Globus Medical, Inc. Class A

Good day and thank you for standing by and welcome to the Globus Medical's third quarter 2023 earnings call. At this time, all lines will be on mute and a Q&A session will be held after the prepared remarks. I will now turn the call over to Brian Kearns, Senior Vice President of Business Development and Investor Relations. Mr. Kearns, please go ahead.

Thank you, Li-Huei, and thank you everyone for being with us today. Joining today's call from Globus Medical will be Dan Scavilla, President and CEO, and Keith Feil, Chief Financial Officer. This review is being made available via webcast accessible through investor relations section of the Globus Medical website at www.globusmedical.com. Before we begin, let me remind you that some of the statements made during this review are or may be considered forward-looking statements. Our Form 10-K for the 2022 fiscal year and our subsequent filings with the Securities and Exchange Commission identify certain factors that could cause our actual results to differ materially from those projected in any forward-looking statements made today. Our SEC filings, including the 10-K, are available on our website. We do not undertake to update any forward-looking statements as a result of new information or future events or developments. Our discussion today will also include certain financial measures that are not calculated in accordance with generally accepted accounting principles or GAAP. We believe these non-GAAP financial measures provide additional information pertinent to our business performance. These non-GAAP financial measures should not be considered replacements for and should be read together with the most directly comparable GAAP financial measures. Reconciliations to the most directly comparable GAAP measures are available on the schedules accompanying the press release and on the investor relations section of the Globus Medical website. With that, I'll turn the call over to Dan Scavilla, our president and CEO.

Thanks, Brian, and good afternoon, everyone. This quarter's earnings release will have a different format than our usual approach. On September 1st, after clearing the FTC second request timeframe, we executed the Globus NuVasive merger. With the timing of this event, We have a full third quarter revenue and financials for Globus, combined with the month of September only for Nuvasiv revenue and financials. For this quarter, and possibly the next, we'll share total financial results and comment on standalone Globus and standalone Nuvasiv to show how these businesses are performing. However, as we move into 2024 as one company with one focus, we're not planning on providing standalone company information. For Q3, We delivered record sales of $384 million, a day adjusted growth of 53%, or $130 million versus Q3 2022, reflecting three months of Globus and one month of NuVasive sales. Non-GAAP EPS was $0.57, up 15%, and cash flow remained strong with $29 million, a 38% increase from prior year. Adjusted EBITDA for the quarter was 29%. Globus standalone sales for Q3 were $281 million, increasing $27 million or 12% on a day adjusted growth versus prior year, delivering an adjusted EBITDA of 32%. Sales were driven by the continued above-market growth of 8% in the U.S. versus prior year and increasing momentum internationally of 25% growth, including significant gains in Japan. Enabling technology sales remained strong with 10% growth and over 59,000 procedures performed to date. Trauma achieved its 15th consecutive quarterly record, adding 53% annual growth or 12% sequentially. The foundation remains strong, and I'm proud of the GMED team delivering solid growth and profitability as we enter into our combined future with Nuva. Nuva's standalone sales for the month of September were $102 million, down 2%, primarily driven by one less selling day in the U.S., combined with a one-time 2022 credit not repeated in 2023 for U.S. Spine. Newvasive clinical services and pulse sales were lower versus prior year, partially offset by continued strength in international and newvasive specialty orthopedics, or NSO. Pulse sales have been impacted by customer uncertainty with the merger, while international remains focused on continued market penetration and NSO on market reentry of key technology. I'm seeing the incredible talent we have with our new teammates from Nuvasiv and I'm excited to join forces as we focus on gaining momentum throughout our businesses. In Q3, we launched Hedrone, our anterior 3D printed inner body fusion device, and Stredo, a cerclage wiring system for trauma. Year to date, we've launched nine products and plan to launch several more new products by the end of the year. Our product pipeline is full and further enhanced by what is being developed in San Diego. setting the stage for a record year of product introductions in 2024. Over the next few months, we'll be adding to our best-in-class expandable portfolio, new INR offerings including eHub navigation system to provide seamless navigation when combined with our E3D system, and expansion of the precise trauma nailing system. Moving into integration status and starting with the deal rationale. Both companies recognized that a combination of Globus Innovasiv would create a leading world-class organization. The global scale and expanded customer reach with minimal Salesforce overlap, combined with a comprehensive and innovative portfolio in spine, enabling tech and orthopedics, positions us well for long-term sustained growth. Combining our product development strengths focused on rapid development of innovative solutions to address unmet clinical needs of our surgeons and their patients, while continuing to focus on surgeon education and research, will help us shape solutions through the continuum of care as we bring procedural solutions into the marketplace. Investing in our complementary operational footprint will allow rapid expansion of in-house capabilities to support commercial growth and drive cost savings. Our financial discipline provides the ability to redirect investments into key growth areas while improving combined profitability and cash flow. With the unblinded data available to us after September 1st, we were able to move from integration planning into execution, focused on our combination of sales forces. The actual surge in overlap is better than we projected, both domestically and internationally, falling below the 5% we shared previously, which helps in defining territories and reducing overlap. We're completing and communicating our U.S. commercial structure currently. Newly formed teams are beginning to develop 2024 action plans, cross-training and account building as they complete the busy Q4 season and prepare for launching into the new year. international is also progressing well with regional and market leadership defined we're completing international territories in november with cross training planned in december overall i'm pleased with our work here and look forward to completing this shortly as we get as we set the stage for the new year we're also receiving significant inbound interest from competitive sales professionals who are seeing the opportunity to carry a bag second to none the combined company will be a destination of choice for sales personnel who cherish an incredible product portfolio, financial security, and longevity. To date, we've seen some smaller sales disenergies, but these still fall well within our projected estimates provided in the S4. One of the immediate benefits of the combination is our ability to cross-sell our existing portfolios. We made significant investments in key product sets earlier this year and are poised to begin cross-selling as early as next quarter. expanding it over time as we get more sets completed. Surgeons will soon start gaining access to our broader expandable offerings, 3D printed interbody portfolio, cervical disc, robotic prone lateral system, eGPS e3D, neuromonitoring solutions, improved retractors, MAGIC, and the precise family of limb lengthening trauma products. We also made significant investments in long lead time components and manufacturing resources, to scale up our enabling tech capacity and we're increasing production output now in preparation for increased demand. For implants and instrumentation, we're not rationalizing the product offerings as part of our synergy targets. We believe our surgeons should have their choice of products and will, over time, shape our future portfolio offering. Our financial discipline gives us the ability to continue to keep these products available without negative impacts while continuing to innovate future offerings. In our product development innovation engines, we will carry forward our rich histories of rapid development and launch to remain an industry thought leader, working with our surgeon partners to address unmet clinical needs from pioneering the XLIFT procedure that is now the gold standard of lateral surgery, market-leading expandable cage technology, the best spinal robot, and the most advanced interoperative CT imaging. We are working to create surgical proceduralization of all key spine procedures combining with enabling technology to create the standard of care across all of Spine. Our intellectual property portfolio has been number one in the spinal industry for the last decade, and we are committed to further expanding this lead, especially in the enabling tech arenas, as we continue to be at the forefront of imaging, navigation, and robotics. We remain committed to continuing all in-progress projects on both sides and expect to have a core PD hub on the West Coast. We brought together significant resources to enhance our surgeon engagement program, from adding scientific affairs, increasing research and clinical investments, adding strong talent to our professional affairs team, coordinating education programs, and enhancing our presence in teaching institutions. In addition, we've added innovative marketing communication teams. We're well poised to increase our impact with surgeons and further strengthen how we interact with them in all aspects of our business. The complementary fit of our operations remains a strength of the merger. Our strong financial position will allow us to expand investments in West Carrollton production facility to support our inventory needs. The Memphis Distribution Center is expected to support global distribution for the combined organization. We will continue to invest in high-tech manufacturing equipment for our implants, instrumentation, and enabling tech production capabilities. We're currently working to consolidate volumes and orders with third-party vendors to accelerate delivery times and drive cost savings. Synergy targets have been refined and communicated to functional leads who are planning out actions for the next several years, focused on out-of-pocket spending and prioritizing investments to match our future growth plans. Organizational designs are in progress with planned rollout in the beginning of 2024. As we've said before, this is not a slash-and-burn exercise. The acquisition payback is not driven by deep spending cuts, and we're not racing to impress the market with a quarterly flash. We remain focused on long-term sustained growth and not making cuts that impact our strengths. I want to conclude by sharing a recent event that reminded me of who we are. As part of the integration, we sent a group of former Nuva teammates to visit our enabling tech facility in Methuen. They expressed excitement regarding the number of employees focused on the marketed products, the short-term development launches, and the long-term game changers, along with the building square footage we have invested in. supporting enabling tech. This increased their realization that an ecosystem designed and built from the ground up to seamlessly communicate with each other with options to expand functionality over time is positioned to outperform patchwork to market alternatives. We will continue to accelerate and increase our investment in this space and place these offerings through our expanded commercial team as part of addressing unmet clinical needs and shaping procedural solutions. I believe the potential for Globus has never been greater. It's up to us to harness our resources and shape the future of our market. We have at our fingertips everything we need to realize this. I will now turn the call over to Keith.

Thanks, Dan, and good afternoon, everyone. As Dan alluded to in his earlier comments, our discussion today will have a different feel as compared to our earlier calls. The resulting impact of the September 1st merger completion with Nuvasiv is such that my discussion on our results will seek to identify the underlying legacy Globus medical results, as well as the contributions from the inclusion of Nuvasiv financial information. I ask everyone to remember that our Q3 2023 results include three months of legacy Globus financial information and one month of Nuvasiv, reflective of the September 1st merger closing date. My comments today will seek to provide insights into our quarterly business performance, insights into our capital allocation priorities, early insights into integration and synergy tracking, as well as views on overall guidance for the remainder of the year. As I move through my discussion this afternoon, I will first comment on our as-reported results, providing insights into the legacy Globus business, as well as high-level comments on the contributions from Nuvasiv on an as-reported basis. All information presented is done so based on Globus accounting policies and is consistently applied in the as-reported results for both legacy Globus and legacy Nuvasiv. We are extremely pleased with our third quarter results, both with and without the impact of Newvasive. Our sales results clearly demonstrate that we are still driving market share growth. Third quarter revenue was $383.6 million, growing 51% on an as reported basis and 50.3% on a constant currency basis as compared to the third quarter of 2022. Day adjusted sales growth was 52.9% with one less selling day in Q3 23 versus Q3 22. Net income in the third quarter of 2023 was $997,000, reflective of merger and acquisition related costs due to the September 1st merger completion with NuVasive. Non-GAAP net income was $65.5 million compared to $50.3 million in the prior year quarter, resulting in 57 cents of fully diluted non-GAAP earnings per share. Our fully diluted non-GAAP BPS grew 14.7% versus the prior year quarter, despite our diluted share count growing by 13.7% versus Q2 of 23 to 115.2 million fully diluted shares. Adjusted EBITDA was 29.4% and we generated $29 million of free cash flow during the quarter. Legacy Globus business adjusted EBITDA was 31.6% while Legacy Globus free cash flow was $26 million. Delving into revenue further, our third quarter net sales of $383.6 million reflect Legacy Globus sales totaling $281.2 million, growing 10.7% as reported compared to the prior year. Legacy Globus musculoskeletal revenue was $254.7 million, growing 10.7% as reported. Legacy Globus enabling technologies revenue was $26.5 million, growing 10.2% as reported. NuVasive contributed $102.4 million of revenue during the quarter, inclusive of $92.8 million of musculoskeletal revenue, $8.5 million of neuromonitoring revenue, and $1.1 million of enabling technologies revenue. U.S. revenue during the third quarter of 2023 was $309.3 million, growing 42.5% as reported. Legacy Globus U.S. revenue during the third quarter of 2023 was $234.7 million, growing 8.1% versus the prior year quarter. Our legacy Globus business continues to drive share growth across its U.S. spine and trauma portfolios, while our enabling technologies business is benefiting from the continued uptake of our systems, namely eGPS and e3D. Q3 international revenue was $74.3 million, growing 100.2% as reported and 96% on a constant currency basis. International revenue for the legacy Globus business was $46.6 million, growing 25.5% as reported compared to the prior year quarter. The continued strong growth from our international business was driven by further penetration of our focus countries, including Australia, Italy, Belgium, Poland, Austria, and Ireland. Shifting to Newvasive, standalone September 2023 results total $102.4 million, which was $2.5 million or 2.4% lower as compared to the prior year month. This is driven by one less selling day in the month of September, as well as a $2.7 million non-repeating sales credit in the prior year, which did not repeat in the current year. Gross profit in the third quarter was 64.7% compared to 74.2% in the prior year quarter, and is inclusive of the mixed impacts from Nuvasiv, as well as $19 million of inventory step-up amortization related to the merger. Given the impact of step-up amortization on GAAP results, we are introducing an adjusted gross profit metric to better provide comparability with actual operating results. Adjusted gross profit was 69.7% compared to 74.2% in the prior year quarter. Looking ahead, we expect step-up amortization to impact GAAP gross profit for at least the next four fiscal quarters, thus we plan to report on this metric more during this time. Legacy Globus gap in adjusted gross profit was 73.9%, essentially in line to the 74.2% in the prior year quarter, with the slight decline being driven by primarily higher inventory obsolescence reserves and write-off expenses. NuVasive adjusted gross profit was $59.4 million, or 58% in the quarter. On a pro forma basis, NuVasive gross profit of 58% in September 2023 compares to 62% in the prior year month, reflective primarily of higher depreciation expenses and operational spending. Q3 research and development expenses were $29.3 million, or 7.6% of sales, compared to $18.7 million, or 7.4% of sales, in the prior year quarter. Legacy Globus R&D expenses totaled $20.4 million, or 7.3% of sales, compared to the prior year quarter of 7.4%. The growth in legacy Globus R&D spending is reflective of additional headcount primarily within our spine and enabling technologies businesses, which is in line with our expectations. Our consolidated R&D expense of $29.3 million includes $8.9 million of R&D expense from Nuvasiv, which equates to 8.7% of sales based on the $102.4 million of revenue contributed from Nuvasiv during our fiscal third quarter. The September 2023 nuvasive R&D expense of $8.9 million, or 8.7% of sales, compares to September 2022 R&D expense of $7.5 million, or 7.1% of sales. The increase in pro forma nuvasive R&D expense in 2023 is primarily the result of adopting Globus accounting policies, specifically that internal labor and third-party consulting expenses are treated as period costs, and not capitalized on the balance sheet and ultimately amortized. SG&A expenses for the third quarter were $156.2 million or 40.7% of sales compared to $106.6 million or 41.9% of sales in the third quarter of the prior year. Legacy Globus SG&A expenses were $118.7 million or 42.2%. The increased spending is primarily reflective of additional sales compensation costs from higher volume higher benefit costs, and some additional bad debt expenses. Nuvasiv contributed $37.5 million of SG&A expenses in the quarter, or 36.6% of sales. Turning our attention to cash and liquidity, as part of the merger closing on September 1st, Globus paid off the outstanding Nuvasiv line of credit balance and subsequently terminated the former Nuvasiv line of credit. The total amount paid was $420.8 million. In addition to the line of credit, Globus also assumed the .375% senior convertible notes due in 2025, which have a principal balance of $450 million. Our current intent for these notes is to remain part of our capital structure until they are due to be settled in March 2025. During the month of September 2023, we entered into a new five-year unsecured $400 million syndicated line of credit agreement. At our request, this line of credit has the ability to flex up to $600 million if needed. As of September 30, 2023, we have not borrowed under this credit facility and fully expect this credit facility to provide sufficient additional liquidity if needed. Cash, cash equivalents, and marketable securities were $744.9 million at September 30. Our net cash, defined as total cash, cash equivalents, and marketable securities, less debt, was $335.2 million at September 30th. Shifting to cash flow, our net cash provided by operating activities was $50.4 million, and free cash flow was $28.9 million for the third quarter of 2023. Net cash provided by operating activities for the nine months ended was $138.8 million, and free cash flow was $83.4 million. Our capital allocation priorities remain unchanged. Our primary use of capital will be to fund internal investment and drive complimentary M&A. Our share repurchase program will remain an integral part of our capital allocation priorities. However, we will continue to focus our primary use of capital on driving investments for long-term growth. During the quarter, our Board of Directors authorized an additional $350 million to be used to fund share repurchases, bringing the total amount authorized to $500.8 million. The company will utilize its cash reserves to fund share purchases. Turning our attention to integration, Dan provided a detailed update in his earlier comments. However, I'd like to add a few comments in addition to his prepared remarks. We are actively working to integrate the business and are laser focused on the key activities that will help drive commercial success and generate internal efficiencies. Our integration activities are deliberate and aggressive. We want to go fast to maximize our ability to generate value, However, we are taking the time to understand differing processes and approaches as we bring the two organizations together. Our Globus culture is one where we will seek to move and drive actions which lead to swift decision-making. When we announced the deal earlier in 2023, we commented on generating $170 million in cost energy savings over three years. Internal synergy targets have been defined, and the team is actively taking steps to achieve the savings previously stated. Given the delay in our merger closing with the FTC second request process, we now expect our synergy targets to push out to 2024. As such, we still expect to generate the $170 million in synergies as previously communicated. However, this will begin with the 2024 fiscal year and will be realized over three years with 40% in year one, 70% in year two, and 100% by year three. The realization of synergies will come predominantly from the legacy NuVasive business and will be across most facets of the business, with the exception of the commercial portion of the business. The primary areas of focus are on A, operations, B, spending, specifically more stringent spending controls, as well as C, the elimination of redundant costs. Our operational synergies will focus on manufacturing insourcing, renegotiating supplier and raw material contracts, and enhanced controls around capital expenditures. Spending controls will seek to eliminate or greatly reduce third-party spending, while further centralizing decision making around cash and cash expenditures. Cost reductions will occur in a manner that allows us to deliver best-in-class service to our internal organization while setting the business up for success through greater cash and profitability. As Dan stated earlier, we do not need a slash-and-burn exercise to drive success. We seek to institute a more disciplined approach to spending and investment, moving ahead to drive greater value creation. Shifting attention to guidance, The company is updating its financial guidance for 2023. We expect our full-year 2023 revenue guidance to be $1.55 billion, representing 51.5% growth over the prior year. Our non-GAAP EPS guidance remains unchanged at $2.30 per share. However, it is important to note that our full-year share count will increase as a result of the merger and the 0.75 exchange ratio of Globus shares for each former NuVasive share. On a pro forma basis, assuming Globus and NuVasive were together on January 1st, 2023, our $1.55 billion revised guidance for revenue implies full year pro forma revenue of $2.377 billion or 6.9% growth over the prior year 2022 combined revenues of Globus and NuVasive, which was $2.225 billion. I also point out that our revised revenue guidance of $2.377 billion is in line with the Globus Management combined standalone revenue estimate of $2.361 billion as reflected in our S4 document. 2023 has been a year of dramatic change for Globus as well as a larger spine industry. Our merger with Nuvasiv brings together two industry powerhouses. To our patients, we will remain focused on improving your outcomes by bringing a best-in-class product portfolio to market. The combined resources will drive future innovation to solve unmet clinical needs. To our surgeons, we will continue to expand our product offerings and drive procedural improvements with our implants and enabling technologies. We will leverage the talent of both organizations and remain committed to global surgeon education and research. To our employees, we will drive passion and a shared commitment to patient-focused innovation. Specific to our commercial team, we will bring our groups together in a manner that drives success for the organization and for you. Remember that you have access to the best products in the market and you will be someplace where the innovation engine keeps running, giving you new and exciting things to discuss with your customers. To our shareholders, we will remain focused on driving innovation and investing for the long term, taking our globus approach to advance patient care while maintaining operational excellence and a focused, disciplined approach to cost containment, driving expanded profitability. We couldn't be more excited with where we are. There's still a lot of work to do. However, we have a team capable of executing the integration and truly separating ourselves from the competition. As always, thank you to the Globus team, including our newest team members from NuVasive, as we continue our pursuit for excellence. The best is yet to come. We will now open the call for questions.

Thank you so much, presenters. Ladies and gentlemen, to ask a question, you will press R1 on your telephone. So, if there are questions, please press R1 again. And please stand by while we compile the Q&A roster. Your first question comes from the line of Matt Mixick of Barclay. Your line is now open.

Can you hear me okay? Yes. Great. Well, congrats on a solid start here to the new company. Maybe first, I think we'd love to hear about what kinds of things were sort of positive surprises to you as you sort of like wrap up this quarter and head into the end of the year in terms of momentum or the synergies or lack thereof, and then maybe what are some of the areas where you feel you need to maybe work a little harder and focus areas maybe, and I have one follow-up.

Hey, thanks, Matt. It's Dan. I'll start with that. You know, truthfully, a lot of positive things. And, you know, you're right. Like anything, when you come in at this size, some things are working, some things are not. So it's not all sunshine. It's a lot of hard work. But with the positive things, it really is going to get back down to the people and the fit. I know that everyone goes to extremes to talk about different cultures, but I'm going to go back and say the more I work with everybody, the more I see how much we have in common versus apart. I really think that's big. The rate and the depth at which I see the teams working together, whether it be U.S. commercial or international commercial, or even all the support teams, it really is amazing. I think that they're positive more than anything. Areas of harder focus, look, we're creating a great deal of disruption, and in that creates some uncertainty, and there are some folks that are looking to get answers faster. So what I'd like to do is move at a faster pace. I know we're moving quickly, but the sooner we can move and create a steady state and get back into the stronger growth that we're poised to do, all the better. So for me, it's about keep moving forward, make the tough decisions, and get into the steady state at a faster pace.

That's great. A follow-up on the cost side, if you could maybe remind us. I know there was a number of cost avoidance opportunities for you at a combined organization and distributions. There's obviously, as you talked about, leverage opportunity of existing facilities that do ramp up insourcing and things like that. If you could remind us maybe specifically what's included and what's excluded in that $170 million target. I have lots of follow-ups, but I'll just stop there and pass it back to you guys and the rest of the group.

Sure, Matt. Great question. This is Keith talking. As we think about the $170 million, it's going to touch on a couple of things. It's going to touch on manufacturing and product insourcing. I might say that we have the ability to positively impact gross margin on a combined basis going forward. That's really going to be achieved by bringing products from the outside in, getting more efficient with our spending. From a distribution perspective, we believe that there's efficiencies to be gained. NuVasive has a facility in Memphis. We think that we could further leverage that facility to drive distribution for both companies moving forward. So that's included in the $170 million. And then on top of that is redundant costs that you primarily find in SG&A and focused approaches to taking a more discerning look at cash spending. That's what's contemplated in $170 million. As we've closed this merger and are looking forward, we feel confident about achieving that $170 million. And at this point, it ties back to Dan's earlier comments that we're finalizing org design. We're really going to be rolling things out as we get into 2024.

That's great. Well, thanks. And I'll pass it on to the deliverer next. Thanks. Thank you.

Thank you so much. Your next question comes from the line of Shravan Singh of RBC. Your line is now open.

So much and congratulations on the combined entity. I'm sorry for any background noise here. I was just wondering if you can help us, you know, with the framework for 2024. You know, how should we think about, you know, top line growth? You know, what are you assuming initially for maybe the synergies? You know, is single-digit growth the right target? I think on a combined basis, you guys called out 6.9% for 2023. And then for EBITDA, you know, should we be in the high 20s? You know, any comments on EPS accretion? I think last time you had indicated plus 20% at year one. Any tips and takes on 2024, even directionally, would be really helpful.

Thanks, Shigen. We're very limited on the information we're going to provide for 2024 at this time. I would reference folks back to the S4 document. We still feel positive that this could be EPS accretive in year one, so we feel good about that, but as time passes and we get closer to providing initial insights in the 24 in early January, we'll have more color then.

I'll just add to that, too, that with Keith and the team and the projections they put out in the S4, we're not anticipating making any material moves off of that at this point. We certainly have one month under our belt and a whole quarter to go, but feel positive that we're in the right direction and have shared that earlier with our submissions.

Got it. And then, you know, I was just wondering if you can elaborate a little bit more on Salesforce integration plans, you know, how you're thinking about territories, you know, obviously that has been, you know, kind of a sticking point for you know, for a lot of previous, you know, mergers, but, you know, we do think this is different. So, you know, maybe you can elaborate on Salesforce integration and how you think about that. Thank you for taking the question.

You got it, and I'll take that for you. So, you know, we'll go down into the two areas, obviously being U.S. and international. with that. And remember what we've called out and have been calling out is we felt that there's a small amount of overlap. And what we're signaling is with the actual data that's proven correct and better than we anticipated. And remember, we're not a 20 share company and a 20 share company coming together and bumping in, you know, both of us were in that range of say seven to 9% of market share in the U S. So it did naturally leave a lot of room for us to move around and grow without redundancy. what I would tell you is throughout the world we really did well with the existing management team with very small changes and our intent is and to date has been to keep all reps like I said we don't see any reason why we would have to shift or change from that even with our distributor partners the message is clear we want to go forward with you and work with you on that and to date we've been lucky with that unlike other acquisitions of the past where we have less redundancy and the chance, therefore, to grow and focus faster.

Thank you. Thank you so much. Your next question comes from the line of Vic Chopra of Wells Fargo. You may now ask your question.

Andy, good afternoon. Thanks for taking the question and congrats on the deal close. So two for me. I guess on the first one is maybe on the guidance, you know, you provided the top line guidance, which you increased as a result of New Basin. but you kept the EPS the same at 230. Maybe just talk about why the EPS guide is not being raised from deal close, and then I just have one follow-up, please.

Yeah, sure. Thanks, Vic. This is Keith. Really, the primary driver of that is you have to remember the share count is increasing. So we had, give or take, 102 million shares coming out of the second quarter. That grew to about 115 here in Q3, and that'll grow to about 140 in Q4. So your share count's really growing there, and that's really the driver of keeping it up to 230.

Okay, great. Thanks for that color. And then I was just wondering on the hiring trends, maybe talk about what the hiring trends were like in Q3, heading into Q4, and how you see your recruiting and retention efforts shaking out given the deal close. Thanks so much for taking the questions and congrats again.

Thanks, Vic. No, no problem. So, you know, admittedly, we obviously went a bit slower in the third quarter, even though we are getting a lot of activity with competitive reps, but just making sure that we fleshed out where our territories would be and what we're doing. We're on the tail end of that now, which is good news for us as we move forward. And so we're going back as we enter into the fourth quarter, ramping up competitive recruiting, been very active with it. And like I said, now that we really know and define the seats, we're able to see where some of those opportunities are. And I think, like I said, it was an okay third quarter, intentionally a bit slower. will accelerate in the fourth quarter now that we've got the roadmap in place.

All right.

Thank you so much. And your next question comes from the line of Steve Lignan from Albenheimer. Please go ahead.

Thank you. Hi, guys. Thanks for all the color. I appreciate the color on the surgeon overlap. Can you give us a sense of what the overlap is by account, which I assume would be higher than that?

You know, Steve, probably not right off the top of my head. What I would tell you is it's not materially different where you would get into, because keep in mind, if you've got a surgeon, which is what you're right, we were talking about, and it's there, it's okay. We'll keep the reps in both of those places. We're capable of doing that if we can support the sales. parsing this out by account. We still keep a surgeon focus where that is. So, you know, I would certainly agree with you that that would get up higher, but it's not going to get into the teens of an overlap or anything material that way when it really looks at it. Again, but we're more focused on the surgeon side of this than it is by a hospital or location.

Okay, got it. Thanks, Dan. And Keith, again, thanks for the color on the layout of the cost synergies. What is going to be the cash outlay to achieve those synergies, and will that be about the same percentages in terms of the timing of those costs?

That's a great question. Our assumption is that the cost to achieve the synergy will be 50 cents on the dollar, and I would lay that out over the trajectory of the three years equally as I stated in my prepared statements.

Okay, great. Thank you, guys.

You're welcome.

Thank you so much. And your next question comes from the line of Matthew O'Brien of Fiverr. Your line is now open.

Still on for Matt. Thanks for taking our questions. For starters, on the enabling tech side of things, how are those early conversations going with placing the robot with new accounts? I can appreciate the uncertainty that led to some weakness in sales on the Pulse side of things as well, but any color on that would be helpful.

Sure, I'll take that. So let's start with the Globus Enabling Tech. Like I said, we've actually been working with our former NuVasive counterparts to train them on the systems, get them familiar with what we offer, understand where these things are going, and create that familiarity as we start getting out to the surgeons. We've not been pushing hard on surgeons. We have done several. But the real goal is to make sure that we have one team that can support this and do it in a way that's non-disruptive. And so that's been progressing and it will accelerate into the fourth quarter as we get ready for next year that way. The pull system itself, I think there is a natural hesitancy of customers who thought we were going to pull it and get rid of it. We've been communicating that our intent is to support it, not only as is and in the field, but actually enhance it and finish up some of the in-progress ways to expand its capabilities. And we'll make sure that we take that forward in a way that they can perform the functions they want with their systems.

That's helpful. And just as a quick follow-up, any color on upcoming pieces of the enabling tech ecosystem? How big of a deal is it to combine the legacy offering with neuromonitoring, the Nuva's neuromonitoring down the road? Any idea in terms of Excelsior software updates for areas of targets? and then any updates to the extended reality headset. Thank you.

Sure. So you kind of hit a lot of those things. So one of the first things coming out is going to be our nav hub and the instrumentation for that so that, you know, we've got the robotic navigation through GPS and now we'll come out and do the free hand navigation with our hub that we plan to put out. A key part of that can be, as you said, the augmented reality headset. The anticipation is an approval, obviously, in 2024. I'm hesitant to give you a date, but I would tell you in mid-year, possibly into third quarter is what I'm looking at, depending on what we get or push back from FDA. So we're waiting for that through the thing. As far as one of your questions, which if I understood it correctly, we are evaluating the benefits of pulse and neuromonitoring and seeing where it would make sense, if at all, to build that capabilities into our existing enabling tech and, in effect, blend them together. So that progress is occurring right now. We'll decide probably within the next month or two what we think the future of that will be.

Thanks so much.

Thank you so much. Your next question comes from the line of David Saxon of Needham. Your line is now open.

Oh, great. Good afternoon, Dan and Keith. Thanks for taking my questions. Maybe I'll have a follow-up question on the integration of the Salesforce. I guess, you know, how long does that take? I think you said you're doing territories in November, cross-selling in December. So, you know, what are the next steps after that? And then which, I guess, major milestones or steps in that process do you think carries the most risk?

That's a great question. So we're doing it in two phases. The U.S., we're just finishing up territory. So we've gone from the senior leadership into the field leadership to the territory level. And we're just communicating that out and getting them together. We're doing cross-training in the fourth quarter for products and the availability for them as they form teams to obviously support each other so that they would be active in doing that beginning in January. We're looking to do something similar internationally. We're probably, you know, say about a month behind with that, where we have the leadership defined. We're finishing up territories probably in November, start the cross-training as well in December, and I think that will probably take us into January with a little more solidity internationally in the February timeframe. Great limiting steps, I think, are just going to be the availability of the people to get together and train without disrupting surge in support. we're going to make sure that that's first and foremost. I would think one of the key milestones for us is the combination of our systems that will support the field and the replenishment and the ordering. We're working on that at a rapid pace as well. And I would think that they're the two items that are probably first and foremost on us to make sure we get right.

Okay. Super helpful. Thanks for that. And then just on the knee robot, you know, I feel like I ask about it every once in a while. So just, you know, it, What's the update there, especially around timing? Is that an early 24 launch? And then also, how are you feeling about the Stahlkast implant portfolio and the strategy with that on the back of the knee robot launch? Thanks so much.

You're welcome. I'll answer that one as well. The knee robots really progressed far. I think we're in the process of fine-tuning what we want to do for filings. I would tell you the first half Of 2024 is the target. Again, remember, we're at the FDA's disposal with that. But I would be surprised, honestly, if we didn't exit the first half of the year with that. With that comes, obviously, the cementless knee, which I think will be the major player there, and that as well, progressing on a good pace with it. I think 2024, we'll start talking, obviously, more about the joints in total. While I don't know if, given our current size with the merger, it'll be a material lift, it'll be nice to actually get out the door with this, start talking about it, and then see it contribute in the years after that.

Great. Thanks so much.

Thank you so much. Your next question comes from the line of Blackman of Cecil. Your line is now open.

I appreciate you taking my questions, and I appreciate it's really early, but just curious if you're seeing any call it green shoots as we think about cross-selling and potential revenue synergies, for instance, any uptick and surge in engagement or training from the new basis side, just anything worth calling out. And I've got one quick follow-up.

I would say that that's probably a great question. And the answer is yes. So what you're seeing is there's some great products that come together, whether it be the pedicle screw system with a different retractor, our expandables with the lateral Different items like that. So, as we've talked about, when we begin coming out with one combined portfolio, the surgeons are excited about that. They see the ability to do that. Obviously, we need surgeons to help us cross-train our reps and to help spread those around. So, you're right. We're looking to increase surgeon engagement through different paths like that. We're also being mindful as to what products are in development for, you know, the NUVA team and the GMAT team. and looking to make sure that they come out as a complementary approach and not conflicting, and again, working with surgeons in those development teams to do that as well.

Okay, I appreciate that. And then a specific question, do you need 510K approvals to get the new invasive implants on the robot, or any help on how to think about potential timelines for when that might be available? Thanks, appreciate it.

All right. Well, listen, I would tell you that we're in the process of designing instrumentation. The implants are there. We're putting the software in place. I think we have to evaluate what that would warrant. We're obviously going to do what's required. Some may and some may not, depending on the extent of where we're going with that. So we're in the evaluation of it. Your real question and what I'm going to answer is we're actively modifying software and making sure that there's instrumentation that allow our systems to use the new base of products, and that is first and foremost with enabling tech. Doing it in a compliant way that makes sense is what we'll do as the next step. Thanks again.

And your next question comes from the line of Jason Witt of Ross. Your line is now open.

I'm just curious on Salesforce, the synergy, things like that. I know there's been quite a few questions on this for obvious reasons, but When do you guys think you have a handle on sort of where things fall? Is that after you've kind of just made your final decisions on management territories? Or is it six months out after that? Or is it kind of something that lingers for two years?

Yeah, Jason, that's a good question. Look, like anything, you've got to tease out natural moves and attrition with maybe something that is a bit more because of the disruption created. Things will always be ongoing, but I wouldn't say that because of the coming together of the merger that we would be experiencing this two years from now. We've already defined the U.S. sales force in particular, and that's where most of you guys have your focus on, all the way down and just finishing up rep levels. And so I think as we un-tease that and make sure that people understand where they sit and how beneficial this is to them, I would think that as we get through the third quarter and the fourth quarter through this call and into it, that we should see things settle down more, and then as we get into a stabilizing of this in the first quarter, that's where I'm going now. I think folks will decide and move, as always, but I don't think there's a big holding the breath and all of a sudden this will happen. I don't anticipate that at this point.

Okay, that's very helpful. And maybe just a very quick follow-up. I don't know if this has been asked in the past, but I assume for the knee products specifically, It's going to be completely focused on robotics. There's not going to be manual tools to put them in as well. I just want to clarify that for the knee launch.

Yeah, there's definitely the ability to do it freehand, do it robotically, do it through navigated procedures. We're going to give all of the options needed so the surgeon's choice to do that, not just a pure robotic move for our implants.

Got it. Thank you very much.

Thank you so much. And again, if you would like to ask a question, please press R11 on your telephone. And your next question comes from the line of . Your line is now open.

Sam on for Rich. Can you hear me okay?

Yes.

Just, I know we're not talking about 2024, but I just wanted to see if we could put a finer point on the EPS side of things. pretty wide range of consensus right now. It looks like about a $0.40 range in 2024 for EPS. I mean, is the midpoint of, call it like $2.60 to $3.00 directionally a good place to start? And could you just walk us through the puts and takes to bridge the consensus to an MRO range maybe?

Yeah, Sam, I'm not going to give point of guidance here as it relates to 2024. What I will tell you is We're excited about where the business is going. There's lots of products coming. Dan talked about the number of product launches that we had this year. Next year, there's a lot of capital coming out. Cross-selling is going to take effect. Obviously, that's going to be offset by some sales synergies, but that, to me, points positive and really ties back to the earlier comment that I made that, for now, I would focus on our S4 estimate for revenue. As it relates to cost synergies and achieving synergies, A couple of things that are going to happen. Obviously, you're going to be looking to eliminate redundant costs. But one of the things that I talked about was manufacturing and manufacturing efficiencies and supply chain efficiencies. You have to remember that some of those costs will get captured on the balance sheet and roll through the P&L in future periods. The thing to pay attention to is the cash and the cash flow generation of the business as you move forward. That's about all I would say right now as it relates to 2024. If I think about consensus and consensus estimates, I know there is a wide range out there. But I also recall that not all of the models were updated for 24. So that's how I would leave it.

Got it. And then I guess on the synergy side, I think one of the areas a little bit less focused on is potential for trauma or overlap and potential cross-selling there. Could you just sort of tell us how you think about those portfolios getting integrated and where that growth rate can go going forward? Thanks.

Thanks, and I'll take that. So there's a couple things. Really, the NSO specialty orthopedics part is a fantastic add to our bag. That now will allow us to do many things for long bones. Its ability with ankle fusion will be amazing with hind foot. And so that in itself we see bringing in and bringing to our existing trauma team that will further accelerate growth and create pathways into accounts. The majority if not all of the Nuvasiv activity is really done through third parties and so we're evaluating those distributorships and understanding where they are and making the determination if we want to do anything with our Globus trauma business that way or not. But really the goal here and what was a great add was those nails from Nuvasiv coming into our bag and actually pulling us forward several years in our innovation and ability to address the market.

Thanks for taking the questions.

Thank you so much. And your next question comes from the line of Drew Ranier of Morgan Stanley. Your line is now open.

Sorry about the background noise here. But could you just speak to maybe some of the enabling technology trends that you saw in the quarter? And just as we do think about the merger looking ahead, you've had a history of really kind of placing systems via capital versus lease, but you have a significant cross-selling opportunity ahead of you with the new basis account. So do you expect a dramatic change in the mix of capital versus leasing looking ahead? And then I have a follow-up.

This is Keith. I'll take the question. So as I think about enabling tech, The market still has a lot of appetite for enabling tech. I will say that I think capital dollars are perhaps a little bit tighter, so there are more options available to customers in terms of how they acquire the capital. You commented on leasing. I want to remind everyone that, yes, the majority of our capital purchases are outright sales in net 30 terms, but we have the ability to offer other ways to acquire the capital. including rental programs, leases, you name it. So as the market shifts, we have the ability to respond to the market. We're taking into consideration the point of obviously all these new invasive territories opening up to ourselves to sell the capital. Dan commented earlier that from a manufacturing perspective, we've been building that capital to have it ready because we want to be able to strike as we really roll out the cross-selling plan. But to answer your question, we will be able to address the market to sell the capital in any way that the customer needs to acquire it.

Thanks, Keith. And maybe also for you, with breaking out kind of three segments now for revenue, can you just give us a little better sense of maybe how you expect growth to play out in the fourth quarter now that you are breaking up this revenue a little bit of a different way? Thanks for taking the question.

The revenue is broken out. So historically, we reported on musculoskeletal and enabling technologies. That obviously remains. We added the neuromonitoring services. As I think about Q4, you would expect to see the same seasonality in capital as you always do. Q2 and Q4 are the two highest quarters. We don't expect that to change. And obviously, you would expect to see the seasonal bump that you would experience in spine as it gets towards the end of the year and the harvest season.

Yeah, Drew, one thing I would add, too, from my earlier comment, We are breaking that out more for visibility right now. We may decide that it fits better and consolidate that over time. But right now, we're just kind of following through what our NuvaGuys did as we got into the year for our first time announcing some of this.

Got it. Maybe one last question. But as you are looking at the businesses today that you're now combining, Do you see any incremental opportunities to divest anything non-core or slower growth just to refine the portfolio and really get some more accretive growth out of the merger? Thanks.

Yeah, I would say no, not at this time. We're evaluating everything. We've not seen anything that would be a good candidate at this point. We'll always do what's best. But right now, there's nothing that comes to mind.

All right.

Well, thank you so much. And your next question comes from the line of Ryan Zimmerman of BDIG. Your line is now open.

Glad I could get squeezed in here. Just on the quarter itself, if I look at kind of NUVA's revenue, look at kind of next quarter, I think, you know, the street was estimated around $445 million or so for consensus for NUVA. You know, we're kind of honing on maybe 415. And just wondering if you can kind of comment on that delta. You know, is that in line with kind of where you're tracking from a synergy standpoint, kind of how to think about that difference there? And then I'll ask another question afterwards. Thanks.

Thanks, Ryan. This is Keith. Your question, you said the street was modeling $415,000 for new basis?

No, I think, well, if you take the $102,000 and you assume that coupled with, I think, next quarter, which was maybe about $300,000 or so million, you kind of come out to $415,000. And I think the street was around $445,000 if my numbers are correct.

Yeah, I think that it's a great question. As I think about the numbers we put out, the implied guidance represents $2.377 billion. Coming into the year, Globus projected guidance of $1.1 billion in evasive. They were a range of 68%. If I take the low end of the range in our number, that's $2.374 billion. We're projecting $2.377 billion on a combined basis. We think that that, relative to what we've previously stated in our S4, we feel that the business is lined up as to where it should be.

Yeah, and Ryan, one of the things I'd add in there, because I'm not sure if I'm reading this between the lines, so forgive me, but we're not saying we're bleeding out because of the synergies. We've not seen anything that would have materially moved us off of any of our estimates related to that.

Yeah, I appreciate that and recognizing that. Right now, consensus is kind of messy, but with the integration and the merger, I just want to ask about it. And then the second question I want to ask is just around your margins, particularly your gross margins, Keith. I recognize there's this step up in inventory that you're accounting for. Just maybe help us, because I'm not entirely clear where your gross margins can go on a combined basis and how to think about those. you know, not just for the fourth quarter, but really into 2024?

Long return. Yeah, no, that's a great question. You know, it's always our intent to be extremely clear to be a mid-70s gross profit business. That is the goal of Globus. It has been, and it will be going forward. As we work through bringing the businesses together, I commented on earlier about some of the manufacturing efficiencies that we see, some of the warehousing efficiencies that we see. Those, to me, will all contribute to us showing an increasing consolidated gross profit rate from where we are versus the initial combination of the business. It's our belief that we can still drive mid-70s GP going forward. Obviously, there's going to be some step changes as we get there, as we bring the companies together. But, you know, the global goal of mid-70s hasn't changed.

Yeah, and Ryan, I'll build on that too. So we talk a lot about insourcing and investing in manufacturing in addition to what Keith said, because that will be a key driver. We can drive our product costs down. That will allow us to not only improve gross margin, but instead to turn around and invest deeper into the sales force. So it's a major focus of us to do in-house manufacturing, line up with our contracts, and come out with the best pricing with our vendors. And that in itself will help lift us back to our targets that Keith mentioned. Okay. Thanks, guys. Thank you.

Thank you so much. And your next question comes from the line of Matt Taylor of Trebris. Your line is now open.

Hey, thanks, guys. I wanted to ask a similar question in a slightly different way. I guess I'll start with, you know, some of your competitors have made noise about taking reps from the combined entity, you know, big for them, kind of small for you. And everything I heard on this call from you today in terms of lower surgeon overlap and being within your targets and seeing competitive activity coming your way sounds positive for the integration. So my question is really, Is that right? Are you on track? And is there any thought or potential for you to actually outperform the synergy or the synergy estimates that you've put out there? Is it right to think about being straight down the fairway or the base case is most likely?

Yeah, Matt, we're early on on that. So I'm going to let you know in about three years. No, but I think what we'll do right now is we've not seen surprises. And I think we're standing behind our numbers is what we're saying. And again, there's one month of actual and everything you've said is legitimate. What we've got to do is focus on getting the commercial team stabilized, make sure we train, get our products delivered, accelerate how we have common systems, bring in-house manufacturing for more flexibility, and then go back and flex all of that strength to become who we need to be. But at this point, we're going to shy away from saying we can outperform or fall short. We're going to stick to the synergies that we've thrown out. We've got a pathway to go get there. As we get more data and experience under our belt, maybe that's a different conversation.

And the only comment that I would add there is obviously change creates disruption in the market. But as I think about Globus, Globus needs to be Globus and focus on our plan. We obviously need to be aware of the competitive landscape, but we have to stick to our plan and work our plan. And if we do that, we believe we'll be successful.

Okay. Great. Thank you, guys.

Thank you so much. And with no further questions, that concludes the Globus Medical Earnings Call. Thank you for participating, and you may now disconnect.