Intuitive Surgical, Inc. (ISRG) Earnings Call Transcript & Summary

Good afternoon, and welcome to the 2021 Intuitive Surgical, Inc. Annual Meeting of Shareholders. I would now like to introduce the first presenter, Craig Barratt, Chairman of the Board.

Good afternoon, ladies and gentlemen. I am Craig Barratt, Chair of the Board of Directors of Intuitive. I welcome you to the 2021 Annual Meeting of Stockholders. We are hosting our annual meeting virtually due to the ongoing public health impact of the COVID-19 pandemic. Before I call the meeting to order, I would like to introduce to you the other members and nominees of the Board of Directors as well as the management team who are online with us today. Joseph Beery, an Intuitive Director since 2020; Dr. Gary Guthart, President and Chief Executive Officer of Intuitive and Intuitive Director since 2009; Amal Johnson, an Intuitive Director since 2010; Dr. Don Kania, an Intuitive Director since 2018, Dr. Amy Ladd, an Intuitive Director since 2019, Keith Leonard, an Intuitive Director since 2016; and Dr. Alan Levy, an Intuitive Director since 2000; Jami Dover Nachtsheim, an Intuitive Director since 2017; Dr. Monica Reed, a nominee for election to our Board at this meeting; and Mark Rubash, an Intuitive Director since 2007. Other officers and members of the management team of the company online with us today are Marshall Mohr, Executive Vice President and Chief Financial Officer; Kara Andersen Reiter, Senior Vice President, General Counsel and Chief Compliance Officer; Siang Chin, Vice President, Assistant General Counsel and Corporate Secretary; and Philip Kim, Head of Investor Relations. I would also like to introduce Kris Veaco, our inspector of election; and [ Jeff Molinao ] and Rishi Jobanputra, partners of PricewaterhouseCoopers LLP, the company's independent registered public accounting firm. Ms. Chin will act as secretary of the meeting. Let me start with a brief review of the agenda for today's meeting. We will start by taking care of some housekeeping items, and then we will move to the formal business for today's meeting, consideration of the proposals described in our proxy statement. After the conclusion of the formal business, Gary will provide an overview of recent company highlights, and we will have time for appropriate questions. Only stockholders may ask questions, which must be submitted in the designated field on the web portal. [Operator Instructions] If you encounter any difficulty submitting questions during the meeting, please refer to the proxy statement for information on how to reach our support team. The time is now 3:04 p.m. Pacific Time. The meeting will now come to order. I have confirmed with Computershare that we have a complete list of the stockholders of record of the company's capital stock on March 5, 2021, the record date for this meeting. That list of stockholders and the number of shares held by each stockholder as of the record date is available on the web portal for any stockholder wishing to inspect it. The stockholder list shows that as of the record date, there were 118,378,130 shares of common stock outstanding and entitled to vote at this meeting. I also have an affidavit certifying that on March 10, 2021, either: one, a notice of Internet availability of the proxy materials; or two, the proxy materials themselves were sent either by e-mail or by United States mail to all stockholders of record at the close of business on March 5, 2021. Kris Veaco has been appointed to act as inspector of election at this meeting. Kris Veaco has taken and subscribed the customary oath of office to execute her duties with strict impartiality, which will be filed with the records of the meeting. Her function is to decide the qualifications of voters, accept their votes and, when voting on all matters is completed, to tally the votes as to each matter. I'm informed by the inspector of election that based on the number of proxies received to date, a quorum is present, and the meeting will proceed. Accordingly, I hereby declare this meeting to be duly constituted for the transaction of all business. We will now proceed with the formal business of this meeting. There are 4 proposals to be considered by the stockholders at this meeting, which are listed in our proxy statement. The polls are open for voting on all matters to be presented. The polls will be closed to voting after we go through the matters to be voted upon. The first item of business is the election of the 11 directors nominated by the Board of Directors. The following individuals have been nominated to the Board of Directors to serve until the 2022 Annual Meeting of Stockholders, Dr. Craig Barratt, Mr. Joseph Beery, Dr. Gary Guthart, Ms. Amal Johnson, Dr. Don Kania, Dr. Amy Ladd, Mr. Keith Leonard, Dr. Alan Levy, Ms. Jami Dover Nachtsheim, Dr. Monica Reed, and Mr. Mark J. Rubash. The Board of Directors recommends that stockholders vote for the election of each of the nominees. No other nominations complying with the nomination procedures in the company's bylaws have been received, and the nominations are closed. The second item of business is the approval on an advisory basis of the compensation of Intuitive's named executive officers as disclosed in the compensation discussion and analysis, compensation tables and narrative discussion of the proxy statement for this annual meeting. The Board of Directors recommends that stockholders vote on an advisory basis for the approval of the compensation of Intuitive's named executive officers. The third item of business is the ratification of the appointment of PricewaterhouseCoopers LLP as the company's independent registered public accounting firm for the fiscal year ended December 31, 2021. The Board of Directors recommends that the stockholders vote for the ratification of the appointment of PricewaterhouseCoopers LLP as the company's independent registered public accounting firm for the fiscal year ended December 31, 2021. The fourth item of business is the approval of the amendment and restatement of the company's 2010 Incentive Award Plan. The Board of Directors recommends that the stockholders vote for the approval of the amendment and restatement of the 2010 Incentive Award Plan. Any stockholder who has not yet voted or wishes to change their vote may do so by clicking on the Voting button on the web portal and following the instructions there. Stockholders who have sent in proxies or voted via telephone or Internet and who do not want to change their vote do not need to take any further action. Only stockholders of record on March 5, 2021, or their proxy holders are eligible to vote at this meeting. We are now going to take a short pause to allow for any stockholders who have not yet voted to do so. [Voting]

The time is now 3:09 p.m., and the polls are now closed for voting. We have been informed by the inspector of election that the preliminary vote report shows that there were sufficient votes for the election of each of the nominees, Dr. Craig Barratt, Mr. Joseph Beery, Dr. Gary Guthart, Ms. Amal Johnson, Dr. Don Kania, Dr. Amy Ladd, Mr. Keith Leonard, Dr. Alan Levy, Ms. Jami Dover Nachtsheim, Dr. Monica Reed, and Mr. Mark Rubash. And each is hereby elected to the Board of Directors to serve until the 2022 Annual Meeting of Stockholders. In addition, the inspector of election's preliminary vote report for each of the other proposals is as follows: The proposal to approve the compensation of named executive officers on an advisory basis has received sufficient affirmative votes and is approved; the proposal to ratify the appointment of PricewaterhouseCoopers LLP as the independent registered accounting firm for the fiscal year ended December 31, 2021, has received sufficient affirmative votes and is approved; the proposal to approve the amendment and restatement of the company's 2010 Incentive Award Plan has received sufficient affirmative votes and is approved. The inspector of election will prepare a final report that will be included as part of the record of this meeting. We will be reporting the final vote results in a Form 8-K, which will be filed with the Security and Exchange Commission within the next 4 business days. The results can also be obtained before that date by writing to our corporate secretary. This concludes the formal portion of the meeting. This meeting is adjourned at 3:11 p.m. Now I will turn it over to Gary for a presentation on our business. Gary?

Okay. Well, thank you, Craig. Before I begin my overview on the company's business, as with most presentations, the following discussion contains forward-looking statements, and the company's actual results may differ materially from those discussed here. Additional information concerning factors that could cause such a difference can be found in the company's annual report on Form 10-K for the fiscal year ended December 31, 2020, as updated by the company's other filings with the Securities and Exchange Commission. I'd like to go ahead and get into the presentation. Thank you for joining us today, and thank you for supporting the company over the years. As we said before, we have forward-looking statements, and I've just read you a forward-looking statement language. Just really quickly, looking at 2020 overview and review. A little bit more than 1.2 million procedures were performed in 2020. Kind of final count came in almost 1.25 million. Today, surgeons have used our products over 8.5 million times in procedures. 300 -- 936 da Vinci systems were placed in the year. The installed base in clinical use is roughly 6,000. It continued to be well studied. One of the most studied medical devices that an additional 3,000 peer-reviewed clinical journal articles in 2020. And the clinical database of publications is now quite large, over 24,000. I'll talk a little bit more later in the talk about data and clinical publications. Sometimes I ask, when you think about it, is 1.2 million procedures a big number in -- or a small number? And I think the reality is it's certainly bigger than it's been in the past. It will likely be small compared to what the opportunity is in the future. We like to check in with what we said we would do in the year. And of course, when we started 2020, we didn't see the full depth of what the pandemic could be and how it kind of came out. So we started 2020 with the following objectives: We expect to grow in general surgery in the United States; extend our depth and capability in markets outside the United States, particularly in Asia and Europe; and only to focus on growing beyond urology wherein several countries, we're the standard of care for urologic surgeries; progress in the launch of our SP system, our Ion system, imaging systems and analytics. And I'll share with you a little bit today about how we're doing there; and continue to expand our clinical [indiscernible] and analytical evidence space over time. You've just seen a little bit of that, and I'll share some more. We have some areas of strength in the year despite a very difficult year for the globe. We saw that recover in the use of da Vinci systems, as COVID starts to decline, pops back up, rises, indicating that customers really want to use our products. We see customers standardizing on our fourth-generation products for X and Xi. Surgical practice strength in the year in general surgery, particularly for obesity surgery called bariatrics, was very strong. We have a nice growing business in China. It's also a small base. We don't have a huge number of procedures compared to the United States, but it's growing quite quickly. And response by customers in China is really strong. And our customers' view of us, of Intuitive, as measured by our Net Promoter Score, we use a standard scoring system led by J.D. Power, has been strong through the year, which is [ growth ]. Every year has its challenges, and no surprise, 2020 was a challenging year. Clearly, as surgeries get shut down or delayed, that impacted us. We know that regulatory time lines for new clearances for our industry as a whole have been lengthening, particularly in the United States and Europe as regulators ask for additional requirements and additional data. We will navigate that, but it takes more time and more investment. We struggled in the fourth quarter with supplying our Ion catheters. We had higher demand than we expected. We had some struggles with some components and some manufacturing process. We are recovering nicely from that set of struggles, but in that early performance in Q4, it was a struggle, and we're coming back. Just touching on Q1. We've seen a recovery, as I said before, as COVID has eased, particularly in parts of the United States where the bulk of our procedures are performed. So you see here our monthly growth rates as measured year -- from the year prior for that like -- quarter. So 16% growth in the first quarter of 2021. System placements surprised us on the positive side. We continued to see customers install our systems despite the slowdowns they had for procedures in 2020. Procedure -- global procedures using da Vincis were about flat in 2020 to 2019, and yet folks kept -- our customers kept installing new systems in anticipation of recovery and standardizing on our latest generation products. So our Q4 performance for system placements was 326. We had 298 in the first quarter of 2021, which was ahead of plan. Utilization of our systems ticked up, which was great. So we saw recovery in their use. We know that system placements are an indicator of future confidence by our customer base. So this was positive for us. One of the other things I'd say in system placements is that we're seeing our biggest customers who know the technology the best continue to reinvest. So many of the system placements are into customers who know us, who have systems either in their hospital or elsewhere in their health system and want to continue to double down or continue to invest with us. I think it's a really good spot. With those results, you can see what our revenue was and what the growth was over Q1 of 2020. That came in at 18% revenue growth for the quarter. Kind of zooming out, what's the opportunity look like long term? And you can ask the question, has the pandemic impaired in any way long-term opportunities? Here's how we think about it. If you look out and, say, for the products we have in the market today, with the clearances we have in the countries in which we operate, we think there are about 6 million procedures that make good sense to be on our products as they exist today. So that is 6 million annually, 6 million a year. And I said we came in 2020 with about 1.25 million done. So there's a lot of upside potential, a lot of business for us to pursue with the existing product lines. If you ask the question, well, for those customers you're serving, that set of surgeons in the hospitals that you're in, how many procedures do they do that are beyond just what they might do with today's products? That number is about 20 million. So that's what that customer base is doing, that set of surgeons, soft tissue surgery where we operate. So we think there's an opportunity over time to grow that 6 million blue bubble to be bigger, and it may take new products and great innovations and other kinds of arrangements and services with our customers to get there. And that's the job of our innovation teams, is to continue to grow the opportunity. And I think it's a multiyear opportunity for the company. As I said before, we have seen customers who know us best continue to invest. And we know that the process for customers engaging a product like ours, in the beginning, they get interested in it and they adopt. Usually, they'll buy a system and start to use it. As they have success with it, they'll buy a second system or a third system and start to make it routine or operationalize it or build it into their daily schedule. And as they see good results and measure their own response, they'll start to standardize on it, which is, hey, this is the right way to do it for us going forward. And they may standardize within a hospital or across hospitals. So even in this year in which we had COVID as a pandemic, hospital systems, and by this, I mean, a building that owned 7 or more, increased 20%, is really remarkable. And IDN stands for integrated delivery network. That's a corporate owner of many hospitals. Global IDNs that owned within their IDN more than 7 systems continue to grow through the pandemic. And you see here the trend quarter-by-quarter with the last 4 quarters in 2020 being pandemic-impacted, and yet they kept standardizing here. And so you can ask, okay, well, what's going on? That looks like good capital placement performance. Wonder what's underneath that. And I think it comes down to really the completeness of the product line and the evidence in their hands they're seeing, and I like to talk to you about that. So many of you who have followed us have seen this before. The issue is not whether somebody has a surgical robot. A robot is necessary but not sufficient. It's not enough. So it takes -- to get to great outcomes, what our customers are looking for is not a wonderful robot. They're looking for a high-performing, minimally invasive surgery department. That's what matters to them. So to do it, to get there, you need the system, the da Vinci system. But you need more than that, instruments and accessories, things like stapling. You need your regulatory clearances so you're allowed to market and promote it. You need your training capabilities and your optimization resources. We call that Genesis or our consulting group is Genesis. You need to provide clinical evidence for now. Sales and service has to be great competency. You need to have marketing programs. And they need to have marketing programs, relationships with economic and surgical societies and, finally, economic validation. And that work is required procedure by procedure and country by country. It doesn't happen all at once. Data is a big conversation in analytics, machine learning, AI. These are all buzzwords that have become quite popular. And as you think about those things, the way to think about it from our perspective is that data and analytics and machine learning don't replace the things on this chart. They still have to be done, but they facilitate or enable or accelerate the activities on these trends. So as we become more [indiscernible] with data, as our cloud computing gets better and machine learning and AI capabilities increase, we can speed up or deepen these activities that make it easier to get great outcomes, and that's what we're focused on. I talked a little bit about clinical data, the clinical evidence base now at 2,000 -- or 24,000 peer-reviewed articles. It is actually so large that one of the problems is that most folks can't read the entire data set. And if you ask yourself, okay, aggregated clinical evidence, peer-reviewed journal articles, randomized controlled trials, retrospective studies, are these things important? The answer is yes. They point the way to value, but they often don't change practice quickly. And the reason they don't is that if you run a hospital, you might look at one of these papers and read it and say, okay, well, it came out of a large academic and medical center. But I'm a community hospital in a suburb, and I don't run the way they do. I don't have the same patient population. Or you might see interesting data coming out of Sweden and say, well, that's interesting, but it turns out that in Texas, it's a little bit different. Our patient population is different. So people read those things, but it doesn't change practice in a big way. But something has changed in the last decade, and particularly in the last 5 years, and that change is that most hospital systems in the United States and many around the world have invested in electronic medical records, electronic health record systems. And they now can look within their own databases, and we can help them with our da Vinci system, which is an Internet of Things. The vast majority of our da Vinci systems are cloud-enabled. So we can combine data with them and look at what's the performance of their minimally invasive surgery program within their own environment. So we talk about that as my data, my truth, meaning the hospital's data and the hospital's truth. And we found that to be exceptionally powerful. We've engaged in custom analytical activities with over 350 of our customers and over -- and approaching 700 different engagements. It's fantastic. It's interesting. And here, instead of it being kind of a theoretical discussion of what might be, this can be a very data-anchored conversation about what is and what can change. And we see that driving change. So when you look back at why are large customers continuing to invest with us, I think a large driver is they have the data now to understand the value and operationalize to make change, to get better results. And I think this is fantastic. There are many groups out there that are interested in working on surgical robots. You've probably seen some of them, and I guess I'd start with the following. But it's a hard job to create a great robotic system. And in the end, competition won't be robot versus robot. Competition will be an enabled ecosystem including the robot versus enabled ecosystem including the robot and helping customers get to what they want, a high-performing, minimally invasive surgery system. We take customer perception of us extremely seriously. We measure it every year. This is our latest update measured in the middle of the pandemic. It's a standardized Net Promoter Score survey that J.D. Power runs, and we came out well. We held our own year-over-year in a very tough time. World-class, ranks as 70. We're just underneath. We are leading our peers in this space, and many peers declined during this period. When we look at the survey results, most companies struggled through the pandemic period, but Intuitive did not slip. And if you ask, why is that? I think it's the set of activities we performed on the right side of the page here. We were agile about helping our learners continue to learn even when there were travel restrictions and work-from-home requirements. We forward-deployed learning capabilities. We adapted to our customers' financial needs. We created a customer relief program that had them not having to pay for things that they couldn't use during the pandemic. We have increased our analytic capability. We've lowered their per procedure costs by rolling out extended use instruments and adjusting pricing in some sensitive markets. Our service performance and our uptime performance remains outstanding. And we've been quite flexible in the way people can apply our capital with leasing and alternative capital arrangements. In other words, other ways to buy a capital rather than just writing a check has made it possible for people to continue to build their programs even without having to have a lot of capital in the bank at the time they get it. So I think this has been powerful for us. We are working on multiple things. This is one of our new programs. I'm just going to sample a couple of them for you, just given the limited amount of time. We have augmented reality program that allows surgeons to look at preoperative images during the surgery, both before the surgery, during the surgery and then the review with the patient. We call it Iris. Our first activity is looking at kidney or tumors in the kidney. And what this does is it takes something that's already in the hospital health system, and it's called a PACS system and the imaging system of the hospital, but it's kind of hard to access. They have it already -- the health system has already paid for the acquisition of this CT scan, but the surgeon rarely uses it during the case because it's kind of hidden away in a hard-to-get-to format. We use cloud computing and machine learning, machine vision, to create a model of the kidney based on that preoperative scan. We present it back to the surgeon in a mobile device who can review it prior to the case and can review it with the patient prior to the case. And then they use it real time inside our console to use it as a reference image. What we've seen in a retrospective study is that in the case of kidney cancer using this technology, surgeons would have changed their course of treatment about 20% of the time. About 1 in 5x, they estimate, they would have taken out less tissue, they would have left more healthy tissues on 16.5% of the time. And 3.5% of the time, they would have taken out more tissue. They would have done a more aggressive resection because they were worried about the tumor, more worried about the tumor. In either case, this is a good outcome because what it says is that it helps them think through and plan the case prior to getting into the case. And we've seen this continue to rise. We're in early launch. We're learning from the -- our early engagements and refining our user interface and the agility with which we provide these images. But I think it's a great step in the right direction. Our single port system is rolling out. This is part of the da Vinci family that goes into the body through 1-, 2.5-centimeter incision on an inch cross. You can see that it's been growing even through the pandemic. We're seeing really interesting clinical data coming out that you'll start to hear more of over time. It grew -- procedures on SP grew 64% year-over-year through the pandemic. So the interest in this technology remains robust. We are limited in the United States by the indications we have cleared. We are working with IDE sites, Investigational Device Exemption with hospitals to get additional clinical data to submit to get additional clearances. But we have broad clearances in Korea where it's being used. And what we find in Korea, so if you look to Korea, you can see where it might be used when all the clearances come through. And it's used more frequently than even our flagship Xi system, which is remarkable. This is a early stage product that's getting a ton of use. It's being used in head and neck surgery, in urology, in gynecology, in general surgery. So to us, it points to a bright future and a high interest by surgeons to advance care by being less invasive. We have our flexible bronchoscopy systems called Ion. The idea of Ion is to navigate through the mouth into the bronchial tube to sample tissue from suspicious lesions at the distal lines of the lung. This has been a hard problem. We know that lung cancer is one of the most morbid and serious cancer diagnoses that are out there, and we'd like to help pulmonologists and thoracic surgeons get early answers. Our clinical data on this has been great. Our demand has outstripped our early models. And we're seeing great utilizations. So here, we're working as hard as we can to supply/demand to get the manufacturing and our supply chain build to keep going with the growing opportunity. You'll start to see additional data published. There's just one example on the right. But our preliminary studies here show that it is the most capable system in the market either manual or robotic at positively identifying -- unambiguously identifying whether something is benign or cancer once the tissue is sampled and pathology gets ahold of it. Just moving to close, our investment philosophy has not changed. We invest in priority order here. First, we believe that the need for improvement in acute interventions is substantial and durable. When we're assertive in pursuit of organic innovation in products and regions of the world as our first priority, we think that is a high-return way to invest on one. We know that as we grow, investing in operational efficiencies at scale and allow for flexibility in pricing for our customers allows us to access more customers over time, and it allows us to reinvest those savings in our business. We call this a virtuous cycle. We know that there are some regions in the world and some markets where price sensitivity is high. And if we can use manufacturing at scale advantages for lower cost for everybody, that's good for our customers, it's good for us. We've done that very well in the last few years, and we'll continue to do that. We are a good and capable group of folks, but we're not the only capable people in the world. And so we pursue partnerships and acquisitions that can accelerate the outcome and efficiency improvements we desire. Typically, we try to bring in technologies and people that can accelerate the business and speed us up. We tend to look for things that fit with us well. And we look for opportunities to return capital to shareholders over time with a focus on long-term value for shareholders. We try not to do this in any symbolic way, but to do it in times where we think it's a good investment in shareholder money. So this is what we've been doing. We expect to invest significantly in the first left side here, 2 in 2021. And that's because we believe that the health care system really values what we do. And most of the industry is moving to a model kind of like ours, a combination of hardware and software and the Internet of Things, plus some analytical services to help customers. That combination is something that people are finding quite attractive. And we want to invest to maintain our leadership position. Our 2021 priorities. The pandemic is variable. It's not over, and it varies by country and by region. And we'll support our customers as they recover during and post pandemic as they need to be supported. So that needs to be done by region [indiscernible]. We expect outstanding regional performance by country, and we continue to invest in great people, in clinical trials, in our relationships with surgical societies and others. We will advance our launches over da Vinci SP, our Ion system, our fantastic imaging and analytics products and new indications for our new platforms. And this is important to us and something that we're tightly focused on. And data matters in health care. We'll continue to expand our clinical, economic and analytic evidence for key procedures in countries in service of our customers and in service of the health systems. We did reinstate guidance at our last earnings call. We start to see some ability to predict. It's not perfect. So we see -- I won't take you through all the numbers on this page. It's available in our earnings release. We see full year procedure growth somewhere between 22% and 26%. Condition on the following: One is if the pandemic keeps going roughly as it is. It worsens, we'll be at the low end or some of that range. It worsens badly, we may not be at range; if the pandemic starts to abate and ease, then we would expect at the higher end of the range. Gross profits are about in ranges they've been over the years. And just staying on the left side, we expect our operating expense to grow somewhere between 18% and 22%. So we're continuing to invest in the business to pursue the aims that I've just described to you. I think the pandemic has shown the durability of good minimally invasive surgery, trying to work on things that do surgery right the first time, that have people recover quickly and recover at home rather than taking ICU space and so on. I think that will be durable, and the pandemic has shown us value. There are some things that I would caution. The supply chain out there for things like semiconductor chips and other materials is quite stressed globally. This guidance assumes that we can get the parts that we need and as soon as we get them roughly at the price we had expected to pay. If that changes, then these numbers would change. We're working hard with our supply chain to make sure that we can get what we need for our customers. So in closing, our mission is intact. We believe minimally invasive care is life-enhancing care. We saw that strongly this year. Through ingenuity and intelligent technology, we expand the potential of physicians to heal without constraints. With that, that concludes my presentation. We'll now answer appropriate questions from stockholders that are being entered today on the web portal. Please note that we'll attempt to answer as many questions as time allows, but only the appropriate -- or appropriate questions that are domain to the meeting will be answered. So just give me a minute, and I'll pull this forward and we'll go from there.

Okay. First question. Can you elaborate on why the terminology sustainability has taken on such significance or significant scope in the annual report and proxy statement? What does it encompass? What does it mean? And kind of why is that word being used? Sustainability is -- it encompasses a few things. People started using it more in the domain of environmental sustainability. That's kind of where it started coming out, what are we doing with regard to preservation of natural resources. It has, over time, come to meet a broader set of activities. What are you doing in terms of risk management and sustaining the business as a whole, whether it's sustainability from the point of view of your employment base, sustainability from the point of view of supply chain shocks or supply chain risk? Frankly, the prominence you see in the reporting that we do and the annual report and proxy statement is largely a response [Audio Gap] carefully, and we walk through it and speak to those things that we do that are relevant to our business. Many things in sustainability are -- vary from company to company. If the company were an energy business or an energy producer, what they would talk about might be a little bit different than Intuitive. So we talk about those things that we think are relevant and important in our universe. So thank you for that question. I'll see if there are others. Next question, do you plan on breaking out international Net Promoter Scores? Do we have those current numbers currently available? We do our best to measure by country. In some cases, it's a little bit more difficult based on the size of the installed base and getting some of the structures in place to do it right. Over time, as those businesses get bigger, we'll disclose more. Generally, if it's relatively small and immature, then we'll wait a little while. We do seek to develop it over time. Okay. That looks like that was it. So I appreciate your attention. More importantly, I appreciate your following the company and staying with us. That concludes the question-and-answer session. Thank you for your attendance and for your attention. I look forward to speaking to you again in the future.