德維特 (DVA) 2025 Q3 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 third-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。在此，我謹代表 DaVita 公司歡迎各位參加 2025 年第三季財報電話會議。（操作說明）

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

謝謝。伊萊亞森先生，您可以開始您的會議了。

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

謝謝，歡迎參加我們的第三季電話會議。感謝您一直以來對我們公司的關注。我是尼克‧伊萊亞森，集團投資人關係副總裁。今天和我一起出席的還有我們的執行長哈維爾·羅德里格斯和我們的財務長喬爾·阿克曼。

Please note that during this call, we may make forward-looking statements within the meaning of the Federal Securities Laws. All of these statements are subject to known and unknown risks and uncertainties that could cause the actual results to differ materially from those described in the forward-looking statements.

請注意，在本次電話會議中，我們可能會做出符合聯邦證券法規定的前瞻性聲明。所有這些陳述都受到已知和未知風險及不確定性的影響，這些風險和不確定性可能導致實際結果與前瞻性陳述中所述的結果有重大差異。

For further details concerning these risks and uncertainties, please refer to our third-quarter earnings press release and our SEC filings, including our most recent annual report on Form 10-K, all subsequent quarterly reports on Form 10-Q and other subsequent filings that we make with the SEC.

有關這些風險和不確定性的更多詳情，請參閱我們的第三季收益新聞稿和我們向美國證券交易委員會提交的文件，包括我們最新的 10-K 表格年度報告、所有後續的 10-Q 表格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，除法律可能要求的情況外，我們不打算也不承擔更新這些聲明的義務。

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

此外，我們想提醒您，在本次電話會議中，我們將討論一些非GAAP財務指標。這些非GAAP指標與最可比較的GAAP財務指標的調節表已包含在我們提交給美國證券交易委員會的盈利新聞稿中，該新聞稿可在我們的網站上查閱。

I will now turn the call over to Javier Rodriguez.

現在我將把通話交給哈維爾·羅德里格斯。

Thank you, Nic. Good afternoon, everyone, and thank you for joining the call today. We are accustomed to operating in a dynamic health care environment and today is no different. The government shutdown is on its 29 day and key health care policy decisions remain in flux. And while these developments have real implications, we remain focused on what matters most, providing excellent care. This focus is not only in the best interest of our patients but continues to generate consistent financial results.

謝謝你，尼克。各位下午好，感謝各位今天參加電話會議。我們早已習慣在瞬息萬變的醫療保健環境中工作，今天也不例外。政府停擺已進入第29天，關鍵的醫療保健政策決定仍處於不確定狀態。儘管這些事態發展具有實際意義，但我們仍然專注於最重要的事情，那就是提供優質的醫療服務。這種做法不僅符合我們病患的最大利益，還能持續產生穩定的財務效益。

Our third quarter performance was in line with our expectations and keeps us on track to achieve our full year guidance. These results also enable continued investment to improve the lives of our patients and enhance the experience of our teammates and physicians. Today, I will share the highlights of our third quarter performance, update our guidance for the full year and walk through a few swing factors for 2026. But first, as always, we will begin with our clinical highlights.

我們第三季的業績符合預期，並使我們有望實現全年業績目標。這些成果也使我們能夠繼續投資，以改善患者的生活，並提升我們團隊成員和醫生的體驗。今天，我將分享我們第三季業績的亮點，更新我們對全年的預期，並探討2026年的一些影響因素。但首先，像往常一樣，我們將從臨床亮點開始。

Today, I will feature our research team, known as DaVita Clinical Research, or DCR, powered by a dedicated team of medical directors and data scientists, in fact by one of the largest patient data sources in the country, DCR has been instrumental in advancing kidney care research.

今天，我將重點介紹我們的研究團隊，即 DaVita 臨床研究部（簡稱 DCR）。 DCR 由一支敬業的醫療總監和數據科學家團隊提供支持，事實上，DCR 擁有全國最大的患者數據源之一，在推進腎臟護理研究方面發揮了重要作用。

A few metrics that puts this team's contributions in perspective. DCR maintains more than 250 research sites in the United States and has conducted more than 500 clinical trials. This team of researchers has helped achieve FDA approval for dozens of ESKD drugs and DCR research and data has fueled more than 700 clinical publications.

以下幾個指標可以幫助我們更全面地了解這支團隊的貢獻。DCR在美國擁有超過250個研究基地，並已進行了500多項臨床試驗。該研究團隊已幫助數十種 ESKD 藥物獲得 FDA 批准，DCR 研究和數據已推動 700 多篇臨床出版物發表。

With a drive toward innovation and patient safety, DCR has helped to develop new therapies, improve outcomes and generate benefit to patients and physicians across the kidney care community. This long-standing commitment underscores our position as a leader in clinical research.

秉持著創新和保障病人安全的理念，DCR 幫助開發了新的療法，改善了治療效果，並為整個腎臟護理界的患者和醫生帶來了益處。這項長期承諾凸顯了我們在臨床研究領域的領導地位。

Most recently, DCR is evaluating outcomes of middle molecule clearance using middle cutoff dialyzers, which will provide critical US specific data and has the potential to represent a significant step in advancing patient outcomes. This is just the latest example of how DaVita is advancing the development of new therapies and actively shaping the future of kidney care.

最近，DCR 正在使用中等截留率透析器評估中分子清除率的結果，這將提供關鍵的美國特定數據，並有可能代表在改善患者預後方面邁出的重要一步。這只是 DaVita 如何推進新療法的研發並積極塑造腎臟護理未來的最新例證。

Transitioning now to our financial performance. We delivered the third quarter adjusted operating income of $517 million and adjusted earnings per share of $2.51. These results were consistent with our internal expectations. Joel will provide detail on the quarter, but at the highest level, we continue to manage patient care costs effectively while the US treatment volume was down approximately 1.5% year-over-year.

接下來進入財務業績部分。我們第三季調整後營業收入為5.17億美元，調整後每股盈餘為2.51美元。這些業績符合我們的內部預期。Joel 將詳細介紹本季度的情況，但從總體上看，我們繼續有效地控制患者護理成本，而美國治療量同比下降了約 1.5%。

Before I cover full year guidance, let me provide a bit of detail on one of the ongoing strategic priorities, investing in technology infrastructure. As a reminder, last year, we completed the rollout of our next-generation clinical platform. We continue to enhance that system and are making other long-term investments to replace our scheduling system and further upgrade our revenue operations technology.

在介紹全年業績指引之前，讓我先詳細介紹我們正在進行的一項策略重點，即投資技術基礎設施。再次提醒大家，去年我們完成了下一代臨床平台的推出。我們將繼續改進該系統，並進行其他長期投資，以更換我們的排班系統並進一步升級我們的收入營運技術。

Simultaneously, we're adopting AI solutions across our platform. This includes internally developed use cases, opportunities with commercially viable applications and working with external providers. While these projects result in higher G&A growth, we believe that these investments are critical to advancing clinical care, improving the experience of our patients and teammates and driving long-term cost efficiencies.

同時，我們正在整個平台上採用人工智慧解決方案。這包括內部開發的用例、具有商業可行性的應用機會以及與外部供應商的合作。雖然這些項目會導致一般及行政費用成長增加，但我們相信這些投資對於推進臨床護理、改善患者和團隊成員的體驗以及推動長期成本效益至關重要。

Let me now transition to our full year outlook. We're reaffirming the midpoint of our guidance ranges for adjusted operating income and adjusted earnings per share, while narrowing each range. We now anticipate full year adjusted operating income between $2.035 billion and $2.135 billion and adjusted earnings per share of $10.35 to $11.15.

現在讓我來談談我們全年的展望。我們重申了調整後營業收入和調整後每股盈餘預期範圍的中點，同時縮小了每個範圍。我們現在預計全年調整後營業收入將在 20.35 億美元至 21.35 億美元之間，調整後每股收益將介於 10.35 美元至 11.15 美元之間。

I recognize that many of you are already looking ahead to 2026. While it's too early to provide formal guidance, let me walk through several key variables that will influence our perspective on next year. First is volume. We faced several headwinds in 2025 that we don't expect to recur, including Hurricane Helene, the severe flu season and the cyber incident. Beyond those discrete events, and as I talked about last quarter, we will continue our efforts to drive clinical progress to improve mortality and support treatment growth.

我知道你們中的許多人已經在展望2026年了。雖然現在提供正式指導還為時過早，但讓我來介紹幾個將影響我們對明年看法的重要變數。首先是音量。2025 年我們面臨一些預計不會再次發生的逆境，包括颶風海倫、嚴重的流感季和網路安全事件。除了這些零星事件之外，正如我上個季度所談到的，我們將繼續努力推動臨床進展，以改善死亡率並支持治療發展。

Second is payer mix, where there's active policy debate right now. We're among the many who are closely monitoring the impact of enhanced premium tax credits on commercial mix. We'll also be assessing the ongoing recalibration of Medicare Advantage landscape, as evolving market dynamics from government policy and payer behavior affect Medicare Advantage enrollment and insurance mix.

其次是支付方構成，目前這方面有積極的政策辯論。我們是眾多密切關注提高保費稅收抵免對商業組合影響的機構之一。我們還將評估 Medicare Advantage 格局的持續調整，因為政府政策和支付方行為等不斷變化的市場動態會影響 Medicare Advantage 的參保人數和保險組合。

Third is Integrated Kidney Care or IKC. We're awaiting the release of final 2024 performance year results from the government CKCC program. The timing of the release and the recognition of the associated operating income could shift between 2025 versus 2026. We feel good about our progress in 2025 and it's an important reminder that timing of operating income remains difficult to predict.

第三種是綜合腎臟護理（IKC）。我們正在等待政府 CKCC 計畫公佈 2024 年最終績效年度結果。發佈時間和相關營業收入的確認時間可能會在 2025 年和 2026 年之間發生變化。我們對 2025 年的進展感到滿意，這也提醒我們，營業收入的時機仍然難以預測。

In short, there remains a range of potential outcomes for 2026 and and we expect to learn more about each of these factors over the coming months. And as customary, we'll provide formal guidance during our fourth quarter earnings call in February.

總之，2026 年仍存在一系列可能的結果，我們預計在接下來的幾個月會對這些因素有更多了解。按照慣例，我們將在2月份的第四季財報電話會議上提供正式的業績指引。

To wrap up my comments, we remain on track to achieve our full year goals. Meanwhile, our long-term investment in IT and clinical innovation, strengthen our ability to deliver superior patient care and create sustainable value. As we look to 2026, we're monitoring a number of variables that will shape the coming year, and we remain confident in our ability to navigate them effectively.

最後我想說，我們仍有望實現全年目標。同時，我們對資訊科技和臨床創新的長期投資，增強了我們提供卓越患者護理和創造永續價值的能力。展望 2026 年，我們正在密切關注影響來年發展的許多因素，並且我們仍然有信心有效應對這些因素。

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

現在我將把發言權交給喬爾，讓他更詳細地討論一下我們的財務表現。

Thank you, Javier. Third quarter adjusted operating income was $517 million, adjusted earnings per share was $2.51 and free cash flow was $604 million. I'll provide detail on the individual components of our results, beginning with US dialysis.

謝謝你，哈維爾。第三季調整後營業收入為 5.17 億美元，調整後每股收益為 2.51 美元，自由現金流為 6.04 億美元。我將詳細介紹我們研究結果的各個組成部分，首先從美國透析開始。

First, on treatment volume. US treatments per day declined 1.5% versus the third quarter of 2024, in line with our expectations. The decline is primarily the result of two factors. First, the mix of days as this quarter was slightly skewed towards Tuesdays, Thursdays and Saturdays as compared to Q3 last year; second was the negative impact of the census trends from higher mortality from a severe flu season and lost admissions opportunities as the result of Hurricane Helene and the cyber incident.

首先，關於治療量。與 2024 年第三季相比，美國每日治療量下降了 1.5%，符合我們的預期。這一下滑主要是兩個因素造成的。首先，本季就診日期的組成與去年第三季相比略微偏向週二、週四和週六；其次，由於嚴重的流感季導致死亡率上升，以及颶風海倫和網路事件造成的入院機會損失，人口普查趨勢受到了負面影響。

Next, revenue per treatment increased approximately $6 versus the second quarter. This was primarily driven by rate increases, higher revenue from phosphate binders and the negative impact of the cyber incident on Q2 RPT. These improvements were offset by a slight decline in payer mix and normal variability. We continue to expect full year RPT growth will be at the low end of our original 4.5% to 5.5% guidance. Achieving this will require some acceleration of RPT in Q4, which we expect from vaccines, normal rate increases and higher than typical impact from the resolution of aged claim balances.

其次，每次治療的收入比第二季增加了約 6 美元。這主要是由於費率上漲、磷酸鹽黏合劑收入增加以及網路事件對第二季零售利潤的負面影響。這些改善被支付方組合的輕微下降和正常的波動所抵消。我們仍然預計全年零售利潤成長率將處於我們最初預測的 4.5% 至 5.5% 的低端。要實現這一目標，需要在第四季度加快 RPT 的實施，我們預計疫苗的普及、正常的費率上漲以及解決長期索賠餘額帶來的高於往常的影響將推動 RPT 的實施。

Now moving to patient care costs. PCCs per treatment increased by approximately $5 sequentially. The majority of the change was the result of typical increases in wages and higher pharmaceutical expense due to higher dispensing volumes of phosphate binders relative to the second quarter. Excluding the impact of phosphate binders, patient care costs continue to outperform our expectations from the beginning of the year. We continue to expect full year PCCs per treatment to increase between 5% and 6% versus 2024.

接下來談談患者照護成本。每次治療的PCC費用依序增加約5美元。與第二季相比，第二季磷酸鹽結合劑的配藥量增加，導致薪資普遍上漲，藥品費用也隨之增加，這是上述變化的主要原因。剔除磷酸鹽結合劑的影響，病患照護成本自年初以來持續超出我們的預期。我們繼續預計，與 2024 年相比，全年每次治療的 PCC 將增加 5% 至 6%。

International adjusted operating income was $27 million. This was down $9 million versus the second quarter, primarily due to the one-time benefit that we called out last quarter.

國際調整後營業收入為2700萬美元。與第二季相比，減少了 900 萬美元，主要是由於我們上個季度提到的一次性收益。

In IKC, our value-based care business, our Q3 adjusted operating loss was $21 million. As I have mentioned in the past, the quarterly phasing of IKC is hard to forecast. That said, we feel good about achieving flat or better IKC adjusted operating results in 2025 as compared to last year consistent with our guidance from the beginning of the year.

在我們的價值醫療業務 IKC 中，第三季調整後的營業虧損為 2,100 萬美元。正如我之前提到的，IKC 的季度分階段實施很難預測。儘管如此，我們仍然有信心在 2025 年實現與去年持平或更好的 IKC 調整後經營業績，這與我們年初的預期一致。

In aggregate, third quarter operating results were in line with our expectations. At the midpoint of our tightened adjusted operating income range, the implied guidance for the fourth quarter represents an approximately $60 million sequential increase. We expect this fourth quarter improvement to be primarily driven by higher treatment volume due to better treatment day mix, sequentially higher revenue per treatment and timing of IKC revenue, offset by typical seasonal increases in patient care costs and G&A.

整體而言，第三季經營業績符合我們的預期。根據我們收緊的調整後營業收入範圍的中點，第四季的隱含預期比上一季成長約 6,000 萬美元。我們預計第四季度的改善主要得益於治療量增加（治療日組合改善）、每次治療收入環比增長以及 IKC 收入的時機，但會被患者護理成本和一般及行政費用的典型季節性增長所抵消。

Switching to capital allocation. During the third quarter, we repurchased 3.3 million shares, and we have repurchased an additional 400,000 shares since the end of the quarter. Year-to-date, through today's earnings call, we have repurchased approximately 10 million shares representing approximately $1.5 billion.

轉而進行資本配置。第三季度，我們回購了 330 萬股股票，自該季度末以來，我們又回購了 40 萬股股票。截至今天財報電話會議召開之時，今年以來我們已回購約 1,000 萬股股票，價值約 15 億美元。

As a reminder, the 400,000 shares we repurchased in October were pursuant to our publicly filed repurchase agreement with Berkshire Hathaway. According to that agreement, just prior to each DaVita earnings call, we buy from Berkshire the number of shares necessary to return its ownership to 45%. This transaction is contractual and formulaic.

再次提醒大家，我們在 10 月回購的 40 萬股股票是根據我們與波克夏·哈撒韋公司公開提交的回購協議進行的。根據該協議，在每次 DaVita 財報電話會議之前，我們會從伯克希爾哈撒韋公司購買必要的股份，使其持股比例恢復到 45%。這是一項具有合約效力且按既定程序進行的交易。

We finished the quarter with leverage at 3.37 times consolidated EBITDA within our target leverage ratio of 3 times to 3.5 times. As we look to the remainder of 2025, as Javier mentioned, we are reaffirming our guidance for full year adjusted operating income with a midpoint of $2.085 billion and adjusted earnings per share with a midpoint of $10.75 while narrowing the band of each range. We look forward to sharing full year results and providing 2026 guidance when we speak again in February.

本季末，我們的槓桿率為合併 EBITDA 的 3.37 倍，符合我們 3 倍至 3.5 倍的目標槓桿率。展望 2025 年剩餘時間，正如 Javier 所提到的，我們重申全年調整後營業收入的預期中位數為 20.85 億美元，調整後每股收益的預期中位數為 10.75 美元，同時縮小了這兩個區間的範圍。我們期待在二月再次與大家分享全年業績，並提供 2026 年的業績指引。

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

我的發言稿今天就到這裡。操作員，請開啟問答環節。

(Operator Instructions)

（操作說明）

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great, thanks. I guess a couple of things came out from your prepared remarks. I guess the first thing, you talked about the volume number for next year. I guess I understand the one-time items that you highlighted this year.

太好了，謝謝。我想你事先準備好的發言稿裡提到了幾點。我想首先，你談到了明年的銷售數字。我大概明白你今年重點提到的那些一次性專案了。

How do you think volumes would have played out this year? Ex. those three -- I guess it was four items that you or three items that you mentioned, the hurricane, the cyber, and flu. What would that number look like this year?

你認為今年的成交量會如何改變？例如，那三件事——我猜你提到的是四件事或三件事，颶風、網路攻擊和流感。今年這個數字會是多少？

Yeah, Kevin, I'll take that. I think the number is probably about a 75 basis points to 100 basis points headwind on '25 volume from those three things combined, and that's a combination of census and missed treatment rate.

好的，凱文，我接受。我認為這三件事加起來可能會對 2025 年的銷量造成 75 到 100 個基點的不利影響，這是人口普查和漏診率的綜合影響。

Okay. And the other thing that jumped out on our volumes was that you were, you mentioned working to improve mortality. Is there anything that you can provide color on there? I assume that's not something that necessarily shows up in a given quarter, but maybe there's optimism that can improve next year or is that a slow steady improvement over time?

好的。我們從您的來信中也注意到，您提到您致力於改善死亡率。你能為它增添一些色彩嗎？我認為這不一定會在某個季度顯現出來，但或許人們樂觀地認為明年情況會有所改善，或者這是一個隨著時間推移緩慢而穩定的改善過程？

Yeah, Kevin, as you called it out, it's a study over time. We are looking at all our clinical protocols, looking at time on therapy, fluid, other protocols, GLP-1s and other medications to try and see what the best way to go after this because we really have to lower our mortality. Of course, over time, we will talk about the mid molecule clearance and but back to your point, that will take time.

是的，凱文，正如你所說，這是一項需要時間的研究。我們正在研究所有臨床方案，包括治療時間、輸液、其他方案、GLP-1 和其他藥物，以找出最佳的後續治療方案，因為我們真的必須降低死亡率。當然，隨著時間的推移，我們會討論分子中部的清除問題，但回到你的觀點，這需要時間。

Yeah, okay. And then last question for me, on the MA enrollment point about that being -- it sounds like it sounds like it's a bigger swing factor than I might have thought it would have been for 2026. I understand that it is in flux. Are you -- when you say swing factor, are you talking about just shifts in membership between payers that that could have a meaningful impact as in your rate with different payers are significant enough to move the needle or are you worried about declines in MA enrollment, broadly speaking back into traditional Medicare or Medicare plus supplemental.

好的。最後一個問題，關於碩士入學人數這一點——聽起來它對 2026 年的影響比我預想的要大。我知道情況瞬息萬變。您所說的「搖擺因素」是指會員在不同支付方之間的轉移，這種轉移可能會產生重大影響，例如您在不同支付方的費率是否顯著到足以改變局面；還是您擔心醫療保險優勢計劃 (MA) 的參保人數下降，從而重新回到傳統的醫療保險或醫療保險加補充保險？

At the end of the day, you highlighted two variables which is mix, and within that mix there's a different revenue within each payer. We're agnostic on that because we don't know which way it's going to go.

歸根結底，你強調了兩個變量，即組合，而在這個組合中，每個付款人的收入都不同。我們對此持中立態度，因為我們不知道事情會如何發展。

On the other hand, you do have different enrollment and you're seeing a lot of payers talk about their volatility in their enrollment, so we're just highlighting. That we don't have any particular insight, but rather it feels like the marketplace is more dynamic at this juncture.

另一方面，參保人數確實有所不同，而且很多支付方都在談論參保人數的波動性，所以我們只是重點強調這一點。我們並沒有什麼特別的見解，但感覺目前市場更加活躍。

Okay, but is it -- but that is a potentially big enough swing factor that you felt necessary to call out. I didn't -- is it, I guess in my mind, I don't think about it as being that big of a variable, but it is?

好吧，但是——但是這是一個可能足夠大的搖擺因素，以至於你覺得有必要指出來。我沒有——我想，在我看來，我並不認為這是一個很大的變量，但實際上它確實是一個很大的變量？

Well, significance obviously is in the eye of the beholder, but at the end of the day there's enough dynamics and enough membership in there that you could see a scenario where it could swing in one direction or another. We wanted to call it out. I mean, if you were going to talk about revenue per treatment next year, you have that dynamic, and then of course you have open enrollment, which has the dynamic of the tax premium credits that's being discussed right now with the federal government and so those two are just a little more in the air as we speak than in normal years.

當然，重要性顯然因人而異，但歸根結底，其中存在著足夠的動態因素和足夠的成員，因此你可以看到這種情況可能會朝一個方向或另一個方向發展。我們想把這件事指出來。我的意思是，如果你要談論明年每次治療的收入，你就會面臨這種動態變化；當然，還有開放註冊期，這其中涉及到目前正在與聯邦政府討論的稅收保費抵免政策，所以這兩個問題目前比往年更加不確定。

That's fair. Thank you.

這很合理。謝謝。

Kevin. I think I agree with Javier. We're trying to highlight where there might be variability. That said, I think it is safe to say that commercial mix is a more significant financial swing factor than MA mix.

凱文。我同意哈維爾的觀點。我們試圖指出可能存在差異的地方。也就是說，我認為可以肯定地說，商業組合比市場進入組合對財務波動的影響更大。

Okay, perfect. Thanks.

好的，完美。謝謝。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

Hi, good afternoon. I appreciate all the color on 2026. Maybe just back on the volume side, you called out the 75 basis points to 100 basis points of discrete items that are not going to recur next year. So I guess, is it fair to think of that as a reasonable starting point as we contemplate potential growth for next year?

您好，下午好。我喜歡2026年呈現的所有色彩。或許只是回到數量方面，你提到了 75 到 100 個基點的離散項目，這些項目明年不會再次出現。所以我想，在考慮明年的潛在成長時，將此視為一個合理的起點是否公平？

And Javier, I think you noted investments in technology, infrastructure, scheduling systems. Are any of those items expected to have a meaningful impact on treatment growth, or is there anything else that you can do in your control to influence the volume environment? Thanks.

哈維爾，我想你提到了對技術、基礎設施和調度系統的投資。這些因素中是否有任何一項預計會對治療成長產生實質影響？或者，您還有其他可控制因素可以影響治療量環境？謝謝。

Yeah, Andrew, I'll take the first one. So if you were to translate that 75 bps to 100 bps from '24 to '25, I think '26 over '25, again, if you're comparing year over year growth rates, you're probably looking at a 50 basis points to 75 basis points structural improvement in '26 growth relative to '25 growth. And that comes largely from the flu and the cyber incident. The hurricane is kind of annualizing out and is offset the kind of -- the benefits of that is offset by the fact that there's a small headwind in '26 over '25 from day mix.

好的，安德魯，我要第一個。所以，如果將 2024 年到 2025 年的 75 個基點換算成 100 個基點，我認為 2026 年相對於 2025 年，同樣地，如果你比較的是同比增速，那麼 2026 年的增長相對於 2025 年的結構增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 75 個點的結構性增長，可能會有 750 到 基點的結構性。這主要是由流感和網路安全事件引起的。颶風正在逐漸消失，這種好處被抵消了——2026 年比 2025 年多出的一點逆風（來自日間混合氣流）所抵消。

Just as a reminder, '25 over '24 had a 20 basis points day mix headwind, and then '26 over '25 has an additional 10 basis points headwind, '27 will be a tailwind.

提醒一下，2025 年比 2024 年有 20 個基點的日間混合逆風，2026 年比 2025 年又有 10 個基點的逆風，2027 年將是順風。

And when you do all that math and you net it all out --

當你把所有這些計算都算出來，然後把所有結果都匯總起來…--

When you do all that math and you net it out, if you start with 2025 where we've guided to 75 basis points to 100 basis points decline in volume, and I would say from where I'm sitting now that probably looks like it's going to be closer to 100 basis points, missed treatment rate is really the culprit around that. So let me use negative 100 basis points as the math for 2025 growth, you would say -- structurally you would adjust that to say before all the other dynamics, so I'm not giving guidance here. I'm just trying to bridge how to think about the starting point for building '26. You'd improve that negative 100 basis points in '25 by 50 basis points to 75 basis points, so you'd start with kind of an adjusted growth in '25 of negative 25 basis points to negative 50 basis points off of which to build a '26 number.

當你把所有這些計算都匯總起來，如果你從 2025 年開始，我們預測銷量將下降 75 到 100 個基點，而就我目前的情況來看，這可能更接近 100 個基點，漏診率才是造成這種情況的真正原因。假設 2025 年的成長率為負 100 個基點，你會說——從結構上講，你會將其調整為在所有其他動態因素之前，所以我在這裡不提供指導。我只是想探討如何思考建構「26」的起點。2025 年的負 100 個基點可以提高 50 個基點，達到 75 個基點，因此 2025 年的調整後成長率將為負 25 個基點至負 50 個基點，以此為基礎來建構 2026 年的數字。

Got it. And you want to comment on --

知道了。你想對以下內容發表評論？--

And for your second question, we are investing in a lot of things. You asked specifically, will it impact volume? The short answer is, we don't know specifically of volume, but if you were to expand that question to the P&L, I would say that we are optimistic and we're working hard. Some of the models that we're working on could impact volume.

至於你的第二個問題，我們正在投資很多方面。你特別問到，這是否會影響銷售？簡而言之，我們目前還不清楚具體的銷售量，但如果將問題擴展到損益表方面，我會說我們持樂觀態度，並且正在努力工作。我們正在研究的一些模型可能會對銷售產生影響。

For example, we are working on something that would risk stratify hospitalization, and if we can make an intervention that changes hospitalization that would of course impact volume. On the other side, we're doing models to affect the cost structure. Things like administrative things in the call centers and revenue operations that can do authorizations in a much more rapid way and more reliable way that would likely get you a higher collection. So there are a couple of examples of the things that I highlighted in the opening.

例如，我們正在研究如何對住院治療進行風險分層，如果我們能夠採取乾預措施來改變住院治療，那當然會對住院人數產生影響。另一方面，我們正在建立模型來影響成本結構。例如呼叫中心和收入營運中的行政事務，可以以更快、更可靠的方式進行授權，這可能會提高收款率。以上就是我在開頭提到的幾個例子。

Great. And on the premium tax credits, I think the last estimate of the headwind you gave was $120 million over three years. Is that still a good number to think about? And can you comment on your growth in the exchanges and how that's played out throughout the year? Thanks.

偉大的。至於保費稅收抵免，我認為您上次估計的不利因素是三年內 1.2 億美元。這個數字現在還值得考慮嗎？您能否談談您在交易所的成長情況，以及這一年中您的成長情況如何？謝謝。

Sure, I think that number is still a good number. The reality is, as you know, you have to think about what happens with these extended premium tax credits. And the way that we have it thought out is that, if they go away we would lose that $120 million roughly over a three-year period, but it's not evenly spread out. We would have something our estimates are somewhere like $40 million in year one. $70 million in year two and $10 million in year three. And the reason why it's a little lumpy is because our models divide the population and so we assume that our existing patients -- because they are, in high need of insurance and understand the need for coverage would be more likely to retain that coverage and also in many cases it is the most affordable option.

當然，我認為這個數字仍然不錯。事實上，正如你所知，你必須考慮這些延長的保費稅收抵免政策會帶來什麼後果。我們考慮的方式是，如果他們離開，我們將在三年內損失約 1.2 億美元，但這筆損失不會平均分配。我們預計第一年收入約 4,000 萬美元，第二年約 7,000 萬美元，第三年約 1,000 萬美元。之所以結果有點不均勻，是因為我們的模型將人群進行了劃分，所以我們假設我們現有的患者——因為他們非常需要保險，並且了解保險的必要性——更有可能保留保險，而且在很多情況下，保險也是最經濟實惠的選擇。

That math changes when you grab the second group, which is those patients that yet don't know that their kidneys are going to fail, so they're CKD patients, and they might let their insurance lapse and in that case when their kidneys fail, they would become Medicare patients. And of course there's a spectrum in there because some of these people in CKD4 are already pretty ill and so they might opt out for an exchange.

當你把第二組人也算進去時，情況就不同了。第二組人是那些還不知道自己腎臟即將衰竭的患者，他們是慢性腎病患者，他們可能會讓自己的保險失效，在這種情況下，當他們的腎臟衰竭時，他們就會成為聯邦醫療保險的患者。當然，這裡面也存在一個範圍，因為有些 CKD4 患者病情已經相當嚴重，所以他們可能會選擇不進行腎臟置換。

So when you do all that math and as you can see, it's full of assumptions, you get into that sort of lumpy '26, '27, and '28. And then of course we're watching with Congress because there's a lot of conversations going on, conversations about some kind of off-ramp, meaning that they change the enhanced tax credits over time. There's also talk about lowering the poverty level to different levels, and then of course there's conversations about doing nothing. And so all these assumptions will change depending on what happens.

所以當你進行所有這些計算，並且正如你所看到的，其中充滿了假設，你就會得到那種不規則的「26」、「27」和「28」。當然，我們也在關注國會的動向，因為目前有很多討論正在進行，討論的內容是關於某種“退出機制”，也就是說，他們會隨著時間的推移改變增強型稅收抵免政策。還有人討論將貧窮線降低到不同水平，當然也有人討論什麼都不做。因此，所有這些假設都會隨著事態的發展而改變。

And Andrew, just on your question on private pay mix, mix is down about 15 basis points in the quarter, which I would call normal variability, and year over year it's flat.

安德魯，關於你提出的私人付費比例問題，本季該比例下降了約 15 個基點，我認為這屬於正常波動，與去年同期相比則持平。

Great. Thanks for the color.

偉大的。謝謝你提供的色彩。

(Operator Instructions)

（操作說明）

AJ Rice, UBS.

AJ Rice，瑞銀集團。

Thanks. Hi everybody. Maybe there's an obvious answer to this, but the headline number looks like your operating income for the quarter was about $50 million below the consensus. I know you're saying it was in line with your expectation and you've not changed the midpoint, for the year to where you think. Is it just a matter of people were mismodeling given the day counts you're referencing for the third and fourth quarter relative to what you were internally thinking or what is going on there if you have any view?

謝謝。大家好。或許這個問題有顯而易見的答案，但從目前的數據來看，貴公司本季的營業收入比市場普遍預期低了約 5,000 萬美元。我知道你認為這符合你的預期，而且你也沒有改變你認為的年度中點。是因為你引用的第三季和第四季的天數統計與你內部的預期不符，所以才導致了模型錯誤？或者說，你有什麼看法？

Yeah, so we don't give quarterly guidance and we appreciate this can lead to a little bit of a mismatch with the Street. Let me -- I think the best way to explain it is how we're thinking about it, which is, if you look at Q4 over Q3 to hit the midpoint of our guide, we need about a $60 million uplift in OI and the way we think we get there, and these are numbers are all approximate, first, there's the typical headwind from seasonal costs, and we see that both in patient care costs and G&A. I'll call that out as roughly a $30 million headwind.

是的，所以我們不提供季度業績指引，我們也意識到這可能會導致與華爾街的預期略有偏差。讓我來解釋一下——我認為最好的解釋方式是，我們是這樣看待這個問題的，也就是說，如果你看看第四季度與第三季度相比，要達到我們指導方針的中點，我們需要營業收入增加約 6000 萬美元。我們認為實現這一目標的方式是（這些數字都是近似值），首先，會面臨季節性成本帶來的典型不利因素，我們在患者護理成本和一般及行政費用中都看到了這一點。我估計這會造成約 3000 萬美元的不利影響。

That's offset by three things. First is volume, which is really about a day mix issue. Q3 had a 60 basis point headwind on day mix year over year. Q4 has a 60 basis point tailwind on day mix, and that's worth about $15 million.

但有三件事可以抵消這種影響。首先是音量，這實際上是一天的歌曲組合問題。第三季日供組合年減 60 個基點。第四季日間交易組合有 60 個基點的利多因素，這相當於約 1500 萬美元。

Second is IKC, which is -- call it plus $25 million from Q3 to Q4 to hit the IKC guide we gave at the beginning of the year. And the last would be revenue per treatment of -- call it a $50 million pickup. There's some seasonality in that from vaccines and normal rate increases. There's also, I'd say, more than typical variability from resolution of older claims with payers. These happen virtually every quarter. They're hard to predict both in terms of size and timing. They -- I'd say more often than not are weighted towards Q4, although not every year. And for Q4 25, we just expect these to be more favorable than usual.

其次是 IKC，也就是——假設從第三季到第四季增加了 2500 萬美元，以達到我們年初給出的 IKC 指導目標。最後一點是每次治療的收入——姑且稱之為 5000 萬美元的收入。這其中存在一些季節性因素，例如疫苗接種和正常的利率上漲。此外，我認為，與付款方協商解決舊索賠的差異也比通常情況要大。這種情況幾乎每季都會發生。它們的規模和時間都很難預測。我覺得它們通常都集中在第四季度，雖然並非每年都是如此。對於 2025 年第四季度，我們預計這些情況會比平常更有利。

Okay, well, that's helpful to explain it I think. On the cyberattack and you're taking this charge for the Mozarc relationship. Do they have impact on the adjusted earnings -- maybe cyberattack, what was the earnings and volume impact in the quarter that you estimate specifically to that event?

好的，我覺得這樣解釋很有幫助。關於網路攻擊，你承擔了與莫札克關係相關的責任。這些事件是否會對調整後的收益產生影響？例如網路攻擊，您估計該事件對當季收益和銷售量產生了怎樣的影響？

And then the Mozarc charge, it looks like there's some you were expecting it to be a drag somewhat for next year or two, and now you're taking the charge. Does that eliminate the drag and is that meaningful in operating earnings?

然後是莫扎克衝鋒，看起來你原本預計它在未來一兩年內會有些拖累，但現在你卻要發動衝鋒了。這樣能否消除拖累？這對營業利潤有意義嗎？

Yeah, so let me take these one at a time. So first on Mozarc, the answer is the charge will largely eliminate the Mozarc drag on the P&L next year. It doesn't hit the operating income line, it hits the other income line. So it's not in our adjusted operating income, but it is in our pre-tax, and that's been a significant drag both last year and this year, and it'll get pretty close to zero for next year.

好的，那我一個一個來。首先關於莫札克，答案是這項收費將大大消除莫札克對明年損益表的拖累。它不計入營業收入，而是計入其他收入。所以它不在我們的調整後營業收入中，但它在我們的稅前收入中，這在去年和今年都造成了很大的拖累，明年將接近零。

In terms of cyber, the big impact was last quarter through both RPT and volume as we play it forward in Q3 and Q4, that the impact goes way down and it's primarily volume. The cost side of it has been non-GAAP both last quarter and this quarter.

就網路攻擊而言，上個季度受到的影響最大，無論是 RPT 還是交易量都大幅下降。隨著我們預測第三季和第四季的情況，網路攻擊的影響將大幅下降，主要體現在交易量上。其成本方面，上季及本季均未採用GAAP準則。

Okay, I'll leave it at that. Thanks a lot.

好吧，我就說到這裡吧。多謝。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Hey, good afternoon. So one more question on treatment growth. I feel a little bit like a broken record here, so I apologize. But can you talk specifically about new patients starts in 3Q and how that changed year over year and also on mortality, how's mortality trending in the third quarter versus the first half of the year, and then finally, any impact from IOTA on treatment or on new patient starts or treatment growth.

嘿，下午好。那麼，關於治療成長還有一個問題。我感覺自己有點像是複讀機，所以很抱歉。但您能否具體談談第三季度新患者入院情況以及與去年同期相比的變化，還有死亡率情況，第三季度死亡率與上半年相比趨勢如何，最後，IOTA 對治療、新患者入院或治療增長有何影響？

Pito, the last part of your question, any impact -- from what was -- I missed that.

Pito，你問題的最後一部分，即「從過去的情況來看，任何影響」——我錯過了。

It's IOTA, the new bundle system for kidney transplants.

這是 IOTA，一種用於腎臟移植的新型捆綁系統。

Okay, yeah. No impact from that, going back to the original part of your question, I'd say volume for the quarter came in largely as expected with a little bit more pressure on missed treatments than we expected. Remember, we called missed treatment rate out as elevated in Q2 as a result of the cyberattack, they came down off that peak but still running higher than in Q3 of 2025.

好的，是的。回到你最初的問題，我認為這並沒有造成影響。我認為本季銷售量基本上符合預期，只是漏診治療帶來的壓力比我們預期的要大一些。請記住，由於網路攻擊，我們在第二季指出漏診率較高，雖然漏診率已從高峰迴落，但仍高於 2025 年第三季的水平。

In terms of both admissions and mortality, there's really not a lot new to call out there. Admissions continues to run within the normal band that we've seen post COVID and mortality again down versus Q1, but that's largely a flu phenomenon. There's really no pattern or trend to call out about mortality either quarter over quarter or year over year.

就入院人數和死亡率而言，並沒有什麼新的變化值得一提。入院人數持續維持在新冠疫情後的正常範圍內，死亡率也比第一季下降，但這很大程度上是流感現象。無論是季度環比還是年度環比，死亡率都沒有明顯的規律或趨勢可言。

Okay, and then can you talk about the timing of the IKC funds? I mean, typically they close at the end of the third quarter for the previous calendar year. Are there any changes to timing of those contracts, and have you already settled some of those funds in October for calendar '24?

好的，那麼您能談談IKC基金的到位時間嗎？我的意思是，通常情況下，他們會在上一日曆年的第三季末結束營業。這些合約的時間安排是否有任何變更？您是否已在 2024 年 10 月結算了部分款項？

Yeah, so the big change on IKC timing for the year was moving some of the revenue from plan year '24 from what we would have thought would have been the back half of the year and some of which would have hit in Q3 into Q2, and that's why IKC was so strong in Q2, and we called it out as timing.

是的，IKC 今年的時間安排上最大的變化是將 2024 年計劃年度的部分收入從我們原本認為的下半年（其中一些原本會在第三季度到賬）提前到了第二季度，這就是為什麼 IKC 在第二季度表現如此強勁的原因，我們稱之為時間安排。

So that's really the big thing I would call out. Look, I think timing on IKC will continue to be difficult to predict. A lot of it is a function of when we get information from payers as well as the federal government and our ability to recognize revenue is really subject to the timing of that which we don't have control over.

所以，這正是我要重點強調的一點。我認為IKC的時機仍然很難預測。很多時候，這取決於我們何時從付款方和聯邦政府獲得信息，而我們確認收入的能力實際上取決於我們無法控制的時間。

Okay, and the last one for me, the implied fourth quarter guidance range is pretty wide and it's like $0.80, what would have to happen or if you'd be at the low end, versus the high end of guidance, and if everything about the midpoint, you talked about treatment growth in the tailwind coming from the day mix, but you know what treatment growth should we be modeling to get to the midpoint of the guidance.

好的，最後一個問題，第四季的隱含指引範圍相當寬，大約是 0.80 美元，如果要達到指引的下限或上限，需要發生什麼情況？如果一切都圍繞著中點，您提到了治療增長受到日間組合帶來的利好，但您應該模擬怎樣的治療增長才能達到指引的中點？

So in terms of what's driving the range, I would point to both RPT and IKC as the things that probably have the most potential mix there. In terms of treatment volume growth, what you should expect for Q4 is year over year volume growth that is positive. Nothing to write home about, 20 bps-30 bps somewhere in that range, but positive.

所以就推動價格波動的因素而言，我認為 RPT 和 IKC 可能是最有潛力的組合。就治療量增長而言，預計第四季度將實現同比增長。沒什麼值得大書特書的，大概在 20 bps 到 30 bps 之間，但總算是正數。

For the same reason, it was so negative this quarter, which is the day mix being a headwind, next quarter it's a tailwind, which is why it will drive it positive.

基於同樣的原因，本季業績如此糟糕（即日組合構成不利因素），而下個季度則成為順風，因此將推動業績向好。

Okay, and then last one here, does market share -- what do you think the market share is done in '25, if we exclude these cyber incidents. Thanks.

好的，最後一個問題，市場佔有率——如果我們排除這些網路事件，你認為 2025 年的市佔率是多少？謝謝。

Yeah, look, it's a really tough question. The best way to answer that question is US RDS data, but the latest US RDS data is for Q1 of '25. It just came out, both Q4 of '24 and Q1 of '25, and the reality with the quarterly US RDS data is we think the incidence data is more reliable, the prevalence data is less reliable. So you put that all together, there's almost no US RDS data to use to really try and predict what's going on with market share.

是啊，這確實是個棘手的問題。回答這個問題的最佳方法是使用美國 RDS 數據，但最新的美國 RDS 數據是 2025 年第一季的。2024 年第四季和 2025 年第一季的數據剛剛公佈，而根據美國季度 RDS 數據，我們認為發病率數據更可靠，盛行率數據不太可靠。綜上所述，幾乎沒有美國 RDS 數據可以用來真正預測市場佔有率的變化趨勢。

But if you grab that data as imperfect as it is, and you grab the intelligence that we have in the field and you make the adjustments for roughly the 1,600 patients that are both impacted by the PD and the cyber outage, we have no reason to see any meaningful shift in market share.

但是，即使數據並不完美，只要我們掌握了現場情報，並對受 PD 和網路中斷影響的大約 1600 名患者進行調整，我們就沒有理由看到市場份額發生任何實質性的變化。

Great, thanks so much.

太好了，非常感謝。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Thanks. Good morning. Our growth sounds like it's gotta be about $10 sequentially of improvement. Is that the right ballpark?

謝謝。早安.我們的成長聽起來像是每季大約提高 10 美元。這個範圍差不多嗎？

I think it's more like $8.

我覺得更像是 8 美元。

Okay. And how much of that do you think is this collection that we would think of is maybe you know non-recurring in the same magnitude?

好的。你認為這其中有多少是我們認為的那種不常出現的、數量級相同的集合？

I would -- it is -- I called out $50 million of RPT improvement, and that's about $7 of RPT. It is the biggest component of that. So I don't want to give an exact size there. This is ranges upon ranges, but it would be more than half, I'd say is probably a reasonable estimate.

我會——確實——我指出了 5000 萬美元的 RPT 改進，而這大約是 7 美元的 RPT。它是其中最重要的組成部分。所以我不想給出確切的尺寸。這涉及到很多不同的範圍，但我覺得超過一半應該是一個合理的估計。

Perfect. And then the fourth quarter volume assumption. I apologize if I missed it, but did you give a number there in terms of what you're assuming for volume?

完美的。然後是第四季銷量預測。如果我錯過了，請見諒，但您有沒有給出您預估的成交量數字？

Look, you can back into it more or less, and on treatment volume it would be growth of somewhere around 20 bps or 30 bps. And remember that's treatment volume. It's not treatments per day. It's not NAG. That it would be an absolute year over year growth of about 20 bps or 30 bps.

你看，你可以大致推算出來，治療體積的成長幅度大概在 20 bps 到 30 bps 之間。請記住，這是治療劑量。不是每天的治療次數。這不是 NAG。這將比上年同期增長約 20 至 30 個基點。

Okay. Thank you.

好的。謝謝。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

Thanks. Good afternoon. You mentioned changes in payer mix driving RPT down a bit. Can you give us what the commercial treatment mix was in the quarter, or at least the proportion from or the change from second quarter? And Joel, I heard you mention the sequential components on RPT. I appreciate that, but does the 4Q guide assume any sort of positive move in that payer mix?

謝謝。午安.您提到支付方結構的變更導致 RPT 略有下降。能否告知我們本季商業處理方案的組合情況，或至少與第二季相比的比例或變化？喬爾，我聽你提到了 RPT 上的順序組件。我明白了，但是第四季業績指引是否假設支付方結構會出現任何正面的轉變？

I don't think it will be a significant component of it. In terms of where mix is today, it's right around 11%. It was down 11% -- it was down 15 bps from Q2 to Q3. It went from just above 11% to just below 11%.

我認為這不會是其中的重要組成部分。就目前的混合比例而言，大約在 11% 左右。下降了 11%——比第二季度下降了 15 個基點。它從略高於 11% 降至略低於 11%。

Okay, and last thing, I guess over the past year or two we've seen nice growth in RPT, the binders, of course. But focus on the revenue cycle improvements, I guess where are we at in the life cycle of those or seeing at least some outsized benefit from those. Javier, I heard you mention some initiatives in your prepared remarks, but just anything on revenue cycle initiatives and improvements would be helpful. Thanks.

好的，最後一點，我想在過去一兩年裡，我們看到了RPT（當然是指活頁夾）的良好成長。但重點應該放在收入週期改進上，我想我們現在處於這些改進的生命週期的哪個階段，或至少從中獲得一些顯著的收益。哈維爾，我聽你在準備好的發言稿中提到了一些舉措，但任何關於收入周期舉措和改進方面的信息都會很有幫助。謝謝。

Yeah, I would say some people would ask what inning of the game we're in. I think that's the wrong metaphor. This is a continuous process that I don't think we kind of we finish and then we move on. I think there's there'll be a continuous process for years and years to continue to get better at it. Remember, a 1% improvement in ROPS collections is equal to about $120 million of OI. So even if we can just get 10 basis points or 20 basis points a year in, year out, there's real value there.

是的，我想有些人會問我們現在進行到比賽的哪一局了。我認為這個比喻用錯了。這是一個持續的過程，我認為我們不會完成一個過程然後就繼續前進。我認為這將是一個持續多年的過程，才能不斷提高這方面的能力。請記住，ROPS 收款率提高 1% 相當於約 1.2 億美元的營業收入。所以即使我們每年只能獲得 10 個基點或 20 個基點的收益，那也是非常有價值的。

The cyber incident definitely slowed things down there. But we're continuing to invest there as Javier said, AI is an opportunity, just old fashioned automation is an opportunity there as well. So I would say, we're not -- there's more to be had there. It's not going to feel like it did in '23 and '24, where it's really moving the needle in a big way, but I think there will be continue to be opportunity there year in and year out.

這次網路安全事件無疑減緩了那裡的發展速度。但正如哈維爾所說，我們將繼續在那裡投資，人工智慧是一個機遇，傳統的自動化在那裡也是一個機會。所以我想說，我們還沒有——那裡還有更多值得挖掘的東西。雖然不會像 2023 年和 2024 年那樣產生巨大的影響，但我認為每年都會有這樣的機會。

Okay, thank you.

好的，謝謝。

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。目前我不再提出其他問題。各位發言者，現在我把發言權交還給你們，請做總結發言。

Okay, thank you, Michelle, and thank you for all of your questions. As we wrap up today, I will leave you with four thoughts;

好的，謝謝你，米歇爾，也謝謝你提出的所有問題。今天就到這裡，我想跟大家分享四點想法；

First, early in the year, we faced two unexpected challenges with meaningful economic impact. We navigated through those issues, delivered clinical excellence for our patients, and remain on track to achieve our annual guidance. All the while, we continue to invest in creating long-term capabilities.

首先，年初時，我們面臨兩個意想不到的挑戰，這些挑戰對經濟產生了重大影響。我們克服了這些問題，為患者提供了卓越的臨床服務，並繼續朝著實現年度目標穩步前進。同時，我們持續投資，致力於打造長期發展能力。

Second, we will continue our disciplined capital allocation strategy, including share repurchases.

其次，我們將繼續執行我們嚴謹的資本配置策略，包括股票回購。

Third, we provided a few forward-looking thoughts on next year. Although the current dialogue is focused on enhanced premium tax credits, more broadly, we'll be monitoring open enrollment which is perhaps the biggest variable heading into 2026.

第三，我們對明年提出了一些展望性的想法。儘管目前的討論重點是提高保費稅收抵免，但更廣泛地說，我們將專注於開放註冊，這可能是 2026 年最大的變數。

And finally, the clinical and operational processes behind middle molecule clearance will take approximately three years to see results. Yet, the potential to enhance patients' lives is meaningful and exciting.

最後，中分子藥物審批背後的臨床和營運流程大約需要三年時間才能看到結果。然而，改善患者生活品質的潛力是意義非凡且令人興奮的。

Thank you all for joining the call and be well.

感謝各位參與通話，祝福大家身體健康。

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。您現在可以斷開連線了。