DaVita Inc. 3rd Quarter 2024 Results
DENVER, Oct. 29, 2024 /PRNewswire/ -- DaVita Inc. (NYSE:DVA) announced financial and operating results for the quarter ended September 30, 2024.
"We continue to provide quality care for our patients across the continuum of care, while delivering solid third quarter financial performance," said Javier Rodriguez, CEO of DaVita Inc. "And, in light of recent severe storms, I am grateful for the remarkable resilience of our patients and our frontline caregivers."
Financial and operating highlights for the quarter ended September 30, 2024:
Consolidated revenues were $3.264 billion.
Operating income was $535 million.
Diluted earnings per share was $2.50 and adjusted diluted earnings per share was $2.59.
Operating cash flow was $810 million and free cash flow was $555 million.
Incurred an incremental Term Loan A-1 tranche in the aggregate principal amount of $1.1 billion and issued an aggregate principal amount of $1.0 billion of 6.875% senior notes. A portion of the proceeds of these transactions was used to repay the Term Loan B-1 maturing in 2026 of approximately $950 million and the balance then outstanding on our revolving line of credit.
Repurchased 2.7 million shares of our common stock at an average price paid of $147.20 per share.
Three months ended
Nine months ended September 30,
September 30, 2024
June 30, 2024
2024
2023
Net income attributable to DaVita Inc.:
(dollars in millions, except per share data)
Net income
$ 215
$ 223
$ 677
$ 541
Diluted per share
$ 2.50
$ 2.50
$ 7.66
$ 5.80
Adjusted net income(1)
$ 222
$ 230
$ 657
$ 566
Adjusted diluted per share(1)
$ 2.59
$ 2.59
$ 7.43
$ 6.06
(1)
For definitions of non-GAAP financial measures, see the note titled "Note on Non-GAAP Financial Measures" and related reconciliations beginning on page 15.
Three months ended
Nine months ended September 30,
September 30, 2024
June 30, 2024
2024
2023
Amount
Margin
Amount
Margin
Amount
Margin
Amount
Margin
Operating income
(dollars in millions)
Operating income
$ 535
16.4 %
$ 506
15.9 %
$ 1,525
16.0 %
$ 1,213
13.5 %
Adjusted operating income(1)
$ 535
16.4 %
$ 506
15.9 %
$ 1,490
15.6 %
$ 1,252
13.9 %
(1)
For definitions of non-GAAP financial measures, see the note titled "Note on Non-GAAP Financial Measures" and related reconciliations beginning on page 15.
U.S. dialysis metrics:
Volume: Total U.S. dialysis treatments for the third quarter of 2024 were 7,350,784, or an average of 93,048 treatments per day, representing a per day decrease of (0.1)% compared to the second quarter of 2024. Normalized non-acquired treatment growth in the third quarter of 2024 compared to the third quarter of 2023 was (0.2)%.
Three months ended
Quarter
change
Nine months ended
Year to date
change
September 30, 2024
June 30, 2024
September 30, 2024
September 30, 2023
(dollars in millions, except per treatment data)
Revenue per treatment
$ 394.49
$ 390.22
$ 4.27
$ 389.79
$ 374.46
$ 15.33
Patient care costs per treatment
$ 257.46
$ 255.25
$ 2.21
$ 255.96
$ 253.30
$ 2.66
General and administrative
$ 301
$ 282
$ 19
$ 858
$ 819
$ 39
Primary drivers of the changes in the table above were as follows:
Revenue: The quarter change was primarily due to increases in average reimbursement rates and other normal fluctuations. The year to date change was primarily driven by the increase in average reimbursement rates from normal annual rate increases including from Medicare, as well as revenue cycle improvements, favorable changes in mix and an increase in hospital inpatient dialysis rates.
Patient care costs: The quarter change was primarily due to increased compensation expenses, health benefit expense, and other direct operating expenses associated with our dialysis centers. These increases were partially offset by decreases in insurance costs, travel costs, professional fees and center closure costs. The year to date change was primarily due to increases in compensation expenses, health benefit expense, and medical supplies expense. These increases were partially offset by decreased contributions to charitable organizations, contract wages, and center closure costs.
General and administrative: The quarter change was primarily due to increased advocacy costs, compensation expenses, IT-related costs, travel costs and professional fees. These increases were partially offset by a decrease in center closure costs. The year to date change was primarily due to increases in compensation expenses, advocacy costs, including a refund received in 2023 related to 2022 advocacy costs. Other drivers of this change include increases in IT-related costs, contract wages, center closure costs and professional fees. These increases were partially offset by decreased severance costs and contributions to charitable organizations.
Certain items impacting the quarter:
Closure costs. In the third quarter of 2022, we began a strategic review of our outpatient clinic capacity requirements and utilization, which had been significantly impacted by declines in our patient census due to the COVID-19 pandemic. This review continued through 2023, and has resulted in higher than normal charges for center capacity closures over the last several quarters. These capacity closure costs include net losses on assets retired, lease termination costs, asset impairments and accelerated depreciation and amortization.
During the three months ended and nine months ended September 30, 2024, we incurred charges for U.S. dialysis center closures of approximately $18.3 million and $48.2 million, respectively. During the three months ended September 30, 2024 these center closures increased our patient care costs by $3.5 million, our general and administrative expenses by $3.8 million and our depreciation and amortization expense by $11.0 million. During the nine months ended September 30, 2024, these center closures increased our patient care costs by $13.3 million, our general and administrative expenses by $19.6 million and our depreciation and amortization expense by $15.3 million.
As previously disclosed, we have updated the presentation of our non-GAAP measures to no longer exclude center closure costs for all periods presented as well as for our current full-year 2024 guidance. To facilitate comparisons, prior periods shown herein now conform to this revised presentation.
Debt transactions. In August 2024, we entered into the Sixth Amendment to our senior secured credit agreement. The Sixth Amendment extends an incremental Term Loan A-1 tranche in the aggregate principal amount of $1,100 million. The Company also issued $1,000 million aggregate principal amount of 6.875% senior notes due 2032. A portion of the net proceeds from these transactions were used to prepay the remainder of the balance outstanding on its Term Loan B-1 maturing in 2026 in the amount of $950 million, the balance outstanding on its revolving line of credit and related accrued interest and fees. The remaining borrowings added cash to the balance sheet for general corporate purposes.
Change Healthcare. During the nine months ended September 30, 2024, we experienced delays in claims processing as a result of the Change Healthcare outage. As a result, we applied for and received interest-free funding from UnitedHealth Group under the Temporary Funding Assistance Program. As of September 30, 2024 we have $120 million outstanding under this program. Amounts provided under this program are subject to repayment within 45 business days from a future date to be mutually agreed to by Change Healthcare and the Company.
Share repurchases. During the three months ended September 30, 2024, we repurchased 2.7 million shares for $406 million, at an average price paid of $147.20 per share.
Subsequent to September 30, 2024 through October 25, 2024, the Company has repurchased 0.6 million shares of our common stock for $101 million at an average price paid of $160.77 per share.
Financial and operating metrics:
Three months ended
September 30,
Twelve months ended
September 30,
2024
2023
2024
2023
Cash flow:
(dollars in millions)
Operating cash flow
$ 810
$ 661
$ 1,960
$ 1,918
Free cash flow(1)
$ 555
$ 453
$ 1,139
$ 1,054
(1)
For definitions of non-GAAP financial measures, see the note titled "Note on Non-GAAP Financial Measures" and related reconciliations beginning on page 15.
Three months ended September 30, 2024
Nine months ended
September 30, 2024
Effective income tax rate on:
Income
20.8 %
19.3 %
Income attributable to DaVita Inc.(1)
26.5 %
24.1 %
Adjusted income attributable to DaVita Inc.(1)
26.5 %
25.0 %
(1)
For definitions of non-GAAP financial measures, see the note titled "Note on Non-GAAP Financial Measures" and related reconciliations beginning on page 15.
Center activity: As of September 30, 2024, we provided dialysis services to a total of approximately 265,400 patients at 3,113 outpatient dialysis centers, of which 2,660 centers were located in the United States and 453 centers were located in 13 countries outside of the United States. During the third quarter of 2024, we opened three and closed 15 dialysis centers in the United States. We also acquired one, opened four and closed four dialysis centers outside of the United States during the third quarter of 2024.
Integrated kidney care (IKC): As of September 30, 2024, we had approximately 69,500 patients in risk-based integrated care arrangements representing approximately $5.4 billion in annualized medical spend. We also had an additional 13,900 patients in other integrated care arrangements; we do not include the medical spend for these patients in this annualized medical spend estimate. For an additional description of these metrics, see footnote 4 in the "Supplemental Financial Data" table below.
Outlook:
The following forward-looking measures and the underlying assumptions involve significant known and unknown risks and uncertainties, including those described below, and actual results may vary materially from these forward-looking measures. We do not provide guidance for operating income or diluted net income per share attributable to DaVita Inc. on a basis consistent with United States generally accepted accounting principles (GAAP) nor a reconciliation of forward-looking non-GAAP financial measures to the most directly comparable GAAP financial measures on a forward-looking basis because we are unable to predict certain items contained in the GAAP measures without unreasonable efforts. These current non-GAAP financial measures do not include certain items, including gains on changes in ownership interest and foreign currency fluctuations, which may be significant. The guidance for our effective income tax rate on adjusted income attributable to DaVita Inc. also excludes the amount of third-party owners' income and related taxes attributable to non-tax paying entities.
As previously disclosed, our 2024 guidance provided below no longer excludes center closure costs.
2024 guidance
Low
High
(dollars in millions, except per share data)
Adjusted operating income
$1,910
$2,010
Adjusted diluted net income per share attributable to DaVita Inc.
$9.25
$10.05
Free cash flow
$950
$1,200
We will be holding a conference call to discuss our results for the third quarter ended September 30, 2024, on October 29, 2024, at 5:00 p.m. Eastern Time. To join the conference call, please dial (877) 918-6630 from the U.S. or (517) 308-9042 from outside the U.S., and provide the operator the password "Earnings." This call is being webcast and can be accessed at the DaVita Investor Relations website investors.davita.com. A replay of the conference call will also be available at investors.davita.com for the following 30 days.
Forward looking statements
DaVita Inc. and its representatives may from time to time make written and oral forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 (PSLRA), including statements in this release, filings with the Securities and Exchange Commission (SEC), reports to stockholders and in meetings with investors and analysts. All statements in this release, during the related presentation or other meetings, other than statements of historical fact, are forward-looking statements and as such are intended to be covered by the safe harbor for "forward-looking statements" provided by the PSLRA. These forward-looking statements could include, among other things, statements about our balance sheet and liquidity, our expenses, revenues, billings and collections, patient census, availability or cost of supplies, including without limitation the impact of the reduction in clinical and other supplies delivered to DaVita by Baxter International Inc. or its subsidiaries (collectively, Baxter) due to closures of Baxter facilities following Hurricane Helene, treatment volumes, mix expectation, such as the percentage or number of patients under commercial insurance, the effects of the recent Change Healthcare (CHC) cybersecurity outage on us and our operations, current macroeconomic, marketplace and, labor market conditions, and overall impact on our patients and teammates, as well as other statements regarding our future operations, financial condition and prospects, capital allocation plans, expenses, cost saving initiatives, other strategic initiatives, use of contract labor, government and commercial payment rates, expectations related to value-based care (VBC), integrated kidney care (IKC), Medicare Advantage (MA) plan enrollment and our international operations, expectations regarding increased competition and marketplace changes, including those related to new or potential entrants in the dialysis and pre-dialysis marketplace and the potential impact of innovative technologies, drugs or other treatments on the dialysis industry, expectations regarding the impact of our continuing cost savings initiatives and our stock repurchase program, and statements related to our guidance and expectations for future periods and the assumptions underlying any such projections. All statements in this release, other than statements of historical fact, are forward-looking statements. Without limiting the foregoing, statements including the words "expect," "intend," "will," "could," "plan," "anticipate," "believe," "forecast," "guidance," "outlook," "goals," and similar expressions are intended to identify forward-looking statements. These forward-looking statements are based on DaVita's current expectations and are based solely on information available as of the date of this release. DaVita undertakes no obligation to publicly update or revise any forward-looking statements, whether as a result of changed circumstances, new information, future events or otherwise, except as may be required by law. Actual future events and results could differ materially from any forward-looking statements due to numerous factors that involve substantial known and unknown risks and uncertainties. These risks and uncertainties include, among other things:
current macroeconomic and marketplace conditions, including, without limitation, the impact of global events and political or governmental volatility; the impact of the domestic political environment and related developments on the current healthcare marketplace, our patients and on our business; the continuing impact of the COVID-19 pandemic on our operations, reputation, financial condition and the chronic kidney disease (CKD) population and our patient population; supply chain challenges and disruptions, including without limitation with respect to certain key services provided to us and certain critical clinical supplies and equipment, and including any impacts on our supply chain as a result of natural disasters; the potential impact of new or potential entrants in the dialysis and pre-dialysis marketplace and potential impact of innovative technologies, drugs, or other treatments on our patients and industry; elevated teammate turnover or labor costs; the impact of continued increased competition from dialysis providers and others; and our ability to respond to challenging U.S. and global economic and marketplace conditions, including, among other things, our ability to successfully identify cost saving opportunities and to invest in and implement cost saving initiatives;
the concentration of profits generated by higher-paying commercial payor plans for which there is continued downward pressure on average realized payment rates; a reduction in the number or percentage of our patients under commercial plans, including, without limitation, as a result of continuing legislative efforts to restrict or prohibit the use and/or availability of charitable premium assistance, or as a result of payors implementing restrictive plan designs;
risks arising from potential changes in or new laws, regulations or requirements applicable to us, including, without limitation, those related to healthcare, antitrust matters, including, among others, non-competes and other restrictive covenants, and acquisition, merger, joint venture or similar transactions and/or labor matters, and potential impacts of changes in enforcement thereof or related litigation impacting, among other things, coverage or reimbursement rates for our services or the number of patients enrolled in or that select higher-paying commercial plans, and the risk that we make incorrect assumptions about how our patients will respond to any such developments;
our ability to successfully implement our strategies with respect to IKC and VBC initiatives and home based dialysis in the desired time frame and in a complex, dynamic and highly regulated environment;
a reduction in government payment rates under the Medicare End Stage Renal Disease program, state Medicaid or other government-based programs and the impact of the MA benchmark structure;
our reliance on significant suppliers, service providers and other third party vendors to provide key support to our business operations and enable our provision of services to patients, such as, among others, CHC, Baxter and other suppliers of certain pharmaceuticals, services or critical clinical products; and risks resulting from a closure, reduction or other disruption in the services or products provided to us by such suppliers, service providers and third party vendors, such as the closure of certain Baxter manufacturing facilities following Hurricane Helene;
noncompliance by us or our business associates with any privacy or security laws or any security breach by us or a third party, such as the recent cyberattack on CHC, including, among other things, any such non-compliance or breach involving the misappropriation, loss or other unauthorized use or disclosure of confidential information;
legal and compliance risks, such as compliance with complex, and at times, evolving government regulations and requirements, and with additional laws that may apply to our operations as we expand geographically or enter into new lines of business;
our ability to attract, retain and motivate teammates and our ability to manage potential disruptions to our business and operations, including potential work stoppages, operating cost increases or productivity decreases whether due to union organizing activities, legislative or other changes, demand for labor, volatility and uncertainty in the labor market, the current challenging and highly competitive labor market conditions, including due to the ongoing nationwide shortage of skilled clinical personnel or other reasons;
changes in pharmaceutical practice patterns, reimbursement and payment policies and processes, or pharmaceutical pricing, including with respect to oral phosphate binders, among other things;
our ability to develop and maintain relationships with physicians and hospitals, changing affiliation models for physicians, and the emergence of new models of care or other initiatives that, among other things, may erode our patient base and impact reimbursement rates;
our ability to complete and successfully integrate and operate acquisitions, mergers, dispositions, joint ventures or other strategic transactions on terms favorable to us or at all; and our ability to successfully expand our operations and services in markets outside the United States, or to businesses or products outside of dialysis services;
the variability of our cash flows, including, without limitation, any extended billing or collections cycles including, without limitation, due to defects or operational issues in our billing systems or in the billing systems or services of third parties on which we rely, such as the operational issues at CHC resulting from a recent cyberattack; the risk that we may not be able to generate or access sufficient cash in the future to service our indebtedness or to fund our other liquidity needs;
the effects on us or others of natural or other disasters, public health crises or adverse weather events such as hurricanes, earthquakes, fires or flooding;
factors that may impact our ability to repurchase stock under our stock repurchase program and the timing of any such stock repurchases, as well as any use by us of a considerable amount of available funds to repurchase stock;
our aspirations, goals and disclosures related to environmental, social and governance (ESG) matters, including, among other things, evolving regulatory requirements affecting ESG standards, measurements and reporting requirements; and
the other risk factors, trends and uncertainties set forth in our Annual Report on Form 10-K for the year ended December 31, 2023 and Quarterly Reports on Form 10-Q for the quarters ended March 31, 2024 and June 30, 2024, and the risks and uncertainties discussed in any subsequent reports that we file or furnish with the SEC from time to time.
The financial information presented in this release is unaudited and is subject to change as a result of subsequent events or adjustments, if any, arising prior to the filing of the Company's Quarterly Report on Form 10-Q for the quarter ended September 30, 2024.
DAVITA INC.
CONSOLIDATED STATEMENTS OF INCOME
(unaudited)
(dollars and shares in thousands, except per share data)
Three months ended September 30,
Nine months ended September 30,
2024
2023
2024
2023
Dialysis patient service revenues
$ 3,138,561
$ 2,951,950
$ 9,141,195
$ 8,602,669
Other revenues
125,029
169,382
379,672
391,731
Total revenues
3,263,590
3,121,332
9,520,867
8,994,400
Operating expenses:
Patient care costs
2,151,875
2,067,315
6,373,150
6,181,348
General and administrative
393,534
376,883
1,123,859
1,072,513
Depreciation and amortization
187,014
188,423
549,758
550,166
Equity investment income, net
(3,711)
(7,228)
(15,874)
(22,502)
Gain on changes in ownership interest
—
—
(35,147)
—
Total operating expenses
2,728,712
2,625,393
7,995,746
7,781,525
Operating income
534,878
495,939
1,525,121
1,212,875
Debt expense
(134,583)
(98,080)
(331,748)
(302,361)
Debt prepayment, extinguishment and modification costs
(10,081)
—
(19,813)
(7,962)
Other loss, net
(16,780)
(19,650)
(56,900)
(14,525)
Income before income taxes
373,434
378,209
1,116,660
888,027
Income tax expense
77,674
68,848
215,168
161,621
Net income
295,760
309,361
901,492
726,406
Less: Net income attributable to noncontrolling interests
(81,072)
(62,729)
(224,479)
(185,536)
Net income attributable to DaVita Inc.
$ 214,688
$ 246,632
$ 677,013
$ 540,870
Earnings per share attributable to DaVita Inc.:
Basic net income
$ 2.56
$ 2.70
$ 7.86
$ 5.95
Diluted net income
$ 2.50
$ 2.62
$ 7.66
$ 5.80
Weighted average shares for earnings per share:
Basic shares
83,721
91,322
86,123
90,937
Diluted shares
85,795
94,041
88,422
93,317
DAVITA INC.
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
(unaudited)
(dollars in thousands)
Three months ended September 30,
Nine months ended September 30,
2024
2023
2024
2023
Net income
$ 295,760
$ 309,361
$ 901,492
$ 726,406
Other comprehensive income (loss), net of tax:
Unrealized (losses) gains on interest rate cap agreements:
Unrealized (losses) gains
(21,576)
6,996
(2,340)
28,305
Reclassifications of net realized gains into net income
(1,870)
(21,198)
(45,539)
(55,895)
Unrealized gains (losses) on foreign currency translation:
56,202
(47,644)
(62,371)
27,878
Other comprehensive income (loss)
32,756
