You are given a text that consists of multiple sentences. Your task is to perform abstractive summarization on this text. Use your understanding of the content to express the main ideas and crucial details in a shorter, coherent, and natural sounding text. 
Text: We appreciate your continued interest in our company.
I'm Jim Gustafson, Vice President of Investor Relations.
Over the last several months, we have made incredible progress in our efforts to combat the COVID-19 pandemic.
And it's with continued optimism that I provide several updates today, starting with vaccination followed by a summary of the first quarter performance then an update on our improved outlook for the year and finally, an overview of our ongoing commitment to ESG.
Q1 brought a lot of smiles as the Kidney Care community administered hundreds of thousands of vaccines to its patients.
Providers worked closely with the Biden Administration, the CDC and state government so that dialysis patients could be vaccinated in a trusted and convenient side of care.
We knew that this would help our patients overcome transportation and other access challenges getting to third-party sites.
And we had confidence that the hesitancy rate would decline when they received education from a trusted caretaker.
We also saw an opportunity to positively impact health equity by administering COVID vaccine in our clinics.
Similar to the early results in the broader U.S. population, in the first few weeks of the vaccine rollout, we saw the vaccination rate for Black and Hispanic were approximately 40% below that of White and Asian American.
This did not sit well with us.
We've got to work and mobilized our care teams, including social workers, dietitians and medical directors to have one-on-one conversations with patients to address common causes of hesitancy.
Our Hispanic patients have now been vaccinated at nearly the same rate as white patients and the gap for our black patients has been reduced to 10%.
We are not done.
Our pursuit for health equity continues.
On to our first quarter financial results.
We delivered solid performance in Q1 as our operating margins returned to 15.7% in the quarter, while we continue to lead through the continued challenges presented by the pandemic.
As we covered on our last call, treatment volumes declined in Q1.
Our treatments per day hit a low point in mid-February, including the impact of approximately 25,000 missed treatments from the winter storm.
Since then, our daily treatment trends have steadily improved.
As these trends continue, absent any further infection surges, we believe that our sequential patient census growth through the end of the year could return to pre-COVID levels, which is what we incorporated in our guidance ranges we provided last quarter.
Let me provide a bit more detail on volume that supports our outlook.
First, since our update in Q1, COVID case counts and new infections within our dialysis population have continued to decline.
As of last Friday, the number of active cases among our patients across the country decreased approximately 85% from peak prevalence on January 6, 2021, and the last seven-day incidence rate for new cases decreased approximately 91% from the week ending January 9, 2021.
Second, we're grateful that we're seeing a dramatic decline in the mortality rates associated with COVID.
We've previously shared that the unfortunate incremental mortality associated with COVID was approximately 7,000 in 2020.
In 2021, both our patient mortality count and mortality count in the general population peaked in January.
In the first quarter, incremental mortality associated with COVID was approximately 3,300 lives, with more than half of that number occurring in January, decreasing to approximately 600 in March.
It is too early to provide an estimate for April, but we expect the results will improve versus March.
Shifting to full year outlook, our view of core operation performance for the year remains largely unchanged from our original guidance.
However, now that the likelihood of some downside scenarios have decreased due to the trends I've previously mentioned, we are increasing our adjusted earnings per share guidance range to $8.20 to $9 per share and our adjusted operating income guidance range to $1.75 billion to $1.875 billion.
At the midpoint of our revised adjusted operating income guidance, this would represent approximately a 4% growth year-over-year.
These revised ranges assume no further major disruption from the virus strain.
My final topic is our ongoing commitment to environmental, social and governance matters or ESG.
ESG has become a more significant topic of conversation in the investment community over the last couple of years, but these are not new areas of focus for us at DaVita.
Our beliefs are incorporated into our stated vision of social responsibility that has three components: caring for our patients, caring for each other and caring for the world around us, including both our communities and our environment.
DaVita continues to execute against this vision, providing top quality clinical care for our patients is at the core of what we do and because I've already spoken at length about our patients care and our efforts to vaccinate our patients, I would like to highlight a few of our achievements in caring for our teammates and caring for the world around us.
I believe that fostering an environment rich in diversity and where we all feel that we belong is imperative to our culture and how we connect with each other and how we connect with our patients every day.
And our commitment to cultivating diversity is evident throughout the organization.
It starts with the Board of Directors, currently made up of nine leaders, of whom 67% are diverse, including four women and three people of color.
The diversity of our team extends to the leaders who run the core operations in our clinics of whom 52% are female and 27% are people of color.
These results have been achieved through thoughtful and deliberate practices to create a diverse pipeline of talent.
In 2021, we published our first report on diversity and belonging, disclosing many of our company's diverse metrics and our ongoing efforts to cultivate a diverse organization in which everyone feels that he or she belongs.
We also recently published our 14th Annual Corporate Social Responsibility Report and our first ESG Report.
These reports disclose the progress we made in 2020 and lay out our ambitious ESG goals for 2025, including goals to reduce carbon emissions by 50% and to have vendors representing 70% of emissions set by climate change goals and to achieve engagement scores of 84% or higher among our teammate population.
We are pleased with our progress to date on diversity and ESG.
And as you can see by our goal, we have a lot more we hope to accomplish.
Q1 was a strong start to the year with solid financial performance.
For the quarter, we recorded revenue of approximately $2.8 billion, operating income of $443 million and earnings per share of $2.09.
As Javier referenced, treatment volume was a large headwind and our nonacquired growth was negative 2.2% compared to negative 0.3% in Q4.
While COVID presented the main challenge to NAG in Q1, winter storms, particularly Uri, were responsible for about 30 basis points of the NAG decline.
Treatments per day bottomed out during the first quarter, so we expect to start seeing quarter-over-quarter growth in Q2.
We continue to expect that NAG will be negative for the year, although we expect to see an acceleration of NAG in 2022 and 2023 as mortality rates may be lower than the pre-COVID levels for a few years.
U.S. dialysis revenue per treatment grew sequentially by almost $3 this quarter as a result of the Medicare rate increase, higher enrollment in MA plans, a slight improvement in commercial mix and higher volume from our hospital services business, partially offset by the seasonal impact of coinsurance and deductible.
U.S. dialysis patient care costs declined sequentially by approximately $6 per treatment.
Although we continue to experience elevated costs due to the pandemic, such as higher PPE and certain clinical level expenses from continued infection control protocols, our Q1 patient care costs included a nearly $2 per treatment benefit from our power purchase agreement, a benefit that we do not expect to persist through the rest of the year.
For the quarter, the net headwind related to COVID was approximately $35 million, consisting primarily of higher PPE costs and the compounding effect of patient mortality associated with COVID, partially offset by the benefit from the sequestration suspension with a number of other items that largely offset each other.
For fiscal year 2021, we now estimate the net negative impact from COVID to be approximately $50 million lower than our guidance last quarter.
This is the result of lower COVID impact in Q1, the recently passed extension of the Medicare sequestration relief through the end of the year and lower other offsets, including T&E in the back half of the year.
At the middle of our guidance range, this would equate to $150 million negative impact from COVID in 2021.
Our DSO increased by approximately seven days in Q1 versus Q4, primarily due to temporary billing holds related to the winter storm and the changes in calcimimetics reimbursement.
In certain circumstances, we hold claims to make sure we have complete and accurate charge information for payments.
This quarter, we had more of these holes and the single largest driver was related to winter storm Uri, which impacted more than 600 of our centers until right in the middle of the quarter.
This has the effect of pushing a significant amount of cash flow from this quarter to the next and caused the corresponding DSO increase in the interim.
While claim holds shift cash flow between quarters, they have no negative impact on what we ultimately expect to collect.
We've already seen a significant increase in cash collections in April and expect a corresponding positive impact on both cash flow and DSOs over the next two quarters.
A couple of final points.
In the first quarter, we repurchased 2.9 million shares of our common stock.
And to date, in April, we repurchased approximately one million additional shares.
Debt expense was $67 million for the quarter.
We expect quarterly debt expenses to increase to approximately $75 million beginning next quarter as a result of the $1 billion of notes issued in late February.
Before we open up the line for Q&A, let me share some reflections.
Over the past year, our teams and our business experienced unusual volatility and challenges due to the pandemic.
We have weathered this very difficult period because of our dedication of our people, our scale, our innovation and our holistic platform and approach to patient care.
As I look forward, our organization is stronger, our relationships with patients have deepened and I have even more resolve that our comprehensive Kidney Care platform is well positioned to deliver a best-in-class value proposition to our patients, physicians in hospitals and payer partners.
Now let's open it up for Q&A.

user
1st quarter 2021 results.
q1 earnings per share $2.09 from continuing operations.
now sees fy 2021 adjusted net income from continuing operations per share $8.20 - $9.00.

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