Welcome everybody to today's live call together with Acarix. Besides myself, we have with us the Acting CEO, Fred Colen, as well as the CFO, Christian Lindholm, and we're going to dig deeper into the Q3 report released earlier this morning, as well as the company's outlook, which is currently commercializing its CADScor System in the US. Without further ado, I'm going to hand over to the Acting CEO, Fred Colen.
Thank you, Philip. Much appreciated, and good afternoon, everybody in Sweden. Here's Fred Colen, the Acting CEO of Acarix, and I'd like to start with a short presentation. I will give you an update on the corporate side in general, and then Christian will give you some more details on the financial side, and then we'll have a short Q&A session in the end as well. Let's get started today. At number one l et me move my slide. Number one is the disclaimer. It's important always to understand what we talk about and in the context of which we present. It's very important that you rely on your own research before you make any investment decisions. That's the long and short of this.
The other part I'd always like to say is nobody can predict the future, and I cannot either, so there's always uncertainty in forward-looking statements. But please keep this in mind. Let's talk about Acarix. I think the headline here, in terms of our mission statement, is quite significant. We are on a mission to transform early cardiac diagnostics. And then you see a little bit more of the details about what this is all about, which I'm sure most of you are already very well familiar with. Transforming early cardiac diagnostics, meaning transforming a clinical practice, is something that, you know, is certainly achievable and is achievable with a very promising new diagnostic tool as we have, but it also takes time.
This is not something that you can do from one day to the next. It takes consistent hard work, continued, you know, energy pouring into this transformational process on many levels. And I'll touch base on a few of those while we go through this presentation. So that is our mission, and I believe we can be successful with it, but again, it takes time to accomplish that. Here's the background, and I think it's quite significant when you look at the data. There are a lot of patients that go to their family physician, their primary care physician, or an emergency clinic, and they basically complained about chest pain that is there, that has been there, comes up once in a while.
We were not talking about acute, chest pain, like a heart attack. That's obviously not what we're talking about. We're talking about more what we call chronic, chest pain, something that, is really starting to bother these patients, and they go to physicians to figure out what is this. And then the clinical reality is that in nine out of ten cases, it's actually not related to significant coronary artery disease. And so, these patients today go through a lot of, testing, or, you know, the patient, the physician takes a risk, of not doing anything, which is also not a good thing. It doesn't give you peace of mind.
Or they go through significant testing in the hospital, or they need to be moved over to a cardiology practice or to a hospital for more in-depth and more invasive testing. And so obviously, if there would be a good tool available already at the point of care, that can be used by the primary care physicians, as well as physicians in emergency scenarios, you know, this could be very meaningful. And so we do believe that this is a very promising proposition for the community. So what is CADScor? It is designed for an early and rapid cardiac assessment using acoustics and integrated computer processing. It's actually a very intelligent device. It works very well, but it's very simple.
It can be done right on the spot. Nobody needs to be transferred over to a different clinic or different physician. It can provide peace of mind to the patients rather quickly. And the flip side of that, by the way, I should also mention, which is that if you do have significant coronary artery disease and you get a high reading on the CADScor System, it actually elevates the importance of going through this additional test. So there are two sides to this coin.
One is that if you, if you really don't have serious coronary artery disease, it is a, it is a quick and easy tool, non-invasive, can be done right there at, at the, point of care, to give the patient peace of mind, and to avoid a lot of additional testing, which always takes more time. So it really has these benefits. But on the other side, if you do have a serious cardiac, coronary artery disease, you can actually be elevated in the importance of going through additional testing, therefore, you know, reducing the risk to these patients. So it, it actually provides a benefit on both sides. And by the way, when I talk about benefits, I have been talking to the team a lot about
You know, we talk a lot about benefits to the healthcare system, and we also need to put together benefits as it relates to the patient and benefits as it relates to the physicians that are using the system. The team is working on that right now, because I think we can actually provide for a broader package of where this is beneficial. You know, we are convinced that it's beneficial for the healthcare systems, but not only there, it also has benefits for the physicians that use the system, as well as for the patients. We are working on getting that more sharply defined, and then also start to use that as a tool in our sales process. So again, it's. We are positioning this as a first-line diagnostic aid.
So, you know, you basically go to the primary care physician. Primary care physician probably wants to do a regular ECG, but that really doesn't tell you much about any potential coronary artery disease, and therefore, we would like for patients that have these coronary artery disease symptoms, we would like the physician to use this device as a first-line diagnostic aid. It's not something that has only been used on a few patients. When you see the third bullet point, we have already used this on about 29,000 patients worldwide. It has been around for quite some time. It's well patent protected, and there's a lot of sophistication behind it, something like 50 years of R&D.
So it actually, when you talk to the physicians about it and they really start to understand what it does, they're actually quite amazed how good this can work. Now, important also in the first bullet point is this so-called NPV value. So, you know, we basically are able to rule out a patient with significant coronary artery disease with a 96.2% level of certainty. As I'm sure you are aware, there's hardly any test that gives you a 100% certainty, and we specifically, in our clinical data, worked out that the certainty, the NPV certainty, is indeed in the range of 96%. So that's quite significant.
For the usage in the United States, in the United States, the American Medical Association, AMA, issued us in July 2022, a CPT III code, so that the usage of the system in clinical practice can indeed be tracked in the administrative systems. Again, this is a very nice picture to show you what we are trying to do, transform a clinical practice, again, to incorporate an early assessment of patients with stable chest pain. First-line diagnostic aid before any other diagnostic, if and when you have CAD symptoms, and you see that that's what we like to do, and insert it before you have to go through any more much more invasive, much more daring and much more sophisticated testing that also has risks associated with them.
For example, radiation, is associated with quite a few of these more invasive tests and other risks. So again, if you can separate the patients out and avoid patients that don't need it to go through it, great. And if you can find the patients that actually do need to go through it because they are really at risk, even better for those patients as well. So initially, and this is a little bit of history here, initially, the company started with the CE Mark process and has CE marked in Europe, and developed sales in Germany and what we call the DACH countries, Germany, Switzerland, Austria, a little bit in the Nordics, and did some clinical studies in the U.K.
In about a year ago, a year plus ago, the company decided to really focus its attention and investment on the U.S. expansion. So really, all of our focus, to grow revenue, and to grow the company is focused on the United States. That is a big market, it has great opportunity for us to establish ourselves, but obviously, it will take time. You should also remember that, we have a U.S. FDA approval for our device, and that is an FDA De Novo clearance. But it was done with clinical data from Europe. And so we are really doing a lot of educational work in the United States to really become visible in the market. You know, that takes time.
When you do a U.S. clinical study, as part of U.S., FDA approval, you already start to establish some level of visibility in the U.S. market. That was not the case with Acarix. So we need to continue to really build momentum and visibility in the United States, which we are doing. That's what we are focused on. That is what we are investing in. Now, having said that, and you've seen the financial results, and Christian will talk about it, we had a somewhat disappointing Q3 quarter in Europe. We are well aware of that. We, I think, explained the reasons for it, and we are working hard to counteract those reasons for Q4. So we are not making additional investments in Europe.
We don't believe that's necessary, but we are certainly aiming at going back to the levels of revenue in Europe from about a year ago, because we think that should be possible, even with the infrastructure that we have today in the European marketplace. Now, as it relates to United States, since the company does not have any, you know, overall reimbursement approval from the United States CMS, the best entrance into the United States system is the VA. This is the Veterans Administration, the military side, so to say, of the United States. There are a huge amount of clinics in the U.S., where the Department of Defense, through its VA arm, basically takes care of all of its military personnel.
The Department of Defense, via the VA, is responsible for all of its members. So this has nothing to do with any, you know, generic U.S. CMS-wide reimbursement system. It doesn't matter because VA has to pay for their soldiers and for the veterans in any case. So this is why this is a perfect opportunity for us to enter. The flip side of that is that the VA is notorious for being extremely slow. They are an extremely slow organization. They are not like the quickest moving forward with new things. They are very conservative and not very fast-moving.
But as you've heard, we were able to work with one what I call beachhead VA system in Southeast Louisiana, and they had ordered systems in February of this year. Then there was a little bit of a pause, and we actually went back and spent a lot of time, since I have been with the company, to really trying to figure out what's going on at the VA in Southeast Louisiana. And we found out that they did have the correct overall standard operating procedure in place to utilize the CADScor System in their VA system.
However, there were some issues with the implementation of that SOP in their electronic record system, their ERP system, which also includes the ordering by physicians to the nurses to implement certain overall SOP requirements. We have worked very hard on that during the months of October. We've also trained a lot of additional personnel at the VA in Southeast Louisiana, and things are moving forward now. They are in the process of modifying their ERP system, and we are waiting, like, any day to get confirmation it's completely through. We have the approvals of all the physicians at that particular VA to indeed modify that ERP system. Everybody is in favor of it. It was just some unfortunate mistakes that were made.
I'm quite optimistic that this will indeed move forward, and we'll, we'll be able to announce rather soon, I hope, that it's completely modified and therefore will be utilized a lot more than it has been in the last, call it, half year. So I think that's really good news on the VA side. And the VA is also important, not just only, you know, as a VA organization, but in general, because it has a radiating effect elsewhere in the U.S. market as well. As you know, we have, we made good progress. Here is a little more detail on that, and I can tell you that, on top of everything else, you see on the bottom of the slide, a Q4 so far, that Southeast Louisiana VA has indeed reordered patches now twice.
So, as a confirmation of what I just explained to you, you know, we are actually quite optimistic that we will now really see a continuous business and a growing business at that particular VA. The other VAs, you're probably wondering what's happening with these other VAs going on. The other VAs, we have two or three additional ones in the pipeline in different locations that are also very interested in implementing that same standard operating procedure that we have established at the Southeast VA in Louisiana. However, they are waiting for new budgets. The VAs are notorious for budget cycles. At the end of the budget, they all clamp down.
They wanna make sure they have enough money to get through the end of the year, and then they really wait to get a new budget before they make any new commitments to new items, of which the CADScor System would be one. They really need to invest in the CADScor System first before they can realize savings, and that's, you know, really, really what's behind this. So that's the update on the VA. And then, as it relates to other initiatives, we are really getting close to working with one particular IDN, in the United States. We have very, very advanced discussions with them at the highest level now. The physicians are on board.
It's hopefully a matter of a few more weeks, and we hope to be able to get to an agreement with one particular IDN, a large integrated delivery network in the U.S., on the general population side. On the payment side, we are getting paid by some insurance companies, not by all. Sometimes they pay, sometimes they don't, then we have to appeal. Sometimes they pay on appeal, sometimes they don't. So this is an ongoing, continuous battle for payment that we are very engaged in and also spend quite some time on. So I think that's all from my side at this point. So Christian, why don't you talk about the financial side?
Sure. Thank you, Fred. So, if you go to the next slide.
Yep.
As in previous presentation, I will start to talk about patch utilization, and that is actually one of our most important key figures that we follow weekly on a customer level, and also patch utilization will drive both the company's growth and the profitability in the long term. Globally, we see a fluctuation between 0.5-3.3 patches per day and per system as it looks today, depending on the market and of course, depending also on the size of the customer. Based on the customers that we currently have, we can definitely see and conclude that the average utilization is and will be higher on the U.S. market compared to the European market.
In total, we have sold over 31,000 patches as of today, and that's an increase of 9,300 patches compared to the same quarter, 2022. If you could go to the next slide, please. Looking at the rolling twelve-month revenue, we see an increase of 31% from SEK 5.1 million in Q3 2022 to SEK 6.7 million in this quarter, 2023. If we divide our two markets, the U.S. accounts for 58% of the total revenue during the first nine months. We see also an increase on a quarterly level of 344% in the U.S.
At the same time, we see a decline in Europe, as Fred was talking about previously. This is, of course, an effect from our decision in 2022 to focus our resources and the liquidity on the US market. Next, slide, please. Looking at the total revenue for the quarter, and that amount to SEK 1,000,573, and that's an increase of approximately 35% compared to the same quarter in 2022. On a nine month basis, we see a revenue growth of 21%, and the revenues, they are generated from 14 systems and 1,900 patches that was sold during the period, and that's both in line with previous year.
If you look into the gross margin, we can see that we improved by three percentage units from 79% to 82%. That positive development of the gross margin is to increase sales in the U.S. market, where we have a different pricing model compared to Europe. Next slide, please. Here we are looking into U.S. specifically, and the revenues in the U.S. market increased by 236% the first nine months, while the quarter more than tripled. We sold a total of 10 systems and 640 patches in the U.S. during the quarter.
Looking into rolling twelve-month basis, revenue in the quarter increased from SEK 1.2 million to SEK 3.9 million, and that's an increase of 233%. We can go to the next slide, Fred. That's the last slide, and my last slide here shows the development of the earnings. For the quarter, we show a loss of SEK 17.2 million, compared to SEK 20.7 million in the same quarter previous year. What we can say here is that we continue to be extremely cautious with both liquidity and the cost in the company. We are really scrutinizing everything we do, and we make sure that the majority of our cost is being allocated to sales-related activities in the U.S. market, as we have said before. And that's, I think that's an important message. So that's it. That was quick. And with that, I hand over to you, Fred, to continue the presentation.
Yes, thank you very much, Christian. Very well stated here. So this is the team that we have, and you know, I like to point out that on the US side, you know, we have, you know, on the bottom right, you know, Jennifer, who is the head of marketing and communication, but mostly marketing. And I call that downstream marketing sales support. She is dedicated to that work. Karma is dedicated to training and onboarding, and she works with all the customers, also in particular, as it relates to getting payments. And then Jennifer Mattson, she is really important on the medical affairs side.
One additional thing that I'd like to mention here is that we are also gearing up to do some, what I would like to call, low-cost actual real-world clinical studies in the United States that are mostly driven by physicians, and we, you know, financially support to some extent, but not very expensive. So, we are actually looking at, at the moment, two different what we call the physician-initiated clinical studies that we think are gonna be quite interesting and good for us because they will not so much focus on the performance of the system, but more on how does this system, when you implement it in the clinical practice, how does it transform the clinical practice in real world, and how does it actually do compared to the historical situation?
So I think that's all, very interesting. So, before we get to the Q&A, here is the, here's the final slide. I can tell you from my perspective, it's all about the, the top line. It's all about revenue, it's all about sales, sales, sales. That's what we are focused on, and we do that very well as a team. I think I touched base, on a few important things, in particular, the VA and, our, our hopes to, to make a first inroad with a, with a large IDN.
I can also report that, we had an earlier press release on osteopathic physicians. We have a couple of those that are actually using our system, so they acquired it and, and are using it. We've gotten some good feedback from them as well. This is more in a preventative space, where they use it in their actual clinical practice to take care of patients' well-being. With that, I think that basically sums it up. Philip, I think we can go to the Q&A session.
All right. Thanks a lot for a good presentation. And, to start things off here, I actually wanna turn towards you, Fred. I mean, you have come in as acting CEO of the company. It would be really interesting to hear sort of from your point of view, what were your first interaction with the CADScor System and a little bit of your background, please.
Yes. So, you know, I am intrigued by the CADScor System. I think it has a very good promise to actually become a first-line diagnostic tool for patients that have CAD symptoms, and to rule out the ones that really don't, at least a certain portion of them. I think it is a promising system, and it deserves attention, and it deserves energy and investment to actually get it going, in particular United States. So I'm actually very intrigued with what I see. I also see that physicians in the U.S. are really interested in it, in particular, the primary care physicians.
They really do like it because they are able to do something themselves right on the spot, instead of thinking about: What shall I do with this patient? What kind of additional tests can I still do? They have limited amount of test capabilities in their own practice, typically. And so they, they're mostly wrestling with, you know, having to transfer the patient over to another clinic or to another cardiology group. And so, you know, if you are able to give them something where they can do more on their own, they like that. So, so that is something I think that's going well. So it's very promising. For me, from my standpoint, I have been in medical technology for about 40 years. I came up through the technology product development side.
I have brought a lot of products to the market, very successfully, a whole range of products in my career. I've also been engaged on the sales side, in a lot of different companies, from start-up companies to mid-size level companies to very big companies. On the big side, I can tell you that I ran the cardiac rhythm management group of Boston Scientific, the ex-Guidant organization, for a few years, as the president and an overall division head. So that was an organization with about $2 billion of revenue on a worldwide basis.
I grew that revenue base in the years that I was there by about 10%, in a flat market, basically taking away from the competition through better interactions with physicians and better products. So I have quite a bit of experience also on the sales side. That is a very big one, but I also have been engaged with quite a few small companies and getting engaged in really developing early sales. I'm also on the board of two other European companies.
The one is called Xeltis, and one is called ONWARD Medical. So I'm involved in board work for those two companies. But you know, I had time to take on another opportunity like this. I felt bad for what happened to Helen, getting diagnosed all of a sudden with some serious stuff that she needs to take care of. She has a very, very good prognosis. It's very treatable, but, you know, she just needs to step back for a while. And so I was happy to step in and keep this going and keep the development of the product going.
Perfect. Thanks. So now I wanna change scope a little bit to the quarterly report, and I noted in the message from the CEO, you mentioned that you've established a new purchase model in the U.S., and I'm curious if you could sort of just expand on the implications a little bit of this.
Yes, certainly. So in the United States, we historically had a, what I call a straight purchasing model, which is basically you buy the equipment, and then you buy the patches as you need it. That model is still available, and sometimes that work just fine. Like the VAs, that's what they do. That is what they use in that system. And then we had a lease model, where basically, you know, a clinic would sign up to lease the equipment for a monthly charge, but it was really not y ou know, I wouldn't say it was a real commitment. It was like: Well, yeah, we signed up for it, and we'll try it. And some tried it and really gave it some effort, and then really went with it.
But there were also quite a few that really didn't give it any attention because there was no real skin in the game for them. And they never really, you know, bought any patches, and some of them actually returned the equipment. And you've seen that in some of our financial results as well. So when I came in, I really wanted to replace that, that lease model with something else, and I call it the use model. Basically, what we do is we try to avoid the initial high hurdle of having to buy a piece of capital equipment, which is the system itself. Because that is always a difficult thing to do for anybody. It goes through additional scrutiny in terms of approvals.
Why do you need to buy capital equipment? Capital equipment sounds already very, very expensive. Our box isn't that expensive, but, you know, it's still capital equipment for them. So that is a hurdle that's pretty high. So in the use model, we basically, what we are selling to the clinic is a certain amount of usages. So they can sign up for, okay, well, I would like to, for example, I like to use it on 100 patients. And then we basically, provide them a system and patches for 100 uses, and they pay per usage, and then we basically account for the cost of the equipment in the use on top of the patch expense.
So they pay more per usage, but now they don't have to really buy a piece of equipment separately, and the company still gets paid for it because we get paid for the usage. So this is the model that I developed, and we're in the process of rolling out. So far, I've heard very positive news and feedback from several clinics in the U.S., that they really like this. It's an easier way for them to get going.
And what I like is they really still now have some skin in the game, and they really sign up for something. Not just like, "Yeah, you know, I pay $350 a month, and as long as I want to," and it's not much, but it's also not really any skin in the game in this lease model. So I think that's a good development, and we are still in the process of rolling that out. It's still in the initial phase, but I think it will be promising.
Interesting. And is that, just a short follow-up, to this, is that something you have sort of worked with before in your career within medical technology and then sort of extrapolated into to Acarix here?
Yes, it exists. It exists elsewhere, too. Other companies and other products are being sold like that as well. In that sense, it's not completely novel. We are leveraging something that is being used elsewhere. But yeah, this is certainly a doable thing. Absolutely.
Perfect. And also, I saw you discussing, sort of, ongoing discussions and tangible progress together with, large IDN, and this is, of course, a topic that has been, discussed, a lot, when we were talking about Acarix. So could you please tell us a little bit more?
Yeah. So we are working with one specific IDN since quite some time, and it was also talked about, as you said, in the past. We've now gotten to a stage where we've actually presented them a proposal, which is also based on the use model, by the way, which helps them a lot in signing up for it. We have the physicians on board. The physicians at the clinic are supporting it, and it's now at the highest level on the executive level of that IDN.
The person who needs to approve it is, in principle, in agreement and supportive, but, you know, it just takes time to get to the final step. So, I think, they're reviewing the use model contract at the moment, and we hope to hear back from them rather soon. I hope this will fall in place in the next few weeks. It should certainly fall in place in Q4. That is our plan.
Perfect. So we'll also have a little bit of questions coming in from, I would assume, investors here interested in. I mean, you touched upon that sort of, budgeting in the US and the implications for, for Acarix. So the question is sort of related to, when do you have sort of a, a time when these budgets in the US for customers related to you are being set, and how are you keeping track of this?
Yeah. So, the budget item is specific to the VAs, so don't mix it up with anybody else. I mean, this is not an issue for IDNs, it's not an issue for clinics, for primary care facilities. The budget item that I mentioned is specifically there for other VAs, other than the two that we have in Louisiana, where we already are an ongoing budget item, because they already bought the systems. We are in their system. We are in their budget, so to say. It pertains to an additional two or three other VAs that are interested, where the physicians are saying, "Yes, we would like to also use this just as the Louisiana VAs, and we would like to get going on this," but they don't have, you know, they don't have it in their budget yet because it's a new item.
And so that's what I'm talking about. I'm particularly talking about those other VAs that want to get going and are waiting for a new budget cycle. The budget cycle is typically associated with the calendar year, so it's basically, you know, you're talking. I don't think it's gonna happen yet this year. It's probably gonna be early next year because that's when a new budget will be available. That's basically what I'm alluding to for these other VAs in the US, outside of the ones where we're already in.
Got it. So just to wrap things up on at least the IDN part here, we've talked about it. It's, it's, of course, an interesting customer for you, it's potential large potential, et cetera. But in terms of systems, at least in the first stage, do you have any sort of estimate or range of what can investors be expecting here? If any one of you could, could you give us some context there?
Yeah, I do, but I think it's too early to talk about that. And also, I can tell you that this is a large IDN. They are not gonna jump in, you know, with like ten feet at the same time. You know, they go, as I always say, you know b y the way, I think it's a very good talking point. I always talk about you gotta, you gotta walk before you run, right? You gotta walk before you run. I think they apply the same concept.
Let's walk, and let's see how it goes before we run with the system. So I think it could be a sizable order, but it's not gonna be like, you know, we're gonna use it everywhere. It's not gonna be that kind of a scenario, because they also want to really see how it works in the clinics, how it falls in place before they extend it to every office that they have. But it's, you know, it I certainly suspect it'll be more than one or two, but it's not gonna be like, you know, their whole IDN at the same time.
Right. And, this is also a sort of a returning topic, and, we have see, we've seen a large interest, of course, from shareholders, investors related to this. And, Acarix has previously announced a financial target for 2024, which is practically next year here. And, I mean, we just saw the quarterly reports here presented by Christian. But, what is your view of this financial target? This question goes to both of you. At the current state and outlook with, of course, exciting times, exciting things going on with both the VA and IDNs, but sort of the sheer numbers, 3,000 systems and the SEK 200 million in revenues. What can you give us?
Yeah. Yeah, Philip, you know, at this point in time, I mean, I'm on board with the company now for just over a month, and so it's really too early for me to give a prognosis for next year. I don't think that would be right. So let me refrain from commenting on that at this point. I'm sure later in the year, we'll get to a better understanding of, you know, where we can be next year, but at this point, I don't think it would be correct for me to make any statement on that. It's just too early for me.
Right. And, maybe I'm turning a little bit to you, Christian, here now. I mean, Acarix recently went through a financing round and got some fresh growth capital into the company. Could you give us a little bit overview of where you stand in, in that regard right now, and, and how is the outlook looking for 2024?
Yeah, I mean, that's correct. We did, we actually did a package of financing set up for Acarix in 2024, and it's really three buckets. The first one is the rights issue that we have announced as final, and that's net proceeds from that part is, was SEK 45 million after costs related to the, to the rights issue. And the second bucket is the, is the warrant program, Series One. And that, depending on the share price that, that we will have by that time, it's something between SEK 22 million-SEK 45 million.
And the same with the, with the, with the last and the, the second, one series. The first one, we have a subscription time, in, March, and the second one is in September. So if all go well with the sales, we will be able to capitalize both of them and take us through 2024 cash-wise. But, of course, it requires an increase in the sales now in quarter four and moving forward.
So, if I can just add to that. So, the intent of the company really was not just to come up with financing for the next, let's call it six months or so, but to really put together an integrated, plan, financial plan, to get to a, longer-term financial, security. And so this is how I view it. It's like, well, step number one has been done, and, you know, that gets us to, you know, sometime in March or so, March or April next year, depending on, you know, how things go. And, and then, you know, there is a first, level of warrants, and then a, in, in the springtime, and then in the March period. And then there's another, you know, warrant, exercise model in September.
So you really should look at this as an integrated approach to provide for financing of the company, not just for the next, you know, five to six months, but, you know, for a much longer period of time. That really was the intent of the board from the get-go, and I think it's actually a quite good and very interesting value proposition that so far has been falling in place very nicely.
Okay, gotcha. So sort of to wrap things up here, I want... I have one last question from an investor here, actually, who is interested in how the sales force is progressing in regards to sales of individual clinics? So if we change the scope a little bit to sort of smaller individual clinics, I guess, in the US.
Yeah, yeah, right. I mean, I talked about the VA in particular about the IDN, because it's strategically important, but obviously, we have other things happening as well. We have small clinics that are actually quite good users of the system. You know, we have some primary care offices that are using the system on a regular basis, which also drives what Christian was talking about in terms of patch utilization going up. So we have that as well. And I mentioned the osteopathic. We have a couple of osteopathic physicians in their own clinic doing this as well. So I didn't talk about that too much because I talk about more of the strategic, important things. Yeah, there's a lot of smaller level primary care offices that are also involved, and where we have ongoing sales.
Perfect. I think that was everything for me. Thanks a lot, Fred, and thanks a lot, Christian, for, for this conversation and for the presentation, and I wish you the best of luck going forward.
Thank you.
Great. Thank you so very much.
Thank you.
Yeah.