Fresenius Medical Care AG (FMS) 2024 Q3 法說會逐字稿

Ladies and gentlemen, welcome to the report of the third quarter 2024 of Fresenius Medical Care conference call. I'm Sandra, the Chorus call operator. I'd like to remind you that all participants will be in listen-only mode and the conference is being recorded. The conference must not be recorded for publication or broadcast.

女士們、先生們，歡迎收聽費森尤斯醫療2024年第三季電話會議報告。我是桑德拉，合唱團的接線生。我想提醒您，所有與會者都將處於僅聽模式，並且正在錄製會議。不得錄音會議以供出版或廣播。

At this time, it's my pleasure to hand over to Dominik Heger, Head of Investor Relations. Please go ahead.

此時此刻，我很高興將工作交給投資人關係主管 Dominik Heger。請繼續。

Thank you, Sandra. I would like to welcome everyone to our earnings call for the third quarter of 2024. Thank you for joining us today. I'll start 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，桑德拉。我謹歡迎大家參加我們 2024 年第三季的財報電話會議。感謝您今天加入我們。首先，我將提及我們的安全港聲明、簡報以及我們今天早些時候分發的所有資料中的警告性語言。

For further details concerning risks and uncertainties, please refer to these documents as well as to our SEC filings. The call is scheduled for 60 minutes. We have prepared a presentation, and we'll have time for your questions after the prepared remarks. We would like to limit the number of questions to two in order to give everyone the chance to ask a question.

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。通話時間預計為 60 分鐘。我們已經準備了一份演示文稿，在準備好的演講後我們將有時間回答您的問題。我們希望將問題數量限制為兩個，以便讓每個人都有機會提問。

Let me now welcome Helen Giza, CEO and Chair of the Management Board; and Martin Fischer, CFO of Fresenius Medical Care. Following the prepared remarks, we are happy to take your questions.

現在請允許我歡迎執行長兼管理委員會主席 Helen Giza；馬丁費雪 (Martin Fischer)，費森尤斯醫療保健公司 (Fresenius Medical Care) 財務長。在準備好的發言之後，我們很樂意回答您的問題。

Helen, the floor is yours.

海倫，地板是你的。

Thank you, Dominik, and welcome, everybody. Thank you for joining our presentation today and for your continued interest in Fresenius Medical Care, which we appreciate even more, given the attention to the US elections today.

謝謝你，多明尼克，歡迎大家。感謝您今天參加我們的演講，並感謝您對費森尤斯醫療的持續關注，考慮到今天美國大選的關注，我們更加感激您。

Before I start with details on the quarter, it's important for me to say a few words upfront. I'm continuously inspired by the dedication of our employees around the world who go above and beyond to ensure our patients receive the life-sustaining dialysis treatments they need and with the highest level of care, irrespective on how much effort, challenge and difficult the environment around them is.

在開始介紹本季的詳細資訊之前，我有必要先說幾句話。我不斷受到我們世界各地員工的奉獻精神的鼓舞，他們竭盡全力確保我們的患者獲得他們所需的維持生命的透析治療和最高水平的護理，無論需要付出多少努力、挑戰和困難。是。

We see what continued in the Ukraine and Russia, and more broadly in the Middle East and other crisis areas. Also, the US faced some severe weather events, including Hurricane Beryl in Texas in July and Hurricanes Helene and Milton, impacting the Southeastern United States this fall.

我們看到烏克蘭和俄羅斯以及更廣泛的中東和其他危機地區繼續發生的事情。此外，美國還面臨一些惡劣的天氣事件，包括 7 月德克薩斯州的颶風貝裡爾以及今年秋天影響美國東南部的颶風海倫和米爾頓。

In anticipation of these hurricanes, we mobilized command centers a week in advance to begin the coordination with our local teams, doctors, hospitals and local authorities. We worked closely with patients to find alternative appointment times where patients could receive life-sustaining dialysis treatments before and immediately after the storms.

考慮到這些颶風，我們提前一周動員指揮中心，並開始與當地團隊、醫生、醫院和地方當局進行協調。我們與患者密切合作，尋找替代預約時間，使患者可以在風暴之前和之後立即接受維持生命的透析治療。

Thanks to the tremendous response by our team, we were able to get our patients the treatment they require. Many thanks to the teams around the world who did an outstanding job in all these situations.

感謝我們團隊的巨大反應，我們能夠為患者提供所需的治療。非常感謝世界各地的團隊在所有這些情況下都表現出色。

I'll now begin my prepared remarks on slide 4. The third quarter marked another period where our clear focus on improving operational performance and continued momentum in our company transformation directly resulted in strong improvement in our financial performance and meaningful progress towards our 2025 group margin target.

現在我將在投影片 4 上開始我準備好的演講。第三季標誌著我們明確關注改善營運績效和公司轉型持續動能的另一個時期，直接導致我們的財務表現強勁改善，並在實現 2025 年集團利潤率目標方面取得有意義的進展。

Across both of our operating segments, we are realizing important progress as well as demonstrating our industry-leading capabilities. Beginning with Care Delivery. In the third quarter, we reached an important and reassuring milestone as underlying same market treatment growth in the US turn positive.

在我們的兩個營運部門中，我們正在取得重要進展，並展示了我們領先業界的能力。從護理服務開始。在第三季度，我們達到了一個重要且令人放心的里程碑，因為美國的基本相同市場治療成長轉為正值。

While the volume development is positive, it remains muted in the US due to still elevated mortality. We continue to work on the volume pieces that are in our control, such as streamlining the admissions process and reducing missed treatments. As a result of these efforts, in the third quarter, we recorded improvement in cancellation rates and lower missed treatments.

儘管銷售成長是正面的，但由於死亡率仍然較高，美國的銷售成長仍然緩慢。我們將繼續致力於我們控制範圍內的工作，例如簡化入院流程和減少錯過的治療。由於這些努力，在第三季度，我們的取消率有所改善，錯過的治療也有所減少。

In our international business, we saw same market treatment growth accelerate to 3%, demonstrating that underlying trends for our industry worldwide remain intact. We like how the future of our international portfolio shapes up following the significant progress we made on our portfolio optimization.

在我們的國際業務中，我們看到同樣的市場待遇成長加速至 3%，這表明我們行業在全球範圍內的基本趨勢保持不變。隨著我們在投資組合優化方面取得重大進展，我們對國際投資組合的未來前景感到滿意。

And as a result, we are more focused on growth markets with attractive returns. As already mentioned, thanks to the excellent hurricane disaster response by our teams, we were able to provide our patients their treatments and minimize miss treatments.

因此，我們更加關注具有有吸引力回報的成長市場。如前所述，由於我們團隊出色的颶風災難應對能力，我們能夠為患者提供治療並最大程度地減少錯過治療的情況。

In the third quarter, hurricanes and weather-related events only had a negative impact of 5 basis points on treatment volumes due to our strong disaster preparedness and quick response. I'm proud to say that our continued focus on quality of care as part of our day-to-day clinic operations has not wavered either.

由於我們強大的備災能力和快速反應，第三季颶風和天氣相關事件僅對處理量產生了 5 個基點的負面影響。我很自豪地說，作為日常診所運作的一部分，我們對護理品質的持續關注也沒有動搖。

Fresenius Medical Care dialysis centers in the US routinely rank amongst the safest and highest-quality dialysis centers in the country as measured by the CMS 5 Star quality rating system. In the just recently published rating for 2023, 65% of our dialysis centers in the US received a weighting of 3 Stars or higher.

根據 CMS 5 星品質評級系統的衡量，美國 Fresenius Medical Care 透析中心通常被評為美國最安全、品質最高的透析中心之一。在最近發布的 2023 年評級中，我們在美國的透析中心 65% 獲得了 3 星或更高的權重。

This was higher than the nationwide averages, which found fewer than 60% of all dialysis centers received similar 3 Star or higher ratings. Earlier in October, it was reported that InterWell, our value-based care business achieved best-in-class quality performance in the first year of the US government CKCC program.

這高於全國平均水平，全國平均水平表明只有不到 60% 的透析中心獲得類似的三星或更高評級。10 月初，據報道，我們的價值護理業務 InterWell 在美國政府 CKCC 計劃的第一年取得了一流的品質表現。

InterWell operated 10 of the top 10 and 17 of the top 20 highest scoring kidney contracting entities, based on results recently published by the Center for Medicare and Medicaid Innovation. These results are a testament to the incredible partnership with our physician partners and our leading efforts to deliver value-based care initiatives and opportunities to the market.

根據醫療保險和醫療補助創新中心最近發布的結果，InterWell 經營著得分最高的前 10 名腎臟合約實體中的 10 名和前 20 名中的 17 名。這些結果證明了我們與醫生合作夥伴之間令人難以置信的合作關係，以及我們為向市場提供基於價值的護理計劃和機會而做出的領先努力。

We believe this further strengthens InterWell's position as a partner of choice for nephrologists, payers and patients in the future. While these results demonstrate our industry-leading efforts to deliver value-based care, we must also acknowledge that value-based care is still a relatively nascent industry with lumpy and at times volatile financial returns.

我們相信，這進一步鞏固了 InterWell 作為腎臟病專家、付款人和患者未來首選合作夥伴的地位。雖然這些結果表明我們在提供基於價值的護理方面處於行業領先地位，但我們也必須承認，基於價值的護理仍然是一個相對新興的行業，財務回報不穩定且有時不穩定。

CMS also announced the final ESRD PPS reimbursement increase for 2025 just last Friday. While the 2.7% increase is slightly better than the draft rule, it is still below what we would have liked to see given the inflationary pressures on our industry. It is in line with our moderate assumption for reimbursement increases in our 2025 margin outlook.

就在上週五，CMS 也宣布了 2025 年 ESRD PPS 報銷的最終增加。雖然 2.7% 的增幅略好於規則草案，但考慮到我們行業面臨的通膨壓力，它仍然低於我們希望看到的水平。這符合我們對 2025 年利潤前景中報銷增加的溫和假設。

Our Care Enablement business has continued to achieve improving returns through the third quarter and has maintained the significant margin progress realized in the first six months. Solid volume growth as well as continued execution of targeted pricing initiatives and significant contributions from our FME25 program supported the strong performance.

我們的護理支援業務在第三季度繼續實現不斷提高的回報，並保持了前六個月實現的顯著利潤成長。銷售的穩健成長、目標定價計畫的持續執行以及 FME25 計畫的重大貢獻支持了強勁的業績。

As expected, we did experience a greater negative price impact in China related to the implementation of volume-based procurement. This developed in line with our assumptions, and China remains an important and attractive market for our product business. Beyond our pricing initiatives, the continued optimization of our supply chain and manufacturing footprint remains a critical focus of our FME25 program.

正如預期的那樣，我們在中國確實經歷了與實施帶量採購相關的更大的負面價格影響。這符合我們的假設，中國仍然是我們產品業務的一個重要且有吸引力的市場。除了我們的定價舉措之外，持續優化我們的供應鏈和製造足跡仍然是我們 FME25 計畫的關鍵焦點。

At the same time, we are focused on the future, ensuring we are strategically positioned to leverage our industry-leading capabilities and maximizing opportunities. We are fully on track with our preparations for the launch of our HDF enabled 5008X machine in the United States at the end of next year with full commercial launch in 2026.

同時，我們著眼於未來，確保我們處於戰略地位，能夠利用我們行業領先的能力並最大化機會。我們正在全面做好準備，將於明年底在美國推出支援 HDF 的 5008X 機器，並於 2026 年全面商業發布。

And we have seen strong interest at the American Society of Nephrology Congress at the end of October. While the 5008X will not need IV solutions for operations, we are also today benefiting from our vertically integrated business model. Thanks to our Care Enablement team stepping up after the hurricanes impact on one of our competitors' production site, we had no interruptions in supply due to access to our own IV solution and PD products for our patients.

我們在 10 月底的美國腎臟病學會大會上看到了濃厚的興趣。雖然 5008X 不需要 IV 解決方案來進行運營，但我們今天也從我們的垂直整​​合業務模式中受益。由於我們的護理支援團隊在颶風影響我們競爭對手的生產基地之一後採取了行動，因此我們沒有因為為患者提供我們自己的靜脈注射解決方案和腹膜透析產品而導致供應中斷。

As a consequence, we were not only able to accept more new PD patients at the end of the quarter in care delivery, but additionally, we were able to help other dialysis providers with access to products from our production.

因此，我們不僅能夠在本季末接受更多新的帕金森氏症患者的照護服務，而且我們還能夠幫助其他透析提供者獲得我們生產的產品。

Moving to slide 5. Turning to our specific third quarter developments, we delivered organic revenue growth of 2% with positive contributions from both Care Delivery and Care Enablement. As mentioned, our underlying US same market treatment growth turned positive in the quarter with 0.2% growth when adjusted for the exit of acute contracts. This also includes a 5 basis points negative impact from the hurricanes.

轉到投影片 5。談到我們第三季的具體發展，我們實現了 2% 的有機收入成長，這得益於護理服務和護理支援的積極貢獻。如前所述，我們的基本美國相同市場待遇成長在本季度轉為正數，根據緊急合約的退出進行調整後成長了 0.2%。這也包括颶風帶來的 5 個基點的負面影響。

Both segments realized both increased operating income and increased operating income margins. Care Delivery extended well into its target band for 2025, and Care Enablement improved its margin significantly year-over-year. This was supported by strong contributions from the execution of our FME25 program.

這兩個部門都實現了營業收入和營業利潤率的增加。護理交付遠遠超出了 2025 年的目標範圍，護理支援的利潤率同比顯著提高。這得歸功於我們 FME25 計畫執行的大力貢獻。

FME25 contributed EUR64 million in additional savings, resulting in EUR173 million by the end of the third quarter. We are well ahead of the targeted EUR100 million to EUR150 million for 2024. And with this acceleration, we now expect to achieve already in 2024 around EUR200 million. This confirms how well we are on track to achieve our target of EUR650 million in sustainable savings by the end of 2025.

FME25 貢獻了 6,400 萬歐元的額外節省，截至第三季末節省了 1.73 億歐元。我們遠遠領先 2024 年 1 億至 1.5 億歐元的目標。隨著這種加速，我們現在預計到 2024 年將實現約 2 億歐元。這證實了我們正在順利實現到 2025 年底可持續節省 6.5 億歐元的目標。

In line with our disciplined financial policy, we further reduced our net financial debt and improved our net leverage ratio to below our target corridor, which Martin will speak about later.

根據我們嚴格的財務政策，我們進一步減少了淨財務債務，並將淨槓桿率提高到低於我們的目標走廊，馬丁稍後將談到這一點。

Given our year-to-date performance through the third quarter and development against our assumptions to date, we confirm our revenue growth outlook and heighten our previous operating income outlook towards the upper end of our range with 16% to 18% growth for full year 2024.

鑑於我們第三季度迄今為止的業績以及迄今為止的假設的發展，我們確認了我們的收入成長前景，並將先前的營業收入預期提高到我們範圍的上限，即全年增長 16% 至 18% 2024年。

I'll now hand you over to Martin to take you through the third quarter financial performance in more detail.

現在，我將把您交給馬丁，讓您更詳細地了解第三季的財務表現。

Thank you, Helen, and welcome to everyone on the call. I will recap our third quarter financials beginning on slide 7. In the third quarter, we achieved organic revenue growth of 2%, supported by both Care Delivery and Care Enablement. On an outlook base, revenue decreased by 0.7%, and our revenue development was negatively affected by divestitures, resulting from the successful execution of our portfolio optimization plan.

謝謝你，海倫，歡迎大家參加電話會議。我將從投影片 7 開始回顧我們第三季的財務狀況。第三季度，在護理服務和護理支援的支持下，我們實現了 2% 的有機收入成長。展望基礎上，收入下降了 0.7%，由於我們的投資組合優化計劃的成功執行，我們的收入發展受到資產剝離的負面影響。

The divestitures realized through the third quarter negatively impacted growth by 230 basis points. As you might recall, we decided not to adjust our numbers in the current financial year for the divestitures we are closing this year. We absorbed this impact in our guidance range for the year.

第三季實現的資產剝離對經濟成長產生了 230 個基點的負面影響。您可能還記得，我們​​決定不調整本財政年度的資產剝離資料。我們將這一影響納入了今年的指導範圍。

Moving to operating income. On an outlook base, we saw an increase by 10%, driven by the improved performance of both segments. This resulted in a meaningful higher margin of 9.8%. With that, we are approaching our 2025 target margin band of 10% to 14%. Divestitures realized so far had a neutral effect on operating income margin. Special items during the quarter largely offset each other.

轉向營業收入。從前景來看，由於兩個細分市場業績的改善，我們看到成長了 10%。這導致利潤率顯著提高，達到 9.8%。至此，我們正接近 2025 年 10% 至 14% 的目標利潤率。迄今為止實現的資產剝離對營業利潤率有中性影響。本季度的特殊項目在很大程度上相互抵消。

Moving to slide 8. This slide provides an overview of the 90 basis points group margin improvement. On the left you see, how we get from the reported third quarter 2023 operating income to the starting point of our outlook base by adjusting for special items and 2023 divestitures.

轉到投影片 8。這張投影片概述了 90 個基點的集團利潤率改善。在左側，您可以看到我們如何透過調整特殊項目和 2023 年資產剝離，從報告的 2023 年第三季營業收入得出我們的展望基礎的起點。

In the middle, the chart shows the quarterly contribution by segment, including inter-segment, eliminations and corporate. Both operating segments contributed positively. The impact on the progress we made in our Care Enablement transformation efforts stands out in particular.

中間的圖表顯示了各部門的季度貢獻，包括部門間、沖銷和公司。兩個營運部門都做出了積極貢獻。對我們在護理支援轉型工作中取得的進展的影響尤其突出。

Last quarter, we explained that we entered into virtual power purchase agreement for renewable energy, so-called vPPAs. This is an important step towards our goal of becoming carbon neutral in our operations by 2040.

上個季度，我們解釋說，我們簽訂了再生能源虛擬購電協議，即所謂的 vPPA。這是我們實現 2040 年營運碳中和目標的重要一步。

vPPAs do introduce a degree of volatility to the earnings development due to the required quarterly evaluation of the embedded derivatives that then flows through the P&L. While vPPAs had a small positive earnings impact in the second quarter of EUR6 million. In the third quarter, vPPAs had a negative impact of EUR24 million on our corporate line.

由於需要對隨後流經損益表的嵌入衍生品進行季度評估，vPPA 確實會為獲利發展帶來一定程度的波動性。vPPA 對第二季的獲利產生了 600 萬歐元的小額正面影響。第三季度，vPPA 對我們的公司產品線產生了 2,400 萬歐元的負面影響。

On the right, special items for the quarter included negative onetime costs associated with the FME25 program, which were partially offset by positive onetime effects from the Humacyte remeasurement and legacy portfolio optimization.

右側，本季的特殊項目包括與 FME25 計劃相關的一次性負成本，該成本被 Humacyte 重新測量和遺留投資組合優化的一次性積極影響部分抵消。

Turning to slide 9. In Care Delivery, the 2% revenue decline in the third quarter specifically reflected a negative 330 basis points impact from divestitures closed this year. Our underlying Care Delivery business contributed positive organic revenue growth in the third quarter. In the US, revenue increased by 1% on an outlook base, driven by growth in our value-based care business, an overall increase in underlying treatment volumes and improved reimbursement rates and payer mix.

轉到投影片 9。在護理服務領域，第三季收入下降 2%，反映了今年完成的資產剝離帶來的 330 個基點的負面影響。我們的基礎護理服務業務在第三季度貢獻了積極的有機收入成長。在美國，由於我們基於價值的護理業務的增長、基礎治療量的整體增加​​以及報銷率和付款人組合的改善，推動收入在展望基礎上增長了 1%。

This was partially offset by implicit price concessions. Thanks to a strengthened Care Delivery international portfolio, our international business contributed a very solid 4% organic growth supported by accelerated same-market treatment growth of 2.9% and higher reimbursement rates.

這被隱性價格優惠部分抵銷。由於國際醫療服務組合的加強，我們的國際業務在同市場治療加速增長 2.9% 和更高的報銷率的支持下，實現了 4% 的強勁有機增長。

Shifting now to operating income. In the third quarter, Care Delivery recorded an increase of 5% and a 70 basis points margin improvement, resulting in a margin of 11.2%. This is well within our 2025 target margin band.

現在轉向營業收入。第三季度，護理交付業務成長了 5%，利潤率提高了 70 個基點，利潤率為 11.2%。這完全在我們 2025 年的目標利潤範圍內。

Positive business growth development was driven by price and volume effects as well as the phasing of a consent agreement on certain pharmaceuticals. While the phasing varies within a year, on a full year basis, we expect this to be broadly neutral.

積極的業務成長發展是由價格和銷售效應以及某些藥品的分階段同意協議所推動的。雖然一年內的分階段有所不同，但就全年而言，我們預計這將大致保持中性。

Business growth development was partially offset by negative contributions from the value-based care business. While value-based care is a positive contributor in the first half, unfavorable financial developments within the CKCC program had an adverse impact on business growth of around EUR40 million in the quarter.

業務成長的發展被基於價值的護理業務的負面貢獻部分抵消。雖然基於價值的護理在上半年做出了積極貢獻，但 CKCC 計劃內不利的財務發展對本季度的業務增長產生了約 4000 萬歐元的不利影響。

As mentioned in the past, there is some earnings volatility of this business and nine months in, we now assume a negative contribution of value-based care to operating income of EUR20 million to EUR40 million for the year.

正如過去所提到的，該業務存在一些盈利波動，九個月後，我們現在假設基於價值的護理對當年營業收入的負面貢獻為 2000 萬歐元至 4000 萬歐元。

FME25 savings were a relatively smaller contributor for Care Delivery as the majority of the program's initiative is focused on global G&A functions and our Care Enablement segment. Finally, the labor headwind in the third quarter was driven by higher personnel expenses, which were in line with our expectations.

FME25 節省的費用對護理服務的貢獻相對較小，因為該計劃的大部分舉措都集中在全球 G&A 職能和我們的護理支援部門。最後，第三季的勞動力逆風是由人事費用增加所推動的，這符合我們的預期。

Next on slide 10. In the third quarter, Care Enablement realized 4% organic revenue growth. This was primarily driven by solid volume development across all geographical regions. Continued pricing momentum outside China added to this positive development.

接下來是投影片 10。第三季度，Care Enablement 實現了 4% 的有機收入成長。這主要是由所有地理區域銷售的強勁成長所推動的。中國境外持續的定價動能加劇了這一積極的發展。

As expected, the extended rollout of volume-based procurement in China negatively impacted the pricing development. This was in line with our expectations and is factored into our outlook for the full year.

正如預期的那樣，中國擴大批量採購對定價發展產生了負面影響。這符合我們的預期，並已納入我們對全年的展望中。

Turning to operating income now. Care Enablement achieved a significant increase, nearly quadrupling from the prior year quarter-three. Accelerated savings from FME25 were the biggest contributor of operating income growth. A solid contribution from business growth was driven by positive volume and pricing development.

現在轉向營業收入。護理支援實現了顯著成長，比去年第三季幾乎翻了兩番。FME25 的加速儲蓄是營業收入成長的最大貢獻者。銷售和價格的積極發展推動了業務成長的堅實貢獻。

This was partially offset by negative pricing effects related to volume-based procurement in China and impact from foreign currency transaction. Inflationary cost increases developed in line with our expectations.

這被與中國批量採購相關的負面定價效應以及外幣交易的影響部分抵消。通貨膨脹成本的增加符合我們的預期。

Care Enablement already achieved significant margin progress in the first half of the year, and it is positive to see the business maintaining its momentum through the third quarter, while absorbing the negative effects from volume-based procurement. The strong brokers today put us well on track to achieve our 2025 margin targets.

Care Enablement 在上半年已經實現了顯著的利潤率增長，並且看到該業務在第三季度保持增長勢頭，同時吸收基於數量的採購的負面影響是積極的。今天強大的經紀商讓我們順利實現 2025 年的利潤目標。

Moving to slide 11. In the third quarter, operating cash flow increased mainly due to the recovery of the cash impact following the cyber incident at Change Healthcare. With this strong quarter, we have partially caught up on the delayed collections in the first nine months.

轉到投影片 11。第三季度，營運現金流增加主要是由於Change Healthcare網路事件後現金影響的恢復。憑藉這個強勁的季度，我們在前九個月部分彌補了延遲收款的情況。

For the first nine months, the decrease in free cash flow was additionally affected by the phasing of dividend payments received from equity method investments as well as income tax payments for current and prior year periods, particularly in the US. Both our total debt and lease liabilities as well as total debt and lease liabilities and net debt and lease liabilities have further decreased compared to the prior year third quarter.

前九個月，自由現金流的減少也受到權益法投資分階段支付股利以及本年和上年期間所得稅支付的影響，特別是在美國。與去年第三季相比，我們的總債務和租賃負債以及總債務和租賃負債以及淨債務和租賃負債均進一步下降。

And as a result of our commitment to a disciplined financial policy and positive EBITDA development, our net leverage ratio improved to 2.8. This is a great achievement, and it is below our self-imposed target corridor of 3 to 3.5 times net debt to EBITDA.

由於我們致力於嚴格的財務政策和積極的 EBITDA 發展，我們的淨槓桿率提高至 2.8。這是一項偉大的成就，並且低於我們自行設定的 EBITDA 淨債務 3 至 3.5 倍的目標走廊。

Our priorities have not changed. In line with our current strategic ambitions through 2025, deleveraging remains our top capital allocation priority. As we continue to execute our portfolio optimization plan, we will use the proceeds to further reduce debt and strengthen our balance sheet. We want to ensure that our company is in good financial health as we start to prepare for our future strategy.

我們的優先事項沒有改變。根據我們目前到 2025 年的策略目標，去槓桿仍然是我們資本配置的首要任務。隨著我們繼續執行投資組合優化計劃，我們將利用所得款項進一步減少債務並加強我們的資產負債表。當我們開始為未來策略做準備時，我們希望確保公司財務狀況良好。

With that, I hand over to Helen.

說完，我把任務交給海倫。

Thank you, Martin. I'll pick it back up on slide 13 with an update on our outlook. Overall, and despite some headwinds like vPPAs and lower contributions from value-based care, we are well on track to deliver against our positive outlook for this year. We expect to realize further improvements in our operational performance and transformation efforts in the fourth quarter.

謝謝你，馬丁。我將在幻燈片 13 上回顧它，並更新我們的前景。總體而言，儘管存在 vPPA 等一些不利因素以及基於價值的護理貢獻較低，但我們仍有望實現今年的積極前景。我們預計第四季的營運績效和轉型工作將進一步改善。

Therefore, we confirm our revenue outlook for full year 2024 and heighten our expected operating income growth towards the upper end with 16% to 18%. When we compare our assumptions, which we initially shared back in February against the development after nine months, we are broadly in line with our expectations in phasing.

因此，我們確認 2024 年全年營收前景，並將營業收入成長預期上調至 16% 至 18%。當我們將我們最初在二月分享的假設與九個月後的發展進行比較時，我們基本上符合我們的分階段預期。

The biggest deviations from our initial assumptions were the successful acceleration of our FME25 savings program, which compensated for the more muted US volume growth, negative contribution from our value-based care business, as well as the impact from vPPAs.

與我們最初假設的最大偏差是我們的 FME25 儲蓄計劃的成功加速，該計劃彌補了美國銷售增長放緩、基於價值的護理業務的負面貢獻以及 vPPA 的影響。

Just a reminder that in last year's Q4, we entered into a favorable settlement agreement with the US government. The Tricare settlement positively impacted Q4 revenue by EUR191 million and Q4 operating income by EUR181 million and would not report as a special item. We excluded this effect from the 2024 outlook base.

只是提醒一下，去年第四季度，我們與美國政府達成了一項有利的和解協議。Tricare 和解協議對第四季度收入產生了 1.91 億歐元的積極影響，對第四季度營業收入產生了 1.81 億歐元的積極影響，並且不會作為特殊項目報告。我們將這種影響排除在 2024 年展望基礎之外。

We are also confirming our 2025 margin outlook of 10% to 14% group margin. The quarter once again demonstrated that we are on track with our turnaround and that we deliver on what we said. Both Care Delivery and Care Enablement are meaningfully progressing towards the 2025 target margin bands. Our transformation momentum continues positively.

我們也確認 2025 年集團利潤率展望為 10% 至 14%。本季再次證明我們正在扭虧為盈，並且我們兌現了我們的承諾。護理服務和護理支援都在朝著 2025 年目標利潤帶取得有意義的進展。我們的轉型勢頭持續積極。

For 2025, we are still unpacking the full impact of the new rules of binders moving into the bundle. We still have elevated mortality and a flu season ahead of us as well as some other moving parts like vPPAs, value-based care volatility and the volume increase from volume-based procurement in China just to name a few of the moving parts.

到 2025 年，我們仍在分析綁定程式新規則進入捆綁包的全部影響。我們仍然面臨著較高的死亡率和流感季節，以及其他一些變化因素，例如 vPPA、基於價值的護理波動以及中國基於數量的採購帶來的數量增加，僅舉幾個變化因素。

Therefore, we have decided that we do not tighten our 2025 target range today. As every year, in February, we will share the detailed outlook and the corresponding assumptions for 2025. Meanwhile, rest assured that my ambition for 2025 remain rock solid, deliver as promised.

因此，我們決定今天不收緊 2025 年目標範圍。與每年的 2 月一樣，我們將分享 2025 年的詳細展望和相應假設。同時，請放心，我對 2025 年的野心依然堅定，如期實現。

And finally, as we approach the end of 2024 and everyone starts arranging their calendars for next year, I do want to highlight that we plan to host our next Capital Markets Day on June 17 in London. We hope many of you will be able to attend. So please save the date and look out for future communications from Investor Relations in the coming weeks.

最後，隨著 2024 年即將結束，每個人都開始安排明年的日曆，我想強調的是，我們計劃在 6 月 17 日在倫敦舉辦下一次資本市場日。我們希望你們中的許多人能夠參加。因此，請保留日期並留意未來幾週投資者關係部門的後續通訊。

This concludes my prepared remarks. I'll now hand it back to Dominik to start the Q&A.

我準備好的發言到此結束。我現在將其交還給多米尼克以開始問答。

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 two. If we have remaining time, we can go another round.

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兩個以內。如果還有剩餘時間，我們可以再進行一輪。

With that, I hand it over to Sandra to open the Q&A please.

就這樣，我把它交給桑德拉來開始問答。

(Operator Instructions)

（操作員說明）

Richard Felton, Goldman Sachs.

理查費爾頓，高盛。

Thanks for taking my questions. My first one is on the medium-term margin guidance, please. So obviously, still quite a wide range heading into 2025. Should we assume that the decision not to narrow the range at this stage does indicate you still see a path to getting into the upper half of that 10% to 14%? That's question one.

感謝您回答我的問題。我的第一個問題是關於中期保證金指導。顯然，進入 2025 年，範圍仍然很大。我們是否應該假設，現階段不縮小範圍的決定確實表明您仍然看到進入 10% 至 14% 上半部的路徑？這是問題一。

And question two, also on the topic of margin and specifically on the Care Enablement business. This year is making very good progress improving profitability, but I suppose, still quite a big gap up to the lower end of the 2025 target. Could you remind us of some of the levers you've got to keep up the momentum on margin progression for that part of the business? Thank you.

問題二，也是關於利潤的主題，特別是關於護理支援業務。今年在提高獲利能力方面取得了非常好的進展，但我認為距離 2025 年目標的下限仍有相當大的差距。您能否提醒我們，您必須採取哪些措施來維持這部分業務的利潤成長動能？謝謝。

Thanks, Richard. I think I'll tackle both of those. On the medium-term margin, as you can appreciate and what I tried to provide color on, there's still a lot of moving parts. And as we've seen this year, every quarter informs us, I think, particularly on the volume and mortality.

謝謝，理查。我想我會解決這兩個問題。從中期來看，正如你所欣賞的以及我試圖提供的色彩，仍然有很多變化的部分。正如我們今年所看到的，我認為每個季度都會向我們提供信息，特別是在數量和死亡率方面。

We are currently in probably next deep into our budget discussions for next year already. So we feel with a few more data points, we'll be able to guide that accordingly and we will do so in February. Obviously, we recognize there are still wide ranges out there, but we want to be able to provide the right color in February with a few more data points.

我們目前可能正在深入討論明年的預算。因此，我們認為有了更多的數據點，我們將能夠相應地進行指導，我們將在二月這樣做。顯然，我們認識到仍然存在很大的範圍，但我們希望能夠透過更多數據點在二月提供正確的顏色。

On your second question on margin for CE, we're thrilled with the progress we are making there. And as you can see, meaningful development over the course of this year. We've always said that CE would be back-end loaded because of the size and scale of many of the FME25 programs particularly around manufacturing footprint and so on.

關於你關於 CE 利潤的第二個問題，我們對我們在這方面取得的進展感到非常興奮。正如您所看到的，今年取得了有意義的發展。我們總是說 CE 將是後端加載的，因為許多 FME25 項目的規模和規模，特別是在製造足跡等方面。

So again, we have a range out there as we get more color on that in February, we'll be able to advise that range accordingly. But again, you can expect that to be back-end loaded. And as we're still standing behind those margin targets, I think you can expect us to see continuous progress on that through 2025.

因此，我們有一個範圍，當我們在二月獲得更多資訊時，我們將能夠相應地建議該範圍。但同樣，您可以預期它會被後端加載。由於我們仍然支持這些利潤率目標，我認為您可以期望我們在 2025 年之前看到這方面的持續進展。

Victoria Lambert, Berenberg.

維多利亞·蘭伯特，貝倫貝格。

Thanks for taking my question and thanks for providing the like-for-like impact from the hurricanes in Q3. You said it was about 5 basis points. What is the expected impact from hurricanes in Q4 just given the timing of Hurricane Milton? And then just on the Care Enablement margins, what benefit can we expect in Q4 from FMC being able to step in and supply the PD machines and will this benefit next year as well? Thank you.

感謝您提出我的問題，並感謝您提供第三季颶風的類似影響。你說大約是5個基點。鑑於颶風米爾頓發生的時間，第四季颶風的預期影響是什麼？然後就護理支援利潤率而言，我們可以預期 FMC 在第四季度介入並供應 PD 機器會帶來什麼好處？謝謝。

Thanks, Victoria. I think I'll take those two. On the hurricane, we're still quantifying what the impact is on the hurricanes for Q4, but we could expect it to be similar, maybe slightly lower level. Obviously, we were impacted but back up and running pretty quickly, but we'll provide more color on that when we get to full year.

謝謝，維多利亞。我想我會帶那兩個。關於颶風，我們仍在量化第四季度颶風的影響，但我們預計其影響將是相似的，甚至可能略低。顯然，我們受到了影響，但恢復並運行得很快，但當我們進入全年時，我們將提供更多的資訊。

And then on the CE benefit, obviously, we are seeing increased demand from the CE product side for PD products where, obviously, I'm packing some of that in real time. I don't have anything I can speak to today in terms of sizing, but I think we'll take that into account when we do the business development growth numbers for 2025.

然後，在 CE 效益方面，顯然，我們看到 CE 產品方面對 PD 產品的需求不斷增加，顯然，我正在即時打包其中一些產品。今天我在規模方面沒有什麼可以說的，但我認為我們在計算 2025 年業務發展成長數據時會考慮到這一點。

And we'll be able to scale it accordingly once we have a little bit more dissolidified. But obviously, happy to help out and work through the increased demand from PD and on the CE projects business.

一旦我們變得更加分散，我們就能夠相應地擴展它。但顯然，我們很樂意協助解決 PD 和 CE 專案業務不斷增長的需求。

Robert Davies, Morgan Stanley.

羅伯特戴維斯，摩根士丹利。

Thanks for taking my question. My first one was just around the issue of, I guess, the growth progression, the same market treatment growth. And just if you could provide any color in terms of what you're seeing on the excess mortality side, it has obviously been a big discussion topic over the year.

感謝您提出我的問題。我的第一個問題是關於成長過程、相同的市場待遇成長的問題。如果你能就你所看到的超額死亡率方面提供任何顏色，這顯然是今年的一個大討論話題。

Just be curious of what your view of where we sort of stand on that and how that would impact the sort of outlook over the next sort of three to six months.

只是想知道您對我們的立場有何看法，以及這將如何影響未來三到六個月的前景。

The other one was just where we are in terms of clinic closures? Anything additional since the last quarter that you've identified for potential kind of closures that wasn't in the original plan or anything left to go? Thank you.

另一個問題是我們的診所關閉情況如何？自上個季度以來，您是否發現了原計劃中未包含的潛在關閉類型或尚未完成的任何其他內容？謝謝。

Thanks, Robert. On the same market treatment growth, obviously, we're still talking about small numbers here. We did see the underlying progression in the quarter. Obviously, though, as you can appreciate, September was hit by the hurricane impact. So small numbers on small numbers. On the excess mortality, we still see that elevated.

謝謝，羅伯特。顯然，在相同的市場治療成長情況下，我們在這裡談論的仍然是小數字。我們確實看到了本季的潛在進展。但顯然，如您所知，九月受到了颶風的影響。所以小數字上的小數字。就超額死亡率而言，我們仍然看到這種情況有所上升。

And I think that's the number that we are obviously closely watching in terms of our -- we're also saying that we expect the growth to return back to normal levels once the excess mortality numbers stabilize. So again, I think that's why we're watching this every month and every quarter to be able to provide color on our growth expectations for next year.

我認為這顯然是我們正在密切關注的數字——我們還表示，一旦超額死亡率穩定下來，我們預計成長將恢復到正常水平。再說一次，我認為這就是為什麼我們每個月和每個季度都會關注這一點，以便能夠為我們明年的成長預期提供色彩。

On your clinic closures, it's a little bit of a complex answer because where we have growth opportunities in certain parts of the country. We are investing in opening new centers. So I think net-net, we opened 11 centers this year, but that's only where we were at full capacity.

關於關閉診所，這是一個有點複雜的答案，因為我們在該國的某些地區有成長機會。我們正在投資開設新中心。所以我認為今年我們開設了 11 個中心，但這只是我們滿載運作的地方。

And where we have underutilized capacity or clinics that are not performing, we are looking on a case-by-case basis if there's more to close. I don't expect that to be a big, big program, but every quarter, we are looking at those clinics and teeing up handfuls of clinics to close where that makes sense. But I think we're being very selective in where we invest, but also where we close as well.

如果我們的產能未充分利用或診所表現不佳，我們會根據具體情況進行分析，看看是否還有更多診所需要關閉。我不認為這會是一個非常大的計劃，但每個季度，我們都會研究這些診所，並在有意義的地方關閉一些診所。但我認為我們對投資地點和關閉地點都非常有選擇性。

Thank you. Maybe just one quick follow-up. Just in terms of where you are in terms of those new clinic openings in terms of getting staffing and head count because obviously, labor inflation was a bigger issue maybe a year ago. Are you having any issues in terms of getting new dialysis nurses into the clinics in terms of cost or difficulty in finding them? Thank you.

謝謝。也許只是一個快速跟進。就新開設的診所在人員配備和人員數量方面的情況而言，因為顯然，勞動力通膨可能在一年前是一個更大的問題。在讓新的透析護理師進入診所方面，您是否在成本或尋找困難方面遇到任何問題？謝謝。

Yeah. Thank you. Taking your third question. In terms of open positions, we actually came down in the quarter from 3,500 to 3,300. The mix of nurses and PCTs has stayed pretty stable. So we're selling more nurse positions, which is great than PCTs.

是的。謝謝。回答你的第三個問題。就未平倉部位而言，本季我們實際上從 3,500 個下降到 3,300 個。護士和 PCT 的比例保持相當穩定。因此，我們正在出售更多的護士職位，這比 PCT 更好。

So I'd say labor is pretty stable. I mean clearly, we're still through some hotspots in terms of where we do have some constrained clinics and trying to do what we need to with staffing, but that number has come down significantly over the course of the year. So overall, managing labor quite well, I would say.

所以我想說勞動力相當穩定。我的意思是，顯然，我們仍然遇到一些熱門問題，例如我們的診所確實受到限制，並試圖在人員配置方面做我們需要做的事情，但這一數字在這一年中已顯著下降。總的來說，我想說，勞動力管理得很好。

Hugo Solvet, Exane BNP.

雨果·索爾維特，Exane BNP。

Thanks, Dominik. Hi, guys. Thanks for taking my questions. I have a couple. First, thank you, Helen, for the details on the volume progression during the quarter. Just a quick clarification. I think in previous calls, you mentioned that we potentially expect an exit rate in FY 2024 of about 2% to 3%. Do you still think that this could be possible?

謝謝，多米尼克。嗨，大家好。感謝您回答我的問題。我有一對。首先，謝謝海倫提供有關本季銷量進展的詳細資訊。只是快速澄清一下。我想在之前的電話會議中，您提到我們可能預計 2024 財年的退出率約為 2% 至 3%。您仍然認為這可能嗎？

And lastly, I'm sorry if I missed that, Martin, in your comments. Can you maybe quantify the impact of the consent agreement on pharmaceuticals in the quarter? That would be helpful. Thank you very much.

最後，馬丁，如果我在你的評論中錯過了這一點，我很抱歉。您能否量化同意協議對本季藥品的影響？那會有幫助的。非常感謝。

Thanks, Hugo. I'll take your first question and Martin can take your second. We stay confident in the underlying fundamentals of the industry that when we see the normalization of mortality and the normalization of the funnel that we do expect to return to that 2% to 3% pre-COVID growth rate.

謝謝，雨果。我回答你的第一個問題，馬丁回答你的第二個問題。我們對該行業的基本面保持信心，當我們看到死亡率和漏斗正常化時，我們確實預計將恢復到新冠疫情前 2% 至 3% 的成長率。

Obviously, as we see, we are across the industry still seeing elevated mortality. I think the timing of that is something that we are obviously watching. But there's nothing to say that once that normalizes, we don't return. We had always said that was an exit way for 2025. So more of a kind of a normalization rate for 2026.

顯然，正如我們所看到的，整個產業的死亡率仍然很高。我認為我們顯然正在關注這一時機。但沒有什麼好說的，一旦恢復正常，我們就不會再回來。我們一直說這是 2025 年的退出方式。所以更多的是 2026 年的標準化率。

And I think that's why, obviously, as I talk about guidance and tightening those ranges for '25, I'm really thinking through what do those volume trends continue to progress through the next few months and quarters here. But the improvement in mortality, obviously, is something that we are looking for as well as the normalization of the CKD funnel.

我認為這就是為什麼，顯然，當我談論 25 年的指導和收緊這些範圍時，我真的在思考這些數量趨勢在接下來的幾個月和幾個季度中將繼續取得進展。但顯然，死亡率的改善以及 CKD 漏斗的正常化是我們所尋求的。

Yeah. And Hugo, perhaps on the margin development for Care Delivery in quarter three, main drivers were positive price and volume effects. And then we saw the phasing of the consent agreement that you mentioned. This was this year in quarter three.

是的。雨果，也許在第三季護理服務的利潤率發展中，主要驅動因素是正面的價格和數量效應。然後我們看到了你提到的同意協議的階段性。這是今年第三季的情況。

Last year, we had that in quarter four. So that is from our perspective over the full year more or less neutral. And when you look in quarter three, you had then the consent agreement positivity. Also, as outlined in the presentation, partially offset by the volume-based care topic.

去年，我們在第四季就做到了這一點。因此，從我們對全年的角度來看，這或多或少是中性的。當你看第三季時，你會發現同意協議是正面的。此外，正如簡報中概述的那樣，部分被基於容量的護理主題所抵消。

Oliver Metzger, ODDO BHF Bank.

Oliver Metzger，ODDO BHF 銀行。

Thank you. Good afternoon. First question is on your updated EBIT guidance. So I like the narrowing, but it is still a big range given there's just one quarter to go. So how do you think about it? Is it more the mid -- you look for the midpoint and you've added 1 percentage points to each site as a safety margin? Or have you worked on the updated guidance with different scenarios for the lower and upper end?

謝謝。午安.第一個問題是關於更新後的息稅前利潤指南。所以我喜歡這種收窄，但考慮到只剩下四分之一的時間，它仍然是一個很大的範圍。那麼您對此有何看法？是不是更接近中間點——您尋找中間點，並且為每個網站添加了 1 個百分點作為安全裕度？或者您已經針對低端和高端的不同場景制定了更新的指南？

The second question is on FME25. It's good to see that your saving progress is ahead of expectations. So is it on the one hand a kind of pull-forward effect? Or do you see some additional savings which might be -- and Martin, I remember you commented in the past that you won't expand FME25, but do you still see some additional saving potential, which might come on top for 2025. Thank you.

第二個問題是關於FME25的。很高興看到您的儲蓄進度超出了預期。那麼，它一方面是一種前拉效應嗎？或者您是否看到了一些額外的節省，馬丁，我記得您過去評論過，您不會擴展 FME25，但您是否仍然看到一些額外的節省潛力，這可能會在 2025 年達到頂峰。謝謝。

Thanks, Oliver. Yeah, let me take those questions. On EBIT guidance, it is clearly, as we do every quarter, bottoms up build of what we see through the year-to-date and what we expect for, as you say, just a couple of months left in this quarter. It is not just taking the midpoint. We do have sensitivities of one thing going one way, positive or negative.

謝謝，奧利佛。是的，讓我來回答這些問題。在息稅前利潤指引方面，正如我們每季所做的那樣，顯然是我們從今年至今看到的情況以及我們對本季僅剩幾個月的預期的預期。它不僅僅是取中點。我們確實對一件事朝某一方向發展很敏感，無論是正面的還是負面的。

So overall, clearly, that's why we have a range, and we're watching things that could go as headwinds or tailwinds. So we've narrowed it. We feel confident in what we need to deliver, but obviously, that 1% either way, it's not just a let's take the piece in the middle.

總的來說，顯然，這就是我們有一個範圍的原因，我們正在觀察可能成為逆風或順風的事情。所以我們縮小了範圍。我們對我們需要交付的東西充滿信心，但顯然，無論哪種方式，這 1% 都不僅僅是讓我們把中間的部分拿走。

On FME25, I'm thrilled with the progress we're making here. And clearly, the acceleration and the momentum is good to see. We're not thinking of that, as you rightly said, of expanding the FME25 program. We're still committed to delivering that EUR650 million. Some of these are initiatives that are delivering earlier than we had first thought. So that's great.

在 FME25 上，我對我們在這裡取得的進展感到非常興奮。顯然，加速度和勢頭是值得一看的。正如您所說，我們並沒有考慮擴大 FME25 計劃。我們仍然致力於提供 6.5 億歐元。其中一些措施的實施時間比我們最初想像的要早。那太好了。

As I've shared with many of you while we've been on the road, increasingly as we think about the culture shift and strategically how we run the business, we are thinking more about -- not a new concept, but the concept of continuous improvement where we are looking to drive efficiencies to offset the inflationary headwinds that we see.

正如我在路上與你們許多人分享的那樣，當我們越來越多地思考文化轉變以及策略性地經營業務時，我們更多地考慮的是——不是一個新概念，而是一個概念持續改進，我們希望提高效率，以抵消我們所看到的通膨阻力。

So outside of FME25, clearly, we're still working on the turnaround and driving efficiency improvements. And I think that shouldn't need big programs like we've gone through the past few years in the future, but just more this mindset of trying to drive that continuous improvement. And obviously, when we give the guidance for 2025, we can provide more color to that in February.

因此，顯然，在 FME25 之外，我們仍在致力於扭虧為盈並推動效率提高。我認為未來不需要像我們過去幾年所經歷的那樣的大型計劃，而只是更多地嘗試推動持續改進的心態。顯然，當我們給出 2025 年的指導時，我們可以為 2 月的指導提供更多色彩。

Okay. Thank you. Very, very quick follow-up on this. So do you see from now a higher saving potential by 2025 compared to the FME25 saving aspiration?

好的。謝謝。對此的後續行動非常非常快。那麼，與 FME25 的儲蓄願望相比，您是否認為到 2025 年會有更高的儲蓄潛力？

No. We're still saying we save EUR650 million for FME25 through 2025.

不。我們仍然表示，到 2025 年，我們將為 FME25 節省 6.5 億歐元。

Sezgi Ozener, HSBC.

塞吉‧奧澤納 (Sezgi Ozener)，匯豐銀行。

Hi. Thanks for taking my questions. I will also have two, please. One very -- [if you want maybe], but the other income that you have in this quarter seems quite strong with underlying factors from that? And the second one is on this consent agreement on the pharma side that you've mentioned. What's the outlook going forward? What are some of the deciding factors behind it? And what's the impact you're estimating, if any beyond '24?

你好。感謝您回答我的問題。我也想要兩個，拜託。一個非常 - [如果你願意的話]，但是你在本季度擁有的其他收入似乎相當強勁，有潛在的因素嗎？第二個是關於您提到的製藥方的同意協議。未來的前景如何？背後的決定因素有哪些？您估計的影響是什麼（如果在 24 年後有影響的話）？

So thank you, Sezgi. Let me start with the other operating income one. So there is a couple of effects that we see in the year-over-year improvement here. On the one hand side, you have the special items like Humacyte remeasurement and the legacy portfolio optimization positively impacting this.

謝謝你，塞吉。讓我從另一個營業收入開始。因此，我們在同比改善中看到了一些影響。一方面，Humacyte 重新測量和遺留投資組合優化等特殊項目對此產生了積極影響。

And then you have FX exchange topics in here as well and also the consent agreement on the pharmaceuticals that we mentioned in the CD business is showing up in that line as well. So that should give you a bit of a flavor of the underlying driving factor.

然後這裡還有外匯交易主題，我們在 CD 業務中提到的藥品同意協議也出現在該行中。因此，這應該能讓您對潛在的驅動因素有所了解。

And then on the consent agreement itself, this is a topic that we normally have throughout the year. As I mentioned before, it is a phasing topic, which is why it shows up in quarter three this time. Last year, it was in quarter four. And on a full fiscal year basis, we see this broadly neutral and it is not an underlying driver of our improvement. I hope this helps and answers.

然後關於同意協議本身，這是我們全年通常討論的話題。正如我之前提到的，這是一個分階段的主題，這就是為什麼它這次出現在第三季。去年是第四季。在整個財政年度的基礎上，我們認為這大致是中性的，而且它不是我們改進的根本驅動力。我希望這能有所幫助和解答。

Giang Nguyen, Citi.

江阮，花旗銀行。

Hi guys, thanks for taking my questions. My first question is back on the US volume growth. Could you quantify the headwind from elevated mortality in the quarter, please? And also, given your progress on new patients, does it make you more confident now?

大家好，感謝您回答我的問題。我的第一個問題是關於美國的銷售成長。您能否量化本季死亡率上升帶來的不利影響？而且，考慮到您在新患者身上取得的進展，現在是否讓您更有信心了？

Just looking at the trends from here, do you expect this progression to continue in the next quarter so Q4 and Q1 next year? And then on top of that, how are you feeling about your relative momentum versus peers this quarter?

僅從這裡的趨勢來看，您是否預計這種進展會在下個季度（即明年第四季和第一季）繼續下去？最重要的是，您對本季與同業相比的相對勢頭有何看法？

Thanks, Giang. I think I may have you repeat the third part of that question. But let me start by talking about the US volume growth and the elevated mortality. We had called out in half one that we had seen about 60 basis points of increased mortality impact from flu and COVID, and we're still seeing the overall mortality number higher than what we had seen pre-COVID.

謝謝，江。我想我可以讓你重複這個問題的第三部分。但首先讓我談談美國的銷售成長和死亡率上升。我們在上半部指出，流感和新冠肺炎對死亡率的影響增加了約 60 個基點，我們仍然看到總體死亡率高於新冠疫情之前的水平。

So for the quarter and the rest of the year, we're assuming similar levels. Obviously, what that looks like for 2025, we still need to shape that once we see the numbers coming in for Q4 when we give guidance in February. And obviously, when we get to February, we will quantify it accordingly.

因此，對於本季和今年剩餘時間，我們假設水平相似。顯然，對於 2025 年的情況，我們仍然需要在 2 月給出指導時看到第四季度的數據後進行調整。顯然，當我們到二月時，我們將相應地對其進行量化。

I think the other piece, and I mentioned this in my talk outline was the flu season and seeing if we get some insight into how that flu season for 2025 is translating. Obviously, it was a later flu season this year.

我認為另一篇文章（我在演講大綱中提到）是流感季節，看看我們是否能深入了解 2025 年流感季節的變化。顯然，今年的流感季節較晚。

In terms of new patients, our improvement, I'd say, is while we're excited to see the positive volume, there is a piece there that is new patient -- net new patient inflow, and obviously, a piece that's due to the work that we are doing on improving a lot of our processes. So overall, treatment volumes coming up.

就新患者而言，我想說，我們的改進是，雖然我們很高興看到積極的數量，但有一部分是新患者——淨新患者流入，顯然，這一部分是由於我們正在做的許多流程的工作。整體而言，治療量不斷增加。

And I think the last part of your question was about momentum compared to the competition. I think we're all talking about improvements in small numbers. And I think we see we're all seeing the market quite similar.

我認為你問題的最後一部分是關於與競爭對手相比的動力。我認為我們都在談論少量的改進。我認為我們所看到的市場非常相似。

But obviously, pleased with our operational performance and progression this quarter, particularly. And I think that just shows that the work that we are doing and what we are doing in rebuilding and turning around our Care Delivery US business is paying off. And I think it's a great inflection point for us.

但顯然，我們對本季的營運績效和進展尤其感到滿意。我認為這只是表明我們正在做的工作以及我們在重建和扭轉我們的美國護理服務業務方面所做的工作正在得到回報。我認為這對我們來說是一個很好的轉捩點。

Thank you. And I just have a quick follow-up question remain. This is to do with a different topic, which is the PD business in the US. Can this opportunity or this hurricane situation change in any way your structural thinking around this PD business? And when you said you would be able to help other providers, is it based on some new long-term contract? Or is it on a more adhoc basis? Thank you.

謝謝。我還有一個快速的後續問題。這就牽涉到另一個話題了，那就是美國的PD業務。這個機會或颶風情勢能否以任何方式改變您圍繞 PD 業務的結構性思維？當您說您將能夠幫助其他提供者時，這是基於一些新的長期合約嗎？還是更臨時的基礎？謝謝。

Obviously, we have been quite vocal over the last couple of years that our PD business in US is a loss-making business, and we are doing a lot of work on that to turn that profitability around. And some of that is part of the CEFME25 program. Obviously, for PD, we supply ourselves, and we already have contracts where other dialysis providers.

顯然，過去幾年我們一直直言不諱地表示，我們在美國的 PD 業務是一項虧損業務，我們正在為此做大量工作來扭轉獲利能力。其中一些是 CEFME25 計劃的一部分。顯然，對於腹膜透析，我們自己供應，並且我們已經與其他透析提供者簽訂了合約。

So I think to the extent that we have more patients that we can serve on PD that benefits our Care Delivery business as well as our Care Enablement business, and to the extent that we are entering into extended contracts on new contracts with other providers. Obviously, that benefits the Care Enablement products business.

因此，我認為，我們可以為更多患者提供 PD 服務，這有利於我們的護理交付業務以及護理支援業務，並且我們正在與其他提供者簽訂新合約的延期合約。顯然，這有利於護理支持產品業務。

So that work is continuing, and we are -- as I mentioned, we will give color on that and how we see the volume progression for Care Enablement when we give the outlook for 2025.

因此，這項工作仍在繼續，正如我所提到的，我們將在給出 2025 年展望時對此進行說明，以及我們如何看待護理支持的數量進展。

David Adlington, JPMorgan

大衛阿德靈頓，摩根大通

Thanks, everybody. So maybe just it would be great to get your thoughts on the inclusion of the oral drugs in the bundle next year, and how much of a tailwind that might bring you, but also your thoughts in terms of whether it actually gets them active? And maybe just any update you got in terms of the timing of the pharma companies' appeal against that? Thank you.

謝謝大家。因此，也許如果能了解您對明年將口服藥物納入捆綁銷售的想法，以及這可能給您帶來多大的推動力，以及您對它是否真正讓它們活躍的想法，那就太好了？也許您只是得到了有關製藥公司對此提出上訴的時間方面的任何更新？謝謝。

Hi, David. Happy to take that question. Obviously, we're still unpacking the language in the ruling. It's still not final, but that came out on Friday, which obviously starts to give color into what that reimbursement for it will be.

嗨，大衛。很高興回答這個問題。顯然，我們仍在解讀裁決中的措詞。它仍然不是最終版本，但在周五發布，這顯然開始為報銷的內容帶來色彩。

We're thinking -- I think -- we're not just -- the orals in the bundle obviously don't just impact our FKC clinic business. It also impacts pharma and pharmacy business. So we're unpacking that in real time. Right now, we're thinking that it's neutral to positive. We'll frame that again when we get to guidance, and we get a final rule in February. But yes, a lot to work through there.

我們在想——我想——我們不僅僅是——捆綁中的口服產品顯然不僅僅影響我們的 FKC 診所業務。它也影響製藥和製藥業務。所以我們正在實時解壓縮它。目前，我們認為這是中性到積極的。當我們得到指導時，我們將再次製定這個框架，並在二月得到最終規則。但是，是的，還有很多工作要做。

In terms of your question on what pharma companies are doing and what maybe our industry is doing, I think there's still a fair amount of discussion in DC, regardless of whether it goes into the bundle or stays out of the bundle, I think where we have to be prepared regardless for either option, come January 1 because if something does change, one way or the other, we're unlikely to know probably the lame-duck season in February -- sorry, December. Maybe I'm thinking that we will have an election announcement by February.

關於您關於製藥公司正在做什麼以及我們的行業可能正在做什麼的問題，我認為華盛頓仍然存在相當多的討論，無論它是否進入捆綁包或不包含在捆綁包中，我認為我們在哪裡無論哪種選擇，都必須做好準備，1 月1 日到來，因為如果事情確實發生變化，不管怎樣，我們不太可能知道2 月的跛腳鴨季節——對不起，12 月。也許我在想我們將在二月公佈選舉公告。

So yeah, I think, look, the rule it's still in draft form, and we'll figure out what that means for us as well as the absolute timing on the ruling.

所以，是的，我認為，看，該規則仍處於草案形式，我們將弄清楚這對我們意味著什麼以及裁決的絕對時間。

Perfect. And then maybe just a quick follow-up. You obviously wanted to start this year expecting to narrow the guidance for next year, the 10% to 14% guidance as it went for the year, and you've now pushed that back out to February. Do you think your visibility has reduced as the year is going on? Or has it maintained economies or steady trajectory? And if most of that visibility is just down to the lack of volume growth?

完美的。然後也許只是快速跟進。顯然，您希望從今年開始就縮小明年的指導範圍，將今年的指導範圍縮小到 10% 至 14%，而您現在已將其推遲到 2 月。您認為隨著時間的推移，您的知名度是否有所下降？或者它是否保持了經濟或穩定的軌跡？如果大部分可見度只是因為銷售成長不足而導致的呢？

Great question. I think we've got pretty detailed bridges of how we saw the moving parts of the margin band, both for Care Delivery and Care Enablement. I would say, the transparency that we now have a new operating model is terrific and actually gives us more insight into the moving parts, but I think we can we have a better degree of forecasting them than we ever have. But as you can appreciate, there's many, many moving parts, volume being one of them.

很好的問題。我認為我們已經有了非常詳細的橋樑來了解我們如何看待護理交付和護理支援的邊緣帶的移動部分。我想說，我們現在擁有的新營運模式的透明度非常好，實際上讓我們對移動部件有更多的了解，但我認為我們可以比以往更好地預測它們。但正如你所意識到的，有很多很多移動部件，體積就是其中之一。

So as I mentioned in the I wasn't trying to just throw the laundry list out there of all the things we're balancing. But there truly is a laundry list of all the things that we're balancing, whether it be volume growth, value-based care, volume-based procurement, binders in the bundle, reimbursement, all of these things, plus positives and negatives, we are weighing up in real time.

正如我在 中提到的，我並不是想把我們正在平衡的所有事情的清單都列出來。但確實有一份我們正在平衡的所有事情的清單，無論是數量增長、基於價值的護理、基於數量的採購、捆綁中的粘合劑、報銷，所有這些事情，以及積極和消極的因素，我們正在實時權衡。

And I think it can easily be the difference between the one end or the middle of a range. So we just don't want to tighten something or give something prematurely as there's still many, many moving parts.

我認為這很可能是一個範圍的一端或中間之間的差異。因此，我們只是不想收緊某些東西或過早給予某些東西，因為仍然有很多很多活動部件。

And as you said at the beginning of the year, I'd love to have been in a situation where they are many moving parts to watch, but clearly, the volume piece of this and our own turnaround and transformation efforts weigh into all of that.

正如您在今年年初所說，我很樂意處於這樣一種情況，其中有許多值得關注的活動部分，但顯然，這一部分以及我們自己的周轉和轉型努力對所有這些都產生了影響。

So I appreciate you all bearing with me. I'd rather as you all know, I'd rather be giving something that is definitive where we have as much data in real time, considering all the different moving pieces that we're dealing with.

所以我很感謝你們對我的包容。正如你們都知道的那樣，我寧願提供一些明確的東西，我們擁有盡可能多的即時數據，考慮到我們正在處理的所有不同的移動部分。

Marianne, Bank of America.

瑪麗安，美國銀行。

Thank you for taking my question and good afternoon. I just have one quick one. On your leverage ratio now that you have reached below your target range. Just wondering if you had any idea on how you think about capital allocation going forward? Anything special that has come up in your discussions?

感謝您提出我的問題，下午好。我只有一份快的。現在您的槓桿率已低於目標範圍。只是想知道您是否對未來的資本配置有什麼想法？你們的討論中有什麼特別的事情嗎？

Yes. Martin, do want to take that?

是的。馬丁，你想接受嗎？

Happy to take that. So first of all, we are very Yes. Happy to take that. So first of all, we are very happy that we reduced our leverage ratio by 0.4 points and [0.3] comes from debt reduction, [0.1] comes from EBITDA improvement. And we will continue to deploy our capital to further reduce debt in line with our priorities that we set. And as I outlined in the prepared remarks, we are strengthening our balance sheet on purpose. And until 2025, that's our core focus.

很高興接受。所以首先，我們非常肯定。很高興接受。首先，我們很高興我們的槓桿率降低了0.4個點，[0.3]來自債務削減，[0.1]來自EBITDA改善。我們將繼續根據我們設定的優先事項部署資金，進一步減少債務。正如我在準備好的演講中所概述的那樣，我們正在有目的地加強我們的資產負債表。直到 2025 年，這都是我們的核心重點。

Yeah, And Marianne, maybe I would just add to Martin's comments. We clearly want to align our new capital allocation priorities to our new strategy. I don't want to be changing that around or kind of anybody speculating on what that means until we have done kind of a clear articulation of our strategy in post 2025, and the capital allocation will be aligned with that, and that's what we'll get to share when we do the Capital Markets Day on June 17. My plug for Dominik there.

是的，瑪麗安，也許我會補充馬丁的評論。我們顯然希望將新的資本配置優先事項與我們的新策略保持一致。我不想改變這一點，也不想讓任何人猜測這意味著什麼，直到我們明確闡述 2025 年後的策略，並且資本配置將與之保持一致，這就是我們的目標。市集日活動時分享。我的多米尼克插頭就在那裡。

Falko Friedrichs, Deutsche Bank.

法爾科·弗里德里希，德意志銀行。

Thank you. I have two questions, please. Firstly, outside of COVID and the flu, are there any other reasons that explain the sticky excess mortality that just doesn't really want to come down? And then secondly, and I'm sorry if I missed that point. Is it fair to assume that the same-store treatment growth should improve further in the fourth quarter over the third quarter? And are trends in October, have they been supportive of that? Thank you.

謝謝。我有兩個問題，請問。首先，除了新冠病毒和流感之外，還有其他原因可以解釋為何死亡率過高卻不願意下降嗎？其次，如果我錯過了這一點，我很抱歉。假設第四季同店家待遇成長應比第三季進一步改善是否公平？十月份的趨勢是否支持此趨勢？謝謝。

Yeah. Thanks, Falko. Look, on the mortality, I don't think there's anything further to kind of that we can explain on that outside the it remains elevated in the current patient population and the flu and COVID numbers.

是的。謝謝，法爾科。聽著，就死亡率而言，我認為除了目前患者人數以及流感和新冠病毒的死亡率仍然很高之外，我們沒有什麼可以解釋的。

But obviously, the other piece of this, and we've continued to say, we don't we truly don't believe it's the impact from new drugs because those numbers are pretty small and the fallout rate is high, but its normalization of the CKD funnel, which obviously impacts the inflow of patients. So I think that's something, obviously, that we are continuing to work through and watch.

但顯然，另一方面，我們繼續說，我們真的不相信這是新藥的影響，因為這些數字非常小，而且影響率很高，但它的正常化CKD漏斗，明顯影響患者流入。所以我認為這顯然是我們正在繼續努力解決和觀察的事情。

On the Q4 trend for same market treatment growth, as I mentioned, in Q3, every month, we saw a small sequential improvement. Obviously, it's dampened by the hurricane number. And as you can imagine, when you got 20 basis points of growth and 5 basis points is hurricane, you can see the impact that, that has on any given month.

關於相同市場治療成長的第四季度趨勢，正如我所提到的，在第三季度，每個月我們都看到了小幅環比改善。顯然，它受到颶風數量的影響。正如您可以想像的那樣，當您獲得 20 個基點的增長並且 5 個基點是颶風時，您可以看到這對任何特定月份的影響。

But we are expecting that underlying positive trend to continue through Q4 and consistent with the range we've given of [0 to 0.5] of volume for the full year. So we're kind of encouraged by the underlying question there, recognizing they're still small numbers.

但我們預計潛在的正面趨勢將持續到第四季度，並與我們給出的全年成交量範圍 [0 到 0.5] 一致。因此，我們對那裡的根本問題感到鼓舞，並認識到他們仍然是很小的數字。

Sezgi Ozener, HSBC.

塞吉‧奧澤納 (Sezgi Ozener)，匯豐銀行。

Oh, sorry. Thanks for the question as well. I just wanted to ask about why you have decided not to adjust your '24 base for the divestments going forward? Is it because they're coming towards an end? Or is there a different reason that makes it different from '23 position?

哦，抱歉。也謝謝你的提問。我只是想問一下，為什麼你們決定不調整 24 年的基礎以進行未來的撤資？是因為他們快要結束了嗎？或者是否有其他原因使其與'23位置不同？

Yes, I'll take that, Sezgi. So when we outlined our portfolio optimization plan, we were very specific about the scope of those. And hence, since we shared that transparency, we also said we will build the effects of the ones as we plan them into our guidance and absorb them. And therefore, every quarter, when we are calling out the effect from divestiture with the 330 basis points you saw this time for the Care Delivery, this is how we are progressing.

是的，我會接受的，Sezgi。因此，當我們概述我們的投資組合優化計劃時，我們非常具體地說明了這些計劃的範圍。因此，由於我們分享了這種透明度，我們還表示，我們將在將這些影響納入我們的指導方針並吸收它們時將其納入計劃。因此，每個季度，當我們以您這次看到的護理服務 330 個基點來指出剝離的影響時，這就是我們取得進展的方式。

And we are pushing to also complete that list and are executing well and are well on track to do so. And for 2025, we have not adjusted we have not decided yet how we're going to adjust that. It also depends on the timing of the final execution of the closing from a couple of transactions.

我們正在努力完成該清單，並且執行良好，並且正在順利實現這一目標。對於 2025 年，我們還沒有調整，我們還沒有決定如何調整。它還取決於幾筆交易最終執行平倉的時間。

Christian Ehmann, Warburg Research.

克里斯蒂安‧埃曼，華寶研究公司。

Thank you for taking my question. I have just one. Considering that we are now at plus 3% same market treatment growth, and you stated before that you expect those to return to 2% to 3% over the next years. What kind of factors play into this assumption?? Thank you very much.

感謝您回答我的問題。我只有一個。考慮到我們現在的市場治療成長率為 3%，而且您之前曾表示預計未來幾年將恢復到 2% 至 3%。這個假設會受哪些因素影響？非常感謝。

Yeah. Hi, Christian, obviously, we're moving from what is currently in this quarter, 0.2% to still our underlying expectation that this though the market does resume to pre-COVID levels. Obviously, the elevated mortality plays into that as well as the normalization of the CKD funnel. We obviously we recognize we have transplant numbers that are very consistent year-over-year that and the drug impact that we don't feel is having an impact either.

是的。你好，克里斯蒂安，顯然，我們正在從本季度目前的 0.2% 調整為我們的基本預期，儘管市場確實恢復到了新冠疫情前的水平。顯然，死亡率的增加以及 CKD 漏斗的正常化都與此有關。顯然，我們認識到我們的移植數量與去年同期非常一致，我們認為藥物的影響也沒有產生影響。

So truthfully, it's the kind of reduction in mortality as well as the inflow of patients from the sorry, the inflow of patients from the CKD funnel.

所以說實話，這是一種死亡率的降低，以及來自遺憾的患者的流入，來自 CKD 漏斗的患者的流入。

In terms of the international growth, we're very we're thrilled with what we're seeing there. I mean, obviously, that was a significant cleanup of the portfolio where we had exited a lot of countries over the past two years here. So there, we're seeing 2.9% same market treatment growth.

就國際成長而言，我們對在那裡看到的情況感到非常興奮。我的意思是，顯然，這是對過去兩年我們退出許多國家的投資組合的重大清理。因此，我們看到市場治療成長率為 2.9%。

We do see in Europe and other parts of the world that the mortality has come back down to pre-COVID levels. That's also what gives us the confidence that the US mortality should come back down. It's clearly just taking longer.

我們確實看到歐洲和世界其他地區的死亡率已回落至新冠疫情前的水平。這也讓我們有信心美國的死亡率應該會回落。顯然只是需要更長的時間。

But I think on the international side, it's a much more focused effort on countries that we see significant improvement in growth and operational performance, but the volume is looking really good there and thrilled with the performance of the CDI or the Care Delivery International team. So thank you.

但我認為在國際方面，這是一項更集中的工作，我們看到成長和營運績效顯著改善的國家，但那裡的數量看起來非常好，並且對CDI 或國際護理服務團隊的表現感到興奮。所以謝謝你。

Thank you. So we do not have any further questions, have three minutes left. So we'll not fill those. You're lucky. Thank you for joining and your interest and the many questions, highly appreciated, and we'll hope to see you or some of the listeners on the road in the next couple of weeks. Thank you. Take care.

謝謝。所以我們沒有任何進一步的問題，還剩三分鐘。所以我們不會填寫這些。你很幸運。感謝您的加入、您的興趣以及提出的許多問題，非常感謝，我們希望在接下來的幾週內見到您或一些聽眾。謝謝。小心。

Thanks, everybody. Have a good day.

謝謝大家。祝你有美好的一天。

Ladies and gentlemen, the conference is now over. Thank you for choosing Chorus Call, and 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 Chorus Call，也感謝您參加本次會議。現在您可以斷開線路。再見。