德維特 (DVA) 2025 Q2 法說會逐字稿

Good evening. My name is Michelle, and I will be your conference facilitator today. At this time, I would like to welcome everyone to the DaVita second quarter 2025 earnings call.

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 年第二季財報電話會議。

(Operator Instructions) Thank you, Mr. Eliason, you may begin your conference.

（操作員指示）謝謝您，埃利亞森先生，您可以開始會議了。

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

謝謝，歡迎參加我們的第二季電話會議。感謝您對我們公司的持續關注。我是投資者關係集團副總裁 Nic Eliason。今天與我一起的還有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 (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 second quarter earnings press release and our SEC filings, including our most recent annual report on Form 10-K, all subsequent quarterly reports on Form 10-Q, and other subsequent filings that we may make with the SEC.

有關這些風險和不確定性的更多詳細信息，請參閱我們的第二季度收益新聞稿和我們向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可能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. Additionally, we'd like to remind you that during this call we will discuss some non-GAAP financial measures.

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。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。

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. I will now turn the call over to Javier Rodriguez.

這些非 GAAP 指標與最具可比性的 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。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. We are pleased to report another solid quarter where our focus on providing exceptional care for our patients and fostering a positive experience for our caregivers, continuing to drive results.

謝謝你，尼克，謝謝你今天參加電話會議。我們很高興地報告本季業績表現穩健，我們專注於為患者提供卓越的護理，為護理人員創造積極的體驗，繼續推動業績成長。

We delivered on our financial commitments, supported by strong clinical performance and disciplined execution across our businesses. Today, I will share the highlights of our second quarter results, offer insights on key policy development, discuss the evolving landscape of device innovation, and finish by sharing our outlook for the rest of the year.

在強大的臨床表現和各項業務的嚴格執行的支持下，我們履行了財務承諾。今天，我將分享我們第二季業績的亮點，提供對關鍵政策發展的見解，討論設備創新的不斷發展的前景，並最後分享我們對今年剩餘時間的展望。

But first, as always, let's begin with a clinical highlight. While I usually focus on a specific clinical achievement, today, I want to take a step back and reflect on the exciting opportunities ahead for DaVita in the kidney care community.

但首先，像往常一樣，讓我們從臨床重點開始。雖然我通常關注的是特定的臨床成就，但今天，我想退一步思考 DaVita 在腎臟護理領域未來令人興奮的機會。

To offer some historical perspective, in the two decades leading up to COVID-19 pandemic, the kidney care community made remarkable clinical strides. Advances in technology and pharmaceuticals, combined with the adoption of more standardized care led to improved outcomes and significant reductions in mortality rates.

從歷史角度來看，在 COVID-19 大流行之前的二十年裡，腎臟護理界取得了顯著的臨床進展。技術和藥品的進步，加上更標準化的護理的採用，帶來了治療效果的改善和死亡率的顯著降低。

Then came COVID, a disruption that impacted not only operations, but also the health acuity of our patients, yet from where we stand today, I am optimistic about what's ahead, and I believe we're entering a new wave of clinical innovation that holds exciting potential for the patients we serve.

隨後，新冠疫情爆發，這場疫情不僅影響了我們的運營，也影響了我們患者的健康狀況，但從我們今天的立場來看，我對未來充滿樂觀，我相信我們正在進入新一輪臨床創新浪潮，這將為我們服務的患者帶來令人興奮的潛力。

Breakthrough technologies from advanced IT systems to the transformative power of artificial intelligence are positioned to help us personalize care in unprecedented ways. Greater adoption of new drug classes like GLP-1s and SGLT2, along with the next-generation devices that improve the clearance of middle-sized molecules offer the potential to extend life and ease recovery from dialysis.

從先進的 IT 系統到人工智慧的變革力量等突破性技術旨在幫助我們以前所未有的方式實現個人化護理。更廣泛地採用 GLP-1 和 SGLT2 等新型藥物，以及改善中型分子清除的下一代設備，有可能延長壽命並簡化透析後的恢復。

Higher with these tools, the kidney care community is positioned to once again improve clinical outcomes. We have the opportunity to lower mortality enhance the quality of life of our patients and deliver better care. Of course, this evolution will take time and investment, but we're moving forward with conviction grounded in our vision of an unwavering pursuit of a healthier tomorrow.

有了這些工具，腎臟護理界就能再次改善臨床結果。我們有機會降低死亡率、提高患者的生活品質並提供更好的照護。當然，這種轉變需要時間和投資，但我們將滿懷信心地向前邁進，並堅定不移地追求更健康的明天。

Let me transition now to our second quarter performance. Adjusted operating income and adjusted earnings per share came in slightly ahead of our expectation. These results are indicative of two important themes that we highlighted last quarter and which continue to resonate strongly today.

現在讓我轉入我們第二季的業績。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。這些結果顯示了我們在上個季度強調的兩個重要主題，並且至今仍引起強烈共鳴。

The first theme is our ability to deliver on our commitment of 3% to 7% adjusted OI growth despite not yet achieving our volume growth objectives. This was evident during the second quarter where the strong performance in patient care costs more than offset cyber-related weakness in revenue per treatment and volume.

第一個主題是，儘管我們尚未實現銷售成長目標，但我們仍有能力兌現 3% 至 7% 調整後 OI 成長的承諾。這在第二季度表現得很明顯，患者護理成本的強勁表現足以抵消網路相關的每次治療收入和治療量方面的疲軟。

That said, improving volume remains a primary focus and we continue to believe we will return a 2% annual treatment growth over time.

儘管如此，提高數量仍然是我們關注的重點，我們仍然相信隨著時間的推移，我們將實現每年 2% 的治療成長率。

While the rebound takes shape, we're executing against other opportunities to achieve our long-term operating income and EPS targets. Our proven track record of managing costs across our operations, coupled with our significant investment in systems and IT in recent years give us the confidence that we can achieve cost savings that offset current volume weakness.

在反彈形成的同時，我們正在抓住其他機會，實現我們的長期營業收入和每股盈餘目標。我們在整個營運過程中擁有良好的成本管理記錄，加上近年來在系統和 IT 方面的大量投資，讓我們有信心實現成本節約，從而抵消當前銷售疲軟的局面。

The second theme I want to highlight is the resilience of our business to navigate environmental and unexpected challenges. We're now roughly three months out from an onset of the cyber incident we discussed last quarter.

我想強調的第二個主題是我們的企業應對環境和意外挑戰的韌性。現在距離我們上個季度討論的網路事件發生已經過去了大約三個月的時間。

So let me provide more detail on our recovery and associated financial impact. Operationally, we continue to provide uninterrupted patient care. The financial impact incurred can be split into two high-level categories. The first, the discrete costs associated with the incident such as outside consultants, technology costs, legal costs, et cetera. In the second quarter, those costs were approximately $13 million and are excluded from second quarter adjusted operating income as non-GAAP expenses.

因此，讓我更詳細地介紹一下我們的復甦及其相關的財務影響。在營運方面，我們繼續提供不間斷的患者護理。產生的財務影響可分為兩個高層次類別。第一，與事件相關的離散成本，例如外部顧問、技術成本、法律成本等。在第二季度，這些成本約為 1300 萬美元，作為非 GAAP 費用不計入第二季度調整後的營業收入。

The second, and more significant category, is the impact on treatment volume and revenue per treatment due to lower patient admissions, increased missed treatments, and lower expected yield on claims for treatment this quarter, among other things.

第二類也是更重要的類別是，由於本季度患者入院人數減少、錯過治療人數增加以及治療索賠預期收益降低等因素，對治療量和每次治療收入產生了影響。

Aside from the continued impact of the lower census from lost admit opportunities, we believe the impact of the cyber event is largely behind us, and there will be a limited ongoing effect to adjusted results. Joel will provide more color on these dynamics.

除了因失去錄取機會而導致入學人數減少的持續影響外，我們認為網路事件的影響基本上已經過去，對調整後結果的持續影響有限。喬爾將對這些動態提供更多說明。

I'll now transition to providing a few policy updates. Last quarter, we provided an update on various policy changes including tariffs, Medicaid cuts, and qualified health plans. Although Congress has passed further legislation in each of these topics remain fluid, our estimates of the impact of these items on DaVita remains unchanged from last quarter.

我現在將提供一些政策更新。上個季度，我們提供了各種政策變化的最新消息，包括關稅、醫療補助削減和合格的健康計劃。儘管國會已就上述每個主題通過了進一步的立法，但這些立法仍不確定，我們對這些項目對 DaVita 的影響的估計與上一季相比沒有變化。

Additionally, in late June, CMS published the 2026 ESRD proposed rule. The approximate 2% increase from dialysis rate was in line with our expectations, yet much like recent years continues to fall short of actual inflation experience by dialysis provider. As a reminder, the Medicare rate is subject to an incremental update in the final rule later this year.

此外，6 月底，CMS 發布了 2026 年 ESRD 擬議規則。透析率約 2% 的成長符合我們的預期，但與近年來一樣，仍未達到透析提供者的實際通膨經驗。提醒一下，醫療保險費率將在今年稍後的最終規則中進行增量更新。

One final topic before I move on to guidance. There's a lot of discussion and energy in the industry regarding new technology to the United States to improve clinical outcomes through better clearance of middle-sized molecules during dialysis.

在我繼續講解指導之前，還有最後一個主題。業界對美國引進新技術進行了大量討論，並投入了大量精力，希望透過在透析過程中更好地清除中等大小的分子來改善臨床結果。

High-volume hemodiafiltration, or HDF, is one example of this technology. We actively champion clinical innovation that can improve patient outcomes and quality of life, and these technologies offer promising potential. In terms of where we stand today, we are active with a number of work streams.

高容量血液透析濾過（HDF）就是這項技術的一個例子。我們積極倡導能夠改善患者預後和生活品質的臨床創新，這些技術具有廣泛的潛力。就我們目前的狀況而言，我們正在積極進行多項工作。

This includes monitoring existing and future clinical studies to assess the efficacy of various solutions including not only HDF machines, but advanced dialyzers, which may provide similar clinical outcomes.

這包括監測現有和未來的臨床研究，以評估各種解決方案的功效，不僅包括 HDF 機器，還包括可能提供類似臨床結果的先進透析器。

As more clinical evidence comes to light, we will listen to physicians' preferences. And finally, we're assessing the operational implications of each innovation with consideration of clinical outcomes and health economics. So there's a lot to be excited about, but still a lot to learn. We remain committed to staying at the forefront of clinical innovation and are energized by the opportunity to deliver even better care for the patients we serve.

隨著越來越多的臨床證據浮出水面，我們將聽取醫生的意願。最後，我們會根據臨床結果和健康經濟學來評估每項創新的營運影響。因此，有很多事情值得興奮，但仍有許多事情需要學習。我們始終致力於走在臨床創新的前沿，並為能為我們服務的患者提供更好的護理而感到振奮。

Looking ahead to the remainder of the year, we're reaffirming our guidance range for adjusted operating income of $2.01 billion to $2.16 billion and our adjusted earnings per share range of $10.20 to $11.30 despite the negative impact of the cyber incident.

展望今年剩餘時間，儘管受到網路事件的負面影響，我們仍重申調整後營業收入 20.1 億美元至 21.6 億美元的指導範圍，以及調整後每股收益 10.20 美元至 11.30 美元的指導範圍。

Furthermore, we continue to have confidence in our ability to deliver adjusted operating income and adjusted EPS growth consistent with our long-term guidance. I will now turn it over to Joel to discuss our financial performance and outlook in more detail.

此外，我們仍然對我們實現與我們的長期指導一致的調整後營業收入和調整後每股收益成長的能力充滿信心。現在我將把時間交給喬爾，讓他更詳細地討論我們的財務表現和前景。

Thank you, Javier. Second quarter adjusted operating income was $551 million. Adjusted earnings per share was $2.95 and free cash flow was $157 million. I'll provide detail on the individual components of our results beginning with US dialysis.

謝謝你，哈維爾。第二季調整後的營業收入為 5.51 億美元。調整後每股收益為 2.95 美元，自由現金流為 1.57 億美元。我將從美國透析開始詳細介紹我們研究結果的各個組成部分。

Starting with treatment volume. US treatments per day declined 1.1% versus the second quarter of 2024, which was approximately 50 basis points below our expectations for the quarter. The weakness was largely the result of a higher-than-expected missed treatment rate. We believe that the cyber outage was the primary driver but it's difficult to differentiate between impacts from cyber and other underlying trends.

從治療量開始。與 2024 年第二季相比，美國每日治療量下降了 1.1%，比我們對該季度的預期低約 50 個基點。疲軟主要是因為漏診率高於預期所致。我們認為網路中斷是主要驅動因素，但很難區分網路影響和其他潛在趨勢的影響。

In light of the higher-than-expected missed treatment rate in Q2 and we've increased our expectations for missed treatment rate for the remainder of the year, thereby lowering our expectations for full year treatment volume.

鑑於第二季的漏診率高於預期，我們提高了今年剩餘時間漏診率的預期，從而降低了對全年治療量的預期。

We now anticipate a year-over-year decline of 75 basis points to 100 basis points as compared to our previous guide of down 50 basis points. I will remind you that this forecast is for the absolute number of treatments and not treatments per day or non-acquired growth.

我們現在預計將年減 75 個基點至 100 個基點，而我們先前的預測是下降 50 個基點。我要提醒您，這個預測是針對絕對治療次數，而不是每天的治療次數或非後天生長。

Moving on to revenue per treatment. RPT increased approximately $4.50 versus the first quarter. This typical sequential step-up is due to higher patient responsibility for copays and deductibles in Q1. The overall increase was below our expectations, primarily related to the cyber incident in April. RPT for the quarter was also negatively impacted versus our expectations by lower dispensing volumes of binders.

接下來討論每次治療的收入。與第一季相比，RPT 增加了約 4.50 美元。這種典型的連續上升是由於第一季患者承擔的共付額和免賠額更高。整體增幅低於我們的預期，主要與 4 月份的網路事件有關。由於黏合劑分配量較低，本季的 RPT 也受到了與我們的預期相反的負面影響。

As a result of these two dynamics, we now expect full year RPT growth near the lower end of our original range of 4.5% to 5.5%.

鑑於上述兩種動態，我們現在預計全年 RPT 成長率將接近我們最初 4.5% 至 5.5% 範圍的低端。

Moving on to Patient Care Costs. PCCs per treatment declined by approximately $3.50 sequentially. This was primarily the result of three factors, first is higher treatment count compared to Q1; second is improved labor productivity in our centers; and third is binders.

繼續討論患者照護費用。每次治療的 PCC 比上一季下降了約 3.50 美元。這主要是由於三個因素造成的，首先是與 Q1 相比治療次數增加；其次是我們中心的勞動生產力提高；第三是黏合劑。

As I mentioned before, binder dispensing volume was below our expectations and down from Q1. We anticipate the outperformance in Patient Care Costs to continue for the rest of the year, resulting in a full year increase of 5% to 6% versus 2024, better than our original expectations.

正如我之前提到的，黏合劑分配量低於我們的預期，並且低於第一季。我們預計，病患照護成本的優異表現將在今年剩餘時間內持續下去，導致全年與 2024 年相比成長 5% 至 6%，優於我們最初的預期。

Focusing on binders for a moment. As I mentioned, both revenue and patient care costs associated with phosphate binders were lower in Q2 versus Q1 due to lower dispensing volumes. We expect no net impact from this and other small changes in our assumptions for the back half of the year. As a result, our full year adjusted OI expectation from the addition of binders to the bundle remains unchanged at approximately $50 million.

暫時集中討論一下活頁夾。正如我所提到的，由於配藥量較低，第二季與磷酸鹽結合劑相關的收入和病患照護成本均低於第一季。我們預計，這項變更以及我們假設中的其他微小變化不會對今年下半年產生淨影響。因此，我們對捆綁包中添加黏合劑後全年調整後的 OI 預期保持不變，約為 5000 萬美元。

International adjusted operating income increased $6 million versus the first quarter, primarily due to a one time benefit. We are excited that the fourth and final of the Latin American acquisitions related to clinics in Brazil closed last week.

國際調整後營業收入較第一季增加了 600 萬美元，主要原因是一次性收益。我們很高興，與巴西診所相關的第四筆也是最後一筆拉丁美洲收購案已於上週完成。

Integrated Kidney Care, or IKC, our value-based care business had adjusted operating income of $26 million in the second quarter. IKC benefited from approximately $40 million of revenue that we expected to recognize later this year. This reflects a timing benefit for the second quarter and has no impact on our full year expectations.

綜合腎臟照護（IKC）是我們基於價值的照護業務，其第二季的調整後營業收入為 2,600 萬美元。IKC 獲得了約 4000 萬美元的收入，我們預計今年稍後將實現這一目標。這反映了第二季的時間優勢，並且對我們的全年預期沒有影響。

Transitioning to capital structure. During the second quarter, we repurchased 3.1 million shares and we repurchased an additional 2.7 million shares since the end of the quarter. We finished the quarter with a leverage ratio of 3.34 times consolidated EBITDA, which is up from Q1, but still comfortably within our target range.

向資本結構轉變。在第二季度，我們回購了 310 萬股，自本季末以來我們又回購了 270 萬股。本季結束時，我們的槓桿率為合併 EBITDA 的 3.34 倍，高於第一季度，但仍在我們的目標範圍內。

In May, we raised $1 billion of senior unsecured debt. And in July, we repriced our Term Loan B reducing the spread by 25 basis points and raised an additional $250 million, which we used to pay down a portion of our Term Loan A. These transactions represent our continuous efforts to optimize our interest rates, maturities and liquidity, all within our existing capital allocation philosophy.

五月份，我們籌集了10億美元的無擔保優先債務。7 月份，我們重新定價了定期貸款 B，將利差降低了 25 個基點，並額外籌集了 2.5 億美元，用於償還部分定期貸款 A。這些交易體現了我們在現有資本配置概念下不斷優化利率、期限和流動性的努力。

Let me now turn to our expectations for full year 2025. As Javier noted, we are reiterating our full year adjusted operating income and adjusted earnings per share guidance ranges as reflected in our press release. We are confident that we can continue to deliver results consistent with our 2025 and long-term guidance while caring intensely for our patients and teammates and investing in our future. That concludes my prepared remarks for today. Operator, please open the call for Q&A.

現在，我來談談我們對 2025 年全年的期望。正如哈維爾指出的那樣，我們重申了新聞稿中反映的全年調整後營業收入和調整後每股收益指引範圍。我們有信心，我們能夠繼續取得與我們的 2025 年和長期指導一致的成果，同時密切關心我們的患者和隊友並投資於我們的未來。我今天的準備發言到此結束。接線員，請打開電話問答。

(Operator Instructions)

（操作員指示）

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

I appreciate all the color on guidance. Can you give us a sense for how census and treatments tracked following the cyber-attack and how you're thinking about volumes in the back half, because on the one hand, you signaled there wouldn't be an ongoing impact, but then you assumed, I think, elevated missed treatments persist for the back half of the year and revise the treatment growth outlook. So maybe just help us understand how you're thinking about that.

我感謝所有有關指導的顏色。您能否讓我們了解一下網路攻擊之後人口普查和治療情況如何，以及您如何看待下半年的數量，因為一方面，您表示不會產生持續影響，但另一方面，我認為您假設下半年錯過治療的情況會持續增加，並修改治療增長前景。所以也許可以幫助我們了解您對此的看法。

Thanks, Andrew. This is Javier. Before Joel gets into explaining that's very important because there's a lot of dynamics going on in treatment volume. I think, on the simple side, so we can start at 10,000 feet. The year is going as expected with the exception of two significant items, which is a severe flu season and the cyber incident.

謝謝，安德魯。這是哈維爾。在喬爾開始解釋之前，這一點非常重要，因為治療量中有很多動態變化。我認為，簡單來說，我們可以從 10,000 英尺開始。除了兩個重大事件，即嚴重的流感季節和網路事件外，今年的情況與預期一致。

And that, of course, puts all those dynamics that you highlighted in play. But sometimes it's just easier to start with a high level before you get into the detail. So now, Joel if you can bridge all those questions more.

當然，這會將您所強調的所有動態都發揮出來。但有時，在了解細節之前，先從高層次開始會比較容易。那麼現在，喬爾，你是否可以進一步解答這些問題？

So Andrew, let me try and unpack this for you. So during the call last quarter, we anticipated challenges on the admin side associated with the cyber-attack of a few hundred, 500, 600 admits. And that has played out largely as we expected.

那麼安德魯，讓我試著為你解開這個問題。因此，在上個季度的電話會議中，我們預期管理方面將面臨與數百、五百、六百次網路攻擊相關的挑戰。而這一切基本上都如我們所預期的。

We saw the challenges for a few weeks, but everything has normalized since then. What we did not anticipate was a spike in missed treatment rates, which is a number that tends to follow a regular seasonal pattern high in Q1, down in Q2 and Q3 and then back up in Q4.

我們經歷了幾週的挑戰，但從那時起一切都恢復正常了。我們沒有預料到的是漏診率會大幅上升，這一數字往往遵循一個規律的季節性模式，在第一季度達到高位，在第二季度和第三季度下降，然後在第四季度回升。

Q1 was higher than normal associated with the flu, and we expected it to come down along a typical curve in Q2 and that's not what we saw. It was elevated in April and actually even worse in May and then came back down in June, although not as far as we would normally expect. So we saw a big jump in missed treatment rates in Q2 year over year, which we attribute to the cyber incident.

第一季的流感病例數高於正常水平，我們預計第二季的流感病例數會沿著典型曲線下降，但事實並非如此。四月有所上升，實際上五月甚至更糟，然後六月又回落，儘管沒有我們通常預期的那麼多。因此，我們發現第二季的漏診率較去年同期大幅上升，我們將其歸咎於網路事件。

And as a result of that dynamic we decided to change our view on missed treatment rate for the back half of the year, where previously, we had thought it would come down a bit relative to 2024, given the challenges we've seen in the first half of the year due to both flu and cyber, we updated our assumptions and assume missed treatment rate is roughly flat relative to last year for the back half of the year.

由於這種動態，我們決定改變對下半年漏診率的看法，此前，我們曾認為該比率相對於 2024 年會有所下降，但考慮到上半年流感和網路攻擊帶來的挑戰，我們更新了假設，並假設下半年漏診率與去年基本持平。

So that's the math. I'll remind you, we're talking about 0.1% delta roughly. So we're really focusing in on numbers and the tighter you get, the harder it is to really call out the precision. But that's the dynamic. So if you think about the change in guide on volume growth from negative 50 bps to negative 75 to negative 100, it's pretty much all about a higher missed treatment rate, partially in Q2, partially in the back half of the year.

這就是數學。我提醒你一下，我們討論的是大約 0.1% 的增量。因此，我們真正關注的是數字，數字越嚴格，就越難真正確定精度。但這就是動態。因此，如果您考慮一下銷售成長指南從-50個基點到-75個基點再到-100的變化，那麼這幾乎都是由於更高的漏診率造成的，部分發生在第二季度，部分發生在下半年。

Great. And maybe just a few follow-ups on phosphate binders. First, can you give us the phosphate binder contribution to RPT and CPT in the quarter? And why was the dispensing volumes lower in the quarter? Is that due to the lower treatments or did the mix of patients on binders go down?

偉大的。也許只是對磷酸鹽結合劑進行一些後續研究。首先，您能否告訴我們本季磷酸鹽黏合劑對 RPT 和 CPT 的貢獻？為什麼本季的配藥量較低？這是因為治療次數減少還是使用黏合劑的患者數量減少？

Yeah. So on the volume side, it's about a reduction in the number of scripts. It's not a mix issue. What we believe is happening is adherence is not what we expected. Some patients are getting their binders through other means outside of DaVita, and some are just relying on over-the-counter solutions. So volume is lower than expected. In terms of contribution to RPT and CPT, the RPT number was somewhere in the low-8s and CPT was in the high-6s.

是的。因此從數量方面來說，就是腳本數量的減少。這不是一個混合問題。我們認為正在發生的情況是，依從性並不像我們預期的那樣。有些患者透過 DaVita 以外的其他方式取得黏合劑，而有些患者則僅依賴非處方解決方案。因此交易量低於預期。就對 RPT 和 CPT 的貢獻而言，RPT 數字在 8% 以下，而 CPT 在 6% 以上。

Andrew, one of the things that you might not be familiar with other people on the call is for these binders, the pill burden is pretty heavy. And so there's also some adherence issue around that because you have to take the pills with a meal, and I think that there's some leakage in that dynamic.

安德魯，您可能不熟悉電話中的其他人的一件事是，對於這些黏合劑來說，藥丸負擔相當重。因此也存在一些依從性問題，因為你必須隨餐服用藥片，我認為這種動態方式會有一些洩漏。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

I guess starting on operating income guidance, can you just bring us how you're maintaining the guidance from last quarter with treatment growth getting worse due to missed treatments and revenue per treatment at the lower end of the guidance. Can you sort of walk us through how you're sort of getting there? Is it from cost on core kidney, is it from better international or IKC just how you bridge to me sort of there's two negative moving parts on how we're maintaining operating income guidance.

我想從營業收入指引開始，您能否告訴我們，由於錯過治療導致治療增長變得更糟，且每次治療的收入處於指引的低端，您是如何維持上一季度的指引的？您能向我們介紹一下您是如何實現這一目標的嗎？它是來自核心腎臟的成本，還是來自更好的國際或 IKC，您如何向我解釋我們如何維持營業收入指引有兩個負面變動部分。

Yeah. Generally, it's two components. By far, the biggest one is cost per treatment. And that's largely a labor dynamic in US dialysis and the other is on international, which was roughly $10 million ahead of plan for the quarter, largely non-recurring. So I wouldn't annualize that in the back half of the year.

是的。一般來說，它有兩個組成部分。到目前為止，最大的問題是每次治療的費用。這主要是美國透析領域的勞動力動態，另一個是國際動態，該季度的支出比計劃提前了約 1000 萬美元，基本上是非經常性的。所以我不會在今年下半年將其年度化。

Okay. And then with the updated treatment growth of down 75 basis points, 100 basis points, the first half of the year was down 70. So to get to the midpoint of the range, we're now down 1% to 1.1% in the back half of the year. Can you just talk to us about incidence, mortality in transplants? And then on the missed treatment side, why would they be structural?

好的。然後隨著更新後的治療成長下降 75 個基點、100 個基點，今年上半年下降了 70。因此，為了達到該範圍的中間點，我們現在在下半年下降了 1% 至 1.1%。您能和我們談談移植的發生率和死亡率嗎？那麼在錯過治療方面，為什麼它們會是結構性的？

Because I get this -- I get the flu in the first quarter, and I get cyber security in the second quarter, but generally, these patients need treatments, otherwise they die. So how can missed treatments become a structural headwind?

因為我得到這個 - 我在第一季得了流感，在第二季度我得到了網路安全，但一般來說，這些病人需要治療，否則就會死亡。那麼錯過治療如何會成為結構性障礙呢？

Yeah. So let me start with the missed treatment rate. Missed treatment rate is a number that varies. It has been elevated since COVID roughly, it peaked at about 1% worse than the pre-COVID levels in 2022, and we had expected it to come down since then. And it did.

是的。那麼，讓我先從漏診率開始。漏診率是一個不同的數字。自新冠疫情爆發以來，該數字大致處於上升趨勢，在 2022 年達到峰值，比新冠疫情爆發前的水平低了約 1%，我們原本預計此後該數字會下降。事實確實如此。

It was down in '23 and '24. It's back up again this year. And I think your point is a very reasonable one. But again, we're talking about maybe 1/10, maybe of 1%, maybe of 15 bps. So I think we're comfortable with just keeping it flat relative to [2024] (corrected by company after the call). I wouldn't say it's a structural issue, but just our anticipation for the next couple of quarters, we brought it down a bit.

23年和24年則有所下降。今年又回升了。我認為你的觀點非常合理。但同樣，我們談論的可能是 1/10，可能是 1%，可能是 15 個基點。所以我認為我們只要保持相對穩定就可以了[2024]（本公司於通話後更正）。我不會說這是一個結構性問題，但只是我們對未來幾季的預期，我們將其降低了一點。

In terms of -- let me fill out some of the other dynamics, which is really about admits and mortality. So admits in Q2 was negatively impacted by cyber roughly in line with what we expected. Excluding that, it would have been a normal admit month showing year-over-year growth similar to what we've seen most quarters over the last few years.

就此而言——讓我補充一些其他動態，這些動態實際上是關於承認和死亡率的。因此，承認第二季受到網路負面影響的情況大致符合我們的預期。除此之外，這將是一個正常的入學月份，其同比增長與過去幾年大多數季度的增幅相似。

Mortality, again, mortality remains elevated, but consistent with what we saw in Q2 of last year. So the excess mortality we saw in Q1 from flu has come back down, but the overall mortality level remains higher than pre-COVID, but consistent with last year.

死亡率再次保持高位，但與去年第二季的情況一致。因此，我們在第一季看到的流感超額死亡率已經下降，但整體死亡率仍然高於新冠疫情之前，但與去年持平。

Pito, one of the things that's really important because sometimes, in the interest of being simple, people talk about the CKD population and GLP-1s and the impact upstream. We are not seeing it in the admits. And so it's really important what you asked because, it's this mortality and missed treatments dynamic that really needs to be rectified. As you mentioned, missed treatment are a little trickier. But mortality, we have a three-pronged plan to work on it.

Pito，其中一件非常重要的事情是因為有時為了簡單起見，人們會談論 CKD 人群和 GLP-1 以及上游的影響。我們在承認中沒有看到這一點。所以你的問題非常重要，因為這種死亡率和錯過治療的動態確實需要糾正。正如您所說，錯過治療有點棘手。但對於死亡率，我們有一個三管齊下的計畫來應對。

It will take some time to get there. But at the end of the day, you've heard it in the opening remark, we need better clearance of metal molecules is the first step. Number two, on pharma, we need more patients on GLP-1. There's barely any patients on them. And then number three is we're working on a whole bunch of protocols and IT to make sure that we can predict hospitalization and other things like that. But at the end of the day, we need to lower mortality.

到達那裡需要一些時間。但最終，正如您在開場白中聽到的那樣，我們需要更好地清除金屬分子是第一步。第二，在製藥方面，我們需要更多使用 GLP-1 的患者。那裡幾乎沒有病人。第三，我們正在製定一系列協議和 IT 技術，以確保我們能夠預測住院情況和其他類似情況。但最終，我們需要降低死亡率。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Just maybe ask about the comment on IKC, 40 million more in the Q2. And it sounds like you obviously believe that's a pull forward. I wonder, can you maybe give us a little more of what happened and why do you think that's a pull forward versus potentially a better trend in the underlying business that might carry over in the back half of the year?

也許只是詢問有關 IKC 的評論，第二季增加了 4000 萬。聽起來你顯然相信這是一種向前的推動。我想知道，您能否向我們詳細介紹一下發生的事情，以及為什麼您認為這是一個向前的拉動，而不是可能在下半年延續的基本業務更好的趨勢？

Yeah. So the reason we feel comfortable that it's a pull forward, it is all revenue associated with 2024 plan years. And the dynamic is as the data comes in and our actuarial and accounting teams gain confidence that we have actually earned shared savings then we will recognize revenue. And our expectation was that we would get that level of clarity in Q3 and Q4. But we were able to get some of the clarity earlier in the year.

是的。因此，我們之所以放心將其提前，是因為所有收入都與 2024 年計畫年度相關。隨著數據的湧入，我們的精算和會計團隊確信我們確實獲得了共享節省，然後我們就會確認收入。我們的預期是，我們將在第三季和第四季達到這種清晰度。但我們在今年早些時候就已經獲得了一些清晰的認識。

And as a result, we recognized the revenue early but we didn't recognize more revenue than we had expected during the year, which is why it's a timing thing rather than a net positive for the year.

因此，我們提前確認了收入，但全年確認的收入並未超過預期，這就是為什麼這是一個時間問題，而不是年度淨收益問題。

Okay. Maybe I'll also just ask, I think in the prepared remarks, you said the cyberattack also had an impact on revenue per treatment. I really wasn't -- maybe I'm missing something that's obvious, but it wasn't clear to me why that would occur. What's the dynamic there? Is that something that you think is going to impact the back half as well?

好的。也許我也會問一下，我想在準備好的評論中，您說網路攻擊也會對每次治療的收入產生影響。我真的不知道——也許我忽略了一些顯而易見的事情，但我並不清楚為什麼會發生這種情況。那裡的動態是怎麼樣的呢？您認為這也會對後半部產生影響嗎？

Yeah. So you heard it right, AJ. We do think the cyber incident had an impact on RPT. We don't think it will impact the second half of the year. There are really 2 components to this.

是的。所以你沒聽錯，AJ。我們確實認為網路事件對 RPT 產生了影響。我們認為這不會影響下半年。這實際上有兩個組成部分。

The larger one is impact on revenue for treatments done in Q2. So think about as we're working our way through the cyber incident, some processes have gone manual some things are other processes are either delayed or not being done. If I had to give you a couple of examples here, it would be something like prior authorizations or data gathering of certain elements that you'd want on a claim.

較大的一個是對第二季治療收入的影響。所以想想看，當我們處理網路事件時，有些流程已經變成手動的，而有些事情則被延遲或沒有完成。如果我必須在這裡給你舉幾個例子，那將是類似於事先授權或你在索賠中想要的某些要素的資料收集。

And as we're working either manually or in a delayed fashion, we expect some of the claims that would normally get approved will not get approved for Q2. So that's the bigger chunk.

由於我們採用手動或延遲方式工作，我們預計一些通常會獲得批准的索賠將不會在第二季度獲得批准。所以這是較大的一塊。

The smaller chunk relates to older claims that were in the queue that had been previously denied and we're now working to get them reapproved, either gathering information that wasn't on the claim or updating coverage that had changed.

較小的部分與隊列中先前被拒絕的舊索賠有關，我們現在正在努力重新批准它們，要么收集索賠中沒有的信息，要么更新已更改的保險範圍。

And just as time moves on, it gets harder and harder to collect on those claims and so we think the impact of the cyber incident on systems and other processes will lower our ultimate yield and basically increase bad debt on some of those older claims.

隨著時間的推移，收回這些索賠變得越來越困難，因此我們認為網路事件對系統和其他流程的影響將降低我們的最終收益，並基本上增加一些舊索賠的壞帳。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Appreciate it. Just a few numbers questions for me. Joel, I think you said last quarter, you expected revenue per treatment ex binders at about 3% for the year. Just curious if you got an updated assumption on that number.

非常感謝。只要問我幾個數字問題。喬爾，我想你上個季度說過，你預計今年每項治療（不包括黏合劑）的收入約為 3%。只是好奇您是否對這個數字有最新的假設。

Yeah. We would peg the number now at around 2.25% for the year. And the big difference really is the RPT impact of the cyber incident.

是的。我們現在將今年的成長率定為 2.25% 左右。而最大的差異其實在於網路事件對 RPT 的影響。

Even though that was you're saying you think is contained to the quarter. How much was that of an impact to the revenue per treatment in the quarter? Do you have a number there?

即使您說的是，您認為這只限於本季度。這對本季每次治療的收入有多大影響？你有電話號碼嗎？

I'd call it 40 million to 50 million.

我認為是 4000 萬到 5000 萬。

Great. Then you talked about the missed treatments in the first half of the year. And then I think you talked about the second half as being flat year over year, where before you had expected it to be down. Is that right?

偉大的。然後您談到了上半年錯過的治療。然後我認為您談到下半年同比持平，而之前您預計它會下降。是嗎？

That's right.

這是正確的。

And what was the growth year-over-year in missed treatments in the first half? Trying to get a comparison.

上半年錯過治療的人數年增了多少？嘗試進行比較。

It was a little worse in Q1 than in Q2, but it averaged about 50 bps for the first half of the year.

第一季的情況比第二季略差，但上半年平均約為 50 個基點。

Okay, got it. Then last one for me is just you're giving a treatment growth number of down 75 bps to 100 bps, and that's total treatment growth, what do you think that --

好的，明白了。那麼對我來說最後一個問題是，你給出的治療增長數字是下降 75 個基點到 100 個基點，這就是總治療增長，你認為--

US treatment.

美國治療。

Right. That's total US treatment growth right? But I think most people, including myself, focus on same-store non-acquired. What do you think that equates to there?

正確的。這就是美國治療總量的成長嗎？但我認為大多數人，包括我自己，都關注同店非收購。您認為這相當於什麼？

I would say the same store non-acquired number would be roughly down 50 bps.

我想說的是，同一家商店的非收購數量將大約下降 50 個基點。

Okay. So on a non-acquired basis, you're expecting things to get a little bit better than the second quarter look more like the first quarter and that's because you think the second quarter cyber-attack kind of filters through and is done. Why do you expect it to get better than the first half?

好的。因此，從非收購的角度來看，您預計情況會比第二季度好一點，更像第一季度，這是因為您認為第二季度的網路攻擊已經滲透並結束了。為什麼您預計它會比上半年更好？

Yes. I don't think NAG is a great number for modeling. So I'm a little reluctant to answer your question. Remember, year-over-year growth also depends on the shape of the census trend from the prior year, so you can't just rely on quarter-over-quarter numbers. But I would say volume growth in the back half of the year, you'd expect it to be worse in Q3 and then better in Q4.

是的。我認為 NAG 對於建模來說不是一個好數字。所以我有點不願意回答你的問題。請記住，年成長也取決於前一年人口普查趨勢的形狀，因此您不能只依賴季度環比數據。但我想說，今年下半年的銷售成長預計在第三季會更差，然後在第四季會更好。

(Operator Instructions)

（操作員指示）

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

I wanted to ask another question about the volumes, I guess, in particular, the increased mortality. I appreciate the comments about some of the things that you guys are planning to do to address it, but it's still not clear to me why we have a higher mortality issue to begin with because I guess higher mortality implies something that is above where it was pre-COVID.

我想問另一個關於數量的問題，我想，特別是關於死亡率的增加。我很感謝你們對解決這個問題計劃採取的一些措施的評論，但我仍然不清楚為什麼我們的死亡率會更高，因為我猜更高的死亡率意味著死亡率高於新冠疫情之前的水平。

So the issue that you signaled out kind of sound like newer options to potentially address the issue rather than something went backwards, and we're going to get it back to where it was. It's more that it's elevated and now you have new tools to potentially bring it down.

因此，您所指出的問題聽起來像是可以解決問題的新選擇，而不是倒退，我們會將其恢復到原來的狀態。更確切地說，它被提升了，現在你有了新的工具來潛在地將其降低。

So I'm just trying to figure out why mortality in your view is persistently elevated versus where it was historically?

所以我只是想弄清楚為什麼您認為死亡率與歷史水準相比持續上升？

Yeah. Thanks for the question, Kevin. Actually, the actuarial teams are asking that across the country because not just elevated in kidney, but it's elevated in all disease states. The hypothesis is that COVID had an impact, number one, on just the delay of care. And secondly, that comorbid conditions, and in particular, more acutely sick people are dying faster.

是的。謝謝你的提問，凱文。實際上，精算團隊正在全國各地詢問這個問題，因為不僅是腎臟疾病會導致血壓升高，而且所有疾病狀態下血壓都會升高。假設是，COVID 首先對護理的延遲產生了影響。其次，患有合併症，尤其是病情較重的人死亡速度較快。

And so those are the two, but they're hypothesis, there's no real study that can prove that to now. I don't know, Joel, if you've seen anything else you want to add.

這兩個都是假設，目前還沒有真正的研究可以證明這一點。喬爾，我不知道你是否還看到了其他想要補充的內容。

Well, first, welcome back, Kevin. Look, Javier said it right. This is, we believe, a holdover from COVID, and you see it nationally, the mortality rate for all-cause mortality in the US is up roughly similar to what DaVita sees our mortality is up. So it's a national issue. It's not a kidney issue.

嗯，首先，歡迎回來，凱文。瞧，哈維爾說得對。我們認為，這是 COVID 的遺留影響，從全國範圍來看，美國全因死亡率的上升與 DaVita 看到的我們的死亡率的上升大致相同。所以這是一個國家問題。這不是腎臟問題。

I think the point we were trying to emphasize here is we're not passively waiting for the environment to improve, although obviously, that would help, but there are things that we and the rest of the industry can do to improve mortality. And this is not a new dynamic. This is really the underpinning of volume growth for the better part of 20 years pre-COVID was mortality improvements in the dialysis community as a result of things that dialysis providers were able to accomplish.

我認為我們在這裡試圖強調的一點是，我們不會被動地等待環境改善，儘管這顯然會有所幫助，但我們和業內其他公司可以採取一些措施來降低死亡率。這並不是什麼新鮮事。這實際上是新冠疫情爆發前 20 年大部分時間透析量增長的基礎，這是透析領域死亡率的改善，這是透析服務提供者能夠完成的事情的結果。

And then that's helpful. I guess as we think about the three things that you outlined as a way to try to mitigate this, I mean, how should we think about the timing of these and when they might expect to impact results?

這很有幫助。我想，當我們思考您概述的三種緩解這種情況的方法時，我的意思是，我們應該如何考慮這些方法的時機以及它們何時可能會對結果產生影響？

Yes. The timing will be gradual. If you look at the better clearance of middle molecules, HDF or the cutoff dialyzer, that will take some time to play out. If you look at pharma and GLP-1s, again, here we are x years into it, and the numbers are in the low teens of patients on the drug. So it's also low.

是的。時間將會逐步推進。如果您觀察中分子、HDF 或截止透析器的更好清除，那將需要一些時間才能發揮作用。如果你再看一下製藥業和 GLP-1，你會發現，我們已經進入第 x 年了，服用該藥物的患者數量只有十幾歲。所以它也很低。

And then on the protocols and systems, again, they're gradual and they're incremental, but it's a cumulative portfolio of things that over time has an impact, but you should think about it in years and not just a couple of quarters.

然後，就協議和系統而言，它們是漸進的、增量的，但它是一個累積的組合，隨著時間的推移會產生影響，但你應該以年為單位來考慮它，而不僅僅是幾個季度。

Okay. And then just maybe the last question, it sounds like the story for the quarter is you obviously had some headwinds from volume headwinds from pricing, but you were able to offset it on the cost side of things. Are these cost initiatives, things that you can still pull even when volumes come back? I mean it's been impressive to see the cost control the last few years.

好的。然後也許只是最後一個問題，聽起來本季的情況是，你們顯然遇到了來自定價方面銷售阻力的一些阻力，但你們能夠在成本方面抵消它。這些成本措施是否是即使銷售回升後您仍可以採取的措施？我的意思是，過去幾年的成本控制令人印象深刻。

Does that mean when volumes do start to come back that you should be growing even faster than the 3% to 7% OI? Or like it seems that you can maintain this cost control, then there's a lot of opportunity once volumes normalize?

這是否意味著，當交易量開始回升時，你們的成長速度應該比 3% 到 7% 的 OI 還要快？或者看起來您可以保持這種成本控制，那麼一旦產量恢復正常，就會有很多機會？

Well, we take a lot of pride in our operational excellence and discipline and we're always looking for variables that can move the needle. So the short answer is, of course, who knows because it depends on what volume pickups, et cetera. But our hope and our strategy right now is that we will continue this efficiency. And of course, as technology advances, we think we can make it happen.

嗯，我們對我們的卓越營運和紀律感到非常自豪，我們一直在尋找可以推動事情發展的變數。因此，簡短的回答當然是，誰知道呢，因為這取決於音量拾取器等等。但我們現在的希望和策略是繼續保持這種效率。當然，隨著技術的進步，我們認為我們可以實現這一目標。

But there's no inherent roadblock to controlling costs if volumes are growing something like an obvious.

但如果產量明顯成長，那麼控製成本就沒有內在的障礙。

No.

不。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

Maybe just to Kevin's question a little bit more, I guess, on the patient care costs, any specifics on what's sort of driving that performance? And I guess, I think it sounds like you're expecting this to continue through the rest of the year. If that's true, is there really any reason why we shouldn't expect this to carry into next year?

我想，也許我只是想再多回答一下凱文提出的問題，關於病人照護費用，有什麼具體因素推動了這種表現嗎？我想，這聽起來像是您期望這種情況會持續到今年剩餘時間。如果這是真的，我們有什麼理由不期待這種情況會持續到明年？

The main driver, as Joel said, is productivity. And if you were going to double click because as you know, productivity has a lot of variables in there, you would say that our teammates are staying longer. So our retention is a bit better. And our training costs have come down a bit as we are more effective at putting people in their jobs effectively quicker.

正如喬爾所說，主要驅動力是生產力。如果你要雙擊，因為你知道，生產力有很多變量，你會說我們的隊友會停留更久。所以我們的保留率會好一點。由於我們能夠更有效地讓人們更快投入工作，我們的訓練成本也下降了一點。

Got it. And then just lastly, I guess, on the cyber incident, does this have any sort of impact on longer-term spending sort of expectations in terms of hardware, software, anything you might need to invest in, just to mitigate the chances that it's happening again?

知道了。最後，我想，關於網路事件，這是否會對硬體、軟體或任何可能需要投資的長期支出預期產生任何影響，以減輕再次發生此類事件的可能性？

It's a marginal cost. Look, at the end of the day, these cyber criminals are quite sophisticated and they keep reinventing themselves. And so the corporations and the industry has to continue to innovate ourselves. So we've made some investments that we believe to be appropriate and prudent, but I don't think I would call out anything material.

這是邊際成本。看看吧，說到底，這些網路犯罪者相當老練，而且他們不斷重塑自己。因此，企業和產業必須不斷自我創新。因此，我們進行了一些我們認為適當且謹慎的投資，但我認為我不會宣布任何實質的投資。

Would you like to go to the next question?

您想進入下一個問題嗎？

Yes, please. Ryan, are you done?

是的，請。瑞安，你做完了嗎？

Yeah, I'm good. Thank you.

是的，我很好。謝謝。

Lisa Clive, Bernstein.

麗莎·克萊夫，伯恩斯坦。

Just a question on the new technologies available in the market, and this focus on removing larger molecules. Baxter's Theranova dialyzer has been in the market in the US for several years. And obviously, FMC is ramping up their HDF rollout for next year. For Theranova, and I guess also for HDF because you run clinics in Europe too.

我只是想問市場上有哪些新技術，其重點是去除較大的分子。百特的 Theranova 透析器已在美國上市數年。顯然，FMC 正在加緊明年推出 HDF。對 Theranova 來說，我想對 HDF 來說也是如此，因為你們也在歐洲經營診所。

How much have you used these technologies in your clinics thus far? And I suppose how are you going to go about really collecting the clinical data running sort of effectively, I assume clinical trials? And how long do you think it will really take to get an idea of how much of an impact these new technologies can make?

到目前為止，您在診所中使用這些技術的情況如何？我想，您打算如何真正有效地收集臨床試驗的臨床數據？您認為需要多長時間才能真正了解這些新技術能產生多大的影響？

Yeah. So let me unpack it and see if I get to all your questions. Number one, we are experienced on both the HDF and the middle molecule dialyzers. We are using different brands, so I won't get into what brand of dialyzer we are using. Different countries have different beliefs.

是的。因此，讓我來解開它，看看是否能解答您的所有問題。首先，我們在 HDF 和中分子透析器方面都有經驗。我們使用的是不同的品牌，所以我不會談論我們使用的透析器的品牌。不同國家有不同的信仰。

And so in countries where HDF is there, sometimes you have almost the entire country there, and sometimes you have literally only 20%. So it's got dynamics of clinical practices. It's got dynamics of reimbursement and other things. So as you know, the CONVINCE study had some very encouraging results on mortality. And now there is a study in Spain called the MOTHER study, and that is literally putting both technologies head-to-head.

因此，在有 HDF 的國家，有時幾乎整個國家都在那裡，有時只有 20%。因此它具有臨床實踐的動態。它具有償還機制和其他功能。如您所知，CONVINCE 研究在死亡率方面取得了一些非常令人鼓舞的結果。現在西班牙有一項名為「MOTHER」的研究，這項研究其實是對兩種技術的對比研究。

At the end of the day, what we want is what's best for the patients and what our physicians and patients want. But of course, we're watching the science because it's a lot easier to change a dialyzer than it is to change your fleet of machines and prescriptions and all the other things.

歸根究底，我們想要的是對病人最有利的，也是我們的醫生和病人想要的。但當然，我們正在關注科學，因為更換透析器比更換機器、處方和所有其他東西要容易得多。

But at the end of the day, if that's what the doctors want or that's where the science points us, of course, we will do it. So we are watching like you are, and we're conducting a couple of studies ourselves, and we will be moving as appropriate.

但最終，如果這是醫生想要的，或者這是科學指引我們去做的事情，我們當然會這麼做。因此，我們和你們一樣在關注，我們自己也在進行一些研究，並將採取適當的行動。

Great. And just a follow-up on the phosphate binders. There's a lot of generics in the market and then there's, I guess, two newer alternatives. Are the pill loads on that better? Because I know 1 of them should be going generic soon. Or do you see this as more of an adherence problem rather than a cost problem?

偉大的。這只是對磷酸鹽結合劑的後續研究。市面上有很多仿製藥，但我想，有兩種較新的替代品。吃藥量這樣會比較好嗎？因為我知道其中 1 個很快就會變得通用。或者您認為這更多的是一個依從性問題而不是成本問題？

I would say probably more adherence, the mix that we saw hasn't changed much between Q1 and Q2. That said, look, we're only about six months into this. So we're still learning. That said, I think from an OI standpoint, we feel pretty good about where we are for the year and the number of moving pieces are going down every quarter. So the $50 million of OI feels like a pretty reasonable estimate for the rest of the year.

我想說的可能是更多的堅持，我們看到的組合在第一季和第二季之間並沒有太大變化。話雖如此，但看看，我們才剛開始大約六個月。所以我們仍在學習。話雖如此，我認為從 OI 的角度來看，我們對今年的狀況感到相當滿意，而且每個季度移動件的數量都在下降。因此，對於今年剩餘時間而言，5000 萬美元的 OI 似乎是一個相當合理的估計。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Just free cash flow, I think it's tracking about $112 million for the first half of the year, but guidance is reiterated at $1 billion, $1.25 billion. I guess, can you bridge us to get back to that level of free cash flow in the back half of the year?

僅自由現金流，我認為今年上半年的自由現金流約為 1.12 億美元，但指導價重申為 10 億美元、12.5 億美元。我想，您能幫助我們在下半年恢復到那種自由現金流水準嗎？

Yeah. Free cash flow is generally lighter in the first half of the year, and the cyber incident slowed us down a lot in Q2. So catching up on cyber will be the biggest component. I think cash taxes is probably the other thing I'd point to in the back half of the year that will be significantly better than the first half.

是的。上半年的自由現金流整體較少，而第二季的網路事件又大大拖慢了我們的發展速度。因此，追趕網路將是最重要的組成部分。我認為現金稅可能是我要指出的另一件在下半年會比上半年好得多的事情。

Okay. Great. And then on IKC, this big reversal of operating income in 2Q, patients began growing again. I guess what are you seeing there? And what do you see in the back half of the year from IKC just because you guys unloaded a bunch of patients in the first quarter? Or just kind of what should we expect for IKC in the back half of the year?

好的。偉大的。然後，對於 IKC 來說，第二季的營業收入出現大幅逆轉，患者數量又開始成長。我猜你在那裡看到了什麼？由於你們在第一季接診了一批病人，你認為 IKC 今年下半年的前景如何？或者說，我們對今年下半年的 IKC 有何期待？

Look, IKC was roughly breakeven for the first half of the year. We haven't changed our guide for the year of, call it, negative $20 million-ish. So that's what you should expect negative 20 over the back half of the year. Typically, Q4 should be a better quarter than Q3, although the phasing of OI and IKC is very variable and tough to predict as you can see based on what happened in Q2.

你看，IKC 今年上半年基本上實現了收支平衡。我們沒有改變今年的指導方針，可以說是負 2000 萬美元左右。因此，預計下半年的收入將為負 20。通常情況下，第四季應該比第三季表現更好，儘管根據第二季發生的情況可以看出，OI 和 IKC 的階段變化很大且難以預測。

Okay. Then a few quickies here. What is your MA penetration at this point? Are you still getting positive pricing pressure or pricing tailwinds from growth in MA?

好的。然後這裡有幾個快速動作。此時您的 MA 滲透率是多少？您是否仍從 MA 的成長中獲得積極的價格壓力或價格順風？

There is really not much to call out any more on MA. We're roughly moving with the market. There's really very little of note there.

關於 MA 確實已經沒有什麼好說的了。我們大致與市場同步發展。那裡確實沒有什麼值得注意的地方。

Okay. And then on fixed subsidies expiring for 2026, can those patients get enrolled via the American Kidney Fund before the drop into government reimbursement?

好的。那麼，在 2026 年固定補貼到期時，這些患者是否可以在政府報銷之前透過美國腎臟基金會登記？

Certainly, a possibility, yes.

當然，有可能，是的。

Okay. And then second last one here. What was the commercial mix this quarter? Any changes to home dialysis?

好的。這是倒數第二個。本季的商業組合是怎麼樣的？居家透析有什麼變化嗎？

Immaterial, minor, minor variability on both, so nothing to call out.

兩者的變化都是無關緊要的、微小的、微小的，所以沒什麼好說的。

Okay. And then my last one here, I promise here. That Berkshire sale came out today, was that just part of the normal they get to that 45% range. And that's what it is.

好的。這是我最後的一個，我在這裡保證。今天伯克希爾的銷售額有所下降，這只是他們正常情況下達到 45% 範圍的一部分。事實就是這樣。

That's exactly right, Philip. It was in a normal course. It was pursuant to the standstill agreement that we have with them.

完全正確，菲利普。這是正常的。這是根據我們與他們達成的暫停協議。

At this time, we are showing no further questions. I'll turn the call back over to you.

目前，我們沒有其他問題。我會把電話轉回給你。

Okay. Thank you, Michelle, and thank you all for your time this afternoon. As we highlighted today, we're first and foremost committed to providing exceptional care for our patients as we achieve our clinical objectives, our financial performance will follow. Thank you all for joining the call and be well.

好的。謝謝你，米歇爾，也謝謝大家今天下午抽出時間。正如我們今天所強調的那樣，我們首先致力於為我們的患者提供卓越的護理，當我們實現臨床目標時，我們的財務表現也會隨之提高。感謝大家參加電話會議並祝大家一切安好。

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。