Decide when we should start. Should we wait for one or two minutes, perhaps, or?
I was just waiting to see whether, because I can just see just a couple of people joining in, but maybe I can just get started and start by saying hello to everyone, and thank you for joining this call, and thank you to Klaus Sindel, head of IR of Embla Medical, for organizing this, and just as a reminder for everyone joining this call, this will be recorded, but today, we have with us the two founders of Fior & Gentz, Jörg Fior and Ralf Gentz, and we also got Thomas Beckers, VP of Strategy Office, and a guy who I know has been heavily involved in the acquisition process and is now heading up the portfolio brands of Chronic Solutions of Embla Medical. These three gentlemen will present for roughly 20 minutes, and then we will head into a Q&A session. So let's just crack on, and the floor is yours, Jörg, Ralf, and Thomas. You are both muted.
Hello, everybody. I'm Ralf Gentz, one of the founders from Fior & Gentz. You see all three of us on this slide. On top is Jörg Fior , my partner. We both, Jörg and I, we founded the company Fior & Gentz in 1997. And you see the third guy is Thomas Beckers. He is from Embla and made the acquisition from Fior & Gentz in January. So when we started our company in 1997 in Lüneburg, Jörg and I were former workers in another company called IPOS. So we were working in the field of prosthetics and decided at that time there's a lot to do in another field, which is called orthotics. You have to know that at that time, the orthotic field was very well developed. But in that time, the field of orthotics was almost not developed.
What we want to show here, this is a small photo what you can see here. It's a photo from the video of Forrest Gump. I guess everybody has seen this video, or most of you will have seen this video, and you see here, there is this very old kind of orthotics, which happened at that time when we started our company, and it's still a situation in more or less all over the world that you can see this old style of orthotics. Those kinds of orthoses are developed for patients with neurological diseases like stroke, spinal cord injury, and so on and so on, so we decided in 1997 there's a lot to do to make some improvement in the design of the orthotic field, and that's why we started the company in 1997. May you switch to the next slide, please?
So that time, we found out that there have to be designed some different joints for producing custom-made orthoses. So custom-made orthoses are produced from our customers. These are orthopedic workshops, which are existing, for example, in Germany and many in every city. And that's the same situation in the U.S. and in all developed markets. So we started with designing ankle joints, which you can see in the left circle. This is one example of an ankle joint with pre-compressed spring units, which helps the people who have weakness in calf muscles or in foot lifter muscles to stabilize the balance of the patient. Because you should imagine if these muscles are weak or totally paralyzed, the patient cannot stand at all. So they simply fall down.
So therefore, we developed these ankle joints, which allow a range of motion, but give some stability back to the patient so that they are able to stand and walk easily. Then in the middle circle, you see knee joints. These are knee joints for so-called KAFOs. KAFO is a knee, ankle, foot orthosis, which shows that it covers the knee, the ankle, and the foot. And AFO on the left circle is an ankle-foot orthosis, which covers the ankle and the foot. So in the knee joints, there are that time existing knee joints for free motion that keep the knee in a free motion. And the other range of knee joints that time was locking knee joints. I guess everybody has seen people walking with a stiff leg in the field. That is, these patients are using a locked knee joint, very often visible with polio patients.
We also designed knee joints with automatic function. So they are free during swing. When you swing the leg forward, and they are stabilizing the knee when you stand on the foot. So therefore, with this kind of knee joint, you don't see these people anymore like with this Forrest Gump picture walking with stiff legs. So these patients start running and walking with a leg. So in the case that you cannot see them sometimes anymore, that they have a device under their trousers. Also, in the red circle, you see our bionic joints. Bionic joints are automatic joints with some electronics and sensors. So this is our highest development with also hydraulics inside and so on. So this is the latest state-of-the-art of ankle and knee joints, what you can see in the right circle. May you switch to the next page?
Here we prepared one or two videos of only one case of a patient. This patient, what you can see here, has multiple sclerosis , short MS. Maybe you have seen patients like this walking in the street anywhere. Normally, they're using these walkers or crutches, and you can see it looks horrible. They are more or less fully paralyzed in the legs and cannot stabilize the ankle joint and not the knee joint. So that's why it looks like you can see it in the videos how they are walking. This patient here is treated with a neurobionic knee joint with a normal mechanical ankle joint on both legs. So this patient has two KAFOs on both legs. And as you can see, this patient can walk more or less like you cannot see anymore that they have any problem.
It's just one example from thousands what we can see every day. So it helps a lot to bring people out of wheelchair and from walkers and crutches to normal life again. So please go to the next slide. So here we show just some examples, the most common examples of neurological disorders. We describe here on this slide four of these neurological disorders. In the left side, you see stroke, called apoplexy very often. This is a very, very typical indication, which maybe everybody from us has some friends or relatives who have these problems. So you know how it acts when somebody has this problem. Stroke happens in the brain, and when something happens in the brain, these patients are not able to control the muscles anymore. So it looks a little bit like this lady what we have seen before.
It is a very, very common thing. One of four adults will have a stroke in the age of older than 25 years. When you see on the last row, you see that only a few of the people in the worldwide markets are developed with or have got some treatment like our AFOs or KAFOs to treat these patients so that they can walk again. Another thing is this multiple sclerosis, what you have seen in the video before. These patients are using canes, crutches, wheelchairs. They also get physiotherapy, balance training, and so on and so on. But at the end, what really helps are these orthoses, either AFOs or KAFOs. The third thing is cerebral palsy, called CP, shortly. CP is a problem which acts with children.
Normally, when they got born, very often they got born too early and have also some brain issues, a little bit like stroke, but they are born with this problem, so it also acts as a problem of paralysis of some muscles, very often the same muscle groups like always, like foot lifter and calf muscle weakness, so all these patients have the same problem that they cannot stabilize their weight and have no balance, and with our orthoses, we help to give them back the balance and the stability of standing and walking. Spinal cord injury is a very common and typical thing what you see everywhere. This comes mostly from an accident, car accident, or falling, or whatever, so you have some accident, and then you have a cut spine, which acts also in paralysis.
This paralysis in the legs can be full or partial paralysis, or in some cases it's not a complete paralysis. Also, all these indications are treated worldwide just a little bit. So only a few of the patients have the chance to get treated with the right products at the moment. So that's why we came into the market, designed these products, and getting more and more into the field that all these patients will get some orthoses. Okay, next page. I think I will hand it over to Jörg now. I think Jörg has some words to this slide.
Yes. Hello, everybody. Also, regards from me. Yeah, well, Ralf talked about now for sure these chronic neurological disorders. We explained a bit some examples of indications we need to cover with our products. But now you could believe it is like a little bit as when you want to buy a car, how to find the right products for an individual treatment for a neurological patient. And this is where it comes up to our idea when we established the company also to create a really concept, okay, to create a tooling in need to select the correct components to make a custom-made orthosis.
Yeah? Because as you could believe, we have small patients like the children, Ralf explained for the CP, and we also have the adults for stroke, for example. So we have different joints, ankle joints and knee joints in a lot of different sizes. But how to select now the correct size for each patient? This is a bit a tricky point. And therefore, we decided, okay, we need a tool. We need a tool to select the right componentries to realize also most efficient lightweight treatment made in carbon fiber in a really good circle around.
And this concept we created, it's called 360-degree Orthotic Concept. So what we are doing, and this is really the difference to competitors, we are bringing a concept on the table, okay? And the concept starts from the physical examination over the planning of the orthosis, model technique, production of the orthosis, important for sure. We have to produce it also, handling it over, and also create the maintenance. And this concept, bringing this into the market, allows the technicians, our customers, the clinics worldwide to follow a really strict rule set of recommendations and also rules to create these really good high-level orthotic devices, okay, for the indication, for example, Ralf explained before. But it's not only the concept, the 360-degree.
It's also a really unique tool, and you can see that on the right side. This is an orthotic configurator, okay? What is an orthotic configurator? Everybody knows a configurator from the car, so you type in, "I want to have these seats, these wheels, these engines," and this is exactly what we are doing here now, so we make a good patient examination. You see on the left side under point one, so we see what is the muscle status, how are the nerves working, how could they invite also muscles to work. And all these patients' information, we bring into this software tool. This is an open-source software tool. Everybody can use. Everybody can check after that call how the system is working, so we're bringing patient data, activity levels, etc., pp.
At the end, what you get at the end is an article list, okay, an article list of componentries you need to produce this custom-made orthosis for this neurological patient. I think this is so unique, and nobody from our competitors can, I mean, copy it because our product portfolio was developed under the same rules. So we are able to use this kind of, in Germany, we call it Plattformbau. So we have one chassis, but you can build several cars on top of it, okay? And this is really unique worldwide in the market. These are a bit two key points, marketing sales-wise, okay, to sell in a really good way our products. Okay. Now is Thomas coming.
Good afternoon, everyone. Good to be with you. Before I go into this slide, I'll take a step back, and I think just to explain rationale a bit, in 2022, with Sveinn, our CEO, we developed a five-year strategy, which we called Growth '27 , and part of that strategy was to find ways to reach a broader population of patients with chronic mobility impairments and do that in a way that where we tick the boxes of providing innovative solutions, reach more patients, and create value for the O&P industry. And Fior & Gentz was and is just a great company that ticks all these boxes. The value proposition is really compelling, and it addresses the customer needs, the prescribers, and the patient needs, and provides great clinical outcome, so that was sort of the starting point.
That's why the fit of Fior & Gentz to Embla Medical, Sölvason, and also strategy is really good. If I go into the chart that you see on the left side, you see the regional split that we summarized there, so where Jörg and Ralf started, obviously, was in Germany and built that market, and we go more into the geographic aspects of the business later, but Germany's roughly 70% of the sales today and reducing. Then the customer split, a lot of it, and that's on the patient side. Obviously, a lot we call it Chronic Solutions, and that's for a reason. Those customers, after two or three years, need a new orthosis and are coming in for repeated fittings, so we can create, in certain instances, lifetime value for this patient population.
And the key channel, as you're familiar with, same as in prosthetics, O&P is orthotic and prosthetic clinics are our key channel to provide those solutions. And then on the bottom, you see just the revenue trajectory, both historic and the outlook. And Fior & Gentz has been doing really well, growing above the market with 14% over recent years. And we believe we can continue that journey and potentially even accelerate it with our market reach and do that in a profitable way, maintaining the high EBITDA ratio that we've communicated, which is roughly around 30%. And on the right side, and I think we are probably taking a bit too much time now here, but on the right side, you see the key points summarizing the strategic rationale for having acquired Fior & Gentz, which is the strategic fit, the complementary offering.
Össur it doesn't have such an offering today in its portfolio. I already mentioned there are also compelling commercial synergies when it comes in terms of market reach and commercial infrastructure. The culture fit is high. And overall, the segment we see there are also other companies focusing on it. The neuro-orthotics market is finally catching up a bit to the prosthetic market. And obviously, it is financially accretive to Embla Medical overall, this acquisition. If we go to the next slide, Ralf explained the product offering that we have. And this is more a view on the market overall. And you've seen a similar chart for prosthetics, illustrative chart, where we explain the functional trade-off for prosthetics going from wooden SACH feet to bionic prosthesis. And in this case, it is very similar. So you have on the axis on the left side, you have the clinical value.
On the bottom, on the x-axis, you have the level of customization, and on the right side of the graph, you have a reimbursed price level range, which is also a bit illustrative, going from $50 up to $50,000. In the bubbles, you have the different offerings that are there to treat, in this case, for example, stroke patients with ankle-foot orthosis. This is as in prosthetics. There is quite some difference in terms of the offering with actually pretty low clinical value for a plastic AFO, which is on the bottom left, the circle you see there, that is sold maybe or reimbursed for $50-$100. Going up the ladder into carbon off-the-shelf products, and then the underlying sort of gray or like a brown underlying area that you see in the bottom right side is the offering where Fior & Gentz is focusing.
And that is functional carbon custom lower-limb orthosis, and then also microprocessor-controlled or bionic lower-limb orthosis, which are really the highest end today, and that's the area where we want to focus on and actually upgrade where most of the market is today in the very simple products and upgrade them to the more high-end products. So that is a maturity journey that we are on, and as Ralf mentioned also, we are probably more than a decade behind the prosthetic field, and there's a lot of education of the markets needed to advance that field of neuro-orthotics. If we go into the next slide, so that is the infrastructure or how do we leverage our presence and Össur and Embla presence for the Fior & Gentz portfolio.
And the key points again, I mean, on the right box, you see Germany, where roughly 70% of the sales is today out of the EUR 23 million that were realized in 2023. And that was sort of the proof of concept. But Fior & Gentz, even before we acquired them, has expanded into France, Norway, Switzerland, and some other countries, and established a sound presence there. And now we are in progress of leveraging the Össur infrastructure and going into new markets, including the U.S., including South Europe, including the U.K., Scandinavia, Australia, and establishing the presence there. And as we go along, we will address more and more markets where we have direct presence through the Össur organization and tap into those markets, including South Africa, Turkey, and other markets.
So the underlying growth drivers, and you see that in the bottom, that's definitely grow the patient reach, both exploring and exploiting the presence we have through Össur in those local markets and ensuring we educate the market and we manage to increase the fitting rate in those markets, both talking to our O&P customers and prescribers as needed. And then increase the use of the product, which we call market access and renewal. That's very important because the market access, as I said, the neuro-orthotics market is often a bit behind the prosthetic market. That also means that the reimbursement levels are not always on the same level as for prosthetics. And that is something we need to work on with our teams to make sure that those patient populations that we are addressing get the necessary service and solutions that they really need.
And increasing the value, I mentioned that on the slide before. That's about the functional trade-off and making sure that even that we can move where needed people, patients from mechanical products to bionic products and therefore increase both the clinical outcome, the value that the patients get, but obviously also the sales price. So yes, so that is it on the market strategy.
All right. Thank you so much for taking this time for a very thorough presentation. I think we all appreciate that you would take the time out of your busy calendars here to educate us on this very interesting topic, so I'll maybe just kick off with a couple of questions, and then the investors who are on this call can maybe raise their hand meanwhile. So the first questions would probably be to you, Jörg and Ralf. I think you had this quite interesting slide where you were showing the penetration today, which is around 5% in the developed market across the different therapeutic areas, and 15%-20%, I think it was in Germany, specifically at least for the strokes.
Can you maybe put some words on, of course, you want to reach the 100% for sure, but which level do you maybe see as realistic over, let's say, the next five years or whatever medium-term timeframe? And what sort of the main speed bumps that you see from increasing penetration from this level here?
Yeah. Yeah, it's a good question for sure. I mean, penetration is, I think, for us, it's an always ongoing process, okay? So we are working on that process every day with our sales team, with our marketing, with the whole setup for the whole marketing exhibitions, visiting physios, doctors, etc. So I think it's daily work we have to do. And it's hard work because it's still the fact that a lot of people, like this MS patient, Ralf showed the videos, they are just walking around in the streets. They are not treated, okay? So what we need to find is sensibility also for patients, but also for prescribers to think about good possibilities to treat them in a proper way. And this does not come overnight. But I think also now time is changing, okay? Patients are more self-oriented.
Families are building teams, searching for the good solutions for the grandpa or for their children, so this is all speaking for us, I think, in terms of or for the society to get patients more and more treated with, for sure, good walking aids like we provide with our AFOs and KAFOs, but again, it's a process. It never will stop, but as we see also on our growth level, I think it will continue always up, up, up, up, up, up, so this is something I must say, and this is a case here in Germany, which is a highly developed country, okay? Also Scandinavia, so the knowledge here is a little bit on a higher level. But if you, for example, see also totally different markets, like Asia, we didn't knock on yet, okay, but this is super high potential markets, I think. And the volume of patients is exponential, super high. So there's a lot of work to be done for the whole world. Yeah, I hope that gets a bit clarification on that penetration.
Yeah, no, it's super helpful. Maybe if you take Germany as that's where you got your main knowledge and where you've built up some penetration now, how do you see Germany versus the other developed markets? Thomas was talking about also you were getting into France and other markets already. Is there any big differences between the markets in terms of penetration?
Yeah, there are differences. Absolutely. I mean, you have to see also what we are. We are both educated, as you call it in Germany, Orthopädietechniker. So we started our education in a workshop. We are building prosthesis and orthotics. But in Germany, we have a high level of education, okay? Also in other European markets, we have that high level of education. In several outstanding markets, you even don't have an education in that field to build proper orthotics and prosthetics. So what is the point is the penetration also depends on the market's education, okay? As fewer markets are educated, the more you have to invest in trainings to even let them realize to make these really wonderful AFOs and KFOs for their Chronic Solutions patients. So education is one factor. The other factor for sure is also a little bit reimbursement, okay?
The work, the clinics, and the Orthopädietechniker has to make in their own all these several workshops all over the world, they have to be paid, okay? So who's paying for that? Normally, reimbursements are paying for these aids, okay? In Germany, we have a good level of reimbursement, but also in other European countries, if there is not a good reimbursement, you have to work on the reimbursement to get products even reimbursed, yeah? But I think this is something, well, which depends a little bit on the potential on the market, where you want it to go.
I think Europe in general is quite good, okay? But for sure, we have also markets. This is private-paying markets, I think, more or less. I don't know what's up in China or in India. Maybe there's also for the military, they're paying something. But this has to be set up, okay? There's always a way to find possibilities to bring these good products to the patients. This is what I wanted to say in total, okay? It's absolutely possible. Even if it's some work to be done.
Okay. I'll just shoot a couple of more questions, and then I'll let investors get in. I can see we got one, but maybe just because you've shown these quite impressive products, I think the videos that you showed are quite frankly super impressive when you show the differences, but can you maybe provide some clarification on how the innovation cycle looks like for you? How often do you need to launch new products that is better than the one before? And how important is it that you keep on rolling out better and better products in order to educate and maybe make them switch to your products?
Okay, I can talk a little bit to that question. After all, I can say, we at Fior & Gentz, we have a mass of product ideas, what we can do until now, and we have a lot of things in the pipeline, what we want to do in the future. And therefore, we create every year some new products, some small things, and some very highly developed things. So every year, coming something new into the market. Most of them are highly innovative in the future because we are more and more going into the field of bionic products. And I think this is all I can say to that point. So it's a lot, many ideas, and we will bring every year some new products into the market. Maybe Jörg, you have some other point regarding this, or do you think I forgotten something?
No, I think it's fine. Yeah, we are launching every year new products. We have to.
Yeah. And which product is most important? Is that the ankle or the whole leg that you showed us? Is there any differences to that?
Okay, that's a good question. So from the math, you must see that all paralyzed people, and the biggest problem is always in the end of the muscle group. So it starts with the feet. So lifting up the foot or stabilizing the foot by standing is the biggest problem. So therefore, the most products what we are selling are the ankle joints. So in the future, we have to be focused on the ankle joints for sure because there is a bigger market. But the more innovative and complicated market is everything around the knee joint, to stabilizing the knee. You can imagine that it has to be free and free motion during swing. It has to be stable during stance. So it's a little bit more complicated, but the bigger volume we have in the ankle joints. We are focused on both ankle and knee joints, but it's going more and more into the bionic things.
Makes sense. That's very clear. And the question, I guess you knew were coming is, how do you see the competition and the landscape there? How has it evolved lately? Is there any changes to the competition? And what's the main threats to your business as you see it?
You mean competitors from us? I mean.
Yes, please.
Yeah. For sure, we have competitor. We have the other German company here called Ottobock, who's also a global player in the world, for sure, also in orthotics. But I think when we started 1997, this product portfolio, what we created, was really, as we discussed already, was totally underdeveloped, and Ottobock also slept. They are sleeping. They're just not investing into that product portfolio. So they did nothing. Even I think maybe 15 years later, they recognize us a little bit because then their shares are shrinking in the German market, and everyone's wondering what are these boys are doing there. So they started quite early to create something more new stuff in orthotics, lower extremity ankle and knee joints. So I think they lost a big time slot in their development. And now for sure, they want to follow us and bring also solutions on the market.
I mean, this is a global player company, okay? They are playing worldwide in all the markets, which is good for us, okay? This is good for us because they in these other bigger markets, they have a big market share, and now we are grabbing on that market share. So I think we will take a lot of their shares, market shares from these markets because we are just better. We are really better, and I don't say that because I'm Fior & Gentz or one of Fior & Gentz. No, I'm just saying it because I really believe in it. We have better solutions for patients, but okay, again, we have competition in the market, and this is also what we have to work with and to live with, but it's good. It's constructive, I think, yeah.
Makes sense. Very interesting. Just a couple of questions to you, Thomas, before opening up to investor questions. You had this really, really great asset for a year. And you, of course, did your due diligence, and you do what you can before you actually open up the hood and see what's underneath it. Can you maybe provide some color on what maybe have surprised you, good or bad, in this asset? And maybe the feedback that you are getting in general as you are rolling this out in your clinics and integrating it into the user distribution?
Yes. As you mentioned, we did quite lengthy due diligence, and Ralf and Jörg were very helpful there. So I don't think there are any surprises or something that came up that we did not anticipate. What is definitely positive is wherever we go with the Fior & Gentz portfolio to internal stakeholders, the positive is always feedback, and there is actually a pool of people who are interested to cooperate and launch it into the markets if it wasn't done yet. And also, wherever we go with bigger customers, when we do test fittings with the products, the feedback is immediately positive from the customers that are not familiar with Fior & Gentz and also patients that walk the first time on the products. But I think this is really good. And then the cooperation is going very well.
Maybe the thing which we also knew is that building up markets takes a little bit of effort. The patient population also that we are addressing is a bit more, almost you could say a bit more difficult than amputees or people that suffer from limb loss because they need a leg, definitely. I think neuro-orthotics is definitely a demanding field that requires a lot of education of the key stakeholders. Yeah, the journey has been great so far this year and will continue.
Yeah, makes sense. And super helpful. Maybe just one last question for opening up. I met just on Teams. I met Jörg and Ralf for just 10, 15 minutes, and I could sense that these guys, they're moving fast. And I'm just wondering a little bit, how much can you as an outsider coming in actually add value to this? What seems from the outsider quite well-oiled machine, has there been any quick wins that you have been able to harvest, or are there any quick wins that you are going to harvest here with this asset?
Yeah, definitely. That's going to be a balance of keeping that agility that Ralf and Jörg have with Fior & Gentz and the organization and leveraging the Össur infrastructure. That's going to be a balancing act. The quick wins are definitely our global reach and customer relations, which are very sound. They help open doors. That is the quick wins. What we're trying to do is put them into those markets dedicated people that have the right knowledge of the Fior & Gentz offering and can help to educate the local markets. We're doing sort of both leveraging the local organization, strengthening at the same time. Yeah, so far, so good. The biggest hurdle, as I mentioned before, is maybe market access or where the reimbursement is lagging behind to create that reimbursement. But also there, we have local resources that can help us with fighting those battles.
Makes sense. Thank you so much. We've got a question from Henrik. You can unmute.
Okay. Thank you. Vielen Dank für eine super gute Präsentation hier. I have two questions here. One is the scalability of your business model. How can you because you're really fitting for each person here. How is it possible to scale it up if you really get a success in the rest of Europe and the US? And the other one is to hear from the two founders here why you chose to sell to Embla. That was all.
I would just take answer question number two. Number two, okay? I can also take number one, but number two first because this is a good question, I think, and this is a match point, okay? Össur or Embla, Fior & Gentz is a match point. I'll tell you why. Because we considered once, I mean, we started both a company with two of us. We make it big. We never had the family in the company or anybody else. We thought, okay, we will bring it up to a certain level where we think, well, this is now difficult to manage on the long run, okay? Then for sure, we need to consider, okay, whom might be our best partner to go with, okay? We always had a bit Össur in mind because Össur is a Nordic company.
They have a little bit the same mentality as we have. I don't know if it's common, but Nordic, Norwegian. So it's a bit this leisure professional market feeling we found in them. But the most important point was that they don't cover the product portfolio we have, okay? So they are not into chronic neurological indication, custom-made AFOS, ankle and knee joints. And from our point of view, this was always the perfect fit, okay? It's a perfect fit because they don't have the portfolio we have, and they had the super global big infrastructure. This is a really innovative company with really good people working. And so we thought this is a super match. And this was a little bit our target also to go with them or our idea. And luckily, it also worked out. Yeah.
Yeah, I can take over a little bit. I fully agree to that what Jörg explained. That was always our target in the last years to talk with Össur. That was our first choice always. And as you can mention, the company Fior & Gentz, we had it now 27 years until the acquisition. And it was a little bit Jörg's and my baby, we have to say. It was really our baby. We growed it with a lot of effort, and we were, I think, very, very successful. But we knew that time and our possibilities are limited. We are now 100 people in our company, and we knew we were very successful in Germany. But even in Germany, it's so much to do to scale it up. But coming to other countries, we are too small.
And in our lifetime, we would have never the chance to see our, let's call it that way, we have never the chance to see our own baby growing too big. So that was why we decided. So we want to see it until we are young enough. And it was not too late to ask Össur if they will help us to grow it into the world. And we see the perfect match in this field now.
And then we have the scalability, which we didn't answer. Do you want to, Ralf or Jörg, do you want to take that one?
Yeah, scalability. I mean, what we are doing is, if you take, for example, Germany, scalability in Germany. In Germany, we have sales teams. We are visiting doctors or the clinics or the Orthopädietechniker, which are working in the clinics to build these nice AFOs and KAFOs. So we made training, okay? We educate them in the products as we described a bit in the 360-degree orthotics. So we get them as a customer. They trust us. They trust our products. They believe in our products. And they think, okay, using Fior & Gentz products with their patient treatments, this is a win-win for them.
So the scalability is they are using us always if it comes to neurological indications in these markets for their custom-made AFOs and KAFOs. The closeness to the customer is also in terms of the reimbursement, okay? Also there, we have really close relationships with the reimbursement persons who are in charge for the payments that we also keep them on board, so the growth is getting automatically out of a trust situation, yeah, so people trusting us, people believe in us and think, okay, they are good, and coming out of this, doctors are prescribing more and more orthotic devices for their patients, and it's a kind of, it's an in-themselves growing system where we just are able to increase all our volumes for sure, plus acquiring new customers also here in Germany, new clinics, new talks. But again, scalability is a bit like coming out of a good positioning, of a good relationship with the customers based on trust, I think. This is a big point.
What about scaling production?
Sorry? Scaling production. But yeah. Yeah. Yeah. Well, scaling production, you mean from our side, from Fior & Gentz, if we need to scale it up because we have higher demand on volumes. Yeah, but this is also no problem for us because when we set up the company, okay, we are working, we have an engineers team, okay? A lot of engineers are working for Fior & Gentz designing all these nice products. Then we make all the drawings. And then we have external suppliers delivering us single mechanical products.
So they are all in stock here. So we are not depending on our own machines or etc. So we have a lot of several suppliers. And then we bring everything in our assembly department, and there we got the assembling of the products and make the quality management, yeah? Which means, yeah, we don't need to buy a new ground here to produce, put their new machines or something. So the scalability of the volume of the products, I think it's a bit unlimited because it's, yeah, machinery work.
If I can step in at two parts, the component sales of Fior & Gentz, that's highly scalable, as Jörg says. But then what you mentioned, the custom manufacturing of the complete orthosis, which includes the Fior & Gentz components, which is done by our customers, that depends a bit on their scalability and their availability of technicians that build those orthoses. Sometimes that can be a bottleneck if you want to scale that. And in some markets, like in the U.S., for example, we are also working on offering a service fabrication to certain customers that don't have the scalability or the knowledge to build those orthoses. So these are the two parts that we are working on. But definitely producing a custom orthosis takes an effort, education, and time, yes.
Yeah, correct.
We got Johan Karlsson has the hand raised.
First off, thank you very much to all three of you for a very, very good presentation. Super interesting to hear. I had a question on when you talk about growth in new markets, and especially when you say that one of the big speed bumps may be market access. Do you see that competition already have some of their products reimbursed in certain markets? And can you piggyback on that existing reimbursement code, or is it breaking new markets with new reimbursement codes in those markets? And perhaps the U.S. is a big market, so that would be particularly interesting.
Yes. Yes, you're right. Also really good questions. I don't know if you're a bit in these markets already, but you're right. I mean, this is possible. When we searched for the entrance to the French market, there was also a bit of questions about reimbursement for special products. So we also could, but for sure with some study work also we have done in the past. But for example, for France, we could set up a study comparing our products with already existing products in the market. So compare them a little bit and give out of the study, the study result was then, okay, we are even better than the existing products. So on top of that, we got the reimbursement.
So it could be a key to get into the reimbursement even if there is somebody else in that market covering orthotics, lower extremity, AFOs and KAFOs, what we described. And for sure, you're also right, even in the U.S., we are working on strategies to get more and more products reimbursed in that market, yeah? And this is also good now, what Thomas said with Össur, with Embla. The good thing really is now there is an infrastructure working on these issues, yeah? So taking care, high professional level. And I think that might help us also quickly in the future to get even, as you described, on a smoother, quicker access to existing or markets which we don't cover before, yeah?
Maybe just a follow-up on that question. When you go into a market and you aim for reimbursement with your products, you can show that they are superior. But I guess there's also the price aspect of how you can get them reimbursed. And as you showed on the graph, the prices can be a bit lofty if you pay $25,000 for a product. I know that's in the high end. But how is the price discussion and how much do you think that you might need to do something about prices over time? Also, as this is growing to be a bigger part of the budgets in healthcare as it grows and the penetration increases.
You know, I think the price discussion is. I will not say it's not relevant, but this is not the key, okay? The price discussion is not the key. I mean, if you want to sell a high-quality product and you think you have the best product ever, then for sure you don't start with the price, yeah? You show the quality, the. We call it Mehrnutzen, what is that, the more.
Added value.
The added value, you show the added value. Thank you, Thomas. You show the added value. You explain the added value. You show, okay, this is a difference. You make what Thomas said, yeah? You make, in certain markets, we make just some tests with some patients. The patient said, "Hey, wow, this is what I need, you know? This gives me so much more freedom in my daily life and so much more," or see the patient who was walking without the crutches, yeah? Was able to walk again, and then pricing is, pricing is not the target. It's not an issue. For sure, if it comes to the payment, then somebody needs to talk about also pricing. But this is not, I think this is not the barrier. Not in one single market. It is the barrier to get in, yeah?
I think this is really. It's not the key. We always need to find agreements. We always need to work on reimbursement or also on other solutions. But the price discussion is not a focused issue, even also not in the markets we are setting up now with Össur, because there are price-sensitive markets. But we don't have this discussion on these markets, I think.
Makes sense.
I think there is, and I think there is a similarity to prosthetics. Again, we managed to evolve the reimbursement in prosthetics over the last two decades. And we see examples, individual examples where in the neuro-orthotic field this is happening as well, including in the U.S. So yes, there are some codes we could commit to short to mid-term, we can piggyback on, those exist. And so we see, yeah, we are quite confident it will take some time, but we are quite confident that we can evolve some of the markets into better solutions.
I have one spontaneous thing here to ask you, everybody, please, everybody, go to Instagram right now, open Fior & Gentz, look what is visible there, and all these questions will be answered when you see the videos from Össur. There are many videos, but for example, the video from today.
Yeah, good.
Instagram, Fior & Gentz.
Minutes also to do that. We will close this call in four minutes, so I'll just let Simon ask a question which might be.
Great, thank you. So could you just, how much of your patients are actually out of pocket? And is it all 100% reimbursed, or is there some out-of-pocket payments going on here? Because as you rightly pointed out, Martin, these things aren't cheap. And then I guess the second question is, presumably the gross margins on these things are probably going to be better than Embla, the group, before this acquisition. Are you able to give any indication about that? And then just maybe a slightly more basic question, how many units do you actually ship every year? Or just to give an idea of the overall market.
Who's answering right now? Three questions. Wasn't it three questions?
I think so, yeah.
Out of the pocket, okay. This was the first question. I think, yeah, this is a bit tricky for us to evaluate because we, for sure, we are not bringing these orthotic devices into the market, so we don't know actually what patient might pay something. In Germany, there's nothing to be paid, okay? There's nothing to be paid. In other markets, like in France, there's also nothing to be paid. But maybe we have markets like Turkey, for example, or other markets which have at all no really good reimbursement. Maybe there they pay an additional amount of money. But again, I cannot tell you. I mean, if I need to tell you now a percentage, I might say 90%, maybe 90% is covered by complete reimbursement and 10% is private payers. Something like that, yeah? Second question.
Maybe, yeah. So
Thomas, please go ahead.
The second was around the margins. I mean, we have very good margins, and obviously you saw the EBITDA ratio, but I don't think we don't go more into details than that level.
Okay. And how many units? How many units do you ship every year? Or how many do you put in?
Your third question, I had a quick look and it's around.
We don't talk about that. We don't go into details.
Okay, that's fair enough. Just to get an idea of the overall market, because clearly it is all very specialized and bespoke stuff, just to give some sort of idea. But anyway, fair enough. Thank you.
But the average, and you saw the price levels, obviously it depends a bit, and then you can take your own assumption. I mean, the price levels, and Ralf, you're to step in, but for a NEURO SWING, which is the brand we sell under, NEURO SWING included everything, the component part, that might range anywhere around $1,000 for one NEURO SWING ankle AFO component these days. And then, as we said, if we go into the bionic products, the price tags, you saw that on the slide, they go, they are closer to $20,000. But that's a bit the price range we play within.
That's fair enough. Thank you.
I think that we're slowly rounding off here today. Maybe I can just ask one very last brief question, hopefully, before rounding completely off. I could go on for another 30 minutes or so, I think, with questions. There are so many interesting topics here, but maybe just on the slide that you were showing on each of the neurological disorders, which one is the key here? And do you get reimbursements for each of them separately, or how does it work? Is it per disorder that you get it, or is it simply by sort of an assessment of the need for a product due to sort of inferior muscles in the knee and ankles?
Yeah, it's a good question. It's different. So, for example, it was very common to treat patients with polio, always. Polio, poliomyelitis. That was very common. And when we started our company, for all the other neurological diseases, we are more or less not treated because of the poor quality of the existing products. So people with spinal cord injury, for sure, they were sitting in the wheelchair instead of they got orthoses, old orthoses, but these orthoses were bulky, they broke, they were not able to help really. So they were not used, and therefore they were not described anymore. Now there are totally different possibilities, and doctors and everybody starting to prescribe people with spinal cord injury with these products. Same, for example, with stroke. Stroke patients almost never got treated, only with very, very poor products, same thing.
And in that moment, when they got a new good product with highly developed from us, that is a new world. So it's coming step by step, so we have to do a lot of public relation work, what we are doing already, and stepping into these fields. So biggest market, that was your question, I think for sure is stroke. If we are only focused, would be focused on that market, it's incredibly huge when we only get a small percentage of these patients treated with a good treatment.
The reimbursement, the reimbursement is always per solution. It's not per indication. It is our O&P customers that claim these amounts then from the reimbursement, similar to prosthetics. Most of it, that was another question before, most of it is, most of the sales are just reimbursed channels or solutions today.
All right, I think we are a little bit over time. Thank you so much, Jörg, Ralf, and Thomas for spending the time here with us today. Super, super helpful. Appreciate it, and for those who cannot get enough of Fior & Gentz, I have put the Instagram link in the chat here if you want to look at it afterwards, but thank you all, and thank you guys.
Thank you. I also would like to say, just have a look also on our webpage shortly, if you really have the time, if you would like to get a little bit of feeling also about products and what we submit also to our customers and to our patients. Quite interesting, I think. Okay?