Wei, and I'm the analyst covering Embla at SEB. And today, we have a guest, David. David is vice president for the market access function of Embla's U.S. operation. And David has many years experience in the U.S. patient care business and also the deep knowledge in the U.S. reimbursement system. And I think it is now a pretty interesting time to discuss and to gather the knowledge about this U.S. CMS reimbursement reform. And, David, thank you very much for being with us today. And if you can maybe start to introduce yourself-
Yeah
... and then your current role and at Embla, and then I think you have also some interesting slides to share.
Yeah, absolutely.
Yeah.
Thank you.
And then we'll do a Q&A afterwards.
Fantastic.
Yeah, our-
Thank you.
Yeah.
Thank you, Wei.
Yeah.
Appreciate the introduction, so I'm very excited to talk to you all today about these new changes in Medicare, and the impact that we think they're gonna have in the-
Mm-hmm
... short, medium, and long term on the orthotic and prosthetic marketplace. As Wei indicated, I'm gonna start with just a few quick things about myself, so you know who I am and why I was the one chosen to talk to you all today. My name is David McGill. I'm the Vice President of Market Access here in the Americas. I entered the world of orthotics and prosthetics not because I had a lifelong dream to be in orthotics and prosthetics, but because I actually became a user of these devices. So I started my career in the mid-'90s, actually, as a lawyer. Practiced law here in New York State, where I live. But shortly after becoming a lawyer, I was involved in a car accident, and I lost my left leg above the knee.
I was trying to push a stranded car off the road. I got hit by somebody from behind, crushed between the cars, and I woke up in the hospital two days later with my left leg amputated above the knee. And as you might imagine, this had a pretty significant change on my outlook on life generally, and thinking about why I do what I do. And I very quickly learned that I didn't want to stay and practice law for the rest of my life. And that led me, in 2000, to co-found and co-own a prosthetic facility here in New York State. And as a lawyer, my background had been representing insurance companies on the one hand, and representing doctors and hospitals in lawsuits against them on the other.
So I had this interesting mix of insurance law experience on the one hand, and how to break down a medical file and understand medical issues in a complex way, on the other. And that ended up sort of being the focus of my work when we started our O&P facility. I was running the operational side of that business, and I was specifically focused on: How do we create access for our patients who are getting denied access? So when a health plan is saying, "We're not gonna pay for item X," how do we make sure they get access? How do we win that appeal? And so patient by patient, claim by claim, appeal by appeal, we developed a reputation for being able to get our patients access to different technologies that other prosthetic facilities couldn't at that time.
And I did that for a number of years, but then, ultimately decided I want to do something that's beyond patient by patient, claim by claim, denial by denial. I want to try to have an impact at a larger level, at a national level, in the world of prosthetics, and that led me to Össur, one of Embla Medical's companies, and I joined Össur in 2006. While here, I co-founded, or I founded our legal department in the United States. We had no legal department in the U.S., so I founded that, while also leading our reimbursement efforts, and that joint legal and reimbursement function was something I did for a number of years here. In 2018, I was asked to be the first leader of our patient care division in the United States.
That's now operating under the ForMotion brand. And I did that for four very exciting years, as you might imagine. You know, 2018, I start late in the year, 2019, great first year, and then COVID hits. So it was really exciting and different, and not what any of us had planned for, but learned a lot over that four-year time period on the patient care side of our business, and then in 2022, stepped back towards sort of my core competencies and developed, and now lead the market access function here in the Americas. So that's how I got to where I got today and why I'm talking to you about these Medicare changes. So if we go forward one slide, what I want to talk to you about today is, first, give you kind of a bottom line up front.
I want to walk you through what the main changes are, and if there's one thing that I want you to take away from the presentation as a whole, it's this: the Medicare coverage expansion that just took effect, this went into effect on September 1st. This coverage expansion is the largest expansion and most significant expansion of coverage that Medicare has created in the last quarter-century. There's nothing comparable to it in the last twenty-five years, and so that's the biggest high-level takeaway. Now, if we look at the specifics here, there are three things that I really want to emphasize. First, kind of the headline-grabbing news, when this was finally published, was there are now lower activity patients, patients who are less mobile, with a transfemoral above-the-knee amputation.
So if you're a less mobile transfemoral amputee, you know, for the first time, can get access to more sophisticated higher tech, higher reimbursing solutions, in particular, microprocessor knees. This is the headline that everyone has been talking about. This is not the big surprise of the news. This is sort of, it's been known since January when they published the draft of this, that this was the likely outcome and the hoped-for outcome. So that's, that is the bulk of what people have focused on. The second thing I want people to be aware of, though, and slightly less talked about, is those same less mobile transfemoral patients who are getting that microprocessor-controlled knee, that more sophisticated knee technology, those same patients now, in some instances, subject to certain criteria, can also get access to higher functioning, more sophisticated, higher reimbursing prosthetic feet.
So there is some subset of this population that's getting access to MPKs, that will also have the ability to access higher tech feet as a result of this. The third thing, and the last thing that I want to emphasize in this bottom line, right up front, element of the presentation is this: it's not super well understood, it hasn't been talked about nearly as much, but outside of this lower active patient getting access to higher tech knees and feet, there is another policy change that affects all lower extremity amputees. So not just that lower active transfemoral amputee, we're now talking about every lower limb amputee, above-the-knee amputees, below-the-knee amputees, applies to all claims, and that is an update in what are called the functional level characteristics. Medicare has long had functional levels describing different types of patients and their activity levels.
I'm going to walk you through that in a few minutes in a bit more detail, so you can really see how it works mechanically. But the important thing to understand about these functional levels is that they have historically tied directly to the reimbursement codes describing different types of technology. So in the loosest possible terms, highest level, what this has meant historically, lower functional levels, less access to high-end technology. Higher functional levels, more access to higher-end technology. These new functional level characteristics that have been published have provided a level of clarification and a kind of clarification that we think is going to have the effect of shifting some subset of amputees up in functional level, meaning that their access to more sophisticated technologies will increase over time.
This is a really important change, and again, to clarify, it applies to all lower extremity claims, not just to those that the main headline, MPKs for less mobile patients, would imply. So those are the three main things that the coverage expansion does. Now, having said that, I'd like to turn just for a moment to sort of what the current state of the market is, both from a payer landscape perspective and what the bionic marketplace, in particular, looks like. So if we go to the next slide here, the first thing that I'd like people to focus on, on the top part of this slide is on the far right side of the screen, and that is that pie chart that shows that for Embla Medical, 20%-25% of its prosthetic sales are bionics.
These are the more sophisticated technologies, like microprocessor knees. And specifically here in the United States, we've seen very strong growth in this segment over the last two years. That's before the coverage expansion took place. So as we look at a product segment where we've seen strong growth for a few years now, and then we look at this coverage expansion, the mid to long-term growth opportunity here looks really promising. So let's shift from that to the payer landscape, and I want to walk you through a few different elements here on this slide. What you're seeing as you move from left to right, different payer types, public payers to commercial payers, and you see those big percentages there. Those percentages represent the percentage of Americans in general, insured by each of these payer types.
So this is not what the average mix looks like in an orthotic and prosthetic facility of patients. This is just the population as a whole. But if you focus in on Medicare, on the left side of the screen, you see that while Medicare as a whole only insures about 15% of the U.S. population, in the average O&P facility, it's closer to a third. It's 30-35% in most prosthetic facilities. So as we talk about the coverage expansion that I just walked you through at a high level before on that previous slide, if you look at that coverage expansion and say, "What's the near-term impact?" It's with this Medicare population. As I said, the new guidelines went into effect this week. This is now live from a coverage perspective.
What that means is that the short-term opportunity sits with Medicare, which represents on average 30%-35%, roughly a third of the average O&P's patient base. That's the exciting short-term opportunity. Now, as you slide across and move into that commercial payer space, you see commercial payers account for more than half of patients that go to the average orthotic and prosthetic facility. Those percentages, by the way, those are the national percentages, they line up pretty well with our estimates on what happened at O&P clinics as well. You got more than half of the patients insured by commercial payers. The relevance of this is that commercial payers do not have to follow Medicare policy. Medicare policy is something they look at.
They often integrate it into their coverage policies, but they don't have to follow it, and history teaches us that they do tend to follow it, albeit with lag time. We see kind of a trickle-down effect of Medicare coverage changes or policy changes into the commercial market... And so when we talk about a meaningful mid to long-term growth opportunity created by Medicare's coverage expansion, the reason we say that is because more than half of the patients are insured by payers who are probably going to follow Medicare's requirements over time here. This will bleed in, and the reason for that is commercial payers tend to update their coverage policies once a year, maybe once every other year. And so that's one of the reasons for this lag time. So that's why we say mid to long-term growth opportunity.
The biggest part of the patient population covered by these commercial payers, that's where we're going to see this bleed in. Now, a few other quick points just relating to payers in the United States. The first is that Medicare codes and fees are the same codes and fees that commercial payers use. So Medicare's basically reimbursement system is the one that has become the payment system from a code and fees perspective for everybody. But commercial payers are not required to adopt Medicare's exact fees. So Medicare says the fee for an item is $1,000. Commercial payers typically base their fee schedule off of Medicare, but they also try to negotiate lower rates for those same codes. So the impact of this is that if you talk to an O&P business owner, that owner would say, "Medicare is typically my best payer.
They have the highest reimbursement rates, and my commercial payers pay a percentage off of Medicare, and the range of that is as wide as 5%-50% below Medicare, but most commercial payers are sort of sitting in a 70%-80% of Medicare. They're discounting another 10%-20% to maybe 30% off of Medicare. 30 would be on the lower end of that spectrum, so it's important to understand that different payers pay different amounts, even though Medicare sort of sets the standard for everything, so let's turn from the discussion of those growth opportunities, medium to long term, and that payer landscape. Let's turn now to this discussion of the K-levels, because this becomes really, really important for that third point that I mentioned on the very first slide.
So I talked about the publication of functional level characteristics, and functional level characteristics supplement what are called the functional levels or the K-levels. These K-levels describe different types of patients, and as you can see here on the screen, K1, K2, lower active patients. K3, K4, higher active patients. Before this coverage expansion, as I alluded to at the beginning, K1, K2, you couldn't get access to higher end, higher reimbursing devices. K3, K4, you could. So that's the way it has always been. This new functional level characteristics set of lists sort of sits underneath each of these K-levels. So for K1, here's a list of activities that we think a K1 patient can engage in. For K2, here's a list of activities that we think that patient can engage in. Same for K3, K4.
Medicare never has published a list like this before, and the really interesting thing about the list is, as I alluded to, we think it's going to have the effect of actually shifting a subset of all patients up a K level. Let me give you just a few quick examples to illustrate why we think that's the case. So historically, a K2 patient is somebody who's a limited community walker. They can handle curbs and stairs, as you can see on the screen in front of you. The new list of functional level characteristics says that this K2 walker may require the use of a wheelchair extensively outside of the home. If you had asked a prosthetist before the functional level characteristics were published, "Hey, we've got a patient.
They use a wheelchair a lot, especially outside of the home," they would not have said that patient was a K2. They would have said, "That's a K1 patient." If you look at the K3 segment, the functional level characteristics list includes the ability to traverse three to seven stairs. It includes the ability to perform dual ambulation tasks. It performs the ability to open and close doors.
If you had said to a prosthetist before the functional level characteristics got published, "Hey, patient can navigate three to seven stairs, patient can open and close doors, patient can walk and talk at the same time, can walk and carry a bag or a box at the same time," they wouldn't have said, "That's a K3 patient." They would have said, "Oh, that's a K2 patient." K2 patient can open and close doors, can handle three to seven stairs, can walk and talk at the same time. And if we look at K4, the new list of functional level characteristics says that the patient can act as a caregiver for another person or performs home maintenance.
And if you'd asked a prosthetist before publication of these lists, "Hey, patients performing home maintenance, patient acts as a caregiver," they would have said, "Those are K3 activities." So by clarifying the kinds of activities under each functional level, Medicare has, I think, for prosthetists, sort of redefined those K-levels upward a little bit. Prosthetists interpreted these K-levels historically, more conservatively than what Medicare's final publication suggests. And what this means is that some subset of all of these patients are going to potentially slide up a K level. And why is that important? Remember what I said at the beginning: lower functioning, lower K-level patients, less access to higher-tech solutions, higher reimbursing devices.... And the big thing to really look at here is the switch between K2 and K3.
If you look at the bottom part of this slide, what you see is, you know, the breakdown between K2 and K3 patients just in terms of number of claims per year, it's roughly the same. 45-55, K2 to K3, almost 50-50. It's right in that range. But if you look at where the revenue is, only 10% of that revenue sits with K2, K1 users. 90% of the revenue from Medicare, the payments by Medicare is with that K3, K4 population. So as we see patients shift from K2 to K3, their access to technology changes significantly, as does the reimbursement opportunity for that prosthetic facility and the functional outcome for that patient. So that's the really important element here. As I said, this isn't limited to K2 patients, K2 transfemoral amputees getting microprocessor knees.
This is across every lower extremity claim that an O&P is going to file. This, these new coverage criteria apply to everything. Why is that important? Below-knee amputees, transtibial amputees, are roughly three-quarters of the amputee population. People like me with an above-knee amputation, 25%-30%, roughly, of the number of amputees out there, which means that 75% of the market is going to be affected by these coverage, these functional level characteristics addition to Medicare guidelines. So we're very excited about that opportunity, again, medium to long term here. With all of that being said, those are the main things that I wanted to cover in my slides, and, Wei, I'm going to turn it to you so that we can do the Q&A.
Great. Thank you very much for the great presentation. I will just start with one question, and I'll give the opportunity to the audience. David, you mentioned that the private payers, you're saying it's normally one to two years, like, lagging, and so it has to be when it comes to time when they review their policy. But it's been a few months, but based on your knowledge or interaction with those private payers, I mean, have you seen any sort of... What has been the response, and what is their sort of a view on this change? I mean, could you maybe elaborate a bit?
Yeah. So we expect... and to be clear, what I was saying was that private payers tend to review their policies every year to two years. It doesn't mean that they're going to automatically adopt Medicare's new guidelines.
Mm.
on the first go-around. So it, some payers, they will wait longer. There are payers that are notoriously-
Mm.
... resistant to coverage expansion, and so, for example, you know, we expect there will be some payers that this might take three, four years before they adopt it. Other payers will move more quickly. In general, what we expect is that private payers react to coverage expansions negatively. Private payers don't love all of a sudden creating more payment opportunities at higher cost, and so that's why we have historically seen the resistance, but we do see them fall in line, and maybe just a few quick illustrations here, to bring some specificity to the point. In 2000, when I opened my prosthetic facility, we opened it in November of that year, and in January of 2001, the new codes for microprocessor knees went into effect.
All of a sudden, we were in this space where two months after we opened, this whole new technology is available. We started filing claims with Medicare, and Medicare started paying those claims immediately. No lag time, we were able to simply work through Medicare quite easily. Commercial payers immediately said, "Experimental and investigational. This new technology is experimental and investigational, we don't want to pay for it." It took some time for them, especially waiting for clinical evidence to come in, it took time for them to change their coverage positions. When I joined Össur in 2006, one of my first tasks was get a reimbursement code for Össur's Proprio Foot, microprocessor-controlled ankle-foot system. A few years later, I had to get a code for Össur's Power Knee.
We were successful ultimately in both of those efforts, and we saw some private payers immediately update their medical policies to allow for coverage of it, of those devices, and some private payers, it took a while, and so our experience tells us here there is going to be lag time. They don't embrace coverage expansion. They don't sit here and say, "Isn't this wonderful?" They are resistant to it, but this is why we continue to frame this as a medium to long-term opportunity. What we do know is, over time, they do follow Medicare policy. There's going to be too many patients receiving these devices for the commercial payers to ignore it and say, "They- it's- this is totally irrelevant. We refuse to do it." We do expect this positive impact, but again, medium to long term, phasing in over the next several years.
Right. Very, very clear and very helpful. And any question from the audience? And if you have any question, please raise your hand or just unmute yourself. Then I'll do the next question here is. Oh, okay, there is a question from Sean.
Yeah. Hi, it's just a clarification.
Yeah
... because, I mean, you said that Medicare, was it 15%? But in the clinics, it was 30%. I just don't understand what-
... Sure. Yeah, let me explain that again. Sorry that I didn't make that clear. So on that slide, what we were showing was, in the big numbers, what we were showing was the insured population of the United States. So what percentage of patients in the United States as a whole are insured by each payer type? So 15% of Americans are covered by Medicare. That's what that was showing. But within an O&P clinic, the percentage of patients in an O&P clinic insured by Medicare is significantly higher. The reason for that is older patients, more vascular disease, more obesity, more diabetes, so you see a higher level of amputations in that population than you do in the population at large. You've got about 30% of the average O&P patient base being insured by Medicare.
So if we talk about the American population as a whole, it's 15%. If we talk about prosthetic facilities, specifically, Medicare represents about 30%-35% of their patient base. Does that clarify the issue?
Yeah. Yeah, just would it be fair to say then that Medicare might be 15% of the population, but it's more like 30% of the addressable market for implants?
Exactly right. Exactly right.
Okay.
Correct.
Thanks. Yeah, next question from Peter. Please unmute yourself.
Yeah. Thank you. Thanks for doing this.
Yeah.
I just want to ask you, does this change come with a budget? I mean, capping the number of amputees, like, K2 amputees that can be fitted with a bionic knee?
No. So Medicare, when it creates coverage policy like this, there is no specific budget attached to it. There is no ceiling that's addressed. What Medicare will do over the next several years is they will monitor what is their spend and how has this shifted their spend. But there is no cap on this, so there is no ceiling, and there is no formal process even for Medicare to do that. If Medicare is going to control costs, ultimately, it's going to do it in other ways, not through anything that's sort of built into this coverage expansion.
Okay. And do you have an estimate of what proportion of the K2 patients will be eligible to get this bionic-
It-
-product?
Yeah, no, it's hard to say. There are a lot of criteria here or a lot of characteristics that could come into play, so we don't have a good feel for what that looks like. I will tell you, just anecdotally, that there are some prosthetists who historically have been very conservative about fitting less active patients with MPKs. I'll get into a layer of complexity here that I sort of hesitate to do, but I think in order for you to get a clear picture of the K-levels and how they work, it's important to do this.
So the K-levels have always included not only with the definition of what the K level is, but the coverage criteria are that if the patient is that functional level or has the potential to be that functional level, then they're eligible for products in that category. So, for example, if you had a person who today was not a K3 patient, but they had the potential to be a K3 patient, under historical Medicare policy, you could get access to those K3 components.
Mm-hmm.
That potential element, prosthetists have dealt with it differently over the years. I think before 2011, prosthetists were very aggressive in how they viewed this. And then in 2011, Medicare started auditing in a very aggressive way and clawing back payments from prosthetic facilities. And at that point, many prosthetists basically said, "The word potential functionally no longer has any meaning, and I'm not going to deal with potential, and I'm just going to... If there's any question, I'm putting the patient in a lower K level." So, the reason I'm hesitating to give you an exact answer or try to even estimate one is that we don't really know what percentage of the market has been more aggressive and less aggressive.
It's fair to say that some percentage of K2 amputees are now going to have access to these K3 components, whether that's 60%, 40%, 20%. It's really just going to be borne out by the data in the coming years, but we don't have a clear view on what that looks like.
Okay. Thank you.
Henrik?
Thank you for a really interesting presentation. My question is to understand this dynamic, how fast will it go? Is it something you will start to see over the next quarter, or will it take years before you really start to see the impact?
Yeah, good question. So I think the answer is it depends by payer type. The short-term impact with Medicare, you'll start to see that in Q4 of this year, but more broadly, early next year and across 2025. But as early as sort of middle Q4 and late Q4, there will be some K2 transfemoral amputees getting access to K3 devices, and you may see sort of this shift upwards in the broader lower limb amputee population because of these functional level characteristic lists that have been added. That'll happen with Medicare. Like I said, roughly one-third of the average O&P's patient population, that's going to happen immediately.
When you look at the commercial payer space, when you look at the Aetnas and the UnitedHealthcares, and the Cignas of the world, they're going to adopt these coverage requirements more slowly, and so we expect that to phase in over several years, and it just depends by payer. What I can tell you is, historically, Blue Cross Blue Shield plans tend to be early adopters of Medicare updates, whereas maybe the Aetnas and UnitedHealthcares tend to take a little bit longer. But there is no fixed rule here, and that's sort of an anecdotal thing. There's nothing scientific about it, but we will see some plans, some commercial health plans, as early as twenty twenty-five, update their policies, and we will see some wait a few years before doing it.
One other point that I should clarify here, specifically around those functional level characteristics. The functional levels apply across the entire claims universe, whether you're Medicare or commercial. And so it's going to be very interesting to see whether or not these new lists of functional level characteristics automatically just get updated by the commercial payers themselves, as they keep going through their update cycle without a whole lot of thought. Because for them, this is just K-levels. The MPK piece of this and K2 transfemoral patients access to MPKs is something they're likely to look at with a bit more scrutiny. The functional level characteristics, they may just adopt wholesale because it's part of the core claims process that Medicare has set up that they follow.
So we might see faster uptake, specifically in the commercial market, of functional level characteristics than we do of the MPKs, where we're talking that mid to long-term opportunity.
Renny?
Yes, thank you. How can you work with this? As in, what sort of strategies can you implement to get the best out of this?
Yeah, that's it. That's where actually, we have spent my department has spent a lot of time focused on that exact issue. So, I think where this becomes really interesting from a capitalizing on the opportunity standpoint is thinking about how this relates to the actual products in the Embla Medical portfolio that we sell to OMPs. And within our ForMotion, the clinics that we own, how do we educate our clinicians and our staff about these changes so that they can take advantage of them? Focusing first on the products. So we have, in the Embla Medical portfolio, two products that fit very nicely into this new market opportunity. The first is Össur's RHEO Knee, and the second is College Park's Icon, which is a new microprocessor knee that they just launched over the last, I think, 60 days or so.
These two products do. They work very differently. One of the interesting things about these products is that mechanically, they're different. The reason that's important is because they actually impact a potential K2 user in different ways. The RHEO technology is particularly good at initiating swing of the gait. When you take that first step, imagine that you are a less mobile patient, and you're standing, and you take your first step, what do you need the prosthetic knee to do? You need it to bend. You need it to go into swing phase easily so that you don't lose your balance in that first step. For the K2 patient population, in particular, this is enormously important.
One of the things we have been focused on over the last several months is looking comprehensively at what the clinical research shows about less active patients, less mobile individuals, and when they're most at risk. And interestingly, what we've learned is that population tends to fall the most during the first few steps of gait. It's not when they're walking and walking and walking. It's that first or second step, that's when they fall. And a knee that cannot release into swing phase easily puts them at risk. And so one of the characteristics of RHEO that maybe isn't talked a lot about in the K3 patient population, 'cause most of those patients are strong enough to get the knee to go into swing, no matter what type of knee they're using.
For the K2 patient population, we think RHEO Knee is actually really uniquely positioned to potentially solve some problems that not a lot of people have historically talked about. And we're going to be educating customers and our own sales force about that reality. With the ICON, ICON is built on a more traditional hydraulic platform, which is characteristic of most of the competitive marketplace out there. And those knees are built first and foremost for stability, stability, stability. Whenever the knee hits the ground, that knee is going to have resistance in order to prevent it from collapsing. And there is definitely a subset of that K2 patient population that wants that security and that needs that security. So when you take both of these knees together, we think we have a really nice range of opportunity to fit the specific needs of different types of K2 patients.
I will also just say briefly that Össur has another microprocessor knee that is going to be in much more wide launch as we head into the new year, called the Navii, and the Navii does a really nice job, by all accounts, based on the early results we're getting back from the field. It does a really nice job of balancing this initiating swing easily when that patient takes their first step, and more security in situations where they need it, so it might be kind of a best-of-both-worlds product, and so we think there's real opportunity with the Navii in the K2 population when that product goes into more widespread launch here in the United States. As we talk about capitalizing that opportunity now also within the patient care segment, most of it centers around education around the new requirements.
In particular, there are several new things that a prosthetist has to document in order to get approval for that MPK, for that K2 patient. Making sure that prosthetists are aware of what those requirements are, how they work, and frankly updating the clinical staff at O&Ps as well, sorry, the administrative staff at O&P, so that they understand those requirements, is gonna be very important. We don't think that these new coverage requirements, by and large, are gonna be very hard to satisfy in terms of just if you document them all, we think claims will get authorized reasonably easily. We do know Medicare will scrutinize these claim submissions closely, and so if there are eight requirements and you only hit six of them, they will deny that claim.
So the biggest barrier here is just gonna be prosthetist awareness and understanding of what the full list of requirements are, and making sure that they're documenting each and every one of them. And this is particularly important because we know from both our own clinics and from clinics around the United States, the electronic medical record systems that they use, they have not updated to include these, reminders of specific, coverage requirements in line with the new coverage policy. So this is all gonna have to be done manually. Basically, a prosthetist is gonna need a checklist that they're looking at outside of the EMR to make sure that it all gets into the EMR, 'cause the EMRs have not updated yet.
So that's where we see the primary issue, from a patient care perspective, but that's a straight educational issue, and we've already done education in our own clinics, our ForMotion clinics. We're rolling out education in the coming weeks to external customers, and we think that this is something that they will very quickly adapt to and be able to satisfy.
Thank you. Henrik?
I have one question, and maybe you will not answer, but could you talk a little bit about the competitive landscape now here? That could be interesting to hear if you're ready to really get this opportunity now, yeah, if you have-
Yes.
... the right products and.
So in the competitive landscape at large, you know, there's obviously a host of microprocessor knees out there. The first company to market in the microprocessor knee space has historically been the largest, which is Ottobock. We believe that our knees stack up well against what Ottobock has to offer. We believe, as I said, that between Icon, College Park's knee, RHEO, Össur's current knee, and Navii, as it hits the market, in the coming months more broadly, we believe that we have a nice portfolio of products, to work against the competition with. And we also believe that the narrative around what K2 patients need and why they need it in the MPK space has been only partially defined.
We're gonna be spending a lot of time and energy in the coming weeks and months trying to clarify actually what the needs of that K2 patient population are. This is something we should do better and can do better in, and so we think that combined with the products we have and a clearer narrative about what they offer to the K2 population, that we can be competitive in this space against Ottobock and others.
More questions? Actually, I have a question here.
Yeah.
David, you mentioned that the private payers normally they provide a sort of copay, a less reimbursement fee than the Medicare.
Mm-hmm.
But to capitalize the potential in those channel, would you consider that you probably will also be willing to offering some price discount that if to apply?
I'm certainly not an expert on our discount strategies on the sales side of our business, but what I'll generally say is that it is very common practice in orthotics and prosthetics to provide discounts to customers based on a whole range of criteria. Every product manufacturer does it. So the list price of a prosthetic knee, of a microprocessor knee, is frequently not the price that a customer is actually buying it at. And I can tell you that I know that as part of the Embla Medical restructuring at Össur, I think focusing on pricing and how we price products and why we price products the way we do is something that we're looking at more closely and think we can do a better job of.
But it is common to discount on across a whole range of products in prosthetics as a manufacturer, and I don't expect that to change in any material way as a result of this coverage expansion.
Clear. And then, just a clarification. You mentioned that the reclassification will affect or move the patient group up. But you're just looking at the K2 and K3 patient in total. Would this reclassification increase the addressable market, or it basically will be the same? Because what I understand is that, you know, some patients will be reclassified in, and then some patient will be out.
Essentially, the size of the market addressable market, the total number of patients doesn't change as a result of the functional level classification update. What may change is the percentage of patients that are currently classified as K1 or K2, versus the percentage of patients that are classified as K3 and K4. Where I'd expect to see the most significant shift there would be between that K2 and K3 patient population. Historically, there would have been more patients classified as K2 than there will be after the implementation of this new rule. We will see a shift upwards of some percentage of historical K2 patients into that K3 category.
One of the reasons that becomes important, specifically around microprocessor knees, is, you know, even though K2 patients now have access to K3 microprocessor knees, if some of those K2 patients now you just classify as a K3, you don't have to satisfy these new coverage criteria that I was just talking about a few minutes ago. You don't have to go through sort of this multi-step process-
Mm
... to document all of these new things. So there will be less friction from a claims perspective as a result of that shift, specifically within that MPK product category.
Mm.
So again, that results in administrative efficiency for an O&P, less internal cost, and that should hopefully impact their ability to operate more profitably.
Yeah, so is it fair to understand that the total addressable market will not change but-
Correct. Correct
... it will be easier for some patients to get an MPK?
Exactly. Exactly right.
Thanks. Thanks for clarification. Any more question from the audience? We have time for one last question. Great. Then I would say thank you very much, David, for the time, and it's very helpful and very insightful.
Thank you. Really appreciate the opportunity. Great to speak to everyone today. Thank you all for your time.
Thank you, everyone.