Chemed Corporation Q2 2026 Earnings Call

Thank you for standing by, and welcome to Chemed Corporation's second quarter 2026 earnings conference call. Currently, all participants are in a listen-only mode. After the speaker's presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press star one one on your telephone. To remove yourself from the queue, you may press star one one again. I would now like to hand the call over to Holley Schmidt, Assistant Controller. Please go ahead. Good morning.

Our conference call this morning will review the financial results for the second quarter of 2026 ended June 30th, 2026. Before we begin, let me remind you that the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 apply to this conference call. During the course of this call, the company will make various remarks concerning management's expectations, predictions, plans, and prospects that constitute forward-looking statements. Actual results may differ materially from those projected by these forward-looking statements as a result of a variety of factors, including those identified in the company's news release of July 28th and in various other filings with the SEC. You are cautioned that any forward-looking statements reflect management's current view only and that the company undertakes no obligation to revise or update such statements in the future.

In addition, management may also discuss non-GAAP operating performance results during today's call, including earnings before interest, taxes, depreciation, and amortization, or EBITDA and adjusted EBITDA. A reconciliation of these non-GAAP results is provided in the company's release dated July 28th, which is available on the company's website at chemed.com. I would now like to introduce our speakers for today, Kevin McNamara, President and Chief Executive Officer of Chemed Corporation, Mike Witzeman, Chief Financial Officer of Chemed, and Joel Wherley, President and Chief Executive Officer of Chemed's VITAS Healthcare Corporation subsidiary. I will now turn the call over to Kevin McNamara.

Thank you, Holley. Good morning. Welcome to Chemed Corporation's second quarter 2026 conference call. I will begin with highlights for the quarter, then Mike and Joel will follow up with additional details. I will then open the call up for questions. VITAS's performance during the quarter exceeded even the high end of our expectations. VITAS continues to add ADC through accelerated admissions from non-hospital pre-admission locations while also maintaining a high level of hospital-based admissions. This was achieved while also keeping hospice labor costs lower than budgeted. These factors combined to allow VITAS to achieve higher than expected revenue growth and EBITDA margins while continuing to add cushion to the Medicare Cap position in our Florida Combined Program. Admissions at VITAS during the quarter totaled 19,125, which equates to a 9% improvement from the same period of 2025.

Hospital admissions as a percent of total admissions for our Florida Combined Program were 42.9% during the second quarter of 2026. As we've previously discussed, an appropriate balance for a sustained long-term stability in the Florida patient base, given the current mix of referral sources, is that between 42% and 45% of total admissions come from hospitals. Equally as important, as Joel will discuss in greater detail, admissions from all other pre-admission locations increased 8.1% compared to the second quarter of 2025 in our Florida Combined Program. Improved admissions led VITAS to outperform our expectations while also adding $8.9 million to cap cushion in the Florida Combined Program in the second quarter of 2026. This strong performance makes us more confident than ever that VITAS has put the Florida cap issue of 2025 behind us and has returned to a normalized rate of growth.

Let's turn to Roto-Rooter. In the second quarter, Roto-Rooter performed as we anticipated. Commercial sales and water restoration collections exceeded our expectations for the quarter, while marketing costs and the independent contractor business continue to be a challenge. Our commercial business manager program continues to perform at a high level. Total commercial revenue in the second quarter of 2026 increased 6.8% compared to the second quarter of 2025. There were 30 productive commercial business managers in place for the entire quarter, resulting in a commercial revenue increase of approximately 13% in their respective branches. This compares to a commercial revenue in branches without a commercial business manager, which saw a decline of 1%. We continue to evaluate the ability of the remaining branches to add a commercial business manager, which will drive additional growth. Centralization of water restoration billing and collections function continues and has resulted in improved collections.

Total write-offs improved by $1.3 million during the second quarter of 2026 compared to the second quarter of 2025. The centralization effort has resulted in a reduction of approximately 20 employees compared to the second quarter of 2025. Lead generation and the resulting cost of customer acquisition remained a challenge in the second quarter. Total leads during the second quarter of 2026 were down 1.6% compared to the second quarter of 2025. Continuing the same trend as the past quarters, free leads generated from internet searches declined 13.1%, while paid leads increased 7.3%. Of all leads generated during the quarter, approximately 59% were paid, compared to the 54% in the second quarter of 2025. This change resulted in increased marketing spend of about $3.1 million in the quarter compared to the second quarter of 2025.

In June, Roto-Rooter purchased the territory and assets of franchises operating in South Texas, including Corpus Christi. The purchase price was approximately $12 million. This territory will be an independent contractor and represents a significant new population base to incorporate into the contractor portfolio. It is not expected to add a material amount of revenue or income in the last half of the year, but represents a nice growth opportunity for 2027 and beyond. Through the first six months of 2026, we have spent an aggregate total of $33.5 million repurchasing four franchises in strategically advantageous locations. Additional opportunities exist to purchase desirable Roto-Rooter franchises, and we intend to continue to take advantage of those opportunities. We are very happy with the performance of VITAS in the quarter and its prospects for the remainder of 2026 and beyond.

Roto-Rooter is building positive operating momentum while being in a great position to take advantage of franchise acquisition opportunities as they arise. The combination of the two business units drove an increase in total Chemed revenue of 8.8% and an increase in adjusted diluted earnings per share of 41.9% in the second quarter of 2026 as compared with the same period of 2025. Additionally, the consolidated business generated cash flow from operations in excess of $173 million in the second quarter, which, along with minimal leverage, allows us to pursue accretive acquisitions, aggressive share repurchases as those opportunities present themselves. With that, I would like to turn this teleconference over to Mike.

Thanks, Kevin. VITAS net revenue was $443.3 million in the second quarter of 2026, which is an increase of 11.9% when compared to the prior year period. This revenue increase is the result of a 6.1% increase in days of care and a geographically weighted average Medicare reimbursement rate increase of approximately 2.4%. Acuity mix shift negatively impacted revenue growth 115 basis points in the quarter when compared to the prior year revenue and level of care mix. The combination of Medicare Cap and other contra revenue changes positively impacted revenue growth by approximately 455 basis points. In the second quarter of 2026, VITAS accrued $500,000 in Medicare Cap billing limitation. This is below our original expectations, due mainly to improved admission performance in California.

No Medicare Cap billing limitation was recorded in the second quarter of 2026 for the Florida Combined Program, and none is anticipated for the 2026 fiscal period. This compares to a Florida Medicare Cap billing limitation recorded in the second quarter of 2025 of $16.4 million. Average revenue per patient day in the second quarter of 2026 was $209.98, which is 143 basis points above the prior year period. During the quarter, high acuity days of care were 2.2% of total days of care, a decline of 24 basis points when compared to the prior year quarter. Adjusted EBITDA, excluding Medicare Cap, totaled $80.6 million in the quarter, an increase of 20.6% when compared to the prior year period. Adjusted EBITDA margin in the quarter, excluding Medicare Cap, was 18.2%. Let's turn to Roto-Rooter. Roto-Rooter branch commercial revenue in the quarter totaled $56.8 million, an increase of 6.8% from the prior year period.

All lines of business in the commercial sector had increasing revenue during the quarter. Roto-Rooter branch residential revenue in the quarter totaled $159.1 million, an increase of 1.7% over the prior year period. Similar to the first quarter of 2026, all lines of service increased with the exception of water restoration. Water restoration revenue declined 6.7%. Demand for water restoration services continues to be strong, and our conversion rates remain high. During the transition to a centralized billing and collection model, we anticipated some disruption to the day-to-day bill processing function. In the second quarter of 2026, the average revenue per water restoration job declined by roughly 3.5%.

This is a sequential improvement compared to the approximate 13% decline in average revenue per water restoration job in the first quarter of 2026. We anticipate that this challenge will continue to improve as the year progresses with centralized staff gaining experience and proficiency. Revenue from our independent contractors declined 1.9% in the second quarter of 2026. Our independent contractors are generally smaller operations in middle-market cities. Because they are independent, they tend to operate more like a small mom-and-pop business than our owned and operated branch locations. We are actively working with the contractor group to help mitigate the challenges in this segment of our business to get it back to a growth trajectory. Adjusted EBITDA for Roto-Rooter in the second quarter totaled $48.5 million, essentially flat when compared to the second quarter of 2025.

The adjusted EBITDA margin in the quarter was 21.1%, which represents a 77 basis point decline from the second quarter of 2025. Roto-Rooter's gross margin of 50.4% was in line with our expectations and 135 basis points better than the second quarter of 2025. As discussed by Kevin, the decline in adjusted EBITDA margin was mainly caused by increased internet marketing costs. With that, I will turn the call over to Joel.

Thanks, Mike. In the second quarter of 2026, our average daily census was 23,687 patients. This represented an increase of 6.1%. By the end of the second quarter, our total patient census exceeded 24,000 for the first time in VITAS history. In the quarter, hospital-directed admissions increased 9%. Home-based patient admissions increased 9%. Assisted living facility admissions increased 13.5%, with nursing home admissions declining 8.6% when compared to the prior year period. The continued high level of hospital admissions allows us to also take a high number of admissions from other pre-admission locations. This allows us to continue to build Medicare Cap cushion while growing ADC more quickly than our original projections. We were able to achieve this level of ADC growth while maintaining full-time equivalents below our budgeted targets for the quarter. With respect to the workforce, we continue to run full-time equivalents below our estimated totals.

We monitor each location very carefully and ensure that staffing is adequate to provide high-quality care for our patients and their families, as well as maintaining a healthy work-life balance for our caregivers. The current level of staffing does not reflect any issues with our ability to hire or retain qualified caregivers, and it does not impede our current growth expectations. Our average length of stay in the quarter was 101.2 days. This compares to 137.1 days in the second quarter of 2025. Our median length of stay was 16 days in the second quarter of 2026, a decline of four days from the second quarter of 2025. The new starts in Florida continue to grow at a very rapid pace. Marion, Pasco, and Pinellas Counties combined had 594 admissions in the second quarter of 2026. ADC for each new start continues to exceed our expectations.

Manatee County admitted their first patient in the second quarter. We are happy with the progress of that program to date. VITAS has never been in a better position to take advantage of growth opportunities. We have put the difficulties of 2025 behind us. We are looking forward to executing strategies for the remainder of 2026 and beyond that will translate into high, sustainable growth while providing the best possible care to our patients and their families. With that, I'll turn the call back over to Mike.

Thanks, Joel. In a slight break from tradition, we decided to cover the revised guidance at the end of our prepared remarks. Although historically we do not give quarterly updates, our guidance was revised in conjunction with the first quarter of 2026 due to the materially improved performance of VITAS, coupled with the high level of share repurchases. We have updated the guidance again in the second quarter, mainly to continue our normal historical cadence of updating expectations at the mid-year earnings release. Barring any unusual developments, updating guidance once per year in conjunction with our second quarter press release is our ongoing expectation. VITAS' initiatives to return to a normal growth pattern after managing the 2025 Medicare Cap issue progressed more quickly than anticipated and continued to provide higher than expected growth in the business. These results led us to raise full-year guidance for VITAS as follows.

Full-year ADC growth for 2026 is updated to a range of 5.75%-6.25%, compared to the previous guidance range of 4.5%-5.5%. Anticipated revenue growth, excluding the impact of the Medicare Cap, improves from the previous guidance range of 6.5%-7.5% to a revised range of 8.25%-9.25%. Finally, revised EBITDA margin, excluding the impact of the Medicare Cap, is anticipated to be 19%-19.5%, compared to the previous guidance of 18%-18.5%. Our anticipated full-year Medicare Cap billing limitation is reduced to $7 million from our previous guidance of $9.5. Roto-Rooter performed in line with our expectations and reflects stable earnings, very positive cash flow, and a continued emphasis on investment in growth opportunities. Full-year guidance for the segment remains unchanged.

Full-year anticipated revenue growth is 3%-3.5% for Roto-Rooter, with an estimated adjusted EBITDA margin of 21.5%-22.5%. Based on the above, full-year 2026 earnings per diluted share, excluding non-cash expenses for stock options, tax benefits from stock option exercises, costs related to litigation, and other discrete items, are estimated to be in the range of $25-$25.75. The midpoint of the revised guidance represents a 17.8% increase from 2025 adjusted earnings per diluted share of $21.55. The revised 2026 guidance assumes an effective corporate tax rate on adjusted earnings of 24.5% and a diluted share count of 13.5 million shares. I will now turn the call back to Kevin for his closing remarks.

Thank you, Mike. I will now open this teleconference to questions.

As a reminder, to question, you will need to press phone. To remove yourself from the queue, please press star one one again. Please stand by while we compile the Q&A roster. Our first question comes from the line of Ben Hendrix of RBC Capital Markets. Your line is open. Great.

Thank you very much. Maybe start with a question for Joel. Just wanted to touch on your long-term growth outlook for VITAS. We get a lot of questions on the growth capacity. When we think about the overall demand in the markets versus your ability to sustain that 42%-45% mix of short-stay patients, how sustainable is this level of growth? What should we assume for a long-term growth outlook for ADC and revenue? Thanks. Yeah. Thanks, Ben. We absolutely believe it is very sustainable.

We feel like the KPI management associated with those strategies, helps us much better understand how to react to market changes and adjust resources accordingly. We have no concerns whatsoever about that ability. As we mentioned in the transcript, we believe VITAS has returned to normal growth rates. We fully expect to continue to generate those growth rates, as we look at the short and middle future, as we look at going into 2027.

Let me just remind the listeners, I guess, that what that means to me is if you look at the 21-year period up to 2025 that Chemed owned VITAS grew their net income at about 11% per annum. I guess my point is, we're talking about double digit. What we consider traditional growth rates is in the double digits. It's in the low double digits, but it's a good block-and-tackle, very reliable kind of grinded out service industry. We look forward to achieving the results that Joel has articulated.

Great. Thank you. If we could move to Roto-Rooter for a quick one there. Looks like your EBITDA came in just maybe marginally shy of our estimate. Just wanted to see what you guys are seeing on the SG&A side in terms of mix of paid versus non-paid leads, kind of how that's evolving and what we can expect that to stabilize. Thanks. Ben, this is Mike.

I think we believe it's not going to deteriorate from here, even though we have really not a lot of insight as to what exactly might happen in the future with internet marketing and the main provider of our internet marketing services. Having said that, I don't believe that free leads will go to zero. We're working on strategies to get around Google, honestly, to get leads through commercial business managers is one strategy. We've talked a lot about the app in the past. We're trying to minimize our reliance on Google. I would say that we think that the situation is stable. It's not deteriorating from here. I would also really hesitate to say that we think it's going to significantly improve from here either.

It's hard to see improvement. It's probably clear to surmise that at this point, Google hates the idea of free leads. Initially, it grew its audience and its users by saying, "Here's a treasure trove of free information." Once they built that allowed them to start charging for what they built, and they've systematically try to drive their users away from the free aspects of service providers. That just goes without saying. At the very least, we're at a new normal, and it has largely stabilized. The kind of thing that we're constantly looking at is I don't want to go in too much detail, but Google's not done. AI is rapidly gaining on them, and they know it. They have their own AI product as well, obviously.

Our view is it's like when the internet was coming in, Yellow Pages was losing its dominance. It's just that's the way it is. I think Roto-Rooter has done a pretty good job of dealing with it. We're living with the biggest issue that we'll continue to deal with to some extent is leakage on the marketing expenses. We want to do jobs. Every job we do at Roto-Rooter is profitable. To the extent that we have to pay for those leads, increasingly that's what we do. As Mike said, the real win here is getting leads outside of the paid Google search. There's no question about it. That's really what we're trying to do. We can't kid anybody. Paid leads have gone from 44% a year and a half ago to 59%.

It's kind of an inexorable change, it's going to be a continued battle for Roto-Rooter. Again, the reason that they've been, I think, more successful than certainly our franchisees or the other companies we're familiar with is that they're fortunate to have, in this case, what we call our ancillary services, excavation, water restoration. The sales we get from those actually now are expected to slightly exceed sales from all other sources in Roto-Rooter. We have additional services that we charge for these jobs that we do get through the internet. It still all makes sense to us. As we said, the momentum that we're starting to see in the last several months is something that we're taking to the bank.

Ben, I think it might make sense also to point out, I think inherent in your question is where do we see margins going from here and what are our thoughts on that? I would tell you that the 21.5%-22.5% margin that we've estimated for the full year at Roto-Rooter this year is right in line with where our margins were pre-pandemic. Obviously, they spiked some during the pandemic, but it hasn't caused a huge deterioration in our margins overall from a long-term standpoint. I think we would love at Roto-Rooter to see margins in the 23%-24% range, but ultimately even at the, call it, 22% range, that's pretty healthy for a home services business. We're doing everything we can in marketing, but I think we've done a lot of other things in other areas to try and overcome some of those higher expenses.

That's helpful. Thank you very much.

Thank you. Our next question comes from the line of Brian Tanquilut of Jefferies. Your line is open, Brian.

Hey, good morning, guys, and congrats on the quarter. Maybe for Joel and Mike, as I think about the margins at VITAS, obviously pretty good in the quarter and then the guidance adjustments solid. How do we think about, number 1, the drivers of that and then the sustainability of those margins as we look beyond 2026?

Yeah. The biggest driver associated with that is our ability to expand our length of stay and appropriately balance from a pre-admission perspective the types of patients that are coming on service, i.e., balancing our hospital pre-admit environment, which typically drives a shorter length of stay patient with our community-based or home-based patients would typically drive a longer length of stay. That allows us and has allowed us, and as we had previously talked about, would allow us to expand our margin through the end of the year. That certainly has come to fruition.

As we look at sustainable longer-term margins, we absolutely believe that the strategic management of the resources that we have in the field, our labor force, as well as our controllable costs associated with the care of those patients, all is in line with expectations and allows us to continue to drive at that margin level.

The only thing I would add to that, Brian, is one thing that we certainly are comfortable with the sustainability of, is we've always had an internal benchmark at VITAS that back office, essentially SG&A costs, grow at half the rate of our revenue growth. There are years we hit that, and there are years we don't if we're doing something specific. If we're going to grow top line in the high single-digit range, we can certainly gain leverage on our back-office costs year-over-year methodically. I think that the EBITDA ranges we're talking about now are very sustainable going forward.

No, I appreciate that. Maybe Kevin, as I think about Roto here, obviously there are some investors who believe that more investments need to be made there, service line expansions are probably strategically appropriate. Just curious how you're thinking about where Roto stands today. I know you mentioned in your prepared remarks buying franchisees out, how are you thinking about expanding the service offerings? Thanks. Okay. I mean, what we say, what we've thought about, first of all, is colored by our past history.

The first issue. What has worked very well for Roto-Rooter certainly is to the extent that if we can provide additional services to customers who call for our main line of service, that is plumbing or drain cleaning, the cost of acquisition for that additional business is near zero. Not surprisingly, that's always been where when Roto-Rooter added plumbing to drain cleaning, that's what made that a success. When they added excavation to drain cleaning and plumbing, of course, that was at issue then. A few years ago, we added water restoration. Again, it was to that same customer base. Roto-Rooter historically has tried basically every service that you can imagine that involves putting a person in a truck and going to your house.

Again, generally speaking, that's a different type of customer. It comes with an acquisition cost. We would like to try, and we've tried repeatedly to use the fantastic service mark that is Roto-Rooter, to drive the growth of those businesses. We've been unsuccessful historically. Now, does that mean that we've then foreclosed all thought of those additional service lines? No. I'll tell you that the answer. That just gives you the background. We're dealing with the fact that we have tried it. We tried Roto-Rooter air conditioning. We tried it under the Roto-Rooter service mark. We tried it under our own mark. We tried it under businesses we bought that kept their old service name. It doesn't mean we've given up on air conditioning.

It just means we made a pretty big investment in that in the 1990s, for a six or seven-year period, just wasn't happy with the results. That colors our thinking with regard to additions to the service line. I'll give you a specific example, and you might say, what are we thinking we're doing that might be a hybrid that we can sell to our existing customer base and people who don't have a plumbing problem as well? Through the middle of last year, we had, from our perspective, a fairly aggressive inroad into water quality. That is both drinking water and the hardness and softness of water, the overall quality of water, which is a huge industry. We, as I said, made an investment, had the water quality business up and running in the majority of our branches. It was losing money. We just weren't gaining quite the foothold we wanted, and given the other problems in Roto-Rooter last year, we suspended the program.

That just gives you an example of, yes, we're constantly looking at additions to the service line. For this forum, I guess I'd say there's nothing really at this point other than say, yes, we're investigating. We have investigated in the past. There's nothing really that has risen to the level that probably requires any discussion in this type of forum.

Got it. Thank you. Thank you.

Again, to ask a question, please press * one one on your telephone. Our next question comes from the line of Joanna Gajda of Bank of America. Your question please, Joanna. Hi, good morning.

A couple of questions. Maybe first on the Roto-Rooter business. Here, again, we talk about the higher marketing costs again, but the guidance is the same, and you're talking about this margin is sustainable. How exactly are you thinking about this in terms of, are there some offsets that you're expecting? Is this coming maybe from buying these franchisees, or there's something else there, I guess, that's helping you sustain that margin?

Well, here, I'll turn it over to Mike, but let me just say, Joanna, from my perspective, to the extent that we do When we talk about our excavation business and water restoration business, we talk internally. It has a relatively low hit rate. Have we been getting, and do we expect more improvement in the conversion of those opportunities? The answer is always yes. To the extent that improvement in that area continues, you can see if the average price of a job continues to go up because there's more services. I'm kind of adjusting for inflation here. If the price is going up, not by inflation, price increase, but by the fact that we're doing a higher conversion rate on water restoration or excavation, you can see how that makes the marketing costs less of an issue.

Again, you have a service that has no acquisition cost to getting the job. Basically, we said over the last nine months, to the extent that the successes that Roto-Rooter has had, largely has been in the fact that the ancillary services have seen that type of improvement. It's an advantage that Roto-Rooter has. I have a hard time believing. We have a lot of competitors, and I think a lot of them are running plumbing and drain cleaning at a loss leader if they're not also offering excavation and water restoration. It's too tough. We see that ourselves with small independent contractors or small franchisees that aren't in those ancillary services, and they're saying, "Things are tough." They don't have a 21% margin. They have a 5% margin. That's a tough way to go. I guess turning it over to Mike.

Mike, that's off the top of my head response.

Joanna, at a high level. In the second quarter, Roto-Rooter missed their EBITDA by roughly $1 million from our point estimate. That was all marketing costs. I would tell you that we didn't think that that was material enough to change our forward thoughts on where they could be. As Kevin said, there's plenty of things that can happen at Roto-Rooter to offset a $1 million elevated expense. One is, the add-on services Kevin talked about. Water restoration collections continues to improve. We didn't need to exceed our expectations in that by not very much in order to make up that $1 million. In the grand scheme of Roto-Rooter, an extra $1 million of marketing costs is not enough to change our current or long-term outlook for where we think their margin and where the business is going.

Okay. That's great. Thanks for that. I guess, in terms of these acquisitions, talking about buying franchisees, are there still some larger ones that are potentially available? To that end, what's the level of interest in adding, I guess, hospice assets, and how does the moratorium on new centers and the related provisions there impact your ability to add hospice assets?

I'll start with the Roto-Rooter side. There's a few. Joanna, yeah, I would be very surprised if before the end of the year the opportunity is there. I'd be surprised if we don't make a nice Roto-Rooter acquisition before the end of the year of some size, internal, I'm talking about in our franchise network. With regard to VITAS, I got to turn it over to Joel. Say it really breaks down in two. There's a few counties left, a couple counties in Florida, that we're not in. We'd probably love to do an acquisition or something in Florida. We're almost everywhere in Florida. There's a few real nice counties left to go. The acquisitions really go to kind of CON states other than Florida. Joel, what do you see in that regard?

Yeah. Joanna, our targeted acquisition interest remains in areas where there's a barrier to entry in the market. The moratorium does influence our ability to apply for new CONs in states that have that, of which the timing, the moratorium is due to end in November. It could be extended. We don't know that. We will be in the next 60 days. As far as acquisitions, the moratorium does not prevent us from moving forward with potential acquisition as long as that existing provider had been in service for three years and billing to the federal government for three years. We're still actively reviewing any of those opportunities. Again, with markets that have a barrier to entry, that has our first interest, but we're continuing to look at what other opportunities could potentially exist out there.

If I may, on the Medicare Cap. Here in Florida, where it sounds like you're building a cushion there and you're growing census. I'm thinking, how much of that kind of building the cushion is coming from these de novos? I guess, is there a risk that you could get into trouble, so to speak, over the Cap when somehow these de novos slow down or you don't have incremental de novos or markets to add to kind of manage that Medicare Cap?

Yeah. Thanks, Joanna. The metrics that we put in place to strategically manage where we deploy our resources, balancing out the admissions in the pre-admit environment are separate from the growth strategies we have in de novo markets. There's no question those markets have contributed significantly to our ADC growth, but they're also contributing significantly to admissions. The opportunities we have in those markets, as well as all across Florida to continue to balance that admission mix, gives us no concern going forward, specific to Cap management and having that re-emerge as a significant concern for us at any time in the near future.

Let me add on that, the Cap cushion that VITAS has been helped by the new starts, but it's not all of it. Frankly, at an average length of stay, as we mentioned, of 101 days, which is driven by having the mix of between 42% and 45% of hospital-based admissions, that's very sustainable. You're not going to run into a problem with that, assuming reimbursement is within an acceptable range, which we see as 1% above the national average or 1% below the national average. We're there, Joanna, I guess what I was saying. That's our run rate, where we are. What you're talking about is certainly theoretical, but that would be absent a big change, like a 10% increase in reimbursement in Florida, or another 5% increase in Florida, with the national average going up 2% or 3%.

Absent something like that, VITAS is sailing right in the perfect channel for not worrying about Cap in the shorter midterm. Long run, of course, we're all dead, as they say. Again, that's not a major concern under these circumstances.

One of the things I think that gives us the most comfort, Joanna, we love Florida for many reasons. The CON is probably the main one, but another significant reason is the availability of hospital-based admissions to hospice is very high, continues to grow with the demographics over the next 8 to 10 years. The demand for hospital-based admissions into hospice is very much there, as long as Joel said, like Joel said, as long as we continue to focus on that, we will garner our share of that demand, and we should not run into any problems with Medicare Cap going forward in Florida.

Let me give you one other comment about the new starts. How early are we in our development of those programs? If it goes to past historical averages, we still have a very small % of the admits in each of those new starts. Again, if you look at if the past is prologue to the future, to the extent that we get something like 40%-60% growth of market share of that, we're just in the very germinal stages of the development of these new starts.

Yes. I'll add one more thing, Kevin. Joanna, as part of our overall strategic management of Cap mitigation, especially in the Florida CCN, that is also part of expanding additional new relationships for high acuity, short length of stay patients. We've just recently broke ground on two new inpatient units that will come online in 2027, with two additional relationships that will be lifted up in 2027, that will be inside of other facilities. That is a extremely strategic part of our Cap mitigation, and we'll continue to manage that as needed going forward.

All right. This is great, and actually on that note, because we didn't get the final hospice reg yet, but we do have the proposal. In that proposal, the rate update for Florida didn't seem like it was an issue versus what a Cap is increasing. Any updated thoughts on based on the proposal, what the rate update will be Florida versus the Cap for 2027?

Yeah. National average 2.4% in the proposed rule. That'll be final in the next couple weeks.

Right. VITAS specifically, 1.9%. Florida is a little over 1% of an increase against the national average.

That's based on our current mix in Florida.

Yes. Right. All right. That's manageable there.

To that end, you had a $0.5 million accrual for Medicare Cap in second quarter because I guess you're running better, I guess, in California. What do you assume for fourth quarter of 2026 in your guidance?

Yeah. For Medicare Cap. Joanna.

We've talked about, and in the first quarter, Joel talked some about a little bit of activity increase in California as a result of VITAS being a big, trusted provider, and some of the referral sources are sort of fleeing to safety and referring to the big trusted providers during the time when people are talking about fraud and abuse with smaller providers. That's given us a lift this year in California with the Medicare Cap situation. Over the last four or five years, on average, we've run roughly $9.5 million in Medicare Cap. We kept our forecast for 2027 at that $9.5 million. Baked into the guidance in the fourth quarter is one-fourth of that $9.5 million. I think it's $2.3 or $2.4 million.

We're a little early in the sort of that fraud and abuse and how that's going to all shake out in California to really want to change our run rate expectations. It certainly has helped us in this calendar year or in this Cap year.

Great. If I may, since you mentioned the moratorium kind of focus on fraud and abuse in hospice, and obviously, we've heard you talk about you're supportive of that and getting rid of fraud in the industry would help everyone. There were a couple of other things that came up. There was the OIG report, and then there was the GAO report, right? Different issues being discussed and such, but is there something building in the background? Do you expect CMS respond to these reports in some ways? Do you essentially expect any changes to reimbursement, say, for 2028? Because obviously we know it's not possible for 2027. Any thoughts on these reports and kind of where CMS might land in the end after getting those? Thank you. Yeah. Joanna, we have no reason to believe at this point that there would be a unbundling of the hospice benefit.

There is legislation out there testing the waters specific to an MA carve-in plan. That has been shelved for 2027. Whether that is resurrected at some point in the future, I think is yet to be seen. We have no reason to believe there would be significant or material reimbursement changes to the current structure. What we do know is that the final rule is going to come out for 2027 in a couple of weeks. We do expect there to be some elevated degree of program integrity oversight, i.e., the SSVI or service spend variation index. We don't know the components of a final integrity plan, but we do believe that there's going to be a increased focus on quality.

What that quality is measured by is yet to be determined. We do not see necessarily a indication of reimbursement change at this point.

Thank you. Thank you. I would now like to turn the conference back to Kevin McNamara for closing remarks.

Sir? Well, I'd just like to say that yes, we were gratified with the results of the quarter and thank everyone for their questions and their attention.

We'll reconvene in about three months. Thank you. This concludes today's conference call.

Thank you for participating. You may now disconnect.