Specialist
Former VP at DaVita Inc
Agenda
- Key trends and developments for DaVita (NYSE: DVA) and US dialysis market
- Coronavirus impact on volumes and reimbursement outlook
- DaVita's competitive positioning vs Fresenius (ETR: FME) and independent dialysis centers
- Shift to at-home dialysis care and ability to take advantage of the trend
- Market outlook, consolidation trends and growth potential
Questions
1.
What major trends and developments in the US dialysis market have you been following over the past 12 months or so?
2.
How has DaVita’s story evolved over the past couple of years in light of the dynamics you mentioned?
3.
How would you quantify the TAM for dialysis treatment in the US and how has this figure shifted during the coronavirus pandemic?
4.
How much have mortality rates increased during the pandemic and how do these rates differ between the CKD [chronic kidney disease] and ESRD [end-stage renal disease] demographics?
5.
Has the pandemic brought about any other shifts in the age or acuity level of DaVita’s typical dialysis patient? Is this mix shifting towards fewer ESRD patients?
6.
What is important to understand about equipment purchasing costs and how these affect dialysis providers’ bottom lines?
7.
You touched on it earlier, but how has the 21st Century Cures Act affected DaVita? How significant is this legislation for driving patient volume recovery?
8.
How much further pressure might there be on commercial reimbursement longer-term?
9.
What are your thoughts on the opportunity in the Medicare Advantage segment? What percentage of patients might be on Medicare Advantage plans in the next 2-3 years and what are the reimbursement implications for DaVita?
10.
DaVita referenced on its Q1 2021 earnings call the continued suspension of Medicare’s sequestration cuts. When do you expect this to reverse and how significant of a headwind could it represent?
11.
Are there any other regulatory developments, whether from the Biden administration or CMS [Centers for Medicare and Medicaid Services] that could significantly impact DaVita and the dialysis market?
12.
Could you break down DaVita’s patient mix across Medicare, commercial and Medicaid? How is this mix shifting?
13.
How does subsequent reimbursement differ between commercial and Medicare?
14.
How might some of the reimbursement pressures in commercial that we discussed impact DaVita’s ability to capture further commercial patient volumes?
15.
How are you assessing the shift to value-based care in the dialysis market? How might this trend affect DaVita’s short-term profitability and adoption timeline?
16.
How would you compare the unit economics of reimbursement per patient between PD [peritoneal dialysis] and HHD [home haemodialysis]?
17.
How do you think the percentage of PD treatments will trend over the next few years?
18.
What are some cost-reduction opportunities that DaVita could focus on to combat margin pressure from some of the reimbursement and volume headwinds we’ve discussed?
19.
How would you assess DaVita’s competitive positioning and relative market share vs Fresenius? Are there any other areas of differentiation to note?
20.
How does DaVita’s HHD machine offering compare to Outset Medical and Fresenius’?
21.
How would you reconcile Fresenius slashing its near-term guidance – a 20% net income decline in 2021 – while DaVita projects 7% growth YoY? What factors could explain this discrepancy?
22.
How are you assessing the competitive threat from smaller players such as US Renal Care, American Renal Associates and other independent dialysis providers?
23.
How much of an advantage does DaVita enjoy due to its scale and ability to obtain volume discounts on purchasing?
24.
Do the smaller players have any notable advantages?
25.
What’s your 12-18-month outlook for DaVita in the US dialysis market? What important factors should we monitor over that time frame?
