About DaVita Inc
DaVita Inc. (DaVita) operates as a healthcare provider focused on transforming care delivery to improve quality of life for patients globally. The company is one of the largest providers of kidney care services in the U.S. The company cares for its patients at every stage and setting along their kidney health journey–including earlier diagnosis and prevention, supporting the transplant process, helping with end of life and ensuring they are supported at home, in the company’s dialysis centers, in the hospital and/or skilled nursing facilities and at the end of life. The company is committed to bold, patient-centric care models, implementing the latest technologies and advancing integrated care offerings. The company is one of the two largest dialysis providers in the United States. The company’s U.S. dialysis and related lab services (U.S. dialysis) business treats patients with chronic kidney failure, ESKD, in the United States, and is the company’s largest line of business. The company’s robust platform to deliver kidney care services also includes established nephrology and payor relationships. In addition, as of December 31, 2023, the company’s international operations provided dialysis and administrative services to a total of 367 outpatient dialysis centers located in 11 countries outside of the U.S., serving approximately 49,400 patients. Finally, the company’s U.S. integrated kidney care (IKC) business provided integrated care and disease management services to 58,000 patients in risk-based integrated care arrangements and to an additional 17,000 patients in other integrated care arrangements across the United States as of December 31, 2023. The company also maintains a few other ancillary services and investments outside of the company’s U.S. dialysis, the U.S. IKC, or international operations, which the company refers to as its U.S. other ancillary services. The company refers to its U.S. integrated kidney care business, the U.S. other ancillary services and international operations as, collectively, the company’s ‘ancillary services.’ The company also has a separate corporate administrative support function that supports the company’s U.S. dialysis business and these ancillary services. Care Model The company’s patient-centric care model leverages its platform of kidney care services to maximize patient choice in both models and modalities of care. The flexibility the company offers coupled with a focus on comprehensive kidney care supports its commitments to help improve equitable clinical outcomes and quality of life for the company’s patients. According to the most recently published data, for the nine most recently reported years, the company has continued as an industry leader in the Centers for Medicare & Medicaid Services’ (CMS) Quality Incentive Program (QIP), which promotes high quality services in outpatient dialysis facilities treating patients with ESKD. In addition, according to the most recently published data, for the eight most recently reported years, the company has also continued as an industry leader under CMS’ Five-Star Quality Rating system, which rates eligible dialysis centers based on the quality of outcomes to help patients, their families, and caregivers make more informed decisions about where patients receive care. The company has seen strong results from the company’s participation in the ESRD Treatment Choices (ETC) Model, which was launched by the CMS Center for Medicare and Medicaid Innovation (CMMI) in January 2021 with the stated intent to ‘encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESKD, while reducing Medicare expenditures and preserving or enhancing the quality of care furnished to beneficiaries with ESKD.’ The company’s quality clinical outcomes are driven by its experienced and knowledgeable caregivers. The company employs registered nurses, licensed practical or vocational nurses, patient care technicians, social workers, registered dietitians, biomedical technicians and other administrative and support teammates who strive to achieve superior clinical outcomes at the company’s dialysis facilities. The U.S. dialysis business The company’s U.S. dialysis business is a leading provider of kidney dialysis services for patients suffering from ESKD. As of December 31, 2023, the company provided dialysis, administrative and related laboratory services in the U.S. through a network of 2,675 outpatient dialysis centers in 46 states and the District of Columbia, serving a total of approximately 200,800 patients. The company also has contracts to provide hospital inpatient dialysis services in approximately 790 hospitals throughout the U.S. The U.S. dialysis services the company provides Outpatient Hemodialysis Services As a condition of the company’s enrollment in Medicare for the provision of dialysis services, the company contracts with a nephrologist or a group of associated nephrologists to provide medical director services at each of the company’s dialysis centers. In addition, other nephrologists may apply for practice privileges to treat their patients at the company’s centers. Each center has an administrator, typically a registered nurse, who supervises the day-to-day operations of the center and its staff. The staff of each center typically consists of registered nurses, licensed practical or vocational nurses, patient care technicians, a social worker, a registered dietician, biomedical technician support and other administrative and support personnel. Hospital Inpatient Hemodialysis Services As of December 31, 2023, the company had contracts to provide hospital inpatient dialysis services to patients in approximately 790 hospitals throughout the U.S. The company renders these services based on a contracted per-treatment fee that is individually negotiated with each hospital. When a hospital requests the company’s services, the company typically administers the dialysis treatment at the patient’s bedside or in a dedicated treatment room in the hospital, as needed. Home-based Dialysis Services Home-based dialysis services include home hemodialysis and peritoneal dialysis. Many of the company’s outpatient dialysis centers offer certain support services for dialysis patients who prefer and are able to perform either home hemodialysis or peritoneal dialysis in their homes. Home-based hemodialysis support services consist of providing equipment and supplies, training, patient monitoring, on-call support services and follow-up assistance. Registered nurses train patients and their families or other caregivers to perform either home hemodialysis or peritoneal dialysis. The 2019 Executive Order and related HHS guidance described above also included a stated goal of increasing the relative number of new ESKD patients that receive dialysis at home. Other ESKD Laboratory Services The company operates a separately licensed and highly automated clinical laboratory, which specializes in ESKD patient testing. This specialized laboratory provides routine laboratory tests for dialysis and other physician-prescribed laboratory tests for ESKD patients. The vast majority of these tests are performed for the company’s ESKD patients throughout the U.S. These tests are performed for a variety of reasons, including to monitor a patient’s ESKD condition, including the adequacy of dialysis, as well as other medical conditions of the patient. The company’s laboratory utilizes information systems which provide information to certain members of the dialysis centers’ staff and medical directors regarding critical outcome indicators. Management Services The company operates or provides management and administrative services pursuant to management and administrative services agreements to 59 outpatient dialysis centers located in the U.S. in which the company either own a noncontrolling interest or which are wholly-owned by third parties. Management fees are established by contract and are recognized as earned typically based on a percentage of revenues or cash collections generated by the outpatient dialysis centers. Sources of Revenue The company’s U.S. dialysis revenues represent approximately 89% of the company’s consolidated revenues for the year ended December 31, 2023. The company’s U.S. dialysis revenues are derived primarily from the company’s core business of providing dialysis services and related laboratory services and, to a lesser extent, the administration of pharmaceuticals and management fees generated from providing management and administrative services to certain outpatient dialysis centers. The sources of the company’s U.S. dialysis revenues are principally from government-based programs, including Medicare and Medicare Advantage plans, Medicaid and managed Medicaid plans, other government-based programs, including the company’s agreement with the Veterans Administration, and commercial insurance plans. Physician Relationships Joint Venture Partners The company owns and operates certain of its dialysis centers through entities that are structured as joint ventures. The company generally holds controlling interests in these joint ventures, with nephrologists, hospitals, management services organizations, and/or other healthcare providers holding minority equity interests. These joint ventures are typically formed as limited liability companies. Community Physicians The company’s relationships with local nephrologists and its ability to provide quality dialysis services and to meet the needs of their patients are key factors in the success of the company’s dialysis operations. Over 5,200 nephrologists refer patients to the company’s outpatient dialysis centers. Medical Directors The company engages physicians or groups of physicians to serve as medical directors for each of the company’s outpatient dialysis centers. At some outpatient dialysis centers, the company also separately contracts with one or more other physicians or groups to serve as assistant or associate medical directors over other modalities, such as home dialysis. The company has over 900 individual physicians and physician groups under contract to provide medical director services. The company’s medical director contracts and joint venture operating agreements generally include covenants not to compete or own interests in dialysis centers operated by other providers within a defined geographic area for various time periods, as applicable. Location of the company’s U.S. dialysis centers The company operated 2,675 outpatient dialysis centers in the U.S. as of December 31, 2023 and 2,616 of these centers are consolidated in the company’s financial statements. Of the remaining 59 nonconsolidated U.S. outpatient dialysis centers, the company owns noncontrolling interests in 56 centers and provides management and administrative services to three centers that are wholly-owned by third parties. Ancillary services, including the company’s international operations The company’s ancillary services relate primarily to its core business of providing kidney care services. As of December 31, 2023, these primarily consisted of the company’s U.S. integrated kidney care (IKC) business, certain U.S. other ancillary businesses (including the company’s clinical research programs, transplant software business, and venture investment group), and the company’s international operations. The U.S. Integrated Kidney Care Integrated Kidney Care. DaVita Integrated Kidney Care (DaVita IKC), provides advanced integrated care management services to health plans and government programs for members/beneficiaries diagnosed with ESKD and CKD. Through a combination of health monitoring, clinical coordination, innovative interventions, predictive analytics, medical claims analysis and information technology, the company endeavors to assist its health plan and government program customers and patients in obtaining superior renal healthcare and improved clinical outcomes, as well as helping to reduce overall medical costs. Integrated kidney care management revenues from commercial and Medicare Advantage insurers can be based upon either an established contract fee recognized as earned for services provided over the contract period, or related to the operation of risk-based and value-based care programs, including shared savings, pay-for-performance, and capitation contracts. DaVita IKC also contracts with payors to support MA ESKD chronic condition special needs plans (C-SNPs) to provide ESKD patients full service healthcare and integrated care management services. DaVita IKC supported the company’s ESKD seamless care organizations (ESCO) joint venture programs until their completion in 2021, and participates in both the involuntary and certain voluntary payment models administered by CMMI. The company is also developing, and has entered into, various forms of technology-based, administrative, financial and other collaboration and incentive arrangements with physician partners and other providers in the support of the company’s innovative care model, developing and expanding IKC programs and arrangements. Physician services. Nephrology Practice Solutions (NPS) is an independent business that partners with physicians committed to providing outstanding clinical and integrated care to patients. NPS provides nephrologist recruitment and staffing services in select markets that are billed on a per-search basis. NPS also offers physician practice management services to nephrologists under administrative and management services agreements. These administrative and management services include physician practice management, billing and collections, credentialing, coding and other support services that enable physician practices to increase efficiency and manage their administrative needs. The U.S. Other Ancillary services Clinical research programs. DaVita Clinical Research (DCR) is a provider-based specialty clinical research organization with a wide spectrum of services for clinical drug research and device development. DCR uses its extensive real-world healthcare expertise to assist in the design, recruitment and completion of retrospective and prospective studies. Revenues are based upon study generated fees, as determined by contract with drug companies and other sponsors, and are recognized as earned according to the contract terms. Transplant software business. DaVita's transplant software business, MedSleuth, works with transplant centers across the U.S. to provide greater connectivity among transplant candidates, transplant centers, physicians and care teams to help improve the experience and outcomes for kidney and liver transplant patients. Venture group. DaVita Venture Group (DVG) focuses on innovative products, solutions and businesses that improve care for patients with kidney disease and related conditions. DVG identifies companies and products for acquisitions, strategic partnerships, and venture investment opportunities. DVG’s focus includes innovation in digital health, pharmaceuticals, medical devices, and care delivery models. International Dialysis Operations The company operated 367 outpatient dialysis centers located in 11 countries outside of the U.S. serving approximately 49,400 patients as of December 31, 2023. The company’s international dialysis operations have continued to grow steadily and expand as a result of acquiring and developing outpatient dialysis centers in various strategic markets. The company’s international operations are included in the company’s ancillary services. Government Regulation The company’s dialysis centers are certified by CMS, as required for the receipt of Medicare payments. In the ordinary course of the company’s business operations, DaVita and its ancillary businesses and subsidiaries enter into numerous arrangements with physicians and other potential referral sources, that potentially implicate the Anti-Kickback Statute. In the ordinary course of business operations, DaVita and its ancillary businesses and subsidiaries have many different types of financial arrangements with referring physicians that potentially implicate the Stark Law, including, but not limited to, medical director agreements, joint ventures, leases and subleases with entities in which physicians, hospitals or medical groups hold ownership interest, consulting agreements, hospital services agreements, discharge planning services agreements, acute dialysis services agreements, value-based care arrangements, employment agreements and incentive performance arrangements. The company is subject to the provisions of the Foreign Corrupt Practices Act (FCPA) in the United States and similar laws in other countries, which generally prohibit companies and those acting on their behalf from making improper payments to foreign government officials and others for the purpose of obtaining or retaining business. The Health Insurance Portability and Accountability Act of 1996 and its implementing privacy and security regulations, as amended by the federal Health Information Technology for Economic and Clinical Health Act (HITECH Act) (collectively referred to as HIPAA), require the company to provide certain protections to patients and their health information. Competition The company’s largest competitor is Fresenius Medical Care (FMC). History The company was founded in 1994. It was incorporated as a Delaware corporation in 1994. The company was formerly known as DaVita HealthCare Partners Inc. and changed its name to DaVita Inc. in 2016.
