Q4 2023 Viemed Healthcare Inc Earnings Call

Participants

Todd Zehnder; COO & Director; Viemed Healthcare, Inc.

Casey Hoyt; Chief Executive Officer, Director; Viemed Healthcare Inc

Brooks Gregory O'Neil; Analyst; Lake Street Capital Markets, LLC

Doug Cooper; Analyst; Beacon Securities Limited, Research Division

Eric Coldwell; Analyst; Robert W. Baird

Presentation

Operator

Greetings, and welcome to the Viemed Fourth Quarter 2023 earnings call. (Operator Instructions) this conference is being recorded.
It is now my pleasure to introduce your host, Todd Zehnder, Chief Operating Officer. Thank you. You may begin by.

Todd Zehnder

Good morning, everyone. Please note that our remarks in this conference call may include forward-looking statements under the U.S. federal securities laws or forward-looking information under applicable Canadian securities legislation, which we collectively refer to as forward-looking statements. Such statements reflect the Company's current views and intentions with respect to future results or events and are subject to certain risks and uncertainties which could cause actual results or events to vary from those indicated in forward-looking statements. Examples of such risks and uncertainties are discussed in our disclosure documents filed with the SEC or the Securities Regulatory Authorities and certain provinces of Canada. Because of these risks and uncertainties. Investors should not place undue reliance on forward looking statements. The forward-looking statements made in this conference call are made as of today, and the Company undertakes no obligation to update or revise any forward-looking statements, except as required by law.
The fourth quarter and year-end financial results news release, including the related financial statements, are available on the SEC's website now I'll turn it over to Casey to get things started.
Okay.

Casey Hoyt

Thank you, Todd, and good morning, everyone. Welcome to our fourth quarter 2023 earnings call. I'm thrilled to share the exciting developments and achievements that highlight our quarter and overall year. First and foremost, I want to thank our VIPnet family made up of over 1,000 health care professionals treating patients in all 50 states. Our people signify the collective strength, passion and expertise required to improve life. Each member of our team plays a pivotal role in our ability to enhance the lives of our patients and produce positive outcomes for physicians and payers alike. Our growing workforce, fueled by our best-in-class HR department and staffing division enables us to extend our reach to a broader community commitment to our employees is reflected in the investment we make in their development, well-being and job satisfaction. This fosters a positive work culture that separates us from our competition, and it's most certainly the cornerstone for our success.
Moving onto the quarter, perhaps some of the most significant work we accomplished in the fourth quarter was our efforts surrounding the restructuring of our sales force, recognizing the need for more localized training and management infrastructure, we reorganized the country to create a more regional and localized approach to help with training and work-life balance for our people. Our new structure, which launched in early 2024, paved the way for multiple territory sales manager and national sales directorship promotions. This expansion and fortification of our team is driven by the vision of accommodating the growth trajectory of our organization. By leveraging the strengths of our top-performing sales personnel. We are not only strengthening the leadership of our sales force, but also fostering a culture of excellence and continuous development. These leaders and trainers play a crucial role in shaping the capabilities of our team, ensuring that every team member is equipped with the knowledge skills and motivation necessary to excel in their roles after the restructuring, we finished the year with 106 sales territories with the current bandwidth to expand as needed to another 30, our people are effectively empowered and even better equipped with the clinical experience and coaching to reach more patients than ever before at the heart of BioMed. Healthcare's operational efficiency is our proprietary clinical management technology, engage care manager. This innovative technology has revolutionized the delivery of respiratory care, empowering our respiratory therapists to maximize their patient reach and significantly contribute to heighten patient satisfaction. Our technology captures sophisticated data, demonstrating improved clinical outcomes and substantial cost savings, becoming a linchpin in securing contracts and pilot programs. The ongoing VA pilot is a noteworthy initiative showcasing the positive impact of our technology on shaping the future respiratory care for veterans across the country. Behind the scenes, we continue to uncover more technological solutions that are helping streamline our workflow processes. Engage care manager has been adding more machine learning types of features that have the potential to really drive faster access to care for our patients and help BioMed improve reauthorization pass. Furthermore, we are seeing rapid adoption to the use of e-prescribing from our referral sources that help with our authorization and conversion rates. These technological tools are not only creating operational excellence for us, but also improving efficiencies for our referral sources. All of our departments at BioMed are hyper focused and empowered to utilize technological advancements that can contribute to our strong human touch offering in the home. Further contributing to this technological success success or the advancements with the majority of our suppliers who have embraced connectivity to their devices, which in turn delivers data to our engaged care manager platform, particularly those who have emerged as new entrants into the market post the Philips recall, these direct and collaborative supplier partnerships are helping to control costs and improve quality. A key to our competitive edge lies in our software being seamlessly integrated across multiple companies. Ultimately, this integration strengthens our relationships with these manufacturers and enhances operational efficiencies while streamlining processes.
On the regulatory front, our reimbursement environment remained strong despite the expiration of the 75, 25 blended rates. When combined with the CPI adjustments, we anticipate experiencing no net deterioration of average reimbursement rate. Importantly, should the 75, 25 rate be extended through the legislation, we are poised to experience some potential upside. The final rule for Medicare Advantage plans and other positive changes open the door for further growth of our services due to the payer expansion. With these positive regulatory shifts, we anticipate a noteworthy improvement in the behavior and compliance of Medicare Advantage payers. The increased transparency and accountability introduced by the final rules that will attract transformative era, fostering an environment where payers are incentivized to align with BioMed healthcare's commitment to delivering high-quality respiratory care. These regulatory changes act as a powerful catalyst, not only for our financial stability, but also for our ability to extend our services to a broader spectrum of patients as we gain clarity on the limited impact of GLP-1 drugs on the home medical equipment industry. Specifically regarding C-BASS usage, the available evidence suggests that initial concerns were significantly overstated. The industry has shown resilience with no current negative impact on the Biomed sleep business. Our sleep business is growing faster than previous years, with new patient rental, starting with new patient rental starts indicating promising future resupply revenue growth. A real-world study conducted by ResMed's revealed a modest increase in the adherence with CPAP. users also take GLP-1 drugs aligning with the industry observations. The industry remains proactive, addressing potential long-term pressure from GLP ones by focusing on increasing awareness, reducing operational costs through automation and enhancing patient adherence and retention efforts.
In 2023, our commitment to enhancing the lives of patients and reaching a broader demographic became evident through a series of strategic initiatives. We meticulously expanded our geographical reach, broaden our product offerings and diversified our payer mix, aligning our trajectory with the evolving needs of the health care landscape. An undeniable highlight of our strategic endeavors was the targeted acquisition of HMP., which was immediately accretive accretive to net income and EPS highlighting the effectiveness of our M&A strategy and integration capabilities. Subsequent to the acquisition date, we have also achieved a significant cost savings resulting in improved profitability of the acquired operations, primarily because of the fleet diversification that we accumulated through the acquisition.
Our total rental patient count is up 85% over the prior year, and our resupply patient count is up 205%. While we actively pursue strategic acquisitions, our core strength and foundation for growth remains our robust organic engine. We continue to emphasize that provide that acquisitions are not a necessity, but rather a thoughtful and complementary strategy to accelerate our success.
With that being said, we continue to be actively engaged in multiple processes, analyzing strategic initiatives and partnerships that capitalize on our competitive advantage as a high-touch, high-tech critical provider of home medical services. Our team does fully expect to incrementally grow inorganically through strategic JV partnerships and acquisitions in 2024 with more financial and operational updates on the quarter.
I'll now hand the call over to Chief Operating Officer, Todd Zehnder.

Todd Zehnder

Todd, I think, Casey, in reviewing the financial results. All figures are in U.S. dollars and the full results have been made available on the SEC website as well as CDR.
Our core business generated net revenue of $50.7 million during the fourth quarter of 2023 as compared to net revenues of $37.5 million in the fourth quarter of 2022, which equates to a 35% increase or sequential growth for the core business was 3%, which is good, a good sign that the integration of the HMP. acquisition along with our organic growth continued in line with our historical norms. Our revenue for the year ended December 23rd, December 31st, 2023, came in at $183 million, which is a 32% increase over 2022. We continue to stay optimistic that we will be able to continue our high organic growth rates as well as continue our evaluation of inorganic opportunities.
Our fourth quarter revenue from vents was approximately 58% of our revenue as compared to 66% in the fourth quarter 2022. Our gross and EBITDA margins are still strong and improving as we are focused on both margin and diversification. We have been very successful in managing our cost structure this year, and it is showing in both growth and EBITDA contribution. As is typical, we want to point out the rapid notional growth of our margins, but are also proud of the increase in the percentages over the last six months.
Our gross and EBITDA margins during the quarter came in at 63.3% and 25.3% respectively. Our fourth quarter gross and EBITDA amounts came in at $32.1 million and $12.8 million, respectively. Both gross and EBITDA margin and margin percentages grew sequentially and continues our theme of profitable growth, both organically and inorganically. Our full year EBITDA for 2023 was $43.1 million, which is a new Company record, and we are really starting to see the advantages of building scale. But we don't always comment on net income, I think is important to point out that this is our seventh consecutive year of positive net income marketing profitable growth every year since our public formation. Additionally, we are at a point in our company life cycle and revenue composition that free cash flow is really ramping up during the quarter, we generated $45.4 million of free cash flow and we generated over $19 million for the year. I will address capital allocation priorities later in the call.
Our SG&A for the quarter totaled approximately $23.9 million as compared to $17.2 million in the fourth quarter of 2022 for the full year, our G&A totaled $87.9 million as compared to $68.2 million during 2022. The latter of which did not include any agent fee contribution. G&a as a percentage of revenue decreased from 49% during 2022 to 48% during 2023, which is another good sign that we are managing our G&A well along with effectively integrating the first acquisitions. We will continue to invest in our patient and employee experiences and once again, expect to grow revenues at a faster rate than expenses. For the quarter, we invested approximately $7.9 million on capital expenditures and once again, the highest amounts have been spent on vents and oxygen equipment we continue to allocate capital across a diverse supplier network and once again, have had no problems with procuring the equipment necessary to service our growing patient base.
As previously mentioned, we funded all of our CapEx with discretionary cash flow during the quarter and our core business is generating significant free cash flow after CapEx. We are very proud of the pristine balance sheet. We maintain where we ended the quarter with a cash balance of $13 million. Additionally, we ended the quarter with an overall working capital at $6 million. We've paid down all the $2 million on our revolver facility and have lowered our long-term debt at December 31st to approximately $6 million. We will opportunistically pay down or use the revolver portion of our credit facility depending on the needs of cash resulting from additional organic growth for future inorganic opportunities.
The end of the year gives a great time to step back and analyze the performance of a business. We are very proud of the organic growth that we exhibited and are extremely pleased that we augmented that with a very complementary and significant acquisition. Additionally, we have remained profitable, further diversified our business and continue to generate very solid liquidity. We continue to grow the amount of revenue that is transactional and are confident in our ability to generate free cash flow, giving us flexibility as we continue to monitor our capital allocation on that front.
Our capital allocation opportunities are similar to last quarter, and we will reiterate that our organic growth is the highest priority. Like last quarter. We use free cash flow to pay down on our revolver, and we'll continue to do so unless we transact on another inorganic opportunity. Lastly, we will actively monitor our share price and other factors to determine if another share buyback would make sense to be implemented.
Moving on to the first quarter, we have provided net revenue guidance in the $49.7million to $51 million range related to our core business. The midpoint of our net revenue guidance is up 27% over the core revenue in the first quarter of 2023. The first quarter brings the seasonality of patients changing insurance carriers, more significant reauthorizations and deductible resets, but we are very pleased with how the first quarter new patient setups are trending across all of our product lines. We remain active in our discussions with existing and potentially new investors and our recent voluntary delisting from the TSX has consolidated our daily trading volumes onto the NASDAQ. We have seen our US institutional ownership increase over the last couple of months. We continue to participate in institutional investor conferences and plan on attending to more during March and April. We remain excited about telling our story of growth and see the current market as an opportunity to attract new investees.
At this time, I'm going to turn it back over to Casey to wrap things up.

Casey Hoyt

Okay.
Thank you, Todd. After looking back on BioMed journey, how is reflecting on some of the financial milestones Our company has achieved since our initial public listing, we have grown adjusted EBITDA to nearly equal to total revenue for this spin spin out year in 2017. Along the way, we have achieved this incredible growth while doing so as a profitable company and every single year from its financial success and consistent track record is a testament to the resilience, strategic acumen and unwavering commitment of our entire team. The aging population continues to be a significant factor in our industry dynamics simultaneously technological advancements and increased awareness or shaping the adoption of our specialized home medical services. We believe the home medical equipment markets hold promising opportunities for continuous expansion, and we stand ready to leverage our expertise in navigating this landscape.
Fourth quarter of 2023 stands as a testament to BioMed healthcare's unwavering dedication to excellence and growth. Our growth is propelled by strong relationships with suppliers, seamlessly integrated proprietary technology and a commitment to innovation engaged care manager. Our innovative clinical management technology exemplifies our dedication to operational excellence, providing transformative benefits for restoring therapies and enhancing patient care expansion into new geographies. Diversification of product and payer mix and targeted acquisition initiatives underscore our commitment to reaching more patients in closing, BioMed healthcare's BioMed healthcare enters the future with confidence guided by resilient team, a strong financial foundation and a commitment to delivering exceptional respiratory care. Positive regulatory environment supports our growth initiatives, allowing us to strategically strengthen our sales force and make investments that position BioMed for sustained success as we build towards the future.
The strategic addition of leaders and trainers, coupled with our commitment exploring innovative partnerships reflects our patients. Our reflects our dedication to not just keep pace with the industry, but to set new standards of excellence. As we look ahead, the path is clear provided that we will continue to expand our footprint and refine our offerings. The combination of these activities, coupled with our ability to track our success, translates into an unparallel ability to drive value for payers. We thank all of our shareholders who have placed their trust in BioMed and look forward to telling our story to more shareholders as our company continues to expand across the country.
This concludes our prepared remarks. Thank you, and we'll now open up further questions.

Question and Answer Session

Operator

Thank you. We'll now conduct our question and answer session. If you would like to ask a question, please press star one on your telephone. Confirmation tone will indicate that your line is in the question queue. You may press star two, if you would like to remove your question from the queue For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please. While we poll for Quest.
And our first question comes from Brooks O'Neil with Lake Street Capital Markets. Please state your costs.

Brooks Gregory O'Neil

Thank you very much. Good morning, guys. I wanted to I thought I had thought perhaps I had jumped on the wrong conference call when I heard Casey talking about all that high-tech stuff, but it's pretty impressive.
Fair enough. Yes, I would say very exciting technology advancements. But what's your question, Brett?
And so my first question, I'm just I hate to betray my my ignorance here, but give us just a little background on the 75, 25 blended Medicare rate, how much impact you think that might have add in 2023 and from what you're seeing in terms of the outlook for 2024. It sounds like make my goal what.

Todd Zehnder

Yes, Raghu thought I'll take that one. During the PAT., there were several concessions obviously made by CMS during during that time. And one of them was to give some rate relief to formal competitive bid product. So when we're talking about it specifically relates to in our in our stance as it relates to the sleep and oxygen business and long story short, the they given rate relief by making it a little bit less weighted towards the competitive bid area rates and more to the rural rates. So with the expiration of that and it really comes down to the only way it's going to get bought back is the rate of congressional bill. I guess on the budget that would give us the relief from it has now gone back to former rate. I don't have a 2023 number, but what we can tell you is it's roughly about a $3 million impact on an annual basis to our comp our Company for 2024. You can think about it as $750,000 plus or minus for the first quarter that we are not factoring in. I mean, we have lowered our guidance assuming that is not going to happen. So it's not super material, but something that we would much rather have. And these higher rates because you know the value added service for these people into those smaller cities around the country.

Brooks Gregory O'Neil

Sure. That's extremely helpful. I really appreciate that color. Let me just ask you this. It sounds like things just broadly are going well. I know that in over the last several years, maybe RT. availability has been a bit of a headwind. How are you feeling about that situation today?

Todd Zehnder

We're not seeing any pullbacks on finding our teams right now. The staffing division is pretty much clicking on all cylinders and finding our folks think what we are I'm talking a lot about in the script about the restructuring of the sales force and ITO was what's interesting is that we're selling more support, more clinical support behind our head sales folks that are really developing into veteran productive areas. And so just the landscape of that type of personnel, the type of RT. that we're looking for has evolved a little bit more of your support role, but we still look for our sales roles as well but not having any issues trying to buy are finding our restored therapies at this time.
To answer your question, the price that's clear.

Brooks Gregory O'Neil

Let me just ask you a little technical question about my model. I noticed that the tax rate this quarter was a little bit higher than I would have been modeling. Is that a rate somewhere in the very low 30% range that you think is likely to play out in 2024?

Todd Zehnder

Again, it will probably go back down some books. I think this had to do with some permanent differences, and I'll probably reserve the right for you to talk to trade later on. But I think it has something to do with some permanent differences that we had to take the expense for during the fourth quarter really related to future periods.

Brooks Gregory O'Neil

Okay. That's very helpful. I think that does it for me. I'm excited to be here. You know about all the progress and the opportunity and the incredible results you delivered last year. So I know '24 is going to be another great year,

Todd Zehnder

THANKS brushstrokes.

Operator

And our next question comes from Doug Cooper with Beacon Securities.
Please state your question.

Doug Cooper

Good morning, guys, and congrats on another nice quarter. I just want to talk about organic growth. By my calculations. I guess excluding the impact of HMP. organic growth year over year in Q4 was about 16% and that's in the ballpark?

Casey Hoyt

Yes, that sounds about right.

Doug Cooper

Okay. So and then the Q1 guidance again, excluding if I compare Q1 your guidance midpoint to Q1 last year, which obviously didn't have a champion there, it looked about 10% and then sequentially about flat. So maybe just talk a little bit about what you're seeing on the side.

Casey Hoyt

Yes. I'll as it relates to 1Q over 4Q, the main thing or 1Q over last year's 1Q. We have we do have more of our business coming from what I would consider the sleep products, which has a probably a little bit more susceptible to deductibles and seasonality. And truthfully, as more of our patient's arm hit insurance changes, it's becoming more common that people are swapping around on insurances and it puts patients on hold. We don't lose the patient, but we just maybe miss a bill or two, and that is seeming to have a little bit higher impact on us as it relates to the 16%.
I mean, I think that's a it's a really good growth year for us is not as high as our historical rates, but we've always been clear that say that as we get bigger, the ability to grow 25% and 30% is getting harder just because the notional amounts are getting larger.
I think the one important thing to think about as it relates to sequential is our new patient starts are as high or higher than we've ever seen in the first couple of months.
So the fix is there.
We just got to get more patients just to see their doctors to get paperwork submitted. And we're on track with what is setting up to be a really good 2024.

Doug Cooper

And then just sort of what you're talking about, obviously that's going to set up well for the resupply business.
Can you give us some actual metrics of the resupply business reported four for 2018, Q4 or for 20 formed a perfect for Q4.

Todd Zehnder

Q4 I want to say that Q4 resupply made up about 10% of our revenue base as a company. That's a I don't have that number right in front of me, but I think that that's probably pretty close to where we are.
And if you think about that now that's including both BioMed and H & P, I think about where that was probably a year ago that would have been at best 3%. So the resupply, I mean, like like we've talked about our own organic BioMed sleep growth. The end game is to get more and more patients on that resupply program, obviously continue to set up new patients for them to add to the funnel. But that's really brought out with HMP. our own business. So when I'm when I referenced several times in the script about transactional revenue and being able to generate free cash flow. The fact that we have that number upwards of call it gaining on double digits is a major milestone for us.

Doug Cooper

Yes. And you seeing sort of roughly $600 annualized per patient on the resupply. Is that a decent number to use?

Casey Hoyt

I'm sorry, what was that number lately?

Doug Cooper

The revenue per for resupply patient? Is it is it sort of annualized run rate about $600 bucks? Is that the number that makes sense?

Casey Hoyt

Yes, I would say we're about $200, $215 per order. And it just I mean, if you want to say that three times that might be a little high for us, I want to say we're somewhere in the 2.5 orders per patient per year, but it may be gaining on that. So somewhere between $550 $650 per patient per year again.

Doug Cooper

And what percentage of your sleep patients would be on the resupply program today as far as our active sleep patients like the active PAP renovation?
Yes or yes, all Yes, I'm a fact.

Casey Hoyt

I mean everybody that know compliance is going to be on the resupply program. So we end up for setting up a thousand about 1,500 on a consolidated basis a month. Our resupply programs more probably in the 30,000 patients. So it's obviously a lot bigger because the path caps out there.
Yes.

Doug Cooper

Okay. And I guess just my final one, the actual then patients 10,327 to end the year, up marginally from the 10,244. Can you just talk about your outlook for actual vent patient growth this year.

Todd Zehnder

But yes, well, I mean, we're going to continue to say that our expectation is to grow that patient count, call it 100 a month. We didn't get there in the fourth quarter. We'll see if we get there in the first quarter, obviously, as we get larger, the attrition is higher. You start out with I mean, our average length of stay is staying at 17 months. So we're losing more patients just due to on expiration, unfortunately. But some of the stuff that Casey talked about were a lot of new sales initiatives and we're obviously out there trying to get new new regions and new contracts. We still show up every day expecting to grow that on a net basis, about 100 a month, some quarters.
We do it some.We don't we're still we're still very confident that that growth is going to continue. And once again, I'm very pleased with where we're seeing new patient setups in the first quarter.

Doug Cooper

Okay, great.

Todd Zehnder

That's it for me. Thank you, guys, and thanks, Doug.

Operator

As a reminder to the audience, press star one to ask a question, you can press star two to remove yourself from the question queue.
Our next question comes from Nick Corcoran with Acumen. Please state your name.

Hello, this is Megan on the line for next this morning. Nick had a question regarding the vent patient growth and respiratory illnesses this winter. Have respiratory illnesses, winter tempered your patient expectations at all or has it been pretty nice for the season?

Todd Zehnder

Well, I mean, we don't have the specific number on respiratory illnesses. It's not something that we watch on a daily basis, but you're seeing our bit growth in terms of total patients that we were just talking about on the right. So we're optimistic that there's plenty of patients out there for 2024 is just a matter of getting our people trained and up and running and producing and in an efficient manner, which is what the the restructuring is focused on.

Yes. Okay.
Thank you.
Thank you.

Operator

And our next question comes from Eric Coldwell with Baird. Please state request.

Eric Coldwell

Thank you and good morning. I wanted to ask two questions. The first is on Philips and their decision to stop selling equipment in the US. So just what kind of knock-on effects have you seen? And is there any lingering impact of their recalls and their regulatory issues and now their decision to extricate themselves from the U.S. marketplace? Thank you.

Todd Zehnder

Yes, I'll take it as it relates, I'll split it up into two products who really affects paps and vents more than other brother either on the Pap side, it really doesn't impact us outside of the fact that in the event that we have patients that are on a Philips product, they might want a different product. I don't think we're not seeing that in any large scale or really any scale for that matter. So it shouldn't impact the sleep business anymore. It did in the past when we had to get all of those patients set up on new equipment, be it either a new Philips device that was FDA compliant or some of our other vendors. This has been going on for a few years now. And so the good news is we have adequate sleep providers or other manufacturers who are able to fulfill all of our needs at this point. So no issues there.
As it relates to the events, the recall is still in place, and I know that Philips and the FDA are working on a remediation. It's very minor, in our opinion, a very minor remediation, but one that has taken a long time to get done and the ability for us to continue to service patients with those ventilators remains and we are we are still servicing patients and had been reworking devices. So the ability for us to continue with that is not at risk, in our opinion, at some point, they won't be in the market of making parts down the road and so forth. But we are planning effectively for that. I think the best thing though, Eric, is that it's been going on for three years and we diversified our fleet at this point. And there are other three other very competent manufacturers out there, and we're probably up to roughly 50% of our fleet being non Phillips at this point and only getting larger every month.

Eric Coldwell

Perfect. Secondly, second topic, you alluded to this in the prepared remarks I've been focused on at the and CMS final rules are actually, I think a set of three of them in total, one that went live in January one that goes another one that goes live in 2026. But in general, we're seeing CMS really reined in these Medicare Advantage and managed Medicaid plans for things like improper denials, unnecessary and improper prior authorizations. Also, CMS forcing these plans to fully cover everything that's covered under fee-for-service, which was not always the case in the past, providing faster appeals resolution transparency and a lot of good things for the DME industry. I believe I'm curious, you mentioned it could be a good guy. I'm just curious, have you do you have any statistics or analysis that might suggest how these tight tighter rules around the DMCO.'s could actually a quantum Quantum quantitatively impact to is that something that is available and have you seen any impact at this point given the last rule went into effect a couple of months ago?

Todd Zehnder

Yes. I mean, we've seen a little bit of a behavior shift. And everything I have is really anecdotal in terms of stories and approvals. I don't have a number of right here in front of me, but I can circle back with you, Eric, on on a on what we're seeing. I had predict that where the behavior is going to change here with all of these final rules now in place and you know it's not material at this moment in time. I checked back in Q2 when we might have some metrics there that hopefully we see some metrics that are signs of life for improvement on authorizations and they're following Medicare guidelines, which is all they really need to do so where often they do.

Eric Coldwell

Oh, go ahead, please.

Todd Zehnder

Sorry. No, that's it. We're just optimistic about what's going to happen.

Eric Coldwell

It can't hurt tax impacts. It could prove we can look at it from the last one, just maybe a bit of a bit of a reach and a derivative of something that's happening nationally with this change healthcare cyber attack, have you seen any have you seen any impact in the last two plus weeks regarding this in terms of and any form of patient challenge or customer behavior shift in the marketplace. It's getting a lot of headlines. I think most of our companies are saying it's probably not going to be a material knock-on effect, but I am curious if you've seen any ripple effect from us, the challenges that United is having with Change Healthcare and then therefore, a number of providers are having challenges as well?

Casey Hoyt

Yes, I'll take that. I mean, the beginning part of your question is the part that we can definitively say we're thankful nothing has happened. Patient Care has not been compromised at all. And so that's the most important thing I know two weekends ago, yes, the Pharmaceutical Benefits were were some issues, and I think that was the first thing they tackled. So they got that stood up and things are good. So we can definitively say we've been able to take care of patients and continue to get authorizations in a timely manner. What will happen is the submission of claims is getting slowed down. We anything that's going to change has been halted for about the last 10 days, we have proactively worked to get and through two phases to go ahead and reroute some of our largest carriers to other clearing houses so that we can keep the I really the cash flow coming in on this is really a delay more than anything. But just to wrap that up, yes, it's a disruption to the industry for sure we We applaud and support their efforts to make sure that it's secure going forward because we take security very seriously around here. So they need to do the right thing. I know they are in the interim we are taking on taking the time to go ahead and just reroute payers to make sure we're not negatively impacted from a cash standpoint.

Eric Coldwell

Are you willing to share who you're rerouting to what other payer switches you're using?

Todd Zehnder

I mean currently our law and I don't mind saying that currently the largest reroute is going to waste. Our slides are mad. I think it's one of the saying, but that's probably our second largest. And then all of our all of our federal monies are directly with CMS So that's not impacted.

Casey Hoyt

You're not not in test, not anticipating a notable impact on cash flow this quarter, which I think is the knock-on effect that most of our supply chain coverage is focused on, but it doesn't sound like it's a immaterial concern and whatever it is likely a transitory.

Todd Zehnder

Yes, assuming that all of our efforts that are ongoing, I'm comfortable that cash flows are from our as we expected, we shouldn't see a material impact. It may slow down some cash for a little while, but nothing that's going to hamper our ability to continue to do anything around here.

Eric Coldwell

Perfect. Let me add, let me add my congrats to a nice continued performance. Some good talking to you, guys. Thanks very much.

Todd Zehnder

Thank you, Eric, have a good dynamic. Thank you.

Operator

And there are no further questions at this time. I'll hand the floor back to management for closing remarks.
Thank you.

Todd Zehnder

Yes, we want to thank everybody for your interest in VieMed today, and if there are any follow-ups just reach out to us. Have a great day.

Operator

Thank you. This concludes today's conference. All parties may.