2008 | 2009 | ||||||
Price: | 6.07 | EPS | |||||
Shares Out. (in M): | 0 | P/E | |||||
Market Cap (in $M): | 2,922 | P/FCF | |||||
Net Debt (in $M): | 0 | EBIT | 0 | 0 | |||
TEV (in $M): | 0 | TEV/EBIT |
Sign up for free guest access to view investment idea with a 45 days delay.
Tenet Healthcare Corporation (“THC” or the “Company”)
operates general acute care hospitals in the
Tenet’s management team has acted to settle
substantially all legal issues with the government, exit unprofitable
facilities, reinvest capital in its remaining core markets, cut operating costs,
bolster its regional management talent, and increase its focus on physician
retention and relationships to increase referral volumes. Although management
has expressed a high degree of conviction in their turnaround plan, Wall Street,
for the most part, has been very skeptical and the majority of sell-side
analysts maintain a fairly negative view of the Company. As of September
23rd, 2008, there were 3 Buy recommendations on the stock, 11 Holds
and 7 Under-performs or Sells. While the Company has guided to 2009 EBITDA of
$1.0 billion, 2009 consensus EBITDA is only $865mm.
Tenet does not look cheap on trailing twelve month
earnings multiples as a result of the significant margin compression the Company
has experienced during its years of legal and operational turbulence. However,
we believe the business is poised to recover strongly over the coming quarters
and years as management has implemented a significant turnaround plan. Given
the compressed margins, we believe THC’s valuation looks very attractive
compared to its peers on a number of other valuation metrics, which we present
below:
-------------------------------------------
CYH 1.12x
UHS 0.87x
HMA 0.98x
LPNT 1.23x
Median 1.05x
THC 0.74x
---------------------------------------------------------
CYH 1.35x
UHS 1.46x
HMA 1.24x
LPNT 1.64x
Median 1.40x
THC 0.94x
-------------------------------------------
CYH $670
HMA $537
LPNT $587
Median $587
THC $467
It is worth noting that new hospitals today cost
approximately $1mm per bed to construct; therefore Tenet is trading at about a
55% discount to replacement cost. It is also worth noting that when HCA was
bought out, the EV / Revenue, EV / EBITDA, EV / Bed, and EV / Non-Cash Tangible
Assets multiples were 1.28x, 8.3x, $776, and 1.68x,
respectively.
If Tenet were to trade at multiples similar to its peers
on the above metrics, the stock would be worth between $9 and $13 per share or
at least 40% upside from current levels. Moreover, given the relatively
defensive characteristics of the hospital industry, we believe Tenet is an ideal
equity to hold in today’s turbulent markets.
Of course, we recognize that the key to THC’s success is
a recovery in EBITDA margins. THC’s results were hurt during its legal battles
as patient volumes declined precipitously and facility utilization levels
dropped off. Moreover, managed care providers squeezed Tenet on pricing
contracts further pressuring margins. In the LTM period, THC’s EBITDA margin as
a % of “Net Net” Revenue** was 9.0%. This compares to its peers 5-year average
margins as follows:
5-Year Average EBITDA Margins % of “Net Net”
Revenue**
-----------------------------------------------------------------------------------------
CYH 16.1%
UHS 14.8% (Acute Care
Only)
HMA 21.7%
LPNT 21.2%
HCA 18.2%
Median 18.2%
Tenet LTM 9.0%
** Note: we calculate margins as a % of revenues after
deducting provisions for doubtful accounts. Industry convention is to report
revenue before such expense, but due to different pricing and reserving policies
amongst various companies, results are more comparable after deducting such
expense from revenue to approximate “cash” revenue or “Net Net”
revenue.
Clearly, THC is underperforming its asset potential and
has plenty of room to improve these margins; we believe they will do so for a
number of reasons. Having settled all significant outstanding litigation,
management is now focused on operational results. Management has had a laser
focus on delivering the best possible quality of care at its facilities and THC
now ranks among the top hospital chains in the country for quality of care as
rated by Medicare. After cutting back on CapEx for years the Company spent
significant capital in 2007 reinvesting in state-of-the art equipment. These
actions have allowed THC to renegotiate its pricing contracts with large managed
care payers on more favorable terms which will provide a tailwind to THC’s
revenue and margin growth. The Company has also renewed efforts to add
physicians to its medical staffs after years of relative inactivity due to the
Company’s legal problems. As the Company adds physicians to its staff, those
physicians bring new patients to THC facilities thereby driving volume, revenue
and earnings growth. We note that pricing and volume growth benefit Tenet at
high incremental margins given the relatively high fixed cost nature of the
hospital business.
If Tenet succeeds in achieving margins similar to its
peers, the implications for its equity holders is significant. THC’s peer group
currently trades at approximately 7.5x LTM EBITDA which is below the 15-year
median of 8.6x. Assuming THC could trade at an 8.0x EBITDA multiple, there is
significant upside to the shares:
Margin EBITDA Share
Price**
----------------------------------------------------
12% $9.7B
$8.50
14% $1.1B
$11.25
16% $1.3B
$14.00
18% $1.5B
$16.75
** Note: based on TTM Net Net revenue of $8.1 billion.
Margin presented as a % of Net Net revenue. Includes estimated divestiture
proceeds of approximately $660mm expected to be closed in next 18
months.
The Bears point out THC’s negative free cash flow and
high debt levels as a reason to stay out of the name. We acknowledge that
achievement of real free cash flow will be necessary for a successful
turnaround, but if the Company achieves the EBITDA levels we describe above,
there will be significant free cash flow that accrues to equity holders. THC
has roughly $400mm in annual interest expense obligations and $600 to $700mm in
annual CapEx needs for total fixed charges of $1.0 to $1.1B. THC has a
substantial NOL position which means that it will not have cash tax obligations
for a number of years and any EBITDA in excess of its fixed charges accrues to
equity holders. Tenet’s debt is substantially all senior subordinated notes,
with no maturities until the end of 2011 which gives the Company plenty of time
to execute its turnaround. The Company also has a large, undrawn revolver that
is secured by receivables and has no material operating covenants which can fund
liquidity if need be.
To further enhance Tenet’s liquidity situation, the
Company has embarked on a series of asset sales that are expected to raise
between $750mm and $950mm through the end of 2009. The announced sale of three
hospitals thus far in 2008 will yield approximately $370mm in cash proceeds,
while the recent sale of Tenet’s minority interest in Broadlane (a group
purchasing organization) yielded $144mm in cash proceeds (plus another $16mm in
consideration placed in escrow) for total year-to-date proceeds of $515mm. The
Company is also in the process of selling a portfolio of 31 medical office
buildings with over 2.4mm square feet of medical office buildings which do not
currently contribute significantly to EBITDA. Assuming a conservative valuation
of $100 per square foot, these properties could easily be worth $250mm, which
makes the low end of Tenet’s expected range of $750 to $950mm easily
achievable. While Tenet estimates that these asset sales will reduce annual
EBITDA by approximately $50mm, the combined effect from eliminated CapEx,
reduction of net interest expense, and other cash items would result in $80mm of
annual cash savings resulting in a $30mm net positive benefit to operating cash
flow.
Tenet’s turnaround is well underway. During the
Company’s second quarter earnings call, the THC announced positive comparable
facility volume growth of 3.2%, a remarkably resilient figure considering the
tremendously challenging period from which Tenet is beginning to emerge. We
nonetheless believe that estimates for THC remain too low and that the Company
will continue to outperform expectations.
show sort by |
Are you sure you want to close this position Tenet Healthcare Corp.?
By closing position, I’m notifying VIC Members that at today’s market price, I no longer am recommending this position.
Are you sure you want to Flag this idea Tenet Healthcare Corp. for removal?
Flagging an idea indicates that the idea does not meet the standards of the club and you believe it should be removed from the site. Once a threshold has been reached the idea will be removed.
You currently do not have message posting privilages, there are 1 way you can get the privilage.
Apply for or reactivate your full membership
You can apply for full membership by submitting an investment idea of your own. Or if you are in reactivation status, you need to reactivate your full membership.
What is wrong with message, "".