Ladies and gentlemsn, thank you for standing by. I'm Timo, your Chorus Call operator. Welcome, and thank you for joining the Fresenius Medical Care report on the Q1 2023 earnings results. Throughout today's recorded presentation, all participants will be in a listen-only mode. The presentation will be followed by a question and answer session. If you would like to ask a question, you may press star followed by one on your touchtone telephone. Please press the star key followed by zero for operator assistance. I would now like to turn the conference over to Dominik, head of investor relations. Please go ahead, sir.
Thank you, Timo. As mentioned by Timo, we would like to welcome you to our earnings call for the Q1 in 2023. We appreciate you joining today to discuss the performance for the Q1. I will, as always, start out the call by mentioning our cautionary language that is in our safe harbor statement, as well as in our presentation and in all the materials that we have distributed earlier today. For further details concerning risks and uncertainties, please refer to these documents as well as to our SEC filings. We will try to keep the presentation short and leave time for questions that might be new to all of us in the new reporting structure. As always, we would like to limit the number of questions again to two, without sub questions, in order to give everyone the chance to ask questions.
Should there be further questions and time left, we can go a second round. It would be great if we could make this work again, please. With us today is Helen Giza, our CEO and Chair of the Management Board, and still also our acting CFO. Before I hand over to Helen, I want to remind everyone that we hosted a virtual Capital Markets Day on April nineteenth. If you were not able to join, the slides and replay from the CMD are both available on our website and worth watching. With that, Helen, the floor is yours.
Thank you, Dominik. Hi everyone. Thank you for joining our presentation today and for your continued interest in Fresenius Medical Care. I'll begin my prepared remarks on slide five today. A few weeks ago at our Capital Markets Day, we spoke at length about our operational turnaround to improve profitability. We have a clear aspiration to unlock value as the leading kidney care company and a clear path to achieve that. What I hope came across at the CMD is that we not only have a detailed plan, but we are already executing against these important initiatives. I would like to highlight some Q1 accomplishments and area of focus before I turn to the quarter's financial performance. Starting with structure, the conversion of the legal form, including the preparation of the carve-out and all the administrative filing requirements, are progressing as planned.
A physical EGM is expected to take place on July 14th. This is an important step towards simplifying and improving our governance structure and strengthening the rights of our free float shareholders. Our new global operating model with two distinct global segments has been fully in place since January 1st of this year. In April, along with our CMD, we published the historical financials for the FY 2022, reflecting the new financial reporting format. As acting CFO, I have to say this was a herculean effort to reorient our entire reporting. I know that we still owe you the quarterly numbers for 2022. We will be providing those soon. Today, as promised, we are able to present our Q1 results in this simplified reporting format around our two global segments: Care Delivery and Care Enablement.
We continue to make progress on our FME25 transformation program. In the Q1 we achieved sustainable savings of EUR 60 million, which keeps us on track to achieve EUR 250 million- 300 million in savings by the end of this year. In terms of other strategic drivers, we are seeing a necessary and overdue increase in home trainings in the US by 14%. We have expanded our value-based care population in the Q1 by 5% to around 95,000 lives. We also realized the first tangible results of our portfolio optimization efforts with a discontinuation of a development program for PD cycler. We are continuously working on developing a winning culture focused on accountability and underpinned by our efforts around sustainability, diversity, equity and inclusion.
As a sign of our commitment to gender equity in the workplace, we signed the United Nations Women's Empowerment Principles last month. Turning to slide six. Our patients are core and center to everything we do. Through the Global Medical Office, we are continuously monitoring our clinical performance to enhance care. We take a consistent global approach to pursue equity and high standards of care across diverse patient populations. An important KPI in this regard is our quality index, a global indicator for patient well-being and treatment success. The quality index considers dialysis effectiveness, vascular access, and anemia management. We are tracking this on a quarterly basis and saw sequential stability at a high level. Next on slide seven. While we continue to face macro pressures and the annualization effect of COVID-19 related excess mortality, I'm encouraged by the improving trends and execution on our turnaround plans.
During the Q1, both Care Delivery and Care Enablement segments contribute to organic growth. This was driven by improving sequential volume development in Care Delivery and strong performance within our critical care business in Care Enablement. Our expected strong year-over-year decline in operating income was moderated by several factors. An improved business performance, like the phasing of critical care product sales in China, which were especially strong in the Q1, and the turnaround measures starting to materialize. As I just referenced, and will speak more about in a moment, I executed the first steps of our legacy portfolio optimization. Turning to slide eight. In the Q1, we delivered revenue growth of 2% at constant currency. We continue to deliver organic growth with positive contributions from both Care Delivery and Care Enablement in line with our expectations.
During the Q1, operating income on our guided basis, which is in constant currency and excludes special items and US provider relief funding, declined by 13%, resulting in a margin of 7.5%. As expected, our business development continued to be impacted by macroeconomic inflationary pressures. While we are seeing signs of stabilization, the increased costs, especially relating to raw materials, continue to put pressure on Care Enablement. The turnaround drivers are leading to improved business performance, which was also supported by the phasing of strong product sales in China. A significant contributor to the year-over-year decline in the margin relates to the absence of positive prior year effects in the base in Care Delivery. Moving to slide nine. This slide shows our operating income development compared to the Q1 of 2022.
Starting from the left, you can see how we get to the starting point on our guidance basis, which excludes special items and the US provider relief funds applied in 2022. It is a milestone for us to share for the first time the earnings development of our two operating segments. I will go into specific detail on the margin drivers for the segments later. With inter-segment eliminations, operating income for products transferred between Care Enablement and Care Delivery remained stable year-over-year. In the new reporting format, we have significantly reduced the corporate bucket and development of the corporate line was stable year-over-year. By far, the biggest special item in the quarter related to our legacy portfolio optimization, especially in our Care Enablement business. I will speak more to that when I get to the segment.
Other special items relate to FME25 costs, the human side investment remeasurement, and costs associated with the conversion of legal form. We are still assuming costs of EUR 50 million-EUR 100 million for the conversion of legal form for the year. Most of these costs in this respect will be incurred after the shareholders have approved the change of the legal form later this year. Turning to slide 10. In Care Delivery, we continue to execute on our turnaround plan to drive operational efficiencies, and we are seeing green shoots of recovery, particularly around labor trends and volume. We are seeing stabilization in the US labor market. Our open positions for direct patient care staff have decreased since year-end by around 10% to 4,000. As a reminder, historically, we would have had around 2,500-3,000 open positions at any point in time.
The improved staffing situation enables us to increase our home dialysis trainings and also increases our ability to take on new patients. While the annualization effect of COVID-19 related excess mortality continues to weigh on growth, we see sequential improvement. In the Q1, our same market treatment growth in the US was slightly negative at -0.3%, compared to -1.9% in the Q4 of last year. As a reminder, for full year 2023, we expected a US dialysis treatment growth between -1% and +1% compared to last year. For Care Delivery International, same market treatment growth was positive at 0.5%. This improved trend in volumes is supportive of both revenue growth as well as improving operational efficiencies and clinic utilization. The optimization of clinical infrastructure is underway.
More than 50 US clinics have been closed during Q4 2022 and Q1 of 2023. Overall, our FME25 transformation initiatives are moving forward, and we continue to deliver on clinical operational efficiencies. Next on slide 11. Here we look at how these trends translated into financial performance for Care Delivery. Revenue increased by 3% on a reported basis and 1% at constant currency. Care Delivery US revenue grew at 2% reported, mainly driven by positive exchange rate effects. It declined by 2% on a constant currency basis due to a negative organic development and the absence of positive prior year effects. Care Delivery International saw strong revenue growth of 5% reported and 12% on a constant currency basis.
At constant currency, this was mainly driven by strong organics growth, which was mostly due to the effects of hyperinflation in various markets and due to contributions from acquisitions. Operating income from Care Delivery decreased by EUR 8 million, resulting in a margin of 8% on our guided basis. The negative business growth development largely relates to the absence of positive prior year effects, which include the partial reversal of an accrual related to a revenue recognition adjustment for accounts receivable in legal disputes, the reconciliation of revenues for the final performance year of the ESCO program, and last, the suspension of sequestration in the US Besides these base effects, we have seen a promising development in price and volume impacted by timing of claims in Interwell Health.
While we still assume a labor headwind for the full year, on a comparative basis, we saw slightly better labor and inflationary impact compared to the Q1 of 2022, when the entire industry was facing significant staffing challenges due to Omicron. The easing of the US labor market since then has meant moderating wage increases and significantly reduced usage of, and rates paid for temporary labor. Finally, Care Delivery had a strong contribution from FME25 savings, mainly due to clinical operational efficiencies. Turning to slide 12. Even though we have seen some stabilization in the macro environment, Care Enablement continues to face significant inflationary pressures, and delivering on our turnaround plans are more important than ever.
Although much of our business is locked into longer term contracts, pricing and contract excellence are among the most important initiatives which we did launch at the end of last year. As mentioned at the CMD, we are already executing on our legacy portfolio optimization measures, which are treated as a special item. In the Q1, we terminated the development of VersaPD, a US-specific PD cycler. This decision was as a result of strategically aligning on a global PD cycler portfolio. Improved business performance in Care Enablement was driven by higher sales of critical care products in China as the government there made a big push to ensure all hospitals were well equipped for future pandemic situations.
Therefore, we do not expect this level of critical care sales to continue in the remainder of the year as a significant portion of the expected demand for the year has been covered in the Q1. Care Enablement performance was additionally supported by higher sales of home hemodialysis machines. Our FME25 transformation program is on track and delivering savings for the business, and savings in the Q1 largely related to productivity efficiencies. The strong inflationary pressures and high material prices are expected to continue to weigh on our cost development in Care Enablement for the remainder of the year. On slide 13. Here we look at how these trends have translated into financial performance. Care Enablement revenue increased by 3% on a reported and constant currency basis.
As I just highlighted, growth was driven by higher sales of critical care products in China and home hemodialysis products. Operating income for Care Enablement decreased by EUR 27 million, resulting in a margin of 5.2% on our guided basis. Inflation continues to be the biggest headwind for this business. It was partially offset by FME25 savings and positive business growth. Excluded from the shown operating income on guidance base is the largest special item in the quarter. The EUR 83 million write-off associated with the previously mentioned discontinuation of the PD cycler program. Turning to slide 14. The slightly lower operating cash flow in the quarter was mainly due to the decrease in net income. Free cash flow conversion remained at a stable level.
While toward the upper end of our self-imposed range, our leverage ratio of 3.4 times remained in our target corridor of 3-3.5 times. As I have emphasized previously, deleveraging remains our top capital allocation priority, especially given the high interest rate environment. I'll conclude with our outlook on slide 16. We reiterate our guidance for 2023. We have described 2023 as a year of level setting. While we continue to face certain headwinds, I am encouraged that we are already seeing green shoots of recovery and traction on our turnaround plans. Thus, we remain confident in our path to unlock value as the leading kidney care company and to achieve the improved operating profit margin of 10%-14% in 2025. That concludes my prepared remarks. I'll now turn back to Dominik.
Thank you, Helen, for the very first presentation in the new structure.
Mm-hmm.
I'm sure there are many questions, and I turn it over to Q&A. Timo, could you please open the line.
Thank you. Ladies and gentlemen, at this time, we will begin the question and answer session. Anyone who wishes to ask a question may press star followed by one on their touch tone telephone. If you wish to remove yourself from the question queue, you may press star followed by two. If you're using speaker equipment today, please lift the handset before making your selections. In the interest of time, please limit yourself to two questions only. Anyone who has a question may press star followed by one at this time. One moment for the first question, please. First question is from the line of Victoria with Lambert. Your question please.
The first one is just on the outlook for wage increases this year. Is this still expected to be around 4-5% increases? My second question is just on the progress of clinic closures. Is your guidance for the year still, 50-100, closures targeted for the year? How many have you closed so far? Thank you.
Hi, Victoria. Thanks for your questions. Yeah, look, I think, in Q1 we saw this wage inflation, around this 4%, maybe just, you know, just a little bit over 4%, which seems to be consistent across the industry. Obviously, you know, when you look at our guidance on labor for 2023, we, you know, have this EUR 140 million- 180 million. Q1 looks a little strange because of the quarterly year-over-year comp from Q1 last year, where obviously labor was very, very significant due to Omicron. I think, you know, we're seeing this sizing of the labor number as the year-over-year impact holding, and in line with our guidance.
I think for the quarter, we did see it just a little bit over 4%. In terms of your question on clinics, we're really pleased with how that is progressing. We closed already 51 clinics in Q4, Q1. And, you know, I think that that sizing that we've given of 50-1 00, I think if you take the midpoint of that's kind of how we're thinking about that right now.
Timo, we can take the next question, please.
Sure. The next question is from the line of Hassan Al-Wakeel with Barclays.
Hi. Thank you for taking my questions. I have two, please. Firstly, given the better development in patient dynamics in the US, could we see same market treatment growth turning positive in the Q2? Could this perhaps point to the upper end of the volume growth guidance range being more realistic for the full year? Secondly, could you talk about the Care Enablement strength and how significant the contribution was from China acute sales? How should we think about margins for the remainder of the year in this business? Thank you.
Thanks, Hassan. As you know, we have one quarter under our belt. We saw that at -0.3%. Obviously that it does include the impact of the clinic closures as well as some of the acute unprofitable contracts that we're exiting. I think right now we still feel pretty good around our guidance of -1% to +1%. I'm not gonna tighten that guidance yet. I think we just need to see another, you know, another quarter or two under our belt. Obviously we're pleased with the development from Q4 to Q1. The your question on the CE strand. The China impact was roughly around EUR 20 million of operating income in the quarter.
Obviously, you know, we saw that as a kind of an accelerated pull forward, which, you know, which we're encouraged by. We obviously would expect, you know, the kind of the forecast that we had for the back of the year now to have already been achieved. You know, I'm not gonna give, you know, kind of the guidance by quarter, on CE and what we're seeing. You know, obviously what we outlined at Capital Markets, we're, you know, executing against every component of that. I know we haven't guided between CD and CE, and don't intend to at this stage. Very encouraged by the progress, in the Q1, particularly in Care Enablement. That inflation number is real.
As you can see, you know, we have over EUR 50 million or so of inflation in Q1 against a, you know, a guided number, that looks to be tracking, against that full year.
Very helpful. Thank you.
The next question is from the line of Veronika Dubajová with Citi. Your question please.
Hi, Helen. Hi, Dominik. Thank you for taking my questions. I have two, please. One, Helen, just wanted to circle back to the wage, overall labor dynamics. Obviously you commented on inflation. I think the other sort of dynamic that you've been seeing is the switch from temporary to permanent labor. You also gave us some stats on the openings. As you look through the second and the third quarter, would you expect those open positions to come back down to the historical 2,500- 3,000? If that is the case, are you still comfortable with that EUR 140 million- 180 million labor cost headwind that you've assumed for the full year? I have a follow-up after that. That was a lengthy question, so I figured we could get it out of the way.
Okay, let me hit the labor one. Hi, Veronika. Thank you for the question. Look, there's a lot of moving parts on labor, as I think you can appreciate. What we are seeing, and I think consistent with the industry is definitely a decline in the use of contract labor, both in kind of traveling nurses, if you will, as well as a decline in agency. At the same time, we're seeing a decline in volume. We're also seeing a decline in hourly rates. I touched on the, you know, the kind of what we're seeing on the, you know, the kind of the inflationary aspect, if you will. Of that, you know, that 4,000 open positions, we are encouraged by that. It's about down 10%, as I said, over the last quarter.
Those open positions still sit at around 50/50 between PCTs and nurses. We're encouraged with our recruiting efforts there, and you know, kind of where the, where the sources are coming from, either in referrals or rehires. On top of that, our turnover trends are improving, you know, quarter-over-quarter as well. Look, I think we're on a good track. I still feel good about the 140-180. We obviously had assumed that we would be reducing open positions and, you know, kind of reducing some of this over the course of the year when we gave guidance. For now, I feel good, and I think we just take this quarter by quarter as we go through the year.
you know, I think we're seeing it the same way as the industry and obviously encouraged by it.
Okay, that's great. My second question is just on the sort of one-time contribution from China to crit care. Apologies if I missed this in your prepared remarks, but what would the products growth have been excluding that guys? Do you expect that to reverse out in the rest of the year or just not to recur? Thank you.
I didn't say in my prepared remarks, but I think I just answered it in the question from Hassan, which was the about EUR 20 million of EBIT impact for the year. I mean, that kind of is a pull forward of how we'd forecast. Might there be a little bit of favorability? We'll see as the rest of the year demand plays out. Did I answer both aspects of that, Veronica?
Yep, that's perfect.
Perfect.
Thank you.
Thanks.
Thanks, Helen. Thanks, Dominik. Catch you guys later.
Thanks.
The next question is from the line of Oliver Metzger with ODDO BHF.
Hi, good afternoon. Two questions from my side. The first one is also on your US clinics network. On net base, we were down by 2%. You also made the comments regarding recent closures. That's basically the reflection of the low volumes. Now, things really seem to normalize. How should we think conceptually about your clinic network? Do you regard us if we talk about a one-year horizon, that a further consolidation is still necessary? Do you expect at one point of time, even some net growth also in the context of the home hemodialysis? That's also part of my second question, because you mentioned the HHD machines and how should we think about the output of your machines versus your internal demand?
In theory, I would assume you could digest all the machines you produce just only for yourself, but you still want to sell some in the open market. Potentially, can you give us some more visibility on how we should think about these external sales of the machines?
Yeah. Thanks, Oliver, for your questions. look, I think, you know, obviously we had underutilized capacity in our clinic network, and obviously we are addressing that with the clinic closures and, you know, probably still expect some more to happen over the course of the year. you know, at the same time, we want to make sure that we are driving, you know, productivity and efficiencies to make sure we're maximizing that, you know, that overhead structure. The other piece of this, which you touched on, is obviously as home now starts to ramp back up, we're really encouraged by what we saw and the increase in trainings here in the quarter. That will obviously kind of take some of that capacity. In terms of normalizing, it's been a while since we've talked about normalizing.
I think, you know, this is just gonna get us back to the, you know, the kind of the plans that we had pre-pandemic, which was carefully, you know, utilizing the network of both clinics and home, and not overbuilding and not having too much capacity. I think from here on in, the volumes will naturally take care of itself and that infrastructure will follow. On your second question regarding HHD. Obviously it's important to us that we have, as you mentioned, enough machines for our own business, but also we have capacity and we have external third-party customers and we don't see that changing. Our goal is to obviously supply as much of the market with our machines as possible. And, you know, obviously we're, we've seen some benefit from that this quarter.
Yeah. One quick follow-up. Did you see significant room for an increase of production capacities for HHD machines?
We're not capacity constrained there.
Yeah. Okay. Good. Thank you.
The next question is from the line of Robert Davies with Morgan Stanley. Your question please.
Yes, thanks for taking my questions. I just wanted to pick up on your capacity utilization comment earlier across your clinics. Given the sort of clinic numbers you were talking about earlier, where do you expect the utilization of the clinics to be at the end? Are there still gonna be certain clinics in the network where capacity like the utilization is still very low, but you just have to hold on to them for strategic reasons or political reasons where you couldn't exit them? That was my first question. The second one was just on, I guess, the overall profitability guidance over the medium term.
I just wonder, in terms of kind of current market developments, is there anything that sort of changed your thinking, versus what you previously gave out, and what would take you to the sort of lower or upper end of that guidance range? Thank you.
Thanks for your question, Robert. Look, obviously capacity, we look across our entire network and in the US, you know, across 2,600 clinics. You know, obviously our utilization has been under what we would have liked it to have been. If I recall, Bill said we were around 60% at the moment, when we gave Capital Markets their update a couple of weeks ago. Obviously, we continue to want to drive that number up and kind of continue to increase that. Of course, you're right. It does vary state by state, region by region. You know, if you can appreciate, this is a complex overview of the entire network, of where we see for, you know, things like network adequacy and so on, and obviously, you know, the balance with home.
It's a number. You know, we track these clinics, clinic by clinic. We track the, you know, the utilization clinic by clinic. That's really part of the underlying operations and focus on improving our operating leverage. You know, on your second question on guidance and, you know, do I change that guidance and what would have to happen to be on the, you know, a higher end. Look, it's Q one. We have a lot of moving parts. I, you know, I think I'm pleased with how the Q1 has developed, but I'm gonna continue to be careful and cautious here and take it quarter by quarter and hopefully have more of a, you know, more of an update in Q two.
Okay. Thank you.
The next question is from the line of David Adlington with J.P. Morgan.
Yeah, thanks for the question. Maybe just on US pricing on the Care Delivery side, just on what you're seeing there, obviously on the private side and what your expectations were for evolution from here on sort of price mix through the rest of the year. Maybe sort of following on from that, any early thoughts on the proposal for CMS for next year, which will be out fairly shortly.
Hi, James. I just want to make sure I understood your question correctly because you said CD and products, but I'm assuming you mean CD and services.
That's correct. Sorry.
Yeah, yeah. That's okay. We're all reorienting to the new model. You're asking what are we assuming for reimbursement and what we're expecting or what we're seeing there in CMS. You know, we've had this discussion over the last, you know, the last months in terms of, you know, the kind of the mechanisms, right, for PPS and the cost reports and, you know, all things being equal that should hold that when inflation is high, and the costs are high, you should get that in the reimbursement, but obviously with a lag. You know, as you know, we have 3% assumed in for this year. The MedPAC report, you know, that's preliminary and kind of feeds into the preliminary PPS, you know, suggested a full increase.
We'll see how that plays out, depending on, you know, the CMS logic here. I think it's about July that we start to see a preliminary, PPS rate. I think by the time we get to Q2, we'll have more of a view on that.
Thanks. I just wonder what you're seeing on the private side as well to the pricing.
On the private side, on the pricing, no, nothing of note, I would say. You know, we, you know, we're on this cycle of, kind of renegotiations with the, with the bigger payers, nothing of note for 2023. I think a smaller one at the end of this year, but nothing of note to mention on commercial pricing.
Thank you.
The next question is from the line of James Vane-Tempest with Jefferies. Your question, please.
Hi, good afternoon. Thanks for taking my questions. It's James Vane-Tempest from Jefferies. Two, please. Firstly, a full year, I think, missed treatments were up, which I understood was somewhat of a mystery. I was just wondering what you're seeing there and what the reasons were for missed treatments, and is that why volumes are better? Second question is just on the portfolio optimization we've seen today, which isn't insignificant. I guess when we look what's more to come from portfolio optimization, would you say that's gonna be more streamlining existing businesses, or would we look at other kind of further product development? Thank you.
Let me take your second question first, on portfolio optimization. Yes, I acknowledge that, you know, the VersaPD write-off is a significant one. The way I'm thinking about, you know, this portfolio and these different buckets is maybe fourfold. You've got these, you know, initiatives and projects that sit under FME25, which are really, you know, kind of this structural, operational, internal changes that are driving efficiencies and savings. We've got, you know, this bucket, which I would call the R&D product portfolio of which VersaPD we've taken a hard look at our portfolio and quickly made the decision to terminate this one. My You know, I think this will be the biggest by far, and anything that follows there, will be relatively insignificant.
I think on the portfolio piece, on products there, I think we have a good line of sight into what we're doing there, and this is by far the largest. I think we've got this country bucket. You know, we've talked about this international services market, where we have said we will exit and divest, you know, kind of non-performing or non-profitable markets where we can't make a significant or meaningful difference in the profitability. That might be because of reimbursement. It may be for a whole host of reasons. We are, you know, starting to progress on that. I think the challenge with that one is the timing, and it's very difficult to phase and forecast when they might happen.
We have clearly identified some markets that we would want to exit. I think we've got this fourth bucket, which is really divesting non-core assets. With those, I would expect to, you know, you know, kind of get proceeds in, and, you know, maybe smaller or gains or losses there, as we exit those. Look, I think that we're very focused on what those four buckets are, and each one is being driven quite differently. We will update as we go through the year, but I think, you know, this product one and the R&D portfolio review was critical, that we were making sure we were investing in the right portfolio for the future.
I think we'll continue to update on country exits and sales of non-core assets as we go through the year. In terms of your first question on mistreatments. We are seeing that improving in the quarter compared to last year. We know it's not yet normalizing. Not yet normalized, I should say. We have seen promising developments in new starts and a lesser number of mistreatments and patients are staying on the schedule. I think that's also part of the reason why we have 160 basis points improvement in our same market treatment growth. Of course, you know, that also includes the fact that we have, you know, termination of clinics or clinic closures and the acute contract exits in there.
I think it's getting better. Not yet back to where it was, but promising developments would be my summary.
Thank you.
The next question is from the line of Lisa Clive with AB Bernstein. Your question, please.
Hi there. Just two questions from me. Number one, DaVita and Medtronic have started this product JV. Baxter is now gonna be a standalone company. There's a lot of moving parts with the competitive landscape, and given the just discontinued products. How should we think about the FMC products business from here? You know, you've long been the industry leader, but given the profitability of that business, it sounds like there just hasn't been a lot of, you know, focus on new product introductions. Should we expect R&D to go up? Do you expect more commercial intensity from the sort of structural changes amongst your competitors? Then second question, just in terms of new patient starts training for home hemodialysis and all that, thank you for some of the commentary on that.
Are you sort of happy that we're kind of back to normal run rates now, and should continue on that path? Thanks.
Thanks, Lisa. Appreciate your questions. Yeah, look, obviously we're watching the market developing in this space with Mozarc Medical and Baxter quite closely. We obviously are cleaning up our own portfolio. VersaPD is a good example of that. We, you know, we feel we're very focused on improving our profitability. I think that's the big key for us, driving through, you know, efficiencies internally, but also on pricing externally as well. Kadina, I think, gave a nice update on that at CMD, where we talked about, you know, where we have some challenges on profitability, and we're focused on that. You know, we feel good about what we have in our portfolio and what we can do with it. On your second question, on new patient starts and training and home.
I mean, obviously the labor challenge really thwarted our ability to train, you know, in the home setting. To see this bump, you know, after many, many quarters where we hadn't seen anything is really, really encouraging. The focus is really back on pulling through, you know, the training and the starts in home. I hope this is the, you know, the start of the, you know, the kind of the acceleration again, that, you know, we saw pre-COVID and gets us back on our track to hit our aspiration of 25%.
Great. Just one last follow-up question. Did you mention the actual number of COVID excess deaths, or if not, could you give us a number on that?
No, we moved away from that. It's now just all wrapped up in our organic growth number. We, the number that we have been speaking to, and I think it's probably more relevant now than ever, is what is the total mortality number. I think as of February, I don't think we have anything for later than that yet, but the overall mortality number was 18%, which compares to a 17% historically. I think we're seeing it come down and come down rapidly, but nothing new. We're not teasing out this excess mortality number going forward.
Okay. Thanks for that.
The next question is from the line of Christoph Gretler with CS. Question, Christoph.
Thank you operator. Good afternoon or morning, Helen. Thanks for the presentation. Order two questions, one on PD and on the other on same store market growth. On PD, I was a bit surprised by this, you know, write off of the PD cycler program, you know. Could you discuss now how you think that now will impact, you know, your future growth and the achievability of these, you know, 25%, you know, home dialysis treatment target term in the midterm? Then the second question is just on excess mortality to follow up on that, you know. I think there is a quite a substantial drop off, you know, in this 12-month mortality rate, particularly internationally in Q2, looking at the comp base, you know.
Is it reasonable to assume that, you know, we should see, you know, some positive, you know, growth, also in the US, you know, from Q2 onwards already?
Yeah. Thanks, Chris. Yeah, let me maybe give some more color on the decision around VersaPD, because we, you know, we feel very, very strongly about this and hence the reason why we've acted on this decision so quickly. We've taken a look at our entire portfolio. Obviously we are a global company. When we looked at VersaPD, it was much more of a regional play. We have another offering in development called sleep•safe harmony, and that is a global offering. So we've discontinued the regional one, if you will, to really focus on the global one. You know, we feel that sleep•safe has a much more competitive profile for PD than what VersaPD has had.
Sometimes you just have to make these tough decisions and I think it's given the clarity to the organization and we move on. You know, your question on excess mortality is a good one and one that we've asked ourselves many times, right? As we normalize coming out of COVID, do we see a point where the overall mortality number is less than the previous historic excess mortality number? We haven't seen that yet. Obviously every quarter that goes by we start to see it. You're absolutely right. We do see, you know, better trends in Europe than maybe the US and I think we reported that at CMD as well. We'll see how that plays out in the US over time.
It'll be what it'll be. I think it'll be an interesting dynamic, you know, after all the unfortunate lives that we have lost over the last 3 years.
Okay. Thank you. Appreciate the comment.
Yeah. Thank you.
The next question is from the line of Sezgi, who's now with HSBC.
Hi. Thanks for taking my questions. I hope you can hear me well. We have heard that labor market is easing, at the same time you still have the higher year-on-year growth. Is there any hopes whatsoever that there might be another provider re-relief fund or something similar? My second question relates to, I know you looked closely into the product portfolio and what kind of other write off discontinuations can we expect? Can you maybe provide more color on the potential volume impact that might come from that?
Yeah. Thanks, Sezgi for your question. We're not anticipating any PRF or any government funding for this year. That was clearly stated in our guidance assumptions. You know, our hope and anticipation now is that, you know, the increased cost base gets reflected in the reimbursement rate increase prospectively here. You know, no anticipation of anything there or funding or discussions, quite honestly. You know, on the portfolio, as I mentioned, you know, when I was going through, you know, kind of the different buckets, obviously this is an R&D program that we have discontinued. We feel a better program in development that replaces that, there's no volume implications.
I think, you know, anything else that we would do, I think, you know, anything that we're looking at would be quite small and smaller in nature, and don't anticipate, hard to anticipate what the volume impact could be for something smaller there.
Thanks very much.
Thank you.
There are no further questions at this time, and I hand back to Dominic for closing comments.
No questions. Thank you very much for the participation, the lively discussion. With that, we would close the call now and we look forward to seeing you over the next couple of weeks, on the road or virtually. Thank you for participating.
Thank you all. Thank you for your continued support. Take care.
Ladies and gentlemen, the conference is now concluded and you may disconnect your telephone. Thank you for joining and have a pleasant day. Goodbye.