德維特 (DVA) 2024 Q3 法說會逐字稿

Good evening. My name is Michelle, and I will be your conference facilitator today. (Operator Instructions) At this time, we would like to welcome everyone to the DaVita third-quarter 2024 earnings call. (Operator Instructions) Thank you, Mr. Eliason, you may begin your conference.

晚安.我叫米歇爾，今天我將擔任你們的會議主持人。（操作員說明）此時，我們歡迎大家參加 DaVita 2024 年第三季財報電話會議。（操作員指示）謝謝您，Eliason 先生，您可以開始會議了。

Thank you, and welcome to our third 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. Please note that during this call, we may make forward-looking statements within the meaning of the federal securities laws.

謝謝您，歡迎參加我們的第三季電話會議。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)，投資人關係集團副總裁。今天加入我的是我們的執行長哈維爾·羅德里格斯 (Javier Rodriguez)；和我們的財務長喬爾阿克曼。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。

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 third 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 we 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. Additionally, we'd like to remind you that during this call, we will discuss some non-GAAP financial measures.

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有重大差異。有關這些風險和不確定性的更多詳細信息，請參閱我們的第三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與美國證券交易委員會。我們的前瞻性陳述是基於我們目前掌握的信息，我們不打算也不承擔更新這些陳述的義務，除非法律要求。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。

A reconciliation of these non-GAAP measures to the most comparable GAAP financial measures is included in our press release furnished to the SEC and available on our website. I will now turn the call over to Javier Rodriguez.

這些非 GAAP 衡量標準與最具可比性的 GAAP 財務衡量標準的對帳包含在我們向 SEC 提供並可在我們的網站上取得的新聞稿中。我現在將把電話轉給哈維爾·羅德里格斯。

Thank you, Nic, and thank you all for joining the call today. I'm grateful for the incredible effort of our frontline caregivers as we deliver outstanding care for our patients while also navigating recent hurricanes and related supply disruption. Alongside these challenges, we continue to execute on operating efficiencies and innovate across the continuum of care. Today, I will cover our third quarter performance, which was in line with our expectations, provide an update on our supply chain, discuss our expectations for upcoming CMS 2025 final rule and wrap up with some comments about next year.

謝謝尼克，也謝謝大家今天加入電話會議。我感謝第一線護理人員所做的令人難以置信的努力，他們為患者提供了出色的護理，同時也應對了最近的颶風和相關的供應中斷。除了這些挑戰之外，我們還繼續提高營運效率並在整個護理過程中進行創新。今天，我將介紹我們第三季的業績，這符合我們的預期，提供我們供應鏈的最新情況，討論我們對即將到來的 CMS 2025 最終規則的預期，並總結一些關於明年的評論。

But first, we will start the call as we always do with a clinical highlight. This quarter, we'll use this opportunity to highlight the remarkable resilience our patients and teammates have demonstrated in the face of recent storms. Over the past month, millions of lives were impacted by the devastation caused by Hurricanes Helene and Milton despite hundreds of centers being in the path of these storms, most were open within days of the storm relenting and all but one is fully operational today, providing care in these communities. Many inspirational stories emerged from the dialysis community, which came together to support those in need.

但首先，我們將像往常一樣以臨床要點開始通話。本季度，我們將利用這個機會強調我們的患者和隊友在面對最近的風暴時所表現出的非凡的韌性。在過去的一個月裡，數百萬人的生命受到了颶風海倫和米爾頓造成的破壞的影響，儘管風暴路徑上有數百個中心，大多數中心在風暴減弱後幾天內就開放了，除了一個中心外，所有中心今天都已全面投入使用，提供這些社區的護理。透析社區湧現許多鼓舞人心的故事，他們齊心協力為有需要的人提供支持。

In the immediate aftermath of these storms, our care teams from across the country rallied to support the regions affected. DaVita deployed generators, water tankers over 20,000 gallons of fuel and high water crews to conduct wellness checks and search for missing patients and teammates. Local leadership worked tirelessly to account for all patients and teammates and to coordinate transportation for urgent access to the dialysis care many patients needed to survive. Our Asheville Kidney Center opened on the Sunday immediately after Hurricane Helene, under generated power to provide the care for patients from six nearby facilities.

這些風暴發生後，我們來自全國各地的護理團隊立即集結起來，為受影響的地區提供支援。DaVita 部署了發電機、超過 20,000 加侖燃料的水罐車和高水位工作人員來進行健康檢查並尋找失踪的患者和隊友。當地領導不知疲倦地工作，為所有患者和隊友負責，並協調交通，以便許多患者能夠緊急獲得生存所需的透析護理。我們的阿什維爾腎臟中心於颶風海倫過後的周日開業，利用發電為附近六個設施的患者提供護理。

We and others in the kidney care community open our doors to anyone needing treatment, including those who normally treat with other providers. I was proud to see the dialysis community come together in common support of patient care. Combined with the dedication of our local care teams, our successful emergency response has again underscored the importance of scaled resources and operating discipline. Although the storms have since passed our efforts are ongoing to coordinate humanitarian needs, including food, housing and other assistance.

我們和腎臟護理社區的其他人向任何需要治療的人敞開大門，包括那些通常與其他提供者一起治療的人。我很自豪地看到透析界齊心協力支持病患照護。結合我們當地護理團隊的奉獻精神，我們成功的緊急應變再次凸顯了規模化資源和操作紀律的重要性。儘管風暴已經過去，我們仍在繼續努力協調人道主義需求，包括食物、住房和其他援助。

We continue to work with the impacted communities to rebuild. Thank you all to the teammates who have gone above and beyond to care for one another and our patients. Beyond the community impact, key supply lines were disrupted by Hurricane Helene due to the closing of Baxter's North Cove facility. Baxter supplies us with the majority of our peritoneal dialysis or PD solution used for home PD therapy and the majority of our saline used during each in-center hemodialysis treatment. Baxter and other manufacturers have been able to provide sufficient supply for all our current PD patients to continue their treatment relatively uninterrupted.

我們繼續與受影響的社區合作進行重建。感謝所有竭盡全力照顧彼此和我們的患者的隊友。除了社區影響之外，由於百特北灣工廠關閉，颶風海倫也中斷了主要供應線。百特為我們提供家庭腹膜透析治療的大部分腹膜透析或腹膜透析溶液，以及每次中心血液透析治療期間使用的大部分生理食鹽水。百特和其他製造商已經能夠為我們目前所有的帕金森氏症患者提供足夠的供應，以相對不間斷地繼續治療。

While we have had to temporarily suspend new patient starts, on PD, thanks to the great efforts of our regulators, government officials and Baxter, we expect to resume new PD starts next month, and we expect supply dynamics to normalize in the first quarter. Shifting to saline, Baxter is now able to supply us with approximately 60% of their pre-storm levels as they continue their work to bring the North Cove facility back online. Fortunately, we've been successful in securing alternative supply to ensure continuity of care and safety for our patients. Because these challenges occurred near the end of the quarter, the impact on Q3 financial results was minimal.

雖然我們不得不暫時中止新患者的啟動，但在PD 方面，由於我們的監管機構、政府官員和百特的巨大努力，我們預計下個月將恢復新的PD 啟動，並且我們預計第一季的供應動態將正常化。轉向使用鹽水，Baxter 現在能夠向我們提供風暴前水平的大約 60%，同時他們將繼續努力使北灣設施恢復正常運作。幸運的是，我們已經成功地獲得了替代供應，以確保患者護理的連續性和安全性。由於這些挑戰發生在本季末附近，因此對第三季財務表現的影響很小。

For the fourth quarter, we estimate an impact of approximately $10 million to $20 million due to the high supply costs, lower PD patient starts and lower productivity from our home caregivers. This is now included within our 2024 adjusted operating income guidance range, and we expect a portion of this quarterly impact will continue into 2025, depending on the duration of the supply challenges. I'll transition now to our expectations for the ESRD final rule from CMS, which we anticipate will be published shortly. While there are many aspects of the rule, we will be primarily focused on two areas.

對於第四季度，由於供應成本高、PD 患者啟動率較低以及家庭照護人員的工作效率較低，我們預計影響約為 1,000 萬至 2,000 萬美元。這現已包含在我們 2024 年調整後的營業收入指導範圍內，我們預計該季度影響的一部分將持續到 2025 年，具體取決於供應挑戰的持續時間。我現在將過渡到我們對 CMS 的 ESRD 最終規則的期望，我們預計該規則將很快發布。雖然該規則有很多方面，但我們將主要關注兩個領域。

First, the market basket update, including how CMS handles the new proposed wage index and the base rate. As a reminder, the proposed rule led to an approximate 2.1% increase. Second is the transition of oral-only drugs into the bundle beginning January 1. As a reminder, this is a statutory mandate by which oral-only drugs which are mostly phosphate binders will transition from the Medicare drug benefit over to Medicare Part B.

首先，市場籃子更新，包括 CMS 如何處理新提議的工資指數和基本費率。提醒一下，擬議的規則導致了大約 2.1% 的增長。其次是從 1 月 1 日開始將口服藥物轉變為捆綁藥物。提醒一下，這是一項法定任務，主要是磷酸鹽結合劑的口服藥物將從 Medicare 藥物福利過渡到 Medicare B 部分。

While CMS made clear, it intends for these drugs to enter the bundle, we are waiting on information such as initial reimbursement and the treatment of unbillable items. We continue to believe this transition to the bundle will provide more patients with access to these important therapies. We recognize that some pharmaceutical manufacturers continue to advocate for the legislation to delay the implementation of this long-standing role but urge legislators to put patient access first. We're prepared to implement this transition in support of our patients.

雖然 CMS 明確表示打算將這些藥物納入捆綁銷售，但我們正在等待初始報銷和不可計費項目處理等資訊。我們仍然相信，向捆綁銷售的轉變將為更多患者提供獲得這些重要療法的機會。我們認識到，一些製藥商繼續主張立法推遲這一長期作用的實施，但敦促立法者將患者的使用放在首位。我們準備實施這項轉變來支持我們的患者。

Transitioning to our third quarter performance, adjusted operating income was $535 million and adjusted earnings per share was $2.59. We view our third quarter results as fairly straightforward, consistent with how we have delivered value through this entire year. Although treatment volume growth remains a challenge, our business continues to demonstrate resilience as we mitigate the volume headwinds with margin expansion, including the momentum of our IKC and international results, all while continuing to invest in our future. Cash flow remains strong, and we continue to deliver on our disciplined capital allocation strategy returning capital to shareholders through share repurchases.

從我們第三季的業績來看，調整後的營業收入為 5.35 億美元，調整後的每股盈餘為 2.59 美元。我們認為第三季的業績相當簡單，與我們全年交付價值的方式一致。儘管治療量成長仍然是一個挑戰，但我們的業務繼續表現出彈性，因為我們透過利潤率擴張來緩解數量阻力，包括我們的 IKC 和國際業績的勢頭，同時繼續投資於我們的未來。現金流依然強勁，我們持續實施嚴格的資本配置策略，透過股票回購將資本返還給股東。

Turning to the full year, we remain on track to deliver results consistent with our 2024 guidance range. We're reconfirming our 2024 adjusted operating income guidance of $1.91 billion to $2.01 billion. This forecast now includes the impact of Baxter supply shortage. It is a bit early to give specific guidance for 2025, although I know that many of you are already looking ahead to next year.

展望全年，我們仍有望實現與 2024 年指引範圍一致的業績。我們再次確認 2024 年調整後營業收入指引為 19.1 億美元至 20.1 億美元。該預測現在包括百特供應短缺的影響。儘管我知道你們中的許多人已經在展望明年，但現在給出 2025 年的具體指導還為時過早。

Over the next few months, we'll learn more key factors, including open enrollment, oral drugs in the bundle, integrated kidney care and others, so we will provide formal 2025 guidance on the fourth quarter call, consistent with our normal cadence. That said, some multiyear context may be helpful. After challenging years in 2021 and 2022 during the pandemic, we're now on track to deliver our second consecutive year of double-digit adjusted OI growth despite continuing volume and labor pressures. Looking forward, we expect to return to adjusted OI growth more consistent with our historic pre-pandemic multiyear guidance.

在接下來的幾個月裡，我們將了解更多關鍵因素，包括公開招募、捆綁口服藥物、綜合腎臟護理等，因此我們將在第四季度電話會議上提供正式的2025 年指導，這與我們的正常節奏一致。也就是說，一些多年的背景可能會有所幫助。在經歷了 2021 年和 2022 年疫情期間的挑戰之後，儘管數量和勞動力壓力持續存在，但我們現在有望連續第二年實現調整後的 OI 兩位數增長。展望未來，我們預計調整後的 OI 成長將更加符合我們歷史性的疫情前多年指引。

I will now turn it over to Joel to discuss our financial performance and outlook in more detail.

我現在將把它交給喬爾，更詳細地討論我們的財務表現和前景。

Thank you, Javier. For the quarter, adjusted operating income was $535 million. Adjusted EPS was $2.59 and free cash flow was $555 million. Let me start with some details behind the Q3 results. Quarter-over-quarter treatment volume per day was flat.

謝謝你，哈維爾。該季度調整後營業收入為 5.35 億美元。調整後每股收益為 2.59 美元，自由現金流為 5.55 億美元。讓我從第三季業績背後的一些細節開始。每日治療量環比持平。

This was in line with our expectations and is the result of continued strong admissions offset by elevated mortality and slightly higher missed treatment rates, resulting from inclement weather namely Hurricane Beryl in July and Hurricane Helene in September. We remain confident that our full year treatment volume growth will fall in the range of 0.5% to 1%. Revenue per treatment was up more than $4 versus the second quarter, in line with our expectations. Our revenue cycle performance is sustaining the strong RPT results we've seen throughout the year.

這符合我們的預期，是由於惡劣天氣（即 7 月的貝裡爾颶風和 9 月的颶風海倫）造成的死亡率上升和略高的錯過治療率所抵消的持續強勁入院人數的結果。我們仍有信心全年治療量成長將下降在 0.5% 至 1% 的範圍內。與第二季相比，每次治療的收入增加了 4 美元以上，符合我們的預期。我們的營收週期表現正在維持我們全年看到的強勁 RPT 業績。

We still expect for RPT growth to be within the range of 3.5% to 4%. Patient care cost per treatment increased $2 sequentially. This was primarily the result of continued labor cost pressure plus higher medical benefits expense in the quarter. G&A costs increased by $19 million quarter-over-quarter due to typical quarterly variability in expense timing.

我們仍然預計 RPT 成長將在 3.5% 至 4% 的範圍內。每次治療的患者護理費用連續增加 2 美元。這主要是由於本季持續的勞動力成本壓力以及較高的醫療福利費用所造成的。由於費用時間的典型季度變化，一般管理費用環比增加了 1900 萬美元。

Depreciation and amortization increased by $11 million in Q3 versus Q2 as a result of higher center closure costs. International OI increased slightly in the quarter as the result of strong operational performance offset by $4 million of unfavorable foreign exchange impact. Adjusted operating results within Integrated Kidney Care, our value-based care segment, increased $32 million sequentially due to lower costs in our special needs plans and timing of revenue recognition related to CKCC the government value-based care demonstration program. As always, we recommend evaluating IKC performance on an annual basis given the propensity for quarterly variability.

由於中心關​​閉成本較高，第三季的折舊和攤提比第二季增加了 1,100 萬美元。由於強勁的營運業績抵消了 400 萬美元的不利外匯影響，本季國際 OI 略有增加。由於我們的特殊需求計劃成本降低以及與政府基於價值的護理示範計劃 CKCC 相關的收入確認時間，我們的基於價值的護理部門綜合腎臟護理的調整後經營業績環比增加了 3200 萬美元。與往常一樣，考慮到季度變化的傾向，我們建議每年評估 IKC 表現。

We still believe IKC will have a full year operating loss of approximately $50 million. Below the OI line, third quarter debt expense was $37 million higher than in Q2. This was due to two main factors: first, our 2% interest rate caps expired at the end of June and our current caps have a weighted average rate of approximately 4.3% for the rest of 2024. This impact is in line with our expectations and consistent with our guidance from the beginning of the year.

我們仍然認為 IKC 全年營運虧損約 5,000 萬美元。在 OI 線以下，第三季債務支出比第二季高出 3,700 萬美元。這是由於兩個主要因素：首先，我們 2% 的利率上限已於 6 月底到期，而我們目前的利率上限在 2024 年剩餘時間內的加權平均利率約為 4.3%。這種影響符合我們的預期，也與我們年初的指導一致。

The said factor contributing to the increase this quarter was the additional debt raised in August. Following our second quarter earnings call, we successfully completed two debt transactions totaling $2.1 billion. The proceeds from these deals were used in part to repay our Term Loan B maturing in 2026, now making our nearest debt maturity 2028. Leverage at the end of Q3 was 3.17 times EBITDA, a slight increase from Q2, while remaining below the midpoint of our target range of 3 to 3.5 times EBITDA.

上述導致本季成長的因素是八月籌集的額外債務。在第二季財報電話會議之後，我們成功完成了兩項總計 21 億美元的債務交易。這些交易的收益部分用於償還 2026 年到期的定期貸款 B，現在我們最近的債務到期日為 2028 年。第三季末的槓桿率為 EBITDA 的 3.17 倍，較第二季略有增加，但仍低於我們 3 至 3.5 倍 EBITDA 目標範圍的中點。

In the third quarter, we repurchased 2.7 million shares, and we have repurchased approximately 600,000 shares to date in October. Let me close out with some comments on what remains of 2024 and our thoughts as we look towards 2025. As Javier said, we are reaffirming our adjusted OI guidance range of $1.91 billion to $2.01 billion. Despite the anticipated hurricane-related OI impact in the fourth quarter, we expect continuing operating momentum to offset the headwind.

第三季度，我們回購了270萬股，10月份至今我們已經回購了約60萬股。最後，讓我對 2024 年剩下的事情以及我們展望 2025 年的想法發表一些評論。正如哈維爾所說，我們重申調整後的 OI 指引範圍為 19.1 億美元至 20.1 億美元。儘管預計第四季度將受到颶風相關的 OI 影響，但我們預計持續的營運動能將抵消不利因素。

We are also maintaining our adjusted EPS range of $9.25 to $10.05 and our free cash flow range of $950 million to $1.2 billion. Looking forward to 2025, as Javier mentioned, it is too early to give formal guidance. Regarding some of the components of earnings, I would like to call out a few unique potential headwinds and tailwinds outside of our normal dynamics. For the headwinds, first, we expect mortality will remain elevated in 2025.

我們也將調整後每股收益維持在 9.25 美元至 10.05 美元之間，自由現金流維持在 9.5 億至 12 億美元之間。展望 2025 年，正如哈維爾所說，現在給予正式指導還為時過早。關於盈利的一些組成部分，我想指出我們正常動態之外的一些獨特的潛在逆風和順風。對於不利因素，首先，我們預計 2025 年死亡率將維持在較高水準。

Second, we expect the impact of the Baxter facility closure will continue in 2025. Third, the full year impact of the expiration of our 2% interest rate caps will negatively impact EPS. For the tailwinds, first is the declining center closure costs in 2025 that we called out last quarter. Second is the positive OI impact from our international business, driven by our Latin America acquisitions.

其次，我們預計百特工廠關閉的影響將持續到 2025 年。第三，2%利率上限到期對全年每股盈餘產生負面影響。對於有利因素，首先是我們上季度指出的 2025 年中心關閉成本下降。其次是我們的國際業務在拉丁美洲收購的推動下所產生的正面的 OI 影響。

And finally, we expect that the inclusion of orals in the bundle would be a tailwind if the pharma companies are unable to get legislation passed to delay the inclusion. Lastly, regarding RPT and PCC growth, we expect both to be elevated relative to pre-COVID levels. We will give an update on all these factors, along with more quantitative guidance on the Q4 earnings call. That concludes my prepared remarks for today. Operator, please open the call for Q&A.

最後，我們預計，如果製藥公司無法透過立法來推遲口服藥物的上市，那麼將口服藥物納入捆綁產品將是一種順風。最後，關於 RPT 和 PCC 的成長，我們預計兩者都將高於新冠疫情前的水平。我們將提供所有這些因素的最新信息，以及第四季度財報電話會議的更多定量指導。我今天準備的發言到此結束。接線員，請打開電話問答。

(Operator Instructions) Andrew Mok, Barclays.

（操作員指示）Andrew Mok，巴克萊銀行。

It sounded like there was a fair amount of operational changes to help navigate the hurricanes, but most of that would be felt in Q4. So I wanted to better understand, one, how much of an impact hurricanes had on 3Q treatment volumes, if any. And then, Joel, I think I heard you reiterate full year treatment growth between 50 to 100 basis points of growth which would imply a fairly significant acceleration in 4Q against the presumably greater impact from hurricanes. So I just want to understand how we should think through that and square those comments?

聽起來好像有相當多的營運變化來幫助應對颶風，但其中大部分將在第四季度感受到。因此，我想更了解颶風對第三季處理量的影響有多大（如果有的話）。然後，喬爾，我想我聽到您重申全年治療增長在 50 到 100 個基點之間，這意味著第四季度將出現相當顯著的加速，以應對颶風可能帶來的更大影響。所以我只是想了解我們應該如何思考並糾正這些評論？

Yes. Thanks, Andrew. So for Q3, I'd call out the impact from hurricanes as about 10 basis points, and that shows up in missed treatment rate. In Q4, I don't think this does much to change how we were thinking about Q4 before hurricanes.

是的。謝謝，安德魯。因此，對於第三季度，我認為颶風的影響約為 10 個基點，這體現在錯過治療率中。在第四季度，我認為這不會太大改變我們對颶風發生前第四季的看法。

So Q4, so the hurricanes aren't expected to have an impact on Q4 volumes?

那麼第四季度，颶風預計不會對第四季的銷售產生影響嗎？

Less. Significantly less than the 10 basis points from what we've seen so far. The quarter is not over, obviously. So there could be additional challenges. But so far, no, it would be less than the 10 basis points.

較少的。遠低於我們迄今為止所看到的 10 個基點。顯然，本季還沒結束。因此可能還會存在額外的挑戰。但到目前為止，不會，會低於10個基點。

Got it. Okay. And then I appreciate the early comments on 2025 headwinds and tailwinds. Can you help us understand the order of magnitude of some of those? And hoping specifically you can comment on the potential financial impact of the inclusion of phosphate binders that, that could have on next year's results.

知道了。好的。然後，我很欣賞早期關於 2025 年逆風和順風的評論。您能幫助我們了解其中一些的數量級嗎？特別希望您能評論一下磷酸鹽黏合劑的潛在財務影響，這可能會對明年的業績產生影響。

Well, let me start with the end on that, on the phosphate binders because we really tried quite a lot to give you a useful range. And unfortunately, we can't, and it's just because there's not enough information to give you a useful number. So let me just give you an explanation of the underlying dynamics. So everybody can be on the same page.

好吧，讓我從磷酸鹽結合劑的結尾開始，因為我們確實做了很多嘗試來為您提供一個有用的範圍。不幸的是，我們不能，這只是因為沒有足夠的資訊來為您提供有用的數字。因此，讓我向您解釋一下潛在的動態。這樣每個人都可以在同一頁上。

So first of all, there is a class of drugs, phosphate binders that will be the biggest part of the orals in the bundle. The first thing is we do not know because the rule hasn't come out, although we expect to hear shortly what the reimbursement will be by the government. Secondly, there are four products within the phosphate binders, and we don't know the mix of those products. And the pricing is quite different between those 4 products between branded and generic.

首先，有一類藥物，磷酸鹽結合劑，將成為捆綁中口服藥物的最大部分。首先，我們不知道，因為規則還沒有出台，儘管我們預計很快就會聽到政府將補償多少。其次，磷酸鹽結合劑中有四種產品，我們不知道這些產品的組合。這 4 種品牌產品和非專利產品的定價差異很大。

And within that, be branded have had restrictions and authorizations and other things that once those go away, we don't know what's going to happen with the mix. And then the last thing is the volume, there's about 10% to 15% of our patients that don't have Medicare Part D and weren't participating in these orals in the bundle, and that's why we think that this is so good for access for those patients. And so we don't know what will happen with that volume. So if you start to play with the variable, they start to get quite wide because, in essence, the volume could tighten up, but then the reimbursement has a wide range.

其中，品牌有限制、授權和其他事情，一旦這些限制和授權消失，我們不知道混合後會發生什麼。最後一件事是數量，大約有 10% 到 15% 的患者沒有 Medicare D 部分，也沒有參加捆綁中的這些口頭活動，這就是為什麼我們認為這對於這些患者的訪問權限。所以我們不知道這個卷會發生什麼事。因此，如果你開始考慮這個變量，它們就會開始變得相當寬，因為本質上，交易量可能會收緊，但報銷的範圍很寬。

And then the one that really throws a lot of dynamics into it is the pricing and the mix within that pricing. So unfortunately, we're going to have to wait until next quarter to give you a better number, better sense of that.

然後真正帶來很多動力的是定價和定價中的組合。不幸的是，我們將不得不等到下個季度才能給您一個更好的數字，讓您更好地了解這一點。

Yes. And Andrew, to follow up on the first part of your question. So I called out five factors: three tailwinds, two headwinds that would impact operating income. There was one additional, the interest expense, but that only hits EPS. Like the orals in the bundle, it is hard. There's a lot of swing factors that could apply to each of these.

是的。安德魯，跟進你問題的第一部分。因此，我列出了五個因素：三個會影響營業收入的順風因素，兩個逆風因素。還有一項額外的費用，即利息費用，但這只會影響每股收益。就像捆綁中的口語一樣，它很難。有很多搖擺因素可能適用於其中的每一個。

So I'm not going to quantify them individually. That said, I think a reasonable starting point for modeling would be that the headwinds and the tailwinds will offset each other at the OI line.

所以我不會單獨量化它們。也就是說，我認為建模的合理起點是逆風和順風將在 OI 線處相互抵消。

Got it. So when we think about the reference target growth, which I think is 3% to 7% pre-COVID, that's inclusive of headwind and tailwinds. So that's how we should think about it?

知道了。因此，當我們考慮參考目標成長時（我認為在新冠疫情之前為 3% 至 7%），這包括逆風和順風。那我們該如何思考呢？

I think that, yes, I think that's right.

我認為，是的，我認為這是對的。

AJ Rice, UBS.

AJ 賴斯，瑞銀集團。

Thanks, everybody. I think I know the answer to this point of clarification, but I'll just make sure you get on the record. The $10 million to $20 million of hurricane impact, I assume that's EBITDA not revenue. And then maybe just more broadly on the treatment patterns last quarter, you said that new to therapy was back to pre-pandemic levels. It sounds like it was positive again this quarter.

謝謝大家。我想我知道這一點澄清的答案，但我只是確保您記錄在案。颶風造成的 1000 萬至 2000 萬美元的影響，我認為那是 EBITDA，而不是收入。然後，也許更廣泛地討論上個季度的治療模式，您說新的治療方法回到了大流行前的水平。聽起來本季再次表現積極。

Is it stronger? Or is it about the same? And then the elevated missed treatments, is that strictly the hurricane impact? Or is there anything else going on there? And then mortality.

更強嗎？或者說是差不多的嗎？然後，錯過治療的人數增加，這完全是颶風的影響嗎？或者有其他事情發生嗎？然後是死亡。

It sounds like you're now extending that into 2025. Is that just because this is the first time you're commenting on '25? Or is there something new that's making you call out '25 on the heightened mortality rates?

聽起來你現在要把這個期限延長到 2025 年。這只是因為這是你第一次評論「25」嗎？或者有什麼新的事情讓你對死亡率的上升發出「25」的呼籲？

Yes. So let me try and get these in order. So first, in terms of the Baxter impact in Q4, it would be largely in EBITDA, there's the potential for a little bit in the revenue line if we lose some patients to another provider that's able to provide peritoneal dialysis and a patient for whatever reason, chooses to go that direction. But I would say the vast majority of it will not be revenue. On the three factors affecting volume, nothing new on admits, it's running consistent with what we've talked about in the past.

是的。所以讓我試著把這些整理好。因此，首先，就Baxter 對第四季度的影響而言，它將主要體現在EBITDA 上，如果我們因某種原因將一些患者轉移給另一家能夠提供腹膜透析的提供者和患者，那麼我們的收入可能會有所下降。但我想說，其中絕大多數不會是收入。關於影響交易量的三個因素，沒有什麼新的承認，它與我們過去討論的一致。

Mistreatment rate is it's never just storms, right? Historically, it's always been somewhere around 6% on average during the year, although not the same quarter-to-quarter, Q1 and Q4 elevated and Q2 and Q3 less so. So the 10 bps from the storms was kind of the 10 bps more than what we probably otherwise would have expected, but it's not the total miss treatment rate. And then, on mortality, I don't think there's anything new here that negatively impacts our view of 2025.

虐待率不只是暴風雨，對嗎？從歷史上看，全年平均成長率始終在 6% 左右，儘管每個季度的成長率並不相同，第一季和第四季有所上升，第二季和第三季有所下降。因此，風暴帶來的 10 個基點比我們原本預期的要多 10 個基點，但這並不是總的漏診率。然後，關於死亡率，我認為沒有任何新內容會對我們對 2025 年的看法產生負面影響。

I think the fact that the elevated mortality continues and having gone back to pre-COVID levels, every quarter that, that happens, it informs our views a bit. But I don't think we saw anything over this quarter that changed our views for next year significantly.

我認為死亡率持續上升並回到新冠疫情前的水平這一事實，每個季度都會發生這種情況，這在一定程度上影響了我們的觀點。但我認為本季我們沒有看到任何事情顯著改變我們對明年的看法。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

So back on the nonacquired treatment growth number here, obviously a lot of focus here. Can you just quantify the number of new patients you added in the first quarter, second quarter and third quarter. Any color on how many you lost to transplants for this year. Any color on those patients moving to other centers or geographies.

回到這裡的非獲得性治療成長數字，顯然這裡有很多焦點。能否簡單量化一下第一季、第二季、第三季新增的患者數量？任何關於今年您因移植而損失的人數的顏色。這些患者轉移到其他中心或地區的任何顏色。

I'm just looking for sort of any other reasons to size mortality is in trying to tie out the treatment growth the guys are looking at your selling with the delayed US RDS quarterly data on incidence and prevalence.

我只是在尋找任何其他衡量死亡率的原因，試圖將這些人正在考慮的治療成長與延遲的美國 RDS 發病率和盛行率季度數據聯繫起來。

Thank you, Pito. Let me just grab it at the high level because there is sort of, let's call it, the restless energy of trying to figure out what's happening with volume. But the reality is that it's just as straightforward as elevated mortality, that when you look at the admit growth, it is healthy when you look at the mix, it is healthy. When you look at transplant, they are constant and moved a little, but it doesn't really move the needle at all.

謝謝你，皮托。讓我從高層次抓住它，因為有一種，讓我們稱之為，試圖弄清楚成交量發生了什麼的不安的能量。但現實是，這就像死亡率上升一樣簡單，當你看承認的增長時，它是健康的，當你看組合時，它是健康的。當你觀察移植時，它們是恆定的並且移動了一點，但它根本沒有真正改變針。

It goes up and down a bit. Our share of transplants has continued to be constant. So at the end of the day, we could have missed treatments move a little here and there because the storms or other things that are seasonal, but the bulk of it is elevated mortality.

它有點上下。我們的移植份額持續保持穩定。因此，歸根結底，我們可能會因為風暴或其他季節​​性因素而錯過治療，但其中大部分是死亡率升高。

The first question was about the NAG in the quarter. And let me just give you a little bit on that quarterly NAG has some volatility in it. If you're trying to do what I think you're trying to do, which is trying to piece out the volume trends, which we're all trying to figure out. I don't think looking at quarter-over-quarter NAG is a great number for that.

第一個問題是關於本季的 NAG。讓我簡單介紹一下季度 NAG 存在一定的波動性。如果你想做我認為你想做的事情，那就是試圖找出數量趨勢，這是我們都在努力弄清楚的。我認為看季度環比 NAG 並不是一個很好的數字。

Within that number is factors, including missed treatment rate, a lot about timing of census during the quarter. So it's down 60 bps quarter-over-quarter. I don't think that says anything material about where the volume overall is trending.

這個數字中有很多因素，包括漏診率，以及本季人口普查的時間表。所以季度環比下降了 60 個基點。我認為這並不能說明整體成交量的趨勢。

Okay. Fair enough. Sort of a follow-up here on IKC, Usually, you true up with your payers during the third quarter. Payers have had a lot of, we'll say, lately volatility this quarter. Just curious how that true-up went with the payers for 2023 during the third quarter.

好的。很公平。有點像 IKC 的後續行動，通常情況下，你會在第三季向付款人兌現承諾。我們可以說，本季付款人最近經歷了很大的波動。只是好奇 2023 年第三季付款人的情況如何。

Yes. So we are on track for the year. I would encourage you and everyone as we always have, let's look at IKC on an annual basis rather than a quarterly basis. We're reaffirming our negative $50 million for the year, which has been our number all year long. And I would say the volatility that we read about in the payer market largely has not impacted us.

是的。因此，今年我們正步入正軌。我會像往常一樣鼓勵您和每個人，讓我們以年度而不是季度為基礎來看待 IKC。我們重申今年的負 5000 萬美元，這是我們全年的數字。我想說的是，我們在支付市場上所了解的波動很大程度上並沒有影響到我們。

Okay. But then don't you guys do your big annual true-ups from the previous year during the third quarter. Is that the --.

好的。但是，你們不要在第三季對上一年進行年度大調整。那是不是--.

In the third quarter and the fourth quarter, and they're going as planned.

第三季度和第四季度，它們正在按計劃進行。

Okay, fair enough. Okay. And then sort of last question here, just looking at commercial and MA price increases for '25, are these tracking in line with historical levels.

好吧，很公平。好的。最後一個問題是，看看 25 年的商業和 MA 價格上漲情況，這些漲幅是否符合歷史水準。

Yes, there's nothing interesting to call out going as expected.

是的，沒有什麼有趣的事情可以說是按預期進行。

Lisa Clive, Bernstein.

麗莎·克萊夫，伯恩斯坦。

Just on volume growth, given the continued decline, how should we think about volume growth for the year? I think previously, you were at 0.5% to 1% and any thoughts into 2025? And also in IKC, can you give us any indication in terms of how your reimbursement is split between capitated shared savings. That would be helpful.

就銷售成長而言，鑑於持續下滑，我們該如何看待今年的銷售成長？我想之前的成長率是 0.5% 到 1%，對 2025 年有什麼想法嗎？另外，在 IKC 中，您能否向我們說明您的報銷如何在按人頭共享儲蓄之間分配。那會有幫助的。

Yes. Starting on the volume for 2024, we're still thinking 50 bps to 100 bps of growth, so no change there. On the IKC thing, I think we'll have to get back to you on that one. Did I miss a question, Lisa?

是的。從 2024 年的銷售量開始，我們仍然認為成長 50 到 100 個基點，因此沒有變化。關於 IKC 的事情，我想我們必須就這一問題回覆您。我錯過了一個問題嗎，麗莎？

Yes, I mean I think just trying to think through the potential growth of IKC, both on the top line and revenue, just it would be helpful at some point to get some indication of how the economics work in there. But I'll wait for you to get back on that.

是的，我的意思是，我認為嘗試思考 IKC 的潛在成長（無論是在營收還是在收入方面），在某些時候了解其中的經濟運作方式會很有幫助。但我會等你回來。

(Operator Instructions) Joanna Gajuk, Bank of America.

（操作員指示）Joanna Gajuk，美國銀行。

So I guess I'll just follow up on the last question here around volumes, right? So you expect to still grow slightly for the year? And then how should we think about, I guess, next year and your kind of ultimate target of growing 2% volumes same-store?

所以我想我會繼續討論關於卷的最後一個問題，對吧？那麼您預計今年仍會小幅成長嗎？然後我們應該如何考慮明年的同店銷售成長 2% 的最終目標？

Yes. So for next year, as Javier mentioned, most of the story is about mortality and what happens to mortality next year, to put a little more color on that. I would say, if you take the middle of our range for this year of 75 basis points of growth, if you want to think about how to model next year there's a slight headwind on treatment days for next year, about 25 basis points. And then there's one headwind and one tailwind. The headwind would be associated with clinic closures.

是的。因此，正如哈維爾所提到的，明年的故事大部分都是關於死亡率以及明年死亡率會發生什麼，以便對此有更多的了解。我想說，如果你採用今年 75 個基點增長區間的中間值，如果你想考慮如何為明年建模，那麼明年的治療天數會出現輕微的阻力，大約為 25 個基點。然後還有一股逆風和一股順風。不利因素將與診所關閉有關。

We called that out last quarter as a source of headwind on volume for the year. And as the clinic closures come further into the background further into our history, then I think we'll see a little bit of tailwind of that. And then we could also potentially have a headwind next year associated with PD and the Baxter issue that we're having and that's pretty simple. There are some patients who might want to start PD now.

我們在上個季度指出這一點是今年銷量的不利因素。隨著診所的關閉進一步成為我們歷史的背景，我認為我們會看到一些順風車。然後，明年我們也可能會遇到與 PD 和我們遇到的 Baxter 問題相關的逆風，這非常簡單。有些患者可能現在就想開始 PD。

We don't have the ability to start all of the new PD patients over the quarter, and they might go to another provider. I would call those two things, the clinic closures and the Baxter PD as offsetting. So you really have next year, starting with a base of this year's 75 basis points, less 25 basis points of day mix. And so you start with a base of 50 basis points and then getting back to what Javier said, it's up to everyone to figure out what they think will happen to mortality next year versus this year.

我們沒有能力在本季讓所有新的腹膜透析患者開始治療，他們可能會去找其他提供者。我將診所關閉和巴克斯特警察局這兩件事稱為抵消。所以明年確實是這樣，從今年 75 個基點的基礎開始，減去 25 個基點的日間組合。所以你從 50 個基點開始，然後回到哈維爾所說的，每個人都應該弄清楚他們認為明年與今年的死亡率會發生什麼變化。

And then obviously, missed treatment rate can also be another source of variability from one year to the next. So that's the framework I would lay out for how to think about it.

顯然，漏診率也可能是一年與下一年變異的另一個來源。這就是我為如何思考這個問題而製定的框架。

Okay, that's very helpful. But if I may, I have another question, but before I go there, just a follow-up on the PD patients. So I guess what's your home dialysis mix and then inside that, what's the PD versus HD Home.

好的，這非常有幫助。但如果可以的話，我還有另一個問題，但在我去那裡之前，我想對帕金森氏症患者進行一次隨訪。所以我猜你的家庭透析組合是什麼，然後在其中，PD 與 HD Home 是什麼。

So our mix in PD hasn't changed because it happened by the end of the quarter. And that's in the mid-15s is the range. HHD is like a 2% or so mix. And I would take this moment just to thank Baxter and the government, they've been amazing working literally around the clock to make sure that all of our patients get their supply. And so as we look at what they've told us, we will obviously see a little deterioration in that through the fourth quarter, but we will normalize by the first quarter and try to get all our patients back on track.

所以我們的 PD 組合沒有改變，因為它是在季度末發生的。這個範圍是 15 左右。HHD 大約是 2% 左右的混合物。我想藉此機會感謝巴克斯特和政府，他們日以繼夜地工作，以確保我們所有的患者都能得到供應，這真是太棒了。因此，當我們看看他們告訴我們的情況時，我們顯然會看到第四季度的情況惡化，但我們將在第一季之前恢復正常，並努力讓所有患者重回正軌。

Yes. And the one thing I'd add, Joanna, of those PD patients, remember, we expect to keep the vast majority of them. The new patients, many of them, about half of them are already dialyzing in our clinics. And we think it won't be too much of an inconvenience for them to wait a little bit before they move to PD. Those new to dialysis patients who are going to go on PD have options, including postponing dialysis, assuming they have residual renal function, they could go in center and then transition to PD.

是的。我要補充的一件事是，喬安娜，請記住，對於那些 PD 患者，我們希望保留其中的絕大多數。新的病人，其中許多人，大約一半已經在我們的診所進行透析。我們認為，在他們轉到 PD 之前稍等一下，不會給他們帶來太多不便。那些即將進行 PD 的新透析患者有多種選擇，包括延遲透析，假設他們有殘餘腎功能，他們可以先進行中心治療，然後過渡到 PD。

And then there could be some who decide that they don't want to wait, and will go to another provider. So what we would expect you to see is a decline, a potentially significant decline in our home mix over the next quarter but the number of patients that actually leave DaVita or don't join DaVita, we don't think will be that high.

然後可能會有一些人決定不想等待，而會轉向另一家提供者。因此，我們預計您會看到下降，下個季度我們的家庭組合可能會顯著下降，但實際離開 DaVita 或不加入 DaVita 的患者數量，我們認為不會那麼高。

Okay. That's super helpful. If I may, another question I had on next year's outlook. I guess following up on your comment around you expect the RPT growth next year to be still elevated? So are you kind of implying 3.5% to 4% that you're guiding for this year, is the number to think for next year? Or is it a little bit less, a little bit more how to think about it?

好的。這非常有幫助。如果可以的話，我還有一個關於明年前景的問題。我想根據您的評論，您預計明年的 RPT 成長仍然會很高？那麼，您是否暗示今年的指導值為 3.5% 至 4%，這是明年要考慮的數字？還是少一點、多怎麼想？

It's too early to guide quantitatively, but I would think lower than that.

現在進行定量指導還為時過早，但我認為會低於這個數字。

Okay. So it's lot lower than 3.5% to 4%, but you're saying higher than like your historical range?

好的。所以它比 3.5% 到 4% 低很多，但你是說比你的歷史範圍要高？

Yes.

是的。

This is Javier. Just to clarify, the comment I said because I don't think I was clear that it should have been 15.5% is our mix of home patients total, of which 2% or HHD and 13% and change are PD. I don't think that, that was clear.

這是哈維爾。只是為了澄清一下，我說的評論是因為我認為我不清楚，應該是 15.5% 是我們家庭患者總數的組合，其中 2% 或 HHD，13% 和變化是 PD。我不這麼認為，這已經很清楚了。

13% is PD.

13%是PD。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓，TD·考恩。

In the release, I think it said that 3Q advocacy costs had increased. But I think in the second quarter, those were down year-over-year. Can you just kind of give us a sense on what those are related to?

在新聞稿中，我認為它說第三季的宣傳成本增加了。但我認為在第二季度，這些數字比去年同期下降。您能否讓我們了解這些內容與什麼有關？

We've got several things going on through the advocacy costs, but a couple of the main drivers are California and the elections there and then, of course, what we're doing with the restore of the patients in Washington, DC. And the last one would be the orals in the bundle because you might have heard there are some campaigns from pharmaceutical companies that are trying to delay orals in the bundle. And so we're having to mobilize our resources in Washington, DC to make sure people are educated as to the good that oral in the bundle can do.

我們透過宣傳成本做了幾件事，但幾個主要驅動因素是加州和那裡的選舉，當然還有我們正在為華盛頓特區患者的康復所做的事情。最後一個是捆綁中的口服藥物，因為您可能聽說製藥公司正在進行一些活動，試圖推遲捆綁中的口服給藥。因此，我們必須調動華盛頓特區的資源，以確保人們接受教育，並了解捆綁包中的口頭表達可以帶來的好處。

Got it. And then just last from me. I think on missed treatments second quarter in a row just elevated from weather. Assuming we don't have any more, I guess, hurricanes, other weather events, et cetera, would we expect those to revert back to sort of normalized historical levels.

知道了。然後就在我的最後。我認為連續第二季錯過治療的情況只是因為天氣原因而增加。我想，假設我們不再有颶風、其他天氣事件等，我們是否會期望這些事件恢復到正常化的歷史水準。

Missed treatment rate is still running elevated relative to pre-COVID levels. So I think without additional storms, we would expect them to continue to tick down over time, the pace of that is to be determined. That said, remember, they do go up seasonally in Q4. So even without additional storms, you'd expect missed treatment rate to be up in Q4.

與新冠疫情爆發前的水平相比，錯過治療的比例仍然較高。因此，我認為，如果沒有額外的風暴，我們預計風暴將隨著時間的推移繼續減弱，其速度有待確定。也就是說，請記住，它們確實在第四季度季節性上升。因此，即使沒有額外的風暴，您預計第四季度的錯過治療率也會上升。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究中心。

First question, just going back to your headwinds and tailwinds. I didn't hear you mention RPT annualizing the strength of 2024 annualizing next year. Just my numbers, I have you going from 2.5% to 3% to 3.5%, right? So you've guided up by 1%.

第一個問題，回到你的逆風和順風。我沒聽你提到RPT年化2024年年化的實力明年。只是我的數字，我讓你從 2.5% 到 3% 再到 3.5%，對嗎？所以你已經指導了 1%。

A lot of that ramps in the second half of the year. So I would have thought the annualization of that strong second half '24 growth would be a pretty good tailwind to 2025. Any comment on that? Am I missing something?

其中很多都是在下半年增加的。因此，我認為 24 年下半年強勁的年化成長將成為 2025 年的一個很好的推動力。對此有何評論？我錯過了什麼嗎？

Yes. Justin, your math is all right, and we stand by our comments. We had a lot of debates, as you can imagine, about what to call out as unique headwinds and tailwinds versus non-unique headwinds and tailwinds. So I think we stand by that, and that's why we called out RPT is going to be higher than normal next year. We just chose not to put it in the bucket of headwinds and tailwinds we called out.

是的。賈斯汀，你的數學沒問題，我們堅持我們的意見。正如你可以想像的那樣，我們對什麼稱為獨特的逆風和順風與非獨特的逆風和順風進行了很多辯論。所以我認為我們堅持這一點，這就是為什麼我們呼籲明年 RPT 將高於正常水平。我們只是選擇不把它放在我們呼籲的逆風和順風的桶中。

Okay. I'll take that offline. Then the $135 million of interest expense, is this a good run rate? Or does it potentially migrate higher into 2025?

好的。我會把它離線。那麼1.35億美元的利息支出，這是一個好的運行率嗎？或者它有可能遷移到 2025 年？

No. I think it's a good run rate. Our caps for next year are actually slightly lower than our caps for this year. So that could work, just to be clear, the $135 million is the uptick for next year. So I think you should think about this as $270 million for the year. I will hold on one second, my team is looking at me. Let me come back to you in a second, Justin.

不。我認為這是一個很好的運行率。我們明年的上限實際上略低於今年的上限。所以這是可行的，需要明確的是，1.35 億美元是明年的成長。所以我認為你應該將其視為今年 2.7 億美元。我等一下，我的團隊正在看著我。讓我稍後再回覆你，賈斯汀。

Sure. Sure. To be clear, I wasn't talking about the year-over-year. I was just talking about --.

當然。當然。需要澄清的是，我並不是說同比情況。我剛才正在談論--.

Sorry. I'm sorry, the $135 million for the quarter, that is a reasonably good number. For next year, it could come down as a quarterly number because our caps are a little bit lower. But if you think of the two things that are driving the number up, it's more debt, which I wouldn't expect us to incur more debt over the next few quarters and then our caps aren't going to change materially.

對不起。抱歉，本季 1.35 億美元是一個相當不錯的數字。明年，它可能會下降為季度數字，因為我們的上限有點低。但如果你考慮一下推動這一數字上升的兩件事，那就是更多的債務，我不認為我們在接下來的幾個季度會承擔更多的債務，然後我們的上限不會發生重大變化。

Okay. Do those caps expire? Or are they kind of at a reasonable rate, like you could re-up them right now. If they expired at the end of next year and interest rate seems to be fine.

好的。這些上限會過期嗎？或者它們的價格是否合理，就像你現在可以重新調整它們一樣。如果它們在明年年底到期且利率似乎還不錯。

Yes. So we changed the way we do it. We have a cliff, we had a cliff at the end of Q2 because we used to do a three or four-year cap. Now we do it rolling. So going forward, you wouldn't see a big change like this. It will gradually move up and down depending on where interest rates are when the caps are put in place.

是的。所以我們改變了做事的方式。我們遇到了懸崖，我們在第二季末遇到了懸崖，因為我們曾經設定了三年或四年的上限。現在我們滾動進行。所以展望未來，你不會看到這樣的大改變。它將根據上限實施時的利率水準逐漸上下波動。

Perfect. And then lastly, just I apologize if I missed this, but did you give a mix number for the quarter versus, I think, the 11% you talked about last quarter, commercial market?

完美的。最後，如果我錯過了這一點，我深表歉意，但是您是否給出了本季度的混合數字以及我認為您上季度談到的 11% 商業市場的混合數字？

Yes. There was really nothing material changes in the mix for any of our usual mix numbers.

是的。對於我們通常的混音數字來說，混音實際上沒有任何實質變化。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

I just wanted to follow up on G&A. It looks like that was up 7% sequentially and 10% year-over-year. What were the drivers of that in the quarter?

我只是想跟進 G&A。看起來環比增長了 7%，年增了 10%。本季的驅動因素是什麼？

Yes. In G&A, we have a lot going on because we're trying to really go through the entire continuum of care united all the transitions of care. But the big bulk of it is going into IT is going. And the second part is, of course, you've got wages in there. And the third part would be the reimbursement operations investment that render the increase in revenue per treatment. So those explain the vast majority of the increase.

是的。在 G&A 中，我們做了很多事情，因為我們正在努力真正經歷整個護理的連續過程，將所有護理的轉變結合起來。但其中很大一部分都投入了 IT 領域。當然，第二部分是你那裡有薪水。第三部分是報銷業務投資，這會增加每次治療的收入。所以這些解釋了絕大多數的成長。

Got it. Okay. And then maybe on the follow-up to the commercial mix. How much is the ACA exchange mix within the commercial mix within that 11%? And how much growth are you seeing on the ACA exchanges this year?

知道了。好的。然後也許是商業組合的後續行動。在這 11% 的商業組合中，ACA 交易所組合佔多少？您認為今年 ACA 交易所有多少成長？

So just to make sure I've got the right language, I think on the QHPs. So on the QHPs, the country is running around 7% to 8% mix. And our population is running around 3% mix. And so we're underrepresented because in QHPs, if 1 of our patients pick Medicare they are out of the QHP. So that's why we're underrepresented.

因此，為了確保我使用正確的語言，我想到了 QHP。因此，在 QHP 上，該國的混合比例約為 7% 至 8%。我們的人口比例約為 3%。因此，我們的代表性不足，因為在 QHP 中，如果我們的 1 名患者選擇 Medicare，他們就被排除在 QHP 之外。這就是我們代表性不足的原因。

Got it. And can you give us a sense of how much growth you've seen in that payer class?

知道了。您能否告訴我們您在該付款人階層中看到了多少成長？

We're growing exactly as the market grows. So that has been literally the lines are on top of each other.

我們的成長正是隨著市場的成長而成長。所以從字面上看，這些線是相互重疊的。

Pito Checking, Deutsche Bank.

Pito 支票，德意志銀行。

A quick follow-up here for 2025. Will depreciation be another tailwind for next year?

這裡是 2025 年的快速後續。貶值會成為明年的另一個動力嗎？

I'm sorry, I didn't hear that. Pito, can you say that again?

抱歉，我沒聽到。皮托，你能再說一次嗎？

Yes, you bet. Will depreciation be another tailwind for next year EPS?

是的，你敢打賭。貶值會成為明年每股收益的另一個推動因素嗎？

It will be flat to down. Well, the answer is yes. Part of it comes from the center closure number coming down. But excluding that, it will be flat to down.

它將是平坦的。嗯，答案是肯定的。部分原因是中心關閉數量下降。但排除這一點，它將持平甚至下降。

Okay. So sort of doing just some quick back of the envelope math, mortality, I get, on the lack of PD that hurts, but Baxter is ramping up their facilities pretty rapidly. So that's pretty much all in the first part of the first quarter. Justin's question is on interest cap, that's just math, the center closures international, that's, I guess, math. Depending upon where the bundle goes, when you put together the headwinds and tailwinds depending upon the bundle. Is this a possibility this will be more of a tailwind and headwind. But we just want to see where the bundle ends up. Is that a fair way to think of thinking about this?

好的。因此，我只是簡單地進行了一些粗略的數學計算，死亡率，我知道，缺乏PD會帶來傷害，但百特正在迅速擴大他們的設施。這就是第一季第一部分的全部內容。賈斯汀的問題是關於利息上限，這只是數學，國際中心關閉，我想，這就是數學。取決於捆綁包的去向，當你根據捆綁包將逆風和順風放在一起時。這是否有可能，這將更多是順風和逆風。但我們只是想看看捆綁包最終會去哪裡。這是一個公平的思考方式嗎？

I'm just help me again with the end of the question, Pito, what specifically are you asking if it's a headwind or tailwind, the bundle?

我只是再次幫我解決這個問題，皮托，你具體想問什麼，是逆風還是順風，捆綁？

Yes. So the tailwinds seeing is just putting the math together on the headwinds, understand those and understand the math of the tailwind, the biggest variable here seems to be with the bundle.

是的。因此，順風看到的只是將數學放在逆風上，理解這些並理解順風的數學，這裡最大的變數似乎是捆綁。

Got it. Okay.

知道了。好的。

And so depending upon where the bundle goes, that will define whether the head of tailwinds are a tailwind versus maybe your commentary about a push depending upon the pricing we’ll get soon. This could be, I guess, more favorable depending upon what the government says and we could do. Is that a fair way of thinking about it?

因此，根據捆綁包的去向，這將決定順風的方向是否是順風，或者您對推動的評論取決於我們很快就會得到的定價。我想，這可能會更有利，這取決於政府的說法和我們能做的。這是一個公平的思考方式嗎？

I think there's probably a little bit more variability in a bunch of these lines than you're giving credit to. So orals could be better, it could be worse, but all of these probably have a decent amount of play in them. So I think it could go either way a net headwind or a net tailwind.

我認為這些行中的一些變化可能比您認為的要多一些。所以口語可能會更好，也可能會更糟，但所有這些都可能有相當多的發揮。所以我認為它可能會出現淨逆風或淨順風。

Thank you. At this time, I am showing no further questions. I'll turn the call back over to you for closing comments.

謝謝。目前，我沒有再提出任何問題。我會將電話轉回給您以供結束評論。

Okay. Thank you, Michelle, and thank you all for your interest in DaVita. I will end the call where we started with appreciation for the hard work of our DaVita care teams on behalf of our patients. Although we will incur some additional expenses related to recent storms, we expect to absorb these costs within the continued strong performance of our underlying business. We've covered a lot on volume and as we said, while mortality remains elevated, our investments in people and infrastructure and capabilities has returned our operating income to the pre-pandemic trajectory. Thank you for your continued interest and be well.

好的。謝謝米歇爾，也謝謝大家對 DaVita 的興趣。我將結束我們一開始的通話，感謝我們的 DaVita 護理團隊代表我們的患者所做的辛勤工作。儘管我們將承擔一些與最近的風暴相關的額外費用，但我們預計將在我們基礎業務的持續強勁表現中吸收這些成本。我們已經在數量上進行了很多報道，正如我們所說，雖然死亡率仍然很高，但我們對人員、基礎設施和能力的投資使我們的營業收入恢復到了大流行前的軌跡。感謝您的持續關注並祝您一切順利。

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線。