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Just listened to the 16 minute jpm presentation however the q and a wasn't part of the recording. Anyone know where to find the q and a portion written or otherwise?

 

Had the same problem. Go in their again and look right over the presentation. There should be a tab next to "presentation" labeled with "Q&A".

 

Otherwise: https://jpmorgan.metameetings.net/events/healthcare18/sessions/13926-davita-inc-q-a/webcast

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Just listened to the 16 minute jpm presentation however the q and a wasn't part of the recording. Anyone know where to find the q and a portion written or otherwise?

 

Had the same problem. Go in their again and look right over the presentation. There should be a tab next to "presentation" labeled with "Q&A".

 

Otherwise: https://jpmorgan.metameetings.net/events/healthcare18/sessions/13926-davita-inc-q-a/webcast

 

Presentation (only)

http://investors.davita.com/static-files/915e0798-b9c0-44c9-b3a4-02bfead9a001

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This is a very interesting deck...prob explains why DVA has been on fire recently.  If Thiry is able to pull this off, we are looking at a stock thats going to go much higher...I still think Berkshire might acquire this (regardless of the standstill letter that was signed 5yrs ago)

 

Sincerely,

VM

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Ha, I saw that in my Twitter feed & thought he was a shill but I want to avoid confirmation bias so...

 

---

 

On another note; I spotted a shiny, brand new, Fresenius in town the other day (almost ready to open up.)

 

Is Fresenius' 5% +/- higher GM's (from a quick look at MStar numbers) a result of their being more vertically integrated?

 

Seems like this would be a priority for DVA given the pricing environment.

 

Baxter has spun out some winners in the past (I own one) & owning their dialysis biz should make DVA even more attractive?

(I know this is just noodling & most of you are presenting JUST facts but...)

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The short argument can only have short-term implications. 

 

If dialysis is no longer profitable, dialysis centers will close and people will move closer to where there is a profitable center or make long commutes 2-3x a week. 

 

A politician who doesn't fight to increase medicare reimbursement for dialysis will be killing sick people.

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"Can anyone get hold of this report please?

 

Government Report Reveals Dialysis Industry Improves Patient Care

https://www.prnewswire.com/news-releases/government-report-reveals-dialysis-industry-improves-patient-care-300593123.html"

 

I think that certain reports have circulation limited to providers and internal use and not to the general public (or the retail investor:)).

 

A nice complementary article:

http://cjasn.asnjournals.org/content/early/2017/12/19/CJN.11231017.full#F1

 

Slowly but surely moving in the direction of evidence-based conditional funding/payments.

 

Reference 10 of the article is also interesting.

https://www.healthaffairs.org/do/10.1377/hblog20161228.058133/full/

A lot of work to be done, but potential ways to include true measures of patient satisfaction and coming to grips with the transparency paradox.

Maybe patients will read rating surveys and reliable review sites (just like what you do before you go to a restaurant, hotel etc) before making a healthcare choice.

 

 

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If I read it correctly, it looks like they would be allowed to make a 15% margin before interest, taxes, and headquarters.

 

If that's right, presumably, some facilities would be making substantially less and some substantially more. On the whole, it would be a bad thing. Unless they built a bunch of facilities that weren't being used to grow .

 

However, if a facility is underperorming/losing money and assuming cms is close to break even... is commercial really going to allow them to be charged more than the going rate in these cases? Hard to imagine.

 

If they don't allow that, than many current and future facilities would be closed/not built.... causing a serious proximity problem for patients. There's really no point in building some out that may take years to eek out a profit... or keep one open.

 

Anyways, I should read it again... just breezed through it.

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Submission of Amendment to the Fair Pricing Dialysis Act (attached)

Interesting that they make no mention of the fact that private dialysis companies make no money on their Medicare/Aid patients.

 

"The Act is intended to be budget neutral for the State to implement and administer." 

 

Perhaps this statement is true to the extent that if this legislative non-sense were enacted there would be no consequences. 

 

It's obvious that the sole beneficiary would be the carrier.  What's missing is that a carrier's job is to insure risk.  This isn't Federally-subsidized flood insurance.  Carriers should increase premiums to cover the difference and deal with the consequences. 

 

Wait... they already have increased premiums after ACA. 

 

Now carriers want to reduce reimbursement AND increase premiums again? 

 

Sure, DaVita is for profit, but DaVita has a positive impact on the health care system as a whole. 

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If I read it correctly, it looks like they would be allowed to make a 15% margin before interest, taxes, and headquarters.

 

If that's right, presumably, some facilities would be making substantially less and some substantially more. On the whole, it would be a bad thing. Unless they built a bunch of facilities that weren't being used to grow .

 

However, if a facility is underperorming/losing money and assuming cms is close to break even... is commercial really going to allow them to be charged more than the going rate in these cases? Hard to imagine.

 

If they don't allow that, than many current and future facilities would be closed/not built.... causing a serious proximity problem for patients. There's really no point in building some out that may take years to eek out a profit... or keep one open.

 

Anyways, I should read it again... just breezed through it.

 

I've said before, at some point, what's to stop any dialysis co from simply raising their costs considering the cost plus nature of this proposed legislation? They couldn't do it quickly, but they could come in high and raise costs slowly, deliberately.

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If I read it correctly, it looks like they would be allowed to make a 15% margin before interest, taxes, and headquarters.

 

If that's right, presumably, some facilities would be making substantially less and some substantially more. On the whole, it would be a bad thing. Unless they built a bunch of facilities that weren't being used to grow .

 

However, if a facility is underperorming/losing money and assuming cms is close to break even... is commercial really going to allow them to be charged more than the going rate in these cases? Hard to imagine.

 

If they don't allow that, than many current and future facilities would be closed/not built.... causing a serious proximity problem for patients. There's really no point in building some out that may take years to eek out a profit... or keep one open.

 

Anyways, I should read it again... just breezed through it.

 

I've said before, at some point, what's to stop any dialysis co from simply raising their costs considering the cost plus nature of this proposed legislation? They couldn't do it quickly, but they could come in high and raise costs slowly, deliberately.

 

They would need to collude with each other and the many smaller competitors to make this work. This  work ifnthetr is essentially only Fresenius and DaVita left. There is a point however to this argument, if you are the lowest cost provider, there is no point in lowering the cost even more, if the government truly runs this as a cost plus business.

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Trying to run various long term scenarios in terms of potential cost containment pressures.

Demand for dialysis will rise ++ (demographics, higher incidence of risk factors, probable absence of a suitable substitute) but the exposure to Medicare or equivalent is likely to remain high.

https://spectator.org/healthcare-spending-to-reach-5-7-trillion-by-2026/

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ForecastSummary.pdf

 

Something has to give.

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DaVita saves money for the system and closing locations could have a disastrous impact if too many patients are not on commercial plans. 

 

What happens if patients start going to hospitals for care?  Certainly, neither the carriers, government, or even hospitals would want this to happen, especially if the patient is in the initial window of ineligibility and otherwise does not have coverage. 

 

Commercial plans can and might get even more expensive to compensate, but current Medicare/aid reimbursement for ESRD patients is poor. 

 

It doesn't sound like the Trump administration wants to put more into healthcare?

 

At some point, something will give, but it's likely it hits the fan if Fresenius and DaVita start to close locations. 

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