Augmedix Inc. Q1 2023 Earnings Call
Speaker 1: I.
Speaker 2: and answer session will follow the formal presentation.
Speaker 2: If anyone should require operator assistance during the conference, please press star zero on your telephone keypad.
Speaker 2: As a reminder, this conference is being recorded.
Speaker 2: It is now my pleasure to introduce your host, Matt Chessler, Investor Relations. Thank you, please go ahead.
Speaker 3: Thank you, operator. Joining me today for my medics are Manifur Carras, Chief Executive Officer and Paul Genelvio, Chief Financial Officer.
Speaker 3: This morning, Augmetics released financial results for the quarter ended March 31, 2023. We have posted the press release and investor presentation on our website at Augmetics.com.
Speaker 3: We'll begin our call with prepared remarks to be followed by a Q&A session. This call is also being simulcast and will be archived on our website.
Speaker 3: Before we begin, I'd like to remind you that management will make statements during this call that include forwardal statements within the meeting of Federal Security's laws, which are made pursuant to the safe harbor provisions of the Private Security's litigation reform act of 1995.
Speaker 3: Any statements that relate to expectations or predictions of future events, results, or performance are forward-looking statements.
Speaker 3: They are based on current estimates and various assumptions and involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied.
Speaker 3: Accordingly, you should not place and do reliance on these statements.
Speaker 3: For a list in description of the risks and certain fees associated with our business, please refer to the risk factors and management discussion and analysis in our most recent form 10K and form 10Q filed with the Securities and Exchange Commission. And some more disclosures in subsequent reports filed with the SEC.
Speaker 3: Also during our call today, we may discuss non-gavelianter measures, which adjust our gap results to eliminate the impact of certain items.
Speaker 3: We will find additional information regarding these financial measures and the reconciliation to GAAP measures in today's press release.
Speaker 3: This conference call contains time sensitive information and is accurate only as of the live broadcast today, May 12, 2023.
Speaker 3: Augmented explains any intention or obligation except as required by law to update or revise any financial projections or the word-looking statements, whether because of new information, use your events or otherwise.
Speaker 3: And with that, I'll turn the call over to Mani.
Speaker 3: Thanks, Matt. Good morning, everyone, and welcome to our earnings call. The start to 2023 is highlighted by strong top-line growth, continued development and commercialization of our broad product offerings, strengthening of our financial position, and solid momentum exiting the quarter.
Speaker 3: Last month, we concluded a landmark strategic partnership and financing with HCA health care. This partnership with one of the nation's largest and most forward-thinking health care providers serves as a powerful vote of confidence in our technology and our approach to bringing technology up scale to the point of care.
Speaker 3: HCA is collaborating with us on the development of the technology underlying our Augmetics GO product that aims to transform the way patient care is documented in the acute care setting.
Speaker 3: also made a substantial investment in length ofCar Novel That was a Olympicache is To farmersBut the companies. I think is. Thought
Speaker 3: serving as a clear indication that we are on the right strategic path.
Even prior to our HCA partnership announcement, we were experiencing increased commercial demands from clinicians, and I'm confident that our collaboration with HCA will only accelerate our commercial momentum.
The need for our technology at the point of care is real.
urgent and growing.
The administrative burden on practitioners is significant, leading to higher costs and physician burnout.
No healthcare professional went to medical school to manage documentation.
They want to see and help their patients and practice at the top of their license.
We are developing products that enable them to do just that.
allowing clinicians and patients to truly connect with the point of care, improving patient access as clinicians spend less time documenting visits, and improving healthcare operating efficiency.
HCA fully understands this.
With the industry's increasing adoption of powerful AI tools such as large language models, we are mindful that all of our products must engender trust among our customers if they are to be adopted at scale.
That is why we take great pains to ensure our automation technology is built thoughtfully and respectfully.
while others throw intrusive technology or black box AI to automate their processes.
We are developing a platform modeled on practitioner workflow that provides clinicians with transparency and control.
Our clinician customers will be able to see how their medical notes are built and can set their own preferences for the notes looking feel.
We believe this will instill confidence among clinicians in the finished product.
Our medical notes are presented in well understood formats and focused just on relevant medical issues as opposed to being long and meandering transcripts summarizations.
Beyond the medical note, data we deliver to customers is structured and formatted to be easily ingested by third-party platforms.
Finally, we don't believe a one-size-fits-all is the right product strategy.
So we've developed a portfolio of products as part of our platform that provide health care systems and clinicians the flexibility to choose the product that best works for them and provides the highest ROI.
We believe thoughtful and responsible use of AI tools, transparency and clinician control in no creation, structured output and product functionality across a wide spectrum of care settings are key differentiators that set us apart from other players in our space.
We generated record first quarter bookings and 38% revenue growth, demonstrating the acceleration in commercial adoption we are seeing, even before Augmetics Go is released later this year. We continue to build our base of recurring revenue, adding both new customers and expanding within existing customers.
Existing customer expansion is best highlighted by our dollar-based net revenue retention of 136% in the quarter, up from an already strong 133% in the first quarter of 2022.
This NRR demonstrates that our land and expand strategy within our large healthcare customers is working.
We are adding incremental recurring revenue with minimal increases in fixed costs and attractive customer acquisition costs.
Importantly, we were able to deliver this 38% revenue growth while holding operating expenses flat sequentially compared to the fourth quarter and with only a 9% increase year over year.
The effects of high operating leverage become more evident as we scale our offering, providing clear evidence that we are moving toward cash flow sustainability.
As we noted in the announcement of the HCA and Red Mile transaction, we expect to reach operating cash flow breakeven as we exit 2024.
Our results demonstrate that we are making solid progress towards this critical goal.
With that, I will now turn the call over to Paul Genocchio, our CFO , then we will return with closing comments. Hello, Paul margin!
With that, I'll now turn the call over to Paul Genokeo, our CFO , then we'll return with closing comments. Paul?
Thank you Manny. As stated, revenue for the three months ended March 31st, 2023 was $9.6 million, a 38% increase from the $7.0 million in the same period a year ago.
Growth was primarily driven by existing client expansion, new clients, and growth in our notes offering.
The database net revenue retention in the first quarter of 2023 was 136% for our health enterprise customers compared to 133% in the first quarter of 2022.
and 126% in the fourth quarter of 2022.
As many of you know, that revenue retention measures what a dollar of revenue at our existing clients a year ago grew into in this most recent quarter. It includes upsells, expansion, and churn.
but excludes revenue from any new logos that were added during the last 12 months.
The acceleration of NRR was driven primarily by significant expansions at two of our larger health system customers.
Our NRR results put us at best-in-class levels for SAS companies.
Average clinicians in service for the first quarter of 2023 rose 43% as compared to the first quarter of 2022.
and compares to 41% year-on-year growth in the fourth quarter of 2022.
We define a clinician service as an individual doctor, nurse practitioner, or other healthcare professional using either our live or note service.
We believe the growth in the number of clinicians in service is an indicator of the performance of our business.
as it demonstrates our ability to penetrate the market and grow our business. Adjusted gross margin for the first quarter of 2023 was 45.8% as compared to 45.3% in the corresponding prior year period and then compares to 46.5% in the fourth quarter of 2022.
The exposure to clinicians serviced out of the US reduced our quarter-on-quarter gross margins.
partially offset by efficiency gains. We expect gross margins to benefit later this year from the shifting of a significant number of US service clinicians to outside the US.
along with continued scale benefits and improving automation.
Total operating expenses for the first quarter of 2023 were $9.5 million.
flat sequentially from the fourth quarter of 2022. non-GAAP operating expenses, which exclude stock-based compensation and one-time items, grew 9% compared to the first quarter of 2022, a deceleration from the double-digit growth rates we reported in the past several quarters.
You are beginning to see the inherent operating leverage in our model come through as we scale.
We are continuing to incrementally invest in sales and marketing and engineering to drive innovation and growth.
but other cost categories are largely flat outside certain costs such as audit fees and legal fees.
Growth and gross profit outpacing OpEx growth resulted in a reduction in our quarterly operating losses for the third consecutive quarter. Adjust the EBITDA, which we calculate by adding back depreciation, amortization, taxes, interest, one-time items, and stock-based compensation to net loss.
was a loss of $4.1 million in the first quarter of 2023 compared to a loss of $4.8 million in the first quarter of 2022.
Along with this improvement in adjusted EBITDA loss was a year-on-year improvement in our adjusted EBITDA margin from negative 69% in the year-ago quarter to negative 43% in the most recent quarter.
Cash flow from offered activities was an outflow of 6.2 million in the first quarter of 2023 compared to 4.2 million last year. The first quarter is typically our largest cash burn quarter of the year due to some annual payments and bonuses. We continue to expect the reduction in cash burn in 2023 versus 2022 and cash burn will improve from these 1Q results. At March 31, 2023, we had 20.6 million of cash, cash equivalents and restructur-
five million equity line of credit and we are in the final stages of putting it in place.
The new equity line of credit will provide further capital certainty and give us backstop capital access even if the markets are closed.
But as we have said before, our expectation is that we will reach cashflow sustainability without accessing this facility.
In terms of our common share count, we had 37.5 million weighted average common shares for 1 Q2 023.
For modeling purposes, remember we sold another 3.125 million common shares to HCA and RedMile combined.
and a combined 4.375 million pre-funded warrants.
Positioning the company to reach profitability is a top priority for our company.
With the tremendous opportunity in front of us and our technology platform, we believe we can deliver both strong revenue growth and operating leverage.
to reach operating cash flow breakeven before net interest expense as we exit 2024. Now moving on to guidance. Positive momentum we saw coming into this year is continuing. We now expect revenue to be at least $42 million for the full year 2023.
Turning to our outlook for the second quarter of 2023, given the strength of our recent bookings and the health of our current backlog, we expect revenue in the second quarter to be approximately 10.4 million to 10.5 million.
We expect GAAP gross margins to be similar to the first quarter 2023 GAAP gross margins. As you saw this quarter, we expect the overall increase in operating expenses in the coming quarters will be lower than the overall increase in revenue and gross profit. We do expect some incremental OPEX investments in 2023.
Thank you, Paul.
Our product and technology strategies are resonating with customers as evidenced by our strong top-line growth and adoption by five of the top ten
U.S. healthcare systems. The proliferation of LLMs within the healthcare industry will inevitably level the technological playing field.
However, LLMs alone are not a complete solution to the dilemma facing the industry.
Using this technology in a thoughtful and responsible manner and incorporating it into a compelling product portfolio that accommodates the widest range of clinician workflows in both the ambulatory and acute care settings are what set Augmetics apart from others in this space. Zeus.
I am proud of our team's mission focus.
grateful to our customers for entrusting us with this vital work. As we look at the rest of the year and beyond, I remain very excited by the opportunity that lies in front of us. Thank you.
Operator, let's open it up to questions. Thank you. The floor is now open for questions. If you would like to ask a question, please press star 1 on your telephone keypad at this time.
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Today's first question is coming from Ryan Daniels of William Blair. Please go ahead. Hey Ryan, great to see you at Uranus.
Hey, good morning. This is Jared Hassan for Ryan, and thanks for taking our questions. I wanted to start just hoping to give you an update on the opportunity to unlock notes within your existing client base. It sounded like that product was a source of strength in the quarter, and I know you had a filing recently indicating you achieved this unlock with an existing customer, Dignity Health.
Could you just speak to how you're thinking about the growth opportunity from adding this? Maybe what aiming we're in in terms of getting this unlocked across the client base or how penetrated you are today. And then with clients that have turned on notes, have you seen any signs of, I guess, cannibalization from live users just given the difference in pricing? Let me take that. Great question. Great.
that they'll be unlocked as well.
locked as well.
And in terms of the second question in terms of cannibalization we haven't seen any cannibalization to date between our notes and our live offering.
Okay, fair enough. Appreciate that, Color. And then, one other follow-up, and Manny spoke a little bit to transparency and control of the product as key differentiators during the prepared remarks.
I was wondering if you could provide a bit more color just to help illustrate that a bit more. Are there any sort of examples of what that means in terms of either the output or the actual clinician experience relative to maybe a more cookie cutter or black box approach?
Sure, so, and I'll speak specifically to our Go product, which is...
currently being tested at HCA and one other health care organization.
The user interface shows the various steps that
back end goes through.
goes through to create the note.
It'll expose the ASR converting the audio into text. It'll expose our NLP which identifies the key elements within that transcript that we believe, our technology believes is relevant to the medical note.
It'll show the structured data breakdown of those key elements into significant and relevant blocks.
that need to be incorporated into the medical note, and it will also expose
sections of the medical note, the output, where the LLM generated output or content.
So all of that is exposed to the customer, to the user.
and they will have the ability to adjust the preferences within the structure of data elements to...
affect the look and feel of the output and then of course they can also add their own content manually to the extent they wish to do so.
I think that is really helpful. Thanks for the call.
Thank you. The next question is coming from Brooks O'Neill of Lake Street Capital. Please go ahead. Good morning, guys. Congratulations on a great start to the year. I have a couple questions. I'd like to start by just asking you a little bit about what you anticipate the work for
We're currently testing our Go product
with several doctors at HCA.
with several doctors at HCA. We've also
deployed our live solution in the emergency department of a couple of hospitals at HCA. We will add in the process of adding a couple more hospitals to that deployment in the emergency department.
and incorporating that into our...
Go technology for the acute care setting.
for the acute care setting. So the rollout is...
at this point and we expect that once we get a little closer in terms of finalizing the design on the Go product we will be rolling that out much more aggressively across other hospitals.
And as you know, HCA has 188, a little over 188, I think 188 hospitals in the US.
Pretty good number, huh? Brooks, the only thing I would add is that we're also hiring to accelerate the roadmap of GO, and that's what's also included in our second quarter OpEx guidance.
Great. Can you guys say, I mean, I don't follow HCA directly, obviously, but would you say there's any opportunity in working with HCA outside the acute care setting? I mean, do they
employee doctors in outpatient or freestanding centers across that 187 hospital network.
Great question. So they have a substantial ambulatory practice or clinical practice. You know they have I think 2,200 care centers around the US outside of those 188 hospitals.
Yes, we are planning to deploy outside the acute care setting. That is a separate commercial thread that we are pursuing actively with HCA today. Great, and I would assume you might...
follow the same kind of footprint. Start with a couple facilities, a limited number of doctors, get your feet on the ground and do the lands and expand like you've done with many of your customers over time.
Exactly. We've already identified the initial candidate hospitals or sorry care facilities for ambulatory and we're just setting things up right now.
Great. All that sounds good. I want to ask you just one more, but it's a little bit of a multi part, so I apologize for it. But just thinking about product development initiatives and opportunities. Obviously, AI is a huge buzzword. You mentioned it in your prepared remarks. I'm curious how you're thinking about
opportunities with AI. Obviously you've had a historic partnership with Google. I'm curious how you're working with them and whether in fact they're helping you with the HCA would be interesting to know. And then the last piece I'm just curious about is how you're seeing developments with the EMR
The key EMR vendors that are out there obviously Epic and Oracle Cerner today, is there anything going on there that's worth talking about?
Thank you.
Okay, let me start with the first one in terms of LLMs, our use of large language models in our quest to further automate the note creation process. advises graduations only one on language of reversed for country Update Education.
all of this.
use of technology, the whole point of it is to improve operating efficiency, improve the speed with which you can create a medical note and reduce the cost of creating that medical note and pass those cost savings on to your customers.
So we're very keen on incorporating that technology as much as we can, but as I mentioned before, we want to do it responsibly.
and we think we're on the right track in terms of earning the trust of our customers that the technology is not being used blindly by us so we've been putting in the appropriate guardrails to ensure that the product that we deliver is trustworthy.
So, we will continue to do that. And as you mentioned, rightly so, Google is, we do use Google's large language models today. We've been using them for a while. And we are testing new ones, new releases as we speak. We've got a whole team of people that are using Google's large language models today. So, we will continue to do that.
machine learning engineers working on that, on their latest LLM that is specifically tailored to the healthcare environment.
And we're really excited to be able to deploy that commercially over the coming months.
In terms of EMR activity, we continue to have conversations with Epic and Cerner slash Oracle. I would say that the conversations are are healthy, they're progressing and there's not much more to say other than that. And for us...
The first order of business with them is to develop as close an integration with the EMRs as possible to facilitate the deployment of our Go product.
I appreciate all that color and it's all fascinating and exciting.
Let me ask one last one and I'm just curious if you know.
I'm guessing HCA maybe has multiple EMR vendors, but do you happen to know if there's a predominant system they use within the HCA organization or is it is it literally hospital by hospital in their world? It's not. It's pretty...
It's pretty uniform and it's Metatec that they use. Metatec Magic is the particular version of Metatec that they have deployed.
And could you see yourself on some level having discussions and integrating on some level with them? We're actually in the process of doing that just now. Yes.
you see yourself on some level having discussions and integrating on some level with them? We're actually in the process of doing that just now. Yes. Okay. Let's go the other way.
Great. I will follow up offline. I would like to learn more about it. Absolutely. Thank you. The next question is coming from Alan Klee of Maxim Group. Please go ahead. I think it was Alan Klee. Yeah. Thanks.
Hi, good morning. Two small modeling related questions. Can the gross margin decline a little sequentially? Could you address what was behind that? And then second, how much dollar amount do you think you have to increase operating expenses to build up sales and marketing for the Go launch?
Thank you. Thank you.
Hey Alan, it's Paul. I'll take those. So for the Q1Q change in our gross margin, the US serviced business, which is less than 10% of our total business.
you know, drove that Q on Q decline and that's due to the sort of normal beginning of the year payroll tax bucket refills. Less holidays in the first quarter versus the fourth quarter and then just higher health care costs here in the first quarter. Those were the main drivers of that sequential change in gross margin. And when it comes to sales and marketing for Go.
We're doing some things but We think it's going to be a pretty efficient launch You know you're seeing some opex increases as we accelerate the Product development roadmap for Go in the Qcare setting
But obviously we feel very comfortable with both our commentary around getting the cash flow break even and and our ability to successfully launch go. Thank you. Thank you once again that star one for any questions. The next question is coming from Neil Chatterjee at B Riley Securities. Please go ahead.
Good morning guys. Thanks for taking the questions and congrats on the quarter. Maybe just on HCA, I know you've mentioned it wasn't, you know, it's not an exclusive agreement. So just curious, you know, given kind of the aggressive expansion plans, you know,
maybe across those 180 plus hospitals. Just curious, you know, how much bandwidth does that leave for, you know, similar pilots or rollouts with other other large systems, you know, in 2023 or is that more of a focus for 24?
Hey, Neil, it's Manny. I think we've guided that we don't expect a lot of significant impact to revenue from Go sales in 2023.
That doesn't mean we're not going to be piloting or testing Go.
with other healthcare organizations this year. It just means that we've muted our expectations in terms of what commercial benefit we will expect for this current year.
So, we have the bandwidth to deploy outside of HCA and that is the plan.
Just to keep in mind, we've been just to add that, sorry.
several of our major enterprises have been asking for this product and want to be included in pilots. So we do expect to be able to accommodate them later this year.
several of our major enterprises have been asking for this product and want to be included in pilots. So we do expect to be able to accommodate them later this year. Great.
And then just on the guidance, kind of given the strength you saw in the first quarter, record bookings, second quarter guy was pretty strong. Just curious, you know.
You know giving you confidence in that and you know what was driving from that strengthunda and some other high strength people that wereiggling with a skills model for changing
On the bookings we saw, the record bookings in the first quarter, we saw a number of, you know…
health systems make incremental investments into our products that drove that strong bookings quarter. Obviously, we're guiding to a healthy increase Q1Q in terms of revenue growth and we feel good about our guidance for the full year and obviously I slightly tweaked it.
we'll continue to revisit as we progress through the year. We've only given that $42 million guidance less than two months ago initially.
But you know everything's at this point in time. We're feeling really good about the year Great and I just in terms of like quarterly cadence, you know how to think about the back half of the year and seasonality there.
I think we always show nice.
Q on Q revenue growth, how one quarter grows versus the previous quarter kind of depends on the bookings over the last quarter, potentially the last two quarters. And so that is yet to be determined, I continue to feel really good about at least 42 million a revenue.
Q1Q revenue growth, how one quarter grows versus the previous quarter kind of depends on the bookings over the last quarter, potentially the last two quarters. And so that is yet to be determined, but we continue to feel really good about at least $42 million of revenue. Great. That's it for me. Thanks.
I'd like to turn the floor back over to Mr. Cacares for closing comments. Well, if there's no more questions, look, I want to thank everybody for participating in this earnings call. I'm sure we'll have more news to share with you as the year progresses. But as I said with my closing comments, we're really excited about the year.
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