Outset Medical Inc (OM) 2023 Q3 法說會逐字稿

Good day, and thank you for standing by. Welcome to the Outset Medical Q3 2023 earnings conference call. (Operator Instructions)

美好的一天，感謝您的支持。歡迎參加 Outset Medical 2023 年第三季財報電話會議。 （操作員說明）

Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Jim Mazzola, Head of Investor Relations. Please go ahead.

請注意，今天的會議正在錄製中。現在我想將會議交給今天的第一位發言人，投資者關係主管吉姆·馬佐拉 (Jim Mazzola)。請繼續。

Okay, thank you. Good afternoon, everyone, and welcome to our third quarter 2023 earnings call. Here with me today are Leslie Trigg, Chair and Chief Executive Officer; and Nabeel Ahmed, Chief Executive Chief Financial Officer. We issued a news release after the close of market today and updated our investor presentation, both of which can be found on the Investor Relations pages of outsetmedical.com. This call is being recorded and will be archived on the Investors section of our website.

好的謝謝。大家下午好，歡迎參加我們的 2023 年第三季財報電話會議。今天和我在一起的還有董事長兼執行長萊斯利‧特里格 (Leslie Trigg)；和執行長財務長納比爾·艾哈邁德 (Nabeel Ahmed)。我們在今天收盤後發布了一份新聞稿，並更新了我們的投資者介紹，這兩個內容都可以在 outsetmedical.com 的投資者關係頁面上找到。本次電話會議正在錄音，並將存檔在我們網站的投資者部分。

It is our intent that all forward-looking statements made during today's call be protected under the Private Securities Litigation Reform Act of 1995. These statements relate to expectations or predictions of future events are based on our current estimates and various assumptions and involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied. Outset assumes no obligation to update these statements.

我們的目的是，今天電話會議期間所做的所有前瞻性陳述均受到《1995 年私人證券訴訟改革法案》的保護。這些與對未來事件的預期或預測相關的陳述是基於我們當前的估計和各種假設，涉及重大風險和風險。可能導致實際結果或事件與預期或暗示的結果或事件有重大差異的不確定性。 Outset 不承擔更新這些聲明的義務。

For a list and description of the risks and uncertainties associated with our business, please refer to the risk factors section of Outset public filings with the Securities and Exchange Commission, including our latest annual and quarterly reports.

有關與我們業務相關的風險和不確定性的清單和描述，請參閱向美國證券交易委員會提交的公開文件中的風險因素部分，包括我們最新的年度和季度報告。

With that, I will now turn the call over to Leslie.

現在，我將把電話轉給萊斯利。

Thank you, and good afternoon, everyone, and thank you for joining us. A few weeks ago, we provided our preliminary third-quarter results and shared details on the headwinds that will continue to affect our business through this year and into next.

謝謝大家，大家下午好，謝謝您加入我們。幾週前，我們提供了第三季的初步業績，並分享了今年和明年將繼續影響我們業務的不利因素的詳細資訊。

Today, we will review our results for the full quarter, share an update on the actions we have taken to adapt and respond to the current environment, and provide our outlook for 2024 and the longer term. We will also discuss what has not changed. Despite some recent setbacks, all the structural tailwinds remain in place, near on the front end of growth into two very large end markets, anchored by 36 million patients living with chronic kidney disease.

今天，我們將回顧整個季度的業績，分享我們為適應和應對當前環境而採取的行動的最新情況，並提供我們對 2024 年及更長期的展望。我們還將討論沒有改變的內容。儘管最近遇到了一些挫折，但所有結構性有利因素仍然存在，接近兩個非常大的終端市場的成長前端，而這兩個市場的基礎是 3,600 萬慢性腎臟病患者。

Our pipeline continues to expand, and our value proposition remains compelling. Tablo's ability to disrupt an $11 billion US market with a better solution in the acute and home environment is firmly intact.

我們的產品線不斷擴大，我們的價值主張仍然引人注目。 Tablo 憑藉在急性和家庭環境中提供更好的解決方案來顛覆價值 110 億美元的美國市場的能力完好無損。

To begin, revenues for the third quarter were balanced between our acute and home end market, with a roughly equal number of consoles shipped to acute and home providers. In the acute end market, our land-and-expand strategy continues to support a strong pipeline and growing installed base. 30% of console placements during the first three quarters of 2023 came from accounts we won during 2022. The other 70% are from expansion site.

首先，第三季的收入在我們的急性和家庭終端市場之間保持平衡，運送給急性和家庭提供者的遊戲機數量大致相等。在急需的終端市場，我們的土地擴張策略繼續支持強大的管道和不斷增長的安裝基礎。 2023 年前三個季度的主機投放量中有 30% 來自我們在 2022 年贏得的客戶。另外 70% 來自擴展網站。

Tablo is now used in more than 650 acute and post-acute facilities, including contracts with top national health system where we have about 20% penetration, and also within the top 50 regional IDNs, where we are less than 10% penetrated today.

Tablo 目前已在650 多個急性和急性後期設施中使用，包括與頂級國家衛生系統簽訂的合同，我們在其中的滲透率約為20%，也在排名前50 的地區IDN 中使用，目前我們在這些系統中的滲透率不到10%。

Further, we continue to see success with initiatives, such as expanded physician education and published cost reduction data, which are all having a positive impact in the acute setting. During 2023, we have reached more than 400 nephrologists and dialysis professionals with our peer-to-peer educational programs. This is in addition to the more than 10,000 nurses already trained on Tablo.

此外，我們繼續看到各種措施取得成功，例如擴大醫生教育和發布成本降低數據，這些都對緊急情況產生了積極影響。 2023 年期間，我們的點對點教育計畫涵蓋了 400 多名腎臟病專家和透析專業人士。除此之外，已有 10,000 多名護理師接受過 Tablo 訓練。

Physician and nurse awareness and belief in Tablo continues to be bolstered by published clinical, operational, and economic data. To date, over 70 abstracts and 15 manuscripts on Tablo have been generated. Building on this strong foundation, last week, American Society of Nephrology Annual Meeting produced numerous abstracts on Tablo. In the acute setting, these abstracts continue to demonstrate Tablo's differentiated potential to reduce costs and enhance care in both the ICU and at the bedside.

已發布的臨床、操作和經濟數據繼續增強醫生和護士對 Tablo 的認識和信念。迄今為止，Tablo 已產生 70 多份摘要和 15 份手稿。在此堅實的基礎上，上周美國腎臟病學會年會在 Tablo 上發布了大量摘要。在緊急情況下，這些摘要繼續證明 Tablo 在降低成本和加強 ICU 和床邊護理方面的差異化潛力。

One large health system reported achieving more than a 50% reduction in their treatment cost per hour, while also reducing length of stay in the ICU. A hospital in Alaska presented data showing that Tablo dramatically reduced the number of patients they had to transfer out of their hospital for care. After adopting Tablo, the hospital only had to transfer one patient out in 12 months compared to 70 patients transferred out the prior year before using Tablo.

一個大型衛生系統報告稱，每小時的治療成本降低了 50% 以上，同時也縮短了 ICU 的住院時間。阿拉斯加的一家醫院提供的數據顯示，Tablo 大大減少了必須轉出醫院接受治療的患者數量。採用 Tablo 後，醫院在 12 個月內只需轉出一名患者，而使用 Tablo 前一年則轉出 70 名患者。

Several abstracts related to the use of Tablo in the home, including data from the first 500 patients home on Tablo, which demonstrate a very broad demographic spectrum of adopters, and in a separate abstract, showed improvement in physical and mental health scores over 12 months of using Tablo at home, including improvement in sleep, which is among the most frequently cited issues among patients on dialysis.

與在家中使用Tablo 相關的幾份摘要，包括來自前500 名使用Tablo 在家的患者的數據，這些數據表明了採用者的人口統計範圍非常廣泛，並且在單獨的摘要中，顯示了12 個月內身體和心理健康評分的改善在家使用 Tablo 的好處，包括改善睡眠，這是透析患者最常提到的問題之一。

In terms of our home sales in the quarter, orders and shipments were weighted toward mid-sized dialysis organizations and new home market entrants, where we continue to see a strong response to Tablo's economic value proposition, positive patient feedback, faster training time, and higher retention rates. We have made progress this year landing or expanding within several new innovative alternative providers, evidence to our strategy to broaden the access to home hemodialysis while in the early stages is working.

就本季的房屋銷售而言，訂單和出貨量主要面向中型透析組織和新的家庭市場進入者，我們繼續看到對Tablo 經濟價值主張的強烈反應、積極的患者反饋、更快的培訓時間以及更高的保留率。今年，我們在幾家新的創新替代供應商的登陸或擴張方面取得了進展，這證明了我們在早期階段擴大家庭血液透析覆蓋範圍的策略正在發揮作用。

Overall, for 2023, we expect to place approximately 1,400 new Tablo consoles, split two-thirds in the acute setting and one-third in the home setting. With these new placements, we would exit 2023 with approximately 5,400 units in the installed base, which we project will reach $100 million in recurring annual revenue over time.

總體而言，到 2023 年，我們預計將投放約 1,400 台新 Tablo 遊戲機，其中三分之二用於急性環境，三分之一用於家庭環境。憑藉這些新的配置，到 2023 年，我們的安裝量將達到約 5,400 台，我們預計隨著時間的推移，經常性年收入將達到 1 億美元。

We felt it was important to provide investors with this annual update on console placements earlier than normal as it is relevant to the financial guidance we will also provide today. In terms of the broader competitive market, our sales team has been working diligently over the past several weeks to address misconceptions created by competitors as a result of the FDA warning letter issued in July. While we expect this competitive response to continue through Q4, our team is better prepared to respond and is doing so accordingly.

我們認為，比平常更早地向投資者提供有關主機佈局的年度更新非常重要，因為它與我們今天也將提供的財務指導相關。就更廣泛的競爭市場而言，我們的銷售團隊在過去幾週一直在努力解決競爭對手因 7 月 FDA 發出警告信而產生的誤解。雖然我們預計這種競爭性反應將持續到第四季度，但我們的團隊已經做好了更好的應對準備，並且正在採取相應的行動。

As noted previously, we believe we have addressed concerns regarding promotion and the TabloCart with prefiltration 510(k) has been submitted with interactive 510 -- excuse me, with interactive FDA review underway. We have not factored in its clearance into our 2023 outlook.

如前所述，我們相信我們已經解決了有關促銷的問題，並且帶有預過濾 510(k) 的 TabloCart 已與互動式 510 一起提交——對不起，互動式 FDA 審查正在進行中。我們尚未將其清除納入我們的 2023 年展望中。

As we look beyond 2023, we would like to take this opportunity to share our perspectives on how this business scales over the longer term. Three years post IPO, we recognize the need to update investors on what we believe the next several years will look like relative to revenue growth, gross margin expansion, and cash flow breakeven. And being in the market now at some level of scale for several years has given us a lot more data and experience from which to project forward with confidence and clarity.

展望 2023 年以後，我們想藉此機會分享我們對該業務如何長期擴展的看法。在首次公開募股三年後，我們意識到需要向投資者通報我們認為未來幾年相對於收入成長、毛利率擴張和現金流盈虧平衡的最新情況。多年來，我們在一定規模的市場上投入了很多年，為我們提供了更多的數據和經驗，使我們能夠自信、清晰地向前邁進。

While the progress path won't always be linear across all our key goals, we've also heard investors loud and clear on their desire for more metrics, particularly around the installed base and use setting. And so, we intend to do that going forward starting with today's call.

雖然我們所有關鍵目標的進展路徑並不總是線性的，但我們也聽到投資者大聲而明確地表達了他們對更多指標的渴望，特別是在安裝基礎和使用設定方面。因此，我們打算從今天的電話會議開始繼續這樣做。

And finally, we are acutely aware of shareholders' desire for Outset to reach profitability, and we remain committed and urgent around getting there. Cash consumption is obviously a big part of that equation. And to that end, we have already taken prudent steps to reduce spending while continuing investments that drive revenue growth, gross margin expansion, and operating leverage.

最後，我們敏銳地意識到股東希望 Outset 實現盈利的願望，並且我們仍然致力於實現這一目標並迫切需要實現這一目標。現金消費顯然是其中的重要組成部分。為此，我們已經採取審慎措施減少支出，同時繼續投資以推動收入成長、毛利率擴張和營運槓桿。

Nabeel will lay out the specifics in greater detail. And so with that, I will now turn the call over to him.

納比爾將更詳細地闡述細節。因此，我現在將把電話轉給他。

Thanks, Leslie. Hello, everyone. I'd like to talk today about three things.

謝謝，萊斯利。大家好。今天我想談三件事。

First, 2023, including our Q3 performance guidance for the remainder of the year and actions we've taken here early in the fourth quarter to reduce our rate of cash consumption. Second, our 2024 guidance, our longer-term view, and our path to cash flow breakeven. And third, our balance sheet and our cash position.

首先是 2023 年，包括我們今年剩餘時間的第三季業績指引以及我們在第四季初為降低現金消耗率而採取的行動。其次，我們的 2024 年指導、我們的長期願景以及我們實現現金流收支平衡的路徑。第三，我們的資產負債表和現金狀況。

With respect now to Q3 and 2023, our third quarter revenue of $30.4 million is a 9% increase over the third quarter of 2022 and a sequential decline compared to Q2 2023. The sequential decline in revenue was driven by fewer console placements for the factors that we outlined in October. Consumable revenue was $11 million, up 14% from the prior quarter and 62% versus the prior year.

就目前的第三季和2023 年而言，我們第三季的營收為3,040 萬美元，比2022 年第三季成長9%，與2023 年第二季相比連續下降。營收連續下降的原因是主機投放量減少，原因是我們在十月概述了。消費品收入為 1,100 萬美元，季增 14%，年增 62%。

Cartridge utilization continued to perform well and in line with our expectations, highlighting the strength of our recurring revenue model. Based on our cloud data, we see console utilization in the hospital setting of around five treatments per week and home consoles at just about three per week.

墨盒利用率持續表現良好，符合我們的預期，凸顯了我們經常性收入模式的優勢。根據我們的雲端數據，我們發現醫院環境中的控制台利用率約為每週 5 次治療，而家用控制台每週約為 3 次。

Service and other revenue of $6.8 million was up 1.8% from the prior quarter and higher by 13.4% compared to the prior year. Excluding service revenue from our HHS agreement that was included in Q3 '22 and did not repeat this Q3, service and other revenue increased by 42.6%, demonstrating the high renewal rates in our recurring service contracts.

服務及其他收入為 680 萬美元，季增 1.8%，年增 13.4%。不包括 22 年第 3 季包含的 HHS 協議中的服務收入，且本第 3 季沒有重複，服務和其他收入成長了 42.6%，這表明我們經常性服務合約的續約率很高。

Moving to gross margin and operating expenses, I will highlight our non-GAAP results. I encourage you to review the reconciliation of GAAP to non-GAAP measures, which can be found in today's earnings release.

談到毛利率和營運費用，我將重點放在我們的非公認會計準則績效。我鼓勵您查看 GAAP 與非 GAAP 衡量標準的對賬，這可以在今天的收益報告中找到。

Our third-quarter gross margin was 25.6%, a sequential improvement of 312 basis points and an improvement of just above 9 percentage points versus the prior-year period. Gross margin expanded for the 10th consecutive quarter with our mix of higher margin recurring consumable revenue and service and other revenue representing roughly 60% of total revenue as compared to 45% in Q2 of this year. As expected, service and other gross margin increased sequentially to 15.4%, and our expectation remains that it will continue to improve again in the fourth quarter.

我們第三季的毛利率為 25.6%，季增了 312 個基點，比去年同期提高了 9 個百分點以上。毛利率連續第 10 個季度增長，我們的經常性消費品收入和服務以及其他收入的利潤率較高，約佔總收入的 60%，而今年第二季度為 45%。如預期，服務及其他毛利率較上季成長至 15.4%，我們的預期仍是第四季將繼續改善。

Operating expenses of $42.3 million in the third quarter were roughly flat sequentially and up 11% versus the prior-year period. We reported third-quarter GAAP net loss of $46.2 million, resulting in a net loss of $0.93 per share compared to a net loss of $40.8 million, or $0.85 per share for the prior-year period. Non-GAAP net loss was $35.3 million, or $0.71 per share, compared to a non-GAAP net loss of $33.4 million, or $0.70 per share, for the same period in 2022.

第三季營運支出為 4,230 萬美元，與上一季基本持平，但與去年同期相比成長 11%。我們公佈的第三季 GAAP 淨虧損為 4,620 萬美元，導致每股淨虧損 0.93 美元，而去年同期淨虧損為 4,080 萬美元，即每股淨虧損 0.85 美元。非 GAAP 淨虧損為 3,530 萬美元，即每股 0.71 美元，而 2022 年同期的非 GAAP 淨虧損為 3,340 萬美元，即每股 0.70 美元。

We ended the quarter with approximately $197.3 million in cash, cash equivalents, short-term investments, and restricted cash.

截至本季末，我們擁有約 1.973 億美元的現金、現金等價物、短期投資和限制性現金。

Moving now to our full year 2023 outlook. We are reiterating our expectation for revenue to be approximately $130 million, which represents 13% growth over fiscal year 2022 revenue. We continue to expect gross margin to be in the low-20% range and to exit the fourth quarter in the mid-20% range. Further, we continue to expect to consume less cash in 2023 than we did in 2022 and to exit 2023 with approximately $160 million of cash, cash equivalents, short-term investments, and restricted cash on our balance sheet.

現在轉向我們對 2023 年全年的展望。我們重申，我們預計營收約為 1.3 億美元，比 2022 財年營收成長 13%。我們繼續預計毛利率將在 20% 的低水平範圍內，並在第四季度結束時在 20% 的中水平範圍內。此外，我們仍預期 2023 年消耗的現金將少於 2022 年，並在 2023 年退出時資產負債表上的現金、現金等價物、短期投資和限制性現金約為 1.6 億美元。

I want to take a moment now to talk about the cost reduction we implemented in the fourth quarter to better align our operating expenses with our expected rate of revenue growth and with our commitment towards driving towards profitability. We will record a charge of approximately $2.5 million in our statement of operations in the fourth quarter, composed largely of severance and related benefits. These actions, combined with other cost savings initiatives we have put in place, mean that our expected OpEx in 2024 will be $20 million to $25 million less than we expect it to be in 2023.

我現在想花點時間談談我們在第四季度實施的成本削減措施，以便更好地使我們的營運支出與我們的預期收入成長率以及我們對推動獲利的承諾保持一致。我們將在第四季的營運報表中記錄約 250 萬美元的費用，主要包括遣散費和相關福利。這些行動與我們實施的其他成本節約措施相結合，意味著我們預計 2024 年的營運支出將比 2023 年的預期減少 2,000 萬至 2,500 萬美元。

Now, turning to 2024. For the full year 2024, we expect revenue growth in the mid-teens as compared to fiscal year 2023 revenue. This is a conservative expectation based on the following assumptions. One, we place a similar number of consoles in 2024 as we have in 2023; two, recurring revenues, again, contribute to our growth in the same manner as they have in 2023; and three, that TabloCart with prefiltration is approved in the second half of the year.

現在，轉向 2024 年。對於 2024 年全年，我們預計與 2023 財年的營收相比，營收成長將達到 15%左右。這是基於以下假設的保守預期。第一，我們在 2024 年投放的遊戲機數量與 2023 年相似；第二，經常性收入再次以與 2023 年相同的方式為我們的成長做出貢獻；第三，具有預先過濾功能的TabloCart將於今年下半年獲得批准。

As always, overperformance in any year could be driven by a variety of factors, including greater console placements in our large acute and home end markets, higher ASP of our consoles, driven by increased uptake of Tablo [Pro plus] software and TabloCart, as well as higher volume consumable sales. We expect gross margin for the full year 2024 to be in the low-30% range and to exit the fourth quarter of 2024 in the mid-30% range.

與往常一樣，任何一年的超額表現都可能受到多種因素的推動，包括在我們大型急性和家庭終端市場中更大的遊戲機佈局、由於Tablo [Pro plus] 軟體和TabloCart 的使用增加而推動的遊戲機平均售價較高，以及較高的消耗品銷售量。我們預計 2024 年全年毛利率將在 30% 的低水準範圍內，並在 2024 年第四季結束時在 30% 的中水準範圍內。

The drivers of gross margin improvements are the same as we have discussed for the past three years, console cost-down programs, the pull through of higher margin products and consumables as consoles are placed, and service leverage.

毛利率提高的驅動因素與我們過去三年討論的相同，即主機成本降低計劃、主機放置時利潤率較高的產品和消耗品的拉動以及服務槓桿。

With the cost reductions we are undertaking in 2023 and the further actions we're taking to manage our OpEx, we anticipate OpEx in 2024 of $140 million to $145 million, or $20 million to $25 million below where we expect to exit 2023. This combination of revenue growth, gross margin expansion, and reduced OpEx is expected to drive significant operating leverage and a further reduction in our cash consumption. We expect to use approximately 25% less cash in 2024 than we anticipate using in 2023.

隨著我們在2023 年採取的成本削減措施以及我們為管理營運支出而採取的進一步行動，我們預計2024 年的營運支出將達到1.4 億至1.45 億美元，比我們預計2023 年退出的水平低2,000 萬至2,500 萬美元。收入成長、毛利率擴張和營運支出減少預計將推動顯著的營運槓桿並進一步減少我們的現金消耗。我們預計 2024 年的現金使用量將比 2023 年的預期減少約 25%。

Now looking out beyond 2024, we project that our business will grow at a high-teens rate annually after 2024 as we gain scale, adjusted the capital spending environment, and achieve TabloCart prefiltration clearance. For modeling purposes, we expect this ramp to show home revenues increasing from approximately 20% of revenue in 2023 to approximately 25% of revenue in 2027. Beginning in 2024, we will share our installed base twice a year to provide additional visibility to this ramp.

現在展望 2024 年以後，我們預計，隨著我們擴大規模、調整資本支出環境並實現 TabloCart 預過濾許可，我們的業務將在 2024 年之後每年以高雙位數的速度增長。出於建模目的，我們預計這一增長將顯示家庭收入從2023 年收入的約20% 增加到2027 年收入的約25%。從2024 年開始，我們將每年兩次共享我們的安裝基礎，以提供對該增長的更多可見性。

Our track record for gross margin expansion gives us ongoing confidence in our ability to get to our 50% gross margin milestone. At our projected revenue growth rates, we now anticipate reaching our 50% gross margin milestone exiting 2027 as full-year revenues reached $250 million. Our conviction in this gross margin ramp is driven by the same factors that have been 10 consecutive quarters of gross margin expansion.

我們的毛利率擴張記錄使我們對達到 50% 毛利率里程碑的能力充滿信心。按照我們預期的營收成長率，我們現在預計 2027 年全年營收將達到 2.5 億美元，毛利率將達到 50% 的里程碑。我們對毛利率上升的信心是由連續 10 個季度毛利率擴張的相同因素推動的。

Moving to OpEx. As we have previously shared, we believe that we've already made our key structural investments in talent and infrastructure, and we plan to expand OpEx by a mid-single-digit percent annually beyond 2024. This combination of revenue growth, gross margin expansion, and operating leverage is expected to support achievement of cash flow breakeven exiting 2027 as we get gross margins to 50%.

轉向營運支出。正如我們之前所分享的，我們相信我們已經在人才和基礎設施方面進行了關鍵的結構性投資，並且我們計劃在2024 年之後每年以中個位數百分比的速度擴大營運支出。收入成長、毛利率擴張的結合，隨著我們的毛利率達到 50%，預計營運槓桿將支持 2027 年實現現金流盈虧平衡。

Now turning to our balance sheet and our cash runway. While there are overperformance scenarios that get us to cash flow breakeven without the need for additional capital, it is reasonable to expect that we may need to top off the balance sheet before 2027. With approximately $160 million of cash exiting 2023 and access to the next $100 million of debt under our SLR agreement, our cash position provides us with time and levers to operate and grow the business effectively for the next several years.

現在轉向我們的資產負債表和現金跑道。雖然在某些情況下，我們可以在不需要額外資本的情況下實現現金流收支平衡，但我們有理由預計，我們可能需要在2027 年之前完成資金負債表。2023 年將有約1.6 億美元的現金退出，並可進入下一個階段。根據我們的 SLR 協議，我們的債務為 1 億美元，我們的現金狀況為我們提供了在未來幾年有效運營和發展業務的時間和槓桿。

With that, let me turn the call back to Leslie for closing comments.

接下來，讓我將電話轉回給萊斯利以徵求結束意見。

Thanks, Nabeel. I'd like to close by going back to the fundamentals of this market, the business model, and our products. We are penetrating one of the largest healthcare markets in the world with over 85 million dialysis treatments performed each year in the United States alone, and we have two growth platforms within it, acute dialysis and home dialysis.

謝謝，納比爾。最後，我想回顧一下這個市場的基本面、商業模式和我們的產品。我們正在打入世界上最大的醫療保健市場之一，僅在美國每年就進行超過 8500 萬例透析治療，並且我們擁有兩個增長平台：急性透析和家庭透析。

Our acute TAM in the US is $2.5 billion, that's nearly 40,000 consoles. By year end, we expect to have sold just over 4,000 acute consoles. So a very, very long growth runway still lies ahead of us. The home TAM in the US is nearly $9 billion, and that's assuming only 30% of dialysis patients can or ever want to go home. And from what we've seen across the country with Tablo, this is an incredibly conservative estimate. We have barely scratched the surface.

我們在美國的總 TAM 為 25 億美元，相當於近 40,000 台遊戲機。到年底，我們預計將售出超過 4,000 台急性遊戲機。因此，我們前面還有一條非常非常長的成長跑道。美國的家庭 TAM 接近 90 億美元，而且這是假設只有 30% 的透析患者能夠或曾經想要回家的情況。從我們在全國各地透過 Tablo 看到的情況來看，這是一個極其保守的估計。我們僅僅觸及了表面。

With so many tailwinds pointing toward more care in the home and more dialysis care in the home. specifically, we are on the right side of healthcare with the right technology at the right time.

如此多的有利因素都指向更多的家庭護理和家庭透析護理。具體來說，我們在醫療保健領域處於正確的位置，在正確的時間提供正確的技術。

The business model. Just four years into commercialization, roughly half of our revenues already come from recurring revenue. When Tablo consoles are sold and installed, they're used. Each console sold over time generates between $15,000 and $20,000, depending on acute setting per year every year. This is a business that produces operating leverage.

商業模式。商業化才四年，我們大約一半的收入就已經來自經常性收入。當 Tablo 控制台被出售和安裝時，它們就被使用了。隨著時間的推移，每台控制台的銷售收入在 15,000 美元到 20,000 美元之間，具體取決於每年的緊急情況。這是一項產生經營槓桿的業務。

For example, we have grown revenue more than 70% on a compounded annual basis over the last four years with the same size capital health team. This is a business that will generate gross margin of 50% and beyond. We have 10 consecutive quarters of gross margin expansion behind us and a clear itemized execution plan that gets us there. This is a business that can be profitable and will be profitable due to inherent operating leverage, gross margin profile, and an ever-thickening foundation of predictable, sticky recurring revenue.

例如，在過去四年中，在資本健康團隊規模相同的情況下，我們的年複合收入成長了 70% 以上。這項業務的毛利率將達到 50% 甚至更高。我們已經連續 10 個季度實現毛利率擴張，並有明確的逐項執行計劃幫助我們實現這一目標。由於固有的營運槓桿、毛利率狀況以及可預測的、黏性的經常性收入的不斷增長的基礎，這是一項可以盈利並且將會盈利的業務。

And the product. What we do well goes beyond the technology. Our product is not just the device but change management and customer success expertise that is proprietary and very hard to replicate. There are high barriers to success, and we are actively elevating those barriers by expanding both our technology moat and our regulatory moat.

還有產品。我們做得好的事情超出了技術範圍。我們的產品不僅僅是設備，還包括專有且難以複製的變革管理和客戶成功專業知識。成功的障礙很高，我們正在透過擴大我們的技術護城河和監管護城河來積極消除這些障礙。

Our economic, clinical, and operational value proposition is evergreen, save healthcare providers' money, simplify their operations, and improve the quality of living for patients. These fundamental benefits are unlikely to go out of style, and Tablo brings a highly differentiated, difficult-to-copy product market fit to them. So all these reasons, this is a market, a business model, and a product that supports double-digit growth rates for many years to come.

我們的經濟、臨床和營運價值主張是常青的，可以節省醫療保健提供者的資金，簡化他們的操作，並提高患者的生活品質。這些基本優勢不太可能過時，而 Tablo 為它們帶來了高度差異化、難以複製的產品市場。所以所有這些原因，這是一個市場，一個商業模式，一個支持未來多年兩位數成長率的產品。

With that, I think we are ready for Q&A. Operator, please open the line.

至此，我想我們已經準備好要進行問答了。接線員，請開通線路。

(Operator Instructions) Rick Wise, Stifel.

（操作員說明）Rick Wise，Stifel。

Good afternoon, Leslie. Hi, everybody. Thank you for that very clear -- almost clear perspective and numbers, the incremental guidance. There's a lot to focus on. But maybe for starters, Leslie, we attended new -- Outset was there, the ASN meetings in Philadelphia this past week. I'd just be curious from your perspective. Your high-level takeaways, any updates or -- reactions to the opportunities that emerged at ASM?

下午好，萊斯利。大家好。感謝您提供非常清晰的——幾乎清晰的觀點和數字，以及增量指導。有很多事情需要關注。但也許首先，Leslie，我們參加了新的——上週在費城舉行的 ASN 會議。我只是從你的角度好奇。您對 ASM 出現的機會有什麼最新的看法或反應嗎？

And maybe just as part of that, we heard from one of your larger acute customers about the cost savings they're seeing. How are you driving that awareness? Clearly, there's a major customer high volume that seeing and significant economic benefits. How are you powering that message forward as well? Thank you.

也許只是作為其中的一部分，我們從一位敏銳的大客戶那裡聽到了他們所看到的成本節省。您如何推動這種意識？顯然，有大量的主要客戶看到了巨大的經濟效益。您又如何推動這訊息的傳播？謝謝。

Yeah, sure. Thanks for the question, Rick. We're creating awareness of the, I would call it now, the proven and reproducible cost reduction benefits in a couple of ways. I mentioned on the scripted remarks that we have actually reached a lot of people through these peer-to-peer educational sessions. We're doing now amongst nephrologists, amongst nurses, and amongst health system executives, having reached over 400 professionals just in the last call it 9 or 10 months. That's been a big new focus for us this year, and I think that's really paying off. So that's one venue.

好，當然。謝謝你的提問，瑞克。我們正在透過多種方式提高人們對（我現在稱之為）經過驗證且可重複的成本降低效益的認識。我在有稿的發言中提到，透過這些點對點教育課程，我們實際上已經接觸到了很多人。我們現在正在腎臟病專家、護士和衛生系統管理人員中開展工作，僅在過去的 9 或 10 個月內就已經涵蓋了 400 多名專業人士。這是我們今年的一個新的重點，我認為這確實得到了回報。這就是一個場地。

The second venue is by continuing to add to the published evidence base. I mentioned you over 70 abstracts, 15 manuscripts, any number of those actually reference and documents the cost reduction benefits and the operational and clinical benefits as well, and I think that's really paying off.

第二個途徑是繼續添加已發布的證據庫。我向您提到了 70 多篇摘要、15 篇手稿，其中任何數量都實際參考並記錄了成本降低效益以及營運和臨床效益，我認為這確實得到了回報。

And then lastly, in large national and regional medical meetings like the one that you just alluded to, the ASN, where we have the opportunity to not only speak directly to customers but also connect customers with their peer groups. So I will say that I think we are starting to see a bit of a network effect here. That network effect is certainly turning the flywheel on the acute and continues to create momentum for us in that segment.

最後，在大型國家和地區醫學會議（例如您剛才提到的 ASN）中，我們不僅有機會直接與客戶交談，而且還將客戶與他們的同行群體聯繫起來。所以我想說，我認為我們開始在這裡看到一些網路效應。這種網路效應無疑正在加速飛輪的運轉，並繼續為我們在該領域創造動力。

Great. That's excellent. And just specifically, you highlighted innovation. I'm just curious, are there other products we should be aware of or you want to talk about? But specifically, can you update us or add in additional color? I know it's difficult on your interactions with FDA or just where do things stand with TabloCart?

偉大的。那太好了。具體而言，您強調了創新。我只是好奇，還有其他我們應該注意的產品或您想談論的嗎？但具體來說，您可以更新我們的資訊或添加其他顏色嗎？我知道您與 FDA 的互動很困難，或者 TabloCart 的情況如何？

With TabloCart, sure. Well, no updates on the regulatory path. It is under review, and we feel that it was a very, very, very strong submission, one that we're really proud of. We aren't factoring in its clearance into 2023. And for the purposes of modeling, assume that TabloCart is cleared in the second half of 2024, but that's not driven by anything specific or new. With regard to our interactions with the FDA, we just think it's a prudent assumption to make.

有了 TabloCart，當然可以。嗯，監管路徑上沒有任何更新。它正在接受審查，我們認為這是一個非常、非常、非常有力的提交，我們對此感到非常自豪。我們沒有將其清除時間考慮到 2023 年。出於建模目的，假設 TabloCart 在 2024 年下半年清除，但這並不是由任何特定或新的因素驅動的。關於我們與 FDA 的互動，我們認為這是一個謹慎的假設。

And then I think, yes, we're still facing and would expect to face in Q4 some of the competitive activity around TabloCart not being available by our choice and some competitive noisemaking around the other aspect of the warning letter around some case studies that were on our website. We feel that we have fully satisfied the FDA's concerns around the website. And of course, we filed a 510(k) on TabloCart.

然後我認為，是的，我們仍然面臨並且預計將在第四季度面臨一些圍繞TabloCart 的競爭活動，這些競爭活動是我們無法選擇的，並且圍繞一些案例研究的警告信的其他方面產生了一些競爭噪音，這些案例研究是在我們的網站上。我們認為我們已經完全滿足了 FDA 對網站的擔憂。當然，我們在 TabloCart 上提交了 510(k)。

Our team is absolutely better prepared this quarter. But there are a lot of customer conversations to have. I mentioned again in the prepared remarks that Tablo is being used in over 650 facilities, that's thousands of users, nurses and health system administrators, and nephrologists that our team has to and want to have conversations with just to ensure that there are no misconceptions or misinformation out there. So I would expect that that communication process, those conversations will certainly take us through Q4, which, again, was factored into the guidance that we've provided around year-end 2023.

我們的團隊本季絕對準備得更好。但有很多客戶對話需要進行。我在準備好的演講中再次提到，Tablo 正在超過650 個設施中使用，其中包括數千名用戶、護士和衛生系統管理員以及腎臟病專家，我們的團隊必須並且希望與他們進行對話，以確保不存在任何誤解或誤解。那裡有錯誤的訊息。因此，我預期這種溝通過程、這些對話肯定會引導我們度過第四季度，這也被納入我們在 2023 年底左右提供的指導中。

Great. And just one last one for me. Just maybe update on your home efforts, some of that key milestones from your perspective this quarter, and the setup for the home outlook for '24 a little bit? Thank you so much.

偉大的。對我來說只是最後一件。也許只是更新一下你的主場努力，從你的角度來看本季的一些關鍵里程碑，以及 24 年主場前景的設置？太感謝了。

Oh, sure. I appreciate the question. Yeah. Again, our home continues to grow. We still expect it to be a very significant contributor to revenue over the long term as we alluded to. What we're really focused on strategically is, number one, I'd say top of the funnel expanding the provider universe, whether those are new market entrants, and we've seen actually the emergence of several new market entrants. These are adjacent healthcare providers that have not previously been in the home dialysis market before and have entered seeing the opportunity there and are using Tablo exclusively to drive more patient adoption in the home. So that's part one, extending the provider universe. And I think we have a lot of nice proof points out of 2023 on that one and heading into '24.

哦沒問題。我很欣賞這個問題。是的。再次，我們的家繼續成長。正如我們所提到的，我們仍然預期它將成為長期收入的一個非常重要的貢獻者。我們真正關注的策略是，第一，我想說的是擴大供應商範圍的管道頂部，無論這些是新的市場進入者，我們實際上已經看到了幾個新的市場進入者的出現。這些鄰近的醫療保健提供者以前從未涉足過家庭透析市場，但他們看到了那裡的機會，並專門使用 Tablo 來推動更多患者在家中採用。這是第一部分，擴展提供者的範圍。我認為從 2023 年到 24 年，我們有很多很好的證據。

The second one is to drive the depth of the home programs that we have. Historically, these home programs with the incumbent device typically tended to peter out at maybe low single-digit numbers of patients in the home. That has not been our experience.

第二個是推動我們家庭計畫的深度。從歷史上看，這些使用現有設備的家庭程序通常會隨著家庭患者數量的減少而逐漸消失。我們的經驗並非如此。

With the home programs that are offering Tablo, these are well, well, well into the double digits. And I would say, actually, I don't know yet where the ceiling is for how big a home program can be. Tablo was designed to really accelerate training to really simplify operations, and therefore, expand the number of patients who feel that home is accessible to them and feel that they can be successful at home, and we see it doing that.

透過提供 Tablo 的家庭節目，這些數字已經達到了兩位數。我想說，實際上，我還不知道家庭專案的上限在哪裡。 Tablo 的設計目的是真正加速培訓，真正簡化操作，從而擴大更多患者的數量，讓他們覺得自己可以在家中獲得成功，並認為他們可以在家中取得成功，我們看到它正在這樣做。

And actually, a couple of our abstracts really demonstrate that as well. So that's point two driving depth in each home program.

事實上，我們的一些摘要也確實證明了這一點。這就是每個家庭計畫的第二點驅動深度。

And then point three is always the retention rate because the longer that Tablo patient stay at home on Tablo, the thicker that foundation for future growth is. We have continued through Q3, and as we sit here today, even in Q4, seeing a very steady and stable retention rate that is markedly higher than the retention rate seen with other home devices in the past.

第三點始終是保留率，因為 Tablo 患者在 Tablo 上待在家裡的時間越長，未來成長的基礎就越厚。我們一直持續到第三季度，當我們今天坐在這裡時，即使在第四季度，我們也看到了非常穩定的保留率，明顯高於過去其他家用設備的保留率。

Appreciate that. Thanks.

感謝。謝謝。

Shagun Singh, RBC Capital Markets.

Shagun Singh，加拿大皇家銀行資本市場。

Hey, this is [Avi] on for Shagun. Thanks for taking the question and thank you again for the detailed longer-term outlook. It's very helpful. I had a couple. First is how should we think about the cadence of revenue growth and margin expansion from 2024 to 2027? Do you expect it to be linear or more back-end loaded, especially as you get closer to the EPC deadline in 2027?

嘿，這是 Shagun 的 [Avi]。感謝您提出問題，並再次感謝您詳細的長期展望。這非常有幫助。我有一對。首先是我們該如何思考2024年至2027年營收成長和利潤率擴張的節奏？您希望它是線性的還是更多後端負載，特別是當您接近 2027 年 EPC 截止日期時？

Yeah. Hey, this is Nabeel. So with respect -- so let me sort of first start with the annual and then I can dial into the quarters here. So with respect to the annual, our expectation is roughly mid-teens for 2024 and then getting into the high-teens for 2025 and beyond.

是的。嘿，這是納比爾。恕我直言，讓我先從年度報告開始，然後我可以在這裡撥入季度報告。因此，就年度而言，我們的預期大約是 2024 年的中位數，然後是 2025 年及以後的高位數。

Now with respect to the quarters within that -- that's on revenue. From a gross margin perspective, again, in the annual, it will be linear. Our margin expansion has been linear annually and if you think about the quarters now going back for a while.

現在就其中的季度而言——這是關於收入的。從毛利率的角度來看，年度毛利率將是線性的。我們的利潤率每年呈線性增長，如果您考慮一下現在已經回溯了一段時間的季度。

Now with respect to the quarters, from a top line, from a revenue perspective, we have historically observed this capital purchasing cyclicality where Q1 tends to be the slowest grower and we see accelerating growth as we move through the year. That sort of apply this year, that will apply in any year.

現在就季度而言，從收入的角度來看，我們歷史上觀察到了這種資本購買週期性，其中第一季往往是成長最慢的，而隨著全年的推移，我們看到成長加速。今年適用，任何年份都適用。

In 2024, given that we expect TabloCart with prefiltration to get cleared in the second half, this first half, second half effects will be a little bit more pronounced, and you'll see more growth in the back half of the year. But again, when you go to '25 and beyond, it will be just the capital purchasing cyclicality impacting a slower Q1 and accelerating through there.

2024年，考慮到我們預計預先過濾的TabloCart會在下半年得到清除，這個上半年、下半年的影響會更明顯一些，下半年你會看到更多的增長。但同樣，當你進入 25 世紀及以後，這將只是資本購買週期性影響第一季放緩並在此期間加速。

Yeah, let me add on to that because I heard also something in there a little bit about home and the EPC model, so let me address that. As I think about home, I would expect this home growth again to remain relatively linear. We'll have quarter-to-quarter variability, that's to be expected. But over a period of '24 to '27, let's say, I expect the growth rate to be relatively linear.

是的，讓我補充一下，因為我還聽到了一些關於家庭和 EPC 模式的內容，所以讓我解決這個問題。當我想到房屋時，我預計房屋成長將再次保持相對線性。我們將出現季度與季度之間的變化，這是可以預料的。但在 24 至 27 年間，我預期成長率將是相對線性的。

And I also just want to make a comment on this EPC model. Those incentives and disincentives are getting richer as we get closer to 2027. I think by '26, '27, it gets up to either plus 8% over the Medicare base rate, or minus 10% under the base rate if providers are not growing their home and transplant programs to the threshold that CMS has established.

我也只是想對這個EPC模式發表一下評論。隨著2027 年的臨近，這些激勵和抑制措施將變得更加豐富。我認為，到26 年、27 年，如果提供者不成長，它可能會比Medicare 基本費率高出8%，或比基本費率低-10%他們的家庭和移植計劃達到 CMS 設定的門檻。

So that is certainly going to remain a powerful tailwind. It's not the only tailwind, though. We recently have actually seen clinic closures become a tailwind. Both of the biggest service providers in the nation have announced clinic consolidation and clinic closures due largely to their own staffing challenges. And that is, in our experience, really encouraging nephrologists and health systems and other providers to really expand their home and looking at home as a near-term and long-term solution for that problem. So that's another tailwind.

因此，這肯定仍將是一個強大的推動力。但這並不是唯一的順風車。我們最近實際上看到診所關閉成為一種順風車。美國兩家最大的服務提供者都宣布了診所合併和關閉診所，這主要是由於其自身的人員配置挑戰。根據我們的經驗，這確實鼓勵腎臟科醫生、衛生系統和其他提供者真正擴大他們的家庭，並將家庭視為該問題的近期和長期解決方案。所以又是另一輛順風車。

And then generally, Medicare advantage. I think, again, over the long term that this will go far beyond '27 as Medicare advantage is now available to all dialysis patients and has been reported to be up to 40% now plus of the dialysis population. These payers, again, in our experience, have never been more motivated to send higher and higher numbers of patients home on dialysis and ensuring that they can reap the benefits, both clinical, economic, and operational with MA plan.

一般來說，醫療保險有優勢。我再次認為，從長遠來看，這將遠遠超出 27 年，因為醫療保險優勢現在可供所有透析患者使用，據報道，目前透析人群的比例高達 40% 以上。根據我們的經驗，這些付款人從未像現在這樣更有動力將越來越多的患者送回家接受透析，並確保他們能夠透過 MA 計劃獲得臨床、經濟和營運方面的好處。

So those are my additional remarks on home. I hope that's helpful.

以上是我對家鄉的補充說明。我希望這有幫助。

That's great. Thank you.

那太棒了。謝謝。

Great, thanks. Operator, next question.

萬分感謝。接線員，下一個問題。

Joshua Jennings, TD Cowen.

約書亞·詹寧斯，TD·考恩。

Hi, good afternoon. Thanks for taking my questions. I wanted to just ask about the strategy to launch into international markets. Just with the updated outlook. Does that seem like it includes any international expansion plans? And so would that be additional, and any updates just on that international strategy, which would be a couple to think through?

嗨，下午好。感謝您回答我的問題。我只想問一下進軍國際市場的策略。只是更新了展望。這似乎包括任何國際擴張計劃嗎？那麼這是否是額外的，以及有關國際戰略的任何更新，這將是需要考慮的幾個問題？

Yeah. Thanks for the question, Josh. The forward-looking guidance that we provided today is US only and over the near term and the long term out through 2027. We have filed for regulatory clearance in a small number of by and large English-speaking countries outside the United States, and we have had an effort underway to evaluate those markets.

是的。謝謝你的提問，喬許。我們今天提供的前瞻性指導僅針對美國，涵蓋近期和長期直至 2027 年。我們已在美國以外的少數大部分英語國家申請了監管許可，並且我們我們正在努力評估這些市場。

This is -- it's certainly a growth vector -- potential growth vector in the future, but I would call it a longer-term growth vector. Our team and our management team here remains very, very focused today on the largest dialysis market in the world, which is here in the United States.

這當然是一個成長向量，未來的潛在成長向量，但我稱之為長期成長向量。今天，我們的團隊和管理團隊仍然非常非常關注世界上最大的透析市場，即美國。

Understood. Thanks for that. And I wanted to ask a follow-up on the event at ASN. The nursing executive from HCA commented that about 145 HCA hospitals adopted Tablo. And I was wondering if that IDN has incorporated Tablo as the best practices' technology for patient dialysis. And maybe you can just share your view on the opportunity at HCA to more deeply penetrate their hospital network in acute setting but also catalyze development of HCA home from hemo programs. Thanks for taking my questions.

明白了。感謝那。我想問 ASN 事件的後續情況。 HCA 的護理主管評論說，大約 145 家 HCA 醫院採用了 Tablo。我想知道 IDN 是否已將 Tablo 作為患者透析的最佳實踐技術。也許您可以分享您對 HCA 機會的看法，以更深入地滲透其急性環境下的醫院網絡，同時也透過血液計畫促進 HCA 之家的發展。感謝您回答我的問題。

Sure. Yeah, I appreciate it. Well, let me kind of zoom back up. We talked about roughly the 650 different facilities in the acute and also sub-acute. I think I talked about that more in October as really being a big grower for us, this post-acute or sub-acute space as well, inclusive of very large national hospitals and health systems like HCA and others, and these regional kind of top 50 to 100 largest regional IDNs.

當然。是的，我很感激。好吧，讓我放大一下。我們討論了大約 650 個不同的急性和亞急性設施。我想我在10 月更多地談到了這一點，因為這對我們來說確實是一個大種植者，這個後急性或亞急性空間也是如此，包括非常大型的國家醫院和衛生系統，如HCA 等，以及這些區域性的頂級醫院50 到 100 個最大的區域 IDN。

HCA has been a phenomenal partner to us. They were and remain an innovator and very forward thinking, both on the acute side and also, I think, on the home side in terms of how they're thinking about the future of dialysis care.

HCA 一直是我們出色的合作夥伴。他們過去是、現在仍然是創新者，具有非常前瞻性的思維，無論是在敏銳的一面，還是在家庭方面，我認為，他們如何思考透析護理的未來。

As we look at the, let's just say, the national health systems themselves, we are just 20% penetrated there. We're proud of getting to 20%, but that leaves 80%-plus that we still have ahead of us. So we're excited about replicating the success that we've had with many of our customers, again, acute and sub-acute throughout the rest of the national and these large regional providers as well.

當我們觀察國家衛生系統本身時，我們的滲透率只有 20%。我們為達到 20% 感到自豪，但我們還剩下 80% 以上。因此，我們很高興能夠在全國其他地區以及這些大型區域供應商中複製我們與許多客戶取得的成功，無論是急性還是亞急性。

Great. Thanks for the question, Josh. Operator, can we go to the next question?

偉大的。謝謝你的提問，喬許。接線員，我們可以進入下一個問題嗎？

Travis Steed, BofA Securities.

特拉維斯·斯蒂德（Travis Steed），美國銀行證券公司。

Hi, this is Stephanie Piazzola on the line for Travis. Thanks for taking the question and providing the longer-term guidance. I think that's really helpful. Just wanted to ask about first, on the pre-announcement call. You talked about a few headwinds that are leading to a longer sales cycle. I know that was only a few weeks ago, but if there's any update on those from a competitive noise or capital spending standpoint and what is factored into the 2024 guidance for those?

大家好，我是史蒂芬妮·皮亞佐拉 (Stephanie Piazzola)，正在接聽特拉維斯 (Travis) 的電話。感謝您提出問題並提供長期指導。我認為這真的很有幫助。只是想先在發布前的電話會議上詢問一下。您談到了一些導致銷售週期延長的不利因素。我知道這只是幾週前的事，但從競爭噪音或資本支出的角度來看，這些內容是否有任何更新，以及 2024 年的指導方針中包含哪些因素？

And I think you mentioned that the guidance you put out is maybe a conservative starting point. So maybe more detail on why you think this is the right spot to be for now and any drivers that could get you above this expectation?

我認為您提到您提出的指導可能是保守的起點。那麼也許更詳細地說明為什麼您認為這是目前的正確地點以及任何可以讓您超越這一期望的驅動程式？

Yeah, sure. Thanks, Stephanie. Well, as I said in the prepared remarks, there is a lot of momentum in both acute and home. And I think that's due to the large evidence base now around Tablo, this growing network effect we just talked about in the previous question, and I think the proven reproducibility of the cost reduction benefit.

好，當然。謝謝，斯蒂芬妮。嗯，正如我在準備好的發言中所說，急性和家庭都有很大的動力。我認為這是由於目前圍繞 Tablo 的大量證據基礎，我們在上一個問題中剛剛談到的這種不斷增長的網絡效應，而且我認為成本降低效益的可重複性已得到證實。

So those are all things that give me and us a lot of confidence in the forward projections that we provided here near term and longer term. Having said that, at the same time, we are obviously going to want to be mindful of some of the changes we're noting in the capital purchasing environment. I'll get to that part of your question in one sec.

因此，這些都讓我和我們對我們在此提供的近期和長期前瞻性預測充滿信心。話雖如此，同時，我們顯然要注意我們在資本購買環境中註意到的一些變化。我將在一秒鐘內回答你問題的這一部分。

And also maybe customers continuing to wait for the availability of TabloCart potentially well into next year depending on when clearance comes and how that's affecting the duration of our sales cycle. And so, as we look forward, we try to be considerate of both the very real upside drivers and then some of the potential lingering headwinds in a way that allows us to have confidence and clarity in our projections. So that's maybe part one.

而且，客戶可能會繼續等待 TabloCart 的上市，這可能會持續到明年，具體取決於清倉時間以及這對我們銷售週期持續時間的影響。因此，當我們展望未來時，我們會嘗試考慮非常真實的上行驅動因素，然後考慮一些潛在的揮之不去的阻力，以使我們對預測充滿信心和清晰。這可能是第一部分。

Specifically, about capital spending, as I talked about on our call about a month ago, we're just seeing more stakeholders involved in decision-making at all levels. That's not necessarily -- it's not bad. It's very understandable, and it's prudent on their part. We're seeing more steps in their financial analysis and their processes and just all around more eye dotting and tea crossing.

具體來說，關於資本支出，正如我在一個月前的電話會議中談到的那樣，我們只是看到更多的利害關係人參與各級決策。這不一定——這還不錯。這是非常可以理解的，而且他們也很謹慎。我們看到他們的財務分析和流程中採取了更多步驟，以及更多的點睛和茶點交流。

Now, the good news is we're not seeing customers or potential customers turn away from expansion or turn away from in-sourcing or backing out of deals. We're not seeing people say that they don't want to move forward with Tablo in either the acute or the home end market. It's just rather kind of the extra process depth people deliberation that's elongating our sales cycle maybe towards the outer edge of what we've communicated in the past, which has been about 9 to 12 months, I would say we're probably closer to 12-plus months. '

現在，好消息是我們沒有看到客戶或潛在客戶放棄擴張或放棄內包或退出交易。我們沒有看到人們說他們不想在急性或家庭終端市場上與 Tablo 一起前進。這只是人們深思熟慮的額外流程深度，這延長了我們的銷售週期，可能接近我們過去溝通的時間的外緣，大約是 9 到 12 個月，我想說我們可能更接近 12 個月-加上幾個月。 '

And then how did it inform our views on '24, well, I think it is very reasonable and yet conservative to assume that some of these factors carry forward for us both on some of the competitive, we call it, noisemaking, and also capital is -- elongated capital spending decision processes into and through 2024. But that's kind of how we thought about it, clear upside drivers and some considerations on the headwind side as well.

那麼它是如何影響我們對「24」的看法的，嗯，我認為假設其中一些因素對我們來說在一些競爭性的（我們稱之為噪音製造）和資本方面都有利，這是非常合理但保守的。是——將資本支出決策流程延長到 2024 年並持續到 2024 年。但這就是我們的想法，明確的上行驅動因素以及逆風方面的一些考慮因素。

Thank you. That's helpful. And then just one more on the long-range plan. Maybe if you could just provide a little bit more detail on the overall thought process of how you put this together, just generally what's assumed in the high-teens annual growth rate from a macro or micro perspective. I know you talked about some of the reimbursement factors. So anything else there, maybe some other drivers within acute and home.

謝謝。這很有幫助。然後是關於長期計劃的另一項內容。也許您可以提供更多有關如何將其組合在一起的整體思維過程的詳細信息，從宏觀或微觀角度一般假設高十幾歲的年增長率。我知道您談到了一些報銷因素。所以還有其他的事情，也許是急性和家裡的其他司機。

Sure. Well, I'll ask Nabeel to weigh in here too. I would say the last four years here in the marketplace have given us a lot more data and experience than we had at the time of the IPO. Our first full-launch year was 2019. So we've learned a lot in a briefer fashion.

當然。好吧，我也會請納比爾在這裡權衡一下。我想說，過去四年的市場為我們提供了比首次公開募股時更多的數據和經驗。我們的第一個全面啟動年是 2019 年。因此，我們以更簡短的方式學到了很多。

We also, though, today have a lot more scale from which to build on. And this -- again, this very predictable, very sticky recurring revenue that provides even greater visibility and predictability than we've ever had before.

不過，今天我們也有更大的規模可供發展。再說一遍，這種非常可預測、非常黏性的經常性收入提供了比我們以前更高的可見性和可預測性。

Our evidence base, the thousands of nurses and physicians, the hundreds of facilities, this network effect all helps a lot as we look forward. And we also have, I'll say, at the same token, we also have better knowledge of the challenges and the timeline associated with true disruption. And what we are doing is truly disruptive, not only on the home side, but also in the acute side.

我們的證據基礎、數千名護士和醫生、數百個設施、這種網路效應對我們的未來有很大幫助。我想說，同樣，我們也對與真正顛覆相關的挑戰和時間表有了更好的了解。我們正在做的事情確實具有顛覆性，不僅在主場，而且在急性方面也是如此。

So I guess I'll use analogy and say we've certainly seen the full movie play out, if you will, which has given us a lot more visibility, both on upside and potential headwinds. So all of that informs our confidence in describing how we think this business will scale over the next few years and our expectations not only on revenue, but how quickly we will achieve gross margins at 50% and cash flow breakeven getting to this third very vital goal for us, which is reaching profitability.

因此，我想我會用類比的方式說，如果你願意的話，我們肯定已經看到了整部電影的播出，這讓我們對上行和潛在的不利因素有了更多的了解。因此，所有這些都讓我們有信心描述我們認為這項業務在未來幾年將如何擴展，我們的期望不僅是收入，還有我們將多快實現毛利率50% 和現金流盈虧平衡達到第三個非常重要的目標我們的目標是實現盈利。

But anyway, Nabeel maybe I'll pass to you for any other comments.

但無論如何，Nabeel 也許我會轉告你以徵求任何其他意見。

Yeah. Stephanie, I would just add a little bit more color here. So if you think about placing roughly 1,400 consoles, which is what we placed in '22, what we expect to place in '23, if you think about that same 1,400 consoles overtime and you think about the recurring revenues that we get from this growing installed base, that alone will get you to a roughly mid-teen CAGR between now and 2027, right?

是的。史蒂芬妮，我只想在這裡添加一點顏色。因此，如果你考慮放置大約1,400 台遊戲機，這就是我們在22 年放置的數量，我們預計在23 年放置的數量，如果你考慮到同樣的1,400 台遊戲機加班，並考慮我們從這種增長中獲得的經常性收入從現在到 2027 年，光是這一點就能實現約 15 左右的複合年增長率，對吧？

And then to get to the high-teens in any year, you're looking for console growth. And again, for all the reasons that Leslie talked about, we do believe we can drive higher consoles. By the way, we will have placed 1,400 consoles last year and expect to place this year in years when we have had two exogenous events hit us. And so, we believe that is a relatively conservative assumption as we move forward.

然後，為了在任何一年達到十幾歲的水平，你都在尋找遊戲機的成長。再說一次，出於萊斯利談到的所有原因，我們確實相信我們可以駕駛更高的遊戲機。順便說一句，去年我們將投放 1,400 台遊戲機，預計今年將在遭遇兩次外生事件的情況下投放。因此，我們認為，隨著我們的前進，這是一個相對保守的假設。

So I say all that to say, getting to roughly mid-teens CAGR over the longer term here is possible with flat consoles. And for all the reasons, Leslie talked about, we believe we can get to high-teens.

所以我想說的是，從長遠來看，平板遊戲機的複合年增長率可能達到大約十幾歲。萊斯利談到，出於所有原因，我們相信我們可以達到高中階段。

Okay, great. Thanks, Stephanie. I think we're ready for our next question, operator.

好的，太好了。謝謝，斯蒂芬妮。我想我們已經準備好回答下一個問題了，接線生。

Kristen Stewart, CL King.

克里斯汀·斯圖爾特，CL King。

Hi. Thanks for taking my question. I was wondering if you could expand a little bit more color on the competitive landscape and maybe comment on the launch of Quanta's product at ASN as well, and just your thinking on the competitive landscape going forward and your thought process for not only in 2024 but the longer term as well?

你好。感謝您提出我的問題。我想知道您是否可以對競爭格局進行更多的闡述，也許還可以評論一下廣達在 ASN 上推出的產品，以及您對未來競爭格局的看法以及您對 2024 年和 2024 年的思考過程。長期也是如此？

Sure. Happy to. Well, we believe we have a better product with pretty deep expertise supporting customers. As I said in the prepared remarks, what I've really learned more than anything over the last four years is the importance of product and programs around the product. What we do when we walk into an acute site, we're not selling a dialysis machine. We're not trying to convince somebody that our dialysis machine is better than somebody else's to help this machine.

當然。高興。嗯，我們相信我們擁有更好的產品，擁有為客戶提供支援的深厚專業知識。正如我在準備好的演講中所說，在過去四年中，我真正學到的最重要的是產品和圍繞產品的計劃的重要性。當我們走進急診現場時，我們所做的並不是透析機。我們並不是試圖說服某人我們的透析機比其他人的透析機更好來幫助這台機器。

First and foremost, we're creating opportunities strategic cost-reduction opportunities for that hospital. We showed them the financial analysis showing the cost-benefit in labor and in supplies reduction. And then step two is the how-to.

首先也是最重要的是，我們正在為該醫院創造策略性成本削減機會。我們向他們展示了財務分析，顯示了勞動力和供應減少的成本效益。然後第二步是操作方法。

Hospitals and health systems have never done this before. And therefore, they -- by and large, they don't already have that road map for change management. They don't already have the recipe book for how do you in-source in-patient dialysis. We have developed that in quite a proprietary way over the last several years. And so, it's really the one-two-punch of a superior product, a superior team, and a proprietary playbook that I think makes our offering so compelling and so protectable.

醫院和衛生系統以前從未這樣做過。因此，總的來說，他們還沒有變革管理的路線圖。他們還沒有關於如何內部購買住院透析的食譜書。在過去的幾年裡，我們以相當專有的方式開發了它。因此，我認為，這確實是卓越產品、卓越團隊和專有劇本的一擊兩拳，使我們的產品如此引人注目且受到保護。

I think the other advantage here is that our footprint now is large. The Tablo evidence base is large. We do have thousands of nurses and physicians who have been trained and educated. I'll give you a quick anecdote from ASN. I was talking to our team there at the booth, and I said, hey, how many physicians who came up to the booth this year have heard of Tablo or heard about that? And the answer was all.

我認為另一個優點是我們現在的足跡很大。 Tablo 證據基礎很大。我們確實有數千名接受過培訓和教育的護士和醫生。我將向您簡要介紹 ASN.1 的軼事。我在展位上與我們的團隊交談，我說，嘿，今年有多少來到展位的醫生聽說過 Tablo 或聽說過它？答案就是全部。

Now that's not probably precisely accurate. But I would say, even two years ago, that answer was probably more like 40% or 50%. So we made a lot of strides in just pure awareness. And so, I think we have succeeded interacting a pretty substantial commercial moat around Tablo and as well as the technology mote.

現在這可能不完全準確。但我想說，即使在兩年前，這個答案可能更像是 40% 或 50%。因此，我們在純粹的意識方面取得了巨大的進步。因此，我認為我們已經成功地與 Tablo 周圍的相當大的商業護城河以及技術微粒進行了互動。

For example, Tablo is fully integrated with both EPIC and Cerner. That interoperability is a big deal, and that is no trivial task to fully integrate with EPIC and Cerner. We've just done that quietly in the background.

例如，Tablo 與 EPIC 和 Cerner 完全整合。互通性是一件大事，與 EPIC 和 Cerner 完全整合並非易事。我們只是在後台悄悄地完成了這件事。

And of course, a regulatory moat. We continue to be new and higher bars. And so, I think all of those things help us to further elevate the barriers to success in addition to the barriers that we've already overcome to become the recognized leader here in the space.

當然，還有監管護城河。我們繼續成為新的更高的酒吧。因此，我認為所有這些事情都有助於我們進一步提高成功的障礙，除了我們已經克服的障礙，成為該領域公認的領導者。

Perfect. Thanks very much.

完美的。非常感謝。

Okay, great. Thanks for the question, Kristen. Next question, operator.

好的，太好了。謝謝你的提問，克里斯汀。下一個問題，操作員。

Suraj Kalia, Oppenheimer & Co.

蘇拉吉·卡利亞，奧本海默公司

Good afternoon, everyone. Leslie, quick question, and I'll just -- I have one question. Appreciate you guys laying out the road map from FY24 through '27. And Leslie, just trying to understand the rationale for this road map at this point in time, you all do talk about structural tailwinds for Tablo.

大家下午好。萊斯利，快速提問，我只是──我有一個問題。感謝你們制定了從 2024 財年到 27 財年的路線圖。 Leslie，只是想了解此時此路線圖的基本原理，你們都在談論 Tablo 的結構性順風。

I'm hoping you could thread the needle for us. We know GLP-1s are at the doorstep. There's a new competitor coming online next year. Just kind of walk us through putting yourself in some -- within certain benchmarks already long term. If you could kindly help us understand the rationale at this point in time. Thank you.

我希望你能為我們穿針引線。我們知道 GLP-1 即將到來。明年會有一個新的競爭對手上線。請引導我們將自己置於某些長期的基準範圍內。如果您能及時幫助我們理解其基本原理。謝謝。

Yeah, sure. Happy to. Thanks for the question, Suraj. So which I'll kind of interpret the why now simply put. I think a couple of reasons. First of all, we have heard investors loud and clear about what they most care about, what matters most to them about Outset today and where Outset going tomorrow. We're listening.

好，當然。高興。謝謝你的提問，蘇拉吉。所以我現在簡單地解釋為什麼。我認為有幾個原因。首先，我們清楚地聽到了投資者關於他們最關心的事情、今天對他們最重要的 Outset 以及 Outset 明天的發展方向。我們正在聽。

And what we've heard from investors is a very strong desire to understand how and when Outset gets to profitability, how and when Tablo and Outset reaches a gross margin of 50%, and then when we start the next leg of a journey, which is going beyond 50%. And so, we felt having listened to all of our important shareholders, that we wanted to provide the information, the transparency, and the clarity that our shareholders are seeking. So that's point one.

我們從投資者那裡聽到的是非常強烈的願望，想要了解 Outset 如何以及何時實現盈利，Tablo 和 Outset 如何以及何時達到 50% 的毛利率，然後我們何時開始下一段旅程，超過50 %。因此，在聽取了所有重要股東的意見後，我們認為我們希望提供股東所尋求的資訊、透明度和清晰度。這就是第一點。

Point two is that, as I mentioned, Suraj, I think three years post-IPO and now four years here in the marketplace, I think we do have the data and the experience, which we didn't have at the time of the IPO, at that point just having been in the marketplace there for maybe just a year or two. We just have a lot more insight and a lot more scale from which to build on.

第二點是，正如我所提到的，Suraj，我認為 IPO 後三年和現在在市場上四年，我認為我們確實擁有 IPO 時所沒有的數據和經驗，那時剛剛進入市場可能只有一兩年。我們只是擁有更多的洞察力和更大的規模來建立。

As I mentioned a few minutes ago, I think we've got a lot more clarity and confidence around what the upside drivers are and also what some of the challenges are, and what that timeline is likely to look like as we disrupt this market, both on acute and home. So I think we're in a good position based on our experience over the last four years, and also out of our genuine desire to ensure that shareholders have the information that they want, need, and deserve about the business and how it's going to scale over the next few years.

正如我幾分鐘前提到的，我認為我們對上行驅動因素是什麼、挑戰是什麼以及當我們擾亂這個市場時時間表可能是什麼樣子有了更多的清晰度和信心，無論是急性還是家庭。因此，我認為，根據過去四年的經驗，我們處於有利的位置，也出於我們真誠的願望，即確保股東獲得他們想要、需要和應得的有關業務及其未來發展的信息。未來幾年規模。

This concludes the question and answer session. I would now like I'd like to turn it back to Leslie Trigg for closing remarks.

問答環節到此結束。我現在想請萊斯利·特里格 (Leslie Trigg) 做結束語。

Great. Thank you. Well, thanks to all of you for joining today. We look forward to our next update on our fourth-quarter call, and have a great evening.

偉大的。謝謝。好的，感謝大家今天的加入。我們期待第四季度電話會議的下一次更新，祝您度過一個愉快的夜晚。

Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.

感謝您參加今天的會議。這確實結束了該程式。您現在可以斷開連線。