Monitor the surgeries. The benefits of minimally invasive surgery are real and undisputed. There are some bad result of individual surgeries to be sure. Cars replaced horses and more people were killed in traveling accidents than before for sure, but individual drivers or individual mechanical failures must be weighed in light of the benefits of mass, economical, rapid transportation. Use the same approach to robotically assisted surgery. Without the improvements of the Da Vinci and "Firefly" technologies used by it 30-35% of all colon cancer patients died from the complications and inefficacies of conventional surgical treatments. Without any surgery 100% died. With the Da Vinci / Firefly treatment the death rate has dropped to less than 2%. Which would you choose for your loved one, 100% death rate, 35% death rate, or
Couldn't find anything on the web. His list of companies worked for and responsibilities seems to put him in the center of what experience could help Novadaq though.
Last year they announced the Investor Day would be November 18, 2014 on September 18, 2013. I suspect we won't hear anything for a couple of weeks.
Took advantage of the sub-$13 prices. I don't see how the institutions will be able to stay away from this one. Perhaps the Investor Day will be the catalyst.
The following Surgeon additions to the ISRG Web site definitely show a trend. I suspect the Obamacare impacts on both providers (surgeons and hospitals) as well as consumers (patients who need medical attention) have had dilatory impacts that will be analyzed for years.
New Surgeons Added to ISRG Web Site:
Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014(pro-rated after 2 months)*
Domestic 465 242 188 174 126*
Domestic General Surgeon Percent of Total
41% 50% 43%
International 156 21 66 71 14*
International General Surgeon Percent of Total
8% 20% 33%
I do not think this trend leads to the imminent obvious terminal of zero new additions, though it will lead to the net zero terminal eventually. The number of attritions must also be considered. Initial attritions are only a small fraction of the total additions, typically less than 10 per quarter. Of these almost all are women, I suspect family priorities are the cause for most of these. However the number of men and non-family driven causes will naturally increase with age and random health causes. Even physicians can develop cancer or have heart attacks.
I suspect from this secondary indicator that the Q3 2014 results will surprise the analyst that look at the last 2 Quarters for their "revisions" and "valuation" models. We could see the stock price retrace its climb come October.
Sorry to be the bearer of bad news but I wouldn't be faithful to those that read my blogs unless "I called them as I see them."
ISRG still has a bright future with Gen Surgery additions and the new XI enhancements coupled with Japanese insurance approval in Q2 2016.
The little green Gecko says it best in the commercial, walking across the bridge in NYC...you want a parking space?....
I was talking to one of my friend and co-investors of ISRG when it was in its infancy and we talked about hiring a fellow to sit across the street from their production facility and count the Fed Ex trucks! We never did of course but the thoughts were the same....I too like you are tied to the dock and will wait for this ship to either load up and depart or ...
Absolutely agree, as I stated in an earlier blog, there are 6k to 10k US hospitals that will eventually have Novadaq's suite of diagnostic/operational/confirmatory hardware and software to assist the medical process writ large. The international market penetration will be comparable eventually because the use of this revolutionary technology and process both increases the efficacy of existing medical treatment regiments and simultaneously reduces cost! There will also as if this is not enough, be clinics and medical practices which could be equal to in size to the hospitals, for wound care, diabetes, and aging diseases.
Tred, the results we all see, i.e. a slower adoption than theory would have indicated was largely influenced if not responsible to the "Affordable Care Act". In the US hospitals....the marginal ones and many of those in remote regions are under so much stress that they are closing. The rest are trying to cope with the ~40% of "discretionary" patients that have weighed the new "deductible", real out of the pocket cash expense that are now in the thousands instead of the hundreds, that are not now in the revenue stream. When there is a cash flow transient like the one hospitals are living through, there are two main responses. One, lay off employees....very painful and not easily repaired if the revenue stream recovers. Two, reduce, even eliminate capital equipment purchases.
These "discretionary" patients will eventually either become non-discretionary--when the benign tumor becomes cancerous...or they will decide to pay the new increased deductible...or they will be removed from the market for health treatment...death.
The big picture seems to be a marked increase of GDP percent going to the health segment in higher insurance and deductible and tax (government subsidies) payments. Yes, our president bent the cost curve, just not the way it was advertised. So where is all that money going? Insurance companies seem to be doing better. The government initially is doing better with justification for higher taxes...individual penalties (taxes according to the Supreme Court) and the new plethora of medical taxes...Capital Equipment Revenue tax, insurance "Surcharge" ....etc. This money will eventually work its way through the pipeline or else new pipelines will be created to meet the demand for health care. Else we will all suffer higher costs and less health care...rationing is what we use to call it.
If you put one more intermediary (new ACA regulatory bureaucracy) between the patient (consumer) and the doctor (provider) there will be a delay.
You put your finger right on the key takeaway again Endo. First Breast Reconstruction, then G.I., then Lymph Node, then Endometriosis, then....Standard of Care. This company's suite of equipment and applications will be in 80% of all hospitals in the US one day. ISRG is in 20%. Internationally the ratio of NVDQ to ISRG's presence will be even higher due to the cost effectiveness of it's technologies. It pays for itself even in a low cost environment. Currently the company sees about $1 to $2 Billion in annual revenue, I see $4-$8 Billion eventually counting all the clinics that will use it for wound care and diagnostics.
Thank you so much Endo. I really appreciate your thorough, relevant, unbiased thoughts and comments in your blogs. Keep up the good work. Someday, perhaps when NVDQ passes $100 a share I will come to one of the annual meetings and take you out to dinner.
I thought Arun said in a previous call that he would have each quarter the number of SpyElite, LUNA, and PinPoint units ---Sold, Placed, and # of Hospitals using them. Would be nice to have a web site that was updated telling us what hospitals have these pieces of equipment both so we can monitor their progress and so I can guide folks I know that could benefit from these wonderful technologies. Similar to the ISRG hospital and surgeon web site. That would be a help to us that have invested and to potential users of these services.
What if NVDQ is in the midst of a tactical battle over SpyElite? If the breast reconstruction becomes the "standard" of practice will they have to pay more for taking it back inhouse? "I don't think all of the evidence is in yet" rings true. I would like to be a fly on the wall of the NVDQ strategic/tactical management discussion about how to proceed with the relationship/contract negotiations or the break-up of thereof! If played right someone will have a lot of value to be captured. Now is not the time to show your hand---hold em!
No. Conference call was as expected. Nothing that indicated the company was off course from what they have all along been projecting.
Looks to me like some institutional sale of 50k plus volumes with no countervailing buy side driving the price down big chunks. A year from now someone who monitors those institutions will be asking why we sold NVDQ at $13 and now its at $26 and we are buying it.
Spot on Endo...The volumes of procedure growth are encouraging and as less machines than hoped for are in the field, that means the existing machines are being used with increasing regularity. Higher throughput for the hospitals means more efficient, hence profitability for the hospitals. Good!
Tred, I believe you are correct. ISRG sold half of their 97 machines as the new Xi and none of those could have the Novadaq technology "revenue" recognized because the FDA has not approved it yet. All of the other half ~50 Si machines would not have the Novadaq tech as historically it ran around 80-85%. I also think you are correct about LifeCell as last quarter they were essentially only selling from their existing inventory with no new orders to Novadaq.
The revenue was a little light but lets put things in perspective. The shortfall was about $300k. That's less than two sales of LUNA or PINPOINT. TWO! come on, given that the company itself said it would take 6-9 months for its marketing hires to come up to speed, and the real gauge of how they are doing won't be fully realized until the 3rd and mostly 4th quarter, lets wait an see. More on this once I listen to the conference call. Earnings were spot on...The analyst said a loss of $0.08 yesterday and that what they came in at, meaning the gross margins are ~60%-70%. Once volumes pick up expect the gross margins to approach and then breach the 70% mark.