Neuronetics Inc (STIM) 2025 Q3 法說會逐字稿

Good day, and thank you for standing by. Welcome to the Neuronetics third-quarter 2025 earnings conference call. (Operator Instructions) Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Mark Klausner, Investor Relations. Please go ahead.

大家好，感謝您的耐心等待。歡迎參加Neuronetics 2025年第三季財報電話會議。 （操作說明）請注意，本次會議正在錄音。現在我將會議交給今天的第一位發言人，投資者關係部的Mark Klausner先生。請開始。

Good morning, and thank you for joining us for the Neuronetics third-quarter 2025 conference call. Joining me on today's call are Neuronetics’ President and Chief Executive Officer, Keith Sullivan; and Steven Pfanstiel, Neuronetics’ Chief Financial Officer. Before I 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 Greenbrook integration and other operational issues and metrics.

早安，感謝各位參加Neuronetics 2025年第三季電話會議。今天與我一同出席會議的有Neuronetics總裁兼執行長Keith Sullivan先生，以及Neuronetics財務長Steven Pfanstiel先生。在會議開始之前，我想提醒各位聽眾，管理層在本次電話會議中討論的某些資訊將包含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、財務和收入預期、Greenbrook整合以及其他營運問題和指標相關的陳述。

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 a discussion of risks and uncertainties associated with the Neuronetics business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's quarterly report on Form 10-Q, which was filed premarket today.

由於公司業務存在風險和不確定性，實際結果可能與這些前瞻性聲明中明示或暗示的結果有重大差異。如需了解與Neuronetics業務相關的風險和不確定性，我建議您查閱公司向美國證券交易委員會提交的文件，包括公司今天盤前提交的10-Q季度報告。

The company disclaims any obligation to update any forward-looking statements made during the course of this call, except as required by law. 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 US GAAP financial measures provide useful information for both management and investors by excluding certain noncash 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. Reconciliations between US GAAP and non-GAAP results are presented in the tables accompanying our press release, which can be viewed on our website. With that, it's my pleasure to turn the call over to Neuronetics' President and Chief Executive Officer, Keith Sullivan.

除法律另有規定外，本公司不承擔更新本次電話會議中任何前瞻性陳述的義務。在本次電話會議中，我們還將討論一些非公認會計準則（非GAAP）下的財務信息，包括EBITDA。管理階層認為，結合美國公認會計準則（US GAAP）財務指標來看，非GAAP財務資訊能夠排除某些非現金支出和其他無法反映公司經營績效趨勢的費用，從而為管理層和投資者提供有用的信息。管理階層使用非GAAP財務指標來比較公司績效與預測和策略計畫的差距，並將公司績效與外部競爭對手進行基準比較，並用於某些薪酬決策。美國公認會計準則和非GAAP績效的調節表已在新聞稿隨附的表格中列出，您可以在我們的網站上查看這些表格。接下來，我很高興將電話會議交給Neuronetics總裁兼執行長Keith Sullivan先生。

Thanks, Mark. Good morning, and thank you for joining us today. I'll begin by providing an overview of the third quarter performance and key operational updates. Steve Pfanstiel will then review our financial results, and I will conclude with some comments before turning to Q&A. In the third quarter, we built real momentum as we work through the integration and optimization of our combined operations. We are finding opportunities to improve efficiencies, take advantage of our scale and streamline operations to capture the full value of the combined businesses. Our recently announced partnership with Elite DNA is a great example of this, which I'll provide more details on later in the call.

謝謝，馬克。早安，感謝您今天參加我們的電話會議。首先，我將概述第三季的業績和關鍵營運更新。之後，史蒂夫普凡斯蒂爾將回顧我們的財務業績，最後我將作一些總結，然後進入問答環節。第三季度，隨著我們整合和優化合併後的運營，我們取得了顯著進展。我們正在尋找提高效率、利用規模優勢和精簡營運的機會，以充分發揮合併後業務的價值。我們最近宣布與Elite DNA建立合作關係就是一個很好的例子，稍後我將在電話會議中詳細介紹。

Total revenue was $37.3 million, up 11% on a pro forma basis compared to prior year quarter. This growth was primarily driven by strong performance at our Greenbrook clinics, which generated $21.8 million in revenue, up 25% on an adjusted pro forma basis compared to the prior year quarter. Our integration efforts are delivering high treatment volumes across the NeuroStar TMS and SPRAVATO patients. Within the NeuroStar business, we had a solid quarter for system sales with 40 systems shipped, an average selling price above our target for the third quarter in a row. That tells us customers see real value in our technology and support. Importantly, total NeuroStar treatment session utilization in the third quarter grew 11% versus the prior year on a pro forma basis.

總營收為3,730萬美元，以備考基準計算，較上年同期成長11%。這一成長主要得益於Greenbrook診所的強勁表現，該診所創造了2,180萬美元的收入，以調整後的備考基準計算，較上年同期成長25%。我們的整合工作正在為NeuroStar TMS和SPRAVATO患者帶來高治療量。在NeuroStar業務方面，我們本季系統銷售表現穩健，共交付40套系統，平均售價連續第三個季度高於目標價。這顯示客戶認可我們的技術和支援所帶來的真正價值。值得注意的是，第三季NeuroStar治療療程總使用量以備考基準計算，較上年同期成長11%。

Beyond our revenue performance, we made significant strides on our path to cash flow positivity. That progress comes from careful expense management and better cash collections. Now turning to an update on our achievements during the third quarter. First, our Greenbrook growth strategy delivered strong results and continues to be a significant opportunity moving forward. Contributing to the growth is our regional account manager or RAM program. The optimization of the RAMs continues to produce results. As part of the initiative to build awareness among referring physicians, we executed a targeted outreach campaign during the third quarter. We quickly scheduled over 350 physician meetings for our RAM team, most of which took place in the third quarter, with the remainder in the fourth quarter. These educational sessions are already building awareness and driving results.

除了營收表現之外，我們在實現現金流為正方面也取得了顯著進展。這項進展得益於嚴格的費用管理和更有效率的現金回收。現在，讓我們來看看第三季所取得的成就。首先，我們的Greenbrook成長策略取得了強勁的成效，並且在未來仍將是一個重要的發展機會。區域客戶經理（RAM）專案為這一成長做出了貢獻。 RAM的優化工作持續取得成效。為了提高轉診醫師對我們服務的認知度，我們在第三季進行了一項有針對性的推廣活動。我們迅速為RAM團隊安排了超過350場醫生會議，其中大部分在第三季舉行，其餘的則在第四季舉行。這些培訓課程已經開始提升醫生的認知度並推動績效成長。

To build on this momentum, we have dedicated two full-time intake team members to this effort, equipping them with educational materials that will make it simple for the physicians to refer patients to Greenbrook clinics. We have also seen notable enhancement in patient conversion rates through the coordination of automated patient transfer process, QR codes and the Greenbrook intake team. This process engages patients while they are still at the referring physician's office, which significantly increases the likelihood that they will follow through with the treatment in a Greenbrook clinic.

為了鞏固這一勢頭，我們專門安排了兩名全職接診團隊成員負責這項工作，並為他們配備了教育材料，以便醫生能夠輕鬆地將患者轉診至格林布魯克診所。我們也看到，透過協調自動化病患轉診流程、二維碼和格林布魯克接診團隊，病患轉換率顯著提高。這個流程讓患者在轉診醫生的診間就能參與其中，這大大提高了他們在格林布魯克診所接受治療的可能性。

In the third quarter alone, patients referred through the RAMs totaled more than 2,200. Our SPRAVATO rollout remains on track with 84 of the 89 SPRAVATO-eligible clinics now offering the therapy, and we are on pace for a full rollout by year-end. As we scale the program, we learned a lot about the economics of billing methods of Buy & Bill versus administer and observe across our network, mainly that reimbursement varies by contract, by state and by clinic. Based on these insights, we have expanded Buy & Bill where the economics are favorable. And this quarter, we added this billing method in Connecticut, Texas, Missouri, California and Virginia. We can now use the best model for each patient and location, allowing us to drive increased sequential SPRAVATO treatment session volume while delivering stronger margins. Turning to our second focused area, our Better Me Provider Program.

光是第三季度，透過RAMs轉診的患者總數就超過2,200人。我們的SPRAVATO推廣計畫進展順利，89家符合SPRAVATO資格的診所中已有84家提供該療法，我們預計在年底前全面推廣。隨著專案規模的擴大，我們對「購買並結算」（Buy & Bill）和「管理並觀察」（administration and observation）兩種計費方式的經濟效益有了更深入的了解，主要體現在報銷金額因合約、州和診所而異。基於這些洞察，我們在經濟效益有利的地區推廣了「購買並結算」模式。本季度，我們在康乃狄克州、德州、密蘇裡州、加州和維吉尼亞州新增了這種計費方式。現在，我們可以根據每位患者和每個地點的具體情況選擇最佳模式，從而在提高SPRAVATO治療療程數量的同時，實現更高的利潤率。接下來，我們將重點介紹我們的第二個領域—「更好的自我」（Better Me）醫療服務提供者計畫。

This remains a key growth driver. We now have nearly 425 active BMP sites with another 100 sites working towards qualification. The numbers prove this works. BMP sites respond to patients faster and are more knowledgeable about NeuroStar TMS, resulting in them treating significantly more patients per quarter than the non-BMP practices. Our NeuroStar Provider Connection program keeps building momentum. As I mentioned last quarter, this program takes what is working at Greenbrook and applies it to our NeuroStar customers. Through this initiative, our practice development managers are building awareness of NeuroStar TMS within primary care settings, where 69% of patients with depression are currently being treated.

這仍然是關鍵的成長驅動力。我們目前擁有近 425 家活躍的 BMP 認證機構，另有 100 家機構正在努力獲得認證。數據證明這種模式行之有效。 BMP 認證機構能夠更快地回應患者需求，並且對 NeuroStar TMS 有更深入的了解，因此每季治療的患者數量顯著高於非 BMP 認證機構。我們的 NeuroStar 供應商連接計劃持續發展壯大。正如我在上個季度提到的，該計劃借鑒了 Greenbrook 的成功經驗，並將其應用於我們的 NeuroStar 客戶。透過這項計劃，我們的診所發展經理正在基層醫療機構中推廣 NeuroStar TMS，目前 69% 的憂鬱症患者都在基層醫療機構接受治療。

Since we launched this program in April, we have hosted over 300 primary care physician meetings, educating approximately 3,000 providers on NeuroStar TMS and the results it can deliver for their patients. The impact has been significant. Many of these doctors did not know about NeuroStar TMS and are now excited to have a new option for patients who have not responded to antidepressants. We do not just educate them about NeuroStar TMS, we help connect them with the NeuroStar provider in their area. Many of the primary care physicians we talk to prefer to send patients to the BMP sites because of their commitment to patient responsiveness and education. The feedback I have heard from our customers validates this approach. For example, Dr. Ken Pages, who operates a private practice in Tampa, Florida, told us that the NeuroStar Provider Connection Program has been the most valuable resource we have offered to help grow his practice.

自四月啟動此計畫以來，我們已舉辦了超過300場初級保健醫生會議，向約3,000名醫生介紹了NeuroStar TMS及其為患者帶來的療效。此項目的影響顯著。許多醫生先前並不了解NeuroStar TMS，現在他們很高興能為那些對抗憂鬱藥物無效的患者提供新的治療選擇。我們不僅向他們普及NeuroStar TMS，還幫助他們聯繫所在地區的NeuroStar供應商。我們交流過的許多初級保健醫生都更傾向於將患者轉診至BMP中心，因為這些中心致力於以患者為中心，並提供良好的教育。我從客戶那裡得到的回饋也證實了這種方法的有效性。例如，在佛羅裡達州坦帕經營私人診所的Ken Pages醫生告訴我們，NeuroStar供應商對接計畫是我們提供的最有價值的資源，幫助他拓展了診所業務。

He explained that having our representative personally visit local psychiatrists, therapists and primary care office to share information about NeuroStar TMS has been a home run for his business. Dr. Pages noted that for providers who have never heard of NeuroStar TMS, it is a great introduction. And for those who have referred to him in the past, it serves as a helpful reminder to keep their treatment option in mind for patients who could benefit from it. In addition to our outbound cold calling team, we have also launched a direct-to-provider ad campaign that has generated significant interest from PCPs who have requested a meeting with our local NeuroStar practice development manager.

他解釋說，我們的代表親自拜訪當地精神科醫生、治療師和初級保健診所，介紹NeuroStar TMS，這對他的業務發展起到了非常積極的作用。 Pages醫生指出，對於從未聽說過NeuroStar TMS的醫療服務提供者來說，這是一個絕佳的介紹機會。而對於過去曾向他轉診過的醫師來說，這也提醒他們，對於可能從中受益的患者，也應該考慮這種治療方案。除了我們的外呼團隊之外，我們還發起了一項直接面向醫療服務提供者的廣告宣傳活動，該活動引起了初級保健醫生的極大興趣，他們紛紛要求與我們當地的NeuroStar業務拓展經理會面。

Now turning to our third strategic priority, operational excellence and cash optimization. We made real progress here this quarter. Since closing the Greenbrook acquisition, we have been improving efficiency across the network and several initiatives are driving results. For example, our self-check-in kiosks. As of mid-November, the kiosks are live in over 30 centers. More locations are coming online each week, and we are on track for a full network rollout by mid-November. Adoption has been exceptional. Nearly every patient uses the kiosk for check-in and payment. The impact was immediate. Sites saw an increase in collection in the first week after installation. We have integrated the kiosks with our EMR system, so paperwork gets completed right on the kiosk.

現在來談談我們的第三項策略重點：卓越營運和現金流優化。本季我們在這方面取得了顯著進展。自從完成對Greenbrook的收購以來，我們一直在提升整個網路的效率，多項措施正在推動成效。例如，我們的自助登記亭。截至11月中旬，已有超過30家中心啟用了自助登記亭。每週都有更多地點上線，我們預計在11月中旬實現全網推廣。自助登記亭的普及率非常高。幾乎所有患者都使用自助登記亭進行登記和支付。效果立竿見影。安裝後的第一周，各站點的收款額就有所提高。我們已將自助登記亭與電子病歷系統集成，因此所有文書工作都可以在自助登記亭上直接完成。

Check-in is faster. Front desk bottlenecks are reduced, and this enables our staff to focus more on direct patient care. The feedback has been positive. These tools led our technicians and intake coordinators to care for more patients daily without adding headcount. We also plan to leverage AI and digital forms in the intake process. These tools will reduce the traditional 45-minute consultation call by enabling patients to enter personal health information on their own time from home, reducing the friction and improving the patient experience while freeing up resources. While technology is enabling efficiency, we are also taking a hard look at our organizational structure.

登記速度更快了。前台瓶頸減少，使我們的員工能夠更專注於直接的病患照護。反饋非常正面。這些工具使我們的技術人員和接診協調員能夠在不增加人手的情況下，每天照顧更多患者。我們也計劃在接診流程中利用人工智慧和電子表格。這些工具將使患者能夠在家中自行填寫個人健康訊息，從而減少傳統的45分鐘諮詢電話，降低就診難度，改善患者體驗，同時釋放資源。在科技提高效率的同時，我們也正在認真審視我們的組織結構。

Last quarter, I mentioned that we had brought in a consultant to review operations across the Greenbrook network. That review found opportunities to eliminate overlapping responsibilities and reduce management layers. Many of these changes are being implemented. For example, we have moved staff from our intake team to our provider connection group to support growth initiatives without additional headcount. We have identified several other opportunities that will be implemented in the fourth quarter. Revenue cycle management has been a major priority, and we are seeing real gains. We have accelerated collection timing compared to earlier quarters. We are also shifting more patient payments to time of service through the kiosks, which speed up cash collections.

上個季度，我提到我們聘請了一位顧問對格林布魯克醫療網路的運作進行審查。審查發現了一些可以消除職責重疊和精簡管理層級的機會。許多此類調整正在實施中。例如，我們已將部分員工從接診團隊調至供應商聯絡團隊，以在不增加人手的情況下支援業務成長計畫。我們也確定了其他一些將在第四季度實施的調整方案。收入週期管理一直是我們的重中之重，我們已經看到了顯著成效。與前幾季相比，我們的收款速度明顯加快。此外，我們也將更多病患付款方式改為透過自助服務終端在就診時支付，從而加快了現金回收速度。

For the first time, we collected more cash in the quarter than we booked as revenue in the quarter. That is real proof that the improvements we have made are working. While we have made progress, we are not done. The entire executive team is dedicated to further improvements. Beyond these three priorities, we also focused on expanding treatment access and advancing our clinical evidence. We recently submitted a filing to the FDA, which would broaden the eligible patient population. I'm also pleased to share that as of October 1, New York State Medicaid began covering NeuroStar TMS therapy for adults with major depressive disorder, expanding access to over 5 million members statewide.

本季我們首次實現了現金流入超過營收，這有力地證明了我們所做的改進措施正在奏效。儘管我們取得了進展，但這並非終點。整個管理團隊致力於進一步提升服務品質。除了這三項重點工作之外，我們還著重擴大治療覆蓋範圍並推動臨床證據的累積。我們近期已向美國食品藥物管理局 (FDA) 提交申請，旨在擴大符合條件的患者群體。此外，我很高興地宣布，自 10 月 1 日起，紐約州醫療補助計劃 (Medicaid) 已開始為患有重度憂鬱症的成年人提供 NeuroStar TMS 療法，使全州超過 500 萬名投保人員受益。

Together, these regulatory and reimbursement advancements show growing recognition of NeuroStar TMS as an effective treatment option and reflect our commitment to making sure patients who need NeuroStar therapy can access it. To wrap up, our third quarter results demonstrate solid execution across our priorities. The Greenbrook integration keeps beating our expectations. The BMP program is scaling effectively, and our operational improvements are producing progress towards cash flow positivity. I am confident in our team's ability to execute and in the value we are creating for both patients and shareholders. I'd like to turn the call over to our CFO, Steve Pfanstiel, for a financial update.

這些監管和報銷方面的進展共同表明，NeuroStar TMS作為一種有效的治療方案正日益獲得認可，也體現了我們致力於確保所有需要NeuroStar療法的患者都能獲得治療的承諾。總而言之，我們第三季的業績表明，我們在各項優先事項上都取得了穩健的執行。 Greenbrook的整合工作持續超乎預期。 BMP專案正在有效擴展，而我們的營運改善也正朝著實現現金流為正的目標邁進。我對我們團隊的執行能力以及我們為患者和股東創造的價值充滿信心。接下來，我將把電話交給我們的財務長Steve Pfanstiel，請他介紹一下財務方面的最新情況。

Thanks, Keith, and good morning, everyone. Unless otherwise noted, all performance comparisons are being made for the third quarter of 2025 versus the third quarter of 2024. Total revenue in the third quarter of 2025 was $37.3 million, an increase of 101% compared to the revenue of $18.5 million in the third quarter of 2024. The increase is primarily driven by the inclusion of Greenbrook operations following our acquisition in December 2024. On an adjusted pro forma basis, which includes adjusting for both the impact of the Greenbrook acquisition and site closures, third quarter revenue in 2025 increased by 11% versus the prior year.

謝謝基思，大家早安。除非另有說明，所有業績比較均以2025年第三季與2024年第三季為基準。 2025年第三季總營收為3,730萬美元，較2024年第三季的1,850萬美元成長101%。成長主要得益於我們在2024年12月收購Greenbrook後，將其業務納入營收計算。經調整後的備考基準（包括對Greenbrook收購和站點關閉的影響進行調整）顯示，2025年第三季營收較上年同期成長11%。

Total revenue from our NeuroStar business, which includes our system revenue as well as our treatment session revenue was $15.5 million in the third quarter of 2025. On a pro forma basis, taking into account the impact of the intercompany revenue, this represents a decrease of 4% versus the prior year. The change was primarily driven by the previously announced realignment of our capital team to focus on strategic higher growth accounts and a change in customer purchasing patterns for treatment sessions in 2025 versus 2024. US NeuroStar System revenue was $3.5 million in the third quarter of 2025 and included shipment of a total of 40 systems.

2025年第三季度，我們NeuroStar業務的總收入（包括系統收入和治療療程收入）為1550萬美元。以備考基準計算，併計入公司間收入的影響，該數字較上年同期下降4%。這項變更主要源自於先前宣布的資本團隊重組，旨在專注於策略性高成長客戶，以及2025年客戶治療療程的購買模式與2024年相比發生了變化。 2025年第三季度，美國NeuroStar系統營收為350萬美元，共出貨40套系統。

The third quarter also represented our third consecutive quarter of system ASP greater than our target, demonstrating the value of our system and its features. US treatment session revenue was $10.5 million in the third quarter of 2025. As Keith mentioned, third quarter NeuroStar treatment session utilization increased 11% versus the prior year and treatment session purchases in the third quarter were closely aligned with utilization.

第三季也是我們系統平均售價連續第三個季度超過目標，這充分體現了我們系統及其功能的價值。 2025年第三季度，美國治療療程收入為1,050萬美元。正如Keith所提到的，第三季NeuroStar治療療程的使用率較上年同期成長了11%，且第三季的治療療程購買量與使用率基本一致。

The decrease in third quarter treatment session revenue versus the prior year is largely due to the impact of a change in customer purchasing patterns, which led to increased customer inventory levels during 2024. US clinic revenue was $21.8 million for the 3 months ended September 30, 2025, a 25% adjusted pro forma increase, driven by growth in treatment sessions across both NeuroStar TMS and SPRAVATO patients. SPRAVATO volumes were up sequentially in the third quarter versus the second quarter, while we also shifted to a higher percentage of administer and observed compared to Buy & Bill. This reflects our strategy of optimizing our SPRAVATO offering to drive the strongest profitability, which we evaluate on a by-state, payer and clinic basis. Gross margin was 45.9% compared to 75.6% in the prior year quarter. This change in gross margin was primarily a result of the inclusion of Greenbrook's clinic business, which operates at a lower margin.

第三季治療療程收入較上年同期下降，主要原因是客戶購買模式的變化導致2024年客戶庫存水準上升。截至2025年9月30日的三個月，美國診所營收為2,180萬美元，經調整後較去年同期成長25%，主要得益於NeuroStar TMS和SPRAVATO患者治療療程數量的成長。 SPRAVATO治療量在第三季度環比增長，同時我們也提高了「管理觀察」模式的比例，而非「購買併計費」模式。這體現了我們優化SPRAVATO產品以實現最高獲利能力的策略，我們根據各州、各支付方和各診所的情況進行評估。毛利率為45.9%，而上年同期為75.6%。毛利率的下降主要是由於納入了Greenbrook的診所業務，該業務的毛利率較低。

Operating expenses during the quarter were $24.4 million, an increase of $2.7 million or 12% compared to $21.7 million in the third quarter of 2024. The increase was primarily attributable to the inclusion of Greenbrook. During the quarter, we incurred approximately $1.4 million of noncash stock-based compensation expense. Net loss for the quarter was $9.4 million or $0.13 per share as compared to a net loss of $13.3 million or $0.44 per share in the prior year quarter. Third quarter 2025 EBITDA was negative $6.4 million as compared to negative $11.6 million in the prior year. Turning to the balance sheet. As of September 30, 2025, total cash was $34.5 million, consisting of cash and cash equivalents of $28 million and restricted cash of $6.5 million. As previously communicated in our August earnings call, we became eligible and received an additional $10 million of funding under our existing debt agreement with Perceptive Advisors. We became eligible for those funds as a result of achieving required revenue conditions under the Tranche 2 funds.

本季營運費用為2,440萬美元，較2024年第三季的2,170萬美元增加270萬美元，增幅為12%。此成長主要歸因於Greenbrook的併入。本季度，我們產生了約140萬美元的非現金股權激勵費用。本季淨虧損為940萬美元，即每股虧損0.13美元，而上年同期淨虧損為1,330萬美元，即每股虧損0.44美元。 2025年第三季EBITDA為負640萬美元，去年同期為負1,160萬美元。接下來是資產負債表。截至2025年9月30日，現金總額為3,450萬美元，其中包括現金及現金等價物2,800萬美元及受限現金650萬美元。正如我們在8月份的財報電話會議上所溝通的，我們根據與Perceptive Advisors的現有債務協議，獲得了額外的1000萬美元融資。我們之所以符合獲得這筆資金的條件，是因為我們達到了第二期基金規定的收入目標。

We remain eligible for an additional $5 million of funds under the Tranche 2 funds. Additionally, within the third quarter, a total of 2.3 million shares were sold through the company's at-the-market facility, contributing net proceeds of $8 million. The addition of these funds strengthens our cash position, providing us with strategic financial flexibility for the future. Turning to cash flow. I am very pleased with our progress this quarter. Our cash used in operations for the third quarter was $0.8 million, which represents our second consecutive quarter of substantial improvement. To put this in perspective, our operating cash burn has decreased from $17 million in Q1 to $3.5 million in Q2 and now just $0.8 million in Q3. This steady sequential improvement validates the operational initiatives we have implemented. The progress reflects multiple factors coming together.

我們仍有資格獲得第二期基金項下的額外500萬美元資金。此外，在第三季度，公司透過市場交易機制共售出230萬股股票，淨收益達800萬美元。這些資金的注入增強了我們的現金儲備，為我們未來的策略財務彈性提供了保障。接下來談談現金流。我對本季的進展非常滿意。第三季營運現金流出為80萬美元，這是我們連續第二季實現顯著改善。具體而言，我們的營運現金消耗已從第一季的1700萬美元降至第二季的350萬美元，而第三季僅為80萬美元。這項持續的改善驗證了我們所實施的營運措施的有效性。這項進展是多種因素共同作用的結果。

Revenue cycle management improvements are accelerating the timing of current collections as well as ensuring collection of longer age receivables. Additionally, expense discipline is paying off and operational efficiencies across Greenbrook and Neuronetics are taking hold. Now turning to guidance. For the fourth quarter, we expect net revenue of between $40 million to $43 million. For the full year 2025, we now expect total revenue of between $147 million and $150 million compared to previous guidance of $149 million and $155 million. The change in guidance is primarily driven by our expectations around SPRAVATO Buy & Bill usage. As we have learned more about the state and payer reimbursement dynamics, we have adjusted our SPRAVATO offering to include the Buy & Bill option only where reimbursement makes financial sense to do so. For gross margin, we now expect our full year to be between 47% and 49% versus our prior guidance of approximately 48% to 50%.

收入週期管理的改善正在加快當前應收帳款的回收速度，並確保較長的帳齡應收帳款回收。此外，成本控制正在取得成效，Greenbrook 和 Neuronetics 的營運效率正在逐步提高。接下來是業績展望。我們預計第四季淨收入將在 4,000 萬美元至 4,300 萬美元之間。對於 2025 年全年，我們現在預計總收入將在 1.47 億美元至 1.5 億美元之間，而先前的預期為 1.49 億美元至 1.55 億美元。業績展望的調整主要源自於我們對 SPRAVATO 購買與結算 (Buy & Bill) 服務使用的預期。隨著我們對各州和支付方報銷機制的了解不斷深入，我們調整了 SPRAVATO 產品，僅在報銷具有經濟效益的情況下才提供購買與結算選項。在毛利率方面，我們現在預計全年毛利率將在 47% 至 49% 之間，而先前的預期約為 48% 至 50%。

The change is driven by a shift in the overall mix of the business. We continue to project operating expenses of between $100 million and $105 million for the full year. We continue to target positive cash flow from operations in the fourth quarter of 2025 with a projected range of between $2 million of positive and $2 million of negative operating cash flow. We further project year-end 2025 total cash, consisting of cash, cash equivalents and restricted cash to be in the range of $32 million and $36 million. I will now turn it back to Keith for his closing remarks.

這項變化是由公司整體業務結構的調整所驅動的。我們繼續預計全年營運支出將在1億美元至1.05億美元之間。我們繼續以2025年第四季實現正的經營活動現金流為目標，預計經營活動現金流為正200萬美元至負200萬美元。我們也預計2025年底的總現金（包括現金、現金等價物和受限現金）將在3,200萬美元至3,600萬美元之間。現在我將把發言權交還給基思，請他作總結發言。

Thank you, Steve. Looking ahead, we are focused on driving growth across the business while being smart stewards of capital and cash collections. Before I end, I want to highlight 2 exciting near-term opportunities within the NeuroStar business. As outlined in last year's Q3 earnings call, one of the key benefits of the Greenbrook transaction is that our scale allows us to provide broader service offerings to all of our customers.

謝謝史蒂夫。展望未來，我們將專注於推動業務全面成長，同時謹慎管理資本和現金回收。在結束之前，我想重點介紹NeuroStar業務中兩個令人振奮的近期機會。正如去年第三季財報電話會議所述，Greenbrook交易的關鍵優勢之一在於，我們的規模優勢使我們能夠為所有客戶提供更廣泛的服務。

By leveraging our central intake center operation, we can help manage patient calls and education more efficiently, potentially increasing conversion rates and reducing the administrative burden required to meet the demands of NeuroStar TMS. Late in the third quarter, we finalized a three-year agreement to be the sole provider of TMS systems within Elite DNA Behavioral Health, one of Florida's largest and fastest-growing mental health networks, which has over 30 clinics. As part of this agreement, through a new wholly-owned subsidiary, we would utilize the intake center to pilot a fee-for-service offering to Elite DNA, which would include processing patient PHQ-10 responses as well as conducting and scheduling consultations and preassessments. In another important partnership, we deepened our relationship with Transformations Care Network, which operates 72 clinics in the Northeastern United States.

透過利用我們的中央接診中心運營，我們可以更有效率地管理患者來電和健康教育，從而提高轉換率，並減輕滿足NeuroStar TMS需求所需的行政負擔。第三季末，我們最終敲定了一項為期三年的協議，成為佛羅裡達州最大、發展最快的心理健康網絡之一——Elite DNA Behavioral Health（擁有30多家診所）的TMS系統獨家供應商。作為該協議的一部分，我們將透過一家新成立的全資子公司，利用接診中心試點向Elite DNA提供按服務收費的服務，包括處理患者的PHQ-10問卷調查結果，以及進行和安排諮詢和預評估。在另一項重要的合作中，我們深化了與Transformations Care Network的合作關係，該機構在美國東北部經營72家診所。

Through our service offerings, we can accelerate time to treatment for patients by leveraging the Greenbrook Intake Center's expertise in performing benefits investigations. These partnerships will expand NeuroStar's footprint and will bring advanced NeuroStar TMS access to thousands of patients through a scalable, systemized model of care. Before we open up the call for questions, I would like to comment on the announcement today that I intend to retire from Neuronetics on June 30, 2026. I'm extremely proud of what we have accomplished in the five-plus years with the company.

透過我們的服務，我們可以藉助格林布魯克接診中心在福利調查方面的專業知識，加快患者接受治療的速度。這些合作關係將擴大NeuroStar的業務範圍，並透過可擴展、系統化的護理模式，為成千上萬的患者帶來先進的NeuroStar TMS治療。在正式開始提問環節之前，我想就今天宣布的我將於2026年6月30日從Neuronetics退休一事發表一些看法。我為過去五年多來我們在公司的成就感到無比自豪。

These accomplishments include the acquisition of Greenbrook TMS, which has vertically integrated the company's value chain and the advancements of the NeuroStar TMS technology and the millions of treatments we have performed that have saved so many lives. Our performance in the third quarter, combined with the strength of our balance sheet has us entering the fourth quarter and 2026 with tremendous momentum and has the company well positioned for long-term growth.

這些成就包括收購 Greenbrook TMS，實現了公司價值鏈的垂直整合；NeuroStar TMS 技術的進步；以及我們已實施的數百萬例治療，挽救了無數生命。第三季的出色業績，加上我們穩健的資產負債表，使我們以強勁的勢頭進入第四季度和 2026 年，並為公司的長期成長奠定了堅實的基礎。

I am confident in the company's ability to execute on our priorities and create meaningful value for both our patients and our shareholders. I look forward to participating in the search for my successor and to working closely with the new CEO once on board to ensure a seamless transition. With that, I'd like to turn the call over to the operator for questions.

我對公司執行各項優先事項並為患者和股東創造實際價值的能力充滿信心。我期待參與尋找繼任者的工作，並在新任執行長上任後與其緊密合作，確保平穩過渡。接下來，我將把電話交給接線員，回答您的問題。

(Operator Instructions) William Plovanic, Canaccord Genuity.

（操作說明）William Plovanic，Canaccord Genuity。

Just to kick it off, I was wondering, definitely, you're seeing solid growth on pro forma in the Greenbrook sites and maybe less so in the former NeuroStar sites. I'm just kind of curious what's really driving those dynamics?

首先我想問一下，您確實看到Greenbrook站點的業績按備考數據實現了穩健增長，而之前的NeuroStar站點增長可能稍遜一籌。我只是好奇究竟是什麼因素導致了這種差異？

Yes, Bill, thanks for the question. I think on the Greenbrook side, certainly, we've given out kind of our clinic activity and looking at that quarter-over-quarter, you could see that's up nearly 28% year-over-year. I think that is leaning into SPRAVATO, inclusive of the Buy & Bill offering, although we're being very smart about how we optimize that. But also, we continue to see growth on the TMS segment as well. So I think in general, we've got the right clinics to be driving that growth. We're very focused on having a nice extra growth driver in SPRAVATO, especially with B&B. But we just see kind of continued strong growth in Greenbrook driving along.

是的，比爾，謝謝你的提問。就格林布魯克而言，我們已經公佈了診所的營運情況，從季度環比來看，比去年同期成長近28%。我認為這主要得益於SPRAVATO，包括「買入並結算」服務，儘管我們在優化這項服務方面做得非常出色。同時，我們也看到TMS業務持續成長。所以總的來說，我認為我們擁有合適的診所來推動成長。我們非常注重SPRAVATO的額外成長動力，尤其是「買入並結算」服務。但我們也看到格林布魯克業務持續強勁成長。

On the NeuroStar side of the business, I think the big thing to remember is we look at kind of, hey, what are the actual treatment utilization. So how many times of our systems being used year-over-year. What we're seeing is that's more than double digit year-over-year compared to Q3 a year ago. I think the change and why we're not seeing that happen translate to revenue growth is that this year, we're seeing those treatment session usage match the purchases. That makes sense. It means our customers are keeping a pretty steady level of treatment session inventory.

就NeuroStar的業務而言，我認為最重要的是要專注於實際的治療使用情況。也就是說，我們的系統每年的使用次數是多少？我們看到，與去年第三季相比，這一數字比去年同期成長了兩位數以上。我認為這種變化以及我們尚未看到收入成長的原因在於，今年的治療次數與購買量基本持平。這合乎情理。這意味著我們的客戶保持相當穩定的治療次數庫存水準。

This is different from 2024, where we saw customers strategically increasing inventory levels. Some of that was their own purchasing processes. There were some marketing, other incentives that drove a little bit of that. But particularly in Q3 of last year, we were still dealing with the impact of the Change Healthcare cyber events, which caused a lot of our customers to shift orders from Q2 into Q3. So in fact, while we're up utilization 11% year-over-year, that's more than offset by the fact that our customers in Q3 of last year bought 13% more than they utilized in Q3.

這與2024年的情況有所不同，當時我們看到客戶有策略地提高了庫存水準。部分原因是他們自己的採購流程，部分原因是行銷和其他激勵措施。但尤其是在去年第三季度，我們仍在應對Change Healthcare網路攻擊事件的影響，這導致許多客戶將訂單從第二季度轉移到了第三季度。因此，儘管我們的利用率年增了11%，但這被去年第三季客戶採購量比實際利用量高出13%這一事實所抵消。

So that's 11 days they increased inventory just in Q3 of last year. So that headwind is really kind of what's driving, I would say, the lack of translation of that utilization increase to the revenue side. I think the positive note is for us is as we enter 2026, we expect it will be with normalized inventory levels, and we wouldn't expect this kind of headwind to reoccur as we get into '26. We'll have normal kind of comparator periods.

所以，光是去年第三季度，他們就增加了11天的庫存。我認為，正是這種不利因素導致了產能利用率的提高未能轉化為營收成長。對我們來說，好消息是，我們預計進入2026年後，庫存水準將恢復正常，並且我們預計這種不利因素不會再次出現。屆時，我們將擁有正常的比較期。

Perfect. Okay. And then just on the gross margin dynamics, it's really been different, the reality or the outcomes versus what the expectations were at the time of the Greenbrook merger. And I'm just trying to figure out kind of what changed different than expected? And are there any onetime headwinds kind of hitting things today? How should we think about this?

好的。那麼就毛利率動態而言，實際情況與格林布魯克合併時的預期大相逕庭。我只是想弄清楚究竟是什麼導致了與預期不同的結果？目前是否存在一些一次性的不利因素？我們該如何看待這個問題？

Yes. I'll start with the general comment there. When I look at the margin, I really view it as we're kind of a mix of kind of a higher margin and a lower-margin business. If you look at the NeuroStar margins prior to the acquisition, go look Q3 year-to-date, you'd see that our GP margin was just under 75%, right in that mid-70% range. That cost structure for the NeuroStar business largely remains the same today. There's been no significant change there. So really, what's happened is we mixed in this Greenbrook acquisition with the clinic business, we know that's operating at a lower margin.

是的。我先從整體來說說起。就利潤率而言，我認為我們實際上是高利潤率業務和低利潤率業務的混合體。如果你查看收購前NeuroStar的利潤率，例如今年第三季至今的數據，你會發現我們的毛利率略低於75%，大概在70%左右。 NeuroStar的成本結構目前基本上保持不變，沒有發生重大變化。所以，實際上發生的情況是，我們將Greenbrook的收購與診所業務（我們知道診所業務的利潤率較低）混合在一起。

So the big piece in my mind is, okay, as you bring these together, it's understanding that revenue mix and how much are you growing on the NeuroStar side relative to Greenbrook. So trying to bring that together, it's somewhat a math, but really the big picture is what is that revenue mix that's going to drive ultimately that gross profit margin. Now with that said, in the quarter, if I compare, say, Q3 to Q2, we saw a slight decline of about 70 basis points in our overall margin. I would say between Q2 and Q3, these were smaller items, really not significant long-term drivers.

所以，在我看來，關鍵在於，當你把這些因素綜合起來時，要理解收入構成，以及NeuroStar業務相對於Greenbrook的成長情況。這其中涉及到一些數學計算，但更重要的是，最終決定毛利率的收入組成是什麼。話雖如此，如果將第三季與第二季進行比較，我們發現整體毛利率略微下降了約70個基點。我認為，第二季到第三季之間的這些因素影響較小，並非重要的長期驅動因素。

We had capital sales that were a little bit higher percent of the NeuroStar sales. We were still optimizing Buy & Bill in Q3. We had some carryover of patients where we know it's just not as advantageous from a reimbursement standpoint. And we had some revenue in Q3 from our Compass collaboration that we had revenue in Q2 that didn't repeat in Q3. If you just excluded that kind of episodic Compass revenue, that would account for 60 of the 70 basis point change we saw between Q2 and Q3. If I think long term, what I'm probably most excited about on the Greenbrook side is we see the opportunity to optimize SPRAVATO, making sure we stick with A&O where that makes financial sense and then expanding B&B where the reimbursement allows us to do that.

我們的資本銷售額佔NeuroStar銷售額的比例略高。第三季我們仍在優化「買進結算」（Buy & Bill）模式。我們有一些患者延續了先前的模式，我們知道從報銷角度來看，這種模式並不划算。此外，我們第三季從Compass合作專案中獲得了一些收入，而第二季也有這部分收入，但第三季沒有出現。如果排除這類Compass的臨時性收入，那麼這部分收入就能解釋我們第二季到第三季之間70個基點變動中的60個基點。從長遠來看，Greenbrook方面最讓我興奮的是，我們看到了優化SPRAVATO的機會，確保在財務上合理的情況下繼續採用A&O模式，然後在報銷允許的情況下擴展“買入並結算”（B&B）模式。

With the volumes we're seeing, we have some pretty significant leverage that we'll see in the 95 clinics. And that is our focus, getting those 95 clinics as efficient as possible, where we'll be able to leverage provider fees, which are a big part of that cost of goods. But also we're leaning into some of the automation and other things that I think are going to help us continue to drive high patient growth and high treatments, but also do that very cost effectively where we're not having to add cost and in some cases, hopefully reduce costs.

鑑於我們目前的業務量，我們在95家診所擁有相當大的議價能力。我們的重點是盡可能提高這95家診所的效率，從而有效利用供應商費用——這部分費用佔了我們營運成本的很大一部分。同時，我們也在積極推動自動化和其他一些舉措，我認為這些舉措將有助於我們繼續保持患者數量的快速增長和治療量的顯著提升，並且能夠以極具成本效益的方式實現這些目標，避免增加成本，甚至在某些情況下降低成本。

And then lastly, as I think about some of the operational efficiencies you announced that you're finding even a year later after the deal, I was wondering if you can quantify that for us. Is this another $2 million, another $5 million in cost savings? Because I mean you're so close to that cash flow positive, I mean it's a pretty important cost savings. So I'm just trying to wonder if you could quantify that for us. And Keith, I know you'll be around a couple more quarters, so I'm not saying goodbye yet.

最後，我想談談您之前宣布的一些營運效率提升措施，這些措施是在交易完成一年後才實現的。我想請您具體說明一下。這些措施能帶來200萬美元還是500萬美元的成本節約？因為你們離實現正現金流已經非常接近了，所以這筆成本節約相當可觀。因此，我想請您具體說明一下。另外，基思，我知道你還會在這裡待幾個季度，所以我現在還沒說再見。

Thanks, Bill.

謝謝你，比爾。

Yes, Bill, I don't think we've specified kind of the total full impact that we can have. We are leaning into, like I said, on a few places where we have -- automation is going to help us. I think the challenge here in the short term, maybe in the next quarter or two is there are some places where I think investment is going to make sense short term that's going to drive long-term efficiency here. So the clinic kiosks are one we've talked about that was cost to implement in Q3 and Q4, but that's going to make us more efficient from a scheduling collection standpoint. There's also additional automation we can do.

是的，比爾，我認為我們還沒有完全確定我們所能產生的全部影響。正如我所說，我們正在專注於一些領域——自動化將對我們有所幫助。我認為短期內，或許未來一兩個季度，我們面臨的挑戰是，在某些領域進行短期投資是有意義的，這將推動長期效率的提升。例如，我們之前討論過的診所自助服務終端，雖然在第三季和第四季實施成本較高，但它將使我們在預約收集方面更加有效率。此外，我們還可以進行其他自動化改造。

We've just started leaning into patient text alerts. I know that's been around for a little while, but we're adding that into our arsenal as well. So there's going to be investments in Q4 and probably even into Q1 that I think will offset some of those gains. Obviously, we guided -- kept the guidance the same on OpEx. But I do view it as long term, there's still a significant opportunity for cost reduction. And I think we'll provide more detail on that as we get towards next year.

我們最近開始大力推廣患者簡訊提醒。我知道這項技術已經存在一段時間了，但我們也正在將其納入我們的業務組合中。因此，第四季甚至可能第一季都會有一些投資，我認為這會抵消部分收益。顯然，我們維持了營運支出的預期。但我認為從長遠來看，成本降低的空間仍然很大。隨著我們接近明年，我們會提供更多細節。

Adam Maeder, Piper Sandler.

亞當梅德，派珀桑德勒。

This is Kyle Winborne on for Adam. Maybe just to try a little bit more on the treatment session revenue in the quarter. Even when you add back kind of the $2.2 million that was attributable to Greenbrook, it was still down year-over-year. And I understand some of the commentary there, maybe it's a little bit of a comp issue year-over-year with the inventory dynamic. Just curious maybe like what gives you confidence going forward that there's enough resources to kind of drive success in both this business and the Greenbrook business, just kind of to alleviate any worries that like there's a little bit of cannibalization going on there. Just any additional color would be helpful kind of as we think about the treatment session business going forward.

我是Kyle Winborne，替Adam發言。我想再詳細談談本季的治療服務收入。即使加上Greenbrook貢獻的220萬美元，年比仍然下降。我理解一些評論，這可能是由於庫存動態導致的同比數據差異。我很好奇，是什麼讓您對未來充滿信心，認為有足夠的資源來推動這項業務和Greenbrook業務的成功，從而消除任何關於兩家公司之間可能存在業務蠶食的擔憂。任何補充資訊都將對我們思考治療服務業務的未來發展有所幫助。

Yes, absolutely. I think the key piece, and we've added two slides to our investor presentation deck towards the back, but we are showing kind of quarterly trends on utilization for the NeuroStar system. And I mentioned that earlier. That's the key to me, are our systems being used more and more for specific treatment sessions, that utilization piece, the fact that we see it at around 11% year-over-year, and we expect to continue to see that type of growth, that gives me just a lot of confidence that we have momentum in this business, and it really is a comp issue that we're dealing with from last year. Otherwise, I wasn't seeing double-digit increases year-over-year, maybe I feel different.

是的，當然。我認為關鍵在於，我們在投資者簡報的後半部分增加了兩張投影片，展示了NeuroStar系統的季度使用趨勢。我之前也提到過這一點。對我來說，關鍵在於我們的系統是否越來越多地用於特定的治療療程，也就是使用率。我們看到其同比增長約11%，並且預計這種增長勢頭會持續下去，這讓我對我們業務的發展勢頭充滿信心。這其實是去年同期業績比較帶來的問題。否則，我並沒有看到兩位數的同比增長，也許我的看法會有所不同。

It's actually the same on the Greenbrook side. If you look, the clinic visits year-over-year are up almost 28% from Q3 a year ago. Again, that's an incredible momentum we have in the business, not just for SPRAVATO but TMS as well, continuing to grow. Those to me are the kind of the leading signals to say, hey, do I have a healthy business? Do I feel good about, hey, driving to increased revenue growth on the NeuroStar side, but maintaining a high revenue growth on the Greenbrook side. Those are the trends we look at, and that's the type of thing that gives us comfort that we're executing. We're still finding ways to take cost out but continue to drive top line growth.

實際上，Greenbrook方面的情況也是一樣。如果你看一下，診所就診量年增了近28%，比去年第三季成長了近28%。這再次證明了我們業務的強勁成長勢頭，不僅SPRAVATO如此，TMS業務也持續成長。對我來說，這些都是重要的訊號，可以判斷我的業務是否健康？我是否對NeuroStar業務的營收成長充滿信心，同時又能維持Greenbrook業務的高收入成長？這些都是我們關注的趨勢，也是讓我們確信我們正在執行正確策略的關鍵。我們仍在努力降低成本，同時繼續推動營收成長。

This is Keith. I also think a good indicator for us is what we're seeing on both the RAM referral side and the provider connection. Both of those are gaining traction within the primary care network, and we are seeing a large number of providers who are interested in sending their patients to either a Greenbrook clinic through the RAM program or through provider connection. So I think we have seen that when a provider refers a patient in, they show up at a much higher rate than a patient that we get off of our marketing. So it's very encouraging to see the adoption on both sides.

我是基斯。我認為，RAM轉診和醫護人員聯繫這兩個方面的情況都是一個很好的指標。這兩個方面在基層醫療網絡中都越來越受歡迎，我們看到許多醫護人員都有興趣透過RAM計畫或醫護人員聯繫將他們的病人轉診到格林布魯克診所。所以，我認為我們已經看到，醫護人員轉診的病人到診率遠高於我們透過市場推廣獲得的病人。因此，看到雙方的積極參與，我們感到非常鼓舞。

Super helpful color. And then maybe, I guess, last one for me on guidance, the $40 million to $43 million for Q4. I was curious if you could kind of just unpack the different businesses there. Just since this was a little bit below where we were and where the Street was for Q4, just would be helpful to kind of hear how you're thinking about the business trends for these different businesses looking out to the year-end.

顏色非常實用。最後，我想問的是關於業績指引的最後一個問題，就是第四季4000萬至4300萬美元的業績預期。我想請您詳細分析一下各個業務板塊的情況。因為這比我們先前的預期以及華爾街對第四季度的預測略低，所以很想聽聽您對這些業務部門在年底前的發展趨勢有何看法。

Yes, happy to share a little bit more color. Obviously, we guided to $40 million to $43 million for the fourth quarter, which translates to $147 million to $150 million for the full year. This really reflects, I think, just a couple of items. The biggest piece is really the impact of the SPRAVATO mix between A&O and B&B. We continue to see strong total SPRAVATO growth, but that mix between A&O and B&B is something we have to monitor. In the third quarter, A&O represented about 86% of our SPRAVATO volume. That was up 300 basis points from where we were in Q2. So obviously -- and that's a big revenue driver. In fact, if we had held our percentage of A&O flat from Q2 to Q3, our Q3 revenue would have been $38 million.

是的，很高興能分享更多細節。顯然，我們預計第四季營收為 4,000 萬美元至 4,300 萬美元，全年營收預計為 1.47 億美元至 1.5 億美元。我認為這主要反映了幾個因素。其中最主要的是 SPRAVATO 產品中 A&O 和 B&B 的比例變化。我們持續看到 SPRAVATO 整體銷售強勁成長，但 A&O 和 B&B 的比例變化是我們需要密切關注的。第三季度，A&O 產品約佔 SPRAVATO 總銷量的 86%，比第二季度成長了 300 個基點。顯然，A&O 是重要的營收驅動因素。事實上，如果我們保持 A&O 產品在第三季的佔比不變，第三季的營收將達到 3,800 萬美元。

So that's about a $0.75 million impact of shifting to a higher amount of A&O. We know A&O provides less revenue on a per patient basis. But with A&O, we don't have to cover the cost of the drug, handling the drug, inventory. And as we said, there's just times where B&B just doesn't make financial sense, we don't get the right margin return. So this $147 million to $150 million really reflects that shift of strategy to making sure we optimize that B&B offering. That's something we spent a lot of time on this past quarter, as Keith mentioned, the additional geographies that we're going to launch B&B here or just starting to launch in Q4. We wanted to be very deliberate and take our time on that. I was actually proud in Q3 of how quickly we were able to pivot and shift the percentage of A&O higher, moving in those regions where we just weren't getting the right return on B&B.

所以，轉向更高比例的A&O（替​​代和替代）模式大約會帶來75萬美元的影響。我們知道，A&O模式的單次患者收入較低。但A&O模式無需承擔藥品成本、藥品處理成本和庫存成本。正如我們所說，有時B&B模式在財務上並不划算，我們無法獲得理想的利潤回報。因此，這1.47億美元到1.5億美元的支出實際上反映了我們策略的轉變，即確保我們優化B&B模式的供應。正如Keith所提到的，這是我們上個季度投入大量精力的一項工作，包括我們將在哪些地區推出B&B模式，或在第四季開始推出。我們希望謹慎行事，不急於求成。事實上，我對第三季我們能夠如此迅速地調整策略，提高A&O模式的比例感到自豪，尤其是在那些B&B模式收益不佳的地區。

We moved that very quickly, much more quickly than actually I would have thought. So our updated guidance is really, I think, primarily driven by this assumption of how we see the A&O and B&B mix evolving for the SPRAVATO business. Other than that, I don't think there's a lot of impact from what we've been seeing on the NeuroStar side of the business. Q4 is generally a good growth driver on the NeuroStar side of the business. We do have a little bit of summer seasonality as you look at the month of July and into August. But there's also some positive capital seasonality we see here in Q4, just things lined up for people to do heavier purchases at year-end. So hopefully, that gives you a little color on the trends as we think about the fourth quarter and the full year.

我們迅速採取了行動，比我預想的要快得多。因此，我認為我們更新後的業績指引主要基於我們對SPRAVATO業務中A&O和B&B業務組合演變的預期。除此之外，我認為NeuroStar業務方面的情況不會產生太大影響。第四季通常是NeuroStar業務的良好成長動力。 7月和8月確實存在一些夏季季節性因素。但我們也看到第四季存在一些正面的資本季節性因素，人們會在年底進行更多採購。希望這些資訊能讓您對第四季和全年的趨勢有所了解。

Daniel Stauder, Citizens.

丹尼爾·施陶德，市民。

First question I have was just on operating expense. It looks like you're making good progress on the G&A line, but I wanted to ask how we should be thinking about the sales and marketing spend, both as we contemplate fourth quarter and 2026. So from our understanding, the provider connection program should be a more efficient use of your marketing dollar, but just wanted to ask your broader thoughts on this spend and any strategy you have going forward.

我的第一個問題是關於營運費用的。看起來你們在一般及行政費用方面進展順利，但我想請教一下，在考慮第四季度和2026年銷售和市場營銷支出時，我們應該如何看待這部分支出。據我們了解，供應商連結計畫應該能更有效地利用你們的行銷預算，但我還是想聽聽你們對這部分支出以及未來策略的更廣泛看法。

Yes, Danny, I think on the OpEx, obviously, we kept that guidance flat to $100 million and $105 million. We don't break out the selling and marketing relative to the other. That would put our Q4 spend between [23% and 28%] kind of for total OpEx there. I think we're going to continue to drive the cost efficiencies across the board. And those are in selling and marketing in addition to our other G&A pieces. In terms of Q4, I think I'd go back to what I said earlier is there's places where we're going to make investments in patient alerts, other technologies. We're doing some, I think, some great things doing more targeted marketing in several regions for the Greenbrook side of the business that I think could pay off.

是的，丹尼，關於營運支出，我們顯然維持了1億美元到1.05億美元的預期不變。我們沒有單獨列出銷售和行銷支出。這樣算下來，我們第四季的營運支出佔總營運支出的比例大概在23%到28%之間。我認為我們將繼續全面提升成本效益。這些成本節約不僅體現在銷售和行銷方面，也體現在其他一般及行政費用上。關於第四季度，我想重申我先前的觀點，我們會在一些領域進行投資，例如病患預警和其他技術。我們正在為格林布魯克業務在幾個地區開展更有針對性的行銷，我認為這些舉措非常有效，並有望帶來回報。

So for me, it's really a balance of there's some key investments we want to make that are going to drive long-term efficiency, but also things that are going to drive long-term top line growth. So I think as we get into '26, like I said, we'll give a little more color on some of the other efficiencies and cost reductions and where we see OpEx heading. But my commitment here is to make sure that we have great cost control. We're investing where it makes complete sense. But we still know that there are a ton of opportunities here for efficiencies via cost reduction. I just want to be really smart about how we evolve and make sure we put the right investments in place. So as we're reducing costs, we are not sacrificing top line growth.

對我來說，關鍵在於平衡兩方面：一方面，我們希望進行一些關鍵投資，以提高長期效率；另一方面，我們也希望推動長期營收成長。正如我之前所說，到了2026年，我們會更詳細地闡述其他一些提高效率和降低成本的措施，以及我們對營運支出（OpEx）走向的預測。但我在此承諾的是，確保我們有效控製成本。我們會把投資放在真正有意義的地方。同時，我們也清楚，透過降低成本來提高效率的機會還有很多。我希望我們能夠明智地發展，確保我們進行正確的投資。這樣，在降低成本的同時，我們就不會犧牲營收成長。

Okay. Appreciate that. And just one follow-up for me. I wanted to ask on the adolescent indication. I think last quarter, you mentioned you saw an uptick in patient starts here and saw some pretty good trends. But I don't think you gave too much color on it today. So I was just curious on what you're seeing there in the third quarter and what we should expect in the rest of '25 and into '26. And also wanted to ask with this indication in mind, are you seeing more of a benefit from the provider connection program for these patients?

好的，謝謝。我還有一個後續問題。我想問關於青少年適應症的問題。我記得上個季度您提到過，青少年患者數量有所增加，而且趨勢也相當不錯。但今天您似乎沒有詳細說明。所以我很好奇您在第三季觀察到的情況，以及我們對2025年剩餘時間和2026年的情況有何預期。另外，考慮到這個適應症，您是否認為醫護人員聯繫計畫對這些病人更有益？

Thanks, Danny. This is Keith. So on the adolescent front, we are seeing an uptick every single quarter, and a lot of it is starting to come from the provider connection network where these primary care physicians really had no idea that there was another alternative for their younger patients with depression. So I don't think we're breaking out exactly how many patients that is, but it is good growth with it. We also mentioned on the call that we have another submission into the FDA that I think will also be meaningful as soon as we hear back from them.

謝謝丹尼。我是基斯。在青少年方面，我們看到每個季度都有成長，其中很大一部分是成長來自醫療服務提供者聯繫網絡，這些初級保健醫生之前根本不知道還有另一種針對年輕憂鬱症患者的治療方案。所以我們目前還無法準確統計這部分患者的數量，但成長動能良好。我們在電話會議上也提到，我們向FDA提交了另一份申請，我認為一旦收到回复，這份申請也將意義重大。

This concludes the question-and-answer session. I would now like to turn it back to Keith Sullivan for closing remarks.

問答環節到此結束。現在我把時間交還給基斯‧沙利文，請他作總結發言。

Thank you for your interest in Neuronetics, and we look forward to updating you in the next quarterly call. Thank you.

感謝您對Neuronetics的關注，我們期待在下次季度電話會議上向您報告最新進展。謝謝。

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。本次會議到此結束，您可以斷開連線了。