Operator
Operator
Ladies and gentlemen, thank you for standing by. My name is Emma, your Chorus Call operator. Welcome and thank you for joining the Fresenius Medical Care Earnings Call on the First Quarter 2018. 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. And 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, Emma. We would like to welcome all of you to the Fresenius Medical Care earnings call for the first quarter 2018. As always, I'm happy 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, as well as to our SEC filings. Given that there are three major earnings call of German healthcare companies today, I assume it is in your interest to limit the call to 60 minutes. It turned out to be a good approach in our recent calls to limit the number of questions to two. Given the press releases we have issued over the last two weeks, I assume that there might be more questions than usual, and therefore, it would be fair to leave your colleagues also the opportunity to ask questions. With us today is Rice Powell, our CEO and Chairman of the Management Board. Rice will give you a business update, go through some of the highlights of the quarter and a brief wrap-up of our Care Coordination approach in order to pre-empt some of the potential questions. Also with us is Mike Brosnan, our Chief Financial Officer, who will give you an update on the financials and the outlook. I will now hand over to Rice. The floor is yours. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Thank you, Dominik. Good morning, good afternoon, everyone. We're delighted that you could be with us today. Mike and I are going to move through our prepared remarks very quickly in order to try to leave ample time for your questions. I know this is probably not as simple and straightforward a quarter as some others we've had. And we really want to make sure we give you every opportunity to get your questions answered. I'd like to begin my prepared remarks on slide 4, which is the Q1 2018 on track for another record year. Just a couple of comments on this particular slide, I am very happy and pleased with our highest Five-Star Quality Ratings award that we just received from CMS. This means that our Five-Star Quality Ratings for Four-Star and Five-Star clinics that combination was the highest in the industry and so I'd like to give a nice warm congratulations and thank you to our caregivers in the United States for that achievement. Looking at our growth indicators, Clinics up 4%, Patients up 4% and our Treatments up 3%. We routinely present this to you, so I won't make any further comment on it, but just to show you we continue to see growth in those areas. And then lastly, I would just make a comment on our net income growth on track. I know from what I've read this morning, you'll have some questions on how do you do that when you've had your revenue come down and Mike and I will attempt to take you through that. But rest assured that we are comfortable and confident that we're going to achieve our net income guidance over the course of this year. Turning to our quality outcomes for the clinical side of the business, I would say that we continue to see stable performance at a very high level. You can take any one of these particular key clinical indicators and you can see where we are in a very stable position, a little bit of movement up or down, but nothing that really changes where we sit in our ability to drive high performance, good clinical outcomes, no matter what the region. And I'm pleased, and I'm proud of that. So, we continue to continue on in a very stable environment. Now, looking to our highlights for the first quarter. I would say that when you look at what is on this slide, there is truly in my mind only one surprise that we've given you and that is the Sound divestiture. And as we sit here today, it's a week-and-a-half old, but I know it was a surprise nonetheless, and we're going to spend some time talking about that in a couple of other slides here and certainly, we'll entertain your questions that you have on that topic. I'm pleased that we've had a very strong start in the healthcare products area, 6% constant currency growth. I'll detail that a little bit more, we'll focus primarily on the dialysis product side of this and I'll walk you through some ins and outs there to give you a better understanding of what I think is a consistently good performance now from one quarter to the next. We told you in February that we were going to see a decline in our Care Coordination book of business, and we told you it was going to be in the pharmacy business. And it revolved around the fact that we had a branded drug going generic, and we were going to try to understand how best to manage calcimimetics, moving from Part D to Part B. And that is ongoing. It's not over yet, but we're going to walk you through some detail on that and try to give you a sense of comfort about how we're looking at that piece of the business. But again, it shouldn't be a surprise. Mike and I tried very hard to highlight that for you in the February full year 2017 earnings call. The VA agreement, I'm not going to say anything, we've talked about that enough, it does have an impact obviously, but we'll get to that. And then obviously, the divesture of Sound, I'll talk more about that at a later date. So I would say that should be the wrap-up of my comments for the highlights for the first quarter. I'd like to now spend a little bit of time on organic growth for the first quarter. What you see is that in the international markets, every region had good growth and good contribution, Asia 14% constant currency, revenue growth organic at 7%, you see EMEA and you see Latin America as well, all of them doing very well and obviously, we're going to spend more time. When you look at North America, we've tried to lay out our material in such a way that you can see it, but a negative 5% constant currency growth and organic growth of only 1%. But again, just to give you a sense of how this is playing out when you think about the IFRS 15 accounting change, that's about an €88 million impact and you know that the agreement was about €100 million. So just to give you a little bit of scale and I think Mike's going to be in a place where he'll take you through that in some more detail, should you have questions. Now, looking at healthcare services, I don't like putting a soft start into the year as my header, but I have to call it as I see it, in particular, when it comes to what we've seen in North America, but again, I think you understand those circumstances for why we're seeing it the way we are. So we're seeing, let's highlight Care Coordination, 14% negative constant currency growth, organic growth is down about 9% and again that sits within the pharmacy business and the impacts that I've mentioned and then we'll talk some more about in detail. Looking at EMEA, Asia-Pacific and Latin America, again, constant currency growth looks good in healthcare services and you can see the actual organic growth, particularly in Asia and Latin America, it looks strong and then, obviously, the acquisition we made in Australia with Cura, for the international, Care Coordination is continuing to work and progress nicely. And then, our same-market growth at 2.3% for North America, I think it's around 2.4% for EMEA and Asia-Pacific is up around 4.2%. We mentioned to you for two quarters now that we are still working through terminating acute contracts in the U.S., because the pricing didn't fit what we wanted it to fit. I guess, you could argue maybe we shouldn't have signed them in the first place, but we did. But we've turned them and we're moving on. We've got probably another quarter or two before we see that turnaround, but it does have a significant contribution to the drag that we're seeing. But we still will tell you that we think we'll be back in the three territory before we exit the year, hopefully halfway through the year, we'll begin to see that come back. Now looking at products. I'd like to just for the moment focus on the dialysis products side of the equation. You can see 7% constant currency growth. I will remind you that we were at 7% constant currency growth on the total book of business in the fourth quarter as well. Looking at North America, with this 1% constant currency growth increase, of note, the renal pharmaceutical book of business in North America was up 38% in the quarter and that's predominately on the strength of Velphoro, our phosphate binder. We're seeing great progression with that product. Our PD book of business in the U.S. is up 18%. So we continue to see good growth. We were at 20% in the fourth quarter. So we continue to see our PD book of business in the U.S. growing significantly. Now, when we take a moment and we think about particularly hemo equipment, the overall quarter for U.S. products or North American products in the fourth quarter was 9% constant currency and the big contributor there beyond the PD was home hemo equipment. Not unusual, those of you that have covered us for a number of years, you clearly know that when we see huge machine sales in the third quarter and fourth quarter, as we did, it's not unusual to see that tail off in the first quarter. So I'm relaxed, it will come back. There's a little bit of noise in there because of IFRS 15, but not much. It's really more about people aren't buying at the moment, but they'll come back around, as you know we see that sort of pattern. So I feel very good about the start into the products business. And as you will remember, Mike had indicated to you we thought for this year, we would be at about 6% growth in products and well, we're there in the first quarter, so we feel good about that. Now I'd like to take a little bit of a detour and talk some about strategy and particularly about Sound. In this first slide that I have here, you've seen this before. Yes, it's a capital markets slide. We've updated it a little bit. The message I'm trying to get across to you is we've made this journey and we're still on it. From a fee for service world, now we've moved in 2011 to a Bundled Payment. Now we're in a shared savings program, which fits under value-based care and ultimately, we want to get to a capitated program and that's why we're such big supporters of the Patient Act, because it really gets us to the place that we think is a sweet spot for us and for the industry. Now a little bit of history, 2014, we became the majority shareholder in Sound. Why? Because as we told you quite honestly and openly, we lost track of our dialysis patients many times when they're hospitalized, we didn't know which hospital they were in, we didn't know why they were there and we certainly didn't know when they were coming back. And we felt that was a weakness for us, a blind spot, if you will, as we move down this path of value-based care, moving from volume to value. Many of you ask, why did you have to be the majority shareholder in Sound? Couldn't you have just partnered or made a little less of an investment? We said no, because we felt like we should have control of the asset, we should be able to work, make changes, invest, whatever we wanted to do without getting too tied up with a whole bunch of partners. Now maybe that means we don't play well with others. I don't think that's what it means, but you can infer that if you like. But sitting here today now, having been able to have this business, get a much better understanding of the in-patient experience for our dialysis patients in the hospital, I'm glad we did what we did. We were able to turn this asset, divest it at a very nice profit and yet, we don't lose the knowledge of what we gained. What we learned with Sound and our ability to help manage more effectively and efficiently, patients moving through – dialysis patients moving through the hospital. We're not going to forget that. And we don't really think that we would have ever been in a position to develop the clinical interventions that we've been able to develop with our healthcare plan and in our clinic, had we not had the experience and understood where we perhaps weren't communicating as well with hospitals as we should. Now I say all of that, keeping in mind that Sound did not have contracts or control every one of the 4,600 acute care hospitals in the U.S. They had a nice book of business, but we were having to take this knowledge and use it with other hospitalist groups or other health systems that had their own hospitalist program, but we believed and we feel that we came to a point that we had gotten the value that we need, the understanding that we needed. We firmly believe that the period of time where we have been the largest value-based care provider in U.S., opened doors and gave us a chance to have some dialog in Washington that we might not have had in other circumstances. So we feel good about this experience and where we're going. But please hear me. We are not changing our strategy. We are continuing to move down the path from volume to value. We see the culmination of that coming over the next couple of years and I'll speak to that more in a moment. But we are continuing down the path that we said, albeit a little differently without having Sound. Now if you move to the next slide, there are eight businesses on this slide that make up Care Coordination. And now we've gone to seven. Sound will be leaving us, okay. But the thing I just want to continue to highlight is that through these businesses, we're in a position to try to improve clinical outcomes while driving down or bending the cost curve. And Sound helped us to do that. They helped us get to a component of that which was hospitalization for dialysis patients that was essential and important for us. Knowing full well that the majority of Sound's business was acute hospital episodes of a general nature and not just focused on dialysis, but we got value out of that relationship. They've helped us with that one component, but now it is time for us to move on. We have to look at the horizon. If we just stare at our feet, we're going to trip and fall. And what I mean by that is, we know the Patients Act will become a reality. We will move our health plan into capitated arrangements at some point, don't know exactly when, but that's going to come. We have the Cures Act and Medicare Advantage coming in this January of 2021. Those are all sitting on horizon and we need to be operating ourselves looking at that horizon, so we are in the very best place to act when that time comes. So what I'm saying to you is, we are not running away from Care Coordination. We're not taking a left turn on Care Coordination. In fact, we're running harder, but more focused on that path from volume to value. And we think when we look out at the horizon, at least, through 2021 and Medicare Advantage coming into our world at a much bigger way and then where we go beyond that, we think our focus on trying to continue to find the right clinical interventions for dialysis patients, being able to bend that cost curve is what's going to be key and critical to our success. And we think it should have every ounce of focus that we can put on it, not to say Sound was a distraction, it's not, but it was a focus requirement that we needed for a while, but I don't think it is critical to the mission as critical today as where we're going. Hopefully, that helps. But let me say it again, our strategy hasn't changed. Have we refined it? Sure. Tell me who doesn't refine their strategy. If they're going to be successful, they have to adjust and adapt. And that's all we've done here. In conclusion, a lot of stuff went on in Q1. A lot of big movements, don't let that noise distract you from the underlying performance that we have given you in Q1. We are working our plan, we are confident that we're going to deliver the net income growth. We're going to continue with the core Care Coordination strategy. And yes, we have two things we have to do and that all revolves around closing NxStage and closing Sound, and we'll get those things done. And that's the conclusion of my remarks and I'll turn it over to Mike. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Thanks, Rice. Good morning, good afternoon, everyone. So, I'll continue with chart 14. And rather than a P&L, I'm just giving you a series of reconciliation charts to give you a sense as to how the quarter progressed. So, on chart 14, I'll go through revenues. And you see the 2017 and 2018 reported revenues with the major elements in between. Rice already mentioned that we have the implementation of IFRS 15 this year. So, what we've done is, we've reflected the €139 million to adjust the base period on a consistent basis with IFRS 15. In addition, we've adjusted for the VA agreement, which you are all very familiar with. This gets you to a base of €4.309 billion. And then you can easily see the 4% business growth that we had or €185 million on a constant currency basis. That was made up of about 3% acquisition growth, 2% same-market growth and a little bit of leakage of around 1% for sold or closed clinics around the world. Last, you can see the currency headwinds that we are seeing in 2018 with the €518 million on the top line, to get down to the reported revenues of €3.976 billion. So turning to chart 15 and looking at net income. Here we're showing you two views. View at the top of the chart is the published approach to guidance that we gave you in February, which was net income would grow 13% to 15% on a constant currency basis based off of 2017's reported earnings of a €1.280 billion. The view on the bottom of the chart formalizes what we discussed in our last call. This considers the 2017 base earnings of €1.204 billion. In this case, our reported earnings are adjusted for special items in both years that we don't think represent the underlying operational performance of the business. So for 2017, just as a reminder, those adjustments were the veterans administration agreement, which you see in the first quarter and then, later on in the year, as we report out subsequent quarters, you'll see the natural disasters, the FCPA charge and the effect of tax reform as special items in the base. It was clear in February that you needed both the reported guidance and what we have now been calling the more operational guidance to make sense out of what was happening in the business, given all the variables that we saw in 2017 and that we anticipated with tax reform in 2018. So going back to the top of the chart, you can see the business growth of €16 million to get to earnings growth on a constant currency basis of 5%. This growth rate is not surprising given what was in the base period for the quarter last year. Following on with currency at €32 million and a €13 million adjustment related to Sound's equity program. Just one comment on that equity program, this valuation adjustment was influenced in the quarter by the fact that Sound was being sold. So, we've kept this adjustment outside of our operational results. When the sale closes, we'll consider this charge and any other similar charges as part of the cost of the sale. On the bottom of the chart, we show the relevant Q1 adjustment to the base period, which, as I mentioned, was the VA agreement. And then, looking at the business growth for the quarter of €22 million, this brings you to €270 million of net income or an 8% growth rate on a constant currency basis. And this is very much in line with the guidance we provided, the operational guidance we provided in this view of 7% to 9% growth for the year. What follows are similar FX effects for the business, the Sound valuation adjustment and the net effect of tax reform in the first quarter of 2018. So turning to chart 16 and looking at the underlying margins. So these are the global margins and in the first quarter, again, last year, we had the VA agreement, which had a very significant positive effect on the margins, about 190 basis points. This was partially offset by the effect from the implementation of IFRS 15. And so therefore, adjusting for both of these effects, the margins of Q1 2017 would be about 12.8%. And then, when you look at the operating margins for the first quarter of 2018, reported was 12.5%, adjusting for the initial Sound valuation impact, it also shows a 12.8% on an adjusted basis. So we're looking at the operating performance of the business year over year being very stable just under 35%. So turning to chart 17 and looking at the underlying margins of the regions, I would go through starting with North America. North America, the operating income was down on a reported basis €164 million to €362 million for Q1 2018. That's about a 21% decline on a constant currency basis. The total margins for North America decreased 2.5 percentage points from 15.6% to 13.1%. Excluding IFRS 15 and the VA agreement and the Sound valuations, those three items, margins decreased only 10 basis points from 13.6% to 13.5%. In our dialysis business, the operating margins decreased by 4.2 percentage points from 19.6% to 15.4%. Again, excluding the IFRS adjustment and the VA agreement, as well as the dilutive effects that we're seeing in calcimimetics in 2018, they're dilutive, because revenue is increasing associated with the reimbursement from the government for calcimimetics on what effectively is a breakeven at the margin line. So that dilutive effect is worth another 60 basis points. So consequently, operationally, we're looking at about 110-basis point decline in fiscal 2018 from 17.1% in the prior year to 16% in 2018. This decline was due to higher implicit pricing concessions, that is a new terminology under IFRS, essentially, the result of having to bifurcate what we used to call bad debt into true bad debt associated credit risk and bad debt that is associated with the portion of a payment that even at the time you're providing the service, you know there's a very low likelihood of collection and this very often is a portion of the self-pay elements inherent in reimbursement schemes in North America. So shorthand, it's called implicit pricing concessions and it pretty much relates to these self-pay elements. There was also in the first quarter, on a comparative basis, lower revenue from commercial payers. We had a slight net cost associated with the calcimimetic program. We had increased property and other occupancy related costs, higher costs for medical supplies, some increased rate (00:26:45) costs and those were partially offset by lower personnel expenses in the first quarter and a favorable effect associated with foreign currency translation. So I'll just comment on a revenue per treatment basis here for North America, and in particular, the dialysis business. Adjusted for the VA agreement and the implementation of IFRS 15, revenue per treatment, as we reported to you, increased by $6 from $342 a treatment to $348. The cost per treatment increased by $12 from $276 to $288. So if I put this in the context of our guidance, it's worth noting that for the year on revenue per treatment, we guided, excluding calcimimetics, that we would be flat to slightly down. We still believe this is the case. In the first quarter, you're seeing an increase of $6, including calcimimetics. The drug was worth about $11 per treatment in the first quarter. So, adjusting for this, we're down about $5 per treatment in revenues. This was a combination of lower commercial rates, higher implicit pricing, as I mentioned a few minutes ago and these were offset by a number of other inputs. As I indicated in February, we would start with a comparison against a very high base for the prior year and that this would mitigate over as the year progresses. So, that is still the case as we look at the full year expectations for revenue per treatment. On the cost per treatment side, we also guided, excluding calcimimetics, to flat to up slightly in terms of cost. When you look at the quarter, we're tracking to this. We were up $12 in the quarter on cost, $11 of that due to calcimimetics. That puts us at about a $1 increase in cost per treatment year over year. So moving to Care Coordination in North America, the reported margins improved from a loss of 10 basis points to a positive 2.6%. Adjusted for the implementation of IFRS 15, which had a de minimis effect on the margins, about a $50 million effect on revenues, as Rice commented. And more importantly, the Sound valuation impact, the margin improvement – the margin for 2017 would be 5.1%, which is about a 5.2% improvement year over year. This was largely driven by the favorable impact from pharmacy services. In addition, we did see lower bad debt expense in Care Coordination We had a benefit from a lower charge in the first quarter with regard to subsidiary share-based compensation. We saw increased earnings related to the ESCOs as a consequence of the expansion of that program and that was partly offset by lower earnings from BPCI, which, not surprisingly was due to the fact that our initial quarter where we recognized revenues under the BPCI program was Q1 2017, and now we're recognizing revenues on a current basis from BPCI, so that was a slight negative, the earnings year over year. So 5.1% margin in Care Coordination. For all the reasons I've indicated, we also continue to believe that our Care Coordination margins will achieve what I guided for back in February. So turning to chart 18, looking at the remaining regional performance, EMEA operating income down €5 million or 5%, 4% on constant currency. The margins 18.7% down to 17.1%, driven principally by unfavorable foreign currency transaction effects, some unfavorable impacts for manufacturing, which were partly offset by additional dialysis day in the region. Asia-Pacific income was down about €8 million, 4% at constant currency. The operating margins decreased 2.7 percentage points from 21.7% to 19%, still incredibly robust margins in this region. The decrease was again primarily due to the impacts of foreign currency transaction losses, as well as some delayed product sales, which we would anticipate we would recover, partially offset by some favorable currency translation effects. Care Coordination operating margins in the Asia-Pacific region improved from 12.7% to 13.7%. This is clearly the result of the Cura acquisition and the good operating performance we're having in that business. Latin America operating income was flat, margins increasing slightly from 8.1% to 8.3% and that not surprisingly, is largely related to currency translation, some inflation improvements and some improvements in revenues and some inflation impacts on the cost side of the business. So turning to chart 19 and looking at cash flows, last year's operating cash flows were positively influenced by the VA agreement just under €200 million. Also, just as we did in the first quarter of last year, there was some seasonality in our invoicing, which impacts cash flows in the first quarter of 2018. If you adjust for these elements, the cash flows year over year would be 8% of revenues in Q1 2018 compared to 6.4% in Q1 2017. Lastly, in addition, cash flows in 2017 were impacted by a delay in some tax payments that we made in the U.S. So we had an unusual decline in Q1 2017 related to just our Q4 tax payments. All of these things influence our DSOs. DSOs increased from 75 days at December 2017 to 85 days at the end of the first quarter. This does not concern us as it is simply seasonality associated with invoicing. Keep in mind also that DSOs are impacted by the implementation of IFRS 15 with an effect of about eight days in the quarter. Looking at CapEx, nothing remarkable to comment on and free cash flow is a derivative of what we just discussed. So turning to my last slide, the outlook, just a couple of words with regard to 2018. We already confirmed in our announcement that our guidance with regard to our net income growth target and we indicated that the adjustment to our revenue guidance was essentially due to the reduction in dosing of calcimimetic drugs, occurring a little bit faster in 2018 than we had anticipated. So as a consequence, our guidance now for revenues is 5% to 7% on a constant currency basis, based on an adjusted 2017 revenues for the IFRS 15 implementation, as shown on the chart. The increase over reported 2017 net income is 13% to 15% on a constant currency basis, again confirming and we've now added to this chart the increase on the more operational guidance of 7% to 9% for the adjusted 2017 earnings. And this would be without tax reform in 2018 as well. The targets overall, including the 2020 targets, do not include the effects from NxStage or the Sound Physicians divestiture. In addition, the 2020 mid-term targets also exclude the recurring impact from the U.S. tax reform for years 2018 through 2020. So that concludes my remarks and I'll turn the call back to Dominik. Dominik Heger - Fresenius Medical Care AG & Co. KGaA: So thank you, Mike and thank you, Rice, for the presentation. I think we might have already pre-empted some of the most pressing questions, I hope. Nevertheless, I'm happy to open the Q&A for more insights now.