A month has gone by since the last earnings report for Select Medical (SEM). Shares have lost about 55.9% in that time frame, underperforming the S&P 500.Will the recent negative trend continue leading up to its next earnings release, or is Select Medical due for a breakout? Before we dive into how investors and analysts have reacted as of late, let's take a quick look at the most recent earnings report in order to get a better handle on the important drivers. Select Medical Beats Q4 Earnings Estimates, Up Y/YSelect Medical’s fourth-quarter earnings of 31 cents per share beat the Zacks Consensus Estimate by 55% and were also up by the same magnitude year over year.Net operating revenues increased 8.7% year over year to $1.38 billion, due to increase in contribution from its segments namely Critical Illness Recovery Hospital, Rehabilitation Hospital and Outpatient Rehabilitation. Revenues beat the Zacks Consensus Estimate by 2.8%.Total cost and expenses increased 7.3% to $1.26 billion, due to rise in cost of services, general and administrative expenses, and depreciation and amortization.Adjusted EBITDA increased 16.9% year over year to $171.9 million.Critical Illness Recovery HospitalOperating revenues increased 5.2% to $426.4 million. The increase can be attributed to growth in patient volumes and revenue per patient day.Adjusted EBITDA rose 8% to $56 million.Rehabilitation Hospital SegmentOperating revenues rose 21% to $151.1 million, led by an increase in patient volumes and revenue per patient day.Adjusted EBITDA increased 51.4% to $28.6 million.Outpatient RehabilitationOperating revenues increased 7.7% to $252.4 million, led by growth in number of visits.Adjusted EBITDA increased 14.9% to $35 million as a result of newly acquired and developed clinics.ConcentraOperating revenues increased 3.4% year over year to $384.32 million, due to rise in patient visits, partly offset by a decline in net revenue per visit.Adjusted EBITDA increased 6.8% to $52.9 million.Balance Sheet PositionAt the end of the quarter, the company had $3.25 billion of debt outstanding, up 5.2% from year-end 2018 level.Total equity of $929 million decreased 1.4% from Dec 31, 2018 level.Total cash of $335.8 million was up 92% from Dec 31, 2018 level.Cash flow from operations during the quarter was $133.7 million, up 57.7% year over year. How Have Estimates Been Moving Since Then?Analysts were quiet during the last two month period as none of them issued any earnings estimate revisions.VGM ScoresAt this time, Select Medical has a strong Growth Score of A, a grade with the same score on the momentum front. Following the exact same course, the stock was allocated a grade of A on the value side, putting it in the top 20% for this investment strategy.Overall, the stock has an aggregate VGM Score of A. If you aren't focused on one strategy, this score is the one you should be interested in.OutlookSelect Medical has a Zacks Rank #3 (Hold). We expect an in-line return from the stock in the next few months.Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report Select Medical Holdings Corporation (SEM): Free Stock Analysis Report To read this article on Zacks.com click here.