And earlier the -- earlier this week, we entered into a new outpatient rehab joint ventures with Cedars-Sinai in Los Angeles, California, contributing our 26 outpatient clinics in that market to the joint venture.
4 in the country, it's 29th consecutive year of being named among the nation's best.
13, Emory Rehabilitation Hospital in Atlanta at No.
26 and OhioHealth Rehabilitation Hospital in Columbus, Ohio at No.
Overall, for the second -- revenue for the second quarter increased 26.9% to $1.56 billion and for year to date has increased 17.5% to $3.11 billion.
Revenue in our critical illness recovery hospital segment in the second quarter increased 4.7% to $544 million, compared to $520 million in the same quarter last year.
Patient days were down 1.4%, compared to the same quarter last year with 273,000 patient days in the quarter.
Occupancy in our critical illness recovery hospital segment was 69% in the second quarter, compared to 72% in the same quarter last year and 69% in the second quarter of 2019.
Revenue per patient day increased 6.4% to $1,986 per patient day in the second quarter.
Case mix index in our critical illness recovery hospitals was 1.33 in the second quarter, compared to 1.32 in the same quarter last year.
This cap in census represents a reduction of occupancy of approximately 1.5%.
Revenue in our rehabilitation hospital segment in the second quarter increased 26.1% to $213 million, compared to $169 million in the same quarter last year.
Patient days increased 24.8%, compared to the same quarter last year, with almost 105,000 patient days.
Occupancy in our rehab hospitals was 85% in the second quarter, compared to 71% in the same quarter last year and 75% in the second quarter of 2019.
Revenue per patient day increased $0.01 to $1,840 per day in the second quarter.
Revenue in our outpatient rehab segment in the second quarter increased 67.8% to $280 million, compared to $167 million in the same quarter last year.
Patient visits were up 79.2% with 2.4 million visits in the quarter, compared to 1.3 million visits in the same quarter last year and 2.2 million visits in the second quarter of 2019.
Our revenue per visit was $102 in the second quarter, compared to $106 per visit in the same quarter last year.
Revenue in our Concentra segment in the second quarter increased 46.1% to $456 million, compared to $312 million in the same quarter last year.
For the centers, patient visits were up 40.9% to 3 million visits, compared to 2.15 million visits in the same quarter last year and 3.1 million visits in the second quarter of 2019.
Revenue per visit in the centers increased to $125 in the second quarter, compared to $124 in the same quarter last year.
I also want to recognize $98 million in other operating income in the second quarter related to the fund we received under the CARES Act Provider Relief for incremental costs and lost revenues incurred as a result of the COVID pandemic.
Last year, we recognized $55 million in other operating income related to these funds.
Adjusted EBITDA results for our Concentra segment included recognition of this income, including $32.3 million in the second quarter of this year and $800,000 in the same quarter last year.
Total company adjusted EBITDA for the second quarter increased 91.3% to $342 million, compared to $178.8 million in the same quarter last year.
Our consolidated adjusted EBITDA margin was 21.9% for the second quarter, compared to 14.5% for the same quarter last year.
Our critical illness recovery hospital segment adjusted EBITDA was $72.9 million in the second quarter, compared to $89.7 million in the same quarter last year.
Adjusted EBITDA margin for the segment was 13.4% in the second quarter, compared to 17.3% in the same quarter last year.
Our rehabilitation hospital segment adjusted EBITDA increased 83.9% to $50.8 million in the second quarter, compared to $27.6 million in the same quarter last year.
Adjusted EBITDA margin for the rehab hospital segment was 23.9% in the second quarter, compared to 16.4% in the same quarter last year.
Our outpatient rehab adjusted EBITDA was $45.6 million in the second quarter, compared to adjusted EBITDA loss of $6.3 million in the same quarter last year.
Adjusted EBITDA margin for the outpatient segment was 16.3% in the second quarter.
Our Concentra adjusted EBITDA increased 230.3% to $137.1 million in the second quarter, including the $32 million in CARES Act payments recognized in the quarter.
This compares to $41 million in the same quarter last year, which included $800,000 in CARES' payment recognition.
Adjusted EBITDA margin was 30% in the second quarter, compared to 13.3% in the same quarter last year.
Excluding the $32.3 million of CARES Act payments, the adjusted EBITDA margin would have been 23% for the quarter.
Earnings per common share increased 213% to $1.22 for the second quarter, compared to $0.39 for the same quarter last year.
Excluding the CARES Act income, earnings per share would have been $0.72 in the second quarter this year and $0.09 per share in the same quarter last year.
The final rule includes a 2.3% increase in the standard payment amount, which is slightly less than the 2.5 % included in the proposed rule.
In addition, the high-cost outlier threshold increased by 20%, which was slightly worse than what was in the proposed rule.
The final rule included a 2.2% increase in the federal base rate, again, slightly less than the 2.5% increase outlined in the proposed rule.
The high-cost outlier threshold was increased 21% and the MS-LTC-DRG relative weights and expected length of stays were also updated in the final rule.
For the second quarter, our operating expenses, which include our cost of services and general administrative expense were $1.33 billion or 84.9% of revenue.
For the same quarter last year, operating expenses were $1.12 billion and 90.5% of revenues.
Cost of services were $1.29 billion for the second quarter.
This compares to $1.08 billion in the same quarter last year.
As a percent of revenue, cost of services were 82.6% in the second quarter.
This compares to 87.8% in the same quarter last year.
G&A expense was $35.7 million in the second quarter.
This compares to $33.5 million in the same quarter last year.
G&A as a percent of revenue was 2.3% in the second quarter, compared to 2.7% of revenue for the same quarter last year.
As Bob mentioned, total adjusted EBITDA was $342 million, and adjusted EBITDA margin was $21.9 million for the second quarter.
This compares to total adjusted EBITDA of $178.8 million and an adjusted EBITDA margin of 14.5% in the same quarter last year.
Excluding the CARES Act income recognized in the quarter, adjusted EBITDA margins would have been 15.6% in the second quarter this year and 10% in the same quarter last year.
Depreciation and amortization was $51 million in the second quarter.
This compares to $52.3 million in the same quarter last year.
We generated $11.8 million in equity and earnings of unconsolidated subsidiaries during the second quarter.
This compares to $8.3 million in the same quarter last year.
Interest expense was $33.9 million in the second quarter.
This compares to $37.4 million in the same quarter last year.
We recorded income tax expense of $65.7 million in the second quarter this year, which represents an effective tax rate of 25.1%.
This compares to the tax expense of $23.3 million and an effective rate of 25.7% in the same quarter last year.
Net income attributable to noncontrolling interest were $31.3 million in the second quarter.
This compares to $15.8 million in the same quarter last year.
Net income attributable to Select Medical Holdings was $164.9 million in the second quarter and earnings per common share were $1.22.
At the end of the second quarter, we had $3.4 billion of debt outstanding and over $800 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 $70 million of other miscellaneous debt.
Net leverage based on the credit agreement EBITDA dropped to 2.51 times at the end of the second quarter.
This is down from 3.02 times at the end of the first quarter and 3.48 times at the end of the year.
We increased the availability on Select's revolving loan from $450 million to $650 million and simultaneously canceled the $100 million Concentra revolving loan, which was set to mature in March of next year.
Operating activities provided $123.1 million of cash flow in the second quarter.
Our days sales outstanding, or DSO, was 54 days at June 30, 2021.
This compared to 56 days at both March 31, 2021 and December 31, 2020.
During the second quarter, we repaid $73 million of Medicare advances.
And as of June 30, 2021, we have $251 million remaining on the balance sheet.
Investment activities used $35.7 million of cash in the second quarter.
The use of cash included $36.7 million in the purchase of property and equipment and $8.4 million acquisition and investment activity in the quarter.
We also generated $9.4 million in proceeds from the sale of assets in the quarter.
Financing activities used $34.3 million of cash in the second quarter.
This included $16.9 million in dividend payments, $9.8 million in net payments and distributions to noncontrolling interest, and $6 million in repayments of other debt in the quarter.
Our total available liquidity at the end of the second quarter was almost $1.4 billion, which includes the $800 million of cash, and close to $595 million in revolver availability under the Select credit agreement.
For the full year of 2021, we now expect revenue in the range of $5.85 billion to $6.05 billion.
Expected adjusted EBITDA to be in the range of $970 million to $1 billion and expected earnings per common share to be in the range of $2.91 to $3.08.

Summary:
Earnings per common share increased 213% to $1.22 for the second quarter, compared to $0.39 for the same quarter last year.
Net income attributable to Select Medical Holdings was $164.9 million in the second quarter and earnings per common share were $1.22.
For the full year of 2021, we now expect revenue in the range of $5.85 billion to $6.05 billion.
Expected adjusted EBITDA to be in the range of $970 million to $1 billion and expected earnings per common share to be in the range of $2.91 to $3.08.