Q4 2020 Neuronetics Inc Earnings Call
Good morning, ladies and gentlemen, and welcome to the newer net ex reports fourth quarter and full year, 'twenty and 'twenty financial and operating results call.
At this time all participants are in a listen only mode. Later, we will conduct a question and answer session and instructions will follow at that time.
And once you require any assistance during the conference. Please press Star then zero on your Touchtone telephone.
And as a reminder of this conference call is being recorded I would now like to turn the conference over to your host Mr. Mark Klausner. Please go ahead Sir.
Good morning, and thank you for joining us for neuro networks fourth quarter, 'twenty and 'twenty conference call. A replay of this call will be available on our website for 30 days joining me on today's call. Our neuro net ex President and Chief Executive Officer, Keith Sullivan, and Chief Financial Officer, Steve Furlong.
Before we begin I would like to caution listeners that certain information discussed by management. During this conference call will include forward looking statements are covered under the safe Harbor provisions of the private Securities Litigation Reform Act of 1995, including statements related to our business strategy financial and revenue guidance the impact of COVID-19 and <unk>.
Other operational issues and metrics.
Actual results could differ materially from those stated or implied by these forward looking statements due to risks and uncertainties associated with the company's business.
For a discussion of risks and uncertainties associated with neuro net ex business I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's annual report on form 10-K, which will be filed after the close of market today The company disclaims.
Disclaims any obligation to update any forward looking statements made during the course of this call except as required by law.
During the call. We'll also discuss certain information of on a non-GAAP basis, including EBITDA.
Management believes that non-GAAP financial information taken in conjunction with U S. GAAP financial measures provide useful information for both management and investors by excluding certain noncash and other expenses that are not indicative of trends and our operating results.
And that's been uses non-GAAP financial measures to compare our performance relative to forecast and strategic plans to benchmark our performance externally against competitors and for certain compensation decisions reconciliations between U S. GAAP and non-GAAP results are presented and the tables accompanying our press release, which can be viewed on our website with that.
It's my pleasure to turn the call over to neuro net ex President and Chief Executive Officer, Keith Sullivan.
Good morning, and thank you for joining us I will provide an overview of our fourth quarter performance and discuss the progress we made on our near term focus areas and Steve will then give our fourth quarter financial results and I'll conclude with our thoughts on 2021 before turning to questions and answers.
Starting with the review of the fourth quarter total revenue was $15 $6 million slightly ahead of our January pre announcement of 15 million to 15, and a half million dollars on a.
<unk> basis revenue was up 25% over the third quarter of 2020, driven by growth and both system sales and treatment session revenue.
While total revenue was down year over year. We are encouraged by the continued recovery of the business and the momentum we have built going into 2021.
On the capital equipment side.
S. Neurostar advanced therapy system revenue grew by 42% over the third quarter of 2020.
Our fourth quarter is seasonally strong quarter, and we did see some pent up demand from the second and third quarters convert into sales.
In addition to some customers looking to take advantage of the section 179 tax and ex center prior to year end.
The total treatment session revenue was up 21% over the third quarter of 2020 and was down only 2% compared to the fourth quarter of 2019.
We did not experience the typical seasonal decline and treatment sessions between Thanksgiving and new years due to the reduction and patient travel during COVID-19.
Turning to the fourth quarter operational update the most notable achievements during the quarter was the completion of our market Research study as previously mentioned, we engaged a market research firm to identify the proper target audience. The.
Messaging that resonates with them and the most efficient way to communicate with them.
Ultimately our goal is to take this information analyze it and then use it to develop optimal tools and business development strategies to help educate customers on the benefits of Neurostar advanced therapy from mental health and ultimately drive increased patient volume.
I'd like to highlight some of the key takeaways from the study.
Awareness of Neurostar advanced therapy from mental health as a safe effective non drug therapy for the treatment of M. D. D is extremely low.
Furthermore, even among patients who are under the care of of physician and have previously failed multiple courses of drugs awareness of the Tms as a treatment option is also very low.
And this points to a significant opportunity to engage a largely untapped patient population and help bring relief to a huge number of patients suffering from drug resistant and D. D. We.
We believe this lack of awareness can be addressed on both the patient and the health care provider side.
Which is factored into our strategy going forward.
From a market definition perspective, we identified a group of approximately 8 million patients suffering with depression in the U S or roughly 48% of the total M. D D population.
Who are good candidates for Neurostar advanced therapy for mental health.
This group includes patients up to 70 years old debt are unhappy about the about how they feel and their quality of life as a result of their current drug regimen and.
And they have a strong desire to do what is possible to treat their depression.
When we describe the benefits of Neurostar. These patients were highly interested and would consider it as a treatment option.
Historically.
Our average patient has been a woman in their fifties, who tends to respond to traditional media sources like TV and radio ads.
There was a broader demographic that is highly active online.
They will use social media to find a better alternative treatment and are willing to take action to explore these treatments.
With this research completed we now have a much better understanding of who our target patients are how to effectively reach them and how best to communicate with them.
In addition to the development of the new communication strategy, we went through a process of optimizing our sales force as part of that we have added 28, new hires since January 1st 18, BD EMS or business development managers, 10, Npcs or neuro.
Star practice consultants.
This brings our total number of BD and <unk> to 'twenty, two and Mpc's 227.
The group of new hires of immediately went through two and a half weeks of virtual training and then spent a week out and the field ahead of our sales force kickoff meeting in mid January These new hires all have a track record of success and prior roles working with the capital equipment and ongoing.
Treatment session model, we are very excited about the level of talent, we have been able to attract which speaks to the level of enthusiasm there is and the market for our company our technology and the opportunity.
Typically the ramp to full productivity is approximately six to nine months.
We expect this new class to begin being productive during the second quarter.
In December we announced that we received FDA clearance for our touch start treatment.
Three minute treatment protocol used with our Neurostar advanced therapy system on.
Our hope.
Is that this third treatment protocol. In addition to the 38 minute and 19 minute options will mean, even more patients in.
And need will have access to neurostar advanced therapy to help them and the battle with depression. We are currently working with the group of Kols to determine how best to utilize the three minute protocol with the Tms treatment paradigm for depression.
Overall, we are pleased with our performance during the fourth quarter and what we were able to accomplish during what has been a universally challenging year.
The organization went through a significant reorganization during the early part of 2020.
Followed by our management transition and the middle of the year.
And then of change and focus from a capital based company to a patient focused company.
All of which occurred during the uncertainty of Covid. Despite all of that we have built a tremendous foundation to grow from going into 'twenty and 'twenty, one and beyond and we are incredibly excited to take what we have learned over the past few months and begin the process of building awareness of.
Neuro star as a treatment for depression.
With that I'll turn the call over to Steve.
Thank you Keith.
It was the big driver for all year over year comparison, so and this unusual period, we will be discussing sequential changes to illustrate the pace of our recovery.
Total revenue for the fourth quarter was $15 $6 million up 25% over the third quarter of 2020.
The U S. Neurostar advanced therapy system revenue was $3 $6 million up 42% over the third quarter of 2020, driven by 38% increase and the number of systems sold.
Compared to the prior year fourth quarter U S. Neurostar advanced therapy system revenue was down 33%.
And the quarter the company sold 54 systems down from 78, and the fourth quarter of 2019.
U S treatment session revenue was $11 million up 21% over the third quarter of 2020.
Compared to the prior year U S treatment session revenue was down just 2% the.
The strong treatment session performance was due to a significant decrease and travel between Thanksgiving and year end holidays, which enabled patients to start or continue therapy. During this historically slow period.
In line with our new commercial strategy, we are utilizing U S treatment session revenue per active site to discuss trends and utilization.
This metric better aligns with our patient and focused strategy to have NPC is focused on driving awareness and patient education, leading to overall account growth rather than revenue per system.
And over time with some level of seasonality as we continued to execute on our strategy U S treatment session revenue per site figures should improve.
We calculate this metric by dividing total U S treatment session revenue by the beginning of the quarter active sites.
And the fourth quarter of 2020 revenue per active site was approximately $12133 compared to approximately 13000 and $497 and the prior year quarter.
Sequentially, we experienced a 19% increase increasing from $10217 per site and Q3 2020.
The new metrics along with the historical performance can be found on the supplemental data sheet posted to the Investor Relations section of our website.
Gross margin for the fourth quarter of 2020 was 75, 8% up slightly compared to the fourth quarter of 2019 gross margin of 75, 7%.
Operating expenses during the quarter were $14 $5 million, a decrease of $5 $6 million or 28% compared to the fourth quarter of 2019.
The decrease was primarily due to the cost savings initiatives, we implemented in April as well as reduced marketing and product development expenditures.
Net loss for the fourth quarter of 2020 was $3 $7 million or <unk> 19 per share as compared to a loss of $7 $5 million or <unk> 41 per share during the fourth quarter of 2019.
EBITDA for the fourth quarter of 2020 was negative $2 $4 million as compared to negative $6 $3 million for the fourth quarter of 2019.
Moving to the balance sheet.
As of December 31, and 2020 cash and cash equivalents were $49 million, our cash burn for the quarter was $1 $8 million as we continue to work towards profitability, while continuing to make strategic strategic investments and the business.
As a reminder of the first quarter of the year is typically the highest burn quarter due to the payout of employee bonuses and sales commissions and our national sales meeting.
Both in the quarter and subsequently, we bolstered our balance sheet and a meaningful way.
First through the amendment of our credit facility with solar capital partners.
Which gave us greater flexibility to withstand disruptions from COVID-19, and pursue our growth strategy.
And second through the closing of an underwritten public offering of common stock, including the full exercise of the over allotment option, resulting in net proceeds of $86 million to the company.
Pro forma for these activities our cash at year end would have been $129 million $6 million.
Now turning to guidance.
For the full year 2021, we expect revenue and the range of $58 million to $62 million.
For the first quarter 2021, we expect revenue and the range of 11 million to $12 million.
Our guidance assumes the COVID-19 headwinds subside as we progress through the year and there are no major resurgence is in the U S debt impact our customers or patients on a quarterly basis. We expect the first quarter will be the lowest revenue quarter of the year in line with typical seasonality driven by the reset.
Adding of patient deductibles as well as the resetting of our customers' capital budgets.
We expect that as Covid restrictions are lifted and the vaccine becomes more widely available during the year, we should see a pickup and new customer starts.
In addition, we expect that our newly hired Bds and Npcs will begin to have a modest positive impact on revenue and the second quarter moving.
Moving into the second half of the year, we would expect their contribution to increase as they gain experience and progress towards full productivity.
The company projects total operating expenses for the full year 2021 to be and the range of $62 million to $66 million.
In line with our strategy, we are going to prudently increase our investments during the year to support top line growth.
I'd now like to turn the call back over to Keith.
Thank you Steve.
Before providing our thoughts on strategic priorities for 2021 I wanted to discuss some of the activities that have occurred since the beginning of the year as noted earlier, we kicked off of the year with our National sales meeting in January which was held in person and Orlando, Florida over 100 people attended.
The weeklong meeting, which started on a Monday when we rolled out the new revised compensation plans to the team and ended on a Friday afternoon.
We felt that hosting this event in person was critical to introduce new programs and generate the excitement needed to be successful going forward.
We took the utmost precautions when putting on the event to ensure the safety of those employees, who attended as well as people who would come in contact with them. After the fact.
All attendees were required to produce multiple negative tests before arriving pass of rapid test. Upon arrival and then go through daily monitoring protocols, including temperature screening and contact evaluation forms throughout the event, we had of medical team on staff and we required everyone too.
Strictly adhere to the guidelines related to face coverings and social distancing.
Attendings, we're also required to get of Covid test after they returned home and I am pleased to report that 100% of these tests were negative.
A major theme of our meeting was understanding the MD the patients' journey and how the neurostar treatment can help them.
Over the last several months, we went through and exhaustive exercise to gain thorough insight into the patient journey for someone suffering from major depressive disorder.
If someone can't sleep because of the medications that they're on and begins to do research on treatment alternatives, what happens to the patient from that point up until they complete their first neurostar treatment session. Specifically, we wanted to identify where that patient might encounter.
The barrier that causes them to fall out or discontinue their journey to treatment with.
We identified a number of dropout points, many of which happened within our customers' practices.
And we now trained our customers to close those gaps and improve patients' access to care.
Much of our time spent together at the National sales meeting was focused on new practice education initiatives, <unk> and MPC training and rollout rolling out partnership programs with our customers to make sure that we're helping them assist many as many patients as possible.
And <unk>.
During the week, we launched two unique exciting programs that and partnership with our customers will increase awareness of neurostar as the safe effective non drug alternative for treating <unk>.
We are also working to make it easier for those seeking treatment to get the help they need by removing the barriers and eliminating the drop off points in the patient's journey to improve their mental health.
And.
First is the five stars to success program, which is a proven detailed and very prescriptive formula to improving a customer's Tms practice, regardless of where they fall and the spectrum of using neurostar from completely new to performing neurostar treatment.
Two marketing savvy.
The five stars the success Formula is based on the best practices from over 10 years of experience working with customers to make access to care with Neurostar easy for patients the <unk>.
And five stars include best practices for identifying and consulting and treating patients.
On <unk> call Center National marketing and digital and social engagement the.
Second program is our precision pulse program, which is designed to build awareness among the <unk> patient population about neurostar.
And within the program there is a series of benefits customers can access based on their volume of treatment session purchases.
These include access to our co op marketing program and co branded social media assets.
At the highest level the goal within the commercial organization is to help each customer site treat one additional patient per month.
As customers more effectively deploy their neuro stars and help more patients. This goal will provide meaningful revenue for them.
One additional patient per month averages out to around $100000 and practice revenue on an annualized basis.
<unk> patients are of woefully underserved population and.
So there are many levers to pull to drive neurostar awareness and help patients access treatment.
We are teaching our customers to better identify existing patients who can benefit from neurostar within their practice.
The the five stars practices learn to better handle new patients. These patients may come through our concierge and call center or in response to our Geo targeted social media marketing programs.
Over the past 30 years my teams have successfully implemented these types of programs and were very excited to start executing them here at neuro networks.
Turning to our strategic priorities for 2021.
For the year, we're primarily focused on two areas one building awareness and teaching accounts had of educate patients on the benefits of Neurostar and too.
Executing on our clinical and regulatory strategy.
Taken together, we believe that this will educate additional patients resulting in increased treatment session revenue over the long run and.
And that focusing on initiatives to drive increased pull through will ultimately make the process of selling new systems easier.
As we went through in detail earlier on the call. We have crafted of new communication strategy realign the priorities of our commercial organization and developed the partnership programs aimed at building awareness and educating both patients and customers on the benefits of Neurostar the.
The application of new initiatives have already begun and we expected to see continued acceleration of growth as we progress through the year. We have seen early success with our new messaging and customer programs through the results of the targeted call Center effort. We ran during January with nine and.
Dividual psychiatrist accounts, while we are not going into the details. We are very excited that the new messaging. We tested has been able to get people to act and seek treatment with Neurostar advanced therapy from mental health.
Our second focus is executing on our clinical and regulatory strategy we.
We recently hired a new vice president of clinical and we intend to put into place a new efficient effective clinical strategy that not only supports our commercial goals, but also supports our longer term regulatory strategy in January we announced that our outcomes registry.
Now included data from over 10000 patients and the number is large and impressive but it's only part of the story. The fact is we've treated over 90000 patients. This creates and an even greater database of patient data weak and mine.
We will leverage all of this data to help us drive commercial adoption aid and payer reimbursement changes and potentially support indication expansion efforts in the U S and regulatory filings in the international markets.
In closing I am very excited about the future of <unk>, we have generated a tremendous amount of momentum during the second half of 2020, and thus far and 2021 I can feel the energy throughout the organization.
As we are finally able to transition from the rebuild mode in 2020 into the execution mode. In 2021, we have a massive opportunity in front of us and we will work diligently to bring the benefits of Neurostar advanced therapy to all of the patients suffering from drug resistant depression.
I would now like to open the line for Q&A.
Ladies and gentlemen, if you have a question at this time. Please press star and then the number one on your Touchtone telephone.
Your question has been answered or you wish to remove yourself from the queue. Please press the pound key.
Your first question comes from Margaret Kaiser with William Blair.
Hey, guys. Good morning, Thanks for taking the question.
And I'd love to start off on the on the short term.
Did you guys see side, three Clos and through the last Covid wave of pretty steady improvements and.
Really the Genesis of the question is what does this mean for the first half and first quarter guidance in terms of that mix of systems versus consumables and it just seems like that sequential revenue change that's implied in guidance and maybe down a little bit more than what we saw in 18 and 19. So I didn't know if that was conservatism or driven by something else.
Sure.
Thank you Margaret this is Steve.
And so our first quarter. It really is tough on the treatment session side and so while we didn't see the seasonal decline that we've experienced and 18 19.
We did see it and the first part of 'twenty and so debt last week of December was very light and it has taken the better part of January to start rebounding.
And trends do indicate that the year over year increases on.
A very encouraging and so as we track.
'twenty, one performance versus both the 'twenty and 'twenty, one and we are above prior year levels at this point and so.
So there may be a little conservatism built into it but we did get off to a slower than expected start.
On the the capital.
The component of the business.
We currently have.
2019 really new.
<unk> out and the field right now they joined US January 4th.
As a reminder, they were trained prior to the national sales meeting so they didn't have an opportunity to go out and prospect.
Since the national sales meeting when they were able to go out and prospect and the level of activity has been extremely impressive and the <unk>.
Issue is the sales arent day, one visit type of clothes and so it will take multiple visits for the the new BD and to get out there and transact business again based on the level of activity, we've seen post the sales meeting.
We do expect and extremely strong March.
So again, we knew this was going to be a slow quarter theres a lot going on a lot of change a lot of the newness and all aspects of the commercial team. So we're still holding to our full year number and very encouraged from what we've seen and the four weeks since the national sales meeting.
Okay.
And I couldn't quite get a sense of maybe the treatment revenue was the mid.
And single digit number about accurate maybe to start out the year and then just.
Kind of bigger picture, Keith you talked about the productivity per rep.
Starting to hit towards the end of the year what is that number for you.
Is it and.
Annualized systems for F 15, more and then how are you looking at that one patient per month per kind of is that does that and guidance as well.
Some of it.
Prefer not to give the exact number for what.
What our quotas are for our capital team.
But it is it is north of $1 million per rep.
And and I think that our pace of.
Activity in the field as tracked through our dynamic database indicates that.
We are putting opportunities into that pipeline to support those.
Those quotas so.
Okay, Yeah and and.
Yeah.
And again, if I can just follow up with speed is the.
The mid single and potential.
And for Neurostar treatment growth and the first quarter possible I'm just trying to think about that makes and we make sure that we're kind of and the right ballpark relative.
We're planning on.
So year over year, Margaret I think it's going to be.
And fairly flat.
Impaired to 'twenty significantly down obviously from Q4.
Okay.
Very helpful. Thanks, guys.
Thank you Margaret.
Your next question comes from Bill <unk> with Canaccord.
Great. Thanks, good morning.
So Keith and <unk>.
You had the.
Sales meeting about a month ago and they've been out in the field for four weeks I'd just like to get some feedback on what has the feedback been from that would of the learnings from that is there anything you need to emphasize or deemphasize as you kind of get out of the gates here.
So our learning on the on the capital side is that.
Physicians that we are able to to get to through either video conferencing or in person.
And our.
Exactly as we thought.
And would be nervous about spending of $100000 on.
The piece of equipment and their practice and how they are going to be successful. So I think the.
The the messaging around all of the programs that we have rolled out on how we're going to generate awareness and patients into the practice.
Is resonating very well with these new new accounts on the NPC side.
I think that the feedback that we're getting is that the.
The programs as we are rolling them out is a welcome addition, they have been asking for it for the last several years and the fact that it is now organized prescriptive.
Has measurements all along the way and most of the work is done by our great MPC team I think has been a huge welcome sigh of relief to our existing accounts.
And in terms of the awareness programs as they're in.
And I wonder if we get some detail on that just is that incremental from which we're doing and the fourth quarter have you added in the new types of channels that were not in place before and kind of where are you and the rollout of the debt.
So we have we received our market research back on December 15th.
We have.
<unk> taken those learnings and given them to our <unk>.
<unk> agents, our creative agencies to start creating the the materials that will be rolled out within the practice and the assets that it would be rolled out.
Outside of the practice, both socially digitally and and.
And elsewhere, so I think.
Throughout the the.
The first half of the year most of those assets will be.
The rolling out so it will be a constant level of excitement for both our reps and our our accounts.
Great and then just last question from me is you talked about the new <unk>.
Data burst.
Approval back in December and the rollout of that I was just wondering if you could help us understand whats I understand the time going from 40 minutes roughly the 20 minutes the three minutes.
And what does that mean for the practice and the patient the patient still has to travel to get to the site and it sort of.
And we'll cut some time off for them, which is never a bad thing and I'm just kind of understand how has the feedback been on there the reception from from that approval and how are you rolling that out to the physician channel.
Terrific.
As I think we've talked about before bill the.
Even though it's a 36.
Of course of treatments of five days of week for seven weeks, our dropout rate is under 3% so is that it.
It may appear to be inconvenient, but it does seem to be.
Okay with the patients I don't think that the touch star treatment is going to reduce debt. What we are trying to find out.
From physicians is how best this should be deployed and the field and we are learning from accounts that had been using a data burst in the past debt. Some of them are using it as a maintenance treatment others are using it.
The supplemental treatment so.
I think our position right now as we are working with a team of kols to actually determine how and when this should be rolled out.
Okay, great. Thanks for taking my questions.
Your next question comes from a REIT the boat with BT and EE.
Hi, Good morning, Thank you for taking the questions.
The first question, if I could on a full year guidance.
I think you know when we spoke with you on the Q3 call there was some hope.
That you might be able to return to nearly or possibly even exceed 2019 levels I know that wasn't formal guidance, but something that was sort of tossed out there so wanted to.
Get your sense of perhaps what is sort of making up the GAAP between <unk>.
2000, and 'twenty, one guidance and 2019 levels in terms of whether that's conservatism the pandemic or something else.
And Marie this is Steve. Thank you for the question and.
I guess the language, we did use was approaching 2019 levels and our expectations.
And enthusiasm for 'twenty, one hasnt changed and so the guidance of 58 to 62, and we felt gives us a little bit of flexibility.
To get to 2019 levels and hopefully.
Do better depending upon how the environment reacts to what we're rolling out.
But none of our expectations haven't changed we had a great sales meeting the receptiveness to the pilot group that have seen some of the programs as well as the initial feedback from our call Center users again, we believe we're right on track to what we had previously communicated.
Okay understood.
And then on expenses.
I'm curious if you plan to do additional hiring or what else.
Might be.
Part of the Opex investments this year.
At this point most of the incremental hires between 'twenty and 'twenty. One are on board I believe we have a handful left.
And a few of the departments, but they will they will not be.
And the floodgates due to the the follow on activity that we had in February. So we will see some increases in marketing spend discretionary, but not necessarily fulltime heads.
Okay perfect one last one if I may.
The strong data that was published and brain simulation last week and I think we've seen some encouraging data coming out over the last couple of quarters or so so would love to hear about how narrow nellix is thinking about the core MDT indication as well as the potential for additional indications this year. Thanks.
So Murray.
We are we are planning as we said on the last call to use our 90000 patient database to be able to speak to the FDA about retrospective studies to look at other indications. So so far the EFT.
It has been.
The willing to talk to us about it and.
We are we have requested a meeting with them to formally present it to them. So I think that is that is our use of the data and.
Our first.
Target, we should know something towards the second half of the year third quarter.
Alright very helpful. Thank you.
Your next question comes from Matt O'brien with Piper Sandler.
Hi, This is clean on for Matt. Thank you for taking the questions. This morning. So first thanks for all of the color on guidance, but we were wondering how should we be thinking about your international business contributing in 2021, especially with Japan rampion. Thank you.
Yes, so our international business.
And actually primarily in Japan, but also in Korea.
Both of those countries right now are essentially shut down due to COVID-19.
Japan was supposed to reopen February 7th that got pushed out to March.
And Korea is really suffering the same set of circumstances.
Right now, it's more of a timing impact on our forecast and guidance.
And so from a full year perspective our.
Our expectation is they will hit on what they signed up for in 2021 again, there may be some timing between Q1 and Q2 as they start to reopen their their individual countries.
Great. Thank you and lastly from me you mentioned a number of things.
Contributing to growth can you just highlight what you believe to be the biggest growth driver of the session sales this year, and which will start continue to drive the topline growth and the coming years.
I think our program that we rolled out at the sales meeting that are all focused on driving awareness and driving.
And.
Putting patients into the practices educating them on the benefits of Neurostar and then if if appropriate and having them treated I think all of those programs and combination of what is going to drive our growth going forward so and.
As I said in the remarks I think of.
And when we start to gain traction with these programs and the field.
It will give.
Give us a softer landing to be able to place more systems into new accounts.
Thank you.
Your final question comes from David <unk> with J M P Securities.
Yeah, Hi, this is actually Danny on for Dave just a few quick ones from me.
Just following up on touched on its three minute protocol.
It sounds like you're still formulating your approach here, but.
The near and long term, what do you think will be the biggest impact from touched on is that something your existing customers have been asking for should help drive competitive conversions or do you expect it more so to attract psychiatrist not currently utilizing two months. Thanks.
And we have talked to 10 physicians.
And the course of the last few months on their utilization of this three minute protocol.
And.
It looks like the most common use for it as a maintenance treatment.
Post a full course of of Neurostar treatment. So.
I think again, we need to find out where.
Where the majority of physicians lie with that and possibly do a little work to find out if.
If thats exactly where it should be used but that's the road, we're going down at the moment.
To listen to the Kols on it.
Great.
Great and then just one follow up from me on <unk>.
Several payers updated their.
Pharmacotherapy criteria of last year and moving requirements for.
From sale of drugs from 42.
And if we can just get any updates here.
Are there any known timeframe that you could expect that some of them might announce something new and then what.
Driving this going forward. Thanks.
So I recently had a call with the head of the Tms Society.
Talk about exactly this.
How can we use.
Our our vast database to be able to.
To help them go to the payers and support a a drop from four drugs to two drugs or two drugs to one drug. So we are in the process of looking at how to put debt.
Debt data together, we have hired a consultant to help us do that so I can't give you a timeline right now I can just tell you that.
There is a lot of a lot of physicians and the society that are interested in it.
Great. Thank you guys.
Thanks Danny.
There are no further questions at this time I will now turn the call back over to Keith Sullivan.
Thank you operator, and thank you again for joining us on the call today I look forward to updating you on the progress and the next quarterly call and I Hope you and say thank you.
Ladies and gentlemen. This concludes today's conference. Thank you for your participation and have a wonderful day you may now disconnect.
Yeah.