Author Topic: DVA – DaVita HealthCare Partners  (Read 215701 times)

Happy

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Re: DVA – DaVita HealthCare Partners
« Reply #340 on: October 24, 2017, 02:02:05 AM »
If they strongly cut reimbursements, smaller dialysis providers would go broke. DaVita/FMC either would buy them (making the government even more dependent on them to provide the service) or the replacing treatments would be significantly more expensive. In the end DaVita should be allowed to earn a good profit as long as they provide the service better and more efficiently than the alternatives.

People like to ridicule managers that do things differently when things aren't going so well. When all is great, he has "real character".



Spekulatius

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Re: DVA – DaVita HealthCare Partners
« Reply #341 on: October 24, 2017, 04:20:37 AM »

Also, I would note, that the John Oliver piece argues that DaVita should tell its patients to get transplants.  This is not feasible given the number of ESRD patients versus the number of available organs for transplant thereby rendering his argument solely sensationalist.

That part is a joke, DVA is clearly a service organization, since when should they do consult on treatment options? That is what the doctors are for. Also, obtaining an organ transplant isn’t easy and the waiting list is long. Patients are generally aware of the transplant option, but it they just aren’t enough transplants available and many patients are ill suited for the procedure.
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MrB

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Re: DVA – DaVita HealthCare Partners
« Reply #342 on: October 24, 2017, 04:58:12 AM »
apologies if the idea was not unpacked enough

one becomes eligible for Medicare when turning 65

Roughly half of those who need dialysis are under 65...most of those who need dialysis are around 60

The Social Security Amendment during the Nixon years allows for ESRD patients to be eligible for Medicare regardless of age

From day 1 and session 1, ESRD patients are covered for at-home or peritoneal dialysis.

However, due to various factors, the most ubiquitous and available service is in-center hemodialysis. 

In-center hemodialysis, however, is not covered under Medicare until three months after the first dialysis session (as per the previous quotation taken from Medicare's website).  While helpful later, not so for new dialysis patients.

A new patient walks into a DaVita center needing dialysis and doesn't have appropriate coverage.  Though being the largest at-home dialysis provider in the US, not every center provides in-center let alone peritoneal dialysis.

As a result, DaVita tells the patient that s/he has to pay for dialysis out-of-pocket until Medicare kicks in or DaVita tells the patient, if eligible, to make a request for premium assistance via the AKF. 

If/when the AKF approves, the patient gets in-center hemodialysis coverage and faces no possible out-of-pocket costs. 


Also, I would note, that the John Oliver piece argues that DaVita should tell its patients to get transplants.  This is not feasible given the number of ESRD patients versus the number of available organs for transplant thereby rendering his argument solely sensationalist.
https://www.kidney.org/atoz/content/insurance
So between the AKF and other HIPP operators such as some state Medicaid programs a good number of these patients must end up on private insurance via ACA due to not being allowed to decline a patient as a result of his/her pre-existing condition. This really makes it a case of I pay everything or a take on private insurance coverage. This might sound insensitive, but it is a bit like shopping for insurance after you crashed your car and the private insurers are forced to take you?

MrB

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Re: DVA – DaVita HealthCare Partners
« Reply #343 on: October 24, 2017, 05:13:03 AM »

Also, I would note, that the John Oliver piece argues that DaVita should tell its patients to get transplants.  This is not feasible given the number of ESRD patients versus the number of available organs for transplant thereby rendering his argument solely sensationalist.

That part is a joke, DVA is clearly a service organization, since when should they do consult on treatment options? That is what the doctors are for. Also, obtaining an organ transplant isn’t easy and the waiting list is long. Patients are generally aware of the transplant option, but it they just aren’t enough transplants available and many patients are ill suited for the procedure.
Just to add and please check the data for yourself, because I'm not convinced it is the right way to look at it. If you look at the D.14 sheet of the modality data workbook put out by the USRDS (https://www.usrds.org/reference.aspx D.Treatment Modalities) then you will note that of all the ESRD patients 7% have a functioning graft (transplanted) kidney after 1 year, ramping up to 52% after 5 years and 80% after 10 years. Obviously anything less than 100% is not desirable, but probably not bad considering the limited supply of kidneys and latest cost estimates pegged at $414,880/transplant.

MrB

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Re: DVA – DaVita HealthCare Partners
« Reply #344 on: October 30, 2017, 10:33:30 AM »
From 2015 "Renal ventures transaction" comments by FTC https://www.ftc.gov/system/files/documents/cases/1510204_davita_analysis.pdf

..Entry into the outpatient dialysis services markets identified in the Commission’s
Complaint is not likely to occur in a timely manner at a level sufficient to deter or
counteract the likely anticompetitive effects of the proposed transaction. By law, each
dialysis clinic must have a nephrologist medical director
, and most dialysis clinics have
long-term (seven to ten year) contracts with nephrologist medical directors that also
include non-competes. As a practical matter, medical directors also serve as the primary
source of referrals and are essential to a clinic’s success. The relative shortage and lack
of available nephrologists, particularly those with an established referral stream, is a
significant barrier to entry into each of the relevant markets
. These obstacles make entry...

cubsfan

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Re: DVA – DaVita HealthCare Partners
« Reply #345 on: October 30, 2017, 10:59:31 AM »
From 2015 "Renal ventures transaction" comments by FTC https://www.ftc.gov/system/files/documents/cases/1510204_davita_analysis.pdf

..Entry into the outpatient dialysis services markets identified in the Commission’s
Complaint is not likely to occur in a timely manner at a level sufficient to deter or
counteract the likely anticompetitive effects of the proposed transaction. By law, each
dialysis clinic must have a nephrologist medical director
, and most dialysis clinics have
long-term (seven to ten year) contracts with nephrologist medical directors that also
include non-competes. As a practical matter, medical directors also serve as the primary
source of referrals and are essential to a clinic’s success. The relative shortage and lack
of available nephrologists, particularly those with an established referral stream, is a
significant barrier to entry into each of the relevant markets
. These obstacles make entry...

There's the moat that many do not see.

DooDiligence

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Re: DVA – DaVita HealthCare Partners
« Reply #346 on: November 01, 2017, 03:05:48 PM »
https://www.bizjournals.com/denver/news/2017/10/26/davita-ceo-thiry-to-chair-colorado-effort-to.html

At the end of the article:

“Thiry spent more than $1 million of his own money in support of last year's pair of ballot measures to open up the state's primaries to non-partisan voters, propositions 107 and 108, both of which passed.”

I wish he lived in Florida (said another disenfranchised voter.)
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Gregmal

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Re: DVA – DaVita HealthCare Partners
« Reply #347 on: November 07, 2017, 01:44:35 PM »
Shit guidance it looks like

cubsfan

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Re: DVA – DaVita HealthCare Partners
« Reply #348 on: November 07, 2017, 03:29:53 PM »
Damn, they bought back a lot of shares. 6M just since Sept 30th.

walkie518

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Re: DVA – DaVita HealthCare Partners
« Reply #349 on: November 07, 2017, 05:16:43 PM »
net loss predominantly due to asset impairment (non-cash gaap loss) resulting from ruling on charity assistance, but both revenues +5% and cash flow from operations +6% are up

I would think they appeal? 

after hours action looks pretty bad (down 7%)...may or may not stick by the morning, but perhaps there is fear the downside is greater than where mgmt is guiding? 

Maybe this is another buying opportunity?