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Select Medical Holdings Corp (SEM -1.19%)
Q3Â 2019 Earnings Call
Nov 1, 2019, 9:00 a.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
Good morning, and thank you for joining us today for Select Medical Holdings Corporation's Earnings Conference Call to discuss the Third Quarter 2019 Results and the company's business outlook. Speaking today are the company's Executive Chairman and Co-founder, Robert Ortenzio; and the company's Executive Vice President and Chief Financial Officer, Martin Jackson. Management will give you an overview of the quarter and then open the call for questions.
Before we get started, we would like to remind you that this conference call may contain forward-looking statements regarding future events or the future financial performance of the company, including, without limitation, statements regarding operating results, growth opportunities and other statements that refer to Select Medical's plans, expectations, strategies, intentions and beliefs. These forward-looking statements are based on the information available to management of Select Medical today, and the company assumes no obligation to update these statements as circumstances change.
At this time, I will turn the conference call over to Mr. Robert Ortenzio.
Robert Ortenzio -- Co-Founder & Executive Chairman
Thank you, operator. Good morning, everyone, and thanks for joining us for Select Medical's Third Quarter Earnings Conference Call for 2019. We start out by saying Q3 was a very good quarter for us with three of our four business segments exceeding prior year adjusted EBITDA by double-digit growth and our fourth business segment grew EBITDA by over 7%. We experienced nice growth in terms of patient admissions in our specialty hospital business with critical illness recovery hospitals growing at almost 5% and inpatient rehabilitation hospitals growing at over 19%. Our outpatient rehabilitation clinic visits grew by more than 8% and Concentra visits grew by over 5%. We also saw a nice growth in our pricing.
We completed two significant refinancing transactions during the quarter, both at Select and Concentra, which Marty will provide some color in his remarks. We also opened a new non-consolidated joint venture rehabilitation hospital in the quarter, affiliated with several partners in New Orleans, Louisiana.
Overall, our net revenue for the third quarter increased 9.9% to $1.39 billion in the quarter compared to $1.27 billion last year. Net revenue in our critical illness recovery hospitals segment in the third quarter increased 10.2% to $463 million compared to $420 million in the same quarter last year. The increase is attributable to both in increase in patient volumes and revenue per patient day. Patient days increased 5.8% compared to the same quarter last year, with 258,000 patient days in the third quarter. Occupancy in our critical illness recovery hospitals segment was 67% in the third quarter this year compared to 65% in the same quarter last year. Net revenue per patient day increased 4% to $1,773 per patient day in the third quarter compared to $1,705 per patient day in the same quarter last year.
Net revenue on a rehabilitation hospital segment in third quarter increased 19.9% to $173 million compared to $145 million in the same quarter last year. Patient days increased 12% to over 89,000 days compared to 79,000 days in the same quarter last year. The increase in patient days was related to new hospitals that recently opened as well as a 4% increase in our existing hospitals. Net revenue per patient day increased 9% to $1,724 per day in the third quarter compared to $1,582 per day in the same quarter last year. Net revenue in our outpatient rehab segment in the third quarter increased 8.2% to $265 million compared to $245 million in the same quarter last year. Patient visits increased 8.1% to 2.2 million visits in the quarter compared to 2 million visits in the same quarter last year. Net revenue per visit was $103 in both the third quarter of this year and last year.
Net revenue in our Concentra segment increased 4.3% to $422 million in the third quarter compared to $404 million in the same quarter last year. For the third quarter, revenue from our centers was $381 million, and the balance of approximately $41 million was generated from onsite clinics, community-based outpatient clinics and other services. For the centers, patient visits increased 5.6% to over 3.1 million visits compared to a little less than 3 million visits in the same quarter last year. Our net revenue per visit was $120 in the third quarter compared to $124 per visit in the same quarter last year. The decline in net revenue per visit was primarily due to a higher mix of employer services visits, including drug screens, which yield lower per-visit rates.
Total company adjusted EBITDA for the third quarter increased 6.6% to $182.7 million compared to $156.6 million in the same quarter last year. Our consolidated EBITDA margin was 13.1% in the third quarter compared to 12.4% in the same quarter last year.
In our critical illness recovery hospitals segment, adjusted EBITDA increased 7.4% to $57.2 million in the third quarter compared to $53.3 million in the same quarter last year. Adjusted EBITDA margin for the segment was 12.4% in the third quarter compared to 12.7% in the same quarter last year. The decline in adjusted EBITDA margin is related to our newly acquired hospitals operating at lower margins than our existing hospitals.
Our rehabilitation hospital segment adjusted EBITDA increased 45.1% to $36.8 million in the third quarter compared to $25.3 million in the same quarter last year. Adjusted EBITDA margin for the rehabilitation hospital segment was 21.2% in the third quarter compared to 17.5% in the same quarter last year. The increase in adjusted EBITDA and margin was primarily attributable to an increase in volume at our existing hospitals.
Outpatient rehab adjusted EBITDA increased 16% to $40 million in the third quarter compared to $34.5 million in the same quarter last year. Adjusted EBITDA margin for the outpatient segment was 15.1% in the third quarter compared to 14.1% same quarter last year. Adjusted EBITDA margin in the quarter increased as a result of increased volumes as well as other cost reduction initiatives implemented in the quarter.
Concentra adjusted EBITDA increased 13% to $17.7 million for the third quarter compared to $68.8 million in the same quarter last year. Adjusted EBITDA margin was 18.4% in the third quarter compared to 17% in the same quarter last year. The increase in adjusted EBITDA margin was primarily the result of us achieving operating cost synergies across our combined Concentra and U.S. Healthworks business.
Earnings per fully diluted share was $0.23 for the third quarter compared to $0.24 in the same quarter last year. Adjusted earnings per fully diluted share, which excludes the loss on early retirement of debt and related costs in their tax [Indecipherable] was $0.33 in the third quarter. During the third quarter last year, adjusted earnings per fully diluted share, excluding gain on sale of business related tax effects, was $0.23.
At this point, I'll turn the call over to Marty Jackson for some additional financial details before we open the call up for questions.
Martin Jackson -- Executive Vice President & Chief Financial Officer
Thanks, Bob. Good morning, everyone. For the third quarter, our operating expenses, which include our cost of services and general and administrative expense, we're $1.2 billion. As a percent of net revenue, operating expenses were 87.4% in the third quarter of this year. This compares to 88.1% in the same quarter last year. Cost of services was $1.18 billion for the third quarter. This compares to $1.09 billion in the same quarter last year. As a percent of net revenue, cost of services was 84.9% for the third quarter compared to 85.8% in the same quarter last year.
G&A expense was $34.4 million in the third quarter of this year. This compares to $30 million in the same quarter last year. G&A as a percent of net revenue was $2.5 million in the third quarter. This compares to 2.4% in the same quarter last year.
As Bob mentioned, total adjusted EBITDA was $182.7 million and the adjusted EBITDA margin was 13.1% for the third quarter. This compares to total adjusted EBITDA of $156.6 million and adjusted EBITDA margin of 12.4% in the same quarter last year. Depreciation and amortization was $52.9 million in the third quarter. This compares to $50.5 million in the same quarter last year.
We generated $7 million in equity and earnings of unconsolidated subsidiaries during the quarter. This compares to $5.4 million in the same quarter last year. The increase in equity and earnings was attributable to the growth of our non-consolidating subsidiaries as a result of the sale of outpatient rehabilitation clinics to these non-consolidated subsidiaries.
Interest expense was $54.3 million in the third quarter. This compares to $50.7 million in the same quarter last year. Interest expense in the third quarter includes $3.6 million in incremental interest due to the timing of issuing Select's new 6 1/4% senior notes and the repayment of Select's existing 6 3/8% senior notes. We recorded income tax expense of $12.8 million with an effective tax rate of 22.6% in the quarter.
Net income attributable to Select Medical Holdings was $30.7 million in the third quarter, and fully diluted earnings per share was $0.23. And adjusted earnings per fully diluted share was $0.33 in the third quarter. As Bob mentioned, we completed two refinancing transactions in the third quarter. On August 1, Select completed a refinancing transaction, which included the issuance of $550 million of new 7-year senior notes at a coupon of 6 1/4% quarter and a new $500 million incremental term loan, which is on the same terms as our existing term loan. We use the net proceeds from the new debt to redeem our existing $710 million 6 3/8% senior notes and paid off the balance of our revolving loans with the excess cash Netherlands Select's balance sheet.
On September 20, 2019, Concentra entered into an incremental amendment to its first-lien term loan, adding an additional $100 million to its existing $100 billion to $1.14 billion first-lien term loans. Proceeds from the incremental first-lien term loan, together with the cash on Concentra's balance sheet, were used to repay in full the $240 million in second-lien term loans outstanding.
At the end of the quarter, we had $3.4 billion of debt outstanding and $136 million of cash on the balance sheet. Our debt balance at the end of the quarter included $1.53 billion in Select term loans, $550 million in Select 6 1/4% senior notes, $1.24 billion in Concentra first-lien term loans, $45 million in unamortized discounts premiums and debt issuance cost that reduced the overall balance sheet debt liability, and we had $76 million of other miscellaneous debt.
Operating activities provided $133.7 million of cash flow in the third quarter. The provision of operating cash flow for the quarter is primarily driven by cash income and an increase in accrued expenses. Our days sales outstanding, or DSO, was 53 days at September 30, 2019. This compares to 53 days at June 30, 2019 and 51 days at December 31, 2018.
Investing activities used $43.2 million of cash in the third quarter. The use of cash was related to $34.7 million in purchases of property and equipment, an $8.5 million of net acquisition and investment activities during the quarter. Financing activities used $78.6 million of cash in the third quarter. We had net term loan and senior note borrowings of $185 million. This is offset by $195 million in repayments on the revolving related to the refinancing activities we just talked about.
We also had $27.3 million reduction in bank overdraft, as excess cash balances offset outstanding checks. In addition, we used $23.7 million to repurchase stock during the quarter. Net payments of other debt to $4.9 million and $8.3 million in net distributions to non-controlling interest in the quarter. We purchased 1.26 million shares under the company's authorized repurchase program at an average price of $15.87, which includes transaction cost during the third quarter.
Additionally, in our earnings press release, we updated our business outlook for the calendar year 2019. We now expect net revenue to be in the range of $5.37 billion to $5.425 billion, adjusted EBITDA to be in the range of $685 million to $700 million, fully diluted earnings per share to be in the range of $1 to $1.6, and adjusted earnings per share of $1.7 to $1.13, which excludes the loss on early retirement of debt and its related costs and the gain of sale of businesses and the related tax effects.
This concludes our prepared remarks. And at this time, we'd like to open up the call. So, operator, if you can please do so?
Questions and Answers:
Operator
Thank you. [Operator Instructions] Our first question comes from Frank Morgan with RBC Capital Markets. Your line is now open.
Frank Morgan -- RBC Capital Markets -- Analyst
Good morning. I wanted you to talk a little bit about the strong rate growth across the segments. I know on the LTAC side, I believe there was probably a decline in some of the threshold days that you've had in the past. But just any other thing that you can call out about the rate growth any kind of change in mix or acuity that might have driven that. And then the same thing on the rehab hospital side. IRF rate separately strong there. Any color around that? And we've heard others talk about the growth in Medicare Advantage in their overall business mix in the IRF business. So, are you seeing that? And how do those rates compare? We've been hearing that those case rates -- the discounts to fee-for-service have been declining, but just any color on that as well?
Martin Jackson -- Executive Vice President & Chief Financial Officer
Yes. Frank, the pricing on the LTAC side, we saw a bump-up in on the Medicaid side, we saw a decent increase in rates there. So that was a predominantly one of the items. Actually that was predominantly the reason why we saw the rate increases there. On the -- the next question you had I think it was on the...
Frank Morgan -- RBC Capital Markets -- Analyst
on the IRF side, strong rate growth there.
Martin Jackson -- Executive Vice President & Chief Financial Officer
Yeah, I think a good portion of that has to do in particular with California rehab. We see some very nice increased rates there, and that's one of the predominant drivers for that increase.
Frank Morgan -- RBC Capital Markets -- Analyst
Got you. And then in terms...
Martin Jackson -- Executive Vice President & Chief Financial Officer
As we see more of our new start-ups coming on board, that increase will probably mitigate because we're not going to see the same type of rates increase like we do in the California hospitals.
Frank Morgan -- RBC Capital Markets -- Analyst
Got you. And maybe on that point, if you would just kind of remind us of the roll-out maybe over the next year, which quarters you have additional development coming online? And then back to that one of the earlier questions that you didn't catch was that how much growth are you seeing in Medicare Advantage in the rehab hospital business? Is that a -- how big a part of the mix is that? And how do those rates compare? And are you paid day rates or case rates? And how does that compare fee for service? And I'll hop off. Thanks.
Martin Jackson -- Executive Vice President & Chief Financial Officer
Sure. Let me answer the -- your last question first, and that is Medicare Advantage. We are seeing Medicare Advantage increase across the specialty hospital -- across both LTACs and our inpatient rehab hospitals and how does that compare? Most of the Medicare Advantage rates piggyback off traditional Medicare. So we're not seeing case rates. We're not seeing per diems. It's basically -- it's predominantly, as I said, just doing the same reimbursement that we see on traditional Medicare.
Robert Ortenzio -- Co-Founder & Executive Chairman
And I think, Frank, the other thing about that is Medicare Advantage, obviously unlike Medicare fee-for-services, is going to have some variation geographically around the country. We have Those rates are not standard. And so we'll see different things in different parts of the country with different hospitals.
Frank Morgan -- RBC Capital Markets -- Analyst
Okay. I'll hop back in the queue.
Martin Jackson -- Executive Vice President & Chief Financial Officer
Thanks, Frank.
Operator
Thank you. And our next question comes from Peter Costa with Wells Fargo. Your line is open. If your line is on mute, please unmute. If your phone is on speaker, please lift your handset.
Peter Costa -- Wells Fargo -- Analyst
Sorry about that. Congratulations on the quarter. Nice job, guys. And good morning. My question is more on the balance sheet and interest expense. Marty, you've been kind of busy on the balance sheet there. Can you tell us where would you think interest expense is going to settle out for the rest of the year? And then can you talk about the puts and the timing on when that's going to happen, if that's going to happen?
Martin Jackson -- Executive Vice President & Chief Financial Officer
Sure, Pete. As far as -- let me take a look at the -- or let me provide you with information on what we would anticipate on an apples-to-apples comparison. The refi that occurred at Concentra will have a significant impact on an overall basis just because the elimination of that second lien. That annual interest number on a pre-tax basis should be somewhere in the $15 million to $16 million range. What we've seen is on the Select refinancing. We basically took out the 6 3/8s notes, put in place $550 million of 6 1/4%. So there is not that much of a difference there. There was another, I think, close to $200 million that was -- that went to our of first lien. So there's a little bit of a spread there, but we added additional or a nominal dollar amount, take into consideration of the put payments that we had coming up in for second quarter of 2020. So there's really not that much of a savings on the Select refinancing.
Peter Costa -- Wells Fargo -- Analyst
Okay. And then in the quarter itself, you had the $3.6 million of just transitional costs, so that on right?
Martin Jackson -- Executive Vice President & Chief Financial Officer
That's correct. Yeah, that's right. If you take a look at, I think the overall tax -- the nominal tax amount was about $54 million, and that should probably adjust somewhere in that $50 million, $51 million range.
Peter Costa -- Wells Fargo -- Analyst
Okay. And then the puts recur in the second quarter of next year, if they occur?
Martin Jackson -- Executive Vice President & Chief Financial Officer
Yeah.
Robert Ortenzio -- Co-Founder & Executive Chairman
Based on the contract, if the first put can start -- the mechanism that we have is basically on the 2nd year anniversary of the U.S. HealthWorks transaction. Our joint venture partners can request evaluation to be done. And we anticipate that could take a couple of months to do that. And so it would probably be in the second quarter.
Peter Costa -- Wells Fargo -- Analyst
Okay. And then the last question. The drug screening has continued this quarter. I know there were some thought that those would lead to more business down the road. Have you seen any of that happen so far in terms of the first drug screenings that you started to do?
Robert Ortenzio -- Co-Founder & Executive Chairman
We have seen some additional pull-through of worker comp business, because the employers have now come back to us with the drug screens. So the answer to that is yes.
Peter Costa -- Wells Fargo -- Analyst
Okay, great. Thank you.
Robert Ortenzio -- Co-Founder & Executive Chairman
Thanks, Pete.
Operator
Thank you. And our next question comes from the line of Kevin Fischbeck with Bank of America. Your line is open.
Joanna Gajuk -- Bank of America -- Analyst
Good morning. Actually this is Joanna Gajuk filling in for Kevin today. So first question on your guidance, which now implies the revenue actually decline of a 5% quarter-over-quarter and EBITDA will be down almost $29 million or so sequentially. I know that in the past seasonality was such that the EBITDA was down sequentially in Q4s over Q3, but this year, this guidance implies the more dramatic decline. So I just want to clarify what's driving that.
Martin Jackson -- Executive Vice President & Chief Financial Officer
Joanna, you're going to have to walk us through those numbers again because -- I mean, the -- we don't see -- could you say that again?
Joanna Gajuk -- Bank of America -- Analyst
So we have -- because of the annual guidance for revenues, right, is $5.4 billion and year-to-date was $4 billion, so it implies $1.3 billion for fourth quarter. So sequentially it's a decline of 5% decline Q4 from Q3. And I'm doing similar math on adjusted EBITDA versus your midpoint of, call it, $693 million annual and a year-to-date $539 million. So that implies, call it, $154 million so midpoint for Q4. So that's down from $183 million in Q3.
Martin Jackson -- Executive Vice President & Chief Financial Officer
It's actually going up, Joanna.
Joanna Gajuk -- Bank of America -- Analyst
Okay. So I guess I am maybe using the incorrect year-to-date. So what's the year-to-date EBITDA?
Martin Jackson -- Executive Vice President & Chief Financial Officer
Yeah, I mean what you've got to do is you've got to compare Q4 of '18 to Q4 of '19, and in both situations it's going up.
Joanna Gajuk -- Bank of America -- Analyst
Right. But I'm just looking at sequentially from Q3 of this year to Q4.
Martin Jackson -- Executive Vice President & Chief Financial Officer
Yeah, Joanne. We don't take a look at the business sequentially. Everyone knows the Concentra's business down in Q4 Yes.
Joanna Gajuk -- Bank of America -- Analyst
Okay. Right. So I just wanted to clarify that. Okay, good. And then I guess also in terms of Q4, what does the guidance assume for the impression we have final regulation implications for that business? Because the revisions to the case mix were previously you said that would be positive. So, is there a way to quantify those?
Martin Jackson -- Executive Vice President & Chief Financial Officer
There is not. No,, we basically said the impact is neutral to a little bit positive. And so I think what you would assume is it's pretty much the same.
Joanna Gajuk -- Bank of America -- Analyst
Okay. And then the last question. So margins were pretty good in all the segments. I guess LTAC suggesting servicing like impacted somehow by the new hospitals. So are you -- are these margins, I guess, that we -- over the result this quarter for this segment, are these a good run rate? It seems like they were doing pretty in IRF segment and outpatient and also Concentra. So is it a good revenue numbers? I mean, I guess there is some seasonality quarter-to-quarter, but are there any upside you're seeing to these margins you reported this quarter?
Martin Jackson -- Executive Vice President & Chief Financial Officer
No. I think if you go through each of our business segments, the LTAC margins were down a little bit, but as we mentioned on the call, that's predominantly because the new hospitals that we brought on board, or the acquired hospitals that we brought on board, and their margins are single digit this time. They'll grow into our margins, but those margins should be up.
For inpatient rehab, inpatient rehab was up nicely, where it's over the 21% range. But you're going to see fluctuations in the inpatient rehab as we continue to add new hospitals on board. So I would think you could expect to see 19% to 20% margins. On the outpatient at 15%, I think that's probably a pretty good rate. And then on Concentra rates, I think Concentra rates are on an annualized basis in that 17% range.
Joanna Gajuk -- Bank of America -- Analyst
Alright, thank you so much. It's very helpful. I'll go back to the queue.
Operator
Thank you. And our next question comes from Justin Bowers with Deutsche Bank. Your line is open.
Justin Bowers -- Deutsche Bank -- Analyst
Hey, good morning, everyone. And nice broad-based performance this quarter. So just going and looking at a few of the segments, on the LTAC side, it looks like you guys added another hospital in the quarter, and I'm just trying to get a sense of what the -- kind of like what the underlying growth was versus the contribution from the new ads, either on a volume or admission basis?
Martin Jackson -- Executive Vice President & Chief Financial Officer
Yeah, Justin. We did add another hospital. That is a non-consolidating hospital. So that will not come through the P&L just under the equity line. So that should answer your first question, right. And then the second one. What we've seen was a very nice increase on the inpatient rehab due to the new hospitals and the volume that was generated there, in particular Shanes [Phonetic] and Dignity on Las Vegas.
Justin Bowers -- Deutsche Bank -- Analyst
Okay, got it. And then just in terms of looking ahead, what are we thinking about in terms of the pace of the start-up losses, is that -- is it going to be similar to kind of what we saw in 2018? Ar are we looking at something a little more moderate?
Martin Jackson -- Executive Vice President & Chief Financial Officer
Yeah. With regards to start-up losses, the next time we're going to see start-up losses, we'll probably see some start just a little bit in Q2, and then in Q3 and Q4 we will see some more, and that's due to two banner hospitals coming on. Okay?
Justin Bowers -- Deutsche Bank -- Analyst
Yeah. Thank you. And then just in terms of the new hospitals in critical illness, what are we thinking in terms of the ramp to get those back up to the core margins? Is that a one-year, is that a 2-year kind of trajectory? Or how are you guys thinking about that?
Martin Jackson -- Executive Vice President & Chief Financial Officer
Yeah, how we're thinking about it is we would expect to see improvements in the next 2 to 3 months -- 2 to 3 quarters.
Justin Bowers -- Deutsche Bank -- Analyst
Okay. And then just any thoughts on just outpatient rehab. Is there some seasonality to that as well or something like funky with the high deductible plans? I mean, it was just the volume was impressive there.
Martin Jackson -- Executive Vice President & Chief Financial Officer
Yeah, there is seasonality with that business, and typically it's down in the third quarter. So this third and the fourth quarters you typically see that volume down, but the operators did a terrific job. So, it was -- the margin was terrific and we've talked to the operators and they said they think that can continue.
Justin Bowers -- Deutsche Bank -- Analyst
Okay, great. Thanks so much. I'll take the rest offline.
Martin Jackson -- Executive Vice President & Chief Financial Officer
Sure. Thanks.
Operator
Thank you. And our next question comes from the line of A.J Rice with Credit Suisse. Your line is open.
Albert J. Rice -- Credit Suisse -- Analyst
Hey. Everybody. I know you had good results across the board. Some of the companies have talked about how they did get a little bit of help from that extra business day. Have you sort of sized how much of that was a factor in these volume numbers and performance?
Martin Jackson -- Executive Vice President & Chief Financial Officer
Yeah, A.J., it was about $1.5 million to $2 million.
Albert J. Rice -- Credit Suisse -- Analyst
Okay, that's across the entire company pretty much?
Martin Jackson -- Executive Vice President & Chief Financial Officer
That's correct. Yeah.
Albert J. Rice -- Credit Suisse -- Analyst
All right. And you mentioned the U.S. HealthWorks synergies was helpful. Any update on exactly how much of that you've realized at this point? And do you have -- is there still more to come on that? Or we had sort of a run rate at this point?
Martin Jackson -- Executive Vice President & Chief Financial Officer
Through the third quarter, we've achieved most of the synergies. We think there is probably an additional $3 million to $4 million over the next quarter or two.
Albert J. Rice -- Credit Suisse -- Analyst
Okay. And we think about the raise, $100 million in revenue guidance, about $12.5 million on EBITDA. Is that mainly reflecting the outperformance in relative to your internal forecast on Q3? Or have you made any adjustments to your Q4 assumption in that updated guidance?
Martin Jackson -- Executive Vice President & Chief Financial Officer
It's basically taken consideration what occurred in Q3.
Albert J. Rice -- Credit Suisse -- Analyst
Okay. Alright, great. Thanks a lot.
Martin Fullenbach -- Chief Executive Officer
Thanks, A.J.
Operator
Thank you. And our next question comes from Frank Morgan with RBC Capital Markets. Your line is open.
Frank Morgan -- RBC Capital Markets -- Analyst
Hey, Mike. My follow-up question was actually asked, but I will, since I'm back. On California Research Institute, obviously a big source of the rate growth there, but just maybe a little more color like how much upside do you see left there? Where the occupancies today? I know that's been a big project and has a lots of capacity, but maybe how much upside do you see left in that one? Thanks.
Robert Ortenzio -- Co-Founder & Executive Chairman
Well there is some upside, Frank. The hospital is running at very high occupancy. So are we will be very shortly capacity-constrained, so -- and then -- but I think there's other opportunities out there and perhaps we can begin to develop some outpatient. All the results from the inpatient of California rehab Institute has really been the inpatient with modest amounts of outpatient. So I would say we have a little bit of the incremental opportunity on inpatient census and then we'll begin to look to use the market share that we've gained to, as we've done in other markets, to expand and snap-on hopefully some other services.
Frank Morgan -- RBC Capital Markets -- Analyst
Thank you.
Operator
Thank you. And I'm not showing any further questions at this time. I would now like to turn the call back to Mr. Ortenzio for any further remarks.
Robert Ortenzio -- Co-Founder & Executive Chairman
No further comments. Thanks, everybody, for joining us. And we'll look forward to updating you again next quarter.
Operator
[Operator Closing Remarks]
Duration: 35 minutes
Call participants:
Robert Ortenzio -- Co-Founder & Executive Chairman
Martin Jackson -- Executive Vice President & Chief Financial Officer
Martin Fullenbach -- Chief Executive Officer
Frank Morgan -- RBC Capital Markets -- Analyst
Peter Costa -- Wells Fargo -- Analyst
Joanna Gajuk -- Bank of America -- Analyst
Justin Bowers -- Deutsche Bank -- Analyst
Albert J. Rice -- Credit Suisse -- Analyst
