Acadia Healthcare Company, Inc. (ACHC) 2026-07-29 Earnings Call Transcript

Good morning and welcome to the Acadia Healthcare second quarter 2026 earnings conference call. [Operator Instructions] I would now like to turn the conference over to Jason Friedman. Please go ahead. The conference is now being recorded. The conference is no longer being recorded. The conference is now being recorded. Please pardon me, we are having technical difficulties at this time. Just give us one moment. The conference is now being recorded.

Thank you and good morning. Yesterday, after the market close, we issued a press Release announcing our second quarter 2026 financial results. This press release can be found on the investor Relations section of the acadiahealthcare.com.com website. Today, Debbie Osteen, Acadia’s Chief Executive Officer and David Duckworth, Interim Chief Financial Officer, will discuss the results. To the extent any non GAAP financial measures is discussed in today’s call, you will also find a reconciliation of that measure to the most directly comparable financial measure calculated according to GAAP in the press release that is posted on our website. This conference call may contain forward looking statements within the meaning of the Guggenheim Securities Litigation Reform act of 1995, including statements, among others, regarding Acadia’s expected quarterly and annual financial performance for 2026 and beyond. These statements may be affected by the important factors, among others, set forth in Acadia’s filings with the securities and Exchange Commission and in the company’s second quarter news release and consequently, actual operations and results may differ materially from the results discussed in the forward looking statements. At this time I would like to turn the conference call over to Debbie.

Good morning and thank you for joining us. I am pleased to be with you today to discuss Acadia’s results for the second quarter of 2026. Overall, Acadia delivered solid results in the second quarter that were consistent with our expectations across our key financial and operating metrics including revenue adjusted EBITDA, adjusted EPS and free cash flow. David and I will discuss our results in more detail. As always, Acadia is guided by our mission to provide compassionate care that improves lives, inspires hope and elevates communities. Our capabilities allow us to stand as a leader in the behavioral healthcare industry through the important work we do. Since I returned as CEO six months ago, we have refocused on our key priorities in order to create lasting value for our patients and communities, our partners, our employees and our investors. We are building on our strong foundation with operational discipline. As I discussed last quarter, our primary focus in 2026 continues to be on operational execution and serving patients through our existing facilities and our new locations. I am pleased to say that we have made significant advances on these priorities in the first half of the year and we are confident in our ability to deliver further progress in the coming quarters. Looking at our second quarter results, a few notable highlights include the following we delivered revenue that was above the high end of our guidance range as well as adjusted EBITDA and adjusted EPS that were near the high end of our guidance. We generated 124 million of free cash flow and reduced our debt by 113 million. We are taking a disciplined approach to capital deployment including CapEx and we expect to generate additional free cash flow in the second half of the year. During the quarter, we opened two new acute facilities on schedule, 144 bed JV facility with Orlando Health in Florida and a 96 bed JV facility with Methodist Jenny Edmondson in Iowa. For the second quarter, our total revenue was flat compared with the prior year period. After normalizing for the impact of the timing of supplemental payments related to prior periods in Florida and Tennessee, our total revenue growth would have very 2.8% on a year-over-year basis and 3.2% on same facility revenue growth. In our acute business, we saw continued progress in ramping occupancy and revenue at our new facilities that have opened over the last few years and our growth in same facility volumes was consistent with our expectations. Our specialty business delivered solid performance in the second quarter including a 5 million sequential increase in revenue. The team also made progress in mitigating some of the impact on our Pennsylvania facilities related to changes in the New York Medicaid program that we have discussed in prior quarters. Our RTC business delivered strong revenue growth in the second quarter driven by volume growth and capacity expansions that were completed last year. In our CTC service line, revenue was flat on a year-over-year basis. Our CTC clinics provide important services that are highly valued by patients, families and payers and we opened two new CTC clinics during the second quarter. Our adjusted EBITDA for the second quarter was 149.2 million. Adjusted EBITDA includes two items that were not included in our guidance. A benefit related to the Florida Supplemental Payment Program and an expense related to an increase in our professional and general liability reserves for prior years. The combined impact of these two items was a 2.5 million reduction to adjusted EBITDA in the second quarter. David will provide additional details. Switching to our key operational priorities, we continue to focus on delivering more value from our increased bed capacity and the new facilities that we have opened over the last few years. During the second quarter, we made further progress with that group, including revenue and facility level EBITDA results for those 2023-2026 cohorts that were ahead of our expectations. I am pleased with the progress we have made in these facilities and I want to highlight a few contributing factors that have enabled this success. First, our team has been operating with a heightened sense of urgency and focus, which has allowed us to accelerate timelines across multiple critically important milestones for new facilities including licensing, accreditation and payer contracting. Second, we have been emphasizing expense discipline alongside the occupancy ramp through a focus on execution, ensuring our facilities have the resources necessary to support patient care and operational needs. Third, we are maintaining strong referral partnerships in the markets we serve. We have increased our focus on consistent communication with our JV partners to better align around shared growth objectives, patient access, and ensuring that patients are receiving the right care at the right level and in the right setting. The organization is now operating with a clear set of priorities and has the right resources in place and the combination of ramping volumes and disciplined expense control has allowed us to outperform our startup targets for two quarters in a row. An increasing number of our new facilities are beginning to contribute positive adjusted EBITDA. We remain confident in this group delivering on the 200 million of incremental adjusted EBITDA relative to 2025 that we have discussed previously. We also continue to strengthen our leadership team at both the corporate level and at our facilities as we focus on having the right leaders in place to support our facilities. We are seeing increasing benefits from our decision to refine the structure of our acute service line. And we are confident that we will continue to see clinical excellence and consistent value over the coming quarters. We are also advancing in our initiatives to deliver quality care for the patients that we serve. For example, we are expanding our measurement based care initiative to additional acute facilities as well as to our specialty and CTC service lines. We are leveraging evidence based practices to guide clinical decision making and improve treatment outcomes. It allows clinicians to use real time data to identify changes in symptoms, adjust treatment plans, and help patients remain engaged in their own care. As I previewed earlier, we are also pleased to share that we successfully opened two new acute facilities in June and in partnership with Premier Conference System. In total, we have added over 300 beds in the first half of the year and we remain on Track to add 500 to 600 beds in 2026, including our planned opening in the third quarter of a de novo acute facility near Jacksonville, Florida. As we look ahead, we see that demand for our services remains strong and we are well positioned with added capacity to meet this demand. Above all, we remain committed to our mission and to providing clinical excellence for patients and the communities we serve. With that, I will turn it over to David to review the financial details.

Thanks Debbie and good morning everyone. I am glad to be back at Acadia Healthcare and collaborating with the team as we execute on our mission and build upon our leadership position in the behavioral healthcare industry. Looking at our second quarter results, we reported revenue of $866 million, which was flat compared to the second quarter of last year. As previously discussed, the second quarter of 2025 included $48.7 million of revenue from the Tennessee Supplemental Payment Program that related to prior periods. Our second quarter results this year include 22.3 million of revenue from the Florida Supplemental Payment Program related to the 2025 program. Year after normalizing for these two items, our total revenue growth would have been 2.8%. Same facility revenue in the second quarter was flat on a year-over-year basis with a 0.8 increase in patient days offset by a 0.8% decrease in revenue per patient day after normalizing. For the impact of the Florida and Tennessee supplemental payments related to prior periods, our same facility revenue growth would have been 3.2%. Our same facility revenue growth rate was further impacted by approximately 1% from the changes in the New York Medicaid program on our Pennsylvania facilities. Revenue in our acute business was 495 million in the second quarter, which was flat on a year-over-year basis but reflects 6% growth after normalizing for the supplemental payments related to prior periods. We delivered strong volume and admissions growth in the second quarter from both existing acute facilities and our new JV and de novo facilities. Specialty revenue in the second quarter was 134 million and increased 4% sequentially as compared with the first quarter. The second quarter included a full quarter of impact on our specialty business from the New York Medicaid decision that was implemented at the beginning of the year. Our team continues to work to build upon and expand our referral sources within Pennsylvania and in additional states. In our RTC service line, revenue in the second quarter was 97 million and increased 12% year-over-year, driven by solid volume growth as well as growth in revenue per day. In our CTC business, second quarter revenue was 141 million. Demand for CTC services remains steady and our team is focused on meeting the needs of current and potential patients. Moving down the Income Statement Adjusted EBITDA for the second quarter was one 49.2 million. Adjusted EBITDA includes two significant items that were not included in our guidance. A 26.1 million benefit from Florida supplemental payments related to the 2025 program year, which is offset by a $28.6 million actuarial adjustment to increase the company’s professional and General Liability, or PLGL, reserves. The total impact of these two items was a negative $2.5 million impact on second quarter adjusted EBITDA relative to our guidance provided in April. With respect to the PLGL adjustment, we made a proactive decision going into 2026 to conduct midyear actuarial reviews in addition to our traditional fourth quarter review. This quarter’s PLGO adjustment is primarily driven by our progress in moving towards settlement related to certain prior year cases from the 2025 policy year. While reserves for the current year are trending in line with our expectations. The resolution of these prior year matters was incorporated into the mid year Actuarial Reserve estimates and were the primary driver of the adjustment. On a same facility basis, adjusted EBITDA was 200.9 million in the second quarter. Our focus on operational discipline helped drive strong cost efficiencies at both the corporate level and at our facilities. In the second quarter, our corporate overhead cost declined by approximately $3 million compared with the first quarter and were flat on a year-over-year basis. Outside of the same facility group, our losses from startup facilities were 12 million in the second quarter, which was better than our expectation. Startup losses in the second quarter included a ramp up in preopening expenses as we prepared for the two new facility openings that Debbie mentioned. For closed facilities, we had $1 million in operating losses during the second quarter. Moving to the balance sheet, we remain in a solid financial position. As of June 30, 2026, we had $171 million in cash and cash equivalents. Operating cash flow in the second quarter was 162 million and capital expenditures were 39 million, resulting in free cash flow of $124 million. We repaid $113 million on our debt during the second quarter and our net leverage ratio at the end of the quarter stood at approximately 4.1 times adjusted EBITDA. From a revenue cycle perspective, our bad debt and denials in the second quarter were stable and our days sales outstanding or DSOs declined compared to the first quarter. With respect to capital expenditures, following a review of our ongoing and planned capital projects, we have revised our full year forecast for CapEx to a range of 235 million to $255 million, which includes a range of 120 million to $140 million for the second half of the year. This updated expectation reflects our focus on free cash flow and our disciplined approach to capital deployment as well as the timing of our capital projects. We expect positive free cash flow in the second half of 2026. Turning to our guidance, we are updating our guidance ranges based on progress made this year and our updated full year guidance now reflects revenue in a range of 3.4 billion to $3.45 billion, adjusted EBITDA in a range of 590 million to $615 million, adjusted EPS in a range of $1.45 to $1.60 and operating cash flow in a range of 350 million to $400 million. Our team continues to monitor supplemental payment programs that we believe could be approved in 2026. We have not fully reflected expanded programs in our guidance at this time beyond a $5 million historical baseline amount for Florida that is included in our Q3 expectations. We estimate that programs in Florida and Ohio currently under regulatory review for the 2026 program year could add more than $20 million in incremental EBITDA. I will now turn the call back over to Debbie.

We have made significant progress on our key priorities in the first half of the year and we expect to deliver consistent operational performance in the coming quarters. Acadia is fortunate to have an experienced and dedicated team who work every day to improve the lives of the patients we serve. We have an important mission to provide safe, quality care and we share a clear purpose, meeting a critical need and making a difference in the communities we serve. With that, we will now turn it over to the operator for questions.

Thank you. We will now begin the question-and-answer session. [Operator Instructions] Our first question comes from Brian Tanquilut from Jefferies.

Please go ahead guys, and congrats on a solid quarter. Debbie, maybe first, as I think about your comments on the continued confidence in the 200 million of ramp in the beds that were open from 23 through 26. Just thinking, are there any measures or qualitative comments you can share with us in terms of the progress that you are already seeing We other than the 2.5% or so growth rate that we saw in that cohort? So just curious, anything you can share with us in terms of achievability of that path and the progress you are making there?

Thank you, Brian. I mean, we have confidence in delivering on the 200 million of the incremental adjusted EBITDA. it has been a significant focus for the team. I think we have made further progress during the second quarter with really revenue volume, facility level, EBITDA. They were ahead of our expectations for each cohort. We expect to deliver additional progress and visibility over the second half of 2026. And as the facilities continue to ramp, each step gives us more confidence and visibility to the 200 million that we feel very, very confident about. I will give an example of the cohort, just one, which is Coachella Valley. We have made very, very good progress there and it was one of our 2024 De Novo facilities. It is now above 90% occupancy and we are actually planning and looking at building additional beds, which we think we can do with the space that may already be there. We want to meet the demand in the market. And so that is one facility that I can point out and we have others that are now positive EBITDA. But it is really a result of all of what the team has done to focus on new dashboards, strategic plans to build occupancy and really to be ready to meet the needs of our partners and the community.

I appreciate that. And then maybe David, just really quickly, obviously you raised the EBITDA guidance, but the free cash flow or the operating cash flow guidance is pretty notable. Just curious, what is driving that delta and then what are the levers that you have pulled to get that CapEx spend target down? Thanks.

Yeah, thank you, Brian. We were pleased with the free cash flow performance during the second quarter and expect that to continue into the back half of the year. And it is attributable to strong performance in the core business and strong execution on many of our new facilities. In addition to just some EBITDA visibility and confidence in the full year number that we have after being through the first part of the year moving into the second half of the year, we are also seeing positive trends in our working capital and would highlight that AR days declined relative to where they were, not only in the first quarter, but the forecast that we had going into the year. With respect to AR days, we are pleased to be at 49 at the end of the second quarter and that is a key contributor to not only our second quarter performance on operating cash flows, but our outlook in the back half of the year. There are a few other items that we would point to just related to other working capital management initiatives that we have as a company, in addition to cash interest and a few other items being lower than we had forecasted with our ability to pay down some debt during the quarter. So pleased with that performance from a CapEx perspective, we also went through all of our projects in detail, our expansion and other projects in detail. Some of the lower number during the second quarter does just reflect timing and you can see in our second half outlook there is some increase relative to where we were in the second quarter, but we have a disciplined approach to not only managing our existing projects, but managing any additional expansion or maintenance projects moving forward and are pleased to just see the free cash flow performance of the business really across both earnings items, working capital and just a more disciplined approach to capital expenditures.

Our next question comes from A.J. rice from UBS. Please go ahead.

Hi everybody. You know Debbie, when you came on six, seven months ago, the company over the last year or two had faced a number of challenges, some related to managed care contracting, some related to litigation. I think there was also some uncertainty around the pacing of development, JVs and so forth and how the returns on those would look. Maybe just if you could comment on where you have made progress, where there is still opportunities to be had maybe in those areas or any other that you would highlight.

Sure, AJ I mean we really have the back to basics and you mentioned some of the challenges that the company faced. But. But I think just building a strong, experienced operations team has just made a big difference to our focus and our execution. And as I think about what we have been able to accomplish in the first two quarters we are seeing those facilities in the cohorts which I talked about just a minute ago, ramp actually exceeding our expectations on that. I think that we continue to have positive, strong relationships with our referral sources. We are now able to show them outcomes, which has been a very keen focus for not just the clinical team, but the operational team in the field to be able to demonstrate what we do. But we really, we are focused on problem solving. So as things come up and we see something that is not going as we expected, then the team is really doing a good job of saying, what can we do to change this? What actions do we need to take? We have developed additional dashboards that we can look at to monitor our progress, not just on the cohorts, the 2023-2026, but on our same facility metrics, as well as looking at expense management that has the team has done a great job there of just, let us make sure we are matching our staffing to the needs of our patients. So all of that has come together and there is a real momentum that I think we have. So as we look for the second half of the year, I think we are going to continue to see the progress. And I believe that as we start to execute as we are doing now, that is going to be sustainable. And so I am very encouraged and I know the team, they work very well together and they are also working very hard to make sure that we improve what we can control and that we are able to see the value of the investments that we have made.

Okay. And maybe just labor. I know in this segment that is sometimes a gating factor on your ability to get growth, ability to get people at reasonable rates. What are you seeing in labor? What is the wage rates, Turnover. Any updated thoughts on that? Yeah, A.J. we are continuing to see a stable and positive labor environment and have seen for several quarters just a strong recruiting, ability to recruit, as well as just a retention of our existing employees. And importantly, as we bring on new facilities and new beds, we have had success bringing on new teams and are just very excited to bring on new leadership teams at our new facilities and build staff and have been able to do that at our new facilities. And at the same time, just we mentioned operating discipline, just making sure across the company, corporate and at our facilities, we have the right discipline and focus on staffing, just as we ramp up our census in certain facilities. And the team’s done a great job just managing and having the right resources for our facilities. From a wage perspective, it has been trending in the 3% or so level. It does depend on just the role and the geographic market and other factors. But overall, for the company, we have seen a stable year-over-year wage, cost growth.

And AJ I will just add with our JVs, one of the advantages of our partnership is many of them have, have had units and actually hospitals. So as we open and we prepare for all of the processes that we go through, we very often can bring those staff to the new facility. And that has been a real advantage of just having those partnerships.

Our next question comes from Matthew Gilmore from KeyBanc. Please go ahead. Hello, Matthew, is your line muted?

Hey, good morning. Can you hear me?

Yes.

Hey, thanks. So I wanted to ask about bad debt and payer denials. I think the year-over-year impact for bad debt was 7 million, which is a little bit better than last quarter. Can you just update us on the trends you are seeing and some of the progress that Larry has made as he is come back to the team and try to tackle this?

Yeah, we are encouraged to see some progress in our revenue cycle initiatives which have been a focus in the first half of the year. And the team’s doing just a good job just assisting where we do have isolated issues in certain markets and facilities related to either bad debts, denials, Arkansas collection, et cetera. The team is doing a nice job just making progress there. And we were encouraged in the second quarter to see stability in our bad debts and denials. As we look at that sequentially versus Q1, we did see a stable number sequentially compared to the first quarter and on a year-over-year basis. You mentioned just the improvement on a year-over-year headwind basis from 9 million in the first quarter to a $7 million year-over-year headwind in the second quarter. And that improves as we go through the second half of the year because the second quarter or the second half of 2025 is where we saw a step up in overall bad debts and denials. And we continue to have just a three pronged approach to improving revenue cycle performance. We mentioned the team, the revenue cycle leaders, the specialists that we have are doing a nice job just strengthening our processes, leveraging technology. Secondly, just the tools that we have to proactively intervene and assist with specific issues that we have at the payer and local level and in select cases, the appeals and the process for appeals is important to just the way that we respond, the way we learn from one market and apply that to other markets and documentation of the care we provide and how we can just control what we can control to drive improvement going forward. But we have seen just good progress in the second half of the year with more Opportunity as we look ahead into the second half of the year.

Okay. And I was hoping to get an update on the De Novo pipeline. I think you mentioned you had another opening scheduled for the third quarter. Can you just remind us what the pace is over the next few quarters? And if you had any comments on the trajectory of start-up losses and cash flows, even as you look out to 27, if you are able to comment on that, that’d be great.

Yeah, we did mention we have one other De Novo facility to bring online and that is our facility near Jacksonville, Florida. Have confidence just having made so much progress in the first part of the year around new facilities and expansion projects at other facilities have just high level of visibility at this point in the year as to 500 600 beds that we are adding in total for the year beyond that De Novo facility. We believe the opportunity that we have as a company is the capacity that we have added over the last several years. And so we do not have at this point another de novo or JV project that begins in the fourth quarter or in early 2027 just based on the current pipeline. Of course, we continue to look at attractive opportunities. Some focus there just on existing facilities and not as much joint-ventures de novos, De Novos, but we do continue to look at those opportunities as well. But the bed additions for the year is a strong number with high visibility and a lot of that having already happened in the first part of the year or getting close to happening in the third quarter. With respect to the startup losses, we have had two quarters in a row where our losses for the facilities opening in the last 12 months has been around $12 million. Those facilities are doing a great job in the early stages of opening and are ahead of our expectations. And, and we revised our full year expectation there slightly and would kind of guide everyone towards a little bit step-up in that $12 million as we think about the third quarter, just given two new facilities at the end of the second quarter as well as one more facility opening in the third quarter. So I think it could get a little bit larger, not significantly, but maybe in the 12 to 14 million dollars range before we really have an opportunity starting in the fourth quarter to see that number come back down, certainly below the 12 million as we think about what is possible for the fourth quarter based on progress that we have made so far with those new facilities.

And I will just add, as you look at the facilities that we have, and certainly we have our cohort group. But we also have same facility that we have had for some number of years. When they become 75% or higher in occupancy, they really are at a point where they have to start turning away patients due to age and sex and male, female, the kind of program. So we are looking at those facilities and we believe that we have potential to add additional beds and that is really the best return on our capital. And so we have a focus on that. In fact, we had a meeting earlier this week to look at what is out there, where our facilities add and how many of them can we start to really do our due diligence around whether bed additions are needed.

Our next question comes from Whit Mayo from Leerink Partners. Please go ahead.

Come back to the Med Mal PLGL stuff for a minute. I mean, you knew a lot about the cases that you referenced. Has the frequency of claims changed or the settlement per claim changed? Or is this all just new information on the movement in current legal proceedings? And just to be clear, is this viewed as one time and not having an impact on forward reserves? And lastly, just how we get comfortable that there will not be additional actuarial reserves that you have to take. Thanks.

Yeah, Whit, thanks for your question. We did plan just moving into 2026 to conduct a midyear review in addition to our fourth quarter review that we have traditionally done. And I would point you back to last year’s actuarial adjustment. It was somewhat broad and the company talked about frequency of claims. And as we went through the update process with our actuary in the second quarter, we did see just for some of those 2025 claims that the company talked about last year that had a higher frequency where we have seen the team be able to successfully move towards settlement just in a real intentional and proactive way of managing through some of those cases, we saw an adjustment 28.6 million related specifically to some of those 2025 claims. And so would attribute this year’s adjustment to just the higher case severity, certainly something that we believe is consistent with the litigation environment, the industry trend that many others in healthcare are seeing, but was specifically related from our perspective to the 2025 cases that we highlighted in terms of thinking about that as one time or making a prediction as to going forward. Are we going to see this again? That is very difficult to predict. We do a tremendous job as team from my perspective just on our risk management programs, controlling what we can control and focusing on safety reducing events and negative outcomes. And this involves technology, this involves people processes at our facility. So there continues to be a tremendous focus on that as well as our approach for defending and managing claims which is customized for each case that we have that we are working to resolve in a strategic and an aggressive way to defend those cases that we do have for previous years. I will highlight for the current year. Our recent actuarial report did not change the forecast that we had for 2026 from the previous year’s actuarial report. We have talked with investors about seeing a PLGL step up over the last several years and having a range of expected costs for 2026 of 100 to $110 million. Our mid year review continues to have that expectation for the current year. But as we think about adding the prior year adjustment to that the current year will now be trending in more of 130, $135 million range. But continue to see and be encouraged by the current year being in line with our expectations.

Okay. And then my follow up just on Medicaid work requirements. A lot of this is very confusing to me. I do not understand the definition of a lot of stuff around the definition of treatment and disabling. Just wanted to get any updated views, Debbie, that you may have.

Yeah, as we think about the work requirements, I am sure you know that it does not impact all of the states. That is kind first point here As they implement this in January, it will be for those that have expanded Medicaid. And what I think the and nabh, which is our association and just various groups have done is really show that our patients need to have some provision for these work requirements. And I think that as we look at it and how it will impact Acadia, we do not believe that there will be a material impact. We think our patients will qualify for the exemptions that have been laid out. I think they have been very thoughtful about how they have done that. And with respect to severe mental illness as well as substance use and there are provisions in there, we feel like they will cover our patients. And so we worked in collaboration just trying to lay out the difference between a behavioral health and substance use patient and a med surg patient.

Our next question comes from Peter Chickering from Deutsche Bank. Please go ahead.

I guess the first question, could you talk about the revenue growth within the CDC clinics? I think it is sort of down just a smidgen year-over-year. Just by adding six more centers. I guess, how is the methadone market? How is sort of the macro demand there? And how should we think about two key results as decelerating trends? And what do you assume in guidance for the rest of the year?

Yes, PETA, we mentioned earlier we are pleased with just the demand, the opportunity that we continue to see, and the team that we have leading the CTC service line. It did perform slightly behind our expectations for the second quarter and was flat on a year-over-year basis. From a revenue perspective, we have seen growth in the number of clinics in that market and continue to see some opportunities in other markets add clinics selectively and based on where we now see some opportunity and ability to think about capital investments and growth in that space. But we do see an opportunity there, given some of the slight underperformance in the second quarter. But with the strong demand capacity and team that we have and demand that we still see in that service line, we do see continued opportunity there to improve the revenue growth and the performance of that business.

And I will just add 25% of Americans receive treatment, which leaves a very large group of individuals in the country that do not seek care and the incidence of opioid use remains high. And I think that there is as David said, we see continued demand. What we want to do is make sure that our clinics are the first choice. And so we are looking at all aspects of that business to make sure that our services and just the patient client experience is positive and other things with respect to just how we might deploy our marketing dollars. So it is an area that we still feel very positive about and demand remains strong, but we want to make sure that all of our clinics are first choice in all the regions that we are in.

Okay. And then a follow up here. Debbie, you brought in turn this company around a second time. Can you give color on the initiations you put in place in the second quarter as it relates specifically to corporate changes and why the de novos are ramping better in 26 than they were in 25. Thanks.

Well, I think I have said in previous calls that to me, the people are one of the most important things that we have. They have to. We have to have the right experienced people So I have given a lot of focus to just reviewing our talent across, not just at the corporate level, but at the facility level as well. And we made some changes around how moving organized within the operational structure, particularly in the acute service line. We restructured that really to flatten some of the structure and to think about geography and think about scope as the leaders in acute assist the facilities and assist the CEOs. So that has been a, a key focus. And I think everyone, I think it is working. And as I said in my remarks, I think we are seeing the benefit of that. We did at the corporate level, we did take out a level of middle management just to facilitate problem solving to assist the facilities. We looked at what is essential for them to have and support. We documentation. We also- with respect to just the cohorts, they are not just JV partners, as you mentioned, they are de novos as well. But we have improved our alignment and communication. Part of that was bringing in management to focus on the JVs. I think there are best practices that can be really deployed across our company with respect even though they are all very different. So as we have looked at those cohorts, we have been able as we looked at the process last year, that was difficult and in some cases took longer than was expected. We have been able to cut the time in half for those approvals. And I think that is really just a matter of focus. We are working with our partners, we are leveraging them and we are moving faster to those approvals so that then we can begin ramping and taking patients with respect to Medicare and Medicaid, but also just accelerating our payer contracting and other pieces that have to work together to see those facilities ramp. And our goal is to faster and we are pleased with what we see in the second quarter.

Our next question comes from Ryan Langston from TD Cowen. Please go ahead.

Good morning. Thanks. Government investigation costs continue to decline. Should we read anything into that in terms of settling some of the outstanding issues you are dealing with there? Or is this maybe more of just a good run rate expense we should be thinking about modeling in the near term?

We, it is difficult to provide any sort of outlook on those costs. Yeah, it was lower in the quarter certainly than than what we incurred in the second quarter of last year. But the expense going forward will just be a function of the next steps in that process. We are cooperating fully and heavily focused on the process and would not make a prediction at this point in time as to where those costs will be in the second half of the year going forward.

Okay. And then obviously over the last few quarters, you have highlighted some friction with your payer partners. Maybe just give us a sense sort of where you are at in those payer relationships and if you have been able to make any progress on improving those relationships in general or maybe settling any particular disagreements we have had over maybe the last year or so. Thank you.

Well, I think I have said before that there is always the push and pull that we have. And over my career in behavioral health, there is always that push and pull. So as far as our relationships with payers, I think that they are strong. I think that they want to ensure that their patients get the right care. We want that too advocate for our patients and we make sure that we are able to document acuity. And so as we, I think about just where we sit today, I think that we have good relationships really in many of our markets. It is really specific, I think, to certain geographies. Sometimes you find a payer that might be more aggressive than others. We are prepared to start, step up and make sure we are doing our job, make sure we are giving them what they need with documentation. We also, we have been receiving rate increases from our payers low to mid single digits. But on the other hand, we also now have outcomes which we are sharing with our payers. And I think that my view on payers is we need to be collaborative. And we need - in many cases, I can think of several they have asked us to do certain services and so we want to work with them. But there is still going to be that tension And I have seen it over many years, but it is still. They respect our clinical expertise. And I think that what we want to do is make sure that we are doing our job with providing clinical excellence And we have to demonstrate that to them. And I think that is always going to be there, this kind of tension that happens between us and restricting care. Our job is to make sure that our patients get the right care at the right setting at the right time. And so that is what we are focused on

Our next question comes from Ann Hynes from Mizuho Securities. Please go ahead.

Great. Thank you. So your same store admission growth is very strong at over 6%. But your revenue, same store growth adjustment for the DPP was only 3.2%. And I would think those should kind of align. So admission? And then maybe- can you tell us like why the revenue grew under admission? And then maybe I do not Know if you have ever done this, this, but can you break-out admission by your service line and how that trended through the quarter?

Yeah. And we would just highlight the service mix changes that we have talked about with bed additions being heavily weighted on the acute side. So what we are seeing, and we will continue to see, is just a stable mix within the service lines as we look at metrics on admissions and patient days. But with the heavier mix of acute within our bed count and within our business, the acute admissions are at a much higher level, just given the longer stay associated with RTC and specialty. And so it’s just - it is a mix item. We were pleased with the performance of the individual service lines, but acute being a heavier mix of the company, both this quarter and even continuing moving forward, we are going to continue to see that dynamic.

Great. Thank you. And I know some of the payers are pushing for more outpatient intensive care rather than an inpatient admit. Is that trend still continuing? Can you remind us what your exposure is to outpatient intensive? Thanks.

Well, we want our patients to get the right care, and so if stabilized, then would go to outpatient. Do meet inpatient criteria and medical necessity and that is where they need to be. However, we believe fully in the continuum. And so I think you used the word push. I think what we want to do is make sure that they are getting the right level of care. So we have in many of our hospitals, a step down in either iop, which is intensive outpatient, and partial, which is partial hospital. So as we look at that, we see that as a natural part of where patient after they get stabilized, then they would go to outpatient. And I think that we want to make sure that we have those resources available. We have continued to grow that line, and we are going seek look at in total to see if there are other opportunities. But we are very much a believer that a patient needs to be in the right setting. So if outpatient is appropriate and they are ready for that, then we support that fully.

Due to time constraints. This concludes our question and answer session. I would like to turn the conference back over Debbie Osteen for any closing remarks.

I want to thank you for your time this morning and for your interest in Acadia Healthcare. Please feel free to contact us if you have any additional questions. Have a good day.

[Operator Closing Remarks]