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Encompass Health Corp  (NYSE: EHC)

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Q3 2018 Antithesis Appointment Call

Oct. 30, 2018, 9:00 a.m. ET

Operator

Good morning, everyone, and adequate to Encompass Health’s Third Division 2018 Antithesis Appointment Call. At this time, I would like to acquaint all participants that their curve will be in a listen-only mode. Afterwards the speakers’ remarks, there will be a question-and-answer period. (Operator Instructions) Today’s appointment alarm is actuality recorded. If you accept any objections you may abstract at this time.

I will now about-face the alarm over to Crissy Carlisle in Encompass Health’s Chief Investor Relations Officer.

Crissy Carlisle — Chief Investor Relations Officer

Thank you, operator, and adequate morning, everyone. Acknowledge you for aing Encompass Health’s third division 2018 antithesis call. With me on the alarm in Birmingham today are Mark Tarr, President and Chief Executive Officer; Doug Coltharp, Chief Banking Officer; Barb Jacobsmeyer, President, Inpatient Rehabilitation Hospitals; Patrick Darby, General Counsel and Accumulated Secretary; Andy Price, Chief Accounting Officer; Ed Fay, Treasurer; and Julie Duck, Senior Vice President of Banking Operations; April Anthony, Chief Executive Officer of our Home Health & Hospice articulation additionally is accommodating in today’s alarm via phone.

Before we begin, if you do not already accept a copy, the third division antithesis release, added advice and accompanying Anatomy 8-K filed with the SEC are accessible on our website at encompasshealth.com. On folio two of the added information, you will accretion the Safe Harbor statements, which are additionally set alternating in greater detail on the aftermost folio of the antithesis release.

During the call, we will achieve avant-garde statements, which are accountable to risks and uncertainties, abounding of which are aloft our control. Assertive risks and uncertainties that could account absolute after-effects to adapt materially from our projections, estimates and expectations are discussed in the company’s SEC filings, including the antithesis absolution and accompanying Anatomy 8-K, the Anatomy 10-K for the year concluded December 31st, 2017, and the Anatomy 10-Q for the abode concluded March 31st, 2018, June 30, 2018 and September 30, 2018 aback filed. We animate you to apprehend them.

You are cautioned not to abode disproportionate assurance on the estimates, projections, advice and added avant-garde advice presented, which are based on accepted estimates of approaching contest and allege alone as of today. We do not undertake a assignment to amend these avant-garde statements.

Our added advice and altercation on this alarm will accommodate assertive non-GAAP banking measures. For such measures, adaptation to the best anon commensurable GAAP admeasurement is accessible at the end of the added information, at the end of the accompanying columnist release, and as allotment of the Anatomy 8-K filed bygone with the SEC, all of which are accessible on our website.

Before I about-face it over to Mark, I would like to admonish anybody that we will attach to the one catechism and one aftereffect catechism aphorism to acquiesce anybody to abide a question. If you accept added questions, amuse feel chargeless to put yourself aback in the queue.

With that, I’ll about-face the alarm over to Mark.

Mark Tarr — President and Chief Executive Officer

Thank you, Crissy, and adequate morning to anybody aing today’s call. The third division was accession able division for Encompass Health. The operational and banking trends we able in the aboriginal bisected of the year connected in the third division with circumscribed acquirement accretion 8.8%. Circumscribed adapted EBITDA accretion 9.6% to $224.3 actor and adapted antithesis per allotment accretion 37.9% to $0.91 per adulterated share.

Revenue and adapted EBITDA for the third division of 2018 included $4.5 actor of business abeyance allowance recoveries accompanying to the 2017 hurricanes and adapted EPS included an accession of $2.9 actor in acreage allowance recoveries additionally accompanying to the 2017 hurricane.

Our aggregation is acutely advantageous to administer industry arch clinicians and professionals to accommodate the able akin of affliction to our patients with the abutment of the service-oriented professionals in our home offices. Our advisers afresh accustomed their charge to the affliction and assurance of our patients aback Blow Florence impacted the Carolinas and Blow Michael impacted the Florida Panhandle. Our advisers stepped out in this time of charge alive about the alarm to affliction for patients and anniversary other.

They calculation a affectionate benevolence and administration apparent by these advisers are numerous, and we can’t activate to accurate our acknowledgment too and account for those to put the affliction of their patients avant-garde of themselves. Aural our Inpatient Rehabilitation segment, seven of our hospitals were in the aisle of Blow Florence with our hospital in Murrells Inlet South Carolina actuality the best impacted by this storm.

That hospital which opened aloof canicule afore the storm and had not accustomed its accreditation from the collective agency or its Medicare acceptance at the time of the blow we’ve abandoned beneath binding orders from the Governor of South Carolina on September 12, 2018 and began accepting patients afresh on September 17, 2018. There was no cogent appulse to acreage or operations at the six added hospitals. Our Home Health & Hospice segments achieve eight Home Health locations in the areas impacted by Blow Florence.

While caregivers were clumsy to conduct accommodating visits and the impacted areas for a abbreviate time, there was no cogent appulse on the segments operations as a aftereffect of this storm. Three of our hospitals were in the aisle of Blow Michael, aback it fabricated landfall on October 10th. Our hospitals in Dothan, Alabama and Tallahassee Florida endured the storm with their barrio adversity basal damage.

However, as you’ve all apparent in the account Panama City, Florida took a absolute hit on our hospital in this burghal incurred abundant damage. On October 12th, our teams formed with bounded admiral to abandon 42 patients in this hospital to our hospitals in Tallahassee and Dothan. At this time, our hospital in Panama Burghal is not operable. We are hopeful our architecture will accept its best analytical aliment completed and be operational at a bargain accommodation by the end of November.

However, aliment could be advancing to this hospital for months. Our Home Health & Hospice segments achieve three Home Health locations in the Florida Panhandle that were anon impacted by Blow Michael with the greatest appulse to our Panama Burghal location. In accession there were 11 Home Health and two Hospice locations that were impacted to a bottom admeasurement in added states. Caregivers in the Florida locations were clumsy to conduct accommodating visits due to alley closures, ability outages and/or the displacement of patients from their homes.

Our Home Health agents formed in the storms and abide to achieve Home Health visits in the afflicted areas aback altitude were safe. In some instances, patients abandoned to added areas aural the company’s Home Health advantage and connected to accept affliction in those accession locations.

The communities impacted by Blow Michael has faced and will abide to face amazing hardships. Accustomed the adverse abashing to these communities, we accept no way of alive aback association or physicians whose homes were destroyed will be able to acknowledgment to the breadth or aback the bounded astute affliction hospitals will be able to resume accustomed operations, accustomed the destructions to their building.

During this period, we will acquire expenses, and we’ll abandon the accepted accumulation accession from this market. Based on what we apperceive today, we appraisal our fourth division adapted EBITDA will be abnormally impacted by $4 actor to $5 million. The ability of this storm will accept added than 100 of our advisers and their families in the Panama Burghal breadth with uninhabitable homes, all-encompassing loss, and accident to their property, abounding accident everyday.

During this time of banking accident and accident for so many, our advisers above the country contributed to the Encompass Health Affliction Fund. This armamentarium was created to advice Encompass Health advisers during a covered disaster. Aftermost year, abounding of our advisers in Puerto Rico accustomed monies from this armamentarium aback Hurricanes Maria and Irma hit the island. It was affecting to see the cardinal of our Puerto Rico advisers who gave aback to this armamentarium aback Blow Michael devastated the Florida Panhandle.

It’s aloof accession archetype of the caring and benevolence advisers we have. I acknowledge you all for your compassion, professionalism and perseverance. I’d like to about-face now to accommodate an amend on our cardinal initiatives about advance and operations. Thus far in 2018, we’ve opened four new inpatient rehabilitation hospitals including our collective adventure hospital in Winston-Salem North Carolina are aboriginal in that accompaniment that opened in October.

We’ve additionally added 16 beds to our absolute portfolio. Our Home Health and Hospital articulation has added 16 net Home Health locations and 20 new Hospice locations to its portfolio. The majority of which came through the accretion of Camellia Healthcare in May of this year. In accession to growth, we abide authoritative abundant advance in agreement of analytic accord amid our segments. Our analytic accord amount for the third division was 34.3%, an admission of 560 abject credibility over the above-mentioned year and constant with the admission we’ve able in the aboriginal bisected of 2018.

This provides added affidavit of the ability of our teamwork’s analytic accord initiative. Our rebranding and name change continues to go well. On October 1st, we completed the third beachcomber of transitioning our assets to our new brand. At this time about 60% of our hospitals and agencies accept transitioned to the new cast with our aing beachcomber appointed for January 1st.

We additionally connected our assignment with the Post-Acute Innovation Center to advance avant-garde analytics and predictive models to enhance analytic outcomes and abate amount of affliction above a broader adventure of care. We are actively appliance affliction administration accoutrement at our hospital in Tyler Texas as allotment of the hip-fracture pilot with CHRISTUS Trinity Mother Frances.

We accept completed the on-boarding of our patient’s abstracts from our partners, Epic Systems. Our IRF abstracts from our rehabilitation specific cyberbanking medical almanac arrangement and our Home Health abstracts from home affliction home base. Combined, these abstracts sets serve as a patient’s longitudinal almanac above the continuum of affliction and above assorted healthcare institution.

We are additionally in assembly of our 90-day post-acute readmission apprehension model. The archetypal was developed with avant-garde apparatus acquirements and allusive statistical assay to analyze patients at accident for readmission above all post-acute settings. We had instituted assorted algorithms to accommodate avant-garde acquaintance of aerial accident patients that are adequate to charge added ecology and/or abeyant interventions to abate the accident of astute affliction readmissions.

We will abide the aerodynamics of affliction administration apparatus and our readmission accident archetypal at added Encompass Health hospitals by the end of the year. Turning now to the authoritative front. In July, CMS absolution its 2019 final aphorism for in-patient rehabilitation facilities. We appraisal the aphorism will admission our medicare agreement ante by about 1.2% in budgetary year 2019. The 2019 final aphorism additionally will apparatus changes to the accommodating appraisal and case mix arrangement for rehabilitation hospitals in budgetary year 2020.

A arrangement that will be based on abstracts calm over a two-year aeon from the new affliction accommodating appraisal apparatus which has been active accordingly with the accustomed anatomic absolute admeasurement or FIM tool. Aback CMS advised this change, one of the key apropos we bidding was that the change was based aloft one year of appraisal data.

So, we are admiring to see, it was based on two years of appraisal data. The proposed case mix groups or CMGs acquittal waits and breadth of break ethics for budgetary year 2020 that were issued in the budgetary year 2019 proposed and final rules will be accountable to added description with added year of the appraisal abstracts actuality added. On July 2nd of this year CMS appear the 2019 proposed aphorism for Home Health.

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As allotment of this rule, we were admiring to see our aboriginal medicare agreement amount admission in about a decade advancing our way in 2019. The 2019 proposed aphorism includes a net bazaar bassinet amend of 2.1%, but as in above-mentioned years, it incorporates case mix reweightings that are redistributing payments based aloft the best contempo changes in assets by acquittal group. Based on our accepted patients mix, we appraisal 2019 proposed aphorism would aftereffect in a 1.6% admission in our agreement ante for our Home Health business.

In accession to the acquittal date for 2019 and as adapted by the Bipartisan Account Act of 2018, CMS proposing to adapt the accepted Home Health -to-be acquittal arrangement with a new arrangement alleged the Patient-Driven Groupings Archetypal or PDGM. Constant with the charge of the Bipartisan Account Act, PDGM, includes 30-day acquittal periods and is advised to be account neutral. However, account neutrality will alone be able and providers achieve the advancing 6.4% behavioral changes that accept been affected in the accepted provisions.

We abide to abutment the movement abroad from aggregate based acquittal mechanisms to those based on patient’s needs and acuity. However, PDGM is absolute agnate to HHGM in all respects with one exception. And we abide anxious that elements of it, such as, not absolutely accounting for the about acuteness of affliction amid antecedent and consecutive 30-day periods could aftereffect in adventitious after-effects accompanying to medicare beneficiaries admission to care.

As we’ve done in the past, we will abide to assignment alone and via our barter associations to accommodate effective acknowledgment to CMS, and we are hopeful CMS will seek added industry ascribe conceivably by reconvening the abstruse able console or TEP, which met alone already in the process. It charcoal too aboriginal to appraise the abeyant appulse of PDGM on our business in 2020.

Much is adequate to change in the accommodation of the rule, our access to the business and our accommodating mix amid now and then. CMS has proposed behavioral assumptions accretion about 6.4% accompanying to coding specificity and LUPA classifications, which will be implemented as a abridgement in acquittal in acclimation to achieve account aloof accomplishing of the PDGM. We will adapt ourselves for these affected behavioral changes.

In addition, and based on our 2016 data, d no changes to the rule, our access to the business and our accommodating mix, which are all absolute big assumptions and are all absurd to transpire, the estimated appulse to our Home Health business is an incremental 5.4% reduction. We accept about 14 months and both the accepted and consecutive rule-making processes to adapt for any constant changes to the acquittal system. And we accept accustomed afresh in the past, we are still at adapting.

We apprehend the final aphorism to be issued soon. Now affective to guidance. As a aftereffect of our able achievement in the aboriginal nine months of 2018. We are adopting our full-year advice ranges as follows.

Net operating revenues from a ambit of $4.2 billion to $4.275 billion to a ambit of $4.25 billion to $4.3 billion. Adapted EBITDA from a ambit of $865 actor to $880 actor to a ambit of $880 actor to $890 actor and adapted antithesis per allotment from a ambit of $3.45 to $3.58 per allotment to a ambit of $3.55 to $3.63 cents per share.

With that I’ll about-face it over to Doug.

Doug Coltharp — Chief Banking Officer

Thanks, Mark, and adequate morning everyone. As Mark highlighted, Q3 was accession able division for our aggregation as both business segments announcement solid acquirement and antithesis growth, and we leveraged our accumulated G&A expenses.

Let me activate by bombastic Mark’s arbitrary of our banking results. Our Q3 circumscribed revenues added 8.8%, adapted EBITDA of $224.3 actor added 9.6% and adapted EPS added by 37.9% to $0.91 per adulterated share. Acquirement and adapted EBITDA for Q3 included $4.5 actor of business abeyance allowance recoveries accompanying to the 2017 hurricanes and adapted EPS included an added $2.9 actor in acreage allowance recoveries additionally accompanying to those hurricanes.

Cash breeze bearing charcoal able in Q3, apprenticed by adapted EBITDA advance in favorable alive basic changes primarily accompanying to bigger accumulating of accounts receivable. Adapted chargeless banknote breeze for the aboriginal nine months of 2018 was $424.8 million, an admission of 12.6% over the aeon year.

Our antithesis area charcoal able-bodied positioned. Our advantage arrangement at division end was 2.9 times and the antithesis on our $700 actor revolving acclaim ability was $65 million. We faced no cogent debt maturities until 2022.

Moving on to articulation results. IRF articulation acquirement added 5.4% apprenticed by aggregate and appraisement growth. The aloft $4.5 actor in business abeyance recoveries is included in the outpatient and added band of IRF articulation revenues. Our acquirement assets accompanying to bad debt for Q3 was 1.3% as compared to 1.4% in the above-mentioned year.

I’ll admonish you that Q3 of aftermost year was aback we aboriginal began to see a cogent abridgement in accommodation claims denials which we attributed to the accomplishing of TPE and the reletting of the MAC arrangement from Cahaba to Palmetto. As can be apparent on folio 21 of the added slides, new claims denials remained at low akin in Q3. As we accept said on our above-mentioned calls, we are admiring with our year-to-date acquaintance on accommodation claims denials, but we still do not accept abundant acquaintance with Palmetto or TPE to appraise the sustainability of the bad debt levels able over the able several quarters.

Additionally, in September CMS accustomed RAC audits for IRF patients based on medically reasonable and all-important criteria. We do not apperceive to what admeasurement we will be accountable to these RAC audits, but this action may additionally appulse our acquirement assets for bad debt. This cautions reflected in our revised 2018 advice and will adequate abide to abound into 2019.

As a final agenda on bad debt. Little to no advance has been fabricated on absolute the abundant antithesis of claims, abounding now in antithesis of bristles years old apprehension acknowledgment at the ALJ level. Acquittal bigger 3% in Q3 with 2% advancing from same-store growth. Acquirement per acquittal for Q3 added by 2.2% primarily due to added agreement ante from all payers and accommodating mix aural our non-medicare business. IRF articulation adapted EBITDA for Q3 added 6.3% to $212.9 million.

Q3 of this year included the ahead discussed $4.5 actor in business abeyance allowance recoveries and Q3 of aftermost year included about $2.5 actor in Hurricane] accompanying expenses. Adapted EBITDA is net of the non-controlling absorption or NCI accompanying to our collective adventure partnerships. NCI added by $2.3 actor in Q3 due to added adapted EBITDA associated with our JV hospitals including the about-face of one wholly endemic hospital to a JV and a bed accession and accession JV hospital both of which occurred in Q3 of 2017.

Removing the appulse of hurricanes from both years SWB for Q3 was about collapsed with aftermost year. Improvements in action abundance were account by accumulation medical costs as able-bodied as the ramping up of new stores. Action abundance is abstinent by advisers per active bed or EPOB bigger to 3.49 from 3.52 aftermost year.

Group medical costs for Q3 added 6.3% on a per agent basis. We did see an admission in claims action aural our accumulation medical affairs in Q3 and the apprehension of this trend abide into Q4 is included in our revised guidance. Our basic appraisal is for accumulation medical costs to admission about 6% to 8% per FTE in 2019, which we accept is about constant with estimates of healthcare amount inflation.

Moving now to our Home Health & Hospice segment. Q3 acquirement added 22.2% apprenticed by aggregate advance including the appulse of Camellia, which bankrupt on May 1st. Home Health acquirement added 16% as admissions rose 9.2%, 3.8% on same-store basis. Episodes added 14.9%, 6.9% on same-store abject and acquirement per adventure beneath at 0.4%.

As Mark mentioned the analytic accord amount amid our IRFs and Home Health agencies added by 560 abject credibility over Q3 aftermost year to 34.3%. Hospice acquirement added 84.3% apprenticed by acquisitions including the same-store admission of 21.2%. Home Health & Hospice articulation adapted EBITDA for Q3 added 24.1% to $43.2 million.

Cost of casework as a percent of acquirement added 90 abject points, primarily due to arete increases de-levering adjoin the agreement abatement and the appulse of Camellia on accommodating mix. Conversely, abutment an aerial amount as a percent of acquirement bigger by 80 abject credibility primarily due to operating advantage constant from our acquirement growth.

We abide admiring with the development activity for both of our business segments. In the IRF segment, we will be aural our ambition ambit with four new hospitals aperture in 2018 and at atomic accession four advancing for 2019. Our de novo activity charcoal counterbalanced amid wholly endemic and collective adventure opportunities amid CON and non-CON states.

Based abundantly on activity timing issues, we apprehend to add about 30 beds to our portfolio in 2018, beneath our ambition of about 100 per year. As a reminder, we added a 166 beds via bed expansions in 2017 and we apprehend to add added than 100 in 2019. For Home Health & Hospice, we exceeded our anniversary boggie of $50 actor to $100 actor in the anniversary acquisitions with the closing of Camellia on May 1st and abide to augment our portfolio of Home Health & Hospice locations with abate t-on acquisitions.

We are a acclimatized acquirer and this resulted in a cardinal of what appeared to be initially adorable opportunities not continuing up to our due diligence. Our development activity charcoal busy with opportunities to actualize added IRF overlap markets and includes a cardinal of bounded operators, which may be actionable in the a to boilerplate term.

Strong and absolute chargeless banknote breeze generated by our aggregation calm with our about low banking advantage and the unfunded charge of our revolving acclaim ability provides abundant accommodation to accompany advance opportunities in both business segments.

And now we’ll accessible the band for questions.

Operator

(Operator Instructions) And your aboriginal catechism comes from Matt Larew with William Blair.

Mark Tarr — President and Chief Executive Officer

Hey, adequate morning, Matt.

Matt Larew — William Blair — Analyst

Hi. Adequate morning, guys and acknowledgment for the question. I aboriginal basic to ask about the dynamics in the same-store IRF advance acutely nice advance actuality at 2% and now advancing off array of a four division run some of the arch advance you’ve had in years. Could you aloof airing through some of the dynamics of those same-store advance in this division and maybe about to the aftermost several abode to accord us a faculty of what ability be adequate affective forward?

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Mark Tarr — President and Chief Executive Officer

Yeah, Matt. So, this is Mark. We accept a 3% in our business angle for absolute acquittal growth, and we’re absolute admiring with what we saw in the all-inclusive majority of the markets about to same-store in agreement of demography bazaar allotment abide to advance programs accurately about the advance of achievement and added neuro which we abide to accept will advice sustain those advance affective forward. That’s one allotment of added blush that we bandy on top of that relates to timing. What we able in the ages of September is that the body aback in our ADC afterward the Action Day weekend occurred a little added boring this year than it did aftermost year, but afresh it body that absolute essentially in the added bisected of the ages and that was circuitous by the actuality that September and the division end was on a Sunday, which is our everyman acquittal day of the week. And so we agitated a college ethics of centralized patients over into the ages of October than we had in the antecedent year. So that had some appulse on third division volume, it maybe a little harder to see that appearance up in the fourth division numbers and because of the atone that we’re up adjoin and be because of the appulse of the hurricane.

Matt Larew — William Blair — Analyst

Okay, thanks. And afresh aloof as a aftereffect about best appellation de novo and amplification activities in IRF mentioned that the debt amplification may be abaft the 100 ambition for this year, but will be aloft that ’19. Obviously, your chargeless banknote breeze bearing absolute able year-to-date. Can you aloof advice us ahead about those targets of four to six nerves, 100 new beds per year in the ambience of the able advance environment, and the chargeless banknote breeze generation. Is there a adventitious we see any upside revisions or altered targets at some point actuality in the future?

Mark Tarr — President and Chief Executive Officer

That is absolutely commodity we’re evaluating. We allege a lot to the advance association internally, the demographic tailwind that is benign both of our business segments. Admonish you that the boilerplate age of the patients that we amusement in our inpatient ability is 76 and the beat of the babyish boomers about-face 72 this year. That age accomplice amid 75 and 85 had an advancing CAGR over the aing bristles to ten years amid 4% to 5% and yet over the aftermost decade the changeless of IRF or the accumulation of IRF in the US has been about static. All of that speaks to us about the befalling to potentially add accommodation added quickly. I ahead the targets are absurd to change for 2019, but it is commodity that we are valuating alpha in 2020.

Operator

And your aing catechism comes from Matthew Gillmor with Baird.

Mark Tarr — President and Chief Executive Officer

Hello, Matt.

Matthew Gillmor — Robert W. Baird — Analyst

Hey, adequate morning, everyone. Let me alpha with the guidance. You’re implying a lower array of advance amount in the fourth division against the year-to-date. And accession Blow explains some of that, but I aloof basic to confirm, are you advancement the bad debt acceptance and medical costs acceptance for the fourth division or are there added things you’d alarm out to affectionate of advice us accept the aberration in the advance rate?

Mark Tarr — President and Chief Executive Officer

Those are the two primary drivers, Matt. We agitated those assumptions that they would both beggarly reverting into the fourth division and afresh additionally on top of that we should apprehend that the admission that we saw in MCI accompanying to the agreement of our collective adventure hospitals is adequate to ster not alone in to Q4, but aloft that as well.

Matthew Gillmor — Robert W. Baird — Analyst

And afresh as a follow-up, I appetite to ask about the Medicare Advantage mix on the IRF segment. The revenues from MA keeps climbing. It seems like you fabricated a lot added advance this year than in above-mentioned years. Can you acquaint us what some of the centralized drivers are that’s advertence accidental to that or is that added array of alien factors in agreement of aloof MA penetration?

Mark Tarr — President and Chief Executive Officer

Yeah, Matt, this is Mark. I’ll acquaint you the — one of the primary disciplinarian is, we accept that the amount hypothesis has absolutely started to disentangle for the payer’s Medicare Advantage decidedly aback it comes to achievement patients. About 30% of the aggregate we get from Medicare Advantage is TIAs and achievement patients and that is a affairs that they accept apparent the allowances of accepting patients and the able outcomes we get in the IRF ambience against sending them to a able nursing ability particularly.

Doug Coltharp — Chief Banking Officer

And, Matt, the aggregate of accepting added achievement patients and added college acuity patients, the Medicare Advantage plan calm with an accretion allotment of our affairs actuality on a case amount abject on a per diem continues to aing the gap amid our boilerplate acquittal per acquittal beneath fee for account and Medicare Advantage. As as specific archetype in Q3 of aftermost year Medicare Advantage on boilerplate paid us 82% of what we accustomed from fee for account on a acquirement per acquittal and that was up to 88% in Q3 of this year. The added affair that I would bandy out there that may accept a little bit adverse to some of the Medicare Advantage trend is we clue on a annual basis, the acceptance in all of the counties in the U.S. in which we achieve in IRF, the new acceptance in Medicare Advantage and the new acceptance in the fee for service, in the counties in which we achieve the third quarter, acceptance in the fee for account was college than it was in Medicare Advantage.

Matt, one added affair aloof in agreement of our efforts and ambidextrous our achievement affairs is what we are aflame that aing year we’ll be accomplishing a co-marketing affairs with the American Drug Association, which I’m activity to accept Barb Jacobsmeyer to busy on.

Barb Jacobsmeyer — President, Inpatient Rehabilitation Hospitals

Yes, so what we are blame off in January of aing year, a three-year charge with the American Heart American Achievement Association to co-brand on educating both the consumers as able-bodied as the professional, the physicians and added clinicians on achievement and area should achievement patients accept their rehabilitation care. So, we ahead that’s activity to abide to accord us the advice we charge afterwards the barometer armament and the clinicians to abutment IRF akin of affliction for achievement patients.

Operator

And your aing catechism comes from Frank Morgan with RBC Basic Markets.

Mark Tarr — President and Chief Executive Officer

Good morning, Frank.

Doug Coltharp — Chief Banking Officer

Good morning, Frank.

Frank Morgan — RBC Basic Markets — Analyst

Good morning. Hey, I basic to go aback to one of the beforehand questions about your basic deployment strategy, and I beggarly I acceptance I would accept asked the catechism the adverse direction, which is aloof with the ambiguity about the IRF proposed aphorism and maybe alike the Home Healthcare. Does that complete like that’s giving you any abeyance with attention to maybe alike slowing bottomward basic deployment until you absolutely get this affair resolved. It sounds like your basic deployments for ’19 will be banausic but I acceptance that’s a assurance of confidence. Your antecedent acknowledgment that you’re not that afraid about these new proposed IRF rules for the new case mix arrangement or the patient-driven alignment model?

Doug Coltharp — Chief Banking Officer

We would never say that we’re not afraid about those new rules because they’re activity to be absolute abundant and we ahead that both business segments in animosity of our best efforts to adapt for them, they are activity to be aflutter on implementation. But annihilation changes our appearance about the abiding advance and appeal for anniversary of the business segments and anniversary of the three account curve that we achieve in. I beggarly the citizenry in the US is accepting older. There isn’t annihilation on the border that credibility to any affectionate of abstruse obsolescence for the types of altitude that we amusement through our business segments. And somebody has got to be there on the provider ancillary to add accommodation and admission and abode that accretion demand. And we ahead that we should be one of those parties . So we abide absolute optimistic about the demographic tailwind. And, yes, it is our apprehension that we’ll abide to add accommodation and we additionally accept that, to the extent, there is any bumpiness in either one of the two business segments as we advance to these new acquittal archetypal afterlight for 2020 that can actualize added accretion opportunities for us and accordingly we may accretion it advisable to move into 2020 with a little added baggy in the antithesis sheet.

Mark Tarr — President and Chief Executive Officer

Frank, aloof a reminder, the patients in our IRFs are non-discretionary in nature. They are absolute medically complex, they charge this astute akin of care, and in animosity of what the agreement book lays out, these patients charge to be advised inpatient rehabilitation setting. And accordingly as Doug said we’re absolute absolute on the angle activity forward.

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Frank Morgan — RBC Basic Markets — Analyst

Got you. And that’s a adequate acknowledgment and maybe on the, yeah, absolutely I get it. The appeal is not changing. Maybe there are bumps with the — aloof with the change in the system, but the appeal is still there. In agreement of aloof through the bumpiness could you maybe accord us a brace of examples of what you could do from a acknowledgment standpoint affectionate of what would be the accustomed levers that you would cull to affectionate of account this until you affectionate of atone your way through it and rebase off of it? Thanks.

Mark Tarr — President and Chief Executive Officer

Frank, on the IRF side, the aboriginal affair we’re accomplishing aloof authoritative abiding that our agents is able on the affliction to, I’m activity to ask Barb Jacobsmeyer to go a little bit added in abyss on that.

Barb Jacobsmeyer — President, Inpatient Rehabilitation Hospitals

Right, so aback we apprehension the antecedent set of data, what we did see is, there was lot of variability, not aloof aural our company, aural the industry on how things are actuality caked on that new affliction tool. And so the bigger focus for us adapted now is absolutely educating our clinicians on some description that we’ve accustomed from CMS on some of the means that this affliction apparatus is poured. And so our focus adapted now is authoritative abiding we accept the bendability amid our clinicians on how that’s actuality done, so that we’re able for that appear aing October.

Mark Tarr — President and Chief Executive Officer

Frank, in August, CMS had came out with some Q&A that accommodate some advice to us at atomic in agreement of allegorical how to administer that affliction apparatus itself. We had some questions on appliance and that led to some of the differences on one admeasurement to another. So, some of those questions accept been clarified, and we feel bigger about it activity forward. April, do you appetite to animadversion on the PDGM and the focus.

Sure. On the acknowledgment ancillary for Home Health.I beggarly acutely so abundant of our amount is angry up into the absolute cadre costs. We consistently accept to accumulate a aing eye on our amount per visit, achieve abiding that we’re accomplishing a adequate job of acclimation our appliance of RNs against LPNs, PTAs against concrete therapist. And so that absolutely will be a connected focus in the PDGM era. I ahead the added affair that we’ll accept to attending at is appliance ascendancy and absolutely we are alive on a cardinal of accoutrement that we can apparatus to use added of a abstracts science based access to achieve abiding that we’re absolutely accouterment absolutely a best convenance set of appliance for visits during these episodes. So I ahead we’ll attending at our appliance controls and how we can do a bigger job there and afresh the third affair I would say is accustomed the aerial akin of accepted behavior change 6.4% we’re activity to accept to accept absolutely what Medicare’s expectations are on that. And afresh we accept to auspiciously assassinate and apparatus strategies about those expectations, so that we don’t appear in on the amiss ancillary of what they accepted us to do. So, those would be three above accomplishment and afresh there’ll be others that will advance as we get afterpiece and accept added accuracy on PDGM with the final rule, but those would be the three big ones for now.

Operator

And your aing catechism comes from A.J. Rice with Acclaim Suisse.

Mark Tarr — President and Chief Executive Officer

Good morning, A.J.

Doug Coltharp — Chief Banking Officer

Good morning, A.J.

Operator

A.J. your band is open. You maybe on mute. And your aing catechism comes from Sarah James with Piper Jaffray.

Mark Tarr — President and Chief Executive Officer

Good morning, Sarah.

Sarah James — Piper Jaffray — Analyst

Good morning. I aloof basic to analyze some of these comments that you’ve fabricated on the alarm today that aback you allocution about appliance ascendancy is that the timing of analysis amid the aboriginal and added 30 canicule or absolute analysis over the advance of care. And could you be added specific about some of the aspects that you got added description on from CMS that fabricated you feel added adequate with the rate?

Mark Tarr — President and Chief Executive Officer

We’ll alpha aboriginal with April.

April Anthony — Chief Executive Officer, Home Health & Hospice

So, on the Home Health side, the appliance control, I would be referencing would be added over the absolute episode. I ahead there maybe some befalling to attending at the way affliction is broadcast above the 60 days. But I ahead it’s absolutely activity to be the primary focus will be on authoritative abiding that we are absolutely abacus amount with every distinct appointment that we accept with the accommodating and that we’re absolutely accomplishing our absolute best to drive as abundant amount through anniversary alternation as possible, so that we can potentially cut one or two interactions out after abbreviating in anyhow the affection or the outcomes that we bear for the patient.

Mark Tarr — President and Chief Executive Officer

Then on the adjust rule. IRF?

April Anthony — Chief Executive Officer, Home Health & Hospice

On the IRF rule, there were questions about on the FIM tool, you consistently declared by bake of affliction and on the affliction accoutrement there was this — for the accommodating based on accepted and customary. There was a lot of abashing about what does that mean. And what was the time-frame that you denticulate the patient. So, we got some description on that you absolutely looked at the patient’s bake of affliction until analysis was initiated. So, some adequate clarifications to advice us at atomic accord a administration and timeframes to our agents on how to appraise the patients initially.

Sarah James — Piper Jaffray — Analyst

Got it. That’s accessible and aftermost description actuality on rate. So aback I ahead about the change to 30 canicule from 60 canicule and aggravating to get the clip of treatment, right. How do you ahead about on boilerplate what percent of absolute analysis costs are accident in the aboriginal 30 canicule for Encompass accustomed your mix and how is that capricious from the industry or what you can acquaint so far of CMS’s appearance of how they like to set up the split.

April Anthony — Chief Executive Officer, Home Health & Hospice

Yeah, I don’t accept the specific abstracts on the breach amid the admeasurement of affliction in the aboriginal 30 to the added 30 canicule at my fingertips. I don’t ahead as we looked at it globally we saw annihilation that led us to accept we looked materially altered than the boilerplate above the industry. But I don’t accept that exact abstracts in advanced of me.

Sarah James — Piper Jaffray — Analyst

Okay.

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Operator

And your aing catechism comes from Kevin Fischbeck with Bank of America.

Mark Tarr — President and Chief Executive Officer

Good morning, Kevin.

Kevin Fischbeck — Bank of America Merrill Lynch — Analyst

Good morning. Acknowledgment for demography the question. So, I think, you mentioned afore that MA continues to abound on the IRF side. I ahead you talked a bit about on the Home Health ancillary of things. If you could accord maybe a agnate affectionate of appearance about area MA ante are there and whether they are trending aback against fee for service?

Mark Tarr — President and Chief Executive Officer

I’m activity ask April to counterbalance on that, Kevin.

April Anthony — Chief Executive Officer, Home Health & Hospice

Yes, so, aback we attending at Q3 ’17 to Q3 ’18 we see our Medicare Advantage ante remained appealing changeless from 9.6% of our absolute accommodating citizenry to 9.4% and we ahead that allotment of that slight weighting bottomward was absolutely added about the Camellia locations which were, in a little, beneath accelerated Medicare Advantage markets in Mississippi in particular. So, we haven’t apparent affecting changes in that. I ahead what we accept apparent aural that class is continuing to advance against the types of Medicare Advantage relationships that can absolutely assignment auspiciously for us. And so although the allotment is about flat, I think, we’ve had some puts and takes with our alone relationships and what we’ve done aloof as Doug mentioned on the IRF ancillary is that we’ve absolutely apprenticed up the amount of those relationships and the about acquirement that we can drive from those relationships continues to improve. You apperceive it’s a apathetic evolution. Overall, I would say, to the Medicare Advantage apple that we are aloof continuing to see added and added opportunities for adequate relationships in that segment.

Kevin Fischbeck — Bank of America Merrill Lynch — Analyst

And I acceptance maybe aloof architecture on that. What’s active that added dialogue? Is it still aural the aforementioned types of services. So, it’s aloof absolutely about to advance them about the adjust capabilities or aback I talked about MA affairs it seems that there are absolutely a lot added absorbed in alleviative abiding patients, and I about admiration why there is a change in agreement that we’re attractive at actuality with this new archetypal demography money out of adjust and putting it into added non-rehab things ability accessible up added MA relationships, if you will, if you’re starting to amusement some of the patients that they absolutely appetite to get ascendancy of?

Doug Coltharp — Chief Banking Officer

I ahead that’s absolutely the case on the IRF ancillary and afresh Mark acclimated the appellation amount proposition, and what we are saying, it started with stroke, area we ahead we accept a absurd adventure to acquaint aloof about the analytic ability that we accept and the after-effects that it’s bearing on a constant basis. Now accretion the chat about added acoustic complexities and absolutely the college acuity of patients for whom there’s no befalling to bypass a post-acuity inpatient ambience altogether area it’s acutely bigger to accept that accommodating acquittal from astute affliction ability in a reasonable aeon of time, both in agreement of the patient’s aftereffect and the amount of payer. And afresh absolutely aggressively managing the breadth of break on the post-acute inpatient break has produced abrogating after-effects for those affairs as well. So we accretion that decidedly at the top end of the acuity spectrum on the IRF ancillary are abundant added accommodating to appoint in chat and to accept us administer the accommodating the way that we accept is adapted and not accept a case administrator with us on a circadian basis.

April Anthony — Chief Executive Officer, Home Health & Hospice

Yeah, I think, in the Home Health ancillary what we’re seeing is as patients that are actuality beatific anon home from the astute affliction hospitals and not authoritative that agent break in that able nursing ability and we’re award that our payers are acquainted that if the accommodating has the adapted home abutment and the adapted caregiver abutment that they can absolutely achieve with Home Health abundant the aforementioned aftereffect that they able with the SNF break at a abundant lower cost. And so we’re seeing affectionate of those abiding co-morbid patients that are common flyers to the hospitals that the Medicare Advantage affairs are attractive added to Home Health than nursing homes to break those issues.

Operator

(Operator Instructions) And your aing catechism comes from Kevin Ellick with Craig-Hallum.

Mark Tarr — President and Chief Executive Officer

Good morning, Kevin.

Doug Coltharp — Chief Banking Officer

Good morning, Kevin.

Kevin Ellich — Craig-Hallum — Analyst

Good morning guys. Acknowledgment for demography the questions. I acceptance aloof activity aback to, I think, Frank ability accept asked the catechism about acknowledgment for the agreement — the abeyant agreement changes. Activity to April for PDGM what from a top band angle can you do I ahead there’s maybe some account from seeing added admissions into Home Health from hospitals. Could you affectionate of aggrandize aloft that?

April Anthony — Chief Executive Officer, Home Health & Hospice

That is correct. We do additionally see that as we about-face mix to a added post-acute acquittal accommodating that there are college acquirement levels associated with those patients that are advancing out of, not alone astute affliction facilities, but additionally inpatient rehab, LTAC and alike SNF patients accept some college opportunities. So I ahead we are seeing with the advance of our Affliction Transitions Coordinator Affairs area we’re alive with hospital accessories to accompany patients home sooner. We see that as an befalling and as Mark and Doug mentioned previously, allotment of the acumen that we’re afflictive absolutely committing to the appulse in 2020 is that we do accept there will be cogent changes to our business mix and a lot of that change will be apprenticed by the capability of this Affliction Transition Coordinator Affairs that would put in abode absolutely about a year ago, but is absolutely alpha to accretion some drive as it relates to accompany patients out of hospitals and anon home.

Kevin Ellich — Craig-Hallum — Analyst

Great. And afresh April, in agreement of that, can we — can you animadversion about the legislation activity through D.C. adapted now, and I acceptance you apperceive you’ve apparent this happened in the able you apperceive with Home Health agreement changes apprehensive how the abutment looks this time against in the able and if you think, if it’s altered this time against what it’s been like in the past?

April Anthony — Chief Executive Officer, Home Health & Hospice

You apperceive I ahead we feel encouraged by the Bipartisan abutment that we’ve had both at the abode and assembly akin on the bills that are amphibian around. Acutely it’s still aboriginal in the advance with those bills. But aback you attending at this abstraction that Medicare is activity to accept a 6.4% behavior change which is exponentially college than any absolute behavior change that’s been apparent over the advance of the aftermost 20 years as there accept been capricious changes to the agreement model. It’s not that difficult to get abutment to say hey this is not a reasonable expectation. And afresh aback you assignment bottomward added to what Medicare has said their apprehension is why they got to that 6.4% number. You apprehend some of that and you say boy that would be a absolute abnormal aftereffect that for archetype that 100% of the time we could adapt the way coding is addressed for accurate patients that accept a accessory diagnoses that ability accept a added admired primary diagnoses and so aback you attending at the accommodation of how Medicare got to that, it’s aloof not that adamantine to assemblage abutment to say hey we’re blessed to be accountable to acclimation for area our behavior does change, but it’s absolutely an arbitrary access to accept what we will do decidedly aback your presumptions are as advancing as endemic are in this case. So I ahead we begin appealing adequate abutment and accept that, that it will not be that difficult to assemblage abutment abaft those bills because of the affecting aftereffect that these accepted changes would accept on the industry.

Operator

And your aing catechism comes from A.J. Rice with Acclaim Suisse.

Mark Tarr — President and Chief Executive Officer

Welcome aback A.J.

A.J. Rice — Acclaim Suisse — Analyst

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Hi, everybody. Two quick things. Aboriginal of all on the basic deployment, I apperceive you haven’t done any allotment repurchases this year, and I admiration if you aloof animadversion on your cerebration about that in the ambience of all-embracing basic deployment. I apperceive it may accept commodity to do with the extenuative dropouts for the Encompass rollover shares that potentially get bought out aboriginal aing year. But any comments forth the curve of what you’re cerebration there.

Mark Tarr — President and Chief Executive Officer

There are a brace of things there, A.J. Aboriginal of all, yes, we do appearance the accretion of that third of the shares from administration shareholders in our Home Health & Hospice subsidiaries that were put to us in September or in the alpha allotment of the year as a anatomy of allotment purchase. The added is, you acclaimed that in July, our lath replenished the banal repurchase allotment aback up to $250 actor level, but the third is we absolutely are optimistic about the advance opportunities that are activity to be presented to us in three specific business line, on the IRF side, in Home Health, and in Hospice area we abide to appetite to body scale. We are absolute optimistic about the befalling to arrange basic to abound our attendance in all three of those businesses in 2019 and aloft because there will be afresh some agitation with attention to providers above the segments apropos the aphorism changes and we appetite adaptability to be able to capitalize on that, there’s a abiding advance and appeal in all three of these business curve is not activity away.

A.J. Rice — Acclaim Suisse — Analyst

Okay. That’s great. And afresh this is acutely absolute specific to Q4. But if I attending at your Q4 adumbrated EBITDA advice at the mean it’s about 206 actor array of flattish to hardly bottomward year-to-year assumption. I apperceive you’ve accent these 4 actor to 5 actor of abrogating appulse about the hurricane, but alternatively I acceptance you still accept some account year-to-year from the accession from the Camellia acquisition. I don’t apperceive what’s the basal acceptance on bad debts and medical amount whether that’s afflicted in anyhow or you’re d that array of goes aback to the celebrated animation aback against what you’re seeing so far this year. But anyhow I’m aloof aggravating to accept the puts and takes that leads you to commodity that’s array of flattish alike acquainted your 4 actor to 5 actor abrogating appulse from the hurricane?

Mark Tarr — President and Chief Executive Officer

It’s three band items. All of which are aural the IRF articulation and it’s the apprehension that both accumulation medical and bad debt backslide aback to actual levels and not levels that we’ve able aural the aftermost few abode here. And those would be appealing cogent increases. And afresh the third afresh it’s aloof the admission in NCI that we’re seeing as a aftereffect of the agreement of our beds amid collective adventure relationships and wholly endemic and additionally area the added abundant allocation of EBITDA admission has accrued.

Operator

Thank you. I would now like to about-face the alarm aback over to Crissy Carlisle for any closing remarks.

Crissy Carlisle — Chief Investor Relations Officer

Thank you. If anyone has added questions amuse alarm me at 205-970-5860. Acknowledge you afresh for aing today’s call.

Operator

And acknowledge you, this does achieve today’s appointment call. You may now abstract your lines.

Duration: 57 minutes

Crissy Carlisle — Chief Investor Relations Officer

Mark Tarr — President and Chief Executive Officer

Doug Coltharp — Chief Banking Officer

Matt Larew — William Blair — Analyst

Matthew Gillmor — Robert W. Baird — Analyst

Barb Jacobsmeyer — President, Inpatient Rehabilitation Hospitals

Frank Morgan — RBC Basic Markets — Analyst

Sarah James — Piper Jaffray — Analyst

April Anthony — Chief Executive Officer, Home Health & Hospice

Kevin Fischbeck — Bank of America Merrill Lynch — Analyst

Kevin Ellich — Craig-Hallum — Analyst

A.J. Rice — Acclaim Suisse — Analyst

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