Neuropace, Inc.

Q4 2021 Earnings Conference Call


spk_0: good afternoon and welcome to your papers fourth quarter and conference call at the time all better than santa lip and only mode we will be facilitated a question and answer session to with the end of race car as a reminder that causes they recorded for replay purposes oh now like the time the call over to map back though from the gilmartin group for a few introductory comment
spk_1: thank you operator good afternoon and thank you for participating in today's call join me from europe hates or my fav it's ceo and rebecca coon cfl are there today neuropace released an inch results for the fourth quarter and four year ended december thirty first twenty twenty one a copy of the press releases available on the company's website before it began i like to remind you that management will make statements during this call and include for looking statements within the meeting a federal securities laws which are made percent safe harbor provisions of the private securities litigation reform act of night any five any statements made during this call that relates expectations are predictions of future events results are performance or for are looking statements all for the can savings including those around her pieces clinical trials and as relating to are operating trends and future financial performance ft a approvals the impact of called nothing on our business and prospects for recovery expense management expectations for hiring growth and organization market opportunity revenue guidance commercial expansion product performance and product pipeline develop that are based on based upon our current estimates and is some since he statements involved material risks and uncertainties that cause actual results are events to materially differ from those imply bodies for looking statements correlate you should not place undue reliance on these statements for more detailed description of the risks and uncertainties associated with our business please refer to the risk factors section of our public filings with the securities and exchange commission or se si including are clear report on for ten que fog with yes you see on november tenth twenty twenty one the any report on for ten k for the year ended december thirty first twenty twenty one to be fine with the as see as well as any reports that the that we may file with the fcc in the future or it's happens call contains time sensitive information which we believe is accurate only as of the live broadcast on march tenth twenty twenty two neuropace disclaims any intention or obligation as set except as required by law to update or revise any financial projections are forward looking statements weather because of new information future events or otherwise and that i'll turn turn the colorado mike thanks matt good afternoon everyone and thank you for joining us for today's call i'll provide opening comments and a business update followed by rebecca who will provide additional detail regarding her quarterly results and twenty twenty two guidance before opening the call the qnx moving to our quarterly revenue results consistent with our pre announcement on january eleven total revenue for the fourth quarter of twenty twenty one was eleven million dollars initial imply revenue in the fourth quarter of twenty twenty one was a point five million dollars representing nine percent growth over the third quarter of twenty twenty one and ten percent growth or the fourth quarter of twenty twenty for the four year twenty twenty one we generated revenue of forty five point two million dollars representing growth of ten percent compared to four year twenty twenty despite the continued covered nineteen impact we navigated quite well through the pandemic and twenty twenty one and i'm proud to report that initial system implants represented seventy five percent of our revenue it's on a twenty one and grew by twenty percent over twenty twenty before providing a business update i want to speak to trends we experienced in the fourth quarter of twenty twenty one that extended into the first quarter a twenty twenty two while pleased with our initial and plant growth and the fourth quarter is important to point out that we did see business and back due to the delta variants at the beginning of the quarter and on the crime variant cases started to impact our business and late summer as we entered the first quarter at twenty twenty two headwinds associated with the surgeon omer cranberry a cases were severe in january cause things causing revenue to sequentially declined from december the decrease in january procedure volumes was driven by temporary limits on elective procedures staffing shortages and patient coded infections as a result january was one of our most coven impacted months of the pandemic however the operating environment has improved and the month of february we saw a marked improvement pop of january levels with improving trends continuing into march throughout the pandemic we have seen the volume of patients going through the epilepsy monitoring units or am use reduced compared to prevent an iq levels as a result we believe there is an an increasing backlog of patient happy yeah years as we have discussed previously it takes about six months from initial am you admission to rns system implant we expect that am you volumes will eventually return to pre pandemic levels and grow from there creating significant opportunity for our business the progress we have made and the investments we are making to increase the number of implanting planning centers and to increase utilization positions as well for when you have you volume increase now let me provide you an update on our key initiatives as we look to extend our leadership position and drive long term growth starting with our commercial organization and our focus on increasing awareness and demand generation
spk_2: as we have communicated throughout out the pandemic
spk_1: go get has presented a number of unique challenges which have impacted our patients and our commercial efforts given this reality we believe it is more critical than ever to make investments in the commercial channel we will continue to increase the number of in planning centers and increase the utilization rate of our or enough system within the atlantic centers one area we are increasingly focused on is targeting epilepsy specialists who practice outside of level for centers over the last few years the number of epilepsy specialist has grown significantly and it is our understanding that there are now more apple apologists practicing outside of level for comprehensive up love see centers then within level he sees we plan to educate these epilepsy specialist about the are in a system and to help them collaborate with ccs to have their patients treated with the are in a system through these relationships we can make our and as therapy available to a larger number of patients with ongoing device programming and patient management provided by epilepsy specialists practicing outside level for services in order to do this we are accelerating hiring within our field organization we ended twenty twenty with forty two field representatives and the size of our field organization did not materially change and twenty twenty one given the investments we are making we expect to and twenty twenty two with approximately fifty six field representatives with most of those additions coming in the first half of the year this would get us to the size field organization we initially anticipated having the and twenty twenty three a year earlier it takes time for a new hire to be fully productive and we want to ensure that our team is in place of productive as we anticipate the increase impatient volumes and coming quarters we also driving demand generation by identifying and educating drug resistant epilepsy patients per earlier in their treatment journey as they consider treatments be on medication we intend to expand our multi channel marketing programs including an increase and digital in social advertising regeneration efforts and pasted or a patient ambassador connections as we connect with more are enough candidates earlier in their care journey or patient education team will provide information about neuropace as current system and died appropriate patients through the process moving to research clinical updates and future indication expansion opportunities he has communicated on our last earnings call we receive id approval for that from the up to a for our nautilus pivotal trial to support a pm a supplement to expand our indication to include primary generalized epilepsy we remain on track to enroll our first patient around the middle of twenty twenty two in addition to the large market opportunity for generalized epilepsy there are important differences from our current focal epilepsy patient population that make this an excellent opportunity for our or and us therapy first diagnosis of generalized epilepsy can often be established with an outpatient eg and does not require intracranial monitoring in contrast seizure onset localization for patients with vocal epilepsy requires a one to two week hospital stay in a yam you for not invasive monitoring approximately seventy percent of our patients are admitted for a second one to two weeks day and if you were temporary electrodes implanted in the brain mean to identify the seizure onset location as a consequence on average it takes vocal epilepsy patients approximately six months from the initial e you admission until the implantation of the neuropace rns device for generalized epilepsy we expect the path from diagnosis to are in a streamer to be shorter and simpler another difference with double up see is that there are no surgical alternatives to treat generalized epilepsy since there is no focus the can be respected or a bladed upon have to a approval we expect a relatively fast commercial roll out because we anticipate selling to the same physicians who are already treating focal epilepsy patients using the same neuropace device we are excited to start enrollment in the nautilus study and look forward to an indication expansion into this large an underserved
spk_3: the population
spk_1: what progress on the responsibility for patients aged twelve to seventeen with focal epilepsy has been slower than expected the first patient enrolled in the study was recently implanted with the are a sister we expect to continue to support the response trial and twenty twenty two and look forward to seeing the impact of our current us system on patients going through the study next i would like to provide an update on the estimated battery life of the nerve stimulator we have been selling and two thousand and eighteen i am pleased to announce that we received approval from the f t a to update our labeling to claim an estimated battery life of nearly eleven years under typical use conditions the this represents more than a two year increase from our previously approved labeling we believe that a longer battery life removes and important barrier for initial implanted implant adoption and gives us a distinct competitive advantage over other neuromodulation devices for epilepsy which have much shorter expected battery life given the relatively young age of our patients and a replacement rate of over ninety percent this change bring significant benefit by reducing the number of required replacement procedure however he patients lifetime we believe that providing an estimated service life of nearly eleven years with no recharging burden want to hands the patient experience especially as we continue our pivotal trial to support expanding our indication to adolescent patience while the longer battery life with of his of significant benefit to our patients it will reduce rick placement and play revenue in the coming years has was communicated previously to provide increase transparency as of the end of twenty twenty one there were two hundred and eighty two patients being actively treated with first generation devices we expect approximately two thirds of those devices to reach the end of their battery life and twenty twenty two as i look back on twenty twenty one i can proudly say we have been able to make significant progress on key company milestones on the clinical side we enrolled our first patient and the adolescent study and received breakthrough device designation and id a approval for the primary generalized epilepsy indication study important steps to expand our indication and market opportunity on the commercial side we were able to make significant progress by expanding into one hundred and fifty implanting centers driving increased utilization and expanding the number of physicians prescribing and programming or an assistant lastly we completed a successful i p and april raising that proceeds of one hundred and five point five million dollars and drug capital to facilitate investments to make our in as therapy the future standard of care for athlete epilepsy patients globally without i will turn the call over to rebecca therapist as chief financial officer
spk_4: thanks mike
spk_5: no passage revenue for the fourth quarter twenty twenty live like eleven million dollars compared to ten point eight million dollars for the fourth quarter twenty twenty an increase of to press tab
spk_4: the increase was primarily driven by an increasing unit sales of our i know it's going to comprehend for that bletchley century financial empire procedures in the fourth quarter revenue from initial and class like eight point five million dollars an increase in ten percent over the fourth quarter and twenty twenty
spk_5: fourth quarter twenty twenty one initial and plant revenue like driven primarily by an increasing number of and planting accounts compared to the prior year period
spk_4: as like mentioned previously we ended twenty twenty one wrinkling hundred fifty active and planting accounts up from one hundred thirty two and twenty twenty
spk_5: growth in the quarter with impacted by headwinds on the delta they are yet at the beginning of the quieter and by elmo crime in the back half of december
spk_4: revenue from replacement and price was two point five million dollars a decrease of nineteen percent compared to the fourth quarter twenty twenty
spk_5: we continue to expect replacement implant revenue generally to decrease for the next several years due to the transition to the current model of i device which has a longer lasting battery gross margin for the fourth quarter twenty twenty one was seventy three percent compared to seventy six percent in the fourth quarter at twenty twenty
spk_4: declining i live in relative to the prior year period was primarily due to an increase in certain cause as our manufacturing operation is return to normal levels following covered night team related disruption and twenty twenty
spk_5: total operating expenses in the fourth quarter as twenty twenty one was seventeen point one million dollars compared with eleven point two million dollars and the same period of the prior year i the expanse in the fourth quarter of twenty twenty one was five point three million dollars compared with three point nine million dollars in the same period and twenty twenty
spk_4: the increase for ninety expense was primarily driven by an increase in product development and clinical study expensive
spk_5: es una expanse in the fourth quarter twenty twenty one was eleven point seven million dollars compared with seven point three million dollars in the prior year period the increase in es una was primarily driven by increase costs associated with operating as a public company and increase sales and marketing expenses last from operations with nine million dollars in the fourth quarter twenty twenty by can catch his three million dollars in the prior year period we recorded one point nine million dollars and interest expense in the fourth quarter which was flat compared to the prior year period that was to was ten point seven million dollars for the fourth quarter twenty twenty one compared with four point six million dollars in the fourth quarter of twenty twenty our cash in short term investments balance as the december thirty one twenty twenty one was one hundred fifteen point six million dollars while i long term borrowings totaled forty nine point eight million dollars now turning to our outlook for twenty twenty two given the impact on the cranberry had had on procedure volumes in january we remain cautious given near term uncertainty surrounding the severity and duration of covered nike and the potential impact on hospital position and patient behavior
spk_4: our twenty twenty two outlook is highly sensitive to assumptions around said a global recovery which anticipated cave scheduling and elective procedure levels normalizing throughout the year
spk_5: for twenty twenty two we expect annual revenue range between forty five million to forty eight million dollars this guidance assumes initial and plant revenue to be in the range of thirty nine million to forty two million dollars consistent with the last several quarters and given uncertainty around clinical trial revenue our initial and plant guidance assumes enamel revenue from clinical trials and twenty twenty chill
spk_4: lastly given the replace that revenue dynamics like mentioned previously we anticipate replace that revenue to be approximately six million dollars
spk_5: following one of the lowest initial implant revenue months and the pandemic in january february bounce back strong as of today much booking trends suggest this the quench initial implant revenue increased compared to february given this positive momentum we expect first quarter twenty twenty two total revenue to be in the range of ten million she'll levin million dollars which includes and initial implant remedy range of eight million to eight point five million dollars and him replacement implant read the range of two million to two point five million dollars
spk_6: moving down the income statement
spk_5: we expect gross margin to be in the mid seventies percent and operating expenses should be in the range of seventy four million to seventy six million dollars
spk_4: of with approximately eight million to nine million dollars is non cash stock based compensation expand
spk_5: this concludes are prepared remarks i would like to turn the call back over to the operator who will open the call for question
spk_7: thank you
spk_0: as a reminder to ask a question you need to press star one on your telephone to withdraw your question please press the pound key please them by while we compiled acuity a roster i coworkers question comes from the line of robbie marcus prospects jp morgan please go ahead
spk_8: ah great they heard take the questions and maybe to start it it's great to hear that you know trends are proving throughout first quarter on you know the maybe just the start their do you think the streets in a good place where we sit now i'd first quarter and he noted guidance assume that puppy trends materially improve from here it does it assume they they very modestly a better
spk_1: thanks for the question robbie so for a q one we provided guide and so revenue in the range of ten to eleven million dollars which is really based on what we've seen in the quarter so far and where that's where we see trans going and the quarter to be able to close out your the last few weeks of the quarter of i i think what we pray by did and guidance is or but usually or best our best thoughts about where things stand overall for que one as we think about the rest of the year the guidance for the rest of the year we continue to believe that the additional imply a revenue portion of our business is a growth in their low to mid twenties percent on over year over year growing up drawing at that pace and and normalized coburn environment i'm primarily that's true than my assumptions about the number of patients coming through the if you are being similarly similarly impacted to the way that they were in twenty twenty one of our guide him specifically the lower end of the guy to train to that we provided for twenty twenty two revenue incorporates the slow starts to the year with all micron having a higher to
spk_2: of disruption early on the quarter and we saw another recent wait recent waves of kobe intel taking that into account and and being thoughtful about the the guidance we incorporated that into the first i'm into the lower end of the guy been trained to them are providing for initial empire ravenel a replacement revenue really being driven by the number of those
spk_1: devices of the old generation their remaining and provided numbers for were that and for specifically where that's coming from a were encouraged by the progress that we the continuing to make and que one of this year we finished to for as you know i'm better than better than where we thought that we would one we're in november so we're very pleased with how we were able to finish the year on things have been can senior into training a positive direction after that if the significant impact january i mean really incorporating that as we go forward i'm just as a reminder we did increase our business and twenty twenty one by about twenty percent year over year for the initial employer revenue portion of our business that was really driven by the combination of new centers additional centers prescribing the device as well as mark utilization and each other's centers of we expect to be able to continue to do that in the foundation that we built a for the business and twenty twenty one is that as a strong one that will be able to build author and over the longer run when we do anticipate that number of the and you visit going back up to pre pandemic mob bulls and growing from their puts us in a strong position to be able to grow from nappa really anticipating that that will be a longer enter a longer term impact on a not so much of an impact and twenty twenty two they're really and back beyond twenties right
spk_8: i apologize semi i made for not here in the first quarter guidance and maybe i just is that a quick follow up here at it out it sound like you're you're filled out the salesforce faster than expected feels like awareness is still a major limiting factor here
spk_1: you know how do you think that the increase been on the street can help gross sales and and where they really going to be spending their time is it driving interest within existing accounts or try to bring on new accounts thanks thanks robbie so they focus of the field organization primarily is on driving increase utilization are pushing increased utilization with that the epilepsy centers and bringing on do centers that we grew our business last year from a combination of those two we expect to continue to do that of has we have communicated previously with more implanting centers there's more feet on the street to be able to support those as well as to bring on more sensors beyond that the one additional reason that we're accelerating the timing of hiring in the field organization is to allow our team to call on epilepsy specialist apple apologists that are practicing outside of level or centers and establishing relationships for those patients being managed by these epilepsy specialists to be i'm implanted with the neuropace device at a level four center and they go back to the to the community settings with these epilepsy special as for ongoing care so we we want to be able to have that combination of bringing on new and planning centers increasing utilization but also recognizing that a large portion of my eighty percent of patients with drug resistant epilepsy are not currently being seen any a level force our and they recent friends were there's more and more epilepsy specialist not my general neurologists but up what's the specialists that are the salish in practice outside of those centers with businesses practices that are focused on treating patients with epilepsy really creating a great opportunity for us to be able to identify those patients additional patient opportunity pie those and with a level four son there's for implantation on to be able to it to overtime accelerate the growth of the business
spk_9: great thanks a lot
spk_0: thank you i try next question comes from the line of larry bagels and from wells fargo pick ahead
spk_10: k good afternoon that is big and palermo think the much for taking the question maybe a couple from us you mention the fact that patient volumes and not yet back to pre cold levels you know help us understand when you expect that he a new patient volumes to return to twenty nineteen level i'm that's my question and then the second question i had was perhaps on your margin guidance help us understand how we should think about the the cadence for twenty twenty two thanks so much
spk_1: thanks so specifically on assumptions built into our forecast for e m you volumes and maybe just her as a reminder for everybody to start off their patients that are candidates are become candidates for the nervous system go through a diagnostic process and and dissenters through and up what's the monitoring units stay they or and seventy percent of cases to stays in the up you monitoring yet those number of patients that the number of patients coming through those epilepsy monitoring units for the last couple of years has been decreed has been reduced relative to pre pandemic levels because of a variety of a we have reasons hospital limitation staffing challenges in our guy and and then the other comment on a can top of that is from the time occasion comes into the epilepsy monitoring unit it takes about six months for that patients you ultimately get a neuropace device implanted we and our guidance for twenty twenty two are assuming that the impact of increasing e m uses it doesn't have a significant impact on our revenue oh and twenty twenty two so in other words were assuming that those gm you volumes come back to pre pandemic levels later in the year this year i'm not not in a time where that six month delta between when they initially get implant get admitted to the m you and when they get implanted with the neuropace to buy his would have a significant impact on our business and twenty twenty two
spk_5: and then rebecca do you want to talk about the margin share absolutely on our guidance is that our growth my son will be in and mid seventies rounds
spk_11: we doubt anticipates as significant differences throughout the year of quite the grace like and will fluctuate with volume
spk_5: it's on
spk_0: in general throughout the year we expect that it will stay within a fairly narrow range within that general guidance as are dead set against and every time we expect and it will improve that throughout the year i generally within that range of insanity
spk_12: they get ikea i show on next question comes from the line of danielle and kathy some as the the lyric please go ahead
spk_1: hi guys his prey on for and now on our choir thought acquired by oliver the cover challenges and first time for me here and a pretty that you guys that fact an increased and number of implanting center is that only look at you live nation for center what are some of the barriers to adoption aside from tell them that easy as the corners and now that you've got advantage sell for salesforce has a team anticipating the combat these barriers and electric bass lake thanks they the growth that we see within the businesses as you mentioned as a combination of additional am planning centers and utilization with and planning set with and implanting centers they the work that were doing and the barriers the rover coming within the comprehensive up loves the centers that if started using to grow utilization is a combination of more of the doctors within those sensors prescribing the neuropace device for their patience the centers are larger institutions typically multiple apple autologous epilepsy specialist practicing and we're moving from one or two of loves his specialists which is usually where we start with option with an a center to a larger number of those epilepsy specialists prescribing the neuropace device for their patience and so for that there are the i'm a corp rating i guess identification of patience and then incorporating the neuromodulation specifically neuropace neuromodulation into the practice of those additional those additional physicians the things that were doing they're providing education to those positions about the clinical benefit the outstanding clinical results of our product the ease of use improvements that we've been able to make to the able to make is this really easy to be able to fit into practice and the com overall benefit that it can provide for the practice in terms of treatment options for these faces that otherwise don't have good options the grow time the field team adjusted to specify we have not yet increase the size of the field team so there's gonna be expansion largely of the first half of this year but what we expect the that larger field organization to support for us over time he has one getting into more centers to those people on the new at the new representatives will be able to support
spk_12: getting into more centers and all the also be able to call and more of those positions within the center's to be able to increase that that number of prescribing physician and then the important other aspect it's really a new area for as has to call on how pull ups his specialist for that are outside of the level for sensors that
spk_1: it can refer their patients into a level poor center for implantation and then have those patients come back to the epilepsy specialist outside of the love of course and her for ongoing management and care we haven't done much about as an organization up to this point that the trends in the industry the medical industry are such that there's no more and more epilepsy specialist that are coming into practice and and many of them are going into practice outside of the level for centers and so we want to have a team that can call on those epilepsy specialist to be able to help patients they're managing have that access to the neuropace device on and and on and then provide the ongoing care give are helpful thanks and i could squeeze one more and i was wondering if he could be for some in the early feedback to receive on the remote capabilities of the are necessary especially in operating environment where staffing shortages have played a large while and how do you think of could benefit york a couple hunter thanks and question that though one of the need the interesting and i think really unique aspects of the neuropace devices the we do have a system that records information that happening inside of the patient's brain records information including the electrical signals that are associated with abnormal had i have normal of and that are device to tax we also provide trending information about how often those events are being detected when they're being detected and all that information is uploaded into a database the can be viewed by the physician anywhere without the with or without the patient present that's been really helpful through the pandemic as there's been fewer pay asian ten percent visit so it enables physicians to get information objective information about what's happening with their shit without requiring the patience of physically come into the hospital to be able to you to be able to get that information the diagnostic hum review of those he cogs are intracranial eg signals
spk_12: as also reimbursed and so it's a mechanism in a remote setting for the epilepsy specialist to get reimbursed for that work that they're doing reviewing the diagnostic information stored by the device
spk_0: as we go forward and were doing more focus on patience to be implanted and level for centers were potentially managed by epilepsy specialists outside of those little for centers we also expect that that you get data contaminated visibility of the diagnostic information becomes even more important as multiple physician some within law
spk_13: for centers and and someone the community will all be able to access that has that data for those patients to be able to really optimized the treatment for the patience of a again with reimbursement establish for those positions when they do that diagnostic review keep are helpful thanks them thank you i sat next question comes from the line of to ranieri from morgan stanley please gap
spk_1: i lecture to concussions odd just under a close asian offer up the privatization question for a moment i understand that you're trying to add more centers get more prescribers but can you may be talk about underlying trends that you're seeing eye and business ah to help us get a better sense that ah i'm like how many and planters are actually prescribing are it out that the point maybe compared to twenty nineteen levels just so we can get a get a better censor ice we know how the centers but just kind of what it what what's the title connections that are using are perfectly are it as at this point and maybe what do you expect for that to look like for twenty twenty two
spk_13: we haven't provided specific numbers at this point of prescribing physician so that their level of detail we provided it has you know is that they account level or what i can tell you is that the growth they we're seeing and utilization so that number of patients being treated percent or per year is driven calm and significant part by more physicians within those sensors prescribing for their patience and so we are seeing trend similar to what we're seeing for more centers and plan thing for more physicians prescribing i'm within those sensors and and then overtime also you push
spk_14: going to have more utilization purposes so without getting into specific numbers dance answer your question drew on the utilization increases the are seeing i'm in large part of being driven by more positions within those sensors prescribing for their patients
spk_1: aka up like you are and with the clinical trial revenue i heard the word met him off on the can you just have of think her that it it only takes a few ah few implants really to drive a percentage point of growth for the business but should we be thinking ten twenty implies as have what you're thinking and terms of clinical trial day some plants for the year so that the couple of things that i want to just to add to clarify around clinical studies and then and get into the specific answers to answer your question so we have the to clinical studies that were pursuing and twenty twenty two on continuing to pursue and twenty twenty two their primary focus for our organization is on the nautilus study for expansion into generalized epilepsy and we have a has significant opportunity there in they're prepared remarks i made a number of comments about why we think of an opportunity is especially as thing for our business and what that means for us over time and so were were very much focused in particular on execution of that study he timing wise were expecting to start rolling in that trial around the middle of this year on there there's a there is a pay delay the required because a baseline information collection between where patients old and when a patient planted so there's an element of this which is based on timing of when the when the bulk of the patience for these studies are gonna
spk_13: be implanted on the other comment that i would that i'll make is that while we are seeking reimbursement for the patient in the nautilus study a weed out know on how effective we will be had getting insurance companies to reimburse for the patience and natural health and so we've taken a much more conservative view around the car ability to get reimbursed for the patients and the trial of it as a result of the combination of the timing of when the study is going to be starting and i'm questions around or more conservative assumption of the well around the reimbursement on that result then the comments of pub guiding to minimal revenue for twenty one need to and and really incorporating i within the guidance for a national enquirer new overall
spk_1: got it and last for me like he dimensions you're building up a salesforce going to fifty six from ah from forty to i and twenty twenty one but you haven't a sound like you haven't made any salesforce higher ads yet for the year it looks like there's kind of a fight for talent across my taxi several companies appointed the us increased that our our labor challenges for forgetting your talent but how dependent is or twenty twenty two revenue to adding these are adding these potential sales people for the earth thank you thanks to the to clarify we if we have just started that process and so it's night the results of of that are still largely ahead of us but we've been at work were in the process of doing doing the hiring an expansion of the field organization they hiring coming in the largely in the first half of the year i'm following that there's a period of time before and new representative really becomes productive in the field it takes about three months on average for and for a new representative to be qualified to the treating or to be in the hospital
spk_15: by themselves to be able to manage the come implantation procedures or to to really support the clinicians and i would say really ten or twelve eighteen months to be fully productive in so given the assumptions that we talked about for most of these fires happening in the first half of the year and time to be productive there's really not
spk_0: significant impact that we're building into our guidance for twenty twenty two for that expansion the expansion any investments were making and twenty twenty two are really to put us at a position to benefit from an increased number of patients coming through epilepsy monitoring units as those come back and to be able to support the growth of the business over a longer life so not
spk_1: not significantly built into our numbers for twenty twenty two but important investments for us to act to be able to support the growth of we expect a kilometer
spk_0: thank you

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