Image source: The Motley Fool.
Acadia Healthcare Co Inc (ACHC 0.64%)
Q3Â 2018 Earnings Conference Call
Nov. 06, 2018, 9:00 a.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
Please stand by, we are about to begin. As a reminder, this call is being recorded. Please proceed.
Brent Turner -- President
Good morning. I'm Brent Turner, President of Acadia Healthcare, and I'd like to welcome you to our Third Quarter 2018 Conference Call. To the extent any non-GAAP financial measure is discussed in today's call, you will also find a reconciliation of that measure to the most directly comparable financial measure, calculated according to GAAP, on our website by viewing yesterday's news release under the Investors link .
This conference call may contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including statements, among others, regarding Acadia's expected quarterly and annual financial performance for 2018 and beyond. For this purpose, any statements made during the call that are not statements of historical fact may be deemed to be forward-looking statements. Without limiting the foregoing, the words believes, anticipates, plans, expects, and similar expressions are intended to identify forward-looking statements.
You are hereby cautioned that these statements may be affected by the important factors, among others, set forth in Acadia's filings with the Securities and Exchange Commission and in the Company's third quarter news release, and consequently, actual operations and results may differ materially from the results discussed in the forward-looking statements. The Company undertakes no obligation to update publicly any forward-looking statements whether as a result of new information, future events or otherwise.
At this time for opening remarks, I'll now turn the call over to our Chairman and Chief Executive Officer, Joey Jacobs.
Joey A. Jacobs -- Chairman & Chief Executive Officer
Good morning and thank you for being with us today for our third quarter conference call. In addition to Brent, I'm here today with our Chief Financial Officer, David Duckworth and other members of our executive management team. David and I each have some remarks about the third quarter and our outlook for going forward in 2018. Then we'll open the line for your questions.
Acadia produced solid growth of 6.2% in revenue for the third quarter. Our revenue growth continues to be driven primarily by organic growth, including a 6.2% increase in total same facility for the quarter. This increase was mainly the result of adding 806 beds to our operations over the last 12 months. We added 132 beds during the third quarter and 408 in the first nine months of the year and we expect to add more than 800 beds to existing and new facilities in 2018.
Our 6.2% total same-facility revenue growth included a 2.4% increase in patient days and a 3.8% increase in revenue per patient day. U.S same-facility revenue increased 7.2% for the quarter with a 3.3% increase in patient days and a 3.8% increase in revenue per patient day. U.S same-facility EBITDA margin increased 60 basis points to 27.4%.
For our operations in the UK, same-facility revenue was up 4.4%, consisting of 1.3% increase in patient days and a 3.1% increase in revenue per patient day. Same-facility EBITDA margin declined 450 basis points to 16.9% for the quarter. Our operations in the UK were affected by a lower census and higher than expected operating expenses.
Our operating costs were significantly higher, primarily due to the ongoing nursing and clinical staff shortage and our dependent on higher cost agency labor. The census in our existing healthcare business declined as we experienced a decrease in referrals from the NHS. Similar to industry trends, we continue to experience difficulty with recruiting nurses and clinical staff, which requires us to utilize agency labor to fill those positions. Because our census did not reach its sufficient level to absorb the higher wages and other operating costs, our third quarter margins and earnings were adversely affected. We expect continued difficulties resulting from the nursing and clinical staff shortage for the foreseeable future.
We signed definitive agreements for two acquisitions following the end of the third quarter; one was with Mission Treatment, which operates nine comprehensive treatment centers for substance abuse with locations in California, Nevada, Arizona and Oklahoma. We also announced an agreement to acquire The Whittier Pavilion, a 71-bed inpatient psychiatric hospital in Haverhill, Massachusetts.
Thanks for your time this morning and your interest in Acadia. Now here's David Duckworth to discuss our financial results and guidance in more detail.
David Duckworth -- Chief Financial Officer
Thanks, Joey, and good morning. The Company's revenue for the third quarter of 2018 was $760.9 million, an increase of 6.2% from $716.7 million for the third quarter of 2017. Adjusted earnings per diluted share were $0.55 for the third quarter of 2018 compared with $0.58 for the third quarter last year. Adjusted EPS excludes transaction-related expenses of $2.4 billion for the third quarter of 2018 and $5.7 million for the third quarter of 2017. The Company's consolidated adjusted EBITDA for the third quarter of 2018 was $148.9 million or 19.6% of revenue. Acadia's operating cash flows from continuing operations were $288.7 million for the nine months ended September 30, 2018, compared with $272.6 million for the same period last year.
Turning to our financial guidance. As announced in yesterday's news release, we have adjusted our 2018 financial guidance based on the Company's performance for the first nine months of the year and our expectations for the fourth quarter. Our full year guidance is as follows. Revenue of approximately $3 billion, adjusted EBITDA in a range of $605 million to $610 million and adjusted diluted EPS in the range of $2.25 to $2.27.
This concludes our prepared remarks this morning, and I'll now turn it over to Joey for some final comments.
Joey A. Jacobs -- Chairman & Chief Executive Officer
Thank you, David. Before we move into Q&A, I want to briefly address the recent press reports and rumors regarding Acadia being approached by private equity firms. It is our Company's policy not to comment on rumors or speculation. That's all we will say today on this topic. So we ask that you keep your questions focused on our results. I will now ask Kathy to open the floor for your questions.
Questions and Answers:
Operator
(Operator Instruction) And we'll go first to A.J. Rice of Credit Suisse.
A.J. Rice -- Credit Suisse Securities -- Analyst
Hi, everybody. Maybe two questions if I could. First of all, there's also been some reporting, mainly in the financial press this quarter about regulatory issues that maybe the Company has been facing and I wanted to give you a chance to give any comments you'd like to give about that. And then also to ask you in the aftermath, because it didn't seem to get picked up in the popular press. I would think there hasn't been any change in your interaction with regulators, but just to ask whether that is indeed the case.
Joey A. Jacobs -- Chairman & Chief Executive Officer
Sure, AJ. Referring to the statements that I've made in previous earnings calls concerning regulatory issues at a few of our facilities, I'm pleased to announce that all of those have been resolved and that those facilities do not have admission holds as of this time. As you know, AJ, we are a large Company with a large number of facilities. So at any time we can have an inspection go bad or an incident occur or an investigation be instigated. But I'm pleased to report that for the ones we've been talking about this year, those facilities have their admission holds removed and have their license and are building back their census.
A.J. Rice -- Credit Suisse Securities -- Analyst
Okay. All right. And the other question I was going to ask was obviously about the UK operations. It sounds like the issues that you're experiencing are really more the market, not really anything you'd say with respect to your management team over there, not doing what they should be doing. I want to confirm that that is indeed what you think. And then as you sort of said in your prepared remarks that this is potentially could go on for a while, does it make you think about capital allocation to the UK differently, does it makes you think about repositioning that portfolio some. I don't know what the options are, but give us some flavor for, OK, if this does persist what can you do to try to at least minimize the impact on Acadia overall, given that the U.S operation still seem to be doing pretty well.
Joey A. Jacobs -- Chairman & Chief Executive Officer
Sure, AJ. First in the UK, absolutely, the nurse shortage continues and actually grows. So we see that occurring -- continuing and going forward. So that's the reason for lowering the guidance. We do expect to hopefully rebound on the census, to grow the census, however, small it might be. But we do have beds coming online that the NHS wanted us to retool, so that we could take those patients. However, unfortunately, when we get those patients, a part of that staffing will be nurse agency cost, but it would still be incremental positive to us. So as far as capital deployment to the UK, we have a pretty stringent policy, whether it's in the UK, in the US now about capital deployment. But it will be a little bit tougher for capital to be deployed in the UK. We are seeing a lot of activity here in the US for the use of our capital. So we'll just take that a day at a time, but yes, we will be more careful about deploying capital to the UK.
A.J. Rice -- Credit Suisse Securities -- Analyst
Okay, all right, thanks a lot.
Operator
Our next question will come from Kevin Fischbeck of Bank of America Merrill Lynch.
Kevin Fischbeck -- Bank of America Merrill Lynch -- Analyst
Hi. Great, thanks. I guess given some of those comments, do you think that the kind of the margin profile that you showed this quarter in the UK is the right way to think about it, at least for the next several quarters?
Joey A. Jacobs -- Chairman & Chief Executive Officer
Well, Kevin, I think that is the profile for the next quarter, for sure. Could it go a little bit lower? Yes, but the team is working on making it -- growing it. So -- but it is tough all across UK for healthcare providers concerning this nurse and clinical staff shortage. So that does continue to put pressure on us and everybody. So -- but our goal would be to improve the margin and we would have to get there through growing the census incremental to the centers, I think.
Kevin Fischbeck -- Bank of America Merrill Lynch -- Analyst
Okay. Then I guess to that end, could you talk a little bit about what happened -- you said that centers was lower because the NHS had a decrease in referrals, then you also talked about them asking you to take -- to add more beds. So can you talk about what happened in the quarter, why that was an issue and how long it takes to fix itself?
Joey A. Jacobs -- Chairman & Chief Executive Officer
Well, in this quarter those are the holiday months over in the UK and we should have been more pessimistic in our budget for what the census would do. And yes, during the year the NHS has come to us and asked us to build beds for certain services and those beds are coming online. And so, both of those things occurred. The census was softer, but the NHS is asking us to build beds to meet the needs of the patients in the UK.
Kevin Fischbeck -- Bank of America Merrill Lynch -- Analyst
Okay. So when do those kind of new referrals start to kick in?
Joey A. Jacobs -- Chairman & Chief Executive Officer
We already have some of the new referrals now and we expect that to grow, but that -- Kevin, I can't predict the existing base census soften a little. I hope it doesn't. I want it to grow. Everybody in the UK wants it to grow and that's what we're focused on, but we'll just have to wait and see. But we are predicting more of the same for the fourth quarter that we saw in the third quarter.
Kevin Fischbeck -- Bank of America Merrill Lynch -- Analyst
And just maybe last question, because like 4.5% same-store growth is actually not a bad number. But obviously given the labor pressures you need a higher number. What number do you think you need to get to on a same-store basis in the UK to be able to maintain margins?
Joey A. Jacobs -- Chairman & Chief Executive Officer
Well, we know 4% won't do it. So, Kevin, quite frankly, we're going to have to have some relief on the premiums who are having to pay for the nurse agencies. There's got to be more staff, more nurses, more clinicians in or into the system and we are actually -- I think going through this environment, the best of any of the providers, the NHS, they have the worst of the problem. They have, I think thousands of open positions for nurses. So that has to be fixed. We can grow the census and marginally improve the margin and earnings, hopefully, but it's really the salary and wages, that's the issue.
Kevin Fischbeck -- Bank of America Merrill Lynch -- Analyst
Alright. Great, thanks.
Operator
We will now take a question from Matt Borsch of BMO Capital Markets.
Matthew Richard Borsch -- BMO Capital Markets -- Analyst
Yes. Thank you. Just a little bit more on the UK. Can you just talk about your level of commitment to the UK as a market, given these results, and you look into 2019? I mean I guess one of the questions here, in addition to the unfavorable developments and the uncertainty of Brexit impact is, given that they're an ocean away, does that impact your ability, top management's ability to be on top of trends in this close a way as you are in the US?
Joey A. Jacobs -- Chairman & Chief Executive Officer
We have a psych hospital 40 minutes from us here in the corporate office, so I can keep an eye on that facility basically from my office. But the UK distance really is not an issue. They keep us up-to-date and we have enough detail and know what's happening over there. So a 17% EBITDA margin that's OK. It's not what we expect, but that's a pretty good margin. And as Kevin mentioned earlier, more than a 4% revenue growth that would be a strong number here in the US. So we have some positive numbers and we're just weathering the storm and doing everything we can on the expense side to make a stronger asset today than we had yesterday.
Matthew Richard Borsch -- BMO Capital Markets -- Analyst
Got it, that makes sense. Has anything changed with respect to what you had talked about last quarter in terms of -- last quarter you talked about the ability to bring in labor from the Commonwealth countries and how that was something that was helping. Has the situation changed or it's just tougher than you would hoped it would be for the second half?
Joey A. Jacobs -- Chairman & Chief Executive Officer
It's just tougher. It's just tougher. And the government (multliple speakers) -- yes, it's just tougher. Thank you.
Matthew Richard Borsch -- BMO Capital Markets -- Analyst
Thank you.
Operator
And next we have Peter Costa of Wells Fargo Securities.
Peter Heinz Costa -- Wells Fargo Securities -- Analyst
Hi, thanks. Back to the same area, couple of questions. I'll start with the slowdown in NHS referrals, do you believe those referrals are going somewhere else? Do you believe to competitors? Do you believe they are staying with NHS beds or is it just less demand?
Joey A. Jacobs -- Chairman & Chief Executive Officer
I don't think they're going to competitors; NHS maybe keeping them longer in the system before they get to us. But quite frankly, just getting them through the system and getting them funded is the speed of the referrals. And once again, during the third quarter it slows down historically and it did this time too. So we hope that the referrals will pick up in pace, because everybody's back, but we're getting ready to head into the holiday. So we're trying to be a little bit conservative about that too, and we hope that the funding of the individual patients will happen at a quicker pace. So those are the things we're working on and talking to the referral sources over in the UK.
Peter Heinz Costa -- Wells Fargo Securities -- Analyst
Okay. And then second question. The talk of your Company being taken private has been more recent than the talk of you perhaps selling the UK assets, which extended some time ago. Did that talk ever filtrate down into the management of the UK facilities or perhaps to the NHS, in terms of impacting their referral streams to you, so sort of that conversation or that talk impacted your business?
Joey A. Jacobs -- Chairman & Chief Executive Officer
I do not think so. No one brought that to my attention.
Peter Heinz Costa -- Wells Fargo Securities -- Analyst
Okay. And then lastly, can you give us some some concrete things about what you're doing to improve the margins going forward here? For example, if you don't have the business you could consolidate facilities perhaps. So is there some mechanism that you can talk about the concrete steps of how you're going to fix things?
Joey A. Jacobs -- Chairman & Chief Executive Officer
Yes. We have more than 500 facilities there. We're looking at the the lower number of performing facilities and what we can do with them. And worst-case scenario, it would be that we would close them. In that we are not adverse to doing that. If we decided we could put 20 facilities together and maybe somebody would want them or whatever, we would look at that too, but primarily if we can't turn around the lower performing facilities, then we will make a decision to close them.
Peter Heinz Costa -- Wells Fargo Securities -- Analyst
Do have a number as to how many of those lower performing facilities fit that target list?
Joey A. Jacobs -- Chairman & Chief Executive Officer
We're going through that process right now.
Peter Heinz Costa -- Wells Fargo Securities -- Analyst
Okay, I'll leave it there. Thank you very much.
Operator
Now our question will come from Brian Tanquilut from Jefferies.
Brian Tanquilut -- Jefferies -- Analyst
Joey, just -- sorry to go back to the UK, but what changed --
Joey A. Jacobs -- Chairman & Chief Executive Officer
Brian, you can't go back to the UK, let's talk about the US (multiple speakers) about the 7%.
Brian Tanquilut -- Jefferies -- Analyst
Yes, no that will be my next question. But just really quickly in the UK, the big drop in margins, we saw challenges in Q3 of last year and margins dropped to 21%, but the 450 basis point drop just seemed really big and it seems like the last few quarters you had your eye on the ball really closely on staffing. So what blindsided you here in the quarter?
Joey A. Jacobs -- Chairman & Chief Executive Officer
The census was softer than our expectation and then we had to use -- our discussions with the UK operators, we had to use more nurse agency expense just on the base patients and then own the new beds that we opened up that we utilized more nurse agency expense there. And the census, you know it takes a little while for that census to ramp up. I think we'll be fine once it ramps up. It will cover the additional costs of the agency nurse . But those are the two things that hit us in the third quarter, was the softening of the census, but more importantly, the nurse agency just was too great.
Brian Tanquilut -- Jefferies -- Analyst
Got it. And then I'll shift to the US business now. So pretty good same-store this quarter. How are you thinking about your ability to maintain or ratchet up that same-store volume trend? Number one. And then how are you thinking about potential facility closures in 2019 or any impact from news reports that it seems like you're exiting some markets here in the U.S.?
Joey A. Jacobs -- Chairman & Chief Executive Officer
Say that one more time Brian.
Brian Tanquilut -- Jefferies -- Analyst
Yes. So your same-store volumes were stronger this quarter. So how are you thinking about the sustainability of that or your ability to ratchet that up? And then the follow-up is just, I think there are reports that you're exiting some markets in the U.S. Just want to hear your thoughts on that and how that impacts 2019.
Joey A. Jacobs -- Chairman & Chief Executive Officer
Sure, absolutely. First, absolutely, the key to this is building the beds and we've got those beds coming online and we've got a group of de novo facilities and joint venture facilities that will be going into the same store, in addition to the beds that we have built at those facilities. So, it is good to see that it looks like the U.S census wants to grow. Same-store facility wants to grow more than 3% and you saw that in the third quarter and I think that is a goal for us, is to get more than 3%, closer to the 4%. So as your comment about ratcheting up, I think the potential for us to grow the census higher here does exist. Now, the only thing I'm aware of that we might be closing -- or we are closing is we have an outpatient business in the state that we made a decision to close that due to the state not reimbursing us and they had cut reimbursement, so it didn't make the business model work. And we reviewed that and so we are closing those outpatient services in that state. And it was the right decision to do.
Brian Tanquilut -- Jefferies -- Analyst
All right. Got it. Thanks Joey.
Operator
Our next question will come from Frank Morgan of RBC Capital Markets.
Frank Morgan -- RBC Capital Markets -- Analyst
Good morning. I kind of want to go back to that last question in a little more detail. Obviously, when we started thinking about 2019 from what you're saying about the UK, we don't -- tell me if I'm wrong, but I don't think we should expect a lot of improvement there. So my question is in terms of how you can compensate for that in your U.S operations, either through margin expansion on your consolidated base today, but also perhaps even acquisitions. So if you could kind of give us a little color on perhaps how you could offset some of the lack of growth in the UK, how you could accelerate growth in the U.S. to maintain a higher overall growth enterprise. And then, specifically, maybe even comment a little bit about these acquisitions you've announced today. Thanks.
Joey A. Jacobs -- Chairman & Chief Executive Officer
Sure, Frank. The key to here in the U.S is to increase our occupancy and fill the beds we're building to absolutely in the same-store numbers that will drive that. And secondly, those facilities that AJ talked about that had regulatory issues this year, if we can keep that to a minimum -- that was me knocking on wood -- if we can keep that to a minimum, that will improve the margins. So we have an opportunity here that if we'll execute and have a little good luck that we can grow the census and actually improve the margins here in the U.S. on a same facility basis. So that is one way we can help offset some of the UK.
And then as far as the acquisitions, we had been analyzing these acquisitions probably for the last five months and you probably have heard me mention it on the call that we would be making some acquisitions this year. And we liked the facility up in Massachusetts, the acute hospital. As you know, we have one of our large joint ventures in Massachusetts and we have quite a bit of penetration on the CTC side in Massachusetts. And then the Mission acquisition, the CTC acquisition, this is a single owner that had started this business several years ago, had grown it and was wanting to start planning for his retirement and we were fortunate in that the team was able to negotiate that transaction also. So we think they both fit us very well in the existing businesses and markets. So good acquisitions.
Frank, are you still there?
Frank Morgan -- RBC Capital Markets -- Analyst
I'm sorry, yes. In terms of just the sort of embedded growth potential in your U.S operations, from -- we've had these issues and you can fill them up. Do you have a number on, like, how many beds we're talking about that will be available for -- If we were trying to get to a number on how much EBITDA growth potential there is from these underutilized beds?
Joey A. Jacobs -- Chairman & Chief Executive Officer
I don't have that number, Frank. I'm sure in our analysis working on this project we have that. We're getting ready to introduce (ph) it. We're in the process of doing the 2019 budgets. So I would be able to speak more about that in the first quarter about what the assumptions are for that in 2019.
Frank Morgan -- RBC Capital Markets -- Analyst
Okay, one last one. Do you think '19 would be a year where you would make more acquisitions, would you accelerate the pace of acquisitions in '19, or is it going to be sort of a retrench in the UK and fill up what you've got in the U.S. (inaudible)? Thank you.
Joey A. Jacobs -- Chairman & Chief Executive Officer
I mean carefully deploying our capital, which means more of it will be going to the U.S. and we will make acquisitions next year. The number is still not -- we haven't pegged a number, we will just take them one at a time the opportunities. We have several joint ventures that we're looking at. So we'll just take it one at a time.
Operator
And we'll go now to Ana Gupte of Leerink Partners.
Ana Gupte -- Leerink Partners -- Analyst
Hey thanks, good morning. You absorbed the US (multiple speakers) thanks, yeah. The volumes look great, the revenue per patient day also looks really good and wanted to understand what the underlying drivers were. Is it a mix issue around acute residential or peer mix, or more psych versus addiction and what's the sustainability of that going into '19?
Joey A. Jacobs -- Chairman & Chief Executive Officer
I'm going to let David take this question.
David Duckworth -- Chief Financial Officer
Ana, the key driver in the revenue per day is payer increases from our different payers and we've seen the increases for Medicaid, Commercial Medicare really across all payer categories this year, that is the key driver. As you know, we have added more -- a few beds. So that would be a small part of the growth, would be the acute mix becoming stronger, but the key driver is rate increases.
Ana Gupte -- Leerink Partners -- Analyst
Okay. So underlying rate increases. Got it. Then on the length of stay, you've had a little bit of pressure here, it's obviously been offset by the volumes and so you get good patient day growth. One of your peers has talked about this managed Medicaid mix shifting for a while and they continue to talk about that this quarter. Is that likely to accelerate for you, or is your book of business pretty much you kind of reaching a place where the length of stay pressures have reached a floor?
Joey A. Jacobs -- Chairman & Chief Executive Officer
Ana, this is Joey. The length of stay is very stable. The length of stay for acute patients is nine days this year versus last year for this quarter, and it was nine days. The specialty is 21 days this year versus 21 days last year, and the RTC is basically the same as it was last year. What's driving it down is -- or mathematically what does this is the lower length of stay on more of the acute patients. So our length of stay is not an issue internally.
Ana Gupte -- Leerink Partners -- Analyst
It's not n issue for you. Okay. I mean it's very modest this time around compared to your volumes anyways. And then the last one was on the labor on the US side. Again you've had very good success recruiting, your markets are not the same as UHS, they did have some wage inflation pressure and I think they also talked about competition from new entrants or maybe it's private companies, the P/E investing was hard to understand really. But is there anything that might suggest that going forward in the US too there'll be wage pressure, which would impact your margins, are you comfortable on that one?
Joey A. Jacobs -- Chairman & Chief Executive Officer
Well Ana, we feel pretty comfortable. We think we're going to be able to live with it, 2% to 3% raise in wages next year as we go through our merit increases. There are -- there will be and has been, there will be a few isolated markets where we might have to do something different in those markets, just because of not being able to find all the staff we need and we address those as one-offs, and so that's how we'll approach 2019. So we feel good about the position that we're in, but once again, we have different markets; that's right. We are going to probably have more rural markets. But we're OK, we'll do 2% to 3% in our budget for next year. And hope to stay within it.
Ana Gupte -- Leerink Partners -- Analyst
Got it, thanks so much. Appreciate it.
Operator
We'll take our next question from John Ransom of Raymond James.
John Ransom -- Raymond James -- Analyst
Good morning. Let's just say hypothetically that the team decides or maybe the better part of valor is to look at -- maybe see if there's a buyer out there for UK and refocus on the US. Do you have any market feedback as to what kind of multiples assets are trading for over there?
Joey A. Jacobs -- Chairman & Chief Executive Officer
John I'm going to pull out the no comment answer.
John Ransom -- Raymond James -- Analyst
I had to try. The other thing you used to give an agency labor percentage number latter part of last year, early part of this year. Obviously, that number has gone up, but can you give us some ballpark range of how much that's up versus a year ago?
Joey A. Jacobs -- Chairman & Chief Executive Officer
David will give that to you.
David Duckworth -- Chief Financial Officer
John, we have seen, as we mentioned, higher agency labor as a percentage of our total labor cost. That's 14% in the third quarter this year compared to just under 12% last year. And total labor cost as a percentage of revenue, 68.5% this quarter and we were at 65% last year.
John Ransom -- Raymond James -- Analyst
So David, what's a rule of thumb, every 1%, is it double the cost, is it something like that or what's the rule of thumb?
Joey A. Jacobs -- Chairman & Chief Executive Officer
For every 1% of the contract increase.
John Ransom -- Raymond James -- Analyst
I'm sorry, I think you cut out there.
Joey A. Jacobs -- Chairman & Chief Executive Officer
We're having to pay a 30% premium to the agencies for a nursing hour.
John Ransom -- Raymond James -- Analyst
Got you, OK. (Multiple speakers) And then lastly, switching to the US, how should we think about over the next three or four quarters how new beds in the US will come online?
Joey A. Jacobs -- Chairman & Chief Executive Officer
Similar to how they've done this year, I think. I don't have that schedule with me. David will be glad to give that to you offline, John, but I think it's going to be similar to this year (multiple speakers).
John Ransom -- Raymond James -- Analyst
And do you have an estimate -- are the start-up losses from do novo, not bed adds, but brand new facilities, does that ever hit a -- will that hit a point of materiality next year or is it just something you could absorb?
David Duckworth -- Chief Financial Officer
John this is David. I think as we think about next year and we have had several de novos over the last 12 months, we have four different facilities incurring losses and we do see that continuing, just as we have other projects coming online next year, but I do think as these four projects and new facilities mature, it would be potentially less of a loss number as we think about 2019 than it has been in 2018.
John Ransom -- Raymond James -- Analyst
What's your number for '18 approximately?
David Duckworth -- Chief Financial Officer
Well, for the full year there's approximately $7 million of losses from that group of facilities.
John Ransom -- Raymond James -- Analyst
Got you. All right, thanks so much.
Joey A. Jacobs -- Chairman & Chief Executive Officer
Thanks John.
Operator
We will now go to Gary Taylor of JPMorgan.
Gary Taylor -- JP Morgan -- Analyst
Hi, good morning. Most of my questions been answered, just two left. Did I hear you guys talk about the DSO growth and the cause of that? Did I miss that?
David Duckworth -- Chief Financial Officer
Gary, this is David. The DSO growth, part of it is the de novo facilities that we have, we have seen our DSOs increase from 40 in the first part of this year to 42. Part of that is the de novos and that's just timing, we should see that return. Part of it is just -- as we look at the calendar, the month of September, we did have just timing of payments that we expect to improve in the fourth quarter as well. So it's timing between collections in the month of September and then the working capital being built up for our de novo facilities.
Gary Taylor -- JP Morgan -- Analyst
Got it. And then just my second question, I don't recall if you've yet talked about bed growth guidance for 2019. But I'm asking the question in the context of planned capital spending. Obviously, there's been a lot of de novo bed growth bed adds that have driven CapEx, you guys have been spending probably roughly 75% of your cash from ops on CapEx over the last several years. When you look at the trajectory of CapEx over the next couple, is that large majority of the cash from ops invested in CapEx, does that continue to be the case or do you see an opportunity to bring CapEx down and free cash flow up?
Joey A. Jacobs -- Chairman & Chief Executive Officer
I think Gary with the opportunities we have to grow the Company and to be in supermarkets with these joint ventures and de novos that we'll continue to do that next year that if you're doing some modeling or whatever. So I think our CapEx spend will stay about the same. And I think we'll be able to build somewhere, hopefully, between 700 to 800 beds, just based on the number of de novos that we get finalized for the year. So that's our thoughts right now. Now, we'll be able to give you a better number at the end of the year call, because we'll have our budgets done and the initial capital allocations made.
Gary Taylor -- JP Morgan -- Analyst
Got it. Thank you.
Joey A. Jacobs -- Chairman & Chief Executive Officer
Thank you.
Operator
We will now take a question from Ralph Giacobbe of Citi.
Ralph Giacobbe -- Citi -- Analyst
Thanks, good morning. Just a couple of quick ones from me as well. I wanted to ask about length of stay in the UK. Obviously, admissions were down, the length of stay was up, it's a little bit of a different dynamic. Maybe just -- if this is you think kind of a one-off quarter, just wanted to get off any details on that, and if there's anything to sort of call out there?
Brent Turner -- President
Hey, Ralph, this is Brent. It's really just a mix of the patients there. I mean we are not seeing any trends within each of the service line, similar to the US as far as a change over last year, but just given the mix of patients across the different service lines that's really what's extended the length of stay. And also in a period where you have a little lighter admission activity, just mathematically you're going to have a higher ALOS.
Ralph Giacobbe -- Citi -- Analyst
Okay. Alright, fair enough. And then I wanted to go back to a question earlier, I think in the past you had talked about potential, I think it was regulatory relief around Brexit and the ability to bring in offshore staff. So where does that stand? Does that just kind of go away? Or is that still in the works? Is there any specific sort of timing that you can provide around where that stands?
Joey A. Jacobs -- Chairman & Chief Executive Officer
They have made the change where we can now get staff from the Commonwealth countries, but that is becoming harder than we initially thought and also there is a unique requirement in the UK that you have site certification if you're a nurse and maybe some of the Commonwealth countries do not have that same requirement in their teaching. So if we got them here, we would have to educate them, get them educated and then it appears that the government there actually canceled that course. So it's made it tougher for us.
Ralph Giacobbe -- Citi -- Analyst
Okay, alright. And then lastly from me in UK. Is there any way to break down and just give a sense whether it's 10% of the facilities that are driving 80% of the pressures or is it really broad based and we shouldn't think of a smaller subset that's driving disproportionate pressure in the UK?
Joey A. Jacobs -- Chairman & Chief Executive Officer
Well, I think on the nurse agency, that's the one I cam give you the best on, the nurse agency expense is probably the vast majority of that expense, is being driven by 10 large -- 10 facilities.
Ralph Giacobbe -- Citi -- Analyst
Okay, alright, thank you very much.
Operator
And with that, that does conclude today's question and answer session. I would like to turn things back to Joey Jacobs for any additional or closing comments.
Joey A. Jacobs -- Chairman & Chief Executive Officer
Thank you, Kathy. Thanks again being with us today and for your interest in Acadia Healthcare. If you have any additional questions today, please do not hesitate to contact us directly and have a good day.
Operator
And, again, ladies and gentlemen, that does conclude today's call. We thank you again for your participation, you may now disconnect.
Duration: 45 minutes
Call participants:
Brent Turner -- President
Joey A. Jacobs -- Chairman & Chief Executive Officer
David Duckworth -- Chief Financial Officer
A.J. Rice -- Credit Suisse Securities -- Analyst
Kevin Fischbeck -- Bank of America Merrill Lynch -- Analyst
Matthew Richard Borsch -- BMO Capital Markets -- Analyst
Peter Heinz Costa -- Wells Fargo Securities -- Analyst
Brian Tanquilut -- Jefferies -- Analyst
Frank Morgan -- RBC Capital Markets -- Analyst
Ana Gupte -- Leerink Partners -- Analyst
John Ransom -- Raymond James -- Analyst
Gary Taylor -- JP Morgan -- Analyst
Ralph Giacobbe -- Citi -- Analyst
Transcript powered by AlphaStreet
This article is a transcript of this conference call produced for The Motley Fool. While we strive for our Foolish Best, there may be errors, omissions, or inaccuracies in this transcript. As with all our articles, The Motley Fool does not assume any responsibility for your use of this content, and we strongly encourage you to do your own research, including listening to the call yourself and reading the company's SEC filings. Please see our Terms and Conditions for additional details, including our Obligatory Capitalized Disclaimers of Liability.
