Good day, and welcome to the Avanos Q4 2022 earnings conference call. All participants will be in a listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star, then one on a touch-tone phone. To withdraw your question, please press star then two. Please note this event is being recorded. I would now like to turn the conference over to Scott Gallivan, Senior Vice President, Strategy and M&A. Please go ahead.
Good morning, everyone. Thanks for joining us. It's my pleasure to welcome you to Avanos 2022 Q4 and full year earnings conference call. Presenting today will be Joe Woody, CEO, and Michael Greiner, Senior Vice President, CFO, and Chief Transformation Officer. Joe will review our quarter and the current business environment and provide an assessment of our execution against our key objectives for 2022. Michael will discuss additional detail regarding our Q4 and full year and share our 2023 planning assumptions. We will finish the call with Q&A. A presentation for today's call is available on the investors section of our website, avanos.com. As a reminder, our comments today contain forward-looking statements related to the company, our expected performance, current economic conditions, and our industry. No assurance can be given as to future financial results.
Actual results could differ materially from those in the forward-looking statements. For more information about forward-looking statements and the risk factors that could influence future results, please see today's press release and risk factors described in our filings with the SEC. Additionally, we'll be referring to adjusted results and outlook. The press release has information on these adjustments and reconciliations to comparable GAAP financial measures. Now I'll turn the call over to Joe.
Thanks, Scott. Good morning, everyone, and thank you for joining us to review our operational and financial results for the Q4 and full year 2022. We are very pleased with our Q4 results, which built on solid execution from both our operational and commercial teams during the first nine months of 2022. Although the macro environment remained disruptive and dynamic, we focused on what we could control and manage. The demand for our products remained strong, and although supply chain disruptions persisted, we executed well, mitigating impacts to our financial results. We anticipate 2023 will continue to present supply chain headwinds, cost pressures, and pockets of product availability challenges. As always, our primary focus is on getting patients back to the things that matter as we meet the needs of our customers.
For the quarter, we achieved sales of $217 million, representing over 14% total growth and 4.7% organic growth, both excluding the negative impact of foreign exchange. We generated $0.60 of adjusted diluted earnings per share and $29 million of free cash flow. For the full year, we grew 12%, including the impact of our acquisition of OrthogenRx, and delivered adjusted diluted earnings per share of $1.65. Our gross margin for the year was 56.8%, a 450 basis point improvement versus the prior year, and we ended the year with a leverage ratio of under one times. These results position us to confidently execute against the transformation priorities we laid out at the JP Morgan conference in January.
Michael and I will address these priorities a bit later in the presentation. I'll spend the next few minutes discussing our results at the product category level. On a constant currency basis, our Digestive Health portfolio again grew by double digits, topping 10%, with NeoMed growing nearly 40%. The positive trends across our Digestive Health franchise continued as second half supply improvements allowed us to maximize North American ENFit conversions. Our legacy enteral feeding product line maintained its global mid-single digit growth with robust double-digit year-over-year growth in North America as supply constraints alleviated in the latter part of the Q4 . Our respiratory business declined by 4% overall, our closed suction catheters grew over 8% versus the prior year.
As we noted in our Q3 call, we experienced improved ordering patterns for our closed suction catheter systems throughout the Q4 , specifically due to trends with pediatric viral cases like RSV and the early flu season uptick. In total, our chronic care business grew just under 6% in the Q4 and 2.6% for the full year, excluding the negative impact of foreign exchange. Turning to the pain portfolio, for the quarter we experienced low single digit growth in Acute Pain coupled with mid single digit growth in our Interventional Pain compared to the prior year. The demand for our products and solutions remained strong, as evidenced by the double digit growth in both Game Ready and COOLIEF sales during the quarter.
As anticipated, we continue to experience supply headwinds, particularly within our surgical pain category, and we expect these headwinds to remain a factor throughout the first part of 2023. Despite some of the ongoing pressures brought about by supply chain challenges as well as hospital staff shortages that have kept elective procedure levels reduced, our team's resilience has ensured that our pain solutions are available to meet the needs of our customers. Separately, OrthogenRx exceeded expectations in 2022 by delivering on our key marketing strategies. OrthogenRx's unique patient access program, coupled with a relentless focus on service and support, allowed us to expand our portfolio to self-pay patients and differentiate our brands to providers. In parallel, our strategic pricing initiatives drove a favorable allowable of the three injection product and maintained five injection customers within the company's portfolio.
In 2023, we will expand our innovative OrthogenRx patient access program for our five injection customers to address the growing self-pay market. We also expect steady increases for the three injection self-pay program. There will be continued reimbursement volatility in 2023, and pricing discipline and accurate average sales price or ASP reporting will be a focus for OrthogenRx to deliver stability for our customers. In total, our pain management business grew 2.6% in the Q4 and 2% for the full year, excluding the negative impacts of foreign exchange and contributions from our OrthogenRx acquisition. We continue to deliver on both our gross margin and SG&A commitments during the Q4 .
Gross margin was 55.6% in the Q4 and 56.8% for the full year, driven by favorable product mix inclusive of OrthogenRx and our plants continuing to incrementally deliver on the manufacturing efficiency strategy we set forth at the end of last year. Separately, we ended the year with back orders around $8 million, slightly higher than we anticipated coming out of the Q3 . Additionally, current back orders have increased to just under $10 million and we're cautiously optimistic that we can meaningfully reduce our back order throughout 2023. Turning to SG&A, our Q4 and full year SG&A numbers as a percentage of revenue were 34.2% and 38.9% respectively, exceeding our commitment to keep SG&A as a percentage of revenue under 40% for the full year.
We remain committed to this financial metric as we enter 2023. Michael Greiner will provide additional insight when he discusses our 2023 planning assumptions. Our final two priorities for 2022 were to demonstrate our ability to deliver consistent, repeatable free cash flow and capital deployment via M&A. For the Q4 , we generated $29 million of free cash flow despite continued inventory and supply chain headwinds. Our ability to consistently deliver free cash flows is critical to support our other strategic growth and capital allocation initiatives, and has been identified in our priorities for 2023 and beyond. While we are disappointed we have been unable to announce another acquisition since OrthogenRx in early 2022, we remain engaged in active dialogue with a number of potential tuck-in targets with the objective of leveraging our existing commercial infrastructure, generating synergies, and enhancing our top-line growth.
We have been disciplined in our approach around strategic fit, valuation, and due diligence, and believe that discipline is critical for long-term ROIC enhancement. On top of the early success of OrthogenRx, it is worth noting that our most recent acquisitions of NeoMed, Game Ready, and Summit Medical, our ambIT device, averaged double-digit growth in 2022. Quickly summarizing 2022, our primary objectives were centered around consistent organic growth, delivering on our OrthogenRx strategy, making meaningful improvements in our gross margin profile, and demonstrating our ability to deliver material free cash flow. With organic growth in the middle of our range, excluding the unusual impacts of FX, OrthogenRx exceeded our internal expectations. Gross margin improved by 450 basis points. We delivered free cash flow of $72 million, or approximately $50 million greater than last year's free cash flow, excluding the CARES Act refunds.
We solidly delivered against our primary objectives, which, as noted earlier, effectively laid the groundwork for our longer-term transformation efforts. We outlined these transformation efforts in our JP Morgan presentation in January. In that presentation, I described four key priorities over the next three years that would optimize our go-to-market opportunities and substantially enhance our financial profile. These priorities include strategically and commercially optimizing our organization, transforming our portfolio to focus on categories where we have attractive margin profiles and the right to win, taking additional cost management measures to enhance operating profitability, and continuing our path of efficient capital allocation to meaningfully improve our ROIC. Now I'll turn the call over to Michael, who will help lead these efforts in his expanded role as Chief Transformation Officer and will elaborate on both the near and longer term goals of these efforts.
Thanks, Joe. As you noted, we are very excited to embark on our transformation journey and believe our execution over the past 18 months has created a solid foundation to build upon. Before diving deeper into these transformation efforts, I'll provide additional color to our Q4 and full year results. Total reported sales for the Q4 and full year were $217 million and $820 million, increases of 12.4% and 10.1% respectively. Adjusted diluted EPS for the quarter was $0.60 and $1.65 for the full year. As Joe already noted, we delivered on both our gross margin and SG&A as a percentage of revenue commitments, with full year gross margin at 56.8% and SG&A as a percentage of revenue for the full year at 38.9%.
We also successfully executed on our OrthogenRx strategy during the year and generated over $70 million of free cash flow, ending the year with $128 million of cash on hand and a leverage ratio of less than one. Excluding the negative impact of foreign exchange, chronic care sales grew by almost 6% for the quarter, with Digestive Health growing over 10% and enclosed suction catheter systems growth exceeding 8%. Within our Digestive Health portfolio, NeoMed grew nearly 40% globally, again fueled by strong execution of customer conversions to our ENFit technology. Our closed suction catheter business showed a return to healthy growth, as we noted would happen during our Q3 conference call, our oral care sales were down almost 27% as we intentionally walked away from contracts with unattractive margin profiles.
Within Pain Management, we grew 2.6% for the quarter, excluding the contribution of OrthogenRx and the negative impact of foreign exchange. Our Interventional Pain business grew 6% with our Acute Pain products growing a little under 1%. As Joe summarized earlier, we had another solid revenue quarter and overall positive financial contributions from OrthogenRx. Game Ready and our COOLIEF water-cooled RF system both grew double digits for the quarter, partially offset by a decline in our surgical pain products. Adjusted EBITDA totaled $45 million compared to $33 million last year. Adjusted net income totaled $28 million compared to $24 million a year ago, translating to $0.60 of adjusted diluted earnings per share versus $0.50 a year ago.
In summary, 2022 was a strong year for the company, with adjusted gross margin improving 450 basis points compared to last year, while adjusted EBITDA margin exceeded 20% in the Q4 . Additionally, we delivered on our internal EBITDA operating profit and adjusted diluted EPS targets while further strengthening our balance sheet, even after allocating over $170 million towards M&A and share repurchases. As Joe noted earlier, our recent execution has positioned us to embark on the transformation efforts we outlined at the JP Morgan conference. Our transformation priorities are designed to shift our product portfolio over time into a higher growth portfolio, leveraging our cornerstone product families in Digestive Health and Interventional Pain.
Additionally, these priorities are aimed at rightsizing our cost structure and enhancing our operating profitability with EBITDA margins ultimately exceeding 22% while generating annual free cash flow of $100 million. Our three-year transformation assumes primarily organic efforts that we have visibility against and strategies that are in our control. While still early, we have made some impactful decisions already, including leadership changes. Kerr Holbrook was promoted to Chief Commercial Officer, leading our combined chronic care and pain franchises with a focus on realizing efficiencies and synergies within our commercial teams. Additionally, my role was expanded to include senior leadership oversight over this critical initiative through the Transformation Management Office. We also announced that internationally, we would cease selling certain products in our Acute Pain category and smaller product categories with insufficient profitability.
As noted earlier, we have also walked away from customer contracts with low margin as we exited 2022. While these strategic decisions will result in an annualized revenue loss of approximately $35 million, we were not set up to win or grow profitably in these markets or categories over the long run. Our cost savings initiatives will primarily offset stranded costs associated with these product categories. In total, we expect to realize approximately $10 million of savings in 2023, anticipate $45 million-$55 million of gross cost savings by 2025, most of which will be achieved in 2024. We will present a refined view of our transformation program at our Investor Day on June 20th to be held at the Convene 101 Park Avenue location in New York City.
Although 2023 will be an uneven transition year, given the product portfolio rationalization and cost management initiatives, we anticipate improving our operating and EBITDA margins by at least 100 basis points. Separately, we expect to earn between $1.60 and $1.80 of adjusted diluted earnings per share for 2023, while delivering at least $60 million in free cash flow, excluding the one-time cash costs associated with the restructuring efforts expected to total between $20 million and $25 million. Finally, including the in-year impact of the approximately $35 million annualized product portfolio rationalization decisions, the company anticipates comparable organic revenue growth to be low single digits.
As I mentioned earlier, we are excited to embark on a transformation journey. I'm confident we will improve on each of these metrics as the year progresses with the Q1 starting off slow and accelerating into the back half of the year, similar pacing to what we experienced in 2022. In summary, given our consistent execution over the back half of 2021 and throughout 2022, considering that the current global, macro, and industry-specific environment remains uneven, we believe this is the appropriate time to proactively and strategically optimize our commercial organization, portfolio, and cost structure. Operator, please open the line for questions.
We will now begin the question-and-answer session. To ask a question, you may press star, then one on your touch- tone phone. If you are using a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star then two. At this time, we will pause momentarily to assemble our roster
First question today comes from Rick Wise with Stifel. Please go ahead.
Good morning, Joe. Hi, Michael. Let me, lot to tackle here. It, you know, I think that, I'm gonna start with the transformation commentary. Sorry, Michael, to make you say it again. Did I hear you correctly, it's $10 million cost reduction this year, and the large portion next year? I'm sorry, it just went by quickly. Maybe you can just, whatever, you'll correct my words if they're wrong, but just help us understand better where the costs are gonna come from, where the, you know, what's involved, how quickly you can get at them, and to what extent, especially in the early part, is this gonna be a net positive, offsetting other cost, and inflation, et cetera, pressures? Sorry for the long start.
Yeah, no, that's okay, Rick. Yes, approximately $10 million in 2023. A majority of the remainder amount of between $45 million and $55 million in 2024. Just to answer that first part of your question. Where a majority of these savings are coming from is a mix of things. We'll be outsourcing some opportunities. We will be rebidding on a lot of third-party contracts. We will be eliminating third-party resources. As we announced through the reorganization of naming Kerr Holbrook the Chief Commercial Officer, there was duplication of roles. Some of those roles have already been eliminated. We'll also just continue on the path that we've done the last couple of years with looking at trimming T&E and other areas as well.
Some of those things, like outsourcing, will take, you know, into the back half of this year to figure out the right partner, to figure out the right way to do that without being disruptive. Majority of those savings won't take place until 2024.
Gotcha. Exciting stuff, you know, as it all unfolds. Your supply chain, backorder situation, maybe you could give us a little more color on the backorder, what drove the higher than expected backorder in Q4 and the increase earlier this year. Is it I don't know. Is it particular product supply shortages or... Again, what's your optimism on resolution working through that now?
Rick, this is Joe, and Michael's welcome to comment as well. We did a nice job at the end of the quarter producing our backlog, and obviously the, it shows in the revenue, but then it built back up again. It's close to $10 million right now. It will come down though, quarter- by- quarter. We think it'll come down pretty significantly in the second half. The three areas right now, it's heavily weighted to Digestive Health at the moment, and particularly there's the Tyvek issue, and I think everybody knows that DuPont's, you know, building a new plant, that'll be up and running in Europe, but not until the Q4 . That's some of it.
In our case, we also have a supplier of catheters for ON-Q and ambIT, where we actually could be producing more revenue and the underlying demand is there, but that's gonna stick with us through the Q3 of this year. There are still electronic components that are issues across the board that does impact COOLIEF. Now, that said, when we look out, we do see by the time we get to Q3 that most of that'll be in the rearview mirror, and that's why Michael has talked about a progression somewhat similar to this year. The aim, though, and what as I listened to Michael, the element of the transformation is to eliminate SKUs, to make some changes further in our portfolio.
We believe that we can build ourselves into a consistent mid-single digit growing business as we enter 2024. Obviously the second half will be stronger than the first.
Gotcha. Just last for me. Joe, I heard your M&A comments that you were disappointed that something hadn't happened by now. As I think back to chatting with you and Michael in mid-November at the Stifel Healthcare Conference, you had said you'd hoped, you thought the potential was there to see two potential bolt-ons sometime in the first half. How are you thinking about those timelines today? Is that the track on your mind or should I imagine, given the timing of the Investor Day, that no, it's been pushed out longer? Just what's going on out there and just where are you now? Thank you.
Yeah, yeah. Very robust pipeline. It's even built further since we last were together, I think up in New York in November. We do think that we will have a transaction in place prior to the Investor Day in the near term. I do think that we'll likely have a second bolt-on in the second half of the year. Maybe not two in the first half of the year. We are orienting a lot of our focus in the Digestive Health area, but we still have a couple of pain items that we wanna do. Again, being more focused in orthopedic pain and recovery than we have been in the past. We feel really good about this.
We obviously have a lot on with the transformation, so we're carefully also looking at phasing and not wanting any missteps in execution because a lot of this, as you can imagine, requires a lot of work. That said, we're gonna be in an excellent position for M&A, and I think we've demonstrated a good track record. We have plenty of powder at one times to go out and conduct these, and they're gonna enhance that growth profile as well. Especially given that, you know, to the extent we do the two, then that's gonna give us an even better outlook for 2024 and.
The end of the year.
Thank you very much.
Uh-huh.
The next question comes from Matthew Mishan with KeyBanc. Please go ahead.
Hey, morning, Joe. Morning, Michael.
Morning.
Yeah. Could you guys help quantify the product exits between chronic care and pain, where the $35 million is coming out of? Does that take the place of potential spins or divestitures, or is that something you're still looking at?
Two points, Matt. We'll get more into details on Investor Day as to where these exits are coming from, partially because we have relationships that were still in place right now, which is why we're giving a range of what the full year impact would be. Some of these we may hand over to an existing distributor relationship. Some we may just get out of altogether due to product availability. Some we may get out of just due to other relationships. We're not gonna get into details into the split of that yet, but we will have more clarity and detail on Investor Day around that first question. To the second question, it's a mix.
Some of the stuff we're deciding to get out of, would be a little bit of, spins, getting out of products that just aren't worth the effort of trying to sell, because we just wouldn't get value for them. It just makes sense to exit those. It doesn't necessarily take place of other product categories where we do believe there's real value there, and we would consider divesting of those product categories.
Okay. Excellent. For 2023, I think. Well, just taking a step back, it looks like Orthogen, including, you know, an extra week or two, that pulls over from, you know, that inorganic, for 2022 would be coming in at about $80 million for a full year on an annualized basis. Just what are the expectations for that in kinda 2023, as some of the pricing dynamics change?
Yeah. Joe will talk in a second about the strategic aspect of what we're doing there. The $80 million, I think it's a little south of the $80 million, but you're directionally right.
Just on a strategic level, I do think in the first half of this year, Q1 and Q2, we're still gonna see a benefit on the reimbursement level really in the TriVisc and the GenVisc categories. That starts to level off in the second half when we see that more as a leveling. We've called a level year year-over-year, and that's where we are. That's a good outcome for us for the business. Just as a reminder, we didn't really make the acquisition based upon, you know, thinking it was going to be north of our mid-single digit on a consistent basis after this year.
We do think it's a low single-digit grower, but excellent contribution to the margins, and more importantly, a fit for our focus going forward in pain is gonna be more around the ambulatory surgical center, orthopedic, office. In that setting, so you can see it pairing well, obviously, with, COOLIEF pairing with Game Ready and just, you know, getting total knees of patients back to recovery, faster and all. Leading up to that, obviously in the case of HA.
Okay. Then on to SG&A. last year you started at a high point in the Q1 , and then it sequentially decelerated through the course of the year. How should we be thinking about SG&A, you know, through the course of 2023? Is the Q4 a good starting point, or does it ramp again and then come down through the course of the year?
Yeah. The pacing will feel very similar. That being said, the $10 million of in-year costs, there may be some movement between Q2 to Q4 as to when some of these costs come out, but the pacing will feel very similar in that, to your point, Matt, we'll have a high point in Q1, and it'll come down on actual dollars as the year goes on. You know, revenue will be a low point in Q1 and will be even-ish in Q2, Q3, but higher than Q1. We'll have a solid Q4, you have that. Obviously, you know, you have your high 30s, low 40s, starting in 2023 Q1 for SG&A as a % of net sales going down into the, you know, mid-ish % in Q4.
Some of it's just math, some of it is the pacing of the savings that we just talked about, the $10 million.
Okay. The last one, maybe I just missed it. Just what are your expectations for growth margin, in 2023? I know you kinda put out the 100 basis points of operating margin, EBITDA margin improvement in kinda 2023.
That was purposeful. we aren't sure exactly where we're going to get the 100 basis points from. What we do know is gross margins should be sticky in these 57% level, if not higher. SG&A at 38.9% should be a little bit lower, if not in the range. Again, depending on how these savings come in and when we exit some of these low margin, lower gross margin product categories, we'll shift where that 100 basis points comes from. We're not trying to be cute on the 100 basis points at Op EBITDA. We're trying to be thoughtful and know that we'll have more information to share at Investor Day in June.
All right. Thanks, Michael. Thanks, Joe.
All right. You got it.
As a reminder, if you would like to ask a question, please press star then one to enter the question queue. The next question comes from Drew Ranieri with Morgan Stanley. Please go ahead.
Hi, Joe. Hi, Michael. Thanks for taking the questions. Just maybe on the cost transformation side for a moment, and I understand that there's a lot going on that we will eventually get details with. Just kind of looking back at the company, it's been kind of a few years of talking of rightsizing the business and getting the expense structure in place. I was just kinda curious how you can, or if you can really kinda give more details about the growth side of the equation and really what you're thinking on that side. It just feels like Avanos has kinda been a low single-digit grower, so I'd like to hear more about how you're thinking about growth improving and accelerating over the next 12, 18, 24 months.
Maybe I can start with a little bit of growth. I think Michael will pick up on some more of the costs. Obviously, we wanna set that foundation so that we get the drop-through and leverage. If you go around and look at what's going on in chronic care, you do see a lot of spots of double-digit growth. I mean, NeoMed almost hitting 40% consistent mid-single digit growth, really, in the rest of the Digestive Health portfolio on a global basis. We're starting to see pain come back. It's limited right now by some of the supply chain issues. You know, there's probably still another $2 million or so a quarter gonna be this year that would be backlogged each quarter that we could sell through.
Also, we know we have a line of sight to some strong acquisitions at good valuations like we've been doing before in the areas where we compete, so orthopedic pain and recovery management. Obviously, we said we're gonna put an emphasis on Digestive Health, so we think that's gonna be enhancing it. If you, if you pull all that back in a normalized situation, we feel like, you know, we do have a mid-single digit growing organic business, not gonna show through obviously in the first half, but starting to show through in the second half, but really being powerful as we move into 2024, coupled with the balance sheet that we have as a size of company. I think putting that together is where we see a lot of strong value creation.
When you see the cash flow now increasing, it gives us also medium-term opportunity to do some what we would call bigger things for us. Not bet the farm kind of a scenario like you see in the market, but larger than the deals that we've been doing, and generally being in many cases anyway, complementary to EBITDA and accretive to growth. I'll let Michael maybe hit some of the costs.
Yeah. No, I would say, Drew, this is not a cost takeout effort. This is a, to Joe's point, a portfolio rationalization optimization effort. Oh, by the way, if we're going to do that, there's some cost opportunities. When you look at all our internal messaging, this has nothing to do with cost takeout. That's just a by-product, and a good by-product for sure, what we're doing with our portfolio.
You know, our intention to make further, you know, portfolio moves, and maybe by the time we get to New York in June, there's some other things that help enhance the profile of our growth that are related there. We're pretty excited about it.
Got it. Thank you. And maybe just a little bit more clarity on how we should think about the product exit for 2023, if there's any way to think about the weighting of what you're going to be doing. I know you don't want to get into specifics of chronic care or pain, but can you at least help us with understanding the cadence for 2023? Just with 2023, with your guidance, the low single-digit growth rate, we should be thinking around like $790-$810 for reported revenue for 2023. Is that the right range? Thank you.
Yeah, I think we're probably a little higher than the 790 just based on the timing of some of the exits. Yeah, 795-810-ish feels like the right range. You did that math correctly, Drew. Again, the timing is incumbent upon some of those relationships. You know, we believe we have responsibility to some of these customers from a medical device product standpoint, some of these we can do sooner, some of these we are choosing to do later. There's some opportunities to work with distributors in some of these categories to hand off, you know, 1, 2 years of inventory and have them continue to run that, maybe even buy, you know, some of our assets for a few dollars.
There's a range of things we're still very much working through on the, as in timing. Your, your math broadly, your range is appropriately stated.
Did I answer that, Drew?
The next question.
All set. Thank you, Michael.
All right. Thanks, Drew.
Thanks, Drew.
The next question comes from David Turkaly with JMP Securities. Please go ahead.
Great. Thanks. You mentioned the new CCO position and, you know, you mentioned some synergies and kinda putting chronic and pain under one organization. I'd love to, you know, again, it doesn't sound completely intuitive that would be the case, that there would be opportunities like that, but maybe you could highlight some of the areas where you see those opportunities and why that makes the most sense.
Yeah, there are a lot of areas where we're seeing, you know, headcount opportunity and strategic marketing, areas like customer service. Really, Kerr can also look at the way he spends and the returns in various areas of the business. That's been actually a strong piece for us. He's also looking at his channels right now, and there's opportunity to deploy our channels somewhat differently and in some cases, utilize 1099s to help expand our business and also addresses sometimes some of the cost of sales. All those areas are areas that are built into Michael's plans.
Got it. The comments you made on the EBIT down north of 22%, free cash flow of $100. Is that what you expect to do at the end of the three years? Like say exiting 2025, is that the timeline for that?
Yeah, that's correct. At the end of 2025, yes.
Great. Thanks.
David, again, to that question, we will have some more specifics around the pacing on that. You know, one of the signals obviously we're providing today is that we exited the Q4 at 20.8% EBITDA margin. Last year, we exited the Q4 at 16%, and we did full year this year at 16.8%. You know, we're not gonna do 21% in 2023, but these are how the pacings will work for us, right? Our Q4 ultimately as we manage our portfolio optimization, some of this offsetting cost opportunity, these are the types of numbers we produce on an annual basis, not just the Q4 basis.
Got it.
Thank you.
The next question comes from Matthew Mishan with KeyBanc. Please go ahead.
Thank you. Just one follow-up. I just wanna give you guys the opportunity to talk a little bit about NeoMed and the ENFit. It was up 40% again. I mean, this product has grown like significantly for you, over the last, you know, one to two years. Where are you at in this conversion cycle? How much more, like, is there? Then are some of the initiatives that you're doing, you know, gonna help improve the profitability of this product as well?
Yeah. I mean, you know, yes to all the above. I will say that, I think we had a line in the script about the double-digit growth of the acquisitions that we've made. We see another strong year for NeoMed with continued ENFit across the globe being converted. I think ultimately it becomes a strong, high single digit type of growth for us. It's opened up our aperture to looking at why we're focusing more on Digestive Health and neonatal type of targets where we think we can build, you know, get strong synergies at good gross margins in our organization where we have a right to win, where we can get deals, really pay, you know, fair, reasonable prices for those deals. It's been a home run.
Obviously, you know, CORTRAK was strong for us. We're benefiting even with ambIT moving into the ambulatory surgical center and replacing sort of what was ON-Q. There's no doubt that the NeoMed acquisition has been an absolute home run for us. Again, it does have. There's opportunities everywhere, including NeoMed, around with our manufacturing efficiencies and transportation and just all the ways that we're going to market. I don't know if you particularly want to add anything. No, Michael's good with that. Thanks for pointing that out, Matt.
What inning do you think you're in that conversion? Like, how much is kinda left? Yeah.
Transitioning from the seventh to the eighth inning, but then just remember, you know, we still think we'll be north of our mid-single digit for quite some time beyond that. It's just that you can't grow at 30%, 40% forever.
All right. Thank you.
Thank you.
This concludes our question- and- answer session. I would like to turn the conference back over to Joe Woody for any closing remarks.
I'd like to just basically thank everybody for the continued interest in Avanos. You know, as you're hearing from us, the demand for our products does remain strong. We feel like the fundamentals across the business are strong. We're focused on what we can control and manage. We think 2022 results have built the foundation, as we said back in January, to deliver on a commitment that we're confident the priorities we've detailed in this transformation program, combined with our market-leading portfolio and the markets we're in, position us for sales growth, margin expansion, and meaningful free cash flow generation in 2023. We look forward to sharing a lot more detail about the transformation program on our June 20 Investor Day in New York City. Thanks for your time today.
This conference is now concluded. Thank you for attending today's presentation. You may now disconnect.