4/30/2020

speaker
Diego
Conference Operator

Welcome to the Q3 fiscal year 2020 ResMed earnings conference call. My name is Diego and I will be your operator for today's call. At this time all participants are in a listen only mode. Later we will conduct a question and answer session. Please note that this conference is being recorded. I will now turn the call over to Amy Wakeham, Vice President of Investor Relations and Corporate Communications. Thank you Amy, you may begin.

speaker
Amy Wakeham
Vice President of Investor Relations and Corporate Communications

Great. Thank you, Diego. Good afternoon and good morning, everyone. Welcome to ResMed's third quarter fiscal year 2020 earnings call. We appreciate you joining us and I hope you all remain healthy and safe during these times. This call is being webcast live and the replay along with a copy of the earnings press release and our updated investor presentation will be available on the investor relations section of our corporate website later today. Joining me on the call today to discuss our quarterly results from various remote locations across San Diego and Sydney are CEO Mick Farrell and CFO Brett Sandercock, as well as other members of management who will be available during the Q&A portion of our call. During today's call, we will discuss several non-GAAP measures. For reconciliation of these measures, please review the notes to today's earnings press release. And as a reminder, our discussion today may include forward-looking statements, including but not limited to expectations about ResMed's future performance. We believe these statements are based on reasonable assumptions. However, our actual results may differ, particularly in light of the highly uncertain global environment we are currently operating in and the effects of the COVID-19 coronavirus on our business. You are encouraged to review our SEC filings for discussion of the risk factors that could cause our actual results to differ materially from any forward-looking statements made today. With that, I'd like to go ahead and now turn the call over to Mick.

speaker
Mick Farrell
CEO

Thanks, Amy, and thank you all for joining us today. These are unprecedented times, as Amy just noted. We are in the midst of a global pandemic, which is having profound effects on public health, particularly the most vulnerable among us. During this time, our top three goals here at ResMed are simple. Goal one is the preservation of life, helping people breathe with world-class ResMed ventilators and ventilation masks, while their own immune system fights against this novel coronavirus and the disease it causes, COVID-19. Goal two is the safety and health of our amazing team of 7,500 ResMedians providing solutions in 140 countries worldwide. Because without our people, we can't help anyone breathe better. And goal three is the ongoing delivery of world-leading products and services to treat sleep apnea, chronic obstructive pulmonary disease and asthma, as well as the ongoing production of market-leading software to take care of over 110 million people with care delivered by home medical equipment providers, skilled nursing facilities, nursing homes, hospice, and importantly, in the place where people prefer to be, their home. I've never been more proud to call myself a ResMedian than I am today. Every one of our global team is fully engaged in the COVID-19 crisis. They are demonstrating impressive feats of ingenuity, compassion and drive to support patients, clinicians, providers, health systems and beyond. My email inbox is overflowing daily with stories of ResMed heroes, including frontline workers such as our own respiratory therapists and clinicians, as well as ResMedians who are showing up every day using all of our updated safety procedures to source ventilator components from around the world to produce ventilators and masks and tubing and software and deliver these life-changing solutions worldwide. To share just one example from many is the story of a ResMed hero from our China team, actually in Wuhan in Hebei province. who donned a full hazmat suit every day for the first 10 weeks of the corona outbreak in that region. He was setting up thousands of people on ResMed ventilators and ResMed masks, including a ventilator that we call the Guardian Angel, or GA ventilator, produced right there in China. We don't know how many lives this gentleman saved there in Hubei province, but I have the good fortune of calling him my ResMed teammate. So to all those ResMed heroes, I say thank you and that I'm inspired by you and how you stepped up to help patients at the start of this crisis there in January and for the duration now through April and beyond. As a global company providing solutions in over 140 countries, we have mobilised our efforts and resources to address COVID-19 as this deadly disease moves from region to region. We have accelerated production and distribution of invasive ventilators, non-invasive ventilators, including bi-level devices, as well as ventilation masks for the patients who need them most, no matter where they live. We produced over 52,000 non-invasive ventilators, including bi-levels, and invasive ventilators during the quarter. This is a three-fold increase on our production from the same quarter in 2019, living up to the expectations that we set publicly. We have also driven a tenfold increase in our ventilation mask production, actually more than tenfold. We are aligning distribution of these ventilation products worldwide using a global, ethical, epidemiology-based model of ventilation needs based on our models of the surge of COVID-19 patients around the world. And our key guiding principle is the preservation of life. We can and will do more over the coming days, weeks, months and quarters to support healthcare systems as COVID-19 continues to impact countries across Asia, Europe and North America and with future patient surges just starting to begin in South America, Africa, Middle East and beyond. We have been able to achieve these outcomes while ensuring that we always place the health, safety and wellbeing of our ResMed team at the top of our priority list. Without our people, as I said earlier, we can do nothing. Our actions have included work from home policies for all whose job function allows for that. We have instituted non-contact temperature screening, mask wearing policies and physical distancing protocols for all of our supply chain, production, distribution and technical service teams worldwide. While we have around 65% of our global team now working from home, these important jobs such as production, distribution and tech service, just can't be done from home. We've established world-class safety and quality procedures in all of our manufacturing plants, distribution centres and offices, and we're ready to get back to work as cities and countries plan to do that. Safety and quality are part of our DNA at all times, and today, more than ever, these capabilities enable us here at ResMed to support our customers with a sustainable supply of products, services and solutions throughout this COVID-19 crisis and beyond. I also want to express my gratitude and appreciation for the extraordinary efforts of people beyond the boundary of ResMed, especially the frontline healthcare workers in hospitals worldwide. Respiratory therapists, critical care nurses, critical care doctors, and many others have demonstrated extraordinary leadership and personal sacrifice at this time. These clinicians are triaging people with symptoms into various therapeutic pathways. depending on the changing acuity of each individual with this novel coronavirus. From CPAP therapy to bi-level therapy to more advanced non-invasive ventilation, as well as to full endotracheal intubation with invasive ventilation for the patients who need that. These clinicians are using ResMed ventilators and ResMed ventilation masks with direct person-to-person engagement, which even with full personal protective equipment, still includes significant risk for that clinician. We are working with customers worldwide to drive digital pathways to try to minimise unneeded person-to-person interaction. Examples of this include remote monitoring of ventilation devices, telehealth solutions and virtual patient population management. We have over 11 million devices with available connectivity to our cloud-based solutions, including MyAir and AirView. We have over 13 million patients as well as over six billion nights, six billion nights of respiratory medical data in the cloud. We had a running start in the field of digital health well before this COVID-19 crisis. One of the few positive benefits out of this awful crisis is that it has brought to the forefront the importance of digital health for the health and safety of respiratory therapists, respiratory nurses and critical care physicians. Digital health also brings benefits of more scalability, more cost efficiency, and better outcomes for patients. Throughout the quarter, despite all the changes brought by this coronavirus, we have continued to execute on our long-term ResMed 2025 strategy, including digital health, expanding end-to-end pathways for sleep apnea, for COPD, and for asthma, as well as building the world's best out-of-hospital healthcare software network. Fundamentally, we believe and continue to believe through this crisis, even more so, that the future of healthcare is outside the hospital. That's where ResMed competes today and that's where ResMed wins today. The COVID-19 pandemic has proved an interesting point. The more we can establish non-contact digital health pathways at scale, the better the health of therapists, nurses and physicians and the better the efficacy, the efficiency, the scale and the quality of care for patients. We have accelerated our ability to improve over 250 million lives in outside the hospital healthcare by 2025. The fundamentals of our ResMed business are strong, even as we see uncertainty in the changing kinetics and dynamics of the COVID-19 disease. as it continues to move across geographies, from Asia to Europe to now North America and on to South America, Africa and regions worldwide. We are seeing tailwinds in our business from increased demand of our ventilators, such as Astral, Stella, Loomis, as well as our non-invasive ventilators, Aircurve, Flexo and the GA. We are also seeing increased demand for ventilation mask solutions, We do not know exactly how long the surge of demand will last for each hospital, for each city, for each country and for each region as this COVID-19 virus moves. But as patient flow surges, peaks and then flattens, we are there. And we are getting pretty good at modelling these demand curves using our global COVID-19 epidemiology model of patient flow and the learning from each city that we serve. Currently a lot of short-term impact also depends on our ability to keep ventilator production at its maximum capacity and as I mentioned earlier we are already at three times last year's production capacity and we are doing our best to meet the surge and peak flow in multiple geographies worldwide. A key element in our ability to deliver is our ability to source critical components and ship product in response to the incredible demand as this COVID-19 virus moves around the world. I want to be clear on this point, though. Even as we face increased demand for our products, we are doing everything that we can to keep efficiency high and to keep our costs down. Our primary humanitarian goal is 100% locked. At ResMed, we are committed to enabling access to ventilators for COVID-19 patients in order to preserve life. We are keeping pricing steady and we will not opportunistically increase prices or per unit profit in our response to COVID-19. We believe that there will be lessons learned during the crisis that will enhance our ability here at ResMed to drive innovation in the quarters coming years through our research and development pipeline, particularly in the fields of digital health technology, as well as our product and software innovation. We are very competitively positioned in these fields today but we think we will be even more so tomorrow. While balancing our response to the global public health crisis, we have also been executing well in our core business. We have delivered strong growth in our sleep apnea, COPD and asthma businesses across geographies with solid contributions from our software as a service business during the quarter. In a few minutes, our CFO, Brett Sandercock, will provide the details of our third quarter financial performance along with our outlook for the remainder of fiscal 2020. But first, I'll provide just a few financial highlights and briefly discuss execution towards our ResMed 2025 strategy, along with some milestones for the quarter. So for the third quarter of fiscal year 2020, we delivered just around $770 million in quarterly revenue, which is up 17% year over year, reflecting growth and positive momentum across our product portfolio, software solutions, and global markets. As part of our global COVID-19 response, we have seen tailwinds for the increased demand for invasive ventilators and non-invasive ventilators, including bi-level devices, masks, and accessories, as I mentioned earlier. We estimate the incremental impact to be approximately $35 million of COVID-19-related revenue during the quarter. So from this $770 million in quarterly revenue, we generated a strong $240 million in cash flow from operations during the quarter. enabling us to return cash dividends to shareholders as declared by our board today. We continue to invest in the future growth of our enterprise with double-digit increases in our research and development investments during the quarter. This R&D investment includes shifting resources to ventilators and ventilation masks and clinical research and technical help people to help clinicians, physicians, inventors, and people worldwide during the COVID-19 crisis, as well as keeping the ongoing innovation work going for our core sleep apnea, COPD, asthma, and software as a service businesses. We have set a clear path for ResMed to maintain our position as the global leader in digital health technology, transforming the way healthcare is delivered for those suffering from sleep apnea, COPD, and asthma, as well as enabling people to live healthier lives in a portfolio of settings away from the hospital. The execution of our long-term strategy drives progress against our triple aim of first, slowing chronic disease progression, second, reducing overall healthcare system costs, and third, improving the quality of life for our ultimate customer, the person who uses our products to help them sleep better, breathe better, and to live a higher quality of life away from the hospital. We believe that when we help a person sleep better, breathe better and live a better quality of life away from acute care, this positions ResMed to help those people achieve their best health outcome in other chronic disease conditions, including cardiovascular disease, diabetes, mental health and beyond. We are forming multiple partnerships to drive these long-term health benefits, including our joint venture with Verily and many other private partnerships beyond. Watch this space. We have three priorities that guide our daily focus. Number one, to grow and differentiate our core sleep apnea, COPD, and asthma businesses across global markets. That's just our clear number one priority. Number two, to deliver world-leading medical devices and digital health technology to engage physicians, providers, and patients so that together we can improve clinical outcomes, reduce costs, and enhance patient experiences. That's our triple aim. And our third priority is to build the world's best software solutions network for healthcare that is delivered outside the hospital, and we're well on track to do that. We have advanced on all three of these priorities during the quarter, and I'll briefly touch on a few recent highlights to demonstrate areas where we have momentum and are driving innovation. We had an exceptionally strong growth this quarter on a geographic and product basis, including 17% growth globally. Our team delivered strong and distributed geographic growth, including a 12% increase in the combined United States, Canada and Latin America regions, as well as an incredibly strong constant currency increase of 27% across the combined Europe, Asia and other regions. As discussed earlier, there was an impact from the COVID-19 surge in demand for ventilation in the quarter of around $35 million in revenue, So that's around 4.5% of the $770 million in revenues for the quarter. In short, our core underlying business remain robust over and above that of the ongoing surge of demand. On a product basis during the last 12 months, we improved over 16 million lives by providing a person with a ResMed device or a ResMed complete mask system to help them breathe better and live a better life. Including our digital health solutions for out-of-hospital software in this number, we impacted together over 110 million lives during these last 12 months. The ability to improve these lives is supported by over 6 billion nights of respiratory medical data in the cloud. These data allow us to perform sophisticated data analytics and to drive actionable insights for the benefit of customers, including patients, physicians, providers, and healthcare systems. This makes ResMed the global leader in digital health for our field and the partner of choice for our customers, helping them increase efficiency, reduce costs and improve outcomes. So shifting to a discussion of our core sleep apnea business, we are seeing significant impact from the COVID-19 related lockdowns on new patient diagnoses in sleep. We have seen double digit declines in diagnosis rates in affected markets. Many sleep clinics, especially hospital clinics, are temporarily closed, and many pulmonary and critical care physicians that often work in sleep clinics are shifting their focus to treat COVID-19 patients as the surge comes to their city, their region, their state, their hospital. It is important to note that we have seen the mask and accessories resupply dimension of our business not only maintained, but actually increased during the quarter. As we look forward, there is uncertainty and it is not clear to what extent what extent the upsurge in ventilation device and ventilation mask revenue will offset the decline in sleep device revenue and whether sleep mask revenue will maintain its growth or decelerate somewhat. But we know these facts. Number one, that sleep apnea prevalence remains incredibly high, over 936 million people worldwide. And we know, fact two, that there is a backlog of diagnostic activity for sleep apnea and COPD that many clinics and physicians are preparing to ramp up their home sleep apnea testing, both now during the crisis and in the future as lockdowns are lifted around the world. For the on-premise or in-laboratory tests for sleep apnea, we are modelling how those will scale back up again, customer by customer, city by city and country by country, as the economy opens up and primary care physician visits and elective medical procedures come back online through telehealth and beyond. Physicians and therapists will then have to work through the backlog of undiagnosed patients that has been built through the COVID-19 lockdown in their region with a portfolio of both home sleep apnea testing and in-lab tests. The velocity of the diagnostic pathway return rate will depend on local regulations and behaviours and what we're calling a new normal for patient care. We have real-time experience of the opening back up in some cities in Asia, and throughout Europe, and we're starting to see them open up in the U.S. And we have modeled these open-ups carefully to ensure that we can best support customers as they start their home sleep apnea test scale and their in-lab test scale over time to meet the backlog of demand. Even today, around the world, we're working closely with our customers to accelerate these home sleep apnea testing models and remote patient setup on sleep apnea therapy where customers are pursuing those pathways. as well as our ongoing remote sleep apnea patient monitoring. And I mentioned earlier, we have over 11,100,000 cloud-connectable medical devices out there in the field and more that are distributed every day. It's important to note that these types of partnerships aren't new due to COVID-19. These are things we've been working on for years and decades in some states. And we believe these types of digital health and telehealth and remote monitoring models will only increase due to COVID-19 and as we move into a post-COVID-19 world. In terms of digital health innovation, we have recently rolled out a new pilot for telehealth over video chat so that the physician can not only access information on air solutions and air view, but it can also interact directly with the patient. And we think that will reduce the need for a recovered COVID-19 patient to return to the emergency room or a physician outpatient setting We view this as a trend that will be accelerated by a combination of changes in reimbursement methodologies and overall focus on safety and the preventative and health benefits for both the patient and the healthcare worker. Solutions like this can provide incredible scale when leveraged across a digital health network, including over 110 million patient lives. As I noted earlier, our investment in research and development grew by double digits in the quarter, and we put these R&D monies to work to expedite the tripling of ventilator production in the quarter and tenfold capacity increase in our ventilation mask production. We have also formed partnerships with clinicians around the world to help with the COVID-19 crisis, to help create and share clinical white paper best practice solutions in clinical practice to help with COVID-19 ventilation management, including triage between CPAP, oxygen, bi-level therapy, non-invasive ventilation therapy, and invasive ventilation therapy. At the same time, though, we have continued to invest in our core businesses for future growth in sleep apnea, COPD, asthma, and software as a service. As an example of this innovation in our core sleep apnea business, we introduced during the quarter the AirFit F This is the first CPAP mask with a tube up design in the full face category. This product now gives ResMed the most complete full face mask portfolio versus all our competition on the planet. So what does this tube up design of the AirFit F30i do for customers? In essence, it gives the freedom of movement back to that ultimate customer, the patient, so they can sleep naturally in any position, that their slumber architecture follows during the night. The F30i also has an innovative cushion that prevents irritation on the nasal bridge, and it has a quick-release elbow that allows users to quickly disconnect and reattach the mask from its tubing, making it very simple to start therapy at the start of the night and to stop therapy in the morning. All this technology built into the AirFit F30i supports the third tenet of our triple aims, to improve the quality of life for the patient. If they have freedom of movement and don't wake up, that improves their sleep, it improves their day, it improves their life. Clearly, it is very early in the product life cycle for the F30i, and this product was launched amid a pretty unique global environment. However, despite some of the noise in the signal, we've been able to see good early acceptance as physicians, respiratory therapists, and that ultimate customer, the patient, recognized the benefit and functionality of the innovation in the F30i. Additionally, during the quarter, we invested $100,000 in partnership with the not-for-profit American Thoracic Society Foundation through a research grant. The goal of the research and the study is to look at how remote monitoring can help improve the management of patients with COPD. The study aims to detect early changes in lung function from daily recordings. and to notify patients and or physicians when to commence more intensive treatment or to seek high-level medical attention. Nearly 400 million people suffer from COPD worldwide, and we do not believe these people are well served currently by global healthcare systems. Our vision of better management for COPD patients through the use of digital health technologies will be accelerated from the findings of this study. It's great to partner with the non-profit ATS Foundation to help this move forward. As we discussed earlier, COVID-19 has accelerated the movement to fully remote care in our core sleep apnea and ventilation businesses. Looking at our growing digital health solutions for COPD and asthma, the Propeller platform continues to play an important role in keeping patients outside the hospital, out of acute care locations, leveraging the Propeller's world-leading pharmaceutical adherence technology for these diseases. Active use of propeller technology has actually increased during the COVID-19 crisis. We think this is due to the rising awareness of the importance of respiratory health and the fact that people just don't want to go to acute care settings and so they're using preventative medicines more to do so. While it's not yet material to ResMed's overall revenue, we are seeing increased interest in propellers technology to support health systems with population health. We'll keep you updated on any significant milestones with our pharmaceutical partners, as well as our work with global healthcare system partners throughout calendar year 2020 and 2021, as they adopt the Propeller platform for COPD, asthma, and beyond. Before I transition to a discussion of our out-of-hospital software as a service business, I'd like to recap briefly why we believe that the SAS business is critical to ResMed's long-term success and how it fits into our broader portfolio. Our consistent view of the evolution of the healthcare system is that care will be delivered outside the hospital. The contamination of hospitals with COVID-19 is just one of the latest examples of the types of contagion that are present in many hospital locations worldwide. Our vision is to enable a system where a patient can seamlessly transfer across a portfolio of outside hospital care settings, from home care providers to skilled nursing facilities to home health to independent living, assisted senior living and beyond. These settings have reduced costs versus the hospital, as well as increased efficiency and better health outcomes than the hospital. People are simply happier and healthier in the residential setting of their choice, and the ultimate residence of choice is their home. The SAS business clearly leverages the global trend for seniors to want to age in place and supports ResMed's continued execution against the triple AIM. Our SAS businesses enable us to participate more deeply in broader chronic disease across a patient's life cycle, creating additional strategic growth options. During the quarter, our software as a service business grew at 12% from the period a year ago. We are integrating and optimising this out-of-hospital SAS portfolio to support long-term growth. We continue to believe that the long-term weighted average growth of the SAS markets that we serve is in the high single digits. We clearly beat that growth this quarter, and we plan to exceed that rate in the long run as we execute to our SAS strategy. During the COVID-19 crisis, many out-of-hospital healthcare settings have switched their use to support overflow from hospitals, and there has also been a reduction in patient flow to these out-of-hospital facilities due to a reduction in elective surgeries at hospitals. Skilled nursing facilities and nursing home volumes have been extremely hard hit by COVID-19 and this will impact our matrix care business growth in the coming quarters. We expect market growth in our current portfolio of SAS businesses that we serve to be in the mid single digit range for the next few quarters before its recovery to high single digit growth in the medium to long term as the COVID-19 surge passes and people return to their primary care physicians and return to their elective surgeries and patient volume returns. In support of the increased growth of the SAS portfolio during the third quarter, we completed the acquisition of a company called Snapworks. Snapworks provides patient contact management and workflow optimization for sleep apnea resupply for our HME customers. The combination of BrightTrees technology And live call services with this new Snapworks tech creates the largest resupply base in the industry with end-to-end workflow automation for HME customers. Resupply is an area of the HME business that has been a strong ballast in the boat during the COVID-19 lockdowns. And these types of programs, including Brighttree and Snapworks together, set up our customers for ongoing success and better patient engagement through the crisis and beyond. In summary, the SaaS portfolio is an important driver of our long-term success and a critical enabler of our ability to impact our triple aim. We are investing for long-term growth in SaaS and leadership in this space. Our performance across the entire ResMed portfolio during the quarter demonstrates the resiliency of our business during what I would call extremely challenging global times. And it highlights the dedications of ResMedians all over the world and the dedication of our customers, the clinicians, providers, and health systems to deliver for the people who need our help. Looking forward, we are modelling impacts of headwinds and tailwinds from the COVID-19 crisis with detailed scenarios of impacts by customer, by city, by region, and by business line. While we face temporary headwinds in sleep apnea diagnosis and SAS patient business flow, as I just talked about, We're also seeing tailwinds from increased demand for our ventilation devices, our ventilation masks around the world. The fundamentals of our overall business are strong, but these are uncertain times, and the crisis continues to unfold across geographies, and we don't know exactly how long the related headwinds and the related tailwinds will last. We don't know specifically by each city, country, and region how fast they will open up, but we know they will open up. And as we have seen in Asia and Europe, as these economies open up over the coming days, weeks and months, ResMed will be there to serve them. And we know one thing, that as they start to open up, there has been and will be a backlog of patients who need the channel's help for sleep apnea, COPD, asthma and out-of-hospital healthcare needs. We're investing now to be ready for those realities of the open up so that we can be there to support our customers with the best digital health solutions and the most scalable solutions to help them grow now. We are leading from the front. The nature of the COVID-19 crisis has highlighted the importance of our digital health strategies I mentioned earlier. Our ability to improve over 250 million lives by 2025 in out-of-hospital healthcare is not only on track, we think it's accelerated these last three months. This is the one welcome benefit in what has been an incredibly challenging 90 days for every company, not just ResMed, in every nation, every government dealing with this crisis. We're glad that we have made extensive investments in remote monitoring, remote patient setup, digital health, population health management over the last five, 10 plus years that we can now offer and bring to the market to help them when they need it. The combination of accelerated digital health technology and the recognition of the value of remote monitoring and the projected changes that are already happening in global reimbursement models for digital health, combined with the growing acceptance of virtual diagnosis and virtual setup represents a new and significant medium to long-term tailwind for the ResMed business. This, combined with our strong pipeline of new products and digital health solutions, including sleep apnea, COPD, asthma, and the out-of-hospital SAS, gives us strong confidence in our future. We think this is unique positioning that solidifies our leadership role in global digital health in MedTech, but will also support ResMed's growth over the medium to long term. Before I hand the call over to Brett for his remarks, I'd like to commit that while we have already played a significant role providing tens of thousands of ventilators, many, many more ventilation masks and clinical support to clinicians worldwide to fight the COVID-19 crisis, we are not done. We will do even more in the coming quarter and the coming quarters to deliver more ventilators, more ventilation masks for countries as they go through the patient search. And we will be there to support health care systems around the world in respiratory medicine and digital health. Not only during this COVID-19 crisis, but in what we call the new normal post-COVID-19 world that will be more digitally enabled and more digitally connected than ever before. With that, I'll turn the call over to Brett in Sydney. Brett.

speaker
Brett Sandercock
CFO

Great. Thanks, Mick. In my remarks today, I'll provide an overview of our results for the third quarter of fiscal year 2020 and some remarks for our Q4 outlook. As Mick noted, we had a strong quarter. Revenue for the March quarter was $769 million, an increase of 16% over the prior year quarter. In constant currency terms, revenue increased by 17% compared to the prior year quarter. Revenues for the third quarter were favourably impacted by significant sales of ventilated devices and accessories. We estimate that the incremental revenue benefit from COVID-19 related sales was in the order of $35 million. Excluding this incremental impact, our group revenue increased by 12% in constant currency terms. Taking a closer look at geographic distribution and excluding revenue from our software as a service business, Our sales in US, Canada and Latin America countries were 394 million, an increase of 12% over the prior year quarter. Sales in Europe, Asia and other markets totaled 286 million, an increase of 23% over the prior year quarter, or in constant currency terms, a 27% increase. By product segment, US, Canada and Latin America device sales were 196 million, an increase of 8% over the prior year quarter. Masks and other sales were 197 million, an increase of 17% over the prior year quarter. In Europe, Asia and other markets, device sales totaled 195 million, an increase of 26% over the prior year quarter, or in constant currency terms, a 29% increase. Masks and other sales in Europe, Asia and other markets were 91 million, an increase of 18% over the prior year quarter, were in constant currency terms a 22% increase. Globally, in constant currency terms, both device sales and mask and other sales increased by 18% over the prior year quarter. Software as a service revenue for the third quarter was $90 million, an increase of 12% over the prior year quarter. On a non-GAAP basis, SaaS revenue increased by 9%. During my commentary today, I will be referring to non-GAAP numbers. The non-GAAP measures adjust for the impact of amortisation of acquired intangibles, the purchase accounting fair value adjustment to matrix care deferred revenue and impairment of minority interest investments. We have provided a full reconciliation of the non-GAAP to GAAP numbers in our third quarter earnings press release. Our non-GAAP gross margin improved by 70 basis points to 60% in the March quarter compared to 59.3% in the same quarter last year. The increase is predominantly attributable to favourable product mix and manufacturing efficiencies, partially offset by typical declines in average selling prices. Moving to operating expenses, our SG&A expenses for the third quarter were $172 million, an increase of 5% over the prior year quarter. In constant currency terms, SG&A expenses increased by 7% compared to the prior year period. SG&A expenses as a percentage of revenue improved to 22.4% compared to 24.8% reported in the prior year quarter. Given the volatility in potential future revenue outcomes, I will not provide our normal guidance with respect to SG&A as a percentage of revenue. However, looking forward, we expect SG&A expenses to increase in the low single digits compared to the year-ago period. R&D expenses for the quarter were $51 million, an increase of 8% over the prior year quarter, or on a constant currency basis, an increase of 11%. R&D expenses as a percentage of revenue was 6.7% compared to 7.2% in the prior year. We continue to invest in our business, particularly targeted at innovation. This is evidenced by the double-digit growth in R&D expenses in Q3. We believe our long-term commitment to innovation will deliver a sustained competitive advantage. Looking forward, we expect R&D expenses to continue to grow in the high single digits to low double digits, reflecting our commitment to innovation through the economic cycles. Total amortisation of acquired intangibles was 20 million for the quarter, a decrease of 10% over the prior year quarter, reflecting historical intangible assets becoming fully amortised during the quarter. Stock-based compensation expense for the quarter was $14 million. Non-GAAP operating profit for the quarter was $238 million, an increase of 31% over the prior year quarter, reflecting strong top-line growth, expansion of gross margin and well-managed operating expenses. Including the benefit from COVID-19 impacts, we still continue to experience solid operating leverage. Non-GAAP net income for the quarter was $188 million, an increase of 47% over the prior year quarter. On a GAAP basis, our effective tax rate for the March quarter was 14.9%, while on a non-GAAP basis, our effective tax rate for the quarter was 15.1%. Looking forward, we estimate our effective tax rate for the fourth quarter and fiscal year 2021 will be in the range of 18% to 20%. Non-GAAP diluted earnings per share for the quarter were $1.29, an increase of 45% over the prior year quarter. Excluding the benefit from COVID-19 impacts, we estimate our diluted earnings per share were $1.16, an increase of 30% over the prior year quarter. Our GAAP diluted earnings per share for the quarter was $1.12. Additionally, during the quarter, we recognised write-downs of $9 million associated with minority equity investments. Cash flow from operations for the third quarter was $240 million, reflecting robust underlying earnings and working capital management. Capital expenditure for the quarter was $30 million. Depreciation and amortization for the March quarter totaled $46 million. During the quarter, we paid dividends of $56 million. During the quarter, we also completed the acquisition of our previously announced tuck-in acquisition of Snapworks. The acquisition will be non-GAAP EPS neutral in year one and is expected to be accretive to non-GAAP EPS in year two. However, overall, the impact will not be material to growth earnings. We recorded equity losses of $5 million in our income statement in the March quarter associated with the fairly joint venture. We expect to record an underlying run rate of approximately $5 million of equity losses each quarter through fiscal year 2021 associated with the joint venture operations. Given the unprecedented nature of current events, I would like to make some comments on our financial health. Strong balance sheet has always been a hallmark of ResMed and is most valued by investors in times of economic uncertainty. We ended the third quarter with a cash balance of $353 million, having generated $240 million in operating cash flow during the third quarter and $472 million in the first nine months of our fiscal year 2020. As of March 31, we have $1.4 billion in gross debt and $1 billion in net debt. We had total assets of $4.5 billion. Our debt levels remained modest and at March 31, we had a further $895 million available for drawdown under our existing revolver facility. In summary, our liquidity position is strong. However, I also want to highlight that in these times of uncertainty, we are maintaining a disciplined approach and we are tightly managing expenses cash flow and liquidity. Today our board of directors declared a quarterly dividend of 39 cents per share. Dividends are important to many of our shareholders and the declaration of our dividend reflects the board's confidence in our strong liquidity position and operating performance. Turning to our fourth quarter outlook, at a high level we expect to see continued strong growth in our respiratory care business and expect incremental respiratory care revenue to significantly exceed Q3. However, we expect to see a headwind in sleep device sales in Q4 in response to a temporary reduction in the diagnosis of new patients. Masking accessories have shown resiliency over the past three months, which reflects the insulating value of the large patient installed base. Like many other companies, we are experiencing high uncertainty in the current environment with circumstances and information changing almost on a daily basis. As a result, our forecast and possible future revenue outcomes remain dynamic. And with that, I will hand the call back to Amy.

speaker
Amy Wakeham
Vice President of Investor Relations and Corporate Communications

Great. Thanks, Brett. Thanks, Nick. We'll now turn to the Q&A portion of the call. I would like to remind everyone to please limit yourself to one question, and if you have additional questions, please feel free to return to the call queue. Diego, we're now ready for the Q&A portion.

speaker
Diego
Conference Operator

Thank you. We will now begin the question and answer session. If you would have a question, please press star, then 1 on your touch-tone phone. If you wish to be removed from the queue, press star, followed by 2 on your touch-tone phone. If you're using speakerphone, you may need to pick up the handset before pressing the numbers. Once again, if you have a question, press star, then 1 on your touch-tone phone. Your next question comes from Leanne Harrison with Bank of America. Please state your question.

speaker
Leanne Harrison
Bank of America

Hi, good morning all, and congratulations on a great result. I'm very interested in, I guess, the outlook that you're getting on ventilators. You know, you mentioned you've got a 35 million tailwind for this quarter due to a three-fold increase in devices production at a 10-fold increase in ventilator masks. Can you tell me whether or not you're able to increase your volume of production for ventilators as you go through quarter four to meet any increased demand coming from other countries?

speaker
Mick Farrell
CEO

Thanks, Leanne. Thanks for the question. And yeah, you're right. We had two separate metrics that we sort of laid out there. One that we sold an extra $35 million worth of ventilator in the quarter. Those were from our inventory and stuff that we produced in Q2 and somewhat in Q3. And so that was a $35 million tailwind for our business and we expect some of that certainly to continue as the surge continues worldwide into Q4. And then in addition to that, we tripled our production from a year ago and we made over 52,000 non-invasive ventilators, bi-level devices and invasive ventilators. So your question of, you know, can we continue and or increase the production capacity? And the answer is absolutely yes. We are constrained on some key components for the invasive ventilators. So the Astral and Stella have some significant constraints in the components that go into those invasive ventilators. So the Astral and Stella type products. Well, Astral's an invasive ventilator. Stella's actually a non-invasive ventilator. But we really don't have significant constraints to the Loomis STA other than some components around the alarms module and the extra components and the air curve ST. So those non-invasive ventilators can scale to 5x or 10x and we can really scale to whatever the demand is. And so then it comes down to our ability to predict hospital by hospital, customer by customer, what those surges in demand are going to be as the virus moves around the world and to make sure that ResMed is there getting an order and making sure we can deliver those invasive ventilators, but really importantly, those non-invasive ventilators and alternative therapies that are also used in the different levels of acuity for a patient with COVID-19. So the answer in short is absolutely. We did all we could, and we tripled production in the quarter, and we're looking to do that and more in Q4 to deliver for the needs that continue worldwide.

speaker
Leanne Harrison
Bank of America

Okay. So just to clarify, do you think that you might be able to increase by 5x to 10x the remittance in airports? By how much can you increase production on the ventilator mark? Is that the number you have identified to drive the level? Okay.

speaker
Mick Farrell
CEO

I've got to say, Leanne, the audio wasn't fantastic during that, but I think I heard you say that how would we or how fast would we move from the sort of 3x increases to a 5x or 10x on air curve ST. That's going to be dependent upon our modelling of the different surges that happen city by city and country by country. And clearly, you know, the masks are used far more rapidly because they are changed over pretty regularly, certainly patient to patient, but often day to day with these non-vented ventilation masks. And so we expect the surge to continue and us to continue to be able to produce throughout Q4 and beyond for the needs as this virus goes around the world and continues to expand. Yeah, I've got to say, I think I heard you say, can we increase the ventilation mass production? We've increased it tenfold and we'll continue to do so. I think we should go to the next question. Sorry, Leanne.

speaker
Diego
Conference Operator

Our next question comes from Siraj Kalia with Northland Securities. Please state your question.

speaker
Siraj Kalia
Northland Securities

Good afternoon, everyone. Hope everyone is safe and healthy. Mick, just one from my side, and forgive me if you all mentioned this. Can you all help characterize your investment in Nexo? How you all are thinking about the neuromod market specifically for sleep apnea? What is the construct of ResMed's investment? That would be greatly appreciated. Thank you for taking my question.

speaker
Mick Farrell
CEO

Thanks Suraj, it's a great question and as you know, you've followed our stock for a long time, we look at a portfolio of investments to treat sleep apnea and around 10 years ago we actually invested in the 3D printing of a sleep apnea dental device called Narval and that's now a great part of our portfolio. and treats a great number of patients in France and across Northern Europe. The neurostimulation market is an interesting one. Nixoa, we think, is a leader in that space, and we decided to make a minority equity investment in them. I will actually hand over to Jim Hollingshead, who's the president of our global sleep business, to talk about how neurostim, dental, CPAP, and how it all fits together.

speaker
Jim Hollingshead
President of Global Sleep Business

Thanks, Mick. Just very briefly, since I know we're probably short on time now. The gold standard therapy for sleep apnea continues to be CPAP therapy, and we think that will continue for the foreseeable future. We get a chance to see a wide range of technologies as they emerge, and we always look very carefully at anything we think is an alternative. And as Mick mentioned, we obviously have a fantastic oral device, which we're selling Europe very successfully, the Narval device. High-tech, 3D-printed, very low volume in the mouth, very comfortable. We've looked at the NerveStim space for quite a long time. There have been a number of companies that have tried to succeed in the NerveStim space. We think Nixoa has a novel offer and is potentially disruptive, but it's very early days. It's a minority investment in what's effectively a startup company. So we like the technology, we like the play, but we'll have to see how it plays out.

speaker
Diego
Conference Operator

Thank you. Our next question comes from Chris Cooper with Goldman Sachs. Please state your question.

speaker
Chris Cooper
Goldman Sachs

Hi. Morning and afternoon. Mick, can you just remind us of the approximate pay mix in the sleep apnea business, please? And I appreciate this is a highly dynamic situation, but can you just share your thoughts on how you expect the higher rates of unemployment we're seeing in the U.S. to impact that business, please? Sure.

speaker
Mick Farrell
CEO

Yeah, Chris, thanks for the question. And yes, certainly, you know, every country around the world is different. I presume you're asking about the U.S. payer mix, Chris? Maybe you're on mute, but I'll start with the U.S. Okay. Yeah. So obviously we sell in 140 countries outside the US and on the reimbursed part of our business, the non-SAS part, it's close to that 60-40 range, 60% being within the US and 40% being beyond that. And if you include SAS businesses, it's more like 65% of our global business in the US. So I'll start with that. So, we don't have contracts directly with payers, but our portfolio of home medical equipment customers do, and there's around 5,000 customers in the US, home medical equipment providers, and their payer mix for the field of sleep apnea and COPD that we serve is around 20, maybe 25% for some regions, Medicare, and around 75, 80% private pay. And as we've seen through the COVID-19 crisis, we have seen ongoing payments from both the government and private payers through to ResMed. We are carefully watching our accounts receivable. And as Brett said, we're carefully watching our cash flow to make sure that payers pay on time and with time. But we haven't seen any issues as yet. Clearly, unemployment has increased in the country from single digits to double digits through this crisis, and it's something that all companies are looking at very carefully. But we haven't seen any issues as yet, but we are watching the cash flow very carefully to make sure that we have continuing flow of capital and cash through our business.

speaker
Diego
Conference Operator

Thank you. Our next question comes from Mike Mattson with Needham & Company. Please say your question.

speaker
Mike Mattson
Needham & Company

Yeah, thanks. So I guess first I just wanted to ask about the resupply business. You know, wondering, you know, why you think that that's been so strong. Is there any kind of demand pull forward happening there? Do you think that can be sustained as long as the pandemic continues?

speaker
Mick Farrell
CEO

Yeah, Mike, thanks for the question. And certainly, yeah, You know, it's quite interesting. As you know, you've followed us for a long time too, Mike. Our installed base of CPAP patients, sleep apnea patients, is a very strong part of our mask business. You know, we're talking north of 80 plus percent of our mask sales across the US are to that installed base of a diagnosed patient who loves their therapy, it's changed their life, and they're going to go to sleep. and reorder every time. I think the focus of COVID-19 and that it's a respiratory medical issue and that has raised the importance of making sure that your lungs are well taken care of and that you breathe well and that your overall health is well has increased people to make sure they get their prescriptions for everything, including post-heart attack patients are getting more prescriptions of their pills. As I noted earlier, the propeller side, COPD medicines and asthma medicines, we're seeing increased use of those in respiratory medical health. And we've seen a similar thing, I think, in the CPAP mask side, where when you are capable of getting a mask, you are more likely to click, yes, I would like that. And we haven't seen any reduction in people saying, oh, the copay's too high, or I don't want to go there. We've seen actually the reverse, where people are saying, wow, it's been 90 days, I'm due for a therapy, for a CPAP mask, tubing, et cetera, and they're clicking yes, and they're getting those devices delivered to them. We saw very strong ballast in the boat for our HME customers. And, you know, the HME customers themselves are really focusing on this part of their business because it's a good opportunity for them. We think, look, there will be some deceleration if there's some sort of that surge of the sort of The toilet paper model where I'm going to over inventory, I'm going to make sure I've got enough masks, that might decelerate somewhat. But we don't think, we think there's a lot of ballast in that. And people who are on CPAP therapy and loving their CPAP therapy are going to want to get new masks. And through COVID and beyond, the importance of respiratory medicine will only be increased because of this. So we think that part of our business is very steady through the crisis and even stronger beyond. I think it'll change behaviours that will last well beyond COVID-19 surge.

speaker
Mike Mattson
Needham & Company

Okay, thanks. And then just with regard to sleep diagnostic testing, you know, can you provide any more detail around the decline that you're seeing kind of late in the March quarter? And then, you know, to what degree could increased use of home testing, kind of some sort of remote telemedicine model offset that? And are you doing anything to try to, you know, enable the sleep labs to implement, you know, to ramp up, I guess, their home sleep testing? Thanks.

speaker
Mick Farrell
CEO

Yeah, great, great follow-up question, Mike. And we're doing a lot in that space. I'm focused a lot with Rob Douglas on our global task force on COVID-19 and ventilators. Jim Hollingshead, in the same time, has been running our sleep business strongly. Jim, do you want to follow up on the follow-up there on home sleep apnea testing and scale?

speaker
Jim Hollingshead
President of Global Sleep Business

Sure. Thanks, Mick. I think it's very difficult to quantify the effects and the balances of decline in lab testing and increase of home sleep testing in general. And it's very different country by country. both because of the timing of the pandemic and then how different health care systems are structured and so on. So, you know, trying to get a quantification, I think, is quite difficult. What we do know is we have seen some decline in in-lab testing. That's not a surprise. Health care systems around the world have shifted their focus to COVID-19. Many countries have gone on lockdown. Much of the U.S. has gone on lockdown. So we know that In lab testing has declined and dipped. We have some evidence to suggest it's stabilized at a lower level. It's hard to know exactly what that level is, but we think it's potentially stabilized at this point. But in parallel, we also know there's been an increase in home sleep testing and remote testing. A number of the labs around the U.S. have increased their use of home sleep testing devices and routines. And where that's done in Europe and can be done in Europe, it continues to be done. We think it will turn on faster in Europe. And the final point of your question is what are we doing? We're actually working very hard to enable home sleep testing to figure out how to help our lab customers and our physician customers virtualize their model, not just through our device offerings, but through workflows, through webinars and trainings. And we're working hard to see if we can virtualize some of that with software, which will take a little bit more time. We do think that a shift to home sleep testing, which has been going on worldwide for years, will be accelerated by this. And just as Nick said in his prepared comments, one of the things that we think will come out of the crisis generally for the sleep business is increased adoption of our already very broad offerings, virtualized care offerings. And so we think that will accelerate through the crisis and then head to new normal coming out of the crisis.

speaker
Diego
Conference Operator

Thank you. Our next question comes from Margaret Cazor with William Blair. Please state your question.

speaker
Margaret Cazor
William Blair

Hey, good afternoon and good morning, Brett, to you. Just wanted to follow up on the comment you guys had on production of NIVs and LSVs. I think I heard you guys say you produced 52,000 of those devices in the quarter, which I know you guys don't give ASPs, but it seems like it could be $200 million or $300 million worth of products in the device side versus the $35 million benefit you saw in the quarter. So I guess long intro, but the question is, were those made to order or in advance of demand, and how should we think about that product entering the field? Thanks.

speaker
Mick Farrell
CEO

Margaret, that's a great question. And yes, certainly, you heard correctly, we made 52,000 non-invasive ventilators and invasive ventilators. So that includes everything across the Astral, Stella, Loomis, Flexo. GA and Aircurve, all those devices. So we included across all that group 52,000 and they have very different pricing. But clearly it's a lot more than just the $35 million of sales in that quarter. So we are prepared for demand ahead The only thing I'm really willing to say on a public call like this is that we have a public capability with the US government through HHS and FEMA. of over $30 million contract. And so that's a fixed contract that we will fulfil, mostly in ASTRALS. But we have many other contracts with hospitals, states, governments, nations around the world. I'm not going to go in and quantify any of those. They're usually one-to-one directly to those countries and directly to those hospitals. But what I can tell you is All the demand that they have and all the supply that we have, our supply just cannot keep up with the demand as it moves around the world. And so what we're doing is maximizing production in advance and then making sure we get through the peak and through the surge, but not have an over amount of inventory at the other side. And so we're carefully managing the peak. The surge, the flattening, and then making sure we get back to normal COPD, neuromuscular disease, ALS, and other sales with those ventilators, because those patients will be there beyond. And that's how we're looking at it, Margaret. But yes, clearly, we are preparing for more sales in the future of those ventilators and ventilation masks. Those tailwinds will last through Q4 and likely beyond.

speaker
Brett Sandercock
CFO

Yeah, I'll just add quickly, Mick. Margaret, yeah, there's a lot. There's a meaningful amount that's in transit, so to speak, as we're trying to get those into our DCs and then ultimately to customers. So there's that. That impacts it as well. So that will continue to produce. And as Mick said, the demand is there. It's just a matter of getting it through the logistics.

speaker
Margaret Cazor
William Blair

Thanks, guys. Congrats.

speaker
Diego
Conference Operator

Our next question is from Steve Ween with Evans & Partners. Please state your question.

speaker
Steve Ween
Evans & Partners

Yeah, good afternoon, good morning. Just a question on the FDA in terms of its response to COVID-19. It was alluding to the use of CPAP as being something that could be utilised. I just wondered what the experience was there. And then the other item that the FDA had done was to remove ventilators from the competitive bidding process. and there appears to be some pressure to delay competitive bidding in the latest round. Just any comments on any of those three things would be very useful. Thanks.

speaker
Mick Farrell
CEO

Yes, Steve, those are great questions, and I've had actually quite a lot of conference calls with the FDA Commissioner Hahn and HHS Secretary Azar during this crisis. ResMed was part of a Defence Production Act that was put in place by the White House to secure component supply for our ventilators so that we could supply HHS, FEMA and beyond. And so had a lot of interaction there. Look, the FDA have really been a great partner through this process. They helped us get emergency use authorization, EUA, for a number of our products there. to be used in different contexts. So, for instance, our non-invasive ventilators, which were very scalable, and as we talked about, we made tens of thousands this quarter. We had doctors wanting to use them in various ways, invasive ways and others, and so the doctors needed an EUA to be able to do that, and they have got that, and the FDA were very quick to us and other manufacturers in providing those emergency use authorisations. Simultaneously, Secretary Azar over at Health and Human Services and CMS, they did take non-invasive ventilators out of competitive bidding round 2021. And that was a very good change for our HME customers. It really took a load off for them, knowing that these NIV and ventilation businesses will be good ongoing concerns for them. So we saw good partnership from both the FDA and HHS as part of this crisis and HHS also worked with FEMA to make sure that we got the demand and that was the 30 plus million dollar contract I talked about to us and there were five other manufacturers who got contracts as well. I think the government's not just in the US but in all 100 plus countries that we're working with here through this crisis have done a great job in contacting us, working with us, helping us with supply chains and helping us with delivery of ventilators to people in the need for this crisis.

speaker
Steve Ween
Evans & Partners

And so the final part was just the pressure that's being or the attempt to delay competitive grid in, the likelihood of that?

speaker
Mick Farrell
CEO

Yeah, I'll hand that over to Dave. He's got more insight on that. Dave Pandavas.

speaker
Dave Pandavas
Company Executive

Yeah, so thanks, Steve. We, along with the rest of the industry, have been suggesting to CMS that they either delay for a year the introduction of the 2021 round entirely, or at least the respiratory offerings, respiratory product codes within that offering of the 2021 round of competitive bidding. We have had a dialogue with CMS on that topic, so they are listening. but I can't really handicap the likelihood that it will happen or not. I would echo what Nick said earlier, that CMS has been very responsive, and I think it has highlighted the importance of DMA and home-based care in ensuring that as few people are in the hospital as not, and that's a real positive, and we hope that that cooperative working relationship will continue.

speaker
Steve Ween
Evans & Partners

All right. Thanks, Steve.

speaker
Diego
Conference Operator

Our next question comes from David Lowe with J.P. Morgan. Please state your questions.

speaker
David Lowe
J.P. Morgan

Thanks very much. Mick, can I just follow up on the use of bi-level devices to treat COVID-19 patients? I mean, there's clearly the aerosol issue and the safety issue there. I have seen some efforts to overcome that. Do you think that's going to be, and I heard your comments, excuse me, about the amount of manufacturing capacity you have. Is your expectation that there will be continued strong demand for that utilisation model?

speaker
Mick Farrell
CEO

Yeah, look, it's a great question, David. And certainly, you know, through this crisis, one of the leading countries early on this was the UK and the National Health Service there, sorry, the NHS. And they created a protocol which looked at the various acuity levels of a COVID-19 patient because the disease... you know, the coronavirus gets into the lungs and then causes the COVID-19 disease, which is where mucus builds up as the alveoli react and try to fight off the virus. And it creates mucus in the lungs and builds it up. And so at different levels of buildup, different levels of acuity, different therapies are needed. And so the NHS created a very strong protocol of using both CPAP with some supplemental oxygen from the wall, as well as bi-level therapy, and then upgrading to more aggressive therapy non-invasive ventilation therapy, because bi-level is non-invasive positive pressure ventilation therapy, but then upgrading to higher levels of non-invasive ventilation therapy and even upgrading all the way to the full intubation through the trachea of invasive mechanical ventilation. And all those different modes can be moved up and down by the doctor as they move through the process. your question about, and it was a big question and concern early on that, oh gosh, what if we have some contagion that some of the COVID-19 will come out? Well, before you put on an invasive mechanical ventilator, if a patient coughs or sneezes, the room is already contaminated. So even with invasive ventilation, there are some contamination protocols. And so what you need is a COVID-19 ward, You need PPE for everybody and you need to establish this floor of the hospital is for COVID-19 with negative pressure and take care of it that way. And that's what they've done in the UK. And actually that moved to different parts of New York, New Jersey. And as we see this go around the world, people are learning to do that. What you have is a non-vented mask. So a ventilation mask with an inlet and outlet and then a filter on the outlet of the device. And so our chief medical officer, Dr. Carlos Nunez, has been working with key opinion leaders worldwide, and we have a clinical white paper with best practice from Wuhan, from Milan, from London, from Munich, where they're doing it really well in Germany, and from New York and around the world. And that protocol does include CPAP, it does include bi-level, it does include non-invasive ventilation with positive pressure, all with specific masks and specific circuits set up, all the way up to invasive mechanical ventilation. Now, the second part of your question, after the crisis, will people continue to use more non-invasive ventilation? I think the answer is yes. I think it's going to be similar to digital health, where you've had to use home sleep apnea testing, you've had to use remote patient monitoring during this crisis, and you don't want to go to a patient's home, you don't want them to have to come to hospital, and so that's driven digital health. I think people, doctors in critical care units, have seen how non-invasive ventilation, including bi-levels, has very well treated patients with COVID-19, why can't it very well treat COPD patients? Well, guess what? It can. So I think the adoption of NIV will increase post-COVID-19 because of the learnings during COVID-19. I can't quantify that exactly. It's more a median long-term thing. But anyway, I hope that answers your question, David. It's a very good one. It deserves a longer answer. And I know we're 10 minutes over. We might just take two more questions and let everyone get back to their workday. Three more questions. Okay.

speaker
Diego
Conference Operator

Thank you. Our next question comes from Matthew Mission with KeyBank. Please state your question.

speaker
Matthew Mission
KeyBank

Great. Thank you for taking the questions. And also, it's really remarkable the efforts of you and the employees of your company to support this crisis. So thank you for that as well. I'll just leave it to one because most of my questions have been asked. I've heard that there's potentially long-term respiratory implications from COVID-19 exposure. How do you see that patient transition to post-acute?

speaker
Mick Farrell
CEO

Yeah, it's a great question, Matthew. I'll hand that to our President and Chief Operating Officer, Rob, to talk about post-COVID-19 discharge. What are the next steps, Rob?

speaker
Rob Douglas
President and Chief Operating Officer

Yeah, thanks, Matthew. That's a good question. You know, it's still an uncertain world in terms of what these post-COVID are going to be across the board. We're seeing different trials and tests being carried out. In some areas, we are seeing patients get discharged with oxygen and we are noticing an uptick in demand for oxygen around the place. And in other areas, we are seeing some discharges with more CPAP. But I think it's still way too early to say. Probably the earliest data we've got is in China where, you know, things are normalising a little bit. The sleep labs aren't yet open, but we're seeing continued ongoing demand for longer-term ventilation. So it's probably leading off the dynamic that Nick mentioned earlier, that ventilation, this non-invasive ventilation and chronic ventilation is recognized as a more relevant treatment than what it had been before.

speaker
Diego
Conference Operator

Thank you. Our next question comes from Sean Lehman with Morgan Stanley. Please do your question.

speaker
Sean Lehman
Morgan Stanley

Hi, Mick. Hello, everybody. And well done, Mick, clearly doing a great job navigating. Sorry if I've missed it, but my question is, the $35 million of COVID revenue, was there any geographic sort of break-up of that? And, you know, just to clarify, was that all bent revenue? Thanks, Mick.

speaker
Mick Farrell
CEO

Sean, that's a great question. Not comfortable going into details of where the $35 million came from. That's sort of our global number. And it's truly an estimate. The vast majority of it is ventilation. And so it's Astrals, Stellars, Loomis, Aircurve ST types of products. I'll hand over to Brett Sandekok, our CFO, to see if he wants to provide any further detail on that $35 million.

speaker
Brett Sandercock
CFO

Yeah, thanks, Mick. I mean, there will be some masks and accessories in that as well. Maybe that accounts for kind of 10% of that number, and the rest would be devices. Great. Thank you, gentlemen.

speaker
Mick Farrell
CEO

Thanks, Sean.

speaker
Diego
Conference Operator

Your last question comes from Gretel Janu with Credit Suisse. Please say your question.

speaker
Gretel Janu
Credit Suisse

Thanks very much. So you mentioned the double digit declines in the diagnosis rates in the quarter due to lockdowns. I'm just wondering whether you saw any slowdown in the actual sleep new patients set up in the third quarter or will most of that impact from the slower sleep diagnosis impact the fourth quarter? Thank you.

speaker
Mick Farrell
CEO

Yeah, Gretel, thanks a lot. Look, as you can understand, there's a lot of moving pieces going on right at the moment, and we're watching it through the quarter and in different countries. And even in some countries in the world, we've seen that decline. Like in China, we saw that decline in January, February, and we're actually starting to pick up on the rates as you started to exit the quarter and some regions of China starting to to open up and then diagnoses starting to open up again. And similarly in South Korea and some other areas that have COVID-19 under control now. But I'll hand over to Jim Hollingshead to see if he wants to provide any further details of the sort of kinetics of the double-digit reduction in diagnostics and the impact on sort of that headwind, I guess, of sleep device sales while we have the neutral element of sleep masks continuing through. Jim.

speaker
Jim Hollingshead
President of Global Sleep Business

Yeah, thanks, Mick, and thanks, Gretel. With a little bit of a lag, you can also see a bit of a drop-off in new patient starts, which we have the ability through our connected solutions to see. As I said before, I think we're seeing diagnosis stabilize a bit, and I expect some countries to start to turn back on in the near term. And we're seeing new patient starts also stabilize a bit. So hopefully we'll get a bounce back. Off of the floor here, it's very difficult to predict what that will look like. It will be different country by country, and even metro area by metro area.

speaker
Mick Farrell
CEO

Great. Well, thanks for all the questions, and thanks to everyone for continuing the 15 minutes over here. I think we'll all agree this was a very unique quarter for not just ResMed, but for all companies worldwide. Look, I'll go with the close now I think here and close on up. I'd like to thank again to all our shareholders who have joined us for this call. I'd also like to shout out again to the 7,500 ResMedians helping people in 140 countries. You guys are also shareholders in the most part, and I want to thank you for your dedication and hard work helping people breathe better, sleep better, and live better lives outside the hospital. Thanks for all that you do all day, every day. Thanks especially to those frontline heroes, the people making the products, distributing the products, and getting those vents to those 140 countries, to somebody who's suffocating and needs our help. I look forward to talking to all of our stakeholders again here in 90 days, and with that, we'll close it up. Thank you, Diego.

speaker
Amy Wakeham
Vice President of Investor Relations and Corporate Communications

Great. Thanks, Mick. Thank you all again for joining us today. And just a reminder, if you have any additional questions, please don't hesitate to reach out to me or to Investor Relations. And as previously mentioned, all the documents along with the transcript and a replay will be available on our website later today. Thanks, Diego. You can now close the call.

speaker
Diego
Conference Operator

Thank you. This concludes ResMed's third quarter of fiscal year 2020 earnings live webcast. You may now disconnect.

Disclaimer

This conference call transcript was computer generated and almost certianly contains errors. This transcript is provided for information purposes only.EarningsCall, LLC makes no representation about the accuracy of the aforementioned transcript, and you are cautioned not to place undue reliance on the information provided by the transcript.

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