Fresenius Medical Care AG (FMS) 2024 Q1 法說會逐字稿

Ladies and gentlemen, welcome to the Fresenius Medical Care Report on First Quarter 2024 Conference Call. I'm Alice, the Chorus Call operator. (Operator Instructions). And the conference is being recorded. (Operator Instructions). At this time, it is my pleasure to hand over to Dominik, Head of Investor Relations. Please go ahead.

女士們、先生們，歡迎參加費森尤斯 2024 年第一季醫療保健報告電話會議。我是愛麗絲，合唱呼叫操作員。 （操作員說明）。會議正在錄製中。 （操作員說明）。此時此刻，我很高興將工作交給投資人關係主管多明尼克 (Dominik)。請繼續。

Thank you, Alice. Good afternoon or good morning, depending on where you are. I would like to welcome you to our earnings call for the first quarter of this year. We appreciate you joining us today. 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 earlier today.

謝謝你，愛麗絲。下午好或早上好，取決於你在哪裡。歡迎您參加我們今年第一季的財報電話會議。我們感謝您今天加入我們。一如既往，我將在電話會議開始時提及安全港聲明、簡報以及今天早些時候分發的所有資料中的警示性語言。

For further details concerning risks and uncertainties, please refer to these documents as well as to our SEC filings. As we have only 60 minutes for the call, we have prepared a short presentation to leave time for questions. As always, we would like to limit the number of questions to 2 in order to give everyone the chance to ask. Should there be further questions and time left, we are more than happy to do a second round.

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向 SEC 提交的文件。由於我們的通話時間只有 60 分鐘，因此我們準備了一個簡短的演示，以便為提問留出時間。像往常一樣，我們希望將問題數量限制為 2 個，以便讓每個人都有機會提問。如果還有其他問題並且還有時間，我們非常樂意進行第二輪。

With us today is Helen Giza, our CEO and Chair of the Management Board; and Martin Fischer, our CFO. Helen will start with an update on the major developments and Martin will provide a review of the financial performance in the first quarter. Then we are happy to take your questions. With that, Helen, the floor is yours.

今天與我們在一起的是我們的執行長兼管理委員會主席 Helen Giza；和我們的財務長馬丁費雪 (Martin Fischer)。海倫將首先介紹主要進展的最新情況，馬丁將回顧第一季的財務表現。那我們很樂意回答您的問題。好了，海倫，地板就是你的了。

Thank you, Dominik. Welcome, everyone. Thank you for joining our presentation today and for your continued interest in Fresenius Medical Care. I will begin my prepared remarks on Slide 4. I'm pleased to report that we continue to make tangible progress on both our transformation and our turnaround efforts. We are meaningfully advancing toward our 2025 group margin target band. The progress is visible in both of our operating segments.

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。我將從投影片 4 開始我準備好的發言。我們正朝著 2025 年集團利潤率目標邁進。我們的兩個營運部門都取得了明顯的進展。

Care delivery, the first quarter was marked by important leadership changes and organizational improvements. As you know, Craig Cordola, our new Head of Care Delivery, officially started on the 1st of January. A key priority for his first 100 days was to implement a new organizational structure and leadership team for his business and focus on holistic end-to-end process improvements. With the streamlined care delivery organizational changes now in place since the 1st of April, I'm very encouraged by the focus, professionalism and speed of implementation that Craig and his new leadership team are bringing to the business and their priorities centered around driving patient growth are very clear.

第一季的護理服務以重要的領導層變動和組織改進為標誌。如您所知，我們新任護理服務主管 Craig Cordola 於 1 月 1 日正式上任。他上任 100 天的首要任務是為其業務實施新的組織結構和領導團隊，並專注於整體端到端流程改善。自4 月1 日以來，簡化的護理服務組織變革已經到位，克雷格和他的新領導團隊為業務帶來的專注、專業精神和實施速度以及他們以推動患者增長為中心的優先事項讓我深受鼓舞非常清楚。

In the U.S., a major focus for the Care delivery team is on improving clinic utilization, optimizing processes as well as unconstraining clinics and optimizing the clinic footprint, especially in growth markets. We were able to decrease the number of constrained clinics by about 1/3 by the end of the first quarter. We have very good visibility on the capacity constrained markets and specific clinics, and the challenges are not uniform. For example, in several constrained markets, staffing shortages remain a factor. Therefore, hiring and reducing turnover remains a priority.

在美國，護理服務團隊的主要關注點是提高診所利用率、優化流程以及不受約束的診所和優化診所足跡，特別是在成長市場。到第一季末，我們將受限診所的數量減少了約 1/3。我們對容量有限的市場和特定診所有很好的了解，而且挑戰並不統一。例如，在一些受限市場中，人員短缺仍然是一個因素。因此，招募和減少人員流動仍然是首要任務。

By the end of the first quarter, our open positions for nurses and technicians across the U.S. were reduced by around 500 to approximately 3,500, which is now very close to a normalized level of 2,000 to 3,000 open positions. This will position us better to take on more patients in the coming quarters.

到第一季末，我們在美國各地的護理師和技術人員空缺職位減少了約 500 個，降至約 3,500 個，目前非常接近 2,000 至 3,000 個空缺職位的正常水準。這將使我們能夠在未來幾季更好地接待更多患者。

In other markets, for example, we are seeing strong demand and do not have sufficient capacity to capture all the patients. For growth markets, it is not just about more hires, but we also need to consider how to make more dialysis chairs available if the expansion drives profitable growth. Expanding our strategic growth areas within Care Delivery remains a priority. The main driver of the mentioned favorable phasing in the first quarter comes from our value-based care business. We had a strong first quarter with patient lives increasing to 125,000 lives and positive revenue and earnings contributions.

例如，在其他市場，我們看到強勁的需求，但沒有足夠的能力來吸引所有患者。對於成長型市場來說，這不僅僅是更多的員工，而且我們還需要考慮如果擴張推動利潤成長，如何提供更多的透析椅。擴大護理服務領域的策略成長領域仍是我們的首要任務。第一季上述有利階段的主要驅動力來自我們基於價值的護理業務。我們第一季業績強勁，患者數量增加至 125,000 人，營收和獲利貢獻積極。

We know that value-based care revenues and returns can be lumpy and therefore, focus more on annual performance. We have planned for our medical costs under management to grow to $8 billion for the full year. We expect our value-based care business to be a positive contributor for full year 2024 and the positive EBIT contribution in the first quarter puts us in a good position to achieve that. As you have seen, we continue to move at speed in our portfolio optimization plan with several additional market exits announced and others closed since our last earnings call. I will review those in more detail later on.

我們知道基於價值的護理收入和回報可能不穩定，因此，更專注於年度績效。我們計劃全年管理的醫療費用增加至 80 億美元。我們預計我們的基於價值的護理業務將為 2024 年全年做出積極貢獻，第一季的積極息稅前利潤貢獻使我們處於實現這一目標的有利位置。正如您所看到的，自上次財報電話會議以來，我們繼續快速推進投資組合優化計劃，宣布了幾個額外的市場退出，其他市場則關閉。稍後我將更詳細地回顧這些內容。

Turning to Care Enablement. I'm very excited about our progress with further proof points demonstrated the continued momentum of our FME25 transformation efforts. This resulted in an inflection point in our Care Enablement margin expansion from 1.3% in the fourth quarter of 2023 to 6% in the first quarter of 2024. Driving this positive margin development is a further improvement in pricing as we both renegotiate and sign new contracts on more favorable terms. With an eye toward cost reduction and margin improvements, several initiatives are underway to optimize our manufacturing footprint and supply chain, which will further benefit the margin development in 2025 and beyond.

轉向護理支援。我對我們的進展感到非常興奮，進一步的證據證明了我們 FME25 轉型工作的持續勢頭。這導致我們的護理支持利潤率出現拐點，從2023 年第四季度的1.3% 增至2024 年第一季的6%。的利潤增長以更優惠的條件。著眼於降低成本和提高利潤率，我們正在採取多項措施來優化我們的製造足跡和供應鏈，這將進一步有利於 2025 年及以後的利潤率發展。

For example, we are in the process of moving production from our plant in Concord, California to Mexico with production set to wind down in California later this year. We continue to optimize the production of a lower-cost fluid line in Knoxville, along with additional cost reductions across initiatives, across the manufacturing network.

例如，我們正在將生產從加州康科德的工廠轉移到墨西哥，並將於今年稍後停止在加州的生產。我們持續優化諾克斯維爾低成本流體生產線的生產，並透過各種措施進一步降低整個製造網路的成本。

In January, we launched further supply chain initiatives in North America to improve operational effectiveness of our distribution network. Pricing as well as margin expansion continue to be a key focus of the CE commercial and operation teams globally. At the same time in Care Enablement, we are preparing for the rollout of high-volume hemodiafiltration in the U.S. and the opportunity to bring much needed innovation and set a new standard of care for patients and at the same time, maximize the benefits of our vertically integrated strategy.

一月份，我們在北美推出了進一步的供應鏈計劃，以提高我們分銷網路的營運效率。定價和利潤擴張仍然是全球 CE 商業和營運團隊的重點關注點。同時，在護理支援方面，我們正在準備在美國推出大容量血液透析濾過，並有機會帶來急需的創新並為患者制定新的護理標準，同時最大限度地發揮我們的優勢垂直整合策略。

While all of these developments in Care Delivery and Care Enablement are essential for the future success of our business, it is terrific to see our turnaround and transformation efforts, driving improved financial performance already and we are on track to achieve our 2025 margin targets.

雖然護理服務和護理支援方面的所有這些發展對於我們業務未來的成功至關重要，但很高興看到我們的扭虧為盈和轉型努力，已經推動了財務業績的改善，並且我們有望實現2025 年的利潤目標。

Moving to Slide 5. For the group, the first quarter result was relatively weaker compared with the full year, which usually ends with a strong quarter. Please keep this in mind when we guide you through our first quarter developments although we have benefited this quarter from a favorable phasing effects, which I'll come back to later.

轉向幻燈片 5。當我們引導您了解第一季度的發展時，請記住這一點，儘管我們在本季度受益於有利的階段性影響，我稍後會再討論這一點。

In the first quarter, we delivered solid revenue growth of 4% with positive contributions from both Care Delivery and Care Enablement. For Care Delivery U.S., we knew that the first quarter was not going to be easy from a volume perspective and it broadly developed in line with our expectations for a broadly flat quarter. Adjusted for the exit from less profitable acute care contracts, U.S. same-market treatment growth came in at minus 0.3%. This reflected some more significant weather events within our clinic footprint and an increased impact from the flu season this year.

第一季度，在護理服務和護理支援的積極貢獻下，我們的收入實現了 4% 的穩健成長。對於美國護理服務，我們知道從數量角度來看，第一季並不容易，但它的發展大致符合我們對季度基本持平的預期。在根據利潤較低的急診照護合約的退出進行調整後，美國同市場治療成長率為-0.3%。這反映出我們診所範圍內發生了一些更重大的天氣事件，以及今年流感季節的影響增加。

Both led to a higher level of mistreatments and while improving at the end of the quarter, we continue to have some capacity-constrained clinics, but at the same time, we are encouraged by the increase in referrals sequentially. Therefore, in line with our planning, we expect to see growth of 0.5% to 2% over the course of the year and the changes and focus of the new Care Delivery leadership are ensuring that we are well positioned to better capture the growth. In the first quarter from an earnings perspective, both segments realized an improved operating income margin on a year-over-year basis. In particular, strong momentum in Care Enablement led to an accelerated margin improvement on a sequential basis and solid development against the strong first quarter of 2023.

兩者都導致了更高程度的虐待，雖然在本季度末有所改善，但我們仍然有一些能力有限的診所，但與此同時，轉診量的連續增加令我們感到鼓舞。因此，根據我們的規劃，我們預計今年將實現 0.5% 至 2% 的成長，新的護理服務領導層的變化和重點將確保我們處於有利位置，並更好地抓住成長機會。從獲利角度來看，第一季度，兩個部門的營業利潤率均實現年增。特別是，護理支援的強勁勢頭導致利潤率環比加速改善，並相對於 2023 年第一季的強勁發展實現穩健發展。

This was supported by strong execution of our FME25 transformation program. As planned, FME25 contributed EUR 52 million in additional savings and we are well on track to achieve the targeted EUR 100 million to EUR 150 million in additional savings by year-end. As already mentioned, we continue to move at speed on our portfolio optimization plan. While we were executing against our turnaround and transformation plans, it is paramount that we do not lose focus on our patients.

這得歸功於我們 FME25 轉型計畫的大力執行。按照計劃，FME25 貢獻了 5,200 萬歐元的額外節省，我們預計在年底實現額外節省 1 億至 1.5 億歐元的目標。正如已經提到的，我們繼續快速推進我們的投資組合優化計劃。當我們執行週轉和轉型計劃時，最重要的是我們不要失去對患者的關注。

In the first quarter, we remained on a high level of clinical quality, which is not only the core of all we do, but integral to our sustainability agenda. To this extent, we will host a sustainability expert call on the 13th of June to highlight our initiatives and achievements in this area. Information on the call is available on our Investor Relations website.

在第一季度，我們保持了高水準的臨床質量，這不僅是我們所做工作的核心，也是我們永續發展議程的組成部分。為此，我們將於 6 月 13 日舉辦永續發展專家電話會議，以強調我們在這一領域的舉措和成就。有關電話會議的資訊可在我們的投資者關係網站上查看。

Turning to Slide 6. As I just referenced, we are moving at pace to exit noncore and dilutive assets. In the first quarter, we announced that we will divest our clinic networks in Brazil, Colombia, Chile and Ecuador. And after further signing the divestments of our clinic networks in Guatemala, Peru and Curacao, we have now signed or closed the exit from all of our clinic operations in Latin America.

轉向投影片 6。第一季度，我們宣布將剝離巴西、哥倫比亞、智利和厄瓜多爾的診所網路。在進一步簽署了危地馬拉、秘魯和庫拉索診所網路的撤資協議後，我們現已簽署或關閉了拉丁美洲所有診所業務的退出。

Additionally, in April, we closed the previously announced divestments of the Care Delivery businesses in Turkey and the Cura Day Hospital Group in Australia during April. These collective transactions that I just described are expected to generate cash proceeds of around EUR 650 million upon closing, which we will use to continue to delever. And all transactions that are currently signed as part of our portfolio optimization plan are estimated to have a negative impact of around EUR 250 million in the full year 2024, mainly from goodwill write-off and book value adjustments, which will be treated as special items in operating income. With that, I'll hand over to Martin to walk you through the first quarter financial performance.

此外，我們在 4 月結束了先前宣布的土耳其護理服務業務和澳洲 Cura Day 醫院集團的撤資。我剛才描述的這些集體交易預計在結束時將產生約 6.5 億歐元的現金收益，我們將用這些收益繼續去槓桿化。目前作為我們投資組合優化計劃一部分而簽署的所有交易預計將在 2024 年全年產生約 2.5 億歐元的負面影響，主要來自商譽沖銷和賬面價值調整，這些將被視為特殊項目在營業收入中。接下來，我將讓馬丁向您介紹第一季的財務表現。

Thank you, Helen, and welcome to everyone on the call. I will recap our first quarter performance beginning on Slide 8. In the first quarter, we delivered strong revenue growth of 4% on an outlook basis. Organic growth of 5% was mainly driven by our growing value-based care business and the favorable rate and mix development in Care Delivery. In Care Enablement, growth was supported by positive pricing development. During the first quarter, operating income on an outlook basis improved by 23%, supported by higher prices, higher value-based care contribution and strong but expected FME25 savings resulting in a meaningful margin improvement of 130 basis points.

謝謝你，海倫，歡迎大家參加電話會議。我將從幻燈片 8 開始回顧我們第一季的業績。 5% 的有機成長主要得益於我們不斷成長的基於價值的護理業務以及護理服務的有利價格和組合發展。在護理支援方面，積極的定價發展支持了成長。第一季度，在價格上漲、基於價值的護理貢獻更高以及強勁但預期的 FME25 節省的支持下，展望基礎上的營業收入提高了 23%，導致利潤率顯著提高了 130 個基點。

As Helen mentioned, our value-based care business not only improved year-over-year, but was a positive earnings contributor in the quarter. This led to an earnings development that was somewhat better than expected from a phasing perspective. The EUR 157 million in special items that you see on the chart comprise EUR 143 million in portfolio optimization costs. This is primarily related to the impairment of tangible and intangible assets resulting from the classification as assets held for sale. It also includes FME25 costs of EUR 28 million as well as EUR 1 million in costs associated with the legal form conversion. Additionally, human site remeasurement contributed positively to special items with EUR 15 million.

正如海倫所提到的，我們基於價值的護理業務不僅同比有所改善，而且為本季度帶來了積極的盈利貢獻。從階段性角度來看，這導致獲利發展略好於預期。您在圖表中看到的 1.57 億歐元特殊項目包括 1.43 億歐元的投資組合最佳化成本。這主要與分類為持有待售資產而產生的有形和無形資產減損有關。它還包括 2800 萬歐元的 FME25 成本以及與法律形式轉換相關的 100 萬歐元成本。此外，人工現場重新測量為特殊項目貢獻了 1500 萬歐元。

Turning to Slide 9. This slide provides an overview of the 130 basis points improvement for our operating income margin compared to the first quarter of 2023 on an outlook base. Starting from the left, as a reminder, the special items in 2023, mainly were related to our portfolio optimization efforts in Care Enablement. This brings us to the starting point of our outlook base and then the quarterly margin contribution by segment. The positive margin contributions from both Care Delivery and Care Enablement are important proof points that we are successfully executing against our turnaround and our transformation plans. While there is more work ahead of us, the step up from 7.3% to a 8.6% group margin in the normally weaker first quarter is visible progress towards our 2025 group margin target band.

轉向投影片 9。從左開始，提醒一下，2023 年的特殊項目主要與我們在護理支援方面的投資組合優化工作有關。這讓我們開始展望基礎，然後是按細分市場劃分的季度利潤貢獻。護理服務和護理支援的正面利潤貢獻是我們成功執行扭虧為盈和轉型計劃的重要證明。儘管我們還有更多工作要做，但在通常較弱的第一季度，集團利潤率從 7.3% 上升至 8.6%，是我們朝著 2025 年集團利潤率目標邁進的明顯進展。

Next, on Slide 10. Care Delivery revenue increased by 5% on an outlook base, supported by 6% organic growth. In the U.S., growth of 6% was driven by a growing value-based care business, assumed moderate reimbursement rate increases and a favorable payer mix development as we continue to see incremental increases in our Medicare Advantage population. As expected, our U.S. volume development was down by 0.3% when adjusted for the impact of acute contract exits. This is broadly in line with our expectation for the first quarter and we expected this to improve over the course of the year.

接下來，在投影片 10 上。在美國，6% 的成長是由不斷增長的基於價值的醫療業務推動的，假設報銷率適度增加，並且隨著我們繼續看到我們的 Medicare Advantage 人口不斷增加，付款人組合發展良好。正如預期的那樣，根據緊急合約退出的影響進行調整後，我們在美國的銷售成長下降了 0.3%。這與我們對第一季的預期基本一致，我們預計這一情況將在今年有所改善。

Revenue in the internal markets increased by 2%, driven by organic growth and the benefit of increased dialysis days year-over-year. In the first quarter, we observed operating income growth of 25% year-over-year. Positive business growth was driven by improved pricing, payer mix effects and higher contributions from value-based care.

在有機成長和透析天數較去年同期增加的推動下，內部市場的收入成長了 2%。第一季度，我們觀察到營業收入年增 25%。積極的業務成長是由定價改善、付款人組合效應以及基於價值的護理的更高貢獻所推動的。

Additionally, FME25 savings also contributed to improved earnings. This was partially offset by higher labor and inflation costs, largely related to the annualization of merit increases in the prior year and fully in line with our assumptions for the current year.

此外，FME25 的節省也有助於提高收入。這部分被勞動力和通貨膨脹成本上升所抵消，這在很大程度上與去年的年化績效成長有關，並且完全符合我們對今年的假設。

Turning to Page 11. In the first quarter, Care Enablement revenue increased by 2% on an outlook basis supported by 2% in organic growth. This growth largely reflects our continued pricing momentum. We need to compare this to a very strong first quarter in 2023 that benefited from higher sales in critical care products in China as part of a corporate-related onetime government initiative.

翻到第 11 頁。這一成長很大程度上反映了我們持續的定價動能。我們需要將其與 2023 年第一季的強勁表現進行比較，該季度得益於中國重症監護產品銷量的增加，這是與企業相關的一次性政府舉措的一部分。

On an outlook basis, operating income for Care Enablement grew by 23%. Business growth remained stable with continued improved pricing being offset by the negative volume base effect from the mentioned prior year China critical care sales as well as unfavorable foreign exchange transaction effects. The positive development was driven by strong FME25 savings but partially offset by inflationary cost increases. This is well in line with our outlook assumptions for the year. Despite the absence of the China Critical Care sales, our first quarter development not only increased, but also better reflects more sustainable improvements in performance. This is, in particular, visible when compared sequentially to the fourth quarter of 2023 with 1.3%. We see a clear inflection point in margin improvement.

從展望來看，Care Enablement 的營業收入成長了 23%。業務成長保持穩定，定價的持續改善被上述上一年中國重症監護銷售的負基數效應以及不利的外匯交易影響所抵消。這一積極的發展是由強勁的 FME25 儲蓄推動的，但部分被通貨膨脹成本的增加所抵消。這與我們對今年的前景假設非常一致。儘管沒有中國重症監護銷售，我們第一季的業績成長不僅有所成長，而且更能體現了業績的更永續的改善。與 2023 年第四季的 1.3% 相比，這一點尤其明顯。我們看到利潤率改善出現明顯的轉折點。

Also the extent of development might vary quarter-by-quarter. We also expect for the full year, a very visible step-up of the Care Enablement margin compares to '23 with clear progress towards our 2025 target margin day.

此外，發展程度可能會因季度而異。我們也預計，與 23 年相比，全年護理支援利潤率將出現非常明顯的提升，並在實現 2025 年目標利潤日方面取得明顯進展。

Continuing on Page 12. Our operating cash flow development was negatively impacted by EUR 58 million, resulting from a cyber incident on February -- in February at Change Healthcare, who is a U.S. clearinghouse provider. This more than offset the otherwise positive operating cash flow development. As a consequence of the cyber incident, we had a ramp-up of open claims during the quarter, which were moderated at the end of the quarter to EUR 273 million. At the end of quarter 1, EUR 311 million of the short-term financing instruments in the U.S. have been utilized.

繼續第 12 頁。這足以抵銷原本積極的經營現金流發展。由於網路事件，我們本季的未決索賠有所增加，但在本季末已降至 2.73 億歐元。截至第一季末，美國已使用短期融資工具3.11億歐元。

On the back of strong crisis management and quick implementation of countermeasures plus advanced payments received from different payers, which totaled EUR 250 million. The impact was mitigated and our gross debt for the group was flat compared to year-end last year. Cash collection has continued to pick up in April and with claim management normalizing, debt levels have also reduced to a normal level in the U.S. We continue to enforce our strict financial policy that includes a disciplined approach to capital expenditures. As a result, we realized free cash flow conversion consistent with prior year level. Our net leverage ratio of 3.2x was stable sequentially. Remaining at the lower end of our self-imposed target corridor of 3x to 3.5x net EBITDA -- net debt to EBITDA.

憑藉強有力的危機管理和快速實施的應對措施，以及從不同付款人收到的預付款，總額達 2.5 億歐元。影響有所緩解，集團的總債務與去年年底持平。 4 月現金收款持續增加，隨著理賠管理的正常化，美國的債務水準也已降至正常水準。結果，我們實現了與上年水準一致的自由現金流轉換。我們的淨槓桿率為 3.2 倍，連續穩定。仍處於我們自行設定的 3 倍至 3.5 倍淨 EBITDA（淨債務與 EBITDA）目標區間的下限。

In line with our 2025 strategic ambitions and current capital allocation priorities, deleveraging remains a top priority. We continue to execute against our portfolio optimization plan and proceeds will be used to further reduce debt.

根據我們2025年的策略目標和目前的資本配置重點，去槓桿仍然是重中之重。我們繼續執行我們的投資組合優化計劃，所得款項將用於進一步減少債務。

I will now hand over to Helen to finish with our outlook.

現在我將請海倫來完成我們的展望。

Thank you, Martin. I will finish the presentation with our outlook on Slide 14. While phasing for first quarter earnings were somewhat better than expected, driven by our value-based care business. Overall, our performance and outlook assumptions developed broadly in line with our expectations. Therefore, we are confirming our 2024 outlook of low to mid-single-digit revenue growth and mid-to-high teens operating income growth for the full year. This quarter once again demonstrated that we are not only focused on executing against our transformation and turnaround initiatives but also serves as another proof point that we can deliver.

謝謝你，馬丁。我將用幻燈片 14 上的展望來結束簡報。整體而言，我們的業績和前景假設的發展基本上符合我們的預期。因此，我們確認 2024 年全年收入成長為低至中個位數，營業收入成長為中至高兩位數的前景。本季再次證明，我們不僅專注於執行我們的轉型和扭虧為盈計劃，而且也是我們可以實現的另一個證明點。

I'm very encouraged by the progress we are making at a group level as we take the necessary steps to strengthen and transform our business and lay the foundation to capture profitable growth. We started 2024 up strong with continued momentum with our FME25 savings and portfolio optimization plan as well as an inflection point in our Care Enablement margin. There is clearly more work to be done, and of course, but we do remain confident in our path to achieve a group operating income margin of 10% to 14% in 2025. That concludes my prepared remarks.

我對我們在集團層面取得的進展感到非常鼓舞，因為我們採取了必要的步驟來加強和轉型我們的業務，並為實現獲利成長奠定基礎。我們在 2024 年伊始就表現強勁，我們的 FME25 儲蓄和投資組合優化計劃以及我們的護理支援利潤率迎來了拐點，勢頭持續強勁。當然，顯然還有更多工作要做，但我們仍然對 2025 年實現集團營業利潤率達到 10% 至 14% 的目標充滿信心。

And with that, I'll hand back to Dominik to start the Q&A.

接下來，我將把問題交還給多明尼克來開始問答。

Thank you, Helen and Martin for your presentation. Before I hand over for the Q&A, I would like to remind everyone to limit your questions to 2. If we have remaining time, we can go another round. And with that, I hand it over to Alice to open the Q&A, please.

謝謝海倫和馬丁的演講。在進行問答之前，我想提醒大家將問題限制在2個以內。就這樣，我把它交給愛麗絲來開始問答。

(Operator Instructions)

（操作員說明）

Thank you. The first question comes from Richard from Goldman Sachs.

謝謝。第一個問題來自高盛的理查。

So 2 questions from me, please. The first one on Care Enablement margins. So obviously, strong sequential improvement. But my question is how sustainable do you think that improvement is now? So obviously, last year, you had a strong start in Q1 and then margins faded slightly through the year. Is there anything that you can call out in terms of sort of phasing for CE margins this year? Or can we expect further improvements from the solid base in Q1. That's the first question.

請我提兩個問題。第一個是關於護理支持利潤的。很明顯，連續性的改善非常明顯。但我的問題是，您認為現在的改善有多可持續？很明顯，去年第一季開局強勁，但全年利潤率略有下降。關於今年的CE利潤率的分階段，您有什麼可以指出的嗎？或者我們可以期待在第一季的堅實基礎上進一步改善嗎？這是第一個問題。

Then my second one is on the Q1 number for U.S. treatment volumes. Obviously, it were relatively subdued start to the year. Are you able to share any additional color or quantifications on the drivers of that between excess mortality, missed treatments and new starts?

然後我的第二個是美國第一季治療量的數字。顯然，今年年初相對低迷。您能否分享有關死亡率過高、錯過治療和重新開始治療之間的驅動因素的任何其他顏色或量化數據？

Richard, this is Helen. I'll take those 2. So on Care Enablement margins, as you can probably tell from my tone here, we're really excited to see the inflection point. We had said that we expected the Care Enablement margin to at least double from last year. And of course, what you see here is quite a decent step-up. We do expect there will be a little bit of phasing as we go through the quarters. And as we know, value -- sorry, VBP, value-based pricing in procurement, excuse me, in China will come in at the back half of the year. But at the same time, we also expect to have further FME25 contributions and the impact from price.

理查德，這是海倫。我會接受這些 2。我們曾說過，我們預期護理支持利潤率至少比去年翻倍。當然，您在這裡看到的是相當不錯的進步。我們確實預計在整個季度中會有一些階段性的調整。正如我們所知，價值——對不起，VBP，採購中基於價值的定價，對不起，在中國將在今年下半年出現。但同時，我們也預期FME25會有進一步的貢獻以及價格的影響。

So I think overall, that 6% might be an aggressive proxy for the year, but definitely trending toward that direction, but with some fluctuations probably through the quarters.

因此，我認為總體而言，6% 可能是今年的激進指標，但肯定會朝這個方向發展，但整個季度可能會出現一些波動。

On your second question, yes, look, we all know. We are watching. I think the world is watching the U.S. treatment volume growth. And obviously, while Q1 came in line with our expectations, it is obviously still hovering around that flat piece. We did have a flu season that was a little bit stronger than we had thought. That did result in higher mortality and missed treatments in January. I think also for us, with our regional footprint, bad weather in the first 6 weeks of the year also impacted those missed treatments. The positive sign that we're signaling here is referral trends are better Q4 to Q1. And then I think outside the external factors, if you will, about kind of the flu season and weather obviously, the operational double down here and pulling apart our end-to-end processes to improve our operational capabilities is well underway. Of course, we know these things take some time, but confident in the overall plan here that we'll get this within the range that we have obviously guided to.

關於你的第二個問題，是的，你看，我們都知道。我們在看。我認為全世界都在關注美國治療量的成長。顯然，雖然第一季符合我們的預期，但它顯然仍在那個平坦的部分徘徊。我們確實經歷了一個流感季節，比我們想像的要嚴重一些。這確實導致一月份死亡率上升和錯過治療。我認為對我們來說，由於我們的區域足跡，今年前 6 週的惡劣天氣也影響了那些錯過的治療。我們在此發出的正面訊號是，第四季到第一季的推薦趨勢較好。然後我認為，除了外部因素之外，如果你願意的話，關於流感季節和天氣，顯然，這裡的運營雙重工作以及分解我們的端到端流程以提高我們的運營能力正在順利進行。當然，我們知道這些事情需要一些時間，但對這裡的整體計劃充滿信心，我們將在我們明顯指導的範圍內實現這一目標。

So the next question comes from Victoria from Berenberg.

那麼下一個問題來自貝倫貝格的維多利亞。

Just the first one for me is, where was clinic utilization tracking in Q1. DaVita commented that they were tracking, I think it was 67% during the quarter. So it would just be good to see the comparison is between both of you. And then I saw that there was a divestiture from your Turkish clinics business. Could you give some color how big that divestment is and what other geographies you may be looking to exit this year?

對我來說，第一個問題是，第一季的診所利用率追蹤在哪裡。 DaVita 評論說他們正在追踪，我認為本季是 67%。所以很高興看到你們兩個之間的比較。然後我看到你們的土耳其診所業務被剝離。您能否透露一下撤資的規模有多大，以及您今年可能希望退出哪些其他地區？

Victoria, I'll take the first question and maybe Martin and I will tag team, the second question. In terms of our utilization, I think we are seeing it very similar to DaVita. I think DaVita said 58% on their call. We are seeing it very similar in that high 50s, obviously not where we where any of us wanted to be, but it is kind of a key focus area for us. And I think the work that we're doing kind of on the operational turnaround, we'll certainly help that as well. Obviously, that constrained clinic coming down by 1/3 from quarter end last year is significant for us as well. Martin, do you want to take the numbers on the Turkey divestiture and I can speak to the overall Turkey -- sorry, the rest of the divestiture few.

維多利亞，我會回答第一個問題，也許馬丁和我會標記團隊，第二個問題。就我們的利用率而言，我認為我們看到的它與 DaVita 非常相似。我認為 DaVita 在電話會議上的回答是 58%。我們在 50 年代看到了非常相似的情況，顯然不是我們任何人想要的，但它是我們的一個關鍵關注領域。我認為我們正在做的關於營運週轉的工作肯定也會對此有所幫助。顯然，受限制的診所比去年季度末減少了 1/3，這對我們來說也很重要。馬丁，你想了解土耳其資產剝離的數據嗎？

Yes. So we have divested Turkey just only recently. I think there is -- it's a smaller sized business and we think in April. In April, exactly. And it is -- sorry, yes. We closed it in April. It's a smaller-sized business. I think it's more in the low double-digit volume range that is relevant for us. And we are in the process or we just closed and have -- in Q2, we expect the divestiture effects to materialize. And with that, I think -- we also divested the remainder or signed that I meant the remainder of Latin America in April and in the first quarter as well. But for the first quarter, there is almost no effect that we have from divestitures. It will be shown in the quarter 2.

是的。所以我們最近才放棄土耳其。我認為這是一個規模較小的企業，我們認為是在四月。準確地說是四月。抱歉，是的。我們在四月關閉了它。這是一家規模較小的企業。我認為這更多的是與我們相關的低兩位數成交量範圍。我們正在這個過程中，或者我們剛剛結束，並且在第二季度，我們預計剝離效應將會實現。我認為，我們也剝離了剩餘部分，或者在四月和第一季簽署了我的意思是拉丁美洲的剩餘部分。但對於第一季來說，資產剝離幾乎沒有產生任何影響。將於第2季上映。

Sorry, on your broader question about what else is in scope, as you can see, we have -- we've moved quite some pace from with Argentina and NCP quite the loans we list in Q1 with many of those also going into Q2 announcements and closing. We have signed roughly around $1 billion of revenues for those divestments. I think you can expect that the majority of what we had in scope is now out there. There's a handful of things that we are still working through some other country footprint, but obviously, we can't speak to that until it's public and kind of maybe some other smaller assets in scope. I think we've been very consistent with our portfolio optimization plan here.

抱歉，關於您更廣泛的問題，即範圍內還有什麼，正如您所看到的，我們與阿根廷和NCP 的貸款相比，已經取得了相當大的進展，與我們在第一季度列出的貸款相當，其中許多也進入了第二季的公告並關閉。我們已經為這些撤資簽署了約 10 億美元的收入。我想你可以預料到我們範圍內的大部分內容現在都已經存在了。我們仍在透過其他國家的足跡進行一些工作，但顯然，在其公開之前我們無法談論它，並且可能是範圍內的其他一些較小的資產。我認為我們與我們的投資組合優化計劃非常一致。

And as you saw in our press release, we expect to get around EUR 650 million of proceeds from what we had signed in 2024, which adds to roughly the EUR 135 million that we got last year. I think all on track, proceeding well, a lot of activity these last few months.

正如您在我們的新聞稿中看到的那樣，我們預計將從 2024 年簽署的協議中獲得約 6.5 億歐元的收益，這使得我們去年獲得的收益約為 1.35 億歐元。我認為一切都步入正軌，進展順利，過去幾個月有很多活動。

The next call comes from James from Jefferies.

下一個電話是來自 Jefferies 的 James 打來的。

Two, if I can, please. If I can just come back to the same-store number you mentioned, I think it was minus 0.7% or minus 0.3% adjusting to the acute clinics. There seems to be a different trajectory to DaVita, who I imagine also had to deal with weather and fluent things. So I guess what are the key differences between them in your business? And did I hear correctly, you're also reiterating the 0.5% to 2% volume rate target for '24 if I didn't see that in the slides.

兩個，如果可以的話，請。如果我能回到你提到的同店數字，我認為根據急性診所調整，這是-0.7%或-0.3%。達維塔似乎有不同的軌跡，我想他也必須應付天氣和流暢的事物。那麼我想您的業務中它們之間的主要區別是什麼？我沒聽錯的話，如果我在幻燈片中沒有看到的話，您還重申了 24 年 0.5% 到 2% 的成交量目標。

And then my second question is just on the intersegment business. I mean the margins were positive here. So I was just kind of curious this is contribute to the Care Enablement margins? And should we expect a positive margin for the eliminations in full year '24?

我的第二個問題是關於部門間業務。我的意思是這裡的利潤是正值。所以我只是有點好奇這是否有助於護理支持利潤？我們是否應該預期 24 年全年的淘汰率會出現正值？

James, I'll take that first question. Yes, look, there's -- clinic footprint does vary. I think there is definitely a distinction between our competitors' performance on same-market treatment growth in ours. But the footprint does vary. We were hit pretty hard on East Coast. So flu season should be roughly the same weather can vary. And clearly, we've got some operational work to do and that is well underway here, particularly on some of our processes as well as unconstraining clinics and still some labor challenging markets for us. So we do reconfirm our growth wasn't on the slide, I think I spoke to Ed, of 0.5% to 2%. But obviously, we know that, that is expected to step up over the course of the year.

詹姆斯，我來回答第一個問題。是的，看，診所的佔地面積確實有所不同。我認為我們的競爭對手在同一市場治療成長方面的表現與我們肯定存在差異。但足跡確實有所不同。我們在東海岸受到了相當嚴重的打擊。所以流感季節應該大致相同，天氣也可能有所不同。顯然，我們還有一些營運工作要做，並且正在順利進行，特別是在我們的一些流程以及不受限制的診所以及對我們來說仍然具有勞動力挑戰的市場方面。因此，我們確實再次確認，我們的成長並未下滑，我想我與 Ed 談過，成長不是 0.5% 到 2%。但顯然，我們知道，這一數字預計將在今年內增加。

And I think what we're looking at in terms of the patient funnel and referral trends, admissions, new patient starts, obviously, they're all important metrics for the incoming funnel. And then for us, operationally, we need to kind of make sure that we can get them into our clinics and service them, and that's kind of the ongoing process work that we're doing.

我認為我們正在關注患者漏斗和轉診趨勢、入院情況、新患者開始情況，顯然，它們都是傳入漏斗的重要指標。然後對我們來說，在操作上，我們需要確保我們可以讓他們進入我們的診所並為他們提供服務，這就是我們正在進行的持續流程工作。

In terms of the intersegment business, nothing has changed there in terms of the intercompany pricing or anything like that. So I want to be very clear that, that's not transfer pricing or intercompany games. This is really -- the progress in Care Enablement is really underlying the operational FME25 transformation programs. But I've been telling you all it's coming. We just -- they take longer. We just got to be patient and now we're starting to see that inflection, particularly on the manufacturing side, and that was evident in the first quarter as well as the continued pricing.

就部門間業務而言，公司間定價或類似方面沒有任何變化。所以我想非常清楚地表明，這不是轉讓定價或公司間博弈。這確實是——護理支援方面的進展確實是 FME25 轉型計劃運營的基礎。但我已經告訴你一切即將到來。我們只是——他們需要更長的時間。我們必須保持耐心，現在我們開始看到這種變化，特別是在製造方面，這在第一季以及持續的定價中很明顯。

Also perhaps to add on the intersegment, it does not roll up into Care Enablement. It rolls up together on the corporate piece. So what you see in the Care Enablement numbers is a true Care Enablement operational performance improvement.

也許還需要補充的是，它不會匯總到護理支援。它在公司部分上捲在一起。因此，您在護理支援數字中看到的是真正的護理支援營運績效改進。

The next question comes from Veronika from Citi.

下一個問題來自花旗集團的 Veronika。

I will also stick to 2 on 2 very predictable topics, I apologize. The first one is just to circle back to the same market treatment growth and Helen, I don't know if you can maybe articulate a little bit better your expectation of the cadence of growth as we move through Q2, Q3 and Q4. I guess would you already expect to be in the 0.5% to 2% range in the second quarter? Or do we need to wait for that until 3Q or Q4? And then apologies for being picky, but any impact from day -- number of days in Q1? And if you can just remind us if that's included or excluded in the minus 0.7%, apologies. I should have asked that of Dominik first thing this morning, but I forgot.

我也會堅持 2 對 2 非常可預測的話題，我很抱歉。第一個只是回到相同的市場處理成長，海倫，我不知道您是否可以更好地闡明您對第二季、第三季和第四季成長節奏的預期。我想您是否已經預期第二季的成長率將在 0.5% 至 2% 的範圍內？或者我們需要等到第三季或第四季嗎？然後為我的挑剔道歉，但是第一季的天數有什麼影響嗎？如果您能提醒我們這是否包含在負 0.7% 之內或排除在外，我們深表歉意。我應該今天早上第一件事就問多明尼克，但我忘了。

My second question is just a bigger question on your revenue per treatment expectations. I know you don't comment on this, but obviously backing out the same market and it does look like revenue per treatment in Q1 was very healthy. Anything unusual here? And if you can give us an update on Medicare Advantage and how that's trending and if that was a meaningful driver.

我的第二個問題是關於您每次治療預期收入的一個更大的問題。我知道您不會對此發表評論，但顯然退出了同一市場，並且看起來第一季每次治療的收入確實非常健康。這裡有什麼不尋常的地方嗎？您能否向我們介紹 Medicare Advantage 的最新情況以及其趨勢如何以及這是否是一個有意義的驅動因素。

Veronika, thank you. Same market treatment growth, not a surprise. Look, I think the cadence of growth, our expectation is that this is going to ramp up over the quarters and we're expecting it to be stronger in half 2. I think the -- obviously, I have a range out there and we're obviously managing the guidance within that range. The work that we're doing, some of that's taking kind of week or month stakehold. So I think that's also why we're kind of saying it will ramp up. I don't think it will be the significant step-up like the numbers you threw out there, Veronika for Q2. But ramping up over the course of the year.

維羅妮卡，謝謝你。同樣的市場待遇成長並不令人意外。聽著，我認為成長的節奏，我們的預期是，這將在幾個季度內加速，我們預計它會在第二季度變得更強。範圍內管理指導。我們正在做的工作，其中一些需要一周或一個月的時間。所以我認為這也是我們說它會增加的原因。我認為這不會像你在第二季發布的 Veronika 數字那樣顯著提升。但在這一年中有所增加。

The impact of dialysis days, there is actually one more day in the quarter, but we actually adjust for that in our same-market treatment growth calculation in our company anyway. So that has been adjusted out already. So obviously, that kind of -- it's a negative adjustment.

透析天數的影響，本季實際上多了一天，但無論如何，我們實際上在我們公司的同一市場治療成長計算中對此進行了調整。所以這已經被調整了。顯然，這是一種負面調整。

Moving to your RPT question. Look, this is something we -- you see the revenue growth. And obviously, as you say, you back out the volume really, really pleased with the progress that we're seeing on that line from reimbursement, from pricing and for mix. MA mix continues to grow. There was a time when I said, "My gosh, if we can get this to 35%, that would be great." And now we're north of 40% and kind of going towards that mid-40 number. So I think the mix -- the commercial mix is strong, slight improvement there and then kind of obviously the contracting that comes with it. So really pleased with the progression on the RPT.

轉到你的 RPT 問題。看，這就是我們——你看到的收入成長。顯然，正如您所說，您對我們在報銷、定價和組合方面看到的進展感到非常非常滿意。 MA 組合持續成長。有一段時間我說：“天哪，如果我們能把這個比例提高到 35%，那就太棒了。”現在我們已經超過了 40%，並且正在接近 40% 左右的數字。所以我認為商業組合是強大的，略有改善，然後顯然是隨之而來的合約。對 RPT 的進展非常滿意。

Next question comes from Graham from UBS.

下一個問題來自瑞銀集團的葛拉漢。

Just first one on GLP-1, which hasn't been asked it's been a while, but we're obviously still waiting to get more information from the flow data. But I was wondering in terms of what you have internally, do you have any data that indicates when you're treating a patient who's currently taking GLP-1 that it actually does translate into longer times on dialysis, i.e., lower mortality overall, therefore, benefit to you guys? So that would be question number one.

這是關於 GLP-1 的第一個，已經有一段時間沒有被問到了，但我們顯然仍在等待從流量數據中獲取更多資訊。但我想知道你們內部有什麼數據表明，當你治療目前正在服用 GLP-1 的患者時，它實際上確實會轉化為更長的透析時間，即總體死亡率較低，因此，對你們有好處嗎？所以這是第一個問題。

And question 2 is, as you continue this great delivery and you're seeing the balance sheet deleverage. What are your thoughts in terms of what you might do with that extra balance sheet room, maybe not the next sort of 6 to 12 months, but beyond that, particularly as you've obviously retrenched from some international markets that lease flex for things like, say, by one of your peers clearly does.

問題 2 是，當你繼續這種出色的交付時，你會看到資產負債表去槓桿化。您對如何利用額外的資產負債表空間有什麼想法，也許不是接下來的 6 到 12 個月，但除此之外，特別是因為您已經明顯從一些租賃靈活的國際市場中縮減開支，例如，說，你的一位同行顯然是這樣做的。

Graham, yes. GLP-1s, we do have good data on the patients -- our patient population that is taking GLP-1s. Two things I would say. For those that are on it, they're not on it long enough yet for us to have any experience to see what that translates into in terms of extended time on dialysis. I think maybe we have about a year's worth of experience there. I think the other comment I would add on GLPs in outpatient population is that we have a very, very high dropout thus far of those patients that are on a GLP-1 and then kind of dropping off it pretty quickly.

格雷厄姆，是的。 GLP-1，我們確實有關於患者的良好數據——我們正在服用 GLP-1 的患者群體。我想說兩件事。對於使用它的人來說，他們使用它的時間還不夠長，我們還沒有任何經驗來了解這對延長透析時間意味著什麼。我想也許我們在那裡有大約一年的經驗。我想我要對門診患者中的 GLP 補充的另一條評論是，到目前為止，那些使用 GLP-1 的患者的退出率非常非常高，然後很快就放棄了。

So I think that the -- there is a study that will read out on GLP-1 drug on dialysis. And I think that's not expected to read out until 2027. So we -- obviously, we're later this month, we will have the expected readout of the double-click, if you will, of the data from flow, but everything that we're seeing so far continues to confirm our expectations. Let me have Martin speak to the current capital allocation and delever plan, and then I'll speak to maybe how I'm thinking about the strategy for the broader capital allocation plan.

所以我認為——有一項研究將在透析中讀出 GLP-1 藥物。我認為預計要到 2027 年才會讀出。看到的情況繼續證實了我們的預期。讓我讓馬丁談談目前的資本配置和去槓桿計劃，然後我會談談我如何考慮更廣泛的資本配置計劃的策略。

Yes. So Graham, we have well articulated 2025 plan. So until then, it is all about execution. It is about making sure that we continue to execute on our divestment plans. And we will continue to deploy capital to deleverage also to make sure that we do what we can do from our side to keep the investment grade. There is a 3.5% own implied -- own applied range that we have. And I think with the 3.2%, we are well positioned there in and there's still some room for us to optimize. Having said that, capital allocation follows strategy and with that, I think I hand the strategy part of the question to Helen.

是的。格雷厄姆，我們已經制定了明確的 2025 年計畫。所以在那之前，一切都與執行有關。這是為了確保我們繼續執行我們的撤資計劃。我們將繼續部署資金去槓桿化，以確保我們盡我們所能保持投資評級。我們擁有 3.5% 的隱含應用範圍。我認為，憑藉 3.2% 的份額，我們處於有利位置，並且仍有一些優化空間。話雖如此，資本配置遵循策略，因此，我想我將問題的策略部分交給海倫。

Yes. Thank you. Graham, I think we feel really good about the capital allocation plans we have in place. And obviously, the combination of the divestments, the improving cash flow, improved operating performance is getting us to a natural delever. We've been asked the question a lot, it's 3x to 3.5x where you're going to stick or are you going to change it? I think that answer depends on our outlook. Obviously, I'm working with the leadership team pretty hard now on the strategy beyond 2025 and what those capital needs are. Obviously, we have HDF launch, clearly, sitting in our strategy wheelhouse as well as continued home and value-based care.

是的。謝謝。格雷厄姆，我認為我們對現有的資本配置計劃感覺非常好。顯然，撤資、現金流改善和經營績效改善相結合，使我們自然去槓桿化。我們已經被問過很多次這個問題了，它是 3 倍到 3.5 倍，你會堅持還是會改變它？我認為這個答案取決於我們的前景。顯然，我現在正在與領導團隊就 2025 年以後的策略以及這些資本需求進行非常努力的合作。顯然，HDF 的推出顯然是我們的策略控制權，以及持續的家庭和基於價值的照護。

So I think we'll be continuing to work that internally. And when we can deliver the strategy, we'll also deliver the capital allocation plan with that. So we're probably thinking next year for a Capital Markets Day on most of this. But now the focus is on strong cash flow generation, improving the profitability, delevering with the cash that we have and building headroom, particularly in this kind of volatile financial market that we're in. I think we all feel good about the current plan.

所以我認為我們將繼續在內部進行工作。當我們能夠交付策略時，我們也將交付資本配置計劃。因此，我們可能會考慮在明年設立一個資本市場日來討論其中的大部分內容。但現在的重點是強勁的現金流產生、提高盈利能力、利用我們擁有的現金去槓桿化並建立空間，特別是在我們所處的這種動蕩的金融市場中。感覺良好。

The next question comes from Lisa from Bernstein.

下一個問題來自伯恩斯坦的麗莎。

Can you just comment on the VBP in dialysis products in China? Is that going to be consumables and machines? And also, if you could just give us rough estimate of what your Care Enablement sales in China are and assuming that, that gets cut in half, perhaps what the profit impact would be as well?

您能否簡單評價一下中國透析產品中的VBP？那是消耗品和機器嗎？另外，如果您能給我們粗略估計您在中國的護理支援銷售額，並假設銷售額減少一半，也許對利潤的影響也會是什麼？

Lisa, yes, the -- it's -- for that business in China, it's consumables. I don't think we've disclosed our separate revenue on the China business per se. We have built in an expected impact for VBP into our guidance outlook and with what we're seeing on tenders and so on. Expect that to be a back half impact, which also, obviously, with the Care Enablement -- with the Care Enablement margin in Q1, obviously, we have -- that's why I'm saying that might be a little phasing through the quarters. So I think what we've seen and what we've been successful on in the work there on VBP in China seems to be holding its own. And yes, we're on good track there, I feel.

麗莎，是的，對於中國的業務來說，它是消耗品。我認為我們沒有披露中國業務本身的單獨收入。我們已將 VBP 的預期影響納入我們的指導展望以及我們在招標等方面看到的情況。預計這將是後半段的影響，顯然，這也與護理支援有關——顯然，我們在第一季的護理支援利潤率——這就是為什麼我說這可能會在整個季度中分階段進行。因此，我認為我們在中國 VBP 工作中所看到的以及所取得的成功似乎仍然有效。是的，我覺得我們進展順利。

And just a follow-up question. Could you give us a rough idea of what your market share is in China consumables? I mean I think globally, you're like in the 40%, 50% range in most markets, if I'm correct on that. Just wondering if China is different.

只是一個後續問題。您能否大致介紹一下您在中國消耗品市場的佔有率是多少？我的意思是，我認為在全球範圍內，大多數市場的這一比例都在 40% 到 50% 之間，如果我的觀點是正確的話。只是想知道中國是否有所不同。

Lisa, I don't have that market share number to hand. Why don't I have Dominik follow back up with you there. I mean you're right in terms of being the clear leader in the HD product, but let me see if we can snag that market share and get back to you.

麗莎，我手邊沒有市佔率數據。為什麼我不讓多明尼克跟你一起去那裡呢？我的意思是，您認為自己是高清產品領域的明顯領導者是正確的，但讓我看看我們是否可以搶佔市場份額，然後再回覆您。

Next question comes from Robert from Morgan Stanley.

下一個問題來自摩根士丹利的羅伯特。

I had a few. One was just -- could you give us an update because I might have missed it earlier, just in terms of where you're seeing sort of labor inflation trends so far this year? Are those still coming down in the way you'd originally expected coming into 2024?

我有一些。其中一個問題是——您能否向我們提供最新情況，因為我之前可能錯過了，就今年到目前為止您所看到的勞動力通膨趨勢而言？到 2024 年，這些數字是否仍按照您最初預期的方式下降？

The second one was on just sort of outlook. I know you said a medium-term margin target. Just in terms of where you're at normalized growth rates given the sort of trend of excess mortality and I guess, exiting COVID comps, there's a lot of moving parts. So just be curious for a little bit more color on what your expectations of what the midterm growth potential for this business is likely to be.

第二個是關於某種前景。我知道你說的是中期利潤目標。就正常化成長率而言，考慮到死亡率過高的趨勢，我想，退出新冠疫情補償計劃，還有很多變化的部分。因此，請對您對該業務的中期成長潛力的期望有更多的了解。

And then the final one, perhaps you could just give us an update on how things are trending around home dialysis where that is a percentage of overall kind of activity at the moment?

最後一個問題，也許您可以向我們提供有關家庭透析的最新趨勢，目前家庭透析佔總活動的百分比？

Martin, do you want to take the labor point and I'll take the next 2?

馬丁，你想拿下勞動點，然後我拿下 2 個嗎？

Yes. As it comes to labor inflation, we are -- Robert, we are well on track. So we have certain assumptions built into our guidance. We assumed a 5% inflation being offset by efficiencies and coming down to a net 3%. We do see that confirmed in our first quarter, so it is developing in line as expectations as we also outlined in the expected headwinds. So we are confident that we see further easing as we assumed also throughout 2024.

是的。就勞動力通膨而言，羅伯特，我們已經步入正軌。因此，我們的指導中內建了某些假設。我們假設 5% 的通膨率被效率所抵消，並降至 3% 的淨通膨率。我們確實看到這一點在第一季得到了證實，因此它的發展符合預期，正如我們在預期逆風中概述的那樣。因此，我們有信心看到進一步的寬鬆政策，正如我們所假設的那樣，整個 2024 年都是如此。

Robert, on your question on the outlook for growth, I think we've been pretty consistent that we feel that the underlying fundamentals in this business are on track. The growing population, the aging population, the increasing incidence of the disease states still no substitution for dialysis other than small numbers of transplantation. And I think with our neutral view on GLPs, we're still, I think, feeling confident that the return to market growth of 2% to 3% back to a pre-COVID level by the end of '25 is on track. So we are still confirming that.

羅伯特，關於您關於成長前景的問題，我認為我們一直非常一致，我們認為該業務的基本面正在步入正軌。人口的成長、人口的老化、疾病發生率的增加，除了少量的移植外，仍然無法取代透析。我認為，鑑於我們對 GLP 的中立看法，我認為我們仍然有信心，到 25 年底，市場成長率將恢復到 2% 至 3%，回到新冠疫情前的水平。所以我們仍在確認這一點。

Home -- your question on home, I think we've all been a little frustrated with the stagnation in home, and we all know why -- whether it the training ability of training capacity of our staff. What I would say is we have a little bit of an increase. It was still in that low 16%. But I think the trends that we're seeing there now is a little bit of an inflection point in the number of patients being trained. So more patients coming in for training. And the expectation and hope is that, that will translate into net patient gains, which is the important number there. So we're making progress. I think we all wish it would be faster. We know we have an aspirational goal out there, but I think this is going in tandem with the operational turnaround and the clinic efficiencies as well.

主場——你關於主場的問題，我想我們都對主場的停滯感到有點沮喪，我們都知道原因——無論是我們員工的培訓能力還是培訓能力。我想說的是我們有一點成長。仍處於 16% 的低水平。但我認為我們現在看到的趨勢是接受培訓的患者數量出現了一些轉折點。因此，有更多的患者前來接受訓練。我們的期望和希望是，這將轉化為患者的淨收益，這是重要的數字。所以我們正在取得進展。我想我們都希望它能更快。我們知道我們有一個雄心勃勃的目標，但我認為這與營運週轉和診所效率同步進行。

The next question comes from Hugo from BNPP.

下一個問題來自 BNPP 的 Hugo。

I have 2. Maybe, Helen, first, you mentioned the strong trends in terms of referral strong, just curious what's the lag here takes to same treatment market growth? And I didn't catch your earlier answer on the Veronika's question. Would you expect as soon as Q2 to be at or above 0.5% for same market treatment growth?

我有 2。我沒聽清楚你之前對維羅妮卡問題的回答。您是否預期第二季相同市場處理成長率將達到或高於 0.5%？

Second, a follow-up on hemodialysis. Curious to get your thoughts and views on the improving access to on dialysis act, maybe the likelihood to go through and the feedback that you're getting from your teams in Washington.

其次，血液透析的追蹤。我很想知道您對改善透析法案的想法和看法，也許是通過的可能性以及您從華盛頓團隊得到的回饋。

We couldn't probably hear your first question. I think you asked how long referrals take to reflect in same market treatment growth. Is that correct?

我們可能聽不到你的第一個問題。我想您問的是推薦需要多長時間才能反映相同的市場治療成長。那是對的嗎？

That's correct.

這是正確的。

Okay. Maybe -- Hugo, maybe I'll take these in reverse order as we pull some numbers here. On the last one about the Dialysis Act, I don't think -- obviously, that we're supportive of what's going on there. We're not expecting that, though, to have any more of an impact to us than what we've already got in here. If I recall correctly, it was budget neutral from CMS. So that likely will kind of maybe reduce the likelihood of getting it -- getting it through. But I don't think that changes our plans or anything on home.

好的。也許——雨果，也許我會以相反的順序來處理這些，因為我們在這裡提取一些數字。關於《透析法案》的最後一項，我顯然不認為我們支持那裡正在發生的事情。不過，我們並不期望這會對我們產生比我們已經在這裡產生的影響更大的影響。如果我沒記錯的話，CMS 的預算是中性的。因此，這可能會降低成功的可能性——獲得成功。但我不認為這會改變我們的計劃或家裡的任何事情。

In terms of the same market treatment growth, I mean, I'm not going to guess what the number is for Q2. I mean I know the work that's underway. I can see the patient funnel. Obviously, we're expecting it to increase, but I'm not going to guess at that number right now. We'll give you the update in Q2. And then in terms of your -- the first question on how long it takes to get referrals. I mean that referral becomes a patient in a chair. And obviously, the more treatments we have, it plays into the treatment number -- pretty quickly, but obviously, one new patient and one treatment adds a lower number to the numerator, if you will.

就相同的市場處理成長而言，我的意思是，我不會猜測第二季的數字是多少。我的意思是我知道正在進行的工作。我可以看到病人漏斗。顯然，我們預計它會增加，但我現在不會猜測這個數字。我們將在第二季向您提供更新。然後就您的第一個問題而言，獲得推薦需要多長時間。我的意思是，轉診變成了坐在椅子上的病人。顯然，我們擁有的治療越多，它就會影響治療數量——速度很快，但顯然，如果你願意的話，一位新患者和一種治療會給分子帶來更低的數字。

I think, obviously, we want to make sure that, that referral gets scheduled, get into our clinic that they're not missing their treatment and overall, that's adding to the growth. But obviously, that does take time to show up in it because the number of patients, the number of treatments in the base takes one additional patient. It takes a while to show up in the number and we need a lot of patients to get that back. But we're optimistic. I feel really confident with the work the team is doing. I think we're addressing it the right way. We're pulling apart processes and improving them end-to-end. So I'm optimistic that it's going to translate into real growth.

我認為，顯然，我們希望確保安排轉診，進入我們的診所，確保他們不會錯過治療，總的來說，這會促進成長。但顯然，這確實需要時間才能反映出來，因為基地的患者數量、治療次數需要增加一名患者。需要一段時間才能顯示數字，我們需要大量患者才能恢復。但我們很樂觀。我對團隊正在做的工作非常有信心。我認為我們正在以正確的方式解決這個問題。我們正在分解流程並端到端地改進它們。因此，我樂觀地認為這將轉化為真正的成長。

The next question comes from Adlington from JPMorgan.

下一個問題來自摩根大通的阿德林頓。

Thanks for taking my call. My call is on behalf of David Adlington. I had 2, please. Firstly, can you please quantify how much of a benefit the VBC was in Q1? And how should we be thinking about that for the rest of the year? And then (inaudible) is just a follow-up on the labor inflation. Could you comment on how much your agency costs have reduced year-on-year? And can you take these agency costs down further?

感謝您接聽我的電話。我代表大衛·阿德林頓致電。我有2個，拜託。首先，您能否量化 VBC 在第一季帶來了多少好處？在今年剩下的時間裡我們該如何思考這個問題？然後（聽不清楚）只是勞動力通膨的後續行動。您能否評價一下你們的代理成本比去年同期減少了多少？您能進一步降低這些代理成本嗎？

Thanks, Anchal. I think I'll take both of those. The VBC business, as you know, obviously fluctuates up and down depending on the claims and experience there. I think probably the number that's meaningful for Q1 is that we saw a low double-digit positive amount in the quarter. So that gives you a sense of when we talk about the phasing of the earnings contribution in Q1 was low double digits. And that's in euros. The kind of -- how that plays out through the rest of the year will depend on that -- the contract and the way the revenue flows.

謝謝，安查爾。我想我會兩者兼具。如您所知，VBC 業務顯然會根據索賠和經驗而上下波動。我認為對第一季有意義的數字可能是我們在本季度看到了兩位數的低正數。因此，當我們談論第一季的獲利貢獻階段時，您會感覺到是低兩位數。這是以歐元計算的。今年剩餘時間的具體情況將取決於合約和收入流動方式。

In terms of your labor question, as quickly as that temporary labor market rose and what I referred to as the hot mess of the summer of 2022, and those weights increased that all dissipated as well. So our use of contract labor is down significantly year-over-year and quarter-over-quarter. We're using it selectively. I would say, though, where we know that it makes sense to use it. There's really tight controls over using it in certain metro areas, hotspots or clear constrained clinics where we need to get temporary labor in, but definitely down in usage and significantly down in rates.

就你的勞動力問題而言，隨著臨時勞動市場的上漲以及我所說的 2022 年夏季的混亂局面，這些壓力的增加也隨之消失。因此，我們對合約工的使用量年比和季比大幅下降。我們有選擇地使用它。不過，我想說的是，只要我們知道使用它是有意義的。在某些大都市地區、熱點地區或需要臨時勞動力的明顯受限的診所，對它的使用確實有嚴格的控制，但使用量肯定會下降，而且費用也顯著下降。

The next question comes from Oliver from ODDO BHF.

下一個問題來自 ODDO BHF 的 Oliver。

So the first one is also on labor. So recent data suggest a stronger-than-expected economy of U.S., also some more positive labor data. So can you elaborate about the current labor shortage situations? And also in this context, maybe after a bad experience you made 2 years ago, if the situation deteriorates quickly, have you learned something from 2 years ago where you can adapt that the consequences might not be as severe, just talking in an extreme case scenario?

所以第一個也是關於勞動力的。最近的數據顯示美國經濟強於預期，還有一些更積極的勞動力數據。那麼能否詳細介紹一下目前勞動力短缺的情況？同樣在這種情況下，也許在你兩年前經歷了一次糟糕的經歷之後，如果情況迅速惡化，你是否從兩年前的經歷中學到了一些東西，你可以適應，後果可能不會那麼嚴重，只是在極端情況下說設想？

Second question is a summer is not far away. So some indication about the next years, the bundled rate increase should come. So I assume you have a lot of interactions with CMS and also government. So is there already any tenancy? How do you think the next year's bundle rate might look like. Also in this context, how is your experience about the weak bundled price increase this year to spread into the commercial plans? How is the mechanism also time-wise? Do you see there an immediate impact from PMS price than a few months later, you see also commercial prices to that also a slower increase. So that would be very helpful.

第二個問題是夏天已經不遠了。因此，有關未來幾年捆綁利率上漲的一些跡象應該會出現。因此，我假設您與 CMS 和政府有很多互動。那現在還有租約嗎？您認為明年的捆綁費率會如何？同樣在這種背景下，您對今年捆綁提價疲弱的經歷如何影響到商業計劃？該機制如何具有時間性？您是否認為 PMS 價格會立即產生影響，而不是幾個月後，您也看到商業價格的成長速度也較慢。所以這會很有幫助。

Thanks, Oliver, to both those questions. Yes, look, I think the -- the labor trends, I think we're balancing, as Martin said, balancing the merit increases and being selective about where we're paying for that labor, but offset by labor efficiencies, that's key. I think also I'm really encouraged by another reduction of 500 open positions in Q1. And when I look at now this open position numbers, 3,000 to 3,500. It's still actually at the same kind of split between nurses and PCTs. Our overall turnover is also improving. So that -- and I think also about 1/3 of those hires that we now are getting in are what we call boomerangs, returning employees. So the benefit of that is we're making inroads into the open positions. We're hiring back experienced tenured employees that require less training and our overall turnover is improving as well.

謝謝奧利佛提出這兩個問題。是的，看，我認為——勞動力趨勢，我認為我們正在平衡，正如馬丁所說，平衡績效增長和選擇性地為勞動力支付費用，但透過勞動力效率來抵消，這是關鍵。我認為第一季空缺職位再次減少 500 個也讓我深受鼓舞。當我現在看到這個未平倉部位數量時，有 3,000 到 3,500 個。實際上，護士和 PCT 之間的劃分仍然相同。我們的整體營業額也在改善。因此，我認為我們現在招募的員工中約有 1/3 是我們所說的“迴旋鏢”，即回歸員工。因此，這樣做的好處是我們正在進入空缺職位。我們正在重新招募經驗豐富、需要較少培訓的終身員工，而且我們的整體營業額也在改善。

I think we've also -- we have learned a lot from the summer of 2022. I think in terms of being able with our metrics to see those signals earlier in a clinic and also this kind of very dedicated use of temporary labor.

我認為我們從 2022 年夏天也學到了很多東西。

I think the market doesn't feel like it was, but obviously, in some areas, we're still watching it quite closely. I love the crystal ball of what the PPS rate is going to look like. And I just about the cost. But I think what we know is MedPAC has put out a suggested 1.8%, I hope that after these spikes of cost inflation and things being a little out of control over the last few years. As things settle down, the reimbursement rate and the mechanisms that we have relied on for years come back into play. And I don't know, common sense on the normality play now. Saying that, we haven't built our guidance on egregious increases. So I think as you've -- as we've said, been quite consistent, we have assumed moderate overall rate increases and if they're higher grade. So I think we're being cautiously conservative there and appropriately serve until we know anything else.

我認為市場感覺並非如此，但顯然，在某些領域，我們仍在密切關注。我喜歡 PPS 費率的水晶球。我只關心成本。但我認為我們所知道的是 MedPAC 提出了 1.8% 的建議，我希望在過去幾年成本通膨飆升和事情有點失控之後。隨著事情穩定下來，我們多年來所依賴的報銷率和機制又開始發揮作用。我不知道，現在的常態是常識。話雖如此，我們的指導並沒有建立在大幅成長的基礎上。因此，我認為正如我們所說的，非常一致，我們假設總體利率適度增長，且等級較高。所以我認為我們在這方面保持謹慎保守並適當服務，直到我們知道其他情況為止。

Okay. And regarding the spillover from the bundled rate into the commercial contracts, what's your...

好的。關於捆綁費率對商業合約的溢出效應，您的...

Yes. Sorry, I missed that. I missed that second part of that question, my apologies. Look, the commercial rate for both MA and commercial are obviously contracted separately. We obviously take into account what -- when we're entering into any negotiation, it's taking the impact of the PPS rate as a baseline into those negotiations and always kind of a healthy trade-off between volume and price, network adequacy and coverage.

是的。抱歉，我錯過了。我錯過了這個問題的第二部分，我很抱歉。你看，MA和商業的商業費率顯然是分開約定的。顯然，當我們進行任何談判時，我們都會考慮到 PPS 費率的影響作為這些談判的基準，並且始終在數量和價格、網路充足性和覆蓋範圍之間進行健康的權衡。

So I think our overall guidance is moderate overall rate increases. So I think the what we -- we have a new head of contracting strategy who is really, really terrific. And I think overall, helping us with our future contracting strategy here. They're not all automatically linked to the PPS weight. I think you know that some have escalators in them, CPI. So they're all quite different. But overall, as I said, we're assuming a moderate increase of the 1% to 2% rate. So yes, I think everything looks good and on track there.

因此，我認為我們的整體指引是整體利率適度上漲。所以我認為我們有一位新的合約策略主管，他真的非常非常出色。我認為總體而言，這有助於我們制定未來的承包策略。它們並非都自動與 PPS 權重相關聯。我想你知道有些裡面有自動扶梯，CPI。所以他們都是完全不同的。但總體而言，正如我所說，我們假設利率適度增長 1% 至 2%。所以是的，我認為一切看起來都很好並且步入正軌。

So we have time for one last caller. Falko from Deutsche Bank.

這樣我們就有時間接待最後一位來電者。來自德意志銀行的法爾科。

Helen, I have 2 clarification questions on guidance, please. Firstly, on the same-store treatment growth guidance and specifically the upper end, 2%. Can we still consider that as a realistic average growth rate for this year? Or should we rather view this as a potential exit rate? And then look at the lower end of 0.5% to 1% as a realistic average growth for this year? And then secondly, I was a little surprised that you confirmed your 2025 EBIT margin target again today. Is there actually still a realistic scenario in which you can get to a 14% margin next year? And if that's not the case, I'm just a little surprised that sort of you keep this type of aggressive hurdle here.

海倫，我有兩個關於指導的澄清問題。首先，關於同店待遇成長指導，特別是上限，2%。我們還能將其視為今年現實的平均成長率嗎？或者我們應該將其視為潛在的退出率？然後看看 0.5% 到 1% 的下限是今年現實的平均成長嗎？其次，我對你們今天再次確認 2025 年息稅前利潤率目標感到有點驚訝。明年是否還有可能達到 14% 的利潤率？如果情況並非如此，我只是有點驚訝你在這裡保留了這種咄咄逼人的障礙。

Falko, yes, I think it's a fair question, and it's obviously one that we are working through in realtime on the back of flat same market treatment growth in Q1. Obviously, we've got a guidance range out there. I think it's fair to assume that, that 2% is more of an exit rate than an average rate at this point. And I think, obviously, as we get another quarter under our belt, we will refine or adjust or update accordingly.

Falko，是的，我認為這是一個公平的問題，顯然，在第一季市場治療成長持平的情況下，我們正在即時解決這個問題。顯然，我們已經有了一個指導範圍。我認為可以公平地假設，2% 更適合退出率，而不是目前的平均率。我認為，顯然，當我們再過一個季度時，我們將相應地進行改進、調整或更新。

On your second question, I don't feel it's aggressive. We clearly have a range out there for our EBIT margin. I think I've been pretty consistent in my commitment to try and give an update on that band itself by half 1. I think that is still my plan -- you know me by now. I'm trying to take it a quarter at a time. I'm really pleased with the progress. It's on track and the financials and bottom line performance are clearly speaking for themselves.

關於你的第二個問題，我不認為它具有攻擊性。我們的息稅前利潤率顯然有一個範圍。我想我一直非常堅持我的承諾，嘗試在一半之前更新樂團本身。我試著一次服用四分之一。我對進展感到非常滿意。它正在步入正軌，財務狀況和底線表現顯然是不言而喻的。

I know there's a question out there of what's it going to take to get to the top end of those EBIT margins. But I think the progress that we're making will continue to inform that and for now, I'm not going to change it today. But clearly, it's top of mind for me knowing that the time I get to half 1, the end of 2025 is only 18 months away. So we'll continue to provide the appropriate color and how we're seeing those guidance ranges as the year goes on.

我知道存在一個問題，即如何才能達到息稅前利潤率的上限。但我認為我們正在取得的進展將繼續表明這一點，目前我不會改變它。但顯然，我最關心的是，距離 2025 年底只有 18 個月的時間，我才能達到一半 1。因此，隨著時間的推移，我們將繼續提供適當的顏色以及我們如何看待這些指導範圍。

So we have run out of time. Thank you, everyone, for this contribution. This is great for I know what you all have a busy day. Thank you very much. We'll appreciate that. And we'll meet you on the road and our latest next quarter. Thank you.

所以我們已經沒有時間了。謝謝大家的貢獻。這太棒了，因為我知道你們今天都很忙。非常感謝。我們將不勝感激。我們將在路上以及最新的下個季度與您見面。謝謝。

Thanks, everyone. Thanks for your continuing support. Take care.

感謝大家。感謝您一直以來的支持。小心。

Take care.

小心。

Ladies and gentlemen, the conference is now over. Thank you for choosing Chorus Call. Thank you for participating in the conference. You may now disconnect your lines. Goodbye.

女士們、先生們，會議現在結束了。感謝您選擇合唱團。感謝您參加本次會議。現在您可以斷開線路。再見。