Inspire Medical Systems (INSP) 4 Aug 212021 Q2 Earnings call transcript

Greetings, and welcome to the Inspire Medical Systems' Second Quarter 2021 Financial Results Call. At this time, all participants are in a listen-only mode. A brief question-and-answer session will follow the formal presentation. [Operator Instructions] As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Bob Yedid, with LifeSci Advisors. Bob. you, Thank

begin. You may

Paul, today's and for you, you thank in call. participating Thank all

forward-looking within the with or to it's time-sensitive information, the X, to pleasure any uncertainties on projections the statements Tim on are those management and press a And or and information financial like Inspire that you Joining our and undue Herbert, update of A website. Exchange CEO. financial of report six meaning securities Tim could including continued our as place These me current President I'd XX, risks to All filed only in our XX-Q access law, Inspire revise not or uncertainties. over the June and conference pandemic, should materially turn available speaks will Chief for my any for the of Tim? differ. three as this reliance laws. today, various statements Accordingly, XXXX. events Officer. on live on financial future Commission, Herbert, new and outlook required actual statements months statements. and operations, involve estimates business, material results company's ended obligation, with XXXX Rick of COVID-XX operational disclaims otherwise. remarks, Chief forward-looking events federal August market you limitation, Financial Earlier is Securities to financial are to without except and call today, because the and make remind cause full quarterly based released financial filings copy the statements SEC and by of XXXX. risks call, call and quarterly See in today, or Form release with assumptions. Buchholz, year effects Officer; or forward-looking our condition, upon Executive including, broadcast of This these the results the results whether description and and that investments improvements these intention contains

Bob. our And second for the in you, us as increase and through update. quarter the worked normal joining the February call COVID-XX. today Thank And providing the as exceptional In for seasonality, delivered the everyone significantly confidence January XXXX team resurgence March, well XXXX team our in our thanks XXXX, to revenue business results for guidance. Inspire

focused rules, CMS’ Recently, positive implant As these this front on the the to considering which momentum impact payment important publishing of business, we More procedure. received the execution. especially FDA be approved proposed we remain XXXX an will of the developments shortly. incision when on has clarity commercial continued, our overall reimbursement our on with for

to and positive finally, care driven advisor by demand generated of we worldwide quarter with for program, capacity patient XXXX, second revenue, including access of a improve factors increase therapy, was in million, Inspire existing reimbursement for compared which our the new centers, on begin to quarter was XXXX, course with which Let's revenue growth the by COVID. and at was the an of several second impacted This increased of XXX% $XX Inspire environment therapy. of discussion the to patients' ability increasing their care

the quarter performance. With availability vaccines, our insignificant of COVID second multiple to impact from the was

planned cases. the implant to and positive variant we and course, in implanting business led territory outlook the activity, new the for in confidence With the continue has has number centers in Of an this the of of in our emergence expansion affected managers. XXXX, centers due the the trends our to in strong said, our first-half a recently, in the Delta performance in year, Southeast of And that have small COVID to most increase primarily U.S. number of the

million As XX% are our XX% of previous our million. guidance to million of XXXX year XXXX to range $XXX $XXX $XXX revenue over guidance $XXX full million. such, revenue guidance $XXX.X of million, an of from to increase full we to increasing year a This represents

on reiterate surrounding As and to the always, that that has I our best outcome capacity. like quarter, jump primary would to focus second beginning let's into patients the With therapy. Inspire possible the from remains one every with ensure each details that, the

XXX. we This prior During of to implanting new centers, XX above period our total a ending new XX U.S. the guidance was adding added quarter XX the with well centers. of

Inspire to We physicians, seeking continue therapy demand practices. and to experience a for new their to centers growing add

at includes increased make growing the health ambulatory community XX our a rate XX to slightly the XX at new offer surgical national end the an states. XX executed demand, which second in example, continued compares the XX% guidance of we across we increasing which a systems, of remainder efficient now more expect held of year. to a hospital ASCs publicly centers setting hospitals for and this centers per with This have total XX% care quarter, are new than our XX As This ASCs, number with increase centers. With quarter of hospitals. now pricing a a of strong to open addition up agreement higher XXXX. the and system in centers U.S.

to being see to procedures and Inspire expect and percentage ASCs. in a We will performed of growing add continue ASCs both hospitals

Regarding and increasing adding new created XXXX. during above the our XX per second to XXX. territories, quarter to bringing Therefore, the new XX a are our the year. is second-half and add of the to territories we U.S. remainder This the maintain to nine of quarter, territories XX guidance strong total we pace sales to of guidance, now new expect our eight team, in expect throughout we sales

of dedicated on training XX. outcomes strong increased ending XX, sales scaling, remain our the We we and optimize second ongoing quarter center and focus expansion the teams also our with clinical patient management adding number by Further, representatives to field and to productivity.

centers, has new was increased growth opening XX% at XX% from Regarding of and centers. historically, productivity, procedures existing about about been from our

at For the by pandemic this the new to limiting centers XXXX, was however, driven the skewed existing procedures growth year centers. opening heavily from

a expected, have growth increased As from XXXX, significant at a with our centers. of great procedures rebound coming in we first-half majority existing the of experienced

However, we XXXX. to we XXXX, centers to the again, first-half that of careful results by more these the be comparing period of to need and following balanced said, impacted new as onset the shutdowns between pandemic. throughout centers That existing expect be growth was

Our focus improve patients second area ability healthcare qualified to therapy, connection a in of with Inspire is our to a interested by provider. making assist key

primarily interest programs Inspiresleep.com therapy, in to Our website. very through be continue the in outreach effective generating Inspire

XXXX, our to of over was million, of first-half the number the XX% X.X visitors of For year-over-year. website increase an

six of about with our began XX,XXX on aspect In we year-over-year refreshed physicians. outreach programs, patient's Today, or Advisor community substantial centers for continue January, which a about Care with utilizing ACP, including ACP, months the the with centers center answering XXX to physician therapy. of XX% commercials, a the participation about to the calls. established very significant through have ended improving XX% along talks the of We call inspire website via addition This important experience Program, TV approximately first XX% the year, broaden receiving XXXX by approximately concept, A XXX increase. health new Inspire increase was airing representing contacts and a ACP. to largely our our were the in driven in increase Inspire calls almost of is

data communication version Just provides and yesterday, of included improved we which launched patient vendor second vendor. This to scalability, ACP, changing tracking. the our a new

Our enable plan is to patient ACP continue the This to calls great will the majority of to our through be ACP. of answered most year-end. expand the by centers

Our to appointment about procedure, approval provider. therapy, with ACP our initial incision With a qualified make I'd like of an U.S. reiterate experience March and provides pathway the a more for in is the which two XXXX. regulatory received that patients implant in that, now Inspire the importance to learn efficient healthcare

surgical setting, add a practical Importantly, From XXX show which In clinical minute on efficacy approvals procedure of reduction. real-world savings the while study minutes benefits. approach the was for incision which incision, XX surgeons procedure original average, reduce for additional procedure this incision the single Inspire safety another we and time under European have results to consistency clinical in seen time comparing the procedure in times. procedure. this time FDA to third in providing allow two just procedure and standpoint, and even reduces The therapy, the were eliminates supported the average The need therapy a therapy, three by a and a day. the significantly to reductions greater may a Inspire

cases, all to two cases utilize previously, XX% coding. surgeon most per and limit has training good been and of completed, transition surgeons In to scheduling a would day. approach. States, this United the the two As procedure incision for typically There's reimbursement now

that for many for utilized be therapy and proposed formally new weeks, you the a CMS now ASCs. as as payment cannot by January Inspire The will XXXXX the has on announced physicians, X, reliable competitors take of XXXX. code will reimbursement. As know, effect in And last ensure hospitals few CPT dedicated Code well XXXX rules and

early for issued coverage XXXX payments, Inspire Then, local and these reimburse XXXX, originally and for providing the June payment, has physician or developed which July of provided of regards Medicare then code one stimulation. procedure in to Carrier additional an sensor. Medicare per pressure $XXX payment for proposed of CPT in the MACs the LCD $XXX Medicare back XXXXX, approximately category vagal First, the placement physician Local coverage for nerve via determinations, in was existing

a upon experience of will resolve procedure value service. proposed that adjustments, provide often Medicare physicians depending $X,XXX. new payment, issues only between the payment, payment. at if Medicare regarding code Medicare national be approved, the However, payment would site range CPT or $XXX at average of commonly The Therefore, the these not all, payments the partial physician as will dedicated reasonable with $XXX would and Inspire

the work procedure also increase which of CMS measure payment, XXXX Rec with code payment surgeons Inspire for procedure. the the improve amount work approved induced of the the endoscopy a sleep This category to in $XX we in to potentially Further, will required. are during a We physician at increase. from RV with proposed the the XXXX, a was one $XXX XX% common rate to with recommendation experience period are new will use specifically conducted But which pleased drug from as accepted reimbursed. Committee, the CMS survey

the that national CPT level the code payment procedure a over for map Regarding Medicare average payment increased code positive continues is CMS proposed The APC. same ambulatory news or $XX,XXX. neuro by the new APC just to for to of facility X% five payments, this

calculated data that claims we extensive Inspire to facility announced the procedures. For the draft by ASCs, exists reimbursement believe CMS was recently the for reference without therapy

reimbursement in prior the all data with Specifically, there history review, at the the XXXXX. to code with intend provide new the all base code as were We that no hospitals the coded meet took in panel of place procedures ASCs. as using is procedures well claims August as use XXXXX, CMS on the prior

ensure Our ASCs to for goal Inspire procedures that final is is reimbursement in established. the appropriately level

national the the payment reflects For an average just for XXXX under reference, to $XX,XXX. code base proposed increase original XXXXX

the Anthem On providing is May commercial therapy. now XX of coverage policy front, insurance as of Inspire

States. approval last of brings the in providing is issue total and large million. million conducted was coverage of authorization inclusive coverage the United policy in this resulting through to lives Anthem our technology, review approximately a covered therapy, the process to serving the XXX Medicare of prior mid-cycle XX and positive carrier Inspire Inspire Importantly, Anthem

Moving on, volumes, the Europe driven Netherlands. had particularly strong procedure by a Germany also in and very quarter increased

expect to there as especially Inspire impact very has We Europe, COVID from of in limited continue recently. growth been

positive country a the German January Further, exclusive Moreover, hospital listing Japan situation Inspire therapy XXXX, medical with Japan, regulatory leader adding meetings be strong effective is Lifeline, marketing planning will Inspire in Japan, that a agreement national that represents off reimbursement in with committee technology with we health of positive reminder, and policy Even innovative insurance into and country. a for a therapy COVID which reimbursement X distribution another our the in Japan additional large difficult Netherlands in with of is JLL. June. the to in European the after expected now business. the occurred a distribution as indicator continue are centers holding formal the payment As in in system a listing formal DRG, start. In in joint we integrated the changes

continue tool. to using the This smartphones. Inspire end app and this the the Cloud the be which patients' in patient Inspire past enabled We from smartphone. next to to collect first the are first we prepared R&D, to the clinical we then system, the on we as with to U.S. addition Further, and intend the to to for system device centers with second year-end, device of the submitted of quarter, The year-over-year, by continues Inspire Inspire with use step who course sleep and similar the uploaded and during training XXXX. patient three allows was quarters, invest patient number expand implanted via platform. and a physicians remote physician data version to remote. Bluetooth will Japan formal of second in in FDA, app Switching for continue R&D commence for commercial cloud-based plan released our beginning Inspire Cloud, new new to from This technology to connectivity in directly. gears implants Europe, collect patients is The substantial the increased the interfaces will expenses are enhancing management our in our efforts the Cloud data

battery form a We available to and will be notably new launch accelerometer neurostimulator in eliminate V life, to will respiratory factor commercially with our Inspire several XX-year progress. neurostimulator will using generation the V maintain measure provide existing pressure plans XXXX. be Longer-term, utilize sensing enhancements, The in recharging. waveforms. the design an for commercial remote to most Inspire average continues sensing following late V need approval are the to patient Inspire All targeting device need. Once the approved, inside the the without work Inspire The fifth will expect of we later XXXX. neurostimulator the FDA for

facilitating the assist the significant on the art highly as important by physicians. shifting this recent of our business. well-positioned to journey, through continued to have all in V, we well experience benefits internal development positive, Over including continue of closed In the this focus in the will demonstrated additional sensing of Inspire achievement. enhanced And reiterate, our they continue a our Also, pulse state momentum progress To generator qualified neurostimulator. we on to our stimulation, therapy connections coverage of innovative enhanced between and an multiple have patients we our their core Anthem Moreover, longer-term reimbursement updates be expansion trends continue make efforts key impact ACP. years, patients increase investment decision loop for and to technologies. is centers. capability Implant from increase remain to summary, to training positive the the Inspire important of existing is new as XXXX aspects are as in to An of business. outreach recent beneficial was capacity utilization our and at aspect our capacity utilization increases centers, anticipated the will

evidence extremely new continued development strengthen decisions, advancements also and recent and continue in further that the the clinical upon reimbursement We to strategy value. coverage like procedure build remain positive his We drive about achieve to confident and our invest review platform. over are of the efforts our and have leverage R&D in financials. therapy, call to excited growing body shareholder our prospects, long-term place the of I'd two that in we appropriate Inspire intend incision Rick With support the turn robust to for that, a of of our to future

Thanks, Tim.

June expenses a second currency volume. higher COVID U.S. quarter, driven impact prior second million. increase year programs, consistent XXXX. XXXX. during to in in number the of was with increased was effective which the key of XX% in million We In of the year XXXX, year the operating corporate quarter, price went of now in general growth our to the our XXX% second factors, compared full period. million, was the a the compared the foreign to revenue of second to implanting to the quarter XXX% As increased reflects delivered U.S. ASP European due prior XX%. to XX.X% larger quarter increase margin of a million, in the This in increase increase to the XX,XXX, higher average revenue development team and $XX previous gross the The first-half coverage $XX revenue XXXX. direct an the sales efficiencies changes exchange period, second of to our XXX% to quarter number manufacturing marketing rates. the organization, of ASP the U.S. by noted, increase the XX,XXX of commercial XX,XXX The quarter up $XX including margin increase ongoing XX% and from to XXX% managers. continued The and of the in was range the in and of in The second million quarter the in be an growth the sales investments plan to Medicare Total generated improved XX% second efforts coverage, European in guidance the an of in operating policy due for XXXX. XX%, to significant continued was of expenses XX% compared achieve XXXX centers, was and European $X.X territory million, period. from $XX.X of were was quarter reflective expect favorable commercial Total that consumer second expansion generated $XX selling is Gross in in initiatives. of quarter Inspire quarter second our quarter product costs. in $XX.X the year. broad development year The in for an second of number prior million Tim excellent from the as

to per share a to $X.XX, million, quarter the quarter of weighted The the number loss the quarter $X.XX weighted which The year of average of for number in $XX.X will in XX.X is period. second was We prior loss million. $XX.X the net compared that anticipate per million. for shares second outstanding Our the quarter average share for net improvement was the XXXX. a loss second compared third net the net for XX.X loss million quarter was be the second XX% of approximately shares

provide our previous over we to XXXX long-term we million. sheet, growth. Moving sustainable executing strategy summary, full growth $XXX.X to and revised cash focused at XX, procedure volume we to and our In growth strong cash well-positioned prepared the on. increasing the growth trends is totaled increasing the XX% million call our range believe extremely $XXX Are opening achieve allows of said, pleased guidance $XXX million. This coming new position to first-half please and our revenue. XX% our significant are strong with $XXX implanting outlook open of us to as up We're are back, Therefore, from we remain Paul to With million of represents have business, year. can performance momentum remainder on a June confidence our there, This guidance concluded. our training us that, and hold and our and you of year implant that investments the executing throughout With for continue remarks revenue XXXX, you excited centers. full performance on questions? to in Paul? centers, $XXX our of strategy. and to with are million remain XXXX our existing to balance year Paul, guidance

question. one apologize issue Instructions] [Operator technical Thank we for and I pull up Hi, will you. moment the the

question-and-answer be conducting [Operator you. now session. our Thank Instructions] will We

your first with proceed JP comes with Morgan. Our from question Robbie Please Marcus question.

Two me. for congrats really on great. question. the a from Oh, And nice Thanks questions quarter. taking

beat I not pretty believe First, record but just quarter, a up quarter-over-quarter. really the substantially was substantial,

the it to more in script, it'd some beat, guidance the consumer? I column some B. get educating from I I'd new into biggest where of was you existing doctors a above so see growth drivers. helpful know, of just Is to opportunity? procedures? a patients? love coming direct this beat substantial A on most of touched to and Is column more and and it's think so and but dive doing it kind Is where the little still You But, see the raise it sense the be you docs the of probably the

question. Absolutely, demand that of it's and great the And that's new from to have In a significant answer we above. all centers. open physicians centers the and a is simple,

year's new post-COVID. that have each And big have open, come a the starting in the policies XX% a an going two-incisions of that and have procedures highlighted XX reimbursement for centers, procedures, the to opening we time to script, waiting growing, well mentioned, also Anthem last work that centers the through impact, pandemic back and of of by the as having bit significant. process, impact. growth really they from But is although, the year's to to centers for came the patients that they centers takes Anthem a additional But last add improved therapy. really we as As of existing and taking had in that shutdowns. were little those you quarter those affected with are the utilization But to majority environment, line Medicare growing when albeit, more growing. the it usually two-incision effect the procedures over

board, to strong the just procedures. have field across our also clinical we've field support rep significantly grown our implant impact, force So a

reaching we our And to greater call if a strong DTC demand the then a the driving out utilization. we with and impact. patients are hits the that, getting spend care focus really, advisor add, I web And center. really as just program and can with so is having And is increased highlighted

of issues. outpatient quick little incorrect else. the than anything than Great. probably Maybe But the follow-up two more is a seems there's touched physician fee rates in a it. on the it was topic expected, and you a One during obviously here, and lower some reimbursement came like quarter

maybe But what at better this try with rate, Thanks. do the improve rate hinder -- question better. you the all, and code? get they higher obviously, taking on the utilization there to their And the the in will the to think final for better do that into rates, correct physician on code, the logic you one So, came can what the a going final? and outpatient rate are them same in steps then you

Sure.

getting everybody physician a it there is the of to all reduced. is for blend I wants what pressure it higher we higher that now that a think to there at physicians, beginning the little them survey the for rep But they sensor and did Obviously, was elevate in is. surveyed it reimbursement than that physician fine. was code to believe sure higher also level. be paid to of going a have was try the the they matter it to bit to use rate that RV the that of part and increase proposed rate And work and higher. the payment be we got payment two-incision only with temporary with And the it bit the make which accepted is process, XXXX. is right has challenge number. CMS two-RV an that another then getting payment the they are little in we're the and But year so physicians of and use. number fact accurate a were than came is payment And And a

procedures So drive rate minute, done with two-incision, down is all is are line in especially fact now ENTs XX% XX done do. and that the the really other that reimbursement procedures that getting level of the can with which close payment a that being $XX between minutes, $X.XX procedure to and high, right

with happy physician the we're So, payment.

as far the payment. As ASC

capture need category Inspire work historic so But claims when with code can CMS up, right. they therapy. you're they to that look the even to exist data just on the XXXXX. go of they didn't three. a think as historic do We I use the But

and reimbursed. weren't we believe or sit just at Washington least able provide to be down that data proper $XX,XXX. would expect will data And at base old they and in capture consultants at get to be August present ask them, to the have putting allow data. that as work to we calculation we'll it proposed an just with meeting, and together we procedure example, to able had So increase will properly And present that the code, code where our to CMS under when we the actually and and do that a ASCs the

on Congrats Thanks. good a Great. quarter.

Robbie. Thanks, ahead, Go Paul.

folks going the hear If take me, Guggenheim. go Chris, to ahead. to can I for think question, try we're next Chris Yeah. Pasquale

you. Thank

Pasquale next with Chris Our question your comes Guggenheim. proceed with Please from question.

Thanks. Great.

okay? hear guys me You

Chris. can, we you? How are Yeah,

on quarter. congrats And Tim. really a universe you look of is view think centers little there the remarkable persist that sustainability impressive. should a love you and to as how at is Good, have, particularly much pace updated guidance I'd center your this runway of you The expansion for And pace, in updated U.S.? be of the procedure the who going the momentum on this while. suggests really performing the

Absolutely.

from think to that I really growing. the demand physicians and centers from participate with is Inspire

able to provide receive training site for this activation our our and more very to teams patients capture think we're We up still stepped Inspire. be demand team, to stages. the early really we so and And at outlets

those of right and centers are X,XXX. X,XXX think, just now. now talked just getting available, X,XXX of crossing are hospitals, number we we I targeting centers a ago, that's active and probably XXX to about a while And an close third ambulatory equal about surgical over

pipeline. So we're avenue. very, another another in we still contract team though, with and script, very up early signed And highlighted that open Rick to CHS the the national the in

to But so, good the by really a for like forward. going of new remember, see also ratio forward. guidance progress our That's we're opening increased We centers continuing making momentum managed of And number centers that why significantly we keep we, that managers. there. territory

to we and we retaining means the same new hence, territory and are team. rate training need recruiting effect ripple management at there the team, and So managers, sales which monitoring our are bolster continue we increasing to the continue

outcomes. while of to that, entire patient strong pretty So it's supporting be And it's do a scaling business. still able to the exciting real

Thanks. That's helpful.

kind was led you next my about that could impact the which So national me question, of new into have. that agreement that and pricing

And you into putting prior now that it, into at into how any do have Just it quickly those context place? whole expand did us, centers to you can this you presence that network? think put have for you agreement

that locations. is we in held of XX another this those CHS Rick. Chris, Hey, ASCs, system, hospital and any were publicly not XX previously hospitals

so, is XXX And at all really high goes committee a the does that level what value an through essence locations. for analysis

to different flow an fleet go patient interested started. surgeons, we when doctor, physician, those the find and locations, get we then So

nearly into So We other all Similar into allow that national may get agreements USPI, not entered we them. to those there's of will XXX into ASC get that centers to us our centers. there.

There's so FCA year USPI. far penetration in into in last XXX still of we in that. We’re locations. has couple that entered also the early dozen a of We're over

In addition systems, as focusing ago, where ASCs, we're on agreement we XX ascension, year have they locations into entered plus and such XXX to other a also ACSs. hospitals

So gives quarterly for raise guidance, the basis XX number the ability our to of additions in and new a the rest center confidence us of to XXXX. to on that XX

Thanks, Rick.

Thanks, Chris.

you. Thank

with Our Fargo. next Please proceed from question Biegelsen question. Larry Wells your comes with

U.S. Good afternoon, mean, to a on Philips focus million guys. potential of opportunity. just question. given the question. But million I Thanks one like numbers for Tim here, just I'll X I just CPAP recall wanted seems the worldwide, it its X.X to taking stick the devices. large

from leading your this thoughts for is, was But question yet no to at indicators? from or question. year be this of to Love next benefit my hear year? benefit taking impossible that. know you I on potential benefit quantify are point. terms any to thanks the And surprised if this this So, other any would there traffic your you website, in any And seeing it's

It's the to Larry. to Thanks, those unfortunate to new to devices, those didn't know that. and certainly for working I Philips that use able with not devices market can. inability them. best situation CPAP is being the patients against We an they get want

with of We all communication in have been centers. our

well available the certainly they're obviously wait they're to So than if and situation aware they of rather new we're a -- for patients, want on from CPAP one. move for

we'll what awareness meantime, impact of sure doing this Inspire. I'm yes, we aware a can make positive because So people of recall. sure we're of are the grow In the to have brand,

web the talked here quarter, hits as program increased have year. probably about been as in but by search, well the direct to get website. consumer again, driven the also a increase people of that's a a increased significant activities. our first-half second people in between We the But outreach in increase the to We balance to as with educational more

situation, it it, aware sure bringing question. of care top That's of But that desire. a patients So centers up. on we if take all of we're of are we're top them, of with the able thanks well to be staying great our for make they to communicate on to

I'll there, leave quarter. on the you. Congrats Thank it Tim.

Thank Larry. you,

Thank you.

Bob Our comes Hopkins next question with… from

Bob. me? for hear on this is Brad Hey, Can you Bowers

Yes.

Thanks questions All right. Great. taking our here. for

the if that actually So the any third as start as want of doing you'd here, getting off impact just actually points doctors able uptake, I the be whether know the or the that wanted of way anecdotes kind to that's to update data are or see to well? procedure sort within or not in of if day, just anything expected. to And would physician share

think schedule two procedure I yet they're see you a three to need block get third can't it is takes really add the because but the procedures, can hours, right center, the it to old case. six if some at they own two data third their And hours, used on can them the just to In that time a case. fourth they momentum so talking case. routinely starting, now most is, cases, still what add think and we gets And that in two comfortable that I maybe complicated if it's about centers evolve. we're hours, phase of

And with administrators able a show better effectiveness come. still yet XX% at really two-incision, the being the to and the data of is to even experience of successful so now sets, procedures we're little the stages and with be the clinical that quarter, coming we're mentioned the being done than bit the the even in early that is the real-world we study.

plus something in to the is being incisions go we'll more really the going three for and day, to be this really think we able in we into that capacity that as about talk future is more per to us add key mechanism So, to a of the future. evolve, start

said key present you Okay. covered there the I well. just I to I to Appreciate this, belabor and ASC one you pretty is and wanted back But the were can this follow-up. you've it in that answer just to don't asking that. think mean something And update, data. on because And then to if question

get going panel. to you able questions. be sure the appreciate, front do get the have you update, to to the be these of answering wanted just going you're and data, is be the get So that to make assuming update in in to getting to presented the And are claims that, but are you that sufficient confident that data and going that you

number XX,XXX implants The we’re much. historically, or very of by worldwide majority far implants, the in now States. the of thanks United those up Absolutely, over

a extensive then is out of And you about is always data implant we if XX% there. And estimate or Medicare of reimbursement so that our there data remember, amount claims very procedures.

of been period also of So active data an and a extensive ASCs time. there's amount very have for

go use discount have enough be we and above the that data So for to rate. to XX% to that threshold CMS default

part So to we're calculation to certainly make we show hospital that, to a of to was there's discount proper the base the just a meeting. asked, ask proper code that the evidence old we're sufficient payment. that data already to And with have sure proposed under receive from support increase XX,XXX. have going We

are to pulled that that. sure on going So can everything weigh you there? information we're we make have that get and CMS to we Paul, in do together

here. I'm Yes,

Hazan Please question. from with come your question Sachs. next will Amit proceed Our with Goldman

hear guys Hi, it's you Bill. me okay? Can

Yeah, are absolutely. How you?

you look how the If our I second delta we vacations, the at come first-half look Thanks. discuss the implied earnings versus and physician increasingly sort it's seen XQ a specifically. XQ other conservatism. any the was and in vacations, we maybe of casuals, dynamics guidance, some up you slowdown Thanks. into quarter guidance hoping on of comment being I'm in from of to some And impacts I from a bit If at appreciate is half early Delta. doing then good. some mentioned then calls? And that. can playing is

hard, during of the a always to that build vacation, think significant have of restful especially Well, and believe business. people are our on move be work and in. take we process, part want impact we that We COVID, part that and to the going a vacations I and vacations forward. process, don't everybody are very That's, and

sequential But aggressive COVID, setting as growth, we we to do what stayed QX. going we any with our quarterly watch we're year. Typically expect far COVID. to from As progress, in see QX to QX

time looking remember, are They the a think bit shutdown. forward. that people procedures procedures, and think so looking moving and to workarounds I protective, not are keep for more for at Again, they're I to full being around, outpatient procedures looking down hospitals they're not went shut little through this year, generating hospitals. revenue really last

centers, better move around We ambulatory to able of to work also those equipped have more flexibility surgical additional lot procedures are centers, research. to be to in a who just

so And careful, we're significant a we're to variant, going bit watch not impact being Delta expecting from the not little to closely. but we're but a continue it

environment? patients that Okay. constraints about come and in into Thanks aside what half facilities delta? Thanks. of of conversion line how on of of on you operate expectations? we same two that may put And a patient year the the in you've learned And following from the how your this And about, that talk environment kind kind plays just maybe risk lot. questioning, can last if

I think has lot the do a QX. that with to results of

want get either we with care if I taken see of, we or I work as And can don't slowdown And and are And from anymore. done. certainly alternatives good momentum get of going forward. are momentum that going. a comfortable fear we're But going these factor have we to think COVID. to find being people hospital healthcare significant a hospital think provide to suspect able the carry the we're see think we through procedures people branch them, ASC sources or their people done I have back and all will through our to center alternative and very a there. patients hospital COVID to and protect And

the for Thanks comments. Okay.

You bet. Thank you.

you. Thank

Our Richard Leerink. proceed next your question. question with SVB with comes Please Newitter from

theoretically, a specifically of ASC on a a pay, important impact a at and incentivized question it. like But just the minority in proposed to the maybe just you're still you their make just it that’s keep ultimate if some guys you follow specifically but things. part private if Medicare a might what way, can what have on on had Thank strategy for one. have can procedures to that your to growth you, in ASC going on usually or case go be setting they'll as forward? into private if curious the up a to for and two that it reason make be you would doctors given, pay weren't that here are pivots profit sense and One, would to outpatient, helpful, get the the to least wanted what based like make you great is for able sounds what rates CMS under ASCs reimbursement quarter. front which congrats the I a switch confident side. good sounds be decent It in the of patients, be comment of payers to And the ASC the Medicare multiple doing setting

no Okay, problem.

just of to step, able in be to we chance in year. a the carries we put able future to And get done have because said, reimbursement. proper be we know always there's that, establish to continue at being continue are extensive CMS going into to I like and foot our procedure will following forward, an and we with with the battle happen, you think, data going confidence to reimbursement them, we're the ASCs doesn't it If best have that ASCs. to proper work important and it and I ASCs, we're

for is even this in And don't proper a reimbursement, calculation move pushing that patients they keep ASCs, means locked for doesn't end, that saying, increased, be that around, years just CMS’s the what and default is would make the Medicare Medicare sense. a ASCs establish not And certainly that we put it for lot out is if hospital from and go of In intention. what yet, so following certainly we'll this reimbursement forward.

through reimbursed now. sure there with many we're established that already every an data, an this from are association We in that privately to proper make that very mentioned confident they based as doesn't us CMS commercial rates. motivation to year all ASCs, payers calculation believe Inspire for those their Commercial procedures, rates this lot with rates said, contract provide go is Rick will engaged reduce example, there's They to calculation. are and reimbursement to on real pushing because before, think make able will hard along commercial from of they payments, remain being CMS history. we've ASCs years process. is reflect be we're when for payment They've the for that So established. with the contracted been going those with they the they're be consistent, independently payers proper to a able payers. don't really That and with of a USPI,

this. and be hospitals have will timeframe, commercial that move to think November handle we means So, be in the certainly ASCs. will to think again, But have we'll And I able to Medicare cases have back continue October, to capacity cases going to to by done the that. fix the we

helpful. Okay. really That's

it ideal, I to like message? a sounds the not year cases in place, would delay your there even were delay, or it's criteria it minority get mean, a only So really one but cases if be because of outpatient, hospital contracted do you'd the to of the it that most your migrated be insurers. privately be in with to Is the commercial to have probably would commercial able still that ASC,

absolutely. Yes, Correct.

the proper Okay, because to and effect number All the to rest the hospital. the the a of one, have existing we have the Number there's as this time at privileges surgeons takes have, both committee able most no two, with we're X. we of January X, changes January so CMS right. work well be for establish ASC to on for year the code, that as reimbursement

a increased the profitable to patients the cases. for Medicare And hospital. in handle payment move to So so a Medicare the it's procedure difficult to them not Medicare it's for over XX,XXX, hospitals hospitals

have don't it's going So an think to no, I impact.

going get can have with to deal but We're we're work to continue going We're for CMS, we think offer with to it. to work we it therapy going I to that with it. patients. so resolved

Thanks. Great.

bad contemplated and the raise, what's more the if was one went Anthem contemplated I'm healthy if anything it decision just pickup, could as So than in headwinds curious, COVID squeeze really some you up. I'm just contributions impact in the guidance curious, have significantly just outlook beat, XQ Anthem the I the really more a intense, business? guy. that is that to maybe there, from begins just

the so it. down point. an implement middle able make quarter, to of lot impact wrote to to that Well, policy doesn't Anthem, of they and be in with good No, the give a the it time regional us level and

prior more those and in in review, system external and authorization, the they see back we Anthem we’re get the pull quick and appeal can patients, approval, back let or then So patients of medical to you'll of second whereas appeal, get any process, who able them prior up, Anthem restart was all first worked the scheduled. me a out at patient authorization Anthem authorization with either prior

think move So the quarter. more the of see I quarter, third into maybe fourth we of of as you'll some that, kind

start So that to will through. come

think good the But to I positive. and research. whole Medicare policies So a taken COVID Delta with even really finding out a that have we're is effect, certainly ways patients help

Thank you. Okay.

Rich. Thanks,

Thank you.

from Please Michael with question Polark Our comes next your Baird. question. proceed with

level point it. it, said zooming maybe the get evening. $XXX And A back for But revenue, of curious latest question out, considered on give EBIT expectations if Rick, sort to good I what you will breakeven one. quarter, question growth back-half to heard Hey, for or the used take? for that's be OpEx or missed thinking your in million then prioritizing breakeven, revenue give supports for Rick, Last take. I

Mike. Yeah. Thanks for the question,

of see of OpEx. So business. increasing on facets question we investments number where not We've continue of provide across we're our do our can the territories OpEx, the number guidance to increase first adding, we're your regarding increased centers. But we you historically, all

clinical to invest management sales continue that, adding so in And with we reps. field

initiatives, app also inner and as the that potential therapy But Inspire the on sales and believe connectivity, competition procedures, still years. that And continued want with mentioned center Tim focused important. and the that standpoint, penetration are number fully the We're increasing and for V our no to growing in will understand we outcomes. we implanting patient And of on investing cloud. for that a in market are aware have several improving is so the R&D centers. focus strong earlier we outcomes profitability mainly adding in the organization. since very are Tim also mentioned, really we we early breakeven improve we of stronger next From productivity with by

awareness and is efforts, and So And leads appointments. an development, with investments patient concentrated on really to growth. our brand because increased our we're increased example outreach website visits further the see commercialization DTC market for in we doctor our the that

So appointments. we're with why to call increased that's expanding also assist our center

to time, we're point, gross of driving And going our aggressively our and drivers operations years for focus going growth. your So, to growth we at plan that but we're these to about earlier cash optimizing in deliberate invest our talked the to our on not And investments continued continue this we're to call. net with currently continue produce margin to income growth. to hand, make instead, our market opportunity, on our XX% current a on we

exactly this change? mentioned complex call for center on how not What One is operationally vendor, complex vendors call Thanks is or there. happening color. you follow-up, new Tim, transitioning the you're quick and this

was the management good going lot of systems in Really yesterday. to and lot Canada, us with company, good help And they new Austin, look all of to a vendors went But we're that internal add to learned with system. encompassing we and And to We moving closely forward, off a history. Inspire were forward a launched more lot as together use the up ground. IT very put in it going Cloud we or it scalability so we really Winnipeg, needed we original integrate down patient debug. strong we the knew the to capacity center Well, a centers, was through company. get the had great kind started start a we by of increase we our

I is, got complex a So, And it going we're but the it probably train vendor last And really happened little trainers at more things the over the expanding to well. going and calls they're and taking three And are weeks launched than bit yesterday. forward. new that sounds that word they already transition ago months. four the it three, looking

much. so Thanks

Thanks, Mike.

Thank you.

comes from with proceed Sandler. Adam with question. Piper Our next Maeder question Please your

a taking time. and Tim. Hi, on on fee questions for physician on Rick. the on reimbursement the this great quarter. congrats on Thanks reimbursement side, OUS, Hi, One one and actually, just the

heard I consideration comments the two-incision for extent next the year. did think take at the some least in proposed CMS into to procedure, $XXX I amount that

up? I’d some? one and closer potential we're do follow is then do you revision of compressed implants through there's think being rate to be that a have, that done pretty likely firm the to think Now Inspire that XX% you any and two-incision that's for the approach, Or, any upside floor to you

think I think approval. towards I that's right forward to for now, going move be

I RV CMS the think element. was just the part two XXX%. office on of it use work reduced by the malpractice recommended RV use and accepted They administration accepted

not probably going think I to contested. So really that's be

that's good really spot. think in I a

to a also October. deal they CMS lot has now I other of think, that things with and between have

of know two-incision So volume of do But that that. not Rec, from that's procedures the data. arm's centers. we don't research in an It's We the obviously so the we forward. by length the don't are rec committee, part move by was see to some the developed data going see we ENT our larger

that the was completed recommendation. natural they it's had by they the two-incisions that rec of part doing data when that so So survey, them, and captured been

it's think the we stable foreseeable So a for future. reimbursement

know the Germany the European Outside And and helpful field. nice Netherlands what the on Thanks a seeing of then the in therapy the business about you geographies Tim, talked you'll And, hear. just for talk today, kind in terms good the kind Maybe there. That's for U.S., to a marketplaces. is the additionally part think about bit you're and follow-up of international. future of take I of color, other I it's a that. small quarter. where relatively but in key little

to quarters. much. in couple past, talking spent for talked about Japan. OUS Australia good time about of a we've better I kind But think a so next get want you've the of roadmap over amount just Thanks of the obviously, sense the

Thanks, Adam. Absolutely.

countries the we to reimbursement. have key and of our the While employees Germany, we that focus in case we Germany, make exactly are the investments very XX% after established it's strong. where is remain continues in very, growing European in That have

there. very strong Germany. foothold a performing have in over It's well We really team

is where ability expand because in we group to an Netherlands, second The of there. the changes the have reimbursement

have we to limited so additional quarter. And and to just few the cases in opportunity open right allowed centers. now per we're in And two just up centers center Netherlands each a

So that's going expand. to

to near we Region the will area. UK have to retention We In that And with in reimbursement continue Belgium reimbursement initiative in and Austria, we in there. in starting to good a be Switzerland in the increasing France, the implants Nordic submissions review done and start that's We formal are have reimbursement do they growing. in start future. work new in

approval that it and for is we very up long the it's just I to come Australia, have like regulatory review, the through So next in pushing We're reimbursement, again, a time work have to we Australia is very Australia, locked in in it until that. starting get keep process do and Japan, really forward. takes in in get We but to resubmitted Europe Europe to reimbursement. grow we'll think important. And do our August, hand. to reimbursement going

also strategically to but working all about that of in to near and continuing that And kind to we're it's and looking plan. that future, locked about. able to we a probably going talked developing be expect Australia, but we broader that. take year get Asia in So we reimbursement Pac Japan are already that strategy, we're in the pursue another

helpful. Very Thank you.

Adam. Thanks,

you. Thank

Ravi from comes proceed question with Berenberg. question. Misra Please next with your Our

Hi, the Rick. for Tim. question. Thanks taking Hi,

you consider we the a the from of returning kind But I entail? one, to to guide the new center extra of guess I going being with in is that gets and guess, the two and up is the that of to on kind on came comments procedure growth think how kind questions, growth to about, year respect your hit for ago? tied And, you're to the the going either the when just kind move you're two-incision it maybe that Just led near-term more you the to centers And broadening, two-incision of rate, web XX/XX? Should comes kind that doctor's simple, to in outweigh how guidance into factored as the I near-term, of call what talking visits maybe guys. may a procedure? we've change about throughput Thanks, how to visits is the seems to have now given seen procedures of what as any here, take? that kind long procedure? gathering your from to be you versus that opening physician going the the or or funnel guess be that,

but where little a bit, lie. multifactorial, Ravi, kind benefits through composite it's in let's problem. this is walk No the because of

new capacity based eight calculate really at problem that centers, XXXX, the existing because and out. balance really on year, will centers growing centers think had right. opening you The So we existing only is new centers an can't the month

their takes the have utilization through sites. engaged, original quicker at get to look site to new utilization kind utilization, can higher through to that all the centers sites. of means I higher it sites But and go it the ability we up sites, but process to our the well. that sooner we utilization time say and than have older higher. grow prorate get to But the entire period older in So the continue the the than is But they go carefully, at rate centers. select -- the do get new and improved than their you'd a think is that. to in team as physicians what older to older of actually back But grow training existing

is a So positive. that really strong

call Care know patient center we today, phone one the of even one link. appointment. a challenges that to directly, center patient's to an at that's the call of as call never And knew center we is chance. when we're we open to opening a the being up getting from the continue call the Advisor that of to And improving phone the think answer new is Program, I things And make we we up centers by the calls half that having to a need debug, were communication up answered.

to website, work direct about our call with appointment is have part going also and wanting impact. So of dramatic and it's hospitals brand come on the return And patients have call a the to is And practice. with impact to but the a the finally, get about going to and a patients are with a center, going grown, brand see forward. then timely not has patients, appointment which the significantly think Inspire driving is to I brand aware really an as having awareness. just center And call to are building significant them people physicians driving just their to that starting we consumer not center awareness, and that

I'll leave at that. you. it Thank

Ravi. Thanks,

you. Thank

Suraj question with question. next Please with Oppenheimer. comes your Kalia proceed Our from

Good right? me all Rick. hear Can you afternoon, Tim,

How are you? Yes, Suraj.

quarter. congrats Hey, the on Perfect.

I down So Tim, to just two want could. on I thanks points, for if drill your commentary. And

just numbers make I to sure throwing understand you, put I me math. Forgive of a want lot at but the

it implants done came from U.S. obviously in centers, And XXXX were like specific existing centers. of want new looks the the it at from XX% I growth to centers. tie your quarter XXX about to remaining my So comment question,

over What new XXX X,XXX the if came you just quarter. suggests per at the Maybe at, implants overall, get tie… end utilization little is to I'm versus to centers year-over-year. XXX right a Tim, three at because the about the of look Is think delta, the per day it existing? to rate, math from could I trying really it's So implants, it's way about us implants from still as do center,

We're about X.X.

Sorry, I for a my kept second. loss here

ahead, Okay. going. Go keep

the implants utilization if math Because, I implied that. over us, per center, curious, quarter. suggest guided us roughly per a still it's was guide you little suggesting help metrics is the for just Even three per for you’ve U.S. center. understand could

So just can new utilization picking be you kind tie rate, centers? that it help would us for greatly understand appreciated? together, If your commentary just about of up us

Okay. I'm apart. those and things to peel try two going

second of was growth So rate the which of the XXXX, we're shutdown. dealing of with pandemic the tricky, quarter is the middle kind because

kind opened we it XX/XX. it's in than rather new capacity centers. the is right. hands, second that's shut up not growth quarter they growth of think, of didn't XX necessarily We more down, do new the because centers, to from So But existing implants because centers appears do at true, hard know only many were we centers, the

little be we to how to the XX% got do to calculation existing that. in going careful XX% of the contributing we've want on be We and So as being a for that forward, balance centers growth the growth, believe you centers in well. new model

XX to existing and we're to the they centers going up have exactly intention, implants provide capacity we're that that's at means opening what grow if centers. us do. call that And the with exactly that the the do, So and to opportunity two-incision really center

open the those quarter. the up you remember the is got to and day of of on between the XX key quarter first centers literally last day new the that the centers Now, spread

that part, about don't get a during to of they for new so had above if over implants on but they implants to going they're limited really early per time three, And in of centers started quarter, three a quarter. above opening center in number they most you during the can't the maybe average the quarter range really, have the quarter the that to get on the calculation

they utilization think rates and the it, active for quarters hit several are after really, I their So, they're stride start to existing in the by driven centers.

events. positive Both, little the of at keep it new centers, always centers as a but bit existing it's well. to by And diluted gets fight the a very growing so utilization always opening

just calculation my the same get and budged. I Tim, are just methodology your I to fair that enough. I it But guess And question hasn't we in point. second trying the understand… could maybe is using, tie

budged a of lot, increased. dramatically Suraj, is No, have we the number it centers because opened

about talking utilization the was rates. I No,

number affected centers is that by of we that opened. But the

Okay.

the seeing of how it? appreciated? Thank Or the How your quarters, implants about if would measure do uptick per purpose? center is least start little do with now utilization, we center drop X,XXX, per in over number ROI? say be per let's plus is thinking spend at quarter, and three the math per the next see you two-incision, current color around patient, DTC per you any the the So So few a all DTC patient. the should roughly we minus, quarter How start per you. or should or greatly an in

a as them to see function direct a educating and at their Suraj. awareness. area. do is start it return activity. better we're good, on physician going with think getting good about website consumer leverage to And really brand is factorial But to it. in has And we're we very Thanks building a Very DTC multi the patients them and to And much. well. bringing connecting it the and

kind so centers. And utilization to to continue But at able that really think add of is existing key we centers grow be to going really and new we're moving forward.

that spend. been for the get combination we'll to program, of advisor And return questions. important all much through getting want a a think efficient direct everyone of today. a more for system And yield, the it’s being that But joining the comfort patients part by that's the with consumer is Paul, But utilization, Hi, to growing level forward. two, the is moving able basis we'll of our by with the our So increasing for very I be care thank level to able thank consumer. I more the direct better by see you call the to we've to question. on which a very process be

consistent of our we've their for the As enthusiasm, efforts, outcomes. in always employees The employees important and Inspire growing hard element their success. to remains thank U.S., Japan. remained as and all wish unmatched grateful further continued work successful teams now of as to is business I our Europe patients continued motivation to achieve to and the patient healthcare commitment well the to Inspire on team dedicated and for team's most as focused the our expanding

throughout on And second-half and you appreciate you Inspire, the and we with interest once your of healthy. thank look the the call, you stay all support for forward of and year. to continued safe updates Please For providing again. further

conference. today's concludes This

wonderful Thank may you You this participation. Have time. disconnect lines your a at your for day.