德維特 (DVA) 2025 Q4 法說會逐字稿

Good evening. My name is Michelle, and I will be your conference facilitator today. At this time, I would like to welcome everyone to the DaVita fourth-quarter 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 年第四季財報電話會議。（操作說明）

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

謝謝伊萊亞森先生，您可以開始您的會議了。

Thank you, and welcome to our fourth-quarter conference call. I'm Nic Eliason, Group Vice President of Investor Relations, and joining me today are Javier Rodriguez, our CEO; and Joel Ackerman, our CFO.

謝謝，歡迎參加我們第四季電話會議。我是投資者關係集團副總裁尼克·埃利亞森，今天與我一起出席的有我們的首席執行官哈維爾·羅德里格斯和首席財務官喬爾·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意義的前瞻性陳述。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 fourth-quarter earnings press release and our SEC filings, including our most recent annual report on Form 10-K, all subsequent quarterly reports on Form 10-Q, and other subsequent filings that we make with the SEC. 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情，請參閱我們的第四季度收益新聞稿和我們向美國證券交易委員會提交的文件，包括我們最新的 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。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獲利新聞稿中，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. As we evaluate 2025, the year represents the latest evidence of our differentiated capabilities, strategy, and platform. We executed it with discipline, met challenges head on, and delivered on our commitments we said at the beginning of the year.

謝謝你，尼克。各位下午好，感謝各位今天參加電話會議。在評估 2025 年時，這一年代表了我們差異化能力、策略和平台的最新例證。我們以嚴謹的紀律執行了任務，迎難而上，兌現了年初做出的承諾。

At the same time, we continue to invest to enhance patient care and fuel growth in the years ahead. As a result, we're well-positioned for 2026 and beyond with opportunities to deliver clinical and financial results consistent with our longstanding track record and guidance.

同時，我們將繼續投資，以提升患者護理水平，並為未來幾年的發展提供動力。因此，我們已做好充分準備迎接 2026 年及以後的發展，有機會取得與我們長期以來的業績記錄和指導方針相符的臨床和財務成果。

Today, I'll review our fourth-quarter results, share insights on our clinical strategy, and wrap up with guidance for 2026. But first, as always, I will start with a clinical highlight.

今天，我將回顧我們第四季的業績，分享我們臨床策略的見解，並總結 2026 年的展望。但首先，像往常一樣，我將從一個臨床亮點開始。

This quarter, I want to spotlight the clinical results achieved in our Integrated Kidney Care or IKC programs. Patients managed under IKC models consistently achieve better outcomes than the broader dialysis population. Our IKC patients are 35% more likely to start dialysis with a permanent vascular access, resulting in a better patient experience and costs that are three times lower during the first 180 days of dialysis.

本季度，我想重點介紹我們在綜合腎臟護理（IKC）計畫中取得的臨床成果。採用 IKC 模式管理的患者，其治療效果始終優於一般透析族群。我們的 IKC 患者開始透析時使用永久性血管通路的可能性高出 35%，從而帶來更好的患者體驗，並且在透析的前 180 天內成本降低了三倍。

IKC patients also experience fewer blood stream infections, achieve higher vaccination rates, and are more likely to choose home dialysis. We also see more than 10% improvement in treatment adherence with fewer missed treatments. Most importantly, these outcomes lead to what matters most: a better quality of life with fewer hospitalizations.

IKC 患者發生血液感染的幾率也較低，疫苗接種率較高，且更有可能選擇居家透析。我們也發現治療順從性提高了 10% 以上，漏診次數也減少了。最重要的是，這些結果帶來了最重要的東西：更高的生活品質和更少的住院。

Transitioning to our fourth-quarter performance, we delivered results in line with our expectations. As anticipated, revenue per treatment accelerated in the quarter alongside strength in IKC. This was partially offset by higher-than-expected health benefit costs. For the full year, we achieved adjusted operating income and adjusted earnings per share in the top half of our guidance range despite the impact of cyber incident on our US dialysis business.

展望第四季業績，我們取得了符合預期的成果。正如預期的那樣，隨著 IKC 的強勁表​​現，本季每次治療的收入也加速成長。但這部分被高於預期的醫療福利成本所抵銷。儘管網路安全事件對我們的美國透析業務造成了影響，但我們全年調整後的營業收入和調整後的每股收益均達到了預期範圍的前半部分。

Let me elaborate briefly on our IKC performance. As we've noted previously, we analyze IKC results on a full-year basis given quarterly volatility driven by timing of revenue recognition. As we look back to our Capital Markets Day in 2021, we outlined a five-year path to IKC profitability by 2026. Our strategy centered on sustainable contract, physician partnership, and a scalable care model supported by technology. With full-year 2025 results, we're reporting our first profitable year in IKC, which is slightly ahead of schedule.

讓我簡單介紹一下我們在IKC上的表現。正如我們之前提到的，鑑於收入確認時間導致的季度波動，我們對 IKC 的業績進行全年分析。回顧 2021 年的資本市場日，我們制定了 IKC 到 2026 年獲利的五年發展路徑。我們的策略以可持續的合約、醫生合作以及由技術支援的可擴展護理模式為中心。2025 年全年業績顯示，IKC 實現了首個盈利年度，略微提前於預期。

This milestone reinforces two key learnings. First, our hands-on clinical models work. As reflected in the outcomes I highlighted earlier, our dedicated IKC caregivers are delivering on the promise of value-based care by keeping patients healthier and out of the hospital. Second, we've proven there's a viable business model that is good for our patients, good for the healthcare system, and can generate value for DaVita and our partners. The business will continue to evolve over time alongside changes in government policy, competitive dynamics, and innovation.

這一里程碑事件強化了兩個關鍵經驗。首先，我們的實踐臨床模型是有效的。正如我之前強調的結果所反映的那樣，我們敬業的 IKC 護理人員正在兌現以價值為導向的護理承諾，讓患者更健康，遠離醫院。其次，我們已經證明存在一種可行的商業模式，對我們的患者有益，對醫療保健系統有益，並且可以為 DaVita 和我們的合作夥伴創造價值。隨著政府政策、競爭格局和創新技術的變化，該產業也將持續發展演進。

Building from this 2025 benchmark, we expect to deliver an incremental $20 million of IKC operating income growth in 2026. Looking more broadly at our business, we see significant opportunities ahead and believe DaVita is uniquely positioned to deliver on them.

以 2025 年的基準為基準，我們預計 2026 年 IKC 的營業收入將增加 2,000 萬美元。從更廣闊的視角審視我們的業務，我們看到了未來巨大的機遇，並相信 DaVita 擁有獨特的優勢來實現這些機會。

Before turning to those opportunities, let me provide some context on our journey to date. Over the past five years, we've navigated wide range challenges from macro events like global pandemic and inflation to supply chain disruption and cyber incident. And through it all, we delivered on our multiyear commitment. We provided high-quality care for our patients, built a solid foundation for the future, and generated a compound annual growth in line with our long-term target for adjusted operating income and adjusted EPS. This performance reflects the determination of our teammates and the resilience of our operating model.

在探討這些機會之前，讓我先介紹一下我們迄今為止的發展歷程。過去五年，我們應對了各種各樣的挑戰，從全球疫情和通貨膨脹等宏觀事件到供應鏈中斷和網路安全事件。一路走來，我們始終履行了多年的承諾。我們為患者提供了高品質的護理，為未來奠定了堅實的基礎，並實現了與調整後營業收入和調整後每股收益長期目標相符的複合年增長率。這項成績反映了我們團隊成員的決心和我們營運模式的韌性。

This experience also gives us the confidence as we look at the opportunities and challenges ahead of us. We're managing two near-term financial headwinds, continued pressure on treatment growth driven by elevated mortality, and the revenue per treatment impact from the expiration of enhanced premium tax credits. Even with these headwinds and the reality of unknown challenges, we remain confident in our ability to sustain our track record of profit growth.

這段經歷也讓我們更有信心面對未來的機會和挑戰。我們正在應對兩個近期財務逆風：一是死亡率上升導致治療成長持續承壓；二是增強型保費稅收抵免到期對每次治療收入的影響。即使面臨這些不利因素和未知挑戰，我們仍然有信心保持獲利成長的良好記錄。

That confidence starts with the most important driver of our long-term success and unwavering focus on clinical excellence. We're executing a set of targeted initiatives designed to enhance patient care, reduce mortality and missed treatment rates, and ultimately, support higher treatment volume growth. I will highlight four specific examples.

這種自信源自於我們長期成功的關鍵驅動力，以及對臨床卓越的堅定不移的關注。我們正在實施一系列有針對性的舉措，旨在提高患者護理水平，降低死亡率和漏診率，並最終支持治療量的增長。我將重點介紹四個具體例子。

First is vaccination. For many years, we achieved flu vaccination rates above 90% for our patients and clinical teammates, and we're working hard to return to that benchmark. Our patients who received a vaccination early in this flu season have shown a 9% lower risk of hospitalization and a 27% lower risk of mortality compared to their unvaccinated peers. Protecting our vulnerable patients from the flu, COVID, and pneumonia is a clinical imperative.

首先是接種疫苗。多年來，我們的患者和臨床團隊成員的流感疫苗接種率一直保持在 90% 以上，我們正​​在努力恢復到這一水平。與未接種疫苗的同齡人相比，在本流感季早期接種疫苗的患者住院風險降低了 9%，死亡風險降低了 27%。保護弱勢患者免受流感、新冠肺炎和肺炎的侵害是一項臨床上的當務之急。

Second is GLP-1 adoption and adherence. A growing body of evidence confirms that GLP-1s can reduce major adverse cardiac events and mortality for many dialysis patients. We're actively working with physicians to help our patients navigate the clinical, operational, and financial complexities of these drugs.

其次是 GLP-1 的採納和依從性。越來越多的證據證實，GLP-1 可以降低許多透析患者的重大不良心臟事件和死亡率。我們正積極與醫生合作，幫助我們的患者應對這些藥物在臨床、操作和財務方面的複雜性。

Third is advancing dialysis technologies to remove middle-molecules. Innovations such as medium cut-off (MCO) dialyzers and hemodiafiltration (HDF) enable the clearance of a broader range of toxins from the body during the treatment. These technologies help the patients recover more quickly after dialysis and show promise of reducing mortality by as much as 20% or more.

第三，推進透析技術以去除中分子物質。中等截留 (MCO) 透析器和血液透析濾過 (HDF) 等創新技術能夠在治療過程中清除體內更廣泛的毒素。這些技術有助於患者在透析後更快康復，並有望將死亡率降低 20% 或更多。

Finally, today we announced a strategic clinical partnership with Elara Caring, a leading home care provider to establish an ESKD-focused offering. This model spans Elara's skilled home health, personal care, and hospice service lines and is designed to lower hospitalizations and missed treatment rates while improving the overall patient experience. Joel will provide more details about the investment we're making alongside this strategic partnership.

最後，今天我們宣布與領先的家庭護理服務提供者 Elara Caring 建立策略性臨床合作夥伴關係，以建立以末期腎病 (ESKD) 為重點的服務。此模式涵蓋了 Elara 的專業家庭健康、個人護理和臨終關懷服務，旨在降低住院率和漏診率，同時改善患者的整體體驗。Joel將提供更多關於我們透過此策略合作的投資細節。

Together, these clinical initiatives demonstrate how our patient-centered strategy directly supports our business objectives. By improving quality of life, reducing hospitalization, and advancing clinical outcomes, we continue to believe we're on a path back to at least 2% volume growth. In parallel, we maintain a diligent focus on costs and innovation to improve efficiency, continue sustainable US dialysis margins, and deliver durable financial performance.

這些臨床舉措共同表明，我們以患者為中心的策略如何直接支持我們的業務目標。透過提高生活品質、減少住院和改善臨床結果，我們仍然相信我們正在朝著至少 2% 的銷售成長目標邁進。同時，我們始終致力於成本控制和創新，以提高效率，維持美國透析業務的可持續利潤率，並實現持久的財務表現。

With that backdrop, we remain confident in our ability to deliver adjusted operating income growth over the next three years that is consistent with our long-term growth target of 3% to 7%.

在此背景下，我們仍有信心在未來三年內實現調整後營業收入成長，這與我們3%至7%的長期成長目標一致。

On adjusted EPS, with our current capital allocation program and removing the headwinds from our investment in Mozarc, we see an opportunity to exceed our long-term adjusted EPS guidance of 8% to 14%. Taken together, these priorities reinforce our ability to generate sustainable shareholder value and continued leadership in kidney care.

就調整後的每股盈餘而言，憑藉我們目前的資本配置計劃，並消除我們在 Mozarc 投資中的不利因素，我們看到有機會超過我們 8% 至 14% 的長期調整後每股收益預期。綜上所述，這些優先事項增強了我們為股東創造永續價值和在腎臟護理領域保持領先地位的能力。

I'll wrap up my comment with our guidance for 2026. We expect adjusted operating income within a range of $2.085 billion to $2.235 billion, which represents 3.2% growth at the midpoint. Our guidance for adjusted earnings per share is $13.60 to $15 even, reflecting a 33% growth at the midpoint. This guidance exceeds our long-term EPS targets, reflecting our expectation for another year of strong operating performance and the cumulative benefits of our capital allocation strategy.

最後，我將以我們對 2026 年的指導方針作為我演講的結尾。我們預計調整後的營業收入將在 20.85 億美元至 22.35 億美元之間，其中數值代表成長 3.2%。我們對調整後每股收益的預期為 13.60 美元至 15 美元，其中數值反映出 33% 的成長。這項預期超過了我們長期的每股盈餘目標，反映了我們對另一個強勁的經營績效的預期，以及我們資本配置策略的累積效益。

Finally, we expect to generate free cashflow between $1 billion and $1.25 billion.

最後，我們預計將產生 10 億美元至 12.5 億美元的自由現金流。

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

現在我將把發言權交給喬爾，讓他更詳細地討論我們的財務表現和前景。

Thank you, Javier. First, I'll provide some detail on our fourth-quarter and full-year 2025 results and then share a detailed breakdown of our 2026 guidance.

謝謝你，哈維爾。首先，我將詳細介紹我們 2025 年第四季和全年的業績，然後分享我們 2026 年業績指引的詳細分析。

Fourth-quarter adjusted operating income was $586 million, bringing full-year adjusted operating income to $2.094 billion. Adjusted earnings per share from continuing operations for the fourth quarter was $3.40, with full-year adjusted EPS from continuing operations of $10.78. Free cash flow was $309 million in the fourth quarter, which brings full-year free cash flow to just over $1 billion.

第四季調整後營業收入為 5.86 億美元，使全年調整後營業收入達到 20.94 億美元。第四季持續經營業務的調整後每股收益為 3.40 美元，全年持續經營業務的調整後每股收益為 10.78 美元。第四季自由現金流為 3.09 億美元，使全年自由現金流略高於 10 億美元。

Starting with US dialysis, treatments declined about 20 basis points versus the fourth quarter of 2024. Although our total patient census growth during the quarter was as we expected, the timing of the census gained was back-end loaded in the quarter. For the full year, US treatments declined by 1.1% versus 2024, in line with our expectations from the Q3 earnings call.

以美國透析治療為例，與 2024 年第四季相比，治療量下降了約 20 個基點。雖然本季患者總數成長符合預期，但新增患者數量主要集中在季度末。全年來看，美國治療量比 2024 年下降了 1.1%，這與我們在第三季財報電話會議上的預期一致。

Next, revenue per treatment growth accelerated in the fourth quarter as anticipated, up approximately $12 sequentially. Fourth-quarter growth was the result of four primary factors: first, the resolution of aged receivables consistent with what we forecasted on the Q3 call; second, normal rate increases and improved yield; third, private pay mix improved slightly after a dip in the third quarter; and finally, RPT benefited from the typical seasonal impact of flu vaccines.

其次，正如預期的那樣，第四季度每次治療的收入成長加速，季增約 12 美元。第四季成長主要歸功於四個因素：首先，應收帳款的解決符合我們在第三季度電話會議上的預測；其次，正常的利率上漲和收益率的提高；第三，私人支付組合在第三季度下滑後略有改善；最後，RPT受益於流感疫苗的典型季節性影響。

Full-year RPT was approximately $410 up 4.7% for the year. As you think about RPT for the first quarter of 2026, keep in mind that Q1 bears a typical $5 or more RPT headwind due to patient responsibility amounts early in the year.

全年 RPT 約為 410 美元，較去年同期成長 4.7%。在考慮 2026 年第一季的 RPT 時，請記住，由於年初患者需承擔一定金額，第一季通常會面臨 5 美元或更多的 RPT 不利影響。

Patient care cost per treatment increased by approximately $6 sequentially. The increase was primarily the result of seasonal increases including health benefit costs and higher supply costs. PCCs per treatment finished the year 5.9% higher than 2024, near the top end of our revised range of expectations but lower than our original guidance for the year. As a reminder, approximately half the year-over-year increase in PCCs was from binders in the bundle.

每次治療的患者護理成本較上月增加了約 6 美元。成長的主要原因是季節性因素增加，包括醫療福利成本和供應成本上漲。每例治療的 PCC 數量在年底比 2024 年增加了 5.9%，接近我們修訂後的預期範圍的上限，但低於我們最初的年度指導值。需要提醒的是，PCC 的年成長中約有一半來自捆綁包中的活頁夾。

Turning to our other segments, International adjusted OI was $21 million resulting in full-year adjusted operating income of $114 million. This reflects strong operating performance for our International business as we delivered positive organic growth and integrated the recent acquisitions in Latin America.

再來看我們的其他業務板塊，國際業務調整後的營業收入為 2,100 萬美元，全年調整後的營業收入為 1.14 億美元。這反映了我們國際業務強勁的經營業績，我們實現了積極的內生成長，並整合了近期在拉丁美洲的收購項目。

In IKC, as Javier noted, we delivered our first profitable fiscal year. Q4 adjusted OI was $46 million, and full-year adjusted OI was $22 million. We saw strength across all three of the businesses within IKC and final reconciliations of our 2024 performance resulted in higher-than-expected shared savings revenue.

正如 Javier 指出的那樣，IKC 實現了第一個盈利的財政年度。第四季調整後未實現營業收入為 4,600 萬美元，全年調整後未實現營業收入為 2,200 萬美元。我們看到 IKC 旗下所有三個業務部門都表現強勁，2024 年業績的最終結算結果顯示，共享節約收入高於預期。

Switching to capital allocation. During the fourth quarter, we repurchased 2.7 million shares, and we repurchased an additional 1.7 million shares since the end of the quarter. As is typical, a portion of these shares were repurchased from Berkshire Hathaway pursuant to the terms of our publicly filed repurchase agreement, which formulaically results in Berkshire's ownership remaining at or below 45%. For the full year 2025, we repurchased nearly 13 million shares for approximately $1.8 billion. At year-end, our leverage ratio was 3.26 times consolidated EBITDA down from the third quarter and at the midpoint of our target leverage range of 3 to 3.5 times.

轉而進行資本配置。第四季度，我們回購了 270 萬股股票；自該季度末以來，我們又回購了 170 萬股股票。按照慣例，我們根據公開備案的回購協議條款，從波克夏‧哈撒韋公司回購了其中一部分股份，這使得波克夏的持股比例保持在 45% 或以下。2025 年全年，我們回購了近 1,300 萬股股票，總額約 18 億美元。截至年末，我們的槓桿率為合併 EBITDA 的 3.26 倍，低於第三季度，處於我們 3 至 3.5 倍目標槓桿率範圍的中點。

With that, let me turn to 2026. As Javier said, we were guiding to an adjusted operating income range with a midpoint of $2.16 billion. At this midpoint, we have built in the following assumptions for US dialysis.

那麼，接下來讓我們來展望一下2026年。正如哈維爾所說，我們預計調整後的營業收入區間中位數為 21.6 億美元。在此中期，我們對美國透析做出了以下假設。

Treatment volume will be approximately flat to 2025. This assumes a flu impact consistent with what we saw in the 2023/2024 season. We are not assuming any improvement in non-flu mortality, though as Javier outlined, we are working on a number of initiatives to actively drive down mortality among our patients.

到 2025 年，治療量將基本保持穩定。這是假設流感的影響與我們在 2023/2024 年流感季看到的情況一致。我們並不認為非流感死亡率會有任何改善，不過正如哈維爾所概述的那樣，我們正在進行多項舉措，積極降低患者的死亡率。

Last, on admissions, we are assuming 2026 looks similar to 2025, excluding the impact of the cyber incident.

最後，關於招生情況，我們假設 2026 年的情況與 2025 年類似，不考慮網路事件的影響。

To help with modeling our treatments by quarter, we have added a table to the press release showing normalized treatment days by quarter. This number adjusts for the mix of treatment days and holiday shifts, making it the most helpful number to model quarterly treatments. For example, you'll notice a year-over-year normalized treatment day headwind in Q1 2026, which drives our expectation for negative year-over-year US dialysis treatment volume growth in the first quarter of this year.

為了幫助我們按季度對治療方案進行建模，我們在新聞稿中添加了一個表格，顯示了按季度劃分的標準化治療天數。該數字根據治療日和假日輪班情況進行調整，因此是模擬季度治療的最有用數字。例如，您會注意到 2026 年第一季同比正常化治療天數出現不利因素，這導致我們預計今年第一季美國透析治療量將年成長。

Moving on to RPT. For 2026, we are forecasting growth of 1% to 2%. The primary driver of this is typical rate increases. We also expect an estimated $40 million headwind from the expiration of enhanced premium tax credits for exchange plans, which is largely offset by the elimination of the $45 million headwind in 2025 from the cyber incident.

接下來是RPT。我們預測 2026 年的成長率為 1% 至 2%。造成這種情況的主要原因是利率上漲。我們還預計，由於交易所計劃的增強型保費稅收抵免到期，將帶來約 4000 萬美元的不利影響，但這在很大程度上會被 2025 年網路安全事件造成的 4500 萬美元不利影響的消除所抵消。

We expect total US dialysis costs to grow 1.25% to 2.25%, mostly driven by typical wage rate increases and G&A investments, partially offset by a decline in depreciation and amortization. The net impact of all this, at the midpoint of our guidance, is an increase in adjusted operating income for the US dialysis business of approximately 1.5%.

我們預計美國透析總成本將增加 1.25% 至 2.25%，主要原因是典型的薪資成長和一般及行政費用投資，部分被折舊和攤提的下降所抵銷。所有這些因素的淨影響，在我們預期的中點，將使美國透析業務的調整後營業收入增加約 1.5%。

Also baked into the midpoint of our adjusted OI guidance range is an expectation for each of IKC and International to contribute approximately 1% to enterprise adjusted OI growth. Altogether, these results reflect our expectation for 3.2% adjusted operating income growth at the midpoint of our range versus 2025. For seasonality, we expect first-quarter adjusted operating income will represent approximately 20% of our full-year guidance. In other words, about $430 million at the midpoint.

此外，在我們調整後的營業收入指引範圍的中點中，也包含了對 IKC 和國際業務各自貢獻約 1% 企業調整後營業收入成長的預期。總的來說，這些結果反映了我們對 2025 年調整後營業收入成長 3.2% 的預期，該預期位於我們預測範圍的中點。考慮到季節性因素，我們預計第一季調整後營業收入將佔全年預期收入的約 20%。換句話說，中間值約為 4.3 億美元。

Below the operating income line, we expect positive other income of approximately $10 million for the year. This represents significant year over year improvement in this line item resulting from no further losses from our investment in Mozarc since we have now recognized cumulative losses equal to our investment.

除營業收入外，我們預計本年度其他收入約為 1,000 萬美元。這表明該項目同比有了顯著改善，因為我們對莫扎克的投資不再產生損失，我們目前已確認的累積損失等於我們的投資金額。

We expect debt expense to decline by $20 million to $40 million versus 2025. This is driven by lower interest rates year over year, both from the decline in rates and from our repricing and refinancing transactions, which lowered spreads.

我們預計到 2025 年，債務支出將減少 2,000 萬美元至 4,000 萬美元。這是由於利率逐年下降所致，既包括利率下降，也包括我們的重新定價和再融資交易降低了利差。

We expect non-controlling interest to be approximately 16% of US dialysis OI, and we expect effective tax rate to be in the range of 24.5% to 26.5%.

我們預計少數股東權益將占美國透析業務的約 16%，預計實際稅率將在 24.5% 至 26.5% 之間。

Regarding capital allocation, related to Javier's comments, we announced the signing of an approximately $200 million minority investment alongside a majority investment from Ares Private Equity Funds to acquire Elara Caring. After the transaction closes, which we expect to happen midyear, we expect this to contribute positively to our other income line.

關於資本配置，與 Javier 的評論有關，我們宣布與 Ares Private Equity Funds 簽署了一項約 2 億美元的少數股權投資協議，以及一項多數股權投資協議，以收購 Elara Caring。交易完成後（我們預計交易將於年中完成），我們預計這將對我們的其他收入來源產生正面影響。

In addition, we will continue to repurchase shares in line with our typical framework, keeping in consideration our liquidity, leverage, and the price of our stock relative to our view of intrinsic value. As a reminder, a significant portion of our repurchases will continue to come via direct purchases from Berkshire Hathaway as part of our ongoing repurchase agreement.

此外，我們將繼續按照我們一貫的框架回購股票，同時考慮到我們的流動性、槓桿率以及股票價格相對於我們對內在價值的看法。再次提醒大家，根據我們持續進行的股票回購協議，我們很大一部分回購將繼續透過直接從波克夏·哈撒韋公司購買的方式進行。

At the midpoint of the range, we are guiding to adjusted EPS in 2026 of $14.30. This does not contain any unusual or non-recurring items and is a good starting point from which to model future EPS.

我們預計，2026 年調整後每股收益為 14.30 美元（取區間中位數）。此預期不包含任何異常或非經常性項目，是預測未來每股盈餘的良好起點。

Our 2026 guidance represents a 33% increase over last year, which is the result of two familiar drivers, increased operating income, and lower share count, plus the elimination of the headwind from our share of the losses at Mozarc, as I previously noted.

我們 2026 年的業績預期比去年增長了 33%，這主要得益於兩個熟悉的因素：營業收入增加和股份數量減少，以及消除了我們分擔 Mozarc 虧損帶來的不利影響，正如我之前提到的。

Finally, on free cash flow, the midpoint of our guidance for 2026 is $1.125 billion, reflecting a resilient business with discipline in the deployment of our capital resources.

最後，關於自由現金流，我們對 2026 年的預期中位數為 11.25 億美元，反映出我們業務的韌性以及在資本資源部署方面的紀律性。

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) Kevin Fischbeck, Bank of America.

（操作員說明）凱文·菲施貝克，美國銀行。

Great, thanks. I wanted to get a little more color on the commentary around, I guess, the confidence in getting back to the 2%-plus volume number. Obviously, I guess, this number you're looking for in the guidance for '26 is a little bit better than '25, but it's still, well below that 2%. So is it all about executing on mortality, or is there something else that you're kind of pointing to that gives you that confidence?

太好了，謝謝。我想對重回 2% 以上成交量水準的信心的評論進行更深入的探討。顯然，我猜，您在 2026 年的指導方針中看到的這個數字比 2025 年略好一些，但仍然遠低於 2%。所以，這一切都與應對死亡有關嗎？還是說，還有其他因素讓你充滿信心？

Yeah, Kevin, this is Javier. I appreciate the question. The reality is it is a clinical story. And if you go back and you look at the time when the industry was at its peak of growth, many people thought it was the incidence. But the reality is that it was also a clinical story throughout, meaning mortality was improving year after year.

是的，凱文，這是哈維爾。感謝您的提問。事實上，這是一個臨床案例。如果你回顧一下該行業處於成長頂峰的時期，許多人認為這就是那次事件。但事實上，這同時也是一個臨床故事，這意味著死亡率逐年下降。

And so to get to that 2%, you have to assume that the thing that we outline in our prepared remarks, come to fruition, and we think of course there's a lag between all of the implementation clinically and the full effect. And so we think that you will start to see some benefits in approximately two years, and you'll probably see the full effect by '29 or so.

因此，要達到那 2% 的目標，你必須假設我們在準備好的發言稿中概述的事情能夠實現，當然，我們認為在臨床實施和完全生效之間肯定存在滯後。因此我們認為，大約兩年後您將開始看到一些好處，到 2029 年左右您可能會看到全部效果。

Okay, that's helpful to get that timing. I forget, you gave some kind of multiyear guidance ranges. Was it three years you said or was it five years? You were giving those OI and EPS comments?

好的，這有助於掌握時間。我忘了，你給的是一個多年期的指導範圍。你說的是三年還是五年？你當時是在發表關於營業利潤和每股盈餘的評論嗎？

We didn't say a year, but we think of it in a three-year or so timeframe.

我們沒說一年，但我們考慮的時間範圍大約是三年左右。

Okay. And then just last one on the free cash flow number. So I guess, the way to think about it is that number, the $1.125 billion, that's before the $200 million investment. So like if we thought about share repo or so, we should take $200 million out of that to think about additional deployable capital or there's some other adjustment?

好的。最後，我們來看最後一個關於自由現金流的數據。所以我覺得，理解這個數字的方式是：11.25億美元，是2億美元投資之前的金額。所以，如果我們考慮股票回購之類的方案，我們應該從中拿出 2 億美元來考慮額外的可部署資本，還是需要進行其他調整？

Yeah, Kevin, that's the right way to think about it then. And I'd say the starting place would be with leverage level where we came out right in the middle of the range, obviously with EBITDA growth, if we didn't increase leverage, we'd wind up in the lower half of the range. So that would be the other thing to consider when trying to figure out what's the right number to put in for share repurchases.

沒錯，凱文，那你就這麼想是對的。我認為起點應該是槓桿水平，我們目前的槓桿水平正好處於區間的中間位置。顯然，如果 EBITDA 成長，如果我們不提高槓桿率，最終就會處於區間的下半部。所以，在決定股票回購的適當數量時，這也是另一個需要考慮的因素。

Okay, but there's no other like obvious use of capital that's kind of like - the most likely use of capital after that $200 million?

好吧，但除了這2億美元之外，就沒有其他顯而易見的資金用途，也就是最有可能的資金用途了嗎？

That's right.

這是正確的。

Great. Thank you.

偉大的。謝謝。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

Hi. I appreciate all the color on 2026 guidance. Can you help us understand how missed treatments and mortality trended throughout the fourth quarter? And is there any connection or causality that you've been able to draw between those two items as you've dug into this issue further? Thanks.

你好。我非常欣賞2026年指導方針中所呈現的各種細節。您能否幫助我們了解第四季漏診率和死亡率的趨勢？隨著你對這個問題的深入研究，你是否發現這兩件事之間有任何關聯或因果關係？謝謝。

Yeah, so nothing really to highlight on mortality during the quarter. Missed treatments were up, but typically, you'd see missed treatments up in Q4. And if you looked at Q4 '25 missed treatments, you wouldn't see much difference with Q4 '24 missed treatments. So year over year, not much of a change. I would say, our clinical folks would say there absolutely is a correlation between missed treatment rate and mortality but with some lag between those two metrics.

是的，所以本季死亡率方面沒有什麼特別值得一提的。漏診率上升，但通常情況下，漏診率上升發生在第四季。如果你查看 2025 年第四季的漏診情況，你會發現與 2024 年第四季的漏診情況並沒有太大差異。所以與往年相比，變化不大。我認為，我們的臨床人員會說，漏診率和死亡率之間絕對存在相關性，但這兩個指標之間存在一定的滯後性。

Great. Okay. And can you provide more detail on how you expect the ACA headwind to play out this year? And maybe comment on how open enrollment performed against your expectations and what level of attrition you're expecting from here. Thanks.

偉大的。好的。您能否詳細說明您預計今年《平價醫療法案》（ACA）帶來的不利影響會如何發展？或許還可以評論一下開放招生是否達到了您的預期，以及您預期的流失率是多少。謝謝。

I'm sorry, Andrew. I missed the first part of the question.

對不起，安德魯。我漏看了問題的第一部分。

Can you give us more detail on how you expect the ACA headwind to play out this year from a cadence perspective, and maybe comment on open enrollment, how that played out relative to expectations and whether you know, what level of attrition you're expecting on that ACA enrollment throughout the year. Thanks.

您能否從節奏的角度，更詳細地說明一下您預計今年《平價醫療法案》(ACA) 的不利影響將如何發展？或許可以評論一下開放註冊的情況，看看它與預期相比如何，以及您是否知道您預計全年《平價醫療法案》註冊人數的流失率是多少？謝謝。

Thank you, Andrew. So the number that we gave, we said approximately $40 million this year, $70 million next year, and $10 million the year after that. The reality is that we're seeing -- what you're seeing in the broader market, which is open enrollment performed better than forecasted by CBO or ourselves.

謝謝你，安德魯。所以我們給的數字是，今年大約 4000 萬美元，明年 7000 萬美元，後年 1000 萬美元。現實情況是，我們看到的——也是你們在更廣泛的市場中看到的——開放註冊的表現比國會預算辦公室或我們自己的預測要好。

And we're all waiting to see the real number, which is right now, we are measuring selection of a plan or enrollment of a plan. And then of course, people are trying to see what the payment of the plan will be to see what the yield will be.

我們都在等待看到真正的數字，而現在，我們正在衡量的是計劃的選擇或計劃的註冊情況。當然，人們也在試圖了解該計劃的支付方式，以了解其收益率。

We don't have any additional color than what you or the marketplace has on what that will be since it's the first time that these enhanced premium tax credits have gone away. But so far, it has been more resilient than people expected. And we will see once the bills start to come, if people pay.

由於這是這些增強型保費稅收抵免政策首次取消，我們對此沒有比您或市場所掌握的更多資訊。但到目前為止，它的表現比人們預期的要好。等帳單開始寄來的時候，我們就能知道人們是否會付款了。

We will say that our patients during the pandemic and at other time periods because they are so ill and needing of the healthcare system are really sophisticated understanding their insurance needs. So on average, they will go out of their way to stay insured.

我們可以說，在疫情期間以及其他時期，我們的患者由於病情嚴重，需要醫療保健系統，因此他們對自己的保險需求有著非常深刻的理解。因此，平均而言，他們會想辦法保持投保狀態。

And that's why last call, we said that there was basically two populations, our current patient population, which we think will be more resilient; and then you have the incoming population, which is in essence right now a CKD population that might not value insurance as much as someone that's already had their kidneys failed, and that's why the number grows over time.

所以，上次通話中我們說，基本上有兩個群體，我們目前的患者群體，我們認為他們更有韌性；然後是即將加入的群體，本質上是目前患有慢性腎病的群體，他們可能不像腎衰竭患者那樣重視保險，這就是為什麼隨著時間的推移，這個群體的人數會不斷增長。

But we will obviously be watching it during the quarter, and we will see once the payments go into effect.

但我們顯然會在本季密切關注此事，並會在付款生效後進行觀察。

Great. If I could -- can I just ask a follow-up on that? Do you have a sense for how many of your ACA patients receive premium assistance? Thanks.

偉大的。如果可以的話——我能再問一個後續問題嗎？您知道您的 ACA 患者中有多少人獲得了保費補助嗎？謝謝。

I do not, because that obviously has a lot of categories from the enhanced premium tax credits to the normal ones and you get into the income levels and other things. So I do not break it down into more detail.

我不這麼認為，因為這顯然有很多類別，從增強保費稅收抵免到普通稅收抵免，而且還涉及收入水平和其他因素。所以我就不把它分解得更詳細了。

Okay. Thank you.

好的。謝謝。

Thank you.

謝謝。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Thanks. Good morning. A couple things. First, on the ability to offset the exchange headwind with the tailwind or the non-recurrence of that cyber headwind from last year -- from 2025. My recollection was the last time you guys talked about this, that the cyber headwind this year, while it hurt the second quarter, was offset by some better collections and therefore wouldn't be as big a tailwind as it might have been in 2026. Did I remember that incorrectly or have you found other initiatives on the reimbursement side?

謝謝。早安.有幾件事。首先，能否利用順風抵銷交易所的逆風，或是能否避免去年網路逆風的再次出現——從 2025 年開始。我記得你們上次談到這個問題時，雖然今年的網路衝擊對第二季度造成了影響，但一些更好的收入抵消了這種影響，因此不會像 2026 年那樣成為巨大的利好因素。我記錯了嗎？還是您在報銷方面發現了其他措施？

Yeah, so let me try and lay out all the pieces for you, Justin, here. So we called out a $70 million headwind from cyber. $25 million of that is volume, and most of that recurs because it's just census that was lost and we're not going to get back in 2026. The balance was $45 million and that was an RPT headwind. We think that RPT headwind is offset in 2026 basically by the enhanced premium tax credit headwind. So you don't see a year-over-year growth problem in RPT because both years have a $40 million to $45 million negative.

好的，賈斯汀，讓我來為你把所有細節都梳理清楚。因此，我們預測網路攻擊將造成 7000 萬美元的損失。其中 2500 萬美元是數據量損失，而且大部分是重複損失，因為丟失的數據是人口普查數據，我們 2026 年也無法恢復。餘額為 4500 萬美元，這對 RPT 來說是一個不利因素。我們認為，2026 年 RPT 的不利因素基本上會被增強的保費稅收抵免的不利因素所抵消。因此，RPT 不存在年成長問題，因為這兩年都出現了 4,000 萬至 4,500 萬美元的虧損。

In terms of some of the other stuff we called out, in particular, around Q4 and the resolution of some older claims, there's really nothing in the year from that to call out. We have resolution of older claims every year. Looking back now, the 2025 number is roughly the same as what we saw in 2024, and the 2026 number we would expect to be similar in 2025. So I wouldn't call that out as unusual in any year. What was unusual was the concentration in Q4 of '25, which is why we called it out last quarter.

至於我們提到的其他一些事情，特別是第四季度以及一些較早索賠的解決，今年實際上沒有什麼值得一提的。我們每年都會處理一些積壓的索賠案件。現在回過頭來看，2025 年的數字與 2024 年的數字大致相同，我們預期 2026 年的數字與 2025 年的數字類似。所以我覺得這在任何年份都不算異常。2025 年第四季的集中度異常高，這也是我們上個季度特別指出的原因。

Got it. And then going back to IKC, can you give us a little more color in terms of what drove the outperformance in 2024 versus what you had previously booked and the level of confidence you have that that can continue and grow from there?

知道了。回到 IKC，您能否更詳細地介紹一下 2024 年業績超出預期的原因，以及您對業績能夠持續增長的信心程度？

Sure, let me grab that one, Justin. It's Javier. A couple of things that we've talked about as it relates to IKC. So just a quick housekeeping reminder, have to look at it on an annualized view because it moves pretty dramatically quarter to quarter.

好的，讓我來拿吧，賈斯汀。是哈維爾。我們已經討論過一些與 IKC 相關的事情。所以，簡單提醒一下，必須從年度角度來看，因為它的季度波動相當大。

We think of it in three categories. The first one is dollars under management. You can think of it as volume, and that's been relatively flat. We talked about it last time.

我們將其分為三類。第一個指標是管理資產規模（美元）。你可以把它理解為銷量，而銷量一直相對平穩。我們上次就討論過這個問題。

Secondly, the model of care costs and the G&A costs, which we've done a nice job of remaining flat there.

其次，護理成本和一般管理費用模型，我們在這方面做得很好，並保持了成本的穩定性。

And then the third category, which is the shared savings. And in that, of course, there is contracting and performance to what you're doing to add value to the system.

第三類是共享儲蓄。當然，其中也包括合約和績效，也就是你為系統增加價值所做的一切。

As it relates to that 2024 reconciliation, we did better in that shared savings part that I just talked about. Does that help you?

關於 2024 年的預算調整，我們在我剛才提到的共享儲蓄部分做得更好。這樣對你有幫助嗎？

Yeah, just how did you do that? What was -- was it in the inpatient admissions, outpatients? Just curious for a little more color there and what gives you confidence that that number is going to continue at that level, given how much --?

是啊，你是怎麼做到的？具體情況是──是住院病人還是門診病人？我只是好奇想了解更多細節，以及鑑於目前的情況，是什麼讓你確信這個數字會繼續保持在這個水平。——？

Yeah. I mean, look, there is a lot of little things, medication management, transitions of care, segmentation of patient population, having more access to patients earlier. We have new interventions and protocols. One of the difficulties of this business is of course understanding exactly what moves the needle, but rather the cumulative portfolio is working, and that's why we felt comfortable giving a plus $20 million for 2026.

是的。我的意思是，你看，有很多小事，例如藥物管理、護理過渡、患者群體細分、更早接觸患者等等。我們有了新的干預措施和方案。這個行業的困難之一當然是了解究竟是什麼因素推動了業績成長，但總的來說，整體投資組合運作良好，因此我們覺得可以放心地在 2026 年追加 2000 萬美元的投資。

Got it. Thanks.

知道了。謝謝。

(Operator Instructions) AJ Rice, UBS.

（操作說明）AJ Rice，瑞銀集團。

Thanks. Hi, everybody. First, you know there's been a lot of discussion and even talk about what you're doing with the IKC business about either people managing patients with CKD better and more effectively, and then obviously there's drugs, discussion about some of the drugs that could have an impact. And I wondered, what are you seeing about disease progression with someone that has kidney disease, time to get to dialysis, and then are you seeing them stay longer yet on dialysis, or when do you think any of that would have an impact?

謝謝。大家好。首先，你知道，關於你在 IKC 業務方面所做的工作，已經有很多討論，甚至有很多關於如何更好地、更有效地管理 CKD 患者的討論，當然還有藥物，關於一些可能產生影響的藥物的討論。我想知道，對於患有腎臟疾病的人來說，您觀察到的疾病進展如何？何時需要透析？透析後，您是否觀察到他們需要透析更長時間？或是您認為這些因素何時會產生影響？

Yeah, thanks for the question. The reality is that we have not seen anything shift, but you would think that that would take some time, as we've talked about. When you talk about these drugs, they're not magic drugs, but rather it takes some time of being on them to have the effect that you're talking about.

謝謝你的提問。現實情況是，我們還沒有看到任何變化，但正如我們之前討論過的，這需要一些時間。當你談到這些藥物時，它們並不是神奇的藥物，而是需要服用一段時間才能產生你所說的效果。

So right now, it's too early to tell. And again, we've only been managing these populations, these CKD populations for five years or so. So that will take longer to play out.

所以現在下結論還太早。再說一遍，我們對這些慢性腎臟病患者群體進行管理也只有大約五年。所以這件事需要更久才能塵埃落定。

Okay, and just maybe a follow-up on the Elara Caring investment. How should we think about that? Is it just a financial investment from your side? Are you going to do things operationally that might make a difference for you? Can you describe a little more of what's going on with that?

好的，或許可以跟進一下對 Elara Caring 的投資。我們該如何看待這個問題？對你來說，這僅僅是一筆財務投資嗎？你打算採取哪些實際行動來對你產生影響？能再詳細描述一下具體情況嗎？

Sure. Our investment thesis has two pieces to it. One is, of course, we have to have a capital return on that $200 million. We want to be disciplined. We think it's a good size investment, and we wanted to have good capital returns.

當然。我們的投資理念包含兩個部分。當然，首要條件是我們必須從這 2 億美元中獲得資本回報。我們想要自律。我們認為這是一筆規模合適的投資，我們希望獲得良好的資本回報。

The second one is to help our patient population. Roughly a quarter of our population uses home health, and by having a specialized kidney protocol, we think we can reduce hospitalization and readmissions and then of course, try to reduce missed treatments. So it is connecting back to this whole loop of trying to do more for our patients while we have them our clinic and now, outside of the clinic.

第二個目的是為了幫助我們的患者群體。我們大約有四分之一的人口使用家庭醫療保健服務，透過制定專門的腎臟治療方案，我們認為可以減少住院和再入院，當然，還可以努力減少漏診。所以，這又回到了我們努力為患者提供更多服務的整個循環中，無論他們是在我們的診所裡，還是現在在診所外。

Okay. thanks a lot.

好的，非常感謝。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Hey, good afternoon. Thanks for taking my questions. Can you talk about the International business for a little bit? How would you think about the top-line growth, whether it's M&A versus organic, and how would you think about margins within that segment?

嘿，下午好。謝謝您回答我的問題。能簡單談談國際業務嗎？您如何看待營收成長，是併購還是內生成長？您如何看待該細分市場的利潤率？

Yeah. I think on International, generally, I would think about the growth both top line and bottom line as half M&A and half organic. We would expect the margins to continue to improve as they leverage the fixed overhead both at the International level as well as in the existing market.

是的。我認為，就國際業務而言，一般來說，我會把營收和利潤的成長視為併購和內生成長各佔一半。我們預計，隨著他們在國際層面和現有市場中充分利用固定成本，利潤率將繼續提高。

International is proving to be a good business for us, a relatively consistent performer and a contributor about of about 1 point to OI growth over the last few years, and we're expecting more of the same in 2026.

國際業務對我們來說是一項不錯的業務，表現相對穩定，在過去幾年中為營業收入成長貢獻了約 1 個百分點，我們預計 2026 年也會如此。

Okay. And then I'm going ask just this question on a case a little bit differently. But looking at the losses you guys had in '22, '23, and '24, I mean, just refresh on those if you could, you know. I guess, why should we think about the rate of improvement of '26 or slowing dramatically? It seems as though the losses have compressed quite significantly as you've gotten scale. And so I'm curious why we wouldn't see the benefits grow sort of levels that we've seen in the last couple of years.

好的。然後，我將以稍微不同的方式就此案例提出這個問題。但看看你們在 2022 年、2023 年和 2024 年的失利，我的意思是，如果可以的話，請回顧一下那些失利。我想，我們為什麼要考慮 2026 年的進步速度，或是大幅放緩呢？隨著規模的擴大，損失似乎大幅減少。所以我很好奇，為什麼我們沒有看到收益成長到過去幾年所看到的水平。

Yeah. So look, your math is right. I think if you go back over the last three years, the average OI improvement has been somewhere in the $40 million to $50 million per year. And now we're seeing -- we're calling out a slowing of that. I think it's just a natural occurrence as the business matures and gets bigger, there's just less opportunity to continue to drive the margins up.

是的。所以你看，你的計算是對的。我認為，如果回顧過去三年，平均每年的 OI 改善額約為 4000 萬美元到 5000 萬美元之間。而現在我們看到——我們正在呼籲這種趨勢放緩。我認為隨著業務成熟和規模擴大，這是自然而然發生的現象，因為繼續提高利潤率的機會就越來越少了。

We're not expecting a high-margin business here. And so I think $20 million a year is a comfortable landing spot for us right now in terms of contribution to OI growth.

我們並不指望在這裡獲得高利潤。因此，我認為就目前我們對 OI 成長的貢獻而言，每年 2000 萬美元對我們來說是一個比較合適的落腳點。

Okay, and the last question here, just about new starts. You talked about new starts in the fourth quarter and we're back-end loaded. But as you think about new starts for 2026, how do you model that, and specifically, how do you break out the payer mix of those new starts versus the previous years as it relates to commercial or HICS or government patients? Thanks.

好的，最後一個問題，關於新的開始。你提到了第四季的新開始，而我們已經做好了後半程的準備。但是，當您考慮 2026 年的新開工專案時，您如何進行建模？具體來說，您如何將這些新開工項目的支付方構成與往年進行比較，例如商業保險、HICS 保險或政府保險患者？謝謝。

Yeah. So we're not calling out any dramatic change in new starts for next year similar to mortality and to some extent, missed treatment rates. When we see those things improve, we'll start calling them out. But until then, we're comfortable with flattish.

是的。因此，我們預計明年新開學人數不會像死亡率和某種程度的漏診率那樣劇烈變化。當這些情況有所改善時，我們會開始指出它們。但在此之前，我們對這種平坦的風格感到滿意。

In terms of mix, look, new patients have always had a higher commercial mix than the average patient. It's just the natural evolution of a patient as they get older. They tend to migrate towards Medicare. I don't see any change to that pattern going forward.

從成分來看，新患者的商業成分比例總是高於一般患者。這只是病人隨著年齡增長而發生的自然變化。他們往往會轉向聯邦醫療保險（Medicare）。我認為這種模式未來不會有任何改變。

Okay, so just to be super clear, the new starts that we're seeing coming in are the same commercial mix we've seen for the last several years. Thank you.

好的，為了說得更清楚些，我們看到的新項目與過去幾年我們看到的商業組合相同。謝謝。

Yeah. With the one call out around HIX and that changing. But other than that, I don't see any other new dynamic.

是的。圍繞 HIX 的一個呼籲正在改變。除此之外，我沒有看到其他新的變化。

Great. Thank you.

偉大的。謝謝。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

Thanks. On the flu vaccine commentary in the prepared remarks, did you say that there was an actual change in the vaccination rates this fourth quarter versus other fourth quarters, or was that just more related to seasonal sequential -- or seasonality sequentially?

謝謝。在準備好的演講稿中，關於流感疫苗的評論，您是說今年第四季度的疫苗接種率與其他第四季度相比發生了實際變化，還是說這更多地與季節性因素有關——或者說季節性因素本身就與接種率有關？

I believe what we said in the opening remarks is that in our high, we were in the 90 percentile, and we aspire to get back to that. And just to give you a bit of sense, right now, we're at 80%, which is from a national perspective, quite healthy, but we could do better.

我相信我們在開場白中已經說過，在我們最輝煌的時期，我們的成績位列前 90%，我們渴望重回那個水準。為了讓大家有個概念，目前我們的感染率是 80%，從全國來看，這相當不錯，但我們可以做得更好。

Got it. And I know the dialysis --

知道了。我知道透析--

The other thing I just point out is flu vaccines do go up in Q4 over Q3 and that does drive a little bit of RPT and a little bit of cost. So that's part of the Q4 over Q3 RPT dynamic as well.

我還要指出一點，流感疫苗在第四季度比第三季度有所增加，這確實會推高一些重複接種率和一些成本。所以這也是第四季相對於第三季RPT動態的一部分。

Yeah, that makes sense. And then just last thing, I know the dialysis population is a bit different from individual MA population, but -- if the kind of flat advanced notice holds for 2027 and the final notice, I guess, is there any maybe just directional change in what we could assume for outlook in terms of growth for 2027? Thanks.

嗯，有道理。最後一點，我知道透析人群與個人醫療援助人群略有不同，但是——如果提前通知的平穩情況持續到 2027 年，最終通知也是如此，那麼，對於 2027 年的增長前景，我們是否可以假設存在任何方向性的變化？謝謝。

Yeah, thanks for the question, Ryan. One of the things that is worthy of highlighting is that the ESRD population has its own funding pool in MA and that CMS has actually realized that there was an underfunding, so there was a catch up. So the dialysis or ESKD population will receive a 6% increase in 2027, which from our perspective, reflects the reality and would put an MA plan in a position to want to add these patients to the risk pool.

謝謝你的提問，瑞恩。值得強調的一點是，馬薩諸塞州為終末期腎病患者設立了專門的資金池，而且美國醫療保險和醫療補助服務中心（CMS）實際上已經意識到資金不足的問題，因此進行了追趕。因此，到 2027 年，透析或 ESKD 患者人數將增加 6%，從我們的角度來看，這反映了現實情況，並將使 MA 計劃傾向於將這些患者納入風險池。

And Ryan, the one thing I'd add to that is not only is the reimbursement different, but the whole coding regime is different. So the questions around V28 and rebasing and the higher coding intensity in a given year, those are not part of -- or they're a much smaller part of the math for ESRD MA rates. And if you look at the notice from last week, you'd see it in there all as well. So it's all spelled out.

Ryan，我還要補充一點，不只報銷方式不同，整個編碼制度也不同。因此，關於 V28、重新基準化以及特定年份更高的編碼強度的問題，這些都不是 ESRD MA 費率計算的一部分，或者說它們只佔很小一部分。如果你看看上週的通知，你也會在裡面看到這些內容。一切都說清楚了。

All right. Thank you.

好的。謝謝。

Thank you.

謝謝。

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

謝謝。目前我不再提出其他問題。各位發言者，我稍後會請你們作總結發言。

Thank you, Michelle, and thank you, all, for joining. I hope it is 100% clear that our energy and excitement around clinical opportunities are absolutely off the charts to expand the lives of our patients. We have a powerful alignment between our clinical ambitions and our financial goals. By fulfilling our mission to deliver the best care for our patients, we can also deliver returns for our shareholders.

謝謝米歇爾，也謝謝各位的參與。我希望大家能夠百分之百地明白，我們對臨床機會的熱情和活力絕對是空前的，我們致力於改善病患的生活。我們的臨床目標與財務目標高度契合。透過履行我們為患者提供最佳照護的使命，我們也可以為股東帶來回報。

Thank you for your interest, and thank you for joining the call today. Have a good day.

感謝您的關注，也感謝您今天參加電話會議。祝你有美好的一天。

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。