Good afternoon, everyone, and thank you for joining us this week at the JP Morgan Healthcare conference. My name is Andrew Lang, and I'm an Associate here on the JP Morgan Healthcare team. I'm pleased to introduce you today, Outset. Joining me today are Leslie Trigg, Chair and CEO, and Nabeel Ahmed, CFO. With that, I'll turn it over to Leslie.
Thank you. So first of all, you will not offend me if you're looking at your phone. I think it's still 7-0. I have not looked in the last couple of minutes. How many Michigan fans do we have? Show of hands. None. That's why you're all here at my presentation versus watching the game. Okay. Charlie Baker, the NCAA President, did contact me and asked me to switch my presentation 'cause he was worried about the competition. I don't think he had much to worry about. But we do have the most beautiful room. I've actually never presented in this room before, and it's lovely. So thank you again to Andrew and JP Morgan for the introduction.
I will shockingly be talking about some non-GAAP financial information and making some forward-looking statements and, of course, direct you to our SEC filings for more information and full financial results. So to start the story here, for those of you that don't know as much about Outset, we are located actually here in the Bay Area. We are a high-growth med tech company focused on transforming Dialysis from the hospital to the home through a technology that we call Tablo. There are really four key things I'd love you to take away from today's presentation. The first is that we've now achieved scale, quite a bit of scale, actually, in the U.S. acute care market, which is over $2.5 billion.
Second, we have a one-of-a-kind product and service ecosystem that has created and will continue to create higher and higher switching costs. This is a difficult market. It's got very high barriers, not necessarily to entry, but high barriers to success, and we are continuing to elevate those barriers to success by widening both our technology moat and our regulatory moat. Third key point, we have an enviable business model. If you think back to 2023, over 50% of our total revenue is already generated from recurring revenue, and I'll talk more about that. But that's a very enviable place to be. It's a visible, predictable, and reliable form of revenue that we only expect to continue to increase over time.
And lastly, most importantly, we have a growing footprint in the almost $9 billion U.S. market for home, and we'll touch more on that in a few minutes. But let me take a step back for those that may be less familiar than you really want to be with Dialysis. The Dialysis landscape, it is by far one of the largest, most costly, and least changed aspects of our U.S. Healthcare system. That's a combination I don't often read that sentence. We spend $73 billion a year on ESRD patients. ESRD stands for end-stage renal disease. Medicare picks up the tab for about $41 billion of that expense. Forty-one billion is roughly 7% of the entire Medicare budget. We are spending that on about 1% of the Medicare population, which is pretty staggering.
This is a problem that is getting bigger, not smaller. As we sit here today, there are roughly 600,000 patients already on Dialysis. These are folks who have irreversible kidney failure, and that translates to about 90 million treatments per year. That's 245,000 treatments that have taken place just today while we've been here at this conference. So on an episodes of care basis, think about that. Somebody telling you, "Oh, yeah, our market is 90 million procedures a year." That's Dialysis. That's the space that we play in. So I'll talk a little bit about how do patients wind up on Dialysis?
Well, there are about 135,000 patients starting Dialysis every single year, and that's just in the United States, and the majority of them actually start, they crash, what's called crash in, unfortunately named, crash into Dialysis in the Hospital setting. They don't have any symptoms. They don't have any Nephrologist. They don't have any planned care prior to the start of Dialysis, which is right in through the doors of a hospital. About 40%, as you can see on the right-hand side, do have some advanced nephrology care, and they are managed into Dialysis, into any one of several thousand Dialysis clinics across the United States, where, unfortunately, the majority of them will spend the rest of their lives. Most people who enter a Dialysis Clinic never leave it.
They are there three times a week for several hours a day, not including their transportation to and from the Dialysis clinic. As many, many patients have told me, when they enter a Dialysis clinic, they instantly enter a zone where they are living to dialyze as opposed to dialyzing to live. That is something that we fundamentally aim to change in terms of the moral mission of the company. 13% of patients today are educated, lucky enough to be educated about home and choose home. This is a very expensive care delivery model, to say the least. In the hospital setting, hospitals are not reimbursed, by and large, for Dialysis delivered inpatient. This is one of the most important facts you can take away from this whole presentation. Spoiler alert if you were looking at the game score.
Dialysis is not reimbursed in the inpatient environment. It is a pure play cost center. I'm gonna come back to that. This is the reason why. 'Cause every time a hospital treats a patient for any range of DRGs, and it happens to involve Dialysis, they lose between $5,000 and $25,000 on that entire DRG. So if you're in for a stent, or you're in for a hip replacement, or you're in for a valve and you require Dialysis, the hospital will lose $5,000-$25,000 on that procedure. It's a staggering amount. Dialysis, as of 2020, was delivered in conjunction with over 600 different DRGs. If you can imagine, 600 different DRGs. Dialysis, said differently, is a margin eroder for hospitals. Now, they go into the clinic.
After the hospital, they are typically referred right into a clinic, where we spend about $30 billion on Dialysis treatment in the clinic environment, with a staggering 34% 30-day readmission rate. We can do better. This is not only an immensely expensive care delivery model, it's challenged with a lot of operational difficulties. Let's just start with staffing. Staffing has been a big challenge in the acutes. I think we're in a very stable environment now in, insofar as Dialysis is concerned in the hospital setting, and now we're on to the next crisis, which is a severe absence of Dialysis nurses inside the Dialysis Clinics. This past year or two, several hundred Dialysis Clinics, Chronic Clinics, have closed around the country, which actually serves as a unique tailwind for enabling home for patients.
I think some of these challenges have also been exacerbated by technology. This is a state-of-the-art, part of the state-of-the-art equipment that you would actually see today in 2024, rolling around the halls of the hospital. Most of this equipment was designed 30-40 years ago. And so being the technology centric people that we are, of course, we see a technology way forward, and that technology way forward is a device that we call Tablo. It is also what we call an enterprise solution for Dialysis. It is the same hardware platform, regardless of where Tablo is used, in the ICU, in home, or anywhere in between. Its simplicity was really aimed at allowing Dialysis to be delivered virtually anywhere, anytime, by virtually anyone. We focused on a couple things. I mentioned the first, this single hardware platform.
We do version the software. There's one version of the software, I guess I'd call it the prosumer version for the ICU, for professional users, and a different version of the software for the consumer user in the home. We also do over-the-air, wireless, two-way data transmission, which allows us to do instantaneous software updates anywhere in the country, again, whether consumer or prosumer. The device is also connected and intelligent. After every treatment, Tablo, every Tablo in the country, and our installed base now is over 5,300 consoles across the country, all of those are transmitting about 500,000 data points after every treatment, every day. Suffice it to say, we have amassed an impressive amount of data in our cloud. We use that data both externally to feed our customers with intelligence.
We use it internally, to guide our decision-making around R&D and future innovation and device improvements. We feed that data into machine learning algorithms that ultimately make Tablo smarter and smarter over time. Of course, Tablo is small, and it's cute. That's my editorial comment. That was not in the script. Every time I look at it, I think it's cute. It's small, and it's mobile. It stands about 36 inches tall. That's kind of right about the height of my hip, and really easy for, again, whether patient or nurse, to wheel around anywhere that Tablo may go. We really thought about Tablo, frankly, as a Dialysis clinic on wheels. That was, from the beginning, the vision.
And those of us that started from the beginning, I've been working on this since 2012, we didn't know anything about Dialysis, and that turned out to be an immense advantage because we were unencumbered by the way it had been done. When we were designing, we didn't know that it was supposed to just look like a Dialysis machine. We didn't know that it was supposed to not be scary, not be intimidating, not take 6-8 weeks to learn. We took a common-sense approach from outside of Dialysis and thought, "Well, what sort of what would we want to use?" And one observation we had right away was that all of these machines that were on the market today, they did the clinical therapy well, but it was pretty narrow vertical.
One machine did this type of Dialysis, another machine did that type of Dialysis, another machine did this one. There was not a single device on the market at that time, and still today, that did it all. And so we actually thought about it kind of as a classic technology roll-up, but housed in a single 36-inch box on wheels. That proved to be very challenging. It took us about eight years to really perfect the technology, because we were trying to roll up all the functionality and the features of all those machines, plus a huge water treatment room. So what the heck is a water treatment room? Every Dialysis clinic in America has one. They are probably about half the size of this room, usually. They are industrial water processing facilities that sit behind the clinic.
They take incoming water from the city water main, let's say. They purify that water in these huge vats, and then there are other vats where they it's basically like a mixing chamber, and they use the purified water with bicarbonate acid, and they make dialysate in bulk, in huge water tanks. And then they feed these, this plumbing in the walls of the Dialysis clinics into the backs of these Dialysis machines, conventional Dialysis machines. So our ambition, which sounds really immensely crazy now that I'm telling this story in hindsight, but we made it, we actually got there. The crazy part was, let's take a 1,000-square-foot water treatment room and put it in a 15-inch box. It had never been done before. It was really hard to do, and we have achieved it, in a single, integrated, as I said, clinic on wheels.
So we got there. So all of the functions, features, and forms of Dialysis are now integrated into a single mobile unit. So I want to talk a little bit about where we're making a difference and where we're making an impact. I'll start with the acute market. I told you the most important thing already about the acute market, and I should mention that, excuse me, by acute, we also include sub-acute. LTACs, rehabs, and skilled nursing facilities, along with acute hospitals, is this market. And the most important thing is that hospitals are not separately reimbursed for Dialysis. As I mentioned, it's a pure play cost center, and it costs a lot. Even a small hospital will typically spend millions of dollars on Dialysis.
Some of the bigger national, Acute players are spending $hundreds of millions providing Dialysis for which they are not paid. So it's a big, big focus and a huge opportunity for hospitals to expand their margin across the board by lowering the cost of Dialysis. We scaled pretty rapidly because we have a pretty darn good product market fit here, in that we save the hospitals a tremendous amount of money. This is an Economic story, and I'll get into some of the numbers in a minute. But the outcome of what we've been able to achieve looks something like this. Over 1 million treatments annually. By the way, our first full commercial year was 2019. So this is still a relatively nascent story. And so we've gotten up to over 1 million treatments a year quickly.
We've trained over 10,000 nurses in the United States. We educated over 400 doctors just last year. And we've amassed a pretty extensive and impressive clinical evidence base demonstrating the power of Tablo clinically, operationally, and economically, with 15 papers and 70 abstracts under our belt. And so that's allowed us to do the following: We are contracted, and Tablo is used as the technology of choice in all 10 of the 10 largest sub-acute providers, again, LTACs and rehabs. We are contracted, and Tablo is used in all 8 of the 8 largest acute health systems in the country. And together, Tablo, you would find a Tablo somewhere, many Tablos, somewhere in the hallways of over 650 acute facilities in the U.S., and again, all just since 2019.
The good news is we still have a ton of runway. We estimate the acute market at about 40,000 consoles, a total addressable market of 40,000 consoles. And as we reported on in our pre-announce release this morning, we have a total of just a little over 4,000 in the Acute space, so we're roughly low double digits penetrated. We have a ton of runway in the acute and the sub-acute market that we're really excited about. So how does Tablo save money? As I mentioned, this is an economic value driver for the hospitals. Well, the cost reduction comes in two forms. First, supply cost reduction. So on the left, you'll see what were they doing before Tablo, on the right, what are they doing now that they have Tablo?
Prior to Tablo, they were using two, typically two incumbent Dialysis machines. Both of those machines require the ICU to buy, maintain, store hundreds of bags of pre-made sterile dialysate, just like the saline bags, and they also had to use a lot of saline. Well, it turns out that was really, really costly, typically upwards of, you know, $1,000-$1,500 per treatment in the ICU. Because Tablo purifies the water and makes the dialysate on demand, just using one container of acid, one container of bicarb, which are very inexpensive, we dramatically lower the supplies cost of Dialysis in the hospital. The second way is labor. Most Hospitals, over time, ended up outsourcing their Dialysis service line. It's pretty interesting when you look at the history of it, like why?
Well, it's because, frankly, the machines were so complicated. Most hospitals had no confidence that they could train and maintain confidence with their own staff using machines that were taking people, like, 6-8+ weeks to learn. They were very, very complex. What we found out with a simplified system that was really originally designed with the consumer in mind, oh, that would really open up the opportunity for hospitals to utilize their own staff or hire a couple Dialysis Nurses on their Team, and they could kind of take back control, control their own destiny of their, of an inpatient service line they had long since lost control over. And so the labor model here is, hospitals terminating their service, Dialysis service agreements with third-party vendors, Dialysis service organizations, and standing up their own inpatient service line enabled by Tablo.
That really is what has led to the really rapid growth rate that we've seen in the acute with Tablo, driven by the financial results. Typically, hospitals will save post-insourcing with labor and supplies, using both of those levers, 50%-80% of what they were paying previously, with about a one-year payback period dependent on the hospital's volume. Let me give you a specific example of this. This is a health system by the name of Covenant. I don't know if any of you all have had exposure to Covenant. It's got about 20 inpatient/outpatient facilities, and they decided to collect their data and find out for themselves, was Tablo really delivering on the results that we promised?
They looked at the ICU mean length of stay, and I think this is a really interesting one and draws out another nuance. Prior to Tablo, their patients on Dialysis had an average length of stay in the ICU, the most expensive part of the hospital, of over 13 days. Then, when they measured the ICU length of stay on patients on Tablo, that was cut to eight days. The reason for that, this hospital in particular, too, they were outsourcing Dialysis. When you are outsourcing a service line, you have to wait for that organization's nurse to show up. And so what frequently happens with patients in the ICU or bedside on the floor, they're not. Those patients are not gonna receive Dialysis when they need it.
They're gonna receive Dialysis when it is convenient for the third-party service provider to get there and provide it. And so waiting for Dialysis ends up being a really big driver of extended length of stay in the ICU. And I think these results really demonstrate what's possible. Again, when you control your own destiny, patients are gonna get the Dialysis care and the clinical care in general that they need at the time that they need it. They also looked at the total ICU Dialysis treatment costs, and you can see here that they went from well over $1 million, $1.3 million, down to $240,000, and then on a per treatment basis, $97, roughly cutting that in half on a per treatment basis to $46.
We now know, having done this dozens and dozens and dozens of times, that these results are very reproducible, and we've gotten really pretty good at it. I think that is ultimately the secret sauce behind Outset. Everybody looks at the device and says, "Well, your competitive advantage is your device." Yes, and our competitive advantage is the device and our team, and what I would describe as sort of our franchise playbook around insourcing. We know how to work with, partner with, and lead those health systems in the change management process. We know every step along the way, and ultimately how to guide them toward replication of results like this. So I think that's a big part of our success. So I'll turn our attention a little bit to the future of chronic care.
We talked about inpatient care, and maybe I'll make a quick editorial note here. The Dialysis market consists of three parts. Part one is the acute. That's the front end. Part two is the middle part. That's Dialysis Clinics. We are not focused on that market at all. We are focused on part three, which is the home. So we're kind of focused on the beginning and the end, if you will. So the home market is $9 billion just in the US alone, and we see really a significant under-penetration. There's been a lot of promise around home. I might state it as right idea, wrong time. I've heard, you know, many Shareholders and investors, potential investors say, "Gosh, this has been tried before.
You know, people have been at this for 2005. There's a season for everything. It takes more than the right technology, it takes more than the right idea, it also takes the right time. And I think where we are today, and I'll show you, my belief set behind this, I think today we are finally at the right idea, at the right time, with the right technology. But some of the barriers that are eroding, which may help make it the right time, there have been reimbursement barriers. In the past, you know, Medicare only reimburses for Dialysis, typically three times a week. The incumbent device required treatments of five to six times a week, which meant providers were only getting paid for three times a week, but paying for the supplies, if you will, for five or six.
There was a gap that was not helpful. We have closed that gap. There were not generally attractive financial incentives in place for providers at large to send more patients home, and I think there was certainly kind of a cumbersome technology and training barrier that we have now erased. So the good news is, the home market, again, is poised to change, and it is changing, actually. What's changed in the macro, CMS put new financial incentives in place through something called the ETC program, ESRD Treatment Choices Program. Effectively, an oversimplified version of this is they pay providers more over the Medicare base rate for patients that are sent home. They also have some disincentives for providers who keep patients in-center.
So that's starting to actually have, I think, a motivating impact on providers, toward home. Dialysis patients are now eligible for Medicare Advantage. That might seem like, so what? Who cares? Ho-hum. But prior to about two years ago, Dialysis patients could not select Medicare Advantage. Now, over 40% of all Dialysis patients are part of an MA plan, and that means that the MA providers are highly engaged, as they have never been before, in ensuring that patients get home. The payers are convinced that home is less costly and higher quality. I also think some of these clinic staffing shortages I alluded to earlier do serve as a tailwind.
We're hearing in many, many, many communities that, nephrologists, hospitals, they simply don't have a chair in their community's Dialysis clinic to put the next patient and the next patient. Home is a pressure relief valve. The patient can go straight to home, whether they're coming out of a clinic or out of a hospital. So we continue to see that as a tailwind and patient preferences.
Yes, of course, I'm talking about COVID, and I think that COVID certainly was a wake-up call for many patients, realizing, "I'd probably rather be dialyzing in my own home rather than being surrounded by 20-30 other immunocompromised people sitting two feet away from me." Yes, that was a part of it, but also I think as everybody's comfort with telehealth has grown, and technology and home care in the home, this has really become quite its own phenomenon. Home Dialysis is really just a subset of care in the home, and we see and hear a lot from patients who are thinking differently about where they think they can get the very best care.
So for all those reasons, home Dialysis is (finally) poised to take off, and I think that that is only aided by and amplified by a better, easier, faster technology. So here's why I think we win. The historical device over on the right was approved by the FDA in 2005. Nothing else was cleared by the FDA for home between 2005 and 2020. So it had been a long time coming. The incumbent device, as I mentioned a few minutes ago, requires patients to treat 5x-6 x a week. I mean, if you think about that, what's your incentive to go home? Most people wanna go home because they wanna spend more time not on Dialysis, not on Dialysis.
This value proposition is: You can go home and spend more time on Dialysis, not less time. So that was a big barrier for them. So one of the things we worked really hard at in the early days of design is making sure that Tablo could deliver good clinical care in the home at 3 x a week, so the patient could maintain their same schedule and really take advantage of the benefit of being home, which should be time. Time and flexibility. So that's point one. Second, it should be just a lot easier to learn. Most patients on the incumbent device reported about a 4- to 6-week training program. And by the way, that's 4-6 weeks, like, five days a week. It was a lot of time, and their caregiver had to come with them, too.
So how many of us could just kinda drop everything we're doing and be going to a Dialysis clinic five days a week for 4-6 weeks, learning something, and oh, by the way, our spouse, friend, son, relative has to come? It's very difficult, very cumbersome to learn. In our real-world data, our training time is now under 2 weeks, less than 25 hours total, and that's everything. That's the technology, clinical protocols, et cetera, et cetera. So we're very proud of that. And lastly, one more point about time. With the incumbent device, patients had to make their dialysate in advance. This was a big tub. You could sort of see it on the bottom. They would typically have to spend eight or nine hours making a batch of dialysate. That batch had a shelf life to it.
It could not be used after a certain number of hours. So you've got a complicated calculus around: When do I want a Dialysis? I have to back up. I have to make it. Do I have enough waiting time? Is it gonna last me with my prescription? There's just kind of a heavy cognitive load there that probably wore people down over time. Again, Tablo's sort of magic is the ability to instantaneously purify water. It's right out of the person's sink or faucet or what have you, and transforming that into Dialysis-ready water on demand and customized to the patient's prescription in real time. So this has all translated to a pretty exciting growth rate for Tablo in the home on the technology front, and I think bolstered also by the beginnings of our clinical evidence base starting to grow in the home.
We're newer in the home. We started our launch in acutes, as I mentioned, in 2019, so we've just had a little bit more time on task there. But we're starting to accumulate data in the home. Here's one peek at it. So what are you looking at? The blue line and the orange line represent two validated, well-established quality of life indices called the SF-12. The blue version of the SF-12 is physical health, and the orange line represents the SF-12 evaluating mental health. What you are obviously seeing, and this is patients on home on Tablo specifically. When patients go on home on Tablo with the blue line, they experience... This is patient-reported outcomes. This is kind of the only way you can do it, is to get the feedback from the patients.
They experience pretty significant improvement in physical well-being and mental well-being. Now, the yellow line is really interesting. I think all of us can relate to sleep as a critical factor of both physical and mental health. I'm experiencing that right now. No, I'm kidding. But you want the yellow line to be going down. The yellow line represents sleep-related symptoms. So obviously, all of us in the room would rather experience fewer sleep-related symptoms rather than more. So the yellow line is going in the right direction. The blue line and the orange line are both going in the right direction. So those are pretty exciting results. More to come. We also, earlier in our rollout, had asked patients about their symptoms during Dialysis. How well are you feeling during treatment?
There is a very, very long and rich clinical literature describing pretty severe symptoms that most patients feel while they're dialyzing in-center. That ranges from nausea to an incredible fatigue. You'll hear patients over and over and over again say. We just actually had a patient webinar in November, and this patient talked about this, that he would go to the Dialysis clinic, do his treatment, come home, and sleep the rest of the day. By the next morning, he would typically be, he said, you know, kind of okay enough to live a normal life, and then boom, you're right back in the clinic the next day. That's no way to live. And so fatigue is really a big deal. And for those of us that would have to experience it, so is cramping, so is nausea, so is migraine headaches.
So across the board, patients have started to report fewer, many fewer intradialytic symptoms. So many so, so, so many so in so many patients that we sort of have a moniker for it called the feeling better effect. It's over and over and over again, patients report feeling better during Tablo and after treatment with Tablo. So we're pretty excited about that. So I'll kind of close home talking a bit about our commercial strategy. We have kind of a first entry point, and then an upstream funnel entry point. So our first entry point has been through what we call the mid-size Dialysis organizations. These are existing, Dialysis Companies, that care for about 180,000 patients in the U.S. That's about 30% of the market, and that's where we derive the roughly $9 billion TAM.
So said differently, this is kind of everybody under DaVita and Fresenius. Those two control about 70% of the patient flow. So if all you ever had access to was 30% of the market, that's $9 billion. So that's where we started, and this segment, this customer segment, has been growing really nicely for us over the last two years. We've seen really nice growth in terms of the number of programs offering Tablo, the number of patients per program. We haven't yet found a ceiling of how many patients a single facility can send home. And of course, we've really had a lot of success with our retention rate, patients staying home much, much longer on Tablo compared to the incumbent device, which is important. So that's the starting point. Now, but wait, there's more.
Because what sits above any Dialysis clinic is actually where patients enter. We talked about in the very beginning, 15 minutes ago, that the majority of patients actually start the Dialysis journey in the hospital. That means hospitals, subacute providers, others at the top of the funnel have an opportunity to actually direct patients home first... and many of them are starting to adopt a home-first program, where the patient would exit the Hospital or the LTAC or the rehab or the SNF and go directly home without ever entering a Dialysis clinic. This is really the disruptive, kind of cool part of what we're doing, is getting patients kind of upstream of the clinic infrastructure, which by definition, in the theoretical, and we're not formally increasing our TAM because I think Nabeel would kill me.
But in the theoretical, this of course, would be beyond a $9 billion TAM, 'cause you would be over time getting access to the other 70% of these patients. That will not happen overnight. But, in 2023, some of our fastest growing programs, our fastest growing customers, were actually at the top of that funnel. They were not in the business of Dialysis, home Dialysis in 2022. They got into the business of home Dialysis for the first time in 2023, and several of them grew faster than everybody else. And I think it's because they're, like we were, what? 8 or 10 years ago, unencumbered by what's not possible, unencumbered by the way it's done.
A lot of them have really experimented with cool ways to get patients home more seamlessly, less in a less costly fashion, and keep patients at home once they're there. So we're really excited ultimately about the transformative aspect of the commercial strategy, while also serving the existing Dialysis organizations in the middle. So I'll close with a little bit about our financials. Our financials are underpinned by, as I said, kind of an enviable revenue structure here. Prior to Outset, all of my companies had been in the cardiovascular space, so I was very accustomed to the environment of kind of one and done, you know, one procedure, one procedure, one procedure, one sale, and every procedure was a new sale in the cath lab, let's say.
What I've really appreciated and grown to love about Outset and Tablo is the predictable, visible nature of this recurring revenue stream, which will only get larger than 50% over time. So every Tablo you see there in the home generates, in perpetuity, roughly $15,000 per year. Every Tablo, in perpetuity, generates roughly $20,000 per year in the acute setting, simply because there are more treatments performed in the hospital than there are with a single patient at home. That recurring revenue is driven, of course, by the sale of disposables that are we sell disposables for every treatment and our service contracts. We have a very, very high service attach rate today. But that's just the beginning of the story.
When I talk about my confidence that this recurring revenue stream, these recurring revenue streams will only grow, it's underscored by our pipeline on the software side and data analytics and EMR interoperability, all of which could enable us in the future to introduce, I'll call it sort of SaaS-like incremental revenue streams, that are also incredibly gross margin friendly as well. And so this is our future, growing recurring revenue to a larger and larger percentage of our total revenue, all ultimately rolling back to our installed base, but increasingly over time, driven by software, data, and EMR. So we exited, frankly, a big part of it through the recurring revenue. We exited 2023 with over 50% of our total revenue coming from our existing recurring revenue streams.
We generated roughly, we announced this this morning in a press release of $130 million for the year. We have driven a 70% compound annual growth rate from 2019 to the end of last year. We do have over 5,300 consoles in the installed base. As I mentioned, roughly 4,000 of those are in the acute, and roughly 1,300 now with home providers. Our estimated cash position as of January second is roughly $270 million. So the company is very well fortified and poised for all of the growth and margin initiatives that we intend to execute against in 2024. Speaking of 2024, I think we have a very exciting year ahead of us.
We had provided some guidance back in November that we expected 2024 to bring a mid-teens growth rate. This morning, we reiterated that guidance and put a little bit more specificity around it with the numbers. As you can see, they're up on the screen, somewhere between 12% and 18%, which kind of frames the midpoint of the consensus for the year. That was preexisting, and on a gross margin basis, it's a big part of our story, and frankly, a big catalyst for the Outset story in 2024. We expect to exit Q4 of next year in the mid-30% range, with full year coming in in the low 30% range. Now, back in the November timeframe, we also decided to put some longer-term guidance out there.
We wanted to give Shareholders and potential investors a sense of the when. "Okay, that's great, but when? When are you going to get to that next mile marker of a 50% gross margin?" Which is, by the way, not the story is not over. That's not a terminal value, but just our next, a marker in the journey. "When are you gonna get to a 50% gross margin? Kind of when are you guys gonna get to, a cash flow breakeven?" And we had put some guidance out there that we expected, a Non-GAAP gross margin to reach about 50% when we were roughly in the $250 million revenue range. We expect to be there, exiting 2027, and nothing about, the guidance that we reiterated today takes us off that path.
We're firmly on that path and very, very dedicated, kind of top to bottom, left and right across the organization to, to getting there, and we have quite a bit of confidence in that. So I will close with, what we, feel matters most, of course, second to Shareholder return, which is the patient impact. You know, these patients and more have been served up good enough for far too long. This has sort of been a forgotten little backwater of healthcare. I don't think anybody really has cared much about Dialysis patients for a very long time. They're not wealthy. Most of them are not employed. They're not, they're not commercial insurance. Most of them are Medicare, now Medicare Advantage, Medicaid. I don't think people have much cared.
And I think that shows up in the absence of new technology over the last three to four decades. You have to actually care. It's hard to innovate in this space, as every Shareholder in this room knows. It's hard to get things through the FDA. It's hard to commercialize. You have to care a lot. We care a lot about these patients. We care a lot about making sure that they have the experience that they deserve, that we would all want for ourselves and for our family members, which is not good, but great. And we will relentlessly prosecute that through 2024 and beyond. I thank you for listening and not checking your phone. With that, we'll open up for some questions. Maybe Nabeel can come up.
Yeah, at this time, if there are any questions, we can get a microphone around. Maybe I'll just ask one question then.
Well, I can talk loud. Hi! Good to see you.
Okay, so, you know, I know gross margins have expanded from being negative at the IPO to now, and you're giving guidance in the low 30% range for 2024. You know, what are the drivers and goals over the next two to three years? I know you had mentioned, you know, potentially 50%.
Yeah, the good news, Andrew, is that the drivers going forward are the same things that we have done to expand gross margins to date. And it's number one, console cost down, so reducing the cost of components in our Tablo device. Number two, it's consumable pull-through, so the consumables are the highest gross margin product we have today, and as the install base grows, we sell more consumables. That will drive margin lift. And then three is service leverage. So some of that is natural. If the install base grows, and then again, you know, Leslie talks about making software investments, some of those investments are also in remote repair, remote diagnostics, capabilities of our console, which will drive further leverage.
So it's the same things we have to do going forward as we've done to date that gets us to the mid-30s exiting next year and then to 50% and beyond.
Great. And I think we have one question over here, and.
Yeah, could you talk a little bit about different approaches to your commercial model? I think at one time there was some work going on in regional partnerships and also what your direct sales force looks like today.
Sure, I'm happy to. We really haven't actually changed the commercial model much. We have always talked about partnerships, obviously in the acute space with, you know, both regional IDNs and also the largest national players, and I think we have, have executed on that really, really well. If anything, we've just added to the partnership circle, kind of the concentric rings around the hospital now are LTACs and rehabs, and I think next up on the, on the list for us are the skilled nursing facilities, where we see a lot of opportunity. It's a similar, value proposition, cost reduction, operational efficiencies kind a dropping to the bottom line for the SNFs.
And then in the home, I think our focus has always been sort of flying at two altitudes: near term with those mid-sized providers, and then longer term, working with our frankly, our inpatient providers and setting up their own home programs. So I think we are. I think we're executing well against a commercial strategy that has been, you know, largely consistent.
Great. Well, that brings us to time. I want to thank-
Great. I love the close. I mean, that. Yeah, exactly.
I want to thank Leslie for a fantastic presentation, and thank you all for joining us today.
Thanks, Andrew.
Thanks, Andrew.