德維特 (DVA) 2025 Q1 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 first-quarter 2025 earnings call. (Operator Instructions)

晚安.我叫米歇爾，今天我將擔任你們的會議主持人。現在，我歡迎大家參加 DaVita 2025 年第一季財報電話會議。（操作員指示）

Mr. Eliason, you may begin your conference, sir.

埃利亞森先生，您可以開始您的會議了，先生。

Thank you, and welcome to our first-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，歡迎參加我們的第一季電話會議。我是投資者關係集團副總裁 Nic Eliason。今天和我一起的還有我們的執行長哈維爾·羅德里格斯 (Javier Rodriguez)；以及我們的財務長喬爾·阿克曼 (Joel Ackerman)。

Please note that during this call, we will 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，我們將根據聯邦證券法做出前瞻性陳述。所有這些陳述都受到已知和未知的風險和不確定性的影響，可能導致實際結果與前瞻性陳述中描述的結果有重大差異。

For further details concerning these risks and uncertainties, please refer to our first-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. 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.

有關這些風險和不確定性的更多詳細信息，請參閱我們的第一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。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，我們將討論一些非公認會計準則財務指標。這些非 GAAP 指標與最可比較 GAAP 財務指標的對帳已包含在我們向美國證券交易委員會 (SEC) 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.

現在我將把電話轉給哈維爾·羅德里格斯。

Thank you, Nic, and thank you for joining the call today. For the conclusion of the first quarter and reflecting on the events of this past few weeks, it is clear once again, the strength and dedication of our caregivers shine through each new challenge.

謝謝你，尼克，謝謝你今天參加電話會議。在第一季結束之際，回顧過去幾週發生的事件，我們再次清楚地看到，我們的護理人員的力量和奉獻精神在每一次新的挑戰中都閃耀著光芒。

We're in the midst of remediating a cybersecurity incident that disrupted portions of our operations. Despite these challenges, we remain steadfast. We continued delivering life-sustaining care, creating meaningful career paths for our teammates, and returning value to our shareholders.

我們正在修復一起擾亂我們部分營運的網路安全事件。儘管面臨這些挑戰，我們依然堅定不移。我們繼續提供維持生命的護理，為我們的隊友創造有意義的職業道路，並為我們的股東帶來價值回報。

Today, I'll share information on the cyber incident, highlight our first-quarter results, discuss key policy developments, and close with our outlook for the balance of the year. But first, as always, we will begin with a clinical highlight, the true foundation of everything we do.

今天，我將分享有關網路事件的信息，重點介紹我們的第一季業績，討論關鍵政策發展，並最後展望今年的平衡情況。但首先，像往常一樣，我們將從臨床重點開始，這是我們所做一切的真正基礎。

Last year, we launched a community-based collaboration with the YMCA to support chronic kidney disease education and prevention. Through the collaborative community kidney health program, YMCA locations nationwide are helping to bring vital education, free chronic disease screenings, and critical kidney health resources directly to the communities that need it the most.

去年，我們與基督教青年會啟動了一項社區合作，以支持慢性腎臟病的教育和預防。透過合作社區腎臟健康計劃，全國各地的基督教青年會正在幫助將重要的教育、免費慢性病篩檢和關鍵的腎臟健康資源直接送到最需要的社區。

Our early results are eye-opening. In our initial pilot, 30% of participants screened were found to have previously undiagnosed CKD, creating powerful opportunities for early intervention and life-changing care. Early detection and education are the cornerstones of kidney disease prevention. And through this collaboration, we're setting ambitious goals to reach thousands of people, empowering communities with the knowledge they need to close the gap in kidney health awareness.

我們的早期成果令人大開眼界。在我們最初的試驗中，30% 的篩檢參與者被發現患有先前未確診的 CKD，這為早期介入和改變生活的照護創造了強大的機會。早期發現和教育是預防腎臟疾病的基石。透過此次合作，我們設定了雄心勃勃的目標，希望惠及數千人，讓社區獲得所需的知識，並縮小腎臟健康意識的差距。

Partnership with the YMCA is more than just a program. It's a reflection of our unwavering commitment to building a healthier, stronger tomorrow.

與基督教青年會的合作不僅僅是一個計畫。它體現了我們堅定不移地致力於建立更健康、更強大的明天。

Before getting into the first-quarter performance, I want to address the cybersecurity incident we disclosed last month. On April 12, we identified and swiftly began addressing a cybersecurity incident that encrypted parts of our system and affected our operations. While it's deeply troubling that bad actors continue to target the healthcare community, the incident highlighted our team's unwavering commitment to patient care.

在介紹第一季業績之前，我想先談談我們上個月披露的網路安全事件。4 月 12 日，我們發現並迅速開始處理一起網路安全事件，該事件加密了我們系統的部分內容並影響了我們的營運。儘管不法分子持續將醫療保健界作為目標令人深感不安，但這一事件凸顯了我們團隊對病患照護的堅定承諾。

I'm grateful to report that we provided uninterrupted dialysis care for our patients on the day we detected the incident and every day since at all of our centers worldwide. Thanks to the incredible responsiveness of our teams and our investment in IT infrastructure, we've been able to restore most functions as of today. All of our major systems used for the patients, physicians, and teammates, including the lab and billing, are up and running.

我很高興地報告，在發現事故當天以及此後的每一天，我們都在全球所有的中心為患者提供不間斷的透析護理。由於我們團隊的出色回應能力以及我們對 IT 基礎架構的投資，截至今天我們已經能夠恢復大部分功能。我們用於患者、醫生和隊友的所有主要係統（包括實驗室和計費系統）均已啟動並運行。

Work on the remaining applications will continue over the next few weeks. While the restoration of our systems is nearly complete, there will be some regulatory and legal follow-ups to address as we work to identify the extent and nature of the data that was taken and make the required notices. We expect that the majority of the costs related to this incident will be one-time items recognized in the second quarter and our current expectations regarding the financial impacts are included in our guidance today.

其餘申請的處理工作將在接下來的幾週內繼續進行。雖然我們的系統復原工作已接近完成，但在我們努力確定被竊取資料的範圍和性質並發出必要的通知時，仍需要解決一些監管和法律後續問題。我們預計與該事件相關的大部分成本將在第二季度確認為一次性項目，我們對財務影響的當前預期已包含在我們今天的指導中。

Transitioning to the first-quarter performance, adjusted operating income and adjusted earnings per share came in slightly ahead of our expectations. At a high level, this was driven by outperformance within patient care costs, phosphate binders, and our international business. This favorability was partially offset by a modest underperformance in treatment volume, partially due to an abnormally high flu season.

從第一季業績來看，調整後的營業收入和調整後的每股盈餘略高於我們的預期。從高層次來看，這是由病患照護成本、磷酸鹽結合劑和國際業務的優異表現所推動的。但這種良好勢頭被治療量略微低於預期所抵消，部分原因是流感季節異常高發生率。

Let me offer some additional color on phosphate binders, which contribute to positive results for the quarter. As a reminder, phosphate binders are oral drugs prescribed to help dialysis patients avoid mineral bone disease. Beginning this year, CMS transitions phosphate binders for Medicare Part D into the dialysis benefit. DaVita's dispensing drugs per physician orders and receiving reimbursement from CMS and Medicare Advantage plans on a per-script basis during the initial TDAPA period.

讓我對磷酸鹽結合劑提供一些額外的信息，這對本季度的積極業績做出了貢獻。提醒一下，磷酸鹽結合劑是一種口服藥物，可以幫助透析患者避免礦物質骨病變。從今年開始，CMS 將把醫療保險 D 部分的磷酸鹽結合劑轉變為透析福利。DaVita 根據醫生的醫囑配藥，並在初始 TDAPA 期間按處方從 CMS 和 Medicare Advantage 計劃獲得報銷。

As we predicted last quarter, the largest source of variability would be in drug mix where we have seen higher-than-expected prescription of iron-based binders. This is a win for our patients for receiving the most effective medication for their individual clinical needs. We're still in the early days of this transition and expect further variability over the course of the year. That said, with initial data on drug mix, we now expect the full-year operating income contribution from phosphate binders to be at the upper end of our previous guidance range of $0 to positive $50 million.

正如我們在上個季度預測的那樣，最大的變化來源是藥物組合，我們發現鐵基黏合劑的處方量高於預期。這對我們的患者來說是一個勝利，因為他們可以獲得最有效的、符合他們個人臨床需求的藥物。我們仍處於這一轉變的早期階段，預計今年還會有進一步的變化。也就是說，根據藥物組合的初步數據，我們現在預計磷酸鹽結合劑的全年營業收入貢獻將達到我們先前指導範圍的上限，即 0 至正 5000 萬美元。

I'll offer one final note for the first quarter regarding capital allocation. Our priority remains to invest available capital in innovation in high return growth opportunities such as our recent Latin America acquisition. Beyond those opportunities, we remain committed to returning capital to our shareholders through share repurchases.

我將針對第一季的資本配置提供最後的說明。我們的首要任務仍然是將可用資本投資於高回報成長機會的創新，例如我們最近在拉丁美洲的收購。除了這些機會之外，我們仍然致力於透過股票回購向股東返還資本。

Since our last earnings call, we repurchased approximately $680 million of stock, representing an accelerated pace over this timeframe. 2025, we expect share repurchases will be more front-loaded than typical and should slow down over the remaining of the year. To be clear, our capital allocation strategy remains unchanged.

自從上次財報電話會議以來，我們回購了約 6.8 億美元的股票，這意味著這段時間內我們回購的速度加快了。到 2025 年，我們預計股票回購將比往年更加前期化，並且在今年剩餘時間內將會放緩。需要明確的是，我們的資本配置策略保持不變。

Now I'd like to shift gears and share some thoughts on the new administration and potential policy changes. Despite the fast-moving environment, our top priority remains the same, advocating for our patients at the state and federal levels.

現在我想換個話題，分享一些關於新政府和潛在政策變化的想法。儘管環境瞬息萬變，我們的首要任務依然不變，那就是在州和聯邦層級維護病患權益。

Today, I'll focus on three policy topics impacting the broader healthcare landscape: tariffs, Medicaid, and enhanced premium tax credits. For the first two, although the policy is fluid on each and there's a lot to learn, we don't currently believe either tariffs or Medicaid reform represent any material financial impact.

今天，我將重點討論影響更廣泛醫療保健領域的三個政策主題：關稅、醫療補助和增強保費稅收抵免。對於前兩個，雖然各自的政策都是可變的，並且有很多東西需要學習，但我們目前認為關稅或醫療補助改革不會帶來任何實質的財務影響。

As it relates to qualified health plans and enhanced premium tax credits, we previously shared a cumulative operating income impact of $75 million to $120 million. This impact is cumulative over three years and assumes a full exploration of the enhanced premium tax credits. We continue to believe this reflects the most likely range of outcomes. And as we've shared, we're likely trending toward the higher end of that range due to a strong 2025 open enrollment for exchange plans. While we're grateful to be largely insulated from recent policy developments, we remain vigilant and committed to strong patient advocacy.

由於它與合格的健康計劃和增強的保費稅收抵免有關，我們之前分享了累積營業收入影響 7500 萬至 1.2 億美元。這種影響是三年內累積的，並假設對增強的保費稅收抵免進行了全面探索。我們仍然相信這反映了最可能的結果。正如我們所分享的，由於 2025 年交換計畫的開放註冊量強勁，我們可能會趨向於該範圍的高端。雖然我們很慶幸自己在很大程度上沒有受到最近政策發展的影響，但我們仍然保持警惕，並致力於強有力的患者權益倡導。

In addition to outlook, we're maintaining our 2025 guidance range for adjusted operating income and adjusted earnings per share as disclosed last quarter. Although we've experienced headwinds from the cyber incident, our strong first-quarter operating performance has put us in a good position to achieve our financial guidance for the full year.

除了展望之外，我們還維持上個季度揭露的 2025 年調整後營業收入和調整後每股收益的指導範圍。儘管我們遭遇了網路事件帶來的阻力，但我們第一季強勁的營運業績使我們處於有利地位，能夠實現全年財務預期。

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

現在我將把電話轉給喬爾，更詳細地討論我們的財務表現和前景。

Thank you, Javier. First-quarter adjusted operating income was $439 million. Adjusted EPS was $2, and free cash flow was negative $45 million. Adjusted operating income was above the guidance we gave last quarter, largely as a result of strong expense management, profitability from orals in the bundle at the high end of our range, and strong performance in international, partially offset by lower-than-expected treatments.

謝謝你，哈維爾。第一季調整後的營業收入為4.39億美元。調整後的每股盈餘為 2 美元，自由現金流為負 4,500 萬美元。調整後的營業收入高於我們上個季度給出的預期，這主要得益於強大的費用管理、我們高端產品組合中口服藥物的盈利能力以及國際市場的強勁表現，但低於預期的治療部分抵消了這一影響。

I'll focus first on the details behind our Q1 operating income performance followed by an update for 2025 guidance. US treatments per day declined 40 basis points versus the first quarter of 2024 and was approximately 50 basis points below our forecast. Weakness was largely the result of higher missed treatment rate, which was caused by a severe flu season and a higher-than-expected impact from storms in January and February.

我將首先關注我們第一季營業收入表現背後的細節，然後再更新 2025 年的指引。與 2024 年第一季相比，美國每日治療量下降了 40 個基點，比我們的預測低了約 50 個基點。疲軟主要是由於漏診率較高，這是由於嚴重的流感季節以及 1 月和 2 月風暴的影響超出預期。

Adding to this shortfall was the negative impact on census from higher-than-anticipated flu mortality in the quarter. Mission growth was strong during the quarter, which supports our hypothesis that the negative admissions growth we saw in the fourth quarter was the result of normal variability and not a trend.

除此之外，本季流感死亡率高於預期，對人口普查產生了負面影響。本季任務成長強勁，這支持了我們的假設，第四季度看到的負入場人數成長是正常變化的結果，而不是趨勢。

Looking forward to the remainder of the year, the flu-related census impact in the first quarter will contribute to lower treatment volume for the remainder of the year than we had previously expected. Additionally, we believe the cyber incident that Javier described resulted in lower-than-normal admissions for about two weeks in April. Taking these two factors together, combined with the treatment shortfall in Q1, we are now expecting an approximately 50-basis-point decline in treatments for the year.

展望今年剩餘時間，第一季與流感相關的人口普查影響將導致今年剩餘時間的治療量低於我們先前的預期。此外，我們認為哈維爾所描述的網路事件導致 4 月份約兩週的入院人數低於正常水平。綜合考慮這兩個因素，再加上第一季的治療缺口，我們預計今年的治療量將下降約 50 個基點。

As a reminder, 2025 volume is also negatively impacted by the PD supply shortage we faced in Q4 2024. Despite these temporary challenges, we still expect to return to 2% volume growth, although the timing is hard to predict.

提醒一下，2025 年的產量也受到 2024 年第四季面臨的 PD 供應短缺的負面影響。儘管面臨這些暫時的挑戰，我們仍然預期銷售成長將恢復到 2%，儘管具體時間很難預測。

Consistent with what we have forecasted in the past, these forecasts are for number of treatments, not treatments per day or non-acquired growth. Revenue per treatment increased $4 in the quarter. Approximately $10 of the increase is attributable to new reimbursement for phosphate binders, partially offset by $5 of decline due to typical seasonality of patient responsibility for co-pays and deductibles in the first quarter.

與我們過去的預測一致，這些預測是針對治療次數，而不是每天的治療次數或非後天生長。本季每次治療的收入增加了 4 美元。約 10 美元的增長歸因於磷酸鹽結合劑的新報銷，但因第一季患者共同支付和免賠額的責任具有典型的季節性，導致報銷金額下降 5 美元，因此部分抵消了這一增長。

Patient care cost per treatment increased by $7, sequentially. This was driven by approximately $8 per treatment of new costs associated with phosphate binders and partially offset by a decline from the seasonally high fourth quarter.

每次治療的患者護理費用連續增加了 7 美元。這是由於與磷酸鹽結合劑相關的每次治療新成本約為 8 美元，並被第四季度季節性高成本的下降部分抵消。

First quarter G&A costs declined by $33 million, sequentially, again as a result of a decline from typical seasonally elevated spend towards the end of the year. Adjusted international OI increased by $29 million versus the fourth quarter. As a reminder, the fourth quarter was impacted by a $19 million reserve recorded against aged accounts receivable in Brazil.

第一季的一般及行政費用較上季下降 3,300 萬美元，這也是由於年底典型的季節性支出增加所導致的下降。調整後的國際 OI 較第四季增加了 2,900 萬美元。需要提醒的是，第四季受到了巴西 1,900 萬美元應收帳款準備金的影響。

Integrated Kidney Care, our value-based care business, had operating losses of $29 million in the quarter, in line with expectations. As a reminder, IKC has seasonally stronger operating performance in the second half of the year. This quarter, we realigned the operations of an IT product from our IKC segment into our US other ancillary segment, which moved approximately $4 million of operating loss from IKC into US other ancillary results for the quarter. We anticipate the full-year impact of this change to be approximately $17 million.

綜合腎臟護理是我們基於價值的護理業務，本季的營運虧損為 2,900 萬美元，符合預期。需要提醒的是，IKC 在下半年的營運表現季節性地更為強勁。本季度，我們將 IKC 部門的 IT 產品營運重新調整到美國其他輔助部門，這將 IKC 約 400 萬美元的營運虧損轉移到本季度美國其他輔助績效中。我們預計這項變更對全年的影響約為 1700 萬美元。

Below the OI line, we incurred $18 million of other loss, mostly related to Mozarc, our joint investment with Medtronic. We expect this to be a consistent quarterly run rate for the remainder of the year. In the first quarter, we repurchased 3.7 million shares and we repurchased an additional 1.7 million shares since the end of the quarter.

在 OI 線以下，我們遭受了 1800 萬美元的其他損失，主要與我們與美敦力的聯合投資 Mozarc 有關。我們預計今年剩餘時間內的季度運行率將保持穩定。第一季度，我們回購了 370 萬股，自本季末以來我們又回購了 170 萬股。

Our repurchases continue to be informed by our typical assessment of leverage ratio, liquidity, and market price relative to our view of intrinsic value. This accelerated purchase pace brought our leverage level at the end of the quarter to 3.27 times, near the middle of our target leverage range.

我們的回購繼續以我們對槓桿率、流動性和市場價格相對於內在價值的典型評估為基礎。這種加快的購買速度使我們在本季末的槓桿水平達到 3.27 倍，接近我們目標槓桿範圍的中間值。

Q1 debt expense was $135 million. Beginning in the second quarter, we anticipate debt expense will increase to approximately $145 million per quarter for the remainder of the year.

第一季債務支出為 1.35 億美元。從第二季開始，我們預計今年剩餘時間內的債務支出將增加到每季約 1.45 億美元。

Let me now turn to our expectations for full-year 2025. We are reiterating our full-year adjusted operating income and earnings per share guidance. Despite challenges associated with a difficult flu season in Q1 and expectations for some headwinds related to the recent cyber incident, the underlying strength of our business performance in the first quarter and the increase in our forecast for profitability of orals in the bundle give us confidence in our full-year guidance.

現在，我來談談我們對 2025 年全年的期望。我們重申全年調整後的營業收入和每股盈餘預期。儘管第一季面臨嚴峻的流感季節帶來的挑戰，並且預計最近的網路事件會帶來一些不利因素，但我們第一季度業務表現的潛在強勁以及我們對捆綁銷售中口服藥物盈利能力預測的提高，使我們對全年指引充滿信心。

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) Andrew Mok, Barclays.

（操作員指示）巴克萊銀行的 Andrew Mok。

Hi, good afternoon. Appreciate all the color on the cyber attack and treatment growth. If we look at the 50-basis-point revision for the full year, can you help us understand how much of that was attributable to flu in the first quarter and how much of that is attributable to the cyber attack? And then similarly, what was the impact of flu in the quarter? Can you help spike that up? Thanks.

嗨，下午好。欣賞有關網路攻擊和治療成長的所有色彩。如果我們看一下全年 50 個基點的修訂，您能否幫助我們了解其中有多少是由於第一季的流感造成的，有多少是由於網路攻擊造成的？那麼，流感對本季的影響是什麼？你能幫忙把它釘起來嗎？謝謝。

Sure, Andrew. So starting on the full year, the biggest impact on the full year was flu, but not because of the first quarter. It's really a census decline in the first quarter that impacts the full year. So that's a little bit more than half of the 50 basis points.

當然，安德魯。因此從全年來看，對全年影響最大的是流感，但並不是因為第一季。第一季的人口普查下降確實影響了全年。這比 50 個基點的一半略多一點。

The other two components are: one, missed treatment rate in Q1; and the third would be the admit -- roughly, call it, 500 admissions we think we lost in a couple of weeks as a result of the cyber, and those two are roughly equal in size. So that's the 50 basis points for the year.

另外兩個組成部分是：一是第一季的漏診率；第三個是錄取——我們認為由於網路攻擊，我們在幾週內損失了大約 500 名學生，這兩個數字大致相等。這就是今年的 50 個基點。

If you're thinking about Q1, the miss was largely missed treatment rate. The census impact in quarter did not have a big impact, and the missed treatment rate was a combination both of storms in January and February as well as flu.

如果您考慮第一季度，那麼錯過的主要是治療率。本季的人口普查影響並不大，而漏診率是 1 月和 2 月風暴以及流感共同造成的。

Got it. Okay. And I think I heard you say that the majority of the costs related to the cyber attack will be one-time items recognized in the second quarter. Can you just help us understand that? Are you going to adjust that out of earnings? Or will you be incurring those costs and absorbing that into guidance?

知道了。好的。我想我聽到您說過，與網路攻擊相關的大部分成本將是第二季確認的一次性項目。你能幫助我們理解這一點嗎？你會從收益中調整這一點嗎？或者您會承擔這些成本並將其納入指導中？

So I think there'll be two different buckets. There will be some that are direct costs that we will non-GAAP and are likely covered by insurance. So those are not included in our adjusted OI forecast. There will also be some that are more indirect, and those will flow through the P&L, and we've included those in our guidance.

所以我認為會有兩個不同的桶子。其中有些是直接成本，我們將採用非公認會計準則，並可能透過保險承保。因此這些不包括在我們調整後的 OI 預測中。還會有一些更間接的，這些將流入損益表，我們已將這些納入我們的指導中。

Got it. That's helpful. And then on the oral phosphate, can you provide a bit more color on what you saw in the quarter with respect to uptake and drug mix? If you have any incremental details on that. Thanks.

知道了。這很有幫助。然後關於口服磷酸鹽，您能否提供更多關於本季度在吸收和藥物組合方面看到的情況？如果您對此有任何增量詳細資訊。謝謝。

Yeah. Thanks, Andrew. What we saw was that the mix came in a little leaning toward the iron-based. And so that's what we said in the opening remarks that in essence, change the guidance to the upper end. We had said $0 to $50 million, and now we will look to be on the higher end of that.

是的。謝謝，安德魯。我們看到混合物有點傾向於鐵基。這就是我們在開場白中所說的，本質上，將指導改為上限。我們之前說的是 0 到 5000 萬美元，現在我們的目標是達到更高的水平。

Do you expect the mix to change or evolve for the balance of the year? Or do you think you have a pretty good understanding of what that mix looks like based on results so far?

您預計今年的組合情況會改變或演變嗎？或者您認為根據目前的結果，您對這種混合是什麼樣子有相當好的了解？

It's our first quarter with this experience. But when we talk to physicians, it appears that they're happy with the current mix.

這是我們有此經驗的第一個季度。但當我們與醫生交談時，他們似乎對目前的組合感到滿意。

Got it. Okay. And maybe one last one for me. Can you help us understand where commercial mix came in in the quarter and how the exchange growth shook out for Q1? Thanks.

知道了。好的。這對我來說也許只是最後一個。您能否幫助我們了解本季的商業組合情況以及第一季的交易所成長情況？謝謝。

Sure. The mix was unchanged, flat in the low 11%, and the open enrollment was healthy. And so we continue the trajectory of growth similar to the rest of the market.

當然。招生結構沒有變化，維持在 11% 以下，且公開招生情況良好。因此，我們將繼續保持與其他市場類似的成長軌跡。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

This is Christian Porter on for Joanna. Just a few questions from us. I was curious if you could dive into the specifics of how much the cyberattack impacted you guys in terms of revenue and EBITDA, and then also the impact of phosphate binders inclusion in the Medicare bundle. Thank you, guys.

克里斯蒂安波特 (Christian Porter) 為喬安娜 (Joanna) 報道。我們只想問幾個問題。我很好奇，您是否可以深入了解網路攻擊對您們的收入和 EBITDA 的影響有多大，以及磷酸鹽結合劑納入醫療保險套餐的影響。謝謝你們。

Yeah. So on the cyber, just to be clear, this happened in April. So there was no impact in Q1, and it remains to be seen what the net impact on adjusted OI will be in Q2. But I'll remind you, it's built into our guidance.

是的。因此，在網路方面，需要明確的是，這件事發生在四月。因此，第一季沒有受到影響，而第二季對調整後的 OI 的淨影響仍有待觀察。但我要提醒你，它已融入我們的指導中。

In terms of -- remind me the second question? Oh, about binders. So I think if the question is how does this build up individually into our lines. Our RPT was up about $10 quarter over quarter as a result of binders, and our cost per treatment was up roughly $8 for the quarter from binders.

就——提醒我第二個問題？哦，關於活頁夾。所以我認為問題是，這如何單獨地融入我們的生產線。由於黏合劑的影響，我們的 RPT 比上一季上漲了約 10 美元，而本季我們每次治療的成本因黏合劑而上漲了約 8 美元。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

This is Dean Rosales on for Justin. Thank you for the updated color on non-acquired treatment growth in the year. Can you speak to your expectations for RPT in the year? Are they still in the 4.5% to 5.5% range? Thank you.

我是賈斯汀的 Dean Rosales。感謝您提供今年非獲得性治療成長的最新情況。您能談談對今年 RPT 的期望嗎？它們還在 4.5% 至 5.5% 的範圍內嗎？謝謝。

Yeah. No change to our guide on RPT for the year. We think we'll get a little bit more from orals in the bundle, as Javier mentioned, but still within the range of the guide from last quarter.

是的。我們對今年 RPT 的指導沒有改變。正如哈維爾所提到的那樣，我們認為我們會從捆綁包中的口語中獲得更多，但仍在上個季度的指南範圍內。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

I guess going back to the treatment growth question, can you sort of quantify just the new patients that started this quarter and how they start tracking in 2Q and sort of how that looks sort of year over year? And are you seeing any changes in mortality right now that we're exiting the flu season?

我想回到治療成長問題，您能否量化本季開始的新患者數量以及他們在第二季度的追蹤情況以及同比情況如何？現在我們正處於流感季節的尾聲，您是否發現死亡率有任何變化？

Yeah. So starting on the admit side, Q1 was a strong admit quarter for us. And we know there was a lot of interest last quarter. We called out a weak admit quarter in Q4. And I think a lot of curiosity on was that a normal variability, which is what we suspected or is it somehow the beginning of a trend.

是的。因此，從錄取方面開始，第一季對我們來說是一個錄取強勁的季度。我們知道上個季度有很多人對此感興趣。我們指出第四季的錄取率較低。我認為很多人好奇的是，這是一種正常的變化，這正是我們所懷疑的，或者說，這是一種趨勢的開始。

And the strength we saw in Q1 certainly supports the hypothesis we have that it was just normal variability. So admits was certainly -- it was in line with what we expected, but it was strong in Q1.

我們在第一季看到的強勁表現無疑支持了我們的假設，即這只是正常的波動。所以承認是肯定的 - 這與我們的預期一致，但在第一季表現強勁。

In terms of mortality in it was absolutely elevated. We think that was 100% as a result of the flu. So not much more to say about that. It's a little early to see what's happening to mortality post flu. As you know, there's a little bit of a lag between when a month ends and when we have good clarity on mortality. So I can't give you much on what happened post flu.

就死亡率而言，那裡的死亡率絕對升高了。我們認為這 100% 是流感造成的。關於這一點，沒什麼好說的。現在判斷流感過後死亡率的變化還為時過早。如您所知，一個月結束和我們對死亡率有清楚了解之間存在一些滯後。所以我無法告訴你太多關於流感後發生的事情。

Okay. Fair enough. And then looking at the revenue per treatment, there's sort of a bunch of pieces in there, and you said that the mix was flat. You actually -- you get positive tailwind obviously coming from the phosphate. Can you quantify what the phosphate was to RPT?

好的。很公平。然後看看每次治療的收入，裡面有很多部分，你說組合是平穩的。實際上——磷酸鹽顯然為你帶來了積極的推動力。你能量化磷酸鹽對 RPT 的影響嗎？

And then any other comments here in the first quarter RPT as it relates to managed care increases for this year? How should we think about co-pays and deductibles sort of comping out in the next couple of quarters?

那麼，對於今年第一季 RPT 與管理式醫療成長相關的問題，還有其他評論嗎？我們該如何看待未來幾季的共同支付和免賠額？

Yeah. I think you asked a lot of questions, but let me just sort of summarize it. We gave a range of roughly 4.5 to 5.5 RPT. I think just speaking in big sort of categories, half of that will be increases in the core business and half of it will be orals. And so I think that kind of bundles all your questions. Does that get to it?

是的。我認為您問了很多問題，但請容許我總結一下。我們給出的範圍大約是 4.5 到 5.5 RPT。我認為，僅從大的類別來看，其中一半將是核心業務的成長，一半將是口服業務的成長。所以我認為這涵蓋了你們所有的問題。這樣就解決了嗎？

Yes, that works. And the last one here is on IKC, a decent reduction in the patients from March versus December. Just wanted to follow up. I think last quarter, you talked about some competitors that they're being more aggressive on pricing. Just what are your views around the IKC patients under treatment sort of at this point and any changes in profitability of that versus your expectations? Thanks.

是的，有效。最後，關於 IKC，與 12 月相比，3 月的患者數量大幅減少。只是想跟進一下。我認為上個季度您談到了一些競爭對手，他們在定價方面採取了更激進的措施。您對目前接受治療的 IKC 患者有何看法？與您的預期相比，其獲利能力有何變化？謝謝。

Thank you. I think a couple of things. Number one, from a clinical perspective, it's unambiguously good for patients. Our doctors are also having to change the way they practice and making sure that they start to get involved in transition of care, hospitalization, and other things. So that takes a while, as we've told you for quite some time.

謝謝。我想到幾件事。首先，從臨床角度來看，它對患者來說無疑是有益的。我們的醫生也必須改變他們的行醫方式，並確保他們開始參與護理過渡、住院和其他事務。正如我們之前告訴過你們的，這需要一段時間。

The financials are playing out as expected, which is -- this is a business has a bit more volatility. So we've told you to look at on an annual basis. Unfortunately, there's been several unproven entrants that have gone in there and have made some amateur risk moves and have really contracted quite poorly and aggressively. And what I mean by that is, economically speaking, so we have been quite disciplined in understanding the impact that we can do to patient care, and we've been very disciplined in our financial modeling.

財務狀況正如預期的那樣，也就是說，這是一個波動性較大的行業。所以我們告訴你要按年度來查看。不幸的是，已經有幾家未經證實的進入者進入了該市場，並做出了一些業餘的冒險舉動，並且簽訂了相當糟糕和激進的合約。我的意思是，從經濟角度來說，我們在理解我們對患者護理的影響方面非常嚴謹，而且我們在財務建模方面也非常嚴謹。

So while we want to, of course, earn and win more business, we want to be able to be in a sustainable way. And so in addition, we've also severed some of these arrangements with some doctors that are not willing to change the way they practice because you have to really change the way you practice to be successful at this.

因此，雖然我們當然希望贏得更多業務，但我們希望能夠以可持續的方式實現這一目標。此外，我們也與一些不願意改變行醫方式的醫生斷絕了一些協議，因為你必須真正改變行醫方式才能取得成功。

Okay, great. I don't think it --

好的，太好了。我不認為--

Let me add one more thing to that, Pito. Some of the decline in lives that you'll see from Q4 to Q1 is also the result of our ability to better predict how many lives will be retroactively removed from attribution based on certain rules that CMS uses in the CKCC program, particularly with CKD live. So it's not an economic change. It's more of how we count the lives and doing a better job of predicting that upfront.

讓我再補充一點，Pito。從第四季度到第一季度，您會看到生命數量的下降，這也是因為我們能夠根據 CMS 在 CKCC 計劃中使用的某些規則更好地預測有多少生命將被追溯從歸因中刪除，特別是對於 CKD 生命。所以這不是經濟變化。這更多的是關於我們如何計算生命，以及如何更好地提前預測生命。

Okay. And then last quick one here on international that looked pretty strong. I guess any sort of good guys or bad guys, you should highlight to us on international as you model that for the rest of the year. Thank you, guys.

好的。然後，最後一個關於國際的快速案例看起來相當強勁。我想，無論是好人還是壞人，你都應該在國際上向我們強調，因為你將在接下來的一年裡樹立這樣的榜樣。謝謝你們。

Yeah. International had a strong quarter, a lot of good guys across a number of markets. We feel good about how the new acquisition is playing out. So we called out last quarter a $50 million jump year over year and we probably picked up another $10 million on top of that $50 million in Q1.

是的。國際市場本季表現強勁，多個市場都有許多優秀企業。我們對新收購的進展感到滿意。因此，我們宣布上個季度的營收將比去年同期成長 5,000 萬美元，而第一季的營收可能會在此基礎上再成長 1,000 萬美元。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Maybe just a couple of things. Just to follow up on that question about the Latin America. Any update on Brazil and maybe more broadly on the M&A pipeline, what you're seeing? Anything to comment on what you might see in the back half of the year?

也許只是幾件事。我只是想繼續回答有關拉丁美洲的問題。關於巴西以及更廣泛的併購管道有什麼最新消息嗎？您看到了什麼？您對今年下半年可能出現的情況有何評論？

Yeah, thanks, AJ. On the Brazil, we're pretty close, although they've given us some restrictions that we got to abide by, so we got to play that out and divest a couple of centers. It's always not a good idea to guess, but we're getting to the finish line here. So hopefully, that will be here shortly.

是的，謝謝，AJ。在巴西，我們已經非常接近了，儘管他們給了我們一些我們必須遵守的限制，所以我們必須發揮這一點並剝離幾個中心。猜測總是不是一個好主意，但我們即將到達終點。希望它很快就能實現。

As it relates to M&A, I think internationally continues to be an interesting place. And domestically, we're still pursuing onesie and twosies and then any practice that's willing to convert. So it's a dynamic place out there, but that's really how it summarizes.

就併購而言，我認為國際上仍然是一個有趣的地方。在國內，我們仍然推行連身衣和兩體衣政策，以及任何願意改變的做法。所以這是一個充滿活力的地方，但實際上這就是它的總結。

Okay. Just a follow-up on the IKC question. The $29 million loss, if I'm hear -- making sure I heard right, that's after moving some business that would have been a $4 million a quarter drag over into the core.

好的。這只是 IKC 問題的後續答案。如果我沒聽錯的話，2900 萬美元的損失是將一些每季造成 400 萬美元拖累的業務轉移到核心業務之後造成的。

I guess two questions on that. It's interesting that you make that move. What's sort of behind that? And second, you still feel like -- I know we've got volatility quarter to quarter, but you're on track for a breakeven by 27 in that business.

我想就此提出兩個問題。你做出這一舉動很有趣。這背後到底是什麼狀況？其次，你仍然感覺——我知道我們每季都會有波動，但你的業務預計在 27 年內實現收支平衡。

Yeah. So just to clarify one thing. We didn't move it to the core. We moved it to other strategic initiatives. But I think the most important thing is it has no bottom-line impact on the enterprise. It's just moving from one business to another.

是的。所以只是想澄清一件事。我們並沒有將其移至核心。我們將其轉移到其他戰略舉措。但我認為最重要的是它對企業沒有底線影響。這只是從一個業務轉移到另一個業務而已。

This was an IT product that when first implemented was expected to largely be used by the IKC business. But over time, it became clear that it had other utility within DaVita, including in the dialysis business. So ultimately, we decided to allocate that a little bit differently, but it has no major impact on the path to profitability. Obviously, it helps a little bit because you're just taking cost out. But within the broader context of IKC and it's scale and variability, we still feel good about the path we were on.

這是一個 IT 產品，首次實施時預計主要被 IKC 業務使用。但隨著時間的推移，很明顯地它在 DaVita 內部還有其他用途，包括透析業務。因此，我們最終決定以稍微不同的方式分配，但這對獲利之路沒有重大影響。顯然，這有一點幫助，因為你只是減少了成本。但在 IKC 的更廣泛背景及其規模和可變性下，我們仍然對我們所走的道路感到滿意。

Okay. Does that then -- if I could just follow up on that then. Is the $4 million run rate loss it's currently had as you move it into the this new area. Does that diminish over time then?

好的。那麼——如果我可以跟進的話。當您將其遷至這個新區域時，目前造成的營運損失是 400 萬美元嗎？那麼這種情況會隨著時間的推移而減少嗎？

No, I wouldn't expect it to go down over time.

不，我不希望它會隨著時間的推移而下降。

Okay. And then just maybe last point of clarification on your G&A. You're up about 3% cost per treatment. I know you called in the release some professional fee reductions as well as I think it pointed to a gain of some sort. Can you just elaborate a little bit more on were those meaningful in the quarter and what was going on there?

好的。這也許就是您對 G&A 的最後一點澄清。每次治療的費用約增加 3%。我知道您在新聞稿中提到了一些專業費用的降低，我認為這表明了某種收益。您能否詳細說明一下這些在本季是否有意義以及當時發生了什麼？

No, I don't think there was a lot there. I think a big change in the G&A per treatment was the result of volume coming down. So there's a big treatment drop between Q4 and Q1, mostly driven by a reduction in the number of days. That was probably I think the single biggest thing that drove the change in G&A per treatment.

不，我認為那裡沒有很多東西。我認為每次治療的 G&A 發生巨大變化是由於治療量下降造成的。因此，第四季和第一季之間的治療量大幅下降，主要是由於天數減少所致。我認為這可能是導致每次治療的 G&A 變化的最大因素。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

So you're keeping the full-year guidance the same, lowering just a little bit on the treatment volumes. I guess is a lot of that sort of the outperformance in the phosphate binder area or some of it from the stronger new set of admits that you called out?

因此，您將保持全年指導不變，僅稍微降低治療量。我猜想這很大程度上是由於磷酸鹽結合劑領域的優異表現，還是由於您所提到的更強勁的新產品？

Yeah. So if I had to break down how we're thinking about guidance, I would say there were two negatives for the quarter -- or for the year. One is the decline in volume, the 50 bps. We brought that down. And the second will be the cyber costs.

是的。因此，如果我必須詳細說明我們對指導的看法，我會說本季或今年有兩個負面因素。一是交易量的下降，50個基點。我們把它降低了。第二是網路成本。

So those are headwinds on the year, offset by two tailwinds. One is strength in Q1 and the second is the increase in the binders. The net impact of those two headwinds and two tailwinds would be no change.

所以，這些都是今年的逆風，但卻被兩股順風抵銷。一是Q1的強度，二是黏合劑的增加。這兩股逆風和兩股順風的淨影響不會改變。

Okay. And I might have missed the first part of AJ's question. But in the release, it's said there was a decrease in professional fees. And then there was a gain, I think, in G&A. Can you help us size the gain, again, I'm sorry, if AJ asked it and also maybe what drove the decrease in pro fees?

好的。我可能錯過了 AJ 問題的第一部分。但新聞稿中稱，專業費用下降。然後，我認為，G&A 方面有所成長。您能否幫我們估算一下收益，再次抱歉，如果 AJ 問到這個問題，也許是什麼導致了專業費用的下降？

Yeah. These are minimal items, single-digit millions. I wouldn't get too concerned about them.

是的。這些都是最小項目，價值個位數百萬。我不會太擔心他們。

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

謝謝。目前，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 all for your questions. If you have been following it, us, we have experienced three temporary externalities, including supply shortages due to a hurricane, a high flu season, and now a cyber incident. Regardless, we continue to achieve our clinical and financial objectives.

好的。謝謝你，米歇爾，也謝謝大家的提問。如果您一直在關注我們，我們經歷了三次暫時的外部因素，包括颶風造成的供應短缺、流感高發季節以及現在的網路事件。無論如何，我們都會繼續實現我們的臨床和財務目標。

We look forward to building momentum over the remaining of the year. We'll talk to you soon. Be well.

我們期待在今年剩餘時間內繼續增強勢頭。我們很快會和你聯絡。保重。

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。