During the pandemic they were hurt- their population of patients are weak to begin with and it seems that mortality was elevated in their population (they lost patients- which means loss of treatments). Missed treatments was a problem for them as well during the pandemic as well as ‘new to dialysis’ patients. They also had issues with labor costs.

Now it seems that ‘new to dialysis’ patients are at pre-covid levels, but mortality is still elevated. So people are not staying on dialysis as long as they are passing away earlier.

They have been buying international assets as well.

I think it’s an essential business- Medicare needs them. They throw off a ton of cash which as Jim mentioned is used for repurchase and I basically think this is the story here. Stable business, with slight rev growth, all cash goes to the buyback, which is not insignificant.

Ted owns 2mm shares and Berkshire now has an agreement with DVA that once Berkshire’s position hits 45%, they will sell into the buyback to maintain a max of 45%.

Seems like they are operating efficiently to me at this time.