Q1 2024 Milestone Scientific Inc Earnings Call
Operator: Good morning everyone, and welcome to the Milestone Scientific Inc. first quarter 2024 financial results and business update conference call. At this time, all participants are in a listen only mode, and we will open for questions following the presentation. If anyone should require operator assistance during the conference, please press star zero on your phone keypad. Please note this conference is being recorded. I will now turn the conference over to your host, David Wildman, of Crescendo Communications. The floor is yours.
Good morning, everyone and welcome to the milestone scientific incorporated first quarter 'twenty 'twenty four financial results and business update conference call. At this time all participants are in a listen only mode and we will open for questions. Following the presentation, if anyone should require operator assistance.
During the conference. Please press Star Zero on your phone keypad. Please note. This conference is being recorded.
I'll now turn the conference over to your host David Waldman Crescendo Communications the floor is yours.
David Keith Waldman: Good morning, and thank you for joining Milestone Scientific's first quarter 2024 financial results conference call. On the call with us today are Arian Haverhals, Chief Executive Officer, and Keisha Harcum, Vice President of Finance of Milestone Scientific. The company issued a press release this morning containing its first quarter 2024 financial results, which are also posted on the company's website. If you have any questions after the call or would like any additional information about the company, please contact Crescendo Communications at 212-671-1020.
Speaker Change: Good morning, and thank you for joining milestone Scientifics first quarter 2024 financial results conference call on the call with US today are Orient Overhauls, Chief Executive Officer, and Keith <unk>, Vice President Finance of milestone scientific the company issued a press release. This morning containing first quarter 2024 financial results, which is also posted on the Companys web.
Speaker Change: If you have any questions. After the call would like any additional information about the company. Please contact Crescendo communications at 2126711020, Companys management will now provide prepared remarks, reviewing the financial and operational results for the first quarter ended March 31, 2024, before we get started we'd like to remind everyone that during this conference call we may make.
David Keith Waldman: The company's management will now provide prepared remarks reviewing the financial and operational results for the first quarter ended March 31st, 2024. Before we get started, we'd like to remind everyone that during this conference call, we may make forward-looking statements regarding the timing and financial impact of Milestone's ability to implement its business plan, expected revenues, and future success. These statements involve a number of risks and uncertainties and are based on assumptions involving judgments with respect to future economic, competitive, and market conditions in future business decisions, all of which are difficult or impossible to predict accurately and many of which are beyond Milestone's control.
David Keith Waldman: Some of the important factors that could cause actual results to differ materially from those indicated by the forward-looking statements are general economic conditions, failure to achieve expected revenue growth, changes in our operating expenses, and adverse patent rulings, FDA or legal developments, competitive pressures, changes in customer and market requirements and standards, and the risk factors detailed from time to time, and Milestone's periodic filings with the Securities and Exchange Commission, including, without limitation, Milestone's report The forward-looking statements made during this call are based upon management's reasonable belief as of today's date, May 16th, 2024. Milestone undertakes no obligation to revise or update publicly any forward-looking statements for any reason. With that, we'll now turn the call over to Arian.
Speaker Change: We're looking statements regarding timing and financial impact of milestones ability to implement its business plan expected revenues and future success. These statements involve a number of risks and uncertainties and are based on assumptions involving judgments with respect to future economic competitive and market conditions and future business decisions, all of which are difficult or impossible to predict accurately and many of which are being.
Speaker Change: Milestones control some of the important factors that could cause actual results to differ materially from those indicated by the forward looking statements are general economic conditions failure to achieve expected revenue growth changes in our operating expenses and adverse patent rulings FDA or legal developments competitive pressures changes in customer and market requirements and standards and the risk factors detailed from time to time.
Speaker Change: The milestones periodic filings with Securities and Exchange Commission, including without limitation milestones report on Form 10-K for the year ended December 31, 2023 milestones report on Form 10-Q for the first quarter ended March 31, 2020 for the forward looking statements made during this call are based upon management's reasonable belief as of todays date may 16 2024.
Speaker Change: Millstone undertakes no obligation to revise or update publicly any forward looking statements for any reason with that we'll now turn the call over to Orient Overhauls Chief Executive Officer. Please go ahead.
Jan Adriaan Haverhals: Thank you, David, and thanks to everyone for joining us today. We achieved revenue of more than $2.2 million for the first quarter of 2024. Although our revenue was down slightly compared to the same period last year, this was largely a reflection of a reserve reversal in the first quarter of 2023, coupled with a decline in international sales during the first quarter of 2024. However, these results do not reflect the true underlying improvement in the business.
Speaker Change: Thank you, David and thanks to everyone for joining us today.
We achieved revenue of more than $2 2 million for the first quarter of 'twenty 'twenty four will do.
Speaker Change: Our revenue was down slightly compared to the same period last year. This was largely a reflection of a reserve reversal in the first quarter of 2023 coupled.
Coupled with a decline in international sales during the first quarter of 2024. However, these results do not reflect the true underlying improvement in the business.
Jan Adriaan Haverhals: Most notably, e-commerce sales, which reflect our new online sales portal, achieved growth of 31% over the same period last year. As you may recall, as part of this strategy, we terminated our relationship with Henry Schein at the end of 2022 and terminated our remaining US distributors in September 2023. As a result, we recorded no revenue for U.S. distributors for the three months ended March 31st, 2024, compared to approximately $219,000 for the three months ended March 31st, 2023.
Speaker Change: Most notably e-commerce sales, which reflect a new online sales portal achieved growth of 31% over the same period last year as you may recall as part of this strategy, we terminated our relationship with Henry Schein at the end of 2022 and terminated our remaining U.
As distributors in September 'twenty, two 'twenty three.
Speaker Change: As a result, we recorded no revenue for U S distributors for the three months ended March 31, 2024 compared to approximately $219000 for the three months ended March 31st 2023.
Jan Adriaan Haverhals: This deliberate shift to a direct sales model has resulted in improved growth margins. Specifically, gross margin in the first quarter of 2024 increased to 74.5% from 72.7% for the same period last year. In addition to these higher margins, establishing a closer and more direct relationship with our dental customers has allowed us to do a much better job selling and providing outstanding customer service, which has led to much greater stickiness and potential repeat orders with existing clients. Specifically, this direct relationship also allows us to provide ongoing training and support to ensure continued usage by dentists and hygienists. For example, we have implemented educational programs to enhance the customer experience.
Speaker Change: This deliberate shift to a direct sales model has resulted in improved gross margins specifically gross margin in the first quarter of 2024 increased to 74 and half a percent from 72, 7% for the same period last year.
Speaker Change: In addition to these higher margins, establishing a closer and more direct relationship with our dental customers has allowed us to do a much better job selling and providing outstanding customer service, which has less has led to much greater stickiness and potential repeat orders with existing clients.
Speaker Change: Specifically this direct relationship.
Speaker Change: <unk> allows us to provide ongoing training and support to ensure continued usage by dentist hygienist. For example, we have implemented educational programs to enhance the customer experience in particular, we anticipate introducing an interactive digital.
Jan Adriaan Haverhals: In particular, we anticipate introducing an interactive digital learning platform targeted at dental teaching institutions, dentists, hygienists, international distributors, and international customers. This direct relationship has proven effective with individual practices, dental service organizations, also known as DSOs, and large group practices. The greater interaction and our ability to provide higher-level support have helped attract premier customers. As an example, we commented on direct sales of the SCA to Meridian EndoImperio, a large endodontics, periodontics, and implant dentistry practice with three offices in Wisconsin.
Speaker Change: Turning platform targeted at dental teaching institutions dentist hygienist international distributors and international customers.
Speaker Change: This direct relationship has proven effective with individual practices dental service organizations also known as Dsos and large group practices.
Speaker Change: The greater interaction and our ability to provide higher level support have helped attract premier customers.
Speaker Change: As an example, we commenced direct sales of the FCA to Meridian Endo in periods of large endodontics periodontics and implant dentistry practice with three offices in Wisconsin. This includes the deployment of the SDA in each of their operatory rooms and across all the endodontist.
Jan Adriaan Haverhals: This includes the deployment of the SDA in each of their operatory rooms and across all the endodontists and periodontists within the practice. We have also added Maine Dental Group, which operates 21 practices across the Northeastern United States.
Speaker Change: Periodontist within the practice, we also added main dental group, which operates 21 practices across the north Eastern United States.
Jan Adriaan Haverhals: As you can hopefully see, the new sales strategy within our dental segment has proven effective, and we anticipate enhanced benefits from this transition to a direct model over the course of 2024. At the same time, we have engaged in more direct-to-consumer marketing, or more direct-to-patient marketing, at the beginning of this year. We launched a digital marketing campaign simultaneously targeting dental clinics and patients. By creating this push-pull strategy, we have seen an increase in qualified leads, resulting in higher conversion opportunities and thus more revenues.
Speaker Change: As you can hopefully see the new sales strategy, we didn't have dental segment as proven effective and we anticipate enhanced benefits from this transition to a direct model over the course of 2024.
Speaker Change: At the same time, we have engaged in more direct to consumer marketing or more direct to patient marketing at the beginning of this year.
Speaker Change: We launched a digital marketing campaigns simultaneously targeting dental clinics and patients by creating the spruce pool, we have seen an increase in qualified leads resulting in higher conversion opportunities and thus more revenues in other words. These activities have resulted in leads from dentists contacting us direct.
Jan Adriaan Haverhals: In other words, these activities have resulted in leads from dentists contacting us directly to order our instruments because patients requested them to do so. We will absolutely continue to increase our marketing efforts with dedicated campaigns directly targeted at patients. In summary, through our direct sales model in combination with enhanced education and targeted marketing campaigns, we continue to focus on new customer acquisition and development of the existing customer base. While international sales declined slightly, it's important to note that orders from third-party distributors can be lumpy due to the timing and size of orders, as well as certain distributors working through inventory. We also made the decision to pull back from China until market conditions improved.
Speaker Change: Lee to order our instruments because patients requested them to do so.
Speaker Change: We will absolutely continue to increase our marketing efforts with dedicated campaigns directly targeted at patients.
Speaker Change: In summary.
Our direct sales model in combination with enhanced education and targeted marketing campaigns, we continue to focus on new customer acquisition and development of the existing customer base.
Speaker Change: While international sales declined slightly it is important to note that orders from third party distributors can be lumpy due to the timing and size of orders as well as certain distributors working through inventory.
Speaker Change: We also made the decision to pull back from China until market conditions improve.
Jan Adriaan Haverhals: As previously disclosed, our focus in 2023 and early 2024 was on the domestic front. However, we have reinvigorated our international focus heading into 2024 and anticipate steady improvement this year. We also look forward to announcing the addition of new international partners, which should support our global expansion strategy over the common cause. We are expanding our efforts to enter new international markets and deepen our penetration with existing international markets.
Speaker Change: As previously disclosed our focus in 2023 and early 'twenty 'twenty four wells on the domestic front. However, we have re invigorated our international focus heading into 2024 and anticipate steady improvement in this year.
Speaker Change: We also look forward to announcing the addition of new International partners, which should support our global expansion strategy over the coming quarters.
Speaker Change: We are expanding our efforts to enter new international markets and deepen our penetration with existing international markets on a final note. We are on track with our next generation dental instruments and look forward to unveiling it in the near future.
Jan Adriaan Haverhals: On a final note, we are on track with our next generation dental instrument and look forward to unveiling it in the near future. So to summarize, within our dental business, our e-commerce sales increased, we are benefiting from higher gross margins, and we continue to generate solid cash flow on a stand-alone basis. In fact, the dental division generated approximately $625,000 of operating income on a standalone basis in the first quarter of 2024.
Speaker Change: So to summarize within our dental business. Our ecommerce sales increased we are benefiting from higher gross margins and we continue to generate solid cash flow on a standalone basis.
Speaker Change: In fact, the dental division generated approximately $625000 of operating income on a standalone basis in the first quarter of 'twenty 'twenty four.
Jan Adriaan Haverhals: Through our new direct sales strategy and increased marketing efforts, we aim to further grow our dental business in the common core. As we continue to grow our revenues, we expect to benefit from economies of scale as well as the recurring nature and high margins on our disposables. I'd now like to take a moment to turn to our medical segment, where we are making significant progress on the reimbursement front. But first, let me provide a recap of our overall strategy and execution.
Through our new direct sales strategy and increased marketing efforts, we aim to further grow our dental business in the coming quarters as we continue to grow our revenues, we expect to benefit from economies of scale as well as the recurring nature and high margins on our disposables.
Speaker Change: I'd now like to take a moment to turn to our medical segment, where we are making significant process on the reimbursement front.
Speaker Change: But first let me provide a recap of our overall strategy and execution.
Jan Adriaan Haverhals: Specifically, we have continued to introduce the CompuFlow technology within prominent hospitals, healthcare systems, and pain management clinics. As an example, during the quarter, we began sales of Disposable Cells with PRC Alliance Pain Relief Center in Florida, which operates seven offices and an ambulatory surgical center located across Central Florida with 15 providers. Adoption of the technology follows a successful evaluation by Dr. Sanjay Bakshi, a pain management physician and CEO of PRC Alliance Pain Relief Centers in Ormond Beach, Florida.
Speaker Change: Specifically, we have continued to introduce the concrete flow technology, we didn't prominent hospitals healthcare systems and pain management clinics as an example during the quarter we commenced sales.
Speaker Change: Disposable sales with PRC Alliance pain relief Center in Florida, which operates seven offices and ambulatory surgical center located across central Florida with 15 providers.
Speaker Change: Adoption of the technology follows a successful evaluation by dropped as Sanjay Boxy pain management physician and see of PRC aligns pain relief centers in Oregon Beach, Florida.
Jan Adriaan Haverhals: Dr. Bakhshi has been practicing for over 30 years and is triple board-certified in anesthesia and pain management. Additionally, we commend sales of CompreFlow Epidural Disposables to Omaha Pain Physicians, a comprehensive medical pain management center in Omaha, Nebraska. The FDA's decision follows an extensive trial and evaluation by Dr. Matthew Stottel, its founder and medical director. Both of these rollouts followed successful evaluation periods and 100% clinical success with zero epidural puncture. The evaluations included epidural steroid injection procedures within the lumbar, thoracic, and cervical-thoracic junction of the spine.
Speaker Change: Dr. Bob She has been practicing for over 30 years, and it's Triple Board certified in anesthesia and pain management.
Speaker Change: Additionally, we commenced sales of constant flow epidural disposables to Omaha pain physicians, a comprehensive medical pain management Center in Omaha, Nebraska.
Speaker Change: This approval follows an extensive trial and evaluation by Dr. Matthew Stopple, its founder and medical director.
Speaker Change: Both of these rollouts followed the successful evaluation periods and hundred percent clinical success with zero Epidural punctures devaluations included epidural steroid injection procedures went into lumbar thoracic and surgical for Essex junction of spine.
Jan Adriaan Haverhals: While the addition of these clinics further validates our technology and strategy, demonstrating CompuFlow's clinical utility and benefit, we believe the true value lies in the support these and other clinics provide in advancing our broader reimbursement strategy. As more physicians and anesthesiologists perform procedures and submit for reimbursement, our goal is to secure broad coverage for our technology as we execute on our goal of establishing CompreFlow to become the standard of care for epidural analgesia.
Speaker Change: While the addition of these clinics further validates our technology and strategy demonstrating Congress close clinical utility and benefit we believe the true value of lives and to support these and other clinics provides.
Speaker Change: Advancing our broader reimbursement strategy.
Speaker Change: As more physicians and anesthesiologist, but form procedures and submit for reimbursement.
Speaker Change: Role is to secure broad coverage for our technology as we execute on our goal of establishing comping flow to become the standard of care and that the dual I know geez yeah.
Jan Adriaan Haverhals: As I have discussed in the past, we have implemented a very strategic and targeted approach to securing reimbursement with Medicare, Medicaid, and private commercial payers. I'm pleased to report that we are making significant progress in advancing this strategy. The first step in this approach was to work closely with key pain management providers in the use of the new CPT tracking code for accurate and timely compuflow claims submission. Additionally, we are providing support to clinical facilities so that each individual claim has an appropriate resource.
Speaker Change: As I have discussed in the past, we have implemented a very strategic and targeted approach to securing reimbursement with Medicare Medicaid and private commercial payers I'm pleased to report, we are making significant process and progress in advancing this.
Speaker Change: Strategy.
Speaker Change: The first step in this approach was to work closely with key pain management providers in there.
Speaker Change: The use of the new CPT tracking code for accurate and timely content flow claims submission.
Speaker Change: <unk>, we are providing support to the clinical facilities for each individual claim to have an appropriate response.
Jan Adriaan Haverhals: We have established multiple sites across the U.S. that are actively utilizing CompuFlow and submitting claims to payers across the country, rather than bringing on too many hospitals and pain clinics before reimbursement approval. We realized it is better to laser focus on working closely with a select group of pain clinics and provide them with the necessary professional support to help ensure positive payer reimbursement.
We have established multiple sites across the U S that are actively utilizing com to flow and submitting claims to payers across the country.
Speaker Change: Rather than bringing on too many hospitals and pain clinics before reimbursement approval. We realized it is better to laser focus on working closely with a select group of pain clinics and provide them the necessary professional support to help ensure positive payer reimbursements.
Speaker Change: We're also supporting these clinicians utilization of company flow across a variety of use cases, which is important in demonstrating widespread utilization of the technology.
Jan Adriaan Haverhals: We are also supporting these clinicians' utilization of CompuFlow across a variety of use cases, which is important in demonstrating widespread utilization of the technology. I'm pleased to report that we are effectively executing on this strategy, as evidenced by the fact we have now submitted more than 160 claims to pay for, including a variety of Medicare jurisdictions, using the specific CPT code, 777T. If you recall, the American Medical Association assigned this CPT code as an add-on code to be used in conjunction with one of the eight existing epidural steroid injection codes.
Speaker Change: I'm pleased to report that we are effectively executing on this strategy as evidenced by the effects. We have now submitted more than 160 claims to pay you said Sims, including.
Speaker Change: Including a variety of Medicare jurisdictions, using this specific CPT code the Triple seven T code.
Speaker Change: If youll recall, the American Medical Association assigned a CPT code as an add on code to be used in conjunction with one of the eight existing epidural steroid injection coal and it is very specific to the unique computerized aspects of our technology.
Jan Adriaan Haverhals: And it is very specific to the unique computerized aspects of our technology, to the high level of claim activity that is now being generated by our... has provided us an opportunity to engage directly with the payers, including Medicare, to directly educate them on Compuflow technology and the unmet need the technology serves. In turn, we believe this is helping build support for the appropriate level of reimbursement. As I mentioned, we are making significant progress, and I look forward to providing further updates as developments unfold.
The high level.
Speaker Change: Of claim activity that is now being generated by us provided us an opportunity to engage directly with the payers, including Medicare to directly educate them on concrete flow technology and beyond that need the technology says in turn we believe this is helping.
Speaker Change: Support for the appropriate level of reimbursement as I mentioned, we are making significant process and progress and I look forward to providing further updates as developments unfold.
Jan Adriaan Haverhals: We also believe there is a significant market opportunity for a Compuflow Epidural Instrument within federal and other government agencies. And as we have discussed in the past, we are advancing this initiative following the SAM approval and working to secure approval with FSS, the Federal Supply System, that would open up a sizable government market. Turning to the international front, we are expanding our network of distribution partners for Comfort Flow. We are targeting independent distributors with existing relationships within key global markets and proven track records of introducing medical devices in their territories.
Speaker Change: We also believe there is a significant market opportunity for our concrete flow epidural instrument within federal and other government agencies and as we have discussed in the past we are advancing initiatives. Following the sem approval in working to secure approval with FSS the federal supply system.
Speaker Change: That would open up the sizable government market.
Speaker Change: Turning to the National front, we are expanding our network of distribution partners, who come to flow, we are targeting independent distributors with existing relationships within key global markets and proven track records of introducing medical devices within their territories.
Jan Adriaan Haverhals: We have also received preliminary indications that Compuflow has received regulatory approval in one of the largest BRIC countries, and we expect to report on this further in the near future. In anticipation of this approval, we have already established key relationships with leading medical institutions and commercial entities in this country, which we look forward to formalizing in the near future. So to summarize, we are continuing our efforts to seed the market among key physicians and pain clinics across the U.S., which we believe will ultimately translate into broad adoption.
Speaker Change: We have also received preliminary indication that comp is slow has received regulatory approval in one of the largest BRIC countries and we expect to report on this further in the near future.
Speaker Change: In anticipation of this approval, we have already established key relationships with leading medical institutions and commercial entities in this country, which we look forward to formalizing the near future.
Speaker Change: So to summarize we are continuing our efforts to seed the market among key physicians in pain clinics across the U S, which we believe will ultimately translate into grow the adoption.
Jan Adriaan Haverhals: We remain committed to our goal of establishing CompliPlow as the new standard of care in epidural anesthesia by providing patients with effective pain relief while reducing the risk of complications. At this point, I'd like to turn the call over to Keisha Harkam, Vice President of Finance, to go over the financials in detail. Please go ahead.
Speaker Change: We remain committed to our goal of establishing comparable as the new standard of care and epidural anesthesia by providing patients with effective pain relief, while reducing the risk of complications.
Speaker Change: At this point I'd like to turn the call over to Keisha Hawken.
Keisha Hawken: Vice President of finance to go over the financials in detail. Please go ahead keisha. Thank.
Keisha Harcum: For the quarter ending March 31, 2024 and 2023, revenue was approximately $2.2 million and $2.6 million, respectively. As of January 3, 2023, the company launched an e-commerce platform, selling and shipping the SBA single-tooth anesthesia system in handy directly to end-users, including dental offices and dental groups, to replace its previous U.S. distribution agreement with Henry Schein. The U.S. e-commerce revenue for the three months ending March 31st, 2024 was approximately 1.3 million compared to 989,000 on March 31st, 2023.
Keisha Hawken: Thank you origin for the quarter ending March 31, 2024, and 2023 revenue was approximately $2 2 million and $2 6 million respectively. As of January three 2023, the company launched a e-commerce platform selling and shipping the SBA system.
Keisha Hawken: Enhancing directly to end users, including dental office and dental groups to replace its previous U S distribution arrangement with Henry Schein.
Keisha Hawken: The U S E Commerce revenue for the three months ended March 31, 2024 was approximately $1 3 million compared to 989000 at March 31, 2023. The company recorded no revenue for other U S distributors for the three months ending March 31 2012.
Keisha Harcum: The company recorded no revenue for other U.S. distributors for the three-month ending March 31st, 2024 compared to approximately $219,000 for the three-month ending March 31st, 2023. The company terminated all non-exclusive agreements with other distributors in the United States in September of 2023.
Keisha Hawken: Four compared to approximately 219000 for the three months ending March 31, 2023, the company terminated all non exclusive agreement with other distributors in the U S. In September.
Keisha Hawken: 23.
Keisha Harcum: For the three months ending March 31st, 2024, international revenue was approximately $930,000, a decrease of $274,000 compared to March 31st, 2023. Gross profit for the quarter ending March 31st, 2024 was $1.7 million, or 75% of revenue, versus $1.9 million, or 73% of revenue, for the three months ending March 31st, 2023. The increase in gross profit margin was due to higher-margin sales with the launch of the new online store.
Keisha Hawken: For the three months ending March 31, 2024 International revenue was approximately 930000, a decrease of 274000 compared to March 31, 2023 gross profit for the quarter ending March 31, 2024 was $1 7 million or 75%.
Speaker Change: Of revenue versus $1 9 million or 73% of revenue for the year ended for the three months ending March 31, 2020. The increase in gross profit margin was due to higher margin sales with the launch of the new online store.
Keisha Harcum: Operating losses for the three months ending March 31st, 2024 were approximately $1.5 million versus $1.3 million for the first quarter ending March 31st, 2023. Net loss was approximately $1.4 million, or $0.02 per share, for the three months ending March 31, 2024, versus a net loss of $1.3 million, or $0.02 per share, for the comparable period in 2023. Now I would like to turn your attention to liquidity and capital resources. We continue to carefully manage expenses to maintain a solid balance sheet. At March 31st, 2024, the company had cash and cash flows, and marketable securities of approximately $5 million, and working capital of $7.2 million, and no long-term debt.
Speaker Change: Operating losses for the three months ending March 31, 2024 was approximately $1 5 million versus $1 3 million for the first quarter ending March 31 2023.
Speaker Change: Net loss was approximately $1 4 million or <unk> <unk> per share of this theory for the three months ending March 31, 2024 versus net loss of $1 3 million or <unk> <unk> per share for the comparable period in 2020.
Speaker Change: Now I would like to turn your attention to liquidity and capital resources. We continue to carefully manage expenses to have maintained a solid balance sheet at March 31, 2024, the company had cash and cash equivalence and marketable securities of approximately $5 million.
Speaker Change: And working capital of $7 2 million and no long term debt at this point I'll turn the call back over to origin horrible.
Jan Adriaan Haverhals: At this point, I'll turn the call back over to Arjun Harahal.
Jan Adriaan Haverhals: Thank you, Keisha. As Keisha mentioned, we continue to maintain a strong balance sheet with approximately 5 million in cash. Cash equivalents and marketable securities as of March 31st 2024, which we believe provides us with sufficient resources to execute on our sales and marketing activities around both our dental and medical devices without the need for additional capital raising. We believe our new direct sales strategy, including the launch of our new online sales portal in the US, as well as our enhanced marketing efforts around the SDA, have been effective, as illustrated by the increase in our e-commerce sales, as well as the gross profit margin improvement during the quarter.
Speaker Change: Thank you Felicia excuse me I mentioned, we continue to maintain a strong balance sheet with approximately $5 million of cash cash equivalents and marketable securities as of March 31, 'twenty 'twenty, four which we believe provides us sufficient resources to execute on our sales and mark.
Speaker Change: Getting activities.
Speaker Change: Around both our dental and medical instruments without the need for additional capital raise.
Speaker Change: We believe our new direct sales strategy, including the launch of our new online sales portal and U S as well as our enhanced marketing efforts around DSD E have been effective as illustrated by the increase in our ecommerce sales as well as the gross profit margin improvement during the quarter.
Jan Adriaan Haverhals: Our dental business continues to generate positive cash flow on a stand-alone basis, and we remain focused on achieving our goal of positive cash flow company-wide. On the medical side, we remain encouraged by the outlook for the business given our sales pipeline, the addition of new pain management clinics, as well as the expansion of our international distribution. Most importantly, we are making progress advancing our reimbursement strategy around the CompreFlow epidural system and look forward to providing an update as developments unfold.
Speaker Change: Our dental business continues to generate positive cash flow on a standalone basis, and we remain focused on achieving our goal of positive cash flow company wide.
Speaker Change: On the medical side, we remain encouraged by the outlook for the business given our sales pipeline. The addition of new pain management clinics as well as expansion of our international distribution partners.
Speaker Change: Most importantly, we are making progress advancing our reimbursement strategy around the comp we flow epidural system and look forward to providing an update as developments unfold.
Jan Adriaan Haverhals: The medical segment represents a large addressable market, and we remain confident in our belief that CompuFlow will ultimately become the standard of care given both the safety, predictability, and efficiency advantages. So to wrap up, we believe we have developed an efficient and scalable platform to help drive high-margin recurrent sales in the coming years and look forward to reporting further developments in our medical segment on the reimbursement front. At the same time, we have maintained a lean operating structure and remain committed to driving shareholder value. I'd like to thank you for joining the call today, and at this point, we would like to open the call to questions. Operator?
Speaker Change: The medical segment represents the largest addressable markets and we remain confident in our belief that concrete floor will ultimately become the standard of care given both the safety predictability and efficiency advantages. So to wrap up we believe we have developed an efficient and scalable plaque.
Speaker Change: For them to help drive high margin recurring sales in the coming years and look forward to reporting further developments in our medical segment on the reimbursement front at.
Speaker Change: At the same time, we have maintained a lean operating structure and remain committed to driving shareholder value.
Speaker Change: I'd like to thank you for joining the call today and at this point, we would like to open the call up to questions operator.
Operator: Thank you very much. We will now be conducting our question and answer session. If you would like to ask a question, please press star 1 on your phone keypad now. A confirmation tone will indicate that your line is in the queue. You may press star 2 if you would like to remove your question from the queue. For anyone using speaker equipment, it might be necessary to pick up your handset before you press the keys.
Speaker Change: Thank you very much we will now be conducting a question and answer session. If you would like to ask a question. Please press star one on your phone keypad now a confirmation tone will indicate that your line is and Nicky you May Press star two if you would like to remove your question from Nicky So anyone using speaker equipment it might be necessary.
Speaker Change: For you to pick up your handset before pressing the keys. Please wait a moment, whilst we poll for questions.
Speaker Change: Okay.
Operator: Please wait a moment while we poll for questions. Thank you. Your first question is coming from Anthony Vendetti of the Maxim Group. Anthony, your line is live.
Speaker Change: Your first question is coming from Anthony Vendetti from Maxim Great. Anthony Your line is live.
Thank you.
Anthony Vendetti: So are you know just on the.
Anthony V. Vendetti: Thank you. On the 160 claims submitted so far to Medicare, was that in the first quarter, or is that a year to date?
Speaker Change: On the 160 claims submitted so far to Medicare.
Anthony Vendetti: It was that in the first quarter or is that a year to date and then can you talk about.
Jan Adriaan Haverhals: And then can you talk about how you think that's going to grow throughout the year? Is there a pipeline of claims that you have? And then the additional pain clinics, I know you announced some. What's that pipeline look like, and the opportunity for the remainder of 2024? Thanks.
Speaker Change: How do you think that's going to grow throughout the year or is there a pipeline of claims.
Speaker Change: That you have and then the additional pain clinics I know you announced some.
Speaker Change: What's that what's that pipeline look like and the opportunity for for the remainder of 2024. Thanks.
Jan Adriaan Haverhals: Thank you, Anthony. So to answer your question, the first question was the number of sites or the number of claims that we have submitted. Just to recall, at the end of 2023, we had submitted, in a nine-month period, about 100 claims. We also explained what was happening with the letter to the shareholders at the beginning of January.
Speaker Change: Thank you Anthony.
Speaker Change: So to answer your question.
Speaker Change: First question was the number of of sites or just the number of claims that we have submitted a just to recall at the end of 2023, we had submitted in the nine months period about 100.
Speaker Change: Claims are we also.
Speaker Change: Explain what was happening to the letter of the shareholders in the in the beginning of the month of January So the 60 additional claims as from the period January until two day, which is May 16, 2024, So those 160 claims.
Jan Adriaan Haverhals: So the 60 additional claims are from the period January until today, which is May 16, 2024. So those 160 claims That means that patients have been treated with the technology, all the documentation that is needed for submission to the healthcare insurance provider, including letters of medical necessity, etc., have been submitted to these healthcare insurance providers, and we can confirm that these claims have been uploaded into their system, which is very important because uploading the claims means that there is evidence and there is an identification of our technology for healthcare insurance providers. So that's the first part of your question.
Speaker Change: That means that patients have been treated with the technology. All the documentation that is needed for submissions for submission to the health care insurance provided including letter of medical necessity et cetera, et cetera has been submitted to the east.
Speaker Change: Healthcare insurance providers, including we can confirm that these claims have been uploaded index in their system, which is very important because uploading. The claims means that there is evidence and there is an identification of our technology for health care insurance provider. So that's the first part of your question.
Jan Adriaan Haverhals: The pipeline of claims, the pipeline of clinicians, like I said, we are laser focused. It's not a matter of getting 20 or 30 more clinics that are sending in the claims. It is more important that we have sufficient and a smaller group of clinics where we are 100% sure that the document that is sent in and submitted to these healthcare insurance providers is professional, is correct, and that we avoid back and forth with the discussion with the healthcare insurance providers to optimize the quality of the documentation.
Speaker Change: The pipeline of claims with a pipeline of clinicians like I said, we are laser focused it's not a matter of getting 20 or 30 more clinics.
Speaker Change: That are sending in the claims it is more important that we have sufficient and a smaller group of clinics, where we have 100% sure that the document that is sending in and submitted its duties healthcare insurance provided is professional is correct and that we avoid back and forth with.
Speaker Change: The discussion with the health care insurance providers to optimize the quality of the document nation.
Jan Adriaan Haverhals: What is key to understand is that it's not so much about just doing the technology and treating the patient with the technology. The main part of the effort made is, I would say, at the back end of this process where the billing and the coding manager of the office has to send it in to the insurance providers. I'm quite sure that everybody, from their own experience, is aware of what kind of paperwork needs to be submitted to get even a payment from insurance providers, the site, additional clinics, additional hospitals that we are in discussions with, and where we are going to perform the first patients to further support the approval and the payment of the procedure by the reimbursement providers.
Speaker Change: What is key to understand it's not so much of just doing the technology in treating the patient with the technology debate the main.
Part of the Oh the effort made is I would say at the backend of this process where the.
Speaker Change: Billing and coding manager of the office has to send it into the insurance provided I'm quite sure that everybody from their own experience is aware of what kind of paperwork needs to be submitted to get even a payment from insurance providers.
Speaker Change: As we speak yes, we are adding additional.
Speaker Change: Sites additional clinics additional hospitals that we are.
Speaker Change: In discussion with them and where we are going to perform first patients to further support.
Speaker Change: D a.
Speaker Change: The approval and the payment of the procedure by the reimbursement provide us now what the outlook will be for the end of the year that is completely dependent on the feedback that we expect to receive from some of the jurisdictions that have already called.
Jan Adriaan Haverhals: Now what the outlook will be for the end of the year, that is completely dependent on the feedback that we expect to receive from some of the jurisdictions that have already confirmed that there is coverage of the technology, but they are in the process now to finally establish prices for their insurance for Medicare in some of the jurisdictions for this technology as an add-on code in addition to the epidural steroid injection. And that will, of course, trigger a faster acceleration of the commercialization of our CompreFlow epidural system in the United States. Does that answer your question, Anthony?
Speaker Change: Firm that desk coverage of the technology, but they are in the process now to finally.
Speaker Change: Stablish or pricing for their insurance for Medicare and some of the jurisdictions for this technology as an add on code. In addition to the epidural steroid injection and that will of course trigger then a faster acceleration of <unk> commercialization.
Speaker Change: Of Ah I accomplish flow epidural system in the United States.
The answer to your question Anthony.
Anthony V. Vendetti: Yes, I was just wondering if, for some of the claims that have been that were submitted last year, what the adjudication process looks like so far? Has there been some price, some reimbursement, uh, established, or is it too early to say?
Speaker Change: Yes, I was just wondering.
Speaker Change: For those some of the claims that have been that were submitted last year.
Speaker Change: What what does the adjudication process looked like so far has there been.
Speaker Change: Some some price.
Speaker Change: Some reimbursement.
Speaker Change: <unk> established or or is it too early to say at this point.
Jan Adriaan Haverhals: Now, as I explained in the first quarter and in January, when you say reimbursement established means, for us, in our terminology, that means Medicare has to establish a price for this technology, right? Commercial payers, some commercial payers have paid for this technology, and the motor vehicle patient or the motor vehicle insurance has decided in some of the clinics here in New Jersey to pay for specific motor vehicle cases.
Speaker Change: No.
Speaker Change: I explained in our in the first quarter and in January when you. When you say reimbursement established means for us in our terminology that means the Medicare has to establish a price for this technology right now commercial payers some of <unk>.
Speaker Change: Commercial payers have paid for this.
Speaker Change: This technology and the motor vehicle Ah patients or the motor vehicle insurance has decided in some of the claim next year in New Jersey to pay for the specific motor vehicle cases, what is very important is to understand in particular why is Medicare important Medicare.
Anthony V. Vendetti: What is very important is to understand, in particular, why Medicare is important. Medicare is important because, in particular, our technology in the patient group of Medicare-insured patients will work very well because of the anatomy and the elderly patient's calcifications, and that is, in particular, part of the letter of medical necessity for the Medicare insurance provider so that they understand what this technology is doing. Like I mentioned this morning, we are allowed to engage with Medicare providers.
Speaker Change: There is important because in particular, our technology in the patient group of the Medicare insured patients will work.
Speaker Change: Very well because of the anatomy and the elderly patients calcifications and that is in particular part of the letter of medical necessity, Florida Medicare insurance provided that they understand what this technology is doing like I mentioned.
Speaker Change: This morning that we are in are allowed to engage with the Medicare providers now yes.
Anthony V. Vendetti: Now, yes, I had, with our medical advisor, a meeting with one of the jurisdictions to explain in detail what this technology is doing, what the benefits are for the patients, and how it helps and supports these jurisdictions to come up with a pricing statement for our technology for Medicare patients. When we get that, that would be, in your terminology, the establishment of reimbursement.
I've had with a medical adviser meeting with.
Speaker Change: With one of the jurisdictions to explain in detail. What this technology is doing what the benefit is for the patients are and which helps and support these jurisdictions to come with a pricing statement for our technology for the Medicare pay.
Speaker Change: <unk>.
Speaker Change: When we get that that would be in your terminology the establishment of reimbursement.
Anthony V. Vendetti: OK, and then maybe just a moment. I wanted to explain the difference or the sales force difference between the dental business, which is now direct as you terminated the Henry Schein Agreement, versus how you're going about the medical side of the Compuflow system.
Speaker Change: Okay, and then maybe just.
Speaker Change: Explain the difference.
Sure.
Speaker Change: The sales force difference between the dental business, which is now a direct as determinate at the Henry Schein agreement versus how your.
Speaker Change: Boeing about the the medical side for the coffee flow system.
Jan Adriaan Haverhals: Well, I'm afraid I do not understand your question, but all the revenues are generated by the dental business year to date, 99.5% of which are dental sales. Your question about the dental business generating revenues, as we have reported, 1.3 million in e-commerce sales in the dental business in the U.S. alone versus, I think about 989,000 in the same period last year, so that's 31%. And then, of course, the revenues that we are getting, including the profitability of the dental business, we use that money to further invest in and help support the build-up of the medical business.
Speaker Change: Well I'm afraid I do not understand your question, but if the matter the dental business older revenues are generated by the dental business a year to date, a 99, 5% is our dental sales.
Speaker Change: Your question about the dental business.
Speaker Change: Generating the revenues as we have reported its $1 3 million on the e-commerce sales in the dental business in the U S alone versus I think about 989000 in the same period last year. So that's the 31% and then of course in revenues that we are getting including the profit.
The ability of the dental business, we use that money to further.
Speaker Change: Invest and help support the buildup of the medical business.
Jan Adriaan Haverhals: The medical business revenue that we hope to enjoy within the year 2024 is strongly dependent on having reimbursement and getting the initial price indication and price positioning of the reimbursement and the healthcare insurance providers. That's exactly what we are doing, and what the strategy has been. We are living in an environment, in a healthcare environment, where, unfortunately, it is not sufficient if you have new technology that is more efficient, safer, more comfortable, and has higher predictability. At the end of the day, it completely depends on what the healthcare insurance providers are going to pay for and reimburse and establish that reimbursement for the patients and the clinicians. Right?
Speaker Change: The medical business revenue that we hope to enjoy within the year 'twenty 'twenty four is strongly dependent on having reimbursement and getting the.
Speaker Change: The initial price indication and price positioning of the of the reimbursement and the health care insurance providers that that's exactly what we are doing and what the strategy has been look we are living in an environment are in the health care environment, where unfortunately.
Speaker Change: It is not sufficient if you have a new technology that is more efficient safer.
More comfortable a higher predictability.
Speaker Change: At the end of the day it completely depends on what the health care insurance providers are going to pay and we induce an established reimbursement for the patients and the clinicians right. So what we are doing is building that up stage by stage and step by step.
Jan Adriaan Haverhals: So what we are doing is building it up stage by stage and step by step, as I've alluded to earlier, where we identified three jurisdictions last year that we are active in. This year, we have expanded the three jurisdictions to seven jurisdictions where we are currently active. There are 12 jurisdictions in the United States, and the goal is to be present in all those jurisdictions. And the seven out of the 12 is, in a way, a confirmation that we are now present in about 60 to 65 percent of all the states in the United States.
Speaker Change: Our diluted on earlier, where we have identified and last year three jurisdictions that we are active in this year, we have expanded.
Speaker Change: The three jurisdictions to seven jurisdictions, where we are currently in that 12 jurisdictions in the United States and the target is to be present in all those jurisdictions and the seven out of the 12.
In a way.
Speaker Change: A confirmation.
Speaker Change: That we are now present in about 60% to 65% of all the states and in the in the in the United States.
Jan Adriaan Haverhals: So the game here is really to roll it out. Every jurisdiction has its own decision-making process, but when we get the establishment of the first jurisdictions in the United States, it will have an effect on the other jurisdictions for Medicare in other parts of the country. That's why it is so important and that's why I said we had made significant progress because, yes, we were able to engage in a meeting with one of these jurisdictions to explain in detail what this technology is about, what the benefits are, That is a pretty, pretty fantastic result, I would say, for the company on our side. The numerous companies that will never ever get as far as we have been.
Speaker Change: So the game here is really to roll it out every jurisdiction has their own decision, making process, but when we get the establishment of the first jurisdictions in the United States. It will have any effect on the other jurisdictions.
Speaker Change: For men.
Speaker Change: Medicare and other parts of the country in the U S. That's why it is so important and that's why I said, we have made significant process and progress because yes, we haven't been able to engage with.
Speaker Change: With a in a meeting with one of these jurisdictions to explain in detail. What this technology is about what the benefits are in particular for that patient population and now we are waiting for their feedback that is a pretty pretty fantastic result, I would say for the company on our site the numerous.
Speaker Change: Companies that never ever get that far as we have been so that's the reason why I say significant progress.
Jan Adriaan Haverhals: That's the reason why I say significant progress and that's also why I'm pretty positive that we will hear in the short to midterm from these healthcare insurance jurisdictions what their price is. But I don't have any influence on what their final price is going to be. I'm also not going to share which jurisdictions we have been in discussions with because I don't want to jeopardize any of their decision-making processes to come to a final price statement and pricing decision.
Speaker Change: And that's the reason also why I'm pretty positive that we will here.
Speaker Change: In the short to mid term from these health care insurance jurisdictions, what that price is I don't have any influence on what that final price is going to be I'm also not going to share which jurisdictions. We have been in discussion with because I don't want to jeopardize any of their decision making process to come to us.
Speaker Change: Final.
Price statement and pricing decision would have we made progress absolutely and I are happy absolutely and I'm proud of what the team and this company has been doing a smaller entity in this whole jungle of reimbursements and and encoding and.
Anthony V. Vendetti: Have we made progress? Absolutely. Am I happy? Absolutely. I'm proud of what the team and this company have been doing as a smaller entity in this whole jungle of reimbursement and coding and getting that established. So, yes, I'm pretty positive. Okay, great.
Getting that established so yes, I'm pretty positive.
Anthony V. Vendetti: Okay, great. Just shifting gears to the dental business, you were talking about e-commerce and then restarting the international business. Is the international business restart this year already underway? And then is there going to be an e-commerce model there as well?
Speaker Change: Okay, Great just shifting.
Speaker Change: Shifting gears to the dental business.
Speaker Change: You you were talking about E Commerce, and then restarting the international.
Speaker Change: Is the restarting.
Speaker Change: Restarting the international this year.
Speaker Change: Already underway and then.
Speaker Change: Is there going to be an e-commerce model there as well.
Speaker Change: Let me.
Jan Adriaan Haverhals: We take the opportunity, I would like to correct your statement. It's not a matter of restarting the international business; it's not a matter that we have not focused on the international business. There have been good reasons why some of these distributors, based on their inventory build-up or based on their quarterly purchase orders and forecast, why they have not ordered the products in the first quarter, right? So, what I meant was that we have a rather lean organization also on the sales side for the dental business. We have, including myself, three people working directly with sales and then three people in the back office from an education, customer service, and customer support point of view, focusing on the higher level of activity within the United States because we now know the customer identity, right?
Casey: Casey opportunity I would like to correct. Your statement, it's another matter of restarting the international business is not a matter that we had not focused on the international business.
Casey: It has been good reasons why some of these distributors based on on on the inventory buildup or based on there.
Casey: Quarterly purchase orders and forecast.
Speaker Change: <unk> has not ordered the products in the first quarter right. So.
Speaker Change: What I mean was that you know that we are having a rather lean organizational so on the sales side for the dental business, we have including myself.
Speaker Change: Three people working directly with the sales and then three people in the back office from an education and a customer service and customer support.
Speaker Change: The point of view focusing on are.
Speaker Change: The higher level of activity within the United States, because we know now the customer identity right now on the international front, we have quarterly business meetings with the top.
Jan Adriaan Haverhals: Now, on the international front, we have quarterly business meetings with the top 15 distributors, which represents 90 percent of our dental business, to really understand and work closely together with these distributors so that we can get a steady and consistent solid baseline of business quarter by quarter. Because we are not in a business of seasonality, it completely depends on the bulk and the magnitude of the order, and we would like to spread that out over all the four quarters so that we can come up with a more efficient sales and operations planning, with a more efficient management of sales efficiencies, and sales execution.
Speaker Change: 15, distributors, which is representing 90% of our dental business to really understand and work closely together with these distributors. So that we can get a steady and consistent.
Speaker Change: Solid baseline of business quarter by quarter, because we are not in a business of seasonality. It's completely depends on the book and the magnitude of the order and we will like to spread that out.
Speaker Change: Overall, the fourth quarter, so that we can come with a more efficient sales and operations planning with a more efficient management of sales efficiencies and sales execution.
Jan Adriaan Haverhals: We will not, for the time being, have an e-commerce platform for the international market, primarily based on language, based on different tax systems, based on different regulatory requirements within these countries, so we prefer to go through distributors. Now, the majority of these distributors do have their own online platform within their country, so what we are doing is supporting them with all the services at the back end to be able for them to increase their marketing and sales efforts to their customer base because we do not own the customer in the individual countries.
We will not for the time being we will not.
Speaker Change: I have an e-commerce platform 40 international markets and primarily based on language based on different tax systems based on a different regulatory requirements within these countries. So we prefer to go through the distributors now the majority of these.
Speaker Change: Distributors do have their own online platform within their country. So what we are doing is supporting them in all of the service at the back end to be able for them to increase their marketing and sales efforts to their customer base, because we do not own the customer in the individual countries.
Jan Adriaan Haverhals: Our customer is the distributor; the distributor owns the customer relationship with the end user in the markets. That's the reason why we decided, and this is a rather beautiful modem, I would say, to develop an interactive learning program that is online with the clinicians and the distributors and the local clinicians in each individual country, where there is real-time translation in their local languages. So that's the type of activity that we are undertaking with the distributors.
Speaker Change: Our customer is the distributor to distributor owns the customer relationship with the end user in the market. That's the reason.
Speaker Change: Why are we decided.
Speaker Change: That's a rather beautiful a modem I would say why we decided to develop an interactive learning program, which is online with the clinicians and the distributors and the local clinicians into into each individual country windows, where there is a real time.
Speaker Change: The translation in their local in their local languages. So that's the type of activities that we are undertaking with the distributors.
Anthony V. Vendetti: Okay, that's very helpful. Yeah, I'll hop back in the queue. Thank you.
Speaker Change: Okay. That's very helpful. I'll hop back into queue. Thank you. Thank you on Tonight. Thank you.
Operator: Thank you, Anthony. Thank you.
Operator: Thank you very much. Your next question is coming from John Corb, who is a private investor. John, your line is live.
Speaker Change: Thank you very much. Your next question is coming from John Cole, who is a private investor.
Speaker Change: John Your line is life.
John Korb: Thank you. Hi Arlen, I'm John Korb. Nice to speak with you again. Um, can you hear me?
Speaker Change: Thank you Ireland I'm John Corp.
John Corp: Nice to speak with you again.
John Corp: Can you hear me.
Jan Adriaan Haverhals: Yes, loud and clear, Joe. OK.
Speaker Change: Yes, loud and clear John.
John Korb: Okay, your discussion with Anthony helped me to better understand the process that Milestone is going through and trying to establish the rollout of the Compuflow technology. One of my questions is...
Okay.
Speaker Change: Your discussion with the ancillary helped me to better understand.
Speaker Change: The process of milestone is occurring I'm trying to establish the rollout of the copter flow technology.
Speaker Change:
Speaker Change: One of my questions is.
John Korb: When you get the pricing fixed, with Medicare and insurers, and when you get that end of it, when you get the insurability part all set up, then where is Milestone? Are all these doctors, I'm really enthusiastic about using CompuFlow technology, or once you get the insurance part of it all established? Are you going to have to engage the sales force?
Speaker Change: When you get the pricing.
Speaker Change: Fixed.
Speaker Change: With Medicare and insurers and when you get that end of it when you get to ensure ability park.
Speaker Change: All set up.
Speaker Change: Then, whereas milestone are all these doctors.
Speaker Change: Really enthusiastic.
Speaker Change: About using cop your flow technology or once you get the.
Speaker Change: The insurance part of it all established.
Speaker Change: Are you gonna have to.
Speaker Change: Engaged sales force.
John Korb: to go around the country to pain clinics and hospitals trying to get them to use it in the dental business. Part of the traction you're getting is from patients. Is the same process going to be necessary for a milestone to do that, or are these doctors that you are engaging with saying, okay, we really like CompuFlow and we want to use it in our whole practice, but we have to make sure we can get paid? Where is the level of acceptance or enthusiasm for the copier flow technology in hospitals and pain clinics? Question. Doctors. Could you tell me that?
Speaker Change: To go around the country to paying clinics and hospitals trying to get them to use it.
And the desktop business.
Speaker Change: Part of the traction you're getting is from patients.
It's the same process going to be necessary for a milestone.
Speaker Change: To do that or are these doctors that you.
Speaker Change: Our encasing, whereas saying, okay, we really liked copter phone, where you want to use it in our total practice, but where you have to make sure we can get paid.
Speaker Change: Whereas the level of acceptance or enthusiasm for the cop your phone technology with hospitals and paying clinics and.
Speaker Change: Classes.
Speaker Change: Doctors could you tell me about it.
Jan Adriaan Haverhals: It's very simple. Like I said, reimbursement is key. We do not have to invest in a heavy sales organization in medical because, as we have shared in the past as well, we are lined up already with a distributor called CTI that is in 24 states in the United States. They are experiencing anesthesia in the operatory room, so I'm not so worried about the expansion of the sales force. From the dental product as well, the short answer to that is that's the reason why we have opened the portal and why we are so successful with sales in the United States combined with digital marketing, increasing marketing qualified leads where we do not necessarily need to have a heavy sales force because what everybody needs to understand is, yes, of course, you need to have additional new customers, but the main part of the business is the recurrent revenue stream of the consumables, and Thank you for the question.
Speaker Change: Yeah, I know, it's very simple.
Speaker Change: Like I said.
Speaker Change: Reimbursement is key.
Speaker Change: We do not have to invest in our in our heavy shelf organization and medical because as you know what we have shared in the past as well we are lined up already with a distributor called.
Speaker Change: <unk> C T I D.
Speaker Change: In 24 states and the United States they are experiencing.
Speaker Change: In anesthesia in the in the Operatory room, so I'm not so worried about the expansion of the sales force.
Speaker Change: From the dental product as well is that.
Speaker Change: Exactly for the question that you asked the short answer to that is that's the reason.
Speaker Change: Why we have opened the portal and why we are so successful in the with the sales in the United States combined with digital marketing.
Speaker Change: Increasing marketing qualified leads where we do not necessarily need to have a a heavy sales force.
Speaker Change: Because what everybody needs to understand yes, you'll of course, you need to have additional new customers, but the main part of the business is the recurring revenue stream of the consumables and that's what we decided to do two opened the portal increase our customer service customer support after sales service and.
Speaker Change: And that's also the reason why we enjoy the growth that we have reported so I think that answers. Your question. Thank you for the question John.
John Korb: Okay, one more question. Uh...
Speaker Change: Okay, one more question.
Speaker Change: <unk>.
John Korb: It seems to me that... You're working on two fronts with government approval. You're working with Medicare. You're also working to get.
Speaker Change: It seems to me that.
Speaker Change: You're working on two fronts with government approved where you're working with Medicare.
Speaker Change: And you're also working to get.
Speaker Change: A copy of flow as the standard of care with certain things certain government agencies.
John Korb: If you get that, wouldn't that kind of eliminate any more influence you have to have with Medicare for the adoptability of this technology? No, I think, John. There are two different things. The one is not going hand-in-hand with the other. So Medicare doesn't have any influence on the government. The government doesn't have any influence on Medicare.
Speaker Change: If you get fab wouldn't that just.
Speaker Change: Kind of eliminate anymore.
Speaker Change: And with once you have to have with Medicare for adaptability.
Speaker Change: All of this technology, I mean cause or no I think John.
Speaker Change: There are two different things.
Speaker Change: One is not going hand in hand with each other so.
Speaker Change: Medicare doesn't have any influence on the government. The government doesn't have any influence on the Medicare that has two different different processes et cetera. So I hope that that is sufficient in answering your question. Thank you John.
Jan Adriaan Haverhals: That are two different processes, et cetera, so I hope that that is sufficient in answering your question. Thank you, John.
Operator: Thank you very much. Your next question is coming from Robert Brennan, who is a private investor.
Speaker Change: Thank you very much. Your next question is coming from Robert Brendan who is a private investor.
Robert Brennan: Hey, Ariane. Thanks very much for the call. So, a couple of questions. Great to see the improvement in the margins in the dental business. I think you're obviously headed in the right direction because if you can sell less and make more, that's great, always going to be a positive in light of the anticipated growth in addition to that. But how many, and what kind of growth do you anticipate? Uh, in the dental business and also what the opportunities might be in Europe.
Speaker Change: Hey, thanks, Thanks, very much for the call.
Speaker Change: <unk>.
Robert Brendan: So a couple of questions great to see the improvement on the margins on the dental business.
Speaker Change: I think you're obviously headed in the right direction, because they can sell less and make more of that.
Oh, it was going to be a positive.
Speaker Change: In light of the anticipated group growth and are in addition to the upfront how many what kind of growth.
Speaker Change: Growth you anticipate.
Speaker Change: In the dental business.
Speaker Change: And also what the opportunities might be in Europe.
Ralph: Yes, that's a really good morning, Ralph Thanks for the question.
Jan Adriaan Haverhals: Yes. Well, good morning, Rob.
Jan Adriaan Haverhals: Thanks for the question. Without going into details about what my growth objective is for the organization, I think, first of all, definitely there is a gigantic growth opportunity in the United States based on what we have been doing in the past, right? So the growth for the company would definitely be driven firstly by growth in the United States. [inaudible] Secondly, in the international markets, what I'm doing there, and this is important to understand this from an operational business perspective, is...
Ralph: Without going into details what [noise].
Ralph: High growth objective is for the organization I think.
Ralph: First of all definitely there is a judge and a growth opportunity in the United States based on what we have been doing in the past right.
Ralph: So the growth for the company would definitely be driven firstly bye bye.
Ralph: But the growth in the United States.
Speaker Change: Uh huh.
You know, let's let's agree on one thing I definitely want to outperform.
Speaker Change: The results that we had over the entire year 2023, because otherwise.
Speaker Change: It's not fun, if we would have similar results right. This one thing secondly in the India.
Speaker Change: India International.
Speaker Change: Markets.
Speaker Change: What I am doing there and that's important to understand that from an operational.
Speaker Change: Businesses.
Jan Adriaan Haverhals: I want the current good distributors to be better distributors. Then what I want to do is the mid-tier, and the good distributors are the 15 distributors being responsible for 85% to 90% of our business, right? And then you have a group below that that you want to develop into the higher tier.
I want to make the current good distributors being better distributors.
Speaker Change: And then what I want to do is the mid tier of and the good distributors is the 15 distributors being responsible of 85% to 90% of our business right and then you have.
Speaker Change: A group below that that you want to develop into D a to be higher.
Speaker Change: Higher tier and then you'll have a number of fragmented the distributors and and it does not always help to put a lot of emphasis on that let's say a distributor that is ordering for five grand or 10 Grand a year.
Jan Adriaan Haverhals: And then you have a number of fragmented distributors. And it does not always help to put a lot of emphasis on that, let's say a distributor that is ordering for $5,000 or $10,000 a year. If I look then at the cost side or the cost of acquisition, that's pretty high based on the revenue that you are getting. So we're cleaning up on that. What is key?
Speaker Change: If I look then at the cost side or the cost of acquisition, that's pretty high based on the revenue that you're getting so we're cleaning up on that what is key.
Jan Adriaan Haverhals: is the expansion in other markets, in other international markets, like, for example, I told you last year that we entered Brazil. Of course, the results could have been better, but the Brazilian dental distributor actually has to continuously invest and has added and grown their dental sales force from two people to eight people. Instead of only being in Sao Paulo, we are in others. We have initiated in-depth discussions with a dental chain in Brazil that owns 100 clinics.
Speaker Change: The expansion in other markets and other international markets like for example, I told you.
Speaker Change: Last year ago, we entered in Brazil.
Speaker Change: And of course, the results could have been better but the Brazilian.
Speaker Change: The dental distributor actually have.
Speaker Change: Continuously to invest and have added and growth.
Speaker Change: There are dental sales force from two people to eight people. So instead of only being in Sao Paolo we are in others. We have initiated a in depth discussions with a dental chain in Brazil, and that 100 clinics, we are doing a financially valuation.
Jan Adriaan Haverhals: We are doing a financial evaluation where we establish the usage of our technology and look at the financial impact of five clinics that belong to the dental chain in Brazil. I do believe that Brazil will also contribute to more revenues as we speak throughout the course of the year. Um... So, in a nutshell, three growth drivers for success: the U.S. market, international expansion, and increased utilization of handpieces and recurrent business in the international market. Does that answer your question?
Speaker Change: And where we establish the usage of our technology and look at the financial impact.
Speaker Change: Of our five clinics that are belonging to that dental chain in Brazil. So I do believe that Brazil will also.
Speaker Change: Contribute to more revenues.
Speaker Change: As we speak throughout the course of the year.
Speaker Change:
Speaker Change: So in a nutshell three growth drivers for success the U S markets International expansion.
Speaker Change: And increase the utilization of hand pieces and recurrent business.
Speaker Change: In the international markets.
Will: Does that answer your question will.
Robert Brennan: Yeah, yeah, it does. I mean, I just. Obviously, I think you've done it the right way in terms of getting margin improvement. Yeah. And then kind of cleaning up the periphery of it and getting rid of Henry Shine and all that stuff. And so how many salespeople do you actually have in the dental department? Did you say three?
Speaker Change: Yeah, Yeah. It does I mean I was just.
Speaker Change: You know, obviously I think you've done it the right way in terms of getting margin improvement.
Speaker Change: Yes.
Speaker Change: I'm kind of cleaning up the periphery of it you got to get rid of Henry Schein and all that stuff on how many how many salespeople do you actually have on the dental did you say three.
Jan Adriaan Haverhals: No. So, to be precise, I have... [inaudible] In our marketing approach and our go-to-market approach, we are not knocking on doors. We are using the digital marketing platform and the lead generation through the marketing platform as a tool to acquire new customers. What we are also not doing is going to the larger dental trade shows and meetings because, from an ROI perspective, that does not make sense. People do not tend to buy at these trade shows.
Speaker Change: No so to be precise I have.
Speaker Change: To people, let's say in the field, including myself I spent time for us as well in the field as part of a CEO role and then we have a free people and back office from a dental hygienist point of view that are doing.
Speaker Change: Education, and after sales support and customer development look we are not in our marketing approach and our go to market approach. We are not knocking on doors, we are using the digital marketing platform.
Speaker Change: And the lead generation over the marketing platform as a tool to acquire new customers. What we also are not doing is to go to the larger dental trade shows and meetings because from an ROI perspective, it doesn't make sense if people do not tend to buy.
Jan Adriaan Haverhals: What we do specifically is a number of smaller-scale hands-on meetings. What you have to imagine then is that you have about 20 clinicians coming to an educational program where they use the technology, where they get lectures, and that normally results in a 50% conversion while we are there. We have to be smarter in our marketing approach and in our sales approach, and that is what we are doing within the current go-to-market setup.
Speaker Change: Hi, one these tradeshows, but what we do specifically is a number of smaller scale.
Speaker Change: Zoom meetings, so what what you'll have to envision then is that you have about 20 clinicians coming.
Speaker Change: Two an educational program, where they use the technology, where they get lectures and that results in a normally in the 50% conversion. Whilst we are there. So we have to be smarter in our in our marketing approach and then our sales approach and that's what we're doing within the current go to market.
Speaker Change: Setup.
Robert Brennan: Okay, so I guess. The other question I would have is that, you know, I too fully expect this to become the standard of care on the epidural side. So, we talk about, you know, what, 11 million epidurals given a year, but can you kind of quantify that in terms of the actual... Monetary market sizes and, you know, in anticipation of getting, you know, I don't want to jinx anything but Medicare approval and FSS approval.
Speaker Change: Okay.
Speaker Change: So I guess.
Speaker Change: The other question I would have is.
Speaker Change:
Speaker Change: To fully expect us to become the standard of care on the epidural side.
Speaker Change: So when we talk about.
Speaker Change: 111 million epidural has given a year.
Speaker Change: But can you kind of quantify that and what the actual.
Speaker Change: Monetary market size.
Speaker Change: And you know in anticipation of getting.
Speaker Change: I don't want to drink side of thing, but Medicare approval and that process approval I would expect that.
Robert Brennan: I would expect that, as you indicated, if you get a couple of Medicare uh areas approved, that's going to have some kind of a cascading effect into the other Medicare jurisdictions, but what kind of monetary revenue market are we looking at in terms of the epidural space?
Speaker Change: As you indicated.
Speaker Change: Got a couple of Medicare.
Speaker Change: Areas approved is going to have some kind of a cascading effect into the other Medicare jurisdictions, but what kind of.
Speaker Change: Like monetary revenue market are we looking at in terms of the epidural space.
Jan Adriaan Haverhals: Yeah, absolutely. This is a very important question, Rob, and thank you for asking that. So the total market for epidurals is 11 million procedures, right? I will take you through it step by step.
Speaker Change: Yes, absolutely.
Speaker Change #100: A very important question Robyn. Thank you. Thank you for asking that so total market of epidural is 11 million procedures right.
Speaker Change #101: Alright, thank you through it step by step.
Jan Adriaan Haverhals: Now let's assume just for doing the math, we do 2 million procedures as a target just to create a good picture about the potential, right? So 20% of that market is 2 million procedures, okay? So 2 million procedures versus what I hope to establish an average sales price on the consumables of $200, right? That would be for you.
Speaker Change #101: Now, let's assume just for doing the math, we do 2 million procedures.
Speaker Change #101: As the target just to create a group picture of biopsy potential life, so 2% or 20% of that market is 2 million procedures. Okay.
Speaker Change #101: So 2 million procedures versus what I.
Speaker Change #101: Hope to establish a and average sales price on the consumables of $200 right.
Speaker Change #101: That would be.
Speaker Change #101: $400 million in revenue with a gross margin of 60% to 70%. So that is that is gigantic so going back to your question.
Jan Adriaan Haverhals: My responsibility is then to say, okay, if the target is, in this case, 20% of the total market, by when can we have that penetration of 20%? And that is where the importance of reimbursement comes in, right? And that's also the reason.
Speaker Change #102: My responsibility is then to say, okay. If the target would be in this case, 20% of the total market by when can we have then that penetration of 20% and that is where.
Where the importance of reimbursement is coming in right and Thats. The also the reason the way that is tied into the finished jurisdictions that we are currently active in represents about 22% of all the epidural steroid injections into United States deaths due reason.
Jan Adriaan Haverhals: The way that I've targeted it, the first two jurisdictions that we are currently active in of all the epidural steroid injections in the United States. That's the reason why it is so important for us to get that price point established by the insurance provider because then we can go full force out. The clinical concept is proven. The clinical efficiency is proven. People would like to use it. And then once they also know that they get paid for it, then all the hurdles, so to say, in the mindset of the clinician are gone. And then we can start moving ahead. So that's a very important driver of growth for the company, Rob.
Speaker Change #102: Why it is so important for us to get that price point.
Speaker Change #102: Points are establishment body insurance provided because then we can go full force out because.
Speaker Change #102: The clinical concept has proven.
Speaker Change #102: The clinical efficiency has proven people would like to use it and then one stay also will know that they get paid for it than all the hurdles so to say in the mindset of the clinician are gone and then we can start moving ahead. So that's a very important driver for growth.
Speaker Change #103: The company Rob.
Robert Brennan: Right. Well, very good call. And I guess my last thing would be, you only have one analyst that covers your company, I believe. Am I correct in that?
Speaker Change #104: Right well very good call in I guess my last thing would be you only have one analyst that covers your company I believe am I correct on that.
Jan Adriaan Haverhals: For the time being, we have Maxim, and historically, we also had Northland.
Speaker Change #105: For the time being we have Maxim and historically also at Northland.
Jan Adriaan Haverhals: Okay. Yeah.
Speaker Change #106: Okay. Yeah. So are there any plans because you know my own.
Robert Brennan: So are there any plans, because my own self-interested opinion is the stock does not belong where it is currently; just the opportunities are so vast. Are there any plans? I know there are only 24 hours in a day, but what kind of roadshow are these guys going to be doing on your behalf, or some kind of investor relations? Of course.
Speaker Change #106: Self interested opinion as the stock does not belong where it is currently.
Speaker Change #106: You know just the opportunities or so that.
Speaker Change #106: Are there plans I know theres only 24 hours in a day, but what kind of roadshow, where these guys are going to be doing on your behalf or or.
Speaker Change #106: Some kind of IRR.
Speaker Change #107: Of course.
Jan Adriaan Haverhals: Again, good question. Thank you for asking that. Definitely, I always welcome coverage to that extent, and yes, I'm working on roadshows, but it's all a matter of timing, and I think the timing is right now. In the second half of this year, we will see an increase in being at conferences. It's not that nothing is happening. I do a number of calls during the course of the week, so that is fine.
Speaker Change #108: No what you well the again good question. Thank you for asking that.
Speaker Change #108: Definitely.
Speaker Change #109: I welcome.
Speaker Change #109: I welcome always cover it to that extent and yet I'm working.
Speaker Change #109: In road shows and but it's all a matter of timing and I think the timing is right now in the second half of this year, we will see an increase in.
Speaker Change #109: In the being at conferences, you know it's not a.
Speaker Change #109: Nothing is happening.
Speaker Change #109: I do a number of calls during the course of the week. So I'm sorry that is fine.
Robert Brennan: Really good call. Great opportunity.
Speaker Change #109: Sure.
Speaker Change #109: Really good call great opportunity I think they're doing a great job.
Operator: I think you're doing a great job. Thank you, Robert. Thank you. Thank you. Thank you very much. Your next question is coming from James Fishtat, who's a private. James, your line is, Thank you. Well, I look at it, I guess, a little different than Robert did when it failed.
Speaker Change #110: Thank you Robert.
James Fishtat: Thank you very much. Your next question is coming from James Vistad, who's a private investor. James, your line is live. Thank you.
Robert Brendan: Thank you very much.
Speaker Change #112: Next question is coming from James fish that he's a private investor James Your line is life.
James: Thank you.
Robert Brendan: Well.
Speaker Change #113: I looked at it and I guess, a little different and Robert did.
Robert Brendan:
Speaker Change #114: When sales go from $2 6 million to $2 2 million and losses continue at $1.5 million.
Speaker Change #114: Per quarter.
Speaker Change #114: And with $5 million of cash I see that.
Speaker Change #114: More investment has to be made in the next nine months or so.
Speaker Change #114: Is there any possibility.
Speaker Change #114: A larger medical instrument company could come in and acquire.
Speaker Change #115: M L SaaS.
Operator: Thank you for your question. In all honesty, I don't agree with your comment. I think what we have stated, we have sufficient cash and cash equivalents at hand, and also, the way we manage the company from a cash preservation point of view, we do not foresee raising capital in the next nine months, but I'm more than willing to give you more details in a call outside of this conference call.
Speaker Change #116: So thank you for your question.
Speaker Change #117: You know in all honesty I don't agree with your with your comment I think what we have stated we have sufficient cash and cash equivalents at hand.
So the way we manage the company from a cash preservation point of view, we do not proceed to raise capital in the next nine months, but I'm more than willing to give you more.
Speaker Change #117: More details and a call out of this scope of the conference call.
Operator: The second part of your question related to, "Is there a willingness by companies to buy and be interested in our technology?" My comment to that is that everybody that has a business background has to understand that what we are currently doing and laying the groundwork for this company will have an effect not only on the stock but also on entertaining other discussions with other companies. There are a number of potential opportunities in terms of strategic cooperation, whether it is synergistic or research and development related, but really, the key for us and also for other potential companies that would like to engage in discussions with us is really the establishment of reimbursement. It's not so much about the technology as such, but it is also very important what people are willing to pay or what they get reimbursed when they use the technology in this business sector. Thank you.
Speaker Change #118: Second call.
The question or the second sorry, the second part of your question related to is there a willingness of companies.
Speaker Change #118: You know buying and being interested in our technology.
Speaker Change #118: And my comment to that is that everybody that has a business background has to understand that what we're currently doing and laying the ground work for this company will have any effect not only on the stock but also on entertaining other discussions with other companies.
Speaker Change #118: There is a number a number of potential opportunities in terms of.
Strategic cooperation whether they're synergistic.
Speaker Change #118: This research and development related but the key really the key for US is and also for other potential companies that would like to entertain discussions with us.
Speaker Change #118: It's really the establishment of reimbursement, it's not so much about the technology as such but it is also very important what people are willing to pay or what they get reimbursed when they use the technology.
Speaker Change #118: In this.
Speaker Change #118: Yeah in this business segment.
Okay. Thank you.
Speaker Change #119: Youre welcome.
Jan Adriaan Haverhals: Thank you very much. And your next question is coming from Richard Durando of Dr. Richard Durando, DDS. Your line is live.
Andrew: Very much Andrew.
Speaker Change #121: Next question is coming from Richard <unk>.
Speaker Change #122: The Doctor if it should given D. D D. S. Your line is life.
Speaker Change #123: Good morning Darwin.
Richard <unk>: Good morning, how are you.
Richard Durando: Very well. So, I have a couple questions. Over the years, you've announced all these centers that used your device and liked it. Yes. And it seems to me that... not that you haven't tried this, but I'm asking what happened.
Speaker Change #125: Very well.
Speaker Change #126: I have a couple of questions over the years, you've announced all these centers that used your device and liked it.
Speaker Change #127: Yes, it seems to me that it could.
Speaker Change #128: Not that you haven't tried this but I'm asking you what what happens.
Richard Durando: Doesn't the, let's say, the Anesthesiology Association, have some say, in that members would go, you know, this is a really good technology. We would like to at least write some, quote, letter of endorsement that this is a wonderful technology and it is superior to what we're using, and elicit that arm because that's a much bigger entity than Milestone is by far? And you have all these, I mean, there was an announcement, I don't know, 18 months ago, where there was a large medical group in New England. And you didn't name it, and that's fine. I don't care who it is from.
Speaker Change #129: Doesn't the let's see the Anesthesiology Association have some.
Speaker Change #129: Okay.
Speaker Change #129: And that members would go you know this is a really good technology.
Speaker Change #129: Would like to at least right. Some quote letter of endorsement that this is a wonderful technology and it is superior to what we're using.
Speaker Change #129: And in.
Speaker Change #129: And elicit that that arm, because that's a much bigger entities of milestone is by car.
You have all these I mean, there was an announcement I don't know 18 months ago, where there was a large medical group in new England.
You didn't name it and that's fine I don't care, who it is we know basically who is so big.
Jan Adriaan Haverhals: We know, basically, who it is. So, the point is, are you able to... I mean, there can't be a lot that says you can't talk to these people and pitch that line of thinking to them, to move this process along a little bit quicker. Can you comment on that? Now, I have maybe some follow-up questions. No, no, definitely not.
Speaker Change #129: <unk>.
Speaker Change #130: Are you are you.
Speaker Change #130: Abel.
Speaker Change #134: It can't be a lot of it. So you can't talk to these people and pitch that line thinking to them too.
Speaker Change #131: Two to move this process along a little bit quicker can you comment on that.
Speaker Change #132: Maybe some follow up questions.
Richard Durando: No, no, that's a very good question. Thank you for the question. Absolutely, endorsement of organizations is, of course, always more than helpful and also important, and that brings us always back to the development of the KOLs that we have been doing, right? Yes.
Speaker Change #133: No no. That's that's that's a very good question. Thank you for the question absolutely endorsements of organizations.
Speaker Change #133: Is of course always more than helpful. And also imports and then that brings I was always back to development of Kols that we haven't been doing right.
Speaker Change #133: Yes.
Jan Adriaan Haverhals: So I also have had discussions with the organizations, you know, the American Anesthesiology Society, I've had meetings with them, and it's a rather long paper trail process as well to get that established. So what we have been doing, we go a little bit different route now because all the work that we have been doing lately in the Interventional Pain Society, we have an abstract, and we are on the platform at the meeting in Miami, Florida, where we use that to spread the news and to share the results of our technology with these organizations.
Speaker Change #133: So I and I also have had my discussions with.
Speaker Change #133: The organization as you know the American a.
Speaker Change #133: Anesthesiology Society I've had meetings with them.
Speaker Change #133: And it's it's a rather long paper trail process as well to get that to establish so what we have been doing we go a little bit of different route now.
Speaker Change #133: Because all the work that we have been doing lately also in the intervention of pain.
Speaker Change #133: Society.
Speaker Change #133: We have an abstract and we are on the platform at the meeting in Miami and Florida.
Speaker Change #135: Where we use that to spread a in a way and use and to share the results of our technology for these organizations.
Jan Adriaan Haverhals: To your point, what we are also doing and what is very important is, with ACIP, with the American Association for Anesthesiologists, and other professional organizations, we are reaching out to them because it is also important, not only from an endorsement immediately, but later on also for supporting the technology for the final pricing on reimbursement establishment. In particular, of course, also for having discussions for further development of this technology. As I would like to recall, we have patents in Europe, and we have patents granted in the United States for peripheral nerve block where we would hope that other entities could be of potential interest in working together with us and developing together with us a new technology or a new entity within the field of anesthesia.
Speaker Change #135: To your point, what we are also doing and what is very important is with Asia, where the American Association for anesthesiologists.
Speaker Change #135: And other professional organizations, we are reaching out to them because it is also important not only from an endorsement immediately but later on so for supporting this technology.
Speaker Change #135: For the the final pricing on reimbursement establishment and in particular of course also for having discussions for further development of this technology.
Speaker Change #135: I would like to recall.
Speaker Change #135: We have patents in Europe, we have patents granted in the United States for peripheral nerve block, where we would hope that other entities could be of potential interest on working together with us and to develop together with us a new technology or a new entities within the field of NFC.
Speaker Change #135: These yet so I know, it's a little bit of a long answer to your question.
Jan Adriaan Haverhals: I know it is a little bit of a long answer to your question because the short answer would be it hasn't happened, but what I want to do and explain to you is, yes, we do have these discussions about how to work with them and how to further endorse that. Of course, you always have to. That's the challenge that we have as a provider of disruptive technology. We always have to explain very well why we have this technology.
Speaker Change #135: It goes to short answer would be it hasnt happened, but what I want to do and want to explain to you is yes. We do have these discussions how to work with them and how to food are endorsed that now.
Speaker Change #135: Of course, you always have to.
Speaker Change #135: And that's the challenge that we have as a provider of a disruptive technology.
Speaker Change #135: We always have to explained very well why we have this technology people perceive anesthesiologist receipt that we are saying.
Richard Durando: People perceive, anesthesiologists perceive that we are saying that they are not doing their job very well or that we want to simplify these types of injections, and all of the above is not true. What we are going to provide to them is actually a guidance system for the trajectory of placing an epidural needle in the epidural space. And my approach is also not only to focus on the anesthesiology department but also on surgical internal medicine and other societies.
Speaker Change #135: That they are doing their job very well or that we bumped to simplify.
Speaker Change #135: These type of injections and all of the above is no true what we are going to provide to them.
Speaker Change #135: It is actually a.
Speaker Change #135: And our guidance system.
Speaker Change #136: The trajectory of placing an epidural needle in DSV dual space and.
Speaker Change #136: My approach is also not only to focus on Anesthesiology department, but also at surgical internal medicine and other societies because.
Richard Durando: The side effects of the current loss of resistance technique are not necessarily detected and described immediately by the anesthesiologist, but they are going to be seen and managed by the aftercare team, for example, in labor and delivery or when doing pain procedures or doing spinal cord stimulator procedures. A good example of what we are working on is neurosurgery, right, where the neurosurgeons are doing spinal cord stimulator procedures, and they are using our technology because, you know, it increases safety and efficiency. They don't get any dura punctures, and they are able to, like I said, have a more efficient and safe procedure.
Speaker Change #136: It's the side effects of the current loss of resistance technique, I'm not necessarily be detected and depicted immediately.
Speaker Change #136: Anesthesiologists, but they are going to be seen and managed by the after care for example, in labor and delivery or doing PE pain.
Speaker Change #136: Procedures or doing spinal cord stimulator procedure is a good example here is what we are working on this.
Speaker Change #137: As neurosurgery, right, where neurosurgeons are doing spinal cord stimulator procedures.
Speaker Change #137: And they are using our technology because.
Speaker Change #137: You know it increases safety and efficiency they don't get.
Speaker Change #137: And Europe punctures.
Speaker Change #137: And they are able to and like I said to have a more efficient and safe procedure.
Richard Durando: Yeah, but here's my point. My point is on the clonase.
Speaker Change #138: Yes, so here's my point my point is that conviction.
Richard Durando: I go in, and I perform a procedure in dentistry. You have anesthesiologists that are brilliant people. Yes, they really want to use this. You should be able to tap into that native interest of those people and have them rally in some way to help augment what you're doing, because their voice is much louder and much clearer. So, absolutely.
Speaker Change #139: When life I perform a procedure in dentistry.
Speaker Change #139: And you have anesthesiologists that are brilliant people.
Yes, they really want to use this you should be able to tap into that needed interest of those people and have them rally in some way.
Speaker Change #139: To help augment what youre doing because their voice is much louder and much clearer. So absolutely. So I assume that you have I assume that you have a listed this form of.
Richard Durando: So, I assume that you have, I assume that you've elicited this form of... Lee for them, because you have all these clinics that have at least some KOL or somebody that says, wow, this is really good. Well, let's get this moving. What's happening there? Where's the color?
Speaker Change #139: Please for them.
Speaker Change #139: As you have all these clinics that have at least some K O L or somebody that.
Speaker Change #139: It says Wow. This is really good let's get this moving.
Richard Durando: I'm not talking about what the company's doing. I'm talking about what the native interests of the clinicians are that are providing the service. That's where, that's where, they could be of huge help to you. I wonder what the same thing is going on in Europe. If you have these people that are so influential, why aren't they able to help bring the cause to you? It should be more organic on their part to want to use this, and I don't sense that that's
Speaker Change #139: What's happening that Where's the color there I'm not talking about the company's doing I'm talking about what the name of interest by the clinicians are that are providing the service, that's where that's where they could be a huge help to you I wonder what the same thing that's going on in Europe. If you have these people were so influential why are they able to.
Help bring the cost to you it should be more organic on their part to want to use this and I don't sense that that's happening.
Jan Adriaan Haverhals: No, well, it is happening. It is happening to the extent that we use... Okay, wait a second. Good, good. I got that part.
Speaker Change #139: No well it isn't happening it is happening to the extend way, where we can really good good I got that part okay. So now when you do do you go out there and request them to do this because that is the key because you can do all the other mark do you want to and you know there's a tremendous number for.
Richard Durando: Okay, so now, do you go out there and request them to do this? Because that is the case. Because you can do all the other marketing you want.
Richard Durando: And you know there's a tremendous number of procedures that are done every day to provide epidurals in all panels. And is there anything going on with labor and delivery? Are there claims being...
Speaker Change #139: Seizures that are done every day to provide epidural and all panels and is is there anything happening with labor and delivery are there are there claims beam.
Speaker Change #140: Uh huh.
Richard Durando: There's a huge amount of procedures that go on there. So what's going on there? Where's the color there? Can you give us some color?
Speaker Change #140: Procedures being done with the epidural there.
Speaker Change #140: And labor and delivery, that's where the money is there's a huge amount of procedures that go on there. So what what's happening there where's the color. There can you give us some color on that.
Jan Adriaan Haverhals: Yeah, no, absolutely. So what we are doing in particular, these people that we are working now with in the pain physician, like the pain physician, the interventional pain market is much larger than OB-GYN, Apodura, and Logesia. So both of them, we have two advisory boards where we use and utilize the input of these people to help us to generate new leads and open doors in other entities and hospitals. But you have to be respectful of the fact that you still have to go through internal procedures, value assessment committees, and financial committees to get that into the hospital.
Speaker Change #141: Slowly so.
Speaker Change #142: What we are doing.
Speaker Change #142: In particular.
Speaker Change #143: These people that we are working now with independent physicians like the pain physicians interventional pain.
Speaker Change #143: Market is much larger than our obgyn.
Speaker Change #143: I used to do.
<unk>, yes, so both we have two advisory boards.
Speaker Change #143: Where we use and utilize the input of these people to help us to generate new leads and opening doors in other.
Speaker Change #143: Other entities in hospitals, but you have to be respectful of the fact that you still have to go through internal procedures value assessment committees financial committees to get that into the hospital, but what we are doing with all these people.
Jan Adriaan Haverhals: But what we are doing with all these people, with the Gephardts, with Campania, with the people in Europe as well, they are part of a group where they continuously help us in opening doors and getting access to additional clinics. You still have to do the groundwork. You still have to do the demonstrations. You still have to follow the internal procedures of the hospital. It's not a top-down approach where they will say, "OK, I will use this right away. There's a cost issue. There's a reimbursement issue, to your point. But absolutely, that's what we are doing as well. Yeah,
Speaker Change #143: With <unk>, they got parts with campagna with people in Europe as well they are part of a group where they continue.
Speaker Change #143: Continuously helpers in opening.
Speaker Change #143: Doors and getting access to additional clinics you still have to do the groundwork you still have to do the demos you still have to follow the internal procedures of the hospital. It is not a top down approach, where they will say, okay. I will use it right away. There's a cost issue desert reimbursement issue to your point, but absolutely. That's that's what we are doing as well.
Speaker Change #144: Well, yes.
Operator: Thank you very much. Well, we appear to have reached the end of our question and answer session. I will now hand over to management for any closing remarks.
Speaker Change #145: Thank you very much.
Speaker Change #146: To have reached the end of our question and answer session I will now hand, it back over to management for any closing remarks.
Jan Adriaan Haverhals: Thank you for your time. Thank you for the lively discussions. Good questions.
Speaker Change #147: Yeah. Thank you for your time, thank you for the lively discussions.
Speaker Change #148: Good questions.
Speaker Change #149: We remain.
Jan Adriaan Haverhals: We remain positive, and encouraged about what we have initiated and what we are going to do. We will keep you posted on any progress made on the activities that we outlined and highlighted, and we will keep you posted. I wish you a fantastic day and look forward to our continued discussions. Have a good day and thanks a lot.
Speaker Change #150: Positive encouraged about what we have initiated and what we're going to do we will keep you posted on any progress made on the activities that we eluded and highlighted on and we will keep you posted I wish you a fantastic day.
Speaker Change #150: Looking forward to more continuous discussions I have a good day and thanks a lot.
Operator: Thank you very much, Ariane. This does conclude today's conference. You may disconnect your phone lines at this time and have a wonderful day. Thank you for your participation.
Thank you very much. This does conclude today's conference you may disconnect. Your phone lines at this time and have a wonderful day. Thank you for your participation.
Speaker Change #150: Yes.
Speaker Change #150: Yes.