Amedisys Reports Second Quarter 2021 Financial Results, Closing of Contessa Acquisition, Expansion of Credit Facility and Authorization of New $100 Million Share Repurchase Program

Wednesday, 04. August 2021 22:05

BATON ROUGE, La., Aug. 04, 2021 (GLOBE NEWSWIRE) -- Amedisys, Inc. (NASDAQ: AMED) today reported its financial results for the three and six-month periods ended June 30, 2021.

Three-Month Periods Ended June 30, 2021 and 2020

  • Net service revenue increased $79.2 million to $564.2 million compared to $485.0 million in 2020.
  • Net income attributable to Amedisys, Inc. of $80.1 million compared to $34.7 million in 2020.
  • Net income attributable to Amedisys, Inc. per diluted share of $2.43 compared to $1.04 in 2020.

Adjusted Quarterly Results*

  • Adjusted EBITDA of $83.8 million compared to $66.4 million in 2020.
  • Adjusted net service revenue of $557.6 million compared to $485.0 million in 2020.
  • Adjusted net income attributable to Amedisys, Inc. of $55.7 million compared to $44.5 million in 2020.
  • Adjusted net income attributable to Amedisys, Inc. per diluted share of $1.69 compared to $1.34 in 2020.

Six-Month Periods Ended June 30, 2021 and 2020

  • Net service revenue increased $124.6 million to $1,101.3 million compared to $976.7 million in 2020.
  • Net income attributable to Amedisys, Inc. of $130.0 million compared to $66.5 million in 2020.
  • Net income attributable to Amedisys, Inc. per diluted share of $3.93 compared to $2.00 in 2020.

Adjusted Year to Date Results*

  • Adjusted EBITDA of $162.4 million compared to $119.7 million in 2020.
  • Adjusted net service revenue of $1,094.8 million compared to $976.7 million in 2020.
  • Adjusted net income attributable to Amedisys, Inc. of $106.9 million compared to $79.3 million in 2020.
  • Adjusted net income attributable to Amedisys, Inc. per diluted share of $3.23 compared to $2.39 in 2020.

* See pages 4 and 16—18 for the definition and reconciliations of non-GAAP financial measures to GAAP measures.

Contessa Acquisition

On August 1, 2021, we closed on our previously announced acquisition of Contessa Health (“Contessa”), a leader in hospital-at-home and skilled nursing facility (“SNF”) at-home services. With the addition of Contessa’s risk-based model and claims analytics capabilities, we will be able to bring the essential elements of inpatient hospital and SNF care to patients’ homes, allowing us to become a risk-bearing, home-based care delivery organization, expanding well beyond traditional Home Health and Hospice. Contessa will operate as a wholly owned division of Amedisys and will be reported as a separate operating segment in our future filings.

Updated 2021 Guidance

While our performance in the first half of 2021 has produced strong EBITDA and expanded margins, our Hospice segment is behind in both admission and average daily census growth. The COVID-19 pandemic has put pressure on our ability to hire and retain business development employees at a level needed to achieve our internal growth targets. Throughout 2020 and into 2021, we have been mindful of our need to deliver results, and we have a history of managing our costs. However, with our recent acquisition activity, we believe that there is a significant opportunity to grow our Hospice segment which has required us to invest in leadership and continue to hire clinical employees to support this future growth. Accordingly, and given that our Hospice growth disruption has been isolated to turnover and hiring and is not a systemic issue, we are committed to staffing our Hospice segment for this growth opportunity despite the impact to near term margins.

COVID-19 has impacted the operating metrics typically used to forecast both growth and cost assumptions for both core Amedisys and Contessa. We are basing our guidance on our current operating environment. COVID-19 continues to evolve in both the disease itself as well as disruptions to the healthcare systems and the economy. Any future regulations or government interventions, spike in clinicians and business development staff on quarantine, reduction in elective procedures, change in patient behavior and further decline in senior living occupancy could impact our ability to achieve this guidance.

Based upon the above discussion, our updated 2021 guidance for our core business (excluding any acquisitions closed subsequent to June 30, 2021) is as follows:

  • Adjusted net service revenue is anticipated to be in the range of $2.230 billion to $2.245 billion.
  • Adjusted EBITDA is anticipated to be in the range of $315 million to $320 million.
  • Adjusted diluted earnings per share is anticipated to be in the range of $6.37 to $6.49 based on an estimated 33.1 million shares outstanding.

Our updated 2021 guidance including all acquisition activity closed as of August 4, 2021 is as follows:

  • Adjusted net service revenue is anticipated to be in the range of $2.241 billion to $2.259 billion.
  • Adjusted EBITDA is anticipated to be in the range of $301 million to $308 million.
  • Adjusted diluted earnings per share is anticipated to be in the range of $6.03 to $6.18 based on an estimated 33.1 million shares outstanding.

This guidance excludes the effects of any future acquisitions, if any are made.

Expansion of Credit Facility

On July 30, 2021, we entered into the Second Amendment to our Credit Agreement (as amended by the Second Amendment, the “Second Amended Credit Agreement”). The Second Amended Credit Agreement provides for a senior secured credit facility in an initial aggregate principal amount of up to $1.0 billion, which includes a $550.0 million Revolving Credit Facility under the Second Amended Credit Agreement, and a term loan facility with a principal amount of up to $450.0 million (the “Amended Term Loan Facility” and collectively with the Revolving Credit Facility, the “Amended Credit Facility”).

Proceeds from the $450.0 million Amended Term Loan Facility were used to pay off the outstanding Term Loan principal balance as of July 30, 2021, as well as to fund 100% of the Contessa acquisition.

Share Repurchase Program

We also announced today that our Board of Directors authorized a share repurchase program, under which we may repurchase up to $100 million of our outstanding common stock through December 31, 2022, to commence upon the completion of the Company’s existing $100 million share repurchase program, approved by our Board of Directors on December 17, 2020 (the “Existing Share Repurchase Program”). Repurchases may be made under the Existing Share Repurchase Program through December 31, 2021.

Paul B. Kusserow, Chairman and Chief Executive Officer stated, “The second quarter of 2021 was an eventful quarter for Amedisys. In our core business, Home Health continued its very strong performance while the lingering and prolonged effect of COVID-19 continued to impact our Hospice business’ ability to grow at previously projected rates. We have identified the issues which are two-fold, business development staff recruitment and retention, and have implemented plans to accelerate performance in the second half of the year. That said, we have revised our full year guidance to reflect these impacts.

I am also very excited about the closing of the Contessa acquisition. Contessa’s industry leading Hospital at Home and SNF at Home platform, along with their advanced Medicare Advantage claims analytics, underwriting capabilities and risk-taking experience, combined with our nationwide, highest quality, Home Health and Hospice platform creates a truly differentiated, tech-enabled, risk-taking, higher-acuity, home-based care delivery asset—one that materially differentiates Amedisys and positions us differently with Medicare Advantage plans. I’d like to welcome all of the Contessa employees to the Amedisys family.

We also have expanded our credit facility giving us access to $1 billion via a term loan and revolver. This should strongly indicate our appetite to do additional Home Health and Hospice acquisitions.

Finally, our Board of Directors has authorized an additional $100 million stock buy-back program that we will deploy opportunistically. It makes sense to have this tool available as part of our capital deployment strategy and again, does not prevent us from doing any deals we currently have in the pipeline.

I’d like to take a moment to thank all of the nearly 21,000 Amedisys employees for their continued dedication, efforts and tireless work throughout this quarter and the entirety of the pandemic. It is humbling to see the incredible care you provide to your patients wherever they call home and makes me proud to work for such a service and quality driven organization.”

We urge caution in considering the current trends and 2021 guidance disclosed in this press release. The home health, hospice and personal care industries are highly competitive and subject to intensive regulations, and trends are subject to numerous factors, risks, and uncertainties, some of which are referenced in the cautionary language below and others that are described more fully in our reports filed with the Securities and Exchange Commission (“SEC”) including our Annual Report on Form 10-K for the fiscal year ended December 31, 2020, subsequent Quarterly Reports on Form 10-Q, and current reports on Form 8-K which can be found on the SEC’s internet website, http://www.sec.gov, and our internet website, http://www.amedisys.com.

Earnings Call and Webcast Information

Amedisys will host a conference call on Thursday, August 5, 2021, at 11:00 a.m. ET to discuss its second quarter results. To participate on the conference call, please call before 11:00 a.m. ET to either (877) 524-8416 (Toll-Free) or (412) 902-1028 (Toll). A replay of the conference call will be available through September 5, 2021 by dialing (877) 660-6853 (Toll-Free) or (201) 612-7415 (Toll) and entering conference ID #13721553.

A live webcast of the call will be accessible through our website on our Investor Relations section at the following web address: http://investors.amedisys.com.

Non-GAAP Financial Measures

This press release includes reconciliations of the most comparable financial measures calculated and presented in accordance with accounting principles generally accepted in the U.S. (“GAAP”) to non-GAAP financial measures. The non-GAAP financial measures as defined under SEC rules are as follows: (1) adjusted EBITDA, defined as net income attributable to Amedisys, Inc. before net interest expense, provision for income taxes and depreciation and amortization, excluding certain items; (2) adjusted net service revenue, defined as net service revenue excluding certain items; (3) adjusted other operating income, defined as other operating income excluding certain items; (4) adjusted net income attributable to Amedisys, Inc., defined as net income attributable to Amedisys, Inc. excluding certain items; and (5) adjusted net income attributable to Amedisys, Inc. per diluted share, defined as net income attributable to Amedisys, Inc. common stockholders per diluted share excluding certain items. Management believes that these non-GAAP financial measures, when reviewed in conjunction with GAAP financial measures, are useful gauges of our current performance and are also included in internal management reporting. These non-GAAP financial measures should be considered in addition to, and not more meaningful than or as an alternative to the GAAP financial measures presented in this earnings release and the company’s financial statements. Non-GAAP measures as presented herein may not be comparable to similarly titled measures reported by other companies since not all companies calculate these non-GAAP measures consistently.

Additional Information

Amedisys, Inc. (the “Company”) is a leading healthcare at home company delivering personalized home health, hospice and personal care. Amedisys is focused on delivering the care that is best for our patients, whether that is home-based personal care; recovery and rehabilitation after an operation or injury; care focused on empowering our patients to manage a chronic disease; or hospice care at the end of life. More than 2,900 hospitals and 78,000 physicians nationwide have chosen Amedisys as a partner in post-acute care. Founded in 1982, headquartered in Baton Rouge, LA with an executive office in Nashville, TN, Amedisys is a publicly held company. With approximately 21,000 employees in 514 care centers within 39 states and the District of Columbia, Amedisys is dedicated to delivering the highest quality of care to the doorsteps of more than 418,000 patients and clients in need every year. For more information about the Company, please visit: www.amedisys.com.

We use our website as a channel of distribution for important company information. Important information, including press releases, investor presentations and financial information regarding our company, is routinely posted on and accessible on the Investor Relations subpage of our website, which is accessible by clicking on the tab labeled “Investors” on our website home page. Visitors to our website can also register to receive automatic e-mail and other notifications alerting them when new information is made available on the Investor Relations subpage of our website.

Forward-Looking Statements

When included in this press release, words like “believes,” “belief,” “expects,” “strategy,” “plans,” “anticipates,” “intends,” “projects,” “estimates,” “may,” “might,” “could,” “would,” “should” and similar expressions are intended to identify forward-looking statements as defined by the Private Securities Litigation Reform Act of 1995. These forward-looking statements involve a variety of risks and uncertainties that could cause actual results to differ materially from those described therein. These risks and uncertainties include, but are not limited to the following: the impact of the novel coronavirus pandemic (“COVID-19”), including the measures that have been and may be taken by governmental authorities to mitigate it, on our business, financial condition and results of operations, changes in or our failure to comply with existing federal and state laws or regulations or the inability to comply with new government regulations on a timely basis, changes in Medicare and other medical payment levels, our ability to open care centers, acquire additional care centers and integrate and operate these care centers effectively, competition in the healthcare industry, changes in the case mix of patients and payment methodologies, changes in estimates and judgments associated with critical accounting policies, our ability to maintain or establish new patient referral sources, our ability to consistently provide high-quality care, our ability to attract and retain qualified personnel, our ability to keep our patients and employees safe, changes in payments and covered services by federal and state governments, future cost containment initiatives undertaken by third-party payors, our access to financing, our ability to meet debt service requirements and comply with covenants in debt agreements, business disruptions due to natural disasters or acts of terrorism, widespread protests or civil unrest, our ability to integrate, manage and keep our information systems secure, our ability to realize the anticipated benefits of acquisitions, changes in law or developments with respect to any litigation relating to the Company, including various other matters, many of which are beyond our control.

Because forward-looking statements are inherently subject to risks and uncertainties, some of which cannot be predicted or quantified, you should not rely on any forward-looking statement as a prediction of future events. We expressly disclaim any obligation or undertaking and we do not intend to release publicly any updates or changes in our expectations concerning the forward-looking statements or any changes in events, conditions or circumstances upon which any forward-looking statement may be based, except as required by law.

   
Contact:Investor Contact:Media Contact:
 Amedisys, Inc. Amedisys, Inc.
 Nick MuscatoKendra Kimmons
 Senior Vice President, FinanceVice President, Marketing & Communications
 (855) 259-2046(225) 299-3720
 IR@amedisys.comkendra.kimmons@amedisys.com


 
AMEDISYS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(Amounts in thousands, except per share data)
(Unaudited)
     
 For the Three-Month
Periods Ended June 30,
 For the Six-Month
Periods Ended June 30,
 2021
 2020
 2021
 2020
Net service revenue$564,166  $485,059  $1,101,310  $976,744 
Other operating income 4,603   22,780   13,304   22,780 
Cost of service, excluding depreciation and amortization 308,691   295,228   605,894   580,965 
General and administrative expenses:    
Salaries and benefits 114,335   105,617   230,160   207,183 
Non-cash compensation 6,156   6,725   13,463   12,634 
Other 54,731   44,003   103,837   93,268 
Depreciation and amortization 6,721   6,334   14,276   11,672 
Operating expenses 490,634   457,907   967,630   905,722 
Operating income 78,135   49,932   146,984   93,802 
Other income (expense):    
Interest income 25   214   49   227 
Interest expense (1,932)  (2,752)  (4,004)  (5,983)
Equity in earnings from equity method investments 1,370   487   2,488   964 
Gain (loss) on equity method investments 31,092   (2,980)  31,092   (2,980)
Miscellaneous, net 475   277   763   540 
Total other income (expense), net 31,030   (4,754)  30,388   (7,232)
Income before income taxes 109,165   45,178   177,372   86,570 
Income tax expense (28,546)  (10,031)  (46,461)  (19,377)
Net income 80,619   35,147   130,911   67,193 
Net income attributable to noncontrolling interests (470)  (473)  (892)  (717)
Net income attributable to Amedisys, Inc.$80,149  $34,674  $130,019  $66,476 
Basic earnings per common share:    
Net income attributable to Amedisys, Inc. common stockholders$2.46  $1.07  $3.98  $2.05 
Weighted average shares outstanding 32,588   32,412   32,684   32,371 
Diluted earnings per common share:    
Net income attributable to Amedisys, Inc. common stockholders$2.43  $1.04  $3.93  $2.00 
Weighted average shares outstanding 32,981   33,285   33,085   33,259 
                


 
AMEDISYS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
(Amounts in thousands, except share data)
   
 June 30, 2021
(unaudited)
 December 31,
2020
ASSETS     
Current assets:  
Cash and cash equivalents$91,646  $81,808 
Restricted cash 1,000   1,549 
Patient accounts receivable 278,216   255,145 
Prepaid expenses 11,979   10,217 
Other current assets 8,124   13,265 
Total current assets 390,965   361,984 
Property and equipment, net of accumulated depreciation of $98,552 and $95,024 20,986   23,719 
Operating lease right of use assets 95,034   93,440 
Goodwill 936,772   932,685 
Intangible assets, net of accumulated amortization of $15,842 and $22,973 66,432   74,183 
Deferred income taxes 25,271   47,987 
Other assets 64,103   33,200 
Total assets$1,599,563  $1,567,198 
   
LIABILITIES AND EQUITY  
Current liabilities:  
Accounts payable$36,668  $42,674 
Payroll and employee benefits 147,017   146,929 
Accrued expenses 166,157   166,192 
Provider relief fund advance 58,328   60,000 
Current portion of long-term obligations 10,160   10,496 
Current portion of operating lease liabilities 30,893   30,046 
Total current liabilities 449,223   456,337 
Long-term obligations, less current portion 179,415   204,511 
Operating lease liabilities, less current portion 63,152   61,987 
Other long-term obligations 31,886   33,622 
Total liabilities 723,676   756,457 
Equity:  
Preferred stock, $0.001 par value, 5,000,000 shares authorized; none issued or outstanding     
Common stock, $0.001 par value, 60,000,000 shares authorized; 37,553,355 and 37,470,212 shares issued; and 32,576,829 and 32,814,278 shares outstanding 38   38 
Additional paid-in capital 714,334   698,287 
Treasury stock, at cost 4,976,526 and 4,655,934 shares of common stock (400,110)  (319,092)
Retained earnings 560,010   429,991 
Total Amedisys, Inc. stockholders’ equity 874,272   809,224 
Noncontrolling interests 1,615   1,517 
Total equity 875,887   810,741 
Total liabilities and equity$1,599,563  $1,567,198 
        


 
AMEDISYS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS AND DAYS REVENUE OUTSTANDING
(Amounts in thousands, except statistical information)
(Unaudited)
     
 For the Three-Month
Periods Ended June 30,
 For the Six-Month
Periods Ended June 30,
  2021  2020  2021  2020
Cash Flows from Operating Activities:    
Net income$80,619  $35,147  $130,911  $67,193 
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 6,721   6,334   14,276   11,672 
Non-cash compensation 6,156   6,725   13,463   12,634 
Amortization and impairment of operating lease right of use assets 9,852   9,500   19,702   18,558 
(Gain) loss on disposal of property and equipment (6)  (149)  8   (94)
(Gain) loss on equity method investments (31,092)  2,980   (31,092)  2,980 
Write-off of other comprehensive income          (15)
Deferred income taxes 15,305   (5,264)  22,716   (4,036)
Equity in earnings from equity method investments (1,370)  (487)  (2,488)  (964)
Amortization of deferred debt issuance costs/debt discount 216   217   432   437 
Return on equity method investments 1,183   375   2,683   2,744 
Changes in operating assets and liabilities, net of impact of acquisitions:    
Patient accounts receivable (2,339)  34,456   (22,787)  8,997 
Other current assets 6,434   2,287   3,560   (3,469)
Other assets 63   (1,092)  (52)  (675)
Accounts payable (3,156)  (3,779)  (6,530)  (6,452)
Accrued expenses (9,997)  38,326   (1,627)  27,990 
Other long-term obligations (928)  17,686   (1,736)  20,746 
Operating lease liabilities (8,941)  (8,233)  (17,955)  (16,365)
Operating lease right of use assets (762)  (1,107)  (1,524)  (1,924)
Net cash provided by operating activities 67,958   133,922   121,960   139,957 
Cash Flows from Investing Activities:    
Proceeds from sale of deferred compensation plan assets 6   5   25   21 
Proceeds from sale of property and equipment    68   42   80 
Purchases of property and equipment (1,325)  (267)  (2,943)  (1,701)
Investments in equity method investees    (875)     (875)
Proceeds from sale of equity method investment    17,876      17,876 
Acquisitions of businesses, net of cash acquired (2,503)  (230,374)  (2,503)  (299,723)
Net cash used in investing activities (3,822)  (213,567)  (5,379)  (284,322)
Cash Flows from Financing Activities:               
Proceeds from issuance of stock upon exercise of stock options 259   1,763   623   2,947 
Proceeds from issuance of stock to employee stock purchase plan 913   826   1,961   1,686 
Shares withheld to pay taxes on non-cash compensation (170)  (2,334)  (6,944)  (6,384)
Noncontrolling interest distribution (276)  (12)  (794)  (372)
Proceeds from borrowings under revolving line of credit 174,000   237,000   389,200   424,500 
Repayments of borrowings under revolving line of credit (224,000)  (222,000)  (410,200)  (259,500)
Principal payments of long-term obligations (2,700)  (3,083)  (5,392)  (4,675)
Purchase of company stock (1,188)     (74,074)   
Provider relief fund advance 3,328   70,000   (1,672)  70,000 
Net cash (used in) provided by financing activities (49,834)  82,160   (107,292)  228,202 
Net increase in cash, cash equivalents and restricted cash 14,302   2,515   9,289   83,837 
Cash, cash equivalents and restricted cash at beginning of period 78,344   177,812   83,357   96,490 
Cash, cash equivalents and restricted cash at end of period$92,646  $180,327  $92,646  $180,327 
Supplemental Disclosures of Cash Flow Information:    
Cash paid for interest$903  $1,537  $1,914  $3,292 
Cash paid for income taxes, net of refunds received$7,696  $2,881  $8,667  $8,153 
Cash paid for operating lease liabilities$9,703  $9,340  $19,479  $18,289 
Cash paid for finance lease liabilities$514  $487  $1,017  $986 
Supplemental Disclosures of Non-Cash Activity:    
Right of use assets obtained in exchange for operating lease liabilities$10,141  $12,454  $20,689  $18,891 
Right of use assets obtained in exchange for finance lease liabilities$350  $233  $527  $487 
Reductions to right of use assets resulting from reductions to operating lease liabilities$625  $248  $904  $407 
Days revenue outstanding (1) 42.7   42.0   42.7   42.0 

(1) Our calculation of days revenue outstanding, net is derived by dividing our ending patient accounts receivable at June 30, 2021 and 2020 by our average daily net patient service revenue for the three-month periods ended June 30, 2021 and 2020, respectively.

AMEDISYS, INC. AND SUBSIDIARIES
SEGMENT INFORMATION
(Amounts in millions, except statistical information)
(Unaudited)

Segment Information—Home Health

   
 For the Three-Month Periods
Ended June 30,
  2021  2020
Financial Information (in millions):  
Medicare$234.8  $192.9 
Non-Medicare 114.5   97.3 
Net service revenue 349.3   290.2 
Other operating income 2.3   15.1 
Cost of service 190.4   184.0 
Gross margin 161.2   121.3 
Other operating expenses 82.5   73.1 
Operating income$78.7  $48.2 
Same Store Growth (1):  
Medicare revenue 22%  (12%)
Non-Medicare revenue 18%  (2%)
Total admissions 20%  (9%)
Total volume (2) (6) 12%  (3%)
Key Statistical Data—Total (3):  
Admissions 89,371   74,327 
Recertifications (6) 46,014   46,758 
Total volume (6) 135,385   121,085 
Medicare completed episodes 79,188   68,660 
Average Medicare revenue per completed episode (4)$2,986  $2,818 
Medicare visits per completed episode (5) 14.2   15.4 
Visiting Clinician Cost per Visit$91.24  $93.17 
Clinical Manager Cost per Visit$9.31  $9.42 
Total Cost per Visit$100.55  $102.59 
Visits 1,894,006   1,793,652 


   
 For the Six-Month Periods
Ended June 30,
  2021  2020
Financial Information (in millions):  
Medicare$456.2  $396.8 
Non-Medicare 221.7   197.0 
Net service revenue 677.9   593.8 
Other operating income 7.3   15.1 
Cost of service 373.4   363.8 
Gross margin 311.8   245.1 
Other operating expenses 163.6   149.8 
Operating income$148.2  $95.3 
Same Store Growth (1):  
Medicare revenue 15%  (8%)
Non-Medicare revenue 13%  %
Total admissions 12%  (3%)
Total volume (2) 9%  (1%)
Key Statistical Data—Total (3):  
Admissions 179,201   160,302 
Recertifications (6) 89,825   86,625 
Total volume (6) 269,026   246,927 
Medicare completed episodes 154,520   144,296 
Average Medicare revenue per completed episode (4)$2,959  $2,774 
Medicare visits per completed episode (5) 14.1   15.6 
Visiting Clinician Cost per Visit$90.79  $88.41 
Clinical Manager Cost per Visit$9.40  $9.19 
Total Cost per Visit$100.19  $97.60 
Visits 3,726,918   3,727,097 
        

(1) Same store information represents the percent change in our Medicare, Non-Medicare and Total revenue, admissions or volume for the period as a percent of the Medicare, Non-Medicare and Total revenue, admissions or volume of the prior period. Same store is defined as care centers that we have operated for at least the last twelve months and startups that are an expansion of a same store care center.
(2) Total volume includes all admissions and recertifications.
(3) Total includes acquisitions, start-ups and denovos.
(4) Average Medicare revenue per completed episode is the average Medicare revenue earned for each Medicare completed episode of care. Average Medicare revenue per completed episode reflects the transition to PDGM effective January 1, 2020 and the suspension of sequestration effective May 1, 2020.
(5) Medicare visits per completed episode are the home health Medicare visits on completed episodes divided by the home health Medicare episodes completed during the period.
(6) Prior year amounts have been recast to conform to the current year calculation.

Segment Information - Hospice

   
 For the Three-Month Periods
Ended June 30,
  2021  2020
Financial Information (in millions):  
Medicare$186.9  $167.0 
Non-Medicare 11.0   10.1 
Net service revenue 197.9   177.1 
Other operating income 2.3   7.2 
Cost of service 105.2   97.2 
Gross margin 95.0   87.1 
Other operating expenses 49.1   41.4 
Operating income$45.9  $45.7 
Same Store Growth (1):  
Medicare revenue 2%  4%
Hospice admissions 2%  (1%)
Average daily census (3%)  %
Key Statistical Data - Total (2):  
Hospice admissions 12,675   11,411 
Average daily census 13,254   12,513 
Revenue per day, net$164.10  $155.51 
Cost of service per day$87.17  $85.34 
Average discharge length of stay 97   94 
        


   
 For the Six-Month Periods
Ended June 30,
  2021  2020
Financial Information (in millions):  
Medicare$368.4  $327.5 
Non-Medicare 21.0   19.0 
Net service revenue 389.4   346.5 
Other operating income 6.0   7.2 
Cost of service 206.8   189.0 
Gross margin 188.6   164.7 
Other operating expenses 96.2   80.7 
Operating income$92.4  $84.0 
Same Store Growth (1):  
Medicare revenue %  5%
Hospice admissions 3%  %
Average daily census (3%)  2%
Key Statistical Data - Total (2):  
Hospice admissions 26,358   22,729 
Average daily census 13,287   12,279 
Revenue per day, net$161.93  $155.04 
Cost of service per day$85.99  $84.58 
Average discharge length of stay 95   96 
        

(1) Same store information represents the percent change in our Medicare revenue, Hospice admissions or average daily census for the period as a percent of the Medicare revenue, Hospice admissions or average daily census of the prior period. Same store is defined as care centers that we have operated for at least the last twelve months and startups that are an expansion of a same store care center.
(2) Total includes acquisitions, start-ups and denovos.

Segment Information - Personal Care

   
 For the Three-Month Periods
Ended June 30,
  2021
  2020
Financial Information (in millions):     
Medicare$ $
Non-Medicare 17.0  17.7
Net service revenue 17.0  17.7
Other operating income   0.5
Cost of service 13.1  14.1
Gross margin 3.9  4.1
Other operating expenses 3.2  3.0
Operating income$0.7 $1.1
Key Statistical Data - Total (1):  
Billable hours 609,301  642,720
Clients served 9,371  9,956
Shifts 260,897  282,207
Revenue per hour$27.95 $27.58
Revenue per shift$65.29 $62.80
Hours per shift 2.3  2.3
      


   
 For the Six-Month Periods
Ended June 30,
  2021
  2020
Financial Information (in millions):  
Medicare$ $
Non-Medicare 34.0  36.4
Net service revenue 34.0  36.4
Other operating income   0.5
Cost of service 25.7  28.2
Gross margin 8.3  8.7
Other operating expenses 6.3  6.4
Operating income$2.0 $2.3
Key Statistical Data - Total (1):  
Billable hours 1,216,738  1,394,797
Clients served 10,908  12,936
Shifts 518,506  615,671
Revenue per hour$27.96 $26.12
Revenue per shift$65.60 $59.17
Hours per shift 2.3  2.3
      

(1) Total includes acquisitions, start-ups and denovos.

Segment Information - Corporate

   
 For the Three-Month Periods
Ended June 30,
  2021
  2020
Financial Information (in millions):  
Other operating expenses$42.4 $40.3
Depreciation and amortization 4.8  4.8
Total operating expenses$47.2 $45.1
   


   
 For the Six-Month Periods
Ended June 30,
 2021
 2020
Financial Information (in millions):  
Other operating expenses$84.9 $79.2
Depreciation and amortization 10.7  8.6
   
Total operating expenses$95.6 $87.8
   

AMEDISYS, INC. AND SUBSIDIARIES
RECONCILIATION OF NON-GAAP FINANCIAL MEASURES TO GAAP MEASURES
(Amounts in thousands)
(Unaudited)

Adjusted Earnings Before Interest, Taxes, Depreciation and Amortization (“Adjusted EBITDA”) Reconciliation:

     
 For the Three-
Month Periods
Ended June 30,
 For the Six-
Month Periods
Ended June 30,
 2021
 2020
 2021
 2020
Net income attributable to Amedisys, Inc.$80,149  $34,674  $130,019  $66,476 
Add:    
Income tax expense 28,546   10,031   46,461   19,377 
Interest expense, net 1,907   2,538   3,955   5,756 
Depreciation and amortization 6,721   6,334   14,276   11,672 
Certain items (1) (33,010)  13,313   (31,298)  17,349 
Interest component of certain items (1) (469)  (446)  (986)  (892)
Adjusted EBITDA (2) (7)$83,844  $66,444  $162,427  $119,738 
     

Adjusted Net Service Revenue Reconciliation:

     
 For the Three-
Month Periods
Ended June 30,
 For the Six-
Month Periods
Ended June 30,
 2021
 2020
 2021
 2020
Net service revenue$564,166  $485,059 $1,101,310  $976,744
Add:    
Certain items (1) (6,541)    (6,541)  
Adjusted net service revenue (3) (7)$557,625  $485,059 $1,094,769  $976,744
     

Adjusted Other Operating Income Reconciliation:

     
 For the Three-
Month Periods
Ended June 30,
 For the Six-
Month Periods
Ended June 30,
  2021  2020  2021  2020
Other operating income$4,603  $22,780  $13,304  $22,780 
Add:    
Certain items (1) (4,603)  (22,780)  (13,304)  (22,780)
Adjusted other operating income (4) (7)$  $  $  $ 
     

Adjusted Net Income Attributable to Amedisys, Inc Reconciliation:

     
 For the Three-
Month Periods
Ended June 30,
 For the Six-
Month Periods
Ended June 30,
 2021
 2020
 2021
 2020
Net income attributable to Amedisys, Inc.$80,149  $34,674 $130,019  $66,476
Add:    
Certain items (1) (24,428)  9,852  (23,161)  12,839
Adjusted net income attributable to Amedisys, Inc. (5) (7)$55,721  $44,526 $106,858  $79,315
     

Adjusted Net Income Attributable to Amedisys, Inc. per Diluted Share Reconciliation:

     
 For the Three-
Month Periods
Ended June 30,
 For the Six-
Month Periods
Ended June 30,
 2021 2020
 2021 2020
Net income attributable to Amedisys, Inc. common stockholders per diluted share$2.43  $1.04 $3.93  $2.00
Add:    
Certain items (1) (0.74)  0.30  (0.70)  0.39
Adjusted net income attributable to Amedisys, Inc. common stockholders per diluted share (6) (7)$1.69  $1.34 $3.23  $2.39
              

(1) The following details the certain items for the three and six-month periods ended June 30, 2021 and 2020:

Certain Items:

   
 For the Three-Month Period
Ended June 30, 2021
 For the Six-Month Period
Ended June 30, 2021
 (Income) Expense
 (Income) Expense
Certain Items Impacting Net Service Revenue:  
Contingency accrual$(6,541)  (6,541)
Certain Items Impacting Other Operating Income:  
CARES Act & State COVID-19 grants (4,603)  (13,304)
Certain Items Impacting Cost of Service:  
COVID-19 costs 4,464   12,944 
Certain Items Impacting Operating Expenses:  
Acquisition and integration costs 2,293   3,492 
COVID-19 costs 160   377 
Pre-acquisition legal settlement 1,825   1,825 
Certain Items Impacting Total Other Income (Expense):  
Interest component of certain items 469   986 
Other (income) expense, net (31,077)  (31,077)
Total$(33,010) $(31,298)
Net of tax$(24,428) $(23,161)
Diluted EPS$(0.74) $(0.70)
   


   
 For the Three-Month Period
Ended June 30, 2020
 For the Six-Month Period
Ended June 30, 2020
 (Income) Expense
 (Income) Expense
Certain Items Impacting Other Operating Income:  
CARES Act & State COVID-19 grants$(22,780) $(22,780)
Certain Items Impacting Cost of Service:  
COVID-19 costs 21,993   23,010 
Severance-reductions in staffing levels 5,183   5,183 
Certain Items Impacting Operating Expenses:  
Acquisition and integration costs 3,599   5,935 
COVID-19 costs 1,051   1,063 
Severance-reductions in staffing levels 271   271 
Certain Items Impacting Total Other Income (Expense):  
Interest component of certain items 446   892 
Other (income) expense, net 3,550   3,775 
Total$13,313  $17,349 
Net of tax$9,852  $12,839 
Diluted EPS$0.30  $0.39 
   

(2) Adjusted EBITDA is defined as net income attributable to Amedisys, Inc. before net interest expense, provision for income taxes and depreciation and amortization, excluding certain items as described in footnote 1.
(3) Adjusted net service revenue is defined as net service revenue excluding certain items as described in footnote 1.
(4) Adjusted other operating income is defined as other operating income excluding certain items as described in footnote 1.
(5) Adjusted net income attributable to Amedisys, Inc. is defined as net income attributable to Amedisys, Inc. calculated in accordance with GAAP excluding certain items as described in footnote 1.
(6) Adjusted net income attributable to Amedisys, Inc. common stockholders per diluted share is defined as diluted income per share calculated in accordance with GAAP excluding the earnings per share effect of certain items as described in footnote 1.
(7) Adjusted EBITDA, adjusted net service revenue, adjusted other operating income, adjusted net income attributable to Amedisys, Inc. and adjusted net income attributable to Amedisys, Inc. common stockholders per diluted share should not be considered as an alternative to, or more meaningful than, income before income taxes or other measures calculated in accordance with GAAP. These calculations may not be comparable to a similarly titled measure reported by other companies, since not all companies calculate these non-GAAP financial measures in the same manner. 


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