Financial Data and Key Metrics Changes - Fourth quarter adjusted operating income was $586 million, bringing full-year adjusted operating income to $2.094 billion [18] - Adjusted earnings per share from continuing operations for the fourth quarter was $3.40, with full-year adjusted EPS from continuing operations of $10.78 [18] - Free cash flow was $309 million in the fourth quarter, totaling just over $1 billion for the full year [18] Business Line Data and Key Metrics Changes - U.S. dialysis treatments declined by 1.1% for the full year compared to 2024, with a slight decline of about 20 basis points in the fourth quarter [19] - Revenue per treatment (RPT) grew approximately $12 sequentially in the fourth quarter, with full-year RPT at approximately $410, reflecting a 4.7% increase [20] - 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 [21] Market Data and Key Metrics Changes - The company anticipates treatment volume for U.S. dialysis to be approximately flat in 2026, with a forecasted growth of 1%-2% in RPT [26] - 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 the previous year's cyber incident [26] Company Strategy and Development Direction - The company is focused on enhancing patient care through clinical initiatives, including vaccination programs and partnerships with home care providers [14][15] - A strategic clinical partnership with Elara Caring aims to lower hospitalizations and missed treatment rates while improving patient experience [14] - The company expects to deliver an incremental $20 million of IKC operating income growth in 2026, building on its first profitable year in IKC [10] 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 [12][13] - 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 [17] - Management highlighted the importance of addressing mortality rates and missed treatments to achieve long-term growth targets [32] Other Important Information - The company repurchased nearly 13 million shares for approximately $1.8 billion in 2025, with a leverage ratio of 3.26x consolidated EBITDA [22] - The midpoint of the guidance for 2026 adjusted EPS is $14.30, representing a 33% increase over the previous year [29] Q&A Session Summary Question: Confidence in returning to 2%+ volume growth - Management indicated that achieving this growth is tied to clinical improvements and expects benefits to materialize over the next two years [32] Question: Trends in missed treatments and mortality - Missed treatments were up in Q4, but year-over-year changes were minimal, with a noted correlation between missed treatments and mortality [41] Question: ACA headwind expectations - The company anticipates a $40 million headwind from ACA changes in 2026, with open enrollment performing better than expected [45] Question: Impact of cyber incident on financials - The cyber incident created a $70 million headwind in 2025, which is expected to be offset by the ACA headwind in 2026 [54] Question: IKC performance and future growth - Management noted that shared savings contributed to better-than-expected performance in IKC, with confidence in continued growth [56] Question: International business growth - The international segment is expected to grow through a mix of M&A and organic growth, with improving margins [67]

Financial Data and Key Metrics Changes - For Q4 2025, adjusted operating income was $586 million, bringing full-year adjusted operating income to $2.094 billion. Adjusted earnings per share (EPS) for Q4 was $3.40, with full-year adjusted EPS of $10.78. Free cash flow for Q4 was $309 million, totaling just over $1 billion for the full year [16][15][17] - Revenue per treatment (RPT) increased approximately $12 sequentially in Q4, with full-year RPT at approximately $410, reflecting a 4.7% increase year-over-year [17][18] - Patient care costs per treatment (PCCs) finished the year 5.9% higher than 2024, near the top end of revised expectations [18] Business Line Data and Key Metrics Changes - U.S. dialysis treatments declined by 1.1% for the full year 2025 compared to 2024, with a slight decline of about 20 basis points in Q4 [16][17] - International adjusted operating income was $21 million for Q4, totaling $114 million for the full year, reflecting strong performance and positive organic growth [18] - Integrated Kidney Care (IKC) achieved its first profitable year in 2025, with Q4 adjusted operating income of $46 million and full-year adjusted operating income of $22 million [18][19] 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% [20][22] - 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 [22] Company Strategy and Development Direction - The company is focused on enhancing patient care through clinical initiatives, including vaccination programs and the adoption of GLP-1 medications, which are expected to improve patient outcomes and reduce mortality [11][12] - A strategic partnership with Elara Caring aims to establish an ESKD-focused offering to lower hospitalizations and improve patient experiences [12][24] - The company expects to deliver adjusted operating income growth of approximately 3.2% in 2026, with a focus on maintaining sustainable U.S. dialysis margins and delivering durable financial performance [15][22] 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 [11][10] - The company anticipates that improvements in clinical outcomes will take time to materialize, with expectations for benefits to become evident in approximately two years [28][29] 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 [19][24] - Free cash flow guidance for 2026 is set between $1 billion and $1.25 billion, reflecting a resilient business model [15][25] Q&A Session Summary Question: Confidence in returning to 2%+ volume growth - Management indicated that achieving 2% growth is tied to clinical improvements and expects to see benefits from initiatives in about two years [27][28] Question: Trends in mistreatments and mortality - Management noted that mistreatments were up in Q4 but did not see significant changes in mortality rates, emphasizing a correlation between mistreatment and mortality with some lag [35][36] Question: ACA headwind expectations - Management provided estimates for ACA headwinds, indicating better-than-expected performance during open enrollment but noted the need to monitor payment behaviors [39][40] Question: Impact of cyber incident on financials - Management clarified that the cyber incident created a $70 million headwind, with expectations for RPT headwinds to be offset by the expiration of enhanced premium tax credits [48] Question: Performance of IKC and future growth - Management highlighted that shared savings in IKC outperformed expectations due to improved care management and interventions, projecting continued growth [50][51] Question: International business growth and margins - Management expects international growth to be driven by both M&A and organic growth, with margins improving as fixed overhead is leveraged [61]