Financial Data and Key Metrics Changes - Fourth quarter adjusted operating income was $586 million, bringing full-year adjusted operating income to $2.094 billion [14] - Adjusted earnings per share (EPS) for the fourth quarter was $3.40, with full-year adjusted EPS of $10.78 [14] - Free cash flow for the fourth quarter was $309 million, totaling just over $1 billion for the full year [14] Business Line Data and Key Metrics Changes - U.S. dialysis treatments declined by approximately 20 basis points in the fourth quarter compared to the same period in 2024, with a full-year decline of 1.1% [14][15] - Revenue per treatment (RPT) increased by approximately $12 sequentially in the fourth quarter, with full-year RPT at approximately $410, reflecting a 4.7% increase [15] - International adjusted operating income was $21 million for the fourth quarter, totaling $114 million for the full year, indicating strong performance and positive organic growth [16] Market Data and Key Metrics Changes - The company anticipates treatment volume for U.S. dialysis to be approximately flat in 2026, with expectations for RPT growth of 1%-2% [19] - The expiration of enhanced premium tax credits is expected to create a $40 million headwind in 2026, offset by the elimination of a $45 million headwind from a cyber incident in 2025 [19] Company Strategy and Development Direction - The company is focused on enhancing patient care through its Integrated Kidney Care (IKC) programs, which have shown improved patient outcomes and profitability ahead of schedule [6][7] - A strategic clinical partnership with Elara Caring aims to improve patient experience and reduce hospitalizations through specialized home care services [10][21] - The company expects to deliver adjusted operating income growth consistent with its long-term target of 3%-7% over the next three years [11] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in sustaining profit growth despite near-term financial headwinds, emphasizing a focus on clinical excellence and targeted initiatives to enhance patient care [9][12] - The company expects adjusted operating income for 2026 to be in the range of $2.085 billion to $2.235 billion, reflecting a 3.2% growth at the midpoint [12] Other Important Information - The company repurchased nearly 13 million shares for approximately $1.8 billion in 2025, with a leverage ratio of 3.26 times consolidated EBITDA at year-end [17] - The midpoint guidance for adjusted EPS in 2026 is $14.30, representing a 33% increase over the previous year [22] Q&A Session Summary Question: Confidence in achieving 2%+ volume growth - Management indicated that achieving 2% growth is tied to clinical improvements and expects benefits to materialize over the next two years [24] Question: Free cash flow considerations - The free cash flow guidance of $1.125 billion is before the $200 million investment, and adjustments for share repurchases should be considered [27] Question: Trends in mistreatments and mortality - Mistreatments were up in Q4, but year-over-year changes were minimal, with a noted correlation between mistreatment rates and mortality [32][33] Question: ACA headwind expectations - The company anticipates a $40 million headwind from ACA changes, with open enrollment performing better than expected [34][37] Question: IKC performance drivers - Management highlighted shared savings and improved care protocols as key drivers for IKC's outperformance [48][49]