Thank you for standing by, and welcome to the Pro Medicus Full Year Results Briefing. 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 via the phone, you will need to press the star key followed by the number one on your telephone keypad. If you wish to ask a question via the webcast, please enter it into the Ask a Question box and click Submit. I would now like to hand the conference over to Dr. Sam Hupert, CEO. Please go ahead.
Thanks. Good morning, everybody. Thanks for joining us. As most of you know, we are a healthcare IT company specializing in enterprise imaging and radiology information systems. We work through three jurisdictions, Melbourne, which is our head office, Berlin, which is our R&D center for the Visage product set, and US, which is our main market. We have two product sets, the Visage RIS, which is practice management, does the billing and business side of radiology, largely Australian-based with some clients in Canada, and the Visage Seven product suite, which is our the main product or the key product set that we sell into globally, but mainly into the US. In terms of our results, we were extremely pleased. We thought all of our key metrics headed definitely in the right direction.
I think, significant boost in revenue, our profit after tax increased by 44%. Our EBIT margins, which were most probably industry-leading for the last few years, have increased a few additional percentage points. Pleasingly, our cash balance increased by 46.5%, and as a result, our full-year dividend was up by 47% and is AUD 0.22 fully franked. In terms of the highlights for the year, we won a number of material contracts, certainly very large, not only for us but for the industry in general. In October 2021, Novant Health, which is a large integrated delivery network, it was a $40 million seven-year contract. It's followed by an extension of the German government contract we signed in 2015.
It's the fourth extension and brings our software to a new region in Hamburg in Germany. Another large IDN in Inova, which was AUD 32 million in eight years, and Allina, which we announced in June, which was AUD 28 million in seven years. I think it's important to reinforce that these are the minimum contract commitments. Usually, we receive a material amount of revenue over and above that. The other pleasing thing that happened in the year were two major renewals, both for long contract terms, one for five years, one for seven years, with a combined minimum value of AUD 47 million. Throughout the year, we continued to get a lot of inbound interest, and our pipeline grew accordingly.
In terms of where we sit, clearly in the tier one academic space, we have doubled the number of clients over our nearest competitor. The top 20, they change each year. Mayo always remains number 1, but we're pleased to say that we still are incredibly well represented in that space, with a growing presence in the non-academic or IDN space. Again, most of you will know our model is transaction-based. We use it for virtually all of our U.S. contracts, and now for our RIS contracts in Australia.
The forward revenue, which is the revenue we know we're gonna get as a minimum from the contracts we have, assuming that renewals renew at the same rate as they were originally, even though now we are renewing at higher rates, has increased significantly to about AUD 420 million over the next 5 years. We see a, you know, a bigger annuity stream with greater predictability. In terms of the exam revenue from year to year, it did have our biggest increase of 65%, 61% on a constant currency basis. We did foreshadow this to the market, I think.
We did say that we knew that we'd had a number of material implementations towards the end of FY 2021, Northwestern, NYU, MedStar, and then we also had Intermountain and the UCs in the first half of FY 2022. We've seen that we believe that will increase. Intermountain, UCs and others will give a full 12 months, which clearly is material given their size. We have three very large contracts coming online in the first half in Novant, Inova, Allina and some others which are a bit smaller. We also expect growth from existing clients, which we've seen throughout the period, and further upside as we get adoption from some of the other Visage 7 products, namely Archive and Worklist. Professional services, I think not much has changed here other than they're roughly 10%.
They're recurring in nature because we spread them over the life of the contract. You'll see when we do the split of revenue that, you know, they do go up and down a little each year, but within a relatively narrow band, but are continuing to grow. We do believe we have very high operating leverage. We have contained our cost base. Our margin grows as our footprint increases, and I think the next slide clearly shows that from 2018 to 2022, we've gone from, you know, low- to mid-40% EBIT margins to now at 67%. Again, we think we're, you know, multiples of our nearest competitor, and obviously we're very pleased with that.
In terms of we often get asked about COVID, and, you know, it has been more prevalent in the news of late, particularly here in Australia. It has not impacted us negatively. We are globally working as a mix of in-office and work from home. We are operating at a full 100% capacity. Sales and marketing efforts continue unabated, clearly as witnessed by the sales and renewals. We think the thinness of our technology has enabled us to do a lot more remote demonstrations, particularly from cloud, which is important. We have seen an increased number of new opportunities come into the pipeline over the past 12-18 months, despite, you know, COVID restrictions in various jurisdictions around the world.
Part of that would be because we enable radiologists to work seamlessly from home, and even in those areas no longer locked down because of COVID. We are seeing more work from home than we saw in pre-COVID levels, maybe two days a week, but it's still material. Exam volumes are back at or above pre-COVID levels. Pretty much zero impact from us. If anything, COVID's been a bit of a tailwind in terms of proving our remote capability and inbound RFPs. Visage RIS, we had another good year with that. There was some incremental growth. We're still rolling out some of the larger contracts we had. I-MED and Healius is now complete.
We are seeing some organic growth via M&A, so some of our clients are expanding their territories, and that all just feeds into the original master contract. We are clear we're the undisputed market leader in this segment. In terms of the core Visage product set, every year or every half year, we review where our technology stack stands compared to competitors in the market. We have previously said that it was, you know, roughly 18 months ahead. We think it could even be more because we don't know of anyone at this point that has come to the point we were a number of years ago. Obviously, we've continued to invest in our technology and move it forward.
I think we can fairly lay claim to the fact that we're number one in terms of speed, functionality, and scalability, which are the key factors that clients look for when looking to get a new system. The things that are driving market adoption, as we said, we've seen more inbound RFPs. There seem to be more healthcare institutions, particularly in the U.S., looking to change or update their systems of their imaging systems. We think that the drivers, which we've talked about many times before, remain the same. Clearly, the dataset explosion continues relentlessly. Legacy technology just wasn't designed for those size files. We call it compress and send.
Basically, a system would take a file from a CT scanner or MRI scanner, compress it as much as they could without losing fidelity, send it down the network where the workstation where the radiologist would sit would have to unpack that, you know, few gigabytes of software in order to manipulate the images, and then make the diagnosis. The trouble with this model is simply the files are just getting too big, even if you're on a local high-speed gigabit network. We do it very differently. It is proprietary technology. As I mentioned, we don't believe anybody has been able to replicate this in production. As we sit here today, we actually stream the pixels rather than moving the file.
Someone asked me recently, and it's a good point, there is a huge cost-saving in hardware, not only in the number of servers you need, et cetera, but also the radiologists, because we don't need a heavily configured workstation with a lot of memory and disk at the radiologist end. We can use anything because all of the processing is done centrally. So anything that can display the necessary number of pixels is fair for us. So the actual cost in these large organizations of, you know, refreshing radiologist workstations every three to five years is very material, and clearly with us, they don't need to do it. So another major advantage. In terms of the contracts, Novant, as we said, was a $40 million seven-year contract. It with Intermountain is our equal biggest to date.
It will be fully cloud deployed, and it is for multiple products in as much as it's for our Visage Seven Viewer and Workflow. I think it you know certainly helped extend our rapidly growing footprint in the IDN market. We were already well represented there with large clients like Sutter, Mercy, WellSpan, and MedStar and others. But this has certainly increased our presence. Like all of our U.S. based contracts, it's transaction based with potential upside. We did announce the fourth extension of the original contract signed in 2015.
It is a capital license, simply because the government has to buy that way, but the $1.3 million doesn't include a material annual support contract that we get every year to support that growing user base for this client. Inova was another IDN, again, on the East Coast, again, cloud-based. It is a combination of Inova Hospitals and their joint private practice venture in Fairfax Radiology Consultants. So it's a mix between inpatient and outpatient. We replaced two key competitors, current competitors that are active in the market, one at Fairfax, one at Inova Hospitals. Again, it's a transaction-based model with upside. Allina, the last of the three contracts, in the Minneapolis region close to where Mayo operate. It's again, a $28 million seven-year contract. It does include workflow.
Again, it is cloud-based, and it is a transaction-based model. Three relatively similar but slightly different contracts, all of them material. The other thing was the renewals. We have a combined minimum value of $47 million. Sutter's for seven years, which the original contract was for six, in which the first year was a phase-in year to do the implementation. WellSpan's for another five. Both of them were at an increased per transaction fee. We feel that the commitment we are getting from our clients when they renew is, you know, more than industry standard. Usually, the industry renews for two or three years, whereas here they're showing long-term commitment. We think that is an endorsement of our offering and our technology.
One thing is to sell it, the other thing is to put it in. Many of you've seen this slide, but we do think it is a material advantage we have in that we can fast track and continue to deliver these systems in large scale. Last year when we did Intermountain, which is one of the larger IDNs in the U.S. landscape, the changeover occurred over two one-week periods where they thought originally it would take over two years. It was across three states and many hundreds of radiologists and thousands of technologists. It is very much a strength of ours. It is dependent on our technology and how we're able to deploy it optimally.
As we've said previously with COVID, we now have a highly optimized model that is a hybrid between on-site and remote, which we think works incredibly well. The key implementations, we did talk about MedStar last year. It was sort of on the border of the financial year crossing, so the bulk of it went live in early July. We mentioned just before Intermountain in October, and we have done three out of the five UC campuses. They were all done on time, and that was UCSF in December, UCI in January, and UCSD in March. In between, we did the bulk of University of Vermont. Active, these are only the main implementations. In background, we're always doing a number of other implementations for existing clients where they open either new greenfield sites or make bolt-on acquisitions.
One of the things that we've always talked about is our price point, where we're at the value end of the market. We think we charge the most, but return the most to our clients. As I mentioned, there's significant IT and infrastructure savings, radiologist efficiency that no one has been able to match. I think importantly, we also provide a clinical ROI. That is, we enable the doctors to do things they otherwise couldn't do, or if they could, it would take so long that they normally don't do it. I think that has been a key feature of the application. This is an example of it.
It's where if you're looking for a stone in the ureters, you need to do this planar reformat, and it could take quite a while with standard systems. It's literally just a few clicks and less than a few seconds with Visage 7. Good clinical practices, you should do it. Again, we find that most of our clients do it because it's so quick and simple. The growth strategy, again, we're executing on that. It's to expand our footprint to new clients, which clearly we did in the past year, and plan to continue to do this coming year. We have had transaction growth pretty much from all of our existing customers, well above their 100% they told us they did when they first came on the contract.
Some of it is quite material in terms of bolt-on acquisitions. Some is opening new greenfield sites, but we're able to garner all of that upside because of the fine-grained nature of how we build, which is per test. We are bringing out new product offerings. We now have in our core stack the viewer, the archive, and the worklist, which we've now sold to a number of clients, and I'll get to that. We are looking at extending further into Europe. We are leveraging our capability to introduce some new next-generation products, such as the video reports that we've released with NYU that I'll get to in a minute. In terms of the pipeline, again, we think it's very robust.
It's not just in terms of quantity, but it's in terms of quality and market spread. For the last six to 12 months, we have been noticing renewed interest from the for-profit sector, which was the hardest hit by COVID, and a sector that really went into its shell a bit, and we are seeing renewed interest, as well as in the academic space, the RDM space, and across clients, both mid and large size. It's about as big a spread as you can get. We have seen increased inbound in RFPs, particularly over the last 12-18 months. The archive, as we've mentioned, this is the ability to store the images electronically.
We've had three recent sales where they're both viewer and archive, and there can be material uplifts, so MedStar and Intermountain were two cases in point. We are seeing more interest in our archive product. It is charged on a per transaction basis, so again, as the client grows, the fees from archive and viewer grow with it. Our newest product, which we released in RSNA 2019, is the workflow. It is based on over 30 years experience with workflow that we've had here in Australia. It does allow us to offer a single vendor solution. It is transaction-based and again, as I said, we've had it. It has been bought by three recent clients, MedStar, Novant, and Allina as they contracted with us.
They've contracted for multiple products, which we think is a trend we'll see increasing and clearly advantages us. We are seeing strong interest from our existing clients in our worklist product as a possible add-on to their Visage implementations. The One Viewer, this was the ability to extend outside radiology. As many of you know, certain departments take what we call DICOM images or radiology-type images that are subspecialized cardiology being the main case in point. We have progressed our efforts in that area. At the RSNA in 2001, we showed a work in progress that we're in the process of commercializing into our product stack.
It is ejection fraction, which basically is how much of the volume of blood in the left ventricle is emptied with each heartbeat. It's a very important function in assessing viability of the ventricle in cardiac failure. It's very specialized to really the cardiac area, and it's filled a functionality gap that brings us much closer to a full cardiology offering that is based on exactly the same viewer and technology as the Visage 7 product. CloudPACS, we've trademarked that name. Again, huge momentum swing towards cloud, particularly over the last two years. We are cloud native. We believe we're the only product that is, and we've been able to prove it with very large-scale implementations, MedStar, Intermountain, UC, U Vermont, to name a few.
I think proof of the pudding is seven of our last seven major implementations or sales are all CloudPACS, and we are seeing pretty much that theme in most, if not all, of the RFPs that we're getting. The last few things with the Accelerator, this is our platform for AI that we use in some of our research collaborations and use for ourselves. Again, that we have been active on a number of fronts with some of our collaboration partners and internally in the building out not only the capability of the platform, but its use in some of the joint collaborations and joint research projects that we've undertaken, which have increased. The number of them have increased over the last six months, which is what we anticipated.
In terms of who leads it, Malte Westerhoff, our CTO, and Detlev, our head of development, they are ideally suited to this function because they are both PhDs in healthcare imaging, processing, and manipulation. That's what they've trained in. We have two people based in the East Coast of the U.S., Ming, who is a PhD that sort of interfaces with on our research projects, and Raj, who is an MD and PhD that assists Ming and assesses not only the research side of the projects, but how we could potentially commercialize those going forward. We have announced previously the research collaborations agreements with NYU Langone, Mayo, and Yale. We have established our New York research hub.
It was a little more difficult than we expected because of COVID restrictions. We couldn't get our people from Germany in till August last year. Since then, that hub is going well. We have an additional staff member that's joined us a few months ago based in New York, and we are working on a number of interesting projects, of which one was announced at RSNA last year, which is the video reports whereby a radiologist can create a one-minute report with a video showing the patient the pathology in their particular test, and the patient can download it and look at it on their iPhones, et cetera. It's proved to be incredibly popular and has now been released in our standard product stack.
The breast density AI, many of you know, we did have an FDA cleared in February 2021. We have been using it at Yale. The accuracy of it over the period it's been there is, it agrees with consensus of 5 radiologists, even more so than any one individual radiologist. So the accuracy is exceptional, and we're now in the process of deploying it to a second existing site, which will be our next step towards commercialization. Finally, we have been very busy. The world is slowly returning post-COVID to normal. RSNA was the first in-person conference in 2021. First in-person conference since 2019. We had a large presence, U.S. and European teams. Despite there being conference attendance down over 50%, we were fully booked the whole time.
We were as busy, if not busier, than 2019, which was very pleasing. Interestingly, there are a higher percentage of new opportunities as compared to a split between new opportunities and existing clients. The opportunities were across a broad range of market segments, for-profit, nonprofit, IDNs, and academics. A really good mix. We've also attended these other major conferences, plus others. HIMSS and SIIM are the two others besides RSNA, not as big, but still important. Then some of the subspecialty conferences where we're well-represented with our technology, such as the Breast Imaging Conference, the Neuroradiology Conference, and one of the key conferences in Berlin or in Germany. Summing up, it has been easily the most successful year in our company's history.
Very pleased with the transaction volume increase because that FY 2022 forms the base on which we build FY 2023. We did have strong contract wins and renewals. The expanded product portfolio is paying dividends. Cloud is incredibly strategic for us. As I said, we were able to establish our office in New York, and that is growing. Importantly, our pipeline continues to grow and hopefully puts us in a very strong position going forward, both this year and into the future. Thank you, happy to hand it over to questions.
Thank you. If you wish to ask a question on the phone, you will need to press the star key followed by the number one on your telephone keypad. Please limit your questions to two per person. If you wish to ask a question via the webcast, please type your question into the ask a question box. Your first question comes from Chris Cooper with Goldman Sachs. Please go ahead.
Good morning, Sam and Clayton. Thanks for taking the question. Firstly, you commented there, Sam, you said that you'd seen increased inbound from RFPs over the last 12 months. Can I confirm?
Yep.
Whether that comment applies across all customer segments, or is that a reflection of the other comment you made, the renewed interest you're seeing in the for-profit sector? That's my first question.
Uh.
If I'm limited to two, I will ask you, please, just on the renewal profile. Obviously very good to see Sutter and WellSpan get done on what looks like pretty favorable terms. What is the sort of forward profile for further renewals over the next year or two at this point? Is there any reason at all we shouldn't be thinking about those being achieved on similar terms?
Well, on the first one, look, the inbound has been across all segments and not only the segments, but various sizes, so mid-size and large. It's not just large ones or just small ones. It's a mixture. It's not just the for-profit but across all the segments we deal in. As you know, some of the segments, they're not black and white. You know, I know there's a good case in point. It's hospital plus imaging centers. Yes, it's been across all segments. I think the next major renewal will be University of Florida Health, which is coming up. After that, I don't think we have anything material for 12 months or longer. So far, we've been able to renew all of those that have come up, so clearly we're very pleased with that.
We don't have any indication that we won't be able to renew the ones or the one that is coming. Still ahead of us, but we don't have any sort of gray clouds over it to indicate that they won't renew.
Thank you. Your next question comes from Josh Kannourakis with Barrenjoey. Please go ahead.
Hi, Sam and Clayton. A couple of questions from me. Firstly, just on the pipeline and outlook. I noticed in the remuneration component of the annual report, you had an annual contract value measure in terms of payment, which despite it being a very strong year, I think you noted was slightly below the top of the target, but below the threshold. Is there any way?
Yeah.
You can give us a little bit of context as to just to help us give a bit of a guide of how that looks for, you know, FY 2023 and, you know, what you guys are sort of thinking in that respect for ACV?
Yeah. Look, when you do ACV, you're looking, you know, minimum 12 months into the future. It's very dependent on timing. As you know, even if you are selected as a vendor of choice, can take 5-6 months in contracting alone. Opportunities can flip either side of the thirtieth of June quite easily. I think what we're saying is the ACV target, you know, we make sure it's not a given in that we're not just gonna get it by default. There's a stretch component in it. I can't comment on FY 2023 'cause we haven't announced that to the market. Obviously, we take into account that we've had more inbound RFPs when we look at that whole component going forward.
Okay, got it. Thanks, Sam. Just in terms of the new products, I guess it's a question that fits into the cost base a little bit, but also a couple of your comments around new products and geographic expansion. In the context of both of those things, new products and, you know, greater expansion into Europe and other regions, how should we be thinking about, you know, the cost base into the future? Obviously extremely high margins in the second half of the year. Thanks.
Well, look, a lot of the R&D, so our newest product is our worklist. It has some of the DNA of what we do for worklist here in Australia with the RIS, but it's on the same technology stack as the Visage 7 product. A lot of R&D has gone into that, and obviously that's all been in, you know, FY 2021 and FY 2022 figures. Clearly every time you have an additional product, it's not a set and forget. You're always looking to enhance it. We don't think that having the multiple products will materially change our cost base, any more than, you know, having more clients 'cause you need to service them.
We've been able to develop and implement those products very efficiently, and any increase in cost base in doing that has been more than you know matched by the increased revenue.
Sam, just on that question. Same question in that respect of the new products on cardiology. You've obviously mentioned that that's progressed on the ejection fraction side. How far do you think you are from, I guess, having the ideal product that you believe as a standalone cardiology product, to bring to market?
Yeah, look, I think we're very close, but I'll just define ideal because what is a more than adequate feature function set for one organization may not be for another. It's not that there's a hard line and if you get there, that's it. I think, look, I think people understand where we're heading, our clients, and I think they're very pleased with that. I think they understand the benefits of having the one platform, the thinness, because in cardiology, the image sizes are going berserk just like they are in radiology 'cause they're similar modalities. look, I think we're getting this gets us a lot closer and obviously shows that we have the smarts to be able to do cardiology-specific type applications within our own platform. I think they're two key things.
Great. Thanks, Sam.
Thank you. Your next question comes from Garry Sherriff with Royal Bank of Canada. Please go ahead.
Morning, Sam. Our first question on the expected timing of revenue contribution, particularly for those big three contracts, Novant, Inova, and Allina. I know.
Yeah.
In the past you'd mentioned that Novant, I guess, had been held up a little bit again on the client side due to data migration issues. I'd love to get a view firstly on that revenue contribution expectation for FY 2023 for those contracts, if possible.
Yeah, look, they'll all be implemented in the first half. You're right. Novant was held up. We had hoped to do it a bit earlier. It was held up at their end because of the large data migration project that we're not doing. They're doing internally and it's taken a little longer, and they wanted to have that complete before we get in. At this stage, we believe all three are very keen and have the you know internal requirements at their end that need these things to be done before calendar year end. All things being equal, all three will be implemented in the next few months.
Perfect. The next one on an update on timing around, again, Josh. Josh started to talk about it around cardiology or sales into new hospital departments outside of radiology. Just an update on timing there and also for sales of the AI imaging platform.
Look, AI imaging, as I said, we're already moving it to a second site, and that's in anticipation of them, you know, being able to use it and being happy with it in commercialization. There has been a material move there. In cardiology, look, we have some things in trial at various organizations and clearly, this particular ejection fraction piece, I think will bring us closer to that point. How long is it? A lot of it also depends on them, you know, how quickly they can test it and use it, and they need to test it in pre-production. Being a clinical product and a new one, it's not something you can just drag and drop in.
I can't give you an exact date, other than, you know, this closed bit, you know, this was a big piece of functionality that I think just significantly improved our prospects in that space.
Thank you very much. Thanks, Sam.
Thank you. Your next question comes from Melissa Benson with Wilsons. Please go ahead.
Morning, Sam and Clayton. Thanks for taking my questions. The first one is just touching again on that One Viewer product that you've shown. I guess,
Yeah.
This is more of a hypothetical question when you're in a cardiology space. Is there more kind of pricing power and do you expect that to be kind of a higher priced product in that market?
I do, because cardiology is not as big by volume, but it is as sophisticated. Within the market then, you know, cardiology specific products tend to be priced a little higher. Bear in mind, when we price in the general radiology market, we price across all modalities. It's a blended average price. For a chest X-ray, most probably is deemed as a percentage a lot, whereas for an MRI, it's not. Whereas in cardiology, you don't have that variation as much. Yes, it would be at a higher price than what we would charge for radiology. That's yeah.
Understood. The second question was actually around on the risk performance.
Mm-hmm.
The growth was ahead of what was perhaps expected. You mentioned there's been some kind of consolidation, particularly in the Australian market with Healius and I-MED. Is that kind of a tailwind that you expect to kind of continue impacting that business in a positive way? More generally, I guess, in the US, are you still seeing quite strong consolidation tailwinds?
Yeah, look, in Australia, you know, the clients you mentioned, namely I-MED and Healius, they're big fish in a small pond. They are, you know, expanding and wherever they go into new sites, we pick those up. Clearly, we don't control how and when, but you know, whatever business they pick up, the way we actually you know, the way we charge our pricing model you know, is fine-grained and picks it up. So that's all been good. We don't see any evidence of contraction, quite the opposite. Again, you know, the pond in Australia is relatively limited. US, on the other hand, I think uniformly, we've seen an uptick in volumes from pretty much all of our clients, particularly in the last six months, Clayton?
Yeah. Yep.
Now, why that is? It's a mixture of organic, it's a mixture of bolt-on acquisitions, it's a mixture of new sites. We are seeing more consolidation. Most of it is being driven in the private space, you know, with private equity-backed buyers. We're also seeing our clients, you know, they're all looking at new sites, new departments, buying regional hospitals that got hit hard with COVID. They're expanding as well. You know, as you know, the way the contracts are structured, we just pick up that work as soon as they put it in. Maybe just in general, they're doing more radiology. It seems to be back on an organic growth path that maybe is bigger than we've seen over the last four or five years.
Just touching on Australia, Melissa, with the Healius contract is also on a transaction basis. The prior year, we were still sort of implementing the last few sites. They didn't get a full 12-month revenue as we got this year. That's also incrementally increased it. As Sam mentioned, as I-MED or others go into new sites, there's additional license revenue there.
Great. Thank you so much.
Thank you. Your next question comes from Julian Mulcahy with E&P. Please go ahead.
Hi, guys. Firstly, you mentioned that exam transaction volumes are up 65%. What were the sort of changes for support and professional services?
In terms of volume or-
Just the recurring revenue numbers, the visibility presentation.
The professional services were in line slightly ahead of growth ahead of last year, sorry. The license revenue was up around 10%-15%, which was mainly driven through the additional contract with the German government and the support contract through LMU Klinikum in Germany as well.
You've previously mentioned, Sam, that a lot of your clients had archive contracts that were due to expire over the next sort of year or so. What's your progress on, you know, potentially selling Pro Medicus archive to them?
Oh, good. Look, we've the more archives and worklist we put out, either with new clients or existing clients, the bigger the reference space. So yeah, look, there's been a lot of interest in both archive and worklist. A worklist, you know, is. Archive is almost transparent to radiologists. They never see it. They only feel it if it doesn't work. Whereas worklist is a bit like the viewer. It sort of dictates their desktop. We are, you know, as we put in more and more in the product, you know, gets disseminated more and more. We are having a lot of interest in worklist. I think one of the other factors is there used to be three independent worklist providers. Medicalis that got sold to Siemens a number of years ago.
There was Clario that Intelerad bought a number of years ago. Then about two years ago, Nuance bought Primordial, which is one of the bigger ones. Now, as you know, Nuance has been bought by Microsoft. The small and nimble, more independent, worklist vendors are disappearing, and that's creating a vacuum that we're looking to fill.
Okay. Thanks, guys.
Thank you. Your next question comes from Sarah Mann with Moelis Australia. Please go ahead.
Morning, guys. Just a question on pricing. Obviously you've had a couple of contracts that you've renewed at higher price points. Just wondering, with inflation in the U.S., does this impact kind of the renegotiation process, i.e., is it, you know, potentially maybe even easier for you guys to get through bigger price increases going forward in the current environment?
I wish, but no.
Okay. Fair enough.
Yeah, but effectively what we're saying, and I think there are a few points. First of all, they wouldn't renegotiate anything with us if they weren't happy, if we hadn't done our job. Part of that is making sure that they're on the latest version. You know, when they come to renew, they don't go, "Oh, it's like an old car. It's four years old." You know, they're on the latest versions and they feel we've done, you know, what we said we'd do. The other thing that they feel is that we keep giving ongoing benefits. Clearly that's important to them in terms of any of the financials, because we are more expensive than the rest of the market and intentionally so. Look, there's always a negotiation.
Everybody wants to pay less, our clients included. We have been able in all of our renegotiations to you know land on a midpoint that we thought was fair, particularly since some of these people were early adopters, and we believe they should have an ongoing benefit. You know, the fact that they've renewed for effectively contract lengths in some cases even longer, I think sort of validates that or underpins it.
Great. Okay. In terms of expansion offshore, I think here you've been in Germany for a while. What is your strategy around going more broadly into Europe? I guess what needs to happen in the US before you start going a bit harder in Europe?
Look, I think, you know, the US is the biggest market, but it's also the most active. There's a lot going on there. There are a lot of groups looking to buy systems, as we've mentioned in terms of pipeline. There's less impediment. Whereas once you go to Europe, and even I dare say here in Australia, you're dealing with government. Once you deal with government, there are layers upon layers you have to navigate through. It just makes it much harder. The opportunities, each one, is actually smaller. That doesn't mean we shouldn't be doing it. We think there are a few things that have happened, particularly recently, that will help us a lot.
Europe doesn't have, you know, healthcare in cloud pretty much, you know, more on-premise. Like the U.S. and like Australia, you know, the advantages of cloud are so compelling that they'll need to go. In the past there's been an issue with the large cloud providers in Europe, simply because if the U.S. government passed AWS or Microsoft or Google, they would have to provide data which contravened some of the data privacy laws in the EU. There is now a new treaty being literally negotiated to enable the Big Three to work unencumbered within Europe. We think that will help us simply because we're already cloud capable, we're already there. What makes the product good in America makes it good in Europe.
You know, that certainly will facilitate a lot of things. The big cloud providers have to deal with government. They're big. They've got teams dealing with it and maybe could help, you know, navigate through some of the bureaucracy that otherwise is incredibly time consuming.
Great. Thanks so much for that.
Thank you. Your next question comes from Mathieu Chevrier with Citi. Please go ahead.
Good morning, Sam. Good morning, Clayton. Thank you for taking my question. I hope you guys are well. The first question.
Yep.
I had was just with regards to the competitive environment and what you've been seeing since we last spoke six months ago.
Look, I think, as I said, we feel our technologies, if anything, has gotten even further ahead. Whilst we will always have competitors and, you know, you can't win every single deal, some people have, you know, long-held preferences from, you know, they must buy product A or B. We've noticed some of the competitors when we started years ago have sort of, you know, diminished in their presence. I'd say some of the, those who came from the film base, you know, Agfa/Fuji days, that we seem to be successful against them. Really we haven't seen any new competition come on board.
There have been a few startups that have been touted, but you know, with FDA approval and other bits and pieces, they may be years away before even being commercializable, let alone on big scale. Look, there's always competition. We think, you know, given our sales, you know, history, we're actually increasing our lead and not the other way around. Clearly we're not looking to be complacent. Quite the opposite. We think now is the time to put the foot on the accelerator even harder, and you know, the efforts we're doing with our New York R&D, they're not all around AI. They're around feature function and the product.
The R&D back in Berlin, and the stuff that we're looking to do AI-wise, through partners and, particularly with the research collaboration agreements, you know, all part and parcel of that keeping even further ahead than we were previously.
Understood. In terms of going to Europe, I just wanted to just focus back on the US and perhaps you can give us an idea of where you think you are in terms of penetration rate and what the way forward could look like in terms of potential penetration rate over the next few years.
Yeah, I think in terms of exam volume, we've spoken about this, you know, a little bit. We've said we're a bit over 5%, and we think we're still around that. The market and some of the data we're getting back is actually the market's grown. We've been using something around 500 million exams annually for the US market. I think it's closer towards 600-650 million. We're still around that 5%, so it's still very early stages. In terms of the future, I think, you know, as Sam's mentioned about pipeline, we think we've got a great opportunity to continue to grow that and keep expanding, you know, our opportunity in the US market. There's plenty of runway in terms of opportunity there.
We've got some good, you know, great clients in different segments of the market. Certainly by no means saturated in terms of the market penetration.
Yeah. Okay. If I can just squeeze one last one, with regards to changing the economic conditions. Obviously, you know, there's a lot of people forecasting a potential recession. I was just wondering how that could potentially impact you in terms of volume and then hospital budgets and spend, especially that you're, you know, you're obviously at the premium solution compared to the other providers.
Look, we haven't seen any downward pressure at this point because we think, you know, in our commentary, we're in an area where it's largely non-discretionary. Our clients are incredibly well funded. They have to provide healthcare, you know, to a scale and level. We haven't seen any impact, you know, over the last six months. From a business point of view, you know, people talk about wage inflation. Yeah, so I mean, we're not, we don't live in a vacuum, but because we're very efficient in terms of staff numbers, the impact of that on us is, you know, very tightly contained. Then, you know, interest rates per se for us as a business, they don't impact us 'cause we don't have any debt to service.
As much as you can be, we have been, you know, very strongly isolated from the, you know, the impacts of the recent events with inflation and interest rates. We have no indication in terms of our, you know, pipeline and everything else that is changing.
Great. Thank you.
Thank you. We will now move to the webcast questions. Once again, if you wish to ask a question via the webcast, please type your question into the Ask a Question box. Your first webcast question comes from Claude Walker, who says, "Thank you for the great results and for including more information, the company's investment in debt and hybrid securities. What is the company's risk versus reward analysis regarding these investments? How likely would it be that the company could lose money from this practice?
Yeah. Thanks, thanks very much, Claude. In terms of looking at this, obviously the board look at the risk reward on an ongoing basis. When those were first entered into in very low interest rate environment, it was used as a mechanism to increase interest, so the cash holdings that we had. Those discussions are ongoing. Clearly, as interest rates increase, term deposits look more attractive and could be an area where we can certainly park some of the additional cash that could be used in future spending, either, you know, in terms of acquisition or, you know, in terms of working on the business and retaining some for development of our products.
In terms of losing money, we do have a policy around the grading of the securities, BBB-. I think our policy talks around 80% of that, but it's in the mid-90s in terms of where we hold that at the moment. Any loss that's made at this stage is unrealized, so it's only fully realized if we were to get out of those opportunities. We think some of those, you know, some of those debts and securities will come back to their coupon rate once they get closer to maturity.
Thank you. The next webcast question comes from Judith Fraser, who asked, "What percentage of the US market do you think you have currently captured? And do you have a target which you think you can achieve over the next five years?
Yeah. I think as Clayton said, we when we look at the market and we've been doing a fair bit of analysis on it lately, the number of exams that come through from all the data points is actually bigger. Our runway is longer. We were assuming around 500 million. We're now saying it's north of 600 million. And based on that, we're a bit over 5% and growing, which doesn't sound like much, but there are very few companies that have done that, certainly not in the time that we've been able to do it. I think that there's plenty of runway to go.
You know, not only is it just the volume, but we think that the product is the only one that will, without modification, can actually service all the different segments of the market. Even, you know, for some people, there's AUD 600 million, but they could only address maybe AUD 50 or 60 million because of the technology itself. We think we could address pretty much close to 100%. Then the only other consideration is, you know, the cost of sale when it's small, too small. Again, that's changing because the small guys are either merging or they're getting bought out. The number of smaller groups is diminishing, which it works in our favor.
Thank you. Your next webcast question comes from Ray David, who asks, "Could you talk about the outlook for cost? For example, are you planning on investing more in resources/staff in FY 2023? And what sort of cost growth should we expect?
Yes, we are. I mean, we have been investing in resources and staff in the current year, so the cost base has gone up around 20% in the past year. I think what's been pleasing, our EBIT margins have still been able to go up, so we've obviously had revenue to be able to cover that and the incremental EBIT we get on the revenue is much higher. We will be looking to increase resources in FY 2023. It's in all three jurisdictions, and it's all in all different departments around technical staff, clinical applications and project management, and support. It will grow, but we do believe we should be able to maintain our margins going forward.
Thank you. Your next question comes from Abby He, who asks, "How does the Visage product work alongside EMR providers, for example, Cerner?
Yeah. Look, we integrate tightly with the EMR in all of our hospital environments. The main ones we see are Epic. We do have some large clients that have Cerner, I think MedStar, Intermountain, and we integrate with that. Clearly it's a standard requirement of ours. We have, you know, very tight level of integrations with all the major EMRs.
Thank you. Your next question comes from Ian Lee, who asks, "Given the scale benefits, is there a cap on the margins? Can you please discuss the TAM on each of the segments? Any comments on the potential contracts in the pipeline for this year?
Look, in terms of cap on margins, we thought, you know, when COVID hit and they were in the mid- to low-50s%, that we would, you know, and then we didn't have major costs like conferences in person and travel obviously stopped and the margins went to the low 60%. We thought they would gravitate back down somewhere in between when all of these costs came back, but they haven't. And so we've been able to incrementally grow them. But having said that, we, you know, we are at multiples of the in terms of EBIT margins over our nearest competitor. So they are industry leading and as Clayton said before, they, we don't expect them to shoot up. We don't expect them to materially decrease.
They could go up and down a few percentage points in this range, just depending on timing of when we bring on additional staff, which are all planned, apropos when revenue comes in from the new contracts. In terms of TAM for each of the sections, like I said, it's almost impossible because some clients span multiple sections. All we're saying is that we think we have the biggest, you know, addressable TAM in the U.S. simply because of the product set being able to address any part of the market from a product perspective.
Thank you. There are no further webcast questions at this time. I'll now hand back to Dr. Sam Hupert for closing remarks.
Thanks very much. Well, thank you everybody for joining us. Hopefully, we've been able to answer the majority of the questions you've put to us. As I said, thanks once again.
Thank you.
That does conclude our conference for today. Thank you for participating. You may now disconnect.