Intuitive Surgical Earnings Call Nuggets: Procedure Trends, Procedure Growth Breakdown

On Tuesday, Intuitive Surgical, Inc. (NASDAQ:ISRG) reported its third quarter earnings and discussed the following topics in its earnings conference call. Take a look.

Procedure Trends

David Lewis – Morgan Stanley: Gary or Aleks, or anyone else for that matter, just thinking about the third quarter kind of from the macro perspective it looks like the third quarter is a lot like the second quarter, we saw significant Japan strength and U.S. de novo system strength offset by Europe and we saw dVP U.S. and O-U.S. weakness offset obviously by dVH as well as some general surgery improvements. So, can you give any sense the fourth quarter guidance sort of implies stable trends on procedures with the third quarter, do you have any sense the balance of these positive and negative forces, how many quarters you think this could persist?

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Gary S. Guthart, Ph.D. – President and CEO: This is Gary. It’s pretty hard to call U.S. prostatectomy, that’s as you know more an issue of medical management and watchful waiting than it is a change in da Vinci surgery versus other kinds of surgery. So, we don’t have a crystal ball as to where that procedures going to go over time. The data we look at is probably pretty similar to the data that you look at in terms of where PSA testing is taking us. On the upside I think the things that are growing, we can measure good interest from our customers, we can measure sales force activity that tends to be little bit more in our camp versus out in the road. So, on the downside, pretty tough to call, on the upside we can look at the activities that we can influence and feel pretty confident about the things that we can do.

David Lewis – Morgan Stanley: Then Gary, just following up one of those key (kettles) which obviously is single incision. I don’t know if I caught it on the call, but could you sort of confirm whether sills has sort of moved into your third largest procedure for the Company?

Gary S. Guthart, Ph.D. – President and CEO: We have talked about before that cholecystectomy has a total procedure of all types multi-port in and Single-Site together combined is the third. Single port on its own is not.

Aleks Cukic – VP, Strategy: It’s important to note that, as a reminder of course it’s a distant third. I mean you have hysterectomy, you have prostatectomy and you have cholecystectomy and so you have other procedures that are sort of in the general neighborhood procedures such as partial nephrectomy and sacrocolpopexy and others. So, it is indeed third, but it’s a reminder, it is a distant third.

Gary S. Guthart, Ph.D. – President and CEO: There’s one more differences that’s worth pointing out is that unlike prostatectomy and hysterectomy, cholecystectomy can be an entry point into a clinical pathway for somebody who wants to end somewhere else and so those procedures can be a little more volatile.

David Lewis – Morgan Stanley: Then Gary just one quick one. I apologize for two, three questions, but you talked about an increase in spending for both U.S. general surgery and potentially I would imagine if you’re going to go after Europe and change structurally how you are selling that there could be increased expense, could you help us sort of frame those relative expenses versus other very significant sales investments you’ve made perhaps the 2010 significant investment in the U.S.?

Gary S. Guthart, Ph.D. – President and CEO: It won’t quite be the same scale. It’s a little bit more targeted. So, in Europe it’s really filling open headcount in the field and investing a little bit more in the back-office in terms of clinical trials and other types of marketing investments economic analysis and so on, so that’s kind of what the European side looks like. On the general surgery side, it will be a general surgery focus expertise in that.

Procedure Growth Breakdown

Benjamin Andrew – William Blair: Gary, can you breakdown the procedure growth for us between the U.S. Europe and RW?

Gary S. Guthart, Ph.D. – President and CEO: I’ll turn it to Calvin.

Calvin Darling – Senior Director of Finance: So, the procedure growth, total procedure growth year-over-year was 22% and then what we said was that the procedure growth outside of the U.S. year-over-year was 9%.

Benjamin Andrew – William Blair: So was the U.S. close to around or it wouldn’t be that high?

Gary S. Guthart, Ph.D. – President and CEO: Yeah, I mean you could probably back into it on your models there. But again worldwide we’re looking at about 22% for Q3, 25% on a year-to-date basis and included in those numbers would be a decline in the U.S. dVP volume that Marshall mentioned of 20% on a quarter basis and 14% on a year-to-date basis. So, I think what it implies is that if the U.S. stayed flat from year-over-year the worldwide growth would have been about 26% ion Q3 and 28% on year-to-date basis.

Benjamin Andrew – William Blair: I guess what I’m getting at is dVP down 20% in the U.S. if you were on a base of say 75,000 cases for `11 if that’s down 20% full year, you’re talking something in the low 60,000 cases negative, 15,000 at the most, 12 to 15 and if dVH has grown 60 and COLI is adding 10 and all the other stuff is adding another 30, 40, 50 you end up with robust procedure growth in the United States and the real evidence of a problem is obviously which is macro and some concern about obviously dVP but at some point dVP has to bottom and so the question becomes is there sort of a structural level of prostatectomy that we can think about where this will shake out over the course of call it six to eight quarters and will end up at maybe a rate of 50,000 dVP’s in the U.S. does that make sense?

Gary S. Guthart, Ph.D. – President and CEO: The flow of your argument makes sense. I think that Calvin may argue with you about some of the numbers. Just to make sure that you tied them out right, but the flow, generally speaking the flow makes sense. Calling that number of kind of what the baseline number of prostatectomy is in U.S. is hard to do. We’ve seen some analysis out there that’s probably similar to the kinds of analysis that you’ve seen. I think we’re just going to have to see where that base establishes itself. I think there are a couple of things that argue for a base, one of them is that prostate cancer, the highest cure rate will come from surgery, not from medical management and the other thing that we know is that over time watchful waiting patients, some fraction of them, usually a majority of them will convert to definitive treatment over time. so, I think both of things will argue for finding a floor and what exactly that floor level is, we’re just going to have to wait and see.

Aleks Cukic – VP, Strategy: But I think Ben, the central theme of your thesis there is accurate and that is if you look outside of those two areas, U.S. dVP and the European weakness, the remainder of the procedure business is very strong year-to-date and for the quarter.

Benjamin Andrew – William Blair: I’ll sneak in one more as well. If you look at Japan we’ve done some calls recently and it sounds as though the Japanese Government has authorized funding for about 150 systems and our sources were sort of indicating that, that could come into play by the end of ’13 and certainly ’16 in the third quarter, there’s a long way towards that, is that consistent with sustaining this sort of a ’16 or pretty substantial rate and is that a reasonable target for an installed base kind of going out of ’13?

Gary S. Guthart, Ph.D. – President and CEO: I don’t think we’re ready to size the total market opportunity and I think that system sales by themselves are going to be lumpy quarter-to-quarter and I would expect some lumpiness. Long-term, we’re really excited about the Japanese market opportunity, the key opinion leaders, the people we talked along the ground are excited about robotic surgery and we think it will build and that’s another area of investment, but again kind of calling the specifics are not something we’re prepared to….

Aleks Cukic – VP, Strategy: Yeah, I think there’s just one caveat that’s worth mentioning is, as a reminder, we have one national reimbursement which is prostatectomy. There are ways for, as evidenced by the activities prior to the national reimbursement that hospitals can go through, let’s call them a one-off basis or a checklist basis where they can apply for certain levels of reimbursement and other procedures, but from a national perspective we are really in this environment where we are working within prostatectomy primarily and then there maybe a few other procedures that it worked in on a one-off basis. So, that’s the environment we’re in for a little while.

Calvin Darling – Senior Director of Finance: The next schedule pass that procedure is being added to the reimbursement list would be April of 2014 for general system-wide reimbursement.

Gary S. Guthart, Ph.D. – President and CEO: Based on the way that MHLW runs (indiscernible).

A Closer Look: Intuitive Surgical Earnings Cheat Sheet>>