德維特 (DVA) 2023 Q2 法說會逐字稿

Good evening. My name is Michelle, and I will be your conference facilitator today. At this time, I would like to welcome everyone to the DaVita Second Quarter 2023 Earnings Call. Today's conference is being recorded. (Operator Instructions) Mr. Eliason, you may begin your conference.

晚上好。我叫米歇爾，今天我將擔任你們的會議主持人。此時，我謹歡迎大家參加 DaVita 2023 年第二季度收益電話會議。今天的會議正在錄製中。 （操作員指示）Eliason 先生，您可以開始會議了。

Thank you, and welcome to our second quarter conference call. We appreciate your continued interest in our company. I'm Nic Eliason, Group Vice President of Investor Relations. And joining me today are Javier Rodriguez, our CEO; and Joel Ackerman, our CFO.

謝謝您，歡迎參加我們的第二季度電話會議。我們感謝您對我們公司的持續關注。我是尼克·埃利亞森 (Nic Eliason)，投資者關係集團副總裁。今天加入我的是我們的首席執行官哈維爾·羅德里格斯 (Javier Rodriguez)；和我們的首席財務官喬爾阿克曼。

Please note that during this call, we may make forward-looking statements within the meaning of the federal securities laws. All of these statements are subject to known and unknown risks and uncertainties that could cause the actual results to differ materially from those described in the forward-looking statements. For further details concerning these risks and uncertainties, please refer to our second quarter earnings press release and our SEC filings, including our most recent annual report on Form 10-K, all subsequent quarterly reports on Form 10-Q and other subsequent filings that we may make with the SEC. Our forward-looking statements are based on information currently available to us, and we do not intend and undertake no duty to update these statements except as may be required by law.

請注意，在本次電話會議中，我們可能會做出聯邦證券法含義內的前瞻性陳述。所有這些陳述都受到已知和未知的風險和不確定性的影響，可能導致實際結果與前瞻性陳述中描述的結果存在重大差異。有關這些風險和不確定性的更多詳細信息，請參閱我們的第二季度收益新聞稿和我們向SEC 提交的文件，包括我們最新的10-K 表格年度報告、所有後續10-Q 表格季度報告以及我們提交的其他後續文件。可能會與 SEC 合作。我們的前瞻性陳述基於我們目前掌握的信息，除非法律要求，否則我們不打算也不承擔更新這些陳述的義務。

Additionally, we'd like to remind you that during this call, we will discuss some non-GAAP financial measures. A reconciliation of these non-GAAP measures to the most comparable GAAP financial measures is included in our earnings press release furnished to the SEC and available on our website.

此外，我們想提醒您，在本次電話會議中，我們將討論一些非 GAAP 財務指標。這些非 GAAP 指標與最具可比性的 GAAP 財務指標的調節表包含在我們向 SEC 提供並可在我們的網站上獲取的收益新聞稿中。

I will now turn the call over to Javier Rodriguez.

我現在將把電話轉給哈維爾·羅德里格斯。

Thank you, Nic, and thank you for joining our call today. I hope that everyone is having a safe and joyful summer. At DaVita, we've been focused on innovation and continuous improvement to provide the highest quality of care for our patients. Hand in hand with these efforts, we've been driving operational improvements across our organization. Our second quarter performance reflects strong traction across those initiatives, putting us on a path to deliver strong clinical outcomes and financial results for the year.

謝謝你，尼克，也感謝你今天加入我們的電話會議。我希望每個人都能度過一個安全、快樂的夏天。在 DaVita，我們一直專注於創新和持續改進，為患者提供最高質量的護理。通過這些努力，我們一直在推動整個組織的運營改進。我們第二季度的業績反映了這些舉措的強大吸引力，使我們能夠在今年提供強勁的臨床成果和財務業績。

Today, I will cover the second quarter results, offer some perspective on the industry landscape and drivers of long-term performance and update our full year guidance.

今天，我將介紹第二季度的業績，提供對行業格局和長期業績驅動因素的一些看法，並更新我們的全年指引。

Before we get into the second quarter details, I would like to take a moment to celebrate a clinical and technological milestone. On our February call, we mentioned the rollout of our next-generation clinical IT system, which we refer to as Center Without Walls or CWOW. I'm happy to report that after 5 years of development, CWOW is now live in each of our approximately 2,700 clinics across the United States.

在我們討論第二季度的細節之前，我想花點時間慶祝一個臨床和技術里程碑。在二月份的電話會議上，我們提到了下一代臨床 IT 系統的推出，我們將其稱為“無牆中心”或 CWOW。我很高興地向大家報告，經過 5 年的發展，CWOW 現已在我們遍布美國的約 2,700 家診所中使用。

This patient-centric cloud-based system combines and replaces four legacy systems and is designed to provide seamless flow of information across each of our centers in all modalities. This includes real-time clinical dashboards, data sharing with our physicians in Integrated Kidney Care platforms and notifications such as critical lab alerts.

這種以患者為中心的基於雲的系統結合併取代了四個遺留系統，旨在以所有方式在我們每個中心之間提供無縫的信息流。這包括實時臨床儀表板、在綜合腎臟護理平台中與我們的醫生共享數據以及關鍵實驗室警報等通知。

For ease of use, it features wrist bands for quick teammate log-in, improve ability to track and reschedule mistreatment, enhance real-time documentation and consolidated reporting for streamlined analysis. And while we're enthused about these immediate benefits, the most significant enhancement is the state-of-the-art data structure and platform upon which we can build further capabilities including artificial intelligence to advance the care delivery in the years ahead. With this groundbreaking platform, our clinicians are able to access the right information at the right time in the right place.

為了易於使用，它配備了腕帶，可讓隊友快速登錄，提高跟踪和重新安排虐待的能力，增強實時記錄和綜合報告以簡化分析。雖然我們對這些直接的好處感到興奮，但最重要的增強是最先進的數據結構和平台，我們可以在此基礎上構建包括人工智能在內的進一步功能，以在未來幾年內推進護理服務。借助這個突破性的平台，我們的臨床醫生能夠在正確的時間、正確的地點訪問正確的信息。

Transitioning to our financial performance. In the second quarter, we delivered adjusted operating income of $432 million and adjusted earnings per share of $2.08. These results were driven by improvements across our financial trilogy of treatment volume, revenue per treatment and patient care costs. I'll touch on each of these in a bit more detail.

轉向我們的財務業績。第二季度，我們實現調整後營業收入 4.32 億美元，調整後每股收益 2.08 美元。這些結果是由我們的治療量、每次治療收入和患者護理成本的財務三部曲的改善推動的。我將更詳細地討論其中的每一個。

On volume, we saw our second consecutive quarter of improvements in census and treatments per day. This is encouraging as it is a result of better macro environment and progress in our operating initiatives. We're trending near the top of our original volume range of down 3% to flat year-over-year. And if these trends continue, we would anticipate delivering volume growth in 2024.

在數量上，我們看到人口普查和每日治療量連續第二個季度有所改善。這是令人鼓舞的，因為這是更好的宏觀環境和我們的經營舉措取得進展的結果。我們的趨勢接近原始成交量範圍的頂部，即同比下降 3% 至持平。如果這些趨勢持續下去，我們預計 2024 年銷量將會增長。

Shifting to revenue and revenue per treatment. Revenue per treatment was particularly strong in the quarter. This was primarily driven by typical seasonal factors from patients meeting their co-pays and deductibles, along with normal expected rate increases and improvement in mix, including Medicare Advantage.

轉向收入和每次治療的收入。本季度每次治療的收入尤其強勁。這主要是由於患者滿足自付費用和免賠額的典型季節性因素，以及正常的預期費率增加和組合改善（包括醫療保險優惠）推動的。

Adding to the RPT increase, we have seen progress from investments we've been making in our revenue cycle capabilities. These investments resulted in higher cash collections and a decline in our DSO. I'm excited about the investments we've been making in these areas, which represent a good example of how we are constantly improving operations.

除了 RPT 的增長之外，我們還看到了我們在收入周期能力方面的投資取得的進展。這些投資帶來了更高的現金回收量和 DSO 的下降。我對我們在這些領域進行的投資感到興奮，這些投資是我們如何不斷改進運營的一個很好的例子。

And finally, patient care costs improved as expected in the quarter. Although base wage increases remain well above historic pre-pandemic levels, other expenses, including contract labor and pharmaceuticals continue to decline. This benefit was partially offset by elevated training costs.

最後，本季度患者護理成本的改善符合預期。儘管基本工資增幅仍遠高於大流行前的歷史水平，但包括合同工和藥品在內的其他支出繼續下降。這一收益被增加的培訓成本部分抵消。

While staffing levels in our clinic are in a much better position compared to last year, we continue to experience above average turnover among facility teammates. As a result, we no longer expect an improvement in our training productivity during the back half of this year.

雖然我們診所的人員配備水平與去年相比要好得多，但我們設施團隊成員的流動率仍然高於平均水平。因此，我們不再期望今年下半年的培訓效率會有所提高。

Taking a step back from the most recent results, I would like to offer some reflections on the broader industry landscape and our effort to drive performance going forward. Beginning with the reimbursement rates, we're disappointed by CMS' proposed rule to update the ESRD Prospective Payment System for 2024. Specifically, the proposed rate increase falls short of expected cost inflation in 2024 and it fails to adjust for the acknowledged inflation forecast miss relative to actual wage and inflation increases over the past two years. The Kidney Care community will continue to advocate for an adjustment mechanism to reconcile these forecasters similar to what exists today for skilled nursing facilities.

從最近的結果來看，我想對更廣泛的行業格局以及我們為推動業績向前發展所做的努力提出一些思考。從報銷率開始，我們對 CMS 更新 2024 年 ESRD 預期支付系統的提議規則感到失望。具體來說，提議的加息低於 2024 年預期的成本通脹，並且未能針對公認的通脹預測偏差進行調整相對於過去兩年的實際工資和通貨膨脹增幅。腎臟護理界將繼續倡導一種調整機制，以協調這些預測者，類似於當今熟練護理機構所存在的機制。

In response to the persistent cost inflation, we're continuing our track record of innovation across all areas of our cost structure. Most recently, we consolidated portions of our facility footprint and reduced pharmaceutical costs through our conversion to MIRCERA for anemia management. These programs are proceeding in line with our expectations.

為了應對持續的成本通脹，我們將繼續在成本結構的所有領域進行創新。最近，我們通過改用 MIRCERA 進行貧血管理，整合了部分設施並降低了製藥成本。這些計劃的進展符合我們的預期。

Going forward, we will continue to drive cost efficiencies across the P&L. Through these efforts and continued improvement in our volume trends, we continue to target 3% to 7% long-term growth of our enterprise adjusted operating income.

展望未來，我們將繼續提高損益表的成本效率。通過這些努力以及銷量趨勢的持續改善，我們繼續將企業調整後營業收入的長期增長目標定為 3% 至 7%。

Looking forward to the remainder of the year, given our progress during the second quarter, we're revising our adjusted operating income range of $1.475 billion to $1.625 billion to a new range of $1.565 billion to $1.675 billion. We're also updating our adjusted earnings per share range of $6.20 to $7.30 and to a new range of $7 to $7.80. Our performance relative to this guidance will continue to depend heavily on momentum in patient census trends, our ability to manage patient care costs within the broader labor environment and sustained improvement in revenue cycle management.

展望今年剩餘時間，鑑於我們在第二季度取得的進展，我們正在將調整後的營業收入範圍從 14.75 億美元至 16.25 億美元修改為新的 15.65 億美元至 16.75 億美元範圍。我們還將調整後每股收益範圍從 6.20 美元至 7.30 美元更新為 7 至 7.80 美元。我們相對於本指引的業績將繼續在很大程度上取決於患者普查趨勢的勢頭、我們在更廣泛的勞動力環境中管理患者護理成本的能力以及收入周期管理的持續改進。

I'll now turn the call to Joel to discuss financial performance and outlook in more detail.

我現在將致電喬爾，更詳細地討論財務業績和前景。

Thanks, Javier. I'll walk through a few factors driving our strong performance in the second quarter, starting with treatment volume. In the second quarter, U.S. dialysis treatments per day were up by approximately 0.3% sequentially. This is the result of continued census gains in the second quarter, driven by an increase in new-to-dialysis admits.

謝謝，哈維爾。我將介紹推動我們第二季度強勁表現的幾個因素，首先是治療量。第二季度，美國每日透析治療量環比增長約 0.3%。這是第二季度人口普查持續增長的結果，其推動因素是新接受透析的人數增加。

Mortality remains higher than pre-COVID levels but came in lower than Q1 and in line with our expectations for the quarter. Our mistreatment rate continues to be elevated relative to historic levels.

死亡率仍高於新冠疫情前的水平，但低於第一季度，符合我們對本季度的預期。我們的虐待率相對於歷史水平繼續上升。

Revenue per treatment was up $10.59 versus Q1. Approximately half of this increase was the result of seasonality, primarily due to higher patient responsibility amounts in the first quarter. Approximately $2 came from normal expected rate increases and continued increases in patient mix.

與第一季度相比，每次治療的收入增加了 10.59 美元。大約一半的增長是季節性的結果，主要是由於第一季度患者責任金額增加。大約 2 美元來自正常預期的利率增加和患者組合的持續增加。

An additional roughly $2 was the result of strong cash collections in Q2. As Javier said, we have been investing in improvements in our revenue cycle management systems and processes and are beginning to see the benefits of these efforts in both RPT and DSOs. We were anticipating these improvements, but they came earlier than forecasted. We expect these benefits to persist in the back half of the year and going forward. As a result, we now anticipate year-over-year RPT growth to be 2.5% to 3%.

由於第二季度現金回款強勁，額外增加了大約 2 美元。正如哈維爾所說，我們一直在投資改進我們的收入周期管理系統和流程，並開始在 RPT 和 DSO 中看到這些努力的好處。我們預計會有這些改進，但它們來得比預期要早。我們預計這些好處將在今年下半年和未來持續存在。因此，我們現在預計 RPT 同比增長率為 2.5% 至 3%。

On a non-GAAP basis, patient care cost per treatment decreased 1.5% sequentially. While base wage increases remain high, we have successfully reduced most of the temporary compensation measures we relied on during 2022. At the end of Q2, contract labor has returned back to pre-pandemic levels.

按非 GAAP 計算，每次治療的患者護理費用環比下降 1.5%。儘管基本工資增幅仍然很高，但我們已成功減少了 2022 年所依賴的大部分臨時補償措施。第二季度末，合同工已恢復至疫情前的水平。

Operating income from our Integrated Kidney Care business was approximately flat with Q1. The quarter benefited from positive prior period developments in our special needs plans and the timing of expenses that were delayed until later this year. For the full year, we now expect IKC adjusted operating income to be approximately flat to 2022 operating income loss of $125 million.

我們的綜合腎臟護理業務的營業收入與第一季度大致持平。該季度受益於我們特殊需求計劃的前期積極發展以及推遲到今年晚些時候的支出時間。對於全年，我們現在預計 IKC 調整後的營業收入將大致持平，至 2022 年營業收入損失為 1.25 億美元。

Regarding our clinic footprint in Q2, we closed or consolidated 16 centers in the U.S. bringing our year-to-date U.S. closures to 36. We continue to assess further facility consolidation and closures during the back half of the year.

關於我們第二季度的診所足跡，我們關閉或合併了美國的 16 個中心，使今年迄今在美國的關閉中心達到 36 個。我們將繼續評估今年下半年的進一步設施合併和關閉情況。

Regarding capital structure, we ended the quarter with a leverage ratio of approximately 3.7x EBITDA and did not repurchase any shares during the second quarter. Our capital allocation strategy remains focused on capital efficient growth, a target leverage ratio of 3x to 3.5x EBITDA and the return of excess cash flow to investors through share buybacks.

關於資本結構，本季度末我們的槓桿率約為 3.7 倍 EBITDA，並且在第二季度沒有回購任何股票。我們的資本配置策略仍然側重於資本效率增長、3 倍至 3.5 倍 EBITDA 的目標槓桿率以及通過股票回購將超額現金流返還給投資者。

Given our increased guidance for the balance of the year, we have increased visibility towards bringing our leverage level back within our target range. That concludes my prepared remarks for today. Operator, please open the call for Q&A.

鑑於我們對今年餘下時間的指引有所增加，我們更加清楚地將槓桿水平恢復到目標範圍內。我今天準備的發言到此結束。接線員，請打開電話進行問答。

(Operator Instructions) Our first caller is Kevin Fischbeck with Bank of America.

（操作員說明）我們的第一個來電者是美國銀行的 Kevin Fischbeck。

Actually, this is Joanna Gajuk filling in for Kevin. So thanks for the color around the revenue per treatment breakdown in terms of the drivers there, including a very strong performance, and I appreciate the commentary. I expect, I guess, a faster growth for the year. So just looking into the pieces because you said a better payer mix, one of the drivers. Can you talk about the specific commercial pricing and what kind of rate increases are you getting this year? And also any indications for how things are tracking into next year? Because I guess that's where maybe one area because you also mentioned the Medicare rate out there being lower than cost inflation. So is the commercial pricing, I guess, tracking better?

事實上，這是喬安娜·加尤克 (Joanna Gajuk) 的替補凱文 (Kevin)。因此，感謝您對每個治療的收入細分（就驅動因素而言）的顏色進行了說明，包括非常強勁的表現，我很欣賞您的評論。我想，我預計今年會有更快的增長。因此，只需研究一下這些內容，因為您說的是更好的付款人組合，其中一位司機。您能談談具體的商業定價以及今年的利率上漲嗎？還有任何跡象表明明年的情況如何？因為我猜這可能是一個領域，因為您還提到醫療保險費率低於成本通脹。那麼我猜商業定價是否跟踪得更好？

Yes. Thank you for the question, Joanna. I'll start off and Joel, you can supplement if I miss anything of importance.

是的。謝謝你的提問，喬安娜。我先開始了，喬爾，如果我錯過了任何重要的事情，你可以補充。

Private pay mix is holding up. It picked up 20 bps and we continue to see that our private-pay patients really value their insurance. As it relates to rate increases, just a reminder, most of our contracts are multiyear, so in any given year, we don't negotiate that many contracts. There's nothing really to call out on that. Our rate per treatment increases are in line with expectations.

私人薪酬結構保持穩定。它上升了 20 個基點，我們繼續看到我們的私人付費患者非常重視他們的保險。由於它與加息有關，請提醒一下，我們的大多數合同都是多年期的，因此在任何特定年份，我們都不會談判那麼多合同。對此確實沒有什麼可挑剔的。我們每次治療的增加率符合預期。

So is there another part to your question that I didn't answer, Joanna?

那麼你的問題還有我沒有回答的部分嗎，喬安娜？

No. This was it, but I guess also related, if I can, a follow-up to that topic in terms of the Marietta case. And I guess we spoke before, and there's still bipartisan support for a fix. So can you give us any update on that? And I guess on that topic, as it relates to pricing -- commercial pricing, are you seeing employers using this court decision to restrict networks? Or are they using it to maybe -- are they bringing it up in the price negotiations when it comes to pricing?

不。就是這樣，但我想如果可以的話，還可以與瑪麗埃塔案的該主題的後續內容相關。我想我們之前談過，而且兩黨仍然支持解決這個問題。您能給我們介紹一下最新情況嗎？我想在這個話題上，因為它與定價——商業定價有關，你是否看到雇主利用這一法院判決來限製網絡？或者，他們是否會在定價時在價格談判中提出這一點？

Sure. Let me take -- let me lens up a little since some people are not tracking all of the Marietta. So it's probably best for me to divide it into what we know and what we don't know. So let me start with what we do know.

當然。讓我把鏡頭放大一點，因為有些人並沒有追踪瑪麗埃塔的全部情況。所以對我來說最好將其分為我們知道的和我們不知道的。讓我從我們所知道的開始。

As we look at our claims year-to-date, we have not seen much change compared to prior years. So there's not a lot of volume. But we have learned more about how employers change benefits and mislead members on how it's done. And so we don't want to accommodate this poor behavior. So what we have done is we've implemented a verification process at admissions and if an employer eliminates a network dialysis benefit for its members, then we have the right to prevent that plan from having access to our centers. In addition, we continue to have very high interest -- bipartisan interest in making sure that policymakers protect our patients. So those are the things that we do know.

當我們審視今年迄今為止的索賠時，與往年相比，我們沒有看到太大的變化。所以體積不是很大。但我們更多地了解了雇主如何改變福利並誤導會員如何做到這一點。所以我們不想容忍這種不良行為。因此，我們所做的就是在入院時實施驗證流程，如果雇主取消其會員的網絡透析福利，那麼我們有權阻止該計劃進入我們的中心。此外，我們仍然對確保政策制定者保護我們的患者抱有非常高的興趣——兩黨的興趣。這些是我們確實知道的事情。

What we don't know is how many employer groups are considering carving out dialysis from network in the future. And we also don't know if or when members of Congress will introduce the bill and how the CBO will score it.

我們不知道的是，有多少雇主團體正在考慮未來從網絡中進行透析。我們也不知道國會議員是否或何時會提出該法案，以及國會預算辦公室將如何評分。

The last part of your question was, are payers using this in one way or another, and it has not come up in one negotiation because this is really more of a dynamic between the employer trying to decide what to do with the plan, not what the payer does with the provider. The provider and the payer both value network.

你問題的最後一部分是，付款人是否以某種方式使用這個，並且在一次談判中沒有出現，因為這實際上更多的是雇主試圖決定如何處理該計劃，而不是做什麼付款人與提供者一起做。提供者和付款者都看重網絡。

Does that help you Joanna?

喬安娜，這對你有幫助嗎？

Yes, does that makes sense. No. That totally makes sense, and I appreciate it. So in terms of what's going on in Congress and the score, so is there any indication of what we might hear about this? Or that's not really something that we can predict from the outside?

是的，這有道理嗎？不，這完全有道理，我很欣賞。那麼，就國會的進展和比分而言，是否有任何跡象表明我們可能會聽到有關此事的消息？或者說這確實不是我們可以從外部預測的事情？

Yes. There's nothing we can predict from the outside. That's left to policymakers, champions and the dynamics of Washington, D.C.

是的。我們無法從外部預測任何事情。這取決於政策制定者、支持者和華盛頓特區的動態。

Great. And if I may, just on the guidance raise, right, it sounds like some improvement in the pricing rate and then, I guess, contract labor. It sounds like that's better. Is that the way to frame the guidance raise, the $70 million of the operating income -- adjusted operating income guidance?

偉大的。如果可以的話，就指導性提高而言，聽起來像是定價率有所改善，然後我猜是合同工。聽起來這樣更好。這就是調整後的運營收入指引（7000 萬美元的營業收入指引）的框架方式嗎？

Yes, Joanna, if I were to kind of give you the pieces of what drove $70 million of increased guidance that's middle of the range -- to middle of the range on OI. I'd say about half is the RPT, as you called it out, the other half is volume. We saw stronger admissions this quarter and the nature of volume is it's cumulative. It will never really kick in, in any one quarter in that big a way. But as it accumulates stronger in Q1, stronger in Q2, and we see it better in the back half of the year, for the full year, we think that will contribute about half of the $70 million beat.

是的，喬安娜，如果我要給你一些推動 7000 萬美元增加指導的部分，那就是 OI 範圍的中間範圍。我想說大約一半是 RPT，正如你所說的那樣，另一半是成交量。我們看到本季度的招生數量有所增加，而且數量的本質是累積的。它永遠不會在任何一個季度真正發揮作用。但隨著第一季度的積累更加強勁，第二季度的積累更加強勁，我們認為今年下半年和全年的情況會更好，我們認為這將貢獻大約 7000 萬美元的一半。

Contract labor, it continues to improve, but it's now pretty much in line with what we were expecting. And as we said in the prepared remarks, it's really back down to pre-COVID levels. And hopefully, it won't be much of a topic going forward.

合同工，它繼續改善，但現在與我們的預期基本一致。正如我們在準備好的發言中所說，它確實回到了新冠疫情之前的水平。希望這不會成為未來的一個話題。

(Operator Instructions) Our next caller is Andrew Mok with UBS.

（接線員指示）我們的下一個來電者是瑞銀集團的安德魯·莫克（Andrew Mok）。

I appreciate all the color on the sequential RPT improvement, but just a couple of follow-ups there. First, is the seasonality component in line with historical seasonality? Or is there something about the patient benefit design that's creating more acute seasonality this year? And can you go into a bit more detail on what's driving the better cash collections?

我很欣賞順序 RPT 改進中的所有色彩，但只有幾個後續改進。首先，季節性成分是否符合歷史季節性？或者患者福利設計是否有什麼因素導致今年的季節性更加嚴重？您能否更詳細地介紹一下是什麼推動了更好的現金收款？

Yes, Andrew, thanks. So on the seasonality, no, it was a little bit more than $5, which is per treatment, which is right in line with what we've seen historically.

是的，安德魯，謝謝。因此，就季節性而言，不，每次治療的價格略高於 5 美元，這與我們歷史上看到的情況相符。

In terms of collections, look, we have invested in our processes and in our technology to get better information and to give better information to the health plans on everything from prior authorizations to other data required, to claim submissions, and that's both the quality of the data and the timeliness of the data. And what we're seeing is we're getting paid quicker, and that's why you saw DSOs come down last quarter and again this quarter. And we're also seeing we're collecting more and that's what's driving the RPT increase. And I think the most important thing from our standpoint is this is not a onetime thing. These are fundamental changes that we've made that we think will persist.

在收集方面，看，我們對我們的流程和技術進行了投資，以獲得更好的信息，並向健康計劃提供更好的信息，從事先授權到所需的其他數據，再到索賠提交，這都是質量數據和數據的及時性。我們看到的是，我們獲得報酬的速度更快，這就是為什麼 DSO 上季度和本季度再次下降的原因。我們還看到我們正在收集更多的數據，這就是推動 RPT 增長的原因。我認為從我們的角度來看，最重要的是這不是一次性的事情。這些是我們所做的根本性改變，我們認為這些改變將會持續下去。

Great. Appreciate the color. And then as a follow-up, the guidance -- the OI guidance is up about 5%. I think your free cash flow is up about 10%. Can you help bridge the difference there? And help us understand why the free cash conversion is better on the new guide and I think I missed your comments on share repurchase, but would love to get your latest thoughts around there on the potential resumption of share repurchase.

偉大的。欣賞顏色。然後，作為後續行動，指導——OI 指導上漲了約 5%。我認為你的自由現金流增加了大約 10%。你能幫助彌合那裡的差異嗎？並幫助我們理解為什麼新指南中的免費現金轉換更好，我想我錯過了您對股票回購的評論，但很想了解您對可能恢復股票回購的最新想法。

Sure. So the big difference between OI and free cash flow is the DSOs. As we see those DSOs come down, that will add to the free cash flow for the year. In terms of share repurchases, we're on track with what we set out to do. Our leverage levels were above our target range I think we were quite clear with everyone, we wanted to get back down to 3.5x or below. We're making good progress on that. We're at 3.7x for the quarter and we didn't buy back any shares. We don't expect to buy back any shares in Q3. But we feel like we've got better visibility now to get back to the 3.5x or below.

當然。因此，OI 和自由現金流之間的最大區別在於 DSO。當我們看到這些 DSO 下降時，這將增加今年的自由現金流。在股票回購方面，我們正在按計劃進行。我們的槓桿水平高於我們的目標範圍，我想我們對每個人都非常清楚，我們希望回到 3.5 倍或以下。我們在這方面取得了良好進展。本季度我們的市盈率是 3.7 倍，而且我們沒有回購任何股票。我們預計不會在第三季度回購任何股票。但我們覺得現在的能見度已經更好，可以回到 3.5 倍或更低。

Our next caller is Philip Chickering with Deutsche Bank.

我們的下一個來電者是德意志銀行的 Philip Chickering。

We'll go to the next caller. Lisa Clive with Bernstein.

我們將接聽下一個來電者。麗莎·克萊夫和伯恩斯坦。

Apologies Javier if you touched on this in the opening remarks, I was a few minutes late. But just could you comment on the CMS rate increase and the fact that they committed a mistake in the calculations and what the chances are of getting an improvement there? And also just as we think about going into 2025, what would a fair rate increase look like? And perhaps what lower numbers should our expectation around that actually be?

如果哈維爾在開場白中談到這一點，我深表歉意，我遲到了幾分鐘。但您能否評論一下 CMS 費率的增加以及他們在計算中犯下的錯誤這一事實以及改善的可能性有多大？而且正如我們考慮進入 2025 年一樣，公平的加息會是什麼樣子？也許我們的預期實際數字應該是多少？

Yes. Thanks for the question, Lisa. It's kind of funny. I've been here for a very long time. And not many questions used to come up about the rate increase with Medicare and so we started to ask ourselves why is this a new dynamic. And the reality is, is that the system is quite complicated, but it works relatively well in times where there's economic stability. And yet, when it's -- when we're experiencing times of inflation or lack of stability, it's really showing that it doesn't work in many ways.

是的。謝謝你的提問，麗莎。這有點好笑。我已經在這里呆了很長時間了。過去並沒有太多關於醫療保險費率上漲的問題，所以我們開始問自己為什麼這是一個新的動態。現實情況是，該系統相當複雜，但在經濟穩定的時期運作相對良好。然而，當我們經歷通貨膨脹或缺乏穩定性的時期時，它確實表明它在很多方面都不起作用。

But -- so let me step back. If you were to spend time on trying to understand the methodology you would really come to the conclusion that it is practically not possible to forecast because there's just too many things that are either proprietary or use lag data or a benchmark that is not related to dialysis, it's a benchmark related to all health care costs, and it's all weighted and then discounted with some kind of productivity factor. And so the short answer is, it's a big complicated equation with some variables that we will not have visibility to. So that's the short answer. We can't forecast it. I can't believe anyone from the outside world can.

但是——所以讓我退後一步。如果您花時間嘗試理解該方法，您實際上會得出這樣的結論：實際上不可能進行預測，因為有太多的東西要么是專有的，要么使用滯後數據或與透析無關的基準，它是與所有醫療保健成本相關的基準，並且全部經過加權，然後用某種生產力因素進行折扣。所以簡短的回答是，這是一個很大的複雜方程，其中包含一些我們看不到的變量。這就是簡短的答案。我們無法預測。我不敢相信外面的世界有人能做到。

Secondly, what is an appropriate one and what we are advocating for is let's not have, let's call it, winners or losers. We understand that forecasting is difficult, but let's have a reconciliation that is actually linked to actual costs. And that if cost -- if you get an increase and it exceeds what inflation that there could be a decrease or vice versa. So that's what we're advocating for. As you know, it is very difficult in Washington, D.C. right now on trying to get funding, but we are trying to make our case.

其次，什麼是合適的，我們提倡的是不要有贏家或輸家。我們知道預測很困難，但讓我們進行與實際成本實際掛鉤的對賬。如果成本增加，並且超過通貨膨脹率，則可能會減少，反之亦然。這就是我們所倡導的。如您所知，目前在華盛頓特區很難獲得資金，但我們正在努力證明自己的立場。

And maybe just touching on MedPAC's role here. I mean they're sort of, well, the economic adviser to Medicare, but they don't have any enforcement power and I think there's sometimes -- some years, there's a big disconnect between the MedPAC recommendation and the rate and then this year, it was actually quite in line. I mean, from your perspective, do you guys even look at the MedPAC numbers? I think it seems like it should be a useful data point, but it often isn't.

也許只是談談 MedPAC 在這裡的作用。我的意思是，他們是 Medicare 的經濟顧問，但他們沒有任何執行權，我認為有時——有些年，MedPAC 的建議和費率之間存在很大脫節，然後今年，其實是很符合的。我的意思是，從你們的角度來看，你們是否看過 MedPAC 數據？我認為它似乎應該是一個有用的數據點，但通常不是。

Yes. The process for MedPAC is a bit opaque to us. We try to educate and highlight what is really happening with our cost structure. And again, in periods of stability, it happened to be, give or take, within reason, acceptable and now the gap is widening and it's widening compounded year after year. So it's really starting to be significant.

是的。 MedPAC 的流程對我們來說有點不透明。我們試圖教育並強調我們的成本結構的實際情況。再說一遍，在穩定時期，無論給予還是採取，在合理範圍內，這種差距都是可以接受的，現在差距正在擴大，而且年復一年地擴大。所以它確實開始變得重要了。

Okay. And then last follow-up is, does this have -- just given how the rate increase was, does this change your decision on some clinic closures in any way? Because obviously, that's always the worry that if the Medicare rates get too low, you just have clinics here and there where you're on all Medicare and it just doesn't financially make sense anymore.

好的。最後一個跟進是，考慮到發病率的增長情況，這是否會以任何方式改變您關閉某些診所的決定？因為顯然，人們總是擔心，如果醫療保險費率太低，你就會到處都有診所，而你卻享受所有醫療保險，這在經濟上就不再有意義了。

Yes. There's lot that goes into the decision to close a clinic. In particular, we've got to really focus on patient care and making sure that our patients are being taken care of. But it is absolutely a consideration when you look at the economics, but the sort of the first filter is continuity of care.

是的。關閉診所的決定涉及很多因素。特別是，我們必須真正關注患者護理並確保我們的患者得到照顧。但當你考慮經濟學時，這絕對是一個考慮因素，但第一個過濾器是護理的連續性。

The second is, is there a convenient place where that patient can be taken care of and then after that, you get into economic factors such as reimbursement, leases and other things, but we are aggressively looking at our footprint, and we continue to right size to make sure that we are thoughtful about our resource allocation and capital allocation.

第二個是，是否有一個方便的地方可以照顧病人，然後，你會遇到經濟因素，如報銷、租賃和其他事情，但我們正在積極地關注我們的足跡，我們繼續糾正規模，以確保我們對資源配置和資本配置深思熟慮。

(Operator Instructions) Our next caller is Pito Chickering with Deutsche Bank.

（接線員指示）我們的下一個來電者是德意志銀行的 Pito Chickering。

Can you guys hear me now?

你們現在能聽到我說話嗎？

Yes.

是的。

Yes, Pito.

是的，皮托。

All right. Sorry, I'm not sure what happened there. Back to treatment growth here, pre-COVID like you were getting about 4,000 new patients a year, about 2/3 of those in the first half of the year from nephrologists dropping on and obviously, the rest coming from hospitalization and started dropping to you guys. I guess, how is that tracking this year at this point relative to sort of that 4,000 x 2/3? Is that -- what are you guys are seeing for new patients at this point?

好的。抱歉，我不確定那裡發生了什麼。回到這裡的治療增長，在新冠疫情之前，每年大約有4,000 名新患者，其中大約2/3 是在上半年，來自腎病專家的患者逐漸減少，顯然，其餘的來自住院治療，並開始減少到您的治療伙計們。我猜，今年此時相對於 4,000 x 2/3 的跟踪情況如何？那是——你們現在對新病人有什麼看法？

Yes. So Pito, the short answer is, if you're looking at admits, we are tracking pretty much to pre-COVID levels. The challenge is excess mortality. And that remains elevated and that's the reason that we're not yet ready to say we're going to return to pre-COVID growth levels. That said, mortality has been coming down year after year since COVID started, it's down Q2 versus Q1. So if mortality continued to decline and return to pre-COVID levels, then the math you laid out of 4,000 new patients a year, we'd be back there.

是的。皮托，簡短的回答是，如果你考慮承認的話，我們幾乎已經恢復到了新冠疫情之前的水平。挑戰是死亡率過高。這一數字仍然很高，這就是我們還沒有準備好說我們將恢復到新冠疫情前的增長水平的原因。也就是說，自新冠疫情爆發以來，死亡率逐年下降，第二季度與第一季度相比有所下降。因此，如果死亡率繼續下降並恢復到新冠疫情之前的水平，那麼按照每年 4,000 名新患者的計算結果，我們就會回到那個水平。

Which is a perfect segue for the next question about mortality. You sort of talked about that sort of coming down. I guess is there any way you can give us sort of what is the rate of that decline? And if it follows its path you've seen for the last three quarters. Is this -- so what glide path would that indicate?

這是下一個關於死亡率的問題的完美延續。你談到了這種下降。我想你有什麼辦法可以告訴我們下降的速度是多少嗎？如果它遵循過去三個季度你所看到的路徑。這是——那麼這表明什麼下滑路徑呢？

Yes. That's -- it's a tough piece of analysis to do because it hasn't necessarily been smooth quarter-to-quarter or year-to-year. So look, we're watching it carefully, we all know there's a minor surge going on, but I think minor is the operative word from what we've seen so far. So we're keeping a careful eye on it, but I don't think we can draw a trend line based on the history to say when we think mortality gets back zero -- where excess mortality gets back to zero.

是的。這是一項艱難的分析，因為它不一定按季度或按年順利進行。所以看，我們正在仔細觀察，我們都知道正在發生輕微的激增，但我認為從我們迄今為止所看到的情況來看，“輕微”是​​最重要的詞。因此，我們正在密切關注這一問題，但我認為我們無法根據歷史畫一條趨勢線來說明死亡率何時回到零——超額死亡率回到零。

Okay. Like is there something that you can quantify for us, say what excess mortality was this quarter and what is -- where it was last quarter?

好的。就像你可以為我們量化一些東西，比如本季度的超額死亡率是多少，上個季度的死亡率是多少？

Yes. Last quarter, it was roughly 900 lives, this quarter it was between 500 and 600. Remember, we will sometimes update those over time. We get better views of excess mortality as time goes on. But somewhere between 500 and 600 is our best estimate for Q2.

是的。上個季度大約有 900 條生命，本季度在 500 到 600 條生命之間。請記住，我們有時會隨著時間的推移更新這些生命。隨著時間的推移，我們對死亡率過高有了更好的認識。但我們對第二季度的最佳估計是在 500 到 600 之間。

Okay. And I definitely understand sort of the complexity of coming up with those for a variety of different reasons.

好的。我絕對理解出於各種不同原因提出這些建議的複雜性。

For Medicare Advantage, what percent of your MA patients are you currently taking risk for, in one way or another?

對於 Medicare Advantage，您目前以某種方式承擔風險的 MA 患者佔百分之幾？

I'd have to do the math quickly in my head. Pito, I don't want to give you a bad number. So I'm going to -- let's take that offline.

我必須在腦子裡快速算算。皮托，我不想給你一個不好的數字。所以我要——讓我們把它離線。

Okay. Next one here is on the managed care rate increase question that was asked earlier. I guess are you seeing managed care do anything different in terms, not just in the rate increases, but potentially trying to [steer] your patients? Like have you seen any behavior changes for managed care in the last 90 days or so, just obviously, as you're seeing increased [utilizations] elsewhere. Just curious if they're trying to control costs within other parts of the business?

好的。下一個是關於之前提出的管理式醫療費率增加問題。我想您是否看到管理式醫療在方面做了什麼不同的事情，不僅僅是在費率增加方面，而且還可能試圖[引導]您的患者？就像您在過去 90 天左右的時間內看到管理式醫療的任何行為變化一樣，很明顯，正如您在其他地方看到的[利用率]增加一樣。只是好奇他們是否試圖控制業務其他部分的成本？

No, we haven't seen no changes at all.

不，我們根本沒有看到任何變化。

Okay. Got it. And then -- so the last one here. On the pace of consolidation for facilities, obviously, you guys do the lowest-hanging fruit first, but as you see success of capturing those patients sort of within other centers, do you get more aggressive about consolidation than maybe you had originally planned for about a year from now? And when these patients are consolidated, do you see an increase of home treatments at that point?

好的。知道了。然後——這是最後一個。顯然，在設施整合的步伐上，你們首先做的是最容易實現的目標，但是當你們看到在其他中心成功捕獲這些患者時，你們是否會比最初計劃的更積極地進行整合一年後？當這些患者合併後，您是否會看到家庭治療的增加？

Yes. I think we want to be really careful about being "aggressive", we want to be really thoughtful and balanced in all the trade-offs that go into closing a center.

是的。我認為我們要非常小心地對待“侵略性”，我們希望在關閉一個中心的所有權衡中都經過深思熟慮和平衡。

We have to remember, our patients are incredibly vulnerable and one of the most important things is to be close to their home. And so 90-some-odd percent of our patients are within 10 miles of their home. And that is one of the best things we can offer, convenience. And we talk a lot about health equity issues and not being in the communities, we are in the communities. And so we take that pretty seriously. But as the economic constraints happen and if we are able to accommodate our patients, we are being very thoughtful on that. And we have other obligations like leases and other things. So there's a natural time to review a clinic to see if it's appropriate for closure.

我們必須記住，我們的患者非常脆弱，最重要的事情之一就是靠近他們的家。因此，我們 90% 左右的患者都在離家 10 英里範圍內。這就是我們能提供的最好的東西之一：便利。我們談論了很多健康公平問題，不是在社區，而是在社區。所以我們非常重視這一點。但隨著經濟限制的發生，如果我們能夠容納我們的病人，我們對此會非常深思熟慮。我們還有其他義務，例如租賃和其他事項。因此，現在是審查診所以確定是否適合關閉的自然時機。

And then the second part to your question, I think -- Pito?

我想，你的問題的第二部分是——皮托？

Yes. So (inaudible) have asked some questions in different ways. I guess, as -- if a patient is consolidated, do you see an increased utilization of home treatments? And then the second part of the question is, so what percent of treatments today are being done in the home?

是的。所以（聽不清）以不同的方式提出了一些問題。我想，如果患者病情得到鞏固，您是否會看到家庭治療的利用率有所增加？問題的第二部分是，現在有多少百分比的治療是在家裡進行的？

No is the answer. We are not seeing any changes in whether a patient goes home or not. We continue to be very much an advocate of home, there's a lot of dynamics and education that go into that. And we want the right modality for the right patient, but we are a huge home champions. And the mix on home is roughly around 15%, a little above that, like 15.2% or so, but it's been hanging around that 15%. COVID had a big impact on home that many patients felt more comfortable in that time of insecurity to go and be taken care of by professionals, but we're starting to see a slight pickup in patient choice to go home.

答案是否定的。我們沒有看到患者是否回家有任何變化。我們仍然是家庭的倡導者，其中有很多動力和教育。我們希望為正確的患者提供正確的治療方式，但我們是巨大的本土冠軍。家庭的比例大約在 15% 左右，稍微高一點，比如 15.2% 左右，但一直徘徊在 15% 左右。新冠疫情對家庭產生了巨大影響，許多患者在那個不安全的時期，感覺去接受專業人員的照顧會更舒服，但我們開始看到患者選擇回家的人數略有增加。

Okay. And then I think last question for me here. Can we get an update on Medtronic JV, I guess, sort of how much of the drag is that on the OI? And just as you look at it today, kind of what's the pathway to that becoming operating-income neutral? And just can you just refresh us on sort of why you saw that as a good opportunity for you guys?

好的。然後我想到最後一個問題。我想，我們能否了解美敦力合資公司的最新情況，比如 OI 的阻力有多大？正如您今天所看到的那樣，實現營業收入中性的途徑是什麼？您能否向我們介紹一下為什麼您認為這對你們來說是一個很好的機會？

Sure. So just as a reminder, it doesn't hit our operating income, it's below the OI line so it hits EPS. It's worth about $15 million pretax per quarter. That's on a non-GAAP basis, this quarter, we actually had some positive gain as a result of the transaction. And we think that number will decline over the next couple of years, and we anticipated getting to breakeven in two to three years.

當然。提醒一下，它不會影響我們的營業收入，它低於 OI 線，因此會影響每股收益。每季度稅前價值約為 1500 萬美元。在非公認會計準則的基礎上，本季度我們實際上因交易而獲得了一些積極的收益。我們認為這個數字將在未來幾年內下降，並且我們預計在兩到三年內實現收支平衡。

In terms of why we like this. Look, as Javier mentioned, we are really interested in figuring out ways to help our patients get home and new technology can be part of that answer. We're looking for other ways to innovate beyond just the service and information capabilities that we can do and we recognize Medtronic as a world-class leader in innovation on the medical device side. And we just thought their history here combined with our knowledge would make for a great partnership, which is why we invested in Mozarc.

就我們為什麼喜歡這個而言。瞧，正如哈維爾提到的，我們真的很想找到幫助患者回家的方法，而新技術可以成為答案的一部分。除了我們所能做到的服務和信息能力之外，我們正在尋找其他創新方式，並且我們認為美敦力是醫療設備方面創新的世界級領導者。我們只是認為他們在這裡的歷史與我們的知識相結合將建立良好的合作夥伴關係，這就是我們投資 Mozarc 的原因。

Perfect. All right. And the last quickie for me. Maybe I missed it. Did you guys quantify what the turnover was? Nurses and technicians for this quarter and how that compares versus 2019?

完美的。好的。對我來說最後的快點。也許我錯過了。你們量化過營業額嗎？本季度的護士和技術人員情況以及與 2019 年相比如何？

Thank you for that last question. We did not go into that level of detail. I think what we can say on labor because we've gone into so much detail on labor, is in the overall category, it is playing out as expected.

謝謝你最後一個問題。我們沒有深入探討這一細節。我認為我們可以就勞動力問題說些什麼，因為我們已經對勞動力問題進行瞭如此多的細節，這是在總體類別中，它正在按預期進行。

Some of the underlying components have shifted a bit. And so just to give a little more detail on that. Base wages are above our normal averages. Our contract labor is back in line to normal, and we continue to have elevated training. And so that's how the levers are moving. But overall, the category is as expected.

一些底層組件發生了一些變化。所以只是想提供更多細節。基本工資高於我們的正常平均水平。我們的合同工已恢復正常，並且我們繼續接受更高水平的培訓。這就是槓桿的移動方式。但總體而言，該類別符合預期。

And at this time, I am showing no further questions, sir.

先生，此時我不會提出任何進一步的問題。

We do have one more question. Andrew Mok from UBS.

我們還有一個問題。瑞銀集團 (UBS) 的安德魯·莫 (Andrew Mok)。

Just wanted a couple of follow-ups on the clinic closures. You closed down 16 clinics but opened 10 new dialysis clinics. I'm just trying to better understand what's driving the new clinics at this point given I thought a lot of the clinic closures was a result of excess mortality. So what are you seeing in the market that's causing you to open new clinics? Are there any characteristics that you would call out about them, whether they're home dialysis programs or anything like that?

只是想了解診所關閉的一些後續情況。您關閉了 16 家診所，但開設了 10 家新的透析診所。我只是想更好地了解目前新診所的推動因素，因為我認為很多診所關閉是由於死亡率過高造成的。那麼，您在市場上看到了什麼促使您開設新診所的原因呢？您是否會指出它們的任何特徵，無論它們是家庭透析計劃還是類似的東西？

In general, you can imagine, health care is local. And so there are areas where there are literally full clinics. There's sometimes relocations. Sometimes, as you called out, there might be just a home center that was needed. So there's a little of all. But as you can see, the number is materially smaller as we are very focused on making sure that capacity utilization is where it needs to be and that we're capital efficient.

一般來說，你可以想像，醫療保健是本地的。所以有些地區確實有完整的診所。有時候還會有搬遷的情況。有時，正如您所說，可能只需要一個家庭中心。所以有一點。但正如您所看到的，這個數字要小得多，因為我們非常專注於確保產能利用率達到需要的水平，並且我們的資本效率很高。

Got it. And on the mortality, I think you gave us the absolute number in the quarter. Can you give us a sense of how the mortality rate in general is tracking? And how far off are you against pre-pandemic levels?

知道了。關於死亡率，我認為您給了我們本季度的絕對數字。您能否讓我們了解一下總體死亡率的變化情況？距離大流行前的水平還有多遠？

The mortality level looks roughly a percentage or so higher than pre-pandemic. And as Joel talked about it, it's a bit cyclical and depending on the surge or if there is one, or sort of the front end tends to have higher mortality at the front end of the year or the back end of the year versus the middle of the year. But I think a good number is roughly 1% or give or take, 2,000 patients.

死亡率看起來比大流行前大約高出一個百分比左右。正如喬爾所說，這有點週期性，取決於激增，或者是否有，或者某種前端往往在年初或年底比中期有更高的死亡率今年的。但我認為一個好的數字大約是 1%，或者說是 2,000 名患者。

And at this time, I'm showing no further questions.

此時，我沒有再提出任何問題。

Okay. Well, thank you, Michelle, and thank you all for your questions. As you heard through our comments today, we've continued to drive operational efficiencies and make investments to fuel our performance now into the future years as well.

好的。好的，謝謝你，米歇爾，也謝謝大家提出的問題。正如您今天通過我們的評論所聽到的，我們將繼續提高運營效率並進行投資，以推動我們現在和未來幾年的業績。

Some of those seeds that we planted are beginning to sprout and some will take additional time and continued effort. We look forward to keeping you updated on our continued progress in the back half of the year. Thank you for joining the call and be well.

我們種下的一些種子已經開始發芽，而另一些則需要額外的時間和持續的努力。我們期待向您通報我們下半年的持續進展情況。感謝您加入通話並祝您一切順利。

Thank you. This concludes today's conference call. You may go ahead and disconnect at this time.

謝謝。今天的電話會議到此結束。此時您可以繼續並斷開連接。