CONMED Corporation (CNMD)
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J.P. Morgan 42nd Annual Healthcare Conference 2024

Jan 8, 2024

Moderator

Great! Welcome, everyone. I'm Robbie Marcus, the med tech analyst at J.P. Morgan. Really happy to introduce our next session. It's gonna be CONMED, introducing Curt Hartman, the CEO, and Todd Garner, the CFO. Curt, I'll turn it over to you, and we'll do some Q&A after.

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

Thank you, Robbie, and good afternoon, everybody. Appreciate you all being here with us today and our opportunity to present to you on behalf of CONMED Corporation. We have the forward-looking information slide. I'll let you peruse that for a moment, and then we'll jump right in here. We always like to start our presentations with CONMED's vision, and at the essence of it is empowering healthcare providers worldwide with the ability to deliver exceptional outcomes. We underpin that with the focus behind the vision, which is really about our people, our products, and ultimately, that leads to profitability. Underneath that, we have the five pillars that CONMED operates under. These were created in collaboration with a broad executive team and reviewed deeper into the organization. You go into any facility around the world in CONMED, you see these in the facility.

They are prominently displayed in all of our business cards, et cetera. I want, I want to pay particular attention to the two bookends. On one side, you see, "We do things the right way." On the other side, you see, "We deliver exceptional results." Those are the two bookends specifically for CONMED Corporation, the way we behave and the way we operate in the marketplace. I wanna, I wanna jump off on the, "We deliver exceptional results," as I go into the next slide, which is relevant to this audience. What are CONMED's objectives for our shareholders? I really wanna spend some time on this slide to help everybody understand how we think about the business. We're not here to run it for ninety days. We're here to run this over time, deliver exceptional results, over time, consistent, predictable delivery.

It starts with aggregating growth and profitability to significantly increase the valuation of the company. Hopefully, that resonates with you. Evolve our product mix towards higher growth, higher margin offerings, and I'll bring that point back home in a few slides, but that is a very essential element of our promise and objectives for our shareholders. Increase our market share. If we're not growing our market share, that means we're not winning in the markets we serve, and we do serve large and attractive markets. I'll show you more detail on that momentarily. Finally, in doing that, we want to deliver above-market revenue and profitability growth over the long term.

You notice the word long term is dispersed throughout those objectives many times, and that above-market revenue, when we get to the slide that talks about markets that we serve, we think the markets we operate in are growing somewhere between 5% and 7% on an annualized, call it, normalized basis. Hard to look at that in 2020, 2021, 2022 with all the ups and downs, but on a normalized basis, the markets and categories we're in, about 5%-7% globally. So important reminders for shareholders, what our objectives are, but also help cement you as you think about CONMED as an investment thesis. So let's start with the markets. If you look at orthopedics, this is about a $13 billion market. I'm doing some rounding there in my math.

For CONMED Corporation, our results through September of 2023, about 37% of the revenue comes out of the U.S., about 63% comes internationally. 76% of global revenue is recurring, single-use consumables, either implants left behind in the body or single-use accessories that are used in affecting the surgical procedure. You can see we break that down into three categories: sports medicine and biologics, that is the repair of soft tissue and healing of soft tissue; capital equipment, visualization systems, saws, drills for reshaping bone, cutting, shaping, bone; and then foot and ankle, an acquisition we did in 2022, it's the implants to restructure the foot, the ankle space, comprehensive foot and ankle solution.

You can see about 60%-70% of that revenue in the U.S. market occurs in surgery centers, and when you take the concept of gathering one share point across all those markets, it equates to about $136 million annually, which would be the equivalent of 11% growth for CONMED Corporation. So we just need to be in the markets with innovative products, and there's a great market share capture opportunity. Jump over to general surgery, not quite as large of an addressable market, about $11 billion, again, rounding my numbers here. For CONMED, through September 2023, about 70% of that revenue is in the U.S., kind of the inverse of our orthopedics business, about 30% internationally, and almost 90% of that is recurring single-use categories. We define the categories as access.

This is when you're doing minimally invasive surgery. How do you access the abdominal cavity? We do that through our AirSeal platform and other devices. The energy, which is about cutting and affecting tissue. The instruments category, which are the things that are used in those laparoscopic procedures and those MIS procedures. Endoscopic technologies, we have a smaller business that focuses on therapeutic GI, and then ultimately, one of the legacy portfolios is our critical care business. But again, great markets, sizable markets, healthy competitors, both in orthopedics and in general surgery. This one's a little bit more pronounced in the hospital, about 90%-95% of the revenue in the hospital. And again, a similar dynamic when you think about one percentage point of market share capture would be the equivalent of nine percentage growth points for CONMED Corporation.

So two very large markets, about $24 billion market opportunity, growing markets, and CONMED has a great presence in all of those markets. I want to jump and remind you of our latest announcement, third quarter announcement. This is a year-to-date snapshot, and what you see here is very consistent growth rates. For total CONMED, 17.6% growth, general surgery, 17.9%, orthopedics, 17.2%. If you look at the split, domestic was about 56% of revenue, international, 44%. We're a little bit different in med tech. Most med tech companies are 70/30. We're a more balanced portfolio, and you see that from the, the definitions I gave on the earlier slide. Domestic revenue growth, 17%, international, 18%, so we have a good physical footprint in both markets. And then single use for the total company is about 84% of the revenue.

So through nine months, we were on track for a very solid year. We'll report our fourth quarter and full year results here at the end of January, but this is the information we provided at our last quarterly earnings call. I want to go back to that statement that I made in the shareholder objectives, long-term performance. I joined the company in 2014. I came to J.P. Morgan, January of 2015. The company was actually shrinking on the top line, and that's pretty tough to do in med tech. These are growth markets we serve. So there was a big turnaround that the initial management team undertook. We're very proud of the results since we affected that turnaround. You can see the impact of COVID in 2020.

In 2022, if you were part of the story, you know, in the fourth quarter, we implemented a new global distribution system that did not go as smooth as we would have liked it. We fixed that subsequently in the first quarter of this year, and you can see our most recent guidance puts this year, 2023, at $1.240 billion-$1.260 billion. You can see earnings have tracked pretty efficiently with the revenue. And again, this is our view. It's, it's not about what we did last year or what we're gonna do next year. It's about performance over time. We want to be one of those med tech stories as a small or mid-cap, however you want to define us. We think there is an outcome where you continue to grow and continue to be flourishing in this market.

A lot of mid-cap companies wind up either as acquisition targets or they're unsuccessful, and we think we've got a management team here that can continue to drive growth in the markets we serve and continue to provide a trajectory similar to the one that we've demonstrated here since 2015. This is a very important slide. If you look at the mix shift of the portfolio, in 2015, we had 79% of the portfolio that was declining. We had 21% that was growing single digits. That was our starting point.

In 2019, we presented this slide and said, "Hey, we're now at 35% of the portfolio growing double digits, 48% growing single digits, and we've taken that 79% down to 17%." Now we're updating that slide, April through September of this year, we're at 41% of our global portfolio growing double digits, 47% growing single digits, and 12% declining. I don't know if you ever get to 0 declining, but I sure like the upper two bars. I think the note on the right here about these high growth product lines, they're also highly margin accretive to the overall offering, which is the next part of the story, which is the growth in mix-mix shift by category. We publicly report general surgery and orthopedics. In 2015, 100% of our general surgery portfolio was declining.

As of September 2023, 64% was a double-digit grower, 25% was single digit grower, 11% declining. You look at orthopedics, 34% back in 2015 was single digit, 66% was declining. As of September 2023, we've got 10% now in double digit grower, 77% single digit, and down to 12% declining. So it's been a substantial mix shift by category for the company over this management tenure that the team has assembled, both through organic R&D, additions to the portfolio, but also some key inorganic acquisitions through the commercial leadership and our strategy and business development team. Some acquisitions we're very proud of, platform technologies that really differentiate us in the market and allow us to deliver real solutions to our customers and help their patients that they serve.

We've also had an ongoing undertaking of our environmental, social, and governance initiatives. Now, we're trying to do this in a form that matches the scale of our company. We're not gonna be the trendsetters on ESG, but we are doing it in a very methodical way. Some of the agenda items here that we're very proud of, our board governance. I think we have best-in-class board governance. Our board tenure, we have a 12-year term limit. Every chair rotates after 5 years. We have 33% of our board that is diverse. I'm also very proud of some of our individual sites and the work that they have done around environmental, but as important, around community and investment back into the community. One of the big agenda items we have in the U.S. is a United Way campaign. Every one of...

We had our highest participation rate ever in 2023 campaign, and every one of our sites invest back into their local community through volunteer activity and volunteer participation in local community work projects and benefits. Further, when we look at this, I'm gonna point to the middle here on social. We partner. I mentioned United Way, but we also partner with TEAMFund , which is an investment that we make that helps provide medical technology to underserved markets around the world. And that is led by a former industry executive, Tim Ring, who used to run C.R. Bard, where Todd came from, and I've known Tim for a long time. So we think that's a really good place to put money to help expand healthcare to underserved populations.

So a small snippet of what we're doing, and our most recent report on ESG and our tear sheet is available on the CONMED website. We put that up in December, and we think it's just kind of something we'll continue to build year in and year out. So closing thoughts. We have an intense focus on the commercial side of our company about solving unmet needs, and when we do that, we garner the attention of our healthcare customers, and we do that through platform technologies, things like AirSeal, Buffalo Filter, the BioBrace platform that we acquired in 2022, and the In2Bones platform that we acquired in 2022. In addition to that, CONMED had some inherently wonderful portfolio technologies in its implantable categories in sports medicine, but also in its general surgery categories.

So all these platform technologies allow us to continue to position and grab market share with our healthcare customers. As demonstrated by the slides, we're not lacking for opportunity. The markets we serve, north of $20 billion global opportunity, they're growth markets, and we are well positioned to continue to take share year in and year out, and continue to invest back in our portfolio. As the slides in the middle showed, our portfolio continues to evolve. Our most recent acquisitions, In2Bones and BioBrace, both have gross margins north of 80%. The AirSeal platform is in the 70s%, the Buffalo Filter platform is in the 60s%, and anything that we put out organically, we have a mandate that it will be accretive to overall company gross margins.

Now, we're willing to make exceptions and let products into the market, as long as we see a clear path to exceeding the company gross margins, but it's a pretty high bar to get over, and our internal R&D teams and marketing teams understand that. And then finally, I just underscore it all with this last statement. We're focused at CONMED on doing things the right way and being good corporate citizens in all the communities around the world that we compete in and that we serve. So with that said, I think Robbie's gonna come back up. Perfect timing, Robbie. And, we're gonna go into Q&A.

Moderator

Great, thanks. I want to start out, you had a couple different slides, and I want to try and tie this all together, where you had the high growth slides, you had all the M&A you've done over the years and how it's higher gross margin. Maybe just start with your philosophy on how... cobbled is the wrong word, but how you've cobbled together all of these high growth, high margin assets and where you are in the process. Are you near done, or are you still just at the beginning?

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

It's a great question, and I'm gonna go back to 2015. I said the CONMED journey, I think you can find those slides out there. It was a pretty ugly slide deck that I put up. It really did not paint a very good story of CONMED's history, and I said, "The only way to turn this around is with people, and we got to get the right people in the company." If you look at my management team, if you look at the guy sitting to my left and his background in med tech, if you look at the gentleman sitting up here, he's ran bigger businesses before he came to CONMED. If you look at the gentleman who runs our general surgery portfolio, got an extensive background in med tech.

If you look at my head of M&A sitting over there, extensive background in investment banking and then in venture investing, and then with a large strategic doing M&A. I could continue on. The leadership team here is what brings the proximity to the market. We've instilled that into the company's culture, and they are the people in the market day in, day out, saying: "What are our customers telling us we need?" So that portfolio mix really comes from their proximity to the marketplace and that specialization that we've driven. Part of it was also org design. We did a substantial change in the organizational design to create these focused specialty businesses, so they are spending time all day, every day with the customer base, learning what they need, trying to find products that address what they're asking for.

We have a very diligent process on M&A. We have, we look at a lot of stuff every year. Even when our leverage was up over 5x, Pete and his team did not get time off because these deals take time to track down, to materialize, and to put through our processes. And obviously, we exclude far more than we approve. But the four that we have found, knock on wood, have been home runs. Home runs in the marketplace, home runs with our customers, and I don't think that ever ends, Robbie. It's a journey.

Moderator

Mm-hmm.

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

You know, we're super excited about what we have. We're working on getting the leverage down. We never, we never told the team to take a year off. Like, they're still looking at stuff. So it's a journey. As we get bigger, we're gonna keep going after the right portfolio mix. And as important, our internal marketing and R&D teams are doing the same thing every single day.

Moderator

Remind me where you are now in terms of leverage and what target you're going for?

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

So we're about 4.8 at the end of Q3, and we said, when Q4 is reported, it should be below 4.25, and then we'll be into the 3s in 2024.

Moderator

The goal is to get to 3.5, 3x ?

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

... Well, yeah, I mean, we'll, we said we'd get down into the low threes. That's what, though, our last disclosure, so we'll update expectations in a few weeks when we report.

Moderator

So when I look at 2024, you have a good growth base business, Buffalo Filter and AirSeal continuing to grow probably 20%+ or so. In2Bones, now in organic growth, still double digits, I imagine. And this should be the first year that BioBrace, the Biorez acquisition, starts to... If I remember right, it was $ high single-digit millions contributing in 2024, and data maybe later this year or early next year.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

High single for 2023.

Moderator

Oh, sorry.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Yeah.

Moderator

With double-digit, I imagine.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Right

Moderator

for this year. Thank you. With data later in 2024 or early 2025, that can really kick in to gear, if it's positive, the revenue growth for next year. So when you add all that up, would you be disappointed if you aren't close to 10% or so, high single digit, 10%, when we end up?

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Yeah. I mean, obviously, it depends on how the underlying market is doing, right? But yeah, I think that the way we define winning at CONMED, as Curt showed in his presentation, is gaining market share.

Moderator

Mm-hmm.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Which means you're growing faster than your markets, right? And so if our markets are growing 5-7, we've got to be better than that. Now, to your point, you called out a few of our significant growth drivers that are growing, you know, 2x the market. And so if you take that part of the portfolio that we've talked quite a bit about, it's about 30% of the portfolio. If that's growing at a 20% area, which we think it is, that's 6 points of growth from 30% of the business. So to hit that magical 10%, you would need the other 70% of the portfolio to grow a little short of 6%, right? For the math to add up to 10 perfectly.

So if the markets are 5-7, and the markets are healthy, and if we're executing like we should, you know, that's a reasonable expectation. If the markets are a little soft in a given quarter, and if we end up in the 9s or, you know... I think we're still winning, right?

Moderator

Mm-hmm.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

And so, we're excited that, you know, again, we, we talked about a little history here, compared to, you know, Curt's first presentation here, where the company wasn't even growing. And now we really are, you know, whether we're double digits or just shy of that, it's a very healthy med tech company. We're clearly, clearly growing faster than our markets and, with, with good durability and good balance, across the portfolio. So we feel very good about, you know, the engine of the company now and, and where we're headed.

Moderator

Maybe we could spend a minute there, because it is the, you know, less sexy part of the business. I'm sure you get a lot less questions on the non-high growth assets. I know you restructured the U.S. Ortho sales force, what, almost a year ago now, ± ?

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

A little more.

Moderator

A little more.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Yeah, yeah.

Moderator

Maybe just, you know, give us a quick highlight clip on some of the new products, some of the new, you know, different initiatives you have in the base business, just because we don't get that great a look at the details there.

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

Yeah, sports medicine's a really sexy business, Robbie. I mean, you go spend a day in a sports medicine OR, highly competitive. Every competitive rep is in the room. It is. If you have a competitive ounce in your body, you walk in that room, it's super competitive. When CONMED Corporation walks in there, we have the full complement for Rotator Cuff repair. We have an evolving portfolio around knee, ACL, MCL, PCL, and then in the middle of that, we dropped this wonderful product called BioBrace, and it is a game changer in terms of getting clinicians' attention. We supplement that with a comprehensive large and small bone power tool offering and a video platform.

When you're doing arthroscopic procedures in the knee and shoulder, you have to have a video platform, and the CONMED Linvatec brand is one of the legacy brands in video for arthroscopy. It is about iterating, it is about next-generation technology. We're gonna be back in this city in a month for Academy. At Academy, I think if you come by our booth at the Moscone Center, you're going to see some new sports medicine technologies. That is about constant innovation, moving the, moving the opportunity a little bit forward every time on your base platform. They don't get the headlines like AirSeal and Buffalo Filter and BioBrace and In2Bones, but they're every bit as important to the customer or the everyday user. So that's why we have internal R&D continue to work on these things and advance those portfolio offerings.

Moderator

Over the course of 2023 and prior years, there were some supply challenges in some of these businesses. How do you feel about supply today, and is it still impacting your availability to sell?

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

You know, 2020 through 2022 were probably the most volatile we've seen in supply chain, both from a pricing and inflationary pressure standpoint, but unpredictability. I think the company candidly did a very good job managing through that. I think there were some announcements by some larger strategics who said, "Hey, we're past that." I think there's still supply chain disruption in the marketplace for med tech, and we actually talked about some of it in our business in the third quarter. So I don't think the category of med tech supply chain challenges is completely back to 2019 and normal. It's certainly better than it was in 2021 and 2022.

But I think our last disclosure on it was, we thought we would be past it or through most of it by the end of Q1 in 2024.

Moderator

Great. Todd, maybe before we dive into some of these high-growth opportunities in the pipeline, we can talk about your margin guidance that you gave, and maybe just remind everyone the details of what you've said for 2024 and 2025, both on gross margin and operating margin.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Sure.

Moderator

Your confidence on being able to hit them?

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Yeah. I'm gonna start with the confidence, actually, and it comes from history. So, like the rest of the world, we experienced all the inflationary pressures of the pandemic and related issues. We might be unique in that our gross margin for the full year of 2022 was the same as our gross margin in 2019. Most companies, I think, saw a deceleration in the gross margin or degradation in the gross margin. Ours was flat, despite absorbing 400 basis points of inflationary cost from freight, labor, and material. Material cost is the biggest portion. So in that three-year period, we absorbed 400 basis points of inflation, and our gross margins stayed flat. And that's because of the mix benefit.

You know, Curt talked about those high-growth product lines for us are also accretive to margins. And so we have this mixed tailwind that has been real and existed the last several years, has been masked by inflation. And that mixed tailwind is not waning because those parts of the business are becoming a bigger part of the portfolio. So if we can just get costs to stabilize, then you'll see that margin benefit come through, and that's what you've started to see in Q3, and we've talked about Q4. We talked about some challenges specific to Q4, but even with those challenges, we're still seeing sequential growth. We guided to still seeing sequential growth in our gross margin, and if you compare it to Q4 a year ago, it's meaningful growth.

So, that margin improvement story, driven by mix, is very much alive, very big part of our future. We think if those costs can stabilize, and then hopefully in 2025, we think that we ought to get about 100 basis points of that 400 of inflation back, through material costs, mostly. That we said that we should have gross margins around 60% by the end of 2025. And so we. You know, I think the improvements in 2025 is bigger than the improvements in 2024, but that mix is built into kind of the portfolio that Curt showed, and the fact that all of those things that are growing faster also bring a higher relative margin to the corporate average.

Moderator

Is there any way to tease out which products contribute what?

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Sure. The 2022 acquisition, so that's In2Bones and Biorez. Those products are both, both north of 80% gross margin. AirSeal, which is our biggest product line, is in the low 70s% from a gross margin perspective, and Buffalo Filter is in the low 60s%.

Moderator

Great. I would imagine R&D investment isn't going to go up materially as a percentage of sales. SG&A, you can probably continue to get leverage. So I'd expect, fair to say, operating margin grows more than the gross margin improvements you talked about?

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

That's exactly right. Yeah. I mean, we're not guiding specifically to 2024 here today, but the general approach to the P&L is exactly as you said, Robbie. We think R&D probably stays in that 4%-5% of sales, and then we should, as we grow, we should get leverage on SG&A. So the improvements that I talked about in gross margin, you should see a little better than that in the operating margin line.

Moderator

Great. Maybe we can move it up to the top line here. Maybe starting with AirSeal, your biggest product line, as you just said. This has been a controversial topic for investors, as I'm sure you've had a few questions over the past year or so. AirSeal is used primarily in laparoscopic and robotic surgery, more robotic surgery. And, you know, people are expecting a new robot to come this year, and the company that you sell into or it's used a lot with, Intuitive Surgical, has talked about insufflation as an area they'd like to get into. So I feel like there's four options that could happen. One, there's no new robot. Two, there's a new robot with no integrated insufflation. One with integrated insufflation, that's a direct, low-pressure, differentiated competitor with AirSeal, and one that's a standard integrated insufflator.

So maybe if you think about those options, I'm sure you're prepared for all of them. I know you remain confident through all of them, but maybe just give us a bit of background on why you're confident and how you think about those four different scenarios.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Wanna go first or you want-

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

Go ahead.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Well, I do want to correct one part of the premise of your question. Actually, Intuitive has not said anything about insufflation. This has been supposition from Novanta, who makes... They're the OEM supplier of standard insufflators to the market. They talked about that they're gonna be working with a robotics company. So the street has connected those dots. Intuitive has actually been silent when it comes to insufflation being integrated with their new robot. But that is the supposition in the marketplace-

Moderator

Mm-hmm.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

-that Intuitive is gonna come out with an integrated insufflator. We understand that people say, "Oh, CONMED's, you know, got a differentiated insufflator. Intuitive coming into that space can't be good." I understand that logic. If you look at the details of what's in the marketplace, we compete with standard insufflation all day, every day, have for a long time. The addition, the features that Novanta is so excited about are actually not new to them, or they're certainly not new to us. We've been evacuating smoke continuously with our insufflator for a decade. This is something new to them that they're excited about, that they can now offer to their standard insufflation customers. We don't believe that reads at all to the differentiation that AirSeal has in the marketplace.

If you go look at our Q2 earnings presentation, our IR deck, the last few slides show the proven benefits over dozens of studies, millions of patients, that show that AirSeal provides 50% reduction in length of stay, 30+% reduction in PACU time. We're the only insufflator on the market that has any data like that. And I would submit to you that no doctor is gonna walk away from those benefits, 50% reduction in length of stay, to something that doesn't have that, that's a standard insufflator with no data, no evidence of clinical performance, just because of a company, whoever sells it. That's not how medicine works. That's not how doctors make decisions. Length of stay is probably the biggest thing that hospitals consider when making purchase decisions.

So it's very simplified to say, "Well, just because if Intuitive comes out with something, everybody's gonna buy it because Intuitive sells it." Not if it doesn't perform as well as what they're using. That's, that's, very simple-minded.

Moderator

What if there is a AirSeal competitor? Would that overlap with some of your patents? Would you - do you think you'd have advanced notice of something differentiated like that?

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Yeah, so, you know, look, the thing about med tech is there's lots of different ways to do things. Now, what's unique about AirSeal, it's, it uses an aerodynamic principle instead of valves to keep the gas from escaping. That's one of the main features that allows us to provide a stable working space that's not always going up and down. We don't... And smarter people than me have looked at it. We don't think you can do it without valves, without stepping on our patents, which go out into the, I think it's 2032-2039, is our current patent, you know, our key patents when they roll off. So we don't believe you can get to trocars without valves, without stepping on our patents.

If, you know, if we're dreaming and imagining, say, if somebody could, that's one part of the equation they would need to solve. The other part is, AirSeal does all functions simultaneously. So we're insufflating, we're measuring, we're removing constantly, simultaneously. We're the only product on the market does, that does that. So if they could solve the valve issue and the aerodynamic principle, they still have to solve, the simultaneous function. You know, and there's no, there's no supposition in the market that anybody's working on that. I'll just remind you what has been said from these competitors. Nobody's talking about valveless. Nobody is talking about low pressure. Nobody.

Moderator

Mm-hmm.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

So that is all imagination. But it... You know, if we're speculating, if somebody could actually get through that and make something that had all of those features, well, yeah, then it would probably be competitive to AirSeal, but nobody is talking about that.

Moderator

Maybe zooming out to the broader smoke evacuation market, you know, how do you feel about trends going into 2024 in that market? Any new states that are bringing on legislation, any other drivers that make you feel really good about this market?

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

So smoke evacuation is a, it's a higher growth market. It's really kind of the genesis is the OR worker and the safety of the OR staff. If you go around the globe, markets like Canada have had long-standing legislation. In the U.S., the legislation has been more recent, and it's going state by state, and different states have different levels of legislation. There's the day they announce it, the day it becomes effective, then the day that they start measuring against that legislation. States like Oregon, Colorado, they've had very solid legislation that has been announced and implemented, and you see more rapid adoption. Other states, there's not quite as much substance in the legislation, so you see a little bit softer. There was some good movement in 2023 in the market for legislation.

As you look at 2024, you have states like Texas and I think Florida and North Carolina, that have legislation that they're talking about advancing. But in 2023, you had states like Texas come on board, very large healthcare market. So these, as legislation comes in, it's tailwind to the overall growth, which is really being driven by the healthcare worker and the safety for the healthcare worker. You go outside the U.S., I've already talked about Canada. The Scandinavian countries have good smoke behavior. The Australian market has good, good behavior as it relates to surgical smoke removal and the safety of the staff and the well-being of the staff. So it's this combination of legislation, but I still think underwriting it all as a healthcare worker and the overriding emphasis on safety.

Moderator

Maybe in the last few minutes, we can talk about BioBrace. I remember at AAOS last year, it was probably one of the best-attended presentations I saw at the event. Lots of buzz at the booth, you know. We're gonna get to your data. What is it, end of this year or early next year?

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

It'll be 2025.

Moderator

Okay, 'twenty-five.

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

Yeah.

Moderator

Maybe just speak to, what does the data allow you to do? Is it reimbursement? Is it really what's needed to drive adoption with physicians? And then how quickly do you think it could be adopted once that comes out?

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

Well, before I answer that, this is second-generation product, so the market has familiarity with collagen and collagen applications. What BioBrace brings is three-dimensional construct that brings strength at time zero. That's, with the collagen, is a differentiation for anything else that's in the marketplace. The approval for the product gives us broad overall indication and application, so we have products that target rotator cuff, which is the largest single market. We also have product for augmentation in the knee, in the ACL case. But you see applications being pursued by the surgical community in foot and ankle space, in Glute Med repair, Subscap repair, which is highly encouraging to us because there's lots of places in the body with diseased underlying tissue that needs a healing application.

Our clinical study right now is focused on rotator cuff, and that, that clinical study is targeting indications of greater than 3-millimeter tears and larger, because large massive rotator cuff are the ones that have the highest rate of failure, and it failed very quick post-surgically. So this is a, a critical piece of evidence that the clinical community wants to see, though they fundamentally understand the underlying strength at time zero in collagen a application. So the study will do that. It will help as it relates to reimbursement in select markets, and it will just help broader adoption. There are some surgeons who just will not adopt until they see that long-term clinical study.

Moderator

Maybe with the last minute or so, so keep it short. What's the direct comparison to the first-gen product, and what makes it better?

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

What's the direct... I'm not sure I'm following you.

Moderator

The-

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

The strength-

Moderator

Why is it better?

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

Oh, strength, strength at time zero. Strength at time zero. That is, that is an absolute game changer, differentiator, fully bioresorbed within two years, and strength at time zero with the collagen a application. Yeah.

Moderator

Okay.

Todd Garner
Executive Vice President and Chief Financial Officer, CONMED Corporation

Yeah, the other product, Robbie, is just the collagen, so it doesn't provide any strength that, you know... So it provides the healing, and it's been very effective and worked. We provide the strength with the collagen, so it's kind of the best of both.

Moderator

Great. We're out of time. Appreciate it. We can end it there. Thanks for joining. Thanks, everyone, for attending.

Curt Hartman
Chair of the Board, President, and Chief Executive Officer, CONMED Corporation

Thank you.

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