Fresenius Medical Care - Earnings Call - Q1 2025

Transcript

Operator (participant)

Ladies and gentlemen, welcome to the Q1 2025 Fresenius Medical Care Earnings Conference call. I'm Sandra, the conference call operator. I would like to remind you that all participants are in listen-only mode and the conference is being recorded. The presentation will be followed by a.

Q&A session.

You can register for questions at any time by pressing Star one on your telephone. For operator assistance, please press Star. The conference must not be recorded for publication or broadcast at this time. It's my pleasure to hand over to Dr. Dominik Heger. Please go ahead, sir.

Dominik Heger (Head of Investor Relations)

Thank you, Sandra. I would like to welcome everyone to our earnings call for the first quarter 2025. I know that this is a very tough day with many companies in the sector reporting today. Nevertheless, thank you for joining us today. As always, I would like to 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. As always, we will have 60 minutes for the call. To give everyone the chance to ask questions, we would like to limit the number of questions to two like in the past, and it would be great if we could make it work again.

As always, let me now welcome Helen Giza, CEO and Chair of the Management Board, and Martin Fischer, our Chief Financial Officer. Helen, the floor is yours.

Helen Giza (CEO)

Thank you, Dominik. I'd like to extend a warm welcome to everyone on the call. Thank you for your continued interest in Fresenius Medical Care. I'm pleased to report that we are off to a great start in 2025. Our first quarter performance further underscores the strength in the execution of our current strategic plan. With the start of the third and final year of our plan, I'm thrilled with our team's energy and focus, maintaining momentum and delivering continued operational and financial progress. I will begin my prepared remarks on Slide 4. In the first quarter, we delivered strong organic revenue growth of 5% with positive contributions from both Care Delivery and Care Enablement. Despite a severe flu season, increasing mistreatments, we realized stable same market treatment growth in the United States.

This was possible due to continuously improving underlying referral trends which was supported by the tremendous operational improvements made within Care Delivery. Our FME25 transformation program continued its momentum, delivering EUR 68 million in additional sustainable savings of our targeted EUR 180 million. For the year, we achieved 11% operating income growth consistent with the expected phasing of our full year outlook positioning us well for even greater growth in the quarters to come. Thanks to robust cash flow development and our strict financial discipline, our net leverage ratio improved to 2.8 times which is well below our self-imposed target range. While tariffs have certainly been a prominent topic this year to date, recent changes in tariffs did not have an impact in the first quarter. Also, for the financial year 2025, we currently expect only a very limited impact from both U.S. and any global retaliatory tariffs.

Overall, the first quarter developed well in line with our expectations and we are therefore confirming our full year outlook. Turning to slide five here, I would like to highlight recent developments in each of our operating segments beginning with Care Delivery. In the U.S. the stable or very slightly positive volume development reflected a 40 basis point impact from mistreatments driven by the severe flu season. We experienced peak flu impact in February and March. Prior to that we realized relatively strong volume development in January. At the same time, we are encouraged by the accelerating number of referrals which have helped to offset the impact from flu related mistreatments. Throughout the quarter we saw improving trends in patient referrals and the results of our operational improvements continuing from the second half of last year. This includes our efforts to streamline our admissions process and reduce patient cancellations.

Therefore, we continue to expect same market treatment growth of 0.5%+ for the US in 2025. While we have not given a specific phasing, we would expect a similar trajectory as last year with Q1 as the low point and stronger performance following throughout the year. While our same market treatment growth adjusts for the number of dialysis days, having one fewer dialysis day in the quarter creates a headwind for absolute volume development and utilization. In our international markets we saw strong same market treatment growth accelerate to 2.5%. This is an encouraging indicator for these markets as well as an outlook for the US recovery. Our value-based care business contributed to overall revenue growth. We saw lives under management increase from around 130,000 at the end of 2024 to around 148,000 at the end of March.

Despite headwinds from one less dialysis day and the severe flu season, we maintained our operating income development at a stable level. Our 2025 outlook anticipated a lower contribution from the first quarter in Care Delivery. All in line with expectations.

Dominik Heger (Head of Investor Relations)

Our.

Helen Giza (CEO)

Care Delivery earnings were supported by favorable rate and mix development as well as a positive impact from phosphate binders within Care Delivery. We are continuing to prepare for the rollout of high volume hemodiafiltration or HDF for short in the U.S. Our first U.S. pilot program has grown from a few patients to 11 currently treated on our new 5008X machine. We are well positioned to expand that further as we approach the official launch at the end of the year. Turning to Care Enablement, after a strong Q4 last year, Care Enablement delivered a strong first quarter with solid volume growth in all regions and continued positive pricing momentum. We realized additional sustainable savings as part of our FME25 transformation program driven by further optimization of our manufacturing and supply chain footprint.

I'm pleased to report that our Care Enablement margin further improved to 8.3% for the first time it entered its target margin band of 8-12%. While there is more work to be done, if you remember where we came from, this is a tremendous achievement and positions this segment for further growth and margin expansion beyond 2025, not only from a Care Delivery perspective, but also from a Care Enablement perspective. We are actively preparing to bring transformational innovation to the US market with the rollout of the 5008X, we are well on track for the launch at the end of the year and we look forward to sharing more detail at our CMD on June 17, 2025. I'll now hand over to Martin to take you through the first quarter financial performance in more detail.

Martin Fischer (CFO)

Thank you, Helen, and welcome to everyone on the call. Also from my side, I'll pick up on slide seven. In the first quarter we achieved solid organic revenue growth of 5% with contributions from both segments. At constant currency, revenue increased by 1%. The muted revenue development reflects the successful execution of our portfolio optimization plan. Divestitures negatively impacted our revenue development by 260 basis points. As a reminder, we decided not to adjust our numbers in the fiscal year 2024 and 2025 for the divestitures that were closed in those years. We decided to absorb the revenue and operating income effects of having sold the business in our guidance range for the respective year. Operating income excluding special items increased by 11% on a constant currency basis, primarily driven by growth in our Care Enablement segment. This reflects the expected phasing for our 2025 outlook.

Special items negatively affected group operating income by EUR 126 million. This mainly includes costs relating to portfolio optimization and our FME25 transformation program as well as negative effects from the remeasurements of our investment in Humacyte. Next on slide eight. This slide highlights the drivers of our year over year margin development. We realized a 90 basis point margin increase largely driven by growth in our Care Enablement segment. This offset the slightly negative Care Delivery contribution which reflected the impact of a severe flu season and one less dialysis day. I will review the drivers when we look at the segments in detail. Favorable contributions from corporate included the positive valuation effects of virtual power purchase agreements amounting to EUR 3 million in the first quarter.

It is worth noting that foreign exchange translation had a beneficial effect on our business in the first quarter and contributed to the growth with EUR 11 million. Moving on to slide 9, Care Delivery showed strong organic revenue growth of 4% driven by both Care Delivery US and Care Delivery International. In the U.S. our growing value-based care business supported revenue development along with favorable rates and payer mix developments. This compensated for the muted same market treatment growth reflecting higher levels of mistreatments driven by the flu season. As mentioned by Alan, we also realized solid international revenue growth supported by accelerated same market treatment growth of 2.5%. In those markets, the revenue development was negatively impacted by one less dialysis day.

Additionally, our portfolio optimization plan negatively impacted Care Delivery revenue development and by 370 basis points we expect the headwind from our portfolio optimization to reduce over the.

Dominik Heger (Head of Investor Relations)

Course of the year.

Martin Fischer (CFO)

Despite the headwinds faced in this first quarter, Care Delivery maintained its operating income contribution at a stable level, even slightly expanding its margin to 9.3%. Earnings were supported by favorable rate and mix developments as well as a positive impact from phosphate binders. Care Delivery earnings also benefited from FME25 savings. These earnings developments were offset by labor and inflation costs in the quarter, which developed in line with our expectations. Let us have a closer look at the developments in Care Enablement on Slide 10. In the first quarter, Care Enablement continued to show strong revenue growth supported by 5% organic growth. This development is mainly attributable to solid volume growth in all regions and continued positive pricing momentum. Globally, in line with our expectations, volume-based procurement in China was again supportive of volume growth but a headwind to pricing.

The segment showed a significant 49% increase in operating income resulting in a margin increase of 240 basis points with an 8.3% margin. Care Enablement also reached its target margin band. This reflected continued execution of our FME25 transformation program as well as improved volume and price effects which more than offset anticipated deflationary pressures. Moving to Slide 11 in the first quarter, the relatively low operating cash flow was driven by seasonality in invoicing. In line with our expectations, we realized a strong increase of 28% against last year's quarter due to improved operating working capital consistent with our current strategic priorities. We further reduced both our total debt and lease liabilities and total net debt and lease liabilities compared to the prior year period. As a result of our continued strict financial discipline, our net leverage ratio improved to 2.8 times.

We remain comfortable being below our self-imposed target corridor of 3-3.5 times. Following the quarter end in early April, we took advantage of the favorable market conditions and our improved credit rating outlook to successfully place two bond tranches with an aggregate volume of EUR 1.1 billion. We used some of the funds to buy back approximately EUR 300 million of bond maturing in 2026. We are planning to provide an update on our future capital allocation plans at our upcoming Capital Markets Day in June. I will now hand back to Helen to review our outlook.

Helen Giza (CEO)

Thank you Martin. I will pick up with our outlook on Slide 13. Given our first quarter performance and current expectations for the remainder of 2025, we are confident to deliver a strong performance in 2025 and are confirming our full year outlook. We continue to expect a positive to a low single digit % revenue development and our Q1 operating income developed in line with our expectations as we anticipated a relatively lower contribution from the first quarter. Therefore, we expect operating income to grow by a high teens-high 20s % rate compared to prior year. I will finish my prepared remarks on Slide 14. Finally, I am looking forward to seeing many of you on June 17th in London for our Capital Markets Day. We plan to share the details of our strategy and capital allocation priorities.

In addition, we have some interesting Deep Dive breakout sessions and a product show that we are excited about. If you have not already registered, please do connect with Investor Relations as our registration will close on May 15. With that, I will now hand back to Dominic to start the Q&A.

Dominik Heger (Head of Investor Relations)

Thank you, Helen and Martin, for your prepared remarks. Before I hand over for the Q&A, as always, I would like to remind everyone to limit your questions to two. If we have remaining time, we could go a second round. With that, I hand over to Sandra to open the Q&A, please.

Operator (participant)

Thank you, sir. We will now begin the question and answer session. Anyone who wishes to ask a question may press star and one. On the telephone, you will hear a tone to confirm that you have entered the queue. If you wish to remove yourself from the question queue, you may press star and two. Questioners on the phone are requested to disable the loudspeaker mode while asking a question. Anyone who has a question may press.

Star and one at this time back.

Over to you, sir.

Dominik Heger (Head of Investor Relations)

Thank you, Sandra. The first question comes from Victoria, from Berenberg. Victoria, the line is yours.

Thanks for taking my question. The first one is just on what you are seeing in April trading so far in the US. I know Q1 was pretty volatile, so just an update.

On April would be helpful.

How this gives you confidence to reiterate your full year guidance for the 50 basis points or more of growth. The second question is just on phosphate binders. What benefits did those have in Q1 and do you still expect the I think $50 million-$100 million operating income benefit for the full year? Thank you.

Helen Giza (CEO)

Hi Victoria. I'll take the first question and Martin can take the second question on the binders. Obviously the flu season hit hard in February and March. It rose pretty quickly and came back down. We are encouraged by what we see with the underlying referrals. That is a very strong leading indicator for us. I think what we'll also see in Q2 is the mortality effect obviously with a six to eight week lag on the flu data. Obviously we haven't seen that kind of data fully for April yet.

I think we have not even closed the month yet. We are encouraged by the kind of the weekly numbers that we are seeing and we would expect that underlying inflow trend to continue and we do feel confident with the phasing that we always see in Q1 that we will continue on a positive trajectory through the end of the year and confident with our 0.5% plus US for the year.

Martin Fischer (CFO)

Yeah.

Victoria, on the phosphate binders, quarter one developed in line with expectations and we have outlined the full fiscal year effect. Given that with the phosphate binders going to the bundle, the ASPs used to start higher and then only being going downwards and revised throughout the fiscal year, we did see a seasonal or a stronger start into the fiscal year and had a double-digit million effect that contributed to the positive.

Thanks so much.

Dominik Heger (Head of Investor Relations)

Thank you. The next caller is Victoria from Citi. Welcome back, Victoria. Sorry, Veronika, welcome back. I even missed your name. You've been away so long. Welcome back.

Thank you, Dominic, and hey Helen and Martin, great to be back. Thanks for taking my questions. I'll keep it to two, please. The first one is just the revenue for treatment trend in the first quarter in the U.S. It seems like it held up particularly well. Just curious, Helen, if you can give us an update on what you're seeing from a commercial perspective and for Medicare Advantage and whether this is something that is sustainable, and I guess to what extent if it's flattered by the phosphate binder dynamic. That is my first question. My second question is around Care Enablement. Congratulations on getting the margin into the target band. Martin, are you able to give us a bit of color on what was the contribution from pricing to revenue growth and profitability and how much scope there is to do more as we go through this year.

Thank you guys.

Helen Giza (CEO)

Welcome back. Veronika, I'll take the first one on RPT. Yeah, look, we are seeing continued prices and mix improvement in development there, obviously with the PPS rate increase as well as what we have always spoken to this past year or so about kind of moderate price increases. That 1-2% price increase across the full portfolio of payers. I think we're comfortable with how that trend is developing and obviously that, you know, that revenue is developing in line with our expectations for the quarter. Martin, do you want to take Care Enablement?

Martin Fischer (CFO)

Yes.

Veronika, you saw from the bridge we provided that business growth was a significant contributor. We also stated that overall pricing is developing in line with expectations and globally it is positive and contributing. We also see that positive momentum that you saw last year also carrying forward in the quarter. To double click a bit on that. This includes the China effect. The China effect, as you remember, was in the second half last year about a mid double digit number. You see the annualization of the China effect now also for quarter one and you can also expect that for quarter two until we have the full cycle of the year. The important thing to note is that the volume contribution that we expected is developing according to our expectations.

Even including the negative China headwinds, we do see a robust solid pricing momentum in the quarter as well. I hope that gives a bit of color.

Martin, maybe I can just push back on that a little bit or maybe ask for a little bit more detail. Obviously you do have a large customer who should be I believe paying some higher prices this year. Are you able to tell us how those negotiations have progressed and whether we're seeing the full impact of that already in Q1?

Veronika, I hope you understand that we do abstain from committing on individual contracts.

I got it. I had to try. Thanks guys.

Okay, fair enough.

Dominik Heger (Head of Investor Relations)

Thank you. Veronika, the next question comes from Graham from UBS. Graham, the line is yours.

Hi guys. Afternoon. Thanks for taking my questions. Just one on HDF first and then on volumes and margins. In terms of how you're thinking about pitching this to competitor clinics or service providers is it primarily the overall mortality benefit or is there nuance as to which patients might benefit?

Is there actual just operational benefit in terms of lower training costs, things like that?

Just understand as we get closer to the launch how you're pitching that once you go commercial and then on margins, you've obviously had phenomenal success in the last two years in terms of expanding.

Margins, but that's been effectively without any.

US volume growth and it's a rough number. What do you think going forward when you get to a normalized recovered margin, what do you think you need to grow at to sustain in terms of US volumes to sustain that margin? When does operating leverage kick in? Is it 1%, 2%? Do we need to get back to 3%? Just understand how that moves. I appreciate both of those.

Might be a little bit early for.

Where we are today versus a couple of markets today, but I thought I'd try.

Helen Giza (CEO)

Thanks, Graham. I'll take both of those and obviously that will be a significant part of our capital markets day and kind of getting into, you know, kind of the innovation and the benefits that we see for HDF. I can click on that a little bit. Of course, the same with the margin outlook, we'll give more color there. Just to kind of double click for a moment, you know, for HDF, as I think we've been talking about this past year, we're incredibly excited about this new machine and the new kind of the new treatment.

A little bit of both on what you touched on, not just the mortality improvement which if we do see that the kind of the results from CONVINCE at 23% improvement in mortality, that in itself full blown could relate to kind of 400 basis points of growth by itself, not just the patient benefit. Look, obviously improving outcomes is a big part of what we do as the leading innovator here. Also there are operational benefits from machine. It is much simpler to use, it does not need saline, the clean down time is quicker, the time needed between treatments and the training time is also better. We will go through that in a ton more detail in June. I think we can kind of clearly see a number of treatment benefits and an operational benefit.

I think you can see why we're excited and why we're looking for the whole industry to adopt this treatment. In terms of your second question, yeah, of course we've been driving efficiencies and I think the result of the new operating model has really lent itself to the improvements that we've driven the past two years. You're right, you know that US volume growth we've got there despite that, obviously we're looking to see and seeing that volume come back and that will improve operating leverage. Clearly the higher utilization and obviously we do expect to be growing above the 0 and even the 0.5. We will give more outlook on how we're seeing these market and volume trends in June as well and kind of the levers that we see both to drive top line growth and innovation as well as bottom line margin expansion.

We're excited and we're excited. It's only a month or so away now, but we'll clearly give more insight to the market then. Thanks for the questions, Graham.

Dominik Heger (Head of Investor Relations)

Great. Thank you guys. Thank you. Next round of questions comes from Lisa from Societe Generale Bernstein.

Hi there. Nice quarter to start the year. Two questions. Your large competitor in the U.S. has talked about significant CapEx investments over the past sort of five plus years, really focused on IT systems. Given that both companies were formed over a series of acquisitions, I imagine that's one area that could still be quite messy. Just curious as to where you are on that sort of transformation. I think of note, DaVita's mentioned it's been particularly useful in terms of their revenue cycle management in the private market. I just want to think through what the opportunities are for Fresenius could be on that front. Second, just on the HDF launch, how should we think about the ramp up?

You know, there's obviously a long replacement cycle for machines, so should we just expect penetration of HDF to increase quite gradually despite the sort of patient benefits and as you mentioned, the operational benefits. Lastly, just on that, what sort of manufacturing capacity will you have for serving the US market and should we worry about any potential bottlenecks there? Thanks very much.

Helen Giza (CEO)

Thanks, Lisa. Martin, do you want to take the first one on the capitalization IT and I'll take the second.

Martin Fischer (CFO)

Yeah, happy to, Lisa. First of all, IT and also driving automation of our processes and efficiencies and also revenue cycle management together with EHR systems is a focused topic of ours as well because of this being a value creation level both on the efficiency side but also on the revenue yield. This has been for quite some time as well. As we continue to invest into our business, we will also here give a little bit more color on our capital allocation priorities, both how we drive profitable growth and improve profitability going forward at the capital market day as well. Rest assured this has been already a focus topic and will continue to be a focus topic also to invest into operational efficiencies.

Helen Giza (CEO)

Thanks, Martin. Lisa. The full rollout plan and how we're thinking about commercialization both from a Care Enablement and Care Delivery, we will share at Capital Markets Day and obviously the capital piece on that as well. This is, while it's exciting and unique innovation, it is also replacing an install base. As you can appreciate, the kind of strategic approach here has been weighing up the implementation and rollout plan versus the current install base. We will give you more color into all of those questions that you had in June with quite a detailed breakout session on HDF and you can see the machine.

Great, thanks. Look forward to seeing you next month.

Likewise.

Dominik Heger (Head of Investor Relations)

Thank you. The next question comes from James from Jefferies.

Hi, thanks for taking my question. Just a couple, please. Firstly, when we look at the operating growth of around 11% in constant currency, the EBITDA level in constant currency, I think it's just under 4%. I think adjusted DNA was down materially, which is about half the margin gain. Are we at the run rate we can expect for 2024, and what are the considerations here, please? My second question is again just on the 5008X you mentioned in terms of, you know, getting preparations for launching at the end of the year. Just wondering, you know, when we might get more detail on either pricing, you know, what sort of feedback you've got in the U.S., you know, ahead of potential upgrades and how we should think about an upgrade cycle.

Thank you.

Helen Giza (CEO)

Yeah, Martin, do you want to take the first one? I'll come back to 5008X.

Martin Fischer (CFO)

Yes, more than happy to. On the DNA, I think it's important to note that when you look at the reported numbers, there's a significant portion and element of last year's divestitures in that which equates to most of the reduction that we saw. Hence, when you look at it in a percentage of revenue, it is not such a large extent where it comes down. It does come down a bit in the quarter, but at the same time the maturity, which was back then over EUR 100 million, hits coming out of that, which we also disclosed, was driven in the depreciation and amortization by the divestitures.

Overall, the DNA is for us a stable development where we do plan for a, let's say also sustainable reinvestment into predominantly our clinics as well as our machines as we place them as well next to our continued R&D invest in C&E and also here on the capital allocation priorities for the innovation we will give additional color also for the capital markets day.

Helen Giza (CEO)

James, on your question about launch, probably a theme of my day more on June 17. No, look, we are excited and the fact that we now have 11 patients, which you know, all in one clinic getting the HDF treatment, is giving us kind of real, real data in real time and obviously trying to get that proven experience in our clinics also helps with the, you know, the commercialization to other players in the industry. Obviously, the pricing is kind of contract by contract and probably not going to disclose that. I think what we are seeing and hearing as well, and we saw it in the CONVINCE study, is for our patients not just the hard outcomes that, you know, we've talked about like mortality, but also their own quality of life measures and how much better they are feeling.

We hope to share some of this. I think we have videos lined up about how the patients are feeling from getting this treatment as well. You know, we are seeing that patients really want to be on this treatment after they have seen what is happening in the pilot. More to come. We are thrilled to be rolling this out and obviously we will give as much detail as we can while keeping what we need to keep proprietary proprietary, if that makes sense. Yeah, look forward to seeing you next month and sharing more on that.

Dominik Heger (Head of Investor Relations)

That's great. Thanks very much. Thank you, James. The next caller is Oliver from ODDO BHF. Oliver, the line is yours.

Yes, good afternoon. Thanks for taking my questions. First one is about a deeper view on the same market treatment growth in US. The peak of flu season was early to mid February. So the six week cycle should have come to an end somewhere in April. Have you seen an excessive mortality or was the negative impact more about that patients stayed longer in hospices and were consequently not available for treatments in your clinics. The second one is on the current foreign exchange environment. Can you give us your view? If the EUR US dollar remains at the level as it stands right now, what might be the, what will be the impact on top and bottom line. Thank you.

Helen Giza (CEO)

Sorry, I'm here. Hi Oliver, I'll take the first one on same market treatment growth. Yeah, look we did see the numbers in February, the spike. We started to see it come down in March. We're still getting data in real time. I'd say too soon to say that anything has changed. We've still seen that slightly elevated mortality. What the full impact was from the flu season, I don't think we'll start to see that until May. Obviously, when we get to Q2 we'll be able to see how that trend is continuing. Yeah, too soon for us to tell at this point. What we saw in Q1 was still elevated, but the flu data with the six-eight week lag will be later. Martin, do you want to take the effort?

Martin Fischer (CFO)

Yeah.

Hi Oliver. On the FX, I mean obviously in the current environment it's very hard to predict where the US dollar will go with the volatility that we see at the same time. Let me give you some color how we think about it and how we are also here specifically on the translation topic that it is for us have started the year and see the rest of the year in the quarter one. For us the EUR/USD rate was about at 1.05 and you also saw that in quarter one we had a positive effect tailwind to the results. At the same time we ended the quarter at a spot rate of 1.08, which is pretty much in line with the indication that we gave to you for the outlook when we shared our assumptions for 2025 with us.

I think currently when you look at it today, in the last couple of days, we are hovering around the 113ish and when you would expect that we stay at a similar level, that would for us mean about 2%-3% headwind on the top and bottom line for the full fiscal year 2025. I hope that helps a bit of color.

Dominik Heger (Head of Investor Relations)

Absolutely. Thank you. Yep, thank you. Next question comes from Hugo from BNP Paribas. Hugo, the line is yours.

Thanks, Dominik. Hi guys and congrats on the quarter. I have three questions, please. First, on tariff. I know probably not very material for you, but could you help us understand a bit more what the impact could be should things change at the beginning of July? Second, follow up on Lisa's question. Your U.S. competitor also suffered a severe attack earlier in April. Just wondering if you could comment on anything you've seen that would impact you positively. More patient or increasing results, for example. Keen to get your thoughts on that. And lastly on volumes, if I'm not mistaken, you mentioned 40 big tailwind on U.S. volumes from referral in Q1. Or should we think about this accelerating potentially throughout the year. Thank you.

Helen Giza (CEO)

Thanks, Hugo. I think I can. I'll tag all of those. First on tariffs, as you heard in my talk outline, no impact in Q1 and we're calling it somewhat limited for full year for the U.S. footprint. We have a lot of U.S. local manufacturing, so all the consumables are produced in the U.S. We do have machines that are coming in from Germany and or final assemblies in Mexico. I think as a result of all that we've done with FME25 and kind of rebuilt our manufacturing footprint and supply chain, we're pretty, pretty resilient here. We see, you know, we see the impact as limited, clearly, with the USMCA agreements as well as other protocols that are in place. We know we feel pretty good about what we are seeing.

Look, I think the broader question is, you know, what does this do ultimately to kind of inflation or labor rates? Obviously we would be looking to see what we would need to pass on in pricing, but at this point, from what we can see through 2025, we're feeling pretty good. As you can appreciate, a lot of work being done on the flows of materials and the relative impact in scenarios. A special call out to the Tariff Task Force for the great work that they've done here. Your second question regarding the cyber attack on DaVita and what we are seeing. Clearly not going to comment on, you know, kind of how, you know, how, you know, what impact that's had there for them, but we have seen during the quarter some benefit in Q2, I should say, not Q1, some benefit for.

From additional patient referrals. What that translates into, we'll see when we close April. Our priority is making sure that patients get the care they need. I think the work that we've done on accelerating and improving our admissions process and patient inflows is clearly working in our favor. Your third point on the 40 basis points impact, that was from a negative mistreatment, not from inflow. What we're saying is the accelerated inflow has neutralized the mistreatment impact that was mainly due to flu. We are flat with a 40 basis points headwind, if you will, from flu, which is also supported by the underlying inflow that we are seeing. Hope that helps.

Dominik Heger (Head of Investor Relations)

Thank you. The next question comes from Marianne from BofA Securities.

Good afternoon and thank you for taking my questions. The first one is, could you talk a little bit about the remaining FME25 savings that you expect for the rest of this year? I've noticed that you have already delivered a large chunk into Q1, so just wondering a little bit, where do you see the most of the remaining saving coming from and what do you need to deliver them? A bit more of a broader question on the company, and appreciate that might be further discussed at the CMD. As you look into your portfolio, have you identified or are you still working on identifying other assets that aren't growing as profitably as you would like and that you could potentially sell over the midterm? Thank you.

Helen Giza (CEO)

Thanks, Marianne.

Martin, do you want to take the FME25 and I'll take the divestiture cost more than it.

Martin Fischer (CFO)

Marianne, as you saw in the quarter, we had a good quarter contribution and also with the EUR 68 million and the total year of EUR 180 million, we feel that we started well. The phasing of that was in line with our expectations. Also, when we give additional color on that, you do see further contributions from the Care Enablement, also from the manufacturing and supply chain footprint optimization that we have, but also some further contributions from the G&A functions as well as Care Delivery to a smaller extent. We continue to see that structure also holding through the remainder of the year. The overall phasing, as I said, is in line with our expectations and should give us good confidence or gives us good confidence for the fiscal year target.

Helen Giza (CEO)

Yeah.

Regarding your question on divestitures, really, really pleased and proud of the progress the teams have made over this last year in cleaning up the portfolio. As you would have seen in the Q1, you know, we had already announced it at full year. The Spectra Labs in Malaysia, kind of the two in the quarter. I would say for the most part we are done. I mean, we obviously, as part of our ongoing review of our country portfolio, will look to make sure that there is nothing, you know, that is changing in the environment that would change our view on it. Any small market. I feel good about where we are and that is part of our new rigor and discipline that we will continue to look at the performance of the assets to make sure they are performing as they need to.

I think we're very clear of what is core and the work that we need to do to continue to drive the improvement in the core. I think you can kind of see how streamlined that has now become compared to where we were two years ago. We can share more on that in June. Thank you very much.

Dominik Heger (Head of Investor Relations)

Thank you, Marianne. The next question comes from Richard from Goldman Sachs. Richard, the line is yours.

Thank you very much.

Thanks for my question. Just two for me, please. The first one is a follow up on the treatment volume dynamics and the strong referrals you mentioned. Could you just tell us where we are on the growth of new starts today and how that compares to this time last year? That's the first question. The second one, it's been a while now, but could you just comment if you've seen any changes in the competitive dynamic or potential opportunities that have been created by Baxter sale of Vantive to Carlyle? Thank you.

Helen Giza (CEO)

I don't know if I have that treatment volume year over year. Let me see if we can snag that as we're talking here. Dominic, if you can pull that for me here. In terms of the competitive dynamic, obviously, you know, we both participate in different parts of, you know, of the whole market, whether it be PD or HHD, you know, where we're happy, we're always happy to have the competition. I think that the focus lens that Vantive is bringing is good for the overall market. We feel very proud of the work that we are doing.

I think the progress that we are seeing in terms of volume growth across all regions, pricing acceleration and margin expansion really speaks to, you know, the kind of how we see our own product asset and the work that we're doing. You know, we are obviously significant market share in HHD. We're clearly number two in PD. You know, we think that there's space for both companies to compete and operate. You know, we're very clear of what the potential is and what we can do. Yeah, it's focus on what's in our control and how we can continue to drive this business. The progress, I think, speaks for itself there. Thank you for the guys are polling the same market treatment growth.

I think on the referrals, on the phasing, what we are seeing is that it has improved every month, but year over year, the referrals are down. I think the challenge we have in Q1 is there's one less dialysis day, and so that's one day left for accepting new patients. We are very pleased with the progress we are making. I think the other piece that we are seeing here, I know clearly on the admissions and the work that we've been doing on getting new patients and getting them admitted and keeping them in the clinics is obviously the operational turnaround taking hold here. You know, I kind of think that the leading indicators are going in the right direction.

Dominik Heger (Head of Investor Relations)

Great. Thank you very much, Helen. Okay, thank you, Richard. The next question comes from David, from JPMorgan. David, the line is yours.

Hey, guys. Most have been asked already, but maybe I could just push you a little bit more on the phosphate binders in the quarter. If you could clarify that. Double digit is quite a wide range, how much you saw in Q1 and just confirm that you're happy with that. EUR 50 million-EUR 100 million still. I suppose just from that, obviously the EUR 12 million improvement in Care Delivery EBIT, basically did that all come from phosphate binders? Just a follow up there and then secondly a wider one. Are you seeing anything in the new U.S. administration on the Medicare side or on the regulatory side that is concerning you? Thanks.

Helen Giza (CEO)

Oh, sorry, do you want to take binders?

Martin Fischer (CFO)

Yes, I'd take the binder one. To also reiterate a bit, we did give an indication of an effect for the full year of about EUR 100 million and also I did say that for quarter one we have always anticipated quarter one to be a bit stronger contribution because of how the mechanics work and also starting out with a higher ASP assumption and then having ASPs being reduced throughout the year consistently. Here we have seen a double-digit contribution or double-digit median contribution in the quarter as we called out on the profitability side. This is across all assets in our portfolio. We have given the color that it is more a positive on the pharma and clinics business and a negative on the pharmacy business. I hope that additional color helps.

Helen Giza (CEO)

Yeah. David, your question on the new administration, obviously we're all navigating all those changes. The color that we've got to date is, you know, not expecting to see changes on, you know, on the base, you know, kind of Medicaid or Medicare programs or, you know, the participation in kidney care or anything changing. Obviously, you know, we have seen some targeted cuts in other parts of healthcare, but, you know, what we are seeing on our core business looks fine. I mean there were some early changes of models. There was the only that tangible change of the ETC models that were ending by the end of 2025. That was a mandatory model actually that worked out quite well for us on minimal impact. That's all we have seen and heard. Of course the conversations and the kind of the.

Yeah, just the relationships building and continue in D.C., but a lot of our input says, you know, that, you know, those big changes that, you know, the President has said are the scope seem to be off the table, which is. Obviously, we continue to monitor.

Thank you.

Dominik Heger (Head of Investor Relations)

Okay, good. Thank you. David. The next question comes from Robert from Morgan Stanley. Robert, the line is yours.

Yeah, thanks for taking my questions. There's a couple left. One was just on the Equipment business and the margin profile through the year. How should we think about that? You've seen two or three quarters now where that margin has been building quite nicely. Is there any seasonality at all in that business? We should think about heading through the year or is that we just assume that 1Q is a sort of base level and it's upwards from here and then the only other one I had left was just around return on capital employed. I saw you put in a slide on that towards the back of the pack.

Just thinking about some of the key elements of driving that ROIC back up into this high single digit territory where you were maybe seven or eight years ago. What are the key elements do you think, in terms of getting there from where you are today? Is it just the operational leverage of the business as the growth comes back or are there other elements as well? Thank you.

Helen Giza (CEO)

Thanks Robert. I'll take the first one and Martin can take the second one. Yeah, look, we don't guide by segment within the year but we've made it very clear that for our Care Enablement business we have a margin band of 8-12 and Q4 is typically the strongest. Starting Q1 at 8.3 I think you can expect that we continue to improve that margin band along the way this year. What I'm excited to show is where we go from here and where we see this med tech margin in the future. Yeah, obviously that will be June but I think passion for this business over the year and we always said look we were starting from a 2% margin here and I always said we have very definitive plans all underpinned with initiatives.

It would be back end loaded and that's what we're seeing. The acceleration that we're seeing is a great testament to the Care Enablement team and all that they're delivering both on FME25 but also on volume and kind of market share as well as pricing. Across the board I feel that we are kind of pulling on every cylinder there. I look forward to kind of showing the outlook for this beyond 2025.

Martin Fischer (CFO)

Let me take the capital efficiency one and thank you, Robert, for the question. You have seen a nice recovery from our low in 2023 and to your point, yes, this is partially on the back of the operational transformation and turnaround and the improvement of the profitability and you can expect us to further drive profitable growth in that regard. Yes, a major part comes from the operational performance improvement. The second piece actually is a continued stringent capital management and yes, we do see still potential and continue to manage that capital efficiency piece. Also on the capital side, when you saw the trajectory where we improved over a percentage point compared to 2023 that we have seen in Q1, I think you also see that those measures are taking effect and we will continue to focus on further improving it.

We are not happy with where we stand. We have been very clear that we want to further improve and drive it also above the mid single digit margin.

ROIC levels as well.

Very clear. Okay, thank you.

Dominik Heger (Head of Investor Relations)

Thank you, Robert. The next question comes from Perko from Deutsche Bank. Perko, the line is yours.

Thank you for taking my questions. Just a few quick ones. Firstly, on the improving referral process that.

You mentioned, that's good to hear.

How far away is that still from where you would want to see it ultimately? Second question on cost cutting, obviously you've done a tremendous job over the recent past on that front. How much of a topic will that still be beyond this year? I know you're going to speak about that at the CMD, but maybe you can give us some initial flavor. I mean the house is still standing. You've taken a lot of cost out. Is there still a lot more to go? You've just had divestments, you're sort of done with that. On the pure cost cutting, what's to be expected beyond 2025? Last but not least on share buybacks, seems to be some excitement in the market that you might be announcing something big in terms of share buyback plans at the CMD.

Anything you can say about that at this point, how you're looking at these, whether that's something you would at all consider going forward. Thank you.

Helen Giza (CEO)

Falko, you made me smile. I'm glad my house is still standing. We'll tag team these questions. Look, in terms of the improving referral process, I mean, when we are all back to a 3%+ growth rate and we're seeing all the patient funnel from CMD refill and we're snagging every patient that we can from any physician that is referring someone to us, I think then we get to a point where we're happy, right? Until then, we'll continue to work and make sure our processes and the patient flows are getting momentum along that way.

I feel like that's where we are finally starting to see that proverbial light where our internal processes are significantly improved, the flows are improving, but more importantly that the CMD funnel that has been a bit of an uncertainty to us through this Covid period or post Covid period. Seeing that improvement is key. We're obviously taking it a quarter at a time on what we can do there in terms of the cost cutting. Yes. Look, I feel incredibly proud of what we've all accomplished on FME25. Not just cost cutting, but really kind of streamlining the organization around the operating model, the new operating model and driving efficiencies.

I think, you know, for us, where we see further opportunities to drive improvements and to invest in the company, we will take a look at those and I think that would obviously be part of our outlook for June and capital allocation. I know that's a big ask from everyone. A bit of a repeat answer. I'm sorry. More to come in June on what we plan to do with that capital and how we deploy it to shareholders. At the end of the day, you know, we're focused on value creation and we'll give you insights into how thinking about that.

Dominik Heger (Head of Investor Relations)

Okay, thank you. Okay, so thank you, everyone. That is the first in 15 years of IR. We have four minutes left and no questions. That is great. We answered all questions. That is good. Thank you very much for listening in to our call. We will go now, very quiet until our capital markets day for obvious reasons, because it is the questions you will get answered at the capital markets day and we look forward to see you all. Please register if you have not and we will see you in London on the 17th of June, I hope.

Helen Giza (CEO)

Yeah. Thanks, everyone. Look forward to seeing you in June. Take care.

Martin Fischer (CFO)

Thank you. Take care. Bye.

Operator (participant)

Bye. 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.