德維特 (DVA) 2026 Q2 法說會逐字稿

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

晚安。我叫 Michelle，今天將擔任本次會議的主持人。此刻，我謹代表主辦方歡迎各位參加 DaVita 2026 年第二季財報電話會議。（接線員指示）

Mr. Lisin, you may begin your conference.

Lisin 先生，您可以開始您的會議。

Thank you, and welcome to our second quarter conference call. We appreciate your continued interest in our company. I'm Nic Eliason, Group Vice President of Investor Relations. And joining me today are Javier Rodriguez, our CEO; and Joel Ackerman, our CFO. Please note that during this call, we may make forward-looking statements within the meaning of the federal securities laws.

謝謝，歡迎各位參加我們的第二季電話會議。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，以及財務長 Joel Ackerman。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。

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

所有這些陳述均受已知與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出現重大差異。關於這些風險與不確定性的更多細節，請參閱我們的第二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，以及我們可能向 SEC 提交的其他後續文件。

Our forward-looking statements are based on information currently available to us, and we do not intend and undertake no duty to update these statements except as may be required by law. Additionally, we'd like to remind you that during this call, we will discuss some non-GAAP financial measures.

我們的前瞻性陳述係基於目前可得資訊；除法律要求外，我們無意且不承擔更新這些陳述的義務。此外，也提醒各位，本次電話會議將討論部分非 GAAP 財務衡量指標。

A reconciliation of these non-GAAP measures to the most comparable GAAP financial measures is included in our earnings press release furnished to the SEC and available on our website.

這些非 GAAP 指標與最可比的 GAAP 財務指標之調節表，已包含於我們提交給 SEC 的財報新聞稿中，並可於公司網站取得。

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. It's been a busy and exciting summer. One exception is that I have to wait another four years to root for Mexico to win the World Cup. Moving on to more important topics. Our strategy is coming together, thanks to the amazing work of our teammates and caregivers.

謝謝你，Nic。各位下午好，感謝今天加入本次電話會議。這個夏天既忙碌又令人振奮。唯一的例外是，我還得再等四年才能為墨西哥贏得世界盃加油。接著談更重要的議題。在我們隊友與照護人員的出色努力下，我們的策略正在逐步到位。

Their effort has led to another positive quarter for our patient outcomes and financial results. On today's call, in addition to our second quarter performance, I will focus on recent innovation in the dialysis industry, specifically the clearance of middle molecules and the steps we're taking to elevate the standard of care for our patients.

他們的付出使我們在病患治療成效與財務表現上，再度交出一個正向的季度。在今天的電話會議中，除了回顧第二季表現外，我也將聚焦透析產業近期的創新，特別是中分子清除，以及我們為提升病患照護標準所採取的措施。

I'll also share our perspective on the recent ESRD proposed rule and close with our guidance for the remaining of the year. But first, as always, I will begin with the clinical highlights. Today, I'd like to reflect on the successful transition of phosphate binders into the Medicare dialysis bundle.

我也會分享我們對近期 ESRD 擬議規則的觀點，並以我們對今年剩餘期間的財測作結。不過首先，一如往常，我將先從臨床亮點開始。今天我想回顧磷結合劑成功納入 Medicare 透析打包給付（bundle）的轉換。

With advanced notice from CMS, this process began more than two years ago with the goal of expanding access to a wide range of therapies for a broader group of patients and that goal has been achieved. With DaVita's broad formulary, our physician partners now have greater flexibility to prescribe the therapy that's best suited for each patient's needs.

在 CMS 事先充分通知下，這項流程於兩年多前啟動，目標是擴大更多病患對多元療法的可近性，而這個目標已經達成。憑藉 DaVita 完整的處方集（formulary），我們的醫師合作夥伴如今在為每位病患開立最符合其需求的治療方案時，擁有更大的彈性。

This has reduced by more than 50% the number of patients relying on less effective over-the-counter options such as Tums and instead now are benefiting from clinically preferred therapies. That means more patients are receiving treatments that better manage phosphate levels and help reduce the risk of cardiovascular complications and bone fractures.

這使得依賴較低效的非處方選項（例如 Tums）的病患人數減少超過 50%，並轉而受益於臨床上更優先採用的治療。這代表更多病患正在接受能更好管理磷酸鹽濃度、並有助於降低心血管併發症與骨折風險的治療。

It's a powerful example of how the right policy, combined with strong clinical execution can expand access to better care and improve long-term patient health. Transitioning to the second quarter performance. Our results were broadly in line with our expectations. Beneath this headline, I will highlight two primary dynamics.

這是有力的例證，說明正確的政策結合強而有力的臨床執行，如何擴大更佳照護的可近性並改善病患長期健康。接著談第二季表現。我們的結果整體上大致符合預期。在這個總體結論之下，我想強調兩個主要動態。

First, year-over-year volume growth continued to accelerate slightly faster than expected, driven by continued improvements in mortality. Second, compared to the first quarter, revenue per treatment declined as we expected, reflecting lower commercial mix from declining ACA enrollment and lower sequential revenue contribution from phosphate binders.

第一，年對年治療量成長持續加速，且略快於預期，主要受死亡率持續改善所帶動。第二，相較第一季，每次治療收入如我們預期下滑，反映商業保險組合因 ACA 投保人數下降而降低，以及磷結合劑帶來的序列性收入貢獻減少。

Joel will provide more detail on these dynamics and other moving pieces within the quarter. Turning to policy. In late June, as is customary, released a proposed rule for 2027 prospective payment system for ESRD. The proposal includes an update to Medicare-based rate and the addition of phosphate binders to the bundled dialysis payment beginning next year. Starting with the base rate.

Joel 將就這些動態以及本季其他變動因素提供更多細節。接著談政策。6 月下旬，依慣例，發布了 2027 年 ESRD 前瞻性支付制度（PPS）的擬議規則。該提案包含 Medicare 基礎費率的更新，以及自明年起將磷結合劑納入透析打包給付。先從基礎費率談起。

The proposed payment update is more complex than in prior years with methodology changes and various TDAPA related dynamics. The net result is a rate increase that once again tracks below the cost trends for the industry. We're providing feedback during the rule-making process and remain hopeful the final role will better reflect the cost of delivering high-quality care.

此次擬議的支付更新較往年更為複雜，包含方法學變更以及多項與 TDAPA 相關的動態。最終結果是費率上調，但再度低於產業成本趨勢。我們正於規則制定過程中提供意見回饋，並仍期盼最終規則能更充分反映提供高品質照護的成本。

On phosphate binders, we continue to support CMS's approach to moving these medications into the dialysis bundle. In addition to the clinical benefit, the policy is lowering projected government spending. Since the initial transition of these medications CMS has reduced their estimate for phosphate binder spend by nearly $500 million.

就磷結合劑而言，我們持續支持 CMS 將這些藥物納入透析打包給付的作法。除了臨床效益之外，該政策也正在降低政府支出預估。自這些藥物初次轉換以來，CMS 已將其對磷結合劑支出的估計下調近 5 億美元。

We also support concluding the TDAPA period after two years. And while the proposed post-TDAPA rate adjustment is appropriate -- our ultimate financial impact for 2027 will depend on the bundle update within the final rule later this year.

我們也支持在兩年後結束 TDAPA 期間。此外，雖然擬議的 TDAPA 後費率調整是適當的——但我們在 2027 年的最終財務影響，仍將取決於今年稍晚發布的最終規則中的打包給付更新。

Let me turn to middle molecule clearance and the recent results from the MOTheR clinical trial. As a reminder, the primary objective of dialysis is to remove harmful toxins from the body. Newer therapies can remove a broader range of these toxins known as middle molecules. The goal is to reduce inflammation, cardiovascular complications and mortality while enhancing the patient's quality of life.

接下來談中分子清除，以及 MOTheR 臨床試驗的最新結果。提醒一下，透析的主要目的在於將有害毒素自體內移除。較新的療法能移除更廣泛範圍的毒素，這些毒素被稱為中分子。其目標是降低發炎、心血管併發症與死亡率，同時提升病患生活品質。

Achieving these outcomes is a key building block in our expectation of returning the treatment volume growth of at least 2% by 2029. Two approaches, which have been used for many years internationally, and are now emerging in the United States. Hemodiafiltration, or HDF, which utilizes a specialized dialysis machine, and expanded hemodialysis or expanded HD, which is performed with an advanced dialyzer.

達成這些結果，是我們預期在 2029 年前將治療量成長恢復至至少 2% 的關鍵基石之一。兩種作法多年來已在國際上使用，現在也正於美國逐步興起。其一是血液透析濾過（hemodiafiltration，HDF），使用專用透析機；其二是擴增血液透析（expanded hemodialysis，expanded HD），以先進透析器（dialyzer）進行。

I'll cover three things: what the study showed, why it matters, and what it means for DaVita going forward. First, the MOTheR trial compared these two dialysis therapies head-to-head and demonstrated that expanded HD using medium cutoff dialyzers is non-inferior to HDF on a composite endpoint of all-cause mortality and major cardiovascular events.

我將涵蓋三點：研究顯示了什麼、為何重要，以及對 DaVita 未來意味著什麼。首先，MOTheR 試驗將這兩種透析療法進行正面對照，並證明使用中截斷（medium cutoff）透析器的擴增 HD，在「全因死亡率與重大心血管事件」的複合終點上，不劣於 HDF。

Why does this matter? First and foremost, it is a great news for our patient. It gives physicians another evidence-based option for middle molecule clearance, allowing them to tailor treatment to the need of individual patients. Expanded HD also offers meaningful operational advantages because it can be delivered on our existing dialysis machines, making it faster to expand access without significant capital investment.

為什麼這很重要？首先，這對我們的病患而言是個好消息。這為醫師提供了另一個以證據為基礎的中分子清除選項，使其能依個別病患需求量身調整治療。擴增型 HD 也提供具意義的營運優勢，因為它可在我們現有的透析機上施作，讓我們能在無需重大資本投資的情況下，更快速擴大可近性。

This brings us to our path forward. We continue to support both HDF and expanded HD and believe physicians should have the flexibility to choose the right therapy for each patient. That said, the recent FDA approval of new expanded HD dialyzer from Nipro represents an important milestone that should materially improve both market supply and economics.

這也引導我們談到接下來的方向。我們將持續同時支持 HDF 與擴增型 HD，並相信醫師應具備彈性，為每位病患選擇合適的治療方式。話雖如此，Nipro 新款擴增型 HD 透析器近期獲得 FDA 核准，代表一個重要里程碑，預期將在市場供給與經濟性方面帶來實質改善。

To capture this clinical opportunity, we have secured supply to these expanded HD dialyzers which are fully compatible with our existing machines and provide highly effective clearance of middle molecules. As a result, we expect to begin deploying expanded HD broadly across our network in the coming quarters. This will allow us to expand access quickly and deliver this option to our patients and physician partners.

為把握這項臨床機會，我們已確保擴增型 HD 透析器的供應；該透析器與我們現有機台完全相容，並能高效清除中分子。因此，我們預期在未來幾個季度開始於我們的網絡中廣泛部署擴增型 HD。這將使我們能快速擴大可近性，並將此選項提供給我們的病患與醫師合作夥伴。

As we move forward, we'll continue evaluating how both approaches perform across different care settings in patient populations in the real-world practice. I'll wrap up my prepared remarks with our financial outlook for the remaining of the year. With the benefit of another quarter, three trends are coming into better focus.

在持續推進的同時，我們也會持續評估兩種作法在不同照護場域與病患族群、於真實世界臨床實務中的表現。我將以今年剩餘期間的財務展望作為事先準備講稿的結尾。在多了一個季度的觀察後，有三項趨勢正變得更為清晰。

First, continued momentum in volume growth; second, greater confidence in our estimate of the impact of effectuation rates for exchange plans; and third, our efforts to provide broad access to middle molecule clearance for our patients. With consideration of these factors, we're reconfirming our full year 2026 guidance ranges.

第一，治療量成長動能持續；第二，對於交換計畫（exchange plans）生效率影響的估計更具信心；第三，我們致力於為病患提供廣泛的中分子清除可近性。綜合考量這些因素，我們重申 2026 全年指引區間。

This reflects the midpoint of $2.2 billion for adjusted operating income at a midpoint of $14.65 for adjusted earnings per share. We look forward to continuing our clinical, operational and financial momentum in the back half of the year.

這反映調整後營業利益的中位數為 22 億美元，調整後每股盈餘的中位數為 14.65 美元。我們期待在今年下半年持續推進臨床、營運與財務動能。

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

接下來我把電話交給 Joel，請他更詳細說明我們的財務表現。

Thank you, Javier. I'll begin with the details on our second quarter results and close with some additional color on the remainder of the year. Second quarter adjusted operating income was $579 million. Adjusted earnings per share was $4.02 and free cash flow was $256 million.

謝謝你，Javier。我將先說明第二季業績細節，並在最後補充一些關於今年剩餘期間的更多說明。第二季調整後營業利益為 5.79 億美元。調整後每股盈餘為 4.02 美元，自由現金流為 2.56 億美元。

Beginning with U.S. Dialysis. Treatments increased 56 basis points versus Q2 of 2025. Treatments per normalized day also increased 56 basis points as there was no impact from the calendar as compared to the same period last year. Volume growth was slightly higher than expected as a result of lower-than-expected mortality offset by fewer admits from closed Fresenius clinics and higher-than-expected miss treatments.

先從美國透析業務開始。相較於 2025 年第二季，治療次數增加 56 個基點。每個標準化日的治療次數也增加 56 個基點，因為與去年同期相比，日曆因素沒有影響。由於死亡率低於預期帶來的正面影響，抵銷了因關閉 Fresenius 診所而減少的收治（admit）以及高於預期的缺席治療（miss treatments），使得量的成長略高於預期。

Our confidence in our treatment volume trajectory for the year continues to grow and we now expect 2026 growth in total treatments near the top end of our previous guidance range of 25 basis points to 50 basis points. As a reminder, our treatment volume expectations are for nominal treatment growth.

我們對今年治療量走勢的信心持續提升，現在預期 2026 年總治療次數成長將接近先前指引區間（25 個基點至 50 個基點）的上緣。提醒一下，我們對治療量的預期是以名目治療量成長為基礎。

This would translate to approximately 50 basis points to 75 basis points of growth when normalizing for year-over-year calendar impacts. The calendar impact in the back half of the year will result in a year-over-year tailwind in Q3 and headwind in Q4.

若將年對年日曆影響標準化，這將相當於約 50 個基點至 75 個基點的成長。下半年日曆影響將使第三季出現年對年順風，而第四季則出現逆風。

Revenue per treatment decreased by approximately $2 sequentially, primarily the result of favorable revenue timing in Q1, lower sequential revenue from phosphate binders, and a decline in commercial mix related to the expired ACA subsidies, in line with our guidance from last quarter. These RPT headwinds were partially offset by the typical sequential increase from higher patient responsibility amounts in the first quarter and higher average rates.

每次治療收入（RPT）較前一季約下降 2 美元，主要原因是第一季收入認列時點較有利、磷結合劑（phosphate binders）帶來的序列收入下降，以及與 ACA 補貼到期相關的商業保險組合占比下降，與我們上季提供的指引一致。這些 RPT 逆風部分被第一季病患自付金額較高所帶來的典型序列增幅，以及較高的平均費率所抵銷。

Although year-to-date revenue per treatment has been 3.6% higher than the first half of 2025, we continue to expect full year 2026 RPT growth of 1% to 2%. The midpoint of that range implies that RPT growth in the second half of 2026 will be slightly negative as compared to the second half of 2025.

儘管今年迄今每次治療收入較 2025 年上半年高出 3.6%，我們仍預期 2026 全年 RPT 成長為 1% 至 2%。該區間的中位數意味著 2026 年下半年相較 2025 年下半年，RPT 成長將略為負值。

This is a function of declining commercial mix, lower phosphate binder revenue, and the benefit in Q4 2025 from the timing of aged claim resolutions. Patient care cost per treatment declined approximately $3 sequentially as a result of operating leverage on labor and other fixed costs, driven by increased treatment volume in Q2 and a decline in phosphate binder costs, offset by higher benefit costs.

這主要是由於商業保險組合占比下降、磷結合劑收入降低，以及 2025 年第四季因久齡理賠（aged claim）結案時點所帶來的利益。每次治療的病患照護成本（PCC）較前一季約下降 3 美元，原因是第二季治療量增加帶動人力與其他固定成本的營運槓桿，以及磷結合劑成本下降；但部分被福利成本上升所抵銷。

Year-to-date, PCCs have grown more than 3% versus the first half of 2025, above our expected range for the full year growth. Similar to the dynamic in revenue per treatment, we expect year-over-year growth in patient care costs to decelerate in the back half of the year, driven by decreasing phosphate binder expenses and lower year-over-year growth of facility maintenance spend.

今年迄今，PCC 相較 2025 年上半年成長超過 3%，高於我們對全年成長的預期區間。與每次治療收入的動態類似，我們預期下半年病患照護成本的年對年成長將放緩，主因是磷結合劑費用下降，以及院所維護支出的年對年成長降低。

In other costs, U.S. dialysis G&A increased $11 million versus the first quarter and U.S. dialysis depreciation and amortization decreased by $9 million sequentially. We continue to expect total cost per treatment to grow between 1.25% and 2.25% for the full year.

在其他成本方面，美國透析的管理費用（G&A）較第一季增加 1,100 萬美元，而美國透析的折舊與攤銷則較前一季減少 900 萬美元。我們仍預期全年每次治療總成本成長介於 1.25% 至 2.25%。

Turning to our other segments. International adjusted operating income was $25 million in Q2, in line with expectations. IKC delivered positive $40 million of adjusted operating income, above our expectations for the quarter as a result of timing of revenue earlier in the year than anticipated.

接著看其他事業部門。第二季國際業務調整後營業利益為 2,500 萬美元，符合預期。IKC 貢獻調整後營業利益正向 4,000 萬美元，高於我們對本季的預期，原因是收入認列時點較原先預期更早落在今年。

We still expect international and IKC growth to contribute approximately $20 million each to full year enterprise adjusted operating income growth. Regarding capital allocation. In July, we closed on our minority investment in Elara caring, which provides an exciting opportunity to help bring dialysis tailored home health services offerings to our patients.

我們仍預期國際業務與 IKC 的成長，將各自為全年企業層級調整後營業利益成長貢獻約 2,000 萬美元。關於資本配置。7 月我們完成對 Elara caring 的少數股權投資交割，這帶來令人振奮的機會，可協助我們為病患提供量身打造的居家健康照護透析服務。

As a reminder, we invested $200 million and expect Elara to provide a small benefit to other income in 2026, likely mid-single-digit millions. Additionally, we repurchased 2.2 million shares during Q2, an additional 183,000 shares since the end of the quarter.

提醒一下，我們投資了 2 億美元，並預期 Elara 在 2026 年將對其他收入帶來小幅貢獻，可能為中個位數百萬美元。此外，我們在第二季回購 220 萬股，並在季末後另回購 183,000 股。

As a reminder, we buy shares from Berkshire Hathaway each quarter pursuant to our repurchase agreement to maintain their ownership near 45%. Our leverage ratio at the end of the quarter was 3.37 times consolidated EBITDA within our target range of 3 times to 3.5 times EBITDA. Debt expense in the quarter was $152 million.

提醒一下，依據我們的回購協議，我們每季都會向 Berkshire Hathaway 回購股份，以將其持股維持在約 45%。本季末我們的槓桿比率為合併 EBITDA 的 3.37 倍，落在我們目標區間（EBITDA 的 3 倍至 3.5 倍）之內。本季利息費用為 1.52 億美元。

During the quarter, we issued $500 million of incremental debt with proceeds primarily used to repay revolver borrowings. For the full year, we are reiterating our adjusted operating income guidance range with a midpoint of $2.2 billion and our adjusted earnings per share guidance range with a midpoint of $14.65.

在本季度，我們新增發行了5億美元的增量債務，所得款項主要用於償還循環信貸（revolver）借款。就全年而言，我們重申調整後營業利益指引區間，其中點為22億美元，以及調整後每股盈餘指引區間，其中點為14.65美元。

To help you model the back half of the year, we anticipate a sequential increase in adjusted operating income of $50 million to $100 million from Q3 to Q4 with timing of IKC being the biggest driver. That concludes my prepared remarks for today.

為了協助各位建立下半年模型，我們預期調整後營業利益將自第三季到第四季按季增加5,000萬至1億美元，其中IKC的時點是最大的驅動因素。以上是我今天預先準備的發言。

Operator, please open the call for Q&A.

接線員，請開放問答。

(Operator Instructions)

（接線員指示）

Andrew Mok, Barclays.

Andrew Mok，巴克萊。

Hi, good afternoon, despite the growth in treatment, U.S. dialysis OI was relatively flat year-over-year, while lapping a $45 million cyber headwind. So can you help us understand why we can see better leverage from the treatment growth and comment on the elevated CPT in the quarter?

嗨，午安。儘管治療量成長，美國透析的營業利益（OI）年對年相對持平，同時也已經跨過了4,500萬美元的網路事件逆風。所以你們能否協助我們理解，為什麼我們沒有從治療量成長看到更好的槓桿效益？另外也請評論一下本季度偏高的每次治療成本（CPT）。

Yeah. I'll take that, Andrew. So OI for the quarter at the enterprise level was up about 5%. And you're right on the RPT dynamic. I think there are a bunch of other moving pieces on the cost per treatment side. So cost per treatment growth is elevated in the first half of the year, similar to RPT.

好的。Andrew，我來回答。所以本季度在企業整體層級的營業利益約成長5%。你提到的RPT動態沒錯。我認為在每次治療成本這一端，還有許多其他變動因素。因此，每次治療成本的成長在上半年偏高，與RPT的情況類似。

So I think there's a bit of an offset there. And G&A growth continues to grow. It was roughly 10% for the quarter. So those would be the big items that I'd point out in the U.S. dialysis side of that.

所以我認為那裡有一些相互抵銷的效果。而且G&A（一般及行政費用）仍在成長。本季度約為10%。以上是我會在美國透析業務這一塊特別指出的主要項目。

Got it. Okay. And maybe on the volume side, there's a lot going on that's impacting volume trends you spoke to an acceleration in volumes, continued improvement in mortality and the high end of treatment growth for the full year. But when I look at the two LDOs reporting together, it looks like same-store treatment growth was negative in the quarter.

了解。好的。另外在量的部分，有很多事情正在影響你們提到的量的趨勢：你們談到量的加速、死亡率持續改善，以及全年治療量成長落在高端。但當我看兩家LDO同時公布的數據時，看起來本季度同店治療量成長是負的。

Is it your sense that industry volumes were negative? Or did smaller chains take market share?

你們的看法是產業量為負嗎？還是較小的連鎖業者取得了市占？

No. We can't comment on the combined because we obviously don't have visibility to everyone else. But what we can tell you is that our growth is mainly performance clinical -- clinically -- that expands life, and therefore, you get the volume treatment. And so I can't speak to what's going on in the rest of the industry, but we are gaining that through clinical outcomes.

不是。我們無法評論合併後的情況，因為我們顯然無法掌握其他所有人的能見度。但我們能告訴你的是，我們的成長主要來自臨床表現——臨床上——延長壽命，因此帶來治療量。所以我無法評論產業其他部分發生了什麼，但我們是透過臨床結果來取得成長。

Yes. And just to build on that. If you think about our performance for the quarter, as Javier said, it's clinically driven also that's mortality and admits was largely in line with our expectations.

是的。再補充一下。如果你看我們本季度的表現，如Javier所說，這也是由臨床驅動；此外，死亡率與收治（admits）大致符合我們的預期。

Great. And maybe just last one. On the RPT side, you noted that the decline sequentially due to commercial mix and phosphate binders. Can you give us the sequential change in mix and RPT from phosphate binders?

很好。最後一個問題。在RPT方面，你們提到按季下降是因為商業保險組合與磷結合劑（phosphate binders）。你們能否提供保險組合與磷結合劑對RPT造成的按季變動幅度？

Yeah. So mix was complicated this quarter because we saw some coverage updates. Remember, in Q1, the impact of the ACA was lower than we expected, although we were waiting to see what happened with effectuation rates and how that would play through with coverage updates in Q2.

好的。所以本季度的組合相當複雜，因為我們看到一些承保更新。請記得，在第一季，ACA的影響低於我們預期，因為我們仍在觀察生效率（effectuation rates）以及它會如何透過第二季的承保更新反映出來。

Turned out, it played out largely as we expected. So if you look at the average mix for the first half of the year, it's in the high 10s and really tracking as we expected, in line with the $40 million headwind that we'd expect for the full year.

結果大致如我們所預期地發展。因此，如果你看上半年平均的組合，落在10%後段，且確實如我們預期地推進，與我們預期全年會有4,000萬美元逆風一致。

A.J. Rice, UBS.

A.J. Rice，瑞銀。

Maybe just first question. If you deploy the expanded HD capability, I just want to make sure I understand the way that would impact the economics of the company would be if it results in improved mortality. Is there any other economic implication for you more near term over deploying that?

第一個問題。如果你們部署擴增的HD能力，我想確認我理解其對公司經濟性的影響方式：也就是如果它帶來死亡率改善。除了這點之外，在較近期部署它，對你們還有其他經濟層面的影響嗎？

Thanks, A.J. I think when you think of the deployment of this new technology, we divide it into sort of three categories. The first is clinical and you know the results of that, and we talked about the studies being encouraging, and you talked about the improvement in mortality.

謝謝你，A.J. 我認為談到這項新技術的部署，我們把它分成大概三個類別。第一是臨床面，你也知道那方面的結果；我們提到研究結果令人鼓舞，而你也提到死亡率的改善。

Of course, you also have to put physician preference and what they choose then you have to kind of move on to operational and the experience on this is we've switched dialyzer before. It's simple, and we can do it quickly and then you have to kind of shift into the supply, and we are now confident that we could get supply.

當然，你也必須考量醫師偏好以及他們的選擇；接著你必須轉到營運面，而我們在這方面的經驗是：我們以前也更換過透析器（dialyzer）。這很簡單，我們可以很快完成；然後你必須再轉到供應面，而我們現在有信心可以取得供應。

And that leads you to sort of the third one, the financial. And what I would say is that in 2026, it's included in our guidance. When you think of the future for 2027 and beyond, there's several puts and takes. But at the end of the day, it will not be significant.

接著就來到第三個面向，也就是財務面。我要說的是，在2026年，這已包含在我們的指引中。至於2027年及以後的未來，會有一些利弊權衡。但歸根結底，影響不會顯著。

Okay. All right. And maybe just a follow-up.

好的。好。那我再追問一下。

Let me just be clear on that. The impact is insignificant until the mortality benefit kicks in. And that's when you'd see a positive economic impact. We wouldn't expect the positive mortality impact to start until 2028. There is a delay from when the new dialyzers are put in place until you see it.

我把這點說清楚。在死亡率改善效益開始顯現之前，影響都不顯著。而當死亡率帶來正面效益時，你才會看到正向的經濟影響。我們預期正向的死亡率影響要到2028年才會開始出現。從新透析器導入到你看見效果之間會有一段延遲。

Okay. Interesting. Okay. I think in the prepared remarks you did mention -- there was a little bit of elevated missed treatments. You also mentioned you didn't pick up as much as you expected from the Fresenius closures, I don't know whether there's anything to expand on there is just normal ebb and flow with respect to the missed treatments, but I wanted to just give you a chance if there was some more color there.

好的。有意思。好的。我想在預先準備的發言中你們確實提到——有一點偏高的缺席治療（missed treatments）。你們也提到，從Fresenius關閉據點所帶來的承接量沒有如預期那麼多；我不確定是否有什麼可以補充的，或是就缺席治療而言只是正常的起伏，但我想給你們一個機會，看看是否能提供更多背景。

Yeah. Look, we're really parsing some pretty small numbers here in trying to bridge 10 or 15 basis point changes, nothing major on the missed treatment rate side. And in terms of the Fresenius closures, it's probably 5 basis points of less positivity than we were expecting on the year.

是的。你看，我們其實是在非常細地拆解一些很小的數字，試著去銜接10到15個基點的變動；在缺席治療率方面沒有什麼重大變化。至於Fresenius的關閉，全年來看，大概是比我們預期少了約5個基點的正面貢獻。

So again, a pretty small numbers, nothing big that I'd call out. Thank you.

所以再說一次，數字相當小，沒有什麼我會特別點出的重大事項。謝謝。

Justin Lake, Wolfe Research.

Justin Lake，Wolfe Research。

Thanks, appreciate it. Can you, first, just Joel, I want to make sure I have the numbers right here. You said $75 million or $50 million to $100 million increase in OI from 2Q to 3Q? Is that right?

謝謝，感謝。首先，Joel，我想確認我這裡的數字是否正確。你說從第二季到第三季，營業利益（OI）增加7,500萬美元，或是增加5,000萬到1億美元？是這樣嗎？

No, no. That's about the phasing in the back half of the year. So we would expect Q3 to be $50 million to $100 million lower than Q4.

不，不是。那是關於下半年時點分布（phasing）的問題。所以我們預期第三季會比第四季低5,000萬到1億美元。

That makes a lot more sense than what it I thought I understood that .

這就合理多了，跟我原本以為自己理解的不一樣。

Just to explain that that's largely driven by IKC.

補充說明一下，這主要是由IKC所驅動。

Got it. And then you talked about mortality being a little better. Can you run out some of the numbers behind what you're seeing there?

了解。然後你提到死亡率稍微好一些。你能把你們看到的背後數據大概說一下嗎？

Yeah. I don't think we're going to call out quarterly mortality fluctuations. What I can say is that the improvement is sustained. So we've seen it over a number of quarters now. It fluctuates, it was significantly better in Q1, which is what you'd expect because you have the flu dynamic there, but we continue to see improvements in Q2 as well.

可以。我不認為我們會特別去點出每季死亡率的波動。我能說的是，這個改善是持續的。所以我們已經連續好幾個季度都看到這樣的情況。它會波動，第一季明顯更好，這也符合預期，因為有流感的因素，但我們在第二季也持續看到改善。

Got it. And what you're saying here is that your new patient starts are relatively flat and all the growth is coming from mortality improvement? Is that the way to think about it?

了解。所以你的意思是，新病人開始治療的人數大致持平，而所有成長都來自死亡率改善？可以這樣理解嗎？

I think what we're saying is the benefit in the quarter relative to expectations was all mortality. It was actually mortality and then some because miss treatment rate came in a little worse than expected and admits was in line with expectations.

我想我們的意思是，本季相對於預期的利多全部來自死亡率。其實是死亡率帶來的利多，甚至還多一些，因為缺席治療率（miss treatment rate）比預期稍差，而收治（admits）則符合預期。

Pito Chickering, Deutsche Bank.

Pito Chickering，德意志銀行。

Thanks for taking my question here. So the first one is looking at the revenue per treatment and the commercial mix. You said it was in the high tens, and now you're seeing the impact of the $40 million that you'd assume. Can you walk us through the process of those patients that are transferring from HIX onto government?

謝謝讓我提問。第一個問題是關於每次治療收入（revenue per treatment）以及商業保險組合。你說是在高十幾（high tens），而現在你看到你原先假設的4,000萬美元影響。你能帶我們走一遍這些從HIX轉到政府保險的病人轉換流程嗎？

Are you seeing new patients come in and going government before they can go into HIX? Or are you seeing HIX patients drop coverage? And do you see that mix change throughout the quarter? Did it start the same as ended? Or did it change through the quarter?

你們是看到新病人進來後先走政府保險，之後才可能進到HIX嗎？還是你們看到HIX病人取消保險？而且你們是否看到這個組合在季度內有變化？期初跟期末一樣嗎？還是季度中有變？

So we're seeing both in terms of patients dropping coverage. We think the more sustained dynamic that we're expecting through the rest of the year and into next year would be the new admits coming in at a lower commercial mix because of a lower QHP mix.

所以兩種情況我們都有看到，包括病人取消保險。我們認為更具持續性的趨勢——我們預期會延續到今年剩餘時間並進入明年——是新收治病人的商業保險占比會較低，因為QHP占比較低。

So hard to predict exactly how it's going to play out, but we would expect that number to sustain itself through some part of next year, and that's what leads to the $40 million impact and then the $70 million impact next year.

所以很難精準預測最後會怎麼發展，但我們預期這個數字會在明年的某段時間維持，而這就是導致今年4,000萬美元影響、以及明年7,000萬美元影響的原因。

The $70 million impact is a combination of the anniversary effect or the annualizing effect of the mix loss in 2026 that happened through the year, plus some additional mix loss in 2027 but again, largely the result of the new patient mix coming in lower.

這7,000萬美元的影響，是2026年在年度內發生的組合流失所帶來的到期效應（anniversary effect）或年化效應（annualizing effect），再加上2027年額外的一些組合流失；但同樣地，主要仍是因為新病人進來時的組合較低。

Thanks. Can you remind us of the current occupancy of your centers are sort of where it was pre-coated if we think about the pure variable costs in patients showing up kind of what is that? I'm just trying to figure out the sort of fixed cost leverage here of the business if you guys can see, keep on increasing the treatment growth throughout the year.

謝謝。你能提醒我們目前中心的使用率大概是多少、相較於疫情前大概在哪個水準嗎？如果我們從純變動成本、病人到院出席的角度來看，大概是什麼情況？我只是想了解，如果你們能在全年持續提升治療量成長，這個業務的固定成本槓桿大概會是怎樣。

Yeah. So capacity utilization is running in the high 50s now. It's been relatively steady for a number of years. If you went back pre COVID at its peak it ran about 65%. The question of fixed cost is a hard one because some things are fixed in the short term and less fixed in the long term. Also the marginal profit of a patient depends on which patient it is.

好的。所以目前產能利用率大概在接近60%（high 50s）。這幾年一直相對穩定。如果回到COVID之前的高峰，大概在65%左右。固定成本的問題比較難回答，因為有些項目在短期是固定的，但長期就沒那麼固定。另外，新增一位病人的邊際利潤也取決於是哪一類病人。

If it's a Medicare patient that has longer mortality, you'll get less marginal economics than adding a new commercial patient. So it's a hard number to pin down. It really depends on the situation you're trying to model.

如果是Medicare病人，因為存活期更長，你的邊際經濟效益會比新增一位商業保險病人來得低。所以這個數字很難精確釘住。真的取決於你想建模的情境。

Okay. And then last one here. Can you refresh us on sort of leverage ratios, kind of what the stock trading at these levels, kind of what do you think the right leverage ratio is for you guys to be running at?

好的。最後一個問題。你能幫我們更新一下槓桿比率嗎？以目前股價在這些水準交易來看，你們認為適合維持的槓桿比率大概是多少？

Yeah. We have not changed our view on that. And so we've given a range, and we are now at 3.37 for the quarter and we had drawn down $65 million on our revolver.

好的。我們對此的看法沒有改變。所以我們之前給過一個區間，而我們本季是3.37，並且我們在循環信貸額度（revolver）上已動用6,500萬美元。

(Operator Instructions)

（接線員指示）

Kevin Fischbeck, Bank of America.

Kevin Fischbeck，美國銀行。

Great. Thanks. I was wondering, the change in the expectation from Fresenius, is that just what you experienced in the quarter? Or have you also changed your expectation for how much you'll pick up from them during the year?

很好。謝謝。我想問，對於Fresenius的預期變動，是只是反映你們本季的實際經驗嗎？還是你們也調整了對於今年從他們那邊能承接多少量的預期？

Yeah. So that was -- is very specific to the 100 clinics that they called out, I guess, last quarter that they were going to be closing. To the best of our understanding, they are done with that effort. And so the pickup is done. I don't expect that to change at all over the course of the year.

是的。那個——是非常針對他們所提到的那100家診所，我想是上季他們點名說要關閉的。就我們的理解，他們已經完成那項行動。因此我們承接的量也已經結束。我不預期今年接下來會有任何變化。

This had nothing to do with any of the other volume dynamics that they've been talking about over the last 24 hours. This was purely about the 100 clinics they closed.

這跟他們在過去24小時談到的其他量能動態完全無關。這純粹是關於他們關閉的那100家診所。

Okay. And then as far as the HD dialyzers, so just to be clear because I think you just said you've got a supply of that. So you have secured enough to completely transition all of your facilities over to that next year? Or is it just a portion of the facilities next year? Within the next year?

好的。然後關於HD透析器（HD dialyzers），我想確認一下，因為我記得你剛說你們已經有供應。所以你們已經確保有足夠的供應，能在明年把所有設施都完全轉換到那個嗎？還是明年只會轉換一部分設施？在接下來一年內？

Got enough to supply the transition as many as the doctors demand. And so we obviously don't think it will happen one day or one week, it will take a little bit of time as the science gets rolled out, but we do have enough capacity to fulfill all the demand.

我們有足夠的供應能力，足以支應醫師所要求的轉換需求。因此我們顯然不認為會在某一天或一週內就發生；隨著科學成果逐步推廣，這需要一點時間，但我們確實有足夠的產能來滿足所有需求。

Okay. And then can you talk a little bit about the IKC business? Obviously, you're talking about $20 million improvement this year. Can you just remind us, I guess, based upon where you think the margins in that business can get to? How many more years of adding, call it, 1% to OI growth?

好的。接著你能談談 IKC 業務嗎？顯然你提到今年將改善 2,000 萬美元。你能否提醒我們，基於你認為該業務的利潤率可以提升到什麼水準？還能再增加多少年——姑且說——每年為營業利益（OI）成長貢獻 1%？

Can that business steadily improves? Can that -- and is it something that could happen over the next 2 years, 5 years? How should we think about that?

那項業務能否穩定改善？那是否——以及這是否可能在未來 2 年、5 年內發生？我們應該如何看待這件事？

I don't I don't see any reason it couldn't continue for a while. It's -- again, it isn't purely a margin play. There's also a volume question of increasing the number of lives and the number of dollars under management, and I could see that continuing to grow and that being as important, maybe more important of a driver than margin expansion. So I think we've got a lot of room to run.

我看不出有任何理由它不能再持續一段時間。它——再說一次——不完全只是利潤率的問題。還有量的問題，也就是增加受保人數（lives）以及管理資產規模（AUM）的金額；我可以想像這會持續成長，而這可能是與利潤率擴張同等重要、甚至更重要的驅動因素。所以我認為我們還有很大的成長空間。

I think you should think of it as a maturing business that requires a lot of coordination between nephrologists, clinics and our teams and so as that matures, and we evolve our model of care and our health evaluations and all that goes into it, we hope that there's improvement that can be sustained over time.

我認為你應該把它視為一個走向成熟的業務，需要腎臟科醫師、診所與我們團隊之間大量的協調；因此隨著它成熟，以及我們持續演進照護模式、健康評估以及所有相關要素，我們希望能有可隨時間維持的改善。

Okay. Then maybe just last question on that. So what has been driving that this year? Is that a function of improved medical expense? Is it growth in G&A leverage? What's driving the growth this year?

好的。那也許最後一個相關問題。所以今年是什麼在驅動這個表現？這是醫療費用改善的結果嗎？是一般與管理費用（G&A）槓桿效益的成長嗎？今年的成長是由什麼帶動的？

Well, right now, it's just timing on revenue recognition. But as we look out, we're getting a bit more confident in our ability to manage the total care cost and so we're getting a little more confidence there, coupled with we want to continue to grow the business, as Joel said, which means more contracts with MA.

嗯，目前主要只是收入認列時點的影響。但往後看，我們對於管理整體照護成本的能力更有信心，因此在那方面信心提升了一些；同時我們也希望持續擴大業務，如 Joel 所說，這意味著與 MA（Medicare Advantage，聯邦醫療保險優勢計畫）簽訂更多合約。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

On the share repurchase, I think you've only repurchased about 0.2 million since the end of June. Obviously, I see the stock price move this year, but does the move change your capital allocation priorities such that we might see a little bit less share repo through the rest of the year?

關於庫藏股回購，我想自 6 月底以來你們只回購了大約 20 萬股。顯然我看到今年股價的走勢，但這個變動是否改變你們的資本配置優先順序，使得我們可能在今年剩餘時間看到較少的回購？

No. I think what you want to think about is more -- our capital allocation and our view on buybacks has been absolutely consistent throughout the years, this particular calendar year, we were heavy on the front end. In Q1, we purchased a fair amount. And so we are in a good spot year-to-date at $785 million.

不會。我認為你應該更這樣看——我們的資本配置以及對回購的看法，多年來一直完全一致；在這個日曆年度，我們在前段執行得比較多。在第一季，我們買回了相當多。因此截至目前，我們年初至今的回購金額達 7.85 億美元，處於不錯的位置。

And you saw where our leverage rate was at 3.37. And you have to remember, we knew that Elara Care was going to close in July and that was $200 million of cash. So it's very consistent, and there is no change in our view of buyback.

你也看到我們的槓桿比率在 3.37。你必須記得，我們知道 Elara Care 會在 7 月完成交割，而那需要 2 億美元現金。所以這非常一致，我們對回購的看法沒有改變。

Okay. And then any updates on what you're seeing on the M&A side? Is that still primarily focused on international? Or are there more domestic-based assets like maybe IKC that you'd consider taking to market.

好的。那在併購（M&A）方面，你們看到的情況有任何更新嗎？是否仍主要聚焦在國際市場？或者是否有更多以美國本土為主的資產，例如可能像 IKC 這樣，你們會考慮拿到市場上？

There's still onesies and twosies out there, small clinics, but the reality is that the United States is pretty consolidated now. The growth will come more through de novos as the industry starts to grow. And this year, we've had a couple of acquisitions, and we will continue to look at them, but there's not that many out there. Thank you.

外面仍有零星的標的，一兩家小型診所，但現實是美國市場現在已相當整合。隨著產業開始成長，成長將更多來自新設點（de novos）。今年我們做了幾筆收購，我們也會持續評估，但外面的標的並不多。謝謝。

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問題。各位講者，我把電話交回給你們做結語。

Okay. Thank you, Michelle, and thanks, everyone, for joining the call today. As we wrap up, I'll leave you with three final thoughts. First, the year is tracking in line with our expectations. Second, I hope you heard in our voice, our clinical strategy is gaining traction. This means improved mortality and extending life for more of our patients.

好的。謝謝你，Michelle，也謝謝各位今天加入電話會議。在結束之前，我想留下三點最後的想法。第一，今年的進展符合我們的預期。第二，我希望你們從我們的語氣中聽得出來，我們的臨床策略正在取得進展。這意味著降低死亡率，並為更多病患延長生命。

And because our clinical and financial objectives are so aligned, this progress directly supports our volume growth. Finally, by delivering new middle molecule technology to our patients and physicians, we're advancing the standard of care to sustain our clinical and financial momentum into the future. Thank you for joining the call today, and we look forward to speaking to you next time.

而且因為我們的臨床與財務目標高度一致，這項進展直接支持我們的量能成長。最後，透過將新的中分子技術帶給我們的病患與醫師，我們正在推進照護標準，以在未來延續我們的臨床與財務動能。感謝各位今天參與電話會議，我們期待下次再與各位交流。

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。您現在可以掛線。