Pediatrix Medical Group (MD) Q3 2026 Earnings Call: EBITDA Outlook Narrows

Key Takeaways

• Pediatrix Medical Group reported Q3 2026 adjusted EBITDA of approximately $85 million and narrowed its full-year adjusted EBITDA outlook to $290 million-$300 million.
• Consolidated revenue increased just under 2% year over year. Same-unit revenue rose 0.6%, with patient volumes and pricing each contributing 0.3%.
• Same-unit pricing benefited from favorable payer mix, higher hospital administrative fees and greater patient acuity. These gains were partly offset by a revenue cycle management comparison headwind of slightly more than 100 basis points.
• Operating cash flow was $118 million, compared with $138 million a year earlier. Quarter-end cash totaled $312 million, net debt was just over $266 million and leverage was below 1x.
• Pediatrix repurchased more than 3 million shares during the quarter. Since August 2025, it has bought back 10 million shares at an average price of $23, reducing shares outstanding to 78 million.
• Management said it has not observed a clear negative impact from the expiration of ACA subsidies. It also expects limited exposure to potential IDR rule changes because less than 5% of the business is typically out of network.

Key Financial Data

Business and Operating Performance

Same-unit patient service volume increased 0.3%. Growth in maternal-fetal medicine services was partly offset by declines in other neonatology services, primarily newborn nursery activity. NICU days were stable year over year.

Payer mix improved by more than 70 basis points from Q3 2025 and remained stable compared with Q2 2026. Management estimated that payer mix represented about 40% of the positive pricing contribution, hospital administrative fees about 25% and acuity about 15%.

The company said improved collection activity from prior periods created a comparison headwind of slightly more than 100 basis points in Q3 pricing. Management characterized revenue cycle management performance as stable while continuing to pursue further automation.

Practice-level salaries, wages and benefits increased year over year, reflecting higher salary expense partly offset by lower benefit costs. Salary growth remained around 3%, while management described clinical salary inflation over recent years as approximately 3%-3.5%.

General and administrative expenses increased, mainly because stronger financial results raised incentive-based compensation. Lower technology expenses, including certain SaaS costs rolling out of the income statement, provided a partial offset.

Pediatrix continues to expand telehealth services and assess selected OB hospitalist opportunities. It is also considering larger acquisitions adjacent to its existing operations, with a stated focus on women’s and children’s healthcare.

Management Guidance

Management narrowed its full-year 2026 adjusted EBITDA outlook to $290 million-$300 million.

The company said the range allows for variability in volumes and pricing. Management did not identify any specific nonrecurring item embedded in its expectations for the fourth quarter.

Pediatrix did not provide a 2027 outlook. Management said it remains in the budgeting process and is monitoring payer mix, coding changes and other operating factors.

Risks and Watch Items

• Management cited rising costs across healthcare delivery, although wage inflation remains below the mid- to high-single-digit levels seen several years ago.
• The company has not seen a clear negative effect from the expiration of ACA subsidies, but it continues to monitor payer mix and enrollment-related developments.
• No Surprises Act IDR rules remain under review. Pediatrix expects limited impact because it is overwhelmingly in network and typically has less than 5% of its business out of network.
• Coding changes affecting OB hospitalist services are scheduled for 2027, but management said the final rules and provider responses remain uncertain. The business is not currently material to Pediatrix.
• Hospital financial pressure could make administrative fee negotiations more difficult. Management said payments depend on demonstrating that Pediatrix can operate NICUs efficiently and provide value relative to hospitals running those services directly.

Analyst Q&A Highlights

Pricing durability: Management expects favorable payer mix, hospital administrative fees and higher acuity to remain supportive, while acknowledging that each factor can fluctuate. The prior collection-related benefit has largely reached a steady-state comparison.

Fourth-quarter outlook: When asked about the EBITDA level implied by full-year guidance, management said the range primarily preserves flexibility around changing volumes and pricing rather than reflecting a specific expected headwind.

Capital allocation: Pediatrix plans to remain opportunistic with share repurchases. Its low leverage also leaves capacity for larger acquisitions, provided targets are adjacent to its women’s and children’s healthcare operations.

Hospital support payments: Management said considerably less than half of its NICU practices receive hospital support and that the proportion has not changed materially year over year. It did not provide a more precise figure.

2027 coding changes: Management declined to characterize the potential impact as positive or negative before the rules are finalized and the response from OB providers becomes clearer.

Full Earnings Call Transcript

Complete Earnings Call Transcript

Management Remarks

Operator

Hello, and thank you for standing by. At this time, I would like to welcome everyone to the Q3 2026 Pediatrix Medical Group, Inc. Earnings Conference Call. [Operator Instructions] I would now like to turn the conference over to David Haddock, General Counsel. You may begin.

David Haddock

Good morning. Certain statements and information during this conference call may be deemed to be forward-looking statements within the meaning of the Federal Private Securities Litigation Reform Act of 1995. These forward-looking statements are based on assumptions and assessments made by Pediatrix's management in light of their experience and assessment of historical trends, current conditions, expected future developments and other factors they believe to be appropriate. Any forward-looking statements made during this call are made as of today, and Pediatrix undertakes no duty to update or revise any such statements, whether as a result of new information, future events or otherwise.

Important factors that could cause actual results, developments and business decisions to differ materially from forward-looking statements are described in the company's filings with the SEC, including the sections entitled Risk Factors. In today's remarks by management, they will be focusing -- they will be discussing non-GAAP financial metrics. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measures can be found in this morning's earnings press release in the company's quarterly and annual reports and on the Pediatrix website at www.pediatrix.com. With that, I will turn the call over to Mark Ordan, Chief Executive Officer of Pediatrix Medical Group.

Mark Ordan

Thank you, David, and good morning, everyone. Also with me today is Kasandra Rossi, our Chief Financial Officer. We are pleased to report a strong quarter with adjusted EBITDA of $85 million. Same unit revenue was positive with equal contributions from volume and pricing, even with pricing reflecting the lapping of the tailwinds we experienced from strong collection activity over the past several quarters. Our overall results for the quarter exceeded our expectations in spite of increasing costs in virtually all areas of providing great health care. We are narrowing the range of our full year 2026 outlook to $290 million to $300 million in adjusted EBITDA. In the quarter, we repurchased just over 3 million shares of our stock, bringing our total buyback since August of 2025 to 10 million shares and our shares outstanding to 78 million, down from 87 million at the end of the second quarter of 2025. The average price of the 10 million share buyback is $23. For several quarters, I've been asked why our numbers have not been adjusted because of the effect of the lapse of the ACA subsidies. Well, as our results continue to show, we have still seen no clear negative effect to date.

Turning from the quarter to what gives us increased confidence in our future are several highlights I'll share. Our annual meeting of all of our practice medical directors 2 weeks ago had basically one agenda item, care quality. It may seem anomalous for a public company to hold such a meeting and not discuss scheduling, expenses, et cetera. However, we believe our core is about care and quality, and that's what our 300 directors came to discuss. It was, of course, led by our clinical leadership team, and my contribution was to be proud to be among our extraordinary clinicians. I've recently reported that we take advantage of our strong financial condition to support internal growth and to be in a position to find larger potential value-add outside opportunities. We continue to work on expanding our telehealth services as well as select opportunities in the OB hospitalist field. On the latter, announced coding changes are scheduled to take effect in 2027, and we will see then how this area changes in response. Of course, it is not a material part of our business at this point, and we'll plan to report to you as we all learn more.

We also know, of course, that the No Surprises Act IDR rules are being reviewed, and we have read about alleged abuses of the process. Pediatrix submits claims that we believe are right down the middle of the spirit and letter of the process rules. And we do not have an outsider determine in their view what is a proper claim. We determine that ourselves. We do not expect the process to be a headwind for us since it is designed to balance fairly the interest of payers and acute care providers who follow the rules.

I'll close by returning to quality. Dr. Medel founded Pediatrix with a clear charge: take care of the patient. That is what our patients and our hospital partners expect of us. Whenever we can find ways to improve, we do. And we do this only because we have, by far, the nation's largest team of world-class clinicians in our sector of women's and children's health. I'll now turn to Kasandra.

Kasandra Rossi

Thanks, Mark, and good morning, everyone. Our consolidated revenue increased by just under 2%, driven by non-same unit activity, primarily recent acquisitions and same-unit growth of 60 basis points. Same-unit patient service volumes were up about 30 basis points, driven by MFM services, partially offset by declines in other neonatology services, primarily newborn nursery. NICU days were stable as compared to the prior year. Same unit pricing was also up by 30 points, driven by favorable payer mix, an increase in hospital admin fees and increased patient acuity primarily in neonatology.

As expected and as Mark stated, we've begun to lap the strong tailwind from improved collection activity, which is flowing through as a decrease in pricing this quarter. Payer mix improved by over 70 basis points as compared to the prior year third quarter and remained stable as compared to the second quarter of 2026. Practice level SW&B expenses increased year-over-year and on a same-unit basis reflected increases in salary expenses, partially offset by lower benefits expense. Salary growth has remained consistent with the ranges we have seen over the past couple of years in that 3% area. Our G&A expense increased year-over-year, primarily related to higher incentive-based compensation based on financial results, partially offset by lower technology-related expenses. D&A expense was up about $700,000 year-over-year, primarily reflecting CapEx at our existing units as well as CapEx and amortization of intangibles from recent acquisitions. Other nonoperating expenses were $200,000 for the third quarter compared to nonoperating income of $19.7 million for the prior year period. The prior year period reflected a net gain on divested businesses of $20.9 million. For the third quarter of '26, we also saw a decrease in interest expense from modestly lower interest rates and borrowings as compared to the prior year period.

Moving on to cash flow. We generated $118 million in operating cash flow in the third quarter compared to $138 million in the prior year, with the change driven by decreases in cash flow from accounts payable and accrued expenses and accounts receivable. Our leverage at 9/30 sits at just under 1x using the midpoint of our updated adjusted EBITDA outlook range for 2026 with cash of $312 million and net debt of just over $266 million. Our accounts receivable DSO at 9/30 of 42.5 days were unchanged from June 30 and March 31 and were down just over half a day year-over-year. I'll go ahead and turn the call back over to Mark.

Mark Ordan

Great. Thank you, Kasandra. And now we will take any questions that you have.

Operator

And your first question comes from the line of Andrew Ryan Daniels with William Blair.

Question-and-Answer Session

Matthew Mardula

This is Matthew Mardula on for Ryan. So, I want to start with pricing. With it coming in at 0.3%, could you break down how each factor's pricing made up this quarter's pricing, especially by quantifying what the RCM impact was? And then looking ahead. Go ahead, Kasandra.

Kasandra Rossi

Sorry, Matt, I cut you off your question. Please finish your question.

Matthew Mardula

No, I was just going to finish up with -- and then looking ahead to next quarter, how should we think about the sustainability of the pricing benefits we saw? And is there just any changes to the, kind of, key drivers of pricing than previously mentioned? And then with that RCM impact we saw this quarter, is that a reasonable way to think about it for next quarter as well?

Kasandra Rossi

Sure. So, first, I'll take the pricing components. And on the positive side, pricing was led by payer mix. A close second was the hospital administrative fees and coming in third was the acuity. So, I'd say for the payer mix impact, that was probably -- if you look at the positive impact for the pricing, it was about 40%. The hospital admin fee is about 25% and the acuity was about 15%. And maybe I'll hit the sustainability of those while we're talking about those. Listen, we've talked about the payer mix impact. It's continued to be favorable for us. And we don't anticipate anything changing there. But if anything, I think it will remain stable.

On the hospital admin fees, we talk about that each and every quarter. The hospital environment is tough. But when we require increases, we go to the hospital. We have those tough conversations, and we've been having success. So, we expect those conversations and those successes to continue. And on acuity, we talked about that a little bit in detail last quarter that we've looked at that really on a 3-year stack, and we have seen just a trajectory that takes that increasing. And of course, that is supported by the fact that we are in more Level 3s and Level 4s than anyone. So, we do consider those to be sustainable. But as with everything, there is variability and they do bounce around a bit.

And as far as the RCM, the lapping, we did start talking about that we would expect in the back half of the year to start seeing that lapping. It did impact the quarter by a little over 100 basis points. And I think right now, we are in a very steady state. But we have talked about continuing to look for ways to further automate. But we think that right now, it is very stable. But again, we'll look to deliver improvement there as we can over the next coming years.

Matthew Mardula

Great. And then in the prepared remarks, you, kind of, discussed the IDR process. Can you help us understand maybe the magnitude of IDR has on your business? Any, kind of, numbers around that? And then as we, kind of, look forward, what's giving you that confidence that this won't become a headwind, particularly if there's, like, many -- particularly if there are any changes to the IDR process that occurs?

Mark Ordan

Well, we're overwhelmingly, as we always have been, in network. So, the IDR process is not something that we've ever had to live based on. So, it's not -- I can't quantify it precisely. But again, we're always overwhelmingly in network.

Kasandra Rossi

Sorry, Matt. I was going to say with the changing rules, like Mark said, we don't anticipate -- we're one of those who -- like we said, we abide by the rules. We're doing the right thing. And so we don't anticipate any changes from the changes that are happening in that process.

Operator

And your next question comes from the line of A.J. Rice with UBS.

Albert Rice

Just to put a finer point on that, do you have a percentage of your revenues or claims or business that is in out of network at this point? I assume it's in the single digits, but is there a figure you can give us?

Mark Ordan

We have typically been out of network of less than 5% of our business. So, it's...

Albert Rice

About...

Mark Ordan

So, if that helps. With the IDR process now for several years. And as I said in my call, we've read about alleged abuses by others and people, I guess, as a learning, use different tactics. We think that the rules were well crafted, and we see the proposed changes. And we think the spirit and letter of the proposed changes is to make sure that there's a fair process between payers and providers.

In 2020, when the No Surprises Act first came out, we were supportive of it. We believe that if you're going to take care of the patient, the patient should be out of the middle. As long as the rules are fair and the payers are playing by the rules and providers are doing it the right way, we're comfortable.

Albert Rice

Yes. The company obviously came in ahead of expectations on the quarter, $85 million -- $85.5 million of EBITDA. You've updated the guidance. When I look at what that implies for fourth quarter, if I'm doing the math right, you get about $70 million to $80 million in EBITDA. Is there anything embedded in there? Is that natural seasonality? Is there something that doesn't recur that occurred in the Q3? Or are you just being conservative?

Kasandra Rossi

No, I'd say it just gives us a little bit of flexibility. Volumes have bounced around, pricing has bounced around, and it just gives us that flexibility to land in that range. So, nothing else baked in there, A.J.

Mark Ordan

No. A.J., it's only November.

Albert Rice

Okay. All right. You mentioned that you're still looking at high-value opportunities in adjacent businesses. I wondered maybe if I could get you to just flesh out what's behind that. What would be things that would be of interest to the company?

Mark Ordan

Well, I can only flesh it out a little bit. I'd say that what we have said repeatedly is that we have a very strong balance sheet, and we have the ability to make larger acquisitions. We strategically would only look at something that is in something adjacent to what we already do. So, staying in the women's and children's space is important to us. So, I'm just underscoring that when people look at our balance sheet and see our very low leverage, I don't want people to think that we're complacent and we're just sitting there. Yes, we've bought back shares, but not to the extent that it limits us from doing something if there's a very good opportunity. So, we do think in the women's and children's space are bound to be attractive opportunities, and we actively consider them.

Albert Rice

Okay. The level of share repurchase, I'll just wrap up with this. $83 million during the quarter. Any comments on pacing going forward on that?

Mark Ordan

No. We've tried to be opportunistic. We're happy that over the course of the last year, our average price was $23, which looks like it was a good buy. We'll consider along with the board what our pace going forward is. There are other opportunities.

Albert Rice

Yes. I understand.

Operator

Your next question comes from the line of Jack Slevin with Jefferies. Please go ahead.

Jack Slevin

There's a note in the release on a little bit of, it sounds like, small disposition activity in the quarter. Could you maybe just provide a little more color on maybe what took place from practice dispositions or how you're approaching that?

Kasandra Rossi

Yes. No, that's just the carryover from the disposition activity that happened in '24. So, when we were talking about non-same unit, it's the net of the acquisitions and any dispositions. So, it's just natural flow-through of that.

Jack Slevin

Okay. Understood. I appreciate the clarification there. A lot of questions have already been asked. Maybe just to understand what you're seeing on the labor front or from, like, a wage inflation perspective, how that's, sort of, tracking underlying in the business?

Kasandra Rossi

Yes. So, I would just say we kind of talked about we've been able to keep those clinical salaries in the last couple of years in that 3%, 3.5% area. And so we're really comfortable that what we saw back a few years back where we were in the mid- to high single digits at times, we're not seeing that. So, nothing really more to say on that, Jack.

Jack Slevin

Okay. And then one more for me, just a quick one. The mentioning of some of the coding changes, my understanding is there's an unbundling that's looking to happen next year of some of the related codes in your space. For those services, the way that I had read it, if you, sort of, trend towards the higher side of the acuity scale, that unbundling might end up being a positive opportunity. Got your comment, Mark, that you're, sort of, still weighing it up and you'll see what happens on the coding front. But I just want to understand if you could, sort of, handicap whether or not you think that possibly is a positive or a negative for you as you look at '27.

Mark Ordan

Rather not handicap it because it's really going to -- first of all, the rules are going to be -- should be finalized in the next few weeks in November. So, handicapping it before it all comes out, I don't think is going to be particularly helpful. And we're going to see based on the rules, how OBs react to that. So, I think it's a little bit hard. Yes, there potentially, depending on how the rules shake out, there could be opportunities on the OBH side or more on the OB side. But I think it's too early to tell, both because the rules aren't finalized, and we don't know how people are going to react to the rules. But again, importantly, for us, it's not a material part of our business, and this gives us an opportunity to see how the rules change and what we make.

Operator

The next question comes from the line of Whit Mayo with Leerink Partners.

Benjamin Mayo

Sorry about that, guys. A little early this morning. I know you're in the budgeting process, the planning process for '27, but just was wondering if you could share any headwinds, tailwinds as you're thinking about next year?

Mark Ordan

No, not at this point. I think, obviously, we'll report. As you said, we're in the budgeting process. We're looking at a lot of things, but we're not going to talk today about '27. I've given the characterization of the things that we're looking at that stand out right now. I think that covers it.

Benjamin Mayo

Okay. Maybe just on, like, the exchange stuff, like, I know you haven't seen a headwind this year. Would you think that maybe you see a little bit of a slip in mix next year? Or just any preliminary thoughts as it relates to payer mix?

Mark Ordan

It's hard for me to say that because we're -- starting in the fourth quarter of last year, we were getting this question, and we said, well, we don't know. And when people say, why aren't you reducing your numbers, I said because I could pull a number out of the air, but we prefer not to do that. We like to do things based on numbers. And that has continued. So, we haven't seen anything that points to it. I hypothesize that, possibly because of the population that we serve, people are doing a different calculation about the value of insurance without the subsidies, but that's me sitting around trying to figure out why our results are different than some people's are. But other than that, we continue -- and a lot of people, I would say, probably you included, thought that by the -- sometime in the first or second quarter, we would see the effect, and we haven't. So, I'm not sitting here worried about what happens next year. I'll be paying attention to it. We do check. And when we hear something anecdotal, we track it down to see if it's affecting us, and it just hasn't.

Benjamin Mayo

Yes. Maybe just last one, Kasandra, you mentioned in your prepared comments lower technology expenses. Can you just elaborate a little bit more on what that was?

Kasandra Rossi

Yes. Just some of the SaaS costs that we had just rolling out of the P&L.

Operator

Your next question comes from the line of Pito Chickering with Deutsche Bank.

Pito Chickering

I guess looking at the pricing, what percent of your NICU practices today have subsidies from hospitals? How has that changed in the last year? And where you can go next year or, sort of, what inning are we in at this point of getting subsidies for your NICU?

Mark Ordan

Yes. I'm sorry, I just want to make sure I understand the question, Pito. You're asking what percentage of our NICU revenue comes from?

Pito Chickering

What percent of your NICU -- so if you have 1,000 NICU practices, are half of them getting subsidies from the hospitals? Sort of, where are we on that at this point? And how has that changed in the last year?

Kasandra Rossi

No. It's not half. It's much lower than that.

Mark Ordan

And there's not much change year-to-year.

Pito Chickering

Okay. Do you think that, that can continue to grow going forward? I mean, I'm trying to understand we're seeing pressures in hospitals from practices getting more subsidies. I'm just curious, I guess, let me ask it differently, what inning are you guys in, in order to get subsidies for your practices? Are we in the second or third inning here, or are we in the seventh or eighth inning?

Mark Ordan

I'm not -- what I'm about to say is not sidestepping the question. But -- so let me -- I'll respond to that. We work very closely with our hospital partners. And we think that along with taking care of the patient, it's very important that they know that we do things very efficiently so that they're better off with us running that NICU than if they did it themselves. And we think we have to demonstrate that value all the time.

So, it's not like you come to the end of the year and you have a discussion, you have a constant relationship with the hospital to show that you're adding value. The reason that you receive a payment from the hospital is because if they did it themselves, they would have that or a greater expense. So, it's not charity. It's saying that they understand the real cost involved in providing the care that we provide and all the expenses that go in it to make sure that they're confident that they have a really, really high functioning NICU.

So, we feel, as Kasandra said, I'm making -- I'm being longer-winded about it. We feel that while those discussions are a push and pull, we feel that we can continue to demonstrate value and be fair in the request that we make of hospitals. And I think if hospitals value us and what we do, we think we'll be okay. Is it a higher pressure environment with the Big Beautiful Bill? Sure. That adds -- that takes away from the system. So, that's going to provide pressure.

Pito Chickering

So, if I ask this a slightly different way, I guess, looking at the economics of a NICU a patient, the technical component the hospital gets is very large, and therefore, the relative cost of any subsidies, frankly, is sort of fairly inconsequential. And so keeping NICU practices happy is a very profitable endeavor for hospitals due to the technical component. I guess I'm just trying to ballpark today, sort of, where we are? Is it, like, 1/4 of your practices today have subsidies? Is that the right ballpark, plus or minus?

Mark Ordan

Well, maybe in the future date. We haven't published that number. I don't want to -- I'd rather not cut it. As Kasandra said, it's considerably less than half. I appreciate your comment about the relative economics for us versus the hospital system. We might add you to our negotiating team, you can be helpful.

Pito Chickering

All right. Fair enough. Okay. Just because you guys look at this thing in the next few years, that for me seems like a pretty massive driver for pricing as a durable set going forward. So, any color you can provide to us in terms of how this has changed over time would be very helpful.

Mark Ordan

Sure.

Operator

And there are no further questions at this time. I would like to hand it back to Mark Ordan for closing remarks.

Mark Ordan

Great. Thank you all for joining us this morning and for your continued support of Pediatrix. Have a great day.

Operator

And this concludes today's conference call. Thank you all for joining. You may now disconnect.