Cardiovascular Systems (CSII) 9 Nov 212022 Q1 Earnings call transcript

Hello everyone and welcome to the Cardiovascular Systems first quarter earnings conference call. My name is Juan and I will be coordinating your call today. [Operator Instructions]. I will now hand over to your host, Jack Nielsen, to begin. Jack, please go ahead.

Juan. you Thank welcome call. and fiscal first XXXX Good to conference quarter afternoon our With Chairman, Points, Ward, Executive Scott me are today CSI and Robb, Operating Officer Officer, Chief President Officer, Financial Jeff Chief Dr. Rhonda Chief and Egeland, Medical Ryan Chief Officer.

earnings we companies morning medtech in to quarter, results quarterly after avoid This close. call multitude to the the our moved of reporting order the market

we fewer three new So slot is ago, in that hours resulting Approximately you. this time a announcing scheduling hope release for I convenient, conflicts results. press first issued minutes more quarter

the may Relations copy You a of find of this website. release corporate on Investor our section

for may also September XX, first After you In includes and quarter our supplement that XXXX. outlook. will we prepared additional results details a questions. few Here, management entertain the an our CSI your performance find ended on moments, remarks, earnings discuss will

as update future result discuss information, most created will revise of condition we which and call. otherwise. uncertainties, financial risks Litigation results safe and differ under or uncertainties today's could those of subsequent the quarterly will statements business, not facts. disclaims developments to duty are XX-K historical prospects, other this are a pandemic or During events, has we or statements implied call, Securities covered of particular, risks our Act Form forward-looking operations, described reports that statements. statements CSI's our and CSI in statements In results due harbor certain future and for any recent provisions statements our forward-looking regarding and operating COVID-XX stated Reform forward-looking These forward-looking from on to new of on the make Private include Form Actual the by those materially and XX-Q. or results our including financial XXXX

call turn our results. Today's also reconciliation will refer now to measures useful Ward. release GAAP table non-GAAP to provide I investors. Scott contains over press will information they the we to because believe for a We

you QX were Good X-K morning And and thank the hospital our decline everyone. impacted the largest greater we Delta joining surge. issued notice the reported shortages of adversely our you constraints the revenue by severity procedures the acuity million, related The pronounced be Consistent than capacity patterns the versus location we caused Jack. volumes are Delta COVID COVID was of that elective a for September, lower Today, of the in claudication. with year. with X.X% The had that and procedure Thank treatment by deemed and impact impact $XX.X prior staffing and was to expected resurgence as of such peripheral referral COVID us variant. today. of disrupted more the more geographic the to patients duration and in timing due of

be tend Our volumes to in procedure quarter September. towards heavily weighted first

pace of that the are staffing recovery However, of predict of the to which dynamics improvement Southeast and do the by the due procedures but We region variable and this expect new the variant of revenue. XX% year be in shortages. Delta recent recovered difficult than our these States capacity was ICU United represents South more severely typically some constrained will the of throughout we and is by the trends introduced encouraged to the

would XX similar XXXX. anticipated transient fiscal fiscal sales sales in experience half result, we guidance or of QX the XXXX impact that month contemplate on a We over trend were financial by a recovery caused experienced of declines a August COVID from in did not that fiscal be we whether later which followed As trends normalized the are and in The full we an then will because recovery waves issued outbreaks more year. COVID the uncertain X our period.. second the in

the first the expect the over larger this due remainder in impact to than do of the we normalize year. impact quarter, the not variant Delta anticipated to fiscal negative and was However

the fee are an remains cause products are in the this new markets factor environment for COVID to increased And anticipating economic perform we who physician the issuance with competitive Although recent most important pressure the we temporary PVI our setting. increasingly of and well. that the office-based course, our players disruption impacting as our procedures in entering market negatively new schedule, and may responding also is following customers of labs business, a

our In moments, As commercial in-human guidance. and financial have revenue an impact, recent update we in revenue to coated fiscal coronary details by Despite guidance will COVID address announcement Egeland reduced then programs our current first associated provide broaden we regarding progress and to developments everolimus our on revenue our streams. Ryan the Jeff? the Dr. a and are our encouraged making we few a commercial Jeff XXXX and first, outlook. our the efforts provide experience with But will our result, reflect CVT's drug results Rhonda widened will uncertainty our our with balloon. regarding are

million. combined million. $XX adoption decreased hospitals revenue to in peripheral with and decreased support Good as Worldwide OAS Device now continued X%. about coronary Scott. coronary the OBLs revenue coronary financial in X%. revenue the the of provide coronary device brief Thank a the a S., morning of $X.X In increased Worldwide Europe. Japan review U. revenue result million. I increased increased strength to XX% peripheral S., decreased U. XX% will results. S., you in million QX X% increased X% revenue to revenue to in $X.X $XX.X Peripheral decreased U. million. revenue revenues Outside everyone. of our $XX.X In growing product to

Net prior profit these with lower loss prior anticipated was securities the $XX.X and $X international X% R&D was million the XX.X%. $X.X marketable volumes the compared This We reflective to no million. and mix continued long totaled of increased Gross while of expenses. $XXX and the given a share. in higher to SG&A revenues. COVID cash quarter per year. margin is $X.XX in million. expenses Turning million expenses year term borrowings. savings and higher or We ended Operating expenses ISD increased achieved

During milestone a our payments to these associated payment QX programs. of investment will notably we our QX in more DCB have with related and we most strategic portfolio had

COVID our pandemic not outlook. dynamics a to Turning over and The is certain market persists.

all Specifically, impacts the patterns, that of XXXX. shortages, an of staffing disrupted OBL reduction competitive impact expected remainder a recovery, and fee customers fiscal referral to timing physician COVID to revenues XXXX environment for schedule the the our are increasingly

in a revenues. in a forecast adjusted the X% the approximately of range will Gross X% For of fiscal ending of X% to of revenues. growth X% the over EBITDA call in revenues range $XXX million Rhonda to X% prior year. turn of XX% update. year will now Net XXXX, to loss we versus million I range now provide who representing XX%. commercial margins to of XX, to June And $XXX our a

thoughts results, the reimbursements and driver you some Thank good XXXX key for Jeff update of provide and you fiscal morning regarding everyone. developments. will QX recent I share my Today, on

the in another the weakness to see we established hospital seen in as Regarding segment in QX, peripheral the QX accelerate did the significant that much we remains surge. have pandemic, business. COVID And of of of throughout momentum face had most our the we

it research select time backlogs anticipating in treatments. customers just believe our market geographies, are of many near now and of that a they return While reveals headwind they matter COVID patient for before a is term remains of

procedures last segment OBL due previous impacted see of increase less We the in to than waves just of pipeline. we improvement Florida service be are like our to starting X% full a patient modest than where appears business to rampant hospital procedures The year. Texas, slower side and states need our issues and referral to now in the was albeit saw the of normalize staffing over

procedures, in devices patient staffing is seeing While for claudication. for the we with this issues impact we targeted than patient trialing were up recently Patient been OBL and sequential given also referrals ATK a recent of type still from and of experiences less challenging. QX resilient low service pronounced showing have flow pandemic. Competitive did equally entrants hospital, the atherectomy their priced and has are increased however more

by to expanded and by competitive believe in this of COVID of trialing offset adoption with was decline S. We introduction Turning procedures. of related to number be continued some OAS U. impacts growth driven decline coronary coronary. and coronary products coronary support X% balloon our X% to a new our revenue as a accounts. into the primarily of a

distinguish to the cases hospitals As is coronary proper we increased use discern see which largely that continue where stated to is And driving imaging given artery atherectomy adoption complex that imaging of of lesion disease enables on to focus orbital selection. why complementary patient as used we morphology in treat previously, these calcium.

eccentric use distinct in simply lesions severely coronary nodular to Revenue such calcium, grow. calcified won't lesions procedure intimal balloons per heavy have a course multi-vessel and calcium, disease continues of We long cross. stenosis, as in where and

During sold. QX, support were our as even coronary products shows for increase, every $XXX modestly OAS we procedures ISDs The coronary of sold how resilient quarter-over-quarter, declined.

doors over are support to to system. products representatives of in enabled agreements were our U.S. total, portfolio expanded XX% ISD sell In contracts health quarter. million the Our new of also for have Recent our in opening coronary access sell. our representatives $X.X sales

fellows the continue new rate revenues restrictions Our leading strength continued as we international case in muted XX% progress beyond business OAS access in of XX where have certified coverage abilities and quarters Japan U.S., our consistent now Nevertheless, was and coronary facilities. coronary of we our to QX And pandemic. on product. with share. $X.X users. the new to our use in million our we of prior with market users grow customers the demonstrated Outside train This the result for indicator a QX many is of in of a QX, is

for that saw pace are are the of increased We of Europe demand in adoption Japan. actually where in our product seeing ahead we we

Australia. we addition, in and Canada launched have In

of strong certifications new the States and exclusively an indicator user sequential important continue physician training growth. training all nearly experience We and QX. United demand for the outside poised leading we certification believe our using to XX in markets. We international We are as Again, support. interventionalists resume growth. remote to for during certified quarter, case Shifting coronary to see we

of OBL. quarter, will users we systems deepen training new PAD accounts new the penetration in large and in hospital continue to This and

launch commercial catheter. full initiate We the the of will ViperCross also peripheral

a catheters products specialty So full forward. will offer adoption and believe that now, strong and going of peripheral experience balloons, to array we continue we these support guidewires

also users revenue focused per our ISDs For will case. the quarter are pipeline and certifications user training with has and along in be significantly accounts new business, driver and new a we growth on coronary new our expanded and

contracts For new penetration. and businesses, we leverage both access ISD for our will peripheral deepen coronary to OAS and and

international. to Turning

several in XX OAS We throughout QX our expect launch us countries strong revenue plan and fiscal close we will bringing countries to beyond, Europe growth by in to and year-end.

the and U.S. this Now, turning of in with complex, X.X%. year, coronary, the inpatient sites increased of for is reimbursement peripheral. of of we positive. except Reimbursement OBL to that see a sites the for with even reduction changes weighted service mostly the changes a including all service, peripheral, increases is notable In It OBL. across both across X.X% lot the outpatient impact Starting weighted is all reimbursement. the all a impact with of decrease, of

results at for look OBL X. atherectomy in OBL The closely. schedule January XXXX fee let's the XX.X% effective a of changes decrease procedures physician So, more

OBL has CMS support, sites anticipation continues rule the will than and of CSI This OBLs developed between a and result that digital of to products this as help of we this trend enable reduction, XX.X% become underserved more be CSI for launching efficiencies customers hospital ASC site new service. reimbursement believe pressure actually technology atherectomy PAD support of to focused in consulting trend areas our help a volume-based outpatient program attractive. This and services, reimbursement could treating contracts, ASC will In clinical patients proposed approximate This We population. assistant mitigate introduce high as expected this the inventory impacted treating drive will dynamics of While consolidation where contemplated new types throughput. in is and economically ongoing trends, business claims further reduction. program our may better and volume challenges OBL of also hospital, is patients management, an like the be option to service continue and/or and these and patient complex on focused. in

The X.X%. to overall the positive procedures minus reimbursement XX% between with our business, business OBL. So, in the our X% of is for seeing of sum and X.X%, is our increase in XXXX weighted to all XX% of exception and reimbursement our continued showing peripheral the coronary stable of CSI impact for procedures an changes for and of

Finally, as recently reviewed last Editorial code once postponed. by review LER codes month. the were that once know, CPT has extremity revascularization the been the again the you panel Panel published lower And been

societies point, panel panel at will believe this it and with set codes the uncertain will we So continue work code remains the to when these the review to again. the restructure

codes estimate XXXX prepared that be completes is over new before it That these are I and Our my it remarks or will will later implemented. to Ryan. turn

two the in long formulation, with associated first almost you Rhonda Thank in hyperplasia coronary restenosis CVT at or and Chansu our Physicians disease we active program CVT's DCB restenosis, are stent week, good developing in-stent we of CSI coronary being and morning. everolimus associated treating agent this announced completed pleased estimated. agent milestone colleagues as in lesions. experience and this and drug-eluting to efficacy bifurcated earlier we of safety increasingly for that with in-human the rapid the tissue acts Vascular first complex vessel has a interested years than small originally incredibly with artery using drug-coated drug coronary in-human reduce Last applications. and cytostatic balloon and CVT. Everolimus, the pace this and Technologies with are We at a history are

excellent reported and deliverability we first in treating crossability anterior procedure the week, As use a CVT's the emphasized successful coronary restenosis of descending and reported case in-stent CVT in the balloon. last of human DCB of artery. physician left The its a conducted

providing In to XX to begin IDE CVT years I you months. this key on submission Looking the look these to used are next pivotal continues will final will coming to will hand that across XX XX two program in I delighted our Europe achievements, program sites your data to ahead, study, it exceptional over further back support approximately and follow-up we meet forward enroll for up coronary DCD to now. to exceed peripheral report to at well. comments. XX from these patients as months milestones the which will CVT from U.S. Six Scott, an year. updates now for be parallel procedures

Ryan. you Thank

while affecting our a are they Our DCB financial example of COVID progress business great innovate near broaden headwinds the term of program term new and is the to streams. diversify pipeline making to are are our long we a revenue our develop And diminishing products. drive results, our and not

As we line as year in we vessel coronary large and catheters CTO have will in soft platforms this indicated fiscal well later previously, full on knee. new of plan our of and scoring greater as is The plaque crown atherectomy to XXXX. available mix above peripheral vessels crown fiscal line introduce treat larger a a balloons and a gain large vessel aluminum of all designed the to providing be the

experience later We first in-human continue excellent continue and support fiscal hemodynamic this on target make to the to device progress year.

strategic strong international the fast for deliver execution Like the stable of to that staffing, segments other and range. targeting volumes our in frustrated performance of coronary growth intend growth the development level, and initiated you with see improvement could The share we have to the we programs at midpoint markets. share procedure coming of of here over fiscal sales new imposed the the combined details revenue of greatest else, products, business. XXXX are If remainder and in continued staffing, end resurgence growing domestic revenue guidance of markets, success our this upper addition, of reflects healthcare specifically how year. by To those up our markets. in variant We everyone reflected of conditions revenue In fiscal peripheral we million in U.S. and the higher impact is in months. I COVID uncertainty market workers now stable range is of the volatility workers modest COVID international in be and current $XXX with the frame dynamics the sustained COVID and of million on we headwinds, introduces clear, $XXX the degree And our of our healthcare that the a Delta guidance. has shortage investments the

share new the and lower our end market decelerating COVID U.S. I While performance surges, staffing range could the described. healthcare of deteriorating to reduce

CSI do of expect near during all continued I CSI rebound to for Although, now and we challenge perseverance, our instructions? growth would would that COVID dedication thank a and delivering would return your transient we your double don't please dramatic to questions. will historical our interest term, for Juan, I compassion orbital believe digit you also the its extraordinary atherectomy is their in take exceptional time. customers trajectory. in a we business like that thank our the will you patients to employees and and support like in this repeat to

[Operator from Matthew, go Please, Stifel. Instructions]. And Mathew our comes ahead. first question Blackman from

Good questions. and morning for Thanks is Jeff. or Maybe my maybe Scott everybody. for this to taking start

quarter, about the fiscal growth? I a And should XQ about XQ? have like like should expect we looking cadence more any Or thinking and thinking think second of then couple Just the sequential follow-ups. we

you first anticipate stronger second Yes, through we Thank year. think this And head the fiscal quarter question, the be of second for continuing our momentum than I half we our as quarter. Matt. will

out Okay. about or that. quantitatively the XX% business saw regions, sense of of the versus in the so get outside we of you maybe U.S. the of XX% it just the of I I in XX% by a those the then COVID? talk of of sort that's in business appreciate heavily that am impact impacted the growth that sort possible And Is you COVID. geographies called qualitatively, business curious, obviously of were

other unaffected in difficult that were states by segment way not it It's necessarily because the to Yes. COVID.

of draw you line. where depends kind the it So

than let's of that states business greater continued larger largely those see In saw utilization, our say, that we ICU disproportionately our XX% pressure anticipate, our to did a were well. the in had Southeast states sales. you that, even in that business segment or South reduction in and larger impacted, which a we represented less better, that although states as If

one I I prepared step in margin apologize does right. quarter. I the first a if remarks. this All from the last But you will the Jeff. for imply, down guide in think, gross squeeze one mentioned And

how margin call And XXXX? so work terms driving that what the you so through of are we sort as pace could if gross about our And you way of in what's anticipating should of out? think that drag, much. Thanks we fiscal

for question. Yes. provide Thanks guidance, did the Matt, for year. In XX% my I the

I And going really forward. for to from was think the quarter that balance it's consistent be the XX% the for at guidance each pretty a biggest I reason mix. moving provided here about reduction previous

are revenues. seeing ISD just of international higher a We and proportion

Of pulling lower of overall bit course, the a revenues, margin down segment. also that's that slightly. think, I also then, a lower is And just

So of will see throughout I really rest the think balanced you the a year. XX%

Thank Pasquale you. question next go Guggenheim The Securities. comes ahead. Please, from Chris from Chris,

think called that hitting with? talk to really are uniquely bit of OAS is deal was peripheral segments way you volume technologies previously. these heard pressure It in like about of fronts, seeing? across you coronary. think you And Can a don't trialing in portion vulnerable what suited your to on other you versus what it competitive procedure of more you some I is that something little really sounded those out I you a think Scott, have do you and two Thanks. really different

Yes. the Chris. question, Thanks for

hospital and we peripheral we now, in new in we our products the enter our players also business. coronary are As the or obviously our market both pressure our renewed And competitive market and consider are OBL. new share segment, in seeing seeing right in new

lower peripheral, for alternatives. new are the let treatment these coming trialed In of and we with peripheral of take products number in being And So first. favorable entrants seeing are acuity are that claudication. more lower that patients cost say, let's segment a have me economically a typically the

impact, our is transient this device. because nature expect unique largely We of a that the of

a have we lesions. calcified on very product. that of severely differentiated know treatment focus these the We You

range. share will mainly hospital in continue, treats market We of in sustained have critical is peripheral below largely that And a that And of technology segment we high that pathology. XX% XX% our anticipate unique our because comes principally that limb focused of generally knee from very our is the as revenue focused, have patients treatment on the ischemia. and that know, you

market that we accounts on So share quite focus volume also segments. we those complex on continue we continue focusing as patients, are confident will sustain to higher these more to strong that in are a

Turning to coronary.

trialing seeing of balloons. IVL We are increased the

I think amount the of have let's being increased trialing say, improvements the of have some resulted, barriers and the removed that economic performed. is have reimbursement

really for However, we example, complex very device believe know, a very the of coronary the very important to care of in a that is vessel of fact patients to change remove place that disease. calcium you We the apposition in you lumen. compliance that our and has it's that use for know still from it good indication unique so artery stent. atherectomy have We important when get that a stent

time this very that and cases digit we to expect indeed you us. out we sustain get we over double to will our that that and expect low So that from have that really to growth confident trialing come will continue are level

fiscal that the XX% number impacting Obviously, we being ability macro will coronary to to XX% in this and impacted variables time over in time. that our to half head of XX% trends growth and expect as in that are a I particular, think year, perform right second business continue But to of by we environmental our to we range over grow. these into normalize. our are business can begin now, we

rule impact to with it's front you based of the that for potentially of And could of a this kind it what codes the quarter on years? first structure. a the final Can the time? then rightsizing Thanks and customers the on the about incremental idea So it's the several this changes little business think like for the was does the How I over bit are be is hearing made, going piece portion in Thank payment other but this out multi-year talk obviously from you of the OBLs. not that seems was that peripheral, the that reimbursement were first piece that. viability of that process to you. now

Thanks Chris.

us it's schedule. think fee to really interpret of early the still I physician days impact for the

patients likely very have office that was staggering. unbelievable an The are are and about the reductions really country. that care. there's based especially cases customers performed by have expense of of the Two single environment of million origin Customers in an disparities with receive high due CMS labs annual are the implemented the incurred in States. demographics from the Americans an at this a in time amputation CMS and reduce to where frustrated. would United at Our PAD comes of growing that This course Caucasians. XXXX. X% few treatment on effort disease that such over times incidents really rate. past direct we reduction frustration digit years important our care, in patients. a more their taken epidemic CLI patient commitment to this to important access continues be on their that's to and The the to PAD seems basis in XX Black in to It two an million have than make

yet, into to to improve is smaller And for to of significantly I positioning more years accounts point, I patients segment some in expect and side of provide be probably is where And Rhonda expect we payment situation critically of office think also more large larger the several that in this makers expect continue of the consolidating do at these will initiatives as consolidation to care see with will that patients chosen that OBL volume a which, expect obviously have frankly, hospital the see market, Quite complex to ability we We over where that with focus the that see of important segment, do the with service. based OBLs expensive. environment, We we way, reduce the improve our implementing policy our return the volumes to need by more high-volume to be have past been their labs in treated. deal of OBLs. described, them are the to those on patients. course to to over the And time. more care large successful high-volume and have OBLs patients

where we has years. no latest PFS next headed. several are will now for over a this be can that going been past challenge that's that continue We This the longer reimbursement Certainly the environment reimbursement ruling just is to assume So in indicates our years. to few It's care answers continue are get our they to to their customers that's that and to OBL be now going better. challenge patients. a able, And to to we ensure focus. Hope the have for work question, with really, that your it Chris.

you. Thank does. it Yes,

go Danielle, next Antalffy SVB ahead. Please, from Danielle Leerink. The question you. from Thank comes

everyone. taking the question. Good for Thanks Hi. morning

on a little procedures OBL bit you from hospital, It with to differentiated a competitive a was changes mean the was and But these of fact service like OBLs. one I happen is in your how these follow-up area the have if back an hospitals? felt go the very of see how into going about this that different? higher where Chris' the competitively support I follow-up. differentiation hospital? of we CSI more How into think what's I question hospital And do perspective, the guess if talk a Just have regarding to all the there can proportion shift about cases transpires. we dynamic any

XX% overall XX% in is of generated Yes. office our the About CSI based to revenue lab.

has hospital have, rate. As in of course, that share to which Rhonda the the had indicated, it that in segment, segment, peripheral is GAP] -- we leading -- back fairly XX% stable [AUDIO market high been

we we favorable very of cases. cases would as those support well cases force. in more more have a gain are the a expect about our pricing. actually we are back move of very XX% obviously, hospital, with position to an in where to And sales So environment probably positioned to we strong And

just simply there back about hospital isn't to that with I PAD today. of think the deal this to exists that migrating is capacity concern our in the patients epidemic hospital

the care And handle to to setting, may so the of back patients hospital difficult. while ability be coming quite may number return the

many I that physicians how questioning about frustrates go these what now we is, of volume the and patients right they will of in see So will be will the where There is just think, the cared open. for, a where market. lot

see that and is course that may that But XXXX. we out, role to year determined of first ASC take question, answers your pointed of the of begin to see I in Rhonda a ambulatory larger may calendar We centers. out think be obviously Hope shake here. over surgery As see Danielle. the on will half that we all

Yes. a of long How multi-quarters? just dynamic, think Should into or long so the persist, of time on Any little this peripheral? follow-up. and trialing competitive dynamic on bit thinking both timing does maybe color of the usually Is one fiscal helpful. competitive we sales? how sort how generally what's give be of whole a us remind Thanks in it can trialing to impact sort and color much. the will hen, trialing about from a about reflected you this XXXX? of coronary And That's The perspective? it quarter? as just trialing, us competitive Is

probably I begin I this then we until to the it IVL And we slow down. will see we think trialing will see continue in coronary, to annualize launch. think

little based more see impact that are result will trialing. will And second the where that head the enabled to that to trialing that probably the for is kind to the we of cost due changed to that of very and has is less a soon. this introduction year, of have product. impact expect perhaps the in the has extended trialed may be slow is for second continuously trialing as business fiscal not begin the expect we think to we our see begin use we this favorable those in coming into head improvement trialing trialing customers peripheral, through also well. IVLs In labs, and that area I period that CSI down. half lower What because a of sites economically products perceived the And of environment as reimbursement impact largely see of products here prolonged I in on period. The the see some close that environment. office as So has we that has to as area maybe here their of half, we

Thank you.

you. Thank

Our from next go Jayson Jayson, comes Bedford question Please, from Raymond James. ahead.

morning. Good all detail thanks for And as always here. the

few me. a for just questions So

business, the guidance, revision the the framework base XX% Can roughly business. strength OUS on was base OAS just your OAS comes that from given Just year all the growth support? we in guidance the think and in for assume I that initial

Yes.

majority think a of assumption, reasonable U.S. I business. our The that's reduction that Jayson. from does come OAS

I getting Okay. in the business, in about to on is XX% mix And ballpark? the your that peripheral OBL am XX% just hospital OBL, hospital,

be would high. No. That

We XX% probably to like OBL are am to more XX% I and wait. XX% sorry. hospital. XX% No,

could correct that? you Jeff,

looking above in nearly just OBL so XX% are the it's if at revenues. Jayson, the and peripheral hospital, Yes. just XX% you or for

helpful. That's Okay.

peripheral, of on a recent and in trends. can coronary, month kind wondering release am just you the in I seeing OBL, improvement, you what in the if little are mentioned hospital, where talk the about more of improvement call just detail today October? on you bit here, this seeing You are an

We seeing are business was in the improvement the much where coronary COVID South of impact improvement really in the and Southeast, we the seeing are come of greatest. the our and

staffing our business chain, but to peripheral themselves. healthcare shortages impact straight staffing and throughout Our with not the only lag. And hospital continues to of referral workers due through is interventional I primary think that continuing actually critical shortages, the care in beginning to shortages, largely staffing

chain South claudicant we has damaged acuity in that been peripheral, and in Southeast. pretty will time the channel. the take patients, let's the for So think lower to the say, It particular in more, in referral rebuild

We have this before seen relationship happen to in COVID.

you and there in had COVID after to the months recover. a the seven period referral channel took well begun, large If was quite to a right impact recall, it the there or for crisis six that as

that it's might I take that We hope we entirely set to us heavily an it for variables us dealing predict pace of hadn't new really But right before. are won't it what states to with that. we difficult that that be predict long. that now, difficult it's impacted. for hope these have isolated geographically will we very just So as seen said, to that be because were And

I Okay. in Thank squeeze could just one And for Rhonda. if maybe you.

program program. the we the mentioned all to when kind various the adapting change this that factors bundle setting, Just new within in of environment together? OBL in of an expected the reimbursement kind you and Is there OBL price into

use the price. we are more efficient that of throughput, increase to the the the some including all help in become and to do new expertise of OBLs environment. really given is CSI development programs, We don't economic really expect really impact brings, their just trying really new What an

Thank you. Okay.

Thank you.

William next William from go ahead. Our Please, from Margaret, question Margaret Blair. comes

will from taking Good I glory on OBL I probably Hi. the hoping to in the my the work question. background. a sort home. bit dog of excuse again. Yes, business focus more was for little the Thanks morning of everyone. Yes,

of question on But am changes by there I the focus sorry, maybe I that of driven B sense one that as are. or it still is growth And segment cases? kind is, to within double some least low peripheral we part given this what to growth of a of that a around it sounded but question, you digit of about I should in in like more because given answered And reimbursement, going mid this risk am get have repeat to trying I be sort think at others rate, guess competition, a market a teens volume what Danielle's overall consolidation. difficult consolidation,

to, And dynamics? I that did So growth could guess, do I what right. market that hear

right. hear you I Margaret, did think that

that for think that's a OBL I reasonable the assumption growth.

digits double mid teens, low roughly? The to

Yes.

OBL, think well the we of that for as site about terms then And you us consolidation have helpful. of quantify over you if seen accounts, in as That's that what in can the service maybe or in they could these some as more the well? bring that sense are last pricing trade concerns potentially a of incremental that guys between and of years because efficient consolidation versus volume that, few potential maybe

is Thanks for predict. exactly little a bit that question, difficult to Margaret. The consolidation

significant economic basically larger of, other becoming consolidation out priced players increasing do see, I you players oftentimes of environment, the moving lower their think service. change smaller lower value, words, with any or a some see in segment really, of the you say, providers in we volume. higher let's pricing when and volume In see a

We treat the have know, strategy that that focus our happening. you complex seen as over been And more volume time patients. higher has on always really to OBLs

to think correct. that moving been As we these believe more of sites. strategy has changes future we will with PFS, we more the patients higher certainly, these And see that we consolidation, in look to the that now, these volume

that will implementing market have We our been these are segment continuing we strategies support and OBLs. of these to implement that and

think a we will patients patients makes payment rate. to that say, that higher shift a anticipate receive say, than, with time just more And let's the acuity sense ischemia, reimbursement where I claudicant let's expensive a stratification more over complex for are also simply let's critical towards, say, care limb patient. it lower

OBL that the do still atherectomy and a from to hospital we very don't one suited and core believe in patients suited cases. really the as that reimbursement accounts is predict The hospital how well are change focusing these is that patients enables setting to know. procedure know the will difficult exactly perform well-positioned now at It's us or environment on volume to this thing time occurs. for effectively to support customers high It the OBL is reimbursed our complex So for physicians reimbursed we continue is migrate is rate that these to the we very that our on the technology. a is for well at strategy more transition the remains that setting of value this we from to also It intact. focus OBL,

Margaret. that your So I answers hope question,

in updates on we early We the to probably as this give or you days continue the next year course of proceed will are we still and so. over

the helpful. to of Thanks bit been that a towards me a guys. of the ask. assume little And a for able to That's able know to it's into accounts have then, you to a And I little last as COVID those talking Okay. delay just about that is headwinds? guys tricky restrictions? get just you launch. bit products whether these little question capacity question get we well, flavor a Or should of were kind with throughout given support

but is of we The some Yes,. impact the delay. less should there, expect

our said, quarter in the VAC the I that review mean, our expectations. But seen Committee a have We performance process slowdown hospitals. with in in consistent some first was

in in expectations think segment see we time, of QX business do from high that beyond for in QX, growth these do reviews the slowdown we because because will and that. over slowdown VAC have a we our As that of of

ISD not what are dramatic as our segment, as are in in some So expecting seeing we atherectomy. we orbital impact probably although

Okay. Great. Thanks guys.

Thank you.

Thank you.

from Our Michael, next line from Company. Needham comes Matson your now question & Michael is open.

Thanks. morning. Good Yes.

want I another on situation. the competition So ask to question

are product, don't it using step. it how words, about new actual I think just one things? So Shockwave sticking the opposed be lot loss? of In the and trialing understand using these you as word start do first with of actually But and share try other we they like other that but to that's trialing market a they kind it, or

obviously in on excellent Thank an of And hands patients that to that physicians you for is trial a very to in that access the variety receive performing. common are wide what they the they question, on we and their interventional Mike. years. over over technology question. it begin to and early a will and see seen new how This It's procedures have cardiology performs when over the and this we product see is

in then their into to want the to center, this patients, to they the incorporate they opportunity to they have utility exactly care technology the they As the new of and care their how use determine, new can ease assess both with technology see their at the technology traditional then individually that of experience patterns. gain of and begin

that It's of time that is period product. to So where is what the performance as really of physician trialing. evaluating the we the refer

oftentimes, their these we periods are What going they proceed. are we collectively, Now well. be impact in want then, to make will other on and is concluding there they the a manager that trialing going setting. that as the seeing cath assessing will cases. on, are how is They cost. as is are on decision our fact evaluations getting trialing most after economic for be The the And hospital lab evaluating

treating So as of they An strong. the are a atherectomy device effectively the where treating balloon are An for remove lesions. changes of in longer also cannot lesions, stenotic atherectomy where device vessel longer remains used atherectomy the calcium can. compliance can lumen vessel be the and IVL from lesions, physicians requirement an as heavily

continue we where the get cases are will these and have growth that years. will these I comprised to So over think, are our circumstances, and also our cases

growth will that. to our from gain continue we So

this range. more of think we will to low environment, we to I care. return standard in settles continue double down, are grow normal or As digit more And we we practices indicated a see as that trialing in well-positioned that to think

Diamondback can where then, of Thanks. And is overlap Shockwave there is between the at Has Okay. suitable And this lesions just knowledge side. overlap of much is in coronary changed anything point? kind that your you of your quantify on to view and the suitable? where best the how

change, really We have any seen Mike. not

We is very the and have market. same. that expand will to substantially the assessment continue remains utilized IVLs the much think think our of technology I where this

awareness market also So going a the market. is tailwind to success very also And that rapidly time, result because will think continuously of in we rapidly that create growing somewhat a good And just increasing that vessel in of of preparation is IVLs. obviously calcium. that the is of and growing

is segmentation, still warranted are orbital happening physician multi-vessel most not be have In nodule have are of where a have are high of treat those simply degree understanding get very continue what presence And The cases the the the for they in where, way observing disease, of appropriate of that's adoption lesion. what for better of about We cases patients would terms the largely care has a those that segmentation and balloon continued using is you imaging XX% really through lesions, that of in And that XX% perhaps or calcified a changed. that to not really IVL those atherectomy. And is would our long used. and cases same see be much to to for PVI strong example, an believe where that are lesion the is be really true it. the a patients the use. our We can't stenosis atherectomy. have severely because indicated environments

market. of So sites do share There a are devices smaller in United very to percentage of extremely Japan very imaging we for our high of example, customers States. to that continue sites high that where obviously are well is that we imaging, continuously is sustain that in have and adoption rate a gaining also market we those volume continue in our position. a the use in focused But strong on imaging, there

But Okay. I Thanks. been mean, was on I And than then gross margin you atherectomy? the Did the It has it pricing about stable? weaker all Diamondback trends margin. decline? my talk gross final can to on expected, in at that guess. just factor question

would question. low thanks Mike, to trends expected we kind what that consistent kind very of the single there. for digit mid were of Pricing range, Yes. have in really

So of an on have impact that did gross really not margin. much

the coming mix more a about was just to lower margin As expectations. and earlier our segments volumes from it I revenue overall earlier, then mentioned down bit little

Got Okay. Thanks. it.

Kalia Thank open. from question Suraj Please, is your Oppenheimer. you, Michael. now last And is Suraj, from our line

right? all everyone. Scott, hear Good me morning can you

morning. Thank Suraj. Yes, you and good

throw for Ryan. of I if Scott I just one together. may. questions, And and three Rhonda, So of one kind all for these for will One you,

for the get expectations shed calculated? some about in the So CAD. could criteria on the the what Rhonda, substantial I mentioned Maybe share embedded if has that on customers my you you give IVL? customers you, improvement there thoughts really, that would are hearing anecdotally spurred how Ryan, on And it, one here? about IVL IVL market was questions. that Maybe of share could, relative your I from for your OAS about a finally, of the XX% XX% believe love NTAP you in clinical love to also, your your PAD, And versus economics heard us are Thank because FY the market you complaining domino changes. just reimbursement XXXX for for take on could taking for shares? first you I clinical get is and just Scott, given that included? is I effect economics to Is we missing part the about light versus NTAP others

for those Suraj, Thanks, questions.

think in because But Just relevant look in to one probably see in begin not share market it's now, Rhonda we hand to will the little that share. off is be to I considering until it share, inappropriate annualize, a at to IVL right I market marketplace bit of market the really terms moment. this

IVL CSI indicates, even to difficult is your the atherectomy. in As only IVL to physicians used versus Boston a words, question broader we other think preparation preparation, market what I about and can begin share, be the And to population say, of balloons is atherectomy Scientific, think how in market let's just population your than used a vessel larger market. market by in balloons of say, very are vessel of really patients, contrast the share broadening expanding determine, where share and it's because let's that in is

to is vessel a I trying think that atherectomy position to are within its that broader make while we continuum continuously prep the treatment expands point population. retains IVL

the begin at market within that that talk be that we plays the the annualize is and then say really preparation to to to about vessel segment. out, atherectomy time, reason I going how exactly So market it's vessel can important this discuss prep

to Rhonda, address try quantitatively. to can with you little and off I a if bit more see So maybe that, hand you it will just

for we that in, different look the a that's the at look I prep all I We Yes. have about right. all just at the distinction where at know companies and think then atherectomy that think entirely two ways is those is indication we that's vessel companies both, clear denominator and look an and market do the we I computation. appropriate me and

I a other of balloons. types as lot other think types screen vessel prep well, brings devices of in balloons, of

going to peripheral trialing. this of see continued think in franchises. important both strength looks But we But an And so, our distinction our marketplace, after of there, where all position our are I and in the all Suraj. project it how in that's we coronary settles really kind

OAS second your economics. Suraj, IVL to versus On question,

not and As result, really a a as setting not quick there. IVL utilized reminder, is the OBL it the in reimbursed is

in we segment, atherectomy a at So IVL. reimbursement improved the in lesions. that recent for largely doesn't we economics in economics equivalent will the that peripheral of barriers rate reimbursement with our it have see lesions. In as our expect that trialing any of expect have the IVL. above knee IVL severely segment. do atherectomy the the in some And impact TPT, hospital, again, largely trialing. reimbursed treatment of reimbursement for there, the for factor of aspects that be an to unique the anticipate is think the least, calcified position we But retaining In segment, to XXXX is once reduced economic because there, the don't of now We improvements in coronaries coronary, are to important clearly, for at device the the the favorable, right because some

that these by or CPT coronary the the say, in Category Over use the technologies IVL, be after that defined an time, the smaller out for time environment So and CPT, role. of in right let's say, improved rebalance get now, need to we a will segment, seeing each received economics has much is and appropriate indications is III order for think more larger are to, say reimbursement over let's we as expires. I let's plays III, a a code a Category that

would and the coronary. at is Does that So, field that the a your be level quite playing question nonetheless, distance. But ways point, yet the is long a to answer economics Suraj? are probably on economics, I this seen in in say

Yes.

question. Okay. Thank the will progress you. All right. third Ryan, we to

Yes. Suraj, thanks question. for the

simple. needs really be The heart to the quite and criteria difference to met over expensive time. that needs I for is new be be add-on-code it really you think of and the to in new adequately the technology I is And think code tech that is the the as know, question reimbursed. really payment

the So the speak evolution as at see really that determines think payors as TLR long you make in data, as X%, years. last what And a is we term not we less payment, of lesions, over have you only to Scott ability can tight, otherwise crossable than the mentioned, lesions. coverage have I if And the decisions. look to OAS ultimately now, with demonstrated XX of validated low at that years treatment three are rates severely as calcified X% we year, of

fact that so are And clinically long-term clinical in will payors the feel show adequate we those benefit to very about to benefits as data, ultimately Time long with tell significant with very ability term real strong IVL. OAS. whether shown and look

hope that Any questions. follow-up I Suraj, answers additional there? your

be No. Thank That you. should good.

We over currently have hand final to no further I Scott remarks. will for Ward questions. any now

all We you and forward pleasant wish everyone to the Canaccord later you month you Thank look for of Okay. today's joining you. call. day. this conferences upcoming many at and a Stifel updating Thank