Thank you for standing by, and welcome to the ImpediMed Limited quarterly results conference call. All participants are in a listen-only mode. There will be a presentation followed by a question-and-answer session. If you wish to ask a question, you will need to press the star key followed by the number one on your telephone keypad. I would now like to hand the conference over to Michael Bassett, Senior Vice President of Corporate and Strategic Development. Please go ahead.
Welcome, everyone, and thank you for joining us today. We're hosting this conference call to discuss our 4C for the financial quarter ending 30 June 2022. Joining us on the call today is Donald Williams, the chairman of ImpediMed, David Anderson, the newly appointed interim CEO, and Timothy Cruickshank, our CFO. We'll be referencing the 4C and speaking from the quarterly activity report we launched this morning, Australian time. The presentation is a summary of the more detailed 4C, and the presentation can be found on the ASX website. After our remarks, we'll be taking questions. Firstly, I'd like to introduce Donald Williams, the chairman of ImpediMed, for an update on the recent management changes and to introduce David Anderson. David Anderson will then provide some initial observations, and I'll ask Tim to take us through the financials. Over to you, Don.
Thank you, Mike, and thank you to those joining us on this call. I'm excited to formally introduce Dave Anderson as the company's interim CEO. While new to this leadership role, Dave has been a member of the board of directors since April 2020. For over 30 years, Dave has held leadership positions in the healthcare and insurance industries and is a subject matter expert on reimbursement strategy. Dave has recently retired from his position as CEO and president of HealthNow New York, the parent company of Highmark Blue Cross Blue Shield of Western New York and Highmark Blue Shield of Northeastern New York, which is a $3.2 billion healthcare organization. He brings a deep understanding of working with medical practices and hospital organizations to develop preferred standards of patient care and third-party insurance reimbursement programs.
David stepping into this role as Interim CEO will be bringing far more encompassing than simply maintaining the status quo while we search for our new CEO. This will be an opportunity for him to accelerate the path to reimbursement, continue to build out the team, and develop a strategic plan to capitalize on our current momentum and achieve accelerated growth and cash flow breakeven. I think it's important to also say that while we are still working through the details, I believe it noteworthy that David has agreed to mirror the remuneration structure of the board of directors by accepting 60% equity and only 40% cash. This will align him directly with you, our investors. It's now my pleasure to turn this over to David.
Well, thanks, Don. Hello, everyone. It's my pleasure to speak with you today. When I accepted this position, did not realize that I would be having a 4C call on my very first day as CEO in the seat. However, we are prepared. I have a great team here with me, for support. What I'd like to do is, I'll begin on page three, and I'll cover off my background, some of my initial observations, and my initial areas of focus. Don already covered off, on my background a little bit, but I thought I should emphasize a couple of points. First, I'm not new to this business.
I've been a director for a little bit over two years now, and I've had the opportunity to see the business progress and de-risk over time. What I see is a business with tremendous opportunities in front of it. They have a strong management team that has built a great product and a great platform, and I'm excited to get involved and lend my expertise to assist in unlocking that potential and assist in reaching our goals. We have received some feedback over the last couple of days since the announcement, so I thought it important to address certain issues right up front. First, and most importantly, the company is in a sound financial position. It has enough capital to reach breakeven, but we need to accelerate sales.
Incremental growth through COVID has been good, but now we need to accelerate growth, and I believe we are well-positioned to do that. Secondly, we'll go into the keys to accelerating growth, but central to that is reimbursement. I'll talk further about this as we go along, but our internal reimbursement team has made great progress, and I feel we're on track to achieving reimbursement. Third, as you know, we have a dual-track process for reimbursement, and I can also report that NCCN is on track to have our submissions heard at the annual meeting in late August, with the results of that meeting expected by the end of this calendar year. Nothing has changed here. Now, moving to my near-term focus and what that will be. First, utilizing my experience to help with reimbursement.
This is the key to accelerating sales. Expect initial acceleration before reimbursement because hospitals are opening up, but long-term growth will require us to be successful in obtaining a reimbursement methodology. Cost control will also be a key focus. We will be looking to managing costs with a focus on achieving breakeven while not stifling growth. It's a balancing act for a company at our stage of evolution, and it's one of the most critical focus areas. A product of the first three comments is getting to breakeven with our existing resources. Once we can do that, we can really look to fully leverage the opportunities of SOZO. The final focus area are the stakeholders in our business, starting with our staff. We have a strong and dedicated team, as I mentioned.
We'll continue to focus on their development and providing them the support for them to maximize their potential. Next, our patients and customers. Our mission and vision statement both have the patient at its core. We can never forget our core mission, which is improving patient outcomes. Clearly, we have long-standing shareholders that have stood by us and deserve to see the business fulfill its potential. The board has listened to your concerns, and we are at all times looking to act in the best interest of the shareholders. We understand your concerns over cash and more diluted raises, and we are focused on ensuring this won't happen. The board's committed to better two-way communication with the shareholders, especially now that COVID will allow us to travel to Australia.
We wanna see the share price move up higher, and we will achieve that through delivering on outcomes. At the end, that is really my number one focus is to deliver on outcomes in the various aspects of our business. With that, I will pass over to Tim to run through the financials. Tim?
Great. Thanks, Dave, and good morning, everyone. I'll be taking you through some of our key financial highlights from the past quarter, which is Q4 FY 2022. All figures presented are in AUD unless otherwise indicated. If you go to slide four, we finished Q4 FY 2022 with AUD 2.8 million in total revenue, 2.6 of which related to SOZO revenue, which was 15% growth year-over-year. This Q4 result put us over AUD 10 million in revenue for the full year, which is an important milestone in the company's initial growth. We finished the year with AUD 40.7 million in cash on hand, which was a result of our Q4 cash receipts increasing to a company record of AUD 2.8 million, and net operating cash outflows being AUD 2.9 million for the period.
Based on this, that gives the organization 14 quarters of available cash based on the ASX 4C definition, and that's prior to factoring in our expected growth and our path to profitability. As we turn to page five, total revenue, SOZO revenue, software as a service revenue, all were record results for the company. We recognized this was just incremental growth. With hospitals in the US opening up and a growing sales pipeline, we would anticipate expanded growth in our core business in the coming quarters. Annual recurring revenue, a key SaaS metric for the core business, was up 19% year-over-year. Continued growth in that core business will be critical moving forward as the AstraZeneca contracts eventually wind down in the coming quarters as expected. Our contracted revenue pipeline, CRP, finished at AUD 16.5 million, up 14% year-over-year.
As I've mentioned in previous quarters, with our SaaS gross margins well in excess of 90%, we expect over 90% margins on that full $16.5 million in future revenue that will be recognized over the life of those contracts. Our churn rate remains negligible at just 2% with our renewal rate on contracts that were up for renewal in the quarter coming in at a healthy 93%. The dip from our typical 97% to 100% for renewal rates related to a few customers with multiple devices where one unit was in a remote location with low patient testing. To give you some insight into that, these customers likely had three units, two in higher volume areas and one in a remote location in order to improve patient care.
The customers kept two units, paused the third until they could justify the cost internally. We wouldn't expect that to continue as reimbursement grows for our customers, and we would expect those devices to even come back online, so this not being a material trend for the business. To date, over 880 SOZO units have now been sold commercially since the launch of SOZO. The key here is that the quality of accounts remains at an extremely high level. As Dave will walk you through on a later slide, our growing footprint in hospitals and health systems will serve as a key foundation for an acceleration of growth as reimbursement takes hold. To touch on cash flow, we reported AUD 2.8 million in cash receipts, as I noted.
As mentioned on last quarter's call for Q4, we anticipated that cash receipts from customers would steadily increase, and we also outlined last quarter that net operating cash outflows, we expected to come in below AUD 3 million, which it did at AUD 2.9 million for the quarter. Using that Appendix 4C definition, that gives 14 quarters of available funds with the anticipated increase in revenue over time and a cash balance of over AUD 40 million. This provides sufficient cash to break even. In the coming quarter, Q1 FY 2023, net operating cash outflows are expected to temporarily increase with one-off expenses associated with the recent management change. Some of the lumpy annual expenses, such as insurance and staff bonuses for the past year, which are expected to be somewhat offset by the anticipated receipt of our annual R&D tax refund.
While we're still finalizing our Q1 FY 2023 cash flow forecast based on recent changes, what I can say is, in the remaining quarters of the financial year, we expect net operating cash outflows to be around AUD three million per quarter despite the headwinds associated with the AstraZeneca trials finalizing in the back half of the calendar year. With continued growth in sales, we would expect net operating cash outflows to move below AUD three million per quarter in the second half of the financial year. On to slide six. Our business model is really starting to show its power. I'm excited to see it unfold as we accelerate sales in the coming quarters. I think there's a few key takeaways on this slide from Q4 FY 2022.
One, we had our largest pool of U.S. SOZO contracts up for renewal this past quarter since we launched SOZO. In that pool, we saw our largest increase in average monthly license fees per unit. We averaged 34% increases on our monthly license fees this past quarter from those renewal contracts. Next quarter's pool of renewals is even larger. This, combined with our annual stairstep pricing and monthly fees, is starting to result in tangible positive impacts on our SaaS metrics. If I put this into perspective, our current contracts in the core business are worth $7.3 million in annual recurring revenue. Those same contracts based on the stairstep pricing are worth $10 million in ARR this time next year. That's a 37% increase in ARR before we even sell another unit. This is only the beginning.
This will continue to grow as we accelerate sales under this exciting pricing model. Thank you. Dave, I'll turn it back over to you now.
Thank you, Tim. I'll be turning to page seven. To further from my prior comments, I thought I'd touch on a few points about the platform that's in place and why I'm excited and have confidence in the future. As has been stated many times previously, patient testing is a leading indicator of the health care business. Clearly, there's been a strong rebound in patient testing this quarter. The strong recovery in patient testing that was mentioned on the April call continued into the June quarter. Why is this so important? To me, it means that U.S. hospitals are indeed opening up. The strong sales pipeline that was mentioned on the April call has also continued to grow.
In Q1, we expect to see an acceleration in sales above the more normal incremental growth we've experienced during the last few quarters due to the impact of COVID. As I mentioned earlier in this call, one of the keys to reaching profitability is reimbursement. I've had a significant experience in this area, and I will tell you, these are impressive set of numbers as shown. Over 3,600 case wins at a rate of 99%, and importantly, over 300 external appeal wins. In my experience, this is not a question of whether if we will get reimbursement, but just a question of when. There is work to be done, but I have to say that I'm very impressed with appeal's win rate.
Again, from my experience, this is a higher win rate than what was required to achieve reimbursement in other verticals of care. Following along with that, we already have a number of important payer meetings scheduled this quarter, and I'll be looking to utilize my experience and contacts to ensure that we have everything we need to be successful in those meetings and in that process. To NCCN, it's fantastic to have a second string in our bow. Both paths lead to the same outcome, which is reimbursement. Most companies only have the traditional path available to them. We are fortunate to have the NCCN pathway also available to us. Clearly, this would be a fantastic outcome as it would accelerate private payer reimbursement. While it's definitely no certainty, we believe we have a compelling business submission.
They will be heard, as I mentioned, at the August 25th, 26th annual meeting, and we would expect to know the outcome before the end of this calendar year. One of the most impressive aspects for me are the agreements that we have already signed with corporate accounts and integrated delivery networks we generally refer to as IDNs. In the last quarterly call, we commented on the growing number of key account agreements and what they could mean in a post-reimbursement environment. They can potentially provide the avenue to significant growth post-reimbursement as the top 25 IDNs represent over 1,700 hospitals and 24,000 facilities, according to the recent IQVIA report. With the signing of Kaiser Permanente in this quarter, we are now in 16 of the top 25 IDNs.
In addition, we renewed or expanded contracts with an additional six IDNs within this quarter and are in advanced discussion with another key corporate account. This is a key part of the platform. IDNs can take over a year to perform technical assessments, business associate agreements, and contract pricing agreements. They typically don't move very fast. Having a number of these agreements in place affords the company the ability to sell into these important clients as reimbursement becomes available in states where they have representation. We've covered off on the key achievements from the past quarter, which are listed on page nine. Therefore, I would like to turn our attention to our summary of key focus areas on page 10. There are a number of positive initiatives ongoing with the company.
We are making good progress with SOZO-2 and had positive steps forward in both heart failure and renal failure for the quarter, and this work will continue. The key focus is revenue growth, and we will continue to focus on accelerating unit sales and further increasing the average monthly license fees. We expect good growth over the remainder of the calendar year as hospitals continue to open up even before we account for initial wins in reimbursement. To get to the next level, we need reimbursement. We keep coming back to it. It is the focus of the business and the key to making ImpediMed profitable. With that final statement, I'd like to thank you all for your support. I look forward to meeting with many of you as much as I can in the near future as well.
Travis, I believe I would turn this back to you as we're ready for questions.
Thank you. If you wish to ask a question, please press star one on your telephone and wait for your name to be announced. If you wish to cancel your request, please press star then two. If you are using a speakerphone, please pick up the handset to ask your question. The first question today comes from Madeline Williams from Wilsons. Please go ahead.
Morning, all. Thanks for taking my question. I just wanna try and understand with the stairstep pricing, does that only apply to new customers or renewals as well? That's sort of the first side of the question, and then just understanding if there's been any pushback in adopting a contract, which increases in price as the contract goes on, and sort of how you've propositioned this with the customer.
Kim, I'll let you answer that question. You can answer.
Great. Thanks, Madeline. Yeah. The stairstep pricing is occurring both in renewal contracts and with new customers. As those contracts are coming up for renewal, that's what you'll see that I mentioned the 34% increase. Inside of that is also a stairstep pricing on a number of contracts. In the short term, it's a bit of a mixed bag. Not all of the contracts will come through with that stairstep pricing, but we'll start to see a majority of accounts have that both new and renewal. You have to remember our pricing for early adopters is often discounted a bit in order for them to build their reimbursement program out.
There's not a lot of reluctance or pushback in terms of our pricing at this stage because as we show the patient outcomes, the benefits there as well as the health economic benefits, it just still fits well within practices. We still have a lot of room to grow in terms of that pricing before we'll see any real pushback.
Okay. Yeah. Just so I can just clarify, because I noticed that say the high percentage of contracts were signed under the pricing model. Just to understand, it means that not every contract will actually be signed under the new model.
That's correct. 'Cause like Dave, yeah. Like Dave mentioned, the number of these IDNs in larger institutions, it takes upwards of a year to get pricing in place. We have some pricing in place already that's still advantageous to the company but might not be at a stairstep. It would be upon renewal of those contracts where you'd see that kick in. It'll take some time for everyone to get on that pricing, but you will see the majority of customers going in that direction over the coming quarters.
Yes. No worries. Thank you.
Thank you. The next question comes from Martyn Jacobs from Canaccord Genuity. Please go ahead.
Morning, everyone. Just interested in the private payer meetings coming up in August. I wonder if you could maybe characterize the size and scope of those particular payers and I guess in what states or what part of the country they're in?
Dave, do you wanna answer that or would you like me to?
Well, go ahead, Michael, and I'll add if I can.
Yeah. Marty, as you know, the private payers have an annual cycle, and we're just ticking them off as they go through. There are most in the next quarter, regional payers, which is exactly where we're aiming for. But there's a few there that are critical to the strategies that we have. Dave?
I would say that these are based on particular schedules at the payers themselves. They have their own capital deployment processes. Having run one myself, I kind of know, and I would schedule opportunities like ImpediMed events specifically around certain times of the year and when those capital meetings take place. We would like to meet with all of them next week if we could. In reality, what we have to do is meet with them on their schedule. We wanted to identify that there's 10 or more of those scheduled in the very near term. I think we're looking for some good success.
Okay. Secondly, in regard to the CAP Program, you've had more big wins quarter-over-quarter. I was just wondering whether that is yet translating to unit sales. I mean, it should be translating to, you know, doctors charging patients, but is it translating to unit sales, or do you foresee that it's gonna translate to unit sales in the near term?
Dave, do you want to answer that?
Well, I don't know if I can quite yet. What I would say is that if I understood the question, it has generated the interest and supported the meetings that we just talked about and created that opportunity. We're early in that game, so to translate exactly to unit sales is probably early in that game. It has definitely increased interest. Tim's giving me a sign here, so I would turn it over to Tim maybe to add something.
Yeah. Tactically, what we're seeing right now from a unit and revenue perspective, we are seeing a lot of traction with renewals. With that huge pool of renewals that we had last quarter and that we have coming up this quarter, that 34% increase in pricing that you're seeing, that's reflective of customers understanding the CAP program and getting on that. As we see wins with the CAP program in these existing accounts, it will over time translate to additional units. Right now, in terms of the numbers and what you're seeing in Q4, it's primarily been impacted on the renewal program.
Just to be direct, Martin, this, we've definitely seen opportunities that have come through the CAP program working in one area that has now rolled over into other hospitals within their group who are looking to add units. We're at the beginning of that process, but there's definitely those opportunities that have been generated through the CAP program.
Just on the IDN, you've got 1,700 hospitals. They should all probably have three units each. It's a big pool that can be tapped into. With the agreements in, you know, 60% of them already in place, once the guidelines change or, you know, various insurance, you know, change, how quickly can those hospitals choose to adopt?
Tim, do you want to answer that or do you want me to?
Sure, I'm happy to. Then feel free to add whatever you'd like, Mike. We think pretty quickly. I mean, the biggest encumbrance you'll see to getting in is getting past IT, getting those security assessments done. That's what takes the longest amount of time. Effectively, getting that part of it done and giving your sales team a license to hunt in these accounts. If you arm them with reimbursement, it's going to accelerate. If you arm them with NCCN, it's going to accelerate even faster than that. We think very quickly once we get to that point.
Just finally from me, just on renal, I thought the that observational trial was going to be completed by now with some sort of data released to us. Can you sort of update us on where things are at?
Yeah, certainly. Our partners on the other side, both Fresenius and Balboa, have experienced significant staff shortages through that period, which has meant that it's very hard for them to have, you know, available nurses to schedule patients through the trial. We've had high hit rates in the shifts that we are in. We're just not getting it across. You know, they basically have four shifts a day, and they have, as you know, two groups. You've got the Monday, Wednesday, Friday, and the Tuesday, Thursday, Saturday group. We just don't have enough coverage there. We're bringing on another site. I've had discussions with the principal investigators in the last week. They're looking at adding more staff.
This isn't new. I mean, if you listen to the DaVita or the Fresenius call, you'll hear the problems that they're having at the moment. We actually do have the initial data. Rochelle's working on that data as we speak. I hope to have a good listen to that over next week. In that period of time, we'll understand how many more patients that we need because we may get away with not actually having the full 50 patients. We're about halfway or just a little bit under halfway, but we think that we've actually got a very good data set, and we'll have a look at that over the next week and see what we can do about it.
The Balboa and Fresenius, I suppose, they've said to us that, you know, they are looking to accelerate now. They are putting extra staff on, and they are trying to help us. We've got good intentions, and we're working as well as we can through that.
Just finally, did staff shortages impact the number of tests that were or patient tests that were conducted in the quarter?
Tim, would you like to answer that one?
Michael, you were referring to staff shortages at the clinical sites for the clinical trial, not in relation to our business, if I'm understanding Martin's question correctly.
Yes, I was pivoting away from the renal, but back into the main business of patient tests for SOZO in lymphedema. I was just wondering, even though it grew 15% year-over-year, I was just wondering whether there was any kind of staff shortage impact on the growth rate.
I would imagine that would have impacted it. We didn't get any direct reports of that, but I would imagine that it's impacting hospitals across the U.S.
Yeah. Okay. Thank you.
Thank you. The next question comes from Ian Hyde, private investor. Please go ahead.
Yeah, good morning, and thanks for taking the call. A bit of a switch to details you've mentioned previously about data, and you've said today in the foreword that data is accelerating and it's also its usage. Previously the company said that they've had over 1 billion data points, and I'm thinking now they're probably close to two billion. There's been no mention at all and is this possible that somewhere in the future that this data can be used for something else besides just the company so they can monetize it in some way? Because everyone knows the world runs on data, and you're collecting huge amounts. Is that something that's possible and but clearly not at the moment or?
Well, I think at the moment, the data set that we have. Like, the data that we're collecting will be far more powerful once we have heart failure, renal failure, and just general body comp across the group. We're collecting fantastic data, but it's a pretty thin patient set in and around cancer, in and around breast cancer at the moment. As we move to more general oncology, then clearly the data set gets, you know, even more interesting. There are definite pathways to commercializing that data, but we're a way off that, and it's definitely not the focus, you know, this week. You know, we've got to get to break even. The focus is around lymphedema. We continue to push ahead with heart failure and renal failure.
It's definitely something on our radar, but it's a little way off yet.
Sure. Understand. I was just curious as to what you're thinking, what the details are. With that as well, SOZO 2 you've mentioned is coming on well. Is there anything you can advise as to, say, the increase in the data that you can be able or will be able to collect from that or the increased accuracy of the data from, say, changing detecting 36 mL of fluid to a lower level or what have you?
Tim, do you wanna do that one? I'll add comments if needed.
Sure. I mean, SOZO 1 is incredibly powerful and accurate, but you get even more accuracy with SOZO 2. In terms of collecting data, it will be seamless or it won't impact how the data is collected. We're able to do that now with SOZO 1. We don't need SOZO 2 to continue to collect data. You will see even more accurate measurements which will help clinicians. Having the scale directly inside of SOZO 2 allows us to put that unit in so many more places. We'll get that many more measurements from SOZO 2 because we'll be able to get into the continuum of care even more than we can now just in the cancer space.
Sure. Okay.
SOZO 2 is about changing the workflow and being able to. At the moment we've got to be alongside a set of scales, and that's valuable space. Being able to take over that set of scales obviously becomes more powerful. It gets us into the more general oncology away from just breast cancer. Importantly it is critical for things like renal failure and heart failure. Obviously the it gives us the ability to you know, potentially, solve the problems around the contraindications. You know, all our data looks very promising at this stage, and we hope to. It's relatively on schedule for late this calendar year.
Okay. That was my next question, which you've kind of answered. CHF is progressing and there'll be something out about that, and particularly with contract by the end of the calendar year.
Yeah.
you anticipate?
Correct.
Lovely. All right. That's it from me. A short one today. Thank you.
Thank you.
Thank you. The next question comes from Richard Bewes from Pacific Union. Please go ahead.
Good morning, and thank you for taking the call. My questions are a bit philosophical. First of all, why has it taken quite so long to get to this point of reimbursement? Secondly, were there philosophical differences between the board and the recently departed chief executive, which actually may affect future policy?
Dave, can I just answer the first question on the reimbursement? I'm happy to add some comments to that. Don, if you could answer the question on the board and the previous MD.
Yeah. There has been a process in place seeking reimbursement, actually for quite some time. Since I have been on the board for the last two years, it has been a process in place. Unfortunately, we're not completely in control of that process ourselves, because it involves outside reviewers, and it involves medical policy by the providers, by the institutions and how they approach that medical policy. It must be qualified by the regulators that are typically Department of Health in the various states. In the United States, the majority of health plans are regulated on a statewide basis, and those regulations are different, often state by state. It is an arduous process.
As we said, we have kind of a dual pronged approach in order to approach it, which is better than most. Starting well over a year ago, we started with our CAP program, which is a process to set up with the providers a process where they can appeal a claim submission, even though it is not a pre-authorized contractual reimbursement by the payer. What our CAP program does is it helps the providers go through an appeal process. As we reported in my remarks, the success of those appeals for reimbursement by the providers is about 99%, so it's almost every one. What we have to do then is, over time, accumulate that data and so that we can then go out to the providers themselves, to the providers.
I'm sorry, to the payers themselves and say, "Listen, this is an established process. You are gonna pay to go through the appeals process," which is something the payers don't wanna do. "And you're going to lose. 99% of the time, you're gonna pay the claim anyway." The process is bringing that information to the forefront so that we can have the meetings we mentioned with the providers and say, "Let's do this in a smarter way, more of a contract systematic reimbursement process." We had to build the data in order to be able to do that through the CAP program. It is a bit of an arduous program.
It does take some time, but we are at the point where we have that data, and we believe that we can begin to work towards reimbursement here pretty shortly.
Thank you.
It's important to us to note, Richard, that a key piece of that puzzle was the PREVENT trial, and that was only peer-reviewed and published in February. You're seeing a real acceleration in those external wins where, you know, prior to December, we had literally a handful, 1-10, where we've now got more than 300, and they're the ones where they're trying to avoid. We've got 300+ now of those external wins. It is accelerating, and PREVENT has allowed us to get there.
Yeah. You basically believe that. You're at the top of the mountain, and from now on, it's going to be better going.
I would say that's our sense. I don't know if we're completely at the top of the mountain, but we're close, and we do expect it to be more traction going forward, yes.
Thank you.
Thank you. The next question comes from Jeremy Thompson from Copsley Trust. Please go ahead.
Thank you for the opportunity to ask the question. The previous private investor was gonna receive an answer in two parts, but the second part wasn't forthcoming. I think that was gonna come from David regarding Richard Carreon's the sudden departure. I've never listened to many quarterly calls over many years. I'm interested to know, receive a succinct explanation, but an honest one as to what happened. Was it a philosophical difference between where Richard was trying to push and where the board wanted to go? Or was it something else?
Don, would you like to answer that question? It's there. Apologies to the previous caller. We just got cut off before we moved to Don. Don, would you like to answer the question around the departure of the MD?
Sure. This is responding to Richard's original question, and then, Jeremy, thanks for reiterating that question. We had been speaking with Mr. Carreon regarding CEO succession planning at the company. Ultimately, he saw this as an appropriate time to step down, where he could leave the company in a very strong cash position. He's leaving us with a strong leadership team that is very well prepared to execute on the plan. The ultimate goals of the company in achieving reimbursement and cash flow, while they are being accelerated, have not changed for the company.
Is that the entire answer?
Jeremy, you just broke up a little bit there. I didn't quite hear that.
Was that the entire answer?
Is there an additional part to the question?
The CEO succession plan. Someone of his caliber, you would expect there to be a handover period and this to be done in a planned fashion. As an investor, to receive notice on Monday that the guy who's been in charge of the team for 10 years is departing on the same day, that suggests there's been some conflict.
There was not a conflict, and we did reach agreement with Mr. Carreon. I think part of what made that acceptable and achievable was the fact that we had the ability to lean on David Anderson stepping into this as an interim role. We certainly view what he brings, what he initially came to the board with in terms of expertise on the reimbursement side, he will now be able to bring to the company from an operational role as the CEO. We also think that with his involvement, we're going to be able to attract a very strong pool of candidates in order to find a CEO and carry the company to the next level.
Okay. Thank you, Scott.
Thank you. The next question comes from Peter Gregory, private investor. Please go ahead.
Thanks very much for your call and good morning to everyone. I'd like to firstly ask about some number questions. The company appropriately reports in Aussie dollars, but the bulk of the revenue and the bulk of the cost is in US dollars. I'd appreciate it if you could, for the percentages on charts four and six, let me know what those percentages would have been if in US dollars.
Tim, would you like to answer that? We might have to get back to Peter on calculating percentages in US dollars, but we can certainly do that, Peter. Tim, do you wanna discuss that?
Yeah, absolutely. Peter, thank you for that. That's something that we often consider here and take into consideration, and we do track revenue in US dollars in the background. We'll take that into consideration for future presentations. I don't have the US numbers in front of me for this past quarter. But, you know, we'd be happy to provide that information. We do still have a fair amount of our costs in Australian dollars as we have a presence in Australia with a lot of our large professional service vendors. There's still been a justification as an ASX company to stay in Australian dollars for overall reporting. Your commentary is noted on the US dollar for the revenue side of the business and some of our SaaS metrics.
We'll be happy to take that one on for consideration.
Yeah. No, that's great. I fully expect you to continue to report in Aussie dollars. If you could look at perhaps alongside that, putting in some form of constant currency reporting so that we can see what's actually happening on the ground. I think the Aussie dollar's fluctuated quite a bit over the last 12 months. The percents I see are not particularly for revenue that meaningful to me.
Absolutely, Peter.
Thanks.
Yeah. That's why we mentioned the incremental growth as well and the expectation for an acceleration of that in, on a constant currency basis. I really appreciate your comments, and we'll take that on.
If I can ask another question about competition, and I'd like to specifically focus on lymphedema detection and treatment. If you look at the marketplace excluding tape measures because that's free and excluding ImpediMed SOZO because it's effectively the gold standard, can you talk me through what other methods doctors are using to detect and treat lymphedema? Are these technologies growing faster than ImpediMed? And who are the other players that perhaps provide a lesser offering than SOZO that have a presence in the market?
Tim, would you like to answer that or would you like me to?
Mike, feel free to add comments. I mean, I think from my perspective, tape measure, as you mentioned, is still, you know, competitive. Discounting that, it's perometry, which is invasive and extremely expensive. We're not seeing that market grow substantially. It's really, ImpediMed as a gold standard is, I would say the fastest growing market. On the heels of progress with reimbursement, there's no real, encumbrances to growth at this point still from an FDA clearance standpoint of medically cleared devices in the lymphedema space.
Okay. What I've done a little bit of Googling, and there's a company called seca Deutschland. Do they have a presence in competing with ImpediMed?
Seca is another bioimpedance device. It doesn't have a regulatory clearance, to my understanding, for lymphedema at this stage. They're not in this market for lymphedema. They're in the markets for body comp. Most of what we come up against is all volumetric measurement. Whether it's water displacement or tape measure, they're effectively gauging volume. One of the, well, the key advantage of bioimpedance is that you're actually measuring fluid increases before you get volumetric increases. Tim mentioned perometry. It is used in some clinical settings in the U.S., but it doesn't have, my understanding is it doesn't have FDA clearance for that either. It's being used in a research type.
At the moment, we don't have.
We don't come across competition apart from, you know, the cheaper tape measure. As seen by the PREVENT result, that really isn't giving you the results that you need. You're still getting large, you know, too large a number of patients suffering from lymphedema because hospitals are continuing to use tape measure.
Well, thanks for that. That's very reassuring for the future, boys. Thank you very much.
Thank you. The next question is a follow-up from Madeleine Williams from Wilsons. Please go ahead.
Sorry, my questions has largely been answered, but I just wanted to clarify. I think I just cut out a little bit. The cash flow increase in the first half 2023 was a result of AstraZeneca and with AstraZeneca trials. Is that correct?
Just to clarify your question, I believe you're referring to my commentary. What we meant was in the first half of 2023, yes, the cash receipts will decrease related to those trials. We'll be offsetting those decreases in cash receipts with growth in the core business. They don't have any impact on our cash outflows aside from the cash we received from the customer.
Thanks. That's all I have.
Yeah. Thanks, Maddie.
Thank you once again. To ask a question, please press star one on your phone. The next question comes from Jim Mack, private investor. Please go ahead.
Hello, everyone, and hello, Tim. Long time no speak.
Hi, Jim.
How you doing? This question is actually for David. With your healthcare background and expertise in reimbursement, and obviously with reimbursement being so critical to the success of the company, why not be considered as the permanent CEO rather than going outside for a new CEO?
Well, thanks for your question. I did actively retire at the beginning of this year. I think at 68, I'm probably not a long-term option for ImpediMed, so I will just do the very best job I can in the time that I have. The intent is to help find a permanent CEO, the best CEO we can find.
Fantastic. One more question. You know, as you alluded to in your presentation, I believe it was Tim that made reference to continuing to manage costs and so forth. You know, will there be consideration, you know, How are you going to reduce some of those costs and considerations of maybe, you know, extending the feet on the street to accelerate sales, so that's gonna be obviously so critical to increasing revenue and so forth?
Yeah. We've always said reimbursement is the key to all of this. As we see an acceleration in reimbursement, we would look to add to the sales team as necessary. Until that point, we have the full complement of sales resources that we need based on where we're at with reimbursement. Obviously that can quickly change as we see progress here. Aside from that, there's no other cost considerations that are particularly incurred at this time because we feel the growth that we're going to see will continue to decrease our cash outflows. We always have those levers if necessary down the road, if reimbursement were to take longer than we would anticipate.
You're saying that your breakeven point in revenues at this point based on cash outflows will roughly be about $15 million in annual revenue?
We haven't given specifics on that, but if you look, we spend AUD 25million to AUD 30 million per year in cash outflows. The number is a bit higher than that in terms of required revenue, but we're already making steps to getting there.
Okay. That's all I have. Thank you.
Yeah.
Thank you. At this time, we're showing no further questions. I'll hand the conference back to Mr. Anderson for closing remarks.
Thank you, Travis. In closing, I just again wanna thank all of you for your time. It really was a pleasure for me to be with you here today. I think that's it. With that, I think we'll probably just conclude the conference. Thanks all for attending.
Thank you. That does conclude our conference for today. Thank you for participating. You may now disconnect.