First Choice Emergency, listed as Adeptus Health, Inc. (NYSE: ADPT), is an emergency room services provider that operates 55 ER clinics across the United States*. The company operates stand-alone centers with board certified physicians that can provide most services offered by conventional hospital ERs. Adeptus Health is backed by growth private equity firm Sterling Partners.
First Choice's business model revolves around privately insured patients who seek increased efficiency and higher quality. Open 24/7, each location has testing facilities, nurses, and doctors on site and integrated into one platform. As a result, patient wait times are shortened to less than thirty minutes and most medical problems can be addressed quickly (only 3-4% of cases are referred to a hospital for further treatment). Although First Choice does not accept Medicare or Medicaid, the company enjoys a lower risk of bad debt than traditional hospitals. Finally, due to a decline in hospital ER capacity relative to demand, First Choice is benefitting from favorable market fundamentals.
For the fiscal year ending 2014, Adeptus posted revenues of $210.6 million, compared to $102.8 million in 2013. Since going public, its stock has double in value to $53.36 per share. While net income last year was negative $3.3 million, a more relevant metric would be Adjusted EBITDA for locations that have been open at least 16 months, which accounts for expenses associated with rapid growth. On average, a stabilized First Choice location generates between $4.5 million and $5.5 million in revenue, with an Adjusted EBITDA margin ranging from 20% to 35%.
In terms of cap rates, several fee simple locations have been listed on the market with cap rates ranging from 6.75% to 7.78%, varied by location, with typical lease terms ranging from 15-20 years. As First Choice started in Texas, most locations are concentrated in that state, although rapid expansion is pushing the company out towards Arizona, Colorado, and the Southeast.
*As of December 31, 2014
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