The company acquired dialysis businesses, spending $105.2 million in cash, net of cash acquired. This expands the company's operational footprint by 9 centers in the US and 67 centers internationally.

DaVita closed 8 centers in the U.S. during the quarter, incurring $14.6 million in closure costs. This indicates a strategic effort to optimize the existing network and improve efficiency.

DaVita entered into an agreement to acquire dialysis service operations from Fresenius Medical Care in Chile, Ecuador, Columbia, and Brazil for approximately $237 million. This demonstrates a strategic focus on expanding its international presence.

While DaVita is actively pursuing cost-saving initiatives, the impact is not yet fully realized. The company continues to invest in and implement cost savings initiatives designed to help mitigate these cost and volume pressures.

The effective income tax rate attributable to DaVita Inc. decreased from 29.0% to 21.5% due to benefits recognized from stock-based compensation and a non-taxable non-cash gain on changes in ownership.

Following the Change Healthcare cyberattack, DaVita quickly suspended claims processing activity, set up alternative methods for Medicare claims, and worked to establish additional methods for claim processing. They also secured interest-free funding from United and its affiliates. This shows operational resilience.

The cybersecurity breach at Change Healthcare (CHC) significantly impacted DaVita's claims processing and cash flow. The company was unable to submit payment claims through CHC's platform, leading to a reduction in cash flow and an increase in outstanding borrowings.

DaVita is subject to various lawsuits, governmental investigations, and audits. The company also received two CIDs in connection with an industry investigation under Section 5 of the Federal Trade Commission Act regarding the acquisition of Medical Director services and provision of dialysis services.

The FTC published a final rule that would generally ban all non-compete clauses with employees and prohibit employers from enforcing existing non-compete clauses in contracts with workers, with limited exceptions. This could have an adverse impact on the company's agreements with teammates, arrangements with medical directors, or the terms of existing agreements with physicians.

DaVita faces continued increased competition from dialysis providers and others, and other potential marketplace changes, including without limitation increased investment in and availability of funding to new entrants in the dialysis and pre-dialysis marketplace.

DaVita faces continued downward pressure on average realized payment rates, and a reduction in the number or percentage of patients under such plans, including, without limitation, as a result of continuing legislative efforts to restrict or prohibit the use and/or availability of charitable premium assistance.

DaVita faces the potential impact of new or potential entrants in the dialysis and pre-dialysis marketplace and potential impact of innovative technologies, drugs, or other treatments on our patients and industry.

DaVita continues the strategic review of outpatient clinic capacity requirements and utilization, which have been impacted both by declines in our patient census in some markets due to the COVID-19 pandemic, as well as by our initiatives toward, and advances in, increasing the proportion of our home dialysis patients.

DaVita continues to invest in and implement cost savings initiatives designed to help mitigate these cost and volume pressures. These include identified cost savings related to the achievement of general and administrative cost efficiencies through ongoing initiatives that increase our use of third party service providers to perform certain activities.

The Change Healthcare outage impacted the company's ability to submit claims, leading to an increase in days sales outstanding (DSOs) and adversely impacted cash flows for the first quarter of 2024, and resulted in an increase in outstanding borrowings under our revolving credit facility.

Since receiving notice from CHC, we have been reviewing and monitoring our information technology infrastructure and network environment, including specifically for the indicators of compromise identified by CHC and its agents.

DaVita faces the potential impact of innovative technologies, drugs, or other treatments on our patients and industry.

DaVita continues to invest in and implement cost savings initiatives designed to help mitigate these cost and volume pressures. These include investments in revenue cycle management.

DaVita repurchased 2,119,415 shares for $240 million during the three months ended March 31, 2024. As of May 2, 2024, $1.073 billion remains available under the repurchase authorization.

The company made regularly scheduled principal payments under its senior secured credit facilities totaling $7.8 million on Term Loan A-1 and $6.9 million on Term Loan B-1. The company's 2019 interest rate cap agreements described below have the economic effect of capping the Company's maximum exposure to SOFR variable interest rate changes on equivalent amounts of the Company's floating rate debt.

During three months ended March 31, 2024 the Company acquired dialysis businesses, as follows: Cash paid, net of cash acquired: $105,163, Liabilities assumed: $357, Fair value of previously held equity method investments: $67,526, Number of dialysis centers acquired – U.S.: 9, Number of dialysis centers acquired – International: 67

The 10-Q filing does not contain specific details regarding new or ongoing ESG initiatives. Further information may be available in other reports.

Current macroeconomic and marketplace conditions, global events and domestic political or governmental volatility, many of which are interrelated and which relate to, among other things, inflation, potential interest rate volatility, labor market conditions, wage pressure, evolving monetary policies.

The extent to which healthcare reform, or changes in or new legislation, regulations or guidance, enforcement thereof or related litigation result in a reduction in coverage or reimbursement rates for our services, a reduction in the number of patients enrolled in or that select higher-paying commercial plans, including for example MA plans or other material impacts to our business or operations.

Risks arising from potential changes in laws, regulations or requirements applicable to us, such as potential and proposed federal and/or state legislation, regulation, ballot, executive action or other initiatives, including, without limitation, those related to healthcare, antitrust matters, including, among others, non-competes and other restrictive covenants, and acquisition, merger, joint venture or similar transactions and/or labor matters.