德維特 (DVA) 2026 Q1 法說會逐字稿

Good evening. My name is Michelle, and I will be your conference facilitator today. At this time, I would like to welcome everyone to the DaVita first-quarter 2026 earnings call. (Operator Instructions)

晚安。我叫 Michelle，今天將擔任本次電話會議的主持人。此刻，我謹代表公司歡迎各位參加 DaVita 2026 年第一季財報電話會議。(接線員指示)

Mr. Eliason, you may begin your conference.

Eliason 先生，您可以開始您的會議。

Thank you, and welcome to our first-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，歡迎各位參加我們的第一季電話會議。感謝各位持續關注本公司。我是 Nic Eliason，投資人關係部門集團副總裁。今天與我一同出席的還有我們的執行長 Javier Rodriguez，以及我們的財務長 Joel Ackerman。

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

請注意，在本次電話會議中，我們可能會在聯邦證券法的意義下作出前瞻性陳述。所有這些陳述均受已知及未知的風險與不確定性影響，可能導致實際結果與前瞻性陳述所描述者存在重大差異。

For further details concerning these risks and uncertainties, please refer to our first-quarter earnings press release and our SEC filings, including our most recent annual report on Form 10-K, all subsequent quarterly reports on Form 10-Q and other subsequent filings that we make with the SEC. Our forward-looking statements are based on information currently available to us, and we do not intend and undertake no duty to update these statements, except as may be required by law.

關於上述風險與不確定性的更多細節，請參閱我們的第一季財報新聞稿以及向美國證券交易委員會（SEC）提交的文件，包括我們最近一期的 Form 10-K 年度報告、其後所有 Form 10-Q 季度報告，以及我們向 SEC 提交的其他後續文件。我們的前瞻性陳述係基於目前可得資訊，我們無意且不承擔更新這些陳述之義務，除非法律另有要求。

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，我們也提醒各位，在本次電話會議中我們將討論部分非 GAAP 財務衡量指標。這些非 GAAP 指標與最可比的 GAAP 財務衡量指標之調節表，已包含於我們提交給 SEC 的財報新聞稿中，並可於我們的網站取得。

I will now turn the call over to Javier Rodriguez.

接下來我將把電話會議交給 Javier Rodriguez。

Thank you, Nic. Good afternoon, everyone, and thank you for joining the call today. DaVita’s foundation is clinical excellence, driven by operating rigor that produces durable results. We have consistently delivered exceptional clinical outcomes and strong financial performance, and this quarter is no exception.

謝謝你，Nic。各位下午好，感謝各位今天加入本次電話會議。DaVita 的根基在於臨床卓越，並由嚴謹的營運管理所驅動，以產生持久的成果。我們一貫交出卓越的臨床結果與強勁的財務表現，本季亦不例外。

To ensure we sustain and build upon this foundation, we're actively investing in our future capabilities. In a rapidly evolving landscape, we're taking a pragmatic approach to expanding our IT systems and digital infrastructure. These targeted technology investments are designed to empower our clinical teams and serve as a backbone for our next chapter of clinical and operational excellence.

為了確保我們能維持並在此根基上持續精進，我們正積極投資於未來能力。在快速演變的環境中，我們以務實的方式擴充 IT 系統與數位基礎建設。這些聚焦的科技投資旨在賦能我們的臨床團隊，並作為我們下一階段臨床與營運卓越的骨幹。

Today, I'll walk through our first-quarter performance, share how technology is enhancing our operations, provide an update on ACA plans and finish with our outlook for the remaining of the year. But first, I'll start as we always do with a clinical highlight.

今天我將說明第一季的表現，分享科技如何強化我們的營運，提供 ACA 計畫的最新進展，並以我們對今年剩餘期間的展望作結。不過首先，我會一如往常先從一項臨床亮點開始。

This quarter, we're highlighting the continued momentum of Integrated Kidney Care, or IKC, our value-based care business. In the latest results from CMS' comprehensive kidney care contracting program, or CKCC, we delivered year-over-year improvements across all three key measurements, which are: gross savings rates, total quality score, and high-performing status.

本季我們要強調的是整合式腎臟照護（Integrated Kidney Care，簡稱 IKC）—也就是我們的價值型照護業務—持續增長的動能。在 CMS 的「全面性腎臟照護契約計畫」（comprehensive kidney care contracting program，簡稱 CKCC）最新結果中，我們在三項關鍵衡量指標上皆較去年同期改善，分別為：總節省率（gross savings rates）、總品質分數（total quality score）以及高績效（high-performing）資格。

Clinically, this means our IKC care model, together with our physician partners, is improving the health and well-being of our patients. Economically, we generated the highest total aggregate savings of any participant driven by our 4.5% improvement in gross saving rate since the beginning of the program. This is a clear example of how IKC clinical rigor paired with data-driven insights is delivering better outcomes for our patients and more sustainable model for the future of kidney care.

在臨床面，這代表我們的 IKC 照護模式與醫師合作夥伴共同提升了病患的健康與福祉。在經濟面，我們自計畫開始以來總節省率提升 4.5%，帶動我們創下所有參與者中最高的總合計節省金額。這清楚展現 IKC 的臨床嚴謹度結合數據驅動洞察，如何為病患帶來更佳結果，並為腎臟照護的未來打造更可持續的模式。

Turning to the first quarter. We delivered a strong financial results ahead of our expectations with outperformance from each element of our US dialysis trilogy: treatment volume, revenue per treatment and cost per treatment. This balanced outperformance reflects the strength of our team and our focus on consistent execution. I'll touch on a couple of key metrics that contributed to the quarter and will help shape the remainder of the year.

接著談第一季。我們交出超出預期的強勁財務成果，且美國透析三部曲（US dialysis trilogy）的每個要素皆有優於預期的表現：治療量、每次治療收入，以及每次治療成本。這種均衡的超預期表現反映了團隊的實力，以及我們對穩健執行的專注。我將提及幾項促成本季表現、並將影響今年剩餘期間的關鍵指標。

Starting with volume. In the first quarter, our treatment volume was slightly ahead of forecast. Quarter-end census was ahead of plan as a result of better-than-forecasted mortality, partially offset by lower than forecasted admits.

先從量談起。第一季我們的治療量略高於預測。季末在治病患數（census）高於計畫，原因是死亡率優於預期，但部分被新收治入院（admits）低於預期所抵銷。

Census also benefited from patient transfers in related to ongoing clinic closures by Fresenius. Although negligible in the first-quarter volume, we anticipate that these transfers will contribute to positive treatment growth over the remainder of the year. As a result, we're raising our volume growth expectations for the full year from flat to a range of 25- to 50-basis-point increase. Approximately half of the increase is from better underlying performance and half is related to transfer in from Fresenius.

在治病患數也受惠於 Fresenius 持續關閉診所所帶來的病患轉入。雖然對第一季治療量的影響可忽略不計，但我們預期這些轉入將在今年剩餘期間帶來正向的治療量成長。因此，我們將全年治療量成長預期由持平上調至增加 25 至 50 個基點的區間。其中約一半的上調來自更佳的基本面表現，另一半則與 Fresenius 的轉入相關。

Switching to labor. Q1 was ahead of plan, primarily from better productivity, which we expect to sustain over the balance of the year.

再談人力。第一季表現優於計畫，主要來自更佳的生產力，我們預期這項表現可在今年剩餘期間持續。

Let me turn to our technology strategy and the investments we're making to strengthen our operations and ultimately, our clinical outcomes. We're taking a disciplined approach to AI that we've been building towards for years, and we're seeing that groundwork translate into real impact.

接著我談談我們的科技策略，以及我們為強化營運、並最終改善臨床結果所進行的投資。我們以嚴謹的方式推進 AI，這是我們多年來持續建構的方向，而我們也看到這些基礎工作正在轉化為實質影響。

Our strategy has two parts. First, we've modernized our data infrastructure. This means standardizing and integrating high-quality data across the enterprise through systems like our proprietary EMR platform. That work gives us a differentiated foundation to power AI applications at scale.

我們的策略分為兩部分。第一，我們已將資料基礎建設現代化。這代表透過我們的專有 EMR 平台等系統，在全企業範圍內將高品質資料標準化並加以整合。這些工作為我們提供了具差異化的基礎，使 AI 應用能以規模化方式運作。

Second, we're actively deploying AI solutions across clinical, operational and business use cases with a focus on supporting our caregivers, improving how we operate and drive measurable impact. One example is Schedule Hub, a new tool that dynamically processes changes in each center's patient census, capacity and teammate availability to recommend optimal patient and staffing schedules in real time.

第二，我們正積極在臨床、營運與商業等使用情境部署 AI 解決方案，重點在於支援照護人員、改善營運方式並帶來可衡量的影響。其中一個例子是 Schedule Hub，這是一項新工具，可動態處理各中心病患在治人數、產能與同仁可用性等變動，即時建議最佳的病患與人力排程。

Given the complexity of the center scheduling, we expect this will reduce administrative burden for our facility administrators and enhance teammate experience while supporting patient care. This is one of many examples where our sustained IT investments translate into tangible scale benefits across the enterprise. We're still early in our AI journey, but given the strength of our data foundation, and the pace of our deployment, we are well positioned to outperform both clinically and operationally as technology evolves.

鑑於中心排程的複雜性，我們預期這將降低院所管理者的行政負擔，並在支援病患照護的同時提升同仁體驗。這只是眾多例子之一，說明我們持續的 IT 投資如何在全企業範圍內轉化為具體的規模效益。我們的 AI 旅程仍在早期，但憑藉強大的資料基礎，以及部署速度，我們已具備良好條件，能隨著科技演進在臨床與營運兩方面持續領先。

Next, on ACA plan enrollment. Based on what we know today, ACA open enrollment is trending towards a slightly favorable outcome relative to our prior expectations of an approximately $40 million headwind in 2026. This favorability will be partially offset by more patients selecting lower-level bronze plans, which translates to higher out-of-pocket costs and modest RPT headwind. We will gain greater clarity on the enrollment outcome and mix impact as we get deeper into the year.

接下來談 ACA 計畫投保。就我們目前所知，ACA 開放投保的趨勢相較於我們先前對 2026 年約 4,000 萬美元不利影響（headwind）的預期，略為有利。這項有利因素將部分被更多病患選擇較低層級的青銅方案所抵銷；這會導致更高的自付費用，並帶來溫和的每次治療收入（RPT）不利影響。隨著我們在今年進一步推進，我們將對投保結果及組合影響取得更高的明確性。

I will conclude my remarks with our financial outlook for the remainder of the year. With our first-quarter results, we're off to a strong start for the year. As a result, we're raising and narrowing our guidance for adjusted operating income to a range of $2.15 billion to $2.25 billion. Similarly, we're raising our adjusted EPS guidance to a range of $14.10 to $15.20 per share. The increased guidance is primarily the result of our higher volume forecast for the year and lower patient care costs.

最後我以今年剩餘期間的財務展望作結。憑藉第一季的成果，我們今年開局強勁。因此，我們上調並收斂調整後營業利益（adjusted operating income）指引至 21.5 億至 22.5 億美元。同樣地，我們也將調整後每股盈餘（adjusted EPS）指引上調至每股 14.10 至 15.20 美元。指引上調主要反映我們對全年治療量預測提高，以及病患照護成本降低。

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

接下來我將把電話會議交給 Joel，請他更詳細說明我們的財務表現。

Thank you, Javier. Today, I'll provide details on our first-quarter results, then give you some more context on the update to 2026 guidance that Javier shared.

謝謝你，Javier。今天，我將提供我們第一季業績的細節，接著再補充一些背景，說明 Javier 所分享的 2026 年指引更新。

First-quarter adjusted operating income was $482 million. Adjusted earnings per share from continuing operations was $2.87 and free cash flow was $140 million. Adjusted operating income came in about $50 million ahead of our forecast. Approximately half was the result of performance ahead of plan and the other half the result of timing.

第一季調整後營業利益為 4.82 億美元。持續營運的調整後每股盈餘為 2.87 美元，自由現金流為 1.40 億美元。調整後營業利益約比我們的預測高出 5,000 萬美元。約一半來自於表現優於計畫，另一半則來自於時點因素。

Starting with detail on the US Dialysis segment. Treatments declined about 20 basis points versus the first quarter of 2025 and treatments per normalized day increased 40 basis points versus Q1 of 2025, approximately 20 basis points ahead of our expectations. As Javier mentioned, we are increasing our full-year volume forecast to 25 to 50 basis points.

先從美國透析（US Dialysis）事業部的細節談起。相較於 2025 年第一季，治療次數約下降 20 個基點；每標準化日治療次數相較 2025 年第一季增加 40 個基點，約比我們的預期高出 20 個基點。如 Javier 所提到的，我們將全年量能預測上調至 25 到 50 個基點。

As a reminder, this represents our forecast for treatment growth. This translates to a 50 to 75 basis points of growth in treatments per normalized day because of the year-over-year treatment per normalized day headwind in 2026 compared to 2025.

提醒一下，這代表我們對治療量成長的預測。由於 2026 年相較 2025 年在每標準化日治療次數上存在年對年逆風，這將轉換為每標準化日治療次數成長 50 到 75 個基點。

Revenue per treatment declined approximately $5 sequentially, primarily as a result of the typical first-quarter headwind from patient pay responsibility. Year-over-year RPT growth was approximately 4% in the quarter. We still expect full-year RPT growth in the range of 1% to 2%.

每次治療收入（RPT）較前一季約下降 5 美元，主要是因為第一季通常會受到病患自付責任（patient pay responsibility）帶來的季節性逆風影響。本季 RPT 年對年成長約 4%。我們仍預期全年 RPT 成長落在 1% 到 2% 的區間。

Patient care cost per treatment were about flat to the fourth quarter. This was primarily the result of a seasonal decline from high health benefit costs in the fourth quarter, offset by typical increases in wages and other cost growth. Patient care costs were lower than expected, largely as a result of better-than-expected productivity improvements.

每次治療的病患照護成本與第四季大致持平。這主要是因第四季健康福利成本偏高，第一季出現季節性下降，但被薪資與其他成本成長的典型上升所抵銷。病患照護成本低於預期，主要是因為生產力改善優於預期。

US Dialysis G&A costs declined $16 million from the seasonally high fourth quarter, although growth versus the first quarter of 2025 was about $37 million or 13%. This growth is the result of continued investment in technology.

美國透析的管理費用（G&A）較季節性偏高的第四季減少 1,600 萬美元，但相較 2025 年第一季增加約 3,700 萬美元或 13%。這項成長來自於我們持續投資科技。

Turning to our Other segments. In the first quarter, International adjusted operating income was $30 million, and IKC had an adjusted operating loss of $19 million, both in line with our expectations. Regarding capital allocation, we repurchased 3 million shares during the first quarter, and we repurchased an additional 2 million shares since the end of the quarter, which includes the shares bought from Berkshire Hathaway pursuant to our repurchase agreement.

接著看我們的其他事業部。第一季，國際事業調整後營業利益為 3,000 萬美元，IKC 的調整後營業損失為 1,900 萬美元，兩者皆符合我們的預期。在資本配置方面，我們在第一季回購了 300 萬股，且在季末後又額外回購了 200 萬股，其中包含依據我們的回購協議向波克夏海瑟威（Berkshire Hathaway）買回的股份。

At the end of the first quarter, our leverage ratio was 3.34 times consolidated EBITDA, well within our target leverage range of 3 to 3.5 times. Below the operating income line, other income was $4 million, a sequential increase primarily as the result of no longer recognizing losses from our investment in Mozarc.

第一季末，我們的槓桿比率為合併 EBITDA 的 3.34 倍，仍明顯落在我們目標槓桿區間 3 到 3.5 倍之內。在營業利益線以下，其他收益為 400 萬美元，較前一季增加，主要是因為我們不再認列對 Mozarc 投資的損失。

Debt expense in the first quarter was $145 million. As an update to our guidance, we now expect quarterly debt expense for the remainder of the year to be similar to Q1 due to higher share repurchases and higher interest rate expectations resulting in full-year debt expense about flat to last year.

第一季債務費用為 1.45 億美元。作為指引更新，我們目前預期今年剩餘季度的單季債務費用將與第一季相近，原因是股票回購增加以及利率預期較高，使得全年債務費用大致與去年持平。

For 2026 guidance, as Javier described, we are raising our adjusted operating income guidance range by $40 million at the midpoint. The largest driver of the increase is our expectations for higher treatment volume. The second factor is an expectation for continued labor efficiencies within patient care costs.

就 2026 年指引而言，如 Javier 所述，我們將調整後營業利益指引區間的中位數上調 4,000 萬美元。上調的最大驅動因素是我們對治療量更高的預期。第二個因素是預期病患照護成本中的人力效率將持續改善。

Regarding the phasing of our guidance through the balance of the year, we currently expect adjusted operating income to be about evenly split across each of the three remaining quarters, which assumes Q4 weighted IKC operating income. Our expectations are that the seasonal pattern we saw in 2025 are not typical, and we expect to see phasing more in line with 2024.

關於今年剩餘期間指引的分布（phasing），我們目前預期調整後營業利益將在剩下三個季度大致平均分配，這也假設 IKC 的營業利益在第四季權重較高。我們認為 2025 年看到的季節性型態並不典型，預期分布將更接近 2024 年。

Moving to EPS. We are also increasing our adjusted EPS guidance consistent with our updated guidance range for adjusted operating income.

接著談 EPS。我們也將依據更新後的調整後營業利益指引區間，同步上調調整後 EPS 指引。

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

以上是我今天準備好的發言。接線員，請開放問答。

(Operator Instructions) Kevin Fischbeck, Bank of America.

(接線員指示) 美國銀行（Bank of America）的 Kevin Fischbeck。

I wanted to dig in a little bit to the volume commentary. I guess, is there any way that you can kind of break out whether weather had an impact, how much that was? And then the improved mortality? Is there a way to kind of break that into what was maybe just a light flu season year over year versus underlying trends you're trying to think about how durable the better mortality at the rest of this year?

我想更深入了解一下你們對量能的評論。我想問，有沒有辦法拆解一下天氣是否有影響、影響有多少？以及死亡率改善的部分？能否拆解為：年對年只是流感季較輕微的影響，還是你們所觀察到的基本面趨勢？我在思考今年剩餘期間較佳死亡率的可持續性。

Yeah. Thanks for the question, Kevin, on weather, weather came in exactly as we expected. As you would imagine, we build weather into our forecast. It can range from year to year. It was, as I said, in line with forecast, I'd call it, about 10 bps better than last year.

是的。謝謝你的問題，Kevin。就天氣而言，實際情況完全符合我們的預期。如你所想，我們會把天氣因素納入預測。它每年可能會有差異。如我所說，與預測一致；若要形容，大約比去年好 10 個基點。

In terms of flu overall, again, came in line with our forecast. What we had said at the beginning of the year was we were building in a flu season that looked like two years ago. And while the pattern was a little different quarter over quarter, the impact for us was about what we expected. As we think about flu, we focus on cumulative hospitalizations, which you can find on the CDC website as the main driver of volume impact for us, and this year is in line with what we saw two years ago.

至於整體流感，同樣也符合我們的預測。我們在年初說過，我們假設的流感季會像兩年前那樣。雖然各季度之間的型態略有不同，但對我們的影響大致如預期。在評估流感時，我們主要關注累計住院數（cumulative hospitalizations），你可以在 CDC 網站上查到；這是對我們量能影響的主要驅動因素，而今年與兩年前所見的情況一致。

In terms of splitting out the mortality coming in a little better than expected. It was probably not about the flu because flu came in as expected. It was more around the underlying mortality.

至於死亡率略優於預期的拆解，可能不是因為流感，因為流感如預期。更多是來自於基本面的死亡率。

Okay. Great. And then can you just give a little more color on the rate update? Why was the rate so strong in Q1 relative to your guidance for the year?

了解。很好。另外，你能否再多補充一些費率更新的細節？為什麼第一季的費率相較你們全年指引來得這麼強？

Yeah. So rate -- RPT was up a little more than 4%, so call it $17.50. I would say two-thirds of that was normal stuff in terms of rate increases and mix shifts. About, call it, $6 I would attribute to timing. Part of that was negative timing in Q1 of '25 and part of it was positive timing this year.

好的。所以費率——RPT 上升了略高於 4%，約 17.50 美元。我會說其中三分之二是正常因素，例如費率上調與組合（mix）變動。大約 6 美元我會歸因於時點因素。其中一部分是 2025 年第一季的負向時點，另一部分則是今年的正向時點。

We see timing -- we call it out frequently around RPT. And for the year, we're sticking with our 1% to 2% guide.

我們經常在 RPT 上提到時點因素——我們會特別點出來。而就全年而言，我們仍維持 1% 到 2% 的指引。

Okay. So nothing unusual there around like drugs or binders or anything like that kind of skewed the number?

了解。所以在藥品或磷結合劑（binders）之類的項目上，沒有什麼不尋常的因素把數字拉歪，對嗎？

No, nothing unusual.

沒有，沒有任何不尋常的情況。

Okay. And then maybe just the last question. Can you talk a little bit more about the ACA impact and how you're thinking about it. It sounds like you're saying it was coming in better, but it sounds like the guidance hasn't changed yet for the year -- did I get that right?

了解。最後一個問題。你能否再多談一些 ACA 的影響，以及你們如何看待它？聽起來你們是說表現比預期好，但全年指引似乎還沒有改變——我理解得對嗎？

And then how are you thinking about the timing? Is it that Q1 came in better? Now you're assuming it's going to ramp? Or did you always assume Q1 was going to be a little bit lighter relative to the year, thoughts there?

另外，你們如何看待時點？是第一季表現較好，現在你們假設之後會逐步升高（ramp）？還是你們原本就假設第一季相對全年會比較輕一些？想聽聽你們的想法。

Yeah, Kevin, it's a great question. And the reality is that it is very early. So just to repeat, Q1 was pretty flattish to Q4. So it has performed better than we expected. That said, the reality is that we haven't seen the effectuation rate and the affordability play out. And so it's too early. We have to see payments and we have to see enrollment over time. And that's why we're thinking it's a little premature to change our numbers.

是的，Kevin，這是個很好的問題。而現實是現在還非常早。所以再重申一次，第一季相較第四季大致持平。因此它的表現比我們預期更好。不過，現實是我們尚未看到實際生效率（effectuation rate）以及可負擔性（affordability）的影響完全展現。所以現在下結論還太早。我們必須觀察付款情況，也必須隨時間觀察投保／註冊（enrollment）。這也是為什麼我們認為現在就改變我們的數字有點言之過早。

But the reality is that we will need -- the real data point that we want to see is the mix of our future incidence. And that is, of course, too early to tell. So we're holding to that 40 number. Although right now, we would be trending -- $40 million number -- we're trending a little better than that.

但現實是我們將需要——我們真正想看到的關鍵數據點，是我們未來發生率（incidence）的組合（mix）。而這當然現在還太早無法判斷。所以我們仍維持那個40的數字。雖然就目前而言，我們的趨勢——4,000萬美元這個數字——看起來略優於此。

Andrew Mok, Barclays.

Andrew Mok，巴克萊。

Hoping you could provide more color on what you're doing to position yourself to capture market share and the visibility you have into those share gains at this point to raise guidance, specifically within to the clinic closures?

希望你們能更具體說明，為了爭取市占你們正在做哪些布局，以及在目前這個時間點，你們對於這些市占提升的可見度有多少、足以提高財測，特別是在診所關閉（clinic closures）方面？

Look, at the end of the day, we, of course, are in a very competitive market. The centers that are being closed, you can assume are small centers, and you can also assume that Fresenius and anyone that closes the center would work hard to try to keep those patients in their own network and with their same physicians, et cetera.

你看，歸根結底，我們當然處在一個競爭非常激烈的市場。那些被關閉的中心，你可以假設是小型中心；你也可以假設，Fresenius以及任何關閉中心的業者，會非常努力地嘗試把那些病患留在他們自己的網路內、並維持由同樣的醫師照護等等。

And so we are, of course, making sure that the market is aware of our chair availability and our physician access and all the things that one would do. And then, of course, the patients and the physicians will make their choice.

因此我們當然會確保市場知道我們的透析椅位（chair）可用量、我們的醫師可近性（physician access），以及所有一般會做的事情。然後當然，病患與醫師會做出他們的選擇。

Great. And then I just wanted to follow up on the mortality comment. I appreciate that flu wasn't necessarily the driver. But any color on the underlying mortality performance would be helpful considering that's an important metric for building consensus and volumes for the balance of the year?

了解。另外我想追問一下關於死亡率（mortality）的評論。我理解流感不一定是主要驅動因素。但考量到這是建立市場共識與全年其餘期間量能（volumes）的重要指標，若能提供一些底層死亡率表現的說明會很有幫助？

Yeah. It is an important metric. You're absolutely right about that, Andrew. I would say the changes are rather small, and we're not ready to call out any significant underlying trend. That said, we did up the volume guidance, and it's captured in there.

是的。這確實是個重要指標。Andrew，你說得完全正確。我會說變化幅度相當小，我們還不準備指出任何顯著的底層趨勢。不過，我們確實上調了量能指引（volume guidance），而這已反映在其中。

I guess, how are you able to isolate that it was mortality versus some of the other dynamics in the market with flu and clinic closures?

我想問的是，你們如何能夠判斷這是死亡率所致，而不是流感與診所關閉等市場其他動態造成的？

Clinic closures are a separate issue because they are about admissions, and we've got a lot of visibility on patients coming in and patients leaving. In terms of mortality, as we've said before, it can be a hard variable to know in real time, but we feel pretty good about what we saw from Q1 now that we're sitting here in May.

診所關閉是另一個議題，因為它關乎收治／入院（admissions），而我們對於病患進來與離開有很高的可見度。至於死亡率，如同我們之前說過的，它可能是一個很難即時掌握的變數，但現在我們坐在五月回頭看第一季的情況，我們對所看到的結果相當有把握。

Andrew, I think let me try and be helpful with this because you're asking the right question. And there are several inputs that go into treatments. As you can imagine, you've got seasonality, you've got mortality, you've got admissions, you've got missed treatments, you've got transfers, but they're all pretty small. And so what we're trying to do is instead of going into a world of small numbers, give you a range that handicaps all of those variables.

Andrew，我想我試著在這點上提供一些幫助，因為你問的是對的問題。而影響治療次數（treatments）的投入因素有好幾個。如你所想像的，有季節性、有死亡率、有收治、有缺席治療（missed treatments）、有轉院（transfers），但它們的影響都相當小。因此我們想做的是，不要陷入一堆小數字的世界，而是給你一個能涵蓋所有這些變數的區間。

Pito Chickering, Deutsche Bank.

Pito Chickering，德意志銀行。

Just a follow-up on the treatment commentary. Can you just talk about the new starts to dialysis in first quarter. And as you think about Fresenius scaling in from their closures, is this an immediate ramp in sort of 1Q, 2Q and then normalize in the back half of the year? Just want to make sure that as you're increasing your treatment growth guidance here that we're also modeling where you guys go from 2Q and then where you guys finished the year in fourth quarter?

針對治療量評論再追問一下。你能談談第一季新開始透析（new starts to dialysis）的情況嗎？另外，當你們考量Fresenius因關閉中心而帶來的規模移轉（scaling in），這會是在第一季、第二季立即爬升，然後在下半年回歸正常嗎？我只是想確認，當你們上調治療量成長指引時，我們在模型上應該如何從第二季推到你們在第四季的全年收尾？

Yeah. So on the admit side, I don't think we've got a lot of color to go in. We're talking about basis points of change and then to go to the next level and bifurcate that among all the inputs that Javier mentioned, I think, gets us to a point of false precision.

是的。就收治（admit）端而言，我不認為我們有太多細節可以補充。我們談的是幾個基點（basis points）的變化；再往下一層、把它在Javier提到的所有投入因素之間做拆分，我認為會讓我們落入一種虛假的精準（false precision）。

In terms of timing on the new starts, we saw, what I would guess is about half the new starts from Fresenius that we would see by the end of the first quarter, we would guess the other half will come in Q2. So if you're thinking about how to model them, I would say we'll get probably two-thirds of a year worth of those new starts.

至於新開始（new starts）的時間點，我們看到的情況是：到第一季末為止，我猜大約已經出現了我們預期會從Fresenius那邊看到的新開始的一半；我們推測另一半會在第二季進來。所以如果你在思考要怎麼建模，我會說我們大概會拿到相當於全年三分之二的新開始量。

So does -- when we pull together with the new starts, in the mortality and the Fresenius, kind of where should we be ending the fourth quarter from a treatment -- organic treatment growth perspective?

所以——把新開始、死亡率以及Fresenius的因素合在一起看，從治療量——有機治療量成長（organic treatment growth）的角度，你們認為第四季結束時應該落在什麼水準？

Yeah. I think the way we're thinking about it is treatments per normalized day, which we think takes out the quarter-to-quarter and year-to-year noise associated with the different number of days in a quarter and a different mix of Monday, Wednesday, Friday, Tuesday, Thursday, Saturday. So what we would expect is the normalized treatment per day count to grow over the course of the year. It's sitting today at about 40 bps positive, and we would expect that to grow over the course of the year.

是的。我們的思考方式是看「每個標準化日（normalized day）的治療次數」，我們認為這能排除因每季天數不同、以及週一三五與週二四六組合不同所造成的季對季、年對年的雜訊。因此我們預期，每日標準化治療次數會在全年過程中逐步成長。目前大約是正向40個基點，我們預期它會在全年過程中持續上升。

Just to make sure everyone's following how we're thinking about this, our new guide for treatment volume is plus 25 to 50 bps. Because there's a 25-day (sic - basis point) (corrected by company after the call) headwind in the year on normalized treatment days, our guide for the year would be plus 50 to 75 bps of normalized treatments per day. So that's 40 now getting to that average of 50 to 75 for the year ending somewhere higher than that.

為了確保大家都跟上我們的思路，我們新的治療量指引是增加25到50個基點。由於全年在標準化治療日（normalized treatment days）上有25天（原文如此——基點）（公司於電話會議後更正）的逆風，我們對全年「每個標準化日的治療次數」指引會是增加50到75個基點。所以現在是40，全年平均會到50到75，年末會落在高於該區間平均值的某個水準。

Okay. Great. And then a follow-up here on the revenue per treatment. If you flow out the $6 you're talking about from a timing perspective, it gets us to $411, $412, typically, 2Q ramps $4 or $5 as you burn through the deductibles and then we see continued ramp in the third quarter and then obviously, fourth quarter, we get the update with the new Medicare rates.

好的。了解。接著追問每次治療收入（revenue per treatment）。如果把你提到的6美元按時間因素攤開，通常會讓我們到411、412美元；一般第二季會因為逐步用完自付額（deductibles）而上升4或5美元，然後第三季持續爬升，接著很明顯第四季會因新的Medicare費率更新而再調整。

I guess, I'm trying to figure out how we're still getting to your 1% to 2% revenue per treatment guidance growth, even pulling out the $6 in the fourth quarter -- from the first quarter -- because of normal seasonality gets you in revenue per treatment?

我想弄清楚的是，即使把第一季的6美元（第四季的部分）扣掉——因為正常季節性會推升每次治療收入——我們怎麼還能達到你們所給的每次治療收入成長1%到2%的指引？

Yeah. So I think there are two dynamics. One is normal variability. So the quarter was a little higher, and you take that out. The second dynamic is around mix and the enhanced premium tax credits. What we would expect is commercial mix to decline over the course of the year, and that will put pressure on RPT, which would help you bridge from a higher number in Q1 to the 1% to 2% for the year.

是的。我認為有兩個動態。第一個是正常的波動。所以這一季稍微高一些，把它剔除。第二個動態與組合（mix）以及加強版保費稅額抵免（enhanced premium tax credits）有關。我們預期商業保險組合（commercial mix）會在全年過程中下降，這會對每次治療收入（RPT）造成壓力，從而幫助你把第一季較高的數字銜接到全年1%到2%的水準。

Okay. But at this point, through April, you haven't seen that negative HIX that you're guiding to, you're just sort of just assuming it comes until the later on the year?

好的。但截至目前、到四月為止，你們還沒有看到你們所指引的那個負向 HIX，你們只是有點假設它會在今年稍晚出現嗎？

That's correct.

沒錯。

Great. And then last question. Your G&A for treatment, you talked about was up 13% due to tech investments. Where does it end the year? And kind of -- should we think about this declining linear throughout the year as those investments were made or just any color around how we should be modeling G&A treatments for -- G&A cost per treatment throughout the year as the tech investments begin to decline?

很好。那最後一個問題。你們提到每次治療的 G&A 上升了 13%，原因是科技投資。那到年底會落在哪裡？另外——我們是否應該把它視為隨著投資完成而在全年線性下降，還是你能提供一些方向，讓我們在全年、隨著科技投資開始下降時，該如何建模每次治療的 G&A——也就是每次治療的 G&A 成本？

Yeah. I appreciate the question on G&A. And I want to reassure you that we are looking at this incredibly diligently. And if one looks at G&A independently, that line is growing at a faster rate than revenue.

是的。我很感謝你對 G&A 的提問。我也想向你保證，我們正在非常嚴謹地檢視這件事。如果單獨看 G&A，那一條線的成長速度確實快於營收。

And so I think it's worthwhile to let you know our philosophy on it, which is we look at G&A as a piece of the total cost. In other words, we're not trying to optimize G&A, but rather not worry about the geography of the expense as long as a sum of the parts add up to a good number.

所以我覺得有必要讓你了解我們的理念：我們把 G&A 視為總成本的一部分。換句話說，我們不是要單獨去最佳化 G&A；只要各部分加總起來是個好數字，我們就不會太在意費用在地理上（在損益表上的歸類）落在哪裡。

So if you look at the last five years CAGR on our total cost, which includes patient care costs, depreciation and amortization and G&A, that CAGR is 2.6%. And so we spend a lot of time trying to make sure that we optimize the cost, and we worry less about the geography on the P&L. So I think that our guide will stand on our cost, which is that 1.25% to 2.25% we gave at the beginning of the year.

所以如果你看我們過去五年總成本的年複合成長率（CAGR），其中包含病患照護成本、折舊與攤銷以及 G&A，那個 CAGR 是 2.6%。因此我們花很多時間確保把成本最佳化，而比較不去擔心它在損益表上的「地理位置」。所以我認為我們對成本的指引會維持不變，也就是年初給的 1.25% 到 2.25%。

(Operator Instructions) Justin Lake, Wolfe Research.

（接線員指示）Justin Lake，Wolfe Research。

This is Dylan on for Justin. Just a couple of quick questions. What did commercial mix do in the quarter? And then also curious on the Medicare Advantage side, can you speak a little bit about what the growth in share was as well?

我是代替 Justin 的 Dylan。我有幾個很快的問題。本季商業保險組合（commercial mix）表現如何？另外也想問 Medicare Advantage 這邊，你能談談市占成長大概是多少嗎？

Yeah. Thanks, Dylan, for the question. The answer is pretty much the same on both. They were pretty flat relative to last quarter.

好的。謝謝你，Dylan，這個問題。兩個問題的答案幾乎一樣。相較於上一季都相當持平。

AJ Rice, UBS.

AJ Rice，UBS。

Maybe just to ask on a couple of items that are mentioned in the press release, whether there's anything significant to call out. You talk about a decrease year to year and health benefit expense, pharmaceutical cost, and then on the G&A line, professional fees, was there -- was that sort of as expected? Or was there anything unusually positive that happened there? Just asking.

我想就新聞稿提到的幾個項目問一下，看是否有什麼重要之處需要特別指出。你們提到健康福利費用、藥品成本年對年下降；另外在 G&A 那一行的專業服務費（professional fees），那——這是如預期嗎？還是有什麼異常正面的情況發生？只是想確認一下。

Yeah, AJ, it was as expected. We'll often see the decline sequentially from Q4 to Q1, especially in health benefits. So nothing unusual there.

是的，AJ，這是如預期。我們經常會看到從第四季到第一季的季對季下降，尤其是在健康福利方面。所以沒有什麼不尋常。

Okay. And then I appreciate the comments about the technology investments and some of the use cases you're looking at. Is there any way -- realizing even if you get savings, you may choose to reinvest it in other ways, but is there any way to sort of size some of the opportunities you see?

好的。另外我也很感謝你對科技投資以及你們正在評估的一些使用情境（use cases）的評論。有沒有什麼方式——我知道即便你們取得節省，可能也會選擇用其他方式再投資——但有沒有什麼方式可以大致量化你們看到的一些機會？

And are those being reflected now in operating results? Or what is your thought about how long it may take for the sum of this to impact operating performance?

而且這些現在有反映在營運結果裡嗎？或者你對於這些加總起來影響營運表現可能需要多久，有什麼看法？

Yeah. I appreciate the question. I think the way we look at it is the long-term view that we, again, are trying to ensure that we are putting our clinicians in the best position and that we're making the trade-off on efficiency for the long term to make sure that we sustain our 3% to 7% OI growth over time.

是的。我很感謝這個問題。我們的看法是採取長期觀點：我們再次強調，目標是確保讓臨床人員處在最佳位置，並且為了長期效率做取捨，以確保我們能隨時間維持 3% 到 7% 的營業利益（OI）成長。

And so as you know, right now, technology is moving at a very quick pace. And some of these will be a lot of user experience, i.e., we're just enhancing the experience. And some of these will be helpful toward the bottom line. And it's a little early, and I don't think we want to get into the timing of it, but rather the sustainability and the outperformance of it.

而且如你所知，現在科技進展非常快。其中一些會更多是使用者體驗，也就是我們只是提升體驗。另外一些則會對獲利（bottom line）有幫助。現在談還有點早，我想我們也不想去談具體時點，而是更著重在其可持續性與超越表現。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

Nice to see the operating income guide up, EPS guide up as well. I noticed the free cash flow guide did not change. I think this was a similar dynamic last year. Just wanted to confirm that's normal course and nothing specific to read into?

很高興看到營業利益指引上調，EPS 指引也上調。我注意到自由現金流指引沒有變。我記得去年也有類似情況。只是想確認這是正常情況，沒有什麼特別需要解讀的？

Yeah. Ryan, you're thinking about it the right way. There's just more variability and a wider range with free cash flow, so we didn't move the number despite the increase in OI.

是的。Ryan，你的理解方向是對的。自由現金流的變動性更大、區間也更寬，所以即便 OI 上升，我們也沒有調整那個數字。

Okay. And then as this administration is really focused on fraud waste abuse. It seems to dialysis might be a little better insulated versus other types of providers.

好的。另外，這屆政府非常聚焦在詐欺、浪費與濫用（FWA）。看起來洗腎相較於其他類型的醫療提供者，可能更能隔離這類風險。

Just any general thoughts on this administration is focused on that FWA and what this could mean potentially for DaVita or maybe not mean for DaVita? Are you going to start broadly for dialysis in general?

你對這屆政府聚焦 FWA 有什麼一般性的看法？這可能對 DaVita 意味著什麼，或可能不意味著什麼？你可以先從整體洗腎產業的角度談起嗎？

Yeah. Thanks for the question. It's tough for us to comment on the broader environment. But what I can say is we take compliance incredibly seriously. And number two, what we do have a little help in is that dialysis is not a controversial diagnosis.

是的。謝謝你的問題。我們很難評論更廣泛的外部環境。但我能說的是，我們非常重視法遵（compliance）。第二點，我們稍微有利的一點是：洗腎並不是一個具爭議性的診斷。

So there's not like, oh, should I go get this treatment or not controversy, so that makes it easier. And then the fact that it is a bundle in a single DRG, in essence, simplifies some of the compliance issues. But again, we are internally focused on making sure we do right by the government.

所以不會有那種「我到底該不該去做這個治療」的爭議，這讓事情更容易一些。再者，因為它本質上是以單一 DRG 的方式打包（bundle），也簡化了一些法遵議題。但再次強調，我們內部的重點是確保我們對政府做對的事。

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

目前我這邊顯示沒有其他提問。各位講者，我把電話交回給你們做結語。

Okay. Thank you, Michelle, and thank you all for joining the call today. I would wrap up with three takeaways.

好的。謝謝你，Michelle，也謝謝各位今天參與電話會議。我用三點重點做總結。

First, our most recent clinical initiatives are beginning to gain traction, and we're seeing early signs of the benefits for our patients. Second, our business is performing well as we continue to achieve our clinical goals, this drives our strong financial results. And finally, we maintain a long-term view on our business, and we'll continue to invest in our future.

第一，我們最新的臨床計畫開始取得進展，我們也看到對病患帶來效益的早期跡象。第二，我們在持續達成臨床目標的同時，業務表現良好，這也帶動我們強勁的財務成果。最後，我們對業務維持長期觀點，並將持續投資於未來。

Thank you all for joining this quarter. Be well, and we look forward to seeing you next time. Happy Cinco de Mayo, everyone.

謝謝各位參與本季會議。祝各位安好，期待下次再見。也祝大家五五節（Cinco de Mayo）快樂。

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。各位現在可以掛線。