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1、Equity ResearchAmericas | United StatesResearch AnalystsMatt Miksic212 325 4381Christoph Gretler41 44 333 79 44Vik Chopra212 325 1749Credit SuisseMedical Supplies and DevicesOrtho Surgery Update from AZ: Current Volume and Capacity Trends -TranscriptMedical Supplies & Devices | Conference CallWhats
2、New?： We hosted a conference call with Dr. Kipling Sharpe, orthopaedic surgeon at OrthoArizona in Phoenix, Arizona, on August 11 to discuss his views on current ortho volume trends, expectations for August and September, new patient flow and implications of the fall and winter flu season. We have in
3、cluded the full, unedited transcript of the call in this document. In addition, we summarized key take-aways from the call in our note OuUook for Volumes and Capac业 Remains Favorable, also published this morning. Replay Details： Domestic: (855) 859-2056/lnternational: (404) 537-3406; Conference ID:5
4、764088DISCLOSURE APPENDIX AT THE BACK OF THIS REPORT CONTAINS IMPORTANT DISCLOSURES, ANALYST CERTIFICATIONS, LEGAL ENTITY DISCLOSURE AND THE STATUS OF NON-US ANALYSTS. US Disclosure: Credit Suisse does and seeks to do businessChristoph Gretler:OK. And then maybe the other kind of comment we heard wa
5、s in a kind of the (inaudible) substantial shift to ASCs now this period. This is also kind of a very remarkable shift that you observed with your colleagues knowing you were kind of off and on ecosystem.Kipling Sharpe:Yes. So, 1 have not had to use an ASC because 1 have this orthopedic specialty ho
6、spital but 1 am aware that people who dont go to that hospital are using ASCs because the hospitals have to some extent restricted.And 1 think patients are more willing to consider that because again hospitals seem like dangerous places to them right now. And so, theyre more willing to consider it a
7、nd say Im OK suffering a little extra pain at home and not getting IV pain meds if 1 can avoid getting this COVID thing and so Im OK going to ASC and having my surgery done as an outpatient.In the U.S. the timing of it was pretty good because Medicare controls a big portion of the joints and commerc
8、ial insurers kind of follow Medicare rules. And over the last couple years total knees first and most recently total hips were taken off of the inpatient only list so that they could be done as an outpatient. Now, they have not approved hips for ASCs. 1 believe they put knees on the ASC list this ye
9、ar.The hips still have to be done - they can be done as out patients but it has to be a hospital outpatient department. So, that was (inaudible) in its timing in its pre-COVID change and next year the CMS rule has proposed that hips now go to that same status as well where they can be done in an out
10、patient center. Thats a proposed rule not a final rule again. But commercial insurers have been allowing it.Christoph Gretler:OK, so there seems to be more tax to set work than trust kind of the pandemic apparently.Kipling Sharpe:Yes.Christoph Gretler:And then maybe one actually company specific que
11、stion if you allow, 1 know kind of one of my companies actually just recently got - its called a (inaudible), got approval of an augmented reality search of a platform for total knee. Have you ever come across or what do you think aboutkind of the use of now this augmented reality classes to visuali
12、ze (inaudible) the surgical actions in your daily practice. Is this something that you could envision or have you ever heard of this company and this technology?Kipling Sharpe:1 am familiar with Medacta. 1 was not aware of the augmented reality. But that 1 had not heard of. Im not sure how that woul
13、d - how that would work. Im not - 1 mean 1 dont know what that would add to my current visualization. Theres all kinds of ways to do knee alignment now. You can get the custom cutting blocks so that thats all preset cuts. You can use the navigation, you can use the robot. So there are a lot of diffe
14、rent ways to get that navigation or alignment done on the knee in addition to just the traditional alignment instruments.So Im now sure where augmented reality fits into that and 1 think one of the things thats delayed Strykers deployment of more robots has been their marketing approach as saying we
15、ll sell you the robot and then theres extra costs. But theres no extra money in the - in the pool of money - hospitals get paid a flat fee for a total joint. And so where do they get the money to pay for that robot. And theyve been able to sell some but 1 think that that has delayed their deployment
16、 of as many robots that they would like.And 1 think that its going to continue unless they change that approach. So how Medacta approaches the market with this augmented reality will probably have an effect on how its accepted. First of all it has to show some value to the surgeon - then if theyre g
17、oing to charge the hospital for it they have to be able to show some value to the hospital.And 1 dont really know much about it specifically but those would be my general thoughts.Christoph Gretler:1 guess (inaudible) place that in the hospital and then you pull through some implants on the back of
18、it. So thats - (1 know) thats obviously a relatively cheap system you know kind of - 1 mean (inaudible) like these (total glasses) and then you have no visualization (inaudible) you see (kind of) the preplanning (inaudible). And then kind of navigational systems so you can locate the implant and ins
19、truments you know in the 3D (inaudible).But Im sure they will approach eventually with it also.Kipling Sharpe:That will probably be more appealing to younger surgeons. 1 mean Ive never done any augmented reality you know just at my age of being in the late 50s that whole augmented reality, virtual r
20、eality stuff has not appealed to me. But 1 think the younger people like that more. So it may be more appealing to the younger surgeon.Christoph Gretler:OK. No, 1 guess its cheaper. So in your (inaudible) it be also quite interesting because not everybody can afford these super duper Stryker robots,
21、 unfortunately.Kipling Sharpe:Well 1 guess at $1 m川ion is a lot money.Christoph Gretler:1 guess, it would it from my side, Matt if you want to kind of take it back for any questions you might have on - from the audience or (something).Matt Miksic:Sure, yes. 1 was going to ask, (Demetria), if you wou
22、ld give the instructions for audio questions. And then while were waiting folks to potentially queue up Ive got a couple of questions on email. So (Demetria), do you want to go ahead?Operator:As a reminder to ask a question you need to press star 1 on your telephone. To withdrawal your questions ple
23、ase press pound key. Once again if you have a question or comment please press star then 1. Please stand by while we compile the Q&A roster.Matt Miksic:Thanks so much. And just if you wouldnt mind just interrupting or letting us know if we have people queue up. We usually dont but of course were gla
24、d to have an audio question. One question that 1 have on email here is we talked about the trajectory of your percent of pre-COVID levels that your volume is running at. It sounds like youve been - (havent) dropped below 100 percent you were above 100 percent when we talked to you in early June.1 gu
25、ess your thoughts and this is where we ask you to get out your crystal ball on what that percent of COVID level looks like for August? Or dare we say September? Do you expect youre going to hang around that 100 percent level or will there be a point where you drop? What are your thoughts there?Kipli
26、ng Sharpe:Well, right now my August and September OR dates are full.Matt Miksic:OK.Kipling Sharpe:So Im at 100 percent. If 1 have to add people on it will go over 100 percent. But right now those dates are full. And they filled quickly, 1 was actually planning on taking two weeks off to travel to Eu
27、rope at the end of August first part of September and 1 just a couple weeks ago 1 opened those up and theyve already filled. So 1 anticipate, unless we get hit by a second wave that is greater than the first wave, 1 anticipate remaining at 100 percent through the rest of the year. Thats my crystal b
28、all.Matt Miksic:OK. Well thats a pretty good crystal ball. 1 guess a full schedule works.So the question 1 had and (Demetria) again interrupt if theres anyone coming in. But there was a lets see, if the fall, winter COVID wave doesnt come through as some might fear or expect how far above or do you
29、think that you - do you think that youre pushed above 100 percent? And if so how far above 100 percent can you sustain?In other words, what is - whats the upper limit? Whats an extra day give you? Whats any extra longer surgery day give you? And if you have to go higher?Kipling Sharpe:Right. So Im i
30、n a somewhat different position than a lot of people because as 1 have been in practice for 25 years 1 kind of work at a somewhat reduced schedule compared to somebody working 40 hours a week. 1 work four days a week and usually my OR days are done by 3:00 and certainly 1 can - 1 could extend my day
31、s to go until 5:00 or 6:00 if 1 wanted. 1 could add a fifth day if 1 wanted. So 1 have capacity. Is there OR capacity? Probably to extend my days (as) the hospital would be willing to give me more OR time to go longer into the day at both hospitals that 1 operate at.1 dont know that 1 could pick up
32、another OR day though 1 dont know that thats available because there are a lot of other surgeons who are also busy in my neighborhood that - its - Ive tried many times to get extra OR time for a one off case and its often difficult. And 1 anticipatethat that will be the case this fall as well. So pr
33、obably 1 could run at 120 percent if 1 could physically maintain that which probably 1 could.1 dont know that 1 want to but thats sort of the - thats - 1 dont know if 1 answered your question - how well 1 answered your question.Matt Miksic:No, no. 1 think that was perfect. That was perfect. 1 had on
34、e - 1 mean just to put this into context it sounded like if youre doing eight to 12 joints a week thats 4 or 500 joints a year or something. Is that approximately right? So -Kipling Sharpe:1 do about 400 because - about 400 because 1 take about six weeks a year off.Matt Miksic:OK. So you know 1 mean
35、 400 in the scheme of things, as you know, it may feel like youve sort of taking a step back in your work week but thats a pretty - its still a pretty significant amount of joints per year.One follow-up on that if 1 could just - as we get into the flu season there was some concern early on, 1 guess
36、April, May we were all trying to figure out what happens when flu season comes and what is the - when is the second wave and all these kinds of theories and hypothesis and scenarios. But what - at this point as you head into Q4 and head into what is - 1 typically and 1 dont know if its your center,
37、a busy kind of end of year push for all kinds of reasons to get cases done before the end of the year?Is that a seasonal pattern that youre expecting to repeat this year or is there any gearing up for a flu season or any concern about hospital occupancy or anything like that? Whats the early convers
38、ation about Q4 look like?Kipling Sharpe:So 1 guess the real question is do we get hit with the flu and COVID, which is what the big fear is. So normally Arizona gets hit with a very big flu season. Thats our norm. We get hit hard with the flu because we have a lot of winter visitors and old folks wh
39、o come down here and those are the people who are sick from the flu. So we normally experience that.One theory is that when we get - because were all wearing masks that we wont have a flu season. That the social distancing that were doing now is going to prevent a flu season, thats one theory.Matt M
40、iksic:Yes.Kipling Sharpe:Its an interesting theory. So every year were prepared, every year our hospitals exceed their stated capacity with flu patients. So if we get hit with COVID and flu that will be bad. Thats sort of a worst case scenario for Arizona.Matt Miksic:Yes. And what is that you mentio
41、ned and go ahead you were going to add something else.Kipling Sharpe:No, no, 1 was done.Matt Miksic:So you mentioned that CO VID patients currently represent about 15 percent of the patients in the hospital (inaudible)-Kipling Sharpe:1 think its dropped down to about that.Matt Miksic:And what was it
42、 at - what was it at its peak when things were - back in early July, 1 guess?Kipling Sharpe:Probably between 30 and 40 percent.Matt Miksic:Wow. OK. So 30, 40 percent of the patients in the hospital were COVID patients; and then maybe just by - if we could get some rough proportions because you go th
43、rough this - Im sure every year - is when do you get hit with flu season? Whats that occupancy look like at peak or the toughest time of the season?Kipling Sharpe:Sorry, give me one second here. 1 .Matt Miksic:Sure.Kipling Sharpe:Sorry, 1 got into my car to drive to work - the timing of this - is th
44、e time for me to go to work.Matt M汰sic:OK. No worries.Kipling Sharpe:Would you repeat the question because part of it cut out of my phone (inaudible)Matt Miksic:Sure - sure. Of course - of course; no, 1 was asking you say similar question to the CO VID occupancy is when youre in the middle of flu se
45、ason, or what a normal heavy flu season looks like.Kipling Sharpe:Yes.Matt Miksic:What percentage of the hospital is occupied by flu patients approximately?Kipling Sharpe:Well 1 dont know that number, but 1 know that the hospitals in the winter here are typically at 110 to 120 percent of their licen
46、sed capacity.Matt Miksic:OK. All right; and so then 1 guess - 1 guess the other question would be do you have any sense of - what - what acute procedures like hips, knees, spine - other things where theres an overnight stay of a day or two or three. Cardiovascular - cardiac surgery etcetera - any se
47、nse of what - 1 know its a bit out of your purview, but any sense of how much of the hospital is taken up by those kinds of patients?Kipling Sharpe:The Orthopedics - well sense - again most of my surgeries 1 do 1 do in an orthopedic specialty hospital, so thats 100 percent orthopedic patients.Matt M
48、iksic:Yes.Kipling Sharpe:But in the community hospital that 1 operate at, orthopedics is probably 10 - between 10 and 20 percent of the inpatients, but its a huge driver of the hospitals bottom line; and so the hospital .Matt Miksic:Of course.Kipling Sharpe:Makes a very big effort to not cancel orthopedic cases.Matt Miksic:Right. Right.Kipling Sharpe:So even when theyre over capacity they find ways - the state kind of looks the other way on the over the capacity during flu season. They find ways to make it work. 1 mean