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DaVita (DVA)

Participants
Jim Gustafson Vice President, Investor Relations
Javier Rodriguez Chief Executive Officer
Joel Ackerman Chief Financial Officer
LeAnne Zumwalt Group Vice President
Jim Hilger Chief Accounting Officer
Justin Lake Wolfe Research
Kevin Fischbeck Bank of America
Pito Chickering Deutsche Bank
Stephen Tanal Goldman Sachs
Whit Mayo UBS
Gary Taylor JPMorgan
Justin Lake Wolfe Research
Maggie Jiang Bank of China New York
Call transcript
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Operator

Good evening. My name is Debbie, and I will be your conference facilitator today. At this time, I would like to welcome everyone to the DaVita Fourth Quarter 2019 Earnings Call. All lines have been placed on mute to prevent any background noise. After the speakers’ remarks, there will be a question-and-answer period. you. Thank Instructions] [Operator Mr. begin may your you conference. Gustafson,

Jim Gustafson

and and call. Hilger, Chief We you I'm CEO; Gustafson, Investor Joel welcome Rodriguez, CFO; Accounting are in Vice everyone conference quarter Jim President; Relations, of President Zumwalt, fourth Ackerman, our Vice me appreciate our our company. today Javier to our Thank with LeAnne your Group our interest continued Jim and Officer.

securities meaning laws. call, we may forward-looking of that the note the federal during this Please statements make within

All are could unknown the the materially statements of and actual risks described those differ and these known to subject to uncertainties in cause that statements. from forward-looking results

most risks subsequent fourth further press SEC Form release reports concerning these refer our on please our on quarter annual XX-K Form and recent For quarterly XX-Q. report and earnings our to and details including uncertainties filing,

information Our to no available currently to forward-looking us these undertake update based statements. are we and duty not statements intend upon do and

Additionally, non-GAAP on this we'd measures most like to measures available will comparable submitted these our press to GAAP and measures. is to release reconciliation financial discuss SEC the non-GAAP the earnings financial website. during of we call in A included our remind you that some

over call now turn Javier I'll the to Rodriguez.

Javier Rodriguez

as than to afternoon, reminder you, your provide and highlights look start of your questions will we everyone. forward life-sustaining people. that more and and Thank a Jim interest good clinical with to appreciate care We in DaVita XXX,XXX comments. I

to discuss life. our of total of patient's we cost care, our While outcomes improve goal is and clinical the lowering quality

out is XX% kept hospital. the patients prior are many of have mortality. This in and prone lengthy infections and off. I’m of our on In often of infection hospitalization XX% in by to the patient's efforts we rate rate days paid has year. of to meaningful DaVita's report excited improved lead versus improvement a specific been can example One focus patients. peritonitis to reducing reduce to infection by increase bloodstream the the XXXX, that their which our

me and results in growth let free We earnings year. to the our had per for outlook share strong performance and transition set XXXX. for Now cash flow XXXX. we target We met a

XXXX fact raising are target will and provide committed XXXX financial guidance. by we financial guidance and both are our $X.XX. our range the in our achieving to the earnings-per-share details on We quarter Joe

Now few a policy. let minutes on share up views me for high on clinical our to level and pull

We are in an care. kidney exciting for time

transition from to nephrologist's the bridging care. are care the of office We types of different

to with avoiding failure. use on CKD the ESRD. working patients analytics our we patients, highest onset of of delaying risk or with to support payers identify predictive Once work the We will to are we these kidney transitioned

about that time. care the excited Provide and world-class with to deploy the best DaVita care be help to nephrology the practice. to nephrologists for physicians new at led connect remain will person X,XXX analytics physician education entity their lines, We nephrologists right goal nearly the time The the vehicle right is simple. to

or empower treatment patients ESRD patients choose start a leading right to transition the who with platform to For those for both to to modality do on education them.

XXXX, ever chose in the -- who serve of modality. most in we home patients platform home high For where provider. any modality, highest growth to our our we continue leading home In patients saw invest PD we our

goal the leadership in double-digit our in of home a PD growth We the are working XXXX achieving modality. dialysis with to maintain

policy. Moving on to

multi-year We journey continue care. our integrated towards

ESCO. such by as are in evident the our improvement We demonstration the are encouraged quality that

while goal value-based the remain cost. will we’ve capabilities collective We managing view that We will national administration's are and the be models built additional for improve care at hopeful support there We optimistic outcomes, clinical ESRD scale opportunities to integrated for believe patients that our total models. care about that levels. to

has been ESRD Century patient. with intent that about lot patient, pass We Act. remind of of to everyone the Medicare and this XXst There Congress conversation Medicare advantage options Cures a would legislation making the recent eligible insurance available additional

to no will respect know expectations one really patient. by made the choices what of With adoption, be

the advance continue We to of patient. gradual. into selection MA with and focused forward to said Medicare partners both funding the And before, will are In we’ve efforts we in eager advocacy for believe our manage remain fee-for-service as and working that the population. care Medicare look We and more be on to plan to these MA. parallel, adequate integrated fee-for-service cost care ready ensuring

policy. state to Shifting

unions California other advocating patients keep labor will policies or costs and the for care that good for system. some states pursuing patients, where We are in our delivery not are

Joe, he let and so the to provide transfer quarter me it on details guidance. additional specific will on on XXXX Now

Joel Ackerman

Thanks, Javier.

I appeared the historically like out that most hope quarter. the results this release. We I the important of to to Before begin, will we’ve section have that the investors later give first point access easier would release press some adjusted of in format this

I the increase revenue XXXX an Now billion of start results and in quarter, generated of with over then X.XX% will to $X.X We move QX XXXX. guidance. QX

operations income approximately profit $XX million was included million, was related $XXX in calcimimetics, margin an $X.XX. XX%.Earnings share in to per operating Our from of operating resulting which continuing

drivers, sequentially of quarters. for flat revenue decrease to U.S with attributable down relatively Non-acquired quarter with which Now a dialysis the was components prior some $X.XX per me the by the treatment Revenue growth starting X.X%, per $X.XX, the was in let includes treatment segment. and calcimimetics. take the lab through of underlying two

Excluding calcimimetics, $X.XX%. up RPT by was

impact provided our guidance, guidance a X%. We to X% recap to XXXX points. of on narrow range finished the that XXXX range RPT calcimimetics, the sell approximately the year-over-year very outside XX of at of we and of we mix of high-end To ended performance for decrease basis full-year the commercial versus with exclude

did not impact a Although our on per treatment. decline meaningful revenue this have

by driven compensation benefits care patient quarter-over-quarter, expense segment, G&A costs. dialysis and and per primarily Combined lower costs $X approximately down treatment lab and was

in revenue per and quarter the $XX cost We treatment generated Turning per to of and respectively. $X.XX, and of calcimimetics. $XX.XX operating fourth income treatment approximately million

cost For the operating full-year, on we negotiated calcimimetics. million we decreases significant oral as $XXX generated approximately in income

now expect approximately decline For of the subsequent this around to $XX given complexity in with realized to approximately there income operating ASP million the of first the be expect from calcimimetics significant as quarter this ASP With methodology. that XXXX, million uncertainty reimbursement to quarters. half in still we we $XX are said, outlook in

international. to turning Now

million. $X was For the million FX of approximately quarter, loss $X operating an including income

the For including an we operating goodwill $X of $X excluding adjusted and income positive loss of million, generated full-year, million. impairments FX

XX.X% XX.X% adjusted DaVita to on the attributable rate continuing the and operations for full-year. tax was effective from for income quarter Our was

for full-year the state a from in tax rate the fourth Our tax decrease and quarter effective rate. benefited estimated our

with cash cash Now $X.X flow were positively impacted $X cash and flow. cash XXXX flow from was continuing billion flow operating on Both to operations our free billion. by operating cash free The flow cash full-year and not significant unusually million. low recur in two combined in these expect and in our These DSOs by improvements factors approximately XXXX. cash We the improve $XXX taxes to XXXX. to do during year flow

the The project year of to million to due the was $XXX $XXX for million $XXX were guidance below certain guidance better the of initial timing well the range XXXX. $XXX million $XXX year revised CapEx below million. and to of slightly in that from our results pushed was QX million, into

$XX.XX almost average amount million per share. an we shares XXXX, purchased Since X.X October of X, at

As reduced or share the million close in XX.X by a XX.X% our June the repurchases, our DMG we since recent count result of approximately of transaction XXXX. shares

on our interest in B now week rate basis subsequent to then term will expect be our billion in repricing expect loan XXXX to expense This that quarter reduce quarters. the debt approximately we complete debt of approximately of this We million the per QX million by $XX XX $X.X our tranche and $XX points.

$X.XX. with our our comments by earnings share XXXX. We're to guidance per conclude per some $X.XX share will on I for $X.XX XXXX adjusted guidance ranges updating to

calcimimetics as in expect reminder, of the this Due that of the a quarters includes cost ballot as this from the mentioned costs in timing half well fluctuations of some I timing related per expected second to of earnings expected and between the we California. year, calcimimetics benefits expected in the the initiative year. share ballot As

$XX.X with guidance income talked our Our we XX% Markets billion at of to XX% revenue Capital to operating that for about $XX.X consistent range our margin the year target Day. is guidance is the billion and

year. generate expect to to approximately this We $XXX million flow free of $XXX cash million

future. that time point of changes tax our swing point other the payments out AR. other such its than subject inter-period I flow way of working This is to cycle, some cash the in to as swing XXXX and in will the and and the could collections timing at in greater worked favor payroll income of the in due inherently items capital operating

for Operator, questions. let's now the line open

Operator

Justin from come Thank Instructions] Research. you. question Wolfe will And first our with [Operator Lake

now Your line is open.

Justin Lake

parts Thanks. here. couple wanted go through to a moving Good I afternoon. of

could First, as costs, there you out two-thirds Is of calcimimetics moving rest before. it range EPS it coming lower to moving the numbers on or debt the the tell about wasn’t from of -- coming in California including ACAS? Maybe us delaying benefit in terms kind of of parts part any maybe higher other from that legislation kind year-over-year. implementation the think fair

Joel Ackerman

Sure.

of right. our plays basics this got this. moving pieces other out. well. two are So, decrease the in are cost XXX in in a is And things call the component for a into you’ve Calcimimetics Justin, lot AB biggest the There as the Those of expected here. big I'd --

moves call share related Our the whole and in of OI. stock price to up XXX say, other out. the I bunch the calcimimetics AB to things as big things are core around count two would goes a But

Justin Lake

that us? you XX. can sustainability down or think in give XX in And you Maybe just the of terms there on expect do update have I do one any the you a mind old neutral? us kind calcimimetics migrate was then, XXXX, your still beyond of new XXX Great. for number to is an AB to change of to --

Joel Ackerman

Sure.

will calcimimetics, we down course migrate the under of it zero still that current the to over on expect XXXX. So TDAPA

can positive down down we know behaved three come pretty result to the ago. of black the has of zero We have how ASP the months to box the that see, would don't predict some the has this way end it combined of our -- think get we do expected numbers XXXX by The of industry for would year. natures how been of improved, not you to we been -- have close is but with not visibility on rest ASP the able coming we've the ASP as down. I

said, the certainly the towards year. In end possibility a XXX Clearly that be there have and AB That terms number the the of some with we be smaller. will associated there implemented is legal gets AB costs of XXX, will don't it new number.

number, specific So clearly I but XX don't a a where it's the size numbers calling are worth getting XX. to below think the out to

Justin Lake

Okay.

Just just of to fair you range, [multiple follow-up the and I queue. The that come before jump kind falls is a one calcimimetics, think back need normal speakers]? number here it and costs kind we that in last $X to say down it track so of [ph] to the ASP to have

Joel Ackerman

saying to not cost bit, for a the the XXXX ASP. but I’m continue is of Yes, couldn’t action real down drift trajectory little on

Justin Lake

guys. helpful. Thanks, That’s

Operator

of will next The Kevin Bank America. question from come Fischbeck with

is now Your line open.

Kevin Fischbeck

bit in I X% to Wanted of [indiscernible] growth your midpoint a little you’re a in metrics, because there it the kind XXXX about per this revenue of year. Great. your of at of year's for looks the guidance like guidance, context lot guess ask kind

is headwind right point year's that still a number, the off. number ABXX goes the to So to that guess, the now think in versus or out. wanted maybe 'XX to different 'XX I I Is this And of are point, is that way have there a I I into going And your guidance guess jumping there long-term still just guess about then, think guidance place. trying that trajectory. calcimimetics about things guess understand coming assumes here to the

out Just to thing make wanted if [multiple one speakers]? are have to that we to we sure that's figure trying

Joel Ackerman

Yes.

here of XXX and both of going into those factors AB place. So you're coming calcimimetics out spot on

taxes. cash and surprisingly script the two number, high factors, In helped note flow impact in that as DSOs things the cash come which terms call OI. flow also on had of was well as and other the calcimimetics cash we down having out of XXXX I've the on the of are called the as some by well I'd was out,

than expected. happened faster that So

in the We also year we're the pushed benefited into extent in the by CapEx of late getting some some expecting to year XXXX.

way. XXXX get number The flip spoke possibility one impacted So and the see of the the XXXX by of about could either to that negative. certainly XX% push is I'd XXXX that margins into There that XX%. call to might some the margins. we other at out will end is We the thing

so think stick number. of about that could world, are margins what as and We changing the with I'd in the view that not XXXX, be you

Kevin Fischbeck

the worry this be Okay. of an MA. That's I sounds helpful. the into on And them companies care then guess, managed preliminary starting I to it appreciate like But is for comments issue are to in going some XXXX.

was wondering anything that companies? you’re years? your on impact there your conversations you change with that rates you talk pushback the I MA it's next about or going you kind the or So Is that would of there highlight have few could over to if could the impact on having

Javier Rodriguez

a is fair We've Javier. This of Kevin. gotten Thanks, MA. amount on questions

the this Number useful population it's the right population, the to pull I and up was to having patient that just pick from excluded one, so it. the And a ESRD only little revisit of origin is MA. think

best is rate it a just role are you what our so patients size try forward? three that system. And something number is sure is like the so the to was of other in volume. is everybody individually. one role the is trying deficiency two two, fixing can to our there's going they and and Number Point variables, one well it make And course, size when this, is make decision informed our

so rate below our said And above commercial. what is we’ve Medicare, is substantially but that

of is coverage individual know not the going lot that’s primary is of pickup etcetera. volume of most the as variable. you the anymore have a We undecided this Medigap at The they and of when all the give which variables we juncture are same insurance, do, one sort that on do play at there's to insurance, the has secondary

to continue will market. to we reasonable overall reflect think the So that think it’s that penetration

there's sort in Medicare many pick In of variables to believe for complicated an that quite so they time been some of quick trigger will going. quo addition, when have patients many have and people might keep just many our status a insurance them

know that So we're people to their of benefit, size it'll and it's so literally and asking movement going continue interpret how some be think don't an we we gradual. to be and patients kind will aggressive our many continuing to so that are more

Kevin Fischbeck

reason want case currently those maybe definitely wouldn't just by that that's that rate the two you I thoughts time, that. to managed anything that as down I guess about think that way that? care, the why delta think you you be that standard whatever bring keep differential over I you things more that contract sustainable? makes would you measure, think that there guess, you that on change could any of Is you -- helpful. obviously take you it be get with think like but but is maybe guess, risk there could or any that actually economics reason

Joel Ackerman

time so the payer an way we're think to how trying the be to in see we be in that best serve and if a leaning we're patients, to exciting where Yes. our in I make for to care would opportunity sure It's to than us opportunity and to contract our partner. them contract think also volume our way. to integrated it expand MA aligned for an have and might be we us can trying they that we that providers. as an going talk all is And higher that and

higher a and when to excited. want up Obviously, we're rates would we get And they then the is coming lower can never all is win-win We rates. like dance change. situation. going question on So that creative

Kevin Fischbeck

guess it in the to isn't the what -- would an of plan? The with will think benefit is plan? under either tend where quite comes MA tends And into into rationale an MedSup is ends would assume XX% I is to that to be dynamic those people those it where patients adoption XX then available MedSup that people up it's health MA a shift where because you’re which a states in in XX states large. that, a populations, to available, those and be these an analysis options to your meet for daunting that affordable the so taken I why for your way being that eligible point then the three fact kind of when our book. a where that shift patients that for to we to people switch And plan difficulty] times similarly move? see point Is but then for And would there to act able insurance, for MA, Okay. classes [technical inertia those the about way, I of potentially an well are from in a dual change question would of the Medicare incentive there do

Javier Rodriguez

access premise They than discussed, more you about to start and when and that it to is usually for most the because People first of insurance, kind don't some talk the of like want worth on talk the talented which Yes, it's people when not when folks. Netflix deductibles, about those patient you to for you is normal you us episode. talk not say bit been Medicare about watching keep exploring when it anything. their is they’ve vernacular to or time you And might glaze that next works these usually for a talk thing, about over you them. coinsurance, be

it's then and can't that into that their see more you they to just some and see doctor, get so then restrictive, it's people it And tune explain but can benefits got maybe you you got to maybe start out. other

go I have that the the insurance. a have back to is because you’re at the just answer And make new option. so We is no, is, with you obligation to sure think them? our satisfied question it And

-- these could little out might very the all to you pocket that and not situation. of sometimes dual on on so actually that want so And have switch

each the specific that is net again very of it we're not different we with. than but it the are is individual, So the think but we all is range overall there population, very going to to that look playing

Kevin Fischbeck

And like in till Will claims start just open or Is wait to coming that period do is when the you QX, question. you in feel new how during know last period know shift time enrollment patient there the you have the for going? under will actually January you actually a payers?

Javier Rodriguez

I Well, to January. wait to going think we’re till have

stuff, want to we're the We it. that'll how it will have it's first experiencing we predict that going unlikely to preliminary until but see some since time play we're

Kevin Fischbeck

Great. you. Thank Right.

Javier Rodriguez

Thank you, Kevin.

Operator

The will from Pito come next question Chickering.

Your line is open now Bank. with -- Deutsche

Pito Chickering

Hey, for taking questions. Thanks ones here. my A few guys.

revenue And the On the assuming for how treatment? reimbursement what you XXXX commercial treatment in of revenue XXXX? and organic guidance, look per guys are growth terms does

Javier Rodriguez

Sure.

we NAV to on -- are hey, So, to X.X% we’ve guiding X.X%.

commercial in The that continuing years. 'XX one in the similar is have Medicare In the revenue to RPT reimbursement. to we going obviously of per and of the in to what out safe are going that look terms big past. forward on The level of looked We see recent that not That play the next it anymore like forward. fee-for-service and specificity I in Medicare way mix think should said, RPT, say they same we past. RPT two treatment guide terms dynamic recent it's in have got it'll the year we change in to

what next the we at if this focus we how as Capital margin out individual of Markets guide more again, So, we've we recent per as things inputs than as inputs. particularly we’ve seen of the with and to to any Day, year the call is well the there of past. and think consistent what raised subcomponents a want about see RPT than said, on That on think and the you about treatment in anything don't different other the cost

Pito Chickering

If exclude it 'XX and was looks calcimimetics then I on exclude And versus income we guiding me improvement the $XX for XXXX XXXX think how is to quarter guidance, XXXX, we XX.X%. let easy a so XXXX Great. margin First think operating easy XXXX operating XXXX? comp points margin the a basis calcimimetics calcimimetics different XXXX, comp, way. you’re If exclude XXXX? ask this XX as income versus first margin million and should quarter for of XXXX, in of though we very if about for in 'XX, core you about

Joel Ackerman

math, think Okay. you my I and can Pito, if you this Jim I with tight me to you math your you I but doesn't will the kick what way tell lost there about apologize in afterwards. but follow on asked,

normalized in So we excludes of XXXX. numbers, in came XX% this for just adjusted so calcimimetics, north

We we guiding OI. -- again, and to not that are expect

our can with and So at said, again, That -- we through all that top-down revenue we either or that. range. -- the bottoms a Markets sticking up Capital we using and come analysis calcimimetics are EPS, said Day through up a guidance do with you margin math

range much the got I’m to we about, margin out going some if of to what that, I to a probably XX% the XX% what’s And XXXX, of give is although point thinking you relative you in XXX of you still in about So, little there. AB range bit of to very have bit at compression thoughts driving Markets Capital which a Day. in high-level talked versus little what show that should XXXX middle should be

on things continued like some in like pressure also looking strong form with in are costs investments operating we associated environment kidney the at future of data things care, are integrated the around You've and the our got costs, investing home, labor and we making analytics. things in like

Is but helpful? So we little about would if over that things XXXX, very come margin bit together, in the of what up -- much all a of at Capital in put still pressure those you those talked Markets. you range with XXXX

Pito Chickering

very Yes, much.

separate programs. and freestanding as just home based options centers have actually home how down sort Can in you to you coming home So treatments Day well? kidney with Analyst you -- are your the how At of And talked sort mentioned start -- XXXX. capital question. you about of centers growth sort quantify many the XXX today capital of last of many which CapEx

Joel Ackerman

don’t the to answer know I that.

Javier Rodriguez

follow-up it. on will We

Joel Ackerman

on that, with can We you Pito. follow-up

Pito Chickering

so Thanks guys. Great. I appreciate it. much,

Operator

The with from Mark next question will come [ph] Barclays. Andrew

now Your line open. is

Unidentified Analyst

Good afternoon. Hi.

parts. follow-up to all components wanted given moving Just on the the guidance XXXX

raised EPS of reversal $X.XX. by sounds by for calcimimetics accounted the guidance like AB You increase XXX. from and is benefit the that It largely

same say So the in that share the underlying repurchase it repurchase should assumptions combined is of last did $X.X share nice share think given you stock the in of fair few about billion we How size cadence the of and on the to remain with repurchase volume price the months? XXXX in XXXX?

Javier Rodriguez

Sure.

So not of the I a range. to see fundamentals believe haven’t X.Xx, time low-end number in Also of would are of value of of our above in we value ensuring buying second the philosophy to bring press take the of what to intrinsic which leverage will guidance what the our that you'll expectation in share all the time, terms stay general and believe not -- within most repurchase our at intrinsic it leverage -- is here changed is. the on with the focusing at we around although Xx notes X.X, release we

you put range. not that think said, it, with has to a higher think philosophy changed. But end on at think excluding that way I is about If which of our our better calcimimetics, it the all it about buybacks would

that share is we that November two is XXs, really the is buy about just many dollars stock in where ways. we in impact the we fewer that stock will stock I now buyback think that and fundamentally buybacks up you where is is as changed because since is, impact would comparing think to share And to buybacks. stock second the -- our up. to in this to low how from thinking think and does high One XXs about apply what spoke the will the has intrinsic value fundamental price shares the the we XXs,

to about to we're thinking a shied foresight you are -- we how give give of away you that. But kind on of I we always So plan what bit any from update to wanted there things. an do. We’ve in going

Quarter

that into even question month, then And And second penetration? delayed. D.C. or that’s permanent order to color. model Are delay got the the of front. the out you anything appreciate model and home from of dialysis strategy I on last now was the go the mandatory Great. supposed home that on The delayed? executive hearing model your temporary impact why increase does effect

Javier Rodriguez

the views. general I it had and its for community was in very executive the think united in No, on they order lot and asked comments a

the are because so its policy, we other has question, time meeting And to at glad rather driving at movement end and it while that juncture. modality pick the the opposed of to People it the a a physician patient and any the And home. impact day, the picking is the what's the as good of no administration we outcome not taken that's course, want changes to deadline. picking or this which than policy

Unidentified Analyst

Okay, great. Thanks.

Javier Rodriguez

Thank you.

Operator

with The next Goldman Steve question Tanal come from will Sachs.

open. is now Your line

Stephen Tanal

Thanks question. Good guys. for afternoon, the

fact guess I go that patients of idea to the I’m market I can't plan. at they enroll XXXX mean, patient freely in market should ESRD large rule change. despite today, to overall with back wanted the that where notion struggling the So for penetration this ESRD is the penetration the just the XX% I is of reach

took MA last XXxXX rates, and XXXX, like then the forecast the thereafter. with -- to for us to could that penetration exceed XX, and then it panel to anchoring that over up wouldn’t advanced XX% this I tell MA week and XX patient So going but that changes XX notice we prefers guess looks time. probably are their I And that, know in still XX CMS

a outlook obviously guys more have. much optimistic much, than So you

there? thoughts any pieces those So on

Javier Rodriguez

don't proclaim to right. Yes. Steve, I think and are be that reasonable all opinions quite of the we

of -- out-of-pocket coordination network. all sort deductibles, data doing are it the max, narrow to We broader care networks same economic or as network of

to bit people that we course we And the think effective than be that be a for general, longer very in call place, think when market of to think I wrong. the so in we choice and in all that efficient just take it'll little and settle will could we a that, others put variables it what

call insight you on. let's we There's have the base CMS And case so doesn't. it detail and low any don't relying we there case range are additional it, is the or and high information that that that -- the that no

Stephen Tanal

Helpful.

correctly, Okay. just terms whether their imagine you regardless all I I Is And of correct? of states, options. guaranteed to Joel, of that heard not. issue there's in applies your patients that then making for MedSup are or sure aware

Joel Ackerman

Yes.

Stephen Tanal

them to through in the all few go wanted the And then, be the guys to don’t dialysis. about maybe some to general? rule I I there. of I and Okay. through all it here, guess, adequacy extent want won't but I share, go do there. of you I open-ended or guess, about in market that could as leave dissuade but another a this, mitigating guess? that part have I there's to things proposed any you read some ask presumably How the also dynamic, maybe proposals, power time guys network think I'd of

Joel Ackerman

any perspective want contract of what coverage, it we're dynamics state. you doing I appreciate, see it's in Steve. When our up they they is that a a got that’s so up make you don't way critical not. have how we have been so partners up if back disease and from in up network value then network. are that matters to And earlier payer adequacy that ESRD, whether in quite to signing do we signing our end to want restricted so Obviously, course win-win. to with you do going with plans conversation The a or what there the vocal. us want change that is adding our to is you want And we kind having you of some sure end are product and for it then

Stephen Tanal

Helpful. yield. Perfect. maybe one on and then more I this And will

you dictate guess, of to deltas, MA to variability comment I is maybe going Just contract DaVita's MA certain I difference, in can spread? much treatment And lower fee-for-service. don’t that different give his the the there want versus spreads factors to for back what willingness how appreciate plans? that you a guys on but higher

Javier Rodriguez

and very I take to so right contract appreciate contract it if the be with how Steve, at answer but being low us. know to try very probably plan think and I and want to actually risk take answered. And specific the and our to plan specific. Well, ability question, ability is even is to it's had steering it you their risk each Every they now I odds helpful,

give And you detail on that. so I can't unfortunately more

Stephen Tanal

a Thanks it. Appreciate fine. That’s lot.

Joel Ackerman

Thank you.

Operator

with The will come Mayo Whit question from next UBS.

Your line is now open.

Whit Mayo

Hey, afternoon. Good thanks.

couple a Just here calcimimetics. on

year. You’re today's of guiding this that of of rate to the $XXX million the XX% quarter, run OI which to XX% quarter. $XX of first million falling first $XX implies about in is in million

off based the you're what So quarter curious I’m quarter How on? do asking. visibility guess, basing I’m this I have for ASP at just that into you Is today? that the this first much is of what contribution point?

Joel Ackerman

for out The ASP but with a for perfect we QX, in in don't visibility that though good that. pretty won't came QX of that. little so number -- and visibility, ASP we've now. got going forward got we We’ve where I while perfect know trajectory Not what December. visibility think is looks The have like

Whit Mayo

Okay.

about a that’s like looks the right? ASP, quarter that XX% of for fourth is decline that sequential So

Javier Rodriguez

Whit, we … are

Whit Mayo

know … you Do

Joel Ackerman

into that that. There other are factors go

the Sensipar of changing between In and Parsabiv the and mix Parsabiv differential. decline, cost cost terms

get not but … you'd that, as I'm can from like So you sure cleaner as number

Whit Mayo

ASP mean, Is for quarter? the disclose numbers presumably you available, it what I so is it the can --

Joel Ackerman

than little It's Yes. XX%. down a bit more

Whit Mayo

Okay.

factor lower cost up to XX%? the So OI some would other be by your driving

Javier Rodriguez

IV there -- the is other because besides cost factors are between a there well. issue there's as oral and mix Well, the

Whit Mayo

yes, Got Yes, it. it. got

that million, not or -- and million mean, remaining about -- you -- think earnings, should ratably throughout we That's about visibility as the help? how fall mean, we as know into thinking about much this we I I Is I I do. any know, just -- year? Okay. earnings? don’t it do remaining but $XX are of how you’ve the progression the the $XX

Javier Rodriguez

Yes, that’s quarter to if reasonable forward, the algorithm goes about cut it getting by then end half you use to each a zero in think the it going year. of and

Whit Mayo

Okay.

Javier Rodriguez

modeling. to Again you with just prediction. That's that’s not a help your all

Whit Mayo

level by the the industry calcimimetics are of presumably market that carrying from some for where scenario below out that the a time sort calcimimetics, you’ve given been still there time? zero of of benefit sees Is Yes. some buying earnings the you

Joel Ackerman

think ultimately question about get more how numbers the I the terms the bundled. calcimimetics of because so in interesting gets just cost, Unlikely is it small

Whit Mayo

Bundled, yes.

Joel Ackerman

quickly. TDAPA will stuff out play The relatively

Whit Mayo

Okay.

ones. quick other of couple a Just

So X.X level to deceleration. guidance of just implies back some that the does NAG of to X.X

bring your decision influencing to factors any down? maybe Joe the range Just

Javier Rodriguez

Javier. Let me grab that. This is

focusing continue ranges that the growth. think and We place of We're to what the is day, capital right But we land. operations have missions, are that placement. just the we profitable continuing have we in and at ensuring at look the to patient simplify we end our other all the macro is that invest in to discipline IT, our to so in

chase not us. the not right to volume. we're And It's thing for so just going

that And X.X comfortable to range so with we're X.X. of

Whit Mayo

Thanks. Okay.

Javier Rodriguez

X.X just is from X.X, an be FYI, We And has I had my wrong. that not right, change capital as to could a but at markets. me memory

check let's that. So

Operator

Thank next JPMorgan. question the Gary with Taylor And from you. comes

Your line is now open.

Gary Taylor

Hi, evening. good

questions for Just me. a of left couple

since some center any I you that going the impact since is that's that to on any you mandatory visibility question which delayed, back The first, contemplated for And you incurring about cuts, ETC, costs could presume prepare demonstration model it? Do guidance? earn delayed. would XXXX back just the been have potential potentially when had the dialysis financial in is the to any this not start? Are reimbursement

Javier Rodriguez

do The and short an and that opportunity of have we all We processing did any not information they’re and have like to answer we any you. is given insight. back. And just providers more opinions we our than heard were give not

was embedded now not are our incurring guidance. in it. And with not associated costs right We any it

So right no even, now Steven, you're will, changes. you if there's

Gary Taylor

actually you you XXXX either because the Joel. and what My wondered for basis Thanks. Right. third dollar us clarify EPS a in review just perhaps if quarter, basis on would I in I costs advocacy is for know to just one or an last up that in back then as direction. normal that recurring your delay, came some I you on $XX costs bumped advocacy, what $X.XX of your the think, maybe that, top of But or, call XXX pre-tax. it, But of sort AB view with million was

So think of the much your how about sort is maybe normal built just your spend some you'd help above -- on guide, into call we advocacy what XXXX when XXXX.

Joel Ackerman

Sure.

any changed initiative They’re interplay ballot independent. really been pretty and between in There spend Gary. XXXX has nothing So XXX. hasn’t AB that,

The $X.XX $XX plan year-out. not the to and to the is costs spend right make number above share we tax per initiative and one over is deductible. your year- the that ballot would in So I numbers correction million that's baseline is, this

is is assuming would to tax because So deductible. million your calculation pre-tax I -- my that you got this $XX overstated guess

Gary Taylor

range, somewhere told probably. that, million, Yes, $XX $XX us like million you I recall

So …

Joel Ackerman

$X.XX sticking a share. with are We

… So

Gary Taylor

Okay. you. right. All Thank

Operator

The question Justin is from Wolfe next Lake Research. with

is line Your open. now

Justin Lake

Thanks.

at available Just list guys figure Do what's out first here. deployment on the left through cash one you your question of my end. for -- so

at to think my is correct, parent million want around quarter at typically recollection you run guys I if end. the $XXX

to fair of your you have guys to deployable cash end that is million or about at another is $XXX think right? So take give

Joel Ackerman

$XXX about have million that’s we in system. the want Yes, typically right. what to is

$XXX the is that. million yes, number above So, the

Justin Lake

here attractive bit give anything of your levels. stocks repo above And read little at you going really you a Okay. the time XXs, those tremendous view should are us the moment amount at of there current And That’s shareholders, price like the into helpful. of x-stock? to update? And of given in expect did we the how repo. coming value kind Is the a [indiscernible] that kind less of intrinsic spend Could into talking then, intrinsic the you at Joe you the price? looks at you about it value that now benefit for

Joel Ackerman

Yes.

here. willing we’ve talk value don’t are -- deviate at any what of intrinsic are that our moment been in to to views expect from never time, and about We really I

would results intrinsic a and can value be everything it I by target. static buybacks impacted else. its think is I not point and our that stays thing and is the one moving out It's our something impacted by

our value six were necessarily what our views views intrinsic of think with intrinsic of ago the today. are I value months same So

Javier Rodriguez

dynamic, that so Joe publicly look two consistent think you with blackout rarely and what what we said. have then One and restrictions is not whatnot talk and big to Justin, is track periods. have record about we do want but or see you one plan at record quarters, that I have you fluid, also quarter time is and overall track our is over quite what it's And our

Justin Lake

That metric Thanks. absolutely And mix. that, basis immaterial impact some really per quickly you year-over-year, treatment. Can it down Joe, revenue how us give is? commercial makes on was XX color more not on but just that said points then sense. given your on key just you

Joel Ackerman

than average commercial payers is and from mix rate. has created not Look, every lower impact with a comes on much RPT an payer is Yes. who rates, our less at the it payer equal if

Justin Lake

of walk And you of kind priced so or thing, of that kind of is say instead fell? this did for of lower were you aging type away the was would just way the some proactively being normal of population contrast things that it kind just

Javier Rodriguez

say way way the is no decision sort is on and or that, is. would ecosystems/ off was still no holds, it of an I Yes, the what out new which play there's with There another dynamic one relatively big it negotiation early Joe stable. start will question and

Justin Lake

Okay.

make little year-over-year, parts guidance, moving Joe, OI of margins, question back on Just down One, we just giving here. are margins a to little ex sure bit. few not core others you a but understand, a kind to up of is you’re couple revenue Pito's

So year-over-year things it? kind [indiscernible] flat that are Is OI your of about that within reasonable changes think way core guidance. -- like a is effectively to

Joel Ackerman

growth should not some the I’m it's That the into guidance at get OI. can of because say question is fair middle expect the the reluctant drawn top-down up. to is that at again think to said, on I OI bottoms or OI you say we're range range would year-over-year. you look I guiding

Justin Lake

parts. moving At core, like ex

Joel Ackerman

With the margin say revenue. of grow to not which going compression would at it's rate

Justin Lake

Okay.

Joel Ackerman

And other yes, that's, excluding noise. other that’s Justin, and core stuff calcimimetics --

Justin Lake

own you in its have you maybe quick -- and off wrong? think to to initiative to do the then California Is decided there was that. or going why run it. back reason And ballot I I some off that back commentary, then Got industry decided

Javier Rodriguez

No, on to think have Justin, you have right. way think options. it you the it, about to very explore right your all I And early is

etcetera. some restrictions filing there's so And

not had straight literally everything to our think our After a the in and it, go we sure opposed that it at at we we as making So that cleaner exploring should disposal. of pursue. not evaluating measure. something strategy did option, doing after that that’s was interest we best it, counter that right It's were to

Justin Lake

time, all Okay. the guys. Thanks for

Javier Rodriguez

Thank you, Justin.

Operator

Jiang come will New from question Branch. Maggie next China with York Bank The of

Your is now open. line

Maggie Jiang

taking that about are call. if my Thank XXX expansion? international you for the that XXXX. of here My your XXXX. sure centers number in inters in as is Not the see is there what of I international priority up question goes

Joel Ackerman

Sure.

growth. are So in which to the efficient capital similar priorities our U.S., international for our is priorities

a We continue as growth it business. to see

deploy add to opportunities attractive see we at can an capital best that and the having we opportunities at value. novos opportunity either we attractive is and there to those are markets where or things where continue the rates in We build de have rates acquire

So growth path. We expectations. in in our with that was line 'XX see relatively continuing XXXX along

Maggie Jiang

will regions you of terms expect long-term and the in the the type just international clientele. reimbursement of -- do different And business, system, because for Okay. affordability growth different customers, have

do you U.S? So versus the expect -- core international in your profitability would you

Javier Rodriguez

very much country. will I country vary by think that

better have less reimbursement, so. others you As noted countries some

chose it bit to where a a up U.S winds of lot we will on different where prioritize think will it depend relative investments. to be the countries a I our in different the mix mix So and the and

relative hard it's be to the ultimate U.S what margin will to predict margin. the So now

Maggie Jiang

coming since is that roughly X.X%. the from about the And international Okay. revenue

look the revenue at if the purely XXXX X.XX%. just international growth XXXX the However, QX I from is QX versus growth

So that around aggregate X.X%. seems spot the growth a brighter be revenue to than

particularly in So do international, continue that approach to you will think you China.

see other do international. net from on the operating loss However, hand, -- profit we

Javier Rodriguez

that. invest on are it grows we faster So, yes, the guidance not continue specific than U.S., in are going international to we do to I think whether giving

reasonable I the looking past Although, a guide at to think the is there. future

So, yes.

Maggie Jiang

few with model business I centers few what’s a there in and China just I of you -- see give terms sense do approach a then China. or And terms branches, are of see. you’re JV. Taiwan how a in And your and in working APAC Asia, in Greater you China? also me footprint Can Asia

Javier Rodriguez

much too generally we don't individual any on into get detail So countries.

So I’m that going one. to pass on

Maggie Jiang

you. Thank

Javier Rodriguez

Thank Maggie. you,

Operator

queue there no at this in questions time. Speakers, are

Javier Rodriguez

look the to again deliver our talk all on time. talking we that Well, I committed. hardest to again. want for you you We going thank are soon. do and to you to investing all to Thank And forward we

Operator

you concludes Thank your for that conference. today’s And participation.

You now disconnect. may