Exagen Inc (XGN) 2023 Q3 法說會逐字稿

Greetings and welcome to the Exagen, Inc. third quarter 2023 earnings conference call. (Operator Instructions) And as a reminder, this conference is being recorded and it is now my pleasure to introduce to you Ryan Douglas with Investor Relations. Thank you, Ryan. Please go ahead.

歡迎參加 Exagen, Inc. 2023 年第三季財報電話會議。 （操作員說明）謹此提醒，本次會議正在錄製中，現在我很高興向您介紹投資者關係部的瑞安·道格拉斯 (Ryan Douglas)。謝謝你，瑞安。請繼續。

Good afternoon, and thank you for joining us. Earlier today, Exagen Inc, released financial results for the quarter ended September 30, 2023. The release is currently available on the company's website at www.exagen.com. John Aballi, President and Chief Executive Officer and Kamal Adawi, Chief Financial Officer, will host this afternoon's call.

下午好，感謝您加入我們。今天早些時候，Exagen Inc 發布了截至 2023 年 9 月 30 日的季度財務業績。該新聞稿目前可在該公司網站 www.exagen.com 上取得。總裁兼執行長約翰·阿巴利 (John Aballi) 和財務長卡邁勒·阿達維 (Kamal Adawi) 將主持今天下午的電話會議。

Before we get started, I'd like to remind everyone that management will be making statements during this call that include forward-looking statements within the meaning of federal securities laws, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995.

在我們開始之前，我想提醒大家，管理層將在本次電話會議中發表聲明，其中包括聯邦證券法含義內的前瞻性聲明，這些聲明是根據私人證券訴訟改革的安全港條款制定的1995 年法案。

Any statements contained in this call that are not statements of historical fact should be deemed to be forward-looking statements. All forward-looking statements, including without limitation, statements regarding our business strategy and future financial and operating performance, including guidance for the quarter, potential profitability, our current and future product offerings and reimbursement and coverage are based upon current estimates and various assumptions.

本次電話會議中包含的任何非歷史事實陳述的陳述均應被視為前瞻性陳述。所有前瞻性陳述，包括但不限於有關我們的業務策略以及未來財務和營運績效的陳述，包括本季度的指導、潛在盈利能力、我們當前和未來的產品供應以及報銷和覆蓋範圍，均基於當前的估計和各種假設。

These statements involve material risks and uncertainties that could cause actual results to differ materially from those anticipated or implied by these forward-looking statements.

這些陳述涉及重大風險和不確定性，可能導致實際結果與這些前瞻性陳述預期或暗示的結果有重大差異。

Accordingly, you should not place undue reliance on these statements for a list and all description of risks and uncertainties associated with our business. Please see our filings with the Securities and Exchange Commission, including our Form 10-K for the year ended December 31, 2022, and any subsequent filings.

因此，您不應過度依賴這些聲明來取得與我們業務相關的風險和不確定性的清單和所有描述。請參閱我們向美國證券交易委員會提交的文件，包括截至 2022 年 12 月 31 日的年度 10-K 表格以及任何後續文件。

In addition, some of the information discussed today includes non-GAAP financial measures such as adjusted EBITDA have not been calculated in accordance with generally accepted accounting principles, the United States or GAAP.

此外，今天討論的一些資訊包括非 GAAP 財務指標，例如調整後的 EBITDA 並未按照美國公認會計原則或 GAAP 計算。

These non-GAAP items should be used in addition to and not as a substitute for any GAAP results. We believe these metrics provide useful supplemental information in assessing our revenue and operating performance.

這些非 GAAP 項目應作為任何 GAAP 結果的補充，而不是取代任何 GAAP 結果。我們相信這些指標為評估我們的收入和營運績效提供了有用的補充資訊。

Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are presented in the tables at the end of our earnings release issued earlier today, which has been posted on the Investor Relations page of the company's website.

這些非公認會計原則財務指標與最直接可比較的公認會計原則財務指標的調節表顯示在我們今天早些時候發布的收益報告末尾的表格中，該報告已發佈在公司網站的投資者關係頁面上。

Information provided in this conference call speaks only to the live broadcast today, November 13, 2023. Exagen disclaims any intention or obligation, except as required by law, to update or revise any information, financial projections, or other forward-looking statements, whether because of new information, future events or otherwise.

本次電話會議中提供的資訊僅針對今天（2023 年11 月13 日）的現場直播。除法律要求外，Exagen 不承擔任何更新或修改任何資訊、財務預測或其他前瞻性聲明的意圖或義務，無論是由於新資訊、未來事件或其他原因。

I'll now turn the call over to John Aballi, President, and CEO of Exagen.

現在我將電話轉給 Exagen 總裁兼執行長 John Aballi。

Thanks, Ryan, and thanks to everyone joining. For today's call, I'll walk through our third quarter results, the significant progress we are seeing and improving our business and provide updates on our overall progress to achieve profitability. I'll then turn the call over to our CFO, Kamal, for further details on our financial performance.

謝謝瑞安，也謝謝大家的加入。在今天的電話會議中，我將介紹我們第三季的業績、我們看到的重大進展和業務改進情況，並提供我們實現盈利的整體進展的最新資訊。然後我會將電話轉給我們的財務長卡邁勒，以了解有關我們財務業績的更多詳細資訊。

To start, I'm extremely pleased with the results we are seeing from initiatives implemented this year. Our strategy of focusing on higher margin products and implementing changes that will allow us to expand margins is yielding results.

首先，我對今年實施的措施所取得的成果感到非常滿意。我們專注於利潤率更高的產品並實施變革以擴大利潤率的策略正在取得成果。

We are doing all of this while paying rigorous attention to controlling costs. For Q3, our performance has continued the trend of surpassing expectations. And we are well on pace to deliver record and growing AVISE CTD trailing 12 month ASP. Record full year revenue and marked improvement in cash burn relative to last year.

我們在做這一切的同時，嚴格注意控製成本。第三季度，我們的業績延續了超乎預期的趨勢。我們正在穩步交付創紀錄且不斷增長的 AVISE CTD，追蹤 12 個月的 ASP。全年營收創歷史新高，現金消耗較去年顯著改善。

The team at Exagen has greatly improved the organization while continuing to serve rheumatologists throughout the US with the best testing available. Specifically highlighting a few key metrics, our trailing 12 month ASP has reached an all-time high for AVISE CTD testing and increased from $279 at the start of the year to over $320 this past quarter, reflecting a $40 increase.

Exagen 團隊大大改進了組織，同時繼續為美國各地的風濕病專家提供最好的測試服務。特別強調幾個關鍵指標，我們過去 12 個月的 ASP 已達到 AVISE CTD 測試的歷史最高水平，並從年初的 279 美元增加到上個季度的 320 美元以上，增加了 40 美元。

This progress corresponds to third quarter revenue of $13.4 million with gross margins of 57%. The increases we have seen in ASP over the past few quarters are the result of a more effective billing operation and improved cash collections.

這項進展相當於第三季營收 1,340 萬美元，毛利率為 57%。過去幾季我們看到的平均售價的成長是由於更有效的計費操作和改進的現金收款的結果。

We've worked extremely hard to improve in this area and the results are showing. Our gains in collections are from commercial payers, which is not easy to do and a direct reflection of our ability to execute. To give an example, historically, accounts over a year old had a very low probability of being collected on. But with the improvements to our billing processes, we've been able to see improved collections on these older cases.

我們在這方面付出了極大的努力來改進，結果正在顯現。我們的收款收益來自商業付款人，這不容易做到，也直接反映了我們的執行能力。舉個例子，從歷史上看，超過一年的帳戶被收集的可能性非常低。但隨著我們計費流程的改進，我們已經能夠看到這些舊案的收款情況有所改善。

In the third quarter, we were able to collect around $600,000 from tests that were completed and billed over a year ago. This momentum is just the start, and we expect to see continued growth in ASP throughout our 2024 performance.

第三季度，我們從一年多前完成併計費的測試中獲得了約 60 萬美元的收入。這一勢頭只是開始，我們預計 2024 年的業績將持續成長。

Our ability to demonstrate improvement in ASP while significantly reducing costs is validating our strategy. Our adjusted EBITDA for the first three quarters of 2022 reflected a negative $26.4 million. Here in '23. We've cut that in half to $13.2 million while delivering improved ASP revenue and volume for the same nine month period. Improvements to ASP continue to be the most powerful tool we can utilize to achieve our goals and we are delivering.

我們能夠在顯著降低成本的同時展示 ASP 的改進，這正在驗證我們的策略。 2022 年前三季調整後的 EBITDA 為負 2,640 萬美元。 23 年在這裡。我們將其削減了一半，達到 1,320 萬美元，同時在同一 9 個月期間提高了 ASP 收入和銷售。 ASP 的改進仍然是我們可以用來實現我們正在實現的目標的最強大的工具。

I'd like to provide a few details on cash management for the organization, as we have seen significant collections this past month. Our accounts receivable balance at the end of September was $17 million, but has improved to approximately $11.6 million on October 31.

我想提供一些有關該組織現金管理的詳細信息，因為我們在上個月看到了重要的收款情況。截至 9 月底，我們的應收帳款餘額為 1,700 萬美元，但到 10 月 31 日已增至約 1,160 萬美元。

Correspondingly, our cash balance at the end of September was approximately $28 million and has increased to over $31 million at the end of October. We anticipate finishing 2023 with more than $30 million of cash on hand, effectively improving our cash balance from the end of Q2, as we've drawn down our AR exactly as we expected. When factoring our quarterly cash needs against our current cash balance, we estimate that we have sufficient cash on hand to execute on our current operating strategy into late 2025 or early '26.

相應地，9月底我們的現金餘額約為2,800萬美元，10月底已增加至3,100萬美元以上。我們預計到 2023 年底，手頭現金將超過 3000 萬美元，從第二季度末開始有效改善我們的現金餘額，因為我們完全按照預期提取了 AR。當將我們的季度現金需求與當前現金餘額考慮在內時，我們估計我們手頭上有足夠的現金來執行我們當前的營運策略，直至 2025 年末或 26 年初。

In the third quarter, we continued our strategy of implementing changes to our processes, which are expected to improve ASP in the future. And while I'm confident, our team has made every effort to prepare and educate clients about these changes throughout the summer. We did experience a modest decline in test volume in the third quarter to 32,600 AVISE CTD tests.

第三季度，我們持續實施流程變更策略，預計未來將提高平均售價。雖然我很有信心，但我們的團隊在整個夏天都盡一切努力為客戶提供有關這些變化的準備和教育。第三季我們的測試量確實略有下降，降至 32,600 次 AISE CTD 測試。

The decline was expected and was the driving factor in our guidance for Q3. We believe our decline in volume will be transient in the long run as we pursue more profitable business. It's important to recognize that not all testing volume aligns with our current strategy of improving ASP and some of this loss is reflective of that.

這種下降是預期的，也是我們第三季指引的驅動因素。我們相信，從長遠來看，隨著我們追求利潤更高的業務，銷量的下降將是暫時的。重要的是要認識到，並非所有測試量都符合我們目前改進 ASP 的策略，部分損失也反映了這一點。

Additionally, when we analyzed the change in ordering patterns, we've observed that the majority of the decline is reflected in reduced test orders on a per physician basis and not tied to a significant contraction in the ordering physician base.

此外，當我們分析訂購模式的變化時，我們發現大部分下降反映在每位醫生的測試訂單減少上，而不是與訂購醫生基礎的顯著收縮有關。

Our team is diligently working to support customers through this transition and established processes which best fit each customer's clinical workflow. We anticipate a return to prior volume levels in the back half of 2024 as we work through these changes.

我們的團隊正在努力支持客戶完成這項轉變，並建立最適合每個客戶臨床工作流程的流程。隨著我們應對這些變化，我們預計 2024 年下半年銷售將恢復到先前的水平。

For clarity, we believe our Q4 volume will be the low point due to the inherent seasonality typically seen in our business this quarter and some lingering effect from our implemented changes but building back from here as we head into the new year. Our strategy remains rooted in improving AVISE CTD ASP, and the pursuit of more profitable business, which these changes have set us up to achieve.

為了清楚起見，我們認為我們第四季度的銷量將是最低點，因為本季度我們的業務通常存在固有的季節性，以及我們實施的變化帶來的一些揮之不去的影響，但當我們進入新的一年時，我們會從這裡開始恢復。我們的策略仍然植根於提高 AVISE CTD ASP，並追求利潤更高的業務，這些變化使我們能夠實現這些目標。

In regard to our R&D efforts, we recently achieved a significant milestone and are pleased to announce that we've entered into exclusive license agreements with Johns Hopkins University, to develop clinical tests, leveraging novel biomarkers for Lupus nephritis.

在我們的研發工作方面，我們最近實現了一個重要的里程碑，並很高興地宣布我們已與約翰霍普金斯大學簽訂獨家許可協議，利用狼瘡性腎炎的新型生物標記開發臨床測試。

This technology and invention is from the laboratory of Dr. Michelle Petri and Andrea Fava. The opportunity in Lupus nephritis, meet our requirements for developing testing solutions to better serve our customers. When I speak to rheumatologists in the field, they have made it very clear. To having access to biomarkers, which would aid in the management of SLE patients with kidney involvement, would provide significant utility to their practice.

這項技術和發明來自 Michelle Petri 博士和 Andrea Fava 博士的實驗室。狼瘡性腎炎的機會滿足了我們開發測試解決方案的要求，以便更好地服務我們的客戶。當我與該領域的風濕病專家交談時，他們已經說得很清楚了。獲得生物標記有助於管理腎臟受累的 SLE 患者，將為他們的實踐提供重要的實用性。

And given that approximately half of all SLE patients go on to develop some form of Lupus nephritis. We believe this technology will be instrumental in enabling better patient outcomes. To hit on a few ancillary topics, with the recent announcement from the FDA, we are closely monitoring the proposed rules to regulate lab developed tests such as AVISE CTD.

鑑於大約一半的系統性紅斑狼瘡患者會繼續發展某種形式的狼瘡性腎炎。我們相信這項技術將有助於改善患者的治療效果。為了討論一些輔助主題，根據 FDA 最近的公告，我們正在密切關注監管實驗室開發的測試（例如 AVISE CTD）的建議規則。

We believe that multiple details need to be addressed with greater clarity and are waiting for the dust to settle in this regard. But we're familiar with the 510(K) route and believe that with our current level of supporting data. If [ICTD] would be well positioned to comply or come into compliance with the FDA's requirements and time lines should they come to fruition.

我們認為，需要更明確地解決多個細節，並正在等待這方面的塵埃落定。但我們熟悉 510(K) 路線，並相信以我們目前的支援數據水準。如果 [ICTD] 能夠很好地遵守或即將遵守 FDA 的要求和時間表（如果這些要求和時間表實現的話）。

Also in October, we finalized our settlement with the Department of Justice for an investigation that was related to activities which have since been discontinued, but occurred in 2014 and 2015. The agreed-upon settlement was approximately $650,000, and we're pleased to put this issue behind us, so we can continue to focus on operating the business.

同樣在 10 月，我們與司法部就一項調查達成了和解，該調查與後來停止但發生在 2014 年和 2015 年的活動有關。商定的和解金額約為 650,000 美元，我們很高興將這個問題已經過去了，所以我們可以繼續專注於經營業務。

Kamal will now highlight the financial performance in greater detail.

卡邁勒現在將更詳細地強調財務表現。

Thank you, John, and good afternoon, everyone. For Q3 2023, total revenues were $13.4 million compared with $14.1 million in Q2 of 2023 and $14.7 million in the third quarter of 2022. As a reminder, for comparisons to prior year revenue in Q3 of '22 included $3.7 million of Medicare revenue from Q2 2022.

謝謝約翰，大家下午好。 2023 年第三季的總收入為1,340 萬美元，而2023 年第二季的總收入為1,410 萬美元，2022 年第三季的總收入為1,470 萬美元。需要提醒的是，與2022 年第三季度的上一年收入相比，包括第二季的370 萬美元醫療保險收入2022 年。

Testing volumes for AVISE CTD were 32,618. Other testing revenue was $1.4 million in the third quarter of 2023 compared with $1.6 million in the second quarter of 2023, and $1.9 million in the third quarter of 2022. Cost of revenue were $5.7 million in Q3, resulting in a total gross margin of 57.4%, compared to 58.7% in Q2 of 2023 and 59.2% in the third quarter of 2022.

AVISE CTD 的測試量為 32,618。 2023 年第三季其他測試收入為 140 萬美元，而 2023 年第二季為 160 萬美元，2022 年第三季為 190 萬美元。第三季營收成本為 570 萬美元，總毛利率為 57.4% %，而2023 年第二季為58.7%，2022 年第三季為59.2%。

Operating expenses were $18.5 million in the third quarter of 2023, compared with $22.5 million in the third quarter of 2022, primarily driven by a decrease in employee related expenses due to the reduction in force in early December 2022. For the third quarter of 2023, our net loss was $5.4 million compared to a net loss of $8.1 million for the third quarter of 2022.

2023 年第三季的營運費用為 1,850 萬美元，而 2022 年第三季為 2,250 萬美元，主要是由於 2022 年 12 月上旬裁員導致員工相關費用減少。對於 2023 年第三季度，我們的淨虧損為540 萬美元，而2022 年第三季的淨虧損為810 萬美元。

As we focus on profitability, we look to provide a consistent financial metric to measure the company's performance and will now be provided adjusted EBITDA on a go-forward basis. Our adjusted EBITDA excludes stock comp expense, since that's a large non-cash expense for the organization.

由於我們專注於獲利能力，我們希望提供一致的財務指標來衡量公司的業績，並且現在將提供未來調整後的 EBITDA。我們調整後的 EBITDA 不包括股票補償費用，因為這對組織來說是一筆巨大的非現金費用。

Adjusted EBITDA was negative $3.6 million for Q3 2023, compared to negative $6.1 million for Q3 2022 and negative $13.9 million for the nine months ended September 30, 2023, compared to negative $26.4 million during the same period in 2022.

2023 年第三季調整後EBITDA 為負360 萬美元，而2022 年第三季為負610 萬美元，截至2023 年9 月30 日的九個月為負1,390 萬美元，而2022 年同期為負2,640萬美元。

We're seeing remarkable improvements in our adjusted EBITDA over the past few quarters, and I fully expect to see the trend continue in 2024. Please refer to our earnings release issued earlier today for a reconciliation of adjusted EBITDA to net loss.

在過去幾個季度中，我們看到調整後EBITDA 取得了顯著改善，我完全預計這一趨勢將在2024 年繼續下去。請參閱我們今天早些時候發布的收益報告，了解調整後EBITDA 與淨虧損的調節表。

Cash and cash equivalents as of September 30, 2023, were $28.4 million. As we have previously communicated with our revenue cycle management strategy, the claims held in Q1 and Q2 contributed to the AR balance increasing to $16.2 million in the second quarter.

截至 2023 年 9 月 30 日，現金及現金等價物為 2,840 萬美元。正如我們之前與我們的收入週期管理策略所溝通的那樣，第一季和第二季的索賠導致第二季的應收帳款餘額增加至 1,620 萬美元。

The AR balance at the end of Q3 was $17 million, with the majority of the increase from Q2 to Q3 due to increases in our accrual rate, driven by the success we have seen in increased collections. From late September and into Q4, we've seen our cash collections accelerate.

第三季末的應收帳款餘額為 1,700 萬美元，其中第二季到第三季的成長大部分是由於我們在催收方面取得的成功推動了應計率的提高。從 9 月下旬到第四季度，我們看到現金回收速度加快。

To reiterate what John said, our AR balance decreased approximately $11.6 million on October 31, which in turn increased our cash balance to $31.4 million. And I anticipate this trend to continue throughout the end of the year.

重申約翰所說的，我們的應收帳款餘額在 10 月 31 日減少了約 1,160 萬美元，這反過來又使我們的現金餘額增加到 3,140 萬美元。我預計這種趨勢將持續到今年年底。

We are seeing greater results in our key metrics as we transform the business to a more profitable testing company. For full year 2023 revenue, we're providing guidance of at least $50 million which will be a record annual revenue for the organization. We also believe that our adjusted EBITDA for 2023 will be around negative $20 million, and we expect adjusted EBITDA to improve in 2024.

隨著我們將業務轉型為獲利能力更強的測試公司，我們在關鍵指標上看到了更大的成果。對於 2023 年全年收入，我們提供至少 5,000 萬美元的指導，這將是該組織創紀錄的年收入。我們也認為，2023 年調整後 EBITDA 將約為負 2,000 萬美元，預計 2024 年調整後 EBITDA 將有所改善。

We will now open the call for questions.

我們現在開始提問。

Thank you. (Operator Instructions) And the first question comes from the line of Kyle Mikson with Canaccord Genuity. Please proceed with your question.

謝謝。 （操作員說明）第一個問題來自 Canaccord Genuity 的 Kyle Mikson 線。請繼續你的問題。

Hey, guys, thanks for taking the questions. So on this volume decline that we're seeing sequentially happen. just -- wanting to understand like why? that's while it's going on your. it sounds like docs are ordering less tests, but the clinician base is some is the same, I guess, or at least relatively stable, not declining unwire rheumatologists ordering less tests. And how do you correct that? And then also, why do you think this will last so far into 2024. It wasn't quite clear on that. Thanks.

嘿，夥計們，感謝您提出問題。因此，我們看到的銷量下降是連續發生的。只是——想了解為什麼？就在你的事情發生的時候。聽起來醫生正在訂購更少的測試，但我猜臨床醫生的基礎是相同的，或者至少相對穩定，不會拒絕無線風濕病學家訂購更少的測試。你如何修正這個問題？還有，為什麼你認為這種情況會持續到 2024 年。對此還不太清楚。謝謝。

Great. Good afternoon, Kyle. Thanks for the question. So we've made it very clear that our top priority as an organization is profitability. And everything that we're doing is in pursuit of more profitable business. So we've changed a lot of things at the company as it pertains to working with us, including the individuals that customers interact with. We went through a change in our sales force team in December of last year.

偉大的。下午好，凱爾。謝謝你的提問。因此，我們非常明確地表示，作為一個組織，我們的首要任務是獲利能力。我們所做的一切都是為了追求更有利可圖的業務。因此，我們在公司裡改變了很多與我們合作有關的事情，包括與客戶互動的個人。去年 12 月，我們對銷售團隊進行了調整。

So even the folks that our individual clinicians interact with us, adjusted the policies and they know us by and interact with us on have fluctuated along with the actual service we provide. We've gotten better in many of these respects. But it has been change. And I fully recognize the change is not easy for all folks, especially customers, and it has an impact on testing demand.

因此，即使我們的臨床醫生與我們互動、調整政策、了解我們並與我們互動的人也隨著我們提供的實際服務而波動。我們在許多方面都取得了進步。但情況已經改變了。我完全認識到這種變化對所有人，尤其是客戶來說並不容易，而且它對測試需求產生了影響。

So that's what we saw here in Q3, again fully expected, and that's why we guided the way we did. These changes will improve our ASPs significantly over time. Some of this is getting medical records on specific cases and using physician advocacy in pursuing appeals. And so having their partnership there is requires a little bit more time on their side, but it is in pursuit of more profitable business.

這就是我們在第三季看到的情況，再次完全符合預期，這就是我們採取這種方式的原因。隨著時間的推移，這些變化將顯著提高我們的平均售價。其中一些是獲取特定病例的醫療記錄，並利用醫生的倡議來尋求上訴。因此，建立合作關係需要他們多一點時間，但這是為了追求更有利可圖的業務。

And I will just say that our team prepared extremely well to educate customers. Our marketing team created very clear materials. We worked very hard to explain the why we're doing this, in a line on the message across the organization. So as customers talk to our internal customer service billing or the actual field-based rep, they got a very clear, concised, aligned communication.

我只想說，我們的團隊為教育客戶做好了充分的準備。我們的行銷團隊創造了非常清晰的材料。我們非常努力地在整個組織中傳達訊息，解釋我們這樣做的原因。因此，當客戶與我們的內部客戶服務計費或實際的現場代表交談時，他們得到了非常清晰、簡潔、一致的溝通。

We did launch the bulk of these changes in early Q3. And pretty quickly there, we recognized an impact to volume, but have since flattened out, we're building back this quarter. We expect to build back in Q1. From our standpoint, this is Q1 would be the low point, excuse me, Q4 would be the low point building back in Q1.

我們確實在第三季初推出了大部分變更。很快，我們就意識到對銷量的影響，但此後已經趨於平緩，我們將在本季恢復銷售。我們預計在第一季恢復。從我們的角度來看，第一季將是低點，對不起，第四季將是第一季的低點。

And so we have a few major, minor holidays here in Q4, which impact this as well, also corresponds to a lower number of lab days. We have our rheumatology national meeting this quarter, it's actually in San Diego, but it pulled a significant majority of the clinicians out of their practices for the full week. And so all of those things kind of mixed together. Or what's factoring into Q4 being the low point building back in the first half of the year and returning to kind of those prior levels in the back half of the year. That's how we envision it right now.

因此，我們在第四季度有一些主要的、次要的假期，這也影響了這一點，也對應於實驗室天數的減少。本季我們召開了風濕病學全國會議，實際上是在聖地牙哥舉行的，但它讓絕大多數臨床醫生整整一周都停止了工作。所以所有這些事情都混合在一起。或者說，第四季的因素是上半年的低點回升，並在下半年恢復到之前的水平。這就是我們現在的設想。

And I personally went into the field those in the field in July, August this month. And I've two trips planned for early December to interact with our customers firsthand, and to understand what are some of the challenges that people are facing with them and being faced with and get that firsthand feedback from clinicians, specifically visiting some of our top customers.

我自己在本月七、八月親自到現場進行了實地考察。我計劃在 12 月初進行兩次旅行，與我們的客戶進行第一手互動，了解人們面臨和正在面臨的一些挑戰，並從臨床醫生那裡獲得第一手反饋，特別是拜訪我們的一些頂級客戶。顧客。

And the primary takeaway is clinicians do understand the changes and why, and that we're just working through as an organization in a partnership. We're trying to figure out a way to optimize their clinical workflow to accommodate some of the things we need to be more effective on our billing and our ASP side, again, we're seeing those improvements on the ASP side. So it's absolutely the right way to go. It just takes an adjustment period.

主要的收穫是臨床醫生確實了解這些變化及其原因，並且我們只是作為一個合作組織進行工作。我們正在嘗試找到一種方法來優化他們的臨床工作流程，以適應我們需要在計費和 ASP 方面更加有效的一些事情，我們再次看到 ASP 方面的這些改進。所以這絕對是正確的方法。只是需要一個調整期。

And so how long does that adjustment period is, it's not set in stone, but we envision it to be reflected in Q4 numbers and building back in Q1, early part of the year. We've already started to see this in many territories building back from where we were at the start of the quarter. So especially when you look at some of the normalized weekly numbers, so at least as it stands for me, feel very confident that our growth in '24 will be a combination of both volume and ASP improvement as we've expected.

因此，調整期有多長，這並不是一成不變的，但我們預計它將反映在第四季度的數據中，並在今年年初的第一季進行調整。我們已經開始在許多地區看到這種情況從本季初的情況開始恢復。因此，特別是當您查看一些標準化的每週數據時，至少就我而言，我非常有信心，我們在 24 年的成長將是銷售量和 ASP 改進的結合，正如我們所預期的那樣。

Okay. That was great. John, thanks for all that. And then I want to ask the kind of the obvious question about the guidance was $10 million to $10.5 million for the quarter. You beat by $3 million, over $3 million. It's kind of a wild, app performance is again very good to see. Did you on -- was there any like one-timers this quarter? I know that's kind of happened in the past. I think I heard something about -- maybe like $600,000 in prior period collections possibly, but anything significant this quarter.

好的。那很棒。約翰，謝謝你所做的一切。然後我想問一個關於該季度 1000 萬至 1050 萬美元的指導的明顯問題。你贏了 300 萬美元，超過 300 萬美元。這有點瘋狂，應用程式的性能再次非常值得一看。這個季度有沒有類似一次性的人？我知道這在過去曾發生過。我想我聽說過一些事情——可能是前期收藏的 60 萬美元，但本季任何重要的事情都可能發生。

And then also just given that I mean, is this gross margin number a good way to think about the run rate level going forward? Because I mean, it's great to see like mid to high 50s just curious about like kind of beyond the longer term.

然後我的意思是，這個毛利率數字是考慮未來運行率水準的好方法嗎？因為我的意思是，很高興看到 50 多歲的中高層對更長遠的事情感到好奇。

Great. So combination of answers to your called this address all the points you brought up, Kamal hit some of the back half items. For me personally, the volume impact is a part of it. And as I mentioned, we expect that to -- could be reflected in our Q4 numbers and then building back here in Q1. So that's part of that guide. Certainly our ASP, we've articulated in the past, it's very difficult for us to forecast and certainly to project increases in ASP.

偉大的。因此，將您提出的所有要點稱為此地址的答案組合起來，卡邁勒擊中了後半部分的一些項目。就我個人而言，數量影響是其中的一部分。正如我所提到的，我們預計這一點可以反映在我們第四季的數字中，然後在第一季重新建立。這是該指南的一部分。當然，我們的平均售價，我們過去曾說過，我們很難預測，當然也很難預測平均售價的成長。

We have shown a can -- and ability to drive consistent progress there over the course of this year, and we believe that will continue. But as we mentioned in the past, our conservative approach to this is to expect that growth to be reflected kind of retroactively, right? So after we have the quarter, we're able to dive into what some of the factors there and the magnitude of that change.

我們已經展示了在今年推動持續進展的能力，並且我們相信這種情況將會持續下去。但正如我們過去提到的，我們對此的保守態度是期望成長能夠追溯，對吧？因此，在我們了解本季之後，我們就能夠深入研究其中的一些因素以及變化的幅度。

So while we do expect growth in ASP, it's difficult to forecast the exact amount, and that's reflected in the guide as well. Kamal can speak to a few of the other points.

因此，雖然我們確實預期平均售價會成長，但很難預測確切的數量，這也反映在指南中。卡邁勒可以談談其他一些觀點。

Thanks, John. Kyle, I'll address your questions in regards to onetime and the impact on gross margin. Historically, we've not had a lot of success on collecting on [Casa] were older than 12 months. And as John mentioned in the prepared remarks, we collected around $600,000 from tax that we have the AR written off because they were older than 12 months.

謝謝，約翰。凱爾，我將回答您有關一次性及其對毛利率影響的問題。從歷史上看，我們在收集 12 個月以上的 [Casa] 方面並沒有取得很大成功。正如約翰在準備好的演講中提到的，我們從稅收中收取了大約 60 萬美元，我們已將 AR 註銷，因為它們已經超過 12 個月了。

Now I don't want to call them one-time because this is the second quarter in a row that we've had this success with tests that have been written off, and that speaks volumes to the changes in building and the strategies that we're executing on there, whether it's appeals of medical records, the small increase in patient pay. We're seeing higher ASP on each task also. So we've seen the AP come up. We've seen improved collections and we've seen collections on things that were written off.

現在我不想一次性給他們打電話，因為這是我們連續第二個季度通過已註銷的測試取得了成功，這充分說明了我們在建設和戰略方面的變化。正在那裡執行，無論是醫療記錄的上訴，還是病人薪資的小幅增加。我們也看到每項任務的平均售價都更高。所以我們已經看到美聯社出現了。我們看到了收藏的改進，也看到了被註銷的東西的收藏。

Now the impact on gross margin, we should have seen -- you can argue higher gross margins in the past because we had lower accrual rate that we've had to take up because the collections have been more successful this quarter. So we came in around 57%. If you back out that $600,000, Yeah, you're in the low 50%. Low to mid-50s as where we have been year to date so that is a good run rate or a good way to think about our gross margin percent.

現在，我們應該看到對毛利率的影響——你可以說過去的毛利率較高，因為我們的應計利率較低，而我們不得不承擔這個利率，因為本季的產品系列更加成功。所以我們的得分約為 57%。如果你退出那 60 萬美元，是的，你就屬於低 50% 的人了。我們今年迄今為止的水平為 50 多歲左右，因此這是一個很好的運行率，或者是考慮我們毛利率的好方法。

Okay. That was like brilliant. Thank you so much for that. And one last question for me, on the cash flow dynamics, great to see what happened kind of like pad like -- after the quarter end, I guess like that, if we could just see that it sounds like pretty positive commentary for '24 as well and you're providing EBITDA metric now going forward to, so that's great.

好的。那真是太棒了。對此感激不盡。對我來說，最後一個問題是關於現金流動態，很高興看到季度末之後發生的事情，我想是這樣，如果我們能看到這聽起來像是對 24 年的相當積極的評論而且您現在正在提供EBITDA 指標，所以這很棒。

I was just wondering if you guys talk about the working capital and kind of like general cash collection, versus burden trends in 2024, like by the quarters. I just want to know if there's any like seasonality on when there could be like significant burn one quarter and then like material, maybe operating cash generation next quarter, kind of thing. Just curious if there's anything you can share on that?

我只是想知道你們是否談論營運資金和一般現金收款，以及 2024 年的負擔趨勢（例如按季度）。我只是想知道是否有任何類似的季節性，例如一個季度可能會出現嚴重的燒錢，然後是材料，也許下個季度會產生營運現金之類的事情。只是好奇你有什麼可以分享的嗎？

Well, Kyle, I'll trust the net working capital comments you had in there. Because obviously the biggest change we've seen this year was the uptick in AR, and that's why we wanted to give more color on that with providing the AR balance on [1031], which was down $5.5 million from where we ended on September 30 in just one month.

好吧，凱爾，我相信你在那裡的淨營運資本評論。因為顯然我們今年看到的最大變化是 AR 的增長，這就是為什麼我們希望通過在 [1031] 上提供 AR 餘額來對此提供更多色彩，該餘額比 9 月 30 日結束時減少了 550 萬美元短短一個月內。

So that is trending in the right direction. But in terms of net working capital and the seasonality, yes, AR is likely something that we will see uptick during the year and it decreased towards the end of the year.

所以這正朝著正確的方向發展。但就淨營運資本和季節性而言，是的，AR 很可能在今年內有所上升，但在年底時會有所下降。

Okay. Perfect. Thanks, Kamal. Thank you, guys.

好的。完美的。謝謝，卡邁勒。感謝你們。

And the next question comes from the line of Mark Massaro with BTIG. Please proceed with your question.

下一個問題來自 BTIG 的 Mark Massaro。請繼續你的問題。

Hey, guys. Thank you for taking the questions. I wanted to start, John, I just wanted to clarify a point that you made in the prepared remarks that you expect Q4 volume to be the low point. I wanted to just clarify that you mean Q4 2023. And just help me understand this sort of bridge back to the back half of 2024 to return to more historical prior record volume levels.

大家好。感謝您提出問題。約翰，我想先澄清您在準備好的評論中提出的一點，即您預計第四季度的銷量將是最低點。我想澄清一下，你的意思是 2023 年第四季。幫助我理解這種回到 2024 年下半年的橋樑，以恢復到之前的歷史記錄成交量水平。

Absolutely. Afternoon, Mark, thanks for the question. So to your first point around timing of -- the impact regarding volume. So what we saw just as a reset here. So what we saw after we implemented changes mostly policy based changes to the way we approach billing and again, this is to give you a flavour for this or feel for this.

絕對地。下午好，馬克，謝謝你的提問。關於時間的第一點－對數量的影響。所以我們在這裡看到的只是重置。因此，我們在實施變更後所看到的主要是基於政策的變更，對我們的計費方式進行了變更，這也是為了讓您對此有所了解或感受到。

This is our patient responsibility. This is the requirement of medical records, these types of things. So that we're more effective on the appeal side, et cetera. As we -- because we implemented those, we saw an immediate response reflected in orders per physician, not so much a contraction in the physician base, but just people are getting adjusted to the change.

這是我們對病人的責任。這是醫療記錄之類的要求。這樣我們在上訴方面就更有效，等等。當我們實施這些措施時，我們看到每位醫生的訂單立即得到了反應，與其說是醫生群體的收縮，不如說是人們正在適應這一變化。

And as I mentioned, working to establish processes within their clinic, that keeps them functioning efficiently, but also meets our requirements. And so we saw that fairly immediately. In the summer, we also had a mix of some vacations with clinicians as well.

正如我所提到的，努力在他們的診所內建立流程，使他們能夠有效運作，同時也滿足我們的要求。所以我們很快就看到了這一點。夏天，我們也與臨床醫生一起度過了一些假期。

And so by the end of the summer, we were getting a feel for what that call it run rate would be. And we saw it basically flatten out. And here in Q4, as I mentioned, so if you assume that the effect we would have anticipated related to volume from these changes has been recognized or reflected in the business.

因此，到夏末，我們對所謂的運行率有了一定的了解。我們看到它基本上變平了。正如我所提到的，在第四季度，如果您假設我們預期與這些變化的數量相關的影響已在業務中得到認可或反映。

Then Q4 has a lower number of effective lab days and that's really what's factoring into that and why we believe Q4 will be the low point for volume is that, we've started to build back and I've spoken with individual clinicians with our field-based team, different territories, and that's the impression that we have across the organization certainly because that we are building back.

然後，第四季度的有效實驗室天數較少，這確實是影響因素，為什麼我們認為第四季度將是數量的最低點，因為我們已經開始重建，我已經與我們領域的個別臨床醫生進行了交談基於團隊、不同的領域，這就是我們整個組織的印象，當然是因為我們正在重建。

But when you take a look at having Thanksgiving Christmas, you have Veterans Day. We've got a week, solid week of meetings here in San Diego with the American College of Rheumatology meeting occurring here, it pulls a significant amount of rheumatologists out of practice into their societies week-long meeting. And so we see that reflected in volume as well. So that on a normalized basis, we have seasonality in Q4. We've seen this in prior years as well. And so that's why we call out Q4 as the low point volume-wise.

但當你考慮過感恩節聖誕節時，你就會想到退伍軍人節。我們在聖地牙哥舉行了為期一周的會議，美國風濕病學會會議也在這裡舉行，這讓大量的風濕病學家從實踐中抽離出來，參加他們的協會為期一周的會議。所以我們看到這也反映在成交量上。因此，在標準化的基礎上，第四季存在季節性。我們在前幾年也看到過這種情況。這就是為什麼我們將第四季稱為成交量低點。

And then building back from here, given that Q1 is a historically strong quarter for us. We've got a full slate of lab days and effective lab days at that. And we've already been working to build back and have that sentiment internally. So that's the function and you're exactly right, I meant 2023. Thanks for the opportunity to clarify that. So this quarter that we're in right now being the low point in the building back from here.

然後從這裡開始，考慮到第一季對我們來說是歷史上強勁的季度。我們有完整的實驗室日和有效的實驗室日。我們已經在內部努力重建並擁有這種情緒。這就是函數，你說得完全正確，我的意思是 2023 年。感謝你有機會澄清這一點。因此，本季我們現在正處於建築的最低點。

Perfect. Thank you for clarifying that. I know -- I believe it was on the last earnings call, you talked about the potential to move [AVISE] CTD into guidelines. I just be curious, I recognize that may not be a near term initiative, but I was just curious if you had an update with respect to anything you're doing on the guideline fronts or how we should think about the opportunity going forward?

完美的。感謝您澄清這一點。我知道——我相信在上次財報電話會議上，您談到了將 [AVISE] CTD 納入指導方針的可能性。我只是很好奇，我認識到這可能不是一項近期舉措，但我只是很好奇您是否有關於您在指南方面所做的任何事情的更新，或者我們應該如何考慮未來的機會？

So conclusion in guidelines would be a catalyst for us, both from a payer side as well as adoption, right? continue to push on both fronts. And we recognize it is a very valuable aspect of product and a differentiating aspect of that. So it's part of our strategy. When I came on board last year about this time, I placed a heightened focus on.

因此，無論是從付款方還是採用方面來看，指南中的結論都將成為我們的催化劑，對吧？繼續在兩條戰線上發力。我們認識到這是產品非常有價值的方面，也是產品的差異化方面。所以這是我們戰略的一部分。當我去年這個時候加入公司時，我高度關注。

And we've laid out some very clear objectives. The first being get to know the people on the guidelines. I think once it starts there, then you get a great flow of feedback and then you can actually make informed decisions, hopefully based on facts and to get included into guidelines. So we've done that and we've been working throughout this year to establish those relationships.

我們已經制定了一些非常明確的目標。首先是了解指導方針上的人。我認為一旦從那裡開始，你就會得到大量的回饋，然後你就可以真正做出明智的決定，希望基於事實並納入指導方針。所以我們已經做到了這一點，並且我們今年一直在努力建立這些關係。

This past quarter, actually, September, we were included in a new update on the Lupus encyclopedia. And this is a book, a publication. It's a very thick book, actually several hundred pages which is met for both clinicians and patients, it�s written by a clinician, Dan Thomas, just give you a feel for him in second, Dr. Dan Thomas. But we have five pages devoted to our testing and it's under the heading of specialized testing within Lupus.

上個季度，實際上是九月，我們被納入了狼瘡百科全書的新更新中。這是一本書，一本出版物。這是一本很厚的書，實際上有幾百頁，臨床醫生和患者都可以滿足，它是由臨床醫生丹·托馬斯寫的，只是讓你感受一下他的第二個，丹·托馬斯博士。但我們有五頁專門討論我們的測試，它位於狼瘡內的專門測試的標題下。

And specifically, it ties in there that there's no other testing worth mentioning. And so from our perspective, having noted inclusion in that publication, if you will, or that book was a very important milestone for our company, for a couple of reasons. One, it specifically reviews the body of literature supporting, advised Lupus and SiteAdvisor Lupus is a very useful tool for both clinicians and patients. So now we have that external validation. We're not affiliated with the Lupus encyclopedia by any means and so that's a huge positive.

具體來說，沒有其他測試值得一提。因此，從我們的角度來看，如果您願意的話，注意到該出版物的收錄，或者該書對我們公司來說是一個非常重要的里程碑，原因有幾個。第一，它專門回顧了支持狼瘡和 SiteAdvisor 的文獻，狼瘡對於臨床醫生和患者來說都是一個非常有用的工具。現在我們有了外部驗證。我們無論如何都不隸屬於狼瘡百科全書，所以這是一個巨大的正面因素。

The other thing is or secondarily, Dr. Dan Thomas sits on the guidelines, six on the panel 15 clinicians who formed the guidelines for diagnostic use -- diagnostics within Lupus. And so to have him put that in the public domain and to reference our company, our tests, the algorithm, multiple aspects about the organization and the tests that we provide is huge for us.

另一件事是，或者其次，Dan Thomas 博士是指南的製定者，由 15 名臨床醫生組成的小組中的 6 名醫生製定了診斷用途（狼瘡內的診斷）指南。因此，讓他將其公開並參考我們的公司、我們的測試、演算法、有關組織的多個方面以及我們提供的測試對我們來說意義重大。

So we are still not in the guidelines, but I think we're having meaningful progress, especially in one year's time to have that reflected in a publication, I think is huge from our standpoint. And so, we're seeing some progress just as we're seeing with ASP, just as we're seeing with cost control, you see it really across the Board results being reflected in many of the things we're doing given our strategy.

因此，我們仍然沒有納入指南，但我認為我們正在取得有意義的進展，特別是在一年的時間內將其反映在出版物中，從我們的角度來看，我認為這是巨大的。因此，我們看到了一些進展，就像我們在ASP 方面看到的那樣，就像我們在成本控制方面看到的那樣，您會看到，根據我們的策略，我們正在做的許多事情都反映了全面的結果。

Okay. Excellent. And then last one for me, I believe you signed a Highmark Blue Cross Blue Shield earlier this year. Would just be curious how conversations might be going with health plans? Do you expect 2024 to be a year where you can make some headway on that initiative? And then is it fair to say that we're -- is there any update on the LCD for advice Lupus to Noridian. I would assume we're just in a waiting pattern, but any commentary you have there would be helpful.

好的。出色的。最後一個是我，我相信您今年早些時候簽署了 Highmark Blue Cross Blue Shield。只是好奇健康計劃的對話會如何進行？您預計 2024 年您可以在該計劃上取得一些進展嗎？然後可以公平地說，我們 - LCD 上是否有任何更新，以向 Noridian 提供狼瘡建議。我認為我們只是處於等待狀態，但您的任何評論都會有所幫助。

Great. I'll start with Noridian first and then work back into the commercial payer landscape. From Noridian, we continue to be in a holding pattern. And what that means is last year, September of last year, Exagen submitted a request for coverage through Noridian, our local MAC. And we got acknowledgment that we have a complete request, but we wait in limbo for either a draft LCD to come out or a CAC meeting, at which point we'd be on the agenda ideally and then progress there to a draft LCD.

偉大的。我將首先從 Noridian 開始，然後再回到商業支付領域。從 Noridian 來看，我們繼續處於等待狀態。這意味著去年，去年 9 月，Exagen 透過我們當地的 MAC Noridian 提交了一份承保請求。我們得到了確認，我們有一個完整的請求，但我們在等待 LCD 草案出來或 CAC 會議，此時我們最好會進入議程，然後進展到 LCD 草案。

So until that happens, we remain in a holding pattern and no further update there. We continue to be have coverage and reimbursement consistent with the clinical lab fee schedule, the -- our expected reimbursement for our Medicare claims, and so no change on either of those fronts to report.

因此，在此之前，我們仍處於擱置狀態，不會進一步更新。我們繼續擁有與臨床實驗室費用表一致的承保範圍和報銷，以及我們對醫療保險索賠的預期報銷，因此在這兩個方面都沒有變化需要報告。

As it pertains to commercial insurers, I have taken the position that or the approach that kind of referencing activity is not and reflective typically of the progress, the underlying progress that's made. What I mean by that is, you can have very productive discussions. But unless cash comes in the door, it's I don't know that speaking about it is that productive.

由於它涉及商業保險公司，我採取的立場或方法是，這種參考活動通常反映了進展，所取得的根本進展。我的意思是，你們可以進行非常有成效的討論。但除非現金進來，否則我不知道談論它是否會那麼有成效。

And so what was the approach we've taken is to reference folks to our trailing 12 month ASP, which at the beginning of the year was $279 and in Q3 is $320. So we've seen a $40 increase in our trailing 12-month ASP, and that's reflective of multiple efforts that we put in place. Some of them on the managed care front and having discussions with individual plans, high marks certainly part of that portfolio of efforts but then we also have our appeals efforts, our prior collections. We've got changes to our patient responsibility and really the confluence of activities is resulting in improved ASP.

因此，我們採取的方法是讓人們參考我們過去 12 個月的平均售價，年初為 279 美元，第三季為 320 美元。因此，我們看到過去 12 個月的平均售價增加了 40 美元，這反映了我們付出的許多努力。其中一些在管理式醫療方面，並與個人計劃進行討論，高分當然是該工作組合的一部分，但我們也有我們的呼籲努力，我們之前的系列。我們對患者責任進行了更改，實際上，活動的整合正在導致 ASP 的改善。

I've got no major contracts to report on. We have talked to many medical directors over the past quarter and gotten some positive feedback, but also some areas for improving. And so kind of getting on both sides, but ultimately trying to turn those conversations into cash in the door. And we've been effective at doing that over the first nine months of this year. We expect the bulk of those efforts to be reflected in our ASP in Q4, Q1 into 2024.

我沒有重大合約需要報告。在過去的一個季度中，我們與許多醫療主管進行了交談，並得到了一些積極的回饋，但也有一些需要改進的地方。雙方都如此，但最終試圖將這些對話轉化為現金。今年前九個月，我們在這方面一直卓有成效。我們預計這些努力的大部分將反映在 2024 年第四季、第一季的平均售價。

Excellent. Sorry. One last quick one for Kamal. It's great to see the cash balance go up in the month of October instead of down. I guess as we think about this AR dynamic that you laid out, is there a chance that we can continue to see this type of trend advance into early next year? Or do you think we'll see this benefit sort of be realized by the end of 2023.

出色的。對不起。卡邁勒的最後一件事。很高興看到十月份的現金餘額增加而不是減少。我想，當我們思考您提出的 AR 動態時，我們是否有機會繼續看到這種趨勢推進到明年初？或者您認為我們會在 2023 年底之前看到這種好處的實現嗎？

Thanks, Mark, for that question. In regards AR, we ended 2022 with an AR balance of $6.1 million. That's kind of how we've been viewing the baseline. Now, keep in mind, our volume did increase year to date through Q3 verse through Q3 '22 by 6.2%. So when I'm thinking about AR internally for managing the business, I'm viewing it as baseline $6.1 million, because that's how we started the year.

謝謝馬克提出這個問題。在 AR 方面，截至 2022 年，我們的 AR 餘額為 610 萬美元。這就是我們看待基線的方式。現在，請記住，從今年第三季到 22 年第三季度，我們的銷量確實增加了 6.2%。因此，當我在內部考慮使用 AR 來管理業務時，我將其視為 610 萬美元的基準，因為這就是我們今年的開始方式。

Volumes up 6.2% and ASP is half of that. So that puts me around $7 million of where I feel comfortable with the AR getting back to, if we make it through all the claims by end of year, which as we just indicated, we brought AR down by $5.5 million in October. So we're making great progress, collecting more than we anticipated and should see that air number get back down to those normal levels by the end of the year.

銷量成長 6.2%，平均售價是其中的一半。因此，如果我們在年底前完成所有索賠，那麼我對AR 的回報感到滿意，這意味著我可以放心地恢復700 萬美元，正如我們剛才指出的那樣，我們在10 月份使AR 減少了550 萬美元。因此，我們正在取得巨大進展，收集的數據超出了我們的預期，並且應該會看到空氣數量在年底前恢復到正常水平。

Awesome. That's it for me. Thank you.

驚人的。對我來說就是這樣。謝謝。

And the next question comes from the line of Dan Brennan with TD Cowan. Please proceed with your question.

下一個問題來自 Dan Brennan 和 TD Cowan 的對話。請繼續你的問題。

Great. Thanks, congrats on the quarter. So this question may be on the fourth quarter math. So we calculate what an ASP in the quarter around $400, right? roughly to get to your numbers ex to $600,000 of prior periods that would imply at the minimum guide for the full year, is said $50 million that would imply roughly around 28,000 tests in 4Q? Is that reasonable sort of thing by pricing at least stable with $20,000, would be likely the bottom end of that range.

偉大的。謝謝，恭喜本季。所以這題可能是第四節數學題。那我們計算一下本季的 ASP 約為 400 美元，對吧？粗略地得出你的數字，前幾期的 60 萬美元意味著全年的最低指導，據說 5000 萬美元意味著第四季度大約有 28,000 次測試？定價至少穩定在 20,000 美元，這可能是該範圍的下限，這是合理的嗎？

So I think that's a little aggressive on the ASP side and underperforming on the volume side. We didn't break out our guidance specifically by volume or ASP, but to give you some qualitative feedback there, we believe we'll have higher volume than that likely, but, and ASP $400 would be a bit of a jump from where we're at the $320.

所以我認為這在 ASP 方面有點激進，但在銷售方面表現不佳。我們沒有具體按銷量或 ASP 給予指導，但為了給您一些定性反饋，我們相信我們的銷量會比可能的更高，但是 400 美元的 ASP 會比我們的預期有所跳躍。價格是320 美元。

I'm sorry, I was talking about the in-quarter ASP, not trailing 12 months ASP. Sorry about that.

抱歉，我說的是季度平均售價，而不是過去 12 個月的平均售價。對於那個很抱歉。

Got you, so in-quarter ASP still jumping up to 400 in Q4 may happen? don't know yet, but I still think that's aggressive.

明白了嗎，那麼季度平均售價在第四季仍有可能躍升至 400 嗎？還不知道，但我仍然認為這很激進。

So yes, we can do the math. I guess, off-line just on the ASP Math. I was just wondering wherever we exit the year on in -- like an in-quarter ASP, how do we think about like the fourth quarter in quarter ASPs at jump-off point for 2024 ASP? should we increase from there?

所以是的，我們可以計算一下。我想，離線只是在 ASP 數學上。我只是想知道我們在今年的什麼時候結束——例如季度平均售價，我們如何考慮第四季度平均售價作為 2024 年平均售價的起點？我們應該從那裡增加嗎？

It sounds like from -- your answer to Mark's question, John, it seems like or come off seems like there's some clearly prices, the focus, but it sounds like there's even some more near-term tailwinds for price. So depending upon where we land on 4Q price, like, should we expect that number to improve as we go through '24?

這聽起來像是——你對馬克問題的回答，約翰，似乎或看起來有一些明確的價格，焦點，但聽起來甚至還有一些近期的價格順風車。因此，根據我們對第四季價格的判斷，我們是否應該預期這個數字在 24 年後會有所改善？

So one way to think about, if you look at the seasonality of the business going from Q4 to Q1 -- calculated just the quarter ASP Q4 '21 to Q1 '22 went from 304 to 281. And then you saw a similar decline from '22 Q4 to Q1 '23 327 to 262. Now the decline from '22 to '23 was a little bit more because the PLA code went to the CFL last schedule and that also impacted what that rate was going into the year.

因此，一種思考方式是，如果您查看從第4 季到第1 季的業務季節性，僅計算21 年第4 季到22 年第1 季的平均售價從304 下降到281。然後您會看到類似的下降22 Q4 到 Q1 '23 327 到 262。 現在，從 '22 到 '23 的下降幅度更大一些，因為 PLA 代碼進入了 CFL 最後的時間表，這也影響了今年的比率。

But what's in common and all the other years, as you can see when you calculate the Q1 versus Q4 ASP. is the deductible reset. That's something that I do factor in for modelling purposes, what's that going to do to our revenue for next year?

但是，與所有其他年份有什麼共同點，正如您在計算第一季與第四季的平均售價時所看到的那樣。是免賠額重置。這是我出於建模目的而考慮的因素，這會對我們明年的收入產生什麼影響？

So hiring in regards to seasonality between the quarters, I should say. So yes, the deductible does -- of COVID come down slightly in Q1, but similar to what you've seen in every year it builds up from that point

因此，我應該說，招聘是根據季度之間的季節性進行的。所以，是的，新冠肺炎的免賠額在第一季略有下降，但與您每年看到的從那時起的免賠額類似

Got it. Okay, that's fair. Yeah, we can work on thinking about the full year. From a patient pay basis, like how did that go in the quarter. I know that was a new initiative you guys put in place. Just wondering what kind of benefit or kind of impact you saw from that?

知道了。好吧，這很公平。是的，我們可以努力思考全年的情況。從患者付費的角度來看，就像本季的情況一樣。我知道這是你們提出的一項新措施。只是想知道您從中看到了什麼樣的好處或影響？

In the quarter, virtually no impact from patient pay. And I'll explain why so far. So we do everything we can to work with the patient's insurance before going back to them, right? So what that means is we file a claim after we perform the tests and then we'll work to appeal that patient's claim regard -- if it was denied.

本季度，患者付費幾乎沒有受到影響。到目前為止我會解釋原因。因此，我們會盡一切努力與患者的保險合作，然後再去找他們，對嗎？這意味著我們在進行測試後提出索賠，然後我們將努力對患者的索賠提出上訴——如果索賠被拒絕。

And so that may take on the shorter end around 90 days and on the more traditional end up to nine months, if you will. And in that process, we're going back and forth getting medical records. It may be different reasons for denials. So having a discussion around that and potentially getting on the phone with a medical liaison or a director there and having a discussion clinician to clinician. Once that process has been exhausted, then we actually go to the patient.

因此，如果您願意的話，較短的時間可能需要 90 天左右，而較傳統的時間可能長達 9 個月。在此過程中，我們會來回取得醫療記錄。拒絕的原因可能不同。因此，圍繞這個問題進行討論，並可能與那裡的醫療聯絡員或主任通電話，並與臨床醫生進行討論。一旦這個過程結束，我們就會真正去找病人。

And so that's when that would start to reflect in our ASP, but yet the policy -- and you have to set the expectation with the patient upfront. So the policy has been put in place as of early July because we want people to be -- we want to be transparent, we want people to know that if we have changed our prices, what they are.

因此，這將開始反映在我們的 ASP 中，但是政策 - 您必須預先設定患者的期望。因此，該政策已於 7 月初實施，因為我們希望人們——我們希望保持透明，我們希望人們知道我們是否改變了價格，價格是多少。

And so you see the impact to volume, if you will, from that change, once you telegraph that to the public and then actually get it reflected in ASP once you start billing patients, which doesn't come for some time as I just explained. So it's a -- does that help?

因此，如果您願意的話，您會看到這種變化對數量的影響，一旦您將其電報給公眾，然後一旦開始向患者開具賬單，實際將其反映在ASP 中，正如我剛才解釋的那樣，這在一段時間內不會出現。所以這是——這有幫助嗎？

Yeah. No. Definitely, I understand the trend. Okay.

是的。不，當然，我理解這個趨勢。好的。

So, there will be some tailwind coming up. Sorry.

因此，將會出現一些順風。對不起。

No, I got it. And then maybe just final one. I know you talked about being profitable. I think it's $75 million in revenue, what, 60% gross margin. Presumably, the success you're having here with the program, if anything, would ideally, hopefully get you to that point earlier. Or does anything really change in how you think about the road to cash flow breakeven, given some of the success you've had so far?

不，我明白了。然後也許只是最後一個。我知道你談到了獲利。我認為收入是 7500 萬美元，毛利率是 60%。想必，您在該計劃中所取得的成功（如果有的話）將理想地幫助您早日實現這一點。或者考慮到您迄今為止所取得的一些成功，您對現金流損益兩平之路的看法是否真的改變了？

So nothing changes in the fact that if we keep our operating expense roughly where it is, at $75 million in revenue, in that 60% gross margin rate, we obtain a cash flow positive state. And so that's the picture that we believe we need to hit from a goal standpoint.

因此，如果我們將營運費用保持在 7,500 萬美元的收入水平，在 60% 的毛利率下，我們將獲得正現金流狀態，這一事實沒有任何改變。因此，從目標的角度來看，這就是我們認為需要實現的目標。

You're right that we've been working ahead of schedule, if you will, to get there. And we have some great momentum with more things on the come as we just discussed, specifically citing some of those patient rates and what have you.

你是對的，如果你願意的話，我們一直在提前工作以實現這一目標。正如我們剛才討論的那樣，我們有一些巨大的動力，即將推出更多的事情，特別引用了其中一些患者的比率以及您擁有的東西。

So our cash burn rate has come down year over year. We're taking a look at from an adjusted EBITDA standpoint year to date, first nine months of 2022, $26.4 million in adjusted EBITDA, a net loss there. And then from 2023, we've cut that in half. As we sit here today, our cash balance is around $30 million, a little bit above, and we expect to be there at the end of the year as well.

因此，我們的現金消耗率逐年下降。我們從年初至今的調整後 EBITDA 角度來看，2022 年前 9 個月，調整後 EBITDA 為 2,640 萬美元，為淨虧損。然後從 2023 年開始，我們將其減少了一半。當我們今天坐在這裡時，我們的現金餘額約為 3000 萬美元，略高一些，我們預計今年年底也將達到這一水平。

That gives us quite a bit of time. We currently believe we're well positioned into late 2025, early 2026 to continue operating with our strategy, our plan, and see what type of impact that has. And we'll see how close we get to our goal, and we believe we're well on track and delivering ahead of schedule here.

這給了我們相當多的時間。目前，我們相信我們已做好充分準備，在 2025 年底、2026 年初繼續實施我們的策略和計劃，並看看會產生什麼類型的影響。我們將看看我們距離目標有多近，我們相信我們已經步入正軌並提前交付。

So nothing changes in the overall picture, the pace is -- I'm happy with the pace that we're making, at which we're going faster, a little bit faster, a little bit better always. But I am happy with the pace that we're taking now.

因此，整體情況沒有任何變化，步伐是——我對我們正在採取的步伐感到滿意，我們總是走得更快，更快一點，更好一點。但我對我們現在的步伐感到滿意。

Great. Perfect. Thank you.

偉大的。完美的。謝謝。

And the next question comes from the line of Andrew Brackmann with William Blair. Please proceed with your question.

下一個問題來自安德魯·布拉克曼和威廉·布萊爾的對話。請繼續你的問題。

Hi, guys, good afternoon, and thanks for taking the questions. Maybe just start on the Johns Hopkins agreement and just sort of recognizing there's probably a little bit of work that still needs to be done there before launching a commercial product. But John, can you just talk to us about how investors should be thinking about evaluating the success of that agreement? And not trying to pin you down on any sort of timeframes or timelines, but anything to keep out in terms of key milestones here? Thanks.

大家好，下午好，感謝您提出問題。也許只是從約翰霍普金斯協議開始，並意識到在推出商業產品之前可能還需要做一些工作。但是約翰，你能和我們談談投資者應該如何考慮評估該協議的成功嗎？不是試圖給你規定任何類型的時間框架或時間表，而是在關鍵里程碑方面有什麼需要注意的嗎？謝謝。

Yeah. Hey, Andrew, good afternoon. Thanks for joining the call. So we are very excited about this opportunity.

是的。嘿，安德魯，下午好。感謝您加入通話。所以我們對這個機會感到非常興奮。

Really, we're working to develop clinically meaningful technology that meets a high customer need. We've laid some of these criteria out in the past, but has clinical -- clear clinical utility proprietary nature to the technology, path to value-based reimbursement. And really, this agreement satisfies all of those requirements and that's why we're so excited to partner with the team there. It's a very renowned group of folks, which discovered and created this invention. So very excited from that standpoint.

事實上，我們正​​在努力開發具有臨床意義的技術來滿足客戶的高需求。我們過去已經制定了其中一些標準，但具有臨床——明確的臨床實用性技術專有性質，以及基於價值的報銷路徑。實際上，該協議滿足了所有這些要求，這就是為什麼我們非常高興與那裡的團隊合作。這是一群非常著名的人，他們發現並創造了這項發明。從這個角度來看，我非常興奮。

To give you a little bit of background, Lupus nephritis affects roughly 50% of the lupus patients. So we're broadening our coverage of lupus patient journey. This technology really has gained a lot of attention, certainly at ACR. That's, again, the annual meeting, American College of Rheumatology, last year. The first abstract came out there and was presented.

為您提供一些背景知識，狼瘡性腎炎影響約 50% 的狼瘡患者。因此，我們正在擴大狼瘡患者旅程的覆蓋範圍。這項技術確實引起了很多關注，尤其是在 ACR。這又是去年美國風濕病學會年會。第一篇摘要已發表並發表。

So over the last year, we were able to secure an exclusive worldwide license to develop these markers into clinical tests. And we've already initiated a prospective trial that was actually part of our R&D spend this year to recruit patients for development and that started. So we anticipate being able to move fairly quickly.

因此，在去年，我們獲得了全球獨家許可，將這些標記物開發到臨床測試中。我們已經啟動了一項前瞻性試驗，這實際上是我們今年研發支出的一部分，旨在招募患者進行開發，並且已經開始。因此，我們預計能夠相當快地採取行動。

Now, I still don't expect significant revenue contribution within a 24-month period, which has been the timeline I've kind of set as a threshold for laying a lot of this stuff out. But that may change. But at least as it stands now, I think that's a conservative approach to this. There's two drugs on the market in this area to help treat this condition. One is from GSK, the other from Aurinia. And we're working to see how this tool can start to improve trials and research in this space as a first step.

現在，我仍然預計 24 個月內不會產生重大收入貢獻，這是我設定的時間表，作為佈置大量此類內容的門檻。但這可能會改變。但至少就目前而言，我認為這是一種保守的做法。該領域市場上有兩種藥物可以幫助治療這種情況。一個來自 GSK，另一個來自 Aurinia。作為第一步，我們正在努力了解該工具如何開始改進該領域的試驗和研究。

As I'm sure you know, being able to profile these patients, identify these patients is very important, and useful in the development process for many of these pharma companies. So that's a logical first step for us to derisk and accelerate the path here. It's a protein-based technology, which aligns very much with our existing competency. Also helps from a value-based pricing standpoint, gives us potential opportunity to crosswalk on a code when we get to that point. But again, kind of leads to some of the -- or lends to some of the excitement we have.

我相信您知道，能夠對這些患者進行分析、識別這些患者非常重要，並且在許多製藥公司的開發過程中非常有用。因此，這是我們消除風險並加速這一進程的合乎邏輯的第一步。這是一種基於蛋白質的技術，與我們現有的能力非常契合。從基於價值的定價角度來看，這也很有幫助，讓我們有機會在達到這一點時跨越程式碼。但同樣，這會導致一些——或者給我們帶來一些興奮。

And then maybe kind of to wrap it up, we have to follow the science. So that's the number one thing here. As you said, there's still some work to be done. But ultimately, we envision this test as a measure of disease activity. So that'd be used to track patient response to therapy over time and would inform on an individual patient's treatment response. So likely a tool that's used to manage this patient throughout their journey and we can go from there.

也許總結一下，我們必須遵循科學。所以這是這裡的第一件事。正如你所說，還有一些工作要做。但最終，我們將這項測試視為疾病活動的衡量標準。因此，這將用於追蹤一段時間內患者對治療的反應，並告知個別患者的治療反應。很可能是用於在患者整個旅程中進行管理的工具，我們可以從那裡開始。

We'll be able to flush this out, again, as the science kind of dictates and share some of those meaningful milestones, especially as they hit print or publication. But it's an area that we believe aligns very closely with what we're doing and should be a very nice bolt-on for us from a development standpoint.

我們將能夠再次根據科學的規定來解決這個問題，並分享一些有意義的里程碑，特別是當它們印刷或出版時。但我們相信這個領域與我們正在做的事情非常吻合，從發展的角度來看，這對我們來說應該是一個非常好的補充。

Okay. That's terrific. And then you've done a lot to revamp the appeals process here over the last year, can you just level set us on where you think we are in recognizing the benefits from those changes and what gives you the confidence that those are going to continue to sort of bear fruit as we look to 2024?

好的。真了不起。去年，您為改進上訴流程做了很多工作，您能否告訴我們您認為我們在認識到這些變化帶來的好處方面處於什麼階段，以及是什麼讓您對這些變化將繼續下去充滿信心展望2024 年，能否取得成果？

Yes. We're really in the pregame warm-up, Andrew, is the way we view it. And the reason I state that is, the revamp of an appeals process takes time. We held claims for the first six months of the year. And in doing so, it let us put many of these changes in place. We implemented the customer facing policy changes here in July. But to actually see results in an ASP standpoint, it takes that 9 to 12 month period. And that's why we've worked hard to communicate around Q4 into 2024 being the timeline that we expect to see consistent improvement in ASP.

是的。安德魯，我們確實處於賽前熱身階段，這就是我們的看法。我之所以這麼說，是因為上訴程序的改革需要時間。我們在今年前六個月持有索賠。透過這樣做，我們可以將其中的許多改變落實到位。我們於 7 月實施了面向客戶的政策變更。但從 ASP 的角度來看，要真正看到結果，需要 9 到 12 個月的時間。這就是為什麼我們努力在 2024 年第四季左右進行溝通，這是我們期望看到 ASP 持續改善的時間表。

Now it just so happens that some of these changes have been reflected earlier. And if we're looking at claims where historically we had more of a challenge getting reimbursed and we've been able to turn that tide, that's great. Our primary focus has been current claims where we haven't passed some of the timely filing restrictions and where we're able to make some meaningful progress on a per payer medical policy standpoint.

現在碰巧的是，其中一些變化已經提前反映出來了。如果我們正在考慮歷史上我們在獲得報銷方面面臨更多挑戰的索賠，並且我們已經能夠扭轉這一趨勢，那就太好了。我們的主要關注點是當前的索賠，其中我們尚未通過一些及時提交的限制，並且我們能夠在按付款人醫療政策的角度取得一些有意義的進展。

So those haven't come yet. We're well in process. We've implemented the changes to attack that area, if you will. But we still have a lot more to see and to do because some of this is also a significant learning process. As we get feedback from individual payers, we'll adjust our game plan. There's certain letters that are going to be more effective on an appeal basis and we'll find out how to make our less effective ones more effective over time.

所以那些還沒來。我們進展順利。如果你願意的話，我們已經實施了攻擊該區域的變更。但我們還有很多事情要看、要做，因為其中一些也是一個重要的學習過程。當我們收到個人付款人的回饋時，我們將調整我們的遊戲計劃。有些信件在上訴的基礎上會更有效，隨著時間的推移，我們將找出如何使效率較低的信件變得更有效。

So I think we're in early stages here. And again, we -- it conveyed that Q4 into 2024 would be where we start to see progress. Great to see it earlier, ahead of schedule. Doesn't mean that there's not more coming. And so I would expect our original communication to ring true here.

所以我認為我們還處於早期階段。我們再次強調，我們將在 2024 年第四季開始看到進展。很高興能早點看到它，比計劃提前。並不意味著不會有更多的事情發生。因此，我希望我們最初的溝通能夠在這裡實現。

Okay. Super helpful. Thanks, guys.

好的。超有幫助。多謝你們。

And there are no further questions at this time. Now, I would like to turn the floor back over to John Aballi for any closing comments.

目前沒有其他問題。現在，我想將發言權交還給約翰·阿巴利，請他發表結束語。

Thanks, again, for joining the call. I'm extremely proud of the team and their efforts this past quarter. We're now very consistently demonstrating performance in key areas. And we transformed the organization into a more profitable entity. We've successfully implemented many changes to improve ASP and are seeing momentum there. We reduced our cash burn and thereby significantly extended our runway well into 2025, early '26. Plus, we're evolving our R&D pipeline, which we expect it to lead to growth in future years.

再次感謝您加入通話。我為團隊及其上個季度的努力感到非常自豪。我們現在在關鍵領域始終如一地展示績效。我們將組織轉變為獲利能力更強的實體。我們已經成功實施了許多變革來改進 ASP，並且看到了這方面的動力。我們減少了現金消耗，從而將我們的跑道顯著延長到 2025 年（26 年初）。此外，我們正在發展我們的研發管道，我們預計這將在未來幾年帶來成長。

So our strategy is clear. We're executing well. We have the Rheumatology Community in town right now for their annual meeting and it's just an energizing time for us with everything going on. And I'm excited to continue building a stronger Exagen going forward.

所以我們的策略很明確。我們執行得很好。我們鎮上有風濕病學社區正在舉行年會，這對我們來說是一個充滿活力的時刻，一切都在發生。我很高興能夠繼續打造更強大的 Exagen。

So thanks, again, and we very much appreciate you joining the call.

再次感謝，我們非常感謝您加入此次電話會議。