
Facility-based services segment:
Balances at beginning of period
Facility-based balance at end of period
Consolidated balance at end of period
2012
2011
$ 153,140
3,517
902
157,559
$ 11,591
11,591
$ 169,150
$ 145,747
6,735
658
153,140
$ 11,591
11,591
$ 164,731
The following table summarizes the changes in intangible assets during the twelve months ended December 31, 2012 (amounts
in thousands):
Balance at December 31, 2011
Additions
Amortization
Other (1)
Balance at December 31, 2012
Trade Names
Certificate of
Need/License
Other
Intangibles
$ 49,840
1,895
—
(327)
$ 51,408
$ 8,502
2,135
—
(537)
$ 10,100
$ 1,047
147
(660)
—
$ 534
Total
$ 59,389
4,177
(660)
(864)
$ 62,042
(1) Includes a non-cash impairment charge of $650,000 and $214,000 to reduce the intangible assets due to the closure of an agency. Of these costs $464,000 was allocated to
the home-based services segment and $400,000 was allocated to the facility-based services segment.
Intangible assets of $60.5 million, net of accumulated amortization, related to the home-based services segment and $1.5 million related
to the facility-based services segment as of December 31, 2012.
During the twelve months ended December 31, 2012, the Company purchased a certificate of need which was previously leased and
entered into a noncompete agreement for $1.7 million, primarily paid in cash. This asset acquisition was allocated among certificate of
need and noncompete agreement in the home-based services segment. The certificate of need has an indefinite useful life and will not be
subject to amortization. The noncompete agreement will be amortized over the life of the agreement, which is three years.
78
Form 10-K Part IV
Notes to Consolidated Financial Statements
We build partnerships. With purpose.
5. Income Taxes
The Company accounts for income taxes using the asset and liability method. Under the asset and liability method, deferred taxes are
determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the
enacted tax laws that will be in effect when the differences are expected to reverse.
Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2012 and 2011 were as follows:
Deferred tax assets:
Allowance for uncollectible accounts
Accrued employee benefits
Stock compensation
Accrued self-insurance
Acquisition costs
Net operating loss carry forward
Valuation allowance
Dividend received deduction
Intangible asset impairment
Litigation reserve
Uncertain tax position—state tax portion
Charitable contribution carryforward
Other
Deferred tax assets
Deferred tax liabilities:
Amortization of intangible assets
Tax depreciation in excess of book depreciation
Prepaid expenses
Non-accrual experience accounting method
Conversion from cash basis accounting
Deferred state tax receivable
Deferred tax liabilities
Net deferred tax liability
2012
2011
(In thousands)
$ 3,901
3,250
1,593
2,097
861
779
(44)
—
60
31
215
—
489
$ 13,232
(21,455)
(7,007)
(765)
(1,302)
—
(161)
(30,690)
$ 3,582
2,665
1,362
2,161
650
542
(44)
(78)
66
41
215
17
—
$ 11,179
(17,508)
(7,182)
(655)
(968)
(120)
—
(26,433)
$ (17,458)
$ (15,254)
Based on the Company’s historical pattern of taxable income, the Company believes it will produce sufficient income in the future to
realize its deferred income tax assets. Management provides a valuation allowance for any net deferred tax assets when it is more likely
than not that a portion of such net deferred tax assets will not be recovered.
The components of the Company’s income tax expense (benefit) from continuing operations, less noncontrolling interest, were as follows:
Current:
Federal
State
Deferred:
Federal
State
Total income tax expense (benefit)
2012
2011
2010
(In thousands)
$ 12,930
2,377
15,307
1,955
249
2,204
$ 17,511
$ (5,924)
(636)
(6,560)
4,545
47
4,592
$ (1,968)
$ 24,811
4,145
28,956
2,520
251
2,771
$ 31,727
Notes to Consolidated Financial Statements
Form 10-K Part IV
79
LHC GROUP
A reconciliation of the differences between income taxes expense on net income attributable to LHC Group, Inc., computed at the federal
statutory rate and provisions for income taxes for each period is as follows:
Income taxes computed at federal statutory tax rate
State income taxes, net of federal benefit
Reduction in valuation allowance
Nondeductible expenses
Uncertain tax position
Other items
Income tax credits
Total income tax expense (benefit)
2012
2011
2010
$ 15,733
1,739
—
844
—
40
(845)
$ 17,511
(In thousands)
$ (5,232)
(443)
(392)
675
3,200
437
(213)
$ (1,968)
$ 28,170
2,984
(193)
766
—
—
—
$ 31,727
The Company is subject to both federal and state income tax for jurisdictions within which it operates. Within these jurisdictions, the
Company is open to examination for tax years ended after December 31, 2009.
As of December 31, 2012, $3.4 million was recorded in income tax payable as an unrecognized tax benefit which, if recognized, would
decrease the Company’s effective tax rate. A reconciliation of the total amounts of unrecognized tax benefits follows:
Total unrecognized tax benefits as of December 31, 2011
Increases (decreases) in unrecognized tax benefits as a result of:
Tax positions taken during the current period
Total unrecognized tax benefits as of December 31, 2012
$ 3,415
—
$ 3,415
The Company recognizes interest and penalties related to uncertain tax positions in interest expense and general and administrative
expenses, respectively. During the year ended December 31, 2012, the Company recognized $132,000 in interest expense and no
penalties in its consolidated financial statements, and recorded an accrued liability of interest payments related to uncertain tax positions.
During the years ended December 31, 2011 and 2010, the Company did not recognize any interest or penalties in its consolidated
financial statements and did not record an accrued liability of interest or penalty payments related to uncertain tax positions.
6. Credit Facility
On August 31, 2012 the Company entered into a Third Amended and Restated Credit Agreement (the “Credit Facility”). The Credit
Facility is unsecured and provides for a maximum aggregate principal borrowing of $100 million (with a letter of credit sub-limit equal to
$15 million). The Credit Facility is scheduled to expire on August 31, 2015. A fee of 0.5% is charged for any unused amounts. A letter
of credit fee equal to the applicable LIBOR margin times the face amount of the letter of credit is charged upon the issuance and on each
anniversary date while the letter of credit is outstanding. The agent’s standard up-front fee and other customary administrative charges
will also be due upon issuance of the letter of credit along with a renewal fee on each anniversary date of such issuance while the letter of
credit is outstanding. The interest rate for borrowings under the Credit Facility is a function of the prime rate (base rate) or LIBOR rate,
as elected by the Company, plus the applicable margin based on the Leverage Ratio, as defined in the agreement.
As of December 31, 2012 the Company had $19.5 million drawn and letters of credit in the amount of $6.0 million outstanding under the
Credit Facility. The interest rate at December 31, 2012 was 4.25%.
The Company paid $1.0 million of credit fees on the Credit Facility during 2012. The Company issues letters of credit as collateral on its
workers’ compensation insurance. At December 31, 2012 and 2011, outstanding letters of credit under this program were $6.0 million
and $3.8 million, respectively.
The Credit Facility contains customary affirmative, negative and financial covenants. For example, the Company is restricted in incurring
additional debt, disposing of assets, making investments, allowing fundamental changes to the Company’s business or organization, making
certain payments in respect of stock or other ownership interests, such as dividends, and stock repurchases in excess of $50.0 million.
Under the Credit Facility, the Company is also required to meet certain financial covenants with respect to minimum fixed charge coverage,
consolidated net worth and leverage ratios. At December 31, 2012, the Company believes it was in compliance with all covenants.
80
Form 10-K Part IV
Notes to Consolidated Financial Statements
We build partnerships. With purpose.
The Credit Facility also contains customary events of default. These include bankruptcy and other insolvency events, cross-defaults to
other debt agreements, a change in control involving the Company or any subsidiary guarantor, and the failure to comply with covenants.
7. Stockholders’ Equity
Stock Repurchase Program
In October 2010, the Company’s Board of Directors authorized a program to repurchase shares of the Company’s common stock, par
value $0.01 per share, from time to time, in an amount not to exceed $50.0 million (“Stock Repurchase Program”). The Company
anticipates that it will finance the Stock Repurchase Program with cash from general corporate funds, or draws under the Credit Facility.
The Company may repurchase shares of common stock in open market purchase or in privately negotiated transactions in accordance
with applicable securities laws, rules and regulations. The timing and extent to which the Company repurchases its shares will depend upon
market conditions and other corporate considerations.
The Company uses the cost method to account for the repurchase of common stock and the average cost method to account for
reissuance of treasury shares. During the twelve months ended December 31, 2012, the Company repurchased 1,540,813 shares of
common stock at an aggregate cost of $27.0 million, including commissions, or an average cost per share of $17.52. During the
twelve months ended December 31, 2011, we repurchased 24,159 shares of common stock at an aggregate cost of $577,000, including
commissions, or an average cost per share of $23.93. The remaining dollar value of shares authorized to be purchased under the share
repurchase program is $22.5 million at December 31, 2012.
Equity Based Awards
At the Company’s 2010 Annual Meeting of Stockholders, the stockholders of the Company approved the Company’s 2010 Long Term
Incentive Plan (the “2010 Incentive Plan”). The 2010 Incentive Plan is administered by the Compensation Committee of the Company’s
Board of Directors (the “Compensation Committee”). A total of 1,500,000 shares of the Company’s common stock are reserved and
available for issuance pursuant to awards granted under the 2010 Incentive Plan. A variety of discretionary awards for employees, officers,
directors and consultants are authorized under the 2010 Incentive Plan, including incentive or non-qualified statutory stock options and
nonvested stock. All awards must be evidenced by a written award certificate which will include the provisions specified by the
Compensation Committee. The Compensation Committee will determine the exercise price for non-statutory stock options, which cannot
be less than the fair market value of our common stock as of the date of grant.
In the event of a change of control as defined in the 2010 Incentive Plan, all restricted periods and restrictions imposed on non-performance
based restricted stock awards will lapse and outstanding options will become immediately exercisable in full.
Share Based Compensation
Stock Options
The following table represents stock options activity for the year ended December 31, 2012:
Options outstanding at January 1, 2012
Options granted
Options exercised
Options forfeited or expired
Options outstanding at December 31, 2012
Options exercisable at December 31, 2012
Number
of Shares
15,000
—
—
—
15,000
15,000
Weighted
Average
Average
Remaining
Exercise Price Contractual Term
Aggregate
Intrinsic
Value
$ 16.88
—
—
—
$ 16.88
$ 16.88
4.0 years
—
—
—
3.0 years
3.0 years
$
—
—
—
—
$
—
$ 66,375
All options are fully vested and exercisable at December 31, 2012. There were no options granted and no compensation expense related
to stock options grants recorded in the years ended December 31, 2012, 2011 or 2010.
Non-vested Stock
The Company issues stock-based compensation to employees in the form of non-vested stock, which is an award of common stock
subject to certain restrictions. The awards, which the Company calls non-vested shares, generally vest over a five year period, conditioned
on continued employment for the full incentive period. Compensation expense for the non-vested stock is recognized for the awards that
Notes to Consolidated Financial Statements
Form 10-K Part IV
81
LHC GROUP
are expected to vest. The expense is based on the fair value of the awards on the date of grant recognized on a straight-line basis over
the requisite service period, which generally relates to the vesting period.
During 2012, 2011 and 2010, respectively, 187,140, 139,470 and 20,000 non-vested shares were granted to employees pursuant to the
2010 Incentive Plan. During 2010, 130,755 non-vested shares were granted to employees pursuant to the 2005 Long-Term Incentive
Plan. No further awards can be granted under the 2005 Long-Term Incentive Plan. Shares granted generally vest over a five year period.
The Company also issues non-vested stock to its independent directors of the Company’s Board of Directors. During 2012, 2011 and
2010, respectively, 26,100, 15,200 and 18,700 non-vested shares of stock were granted to the independent directors under the 2005
Director Compensation Plan. The shares issued under the 2005 Director Compensation Plan were drawn from the 1,500,000 shares
reserved and available for issuance under the 2010 Incentive Plan. The shares fully vest one year from the date of the grant.
The fair value of non-vested shares is determined based on the closing trading price of the Company’s shares on the grant date. The
weighted average grant date fair values of non-vested shares granted during the years ended December 31, 2012, 2011 and 2010 were
$19.02, $26.37 and $30.01, respectively.
The following table represents the non-vested stock activity for the year ended December 31, 2012:
Non-vested shares outstanding at January 1, 2012
Granted
Vested
Forfeited
Non-vested shares outstanding at December 31, 2012
Number
of Shares
494,995
213,240
(153,743)
(68,431)
486,061
Weighted
Average
Grant Date
Fair Value
$ 24.17
$ 19.02
$ 24.54
$ 24.30
$ 22.33
As of December 31, 2012, there was $7.9 million of total unrecognized compensation cost related to non-vested shares granted. That
cost is expected to be recognized over the weighted average period of 3.1 years. The total fair value of shares vested in the years ended
December 31, 2012, 2011 and 2010 were $3.7 million, $3.9 million and $2.8 million, respectively. The Company records compensation
expense related to non-vested share awards at the grant date for shares that are awarded fully vested and over the vesting term on a
straight line basis for shares that vest over time. The Company has recorded $4.4 million, $4.1 million and $3.7 million in compensation
expense related to non-vested stock grants in the years ended December 31, 2012, 2011 and 2010, respectively.
Employee Stock Purchase Plan
In 2006, the Company adopted the Employee Stock Purchase Plan allowing eligible employees to purchase the Company’s common
stock at 95% of the market price on the last day of each calendar quarter. There were 250,000 shares reserved for the plan. The table
below details the shares issued during 2012, 2011 and 2010 under the Employee Stock Purchase Plan.
Shares available as of January 1, 2009
Shares issued in 2010
Shares issued in 2011
Shares issued in 2012
Shares available as of December 31, 2012
Treasury Stock
Weighted
Average
Grant Date
Fair Value
$ 28.04
$ 23.40
$ 15.58
Number
of Shares
178,231
28,508
38,291
50,185
61,247
In conjunction with the vesting of the non-vested shares of stock, recipients incur personal income tax obligations. The Company
allows the recipients to turn in shares of common stock to satisfy those personal tax obligations. The Company redeemed 36,621,
43,182 and 31,531 shares of common stock related to these tax obligations during the years ended December 31, 2012, 2011 and
2010, respectively.
82
Form 10-K Part IV
Notes to Consolidated Financial Statements
We build partnerships. With purpose.
Issuance of Common Stock
During the year ending December 31, 2010, the Company issued 29,988 shares of the Company’s common stock, valued at $950,000,
as settlement of contingent consideration on one of the Company’s 2008 acquisitions. The shares were contingent upon the acquired
company achieving certain financial measurements in the year after acquisition. The acquired company achieved the financial measurements
and the Company remitted the contingent consideration to the seller.
The Company also issued 20,162 shares, valued at $600,000 during the year ending December 31, 2010 as consideration for one of the
Company’s acquisitions.
8. Leases
In certain instances, state laws may prohibit the sale of a home nursing agency or hospitals may be reluctant to sell their home health
agencies. In these instances, the Company, through its wholly owned subsidiaries, enters into a lease agreement for a Medicare and
Medicaid license, as well as the associated provider number to provide home health or hospice services. As of December 31, 2012, the
Company had three license lease arrangements to operate four home nursing agencies and three hospice agencies.
One of the leases was entered into in 2007 and expires in 2017. Expense related to this lease was $210,000, $245,000 and $268,000 for
the years ended December 31, 2012, 2011, and 2010, respectively. Payment due under this lease is $220,500 in 2013.
Two of the leases were amended during 2010 to extend the lease terms to one year with an automatic renewal clause of four years.
Expense related to these leases was $269,176, $135,892 and $201,690 for the years ended December 31, 2012, 2011 and 2010,
respectively. The lease payments associated with these leases are based on a percentage of net quarterly profits; therefore, the future
payments will vary with the future profits.
The Company leases office space and equipment at its various locations. Many of the leases contain renewal options with varying terms
and conditions. Management expects that in the normal course of business, expiring leases will be renewed or, upon making a
decision to relocate, replaced by leases for new locations. Operating lease terms range from three to ten years. Rent expense includes
insurance, maintenance, and other costs as required by the lease. Total rental expense was approximately $17.3 million, $17.3 million and
$15.0 million for the years ended December 31, 2012, 2011 and 2010, respectively. Future minimum rental commitments under
non-cancelable operating leases are as follows (in thousands):
2013
2014
2015
2016
2017
Thereafter
9. Employee Benefit Plan
Defined Contribution Plan
$ 13,332
8,570
4,889
2,450
755
1,437
$ 31,433
The Company sponsors a 401(k) plan to all eligible full-time employees. The plan allows participants to contribute up to 15% of their
compensation and allows discretionary Company contributions as determined by the Company’s Board of Directors. Effective January 1,
2006, the Company implemented a discretionary match of up to two percent of participating employee contributions. The employer
contribution will vest 20% after two years and 20% each additional year until it is fully vested in year six. Contribution expense to the
Company was $1.7 million, $3.4 million and $2.9 million in 2012, 2011 and 2010, respectively. During the twelve months ended
December 31, 2012, the Company applied $2.0 million in forfeitures which reduced the Company’s contribution expense.
Notes to Consolidated Financial Statements
Form 10-K Part IV
83
LHC GROUP
10. Commitments and Contingencies
Contingencies
The Company is involved in various legal proceedings arising in the ordinary course of business. Although the results of litigation cannot
be predicted with certainty, management believes the outcome of pending litigation will not have a material adverse effect, after
considering the effect of the Company’s insurance coverage, on the Company’s consolidated financial statements.
On July 16, 2010, the Company received a subpoena from the Securities and Exchange Commission (“SEC”) that included a request for
documents related to the Company’s participation in the Medicare Home Health Prospective Payment System. The Company produced
the documents requested by the initial subpoena, produced additional documents requested by the SEC as part of its review, and
cooperated fully with the SEC’s review. On December 3, 2012, the Company was advised by the SEC that its investigation was complete
and that it did not intend to recommend any enforcement action against the Company.
On October 17, 2011, the Company received a subpoena from the Department of Health and Human Services Office of Inspector General
(the “OIG”). The subpoena requested documents related to the Company’s agencies in Oregon, Washington and Idaho. The Company
has produced all documents requested by the OIG and has fully cooperated with the OIG’s review. The Company cannot predict the
outcome or effect of this review, if any, on the Company’s business.
On June 13, 2012, a putative shareholder securities class action was filed against the Company and its Chairman and Chief Executive
Officer in the United States District Court for the Western District of Louisiana, styled City of Omaha Police & Fire Retirement System v.
LHC Group, Inc., et al., Case No. 6:12-cv-01609-JTT-CMH. The action was filed on behalf of LHC shareholders who purchased shares
between July 30, 2008 and October 26, 2011. Plaintiff generally alleges that the defendants caused false and misleading statements
to be issued in violation of Section 10(b) of the Securities Exchange Act of 1934 (“Exchange Act”) and Rule 10b-5 promulgated thereunder
and that the Company’s Chairman and Chief Executive Officer is a control person under Section 20(a) of the Exchange Act. On November 2,
2012, Lead Plaintiff City of Omaha Police & Fire Retirement System filed an Amended Complaint for Violations of the Federal Securities
Laws (“Amended Complaint”) on behalf of the same putative class of LHC shareholders as the original Complaint. In addition to claims
under Sections 10(b) and 20(a) of the Exchange Act, the Amended Complaint added a claim against the Chairman and Chief Executive
Officer for violation of Section 20A of the Exchange Act. The Company believes these claims are without merit and intends to defend this
lawsuit vigorously. On December 17, 2012, the Company and the Chairman and Chief Executive Officer filed a motion to dismiss
the Amended Complaint, which was denied by Order dated March 15, 2013. The Company cannot predict the outcome or effect of this
lawsuit, if any, on the Company’s business.
Except as discussed above, the Company is not aware of any pending or threatened investigations involving allegations of
potential wrongdoing.
Any negative findings in the investigations or lawsuits could result in substantial financial penalties or awards against the Company or
exclusion from future participation in the Medicare and Medicaid programs. At this time, the Company cannot predict the ultimate
outcome of these inquiries or the potential range of damages, if any.
Settlement Agreement with the United States of America
On September 30, 2011, the Company announced that it had entered into a settlement agreement with the United States government to
resolve an investigation the Company first announced on July 13, 2009. The investigation resulted from a qui tam complaint filed by a
relator against the Company under the whistleblower provisions of the False Claims Act, 31 U.S.C. sections 3729-3733. Pursuant to the
settlement agreement, the Company paid the United States $65 million (“settlement amount”) in a single lump sum payment. In exchange
for the payment of the settlement amount, the United States and the relator released the Company from any civil or administrative
monetary claim under the False Claim Act for the covered conduct. The released covered conduct includes claims involving home health
services rendered by the Company from 2006 to 2008 with regard to whether such home health services were either not medically
necessary or were delivered to patients who were not homebound. The OIG also agreed to release and refrain from instituting, directing or
maintaining any administrative action seeking to exclude the Company from Medicare, Medicaid and other federal health care programs
with respect to the covered conduct described above.
The government did not find that all aspects of the relator’s complaint deserved intervention, including homebound and medical necessity
claims for 2005 and coding related claims for 2005 through 2008. As previously reported, the Company reached an agreement in principle
84
Form 10-K Part IV
Notes to Consolidated Financial Statements
We build partnerships. With purpose.
to settle these non-intervened claims for $1.0 million with the relator and the government. On April 30, 2012, the Company entered into
the final settlement agreement documenting the agreement in principle for these non-intervened claims.
Effective September 29, 2011, the Company entered into a five year Corporate Integrity Agreement (“CIA”) with the OIG. The CIA
formalizes various aspects of the Company’s already existing ethics and compliance programs and contains other requirements designed
to help ensure Company’s ongoing compliance with federal health care program requirements.
Joint Venture Buy/Sell Provisions
Most of the Company’s joint ventures include a buy/sell option that grants to the Company and its joint venture partners the right to
require the other joint venture party to either purchase all of the exercising member’s membership interests or sell to the exercising
member all of the non-exercising member’s membership interest, at the non-exercising member’s option, within 30 days of the receipt of
notice of the exercise of the buy/sell option. In some instances, the purchase price is based on a multiple of the historical or future
earnings before income taxes and depreciation and amortization of the equity joint venture at the time the buy/sell option is exercised. In
other instances, the buy/sell purchase price will be negotiated by the partners and subject to a fair market valuation process. The
Company has not received notice from any joint venture partners of their intent to exercise the terms of the buy/sell agreement nor has the
Company notified any joint venture partners of its intent to exercise the terms of the buy/sell agreement.
Compliance
The laws and regulations governing the Company’s operations, along with the terms of participation in various government programs,
regulate how the Company does business, the services offered and its interactions with patients and the public. These laws and
regulations and their interpretations, are subject to frequent change. Changes in existing laws or regulations, or their interpretations, or the
enactment of new laws or regulations could materially and adversely affect the Company’s operations and financial condition.
The Company is subject to various routine and non-routine governmental reviews, audits and investigations. In recent years, federal
and state civil and criminal enforcement agencies have heightened and coordinated their oversight efforts related to the health care
industry, including referral practices, cost reporting, billing practices, joint ventures and other financial relationships among health care
providers. Violation of the laws governing the Company’s operations, or changes in the interpretation of those laws, could result in the
imposition of fines, civil or criminal penalties, and/or termination of the Company’s rights to participate in federal and state-sponsored
programs and suspension or revocation of the Company’s licenses. The Company believes that it is in material compliance with all
applicable laws and regulations.
11. Segment Information
The Company’s segments consist of (a) home-based services and (b) facility-based services. Home-based services include home
nursing services and hospice services. Facility-based services include long-term acute care services. The accounting policies of the
segments are the same as those described in the summary of significant accounting policies.
Net service revenue
Cost of service revenue
Provision for bad debts
General and administrative expenses
Operating income
Interest expense
Non operating income, including gain on sale of assets
Income from continuing operations before income taxes and noncontrolling interest
Income tax expense
Income from continuing operations
Noncontrolling interest
Net income attributable to LHC Group, Inc.’s common stockholders
Total assets
Year Ended December 31, 2012
Home-Based
Services
Facility-Based
Services
Total
(In thousands)
$ 563,741
322,189
10,593
184,125
46,834
1,356
133
45,611
15,457
30,154
6,964
$ 23,190
$ 349,740
$ 73,828
43,563
1,282
21,512
7,471
194
51
7,328
2,054
5,274
1,024
$ 4,250
$ 37,154
$ 637,569
365,752
11,875
205,637
54,305
1,550
184
52,939
17,511
35,428
7,988
$ 27,440
$ 386,894
Notes to Consolidated Financial Statements
Form 10-K Part IV
85
LHC GROUP
Year Ended December 31, 2011
Home-Based
Services
Facility-Based
Services
Total
(In thousands)
Net service revenue
Cost of service revenue
Provision for bad debts
Settlement with government agencies
General and administrative expenses
Operating income (loss)
Interest expense
Non operating income, including gain on sale of assets
Income (loss) from continuing operations before income taxes and noncontrolling interest
Income tax expense (benefit)
Income (loss) from continuing operations
Noncontrolling interest
Net income (loss) attributable to LHC Group, Inc.’s common stockholders
Total assets
$ 557,901
307,744
11,680
65,000
190,264
(16,787)
914
1,645
(16,056)
(4,201)
(11,855)
8,404
$ (20,259)
$ 360,340
$ 75,971
44,602
640
—
20,324
10,405
104
136
10,437
2,233
8,204
1,189
$ 7,015
$ 36,036
$ 633,872
352,346
12,320
65,000
210,588
(6,382)
1,018
1,781
(5,619)
(1,968)
(3,651)
9,593
$ (13,244)
$ 396,376
Year Ended December 31, 2010
Home-Based
Services
Facility-Based
Services
Total
Net service revenue
Cost of service revenue
Provision for bad debts
General and administrative expenses
Operating income
Interest expense
Non operating income, including gain on sale of assets
Income from continuing operations before income taxes and noncontrolling interest
Income tax expense
Income from continuing operations
Noncontrolling interest
Net income attributable to LHC Group, Inc.’s common stockholders
Total assets
$ 555,110
281,013
7,078
182,750
84,269
(116)
746
84,899
28,613
56,286
14,170
$ 42,116
$ 319,447
(In thousands)
$ 76,457
45,508
529
19,087
11,333
(18)
59
11,374
3,114
8,260
1,617
$ 6,643
$ 37,858
$ 631,567
326,521
7,607
201,837
95,602
(134)
805
96,273
31,727
64,546
15,787
$ 48,759
$ 357,305
12. Fair Value of Financial Instruments
The carrying amounts of the Company’s cash, receivables, accounts payable and accrued liabilities approximate their fair values because
of their short maturity. For the year ended December 31, 2012, the carrying value of the Company’s long-term debt was based on the
current interest rates and approximates its fair value.
13. Allowance for Uncollectible Accounts
The following table summarizes the activity and ending balances in the allowance for uncollectible accounts:
Year ended December 31:
2012
2011
2010
Beginning of
Year Balance
Additions
and Expenses
Deductions
End of Year
Balance
(In thousands)
$ 10,692
9,769
8,262
$ 11,875
12,320
7,607
$ 10,704
11,397
6,100
$ 11,863
10,692
9,769
86
Form 10-K Part IV
Notes to Consolidated Financial Statements
We build partnerships. With purpose.
14. Concentration of Risk
The Company’s Louisiana facilities accounted for approximately 28.5%, 31.1% and 33.0% of net service revenue during the years ended
December 31, 2012, 2011 and 2010, respectively. Any material change in the current economic or competitive conditions in Louisiana
could have a disproportionate effect on the Company’s overall business results.
15. Unaudited Summarized Quarterly Financial Information
The following table presents the Company’s unaudited quarterly results of operations (amounts in thousands, except share data):
Net service revenue
Gross margin
Net income attributable to LHC Group, Inc.’s common stockholders
Basic earnings per share:
Net income attributable to LHC Group, Inc.’s common stockholders
Diluted earnings per share:
Net income attributable to LHC Group, Inc.’s common stockholders
Weighted average shares outstanding:
Basic
Diluted
First Quarter
2012
Second Quarter Third Quarter Fourth Quarter
2012
2012
2012
$
$
$
158,761
68,902
7,741
0.42
0.42
$
$
$
158,055
65,837
5,963
$ 158,926
67,692
6,336
$ 161,827
69,386
7,400
0.32
0.32
$
$
0.36
0.36
$
$
0.43
0.43
18,333,838
18,399,608
18,385,783
18,423,258
17,656,842
17,726,819
17,056,611
17,155,909
First Quarter
2011
Second Quarter Third Quarter Fourth Quarter
2011
2011
2011
$
Net service revenue
Gross margin
Net income (loss) attributable to LHC Group, Inc.’s common stockholders
Basic earnings per share:
Net income (loss) attributable to LHC Group, Inc.’s
common stockholders
Diluted earnings per share:
Net income (loss) attributable to LHC Group, Inc.’s
common stockholders
Weighted average shares outstanding:
Basic
Diluted
$
$
161,783
72,827
7,694
$
161,015
74,799
9,788
$ 153,398
65,583
(37,960)
$ 157,676
68,317
7,234
0.42
$
0.54
$
(2.08)
$
0.40
0.42
$
0.53
$
(2.08)
$
0.39
18,215,831
18,351,637
18,278,479
18,346,441
18,263,237
18,263,237
18,296,062
18,353,505
Because of the method used to calculate per share amounts, quarterly per share amounts may not necessarily total to the per share
amounts for the entire year.
Notes to Consolidated Financial Statements
Form 10-K Part IV
87
LHC GROUP
SIGNATURES
Pursuant to the requirements of Section 13 or 15 (d) of the Securities Exchange Act of 1934, the registrant has duly caused this report to
be signed on its behalf by the undersigned thereunto duly authorized.
LHC GROUP, INC.
/s/ KEITH G. MYERS
Keith G. Myers
Chief Executive Officer
March 18, 2013
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that each person whose signature appears below constitutes and appoints Keith G. Myers and
Peter J. Roman and either of them (with full power in each to act alone) as true and lawful attorneys-in-fact with full power of substitution,
for him and in his name, place and stead, in any and all capacities, to sign any and all amendments to this Annual Report on Form 10-K
and to file the same, with all exhibits thereto and other documents in connection therewith, with the Securities and Exchange Commission,
hereby ratifying and confirming all that said attorneys-in-fact, or their substitute or substitutes, may lawfully do or cause to be done by
virtue hereof.
Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been signed by the following persons on behalf of
the registrant and in the capacities and on the dates indicated.
Signature
Title
Date
/s/ KEITH G. MYERS
Keith G. Myers
/s/ PETER J. ROMAN
Chief Executive Officer and Chairman of the Board of Directors
March 18, 2013
Peter J. Roman
Executive Vice President, Chief Financial Officer, Principal Accounting Officer
March 18, 2013
/s/ MONICA F. AZARE
Monica F. Azare
Director
/s/ JOHN B. BREAUX
John B. Breaux
Director
/s/ TED W. HOYT
Ted W. Hoyt
/s/ JOHN L. INDEST
John L. Indest
Director
Director
/s/ GEORGE A. LEWIS
George A. Lewis
Director
/s/ RONALD T. NIXON
Ronald T. Nixon
Director
/s/ W.J. “BILLY” TAUZIN
W.J. “Billy” Tauzin
Director
/s/ KENNETH E.THORPE
Kenneth E. Thorpe
Director
/s/ DAN S. WILFORD
Dan S. Wilford
Director
/s/ CHRIS S. SHACKELTON
Chris S. Shackelton
Director
88
Form 10-K Part IV
March 18, 2013
March 18, 2013
March 18, 2013
March 18, 2013
March 18, 2013
March 18, 2013
March 18, 2013
March 18, 2013
March 18, 2013
March 18, 2013
We build partnerships. With purpose.
EXHIBIT INDEX
Exhibit
Number
Description of Exhibits
3.1
Certificate of Incorporation of LHC Group, Inc. (previously filed as Exhibit 3.1 to LHC Group’s Form S-1/A (File No. 333-120792)
filed on February 14, 2005).
3.2
Bylaws of LHC Group, Inc., as amended on December 3, 2007 (previously filed as Exhibit 3.2 to LHC Group’s Form 10-Q
for the quarterly period ended March 31, 2008, filed on May 9, 2008).
4.1
Specimen Stock Certificate of LHC Group’s Common Stock, par value $0.01 per share (previously filed as Exhibit 4.1 to
LHC Group’s Form S-1/A (File No. 333-120792) filed on February 14, 2005).
10.1
LHC 2003 Key Employee Equity Participation Plan (previously filed as Exhibit 10.3 to LHC Group’s Form S-1 (File No.
333-120792) filed on November 26, 2004). +
10.2
LHC Group, Inc. 2005 Long-Term Incentive Plan (previously filed as Exhibit 10.4 to the Form S-1/A (File No. 333-120792) filed
on February 14, 2005). +
10.3
LHC Group, Inc. 2010 Long-Term Incentive Plan (previously filed as Exhibit 10.1 to LHC Group’s Form 10-Q for the quarterly
period ended June 30, 2010, filed on August 6, 2010).
10.4
Form of Award under LHC Group, Inc. 2005 Director Compensation Plan. (previously filed as Exhibit 10.11 to LHC Group’s
Form S-1/A (File No. 333-120792) filed on February 14, 2005). +
10.5
Form of Indemnity Agreement between LHC Group and directors and certain officers (previously filed as Exhibit 10.10 to the
Form S-1/A (File No. 333-120792) filed on February 14, 2005). +
10.6
LHC Group, Inc. 2005 Director Compensation Plan (previously filed as Exhibit 10.5 to LHC Group’s Form S-1/A (File
No. 333-120792) filed on February 14, 2005). +
10.7
Amendment to the LHC Group, Inc. Amended and Restated 2005 Non-Employee Directors Compensation Plan (previously
filed as Exhibit 99.1 to LHC Group’s Form 8-K filed on June 16, 2006).
10.8
LHC Group, Inc. 2006 Employee Stock Purchase Plan (previously filed as Exhibit 99.2 to LHC Group’s Form 8-K filed on
June 16, 2006). +
10.9
Amended and Restated Employment Agreement between Donald D. Stelly and LHC Group, Inc. , dated August 27, 2010
(previously filed as Exhibit 10.1 to LHC Group’s Form 8-K filed on August 30, 2010). +
10.10
Amended and Restated Employment Agreement between LHC Group, Inc. and Keith G. Myers, dated January 1, 2011
(previously filed as Exhibit 10.1 to LHC Group’s Form 8-K filed on January 6, 2011 ). +
10.11
Amended and Restated Employment Agreement by and between LHC Group, Inc. and Peter J. Roman, dated January 1, 2011
(previously filed as Exhibit 10.2 to LHC Group’s Form 8-K filed on January 6, 2011). +
10.12
Employment Agreement by and between LHC Group, Inc. and Pete C. November dated July 25, 2008 (previously filed as
Exhibit 10.18 to LHC Group’s Form 10-K for the year ended December 31, 2009, filed on March 15, 2010). +
10.13
Amendment to the LHC Group, Inc. 2005 Non-Employee Directors Compensation Plan dated January 1, 2010 (previously
filed as Exhibit 10.19 to LHC Group’s Form 10-K for the year ended December 31, 2009, filed on March 15, 2010). +
10.14
Settlement Agreement among the United States of America, LHC Group, Inc. and certain of its subsidiaries and relator,
dated September 29, 2011 (previously filed as Exhibit 10.1 to LHC Group’s Form 8-K filed on September 30, 2011).
10.15
Corporate Integrity Agreement between the Office of Inspector General of the Department of Health and Human Services
and LHC Group, Inc., dated September 29, 2011 (previously filed as Exhibit 10.2 to LHC Group’s Form 8-K filed on
September 30, 2011).
Form 10-K Part IV
89
LHC GROUP
Exhibit
Number
Description of Exhibits
10.16
Third Amended and Restated Credit Agreement, by and among LHC Group, Inc., Capital One, National Association,
as a lender, administrative agent, sole book runner and sole lead arranger, JPMorgan Chase Bank, N.A., as a lender and
syndication agent, Compass Bank, as a lender and documentation agent, and Whitney Bank and Regions Bank, as
lenders, dated August 31, 2012 (previously filed as Exhibit 10.1 to the Form 8-K filed on September 4, 2012).
21.1
Subsidiaries of the Registrant.
23.1
Consent of KPMG LLP.
31.1
Certification of Keith G. Myers, Chief Executive Officer pursuant to Rule 13a- 14(a)/15d-14(a), as adopted pursuant to
Section 302 of the Sarbanes-Oxley Act of 2002.
31.2
Certification of Peter J. Roman, Chief Financial Officer pursuant to Rule 13a- 14(a)/15d-14(a), as adopted pursuant to
Section 302 of the Sarbanes-Oxley Act of 2002.
32.1*
Certification of the Chief Executive Officer and Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted
pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS XBRL Instance Document
101.SCH XBRL Schema Document
101.CAL XBRL Calculation Linkbase Document
101.DEF XBRL Definition Linkbase Document
101.LAB XBRL Label Linkbase Document
101.PRE XBRL Presentation Linkbase Document
Attached as Exhibit 101 to this report are documents formatted in XBRL (Extensible Business Reporting Language). Users of this data are
advised pursuant to Rule 406T of Regulation S-T that the interactive data file is deemed not filed or part of a registration statement or
prospectus for purposes of section 11 or 12 of the Securities Act of 1933, is deemed not filed for purposes of section 18 of the Securities
Exchange Act of 1934, and otherwise not subject to liability under these sections. The financial information contained in the XBRL-
related documents is “unaudited” or “unreviewed.”
* This exhibit is furnished to the SEC as an accompanying document and is not deemed to be “filed” for purposes of Section 18 of the Securities Exchange Act of 1934 or otherwise
subject to the liabilities of that Section, and the document will not be deemed incorporated by reference into any filing under the Securities Act of 1933.
+
Indicates a management contract or compensatory plan.
90
Form 10-K Part IV
Corporate Information
Independent Registered Public Accounting Firm
KPMG LLP
450 Laurel Street, Suite 1700 • Baton Rouge, LA 70801
kpmg.com
Transfer Agent and Registrar
American Stock transfer & trust Company LLC
6201 15th Avenue • Brooklyn, NY 11219
800.937.5449
Corporate Headquarters
LHC Group Inc.
420 West Pinhook Road • Lafayette, LA 70503
Phone: 866.LHC.GROUP • Fax: 337.235.8037
LHCgroup.com
Common Stock
LHC Group’s common stock is traded on the NASDAQ Global Select Market under the symbol “LHCG.”
At March 14, 2013, the company had a total of approximately 3,490 shareholders, including stockholders
of record and approximately 2,351 persons or entities holding common stock in nominee name.
Performance Graph
The graph below matches LHC Group Inc.’s cumulative five-year total shareholder return on common
stock with the cumulative total returns of the NASDAQ Composite Index and a customized peer group
of four companies that includes: Almost Family Inc., Amedisys Inc., Gentiva Health Services Inc. and
National Healthcare Corp. The graph tracks the performance of a $100 investment in our common stock,
in the peer group and the index (with the reinvestment of all dividends) from 12/31/2007 to 12/31/2012.
Performance Graph
Comparison of 5-Year Cumulative Total Return* Among LHC Group Inc., The NASDAQ Composite Index and a Peer Group
$160
$140
$120
$100
$80
$60
$40
$20
$0
12/07
12/08
12/09
12/10
12/11
12/12
12/07
12/08
12/09
12/10
12/11
12/12
LHC Group Inc.
NASDAQ Composite
Peer Group
$ 100.00
$ 100.00
$ 100.00
$ 144.12
$ 59.03
$ 109.21
$ 134.55
$ 82.25
$ 105.93
$ 120.10
$ 97.32
$ 95.83
$ 51.36
$ 98.63
$ 43.80
$ 85.27
$ 110.78
$ 52.62
* $100 invested on 12/31/07 in stock or in index, including reinvestment of dividends. Fiscal year ending December 31.
The stock price performance included in this graph is not necessarily indicative of future stock price performance.
Leadership
executive Officers
Keith G. Myers
Chief Executive Officer
Donald D. Stelly
President, Chief Operating Officer
Peter J. Roman
Executive Vice President,
Chief Financial Officer
Directors
Keith G. Myers
Chairman
W. J. “Billy” tauzin
Lead Independent Director
Compensation Committee
Nominating and Corporate
Governance Committee
Monica F. Azare
Chair — Compensation Committee
Clinical Quality Committee
John B. Breaux
Compensation Committee
Nominating and Corporate
Governance Committee
ted W. Hoyt
Audit Committee
Compensation Committee
John L. Indest
Chair — Clinical Quality Committee
George A. Lewis
Chair — Audit Committee
Ronald t. nixon
Chair — Corporate Development
Committee
Nominating and Corporate
Governance Committee
Christopher S. Shackelton
Audit Committee
Corporate Development Committee
Kenneth e. thorpe, PhD
Clinical Quality Committee
Corporate Development Committee
Dan S. Wilford
Chair — Nominating and
Corporate Governance Committee
Audit Committee
Clinical Quality Committee
It’s All About Helping People.®
LHC Group Inc.
420 West Pinhook Road
Lafayette, LA 70503
1.866.LHC.GROUP
LHCgroup.com