Outset Medical, Inc.

Good day and thank you for standing by. Welcome to the Outset Medical Q3 2025 earnings conference call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask a question, please press star 1-1 on your telephone. You will then hear an automated message, advise your hand is raised. To withdraw your question, please press star 1-1 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today, Jim Mazzola, Head of Investor Relations. Please go ahead, sir.

Good afternoon, everyone, and welcome to our third quarter 2025 earnings call. Here with me today, as always, are Leslie Trigg, Chair and Chief Executive Officer, and Renee Gaeta, Chief Financial Officer. We issued a news release after the close of market today, which can be found on the investor pages of outsetmedical.com. This call is being recorded and will be archived on the investor section of our website. It is our intent that all forward-looking statements made during today's call be protected under the Private Securities Litigation Reform Act of 1995. These statements relate to expectations or predictions of future events, are based on our current estimates and various assumptions, and involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied. Outset assumes no obligation to update these statements. For a list and description of the risks and uncertainties associated with our business, please refer to the risk factors section of Outset's public filings with the Securities and Exchange Commission, including our latest annual and quarterly reports. Leslie?

Thanks for your patience, everybody, and thanks again for joining us. Before I get into the details of the quarter and our revised revenue guidance, I'd like to begin with a few key takeaways. First, while we've made significant progress transforming our sales process and strengthening our team, Our third quarter results show that there's still work ahead. Several large opportunities that remain in the final stages of our sales process were forecasted for the third and fourth quarters, and we now expect them to close over the fourth quarter and into 2026. This is a shift in timing, not in our expectations for closing these significant insourcing opportunities with large nationally recognized health systems. As we shifted towards selling enterprise-wide insourcing, we are managing very large opportunities. that often span dozens of hospitals within a large health system. For example, an opportunity we had forecasted to close in the third quarter required approvals from the executive leadership of more than a dozen different hospitals after approval at the corporate level. We need to and I fully expect we will better anticipate these deal dynamics going forward. We continue to make good progress on this particular opportunity, which we expect to realize via multiple orders spanning the remainder of the fourth quarter and into next year. Second, hospital demand continues to grow as a result of the clinical, operational, and financial benefits that can be achieved by insourcing dialysis with Outset's proven technology, expert know-how, and exceptional service. We continue to see clear evidence that acute customer demand for insourcing with Tableau is growing, and we expect this will support growth for many years to come. Tableau console sales increased 8% in the third quarter, Our pipeline grew meaningfully over last year, and the average size of our sales opportunities increased more than 20%. The markets we serve are large, and we are changing practice within them. Third, our ability to expand gross margin to our next milestone of 50% comes into clear focus with each subsequent quarter of progress. Reaching nearly 40% non-GAAP gross margin in the third quarter and remaining disciplined in expense management provides fuel on our path to profitability. Turning to commercial execution, our third quarter results fell short of our expectations. Last week, I accepted the resignation of our head of sales, who has made the decision to retire. We have a strong sales leadership team in place that will now report to me directly as we conduct a search process which is already underway. This leadership change may result in some internal disruption in the fourth quarter, which is a factor we felt was prudent to take into account as we considered our approach to guidance for the remainder of the year. What I can assure you is that our team has an unwavering commitment to our customers and the patients they serve, and I expect we will demonstrate that commitment as we move through the fourth quarter and into next year. Taking a closer look at the third quarter, revenue was $29.4 million, which represents 3% growth over the third quarter of last year. Treatment utilization was strong, and we remained disciplined in our pricing across consoles and consumables. We believe ASP's strength indicates that customers see Tableau appropriately priced for the value delivered, and consistent utilization reinforces that once a unit is installed, it's used and provides a long tail of recurring revenue. We also were pleased with our progress executing against a clear path to cash flow breakeven and then profitability. This path begins with hotline growth and gross margin expansion. It includes discipline spend management, And it shows up in the both significant reduction in cash use we project for 2025 and in the leverage we see to the bottom line. Additionally, our base of clinical, financial, and operational evidence supporting the advantages of insourcing continues to grow. Last week, there were three new data sets presented at the annual Kidney Week Conference. Among the findings, we presented data from more than one million Tableau treatments across approximately 750 facilities that show the clinical effectiveness of in-source dialysis in achieving rigorous treatment goals, including up to 24-hour treatments that typically involve the most critically ill patients. One of our customers, Advent Health, also presented data from the conversion of their Ocala, Florida site to an in-source dialysis service line with Tableau. Their results over five years showed a 94% reduction in serious cardiac or respiratory events, a sustained reduction in central line bloodstream infections, a very high nurse retention rate with greater than 95% dialysis staff satisfaction, and a strong return on investment in the first two years of operation. These results support the sentiment we hear from many nurse leaders who believe that insourcing with Tableau should be the standard of care at any hospital that provides inpatient dialysis. With that, I'll turn it over to Renee for more detail in the quarter before I provide closing comments.

Thank you, Leslie, and good afternoon, everyone. Revenue for the third quarter of $29.4 million consisted of $20.6 million in product revenue, which was slightly ahead of $20.3 million in the prior year period. Product revenue included console sales of 8.3 million and consumable sales of 12.2 million. Service and other revenue of 8.9 million grew 6% from 8.4 million in the prior year period. Recurring revenue from the sale of Tableau consumables and service was 21.1 million, slightly ahead of the third quarter of 2024. Third quarter recurring revenue was dampened by ordering patterns for treatments across our large volume acute care customers that don't always perfectly mirror underlying utilization. For example, during the quarter, data from connected Tableau consoles showed that several of our large acute care customers performed twice as many treatments as they ordered. Thus far in the fourth quarter, we have seen treatment orders accelerate to better match actual utilization. We expect treatment revenue to normalize next year as we lap the comparison to an unusually strong fourth quarter in 2024, and we see orders from our larger acute care customers catch up with our usage data. We also believe there are steps we can take to help the ordering patterns of our customers more closely align with actual utilization to assist us with better visibility and forecasting. We will be working to make these improvements during 2026. Next, I will walk through our gross margin and operating expenses for the quarter. Please refer to the table in today's earnings release for a reconciliation of GAAP to non-GAAP measures. Non-GAAP gross margin expanded another 350 basis points from last year, reaching 39.9% for the quarter, even with a 138 basis point headwind from the underabsorption of manufacturing overhead. Excluding the manufacturing headwind, we would have seen non-GAAP gross margin above 41% for the first time. Product gross margin increased 250 basis points year over year to 45.7% from 43.2% in the third quarter of 2024. Service and other gross margin was 24.8%, more than doubling from the 12.5% we reported in the third quarter of 2024. This progress keeps us right on our path to the next milestone of 50%. We are making progress against our plan to optimize inventory levels and gradually increase production, which further mitigates the gross margin impact of the manufacturing underabsorption we have discussed all year. For the full year, I continue to expect a headwind of approximately 150 basis points which will have a diminishing effect in 2026. Moving to operating expenses, we continue to see the positive impact of actions taken primarily during the second half of 2024 to remove $80 million of annualized spend. For the quarter, non-GAAP operating expenses declined 17% to $22.1 million compared to $26.5 million in the third quarter of 2024. Non-GAAP operating loss was $10.4 million, over 35% below the operating loss of $16.1 million in the prior year period. Non-GAAP net loss was $12.4 million, was 39% lower than $20.2 million in the third quarter of 2024. These measures reflect the positive results of our drive to profitability. Moving to our balance sheet. We ended the quarter with $182 million in cash, cash equivalents, short-term investments, and restricted cash. We used approximately $6 million in cash during the quarter, driven by expanding gross margin, lower operating expenses, and the optimization of inventory levels. Turning to our guidance for 2025, considering the factors Leslie and I have covered, we revised our 2025 revenue guidance to a range of $115 to $120 million from our prior guidance of $122 to $126 million. We continue to expect gross margin for the full year to be in the high 30% range. With regards to operating expenses, we remain on track in the low $90 million range for 2025. The combination of revenue growth, gross margin expansion, and expense discipline means that we continue to expect to use less than $50 million of cash in 2025. As a reminder, we used more than $100 million in 2024, so we are trending towards more than a 50% reduction in operating cash use. We continue to believe our cash balances are sufficient through cash flow breakeven and beyond. With that, I'll turn the call back over to Leslie for closing comments.

Thanks, Renee. I want to close that we operate in two large end markets where we remain the clear technology leader. We are now approaching 1,000 acute sites using Tableau on a run rate of a million treatments per year. And we expect to close the year having performed more than 3 million cumulative treatments on Tableau systems. We are gaining scale with significant growth runway ahead as our install base matures. With hundreds of customer master sales and service agreements already in place, Our expansion opportunity within our current customer base alone is significant. And on top of that, we continue to convert new customers in this multibillion-dollar acute care market. Gross margin has reached a new high. Our operating expenses have been right-sized, and we are well-capitalized with cash that puts us in a strong position to deliver on our long-term mission. And importantly, our technology, insourcing expertise, and customer experience moat is getting wider and deeper. All of this progress sets a powerful foundation for value creation over the long term. Customer demand for what only Outset can offer continues to grow. Providers, including some of the largest health systems in the country, are realizing the enormous clinical, financial, and operational advantages that insourcing with Tableau can deliver. The market opportunity remains wide open for us as we continue to improve our execution, which I believe will enable us to make significant progress in 2026 and beyond. And with that, I think we are ready for Q&A. Operator, please open the lines, if you will.

Thank you. As a reminder, to ask a question, please press star 11 on your telephone and wait for your name to be announced. To withdraw your question, please press star 11 again. One moment while we compile our Q&A roster. Our first question is going to come from the line of Rick Wise with Stiefel. Your line is open. Please go ahead.

Good afternoon, Leslie. Hi, Renee. A lot of questions. Just maybe, and I think you make a persuasive case for the factors behind the quarter performance and the change in guidance and the positive outlook, but maybe come at this from a couple of directions. The guidance trim, the six or seven million at each end of the range, is that one order, three orders? Is that all reflective of that or is there extra insurance baked in? It must be incredibly frustrating. How conservative are you being about this since you have as you cited that one headquarters approval, and you're just getting the signatures on the other 12 hospitals. Maybe just talk us through all that, if you would, for starters.

Sure, Rick. This is Renee. I'll start sort of on the numbers commentary, and then I'll let Leslie sort of comment on our overall thinking beyond that. But certainly the shortfall, the way we look about it is, first of all, just what happened in the quarter, right? And so if you just look at Q3, A primary driver for the shortfall is a large console opportunity flipping from the third quarter into the fourth. And so then we then took a step back. And of course, when we're trying to think about guidance for the remainder of the year, we're looking at all of those deals that were slated for the back half of the year that didn't close in Q3 and then anticipated to close in Q4. And where are we at with those deals? And I would say there are, again, sort of a couple of these larger enterprise deals where we are trying to change the standard of care and therefore identifying that, just being realistic about where we think that those are at. And I would say factoring in the departure of our head of sales, that this is a disruptive or could be a disruptive situation. And we're just being mindful of that when we forecast the remainder of our guidance for the year.

Gotcha. No, that's clear. I didn't know whether you wanted to say something, Leslie, or shall I go ahead?

Oh, please go ahead, Rick. I thought that was well said by Renee.

Yeah, very clear. And I'm going to ask a couple of questions if I could, but console revenues were better than we were thinking this quarter. Again, I'm not sure how to balance the third quarter performance with the order timing commentary. I mean, that was encouraging, as was the service. Can you talk more about what you're seeing and just help us better understand the individual moving numbers and what we're looking at and how that fits into this larger narrative you're sharing today?

Sure. Yes, we did see an increased growth in council revenue over the third quarter of last year, which felt felt very positive. And at the same time, as you noted, we were very frustrated and not pleased with our own execution in terms of our ability to consistently predict the timing of deal close. We have more work to do there. We can be better and we will be better. I think it is important to recognize as we look forward that, and I noted in the prepared remarks, that the order size, the order sizes of the individual deals in our pipeline, it has grown substantially. The average deal size has grown by about 20%. And that has some implications, but sort of both good and challenging. I think great in the sense that we are seeing demand and very high interest, as we noted, from the largest health systems in the country. And we also have to be ready for the challenges of being able to predictably and consistently call the timing of when those deals are going to close. And so while I think we have made a really meaningful amount of progress, foundational progress on over the last year, implementing a new sales process, new sales tools, hiring to a different sales profile, getting our organization really proficient at selling at the enterprise level, All those changes have taken root, and they really have helped to transform the organization. Our work is not done, and now it's time to refine and continue to improve our ability to control the deal timing and predict time to close. And that's our next step here.

Gotcha. I think it just lasts for me for now. In looking for a new sales leader, Leslie, What kind of individual are you looking for? What kind of experience? What do you need them to bring? And sort of the unfair part of the question is, how quickly do you think you can make this happen? And what are the implications of this sales leader transition for 26? Are we more anxious now? Should we be more anxious about either the outlook for 26 or the magnitude of 26 or the way the 26 year could unfold because of this particular issue? Thanks.

Of course. Sure. I'm happy to address all of that. Maybe I'll take it from the top. In terms of the criteria for our search, and I'll emphasize that the search is already underway, and I'll address your question there in a second, Rick, around timing, but the search is underway. I don't think any of the criteria will surprise you, but I'll take you through it. First and foremost is a background in capital equipment. Number two, a background and strong track record in enterprise sales, total conversion of health systems, total standardization of health systems, the ability to convert many hospitals inside a health system to standardization around one technology and one care delivery model. And someone, I would say, maybe three, who has the capacity to act very strategically, but at the same time is extremely immersed in the details, sort of obsessed with the details and involved with the customer and with our sales team every step of the way. And last, I'll say somebody who is an exceptional coach somebody who's an exceptional leader developer and will ensure that we continue to preserve what's great about Outset and our sales team right now, which is who they are as individuals and in the collective from a culture standpoint. So that's what we're going to have our eye on there, Rick, as we move forward in our search. I will say in terms of impact, let me start by several of our sales VPs We're hired prior to Laura joining. So I think it's important to note that we have really good tenure and, importantly, experience, both in acute and home in these top roles. So I want to emphasize that. At the same time, we have many other very valuable team members who are serving in important roles and making meaningful contributions that remain very committed to outset our mission and the opportunity here. I am very much looking forward to, as I know Renee is as well, is getting even more directly engaged with the team, with the sales team now reporting to me and sales operations reporting to Renee, and getting even deeper engagement with our customers. That said, as Renee noted, whenever you make a change in sales leadership, you do see the potential for some distraction. What does that all mean in a practical level? It can mean fewer selling hours, right, as everybody sort of digests the change, and and gets ready for new leadership. So we did feel it was prudent to account for this in our revised guidance. But I am very confident that hiring a new sales leader will take us to the next level and help us get to the state of predictability and consistency around deal close timing that we're looking for.

Thank you.

Yeah. Thank you. And one moment for our next question. Our next question comes from the line of Shagan Singh with RBC. Your line is open. Please go ahead.

Great. Thank you so much. Leslie, I just wanted to kind of touch on, you know, the visibility and the growth outlook for your business here. You know, in 25, you're delivering about 3% growth off of pretty easy comms last year. You're exiting the year with a 9% year-over-year decline. So, firstly, you know, what does that imply for 26th? I think consensus is at 10.5% year-over-year growth. And then also, how do you think about the long-term growth of this business? Is this mid-single-digit, high-single-digit, low-double-digit growth business? How should we think about it? It's definitely a large market opportunity, but how do you give investors conviction in the execution?

Yeah, sure. Well, I'll start by... by reiterating something that you won't be surprised to hear me say. We haven't obviously provided guidance for any period past 2025, and obviously we look forward to doing that in the future. I'm glad you touched on what hasn't changed, which is demand is growing. Despite the setback this quarter with deal timing, the deals in the pipeline are progressing, and the size of those deals continues to get larger. Our competitive differentiation, our insourcing ecosystem and moat, is getting wider and wider and deeper. And the console utilization remains very high and really consistent, which we've always felt is extremely important because utilization is the most direct reflection of the customer experience. It's something we're really proud of, and it continues to feed that foundation of recurring revenue. Obviously, what we saw this quarter is we still have work to do. on this final piece of the commercial transformation. But we believe that work can be accelerated under new leadership. And so we do remain as optimistic and confident as ever about our future as we look forward. Because what we saw in the quarter, I don't want to trivialize it. We're not happy with it. We're not pleased with the execution. But what we saw in the quarter was a shift in timing. We do know we have more work to do on capital sales execution to better anticipate these deal dynamics with these larger and larger deals. But that said, nothing has changed in our market opportunity or technology or know-how. And the core customer demand from larger and larger health systems really gives us even more confidence in our ability to grow revenue at differentiated rates in the future. But that being said, I'll maybe transition from sort of my color over to Renee for any other comments.

Yeah, sure. I think as you think about You know, just reflecting on the update that we've provided with our 2025 guidance and the trim on that number, it's a good starting point for how we should be thinking about 2026. Of course, highlighting all of the factors that we talked about today. So, you know, change in sales leadership is something that you should probably also factor in in the near term. And I would just sort of reiterate around, you know, we aspire to be a higher growth a company that has a higher growth than 5 or 10%, and we believe that we've got the marketplace to do that. We just need to have some execution here on deal timing. The market has not changed and the product has not changed.

Got it. And just a clarification question, you know, with respect to your comment on You know, there is work remaining to be done. Have the forecasting changes or anything that you're doing in the background, is that completed? Is that behind you? And then you did talk about some ordering patterns and that you would work through that in 2026. So does that mean we should expect 2026 to be a transition year in any way, maybe first half, second half, any color that would be great. Thank you for taking the questions.

Yeah, sure. I think it really sort of depends on which revenue stream you're speaking to. I think on the console side, it's clear that deal close and transition of close to shipment is of most importance. That is something that we need to continue to refine. And I would say it's probably the heaviest lift here in front of us. On the treatment side or the consumables, you know, we get a ton of data from our connected Tableau devices and watch that on a monthly, if not a daily basis at this point and notice that utilization remains strong. And so really it is just a timing issue with regards to the ordering pattern of a few large customers that didn't materialize in Q3. And we have seen that those orders, Q4 orders are beginning to more closely match utilization. So specific to that order or that area where We absolutely do need to do a bit more refinement. We need to get closer to our customers, more visibility. And we believe that we're going to be able to take those steps to help understand their ordering patterns, their supply chain management, et cetera, so that we can fully have better forecasting on the treatment side. But the consoles are being used. They are high utilization. That's remained consistent. And that's what's give us the strength for the opportunity ahead.

I'll just maybe chime in one other thought, Shigan, on the console side, because you had asked about, hey, is there sort of more new, kind of more foundational changes that are needed in this commercial transformation journey? And I would say no. I mean, we have work to do to further cement the impact of all the changes. But look, I mean, a lot of really great foundational work has taken place. place and taken root from sales process to enterprise selling, the sales rep profile, the sales rep structure. I mean, we would not have been able to get this far over the last year without all of it. And now we need to kind of fine tune, focus on predictability and the ability to better forecast the timing of deal close. And there are certainly, suffice it to say, some lessons here from Q3 that we can and will apply to the predictability of deal close going forward. And we are going to get better as a result. But There are no profound or foundational changes incremental to what we've already implemented here over the last year at Chigan, so I just wanted to clarify that as well.

Thank you.

Yeah.

Thank you, and one moment for our next question. Our next question will come from the line that Marie Seibault with BTIG. Your line is open. Please go ahead.

Hi, good evening. Thanks for taking the questions. Just wanted to follow up to understand the consumable sales order timing issue a little bit more closely. Is that just sort of an issue of, you know, the hospitals maybe over-ordered, weren't as good on their own forecasting? I don't recall really hearing of this sort of, you know, difference between the treatment patterns and the order pattern happening in the recent past. So just want to understand that, what's being done to prevent it, And then sort of the timing of that coming back, right? Should we think of Q4 being order and revenue very similar to what we're used to seeing on utilization? Is there some pull forward or making up for some of the missed revenue in Q3? Does that extend into 2026? Just a little more clarity on that.

Sure. I'm really happy to help give some more information and highlights here. I think ultimately, This is a limited group of higher volume customers that we saw for Q3, where we ultimately expected in that third month of the quarter for an additional order to be materialized, and that just didn't happen. Each customer is unique, right? They've got their own supply chain policies and practices and management of their own balance sheets, and so we're going to get closer to that information. We're going to work on that incrementally to providing our customers with all of the information that we have on our side that we're seeing from a forecasting perspective and just having closer collaboration. This is, I would say, a defined set of customers that we need to go after and tackle this work, and we are absolutely committed to doing that for 2026. I think, you know, what we're predicting for the back half of this year within our guidance range is more of a normalized what we saw for Q1 and Q2 of this year. To date for the quarter, we have not seen any significant orders that we were in absence of what happened in Q3. We've seen, again, just very consistent ordering coming through in Q4, matching utilization. Incrementally, too, I think how customers think about their balance sheets and their policies, they're also trying to predict the amount of activities that they're going to have in their hospitals. What does flu season look like? What does, you know, what do they expect just coming through the door? And so we just need to get closer to that information. I think our sales group has done a great start, and we just need to continue to get closer to customers specific to treatment utilization and treatment buying.

Okay. Understood. Thank you for that, Renee. And a follow-up here on the console side and the head of sales resignation, when exactly in the quarter did that happen? And is there a way to sort of size up some of the guidance cut? How much of that is coming from sort of the timing issues around console orders closing versus some uncertainty about Salesforce disruption? Is there a way to kind of parse out what you're assuming in that $6 million guidance cut. And thanks again for taking the questions.

Oh, of course, yeah. Why don't I, I can start by addressing your first question, then, Renee, if you have thoughts on guidance, I'll transition over to you. So, Marita, to answer your question, the change in our sales leader occurred after the close of the quarter recently here, and it was actually last week, so it was very recent. And I think, you know, look, I'm only reflecting back historically as I've seen these sorts of changes and evolutions in the past that there can be some time, you know, in the follow-on quarter where members of the commercial team, you know, naturally need time to kind of digest and absorb. And that can, not always, but can lead to some distraction and less time available for selling forward. And so we were just trying to be cognizant of that and consider it as a potential factor for the remainder of this year. I don't know if you want to pick up on anything further on the guidance.

I would say, Marie, specific to the console activity for third quarter, you might not be surprised in that console activity, because it's a capital sale, is generally in the third month of the quarter where we start to see visibility and what orders are going to be coming in. So late in September was that sort of where that activity fell through. Similarly on the consumables treatment ordering as well, sort of all late in the third month of the quarter. And as we then looked towards what should we update guidance for for the year, what is our full year forecast, we took that into consideration as well as, as I mentioned, our full set of deal review for what was anticipated now for Q4, where are those at, current conversations, getting really close to the sales organization as to the timing of that event, and that plus the resignation of our sales leader, we factored all of those in, and that's how we've come up with the guidance range of 115 to 120.

Thanks so much. Thank you, and one moment for our next question. Our next question comes from the line of Josh Jennings with TD Cowan. Your line is open. Please go ahead.

Good afternoon. Thank you. I was hoping to just follow up on the update on the guidance and just make sure that you're not seeing any orders fall out of the pipeline, not seeing any order cancellation. I believe you may have commented on that, but just to circle back on that if you haven't. And then also just on the... on the sales force, have you seen much transition through the quarter? Is it really just the head of the sales organization that's departed? Is there any other transitions that you guys are considering in the guidance? Sorry, that's two questions in one, but I have one more.

You're efficient, Josh. Thank you. Thanks for asking about the deal flow and sort of the deal progress. Short story long, no. None of the deals that were projected to close in Q3 and in Q4 have dropped out of the pipeline. The deal that we saw, the timing shift around out of Q3 forward specifically remains in the final stages of our sales process. And I think we've given some color to that in the script just to... hopefully provide some context about as we get up into these enterprise-wide deals with a dozen or dozens of hospitals, there are more and more stakeholders and a much greater number of approvals as appropriate. It's a big decision on the part of the health system to down select to one technology and insource. And so we continue to work through all those steps. I think our sales team is taking all the right steps to close them. none of these opportunities have fallen out of the pipeline, which we feel very good about. And then in terms of the change in sales leadership, this is our primary change. As I mentioned, we have several of our sales vice presidents who were hired prior to Laura joining, and so we do have really good tenure experience and commitment at that level. We don't have any other significant changes at this time at the VP level, and we know we have a very, very committed team who believes in the change. This is hard work. We are changing a space that hasn't changed in 40 years, and that's never easy to do. But this is a resilient team, and this is a team who has never been more motivated to kind of make a permanent and profound change in this industry, both acute and home for ultimately the benefit of patients. So we have a team that is ready to execute and ultimately to deliver on our long-term mission and achieve the differentiated growth rates we know are capable in such a large market with a technology leader.

Thanks for that. And just lastly to circle up on Just the home channel and your success there in 3Q and Outlook for 4Q sounds like the turbulence was in the acute channel. You have these MDO contracts in place with the five largest organizations. Any thing of note to provide more detail there and then also in the SNF channel? Thank you.

Yes, sure. Yes, thanks for the question. On the home side, we always start by talking about the retention rate, which is foundational to growth. And we have seen, again, this past quarter, very stable and high retention rates in the home population, even as that home population continues to grow, which is great to see. We have continued to see growth in the home programs of our largest MDO customers, which, again, we see as a direct reflection of their experience and the experience of their patients. We continue to hear from the MDOs that their patients talk about a materially easier training time, materially easier use, day-to-day use, and this feeling better effect, which we don't talk about quarter per quarter on earnings calls, but this feeling better effect has stayed with us, really literally from patient one, talking about feeling physiologically better on Tableau at home and in the acute setting. And so we feel really good actually about the progress across the home and across these MDO customers and into the SNP opportunity, which we continue to look at as a whole future vector of additional growth in the home channel. Thanks for the question. Yeah. Thank you.

Thank you. And one moment for our next question. We have a follow-up question from the line of Shahgan Singh with RBC. Your line is open. Please go ahead.

Great. Thank you so much. Just a quick follow-up on 26. I think you said 2025 is a good proxy for 26 as of now. You know, I just wanted to make sure I heard that correctly. And then also, you know, just anything you can share on Q1, you know, would you expect some of the orders That didn't come in 2025 or Q4 to come in Q1-26, so we should expect a stronger Q1 versus the balance of the year. And then I know that this year in 2025, you started with a pretty broad range of 1% to 10%. Should we expect a wide range in 2026? Just any directional color on guidance philosophy would be helpful. Thank you.

Sure. I think to clarify on my statement specific to 2025 and the good place to start is I specifically said we reduced 2025 guidance by, let's just calculate it, roughly $7 million. And so that's a good place for you to start when you're thinking about 2026 forward. And I would say, you know, at this point, as we updated the orders from Q3 and Q4, have now slipped into Q4 and into 2026. At this point, sort of forecasting forward into Q1 and specifically what our guidance range is going to be at that point. I'm just going to reserve the right to talk about that when we've got a full update on 2026 guidance. Thank you.

Thank you. And I would now like to, oh, hold on a moment. I see another follow-up. Just a moment. And we have a follow up question from the line of Rick wise with Stiefel. Your line is open, please go ahead.

Sorry to put you on the spot, folks. But just listening to Sagan's question, I'm sort of thinking, is it impossible? Is it highly improbable that the 7 million or whatever the number is? Is it impossible that it falls into the fourth quarter? I mean, or does it seem highly likely it won't? I mean, you see where I'm getting at. Sorry to put you on the spot.

Oh, no, that's fine, Rick. As we were thinking about how to guide for the Reindeer of the Year and for 25, our philosophy took into account, again, the fact that we are changing the sales leadership and that some of these deals you know, will close in Q4 and some will close into Q1. And so that new range of 115 to 120 does not assume that all of the deals, again, if you think about a $7 million reduction, it does not assume that all those come into Q4. It's not to say that it's impossible or it could never happen. But again, given all the factors at play here for the remainder of the year, we felt it was, you know, it was prudent to take this approach.

Gotcha. Thank you, Leslie.

Of course.

Thank you, and I am now showing no further questions, and I would like to hand the conference back over to Leslie Trigg for closing remarks.

Okay, thank you, and thank you again for your patience in bearing with our tough technical start there. I do appreciate everybody joining today, and I'd like to close by thanking our customers and our team for the meaningful difference they make every day in the lives of dialysis patients. Thank you all, and have a great evening.

This concludes today's conference call. Thank you for participating and you may now disconnect. Everyone have a great evening.