DaVita Inc. 2026 Q2 Earnings Call

Thank you, and welcome to our second quarter conference call. We appreciate your continued interest in our company. I'm Nic Eliason, Group Vice President of Investor Relations, and joining me today are Javier Rodriguez, our CEO, and Joel Ackerman, our CFO. Please note that during this call, we may make forward-looking statements within the meaning of the federal securities laws. All of these statements are subject to known and unknown risks and uncertainties that could cause the actual results to differ materially from those described in the forward-looking statements. For further details concerning these risks and uncertainties, please refer to our second quarter earnings press release and our SEC filings, including our most recent annual report on Form 10-K, all subsequent quarterly reports on Form 10-Q, and other subsequent filings that we may make with the SEC.

Our forward-looking statements are based on information currently available to us, and we do not intend and undertake no duty to update these statements except as may be required by law. Additionally, we'd like to remind you that during this call, we will discuss some non-GAAP financial measures. A reconciliation of these non-GAAP measures to the most comparable GAAP financial measures is included in our earnings press release, furnished to the SEC and available on our website. I will now turn the call over to Javier Rodriguez.

Thank you, Nic. Good afternoon, everyone, and thank you for joining the call today. It's been a busy and exciting summer. One exception is that I have to wait another four years to root for Mexico to win the World Cup. Moving on to more important topics, our strategy's coming together thanks to the amazing work of our teammates and caregivers. Their effort has led to another positive quarter for our patient outcomes and financial results. On today's call, in addition to our second quarter performance, I will focus on recent innovation in the dialysis industry, specifically the clearance of middle molecules and the steps we're taking to elevate the standard of care for our patients. I'll also share our perspective on the recent ESRD proposed rule and close with our guidance for the remaining of the year. But first, as always, I will begin with the clinical highlights.

Today, I'd like to reflect on the successful transition of phosphate binders into the Medicare dialysis bundle. With advance notice from CMS, this process began more than 2 years ago with the goal of expanding access to a wide range of therapies for a broader group of patients, and that goal has been achieved. With DaVita's broad formulary, our physician partners now have greater flexibility to prescribe the therapy that's best suited for each patient's needs. This has reduced by more than 50% the number of patients relying on less effective over-the-counter options, such as Tums, and instead, now are benefiting from clinically preferred therapies. That means more patients are receiving treatments that better manage phosphate levels and help reduce the risk of cardiovascular complications and bone fractures.

It's a powerful example of how the right policy, combined with strong clinical execution, can expand access to better care and improve long-term patient health. Transitioning to the 2Q performance, our results were broadly in line with our expectations. Beneath this headline, I will highlight 2 primary dynamics. First, year-over-year volume growth continued to accelerate, slightly faster than expected, driven by continued improvements in mortality. Second, compared to the 1Q, revenue per treatment declined as we expected, reflecting lower commercial mix from declining ACA enrollment and lower sequential revenue contribution from phosphate binders. Joel will provide more detail on these dynamics and other moving pieces within the quarter. Turning to policy. In late June, as it's customary, CMS released a proposed rule for 2027 prospective payment system for ESRD.

The proposal includes an update to Medicare base rate and the addition of phosphate binders to the bundled dialysis payment beginning next year. Starting with the base rate, the proposed payment update is more complex than in prior years, with methodology changes and various to TDAPA-related dynamics. The net result is a rate increase that once again tracks below the cost trends for the industry. We're providing feedback during the rulemaking process and remain hopeful the final rule will better reflect the cost of delivering high-quality care. On phosphate binders, we continue to support CMS' approach to moving these medications into the dialysis bundle. In addition to the clinical benefits, the policy is lowering projected government spending. Since the initial transition of these medications, CMS has reduced their estimate for phosphate binder spend by nearly $500 million. We also support concluding the TDAPA period after 2 years.

While the proposed post-TDAPA rate adjustment is appropriate, our ultimate financial impact for 2027 will depend on the bundle update within the final rule later this year. Let me turn to middle molecule clearance and the recent results from the MOTheR clinical trial. As a reminder, the primary objective of dialysis is to remove harmful toxins from the body. Newer therapies can remove a broader range of these toxins, known as middle molecules. The goal is to reduce inflammation, cardiovascular complications, and mortality while enhancing the patient's quality of life. Achieving these outcomes is a key building block in our expectation of returning the treatment volume growth of at least 2% by 2029. 2 approaches, which have been used for many years internationally and are now emerging in the U.S.

Hemodiafiltration, or HDF, which utilizes a specialized dialysis machine, and expanded hemodialysis, or expanded HD, which is performed with an advanced dialyzer. I will cover three things: what the study showed, why it matters, and what it means for DaVita going forward. First, the MOTheR trial compared these two dialysis therapies head-to-head and demonstrated that expanded HD using medium cut-off dialyzer is non-inferior to HDF on a composite endpoint of all-cause mortality and major cardiovascular events. Why does this matter? First and foremost, it is a great news for our patient. It gives physicians another evidence-based option for middle molecule clearance, allowing them to tailor treatment to the need of individual patients. Expanded HD also offers meaningful operational advantages because it can be delivered on our existing dialysis machines, making it faster to expand access without significant capital investment. This brings us to our path forward.

We continue to support both HDF and expanded HD and believe physicians should have the flexibility to choose the right therapy for each patient. That said, the recent FDA approval of new expanded HD dialyzer from Nipro represents an important milestone that should materially improve both market supply and economics. To capture this clinical opportunity, we have secured supply to these expanded HD dialyzers, which are fully compatible with our existing machines and provide highly effective clearance of middle molecules. As a result, we expect to begin deploying expanded HD broadly across our network in the coming quarters. This will allow us to expand access quickly and deliver this option to our patients and physician partners. As we move forward, we'll continue evaluating how both approaches perform across different care settings and patient populations in the real-world practice.

I'll wrap up my prepared remarks with our financial outlook for the remaining of the year. With the benefit of another quarter, three trends are coming into better focus. First, continued momentum in volume growth. Second, greater confidence in our estimate of the impact of effectuation rates for exchange plans. Third, our efforts to provide broad access to middle molecule clearance for our patients. With consideration of these factors, we're reconfirming our full year 2026 guidance ranges. This reflects a midpoint of $2.2 billion for adjusted operating income and a midpoint of $14.65 for adjusted earnings per share. We look forward to continuing our clinical, operational, and financial momentum in the back half of the year. I will now turn the call over to Joel to discuss our financial performance in more detail.

Thank you, Javier. I'll begin with the details on our second quarter results and close with some additional color on the remainder of the year. Second quarter adjusted operating income was $579 million, adjusted earning per share was $4.02, and free cash flow was $256 million. Beginning with U.S. dialysis. Treatments increased 56 basis points versus Q2 of 2025. Treatments per normalized day also increased 56 basis points, as there was no impact from the calendar as compared to the same period last year. Volume growth was slightly higher than expected as a result of lower than expected mortality, offset by fewer admits from closed Fresenius clinics and higher than expected missed treatments. Our confidence in our treatment volume trajectory for the year continues to grow. We now expect 2026 growth in total treatments near the top end of our previous guidance range of 25-50 basis points.

As a reminder, our treatment volume expectations are for nominal treatment growth. This would translate to approximately 50 to 75 basis points of growth when normalizing for year-over-year calendar impacts. The calendar impact in the back half of the year will result in a year-over-year tailwind in Q3 and headwind in Q4. Revenue per treatment decreased by approximately $2 sequentially, primarily the result of favorable revenue timing in Q1, lower sequential revenue from phosphate binders, and a decline in commercial mix related to the expired ACA subsidies, in line with our guidance from last quarter. These RPT headwinds were partially offset by the typical sequential increase from higher patient responsibility amounts in the first quarter and higher average rates. Although year-to-date revenue per treatment has been 3.6% higher than the first half of 2025, we continue to expect full year 2026 RPT growth of 1%-2%.

The midpoint of that range implies that RPT growth in the second half of 2026 will be slightly negative as compared to the second half of 2025. This is a function of declining commercial mix, lower phosphate binder revenue, and the benefit in Q4 2025 from the timing of aged claim resolutions. Patient care cost per treatment declined approximately $3 sequentially as a result of operating leverage on labor and other fixed costs, driven by increased treatment volume in Q2 and a decline in phosphate binder costs, offset by higher benefit costs. Year to date, PCCs have grown more than 3% versus the first half of 2025, above our expected range for the full year growth.