來(lái)源AZ的調(diào)查結(jié)果更新：當(dāng)前產(chǎn)量和產(chǎn)能趨勢(shì)

1、Equity Research Americas | United StatesMedical Supplies and DevicesOrtho Surgery Update from AZ: Current Volume and Capacity Trends TranscriptMedical Supplies & Devices | Conference CallWhats New?: We hosted a conference call with Dr. Kipling Sharpe, orthopaedic surgeon at OrthoArizona in Phoenix,

2、Arizona, on August 11 to discuss his views on current ortho volume trends, expectations for August and September, new patient flow and implications of the fall and winter flu season.We have included the full, unedited transcript of the call in this document. In addition, we summarized key take-aways

3、 from the call in our note Outlook for Volumes and Capacity Remains Favorable, also published this morning.Replay Details: Domestic: (855) 859-2056/International: (404) 537-3406; ConferenceID: 5764088Research AnalystsMatt Miksic212 325 4381 HYPERLINK mailto:matt.miksic matt.miksicChristoph Gretler41

4、 44 333 79 44 HYPERLINK mailto:christoph.gretler christoph.gretlerVik Chopra212 325 1749 HYPERLINK mailto:vik.chopra vik.chopraDISCLOSURE APPENDIX AT THE BACK OF THIS REPORT CONTAINS IMPORTANT DISCLOSURES, ANALYST CERTIFICATIONS,LEGAL ENTITY DISCLOSURE AND THE STATUS OF NON-US ANALYSTS. US Disclosur

5、e: Credit Suisse does and seeks to do business with companies covered in its research reports. As a result, investors should be aware that the Firm may have a conflict of interest that couldCREDIT SUISSE SECURITIES, LLCModerator: Matt Miksic August 11, 202010:00 a.m. ETOperator:This is Conference #

6、5764088Operator:Ladies and gentlemen, thank you for standing by and welcome to the Ortho Surgery Update from Arizona.At this time, all participants are in a listen-only mode. After the speakers presentation, there will be a question and answer session. To ask a question during the session, need to p

7、ress star 1 on your telephone. Please be advised that todays conference is being recorded. If you require any further assistance, please press star 0.I would now like to hand the conference over to your speaker for today, Mr. Matt Miksic, medical device analyst at Credit Suisse. You may begin, sir.M

8、att Miksic:(Hi and) thank you (Demetria), and thanks everyone for joining us. So we are very pleased to have with us today Dr. Kipling Sharpe, an orthopedic surgeon at OrthoArizona in Phoenix, Arizona. This is the second call with Dr. Sharpe, after speaking with him back in early June.Co-hosting the

9、 call today with me is my colleague Christoph Gretler, medical device analyst in Zurich. And well be going through maybe 20 minutes or so 20, 30 minutes of questions, and then well pause for audio questions at any time, really. Were always interested in your questions, so you can e-mail myself at HY

10、PERLINK mailto:matt.miksic matt.miksic, or Chris at HYPERLINK mailto:christoph.gretler christoph.gretler, with questions as well.So with that, Dr. Sharpe, thanks so much again for joining us. I think the first question we have and I think a lot of folks are interested in is, when we talked to you ba

11、ck in early June, I think we were all a little bit stunned as to how busy you were, operating at over 100 percent capacity at some of your centers, catching up on what was a slow and delayed and deferred April and May.And would love to get a sense of how that progressed into late June and July and m

12、aybe where things stand now in terms of volumes or theeffect of COVID cases, and in particular, being in Arizona, the effect of being an in area thats been come to be known as a hot spot more recently.Kipling Sharpe:Good morning, or whatever time it is wherever you are. So just a little background o

13、n Arizona. Im sure you all have some background on it, but we shut down back in April, we really had a shelter in place order from the governor, and it really did delay the onset of our getting hit with the COVID.And when you talk about flattening the curve, I think it did I dont know if it flattene

14、d it or just postponed it, but it gave us a chance to prepare to get enough PPE and get extra ventilators and prepare for the peak, which really did come. We were hit with the peak right about the first of July now, in hindsight. It looks like that was the peak of our COVID-19 cases per day and sinc

15、e then, weve been on a down slope, which has been good. We pushed our resources right about to capacity, but not over capacity.So most hospitals were able to continue doing elective surgeries, a lot of them suggested that they be only outpatients, with a four hour stay and recovery. A few of the hos

16、pitals in late July shut down for about two weeks on elective procedures, but it was not community-wide. The hospitals I operate at, I did not have to shut down at all, I didnt have to cancel a single case because of lack of availability. Im not at the biggest hospitals. The biggest hospitals were t

17、he ones that were hardest hit.One of the hospitals I go to once a month, one of the ones that dialed way back but they did still allow the outpatient surgeries, although they didnt allow utilization of (hospitalists), so really it was just going to be, healthy people that really were going to go hom

18、e same day, and so they had a reduction in cases. It looks like all of the hospitals that I get information from, thats all been lifted now and were back to semi- business as normal.The hospitals are running at about 80 percent bed capacity right now, which is where they like to be, they like to be

19、lower than that, so theyre actually wanting patients. And only about 15 percent of the beds are actually filled with COVID patients right now. Ventilator capacity is about60 percent available, ICU beds I think is about 10 percent to 20 percent available. I havent looked at that in a few days.Our cur

20、ve has come way down, and so things are looking pretty good here. I think we weathered it well. The state is still under some restrictions, gyms have been shut down and theres lawsuits over that. You still have to wear a mask in public, and social distancing. Thats (inaudible) probably going to cont

21、inue until we get a vaccine or it looks like the thing dies out, whichever comes first. So thats sort of the current status.Matt Miksic:No, thats super helpful. And youre when you say the hospitals are 80 percent bed capacity now, youre operating capacity as I mentioned when we spoke to you in early

22、 June, you were quite busy. How did that I guess the way to think the easiest way for us to think about it anyway is maybe percent of pre-pandemic levels, like on a weekly or monthly basis in terms of numbers of patients.So you were I think, in catch up mode in early June and so and you were also I

23、think trying to squeeze in folks before they flew home or something like that, perhaps. But how did that fluctuate at the bottom, where did you go too in terms of capacity of pre-pandemic levels and then where are you now?Kipling Sharpe:So I probably havent dropped below 100 percent yet. Im probably

24、 at about 100 percent right now, just my normal (inaudible). Busier than I would normally be in the summer, but kind of like I would normally be in the spring. So Im still doing eight to 12 joints per week. Im seeing still less patients in office, thats reduced, but similar to what I said last time,

25、 the percentage of patients I see who are ready for surgery is still somewhat higher than pre-pandemic.Its not quite as high as it was the first two months back, but its still I think a little higher. Im still scheduling more patients per clinic than I normally would, even though Im seeing less and

26、less. Normally this time of year, Im booked out for surgery for maybe six weeks, some years, four to six weeks. Right now Im booked out eight weeks. So I still have a significant volume in the books ahead of me.Matt Miksic:Sounds great.Kipling Sharpe:I dont know that thats true with everyone, as Ive

27、 talked to some of my other partners, they didnt seem to get hit some got hit hard like I did early, others, its been a little bit of a slower ramp up. So I dont know that Im necessarily indicative of everybody here, but I think everybodys probably at least at their normal or higher August levels. A

28、ugust is a slower time here in Arizona, because nobody wants to be in Arizona in August, including me. So there are less people interested in being here.Matt Miksic:Yes. But I guess unless you need to get a knee done. So just one clarification on your comment, and it was an important comment you mad

29、e last time we talked about you said youre scheduling more patients out of clinic, was the way that you described it, and that means basically if you have a day that youre seeing patients new patients, consulting in-clinic, in preparation for potentially getting to surgery, on a given day, even thou

30、gh you may be seeing fewer patients on that day that you would have seen six months ago when you allocated a day for clinic hours or something like that.Youre saying that youre scheduling more patients out of that day into surgery, than you normally would, just because if I understand it correctly,

31、because more of the patients that youre seeing are further along and more likely to need surgery. Is that a long winded, the laymans way of describing what you said?Kipling Sharpe:Yes, I think thats a very good description. Now I have talked to some of my other partners about that, and thats not nec

32、essarily what they experienced, so I dont know about thats something you can say is the case everywhere, but I can speak from my experience, and one of my other has had a similar experience. He practices in the same office I do. Partners who practice in different parts of the microgeography here hav

33、e not had exactly the same experience. So, Im in a very well off suburb area if you will.I wish a portion of my practice is lot of retirees who have good financial resources, not necessarily rich but theyre very comfortable. They may own two homes, one here and one in somewhere cooler in the summer.

34、 And so my demographic is probably a little betterdemographic than some of the other microgeography here. Im really in probably one of the best demographics in the Phoenix area.Matt Miksic:OK. Thats great. Thats helpful color. So, we have theres a number of topics wed love to get into and Ill Im sur

35、e we will but Ill pause here for a second just to hand it off to my colleague Chris Gretler who Im sure has a lot of questions as well. So, Chris, do you want to run through some of the varying questions that you have?Christoph Gretler:Yes, hi. Matt, thank you and welcome Dr. (inaudible). I had a fe

36、w questions actually. So, starting on patient behavior have you seen any noticeable kind of change in that respect given the kind of the (inaudible) of the situation in the last few weeks or months. That people are .Kipling Sharpe:Yes. So .Christoph Gretler:. more cautious now or .Kipling Sharpe:Yes

37、. So, its interesting. There are different groups of responses in that. Not everybody behaves the same and its interesting to some extent the responses follow the political polarity in the United States. I have patients who absolutely believe that COVID-19 is nothing more than the flu and that this

38、is a purely political play. And that they dont need the masks and they dont need to worry about it.And I have other patients who are afraid to come into the office for a visit. We have been offering telemedicine. So, there is polarity on how people are responding to this. I have had patients who hav

39、e been offered surgery at this time and have decided they want to kind of wait and see, theyre not sure they want to go to a hospital.I do have an advantage and the hospital I do most of my surgery at is an orthopedic specialty hospital so it has no COVID patients and every patient who comes into th

40、e hospital is screened for COVID in the parking lot. Theyre doing the rapid tests in the parking lot before surgery.So, patients feel comfortable with that. But theres no theres no universal response. There are people who are very afraid and probably the most afraid arent even coming into the office

41、.And I think thats been reflected in some of the emergency rooms but the in the United States, I dont know about Arizona specifically but in the United States the mortality rate from heart attacks has actually gone up.Matt Miksic:Right.Kipling Sharpe:And I think its because people are afraid to go t

42、o the ER when they have chest pain. So, the ER doctors tell me that theyre seeing people come in sicker than they did pre-COVID.So there is still a fear of hospitals and a fear of entering into the healthcare system by some people. And others who just think its total malarkey and that theyve got no

43、fear whatsoever and they dont even want to wear a mask. So its kind of all across the board.Christoph Gretler:OK. And that may be kind nothing, I mean its a bit tied to this question of kind of could you comment on kind of where you see actually the new patients versus kind of working down just in a

44、 backlog of patients that have previously kind of so to say generated or so.Is it all kind of new patients coming in right now or is it still kind of (inaudible) majority more like kind of working down in our previously kind of investigated patients (inaudible) now basically are at that level of the

45、 journey where they would come for surgery?Kipling Sharpe:Yes, its a combination of both. I dont think Im seeing more new patients than normal. I think some of the new patients I am seeing a higher percentage are further along the journey just coming in as new patients. My schedule is set up so that

46、 I only have a certain number of new patients per day just because they take more time.And so, I dont think I had a real significant bump in new patients but the ones the new patients Im seeing and my old patients who as you say are further along the journey are coming in more often ready for surger

47、y than would have been typical pre-COVID.And there are patients who are certainly far enough along in the journey to be thinking about surgery who are actively postponing it because of COVID. So, there will still be a backlog.And if we arent if we dont have a second spike in the fall which some peop

48、le are predicting, if we dont have that second spike there will be a lot of business because well have the winter visitors returning and still all of this kind of the people who now are maybe ready to do it and theyre feeling more comfortable about the healthcare system. So, theres still a potential

49、 big wave to come.Christoph Gretler:OK, thats interesting. Actually kind of (inaudible) that and kind of I think we were maybe a bit surprised in the last couple of I mean in the quarter reporting so to say about kind of how knees did much worse than hips.And one explanation was that basically at Ma

50、rch and a bit more (inaudible) cases, (inaudible) related, hip screw cases for example on the hip side. Is this kind of a change in mix that you observed as well over the course that you did more hips instead of knees or .Kipling Sharpe:Not my practice, maybe a slight increase number of hips but I d

51、ont do trauma. I dont do ER call. So, I have gone in to help a couple of my partners with younger patients with hip fractures and they feel theyre more appropriate for a total hip. So Ive gone in on some of a couple of those but thats only like two patients over the last six months, so not enough to

52、 really move the needle.I think in places where there was more shutdowns and thats probably more reflective of what youre seeing where there was more shutdown. If somebody has a broken hip you have more choice, right? It doesnt matter if its COVID or not.And so, people dont get total knees for knee

53、fractures, they get hardware. But with hips if they break the (inaudible) theyre either going to get a partial hip replacement or a total hip replacement. So, yes, I think that would tend to keep the hip numbers a little more stabilized.But I think youre insight there is correct.Christoph Gretler:OK

54、. And then maybe the other kind of comment we heard was in a kind of the (inaudible) substantial shift to ASCs now this period. This is also kind of a very remarkable shift that you observed with your colleagues knowing you were kind of off and on ecosystem.Kipling Sharpe:Yes. So, I have not had to

55、use an ASC because I have this orthopedic specialty hospital but I am aware that people who dont go to that hospital are using ASCs because the hospitals have to some extent restricted.And I think patients are more willing to consider that because again hospitals seem like dangerous places to them r

56、ight now. And so, theyre more willing to consider it and say Im OK suffering a little extra pain at home and not getting IV pain meds if I can avoid getting this COVID thing and so Im OK going to ASC and having my surgery done as an outpatient.In the U.S. the timing of it was pretty good because Med

57、icare controls a big portion of the joints and commercial insurers kind of follow Medicare rules. And over the last couple years total knees first and most recently total hips were taken off of the inpatient only list so that they could be done as an outpatient. Now, they have not approved hips for

58、ASCs. I believe they put knees on the ASC list this year.The hips still have to be done they can be done as out patients but it has to be a hospital outpatient department. So, that was (inaudible) in its timing in its pre-COVID change and next year the CMS rule has proposed that hips now go to that

59、same status as well where they can be done in an outpatient center. Thats a proposed rule not a final rule again. But commercial insurers have been allowing it.Christoph Gretler:OK, so there seems to be more tax to set work than trust kind of the pandemic apparently.Kipling Sharpe:Yes.Christoph Gret

60、ler:And then maybe one actually company specific question if you allow, I know kind of one of my companies actually just recently got its called a (inaudible), got approval of an augmented reality search of a platform for total knee. Have you ever come across or what do you think aboutkind of the us