Ross. This afternoon, we are joined by Enovis. We have the company's CEO, Damien McDonald, and CFO, Ben Berry. Thanks for being here.
You are welcome. Thanks for having us.
Of course. Before we dive into your recent acquisition, maybe we will start with an overview of the market, how you guys are seeing the ortho space since you last reported earnings.
Six weeks ago.
Yeah.
Look, nothing's changed for us. Again, we recently reported six weeks ago, the way we're seeing the U.S. normal seasonality, it's sort of back to a pre-COVID normal. We always see a bit of slowdown in the summer, which we've seen, but it's bouncing. Friday, I think, was one of our best Fridays that we've had in months, so that's great news. We've been saying international. By the way, we skew Europe when we talk international. We've been saying that the market, since Q1, that the European markets have been slowing. We've been demonstrably taking share in those markets and growing above the market. So nothing's changed for us. I know there's a bit of swirl today about that, but for us, nothing's changed in terms of the way we've seen the market and our normal seasonality.
Great. Any signs of an impact from ACA? We've heard mixed reviews there.
Not for us. Again, we hear that there's noise around clinic to surgical. We hear noise around prior auth delays. Maybe that's affecting other people's mix because of the way they have community hospitals in their numbers. But, for us, the way our markets are structured and the way our customers are structured, we're not seeing that.
Okay. Maybe it's impacting you guys less, but in terms of strikes, government budgets going towards defense versus healthcare, are you seeing anything in Europe to call out there?
Well, that's where we talk about Europe. When we've talked about what's been going on, again, since Q1, we've had visibility to that. We, for sure, have seen the impact of strikes, for sure, the impact of, let's call it financing policy decision making. But nothing's changed for us in our numbers, and we just talked about those recently as we did the acquisition.
Assuming those headlines continue into next year, what's a good normalized growth rate to think about for the ortho business?
Well, I would refer everyone to the presentation that we did the other day about where we think Recon and P&R are growing. Again, we laid it out pretty clearly in terms of the mid to high single digit for Recon and mid single digit for the P&R business.
Great.
I'll just add, Ross. I think the market dynamics in terms of procedural volume and thinking about the health of the macro with regards to the aging population and the need for surgery is going to continue. So for the long-term durability of ortho, we still see a large runway of a population that's going to need these products. And while there might be some iteration from quarter to quarter, we think the market will continue to grow at the rate that it's been growing, and continue from now into the future.
Okay, perfect. As I alluded to earlier, you guys recently announced an acquisition. Why was now the right time? What attracted you to eCential?
We have been looking for how to build on our platform, and we have been very conscious about this. We had a planning and navigation. We have been in the market now for five or six months with the ARVIS AR, and we were looking at how the markets were evolving and what was going to be important, and particularly the waist shoulder. I think knee is well-characterized, right? There is a way that knee surgery has been evolving and the application of assistance, particularly a robotic assistance in knee. What is new for us is how shoulder was evolving. What became imperative for us is how to think about how to continue to grow above the market, and by the way, shape the market. Now, we are knocking on the door of number two position globally in shoulder.
What we understood as we talked to a lot of customers over the last six months is that the form factor that is being offered in shoulder as a potential solution in robotics is not where patients and surgeons want to go. We saw a real opportunity partnering with eCential to be able to shape that debate. As a result of that, we get a proven team with a proven technology, with capabilities in Grenoble that we can apply to the knee space right now because they have literally just developed a knee robot. But applying that and really steering where shoulder goes, we believe gives us a position to continue to grow above the market.
Great. What does that integrated system look like between ARVIS and eCential?
Well, again, we've got an AI-powered platform for planning and navigation, and some of the other offerings, when you switch from planning to navigation to assistance, it's not a seamless ecosystem. Our plan is to have a backward integrated system because we've already got the planning and navigation, put the robot back into that platform and that foundation, so that we'll meet the customer where they are, if they're in a hospital, if they're in an ASC. Our typical persona is a clinician who's going to be doing surgery in a hospital in the morning and then one or two ASCs in the afternoon. They're going to be able to have a robot in both. Or they'll be able to have the robot in the hospital and the ARVIS in the ASCs, but the planning and navigation and the whole ecosystem will be the same thing.
Great. The U.S. knee launch is planned for 2028.
Yeah.
What does the integration roadmap look like between now and then?
We haven't outlined that yet. I'd say, look, first, let's close the deal, which we hope is going to happen in Q4. Then, when we get into early in the new year, I think we'll outline, here are the milestones. Again, not getting into false precision, but being able to give directionally valid information that people can look at us, so we don't just go dark for two years. But let's get into the new year.
Fair enough. Maybe at a high level, just any regulatory hurdles you have to go over manufacturing-wise?
Well, again, I think this is what's great about partnering with eCential, and we did a lot of work. As we were thinking about the arrangement with them, and we looked at partnership, one of the things we did was a technical risk reduction. That whole process led us to believe, again, proven technology, proven team. They already have technology that they've developed, the VELYS spine robot for J&J, the Amplitude Andy knee robot. We're pretty confident we know what the regulatory pathway is.
Okay, great. Then in conjunction with that announcement, you laid out some financial targets. Can you walk through EBITDA margin next year, the puts and takes there? I believe you guided down 100 basis points with underlying improvement up 50 basis points.
Sure, do you want to?
Yeah, I'll say first and foremost, we wanted to be clear that we're not coming off of any of the top-line guidance that we've given in terms of the near-term growth for Recon and P&R. We'll maintain over the course of the next couple of years and accelerate. This is an unlock for us in terms of growth, we think, for the future, and also progress around free cash flow. We'll continue to make progress on free cash flow conversion, generating cash up to $100 million next year on our way to the journey of the 70%-80% free cash flow conversion goals that we had previously laid out. The one change to our near-term guidance is the investment on the profit side. We really want to make sure we set this investment with eCential up for success.
We'll take on that team of engineers in France and then also continue to invest to be ready to commercialize the product in 2028 and 2029. We'll take a one-year step back in terms of margin performance next year as we invest in that technology and those capabilities, and then we'll get back on our margin expansion goals in 2028 and beyond.
I think it's an important thing to stop on for a second. When I first came, I've been here a little over a year, and I spoke to a lot of investors face-to-face. We did a very deep survey with a broad number, and at least 80% of the survey respondents were buy-side investors. What was important to them? One was cash flow. Can you improve and start generating cash? Second was debt reduction. Third was M&A and reducing programmatic M&A, and fourth was solve for robot. What Ben just laid out. In the last 18 months, we've gone from negative free cash flow conversion to +10% last year, to +25% conversion this year, +50% next year. In case any of you said, "Oh, but you changed the denominator," we said, "Okay, and $100 million of absolute." Cash flow, I would say check.
Debt reduction, we went from 3.8 to 3.1. We're saying for a period of next year, we're going to go back up to about 3.5, but we're committing to get back down to 3.1. I would say debt reduction, check. Programmatic M&A. We've stopped the serial M&A, and in fact, we sold an asset last year. I would say that there's more views of the whole portfolio that we're considering. Check. Then fourth was solve for robot, and I would argue we've taken a proven team with proven capabilities and technology and solved the robot question. I would argue that what we've done in the last week is round out what the report card was from all of you.
Absolutely. Maybe just put a finer point on free cash flow. 50% conversion next year, going to 70% in 2029. Along the way, you are launching a robot. It is obviously a bit capital intensive. Can you help us bridge the gap there?
Yeah. This has been a journey that we have been on. I think we laid out when we did the LimaCorporate deal, about three years ago, was that we were going to have a heavy amount of integration work to do over a three-year period. That is now completing as we are stepping out of this year. So our integration cost will significantly step down as we enter next year. The other thing we said with the LimaCorporate deal is that we have become more capital inefficient because we have been investing in moving technology around from higher cost locations to lower cost locations, and investing for all of the cross-selling and growth that came from those acquisitions. So we will see some efficiency in capital, as well as we step into next year and beyond.
One of the benefits of having the robotic solutions and the enabling tech is you can be more efficient with working capital. So while the units themself are now more capital intense, you can offset that through productivity and inventory and field inventory and working capital. So overall, we see this as a relatively net neutral from a capital efficiency standpoint, but also gives us ability over time to think about productivity in broader working capital across Recon. So overall, we feel like we are on a good pace. We have shown progress, and as Damien said, we are marching towards that goal of 70% + in 2029.
Great. I realize that is far out, and I will not ask you to establish launch targets today, but how should we think about what having a robot does for your dollar opportunity post-launch?
Well, I think you touched on it. It is accelerating our plans. I think it is an unlock for us in the knee market, and I think, again, I position ourselves as knocking on the door of number two in shoulder. This is really going to give us an opportunity to shape the direction of the shoulder market and accelerate our program there. We have shown an ability to take market share. We have got great technology, great teachers who are part of our faculty, and you have seen us disproportionately grow above market in that space. So I think for us, this is an unlock and an acceleration.
Great. [Amy], moving back to the near term, looking at the rest of 2026, your guidance implies 6.4% in the second half of this year, so a decent step up from first half growth. What gives you confidence in those numbers?
Yeah, the team is increasingly executing well. Look, there is puts and takes. It is never linear. But we have seen on the Recon side, as I said, meaningfully growing above the market in Europe, where, as I said, we over-index internationally. We are continuing to hire great talent in the U.S. sales organization and enroll and engage. We just had a shoulder surgery symposium that might be the biggest symposium that we have ever had for Med Ed. And that, for us, signals that people want to engage. On the P&R side, the RCM business is continuing to grow strongly. The whole overhang on bone stim got removed, and again, we are continuing to grow on the bone stim program.
We just launched a spine brace. Again, small market, but it is growing well early in days. And then in Recovery Sciences, we have just launched the companion version of a new laser.
Again, it is a small business, but it is going to be a high growth opportunity for us. So the P&R side has got growth opportunities that are reading through on four or five major businesses. And at the Recon side, we are continuing to grow above market. And as you said, through the first half, we are up 8%.
Okay. Anything we should think about on the comp side or potential headwinds in the second half of this year when they get more challenging?
We get an extra day in Q4, so that should provide about 120 basis points or so tailwind to growth, but nothing other than that.
Looking at ARVIS, as you are expanding outside of early adopters and KOL, how would you express incremental feedback?
Yeah, I have been honestly really thrilled with how. We took a very deliberate limited market release approach to this so that we learned how to train and enroll and engage physicians as we rolled this out. We also wanted to make sure that our clinical team was really well developed in this space. We have had tremendous feedback as we have rolled this out. I saw a procedure early on in the 2.0 launch at the Mayo Clinic, and just the way that it enhances the ability to do the procedure is tremendous, and I think we are starting to see that read through in the clinician feedback now.
Great. What is the game plan for ARVIS for the balance of this year and 2027? You throw incremental dollars behind it?
Double the number of placements. Pretty aggressive, but we really want to push the team to get this out there. Again, this is an enabler for physicians. It enables them when they talk to patient, because patients are demanding enabling tech. Often they say the word robot, but really, they are looking for enabling tech. It gives the clinician a chance to say, "Here is how I approach enabling tech," and particularly in shoulder. For us, I think that also sets us up for the long term as we talk about the robot. Now we can train you on the ecosystem so that when the robot does come out, you are not learning the whole ecosystem, you are just learning the assistance part. I think it is really exciting.
Maybe while we are here, can you talk about the training time it takes for someone to ramp up on ARVIS?
Yeah, it is about 5 - 10 procedures. We are handholding the whole way. We do outside the OR training. We are there in the OR with you. We troubleshoot. We have got very rapid customer service response times. Again, it is not unusual to MedTech to have this sort of system, but we think we have done a really good job with this.
In terms of handholding, how are you feeling about your sales force?
Oh, I love our sales force. I think one of the surprises, a lot of people ask me, "What's the surprise since you got here?" The level of talent in our organization is, I think, definitively higher than we're punching above our weight for who we are. One of the things I love about our sales force is the focus on customer intimacy and engagement and responsiveness. I think we're really lucky to have attracted that talent. I have to say, some of the dislocation that's been happening in the market has given us a chance to bring on more talent, and that's been terrific.
Just in terms of headcount, you're bringing on more people. Should we expect incremental hiring next year, or just kind of add on to-
I think we should always be hiring talent, but not outside what we're trying to do in terms of our financial responsibilities, but you should grab talent when you see it.
And then maybe switching LimaCorporate integration, just how you guys feel that has progressed, what cross-selling opportunities are still left?
I think it's gone really well. If you think about what we're trying to do and collapse two international businesses together with the LimaCorporate integration. We went very quick upfront with regards to making sure leadership and management teams were in place. Phase II of that was to start to get legal entity and system rationalization executed while starting to move manufacturing, like I said earlier, from higher cost locations to lower cost locations. All of those programs have proceeded as we have planned through the integration. I'd say have gone a little bit better than what we had expected. We still fully expect to finish that heavy lift at the end of this year. On the cross-selling, I'd say it's still a work in progress. I think the analogy we use is still early innings.
I think we have a great product portfolio offering now that can be more customized depending on which philosophy or which market condition you're participating in. Overall, I think we still see lots of opportunity to drive above-market growth on the international side, driven by the products that we're putting together with both LimaCorporate and the Mathys acquisition. As well as taking some of the legacy Enovis products and making sure that they're available in some of those markets. Overall, we see a lot of benefit to that acquisition. It's got some capabilities that we're still taking advantage of as well with regards to 3D printing and captive ceramic capability. Overall, we see this as a very positive acquisition for ourselves and the integration plan has been executed in good condition.
Great. When thinking about your geographic representation, what markets remain attractive outside of the United States? Should we expect any to come on this year? What about next year?
Yeah, we've got a core focus of a number of countries. I'm not going to declare them here because I don't want to tell everyone our strategy, but there's a core market group outside of the U.S. that we're very focused on. I would say we're still underrepresented in Asia and South America. As we started out, we skew Western Europe. There's still a lot of opportunity for us to continue to expand. I'm excited about that again, because of some of the talent that we've been able to attract in the last 8 - 12 months has really given us a way of viewing those markets with a different lens, and we're excited about that.
Great. Looking at P&R, I think you guys grew 3% organic, those selling days adjusted during the quarter. Where are the areas for improvement to get that number up?
Well, look, I love that team because they've done a great job not only shaping the portfolio. Something like 50% of the portfolio now grows mid-single digit better. They've also been disciplined around how they've thought about gross margin expansion. Notwithstanding the tariff issues and the headwinds, they've still done a really good job on doubling down on how the group operationally runs. Let's be clear, from a strategic point of view, what P&R does is not only have great brands, but it also generates a lot of cash. It's 90 %+ cash conversion. It's a really powerful business in terms of being able to support and grow the rest of the business. As I said, we've got an RCM business, Revenue Cycle Management business, that's very exciting in the U.S.
We've just done a bunch of work to insource that capability that supports that business in India, so that now we can drive productivity improvement inside that capability that we have. We're just launching a cycle of new lasers in the Recovery Sciences. We're showing demonstrably that we're taking share in the bone stim business and in the U.S. I think there's a lot to really like about that business. The brand recognition of DonJoy and Aircast is really powerful.
Great. Lasers come up every once in a while, but maybe an overlooked part of the story. You brought it up a couple of times today.
Yeah.
Could you walk us through the opportunity there and where you are excited?
Yeah. Again, these are small businesses with a lot of brand loyalty, but we just launched the Companion Animal Health just this quarter. There is a large installed base, and we know where that installed base is. The product life cycle here has been about six years, so we have got a lot of installed base that are greater than six years old. So classic funnel management tool is, let us go after those, that installed base, which the team is doing. Again, that is just on the companion animal side. The human version of that is launched next year, and that will give us another growth spurt on that product portfolio. So exciting times.
Great. Then in terms of capital allocation, you obviously have the goal of paying down debt. But as we think about the acquisition closing, hopefully in the fourth quarter this year, how should we think about the mix between cash and debt?
Yeah, I think we're going to continue to make progress through the balance of the year on cash generation, and all that cash can be used to help fund this acquisition. We have about $900 million or so of capacity on our revolver. We'll use a combination of what cash we generate through the balance of the year and the revolver to take out eCential.
Okay, great. Are there any questions from the audience? All right. If not, I'll leave the rest of the time with you guys for some closing remarks and key takeaways for today.
Well, we appreciate you coming to spend some time with us. I would point you to the things that we said early on, which is about we need to grow above market, which I think we're doing. We need to improve gross margins. We're doing that, and we're meaningfully contributing to our free cash flow conversion, and debt reduction. We're trying to be visible. We're trying to be accessible, and we just welcome any engagement as you build out your models and get conviction. We think we've got a long runway ahead of us. We've got great technologies, great customer relationships, great brands, and we'd love you to become part of the story. Thank you.
Thanks for being here.
All right. Thanks, Ross.