Earnings Labs

Fresenius Medical Care AG & Co. KGaA (FMS)

Q4 2010 Earnings Call· Wed, Feb 23, 2011

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Transcript

Oliver Maier

Management

Okay everybody, I think it’s time to continue. Also from my end I would also like to welcome all of you here for the Fresenius Medical Care Q4 and full year 2010 meeting. A warm welcome also from our end to everybody I see on the web. We much appreciate your continued interest in our company. With us today here in the room are Ben Lipps, our Chief Executive Officer and Mike Brosnan, our Chief Financial Officer. I would like to start our presentation also by mentioning our cautionary language mentioned in our safe harbor statement at the end of the presentation. For further details concerning risks and uncertainties, please refer to our filings including our SEC filings. Now with that it’s my sincere pleasure to turn over the presentation to Ben. So, Ben, the floor is yours.

Ben Lipps

Chief Executive Officer

Thank you Oliver. Ladies and gentlemen, all of our employees, management board and our associates around the world and those who have joined us on the internet, welcome. We’re glad you could join us and we also appreciate very much your interest in Fresenius Medical Care. As Oliver said, I’ll cover the business outlook, Mike will cover the finance and then we’ll open it for questions and answers. I also have the privilege that Rice Powell, the CEO of North America and the Deputy Chairman will be available to us by audio. He’s in the US to answer questions at the end of the session here. So we’ll be able to hopefully handle your questions on a global basis. All right, first slide, as you know we’re very pleased with our performance for the year and the performance of our employees. It was a difficult year because we had two balances here, one of them is obviously to continue to grow the business in, as it was mentioned earlier, an interesting economic situation but at the same time we continued to move forward our strategic objectives. We expanded our service network in international, I’ll talk about it a little later, significantly this year. You’ll see it as it rolls in in 2011. And at the same time the actual performance in North America was very satisfying, North America did very well this year with respect to the financial and also the quality metrics. Now as you have seen from all the press releases, revenue a little over $12 billion and net income around $980 million, a gross of 10% for the year. We basically spent a little bit less in acquisitions that we had planned. You’ll see later we’re getting some real traction with our new Cyclers in terms of…

Mike Brosnan

Chief Financial Officer

Thank you, Ben. I’d like to extend my welcome to all of the participants in the call today both here in the room and on the internet, the financial community, our employees and our board members. Ben reviewed the details of our top line and you can see again just very quickly in terms of revenues the 4% growth, 5% on a constant currency basis, 4% organic for Q4. Our employees around the world transformed that into $539 million of earnings, or a 10% level of growth. And that was done essentially by continuing to produce efficiencies with regard to our EBIT margins from 16.2% to 17% for the fiscal year. In North America the margins went up 20%. As Ben commented, that was the result of reduction in our Pharma costs, largely as a result of the lower dependence of pharma utilization in terms of our top line. Lower personnel costs slightly offset by higher bad debts in North America. On the international side the margins improved by 60 basis points. That was largely the result of continued economies of scale as we grow our international business as well as favorable FX and a slight reduction associated with the lower gross margins on acquisitions that we recently completed over the course of 2010 which when they’re fully synergized, we expect will not be dilutive to the gross margins in the international markets. If we continue to walk through the P&L, interest expense, you can see, was slightly favorable to Q4 of 2009. That was largely the result of lower LIBOR and [inaudible] rates despite the fact that year-over-year there was an increase in the borrowing. If you look at sequential quarters, Q3 to Q4, there was an increase of about $4 million in interest expense and that was also…

Oliver Maier

Management

Great. Thank you, Mike; thank you, Ben, for the update on the presentation. And same procedure here, we’re going to start with the questions in the room. So who’s going to start?

Unidentified Analyst

Management

[inaudible] first of all could you give us some thoughts about probably changing landscape with regard to EPO and going forward beyond 2011 when contracts need to be renegotiated. [inaudible] probably getting into the markets or I think [inaudible] stated that very closely [inaudible] in the marketplace, I’m not sure on how far they would be willing to push for a price increases beyond probably the contracts which are due to expire, I think also at the end of the year. Secondly, I just want to hear your thoughts on SFP probably and how the dollar side from Rockvalle [ph] might work going forward with regard to iron replacement which seems to be a quite interesting proposal towards treating patients, especially on the iron deficiency side and probably less used in Venofer going forward. And last but not least, on your [inaudible], just published to my understanding, I mean the asset I think has been on the market three or four years ago already. Why the timing? I’m just trying to understand, did the purchase price come down or what happened there? Just for my understanding, thanks.

Mike Brosnan

Chief Financial Officer

Looks like I’ll take all three of those. As far as the [inaudible] negotiations, let me say that they’ve been a very good partner for FMC over the years. We usually do not comment on the negotiations, I’m sorry, at this point in time. But as we’ve mentioned before, our contract operates through all of 2011 and we hoped that we expect by the end of the year that we will have renewed that contract. And at this point in time I probably shouldn’t go any further than that in terms of discussing it.

Unidentified Analyst

Management

But it was true that you said in the past that we would have liked to have a couple of years, whatever, data on a competitor product by [inaudible] of whatever’s out there in order to make a switch. Is that true still?

Mike Brosnan

Chief Financial Officer

Yes, the second question is as new products come to the market, how do we look at them in terms of bringing them into the clinics. Generally what we do is we have a medical advisory board and they essentially will lay out a protocol and when you have something that’s as important as EPO or iron, you generally try to get somewhere in the range of 4 million to 5 million years of experience, patient experience on these because these are something you administer continuously for these patients. But again, we do 30 million treatments a year so this is something that’s not out of line, okay. So that’s essentially what we would start doing with a new product when it came to market if it’s not got that kind of base coming in. and most of them don’t have that base. So when it comes to market, that’s the type of safety profile we need. The next question is basically the dialysis provided iron. There’s, again, don’t want to say anything that is detrimental to the company, we know them well, but we’ve all looked at that for years and years and one of the difficulties you have is basically how do you dose it because the dosing depends on the membrane, depends on the transport, it depends on the concentration so you’re really creating for basically a situation that is much more complicated. Now if you’re just trying to repeat someone, that might be doable because you just overcompensate. But at the same time we’re looking at some very specific iron protocols to be able to optimize the outcomes for the patients and we think that’d be pretty hard to do when you don’t control the dosing. And finally on Euromedics, I think Euromedic has certainly been, let’s say, discussed as far as availability for the last couple years. One of the situations that basically deterred us from doing something two years ago is that it was a structured financially in such a way that we would be part of the entire company which includes diagnostics. That did not make sense to us. We’re in dialysis, we’re always interested in buying the dialysis assets, so for their own reasons those came to the market in 2010. And quite frankly because of all the synergies that are developed by the European group in terms of operating clinics, we basically just bought the facilities, okay. So when you look at the actual purchase price to EBITDA, it actually turns out to be quite reasonable for a group that’s rolled up 8000 patients. So it became very attractive to us this year because they were willing to sell essentially the dialysis section and Dr. Ghadi and his team knew them well; they’re customers and he was able to pull it off.

Oliver Maier

Management

Okay, next question here. Holger– Holger Blum – Deutsche Bank: I’m Holger Blum, Deutsche Bank. Just two questions; one on the same market growth where you’re seeing an acceleration again. What was driving that and why did you go above the market? What was the attractiveness there of your clinics? Second question, on ACOs and accountable care, how was the timeline there progressing and the feedback after the [inaudible]. What can they expect over the quarter of this year in terms of news flow?

Ben Lipps

Chief Executive Officer

Thank you, Holger. With respect to the same growth, I assume you’re talking about the US because Europe- There’s two components to that. Again, exactly what is the market growing at and we always said between 3.5 and 4, but our mortality has continued to increase. So it’s a combination essentially of your physicians getting the representative market in their areas and at the same time the mortality improves. And I think that’s why you find DeVita and ourselves doing quite well in terms of same market growth in that 4% range because everything I can see on their mortality has been improving also. And now we have not, as an industry, agreed how to measure mortality so all we do is talk about the incremental gain. But we have gained almost 400 basis points in the last four years in reducing mortality. So sooner or later we’ll come together as an industry and provide you that information. But that’s the combination effect you’re seeing there. Now ACOs, it’s my understanding from the latest email this morning, that the regulations are coming out at the end of February but it’s also our feeling right now is that they have not decided, CMS has not decided to include renal. It’s basically going to stay more on the primary physicians. I personally think that’s a major mistake on the part of the administration and on the part of CMS because the five year demonstration program by both DeVita and ourselves has shown that this is an industry, this is a situation where these patients can do better under accountable care concepts and at the same time the government can save money and everyone can benefit. But somehow we have not been able to get that point across where we’ll be in the first wave but at least that’s what they’re telling us, but we hope we’ll be in the second wave and maybe the second wave will come fast. So at this point in time we are still encouraging talk with anybody who wants to talk with us about it, but we don’t get the data that we’ll be in the first wave. Which is hope is wrong, but that’s what I’m hearing today.

Oliver Maier

Management

I think Marcus was next. Marcus Wieprecht – Main First Bank: Yes, Marcus Wieprecht, Main First Bank. One technical question, probably for Mike. How should we model the Galenica joint venture? Who’s booking the revenues or recognizing the benefits, say, what is the impact as far as I understand with the 45% stake you have in this new company, it will be probably the profit below the EBIT line at equities of what kind of impact, what kind of guidance would you give us?

Mike Brosnan

Chief Financial Officer

Thank you, Marcus. We’re a 45% participant in the joint venture so the joint venture will record the revenues and we’ll record our minority share of the earnings in the venture. And you record the minority share actually in your operating earnings. So it will show up in EBIT for the 45% share of the joint venture. That’s the technical accounting associated with the nature of the investment. Marcus Wieprecht – Main First Bank: Would you consider then slightly accretive to your EBIT, the new contract?

Mike Brosnan

Chief Financial Officer

Yes, absolutely. Marcus Wieprecht – Main First Bank: Okay, thanks.

Oliver Maier

Management

One more question in the room?

Unidentified Analyst

Management

Could you just amplify on your comments with respect to the balance sheet and the level of floating rate data as a percentage of the total and where you see your balance sheet longer term; whether you are happy with the ratings as they stand today or whether you’d like those to change and for you to become investment grade?

Mike Brosnan

Chief Financial Officer

Sure, let me deal with the ratings and investment grade first and then I’ll come back to the fixed and variable structure. We’re very comfortable being just below investment grade. We believe that if we were to have, we do not have as a corporate objective to become investment grade. We believe that if we were to undertake that we would have to take a break with regard to some of our acquisition activity for at least one or two years because the worst thing you can do if you’re ready to become investment grade is achieve the objective and then because you see an opportunity in the marketplace, fall back down into high yield. So we think that being a very high quality credit just below investment grade in terms of the high yield market is absolutely where we need to be and that is also driven by the fact that when you look at the opportunities on a global basis, we think that there is still plenty of room to grow, particularly in the international markets and the developing markets over the course of the next several years. So that’s where we stand with regard to our rating. In terms of the structure of the debt, if you look back over the last couple of years we did have a very large credit agreement, as you know, and the notional or the core earnings or interest expense on that was variable but we had done some swap agreements back in 2006 and 2007 such that we had swapped about half of that into fixed rate debt. So our ratios for the last couple of years have been about 70/30 fixed to floating. When you look at 2011 on a higher debt balance because we just floated the billion dollars associated to the ten-year bond, which is obviously fixed, we’ll be probably in the range of 60/40 fixed to floating. And it’s quite possible, over the course of 2011, we’ll be looking at the market, we’ll be looking in particular at what the central bankers are doing around the world and we might decide to swap more of the variable into the loading at that time. But that’s essentially the ratios we have at the moment. We have not added to our swaps pending what we see happening with short-term rates. I think that answers all, yes, thank you.

Oliver Maier

Management

Next question. Martin– Martin Whitbread – Credit Suisse: Thank you. Martin Whitbread at Credit Suisse. So can you remind us what percentage of your US clinics offer the Liberty Cycler at the moment. And the second question to that is what is the CapEx, the capital cost per cycler? And then next question is on the synergies from Euromedic, what percentage of the acquired EBITDA do you think you can add to [inaudible] synergies? Thank you.

Ben Lipps

Chief Executive Officer

Okay, I think as far as the questions on the cycler, Rice are you, can you hear us, would you take that question?

Rice Powell

Management

I can hear you just fine. In terms of the percent of US clinics that are offering the Liberty Cycler, we are fully engaged for those clinics that provide PD therapy, not every clinic does that, they’re not set up that way, but of those clinics, probably 1/3 of our clinics that are offering PD therapy, they all have access to the Liberty Cycler and are training and placing patients on that cycler as we speak. I won’t go into too much detail on cost but I will say that the Cycler stays on our books in the products business. It is a rental piece of equipment, if you will, for the times that the patient is on the PD therapy. We treat it that way both internally as well as externally for our patients in our third party independent externals or perhaps DeVita, someone else. So it really doesn’t impact the capital allocation.

Ben Lipps

Chief Executive Officer

Thank you Rice. And again, this is in our capital projects for next year, the word is. Thank you Rice. Mike will you take the Euromedics?

Mike Brosnan

Chief Financial Officer

Sure. We typically don’t talk specifically about the synergies associated with an acquisition but what I will say, and I think we’ve already commented that the acquisition is accretive in year one. We have also said that, and I think it’s well known that Euromedic was actually a customer of Fresenius prior to the acquisition but we did not have 100% penetration. So there is a synergistic effect that we’ll see with regard to products but perhaps not as great as some of our prior acquisitions where they were not customers of ours prior to acquiring the clinics. And the third I would say that we are acquiring the clinics so we think that there’s a synergistic effect associated with the Legacy GNA which we don’t need to bring across. Martin Whitbread – Credit Suisse: That’s great. Thank you.

Mike Brosnan

Chief Financial Officer

Thank you.

Oliver Maier

Management

Florian [ph] next.

Florian

Management

Thank you for taking my two questions. The first one relates to margins as we go through 2011 how would you see the phasing of [inaudible] most of the quarter. Second question, you mentioned that drug utilization was lower in Q4 versus Q3, could you give us a bit of an update sort of what changed in Q4 specifically when it comes to the utilization of EPO?

Ben Lipps

Chief Executive Officer

I’ll take that one first and then share it with Rice. As a process in Q4 as we’ve mentioned in the past, we were instituting a number of pilots to basically determine where is the optimum level of pharma utilization. So I think Rice, would you like to, and that’s what you’re seeing in Q4. Rice, would you like to add something to that?

Rice Powell

Management

I think, Ben, the only comment that would be of benefit for folk is if you recall in our capital market today, I had projected that we thought we might see EPO utilization drop in the 5% to 10% range. I think I would update you that that range is more in the 10% to 15% corridor and we’re really quite comfortable with the work our medical advisory boards have done in developing the protocols and having them implemented and obviously will continue to monitor them very closely with the single minded goal of making sure that our quality stays where it has been and where we can improve it we will with our protocols for any new management.

Ben Lipps

Chief Executive Officer

Thank you, Rice. Let me make one comment back on Galenica and back on the question of Euromedics. Again, there’s two parts to the Galenica deal, one of them is FMC is a distributor of the product and that’s where the revenue will show up. And the second joint venture is basically at the API level and the development of new products. Another synergy that we didn’t mention for Euromedics is the European operation has a very strong pharmaceutical renal pharma program and so these are clinics then that that product could be sold to the new acquisition Euromedic used internally for more revenue. So we’ve got a couple synergies as Mike mentioned plus an additional synergy here in the renal pharma area.

Mike Brosnan

Chief Financial Officer

I thought with three, Ben, I wouldn’t miss one, but I’m glad you entered the fourth. Just to respond to your question with regard to margin phasing, we actually don’t guide on margin phasing other than to say that we do expect to be an accretive by about 20 basis points on margins. But I will take the opportunity of your question to comment a little bit about earnings over the period. I would tell you that if I just think in terms of first half/second half, I think the first half for all the reasons that we’ve been discussing in the last two, three or four calls that we’ve had, the first half will be a challenge for us. We think that the first half will still be positive on a year-over-year basis but we do see to achieve the earnings guidance I just gave you that we will build momentum over the course of the year and I would expect the back half of the year to be stronger than the first half of the year. If that’s helpful.

Oliver Maier

Management

Any more questions here in the room? If that’s the case, operator, I think we can open up the line since we have some people actually in the queue for further questions from the audio line.

Operator

Operator

[Operator Instructions]. The first question is from Ilan Chaitowitz, Redburn Partners. Please go ahead sir. Ilan Chaitowitz – Redburn Partners: Good afternoon, it’s Ilan Chaitowitz from Redburn Partners in London. I’ve got three questions to start off with. We heard from [inaudible] that they’re expecting vitamin D to drop 40% from their end. Wondering if we should put into our models a 40% drop in your US patient population treatments as well. With regard to your machine products, can you talk around the T-machine uptake, how that’s progressing in North America and also maybe talk a bit about your home hemo approval recently and what do you think for the prospects of that business. And finally I’d just like you to please go over the 5% reduction that you see for Medicare patients for 2011. You mentioned the 2% absolute [inaudible] of 3% transition adjustments. I was wondering if you had factored in the inflation adjustment for 2011 or the 120 day booster from early start patients. If you have factored those in, can you just go into where you might see any other ad winds?

Ben Lipps

Chief Executive Officer

Thank you, Ilan. I’ll take the vitamin D and then if I could, Rice, I’d like you take the T and the home machine and Mike and I will do the 3%. Again, I’d have to read the Abbott announcement but there’s sort of two things going on. Obviously there’s competition in vitamin D between Abbott and Genzyme and there might be a product mix. As far as what we see in vitamin D, yes we believe that we probably are optimizing the vitamin D at this point in time so we’re not really calling it out separately but at the same time it’s part of the pharma utilization that we’re looking at in terms of having the right [inaudible] provide the right patient care but also meeting the economic constraints of the bundle. So I think that’s my comments on the vitamin D. Rice, why don’t I turn it over to you to do the machines and if you have additional comments on vitamin D, feel free to add those.

Rice Powell

Management

Sure, Ilan, hi, it’s Rice. On our T-machine we sold approximately about 1300 machines in Q4 so we were very happy with that. We did our official launch in November at the American Society and Nephrology Meeting. But the machine seems to be well received. It’s functioning well so we’ve been very happy with that. And yes we do have good news on 2008K at home, that was a recent approval. We expect to be shipping that machine in Q2 of this year. We’ve got some ramp up and a few things in the factory that we’d like to do before we start shipping those machines. I’m excited because I think it offers a great opportunity in the home hemodialysis arena because with the technology of that machine, we will be able to have home patients take three times a week treatments, they’ll get the same, if not better clearance, three times a week with our therapy proposal then having to do five or six days per week on perhaps the other home machines that are out in the market. In addition to that we learned through our demonstration project with Integrated Care that had been mentioned. We used a home device, our kidney tail device which basically sits in the patients home, allows them to record data such as blood pressure, weight, how do you feel today, and send that into our care managers. We are anticipating to take an offshoot of that technology, use that with our K at home machine to make sure that we are getting as precise management of the hydration of the patient, do we need to pull more water off, what’s going on, it really gives us an inside day to day as to how that patient feels and what our therapy is providing or perhaps do we need to be looking at something different. So we are quite bullish and excited that we’ll be back on the market with that product. And Ben, I think you covered that just fine. So let me turn it back to you and mike.

Ben Lipps

Chief Executive Officer

Okay, I think Mike and I will do the 5% and again the 5% I talked about was the 2% which was agreed upon by the industry and by ourselves because we get an automatic update starting in 2012, okay. Now there is an update in 2011, a 1% to 2% that’s in the program. The transition adjuster, as we mentioned, should really be .6% but right now it’s still 3. So if you take all that net together, there still will be commercial increases. There is the other 1%, so we’re saying on general you won’t see a total 5% reduction in reimbursement, you’ll see something more like in the range of 3%, right. Is that what we’re saying? So does that sort of layout the picture without any moderation on the transition adjuster, obviously we’re looking somewhere then in the, our projections for the revenue per treatment would be down 3% for 2011 but that’s not, again, our cost structure that we’re working with, will not drop that to the bottom line.

Mike Brosnan

Chief Financial Officer

I would just say that when I commented about our guidance at 6% to 8% growth in revenue. So on a worldwide basis that’s strongly positive for the company. And when I talked about the effect of the transition adjuster and the Medicare cut, I was doing it in the context of organic growth and I think you’re used to seeing an organic revenue growth number from us in the 4% to 5% range in the US and I’ve indicated it’s going to be less than 1%. So there’s two ways to look at it. I had not commented specifically about a revenue rate for a couple of reasons. Even though I know historically we typically give you growth guidance with regard to the revenue rate in the US. And I didn’t do it because when you have a common platform year-over-year in a reimbursement environment that’s not changing, it makes perfect sense to do that. 2011, everything has changed so I think the most important things for us to do is to give you guidance on what we expect the company will report. And that’s what we did. The other reason I haven’t gotten so specific with regard to the US is in Q3 when I talked about the three areas that we would address mitigation of the bundle, the first one we just talked about several times which is the transition adjuster and because of the lack of activity in Washington, I’ve taken that out. The second was the pharma protocols and acquisition costs. The third, which was worth about 20% of the mitigation, I really took a number of different activities and categorized them as one basket of mitigation activities. I said that we would have the traditional cost reduction activities in the clinics but I also said that we had an initiative to increase our home penetration, we have initiatives around training patients on outcomes which gets to the kind of access they have. And I said that we would improve the care at initiation of dialysis. Three of those four have a revenue affect and I can’t tell you specifically today, I can’t parse out those four different initiatives to give you more granular guidance with regard to what’s going to happen on the revenue rate in the US. So that’s why I stayed away from, I don’t want to pretend that nothing has changed and I can give you US revenue guidance with the same kind of clarity that we’ve provided historically. I think it’s better that we give you global guidance and describe the mitigation activities in the three categories that we’ve done now for a couple of quarters.

Ben Lipps

Chief Executive Officer

Ilan, I think we must have answered that question, right? Ilan Chaitowitz – Redburn Partners: Well kind of. Can I just recap briefly and you can tell me if I’m on the right lines, [inaudible] I mean. Your 5% revenue reduction relates to US Medicare patients, that does include the agreed upon 2% reimbursement cut across the industry. It also includes a 3% transition adjustment but does not include any of the other mitigants including the 2011 [inaudible] inflation adjustment and the early mover benefits and other changes that you are sure how are going to play out as a booster to the revenue. Is that a clear summary?

Mike Brosnan

Chief Financial Officer

I think that almost. I think the only thing I’ve said absolutely categorically is we have taken out any mitigation of the transition adjuster. So it’s in the revenue rate adjustment because you’re going from 2010 to 2011 and there’s a reduction in the reimbursement rate which I’ve essentially said because congress is not acting, we will not represent, we’re mitigating for 2011. With regard to all the other detailing associated with the 120 days and with the different rate adjusters you would get with regard to your patient population, we did look at those, we are obviously billing in accordance with the new regulations and when we prepared our budgets and those become the basis for our guidance, we did consider what our patient population was and how much they would contribute to the revenue rate in 2011. But compared, frankly, to the 2% budget cut in the transition adjuster, those are much smaller and those are frankly based on fact. As we’ve commented before, it remains to be seen in particularly with regard to some of the co-morbid conditions how successful the industry will be in terms of being able to capture the precise co-morbid conditions of the patient in order to bill for those. But we are capturing them, we have adjusted our IT systems to treat them appropriately in terms of the invoicing. And so I think I’ve answered your question in that we’ve used our business judgment with regard to the co-morbid conditions, with regard to the initiation of dialysis and all those other smaller elements of move to the bundle. And I’m going to make one more comment and then I’ll let Ben further elaborate on this point, I’m sure. And there’s one piece of good news which I think is worth mentioning and that is that despite all of the complexity associated with a new bundle, we did bill on a timely basis, the month of January. So we are submitting actual bills to Medicare, which is not an inconsequential thing. Thank you.

Ben Lipps

Chief Executive Officer

And not being the CFO with all the information, Ilan, I think the way you stated it you’re correct; and what Mike’s talking about is the things we’re trying to do to move that to basically mitigate that 5%. Is that a fair overstatement? Ilan I think the answer is your statements are correct and you can see we’re very active in trying to basically mitigate as much as we can of this haircut this year. So does that get you where you need to be? Ilan Chaitowitz – Redburn Partners: Eventually, yes.

Ben Lipps

Chief Executive Officer

Okay, thank you very much.

Operator

Operator

The next question is from Kevin Ellich of Collin Stewart. Please go ahead sir. Kevin Ellich – Collin Stewart: Thanks for taking my questions. I’ve got a couple questions for each of you. Maybe I could start with Mike, the easiest one is with the Euromedic acquisition, is that included in your 2011 guidance and if so, how much should we expect?

Mike Brosnan

Chief Financial Officer

Oliver’s adjusting my mic so I’m never sure when it’s on. It is included in our guidance and we would, as I think you know, some of the markets require regulatory reviews so we’ve assumed that the closing will happen sometime in the first half of the year. So it’s pretty much the back half of the year in terms of when we would anticipate it would come on board. Kevin Ellich – Collin Stewart: So about 50% of your revenues. Okay, got it. And then you also mentioned in your prepared remarks that bad debt in the US was higher. Overall, as a percent of sales, it looked kind of flat on a year-over-year basis but can you give us some color as to how much you saw bad debt increase in the US and what was driving that?

Mike Brosnan

Chief Financial Officer

The way I was commenting about bad debt was more in the nature of the fact that when the business is growing, we’re providing more or less at the same level. It may change by just a couple of basis points from one quarter to the next but it was not a material change in the risk assessment on receivables in the US. Kevin Ellich – Collin Stewart: Okay, that’s what I thought. And then maybe this is for Ben or Rice, but, Rice you mentioned that EPO utilization was down maybe more like 10% to 15% in Q4 when you guys thought it might have been 5% to 10%. How much more do you think you can continue to drive down ESA use?

Ben Lipps

Chief Executive Officer

Rice, I’ll let you take that one if you don’t mind.

Rice Powell

Management

Oh, thanks Ben. I would tell you that I am fairly comfortable in that 10% to 15% range. If you’re asking me do I think it could go from 15% to 20%, I don’t think that’s practical. We seem to be in a fairly good spot in the 10% to 15%. Could it go a little over, perhaps, but we’re really in a space now where we are pushing the algorithm and the protocol through our system. We are adjusting it as necessary based on the quality outcomes we see. So let me leave it at 10% to 15% and yes, can it go a percent or two more, perhaps. But I’m not going to start out trying to say the drop will be 15% to 20%, I just don’t believe the data suggests that. Ben has looked at the data as well, he can jump in if he would like. But I’m comfortable with the range I’m giving you.

Ben Lipps

Chief Executive Officer

I am too Rice, I totally agree with you. Kevin Ellich – Collin Stewart: Okay, what type of pricing increases or rate increases did you guys see in the US?

Mike Brosnan

Chief Financial Officer

Pricing increases on EBITDA or on? Kevin Ellich – Collin Stewart: Revenue pretreatments.

Mike Brosnan

Chief Financial Officer

Well year-over-year we saw a 3% increase in terms of average revenue per treatment for 2010 versus 2009. Kevin Ellich – Collin Stewart: Okay, so that’s pretty much what you saw in Q4 as well?

Mike Brosnan

Chief Financial Officer

Yes, that was within the target range that we gave you from 2 to 3 so we ended up on the high end of that range. Kevin Ellich – Collin Stewart: And then last question, Ben. One of your presentations has a Medicare waterfall diagram if you would. It shows where you guys are able to make back, maybe mitigate some of the impact of the bundling effect and you still have a $7 [inaudible] deficit. Just wondering what’s your confidence that you’ll be able to make that up. I mean it shows a $14 add back for a case [inaudible] adjusters and $3 for outlier adjustments. Are there ways you can make up that $7 deficit?

Ben Lipps

Chief Executive Officer

Well I think that was the reason both Mike and I talked about the transition adjuster because that’s the size of the transition adjuster and that turns out to be a penalty for everyone in the industry and for the patents. So at this point we’re working very hard trying to find ways to mitigate that but really it’s an unfair calculation at this point and that’s why it’s not in our guidance. So we had to take it out. SO at this point we’re so active trying to get the right decision for the industry and for the patients but at this point we are trying to also find ways to make up for it if it doesn’t happen this year. Kevin Ellich – Collin Stewart: Okay, thanks. That’s helpful.

Operator

Operator

The next question is from Frank Morgan of RBC Capital Markets. Please go ahead sir. Frank Morgan – RBC Capital Markets: Good morning. You touched on this a little bit but I wanted to go back to the issue of the new coding requirements under the bundle payment system specifically on the documentation from other healthcare providers that are involved in the delivery process. Could you talk a little bit more about any kind of issues you may have seen in terms of getting the necessary documentation in order to recognize rates and what you think are the appropriate levels and then if there has been an issue there in terms of your ability to accrue for the rate, are you accruing it as the ultimate rate that you think you will receive or at a lower rate?

Ben Lipps

Chief Executive Officer

Let’s do that in two steps and maybe you and Rice. This is a problem for the industry and this is why I mentioned that this is so unfair that the transition adjuster hasn’t been fixed because we’ve got a double issue here. But again from FMC standpoint, I think Q4, Mike you want to mention we’ve come pretty close to what we would expect to see looking at the impact files, so if you and Rice want to say more on that.

Mike Brosnan

Chief Financial Officer

I guess I’d say two things. One is having billed one month, we did come pretty close to what our expectations were relative to the impact files but when you look at all the componentry, you don’t necessarily get there by every single item being exactly where it was pegged in the impact file. And I would say generally when you look at the co-morbid conditions that our experience is that it’s difficult to get that information from the physicians and the medical professionals that don’t work for us. They’re not obligated to provide it. So that, so I think we’re very close to where we expected to be in terms of our actual billings in January, we’re getting there with a different componentry but I would also say with regard to your specific question in terms of the co-morbid conditions, we are not accruing for what we cannot support. So we’re billing what we can support consistent with what the requirements are for Medicare and if we can’t support it, we’re not accruing for it.

Ben Lipps

Chief Executive Officer

But it clearly is a problem for the industry. I think we know that, we’re working on it and that’s the additional difficulties we’ve seen. Frank Morgan – RBC Capital Markets: To the extent that you can ultimately get documentation, is there an opportunity to go back and re-bill to catch up for any kind of incremental shortfall?

Mike Brosnan

Chief Financial Officer

Rice, do you want to take that? I don’t know that I have that answer.

Rice Powell

Management

I think there is the possibility but quite honestly, we want to be very clear and very sure about a re-bill opportunity if you will, Frank. So could it happen, yes, but as Mike said, we want to be very conservative and concise in what we’re doing here. So we wouldn’t say no to that opportunity but we’re going to study it very carefully before we go after that. Frank Morgan – RBC Capital Markets: Okay, thank you very much.

Operator

Operator

The next question is from Lisa Clive of Sanford Bernstein. Please go ahead. Lisa Clive – Sanford Bernstein: Good afternoon. A few questions. First, on your private patient mix, yet again, DeVita mentioned that they have seen their proportion of private patients decline in the most recent quarter. Could you just us some thoughts on the trends you’ve seen in your private patient mix over the past, perhaps, 24 months and if you could possibly think of any reasons why you may or may not be having a different experience from you large US competitor. Second question is around private patients bundling. Now given that all the patients are on the same or very similar protocols regardless of payer, from a financial perspective, if you are optimizing drug utilization that’s clearly a good thing financially on the Medicare patient’s side. But that’s potentially a head wind for revenues on the private patient side. Could you just talk through how you’re thinking about mitigating that issue or give us some sense of the proportion of your private patients that are bundled. And then my third question, Rice, thank you for that revised guidance around potential EPO reductions of 10% to 15%. That sounds like it’s due to the changes in the protocols that you’ve been working on for the last several months. You’ve also talked about reducing the number of patients with catheters and as I remember from your Capital Markets Day, you stated that patients who have infections which are often caused by catheters tend to need more EPO. Is that something that could, over a period of perhaps a few years, give you a bit of an ability to reduce EPO even more around the fact that basically you’ll have healthier patients who need less of it?

Ben Lipps

Chief Executive Officer

Lisa, this will be between Rice and myself. I think as far as the long-term effect of catheter reduction, it’s really too early to speculate on that one. Let me pass on that. I think as far as the private pay bundling, we’ve religiously not commented on what percent have been bundled for various reasons. So having addressed those two, let me turn it to Rice. Maybe Rice you can talk a little bit about the private, about the mix and your suggestions on the 10% to 15%.

Rice Powell

Management

Yes, Lisa from our standpoint we have seen a slight increase in our mix in improvement over year-to-year, ten to nine. And so we’re up a little bit. We’re comfortable with that, I don’t think it’d be appropriate for me to try to figure out what’s going on with Kent and his team because they’re very capable in their situation. Perhaps we’re just approaching something a little differently. But so our mix has improved slightly for us year-over-year. I would tell you that in the 10% to 15% utilization drop with EPO yes that was affected by our protocols and the approach we took at trying to find exactly the algorithm that we and our medical advisory boards were comfortable with. So that was a big piece of that. And to sort of touch where Ben is, we are pushing hard for catheter reduction. There’s no question theoretically that you’re going to have some less EPO there. I think it’s very early to try to give you a proposal as to what that could do over time, we don’t know. But I think you should just be aware and comfortable with the fact that we are working hard to drop that reduction in the number of patients with catheters but I think it’s too early to try to give you any warning or any guidance of what we think that ultimately could do for a drop in EPO dose. Lisa Clive – Sanford Bernstein: That’s very helpful. Thanks.

Oliver Maier

Management

Okay, I think we have time for two more questions actually. I think we have two more on the line.

Operator

Operator

The next question is from Martin Wales of UBSaG. Please go ahead. Martin Wales – UBSaG: I just wanted to understand what kind of [inaudible] your net acquisitions in Q4. As I recall there were [inaudible] three closing Q4. [inaudible] quoted a total of $386 million. What was the split between spend between [inaudible] which closed at the end of the year, I guess adrenal care and any upfront payment for the [inaudible]. Could you give me some sense of how we get $6 million of split please?

Mike Brosnan

Chief Financial Officer

Sure, it’s Mike Brosnan. We actually are not disclosing the specifics with regard to the Galenica transaction I think we previously disclosed ARC but that transaction closed in Q2 not Q4 and Gambro I think we previously disclosed and that was $80 million which did close in Q4. Martin Wales – UBSaG: So [inaudible], what was the other $300 by definition must have been the upfront [inaudible]. Is that a reasonable assumption or am I missing something?

Mike Brosnan

Chief Financial Officer

No, I don’t think you can draw that straight a line, cause we did have a number of other smaller acquisitions around the world that closed in Q4. Martin Wales – UBSaG: Were they all [inaudible]?

Mike Brosnan

Chief Financial Officer

Well I think given that I started by saying I’m not disclosing the Galenica transaction I’ve probably given you as much color as I can at this point. Martin Wales – UBSaG: I didn’t ask you to disclose your [inaudible], I just asked you to disclose what your smaller positions actually were.

Ben Lipps

Chief Executive Officer

We have a number of smaller acquisitions which again, as Mike says we don’t disclose the amount because they’re clinics that are owned by people known in the industry. So I think Mike, there were some dialysis clinics closed. ARC closed at the end of the year, Galenica- Not ARC, but PDM.

Mike Brosnan

Chief Financial Officer

I’m sorry I misunderstood your question. I thought you were just trying one more time to come back around. Martin Wales – UBSaG: No, no – I’ve given up on that one.

Mike Brosnan

Chief Financial Officer

If I misunderstood I apologize. Yeah, I think it’s safe to say in the Q4 as I’m thinking about it they were all services acquisitions. There were no products deals in Q4. Martin Wales – UBSaG: Okay, fantastic. Thank you very much.

Operator

Operator

The last question is from Tom Jones Berenberg Bank. Please go ahead. Tom Jones – Berenberg Bank: Thanks very much for letting me sneak in at the end. I’ve got two questions which hopefully you’ll be able to answer both of. Just on the acquisitions front, the $300 million to $400 million that you sort of got left over in your $1.2 billion for acquisitions in 2011, I just wonder how we should be thinking about the spread of that across your main business units – your international clinics, your US clinics, maybe in the products business. I only ask because I noticed that the non-same store growth in North America took up to its highest level since I think Q2 2007, so I just wonder whether that was something we should view as a sustainable trend or it’s just a one-off anomaly that happened in Q4 when a bunch of mom & pops decided they’d had enough under bundling [ph] and wanted out before it started. I just wonder whether that was a sustainable thing. And then the second question, I just wondered if there would be any further write-downs on your Venezuelan business following the second devaluation of the currency right at the end of 2010? Or did you completely write that off in Q1 2010?

Mike Brosnan

Chief Financial Officer

Okay, why don’t I take the second question and then Ben and I can decide who takes the first. Yeah, with regard to Venezuela, in the Q1 of last year that was the most dramatic effect because we had to mark the balance sheet to market. So that was about a $12 million effect that had to be taken in Q1, and then as the year progressed we had to use hyper-inflationary accounting so we recognized whatever the currency effects were each quarter. And so you had a jaundiced effect in Q1 of last year with regards to Venezuela. I guess as long as you’ve asked the question with regard to Venezuela because they did another devaluation at the end of 2010, but the government is handling that one differently in that they’re honoring the exchange rates for all prior transactions. So we will not see the kind of dramatic effect for this most recent devaluation that we did in the beginning of 2010. Tom Jones – Berenberg Bank: Okay, so we’ve spent a bit of this to some extent but similar to what you’d expended through Q3, Q4 last year.

Mike Brosnan

Chief Financial Officer

Exactly. Yeah, you’ll see it will kind of drip in over the course of the year. It’s a smaller effect. Tom Jones – Berenberg Bank: And then on the capital allocation fund?

Mike Brosnan

Chief Financial Officer

Yeah, are you looking specifically at Q4 or year-over-year? Tom Jones – Berenberg Bank: No, no – for 2011. I just wondered where your preference for allocating that $300 million or $400 million of capital would go on the acquisition fund – international or US clinics, or into the products business perhaps?

Mike Brosnan

Chief Financial Officer

Okay, well I always think in terms of acquisitions of “acquisitions and licensing,” if you’ll give me that liberty, in the three fronts – services, products deals and potentially additional pharma deals. I was very specific at the beginning of 2010 in that I commented that I would see the acquisition activity jaundice towards Eastern Europe, Russia and Asia. We did continue to do what we’d done for many years in terms of tuck-away acquisitions in the United States. With regard to 2011 I think we’re looking on a global basis, and when I gave you the metric with regard to organic and acquisition growth this year I didn’t specify as to what part of the world it would be in. I do think you’re going to continue to see us very active in the international markets, and that’s probably all I’d want to say at this point in terms of the guidance for the $300 million to $400 million. Tom Jones – Berenberg Bank: And the tick up in non-same store growth in volumes in North America, I think it’s 1.4%, is that likely to continue at that level or was that just a one-off really in Q4?

Mike Brosnan

Chief Financial Officer

I’m just thinking for a minute to try to dovetail that into what I just told you. I think that there will always be some non-acquired growth. It is up a little bit but 1%, 1.5% is not extraordinary. So I think it’s reasonable to assume that you might see something on the order of say 0.5% to 1.5% in North America over the course of 2011 based on what I know today. Tom Jones – Berenberg Bank: That’s very helpful, thanks very much.

Oliver Maier

Management

Great, with that actually I’d like to thank everybody for your interest and your questions and we will talk to you soon. And I think the only housekeeping item I have is as always we have some food being served actually in the room behind us. So thank you very much.