Fresenius Medical Care AG (FMS) 2023 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by. I'm Andrea, your Chorus Call operator. Welcome, and thank you for joining the Fresenius Medical Care Q3 Results Conference Call. Throughout today's recorded presentation, all participants will be in a listen-only mode. (Operator Instructions) At this time, it's my pleasure to hand over to Dominik, Head of Investor Relations. Please go ahead, sir.

女士們先生們，謝謝你們的支持。我是 Andrea，您的合唱呼叫接線員。歡迎並感謝您參加費森尤斯醫療第三季業績電話會議。在今天的錄製演示中，所有參與者都將處於僅聽模式。 （操作員說明） 現在，我很高興將工作交給投資人關係主管 Dominik。請繼續，先生。

Okay. So unfortunately, we had some technical issues, but I've heard the introduction has happened. Thank you, Andrea, for the introduction.

好的。不幸的是，我們遇到了一些技術問題，但我聽說引入已經發生了。謝謝安德里亞的介紹。

As already mentioned, we would like to welcome you to our earnings call for the third quarter 2023. We appreciate you joining us today to discuss the performance of the third quarter.

如前所述，我們歡迎您參加 2023 年第三季的財報電話會議。我們感謝您今天加入我們討論第三季的業績。

I will, as always, 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 evening. For further details concerning risks and uncertainty, please refer to these documents as well as to our SEC filings that have already happened.

我將一如既往地在電話會議開始時提及安全港聲明、簡報以及我們昨天晚上分發的所有資料中的警示性語言。有關風險和不確定性的更多詳細信息，請參閱這些文件以及我們已經向 SEC 提交的文件。

As we have a hard stop at 4:30 CET, we have prepared only a short presentation to leave time for questions regarding the quarterly earnings and for our new CFO to introduce himself. (Operator Instructions)

由於我們在歐洲中部時間 4:30 暫停，因此我們只准備了一個簡短的演示，以便有時間回答有關季度收益的問題，並讓我們的新首席財務官進行自我介紹。 （操作員說明）

I'm aware that there is, with GLP-1, one dominant topic in health care research overall, which we fully understand, but we would appreciate if we could focus in this call on the quarterly business development.

我知道，GLP-1 是整個醫療保健研究中的一個主導主題，我們完全理解這個主題，但如果我們能夠在這次電話會議中專注於季度業務發展，我們將不勝感激。

With us today is, of course, Helen Giza, our CEO and Chair of the Management Board and as just mentioned, for the first time, Martin Fischer, our CFO. Having joined the company on October 1 and after quarter end, Martin will share a bit about his background and focus areas in his new role, but he will not answer questions today, but for sure in our call in February. Helen will provide an update on the business development, financial performance and outlook and will then be available for Q&A.

當然，今天與我們在一起的還有我們的首席執行官兼管理委員會主席海倫·吉薩(Helen Giza)，以及正如剛才提到的，我們的首席財務官馬丁·費舍爾(Martin Fischer) 首次出席。馬丁於 10 月 1 日和季度末加入公司，他將分享一些關於他的背景和新角色的重點領域的信息，但他今天不會回答問題，但在我們 2 月份的電話會議中肯定會回答。海倫將提供有關業務發展、財務業績和前景的最新信息，然後接受問答。

And with that, Helen, the floor is yours.

就這樣，海倫，地板就歸你了。

Thank you, Dominik. Welcome, everyone. Thank you for joining our presentation today and for your continued interest in Fresenius Medical Care. I'm very excited to talk to you today about the meaningful progress we made in the third quarter as we executed against our strategic plan.

謝謝你，多米尼克。歡迎大家。感謝您今天參加我們的演講並感謝您對 Fresenius Medical Care 的持續關注。我很高興今天與您談論我們在第三季度執行戰略計劃時取得的有意義的進展。

However, before I begin the presentation, I wanted to update you on two changes to our Management Board. As announced earlier this week, Craig Cordola will succeed Bill Valle as Care Delivery CEO as part of a planned transition, following Bill's plans to retire by the end of the year. Craig has many years of proven track record of operational management experience and successfully driving profitable business growth in different companies in the U.S. health care services industry. He will be a very valuable member of our Management Board and will continue our turnaround and transformation while leading Care Delivery into its next chapter.

然而，在開始演示之前，我想向您介紹我們管理委員會的兩項變更的最新情況。正如本週早些時候宣布的，克雷格·科多拉(Craig Cordola) 將接替比爾·瓦萊(Bill Valle) 擔任護理服務首席執行官，這是比爾計劃在今年年底退休後計劃過渡的一部分。克雷格擁有多年良好的營運管理經驗，並成功推動美國醫療保健服務業不同公司的獲利業務成長。他將成為我們管理委員會中非常有價值的成員，並將繼續我們的轉變和轉型，同時帶領護理服務進入新的篇章。

The second change is our new CFO, Martin Fischer, started on the 1st of October. I would like to say how thrilled I am to be joined here today by Martin and I'd like to hand over to Martin to introduce himself.

第二個變動是我們的新任財務長 Martin Fischer 於 10 月 1 日上任。我想說，馬丁今天能來到這裡，我感到非常興奮，我想請馬丁介紹自己。

Thank you, Helen. Good afternoon and good morning to everyone on the call. I'm honored to speak with you today as the new CFO, as I've just completed my first month in the company. I would like to share a bit about my background, and why I'm so very excited to be part of Fresenius Medical Care.

謝謝你，海倫。各位來電的人下午好，早安。我很榮幸今天能作為新任財務長與大家交談，因為我剛剛在公司完成了第一個月的工作。我想分享一些我的背景，以及為什麼我非常高興能夠成為費森尤斯醫療保健公司的一員。

I spent most of my professional career with the technology company, Siemens; especially, within its Healthcare division. In my most recent role, I served as the Global Head of Finance for the Diagnostics segment of Siemens Healthineers, based in Tarrytown, New York. Prior to that, I held the wide area of management roles, mostly in finance leadership with some positions in corporate, as well as operational areas. I have extensive experience in the European and American health care markets and has the opportunity to be an active part of the IPO of Siemens Healthineers in 2018 and to shape the stand-alone organization of the newly listed company post-IPO.

我職業生涯的大部分時間是在西門子科技公司度過的。尤其是在其醫療保健部門內。在我最近的職位中，我擔任位於紐約塔里敦的西門子醫療診斷部門的全球財務主管。在此之前，我擔任過廣泛的管理職務，主要是財務領導職務，並在公司和營運領域擔任過一些職務。我在歐美醫療保健市場擁有豐富的經驗，有機會積極參與西門子醫療2018年的IPO，並塑造新上市公司IPO後的獨立組織。

Joining Fresenius Medical Care was a very conscious and deliberate decision on my part. FME is a global player with a great company purpose, with a great legacy and an even brighter future.

加入 Fresenius Medical Care 對我來說是一個非常有意識和深思熟慮的決定。 FME 是一家全球性企業，擁有偉大的公司宗旨、偉大的傳統和更光明的未來。

In my role, I will work with Helen and the team to drive forward the successful turnaround of the company, particular attention will be paid to securing sustainable, profitable growth. A prerequisite for this is the continuous implementation of the FME25 transformation program and a stringent financial approach.

在我的職位上，我將與 Helen 和團隊合作，推動公司成功扭虧為盈，特別關注確保可持續的獲利成長。實現這一目標的先決條件是持續實施 FME25 轉型計劃和嚴格的財務方法。

I will focus on driving performance with clearly defined value creation priorities, a targeted resource and capital allocation and rigorous financial assessment of our investments and strategic choices.

我將專注於透過明確定義的價值創造優先事項、有針對性的資源和資本分配以及對我們的投資和策略選擇進行嚴格的財務評估來推動績效。

At least doubling the return on capital by 2025 is one of my priorities as is a clear commitment to manage the leverage ratio. To me, transparent capital market communication is a key element of my approach. As a pragmatic and optimistic person, I highly value clarity, integrity and reliability. It is very encouraging to see the company's turnover measures already beginning to translate into improving financial performance. I'm optimistic about our ability to drive further improvements to 2025 and beyond. I look forward to speaking with you in the future.

我的首要任務之一是到 2025 年至少將資本報酬率提高一倍，這也是管理槓桿率的明確承諾。對我來說，透明的資本市場溝通是我方法的關鍵要素。身為一個務實、樂觀的人，我非常重視清晰、正直、可靠。看到公司的營業額指標已經開始轉化為財務表現的改善，真是令人鼓舞。我對我們在 2025 年及以後推動進一步改進的能力感到樂觀。我期待著將來與您交談。

And with that, I will hand back to Helen.

接下來，我會把事情交還給海倫。

Thank you, Martin. I'm really excited to have you on board and already see how great we are working together as a team.

謝謝你，馬丁。我真的很高興您的加入，並且已經看到我們作為一個團隊的合作有多出色。

I will now begin my prepared remarks on Slide 4. You are all familiar with our strategic plan to unlock value as the leading kidney care company. And I would like to highlight some of the accomplishments of the quarter.

我現在將在幻燈片 4 上開始我準備好的發言。你們都熟悉我們作為領先的腎臟護理公司釋放價值的戰略計劃。我想強調本季取得的一些成就。

The simplification of our governance structure with change of legal form is the only remaining structural element to finalize. And I'm pleased to report that we have cleared all relevant hurdles and expect the conversion to be completed by December 1 of this year. With this, we will have completed all of our major structural changes within less than 1 year.

透過改變法律形式來簡化我們的治理結構是唯一需要最終確定的結構要素。我很高興地報告，我們已經清除了所有相關障礙，預計轉換將於今年 12 月 1 日完成。這樣，我們將在不到一年的時間內完成所有重大結構性變革。

We continue to advance our operational efficiency and turnaround plans. Our FME25 transformation program is well on track to deliver EUR 250 million to EUR 300 million in sustainable savings by the end of the year. In the third quarter, we realized an additional EUR 97 million in sustained savings, bringing year-to-date savings to EUR 232 million. This is positively supported by the now 70 net clinic closures in the U.S.

我們持續提高營運效率和周轉計劃。我們的 FME25 轉型計畫進展順利，預計到年底可持續節省 2.5 億至 3 億歐元。第三季度，我們額外實現了 9,700 萬歐元的持續節省，使年初至今的節省達到 2.32 億歐元。美國目前淨關閉 70 家診所，這有力地支持了這一點。

We have realized accelerated productivity improvements in Care Delivery, which have helped to meaningfully mitigate the originally anticipated labor headwind of EUR 140 million to EUR 180 million for the year. As we focus on sustainable profitable growth and seek the divest noncore and dilutive assets, we have continued to execute against our portfolio optimization plan.

我們實現了護理服務生產力的加速提高，這有助於有效緩解原本預計的今年 1.4 億至 1.8 億歐元的勞動力逆風。由於我們專注於可持續的盈利增長並尋求剝離非核心和稀釋資產，因此我們繼續執行我們的投資組合優化計劃。

We announced yesterday that we have entered into an agreement for the sale of National Cardiovascular Partners or NCP. This business comprises 21 facilities, providing outpatient cardiac catheterization and vascular laboratory services in the U.S.

我們昨天宣布，我們已經簽署了出售 National Cardioangio Partners 或 NCP 的協議。該業務由 21 家機構組成，在美國提供門診心導管插入術和血管實驗室服務。

In line with our disciplined financial policy and well ahead of maturity, we were successful in refinancing a EUR 650 million bond expiring at the end of November without accessing the bond market. Rather, we use a mix of long-term bank financing at very attractive conditions, as well as cash and short-term debt. The term loans carry variable interest rates, which gives us more flexibility to reduce debt. And of course, upcoming extraordinary cash inflows will enable us to further delever.

根據我們嚴格的財務政策，並且提前到期，我們在未進入債券市場的情況下成功為 11 月底到期的 6.5 億歐元債券進行了再融資。相反，我們以非常有吸引力的條件混合使用長期銀行融資以及現金和短期債務。定期貸款採用可變利率，這使我們能夠更靈活地減少債務。當然，即將到來的大量現金流入將使我們能夠進一步去槓桿化。

I am not only proud of the fact that we are executing with speed and success against our strategic plan, but also that we are driving an important cultural shift. For the third consecutive year, we were named one of Newsweek's top 100 most loved workplaces in the U.S.

我不僅為我們能夠快速、成功地執行我們的策略計劃而感到自豪，而且還為我們正在推動重要的文化轉變而感到自豪。我們連續第三年被《新聞週刊》評為全美 100 家最受歡迎的工作場所之一。

Turning to Slide 5. While it's not a third quarter earnings topic, clearly, the GLP-1 medication headlines need acknowledging. We think it's important to reinforce our assessment of the future population and volume development.

轉向幻燈片 5。雖然這不是第三季收益主題，但顯然需要承認 GLP-1 藥物頭條新聞。我們認為加強對未來人口和體量發展的評估非常重要。

As our Chief Medical Officer, Frank Maddux outlined at our Capital Markets Day in April and confirmed again more recently in an expert call, we expect the GLP-1 red class to have a balanced impact on the ESRD patient volumes in the long run. We treat a complex patient population with multiple comorbidities, and it's important to remember that roughly 46% of our dialysis patients crash into dialysis, meaning they have even not been diagnosed nor been receiving regular medical treatment for their kidney disease earlier. So when we talk about the potential impact of these new medications, we talk about the other 54% that are more likely to have access to these medications.

正如我們的首席醫療官Frank Maddux 在4 月份的資本市場日上概述的那樣，並在最近的專家電話會議中再次確認，我們預計GLP-1 紅色類別從長遠來看將對ESRD 患者數量產生平衡的影響。我們治療患有多種合併症的複雜患者群體，重要的是要記住，大約 46% 的透析患者陷入透析，這意味著他們甚至沒有被診斷出來，也沒有提前接受腎臟疾病的常規治療。因此，當我們談論這些新藥物的潛在影響時，我們談論的是另外 54% 更有可能獲得這些藥物的人。

At a high level, when assessing the potential real-world impact of the drug, we consider three main features of the use of the medications: Medical effectiveness, prescription rates and patient adherence.

在較高層面上，在評估藥物對現實世界的潛在影響時，我們考慮藥物使用的三個主要特徵：醫療效果、處方率和患者依從性。

Starting with medical effectiveness. Based on the limited information that is available to us today, GLP-1 help control type 2 -- diabetes and have proven benefits for cardiovascular health that are a potential significant positive effect on people with diabetes. More CKD patients are likely to survive earlier CKD stages and progress to ESRD.

從醫療效果入手。根據我們目前掌握的有限信息，GLP-1 有助於控制第 2 型糖尿病，並已證明對心血管健康有益，這對糖尿病患者俱有潛在的顯著積極影響。更多 CKD 患者可能會在早期 CKD 階段存活並進展至 ESRD。

Additionally, we have also assumed that GLP-1s would have a positive impact on slowing the progression of kidney disease. Based on what we know today, we expect these two competing effects to balance each other with respect to population impact.

此外，我們也假設 GLP-1 對減緩腎臟疾病的進展有正面影響。根據我們今天所知，我們預計這兩種相互競爭的影響在人口影響方面將相互平衡。

Looking at the prescription rates, there are unknowns here. Currently, current pricing of GLP-1 is prohibitive to broad adoption in the short term, as could availability or access, but we would assume these would normalize over time. The impact of known and developing side effects will impact prescribing choices as prescribers gain experience in managing patients on the drugs.

從處方率來看，這裡存在未知因素。目前，GLP-1 的當前定價在短期內阻礙了廣泛採用，可用性或訪問也可能如此，但我們假設這些將隨著時間的推移而正常化。隨著處方者在管理患者藥物方面獲得經驗，已知和正在發生的副作用的影響將影響處方選擇。

SGLT2 inhibitors, for example, have been widely available for a decade with proven medical effectiveness for both cardiovascular health and more recently, for slowing the progression of kidney disease, yet only 8% of our patients have ever been prescribed on SGLT2 inhibitor in the predialysis CKD stages unless have consistently taken them.

例如，SGLT2 抑制劑已廣泛使用了十年，其對心血管健康以及最近對減緩腎臟疾病進展的療效已得到證實，但我們的患者中只有 8% 在透析前曾服用過 SGLT2 抑制劑CKD 階段，除非一直採取這些階段。

Finally, we have to consider expected patient adherence and compliance over long periods of time. We know that the adherence rate to medications that require permanent use has not been anywhere near 100%, and that will challenge the full effectiveness of this class of drugs in our patient population.

最後，我們必須考慮患者長期的預期依從性和依從性。我們知道，需要永久使用的藥物的依從性尚未接近 100%，這將挑戰此類藥物在我們患者群體中的全部有效性。

When assessing all of these factors, and based on the limited information available today, we come to the conclusion that the effects would be rather balanced on our patient population development in the long run. Multiple independent experts in this field are of the opinion that it may take at least a decade before we could fully observe the effects and impact from GLP-1 on our patient population.

在評估所有這些因素時，並根據目前可獲得的有限信息，我們得出的結論是，從長遠來看，這些因素對我們患者群體發展的影響將相當平衡。該領域的多位獨立專家認為，我們可能需要至少十年才能充分觀察到 GLP-1 對我們患者群體的作用和影響。

Moving to Slide 6. Ensuring the highest quality of care for our patients is of the utmost importance. To that extent, we are continuously monitoring our clinical performance to enhance care. Our Global Quality Index is an important KPI in this regard. The quality index considers dialysis effectiveness, vascular access and anemia management. Through the third quarter, we continue to see sequential stability at a high level.

轉到投影片 6。確保為患者提供最高品質的護理至關重要。從這個意義上說，我們不斷監測我們的臨床表現以加強護理。我們的全球品質指數是這方面的一個重要關鍵績效指標。品質指數考慮了透析有效性、血管通路和貧血管理。整個第三季度，我們繼續看到較高水平的連續穩定性。

I'll now move to Slide 8 to review our third quarter business performance. In the third quarter, we continue to deliver solid organic revenue growth, both in Care Delivery and Care Enablement. This was supported by sequentially stable same-market treatment growth in the U.S.

我現在將轉到投影片 8 來回顧我們第三季的業務績效。在第三季度，我們在護理服務和護理支援方面繼續實現穩健的有機收入成長。這得益於美國同市場治療連續穩定的成長。

The successful execution of our turnaround plans continue to translate into improved financial performance. Most notably, this included productivity improvements in Care Delivery and higher pricing in Care Enablement. Savings from our FME25 transformation program also contributed meaningfully to the improved performance in the third quarter. And we continue to execute our portfolio optimization strategy. And as I mentioned earlier, we have entered into an agreement to divest NCP in the U.S.

我們扭虧為盈計畫的成功執行持續轉化為財務績效的改善。最值得注意的是，這包括護理服務生產力的提高和護理支援的更高定價。 FME25 轉型計畫帶來的節省也對第三季業績的改善做出了重大貢獻。我們繼續執行我們的投資組合優化策略。正如我之前提到的，我們已經達成了一項剝離美國 NCP 的協議。

Based on the earnings development for the first 9 months of the year and solid business expectations for the remainder of the year, we are raising our full year 2023 operating income guidance, which I will speak to later on.

基於今年前 9 個月的獲利發展以及今年剩餘時間的穩健業務預期，我們正在上調 2023 年全年營業收入指引，我將在稍後談到。

You will have seen on the 27th of October that CMS announced the final ESRD PPS rate for 2024. Final ruling increased from 1.6% to 2.0%. The market basket has not been adjusted to reflect the higher labor costs nor the inflation forecasting error has been addressed. While a 2% increase are a little improvement, it is still disappointing. However, in our 2025 margin targets, we have only assumed a moderate increase. So this is in line with our assumptions.

您會在 10 月 27 日看到 CMS 公佈了 2024 年最終 ESRD PPS 費率。最終裁決從 1.6% 提高到 2.0%。市場籃子尚未調整以反映較高的勞動成本，也未解決通膨預測錯誤。雖然2%的增幅是一個小小的進步，但仍然令人失望。然而，在我們的 2025 年利潤率目標中，我們僅假設適度成長。所以這符合我們的假設。

On a very positive note, last week, the CMS star ratings for clinics were published, and I'm delighted to report that we outpaced the industry for 3-, 4- and most importantly, 5-star clinics. This shows our strong and clear commitment to deliver high-quality care to our patients.

非常積極的一點是，上週，CMS 的診所星級評級已發布，我很高興地報告說，我們在 3 星級、4 星級、最重要的是 5 星級診所方面超過了行業。這表明我們堅定而明確地致力於為患者提供高品質的護理。

Turning to Slide 9. In the third quarter, we delivered revenue growth of 7% at constant currency, and we continue to deliver organic growth with positive contribution from both segments. This development was driven by favorable pricing, including hyperinflation in Care Delivery. And in Care Enablement, it was supported by both volume and price.

轉向幻燈片 9。第三季度，以固定匯率計算，我們的收入增長了 7%，並且在這兩個部門的積極貢獻下，我們繼續實現有機增長。這一發展是由有利的定價所推動的，包括護理服務的惡性通貨膨脹。在護理支援方面，它得到了數量和價格的支持。

During the third quarter, operating income on a guided basis improved by 20%. This resulted in another sequential improvement of our group margin to 8.7%. Earnings development in the third quarter was driven by business performance supported by FME25 savings and reduced personnel expenses from accelerated productivity improvements.

第三季度，營業收入指導性增加了 20%。這導致我們集團的利潤率再次連續提高至 8.7%。第三季的獲利成長是由 FME25 節省的業務績效以及生產力加速提高帶來的人員開支減少所推動的。

Although we have seen a degree of stabilization, our business still faces inflationary pressures that particularly impact Care Enablement. In the third quarter, we also had a negative impact from the absence of a nonrecurring consent payment on certain pharmaceuticals and experienced a further increased transactional exchange rate headwinds in Care Enablement.

儘管我們已經看到了一定程度的穩定，但我們的業務仍然面臨通貨膨脹壓力，這尤其影響護理支援。第三季度，我們也因某些藥品缺乏一次性同意付款而受到負面影響，且護理支援的交易匯率阻力進一步加大。

Next, on Slide 10. Starting from the left, you can see how we get at the starting point of our guidance basis. The EUR 107 million special items in the third quarter specifically comprised EUR 53 million in legacy portfolio optimization costs, primarily relating to the NCP book loss. FME25 costs were EUR 49 million, which has us well below our planned run rate for this year. We will likely stay below the lower end of our planned FME25 onetime costs this year, but should see a shift into the next year. EUR 6 million in costs were associated with the legal form conversion and the human site investment remeasurement contributed positively with EUR 1 million.

接下來，在投影片 10 上。從左側開始，您可以看到我們如何到達指導基礎的起點。第三季 1.07 億歐元的特殊項目具體包括 5,300 萬歐元的遺留投資組合優化成本，主要與 NCP 帳面損失有關。 FME25 成本為 4900 萬歐元，這使我們遠低於今年的計劃運行率。今年我們可能會保持在計劃的 FME25 一次性成本下限以下，但明年應該會發生變化。法律形式轉換產生了 600 萬歐元的成本，而人力場地投資重新衡量則貢獻了 100 萬歐元。

Turning to Slide 11. In Care Delivery, in the third quarter, organic revenue growth was supported by a positive impact from our U.S. value-based care business, InterWell Health, along with reimbursement rate increases and a favorable payer mix. In line with our commitment to drive sustainable profitable growth, we continue to exit less profitable acute care contracts in the U.S. And the negative 60 basis point impact was particularly pronounced in the third quarter. When adjusted for acute contract impact, same market treatment growth in the U.S. improved from negative 0.4% to positive 0.2% compared to positive growth of around 0.1% in the first half of this year.

轉向幻燈片 11。在護理服務方面，第三季度，我們的美國基於價值的護理業務 InterWell Health 的積極影響以及報銷率的提高和有利的付款人組合支持了有機收入增長。根據我們推動可持續盈利增長的承諾，我們繼續退出美國利潤較低的急症護理合同，而 60 個基點的負面影響在第三季度尤為明顯。根據嚴重的合約影響進行調整後，美國相同市場治療的成長率從負 0.4% 改善至正 0.2%，而今年上半年的正成長約為 0.1%。

In Care Delivery International, revenue growth was supported by the effect of hyperinflation in various markets, but was negatively impacted by exchange rate effects.

在 Care Delivery International 中，營收成長受到各市場惡性通貨膨脹影響的支持，但受到匯率影響的負面影響。

Care Delivery earnings overall were positively impacted by business growth, lower personnel expenses resulting from the already mentioned improved productivity and FME25 savings. We had planned to show a bigger contribution to earnings from InterWell Health in the third quarter. And while we are continuing to generate positive savings from CMS' CKCC programs within the late-stage CKD and (inaudible) segments, we realized lower-than-expected contributions from our CKCC models for the 2022 program year. This translated into a higher-than-assumed margin dilution in the quarter. As I highlighted earlier, we also continued to execute on our portfolio optimization strategy with the signing of the agreement to divest NCP in the third quarter.

護理交付的整體收入受到業務成長、由於前面提到的生產力提高和 FME25 節省而導致的人員費用降低的積極影響。我們原計劃在第三季展示 InterWell Health 對獲利的更大貢獻。雖然我們繼續透過 CMS 的 CKCC 專案在後期 CKD 和（聽不清楚）細分市場中產生積極的節省，但我們意識到我們的 CKCC 模型在 2022 年專案年的貢獻低於預期。這導致本季的利潤稀釋高於預期。正如我之前所強調的，我們也繼續執行我們的投資組合優化策略，並在第三季簽署了剝離 NCP 的協議。

Next, on Slide 12. Care Delivery revenue increased by 6% on a constant currency basis, driven by a 7% organic development for the reasons I just outlined on the previous slide. Operating income development for Care Delivery faced a meaningful headwind from currency translation effects in the quarter. And although we realized positive business growth, this lagged our own expectations due to the already mentioned lower-than-anticipated contribution from InterWell Health on CKCC.

接下來，在投影片 12 上。在 7% 的有機發展的推動下，護理服務收入按固定匯率計算增長了 6%，原因我剛剛在上一張幻燈片中概述。本季護理服務的營業收入發展面臨貨幣換算影響帶來的重大阻力。儘管我們實現了積極的業務成長，但由於已經提到的 InterWell Health 對 CKCC 的貢獻低於預期，這落後於我們自己的預期。

FME25 savings were a strong tailwind in the quarter as we continue to drive clinical operational efficiencies with 17 additional net clinic closures in the U.S., bringing the total now to net 70 closures. Although initially expected to be a sizable headwind for the year, we were able to compensate the higher wages and other labor cost increases by the accelerated productivity efficiencies, which yielded strong savings.

FME25 的節省是本季的強勁推動力，因為我們繼續提高臨床營運效率，在美國淨關閉了 17 家診所，使目前的淨關閉總數達到 70 家。儘管最初預計今年會出現相當大的阻力，但我們能夠透過生產力效率的加速來彌補工資上漲和其他勞動成本的增加，從而產生了巨大的節省。

Turning to Page 13. Care Enablement revenue in the third quarter was impacted by negative exchange rate effects, but supported by higher sales of in-center disposables and machines, as well as home hemodialysis products. It also benefited from increased average sales prices driven by our targeted pricing measures. The third quarter earnings were supported by increased volumes, pricing as well as FME25 savings. These positive developments offset inflationary cost pressures, which developed broadly in line with expectations and a further increased transactional exchange rate headwind. Care Enablement continued to execute on the FME25 and turnaround measures. We have made progress with organizational as well as manufacturing and supply chain initiatives.

翻到第 13 頁。第三季的護理支援收入受到匯率負面影響的影響，但受到中心一次性用品和機器以及家庭血液透析產品銷售增加的支撐。它還受益於我們的目標定價措施推動的平均銷售價格的上漲。第三季收益受到銷售增加、定價以及 FME25 節省的支持。這些積極進展抵銷了通膨成本壓力，通膨成本壓力的發展基本上符合預期，且交易匯率阻力進一步加大。 Care Enablement 繼續在 FME25 和周轉措施上執行。我們在組織、製造和供應鏈計劃方面取得了進展。

Next, on Slide 14. In the third quarter Care Enablement revenue increased by 5% on a constant currency and organic basis. This was driven by the reasons I outlined on the previous slide.

接下來，在投影片 14 上。第三季護理支援收入按固定匯率和有機基礎增長了 5%。這是由我在上一張投影片中概述的原因所驅動的。

On our guided basis, operating income for Care Enablement increased to EUR 22 million. The improved operating income was driven by positive business growth, which already includes meaningful currency transaction losses, as well as FME25 savings. Operating income was partially offset by inflation, which as assumed in our guidance, continues to be a headwind for this business. We have also seen a smaller currency translation impact.

根據我們的指導，護理支援的營業收入增加至 2,200 萬歐元。營業收入的改善是由積極的業務成長所推動的，其中已經包括有意義的貨幣交易損失以及 FME25 節省。營業收入部分被通貨膨脹所抵消，正如我們在指導中所假設的那樣，通貨膨脹仍然是該業務的阻力。我們也發現貨幣換算影響較小。

Turning to Slide 15. A clear focus for us is our cash flow management. In the third quarter, we experienced a strong cash flow development compared to the prior year period. The increase in net cash provided by operating activities was the result of a change in working capital items. This was mainly driven by the weaker prior year comparable, resulting from the CMS recruitment of advanced payments previously received under the Medicare Accelerated and Advanced Payment program in 2020. Supported by our disciplined capital allocation policy, free cash flow conversion accelerated in line with operating cash flow.

轉向投影片 15。我們的一個明確重點是現金流管理。與去年同期相比，第三季我們的現金流成長強勁。經營活動提供的現金淨額增加是由於營運資金項目變動所致。這主要是由於去年可比業績疲軟，這是由於CMS 招募了2020 年醫療保險加速和預付款計劃下收到的預付款。在我們嚴格的資本配置政策的支持下，自由現金流轉換與營運現金一致加速流動。

Our leverage ratio of 3.4x remained in our target corridor of 3 to 3.5x. As it is still at the upper end of this self-imposed range, delevering remains a top priority for capital allocation with any proceeds from divestments to be used for further delevering.

我們的槓桿率為 3.4 倍，仍處於 3 至 3.5 倍的目標範圍內。由於仍處於這自我設定區間的上限，去槓桿仍然是資本配置的首要任務，撤資所得的任何收益都將用於進一步去槓桿。

As I mentioned earlier, we were successful in refinancing the EUR 650 million bond expiring at the end of November. We used the mix of long-term bank financing at very attractive conditions, as well as cash and short-term debt. This better positions us for further delevering. And by diversifying away from the bond market, we support further balancing of our financing mix and utilize our ability to access various funding sources.

正如我之前提到的，我們成功為 11 月底到期的 6.5 億歐元債券進行了再融資。我們採用了條件非常有吸引力的長期銀行融資以及現金和短期債務的組合。這為我們進一步去槓桿化奠定了更好的基礎。透過債券市場以外的多元化，我們支持進一步平衡我們的融資組合，並利用我們獲得各種融資來源的能力。

I'd like to finish with an update to the outlook on Slide 17. For 2023, we continue to expect revenue to grow at a low to mid-single percentage weight, but are likely to land in the upper half of this range. For our earnings outlook, we previously guided for a flat to low single-digit operating income decline for 2023.

最後，我想對幻燈片 17 的前景進行更新。對於 2023 年，我們繼續預計收入將以低至中的單一百分比權重增長，但很可能會落在該範圍的上半部分。對於我們的獲利前景，我們先前預期 2023 年營業收入將持平至低個位數下降。

Our assumptions around inflation and volume have broadly developed in line with expectations. FME25 savings are likely to be at the upper half of the EUR 250 million to EUR 300 million range. While labor costs developed as assumed, the accelerated labor productivity we are realizing provides a compensating tailwind, which has additionally helped offset the emerging transactional exchange rate headwind in Care Enablement.

我們對通膨和交易量的假設基本上符合預期。 FME25 節省的資金可能在 2.5 億歐元至 3 億歐元範圍內的上半部。雖然勞動成本按假設發展，但我們正在實現的勞動生產力的加速提供了補償性順風，這也有助於抵消護理支持中新興的交易匯率逆風。

Based on the resulting stronger-than-assumed earnings development in the first 9 months and our solid outlook for the remainder of the year, we now expect operating income not to decline, but to grow at a low single-digit percentage rate. Already in the third quarter, our group margin improved 130 basis points to 8.7%. And in Care Delivery, we are with a 10.3% margin, already at the lower end of our target margin band. Year-over-year, the Care Enablement margin of 1.7% while low has improved.

基於前 9 個月強於預期的盈利發展以及我們對今年剩餘時間的穩健前景，我們現在預計營業收入不會下降，而是會以較低的個位數百分比增長。第三季度，我們的集團利潤率提高了 130 個基點，達到 8.7%。在護理服務方面，我們的利潤率為 10.3%，已經處於目標利潤範圍的下限。與去年同期相比，護理支持利潤率雖然較低，但已有所改善，為 1.7%。

And as laid out at our Capital Markets Day, the complexity and scale of the initiatives in Care Enablement to get into the 8% to 12% band result in a more back-end loaded improvement.

正如我們在資本市場日所闡述的那樣，護理支援計劃的複雜性和規模達到了 8% 至 12% 的範圍，從而帶來了更多後端負荷的改進。

We are confident in our path to unlock value as the leading kidney care company and to achieve an improved operating profit margin of 10% to 14% in 2025.

我們對釋放作為領先腎臟護理公司的價值並在 2025 年實現營業利潤率提高 10% 至 14% 的道路充滿信心。

This concludes my prepared remarks, and I'll now turn it back to Dominik.

我準備好的發言到此結束，現在我將把它轉回給多明尼克。

Thank you, Helen. Thank you, Martin. (Operator Instructions) And with that, I hand over to Andrea to open the Q&A, please.

謝謝你，海倫。謝謝你，馬丁。 （操作員指示）接下來，我請安德里亞開始問答。

(Operator Instructions) The first question comes from the line of Victoria Lambert with Berenberg.

（操作員說明）第一個問題來自維多利亞·蘭伯特（Victoria Lambert）和貝倫貝格（Berenberg）的線路。

The first one is just on home treatments. Could you provide an update on how this is progressing? I think when we last spoke, it was up 16%.

第一個是家庭治療。能否提供最新進展？我想當我們上次談話時，它上漲了 16%。

And then second question is just on the labor market. How many open positions are you at? And where is wage growth trending?

第二個問題是關於勞動市場的。您有多少個空缺職位？薪資成長趨勢如何？

Thank you for your questions. On home, it's still stable at around that 16% that we saw last quarter. And then on your labor question, we have seen some improvements since last quarter, and were sitting at around 4,300 open positions, which is improving. Clearly, where our focus is on labor is kind of on the hotspot areas that some metro areas are still experiencing. But obviously, the labor situation is much more stable and controllable than it was a year ago or even quarters ago. So we feel good with the development that we have there.

謝謝您的提問。在國內，它仍然穩定在我們上個季度看到的 16% 左右。然後關於你的勞工問題，自上季度以來我們看到了一些改善，目前有大約 4,300 個空缺職位，而且正在改善。顯然，我們關注的勞動力是一些大都會地區仍在經歷的熱點。但顯然，勞動力情勢比一年前甚至幾季前更穩定、更可控。因此，我們對那裡的發展感到滿意。

We will take the next question then.

那我們就進行下一個問題。

The next question comes from the line of Hassan Al-Wakeel with Barclays.

下一個問題來自巴克萊銀行的哈桑‧阿爾瓦克爾 (Hassan Al-Wakeel)。

I have two. So firstly, sorry to start with GLP-1. But as it relates to operational performance, to what extent do you think you are already seeing some impact from GLP-1s or SGLT2s amongst diabetes patients? Or could we indeed see an impact sooner than in weight loss? You noted that only 8% of your patients have been prescribed SGLT2 and CKD. Do you know what the number is in GLP-1s for diabetes? And related to this, are you seeing any increased uptake in transplantation on the back of improved eligibility around GLP-1s?

我有兩個。首先，很抱歉從 GLP-1 開始。但由於它與營運績效相關，您認為您在多大程度上已經看到 GLP-1 或 SGLT2 對糖尿病患者產生了一些影響？或者說我們確實能比減肥更早看到效果嗎？您注意到，只有 8% 的患者接受了 SGLT2 和 CKD 處方治療。您知道治療糖尿病的 GLP-1 中的數字是多少嗎？與此相關的是，您是否發現隨著 GLP-1 資格的提高，移植的採用率增加？

And then secondly, you talked about margin dilution from CKCC models in the quarter, could you quantify the full year contribution and help us understand why this is different to ESCOs given the challenging experience you've had in the past here? And to what extent this is a worthwhile business for you?

其次，您談到了本季 CKCC 模型的利潤稀釋，您能否量化全年貢獻並幫助我們理解為什麼這與節能服務公司不同，因為您過去在這裡經歷了充滿挑戰的經歷？這在多大程度上對您來說是一項有價值的業務？

(technical difficulty) They are connected back.

（技術難度）他們是連回來的。

Hassan, could you please repeat your question because we were dropping off.

哈桑，您能重複一下您的問題嗎，因為我們要下車了。

Apologies. Yes. So let me do that again. So firstly, I was saying sorry to start with GLP-1, but as it relates to operational performance, to what extent do you think you are already seeing some impact from GLP-1s or SGLT2s amongst diabetes patients? Or could we see an impact sooner than in weight loss. You noted that only 8% of your patients have been prescribed SGLT2s and CKD. Do you know what the number is for GLP-1s in diabetes? And related to this, are you seeing any increased uptake in transplantation on the back of improved eligibility with respect to GLP-1s?

道歉。是的。那麼就讓我再做一次。首先，我對從 GLP-1 開始表示抱歉，但由於它與營運績效相關，您認為您在糖尿病患者中已經看到了 GLP-1 或 SGLT2 的一些影響嗎？或者我們能比減肥更早看到影響嗎？您注意到，只有 8% 的患者接受了 SGLT2 和 CKD 處方治療。您知道糖尿病中 GLP-1 的編號是多少嗎？與此相關的是，您是否發現隨著 GLP-1 資格的提高，移植的使用率增加？

And then secondly, you talked about the margin dilution from CKCC models in the quarter. Could you quantify the full year contribution and help us understand why this is different to ESCOs given the challenging experience you've had in the past? And to what extent this is a worthwhile business for you?

其次，您談到了本季 CKCC 模型的利潤稀釋。鑑於您過去所經歷的充滿挑戰的經歷，您能否量化全年貢獻並幫助我們理解為什麼這與節能服務公司不同？這在多大程度上對您來說是一項有價值的業務？

Thank you, Hassan. I'm sorry for making you repeat that.

謝謝你，哈桑。很抱歉讓你重複一遍。

Thanks, Hassan. Yes, look, as far as we can tell, we're not seeing any impact or tiny impact on GLP-1s at this time and nothing that we could quantify.

謝謝，哈桑。是的，據我們所知，目前我們沒有看到對 GLP-1 的任何影響或微小影響，也沒有任何我們可以量化的影響。

In terms of your SGLT2 question, yes, it's pretty small, as you say, at 8% at CKD. I don't have that number to hand of what that could be in diabetes. I'd have to follow-up with Frank on that question. But I do know with regard to transplantation piece of your question, the rates are very stable at the normal -- at the moment. So we're not seeing any kind of really change there.

就您的 SGLT2 問題而言，是的，正如您所說，CKD 的比例非常小，為 8%。我手頭上沒有關於糖尿病可能發生的數字。我必須就這個問題與弗蘭克進行跟進。但我確實知道，關於你問題中的移植部分，目前的比率在正常情況下非常穩定。所以我們沒有看到任何真正的改變。

In terms of the number of patients who have any exposure to weight loss, I think we would see that as small, maybe kind of a couple of kilograms and the only improvement was with a slightly lower blood pressure. So in terms of the diabetes piece, I'll follow back up. But overall, so far, we're not seeing really any other impact.

就經歷過減肥的患者數量而言，我認為我們會看到這個數字很小，可能只有幾公斤，唯一的改善是血壓略有降低。因此，就糖尿病而言，我會跟進。但總的來說，到目前為止，我們還沒有看到任何其他影響。

In terms of your margin dilution question on CKCC, what I would say, it came in, and we had the 3 quarter true-up for plan year 2 come in, in the third quarter. While it was positive, it was lower than what we had anticipated. And clearly, immediately asked the same question; obviously, ESCOs is all over again because we've definitely kind of learned the hard way on some of these government programs.

就 CKCC 的利潤稀釋問題而言，我想說的是，它已經到來，我們在第三季對計畫第二年的第三季進行了調整。雖然這是積極的，但低於我們的預期。顯然，立即問了同樣的問題；顯然，節能服務公司又重新開始了，因為我們確實在其中一些政府計畫中經歷了慘痛的教訓。

We're definitely seeing less transparency and more variability in the government reporting in terms of their data and methodologies around trend adjustment factors and patient alignment, which is making it more difficult and challenging actually for us to be able to predict that -- those results with the lumpiness that we're seeing.

我們肯定會看到政府報告在圍繞趨勢調整因素和患者一致性的數據和方法方面透明度較低且變化較大，這實際上使我們能夠預測這些結果變得更加困難和具有挑戰性以及我們所看到的塊狀。

What I would say is we, and the coalition of CKCC participants, are very much providing that feedback to the government to improve the collaboration between CMS and participants to drive the intended results. And I think for us, we will continue to do that work and ensure that we are getting the expected results. And if we're not or something changes, then clearly, we would exit where and when or if it makes sense.

我想說的是，我們以及 CKCC 參與者聯盟正在向政府提供回饋，以改善 CMS 和參與者之間的合作，從而推動預期結果。我認為對我們來說，我們將繼續進行這項工作，並確保我們獲得預期的結果。如果我們不這樣做或發生什麼變化，那麼很明顯，我們會在何時何地或是否有意義的情況下退出。

The next question comes from the line of Lisa Clive with Bernstein.

下一個問題來自麗莎·克萊夫和伯恩斯坦的對話。

Helen, I'll ping you, although it's a shame Frank isn't on for giving the interest in GLP-1 today. But I guess, per your comments around SGLT2s and GLP-1s, I mean, they're not very widely used today, but the SGLT2s are going generic in 2 years. So that will change quite quickly. What I really would love to know is where we've seen sort of similar experiences historically? I mean, looking at the CKD population in the U.S., it's actually been remarkably stable over the last sort of 15-plus years.

海倫，我會聯繫你的，儘管很遺憾弗蘭克今天沒有對 GLP-1 表現出興趣。但我想，根據您對 SGLT2 和 GLP-1 的評論，我的意思是，它們目前的使用還不是很廣泛，但 SGLT2 將在兩年內通用。所以這會很快改變。我真正想知道的是我們歷史上在哪裡見過類似的經驗？我的意思是，看看美國的 CKD 人口，它實際上在過去 15 年多的時間裡一直非常穩定。

Yes, over that time, the ESKD population has grown 3% to 4% per annum. So I know that the ACE and ARB class adoption have really helped control hypertension and improve mortality. And so I take your point that there could be a sort of tailwind of sorts from these drugs to some extent. But would just really love to understand what the sort of historic experience has been within the dialysis population.

是的，在此期間，ESKD 人口每年增長 3% 至 4%。所以我知道 ACE 和 ARB 類藥物的採用確實有助於控制高血壓和降低死亡率。因此，我同意您的觀點，即這些藥物在某種程度上可能會帶來某種順風車。但我真的很想了解透析人群的歷史經驗。

And then secondly, on that, one of the issues around this delay in progression, you may well get these patients in the end, especially if the mortality goes down, but at what age? Because the proportion of patients in the broader ESKD population, 20 years ago, 2/3 of those patients were under 65. Now it's more like 57%. So a lot of these patients may age into Medicare before they end up with ESKD. So just would love to get your thoughts on the delay in progression and how that could affect your economics longer term?

其次，關於進展延遲的問題之一，你最終很可能會得到這些患者，特別是如果死亡率下降的話，但在什麼年齡呢？因為在更廣泛的 ESKD 族群中，20 年前，2/3 的患者年齡在 65 歲以下。現在這個比例大約是 57%。因此，這些患者中的許多人可能會在最終患上 ESKD 之前加入醫療保險。那麼，我想聽聽您對進展延遲的看法，以及這對您的長期經濟有何影響？

Yes. Thanks, Lisa. I will try my best there, but I can also follow up with Frank afterwards. So the RAS inhibitors have been available for they've only been used in about 50% of the eligible people despite the low price and wide availability. As we think about the -- you talk about this 15 years of ESRD population growth. I think we would speak to that as where we've seen an improvement in mortality and the average life on dialysis has extended. Now I think that is more flattening off in recent years and kind of we have COVID effect there in those years, too. But I think the improvement in mortality in average life on dialysis has obviously been a benefit in that patient population growth.

是的。謝謝，麗莎。我會盡力在那裡，但之後我也可以跟進弗蘭克。因此，RAS 抑制劑已經上市，儘管價格低廉且供應廣泛，但僅在大約 50% 的符合條件的人群中使用。當我們思考時，您談到了這 15 年的末期腎病 (ESRD) 人口增長。我認為我們會談論這一點，因為我們看到死亡率有所改善，透析的平均壽命也有所延長。現在我認為近年來這種情況更加趨於平緩，而且這些年我們也受到了新冠病毒的影響。但我認為透析平均壽命死亡率的改善顯然有利於患者人口的成長。

In terms of your kind of question on delay in progression, I think really what's behind your question is, are we going to see a change in kind of mix here, as we think about kind of an extended funnel on CKD and the cardiovascular benefits, which may delay kind of ultimately a larger pool coming into dialysis because they have the cardiovascular benefits. If they have that, we could potentially see an age shift where you have younger, healthier patients who could be kind of working or on commercial insurance coming into the ESRD population.

就您關於進展延遲的問題而言，我認為您問題背後的真正原因是，當我們考慮 CKD 和心血管益處的擴展漏斗時，我們是否會看到這裡的混合發生變化，這可能最終會延遲更多的人進入透析，因為它們對心血管有益。如果他們有這樣的能力，我們可能會看到年齡的轉變，年輕、健康的患者可能會進入末期腎病人群，他們可能正在工作或有商業保險。

And of course, what we see today is, I get my numbers right here, the average commercial patient is on insurance for about 30 months -- or less than 30 months, sorry, I should say that, less than 30 months. So if we get more commercial patients in and then we have that 30 months before they go on to Medicare, that -- we could see that age shift happen in that population. But I think that's something only time is going to tell on what happens to that mix.

當然，我們今天看到的是，我在這裡得到了我的數據，商業患者的平均保險期限約為 30 個月——或者少於 30 個月，抱歉，我應該說，少於 30 個月。因此，如果我們吸引更多的商業患者，然後在他們接受醫療保險之前 30 個月，我們就可以看到該族群中發生年齡轉變。但我認為只有時間才能證明這種混合會發生什麼。

I mean, you're absolutely right that the average age of new starts now is over 65, and we already see that phenomena. So I think what we'll be looking at is to see what happens in the CKD population (inaudible) particularly in stages 3 to 5. And then what happens in that the commercial plans were -- kind of whether already on less than 30 months coverage. I think obviously -- we, obviously, have significant growth in [MA] the last 2 years. That becomes more important as well in the age above 65 in the future.

我的意思是，你說得對，現在新進員工的平均年齡超過 65 歲，我們已經看到了這種現象。因此，我認為我們將關注的是 CKD 人群（聽不清楚）中會發生什麼，特別是在第 3 至 5 階段。然後，商業計劃是否已經在不到 30 個月的時間內發生了什麼覆蓋範圍。我認為顯然 - 顯然，我們在過去兩年中取得了顯著增長。對於未來 65 歲以上的人來說，這一點也變得更加重要。

Okay. Just one quick follow-up. On the patients, obviously, the MSP period is 33 months. But my understanding is actually a lot of your patients drop off after sort of 18 months, if they're on COBRA because it gets a lot more expensive at that point. Is that a fair statement?

好的。只需一個快速跟進。對於患者來說，顯然，MSP 期限為 33 個月。但我的理解是，實際上很多患者在 18 個月後就會放棄使用 COBRA，因為到那時它會變得更昂貴。這是一個公平的說法嗎？

Yes, I think that's fair. I think, on average, it's more like 18 to 24 months.

是的，我認為這是公平的。我認為，平均來說，大約是 18 到 24 個月。

The next question comes from the line of Richard Felton with Goldman Sachs.

下一個問題來自理查費爾頓與高盛的對話。

My first one is on the guidance, EBIT growth. Given the first 9 months has been very strong, the upgraded guidance implies quite a sharp deceleration in Q4. So my question is, is that all comps related? Or is there anything else you're seeing in the momentum of your business that's keeping you a little bit more cautious on Q4? That's my first question.

我的第一個是關於指導、息稅前利潤成長。鑑於前 9 個月的表現非常強勁，升級後的指導意味著第四季度的經濟大幅減速。所以我的問題是，所有的比較都相關嗎？或者您在業務動能中看到的其他因素是否讓您對第四季更加謹慎？這是我的第一個問題。

And then my second one is on Care Enablement. So look, it's another quarter where margin's quite a long way below your target. Can you maybe provide a bit of color on how much the margin was impacted by transactional FX in the quarter? And then maybe a bit of an update on what you're doing to drive better performance and better margin in that part of the business within the new organizational framework?

我的第二個主題是護理支援。所以看，又一個季度利潤率遠低於你的目標。您能否提供一些關於本季外匯交易對利潤率的影響程度的資訊？然後，也許可以介紹一下您正在採取哪些措施，以在新的組織框架內推動該業務部分實現更好的績效和更高的利潤？

Thanks for your question, Richard. Yes, and I think the flavor of the day from many of the analysts has been we seem to be predicting a sharp decline in Q4. And I think the high-level answer, it is one of comps. There is nothing fundamentally happening or shifting in the business in Q4 from an operational perspective. But I do think it's probably worth unpacking that for the wider audience as well.

謝謝你的提問，理查德。是的，我認為許多分析師今天的看法是，我們似乎預測第四季將大幅下滑。我認為高層的答案是比較之一。從營運角度來看，第四季的業務沒有任何根本性的變化或變化。但我確實認為，為更廣泛的受眾解開這一點可能也是值得的。

So Q4, year-over-year, over '23 to '22. In Q4 of last year, with our performance, we had some significant favorability from our bonus plans, if you will, the compensation-related short-term bonus. That was around EUR 30 million last year. And obviously, we're on track this year. We did have some NCP deconsolidation gains in Q4 of last year of around EUR 40 million. And then this year, we also have the foreign exchange impact in CE that we didn't have last year. So that perhaps answers your second question. That number was around EUR 22 million, or projected to be around EUR 22 million. So that's the CE transaction piece.

因此，第四季與去年同期相比，從 23 年到 22 年。去年第四季度，根據我們的業績，我們的獎金計劃（如果你願意的話，與薪酬相關的短期獎金）為我們帶來了一些顯著的優惠。去年這一數字約為 3000 萬歐元。顯然，今年我們正步入正軌。去年第四季度，我們確實從 NCP 分拆中獲得了約 4,000 萬歐元的收益。今年，我們在消費性電子產品領域也受到了去年沒有的外匯影響。這或許可以回答你的第二個問題。該數字約為 2,200 萬歐元，或預計約 2,200 萬歐元。這就是 CE 交易部分。

As I think about kind of what we've seen in Q3 and what our implied guidance assumes for Q4, a couple of things there. And again, some of the more Q3 to Q4 improvement that we saw in Q3 that maybe don't happen in Q4. We do have some favorable phasing in corporate. In the quarter, we would -- you saw a very low corporate number that is kind of timing and phasing that we are expecting to come back in Q4.

當我思考我們在第三季看到的情況以及我們對第四季的隱含指導假設時，有幾件事。再說一遍，我們在第三季看到的一些從第三季到第四季的改進可能不會在第四季發生。我們在企業方面確實有一些有利的階段。在本季度，我們會看到企業數量非常低，這是我們預計在第四季度恢復的時機和階段。

As I mentioned, we had the CKCC true-up of 3 quarters included in Q3 that wouldn't be expected to repeat in Q4, and that's around EUR 25 million or so. We have ongoing exchange plans in CE. And then in Q4, we are expecting lower contribution from equity investments in our JV. So I think it's -- none of this is operational. It's either phasing or kind of onetime that we've already called out and spoke to as watching in our headwinds in the business.

正如我所提到的，我們在第三季度中包括了 3 個季度的 CKCC 調整，預計第四季度不會重複，金額約為 2500 萬歐元左右。我們正在製定CE 交換計劃。然後在第四季度，我們預期合資企業股權投資的貢獻將會下降。所以我認為這一切都不起作用。這要么是分階段的，要么是一次性的，我們已經呼籲並與之交談，以觀察我們在業務中的逆風。

The next question comes from the line of Veronika Dubajova with Citi.

下一個問題來自花旗銀行的維羅妮卡·杜巴約娃 (Veronika Dubajova)。

I will keep it to two, please. One, I just want to follow up on Richard's question on the fourth quarter is. I mean, I appreciate the year-on-year comparison, looks very difficult. But also looking just at the absolute level; I mean, normally, fourth quarter is the strongest quarter that you guys tend to have from an absolute EBIT perspective. And it's looking far from it this year, Helen. Is there something that's changed in the seasonality of the business or something that's been pulled forward into the other 3 quarters of the year? Just trying to understand that.

請我把它保留在兩個。一，我只想跟進理查德在第四季提出的問題。我的意思是，我很欣賞同比比較，看起來非常困難。但也只看絕對水準；我的意思是，通常情況下，從絕對息稅前利潤的角度來看，第四季度是你們往往擁有的最強勁的季度。海倫，今年的情況看起來還很遙遠。業務的季節性是否發生了變化，或者是否被推遲到了一年中的其他三個季度？只是想了解這一點。

And then my second question is on same market treatment growth, and obviously, I appreciate we're still annualizing the mortality impacts from COVID. But just curious on how you're thinking about the fourth quarter and whether you think we're going to be in positive territory? And whether you're still comfortable with an assumption that is greater than 1% for 2024?

然後我的第二個問題是關於相同的市場治療成長，顯然，我很高興我們仍在對新冠病毒對死亡率的影響進行年度計算。但只是想知道您如何看待第四季度以及您是否認為我們會處於積極的狀態？您是否仍然對 2024 年大於 1% 的假設感到滿意？

Yes. Thanks, Veronika. Look, there's nothing fundamental changing in Q4. I think we've got -- you're right, it's always our strongest quarter. I think this really is one of phasing of expenses, I think, as I mentioned earlier, the lower contribution from the equity investment and the ongoing kind of transaction FX effects that we're seeing in CE, kind of -- the quarter was buoyed up a little bit on the true-up of the CKCC which came in with 3 quarters.

是的。謝謝，維羅妮卡。看，第四季沒有什麼根本性的改變。我認為我們——你是對的，這始終是我們最強勁的季度。我認為這確實是費用的分階段之一，我認為，正如我之前提到的，股權投資的貢獻較低，以及我們在 CE 中看到的持續交易外匯影響，該季度受到提振比CKCC 的真實成績稍高一些，後者以3 個季度的成績進入。

So I'm not looking at anything in Q4 with a level of concern that says there's something drastically bad or different happening in either seasonality or the underlying performance. Look, I think some of this will depend on where in the guidance range you're expecting us to come in. But everything that we're doing, and we've done so far this year continues in Q4.

因此，我並沒有對第四季度的任何事情表示擔憂，認為季節性或基本表現方面出現了非常糟糕或不同的情況。看，我認為其中一些將取決於您期望我們進入指導範圍的哪個位置。但我們正在做的一切以及今年迄今為止我們所做的一切將在第四季度繼續進行。

On your question on same market treatment. Obviously, we are encouraged by the continued sequential improvement into positive territory once you've adjusted for the acute contract. The improvement in Q3 over Q2 is obviously encouraging. The -- we have guided minus 1% to plus 1%, and we are -- having said that we'd be more than 1% in '23. So we haven't put anything out there for '24. So we're still working through our internal budgets on that. So we feel very confident in our minus 1% to plus 1% and the trend that we have seen sequentially improving this year.

關於你關於相同市場待遇的問題。顯然，一旦您針對急性合約進行了調整，我們就會對持續的連續改善進入積極的領域感到鼓舞。第三季較第二季的改善顯然令人鼓舞。我們已經指導負 1% 到正 1%，我們說過我們會在 23 年超過 1%。所以我們還沒有發布 24 週年的任何內容。因此，我們仍在為此制定內部預算。因此，我們對負 1% 到正 1% 的成長以及我們今年看到的連續改善的趨勢非常有信心。

And apologies, I didn't mean to imply that you've guided for '24 yet. I just think what you have said is you would have expect an improvement in '24 versus '23. So maybe let me rephrase the question, which is, do you expect an improvement versus the minus 1% to 1% that you've guided for '23 still in 2024?

抱歉，我並不是想暗示你已經為 '24 做指導了。我只是認為你所說的是你期望‘24’比‘23’有所改進。因此，也許讓我重新表達這個問題，即，您預計到 2024 年，與您為 23 年指導的負 1% 到 1% 相比，情況是否會有所改善？

I would expect a continued improvement in that trend.

我預計這一趨勢將持續改善。

The next question comes from the line of Oliver Metzger with ODDO BHF.

下一個問題來自 Oliver Metzger 和 ODDO BHF 的線。

The first one is more broader. So now with the final ESRD PPS rate, can you elaborate about your expectation? What does it mean for the U.S. dialysis market? So the rate is clearly below inflation. So do you really think that this is a rate where also some smaller operators might be forced to leave a field?

第一個範圍更廣。那麼現在有了最終的 ESRD PPS 率，您能詳細說明一下您的期望嗎？這對美國透析市場意味著什麼？所以這個利率明顯低於通貨膨脹率。那麼，您真的認為在這個速度下，一些較小的運營商也可能被迫離開這個領域嗎？

And the second question is on your value-based care approaches in general. So also, Hassan mentioned, you had similar problems with the ESCO some years ago. And it looks, at least from the outside that, yes, you get less money for bringing some extraordinary work. So is there any red line? Are we talking only about some lower benefits? Or would you describe it more as a general problem that potentially CMS-driven value-based care looks nice on the paper, but eventually it makes only sense to do value-based care with some commercial operators?

第二個問題是關於您基於價值的護理方法的整體情況。哈桑也提到，幾年前您在節能服務公司方面也遇到類似的問題。是的，至少從表面上看，你帶來一些出色的作品後得到的錢會更少。那麼有沒有紅線呢？我們只是在談論一些較低的福利嗎？或者您會將其描述為一個普遍問題，即潛在的 CMS 驅動的基於價值的護理在紙上看起來不錯，但最終只有與一些商業運營商進行基於價值的護理才有意義？

Thanks, Oliver. Look, clearly, our PPS final rate is disappointing. And we continue with the industry to engage with CMS on this calculation. And clearly, they've acknowledged that there's a forecasting error in their calculation.

謝謝，奧利佛。顯然，我們的 PPS 最終費率令人失望。我們將繼續與業界就這項運算問題與 CMS 進行合作。顯然，他們已經承認他們的計算有預測錯誤。

There's a lot of pressure here from the service providers to get the right reimbursement increase in this higher cost environment. So we continue to kind of put the efforts in the right place there. And I think coming out of the final rate, we will still kind of be pushing for the right methodology on the calculation. So we're not giving up and we continue to do the good work that we do there.

在這種成本較高的環境中，服務提供者面臨很大的壓力，要求獲得適當的報銷增加。因此，我們繼續將努力放在正確的地方。我認為，從最終的利率來看，我們仍然會推動正確的計算方法。所以我們不會放棄，我們會繼續做好我們在那裡所做的工作。

What does that mean? I mean, obviously, for us, we're also kind of working hard on our operating leverage and our cost structure and everything else through this year and beyond, and we obviously scale where we can.

這意味著什麼？我的意思是，顯然，對我們來說，今年及以後我們也在努力改善我們的營運槓桿、成本結構以及其他一切，而且我們顯然會盡可能地擴大規模。

What does it mean for smaller players, and not just in lower reimbursement, but a higher cost of capital environment? I can't speculate on. Obviously, for us, we're focused on our own turnaround and being moderate in how we are forecasting it, so that we can rightsize our organization accordingly. And as I said, that was within our kind of our guidance assumption.

對於規模較小的企業來說，這意味著什麼？不僅是報銷較低，而且資本環境成本較高？我無法推測。顯然，對我們來說，我們專注於自己的扭虧為盈，並在預測方面保持適度，以便我們能夠相應地調整我們的組織規模。正如我所說，這在我們的指導假設之內。

VBC, clearly CKCC was a disappointment, but still positive. And I think, at the end of the day, we will continue to have those discussions and take a hard look at the government programs that we are participating in.

VBC，顯然 CKCC 令人失望，但仍然積極。我認為，最終，我們將繼續進行這些討論，並認真審視我們正在參與的政府計劃。

We are extremely excited about the role we are playing in value-based care and our partnership with InterWell. I mean, I think our ability -- so CKCC whether we had InterWell and value-based care or not, we'd have been hit with that under the old Fresenius health plan true-ups that we saw with the ESCOs.

我們對我們在基於價值的護理中發揮的作用以及與 InterWell 的合作夥伴關係感到非常興奮。我的意思是，我認為我們的能力 - 所以 CKCC 無論我們是否有 InterWell 和基於價值的護理，我們都會受到舊費森尤斯健康計劃的打擊，我們在 ESCO 中看到了這一點。

What we are increasingly doing is turning the conversation and the discussion about our work with InterWell and how we are participating in value-based care arrangements with the payers in Medicare Advantage and so on. I mean, look, I think as we were talking about the -- managing patients earlier in the CKD, kind of funnel, that's really where this work with InterWell is really helpful in kind of supporting these patients in the CKD population, driving earlier detection and management to patients, which would begin -- we feel the management of these patients at an earlier age.

我們越來越多地做的是改變我們與 InterWell 合作的對話和討論，以及我們如何與 Medicare Advantage 的付款人一起參與基於價值的護理安排等。我的意思是，看，我認為，正如我們所討論的，在 CKD 早期管理患者，一種漏斗，這確實是與 InterWell 的合作真正有助於支持這些 CKD 人群中的患者，推動早期檢測以及對患者的管理，這將開始——我們在更早的時候就感受到了對這些患者的管理。

So we -- kind of it's still early days, I would say, in the maturity of the environment for VBC. We know that when we intervene in the management of this care of this patient population that the medical loss ratio show us that we can save cost in care. And I think for us, it's making sure that we -- getting the full benefit, we believe, will improve with a more stable and mature framework for VBC programs. And CKC is a part of it, but not the whole ecosystem. And we are clearly the market leader in this value-based care environment with the number of patients that we have on contracts as well as our partnerships with physicians.

因此，我想說，VBC 環境的成熟度還處於早期階段。我們知道，當我們幹預該患者群體的護理管理時，醫療損失率表明我們可以節省護理成本。我認為對我們來說，它確保我們獲得全部利益，我們相信，透過更穩定和成熟的 VBC 專案框架將會得到改善。而CKC只是其中的一部分，但不是整個生態系。從我們簽訂的合約患者數量以及與醫生的合作關係來看，我們顯然是這種基於價值的護理環境的市場領導者。

So I think this is one where it's still an early environment, but one we're incredibly excited about and they'll kind of see that we can participate in it. But of course, the government programs, we continue to take a hard look at, and we'll have to determine whether we stay in some, all or none in the future.

所以我認為這仍然是一個早期環境，但我們對此感到非常興奮，他們會看到我們可以參與其中。但當然，對於政府計劃，我們將繼續認真審視，我們必須決定將來是否保留部分、全部或不保留。

One quick follow-up in this context. So basically, there seems to be, say, a disagreement about metrics or quality metrics, which have to be fulfilled. So is it just so difficult to define the right targets and to agree on a variety of targets? Because if you -- we are living in a digital world and normally it's a yes or no, and it seems to be even some more room for discussions in these programs?

在這方面的一個快速跟進。因此，基本上，似乎對於必須滿足的指標或品質指標存在分歧。那麼，確定正確的目標並就各種目標達成一致就這麼困難嗎？因為如果你——我們生活在一個數位世界，通常是肯定或否定，並且在這些程式中似乎還有更多的討論空間？

Yes. Look, I -- we've come a long way. I mean, I know you might be all -- being a little -- kind of questioning this right now, but we've come a long way to the ESCO programs. What we entered into with the CKCC programs was a much better improved program. But what we are seeing -- I mean, it's still not the full transparency and kind of the variability in the government reporting, as I said, that's making it a little bit more challenging for us.

是的。看，我——我們已經走了很長的路。我的意思是，我知道你們現在可能會有點質疑這一點，但我們在節能服務專案方面已經取得了很大的進展。我們與 CKCC 計畫簽訂的是一個更好的改進項目。但我們所看到的——我的意思是，正如我所說，政府報告仍然不完全透明，而且存在一定的可變性，這讓我們面臨更大的挑戰。

I think what is good is the ability to have the discussions and make sure that the kind of the intent of the plan is what's being delivered. So look, I think we -- now we've got data and now we've got reports absolutely makes us equipped to continue to have the conversations with CMS. So it's not a closed door. And I think it's just more making sure that we are getting what we believe to be our fair share of our participation in the program and get paid for what we believe our data suggests.

我認為最好的是能夠進行討論並確保計劃的意圖是正在交付的內容。所以，我認為我們——現在我們已經獲得了數據，現在我們已經獲得了報告，這絕對使我們有能力繼續與 CMS 進行對話。所以這不是一個緊閉的門。我認為這只是更多地確保我們得到我們認為是我們參與該計劃的公平份額，並根據我們認為我們的數據所顯示的內容獲得報酬。

So yes, I think just more to come on this, but obviously, we had to wait to get -- kind of get this PY2 report in before we could even see what we were dealing with. So I think that's a little bit of the challenge as well is the visibility into what's happening and what we -- when we get it. So yes, I think more to come, and we'll continue to provide updates on our VBC book of business.

所以，是的，我認為在這方面還有更多的內容，但顯然，我們必須等待——在我們能看到我們正在處理的問題之前，先得到這份 PY2 報告。因此，我認為這也是一個挑戰，同時我們也需要了解正在發生的事情以及當我們得到它時我們會做什麼。所以，是的，我認為還會有更多內容，我們將繼續提供有關 VBC 業務手冊的更新。

Okay. We can take one last question.

好的。我們可以回答最後一個問題。

The last question comes from the line of Graham Doyle with UBS.

最後一個問題來自格雷厄姆·多伊爾（Graham Doyle）與瑞銀集團（UBS）的聯繫。

Just a quick follow-up on the volume question from Veronika. Just one of the points you made, I think, on the last call was just around some -- working through some mortality in the sort of pre-ESRD funnel. Have you got any visibility on kind of what stage we're on that? Have we got a few more quarters to go, and then we're back to normal? It'd be good to get a sense of that.

只是對 Veronika 提出的音量問題進行快速跟進。我認為，您在上次電話會議中提出的觀點之一就是圍繞一些問題——解決終末期腎病前漏斗中的一些死亡率問題。您知道我們處於哪個階段嗎？我們還有幾個季度才能恢復正常嗎？如果能了解一下這一點就好了。

And then one bit of pricing, it would be great to get a sense of is in the negotiations in terms of what we're thinking about for next year, even 18 months' time, our private payers being a bit more sensible about inflation than perhaps Medicare has been?

然後是一點定價，如果能在談判中了解我們對明年，甚至是 18 個月後的想法，那就太好了，我們的私人付款人對通貨膨脹比對通膨更敏感一些。也許醫療保險已經？

Yes. Thanks, Graham. I don't think that there's anything that we can point to in terms of what is happening with that late-stage CKD funnel and how that's translating into growth. I mean, as you can imagine, growth is -- continues to be a key area for us. But I think the key here is we're dealing with the annualization still of COVID, and we're exiting these acute contracts, but nothing else that I could point to at this point that says anything is changing.

是的。謝謝，格雷厄姆。我不認為我們可以指出晚期 CKD 漏斗中發生的情況以及它如何轉化為成長。我的意思是，正如你可以想像的那樣，成長仍然是我們的關鍵領域。但我認為這裡的關鍵是我們正在處理新冠病毒的年化問題，並且我們正在退出這些緊急合同，但目前我無法指出任何其他事情正在發生變化。

In terms of the private payers, as you know, these are more long-term contracts in nature. So they generally locked up for a couple of years. And with some of them, or many of them, we have escalated in already. So we're not seeing kind of -- I mean, we want a higher price. They want a lower price. So it's always kind of a thoughtful partnered negotiation. But we're not kind of anything here on our big contracts that concerns us. But obviously, there are always ongoing discussions and negotiations.

如您所知，就私人付款人而言，這些本質上是更長期的合約。所以他們通常會被關上幾年。對於其中一些或許多，我們已經升級了。所以我們沒有看到——我的意思是，我們想要更高的價格。他們想要更低的價格。所以這總是一種深思熟慮的合作談判。但在我們的大合約上，我們並沒有任何讓我們擔心的事情。但顯然，討論和談判始終持續進行。

Where we're seeing some of maybe -- plans want to change pricing. Obviously, our focus is on profitability, and we are kind of prepared to go out of contract or walk away from these smaller contracts where they don't make sense. But the larger payers, it very much is a partner discussion, I would say.

我們看到一些可能的計劃想要改變定價。顯然，我們的重點是盈利能力，我們已經準備好終止合約或放棄這些沒有意義的較小合約。但我想說，對於較大的付款人來說，這很大程度上是合作夥伴的討論。

Okay. So thank you, everyone. I'm sorry that we run out of time, and I'm sorry for the technical issues we had, which obviously also did cost time. So apologies for that. But thank you for being patient with us and listening in. Thank you.

好的。謝謝大家。很抱歉我們沒有時間了，而且我對我們遇到的技術問題也很抱歉，這顯然也浪費了時間。所以對此表示歉意。但感謝您對我們的耐心和傾聽。謝謝。

Yes. Thank you all. Take care. Bye-bye.

是的。謝謝你們。小心。再見。

Ladies and gentlemen, the conference is now concluded, and you may disconnect your telephone. Thank you for joining, and have a pleasant day. Goodbye.

女士們、先生們，會議現已結束，請掛斷電話。感謝您的加入，祝您有個愉快的一天。再見。