Welcome. Hello, everyone. I'm Robbie Marcus, the MedTech Analyst at JPMorgan. Really happy to introduce our next speaker, Tim Herbert, the CEO of Inspire. We'll do a presentation followed by some Q&A. Tim.
Very good. Thanks, Robbie.
Very good. It's so good to be here. I'm looking for it. Where did Melissa go? What year did you say this was? 2025? Yeah, 25th anniversary at JPMorgan. Then I had to do a little bit of math, and I think this is like 2018 for Inspire. We're still a small private startup way back when we had our first meeting. Quick message. I think the weather outside is beautiful with all the sunshine. I think anybody would give anything to have the rain like we used to have down in L.A., so our hearts go out to the people down in L.A., and yeah, we have some people affected. We're making sure we take care of everybody, but it's a tough challenge going on there, so let's get going through here. Everybody read this quickly. OK, so Inspire, this goes back.
This slide dates from the beginning of time. It's all about mission, right? It's enhancing patients' lives through sleep innovation, and that's everything that we do is always, always keep focusing on outcomes. We're going to talk about outcomes here today, and everything we do to develop technology may improve the experience of the physician, of the patient, of our own ability to deliver product continues to make things a little bit better and better. The best testimonial to that is, look where we've come, right? We founded the company in 2007. I started working on Inspire back in 1996, right, and I still look young, but the key to it is we've been really developing this over time. I'm going to show you some early slides of the early generation systems, and it all leads to, we're so proud of what's happening with Inspire V.
But back in 2018, when we did the IPO, 4,000 patients treated were generating $50 million in revenue, right? 200 implanters. Here we are today, over 90,000 patients implanted and growing, over $800 million in revenue, and over 1,500 implanters. So it's just going to continue to grow. And there you see our message for our national sales meeting that's coming up is simple. We're just getting started, right? And a lot of changes that we put forward today, it's highlighting that we are just getting started. Interesting way we look at things. So here you can see the 90,000 patients treated. You can see the annual growth rates, both with new employees and averaging up. But what's intriguing is back in 2014, it was about 100 hours between every implant. And then when we did the IPO, it was about five hours between every implant.
And here we are today. A patient receives Inspire therapy every 15 minutes. And that's only getting better. We're going to have to change the scale again as we continue to move forward. Here's the revenue that we put out this morning. We had a great quarter. Very happy. End of the year at $803 million. You can see the three-year CAGR of 40%. Very happy with the team and how they delivered it. We did activate 72 new centers in the U.S. in the quarter. That brings our total to 1,435. We created 12 new territories, bringing our total of 335 territories in the United States. We also increased the number of field clinical reps, too. And remember, the field clinical reps are essential because they do a lot of the case coverage, whereby we want our territory managers to really focus on patient flow driving utilization.
We did receive the FDA approval for the Inspire V neurostimulation system, and we started the soft launch. We actually started it in Singapore. We've completed 40 of a planned 44 implants. There's still four more yet to go. I'll show you that in a slide. We also started the first implants in the U.S., so very, very excited about that, and then we put out our initial revenue guidance, and our initial revenue guidance is between $940 and $955 million. $940 and $955 million, right? Just look back a couple of years on where we were, and we're very, very proud of that. I want to take you back a little bit, and let's talk a little bit about Inspire, though, and make sure we ground everybody what Inspire is all about, right? Obstructive sleep apnea is caused by a blockage of the airway while you sleep.
You think about good friends over at ResMed, and they use CPAP, where you put a mask on. It blows continuous positive airway pressure to shunt the airway open. We do the same thing, except we stimulate a nerve that moves the tongue forward that holds the airway open versus using pressure. So same mechanism of action, just a different way in which to accomplish that. We treat moderate to severe, which is on the right-hand side there. The reasons to treat sleep apnea haven't changed. And that's what brings all the attention to it. That's why everybody has the Oura Rings, or you see all the activity going on with pulse oximetry lately. You see the attention around the GLP-1s with new ways to treat sleep apnea. It's because there's a causal effect of untreated sleep apnea and what it does to the body, right?
Over on the right-hand side, the survival chart really shows the impact. This is a continuous group that they tracked for 15 years, and untreated severe sleep apnea, you see the survival rate at 60% as compared to the high 90s. Very, very impactful. You must treat the severe sleep apnea, or there are going to be consequences. You can read down there: risk of stroke, risk of cardiovascular mortality, sudden cardiac death, atrial fibs in the news right now. If you don't treat the sleep apnea, there's a 57% recurrence rate, so it's very, very important to address it. The other therapies out there, of course, gold standard is CPAP. But as you can see, there's numerous reasons why patients are just unable to benefit from CPAP. Still an effective therapy, very cost-effective. But again, you have to wear the mask every night.
And that makes it more difficult for patients to do that. Not many surgical options for our patients. You can have a uvulopalatopharyngoplasty, which is basically removing any tissue in your airway that could obstruct so it won't obstruct. And that doesn't work very well. It's about 50% effective. And then, of course, the most dramatic is if you have a recessed jaw. They literally break your jaw and shift it forward 10 millimeters. But then it doesn't align with your upper teeth. So they have to break your upper jaw and also move that forward to align. So the surgical options are not that promising. That creates a very large market, right? And adults with moderate to severe sleep apnea is 23 million in the United States, right? CPAP prescriptions a year are estimated at about 2 million a year.
If you say that patients are 70% compliant, and I know that generally people say it's 50% compliance, but if you say it's 70% compliance, that's 700,000 new patients per year that are diagnosed with obstructive sleep apnea not properly being treated with CPAP. If we filter that down to the population that we can treat, it's about 500,000 new patients per year. So that's really the message that we are, in fact, we are just getting started. So we look at what is Inspire Therapy. What's very key is this curve over on the right-hand side. And let's go back to CPAP again. So CPAP, continuous positive airway pressure, right? It blows constant air. But people complain about having to exhale against that pressure. So they came up with something called BiPAP, bi-level pressure. So when you inhale, the pressure is higher.
When you exhale, the pressure is lower. The message being, your airway collapses during the inspiratory phase of respiration. So what we need to do with our system is we need to detect when patients are breathing and when they inhale or inspire. That's when we turn the stimulation on. And when they exhale over here, that's when we turn the device off and rest and monitor. And when they start to breathe again, we turn the device back on. So it is a closed-loop system. And that's how we can maximize both the energy we deliver to take care of the patients. We maximize outcomes. And what's key to it then is the system that we have as a neurostimulator, a stimulation lead, and a sensing lead. And this has been what we've had since the beginning.
A patient has a remote that they use to turn the device on at night, so when a patient breathes, the sensing lead detects that respiration. It's processed with the neurostimulator, which then provides the energy to the stimulation lead to open the upper airway. Let's go back to the very early days. Back in 1995- 2000, when this was started inside Medtronic, you can see we used to put the sensor right in the manubrium. This sounds ridiculous, but if we measured thoracic pressure, we're best to do it. So we literally got a drill bit from the hardware store, threw it in the autoclave, and drilled a hole in these patients right here. We did eight patients back in Medtronic back in 1996. Of course, the heart's right there, so we got all the cardiac artifact, and so that didn't move.
That's why we had to move it with the Inspire II system, where we put it in the intercostal muscles. I was a rep back in the time. I used to have to lug this thing around. This thing weighs about 30 pounds, and you can't check it. You've got to bring it and throw it up in the airplane, but this was the physician programmer back in the day and the old patient remote. Here you see the neurostimulator, the old sensing lead, and then, of course, the stimulation lead. As we evolve, we now are changing this, so the silicone leads we came out in the third quarter. Inspire IV came out in 2017. We went full body MRI. We introduced Inspire Cloud in 2017. The Sleep Sync system came out in 2022. We have a whole new physician programmer came out in 2024.
The new Bluetooth remote, where patients can communicate with their cell phone and with their physicians, it comes out in 2022. Here we are today. We're at the cusp of being able to launch the Inspire V. It's approved by the FDA. We've done the first implants. We're very excited about that. Let's talk about Inspire V then. What it is is we expect a 20% reduced implant time, improved therapy performance, fewer revisions, and then it leads to future innovation. As we kind of walk through it, what we do is the neurostimulator is built for expansion. It does have multiple electrodes. Today, we're only going to use two of them for the stimulation lead that we have. We have the capacity to add feed-throughs and add additional electrodes in the connector block. That allows us to target new stim targets.
We talked about being able to treat high BMI, and high BMI is having multiple stimulation points, so we have a built-in dual channel already in this device. It's software platform, so when we go to Inspire VI, and I'll remind you, when we're talking Inspire VI, what we're talking about is auto activation, so the device will know when the patient's sleeping. It'll know when you're awake, and so the device will turn itself on at night and shut itself off in the morning, and that's just a downloadable feature for the patients who have V. Future features could include posture response, right? It could include auto activation, is when we're looking for more of an automated therapy so the device can detect if you're having apneic events and auto-program itself using all the data that we have to be able to coordinate that.
We want to stay with a consistent long battery life. Right now, we're at average 10, 11 years, and that's been consistent from Inspire II to Inspire IV, now to Inspire V. That's really a key feature. Let's talk about that for a minute. All those patients back in our first year of 2004 received Inspire therapy. They received an Inspire II unit. And here we are, 11 years later, those patients now coming back to receive a new device. So we are now starting to see our new revenue channel with replacement devices. Very excited. Proven security in the patient remote, as well as with the patient app. Everybody's so aware of the risks of devices and people being able to hack into their device. We don't have a significant amount of risk there, but we do have our security already built into it.
When we go with V, the big state-of-the-art change is going to the sensor performance. We put an accelerometer inside the neurostimulator can. This is the same technology that's used for cardiac pacemakers when you do rate-responsive pacing. So when you go jogging, the pacemaker knows to pace faster. Same thing. We can detect respiration. And what we showed from our data is we can detect a tighter respiratory pattern between the Inspire IV and the Inspire V. Multiple reasons with that. If you look back on the Inspire IV device, it can rotate. Here you see the sensor just as flat. If it rotates a little bit, it can disrupt the signal. If it's placed differently in the intercostal muscles, it can affect it. So we believe with the Inspire V the data that we've shown, we're going to get a tighter response.
That's going to help us with the synchronicity of the stimulation with the respiratory pattern. That's what we're looking to show as we kind of move forward. The Sleep Sync connectivity is really going to have great benefits for patients down the road where we can start doing remote monitoring. We're working to develop remote programming. You can program from a physician's office to a patient's home. This is all technology that's built in that we need to prove out and get approval with the FDA. We started with Inspire V. We started with our good friends in Singapore at the Singapore General Hospital, which is a very, very impressive hospital, one of the largest in the world. We also worked over at the National University Hospital. We were doing a group of 44 patients. We've implanted 44 to date.
There's still four patients who are already scheduled, but we haven't completed those implants. The feedback has been very, very strong. Obviously, they don't have to place the pressure sensing lead, so the burden on the surgeon is significantly reduced. But we put other features into it to help with the intraoperative testing and the device programming as we do the device activation. So feedback so far is very good. Those patients are just coming through right now. They're going to do sleep studies too, and we'll continue to monitor how the device is going. Then we started in the United States. We worked with Dr. Ryan Soose over at the University of Pittsburgh Medical Center. Ironically, Dr. Soose was the first surgeon who implanted the first commercial device in 2014 after we received FDA approval. So a little romantic there, and he’s got my favorite doctor name, Dr. Soose.
So he's a great guy. So we're going to continue with a broader soft launch as we keep moving forward. And we'll continue to start phasing that into a full commercial launch. We are in the process of building product. The manufacturing facility is up and running. We're building inventory to be able to support the full launch. And very, very excited about Inspire V as we move into the new year. I mentioned it a little bit on Sleep Sync. We're equally excited about Sleep Sync, though, because that really helps us with the communication between the patient and the healthcare provider, helping them monitor how often are they using their therapy. Is there any challenges with the therapy? How are their outcomes compared? Do they need any reprogramming or device changes? And that really helps the interconnectivity or the intercommunication between the physician and healthcare provider.
really works with the patient's cell phone. There's a lot of things that we're going to be able to accomplish with the Sleep Sync going forward. Let's talk about outcomes. Nothing is successful if we don't continue to maintain our strong outcomes. AHI, Apnea-Hypopnea Index, continues to be tremendously strong from 33 down to 10. This is not small sample size. This is close to 1,000 patients in long-term studies. Looking at the ESS, Epworth Sleepiness Scale, it's a quality of life measure. It's an 18-questionnaire, and high is not good. Low is good. Anything less than 10 is clinically significant. Our patients are routinely at six. What's so important is that if patients don't use the therapy, why do you have it? And so what we monitor very closely is the adherence, and so we average approximately six hours a night in our patients.
That's what it's all about. Think about when we can go to Inspire VI and the device turns itself on at night. We can take adherence up to the highest level. So when the patient's asleep, the device will be on. If the device isn't turned on, you're not going to get effectively treated for your sleep apnea. So very, very important. But then we went to the patients. And this is where we feel so proud of what we've accomplished. We asked the patients, "What do you think?" Right? 90% satisfied with Inspire, right? Given the chance, I would choose to receive Inspire therapy again. 92% after six months following implant said they'd do it all again. That's when we knew we hit a home run. And that's what's really exciting. So then we got to make sure that we monitor our safety.
This is a continuous monitoring of our safety. If you go back and look, this is 2018. Remember the STAR Trial dates from 2012. We got approval in 2014. This is 2018 when we had, what do we have? 50,000 implants and how much revenue at the time. The implant, the freedom from revision, revision rates were just under 10%. Over the years, we put a focus to it of continuous improvement of revisions. To look where we are right now is under 2% revision rates. The majority of the revisions today are caused by the pressure sensing lead because it's a complex product that goes to the intercostal muscle. So when we go to Inspire V, we get another step function in reliability to improve this curve even further by eliminating the pressure sensing lead. Really the focus on that. Freedom to explant.
The majority of explants back in 2018. Again, we're talking 5%. These tended to be voluntary, right? Traces back to the therapy outcomes and patient satisfaction scores. Today, this is less than 1% of the patients who receive therapy are explanted. So very, very focused team. It's very important to everybody at Inspire that it's all about the patients. It's all about the outcomes, and it's all about continuous improvement of our safety. We have the numbers to demonstrate it. This is from our safety report that's on our website. I think there's a new report coming out in the very near future to give updated data. Okay. Now we're just getting started. Now we get the opportunity to really leverage the talent that we have and to be able to take us to the next level, right? My good friend Carlton's right here.
He's going to be up on the stage in a minute. He joined us from Medtronic as Chief Strategy Officer. The purpose then was to come in and learn that company, learn the technology, learn what makes us tick, and learn all the people involved, knowing that his previous job was general manager of a $2 billion division at his previous company. So here we are right now in a position where he's stepping in effect at the beginning of the year to be able to run the U.S. sales team, right? And continue with the strategy role. So it's an expanded role. Very, very excited. As you recall, Phil Ebeling left Inspire to pursue his own career as a CEO. I fully endorse that. I think it's wonderful. He's doing well.
But we started a search several months ago to find the right person who can take our manufacturing to the next level. And we went very broad and wide. And we found the right person from Stryker. And Jason Kelly is joining Inspire on the 20th. What a top individual. He's actually from Ireland and has been with Stryker for many, many years. Has a degree in manufacturing engineering and a diploma in quality. He's perfect for this role. He's got the right attitude, great leadership skills, and the experience for us to be able to start ramping our production as we continue to grow. Now we get to leverage Randy too. Randy knows everything about this business, right? And so Randy now is going to take over parts of it that needs to be separated from the commercial side.
So we're going to have all the training, all the market access, the clinicals, the research, society support, and physician relationships. Very, very exciting. So Randy's very excited about that. It's effective at the beginning of the year as well. And that is going to be able to take that utilization to the next level as we keep going up. Now the next challenge comes in the U.S. team. We need to keep growing same-store sales, but we have more strategic sales that we're going to focus on, including a greater focus on ambulatory surgical centers or ASCs. So Ivan is going to move over and take over that part of it. Joe Sander, who reported to Ivan and led the East, is now going to manage all the U.S. sales team. Joe has been with us since the very first day of approval.
He and Ivan together managed the organization for the first several years until Ivan took over as head of U.S. sales. It's great to just have everybody be able to step up and take a new and really promising role. We're very, very excited about that as we move forward. The key message is great year in 2024. Very excited about 2025 going forward. We have all the keys in position to be successful. We didn't talk about our profitability because Rick is still auditing them. But we want you to all call into our earnings call in two weeks, and we'll be able to give our full profitability report at that time. But very, very excited. We're going to continue to invest in our top-line growth while improving our profitability. That's really kind of the take-home message. Okay? We're bringing Robbie up.
Should we bring these guys up too?
Rick, Carlton Sure. Rick, Carlton.
I guess I didn't wear blue today. No. We planned this.
Okay. Well, great. There's a lot to talk about. Maybe we could start with the fourth quarter pre-announcement reported about a $7 million beat vs the street guided to $940 million-$955 million, which is ballpark, high teens-20% sales growth year over year. Maybe we could just talk about the trends you saw and utilization improvements in fourth quarter and any kind of color. I'm sure we'll get a lot more in the fourth quarter call, but what you saw in the quarter and how it's leading into 2025.
Yeah. I think we had a great quarter. I think the team worked very, very hard. We did work through the org change that you talked about. So there's some adjustments in there.
But the team in the field remained very focused about driving utilization. Prior authorizations were very, very strong. Again, from the beginning of the funnel, bringing appointments through the prior authorization process and scheduling cases, I think were very, very strong. I'm sorry. Had a little bit of a challenge in the beginning of the quarter with the hurricanes, but I think we're able to overcome most of that. But this is the tough time of the year to be able to reschedule cases because everybody is fully booked out. We know that we were booking cases on weekends. So people are committed to getting the cases done because of the high deductible insurance plans. And as we kind of look into next year and lean in with the launch of Inspire V and the continued demand for Inspire, that's why we are able to put the strong guide forward.
Are you seeing at all any warehousing of patients ahead of Inspire V? It's a great device. Are you seeing that trickle down into the patient knowledge or the physician?
I think we have. I think the knowledge of Inspire V continues to grow. When we talk about it here, when we talk about it at other conferences late in the year. So physicians become aware of it. Some patients become aware of it. I don't think it's significant that there are a lot of patients waiting for 5. But we know it exists, right? We know that some of our doctors have patients that they want to wait for the Inspire V. But I'm not too concerned about that warehousing, if you will, at this point. But we'll keep an eye on it, and there's the potential for a little bit.
But again, we don't market this to our physicians yet. It's not publicly announced that we're launching it. Word gets out that we're doing the soft launch, and excitement continues to grow. But yeah, we don't think we see too much of the warehousing yet.
You want to add to that, Carlton? Is that?
No, I think that's right. With the year-end rush with high deductible plans also, we already have that demand at the end of the year. And so we didn't see any warehousing in the Q4. And then as we kick off 2025, we'll get there as we do a full launch. But right now, it's been very quiet, and we're keeping it internal.
Maybe on that full launch, you announced you've done 40 of 44 in a planned limited launch. Any positive or negative signs you've seen in that?
And what does it take before you start a full launch?
Yep. All positive. Those last four patients should be implanted very soon in Singapore to get us to the 44. And the feedback's been tremendous. The doctors are very excited about it. The intraoperative testing is quite more efficient the way the software is set up. Not putting in the pressure sensing lead, that's really the big deal. Think about our surgeons, our ear, nose, throat. It doesn't say anything about putting a sensor in the chest wall. That's going to be the big breakthrough. And that's the key feedback from the physicians in Singapore is not having to do that. As soon as they get the cuff on and they start tunneling, they're calling for the next patient because they know the rest of the procedure is routine.
That's what's going to drive efficiencies, reduce OR time, and allow people to do more cases in a day. We did the first cases in the U.S. We'll be doing additional cases as we kind of work through Q2. It's still operational readiness that's controlling the full launch, making sure we have enough product on the shelf so we don't do a start-stop. But we are going to continue to gain experience with the soft launch, not only with V, but with the new physician programmer. The whole Inspire V system is what we continue to gain knowledge on. But yeah, it's in the process right now.
So if I can reinforce that point, I have the privilege of being one of the first cases in the removal of that sensing lead and that step in the procedure.
It's not just time-saving and efficiency and simplicity, but there is an increase in peace of mind and confidence of these providers and their staff that we believe will lead to stacking of cases and more cases per day, which allows us to drive therapy adoption at the rate that we look forward to.
So on the slides, I think it said full launch in first half of 2025. Is that more of a, maybe I misread that.
I think we just said that we are working towards continuing to build inventory and support a phased commercial launch in the U.S.
Okay. So it sounds like limited launch at least into 2024.
To your point, we are already in the soft launch in the U.S. We'll continue to grow as we go forward. We're working hard with the operational readiness. When we have the inventory, we're going to go.
We think it'll be, to Carlton's point, the excitement of him being in the OR to see it is going to be there. It should be a quick transition.
You know, if I've been listening to you in your public comments over the past couple of months, you've talked about the potential for a destocking in the beginning of the year as you don't sell on consignment. So it's all on inventory. And the expectation is that centers might take down inventory ahead of Inspire V launch and then rebuild inventory when the full launch occurs. So the street's sitting around $197 million in first quarter. You have the guidance out there now. I know you don't guide quarter to quarter, but any comments about how you feel about where the street sits in? Is that an appropriate amount of destocking built in?
Yeah.
I mean, we provide annual guidance, and we're comfortable. We established our initial guidance for 2025. $940-$955 million represents 17%-19% growth over 2024. We're very excited about 2025, especially with the Inspire V launch. Also excited with our announcements of our management optimization changes that we announced today. And so we have stated, though, recently that because we have 1,400 centers now, we need to go through updating contracts with all those customers. We have to train our sales team. We have normal seasonality in Q4s, generally very strong. Historically, our seasonality has ranged anywhere from 7%-15%. But every year, there seems to be some sort of moving item in that quarter. But we're very pleased with our performance in Q4, setting a good initial guidance.
We have talked about how 2025 could be a little bit more back-end loaded because of the launch and all the moving parts with what I just talked about.
Last I checked, I think that first quarter implies something with the beat in this quarter, maybe something like 13%-15% down vs fourth quarter.
That's correct.
So that's probably in a good spot given the historical seasonality.
We're okay with that.
Okay. Tim, there was a lot of personnel announcements this morning, some new to the firm, some not new to the firm. Maybe just spend a minute on how you think this might change or impact the company. Should we expect any disruption from all these new faces being around the office, or is it business as usual?
Oh, I think it's going to be just a significant improvement. Let's start with Jason Kelly.
Right now, I've been the operations lead and working with all the manufacturing. It's silly to get Inspire V ready to go. Having Jason come in with his experience, not only in supply chain and buying, but manufacturing, and then being able to lead the quality organization is going to be just tremendous. And he's got the right attitude and experience to really step in and have an immediate impact right up front. And I think the team's excited to meet him when he joins the team. We have our national sales meeting coming up. He's going to go down there to make sure that he meets the team down there as well. Carlton, right here, has your national sales meeting coming up in a few weeks. And you can talk about how excited you are about that.
Yeah.
I think the beauty of the changes, Robbie, especially on the commercial side, is it's old faces into new expanded roles. We can have hyper-focus on how we think about driving therapy adoption in the areas of evidence, in the areas of research, and then it's older faces in new elevated roles in the commercial organization, so there's actually a positive jolt to the business as we continue to grow, that there's expanded growth opportunities for leaders who have been doing this work for a long time, and now our focus is how do we kind of standardize what great looks like as we build more productive ecosystems across the country and across the world, and so we're focused on driving higher quality patient flow, but then also thinking about that same source sales growth, and then how do we go deeper within the organization?
And so I think the organization on the commercial side is mostly old faces and new roles and with a higher level of expectation to drive that growth.
And it's just not at the top level, right? I mean, as Joe moves up and Joe's been with the company since the beginning, we've now gone to three area vice presidents. So it creates opportunity for other vice presidents to step into a higher role. It creates opportunity for regional managers to move up, for territory managers to move up, for field clinical reps to move up. So it's a positive across the organization as we continue to scale. And as Carl mentioned, it's really about driving consistency in patient outcomes and center management.
We could shift gears and talk about reimbursement for a minute.
I know investors are waiting for some updates on what the physician code will be and the reimbursement and where Inspire V will slot in. Do you have any updates you can share with us, or if not, when we might hear from them?
The first cases at Pittsburgh were all prior authorized before the case. They were commercial cases, and they were prior authorized and billed under 64568.
Maybe just for us that don't know, so let's talk about what that is. You can help us out.
So as we came out in the very early days, 64568 is a code for a neurostimulator and a stimulation lead. But we had a sensing lead. And that always created a little bit of a problem for us, so we had an add-on code that we created.
Then eventually we created a new code, 64582, which was for the Inspire that included the sensor. Now that we go to Inspire V, it has us in a transition period where we can do 64568 with Inspire V, but we can't change the other code yet because Inspire IV is still available. Eventually it will probably look to do a nomenclature change on 64582. In the meantime, the insurance companies are on board. They prior authorize those cases. We're going with 64568 to start with V. 64582 is still available for the Inspire IV units. I think that there are people who have some concerns about a small reduction in the physician payment.
But when the physicians have the experience with Inspire V that we're talking about, the ability to do more cases, the comfort of not placing the sensing lead, I don't think there'll be any debate that people will transition to V without question.
A nd what is the Medicare physician fee between the two codes?
I think it's between like $800 and $600, the two. Remember that what's most important is there's a reduced OR time. So if you look at the time per minute, which is the important one for a physician, it's $10 a minute, whether you do IV or V, because V takes less time. So it's the exact same level of payment for the amount of work that you do. So the payment's fair for both.
So maybe to put that in context, what are you seeing as the average amount of Inspire IVs a doctor will typically do in a day, and what's the expectation for an Inspire V?
Well, I think the top, you look at the quartiles and you look at our utilization and really calculates, and you can see that we have a significant opportunity to continue to grow that utilization as we move forward. There are several centers out there that have set records by doing nine Inspire IVs in one day. They have two suites. And so as they do a case, they go across the hall to a different suite as they clean the first one and back and forth. That's not uncommon now. So when you go to V, we can even take that up another step.
That's not to highlight what a great accomplishment it is, and it is, but it's to look at where do we see the future. We look to have people stack full OR days to be able to take care of a lot of patients. And V really lends itself to be able to do that.
Tim, I even hate to ask the question because I still suffer trauma from a year and a half ago when people freaked out about GLP-1s in the end of MedTech volumes. But GLP-1 just recently got, I must say, added as a label. I have my opinion and what our checks consistently show, but I'd love to hear from you. How do you think this will impact, good, bad, neutral, Inspire's business?
I think it's positive. I think they're getting approval for people with obesity and obstructive sleep apnea. It's really important.
These are patients that we're not able to treat today as it is. Remember, we're tongue-based obstruction. We don't treat the lateral wall collapse. Lateral wall collapse is associated with higher BMI, and we have to filter those patients out, unfortunately, and help them find a way to lose weight to be able to come back and qualify for Inspire. So we already see that with our population of our physicians, that if they can send those patients to go with weight management to lose some weight, stay in touch with them, if they lose weight, they can come back and qualify. If they never had tongue-based obstruction in the first place, it doesn't affect our TAM. They're not in our TAM, right? If they were purely BMI-driven or purely lateral wall collapse, good for them. They used the GLP-1, they reduced their weight, they resolved their sleep apnea.
That's what it's all about. We don't believe that's a significant amount of the population. Most people are going to lose weight and then present tongue-based and be able to qualify for Inspire. So we think GLP-1s are a positive.
Great. Got one minute left. Rick, maybe I could squeeze one financial in. And we're going to wait for the fourth quarter earnings call to get the full profitability for fourth quarter and P&L metrics for 2025. I know you and I have talked for a while now, and the answer is, Robbie, once we turn profitable, we don't expect to look back. Fair to assume that next year profitability should continue to improve at least over 2024 levels, wherever they end up?
Short answer is yes. We're excited. 2024 represents our first full year profitable for the company, profitability.
We expect with our gross margins and the fact that revenue growth will exceed OpEx growth, that we'll have continued improvement on our margins on a year-over-year basis.
Great. With that, we're out of time. I want to say thank you, appreciate it, and thanks everyone for joining us.
Thanks, everybody.