Having said that, we saw a significant rebound in this business segment in June, as revenue increased over 24% for the month on the same period year-over-year basis.
Our June occupancy rate is -- of 78% is close to pre-COVID levels and exceeded June's last year occupancy of 73%.
Our outpatient rehabilitation volumes and revenues were down year over year 48% and 44% respectively in the month of April and May resulting in adjusted EBITDA losses in both of those months in our outpatient rehab segment.
Volume and revenue shortfalls in June compared to prior year were 19.7% and 17.8% respectively which was a significant improvement from April and May and we experienced positive adjusted EBITDA in June.
In our Concentra segment volumes and revenues were down year over year 39% and 33% respectively in the month of April and May, but only down in June 12.4% and 6.4% as restrictions ease and employers started to increase their workforce.
Overall, our net revenue for the second quarter was down 9.4% to $1.23 billion in the quarter.
Net revenue in our critical illness recovery hospital segment in the second quarter, increased 12.7% to $520 million, compared to $461 million in the same quarter last year.
Patient days were up 5.3% compared to the same quarter last year, with close to 277,000.
Net revenue per patient day increased 7.4% to $1,867 per patient day in the second quarter.
Occupancy in our critical illness recovery hospital segment was 72% in the second quarter compared to 69% in the same quarter last year.
Net revenue, our rehabilitation hospital segment the second quarter increased 5.2% to $169 million compared to $160 million in the same quarter last year.
Patient days declined 2.8% compared to the same quarter last year.
However, net revenue per patient day increased 12% to $1,831 per day in the second quarter.
Occupancy -- hospitals was 71% in the second quarter, compared to 75% in the same quarter last year.
Net revenue on our outpatient rehab segment, the second quarter decreased 36.2% to $167 million compared to 262 million in the same quarter last year.
Patient visits declined 39.1% to 1.34 million visits in the second quarter.
Our net revenue per visit was $106 in the second quarter compared to $102 in the same quarter last year.
Net revenue declines were most significant during April which was down 45.6% year over year and May which was down 43.3% year over year.
June showed improvement from those trends with net revenues down 17.8% year over year.
Net revenue in our Concentra segment for the second quarter decreased 24.5% to $312 million compared to $413 million in the same quarter last year.
For the occupational health centers, patient visits were down 30.7% to 2.15 million visits in the quarter.
Net revenue per visit in the centers was $124 in the second quarter compared to $121 in the same quarter last year.
Similar to outpatient net revenue declined for most significant during April which was down 34.9% year over year and May which was down 30.7% year over year, with June showing improvement from those trends with net revenue down only 6.4% year over year.
Total company adjusted EBITDA for the second quarter was down 4% to $178.8 million, compared to 186.2 million the same quarter last year.
Our consolidated adjusted EBITDA margin was up at 14.5% for the second quarter compared to 13.7% for the same quarter last year.
We recorded $55 million in other operating income in the second quarter related to payments received under the provider relief funds, $54.2 million was recorded with our other activities and 800,000 was recorded in the Concentra segments.
Our critical illness recovery hospital segment adjusted EBITDA increased 39.9% to $89.7 million, compared to 64.1 million in the same quarter last year.
Adjusted EBITDA margin for the segment was 17.3% in the second quarter, compared to 13.9% in the same quarter last year.
Our rehabilitation hospitals segment adjusted EBITDA was $27.6 million, compared to 30 million in the same quarter last year.
Adjusted EBITDA margin for the rehabilitation hospital segment was 16.4% in the second quarter, compared to 18.7% in the same quarter last year.
Our outpatient rehab and current adjusted EBITDA loss of $6.3 million in the second quarter compared to $42.6 million adjusted EBITDA contribution in the same quarter last year.
Our Concentra adjusted EBITDA was $41.5 million, compared to 76.1 million in the same quarter last year.
Adjusted EBITDA margin was 13.3% in the second quarter, compared to 18.4% in the same quarter last year.
Earnings per fully diluted share increased over 18% to $0.39 for the second quarter compared to $0.33 for the same quarter last year.
Adjusted earnings per fully diluted share was $0.38 per diluted share for the second quarter.
For the second quarter, our operating expenses which include our cost of services in general and administrative expenses were $1.12 billion and 90.5% of net operating revenues.
For the same quarter last year, operating expenses were $1.18 billion and 86.8% of net operating revenue, cost of services or $1.08 billion for the second quarter, this compares to $1.15 billion in the same quarter last year.
As a percent of net revenue cost of services was 87.8% for the second quarter, this compares to 84.5% in the same quarter last year.
G&A expense was $33.5 million in the second quarter compared to $31.3 million in the same quarter last year.
G&A as a percent of net revenue was 2.7% in the second quarter.
This compares to 2.3% of net revenue for the same quarter last year.
As Bob mentioned, total adjusted EBITDA was $178.8 million and the adjusted EBITDA margin was 14.5% for the second quarter, as compared to the total adjusted EBITDA of $186.2 million and an adjusted EBITDA margin of 13.7% in the same quarter last year.
We recorded $55 million in other operating income in the second quarter related to payments received under the provider relief funds.
I would like to reiterate that with the exception of $800,000 of grant monies to Concentra no grant monies were included in our segment reporting.
Depreciation and amortization was $52.3 million in the second quarter this compares to $55 million in the same quarter last year.
We generated $8.3 million in equity and earnings of unconsolidated subsidiaries during the second quarter, compared to $7.4 million in the same quarter last year.
We also had non-operating gain of $300,000 in the second quarter this year.
Interest expense was $37.4 million in the second quarter, this compares to $51.5 million in the same quarter last year.
We recorded income tax expense of $23.3 million in the second quarter of this year which represents an effective tax rate of 25.7%.
This compares to the tax expense of $20.8 million in effective tax rate of 25.8% in the same quarter last year.
Net income attributable to non-controlling interests were $15.8 million in the second quarter, this compares to $15.2 million in the same quarter last year.
Net income attributable to Select Medical Holdings was $51.7 million in the second quarter and fully diluted earnings per share is $0.39 excluding the non-operating gain as related tax effects our adjusted earnings per share was $0.38.
At the end of the second quarter, we had $3.4 billion of debt outstanding and $510 million of cash on the balance sheet.
Our debt balance at the end of the quarter included $2.1 billion in term loans, $1.2 billion in 6.25 senior notes and $77 million of other miscellaneous debt.
Operating activities provided $642 million of cash flow in the second quarter which included $317 million in Medicare advances and $100 million in provider relief funds $55 million of which was recognized in operating income.
Our accrued liability includes $33 million in deferred employer FICA tax allowed for under the CARES Act.
Investing activities used $35.9 million of cash in the second quarter, the use of cash included $32 million in purchases of property and equipment and $5 million in acquisition investment activity this was offset in part by $1.2 million in proceeds from the sale of businesses during the quarter.
Financing activities used $169.5 million in cash in the second quarter, this includes $165 million in net repayments on revolving loans and $2.6 million in net repayments of other debt during the quarter.
Our total available liquidity at the end of the second quarter was over $1 billion which is evenly split between cash on hand and revolver availability.

Summary:
Earnings per fully diluted share increased over 18% to $0.39 for the second quarter compared to $0.33 for the same quarter last year.
Adjusted earnings per fully diluted share was $0.38 per diluted share for the second quarter.
For the same quarter last year, operating expenses were $1.18 billion and 86.8% of net operating revenue, cost of services or $1.08 billion for the second quarter, this compares to $1.15 billion in the same quarter last year.
Net income attributable to Select Medical Holdings was $51.7 million in the second quarter and fully diluted earnings per share is $0.39 excluding the non-operating gain as related tax effects our adjusted earnings per share was $0.38.