Kevin Fischbeck: Okay. That’s helpful. I guess maybe then a question would be in the quarter, you talked about mortality improving. Are the new starts back to where you would expect them to be? Or does that also have to improve?
Joel Ackerman: Our new starts are back to where we would have expected them to be. We felt that pressure intensely last year, but we are now seeing year-over-year starts back to what we would have expected.
Kevin Fischbeck: Okay. So you’re looking at it and saying 2% volume growth is the right number. Longer term, the new starts back to where it should be, it’s really just the mortality that’s the difference between where we are now at 2%?
Joel Ackerman: I think that’s a reasonable summation of where we are.
Jeffrey Giullian: Yes. If you were to be a little more refined or sharpen your pencil, our miss treatments are slightly higher than before, and we are working on that as well. But your point is bigger.
Kevin Fischbeck: Okay. And so then this comment that you’re making about, if this drug is adopted and the cardiology benefit is the way you think it could be, would we see more new starts then? Is that what would show up, you see that before we saw the progression? Or how does that — how would we ever see that — that’s actually the way that that’s playing out?
Joel Ackerman: Well, I think, yes, you would see it in new starts. I mean you’d never be able to pinpoint these patients, but these are patients who, without these drugs would have passed away at late-stage CKD before being incident to ESRD, but that, again, would be offset by the delay in incidence of patients who are taking these drugs and remain in CKD longer.
Kevin Fischbeck: Okay. Makes sense. And then maybe just last question. The IKC business coming in better, but you’re still kind of keeping that 2026 target, is there anything unusual or prior period in that? Or is it just not a big enough change from your projection to kind of say that the trajectory is accelerated?
Joel Ackerman: Yes. So look, the quarter was really strong, but a lot of that was the result of timing. It was shared savings revenue that we expected in Q4 and came in Q3. As we’ve talked about in the past and we think will be true in the future, the quarter-over-quarter variability in IKC is quite large. And I think the right way to look at IKC is full year, what we see now, we called out $110 million loss approximately for IKC for the year. That’s a bit better than what we were talking about before. But nowhere nearly, as big as the beat this quarter. And again, that’s largely because of the timing between this quarter and next. So I’d say overall, IKC is on track. They are performing slightly better than we expected, but in the range. And for that reason, we continue to expect better number next year, again in ’25 and then breakeven by ’26.
Kevin Fischbeck: Okay, great. Thanks.
Joel Ackerman: Thank you, Kevin.
Operator: Our next question comes from Lisa Clive with Bernstein. Your line is open.
Lisa Clive: Hi. Thanks very much. And talking about the late-stage CKD patients, how should we think about the diagnosis of that group? Obviously, even Stage 3 is severely under diagnosed and there’s been a big push to try and improve that. Now that there are a variety of medications, that can really potentially have an impact, if used early enough, it seems like it’s the right thing to do by patients. How are you involved in this? And where do you see the diagnosis rates going?
Jeffrey Giullian: Thanks, Lisa. This is Jeff again. A couple of thoughts on that. There’s been a push to diagnose patients earlier with CKD for a long time, and yet, we are not seeing epidemiologically a large increase in that. There’s been a push to get the word out about kidney disease and things along those lines. When it comes to the medications available, medications like ACE inhibitors and ARBs, SGLT2 inhibitors and the GLP-1s, they’ve been available for a long time, and the knowledge regarding their kidney impacts have been known to the nephrology community for several years. So for us, this isn’t necessarily new news, although I know it’s been making headlines recently. So from that standpoint, we are not seeing a lot of change.
We are continuing to work with physicians upstream to educate them about medications that are available and things like that. And as we think specifically about our role in Integrated Kidney Care and improving transitions of care for those patients that do go on to dialysis, this is something that’s important to us. We work with our physician partners regularly on managing the care of patients with chronic kidney disease and reducing their risk factors.
Lisa Clive: Okay. And a related question, just looking at the disease prevalence over time. As we’ve seen the obesity rate go over the last 20 years from sort of 30% to 40% of the adult population, Clearly, we’ve seen a notable increase in diabetes and [indiscernible] and depth, but at least the estimated prevalence and it’s a big estimate because there are so many undiagnosed patients. But the estimated prevalence of CKD, has really been pretty flat over that time period. Any thoughts on why that may be the case? I’m just thinking if that obesity rate even potentially pulls back, what the relationship will be with CKD?
Jeffrey Giullian: Yes. Most of the estimated prevalence comes from physicians coding CKD, as a diagnosis, through what’s called ICD-10 codes. And so as physicians focus on other things, cardiovascular risk factors and cancer type risk factors and things like that. CKD in the early stages, especially CKD 1 and 2 and early CKD Stage 3, just isn’t top of priority in some cases. And so we are just not seeing at least the documented prevalence of those with CKD Stage 3 rise.
Lisa Clive: Okay. Thanks for that.
Operator: Our next question comes from Pito Chickering with Deutsche Bank. Your line is open.
Pito Chickering: Hey, guys. So I’ll follow-up here with a couple sort of just quickies here. SG&A, a lot of moving parts this quarter, including, I think, a funding of charity groups. Just curious, if you can just bridge us for what the moving parts in 3Q? And how we should think about G&A for 4Q?
Joel Ackerman: Yes. I don’t think there’s a lot to call out on G&A overall quarter-over-quarter, there’s really nothing that jumps out. In terms of Q4, I would expect a modest uptick from seasonality, but nothing major.
Pito Chickering: Okay. Revenue per treatment had a nice pickup sequentially as well. Was there any mix shift here? Or is that just more of a seasonality thing at this point?
Joel Ackerman: Yes. The biggest impact on RPT quarter-over-quarter was continued progress on our collections efforts. We are really crowd from an operational standpoint of what our team has been able to accomplish there. We talked about it last quarter. We got a little bit more this quarter. And I would say, for the time being, we’ve probably gotten the vast majority of that. So I’m not anticipating a whole lot more of that in the next few quarters. We did see a commercial mix uptick in the quarter but, we also got the benefit of some just negotiated rate increases as well.
