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DaVita Inc. is a leading provider of dialysis and related lab services in the United States, primarily serving patients with chronic kidney failure, also known as end stage renal disease (ESRD) or end stage kidney disease (ESKD) . The company operates 2,675 outpatient dialysis centers in the U.S., serving approximately 200,800 patients as of December 31, 2023, making it a major revenue driver . In addition to its U.S. operations, DaVita offers integrated kidney care services, international dialysis operations, and various ancillary services, including clinical research and transplant software .
- U.S. Dialysis Business - Provides dialysis and related lab services to patients with chronic kidney failure, operating 2,675 outpatient centers and serving approximately 200,800 patients in the U.S. .
- Integrated Kidney Care (IKC) - Offers advanced integrated care management services to health plans and government programs for patients with ESKD and chronic kidney disease (CKD), showing significant growth .
- International Operations - Manages 367 outpatient dialysis centers across 11 countries, serving about 49,400 patients .
- Ancillary Services - Includes clinical research through DaVita Clinical Research, a transplant software business called MedSleuth, and a venture group focused on innovative kidney disease solutions .
What went well
- DaVita achieved significant cost savings from closing approximately 200 centers, resulting in $100 million to $150 million of fixed expense reduction, outweighing the $50 million loss in volume.
- The company is considering share repurchases as a top priority for capital allocation, utilizing excess debt capacity while maintaining their leverage target within 3x to 3.5x.
- Despite higher mortality rates impacting volume growth, new dialysis admits remain strong, indicating that volume should return to normal over time.
What went wrong
- Higher than expected mortality rates are negatively impacting DaVita's patient volume growth by 50 to 100 basis points compared to pre-COVID levels, with mortality up this year relative to six months ago.
- The closure of approximately 200 clinics has led to a decline in clinic share by about 1.25%, resulting in a volume loss estimated at 40 to 60 basis points. This may have allowed mid-sized and smaller dialysis operators to gain market share by building more clinics.
- DaVita's Integrated Kidney Care (IKC) business is underperforming, with a year-to-date loss of approximately $60 million, exceeding the full-year loss target of $50 million. The company expects continued losses in Q3, relying on revenue recognition in Q4 to meet targets, indicating uncertainty in the IKC business's profitability.
Q&A Summary
-
Elevated Mortality Impact
Q: Why is mortality elevated and affecting volume growth?
A: Mortality is higher than expected, contributing to a 50–100 basis point gap in volume growth. It's up this year compared to six months ago, and although we have hypotheses like an elevated flu season, we lack a quantifiable explanation. We believe this is temporary and not structural, expecting volumes to normalize over time. -
Guidance Raise Breakdown
Q: How did you raise guidance by $95 million?
A: We increased revenue per treatment guidance from 3% to 4%, adding approximately $85 million. Improved labor costs contributed $30 million, while lower volume resulted in a $20 million headwind. This bridges to the $95 million increase before accounting for the $60 million in closure costs. -
Revenue Per Treatment Growth
Q: Is the increase in RPT sustainable into 2025?
A: While the improvements are sustainable, we expect contributions to RPT growth to decline over time. Benefits from collections and contracting will annualize in 2025, but it's unlikely to see another 3.5%–4% growth next year. -
Clinic Closures and Volume
Q: How are clinic closures affecting volume growth?
A: Clinic closures have reduced volume growth by 40–60 basis points, as we closed roughly 200 clinics to optimize capacity. Mid-sized and smaller operators have gained share, but we believe the trade-off improves our fixed expenses by $100–$150 million, offsetting the estimated $50 million loss of volume. -
Leverage and Capital Allocation
Q: Do you plan to lever up for share repurchases?
A: We're maintaining a leverage range of 3x to 3.5x. As EBITDA grows, we'll need more debt capacity to stay within this range. Excess capacity may be used for capital-efficient growth or share repurchases, following our capital allocation philosophy. -
Mortality Normalization Outlook
Q: When will elevated mortality normalize?
A: Predicting normalization is difficult, but we don't believe it's structural and expect a return to normal levels. We're working to understand the causes and consulting nephrologists, but no systemic trends have been identified. -
Integrated Kidney Care Losses
Q: Will IKC meet the expected $50 million loss for the year?
A: Despite a year-to-date loss of $60 million, we still expect to meet the $50 million target due to revenue recognition in the back half of the year. The loss is expected to reduce significantly in Q4. -
Commercial Mix and Exchanges
Q: How have exchanges impacted commercial mix?
A: Commercial mix remains around 11%, with exchanges contributing an increase of about 200 basis points to revenue compared to pre-COVID levels. -
Future of Commercial Contracting
Q: Will commercial contracting remain a tailwind?
A: We don't foresee dramatic changes from 2024. While inflation considerations remain, dynamics with payers are consistent. We're focused on providing value with great clinical solutions at the best cost. Margin strength is likely to remain in 2025. -
Collection Improvements Runway
Q: How much runway is left in collection improvements?
A: There's more to come in 2025 due to annualizing current improvements, but contributions to RPT growth will decline over time. The benefits have exceeded expectations since we started this effort. -
Geographic Variations in Census
Q: Is lower census growth isolated to specific areas?
A: No, we're seeing lower census growth pretty much across the board. -
International Business Margins
Q: How will international business margins evolve?
A: Margins may tick up but are unlikely to reach U.S. levels. Dynamics vary by country, affecting revenue and margins unpredictably due to factors like single-payer systems.
- Given that missed treatments were elevated and census growth was below expectations due to elevated mortality, what specific strategies are you implementing to drive volume growth in the back half of the year without relying solely on additional treatment days?
- You mentioned that your improved RPT growth expectations are partly due to modestly higher rate increases from health plan negotiations that still don't fully offset high inflation; how sustainable are these RPT improvements, and what risks do you foresee in maintaining or enhancing these rates amid ongoing inflationary pressures?
- With the inclusion of approximately $60 million in center closure costs in your adjusted operating income and the change in your non-GAAP reporting, can you elaborate on the factors leading to these closures and how they might impact your operational efficiency and cost structure moving forward?
- You're considering increasing debt to maintain leverage within your target range of 3x to 3.5x, potentially for growth investments or share repurchases; how are you balancing the risks associated with additional debt in the current economic climate, and what criteria are you using to prioritize capital allocation?
- Regarding the CMS's proposed inclusion of oral-only drugs in the ESRD bundle, which you support despite it potentially under-reflecting true cost inflation, how do you anticipate this change will affect your cost structure and margins, and what measures are you taking to mitigate potential financial impacts?
Q2 2024 Earnings Call
- Issued Period: Q2 2024
- Guided Period: FY 2024
- Guidance:
- Adjusted Operating Income: $1.91 billion to $2.01 billion .
- Adjusted EPS: $9.25 to $10.05 .
- Revenue Per Treatment (RPT) Growth: 3.5% to 4% .
- Treatment Volume Growth: 0.5% to 1% .
- Center Closure Costs: $60 million for 2024, $20 million to $30 million for 2025 .
Q1 2024 Earnings Call
- Issued Period: Q1 2024
- Guided Period: FY 2024
- Guidance:
- Adjusted Operating Income: $1.875 billion to $1.975 billion .
- EPS: $9 to $9.80 .
Q4 2023 Earnings Call
- Issued Period: Q4 2023
- Guided Period: FY 2024
- Guidance:
- Adjusted Operating Income: $1.825 billion to $1.975 billion .
- Adjusted EPS Growth: 9% .
- U.S. Dialysis Segment:
- Treatment Volume Growth: 1% to 2% .
- Revenue per Treatment Growth: 2.5% to 3% .
- Adjusted Patient Care Cost per Treatment: 2.5% to 3% .
- Depreciation and Amortization: Decline by $10 million to $15 million .
- Interest Expense: $100 million to $110 million per quarter (H1), $130 million to $140 million per quarter (H2) .
- Adjusted Effective Income Tax Rate: 24% to 26% .
- Free Cash Flow: $900 million to $1.15 billion .
- Leverage Ratio: 3 to 3.5x .
- Integrated Kidney Care (IKC):
- Adjusted operating income loss: $50 million .
- Revenue growth: >25% .
- Per member per month cost decline: 15% .
- Medicare Advantage Mix: 54% to 55% .
The documents do not contain information about DaVita's guidance from the Q3 2024 earnings call. Therefore, I cannot provide guidance details for that period.
Competitors mentioned in the company's latest 10K filing.
- Fresenius Medical Care (FMC): Manufactures a full line of dialysis supplies and equipment in addition to owning and operating outpatient dialysis centers worldwide, potentially giving them cost advantages over DaVita due to their ability to manufacture their own products .
- Large and medium-sized dialysis providers: Compete directly with DaVita for acquisition targets, individual patients, and physician relationships in both the U.S. and international markets .
- New dialysis providers, individual nephrologists, and former medical directors or physicians: Have opened their own dialysis units or facilities, adding to the competitive landscape .
- Non-traditional dialysis providers: Entering the integrated kidney care market, competing with DaVita in areas from CKD care to dialysis to transplant facilitation .