Neuronetics Inc (STIM) 2023 Q1 法說會逐字稿

Thank you for standing by, and welcome to the Neuronetics First Quarter 2023 Financial and Operating Results. (Operator Instructions) As a reminder, today's program is being recorded.

感謝您的耐心等待，歡迎閱讀 Neuronetics 2023 年第一季度財務和運營業績。 （操作員指示）提醒一下，今天的節目正在錄製中。

And now I'd like to introduce your host for today's program, Mr. Mark Klausner. Please go ahead, sir.

現在我想介紹一下今天節目的主持人馬克·克勞斯納先生。請繼續，先生。

Good morning, and thank you for joining us for the Neuronetics first quarter 2023 conference call. Joining me on today's call are Neuronetics' President and Chief Executive Officer, Keith Sullivan; and Chief Financial Officer, Steve Furlong.

早上好，感謝您參加我們的 Neuronetics 2023 年第一季度電話會議。參加今天電話會議的還有 Neuronetics 總裁兼首席執行官 Keith Sullivan；和首席財務官史蒂夫·弗隆。

Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements covered under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements related to our business, strategy, financial and revenue guidance, the impact of COVID-19 and other operational issues and metrics.

在我們開始之前，我想提醒聽眾，管理層在本次電話會議中討論的某些信息將包括 1995 年《私人證券訴訟改革法案》安全港條款所涵蓋的前瞻性陳述，包括與我們的業務、戰略相關的陳述、財務和收入指導、COVID-19 的影響以及其他運營問題和指標。

Actual results can differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business. For discussion of risks and uncertainties associated with Neuronetics business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's Annual Report on Form 10-K filed in March 2023 as well as the company's quarterly report on Form 10-Q which will be filed on May 15. The company disclaims any obligation to update any forward-looking statements made during the course of this call, except as required by law.

由於與公司業務相關的風險和不確定性，實際結果可能與這些前瞻性陳述中明示或暗示的結果存在重大差異。為了討論與 Neuronetics 業務相關的風險和不確定性，我建議您查看該公司向美國證券交易委員會提交的文件，包括該公司於 2023 年 3 月提交的 10-K 表格年度報告以及該公司 10 表格季度報告-Q 將於 5 月 15 日提交。除法律要求外，該公司不承擔更新本次電話會議期間所做的任何前瞻性陳述的義務。

During the call, we'll also discuss certain information on a non-GAAP basis including EBITDA. Management believes that non-GAAP financial information taken in conjunction with U.S. GAAP financial measures provide useful information for both management and investors by excluding certain non-cash and other expenses that are not indicative of trends in our operating results. Management uses non-GAAP financial measures to compare our performance relative to forecast and strategic plans to benchmark our performance externally against competitors and for certain compensation decisions.

在電話會議期間，我們還將討論非 GAAP 基礎上的某些信息，包括 EBITDA。管理層認為，與美國公認會計準則財務指標結合使用的非公認會計準則財務信息可以排除某些不能反映我們經營業績趨勢的非現金和其他費用，從而為管理層和投資者提供有用的信息。管理層使用非公認會計準則財務指標來比較我們相對於預測和戰略計劃的業績，以將我們的業績與競爭對手進行外部比較，並做出某些薪酬決策。

Reconciliations between U.S. GAAP and non-GAAP results are presented in the tables accompanying our press release which can be viewed on our website.

美國公認會計原則和非公認會計原則結果之間的調節顯示在我們新聞稿隨附的表格中，您可以在我們的網站上查看這些表格。

With that, it's my pleasure to turn the call over to Neuronetics' President and Chief Executive Officer, Keith Sullivan.

至此，我很高興將電話轉給 Neuronetics 總裁兼首席執行官 Keith Sullivan。

Thank you, Mark. Good morning, and thank you for joining us. I'll begin by providing an overview of our recent performance, followed by an operational update. Steve will then review our financial results and I'll conclude with some thoughts on the rest of 2023 before turning to Q&A.

謝謝你，馬克。早上好，感謝您加入我們。我將首先概述我們最近的表現，然後介紹運營情況的最新情況。然後，史蒂夫將回顧我們的財務業績，在進行問答之前，我將總結對 2023 年剩餘時間的一些想法。

The first quarter was solid as we continued to cleanly execute across the organization, delivering results that were in line with our expectations, notwithstanding some industry headwinds.

儘管存在一些行業阻力，但我們繼續在整個組織內乾淨利落地執行，交付的結果符合我們的預期，第一季度表現穩健。

As Steve will detail in his remarks, based on our first quarter results and increasing confidence in treatment session revenue growth, in the past 3 quarters of the year, we have raised our annual guidance.

正如史蒂夫將在他的講話中詳細介紹的那樣，根據我們第一季度的業績以及對治療療程收入增長的信心增強，在今年過去的三個季度中，我們提高了年度指導。

Total revenue was $15.5 million, up 10% over the first quarter of 2022, primarily driven by strong treatment session performance combined with an on-plan NeuroStar system expansion. NeuroStar system revenue was $3.9 million.

總收入為 1,550 萬美元，比 2022 年第一季度增長 10%，這主要是由於強勁的治療效果以及計劃中的 NeuroStar 系統擴展所致。 NeuroStar 系統收入為 390 萬美元。

As previously noted, our plan was to ship 45 to 50 systems per quarter, which we believe is the optimal range to allow our teams to devote the appropriate amount of time and resources to set our customers up for long-term success using a NeuroStar.

如前所述，我們的計劃是每季度交付 45 到 50 個系統，我們相信這是最佳範圍，可以讓我們的團隊投入適當的時間和資源，幫助我們的客戶使用 NeuroStar 取得長期成功。

In line with that plan, we ended the quarter with 49 systems shipped. This success and steady system expansion is due to the ongoing hard work of our strong team of area sales managers who are firing on all cylinders and are strengthened by yet another sold-out NeuroStar Summit in Charlotte, North Carolina, which was attended by 54 participants from 31 different practices.

根據該計劃，我們在本季度末交付了 49 個系統。這一成功和穩定的系統擴展歸功於我們強大的區域銷售經理團隊的持續努力，他們全速前進，並通過在北卡羅來納州夏洛特舉行的另一場滿座的 NeuroStar 峰會得到加強，該峰會有 54 名參與者參加來自 31 種不同的做法。

These NeuroStar summits continue to be the cornerstone of our strategy to educate customers about the impact NeuroStar can have on patients' lives. Orders coming directly as a result of customers attending a summit contributed meaningfully to the capital sales in the quarter.

這些 NeuroStar 峰會仍然是我們教育客戶了解 NeuroStar 對患者生活的影響的戰略的基石。客戶參加峰會直接帶來的訂單為本季度的資本銷售做出了重大貢獻。

The U.S. treatment session revenue was $10.6 million, up 12% over the first quarter of 2022. This was the result of highly encouraging year-over-year growth at our local per-click sites, stemming from our investment in NeuroStar University, our 5-star training program and the expanded use of PHQ-10 tool and the greater availability of practice management training.

美國的治療療程收入為 1,060 萬美元，比 2022 年第一季度增長 12%。這是我們本地每次點擊網站同比增長非常令人鼓舞的結果，這源於我們對 NeuroStar 大學的投資，我們的 5 所大學-星級培訓計劃和 PHQ-10 工具的擴大使用以及實踐管理培訓的更大可用性。

Importantly, we did see the service provider segment return to growth in the quarter, albeit at a slower rate than our local per-click customers.

重要的是，我們確實看到服務提供商細分市場在本季度恢復增長，儘管增速低於我們本地的每次點擊客戶。

Now turning to our operational highlights. Our first focus for 2023 is increasing the number of customers who participate in NeuroStar University. NSU continues to receive excellent reviews from our customers.

現在轉向我們的運營亮點。我們 2023 年的首要重點是增加參與 NeuroStar University 的客戶數量。 NSU 繼續獲得客戶的好評。

By quarter end, we had hosted 11 full capacity classes with 200 attendees representing 97 accounts. Demand continues to be high. We currently have courses booked out until July with April, May and June classes at capacity. We are continuing to see our customers experience advantages directly related to the NSU training sessions. For instance, NSU attendees use the PHQ-10 more frequently to identify patients in need within their practices, and as a result, see improved monthly utilization as compared to customers who have not yet attended.

截至季度末，我們已舉辦了 11 場滿員課程，有 200 名學員代表 97 個客戶。需求持續高漲。目前，我們的課程已預訂至 7 月，而 4 月、5 月和 6 月的課程已滿員。我們不斷看到我們的客戶體驗到與 NSU 培訓課程直接相關的優勢。例如，NSU 參加者更頻繁地使用 PHQ-10 來識別其實踐中需要的患者，因此，與尚未參加的客戶相比，每月利用率有所提高。

Our second focus for 2023 is to incorporate a higher percentage of our customers into our co-op marketing program. As compared to the first quarter of 2022, co-op participation has increased over 60%.

我們 2023 年的第二個重點是將更高比例的客戶納入我們的合作營銷計劃。與 2022 年第一季度相比，合作公寓參與度增加了 60% 以上。

Not only have we seen an increase in the number of accounts participating, but once in the program, they are leveraging its benefits more. In the first quarter alone, we saw a more than 25% increase in marketing spend amongst participants, indicating that they are seeing value in the program.

我們不僅看到參與該計劃的賬戶數量有所增加，而且一旦加入該計劃，他們就會更多地利用該計劃的好處。僅在第一季度，我們就看到參與者的營銷支出增加了 25% 以上，這表明他們看到了該計劃的價值。

To make things even easier for our customers, on April 1, we launched a new simplified program featuring a prescriptive road map of effective marketing tactics to market inside and outside the practice. These tools include new marketing and training collateral and a revamping of myneurostar.com to digitize the execution of the program.

為了讓我們的客戶變得更加輕鬆，我們於 4 月 1 日推出了一項新的簡化計劃，其中包含有效營銷策略的規定路線圖，以在業務內部和外部進行營銷。這些工具包括新的營銷和培訓材料以及對 myneurostar.com 的改造，以數字化該計劃的執行。

Our third and final focus area for 2023 is creating a network of accounts across the country that follow NeuroStar best practices and we are making good progress on this initiative. We have invested significantly in developing effective marketing strategies for our customers and we are now taking these proven practices to a broad network of accounts.

我們 2023 年的第三個也是最後一個重點領域是在全國范圍內創建一個遵循 NeuroStar 最佳實踐的賬戶網絡，我們在這一舉措上取得了良好進展。我們投入了大量資金為客戶制定有效的營銷策略，現在正在將這些行之有效的做法應用於廣泛的客戶網絡。

By setting certain standards such as consistently high levels of service and increasing patient marketing within the practices, we expect to see progress reflected in our customers who fully utilize the uniqueness of the NeuroStar offering and our approach to the market.

通過設定某些標準，例如始終如一的高水平服務和在實踐中增加患者營銷，我們期望看到進步反映在充分利用 NeuroStar 產品的獨特性和我們的市場方法的客戶身上。

Turning to other recent highlights. In January, we hosted our National Sales Meeting in Nashville, Tennessee. The theme of our sales team continues to be simplification, making working with Neuronetics as seamless as possible for our customers from clinical training through marketing support.

轉向最近的其他亮點。一月份，我們在田納西州納什維爾舉辦了全國銷售會議。我們銷售團隊的主題仍然是簡化，使我們的客戶與 Neuronetics 的合作從臨床培訓到營銷支持盡可能無縫。

We also emphasized our 3 key pillars, which are: patient identification within the practice; ensuring patients complete their full treatment of 36 sessions; and following patients post-treatment to identify when they need retreatment.

我們還強調了我們的 3 個關鍵支柱，它們是： 實踐中的患者識別；確保患者完成36次療程的全部治療；並在治療後跟踪患者以確定他們何時需要再治療。

Shifting gears to an update on the clinical and regulatory efforts. The FDA has recently given us approval to enable connectivity between TrakStar and NeuroStar systems via WiFi or cellular instead of hardwired internet connection. This will allow us to connect all of our accounts into TrakStar over time.

轉向更新臨床和監管工作。 FDA 最近批准我們通過 WiFi 或蜂窩網絡（而不是硬連線互聯網連接）實現 TrakStar 和 NeuroStar 系統之間的連接。隨著時間的推移，這將使我們能夠將所有帳戶連接到 TrakStar。

It provides us 3 key benefits. First, we can collect additional data from the accounts that can be used to support FDA submissions. Second, we can push technology updates remotely rather than needing to install them manually via a service engineer. And lastly, we can monitor the account systems in order to prevent service issues.

它為我們提供了 3 個主要好處。首先，我們可以從帳戶中收集可用於支持 FDA 提交的其他數據。其次，我們可以遠程推送技術更新，而不需要通過服務工程師手動安裝。最後，我們可以監控帳戶系統以防止服務問題。

Moving to reimbursement. Recently, BlueCross BlueShield of Mississippi updated its health care policy to allow non-physician practitioners, including nurse practitioners to prescribe our NeuroStar Advanced Therapy for mental health. This is a significant milestone for Neuronetics as it increases access for patients suffering from major depressive disorder to receive NeuroStar treatment.

轉向報銷。最近，密西西比州的 BlueCross BlueShield 更新了其醫療保健政策，允許包括執業護士在內的非醫師從業者開出我們的 NeuroStar 高級心理健康療法。這是 Neuronetics 的一個重要里程碑，因為它增加了患有重度抑鬱症的患者接受 NeuroStar 治療的機會。

As the largest payer in the state with over 850,000 covered lives, BlueCross BlueShield and Mississippi's policy change is a positive development that aligns with the growing momentum for health payers to expand the coverage for TMS therapy.

作為該州最大的支付者，覆蓋超過 850,000 人的生命，BlueCross BlueShield 和密西西比州的政策變化是一項積極的發展，與醫療支付者擴大 TMS 治療覆蓋範圍的不斷增長勢頭相一致。

They also require only 2 failed medications prior to TMS treatment down from 4. This change will help patients receive TMS treatment earlier in their treatment journey, potentially leading to improved outcomes for those suffering from drug-resistant depression.

他們在 TMS 治療前只需要 2 種失敗的藥物，從 4 種減少到了 4 種。這一變化將幫助患者在治療過程中儘早接受 TMS 治療，從而有可能改善耐藥性抑鬱症患者的治療結果。

As the only TMS company in the industry with a dedicated health policy team, we have been actively partnering with providers to advocate for health policy changes that broaden access to NeuroStar TMS therapy.

作為業內唯一一家擁有專門健康政策團隊的 TMS 公司，我們一直積極與提供商合作，倡導健康政策的改變，以擴大 NeuroStar TMS 治療的可及性。

Lastly, I want to provide an update on Greenbrook. We continue to see disruption resulting from the merger of Greenbrook and Success TMS and the subsequent integration of the 2 businesses. We met with their leadership teams, both on a field and an executive level over the past few months and have developed a strategy to deliver mutual success.

最後，我想提供有關格林布魯克的最新情況。我們繼續看到 Greenbrook 和 Success TMS 的合併以及隨後兩項業務的整合所帶來的顛覆。在過去的幾個月裡，我們會見了他們的現場和高管團隊的領導團隊，並製定了一項實現共同成功的戰略。

This includes strategies to drive greater awareness and help more patients access care and how best to redeploy systems from the recently closed stores and make them productive.

這包括提高認識並幫助更多患者獲得護理的策略，以及如何最好地從最近關閉的商店重新部署系統並提高其生產力。

To that point, we have recently seen a number of systems move from closed stores into active stores where they are replacing competitive systems. As a result of our combined efforts, we have recently seen their business pick up month-over-month. But the current rate of the recovery is in line with the assumptions made as part of our annual guidance.

就這一點而言，我們最近看到許多系統從封閉的商店轉變為活躍的商店，並取代了競爭系統。經過我們共同努力，最近我們看到他們的業務逐月回升。但目前的複蘇速度符合我們年度指導中所做的假設。

We look forward to continuing our strong partnership with Greenbrook as we continue to advance the adoption of TMS therapy for mental illness. To ensure that Greenbrook is as successful as possible in growing the utilization of their fleet of NeuroStar systems, we have scheduled a number of their leadership team members to attend NSU and have additional team members scheduled over the coming months.

我們期待繼續與 Greenbrook 建立強有力的合作夥伴關係，繼續推進 TMS 療法在精神疾病方面的應用。為了確保 Greenbrook 盡可能成功地提高其 NeuroStar 系統群的利用率，我們已安排他們的一些領導團隊成員參加 NSU，並在未來幾個月安排更多團隊成員。

We are encouraged by our performance in the first quarter. We continue to deliver solid treatment session growth and execute on the measured capital expansion strategy. Our commercial team's efforts were supported by best-in-class marketing initiatives, training programs and practice support to enable customer success.

我們對第一季度的表現感到鼓舞。我們繼續實現穩健的治療療程增長，並執行謹慎的資本擴張戰略。我們的商業團隊的努力得到了一流的營銷計劃、培訓計劃和實踐支持的支持，以幫助客戶取得成功。

I would like to thank our entire organization for the dedication to our mission and the savvy they have displayed as we continue to build our leadership position in the industry.

我要感謝我們整個組織對我們使命的奉獻以及他們在我們繼續建立行業領導地位的過程中所表現出的悟性。

With that, I'd like to turn the call over to Steve.

有了這個，我想把電話轉給史蒂夫。

Thank you, Keith. Unless otherwise noted, all performance comparisons are being made for the first quarter of 2023 versus the first quarter of 2022.

謝謝你，基思。除非另有說明，所有性能比較均針對 2023 年第一季度與 2022 年第一季度進行。

Total revenue was $15.5 million, an increase of 10% over prior year revenue of $14.2 million. U.S. NeuroStar Advanced Therapy System revenue was $3.9 million versus $3.6 million in the prior year.

總收入為 1,550 萬美元，比上年收入 1,420 萬美元增長 10%。美國 NeuroStar 高級治療系統收入為 390 萬美元，上一年為 360 萬美元。

We shipped 49 systems, up from 48 in 2022. As Keith noted, our current strategy is to ship between 45 and 50 systems per quarter.

我們發貨了 49 個系統，高於 2022 年的 48 個。正如 Keith 指出的那樣，我們當前的策略是每季度發貨 45 到 50 個系統。

U.S. treatment session revenue was $10.6 million, an increase of 12% over 2022 revenue of $9.5 million. The revenue growth was primarily driven by strong performance within our local per-click customer segments.

美國治療療程收入為 1060 萬美元，比 2022 年 950 萬美元的收入增長 12%。收入增長主要得益於我們本地每次點擊客戶群的強勁表現。

In the first quarter of 2023, revenue per active site was approximately $9,700 compared to approximately $9,900 in the prior year quarter. The decline was primarily a result of the material increase in active sites compared to the prior year over the last year.

2023 年第一季度，每個活躍網站的收入約為 9,700 美元，而去年同期約為 9,900 美元。下降的主要原因是去年活躍站點數量較上年大幅增加。

As a reminder, treatment session revenues are typically lowest during the first quarter of the year due to seasonality.

提醒一下，由於季節性原因，治療療程收入通常在一年第一季度最低。

Gross margins were 73.3% compared to 75.4% in the prior year quarter. The decline in gross margin was primarily driven by revenue mix as well as an increase in capitalized software and the corresponding amortization expense associated with the latest product release.

毛利率為 73.3%，去年同期為 75.4%。毛利率下降主要是由於收入組合以及資本化軟件的增加以及與最新產品發布相關的相應攤銷費用所致。

Beginning on January 1, 2023, we instituted a new accounting policy, which slightly impacted our gross margin in the first quarter. As our NeuroStar products are developed, we continuously make software improvements to each new version and capitalize these software expenses. Upon completion of the software upgrade, we begin amortizing the capitalized software over a period of 2 years.

從2023年1月1日開始，我們制定了新的會計政策，這對我們第一季度的毛利率略有影響。隨著 NeuroStar 產品的開發，我們不斷對每個新版本進行軟件改進，並將這些軟件費用資本化。軟件升級完成後，我們開始在兩年內攤銷資本化軟件。

Beginning this year, we are recording this amortization expense as part -- as cost of goods sold rather than in R&D, where it had previously been recorded. We are required to record this amortization expense to the cost of goods sold. On a like-for-like basis, reflecting the accounting change, margins would have been 74% this year.

從今年開始，我們將這筆攤銷費用記錄為銷售商品成本的一部分，而不是以前記錄的研發成本。我們需要將此攤銷費用記錄到銷售商品成本中。按照會計變化計算，今年的利潤率為 74%。

Operating expenses during the quarter were $21.3 million, an increase of just $500,000 compared to the first quarter of 2022. As part of our strategy to drive toward profitability, we have been prudently managing our operating expenses, and as a result, are beginning to drive operating leverage in the business.

本季度的運營費用為 2130 萬美元，與 2022 年第一季度相比僅增加了 50 萬美元。作為我們推動盈利戰略的一部分，我們一直在謹慎管理運營費用，因此，我們開始推動企業的經營槓桿。

During the quarter, we incurred approximately $1.8 million of noncash stock-based compensation expense. Net loss for the first quarter was $10.5 million or $0.38 per share as compared to a net loss of $10.8 million or $0.41 per share in the prior year quarter.

本季度，我們產生了約 180 萬美元的非現金股票補償費用。第一季度淨虧損為 1,050 萬美元，即每股 0.38 美元，而去年同期淨虧損為 1,080 萬美元，即每股 0.41 美元。

EBITDA was negative $8.8 million as compared to negative $9.5 million in the prior year quarter. As of March 31, 2023, cash and cash equivalents were $55.4 million.

EBITDA 為負 880 萬美元，而去年同期為負 950 萬美元。截至2023年3月31日，現金及現金等價物為5540萬美元。

In early April, we announced that we have secured an amended credit facility with SLR Capital Partners, which will provide us with up to $60 million in borrowings. The maturity date of the credit facility is March 29, 2028 and the annual interest rate will be based on SOFR plus 5.65%.

4 月初，我們宣布已與 SLR Capital Partners 獲得修訂後的信貸安排，這將為我們提供高達 6000 萬美元的借款。該信貸額度的到期日為2028年3月29日，年利率將在SOFR的基礎上加5.65%。

The term loan facility provides for at least 36 months of interest-only payments. This amended credit facility represents a significant milestone for our company as it provides us with additional capital to strengthen our balance sheet and support the continued commercial adoption of NeuroStar.

定期貸款安排提供至少 36 個月的只付利息。此次修改後的信貸額度對我們公司來說是一個重要的里程碑，因為它為我們提供了額外的資本來加強我們的資產負債表並支持 NeuroStar 的持續商業採用。

We remain focused on our goal of achieving cash flow breakeven in 2024 and this financing will further support our efforts as we progress towards this goal. We would like to express our appreciation to SLR for their ongoing support and we look forward to continuing our long-term relationship.

我們仍然專注於 2024 年實現現金流收支平衡的目標，這筆融資將進一步支持我們朝著這一目標邁進的努力。我們對 SLR 的持續支持表示感謝，並期待繼續維持我們的長期合作關係。

Additionally, we also announced that we converted approximately $5.9 million of Greenbrook's outstanding accounts payable balance and transaction expenses into a $6 million senior secured promissory note. This will provide Greenbrook with additional cash buffer to support their growth strategy moving forward. The note will bear interest and matures on March 31, 2027.

此外，我們還宣布將 Greenbrook 的未償應付賬款餘額和交易費用中約 590 萬美元轉換為 600 萬美元的高級擔保本票。這將為格林布魯克提供額外的現金緩衝，以支持其未來的增長戰略。該票據將於2027年3月31日計息並到期。

Now turning to guidance. For the full year, we now expect revenue in the range of $68 million to $73 million. Our updated guidance for 2023 assumes a modest recovery in treatment session revenue from certain service providers and continued strength from our local per-click customers during the remaining 3 quarters of the year.

現在轉向指導。我們現在預計全年收入在 6800 萬美元至 7300 萬美元之間。我們更新後的 2023 年指引假設，在今年剩餘的 3 個季度中，某些服務提供商的治療療程收入將適度復甦，並且我們的本地每次點擊客戶將繼續保持強勁勢頭。

For the second quarter, we expect revenue of $17 million to $18 million. We continue to expect total operating expenses for the full year to be in the range of $84 million to $88 million.

我們預計第二季度的收入為 1700 萬美元至 1800 萬美元。我們仍然預計全年總運營費用將在 8400 萬美元至 8800 萬美元之間。

For the full year of 2023, we continue to expect a year-over-year reduction in cash burn with the highest being in the first quarter, primarily due to our National Sales Meeting and payments for bonuses, sales commissions and our retention costs.

對於 2023 年全年，我們繼續預計現金消耗將同比減少，其中第一季度最高，這主要是由於我們的全國銷售會議以及獎金、銷售佣金和保留成本的支付。

Our operating plan remains on track and we anticipate reaching cash flow breakeven with the cash we have on hand due to our projections for top line growth, gross margin expansion and operating expense management.

我們的運營計劃仍在按計劃進行，由於我們對營收增長、毛利率擴張和運營費用管理的預測，我們預計手頭的現金將實現現金流收支平衡。

I would now like to turn the call back over to Keith.

我現在想把電話轉回基思。

Looking to the balance of 2023, I'm excited about the opportunities that lie ahead and about our ability to continue to execute. We remain focused on increasing the number of customers who participate in NeuroStar University, working to incorporate a higher percentage of customers into the co-op marketing programs and creating a network of accounts across the country that follow NeuroStar best practices.

展望 2023 年，我對未來的機遇以及我們繼續執行的能力感到興奮。我們仍然致力於增加參與 NeuroStar 大學的客戶數量，努力將更高比例的客戶納入合作營銷計劃，並在全國范圍內創建遵循 NeuroStar 最佳實踐的帳戶網絡。

To help execute on these initiatives, I'm pleased to announce that Lisa Rosas has joined our senior leadership team as Senior Vice President and Chief Marketing Officer, effective May 1, 2023. With over 20 years of experience in marketing, Lisa brings a wealth of knowledge and expertise to our team, having previously held leadership roles at Sientra, Obalon Therapeutics, ZELTIQ, Metasys and Allergan. I can personally attest to her extensive experience in driving practice success, building awareness and increasing market share capabilities, which are highly beneficial at Neuronetics. We are excited to have Lisa on board and look forward to strengthening our position as the leader in TMS for mental disorders.

為了幫助執行這些舉措，我很高興地宣布，Lisa Rosas 已加入我們的高級領導團隊，擔任高級副總裁兼首席營銷官，該任命於 2023 年 5 月 1 日生效。Lisa 擁有 20 多年的營銷經驗，為我們帶來了豐富的財富為我們的團隊提供了豐富的知識和專業知識，此前曾在 Sientra、Obalon Therapeutics、ZELTIQ、Metasys 和 Allergan 擔任領導職務。我可以親自證明她在推動實踐成功、建立意識和提高市場份額能力方面的豐富經驗，這些對 Neuronetics 非常有益。我們很高興 Lisa 加入，並期待加強我們作為精神障礙 TMS 領導者的地位。

With that, I'd like to open the line for questions.

說到這裡，我想開通提問熱線。

(Operator Instructions) Our first question comes from the line of William Plovanic from Canaccord.

（操作員說明）我們的第一個問題來自 Canaccord 的 William Plovanic。

First off, just -- I was wondering if -- what gives you the conviction to raise guidance given that Q1 was in line and Q2 is -- actually guide is in line with your original guidance or with consensus there.

首先，我想知道，鑑於第一季度和第二季度一致，是什麼讓您有信心提出指導意見，實際上指導意見與您最初的指導意見或共識一致。

Just considering it's an in-line quarter, a solid quarter, but in line, why raise guidance at this point?

考慮到這是一個符合預期的季度，一個穩定的季度，但符合預期，為什麼要在此時提高指導呢？

So basically, we saw positive signs from Greenbrook during the quarter. Even though their store closures didn't really commence until late March, early April, the metrics that we track being utilization and also purchases were stronger than we thought.

基本上，我們在本季度看到了格林布魯克的積極跡象。儘管他們的商店直到三月底、四月初才真正開始關閉，但我們跟踪的利用率和購買量指標比我們想像的要強。

They were partially offset by some weakness in our fixed price accounts, which is actually a good thing, all things considered. So just looking at how they're doing and how they're doing through the early part of Q2 gave us that conviction that we're comfortable increasing the low end by $2 million and the high end by $1 million.

它們被我們固定價格賬戶的一些弱點所部分抵消，考慮到所有因素，這實際上是一件好事。因此，只要看看他們的表現以及他們在第二季度初期的表現，我們就確信我們可以放心地將低端增加 200 萬美元，將高端增加 100 萬美元。

And then congrats on bringing Lisa on board. You've got a great VP of Marketing there. Just the new co-op program that you talked about with internal external that you're kicking off, just wondering if you could give us a little more color on that, on what exactly you're changing specifically?

然後恭喜麗莎加入。你們那裡有一位出色的營銷副總裁。只是您與內部外部討論的新合作計劃，您正在啟動，只是想知道您是否可以給我們更多的信息，您具體要改變什麼？

On the co-op marketing program, as you know, that's a key piece to our program. We have tried to smooth it out to make it easier for our accounts to sign up, to participate, to submit their ads and then get reimbursed for it.

如您所知，在合作營銷計劃中，這是我們計劃的關鍵部分。我們試圖解決這個問題，以便我們的帳戶更容易註冊、參與、提交廣告，然後獲得報銷。

So I think when we first rolled it out, our accounts felt as though it was -- it had too many rules and regulations, and now we are just smoothing it out to make it simpler for them.

所以我認為，當我們第一次推出它時，我們的賬戶感覺好像——它有太多的規則和規定，現在我們只是對其進行平滑處理，以使其對他們來說更簡單。

Our next question comes from the line of Margaret Kaczor from William Blair.

我們的下一個問題來自威廉·布萊爾的瑪格麗特·卡佐爾。

I wanted to maybe go a little bit deeper into guidance, a follow-up on Bill's question. And maybe start a little bit with Q2.

我想也許更深入地探討指導，這是比爾問題的後續內容。也許可以從第二季度開始。

What is the Q2 guide, I guess, implied for utilization or revenue per active site both with Greenbrook and without Greenbrook and kind of normalizing for that?

我猜想，無論有格林布魯克還是沒有格林布魯克，第二季度的指南對每個活動站點的利用率或收入意味著什麼，並對此進行標準化？

And then as we go on throughout the year, as we kind of look at Q3, Q4 growth rates for a total company basis, obviously, we can back out the first half of the year. But it doesn't imply a little bit of a slowdown.

然後，隨著全年的進展，當我們查看第三季度、第四季度整個公司的增長率時，顯然，我們可以回溯今年上半年。但這並不意味著有一點放緩。

So I just wanted to walk through those dynamics, how you all are thinking about that and what gets you to that high and low end?

所以我只是想了解一下這些動態，你們是如何思考這個問題的，是什麼讓你們達到了高端和低端？

Yes. So I guess, dissecting our guidance. Q2 in particular is usually our second strongest quarter for the year. And then it's consistent in Q3 and then historically, Q4 is our strongest quarter.

是的。所以我想，剖析我們的指導。尤其是第二季度，通常是我們今年第二強勁的季度。然後在第三季度保持一致，然後從歷史上看，第四季度是我們最強勁的季度。

Analyzing some of the metrics that you mentioned revenue per site, it's difficult to pinpoint that right now, because a lot of the Greenbrook sites are still influx. We know they've closed 40 so far, relocated a number of our systems that are actually up and running already.

分析您提到的每個網站收入的一些指標，現在很難確定這一點，因為許多格林布魯克網站仍在湧入。我們知道到目前為止他們已經關閉了 40 個，並重新安置了一些實際上已經啟動並運行的系統。

So we are anticipating that momentum to continue through Q2. I do expect revenue per active site to increase in Q2, again, to remain somewhat steady in Q3, an increase in Q4.

因此，我們預計這種勢頭將持續到第二季​​度。我確實預計第二季度每個活躍網站的收入將增加，第三季度將再次保持穩定，第四季度將有所增長。

That was a long question. I'm not sure if I answered it totally.

這是一個很長的問題。我不確定我是否完全回答了。

And part of it is, again, as we go towards the back half of the year, what that exit rate looks like and what it could imply for '24?

其中一部分是，當我們進入今年下半年時，退出率是什麼樣的以及它對 24 世紀意味著什麼？

Yes. So we -- utilization continues to be strong in our local consumables segment and that's really the target that we're after. Assuming the Greenbrook transition continues positively the way it is, they're going to start contributing more to the -- to our treatment session revenues towards the second half of the year.

是的。因此，我們本地消耗品領域的利用率仍然強勁，這確實是我們追求的目標。假設格林布魯克的過渡繼續以目前的方式積極進行，他們將在今年下半年開始為我們的治療收入做出更多貢獻。

So the co-marketing programs are working. NeuroStar University is working immensely. So exiting 2023, we will have the momentum going into 2024 that will help us get to that cash flow breakeven target.

因此，聯合營銷計劃正在發揮作用。 NeuroStar 大學正在大力開展工作。因此，2023 年結束後，我們將有動力進入 2024 年，這將幫助我們實現現金流收支平衡目標。

And then as we look at some of the reimbursement policy changes, obviously, it's been encouraging to see that this year and the comps and press releases.

然後，當我們看到一些報銷政策的變化時，顯然，看到今年的變化以及比較和新聞稿是令人鼓舞的。

But maybe you guys can true us up on a year-over-year basis, and again, on a net basis, what's been the change in terms of better coverage policies and AV policies that would decrease and take down the number of drugs failed before covering?

但也許你們可以讓我們在逐年的基礎上，再一次，在淨值基礎上，在更好的覆蓋政策和 AV 政策方面發生了什麼變化，這些變化將減少並減少之前失敗的藥物數量覆蓋？

So Margaret, we have a reimbursement team that has focused on policy changes. And as each one of the payers comes up for review, we are actively working with physicians to suggest changes going from 4 drugs to 2 drugs and even adding non-physician practitioners to the list.

瑪格麗特，我們有一個專注於政策變化的報銷團隊。隨著每一位付款人接受審查，我們正在積極與醫生合作，建議將 4 種藥物更改為 2 種藥物，甚至將非醫生從業者添加到列表中。

So it's an ongoing process for us. Honestly, there are enough patients out there that have failed for drugs to keep all of the companies that provide TMS active. But I think our focus is trying to get greater access to care for these patients that are suffering with depression.

所以這對我們來說是一個持續的過程。老實說，有足夠多的患者無法獲得藥物，因此所有提供 TMS 的公司都保持活躍。但我認為我們的重點是努力為這些患有抑鬱症的患者提供更多的護理機會。

So if we can do that, then we have a solid pipeline of patients. But quite honestly, there are plenty that have failed 4.

因此，如果我們能做到這一點，那麼我們就有了堅實的患者渠道。但老實說，失敗的例子還有很多 4.

And sorry, I'm going to squeeze one last one and then I'll hop back in the queue. But just as a follow-up to that.

抱歉，我要擠最後一張，然後我會跳回到隊列中。但這只是作為後續行動。

Is there -- have you been able to see any kind of change in momentum or utilization in those regional geographies maybe where you do see some of those fair coverage changes make a positive impact on you?

您是否能夠看到這些區域的勢頭或利用率發生任何變化，也許您確實看到其中一些公平覆蓋範圍的變化對您產生了積極影響？

Yes. One of the challenges that we have is, as an example, with the Medicare change allowing nurse practitioners is then we -- now we have to go out and educate the nurse practitioners on the benefits of TMS and the NeuroStar treatment.

是的。舉例來說，我們面臨的挑戰之一是，隨著醫療保險的變化，允許執業護士——現在我們必須走出去，教育執業護士了解 TMS 和 NeuroStar 治療的好處。

So we have begun that process. The newest one was up in New England and we are seeing a lot of attention from the nurse practitioners in that region. So we are trying to expand the practitioners on a wider basis and then it's an education process.

所以我們已經開始了這個過程。最新的一項在新英格蘭啟動，我們看到該地區護士從業人員的大量關注。因此，我們正在努力擴大從業者的範圍，這是一個教育過程。

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

我們的下一個問題來自 Piper Sandler 的 Adam Maeder。

Congrats on the solid start. Maybe just a couple of follow-ups to Bill and Margaret's question. So I guess, first, just on the momentum in the business and kind of as you -- as we think about the guidance raised here coming out of Q1, just curious if you're willing to provide a little bit more color on how the business kind of progressed over the course of Q1 and the exit velocity that you saw kind of exiting March and into April on the treatment side? Just any more color you could provide there would be helpful. And then I had a follow-up or 2.

恭喜您有了良好的開端。也許只是比爾和瑪格麗特問題的幾個後續行動。因此，我想，首先，關於業務的發展勢頭，就像您一樣，當我們考慮第一季度提出的指導時，只是好奇您是否願意提供更多關於如何實現這一目標的信息。在第一季度的過程中，業務取得了一定的進展，並且您看到治療方面從三月到四月的退出速度？只要你能提供更多的顏色就會有幫助。然後我進行了一兩個後續行動。

One of the key metrics that we look at specifically in the first quarter, are the benefits investigations. Historically, we see a peak usually around the third week in January of around 375 to 400 benefits investigations, which is really a key metric because if a doctor is requesting a BI for their patients, it's usually a good indication that they're going to be treated with NeuroStar.

我們在第一季度特別關注的關鍵指標之一是效益調查。從歷史上看，我們通常在一月的第三週左右看到一個高峰，大約有 375 到 400 項福利調查，這確實是一個關鍵指標，因為如果醫生為他們的患者請求 BI，這通常是一個很好的跡象，表明他們將接受 NeuroStar 治療。

That peak is still peaking towards the end of April and into early May. And the team is still doing around 350 BIs this month. So that is the key indicator that there is no slowdown in site, which really goes in line with the historical performance of Q2 and Q3.

該峰值在四月底和五月初仍將達到頂峰。該團隊本月仍在完成大約 350 個 BI。所以這是網站沒有放緩的關鍵指標，這確實符合第二季度和第三季度的歷史表現。

And so once the deductibles and the programs are reset at the beginning of the year, there is a lot of administrative paperwork that has to occur by our physicians. But once that's behind them, the treatment session, again, historically really start to accelerate.

因此，一旦在年初重新設置免賠額和計劃，我們的醫生就必須完成大量的行政文書工作。但一旦這一切過去，治療過程再次從歷史上真正開始加速。

And that's what we've seen this quarter and into Q2. Again, the other metrics, we look at utilization. Another strong quarter really in every segment. The only segment that was down was the fixed price.

這就是我們在本季度和第二季度看到的情況。同樣，我們關注其他指標的利用率。每個細分市場又一個強勁的季度。唯一下降的部分是固定價格。

Those customers are historically the older ones. And so we're really targeting helping them, but also really focusing on that local consumable segment.

從歷史上看，這些客戶都是年紀較大的客戶。因此，我們真正的目標是幫助他們，但也真正關注當地的消費品市場。

And I guess my next question would be on Greenbrook. And I just wanted to make sure I had some of the specifics there in terms of number of systems that have been pulled from the field, number of systems that have been already placed at different centers and then how many are currently on the sidelines? And how do you think about those kind of going back into the field? And I have one more follow-up.

我想我的下一個問題將是關於格林布魯克。我只是想確保我掌握了一些具體信息，包括已從現場撤出的系統數量、已放置在不同中心的系統數量以及目前有多少系統處於觀望狀態？您如何看待重返該領域的情況？我還有一個後續行動。

So Greenbrook has announced that they're going to close 50 stores. They're in the 40s at the moment. Not all of those stores have completely shut down. They're still working their way through the patients that were in treatment. So we have moved several systems from stores that have completely shut down to active stores and we're continuing to do that.

因此 Greenbrook 宣布他們將關閉 50 家商店。他們現在40多歲了。並非所有這些商店都完全關閉。他們仍在努力治療正在接受治療的患者。因此，我們已將多個系統從完全關閉的商店轉移到活躍商店，並且我們將繼續這樣做。

We're able to monitor that because we are the ones that send a service engineer, pack it up and then reinstall it in the new stores.

我們能夠監控這一點，因為我們派出了服務工程師，將其打包，然後在新商店中重新安裝。

And then, maybe just one last one on reimbursement changes and specifically non-physician practitioners or NPPs. Just wanted to, I guess, get a little bit more of a level setting or baseline. What percentages of covered lives have this type of policy today? How do you think about that kind of trending over time? And is this something that impacts the business near term? Or do you think we need a little bit of time for just to kind of ultimately lift access?

然後，也許只是關於報銷變更的最後一項，特別是非醫生從業者或 NPP。我想，只是想獲得更多的水平設置或基線。如今，有多少比例的受保人擁有此類保單？您如何看待這種隨著時間推移的趨勢？這會影響近期的業務嗎？或者您認為我們需要一點時間才能最終到達電梯通道嗎？

Well, I think as we're able to provide education to the non-physician practitioners, I think we see a pickup in those nurse practitioners in particular. We have seen an increased number of nurse practitioners attend our NeuroStar summits to be educated on NeuroStar and how they would incorporate it into their practices.

嗯，我認為，由於我們能夠為非醫師從業人員提供教育，我認為我們特別看到那些護士從業人員的數量有所增加。我們看到越來越多的執業護士參加我們的 NeuroStar 峰會，接受 NeuroStar 教育以及如何將其納入自己的實踐。

So as far as covered lives, it's actually increasing as -- I think, as you know, when the Medicare Max adopt a new policy, then the commercial payers over time will adopt similar policy. So -- and that's just starting.

因此，就承保生命而言，它實際上正在增​​加——我認為，正如您所知，當 Medicare Max 採用新政策時，商業付款人隨著時間的推移將採用類似的政策。那麼——這才剛剛開始。

So I think we're encouraged by it. I think it opens up a whole new market for us. But we're at the infancy of educating this group of practitioners.

所以我認為我們對此感到鼓舞。我認為它為我們打開了一個全新的市場。但我們對這群從業者的教育還處於起步階段。

And our next question comes from the line of Daniel Stauder from JMP Securities.

我們的下一個問題來自 JMP 證券的 Daniel Stauder。

So just first off on the 100 incremental sites you introduced into your installed base. I'm assuming that's on a year-over-year basis. But just first off, could you give us an idea, how many of those were per-click sites?

因此，首先要介紹您在安裝基礎上引入的 100 個增量站點。我假設這是逐年計算的。但首先，您能否告訴我們，其中有多少是每次點擊網站？

And then secondly, could you just remind us on the timing as far as how long it typically takes to get a new or newer site ramped up to more typical treatment session run rate?

其次，您能否提醒我們一個新的或較新的站點通常需要多長時間才能達到更典型的治療療程運行率？

So Daniel, we introduced those 100 sites, all of them are per-click. We don't offer the fixed price anymore. So the accounts that were fixed price are [grandfathered] in, but any new accounts that we open up are all per-click.

丹尼爾，我們介紹了這 100 個網站，它們都是每次點擊的。我們不再提供固定價格。因此，固定價格的帳戶是[祖父]，但我們開設的任何新帳戶都是每次點擊。

And right now, from the time that they place the order to when they get on a regular run rate is somewhere around 90 to 180 days. It takes them to get to full strength. So there's a ramp-up period.

現在，從他們下訂單到達到正常運行速度大約需要 90 到 180 天。他們需要充分發揮力量。所以有一個磨合期。

In many cases, we have to help them get their credentials and get on to the payers. So it takes a little bit of time to get them ramped up.

在許多情況下，我們必須幫助他們獲得憑證並聯繫付款人。因此，需要一點時間來讓它們加速。

And then just one quick one. You touched on it a little bit before. But gross margin, you hit on some of the impacts as well as some of the accounting changes. But just how should we think about levels of gross margin as we look out through the rest of the year? Any cadence or additional commentary there would be much appreciated.

然後只是一個快速的。你之前已經觸及過它了。但是，就毛利率而言，您遇到了一些影響以及一些會計變化。但展望今年剩餘時間，我們應該如何看待毛利率水平呢？任何節奏或額外的評論將不勝感激。

Sure. Yes, the reclassification of the amortization expense, we're forecasting almost a 2-point hit to gross margins. We do see tailwinds with respect to margins as we work through the year.

當然。是的，攤銷費用的重新分類，我們預測毛利率將下降近 2 個百分點。在我們全年的工作中，我們確實看到了利潤率方面的順風車。

So as treatment sessions continue to accelerate and become a larger part of our revenue base, margins will increase. We also have some cost reduction strategies that we're working on that will lower the cost of goods on the system.

因此，隨著治療療程繼續加速並成為我們收入基礎的更大一部分，利潤率將會增加。我們還正在製定一些降低成本的策略，以降低系統上的商品成本。

And then I would say our operating expenses within cost of goods sold are consistent throughout the year. So as revenues increase, our margins will also increase. So we continue to expect mid to high 70s as we exit the year for gross margins and then continue to expand upon that into 2024.

然後我想說，我們的銷售成本中的運營費用全年都是一致的。因此，隨著收入的增加，我們的利潤也會增加。因此，當我們結束這一年的毛利率時，我們繼續預計毛利率將達到 70 多歲，然後繼續擴大到 2024 年。

This does conclude the question-and-answer session of today's program. I'd like to hand the program back to Keith Sullivan for any further remarks.

今天節目的問答環節到此結束。我想將程序交還給 Keith Sullivan 以供進一步評論。

Thank you, operator. Thank you again for joining us today. We look forward to updating you on our next quarterly call.

謝謝你，接線員。再次感謝您今天加入我們。我們期待在下一次季度電話會議上向您通報最新情況。

Thank you, ladies and gentlemen, for your participation in today's conference. This does conclude the program. You may now disconnect. Good day.

女士們、先生們，感謝你們參加今天的會議。這確實結束了該程序。您現在可以斷開連接。再會。