PAVmed Inc (PAVM) 2022 Q1 法說會逐字稿

Good day, and welcome to the PAVmed Inc. First Quarter Business Update Call. Today's conference is being recorded. And now at this time, I'd like to turn the conference over to Adrian Miller. Please go ahead, sir.

Thanks, operator. Good afternoon, everyone. This is Adrian Miller, Vice President of Investor Relations at PAVmed. Thank you for participating in today's business update call. Joining me today on the call is Dr. Lishan Aklog, Chairman and Chief Executive Officer of PAVmed; along with Dennis McGrath, President and Chief Financial Officer of PAVmed.

The press release announcing our business update and financial results will be posted shortly on PAVmed's website. Please take a moment to read the disclaimer about the forward-looking statements in the press release. The business update press release and this conference call both include forward-looking statements, and these forward-looking statements are subject to known and unknown risks and uncertainties that may cause actual results to differ materially from the statements made.

Factors that could cause actual results to differ are described in the disclaimer and in our filings with the SEC. For a list and descriptions of these and other important risks and uncertainties that may affect future operations, see Part I Item 1A entitled Risk Factors in PAVmed's most recent annual report on Form 10-K filed with the Securities and Exchange Commission and any subsequent updates filed in quarterly reports on Form 10-Q and subsequent Form 8-K filings.

Except as required by law, PAVmed disclaims any intention or obligation to publicly update or revise any forward-looking statements to reflect changes in expectations or in events, conditions or circumstances on which these expectations may be based or that may affect the likelihood that actual results may differ from those contained in the forward-looking statements.

With that, I'd like to turn the call over to Lishan Aklog. Dr. Aklog?

Thank you, Adrian. Good afternoon, everyone, and thank you for joining our quarterly update call. I'm happy to report that PAVmed and its subsidiaries are making solid progress as we continue driving our long-term (technical difficulty) and mission to create a leading diversified medical technology company.

Before proceeding, I would like to thank our long-term shareholders for your ongoing support and commitment. Our combined team has grown to over 100 employees that is singularly focused on growing the PAVmed enterprise while enhancing long-term shareholder value. Our balance sheet remains strong, providing us with the resources to execute this strategy.

Given the current market volatility, we're particularly focused on deploying our capital as efficiently and effectively as possible to accomplish our strategic goals while preserving and extending our cash runway.

I'd like to start by providing a business -- an overview of our business, and we'll then pass the baton over to Dennis, who will provide our financial update before opening it up to questions.

First, some background on PAVmed. PAVmed is a diversified commercial stage medical technology company operating in the medical device, diagnostics and digital health sectors. Our mission is to utilize state-of-the-art technologies in the service of patients by providing innovative and disruptive products and solutions, which significantly improve or save lives while enhancing health care quality, efficiency and cost effectiveness.

Our vision is to build a growing and profitable diversified medical technology leader across all the 3 major sectors. The PAVmed enterprise today consists of 2 majority-owned subsidiaries, Lucid Diagnostics and Veris Health, 2 business units, CarpX and NextFlo and an R&D pipeline of products at various stages of development.

Lucid is a NASDAQ-listed commercial stage cancer prevention medical diagnostics company, which markets EsoGuard and EsoCheck, the first and only commercial tools for widespread early detection of esophageal precancer to prevent esophageal cancer death. PAVmed owns approximately 76% of Lucid's outstanding shares.

Veris Health is a privately held digital health company developing the first intelligent implantable vascular access port with biologic sensors and wireless communications to improve personalized cancer care through remote patient monitoring. PAVmed owns about approximately 81% of Veris' outstanding shares.

PAVmed operates as a central engine, which provides a broad range of shared services to its subsidiaries and business units as well as to its R&D team. These include general administration, finance, product design and development, regulatory affairs, quality management, clinical research, manufacturing and medical affairs. This centralized shared services model allows each of the subsidiaries and business units to be laser focused on the development, commercialization and clinical evidence for its product or products.

The model provides numerous benefits to facilitate value creation across the enterprise, including economies of scale, risk mitigation through diversification, a lower cost of capital and much greater growth potential.

Operator, could you mute the other participants real quick, if you don't mind? Thank you.

During the past couple of years, especially in 2021, we have undergone a major transition, focusing on expanding our internal human systems and physical infrastructure, laying the foundation for commercial success as well as optimizing and rationalizing our portfolio. We believe this transition is essentially complete. The expanded infrastructure is mostly in place, and we are now entirely focused on commercial expansion and execution, reimbursement and revenue growth in the coming quarters and years.

I'll now proceed with an update of our subsidiaries, business units and R&D pipeline, starting with Lucid, which remains PAVmed's dominant business. My discussion of Lucid will be a distillation of my remarks during yesterday's Lucid call, with the focus on the updated ASG guidelines, EsoGuard commercialization, laboratory operations and reimbursement. I would encourage you to read the transcript or listen to the recording of the Lucid call for additional details. And feel free to contact Adrian to help with this.

So as we previously announced, the American College of Gastroenterology recently updated its clinical guideline on the diagnosis and management of esophageal precancer, the first such update since 2016. For the first time, the guideline endorses non-endoscopic biomarker screening as an alternative as acceptable -- as an acceptable alternative to costly and invasive endoscopy. EsoGuard and EsoCheck, which are described in the guideline, are currently the only such non-endoscopic biomarker screening test. This is an exciting development for Lucid, and I can't overemphasize its importance in supporting our efforts to eradicate esophageal cancer.

Our EsoGuard commercialization efforts are going well. We continue to see excellent traction with robust growth in EsoGuard testing volume. We processed 533 commercial EsoGuard tests in the first quarter of 2022, that represents a 76% sequential increase from the fourth quarter of 2021 and a nearly 500% increase annually from the first quarter of 2021.

Testing volume growth was strong in both sales channels, primary care physician referrals to our Lucid test centers as well as test performed at gastroenterology. (inaudible) specialty practices and institutions. We are investing in sufficient sales infrastructure to demonstrate clinical utility and generate claims to support our reimbursement efforts. Once reimbursement is more fully established, we will transition to full-throttle efforts to drive testing volume and revenue growth.

Our sales team continues to grow and now consists of a national VP of Sales, 3 area directors, 6 market development managers and 17 sales reps as well as several sales operations staff. We are hitting our hiring targets and seek to have new reps operating effectively within about 4 months of hiring.

Our expanding network of Lucid test centers support our primary care channel by providing a facility where patients referred for EsoGuard testing by primary care physicians can undergo the EsoCheck cell collection procedure. The test centers have very modest fixed costs and attractive margins, operating almost entirely as marginal variable cost businesses.

The Lucid test center program completed its first stage during the first quarter of 2022 and now covers 7 Western U.S. cities. We recently launched Stage 2 of our Lucid test center program. We plan to open test centers in 9 additional states this year. Last month, we hired a Director of Clinical Services with extensive operating experience with the [dialysis] facilities to oversee this expansion.

We also do continue the pilot of our EsoGuard telemedicine program, which we launched in December, although patients in any Lucid test center city can access the telemedicine program, we're only actively pursuing a direct-to-consumer advertising program on a limited pilot basis in Phoenix, consistent with the near-term strategy that I previously described.

The first quarter in recent months have been full of important developments in our laboratory operations, which are critical to the future success of the company. At the end of February, LucidDx Labs, a wholly-owned subsidiary of Lucid Diagnostics, acquired the assets necessary to operate our own CLIA certified and CAP-accredited clinical laboratory in Orange County, California. Last month, we hired a new VP of Laboratory Operations, with nearly 2 decades of clinical laboratory leadership experience, and we plan to accelerate the transition from the current management services agreement to the lab being fully staffed by Lucid employees.

In parallel with the acquisition, we upgraded to a new revenue cycle management provider for the first -- and for the first time, a Lucid entity will be billing directly for EsoGuard testing. Claims submissions have been on hold since we took over the laboratory, awaiting license transfers and getting the billing -- the new billing partner online. So the transition from fixed monthly payments from our former laboratory partner to direct billing with -- will result in a temporary pause in out-of-network receipts and recognized revenues, as Dennis will describe in more detail.

Now a brief update on where we stand with reimbursement. On the private payer side, we executed our first commercial payer agreement. LucidDX Labs entered into a participating provider agreement with MediNcrease Health Plans, a national directly contracted multi-specialty PPO provider network with over 8 million lives covered through the clients and payers. The effective payment for EsoGuard under this contract, which is based on a list price of approximately $2,500 is consistent with our goal of protecting the effective Medicare payment of just over $1,900.

In parallel, we continue to collect clinical utility data demonstrating that EsoGuard positively impacts medical decision-making, which is necessary for us to secure direct in-network coverage from regional and national health plans.

We have also seen progress on the Medicare reimbursement front. Last month, Medicare contractor, Palmetto GBA's MolDX program, published a proposed foundational local coverage determination or LCD for test designed to detect upper gastrointestinal precancer and cancer. We've been patiently awaiting this important next step in the process since we received our final Medicare payment determination back in January of 2021.

The proposed LCD outlines criteria that MolDX expects, upper GI, precancer and cancer molecular diagnostic tests to meet. It is important to emphasize that the provisional LCD was published prior to the publication of the updated ACG guideline, and as such, does not take into consideration the recommendation supporting non-endoscopic biomarker testing such as EsoGuard as an acceptable alternative to endoscopy for esophageal precancer screening.

The publication of the proposed LCD triggers a written common period that extends until this Saturday. We, along with multiple other stakeholders, will be submitting comments suggesting important modifications to the proposed LCD. MolDX also held a substantive open meeting 2 days ago, during which we, along with stakeholders and other interested parties, had the opportunity to address the proposed LCD.

In addition, we recently learned that Noridian Healthcare Solutions, the Medicare contractor, which covers Lucid DX Labs and participates in the MolDX program has scheduled its own open meeting on May 26 and a written common period that extends through June 11. We look forward to the opportunity to address the proposed LCD directly with Noridian as well.

A final LCD will not be issued until the Medicare contractors have had the opportunity to assess and consider these comments.

Let's now move on to PAVmed's other majority owned subsidiary, Veris Health. Veris was launched a year ago as our first (inaudible) and to the dynamic and rapidly growing digital health sector. Medical technology sector is in the midst of a digital health revolution, which includes smart and connected devices and an intense focus on data analytics, including artificial intelligence and machine learning.

Veris is developing a remote cancer care platform that integrates an intelligent implantable vascular access device with physiologic sensing, software with symptom reporting and telehealth functions and advanced data analytics. The Veris technology is designed to allow oncologists to detect early signs of common cancer-related complications, provide longitudinal trends of physiologic and clinical data, offer data-driven risk management tools for precision oncology, and incorporate additional prospects for substantial value creation through data monetization and biotherapeutic clinical trial support.

The technology contains biologic sensors capable of generating continuous data on key physiologic parameters that are known to predict adverse outcomes of cancer patients undergoing treatment. Wireless communication to the patient's smartphone and its cloud-based digital health care platform will efficiently and effectively deliver actionable real-time data to patients and physicians.

The Veris business model is based on software-as-a-subscription service that leverages existing reimbursement codes for remote patient monitoring. Veris is advancing its mission on 3 fronts, software, device and data, with the help of a world-class technology and medical advisory board. We are also working very closely with Microsoft as a member of its global partner program. Our team is actually traveling to Microsoft headquarters next week, and we look forward to further strengthening what has been a very productive relationship.

The Veris team is growing in anticipation to our first commercial launch -- in anticipation of, excuse me, our first commercial launch late this year, we've hired a Veris Chief Commercial Officer with extensive experience in the oncology sector. We're also building out our data and analytics team with 4 new hires as we seek to establish strong in-house expertise, including an artificial intelligence and machine learning. I should note that consistent with our shared services model, the data and analytics expertise will be available across the PAVmed enterprise, including exciting research using genomic data analysis and future generations of EsoGuard.

On the software development front, we're making excellent progress on the 3 interconnected software platforms, namely a patient smartphone app designed to communicate with the intelligent implantable monitoring device, a cloud-based software platform to which the patient app uploads its data and provides the oncology team with the clinical data to facilitate patient care, and a smartphone app for the team to engage with the cloud-based platform remotely.

As I previously noted, we have split this work into 3 parallel projects designed to give us the best opportunity to effectively navigate the regulatory landscape. What we're referring to as Veris Solar combines the software platform with existing wearable and connected medical devices. This will allow us to launch the first commercial product and get valuable initial real-world experience with the software platform and engage with early adopters. We're on schedule to launch Veris [Solus] later this year.

Veris Mercury adds our own implantable monitoring smart device. The device will include all of the first-generation biosensing features contemplated, but will be as a separate device that will be implanted alongside a traditional port. By separating the device from the port, we expect to be able to leverage existing implantable monitors as a predicate and proceed down the FDA's 510(k) path. Very happy with the progress on the design and development to date on Veris Mercury. We have a second animal lab scheduled in the coming weeks to test the latest prototypes, and we are targeting submission and launch in 2023.

Finally, Veris Venus will offer the fully integrated intelligent vascular access port, utilizing many of the same components of the Venus marketing -- the Veris markets, excuse me. We will seek to advance this product through the FDA's de novo pathway. The new regulations for the integrated device will be less onerous and could allow a classic year first strategy for the fully integrated intelligent vascular access port. The design and development work on Veris Venus is also progressing well. Because the device will need -- doesn't need to mimic the full ECG recording features of the Veris Mercury predicate, the device will be able to achieve multiyear battery life with a much smaller form factor, and we're really very excited about how this project is shaping up.

Let's move on to CarpX. CarpX is our FDA 510(k) cleared minimally invasive device to treat carpal tunnel syndrome. CarpX continues with its limited commercial release utilizing early adopter key opinion leaders, there really are no major updates from our call 6 weeks ago. As I explained then, we had clinical cases on hold while we implemented product improvements that were derived from the experience of U.S. surgeons to date. The first set of product improvements, including addressing an electrode coating manufacturing issue have been completed, and we now have commercial product just recently back on the shelf.

We have restarted cadaver training labs and our schedule in cases with this cohort of trained surgeons.

As previously noted, subsequent product improvements are also slated that can be completed later this year, at which point we should be in a position to expand commercialization more broadly. And as I introduced last -- during the last call, the development of our next-generation CarpX device that incorporates integrated ultrasound imaging is progressing well with target FDA submission in 2023.

So on to NextFlo. NextFlo is a platform infusion technology. The first product incorporating it is our NextFlo intravenous set, which seeks to revolutionize care by eliminating the need for a complex, expensive and error-prone electronic infusion pumps for most of the 1 million infusions performed in this country each day.

As I noted in our last call, we had reinitiated pre DV testing prior to FDA submission after addressing a manufacturing issue through a small redesign. Pre-DV testing since that call demonstrated good flow regulation, but the repeatability data fell short of our targets. The team is in the midst of a comprehensive root cause analysis on repeatability and exploring several redesign options to improve repeatability. Once this work is complete, we'll have a better understanding of how it will impact time lines for FDA submission and commercialization.

And just a few comments on other key products in our R&D pipeline. Not a lot new to report since the last update 6 weeks ago. PortIO is our implantable intraosteous vascular access device. We believe that PortIO, which does not require flushing, is the first maintenance-free long-term vascular access device. PortIO is in the midst of its first in-human clinical study in Colombia, South America, with 4 successful implants at 1 site. 3 additional sites have been approved and will be trained and begin enrolling patients next month.

We are also working with our partners in Europe to pursue a European study to support EU CE Mark clearance and provide additional human data for U.S. approval. Our EsoCure device is designed to endoscopically treat esophageal precancer, and it's also progressing well. Based on head-to-head chronic animal studies completed to date and the histology thereof, we believe EsoCure compares favorably to Medtronic's market-leading Barrick's device. Current work is focused on optimizing the dose response and the design and development (inaudible).

Finally, we continue to have active discussions on business development opportunities, especially in the smart device space, and we'll provide updates as the opportunities flesh out.

With that, I'll hand the reins over on to Dennis to provide an update on our financials before proceeding with a more comprehensive -- before proceeding to questions, excuse me. Dennis?

Thanks, Lishan, and good afternoon, everyone. Our preliminary and summary financial results for the 3 months ended March 31, 2022, we reported in our press release that was recently published. And we plan to file our quarterly report for PAVmed on Form 10-Q with the SEC on Monday, May 16. And at that time, it will be available at sec.gov and on the PAVmed website.

Tests performed and revenue recognition, as we outlined during Lucid's earnings call as a rule, EsoGuard test performed are recognized as GAAP revenue when cash is actually collected by the company. As also previously mentioned, this will more than likely be true during the transition period of negotiating third-party private payer reimbursement contracts and related coverage policies.

As I reported to you in previous quarters, for compliance purposes during this reimbursement transition period, we negotiated a short-term month-to-month fixed payment arrangement with the contract laboratory that was processing the EsoGuard assay and was performing the insurance company billing and collections function. This commercial agreement became effective on August 1, 2021, and terminated concurrently with the opening of our own lab on February 25. We recognized $189,000 of revenue as part of the EsoGuard commercial agreement with ResearchDx for the partial period from January 1, through the end of the agreement on February 25.

March represented a transition period that included hiring a new revenue cycle management provider. Hence, though we had a record number of EsoGuard tests performed in the month of March, we did not bill for any of these tests during the month. Therefore, the recognized quarterly revenue of approximately $200,000, reflecting the pro rata amount of the previous commercial revenue agreement with ResearchDx, or otherwise $100,000 for the month of January, $89,000 representing 25 of 28 days in February.

As a reminder, now that we are operating our own lab, following the February 2022 asset purchase agreement, we'll be able to directly bill payers. As Lishan described, direct billing will occur in the second quarter once our new revenue cycle provider comes online in the coming days. Future revenues will be recognized based upon actual collections until such time as the coverage policies are in place with CMS and payment contracts with private payers. This obviously can result in the timing of revenues recognized versus timing they are submitted for third-party reimbursement until these future conditions are all met.

The gap in claims submission from this transition will impact near-term GAAP revenue recognized until the system catches up with the claims for the tests performed during the transition. These will all be filed for payments but the timing of collections could be elongated because of those issues.

It is our expectation that we will begin to recognize GAAP revenue related to our Lucid labs in the second quarter, as mentioned, and will be adjusted based upon actual collections received. The number of EsoGuard test performed and submitted for payment are provided in the press release and as discussed earlier by Lishan. Obviously, we're in the early stages of our commercial launch, particularly with our test centers. We'll continue to evolve our reporting metrics as various sales and marketing efforts further influence adoption, particularly with the ramp-up of our Lucid test centers and our EsoGuard telemedicine program in cooperation with Upscript.

Presently, there are now 4 banking analysts who issued coverage on PAVmed and others doing their diligence. The quantity of EsoGuard tests payable at the CMS rate required to meet the 2022 revenue estimates provided by the analysts are achievable. The quarter -- the quantity and collections are highly dependent upon the evolving reimbursement landscape.

So the consolidated 3 months results. Just to provide some summary comments on PAVmed and then follow with similar comments on Lucid diagnostics as standalone. PAVmed remains Lucid's controlling shareholder, holding approximately 73% of the voting interest of Lucid. Lucid's operating results will continue to be consolidated into PAVmed's financial results. The statement of operations will reflect the line items to show the noncontrolling interest of profits or losses to non-PAVmed shareholders of its majority-owned subsidiaries. As well, there will be a corresponding offset in the equity section of the balance sheet for amounts attributable to minority interest equity. This methodology is unchanged as a result of the IPO and will continue to be applicable as long as PAVmed remains the controlling shareholder.

With regard to revenue, PAVmed recognized approximately $200,000 revenues related to EsoGuard for the first quarter ended March 31, despite the negative gross profit for the last quarter, which reflects the initial test center start-up related costs. At modest volumes, incremental gross margins can be around 90% and contribution margins north of 60%.

Two comments on operating expenses. During yesterday's Lucid earnings call, we discussed the 3 components that make up Lucid's operating expenses, namely sales and marketing, general and administrative and research and development. Since Lucid's operating expenses represent more than 60% of PAVmed's consolidated operating expense for the first quarter, we'll summarize the consolidated operating expense.

For the 3 months ended March 31, PAVmed's consolidating operating expenses were $19.3 million compared to $8.1 million during the same period in 2021. The with 83% of the net increase attributable to compensation related to headcount increases, stock-based compensation, consulting services and development costs, particularly in the clinical activities and outside professional services. There is a table in the PAVmed press release published earlier and the Lucid press release published yesterday that adjust each of these 3 components of operating expenses for the embedded noncash stock-based compensation expense. Without including the stock-based compensation, operating expenses for PAVmedicine were $11.7 million, inclusive of $8.2 million of Lucid's OpEx.

PAVmed loss per share. PAVmed reported the first quarter net loss attributable to common stockholders of $16.9 million or a loss of $0.20 per common share versus a loss of $9.4 million or $0.13 in the first quarter of the earlier -- of the previous year in 2021.

The press release provides a table entitled non-GAAP, which highlights these amounts along with noncash charges, namely depreciation, stock-based compensation and acquisition-related costs to enable a better understanding of the company's financial performance. You'll notice from the table that after adjusting the Q1 loss by approximately $5.2 million for noncash charges, the company reported the non-GAAP adjusted loss for the first quarter of '22 of $11.7 million or $0.14 per common share. PAVmed had cash -- had consolidated cash of $64.7 million as of March 31, which compares to $77.3 million as of December 31. The cash balance does not include approximately $24.5 million of net proceeds from the convertible debt financing announced in early April. Hence, on a pro forma basis, had the financing occurred prior to March 31, cash would have been nearly $90 million.

Thank you for your attention. And with that, operator, we can now open the call up to any questions.

(Operator Instructions) We'll take our first question from Ross Osborn with Cantor Fitzgerald.

Maybe starting off with the next-gen CarpX offering with integrated ultrasound. What do you think ultrasound was due to the adoption rate of CarpX? Is that TAM expanding, meaning more patients will be able to benefit from it? Or does it simply enhance attractiveness of the device?

Yes. I think I would say more of the latter. I think from what we've seen in the working prototypes to date, that's really sort of pretty spectacular in that while you're -- if you recall, the way CarpX works is it has a balloon that creates a space and pushes the critical structures away such as the ligaments and nerves and tension to ligament and position the electrode on the ligaments to cut them from the inside out.

And with integrated intraluminal ultrasound, you can see all of that improving beautifully. So it's really to facilitate the procedural simplicity to give the physicians confidence about where the anatomic structures are. And we think it will be a big step forward into procedural in terms of enhancing the procedure.

Okay. Great. And then on PortIO. I think last time we spoke, maybe 3 patients had been implanted. It sounds like maybe a fourth has at this point. I could be wrong there, but any feedback from the fourth patient?

Yes, so far so good. It's doing well. We're looking forward, as I said, to increasing enrollment, with a plan was to have multiple sites. And the IRB approval for the other 3 sites have now been completed. And next month, we'll train those 3 sites and get them starting to enroll as well.

Got it. And then maybe a last one, just on operating expenses. Can you just talk about specific to PAVmed, what you saw during the quarter and kind of how we should think about that for the rest of the year? That would be great.

Yes, sure thing. So the first quarter, when you look at the stock-based compensation expense, that probably is a consistency through the balance of the year. And the level of expenses that you see is probably a pretty good baseline for the year. We'll be increasing some head count, particularly at the Lucid level, that will increase that, as Lishan pointed out on the direct-to-patient advertising for Lucid. That would probably be a very limited expansion and really will be paralleling what happens on the reimbursement front.

The G&A is probably fairly stable between now and then, the end of the year. And the R&D expense, which is influenced by our clinical trials, probably is a good baseline as the year unfolds. We are making some changes to our clinical trials focusing on clinical utility because of the short-term wins with reimbursement and stretching out our PMA expenses over a longer horizon. So you won't see quite the spike that was initially anticipated maybe 6, 7 months ago when we were thinking about the year related to it.

We'll take our next question from Anthony Vendetti with the Maxim Group.

This is actually Jeremy on the line for Anthony. So just 2 quick questions on the Lucid test centers. Just I know you have 9 -- the second stage of 9 centers planned to open up at the end of this year. It's already -- you have 7 months left. Is that -- are any of those centers open or -- and what -- can you give us like what's the time frame for when you choose the center, how long does it take to get that up and running?

Great. Yes. So this is maybe a good opportunity to kind of put a reminder in that the test center, when we talk about test center expansion, we're really talking about sales rep expansion primarily, right? The test centers are there really to support the sales reps. And the -- as I've mentioned on previous calls, the rate limiting factor is usually hiring reps, not actually finding a location and hiring enough practitioner.

That being said, what's different about this stage is that we're doing it all at once. In the first stage, we did it in 3 tranches. Phoenix and then 2, then 3 centers in 2 different moments. We have now -- we're branching out simultaneously across online states we've identified, the actual place within the metropolitan -- the actual metropolitan area, and we have started the process of hiring reps and identifying locales.

So we are -- the ramp in terms of sales reps that we have, we had said last call that we anticipate tripling by the end of the year at a fairly linear pace. We have a bit more reps this year, and it certainly would be more like double between now and the end of the year. And so that should give you a reasonable trajectory. It's not -- again, it's -- we're looking at all at the same time.

There's one other difference which I did mention on the Lucid call yesterday, which is that in some of the cities that we're targeting in this stage, we actually already have a presence with market development managers and reps who are already calling on gastroenterologists. So those will move more quickly. For example, we have the very effective rep in Orange County in Southern California, and one of the locations we intend to open a test center is actually within the physical building of the LucidDx labs, and that also applies in other locales in Ohio, where we have already have a fairly strong presence. So that will accelerate some of those time lines.

Okay. Great. And then just 1 last question also regarding the test centers. I know you had record testing done in this quarter. Is there an internal goal that you have like per test center? Was that spread evenly over the test centers that are currently operational? And what's something that you -- if there's a test center at a certain level where if it's not -- if a test center is not hitting that, you sort of pull it off line?

Yes. So let me again use this as an opportunity. I think trying to make it clear that the perception that the test centers are sort of like stores or retail outlets or facilities where -- that are driving the business, I think, is something that we need to sort of work on getting people to understand a little bit better, right?

The test center is really just a collection center that allows the sales reps to be able to call on primary care physicians and drive patients there. So there really isn't -- when we -- as we start getting more traction and the team expands and we are able to provide more additional metrics, the metrics are going to be traditional metrics along performance of the sales team, not really test center focused, right?

I don't know if that -- hopefully, that makes sense. So the answer to your question is that we do track and we do assess how our entire sales team is doing, and they're held -- it's quite rigorous and data-driven. And we look for improvement and we look to make sure that people are being productive in the regions that we're targeting. We don't expect to sort of move away from particular geographies. If we're not hitting our numbers in that geography, then we'll look to how to -- ways to improve sales engagement in that territory. So again, I just -- hopefully, that makes sense, a bit of a nuance between understanding that the test centers are really passive vehicles where the procedure is performed, and the real action is really happening at the -- in the physician offices with sales reps calling on physicians and try to drive growth for us.

(Operator Instructions) We'll hear next from Ed Woo with Ascendiant Capital.

Yes. Congratulations on the quarter. With a very strong balance sheet, and obviously, a lot of volatility in the capital markets out there, are you seeing more opportunities of companies with products that might be interesting or technology that are interesting for you guys? And have valuations come down significantly in the past couple of months?

We are -- as you know, we do have an active business development process. One of the things I didn't get a chance to mention is that we've hired a very accomplished Vice President of Business Strategy and Development, who will help -- be able to help sort of focus our activities on the BD side of things as well as broader strategy. And I wouldn't say that necessarily we're at the point on any of these where we can -- we certainly would expect given the volatility that valuations would be attractive. But we're not really -- none of them are at the stage where we're really able to assess that yet, but that's a fair expectation.

We are very excited about opportunities that we're starting to see in areas that are synergistic with our current work, particularly in sort of smart device technologies that are potentially synergistic with our efforts on the digital health side. So stay tuned. We really are excited about some of the opportunities that are in front of us.

That does conclude today's question-and-answer session. I would like to turn the conference back over to Dr. Aklog for any additional or closing remarks.

All right. Thanks, operator, and thank you all for joining us today and for, as always, great questions. We look forward to keeping you abreast of our progress through news releases and periodic calls such as this one. As always, a reminder, the best way to keep up with PAVmed news, updates and events is to sign up for our e-mail alerts on our website, the Investor Relations website, and to follow us on social media on Twitter, LinkedIn, YouTube and directly on our website. You can also feel free to contact our VP of Investor Relations, Adrian Miller at akm@pavmed.com.

So again, thank you all again, and have a great rest of your day.

Thank you. And that does conclude today's conference. We thank you all for your participation. You can now disconnect.