Aurora Spine Corporation (ASG) Earnings Call Transcript & Summary

Good morning, and welcome to the Aurora Spine Third Quarter Fiscal Year 2023 Financial Results Conference Call. [Operator Instructions] Please note, this event is being recorded. I would now like to turn the conference over to Chad Clouse. Please go ahead.

Thank you, operator, and welcome, everyone, and thank you for joining us today to conduct an update with investors and review the financial results for Aurora Spine for the third quarter fiscal 2023 ended September 30, 2023. With us on the call representing the company are Trent Northcutt, President and CEO of Aurora Spine; and myself, Chad Clouse, Chief Financial Officer of Aurora Spine. Before we begin, I'd like to remind everyone that statements made during the course of this call may be considered forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 as amended and Section 21E of the Securities Act of 1934. These statements reflect current expectations, concerning future events and results. Words such as expect, intend, believe, may, will, should, could, anticipate and similar expressions are words that are used to identify forward-looking statements, but their absence does not mean a statement is not forward-looking. Statements are not guarantees of future performance and are subject to risks and uncertainties. And other important factors that could cause actual performance or achievements to be materially different from those projected. For a full discussion of these risks, uncertainties and factors, you are encouraged to read Aurora Spine's documents on file with SEDAR plus, including those set forth in periodic reports filed under the Forward-looking Statements and Risk Factors Section. Aurora Spine does not intend to update or revise any forward-looking statements, whether as a result of new information or future events or otherwise. On this call, management may refer to EBITDAC, adjusted EBITDAC, adjusted net income and adjusted EPS, which are not measures of financial performance under the generally accepted accounting principles or GAAP. Management believes that these non-GAAP figures, in addition with other GAAP measures provide meaningful supplemental information regarding the company's operational performance. Investors should recognize that these non-GAAP figures may not be comparable to similar titled measures of other companies. These measures should be considered in addition to and not as a substitute for or superior to any measure of performance prepared in accordance with GAAP. A reconciliation of non-GAAP measures most directly comparable GAAP measure in accordance with SEC Regulation G can be found in the company's earnings release. With that, I'd like to turn it over to Mr. Trent Northcutt, President and CEO of Aurora Spine. Trent, please proceed.

Yes. Thank you, Chad. I'd like to welcome everyone to the call to update everyone about Aurora Spine. First off, I do apologize for the delay in having this call, but I have been out on the road, having meetings with doctors and surgeons. To lay out the agenda for today's call, I'd like to focus on a few topics to update investors as well where we are working on Aurora Spine. After those remarks, Chad and I will be happy to answer any questions that you may have. Topics to cover. First, sales staff. The company has added more sales personnel in some strategic areas of the country, including the Southeast, Southwest. We accept that these individuals will drive sales and growth in 2024. We have hired 4 new sales associates and expect to hire 2 more before the end of the year. Number two, SiLO TFX. SiLO TFX has been fully released. There are 35 instrument sets in circulation. SiLO TFX is currently more than 30% of the sales on a monthly basis. Next is ZIP. Sales has surpassed last year's sales and continue to grow. Growth is due to new accounts brought in by new sales staff. DEXA, the DEXA study has started, and the first patient has been enrolled. The DEXA cells are increasing month over month and we've added new doctors to our continued sales growth. DEXA is being used in conjunction with our cervical plate system, the Apollo. The company's financial structure. Q3 continued to show growth in sales and improved gross margin. The private raise after the quarter was given to the company cash and have fund our future growth. We're expected to be positive EBITDAC trend to continue and profitability is within reach. In summary, I'm extremely proud of our team's performance, staying focused on building this company. We are well positioned to take advantage of growth markets with the release of the SiLO TFX and the expansion of sales force. We remain focused on penetrating these markets further this year and continue throughout trainings and clinical education studies. Looking to the long-term solution, we are positioned for success, especially as we have new products and more clinical studies proving out as our technology and education for more doctors on the benefits of using the Aurora products. We remain highly focused on this opportunity. And at the front of us, we continue to invest in our growth with each of our major platforms, ZIP, SiLO and DEXA. With that said, operator, we're ready for any questions.

[Operator Instructions]. And our first question will come from Tom Fedichin of Microcap Connection. Please go ahead.

Congratulations on a great quarter. Obviously, sales were quite strong and mostly related to the SiLO TFX. Sales of $3.95 million and obviously trending in the right direction now. Would you say that this quarter was really all about the SiLO TFX, given that sales have grown to 30.5% of total sales or roughly $1.2 million. In other words, 120 implants were sold during the quarter or averaging thus averaging 40 TFX sales per month. That's a pretty fair assessment?

Yes, I believe that the TFX definitely added some -- added excitement to the sales organization. It was anticipated. The group was ahead of it. They knew that they wanted to get this technology in front of the customers around the country. We had a list of people that were excited to use the technology, and it has performed exceptionally well. In fact, we've seen some incredible x-ray images and have heard some really good testimonies from not only the surgeon, the doctor and the patients telling us that the relief is virtually instant as they walk out of the surgery center or hospital.

And you had 30 new kits that arrived in September. They went out into the field by month's end. Did you see many new sales from those 30 kits in the month of September that contributed to Q3 sales? Or should we be expecting those new kits to really start to show in Q4?

You're going to see more of that in Q4. There was 30 kits out in the field that were needed desperately to help decompress logistics, right, because we were sending sets out feverishly across the country with the limited inventory we had. We've built up both not only do we have the 30 kits in the field that will show and reflect here in the fourth quarter. We built an additional 5 sets that would help with training and education, so we could help not tie up inventory and use those kits for the training ahead of time so we could be a course with the trades and they wouldn't be out of circulation. And then lastly, the team did a really good job of manufacturing all the components. So the transfixing bridge, the cone and the screws, we were built up with inventory. We have inventory for all the rest of this year and all the way into next year, and we're really comfortable with our inventory levels.

And would inventory mean the build-out of additional kits? Or is that just to service the current kits that you've got today?

Just to service the current kits, but there are extra implants available. We do see -- we are keeping our eye on the trend. And obviously, as the trend increases and continues to show more turn rates, we'll then make the decision on how fast we need to put in another order for more kits.

Okay. And are the 30 kits that are currently in the field, are they moved? Or are they just stationary? That's a question I've had from some people is that they probably are moved around. Are they moved around? Or are they stationed and...

Yes. Well, we have a couple of accounts that use the product week in and week out. So we keep the sets there. So we don't need to ship those trades around. But there are -- the rest of the sets are moved around the country as surgeries are put on -- or as the surgeries are scheduled in areas and locations. So we have 2 Vice Presidents. We have Blake Carver on the East and Matt Paxton on the West. And between the warehouse and customer service, they're moved with their -- with the sales regional managers are located and then put into surgery and then use and then picked up from surgery right away and they return back to the office or sent off to the next location depending on where they lay logistically.

Okay. Now given that SiLO TFX effect seems to be the major growth driver, do you foresee having 60 to 100 kits out in 2024? What's the trigger point to building out more kits?

Well, the trigger point would be getting past -- getting to that -- up to 100 level -- 100 units per month, that would put about a 3x turn rate. So once I start to see about 3 turn rates consistently per kit, meaning a surgery a week per tray, so that would be 4, obviously, but then once I start to see around a 3, 3.2, 3.5 turn rate on that kit, I start to look at adding more inventory. In meaning instrument kits, I've got inventory, so I'm more worried keeping my eye closer on the instrument set themselves. And we're ahead of that. We've got backup parts on the shelf, and we've got -- we're in the queue with any manufacturing build-out as needed.

And having a sneak peek into Q4, would you say you're at least hitting 2.5 turns per kit right now?

Yes, we're very pleased with our current churn rates and certainly see that the momentum hasn't slowed down in Q4.

Okay. Wonderful. Now I noticed that Q2 revenues, excluding the SiLO TFX in the previous quarter, Q2 came in at $3.2 million. By my math, Q3 revenues, excluding SiLO TFX sales came in at $2.74 million. So there was a decline for the rest of the business. Can you dig into the reasons for this? I know you did state ortho, neuro revenues did decline and you had issues with sourcing products. Has that been fixed? Has there been a resolution? And can we expect to see a rebound in that in Q4?

Yes. We certainly made some adjustments in some of the areas that we're not performing well in sales activities. So we've already added and replaced those locations where quotas were not met and performance was not met. And in the building -- in the room I'm in right now, in my office, we're doing this call in the office one over. I've got a room full of new trainees that are regional sales directors that are going to be out in the field promoting Aurora on all the product lines, and they're doing product review right now as we're speaking.

Wonderful. Now I noticed that gross margins during the quarter increased -- improved to 59.6% of revenue. Do you foresee the margin improvement continuing, especially with an increase in SiLO TFX sales expected moving forward?

I do. I think we're going to see an increase, mainly because we're adding more area coverage where we're actually in the surgery and using less distribution, so more direct sales versus distribution. Certainly our big fans of our distribution partners, but we've been in surgeries more often with cases that are underneath Aurora and not through just independent distributor and the price point has been met, which is also key.

Perfect. Can you chat about the ZIP sales during the quarter? What percentage of sales were attributed to ZIP? And what are you seeing from growth from ZIP for this quarter and moving forward?

Yes. ZIP sales still remain very consistent on our -- the products that have really been holding the line has been ZIP sales nudging out TFX sales by a few percentage points on monthly sales. So really, it's been the battle of the ZIP and the TFX. So it's been great to see on the daily pie chart of sliced out products being used. Pedicle screws still is a very large portion of our business, and we are making strides on closing out this year. So we'll have the release of our own lumbar system in the beginning of the year. That's part of the closeout that I was promising investors that I would get us away from all third-party products outside of biologics this year, and I believe that I've done that. It's part of why I was traveling so much recently was to get some of that completed. So right now, the 1, 2 and the 3 is the ZIP with TFX and then lumbar screws because it's a big part of surgery. We're going to continue to introduce our new lumbar system. We'll do a press release later on that beginning of the year and explain more about that product as we start to incorporate that into our sales mix.

Okay. And can you speak about the DEXA cervical implant. How sales has gone this quarter? I'm assuming the company focuses on the TFX currently right now, but there's a lot of promise from the DEXA-C and of course, the DEXA L, maybe you can speak to that thereafter about how soon we can -- until we see that on the market?

Well, the main thing with DEXA-C, our price point was adjusted because of some of the facilities that were at the prices had changed -- it had come down. And so that was something that we talked a lot about in our calls that let's take the price while we can get it, and we did. We're seeing the implant from Q1 to Q2, it increased from Q1 to Q2 in 2023. It dips a little bit not too far off in Q3, but I think in Q4, it'll start to show coming back closer to the Q2 sales. And then we're adding some specific spine sales group -- people to our company that will be focused on spine sales versus pain interventional sales. And these people are now involved with the development of more customers. I think the multicenter study is going to help because now we can say that we have those first patients enrolled. We know that those patients are doing well. The cases that we've done performed well. And we've done 2 key meetings. We did CNS, the Congress of Neurosurgeons in the beginning of the year, talking about how we have over 300 levels of surgery performed by 1 particular surgeon to showing incredible outcomes. The patients are having a lower pain score. The patients are feeling better. He believes his fusion rates have improved. And he then turned around and collected more data, and we submitted that more additional data to the North American Spine Society Conference, where we had a roundtable discussion there, discussing the features and benefits of DEXA. So there's some more hard yards that need to be put into the technology from an explanation standpoint of getting people to understand the benefits of it. And I think most of it comes down to getting more salespeople in front of more cervical spine surgeons that are interested in this technology, and they need to then learn about the technology. They're not just going to read a flyer, they're not just going to read a website and make a quick switch. They want to make sure that the product they're using is a true benefit to them and their patients. So I think 2024 [indiscernible]...

And DEXA L?

DEXA L is in the -- has finished its biomechanical testing and has done great with the biomechanical testing and we are in the process of manufacturing that product to be released as soon as possible.

Okay. You had mentioned on a previous call that you were approved by Veteran Affairs. Have you had any sales yet? Have you trained anybody from VA on your implants? And what sort of returns could investors expect to see from this VA deal?

So we have. We are on the DoD contract now nationwide, and we are able to -- we have done and performed surgeries at different military facilities in veteran hospitals in the country. We're just getting started with it, but we've done a handful of cases, and they've all gone very, very well. And we're really pleased because it's a great population with our veterans and a great population in our existing military who can see the benefits of our technology, helping them get back up on their feet. So we're really encouraged by that. And the price point is fantastic. The service that we've been able to get inside of these facilities has been fantastic. So it's been a real team effort, and I think you'll see more and more of that into the coming year of 2024, we'll see more DoD usage around the country through our distribution channels.

Wonderful. And on a previous call, you had mentioned about hiring 8 regional sales directors by March 2024. You've hired 2. You've mentioned about having 4 new sales associates just moments ago. Do you feel by March, you'll have all 8 hired? And what can we expect in terms of sales per regional sales director per year? I would assume that there will be a lot of demand for doctor training as well from these new sales reps introducing new doctors. So maybe you could speak to the training as that's going to be brought on as a result of these new individuals being brought on?

Yes. We've brought on a new educational coordinator. She's been terrific. She's really gotten things locked down and the training has gone fantastic. We've done in different locations around the country as usual. And to the first part of your question, we added sales management and leadership in Arizona. We added sales leadership in Florida, the Atlanta, Alabama area and the Texas area. So those 4 are actually on our team right now today. And we're adding 2 more -- probably hired within December, if not January, and then to be able to add the additional 2 more by March is achievable. And training and education will be continued. We are breaking down the labs, less national labs and more regional labs. So we're in that region. We had a better ROI on regional labs than we did national labs.

Okay. As a result of the training and whatnot, I would assume the costs will start to increase. Breakeven was $1.32 million. We've discussed this in the past per month or $4 million a quarter. Do you see this rising like maybe $1.5 million should be considered as a breakeven point once these new sales staff are brought on with the additional training?

Yes, I believe that there'll be a slight increase of breakeven line. But obviously, we're not hiring people to come in to sell products to miss the sales goal, we're hiring them to hit the sales goal, so that would help contribute to a larger top line revenue, but also more importantly, a profitable revenue line for us. We're really keen -- we're really focused on our positive EBITDAC, that I was looking for and the third quarter being profitable and the fourth quarter, and then sustaining that and then increasing that profitability line for us in the first quarter and beyond into 2024. That is the absolute plan.

Okay. And with saying that, would 75 SiLO TFX sales per month, is that a fair goal for Q4? Like I understand you've had some pretty good success already in -- with the SiLO with a couple of good sales, I understand. So maybe you can speak to what we can expect from Q4 with numbers -- from a numbers perspective, do you think we can break the $5 million mark for Q4 sales?

It's possible. It's certainly possible. What we're looking -- right now, we're really happy with the beginning of the fourth quarter. We want to see where it lands in December with the holiday schedule. There's a large conference that is in Dubai this December -- beginning of December. And there's a large amount of customers that are going to be attending at that conference. So it's a lot of time away from the hospital away from the surgery. So December, I worry a little bit more only for that week because of how many people will be training. These are customers that we know will not be in surgery. So -- but October, November couldn't be happier. Really pleased with it. We'll see where it lands in December. And the quarter, we feel is still heading in the right direction for us. And then as far as like the units go with the inventory and the sales group that's in place, we're starting to see a couple of different things. One, we're seeing some of the older SI joint procedures that were performed from competitors that were allografts. Now they're using our TFX to secure either the same side or the adjacent side. And we've seen multiple bilateral TFX cases where we've actually fused both sides with the SI joint -- both sides of the patient in their SI joint. So I think the numbers are going to continue to increase. It's still -- we're still early innings on it. We're still getting it out there. But 3 turns a kit on the 30 kits would be 90 implants. And I think that, that's a goal that we can shoot towards because that's my indicator to see if we need to start looking closer at more inventory kit levels to maintain a high turn rate. And the teams in tune with that to get high-level turns be resourceful with the inventory kits and get them in front of as many people as we can because the coding headwinds that we ran into at the end of last year all through the second half of the year and the beginning of this year, we feel are further and further behind us and that the increased awareness of SI treatment is on the rise. So we're really comfortable with this space.

Okay. Now switching gears a little bit. The accounts receivables, you did have quite a few -- well, you had some outstanding debt that was owed. And on a call during your conference with the Lytham conference, I understand, some of this was collected. Can you speak to the collections and I don't think it's shown on your -- this quarterly earnings. The cash should have increased. Maybe you can speak to what you've collected and the improvement on your balance sheet now that you've got the race completed and at the same time, these -- some of these collections have been collected upon?

Yes. We're in a good place with a lot of the collection efforts. Obviously, getting all selected would be best, but we appreciate the people who have been consistent with us, even some of them who dug a big debt with us. We feel like we've made some headway in all the major areas that we needed to focus on. I think a lot of it has to do with people getting their budgets in line across the country, hospitalize, surgery center wise. A couple of locations have been very cooperative with us and even -- they're making payments. So instead of being a flat zero, it's actually receiving $10,000 or receiving $5,000 from them. So we are seeing more of that. And the communication, I think, is improving too. People are actually getting back to us. And I know we're not the only ones. I know there's other companies in the same business that we're in, that are dealt with these facilities, trying to get them to pay their bills on time since we're not funding -- we're in a position to fund companies for their surgical usage. So I do see improvement coming and it has been improving.

Have you put measures in place to prevent a reoccurrence given that sales especially are taking off, so you don't have a reoccurrence so of maybe some of the debt from the past?

Yes, for sure. We've added another layer of financial controls inside of the accounting team, a direct individual who's helping with not only budgets, but cost containments and collection controls in this individual is on this every week to make sure that we are staying ahead of it and not getting behind it, and this is also utilizing our in-house attorney to make sure we send letters appropriately to get their attention to make sure that they stay on time on their payment schedules.

Okay. Can you speak about the latest financing? I know it wasn't opened up to the public. There was a little bit of -- there were some investors questioning why it wasn't opened up, and there was tremendous insider participation. Maybe you can talk about how all this went down?

Yes, we kept it pretty close to Aurora. And we wanted to circulate it and to talk to some close individuals about them and continuing in the investment with Aurora. We felt as though this is what we needed. It wasn't a large rate, as you know. We were able to move quickly on it and everyone was very supportive of it. There was no hesitation on it. They saw what we were seeing and like the words that they had heard on our efforts. And we moved on it because we wanted to be focused on the business. This is all about our business and growing sales and having the right controls in place, the people in place, adding more people where we needed to strengthen up and firm up in our company. And we felt that it was a good sign for everyone that not only was our Chairman still firmly behind us, our Board was firmly behind us, but our investment groups were still firmly behind us. We had virtually no changes. We had no changes to our Board in 10 years. We've had consistency across the Board for 10 years. And this is a -- you've heard me joke about this before, Tom. This is our -- we're 10-year overnight success story. And I think 2024 is really the year that we've been waiting for. And I think it showed a lot of fortitude by everyone involved and from the Board all the way down to our team here in the building and out in the field.

Yes. No, perfect. I agree. And do you have enough funds to see through 2024 and beyond? Any need to raise down the road?

No, there's nothing. We felt that this is money that we took in was what exactly what we needed to firm up the balance sheet to build to make these additional hires, to be able to execute on the sales trainings that we wanted to perform. We have a close eye on inventory level because we've been able to build up. We did a lot of that last year, a lot of the proceeds and everything we had over the last couple of years were to build up this inventory. TFX has been in the works for a long time, as you know. So we really feel good about our position where we are with it. And yes, I don't think we're going to need to raise any money in 2024 because it should be a profitable year for us. We will use that -- those profits accordingly and apply them exactly where we need them.

Okay. And the second question is some investors pointed out the options plan. You were granted 1 million options. Can you tell us the price that those were issued at what sort of time period? Will they vest? And should investors expect to see more options being granted from additional executives?

Nothing is all released yet, so I'll have to hold on that right now. It was a decision that myself and the Board that we work through. And there's nothing immediately pending as far as other stock options being granted. It's a stock option plan. Just like any of our employees, I have to vest those shares like the rest of the team. And so I'm obviously, I'm grateful, and I appreciate the board bringing this to me. And we're in this for the long haul, and we're all focused on the future.

Yes. Was there a price that they were priced at? Is the question that's been asked.

I don't have that in front of me, so I have to come back to you on that, Tom.

Okay. Okay. And by the way, can you speak about the -- first get back to the business for a second, the seasonality of the business, is this something that we can expect to see a stronger Q4 given the seasonality of people trying to get their surgeries before the year-end. So they've got a reset for their insurance going into the follow -- the next year. Do you expect to see a strong Q4 let alone? I know you've got the week with the doctors away, but do you think we're going to be looking at a strong end of the year.

So right now, like I said, Q4 is shaping up ahead of plan, which is great. We really appreciate how it was -- each quarter that went by this year was getting ourselves in a position to be able to sell more, to be able to work with our customers. I guess at the coding headwinds, the coding reimbursement headwinds, I wish you guys could have lived it all 365 days like I did, including all of last year and this year. But it really was a big, big, big deal in all the companies that are in this space, and we're really happy with the way that the TFX, we started the development of this system without the idea of coding and reimbursement. So I think from a seasonality standpoint, I am really concerned about this weeklong trip that many of our customers are going to be attending because it's going to shut down surgery for a week in a lot of our accounts. But I do expect many patients who do want to get back up on their feet when they have time off at the end of each year seasonality-wise, that they'll want to have their surgery done so they can get back to activities in 2024, more travels and more activities for those individuals. And yes, I do -- historically, we've seen seasonality each year up and down from the beginning of the year into spring, the summer, fall into winter and the closeout to each year. People do typically try to update their plans and try to get their surgeries performed before the year closes.

Okay. And a couple more comments or question and the comment is profitability, Q4 will at worst might be profitable?

It's really right there from that Q3 positive EBITDAC. Q4 is ahead. So we really feel good about what's going in Q4 and we are trending as a positive, profitable trend in the company as we speak. Obviously, we've got to continue to build that up. We don't have major expenses here in the fourth quarter. We had higher expenses in Q3. And that was by design because we had trainings, we had educational things going on. So our costs are lower in the fourth quarter. So yes, it's trending that way. I got to see where it lands in December. But I'm very pleased with October. I'm very pleased with November. And I think that the springboard off of Q1 to Q2 to Q3, and like I mentioned, all the headwinds now behind us in the coding and the reimbursement, the performance of the SiLO TFX, adding more feet on the street, as we've been talking about for a while, this is all in place right now today on this call. So everything is pointing in up direction.

Okay. Wonderful. Wonderful. Lastly, is there anything that I happened to ask that I should have asked that you can think of, any comments that you can add about the quarter that we should be -- or items that we should be paying close attention to as we move into Q4?

I think what you're going to see is -- you're going to more discussions of a posterior lateral approach. You're going to see more and more conversations about that in 2024. It's a big hot topic that continues to develop in a positive way. There's just a lot of benefits to being able to perform this procedure where you have real easy exposure to the SI joint, and you're able to fixate this joint in a reproducible way, getting those patients back up and running, smaller incisions, less blood loss, patients walking, coming into the center and not feeling well, not be able to walk well, feeling a lot of aches and pains and literally walking out the same day. I think we're going to talk a lot about that next year. And the 2 things that we'll talk about is that TFX and how well it's performing. And I'm hedging that the DEXA conversation is going to come back to where it was from last year and be stronger than ever in our spine. The last thing I'd say that our spine division will start to show some more strength in 2024. So we'll have a nice friendly competition between our interventional divisions and our spine division of products. So that's going to be our 2024 mantra is to get both those up balanced, so they're not lopsided one way or the other. And I like our shots on goal because we have a lot of great products to sell in both categories.

Wonderful, wonderful. I'll go on hold and listen to others if we may have some questions.

[Operator Instructions] This concludes our question-and-answer session. I would like to turn the conference back over to Trent Northcutt for any closing remarks.

Thank you for joining us. We appreciate your time and interest in Aurora Spine. We are very excited about what's ahead. If you have any questions, please reach out to Aurora Spine and we'd be happy to schedule up a follow-up call. Thanks again. Everyone, have a great rest of your day.

The conference has now concluded. Thank you for attending today's presentation, and you may now disconnect.