Pito Chickering: What are the goals that you’re getting at this point from commercial payers?
Joel Ackerman: Sorry, what was the question?
Pito Chickering: What are the — I guess, the rate increases that managed care payers are giving at this point?
Joel Ackerman: As we’ve said in the past, our contracts are multiyear. So in any given year, you don’t have that many at that. What we’ve seen up to now, is a lot of regional accounts and it’s fair to say that the increases have reflected the environment that we’re in, i.e., an inflationary environment. So they’ve been a bit higher than pre-pandemic. And we will see what next year brings as we have a couple of the larger ones up for renewal.
Pito Chickering: Okay. On IKC, I guess things got a little bit worse there for the year. I guess, what was driving that, if I heard that right. And then you talked about start of 2024 OI in the 4% to 7% range, how much of that is coming from improvements of IKC versus from kidney?
Joel Ackerman: Yes. So, Pito, I think you misheard there. IKC has gotten a little bit better. We have lowered the loss since our prior guidance. So we continue to see improvement over the course of the year. In terms of ’24, it’s too early to give guidance. Javier talked about 3% to 7% as being where we think the midpoint of the range will fall. Again, too early to quantify where that will come from, I’d say, it’s fair to say some of it will come from IKC, but that will not be all good.
Pito Chickering: Okay. And then last question for me, just a follow-up on Kevin’s question, specifically on third quarter. What were the new patient adds in the third quarter? How does that compare versus where we were pre-COVID? And specifically, what was the mortality in the quarter, how did that compare versus sort of pre-COVID. Just curious the interplay between incidents of new patients versus extension of mortality to help figure out treatment growth.
Joel Ackerman: Yes. So, for the quarter, volume came in right where we expected it. The new adds were consistent with kind of a pre-COVID type number, excess mortality, I’m going to peg it at 400. I think the excess mortality number is a number that we are probably going to start phasing out as a metric. It’s getting so close to pre-COVID levels, it’s getting kind of within the error band of what you consider as our pre-COVID number, and that number moved year-to-year pre-COVID. So for consistency with what we’ve called out historically, the number is 400. But I think I would expect that number to continue to decline and ultimately, like contract labor, it was something that was important for a period of time but is no longer important. So we are going to try and move away from that number going forward.
Pito Chickering: Okay, great. That’s it for me guys. Thanks so much.
Joel Ackerman: Thanks, Pito.
Operator: Our next question comes from Lisa Clive with Bernstein. Your line is open.
Lisa Clive: Hi. I just wanted to squeeze in some questions on home dialysis, if I can. Do you have any statistics you could give us about what proportion of your incident private patients are still employed versus on COBRA and how that looks, if there’s any difference in your home dialysis patients and how we should think about that mix going forward?
Javier Rodriguez: I actually don’t know the mix between COBRA and private, but I know that number is pretty steady and when there’s full employment, that usually moves in recessionary periods. So we can look at that, but I don’t think it’s a meaningful change, if that’s what you’re going for. And as it relates to home, it does have a higher mix. We have now roughly 15% change of our patients at home, and that number has been stable. We’ve continued to work hard to get more patients on it. But we have not seen any shift in insurance as it relates to the cohorts.
Lisa Clive: Okay. I guess I was really just wondering for those private patients that managed to go on home dialysis, whether there is more of a — whether more of them can stay employed because my understanding was for the patients that are on COBRA, a lot of them won’t make it through the full sort 33 months. Could you just comment on whether I’m right on that and whether that — whether greater home dialysis could mean sort of more patients employed for longer?
Joel Ackerman: Yes. We’ve looked at that number, and it’s not an easy piece of analysis because you can run into the trap of correlation without causation and you wind up with a number that looks good, but ultimately doesn’t really drive any better financial results as your home dialysis rates go up. So I would put that down as inconclusive.
Javier Rodriguez: And Lisa, one of the things that is important for the last decade or so, people assume that patient would go home, they would have more flexibility and they would keep their ability to work. But the reality is that the dropout rate on dialysis at home has continued to be incredibly high. So roughly about half of the patients that are on therapy would rather be taking care in center or have to be taken in center because of a medical condition.
Lisa Clive: Okay. That’s helpful. Thanks.
Joel Ackerman: Thank you.
Operator: And we have no additional questions in the queue.
Javier Rodriguez: Okay. Well, I know that, that was a very dense conversation, unusual in that it was not so much related into the quarter, but something that is really important to have an understanding of what we are looking at and what you’re looking at. So let me make a couple of closing comments. First, we had a very strong quarter, and we continue our track record of meeting our commitments. Secondly, hopefully, it became clear. We are very happy that these drugs are out there and it can improve the lives of many. But on kidney, it is more nuanced to understand the impact it will have on the population. Third, even with a robust adoption, based on what we know today, we believe that this class of drugs will not impact our plan to deliver a 3% to 7% OI growth for our long-term plan.
And then lastly, but really important, we remain really diligently and focused on delivering the best care today for our patients while also building the capabilities and models of care for a healthier tomorrow. It just dawned on me that this is the last time that we’re scheduled to speak for the year. So on behalf of our team, I’d like to wish you and your families a happy and healthy holidays. Be well.
Operator: Thank you for your participation in today’s conference. You may disconnect at this time.
