Stock Report: Allscripts Healthcare Solutions (MDRX)

Takeaway: We added MDRX to Investing Ideas on the short side on 1/12.

Stock Report: Allscripts Healthcare Solutions (MDRX) - HE MDRX table 1 14 16


Allscripts Healthcare is a legacy provider of Electronic Medical Record and Practice Management software and solutions to physician offices (ambulatory) and hospitals (inpatient). The market for ambulatory EHRs (50% of MDRX Sales) is highly fragmented, with over 400 different vendors claiming some stake to the market. The large number of vendors is the result of government subsidies issued to purchase software under the HITECH Act (2009), which mandated their purchase or face penalties longer term.


However, the stimulus spending has now ended and going forward, we believe market share will naturally accrue to the top vendors in the market. Our view is that Allscripts is NOT a top vendor.


Allscripts has a difficult past and questionable future. The company made a series of acquisitions in the 2005-2010 period and failed to integrate them properly. As HITECH requirements began, also called "Meaningful Use" attestation, in 2011 Allscripts was unable to keep up.


What resulted was a 30% drop in bookings in 2012, 50% drop in stock price, a board shakeup and ultimately a new CEO and management team. The new CEO, Paul Black, has made great strides to turn Allscripts around. Unfortunately, we believe the damage is already done and the most optimistic version of the turn-around story is reflected in the current stock price.


We have done a lot of work in the Health IT space as a derivative of our Best Idea Long call on athenahealth (ATHN), building proprietary tracking tools and analyzing large datasets to track share gain/loss over time. We also conduct a great deal of primary research, mainly in the form of speaking with those in charge of making purchasing decisions at large Health Systems and system users. The results of this research suggest that Allscripts will continue to be a share donor for the foreseeable future.


Stock Report: Allscripts Healthcare Solutions (MDRX) - 20150106 MDRX EHR GainLoss





Based on our assessment of the market, we believe bookings growth will slow over the course of 2016, and expect the multiple to compress as a result. Historically, there has been a 0.85 correlation between bookings growth YoY and the change in forward multiple. This results in a stock price closer to $10 on a trend duration.


We expect our thesis to play out on both a trend and tail duration. Our key thesis points are as follows:

    Data continues to show ambulatory and inpatient share losses. We expect this trend to continue as large health systems consolidate and value-based reimbursement drives the need for a single inpatient EHR. On the ambulatory side (~50% sales), Allscripts will continue to lose business (prospective and current) to peers athenahealth and eClinicalWorks, both of whom surpass Allscripts in interoperability and outsourcing capabilities. We will be receiving quarterly market share updates to monitor our thesis, and will continue to update our proprietary trackers.
    While Allscripts reputation has markedly improved since the dark days of 2012-2013, the reality is that the damage is already done. Many Hospital Executives refuse to include Allscripts in RFPs and estimates of mind share vs. market share do not bode well for bookings growth. Based on industry ratings and anecdotes, the probability of Allscripts unseating the current acute care EMR vendor at any large IDN is low. We will continue to collect anecdotes from industry participants, including current Allscripts customers. 
    Current valuation appears to be supported by accelerating sales growth in 2018-2019 from low single digits to mid-teens. In order for this to occur, bookings would need to sustain +25% growth and backlog conversion would need to accelerate. With system sales in secular decline, new contract lengths ranging from 5-10 years and for the reasons outlined above, we find this unlikely.

Stock Report: Allscripts Healthcare Solutions (MDRX) - 2015 01 06 EHR SHare Losers Gainers




Allscripts has amassed a large install base, and currently ranks 3rd in Ambulatory EHR market share. Share losses at Allscripts will come at both ends:

  1. Competitive displacement from the likes of athenahealth and eClinicalWorks and
  2. Health system consolidation resulting in the rip and replace of the legacy system.

On the last point, the shift to value-based reimbursement will likely accelerate health system consolidation in the coming years. The vendors that survive will be the ones who invest in the usability and interoperability of their products, and whose incentives are aligned with that of the physician. Allscripts does not rank favorable in either of these categories.


While there will certainly be volatility along the way, on a tail duration we believe the stock can reach the $5-7 level. 


Click here to watch a video of Healthcare analysts Tom Tobin and Andrew Freedman laying out their MDRX short thesis.


Stock Report: Allscripts Healthcare Solutions (MDRX) - HE MDRX chart 1 14 16


Cartoon of the Day: Bullard Befuddled

Cartoon of the Day: Bullard Befuddled - Fed grasping cartoon 01.14.2015


"Earlier today, St. Louis Fed James Bullard said market-based inflation expectations were becoming 'worrisome' after he was so hawkish a month ago," Hedgeye CEO Keith McCullough noted today.


We'll say it again. One of the biggest risks to financial markets right now is believing the Fed's economic forecast.

RH | Our Thoughts on Price Action

Takeaway: We think risk is isolated to the multiple, not earnings, and that’s what matters most at a trough 16x p/e and 33% short interest.

We’ve been flooded with calls today on the RH price move – and we should be. We’re the big Bulls on the name, and lately it wants to do nothing but go down.


The stock is moving on no news, no sell-side calls, no conference presentations, etc… We don’t think that the 1010 Data Read-Thru is relevant in this instance.


We’re as confident as ever that NEAR-TERM earnings expectations are completely in check, and that long-term earnings are too low. And we’re as sure as we can be that we’re not about to be blindsided by any kind of press release from the company about management, business trends, or promotions.


We’re now looking at short interest at historical PEAK (33% of float), and the multiple setting a new historical trough (16x).  Put another way, we’re talking a 16x multiple for a 40% EPS grower.


Obviously, the market thinks we’re wrong in our earnings math.  We’re absolutely not ignoring a material slowdown in the economy or Hedgeye’s bearish Macro view. We simply think that RH should still do better than the consensus in that environment, and that’s what we’re focused on given the massive 40% correction since November, and 20% month-to-date in Jan. 


In the end, we think the risk is isolated to the multiple, not the consensus earnings, and that’s what matters most at a 16x p/e and 33% short interest


The key concerns we hear when talking to investors is centered on the 4Q print which won’t be out until late March, and what guidance for 2016 will look like. That’s centered on a few key issues that the CEO brought to the table on the last earnings call; notably Macro headwinds (particularly in oil affected markets like Houston) and Promotional pressure in the home furnishings space.   The ‘wall of silence’ is definitely a concern, as eight-weeks of no info won’t help anyone except the shorts. But our sense is that the company will make some kind of statement about business trends, growth plans, or earnings near quarter-end.


Numbers for the upcoming quarter look to be in check. Due to the following…

1) RH issued guidance on 12/10 with only 6 weeks left in the quarter and most purchase orders in the company’s hands given that the delivery window is 8-12 weeks and RH doesn’t recognize revenue until an order has been delivered.

2) As of 12/10, RH was tracking ahead of its guidance on the top-line which calls for revenue growth of 21-23%. Other than the verbiage, RH hasn’t changed up its promotional posture materially since the added event in mid-December. If, RH needed to make up ground on the top line in a quarter where it absolutely can’t miss we think the company would have pulled another promotional lever.

3) Gross margin guidance calls for 100bps of deleverage, giving the company plenty of room to promote if needed to drive the top line and market share. Coupled with meaningful SG&A leverage we still get to 150bps of EBIT margin expansion in the quarter.


Full thoughts on our outlook over a Trend duration see note below.



RH | It’s Us vs Them


Takeaway: Here’s a detailed overview of where we’re different from the Street, by line item, in each quarter in 2016. RH needs to deliver. It will.


More than any other company/issue we've had questions on since 2016 kicked into high gear,  RH takes the cake – and more specifically, its near-term earnings trajectory. We’d peg it at roughly a dozen queries in just two days, which is very big for us. We’re not surprised, and we agree 100% with the impetus for the concern. We believe fully in the long-term call, and believe now as much as ever that there’s $11 in earnings power, and that people will actually start to believe it within a year.  But the cold hard fact remains that the tactical game changed in December due to promotional activity, perceived economic sensitivity, and timing issues around concept and new store launches.


We can talk all day about the 2-3 year economics of new categories ramping up sales into bigger stores at lower rents. But the fact is that if RH misses revenue and/or earnings in either of the upcoming two quarters, $11/ps in future earnings won’t mean squat, and this multiple will deflate faster than a game ball in Foxboro (sorry Patriots fans).


As such, in the tables and charts below, we compare where we shake out in each of the next four quarters versus consensus, with particular focus on Sales, Gross Margins, SG&A, and EPS in 1H16.  The punchline is that we’re ahead of the Street every quarter on EPS, and are coming in at $4.48 for the year vs the Street at $3.94. The good news is that this is almost entirely top line driven throughout the year, with SG&A leverage to go with it. The downside is that we’re more conservative in both 1Q and 2Q than the Street on Gross Margin.  When all is said and done, however, we think that a better comp and higher EPS will trump lower GM, given that weakness in the latter is so well telegraphed.


[As a point of reference, we’re going to vet every single part of the RH Bear Case across durations in a Black Book to be released on January 25th (1pm EST presentation). We won’t necessarily disprove all of it, but we will fully analyze it. Stay tuned for details.]


EXHIBIT 1: Hedgeye P&L Variance vs Consensus

RH | Our Thoughts on Price Action - RH Trend 1   Summary Table 



EXHIBIT 2: RH Revenue, Hedgeye vs Consensus

4Q15: To get to the streets #’s for 4Q (mid-point of guidance) need to assume a big ramp in the 2yr trend from 16% to 23%. That reacceleration = $79mm in sales. If we attribute all of that to Modern/Teen we have to make modest assumption that M/Teen books run a productivity rate of just 45% of Spring mailings. That would be what we’d consider an obscenely low performance. Plus RH guided down margins appropriately to win market share. It appears to be working. Top line should not be an issue.

1Q16: Modern/Teen not a 1-quarter event – this builds sequentially. Look at big Source Book revamp in 2Q/3Q14 for proof. Plus, vendor network is the M/T revenue bottleneck, not consumer demand. That’s not a bad position to be in.

2Q16: Continued benefit from Modern & Teen, plus newest design galleries (Chicago, Denver, Tampa, Austin + LA Modern) will have more material impact to topline. Increased marketing spend in the form of source book pages.

RH | Our Thoughts on Price Action - RH Trend 2   Rev Chart 



EXHIBIT 3: RH EBIT Margins, Hedgeye vs Consensus

4Q15: Promotional environment pressure takes margins down in 4Q. Guide for -100bps on GM likely overshot to the downside. SG&A leverage from Source Book savings and scale in the model.

1Q16: Assume that promotional pressure persists, coupled with DC occupancy deleverage, and higher shipping cost – offset by one more quarter of SG&A leverage as Source Books savings amortized over 12 month window. Strong top line flows through.

2Q16: Promotional pressure eases, product flow normalizes and retail occupancy starts to kick in. Take spending up on marketing to drive top line.

RH | Our Thoughts on Price Action - RH Trend 3   GM Chart



EXHIBIT 4: RH EPS, Hedgeye vs Consensus

4Q15: Expectations in check for 4th quarter, and RH has to deliver. Sales expectations assume a big acceleration, but product pipe, new galleries, and market share efforts will drive 35% earnings growth even with GM pressure.

1Q16: Street underestimating how long tail is on Modern/Teen product. RH will push envelope to take market share. Enough SG&A levers left to offset any GM pressure.

2Q16: New galleries + Modern/Teen + increased marketing dollars = strong top line. Modest EBIT margin leverage. Street too low by $0.10.

RH | Our Thoughts on Price Action - RH Trend 4   EPS Chart



EXHIBIT 5: RH Peak, Mid, Trough Valuation and Sentiment Summary

Any way you cut it, RH is sitting near a trough valuation on all metrics, and within 200bps of peak short interest (currently 29%). In fairness, RH has trading history for only half of the current economic cycle – but for the stock to be anything other than egregiously cheap at $78, we need to be more wrong on the fundamentals than we’ve been on any name in a very long time.

RH | Our Thoughts on Price Action - RH Trend 5   Valuation 2

Daily Trading Ranges

20 Proprietary Risk Ranges

Daily Trading Ranges is designed to help you understand where you’re buying and selling within the risk range and help you make better sales at the top end of the range and purchases at the low end.

REPLAY of The Macro Show: Why Markets Are Crashing



CLICK HERE to watch the replay.

REPLAY of The Macro Show: Why Markets Are Crashing  - TMS replay final

The Macro Show Replay | January 15, 2016


Fact Or Fiction? Stocks Headed For A Crash

Takeaway: If you're into Old Wall fiction close this post right now.

Fact Or Fiction? Stocks Headed For A Crash - Bubble bear cartoon 09.26.2014  1


Still with us? Okay. Here's the (unfortunate) painful reality for investors who were long U.S. equities heading into 2016. (Note: We've been avoiding equities, net short, since last July.) 


It's a sea of red. 



Despite today's bounce, remember that market conviction and bearish sentiment continues to grow...



Where do U.S. equities go from here?




Click the Image below to enlarge and Understand why...

Fact Or Fiction? Stocks Headed For A Crash - EL profits



That's all from us.

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