Fresenius Medical Care AG (FMS) 2022 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by. I am Nicolas, your Chorus Call operator. Welcome, and thank you for joining the Fresenius Medical Care report on fourth quarter and full year 2022. (Operator Instructions)

女士們，先生們，謝謝你們的支持。我是 Nicolas，您的 Chorus Call 接線員。歡迎並感謝您加入 Fresenius Medical Care 2022 年第四季度和全年報告。（操作員說明）

I would now like to turn the conference over to Dominik, Head of Investor Relations. Please go ahead, sir.

我現在想將會議轉交給投資者關係主管 Dominik。請繼續，先生。

Thank you, Nicolas. Good afternoon or good morning depending on where you are. I would also like to welcome you to our earnings call for the fourth quarter. As always, I need to start out the call by mentioning our cautionary language that is in our safe harbor statement as well as in our presentation and in all the materials that we have distributed yesterday. For further details concerning risks and uncertainties, please refer to these documents and to our SEC filings.

謝謝你，尼古拉斯。下午好或早上好取決於你在哪裡。我也想歡迎您參加我們第四季度的收益電話會議。與往常一樣，我需要通過在我們的安全港聲明以及我們的演示文稿和我們昨天分發的所有材料中提及我們的警示語來開始通話。有關風險和不確定性的更多詳細信息，請參閱這些文件和我們向美國證券交易委員會提交的文件。

Due to the deconsolidation announcement, I have to add that we will be filing a registration statement with the SEC with respect to the conversion. The prospectus for the conversion will be available on the SEC website and will contain important information. You should read the prospectus and other documents we file with the SEC for the conversion when they are available.

由於拆分公告，我必須補充一點，我們將就轉換向美國證券交易委員會提交一份註冊聲明。轉換的招股說明書將在 SEC 網站上提供，並將包含重要信息。您應該閱讀我們向美國證券交易委員會提交的用於轉換的招股說明書和其他文件。

With the Q4 results, we traditionally share an update on our strategic ambitions. Therefore, we have more to cover than in the other quarters. I'm aware that there is a lot of information from Fresenius and us to digest today. (Operator Instructions)

對於第四季度的結果，我們通常會分享我們戰略目標的最新情況。因此，與其他季度相比，我們要涵蓋的內容更多。我知道今天有很多來自費森尤斯和我們的信息需要消化。 （操作員說明）

With us today is Helen Giza, our new CEO and Chair of the Management Board. Helen will start with insights in the new strategic aspirations, followed by a short review of the quarter and the outlook. Then we are happy to take your questions.

今天和我們在一起的是我們的新任首席執行官兼管理委員會主席海倫·吉薩 (Helen Giza)。海倫將從對新戰略願景的見解開始，然後對本季度和前景進行簡短回顧。那麼我們很樂意回答您的問題。

I will now hand over to Helen. The floor is yours.

我現在將交給海倫。地板是你的。

Thank you, Dominik, and a warm welcome to you all. It really is an honor to be speaking with you today as CEO of Fresenius Medical Care. And these are exciting times for sure as we embark on the next chapter in the company's history, and there is a lot I want to cover today, as Dominik already mentioned.

謝謝你，多米尼克，熱烈歡迎大家。很榮幸今天能以費森尤斯醫療的首席執行官身份與您交談。隨著我們開啟公司歷史的新篇章，這些無疑是激動人心的時刻，正如 Dominik 已經提到的，今天我想介紹很多內容。

Before I start with my prepared remarks, I would like to take a moment to recognize the hard work and dedication of our great teams around the world. We are all united behind our common vision of creating a future worth living for our patients worldwide every day. I would also like to express my special thanks to our teams in the Ukraine and in Turkey. My thoughts and prayers are with all of those affected and I thank you for being on location working tirelessly to provide aid and helping our patients.

在開始我準備好的發言之前，我想花點時間感謝我們在世界各地的優秀團隊的辛勤工作和奉獻精神。我們都團結在共同願景的背後，即每天為全球患者創造一個值得生活的未來。我還要特別感謝我們在烏克蘭和土耳其的團隊。我的思念和祈禱與所有受影響的人同在，我感謝你們在現場不知疲倦地工作以提供援助和幫助我們的患者。

I will begin on Slide 5 with our strategic aspiration. As the new CEO, my overarching strategic aspiration is to unlock value as the leading kidney care company and to drive up shareholder return. Today, I will introduce the key elements of the strategy road map, and we will also host the Capital Markets Day on April 19th to delve deeper into these topics.

我將從幻燈片 5 開始介紹我們的戰略願景。作為新任首席執行官，我的首要戰略目標是釋放作為領先腎臟護理公司的價值並提高股東回報。今天，我將介紹戰略路線圖的關鍵要素，我們還將在 4 月 19 日舉辦資本市場日，深入探討這些主題。

The right corporate structure is key in our ability to unlock value, and we are taking important steps to simplify and optimize our structure. Since the first of the year, we have fully implemented our new operating model, reorienting to 2 globalized operating segments: Care Delivery, our health care services business; and Care Enablement, our MedTech business. This new operating model not only provides increased transparency internally, but it will also bring enhanced transparency to our external financial reporting. We will spend time detailing the new reporting structure, along with historical figures and future expectations during our Capital Markets Day.

正確的公司結構是我們釋放價值的關鍵，我們正在採取重要步驟來簡化和優化我們的結構。自今年年初以來，我們全面實施了新的運營模式，重新定位為 2 個全球化運營部門：Care Delivery，我們的醫療保健服務業務；和 Care Enablement，我們的 MedTech 業務。這種新的運營模式不僅提高了內部透明度，而且還將提高我們外部財務報告的透明度。我們將在資本市場日花時間詳細介紹新的報告結構，以及歷史數據和未來預期。

As you will have seen in yesterday's announcement, Fresenius is planning to deconsolidate Fresenius Medical Care. The necessary change in our legal form will create a simplified, more agile and efficient governance structure, which will enable full independent decision-making and at the same time, strengthen the rights of our free float shareholders. I will speak more about that later.

正如您在昨天的公告中看到的那樣，費森尤斯計劃拆分費森尤斯醫療。我們法律形式的必要改變將創造一個簡化、更靈活和高效的治理結構，這將實現完全獨立的決策，同時加強我們自由流通股股東的權利。稍後我會詳細講到。

Another critical step is taking a more rigorous approach to capital allocation. I have implemented a disciplined financial policy to drive the much needed improvement in our return on invested capital. I am proud of what we've accomplished today through our FME25 transformation program, and we will further accelerate and extend it within the new operating model. In addition, we are implementing operational efficiency and cost reduction measures beyond FME25.

另一個關鍵步驟是採取更嚴格的資本配置方法。我已經實施了嚴格的財務政策，以推動我們急需的投資回報率改善。我為我們今天通過 FME25 轉型計劃取得的成就感到自豪，我們將在新的運營模式中進一步加速和擴展它。此外，我們正在實施超越 FME25 的運營效率和成本削減措施。

And with a disciplined wins and some focus on the core business and improving profitability, we are further optimizing our portfolio. I will speak about what these measures entail for both Care Delivery and Care Enablement, respectively, in a moment.

憑藉紀律嚴明的勝利以及對核心業務和提高盈利能力的一些關注，我們正在進一步優化我們的產品組合。稍後我將分別討論這些措施對護理服務和護理支持的影響。

Finally, I am a firm believer that culture eats strategy for breakfast. And none of these measures will be successful if we don't have a winning culture in place. This includes fostering a clear culture of accountability and with the successful implementation of our global sustainability program through 2022, we have laid a strong foundation to drive integration of sustainable principles into our business.

最後，我堅信文化早餐吃策略。如果我們沒有成功的文化，這些措施都不會成功。這包括培養明確的問責文化，以及通過到 2022 年成功實施我們的全球可持續發展計劃，我們為推動將可持續原則融入我們的業務奠定了堅實的基礎。

We have decided on new global sustainability targets for the coming years, focusing on enhancing quality of care and access to health care, reducing the company's environmental footprint and building the best team to serve our patients. As part of this, we continue to promote diversity, equity and inclusion, and I'm proud of the initiatives we continue to advance here.

我們已經決定了未來幾年新的全球可持續發展目標，重點是提高護理質量和獲得醫療保健的機會，減少公司的環境足跡，並建立最好的團隊來為我們的患者服務。作為其中的一部分，我們繼續促進多元化、公平和包容，我為我們在這裡繼續推進的舉措感到自豪。

Next on to Slide 6. As I mentioned earlier, our new simplified operating model went into effect as of January 1st. Our 2 global segments now have complete end-to-end P&L responsibility. This new structure provides increased transparency and enables us to compare directly to our peers. It also provides the basis to drive targeted improvements of our business performance.

接下來是幻燈片 6。正如我之前提到的，我們新的簡化運營模型於 1 月 1 日生效。我們的 2 個全球部門現在負有完整的端到端損益責任。這種新結構提高了透明度，使我們能夠直接與同行進行比較。它還為推動有針對性地改進我們的業務績效提供了基礎。

With our globalized and fully allocated G&A functions, we have the flexibility to scale these functions as needed to provide an appropriate level of support to the respective segments. And for me, it's remarkable to see the difference the new structure has made already, particularly around visibility and transparency, and it has opened up further possibilities to unlock value and improve profitability. This new model also positions us to truly realize the full extent of benefits from our vertically integrated business model.

憑藉我們全球化和完全分配的 G&A 職能，我們可以根據需要靈活地擴展這些職能，從而為各個部門提供適當水平的支持。對我來說，看到新結構已經產生的變化是非常了不起的，特別是在可見性和透明度方面，它為釋放價值和提高盈利能力開闢了更多可能性。這種新模式還使我們能夠真正實現垂直整合業務模式的全部好處。

Next on Slide 7. After simplifying the structure we are working with, the simplification of the structure we are working in is an important step. The announced intent by Fresenius to deconsolidate Fresenius Medical Care and the proposed corresponding change of legal form to a German Stock Corporation would significantly simplify the governance structure of Fresenius Medical Care.

接下來是幻燈片 7。在簡化我們正在使用的結構之後，簡化我們正在使用的結構是重要的一步。 Fresenius Medical Care 宣布的拆分意向以及擬將法律形式相應變更為德國股份公司的提議將顯著簡化 Fresenius Medical Care 的治理結構。

With this change, we would move from a controlled structure with several decision-making Boards to a standard German 2-tier system with 1 Supervisory Board and 1 management Board. This will strengthen the rights of the free float shareholders. One clear hurdle will be overcome with this proposed change. The KGaA structure has been a challenge for many investors.

通過這一變化，我們將從具有多個決策委員會的受控結構轉變為具有 1 個監事會和 1 個管理委員會的標準德國 2 層系統。這將加強自由流通股股東的權利。這一擬議的變更將克服一個明顯的障礙。 KGaA 結構對許多投資者來說是一個挑戰。

Turning to Slide 8. In addition to the improved shareholder rights, there are important business relevant benefits too. This governance structure enables faster and fully independent decision-making, and it also provides more optionality on our future strategic direction. The change removes the operational and coordination burdens of us being part of a larger group organization. It frees up time and capacity of the executive and management team and enables them to focus solely on Fresenius Medical Care.

轉到幻燈片 8。除了改善股東權利外，還有與業務相關的重要好處。這種治理結構可以實現更快、完全獨立的決策，也為我們未來的戰略方向提供了更多的選擇權。這一變化消除了我們作為更大集團組織的一部分的運營和協調負擔。它釋放了執行和管理團隊的時間和能力，使他們能夠專注於 Fresenius Medical Care。

It also avoids potential conflicts of interest within the group. The new legal structure enhances our flexibility to manage capital allocation and shareholder returns. It also provides us with an unrestricted approach to access capital markets from a financing perspective. With the conversion of the legal form, Fresenius will not be a controlling shareholder any more. Consequently, as a large German corporation, we would move from an indirect codetermination via the Fresenius Supervisory Board to a direct codetermination where all Supervisory Board members would be committed solely to the future of Fresenius Medical Care.

它還避免了集團內部潛在的利益衝突。新的法律結構增強了我們管理資本分配和股東回報的靈活性。它還為我們提供了一種從融資角度不受限制地進入資本市場的途徑。法制轉換後，費森尤斯將不再是控股股東。因此，作為一家大型德國公司，我們將從通過 Fresenius 監事會的間接共同決策轉變為直接共同決策，所有監事會成員將完全致力於 Fresenius Medical Care 的未來。

With the separation, the credit ratings may not benefit from the group structure, which some rating agencies take into account. With our focused capital allocation priorities to which I come later and our strong track record of deleveraging, we expect only limited weighting pressure resulting from the deconsolidation.

隨著分離，信用評級可能無法從集團結構中受益，一些評級機構考慮到了這一點。憑藉我稍後提到的我們集中的資本配置優先事項以及我們在去槓桿化方面的良好記錄，我們預計去整合只會帶來有限的權重壓力。

As a well-known issuer, we are confident to maintain our good access to the capital markets. We will also need to carve out in some, although rather limited areas where we share services with Fresenius in Germany such as G&A services for payroll, taxes or treasury, which are already contracted at arm's length. And there will be an additional administrative activities needed to convert to the new legal form. An extraordinary shareholder meeting is required later in the year, currently assumed to be in July.

作為知名發行人，我們有信心保持良好的資本市場准入。我們還需要開拓一些領域，儘管我們與德國的 Fresenius 共享服務的領域相當有限，例如薪資、稅收或財務的 G&A 服務，這些領域已經按公平原則簽訂了合同。並且將需要額外的行政活動來轉換為新的法律形式。需要在今年晚些時候召開特別股東大會，目前假設是在 7 月。

The onetime costs associated and corresponding carve-out measures are assumed to range from EUR 50 million to EUR 100 million, which we will treat as a special item. And the final decision will require a 75% approval by our shareholders. We expect that the entire process of the conversion into a German Stock Corporation will be completed by no later than the end of this year.

假設相關的一次性成本和相應的分拆措施在 5000 萬至 1 億歐元之間，我們將其視為特殊項目。最終決定需要我們股東 75% 的同意。我們預計轉換為德國股份公司的整個過程最遲將於今年年底完成。

Next on Slide 9. Additionally, we are working towards strengthening our financial position with a disciplined approach to capital allocation and improving our return on invested capital. Given our current leverage position and the high interest rate environment, deleveraging is our primary capital allocation priority. We are committed to maintaining our investment-grade status and to managing our net financial leverage in the self-imposed range of 3x to 3.5x. Any potential divestiture gains from portfolio optimization will be used for deleveraging.

接下來是幻燈片 9。此外，我們正在努力通過嚴格的資本分配方法加強我們的財務狀況，並提高我們的投資資本回報率。鑑於我們目前的槓桿狀況和高利率環境，去槓桿化是我們的首要資本配置重點。我們致力於維持我們的投資級地位，並將我們的淨財務槓桿率控制在自行設定的 3 倍至 3.5 倍的範圍內。投資組合優化帶來的任何潛在資產剝離收益都將用於去槓桿化。

We are committed to a dividend policy in line with our earnings development. Consistent with the decline in earnings in 2022, we are proposing a 17% reduction in our dividend. And finally, with a laser focus on driving organic growth in our core portfolio, our investment activities will be limited. We expect minimal acquisition activity and restrictively managing CapEx.

我們致力於根據我們的盈利發展制定股息政策。與 2022 年收益下降一致，我們提議將股息減少 17%。最後，由於專注於推動我們核心投資組合的有機增長，我們的投資活動將受到限制。我們預計收購活動最少，並嚴格管理資本支出。

Turning to Slide 10. I'm very excited about what's been achieved to date with our FME25 transformation program as well as the extended opportunities to improve profitability. With particular acceleration in the fourth quarter, our FME25 program delivered sustainable savings of EUR 131 million, well above our expected range for the year. Additionally, we have increased the scope of the program, largely comprising of additional opportunities to improve the profitability of our Care Enablement segments that continues to be heavily impacted by inflationary pressures.

轉到幻燈片 10。我對我們的 FME25 轉型計劃迄今為止取得的成就以及提高盈利能力的擴展機會感到非常興奮。隨著第四季度的特別加速，我們的 FME25 計劃可持續節省了 1.31 億歐元，遠高於我們今年的預期範圍。此外，我們擴大了該計劃的範圍，主要包括提高繼續受到通脹壓力嚴重影響的護理支持部門盈利能力的額外機會。

We now expect sustainable savings of EUR 650 million by 2025, with onetime costs of up to the same amount. We expect incremental of EUR 120 million to EUR 170 million in sustainable savings in 2023, which will bring us to EUR 250 to EUR 300 million exiting the year. And to achieve this we now expect one-time cost of EUR 250 million to EUR 300 million.

我們現在預計到 2025 年可持續節省 6.5 億歐元，一次性成本高達相同數額。我們預計 2023 年的可持續儲蓄將增加 1.2 億至 1.7 億歐元，這將使我們在當年退出時達到 250 至 3 億歐元。為實現這一目標，我們現在預計一次性成本為 2.5 億至 3 億歐元。

Moving to Slide 11. With our new operating model in place, we now have clear line of sight and the leadership accountability in place to drive performance and run the segments like the 2 separate businesses that they are. This will allow for further operational efficiencies and portfolio optimization beyond FME25.

轉到幻燈片 11。隨著我們新的運營模式到位，我們現在有了清晰的視線和領導責任制來推動績效並像 2 個獨立的業務一樣運行這些細分市場。這將允許在 FME25 之外進一步提高運營效率和投資組合優化。

On this slide, we have outlined our path to unlock value in each of our operating segments. In Care Delivery, our turnaround efforts are focused on productivity and efficiency measures. And in the U.S. specifically, we have focused on labor stabilization, growth and improving our operating leverage and we have already started clinic closures. We have around 50 to 100 clinic closures in the U.S. in our first wave.

在這張幻燈片上，我們概述了我們在每個運營部門釋放價值的途徑。在 Care Delivery 方面，我們的轉型工作主要集中在生產力和效率措施上。特別是在美國，我們專注於勞動力穩定、增長和提高我們的經營槓桿，我們已經開始關閉診所。在我們的第一波浪潮中，我們在美國關閉了大約 50 到 100 家診所。

We are streamlining our portfolio by exiting unsustainable international markets and divesting non-core service assets. In Care Enablement, our product margin had been severely impacted by macroeconomic inflationary and supply chain pressures and is falling short of our aspirations.

我們正在通過退出不可持續的國際市場和剝離非核心服務資產來精簡我們的投資組合。在 Care Enablement 方面，我們的產品利潤率受到宏觀經濟通脹和供應鏈壓力的嚴重影響，並且沒有達到我們的期望。

To improve profitability, we are focused on pricing initiatives, productivity measures and reviewing our manufacturing footprint. We are also taking a hard look at our product portfolio and are in the process of rationalizing our global R&D programs and divesting non-core product lines. This will enable in the future, a more focused capital allocation towards the areas of higher profitable growth in the core business. As I mentioned earlier, the proceeds from these disposals will be used to further deleverage.

為了提高盈利能力，我們專注於定價舉措、生產力措施和審查我們的製造足跡。我們也在認真審視我們的產品組合，並正在合理化我們的全球研發計劃和剝離非核心產品線。這將使未來能夠更集中地向核心業務中利潤增長更高的領域分配資本。正如我之前提到的，這些處置的收益將用於進一步去槓桿化。

With the move to the new operating segments, a reallocation of goodwill and the recoverability of goodwill is required. The current estimate indicates no impairment risk. I have flagged throughout the last year that our products business has faced significant margin pressure. And as the evaluation also takes into account interest rates, WACC and changes to the macroeconomic environment, possible changes to those factors may result in a goodwill impairment in Care Enablement in the future. To be transparent about the potential risk, I wanted to share this reorientation of the goodwill calculations.

隨著轉移到新的經營部門，需要重新分配商譽和恢復商譽。目前的估計表明不存在減值風險。去年我一直指出，我們的產品業務面臨著巨大的利潤壓力。由於評估還考慮了利率、WACC 和宏觀經濟環境的變化，這些因素的可能變化可能會導致未來 Care Enablement 的商譽減值。為了對潛在風險保持透明，我想分享商譽計算的這種重新定位。

Before I turn to our financial performance, I would like to emphasize that our strategic aspiration and planned initiatives are tangible. We are actively implementing and executing on these initiatives already. This gives me the confidence for a recovery of earnings growth in 2024 and beyond, and I look forward to sharing more details during our Capital Markets Day in April.

在談到我們的財務業績之前，我想強調，我們的戰略抱負和計劃中的舉措是切實可行的。我們已經在積極實施和執行這些舉措。這讓我有信心在 2024 年及以後恢復盈利增長，我期待在 4 月的資本市場日期間分享更多細節。

Now I'd like to change course and move to our fourth quarter business update on Slide 13. In the fourth quarter, we continue to deliver organic growth. Currency effects extended our revenue growth to 8% reported and 2% at constant currency. In line with expectations, our operating income declined by 8% on a constant currency basis and before special items. Our net income declined by 14% on the same basis.

現在我想改變路線，轉到幻燈片 13 上的第四季度業務更新。在第四季度，我們繼續實現有機增長。貨幣效應將我們的收入增長擴大到報告的 8% 和固定匯率下的 2%。與預期一致，我們的營業收入在固定匯率基礎上和特殊項目之前下降了 8%。我們的淨收入在同一基礎上下降了 14%。

In the fourth quarter, our headwinds and tailwinds developed roughly as communicated. And as expected, our business development continued to be impacted by higher labor costs and macroeconomic inflationary pressures. While the U.S. labor market remained challenging, our labor stabilization efforts continues to drive gradual improvements in our labor KPIs.

在第四季度，我們的逆風和順風大致按照所傳達的那樣發展。正如預期的那樣，我們的業務發展繼續受到勞動力成本上升和宏觀經濟通脹壓力的影響。儘管美國勞動力市場仍然充滿挑戰，但我們的勞動力穩定工作繼續推動我們的勞動力 KPI 逐步改善。

Next on Slide 14. On a constant currency by organic growth in EMEA and Asia Pacific. The North American region delivered stable organic growth and improvement from the third quarter despite the impact from accumulated excess mortality, staffing challenges and capacity constraints in certain clinics. Revenue for the Products business was flat for the quarter as higher sales of in-center disposables were offset by lower sales of machines for chronic treatments also resulting from delays from the lifted FDA shipment hold.

接下來是幻燈片 14。通過 EMEA 和亞太地區的有機增長實現穩定的貨幣。儘管受到累積超額死亡率、人員配置挑戰和某些診所產能限制的影響，北美地區自第三季度以來實現了穩定的有機增長和改善。產品業務的收入在本季度持平，因為中心一次性用品的銷售額增加被長期治療機器銷售額的減少所抵消，慢性治療機器的銷售額減少也是由於 FDA 發貨暫停的解除而導致的。

Turning to Slide 15. On a year-over-year basis, we experienced the largest margin contribution from business growth, including COVID effect. This was partly driven by reimbursement increases as well as a negative Humacyte investment remeasurement effect in the fourth quarter of 2021. The most significant margin detractors were macroeconomic inflationary pressures, including labor cost increases and the year-over-year headwind from applied U.S. provider relief funds.

轉到幻燈片 15。與去年同期相比，我們經歷了業務增長（包括 COVID 效應）帶來的最大利潤貢獻。這在一定程度上是由於報銷增加以及 2021 年第四季度 Humacyte 投資重新衡量的負面影響。最重要的利潤率下降因素是宏觀經濟通脹壓力，包括勞動力成本增加和美國供應商減免政策帶來的同比逆風資金。

These headwinds were partially offset by the acceleration of our FME25 program, which led to higher savings in the fourth quarter. The FME25 onetime costs, which we treated as a special item was also higher in the fourth quarter. Other onetime costs consist of the remeasurement effect of our investment in Humacyte and impact from the Ukraine war, which included the impairment of a production plans resulting from economic sanctions imposed on Russia.

這些逆風部分被我們 FME25 計劃的加速所抵消，該計劃導致第四季度節省更多。我們視為特殊項目的 FME25 一次性成本在第四季度也有所增加。其他一次性成本包括我們對 Humacyte 投資的重新衡量影響和烏克蘭戰爭的影響，其中包括因對俄羅斯實施經濟制裁而導致的生產計劃受損。

Next, on Slide 16. The year-over-year decline in our operating cash flow was mainly due to the lower net income. However, the focus on lower CapEx resulted in a stable free cash flow development year-over-year. At 3.4x net debt to EBITDA, we were at the upper end of our target leverage corridor and it is a priority for us to stay within this self-imposed range. For me, cash is king. And as I mentioned earlier, future deleveraging is at the top of our capital allocation priorities.

接下來，在幻燈片 16 上。我們的經營現金流量同比下降主要是由於淨收入較低。然而，對較低資本支出的關注導致了穩定的自由現金流量同比增長。我們的淨債務為 EBITDA 的 3.4 倍，處於目標槓桿走廊的上限，我們的首要任務是保持在這個自我設定的範圍內。對我來說，現金為王。正如我之前提到的，未來的去槓桿化是我們資本配置的重中之重。

Turning to our outlook on Slide 18. With our new financial reporting structure and in line with our DAX peer group, we will now change to an annual outlook for revenue and operating profit. It's important for me to continue to be transparent about the assumptions we are making. And for 2023, I really want to focus on the key assumptions and drivers of expected earnings development.

轉向我們對幻燈片 18 的展望。根據我們新的財務報告結構並與我們的 DAX 同行組保持一致，我們現在將更改為收入和營業利潤的年度展望。對我來說，繼續對我們所做的假設保持透明很重要。對於 2023 年，我真的很想關注預期收益發展的關鍵假設和驅動因素。

Despite some stabilization, we are assuming a continued headwind of EUR 200 million to EUR 240 million from the inflationary cost environment, resulting from the annualization effect from these costs plus, although on a lower level, a continuation of the inflationary environment. This remains a headwind, in particular, in Care Enablement.

儘管有所穩定，但我們假設通貨膨脹成本環境將持續帶來 2 億至 2.4 億歐元的逆風，這是由於這些成本的年化效應加上通貨膨脹環境的持續，儘管在較低水平上。這仍然是一個不利因素，尤其是在護理支持方面。

As you know, we have many moving parts on labor. However, we are seeing gradual improvements in the challenging U.S. labor markets. And as outlined last year of the defined labor cost headwind, a portion was expected to become a tailwind for 2023. And some of the permanent measures we implemented in 2022 were always expected to have an annualization effect. We are assuming a merit increase of 3% to 4% across the group assuming that all of these effects and assumptions it results in a labor cost headwind year-over-year of EUR 140 million to EUR 180 million.

如您所知，我們有許多關於勞動的活動部分。然而，我們看到充滿挑戰的美國勞動力市場正在逐步改善。正如去年定義的勞動力成本逆風所概述的那樣，一部分預計將成為 2023 年的順風。我們在 2022 年實施的一些永久性措施一直預計會產生年化效應。我們假設整個集團的業績增長 3% 至 4%，假設所有這些影響和假設導致勞動力成本同比增長 1.4 億至 1.8 億歐元。

In the U.S. As I mentioned earlier, we are assuming sustainable FME25 savings of EUR 250 million to EUR 300 million by the end of 2023. And last year, as we all know, operating income was supported by EUR 277 million of U.S. provider relief funds, and we do not assume any additional funds will be made available in 2023. And to provide a comparable basis for our 2023 operating income outlook, we have adjusted the base accordingly.

在美國，正如我之前提到的，我們假設到 2023 年底可持續的 FME25 節省 2.5 億至 3 億歐元。眾所周知，去年營業收入得到了 2.77 億歐元的美國供應商救濟基金的支持，並且我們不假設 2023 年將提供任何額外資金。為了為我們的 2023 年營業收入展望提供可比的基礎，我們相應地調整了基數。

Next, on Slide 19. As always, our outlook is in constant currency and excluding special items. In 2023, we expect low to mid-single-digit revenue growth. On the adjusted basis that I just explained on the previous slide, we expect a flat to high single-digit percentage weight decline for operating income in 2023. And from a phasing perspective, we do expect the low point in our operating income development in the first quarter. The first quarter is expected to provide only a mid-teens percentage share of the 2023 operating income.

接下來，在幻燈片 19 上。一如既往，我們的前景是不變的，不包括特殊項目。 2023 年，我們預計收入將實現中低個位數增長。根據我剛剛在上一張幻燈片中解釋的調整基礎，我們預計 2023 年營業收入的權重百分比將持平至高個位數下降。從階段性的角度來看，我們確實預計我們營業收入發展的低點在第一季度。預計第一季度僅佔 2023 年營業收入的十幾%。

To help you with your 2023 modeling, we are assuming a tax rate of 25% to 27% and financial cost of EUR 350 million to EUR 380 million at constant currency. While 2023 will be a year of level setting, we are confident in our path to unlock value as the leading kidney care company. We expect to come out of 2023 stronger and well positioned to drive sustainable, profitable growth with the recovery of earnings growth in 2024 and by 2025 with an improved operating profit margin of 10% to 14%.

為幫助您進行 2023 年建模，我們假設稅率為 25% 至 27%，財務成本為 3.5 億至 3.8 億歐元（按固定匯率計算）。雖然 2023 年將是水平設定的一年，但我們對作為領先的腎臟護理公司釋放價值的道路充滿信心。我們預計，隨著 2024 年和 2025 年盈利增長的恢復，營業利潤率將提高 10% 至 14%，到 2023 年，我們將變得更加強大並處於有利地位，以推動可持續的盈利增長。

And when you look at the 2025 margin aspiration, please keep in mind that this includes the assumed strong revenue growth of our value-based care business, which comes with an incremental but lower margins and therefore dilutes the overall margins.

當您查看 2025 年的利潤率目標時，請記住，這包括假設我們基於價值的護理業務的收入強勁增長，這伴隨著增量但利潤率較低，因此會稀釋整體利潤率。

With that, I know I've covered a lot. And I imagine you have some questions for me, and I'll hand it over to Dominik to begin the Q&A.

有了這個，我知道我已經涵蓋了很多。我想你有一些問題要問我，我會把它交給 Dominik 開始問答。

Thank you, Helen, for the presentation and the many insights. And with that, I hand it over to Nicolas, please open the lines for the Q&A.

海倫，謝謝您的介紹和許多見解。然後，我將它交給 Nicolas，請開啟問答環節。

(Operator Instructions) The first question is coming from Graham Doyle from UBS.

（操作員說明）第一個問題來自瑞銀集團的 Graham Doyle。

Just one firstly on this year's guidance. So when I look to the sort of pushes and pulls, you've kindly given us, it kind of implies that there's maybe $130 million of business growth in 2023 to hit the midpoint of your guidance. Is that fair? And how would you go by doing that. And then the extended FME25 program. If you hit the top end of -- if you deliver that, so does that allow you to then hit the top end of that...

只是今年指導的第一個。因此，當我看到那種推動和拉動時，你親切地給了我們，這有點意味著 2023 年可能有 1.3 億美元的業務增長達到你指導的中點。這公平嗎？你會怎麼做呢？然後是擴展的 FME25 程序。如果你達到了最高點——如果你做到了，那你就可以達到那個……的最高點嗎？

In terms of the margin range for 2025, as I'm sure you can appreciate, there's a lot of these initiatives that I've outlined today that will gradually payoff between '23 and '25. And you're absolutely right. Of course, FME25 is a big piece of that. However, these underlying measures that I speak about in efficiencies, productivity, improving the operating leverage as well as certain pricing measures will also contribute to that margin expansion.

就 2025 年的利潤率範圍而言，我相信你會理解，我今天概述的這些舉措中有很多將在 23 到 25 年間逐漸產生回報。你是絕對正確的。當然，FME25 是其中的重要組成部分。然而，我在效率、生產力、提高經營槓桿以及某些定價措施方面談到的這些基本措施也將有助於利潤率的增長。

Additionally, we do expect some reimbursements catch up here with PPS over this period through 2025 as well as the patient growth recovery. So I think what we can see is we're kind of looking at this 3-year window is the combination of all of these measures coming -- and coming to fruition that gets us back closer to historical profits, but I think with a leaner, more focused approach on the -- kind of -- on the operations here.

此外，我們確實預計到 2025 年這一時期以及患者成長恢復時，一些報銷會趕上 PPS。所以我認為我們可以看到的是，我們正在審視這 3 年的窗口，即所有這些措施的結合——並取得成果，使我們更接近歷史利潤，但我認為精簡，更專注於 - 一種 - 此處的操作。

With regard to the '23 guidance, of course, the delta is business growth. Bear in mind that, that labor number is a net number, which includes the merit increase as well. But of course, what we were trying to do was just tease out the main headwinds and tailwinds, but of course, there's an underlying business performance here as well. And rather than just putting that in as a -- maybe last year, we had it in as a plug for everything else, we've got now this year, just trying to focus on the main pluses and minuses, and it's not meant to be a complete exhaustive list as I'm sure you can appreciate it.

關於'23 指導，當然，三角洲是業務增長。請記住，勞動力數量是一個淨值，其中也包括績效增長。但當然，我們試圖做的只是梳理出主要的逆風和順風，但當然，這裡也有潛在的業務表現。而不是僅僅把它作為一個 - 也許去年，我們把它作為其他一切的插件，我們今年已經有了，只是試圖專注於主要的優點和缺點，這並不意味著是一份完整詳盡的清單，我相信您會喜歡的。

The next question is coming from Hassan Al-Wakeel from Barclays.

下一個問題來自巴克萊銀行的 Hassan Al-Wakeel。

I have a couple, please. Firstly, could you talk about the bridge to 2025 margin targets in the key building blocks to achieving this. What are your assumptions around pricing, wage inflation and cost out given EBIT growth at the midpoint based on your margin target, vastly outpaces revenue growth over this period.

我有一對，請。首先，您能否談談實現這一目標的關鍵組成部分中通往 2025 年利潤率目標的橋樑。鑑於基於您的利潤率目標的中點息稅前利潤增長大大超過了這一時期的收入增長，您對定價、工資通脹和成本支出的假設是什麼？

Secondly, could you talk a bit about the potential for disposals where these could hit perhaps in the Care Coordination portfolio or maybe some of the lower growth or margin regions. How long is this list? Is anything being assumed for 2025 in terms of the margin target? And how significant could it be?

其次，您能否談一談處置的可能性，這些處置可能會影響 Care Coordination 投資組合或一些較低增長或利潤率的地區。這個列表有多長？就保證金目標而言，2025 年是否有任何假設？它有多重要？

Thanks, Hassan. Appreciate the questions. So we're not going to lay out a bridge for 2025 today. We will have the CMD in April that will speak to the plans for both segments and the kind of the margin building blocks, if you will, some more to come in April with more detail there. When -- at that time, we'll also roll out the kind of the segment reporting and we'll have the historical views on that as well. So you'll be able to see projects and services in the way you've all been asking to see it for many years.

謝謝，哈桑。感謝這些問題。所以我們今天不會為 2025 年鋪設一座橋樑。我們將在 4 月份發布 CMD，其中將談到這兩個細分市場的計劃和利潤構建模塊的類型，如果你願意的話，4 月份還會有更多的細節。什麼時候 - 那時，我們還將推出那種細分報告，我們也會對此有歷史看法。因此，您將能夠以多年來一直要求的方式查看項目和服務。

In terms of potential disposals, we've taken a hard look at the portfolio. And I guess all I would say right now is we're looking at what really is too far removed from the core, and also what maybe isn't performing at the kind of margin level we would expect. So that does include non-core dialysis services assets, as I mentioned, and we're also looking at international service markets where either -- viable for us. More to come, right now we don't have these built-in, as we bring them to fruition and execution over the course of the -- probably the next -- 12 to 18 months, with some in 2023, we'll update on those in real time.

在潛在處置方面，我們仔細研究了投資組合。而且我想我現在要說的是，我們正在研究真正遠離核心的東西，以及可能沒有達到我們預期的利潤水平的東西。所以這確實包括非核心透析服務資產，正如我提到的那樣，我們也在關注國際服務市場——對我們來說是可行的。更多未來，現在我們沒有這些內置的，因為我們將在 - 可能是接下來的 - 12 到 18 個月的過程中實現它們並執行，其中一些在 2023 年，我們將更新在那些實時的。

And then you asked a question on the -- let me get all your questions here. You asked a question on the margin for 2025. Of course, as I mentioned, VBC will be a little bit of a driver of that dilution as that medical costs under management grows, we'll still get the low single-digit percentage of margin, but that does dilute the overall margin. But I think the key piece here will be what we cover in Capital Markets Day in April on the bridges to the services and products margin improvements.

然後你問了一個問題——讓我在這裡回答你所有的問題。你問了一個關於 2025 年利潤率的問題。當然，正如我提到的，隨著管理的醫療成本的增長，VBC 將在一定程度上推動這種稀釋，我們仍將獲得較低的個位數百分比的利潤率，但這確實會稀釋整體利潤率。但我認為這裡的關鍵部分將是我們在 4 月份的資本市場日中介紹的關於服務和產品利潤率改善的橋樑。

Helen, if I could just follow up, please, in the absence of a margin bridge and looking forward to getting that in a couple of months. But what are your assumptions in terms of pricing and wage inflation? Do you expect a meaningful maturation of the latter? And how are you thinking about reimbursement rates next year and beyond?

海倫，如果我能跟進，請在沒有保證金橋樑的情況下，並期待在幾個月內得到它。但是您在定價和工資通脹方面的假設是什麼？你期待後者有意義的成熟嗎？您如何考慮明年及以後的報銷率？

Yes. I'm not giving that today, Hassan. We'll come back, as I said, in April, with more detail on that.

是的。我今天不給，哈桑。正如我所說，我們將在 4 月份回來提供更多詳細信息。

The next question is coming from Oliver Metzger from ODDO BHF.

下一個問題來自 ODDO BHF 的 Oliver Metzger。

The first one is also on your 25% EBIT margin guidance. So you have increased your exposure to value-based care quite strongly through with premerger with InterWell Health. So the question is, it's a highly dilutive business but still brings some EBIT. So how many revenues have you baked into your '25 assumption. That would be quite interesting to know.

第一個也是關於 25% 的息稅前利潤率指導。因此，通過與 InterWell Health 的預合併，您已經大大增加了對基於價值的護理的接觸。所以問題是，這是一項高度稀釋的業務，但仍帶來了一些息稅前利潤。那麼，您在 25 年的假設中考慮了多少收入。知道那會很有趣。

And the second question is on -- I understand that you don't incorporate any potential governmental support in your guidance. That's quite prudent. I would say, while magnitude and timing is highly uncertain, how do we evaluate from a top-down perspective, which enhances that some funds will be granted as otherwise smaller dialysis centers would not survive.

第二個問題是——我知道你沒有在你的指南中納入任何潛在的政府支持。可以說是很慎重了。我想說的是，雖然規模和時間都非常不確定，但我們如何從自上而下的角度進行評估，這加強了一些資金將被授予，否則較小的透析中心將無法生存。

Thanks, Oliver. Let me take your questions. In terms of the EBIT guidance, yes, you're right. On VBC, when we talk about dilutive. We had previously said that we expect the medical costs under management to be around $11 billion by 2025. And we had said that low single digit, around 1% margin there. Obviously, that is baked into these projections. And I don't really -- I mean, obviously, it's an accretive absolute EBIT contribution but it does dilute the percentage. But obviously, we are seeing with all the other efficiency measures and productivity measures and pricing measures along with FME25, we do see a path to that margin range that we outlined. And of course, that's why we have published that.

謝謝，奧利弗。讓我回答你的問題。就息稅前利潤指南而言，是的，你是對的。在 VBC 上，當我們談論稀釋時。我們之前曾說過，我們預計到 2025 年所管理的醫療費用將達到 110 億美元左右。我們曾說過低個位數，利潤率約為 1%。顯然，這些預測都包含了這一點。而且我不是真的 - 我的意思是，顯然，這是一個增加的絕對息稅前利潤貢獻，但它確實稀釋了百分比。但顯然，我們看到所有其他效率措施、生產力措施和定價措施以及 FME25，我們確實看到了通往我們概述的利潤率範圍的途徑。當然，這就是我們發布它的原因。

In terms of government support, we really don't see any path to that. There is no funding left in any of the bills that have been issued. And of course, we continue to kind of -- along with many providers speak to the concerns that we have. And obviously, we know that the reimbursement system is in a lag. And obviously, we do have a benefit of the 3% PPS rate this year.

在政府支持方面，我們真的看不到任何途徑。已發行的任何法案中都沒有剩餘資金。當然，我們繼續與許多供應商一起談論我們的擔憂。顯然，我們知道報銷系統滯後。顯然，我們確實受益於今年 3% 的 PPS 利率。

Our expectation is that, that will increase in '24 and '25 in line with the increased costs that will get submitted. We'll get the benefit of that. Hopefully, inflation starts to tail off. So I think you're right. It's not just a prudent assumption. I think it's a real assumption. This time last year, we felt that we had line of sight into something, but not here. And obviously, if anything changes, we will update the markets accordingly.

我們的預期是，在 24 和 25 年，這將隨著提交的成本增加而增加。我們將從中受益。希望通貨膨脹開始減弱。所以我認為你是對的。這不僅僅是一個謹慎的假設。我認為這是一個真實的假設。去年的這個時候，我們覺得我們看到了一些東西，但不是在這裡。顯然，如果有任何變化，我們將相應地更新市場。

Okay. And then one follow-up. How do you evaluate the risk that some smaller operators will go out of business?

好的。然後是跟進。您如何評估一些較小的運營商倒閉的風險？

Sorry, Oliver, I did miss that. Yes, look, it's a question we get asked a lot. Obviously, we are larger in scale, and obviously, it's impacting us quite significantly. So we can only imagine that it's hitting the smaller operators harder. If you recall, there was more funding available for the rural providers. But of course, that's used up, too.

對不起，奧利弗，我確實錯過了。是的，看，這是我們經常被問到的問題。顯然，我們的規模更大，顯然，它對我們的影響非常大。所以我們只能想像它對較小的運營商的打擊更大。如果您還記得的話，農村提供者可以獲得更多資金。但當然，這也用完了。

I guess the hypothesis here is that it could put stress on the smaller operators and maybe that becomes a benefit for us if we're able to pick up those patients. But obviously, that's not built into this, and I'm speculating on what duress there under. I can honestly say we're not having them knocking at our door saying, buy us and we're not buying any way. But obviously, it's something that we are keeping our ears to the ground on and watching carefully.

我想這裡的假設是，它可能會給較小的運營商帶來壓力，如果我們能夠接收這些患者，這可能對我們有利。但顯然，這不是內置的，我在猜測那裡受到了什麼脅迫。我可以誠實地說，我們不會讓他們敲我們的門說，買下我們，但我們不會以任何方式購買。但顯然，這是我們正在密切關注並仔細觀察的事情。

The next question is coming from Christoph Gretler from CS.

下一個問題來自 CS 的 Christoph Gretler。

Yes. First of all, congratulations on this steep career from CFO to CEO, and now to a fully public company. So it's quite remarkable. I have now 2 questions for you. The first is just on same-store market growth in the U.S. now it keeps on declining. And I was just wondering if you could share your thoughts on what's going on there. I guess kind of the access mortalities probably kind of passed and it's still kind of not showing any signs of improvement. So that would be very interesting. And the second question with respect to payer mix, whether you could indicate if you had seen any impact from the Marietta Memorial Hospital case particularly on the small and midsized customer base. Now, it's been a while now. So I'm just wondering whether that's kind of an issue or not at all?

是的。首先，祝賀您從 CFO 到 CEO，再到一家完全上市的公司，經歷了這段陡峭的職業生涯。所以這是非常了不起的。我現在有兩個問題要問你。首先是美國的同店市場增長，現在它一直在下降。我只是想知道你是否可以分享你對那裡發生的事情的看法。我想訪問死亡率可能已經過去了，但仍然沒有顯示出任何改善的跡象。所以那會很有趣。關於付款人組合的第二個問題，你是否可以指出你是否看到瑪麗埃塔紀念醫院案例的任何影響，特別是對中小型客戶群的影響。現在，已經有一段時間了。所以我只是想知道這是否是一個問題？

Thanks, Christoph. It's -- I appreciate the congratulations. It's been a busy 78 days. Let me unpack your questions. Same-store market growth, in Q4, that was minus 1.9%, and that was an improvement over Q4. And obviously, to be clear, that's the U.S. And it has been improving every quarter.

謝謝，克里斯托夫。這是 - 我感謝您的祝賀。這是忙碌的78天。讓我來解開你的問題。第四季度同店市場增長率為負 1.9%，比第四季度有所改善。顯然，需要明確的是，這就是美國，而且每個季度都在改善。

Obviously, as you correctly pointed out, there is this -- the accumulation of the excess mortality. But -- and I think it's why we have been quite narrow and flattish with our range on kind of the growth projection for 2023. But we're also seeing kind of the mortality coming down quite significantly from the peak consistently. So that's giving us the confidence that we will return to growth.

顯然，正如您正確指出的那樣——超額死亡率的積累。但是——我認為這就是為什麼我們對 2023 年增長預測的範圍非常狹窄和持平。但我們也看到死亡率從峰值持續大幅下降。因此，這給了我們信心，我們將恢復增長。

I think this question of when do we see it fully back to what it was pre pandemic. We keep talking about this 18- to 24-month period. And every time we see an improvement that gives us confidence. In terms of the payer mix, it's been quite sticky throughout. And we've obviously spoken about that. We continue to see kind of slight improvements now with the Medicare Advantage book of business. So that also helps us as well with MA being in the high 30s.

我認為這個問題是我們什麼時候才能看到它完全回到大流行前的狀態。我們一直在談論這 18 到 24 個月的時間。每次我們看到進步都會給我們信心。就付款人組合而言，它自始至終都很粘。我們顯然已經談到了這一點。我們現在繼續看到 Medicare Advantage 業務簿的輕微改進。因此，這也有助於我們將 MA 置於 30 多歲。

And then the last comment on Marietta, we're still expecting that bill to be passed in the language in the MSP amended. We had hoped it would be at the end of last year in the Lame-Duck period, but it didn't happen. But we're still confident that, that will happen in 2023. We're -- obviously, all the plans were locked and loaded last year for this year. So no impact in 2023, and it's still going through the CBO scoring, and we expect it to be a net cost to the government when that all gets resolved. But obviously, we'd like it resolved and the overhang of the questions to go away.

然後是關於 Marietta 的最後評論，我們仍然期待該法案以 MSP 中修改後的語言通過。我們曾希望它會在去年年底的跛腳鴨時期出現，但它沒有發生。但我們仍然相信，這將在 2023 年發生。顯然，我們所有的計劃都在去年鎖定並加載到今年。所以在 2023 年沒有影響，它仍在接受 CBO 評分，我們預計當所有問題都得到解決時，這將成為政府的淨成本。但顯然，我們希望它得到解決，懸而未決的問題消失。

The next question is coming from Ed Ridley-Day from Redburn.

下一個問題來自 Redburn 的 Ed Ridley-Day。

Great. And I'd also add my congratulations, Helen. Great to see some commentary around return on capital, obviously a clearly important metric and obviously something that the company has struggled with in recent years. Can you give us some idea of your -- the level you would like to see? I know you've laid out but that would be helpful if you could give us some color about how you would like ROIC to develop?

偉大的。海倫，我還要表示祝賀。很高興看到一些關於資本回報率的評論，這顯然是一個非常重要的指標，而且顯然是該公司近年來一直在努力解決的問題。你能告訴我們你的一些想法嗎 - 你希望看到的水平？我知道你已經佈置好了，但如果你能給我們一些關於你希望 ROIC 發展的顏色，那會很有幫助嗎？

And also, a second question would be, have you yet or what are your thoughts on the opportunity in PD in the U.S., in particular, following your peers exit from the market?

而且，第二個問題是，您是否已經或您對美國 PD 的機會有何看法，特別是在您的同行退出市場之後？

Sorry, I think we had a little bit of a connection problem. Can you repeat the last question, sorry.

抱歉，我想我們遇到了一些連接問題。對不起，你能重複最後一個問題嗎？

Sure. Your peer Baxter announced an exit with some PD. And presumably, that might offer an opportunity. I don't know if you have any thoughts on that at this stage.

當然。您的同行 Baxter 宣布退出並與一些 PD 合作。據推測，這可能會提供一個機會。我不知道你現階段對此是否有任何想法。

Thank you.

謝謝。

Thanks, Ed. Thank you for repeating that question. We've lost you at the back end of that. Yes, look, return on invested capital, there's no question it's disappointed being in the 3s. I haven't put a target range out there, but clearly, we need to minimally clear our cost of capital here. So you can see the financial policy I put out. It needs to improve and it needs to improve quickly and concertedly.

謝謝，埃德。謝謝你重複這個問題。我們在後端失去了你。是的，看，投資資本回報率，毫無疑問，它處於 3s 令人失望。我沒有在那裡設定目標範圍，但很明顯，我們需要在這裡最低限度地清除我們的資本成本。所以你可以看到我提出的財政政策。它需要改進，而且需要快速、一致地改進。

We'll think through whether we put some targets out there for April, having really got that far on the rolling target. But obviously, it was so low, it needs to improve, and I'm very mindful of the -- maybe increase in cost of capital and the impact on our WACC. So very much a focused effort internally.

我們將仔細考慮是否為 4 月份制定了一些目標，因為滾動目標真的已經實現了那麼多。但顯然，它太低了，需要改進，而且我非常注意 - 可能會增加資本成本以及對我們 WACC 的影響。內部非常集中精力。

On your Baxter, yes. Look, it would be interesting to see what that -- how that all plays out. We know that some of those assets have been -- how do I say shopped for sale and there wasn't take up on there, now they're doing the spin-off. We'll also see how customers react to it and what that means and if there is opportunity. Obviously, our team are staying close to it and looking at it. But I think for us, we're clear where we are with our portfolio, but maybe it will help with pricing in the market overall and we're all suffering with the same inflationary and cost pressures on the product side here.

在你的 Baxter 上，是的。看，看看這一切是如何發生的會很有趣。我們知道其中一些資產已經——我怎麼說是購買待售的，但那裡沒有佔用，現在他們正在進行分拆。我們還將了解客戶對此有何反應，這意味著什麼，以及是否有機會。顯然，我們的團隊正在靠近它並觀察它。但我認為對我們來說，我們很清楚我們的投資組合所處的位置，但也許這將有助於整體市場的定價，我們都在產品方面承受著同樣的通脹和成本壓力。

So yes, I think we're just watching and waiting to see what happens as they complete the spin out and whether -- yes. What kind of transaction happens as a result of that.

所以是的，我認為我們只是在觀察並等待他們完成分拆後會發生什麼，以及是否 - 是的。結果會發生什麼樣的交易。

The next question is coming from Lisa Clive from Bernstein.

下一個問題來自 Bernstein 的 Lisa Clive。

Helen, it's been a while. Congratulations on the promotion, and good luck with the big changes ahead. Just a few questions on -- just your thoughts on treatment volumes. Can you comment on what's the COVID excess mortality was in Q4? And what are your assumptions for that for 2023?

海倫，好久不見了。祝賀你晉升，祝你在未來的大變化中好運。只是幾個問題——只是你對治療量的看法。您能否評論一下第四季度的 COVID 超額死亡率是多少？您對 2023 年的假設是什麼？

Second part of that is DaVita made a lot of noise at Q3 around missed treatments having ticked up and stayed quite high through 2022, which they said was a 100 basis point headwind to their treatment volumes, which they have expected to continue into 2023. We'll see what they update us on that later. But can you just comment on how missed treatments have been trending for you and whether we should expect a year-over-year change in any way and whether it's sort of elevated?

第二部分是 DaVita 在第三季度大肆宣揚錯過的治療數量上升並在 2022 年之前一直保持在相當高的水平，他們說這對他們的治療量造成了 100 個基點的不利影響，他們預計這種情況將持續到 2023 年。我們稍後會看到他們更新我們的內容。但是你能不能評論一下錯過治療對你來說是如何趨勢的，我們是否應該以任何方式期待同比變化，以及它是否有點升高？

And then the last piece relating to your treatment volumes is just around transplants. There's about 20,000 transplants in the U.S. every year. I assume, given your market share that roughly 35%, 40% of that is your patients. Has that number stayed pretty steady? Has it actually gone down in the pandemic due to lack of operating room capacity? There was a big push under a Trump initiative to try and increase transplants. Has that number been going up? I'm just sort of curious and also in light of the regulatory change where there's now drug coverage for patients under Medicare, which could help some of those patients maintain those transplants in a healthy way. Just trying to think about some of the puts and takes around patient volumes as the next few years unfold.

然後與您的治療量有關的最後一部分是關於移植的。美國每年大約有 20,000 例移植手術。我假設，鑑於您的市場份額約為 35%，其中 40% 是您的患者。這個數字一直保持穩定嗎？由於手術室容量不足，它是否真的在大流行中下降了？在特朗普的倡議下，試圖增加移植手術的努力得到了大力推動。這個數字一直在上升嗎？我只是有點好奇，也考慮到監管的變化，現在醫療保險為患者提供藥物保險，這可以幫助其中一些患者以健康的方式維持這些移植。隨著未來幾年的發展，只是想考慮一些看跌期權和患者數量。

Thanks, Lisa. It's great to hear your voice. Let me make sure I capture all of those. And if I miss something, just tell me at the end, but I think I was scribbling furiously here.

謝謝，麗莎。很高興聽到你的聲音。讓我確保我捕獲了所有這些。如果我遺漏了什麼，請在最後告訴我，但我想我在這裡瘋狂地塗鴉。

Treatment volumes in Q4 were pretty flat. So we didn't see anything untoward there. In terms of the missed treatments, and I think we saw this kind of phenomena in lower growth in Q2 to be [decided] in Q3. And I think at this point, both of us are saying, who we don't know. So we are turning that into -- okay, all we can look at now is where we are with our organic growth, and that's why I think we're kind of -- for us, for sure, at FMC calling it the plus 1, minus 1 for 2023.

第四季度的治療量相當平穩。所以我們在那裡沒有看到任何不妥之處。就錯過的治療而言，我認為我們在第二季度看到了這種增長較低的現象，將在第三季度[決定]。我想在這一點上，我們都在說，我們不認識誰。所以我們正在把它變成——好吧，我們現在所能看到的就是我們的有機增長，這就是為什麼我認為我們有點——對我們來說，當然，在 FMC 稱之為加 1 , 2023 年減 1。

So -- and then as it relates to COVID and the excess mortality, we'd always guided 5,000 to 6,000 for the full year. We ended the year. And bear in mind, these are still somewhat -- not completely final because of the data lag but we ended the year with around 5,200. So a little less than we had expected. And it's -- at the peak, we were seeing this excess mortality driving around 400 basis points. And now we're seeing that at around 250 basis points. So I think that gives you the swing of where we're seeing that.

所以——然後因為它與 COVID 和超額死亡率有關，我們總是指導全年 5,000 到 6,000 人。我們結束了這一年。請記住，由於數據滯後，這些仍然有些 - 不是完全最終的，但我們以大約 5,200 結束了這一年。所以比我們預期的要少一點。而且它——在高峰期，我們看到這種超額死亡率推動了大約 400 個基點。現在我們看到它在 250 個基點左右。所以我認為這讓你了解我們所看到的情況。

And then just maybe as we think about our same market decrease, that's been coming -- as I already mentioned, that's been coming down a little bit every quarter. We were at minus 1.9% at the end of the year.

然後也許就像我們考慮我們相同的市場下降一樣，這已經到來 - 正如我已經提到的那樣，每個季度都在下降一點點。年底我們的增長率為負 1.9%。

And then on transplants, you mentioned 20,000. We're seeing that a little bit higher, maybe around 25,000. So I think there's a little bit of an increase, which obviously is likely to be supported by some of the executive orders there as well. But an increase, but still quite small numbers in terms of the overall patient volumes. Did I miss anything, Lisa?

然後關於移植，你提到了 20,000。我們看到它有點高，可能在 25,000 左右。所以我認為有一點增加，這顯然也可能得到一些行政命令的支持。但是增加了，但就整體患者數量而言仍然很小。我錯過了什麼嗎，麗莎？

No. I suppose just -- well, I guess maybe just one follow-up on the excess mortality around, COVID. Essentially, the average has been that roughly 20% of your patients die -- COVID increased that by a few percentage points. Do you think we're sort of stuck at a slightly higher mortality rate just because these are such clinically vulnerable patients or just trying to think about how that looks going forward?

不，我想只是——好吧，我想也許只是對 COVID 周圍超額死亡率的一項後續行動。從本質上講，平均值是大約 20% 的患者死亡——COVID 使這一數字增加了幾個百分點。您是否認為我們會因為這些臨床上非常脆弱的患者而陷入略高的死亡率，或者只是想考慮一下未來的發展情況？

Yes. Great question. And that's actually maybe a little bit of a bright spot for us because historically, we were sitting around 17% through COVID. It went up to around 20%. And now we're seeing that come back down quite quickly actually to around 18%. So I think that's what also gives us the confidence on the growth recovery in the short term as well. So -- and that was obviously, the numbers I'm giving you kind of more U.S. numbers, but international normalized even quicker, I would say, because obviously, we didn't have the same impact from COVID that we did in the U.S.

是的。很好的問題。這實際上對我們來說可能是一個亮點，因為從歷史上看，我們通過 COVID 坐在 17% 左右。它上升到20%左右。現在我們看到這個比例實際上很快回落到 18% 左右。所以我認為這也讓我們對短期內的增長復甦充滿信心。所以 - 很明顯，我給你的數字更多是美國的數字，但我想說國際化更快，因為很明顯，我們沒有像在美國那樣受到 COVID 的影響。

So I think that's really encouraging for us that these -- the underlying business fundamentals that we speak about with the kind of the patients -- new patients coming in and the growth is somewhat normalizing post-COVID. I guess it all took longer than we all ever imagined.

因此，我認為這對我們來說真的很令人鼓舞，因為這些——我們與患者談論的基本業務基本面——新患者的到來和增長在某種程度上在 COVID 後正常化。我想這一切花費的時間比我們想像的要長。

Yes. Great. And I know you guys have done an incredible job keeping your patients as safe as you can. That's super helpful.

是的。偉大的。我知道你們在確保患者安全方面做得非常出色。這非常有幫助。

Thanks, Lisa.

謝謝，麗莎。

The next question is coming from James Vane-Tempest.

下一個問題來自 James Vane-Tempest。

It's James Vane-Tempest from Jefferies. Just coming back to 2025. Outside of your own execution and numbers, I'm just curious what you're assuming for any industry changes for your projections. So for example, value-based care is progression to ESRD being delayed? So are patients essentially joining that sicker and missing treatments. So are business models increasingly stretched over time for value-based care -- that risk models?

我是 Jefferies 的 James Vane-Tempest。回到 2025 年。除了你自己的執行和數字之外，我很好奇你對你的預測的任何行業變化的假設。因此，例如，基於價值的護理會延遲 ESRD 的進展嗎？因此，患者基本上加入了病情加重和缺失的治療。那麼，隨著時間的推移，基於價值的護理的商業模式是否越來越多——即風險模式？

And secondly, on volumes, I'm curious if patients flow may slow if drugs are more effective in CKD 3 or 4. So patients potentially starting ESRD are not living as long if they're sicker. Is this a trend you think is happening or getting better over time? And then thirdly, apologies as I mentioned earlier about DaVita as reading, given we're talking about 2025. Just wondering if you are assuming in your assumptions, any impact on commercial mix in 2024.

其次，就數量而言，我很好奇如果藥物對 CKD 3 或 4 更有效，患者的血流量是否會減慢。因此，如果病情加重，可能開始 ESRD 的患者不會活得那麼久。您認為這是正在發生的趨勢還是隨著時間的推移會變得更好？第三，抱歉，正如我之前提到的關於 DaVita 的閱讀，鑑於我們談論的是 2025 年。只是想知道你是否在假設中假設對 2024 年商業組合的任何影響。

Thanks, James. So yes, we're not really assuming anything different in the underlying fundamentals in our market situation due to the ESRD or CKD. What we are doing, of course, with our value-based care efforts is moving more into managing that CKD population, which we feel is an important part of our strategy that ultimately we should get healthier patients coming in, into the funnel. So that feels kind of all aligned with the strategy there.

謝謝，詹姆斯。所以是的，由於 ESRD 或 CKD，我們並沒有真正假設我們市場情況的基本面有任何不同。當然，我們正在做的是，通過我們基於價值的護理努力，更多地轉向管理 CKD 人群，我們認為這是我們戰略的重要組成部分，最終我們應該讓更健康的患者進入漏斗。所以這感覺有點符合那裡的戰略。

In terms of the -- what we are feeling there is that if we are getting a healthier patient coming in, then that means that they would be on dialysis for longer. It's an interesting question on the drug piece because, obviously, we're watching SGLT2s closely. And what we see there is a cardiovascular benefit and kind of a diabetes benefit. So that means that we should -- ultimately, they may still kind of as it will still end up on the ESRD, but again, we'll have a healthier patient for longer. But we see that impact is maybe what, 6, 8 years away. But obviously, if we can get benefits on the CKD population, that will ultimately benefit us there.

就我們的感受而言，如果我們讓一個更健康的病人進來，那麼這意味著他們將接受更長時間的透析。這是關於藥物的一個有趣問題，因為很明顯，我們正在密切關注 SGLT2。我們看到的是心血管益處和某種糖尿病益處。所以這意味著我們應該——最終，他們可能仍然會在 ESRD 上結束，但同樣，我們將有一個更健康的病人更長時間。但我們看到影響可能是 6、8 年後的事。但顯然，如果我們能從 CKD 人群中獲益，那最終將使我們受益。

And then we have, say, just healthier patients for longer. On the Marietta situation, we're still assuming that, that will have a positive ruling and there is no impact negative assumed in this outlook. Obviously, we're just waiting to get that resolved with the MSP language.

然後我們有，比如說，更健康的病人更長時間。關於瑪麗埃塔的情況，我們仍然假設，這將有一個積極的裁決，並且在這個前景中沒有負面假設的影響。顯然，我們只是在等待用 MSP 語言解決這個問題。

And just a quick follow-up on one of your slides on for '23 guidance on treatment growth of minus 1% to plus 1%. Is that all in? Or is there any impact from clinic closures with that -- we have to consider that separately?

並且只是快速跟進你的一張幻燈片，以獲得 '23 關於治療增長負 1% 到正 1% 的指導。就這些了嗎？或者診所關閉是否有任何影響——我們必須單獨考慮？

That does include clinic closures.

這確實包括關閉診所。

The next question is coming from Victoria Lambert from Berenberg.

下一個問題來自 Berenberg 的 Victoria Lambert。

I just had one on your home treatment strategy. Is the target still to reach 25% of treatments are formed by 2025. Yes, just an update on the progress of that would be useful.

我剛剛了解了您的家庭治療策略。目標是否仍然是到 2025 年達到 25% 的治療形成。是的，只是更新進展情況會很有用。

Victoria, great to have you on the Berenberg team. The home target, it's still aspirational to be at 25% by 2025. And we recognize that home growth has been impacted by, obviously, the labor challenges and kind of staffing shortfalls that we had in 2023. At the end of Q4, we were at roughly just around 16%. So it's definitely a focus for us to continue to accelerate. And now obviously, as we see this labor situation stabilizing, we should be able to kind of get back on the training and really continue to drive that. Like we had kind of maybe this time last year, where we're seeing that momentum come through.

維多利亞，很高興你加入貝倫貝格團隊。家庭目標，到 2025 年仍然希望達到 25%。我們認識到，家庭增長顯然受到了我們在 2023 年遇到的勞動力挑戰和人員短缺的影響。在第四季度末，我們是大約只有 16%。因此，這絕對是我們繼續加速的重點。現在很明顯，隨著我們看到這種勞動力形勢趨於穩定，我們應該能夠重新開始培訓並真正繼續推動培訓。就像去年的這個時候，我們看到了這種勢頭。

So yes, still really excited about home, very much a key pillar of our strategy to kind of offset in some ways this -- the labor challenges that we have. But ultimately, also feed into our value-based care strategy of really improving outcomes in a home setting, which should ultimately reduce cost as well.

所以，是的，仍然對家感到非常興奮，這在很大程度上是我們戰略的一個關鍵支柱，可以在某種程度上抵消這一點——我們面臨的勞動力挑戰。但最終，也將納入我們基於價值的護理策略，真正改善家庭環境的結果，最終也應該降低成本。

The next question is coming from Falko Friedrichs from Deutsche Bank.

下一個問題來自德意志銀行的 Falko Friedrichs。

My first question is, can you provide an update on the labor shortage situation in the U.S. and also the amount of open positions that you're still looking to fill at the moment. And then related to that, how important is a significant improvement in that regard when thinking about achieving your new 2025 target.

我的第一個問題是，您能否提供有關美國勞動力短缺情況的最新信息，以及您目前仍在尋求填補的空缺職位數量。然後與此相關的是，在考慮實現新的 2025 年目標時，這方面的重大改進有多重要。

And then my second question is whether you can provide an update on the CFO synergy? And can you provide a rough time line for when the new person might be announced?

然後我的第二個問題是你是否可以提供有關 CFO 協同作用的最新信息？您能否提供一個大概的時間來確定新人選的公佈時間？

Thanks, Falko. So labor, yes, as you know, it's been a many moving pallets on that, as I mentioned, which was one of our more difficult numbers to kind of size for 2023. But I'm really starting to feel that we've got our arms around this labor situation and stabilizing it.

謝謝，法爾科。所以勞動力，是的，正如你所知，正如我所提到的，這是我們更難確定 2023 年規模的數字之一。但我真的開始覺得我們已經有了我們擁抱這種勞工狀況並穩定它。

In terms of the open positions, we are currently around 4,400, down from around 5,000 last quarter. I'm also really happy to see that the use of temporary labor, the spend overall has come down quite significantly, and not just the volume that we're using, but the rates are declining as well, which is really important.

就未平倉頭寸而言，我們目前約為 4,400 個，低於上一季度的約 5,000 個。我也很高興看到臨時工的使用，總體支出已經大幅下降，不僅僅是我們使用的數量，而且費率也在下降，這非常重要。

And then the other part that was a challenge for us was this constant churn of labor through the summer. We're seeing some significant improvements in our employee turnover rates, particularly in the less than 1 year period, and that is kind of a better hiring adherence kind of longer training classes, kind of a buddy system. So we're really seeing a lot of these benefits take hold.

然後對我們來說是挑戰的另一部分是整個夏天不斷變化的勞動力。我們看到我們的員工流失率有了一些顯著改善，尤其是在不到 1 年的時間裡，這是一種更好的僱傭依從性，一種更長的培訓課程，一種夥伴系統。所以我們真的看到了很多這些好處。

I think we're also seeing maybe this is some of the inflationary measures, the hot kind of market has subsided, and we're seeing that show up in a little bit lower weights as well overall. So I feel really good about what we're doing there. And on top of that, not just the shortages and the cost, but the productivity improvements that we have both baked into this kind of this midterm view on margins.

我認為我們也看到這可能是一些通脹措施，熱門市場已經消退，我們看到整體權重也略有下降。所以我對我們在那裡所做的事情感覺非常好。最重要的是，不僅是短缺和成本，還有生產力的提高，我們都將這種中期利潤率觀點融入其中。

With regard to the CFO search, that is being initiated by the Supervisory Board of the MAG. That is -- it is progressing. There are slates of candidates and that will move into interview -- an interview time line shortly. I truthfully don't know how long it's going to take. And obviously, it depends on anyone's availability and time line as well. So I have no date, but I can assure you the search is ongoing. And I am yes, looking forward to that.

關於首席財務官的搜尋，這是由 MAG 的監事會發起的。也就是說——它正在進步。有候選人名單，將進入面試——很快就會有面試時間表。老實說，我不知道要花多長時間。顯然，這也取決於任何人的可用性和時間表。所以我沒有日期，但我可以向你保證搜索正在進行中。我是的，很期待。

Okay. Due to time, we can take one last question.

好的。由於時間關係，我們可以回答最後一個問題。

Yes, the next question comes from Robert Davies from Morgan Stanley.

是的，下一個問題來自摩根士丹利的羅伯特戴維斯。

My question was just on -- just in terms of the clinic closures you're doing, just if you could give us some sort of idea of the share a view over an installed base or the overall kind of clinic number that you're taking out? And is there some sort of ballpark figure per clinic or is it too bigger variability as you take this out to get some idea of how much cost would come back?

我的問題只是 - 就您正在關閉的診所而言，如果您可以給我們一些關於分享對已安裝基礎或您正在接受的診所數量的看法的想法出去？每個診所是否有某種大概的數字，或者當你把它拿出來了解會收回多少成本時，它的可變性是否太大？

And then one other thing I wanted to just touch on was just your return on capital employed targets, how do the trends towards home care potentially impact that just from a kind of, I guess, capital employed and equipment standpoint and the way that business would run just a different structure over the medium term?

然後我想談一談的另一件事就是你對資本使用目標的回報，家庭護理的趨勢如何潛在地影響這種趨勢，我猜，從資本使用和設備的角度來看，以及業務的方式在中期運行不同的結構？

Thanks, Robert. Yes, in terms of clinic closures, we're targeting around 50 to 100 in this first wave. And that's on a base of 2,600 in the U.S. And it's a pretty quick payback, usually kind of 2-ish, 2 to 3 years payback there. So obviously, we're quickly accelerating that and ensuring that we keep our proportionate patient volumes as well.

謝謝，羅伯特。是的，就關閉診所而言，我們的目標是第一波關閉 50 到 100 家左右。這是基於美國 2,600 的基數，這是一個相當快的回報，通常是 2-ish，2 到 3 年的回報。很明顯，我們正在迅速加快這一進程，並確保我們也保持相應的患者數量。

And then on your second question, in terms of ROIC, I think that was always kind of part of a positive business case here with home that home should positively impact that because you don't need as much kind of capital infrastructure. It's quite capital-light as you don't need the clinics and so on. So I think that's also why we want to continue to make sure we're accelerating that and making sure it reaches its full potential.

然後關於你的第二個問題，就 ROIC 而言，我認為這一直是一個積極的商業案例的一部分，因為你不需要那麼多的資本基礎設施，所以家庭應該對此產生積極影響。它非常輕資本，因為您不需要診所等。所以我認為這也是為什麼我們要繼續確保我們正在加速並確保它發揮其全部潛力。

In the interest of time, we have to stop the Q&A session, and I hand back to Dominik.

為了節省時間，我們不得不停止問答環節，我把問題交還給 Dominik。

So I'm sorry that we couldn't take all the questions, but we'll need to catch a plane, unfortunately. So I apologize for that one. Thank you for taking the time and the many interesting questions. That was very helpful, and thank you to Helen for doing that again on her own, the third time.

所以很抱歉我們不能回答所有問題，但不幸的是我們需要趕飛機。所以我為那個道歉。感謝您抽出時間回答許多有趣的問題。這非常有幫助，感謝海倫第三次自己再次這樣做。

Thank you, Dominik. Thank you, everybody. I appreciate there was a lot of data today, a lot of information to unpack, but I appreciate your continued interest and support of Fresenius Medical Care. Have a great day, and we'll talk to you soon. Take care.

謝謝你，多米尼克。謝謝大家。我感謝今天有很多數據，有很多信息需要打開，但我感謝您一直以來對 Fresenius Medical Care 的關注和支持。祝你有美好的一天，我們會盡快與你交談。小心。

Thank you. Bye.

謝謝。再見。

Ladies and gentlemen, the conference has now concluded, and you may disconnect. Thank you for joining, and have a pleasant day.

女士們先生們，會議現已結束，你們可以斷開聯繫了。感謝您的加入，祝您度過愉快的一天。