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The Lhc Group Analysis Health And Social Care Essay
With the new administration and new Congress, the United States of America is very much focused today on reforming and re-making its health care system to develop and advance the quality of health care, while making it accessible to a greater number of people. Thus, another aim is to lessen the cost. As the United States now finds new solutions to its many health care problems, finds new researches and room for innovation, home health indeed play not only a serious, but also a vital role in dealing more effectively with post-acute care, and effective management of chronic illnesses, especially in light of America's rapidly aging population (AHHQI, 2009).
Home health has already demonstrated as being clinically sophisticated, cost-effective and patient-preferred, "based on its experiences with millions of patients and their families, multiple examples of medical advances and positive outcomes at home, and a growing body of research from home care organizations and independent sources" (AHHQI, 2009). One of these health care providers is the LHC Group, which is the topic of this "analysis of health care agency" paper. This introduction serves to brief us with LHC's history, services, function in the community. In the last part of this analysis paper, however is the study of the groups' finances based on the documents cited in the reference page.
History
St. Landry Home Health, Inc that was founded in September of the year1994 was the first name of what is now known as the LHC Group. Operations began officially in Palmetto, which is described by the LHC group as a "sleep little town in northern St. Landry Parish". It is located in the bottom part of Louisiana. That little clinic industry was driven to serve, and so a single home health agency grew to be the LHC Group. At present, LHC Group has about 6000 skilled employees in various locations or states such as in Louisiana, Georgia, Texas, Ohio, Florida, Mississippi, Virginia, Arkansas, Oklahoma, West Virginia, Alabama, Kentucky, Tennessee, Missouri, North Carolina, Maryland, Washington and Oregon.
It is traditionally believed that any architect will tell one that the strength of any structure resides primarily within the foundation and the framework. In this line of thought, LHC Group is not at all an exception (LHC group, 2010). Their staffs are proven by years as people who are always willing to lend their unique talents and years of industry experience to the good of the organization as a whole.
In addition, the LHC Group has been grateful as over the years, the group has been working and employee many talented, capable, and nurturing professionals. The services the group offers are provided by a trained physicians, therapists, staff of nurses, and aides. These staff, aside from professionalism, also realizes the significance of and works diligently to "implement the corporate mission; the foundation of which involves simply….to provide care in the least restrictive, most cost effective and appropriate environment possible." (LHC inc., 2010)
Today, the LHC Group presents various lines of services such as the following: home health care, hospice, Philips Lifeline, inpatient and outpatient rehabilitation, long-term acute care, private duty nursing, diabetes self-management, and wound care.
Mission
In its most basic, the guiding philosophy or principle of the LHC Group is this-"it's all about helping people." LHC is an organization that offers various health care services. These various health and care services also come up with a comprehensive health care package that values the patient's needs first. Their services are said to be non-restrictive and cost effective, but are the same time promises to be maintaining the privacy and other needs of those who chose and avail their programs. Also, the physician and family of the patients are not only informed, but are also involved in every step. (LHC Group, 2010)
Facilities
The following report on LHC GROUP INC (LHCG: NASDAQ) is from The Business Week states thus:
LHC Group, as of December 31, 2008, owned and operated 206 home nursing locations, 19 hospices, and 7 long-term acute care hospitals. It has joint venture agreements with Woods Memorial Hospital to provide healthcare services in four counties in Tennessee; and Hardin Medical Center to offer home health care services in six counties in Tennessee. The company was founded in 1994 and is headquartered in Lafayette, Louisiana (2010). Other facilities they have shall be discussed or describe later.
Staff
Board of Directors
Keith G. Myers, President or Chief Executive Officer.
Peter J. Roman, Executive Vice President or Chief Financial Officer.
Donald D. Stelly, Executive Vice President or Chief Operating Officer.
Peter C. November, Executive Vice President or General Counsel and Director of Business Development.
Daryl J. Doise, Executive Vice President or Chief Corporate Development Officer.
Stephen Lepley, Senior Vice President for Sales and Marketing.
Richard A. MacMillan, Senior Vice President or Senior Counsel, Legislative and Regulatory Affairs.
Rajesh Shetye, Chief Information Officer.
LHC GROUP SERVICES
LHC makes that option accessible to the clients by controlling non-patient care expenses. This has allowed LHC group to offer more patient visits than other service-providers. LHC Group has at all times been dedicated in establishing and emphasizing trust with each employee within the organization. This is done so in order to cultivate an equally valuable relationship between the group and the individual employee and, also to minimize turnover and to improve the kind of care they provide
As organizational presentation and quality of work life model and it represents an open systems perspective with minimal boundaries between the organization and external environment. This focus on the quality of work is also the aim of the LHC group. Again, the philosophy of the LHC Group is service to the people. The following are the services they offer, under the home and facility based.
Home-based
Now employing more than 6000 skilled employees in various states, LHC Group actually started as a single house. Their programs have both home-based and facility-based services. Their Home Based Services include first the "Homecare" program. Second is the "Hospice," And last is the "Philips Lifeline Personal Response System" (LHC group, 2010).
Â
.
Homecare- This is becoming more popular because of the rising cost of health services. Aside from the lesser financial burden, this kind of service gives the person's the privilege of enjoying the comfort of one's own home. The LHC Group also maintains that: "For many patients, recovering in the comfort of their own homes truly benefits the healing process. Being close to family in an environment that puts them at ease is an ideal setting for improving their health" (LHC Group, 2010).
The group provides healthcare-related services. These are served by medical professionals in the comfort of one's own home. The LHC Group's services cover a wide range of social, medical, and therapeutic treatments. Their services also include activities associated with daily, normal living. Also, as a licensed home care provider, the LHC provides a wide range of services, and these includes diabetes management, catheter and tube care, n-home therapy and rehabilitation, cardiac and respiratory monitoring, wound care, and pain management.
Hospice. Hospice is meant to provide comprehensive comfort care for those who are inflicted with life-limiting diseases. At some point in their care, it's not uncommon for hospice patients to experience extreme and continuous discomfort. This can include fatigue, depression, physical pain, and shortness of breath. As for those patients, we provide specialized palliative care, which is medical specialty is centered on aggressive, but at the same time remains safe pain management treatments. Such treatments can dramatically improve the patient's comfort and quality of life.
While it usually means there is no further curative treatment to offer when a patient is admitted in a hospice, it does not mean that all treatment will be discontinued because the focus is now on improving quality of life, encouraging the patient to live life to the fullest until the end. Aggressive pain and symptom management will be provided to the patients with the assurance of a peaceful death. In addition, the LHC provide means to managing physical pain. Also, there are counselors who address emotional and spiritual issues of the patient and family their condition. Anyone facing a life-limiting illness may be eligible for hospice care. (LHC Group, 2010).
Â
Philips Lifeline- While living in the comfort of one's own home and enjoying its privacy, with this service, the patients are assured that in a press of a button someone will be there to help them. Whenever the patients need help, all they need to do is to simply press the lightweight, waterproof help button, because this already activates a small in-home unit called a communicator. This communicator then puts the patient in touch with a caring Lifeline Monitor that talks about which kind of assistance is needed.
This Lifeline Monitor is also able to call one of your friends, neighbors or relatives who are the responders, and who will come to the patient's home for response. If professional help is needed, the Monitor will immediately call for it. And if the button is pressed, but cannot speak, Lifeline Monitor knows exactly what to do (LHC Group, 2010). With Philips Lifeline, loved ones are rest assured that a person is, secure and happy in your home. The Philips Lifeline System simply costs $1 per day with no installation fee.
Facility-based
On the other hand the Facility Based Services include: first, "Therapy. Second is the "Long-Term Acute Care." Lastly is the "Family Fitness:
Family Fitness- conducted in the Louisiana Physical Therapy & Family Fitness Center wherein the facility and expert staff offers more than what regular clubs and gyms do.
Long term acute care- This kind of service is an aimed to give an individualized attention to each patient in accordance with their need for a healthy and successful recovery. This is for a long-range, and beyond traditional hospitalization program. Because LHC Group is a leading provider of post-acute care services in the region, they are in turn able to build a strong team of medical specialists to care for their patients.
Leading this program offered by the LHC is their physician group, which has extensive experience in the various long-term acute care specialties. This multidisciplinary team also includes: Advanced Cardiac Life Support Nurses, Respiratory Therapists, Occupational Therapists, Physical Therapists, Speech Therapists, Dietitians, Case Workers / Social Workers (LHC Group, 2010).
Therapy- LHC's therapy program aims to help and to encourage the people who are recovering from a more serious illness or injury. LHC Group makes it a point to note that no two patients are alike, and thus, their programs are also varied and are dependent on the needs of the patient (LHC Group, 2010). Their multidisciplinary team, therefore carries out an premilinary evaluation to help determine the extent of therapy that will be required.
"With the involvement of the patient's physician, we then develop a personalized program of care that addresses all aspects of the patient's health. Throughout the course of treatment, the patient receives regular follow-up evaluations to assess his or her progress and, if necessary, adjust treatment" (LHC Group. 2010). Some injuries and dysfunction addressed are the following: orthopedic injuries, fractures, lymphedema, dislocations, overuse injuries, total joint replacement and TMJ dysfunction.
FINANCIAL STATEMENTS
The following forward-looking statement included in this section is LHC's current views this report is filed with the Securities and Exchange Commission. It is called as the Form 10-K, an annual report of the company's financial statement. Additionally, the selected consolidated financial data presented below is derived from our audited consolidated financial statements included in this Annual Report on Form 10-K as of and for each of the years ended December 31, 2008, 2007 and 2006. The selected consolidated financial data presented beneath as of and for each of the years ended December 31, 2004 and 2005 is derived from our audited consolidated financial statements not included in this Annual Report on Form 10-K. Management's Discussion and Analysis of Financial Condition and Consolidated Results of Operations included herein.
(LHC group inc., 2010, from the form 10-K)
General Administrative Expense
General Administrative Expense is also known as the company's expenses in maintaining or keeping the company in cycle. The LHC group operates in two subdivisions for the financial reporting purposes namely. These two divisions are described above as the home-based services and facility-based services.
The general and the administrative expenses are primarily consiste of the following expenses. These are incurred by the LHC Group's home office and administrative field personnel: Home office, insurance, salaries and related benefits, supplies and services, costs associated with advertising and other marketing activities, and rent and utilities, accounting, professional services legal and office supplies, other, depreciation and other such as advertising and operating locations rent; recruitment; and taxes marketing expenses.
For the year ended December 31, 2008, the general and administrative expenses were reported to be $124.4 million, an increase of $28.0 million, or 29.1%, from $96.4 million for the year ended December 31, 2007. General and administrative expenses represented approximately 32.5% and 32.3% of our net service revenue for the years ended December 31, 2008 and 2007, respectively. (LHC inc., 2010, p. 51)
The LHC Group, just like the any other company, prefers leasing although the health care group already has few numbers of owned lot and building. Annually, the LHC Group's leases costs $7,699, for one-three years $9,103, and has a total of $19,049 approximately (LHC inc., p. 58)
Also, there are non-operating income for the year ended December 31, 2007 that costs $1.1 million, a decrease of approximately $900,000 from $2.0 million for the year ended December 31, 2006. Non-operating income in 2006 includes $1.0 million in proceeds received from the life insurance policy
Income Statements (Annual Data)
Operational Cost
Operating leases is also one of the elements to maintaining the company in process. LHC's operational leases for one-year costs $7,699, for one-three years $9,103, and has a total of $19,049 more or less. Indeed, it costs the company much however leasing is more preferably in this kind of business for easy liquidation if ever their business bankruptcy. Additionally, cost initial capital requires sum of money, leasing can lessen that sum of money.
All of LHC inc. operations are based in the United States, therefore 100% of its revenues from external customers for the years ended December 31, 2008, 2007 and 2006 and 100% of our long-lived assets were attributed to the United States. (LHC inc., 2010, p. 8)
Computers and other tools cause operational costs too. For a business to operate efficiently having enough facilities, tools, equipments and the like are necessary too. However, the cost-benefit and effectiveness of a product or service must be analyzed in order to gain back the profit. Since, equipments, tools, and system require maintenance it affects largely the operational cost in a business.
The federal government's Medicare program, governed by the Social Security Act of 1965, that reimburses health care contributors for services furnished to Medicare beneficiaries are but other element that affects the operational cost of the company. Persons of age 65 and older and those who are chronically disabled are the only beneficiaries of this kind of program. Individuals of age 65 are but a small sector of vast possible client of LHC still it largely affects not just the operational cost but as well as the cash flow in the system.
The salary of company's staff is also, but, a big part in operational costs. Healthcare agency such as LHC is expected to have not just good facilities but quality service too, which can be provided by its medical staff.
Moreover, the LHC is much ready to meet the needs in order to function for the welfare of the many. For in a business, necessarily, expects an initial or capital in order to put up an existing system. Afterwards, a good management in the budget will eventually result to huge income.
Operational Revenue
Healthcare agency like the LHC Group unlike the city hospital, admit an ill person or sick on the conditions that it will give a down payment first. Because of its procedure, the revenue is expected to be higher than the ordinary hospital. This kind of business offers a specialty in a field, for example in hospice service, which is paid with high amount. Therefore, LHC's revenue as the records shows in the lower part of this paper, the revenue or income is much higher than the operational costs and diluted outcome.
As LHC Group announces its third quarter 2009 results, the net service revenue increases 35.2% to $132.5 million, while the net income attributable to LHC Group increases 22.4% to $9.8 million, and the diluted earnings per share increases 20% to $0.54. (LHC group, 2010)
Loans and Insurance Benefits
In the Form 10-K, joint ventures of the company are structured as limited liability companies in which the Company typically owns a majority equity interest ranging from 51% to 99%. (LHC inc., 2010, p. 58) Since, every member of all but one of the Company's equity joint ventures participates in profits and losses in proportion to their equity interests. The Company consolidates these entities as the Company absorbs a majority of the entities' expected losses, receives a majority of the entities' expected residual returns and generally has voting control over the entity. (LHC inc., 2010, p. 59)
Records show derived 85.1%, 81.9% and 75.4% of the company's net service revenue during the year ended December 31, 2008, 2007 and 2006, respectively, from its home-based services segment and derived the balance of net service revenue from LHC's facility-based services segment. (LHC inc., 2010, p.44)
Gross Profit
Sales minus cost of goods sold are the process of arriving for a gross profit. In LHC's case the goods it sale is healthcare services and the buyer is no other than those who are not well or physically not well and willing to pay in order to be cured. In order to determine the gross profit the general administrative expenses is subtracted from the income of the company. As of 2009, the gross margin is $196,447. (LHC Group, 2010)
Net Service Revenue
As the Paul Rolfes puts it in his report about LHC Group: The leader in home-health care:
In a changing Medicare-reimbursement environment and poor overall economy, LHC reported for 2007 that net service revenue increased 36.4% to $298 million, with 81.7% of it coming from Medicare. Net income slipped to $19.6 million, or $1.10 a share, compared with $20.6 million, or $1.20 a share, for 2006. The 2007 results included a $1.7 million loss from discontinued operations. The fourth quarter fell short of expectations, and SunTrust Robinson Humphrey analyst David MacDonald called it a "sloppy" quarter. (2008)
On the other hand, net service revenue for the year ended December 31, 2009, increased 39.0% to $532.0 million compared with $382.6 million in 2008. (LHC inc., 2010)
In the Form 10-K, consolidated net service revenue for the year ended December 31, 2008 was $383.3 million, an increase of 28.6% or $85.3 million from $298.0 million for the same period ending December 31, 2007. The increase in the home- based services net service revenue contributed $81.9 million of the increase in consolidated net service revenue between 2008 and 2007. Net service revenue was comprised of the following for the periods ending December 31: Home-based services with 85.1% in 2008 and 81.9% in 2007, while the Facility-based services 14.9 last 2008 and 18.1. (LHC inc., 2010, p. 49)
Balance Sheet
Below is a copy from the Form 10-K of LHC Annual Financial Report:
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEET
Â
(amounts in thousands, except share data)
Â
Â
Â
ASSETS
December 31
2009
2008
Current assets:
Cash
$394
$3,511
Receivables:
Patient accounts receivable, less allowance for uncollectible accounts
73,651
61,524
of $8,262 and $9,976, respectively
Â
Â
Other receivables
3,850
2,317
Amounts due from governmental entities
1,184
2,434
Total receivables, net
78,685
66,275
Deferred income taxes
4,987
4,959
Prepaid income taxes
2,514
-
Prepaid expenses and other current assets
8,798
6,464
Total current assets
95,378
81,209
Property, building and equipment, net
21,361
16,348
Goodwill
139,474
112,572
Intangible assets, net
46,851
29,975
Other assets
3,169
3,296
Total assets
$306,233
$243,400
It is evident that the total assets for 2009 increases while other assets decline. The balance sheet shows that LHC receivables from 2008 to 2009 increase, as well as the prepaid expenses and other current assets. As the assets grows, the allotted net for property, building and equipment increases too. This shows that the company is doing very well in their field.
Cash Flow
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
(amounts in thousands)
(unaudited)
Â
Year Ended
December 31,
Â
2009
2008
Operating activities
Â
Â
Net income
$Â 57,814
$Â 41,878
Adjustments to reconcile net income to net cash
Â
Â
 provided by operating activities:
Depreciation and amortization expense
4,831
3,740
Provision for bad debts
4,724
12,463
Stock-based compensation expense
2,393
1,935
Deferred income taxes
4,029
462
Loss on impairment of intangible assets
542
 -
Gain on sale of assets and partial sale of entity
 -
-967
Changes in operating assets and liabilities, net of acquisitions:
Â
Â
 Receivables
-17,896
-597
 Prepaid expenses and other assets
-4,130
4,155
 Accounts payable and accrued expenses
-1,550
20,549
 Net amounts due to governmental entities
-1,565
1,886
Net cash provided by operating activities
49,192
85,504
Â
Â
Â
Investing activities
Â
Â
Cash paid on acquisitions, primarily goodwill, intangible assets and advance
-33,427
-69,898
payment on acquisitions
Purchases of property, building, and equipment
-8,236
-8,550
Proceeds from sale of property and equipment
 -
3,094
Purchase of certificate of deposit
-
-522
Net cash used in investing activities
-41,663
-75,876
Â
Â
Â
Financing activities
Â
Â
Proceeds from line of credit
69,206
32,850
Payments on line of credit
-63,483
-32,850
Proceeds from debt issuance
 -
5,050
Principal payments on debt
-508
-3,339
Payment of deferred financing fees
-263
-75
Payments on capital leases
-80
-101
Excess tax benefits from vesting of restricted stock
121
91
Proceeds from issuance of common stock under ESPP
618
493
Purchase of additional controlling interest
-2,286
 -
Noncontrolling interest distributions
-13,971
-9,391
Net cash used in financing activities
-10,646
-7,272
Change in cash
-3,117
2,356
Cash at beginning of period
3,511
1,155
Cash at end of period
$Â 394
$Â 3,511
Supplemental disclosures of cash flow information
Â
Â
Interest paid
$Â 142
$Â 456
Income taxes paid
$Â 35,869
$Â 8,937
(LHC Inc., 2010)
The following table summarizes changes in cash flows (amounts in thousands):
Â
Year Ended
Â
Â
December 31,
Â
Â
2008
Â
Â
2007
Â
Cash provided by operating activities
$
85,504
$
12,014
Â
Cash used in investing activities
Â
(75,876)
)
(32,281)
)
Cash used in financing activities
Â
(7,272)
)
(5,455)
)
Â
Â
Â
Change in cash
Â
2,356
(25,722)
)
Cash and cash equivalents at beginning of period
Â
1,155
26,877
Â
Â
Â
Â
Cash and cash equivalents at end of period
$
3,511
$
1,155
Â
(From Form 10-K of Annual Financial Report of LHC inc.)
The data shows that investing activities used $75.9 million and $32.3 million in cash for the years ended December 31, 2008 and 2007, correspondingly. (LHC inc., 2010, p. 56) Then, in 2008, $69.9 million is the accounted acquisitions of the cash used in investing activities compared to $28.9 million in 2007.
The reported cash flows from operating activities are impacted by various external and internal factors, such as: Timing acquisition, Operating Results, Timing Payrolls, Start-Up Costs, Medical Supplies, and Medical Insurance Plan Funding. (LHC inc., p. 55)
It is very evident that the flow of cash from 2007 to 2008 increases as well as the cash in investing used in financing and activities.
Index
The following are news regarding the LHC board of directors which reflects the business growth and system:
Filed by LHCG last Sep. 16, 2009:
"CEO and President, 10% Owner of LHC Group (LHCG) Keith G Myers sells 129,791 shares of LHCG on 09/16/2009 at an average price of $30.03 a share.
LHC Group provides post-acute healthcare services primarily to Medicare beneficiaries in rural markets in the southern United States. They provide home-based services through their home nursing agencies and hospices and facility-based services through their long-term acute care hospitals and outpatient rehabilitation clinics. Lhc Group has a market cap of $557.3 million; its shares were traded at around $30.21 with a P/E ratio of 13.5 and P/S ratio of 1.5."
An article from Business Wire last January 8, 2009 about Definitive Agreement Signed; Affects 1.6 Million Residents in Southeast Louisiana:
"LAFAYETTE, La.--(BUSINESS WIRE)--Jan. 8, 2009--LHC Group, Inc. (NASDAQ: LHCG), one of the largest providers of home nursing services in the United States, and New Orleans-based Ochsner Health System, today announced a definitive agreement to enter into a joint home health venture allowing both organizations to better serve 1.6 million residents in southeast Louisiana.
The joint venture includes an LHC Group purchase of 75-percent of two home health agencies, currently owned by Ochsner, in Kenner and Raceland, Louisiana, and an Ochsner purchase of 25-percent of three home health agencies, currently owned by LHC Group, in Houma, Lutcher and Hammond, Louisiana. The transaction is expected to close on February 1, 2009.
"Ochsner and LHC Group support this partnership because it's the best move for home health patients in southeast Louisiana. This decision increases Ochsner Home Health locations and patient accessibility to additional home health services provided by LHC Group," said Warner Thomas, President and Chief Operating Officer of Ochsner Health System. "LHC Group's proven leadership in the home health industry is an assurance to our patients."
Keith G. Myers, Chief Executive Officer of LHC Group, added, "Ochsner Health System has a reputation for excellence, and we are proud to become their partner. LHC Group and Ochsner share a common goal of providing high quality patient care in an environment that is exciting and rewarding for our employees and caregivers. Together we intend to develop a home health partnership that will serve as the standard of excellence in the greater New Orleans area and throughout southeast Louisiana."
For more than 100 Ochsner Home Health employees, effective February 1, 2009, they will become employees of LHC Group. "We welcome the new employees who will become part of the LHC Group family through this joint venture. We are dedicated to their continued success and look forward to providing them with the same commitment to employee satisfaction that they experienced during their tenure with Ochsner," says Myers."
Besides, there are some services of LHC which is not-for-profit like the Ochsner Health System. Beneath this is the information on the said service:
Ochsner Health System (www.ochsner.org) is a non-profit, academic, multi-specialty, healthcare delivery system dedicated to patient care, research and education. The system includes seven hospitals and over 35 health centers located throughout Southeast Louisiana. Ochsner employs more than 750 physicians in 90 medical specialties and subspecialties and over 300 clinical research trials annually. Ochsner has been listed as one of the "Best Places to Work" by New Orleans City Business since 2005 and received the Consumer Choice for Healthcare in New Orleans for 13 consecutive years. Ochsner was ranked as "Best" Hospital by U.S. News and World Report in 2007. Ochsner has 11,000 employees system-wide.
Certain matters discussed in this press release constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Such forward-looking statements may be identified by words such as "believe," "expect," "anticipate," "intend," "estimate" or similar expressions. Forward-looking statements involve a number of risks and uncertainties and there can be no assurance that any forward-looking statements will prove to be accurate. Important factors that could cause actual results to differ materially from those anticipated in the forward-looking statements include: changes in reimbursement, changes in government regulations, changes in our relationships with referral sources, increased competition for our services, increased competition for joint venture and acquisition candidates and changes in the interpretation of government regulations.
LHC Group undertakes no obligation to update or revise any forward-looking statements. Further information regarding risks, uncertainties and other factors that could adversely affect LHC Group or cause actual results to differ materially from those anticipated in forward-looking statements are included in LHC Group's Form 10K for the year ended December 31, 2007, as amended, filed with the Securities and Exchange Commission. (LHC Group, Inc., 2009)
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