德維特 (DVA) 2024 Q4 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 fourth-quarter 2024 earnings call. (Operator Instructions)

晚安.我叫米歇爾，今天我將擔任您的會議主持人。現在，我歡迎大家參加 DaVita 2024 年第四季財報電話會議。（操作員指令）

Mr. Eliason, you may begin.

埃利亞森先生，您可以開始啦。

Thank you and welcome to our fourth quarter conference call. 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，歡迎參加我們的第四季電話會議。我是集團投資者關係副總裁 Nic Eliason，今天與我一起出席的還有我們的執行長 Javier Rodriguez；以及我們的財務長 Joel Ackerman。

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.

請注意，在本次電話會議中，我們可能會根據聯邦證券法做出前瞻性陳述。所有這些陳述都受已知和未知的風險和不確定因素的影響，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。

For further details concerning these risks and uncertainties, please refer to our fourth-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 make with the SEC.

有關這些風險和不確定性的更多詳細信息，請參閱我們的第四季度收益新聞稿和我們向美國證券交易委員會提交的文件，包括我們最近的 10-K 表年度報告、所有後續 10-Q 表季度報告以及我們向美國證券交易委員會提交的其他後續文件。

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.

我們的前瞻性聲明是基於我們目前掌握的信息，除非法律要求，否則我們無意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。這些非公認會計準則指標與最具可比性的公認會計準則財務指標的對帳表已包含在我們向美國證券交易委員會提交的收益新聞稿中，並可在我們的網站上查閱。

I will now turn the call over to Javier Rodriguez.

現在我將電話轉給哈維爾·羅德里格斯。

Thank you, Nic, and thank you for joining the call today. As we embark on 2025, we're celebrating the 25th anniversary of DaVita. During this time, we have focused our efforts on improving clinical outcomes, enhancing quality of life for our patients and care teams, and being a force for positive change for the healthcare system. It is an honor to carry on this legacy, and we look forward to pushing these boundaries in 2025 and the years ahead.

謝謝你，尼克，謝謝你今天參加電話會議。當我們進入 2025 年時，我們正在慶祝 DaVita 成立 25 週年。在此期間，我們致力於改善臨床結果，提高患者和護理團隊的生活質量，並成為醫療保健系統積極變革的力量。我很榮幸能夠繼承這項傳統，並期待在 2025 年及未來的歲月中不斷突破這些界限。

Today, I will cover highlights of our 2024 performance, provide updates on several components of our growth trajectory, and conclude with guidance for 2025. But first, I will begin, as we always do, with a clinical highlight. As I noted, we're celebrating our 25 years, a period encompassing remarkable clinical progress.

今天，我將介紹我們 2024 年業績的亮點，提供有關我們成長軌蹟的幾個要素的最新信息，最後提供對 2025 年的指導。但首先，我將像往常一樣，從臨床重點開始。正如我所說，我們正在慶祝公司成立 25 週年，這段時期我們取得了顯著的臨床進展。

Together with our physician partners, we have achieved so much for the people who have entrusted us with their care. Among the many highlights, we have worked to dramatically increase the access to care for patients, especially those living in more rural areas of the country.

我們與我們的醫生夥伴一起，為委託我們護理的人們取得了許多成就。在我們所做的許多工作中，最突出的是努力大幅提高患者獲得醫療服務的機會，特別是那些居住在國家農村地區的患者。

We moved beyond in-center care and supported the proliferation of home dialysis, with more than 4 of every 5 patients living within 10 miles of a DaVita home program. Of the patients now treating at home, more than 80% use connected cyclers, a technology that enables our care teams to remotely monitor and improve patient health outcomes.

我們不再局限於中心護理，還支持家庭透析的普及，每 5 名患者中就有超過 4 名居住在 DaVita 家庭透析計畫 10 英里範圍內。目前在家治療的患者中，超過 80％ 使用連網循環儀，這項技術使我們的護理團隊能夠遠端監控和改善患者的健康狀況。

We have expanded from being a dialysis provider to a comprehensive kidney care company, addressing each step in the kidney care journey. This includes our Kidney Smart Program where we have provided free education on managing chronic kidney disease to more than 300,000 people; and Integrated Kidney Care or IKC, where we have pioneered value-based care delivery, successfully partnering with health plans and CMS to provide holistic patient care in addressing rising costs of the healthcare system.

我們從一家透析服務提供者發展成為一家綜合腎臟護理公司，以解決腎臟護理歷程中的每個步驟。其中包括我們的腎臟智慧計劃，我們已為超過 30 萬人提供了有關管理慢性腎臟疾病的免費教育；以及綜合腎臟護理或 IKC，我們率先提供基於價值的醫療服務，成功地與健康計劃和 CMS 合作，提供全面的患者護理，以應對醫療保健系統不斷上漲的成本。

Finally, we have enhanced quality of care in 13 countries outside the United States where we have consistently outperformed the clinical benchmarks in each market. I'm energized by the progress we have made to create better outcomes and improve millions of lives.

最後，我們在美國以外的 13 個國家提高了醫療質量，在這些國家，我們的表現始終超越每個市場的臨床基準。我們在創造更好成果和改善數百萬人生活方面所取得的進步讓我充滿活力。

And of course. we're far from done. Looking at the next chapter, our vision is to continue our unwavering pursuit of a healthier tomorrow.

當然。我們還遠遠沒有完成。展望下一章，我們的願景是繼續堅定不移地追求更健康的明天。

Transitioning to 2024 performance, we finished the year on a strong note, producing full-year adjusted operating income and adjusted EPS in the top half of our guidance range, with year-over-year growth of 21% and 26% respectively. In a year with several unique hurdles, including Change healthcare outage and hurricane disruption of our supply chain, I am reminded of the resilience of our organization and inspired by the passion of our dedicated care teams.

展望 2024 年的業績，我們以強勁的業績結束了這一年，全年調整後營業收入和調整後每股收益均位於我們預期範圍的上半部分，同比增長分別達到 21% 和 26%。這一年我們遇到了一些獨特的障礙，包括變革醫療保健中斷和颶風破壞我們的供應鏈，這讓我想起了我們組織的韌性，並受到我們敬業的護理團隊的熱情的啟發。

Within US dialysis, we continue to benefit from innovation in our revenue cycle operations, enhanced collection performance and contracting propelled high revenue per treatment growth, offsetting slower than expected rebound in treatment volume. Although volume growth was positive for the first year since the pandemic, growth for the full year was below our expectations.

在美國透析領域，我們繼續受益於收入週期營運的創新、收款績效的提高和合約推動的每次治療收入高成長，抵消了治療量反彈速度低於預期的影響。儘管疫情爆發以來的第一年銷售成長呈正成長，但全年成長低於我們的預期。

Mortality and missed treatment rates remain elevated in the fourth quarter and new patient starts were negatively impacted by supply constraints of our peritoneal dialysis solutions. On the expense side, we continue our track record of identifying efficiencies and executing on cost saving initiatives.

第四季死亡率和漏治率仍然較高，腹膜透析溶液的供應限制對新患者的治療產生了負面影響。在費用方面，我們繼續努力發現效率並執行成本節約措施。

Beyond the US dialysis, we expanded our international presence and continue to grow IKC. We have now closed on 3 of the 4 acquisitions in Latin America announced last year, with Brazil expected to close mid-year 2025. With IKC, we continue making progress on our journey of delivering sustainable integrated care. For 2024, results for IKC were in line with our expectations with an adjusted operating loss of $35 million.

除了美國透析之外，我們還擴大了國際影響力並繼續發展 IKC。我們目前已完成去年宣布的在拉丁美洲 4 項收購中的 3 項，其中巴西收購預計將於 2025 年中期完成。在 IKC 的幫助下，我們在提供可持續綜合護理的道路上不斷取得進展。2024 年，IKC 的業績符合我們的預期，調整後的營業虧損為 3,500 萬美元。

Our strategy remains focused on improving health outcomes and quality of life for our patients, minimizing avoidable medical expense, tightly managing our G&A costs, and pursuing the right opportunities to achieve scale.

我們的策略仍專注於改善患者的健康狀況和生活品質、盡量減少可避免的醫療費用、嚴格管理我們的一般及行政成本、並尋求實現規模的正確機會。

As a reminder, last quarter, we highlighted the temporary closure of Baxter's North Cove facility due to Hurricane Helene and the related impact on home dialysis. As a result of these challenges, we incurred approximately $6 million of operating income impact in the fourth quarter due to higher cost of saline, fewer patient starts due to the availability of PD solution, and lower productivity from our home caregivers. The negative impact was lower than we originally expected due to the extraordinary effort of our supply and physician partners along with that of our procurement and operating teams.

提醒一下，上個季度，我們強調了由於颶風海倫導致百特北灣設施暫時關閉以及對家庭透析造成的相關影響。由於這些挑戰，我們在第四季度遭受了大約 600 萬美元的營業收入影響，原因是鹽水成本上升、由於腹膜透析溶液可用性導致患者開始接受治療的數量減少以及我們的家庭護理人員的工作效率下降。由於我們的供應和醫生合作夥伴以及採購和營運團隊的非凡努力，負面影響低於我們最初的預期。

By year-end 2024, we had resumed admitting new home patients at historical rates. However, our inability to start new patients on PD contributed to lower new admits in the fourth quarter, which will negatively impact volume growth in 2025. This is included in our estimate of approximately $30 million of negative impact to adjusted operating income in 2025.

到 2024 年底，我們將以歷史速度恢復接收新的居家患者。然而，我們無法為新患者開始 PD 治療，導致第四季度新入院人數下降，這將對 2025 年的治療量成長產生負面影響。這包含在我們估計的 2025 年調整後營業收入約 3000 萬美元的負面影響中。

Moving next to orals in the bundle, effective January 1 of this year, oral drugs transition from Medicare drug benefit over to the dialysis benefit. This policy is clearly positive for dialysis patients. We are excited to expand access for patients and expand options for prescribers. We estimate that up to 20% of patients did not have coverage and are now eligible to receive this therapy.

接下來是口服藥物捆綁計劃，從今年 1 月 1 日起，口服藥物將從醫療保險藥物福利轉變為透析福利。這項政策對於透析患者來說顯然是利好的。我們很高興能夠擴大患者的治療機會並為醫生提供更多選擇。我們估計有多達 20% 的患者沒有保險，現在有資格接受這種治療。

Our patients will have support from dietitians and access to all major classes of phosphate binders, including both branded and generic options. We expect the 2025 OI contribution to be $0 to $50 million.

我們的患者將得到營養師的支持，並可使用所有主要類別的磷酸鹽結合劑，包括品牌藥和仿製藥。我們預計 2025 年 OI 貢獻將達到 000 至 5,000 萬美元。

For 2025 guidance, we're back on a more normal adjusted OI growth trajectory. The midpoint of our 2025 guidance for adjusted OI growth is 5.2%, and adjusted EPS growth is 11%. The detailed ranges of which can be found in our press release. This comes on the heels of a strong 2023 and 2024, years in which we exceeded the top end of our original guidance ranges, despite weak volume growth by driving strength in other components of our core and ancillary businesses.

對於 2025 年的指導，我們回到了更正常的調整後 OI 成長軌跡。我們對 2025 年調整後 OI 成長的預期中位數為 5.2%，調整後 EPS 成長的預期中位數為 11%。詳細範圍請參閱我們的新聞稿。在此之前，2023 年和 2024 年的業績表現強勁，儘管銷量增長疲軟，但我們的核心和輔助業務的其他組成部分的強勁增長推動了業績增長，這兩年我們的業績超出了最初指引範圍的最高限度。

A priority for 2025 will, of course, continue to be an intense focus on volume as we believe in an eventual return to a 2% growth trend recognizing timing is difficult to predict. Despite this uncertainty, we continue to have confidence in delivering adjusted OI growth in our target range of 3 to 7% for the years ahead.

當然，2025 年的首要任務仍將是高度關注產量，因為我們相信最終將恢復到 2% 的成長趨勢，但意識到時機很難預測。儘管存在這種不確定性，我們仍然有信心在未來幾年實現調整後的 OI 成長率達到 3% 至 7% 的目標範圍。

We will continue to invest in differentiated capabilities to drive performance across our platform with excess capital returned to shareholders through share repurchases. We remain committed to our capital allocation strategy as a means to achieve double-digit growth in earnings per share.

我們將繼續投資差異化能力，以推動整個平台的業績，並透過股票回購將多餘的資本回饋給股東。我們將繼續致力於我們的資本配置策略，以實現每股盈餘兩位數的成長。

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

現在我將把話題交給喬爾，讓他更詳細地討論我們的財務表現和前景。

Thank you, Javier. Fourth-quarter adjusted operating income was $491 million, bringing full-year 2024 adjusted OI to $1.98 billion. Q4 adjusted EPS was $2.24, taking full-year adjusted EPS to $9.68. Free cash flow was $281 million in the fourth quarter and $1.16 billion for the full year.

謝謝你，哈維爾。第四季調整後營業收入為 4.91 億美元，使得 2024 年全年調整後營業收入達到 19.8 億美元。 Q4調整後每股收益為 2.24 美元，全年調整後每股收益達 9.68 美元。第四季自由現金流為 2.81 億美元，全年自由現金流為 11.6 億美元。

I'll start today with some detail on the fourth quarter, followed by some details on our 2025 guidance. Fourth-quarter US treatment volume increased by 30 basis points over the fourth quarter of 2023, while treatments per day declined 80 basis points versus fourth quarter of 2023.

今天，我將先介紹第四季的一些細節，然後再介紹我們 2025 年的指引。美國第四季的治療量比 2023 年第四季增加了 30 個基點，而每日治療量與 2023 年第四季相比下降了 80 個基點。

Q4 treatment volume came in below our expectations for two reasons. First, missed treatments were higher than expected, primarily as a result of severe weather events, driving a 40 basis point reduction on year over year growth in the quarter. And second, new-to-dialysis admits were below forecast, partially as a result of the impact of Hurricane Helene on PD supply. We estimate the PD supply constraint resulted in the loss of approximately 350 admissions during the quarter.

由於兩個原因，第四季的處理量低於我們的預期。首先，主要由於惡劣天氣事件造成漏診率高於預期，導致本季年增率下降 40 個基點。其次，新入院透析人數低於預期，部分原因是颶風海倫對腹膜透析供應的影響。我們估計，PD 供應限制導致本季損失了約 350 個入場人數。

For the full year, treatment growth was 47 basis points, just below the bottom of the range we gave last quarter. Fourth-quarter revenue per treatment increased approximately $1 sequentially, primarily due to seasonality, bringing full-year RPT growth to 3.7% versus 2023.

全年治療成長率為 47 個基點，略低於我們上個季度給出的範圍底部。第四季每療程收入環比增加約 1 美元，主要由於季節性因素，使全年每療程收入較 2023 年增長 3.7%。

Patient care costs per treatment were up $7 sequentially. This was primarily the result of seasonality, including health benefits and other field costs with additional impact from higher sequential center closure costs.

每次治療的患者護理成本比上一季上漲了 7 美元。這主要是季節性因素造成的，包括健康福利和其他現場成本，以及連續中心關閉成本上升的額外影響。

G&A costs increased by $15 million quarter over quarter. This is in line with expectations as we typically see higher G&A spend in the fourth quarter. Depreciation and amortization declined by $14 million compared to the third quarter. The largest driver of the reduction was lower center closure costs.

一般及行政費用比上一季增加了 1,500 萬美元。這符合預期，因為我們通常會看到第四季度的 G&A 支出更高。折舊和攤銷與第三季相比減少了 1400 萬美元。減少的最大推動力是中心關閉成本的降低。

Adjusted international OI declined by $17 million versus the third quarter. This was driven by a $19 million reserve recorded against aged accounts receivable in Brazil. Underlying operations in our international business remain otherwise in line with expectations.

調整後的國際 OI 與第三季相比下降了 1700 萬美元。這是由於巴西針對應收帳款提列了 1,900 萬美元的準備金。我們國際業務的基本營運仍符合預期。

During the quarter, we closed the third of our 2024 Latin American acquisitions, expanding our presence in Colombia. Our expansion in Brazil remains under government review, and we expect the deal to close mid-year.

本季度，我們完成了 2024 年拉丁美洲收購案中的第三次，擴大了我們在哥倫比亞的業務。我們在巴西的擴張計劃仍在政府審查之下，我們預計該交易將於年中完成。

Integrated Kidney Care, our value-based care business, ended 2024 with a full-year adjusted operating loss of $35 million. We continue to execute against our long-term plan. And while the full year came in approximately $15 million ahead of our 2024 expectations, this is largely due to timing of revenue from our value-based care contracts and normal variability.

綜合腎臟護理是我們基於價值的護理業務，截至 2024 年，全年調整後經營虧損為 3,500 萬美元。我們將繼續執行我們的長期計劃。雖然全年收入比我們 2024 年的預期高出約 1500 萬美元，但這主要是由於我們基於價值的護理合約的收入時機和正常波動所致。

Below the OI line, fourth-quarter debt expense was relatively flat compared to the third quarter. Our leverage ratio at the end of the year was just over 3 times EBITDA. In the fourth quarter, we repurchased 2.3 million shares. And since the start of 2025 we have repurchased approximately 800,000 additional shares.

在OI線以下，第四季的債務支出與第三季相比相對持平。我們年底的槓桿率略高於 EBITDA 的 3 倍。第四季度，我們回購了230萬股。自 2025 年初以來，我們已回購了約 80 萬股額外股票。

I'll turn now to our expectations for 2025. Our 2025 adjusted operating income guidance is $2.01 billion to $2.16 billion. At the midpoint, this represents 5.2% year-over-year growth.

現在我來談談我們對 2025 年的期望。我們對 2025 年調整後的營業收入預期為 20.1 億美元至 21.6 億美元。中間值表示年增 5.2%。

Now for some details starting with treatment volume. The middle of our adjusted OI guidance range assumes treatment volume growth is flat in 2025 compared to 2024. For the key underlying drivers of treatment volume, namely admissions, mortality, and missed treatment rate, our guidance assumes no significant changes to the trends we saw in 2023 and 2024. Embedded in this forecast is approximately 50 basis points of headwinds specific to 2025, associated with the number of treatment days and the headwind associated with the disruption in PD admissions in Q4.

現在從治療量開始介紹一些細節。我們調整後的 OI 指引範圍的中間值假設 2025 年的治療量成長與 2024 年持平。對於治療量的關鍵潛在驅動因素，即入院人數、死亡率和漏診率，我們的指導假設 2023 年和 2024 年的趨勢不會發生重大變化。該預測中包含了 2025 年特有的約 50 個基點的不利因素，與治療天數以及第四季度 PD 入院中斷相關的不利因素有關。

Moving now to revenue per treatment, we anticipate 4.5% to 5.5% revenue per treatment growth year over year. Around 40% of this expected growth is the result of new oral phosphate binder reimbursement. The remaining 60% is driven by rate increases, collections improvements, and changes in mix.

現在談到每次治療的收入，我們預計每次治療的收入將年增 4.5% 至 5.5%。預計這一增長約有 40% 是新的口服磷酸鹽結合劑報銷的結果。剩餘 60% 則是由利率上漲、收款改善以及組合變化所推動。

On patient care cost per treatment, we anticipate growth of 6% to 7% year over year. Again, oral phosphate binders are a key driver, accounting for approximately 40% of the expected growth year over year. We anticipate the remaining 60% of the growth to be driven by inflationary increases in labor and other costs, with some offset from declining center closure costs as compared to 2024.

我們預計每次治療的患者照護成本將年增 6% 至 7%。再次，口服磷酸鹽結合劑是關鍵驅動因素，佔預期年增率的約 40%。我們預計，剩餘 60% 的增長將受到勞動力和其他成本的通膨增長的推動，部分增長將因與 2024 年相比中心關閉成本的下降而得到抵消。

We expect US dialysis G&A to increase by approximately 4%, which is driven by investments in our teams, capabilities, and processes offset by a decline in center closure costs versus 2024. We anticipate US dialysis depreciation and amortization to decline by approximately $25 million to $30 million, driven by declining center closure costs and lower levels of CapEx in recent years.

我們預計美國透析 G&A 費用將增加約 4%，這得益於對我們團隊、能力和流程的投資，但與 2024 年相比中心關閉成本的下降抵消了這一增長。我們預計美國透析折舊和攤銷將下降約 2,500 萬至 3,000 萬美元，這主要是由於近年來中心關閉成本下降和資本支出水準降低。

In our IKC business, we expect relatively flat year-over-year adjusted operating income compared to 2024. This is consistent with our prior expectations, except for the acceleration of $10 million to $15 million of value-based care revenue from 2025 to 2024.

在我們的 IKC 業務中，我們預計與 2024 年相比，調整後的營業收入將相對持平。這與我們先前的預期一致，但 2025 年至 2024 年間基於價值的照護收入將加速成長 1,000 萬美元至 1,500 萬美元。

For international, we expect approximately $50 million of year over year adjusted OI growth. This is the combination of the impact of the Latin America acquisitions we signed in 2024; the reserve against aged accounts receivable in Brazil, impacting 2024's results; and continued growth in our existing markets.

對於國際而言，我們預計調整後的 OI 年成長約為 5000 萬美元。這是我們在 2024 年簽署的拉丁美洲收購協議的影響的綜合；巴西的應收帳款準備金，影響 2024 年的表現；並在現有市場持續成長。

Shifting to EPS. Our guidance for 2025 adjusted earnings per share is $10.20 to $11.30. The midpoint of this range represents 11% adjusted EPS growth versus 2024, primarily driven by adjusted operating income growth and share count reduction due to share repurchases offset by the full run rate of higher debt expenses.

轉向 EPS。我們對 2025 年調整後每股盈餘的預期為 10.20 美元至 11.30 美元。該範圍的中點代表著與 2024 年相比調整後的每股收益增長 11%，主要原因是調整後的營業收入增長和由於股票回購導致的股票數量減少，但被更高的債務支出的全部運行率所抵消。

We anticipate other losses below the operating income line of approximately $75 million roughly flat to 2024. We expect interest expense of $525 million to $555 million which is a continuation of approximately $135 million per quarter. We anticipate an adjusted effective income tax rate of 24% to 26% consistent with 2024.

我們預計，營業收入線以下的其他損失約為 7,500 萬美元，到 2024 年基本上持平。我們預計利息支出為 5.25 億美元至 5.55 億美元，即每季繼續約 1.35 億美元。我們預計調整後的有效所得稅率將與 2024 年保持一致，為 24% 至 26%。

Free cash flow guidance for 2025 is $1 billion to $1.25 billion. Our capital allocation philosophy remains consistent with prior years. We will prioritize capital efficient growth opportunities, target leverage between 3 and 3.5 times EBITDA, and otherwise return capital to shareholders in the form of share repurchases.

2025 年自由現金流預期為 10 億美元至 12.5 億美元。我們的資本配置理念與前幾年保持一致。我們將優先考慮資本高效成長機會，目標槓桿率在 EBITDA 的 3 到 3.5 倍之間，並以股票回購的形式向股東返還資本。

That concludes my prepared remarks for today. Operator, please open the call for Q&A.

我今天的準備發言到此結束。接線員，請打開電話問答。

(Operator Instructions)

（操作員指令）

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

All right. Thanks so much for taking the questions. I guess first on the volume outlook for '25 that you said flat at that point. Is there a range of associated with the OI range?

好的。非常感謝您回答這些問題。我想首先您說的 25 年銷售前景是持平的。是否存在與 OI 範圍相關的範圍？

Hi, Joanna. It's Joel here. Thanks for the question. So yes, there's certainly a range associated with volume. There's a fair bit of natural variability in all three of the inputs of admissions, mortality, and mistreatment rate. And that would be why one of the factors that would drive the range we gave for OI.

你好，喬安娜。我是喬爾。謝謝你的提問。是的，音量確實有範圍。入院率、死亡率和虐待率這三個輸入都有相當大的自然變化。這就是我們給出 OI 範圍的影響因素之一。

Do you have anything else like a range? I get, you know, call it, minus 1 to plus 1 or anything narrower like that? Or how should we think about that? Like let's dive in a range of outcomes.

您還有其他類似的東西嗎？我明白了，你知道，稱之為“-1 到 +1”或任何更窄的數值嗎？或者說我們該如何思考這個問題？讓我們深入探討一系列結果。

And yes, we decided not to quantify it this year and rather focus on the midpoint of the range. I don't know that the variability we would see would dip for a whole lot than the variability we would have thought about going into last year. But we missed our going-into-the-year forecast in 2024 by a bit. So we were a little hesitant to give a range here.

是的，我們決定今年不對其進行量化，而是專注於範圍的中點。我不知道我們看到的變化是否會比我們去年想到的變化下降很多。但我們對 2024 年的年度預測稍有偏差。因此，我們對於在此給出一個範圍有些猶豫。

On the comparable metric -- like the volumes were roughly flat in '24, right, just to make sure. So you're kind of assuming a similar dynamic for the full year '25.

依照可比較指標 — — 例如 24 年的交易量大致持平，對吧，只是為了確保萬無一失。因此，您可以假設 25 年全年的情況也類似。

So the comparable number for '24 was plus roughly 50 basis points. I think it's 47 basis points exactly. And just to be clear for everyone, when we give a volume forecast here, we're forecasting treatment volumes. We give a number of volume metrics like NAG and others that you can calculate, but we're really forecasting total treatment volumes.

因此，24 年的可比較數字增加了約 50 個基點。我認為確切的是47個基點。為了讓大家清楚，當我們在這裡給出數量預測時，我們預測的是治療量。我們提供了許多可以計算的容量指標，例如 NAG 和其他指標，但我們實際上預測的是總治療量。

So the '24 number was up 50 basis points. The midpoint of the range for '25 is flat. There are really two things driving the decline. One is treatment days. Remember, 2024 was a leap year and that's worth about 20 basis points of extra growth in '24 that won't happen in '25. And then we mentioned the disruption of PD supply from the hurricane.

因此，24年的數字上升了50個基點。'25 的範圍中點是平的。實際上有兩個因素導致了這種下降。一是治療日。請記住，2024 年是閏年，這意味著 24 年將有大約 20 個基點的額外增長，而 25 年則不會出現這種情況。然後我們提到了颶風造成 PD 供應中斷。

And the result of that was in Q4, we were unable to admit new peritoneal dialysis patients for some period of time. Some of those patients wound up in center, but we believe we lost roughly 350 patients who otherwise would have come to DaVita, who we think decided to pursue peritoneal dialysis with another provider.

結果是，在第四季度，我們在一段時間內無法接收新的腹膜透析患者。其中一些患者最終進入了中心，但我們認為我們失去了大約 350 名原本會來到 DaVita 的患者，我們認為這些患者決定從其他供應商進行腹膜透析。

And because we lost those 350 patients in Q4, it didn't have much of an impact on Q4 volume. We'll have a much bigger impact on 2025 volume, and that's worth somewhere on the order of 15 to 20 basis points of growth in 2025. So you take that and the days, and that's really what accounts for the 50 basis point decline.

而且由於我們在第四季失去了這 350 名患者，所以對第四季的銷售沒有太大影響。我們將對 2025 年的銷售量產生更大的影響，這相當於 2025 年銷售量成長 15 到 20 個基點。所以，你把這個數字和天數考慮進去，這就是導致 50 個基點下降的真正原因。

In terms of the core metrics of mistreatment rate, mortality and admissions, we're viewing those in our guide as being roughly similar to what we saw in '24.

就虐待率、死亡率和入院率等核心指標而言，我們認為指引中的情況與 24 年的情況大致相同。

All right. I appreciate it. And if I may, on that number, when you quantified the benefit to OI from the inclusion of the oral drugs into the bundle $0 to $50 million. So I'm a little bit surprised that there is actually a zero. So can you give us a little bit more color like why there is such a wide range and also under what scenario is it a zero versus a $50?

好的。我很感激。如果可以的話，關於這個數字，當您量化將口服藥物納入捆綁計劃給 OI 帶來的收益時，收益為 000 到 5000 萬美元。所以我有點驚訝實際上有一個零。那麼，您能否向我們提供更多詳細信息，例如，為什麼範圍如此之大，以及在什麼情況下是零美元而不是 50 美元？

Hi, Joanna. This is Javier. Let me grab that one and for the people that haven't been tracking the orals in the bundle. This is a class of drugs that the largest is phosphate binders, which is a medication to reduce the absorption of dietary phosphate. And it was in Part D and is moving to Part B as in boy. And there are three variables to consider.

你好，喬安娜。這是哈維爾。讓我抓住這個，對於那些還沒有跟踪捆綁包中的口語的人來說。這是最大的一類藥物，即磷酸鹽結合劑，它是一種減少飲食磷酸鹽吸收的藥物。它在 D 部分，現在正移至 B 部分，就像男孩一樣。有三個變數需要考慮。

One is mix, what kind of phosphate binder and there's some generic and there are some branded. Two is volume. And then three, is adherence. This has a heavy pill burden. You have to take it at meals and snacks, et cetera.

一種是混合物，有各種類型的磷酸鹽黏合劑，有些是通用的，有些是品牌的。二是數量。第三，堅持。這會造成很重的藥丸負擔。您必須在吃飯、吃零食等時服用它。

And so many people for different reasons have low adherence. And so this is very new to us. And so with those three variables, we're being prudent in giving you a wide range. And once we get a bit of experience, we will see how that plays out. But the midpoint of the range feels the most likely spot with what we're seeing now.

許多人由於各種原因，堅持治療的依從性較低。這對我們來說是非常新穎的。因此，對於這三個變量，我們謹慎地為您提供一個廣泛的範圍。一旦我們累積了一些經驗，我們就會看到結果會如何。但從我們現在看到的情況來看，該範圍的中點是最有可能的位置。

And then I'll add one last point on the volume side, which is it's hard to see volume up to now because in many instances, people pick up the prescriptions for 90 days. And since we're now only in February, if you picked up your prescription in December, or November, you might not -- we don't have visibility to what kind of medication you're on. So that's why you have such a wide range right now.

然後，我想在數量方面補充最後一點，到目前為止很難看到數量，因為在許多情況下，人們會取 90 天的處方。而且由於現在只是二月，如果你在十二月或十一月拿到處方，你可能就無法知道你服用的是哪種藥物。這就是為什麼你現在有如此廣泛的範圍。

All right. Appreciate. I guess I'll go back to the queue. Thank you.

好的。欣賞。我想我會回到隊列。謝謝。

AJ Rice, UBS.

瑞銀的 AJ Rice。

If I heard you right, you said patient treatment costs will be up about 6% to 7%. And that's largely due to the phosphate binder inclusion. Can you comment on putting that aside? Is there any change in -- significant change in the way you're looking at the growth in patient treatment costs versus what you saw in '24?

如果我沒聽錯，您說患者的治療費用將上漲約 6% 至 7%。這主要是由於磷酸鹽黏合劑的加入。您能評論一下將其放在一邊嗎？與 24 年相比，您看待患者治療費用成長的方式有什麼改變嗎？

Sure. So the way I'd think about it, and there are ranges around this, but I'll use the midpoints here. The midpoint of growth in the patient care cost would be 6.5%. That would be [3.75%] from our historical costs and 2.75% from including the orals in the bundle. So if you're comparing it to what you've seen in prior years, that 3.75% would be the right number.

當然。所以我會這樣想，並且圍繞這個有一個範圍，但我會在這裡使用中點。病患照護成本的成長中間點是6.5%。這將占我們歷史成本的 [3.75%]，加上將口服藥物納入套餐所產生的 2.75%。因此，如果將其與前幾年的情況進行比較，3.75% 是正確的數字。

And as we break that down, we typically think of it as labor and everything else, and we see them both moving at about the same pace of growth for next year. Labor continuing to anticipate some higher pressure than we saw pre-COVID and everything else growing at about that same 3.75% range as well.

當我們對其進行分解時，我們通常將其視為勞動力和其他所有因素，我們認為明年它們的成長速度大致相同。工黨繼續預計面臨的壓力將比疫情之前更高，其他所有領域也都將以約 3.75% 的幅度增長。

Okay. And maybe a follow-up question. On the comments around capital deployment, do you have a figure for what you think you'll do on share repurchase? Any comments on the deal pipeline, either international or in the domestic market and what you're seeing out there?

好的。也許還有一個後續問題。關於資本配置的評論，您對股票回購的具體金額有何看法？您對於國際或國內市場的交易管道以及您所看到的情況有何評論？

So on share repurchases, I'll stick with what we've said in the past, which is our philosophy hasn't changed. We will look for capital-efficient growth, either investing in the business or through M&A and we'll keep our leverage or we'll target our leverage in the 3 to 3.5 range, which it's in right now and everything else will go back to share repurchases. So we're not going to give a number, but I wouldn't expect anything different than what we've seen in the past.

因此，在股票回購問題上，我會堅持我們過去所說的，那就是我們的理念沒有改變。我們將尋求資本高效的成長，無論是投資於業務還是透過併購，我們都將保持我們的槓桿率，或將我們的槓桿率目標設定在 3 到 3.5 的範圍內，也就是現在的槓桿率，其他一切都將用於股票回購。所以我們不會給出一個數字，但我不會期望任何與過去不同的結果。

In terms of M&A, we're looking at a few things. And I could certainly see a scenario in which we invest hundreds of millions of dollars. But as I've said in the past, I don't think we're going to do anything -- I don't see anything on the horizon now that would be -- that would significantly change the share repurchase program.

在併購方面，我們正在關註一些事情。我當然可以想像我們投資數億美元的情境。但正如我過去所說的那樣，我認為我們不會採取任何行動——我目前看不到任何可以顯著改變股票回購計劃的行動。

Pito Chickering, Deutsche Bank.

德意志銀行的 Pito Chickering。

The US RD data showing sort of flat incidents for End Stage Renal disease in '24 and your treatments have been pretty flat this year. There's definitely a pretty big debate now about the impact of SGLT2 inhibitors on treatment volumes. Can you help quantify us the new starts that you guys saw in 2024 versus 2023? Just to help sort of compare and contrast what DaVita is seeing versus what USRDS data is showing us.

美國 RD 數據顯示，24 年末期腎病發生率持平，今年的治療也相當穩定。目前關於 SGLT2 抑制劑對治療量的影響確實存在很大爭議。您能否幫助我們量化 2024 年與 2023 年相比所看到的新開端？只是為了幫助比較和對比 DaVita 所看到的內容和 USRDS 數據向我們展示的內容。

Let me grab a bit of that question, and then Joel can give you the specific answer you asked because we have gotten several people assuming that the medications are having an impact. And the reality is that our physicians have looked at this very carefully. And the odds that this is impacting our patient population are quite low at this juncture.

讓我稍微回答一下這個問題，然後喬爾可以給你具體的答案，因為我們已經有幾個人認為藥物正在產生影響。事實上我們的醫生已經非常仔細地研究過這個問題。目前，這對我們的患者群體產生影響的可能性相當低。

And let me tell you why. Number one, the information that we have from CMS put the prevalence of CKD patients, advanced CKD in the low teens. And the adherence in the mid-60s. And so the ability to have an impact is unlikely.

讓我來告訴你為什麼。首先，我們從 CMS 獲得的資訊顯示，CKD 患者、晚期 CKD 的盛行率在十幾歲以下。以及60年代中期的堅持。因此，產生影響的可能性不大。

If it were to have an impact, you would also see the offset in mortality. So the math would hopefully be a positive, meaning it's stretching people's longevity. And so when we talk to our medical professionals and they're reviewing all this data, they are very confident that, that is unlikely to be the impact.

如果它產生影響，你還會看到死亡率的抵消。因此，希望數學結果是正面的，這意味著它可以延長人們的壽命。因此，當我們與醫療專業人員交談並且他們審查所有這些數據時，他們非常有信心，這不太可能產生影響。

Now the second part of your question is a bit more specific, Joel?

現在你的問題的第二部分更具體一些，喬爾？

Yes. So in terms of the data, Pito, our admission growth has been running ahead of what you see in the US RDS data. It was stronger in the first part of the year, and it actually weakened significantly for Q4. Our new-to-dialysis admit growth was flattish in Q4, which is the first time it hasn't been running positive since -- for, I think, eight quarters. So we've been looking hard at that.

是的。因此就數據而言，Pito，我們的入學人數成長一直領先於美國 RDS 數據中的表現。今年上半年，該指標表現強勁，但第四季實際上大幅減弱。我們的新透析入院人數在第四季度持平，這是自八個季度以來首次沒有呈正增長。因此我們一直在認真研究這個問題。

And I'd say two things about this. First, if you look at US RDS year over year, new to dialysis or incidence growth, and we looked carefully at 10 years leading into COVID. There was a lot of noise in the data during COVID. But if you look at the 10 years before COVID, it's noisy data. There were 2 out of the 10 years where incidence growth was negative.

關於這一點我想說兩點。首先，如果您逐年查看美國 RDS 的最新透析或發病率增長情況，我們會仔細研究導致 COVID 的 10 年。在 COVID 期間，數據中有很多噪音。但如果你看看 COVID 之前的 10 年，你會發現這些都是吵雜的數據。這 10 年中有 2 年發病率呈現負成長。

Those years did not indicate any sort of secular trend, the data bounced back. It would move back and forth, it could move up to 3% year over year. And I think there was a 6% total swing during those 10 years. So we don't see negative -- one year of negative data in USRDS as the start of a trend necessarily. And we're basing that based on history. So that's point one.

那些年並沒有顯示出任何長期趨勢，數據有所反彈。它會來回變動，年同比變動幅度可能會高達 3%。我認為在這 10 年間，整體波動幅度為 6%。因此，我們並不認為 USRDS 一年的負面數據必然是趨勢的開始。我們是根據歷史得出這個結論的。這是第一點。

Second, picking up on what Javier said, if there is negative admit impact in the industry today, we think the much more likely result is from mortality in CKD 4 patients as a result of COVID than it is related to SGLT2 inhibitors or GLP-1s for the reason Javier said.

其次，接著 Javier 所說，如果目前該產業受到負面影響，我們認為更有可能的結果是 COVID 導致的 CKD 4 患者死亡，而不是 Javier 所說的與 SGLT2 抑制劑或 GLP-1 相關。

So again, 2 points. One, a negative year of incidence growth is not a new thing. We've seen it before. It hasn't necessarily been the start of a trend. And second of all, if there really is a signal in that noise, we think it's much more likely the result of COVID than these new drugs.

所以，再說一遍，2 分。第一，發病率出現負成長並不是什麼新鮮事。我們以前見過。這並不一定是一種趨勢的開始。其次，如果這種噪音中真的有訊號，我們認為它更有可能是 COVID 的結果，而不是這些新藥。

Okay. And then going on the PD, I guess, when did your PDs supply stabilize from Baxter? And then can you sort of quantify how those new starts at this point, return to normalized levels. I understand the leap year impact, and I understand the quantification from sort of the drag from the 15 and 20 basis points of losing those 350 patients. But can you actually quantify how the new starts sort of return to normal levels now that PD suppliers have normalized?

好的。然後繼續討論 PD，我猜，您的 PD 從 Baxter 的供應什麼時候穩定下來？然後，您能否量化這些新起點如何恢復到正常水平。我了解閏年的影響，也了解失去這 350 名患者所造成的 15 到 20 個基點的拖累的量化。但是，現在 PD 供應商已經恢復正常，你能否真正量化新開工量如何恢復正常？

Yes. So we're back online, back to normal. And so you should see that number pick back up. Our mix pre-hurricane was in the mid-15s, right below that, about 15.4. So we are right around 14.9.

是的。這樣我們就恢復在線，恢復正常了。所以你應該會看到這個數字回升。我們的颶風前混合溫度在 15 度左右，略低於這個值，約 15.4 度。因此我們的數字正好在 14.9 左右。

So we should see that get back in line, it will take a bit of time, maybe a year or so as the year plays out. but we're back to normal.

所以我們應該看到它重新回到正軌，這將需要一些時間，也許一年左右的時間。但我們已經恢復正常了。

And just to clarify two things, Pito, we're back to normal, but those 350 admits that we lost, they're lost for all of '25. They're not going to come back to us. hence, the impact even though we're back to admitting at a normal level.

只要澄清兩件事，皮托，我們恢復正常了，但那 350 人承認我們輸了，他們在 25 年裡全部輸了。他們不會再回到我們身邊了。因此，即使我們恢復到正常水平，仍會產生影響。

And second, I'll remind everyone, even though PD patients treat every day, when we report our volumes, we normalize that to in-center equivalents. So we don't pick up volume or lose volume in our volume count if a patient goes from PD to in-center or vice versa.

其次，我要提醒大家，儘管 PD 患者每天都會接受治療，但當我們報告治療量時，我們會將其標準化為中心內的等效治療量。因此，如果患者從 PD 轉到中心或從中心轉到 PD，我們的體積計數不會增加或減少體積。

But then let me sort of ask it one more different way is there was a sort of 60-day time period when Baxter couldn't supply sort of these PD supplies. I get you lost those 350 patients, but now that's normalized, why is the midpoint of the range flat? Why is the midpoint range not sort of 50 or 100 basis points, minus the 20 bps from leap year minus the 20 bps from PD? Kind of why is flat, the new level if patient trends are normalized at this point?

但讓我換個方式問一下，有一段大約 60 天的時間段，Baxter 無法供應這些 PD 用品。我知道你失去了那 350 名患者，但是現在已經正常化了，為什麼範圍的中點是平的？為什麼中間點範圍不是 50 或 100 個基點，減去閏年的 20 個基點，再減去 PD 的 20 個基點？如果患者的趨勢此時已經正常化，那麼新的水平為什麼會是平坦的呢？

Because those patients are in center, they're just going to switch modality, but the treatments are the same.

因為這些病人都在中心，他們只是要轉換治療方式，但治療方法是一樣的。

Yes. I would think of it as it's the same 50 basis point dynamic we had last year, driven by mortality admissions and missed treatment rate. And then you've got to subtract off for these two dynamics which are specific to 2025, and we're in the -- we're not the case in 2024.

是的。我認為這與去年的 50 個基點動態相同，由死亡入院率和錯過治療率所推動。然後你必須減去這兩個特定於 2025 年的動態，而 2024 年的情況就不一樣了。

Justin Lake, Wolfe Research.

賈斯汀·萊克（Justin Lake），沃爾夫研究公司。

First, the noncontrolling interest look a little bigger than what I would have expected given the OI in the quarter. Am I missing something there? Is there -- like which drives that number? And was that larger than you expected?

首先，根據本季的 OI，非控制權益看起來比我預期的要大一些。我是否遺漏了什麼？有什麼因素推動了這個數字？這比你預期的還要大嗎？

Yes. Thanks for the question, Justin. It was a little larger than expected. I think modeling NCI as a percent of US dialysis operating income for the year is the right way to model it.

是的。謝謝你的提問，賈斯汀。它比想像中的大一點。我認為將 NCI 建模為美國年度透析營運收入的百分比是正確的建模方法。

And I don't think anything has changed there overall. There were some collection dynamics associated with Change Healthcare that move things from one quarter to the next. But overall, there's no underlying trend there that I'd call out.

我認為總體來說那裡並沒有任何改變。與「變革醫療保健」相關的一些收集動態會將事情從一個季度轉移到下一個季度。但總體而言，我並沒有指出任何潛在的趨勢。

So you're saying the percentage of operating earnings isn't increasing? It might be flipping between quarters, but overall, the '25 should be in line with the '24?

所以你的意思是營業收入百分比沒有增加？各個季度之間可能會有變化，但總體而言，'25 應該與 '24 保持一致？

Exactly.

確切地。

Okay. And the -- I was hoping you could -- I mean, you ran most of the below-the-line numbers. And yet, EPS looks a little bit light versus what I would have thought. The only thing I could think of is the share count. You want to run that, you want to give us an idea what your share count expectation is?

好的。而且 — — 我希望你能 — — 我的意思是，你運行了大部分低於線的數字。然而，與我想的相比，EPS 看起來有點低。我唯一能想到的就是股票數量。您想運行它，您想讓我們知道您的股份數量預期是多少嗎？

I'd rather not. I think I'm trying to think what might not be in there. It depends on how you're modeling it. If you're modeling it by business segment, I think the corporate segment is probably going to be $25 million worse in '25 than in '24. And that's just about the timing of some equity compensation.

我寧願不這麼做。我想我正在努力思考那裡面可能沒有什麼。這取決於你如何建模。如果以業務部門建模，我認為 25 年企業部門的利潤可能比 24 年損失 2,500 萬美元。這只是一些股權補償的時機。

Other than that, I think if you're -- we gave the other income, we gave the interest expense, we gave the tax rate. So I think share count will be ultimately the question. And look, that will depend on a bunch of things, how much capital we deploy to buy back shares, obviously, what the share price is, it is impacted by when we buy the shares during the year as well because it's a weight average count over the course of the year.

除此之外，我想如果你——我們給了其他收入，我們給了利息支出，我們給了稅率。因此我認為，最終的問題在於股份數量。看看，這將取決於許多因素，我們部署了多少資本來回購股票，顯然，股價是多少，這也受到我們在一年中購買股票的時間的影響，因為它是一年中的加權平均數。

Maybe we'll take it offline, Justin. We can make sure there isn't some arithmetic difference.

也許我們應該把它下線，賈斯汀。我們可以確保不存在算術差異。

I appreciate that. The other question I have was on revenue per treatment. A couple of things you said. One, that there's still some kind of juice to squeeze from collections which I had the impression listened to the deal last quarter that you thought that was petering out of bed. So I was curious how much of improvement you expect there.

我很感激。我的另一個問題是每次治療的收入。你說了幾件事。第一，從收款業務中仍然可以榨取一些利潤，而我印像中，聽了上個季度的交易後，你認為這種利潤正在逐漸消失。所以我很好奇您期望那裡會有多少改進。

You also mentioned payer mix would be great to know kind of where you ended the year and what you're assuming next year? And while you're talking about payer mix. Can you give us your -- maybe the percentage of treatments coming from the exchanges? Or members with exchange coverage?

您還提到，付款人組合情況會很好，能夠了解您去年的業績表現如何以及您對明年的預期是什麼？當您談論付款人組合時。您能否告訴我們來自交易所的治療所佔的百分比？或有交換覆蓋範圍的成員？

Sure. So starting on the collections question. What you're seeing in here, I think, is what we've called out over the course of 2024, which is the annualization of collections improvement that kind of hit midyear of 2024, and that's probably worth on the order of $50 million, call it.

當然。那麼就從收藏問題開始吧。我認為，您在這裡看到的是我們在 2024 年所呼籲的，即收款改善的年化，這種改善將在 2024 年中期實現，價值可能約為 5000 萬美元。

On the mix, there's really nothing interesting to call out about MA mix. We'll move with the industry. There's really not a lot there. On commercial mix, we're at about 11% now, and we think we'll pick up a few tens of basis points on that. In terms of the exchanges, we're at about 3% of our population are on the exchanges today.

就混音而言，MA 混音確實沒有什麼有趣的地方。我們將隨著行業一起進步。那裡確實沒什麼東西。就商業組合而言，我們現在的比例約為 11%，我們認為我們將在此基礎上提高數十個基點。就交易所而言，目前我們大約有 3% 的人口在交易所。

And where was that number pre-COVID, Joel, exchanges?

喬爾，在疫情之前，交易所的這個數字是多少？

If you go back pre-COVID, I'll give you the number from before the enhanced premium tax credits came in place and it was right around 2%.

如果您回到 COVID 之前，我會給您提供增強保費稅收抵免實施之前的數字，當時約為 2%。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

I appreciate the comment that 40% of rev per treatment growth is from phosphate binders. It looks like that's worth about $25 per treatment from Medicare patients. Do I have that math right?

我很欣賞這樣的評論：每次治療的轉速增長有 40% 來自磷酸鹽結合劑。看起來，對於醫療保險患者來說，每次治療的費用約為 25 美元。我的計算正確嗎？

And if so, like that deal a little bit light versus what CMS quantified ASP to be in the final rate. So just trying to understand the absolute dollars on the Medicare patients specifically.

如果是這樣，那麼與 CMS 量化的 ASP 的最終費率相比，這筆交易就稍微輕鬆了一些。所以只是想具體了解醫療保險患者的絕對支出。

So no, Andrew, the number is more in the $10 to $15 for a Medicare patient. And just to get everyone the math. So if you use the middle of that range and recognizing not all of our patients are eligible for orals through the bundle, right, if you're on commercial or managed Medicaid, there are payer classes that aren't getting this.

所以，安德魯，不，對於醫療保險患者來說，這個數字更多的是在 10 到 15 美元之間。只是為了讓每個人都知道數學。因此，如果您使用該範圍的中間值，並認識到並非所有患者都有資格透過捆綁服務獲得口服藥物，如果您使用商業或管理的醫療補助，那麼有些付款人類別就無法獲得該藥物。

And even for those who are those on Medicare and Medicare Advantage, not every patient takes it. So that's why the 40% of our number, which is somewhere around $7.80 in RPT is lower than the 10 to 15 because it doesn't apply to all patients.

即使是那些享受醫療保險和醫療保險優勢計劃的人，也並不是每個病人都會接受這種治療。所以這就是為什麼我們的 40%（大約為 7.80 美元的 RPT）低於 10 到 15 的原因，因為它並不適用於所有患者。

Got it. Okay. And then on G&A per treatment, I think that was up 6% sequentially, 11% year over year. That looks like a big acceleration and maybe stronger than typical seasonality. Any additional color on what's driving that?

知道了。好的。然後就每個治療的 G&A 而言，我認為這比上一季增長了 6%，比去年同期增長了 11%。這看起來像是一個巨大的加速，甚至可能比典型的季節性更強勁。您能進一步解釋一下是什麼原因導致的嗎？

Yes. Thanks, Andrew. I think the best way to think of G&A is in two parts. One is the, let's call it, the traditional, which is the sort of thinking of it as a cost basis. The second part is now an investment portfolio that we have in there.

是的。謝謝，安德魯。我認為思考 G&A 的最佳方式是將其分為兩部分。一種是，我們稱之為傳統方法，即將其視為成本基礎。第二部分現在是我們的投資組合。

And so the examples that come to mind is IT, where we're getting a lot of benefit on another cost line item or are revenue operations where you're picking up the benefit, obviously, on RPT. And so the better way to think about that is that about half and half of that split. And so you're just getting the inflationary part of the cost item, and we're getting good productivity on the other half.

因此，我想到的例子是 IT，我們從另一個成本項目中獲得了很多收益，或者是收入運營，顯然您可以從 RPT 中獲得收益。因此，更好的思考方式是，大約一半一半地分割。因此，您只獲得了成本項目中的通貨膨脹部分，而我們獲得了另一半的良好生產力。

Got it. Okay. And then on the patient care costs, I think that benefited from a gain on settlement in the quarter. Can you quantify that for us?

知道了。好的。然後就患者照護成本而言，我認為這得益於本季的結算收益。你能為我們量化一下嗎？

Hold on, one second. Yes, it's not something that I'll want to call out. It's not a big deal and it's kind of relatively routine and small.

等一下，等一下。是的，這不是我想說出來的話。這不是什麼大問題，是一種相對常規和小的事情。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

Appreciate all the guidance details. Joel, I hope I didn't miss it, but did you touch on sort of seasonality maybe at the consolidated level in IKC? Like anything sort of historically or different from historical seasonality or anything that we should be aware of just sort of maybe even first half, second half cadence?

感謝所有的指導細節。喬爾，我希望我沒有錯過，但你是否提到了 IKC 合併層面的季節性？就像歷史上任何不同於歷史季節性的事情，或是任何我們應該知道的事情，甚至是上半年、下半年的節奏？

Yes. Here's the way I'd think about it. So from an operating income standpoint, I'd call out three things. First, revenue per treatment is always lighter in Q1 and builds over the course of the year. So typically, there's about $5 seasonality hit on RPT in Q1 as a result of bad debt associated with patient pay. And then the RPT tends to build over the course of the year. So that would be one.

是的。這是我的想法。因此，從營業收入的角度來看，我想指出三件事。首先，第一季每次治療的收入總是較低，並且會隨著時間而增加。因此，通常情況下，由於與患者支付相關的壞賬，第一季的 RPT 會受到約 5 美元的季節性打擊。然後，RPT 往往會在一年內逐漸建立。這就是其中之一。

Second is IKC, which is always back half loaded. It is very hard to predict the seasonality of IKC, but I think you can reliably count on it being back-half loaded in the Q3, Q4, dynamic can sometimes be complicated.

第二個是IKC，它總是半載返回。很難預測 IKC 的季節性，但我認為你可以可靠地指望它在第三季、第四季後半段負載過大，動態有時會很複雜。

And fourth (sic - third), expenses tend to go up in Q4, and that can hit both patient care costs as well as G&A. So if you put that in the mix, I would say our Q1 OI will be roughly 20% of full year OI that grows through Q2 and Q3, and sometimes will drop down a little in Q4. That's at the OI line.

第四，第四季度的費用往往會上升，這可能會對病患照護成本以及一般及行政費用造成影響。因此，如果將其考慮在內，我會說我們的第一季 OI 將約佔全年 OI 的 20％，並且會在第二季度和第三季度增長，有時會在第四季度略有下降。那是在 OI 線。

As you're modeling EPS, you have to add to that the fact that share buybacks accumulate as the year progresses. And as a result, share count will typically come down. So you'll see a little bit more growth in EPS over the course of the year.

在對每股盈餘進行建模時，您必須將股票回購隨著時間的推移而累積的事實考慮在內。因此，股票數量通常會下降。因此，您會看到每股收益在今年內略有成長。

So Q1 EPS will typically be even lower than that 20% number I talked about for OI.

因此，第一季的每股盈餘通常會低於我所說的 OI 的 20%。

Got it. And just one more thing. Any way you can tell us where you started out or where we're going to start out the year sort of an IKC between the SNP patient count and maybe just similar to the other IKCC lives? And then just any thoughts on anything changed in terms of potentially hitting breakeven in that business by 2026?

知道了。還有一件事。您能告訴我們您從哪裡開始，或者我們將從哪裡開始新的一年，有點像 SNP 患者計數之間的 IKC，也許與其他 IKCC 生活相似？那麼，對於 2026 年之前該業務實現收支平衡的可能性，您認為有什麼變化嗎？

Yes. Thanks for the question. We see the business being flattish this year, and we had a bit of a timing thing that was called out about $10 million that rolled into 2024. So the OI line will look pretty similar in 2025. And what I would say is that we're still sticking to that breakeven in 2026 time period, and we gave that guidance around 2021.

是的。謝謝你的提問。我們看到今年的業務表現平淡，而且我們有一些時間問題，預計到 2024 年會有 1000 萬美元左右的收入。因此，2025 年的 OI 線將看起來非常相似。我想說的是，我們仍然堅持在 2026 年實現收支平衡，並且我們在 2021 年左右給出了這一指導。

And we've been kind of right on top of our model, and so no change in the expectations.

我們一直處於模型的正確軌道上，因此預期沒有變化。

Yes. And on the SNP thing, I wouldn't call out much change in 25 relative to 2024.

是的。至於蘇格蘭民族黨 (SNP) 的問題，我認為 2025 年相對於 2024 年不會有太大變化。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

Most of the last but -- the last one on my list was the free cash flow guidance implies that free cash flow could be down year over year? Is it because '24 is that much better or anything to call out?

最後一點，但是──我清單上的最後一點是自由現金流指引是否意味著自由現金流可能逐年下降？是因為 '24 好很多還是有什麼值得稱讚的？

Yes, I'd say probably the biggest thing to call out is just working capital changes. There can be big swings at the end of each year, which is why we guide to such a wide range. There's nothing in particular I'd call out in the free cash flow.

是的，我想說，可能最需要注意的就是營運資金的改變。每年年底可能會出現很大的波動，這就是我們指引如此廣泛範圍的原因。對於自由現金流，我沒有特別要指出的。

Okay. And in terms of clinic closures, are you willing to give us a range of what you plan for '25 in your guidance for closure?

好的。關於診所關閉，您是否願意在關閉指南中告訴我們您對 25 年診所關閉的具體計劃？

I think we've now hit a pretty normal position. So we will close, what I'd say, pre-pandemic, which is somewhere in the 20 or so centers on a yearly basis.

我認為我們現在已達到相當正常的狀態。因此，我想說，在疫情之前，我們每年會關閉大約 20 個中心。

Peter Chickering, Deutsche Bank.

德意志銀行的彼得‧奇克林 (Peter Chickering)。

Just following up on Ryan's questions on IKC. It looks like since last quarter, like, you picked up 900 patients on the risk-based integrated care, but lost 2,300 patients in the integrated care arrangements. I guess, why did you guys lose those patients?

只是跟進 Ryan 關於 IKC 的問題。看起來自上個季度以來，您在基於風險的綜合護理中接收了 900 名患者，但在綜合護理安排中失去了 2,300 名患者。我想問一下，你們為什麼會失去那些病人呢？

And then the second one there is at your point, the IKF is always sort of back half loaded as you get the true-ups from managed care. And as you guys get more and more experience, at which point do you move from more of a cash-based accounting system into more of an accrual system, to say, the more experience?

然後第二個就是您提到的這一點，當您從管理式護理中獲得真實資訊時，IKF 總是處於後半部分負荷的狀態。隨著你們的經驗越來越豐富，你們會在什麼時候從現金會計系統轉向權責發生製系統，也就是說，經驗越豐富？

So my Chief Accounting Officer is sitting across the table from me, glaring about cash accounting. So I'll just clarify. We don't do cash accounting. We are careful about when we recognize our revenue and when the information flows in.

因此，我的首席會計官坐在桌子對面，怒目而視現金會計。所以我只想澄清一下。我們不做現金會計。我們非常謹慎地確定收入確認的時間以及資訊流入的時間。

That said, I understand the spirit of your question, Pito. And we have evolved, right, our value-based care component, which is the work we do with MA has -- we have been more comfortable estimating revenue a little bit earlier.

話雖如此，我明白你的問題的精神，皮托。而且，我們已經發展了基於價值的護理組件，這是我們與 MA 合作開展的工作——我們可以更輕鬆地提前估算收入。

So we've made progress there on CKCC which is the Medicare fee-for-service program. We still take a more prudent approach and wait for more information to come in until we have better experience with that. And when we might change that, I think, remains to be seen.

因此，我們在 CKCC（醫療保險按服務收費計劃）方面取得了進展。我們仍然採取更謹慎的態度，等待更多的信息，直到我們有更好的經驗。而我認為，我們何時能夠改變這種狀況還有待觀察。

In terms of the count on members, I wouldn't read too much into that. Numbers will flow as attribution changes and small changes like this aren't indicative of any underlying change in our IKC business.

就會員數量而言，我不會對此進行過多的解讀。數字會隨著歸因的變化而變化，而像這樣的小變化並不代表我們的 IKC 業務發生了任何根本變化。

Okay. So apologies to your Chief Accounting Officer on that one. I guess looking at for '25, I guess how do the lives evolve this year? Do you see another step up as you have the last few years? Or is this more sort of the run rate that you guys will have within IKC?

好的。因此，我向你們的首席會計官表示歉意。展望 25 年，我想今年的生活會如何發展？您是否認為自己會像過去幾年一樣再上一個階梯？或者這更像是你們在 IKC 內的運行率？

I would say for '25, we remain focused on driving margin. I think there are contracts out there that we just see as unattractive, and we are not going to pursue just for the sake of volume growth and revenue growth. So I would say '25 is likely to look like a much slower growth year from a membership standpoint.

我想說，對於 25 年來說，我們將繼續專注於提高利潤率。我認為有些合約我們只是覺得沒吸引力，我們不會單純為了銷售和收入成長而去追求。因此，我認為從會員數量的角度來看，2025 年可能會是成長速度緩慢的一年。

Okay. And then last question, and apologies if I missed that. In the script, you talked about a reserve in Brazil of $19 million. Was that an AR write-off that impacted OI? Or kind of what was the details around that?

好的。這是最後一個問題，如果我沒注意到的話，請原諒。在劇本中，您談到了巴西的 1900 萬美元儲備金。這是影響 OI 的 AR 註銷嗎？或其相關細節是怎樣的？

Yes. So it flowed through OI this quarter. It was generally -- it was not generally, it was all about aged AR generally from '23 and even before then.

是的。因此本季它流經 OI。一般來說 — — 一般不是，一般情況下都是關於老年 AR 的，從 23 年甚至更早的時候開始。

So as I think about it and the core earning power of the international business in 2024, this really doesn't impact the underlying earning power of the business, but it did flow through OI from an accounting standpoint.

因此，當我考慮它以及 2024 年國際業務的核心盈利能力時，這實際上並不影響業務的潛在盈利能力，但從會計的角度來看，它確實流經了 OI。

So your adjusted operating income of [$491 million] in the quarter that was impacted by a $19 million reserve that you took in Brazil this quarter?

那麼，您本季的調整後營業收入 [4.91 億美元] 是受到您本季在巴西提領的 1,900 萬美元儲備金的影響嗎？

Correct. But it also benefited -- I mean if you're thinking about headwind, tailwind, quality of earnings, whatever kind of analysis you're thinking, I would also point out it did benefit from that pull forward of IKC revenue from 2025 of about $10 million.

正確的。但它也受益了——我的意思是，如果你考慮逆風、順風、盈利質量，無論你考慮什麼樣的分析，我還要指出，它確實受益於 IKC 收入從 2025 年提前約 1000 萬美元。

Yes. So it's [$491 million], plus $10 million minus $19 million -- plus $19 million, minus $10 million. Got it.

是的。因此它是 [4.91 億美元]，加上 1000 萬美元減去 1900 萬美元 - 加上 1900 萬美元，減去 1000 萬美元。知道了。

That's a reasonable way of looking at it.

這是一個合理的看法。

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

此刻，我沒有其他問題。各位發言人，我將把電話轉回給你們，請你們發表結束語。

Okay. Thank you, Michelle, and thank you for the questions. In closing, I will go back to where we began the call by highlighting 25 years of clinical innovation. We take our responsibility seriously to continue DaVita's legacy of improving the live of our patients and care teams.

好的。謝謝你，米歇爾，也謝謝你的提問。最後，我將回到我們開始呼籲的地方，強調 25 年的臨床創新。我們嚴肅對待自己的責任，延續 DaVita 的優良傳統，改​​善病人和照護團隊的生活。

Regarding the financials, while the components of DaVita OI and EPS growth vary from year to year, what remains constant is our commitment to operating excellence and innovation. We will continue to apply that discipline across DaVitas platform, including our core dialysis metrics as revenue, cost structure and volume while returning excess capital to our shareholders.

至於財務方面，儘管 DaVita OI 和 EPS 成長的組成部分每年都在變化，但不變的是我們對卓越營運和創新的承諾。我們將繼續在 DaVitas 平台上應用該原則，包括我們的核心透析指標，如收入、成本結構和數量，同時將多餘的資本回饋給我們的股東。

Thank you all for joining the call, and be well.

感謝大家參加電話會議，祝大家一切順利。

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。現在您可以繼續並斷開連接。