Fresenius Medical Care AG & Co. KGaA

Second-quarter organic group revenue increased 5%, and at constant currency revenue rose 4%. Operating income increased 23% at constant currency, while group operating margin expanded by 180 basis points. Special items were a negative EUR 103 million, mainly from the TAVNEOS-related impairment. Operating cash flow increased 11% and free cash flow was EUR 625 million. On the segment level, Care Delivery had 5% constant-currency revenue growth and 45% operating income growth with a 390 basis point margin step-up; Value-based Care revenue rose 9% and operating income improved to EUR 18 million from a EUR 9 million loss; Care Enablement organic revenue grew 3% while earnings declined 5%. For 2026, management confirmed broadly flat revenue, operating income expected to remain at a consistently elevated level with a mid-single-digit upside/downside range, full-year TDAPA now expected to be a EUR 50 million year-over-year headwind instead of about EUR 100 million, and value-based care revenue expected to decline by EUR 150 million to EUR 200 million, better than the prior EUR 300 million decline assumption.

Helen Giza emphasized that the quarter showed strong execution on profitability, savings, and capital returns, highlighting the accelerated 5008X rollout, FME25+ savings, and the completed/expanded buyback program. Her tone was confident on the long-term strategy but candid on the U.S. dialysis issue, calling the referral shortfall an operational miss rather than a market problem and saying management has already made organizational changes. She framed 2026 as a year of continued profitability improvement, while acknowledging that some benefits, especially from the referral fix, may not fully show up until 2027.

Martin Fischer focused on the numbers behind the quarter: 5% organic revenue growth, 23% constant-currency operating income growth, 180 basis points of margin expansion, EUR 103 million of special items, 11% higher operating cash flow, and EUR 625 million of free cash flow. He also quantified the TDAPA bridge, saying Q2 benefited by about EUR 80 million year over year, full-year TDAPA is now expected to be a EUR 50 million headwind, and Care Enablement China was a roughly EUR 20 million headwind in Q2. On capital allocation, he noted the second EUR 1 billion buyback was launched in May, 2.5 million shares were repurchased for EUR 94 million by quarter-end, and leverage remained at 2.6x, near the lower end of the target corridor.

Analysts focused heavily on the U.S. same-market treatment slowdown, asking whether the deterioration from Q1 to Q2 was driven by referrals, clinic closures, outflows, or a broader competitive issue. Management said it was mainly an internal business-development and referral-capture miss, not a market problem, and that the remedy will take a few months, with 2026 U.S. same-market growth now expected around Q2 levels. Questions also focused on TDAPA, ACA, China, and 2027; management said TDAPA is now expected to be a smaller overall headwind than previously thought, ACA’s 2026 headwind is still about $50 million, and 2027 would be built from the usual drivers of volume, rate/yield, savings, and HDF, but they did not size 2027 in detail.