Okay. Good afternoon and welcome to the end of day three of the 42nd Annual Raymond James Institutional Investors Conference. I'm Larry Keusch, the Healthcare Analyst, and it is my distinct pleasure to welcome management of Masimo. Joining us today from the company are Micah Young, who's Executive Vice President and Chief Financial Officer, and Eli Kammerman, who's VP of Business Development and Investor Relations. Apologies, guys, that we're not doing the conference from Florida this year, but thank you for participating in our virtual format, and hopefully look forward to seeing you in person next year. There is an opportunity for those joining online to ask a question to management during the fireside chat.
So if you have something that you would like to ask, you can utilize the Q&A function, which is on the upper left side of your OpenExchange screen, and you can register a question that way. So with that, let's just jump in here. So Micah, you joined the company, I believe, in late 2017, and since then there's been a really remarkable amount of activity. The company, you have established a long-term growth algorithm of 8%-10%. You appear to be in a position to drive margin expansion. The new product flow is really nothing short of impressive, and the balance sheet is incredibly strong, and at my last check, I think it's nearly $610 million in cash.
So given that there are investors listening today, and as you know, the Raymond James Conference does attract a lot of generalists, so there are people that are less familiar with the business. Maybe you could start out the conversation with just talking about how the corporate strategy has evolved over the past three years, and really what has you most excited today about where the company's headed.
Yeah. Thank you, Larry. How I look at how we've evolved as a company is originally it was founded over 30 years ago by Joe Kiani and Mohamed Diab, who really came along and introduced SET pulse oximetry to the marketplace, which really changed the way pulse oximetry worked. So it was kind of one flagship product at the time, and that's evolved over the years to expanding into other parameters. If you think about it today, on one fingertip sensor, we can measure up to 12 parameters, and that includes all the Rainbow parameters that were launched into the marketplace over that term, and if you look at where we've evolved from there, we started manufacturing our own Masimo branded equipment. We had, of course, large partnerships with a broad range of OEM partners as well for those multi-parameter devices.
I would say when I first started about three years ago, kind of where we were at as a business and organization was it was really focused around hospital monitoring and kind of those core parameters: SET, or Signal Extraction Technology, pulse oximetry, Rainbow, which has the continuous hemoglobin measurements, as well as multiple other measurements on those eight LED sensors. Then you start to bring in some of those other advanced parameters that make up our hospital monitoring, like capnography and gas with NomoLine, brain monitoring with SedLine and O3 cerebral oximetry.
Those represent very large markets in and of themselves, which we stated at our investor day that we believe the market size for our hospital monitoring alone is about $3.5 billion today, and growing. We expect it to grow to $4.5 billion in terms of total addressable market by 2025. Where we've evolved from there is we've expanded into launching a full suite of hospital automation-type products and technologies. We did that in 2019 and started getting ingrained into that market that we believe is about a $1.5 billion market opportunity or more for hospital automation.
And if you think about we've been at this for 15 years, well before I got here, as far as developing the products that make up our full suite of automation, whether it's Patient SafetyNet, where you can monitor up to 200 patients remotely at a central station, you've got your Iris Gateway server that can move all the real-time data through the hospital, you can connect everything into Root, whether it's an anesthesia machine, infusion pump, all the devices in the hospital. We've got a very large data library of over 1,000 devices now that we can connect to. And that's kind of makes up our hospital automation. And then if you think about it, we're broadening our continuum of patient care from hospital monitoring all the way to home-based monitoring. And that's where we've evolved.
It's gone from hospital monitoring, hospital automation, and now home care in terms of home monitoring. So that's another great opportunity for us when you think about the big market we have in front of us for Opioid SafetyNet. We're still trying to get that device approved, but we believe that's over a $4 billion market in and of itself. We're also currently partnering with hospital systems to try to expand the use of our wearable wireless sensor for SET pulse oximetry. As you know, last year during COVID, we repositioned the Opioid SafetyNet product to address COVID patients with that platform. And the utility has been well received by hospitals.
And now we're looking to partner with hospitals to expand the use of Masimo SafetyNet for chronic diseases like COPD, respiratory diseases like COPD, or heart disease like CHF, and help them manage that patient population for them into the home. Telehealth has been acknowledged as that's going to be more patients going through in terms of telehealth and being monitored in the home. And I think that we have a great opportunity, and we're well positioned to take advantage of that market. So that's kind of how I see that we've evolved in just three short years. And it's pretty incredible to see the innovation. And we're investing more than 10% in R&D now, and we're starting to see the fruits of that labor.
Terrific. Hey, Micah, one, there's been one perhaps subtle shift that investors may or may not have fully appreciated yet. And I'm curious kind of where this might be going. But you have actually moved yourself into some therapeutics and away from just your core monitoring by getting into the high-flow ventilation market. You had that deal around the Bridge device, which is for helping with detoxification of somebody that's addicted to opioids. So there's been a little bit of a move away from just monitoring. Obviously, that is something that you guys are doing with your eyes wide open. But where do you want to take the kind of course of the company outside of just purely monitoring?
Yeah. I think we looked at, for example, through some of these smaller tuck-in type acquisitions that we look at as large and growing markets. I mean, each one of these represents over a billion-dollar market opportunity for us. And we feel that these are companies that have great technologies that address clinical needs with patients. And we think that we can grow this through leveraging our clinical footprint. We're in over 150 countries now and nearly 50% of hospitals. So we have a large clinical footprint that we can take great technologies, even smaller tuck-in acquisitions like the ones you've seen, and really grow these and expand these in large and growing markets. So that's kind of been our strategy there. And if you think about TNI and high-flow, we had entered into an agreement.
We decided to pull the trigger on that acquisition during COVID to really help patients who are having respiratory issues. And as you know, COVID attacks the lungs. And when you combine that with what we're doing with diagnostics and then bring in the therapeutic, we felt that it really helped us to address those patients across the continuum of care. And you're starting to see us build that in the respiratory space. And then if you look at the recent acquisition of LiDCO, it's another great example of it's kind of in our wheelhouse of we've got the clinical footprint. If you look at 10 million patients per year that are undergoing high-risk, high-blood loss surgeries, you start to combine LiDCO's capabilities of measuring cardiac output, stroke volume, or stroke volume variation.
And you bring that together with Rainbow and Rainbow PVI. You can start to really capture the hemodynamics monitoring and the clinical needs around hemodynamic monitoring. It fits well with our portfolio, and it also is right in line with our clinical footprint there because we are touching all those areas of the hospital today. We can commercialize this in a bigger way.
Okay. Look, I know that 2020 was a unique year. Your product portfolio, on one hand, was incredibly important to managing the treatment of COVID patients. You had other aspects of the portfolio that were hit by COVID, mostly due to elective surgical procedures being down. And then, of course, 2021 will be a tough year of challenging comps in some of the quarters. But if you put those two years behind you, is the right way to think about the core growth algorithm still in that 8%-10% range? And is it also fair to still think about hospital automation and opioid safety as being opportunities above and beyond that growth algorithm?
Absolutely. I mean, Larry, if you think about our investor day back in it seems like forever now, May of 2019, we laid out the long-term plan at the time was really around our core parameters and our hospital monitoring, and that's where we kind of build up to that 8%-10% growth rate for our long-term plan. We also said at the time that things are starting to come into view on hospital automation, and we're starting to see opportunities with Opioid SafetyNet. All those things we look at as those are multiple shots on goal that can accelerate our growth rate, and I think you're already seeing that come into play. Even though our core parameters, businesses, and our hospital monitoring, we're achieving those long-term growth rates and even exceeding those so far.
That's driving us above that 8%-10% just on hospital monitoring. We're starting to see hospital automation is starting to contribute. And I think we're also seeing come into view is the opportunity we have in front of us for home monitoring. Even though we haven't got Opioid SafetyNet launched, just the fact that we're able to start piloting that mobile platform with medical-grade technology that can be used in the home, these are all great opportunities and shots on goal for us to accelerate that growth rate that we laid out there. And if you think about another area is we're continuing to expand into new and growing markets like the hemodynamics, respiratory therapy, and just to name a few.
Yeah. Okay. Just moving off the top line and thinking a little bit about margins, you've typically targeted about 100 basis points of operating margin expansion per annum. You've had a couple of years where you've done better than that. Certainly, 2020 fell below, and your margin, I think, fell by about 90 basis points. When I look at 2021, the guide is about a 50 basis point improvement over 2019. So the question is, what's holding the 2021 margin back? And when do you expect to get back onto that sort of more typical 100 basis point expansion?
Yeah. No, great question. As you mentioned, I mean, as we were going through to 2019, we were seeing even north of 200 basis points a year of expansion there. But once COVID hit, we saw some pretty significant headwinds when the mix shifted with our heavy capital and all the drivers we put out there for the year. As you know, that was up about 77% last year. And if you look at that growth, it drove some mix issues with our gross margins. And our capital as a percentage of total revenue is up about 7 percentage points. So if you think about that and it has lower gross margins, we were seeing probably 200 basis points or so of headwinds. We think that that will gradually rebound throughout the year.
We're starting to step up now, and we expect that to continue to improve as mix gets back to normal and sensors start rebounding as well. But one of the big things was we also started experiencing some COVID-related headwinds in terms of costs. So if you think about, we've had higher freight expenses. I think all companies right now are experiencing some higher commercial freight costs to distribute their product because the pandemic has shifted the mix to residential. And I think there's less space on aircraft, and it's created a lot of additional cost for us in terms of distribution. The other costs were we put safety measures in place at our manufacturing facilities and broadly across our business to make sure we keep our workers safe and sustain our business as we move forward and keep product going out the door.
That created a lot of costs because we had to keep social distancing. If you think about separating our production workers and the production lines, it does create manufacturing efficiencies, and we're still seeing some of the repercussions of that. We're hopeful that we can get those costs back in line. As we think about that, that's probably about 100-150 basis points of headwinds that if those were to come back in, you could have seen us back closer to where we were tracking on that 100 basis points per year trajectory.
Okay. Great. I want to just get into a couple of COVID questions. What did you learn, Micah, about the organization as you went through the pandemic? What strengths did you see? Obviously, it was really remarkable to watch not only the way the organization responded to the demands on the product that was needed to treat COVID patients, but also you had an amazing number of new product launches and clearances at the same time. So you were clearly able to deal with a lot of adversity, and this organization really came together. But what were the core strengths that really allowed you to do that?
Yeah. I think when I look back, I mean, it was incredible, especially right in the middle of it, just to see our speed, our agility, our absolute responsiveness to customers. To see our organization kind of rise up and respond to the pandemic was incredible. I remember we were back in what I call the war room, and we were working with our leadership team was trying to figure out, too, what could we do that's innovative and reposition how do we help COVID patients, so we were able to reposition our Opioid SafetyNet device, which is that mobile wearable pulse oximetry sensor, reposition that platform with the software to be able to address patients in the home, and the FDA worked very well with us to get that out there, and that helped patients along the way.
Plus, we were able to launch before that our Radius PPG device, which is that wearable sensor for the hospitals as well. So if you think about the hospital systems, where it was valuable in the hospital, not just in the home, was they could take the monitors, move them outside the room, and see the readings of the patient on the screen without having to enter the room. So you could have that mobile device on the patient, and they could treat that patient in the hospital. It reduced any risk of disease transmission. It helped preserve PPE, all those benefits. And then also, they could manage the patients into the home and safely monitor them from home and free up bed capacity. And bed capacity is very critical during the pandemic. But I think those are the things.
I think it's speed, agility, absolute responsiveness, and our innovation during that time was pretty remarkable.
Okay. You guys have a somewhat unique ability to get some visibility on what's happening with elective surgical procedures. I think anybody following the healthcare space would agree that hospitals in the U.S. have done a tremendous job of learning from the early stages of the pandemic and really putting themselves in a position as we saw this surge come through the summer and then again here later in the winter to be able to care for COVID patients and yet at the same time really have the best efforts to keep ORs open and making sure others are being cared for that need surgical procedures. What did you kind of if you could sort of just think about what did you see late in December and then into January, February, are we starting to see a leveling out now?
Certainly, we can look at the national daily cases and the hospitalization rates, but wondering if you're kind of seeing some of that from your vantage point. And as you think about 2021, when do you sort of think about getting back to a more normalized level? And when I mean more normalized, something that looks like back to 2019.
Yeah. Absolutely. Great question. When everything hit for us, our sensors tracked very closely with hospital admissions and underlying patient volumes. And of course, everybody saw the hit in Q2. Our sensors, I think overall, were down 8% in the second quarter, up 6% in the third quarter, and up 7% in the fourth quarter in terms of growth rates. And so we saw a steady rebound there. In October and November, things were probably tracking even better. December saw some pockets of softness just because of the surge in cases here and there. But overall, we see that it's a steady rebound. We think that probably utilization, underlying utilization in terms of procedures, is probably at the 80-85% range, which were our best estimates for what it's worth. But we think it's a steady rebound over the course of the first six months of this year.
Then I think there's a lot of disease load out there. There's a lot of backlog, I'm sure, that's out there in the pipeline as far as patients that need to get surgery. I think that could start to play in the back half of the year, especially when there's broader immunity and patients. I think it all comes down to patient confidence of going back into the hospital. That's where you start to get back towards that kind of pre-COVID 2019 levels. I think it's going to happen more towards the back half of the year.
Okay. Very good. Just as you were speaking about some of the various platforms, and we'll get into a little more detail, but we did get a question in from somebody listening online. And the question is, how are you thinking about the scaled margin profile of some of those key growth markets, whether it's home monitoring, hospital automation, and recognizing it's still very early in the game for sure. But if you can give some either sort of numbers as to how you're thinking about those scaled margins or at least relative to the business, how you're thinking about it, is this comparable margins, accretive to margins, just any thoughts there?
I'd say the way to look at it is we're continuing to balance investment just like we have with our R&D. I mean, we've optimized in certain areas to be able to fund more investment in R&D over the years. So we're taking a very balanced approach, but as we get into these newer markets for us, there's going to be some earlier investment as we build out where we need the commercial presence. If you think about home monitoring, making sure that we've got the commercial team there that's built for going after that, what we believe is going to be a very large market for us. But I would say early investments, but over time, we look at all these areas that we're going into as supporting our long-term profitability goals.
And that's kind of how we've looked at acquisitions, how we look at a lot of our product launches. I mean, we pay attention to what's gross margins going to generate two, three, five years down the road because that's really going to tell you how you can scale those opportunities. And I think each of these opportunities, we think that over the long term, they're going to support our operating margin profile and be accretive.
Okay. Great. Let's turn to some of the major product initiatives for a moment. So you sized the hospital automation market, TAM, at about $1.5 billion. To me, this is one of the most exciting opportunities in front of the company. It makes sense in terms of what hospitals need. I think it probably resonates even more in what they learned through COVID. So maybe talk a little bit about just where you see your portfolio. Do you consider it complete at this point, or are there still not to say there aren't always things to fill in the gaps, but are there any meaningful missing pieces at this point for that hospital automation portfolio?
Yeah. I mean, if you look at our portfolio now and what we launched back initially in 2019, the broader portfolio, we look at it and we believe we've got a full suite. When you look at it from the monitor in the room, which is Root, and it's a single interface, it can connect all the devices. You've got the connectivity with our Iris Gateway platform that can shuttle all that real-time data. It's high-fidelity data. It's waveforms, parameters, alarms, and events. And it can get it distributed to any endpoint in the hospital where decisions are made. And then you start to think about surveillance. We've got Patient SafetyNet, and you can remotely monitor up to 200 patients at a central nursing station. And then we have mobile alarm and event communication.
If you think about Replica, it replicates everything that's on the screen in the room, the measurements, waveforms onto a smart device, whether it's a smartphone or smart tablet, and where that's important is it's two-way intelligent communication with a care team that can escalate alarms and alerts, so it makes them more efficient in how they care for those patients, then if you think about our reporting capabilities and analytics, we've got what's called Iris Analytics and scoring with Halo ION, where we can provide one patient score where you can accumulate a lot of parameter data coming off that patient, establish their baseline data, and then if they're deviating from that baseline, you can tell if the patient's in distress and respond to that patient, so we've got a lot of things, and then that's not even getting into the algorithms we're building for decision support.
So we believe we've got the comprehensive solution. And then you bring in the parameters that we already have where we're already getting all the information through our main parameters. We've got a very good competitive advantage in this space. And there are some viable competitors in this space as well, but we think we have a comprehensive solution and a very good footprint in the hospital systems to really drive adoption of this technology.
Micah, I want to pick up on just one aspect of your comment there, which is around competition. It's certainly a question that we get a lot for obvious reasons. It seems like you've got the EMR guys on one side. You've got the more traditional device manufacturers on the other side. Maybe the best example is Philips. How do you think about those competitive threats coming in on both sides? And again, what puts you in a good position to compete against both sides of this coming through?
Yeah. I think there's a lot of companies that can offer various components. And I think where we're unique here is that we can install an Iris Gateway server, maybe two servers in a hospital system, and that is a very low-cost profile that can connect everything. And we can manage that data and those workflows. And if you look at what you have to assemble that's out in the marketplace today, there's a lot of companies that offer pieces of the puzzle, but not the full solution out there. So you have to assemble a lot of vendors, a lot of pieces of equipment, multiple servers. If you want to do alarm management reporting or central nursing station surveillance or mobile reporting and all the capabilities I mentioned, you have to add new servers for a lot of those components from different vendors.
I would say there are some that are getting very close to assembling multiple components and elements, but not the full suite. For example, I mean, our Patient SafetyNet software works with Vocera or Voalte alarm notification and those systems to provide clinical data that triggers the alarm. So there's a lot of opportunities for companies to still compete in this space that may have very innovative technologies for certain areas of automation. But as far as comprehensive solution, I think we're very well positioned.
Okay. If I have my dates correct, I think you sort of really start to lift hospital automation off the ground in the second quarter of 2019. I know 2020, again, was a challenge year, but were you able to, and certainly access to hospitals and any bandwidth to think about anything other than COVID was extremely limited. But were you able to get anything done on the hospital automation side? And how do you kind of feel like how set back has your momentum been since where you were at the end of 2019?
Yeah. Great question, so more broadly, I'm going to step back a minute. If you look at the contracting, we were a lot of companies. It was very light in terms of contracting access to hospitals around kind of the April to June timeframe. If you look at it, we ended up, and we announced on the call that we had a record-breaking year in terms of contracting new customers and also renewing existing contracts. That happened late in the second half of the year for the most part, and that's coming off of a full year of contracting back in 2019 where we had another record-breaking year, so we actually exceeded that on a year that was kind of sidelined for about, you call it, three or four months. That's encouraging because we got back into the contracting mode.
We also have seen that our contracting with our health systems that are using hospital automation, we had about 25 health systems last year. Now we're at 75 systems, so we're getting the momentum back, and it's pretty exciting to see some of those new customers come on board and really start to expand our platform there.
Okay. Last one on this. Would you agree that if you looked across your competitive landscape there in hospital automation, Philips might be the one with the most complete system relative to where you sit? Would you agree with that?
Yeah. I think Philips filled several gaps that they had in the hospital automation suite. And I think that was really with the acquisition of Capsule Technologies and Bernoulli Health. So that kind of helped build out some of the areas like connectivity, surveillance, mobile alarm management reporting. Now, I think still where we have the advantages here would be more in kind of our reporting and algorithms for decision support, as well as the parameters, just the fact that we have a significant position in terms of we're getting all the readings off of those fingertip sensors, and all that data flows into that rich data set that's going through the hospital.
Okay. We've got about 10 minutes left here, so I just want to touch a couple of things. On Opioid SafetyNet, again, you indicated earlier that the product is in its review cycle at the FDA. I know FDA timelines are difficult to predict, but do you think that this, and I think you've said this, do you believe that this is something that's approvable this year that you can launch this year?
Yeah. I mean, Joe said it well on the call. We'd be very disappointed if we don't receive approval this year, but of course, I'm still hopeful it's going to be very soon, but there's just no guarantees here, but that being said, we're doing a lot of the things to make sure that we get a running start once it is approved, so we're working through the reimbursement strategies right now. We've hired a reimbursement team. The MCIT rule has been encouraging because we were designated as a breakthrough technology by the FDA, and it's given us more of a path or an understanding of coverage, which could be up to four years for those breakthrough technologies, and we're still working through the checklist to make sure that we qualify, which we believe we do, but for example, it has to be a durable medical equipment device.
So we're trying to make sure we go through and check those boxes, and then we also need to understand coding and payment because that's not very clearly defined by the new proposed rule. And then our team is also reaching out and working with private payers. That takes time because you've got to start working on providing the data and the evidence there for the benefits. So that's kind of where we're at today on the reimbursement side, and then we're also building out a commercial team that can really go after and work with those higher prescribing physicians and really looking at, as there's patients discharged from the hospital into the home with opioids, we've got a good clinical presence there, but it's really making sure that we can follow that all the way through with the patient.
Okay. Great. I mean, I guess from my perspective, you have already shown that this technology can work because essentially it's a similar form function to Masimo SafetyNet. So we know you can monitor for desaturation events or oxygen saturation levels remotely. So it seems like more than anything, it's just convincing the FDA or not convincing, but showing the FDA, demonstrating the FDA that this thing is safe to be used in an environment in the home.
That's right.
But outside of that, and if you get reimbursement, why wouldn't surgeons want to use this? I mean, it just seems like a no-brainer to me.
I think they would because, I mean, I think the clinical value's there. The data shows that opioids induce respiratory depression. And why wouldn't you want to give your patients the most optimal care, especially as you're seeing them from the hospital into the home environment? And opioids is getting a lot of attention in terms of the high use, the number of prescriptions each year, trying to keep patients safe. There's a lot of deaths over the past several years. And I think this is an area of focus. And I think they're going to be encouraged to do that. And hopefully, the reimbursement opportunities will be there to make that a lot less friction to adoption as we go into the marketplace.
Got it. What are you guys trying to do in the home? What really is the home strategy? I mean, you obviously have the MightySat, fingertip pulse oximeter for use in the home. You introduced Masimo Sleep. You've got now the Radius T for temperature monitoring. So what is the goal for the company as you sort of build into the home? Where are you really going with this?
Yeah. I think when I look at home monitoring, I look at a couple of different ways. I think overall, we're taking medical-grade technology that has been proven on patients who are moving, who are active. That's why we differentiate so much is because we can remove the motion interference with the device. So pulse oximetry is a platform technology that can expand into the home. And if you think about it, it's measuring SpO2, measuring heart rate, respiration rate. Those are key components to really managing care for patient populations going into the home. And if you think about it, we're trying to partner with these larger hospital systems to manage those patient populations through care programs and different things that are designed around that. So that's kind of the strategy there is building out how do we best treat all the patients.
COVID, if anything, has accelerated the demand for telehealth and home monitoring. So there's an opportunity here for us to really, truly help improve patient care in the home. And we're looking at providing a broad package of solutions. And in areas where we may not have those solutions, we'd be looking to either acquire those solutions or to partner with other organizations. So I think that that's kind of our strategy there. And then you look at the other aspect, which you mentioned, and we've launched Masimo Sleep. We've launched Radius T, which provides continuous monitoring of core body temperature, especially if you think about infants or if you have a baby that is sick or has some health challenges there, you want to continuously monitor.
Those are all the kind of things you're starting to see play out with Masimo's. I'm sorry, MightySat is one of the other devices that we have. That's more of a spot check. So it's a kind of combination of continuous wearable device monitoring as well as spot checks that we want to do both in treating that patient population as well as for consumer health and wellness is kind of where we're looking at here.
Okay. Great. Three last ones, Micah. We'll do it in sort of a lightning round. You filed suit against Apple for infringement of technology and appropriation of, I guess, IP. There was an update there in the case recently in the last several days. Can you just bring us up to speed what happened there?
Yeah. So where it's at right now is there's the patent side of the case, and then there's also the trade secret side of the case. And of course, we filed for some permanent injunctions there, and those were denied by the judge, but they saw validity in the trade secret side. So that trade secret side of the case is ongoing. The patent side, Apple filed, what was it, over 17 IPRs against us. So we're working through that process. And that'll probably take about 18 months or so before that kind of moves forward. So that's kind of where we're at today. And I think the important thing here is we see this as a valid case for us. And I can't tell you what the outcome will be, but we've taken this seriously.
We've seen the IP cases we've had in the past where we've tried to protect our IP with former cases. And we're making sure that we can protect it for both protecting the hospital opportunity here as well as into the home. And it's really more probably focused around the home area of our business.
Okay. Great. Second one quickly is, but you do have some tough comps, obviously, in 2021 versus 2020. Is there anything that you can do to just help investors in those quarters when you report, understand what the underlying business is doing just to, again, give some feel to people to help work through those comps?
Absolutely. I think one of the things that we did this year was because we saw such a dramatic shift, we had a lot of big cross currents. We tried to really highlight the sensor growth, the mix issues we were having, the capital. And I think that's going to be important as we move out through this year. I think as you look at our guidance, $1.2 billion, it's about a 13% two-year stack growth over 2019 when you kind of ignore those comps. But I think what we've seen is right now we've got a large and growing install base. It's up 17% this year. We had a record, we're coming off a record year of new contracting, contracting with new customers as well as existing renewals. And if you think about it, our connected beds are up 28% last year.
So I think with what's happened last year with COVID, I think, if anything, the foundation is very strong with Masimo, especially as we enter this year. And we're excited about all the opportunities. And as we think about guidance too, there's the U.S. launch of TNI Medical, our high-flow ventilation. We're also launching with LiDCO and hemodynamics. And those give us more shots on goal because we're not including some of those opportunities in our guidance right now. We want to see how those play through.
Okay. The last one, which should be really easy to answer, is a question that came in relative to glucose monitoring. As I recall, the consumer aspect of that still resides with Cercacor. And Masimo only had access to any sort of hospital-based glucose monitoring. Is that still in the works, or is that no longer a project over at Cercacor?
No, I think it's still an ongoing project there, and you're right. I mean, that's how the agreement was, where it's more we would be focused on commercializing in the hospital, and they would be more focused on the home.
Okay. Terrific. That answers that. Listen, thanks, both of you, for your time this afternoon. Really appreciate the conversation. Great seeing you. Stay safe, and hope to see you in person at some point soon.
All right. Great. Thank you, Larry. Thanks, everyone.
Have a good rest of your day. Take care. Bye-bye.
All right. Take care. Bye.
All right. You guys are off the air.
Thank you. All right. Great. Thank you.