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 the company.
I'm Jim Gustafson, vice president of investor relations.
Each quarter, for the last two years, I hope it's the last time that the pandemic is the start of my discussions with you, yet COVID continues to evolve and have a direct impact on our world, especially on our healthcare system.
Similar to what's been seen in the general population, COVID infections within our patient population spiked significantly in late December through January.
At a peak during the second week of January, the new case count was more than twice as high as a peak from last winter.
Gratefully, the mortality rate to date with the latest surge has been lower than in prior surges.
For the fourth quarter, we estimate that the incremental mortality due to COVID was approximately 1,100, compared to approximately 1,600 during the third quarter.
Despite the challenges associated with COVID, I continue to be in awe at the resilience and dedication of our teammates across the DaVita Village.
From our direct patient caregivers to our corporate teammates, all are unrelenting in their commitment to provide high-quality care, respond to quickly changing environment, and show incredible compassion and support for our patients.
For the balance of my remarks, I will cover five topics: transplant; labor market; our supply chain; Integrated Kidney Care, IKC; and then I will wrap up with our fourth-quarter results and our outlook.
Transplant is a preferred treatment option for most of our patients and during 2021, despite the challenges posed by the COVID pandemic, we celebrated that nearly 8,000 DaVita patients received a transplant, exceeding our pre-pandemic level.
With that said, the transplant process is long and complicated with an average wait time of between four and five years for an organ.
Staying active on the waitlist for such a long time is difficult.
As a result, patients sometimes miss their window or a transplant.
We've been working to address some of these challenges through our industry-leading transplant smart education program and our partnership with The NKF to help more patients find living donors.
In early January, we announced the acquisition of MedSleuth, whose software enables closer partnerships and better coordination between transplant centers, nephrologists, and kidney care providers, with all three working together to support our patient transplant journey.
These efforts can also benefit another meaningful goal of ours, to improve health equity.
Many process and outcome results in transplant are quite inequitable, different by race and ethnicity, economic means, and insurance coverage.
We believe it doesn't have to be this way, removing barriers to access, making process as easy as possible, and providing strong care coordination and support through the transplant journey can all contribute to making transplant not just more available, but also more equitable for our patients.
Now let me shift to an update on the labor markets.
I've been fortunate enough to be part of DaVita Village for over 20 years and in all that time across my many roles, I've never experienced the labor market as challenging as we face today.
To help deal with the challenge, we have provided incremental pay-in benefits to help our frontline caregivers during COVID.
We've also accelerated wage increases with a particular focus on our teammates in the clinic.
As previously communicated, we expect higher-than-usual wage increases in 2022, which will put some additional pressure on our cost structure going forward.
We believe this investment in our people will contribute to our ability to track and retain the talent needed to achieve our long-term objective.
That said, the labor markets remain highly dynamic and will continue to be a swing factor for the year.
Over the years, in particular, during the pandemic and natural disasters, we have navigated many supply chain challenges.
To date, our supply chain has proven very resilient.
Currently, we're working through a supply shortage primarily related to dialysis, which is a fluid solution used in hemodialysis to filter toxins and fluid from the blood.
The shortage has rippled through the entire kidney care community and as a community, we have once again come together in support of our dialysis patients and thus far, have been able to provide uninterrupted life-sustaining care.
We expect that these challenges related to dialysis will remain with us until the second quarter.
We now have confirmation on the markets where we will partner with physicians under the federal government's new five-year CKCC demonstration.
These programs added approximately 12,000 ESKD patients and an additional 12,000 CKD patients across 11 value-based programs in different markets.
We're engaging with our nephrologist partners to develop personalized care plans for each covered patient and identify opportunities to improve clinical outcomes and lower cost for each patient.
Participating in these and other programs will more than double the number of patients we serve in value-based care arrangements.
In light of our upfront cost of these programs and the lag of shared savings payment, as we discussed in November, we continue to expect that our operating loss in 2022 in our U.S. ancillary segment will increase by approximately $50 million, although this could increase or decrease depending on the number of new arrangements we enter into during the year.
We believe that we are well-positioned for the future and in particular, to deliver positive clinical and financial results in our IKC business over the long term.
Now, let me finish with fourth-quarter results and our updated outlook.
Despite the negative impact of the omicron surge, our fourth-quarter results were slightly above the midpoint of our revised guidance.
This resulted in a full-year adjusted operating income increase of approximately 3% over 2020.
Adjusted earnings per share from continuing operations grew by approximately 26% year over year, and we generated more than $1.1 billion of free cash flow, which we largely deployed to return capital to our shareholders.
For 2022, we expect adjusted operating income guidance of $1.525 billion to $1.675 billion.
The midpoint of this guidance range is $35 million below our expectations from Capital Markets Day last November, which is primarily driven by our updated views on COVID and labor costs.
As we said previously, while 2022 will be a transition year due to some near-term investment and challenges that we're facing, we continue to believe that we're well-positioned to perform across the kidney care continuum in the years to come.
We still believe we can deliver the long-term compounded annual growth of adjusted operating income of 3% to 7% that we discussed at Capital Markets Day.
As Javier mentioned, our fourth-quarter results were slightly above the midpoint of our revised guidance.
Q4 results included a net COVID headwind of approximately $80 million, an increase relative to the quarterly impact that we experienced in the first three quarters of the year primarily due to the impact of the incremental mortality from the delta surge in Q3 and some temporary labor cost increases.
For the year, we experienced a net COVID headwind of approximately $200 million.
As Javier said, the incremental mortality due to COVID in the fourth quarter was approximately 1,100, compared to approximately 1,600 in Q3.
While it's too early to accurately forecast incremental mortality in 2022, given the significant uptick in infections in January, we expect COVID-driven mortality in the first quarter to be at or above what we experienced in Q4.
U.S. dialysis treatments per day were down 135 or 0.1% in Q4 compared to Q3.
The primary headwind was the increase in mortality and higher missed treatments as a result of the ongoing COVID pandemic.
U.S. dialysis patient care cost per treatment were up approximately $6 quarter over quarter, primarily due to the increased wage rates and health benefit expenses.
Our Integrated Kidney Care business saw an increase in its operating loss in Q4, which is due primarily to positive prior-period development in our special needs plans recognized in the third quarter and increased costs incurred in Q4, including preparation for new value-based care arrangements effective in 2022.
Our adjusted effective tax rate attributable to DaVita was 16% for the fourth quarter and approximately 22% for the full year.
The adjusted effective tax rate was lower quarter over quarter, primarily due to a favorable resolution of a state tax issue during Q4.
Finally, in 2021, we repurchased 13.9 million shares of our stock, reducing our shares outstanding by 11.5% during the year.
We have repurchased to date an additional 1.4 million shares in 2022.
Now looking ahead to 2022, our adjusted OI guidance is a range of $1.525 billion to $1.675 billion, and our adjusted earnings per share guidance is $7.50 to $8.50 per share.
The midpoint of the OI guidance range is $37 million below the $1.635 billion that we discussed during our recent Capital Markets Day due to offsetting puts and takes.
First, we have a tailwind from both higher final Medicare rate update, as well as a partial extension of Medicare sequestration relief.
However, this is more than offset by headwinds due to the recent COVID surge, as well as incremental wage rate pressure.
At the midpoint of our guidance range, we have incorporated the following assumptions related to COVID: excess patient mortality due to COVID of 6,000.
This, along with our normal growth drivers, would result in a total treatment growth range of approximately 1.5% to 1%.
A year-over-year improvement to COVID-driven costs such as PPE, which will be largely offset by the loss of revenue from Medicare sequestration relief beyond Q2 2022.
As you would expect, the high and low end of our guidance incorporates a range of COVID scenarios for 2022.
There are scenarios could lead us to performance above or below this range.
In addition to COVID, the expected headwinds I talked about on the Q3 earnings call and at our Capital Markets Day remain.
As a reminder, we expect to incur expenses related to the biggest portion of the industry effort to counter the expected ballot initiative in California.
Our guidance assumes an incremental increase of between $100 million and $125 million in labor costs above a typical year's increase, which is $50 million higher than what we communicated at Capital Markets Day.
Third, we anticipate a year-over-year incremental operating loss in the range of $50 million as we continue to invest to grow our IKC business; and fourth, we will also begin to depreciate our new clinical IT platform, which we expect to be approximately $35 million in 2022 and will begin in Q2.
A few additional things to help you with our current thinking about 2022.
We expect to offset a significant amount of these incremental costs with continuing MA penetration growth above historical levels and strong management of nonlabor patient care costs.
We are forecasting our tax rate at 25% to 27% due to nondeductibility of valid expense.
Regarding seasonality, remember that Q1 had seasonally higher payroll taxes and seasonal impact of copayments and deductibles.
The vast majority of our ballot-related expenses will fall in Q3.
We have historically experienced higher G&A in Q4.
Looking past 2022, we continue to expect compounded annual OI growth relative to 2021 of 3% to 7% and compounded annual adjusted earnings per share growth relative to 2021 of 8% to 14%.
Finally, we expect free cash flow of $850 million to $1.1 billion in 2022.
As we communicated at Capital Markets Day, we expect free cash flow to remain above adjusted net income with that difference contracting over time.
Operator, please open the call for Q&A.

user
davita fourth quarter 2021 results.
4th quarter 2021 results.
sees 2022 adjusted diluted net income from continuing operations per share attributable to davita inc. $7.50 to $ 8.50.
sees 2022 free cash flow from continuing operations $850 million to $1,100 million.

assistant