Fresenius Medical Care AG (FMS) 2025 Q3 法說會逐字稿

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(Operator Instructions)

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At this time, it's my pleasure to hand over to Dr. Dominik Heger. Please go ahead, sir.

此時，我很高興將麥克風交給多明尼克·赫格爾博士。請繼續，先生。

Thank you, Sandra. Welcome, everyone, to our earnings call for the third quarter 2025. As always, I 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. For further details concerning risks and uncertainties, please refer to these documents and to our SEC filings. We will have roughly 1 hour for the call.

謝謝你，桑德拉。歡迎各位參加我們2025年第三季財報電話會議。像往常一樣，我首先要提到我們在「安全港」聲明、簡報以及今天早些時候分發的所有資料中所使用的警示性語言。有關風險和不確定性的更多詳情，請參閱這些文件以及我們向美國證券交易委員會提交的文件。我們將有大約1個小時的通話時間。

In order to give everyone the chance to ask questions, we would limit the number of questions to two. Thank you for making this work. As always, let me now welcome Helen Giza, CEO and Chair of the Management Board; and Martin Fischer, our Chief Financial Officer.

為了讓每個人都有機會提問，我們將問題數量限制為兩個。感謝你促成此事。和往常一樣，現在讓我歡迎首席執行官兼管理委員會主席海倫·吉扎；以及首席財務官馬丁·費舍爾。

Helen, the floor is yours.

海倫，請你發言。

Thank you, Dominik. I'd also like to extend a warm welcome to everyone on the call. Thank you for taking the time to join us today and your continued interest in Fresenius Medical Care. As many of you know, the US is in government shutdown since the October 1, and many health care policy decisions are open, like the questions of extended tax subsidies for the exchanges and whether they will expire by the end of this year or the publication of final 2026 ESRD PPS rule. This requires us to remain flexible in planning and agile in running our business.

謝謝你，多米尼克。我也要向所有參加電話會議的人表示熱烈歡迎。感謝您今天抽出時間參加我們的活動，也感謝您一直以來對費森尤斯醫療的關注。正如你們許多人所知，自 10 月 1 日以來，美國政府一直處於停擺狀態，許多醫療保健政策決定懸而未決，例如延長交易所稅收補貼的問題以及這些補貼是否會在今年年底到期，或者 2026 年 ESRD PPS 最終規則的發布。這就要求我們在規劃上保持靈活，在業務運作上保持敏捷。

We remain focused on what we can influence. In Q3, we made meaningful progress in advancing our FME Reignite strategy and positioning ourselves for sustained value creation. Our strong third quarter results reflect continued momentum and disciplined execution as we further accelerated top line growth while delivering a clear step-up in earnings growth and profitability. The step-up is in line with our full year planning.

我們始終專注於我們能夠影響的事情。第三季度，我們在推進 FME Reignite 策略和為持續創造價值做好準備方面取得了實質進展。我們強勁的第三季業績反映了持續的成長動能和嚴謹的執行力，我們在進一步加快營收成長的同時，也實現了獲利成長和獲利能力的顯著提升。此次升級符合我們全年的規劃。

I will begin my prepared remarks on slide 4. In the third quarter, we realized strong organic revenue growth of 10%, with positive contributions from all three operating segments. In the US, same market treatment growth was slightly positive. This is in line with our assumption of flat to slightly positive growth for 2025. Operating income growth increased for a third consecutive quarter and accelerated to 28%.

我的發言將從第4張投影片開始。第三季度，我們實現了10%的強勁內生性收入成長，所有三個營運部門都做出了積極貢獻。在美國，同行業治療市場成長略為正。這與我們先前對 2025 年經濟持平或略有成長的預期相符。營業收入連續第三個季度成長，成長速度加快至 28%。

As a result, this drove a step change in profitability with our operating income margin expanding from 9.9% to 11.7%. The improvement in profitability was supported by continued momentum in our FME25+ program, which generated a further EUR47 million in sustainable savings in the quarter. This brings us already to EUR174 million of savings for 2025. As part of our new FME Reignite strategy and capital allocation framework, we announced an initial share buyback of EUR1 billion, in line with our commitment to reignite value creation for shareholders.

因此，這推動了獲利能力的飛躍式成長，我們的營業利潤率從 9.9% 擴大到 11.7%。獲利能力的提升得益於 FME25+ 計畫的持續推​​進，該計畫在本季又創造了 4,700 萬歐元的可持續節約。這樣一來，到 2025 年，我們已經可以節省 1.74 億歐元。作為我們新的 FME Reignite 策略和資本配置框架的一部分，我們宣布了首輪 10 億歐元的股票回購計劃，以履行我們為股東重新創造價值的承諾。

The share buyback program officially commenced in August with a first tranche of up to EUR600 million. Through September 30, 3.6 million shares had been repurchased for a total investment amount of EUR151 million, and until October 31, we have repurchased in total 4.35 million shares for a total investment of EUR188 million. For full year 2025, we are very well on track to achieve our outlook for the year and therefore reiterate our guidance.

股票回購計畫於 8 月正式啟動，首批金額高達 6 億歐元。截至 9 月 30 日，本公司已回購 360 萬股，總投資額為 1.51 億歐元；截至 10 月 31 日，本公司已累計回購 435 萬股，總投資額為 1.88 億歐元。對於 2025 年全年，我們非常有希望實現年度展望，因此重申我們的業績指引。

Next, on slide 5. The American Society of Nephrology's Kidney Week takes place in Houston this week. Already last year, we saw a lot of interest in high-volume HDF and our 5008X machine at the ASN. I do expect a high level of interest and engagement again this year, especially as we start the 5008X rollout. And with that, a new therapy becomes available in the United States. This will set a new standard of care. We submitted around a dozen of clinical abstracts that are specifically focused on high-volume HDF. From the risk reduction resulting from HDF therapy to the implementation of HDF in clinics to AI support for clinicians during implementation.

接下來，請看第5張投影片。美國腎臟病學會腎臟週本週在休士頓舉行。早在去年，我們在 ASN 展會上就看到了大家對大批量 HDF 和我們的 5008X 機器的濃厚興趣。我預計今年大家的興趣和參與度會很高，尤其是在我們開始推出 5008X 的時候。至此，一種新的療法在美國問世。這將樹立新的護理標準。我們提交了大約十幾篇專門針對大容量血液透析濾過 (HDF) 的臨床摘要。從 HDF 療法帶來的風險降低，到 HDF 在臨床上的應用，再到 AI 在臨床應用過程中為臨床醫生提供的支援。

Besides the scientific side of HDF, it's also great to see how the feedback is from nephrologists that visited one of our clinics that are already run with HDF, and I want to share what they said. Being able to see the human experience of HVHDF firsthand was one of the most pivotal moments for me and given our mission and the potential of the HVHDF therapy, we would love to explore having our clinics serve as index centers for the North American rollout of this modality. This shows that we are not only excited about the broad rollout in '26, but how well prepared we are in all dimensions and how well received it might be.

除了 HDF 的科學方面之外，很高興看到參觀過我們診所（該診所已開展 HDF 治療）的腎臟科醫生們的回饋，我想分享他們的看法。能夠親眼目睹 HVHDF 的人體體驗對我來說是最關鍵的時刻之一，鑑於我們的使命和 HVHDF 療法的潛力，我們非常希望探索讓我們的診所成為該療法在北美推廣的指標中心。這表明我們不僅對 2026 年的全面推廣感到興奮，而且對我們在各個方面所做的充分準備以及它可能受到的歡迎程度感到興奮。

Next on slide 6. With the launch of the FME Reignite strategy, we have committed to reignite growth and innovation across our organization. In care delivery, we are supporting overall volume growth by raising the bar on quality even higher, further enhancing clinical outcomes and patient safety. This is especially important to me because it directly reflects our purpose-driven patient-centric approach where the patient is at the heart of everything we do.

接下來是第6張投影片。隨著 FME Reignite 策略的推出，我們致力於重振整個組織的成長和創新。在醫療服務方面，我們透過提高品質標準來支持整體業務量的成長，從而進一步提高臨床療效和病人安全。這一點對我來說尤其重要，因為它直接體現了我們以患者為中心、以目標為導向的方法，在這種方法中，患者是我們一切工作的核心。

We are already seeing encouraging progress on our quality and safety initiatives, and I would like to share some examples from the US market. Treatment adherence is a key focus as patients with chronic illnesses often struggle to adhere to their care plans. This frequently involves helping our patients to understand the importance of sticking to their treatment plan and working with them to remove barriers. Since the beginning of this year, controllable missed treatments have decreased due to improved alignment amongst physicians, patients and clinicians.

我們在品質和安全措施方面已經取得了令人鼓舞的進展，我想分享一些來自美國市場的例子。治療依從性是一個重點，因為慢性病患者往往難以堅持治療方案。這通常包括幫助我們的患者了解堅持治療方案的重要性，並與他們一起消除障礙。今年年初以來，由於醫生、患者和臨床醫生之間的協調性提高，可控的漏診率有所下降。

Many ESRD patients begin dialysis with a central venous catheter, which while necessary, poses a high infection risk. Although our long-term goal is to transition patients to permanent access, bloodstream infection prevention remains even more critical during this period. Antimicrobial interventions reduce infection rates by 70% compared to conventional care.

許多末期腎病患者在開始透析時都會使用中心靜脈導管，雖然這是必要的，但卻會帶來很高的感染風險。儘管我們的長期目標是讓患者過渡到永久性血管通路，但在此期間，預防血流感染仍然至關重要。與傳統療法相比，抗菌藥物幹預可降低 70% 的感染率。

In August, we launched a program to further increase antimicrobial catheter treatments to eligible patients. Adoption to date has been strong with 84% of eligible catheter patients now receiving bloodstream infection protection, and we are on track to achieve even greater utilization. Protection against the flu is especially critical for our vulnerable patient population.

8 月，我們啟動了一項計劃，旨在進一步增加符合條件的患者接受抗菌導管治療的機會。到目前為止，推廣效果顯著，84% 的符合條件的導管患者現在都得到了血液感染防護，我們有望實現更高的利用率。對於我們脆弱的患者族群來說，預防流感尤其重要。

And because flu strains change yearly, annual vaccination is necessary to maintain protection. Our US clinic network has launched its annual vaccination campaign and vaccination rates are 34% higher than where they were at this point in 2024. We already have more than 72% of our patients vaccinated. And like in previous years, we expect to come to 85% before the end of the year.

由於流感病毒株每年都會變化，因此需要每年接種疫苗才能維持免疫力。我們的美國診所網路已啟動年度疫苗接種活動，目前的疫苗接種率比 2024 年同期高出 34%。我們已有超過72%的患者接種了疫苗。和往年一樣，我們預計到年底前能達到 85%。

These are just a few examples of reducing hospitalization and costs for the health care system and at the same time, increasing the number of treatments, while improving patient outcomes and reducing mortality over time. I'm extremely proud of the work we are doing and the results we are already achieving. It gives me great confidence and excitement for the path ahead.

以上僅是幾個例子，說明如何在減少住院治療和降低醫療保健系統成本的同時，增加治療次數，並隨著時間的推移改善患者預後和降低死亡率。我為我們正在進行的工作以及已經取得的成果感到無比自豪。這讓我對未來的道路充滿信心和興奮。

Turning to slide 7. This quarter, we saw strong execution across all three of our operating segments. I will take you through some of the key highlights by segment. In care delivery, in line with our expectations, US same-market treatment growth was slightly positive with 0.1%.

翻到第7張投影片。本季度，我們三大營運部門均展現強勁的執行力。我將分部分帶您了解一些關鍵要點。在醫療服務方面，正如我們預期的那樣，美國同市場治療成長略微為正，達到 0.1%。

This reflected the carryover effect from elevated mortality, which was driven by the severe flu season earlier in the year and positively offset by improving admissions as well as slight improvements in missed treatments. In our international markets, same market treatment growth increased to 1.2%. Third quarter care delivery performance benefited from favorable rate and mix development in the US as well as accelerated contributions from phosphate binders in our pharma business. We further executed on our portfolio optimization plan, closing clinic divestitures in Brazil, Malaysia and some other smaller markets.

這反映了死亡率上升的延續效應，而死亡率上升是由年初嚴重的流感季節造成的，但入院人數的增加以及漏診治療情況的略微改善抵消了這一影響。在我們的國際市場，將同市場治療成長率提高至 1.2%。第三季醫療服務交付業績受惠於美國市場有利的定價和產品組合發展，以及我們製藥業務中磷酸鹽結合劑的加速成長。我們進一步執行了投資組合優化計劃，完成了在巴西、馬來西亞和其他一些較小市場的診所剝離。

One highlight from me in care delivery, which I'm sure it comes as no surprise, is the availability of high-volume HDF treatments in select US Clinics. We are progressing every day and are very encouraged by the initial feedback we have heard from our patients that have been receiving HDF treatments.

在醫療服務方面，我個人認為最值得一提的是，部分美國診所提供大容量 HDF 治療，這一點大家應該不會感到意外。我們每天都在取得進步，並且對接受 HDF 治療的患者給予的初步回饋感到非常鼓舞。

The work we are doing is paying off, and I'm very proud of the team's focus and execution while never wavering on the highest quality of patient care. These patients report feeling significantly better with increased energy levels and improved sleep quality and reduced post-treatment recovery time. Clinic staff have highlighted the benefits of quieter, less stressful workflows, thanks to the enhanced automation of the machine, which supports more efficient and patient-focused care. The excitement is palpable.

我們所做的工作正在取得成效，我為團隊的專注和執行力感到非常自豪，他們始終堅持提供最高品質的病患照護。這些患者表示感覺明顯好轉，精力更充沛，睡眠品質也得到改善，治療後恢復時間縮短。診所工作人員強調了更安靜、壓力更小的工作流程帶來的好處，這得益於機器自動化程度的提高，從而支持更有效率、以病人為中心的照護。興奮之情溢於言表。

While we are not expecting this to be a major driver of operational performance this year, our learnings are rapid from the early rollout of select clinics, which is providing valuable insights allowing us to further enhance and refine the clinic training and conversion process. This will set us up for a seamless large-scale launch in 2026, which will be the start of the broad transition of our clinic network.

雖然我們預計這不會成為今年營運績效的主要驅動因素，但我們從部分診所的早期推廣中迅速獲得了經驗，這為我們提供了寶貴的見解，使我們能夠進一步加強和完善診所培訓和轉換流程。這將為我們在 2026 年順利大規模推出做好準備，這將是我們診所網路全面轉型的開始。

Turning to Value-Based Care. As expected, we continue to face a degree of earnings fluctuations. We are also facing delays to 2026 by CMS in providing reporting data for the CKCC program, which adds to these fluctuations as these cannot be planned. In Value-Based Care, we realized a higher number of member months due to continued contracting growth as well as a growing network of providers, and we are further enhancing our care models through increased use of artificial intelligence.

轉向以價值為導向的醫療保健。正如預期的那樣，我們繼續面臨一定程度的獲利波動。CMS 將 CKCC 計劃的報告數據提供時間推遲到 2026 年，這也加劇了這些波動，因為這些波動是無法規劃的。在以價值為基礎的醫療保健方面，由於持續的合約成長以及不斷擴大的供應商網絡，我們實現了更高的會員月數，並且我們正在透過更多地使用人工智慧來進一步改進我們的護理模式。

As part of our Reignite Strategy, we took an important step forward by increasing and strengthening our ownership stake in our Value-Based Care asset Interwell Health. This reinforces our leadership position in renal Value-Based Care, which is supported by the vertical integration benefits for our business model offers.

作為我們重振策略的一部分，我們透過增加和加強對旗下基於價值的醫療保健資產 Interwell Health 的所有權，邁出了重要的一步。這鞏固了我們在腎臟價值醫療領域的領導地位，而我們商業模式的垂直整合優勢也為此提供了支持。

With this step, we are better able to leverage the full scale and size that Fresenius Medical Care as a total company offers. This and the underlying progress we are already making in Value-Based Care is positioning this business for long term, more profitable growth. Care Enablement delivered another strong quarter, supported by volume growth and positive pricing momentum overall.

透過這項舉措，我們能夠更好地利用費森尤斯醫療作為整體公司所提供的全部規模和實力。這一點以及我們在以價值為基礎的醫療保健領域中已經取得的基礎性進展，將使這項業務朝著長期、更盈利的成長方向發展。在銷售成長和整體積極的價格動能支撐下，護理賦能業務又迎來了一個強勁的季度。

We continued to capture sustainable savings as part of FME25+, driven by disciplined execution of the next level of footprint optimization across both manufacturing and supply chain. And as a result, our Care Enablement margin further progressed compared to the prior year despite being increasingly challenged by transactional exchange rate impact.

作為 FME25+ 的一部分，我們透過嚴格執行下一階段的製造和供應鏈足跡優化，持續實現可持續的成本節約。因此，儘管受到交易匯率影響的挑戰日益加劇，但我們的護理賦能利潤率與前一年相比仍有所提高。

I will now hand over to Martin to take you through the financial performance in more detail.

現在我將把發言權交給馬丁，讓他更詳細地為大家介紹財務表現。

Thank you, Helen, and welcome to everyone on the call also from my side. I will pick up on slide 9. In the third quarter, we achieved organic revenue growth of 10%, with all three segments contributing to this strong performance. At constant currency, revenue increased by 8%. We continue to divest assets as part of our portfolio optimization plan. Divestitures negatively impacted revenue development by 60 basis points. Operating income, excluding special items, increased by 28% on a constant currency basis. This significant increase led to a clear step change in the group margin to 11.7%, well into the implied range of 11% to 12% for 2025.

謝謝海倫，也歡迎各位參加通話。我將從第9張投影片開始講解。第三季度，我們實現了 10% 的有機收入成長，所有三個業務部門都為這一強勁業績做出了貢獻。以固定匯率計算，營收成長了 8%。作為投資組合優化計劃的一部分，我們將繼續剝離資產。資產剝離對收入成長產生了60個基點的負面影響。不計特殊項目，營業收入以固定匯率計算成長了 28%。這一顯著增長導致集團利潤率發生明顯階躍式變化，達到 11.7%，遠超 2025 年 11% 至 12% 的預期範圍。

Special items negatively affected operating income by around EUR100 million. This comprises costs relating to FME25+ and our continued portfolio optimization as well as effects from the remeasurement of our investment in Humacyte.

特殊項目對營業收入造成了約 1 億歐元的負面影響。這包括與 FME25+ 相關的成本以及我們持續的投資組合最佳化，以及重新計量我們對 Humacyte 的投資所產生的影響。

Next, on slide 10. This slide breaks down the significant 180 basis points margin improvement. All three segments contributed to the positive margin development with an especially strong contribution from Care Delivery. Net Corporate costs developed favorably by EUR19 million. This was primarily driven by virtual power purchase agreements with around EUR20 million and Corporate costs broadly stable otherwise.

接下來，請看第 10 張投影片。這張投影片詳細分析了180個基點的顯著利潤率提升。三個業務板塊均對利潤率的積極增長做出了貢獻，其中醫療服務板塊的貢獻尤為顯著。公司淨成本減少了1900萬歐元。這主要是由於虛擬購電協議金額約 2,000 萬歐元，除此之外，公司成本整體保持穩定。

Foreign exchange rates developed unfavorably with a negative EUR24 million translational impact. The average US dollar exchange rate in quarter three was 1.17 compared to 1.13 in the second quarter. I will now walk you through the financial developments in each segment, starting with Care Delivery on page 11. Care Delivery realized organic revenue growth of 6%, supported by both Care Delivery US and International. In the US, organic growth of 6% was driven by favorable rate and payer mix development. Positive contributions from phosphate binders as well as reduced implicit price concessions, which demonstrate our progress on active revenue cycle management.

外匯匯率走勢不利，造成 2,400 萬歐元的負面匯兌損失。第三季美元平均匯率為1.17，而第二季為1.13。接下來，我將帶您了解每個部分的財務發展情況，首先從第 11 頁的護理服務開始。Care Delivery 實現了 6% 的有機收入成長，這得益於 Care Delivery 美國和國際業務的共同支持。在美國，6%的有機成長是由有利的費率和支付方組合發展所推動的。磷酸鹽黏合劑的積極貢獻以及隱性價格讓步的減少，表明我們在積極的收入週期管理方面取得了進展。

Internationally, we realized strong organic growth of 4%, including 1.2% same market treatment growth. The continued execution of our portfolio optimization plan negatively impacted Care Delivery revenue development by 120 basis points. Care Delivery significantly improved profitability in the third quarter with a margin of 14.5%, it is at the upper end of our 2025 target margin band. While we still saw muted same market treatment growth, the business growth was supported by positive rate and mix effects and additional higher contributions by phosphate binders in our pharma business. These factors compensated for the missing income from the consent agreement on pharmaceuticals, which we had in the third quarter of last year.

在國際市場，我們實現了 4% 的強勁內生成長，其中包括 1.2% 的同市場治療成長。我們的投資組合優化計劃的持續執行對醫療服務收入發展產生了負面影響，下降了 120 個基點。第三季度，護理服務業務的獲利能力顯著提高，利潤率達到 14.5%，處於我們 2025 年目標利潤率區間的上限。儘管我們仍然看到同市場治療成長乏力，但積極的利率和產品組合效應以及我們製藥業務中磷酸鹽結合劑的額外更高貢獻支撐了業務成長。這些因素彌補了去年第三季因藥品同意協議而造成的收入損失。

The phasing is different this year, and we do expect this to come in the fourth quarter, but at a lower level. Higher sustainable savings through FME25+ helped to partially compensate for higher labor costs, including elevated medical benefit costs. The unfavorable development of exchange rates also had a sizable negative impact on operating income.

今年的分階段實施情況有所不同，我們預計第四季會實施，但規模會較小。透過 FME25+ 實現的更高永續節約有助於部分彌補更高的勞動成本，包括上漲的醫療福利成本。匯率的不利走勢也對營業收入產生了相當大的負面影響。

Let us move to slide 12 to review the development in Value-Based Care. Value-Based Care further accelerated revenue growth, realizing 42% organic growth. This significant increase was driven by a high number of member months, mainly due to continued contracting growth. The higher growth in Value-Based Care is also driven by gross revenue recognition instead of net revenue recognition of a major contract. This change does not result in additional earnings growth.

讓我們翻到第 12 張投影片，回顧一下基於價值的醫療保健的發展。以價值為導向的醫療服務進一步加速了收入成長，實現了 42% 的內生成長。這一顯著增長主要得益於會員月數的增加，而會員月數的增加又主要歸因於持續的收縮式增長。價值醫療的更高成長也是由於主要合約採用的是毛收入確認方式，而不是淨收入確認方式。這項變更並不會帶來額外的獲利成長。

Operating income in Value-Based Care amounted to a loss of EUR21 million compared to a loss of EUR37 million in the prior year. This reflects the quarterly earnings fluctuations that are inherent to this business model. As mentioned by Helen, we are also facing delays to 2026 by CMS in providing reporting data for the CKCC program, leading to a delayed revenue recognition. Due to this shift, we assume a slightly more negative operating income contribution from the Value-Based Care segment.

基於價值的醫療保健業務的營業收入虧損 2,100 萬歐元，而上一年虧損 3,700 萬歐元。這反映了這種商業模式固有的季度收益波動。正如 Helen 所提到的，由於 CMS 延遲到 2026 年才提供 CKCC 計畫的報告數據，我們也面臨同樣的問題，導致收入確認延遲。由於這項轉變，我們預期價值醫療部門的營業收入貢獻將略微為負。

I will provide an overview of the financial performance in our Care Enablement segment on slide 13. The Care Enablement realized strong revenue and organic growth of 5%. Revenue development was driven by solid volume growth and continued positive price momentum. Care Enablement achieved a 38% increase in operating income, leading to a margin increase of 200 basis points to 7.6%, in line with our expected phasing for the year. Business growth was, as mentioned, driven by volumes and pricing, which was partially offset by higher-than-expected and increasing currency transaction losses. Further sustainable savings from the FME25+ program compensated for the expected inflationary cost increases.

我將在第 13 頁投影片中概述我們護理賦能部門的財務表現。護理賦能業務實現了強勁的收入成長和5%的自然成長。營收成長主要得益於銷售穩定成長和價格持續上漲動能。Care Enablement 的營業收入成長了 38%，利潤率成長了 200 個基點，達到 7.6%，符合我們對今年的預期。如前所述，業務成長主要由銷售和價格驅動，但部分被高於預期且不斷增加的貨幣交易損失所抵消。FME25+計劃帶來的進一步可持續節省，彌補了預期中的通貨膨脹成本增長。

Moving to slide 14. Due to the cash flow disruptions from the Change Healthcare cyber incident in 2024, it is more useful to assess cash flow development on a nine month basis. We have realized strong cash flow development through the first nine months of the year, with operating cash flow increasing 8% year-to-date. In the third quarter, operating cash flow declined compared to an inflated prior year base that benefited from around EUR400 million in catch-up reimbursement following the Change Healthcare cyber incident.

切換到第14張投影片。由於 2024 年 Change Healthcare 網路事件造成的現金流量中斷，以九個月為週期評估現金流量發展更為有效。今年前九個月，我們的現金流發展強勁，營運現金流年增 8%。第三季度，由於去年同期基數較高，加上 Change Healthcare 網路事件後獲得的約 4 億歐元的追趕性報銷，經營現金流有所下降。

The negative year over year effect was partially offset by favorable working capital developments in this quarter. Our disciplined use of cash reflects the priorities set out in our new capital allocation framework, which is designed to reignite value creation. We reduced our net debt and lease liabilities compared to the prior year period. As highlighted by Helen, our share buyback program is well underway.

年比下降的影響被本季有利的營運資金狀況部分抵銷。我們對現金的嚴格使用反映了我們新的資本配置框架中設定的優先事項，該框架旨在重新激發價值創造。與上年同期相比，我們的淨債務和租賃負債均有所減少。正如海倫所強調的那樣，我們的股票回購計劃正在順利進行。

By the end of September, we repurchased 3.6 million shares or 1.2% of our share capital with an investment volume of EUR151 million. In addition, we invested EUR312 million in the third quarter to strengthen the ownership in our Value-Based Care asset Interwell Health. This is reflected in financing cash flow. In parallel, we ended the quarter with a further strengthened net leverage ratio of 2.6 times, well within our target range of 2.5 to 3 times.

截至 9 月底，我們回購了 360 萬股，佔股本的 1.2%，投資額為 1.51 億歐元。此外，我們在第三季投資了 3.12 億歐元，以加強對我們基於價值的醫療保健資產 Interwell Health 的所有權。這體現在融資現金流。同時，本季末我們的淨槓桿率進一步提高至 2.6 倍，遠低於我們 2.5 至 3 倍的目標範圍。

I will now hand back to Helen to review our outlook.

現在我將交還給海倫，讓她回顧我們的展望。

Thank you, Martin. I will finish my prepared remarks on slide 16. The strong growth in our Value-Based Care segment due to the type of revenue recognition of one contract results in stronger-than-expected revenue growth in this segment. Therefore, we expect to be at the very top end of our low single-digit percent revenue growth range for 2025. As explained, this growth in Value-Based Care driven purely by contract type related revenue recognition does not drive additional operating income growth.

謝謝你，馬丁。我的發言稿將在第16頁投影片完成。由於某份合約的收入確認方式，我們基於價值的醫療保健業務板塊實現了強勁增長，導致該板塊的收入增長超出預期。因此，我們預計 2025 年的營收成長將達到我們預期的個位數百分比範圍的上限。如前所述，這種完全由合約類型相關收入確認所驅動的價值醫療成長，並不會帶動額外的營業收入成長。

Looking at operating income growth for the group. We have shown continued progress through the first 9 months with an expected acceleration in the third quarter. This brings us to 18% operating income growth in the first nine months. We are not only in our target range of high teens to high 20% operating income growth already, but also demonstrate with 11.7% a new and improved level of profitability despite a challenging environment and very low same-market treatment growth in the US When I look at the big picture for 2025, we are confident in our continued improvement of our underlying business.

考察集團的營業收入成長情形。前 9 個月我們取得了持續進展，預計第三季將加速發展。這意味著前九個月的營業收入成長了18%。我們不僅已經實現了10%到20%以上的營業收入成長目標，而且在充滿挑戰的環境和美國同市場治療成長非常低的情況下，也以11.7%的成長率展現了新的、更高的獲利能力。展望2025年，我們對持續改善公司基本面充滿信心。

With nine months under our belt, we would like to update you on our latest thinking for the operating income development for the year. The positive momentum in FME25+ will deliver around EUR40 million more, delivering around EUR220 million full year, helping us to directly offset the increasing medical benefit costs. The acceleration in the third quarter of our pharma business contributions from phosphate binders is now estimated to be around EUR80 million higher than the assumed EUR100 million. This is helping to offset the full year headwind from lower volumes in the US and the increased foreign exchange transaction headwinds.

九個月過去了，我們想向大家報告我們對今年營業收入發展的最新看法。FME25+ 的積極勢頭將帶來約 4000 萬歐元的額外收入，全年收入約為 2.2 億歐元，這將幫助我們直接抵消不斷增長的醫療福利成本。第三季度，我們製藥業務中磷酸鹽結合劑的貢獻預計將比預期的 1 億歐元高出約 8,000 萬歐元。這有助於抵消美國交易量下降和外匯交易阻力增加的全年不利影響。

As always, the fourth quarter is our strongest quarter. We do expect further acceleration in earnings growth and margin expansion. With all that I just outlined above and our 18% operating income growth in the first nine months, we are not only already above the bottom end of the range, but we are confident in confirming our full operating income guidance range for 2025. As we approach year-end, I know many of you will want further insight into our outlook and assumptions for 2026.

與往年一樣，第四季是我們業績最好的季度。我們預計獲利成長和利潤率擴張將進一步加速。綜上所述，加上前九個月 18% 的營業收入成長，我們不僅已經超過了預期範圍的下限，而且我們有信心確認 2025 年的全部營業收入預期範圍。隨著年底臨近，我知道你們中的許多人都想進一步了解我們對 2026 年的展望和假設。

To manage expectations here, we are currently in our planning process for 2026. And I'm sure you can all appreciate that there are several moving pieces. In addition to the normal headwinds and tailwinds we navigate any given year, we also need to see how mix evolves for phosphate binders and to what extent price erosion will impact our pharma business. What happens to extended ACA tax subsidies, the final CMS pricing for '26 as well as the potential impact of new tariffs and pharmaceuticals pricing. We acknowledge the key KPI is next year's same market treatment growth.

為了避免大家產生誤解，我們目前正在進行 2026 年的規劃。我相信大家都能理解，這其中牽涉到很多方面。除了每年都會遇到的正常逆風和順風之外，我們還需要觀察磷酸鹽結合劑的組合如何演變，以及價格下跌將在多大程度上影響我們的製藥業務。延長的 ACA 稅收補貼會發生什麼變化？ 2026 年 CMS 的最終定價以及新關稅和藥品定價的潛在影響。我們認為關鍵績效指標是明年同市場治療成長。

Our Q4 volume data will clarify trends in mortality, referrals and overall volume, shaping next year's outlook. Just like every year, we will share our 2026 outlook along with our full year results in February.

我們第四季的業務量數據將闡明死亡率、轉診量和整體業務量的趨勢，從而影響明年的展望。與往年一樣，我們將在2月公佈2026年展望以及全年業績。

With that, I'll hand this back to Dominik to start the Q&A.

接下來，我將把這個環節交還給多明尼克，讓他開始問答環節。

Thank you, Helen. Thank you, Martin, for the presentation and the updates. Before I hand over to the Q&A, I would like to remind everyone to limit the questions to two. If we have time over, we can go another round.

謝謝你，海倫。馬丁，謝謝你的講解和最新情況介紹。在進入問答環節之前，我想提醒大家，請將問題數量限制在兩個以內。如果時間允許，我們可以再玩一輪。

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

接下來，我把麥克風交給桑德拉，請她開始問答環節。

(Operator Instructions)

（操作說明）

Oliver Metzger, ODDO BHF.

Oliver Metzger，ODDO BHF。

First is on your guidance on the margin guidance. So in your slides, you showed that the Care Delivery already stands at the top end of your expectations. And having said this, do you see the stronger progression in Q4 coming over relatively spoken from Care Enablement? Or do you expect due to the timing of payments, a step-up in Value-Based Care.

首先是關於保證金指引的問題。所以，你在幻燈片中展示了醫療服務水準已經達到了你的預期最高水準。綜上所述，您認為第四季較強勁的成長是否主要來自護理賦能方面？或者您是否預期，由於付款時間的原因，價值導向型醫療保健會得到提升？

Second question is on the treatment adherence. So technically, beneath mortality, it's definitely one of the areas where you're not where you want to be. Do you see -- because COVID is already five to six years or five years ago. And you see that you commented that the patients who were -- patients during COVID have a lower adherence than the patients who you recruited afterwards. So do you still this normalization in form of over time patients just passing away due to the normal mortality? Or do you see that there's still some other reasons why this level is elevated?

第二個問題是關於治療依從性。所以嚴格來說，除了死亡之外，這絕對是你沒有達到理想狀態的領域之一。你看——因為新冠疫情已經過去五、六年，或者五年了。而且你也提到過，在新冠疫情期間感染的患者，其依從性低於之後招募的患者。所以，你是否仍然認為隨著時間的推移，病人會因為正常的死亡率而去世，這種現像已經趨於正常化？或者您認為還有其他原因導致這個水平升高？

Look, on your first question regarding guidance, we do expect to see continuous improvement in all segments, but we also see strong support from Care Delivery. On your second question, I'll make sure I unpack all those pieces in there. In terms of -- I think you started with treatment adherence and also kind of wrapped up in their reasons for mortality. There's no question, our mortality levels are still elevated. But where we're focusing on things that we can control are seeing an improvement in missed treatment.

關於你提出的第一個關於指導的問題，我們確實希望看到各個領域持續改進，但我們也看到了醫療服務的大力支持。關於你的第二個問題，我會確保把裡面的零件都拆開。就此而言——我認為你從治療依從性入手，也涉及了他們的死亡原因。毫無疑問，我們的死亡率仍然居高不下。但是，當我們把精力集中在我們可以控制的事情上時，漏診率就會下降。

Obviously, those areas that we can control, if we can make sure our patients continue to get their treatments, that obviously helps with treatment volume and we are seeing those improvements in referrals. So obviously, we work hard on those missed treatments because that has a double effect on improving the number of treatments, but also ultimately, if the patients keep getting their treatments should help with mortality as well.

顯然，在我們能夠控制的領域，如果我們能夠確保我們的患者繼續接受治療，這顯然有助於提高治療量，而且我們在轉診方面也看到了這些改善。顯然，我們努力彌補那些錯過的治療，因為這既能提高治療次數，最終還能幫助降低死亡率。

And as you saw from one of my opening slides, we're also working on our catheter rates kind of coming down as well. So all of that should help mortality just tied up with our general strategy of the focus on patient quality and patient safety. In terms of your comment on the passing away, maybe reason code. I don't know that we can tease out that if anything different. I mean there was a time in COVID that you could kind of get the COVID piece.

正如您從我的開場幻燈片中看到的，我們也在努力降低導尿管的使用率。因此，所有這些都應該有助於降低死亡率，這與我們以患者品質和病人安全為中心的整體策略一致。關於您提到的過世問題，或許可以用原因代碼來解釋。我不知道我們能否從中找出不同的答案。我的意思是，在新冠疫情期間，你確實有可能接觸到新冠病毒。

And if you remember, we used to report that as excess mortality. Now we just pass it all as the general mortality, and there's nothing in those trends or that data that is telling us it's anything new or different. It's just that it continues to stay -- it continues to be elevated.

如果你還記得的話，我們過去常常把這種情況報告為超額死亡率。現在我們都把這一切都歸結為一般死亡率，而這些趨勢或數據並沒有告訴我們有什麼新的或不同之處。只是它一直保持著高位。

I was referring towards the patients who were already on dialysis during COVID that they have a higher average number of missed treatments compared to the patients who came to dialysis afterwards.

我指的是新冠疫情期間已經開始接受透析治療的患者，他們的平均漏診次數比疫情後才開始接受透析治療的患者要多。

Yeah, that would have been the case because they were already kind of vulnerable and those that were with us during COVID would have had more missed treatments than that we see in maybe new patients coming in. Sorry, I misunderstood that direct question on COVID.

是的，情況確實如此，因為他們本來就比較脆弱，而且在新冠疫情期間和我們在一起的患者，錯過的治療可能比我們現在看到的新患者要多。抱歉，我誤解了您關於新冠疫​​情的直接提問。

Veronika, Citibank.

維羅妮卡，花旗銀行。

And hopefully, you can hear me okay. I have two, please. One, I just want to go back, Helen, to your comment on phosphate binders, apologies. There's a lot of numbers, and I probably misunderstood it, but I just want to confirm that you are now expecting EUR180 million of benefit from phosphate binders this year versus the EUR100 million that was assumed in the guidance previously? And I guess just to play a little bit of devil's advocate.

希望你能聽清楚我說話。我要兩份。首先，海倫，我想回到你之前關於磷酸鹽結合劑的評論，抱歉。數字很多，我可能理解錯了，但我只想確認一下，您現在預計今年磷酸鹽結合劑的收益為 1.8 億歐元，而不是之前預期的 1 億歐元嗎？我只是想稍微唱唱反調。

If I strip that EUR180 million out of the Care Delivery margin trajectory, obviously I don't know exactly how much you booked in the three quarters of the year versus the full year, but it doesn't seem like there is a huge amount of margin improvement underlying in the business. Tell me if I'm doing that math wrong, I did it very quickly on the slide, but I just kind of would love to understand what you're seeing margin-wise, if you strip out the phosphate binders.

如果我從護理服務利潤率的走勢中剔除這 1.8 億歐元，顯然我不知道你今年前三個季度的確切收入與全年收入相比是多少，但看起來這項業務的潛在利潤率並沒有很大的改善。如果我的計算有誤，請告訴我。我在幻燈片上計算得很快，但我很想了解，如果去除磷酸鹽結合劑，你看到的邊際效應是什麼。

And then my second question is just looking to 2026, and Medicare Advantage trends in particular, we are seeing some early signs of reduced enrollment. I'm curious how you're thinking about mix as we head into next year from a Medicare Advantage perspective. And to what extent we should be thinking about this maybe no longer being a tailwind to the business into next year?

我的第二個問題是關於 2026 年，特別是 Medicare Advantage 的趨勢，我們看到了一些投保人數減少的早期跡象。我很想知道，從聯邦醫療保險優勢計劃的角度來看，您是如何考慮明年保險組合的。那麼，我們應該在多大程度上考慮，這種情況可能不再對明年的業務發展起到推動作用？

Yeah. Thanks, Veronica. I think I can tackle both of those. Sorry, I may have stumbled, as I was saying, the phosphate binders number. There was EUR80 million and EUR100 million adding up to EUR180 million.

是的。謝謝你，維羅妮卡。我認為這兩個問題我都能解決。抱歉，我可能說錯了，就像我剛才說的，磷酸鹽結合劑的數量。有8000萬歐元和1億歐元，加起來是1.8億歐元。

So my apologies if everyone didn't catch that on the call, you're right. We are now seeing that full year number to be EUR180 million versus the original guide of EUR100 million through Q2. We are seeing favorability in our pharma business, and Q3 was particularly strong with that uptake. The FKC side of the house or the piece that we see in the clinics is developing in line with expectations, but we are seeing more favorable pharma and are now expecting that trend to continue that we saw in Q3 into Q4. Obviously, that's something that we are kind of trying to get our arms around for 2026 as well as we think about utilization and pricing for the binders while it's still under the TDAPA period, but it is in line kind of with what we saw in Q3.

如果大家在電話裡沒聽清楚，我深表歉意，你說得對。我們現在預計全年數字將達到 1.8 億歐元，而最初預計第二季結束時的數字為 1 億歐元。我們的醫藥業務發展勢頭良好，第三季的業績尤其強勁。FKC方面，或者說我們在診所看到的那部分，正在按預期發展，但我們看到製藥方面的情況更加有利，現在預計這種趨勢將從第三季度延續到第四季度。顯然，這也是我們在 2026 年努力應對的問題，因為我們還在考慮 TDAPA 期間的債券利用率和定價，但這與我們在第三季度看到的情況基本一致。

Look, I would say on your broader question and why I thought it was important to bucket the moving parts, yes. I mean, I can pick the favorability from binders. I can pick the favorability from FME25, but it shouldn't be lost that we are -- while we do have this softer volume, we are having to overcome the lost margin from our original assumptions on volume as well as the underlying transactional exchange that we are seeing. So -- and the medical costs that are driving the labor cost higher in terms of increased utilization of our employee benefit claims as well as the volume of claims.

關於你提出的更廣泛的問題，以及為什麼我認為對各個活動部件進行分類很重要，我的答案是肯定的。我的意思是，我可以從活頁夾中看出受歡迎程度。我可以從 FME25 中看出利好因素，但我們不應忽視的是——儘管我們的交易量有所下降，但我們必須克服最初對交易量和我們所看到的潛在交易交換的假設所造成的利潤損失。因此，醫療成本的上升推高了勞動成本，這體現在員工福利索賠的增加以及索賠數量的增加。

So as you can appreciate, we're juggling a big business here. We're trying to keep balancing the pluses and minuses, but there are some underlying negatives that these positives are helping us offset that are all coming through in the year. In terms of your Medicare Advantage question, it's an interesting one because we also started to pick up headlines from the big payers that they were backing off some of the coverage of MA plans.

所以你應該能理解，我們這裡經營的是一門大生意。我們正努力平衡利弊，但這些利好因素正在幫助我們抵消一些潛在的負面影響，而這些負面影響將在今年逐漸顯現。關於您提出的 Medicare Advantage 問題，這很有意思，因為我們也開始從一些大型支付者那裡聽到消息，他們正在減少對 MA 計劃的部分覆蓋範圍。

What we have seen through Q3 and projecting into Q4 is actually no change in that MA mix and that book of business. And actually, it continues to grow episode slightly and is quite sticky. What we are seeing in the market is while some of the big payers might be backing off some plans. It is more of the consolidation of MA plans and the overall enrollment numbers are looking consistent. And that's actually come from the government as well.

我們從第三季以及對第四季的預測來看，MA組合和業務組合實際上並沒有改變。事實上，這一集還在略微增長，而且相當引人入勝。我們看到市場上的情況是，一些大型保險公司可能會取消一些保險計劃。主要是醫療保險優勢計畫的整合，而且整體投保人數看起來比較穩定。而這其實也是來自政府的。

So we see quite a steady mix as well as similar number on enrollment, but there is consolidation of the number of plans out there that payers are doing at a more local level. So right now, our current assumption is that we wouldn't see a big impact in MA. Just -- maybe just to kind of put a finer point on the mix and things that we are watching of course, the ACA exchange, whether that does conclude at the end of the year or whether there will be some deals on extending that. So that is the piece that we are watching closely on where those patients may end up during the current open enrollment period, which started, I think, at the weekend. So we'll continue to navigate that.

因此，我們看到保險產品組合相當穩定，投保人數也相近，但支付方正在地方層級整合現有保險計畫的數量。所以目前，我們的假設是，馬薩諸塞州不會受到太大影響。只是想——或許只是為了更清楚地說明我們正在關注的各種因素，當然還有ACA交易所，無論它是否會在年底結束，或者是否會有一些延長它的協議。所以，我們正在密切關注這些患者在目前的開放註冊期內最終會去哪裡，我認為開放註冊期是從上週末開始的。所以我們會繼續應對這個問題。

But overall, looking quite steady here on MA.

但整體而言，MA方面看起來相當穩定。

Hassan, Barclays.

哈桑，巴克萊銀行。

A couple from me, please. Firstly, on EBIT guidance range remains pretty wide as we move into Q4. What is driving the risks here to your mind? And why is the bottom end of the range, not more likely? And what was the phosphate binder benefit in the third quarter, please?

請給我兩份。首先，進入第四季後，息稅前利潤預期範圍仍然相當廣泛。你認為造成這些風險的原因是什麼？為什麼最低值出現的可能性不大？請問第三季磷酸鹽結合劑的收益如何？

Secondly, on treatment growth, can you talk a bit about admissions and missed treatments as you moved through the year? And how you see Q4 growth given the flu impact was obviously quite meaningful in the first half at 60 basis points. I appreciate that you don't have the Q4 detail, but how do you consider the moving parts as you move into 2026 and the confidence around the 2% plus treatment growth that you've previously talked about?

其次，關於治療進展，您能否談談這一年中入院人數和錯過治療的情況？考慮到流感的影響，您如何看待第四季的成長？上半年的成長幅度顯然相當可觀，達到了 60 個基點。我知道您沒有第四季度的詳細數據，但是您如何看待進入 2026 年後的各種變數，以及您之前提到的 2% 以上的治療增長的信心？

Thanks, Hassan. I'll tackle some of that and maybe, Martin, you can take the phosphate binder Q3 question. But let me unpack what I can and then pass you over to Martin. Yes, look, the EBIT guidance, we always knew that the EBIT range is wide because of the implied margin range that's there as well. As you heard from my commentary, and you can see in the numbers, we're already at the bottom end and we've left the range wide open, which I think you all know me by now.

謝謝你，哈桑。我會處理其中的一些問題，馬丁，也許你可以回答關於磷酸鹽結合劑的第三個問題。但讓我先解釋一下我能解釋的內容，然後把麥克風交給馬丁。是的，你看，關於息稅前利潤預期，我們一直都知道息稅前利潤範圍很廣，因為隱含的利潤率範圍也很大。正如你們從我的評論中聽到的，以及從數據中看到的，我們已經觸底反彈，而且我們把波動範圍擴大了很多，我想你們現在都知道我的風格了。

That tells you that I do think that there are opportunities for that top end to also be in play. As you can appreciate, a slightly bigger number on FME25, slightly less impact from exchange, those numbers can move the needle kind of around that range. So you know I don't shoot for the bottom end. We are still excited about the underlying growth, the momentum we're seeing, and that's why I've left the range wide open. On treatment growth, you know I've been trying to put a lot more color on inflows and outflows rather than orienting around the net number because there's a lot happening there.

這說明我認為高端市場也有機會發揮作用。如您所理解的，FME25 數值稍大一些，匯率的影響稍小一些，這些數值就能讓結果在這個範圍內波動。所以你知道我不會追求最低端。我們仍然對潛在的成長勢頭感到興奮，這就是為什麼我沒有設定過高的利率區間。關於治療增長，你知道我一直試圖更多地關注流入和流出，而不是關注淨數字，因為那裡發生了很多事情。

Over the course of the year, we have seen improving admissions. If I look at it versus Q3 this year versus Q3 last year, they are improving and nine months over nine months is improving. Mortality is down, but still elevated. And missed treatment, we are chipping away at and making improvements. I think the commentary you've seen from the industry is they have been higher, but we are really excited about the work that we've been investing in, taking hold.

在過去一年中，我們看到招生情況有所改善。如果我比較今年第三季和去年第三季的數據，就會發現情況正在好轉，過去九個月的數據也在改善。死亡率下降，但仍居高不下。對於錯過的治療，我們正在逐步改進。我認為業內人士的評論是，價格一直居高不下，但我們對我們一直投資的項目取得成效感到非常興奮。

So that missed treatment number is improving as well, along with all the patient safety and patient quality work we're doing. So we're excited about that. (inaudible), I didn't touch there. On your flu. Obviously, we did have a severe flu season in the first part of this year. And you're right. You remember that number correctly, 60 basis points impact.

因此，漏診人數也在減少，同時我們也努力提升病患安全和病患品質。所以我們對此感到很興奮。 （聽不清楚）我沒碰那裡。關於你的流感。顯然，今年上半年我們經歷了嚴重的流感季。你說得對。你沒記錯，影響是 60 個基點。

We will have to see how the flu season kind of develops, obviously, in Q4. I'm excited about, as you can probably tell, and encouraged by the high level of vaccinations. That's great despite the narrative maybe catching the headlines in the US. Our patients are taking good care of themselves. And we are taking good care of them.

顯然，我們得看看第四季流感季的發展。正如你可能已經看到的那樣，我對如此高的疫苗接種率感到興奮和鼓舞。儘管這一說法可能在美國引起了廣泛關注，但這仍然是一件好事。我們的病人都很注意照顧自己。我們會好好照顧他們。

So we'll see how that develops. But obviously, that's a year-over-year depending on how we see -- how severe a flu season. If it is a severe flu season is going into next year, which the -- kind of the other question that you have on the 2%.

所以，我們拭目以待事態發展。但很顯然，這是逐年變化的，取決於我們如何看待流感季的嚴重程度。如果明年流感季依然嚴重，那麼——你提出的另一個關於 2% 的問題。

We're still confident in that 2% once we see mortality normalize. And as we know, mortality is still elevated. And of course, we're in slightly positive territory currently. So the funnel improving obviously helps all the work we're doing on outflows obviously helps. And once that mortality level normalizes, we have no reason to believe we don't get back to 2%. And obviously, we'll give our best stab on that once we kind of finalize our outlook for 2026.

一旦死亡率恢復正常，我們仍然對2%的目標充滿信心。正如我們所知，死亡率仍然居高不下。當然，我們目前處於略微積極的狀態。所以，漏斗的改善顯然有助於我們所有關於流出的工作，這顯然也有助於。一旦死亡率恢復正常，我們沒有理由相信死亡率不會回到 2%。顯然，一旦我們最終確定了 2026 年的展望，我們就會盡最大努力實現這一點。

And don't forget, I mean, I know it's -- we're kind of in the early stages of HDF, but our expectation as HDF continues to get traction over the course of 2026 that will also help with kind of mortality, missed treatments, et cetera. So there's a lot in your question. Hopefully, I covered all my pieces. And Martin, do you want to just take that Q3 phosphate binder question?

別忘了，我的意思是，我知道我們現在還處於 HDF 的早期階段，但我們期望隨著 HDF 在 2026 年繼續取得進展，這也將有助於降低死亡率、減少漏診等問題。所以你的問題包含的資訊量很大。希望我已經涵蓋了所有內容。馬丁，你想只回答關於磷酸鹽結合劑的第三個問題嗎？

Hassan. Let's take the phosphate binder. As Helen outlined, we did see a pickup in the third quarter against the second quarter in our pharma business, whereas the clinic business assumptions are coming in broadly as expected. For the third quarter, the total effect of phosphate binders was a mid-double-digit million amount and to underpin the EUR180 million that Helen mentioned, we are also assuming a similar dynamic on the pharma side in the fourth quarter, a similar amount in the fourth quarter as well.

哈桑。我們以磷酸鹽結合劑為例。正如海倫所概述的那樣，我們的製藥業務在第三季度確實比第二季度有所回升，而診所業務的假設基本上符合預期。第三季度，磷酸鹽結合劑的總影響額為數千萬歐元，為了支撐海倫提到的 1.8 億歐元，我們也假設第四季製藥方面會有類似的動態，第四季的金額也與之類似。

Hugo, BNP.

雨果，法國國家黨。

A quick one on FME25, which you upside. Can you maybe point to the reasons for that? Is that production move to Mexico that's finally kicking in or any other things? And second, on the rollout of HVHDF, can you maybe share the number of clinics? Sorry if I missed that. And compared to your plan presented at the Capital Markets Day, given the early learnings that you have from the rollout. Does it change anything in your plan from 2026 in terms of how fast you think you will be able to deploy that instrument?

簡單介紹一下FME25，它的優點在於…您能否指出其中的原因？是生產線轉移到墨西哥的計畫終於開始實施了嗎？還是另有其他原因？其次，關於 HVHDF 的推廣，您能否透露一下診所的數量？如果我錯過了，請見諒。與您在資本市場日提出的計劃相比，考慮到您在推廣過程中獲得的初步經驗。從 2026 年起，這是否會改變您部署該儀器的速度計劃？

Martin, do you want to take the FME25 question, I'll pick up with HDF?

Martin，你想回答 FME25 的問題嗎？我來回答 HDF 的問題。

Yeah. Sure. So as you saw in the third quarter, we had strong momentum and we are already after 9 months almost at the full year original guide that we had for FME25+. And that momentum is continuing. And as Helen outlined, we are pushing to further accelerate our efforts.

是的。當然。正如您在第三季所看到的，我們取得了強勁的成長勢頭，9 個月後，我們已經幾乎達到了 FME25+ 全年的原始目標。而且這種勢頭還在持續。正如海倫所概述的那樣，我們正在努力進一步加快我們的工作步伐。

That is true for Care Enablement, where this also helps us to offset some of the inflation and FX transaction headwinds that we have, but it's also true for the global functions as well as for Care Delivery. So we are making good progress, and we are leveraging that momentum, hence, the upgrade of around EUR40 million that Helen articulated.

對於護理賦能而言，情況確實如此，這也有助於我們抵消一些通貨膨脹和外匯交易帶來的不利影響；對於全球職能部門以及護理交付部門而言，情況也是如此。因此，我們取得了良好的進展，並且正在利用這種勢頭，因此，正如海倫所闡述的那樣，升級了約 4000 萬歐元。

Thanks, Martin. And then Hugo, on HDF, as you can all appreciate, we are in the early rollout, and we are adding it to a very small number of clinics, and we're adding them as we go. In fact, we added two more just last week that continues to gain momentum, and we are progressing every day with our kind of installations, training, learnings, getting patients, not just on the new machine, but maybe more importantly on the HDF machine. So that will continue through the rest of the year. And yes, we're fully on track with what we shared for 2026 at our Capital Markets Day. So exciting times for us.

謝謝你，馬丁。然後，Hugo，關於HDF，正如大家所了解的，我們正處於早期推廣階段，目前只在極少數診所中推廣，並且會逐步增加診所的數量。事實上，就在上週，我們又增加了兩台設備，而且勢頭還在不斷增強中。我們每天都在進行各種安裝、訓練、學習，讓患者使用新機器，但更重要的是，讓患者使用 HDF 機器。所以這種情況將持續到今年底。是的，我們完全按照在資本市場日上公佈的 2026 年計劃進行。對我們來說，這是令人興奮的時刻。

Graham, UBS.

格雷厄姆，瑞銀集團。

Just in terms of thinking about Care Delivery and sort of the moving parts for next year, I know it just directionally, but just phosphate binders presumably just lapping it becomes a bit tougher and it's been such a big driver of growth this year. Is it not reasonable to think that volume -- like US volume growth becomes more important? And just if I look at the first nine months of this year, 2024 and 2023, there's not a huge difference. And obviously, next year, we've got the head-to-head of like HDF coming through, but then equally maybe some new drugs for IgA nephropathy.

就思考護理服務以及明年的發展方向而言，我知道這只是一個大致的方向，但磷酸鹽結合劑的研磨可能會變得更加困難，而它一直是今年成長的主要驅動力。難道認為銷售量（例如美國銷售成長）變得越來越重要，這種想法不合理嗎？如果我看今年、2024 年和 2023 年的前九個月，就會發現並沒有太大的差異。顯然，明年我們將迎來 HDF 等藥物的正面交鋒，但同時也可能會有一些治療 IgA 腎病的新藥問世。

So when you look at it, just like how confident are you that you can generate volume growth, which in turn generates operating leverage rather than phosphate binders and cost savings driving Care Delivery margins, just as we shift away from the cost piece driving growth and more so the actual top line?

所以，當你審視這個問題時，就像你有多大信心能夠實現銷量成長，從而產生營運槓桿，而不是磷酸鹽黏合劑和成本節約來推動護理服務利潤率一樣，正如我們逐漸從成本驅動成長轉向實際營收成長一樣？

Yeah. Thanks, Graham. Great question. So obviously, as we're trying to help you guys think about phosphate binders. You can obviously see where we are seeing the benefit is in our pharma business. So that's less of an FKC topic, more of just the pharma volume, which we do supply those projects both within our own clinics, but also to outside customers. So that -- while we're still in this period through 2026 will become a topic of what is the volume, what is the utilization of those drugs and what is the pricing. So obviously, we have to see how that plays out.

是的。謝謝你，格雷厄姆。問得好。所以很明顯，我們正在努力幫助大家思考磷酸鹽結合劑的問題。很明顯，我們在製藥業務中看到了這種優勢。所以這與其說是 FKC 的話題，不如說是製藥量的問題，我們不僅為我們自己的診所提供這些項目所需的藥品，也為外部客戶提供藥品。因此，到 2026 年，我們仍將關注藥物的數量、使用情況和定價等問題。所以很顯然，我們得看看事情會如何發展。

And obviously, on your question on volume, while we've got these low volumes and numbers, you can obviously see that the impact on EBIT in itself is not the number that makes or breaks any given year. And as you know, in running this business, it is all about kind of the balance and think about those moving parts for next year, the balance of underlying volume kind of the reimbursement, our operating leverage and utilization in our clinics. So we're kind of taking a hard look at that. And then the efficiencies that we drive and obviously managing labor.

顯然，關於您提出的銷量問題，雖然銷量和數字都很低，但顯然，對息稅前利潤的影響本身並不是決定任何一年成敗的關鍵因素。如您所知，經營這項業務的關鍵在於保持平衡，並考慮明年的各種變化因素，例如基礎業務量、報銷情況、我們的營運槓桿以及診所的利用率之間的平衡。所以我們正在認真研究這個問題。然後是我們提高效率，而且顯然還有勞動力管理。

So as we all appreciate, volume is always helpful to drive that operating leverage. And I think the other thing here is that there are parts of our country in places that we operate that we are seeing growth, and we are really pleased with that progress. So we're kind of constantly amongst our 2,600 network of clinics, looking at where we're seeing growth, where there's opportunity to further grow and expand. And obviously, in other areas, look to see if we need to sort of consolidate or exit some clinics. So we are preparing all those scenarios, but obviously, under the assumption that volume is returning, and the work that we are doing, which shouldn't be underestimated on the outflow side that if we can reduce hospitalizations and we can reduce missed treatments that obviously adds to the volume on the patients we already have.

正如我們所知，銷售總是有助於提高經營槓桿。我認為還有一點值得一提，那就是在我們開展業務的某些地區，我們看到了成長，我們對此感到非常高興。因此，我們一直在我們 2600 家診所的網路中，觀察哪些地方正在成長，哪些地方有機會進一步成長和擴張。顯然，在其他領域，我們也要看看是否需要整合或退出一些診所。所以我們正在準備所有這些方案，但顯然，前提是業務量正在恢復，而且我們正在做的工作（在出院方面，這項工作不容低估）是，如果我們能夠減少住院人數，減少漏診治療，這顯然會增加我們現有患者的業務量。

So as you say, when you add in the benefit from HDF and for those that are on GLPs, we like that mortality benefit they get to. I think that overall kind of is giving us some confidence that where we can see outside elevated mortality, the things we can control, we're starting to see some improvement on. So I think it's a combination of all the things that we do and what will make us operationally excellent on balancing the volume, the price, the mix, the operating leverage, the clinic footprint and the cost structure. So it's -- I think we understand all those moving parts and more than ever seeing the benefits of the work we've been doing this past couple of years on the turnaround and transformation.

正如你所說，當把 HDF 的好處加上那些接受 GLP 治療的人所獲得的死亡率益處時，我們很喜歡他們所獲得的這種好處。我認為總體而言，這讓我們有信心，在死亡率上升之外，在我們能夠控制的方面，我們開始看到一些改善。所以我認為這是我們所做一切事情的綜合結果，這將使我們在營運上做到卓越，平衡銷售、價格、產品組合、營運槓桿、診所規模和成本結構。所以——我認為我們了解所有這些動態因素，並且比以往任何時候都更清楚地看到了過去幾年我們在扭轉局面和轉型方面所做工作的益處。

Maybe just a quick one on the HDF benefit. Should we -- just based on what we saw in CONVINCE should we see kind of a benefit in the actual headline US treatment number next year? Or should we think about it maybe more like a phasing into the first half of, say, '27?

或許可以簡單介紹一下HDF的好處。我們是否應該——僅根據我們在 CONVINCE 研究中看到的情況——看到明年美國實際治療人數出現某種程度的改善？或者我們應該把它看作是逐步過渡到 2027 年上半年的過程？

Look, I think the expectation is once patients are on it, the CONVINCE trial did show that after three months, we got benefit. So as we ramp up for those patients that are on it, we should start to see improvement. Now obviously, as it ramps up, we -- I would say, maybe this time next year, we can start to say, hey, this is what benefit we're getting from those patients on HDF, but we're going to need to kind of get that data behind us.

你看，我認為預期是，一旦病人開始接受治療，CONVINCE 試驗確實表明，三個月後，我們就能獲得益處。因此，隨著我們加強對正在接受治療的患者的治療力度，我們應該會開始看到療效。顯然，隨著治療的推進，我們——我想說，也許明年這個時候，我們就可以開始說，嘿，這就是我們從接受 HDF 治療的患者身上獲得的益處，但我們需要先收集這些數據。

Obviously, '26 being the ramp-up year, you won't feel or see the full effect. But we are -- as you can appreciate, this is an opportunity for us to track patient 0, if you will, and really start to kind of see the data of those patients that are on HDF and what their performance is on that -- on this treatment. So '26 maybe -- not maybe while we're excited, obviously, it is ramping up over the years. So we will tease out the relevant KPIs as we go through next year and report on what seems to be kind of the right insights for you guys.

顯然，2026 年是啟動年，你不會感受到或看到全部效果。但是，正如您所理解的，這是一個讓我們追蹤 0 號病人的機會，並且真正開始了解那些接受 HDF 治療的病人的數據以及他們在這種治療中的表現。所以，2026 年或許——不是或許，雖然我們很興奮，但顯然，它正在逐年加速發展。因此，我們將在明年逐步找出相關的關鍵績效指標，並向大家報告我們認為比較適合的見解。

David, JPMorgan.

David，摩根大通。

Firstly, maybe your key competitor, DaVita quantified the impact on EBIT next year, well, actually the next three years, if the subsidies aren't extended. I'm just wondered if you were willing to do the same. And then secondly, just a bit of a specific one. But volumes in Q3, were they impacted negatively by a sales day mix? And does that become a tailwind in the fourth quarter?

首先，也許你的主要競爭對手 DaVita 已經量化瞭如果補貼不延長，對明年（實際上是未來三年）息稅前利潤的影響。我只是想知道你是否也願意這麼做。其次，還有一點比較具體的問題。但第三季的銷售是否受到銷售日期組合的負面影響？那這會在第四季成為順風嗎？

Yeah. Thanks, David. Let me tackle that first -- the second one first. [Same] market treatment growth for us normalizes days. So our 0.1% is like-for-like. Where it would be impacted on mixed days is on the overall treatment numbers. So our same market treatment growth is pure. So just want to dispel any conclusion that the market might have picked up on that one. David, on 2026, as you can appreciate, we're still in, as I've mentioned, still in planning, I'm not prepared to put any number out there while we're still working through that and even reviewing it. We haven't reviewed it with our -- finalized it with our management Board at a known Supervisory Board at this point.

是的。謝謝你，大衛。讓我先解決第二個問題。 [同樣的]市場治療成長對我們來說已經恢復正常了。因此，我們的 0.1% 是同類比較的結果。混合日受影響的地方在於整體治療人數。因此，我們同樣的市場治療成長是純粹的。所以，我只是想消除市場可能已經注意到這一點的任何結論。大衛，正如你所理解的，關於 2026 年，我們仍然處於規劃階段，正如我之前提到的，我們仍在進行規劃，在我們仍在研究和審查期間，我不准備給出任何具體的數字。目前我們還沒有與管理委員會或已知的監事會進行審查並最終確定。

So I think you understand the levers, you understand our usual headwinds and tailwinds, you understand some of the moving parts that we're watching. I think that's all I can say at this point, and you'd be surprised if I said anything different because you know me, but thank you for asking.

所以我覺得你了解了其中的利害關係，了解了我們通常會遇到的逆風和順風，也了解了我們正在關注的一些動態因素。我想我目前只能說這麼多了，如果你了解我，如果我說別的，你會很驚訝的，不過還是謝謝你的關心。

Anna, Bank of America.

安娜，美國銀行。

Maybe as a follow-up to one of Graham's questions on the impact of the HVHDF rollout for next year. Do you think that could start to positively impact US same market treatment growth from a referral standpoint as soon as next year? Just any color on how you're thinking about that. And then as well on the Care Delivery growth of the 5.6%, those three components, the favorable rate mix, phosphate binders and implicit price concessions decreasing, I think you've broken out the phosphate binders pretty clearly, but any other numbers you could give us around those other two components and how you expect those to trend into Q4 would be super helpful.

或許可以作為對格雷厄姆提出的關於明年 HVHDF 推廣的影響問題的後續回應。您認為這能否從轉診角度最早在明年開始對美國同市場治療成長產生正面影響？你對這件事的看法可以用任何顏色來形容。此外，關於護理服務增長 5.6%，這三個組成部分——有利的費率組合、磷酸鹽結合劑和隱性價格讓步的減少——我認為您已經很清楚地解釋了磷酸鹽結合劑的情況，但如果您能提供關於其他兩個組成部分的任何其他數據，以及您預計它們在第四季度的趨勢，那將非常有幫助。

Yeah. Thanks, Anna. Let me take the HDF question, and Martin can maybe unpack the CD question that you have. Look, on your referrals number, yes, I would suggest and think that, that is, my pen just fell apart that would help us positively. I deliberately read the quote from one of our nephrologists and we've had a number of nephrologists kind of coming through our clinics to see this.

是的。謝謝你，安娜。我來回答HDF的問題，也許Martin可以解答你關於CD的問題。你看，關於你的推薦人數，是的，我會建議並認為，也就是說，我的筆壞了，這會對我們產生正面的影響。我特意讀了我們一位腎臟科醫生的引言，而且我們診所也來過不少腎臟科醫生，他們都看過這篇。

So yes, we have seen significant interest and positive feedback and we are being -- as you can appreciate, quite deliberate in where we are launching HDF first. So that is, yes, really exciting. And as you kind of -- on the back of Graham's question, that mortality improvement and the kind of the increased treatment improvement, we should see as soon as we get patients moving on this, and that should ramp up over '26. So really exciting to see that, and I can't wait to hear how [AFN] goes this week, but the team that's there.

是的，我們已經看到了極大的興趣和積極的回饋，而且正如您所理解的，我們在HDF的首發地點方面非常謹慎。是的，這真的很令人興奮。正如你所說——在格雷厄姆的問題之後，死亡率的改善和治療水平的提高，一旦患者開始接受治療，我們就應該看到，而且這種情況應該會在 2026 年加速發展。看到這個消息真的令人興奮，我迫不及待地想聽聽本週 [AFN] 的情況，以及那裡的團隊。

Martin, do you want to take the CD piece?

馬丁，你想拿那張CD嗎？

Sure. And for the implicit price concessions as well as for the rate mix assumptions that we have for CD. You saw this being a positive in quarter three. This is the work we do in revenue cycle management paying off and us increasing our revenue yield. So we are collecting more for the amounts that we invoice. This is an ongoing effort, and we are seeing the first benefits and we do expect this to also be a positive in the coming quarters for us as well. And that does also impact then on the, let's say, underlying performance improvement and will be a positive.

當然。對於 CD 而言，隱含的價格優惠以及利率組合假設也是如此。你在第三季就看到了這一點，認為這是一個正面的訊號。這就是我們在收入週期管理方面所做的工作取得成效，並提高了我們的收入收益率的原因。因此，我們收到的發票金額更多了。這是一項持續進行的工作，我們已經看到了初步成效，並且我們預計在接下來的幾個季度裡，這也將給我們帶來積極的影響。這也會對潛在的性能提升產生影響，並且會產生積極作用。

So we do not have any further questions. I would like to thank you all for listening and for asking questions and being interested and hope to see many of you on the road in the next couple of weeks. Thank you.

所以我們沒有其他問題了。感謝大家的聆聽、提問和關注，希望在接下來的幾週能在路上見到你們中的許多人。謝謝。

Thanks all.

謝謝大家。

Thank you.

謝謝。

Take care. Bye-bye.

小心。再見。

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，會議到此結束。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了。再見。

Statements in English on this transcript were spoken by an interpreter present on the live call. The interpreter was provided by the company sponsoring this event.

本記錄稿中的英文陳述是由現場通話中的口譯員翻譯的。本次活動的翻譯人員由活動贊助公司提供。