Q1 2025 DaVita Inc Earnings Call
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Michelle: Good evening, my name is Michelle and I will be your conference facilitator today.
Nick: Nick a liaison group Vice President of Investor Relations and joining me today are Javier Rodriguez, our CEO Joel Ackerman our CFO.
Nick: Please note that during this call we will make forward looking statements within the meaning of the federal Securities laws. All of these statements are subject to known and unknown risks and uncertainties that could cause the actual results to differ materially from those described in the forward looking statements.
Nick: For further details concerning these risks and uncertainties. Please refer to our first quarter earnings press release, and our SEC filings, including our most recent annual report on Form 10-K, all subsequent quarterly reports on Form 10-Q, and other subsequent filings that we make with the SEC.
Nick: Our forward looking statements are based on information currently available to us and we do not intend and undertake no duty to update these statements except as may be required by law.
Nick: We'd like to remind you that during this call we will discuss some non-GAAP financial measures. A reconciliation of these non-GAAP measures to the most comparable GAAP financial measures is included in our earnings press release furnished to the SEC and available on our website I will now turn the call over to Javier Rodriguez.
Javier Rodriguez: Thank you Nick and thank you for joining the call today.
Speaker Change: With the conclusion of the first quarter and reflecting on the events of this past few weeks. It is clear once again.
Speaker Change: And dedication of our caregivers shine through each new challenge.
Speaker Change: We're in the midst of Remediated in a cyber security incident.
Speaker Change: Rapid portions of our operations.
Speaker Change: Despite these challenges we remain steadfast.
Speaker Change: We continue delivering life sustaining care, creating meaningful career paths for our teammates and returning value to our shareholders.
Speaker Change: Today I'll share information on the cyber incident highlight our first quarter results discuss key policy developments and close with our outlook for the balance of the year.
Speaker Change: First as always we will begin with a clinical highlight.
Speaker Change: The true foundation of everything we do.
Speaker Change: Last year, we launched a community based collaboration with a Y N C H to support chronic kidney disease education and prevention.
Speaker Change: Through the collaborative community kidney health program YMCA locations nationwide are helping to bring vital education free chronic disease screening and critical kidney health resources directly to the communities that need it the most.
Speaker Change: Our early results.
Speaker Change: I I opening in our initial pilot 30 per cent of participants screen were found to have previously diagnosed U K D, creating powerful opportunities for early intervention and life changing care.
Speaker Change: Early detection and education are the cornerstones of kidney disease prevention and through this collaboration we're setting ambitious goal to reach thousands of people empowering communities within knowledge, they need to close the gap and kidney health awareness.
Speaker Change: This partnership with the YMCA is more than just a program. It's a reflection of our unwavering commitment to building a healthier stronger tomorrow.
Speaker Change: Before getting into the first quarter performance I want to address the cyber security incident, we disclosed last month.
Speaker Change: On April 12, we identified and swiftly began addressing cyber security incident at encrypted parts of our system and affected our operations.
Speaker Change: Well, it's deeply troubling the bad actors continue to target the health care community incident highlighted our team's unwavering commitment to patient care.
Speaker Change: I'm Grateful to report and we provided uninterrupted dialysis care for our patients on that day, we detected incident and everyday sense at all of our centers worldwide.
Speaker Change: Thanks to the incredible responsiveness of our teams and our investment in 19 infrastructure, we've been able to restore most functions as of today.
Speaker Change: All of our major systems used for the patients physicians and teammates, including the lab in billing are up and running.
Speaker Change: Work on the remaining applications will continue over the next few weeks.
Speaker Change: The restoration of our system is nearly complete.
Speaker Change: It'd be some regulatory and legal follow ups to address as we work to identify the extent and nature of the data that was taken and make their required notices.
Speaker Change: We expect that the majority of the costs related to this incident will be one time items recognized in the second quarter and our current expectations regarding the financial impact are included in our guidance today.
Speaker Change: Transitioning to the first quarter performance adjusted operating income and adjusted earnings per share came in slightly ahead of our expectations.
Speaker Change: At a high level. This was driven by outperformance within patient care cost phosphate binders.
Speaker Change: In our international business.
Speaker Change: This favorability was partially offset by a modest underperformance in treatment volume, partially due to an abnormally high flu season.
Speaker Change: Let me offer some additional color on phosphate binders, which contribute to positive results for the quarter.
Speaker Change: As a reminder, phosphate binders are oral drugs prescribed to help dialysis patients avoid mineral bone disease beginning.
Speaker Change: Beginning this year CMS transitions phosphate binders for Medicare part D into the dialysis benefit.
Speaker Change: Davita dispensing these drugs per physician orders in receiving reimbursement from CMS and Medicare advantage plans on a per script basis during the initial to DAP up period.
Speaker Change: As we predicted last quarter, the largest source of variability would be and drug mix, where we have seen higher than expected prescription of iron based binders.
Speaker Change: This is a win for our patients who are receiving the most effective medication for their individual clinical need.
Speaker Change: We're still in the early days of this transition and expect further variability over the course of the year.
Speaker Change: Set with initial data on drug mix, we now expect our full year operating income contribution from phosphate binders.
Speaker Change: At the upper end of our previous guidance range of zero to positive $50 million.
Speaker Change: I'll offer one final note for the first quarter regarding capital allocation.
Speaker Change: Our priority remains to invest available capital and innovation in high return growth opportunities such as our recent Latin America acquisition.
Speaker Change: Beyond those opportunities, we remain committed to returning capital to our shareholders through share repurchases.
Speaker Change: Since our last earnings call, we repurchased approximately $680 million of stock.
Presenting an accelerated pace over this timeframe.
For 2025, we expect share repurchases will be more front loaded than typical and should slow down over the remaining of the year to.
Speaker Change: To be clear our capital allocation strategy remains unchanged.
Speaker Change: Now I'd like to shift gears and share some thoughts on the new administration and potential policy changes.
Speaker Change: Despite a fast moving environment.
Speaker Change: Top priority remains the same.
Speaker Change: Advocating for Ah patients at the state and federal levels.
Speaker Change: Today I'll focus on three policy topics impacting the broader health care landscape.
Speaker Change: Tariffs Medicaid and enhanced premium tax credits.
Speaker Change: For the first two although the policy is fluid on age and there's a lot to learn we don't currently believe either tariffs or Medicaid reform represent any material financial impact.
Speaker Change: As it relates to qualified health plans and enhanced premium tax credits. We've previously shared our cumulative operating income impact of $75 million to $120 million.
Speaker Change: This impact is cumulative over three years and assumes a full exploration of the enhanced premium tax credits.
Speaker Change: We continue to believe this reflects the most likely range of outcomes and as we've shared we're likely trending towards the higher end of that range due to a strong 2025 open enrollment for exchange plans.
Speaker Change: Well, we're grateful to be largely insulated from recent policy development, we remain vigilant and committed to strong patient advocacy.
Speaker Change: Transitioning to our outlook.
Speaker Change: We're maintaining our 2025 guidance range for adjusted operating income and adjusted earnings per share as disclosed last quarter.
Speaker Change: Although we've experienced headwinds from the cyber incident, our strong first quarter operating performance has put us in a good position to achieve our financial guidance for the full year.
Joe: I'll now turn the call over to Joe to discuss our financial performance and outlook in more detail.
Joe: Thank you Javier.
Joe: First quarter adjusted operating income was $439 million adjusted EPS was $2 and free cash flow was negative $45 million.
Joe: Adjusted operating income was above the guidance, we gave last quarter largely as a result of strong expense management profitability from our morals and the bundle at the high end of our range and strong performance in international partially offset by lower than expected treatments.
Joe: I'll focus first on the details behind our Q1 operating income performance followed by an update for 2025 guidance.
Joe: U S treatments per day declined 40 basis points versus the first quarter of 2024 and was approximately 50 basis points below our forecast.
Joe: The weakness was largely the result of higher missed treatment rate, which was caused by a severe flu season, and a higher than expected impact from storms in January and February.
Joe: Adding to this shortfall was the negative impact on census from higher than anticipated flu mortality in the quarter.
Joe: Admission growth was strong during the quarter, which supports our hypothesis that the negative admissions growth. We saw in the fourth quarter was the result of normal variability and not a trends.
Javier Rodriguez: Looking forward to the remainder of the year the flu related census impact in the first quarter will contribute to lower treatment volume for the remainder of the year than we had previously expected. Additionally, we believe the cyber incident that Javier described resulted in lower than normal admissions for them.
Joe: Out two weeks in April.
Joe: These two factors together combined with a treatment shortfall in Q1, we are now expecting an approximately 50 basis point decline in treatments for the year.
Joe: As a reminder, 2025 volume is also negatively impacted by the PD supply shortage, we faced in Q4 2024.
Joe: Despite these temporary challenges, we still expect to return to 2% volume growth, although the timing is hard to predict.
Joe: Consistent with what we have forecasted in the past. These forecasts are for number of treatments not treatments per day or.
Joe: Non acquired growth.
Joe: Revenue per treatment increased $4 in the quarter approximately $10 of the increase is attributable to new reimbursement for phosphate binders, partially offset by $5 a decline due to typical seasonality of patient responsibility for copays and deductibles in the first quarter.
Joe: Yeah.
Joe: Patient care cost per treatment increased by $7 sequentially. This was driven by approximately $8 per treatment of new cost associated with phosphate binders and partially offset by a decline from the seasonally high fourth quarter.
Joe: First quarter G&A costs declined by $33 million sequentially again, as a result of a decline from typical seasonally elevated spend towards the end of the year.
Joe: Adjusted International O Y increased by $29 million versus the fourth quarter. As a reminder, the fourth quarter was impacted by a $19 million reserve recorded against age accounts receivable in Brazil.
Joe: Integrated kidney care, our value based care business had operating losses of $29 million in the quarter in line with expectations. As a reminder, I Casey has seasonally stronger operating performance in the second half of the year.
Joe: This quarter, we realigned the operations of an IP product from our <unk> segment into Eric U S. Other ancillary segment, which moved approximately $4 million of operating loss from IAC into U S. Other ancillary results for the quarter.
Joe: We anticipate the full year impact of this change to be approximately $17 million.
Joe: Below the.
Joe: Line, we incurred $18 million of others loss, mostly related to Mozart, our joint investment with Medtronic, We expect this to be a consistent quarterly run rate for the remainder of the year.
Joe: In the first quarter, we repurchased three 7 million shares and we've repurchased an additional one 7 million shares since the end of the quarter.
Joe: Our repurchases continue to be informed by our typical assessment of leverage ratio liquidity and market price relative to our view of intrinsic value.
Joe: This accelerated purchase pace brought our leverage level at the end of the quarter to 3.27 times near the middle of our target leverage range.
Joe: Q1 debt expense was $135 million beginning in the second quarter, we anticipate that expense will increase to approximately $145 million per quarter for the remainder of the year.
Joe: Let me now turn to our expectations for full year 2025, we are reiterating our full year adjusted operating income and earnings per share guidance. Despite challenges associated with a difficult flu season in Q1 and expectations for some headwinds related to the <unk>.
Joe: Recent cyber incident you.
Joe: Underlying strength of our business performance in the first quarter and the increase in our forecast for profitability of origin. The bundle give us confidence in our full year guidance.
Joe: That concludes my prepared remarks for today operator, please open the call for Q&A.
Speaker Change: Thank you Sir if he would like to ask a question. During this time simply press Star and then the number one on your touch tone keypad, if you'd like to withdraw your question. Please press star and then the number two.
Andrew Mok: Color is Andrew Mok with Barclays. You May go ahead Sir.
Speaker Change: Hi, Good afternoon I appreciate all the color on the cyber attack that treatment growth. If we take the if we look at the 50 basis point revision for the full year can you help us understand how much of that was attributable to flu in the first quarter on how much of that is attributable to the cyber attack and then similarly.
Andrew Mok: What was the impact of flu in the quarter can you perhaps break that up.
Speaker Change: Sure Andrew So starting on the full year the biggest impact on the full year was flu, but not because of the fourth quarter is really a census decline in the first quarter that impacts the full year. So that's a little bit more than half of the 50 basis.
Andrew Mok: <unk>.
The other two components are one miss treatment rate in Q1.
Andrew Mok: And third would be the admit.
The roughly call. It 500 admissions, we think we lost in a couple of weeks as a result of the cyber and those two are roughly equal in size.
Andrew Mok: So that's the 50 basis points for the year, if you're thinking about Q1, the Miss was largely missed treatment rate the census impact in quarter did not have a big.
Andrew Mok: A big impact and the mistreatment right was a combination both of storms in Q in January and February as well as flu.
Speaker Change: Got it Okay, and I think I heard you say that the majority of the costs related to the cyber attack will be one time items recognized in the second quarter can you just help us understand that are you going to adjust that out of earnings or will you be incurring those costs in absorbing that into guidance.
Speaker Change: So I think there'll be two different buckets, there will be some that are direct costs that we will non-GAAP and are likely covered by insurance. So those are not included in our adjusted Oi forecast. There will also be some that are more indirect and those will flow through the P&L and we've.
Speaker Change: Included those in our in our guidance.
Speaker Change: Got it Thats helpful.
Speaker Change: And then on the oral phosphates can you provide a bit more color on what you saw in the quarter with respect to uptake and drug mix. If you have any incremental details on that.
Speaker Change: Yeah.
Speaker Change: Yeah. Thanks, Andrew what we saw was that the mix came in a little leaning toward the iron base.
Speaker Change: So that's what we said in the opening remarks that in essence.
Speaker Change: Change the guidance to the upper end, we had said zero to $50 million and now we will look to be in the higher end of that.
Speaker Change: Do you expect the mix to change or evolve for the balance of the year. Do you think you have a pretty good understanding of what that mix looks like based on the results so far.
Speaker Change: It's our first quarter with this experience, but when we talk to physicians. It appears that they're happy with the current mix.
Speaker Change: Got it Okay, and maybe one last one from me can you help us understand where commercial mix came in in the quarter and how the exchange growth shook out for Q1. Thanks.
Speaker Change: Sure the mix was unchanged flat in the low 11 percentage.
Speaker Change: In the open enrollment was a healthy.
Speaker Change: And so we continue the trajectory of growth similar to the rest of the market.
Speaker Change: Thanks for all the color.
Andrew: Thank you Andrew.
Speaker Change: Our next caller is Joanna <unk> with Bank of America, you May go ahead.
Christian Quarter: Hi, Thank you guys for taking our question. This is Christian quarter on for Joanna just a few questions from US I was curious if you could dive into the specifics.
Christian Quarter: How much the cyber attack impacted you guys in terms of revenue and EBITDA and then also the impact of phosphate binders inclusion in the Medicare bundle. Thank you guys.
Speaker Change: Yes, so on the cyber just to be clear. This happened in April. So there was there was no impact in Q1 and it remains to be seen what the net impact on adjusted Oi will be in Q2, but I'll remind you it's built into our guidance.
Christian Quarter: In terms of.
Speaker Change: Remind me the second question.
Christian Quarter: Oh about.
Christian Quarter: About binders.
So I think if the question is how does this buildup individually into our lines. Our RPT was up about $10 quarter over quarter as a result of binders and our cost per treatment was up roughly $8 for the quarter from binders.
Christian Quarter: Alright, thank you.
Justin Lake: Thank you. Our next caller is Justin Lake with Wolfe Research you May go ahead Sir.
Justin Lake: Hi, This is Dan Rizzo on for Justin Thank.
Justin Lake: Thank you for the updated color on non acquired treatment growth in the year.
Speaker Change: Can you speak to your expectations are for RPT and there are they still in the four five to five 5% range. Thank you.
Speaker Change: Yes, no change to our guide on RPT for the year.
Javier Rodriguez: We think we'll get a little bit more from oral is in the bundle as Javier mentioned, but still within the range of the of the guide from last quarter.
Speaker Change: Thank you so much.
Peter Chickering: Thank you our next caller is Peter Chickering with Deutsche Bank You May go ahead.
Peter Chickering: Hey, guys. Thanks for taking my questions here, I guess going back to the treatment growth question can you just quantify just the new patients that started this quarter and how the new starts are tracking into Q and sort of how that looks sort of year over year.
Peter Chickering: And are you seeing any changes mortality rate now that we're exiting the flu season.
Peter Chickering: Yeah, so starting on the admin side. It was Q1 was a strong add mid quarter for us and.
Peter Chickering: We know there was a lot of interest last quarter, we called out a weak AD mid quarter in Q4.
And I think a lot of curiosity on was that a normal variability, which is what we suspected or is it somehow the beginning of a trend and the strength. We saw in Q1 certainly supports the hypothesis we have that it was just norm.
Peter Chickering: <unk> variability so admit.
Peter Chickering: Certainly.
Peter Chickering: It was in line with what we expected, but it was strong in Q1 in terms of mortality in Q1, it was absolutely elevated.
Peter Chickering: We think that was.
Peter Chickering: 100% as a result of the flu.
Peter Chickering: So not much more to say about that it's a little early to.
Peter Chickering: See what's happening to mortality post flu as you know, there's a little bit of a lag between.
Peter Chickering: The month when a month ends and when we have good clarity on mortality. So I can't give you much on what happens post flu.
Peter Chickering: Okay Fair enough and then looking at the revenue per treatment, there's sort of a bunch of pieces in there.
Peter Chickering: You said that the mix was flat you actually be a positive tailwind obviously coming from the <unk>.
Speaker Change: Phosphate did you quantify exactly what the phosphate was to RPT and then any of the commentary in the first quarter RPT as it relates to.
Peter Chickering: Mixture increases.
Peter Chickering: For this year and how should we think about Copays and deductibles.
Peter Chickering: So comping out in the next couple of quarters.
Peter Chickering: Yes, I think you asked a lot of questions, but let me just sort of summarize it.
Peter Chickering: We gave a range of roughly four five to five and a half RPT.
Peter Chickering: I think just speaking big sort of categories half of that will be increases in the core business and half of it will be portals.
Peter Chickering: So I think that kind of bundle all your questions does that get to it.
Peter Chickering: Yes.
Peter Chickering: That works and then lots of the year.
Peter Chickering: Can you see a reduction in the patients.
Peter Chickering: For March versus December.
Speaker Change: Just want to follow up I think last quarter, you talked about some competitors that they're being more aggressive on pricing just what are your views around the ITC.
Peter Chickering: Good.
Peter Chickering: Patients under treatment.
Peter Chickering: This point is profitability.
Of that versus your expectations.
Peter Chickering: Yeah.
Peter Chickering: Thank you I think a couple of things number one from a clinical perspective, it's unambiguous see good for patient. Our doctors are also having to change the way they practice and making sure that they start to get involved in transition of care hospitalization and other things. So that takes a while as we've told you for quite some time.
Peter Chickering: The financials are playing out as expected, which is this is a a business has a bit more volatilities that we've told you to look at on an annual basis. Unfortunately, theres been several unproven entrants that have gone in there and have made some immature risk moves and.
Peter Chickering: Really contracted quite poorly and aggressively and what I mean by that is economically speaking.
So we have been quite disciplined in understanding the impact that we can do to patient care and we've been very disciplined in our financial modeling so well.
Peter Chickering: While we want to of course earn and win more business. You wanted me able to be in a sustainable way.
Peter Chickering: In addition.
Peter Chickering: We've also.
Peter Chickering: Some of these arrangements with some doctors that are not willing to change the way. They practice because you have to really change the way your practice to be successful at this.
Peter Chickering: Okay great.
Peter Chickering: Let me add one more thing to that some of the decline in lives that Youll see from Q4 to Q1 is also the result of.
Peter Chickering: Our ability to better predict how many lives will be retroactively removed from attribution based on certain rules that CMS uses in the <unk> program, particularly with CK D lives. So it's not easy.
Peter Chickering: Economic change, it's more of how we count the lives in doing that.
Peter Chickering: Better job of predicting that upfront.
Peter Chickering: Okay, and then last quick one here on international look pretty strong I guess any sort of good guys are bad guys. As you highlight to us on international as you model that the rest of the year. Thank you guys.
Peter Chickering: Yeah International had a strong quarter a lot of.
Peter Chickering: A lot of good guys across a number of markets. We feel good about how the new acquisition is playing out so.
Peter Chickering: We called out last quarter, a $50 million jump year over year, and we probably picked up another $10 million.
Peter Chickering: On top of that $50 million in Q1.
Peter Chickering: Great. Thanks, so much.
Speaker Change: Thank you. Our next caller is AJ rice with UBS you May go ahead Sir.
Speaker Change: Thanks, Hi, everybody, maybe just a couple of things.
Speaker Change: Just to follow up on that question about the Latin America, any update on Brazil and <unk>.
Speaker Change: Maybe brought more broadly on the M&A pipeline, what youre seeing.
Speaker Change: Anything.
Speaker Change: To comment on what you might see in the back half of the year.
Speaker Change: Yeah. Thanks, a J on the Brazil, we're pretty close although they've given us some restrictions that we gotta abide by so we got to play that out and divest a couple of centers.
Speaker Change: It's always a not a good idea to guess, but we're getting to the finish line here, so hopefully that will.
Speaker Change: B here shortly as it relates to M&A.
Speaker Change: I think internationally continues to be an interesting place.
And domestically we're still pursuing.
Speaker Change: Onesies and Twosies and then any practice that's willing to convert so it's a dynamic place up there.
Speaker Change: But that's that's really how it summarizes.
Speaker Change: Okay.
Speaker Change: Just a follow up on the KC question, the $29 million loss, if I'm here, making sure I heard right. That's after moving.
Speaker Change: Some business there would've been a 4 million dollar a quarter drag over into the core Ah I guess two questions on that.
Speaker Change: Are you, saying that you make that move.
Speaker Change: What's sort of behind that in second.
Speaker Change: Do you still feel like I know, we've got volatility quarter to quarter, but you're on track for a breakeven by <unk> 27 in that business.
Speaker Change: Yeah. So.
Speaker Change: Just to just to clarify one thing we didn't move it to the core we moved moved it to other strategic initiatives, but I think the most important thing. It has has it has no bottom line impact on the enterprise, it's just moving.
Speaker Change: From one business to another.
Speaker Change: This was.
Speaker Change: Product that when first implemented was expected to largely be used by the <unk> business, but over time it became clear that it had other utility within davita, including in the the dialysis.
Speaker Change: Dialysis business. So ultimately, we decided to allocate that a little bit differently, but it has no.
Speaker Change: A major impact on the path to profitability, obviously, it helps a little bit because you're just taking cost out but within the broader context of Ik see in its scale and variability we still feel good about the path we're on.
Speaker Change: Okay does that then if I could just follow up on that.
Speaker Change: The 4 million run rate.
Speaker Change: Losses currently had as you're moving into.
Speaker Change: This new area does that diminish over time then.
Speaker Change: No I wouldn't expect it to go down over time.
Speaker Change: Okay, and then just maybe last.
Speaker Change: Quite a clarification on your.
Speaker Change: G&A Europe about 3%.
Speaker Change: Cost per treatment.
Speaker Change: I know you called out in the release the professional fee.
Speaker Change: Reductions as well as I think it points to gain some sort can you just elaborate a little bit more on where that was meaningful in the quarter and what was going on there.
Speaker Change: No I don't think there was a lot there I think the big change in the G&A per treatment.
Speaker Change: Was.
Speaker Change: The result of volume coming down so there's a big treatment drop between Q4, and Q1, mostly driven by a reduction in the number of days that was probably I think the single biggest thing that drove the change in G&A per treatment.
Speaker Change: Okay, alright, thanks, a lot.
Speaker Change: Thank you.
Speaker Change: Our next caller is Ryan Langston with TD Cowen you May go ahead Sir.
Speaker Change: Hey, Thank you so you're keeping the full year guidance the same lowering just a little bit on the treatment volumes I guess is a lot of that sort of the outperformance in the phosphate binder area or some of it from the stronger new set of add Mitch that you've called out.
Speaker Change: Yes, so if I if I had to break down how were thinking about guidance I would say there were two negatives for the quarter one or.
Speaker Change: Or for the year one is the decline in volume the 50 bps, we brought that down and the second will be the cyber costs. So those are.
Speaker Change: Headwinds on the year offset by two <unk> one is strength in Q1 and the second is the increase in the binders and the net impact of those two headwinds and to tail winds would be no change.
Speaker Change: Okay, and I might have missed the first part of <unk> question, but in the release. It said there was a decrease in professional fees.
Speaker Change: And then there was a gain I think in G&A can you help us size the gain again im sorry, if AJ asked it and also maybe what drove the decrease in pro fees. Thanks.
Speaker Change: Yes. These are minimal items are single digit millions I wouldn't.
Speaker Change: I wouldn't get too concerned about them.
Speaker Change: Okay. Thank you.
Speaker Change: Thank you at this time I am showing no further questions speakers I'll turn the call back over to you for closing comments.
Speaker Change: Okay. Thank you Michelle and thank you all for your questions.
Speaker Change: Have you been following us we have experienced three temporary externalities, including supply shortages due to a hurricane or high flu season, and now a cyber incident, regardless, we continue to achieve our clinical and financial objectives.
Speaker Change: We look forward to building momentum over the remaining of the year, we will talk to you soon be well.
Speaker Change: Thank you. This concludes today's conference call you May go ahead and disconnect at this time.