It seems that while several physicians are pushing for the Da Vinci system to be purchased, community hospitals are NOT approving it due to its high price and lack of ROI. Reimbursements on surgical procedures don't change to the hospital whether the surgery is done manually or by the robot, so there is no upside to a smaller hospital purchasing it. (The only upside is increased marketability, however community hospitals are already not competitive against larger hospitals in terms of attracting elective surgical procedures.) In addition, community hospitals have already expended their capital budgets installing Electronic Health Record systems ahead of the 2015 mandate from CMS. It looks like ISRG is approaching saturation in the US, which is evident in their revenue warning. As this becomes more and more clear to investors, I expect ISRG to fall from PE contraction into the mid 300's and eventually stabilize in the 340-360 area.
"It seems that while several physicians are pushing for the Da Vinci system to be purchased..."
That's absolutely awesome. Who do you think is one of the most important players in this equation? You just stated half of main the reason to invest in ISRG (besides the surgeons the other half being the patients pushing for it).
Those community hospitals are simply going to lose their good surgeons to the bigger hospitals and further reinforce the smart hospitals' decisions to have already (and continue to) invest in purchasing multiple da Vinci's because it draws in the best surgeons and thus the combination of patients clamoring the system and the best surgeons.
The only good point that you possibly made is that some attention (and possibly money) has been diverted to accommodate the Obama Care calendar. The other factor is all the vague negative BS hype that has been circulating recently - hospitals may be pausing to see if there is anything to the rumors.
But IMO, all this lull creates is a huge pent demand. Once all of this BS blows over the historical march will continue....
PS: A few years ago "community hospitals" were not even on Intuitive's radar.
Embedded in these two comments is a new paradigm. The US through Obamacare is migrating to a two tiered medical system. One payed for voluntarily by folks that want and can afford excellent health care and the other by folks who can't afford it and so rely on others to pay for thier care through taxes and coersion (forced insurance premiums out of allignment with costs). These second tier offerings are ubiquitous in most third world countries and other regions of the world where the average citizen is not given the freedom to choose services. Not everyone can afford a BMW or a share of Berkshire Hathaway, but there are and always will be the wealthy. The Holy Scriptures tell this of the last days...A meal of Barley (poor grain used for cattle) for a days wages, a meal of Wheat (grain used for people) for three days wages....but see that thou hurt not the oil or the wine (those that have wealth and can afford to pay for luxuries). Sad, but this is where we are going.