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Fresenius Medical Care AG & Co. KGaA (FMS)

Q1 2018 Earnings Call· Thu, May 3, 2018

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Transcript

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…

Operator

Operator

Ladies and gentlemen, at this time, we'll begin the question-and-answer session. First question comes from the line of Tom Jones with Berenberg. Please go ahead. Tom M. Jones - Joh. Berenberg, Gossler & Co. KG (United Kingdom): Well, good afternoon, thank you for taking my questions. I had two for Rice and then a very quick one for Mike, if that's all right. Rice, my first question, Rice, just trying to get a bit of a better handle on what's going on with calcimimetics and why the dosing is changing as rapidly as it is. I remember discussing with you and Ben back in the days when Part D was going to come into the bundle. There was some discussion about what you might be able to do with the dialysate fiddling around with the phosphate binder therapy and a few other things. So I'm just trying to kind of understand, I get the pricing and the reimbursement aspect of it, but I'm still a little bit lost as to why we're seeing such significant changes in the dosing of this calcimimetics. So that will be helpful clarification for us. The second question for you. Now that if we look at it conceptually, Sound and NxStage Medical is effectively an asset swap, the cash inflow, cash outflow are roughly the same. That's going to leave your balance sheet fairly under-levered, well down towards the bottom end of your comfort zone really. Now that you've perhaps got less opportunity to do integrated care stuff, because you seem to be focusing down more specifically on dialysis patients, that avenue may be a bit less attractive for you. How should we now be thinking about capital deployment? I'm sure there's some opportunities elsewhere outside North America that you can continue to pursue, but…

Operator

Operator

The next question comes from the line of Ian Douglas-Pennant with UBS. Please go ahead.

Ian Douglas-Pennant - UBS Ltd.

Management

Thanks very much. Yes, it's Ian Douglas-Pennant at UBS. So first, if you could just sense check something for me, from the numbers you just gave, I calculate something like an €82 million reduction in calcimimetic costs in Q1, which I guesstimate is about a 50% reduction in volume. So first, is that correct? And then, could you also help me understand how Amgen's sales seem to be increasing for Sensipar? There's obviously something I'm missing here between both of those. The second question is, are there any other drivers of the revenue guidance downgrade versus your previous expectations except Sensipar? And – because I'm not sure I fully understood all the adjustments and factors that you highlighted. But my summary is that margins are declining due to payer mix or reimbursement levels. Just wanted to check whether that's fair or not. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Yeah. Let me take those. It's Mike. So on Sensipar, on calcimimetics, I think what we indicated in February was, we anticipated something on the order of $19 to $21 per treatment revenues associated with the drug. And I just indicated in Q1, we're about $11. So I think rough math, it's about a 50% level, somewhere in that range, in terms of what we might have anticipated at the time. And that's reflecting itself in the change in the revenue guidance. We had indicated that the majority of the revenue guidance related to calcimimetics, there is volatility in that. So, moving from an approximate 8% to a 7% to 9%, that range gives us a little bit – excuse me, 5% to 7%, that was 5% to 7%. That gives us a little bit more wiggle room there. Beyond that, I would say we're spending a lot…

Ian Douglas-Pennant - UBS Ltd.

Management

Thank you.

Operator

Operator

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

Veronika Dubajova - Goldman Sachs International

Management

Thank you, gentlemen, and thank you for taking my questions. I'll keep it two, please. My first one is on the North America same-store revenue growth. If I look at the business, so it's now – we're five quarters in of 2% growth, which I describe as a bit disappointing in the context of your historical track record here. I know you called out some specific factors last year, but I'm just curious to know why we haven't seen an acceleration in same-store growth in North America? And what can you do or is there anything that you can do to see an improvement? And then, my second question is on the CVS announcement of entering the home market, just would love to hear your thoughts and reactions and what that means for your business down the line. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Hey, Veronica, it's Rice. So, when you look at same-store, yes, we've had a couple of quarters that I don't think we're pleased with at all. There are three components that we look at when we're looking at how we're growing. It's the acute side of the business, which we were down about 5% or 6% this quarter, so that drives a pretty big – it's a pretty big drag generally on what we're going to see for same-store. We continue to see a good growth on the home side. I would tell you – I can't say that I'm not happy about where we are, but understand, I think, people are working hard to try to see that improve. I think we are a lot more disciplined, we better be about how we handle acute contracts, because this is a little bit of a black eye that we're working our way…

Veronika Dubajova - Goldman Sachs International

Management

Great. Can I just ask a quick follow-up on the home market and NxStage? I understand that the MAC regions are considering reducing the number of payments they make for home hemo from five to three. As far as I understand that would be quite a big negative for NxStage, since you are doing short cycle every day. What's your thought on that and does that change at all the economics that you see in the business? And I'll leave it at that. Thank you. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Yeah. What I would say is, we have anticipated that that could be coming about. If you take the big book of business that we have, we've managed that at a three times basis. So we've never been really up on that curve of 5x if you will. You can't do four times treatments or four treatments in a week, you need medical justification for that. And we do so if we need it, and there are some patients that do. But you can imagine that our modeling was based more off of the way we operate versus what NxStage may have been doing, which fits what they were doing at that particular point in time. But the fact that five going down to three has been talked about for a while. We've sort of tried to gear ourselves toward that, and do our analysis based on that premise.

Veronika Dubajova - Goldman Sachs International

Management

It's very clear. Thank you, both. Rice Powell - Fresenius Medical Care AG & Co. KGaA: You bet.

Operator

Operator

Next question comes from the line of Michael Jüngling with Morgan Stanley. Please go ahead. Michael K. Jüngling - Morgan Stanley & Co. International Plc: Yeah. Hi and good afternoon. I have two questions. So, firstly on EMEA, and you mentioned that the margins declined sort of 160 basis points, sort of primarily because of foreign exchange, but foreign exchange was only down, let's say, 0.5%, yet had a meaningful impact on the margins. Can you explain how the maths and how the sort of science works behind such a large margin decrease on a very small change in FX? And that will help us, I guess, also modeling it forward. And then on Sound Physicians, I'm still a little bit confused because of the disposal, because I remember when you first moved into Care Coordination, it was partly driven by diversifying away from reimbursement in the United States, which was challenging and also this business offers, as part of your CMD slide from last year, very nice growth prospects. Your margins are just about turning and moving to profitability. Why not keep this business for its own prospects? Good growth, margins are inflecting and this diversification angle, I'm trying to understand what has changed, why it is not a good business in its own right. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Yeah. Hey, Michael, it's really Rice. I'm going to – you're ready to go on his first question? Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Yeah, I am ready to go on his first question. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Yeah, go ahead. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: I thought you were going to give me a second and I was…

Operator

Operator

Next question comes from the line of Lisa Clive of Bernstein. Please go ahead.

Lisa Clive - Sanford C. Bernstein Ltd.

Management

Hi. Two questions for me. Firstly, given the movement out in California on the union ballot initiative, is it fair to assume that the industry is going to have to significantly outspend the $15 million that SEIU has earmarked for this initiative. I'm modeling FMC on its own may spend €20 million this year, and then, of course, DaVita will have to spend probably 2X that, but it's not clear to me that this level of spending or higher if it needs to be is in your guidance yet. So if you could just address that, that would be very helpful. And then second of all, Asia-Pacific margins, how much of the impact there comes from increasing your investments in China? Per your comments in Q4 that that market was opening up somewhat. I'm just trying to understand how that translates into incremental costs in the near-term, but potentially also incremental revenues in the mid-term. Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure, Lisa. So I'm going to take the ballot initiative. Mike, I'll let you handle, China. So look, I can't speak for DaVita or anybody else as to what they're doing, but as we've said before, we didn't put spending to fight this ballot initiative in our guidance. We've got money that we budgeted for and I think the way I'm going to say it is, as we are implementing our plan and we're doing it as we speak, we have a level of spending that we're going to undertake. If we find that it's got to be more than that or it's going to be a problem that we can't cover, we'll let you guys know that. At this point, we feel okay about that. There is a big – a large degree of,…

Operator

Operator

Your next question comes from the line of Ed Ridley-Day with Redburn. Please go ahead. Ed Ridley-Day - Redburn (Europe) Ltd.: Hi. Thank you. First is just a follow-up, bigger picture on Care Coordination. Given what you're saying and, Rice, I appreciate the additional color and your thinking on the strategy, but really with the way we are looking at the drivers of that business as it stands now, particularly, of course, the ESCO business and although you book the profits there, you ultimately do all the costs related to the ESCOs are in the dialysis business. Are you thinking potentially of folding that back into dialysis services as you sort of think bigger picture about offering holistic services going forward? And wouldn't that frankly make more sense? That'll be my first question. And secondly, if you could just give us your views as it stands now on where you think you stand with the Medicare Bundle update, of course, which you're going to get in a couple of months? Rice Powell - Fresenius Medical Care AG & Co. KGaA: Sure, Ed. Well, I got to tell you, for me to be talking about organizational moves with you, I'm going to have all kinds of people in the U.S. listening now. It's a great question. No, not at this point, not looking to do that. I still think quite honestly and when I look at a calendarization in my head over the next couple of years, I think if we were going to have that discussion and we were going to think about that, I think we'd want to be in a place where we were in capitated arrangements. We were kind of fully, fully, fully integrated and we've got a couple of different product lines there, Medicare Advantage, we've…

Operator

Operator

The next question comes from the line of Gunnar Romer with Deutsche Bank. Please go ahead.

Gunnar Romer - Deutsche Bank AG

Management

Gunnar Romer, Deutsche Bank. Just two questions left. Actually, one on Care Coordination. If you can provide us with the organic growth number, excluding the calcimimetics effect. I'm still not sure what that would look like. And so, any color around the underlying performance here in Care Coordination would be very helpful. And then secondly, on the corporate cost, also technical question, I guess, it's quite a significant decline here in the first quarter. Can you explain what has driven that? And are you still sticking to your guidance on corporate cost for the year to be slightly up? Thanks. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Gunnar, it's Mike Brosnan. So, on Care Coordination relative to what we guided to for growth, we actually, as you recall, guided that revenues would be down globally 4% to 6%. So part of that was that Sensipar was being – prescriptions were being filled out of the pharmacy. Part of that was also Renagel. But we didn't split out all those pieces. So I think the calcimimetic discussion is really about the core business, the dialysis service business, but overall for Care Coordination, because we sold Shiel, because we saw changes in the pharmacy, we have guided for revenues to be down 4% to 6% and we are holding that guidance. We still think that's the case for the year. No changes there. Relative to the corporate costs, let's get a little bit more under our belts in terms of what the cost experience is going to be for fiscal 2018. I would probably leave my guidance where it is for now and then revisit it in the second quarter.

Gunnar Romer - Deutsche Bank AG

Management

All right. And just a follow-up on the Care Coordination, the 4% to 6% down. Can you just help us understand what the organic growth would be underlying, excluding the Shiel divestment, and maybe, yeah, the calcimimetics impact? Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Well, honestly, I don't think I'm prepared to do that on the call today. I mean, the calcimimetics impact would be organic.

Gunnar Romer - Deutsche Bank AG

Management

Sure. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Shiel, granted Shiel, you could argue we could adjust, but I just don't think we're ready to do that parse through Care. Rice Powell - Fresenius Medical Care AG & Co. KGaA: We'll take your – we'll keep your question live, let us think about it and figure out the right venue for that, but we don't want to start calculating and running numbers right at the moment, but we'll leave your question on the docket, and we'll come back to you, Gunnar.

Gunnar Romer - Deutsche Bank AG

Management

All right, sure. Thank you.

Operator

Operator

Next question comes from the line of Hassan Al-Wakeel with Barclays. Please go ahead.

Hassan Al-Wakeel - Barclays Capital Securities Ltd.

Management

Thank you very much for taking my questions. I have a couple, please. So firstly on calcimimetics, what was the volume difference between those lost in the pharmacy business, and those gained in the clinic and how does this fair with your overall expectation, I guess, at the end of last year? Is the move from the pharmacy to service revenues overall revenue positive based on what happened in Q1 and just less than what was expected? And then also another one on calcimimetics, you mentioned the $11 revenue per treatment impact in Q1, did you say that the cost per treatment impact was also $11? I believe that you expected a dollar or two higher on the cost side, and it would just be very helpful to have your full year expectations for both revenue per treatment and cost per treatment both on an underlying basis, which I think you've mentioned, as well as inclusive of calcimimetics. Thank you. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Hassan, it's Mike Brosnan. We're doing pretty good today. I just had one person I had to disappoint with regard to my answer. Unfortunately, on your first answer to parse through Sensipar in the pharmacy versus calcimimetics and services, we, deliberately, at the start of the year, guided separately for services and Care Coordination. So, we're not planning on parsing through every quarter the trade-off between one drug in our pharmacy and the calcimimetics program and services. That's why we're giving the services guidance in terms of revenue per treatment, which we've been pretty clear on and we're giving the Care Coordination guidance for revenues overall. So, I'd demure on getting into year-over-year revenues associated with the drugs. Keep in mind, in the pharmacy, we're also dealing with the IV Parsabiv. With regard to your $11 per treatment, you're correct. I had said earlier in the call that $11 revenue per treatment and I said it was kind of a breakeven for the first quarter. We'll see how that progresses through the year, I'm not ready to say that we are not going to still have some friction, as the year progresses, it's just our first quarter, we're just right out of the gate.

Hassan Al-Wakeel - Barclays Capital Securities Ltd.

Management

Okay. Thank you very much. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: You did. Yeah, Hassan, your question was a good one. What I would say and I think it was kind of intuitive to – in the overall global guidance I gave, with regard to revenues is, in February, I had guided on the provider side of the business globally, to a growth rate of about 9% to 11%. Rice mentioned earlier the products guidance at 6%, that stands. We just talked again about the Care Coordination guidance 4% to 6% down, that stands, but the services guidance that we provided at 9% to 11%, as a consequence of the changes that we've talked about the calcimimetics and to a lesser extent, a little slower ramp on acquisitions, would affect the additional guidance that I gave on the provider business. So I would say now rather than 9% to 11%, that's probably more in the range of 7% to 9%.

Hassan Al-Wakeel - Barclays Capital Securities Ltd.

Management

Okay. Dominik Heger - Fresenius Medical Care AG & Co. KGaA: Okay. So I think we have answered all questions. No further questions on the line. So, thank you very much. We extended the con call (01:13:32) but I think that was helpful for everyone. So thank you very much. See you next quarter. Rice Powell - Fresenius Medical Care AG & Co. KGaA: We appreciate your interest. Thanks, folks. Thanks, ladies. Thanks, gentlemen. Michael Brosnan - Fresenius Medical Care AG & Co. KGaA: Take care. Bye-bye.

Operator

Operator

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