CVRx Inc (CVRX) 2025 Q2 法說會逐字稿

Good afternoon, ladies and gentlemen. Welcome to today's CVRx Q2 2025 earnings call. (Operator Instructions) Also, today's call is being recorded. (Operator Instructions) Now at this time, I'd like to turn things over to Mr. Mike Vallie with ICR.

女士們，先生們，下午好！歡迎參加今天的 CVRx 2025 年第二季財報電話會議。 （操作員指示）此外，今天的電話會議正在錄音中。 （操作員指示）現在，我想將發言權交給 ICR 的 Mike Vallie 先生。

Mr. Vallie, please go ahead, sir.

瓦利先生，請繼續，先生。

Good afternoon. Thank you for joining us today for CVRx's second-quarter 2025 earnings conference call. Joining me on today's call are the company's President and Chief Executive Officer, Kevin Hykes; and Chief Financial Officer, Jared O'sheim. The remarks today will contain forward-looking statements, including statements about financial guidance. These statements are based on plans and expectations as of today, which may change over time.

午安.感謝您今天參加 CVRx 2025 年第二季財報電話會議。該公司總裁兼執行長 Kevin Hykes 和財務長 Jared O'sheim 將出席今天的電話會議。今天的發言將包含前瞻性陳述，包括有關財務指引的陳述。這些陳述是基於截至今天的計劃和預期，可能會隨著時間的推移而改變。

In addition, actual results could differ materially due to a number of risks and uncertainties, including those identified in the earnings release issued prior to this call and in the company's SEC filings. I would now like to turn the call over to CVRx's President and Chief Executive Officer, Kevin Hykes.

此外，由於許多風險和不確定因素，實際結果可能存在重大差異，包括本次電話會議前發布的財報以及公司提交給美國證券交易委員會 (SEC) 的文件中所述。現在，我將電話會議交給 CVRx 總裁兼執行長 Kevin Hykes。

Thanks, Mike. Good afternoon, and thank you for joining us for our second quarter earnings call. We delivered total revenue of $13.6 million in the second quarter, a 15% increase over the same quarter last year. US Heart Failure revenue was $12.2 million.

謝謝，麥克。下午好，感謝您參加我們第二季的財報電話會議。我們第二季的總營收為1,360萬美元，比去年同期成長了15%。美國心臟衰竭業務的收入為1220萬美元。

We ended the quarter with 240 active implanting centers in the United States, up from 227 at the end of Q1 2025 and 189 at the end of Q2 2024. We also expanded to 47 US sales territories, up from 45 at the end of Q1. Our sales force transformation is proceeding according to plan. We are largely through the necessary transitions in the sales team that we initiated in Q4 and turnover is returning to normal.

截至本季末，我們在美國擁有240個活躍的植入中心，高於2025年第一季末的227個和2024年第二季末的189個。我們也將美國銷售區域擴展到47個，高於第一季末的45個。我們的銷售團隊轉型正在按計劃進行。我們已基本完成第四季啟動的銷售團隊必要過渡，營​​業額正在恢復正常。

Importantly, we have aggressively hired since January to fill the open roles with strong talent. While we are enthusiastic about the team in the field, they are still early in their tenure with more than 35% of territory managers hired since January 1.

重要的是，我們自一月份以來積極招聘，以填補空缺職位。雖然我們對該領域的團隊充滿熱情，但他們的任期尚短，超過35%的區域經理是自1月1日起聘用的。

In addition, over half of our area sales directors have joined in the last 12 months, and all of them bring a significant level of management experience to this team. Overall, the quality of the talent that we've attracted has been exceptional, and these new reps and sales leaders are developing their expertise in our technology and clinical data and becoming increasingly comfortable in their regions and territories. As we near the end of the sales force transformation and as turnover returns to normal, we are shifting our focus from hiring to further optimizing our onboarding and training as we seek to increase the productivity of these new territory managers. We expect territory expansion to resume as territory managers hired early this year become increasingly productive. In parallel, we're seeing encouraging results from our refined approach to developing sustainable Barostim programs.

此外，超過一半的區域銷售總監在過去12個月內加入，他們都為團隊帶來了豐富的管理經驗。總體而言，我們吸引的人才素質非常高，這些新來的銷售代表和銷售主管正在提升他們在我們技術和臨床數據方面的專業知識，並在各自的區域和地域中越來越得心應手。隨著銷售隊伍轉型接近尾聲，人員流動率也逐漸恢復正常，我們將重點從招募轉向進一步優化入職培訓，力求提高這些新區域經理的工作效率。隨著今年年初入職的區域經理的工作效率不斷提高，我們預計區域擴張將得以恢復。同時，我們改進的、可持續的Barostim專案開發方法也取得了令人鼓舞的成果。

Our strategy of targeting centers based on indicators of potential and applying best practices is showing positive signs of traction and is evolving as we gain deeper insights into what makes accounts successful. We've observed that in some instances, the right combination of clinical champion and administrative support may matter as much as heart failure patient volume or new technology adoption history alone. While we are still primarily focused on adding Tier 1 and 2 accounts, some of our most promising recent successes have been with centers that don't qualify as Tier 1 or 2 centers under our current segmentation model. For example, some centers in lower tiers act as satellite centers beneath a Tier 1 flagship and can serve as a future path into the flagship account.

我們根據潛力指標鎖定中心並應用最佳實踐的策略正顯示出積極的發展跡象，並且隨著我們對客戶成功要素的深入了解，該策略也在不斷發展。我們觀察到，在某些情況下，臨床負責人與行政支援的合理組合可能與心臟衰竭患者數量或新技術採用歷史本身一樣重要。雖然我們仍然主要專注於增加一級和二級客戶，但我們近期取得的一些最有希望的成功案例，是來自那些在我們目前的細分模式下不符合一級或二級標準的中心。例如，一些較低階的中心可以作為一級旗艦客戶的衛星中心，並可以作為未來進入旗艦客戶的途徑。

In addition, some centers that were excluded from our segmentation because they were not CardioMEMS adopters in the past can, in fact, be good opportunities for Barostim with the right clinical champion and administrative support in place. While our initial segmentation approach will continue to serve as a valuable guide, we will opportunistically add Tier 3 and 4 accounts where we are convinced that they can develop a successful Barostim program. We're identifying the right combination of clinical champions and administrative partners within these accounts and expanding our network to include multiple prescribers per center as well as relationships with referring physicians and advanced practice providers in the surrounding community. The compensation plan that we implemented earlier this year encourages these program building behaviors and is effectively driving the desired results across the team.

此外，一些中心過去因為未採用CardioMEMS而被排除在我們的細分領域之外，但實際上，如果擁有合適的臨床負責人和行政支持，它們對Barostim來說可能是個好機會。雖然我們最初的細分方法將繼續發揮寶貴的指導作用，但我們會適時地增加三級和四級客戶，因為我們相信這些客戶能夠成功開發Barostim專案。我們正在這些客戶中尋找合適的臨床負責人和行政合作夥伴組合，並擴展我們的網絡，使每個中心都能涵蓋多名處方醫生，並與週邊社區的轉診醫生和高級執業醫師建立聯繫。我們今年稍早實施的薪酬計畫鼓勵了這些專案建立行為，並有效地推動了整個團隊實現預期成果。

The early results of our go-to-market strategy are encouraging. An increasing number of centers are meeting multiple, if not all 4 criteria for qualifying as a sustainable Barostim program. Our approach to dabbler accounts remains unchanged. We're making strategic decisions about where to invest resources, either working with underperforming accounts that have the potential to become sustainable programs or stepping back where the opportunity is limited. This account cleanup helps our utilization and lets our team focus their efforts on accounts where they can have the greatest impact.

我們的市場推廣策略取得了令人鼓舞的初步成果。越來越多的中心滿足了永續Barostim專案的全部（甚至多個）四項標準。我們對待「dabbler」帳戶的方式保持不變。我們正在製定策略決策，決定將資源投入哪些領域：要麼與那些有潛力成為永續專案但表現不佳的帳戶合作，要麼在機會有限的情況下退出。這次帳戶清理有助於提高我們的資源利用率，讓我們的團隊將精力集中在能夠產生最大影響的帳戶上。

Our reimbursement strategy continues to advance, reducing one of the main barriers to adoption for this therapy. First, CMS has proposed maintaining the assignment of the Barostim implant procedure to new technology APC 1580 with its associated payment of approximately $45,000 for procedures performed in the outpatient setting.

我們的報銷策略持續改進，降低了此療法推廣應用的主要障礙之一。首先，CMS 已提議將 Barostim 植入手術繼續歸屬於新技術 APC 1580，並為門診手術支付約 4.5 萬美元的相關費用。

For the second year in a row, CMS is soliciting comments about the need for a Level 6 neurostimulator APC. We expect CMS will publish the 2026 Medicare Outpatient Payment System final rule in November, and it will take effect on January 1, 2026. Second, the transition to Category 1 CPT codes in January of 2026 represents a significant milestone that will directly benefit our commercial efforts. The proposed Medicare physician fee schedule released July 15, specified 11 work RVUs for the Barostim implant procedure, translating to a national average physician payment of approximately $550, consistent with our expectations. Overall, the transition to a Category I code will eliminate the experimental and investigational denials regularly seen with Category III codes, improve prior authorization predictability and ensure that physicians are paid fairly and consistently for the procedure.

CMS 連續第二年徵詢關於 6 級神經刺激器 APC 必要性的意見。我們預計 CMS 將於 11 月發布 2026 年醫療保險門診支付系統最終規則，並於 2026 年 1 月 1 日生效。其次，2026 年 1 月過渡到 1 類 CPT 代碼代表著一個重要里程碑，將直接有利於我們的商業努力。 7 月 15 日發布的擬議醫療保險醫師收費表為 Barostim 植入手術指定了 11 個工作 RVU，相當於全國平均醫師支付約為 550 美元，這與我們的預期一致。總體而言，過渡到 1 類代碼將消除 3 類代碼中經常出現的實驗性和研究性拒絕，提高事先授權的可預測性，並確保醫生獲得公平和一致的手術報酬。

These reimbursement updates follow the positive developments of October 1, 2024, when Barostim was assigned to a higher-paying MSDRG for inpatient procedures.

這些報銷更新是在 2024 年 10 月 1 日的積極進展之後進行的，當時 Barostim 被分配到薪酬更高的 MSDRG 進行住院治療。

Together, these 3 reimbursement improvements over the past 9 months underscore the value of Barostim and reinforce its role in the heart failure care continuum. Moving to our clinical strategy. Our clinical evidence generation efforts are gaining momentum on multiple fronts as we continue building the robust data foundation necessary to support Barostim's adoption as a standard of care. Our discussions with FDA on a category B IDE randomized controlled trial design are progressing. The proposed trial would include patients with an ejection fraction of up to 50% and an NT-proBNP up to 5,000.

過去9個月以來，這三項報銷政策的改進凸顯了Barostim的價值，並鞏固了其在心臟衰竭治療全程中的作用。接下來，我們來談談臨床策略。隨著我們持續建立堅實的數據基礎，以支持Barostim成為標準治療方案，我們的臨床證據生成工作正在多個方面取得進展。我們與FDA就B類IDE隨機對照試驗設計的討論正在推進中。擬議的試驗將納入射血分數高達50%且NT-proBNP高達5,000的患者。

Assuming we reach agreement with FDA on the trial design, we will then approach CMS to seek coverage for the procedures performed in the trial on Medicare patients as this coverage is a prerequisite for moving forward with the trial. As appropriate, we will provide additional updates. Beyond the randomized controlled trial, we continue to develop additional clinical evidence through investigator-sponsored research, multicenter trials and real-world data.

假設我們與FDA就試驗設計達成一致，我們將與CMS聯繫，尋求對Medicare患者進行的試驗程序的報銷，因為報銷是繼續進行試驗的先決條件。我們將在適當的時候提供更多更新資訊。除了隨機對照試驗之外，我們還將繼續透過研究者資助的研究、多中心試驗和真實世界數據來開發更多臨床證據。

This directly supports our commercial efforts by strengthening the foundation of evidence to support physician adoption of the therapy. This further demonstrates our continued commitment to advancing the science behind bar or neuromodulation. As a reminder, our final area of focus is on building awareness of Barostim. We continue to implement these efforts through a variety of educational programs at the local, regional and national level with physicians and advanced practice providers or APPs. We increased our focus on APPs starting in Q1 with over 100 educational programs being completed year-to-date.

這直接支持了我們的商業化努力，增強了支持醫生採用該療法的證據基礎。這進一步顯示了我們持續致力於推動神經調節科學的決心。需要提醒的是，我們最後一個重點領域是提高人們對Barostim的認知。我們將繼續透過與醫生、高級執業醫師（APP）合作，在地方、區域和國家層面開展各種教育計畫來落實這些努力。從第一季開始，我們加大了對APP的關注，今年迄今已完成100多個教育計畫。

These events are driving strong interest and awareness in Barostim therapy from community-based APPs who manage most of our indicated heart failure patients on a day-to-day basis. We believe these efforts are meaningful in moving Barostim towards standard of care, given that these providers are instrumental in managing potential Barostim patients in the community. We are looking forward to attending the Heart Failure Society of America meeting this September, one of the most important heart failure meetings of the year, which gives us a great opportunity to connect with key opinion leaders and physicians and to continue to raise awareness of Barostim therapy.

這些活動激發了社區輔助醫療機構 (APP) 對 Barostim 療法的濃厚興趣和認知，這些機構負責日常管理我們大多數符合指徵的心臟衰竭患者。我們相信，鑑於這些醫療服務提供者在管理社區中潛在的 Barostim 患者方面發揮著重要作用，這些努力對於推動 Barostim 成為標準治療具有重要意義。我們期待參加今年九月的美國心臟衰竭協會 (HESA) 會議，這是年度最重要的心臟衰竭會議之一，這將為我們提供一個與關鍵意見領袖和醫生交流的絕佳機會，並繼續提高人們對 Barostim 療法的認識。

To wrap up, we delivered a solid second quarter with revenue growth in line with our guidance and expectations. Our work to transform the sales force is progressing well, and we're building momentum in the development of sustainable Barostim programs. The positive developments in reimbursement and clinical evidence set us up well for continued growth in the future. Now I'd like to turn the call over to Jared for a financial review.

總而言之，我們第二季業績穩健，營收成長符合我們的指引和預期。我們銷售團隊的轉型工作進展順利，我們正在為開發可持續的Barostim專案積蓄力量。報銷和臨床證據的積極進展為我們未來的持續成長奠定了良好的基礎。現在，我想將電話會議交給Jared，進行財務回顧。

Thank you, Kevin. Let me walk through our second quarter financial results. Revenue was $13.6 million for the 3 months ended June 30, 2025, an increase of $1.8 million or 15% over the prior year period. Revenue generated in the US was $12.2 million for the 3 months ended June 30, 2025, an increase of $1.6 million or 15% over the prior year period.

謝謝凱文。我來介紹一下我們第二季的財務表現。截至2025年6月30日的三個月，營收為1,360萬美元，較去年同期增加180萬美元，增幅15%。截至2025年6月30日的三個月，美國境內營收為1,220萬美元，較去年同期增加160萬美元，成長15%。

Heart failure revenue in the US totaled $12.1 million and $10.5 million for the 3 months ended June 30, 2025 and 2024, respectively. Heart failure revenue units in the US totaled 387 and 339 for the 3 months ended June 30, 2025 and 2024, respectively. The increases were primarily driven by continued growth in the US

截至2025年6月30日及2024年6月30日的三個月，美國心臟衰竭治療收入總計分別為1,210萬美元及1,050萬美元。截至2025年6月30日及2024年6月30日的三個月，美國心臟衰竭治療收入單位總數分別為387個及339個。成長主要得益於美國市場持續成長。

heart failure business as a result of the expansion into new sales territories, new accounts and increased physician and patient awareness of Barostim.

由於擴展到新的銷售區域、新客戶以及醫生和患者對 Barostim 的認識提高，心臟衰竭業務取得了巨大成功。

As of June 30, 2025, the company had a total of 240 active implanting centers in the US as compared to 227 as of March 31, 2025. Active implanting centers are customers that have completed at least 1 commercial heart failure implant in the last 12 months. The number of sales territories in the US increased by 2 to a total of 47 during the 3 months ended June 30, 2025.

截至2025年6月30日，公司在美國共有240個活躍植入中心，而截至2025年3月31日為227個。活躍植入中心是指在過去12個月內至少完成1例商業化心臟衰竭植入的客戶。截至2025年6月30日的三個月內，公司在美國的銷售區域數量增加了2個，總數達到47個。

Revenue generated in Europe was $1.3 million for the 3 months ended June 30, 2025, an increase of $0.2 million or 19% over the prior year period. Total revenue units in Europe decreased to 61 for the 3 months ended June 30, 2025, compared to 63 in the prior year period. The number of sales territories in Europe remained consistent at 5 for the 3 months ended June 30, 2025.

截至2025年6月30日的三個月，歐洲營收為130萬美元，較去年同期增加20萬美元，成長19%。截至2025年6月30日的三個月，歐洲總收入單位數量減少至61個，去年同期為63個。截至2025年6月30日的三個月，歐洲銷售地區數量維持不變，為5個。

Gross profit was $11.5 million for the 3 months ended June 30, 2025, an increase of $1.5 million or 16% over the prior year period. Gross margin was 84% for each of the 3 months ended June 30, 2025 and 2024. R&D expenses decreased $0.3 million or 11% to $2.5 million for the 3 months ended June 30, 2025, compared to the prior year period. This change was driven by a $0.3 million decrease in compensation expenses. SG&A expenses increased $2.2 million or 11% to $23.4 million for the 3 months ended June 30, 2025, compared to the prior year period.

截至2025年6月30日的三個月，毛利為1,150萬美元，較去年同期增加150萬美元，增幅為16%。截至2025年6月30日及2024年6月30日的三個月，毛利率均為84%。截至2025年6月30日的三個月，研發費用較去年同期減少30萬美元，減幅為11%，至250萬美元。這項變更是由於薪酬費用減少30萬美元。截至2025年6月30日的三個月，銷售、一般及行政費用較去年同期增加220萬美元，減幅為11%，至2,340萬美元。

This change was primarily driven by a $1.4 million increase in compensation expenses, a $0.8 million increase in travel expenses and a $0.4 million increase in noncash stock-based compensation expense, partially offset by a $0.5 million decrease in advertising expenses. Interest expense increased $0.5 million for the 3 months ended June 30, 2025, compared to the prior year period. This increase was driven by the interest expense on higher levels of borrowings under the term loan agreement. Other income net increased $0.2 million for the 3 months June 30, 2025, compared to the prior year period. This increase was primarily driven by more interest income on our interest-bearing accounts.

這項變更主要由於薪資費用增加140萬美元、差旅費用增加80萬美元以及非現金股票薪資費用增加40萬美元，但廣告費用減少50萬美元部分抵銷了這項變動。截至2025年6月30日的三個月，利息支出較去年同期增加50萬美元。這一增長是由於定期貸款協議項下借款金額增加導致的利息支出。截至2025年6月30日的三個月，其他淨收入較去年同期增加20萬美元。這一增長主要由於我們的計息帳戶的利息收入增加。

Net loss was $14.7 million or $0.57 per share for the 3 months ended June 30, 2025, compared to a net loss of $14 million or $0.65 per share for the prior year period. Net loss per share was based on 26.1 million weighted average shares outstanding for the 3 months ended June 30, 2025, and 21.6 million weighted average shares outstanding for the prior year period. As of June 30, 2025, cash and cash equivalents were $95 million. Net cash used in operating and investing activities was $8 million for the 3 months ended June 30, 2025, and as compared to $10.2 million for the prior year period. Now turning to guidance.

截至2025年6月30日的三個月，淨虧損為1,470萬美元，即每股虧損0.57美元，而去年同期淨虧損為1,400萬美元，即每股虧損0.65美元。每股淨虧損基於截至2025年6月30日的三個月，加權平均流通股數為2610萬股，而去年同期加權平均流通股數為2160萬股。截至2025年6月30日，現金及現金等價物為9,500萬美元。截至2025年6月30日的三個月，經營投資活動所用淨現金為800萬美元，去年同期為1,020萬美元。現在談談業績指引。

For the full year of 2025, we narrowed our revenue and operating expense guidance we now expect total revenue between $55 million and $57 million. We continue to expect full year gross margin between 83% and 84%, and we now expect operating expenses between $96 million and $98 million. For the third quarter of 2025, we expect to report total revenue between $13.7 million and $14.7 million. With that, I'll turn the call back to Kevin for closing remarks.

對於2025年全年，我們縮減了收入和營運支出的預期，目前預計總收入在5500萬美元至5700萬美元之間。我們繼續預期全年毛利率在83%至84%之間，目前預計營運支出在9,600萬美元至9,800萬美元之間。對於2025年第三季度，我們預計總收入將在1,370萬美元至1,470萬美元之間。至此，我將把電話轉回給Kevin，請他做最後總結。

Thank you, Jared. Looking ahead, I'm confident about the direction of our business and the momentum that we are building. Our sales force stabilization efforts are paying off. Our strategic focus on sustainable Baristom programs is gaining traction and we're making solid progress on clinical evidence, therapy awareness and reimbursement. With strong fundamentals and a remarkably predictable and effective therapy, we're steadily moving towards making Verastem a standard of care for the treatment of heart failure.

謝謝，賈里德。展望未來，我對我們的業務方向和正在建立的勢頭充滿信心。我們穩定銷售團隊的努力正在發揮成效。我們對永續Baristom計畫的策略重點正在獲得越來越多的關注，我們在臨床證據、治療認知和報銷方面也取得了紮實的進展。憑藉強大的基本面和高度可預測且有效的治療方法，我們正在穩步推進Verastem成為心臟衰竭治療的標準療法。

Before we open the line for questions, I'm excited to announce that Brent [indiscernible] was appointed to our newly created Chief Operating Officer role and will be joining CVRx in August. He will be responsible for research and development operations, regulatory affairs and quality of CVRx. Brent brings over 20 years of leadership experience in medical devices with expertise in implantable devices covering interventional cardiology, radiology and urology. His experience building world-class teams and scaling businesses will be of great value to the company. Now I'd like to open the line for questions.

在開始提問之前，我很高興地宣布，布倫特（音訊不清晰）被任命為我們新設立的首席營運官，並將於8月加入CVRx。他將負責CVRx的研發運作、法規事務和品質。布倫特在醫療器材領域擁有超過20年的領導經驗，尤其擅長植入式器械，涵蓋介入性心臟病學、放射學和泌尿外科。他組建世界一流團隊和拓展業務的經驗將對公司具有重要價值。現在，我想開始提問。

Operator?

操作員？

(Operator Instructions)

（操作員指示）

John Young, Canaccord.

約翰楊 (John Young)，Canaccord。

I just want to go over the narrow guidance maybe. And just -- maybe you could walk us through how the new guidance contemplates the brand of 35% of the new territory managers that are new that you highlighted in the call commentary.

我可能只是想簡單介紹一下具體的指引。您能否為我們講解一下，新指引中如何考慮您在電話評論中強調的35%新區域經理的品牌形象？

Yes, I appreciate the question, John. Yes. I mean with narrowing the top end to be $55 million to $57 million, it really only moves the midpoint by about $500,000. It's not too dissimilar to our approach in prior years, where we start to bring that range of $3 million down to a range of $2 million as we go from Q2 to Q3. And it really just does come back to how quickly we're getting this new team up to speed and getting them productive.

是的，約翰，我很感謝你的提問。是的。我的意思是，將最高限額縮小到5500萬美元到5700萬美元之間，實際上只會將中間限額調整約50萬美元。這與我們前幾年的做法並無太大不同，從第二季度到第三季度，我們會將300萬美元的範圍縮減到200萬美元。這實際上取決於我們讓新團隊快速上手並提高效率的速度。

We continue to believe we have the right team and strategy in place and now it's simply focusing on getting those reps up that productivity curve as quickly as possible.

我們始終相信，我們擁有正確的團隊和策略，現在我們只需專注於讓這些代表盡快提高生產力曲線。

And Jared, maybe as a follow-up to there for that one. the commentary you guys gave on Tier 3 and 4 accounts where you have this clinical champion and an admin support as well. How do you guys measure that? I understand Tier 1 and Tier 2, you guys have a lot of data for targeting and all that. But for these Tier 3 and 4 accounts that have this characteristic, does the rep need to go in and find themselves for themselves?

Jared，也許可以作為那篇文章的後續。你們對三級和四級客戶的評論，這些客戶既有臨床專家，也有行政支援。你們是如何衡量這些客戶的？我了解一級和二級客戶，你們擁有大量數據用於定位等等。但是對於具有這種特徵的三級和四級客戶，銷售代表是否需要親自去尋找呢？

And could this further slow the commercial process.

這是否會進一步減緩商業進程。

Yes. I appreciate that question, too, Gong. No, it is not something that we put on to the reps themselves. It's all data that we're tracking internally and providing to the reps as part of that playbook that we've talked about. So -- since Kevin joined, we talked about implementing these go-to-market playbooks that we're giving to these reps.

是的。龔，我也很感謝你的提問。不，這不是我們強加給銷售代表的東西。這些都是我們內部追蹤的數據，並作為我們之前討論過的策略手冊的一部分提供給銷售代表。所以——自從凱文加入以來，我們就一直在討論如何實施這些我們提供給銷售代表的市場推廣策略手冊。

And in there, it includes all the data on heart failure diagnosis, number of CardioMEMS procedures done, mitrals, WATCHMAN, all of that data to help rank the accounts between Tiers 1, 2, 3 and 4. And it's based on that data that we're giving them a guide as to which accounts we want them to open but it also helps them understand which accounts may be more receptive to our therapy than others.

其中包括所有關心力衰竭診斷的數據、已完成的 CardioMEMS 手術數量、二尖瓣、WATCHMAN，所有這些數據都有助於對 1、2、3 和 4 級帳戶進行排名。基於這些數據，我們會為他們提供指南，告訴他們我們希望他們開設哪些帳戶，但這也能幫助他們了解哪些帳戶可能比其他帳戶更容易接受我們的治療。

Robbie Marcus, JPMorgan.

摩根大通的羅比·馬庫斯。

This is actually Rohin on for Robbie. I just want to follow up on the prior question regarding the sales force reorg and kind of the progress that you've made in the second quarter and what's contemplated for the balance of the year, obviously, bringing the midpoint down off of a conservative range. Just want to get a sense first like how you're thinking about the ramp and the cadence and what sort of assumptions you're making around improvement?

這其實是Rohin代表Robbie提問。我想繼續之前關於銷售團隊重組的問題，以及你們在第二季度取得的進展，以及今年剩餘時間的計劃。顯然，今年的計畫會比保守區間中位數有所下調。首先我想了解一下，你們是如何考慮成長速度和節奏的，以及你們對改進做了哪些假設？

Yes. I can maybe touch on the guidance piece, and then maybe Kevin can talk a little bit more about the sales force updates, Ron. So within the guidance, we're still assuming that we're going to be able to activate more territories on a quarterly basis. So in Q2, we activated 2 new territories going from 45 to 47. We are anticipating with the reps that we hired in the first half of the year that we can start to get back on track to adding 3 territories per quarter.

是的。我可以談談業績指引部分，然後 Kevin 可以再多談談銷售團隊的更新，Ron。在業績指引範圍內，我們仍然假設我們能夠每季啟動更多地區。所以在第二季度，我們啟動了兩個新地區，使總地區數量從 45 個增加到 47 個。我們預計，加上上半年招募的銷售代表，我們可以開始回到每季增加 3 個地區的軌道。

And then also within there starting to see productivity within our accounts start to ramp up as we go into Q3 and Q4. A large part of that guidance and the range that exists.

隨著我們進入第三季和第四季度，我們開始看到客戶生產力開始提升。這在很大程度上取決於現有指引和範圍。

The top end assumes that we're going to see more of those reps get productive and maybe at a higher level. And the lower end assumes that maybe you see a couple of those reps get productive and maybe at not quite the same level. But it really just comes down to all of these new people that we brought on board, how quickly we can get them up to speed and productive in the back half of the year.

最高預期是，我們會看到更多銷售代表提高效率，甚至可能達到更高的水準。最低預期是，我們可能會看到一些銷售代表提高效率，但水平可能不盡相同。但最終還是要看我們招募的新員工，看看我們能否在下半年讓他們快速上手並提高效率。

Yes. Rohin, it's Kevin here. I'll take the second part of the question. So I would say the terminations have returned to normal through the course of the second quarter. The hiring continues as that obviously is -- it follows the terminations, but that is also close to being complete as well.

是的。 Rohin，我是 Kevin。我來回答問題的第二部分。我想說的是，第二季的解僱情況已經恢復正常。招聘工作顯然仍在繼續——這是在解僱之後進行的，但也接近完成。

So we would expect our rate of turnover to be very close to sort of typical industry averages, 10% to 20% on an annual basis as we go through the back half of the year. So we're pleased, again, thrilled with the talent we've been able to attract that has continued unabated. And we're starting to see the first of those hires back in early 2025, begin to contribute to the revenue line. And so we'll be watching closely as we get into the back half of the year. Obviously, there's a lot of time and energy spent onboarding that new talent and getting them as productive as possible, as quickly as possible.

因此，我們預計下半年的人員流動率將非常接近行業平均水平，即每年10%到20%。因此，我們再次對能夠持續吸引人才感到欣喜。我們預計第一批員工將在2025年初開始為公司的收入做出貢獻。因此，隨著下半年的到來，我們將密切關注。顯然，我們投入了大量的時間和精力來引導這些新人才，並讓他們盡快發揮最大的生產力。

Got it. And I had a follow-up on gross margin. Based on our estimates, you came a little bit ahead in the quarter at 84.3%. Just want to understand why you chose to keep the guidance consistent? Is there anything that implies kind of a decline from here in the back half?

明白了。我還問了你關於毛利率的問題。根據我們的估算，你們本季的毛利率略有提高，達到了84.3%。請問為什麼你們選擇維持預期不變？有什麼跡象顯示下半年毛利率會下降嗎？

Just things to keep in mind as we model that.

當我們建模時，只需記住這些事情。

Yes, not much of a story here, Rohan. So I think we've been consistently in that 83% to 84% range. I think we beat in the second quarter by a little bit, probably do more to price than the cost. But as we continue to produce more and more units, we could see that cost number come down as well. I don't think we moved to the number enough in the second quarter to adjust the full year guide of the 83% to 84%.

是的，Rohan，這沒什麼特別的。所以我認為我們的業績一直維持在83%到84%的區間。我認為我們第二季的業績略有超出，可能價格因素的影響比成本因素更大。但隨著我們產量的不斷增加，成本因素也可能會下降。我認為我們第二季的業績調整幅度不足以調整全年83%到84%的業績預期。

But still feeling pretty good about being able to continue similar numbers in Q3 and Q4.

但對於第三季和第四季能夠繼續保持類似的數字，我感覺還是相當不錯的。

Matthew O'Brien, Piper Sandler.

馬修·奧布萊恩、派珀·桑德勒。

This is Samantha on for Matt. I guess, yes, we want to continue the conversation on the sales force and kind of the adjustments and how they're trending. I know you mentioned that the first hires begin to contribute to the revenue line. Was that more of a Q2? Or is that more recently in July?

我是 Samantha，Matt 的節目主持人。是的，我們想繼續討論銷售團隊、調整以及目前的趨勢。我知道您提到第一批員工開始為收入做出貢獻。這更像是第二季的事情嗎？還是更近一些，也就是七月？

And how quickly do you anticipate the rest can get up to productivity as well?

您預計其餘人員多久也能達到相同的生產力？

Yes, sure. Thank you. I appreciate the question. So I think we've pretty consistently said it takes between 6 and 12 months for a territory manager to get up to speed. Those that have a background in cardiovascular medicine or heart failure do so more quickly.

是的，當然。謝謝。我很感謝你的提問。所以，我認為我們一直都說，區域經理需要6到12個月才能上手。那些擁有心血管醫學或心臟衰竭背景的經理，上手速度會更快。

Those that have a background in program building, new therapy introductions, get up to speed more quickly. And those that inherit a territory that has a quality mix of accounts are able, again, to contribute more quickly. Conversely, those that have none of those 3 things are going to take closer to 12 months to begin to contribute.

那些擁有專案建構和新療法引入經驗的人員能夠更快地上手。而那些接手的地區擁有優質客戶組合的人員也能夠更快地做出貢獻。相反，缺乏這三項經驗的人員則需要近12個月才能開始做出貢獻。

So I think we're starting to see the first of those well-positioned reps with highly relevant backgrounds, start to contribute here in the tail end of the second quarter, we'd expect them to sort of continue in the back half of the year as we ramp up as some of the other new hires who have less experience or who have more work to do in a territory that doesn't have the same quality of accounts, it will take them longer, as you can imagine.

因此，我認為我們開始看到第一批具有高度相關背景、位置優越的銷售代表在第二季度末開始做出貢獻，我們預計他們會在下半年繼續工作，因為我們會增加一些新員工，他們經驗較少，或者在沒有相同質量帳戶的地區有更多工作要做，所以他們可以花更長的時間，正如你可以想像的那樣。

And we had just 1 more on operating expenses, specifically SG&A. I think that came in just a little bit higher than we were modeling for the quarter. How should we think about that line item for the rest of the year as we're modeling out there?

我們還有一項營運費用，具體​​來說是銷售、行政及行政管理費用（SG&A）。我認為這比我們本季的模型略高一點。鑑於我們正在建模，我們應該如何考慮今年剩餘時間的這一項？

Yes. Thanks for the question, Sam. So that -- that came in a bit higher than what we saw in the second quarter, but Q2 is typically where we see the highest level of SG&A just based on onetime events, whether it's marketing events that are going on during that time period. or other spend. So we would anticipate that number to be coming down and is reflected as such in our guidance for the full year.

是的。謝謝你的提問，Sam。所以，這個數字比我們第二季度看到的要高一些，但第二季度通常是銷售、行政及管理費用（SG&A）水平最高的季度，這主要基於一次性事件，無論是該時間段內的營銷活動還是其他支出。因此，我們預期這個數字會下降，並反映在我們的全年業績指引中。

Brandon Vazquez, William Blair.

布蘭登·巴斯克斯、威廉·布萊爾。

On the -- 1 of the sales reps first, -- as you look at that cohort specifically that are maybe less than 12 months on job, I know you guys have talked about this a little bit, but maybe spend a minute just talking about how that cohort's productivity has ramped recently. Is it in line with your expectations? Is there anything either surprising to the positive or the negative as those new reps are reengaging in some of the territories that maybe had a little bit of noise through this period.

首先，關於銷售代表，特別是那些入職時間可能不到12個月的銷售代表，我知道你們已經討論過這個問題，但或許可以花一點時間談談這個群體最近的生產力提升情況。這符合你的預期嗎？隨著這些新銷售代表重新回到一些這段時間可能有些不順暢的地區，有什麼令人意外的正面或負面消息嗎？

Sure, Brandon. Thanks. I'll take that. I would say it is progressing as difficult as it is to predict specifically how fast a given rep will get up to speed in a given territory. I think we're pleased with what we're seeing.

當然，布蘭登。謝謝。我接受。我想說的是，進展非常順利，很難預測特定銷售代表在特定地區的適應速度。我認為我們對目前的情況感到滿意。

We would not have expected much contribution for any of those reps hired since January at this point. So we're pleased to see some early sort of green shoots from some of them. But I think that's really the work in the back half of the year is getting them as many of them up to speed as we can regardless of their backgrounds or the territories that they're sitting in. We've added resources and focus to our sales training effort and broadened our curriculum. So lots of time shifting from hiring really to now training and onboarding and accelerating productivity.

就目前而言，我們原本預計自一月以來新聘用的銷售代表不會做出太大貢獻。因此，我們很高興看到其中一些初露鋒芒。但我認為下半年的真正工作是盡可能幫助他們快速上手，無論他們的背景或所在地區如何。我們增加了資源，並專注於銷售培訓工作，同時拓寬了課程。因此，我們投入了大量時間，從招募轉向培訓、入職培訓和提高生產力。

Okay. And then maybe on the reimbursement side, a lot of good updates in between [indiscernible] and last quarter with the proposed rates from CMS. But maybe you guys can spend a minute just talking about going deeper into what denial rates are like, what part of the process can be difficult now with a temporary code. And then what part of it specifically you think can get a lot easier now in January when you get a Category I code. You've seen this before in the medical device world.

好的。然後，在報銷方面，從[音訊不清晰]到上個季度，CMS 提出的費率有很多不錯的更新。但也許你們可以花一點時間，更深入地談談拒賠率是多少，以及現在使用臨時代碼後，哪些流程會比較困難。然後，您認為，在明年一月份獲得 I 類程式碼後，哪些流程會變得更容易。您以前在醫療器材領域也看過這種情況。

So just curious how you guys are viewing it today and how it might improve starting in January.

所以只是好奇你們今天如何看待它以及從一月份開始它會如何改善。

Yes. Thank you. So a couple of different ways to answer that. I think today, as a category 3 therapy, we see 100% denials as would anyone with the Category III code -- we have also mentioned though, we have done a very effective job in appealing those denials, and we believe we're doing better than average across the various payer segments in securing ultimately approval for our therapy. So we're happy with where we are.

是的，謝謝。這個問題有幾種不同的答案。我認為，目前，作為三類療法，我們的申請被拒率是100%，就像任何三類代碼的療法一樣——不過，我們也提到過，我們在對這些拒信進行申訴方面做得非常有效，而且我們相信，在最終獲得我們療法的批准方面，我們在各個付款方群體中的表現都高於平均水平。所以我們對目前的狀況感到滿意。

On January 1, the Category III code goes away and becomes a Category I code. And there's 2 important elements to that. The first is that the payer's ability to automatically deny coverage because of an experimental status, the Category I status. That goes away, and they're forced to use a human being to review each and every prior authorization and deny it on the basis of medical necessity as evaluated by a human. And so that makes it much more obviously, complex and expensive for them to do and requires that level of intervention.

1月1日，III類代碼將取消，並升級為I類代碼。這其中有兩個重要因素。首先，付款人有權根據實驗狀態（即I類狀態）自動拒絕承保。一旦I類狀態取消，他們就被迫使用人工審核每一項先前的授權，並根據人工評估的醫療必要性拒絕承保。這顯然會使他們的工作變得更加複雜和昂貴，並且需要一定程度的干預。

So as you've seen with other therapies, perhaps, we believe that while there will certainly still be prior authorizations required. The rate of approvals, the speed of the approvals and the predictability of approval will improve, we think, significantly as of the first of the year.

因此，正如您在其他療法中看到的那樣，我們認為，儘管仍然需要事先授權，但我們認為，從今年年初開始，批准率、批准速度和批准的可預測性將顯著提高。

The second piece is that the formalization of physician payment, which up until now has been negotiated on a payer-by-payer basis. That's another significant step forward. And we're pleased with where we landed 11 work RVUs is exactly where we thought we would land given the SBS survey. So we're pleased that physicians who are for the subset of physicians who are paid for those procedures based on RVUs they now have consistent, predictable payment, which is not something we could always say up until now, but you can't often say with the category 3. So 2 really important steps forward in January.

第二點是醫生付費的正式化，此前一直是在「付款人」基礎上協商的。這是又一個重要的進步。我們對最終獲得的11個工作RVU感到滿意，這與SBS調查的結果完全一致。因此，我們很高興看到，那些根據RVU獲得醫療服務費用的醫生現在獲得了穩定且可預測的報酬，這在過去我們很難做到，但對於第三類醫生來說，通常更難做到。所以，一月我們踏出了非常重要的兩步。

Frank Takkinen, Lake Street Capital Markets.

Frank Takkinen，湖街資本市場。

Great. I'll also start in the reimbursement world. Related to the OPPS, I assume you will put forth comments related to a Level 6 code, but maybe take us a little bit deeper into what that may consist of? And if there's anything in addition you may be asking for in the comment period?

太好了。我也想從報銷方面開始聊聊。關於OPPS，我想你會提出一些關於6級代碼的意見，但能否更深入地講講6級代碼的具體內容？在評論期間，你還有其他要求嗎？

Sure. Thanks, Frank. I'll take that. So we were very pleased for the first time to be starting this process in the Newtek APC 1580, we think that's a recognition by CMS that we do not belong in Level 5. So we were pleased to see that.

當然。謝謝，弗蘭克。我接受。我們很高興第一次在 Newtek APC 1580 上啟動這個流程，我們認為這是 CMS 對我們不屬於 5 級的認可。所以我們很高興看到這一點。

We were also pleased that CMS, again, for the second year solicited comments on the value of a Level 6 cooked. And so we think those are both positive signals. We're going to run the exact same playbook this year that we have in the past, even if we're starting in a better place, we're soliciting comments from physicians, administrators stakeholders on Capitol Hill in support of this Level 6 code. The same 5 companies are fighting for it this year that fought for it last year. And so while there's some slim chance that they would, in fact, grant that code this year, we're very comfortable staying in 1580, and there's no reason we can't stay in that 150 Newtek for a number of years going forward.

我們也很高興CMS再次第二年就6級程式碼的價值徵求意見。因此，我們認為這兩個都是正面的訊號。今年我們將沿用與過去完全相同的做法，即使起點更高，我們也在徵求醫生、管理人員以及國會山莊利益相關者對6級代碼的支持意見。去年爭取6級代碼的公司今年和去年一樣，仍在爭取中。因此，儘管他們今年批准該代碼的可能性很小，但我們非常樂意繼續使用1580代碼，沒有理由不在未來的幾年繼續使用150 Newtek代碼。

Got it. That's helpful. And then maybe 1 on kind of Tier 1 versus Tier I assume you're not going to go in too much detail on composition of additions. But any kind of broad strokes you can provide, like the majority were Tier 1, 2 or majority were Tier 3/4. And then any kind of characteristics of expected launch trajectory of those 2 buckets, which may scale quicker?

明白了。這很有幫助。然後，也許可以談談第 1 層和第 2 層的差異。我想您不會詳細討論新增內容的構成。但您能否提供一些大致的描述，例如大多數是第 1 層、第 2 層，還是大多數是第 3/4 層？然後，這兩個類別的預期發布軌跡有什麼特點？哪個類別的擴充速度較快？

Yes. Frank, like you said, I'm not going to go into the weeds on exact percentages, but what we can say is our go-to-market strategy and our targeting approach is working. We are seeing a higher percentage of the account adds in Q2 in that Tier 1 and Tier 2 bucket as compared to what we saw in Q1. So I think the team is listening, they're understanding the whys behind it. And part of that is driven by the utilization we're seeing in those accounts because we are seeing higher utilization, more implants, more revenue in Tier 1 and 2 accounts than the others.

是的。弗蘭克，就像你說的，我不想詳細討論具體的百分比，但我們可以說的是，我們的市場進入策略和目標定位方法正在發揮作用。與第一季相比，我們在第二季看到一級和二級客戶帳戶新增百分比增加。所以我認為團隊正在傾聽，他們理解背後的原因。部分原因是我們觀察到這些客戶的使用率較高，因為我們發現一級和二級客戶的使用率、新增客戶數量和收入都高於其他客戶。

So I think their understanding that it's not just something that we're kind of making up as we go, but that it actually delivers real results. And I think as a result of that, we're seeing more of those accounts get added each quarter.

所以我認為他們明白，這並非我們臨時想出來的，而是真正能帶來實際效果的。我認為正因如此，我們每季都能看到更多類似帳戶的增加。

Chase Knickerbocker, Craig-Hallum.

蔡斯·尼克博克、克雷格·哈勒姆。

Kevin, I just want to start on the Level 6 code as well. So you had said kind of a slim chance they do it this year. Can you kind of speak to kind of the feedback that you've heard? You just kind of take that commentary from the PPS and that's kind of what underlies that kind of slim chance assumption? And then maybe just longer term, if you do stay in the new tech APC, do you get a sense of what kind of CMS is thinking there?

凱文，我也想先從 6 級代碼說起。你之前說過他們今年實現這個目標的可能性很小。可以談談你聽到的回饋嗎？你只是從 PPS 那裡聽到了一些評論，而這正是你認為可能性很小的假設背後的原因嗎？然後，從長遠來看，如果你繼續關注新技術 APC，你是否了解 CMS 在那裡是怎麼想的？

Because typically, that is a temporary code, right? And is it something where you think you can kind of stay in that for a number of years, like you said? Or do you think, ultimately, they still will kind of do to Level 6 code, just your overall thoughts there on the OPPS?

因為通常來說，這只是一個臨時代碼，對吧？您覺得這個代碼能維持好幾年嗎？就像您說的，還是說，您認為最終他們還是會採用 6 級代碼？您對 OPPS 有什麼整體看法？

Sure. So let me -- I guess, -- on the first question, we've consulted a fair number of experts, as you can imagine. There are instances we understand in the past where CMS has made a change over the course of the comment period. We're an example of that last year when they moved us from the proposed Level 5 back into 150. So it happens, but we're not certain that this will be the year for that.

當然。那麼，我想，關於第一個問題，正如你所想像的，我們諮詢了不少專家。我們了解到，過去CMS在意見徵詢期內做了一些調整。去年他們把我們的人數從提議的5級調整回了150人，就是一個例子。確實有這種情況，但我們不確定今年是否會再次發生。

We'd like to think so, and we're not going to give up Conversely, there is very few, there was not a single instance our experts could find of a company going the other way. So we think the risk of being demoted back to Level 5 is quite low or would be unexpected. So that's the best information we've got.

我們願意相信這一點，而且我們不會放棄。相反，這種情況很少見，我們的專家甚至沒有發現任何一家公司走上相反道路的案例。因此，我們認為被降回第五級的風險很低，或者說是意料之外的。以上是我們目前掌握的最佳資訊。

In terms of what CMS is thinking, we also know there's no statutory limit to how long you can stay in 1580, it's probably driven by how much data they think they need to gather in that specialized data collection mode before they can assign a different category or create a new 1 as we're requesting. So hard to tell where the where their heads they're at, but not surprising. And again, we'd be just fine staying in 1580 for another few years as we continue to build procedure volume. And as our data again, gets better and better, and that's the justification for the level.

至於CMS的想法，我們也知道，1580級別沒有法定的停留時間限制，這可能取決於他們認為在分配不同類別或按照我們的要求創建新的1級之前，需要在該專門的數據收集模式下收集多少數據。很難判斷他們的想法，但這並不奇怪。再說一次，隨著我們繼續增加處理量，我們繼續在1580級別停留幾年也沒問題。隨著我們的數據越來越完善，這就是維持該等級的合理性。

Got it. And then just on center ads. Could you share the gross number? I guess kind of what I'm trying to get at is kind of you outperformed a little bit on some of the expectations you set last quarter as far as center ads. Is that kind of fewer accounts that sunsetted fewer accounts in which you saw attrition?

明白了。然後是關於中心廣告的。能分享一下總數嗎？我想問的是，就中心廣告而言，你們上個季度的表現比預期略有超出。這是否意味著帳戶數量減少，導致帳戶流失？

Or was that just an increase in kind of gross adds that you saw in Q2?

或者這只是您在第二季度看到的總廣告數量的增加？

Yes, Chase, I can take that one. We're not going to get into the weeds on the gross adds and churn, but I can say it's a combination of both, right? As we said, we expect to add a high single-digit to low double-digit number of accounts on a quarterly basis. It's assuming that we are going to continue to sunset some of those dabbler accounts while bringing on some of these accounts that we think have higher potential in the long run. So I think as we look at the Q2 results, it's a little bit over performance on ads and maybe not sunsetting as many as we originally thought going into the quarter.

是的，Chase，我可以接受這個。我們不會詳細討論新增用戶和流失率，但我可以說兩者兼而有之，對吧？正如我們所說，我們預計每季新增帳戶數量將在高個位數到低兩位數之間。這假設我們會繼續關閉一些不活躍的帳戶，同時引入一些我們認為長期來看有更高潛力的帳戶。所以我認為，從第二季的業績來看，廣告表現略有超出預期，而且可能沒有像我們最初預期的那樣關閉那麼多帳戶。

But it's going to continue to be choppy as we go quarter-to-quarter. So just because we saw plus 13% in Q2, we may not see that in Q3.

但季度環比來看，情況將持續波動。所以，即使我們在第二季看到了13%的成長，我們可能也不會在第三季看到同樣的成長。

Just high single digits is still the right way to think about it kind of from here, Jared.

賈里德，從現在來看，高個位數仍然是正確的思考方式。

Yes, yes, in that range of $8 million to $12 million to $13 million. pretty reasonable.

是的，是的，在 800 萬美元到 1200 萬美元到 1300 萬美元的範圍內。相當合理。

Ross Osborn, Cantor Fitzgerald.

羅斯奧斯本、康托費茲傑拉。

So starting off, and if I heard your prepared remarks correctly, it sounds like you're seeing some traction with lower tier centers acting as a referral center would you spend some more time here walking through the dynamic and what you can do from an awareness standpoint to more patients to the funnel and implementation?

那麼首先，如果我沒有聽錯的話，您準備好的發言聽起來似乎您看到了一些將低層級中心作為轉診中心的趨勢，您是否會在這裡花更多的時間介紹一下這種動態，以及從意識的角度您可以做些什麼來讓更多的患者進入渠道並實施？

Sure. Thanks, Ross. This is Kevin. I'll take that one. So yes, what we were trying to point out -- we've learned a lot over the last year as we've implemented this go-to-market strategy, which obviously starts with targeting.

當然。謝謝，羅斯。我是凱文。我接了。是的，我們想指出的是──在過去一年裡，我們在實施這個市場進入策略的過程中學到了很多東西，而這項策略顯然是從目標定位開始的。

And so what we're finding, these are imperfect tools at best. And what we know is that there are actually some Tier 3s and 4s who may not have had the chance to use CardioMEMS in the past because of payer issues or potentially reimbursement or other kind of local factors. And we don't want to necessarily walk away from them without understanding the facts on the ground. So in some cases, we're finding there are really good centers with really good heart failure volume that have a clinical champion and/or an administrative champion. And in those cases, it's worth considering opening a program there.

所以我們發現，這些工具充其量也不完美。我們知道，實際上有些三級和四級醫療機構過去可能因為付款方問題、潛在的報銷或其他本地因素而沒有機會使用CardioMEMS。我們不想在不了解實際情況的情況下就放棄他們。所以在某些情況下，我們發現有一些非常好的醫療中心，心臟衰竭病例數量非常多，並且擁有臨床和/或行政方面的領導者。在這種情況下，值得考慮在那裡開展專案。

And so I guess what we're saying is it's not as black and white as we perhaps thought initially. We're still leaning heavily towards the 1s and 2s, but there are some Level 3s and 4s that are, in fact, satellites, to your question of larger flagship accounts. And what we find in some cases is the flagship account says, "Hey, this is a very bureaucratic center, why don't you go to our sister institution, get the program started, demonstrate success, and you will make it a lot easier for us to bring you then into the flagship. And so those satellite centers in our scheme show up as 3s and 4s, but again, may have a lot of value and maybe a faster way to get into a great, big university center, for example, then kind of a full frontal approach. So that's leading to some of these insights.

所以我想，我們想說的是，事情並非如我們原先想的那樣非黑即白。我們仍然傾向於1級和2級，但也有一些3級和4級的機構，它們實際上是衛星機構，可以解決你提到的大型旗艦客戶的問題。我們發現，在某些情況下，旗艦客戶會說：「嘿，這是一個官僚主義很嚴重的中心，為什麼不去我們的姊妹機構，啟動這個項目，展示成功經驗，這樣我們就能更容易地把你帶入旗艦機構呢？」 因此，在我們的方案中，這些衛星中心雖然顯示為3級和4級，但它們可能具有很大的價值，也許是進入大型大學中心的衛星中心雖然顯示為3級和4級，但它們可能具有很大的價值，也許是進入大型大學中心的中心。這就是我們得出的一些見解。

And again, focusing on the 1s and 2s, but understanding if there's pragmatic ways to get to the 1s and 2s through the 3s and 4s, it's worth it.

再次強調，重點關注 1 和 2，但要理解，如果有切實可行的方法可以透過 3 和 4 達到 1 和 2，這是值得的。

Understood. Makes sense. And then looking to next year, when you have a more tenured sales force and improved reimbursement environment, what is any headwinds or challenges do you need to overcome that wouldn't allow us to see a material inflection adoption in your top line?

明白了。很有道理。那麼展望明年，當你們擁有更資深的銷售團隊和更好的報銷環境時，你們需要克服哪些阻力或挑戰，才能讓我們看到你們的營收出現實質的轉折點？

Sure. Thank you. Yes. So I would say obviously, the reimbursement friction we think will be reduced materially. But we're seeing great coverage now across the various MACs.

當然，謝謝。是的。所以，我想說，顯然，我們認為報銷摩擦會大幅減少。而且，我們現在看到各MAC的覆蓋率都很高。

We think we'll get much stronger coverage from the commercial side and the Medicare Advantage team folks. The headwinds associated with changing the way medicine is practiced, will not change. Again, that's kind of a long-term war of attrition. The 3 barriers we've identified consistently or reimbursement, awareness and evidence, reimbursement is going to get better, certainly. Awareness is getting better, as we mentioned, we did over 100 programs focused on the affiliated craft providers.

我們認為，商業方面和醫療保險優勢計劃（M​​edicare Advantage）團隊的覆蓋範圍將大大增強。改變醫療實踐方式所帶來的阻力不會改變。這就像一場長期的消耗戰。我們一直關注的三大障礙是報銷、認知和證據，而報銷肯定會越來越好。認知度正在提高，正如我們所提到的，我們開展了100多個專注於附屬醫療服務提供者的計畫。

We think that's a key leverage point for heart failure. And number three, the evidence that we'll continue to generate, both in terms of smaller investigator-initiated studies, multicenter studies, perhaps a randomized controlled trial, that's another critical barrier. So there will there will always be friction, but we think the reimbursement piece will help us significantly. And as we grow awareness, we'll bring that barrier down as well, in addition to the evidence work we're doing already. So lots of work to do.

我們認為這是治療心臟衰竭的關鍵槓桿點。第三，我們將繼續收集證據，包括小型研究者發起的研究、多中心研究，甚至可能是隨機對照試驗，這是另一個關鍵障礙。因此，摩擦總是會存在，但我們認為報銷部分將對我們有很大幫助。隨著我們認識的提高，除了我們已經進行的證據工作之外，我們也會降低這個障礙。所以還有很多工作要做。

But again, it's a war of attrition as you wear down these various adoption barriers that you find in the market.

但同樣，這是一場消耗戰，因為你需要消除市場上發現的各種採用障礙。

Thank you. And ladies and gentlemen, this does conclude our question-and-answer session for today. I would now like to turn the call back over to Kevin Hykes for any closing comments.

謝謝大家。女士們，先生們，今天的問答環節到此結束。現在，我想把發言權交還給凱文·海克斯，請他發表最後評論。

Thank you, operator, and thanks again to everyone for joining us for our second quarter earnings call. We appreciate your ongoing support and look forward to updating you on our progress on our next call. Thanks.

謝謝接線員，再次感謝大家參加我們第二季財報電話會議。感謝您一直以來的支持，期待在下次電話會議上向您報告我們的進度。謝謝。

Thank you, Mr. He. Thank you, Mr. Shim. Again, ladies and gentlemen, that will conclude the CVRx Q2 2025 earnings call.

謝謝何先生。謝謝沈先生。女士們，先生們，CVRx 2025 年第二季財報電話會議到此結束。

Again, thanks so much for joining us, everyone. We wish you all a great rest of your day. Goodbye.

再次感謝大家的收看。祝大家今天過得愉快。再見。