MiMedx Group Inc (MDXG) 2025 Q4 法說會逐字稿

Good afternoon, and thank you for standing by. Welcome to the MiMedx fourth quarter and full year 2025 operating and financial results conference call. (Operator Instructions) As a reminder, this conference is being recorded.

I would now like to turn the conference over to your host, Mr. Matt Notarianni, Head of Investor Relations from MiMedx. Thank you, Matt. You may begin.

Thank you, operator, and good afternoon, everyone. Welcome to the MiMedx fourth quarter and full year 2025 operating and financial results conference call. With me on today's call are Chief Officer, Joe Capper; and Chief Financial Officer, Doug Rice. As part of today's webcast, we are simultaneously displaying slides that you can follow. You can access the slides from the Investor Relations website at mimedx.com.

Joe will kick us off with some opening remarks and a summary of our operating highlights as well as a discussion of the market environment and our financial goals. Next, Doug will provide a review of our financial results for the quarter and full year. Joe will then conclude before we make ourselves available for your questions.

Before we begin, I would like to remind you that our comments today will include forward-looking statements, including statements regarding future sales, operating results and cash balance growth, future margins and expenses, our product portfolios and expected market sizes for our products. These expectations are subject to risks and uncertainties, and actual results may differ materially from those anticipated due to many factors, including competition, access to customers, the reimbursement environment, unforeseen circumstances and delays.

Additional factors that could impact outcomes and our results include those described in the Risk Factors section of our annual report on Form 10-K. Also, our comments today include non-GAAP financial measures, and we provide a reconciliation to the most comparable GAAP measures in our press release, which is available on our website at www.mimedx.com. With that, I'm now pleased to turn the call over to Joe Capper. Joe?

Thanks, Matt, and good afternoon, everyone. Thank you for joining us for today's call. In the fourth quarter of 2025, we once again exceeded our expectations, setting full year record highs for revenue and adjusted EBITDA, which bolstered our net cash balance to nearly $150 million at year-end.

We are incredibly pleased with these results, which were driven by excellent growth in our Wound Care and Surgical businesses. Since that record quarter, we have quickly pivoted to adjust to the new reimbursement framework in the Wound Care market and remain laser-focused on delivering continued outstanding performance in our Surgical segment.

As anticipated and previously communicated, the Wound Care market is experiencing disruption following the recalibration of the Medicare reimbursement rate for skin substitutes, which went into effect on January 1.

As you know, we have long advocated for reform to the Medicare reimbursement system to curtail the runaway spend and inappropriate behavior. We firmly believe the steps that were taken will be a net positive for the industry and MiMedx as the market resets. We flourished prior to the high ASP era and are well suited to compete and win in the new reimbursement environment.

Our Surgical business, which grew at 20% for the full year 2025 is benefiting from the investments we have been making. We expect this momentum will continue into the new year. I will touch on some of the highlights of the quarter, then circle back for a deeper dive on our strategic focus for the two businesses.

For-the fourth quarter, year-over-year net sales growth was an exceptional 27%, finishing at a record $118 million. Both Wound and Surgical delivered during the quarter, each growing at or above 25%. Our adjusted gross profit margin was 86% in the quarter.

Adjusted EBITDA was $29 million or 25% of net sales. We continued to build cash, ending the year with $148 million in net cash, a sequential increase of $24 million in the quarter, which is also $63 million higher than where we started 2025.

I am pleased to report that our EPIEFFECT randomized controlled trial is nearly fully enrolled, and we expect to see a final readout in a few months with publications to follow. And we have announced collaborations to commercialize complementary products in both of our businesses. Finally, our Board has authorized a share repurchase program, giving management the ability to deploy up to $100 million to buy back our stock over the next two years.

Those of you who have been following the company for the last few years know that our strategic focus has prioritized the continued innovation and diversification of our product portfolio in both our Wound Care and Surgical businesses. We also continue to seek opportunities to expand our footprint in numerous Surgical specialties.

Our intent has been to drive comparatively higher growth with our Surgical-related products to achieve a more balanced business mix and take advantage of what we believe is an incredibly large and growing opportunity for our Surgical portfolio. I outlined this plan when I joined MiMedx three years ago. Since then, we have achieved top line compounded annual growth of 16%. Clearly, we have executed on that plan and the results have been outstanding.

Let's take a closer look at the Wound Care business, where there has naturally been a great deal of interest given recent events. To recap, the PFS and OPPS were implemented with a price cap of $127 per square centimeter and LCD implementation was once again abandoned.

During these first few months of 2026, the market is in the process of adjusting to the pricing change in a variety of ways. In the states that are part of the WISeR Model, claims processing has slowed to a trickle as providers adjust to the new prior auth requirements.

Many providers are increasingly concerned with the number of audits and callbacks. Some products are being dumped in the market at very low prices, causing even more chaos. And some providers have completely shut down their businesses.

We remain positive about this business for several reasons. First and foremost, it is still a profit center for us despite the reduction in reimbursement. Second, we believe for a host of reasons, MiMedx is in the most desirable competitive position to flourish post the reimbursement changes. We are confident we will emerge as the clear market leader as more customary treatment practices return to the market.

We are working closely with our customers to help them navigate these changes. We do believe that it is likely CMS will eventually establish a basic requirement to prove efficacy for the products they reimbursed like in all other medical product categories. Speculation is that they may move to a national coverage determination in lieu of the LCDs and the clinical effectiveness requirement will still be a well-powered randomized controlled trial.

This should benefit MiMedx, given our rich history of and commitment to funding robust clinical research as we bring new products to market. Our RCT for EPIEFFECT is near full enrollment and will read out soon. We have also committed to running an RCT for another new product, CHORIOFIX, a dual-level chorion membrane allograft, which is in development.

As announced a few months ago, we entered into a distribution agreement with Regen Labs to commercialize their PRP system called RegenKit Wound Gel. This provides clinicians with a proven alternative modality for treating chronic wounds with provider economics that are potentially more favorable than skin substitutes. We are ramping up with this offering and the early feedback is very favorable.

In summary, we remain optimistic about the Wound Care market despite the near-term disruptions. It is still a profit contributor for MiMedx even at the lower reimbursement rates. We continue to develop products, which leverage our gold standard technology. We are providing reimbursement and other assistance as appropriate to help customers through this phase.

We are adding complementary products, and we continue to invest in clinical research, which validates the safety and efficacy of our products. When the dust settles in the Wound Care market, companies which are committed to helping heal chronic and complex wounds like MiMedx will benefit the most.

Let's now pivot to our Surgical business, which has been an outstanding performer, delivering 25% growth in Q4 and 20% full year growth with contributions from the entire product portfolio. As I stated on numerous occasions, our plan has been to expand our Surgical footprint by investing in dedicated commercial resources, innovative products, and meaningful scientific research to validate the clinical and economic benefits derived from the use of our best-in-class technology in a variety of procedures.

At the outset of this year, we realigned our commercial team to dedicate more sales professionals to the Surgical business, and we will continue to look for opportunities to augment this team even further. In terms of portfolio expansion, we recently launched AMNIOFIX Thyroid Shield, a new variant of our AMNIOFIX product, to be used as a protective barrier during thyroidectomy surgery, which is a procedure involving partial or complete removal of the thyroid gland. This surgery carries inherent risk due to the proximity of the recurrent laryngeal nerve and the parathyroid glands, which can be vulnerable to injury.

Damage to the laryngeal nerve can result in significant complications, including loss of voice and an increased risk of aspirating food or fluid, which can in turn lead to serious respiratory complications such as aspiration pneumonia, posing additional health risk and prolonging patient recovery. Equally important are the parathyroid glands, which play a critical role in maintaining calcium balance in the body. Under conditions of surgical stress, these glands can become temporarily dormant, leading to pathologically low serum calcium levels or hypocalcemia.

While calcium levels may gradually recover, in some cases, they fail to normalize, necessitating lifelong calcium supplementation. Slow recovery of parathyroid function can also extend hospital stays, increase health care costs and delay return to normal activity.

Recent evidence highlights the efficacy of AMNIOFIX Thyroid Shield as a protective adjunctive thyroid surgery, significantly reducing or even eliminating postoperative complications. In cases where the nerve injury does occur, use of AMNIOFIX Thyroid Shield appears to accelerate the restoration of normal vocal and swallowing functions.

Additionally, the use of AMNIOFIX Thyroid Shield has been shown to minimize parathyroid gland damage during thyroidectomy. This protective effect promotes a faster recovery of the parathyroid function and helps restore blood calcium levels to normal more rapidly. Such benefits not only improve patient outcomes, but also reduce the likelihood of extended hospitalizations, offering both clinical and economic advantages. In summary, AMNIOFIX Thyroid Shield represents a valuable innovation in thyroid surgery, providing critical protection for both the recurrent laryngeal nerve and parathyroid glands.

To complement our organically developed portfolio, we also licensed commercial rights to 3 additional complementary and 510(k) cleared products with surgical applications. NovaForm Wound Matrix is a proprietary bioglass and collagen-based wound dressing intended for use in the management of partial and full thickness in surgical wounds. This marks our first nonhuman-derived sheet product in our portfolio.

G4Derm Plus is a flowable peptide matrix engineered for rapid protective wound closure. The product forms a 3D scaffold that mimics the human extracellular matrix and serves as an antibacterial barrier that protects the wound and controls bioburden. And Hydrelix Collagen Matrix, which is a sterile type 1 collagen powder formulated from hydrolyzed and modified bovine collagens.

In addition to deploying more direct selling resources and expanding our product portfolio, we continue to view scientific research as a crucial element of our growth plan. To that end, you may have seen the recently published article in the Journal of Inflammation, which found that our DHACM and LHACM allografts exhibited immunomodularity properties that correspond with the beneficial outcomes we observed in the clinical setting. This study marks another important contribution to our unmatched comprehensive library of clinical and scientific research, which has positioned us favorably in the marketplace.

Because our approach in the Surgical market has been producing the desired results, we will continue to prioritize investment in commercial resources, innovation and scientific research. As you have just heard, we have several new initiatives underway that we expect to be additive to our growth, and we remain incredibly optimistic about the future for MiMedx.

Before I turn the call over to Doug for a detailed financial review of the quarter, I want to share my thoughts on guidance and capital allocation. In terms of guidance, our best current estimate for full year revenue is to be in the range of $340 million to $360 million. We expect quarterly revenue to be the lowest in Q1 with substantial increases in each successive quarter as the market adjusts, patients migrate to other care settings and share is redistributed.

We anticipate full year adjusted EBITDA to be in the mid- to high teens. We will update these expectations as necessary as the year progresses. Looking through to 2027, we expect to be back to posting double-digit above-market top line growth with the margin profile we have produced in recent years prior to any acquisitions.

Speaking of which, we have been vocal over the past few years about our desire to deploy capital to acquire assets, which would accelerate our strategic plan. While M&A has been our top priority for use of capital, we have remained disciplined buyers, making only a few small investments. As a result, we find ourselves with a relatively high and growing cash balance. Therefore, the Board of Directors has authorized management to buy back up to $100 million in stock over the next two years. If we are unable to make accretive investments that meet our criteria, we will use capital to invest in our own stock, which we believe is woefully undervalued.

With that, I'll turn the call over to Doug for a more detailed review of our financial results. Doug?

Thank you, Joe, and good afternoon to everyone on today's call. I'm pleased to review our results with you all today. As a reminder, and as Matt mentioned, many of the financial measures covered in today's call are on a non-GAAP basis. So please refer to our earnings release for further information regarding our non-GAAP reconciliations and disclosures.

Moving on to the results. As Joe mentioned, our fourth quarter 2025 net sales of $118 million represented 27% growth compared to the prior year period. By product category, fourth quarter Wound sales of $79 million increased 28% versus the prior year period, while Surgical sales of $39 million were up 25%, reflecting strong results across both of our franchises.

The strong growth in Wound was driven by strong uptake of two new products, EPIXPRESS and EMERGE. And the robust increase in Surgical sales was driven by continued demand for AMNIOFIX, AMNIOEFFECT and our particulate products, which all grew both on a year-over-year and sequential basis.

Our fourth quarter 2025 GAAP gross profit was about $99 million, up $23 million compared to the prior year period. Our GAAP gross margin was 84% in the fourth quarter of 2025 compared to 82% last year. Excluding the incremental acquisition-related amortization expense in the quarter, our non-GAAP adjusted gross margin was 86%, up about 200 basis points compared to the fourth quarter of 2024. This increase was primarily a result of product mix. Looking ahead to 2026, we expect our gross margin to be in the mid- to upper 70s as a result of lower wound ASPs and, to a lesser extent, lower gross margins from new products.

Turning to our operating expenses, GAAP sales and marketing expenses were $61 million or 52% of net sales in the fourth quarter compared to $48 million or 51% of net sales in the prior year period. The dollar increase was due to higher commissions expense. Here again, in 2026, we expect full year sales and marketing expenses to be between about half of net sales, reflecting a similar amount of relative commissions compared to 2025 as well as lower fixed costs.

GAAP general and administrative expenses, or G&A, were $12 million or 10% of net sales in the fourth quarter compared to $13 million or 14% of net sales in the prior year period. We expect 2026 full year GAAP G&A to be flat on an absolute dollar basis compared to 2025.

Our fourth quarter GAAP R&D expenses were $5 million or 4% of net sales, up 33% compared to the prior year period. Our R&D expenses are primarily comprised of costs associated with our RCT efforts as well as additional spend related to the development of future products in our pipeline. As Joe mentioned, we have nearly completed enrollment of the EPIEFFECT RCT and expect a full readout and publication later this year. We are now moving forward with an RCT for CHORIOFIX, our latest innovation out of R&D. CHORIOFIX is a lyophilized human placental allograft that includes two layers of chorion with a taxed intermediate layer.

As we think about the full year 2026, we expect R&D expenses to be flat on an absolute dollar basis when compared to 2025. GAAP income tax expense for Q4 2025 was about $7 million, reflecting an effective tax rate of 30% in the quarter. And our full year 2025 effective tax rate was 27%. We continue to expect our long-term non-GAAP effective tax rate to be 25%.

Our fourth quarter GAAP net income was $15 million or $0.10 per share on a diluted basis compared to GAAP net income of $7 million or $0.05 per share in the prior year period. Adjusted net income for the fourth quarter was $20 million or $0.14 per share compared to $11 million or $0.07 per share in the prior year period.

Fourth quarter adjusted EBITDA was $29 million or 25% of net sales compared to $20 million or 21% of net sales in the prior year period. As Joe mentioned, our expectation for 2026 is to deliver an adjusted EBITDA margin in the mid- to upper teens on a percentage basis.

Turning to our liquidity. We continue to bolster our balance sheet and position the company to make growth investments. In the fourth quarter, the business generated $25 million in free cash flow, and our net cash position rose to $148 million. The steady improvement in our balance sheet provides us with the ability to evaluate a range of organic and inorganic investments. We continue to evaluate numerous opportunities to grow the business and create shareholder value.

Included with today's earnings release, we also announced the recent authorization of a share repurchase program, providing us with an avenue to opportunistically return capital to shareholders. While our top capital allocation priorities remain focused on both organic innovations and M&A, having this tool available to deploy periodically as conditions warrant, provides us with additional optionality for our cash balance.

In summary, 2025 was a very strong year at MiMedx, marked by record top and bottom line financial performance, which bolstered our already strong balance sheet. Just to recap, on a full year basis, in 2025, we delivered $419 million in net sales, representing 20% growth compared to 2024; GAAP net income of $49 million, nearly $106 million in adjusted EBITDA, which represents an adjusted EBITDA margin of over 25%; and we increased our net cash balance by nearly 75%.

We believe these results have afforded us the ability to continue to pursue attractive growth opportunities in Surgical while we navigate near-term noise in the Wound market. I will now turn the call back to Joe. Joe?

Thanks, Doug. As you've just heard, we had an outstanding 2025 and are well positioned to achieve continued above-average market growth in our Surgical business and to capitalize on the changes currently taking place in the Wound Care market.

As I said in the past, our competitive advantages are many. We have a fully vertically integrated business from product development to manufacturing to commercialization, including donor recovery. We have an excellent intellectual property portfolio.

We have arguably the most comprehensive and effective commercial organization in our space. And over the past three years, we have dramatically improved our financial position, amassing a strong cash balance. This gives us optionality to deploy capital to accelerate our strategic plan and/or buy back our stock opportunistically.

In closing, I would like to once again thank the MiMedx team for a tremendous close to 2025 and for your unwavering commitment to the many individuals we serve each and every day. Let's now shift over to Q&A and open up the call to questions.

Operator, we are ready for our first question. Please proceed.

(Operator Instructions) Dave Turkaly, Citizens Bank.

Hey, good evening. Thanks for the guidance in a tough environment and the longer-term outlook reiteration. I think that should be helpful. Joe, you mentioned, players, some of the players in the market, maybe, lowering prices, maybe some ceasing. I guess I'm just curious, was that kind of what you anticipated? And then as we look at that guidance and realize it's kind of a flex, that there's a lot in flex here, how comfortable are you that you've kind of captured, at least, let's say the low end of what what could come.

Yeah, I would say that it's, it is kind of what we anticipated happening once we knew what the final rules were going to look like.

We had been hopeful that Medicare would have put A little bit more stringency around the guidelines, but that didn't happen, right? So, maybe it will over time, and so unfortunately we're still seeing a fair amount of, above average discounting in the marketplace, potentially people clearing out product as they exit the market, who knows, but there is some kind of what I'll refer to as dumping of a very low price product below what we think is appropriate.

But yeah, it's kind of what we expected, and then there's, it's complicated, I think, even further by things like implementation of the wiser model in about 4 or 5 states where they're requiring a pre-authorization has really slowed down the insurance verification request process that. That we help patients work through, which is kind of just delayed uptick of normal volume. You always see kind of a slower January, slower February as the marketplace works its way through.

Deductible season and, we typically get 40+% of our revenue in March, 40+% of our kind of Q1 revenue in March. I think this year, the whole thing is just a bit exacerbated by what's happened in the marketplace. Our team is working really hard to help our customers work through a variety of these issues, in the, right out of the gate, customers were just in a wait and see mode. Candidly, I think a lot of folks were expecting. The government swing back around and increase the price and that did not happen, so, I think folks waited a bit to see if that was plausible, but, kind of we're in the market that we're in and I think most people are just trying to figure it out.

We feel real good about it post the kind of market adjustment as things reset. We'll get down to a new norm and then we'll grow from there. And I think, again, we'll start growing at a rate faster than the market cause we did it prior to the run-up in ASPs. Go back to, early, late 22, early 23 when we were growing at strong double-digits and it was really before we saw the huge proliferation of these high priced products. So I know when, all else is equal and we're not, everyone's not competing just on price, our organization tends to do better.

Great, thank you for that and I imagine you know I know there's some sales force sort of issues related to some of the newer players out there and I'm just curious, in terms of your outlook for this year you kinda expect, a more normalized, turnover rate or or I guess your thoughts on the sales force you have and your ability to kind of maybe even increase that given what's going on in the market.

Yeah, it's a good question. I think we saw some other manufacturers make operational expense changes, including to sales and marketing ahead of this change. We made the conscious decision not to do that in any radical way, because we want to see how things shook out and we're trying to be as flexible as possible with our commercial organization, again, let's wait and see how this thing settles out, see what kind of. Organization, we need to maintain the level of reach of frequency adequate to achieve the growth objectives that we would like to see, but it's more of a let's work through this and I can tell you the entire team is working really hard to TRY to adjust to the market and help our customers work their way through this.

Thank you.

Chase Knickerbocker, Craig-Hallum.

Good afternoon. Thanks for taking the questions. Joe, maybe maybe just to start, I'd love to kind of get a feel for what you've seen from a volume perspective in Q1 so far in the overall market in wound, kind of relative to Q4, and, do you feel like you kind of have visibility kind of most of the way through February February here as far as, that kind of market stabilization point that you kind of just mentioned in the previous question, just an overall kind of state of the market, I guess.

Yeah, well, we saw a pretty significant drop off as we went from Q4 to Q1, as anticipated, I think we would have been foolish not to anticipate a fairly significant drop, and we'll, again, there's, I think.

A little bit more.

Kind of stagnation in the business right now simply because of the things like prior office, etc. Etc.

We're seeing exceptional growth on the surgical side that continued into the into the new year, so we think we'll have another good surgical growth quarter, but you know.

The wound care business is recovering, it took a pretty significant shock. People are trying to adjust to it.

We launched our PRP product as an opportunity for people to bring in other modalities to treat chronic wounds, which is being, widely accepted in the marketplace, and we're, that's, we've just started rolling that out. So, pretty optimistic that we'll work our way through this and, we'll come out on the other side in great shape.

How are you seeing it kind of bifurcate by site of service, have you seen any rotation into the HOPD? Is it too early to tell? And then just any sort of sign of kind of volume, share gains from you guys, or is some of the noise on on kind of the product dumping you mentioned shielding some of.

That.

Way too early to start talking about market share changes just because we're all trying to see how big the market is really. You got to remember a fair amount of that market share or that volume that we saw last year in prior year was probably unnecessary overutilization. So the market is resizing, and we know that several clinics, especially in the mobile care sector, have closed or stopped ordering skin subs altogether.

So if the market is reshaping, resizing, I haven't, we haven't really seen significant increases in any care setting. I think, volume is down pretty much across all care settings right now as the market works through this adjustment.

And then just last for me, kind of putting that all together, your guide assumes fairly meaningful, sequential volume growth at least from, what I could pick up qualitatively from some of your comments. Can you just walk us through, kind of in the early stages of the year here with all this noise, kind of where you're finding kind of the confidence, to anchor kind of expectations there, would be helpful for us to kind of anchor on our models. Thanks.

Yeah, I mean, the best color we could give you is we expect a sequential build as the as the year progresses, and I think it'll be pretty substantial as we go from Q1, Q2, 3 and 4, and again we're we're rolling out some new products, we expect to see good, strong growth in the surgical business.

And clearly we'll see more growth in the back half of the year. I think it's going to take, and we said this last year, Chase, we thought at least a couple quarters so this thing shakes out, resizes, and the dust kind of settles. We'll see who the players are that are still largely driving the industry.

And see if there's any other changes like a national coverage determination, how that helps shape the industry. So, it, it's, I think the first couple of quarters are going to be noisy, and we're going to have to fight hard for everything we get.

Got it. Thanks, Joe.

Yes.

Frank Takkinen, Lake Street Capital Markets.

Great, thank you for taking the questions. I was hoping to follow-up on guidance, any color you can provide on on composition of revenue between wound and surgical as you look at the full year of 2026 and then as a second part of that, any color you can speak to on all of the revenue outside of Medicare wound and what that growth rate might look like specifically.

Yeah, so let me take a shot at Doug and you can correct me if I'm wrong. I think at a high level, the split between, if you take out.

I would say split between surgical and wound is probably somewhere close to fifty-fifty full year.

And then maybe a little bit for international, a couple other parts of the business if you.

The, private pay business will continue to grow at its normal rate. I don't think we've parsed that out in the past, but I would say think about it in terms of high growth in surgical business. Obviously the wound care business is going to compress. We'll get, we'll pick up accelerated volume as we progress through the year, especially in the second half of the year, and obviously the price is going to level out, but somewhere in the 50/50.

Yeah, I think it'll be fifty-fifty-ish, particularly early in the year. We expect as the CMS logjam clears the way later in the year, we're going to see more significant wound growth, together with our Our newest product, around, our PRP offering as well so that that should start to.

To tip the balance a little bit more as we get through the year.

Fine. We -- I think we did $140-plus million in the Surgical business for 2025. If we continue to grow that at 20%, that business is up over $170 million, add in a little bit for the new products that we're going to distribute, apply to Surgical market, a few other things that are happening, you're getting real close to $200 million of run rate revenue, especially as you exit the year. I mean -- and that's all pure-play Surgical. It's high growth.

If you put a traditional Surgical multiple on that piece of business of anywhere from, what, 5, 6, 7x revenue, it would imply that our stock is being burdened with the Wound Care business. Not only are we getting no value for Wound Care, we're probably being ascribed negative value for the Wound Care business.

If you just put that 5 to 6 times multiple on the circa $200 million of revenue, that's high-growth revenue, you're probably at a $7.5 to $9 stock. So we have to get through this so the investor base gets more confidence in the fact that there's going to be a Wound Care business and the Wound Care business is going to get back to a normal growth rate. And that's why I said in my prepared remarks, we're looking through to 2027.

We think 2027, we're back up over $400 million in revenue. We've got a mid-20 EBITDA margin, and the business is growing back at double digits. So we think we have to -- this is going to be a bit of a transition year, but we have to work our way through it. And I think we're in much better shape than anybody else in the marketplace to weather the storm.

That's great.

Fantastic. Maybe on my second one, I wanted to ask a little bit more about surgical. What color can you provide on kind of commercial investments you're making there and then any, data packages we should be looking out for in particular in surgical would be great to hear about.

Yeah, we've been doing this for the last 3 years, gradually moving more dedicated sales resources into the surgical business. It's probably increased. Dedicated sales reps somewhere close to 50% over the last few years. And we'll continue to look for areas, it's still relatively small, but we'll continue to look for areas to augment that. I don't want to go too crazy in terms of transitioning people from wound to surgical because we do still have a very large wound care business. It needs to be serviced properly, especially in a time when it's transitioning. Our patients need our help, but you're absolutely right, we'll look for areas to continue to invest there. Clearly we have more products in development. We talked about the ones we recently licensed. There's other opportunities in the marketplace as well, so that's a business that we're going to continue to invest in.

Got it. That's helpful. Thanks for taking the questions.

(Operator Instructions) Brad Bowers, Mizuho Securities.

Hey, thanks for taking the questions from Anthony and I. Maybe going to zoom out here, we've talked a lot about, where we are in the quarter, progress so far. I just wanted to kind of hear, how informed the customer base is. I mean, I imagine ordering patterns have been kind of built up, on the old system, now that we have kind of this new rule. Place you know maybe some of the hangover, maybe at a mechanical level I know that it's going to be hard to predict the timing of this, but you know anything you can share with, you shared some stuff on product dumping, but you know just some hangover from muscle memory and how that's affecting the business.

Yeah, I think, there's a lot of adjustments going on, right? I think Medicare put out more clarification of the fact that they're, they tightened up their ability to pay for wasted product. We see people changing sizes of product, going from larger to smaller products, so there's a ton of adjustment going on. Audits are way up, clawbacks are way up. People are nervous. Again, I think there was a delay out of the gate. As people were waiting for, hoping, I guess that there was going to be more adjustments.

Certainly lot of certainly there was a lot of uncertainty about LCDs. Were the Mac's going to act as if the LCDs were in effect or not. We don't really see that. So just kind of, the best way I can describe it.

Brad, it's just a ton of noise, a ton of adjustments, and, we're kicking and calling to get back to some level of normalcy, and I think we'll get there. It's just, I know we'll get there. It's just how long will it take to get there? And we have a team of folks out there and it's Fighting hard every single day to help our customers get there.

Got it. That's helpful. Maybe just keeping it, on some of the new pieces here, just the pipeline. It sounds like, the R&D spending in the quarter and also commentary suggests that you, the real traditional med tech pipeline here, to the extent that you.

Setting the paradigm for what new product should look like, gathering data, generating data, publishing that, then getting the product to market, should we expect it, kind of a few product launches, of this, type of strategy, a year, and how do we think about, the pipeline between wound and surgical thanks.

Yeah, I would say amniotic products will continue to develop internally, and you should see a couple of products a year from us and as we launch product, we'll support it with good clinical data and we'll continue to invest in that and support those products, so. That's kind of an important point you brought up, right? Cause these lower price points, I can't imagine there's many manufacturers that can afford to support the development, innovation, R&D, etc.

Necessary to stay competitive in this space. Like, so that's why I keep coming back to, once we get through this transition period, we're going to be one of the very few companies that have the capability. We are as vertically integrated as we are to compete in this marketplace, so, we'll see who survives. We know we will, and we know we have a nice balance in business mix between our surgical and wound care business, we'll see how many competitors are left and how big that market is, but we're very confident that we're going to get our unfair share of the of the market.

Thank you. At this, at the time we've reached the end of our question-and-answer session, I'll turn the floor back to management for closing remarks.

Thanks, everybody. We really appreciate your continued interest in the company and we'll be back to talk to you in a few months.

That concludes today's call.

Thank you. Today's call has concluded. You may now disconnect your lines at this time. We thank you for your participation. Have a wonderful day.