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Fresenius Medical Care AG & Co. KGaA (FMS)

Q4 2016 Earnings Call· Wed, Feb 22, 2017

$22.53

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Transcript

Operator

Operator

Ladies and gentlemen, thank you for standing by. I am Patrick Wright, your Chorus Call operator. Welcome and thank you for joining the Fresenius Medical Care Earnings Call on the Fourth Quarter and Full Year 2016. Throughout today's recorded presentation, all participants will be in a listen-only mode. The presentation will be followed by a question-and-answer session. I would now like to turn the conference over to Dominik Heger, Head of Investor Relations. Please go ahead, sir. Dominik Heger - Fresenius Medical Care AG & Co. KGaA: Thank you, Patrick. We would like to welcome all of you to the Fresenius Medical Care earnings call for the fiscal year 2016. I would 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 today. For further details concerning risks and uncertainties, please refer to these filings, including our SEC filings. With us today is Rice Powell, our CEO and Chairman, and Rice will give you a general business update and go through some of the highlights of the year. Of course, also with us is Mike Brosnan, our Chief Financial Officer, who will give you an update on the financials and the outlook. For the real work, I now handover to Rice. The floor is yours. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Thank you, Dominik. Good morning, good afternoon, everyone. Thank you for being with us today. If I may, before I start my prepared remarks, given we're going to be talking about the full year, I'd like to just offer a very warm thank you to the FMC employees for all their hard work and contributions over the course of 2016. People worked very hard…

Operator

Operator

Thank you. Ladies and gentlemen, at this time we will begin the question-and-answer session. In the interest of time, please limit yourself to two questions and one follow-up only. And our first question today comes from the line of Tom Jones of Berenberg. Please go ahead. Tom M. Jones - Joh. Berenberg, Gossler & Co. KG (United Kingdom): Let's say good morning, whatever it is you. I had a couple of questions. The first is just around guidance and your thoughts on the steering rule. I just wondered what your current thoughts around the steering rule are, whether that's (25:39) risk it might come back and to what extent have you baked something into your guidance for that rule resurfacing and making it to the point where it actually has an effect on anything? And then the second question was just around a tricky area, I guess. Your comment on the commercial pricing. There was quite a jump in Q4, more than I would have expected was possible just from mix alone. So I wondered if you could make some comments about your commercial rates in Q4. And then perhaps, to the extent you can talk about the outlook for 2017 – I know one of your competitors has been making some cautionary comments in that regard, and that can lead – don't want to prejudice any rate discussions that are coming up. But I guess based on the rates that you've locked in for 2017 already, you might be able to comment a little bit more freely. So anything you can give us in that regard would be very helpful, I think. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure. Thanks, Tom. I think what we will do – we will do this is on the…

Operator

Operator

Our next question comes from the line of Veronika Dubajova of Goldman Sachs. Please go ahead.

Veronika Dubajova - Goldman Sachs International

Analyst

Thank you, gentlemen. Good afternoon from me as well. I have two questions. I think actually, Rice, you forgot to comment on the commercial contract renegotiations and what DaVita (30:49) I'm going to ask the same question and let you expand on that a little bit. And just conceptually I think some of the commentary from DaVita has, obviously, been their view is – the difficulty that they're encountering is a feedback mechanism from "steering" today. So maybe you can give us a little bit more color on that. My second question is just on Care Coordination and BPCI. I was hoping you can elaborate, one, just broadly speaking what your expectations for Care Coordination are as far as the 2017 guidance is concerned? And then specifically for BPCI revenue recognition, how far are we from a point of you being able to recognize any revenues here and whether you have assumed any contribution for 2017? Thank you. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure. And, Tom, you got off the phone before I could answer. So I'm glad you picked it back up, Veronika. I'll take number one. Mike, would you take number two... Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Sure. Rice Powell - Fresenius Medical Care AG & Co. KGaA: ...for me? So, look, as you well know, we have three large contracts. We completed a negotiation for one of them in the latter days of last year, so it's done. We are negotiating one as we speak and we have one more that will get started here in not too far distant future. We have had no issue or discussion about AKF premium assistance, any of those issues. We are giving you guidance that we believe we're going to…

Veronika Dubajova - Goldman Sachs International

Analyst

That's great. And if I can follow-up – and thank you both for the color – just really quickly on tax. And two questions, Mike. One, any guidance for 2017? And then more broadly speaking, are you able or willing to comment on how you are thinking about the Trump tax reform proposals and also the proposal that's under discussion in the House? Thank you. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Okay. Yeah, I would guide to 31% to 32% for an effective tax rate in 2017, and I'd say that guidance is status quo in terms of whatever happens in the U.S. More broadly – sorry, we're getting some background noise in the conference room here. More broadly, I would say when you look at what's happening both in terms of the new administration, as well as what Congress may do on a variety of fronts, for 2017 we're looking at status quo, because it's very hard to predict at this point what might happen on any of these initiatives. To answer your question in terms of tax, I think that there seems to be a sentiment that they would like to see a meaningful reduction in the tax burden to corporate. Hopefully, you can hear me over this background noise on the phone, Veronika. But...

Veronika Dubajova - Goldman Sachs International

Analyst

Totally fine. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Okay. Great. So I think the sentiment is, they're looking for a meaningful reduction in corporate taxes. The devil will be in the details, because while they are talking about reducing the marginal tax rates, they are also talking about some pretty sweeping changes with regard to deductibility of capital, deductibility of interest expense. So we'll have to take a wait-and-see in terms of which elements of this Congress likes and which elements of this the new administration wants to push forward.

Veronika Dubajova - Goldman Sachs International

Analyst

That's great. Thank you. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure.

Operator

Operator

Our next question comes from the line of Patrick Wood of Citi. Please go ahead.

Patrick Wood - Citigroup Global Markets Ltd.

Analyst

Perfect. Thank you very much. I have three, if I may, please. The first is a little bit more detail maybe on the cost per treatment side of things. Obviously, year-on-year – maybe this is just an accounting issue, but maybe year-on-year the growth seemed very, very low on the cost per treatment side, especially when compared to one of your peers. I know that the nursing side is getting increasingly inflationary. I mean, we had HealthSource saying just earlier today to expect about 3% inflation on the cost base there. So I'm wondering if that's just Mircera and some accounting bits that are finally sort of rolling off in Q4 or is there anything else happening in there. That's the first one. The second is on the pharmacy business. Again, one of your peers was talking about, they took a write-down in that business and discussing some of the changing regulatory landscape. Appreciate it's probably only about $600 million of revenues and maybe a 5% margin for you guys, but I'm curious if there's any impact on the pharmacy business. And then the final one would be the open exchange, the enrolment period on the exchanges. How have the sign-ups been for exchange patients in your view going into 2017? That would be very helpful. Thank you. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure. Patrick, I think what we will do is, Mike will take cost per treatment and answer your question. I'll speak to – and the nursing inflation, if there is going to be there. I'll take the pharmacy business and the exchanges. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Okay. That's fine. So on the cost per treatment, I would just say broadly, we've said many times that as…

Patrick Wood - Citigroup Global Markets Ltd.

Analyst

That's fairly helpful. If I could just have one quick follow-up. What are the opportunities for an MSP extension do you think this year or next? Then that will be me done. Thank you. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Yeah, I would say that when I was in DC couple of weeks ago, it didn't really get discussed. I think we all would like to see that happen, but I also think that there are some other things that will probably take precedence to that. We certainly wouldn't say no. But it's not the hottest topic going on at this particular point in time, at least in my discussions I'm having with people that we generally work with in DC. Look, we're not negative by any stretch. It's just not top of mind for us at this point in time.

Patrick Wood - Citigroup Global Markets Ltd.

Analyst

Very helpful. Thank you.

Operator

Operator

And our next question comes from the line of Lisa Clive of Bernstein. Please go ahead.

Lisa Clive - Sanford C. Bernstein Ltd.

Analyst

Good afternoon. Three questions for you. First, specific question on premium support. You had given the figure that 1,600 patients have marketplace coverage. Could you comment on what number are Medicaid eligible, including both on and off-exchange? Second question, last month you announced you won 18 new ESCO mandates. Given that the six you have right now, I think represents about 8,000 patients, is it safe to assume that you've now added another sort of 24,000 or so? And can we assume 100% of costs from those patients from when you started enrolment on January 1 and like the initial six ESCOs that you won't actually get paid for probably about 18 months? And then third and final question on the Care Coordination initiative with Cigna, roughly how many patients has that and could you just comment on how you see that developing over time? Rice Powell - Fresenius Medical Care AG & Co. KGaA: Yeah, Lisa, it's Rice. And I think Mike and I'll try to double team this. I'm not sure – run me through your premium support question again, because I'm drawing a blank on your numbers on the on and off exchange. Can you just repeat that one for me?

Lisa Clive - Sanford C. Bernstein Ltd.

Analyst

So you had a response to the CMS RFI that said 1,600 of your patients were on marketplace coverage. I understand you have another, say, 1,900 that are off-exchange, so 3,500 in total that are ACA plans. I'm just wondering of that, how many are actually Medicaid eligible. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Okay. I'm going to have to get back to you. I'm looking at Mike. I don't know right at this moment, but we will come back to you. I'm going to be in your part of the world tomorrow, and I'll try to connect with you. I've got to do some checking on that, Lisa, but I think we can try to find out for you.

Lisa Clive - Sanford C. Bernstein Ltd.

Analyst

Okay, great. Rice Powell - Fresenius Medical Care AG & Co. KGaA: On the ESCOs, your numbers are very good, as always. We are anticipating that there will be 37 total locations. We're going to be in 24 of those, and I think your numbers were spot on as to these additional 18 should yield us somewhere around 20,000, 24,000 patients. And, yes, we would anticipate that's probably 18 months out to payment. And I think Mike may have mentioned it, but I'll repeat it in that fourth quarter of this year, we did recognize revenue again in the health plan modest amounts, but we are seeing some bending of that cost curve. So we do think that the ESCO program is working for us. And let me, if I can make a comment. I've had some people wonder because we're so big and primary in the ESCOs, are we not interested in what's going on on the capitated rate, and that's really not the case. The patient act, which is out there and we're supporting that act, which would allow this shared savings program to move completely to a capitated rate, we would support that as well. We think there's lots of room and ability to do both, but it seemed earlier in the day we had some questions on that, so I wanted to be clear. So, on the Care Coordination with Cigna, I don't know off the top of my head. I'm going to have to come back to you on the number of patients that are going to be involved in that. As you know, the basic component, I'll focus more on that for today, is that we'll continue to get paid, on the one hand, for providing the treatment, the dialysis treatment, and the other set of payment that comes to us is really trying to bend the cost curve, make sure we manage these patients and keep them out of the ER and unnecessary hospitalizations. But I will get back to the guys in the U.S., Lisa, and get a number on what we think that patient count is. I just don't know off the top of my head, but I'll come back to you on that (45:38).

Lisa Clive - Sanford C. Bernstein Ltd.

Analyst

Okay. Thanks very much. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure

Operator

Operator

Our next question comes from the line of Michael Jüngling of Morgan Stanley. Please go ahead. Michael K. Jüngling - Morgan Stanley & Co. International Plc: Great. Thank you. I have three questions. Firstly, on the operating leverage, if I look at your guidance for 2017 in terms of constant currency sales growth and also an income growth, there is no operating leverage. Can you give us a reason why we wouldn't see some leverage in 2017? Secondly, on the cost savings program, what is the potential for additional savings in 2017 from new programs or, if you like, a formal Global Efficiency Program part two? And question number three is on Care Coordination. Is the bad debt expense in the fourth quarter around $26 million? And if so, what went wrong? Are customers unhappy with the services that you've provided? Thank you. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure, Michael. And I'll look to the other Michael. You want to go ahead and answer these, Mike? Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: I think in terms of operating leverage, we're guiding 8% to 10% top-line and 7% to 9% bottom-line constant currency, which I think is consistent with 2020. We expect we will see a slight increase in interest expense. We're indicating a slight increase in the effective tax rate, so I think that contributes to your notion that there is no leverage in fiscal 2017. But I do – with that having been said, I do think that the commitment we're making on the bottom-line is actually a pretty strong commitment, given the operating environment we're managing. We also, in terms of our non-controlling interest, see an increase in that, which you might not be factoring in when you think…

Operator

Operator

Our next question comes from the line of Ines Silva of Bank of America. Please go ahead.

Ines Duarte Silva - Bank of America Merrill Lynch

Analyst

Hi. Good afternoon. Thank you very much for taking my question. So, my first one is just on the growth guidance for the top-line. Is there any assumption of non-organic growth, including debt? And my second question was if you could explain a little bit more the process for BPCI. I appreciate it's being delayed and you've given us the timeframe. But could you just explain in what stage of the process you are? I mean, has the government committed to giving you any kind of amount or are you estimating any kind of amount and how does that work? I mean, are you going to have a firm commitment at some point in time to receive an amount or...? Thank you. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure, Ines. Mike, do you want to take one on the growth guidance top-line... Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Sure. Rice Powell - Fresenius Medical Care AG & Co. KGaA: ...anything inorganic? And I'll speak to BPCI. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Okay. Yeah, I'll give you a couple of additional measure that might help you structure what you want to model for 2017. To answer your question a bit more broadly, I would say worldwide in terms of organic growth, we're thinking in terms of 7.5% to 8.5%, and which implies that there is some inorganic or growth in the figures related to acquisitions, which I would put at about 1% to 1.5% for the range we've indicated, if that's helpful. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Ines, on BPCI, Mike gave you a pretty good indication of when we think we'll see some revenue recognition. The hold-up that we have now, and…

Ines Duarte Silva - Bank of America Merrill Lynch

Analyst

Thank you. But if I can just follow-up. Will there be a time where you will know exactly how much you will receive and when, or will that be more phased, and therefore you'll never get a notion of exactly how much it's going to be? Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: I would say two things. This will come in stages, so we'll get better clarity as 2017 progresses, but then I would just, obviously, remind everybody that this is about what we can – how we can bend the cost curve. So at no point is there really a guarantee. It's really how effectively we can execute against the principles of BPCI, so there will be some variability as – once you get to revenue recognition, there will be some variability quarter-to-quarter, year-to-year, in terms of what we actually achieve in terms of cost savings. Rice Powell - Fresenius Medical Care AG & Co. KGaA: And look, what gives us some comfort with that, which may make you nervous, but where we have some comfort is when we look at our health plan and the ESCOs that we're participating in, we've had two quarters in a row now of being able to recognize revenue. It's not the same amount of money. It differs. There's some variability here. But we do believe that we'll get to where we're in a place where BPCI will be very akin to what we're seeing in the ESCOs, although very different locations, if you will, and different things that you are doing, Ines, but we think we'll get there.

Ines Duarte Silva - Bank of America Merrill Lynch

Analyst

Thank you very much. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure.

Operator

Operator

Next question comes from the line of David Adlington of JPMorgan. Please go ahead.

David James Adlington - JPMorgan Securities Plc

Analyst

Hi, guys. Thanks for taking my questions. Most of them have been asked already, besides I will fix on maybe first on the product side, maybe you could give us some further color on your expectations for this year in the particular regions and any areas you might be seeing some increased competition. And then just a housekeeping question, I may have missed on the call earlier, and apologize if I did, but just wonder what your interest expectations were for this year. Thanks. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Okay. Patrick, I will take number one and Mike will talk about interest. We have, consistently for the last couple of years, said that when we look at the product book of business and we look globally at that, we think a growth rate in that 4% to 5% range makes sense. We clearly are doing better than that when you look at the Asia-Pacific region. When you look at Latin America, they've actually done pretty well. So let's go back to the two other areas. When you look at North America, I will be pleased if we can run in a 2% to 4%, maybe 4.5% range. Obviously, we're talking about three countries in North America, with one huge one as you well know, in that we are very well entrenched, high market shares. So we're going to kind of grow at the rate of whatever the market is growing. When you look at EMEA, beyond the issues that we walked ourselves through, if we were to go take individual countries, we can show you that, yes, they are still seeing that 4% to 5% growth. It slows down in some of the more developed European markets, but if I look over in sort of…

David James Adlington - JPMorgan Securities Plc

Analyst

Great. Thank you. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Okay. We have time for two questions. If I could, Patrick, before you take one question, I want to give Lisa a piece of feedback. We did get a number for you, Lisa. With the Cigna project, we're probably estimating between 752 to 1,000 patients. So just I got you that follow-up, but I'll work on the Medicaid eligible and come back to you maybe even tomorrow when I'm in London. Please, Patrick, let's go ahead with next questions.

Operator

Operator

Next question comes from the line of Oliver Metzger of Commerzbank. Please go ahead.

Oliver Metzger - Commerzbank AG

Analyst

Yeah, hi. Thanks for taking my question. My first one is a strategic one on your international expansion of Care Coordination, which you recently started. So just for understanding how you enter market, so is it (58:47) more important to become first you go to selective market or just through forced (58:54) expansion into eligible market? And my second question is just a modeling one on the current FX rates. Can you give us any projection how strong you expect the impact will be? Thank you very much. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure, Oliver. I'll take number one and Mike will try to help you on the modeling question. So when we think about Care Coordination, as we try to know, we have not closed this deal in Australia with Cura. But we anticipate closing that probably in second quarter – early second quarter we would guess. But when we looked at the opportunity, we were in a market in Australia where we have very good penetration, pretty high market share as we bump up a little bit into antitrust issues just in the pure dialysis side. So as we're looking at that market, which has a very good payer history, we stumbled across and began to think about these day hospitals or freestanding clinics, as we refer to them, and we looked at that. And if you think about our book of business, we run 3,600 freestanding clinics today. These facilities, there are 19 of them. They are in Eastern Australia and Northeastern – I think Southeastern Australia, and they really do a number of things outplay (1:00:13) surgery focused, ophthalmic work, a little bit of orthopedic work. They also were licensed such that in about half a dozen of these we will…

Oliver Metzger - Commerzbank AG

Analyst

Okay. Great. Thank you. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Okay. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Okay. So we come to the last question.

Operator

Operator

Our last question today comes from the line of Oliver Reinberg of Kepler Cheuvreux. Please go ahead.

Oliver Reinberg - Kepler Cheuvreux SA

Analyst

Yeah, thanks for squeezing me at the end. And three quick questions. One, to understand the guidance a bit better. Can you talk about what kind of corporate costs you are going to assume? And does the guidance basically (1:03:13) based on the assumption that the costs for the compliance project will only keep you busy in the first half that you then basically get a settlement or would you also make a guidance that this will keep you busy for the full year? Secondly, on Care Coordination, you gave some kind of color why you missed on the kind of margin guidance. But can you provide more details on the kind of initial expectation of 25% to 35% of revenue growth? What was the delta why you came in below that? I think BPCI cannot fully explain it, so any kind of color here would be appreciated. And, Mike, I would push on that, not sure if I'm successful, but can you be more specific what kind of margin you have in mind for 2017? The improvement is probably clear, given the kind of bad debt effect, if you can give us kind of more quantified guidance that will be helpful. And the last one, just in terms of housekeeping, income from equity was actually in Q4 much lower. How should we think about that in 2017? Thanks. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Okay. Let's see, Oliver. The corporate costs, I think broadly speaking, I'd expect corporate costs to be, including R&D by the way, to be roughly flat, maybe up just slightly in fiscal 2017. And we are anticipating that we'll spend incrementally on R&D, so I think implicit in that corporate costs guidance is a reduction in other corporate spending, which would…

Oliver Reinberg - Kepler Cheuvreux SA

Analyst

All right. Thanks very much. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Yeah. Dominik Heger - Fresenius Medical Care AG & Co. KGaA: Okay. Then thank you very much, everybody. Thanks for detailed questions and your participation today. Please keep in mind, we will have the Capital Markets Day on the 8th of June and we would all like you to meet us there. And we look forward to seeing you soon and talk to you soon. Thank you. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Thank you very much. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Thank you. Take care. Bye-bye now.

Operator

Operator

Ladies and gentlemen, the conference has now concluded and you may disconnect your telephone. Thank you for joining and have a pleasant day. Goodbye.