Ensign Posts Record Q3, Lifts Guidance as Census Rises and 8 SNFs Join Portfolio

San Juan Capistrano, CA — The Ensign Group reported record third-quarter results and raised its full-year outlook, as occupancy climbed and the operator expanded with eight newly acquired skilled nursing facilities in Utah and Alabama. The company also accelerated a physician-led care model it says is helping cut readmissions and bolster managed care growth.

Record quarter and higher outlook

Ensign’s total revenue reached $1.24 billion in the third quarter, up 19.9% from a year ago, according to the company’s earnings release. Net income rose 18.2% to $84.5 million, while adjusted operating margins expanded to 22.1%. Managed care revenue increased 12% to $215 million, reflecting deeper partnerships with national payers.

Same-facility census climbed to 85.2%, the strongest quarterly momentum Ensign has reported in two years. Revenue per patient day increased 3.1% to $285, aided by a higher-acuity mix.

Backed by the results, Ensign lifted its 2025 guidance. The company now expects net revenue between $5.905 billion and $5.955 billion, adjusted EBITDA of $1.235 billion to $1.255 billion, and diluted EPS of about $6.54. “Our census momentum is real and sustainable,” CEO Barry Port said on the earnings call, crediting the operator’s regional “cluster” strategy that concentrates facilities around referral sources.

Footprint expands in Utah and Alabama

Ensign announced acquisitions of seven skilled nursing facilities in Utah from Stonehenge Healthcare and a 90-bed facility in Birmingham, Alabama. The deals add roughly 650 beds and bring Ensign’s portfolio to 332 skilled nursing facilities and 26 senior living communities nationwide. Terms were not disclosed; industry estimates place the Utah portfolio in the $150 million to $200 million range based on typical sector multiples.

The Birmingham addition, The Health Center of Eastview, marks Ensign’s first owned operation in Alabama and extends its reach in the Southeast, where Medicare Advantage penetration continues to rise. Port said the company has “significant bandwidth” for 10 to 15 additional transactions in its pipeline.

Physician-led transitional care gains traction

Ensign is deepening clinical integration through physician-led transitional care units (TCUs) now operating in 15 facilities. The company employs or contracts with about 120 primary care physicians, who are embedded on-site to manage short-stay, higher-acuity patients and coordinate directly with hospitals. In pilot programs, the model has reduced hospital readmissions by 15%, executives said.

Industry observers say the approach aligns with value-based care incentives and is contributing to the operator’s payer mix shift. Managed care now represents about 35% of Ensign’s revenue, up from 28% last year, according to company figures. “Physician involvement isn’t a buzzword; it’s transformative,” said Dr. Christopher Longhurst, Ensign’s chief physician executive, noting that on-site coverage is speeding discharges and smoothing handoffs.

Regulatory readiness and cost pressures

Like peers, Ensign is preparing for the federal minimum staffing rule that phases in through 2026. Leaders emphasized compliance planning and said the physician services arm is designed to complement, not replace, nursing teams. Labor costs rose 4.5% year over year in the quarter, a continued headwind across the sector.

Even so, Ensign’s balance sheet remains conservative. The company ended the quarter with a debt-to-EBITDA ratio of 1.2x, repurchased $50 million in shares, and reported strong free cash flow despite acquisition activity. Shares rose about 8% the day after earnings, according to market data.

Nationally, skilled nursing occupancy has rebounded to 82.3%, industry data show, as post-pandemic admissions recover and demographics add demand. Analysts expect Ensign to benefit from that backdrop, as well as a 2.5% Medicare rate increase slated for fiscal 2026. “They’re outpacing peers in census recovery, with physician services likely adding to margins,” a Jefferies research note said, while cautioning that staffing compliance could pressure costs.

Advocacy groups were cautiously optimistic. In a social media post, LeadingAge CEO Katie Smith Sloan called Ensign’s growth “encouraging,” adding that models integrating physicians could help sustain care in rural markets if paired with regulatory flexibility.

Ensign said integration of the new Utah and Alabama sites is underway, with rebranding and clinical upgrades expected to continue through year-end. “We’re not just acquiring; we’re building care ecosystems,” Port said. “That’s what’s driving durable census and outcomes.”