Good morning. Thanks for joining us again at the 24th Annual Needham Healthcare Conference. I'm Mike Matson, and I lead the MedTech and Diagnostics Equity Research Team at Needham & Company. I'm pleased to introduce ICU Medical. With us today, we have CEO Vivek Jain and CFO Brian Bonnell. Instead of a standard presentation, we're going to do a Q&A session or fireside chat. If you do have questions you'd like to ask, you can submit them electronically through the Needham Conference website, and I'll try to fit them in, or you can also email them to me at mmatson@needhamco.com. With that, we'll just go straight into the questions. I'm going to start with a topic that I think everyone's focused on right now, which is the tariff situation.
I know there's a lot of uncertainty here, but I just want to get your take on kind of where things stand. I guess just let's start with the kind of prior tariffs, which was Mexico and Canada. I think that ICU Medical does have a few plants in Mexico. Can you maybe talk about what products are made in these facilities? I believe you said previously that the plants there account for about one-third of your sales. Does that also mean sort of one-third of your cost of goods as well?
Good morning, Mike. Thank you for including us. Thanks to Needham for having us. I'm glad we could do it this year. We had a little bit of a scheduling conflict last year after you picked us up, so it's great to be here. Obviously, we love talking about tariffs, and we spent the last number of months talking about them. By all measures, things broke in the circumstances as well as they could have for us. The largest area of production we have with multiple sites is in Mexico. We have three different locations. One of those is a legacy ICU site that accounts for the majority of our infusion consumables and oncology business. The other two sites came with the Smiths acquisition in Tijuana and Monterrey, and they impact almost every single Smiths product category. We are all in on Mexico, so to speak.
We were very happy that MCA was carried forward. We were, frankly, tired of talking about this topic in early March. We stuck a slide towards the end of our investor presentation, which has been updated for recent events, that tried to articulate the financial exposure based on the value of production out of those Mexican sites. That slide said, if it was 25% across all Mexican imports, that would be really bad. In the USMCA framework, we said the exposure was $20 million or less and outlined a number of mitigation activities to try to work that number down. Those mitigation activities really are in three areas. It is one, dealing with products that are headed internationally with the right chain of custody to make sure they do not actually touch the U.S., so to speak. Two, analyzing, can those products become compliant?
What are the reasons they're not compliant from a component standpoint, et cetera? That is a long pole item. The third is sort of making sure we're claiming the value made in the U.S. under 9802, et cetera, properly. There are multiple mitigations there. I do not want to leave you with the impression that that 20 goes to zero or something. There will be an impact, and it will take time to work it down, but there are teams working on the three remediations around that portion right now.
Okay. At this point, it's 100% certain that the USMCA compliant manufacturing will not be tariffed from Mexico?
I am not seeing 100%. It is the law of the land as of what time? 8:06 A.M. Pacific this morning.
I would characterize it as being indefinite. It's indefinite for now.
Yeah.
Just right off the end of the tariff.
Okay. All right. Just given the more recent news from last week about the tariffs on basically anything being imported to the U.S., does that provide any incremental exposure? I guess what I'm wondering is, supply chain-wise, are you sourcing any components or raw materials from outside the U.S. that would see tariffs? I guess if it's going into Mexico, then maybe it wouldn't until you bring it into the U.S., but then it's USMCA compliant.
I think that's, I mean, that issue, right, the routing is certainly what part of this whole discussion is about. More specifically, that slide towards the end of our investor deck outlines the three new knock-on effects that happened from last week's decision. The biggest one, and they are negative repercussions to us, though, again, we have to mitigate them. The most dramatic one, which is equal to all of our peers and in some ways better given our geographies, was the 10% flat across the board. That 10% applies to Costa Rica. If you read our 10 Ks or Qs, you would see that Costa Rica has been a long-time manufacturing site for us that came with our acquisition of Hospira in 2017, where the majority of our LVP pump products are made.
We are doing the same analysis to quantify that so we can provide a precise number like we did on Mexico. Our segment revenues were pre the last transaction publicly disclosed there. That gives some estimate, but what's not clear is how much of that business is international versus domestic. A large portion of the LVP business is obviously international. The Costa Rican currency corrected somewhat. Markets actually were efficient there. Costa Rica's 10% is an issue. We need to start working on that topic. The second issue is the tariff on other inbound raw materials. I presume that this kind of pass-through stuff gets sorted out eventually. That is what I think the government is after at some level, to really analyze, are we buying those in the right geographies, and are we buying them with the right price protection, et cetera?
Because the knock-on impact is not only just short-term tariffs on those items, but even if we're buying them in the right geographies via the U.S., are we going to face price increases? We're starting to think about that, right? That is the inflationary effect of all of this stuff, right? The manufacturer who's providing us raw materials is not going to want to eat that. We have to think about protecting ourselves on that front. The third is kind of the unquantifiable, which is what our retaliation—I don't know if the right word is retaliatory or reciprocal or whatever—what if other countries start adding to what we send outbound? Again, most of it's coming from Mexico. There's very little we send out other than because of logistics that is really made in the U.S. and sent directly to other geographies.
We'd have to work on that issue too. That slide outlines those three impacts. What it does not have is a number against it yet. That is what I imagine we and every other company in the world is scrambling to put on paper. We at least got the Mexican numbers on paper.
Okay. No, that was all really helpful. I want to move on and focus on the rest, the actual business as opposed to the tariff headlines. Starting with the consumables business, I think that within that business, the infusion therapy products are mainly driven through contracts with your customers that have your pumps. Aside from just selling more pumps and winning share there, are there ways that you can drive increased infusion therapy product growth without just placing more pumps out there?
Yeah. I mean, just to be nitpicky about it, the minority of what I would call our legacy infusion therapy business, which is IV therapy and oncology, which is about $700 million of that billion-dollar consumables business, $700 million plus, a minority of that is correlated to pump purchases. That is our original business. It's open where we compete based on clinical price, service, customization, et cetera. That business has been growing very successfully even without being correlated to pumps. Being correlated with pumps helps it, but it's been doing great on its own for its own unique drivers. It's compounded, I don't know, 5% or 6% a year, right, for six years in a row. I think our guidance was mid-single digits there. We continue to feel like those underlying drivers independent of pumps are still pretty strong. It's about finding the niche markets.
It's about calling on the demonstrating the value of the products with clinical evidence and delivering them to a way of the customer that makes it easy to use: workflow, standardization, training, et cetera. I think independent of pumps, we feel very good about our consumables. Pumps is a secondary conversation, which can help make it better.
Yeah. Okay. The other part of the business, oncology, I think has been a particular strength for ICU Medical. Can you just provide an overview of oncology and why the products are kind of different from the conventional infusion products and why you've been able to do so well in this category?
Yeah. Sure. I mean, at the simplest level for those new to ICU Medical, we make the plumbing that gets a medication to a patient, right? That plumbing can either go directly to the patient or that can go via an infusion pump. Oncology is essentially the expensive plumbing to make sure that dangerous drugs or expensive drugs are used fully and never exposed in a hazardous way to a clinician, tech, patient, et cetera. We think we've been the innovator there also because we've combined those aspects of drug preparation, which happen in the pharmacy, and attach them physically, in the most literal sense, to the nursing use of infusion sets. The products connect together. It's a very natural staircase adjacency to the IV therapy business.
I think what ICU understood early was hazardous drugs were becoming a greater and greater market share of the valuable items flowing to a pharmacy. How do we add value to those situations, participate in that? ICU got lucky, so to speak, as the industry did, with there's also been a set of tailwinds and regulatory guidance around the world saying you have to use safe plumbing when you use dangerous drugs. It is a combination of kind of natural adjacency, innovator, regulatory framework, all of which continues today.
Okay. Got it. With regard to the Smiths deal, it's been a couple of years now. I think there's been a lot of focus on kind of the pump side in terms of the synergies there. Can you maybe talk about what sort of synergies, if any, there's been on the consumable side between the two companies?
Sure. I mean, I think if we were to outline the strategic reasons for taking on the headache that we did, it was first and foremost about the pumps, right? You are right on that. It also benefited the consumable segment. The third largest business—I am sorry, the second largest business in the consumable segment is the vascular access business. That is the catheters that we lacked historically that physically attach the infusion set and the pump set itself. Smiths was the number two player in that market for a long time, lost its way a little bit. We have been clawing our way back, but that is a very—back to this point, like oncology, a very natural staircase adjacency for us. If we are winning in the first two in IV therapy and oncology, it gives us a right to win in PIVC.
The products, again, literally connect to each other. It is a good example where we can improve our lot in life in consumables there. Smiths had its own $20 million-$30 million business of other OEM consumables, et cetera, right? All that existed despite their best efforts because the products were unique. Those are areas where we can innovate a little bit and add some value. There have been synergies with Smiths on the consumable side also.
Okay. Got it. Can you maybe just talk about pricing trends in consumables? What are you seeing there? I know you've signed some new contracts, I think, with GPOs.
I mean, obviously, it would be great to say that we've recaptured all the inflation of the last few years in price. We have not done that yet. We are working to do that. One, we had to be healthy from a supply side, which on the legacy businesses we were, we had to get there on some of the other ones. We have been now for a long time. We started in earnest, really in the international markets, maybe 18 months ago because the U.S. dollar strength was really painful. The only way to recoup that internationally was through price. That was a concerted effort. That effort continues today despite what is going on with the dollar. Domestically, we had to wait for a series of big contracts, which were negotiated last year and just started their implementation this year from a GPO perspective.
I think we talked last year about the company having the opportunity to get a point. We talked early this year and late last year about the company having the opportunity to get a point of price across IV solutions, which we won't fully capture anymore, IV consumables and pumps. To a large degree, that kicks in this year, and consumables are also a beneficiary of that.
Okay. Got it. Just curious about kind of inventory levels in the channel, either through the GPOs or hospitals. Is there much inventory or consumables out there? Have you ever seen stocking or destocking cycles in this business?
I hope in the X amount of years that we've been here, you don't hear us say the word stocking or destocking in an earnings script. The joke is you have a good quarter, it was stocking, next quarter, so it's those destocking. We try to stay away from that. The only things that make inventory levels out of the ordinary business is when there's some national shortage. And there was a national shortage in IV solutions in the fourth quarter last year. I would suspect distributor inventories are a little bit high there because everybody goes into hoarding mode. That's the only place where I think, right, where we would say that the whole channel thing is even a discussion.
Yeah. Yeah. Most of our end customers do purchase through distributors. If there is any stocking or destocking, that's generally where it happens within the supply chain.
I mean, nobody wants to hold excess capital in these things, right? It's only when there's a shortage in you.
Yeah. Okay. All right. Moving on to the systems part of the business. Starting with the large volume pumps, there's a lot of movement in that market, obviously. Can you just talk about the competitive landscape here? I know you've had some new pumps from some of your competitors, some new pumps from you guys. Back then, it's obviously been back in the market now for a few quarters, I think.
I mean, it's a very interesting time, right? We've grown up in this business, having been in it now for like 16, 17 years. And it's had all these kind of strange periods because of what's happened from a regulatory perspective. I think we're in one of those periods right now. It's a great time to be a customer. There's multiple choices on the market. The biggest issue was the market share leader had to refresh a lot of its devices due to its own regulatory situation. I give them credit. They fix the device, and they're out there trying to do that. They appear to be applying very logical behavior to what's the fair value and life cycle of a device.
Those decisions mean some portion of the U.S. market, a meaningful portion, has to make real decisions about purchasing new equipment because they did not have the ability to purchase equipment for a number of years. As a nature of fixing the product, they have to make some decisions. That circumstance, plus the natural aging of our own fleet and the other competitors' fleets, means for the next couple of years is probably an accelerated replacement cycle. That is why all vendors have been pushing new technology. This morning, we received approval for our Plum Solo device, which finishes our work really in having the most modern LVPs. We think across the Duo and Solo pump, it positions us well for any of the competitive situations we are in. The way you really create value over the long term in pumps is winning competitive share, right?
Short-term wins of refresh of capital can help period-to-period revenues, which is a separate conversation, great opportunity for us. There is a lot of action going on. There is an accelerated pricing cycle. We have new technology. Happy to go through why we think our technology is superior and what is the incremental innovation we have had. It is a good time. It is a good time in pumps.
Yeah. That leads into my next question. I was going to ask about when Plum Solo was going to be launched, but we did have the announcement this morning about the 510K, or, I guess, the clearance. Does that imply that are you ready to launch it now, or is there going to be some kind of period where you have to do a limited release or ramp up production or something, or is it pretty much ready to go now?
I mean, our experience—great question. Our experience in these markets is nothing goes that fast, even if there's the right way to do it to avoid future problems, to put it into a limited market release, make sure we fully understand its use, the use cases, et cetera, and test drive it a little bit before we go with a full release, the same way we did on Duo.
Okay. And then Plum Solo, maybe you could just talk about how it fits with Duo and kind of where you're at in terms of offering that comprehensive platform on a single software system.
I mean, I think there's three pump-specific things about Solo that are important to us. The first is Duo was clearly designed for the high clinical acuity environments where you needed multiplexing of drugs. That was a limitation on the old Plum products that you couldn't deliver multiple drugs, and the footprint was too large. Duo modernized all of that. Candidly, the customer sometimes is also overpumped. They have more devices than they need. The Solo offers an opportunity in competitive high clinical discussions to say, "We have the right product for the ICU, the CCU, the OR, and the right product for the general med-surg floors." You don't need to be using so much tubing. You don't need so much real estate. You don't need so much tech in every single situation.
I think it, again, our whole business model, the small guy has to customize more, be more unique to the customer's needs. We think having the two together and offering choice is great in the high competitive situations. 40% of the U.S. market is still a single channel pump, not a multi-channel pump. That represents kind of our market share and the third player in the market's market share. A single channel pump is attractive for those customers that are comfortable using a single channel pump. Solo offers that opportunity with kind of the 2025 finish of a medical device. More specifically, our own devices, part of the value in infusion is refreshing your own install base.
It may not create NPV because you're already getting the dedicated sets, but it certainly does help period-to-period revenues and potentially margin if you bring enough technology. ICU Medical's devices are only hitting 9 or 10 years old in the market. We've never had the opportunity to refresh our own install base. It was very important for us to get Solo to have valuable new technology for people who have been committed to the Plum platform. There are three really important drivers there. Yes, all Duo, Solo, and ultimately even Medfusion and long-term CADD will be connected on a single IT solution, right? The 40% of America that didn't go with the market share leader was largely running two IT solutions anyway. They can all have one now as we consolidate the platforms.
Yeah. Okay. Just on the, I guess, on the syringe pump, so I guess that's kind of the next product that will be cleared. Can you give us an update on the timing on that and how meaningful that is to the product lineup?
I think the syringe pump is on deck and as fast as we possibly can. We're close. We're not that far away. And we talked about it being on file this year. I think we stick by that disclosure. Solo, again, was a first-pass approval for us, which is rare in the infusion industry. We feel pretty—we hope we have some track record there. I think sorting out some of the long-term issues that the business we acquired had on just older technology. That is just not to the customer. That is supply chain parts, pieces, everything. These devices usually run a lot longer than the people who intend to provide parts for them want to stay in business. Modernizing all of these things really matters. There is a bunch of reasons Med fusion needs to get done.
Customer-facing integration of IT is number one, but just having a better business long-term is an important downstream effect. It is happening as fast as it can possibly happen.
Okay. Just a similar question on the ambulatory pump timing.
Ambulatory pump will be after Med fusion. I don't know that we see the timing with perfect clarity. It's also close, but the resources—it's the same people, and those resources are dedicated more to Med fusion. I think the market share position in ambulatory, we're certainly back and very competitive there. The market share position and the market structure is different than the LVP syringe markets. We obviously have to get the device modernized for the long term, but we've been spending the last two years making sure what we inherited was rock solid, and our efforts continue to be on that. You have seen some of our cleanup activities on that device.
Okay. Can you just maybe compare—I do not know if you can give us specific amounts or just on a relative basis—kind of the pricing differentials between starting with Plum Solo—sorry, Plum Duo, Plum Solo, the Syringe Pump, and then the ambulatory pumps. I assume Duo is the most expensive, followed by Solo.
I would say it's almost a tie, right? The next generation syringe potentially could be at Duo levels or higher because if you can imagine the syringe, you're just selling a dedicated piece of capital. It doesn't have an annuity. It doesn't have a raise. So it's a single instance. The irony was a syringe pump sold for multiples more than LVP pump in this country for many, many years. I think our view is that if the syringe brings the right technology, if it doesn't carry annuity, then you have to make money selling a straight-up piece of capital at a different margin expectation. I don't know that we know final market pricing yet.
There's not enough data points on the Duo Solo market, but any of them are clearly positive margin items superior to where we were selling the historical device because it brings a lot more technology. It's kind of a silly market in a way if you think everybody—the expectation was to get capital at or below cost to clip these razor blades, right? The advantage the market share leader had for many years, certainly when we were helping build that situation, was carrying very attractive margins on the hardware itself. That makes a huge difference. We think we have enough technology to do that.
Okay. The LifeShield software, maybe you can just talk a little bit about that. I think there were some enhancements with this latest clearance that you're applying to the Duo product as well.
I think on the Duo enhancements, there were a few things that didn't get through on the first label: blood, et cetera. I think those have all now been included in the label. That was the biggest item. Some probably mechanical pieces and parts changes inside the device to assure there's long-term supply stability. Those were the main reasons on Duo. On LifeShield, I think it was more just getting the connection to Solo validated and then a few modules. I'm not sure there's a lot more detail. We'd go into it about that.
Okay. In terms of operability, I think you've said recently that less than 20% of the markets implemented the pump in our operability. Why is it at that level? Why isn't it higher? Where do you see this going? Do you think it becomes a majority of hospitals? I've kind of heard some mixed things where it's pretty difficult and costly to implement. Maybe there's some questions about whether the benefits outweigh the cost.
I mean, certainly, if you look at the nation's two large IT vendors, they dedicate a lot of time to this topic. I think the reasons for slow implementation have been there hasn't been consistency in the situation, right? For anybody to do anything the last five years between COVID to where we are today, I'm not sure hospitals have had the time in the midst of their own upgrades and integrations to deal with getting all the way there. I certainly think it matters because it's safer. It's safer to have a pump program by a pharmacist sitting far away from the patient validating and having a second set of eyes come in and just validate the order. I think it's better for reimbursement and billing to make sure you know exactly where the drug is being infused and capturing all of that information.
I think it's better for efficiency to know how many devices you need, et cetera. I think there's lots of reasons. You're right. It's hard. It's a lot of work to get it implemented. It's a lot of downtime, and it's a lot of work for nurse training. People haven't wanted to take on those things. I think the way we would look at it, Mike, is the ramp from kind of 2015 to 2021 was pretty steep, and it's slowed down since then. The drivers that made it steeper from 2015 to 2020 are still here today. We just need the world to be a little bit normal.
Yeah. Okay. That makes sense. Moving on to the vital care business, we want to start with the IV Solutions Joint Venture. Maybe you can just quickly give us an overview of that for maybe people that haven't been paying attention. Can you talk about why it makes sense for both companies? Is this still on track to close in the second quarter? I think you said maybe kind of late April timing, if I'm remembering correctly, but maybe I'm confusing it with something else.
No, I think Brian said after the last call, just assume a May 1 date just to make it somewhat orderly on a monthly basis for the year. Goal is still to close in Q2. For those new to it, we mostly made dry items. We mostly made pumps, consumables, et cetera. With the acquisition of Hospira a number of years ago, it put us into the IV fluids business, which is what I would call a more generic drug-like manufacturing business. It certainly was necessary and continues to be necessary for our customers because people buy the infusion pump and the consumable and the IV solutions together. Like you started the conversation with, it's again, it's still a minority, but a chunk of people purchase that way. It was advantageous for us to have it. Over the last couple of years, it's been evident in our results.
It's been sort of a boom or bust business where we had windfall moments and we had very difficult moments. At its core, it's a capital-intensive manufacturing business that had lower margins than the rest of our company. Even if we could live with that over time, I think our view was it was difficult for us to be the innovator the same way we were in some of our other categories. We were searching for years for a partner who could bring that innovation. That innovation is along packaging. It's along formulation. It's along manufacturing technologies. It's also about capital because it's significant capital to modernize these types of facilities. We think we found the best partner in Otsuka, the leader in Asia who has 17 of these sites around the planet. The transaction is they are buying.
We're creating a true joint venture, which is complicated, not as easy as exiting something, but we couldn't exit because this is important to our customers. It's important to the value prop of our consumables. They are going to purchase 60% upfront for approximately $200 million in value to us. And then there's a series of milestone payments, back-end payments if we choose to exit the JV, minimum five years. We're in it for as long as we can think. They bring all the boxes were checked: new technology, capital, patience, long-term Japanese investment horizon, and innovation. I think it's very interesting. In their minds, just look at the last week, right? You have a multinational that makes good margins on its branded pharmaceutical business in the U.S. investing into U.S. manufacturing..
I think all parties are pretty happy with what's gone down here, and we got the requisite government clearances. We are ready to go. It's the technical parts of the IT setup, the order-to-cash process to ensure nothing feels different for our customer that's taking the setup time right now.
Okay. I mean, it seems pretty straightforward. Putting aside when the deal actually closes, I mean, what, if any, risks are there here that we should be maybe thinking about, or is it not really any kind of real material risk?
As it relates to the transaction, I think it's a giant win for customers because even if people loved us and were with us for years, the criticism of ICU in the moment of the hurricane last fall would be, "Hey, you still are a single-site manufacturer." Now we're part of an airline alliance, right? We have 17 sites around the world, a handful of which have excess capacity, and we'll get registered to be a U.S. manufacturer with very, very competitive costs. I think it's a total win for customers. In the other categories of nutrition, in other words, effective monopolies or duopolies, you're going to have someone who's very disruptive enter those markets. We're going to help them do that.
Okay. Got it. Vital care, kind of putting aside the IV solutions part of it, I think you've guided to kind of flat growth there for this year. Why is this business growing more slowly? Is there anything you can do to drive faster growth here?
I think it just hasn't got the attention yet versus the rest of the portfolio. There are really three businesses in there that are of scale: restaurant anesthesia, critical care, and temperature management. Each has their unique circumstance, which is too much for this call. I would answer the vital care question. Vital care is kind of a bit of a strategic option for us if there's ways to add to make them better. I think we would look at that. If there's ways to monetize, I think we'd look at that too. Obviously hard given the current environment. It has all been secondary to figuring out what to do with infusion solutions with IV solutions, and that was the most important thing to get done.
Okay. Got it. I think you announced the recall for endotracheal tubes recently. I just wanted to ask about this and see, is there any kind of material impact from this? It's always hard with these recalls to know what the numbers are or how meaningful it is from a cost standpoint.
I mean, Mike, we actually recognized the expense for that in the fourth quarter of 2024, and it wasn't very much. So it clearly falls in the not material bucket.
I mean, it's not just the ET tube group, Mike. There's been a lot of them. It's been about cleaning up the portfolio that we bought and making sure. One of our views is if something smells bad or see something bad, say it. It's better to be in full disclosure on every item around the products and put everything out there. It's painful because each one of them costs money, but it's the right thing to do to ensure a clean regulatory bill of health.
Yeah. Okay. Got it. Just a few financial questions in the last few minutes here. In your latest investor presentation, you showed kind of a path for gross margin improvement. Maybe you could just talk about kind of the main components here that will drive that and to what degree does that account for pricing increases?
Yeah. Maybe just to recap our margin improvement initiatives, we had originally set targets for ourselves of eventually getting to 40% gross margins on an organic basis. That would happen over time. That margin expansion at the gross margin level would drop through and yield 20% EBITDA margins. This was sort of before the IV solutions transaction, just setting that aside. At the time we had set those targets around gross margin to get to 40%, we were sort of operating at a normalized 36% gross margin level. We were looking for a 4 percentage point margin improvement there. That was going to be driven really by a combination of three areas. First, and maybe the most important, is the integration synergies.
Contributing to that is the manufacturing network consolidation that we're in the middle of doing, along with the supply chain consolidation that's happening as we're consolidating our IT systems. The third area, which is probably a little less meaningful but still important, is real estate savings. All three of those areas fall within the integration synergies bucket. As you mentioned, price also is a contributor. That's the second category. The third, we would say, is just higher absorption within the manufacturing plants as a result of increased volumes. For 2025, I would say really all three of these categories are contributing to that 1 percentage point of gross margin improvement that we've guided to. This is all.
Before all this craziness of the last.
Exactly. It is sort of we're getting that in addition to kind of the normal stuff you have to offset, plus maybe some of the things that have happened recently around tariffs that are not so normal. I guess in terms of kind of where we stand relative to our original goals of getting to 40%, I think we would expect to exit this year around 38% gross margins. I think that kind of puts us halfway towards our goal. When you, I guess, add the impact of the joint venture transaction and the deconsolidation from IV Solutions, we said that once that transaction happens, going forward, we would expect 3-4 percentage points of gross margin improvement above and beyond the 40% targets that we had originally established.
Okay. All right. And then just for OPEX, I mean, your OPEX has been pretty flat as a percentage of sales, and it's pretty low. I mean, is there any opportunity to drive leverage there? It's really just about driving gross margins higher at this point?
I mean, I think, yeah, for 2025, we did guide to 3% increase in operating expenses relative to 2024. That 3% increase, though, it's very heavily tilted towards some incremental investments that we're making in both R&D and on some commercial resources. I do think that when you look at the 3%, kind of the back office stuff is a small portion of that. I do believe we are getting some natural leverage. It's just that this year we are trying to reinvest some of that into areas of the business that can really help with future growth.
I mean, if you have a gross margin in the 40s, Mike, and we haven't even got there yet, if you have a gross margin in the 40s, you don't have the luxury of having a lot of OPEX, right? That's the reality of.
Yeah. Yeah. I understand. Okay. I think we're out of time.
Sugar coating that.
Yeah. I think we're out of time, so we're going to have to wrap up there. Thanks, guys. Hope you have some good meetings at the conference.
A great schedule. Thank you. Thanks for interesting ICU Medical. We appreciate your efforts, Mike, and happy to spend time with anybody who needs any follow-up. Just email Brian.