Computer Programs and Systems, Inc. (NASDAQ:CPSI) Q4 2022 Earnings Call Transcript
Computer Programs and Systems, Inc. (NASDAQ:CPSI) Q4 2022 Earnings Call Transcript February 14, 2023
Operator: Greetings and welcome to CPSI Fourth Quarter Earnings Conference Call. At this time, all participants are in a listen-only mode. A brief question-and-answer session will follow the formal presentation. . And as a reminder, this conference is being recorded. It is now my pleasure to introduce to you, Dru Anderson. Thank you, Dru. You may begin.
Dru Anderson: Thank you. Good afternoon and welcome to the CPSI fourth quarter 2022 earnings conference call. Leading today's call are Chris Fowler, President and Chief Executive Officer; and Matt Chambless, Chief Financial Officer. This call may include statements regarding future operating plans, expectations, and performance that constitute forward-looking statements made pursuant to the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995. The company caution you that any such forward-looking statements only reflect management expectations and predictions based upon currently available information and are not guarantees of future results or performance. Actual results might differ materially from those expressed or implied by such forward-looking statements as a result of known and unknown risks, uncertainties, and other factors, including those described in our public releases and reports filed with the Securities and Exchange Commission, including, but not limited to, our most recent annual report on Form 10-K.
The company also caution investors that the forward-looking information provided in this call represents their outlook only as of this date and we undertake no obligation to update or revise any forward-looking statements to reflect events or developments after the date of this call. At this time, I will now turn the call over to Mr. Chris Fowler, President and Chief Executive Officer. Please go ahead, sir.
Christopher Fowler: Thanks Dru and thank you to everyone for joining us this afternoon. I'll start the call today with a quick review of our financial and operational highlights from the fourth quarter and then I'll share some of my thoughts on the past year and where I envision CPSI going in 2023. For the fourth quarter of 2022, we delivered total revenue of $83 million, of which roughly 55% was derived from our RCM offering, TruBridge. Our RCM offering has 98% recurring revenue and grew 29% from the fourth quarter of 2021, further demonstrating our progress towards improving the consistency and predictability of our topline. We generated $13 million in adjusted EBITDA during that quarter, a decrease of 7.7% over the prior year, which Matt will elaborate on.
Our total bookings for the quarter were $25 million, an increase of 59% year-over-year and 20% sequentially. Looking at a level deeper, bookings from our RCM solution alone increased 1.6 times year-over-year and 19% sequentially with RCM bookings from cross-sell alone up 98% from the fourth quarter last year. Cross-selling into our EHR customer base is the foundation of our growth strategy, so the recent strength in this bucket of bookings is particularly pleasing. As our business continues to evolve into more RCM dominant themes and to provide more transparency into the health of our business, we are going to start providing net patient revenue under contract or NPR on a quarterly basis. We believe this will be a meaningful metric to track our progress.
After all, improving the financial strength of our hospital customers is the problem that TruBridge strives to solve, and there's arguably no better metric to measure our performance in scale than NPR. Matt will also share some more about this a bit later on the call. On the operational side of things, during the fourth quarter, we have a few things to highlight. In our RCM business, we have 30 go-lives across all of the RCM offerings. Additionally, we continued our expansion of offshore resources ending 2022 with more than 100 offshore employees with the ambitious target of quadrupling that rate of offshore utilization as we exit 2023. This not only represents an abundant margin expansion opportunity for us going forward, but also a strategic imperative to ensure our RCM business can scale as our solutions continue to gain momentum.
In our patient engagement business, I want to briefly touch on the two contracts that we noted were delayed on our previous call. The first is Steward Health in Florida, which was impacted by Hurricane Ian. We've been working hand-in-hand with that team, and we are now live and have rolled out our solution to the majority of their facilities. In regards to the second delay, we anticipate the international implementation to happen in the second quarter. Our conversations with our telecom partner continue to be optimistic as we work through governmental delays in these markets. It's also worth highlighting that our revenue recognition and outpatient engagement solution is a little different than the rest of our business. We recognize revenue once implementation is complete and the solution is turned on only when a patient signs up for the solution.
While the revenue ramp may not be as steep as it is in the RCM business, it's a higher margin than RCM, and it's very sticky once the patient signs on. Finally, in our EHR business, we continue to realize and focus on adoption and utilization of our products by our customers. Many of our long-term customers, those who have been with us more than seven years have not stayed on track with software utilization, but we're going to fix that. The client executive role we've been bolstering this past year will be key to our success in this area. As a testament to our dedication to improve our customer experience and overall satisfaction with our product, we made the necessary investment to improve our client executive to customer ratio to less than a third of what it has been.
Additionally, this increased investment triples the workforce that is focused on generating the opportunity for us to capture the $400 million of RCM cross-sells. As we close out 2022, I want to spend a few minutes looking back at what we've accomplished this past year and why I was so excited to take on the role of CEO. When I accepted the position this past spring, my goal is to build upon our well-established foundation to drive innovation and growth. CPSI is a very mature company founded almost 50 years ago with a large loyal customer base and a comprehensive suite of solutions. This is a critical time to remain acutely focused on what's gotten us to this point and to acknowledge that we've hit some bumps along the way. Moving forward, we will continue to improve as we pivot towards not just execution, but also towards growth.
One of my priorities this past year was to strengthen our relationships with our customers, especially since cross-sell conversion will be paramount to our success in 2023 and beyond. To that end, it has been a high priority during the back half of 2022 to meet face-to-face with as many of our clients' CEOs and CFOs as possible to hear directly from them and to share my vision for CPSI. Through a half a dozen regional customer events and getting out to our client sites weekly, the connection has been invaluable. And this commitment to strengthen customer relationships extends beyond me. It includes our senior management team and our client-facing executives. Not only does this provide scale, but the client executive role, which I mentioned earlier, is key to our customer satisfaction and ultimately, redemption.
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With the pandemic behind us, we are leaning in heavily to an in-person high-touch strategy for our clients. We offer solutions for community health systems and their leadership teams. It's essential that our customers have a good understanding of our solutions as well as our organization and our people because building trust by getting to know each other is an important success factor for our customers. After talking with our customers lately, I'm particularly pleased with the sentiment they've shared with me that they -- that as we invest in our clients, we will see the return materialize into their reengagement with our offerings. The increase in customer-facing activities also raises awareness of our RCM offering and I believe have a real impact on our RCM bookings, which increased 2.4 times in 2022 versus 2021.
Our customer retention rate of 95% in 2022 is consistent with the high marks we've achieved in years prior, but we will strive to do even better in coming years. I view 2022 as a year that we put the pieces into place with new leaders at the helm and I feel good about all the work we've done. Our expansion of the RCM business opens up a new part of the market, expanding beyond hospitals of less than 100 beds where we have historically focused our EHR efforts. We are laser-focused on our vision of selling our RCM solution to both our existing customer base as well as to hospitals of 400 beds or under. There are more than 4,500 hospitals in the US that fit that criteria, representing a total addressable market north of several billion. It's very clear that RCM is the key to our future growth as these hospitals will increasingly look to outsource partner all of their RCM processes to trusted partners like CPSI to simplify their revenue cycle needs.
By the end of 2023, we feel that RCM will represent close to 60% of our total revenue. We've laid the foundation necessary to seize the opportunities ahead of us. We've added the right people to our team, and we have the solution that our customers need. I'm incredibly excited to see what 2023 has in store for CPSI, and I look forward to updating you on our progress. I'll now turn the call over to Matt for a closer look at the financials.
Matt Chambless: Thank you, Chris and thanks to everyone on the call. As Chris shared, we ended the year on a solid footing, and I'll run through the numbers in just a minute. Before I jump into the financial results, though, I want to spend some time explaining how Chris and I have evolved our thinking on the business and the metrics we'll share with you to assess the progress we're making. The business of CPSI has evolved meaningfully with RCM now representing over half of our revenue and a significant portion of our growth. Recognizing that evolution, you'll notice that we've slightly changed the presentation of our revenue streams to better reflect the three distinct business units that we see within CPSI; TruBridge's RCM business, the combined acute and post-acute EHR business, and our nascent high-potential patient engagement unit.
Also, as Chris mentioned, we're going to start providing net patient revenue under contract, or NPR on a quarterly basis. And with that in mind, we ended the year at a hair below $3 billion of net patient revenue under contract, an increase of 37% year-over-year and a three-year CAGR of roughly 17.5%. This NPR was comprised of $2.4 billion from TruBridge and $600 billion or $0.6 billion from the recent HRG acquisition. To help you understand this new metric in the context of our past performance, we've included a table in the press release with our historical NPR data for each of fiscal years 2019, 2020, and 2021, along with each of the quarterly periods of 2022 for your reference. Our intent with this new NPR metric is to supplement our bookings disclosures to provide a more complete picture of growth and scale as bookings alone have proven to be an imperfect metric.
If you followed the CPSI story for a while, you know that our bookings metric is quite lumpy as the deal population is characterized by a relatively small number of high-value deals. The end result is a 90-day measure that oftentimes is more a function of timing for a handful of deals than reflective of any true strength or weaknesses in our sales environment, which can undermine the usefulness of this measure for investors. On that topic, bookings for the fourth quarter totaled $24.7 million, driven by continued strength in our RCM business with the EHR business unit closing out strong with its best bookings performance of the year driven by net new hospital client wins. RCM bookings were up 163% year-over-year and 19% sequentially, continuously earning its title as growth agent for CPSI.
In looking at the individual components of RCM bookings, cross-sell bookings were up 98%compared to the fourth quarter of last year, while bookings from outside of our EHR customer base increased to 7.6 times the prior year amount as the strength of HRG's sales force has made this a core competency. Turning to the income statement. Fourth quarter revenue of $83 million compared to $74 million last year. RCM contributed $45.7 million, EHR revenue was $36 million, and patient engagement made up the remaining $1.6 million. Our gross margins of44.6% for the fourth quarter were down 520 basis points year-over-year due to the increase in our RCM services business, whether through acquisition of HRG or through organic bookings driven growth, the lion's share of 2023's topline gains came from high touchpoint lower margin service lines causing a heavy shift in revenue mix that pulled gross margins down.
As we look to the future, the acceleration of our offshore initiative will be key to the margin expansion. Our operating expenses as a percentage of revenue were 40% in the quarter, the same as last year. Adjusted EBITDA of $13.2 million decreased by $1.1 million year-over-year. Despite the year-over-year revenue growth, the gross margin gains by the RCM business were offset by gross margin losses in our nascent patient engagement business as high incremental margin non-recurring revenues declined. The end result was a gross profit number that was flat, while higher benefits cost and strategic investments in our public cloud migration efforts created further headwinds for EBITDA. Turning to the rest of the financials. Operating cash flows for the quarter were relatively low at $2.2 million.
This is unusual for us and is a direct result of timing issues related to the collections associated with the integration of our recent acquisition. The slowdown in collections negatively impacted the fourth quarter, but we are making progress and saw an improvement in DSOs in January. While we haven't quite reversed the trend just yet, we're heading in the right direction, but it may take until early Q2 to fully unwind. Finally, I'll conclude my remarks by providing some color on our initial 2023 outlook. For full year 2023, we expect revenue to be in the range of $340 million to $350 million and adjusted EBITDA to be between $59 million and $63 million. As for how revenue and EBITDA will be distributed throughout the year, revenue is expected to be slightly weighted toward the back.
And from an EBITDA perspective, in the second quarter, we see our heaviest cost due to the hosting of our National Client Conference in the fourth quarter is generally our lightest cost quarter as a result of the timing of benefits and vacation utilization. One final note on the topic of guidance. The company had previously provided an $80 million EBITDA target for 2024, but we now feel the more appropriate target is returned to double-digit organic revenue growth over the next 24 months, with strategic acquisitions being additive to that growth. From a margin perspective, we believe we can achieve 20% adjusted EBITDA margins over the same time period. Chris and I feel very good about everything we've put into place this year and look forward to continuing to update you on our progress in 2023 and beyond.
Thank you all again for joining us today, and we'll now open the line up for questions. Operator?
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