LivaNova PLC

Q3 2021 Earnings Conference Call


spk_0: the day later and gentlemen and welcome to believe and know that plc third quarter twenty twenty one earnings conference call my name is lydia and on your operator today
spk_1: as a reminder this conference call is being recorded
spk_0: i would now like to introduce your house which state confront mr matthew don't leave the know the senior vice president of corporate development please go ahead sir
spk_2: thirty william and work with your well is go through
spk_3: financial results for the third quarter twenty twenty one joining the i put a trial or gain an advantage or chief executive officer our works were or chief financial officer and windy little or cia director investor relations before we began i would like to remind you that discussions during this call will include for looking statements factors that can cause actual results to differ materially are disgusting the company most recent violence and documents furnished that he actually say including today's press release the as well or alexei would you not undertake the update any forward looking statements also the discussions will include certain non gaap financial measures with respect to our performance including but not limited to sales results which will all be stated on the constant currency basis
spk_2: reconciliation to the most directly comparable gap financial measures can be found that a press release which is available on our website we have also posted a presentation to a website that summarizes the point is that a scar this presentation is complimentary to the other call material and should be used as an enhanced communication tool you can find the presentation aggressively in investor section of our website under news events and presentation
spk_3: and really know that are added gaster down even over that car with that i will now from the garbage again
spk_4: checking that and thank everyone for joining our third quarter twenty twenty one earnings call i'll start up by discussing our third quarter thousand results then wrote review as strategic portfolio initiative after my comments and i could provide you with additional details on our results and increase guys then i'll wrap up with closing comments before moving on to queue and i are encouraged by the third quarter results were excluding heart valves we experience sequential fails growth operating margin expansion and adjusted free cash my generation while navigating a more challenging environment impacted by covert at nineteen related headwinds due to the impact of the pandemic on a prior year results to date commentary been automatically certain comparisons twenty nineteen we believe that the provide helpful context for the undermine trajectory of our business additionally there are comparisons that i reflected on slack twelve of earnings presentation turning to our cool guys drivers epilepsy and i c s epilepsy south and create fifteen percent globally that in the third quarter of twenty twenty with double digit growth across all three regions additionally epilepsy sales for the at were in line with twenty nineteen levels these results reflect improve global market dynamics resulting from increased hospital access and patient willingness to return to clinics lessened the prior year period you had epilepsy sales increased eleven percent this is the third quarter of twenty twenty and were in line with the third quarter twenty nineteen levels total implants grew in the hype single digits rest of the prior year remained below twenty nineteen levels similar to cry for the trains total employment growth was driven by replacements which continue to benefit from a catch up and procedures deferred and twenty twenty additionally while sales were down three percent sequentially primarily due to the delta variants heard we saw an improvement in leading indicator for patient volumes during october our progress in us epilepsy continues to be supported by a go to market initiative which currently encompasses twelve dedicated things these changed now account for approximately nineteen percent of us thousand and implants up from seventeen percent in queue to on the same account basis they continue to deliver sale an implant growth that is trending about the baseline business compared to the third quarters of twenty twenty and twenty nine thing epilepsy felt in europe grew sixteen percent versus prior year led by the uk and italy we take growth of forty seven percent in the rest of world region led by strong recovery and china taiwan and saudi arabia europe and the rest of world and africa get were in line with the third quarter twenty nineteen results we continued to expect global epilepsy sales to grow twenty five to thirty percent for the full year apple cup include sequential growth in new implants in the us at patients and their caregivers return to in person physician visit in addition we anticipate continued i went in replacement implants related to a backlog created in twenty twenty and that has continued into this year i get sales with fifteen million dollars in the corner an increase of twenty three percent from the third quarter of twenty twenty and sequential great the sixteen percent greg was driven by the continued adoption of last back and an increase in proceed to vote against particularly in spirit three distress given that performance in the first nine months of the year we now anticipate atheist to grow over thirty percent in twenty twenty one turning out to dt day south in the third quarter were two million dollars and for the first nine months of twenty twenty one was six million dollars for the forty eight we now it's it's it's like dtt thousand and approximately ten million dollars from a combination of the recover study and replacement imply implants for cms eligible patients while remain encouraged by the progress of patients consenting into the recover study impacts related to the coven delta barrier continued create some delay in implants during the quarter you to the delay it is now more likely that we will exceed two hundred and fifty unipolar patients implanted in early t one of twenty twenty two in addition since we are currently skewing unipolar we anticipate achievement of this mouth time will occur ahead of the bipolar cohort as a reminder we can submit the data from the uniform and bipolar cohorts separately for transition to the postman the to tunnel study or the registry we still anticipate a transition to registry to occur in like twenty twenty two or early twenty twenty three and heart failure the at them have reckon it'll trial continues to advance after reaching a key milestone a three hundred patients enrolled in april once the patient the product and nine months and four hundred tyson is enrolled independent statisticians who of you the dataset it all five criteria have been met including psyche a trend towards primary endpoint and success in the three functional and points we sit with may submit the functional data to the ft i if we do not made all the criteria independents that officials will take another look at the data after the five hundred ppi citizen role we continue to expect the independent that officials to start analyzing the data in the first half of twenty twenty two moving to our say iraq spray trial has commenced and we're activating all twenty selected sites with several already screening patients will remain on track to imply that those type of this corner and still assumes that mission for ft i approval in mid twenty twenty four for the cardiopulmonary business cells one hundred and twenty three million dollars in the corner and increase of fifteen percent versus the third quarter of twenty twenty after tonight about increase in the high teens globally with growth growth across all three regions driven by improvement in cardiac surgery volumes heart lung machine sales increase over twenty five percent with growth across all three regions with particular strength in the us additionally cardiopulmonary sales for the quarter were two percent about twenty nineteen levels lastly hot nelson's divest vested on june one of the year and heartfelt sale for the third quarter of twenty twenty were twenty one million dollars and with that a third avenue alex thank you damien during my portion of the call i'll share a brief recap of our third quarter results and provide an update to our twenty twenty one guidance sales in the quarter were two hundred and thirty three million dollars an increase of fifteen percent versus the third quarter of twenty twenty excluding heart melts
spk_3: sales increased by five percent in comparison to twenty nineteen
spk_4: cardiovascular sales were one hundred and thirty nine million dollars an increase of fifteen percent compared to the third quarter of twenty twenty and nine percent compared to the third quarter of twenty nine king
spk_3: your modulation sales were one hundred and thirteen million dollars an increase of fifteen percent compared to the third quarter twenty twenty and were flat in comparison to the third quarter of twenty nineteen
spk_4: i adjusted gross margin as a percent of net sales in the quarter was seventy one percent up from sixty seven percent in the third quarter of twenty twenty and up from seventy percent in the third quarter of two thousand and nineteen
spk_3: the increase in the margins for both comparative periods where primarily driven by product and geographic mix
spk_4: a job that are the expand in the third quarter with thirty seven million dollars compared to thirty six million dollars in the third quarter of twenty twenty
spk_3: aren't the as a percent of net sales was fourteen point eight percent which was in line with prior year
spk_4: adjusted as she had a expense for the third quarter was ninety three million dollars compared to ninety two million dollars in the third quarter of twenty twenty
spk_5: as dna as a percent of net sales was thirty six point six percent down from thirty eight point two percent in the third quarter twenty twenty
spk_4: adjusted operating income from continuing operations what's forty eight million dollars compared to thirty two million dollars in the third quarter of last year adjusted operating income margin from continuing operations with nineteen percent compared to the thirteen percent in the third quarter of twenty twenty
spk_5: this increase was primarily driven by favorable sales results and gross margin improvements
spk_4: part of the operating
spk_3: income margin improvement was driven by differing certain operating expenses and to the current quarter
spk_5: he adjusted effective tax rate in the quarter with ten point five percent compared to four point five percent in the third quarter of twenty twenty the higher tax rate is primarily attributable to geographic income mix
spk_4: adjusted diluted apia from continuing operations in the quarter with sixty eighth then compared to thirty eight cents in the third quarter twenty twenty following the equity offering adjusted diluted weighted average shares outstanding in the quarter were fifty two point four million
spk_3: our cash balance at the tumblr thirty twenty twenty one was one hundred and eighty two million dollars down seventy one million dollars from cash balance of two hundred and fifty three million dollars a year and twenty twenty let that at quarter and with a hundred and twenty three million dollars versus five hundred and five million dollars a year and twenty twenty
spk_4: the change in our cash balance and that that was impacted by the equity offering where we raise we hundred and twenty three million dollars in net proceeds and the retirement of or hundred and fifty million dollar term loan in addition we executed a one hundred and twenty five million dollar secured revolving credit facility that is available for general corporate purposes and remained on drawn
spk_5: are just a free cash flow for the third quarter twenty twenty one with forty million dollars and was fifty two million for the first nine months of twenty twenty one
spk_4: we invested eighty million
spk_3: and capital spending during the first three quarters of the year which was eleven million dollars lower than the comparative period for twenty twenty now turning to our revise twenty twenty one guidance as damien mention based on our performance during the first three quarters of twenty twenty one were increasing our previously announced for your guidance
spk_5: we are now forecasting twenty twenty one sales growth between eight and eleven percent and between fifteen and eighteen percent when excluding the heart business this is up from our prior guidance of five to ten percent and pet and twelve to seventeen percent respectively
spk_3: our poor your sales growth guidance assumed a two percent tailwind from exchange rates
spk_4: we are projecting adjusted diluted earnings per share from continuing operations in the range of two dollars to two dollars and handsets up from our prior guidance of a dollar seventy five to two oh five we have two largest the diluted weighted average shares outstanding to be fifty four point one million for the fourth quarter of twenty twenty one and fifty one point five million for the full year
spk_3: adjusted free cash flow from operations is now expected to be between fifty five to seventy five million dollars up from our prior guys at fifty to seventy million dollars
spk_4: and with that i'll turn to call back over to damien thanks alex we're building good momentum across a diverse portfolio and taking this into consideration we've increased that gardens ranges while we continue to live with the changing market dynamics resulted from the pandemic we remain focused on delivering improve business performance and delivering on a pipeline commitments on a project hearing additional updates with you at our upcoming invested day on december seven which would be a natural event
spk_0: and with that lydia the type of the month questions thank you damien if you have a question at this time piece by stuff and by one on your telephone keypad it your question has been answered on us to remove yourself from the key piece of stuff on it by came as we enter became an atheist and please limit yourself to one question and one final question and then return to the key if you have any additional for the lap
spk_6: i questions day comes from were quite of people were killed line item please go ahead
spk_7: i good morning game in hand betty in it
spk_6: agassi into the the so much done pack your it's like when we go and look for with neuro mine poorly he continued his another quarter of solid execution is you indicate damien
spk_7: maybe it just you couldn't unpack and a little more oh
spk_6: what if any impact on the momentum been covered have do you think and in the quarter and have the fourth quarter starting out with just hearing so much from so many people
spk_3: it it and just related to the old that
spk_4: i have i know backlog and helped last quarter at and second quarter and i'm guessing this quarter i think he said where are we with that and what you're confident as you as you move ahead nazis in the fourth quarter back into next year on that front comfortable good morning rick thanks for joining us are piano be lucky say a lot to unpack let let's start with you know clearly delta still having an impact particularly the us stranger japan go and pick the us a bit the leading indicators from the us epilepsy business improved significantly in october you know i think for us the important thing is you're right we getting a tailwind from end of service so titled us implants grew at quite single digits and that the strong performance with august and september so it proved through the quarter similar to the last few corners the end of service recovered faster than np eyes and that a lot to do with it differed procedure catch up the end of service grew ah over fifteen percent year on year ah an np eyes grew grew a decline with single digits so was at an end of service that implant business opportunity for us that that really helped out either and and twenty twenty one weeks back and observe to grow over twenty percent and and the npr to go in and me single digits said i'd say in a improve conditions and in the back half of the quarter into october and end of service definitely helped in the us
spk_5: in in in international which i know it's a small little part of the business nevertheless we saw really significant increase in canada china saudi arabia taiwan
spk_8: all really significant growth and we're really pleased about that time one was interesting because there was some recent reimbursement scientists and i felt force investments read through said really plays with how that came executed in the rest of world as well
spk_6: yeah read the match that on that live in the highly were at nine hundred remember last quarter we said we were to thousand and so we we didn't think we ate a little bit into the role in that lot but just given that number and the word i'm not in the capture that in the fourth quarter might capture maybe a hundred or two hundred so did is over all is wanting wanting to as well
spk_7: gotcha a drinker and a second big topic guide and been recovered trial
spk_6: if you're highlight the delayed a you know think about batted generous the of the laying into the first quarter or it you know it seems like a modest polite but can you just a helpless feel confident than that can be worse than that in general and
spk_4: you don't have it and fair i but i don't care i had him mcgreevey in rome and trend i have flown through it in the third quarter do with the when september the weakest are you starting to see that we accelerating pick up and that the paid that gives you confidence that and give this comment that a first corner you know we would be sufficient to get to where you need to be on the uniform that up yet good good set of questions there are so if ever really the last couple of months we just saw the implant right slow down and were largely an impact related to delta patient availability and and this clinical staff shortages at some of that clinical sites
spk_8: look at can sense consent actually sequentially and great nearly twenty five percent quarter on quarter so i actually that that that technical that was with really positive it really was just that the pull through into implants and so that's why that i think of modest delay into in the early you one is
spk_6: enact a eight and that we described and modest delay and doesn't really affect at transitioned registry we sat and weeks to commit to this like twenty twenty two early twenty twenty three depending on see him at his review tommy so that that hasn't changed out with skewing uni poll up so are you know the unipolar
spk_4: one will will come through earlier and bipolar who are sick of patience and deposited to move through the pipeline that that extended a little bit but were really positive about the unit unipolar yet read it if you look at our average human august september october for implants and you extrapolate that through the next three month
spk_9: that play with are still confident the first half of he won twenty seven
spk_5: great that's great at the last else think sneak when my when in life work had a brain quarter obviously
spk_2: and it and maybe just give us a little more color their to what degree has this been covered related patients what percentage common and if i'm doing the quick math right i may not be your guidance while excellent for the for the year
spk_3: imply the fourth quarter slow down
spk_2: why would it slowly that pulled would just give us more perspective thanks so much great to see the corner
spk_4: saturday i'll take care them
spk_7: so for culminated in terms of the or he give alms we estimate it was about forty five percent in the third quarter that is up a little bit of the second quarter probably not a big surprise about what do you think about is when coven in doubt that yet cat gotten worse than the third quarter it author
spk_0: does have a negative impact on the businesses just harder to get into the hospital that's critical or the as business out there are no pluses and minuses to cope with that the percentage was mortified and in a october we actually saw on now that now
spk_10: and get the content that integrates right a key for comp is just more more difficult job and the key three can't because we're ramping up so that that's really the the implied growth rate changed but nothing about from that sequential improvement in in not revenue great thanks again
spk_3: thanks it
spk_4: thank you the next question of the day comes from might maps and ultimatum mike your line is a pen
spk_3: yeah more he thinks are taken my question on
spk_5: i guess ah off guard with br a cardio pulmonary business you know it's pretty strong growth their understand how they had a fairly the complex or maybe couldn't comment their the heart lung machine buccaneers were socket growth and then
spk_4: we're just can you give an update on that the timing of the the new heart lung machine but that's the look can stored what you said before
spk_10: i might get such as alex so the the cardiopulmonary business is really just a function of a recovery from from yale sort of the doldrums of of coded last year
spk_11: yeah we sought strong execution and good performance by our sales teams both on their consumables front as well as hm
spk_10: so we feel pretty good about the quarter it was it was good good strong performance but again i think we were benefiting from the him so far last year and in terms of the the hm role that we're still anticipating you know in the in the second half of next year that start the rollout of the at new a kill him fit first in europe then in there in the us okay got it
spk_3: and then
spk_10: i guess a lot going on the a the what a trial
spk_12: so i'm he maybe to talk a little bit about the it by that trial he hand and expected are coming again the terms of enrollment
spk_0: the mission the at the eight
spk_13: share my gets mad so what we're targeting up to one hundred fifty patients sooner one randomization six month fall of up if we assume about eighteen months to enroll that that we get to our twenty twenty four fps
spk_8: online okay got it thing
spk_10: thanks mike thank you the next question stay comes from adam major of piper sandler
spk_7: i didn't realize is a pen
spk_5: you guys can grab sanccob and next quarter year and thanks for taking the questions
spk_14: to for me i guess the first one it's just down the construction
spk_5: of the u p s guidance and have given the performance in the strength that we psyche three it looks like it's and doing the math right your your your psu mean a little bit of a step down and it just a dps in queue for even with the race guy and so why is that that conservatism or are there any one timers to love call out and cute three and then you know second lead to maybe help us think through our backs band heading into next year you're obviously wiping away our heartfelt related expenses but then in baskin a key growth drivers like neural by a cs and yeah it'll trial so maybe just scam you know touch on out and and had one
spk_15: follow up thanks
spk_5: i add a metallic's so we're still looking at the doubt the marion it kind of continues to impact hospitals and patients willingness to undergo a non acute procedures where we're also
spk_15: or salesforce is indicating staffing shortages at the at the hospital level so and i think we're we're being cautious in that regard
spk_5: in are so are what we're also seeing some were also being cautious in terms of our supply chain risk especially in kind of are larger taken items for each alarm so that's that's kind of the the headline on on revenues and and so from across perspective i would say break costs are going up i think you're hearing that from most of our peers
spk_16: and then in terms of that facing of our expenses as we thought
spk_10: some of the challenges in the quarter round revenue trans
spk_7: yeah we we'd kind of deferred some of the expenses and que three into the current quarter see was here that kind of a little bit of a bounce back and queue for around attacks
spk_2: it's still feeling pretty good about our a pr guy in our ability to achieve our target year
spk_16: okay that that's really helpful color cruciate that alex and then i guess just the one other one for me you know you you touched on i think the investor day in a prepared remarks with hoping just to get ah
spk_17: a sneak peek there for for early december and in terms of what to expect will we get additional twenty two pm l guide and will we get an update the l r p is it primarily focused on increase visibility and on pipeline and pipeline initiative and commercialization plants just you know what should we be looking
spk_0: for a year and a couple weeks thanks so much
spk_18: gerrard and it's matt that we're going to walk through the all the major businesses and the at the eyes the only it's efforts ashes were going to give a long range plan we're not going to focus and i'm twenty two were going to save that for february of this will be pretty comprehensive and build off the educational seriously we've learned over the
spk_15: past twelve months sounds great net the can forget thanks
spk_3: to that a thanks
spk_16: and next question fake from and nepa china jeffrey and ne your line it open you may proceed to kill question
spk_3: ah thank you and good morning everyone hope everyone in well congratulations on on on a shrunk print here a couple on on be an ass and then i have one on depression on the bns i'd certainly year to date
spk_19: shrunk traction he spoke a bit about the backlog sort of contributing here i'm wondering if you can give is just not been on the noble and plans specifically how those are trended in three q and perhaps how their trending versus twenty nine pm levels were tempting to do some math here but we're still getting
spk_3: the you know a look that it's still down relative to the twenty nine pm level so just wondering how the noble placements and dns are trending and then ah the follow up on depression
spk_2: sure sure at a map so on and i every down and that made single digits versus the third quarter twenty twenty
spk_4: and it declined to clench really
spk_5: versus twenty nine keep your dad still trending below it's damn and the twenty five to thirty percent range and again similar what you're hearing from a lot of neuroma companies you know it's still not back to normal from let you alex to find a non acute procedures settle no surprise the replacements are getting getting more to can't
spk_18: in then the nobel
spk_15: but overall a lot of this is still related to the hospital
spk_4: and the patient reluctance to have yet to come in for a procedure today so that we that we said we expect the np i do salary the fourth quarter the pipeline that's good so far and certainly twenty twenty two but yeah that is the one area that is still not that twenty nine pm could fall there just on comprehensive epilepsy centers know just in that context how that fee fees are performing are you saying at at those locations just you know better traction and pulling back talk backlog fruit as well as as de novo placements and then real quickly just on on depression here on the push out to one que love of twenty two or anything in the way up
spk_2: drop out that has led to some of that pushed out
spk_20: and is that a meeting again patient drop out and so that causing a delay thanks again
spk_0: yeah just on on the bit with go to market said at the see c group is still a lung outperforming the baseline
spk_21: freaky twenty one vs three que nineteen and style her in i have been and twenty twenty to thirty percent in that group vs sort of flat better twenty nine in the ice and so i think the game is this group is that continuing to shut attraction in that in that market segment on
spk_22: and i think that is is a good sign for continuing to focus on those that twelve points and when looking to expand that in not and twenty twenty two guest guest on t v day at ever get consent were out sequentially yeah it by by nearly twenty five percent it it just you know having net that pull through into the implant ah cycle that is it taking some time and again i think a large be related to in a patient willingness becoming the clinics ah and and the staff shortages at some of that clinical sites
spk_4: at there some level of drop out of that it it you look at their public cms agreement know that is that for the population of in our understanding so far as that not been something to watch out well thanks again
spk_16: and that question comes from michael pilot of bad michael your line is open
spk_23: he good morning
spk_16: handful for me here
spk_22: bipolar arm would yeah hazard a comment on when he expected return to the milestone and that arm it sounds like clearly later than one que twenty two but i did not hear an updated target now i'm sorry if i missed it
spk_23: not now i don't know whether i said that it is somewhat somewhere in the first half and as we as we hit it as we hit the unipolar you know a lot of attention and will kick of into the bipolar group as a said that the sicker and hadith it to move through and just login with is dealt a variant surge
spk_24: it it just really young chinese summon the trajectory that and at the subway map when much more focused on on pulling through the unipolar given that that that a large a patient ball at like sixty five percent of that the dtt patients say getting that one into the registry cycle is is that priority
spk_25: and tying together the flight delay here on unipolar and bipolar implants but the maintenance of the the foot the registry target late next year early twenty three is that
spk_22: the fair to say that embedded in your
spk_16: flip the registries registry target of late next year early twenty three had a rangers
spk_26: timeline considered for in tv achieving then you know these these important to fifty one fifty miles down i just you know the question is you have pushed the in rome and timing but you have maintained the you know important for the registry timing and i just put a army albums better understand you know how that
spk_16: how does to update for together
spk_23: yeah the ago we only made out a little cushion and there's probably the short answer
spk_26: yeah
spk_5: okay
spk_4: ah i'm i have for us ah i don't think this has been discussed on the scholar i'm certainly not this call but or or the last one the you know m c a t seems to be you know on the shelf here and yeah that was
spk_27: initially thought to be a nice
spk_28: a catalyst for reimbursement for this program to the extent of successful clinically so you know at understanding that there's still the kind of day ahead of us and i don't want to get to foreign frank you know what would you be willing to share few a higher level comments on what the i envision the path the reimbursement for
spk_0: you'd be innocent heart failure given the and phd program seems to be deferred if not
spk_10: dead yeah and look at it closely disappointing that that that whole program disappeared or appears to be disappearing i candidly we we never had that fact that into our model when we started the whole program the at at mc came along after we committed to the program so we we continue
spk_29: to believe that they'll be a pathway and days starting with the max and in building building gotta in a big part of our study was to make sure we were going to generate in a important daughter in in the month we're not only the functional milestones federal it also the primary and points
spk_10: a big part of the program was all five breaking it up and having this embedded study and so that we could have this conversation with the max in in pieces and so it it it is that a headwind but as a said we had never factor that into our initial model thank you so much
spk_4: she had my our next question comes from scott part of and that caught your line is a pen
spk_15: type got your my not now i am
spk_5: typos use cargo some yeah hi guys are things like mccutcheon i'm he has the first crush simply deluxe am i wonder if you run the kind the gives them
spk_4: some view on the eve it's margin just the margin this year for for lead in either i think if i'm right you gods imply some and fourteen percent margin so i wonder if he could confirm that plays an and link to that
spk_10: although he we've had a bit of me lower operating costs is cool to make sure to your whole night he into into this know that of reversion into the full can you give us a flight or actually now that the heart valves is other the business how operating costs are likely to trend next year i'll a money to be up stable or below the issues okay level the some sense that would be helpful am i can question please pay out will go ahead elektra know combat with a follow up thank you
spk_4: sure say he arrived the margin were were forecasting in at fourteen fifteen percent or that is sad that that's our goal in terms of in terms of our margin this quarter obviously someone inflated yeah we talk about differing some of the expenses into the current quarter we saw some sales softness earlier in the quarter right in and so we pulled back on some investments as you know we we typically started than us ahead of twenty twenty two in the second half of
spk_3: of of the of this year so yeah we we we'd look at some discretionary expenses and and decided to the fire them into her to for
spk_4: in intensive and guidance and meet local did that in february but we will gives a long range view at the invented the day in a few weeks time
spk_30: okay well concise and and by the second person displayed on i'm i'm doing a mess
spk_4: an unforgiving the disclose room new patient
spk_10: it's scandal around five percent i'm on implying that and new question as is really the best moving to conquer to the longer term growth of new mods and i wonder if you could then give some sense of where we all that mattered vs twenty nine and are we still down on twenty nine two new patients if you could just call spoiler oh give some some sense they'll be helpful
spk_4: yes oh wait we're we are still than vs twenty nine same on i think this is where matt was trying to indicate that that that been the the lag and in terms of that the shift as then the market started acting up at improving so sequentially would say an improvement with predicting and a sequential improvement in queue for vector that that's the one
spk_31: that were my nightly focused on and that the teams are heavily focused on and be ice because you're right the long long term view the the business is is related to that that that of those dra patience and and deny that in it round because depending on how you cut the model is to the
spk_4: eight hundred thousand and one point two million dra patients are in the us a line you know that we believe that look that long term growth is is important to driving under this is obviously that lakes replacements get given that out you know average age is in that unit late twenties and you know we are implanting patients you three to four times ah in in their life and and so being very focused on n p eyes are being focused on pediatrics is is a key aspect of our lifetime value of a of a patient and we also know that the the significant benefit to the quality of life by impacting and implanting them early to so from a patient point of view we believe it's
spk_32: it's been an excellent to their cognitive development
spk_33: and you know the the hospitalizations and every time you get hospitalized unit it's it's significant number of complications so that that is our primary focus
spk_0: franklin for his last that follow up on are more than for my time in an me if i'm wrong place but it's my understanding that you've you can't the development of your next generation they're more platform
spk_34: i wish some i i think that means and be one i've had a new platform here for about four or five years or so i guess the question is does that matter in terms of weeks i like him the patient additions and perhaps a book what is a plan for me the new platforms for new mode what when the
spk_35: that likely now
spk_36: yeah so much more arrived on that in the and best today in and a few weeks time at it'll be about three years between interactions and not five ah you know our focus is pain in a much more on how to think about our patient connectivity and and the app
spk_37: development
spk_10: don't know or early aspects of what we were looking at with the original bomb iris
spk_2: where we were talking about blue to and significantly wheat we took a step back when we started looking at security and and making sure we had a really stable platform so if you know why we were doing that we shifted their focus more as a set of separate picture that we'll talk more about this in a few weeks but i'm actually in a pleased with what i think we can do here
spk_4: and and how we get engage with patients who clinicians ultimately but that that that to work we're doing and we'll talk about that a few weeks
spk_35: thanks guys
spk_38: just got
spk_35: thank you and our final question taken some matt painter of yeah yeah
spk_2: matt your line is a pen i am i didn't even thinking person i just had here one want them to follow up on hotelier i just wanted to know if you thought you could actually have a pathway to get reimbursement when i guess the shorter term and point in the functional and point nine gave birth to that the to your follow up with you know how failure optimization etc
spk_10: yet to that that mad that the expectation and the already the cpp go for vienna and if you look at a couple other the competitors were out a are getting reimbursed it's just not as easy as open them said
spk_39: yeah
spk_0: can you can you do it with the functional versus the the primary and he answered yes yes yes
spk_4: oprah and in a be kobe has really impact and how coordination
spk_0: we call with

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