Accuray Incorporated

Good day, and welcome to the Accuray second quarter fiscal 2023 financial results. All participants will be in listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star, then one on a touch-tone phone. To withdraw your question, please press star, then two. Please note this event is being recorded. I would now like to turn the conference over to Jesse Chiu, Senior Vice President, General Counsel, and Corporate Secretary. Please go ahead.

Thank you, Operator, and good afternoon, everyone. Welcome to ACRID's conference call to review financial results for the second quarter During our call this afternoon, National will review recent corporate developments. Joining us on today's call are Suzanne Winter, Accra's President and Chief Executive Officer, and Ali Kervais, Accra's Chief Financial Officer. Before we begin, I would like to remind you that our call today includes four looking statements. Actual results may differ materially from those contemplated or implied by these four looking statements. Factors that can cause these results to differ materially are set forth in the press release we issued just after the market closed this afternoon. as well as in our filings of the Securities and Negotiations Commission. The forward-looking statements on this call are based on information available to us at the state's date, and we assume no obligation to update any forward-looking statements as a result of new information or future events, except to the extent required by applicable securities laws. Accordingly, you should not put undue reliance on any forward-looking statements. A few housekeeping items for today's call. First, during the Q&A session, we request that participants limit themselves to questions and then re-queue with any follow-ups. Second, all references we made to a specific quarter in the paragraph marks are to our fiscal year quarters. For example, statements regarding our second quarter refer to our fiscal second quarter ended December 31st, 2022. Additionally, there will be a supplemental slide deck to accompany this call, which can be accessed by going directly to Accurate's investor page at investors.accurate.com. With that, let me turn the call over to Accurate's Chief Executive Officer, Suzanne Wood. Suzanne?

Thank you, Jesse. Good afternoon, and thank you for joining the call. I am very pleased with our excellent performance in the second quarter and our position going into the second half of the fiscal year. During the quarter, we delivered strong revenue and evened out performance, delivered a robust book of orders across all regions, and made significant progress on our FY23 strategic agenda of driving above-market revenue, margin expansion and profitability initiatives, and the formation of strategic partnerships that can create value for all stakeholders. We are doing this while navigating persistent macroeconomic and foreign exchange headwinds, which Ali will elaborate on later in the call. I'd like to start by expressing my thanks to the Accurate team that continues to deliver new levels of performance. While we have seen some improvements in the supply chain environment over the course of the past year, our teams continue to battle and rise to the challenge every day driven by accountability to Accura's higher purpose of ensuring that our customers have access to the highest precision radiotherapy tools available so they can provide advanced cancer care to improve lives. Over this past year, we have taken actions to improve the flexibility of our supply chain and customer-facing teams so that we will fulfill new demand as well as maintain smooth operations and satisfaction in our installed base of customers. These initiatives have put Accurate in a better position to manage the ongoing headwinds with teams performing at the highest levels. This is why I'm especially proud of a couple of key accomplishments within the quarter. The first, we delivered a record system shipments in the second quarter with 29 new systems delivered, which represents a historical milestone for the company. Second, we are proud to be recognized by the 2022 IMV Service Track Report for achieving best in service in radiation oncology based on IMV's annual survey of U.S. radiation oncology professionals. These are shining examples of the talent, agility, and dedication of our global Accurate team. We continue to make significant progress in advancing our innovation-driven growth strategy. Our product pipeline is the strongest in the company's history, and we continue to focus on solving clinical challenges and enhancing the value of our portfolio. I am very pleased with the Q2 orders performance, which included 34 new systems and represents 13% sequential orders dollar growth. These results reflect both growing customer demand for Accurate Solutions and the positive impact from our commercial initiatives. We believe these factors will continue to grow Accuray's revenue faster than our addressable market for FY23 and beyond. Sharing key highlights from the region, the Americas region delivered another quarter of outstanding order performance with 92% year-over-year growth driven by the adoption of our latest innovations. ClearRT, the industry's only helical CT imaging technology, and Synchrony, Accuray's real-time adaptive radiotherapy delivery are capabilities that are differentiated and driving win rates. In the U.S. in Q2, we saw that 100% of RAD Exec orders included the options for ClearRT and Synchrony, up from 80% in Q1. In Japan, Accurate has gained the number two market share position, and in Q2, we continued our strong competitive win rates. Nearly 50% of Q2 orders in Japan were replacements of the competitor's aged installed base. Additionally, the Japan team won a seven RADxAC system public tender in a highly competitive battle against the number one market share leader. Our Japan team continues to drive share gain in this largely replacement market. We also had strategic wins in the EIMEA region. with a competitive replacement rad exec win in Belgium at Charles Roy University Hospital. Additionally, we celebrated a second CyberKnife system win and strategic endorsement at the prestigious Euro Radio Surgery Center in Munich. Dr. Alexander Młaczewicz, director of the facility, is quoted saying he believes that CyberKnife is the number one technology for delivering radio surgery and purchased the additional CyberKnife so they could accommodate the growing patient demand for ultra-precise radiosurgical care. Turning to China, our joint venture continues to be a long-term value driver for Accurate, and we continue to dominate market share in the premier Type A radiotherapy market segment with greater than 75% market share. In Type B, we advanced our progress, completing our NMPA regulatory submission of TOMO-C. Tomo C will be our domestic, China-made JV product that will compete in the Type B segment, which is the largest segment of the China market with an estimated annual market potential of $600 million. We expect Accurate's premier brand reputation and awareness in the Type A segment will also help drive success and share gain of Tomo C in the Type B value segment upon introduction. Further, we believe our success as a total C product in China will have translation potential globally as we enter new geographies with a value segment product, allowing Accurate to compete in the large $1.3 billion annual global value market segment. Additionally, in November, the Ministry of Health central bidding process for Type A licenses resumed after a delay due to COVID lockdown. Eighteen Accurate systems were awarded to customers during the central bidding process and are expected to convert to revenue over the next few quarters. Despite the impact of challenges of the COVID lockdown in China, demand for radiotherapy system installation and training remains very high. We saw this firsthand at Accurate's 10th annual CyberKnife users meeting in November, where training participation rates were tremendous. with over 100 participants attending in person and 850 participants joining the training online. As we continue to accelerate our top line through growth initiatives, we are equally laser-focused on profitability. We made solid progress on our margin and profitability expansion plans and saw early indicators of a positive impact to our service margins in Q2, an area where we think we have tremendous opportunity. As we have mentioned on recent calls, the leadership team and I are focused on three main pillars, pricing discipline in our commercial efforts, including new value-added service offerings, reducing product and service costs through efficiencies, and optimizing operating expenses, which will have a meaningful impact in the midterms. Finally, establishing strategic partnerships are central to our growth agenda, allowing us to provide best-in-class solutions and expand the scope of our commercial access. In Q2, we advanced key strategic partnerships, most recently with C-RAD, introducing the Vital Fold Breast Package that will allow Accurate to offer the most comprehensive breast package in the marketplace. RaySearch also continues to be a very strong partner for us in treatment planning solutions, oncology information systems, and with the development of Artemis Adaptive Radiotherapy that combines ClearRT imaging and RaySearch's industry-leading digital technology and auto-contouring algorithms. This solution will further differentiate Accurate as the only company that offers a comprehensive adaptive radiotherapy solution that can correct for patient changes both during treatment with Synchrony and between treatments with Artemis, both with precision, speed, and patient experience. Finally, we're very excited to have announced a commercial partnership with GE Healthcare. This partnership pairs two industry technology leaders together with the aligned goal of providing personalized, ultra-precision solutions throughout the care continuum, from diagnosis to treatment to survivorship. Our commercial teams are engaged, leveraging our respective strengths, and developing customer pipelines. We believe the GE partnership will be a powerful value driver for patients, providers, and shareholders. I will now turn it over to Ali, who will speak more about our financial performance.

Thank you, Suzanne, and good afternoon, everyone. I'd like to begin by thanking our global cross-functional team who executed with intensity to deliver a strong second quarter of fiscal 2023, despite ongoing macroeconomic challenges, including supply chain shortages, global inflationary pressure, and FX headwinds in our non-U.S. markets. Net revenue for the second quarter was $114.8 million, which was down 1% compared to the prior fiscal year, primarily due to supply chain constraints and $6.1 million of foreign exchange headwinds. Net revenue on a constant currency basis was $120.9 million, which represents a 4% increase versus the same period in the prior fiscal year. Product revenue for the second quarter was $63.3 million, which was up 4% from the prior year and up 8% after adjusting for the impact of defects. As Suzanne mentioned, this product revenue represented 29 systems and upgrades, which is a record number of system shipments in the company's history. It's important to note that this was achieved while continuing to navigate unprecedented supply chain issues, which really speaks to the hard work of our cross-functional teams. Service revenue for the quarter was $51.5 million, which was down 7% from prior year, but flat once adjusted for the negative impact of FX, which was $4.1 million. Growth orders for the second quarter were $79 million, which is an increase of 13% sequentially and a decrease of 7% from the same period in the prior fiscal year and represented a healthy book-to-bill ratio of over 1.2. As mentioned in prior calls, we believe the book-to-bill ratio is the right metric to monitor to ensure a healthy growth for our backlog and to focus our teams to book orders that will convert to revenue within 30 months. Growth orders in the constant currency basis were $82.6 million. Moving to backlog, we ended the second quarter with a backlog of approximately $550 million, which is 11.4% lower than prior year due to $41.4 million of orders that aged beyond 30 months within the quarter, mainly driven by customer installation timelines. We had no order cancellations within the quarter. As discussed in prior quarters, our global commercial teams continue to be focused on converting all orders regardless of age to revenue. In Q2, this resulted in $6.5 million of orders converting to revenue within the quarter that had previously aged out. Our overall gross margins for the quarter was 37.4% compared to 36.7% in the prior year, which is an increase of 70 basis points despite CFX headwinds. This showcases our focus on margin expansion through pricing and cost discipline is starting to take shape. Operating expenses in the second quarter were $40.3 million, which included non-recurring charges of $1.9 million for restructuring charges and $0.5 million of ERP and ERP-related expenditures, compared to $38.6 million in the second quarter of prior fiscal year. Excluding non-recurring charges, total operating expenses were down 2% compared to the same period in the prior year, illustrating good cost control as we continue to push our teams to focus on return on investment. Operating income for the quarter was $2.7 million compared to $4.0 million from the prior year. Adjusted EBITDA for the quarter was $8.5 million compared to $6.8 million in the prior year, which represents a 24% growth year-over-year despite the FX headwinds, which impacted our top line by $6.1 million. The reconciliation between GAAP net income and adjusted EBITDA is described in our earnings release issued today. Starting this balance sheet, total cash, cash equivalent, and short-term restricted cash amounted to $68 million compared to $81 million at the end of last quarter. Net accounts receivable were $89 million, up $12 million from last quarter, as we had quite a few shipments in the last month of the quarter. Our net inventory balance was $156 million, up $3 million from prior quarter, primarily due to three units of finished goods, which we expect to ship out to customer sites in early Q3. Although we continue to battle supply chain constraints, we are taking firm actions to bring our inventory back to healthier levels in the coming quarters to optimize our cash and working capital. While we deliver strong results in Q2 and continue to navigate through supply chain constraints, the headwinds associated with foreign exchange have had a $12 million impact on our top line in the first half of fiscal 2023. Currently, we are reiterating our full-year guidance with revenue in the range of $447 to $455 million and keep it at the target range of $26 to $30 million. We will continue to closely monitor the impact of FX in supply chain as we enter the second half of our fiscal year. Those are our key financial highlights. And with that, I'd like to hand the call back to Suzanne.

Thank you, Ali. In summary, I'd like to again thank our teams for their unwavering support of our customers so they can provide the highest level of care to patients. While we expect to continue to navigate the uncertainty of the macroeconomic conditions we've seen over the last year, we remain encouraged by continued customer demand for Accurate Technologies and our robust product pipeline, as well as market trends that favor Accurate Technology and where we are positioned to win and take share. As an organization, we are strengthening our fundamentals, advancing multiple growth catalysts, and creating new strategic partnerships. I will now turn it back over to the operator for Q&A.

We will now begin the question and answer session. To ask a question, you may press star, then one on your touchtone phone. If you are using a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star, then two. At this time, we will pause momentarily to assemble our roster. Our first question comes from Marie Thibault with BTIG. Please go ahead with your question.

Hi. Good evening, Suzanne and Ali. Congrats on a very nice quarter. I wanted to start here and try to understand a little bit more about what drove that record product revenue, the record shipments that you mentioned in the quarter. Was this a bit of a backlog that had been building up in some geographies? What really drove the strength in that metric this quarter?

Hi, Marie. Thank you for the question. I would say our revenue was really driven by two regions, the EIMEA region as well as the Japan region. We did start to see some recovery in China as well, and so again, really working through our supply chain to be able to manufacture as much product as possible and be able to fulfill that demand. Our customer demand continues to be very, very strong, and again, working through our supply chain to make sure that we can fulfill demand is at the top of our priority list.

Okay, that's great. And while we're talking about supply chain challenges, I know you're navigating quite well right now, but what are the specific components or issues you're dealing with there? And I guess as a partial follow-up on China, are you expecting any impact in the fiscal third quarter from sort of the reopening, the Lunar New Year, any of the COVID dynamics around that quarter? And thanks for taking the questions.

Thanks, Marie. Yeah, in general, just from a supply chain standpoint, I would think that we are seeing, you know, over the course of this past year, some easing of supply chain. And certainly from our standpoint, you know, instead of dealing with, you know, two dozen supply chain vendor issues, I think we've narrowed it down to, you know, less than a half a dozen. Now, those half a dozen are, you know, those challenges are still real. We're working very closely with those suppliers. We are micromanaging those operations. We're helping to source materials. We're building in the flexibility, I think, overall in our supply chain. We're redesigning where we need to. At the same time, it continues to be a headwind, and we battle it every single day. I would say that we are seeing some recovery with opening up since the COVID lockdown. Our orders have been very strong in the first half, so that is a good indication, I think, of things starting to turn in China. And so we are expecting that the second half of the year we're going to see some recovery.

Wonderful. Thanks so much.

Our next question comes from Josh Jennings with Cohen. Please go ahead with your question.

Hi, good afternoon. Thanks for taking my questions. I wanted to just start off and ask about the America's order growth, the big performance for that region. And I wanted to just get a reminder, better understand the strategic initiatives that are in place to kind of drive growth of orders in the America's region. I know you have the the technology portfolio that's in play, but any other strategic initiatives that were successful and that could continue through the remainder of fiscal 23 and beyond?

Yeah, Josh, thanks for the question. The Americas region is obviously the largest healthcare market globally. We have doubled down in terms of our investment in commercial organization and initiatives. One of the big growth catalysts is the very large replacement market. This is largely a replacement market in the US. It's a mature market. We have an older, aged installed base. I would say our sales teams are firmly focused on ensuring customer satisfaction within that installed base, but also encouraging upgrading those systems through trade-in, trade-up to our latest performance capabilities you know, so that they can start to provide advanced care like ultrahypofractionation and in Sarbanife, you know, radiosurgical capabilities. So we do, you know, we do expect to continue to see the return on those investments and that focus.

Thanks for that. And I wanted to ask about the type A wins in China and the revenue conversion cycle here. Seems like that's a great revenue opportunity in the back half and in the early fiscal 24. But one, just any more details you can share just on that, the November bidding process and just within the type A award channel, just what should we expect next? Are there more rounds to go and is there more opportunity for Accuray?

Yeah, again, thanks for that question. Yeah, no, the type A, we were very encouraged to see the bidding, the central bidding process resume, you know, after a period of time during COVID where, you know, it was delayed. And so this is very encouraging, and I think it's a good sign of recovery in China. The bidding process is the next step to achieving the funding for the systems and beginning of the installation. For us, it's very strategic. It is the opportunity to place 18 more systems into the China market, which again, just is that critical mass of premier systems at premier institutions within the market. that we think will drive the branding for Accuray within that sub-region. Now, we do expect there'll be additional bidding, central bidding processes that will happen throughout the year. We don't have any visibility at this time into timing, and certainly there's a new five-year plan that will be announced that will get a better indication, I think, of Type A and Type B market sizes.

If I could just sneak one more in just while we're on China and just seems like everything you downloaded today on the progress with the regulatory submission and some of the completion of production and testing at the manufacturing facility, things are on track. But should we still be thinking about a fiscal 24 kind of approval and launch? Maybe just to refresh any timelines you'd have us thinking about for the Tomosi through the JV in China. Thanks.

Yeah, I think no additional information from what we've discussed in the past. You know, a typical regulatory cycle, you know, is about, you know, 12 months. And again, we can never predict, you know, the regulatory cycle. But if we assume that it will be typical, yes, we have, we're still holding to potential impact in the back half of FY24 from an approval for the Tomo C product.

Great. Thanks again. Our next question comes from Neil Chatterjee with B. Riley. Please go ahead.

Hi, thanks for taking the questions and congrats on a strong quarter. Amy, just first off, you talked about the Munich Center adding the second CyberKnife. Just curious if you could just remind us how often you see that dynamic of centers adding multiple library systems.

Yeah, that's a great question. I think we're seeing it more and more. We're also seeing centers that are starting to get the combination of a CyberKnife and a RADxACT, and I think that that is a commercial strategy that our teams are showing how our sites can really build up their patient referrals, how they can build their business by having this combination of a radiosurgery system and the CyberKnife, but also a workhorse system like the RADxACT. I think we're going to continue to see it more and more, but we're absolutely thrilled with the center in Munich, primarily because they're very well known for radiosurgery. The first system was really bought for intracranial type of applications, and he is buying the second system now for more extracranial, more full-body, FBRT type of applications. Again, we think it's a strong endorsement and a site that we can use for strategic reference.

Great, great. Maybe just one follow-up here. Regarding kind of the customer installation delays or the age-outs, just curious if there's any updated insight on the construction environment, whether that's related to any worker shortages or supply issues, just any update there. Sure.

Yeah, no, I think that's a great question. You know, I would say the age out is really, you know, driven largely by systems that we had in the backlog that are in Russia that have, you know, aged out, you know, still orders that, you know, we hope will go to installation. But, you know, because of the timing and what's going on there, it have aged out. Also, I think that in general, you know, COVID had a impact on the length of time for some of our backlog. We are firmly focused on our new orders, trying to put it through the lens of orders that we believe will go to installation within 30 months so that we don't have this sort of dynamic. But I would say in general, we're not seeing increased length of time for installations. And I think it's very region dependent. But there's some good research that is out there on the capital equipment spend, and I think that there's a couple of key catalysts. One, radiation oncology is a revenue generator for the hospital, so it's well positioned for priority and capital equipment spend. It's also a strategic service line. Oncology is a key care area. And then the third is there is a large replacement market opportunity, and in that research that was done, you know, how old the equipment seemed to be a key – one of the key points of prioritization of capital equipment funds. So, you know, again, we think that that will drive priority amongst the installation dollars that are needed.

Great. Thanks, Beth.

I'll jump back in to you. Our next question comes from Brooks O'Neill with Lake Street Capital Markets. Please go ahead.

Thank you and congratulations on what I think is a terrific quarter under the circumstances. I am pleased to hear you talk about competitive wins, Suzanne, and I wonder if you could just amplify a little bit on sort of what you think the dynamics are that are leading to competitive wins I'm not necessarily expecting you to call out the victims, but if you could just highlight what you think is leading to your wins versus established competitors, that'd be great.

Thank you for the question, Brooks. Yeah, no, we're excited, I think, about our competitive wins. You know, I think obviously a lot of it is driven by our new product innovations. You know, we talked a little bit, you know, in the this part of the call on how many systems are ordering ClearRT, for example, and Synchrony, and Volo Ultra as well. That is driving a lot of the differentiation of our products compared to competition. I think that that's gaining traction. We're seeing the increase in growing demand for our products. Same thing in for the CyberKnife. It continues to be a very unique product that, just based on the technology, is able to do things that other platforms are not able to do. That being said, I think there's disruption in the competitive landscape that is allowing us to get the second look that maybe we wouldn't have gotten five years ago. We are in a very strong position. You know, I think that with the growing use of SBRT and ultrahypofractionation, the need for precision has never been more important. And, you know, we bring unique product innovation to the table that others cannot. So all of those things, I think, are just helping us, along with commercial focus, you know, and a little bit more of a commercial swagger, I think, in knowing that we can win against previous market leaders.

Yeah, that's fantastic. So my second question, I know you talked a little bit about it in the prepared remarks, but increasing your service revenue and driving margin improvement are key strategic objectives. Can you just give us any additional color on where you feel you are, how fast we might be able to see progress, Yeah, absolutely. Some of the key priorities.

Yeah, it's absolutely a key priority. We also think we have tremendous opportunity in the service business as well as margin expansion. I'll let Ali talk a little bit more about what we're doing in those areas.

Yeah, absolutely. Hey, Brooks. On the service side, we think there's a massive opportunity to continue to increase the top line on that annuity business. You know, it's through enhanced offerings that could be around training that are more tailored to our customers' needs. And we think the bigger opportunity in service beyond just the top line growth is around margin expansion. And, you know, really it's focused on just really optimizing that business and making sure that we focus on two of the big cost drivers over there, which is really around parts consumption. Take a look at our parts consumption, understand that a little bit better, and really focus on parts that we're utilizing quite a bit and actually try and optimize those. And then when it comes to FE utilization, really drive that down.

Fantastic. That's great. Thanks for taking my questions.

Our next question comes from Jason Witts with Loop Capital. Please go ahead.

Hi, thank you for taking the questions. First off, two things in terms of what's driving this quarter and looks like should drive through the rest of the year. One, I think you guys have mentioned replacement cycle or replacements at least. I mean, where are we in terms of replacement cycle? And I don't know if you can even give us any kind of color in terms of how many of the systems sold regionally were replacements. And then secondly, you do have quite a bit of new innovations you're offering at this point, can you give us any kind of indication in terms of what the take rate is for those and what that might be doing to ASPs?

Yeah, and I'll start and then I'll hand over the ASP question to Ali. But, yeah, I'd say in our mature markets, in our developed markets like the U.S., like Western Europe, like Japan, you know, it is largely a replacement market. And so, you know, the goal really, you know, for our teams is, you know, heavily on bringing our aged IB up to the latest performance. You know, I would say through COVID, you know, the average use of systems have gone from 10 year life to 12 to 12 and a half year life. And so there is, this is a growing demand, a growing growth catalyst for us to be able to bring those customers to the latest revision. And certainly our NPIs are supporting that as well as the clinical trends. you know, with that, you know, it drives higher value and higher pricing. And, you know, I'll let Ali speak a little bit more to that.

Yeah, you know, so just to reiterate Suzanne's point, the majority of the trade-in, trade-up and activity is really happening within our mature markets. But, you know, going to your pricing question, that's part of our margin expansion initiative, right? Pricing is the cornerstone of our margin expansion initiative. And, You know, we've actually done quite a bit over there in terms of changing things around commercially. Number one, we've actually aligned our commercial teams incentive to ensuring that we can reach the profitability targets for new incoming orders. And we've actually armed them with tools so that, you know, as they are positioning configurations to our customers, we can optimize it so that we meet our customers' needs, but then we're also optimizing our margins. So I think those two things coupled together are really driving a focus, not only on, you know, bringing in orders volume, but bringing in profitable orders volume. And, you know, actually we are starting to see some pretty positive signs of that reflect in our overall ASP quarter over quarter. So that is very encouraging. And so all of that fills our backlog with good, healthy orders. And, you know, those are, and we're just focused on converting those orders into revenue.

Okay. That's helpful. And maybe just a quick follow up. Maybe with the exception of China, I wouldn't say we're in a post-COVID world, but we have been talking to hospitals, and a lot of them are saying, look, we've held back in the last three years, and we're now going back and reinvesting where we have, notably in some capital equipment products. Is that your sense as well in terms of what's going on, especially in the mature markets?

Yeah, I would say it's highly dependent on the institution. I think a big factor is also how old is their equipment, because I do think that that's what's driving certain institutions to be able to upgrade their equipment. But I would say, and again, I go back to the research that was done in this area that really surveyed the sea level in capital equipment. I would say about a third of them have already seen some capital equipment easing, but the rest are feeling like at least by the second half of calendar year 23 and into 24, we should get back to pre-COVID level.

Okay, great. Thanks. I'll jump back in queue.

This concludes our question and answer session. I would like to turn the conference over to Suzanne Winter for any closing remarks.

Thank you very much. And this concludes our earnings call. We are looking forward to speaking with you all again in April for our fiscal year 2023 third quarter earnings release. Thanks for joining us.

The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.