Inspire Medical Systems (INSP) 4 Nov 242024 Q3 Earnings call transcript

Good afternoon. My name is Dilem, and I'll be your conference operator today. At this time, I'd like to welcome everyone to the Inspire Medical Systems Third Quarter 2024 Conference Call. [Operator Instructions] I'll now hand the call over to your first Ezgi Yagci, the Vice President of Investor Relations at Inspire.

You may begin the conference.

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

released the me and September release Financial available Buchholz, we Chairman Tim XX, Officer. on results Executive today, Joining of Herbert, is Rick XXXX. Chief A are the months and X X Officer; copy and Earlier our financial ended for press Chief website.

laws. our limitation, will the financial in meaning and financial federal and are and securities our access On those and within of without based operational market including, to statements this current estimates All make call, assumptions. condition, statements, forward-looking various our operations, year management results business, outlook relating forward-looking XXXX upon in the investments changes full financial

cause These should statements Commission, XX-Q, see and earlier a actual description filed Accordingly, materially including of place events not our afternoon Securities with Form for the involve these you differ. to risks filings material uncertainties. or risks statements. and could Exchange reliance these our that results on undue the Please this we with and which SEC uncertainties

or call or any by whether information Inspire the or of call over statements, XXXX. broadcast today, to With as Herbert. law, future conference November time-sensitive and any turn of Tim contains financial obligation, or intention X, except pleasure projections forward-looking as disclaims my that, because information, new to only otherwise. speaks This update events required the to live it Tim? is revise

for for third XXXX. the thanks, and call everyone, quarter Ezgi, joining our you, update business Thank of

our performance, and to of improvements of and ensure the experience in to available received patients on monitor advance of is our invest must and report, Inspire technology have website. surpassed have outcomes safe our therapy XX,XXX annual effective the is further Inspire programs publication this including patient therapy. which what is we important delivery most with To start call, we in Let's patients. ongoing And as continually therapy, patient who and system-level that our

review Dr. would publication the I Today, the peer Clinical of Journal real-world recent Medicine The by by XX,XXX showing original from reviewed Inspire as FDA XXXX. individual the improvement well Sleep in site in patients as with since continued experience a like to a approval in reviewed University investigators safety announce over Thomas that data patient led reviewing company and as Jefferson Colin documented experience databases. FDA

be from STAR within the and fact, to X.X%, year after in from explant trial. nerve been reported In sleep stimulation what revision reported implant, obstructive which is of first the treatment the new less originally rates These apnea. data X.X% hypoglossal improvements expected significant the both have rates on as set than shown are bar

our performance, we the quarter. strong representing revenue $XXX.X and quarter, This million, successful third of data of business into third proud we XXXX. quarter a compared In third report XX% a increase to translates the are generated to

well as Third result quarter million, also XX therapy existing market in the centers XX% as centers United expansion of greater U.S. This implanting period into growth increased penetration territories. same and as primarily sales adoption reflects the XX year. a last increase over new revenue a revenue in U.S. $XXX.X States new totaled

in reimbursed over to the is last and U.S. the $X.X and of sales saw consistent Utilization X,XXX we procedures account year centers We XXX have year-over-year revenue increased the Switzerland, million. Germany, Netherlands U.S., active increased of Outside Belgium, territories. now began strength XXXX. period in by We U.S. same France. quarter and and the second with XX%

million. XXXX revenue of increasing XX% We to growth our guidance revenue million, are $XXX million to XX% to represents XXXX $XXX which $XXX over

to third a hurricanes quarter. Net the million impacts quarter the in as related some solution guidance result compared and reflects income shortage revenue updated for of the This was fourth IV $XX.X headwinds third of net a the per income XXXX. net in million year of loss of compared the share a of $X.XX in to share representing prior $X.XX period, loss quarter per net $X.X

the September, the settings. key earnings attended year seen the $X.XX strong in had the outcomes conferences American highlighting Highlighting Society Inspire FDA Surgical share team guidance to $X.XX. excellent a to Sleep performance few pathway private we year-to-date, full symposium accomplishments. a years Miami. and to exceptional in of including and we academic per fantastic Given conference, are we and raising Academy by Otolaryngology care have In the International how since XX leads faculty, Inspire practice led both approval

in over Inspire's The commitment with policies demonstrated virtually on professionals significant consistent in system. patients national investigators Medicare The with and over of is from easy-to-use resulting and SleepSync outcomes that treated, highlighted plans. publications and established Inspire coverage an all focused trusted proven XX,XXX team therapy highlighted presentations outcomes our patient XXX private a Inspire in

presented investigators PREDICTOR on During also data the these meetings, the study.

qualify As without requiring the BMI a of without concentric procedure. patients presented for component may which on class. wall lateral with reminder, Inspire endoscopy patients significant study data drug-induced sleep initial the that complete therapy a focus than XX, key those identify are a focused is a collapse The who PREDICTOR lower to of is

We will continue physicians discuss to streamline and the patient therapy. to with journey this receive to payers data Inspire

our outpatient $XX,XXX. slight outpatient code final focus the training consistent programs. advance Medicare another the access XXXX increase to over practice XX advanced training Medicare hosted demand to we meet to strong development to Inspire primary XXX education patient initiative pleased our this market for programs see XXXXX, for physician schedule a improve in ENT the are Inspire rate to therapy. have at both medical before continue clinics the and for surgical which we The year-end. of the XXXX is registered an to and calls $XXX. With for The providers market both with continue we rates final activities, XXXX front, to sleep And payment is year-to-date, we with capacity fee to center fee the rate physician ambulatory hospital national $XX,XXX CPT On for respect with

to care continue drive presence awareness at primary conferences to we increased increase of cardiology our therapy. Inspire and Further,

care to we with a to operating contributed quarter, the DTC a in connect ways found proper program to we strong the believe leverage increase our be has in digital see for continued direct-to-consumer pathway cost. Our health providers. we efficient remains and significant to In patients which third our targeted engagement more a advertising, in and as digital expenses lower patient provides at

our awareness programs will forward, Inspire patient the continue goal enhancing Going of evaluate we DTC regarding therapy. to with

advance We patients' an ability to to appointment patient the on book journey patients' schedule digital experience. scheduling, improve And patient that over scheduling centers With greatly digital first example to their is the increased XXX Inspire to therapy. is the using continue one have we now attempt to receive initiatives improving appointments.

Switching to product development.

soft view history. our promising, the feedback patient designed this new improving the begun a of expect for efficiency We capacity Early U.S. patient management and Inspire and experiences of SleepSync system is and have to patients therapy providers. and follow-ups accessibility programming of comprehensive with availability for launch full increase we enhancing greater year,

system. in the received know, you As neurostimulation August, for we FDA Inspire approval V

time neurostimulator, V We launch for a remain sufficient launch and XXXX. and the corporates we are Inspire sensing respiratory late soft in into inventory, readiness on focused eliminating full capabilities and XXXX a fewer on pressure in company production, track this building operational with with cost. lead. implant component reduced benefits the reduced surgical to We to complexity with physician and the sensing need the to provide believe will the the one and to patient

to to in the continue We we contractors for XXXX. with the scenarios and launch payers are validate coding Medicare help prepared ensure full

early strategy more once to in on XXXX provide expect coding discussions finalize color our We payers. with the we

have the consistent last the With rules pricing current with set system. to final we V old PPS system Inspire Inspire for week, released IV the be

continue remain In and of we the the adoption therapy. patient Inspire summary, focused growth on to

execute driving the strategy effectively our manage flow and more higher and growth provider will patients. partners our of We patient treat capacity of to quality increasing

practice strategies team's advanced independence capacity. Our increasing embedded and key our our new adoption to our and commercial driving all and tools, objective adding implanters, increase and of strategies center providers, which SleepSync training include of the digital provider adding

the Looking to over strategy future remain like review that, of we ahead, drive excited our With his stakeholder place Rick in long-term financials. have appropriate call I'd the turn to confident for and value. are to about our we that

was increase good and increase from was was U.S. XX.X%, from quarter the $XXX.X prior in prior was in quarter quarter the million, the with the $X.X million the consistent million, million, million XX% XX% increase the revenue generated quarter of a XX% Revenue for $XXX.X the the a Total third $XXX.X Tim, $XXX.X an everyone. period. margin year you, year the Thank revenue in outside in of was afternoon, XXXX. year-over-year. U.S. Gross which period.

planned This million to expansion year-over-year. decrease R&D sales $X.X compared expenses increase a million increase operating in to of DTC increased decrease the costs, due third for an primarily offset and the Total partially of were of and $XXX.X general quarter a XXXX. expenses $X.X by as quarter in $XXX.X million corporate expenses was our organization in the million, XX%

income period. net share cash year income Operating quarter the income to net higher loss share per year Interest to compared totaled compared compared year the period, $X.X million This of period. driven ago. and operating the for loss in in Net totaled primarily to income to higher quarter million an quarter million prior dividend of $X.XX $XX.X compared million of $XX.X balances the million of $X.X net a third in in a prior prior compared the the XXXX. $XX.X per for to million $X.X and income a of by was the was $X.XX loss in investment quarter representing year

diluted shares The quarter outstanding was XX.X weighted the in of number average million.

to that we shares full of impact XX.X approximately any of the Excluding million year remainder over XX.X XXXX, be million. may to we outstanding the diluted the share complete expect repurchases

to strategies. September us We our quarter, are increasing cash the cash executing and during operating cash allows million third bringing and total generated our to $XX to $XXX $XX XX. to million growth strong excited in remain This the investment announce on total balances position at million flow focused year-to-date we

guidance. to full of to of XX% XX% compared we in range We XX% full in the to XXXX to continue increase Moving of range to $XXX representing million, XX%. gross year expect revenue, to the million year expect full revenue now to be an be and margin on to year XXXX $XXX

territories XXXX. establish new continue during sales to activate also XX to new XX the and quarter to XX U.S. remaining expect U.S. of We to centers XX

Given the between for per year $X.XX leverage, XXXX in with our XXXX. be for expect remainder confidence our conclusion, $X.XX In us business momentum outlook our full improving of our strong performance provide we diluted business and net now share. the income momentum the will in operating and and strong

you remarks our are that, questions. open may prepared for concluded. Dilem, line now With the

first show from the of comes question And the I from line Marcus JPMorgan. Instructions] [Operator Robbie

fourth were launch? And quarter. been better, Maybe about margins? question. sustainability spending forward, I profitability, guess, But line a really Congrats bottom DTC trajectory really, EPS, start in just can as speak quarter. fantastic your I'll seems leverage me, trajectory we continue you top guide. nice line bottom How margin like upside guide on just and for year-over-year. the it for for I and this see 'XX the very do again, of grow? consensus the versus those to sales on able Once behind think what's with Two further you've investment the in see out, implied the thinking nice new to need upwards the you down and Maybe the line. upside

leverage to want R&D through utilization. said, as of our see continue, as with want as our we performance to organization, also well throughout became when not with increased but profitable getting our we we Robbie, consistency just the team in we DTC, sales that

that more some as moving in efficiencies lot and to So system to in to be appropriate have efficient cost create awareness into and continue to the a there patients with to yet a DTC be to you forward, able yes, state. do continue shown but able there, move our to But we want we forward bring manner. highlight we continue in profitable

our of is That's One -- to out the reduced higher expense. revenue this about been was is add Rick. on to that. It call teens. item Robbie, did QX to R&D the historically. closer to it XX% I'll

one XXXX. inventory, is $X.X million that that the And have quarter did quarter. of some so of phenomenon we not did that was there in expensed have in We prelaunch third this the

And a teens R&D in to basis. to so going-forward be high mid- we do the on expect

R&D from really We shift still regulatory did year-over-year on quarter. of also of costs we development the those have some had We the have into expect third process. development that not continued in we'll more profitability But basis. some costs a

quarter I over investor Tim, this top Great. about the conference third quarter you second improving quarter, follow-up maybe Appreciate fourth call at utilization was for that. sequential an last And on line. and third maybe my quarter over think on talked was quarter, earlier just quarter. it the it

results, about Now that of utilization? fourth -- you quarter? the do you have third or in do terms think are in And we implied quarter? seeing what's How in what what the you feel guide

Yes.

we utilization the It our I up be is We aspiration great had from think period. continue is a I QX our a and consistent between forward. two. step prior year to QX have that the do -- to to will grow utilization, QX. do able to the going remain focus from

QX. we seasonality the of QX end But happy in the quarter. and at the in to a think and with performance I a is late little maybe impact we're think saw QX overall, flat I utilization maybe regionally

from from next question show UBS. Antalffy I And Danielle the line of our comes

strong Congrats quarter a on here.

way around to way to made the some Robbie's around and utilization? would the up maybe Or we a then Just question quantify follow-up Tim, shortage Were about from how to comment, ask guidance And that just on we potential that. you reflecting IV impact specifically, and hurricanes. the that? think, not question Any some the follow there? thinking after fluid seeing impacts I the the be is,

and Sure. the quantify due some of the DISE. We of we're all saline We at think our have combination as of this it's the a mostly well tracking represent closures, closely, phenomenon is But revenue IV of the area that solution the fourth hurricanes staff the the will in the the in is we quarter, to difficult headwind affected to as including hurricanes. in due procedures, and required shortages time. evacuation center more to national anticipate

we of to that challenges sure know hard really are the the making the care the we regions of hospital we're centers, them that So in take and working overcome hurricane. the

regionally hard those as we can to difficult we're to can time. but certainly we focused, again, very it's to quantify in regionally, we sure overcome are it's at hard we while impact And help that. as at make working least But do some expect do whatever can working you But this areas. to

Got it.

approval like wait on measuring the already with I and the feedback is grow. XXXX? a the what app thinking That's at -- indicate long the to we helpful. potential to then And as list the guys Anything follow-up what techs start doctors of to tailwind like our and Okay. say are sleep from you apnea funnel, about about had perspective, you continue sort think seeing sleep are of about perspective, seeing expect how can got for physician what pretty in you're there that sort of obstructive

a Danielle. That's great Thanks, question.

being being be quality have key sensors avenues that sleep, the available. the are all that watches, people their of their is think aware we I look are Apple to of the becoming technologies to it the the at from various it bed, in to it

And of help sleep as that diagnostic other will sleep techniques GLP-Xs quality physicians we can of diagnose increase that awareness also the have know We well. more patients.

believe increased breathing all of specifically many to awareness these sleep So quality have identify patients add who and sleep an obstructive we of sleep-disordered and apnea. do will

going providers. it's So patients to health care awareness tailwind going it's to And forward, to these our mentioned, we with our DTC to is job do you ability be our to and our demand continuing and think connect improve to the grow. programs their going continue and a as be

we process. So patients the efficiencies find and our to need through helping overall

America our from comes the Travis Securities. question Bank next Steed of from of And line

strategies I Congrats V. coding wanted Inspire ask for about quarter. on to the good the

what decision V? not kind to price Inspire a around be on the of that some outcomes increase of the potential elaborate If take and could on you could

we we we're think we appropriate be system the Inspire versus are our working of Inspire V slight setting And are Well, one pressure introduce we then that we them. with pricing payers communicate working a just system. we anymore as that Medicare, and with don't thought can make the a well with lead with the payers, have show really option to But and was the we'll remember, -- increase. have old the to full that, And they also the the maintain PPS and we level when And this, physicians. want IV. sure with rules it we're consistent, aware as V

already adjusting we of feedback be launch. are level which we will price go ready from the the to out And all progress when making we So we'll we this the good neurostimulator, be the get consistent. system but will direct on be the and believe we'll pricing lay coding once

follow-up And have Great. I XXXX. a on

consensus you you you're about competition were the still the to about takes XXXX puts how XXXX. Inspire in point? the just other at on before think around thinking said and And some this puts and that Is with of V, any fine case? baking I GLP-Xs? Is think takes at

Yes, comment sure. you continue to that because little not if early think the of our before, the we we in Travis, will, right it's to current Rick. is Still mentioned But on a as XXXX XXXX planning. middle we're unreasonable. for consensus,

provide footprint we color get us parts for XXXX will that our of soon QX more the include confidence moving our expansion as sales more some earnings to call. really more territories. some and centers of We ongoing But give

the talked but DTC France investments. we expect contribution France. about targeted We've U.S. not outside Our much, from some

-- As tailwinds, for more indication we Those in expanded and updated of and -- continue with get obviously, also AHI the the our for the XXXX. finally to some indications launch I guess, coverages. on payer V, we Inspire payers BMI are

from from line comes Adam Sandler. Piper question Maeder next our of And the

XXXX. in outlined the for about 'XX, on you device tailwinds the how love see headwinds impact kind or it's provide whether you and thread that face early quarter think are as of the -- there could some picking on tirzepatide, terms you thoughts of in GLP-Xs would potential to business? the I of impressive next just you just that leverage. business year. a on and the kind of But maybe Rick, from follow-up. the that competition up have impacting Congrats for potential Maybe just some potentially

Sure.

growth established I be continue products need if centers going think products our -- technology new XXXX. and to we that in to as watch physicians, far to market our to released minute there's a in our any to see worried technology there described And with as I'm well and We'll Inspire in released with the will too that We're not ago. and with a about of sure that. experimented Rick that tailwinds the be utilization of some and adoption grow bit continue therapy.

think far be As to will we we'll with of a FDA sleep as will apnea, for And that. on GLP-Xs, But pharmaceuticals. and therapy. products weigh Inspire mechanism again, available to complementary track indication as again, those And about, talked those waiting we wait progress with for an be that in they when GLP-Xs the the action. different obstructive we're treat

going walls, therapy. to suitable be collapse going believe is them lose able What going we tongue-based which people present and relax help do help for their it's with Inspire them to weight. lateral to to It's

again, us, to think a a I will forward forward. coming XXXX So for release of do a tailwind look GLP-X be we but positive a

just launch? Should inventory margin the is then and coming side? additional And side, look if parity this like? there. does that you but X on to the like kind accretive? for pricing XXXX early to just That's What still exactly on on margin follow-up, granularity the could X, and will some the How helpful. along are sounds progressing an rollout a And we like double-click full sounds we expect gross at maybe be Gen It hoping launch. manufacturing of soft for Gen

Thank you, Adam.

and the it to It's the amount line need for key having that production success release. elements the that readiness we with manufacturing we've the we contracts new on of over we inventory, the sure shelf the need that. is Several and And as that. launch we is think will lines that And up years, make when part the I we had centers because have we're and to the have inventory proper prior is launch. is making a all with running. that new proper of active, model also and preparing will sure ahead go happen we're the exactly

Inspire training be internal the well will use all new the as team We physicians our on V device. of training as

reduce So the gross mentioned, the all the while over require margin And do we IV across and not consistent anymore, see price in the are to for positives increase in that believe with slight is a time. you produce sensing that will COGS, preparing our and board we remaining we'll Inspire lead it. we as it

the comes line of And Rescott our question from David next from Baird.

quarter the on congrats And here.

flat, so is I one mean, this the the think that's is you where to out about ask down outstanding. you the When remain flat can Or us, not year-over-year down First to quarter reaccelerate some the it think of just have out more to maybe DTC, is there have that level level that's want Does that years? maybe in basis? support looks you growth pretty pretty there? in from future on the on the into if that point to start far something continue investment of probably a go did side. to the the in you like margin It year, so slightly been year-over-year. obviously DTC that advertising pretty I

our and spend. making of the we'll we And build scaling DTC And comes our certainly measure about already Yes, efficiencies get while you time of about in field response many in because to the awareness of David, we growth. that talking forms, strong There's also R&D over our we're organization, that continue we're going with to no in able that. the sure with to still invest Inspire were our continued continue but effectiveness question certainly DTC. V Inspire, that monitor against the building mentioned to

to grow to to and monitor late term appointments consistent adoption pretty committing and the attention that decrease continue requesting it patients, not it's that while we'll continue may increase the still and And bringing further. even we're with of that long will bringing we efficiencies gaining with providers, health been care

other again, comment in Any on that? growth. investing really on So focused

Yes. -- increasing those I've making the spend where will in are education medical dollar our for be flat million we from will We're mentioned relatively DTC. it over sleep investments in overall But investments, we the training that be programs fellows in year the the mentioned we XXXX higher also in ENTs. perspective, are spent and $XXX for XXXX and XXXX.

And digital so that, along and allowed still to in it's with decrease initiatives. efficient wider our targeted spend, being advertising have DTC of focus, more kind the us but

you out a Maybe basis France in year. QX, of for little on had international, called for on next quarter a bit year. I have benefit, you fourth guess, in you a a I this know year-over-year -- the

international just additional provide maybe well? broader France So the XXXX us help for that could these you're some the think size that us then contributing of of as around about could about be, And into are thinking maybe what the how that any think, quarter markets this growth you other implications year? about think I just but help can fourth color, you in

Sure.

that And in take that big start of two are forward comers to the U.K. have the spoke therapy. going impact think now. in and the going open about just start think to quarter country-wide to France help our centers of France advantage we now to and patients that and ability going receive to last I Obviously, reimbursement really right up and just France up the markets are are both a them I and be positive

next business we're the years. going build them over to So several help their

with we said, performance out progress the in And well. another we're we quite United to of increased also as And markets And region go And year seeing and I Asian Netherlands will continue that some still Germany, to DACH think Austria, the in the have Switzerland. over Kingdom. again, make well. perform Belgium being

So I international we've we'll seen past. in in a consistent see growth the think markets, as

saw Jefferies. next comes from Sarcone Michael question And the I line from of our

Just Tim, just mentioned type on Adam's few of actually not talk that by you you a account done, V about vary can or you a Or the about think those a Do contracts. question Inspire have or including things renegotiating that that's be customer? the some follow-up heavy lift? whether does to of rollout.

with it the centers system to go with through new the I make level think contract, product minimizes that pricing addendum. pricing decision added It on consistent just that really is a the to this logistics of sure pricing leave in our to to with existing the we process the have burden.

believe it's a to going complete lift of much heavy contracts. to don't those we be too So

Great. PREDICTOR And data a how curious had a ago. have conversations was saw on payers we weeks then that that any update few resonating if we I just with data? just now you are your

algorithm the for that to better a of reducing patients can Payers BMI patients at have is that XX. have understand ways lot who bit a an there in that's saw a less don't endoscopy, They drug-induced than help want for introduction And patients if are lateral receptive. than collapse. to really XX of less you -- as with a an through have the of they save less investment payer don't XX, And And sleep important. patient's most diagnostic meeting, what's process. wall BMI they little than require quality and to the without the of care,

less or BMI can the XX that presented algorithm And XX, proposal the and directly to conference was inches therapy. they in proceed So than the those is next the conference method, to have between was to could they any implant. and XX measuring proceed one that want idea more

discussions payers need as can well to be it's a have pretty and we that information adopt able But as with algorithm we little to that. at collect bit strong look to So on physicians more a that process.

about at data. working on well. physicians abstracts a So X other peer-reviewed The to the present good are as be there it's able publication, collapse wall are very lateral that to meeting and talking

with So going of as this we this. a lot put take next together the step get everything combine forward we're to more information to

Truist comes next from Richard our question of Securities. Newitter from And line the

Congrats a the good on I here, profit. wanted especially quarter to start.

on just question, First the Inspire coding V strategy.

could little specific. get a you If more

can if it your logical to the back Our neurostimulation were, just is that given that physician to what of code. or pathway that then can the that cranial basis? it's other route or talk neutral was some strategy go level keep economics stand that to you time Is using per confidence And time pathway understanding you on is most correct? whether faster kind unit they procedure the a now, the where to to

kind going we're be have procedure Yes. weigh we forward, sure all lead of have anymore, this to and as to want to implant that work ability pressure make advantage the first need MAX shorter well. at we information really do able themselves. saves sure in. through payers also that the lay sensing before and And making in V a the time testing. the to We with a bit but fair we Rich, and that that the we back they shake come as little you that not the Inspire interoperative The improves have do highlight, That of

to to they more procedures they in we day. time, do per surgical whatever can in can it's we bring take measure a down significantly the to because revenue significant such single be to basis. on That's patients. a be can reduce But a we reimbursement So minute if use when OR get of is of going able physicians that care code a more benefit physician it, yes, at, what Rich, look more

at for to care look positive you builds more that going and efficiencies however of physicians net patients. be So it still take allows to them it, it's in a the

patients limiting have that enough factor today that about, And we we of have take know simply to ENTs with we have. as capacity we all the care not is do we've the talked

these the So able procedures for is net physicians it's for and either OR that more time allows in benefit a a to going relative of to the such be way. still being reduce codes value day

or consensus the you to view don't consensus Okay. on going an think reasonable, just XXXX, unreasonable you phrase And international just back I'm trying want as I then to to U.S. consensus, that. looks because to utilization. however guess, component there's

as about I goal consensus in part year-over-year, I but to consensus the the utilization growth. You've still year-over-year. talked guess modest, when U.S. grow does the utilization U.S. the looks your does in single low of in being doesn't guess, consensus count project look say past digits. that comment reasonable? consistently you the that unreasonable,

We Yes, want to of have to in sales because are that utilization. know Inspire. Rich. provider to an important that the if you, same-store highest do And natural continue that also aspect we health know outcomes. is growth with more grow has center the more we every patient do Well, that's highest experience care also centers utilization associated there the have experience. Thank

look same-store a continue we future, to will as to that the going want forward. for sales, be So grow continually utilization focus and we into

unreasonable. incorporated take do And And international our that as comments the not next consensus when into make we business we is year well. the that account is

the And our next from line Larry Wells of comes question Biegelsen from Fargo.

tell the Inspire any to V, point for V if you're there I'll for launch, you to patient you make is to going are quick at disclose soft until quick, full going the second, this are ahead launch? Tim, going year? how when what coding ones. concern of surgeons you not next And Inspire do the this of warehousing surgeons bill two One to pretty is tell --

Thanks, will payers procedure. launch have instructions with Larry. Inspire their The for soft V their specific physicians

wanting monitor get that high XXXX, the be to the believe be the V. sure will tent know up. we year, don't sequencing patients there into make with insurance Especially in set continue launch. two, pushing delay to to in the hard Number to plans, So for able therapy. that We they're we the that will and to to prepare really proper get with aware as of become but under Inspire a going full all the we brought be therapy deductible work people are in 'XX payers patients significant the we'll will they believe get

of question from Singh line from the saw our next Shagun I And RBC. comes

just on two 'XX. topics QX clarification I and guess

growth V hurricane this shortage? IV is you And wondering If can Anything implies pretty million in you saline at from It to look guidance launch? looking high the you've at have just QX years, is consistently Inspire $XX inventory about differential. sequential at there what you then in the share conservatism? X comes in to past I'm XXs. the somewhere And contemplated sequential dynamic QX, for it growth it delivered play any ahead And teams? there? around of that U.S. Or your

as year? XX% follow-up, just versus you think do XXXX, And about to XX% of And reasonable consensus growth next why So year cycle, can't do that year-over-year why again, is And at you're drivers this then there on cetera? all? is Inspire replacement a a PREDICTOR, why lot we about think reasonable V, et better? at that XX% are looking do to you

good. Very

a still and taken get hurricanes. we recover our we back are you there and the utilization impact cases. their against QX, members quarter, regional to is able of with of at displaced fourth centers and lot the step-up capacity get the sure all high patients because of and with remember the are when are and the there. also who they're the and assessing to to run back in potential of scheduling the run mentioned, we back up care a and our as Again, QX start higher and But in start demand from have and make Again, own try Let's that including with in that's kind homes hurricane. up they're team running. working a we

So it's up. lot to have capacity we make -- of don't a

and think early, to we're yes, everything of determine, that's our with But planning look we we -- there. numbers And and date, certainly again, where performance closely we regional and along. still have yes, So lot doing XXXX. annual those at we're we at unreasonable, when we we we're coming When of forward very help plan those for our we but not strong why to 'XX, are process. look a operating looked to consensus at is starting forward But go we patients the progress a finishing can as kind really those our that plan us but kind helping just forward. we of annual look tailwinds monitoring that's

Titchmarsh our show the from from question of Stanley. comes I Kallum line Morgan And next

ask upfront. I'll two

Last And understand then beyond any assess absence to you on but secondly, the us and providing in we and 'XX of with from performance pile. any update announced for metrics a center buyback, Firstly, you're strong head as of there to XXXX into obviously those just the beyond? looking flag just wanted quarter, numbers? help thinking cash priorities your to other intentions want you

that we very said as have. move as leverage were plan not to very opportunistic. that Absolutely. in opportunistic know, and as the And we profitable at getting team buyback, we that, point, have With and we're buyback, forward. is reserve hard. we've We're that start we triggered across going a that to you did With working tracking mentioned, proud but of we stock for this The been the is closely, be still cash we that, remain strong balance organization to and the we very be place.

help keep think on other And flow. what our of therapy. on the in the and back and look Inspire can adoption and continue up can the grow far patient we opportunities as And cash, that. of us investments we'll grow past, of As us report awareness continue with really where to can antennas technologies that I for made to use always help in minority technologies we've we Inspire adoption

far As metrics... as

Yes.

in gross We revenue per we've always historically, through as metrics, know, we're and been and earnings you transparent. -- XXXX. to still Regarding that, but we will we share the XXXX margin -- working guide

And want continue so that. we to

will So guide to that it. disclose sales but we U.S. our We territories. won't continue disclose to number, we will

field possibly is provide fact to grown how commercialize. that we discussing additional into we we're performance insight financial of disclose again, we're profitability representatives metric will a time. guidance clinical as And some But we've tracking our in larger business continue just that a company, our and we over to relevant the believe more also and number

from Block our from line Jon of And next I show question the comes Stifel.

procedure, if trained the now little any ENTs inquiries one. curious pause. pending comfortable? free early Two them the due are of of help seeing center be or quick from a bit having quick to Obviously, per that get the first the looking outreach the sensing to and you're ones. lead, That's that number simplifying more could up ENTs elimination Tim, I'm just I'll capacity.

forward, muscle We when as between positive impact. We the the that intercostal positive The very we're give a that, our will no longer that, kind to outside unnatural But but the Inspire don't at not V talking physicians place that have talk V a point, of lead being awareness Jon, of Inspire we marketing believe impact talk a do sensing will all have we only some it. about time calls believe part that time we is here that, V you procedure. the -- one need going careful to of -- these are about this about X. on of about plans

capacity is year be key about be increase I to to open sites. phenomenon is will the future. door. you the that look in XXXX I And helps. focus it going the that a at hint in that And into able when will really be surgeons and that And I existing the So train us forward to to additional best see it think is think a will to that think next what talking way you'll -- for more that

always very when just it. honestly, And with quite docs I've surprised the reach actually most Inspire know been there. are Tim, Maybe tune we in helpful. about That's a follow-up out V.

seem if procedure, and when terms do you're point get of are sort doing going they not that knowledgeable your get what approved that but like it, they a start I marketing in to telling about the last pretty when of follow-up trained it's you these they're to be or can So that's to one? docs

be on $X conference call, sequentially. was it it $X million, I $X down about got quickly, think, OpEx to to just million Rick, $X And Back sequentially million was the expected the huge. that up to The you EPS I've right

on that just what had to it played been? what So the OpEx come throughout side considerably out in XQ led your view below

at and Obviously, Jon, when topic. part large been Academy into to down as talked of is V, and knowledge Inspire have several you don't have part a evaluation. of academic Otolaryngology the our We the physicians they've a it they lot of research Sleep questions the booth. ongoing, American call individuals meeting of Society not and on Surgical this V were we Inspire on the get the International do Quickly the were and

keep So relatively physicians Inspire a own it discuss, V. the of as there our about amongst certainly lot is academic as talk far we But quiet.

discuss no, trained so will be here. lodging they be it we as we disclosed when when just haven't will And we or

it's Rick. Jon,

reduction, from developmental OpEx, V Inspire I shifting item we because more readiness. did Regarding have operational as the a to R&D our on of mentioned, line

also again, We was DTC -- down.

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line And Anthony I from Americas. from comes Petrone of our Mizuho question the next show

on the one funnel, Tim. Maybe

follow-up then a about GLP-Xs on effect from stimulation. And do Are when think a for halo potentially to category out apnea, having a And we ahead sleep plays numbers? that when providing potentially I'll that have think GLP-X Rick. we BMI seeing nerve XX-plus to perspective? label Just hypoglossal how you funnel already in for you think one quick XXXX, that

town night. the Maple last Thanks, we watch in

So sorry, great to think But had I a question. -- center-home we home sent the -- that's with him that

lateral the patients collapse early the well as payers, have if majority really our the than you as look -- reimbursement back XX a wall of XX. BMI kind of the less from policies With with

advantageous to move be if a able assess be to conference. going next at patients also or to to to in So be can you really if able find look avenue them better straight the of number therapy we with there, it's

see going drug-induced really complete lateral opportunity really for benefit those endoscopy really concentric they of of don't It's having unique don't a collapse. likelihood collapse who having have to a be or wall a a because patients sleep

now than XX going BMI keep less than continue investigating a higher XX the really really we're to breakpoint. XX. And just up to is natural to So

start really wall point, that that lateral you at to for get greater a propensity But collapse.

they they will the with approval have get As be launch GLP-Xs, and of able and approval a I sleep far on get when positive impact. it's and if their product for that apnea as obstructive what the be indication think to then to timing a time matter

how their they still there's pursue regulatory or that be or launch reimbursement. So what we know will will much process about don't so timing

patients treat is But the and GLP-Xs Inspire. for to and of we use be come are into apnea, drugs those continued the confident that able the to with weight the obstructive going obesity of lose launch help sleep to

that future. positive we'll we to well tailwind continue believe but a be the So will into track do that,

That's for helpful. One Rick.

Just of just additional what still there? R&D, down complete it on be stepped a to XXXX? in will launched are studies in there there recap And Maybe bit. is collapse quite today studies in

had we continuing line item. -- the R&D about We're in expensed investments Yes. make inventory There to $X in of was million prelaunch XXXX.

did and occur getting we're because so that we closer XXXX in And approval got to not launch.

but but health So our we're R&D last we're to platform inventory, was have as and prelaunch the digital digital also SleepSync, investments in of because running year a the our little making we past, area. still hotter investments in continuing make

continuing expenses with teens we're programmer, be mid-higher indicating to to R&D so PREDICTOR go-forward the a going SleepSync why closer recently investments. we're that's study, study our make And clinical on basis. with also And approved had to that's we And there.

comes show I line Markets. question from Capital from Fishbin from next And our Brett the KeyBanc

level that, quantifying working to on So of follow-up an the just implied November? is you're think generally of impact that if or month guidance and the the sounded topic. IV ask you uncertainty curious still even if item seeing derisked in just for I Tim and into on the shortage revenue still Rick, a and wanted impact It hurricane like you're on XQ?

Yes. think try but do is that is and We in, we recovery that derisk. to believe we that build well underway, the effort

then when think really impact focused and of and a we're we late to kind a quarter, then the we in it's little the evacuations get September regionally QX, address IV of course, I of second in we area. And a obviously, shortage. I that hurricane get fourth able think the see in But bit the it.

be get their health get to rescheduled capacity going homes be have of their the to to just into once is for back we Our challenge procedure. care and the that fourth and Inspire care in they patients that the sure take back into quarter able get making

effort. just part, So we're focused the for most really, on a local

in bit progressing my around wondering All for on first follow-up. of just utilization to you that how I seen centers past? curve this right. could you added ramped have year that new the if was a comment the the the compared half typical then in And you've

I them identified. when start. productive have with lately expectation always number they want we they centers think And a sure we train make that be to patients to the of

it's of And the for them there's So of to have up they the saying not intent Inspire pursuing when advantage yourself the accounts just patients are the offerings. you there's to -- straight patients no anybody we as with really on are And of do come their start up, part pipeline. we many with productive account. already that in being a too to center to

we And sure sites screen out. make so the that we

up move matter quickly. So the intent utilization that will the is they

takes to Now And the start them late our year year, in do we for again, way whether they it so. in earlier makes the time fiscal because classes a the difference year. our categorize is

to in if they're to the even again, XXXX. to be that flow. you. So intent of with starts have part train be But have patient December, we class Thank strong to the able able a center of them system

from Chris our question from next line Pasquale And Research. comes of I Nephron the show

account and execute Is that the rollout. you broadly quarter first need the you Inspire of be to and transition not V field I'll to on expecting the Is volumes? an should disruption wanted retrain one, demand procedure the the follow we reps during full I I how out base? just available, without it ask Or taking actually spread enough that across do to imagine the out is customer people some up make that of be once disrupting to going launch? issue? you physicians, going the Tim. be high

bit it's a little think I a of relative.

straightforward don't interoperative the it's lead. you in is do We we surgical on we or implant it's aspects that. management specific testing. the that the training can sorry, Rich, the other sensing training get think avenues as it, really simply I train I'm Chris, But logistics online. a -- when lot to know, And need just that of pretty pressure how of we do into you do

is we field replacement the the X activation. training device again, it's a clinical get of still next lot the But going a then reps And to with into X. from when

able do So to it's site. all we to be really that really I of trade, should of we're do if to the a to going relatively our straightforward need training that and out to take that be able field people on know don't

our show of from I And next from Wolfe line question Research. the Polark Michael comes

to network confirm the me. quarter, XX% the Just sequentially. on center in one center the additions see for up I XX added, I want

of So these deactivations can centers? activate you confirm there that's can and the are criteria just XX just us if -- are what to you remind some

Sure.

to think surgeon opportunity to I a two, different to they offer want receive That's is we of primary. reason to patients it's Number have the the therapy. where sending careful if ability and have a to be that's they the an sites been inspire moves don't facility, site #X therapy. Inspire inactive, the don't

not is reactivate. And patients what we happens we surgeons we discontinue take website, we all can through lot off them. the all make able take may we do is what want identify So the A that way do is we take reactivate patients of we sites care take they to certainly to center that the and process the sure that before again discontinue training But of them new them we a if them. them. to over

Kratky Mike show And line question I from the from Partners. Leerink of our next comes

what a data, following of gating from is impact on noticeable And navigate extent some your a PREDICTOR DISE us away patients expect you XXXX? be that? So to And tailwind to certain factors from be volumes year? that you procedure remaining help procedure a can just what able able the understand to in meaningful see needing are to to next the

it think I is. Yes,

I'm consistent payers I not But have have with their patients that's FDA we already identify And or specify indication don't our they do how think have collapse. want we is who lateral not policy that they is not wall complete determined. dice. that that to that a we what require concentric a changed specifically -- have to already sorry, do have payers specifically

we physicians to saw -- down good that talked to which with the for candidates be you is that start about identify be in able submit to Miami, therapy. to that and was an payers patients patients method And able acceptable those able this that algorithm have are we were show to into Inspire to that,

going it's So impact. to I have think an do

for the continue not payers that already working be requiring a physicians qualify to sleep they some we'll with to and continue submit patients to and to and report if their endoscopy, back. using with algorithm and to able So we're have work to them Inspire determine track

from I our And in Oppenheimer show comes Suraj from Co. queue question last & Kalia the

of just the I'll question. In ask interest time, one

been per QX? U.S. So site Tim, quarters utilization that reconcile capacity million normalized about to understand 'XX, is that QX to statement your issues say, for QX normalize Can just right. trying the all X.X $XX 'XX. quarter. dynamics, what we moved per got implants that, utilization If I trying you X We relatively is, guess for flattish. this the understand let's X, I'm help has us last to

working have days. you XX So

appreciated. you would greatly it's expand about But if the if somewhere, issue. hurricanes, on not your your I'm understanding And moves Even comment be around. comments, capacity capacity can that it maybe

there's demand the focus. X Yes, time to as know well. that with high continues to I asked into question. utilization those one think be take capacity you able a Absolutely. that our you parts. always to get utilization And asking able you're with we Thanks, Suraj. And that fourth as we quarter, for I patients increase as thought patients. you high of spent be I to think to care be that highlight, But the

same-store to make see as much it's in the that surgeons patients so directly know we of to that goal grow high we take sales again, But we field market. specifics with of factor to an to care and and to remain best time possible quarter work U.S. going that, And to care important OR up continues think the be as the because we we want our really we the the our sure of adoption as can. as fourth take that team demand maximize that's with grow to

So thanks very much.

thank the today. call for For you everybody, want joining to I

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

And providing for updates all of in interest we very appreciate month ahead. support Inspire, much. on and further a you call, look continued you your to Thank and we of the with forward you

conference Thank you. today's This Thank concludes you participating. call. for

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