U S Physical Therapy Inc /Nv Q4 FY2023 Earnings Call

Good day, and thank you for joining us. Welcome to the US Physical Therapy fourth-quarter 2023 and full-year earnings conference call. I would now like to hand the call over to Chris Reading, President and CEO. Please proceed, Chris.

Thanks, Shelby. Good morning, and welcome, everyone, to US Physical Therapy's earnings call this morning. With me on the call today include Carey Hendrickson, our CFO; Eric Williams, our Chief Operating Officer; Rick Binstein, our Senior Vice President and General Counsel; Jake Martinez, our Senior Vice President of Finance and Accounting. Graham Reeve happens to be on a plane this morning and won't be joining us. Before we begin with some prepared remarks, I'll ask Jake to cover a brief disclosure statement. Jake, if you would please.

Thank you, Chris. This presentation contains forward-looking statements, which involve certain risks and uncertainties. These forward-looking statements are based on the company's current views and assumptions. The company's actual results may vary materially from those anticipated. Please see the company's filings with the Securities and Exchange Commission for more information.

Thanks, Jake. I'm going to go ahead and start this morning with particular thanks to our clinical teams led by our capable partners around the country for their efforts in delivering exceptional care, returning a record number of patients to the things that they enjoy the most and to our prevention partners for weathering what we expected to be a more challenging year in '23, with great continued success in keeping thousands of workers and companies that we serve healthy and injury-free. They finished the year in really strong fashion with 9.7% revenue growth in our final quarter and a 330-basis-point improvement in margin in what has been a seasonally slower quarter for this subset of our business, all of which sets the table for good growth year ahead in 2024. Past year was one of persistently high demand for our physical therapy services. Each quarter in 2023 produced a record for volume across a growing network of clinics finishing the year for the first time in our history at 30 visits per clinic per day visits, grew to more than 5 million for the year, up 11.6% in 2023. Demand remained strong throughout the year. Coming to meet this demand, our clinical teams did an exemplary job caring for our patients, which in turn creates additional demand from happy customers who refer their colleagues, friends, and neighbors to us. Despite a rather tight labor market, we were able to attract and hire therapists to enable us to achieve these record volumes. Our team led by our locally strong partners around the country helped to limit turnover at a time when demand has remained at record levels. And our clinical cost efficiency improved in 2023 despite significant inflationary pressures. I am particularly proud of our ops team and their efforts to keep these many factors and forces in balance throughout the year, all while juggling numerous initiatives, including opening and integrating 35 clinics and working to integrate an additional group via acquisitions in both PT as well as injury prevention. Additionally, we worked to overcome the Medicare cuts, which made our lives more difficult these past few years despite physical therapy saving the system significant costs when compared to more expensive, invasive, and often unnecessary musculoskeletal procedures. Our team renegotiated a significant number of payer contracts in 2023, which is bearing fruit for us across our commercial contract base. We have good work planned for 2024 to carry on that work and to impact rates further. Finally, you saw in the release that we announced a small dividend increase, which started this year with the majority of our attention focused on deploying capital through carefully vetted acquisitions in the quarters and years to come. The partners we added in 2023 are ahead of plan and doing terrific, including the industrial injury prevention partnership that brought us our first software product, which is getting strong reviews. We had a great overall year in injury prevention. On the PT side of things, we are busy at varying stages of diligence and completion, several opportunities that we have included in the guidance we provided in our release. While the environment isn't easy by any stretch, we're supported by a fantastic team whom I love and respect, and I can assure you everyone is working very hard to produce a good year ahead. We have a lot of detail to cover. Carey always does a great job with that, so I'm going to turn it over to him to dive in before we open up for questions.

Great. Thank you, Chris, and good morning, everyone. Despite challenges as we enter 2023, including the 2% Medicare rate reduction that we've talked about in a tight labor environment, our team produced strong results in 2023. As Chris noted, we recorded the highest patient volumes in the company's history in 2023 at 30 patients per clinic per day. Our physical therapy revenues increased more than $50 million in 2024, which was a 10.6% increase over the prior year. Our physical therapy operating costs decreased by $0.55 per visit for the full year. Our industrial injury prevention business strengthened as the year progressed, with fourth-quarter revenues up 9.7% over the prior-year fourth quarter and IIP fourth-quarter operating income up almost 30% over the prior year. We achieved year-over-year growth in both adjusted EBITDA and operating results. We added 46 clinics, through acquisitions and de novos in '23, 31 on a net basis after closures, and we added to our IIP business as well. Further, we strengthened our capital structure with a secondary offering in May 2023, which was done on an accretive basis, providing us with cash to deploy into growth opportunities. So despite the challenges as we began the year, our team produced some very good results, and there was a lot of good work done in 2023 that positions us well as we move forward. We reported adjusted EBITDA for the fourth quarter of $19 million, an increase of $1.1 million over the fourth quarter of the prior year. Our operating results were $0.59 per share in the fourth quarter of 2023, which is an increase over the $0.58 reported in the fourth quarter of last year. Our total company revenues increased 9.6% in the fourth quarter, growing from $141.2 million in the fourth quarter to $154.8 million in the fourth quarter of '23. And our total company gross profit increased by $2.7 million or 9.6% from $27.8 million in the fourth quarter of '22 to $30.5 million in the fourth quarter of '23. Our average visits per clinic per day in the fourth quarter were 29.9, which is the highest volume in the company's history for the fourth quarter. October was at 29.9; November was at 30.3; and December was at 29.5. All three months were higher than the same month in the previous year. Our net rate was $103.68 in the fourth quarter of 2023, which was a meaningful sequential increase from $102.37 that we reported in the third quarter of '23 due to the cumulative impact of progress in our rate negotiations and some operational efforts we've been working at all year. That is a decrease from the $104.28 reported in the fourth quarter of 2022 due to the reductions in Medicare rates, which represent about one-third of our payer mix. All other payer categories increased by 2.1% on a combined basis over the prior year. Our physical therapy revenues were $134.6 million in the fourth quarter of '23, which was an increase of $11.8 million or 9.6% from the fourth quarter of '22. This increase was driven by having 45 more clinics on average in the fourth quarter of '23 than in the fourth quarter of '22, coupled with record fourth-quarter average patient visits per clinic per day, which was partially offset by the decrease in net rate. Our physical therapy operating costs were $108.4 million, which was an increase of 10.3% over the fourth quarter of the prior year also due to having 45 more clinics on average than in the fourth quarter of '22. On a per-visit basis, our total operating costs were $84.09 in the fourth quarter, which is basically flat with the $84.05 that we had in the fourth quarter of '22. For the full year of 2023, our operating costs were $83.34 in full-year '22, and they moved down to $82.79 per visit for the full-year 2023. Our salaries and related costs decreased to $59.72 in the fourth quarter, down from $60.04 in the fourth quarter of 2022. For the full year, salaries and related costs were down $0.33 per visit versus the previous year. Our physical therapy margin was 19.5% in the fourth quarter of 2023. That was down slightly from the 20% we had in the fourth quarter of '22, with the change due to the decrease in our net rate versus the prior year. Even with the decline in our net rate versus last year, our PT gross profit increased 7% in the fourth quarter. As previously mentioned, our IIP business saw nice growth. In the fourth quarter, IIP net revenues were up $1.8 million or 9.7%, and our expenses were up only $800,000 or 5.3%. So that resulted in a $1 million increase in IIP income in the fourth quarter of '23, which was an almost 30% increase over the prior year. Our IIP margin increased from 17.9% in the fourth quarter of '22 to 21.2% in the fourth quarter of '23. Our balance sheet remains in an excellent position. We have $144 million of debt on our term loan with a five-year swap agreement in place that places the rate on our debt at 4.7%, and we expect to remain at that rate going forward. In the fourth quarter of 2023 alone, the swap agreement saved us $900,000 in interest expense with cumulative savings of $3.3 million for the full year of 2023. Our interest expense was $2 million in the fourth quarter of '23. In addition to the term loan, we also have a $175 million revolving credit facility that had nothing drawn on it during the fourth quarter, and we have approximately $120 million of excess cash over and above what we need for working capital ready for deployment into growth initiatives. We also noted in the release that our Board raised our quarterly dividend rate by $0.01 per quarter in 2024. At the new rate, our full-year dividend paid would be $1.76 per share, which is a dividend yield of approximately 1.7% based on our recent stock price. As we noted in our release, we expect our EBITDA for full-year 2024 to be in the range of $80 million to $85 million. The 3.5% Medicare rate reduction that went into effect on January 1 results in a $6 million reduction in revenue and a $5.3 million reduction in EBITDA net of minority interest. So the $77.7 million of EBITDA reported in '23 becomes $72.4 million as we begin 2024 due to the Medicare rate reduction. The 2024 EBITDA range is an increase of roughly 10% to 17% from this starting point. We have tremendous confidence in our team to produce EBITDA growth in 2024. We'll benefit in '24 from the full year impact of rate negotiations that we completed in '23 and in the partial year impact of negotiation work that we do during 2024. We also expect to continue to increase volumes at our existing clinics in '24 and will maintain our discipline in expense control. We'll also benefit in '24 from the full-year contribution of our acquisitions that we completed during 2023. Additionally, we have several acquisitions that we expect to close in the near term by roughly the middle of 2024. So we've included the expected EBITDA contribution from those acquisitions in our 2024 guidance. The acquisitions we're including are similar in size to those we've completed in the normal course between $1 million and $3 million of total enterprise EBITDA with us purchasing between 50% and 90% of those companies. We expect our 2024 EBITDA by quarter to lay out a little differently than it did last year. As a reminder, we had no significant weather events in the first quarter of 2023, which resulted in the best first-quarter volumes we've ever had by a sizable margin. In January of this year, we did have some significant weather events, which was more in line with our historic experience. So we'd expect our year to get off to a little slower start than it did last year. And then to gain momentum as we layer in rate increases, volume growth, and acquisitions as the year progresses against the backdrop of our normal seasonal patterns. As a reminder, we expect our outstanding shares to be a little over 15 million shares in each quarter of 2024 and for the full-year 2024, which is where it has been since we issued the 1.9 million shares with our secondary offering in late May of 2023. That will impact our comparisons for our per-share metrics in the first couple of quarters of 2024. In closing, we feel very good about growth in 2024, and we look forward to producing strong results for all of our stakeholders in 2024. With that, I'll turn the call back to Chris.

Yeah. Thanks, Carey. Great job. Operator, let's go ahead and open it up for questions.

We'll take our first question from Brian Tanquilut with Jefferies.

Hi, everyone. Good morning, and congratulations on the strong quarter. I have a question for Chris and Carey regarding the M&A contributions you included in your guidance. How much visibility do you have on the timing of the deals that are reflected in that guidance? Additionally, Chris, can you share your thoughts on the M&A landscape this year in relation to competition for deals and the deal flow you're experiencing in your own pipeline?

In terms of timing, we've addressed that. One reason we included it in our guidance this year is because of how close we are to the announcement and release. So we're looking at deals that are in the queue between now and July. The overall landscape is as busy as ever. Competition is shifting since some companies are currently sidelined due to leverage and the rates they have to manage. This presents a valuable opportunity for us. However, we remain selective and focused on finding the right partners and attributes, which won't change. We'll maintain our discipline, but it's a good time for us, and we anticipate being busy this year.

No, it's awesome. And then maybe, Carey, as I think about the gross margin side, you highlighted your success there, and it obviously is very impressive. So just curious in terms of what you see as the remaining opportunity either to hold the gross margin line steady as you grow volumes this year or are there remaining opportunities to drive some margin expansion?

Yeah, I think it's going to depend on how much we can do on the rate side this year. We expect to do well there. I think we'll be able to at least maintain our margins where they have been, if not grow them slightly in 2024. But it's going to really be a function of how much we can push on the net rate side. And then to the extent we're able to keep our costs in line. So it's either flat on a per-visit basis or slightly better than that. And if we do that, if we push both of those really well, I think we can see a little margin improvement.

Carey, for Chris, considering the last point about the ability to drive rate growth from commercial payers, how are you approaching discussions around this? What phase are we in when it comes to achieving more rate growth across your various contracts in different markets?

But yes, we've had really good success in these discussions, I'd say they're based around outcomes, and they're based around the value that physical therapy provides. The fact that it's a way to actually decrease the cost of the overall patient's care. And we've been successful in those conversations. We have a team that is focused on this, and we're working on the ones we concentrate on the most are the five largest carriers and our top partnerships. We're going to keep at this work during 2024.

So what inning would you say?

I would say we're probably in the fifth inning or so. We've made some good progress over the last 18 months, but there's still more we can accomplish. We definitely have work to do. The positive aspect is that we've built in step increases. As we've renegotiated these contracts, we've aimed to include one, two, or even three-year step increases to avoid having to revisit these contracts every year. As you know, we have over 1,700 contracts that we constantly need to come back to and renegotiate. The three-year step increases have been beneficial because we receive that automatically as each year lapses. So, that has worked out well.

And I would say that when we get to the ninth inning, we're not done. We're going to play a new game. So we're going to start over. This is going to be a perpetual thing, and I think over time, how we get paid may change, and maybe we have a little bit more latitude to focus on the results and not count minutes like we do right now. It's just a crazy way to do it, but I think we've got continued opportunity.

We'll take our next question from Larry Solow with CJS Securities.

Good morning to both of you. Continuing with that line of questioning, on the commercial side, you mentioned a nice 2% increase this quarter, or 2% excluding the CMS impact. Do you know what it was for the full year, and do you anticipate a similar improvement or perhaps even a bit better in 2024? I think using the baseball analogy, we're in the top of the fifth inning, and we're seeing some benefits from the bottom of the fourth that weren't necessarily present in 2023.

Yeah, for sure.

For 2023, if you combine all the categories except for Medicare, they increased by approximately 1.5%. This growth accelerated in the fourth quarter to 2.1%. The trend has been improving as the year progressed.

No, go ahead.

As we consider 2024, I believe we can achieve a flat rate next year if Medicare decreases by 3.5% and we see an increase of 1.5% to 2% in the other categories combined. I think we can meet that target or possibly exceed it.

Got it. Okay. Regarding the CMS rate cut of 3.6%, it seems there won't be any relief from that. Congress likely won’t take action in the next couple of weeks. Chris, could you remind us that these cuts raise the physician fee schedule and shift more to the general practitioner while keeping budget neutrality? What’s the outlook moving forward? Are we nearing the end of this? Do you anticipate more cuts potentially in 2025? How do you see that?

Yeah, I don't know Larry. I mean, trying to predict what CMS does or the federal government does is a little bit of a hard job. But I think we're at the end, and I think we'll get back into a more normal pattern as we go forward with small increases every year. I think people understand that they're picking on their own providers and that this isn't sustainable, three sequential years of cuts. That's what I believe, so we'll see what happens.

We'll take our next question from Joanna Gajuk with Bank of America.

Hi, good morning. Thank you so much for taking the questions here. So I guess a couple of things. When it comes to these assets that you outlined, so you listed a contribution from deals that you expect to close later this year or this year through the first half, maybe July. I listed out one of the items, but it's one of the last items on that list. So should we read into this as implying the assets you're talking about here versus the $5.3 million, I guess when you have to overcome year over year that the deal contribution from those features is kind of a smaller item? So are you willing to quantify that or quantify some of these other things you listed there as assets?

Sure, Joanna. As you can see, there are various factors at play, and we haven’t shared specific details about the monetary amounts or their effects. Just understand that we anticipate some factors will perform better than expected, while others may not meet our expectations. Therefore, we chose not to discuss the financial specifics for each item. Regarding acquisitions, I've mentioned before that these usually fall within our typical range, generating between $1 million and $3 million of EBITDA on a total enterprise level. We expect to have additional acquisitions that will close later in the year, beyond what we've included in our guidance for the first half. While these later deals can have an effect, it’s important to note that their impact will diminish as we progress further into the year, particularly for 2024.

That's helpful. Regarding the guidance, how should we consider the assumptions for volumes? I understand Q1 will present a tough comparison, but what was the same-store volume growth for the entire year of '23? Additionally, how do you foresee same-store volumes growing for the entire year of '24?

Yes, we believe we can achieve strong volume growth. We have included an estimate in our plan, aiming for a mid-single digit growth rate of around 3% to 5% for our existing clinics. We are confident that this is attainable in 2024.

Okay, thank you. And last one, a follow-up on the discussion around pricing. Good to see the commercial traction there. Can you talk about workers' comp? I guess two things, what rate increases you're getting there? And also, the mix, are you improving or increasing the workers' comp mix? And I guess that will be helping that average rate as well, right?

Yeah, the mix has stayed pretty consistent. The good news is we're growing the other categories well, too. So workers' comp is growing. It had really nice increases, but so is commercial, so is Medicare. We've had a lot of patient volume growth across the mix of categories. So while the mix hasn't changed that much, workers' comp rate is continuing to improve. It's higher in '23 than it was in '22. We're hoping it'll continue to be like that as we go forward. We're negotiating rate on workers' comp just like we are in others now as well.

If I may just squeeze a very last one, sorry about that, and thank you for taking the question. The comment on margins, so these were gross margins when you talk about keeping this level, maybe even expanding. Any comment around the corporate level costs? How should we think about that number going forward? I guess it ticked up a little bit in Q4. I guess maybe this is not the $13.9 million corporate office cost. So how should we think about that number going forward? Thank you.

Yes, I believe we have consistently maintained corporate costs between 8.5% and 9% of total net revenue for several years. This is a reasonable way to consider it, as we will be adding additional costs related to new clinics in the future. Therefore, viewing it in the context of that 8.5% to 9% of total revenue makes sense.

Thank you for the questions. To start, I would like to focus on margin-related aspects, particularly regarding hiring and staffing trends over the next few years. I've noticed in recent quarters there has been a slight shift towards PT assistance, and I'm interested in your thoughts on that mix and the current availability of labor. Are there any notable trends in operating costs that you could highlight?

The market remains competitive, but it hasn't become excessively difficult. Our recruiting team, together with local partners and operations staff, is collaborating effectively to bring new clinicians on board. We have traditionally focused on physical therapy, employing more licensed therapists compared to physical therapy assistants, as well as licensed physicians. However, if we come across a strong opportunity with a talented physical therapy assistant, we are likely to pursue it. The relationships between physical therapists and physical therapy assistants have remained fairly stable over the past year. We need to be mindful of scheduling, especially regarding federal patients. Overall, while it is a competitive market, we are managing well. Eric, do you have anything to add?

No, I think you summed it up pretty well. We'll continue to invest in additional resources as the company grows to help us from a recruiting perspective. Our clinical turnover number this year was the lowest number we've had in five years. I know it was 1.5 percentage points better than 2022, which also helped us from a business per-day perspective. We continue to get better from a retention perspective and continue to improve our ability to source licensed staff across the organization.

Helpful on. And then sticking with this theme of levers for margin expansion, another area I was hoping to hear an update on was, in the past, you talked about rolling out group purchasing across the platform. Just was hoping to hear a little bit more color in terms of just how penetrated that is across your footprint of clinics and then to what extent you see any incremental leverage opportunities from continuing to consolidate purchasing?

Yeah. Well, I mean, you have to unfortunately recognize that you have the rollout of group purchasing, which we've done, and that's pretty complete. Then you have overlaid on that just general inflation. I think it was the right thing to do. I think it was smart to do. We didn't get it done day one last year, so it rolled out across the year. We saw that carry forward. You likely saw some of that, probably a small part of that show up in our total cost per visit last year. But look, inflation has been a little challenging too. So I'm sure that what we got, we gave some of that back in inflation. So that's not a big lever. Our big focus is driving additional volume through our facilities, which gives us a little overhead coverage and helps us be a little bit more efficient. That's really what it comes down to more than anything else.

Yeah. And Jared, just to add on that, I will say that you do gain operating leverage as you increase your volumes at our existing clinics because the fixed costs remain relatively the same, right? So the incremental margin on those extra visits is higher than your overall margin. So that should help us as we go forward if we can keep those costs in line or maybe even a little bit better on a per-visit basis as we go forward, which I think we can do.

Again, very helpful color. And the maybe we've talked around some of the puts and takes to the outlook in 2024. I guess, to put a fine point on, when we think about the low to high end of the range for adjusted EBITDA guidance in 2024, is the biggest swing factor in your opinion just timing related to when you complete the M&A deals that are assumed in that outlook? Is it potentially some variance in your assumptions around the rate trends for the year? Just would love to unpack a little bit about that in terms of what drives that variance from the low to the high end?

Yeah. Let me give Carey a break, and I'm going to take that. I mean, guys, when you run a company, there are things every day that happen, and you try to control as many things as you can, and you try to have a great crystal ball. When you're running close to 700 facilities and delivering care, it's not all one plus one equals two every day. We have a series of things that we're very familiar with that we have to do well. We have to drive additional volume, volume that we're projecting for July and August and September of the year ahead. We have to get contracts updated and renewed and carry those contracts forward and bring in relatively the same mix or a slightly better mix of patients than we've had. None of that is certain. All of that requires anordinate amount of work from everybody clinically, locally, and operationally. Then we have the timing of acquisitions which, as you point out, has some effect. You roll that all together, and we've given you the guidance that we've given you. We think we can do better than the bottom, and we think we'll be somewhere in that range. We'll update as the year goes on according to how things are going if we feel like we need to guide the market in a particular direction. That’s really all I can tell you right now. We're early in the year. We're off to a reasonably good start, albeit a little weather in January, but I think we can overcome that.

We'll take our next question from Mike Petusky with Barrington Research.

Good morning. Can I get the payer mix for the quarter?

Sure. Yeah. For the quarter, it was pretty similar. We had about 48% commercial, 32% Medicare, 9.5% workers' comp, and then the other categories make up the rest.

Carey, I'm sorry, at least on my end, you broke up on workers' comp. How much was workers' comp?

Workers' comp was 9.5%, with 48% from commercial, 32% from Medicare, and the remaining categories making up the rest.

Okay. And then I guess maybe for Chris or somebody else in the room. On workers' comp, I know you guys have expressed some optimism around possibly changing the trajectory there and getting that back up into the low double-digit range. Is that optimism still there or is that just a tough needle to move? Because at one time, you did have that probably 12%, 14% of overall revenue.

Yeah, it's not dead yet, Mike, but it's a tough lift. When you're growing, and we've been able to grow the whole business, it's tough to outgrow just one category, but we've done a lot of training. We've signed a lot of new contracts that should drive additional volume. Our partners have focused on it. Eric, do you want to weigh in?

Yeah, there were a lot of new agreements that were signed, and a lot of those took place at the tail end, late Q3 and Q4. We actually did see a pickup in Q4 last year. In Q4, work comp was 9.2% of our mix, so up slightly from where we are. The work and the things that we executed late in '23 are going to pay dividends to us in 2024. There are additional agreements that are in process that will get executed as we go through the first quarter into the second quarter that will pay dividends for us, we believe, in the back part of the year. This is an area that we continue to really focus hard on, not just from a volume perspective, but from a rate perspective as well. We did get a nice pickup in rate year over year for work comp business. There is opportunity here, but as Chris pointed out, when the whole business is growing, it's really hard to outcheck those other categories on a significant basis. But we are making progress here, and we expect better things in 2024.

Okay. All right. Great. And then just a quick question, I guess, on the lack of action in Washington and just the CMS cuts this year. I know, Chris, that you're very connected and a leader in the industry. I mean, is there an argument to go back to CMS? If you look at '25 and essentially say, look, we've really taken it for the last few years here and essentially make the argument that there was no relief in '24, and that this streak should end at this point? I mean, has there been any talk I guess within the industry that there's got to be an end to this?

Yeah, there's a lot of talk in the industry. I would tell you CMS is a frustrating place. We seem to have a lot more empathy in Congress. We're actually going to be in DC, Nick and I, Nick who serves as our Executive Director for APTQI, who also works with us and a lot of our member companies. CDOs will be in Washington in another month or so. We'll meet with MedPAC to talk about some of their scoring and their lack of ability to score true savers and assist on like, for instance, fall prevention, which is a saver. We know that if you can prevent a fall, we know measurably what the downstream savings look like in there, spectacular level of savings. Based on the rules, we're talking about federal government now, and everything has a million rules associated with it. Based on the rules, MedPAC isn't able to score saver as a saver. They have to score that as a cost. It's a crazy way of thinking when considering the prevention of a massive downstream expense. It doesn't make sense. So there's a lot of coordination that needs to occur between the law-making side and the rule-making side of government and CMS. Yeah, we're going to continue to beat the drum. We’re going to continue to work with the APTA and APTQI and all the constituents and all the good people that I get to work with in those two organizations to push hard. I think we will come out the other side and be okay. To say it's not frustrating would be an understatement. It's been a frustrating period, but I think in everyone's heart, they know that physical therapy and, statistically according to a lot of good studies that are out right now, physical therapy should be the entry point for musculoskeletal care. If it is, it saves a massive amount of cost. We're going to continue to beat that drum. My ability to absolutely predict what happens is not great, but you know we're trying.

No, I think I lost you. Thank you. That's great. And just one quick one on the M&A that's included in the guidance, I'm assuming that's all PT and no injury prevention, is that correct?

Don't make that assumption.

Okay. Fair enough. Thank you so much and nice finish to the year. Thanks.

I will say that for everybody's benefit, I mean, statistically speaking, while we've been active in injury prevention and expect to continue to be active, the majority of the deals that we get done are in the PT space, but you can expect us to be active in both.

And it appears that we have no further questions at this time. I will now turn the program back over to our presenters for any additional or closing remarks.

We truly appreciate your time and attention this morning. Carey and I are available later to answer questions either today or later this week or next week. We appreciate your interest, and we hope you have a great day. Bye now.

Thanks, everyone.

That concludes today's teleconference. Thank you for your participation. You may now disconnect from the room.