Masimo Corporation (MASI) Earnings Call Transcript & Summary

I think we can get started. Welcome to day 2 of the Raymond James Institutional Investors Conference. I'm Jayson Bedford. I cover the med tech sector here at Raymond James. It's our pleasure to have with us today the management team from Masimo. So look, this is going to be a bit different because it's more full fireside. But again, it's really our pleasure to host Eli Kammerman, Head of Investor Relations; and Micah Young, CFO. So let's get started. Micah, for those that don't know the story, can you give a little idea of the portfolio, what you do, the growth algorithm, that would be helpful.

Absolutely. So Masimo was founded, what, over 35 years ago. And the flagship product was our pulse oximetry. And we really changed the way pulse oximeters work. At the time, pulse oximetry, all the pulse oximeters were generating over 90% false alarms. With our technology of being able to measure through motion and low perfusion in the most accurate way for patients, that really changed the game. And we started out where the technology that was needed the most, in areas like the NICU, where babies are moving and we are able to read more accurately than what was out there on the market. If you look at kind of where we've evolved, I mean, we've started out in the NICU, the ICU, high acuity areas like the OR. And of course, more recently, we've seen patient monitoring expand into even lower acuity settings of the hospital. And if you look at where we were, I mean, we were primarily a pulse oximetry company at the time, and we've evolved over the years. And today, if you look at our revenue, our guidance this year for 2025 is $1.5 billion to $1.53 billion. And we're guiding constant currency growth of around 8% to 11%. If you look at our revenue and the makeup of that, about 74% of our revenues this past year were SET pulse oximetry. That's been growing, our long-term growth rate algorithm there is about 6% to 8%. You start to look at other areas we're in today, in like co-oximetry and hemodynamics, that's about 15% of our revenues, and we forecast that about over 10% growth. And then moving into co-oximetry and hemodynamics, I mean hemodynamics is a new platform for us, and we've started to integrate that, but it's really combining what we can do with our cardiac output measurement and combining that with other co-oximetry measurements like continuous monitoring of hemoglobin levels in patients with pulse oximetry. And with that, we can bring it all together and be able to continuously monitor delivered oxygen. And that's something that is available outside the U.S., and we're working to get a 510(k) approval on for U.S. launch. So that's going to be another opportunity to continue to expand as we not only monetize the value of those other parameters, at one fingertip sensor, we can now measure 12 different parameters with the patient versus just the 5 core parameters with our SET pulse oximetry. So combining that with the cardiac output now gives us another opportunity to go in and really take advantage of the large market for hemodynamics. Moving on from that, if you look at other categories we play in, it's capnography and gas monitoring. That's about 4% of our revenues. And our long-term growth range is 10% to 20% in that category. Another 4% of revenues is brain monitoring. So we have SedLine, which really monitors sedation levels with patients, and we also have O3 at cerebral or regional oximetry. So we can measure oximetry through different organs. And then that's 4% of revenues, growing about 10% to 20%. And then the last, another big category for us, of course, is automation, hospital automation and how we're managing and monetizing data through the hospital. And it starts with being able -- we have a device library we can connect over 1,000 devices in hospitals, whether it be multi-parameters with some of the larger OEM partners or anesthesia machines and infusion pumps, but really taking the data that comes off of our sensors and all the different devices and be able to manage that data in real time, not just sending it to the EMR, but being able to distribute it to any end point in the hospital, whether it's a central nursing station where they can monitor over 200 patients centrally, and it can really improve the workflows in the hospital and reduce the amount of rounds with nursing staff. So that's another area for us. And then the last one -- and that's growing. That's 3% of our revenue. It's grown over 20% in our long-range plan. And the last piece is really hospital-to-home with telemonitoring. As our customers discharge patients into the home post-surgery, we have wearable devices, not only in the hospital, but also that we can offer into the home that can continue to monitor those patients as they move their care into the home. That can help hospitals reduce length of stay. It will help better treat those patients in the home where it can reduce readmissions back into the hospital. And then also long-term chronic disease management programs like CHF or COPD patients where we can help continuously monitor those as well. So that's the key categories as you kind of look across all the different platforms that we offer, and that's what gets us to kind of that 7% to 10% long-term growth range as we look forward. The reason we're guiding 8% to 11%, we do have an extra week. Every 5, 6 years because of our fiscal calendar, we have an extra week of revenue. So that's contributing about 1 point of growth there. But we're set up. We feel very well. We're coming off a strong 2024. We've had a really good contracting year, a record year, in terms of gaining share on contracts, and we're set up very well as we enter 2025.

Okay. Great. Micah, there's been a lot of change at Masimo over the last 5 months. Has this change impacted the culture or mood at MASI?

Yes. I think where we are today is we're seeing a very energized workforce. You can see it across the organization. The energy is back. We're focusing back on our core health care business. We took a detour into consumer health and some of those things. And we'll still have some things that play in there with how we partner with OEMs with some of our sensing technology, but it's really getting back to focus on our core health care business and all those categories I just mentioned and how we play and how we really continue to invest in those areas. They want to be -- the organization is excited about the focus. We've seen attrition rates decline over the past year. We haven't seen any departures at critical talent. It's been a lot of transition, of course, for the company, but I think we've got a very stable workforce, and we're pretty excited about what we're going to do in 2025.

Is it fair to assume those who were going to leave have left by now?

Yes. But again, we haven't seen much change or turnover in critical talent. A lot of our leadership, all those have been in place.

Okay. Masimo hired a very experienced executive, Katie Szyman, as CEO. Do you expect much change in the strategy with Katie onboard?

Yes. I think Katie is going to bring a lot of great experience. I mean she's been in health care for a long time. She had probably, I think, a decade working at Edwards in critical care business. That was later sold, of course, recently sold to BD. And then prior to that, she was with Medtronic for a long time. So she's going to bring a lot of different perspective from the outside. I think it's going to be exciting to see as she evaluate some of these platform technologies we have. And I think she's going to be a great operator in terms of commercial, driving commercial excellence. We got the cadence at one point where we were launching a product a month. But I think we want to get back to really launch excellence and really putting the investment to make sure that these products are improving the revenue as we really start to drive and launch those products. So it's going to be much more focused. I think she's going to have a lot of ideas around where she wants to see investment in terms of driving growth. But we've done a -- we'll talk more about this, but we've really improved some operating margins. We really want to be an innovation-based company, continue to drive top line growth. That's a focus for Katie, for myself, for Bilal, our Chief Operating Officer, and we want to see that continue. And margin has been an output of this, not an input. We haven't been focused on just driving operating margins. We want to focus and continue to be the leading innovator in the space.

I think Katie on the call last week mentioned, outside of the ICU, she's surprised there isn't more continuous monitoring throughout the hospital versus intermittent monitoring. So I guess the question is, when you look at penetration, as the way you frame the market, penetration today, where can it go? And what are the hurdles to driving deeper penetration? And I'm referring to pulse ox, over 70% of sales.

Absolutely. So as I mentioned earlier, higher penetration is in the areas of standard of care, where it's the NICU, the ICU, OR, those high acuity areas. And we've seen a shift -- or not a shift, but more of that expanding out into lower acuity areas like the general floor, step-down units, those kind of areas that are on the fringe. And that's happened over the past 5 years. And if you go back 5 years ago, we probably saw equipment at the bedside of some of those lower acuity settings that were probably 10%, 15% penetrated today. You see more of that equipment to the bedside probably closer to 30% to 40% of at each bedside in terms of the lower acuity settings. Now in terms of broader monitoring, it takes time to work through that. I think that can be shaped, whether it's driving standard of care as a requirement, that's a government-type mandate, things like that can influence the rate of adoption there, of course. But we're steadily seeing that start to expand and give us a lot more opportunity to expand the market for pulse oximetry and broader monitoring.

And for those who may be new to the story, remind us of your current share position and the pricing environment?

Yes. I think if you look at the pulse oximetry, I mean, that market, give or take, it's probably about a $2.5 billion market. With broader monitoring and lower acuity settings, maybe the opportunity there is $3 billion plus. Today, with it being about 74% of our revenue, it's kind of in the high-40s range, getting closer to 50% in terms of our share of the market. We have a higher mix of revenue that comes out of the U.S. So we're higher share in the U.S. than outside the U.S. And of course, with those areas that are standard of care, it's a higher mix of market penetration in those high acuity settings like the NICU and the ICU.

Okay. Pre-Sound United, U.S. revenue is about 70% of sales, which is a little under-indexed relative to some of your med tech peers. Is there an emphasis on growing the international component a little quicker?

Yes, absolutely. I mean, today, we're probably closer to 2/3 U.S.; and then the rest, of course, OUS, 1/3. If you look at kind of where we've put investment over the years, I mean, we've gone direct in a lot more OUS markets. That investment, a lot of that investment is behind us, and we'll be able to start to leverage that and continue to grow the OUS business. But I think that's where we'll see a good adoption of our technologies going forward, is really just some of that investment we've gone into, some of these larger direct markets over the years. And that's going to help us to start shifting some of that mix. The U.S. business has performed very well, though, and that's kept that, as far as our mix of revenue, it's pretty high.

I wanted to shift to margins. Core health care gross margins at Masimo at times were in the 66%, 67% range, at a much lower revenue level. You're at, I think, roughly 63% today. Kind of what's changed, meaning what's pressured margins over the last 4 or 5 years?

Yes. If you go back 5 years ago, we were up around 66%, 67%. And if you look at kind of the last 5 years, the biggest thing, of course, every company has been faced with inflationary costs. But we were over-indexed at the time to a lot of production in Mexico. Over 90% of our production was in Mexico. We've shifted that a lot to Malaysia now. But the cost of labor, with the minimum wages going up about 20% to 25% a year, we had watched that very closely. And about, call it, 2 years ago, we ended up seeing Malaysia have a much more lower cost of labor. We saw opportunity to move there. So we pulled the trigger on that. And that's been a good shift for us. And today, high-volume sensors are manufactured in Malaysia. We still have about 25% of our cost of goods in Mexico. But with Malaysia, it gives us a lot more opportunity to really -- a lot more flexibility to shift more and more manufacturing there. So we're going through plans right now, especially with what's been going on with the tariffs and trying to shift more and pull together some mitigation plans. But we do have base plans that continue to shift more and more there. And of course, we're looking at it much more aggressively now with what's been implemented today. But if you look at it, over the past 5 years, it's been inflation. It's been the labor costs. It's also been the peso and the movement on the peso against the dollar. That was a big headwind for us. And now that we've been shifting back over -- shifting more production to Malaysia, we've seen good benefits coming through on the lower labor costs. We're seeing a much more stable workforce, a much more productive workforce there for us. And that's going to give us opportunity to continue to leverage margins going forward. The other thing is, with vendor costs going up over the last several years, we're really focused on taking cost out of products. And we've got a good -- year in, year out, we've been doing that. And that's going to be something that's going to be a good lever for us moving forward as well. The teams, we have engineering teams that are focused on doing that, and we've still got a lot of runway ahead.

Okay. Structurally, is there any reason why you can't get margins back to where they were?

Yes. I mean our long-range plan that we laid out or updated last year, that had us getting to 66% within 5 years. Looking out into 2029, I can tell you that after going through all the operating expense and trying to rightsize our cost structure this past 6 months, a lot of my focus and a lot of Bilal's and our leadership team's focus is going to be really around how can we go faster there in terms of gross margin. So we're going to put a lot of efforts into it. We've got teams that are really focused on how we can get up even higher than that. But that's still a lot of leverage opportunity. I mean, this year, we're guiding gross -- I mean, without the impact of tariffs, we expect to see those gross margins improve from last year. Last year, we ended at 62.7% gross margin. We're expecting that to go up about 80 basis points underlying margins this year. Our operating margin guidance is 27.5% to 28%. So if you look at it, we're well ahead of schedule on driving down operating expenses. We're tracking very well to the 66% gross margins. And that's going to give us a lot of operating margin expansion going forward.

You keep on mentioning tariffs. I don't know what you're talking about here. But just can you -- you mentioned the 25% of COGS in Mexico. Can you kind of frame the potential mitigation efforts here that you're undertaking and how this may roll out?

Yes. So we've been -- this has been a hot topic for the past few months, and we've been working through a lot of plans there. We still manufacture some of our sensors there. For example, we moved all the high-volume pulse oximetry sensors. Now we're focused around things like brain monitoring. We still have some adhesives that we manufacture. We've got reusables. We also manufacture our disposables for capnography and gas monitoring. And those are going to be the ones that are kind of the first priority to move because those are less complex in terms of moving production lines and trying to shift. Then the next steps is kind of cables and accessories, evaluating those and trying to move as much as we can there. The last piece will be instruments, which is it's more complex, but there's definitely opportunities that we can look to get after there as well. So we're going to go through those steps, and we've got baseline plans to shift as much as possible over the next 12 months, and then we're going to get after it.

I realize the situation is quite dynamic. But at what point do you move on this? Is it a matter of, okay, if the tariffs are in for 3 or 6 months, then you start to move? And then the second question is, how long will it take for you to implement these changes?

Yes. I mean, any time you're moving production lines, I mean, you could be up to 12 months on that type of process. But we've already got some plans already in place that are starting to move now as we speak. Again, we're going to work through all those different product categories and see how much we can shift. There may be even things that we look at from a make versus buy standpoint on our equipment instruments to see if there's other vendors that are set up to where we can maybe leverage them as well. So all this is going to be financially driven, and we'll figure out what those trade-offs are. But things are in motion, and we're moving, but it does take time to move those lines.

And just the 25% of COGS, it's about 230 basis points of margin.

Yes. Right there in the zone, yes.

Okay. Just on margin, though, on op margin, in the last 4, 5 months, you've taken your op margin expectation for '25 from 26% to now 27.5%, 28%. It takes some companies years to do that. Why have expectations changed?

Yes. I think, if you look over the past several years and when we started to kind of take that detour over into the consumer health side, I mean, there were investments that were going into marketing products, direct-to-consumers. A lot of that's coming out. We're pulling that completely out. If you look at it year-over-year, if you go from our 23.7% to the 27.5%, 28%, 400 basis points of improvement at the midpoint, half of that's coming from project and product rationalization. We've looked at all the projects that were out there, that were in the pipeline, things that were not contributing to that long-term growth of the 7% to 10%, and we weren't seeing the return on investment. So those were things that came off right away. And then going back through and looking at ways to improve our corporate cost structure, consolidate facilities, all those things were done late last year, and that set us up well for another 1/3 of that 400 basis points. And then the last piece is just, like I mentioned before, the consumer health marketing direct to consumers. We're not going to focus on selling products direct to consumers. We may lean in more on kind of using our sensing technologies with OEM partners in the space, but that's going to be -- that allowed us to really improve the rest of that margin expansion. So these are things that, again, margin is the output, not the input, we focus on. We want to still drive innovation, drive top line growth, and that's what's really going to drive the growth in earnings over the coming years. So it's been a very targeted focus, a very strategic operational cut that we've made, and I think we're set up very well to scale as we move forward.

And to kind of the skeptics that could say, "Hey, you're just kind of pulling forward this margin," we can be confident that there is still margin expansion left in '26 to '25.

Absolutely, yes. Yes. If you look at kind of the 5-year plan that we put out there, 30% operating margins -- 66% gross margins, 30% operating margins, there's a lot of room still to run with gross margins. And we hope 66% isn't the stopping point. We want to go beyond that if we can. But there's also operating expense leverage. We've made a lot of investments outside the U.S. We're leveraging those investments in direct markets. That's going to help us to leverage the P&L going forward. The model is a very high recurring revenue model. We've made the investments in our sales force. There may be some investments here and there that we may make, especially with Katie coming onboard to really emphasize certain product lines. But we still see this as good operating leverage moving forward. And if you kind of do the math, I mean, we're already ahead of getting to 30%, we're already ahead of the OpEx structure, and it's still going to continue to leverage. So it will be exciting as we start to work with Katie on those long-range plans and figure out what can we do to go beyond 30% but also, at the same time, making sure we're balancing investment to drive top line growth.

Okay. In terms of the potential proceeds from the Sound United business, you've hinted that share buybacks may be a better use of this cash than debt paydown. Can you just walk us through the decision tree on that?

Yes. I think we will prioritize share buybacks. You always have to look at the economics. And I look at it not just within the year because sometimes it doesn't make as much sense, but looking out 3 to 5 years, especially with where we believe the business can go and the opportunities we have to really drive earnings power over the next 5 years. So that's the lens we'll look at through, is kind of looking out further and making some of those decisions. You always have to balance the trade-off between the cost of debt and share price. But I think we'll prioritize share buybacks.

Masimo has had ongoing litigation with Apple around your pulse oximetry patents for quite some time. I think your former CEO consistently said, "Hey, we're not interested in settling." Has that changed in any way?

Yes. I think we're interested, if we're going to look out for what's in the best interest of shareholders. This is all financial-driven, and we're going to look at it through a financial lens. But we're going to defend our IP. That's first and foremost, that we'll defend the IP. But we're open to settlements. And again, it's not going to be anything personal. It's more financial-driven.

Okay. If we're sitting here this year and next, if we're sitting here next year, when we're sitting here next year, and you're coming off a fabulous 2025, what would be the reason?

Well, I think a few things. I mean, we're continuing to see the strength in our top line, of course, in those categories that I mentioned. I mean, we came off a very strong year across all those different technology platforms. And I think just continuing to see that kind of performance, consistent performance, across those platforms is going to be great. I'm excited about the opportunities we have in front of us with hemodynamics and if we can get that really moving along. And then we have some other technologies like Radius VSM that is in the pipeline that we're hoping to get a 510(k) approval for, seeing how well that does. But again, it does take time to work through these contracting cycles because we do -- the great thing about our business model is that these are long-term contracts, 5 to 7 years. It's a very strong business model, and it takes time to work through that. But I think another thing is strong contracting, another year of good, solid contracting to continue to drive that recurring set of revenues. And then hopefully, we'll see how we make progress on gross margin and see the opportunities as we start to look beyond '25 and see what we can do there. I think those are some of the areas that will be a focus for us.

And just on the flip side, if things don't go well in '25, what would be the reason? It's obviously a cute way of asking what are the pivots in the model here.

Yes. I mean I think we have a range of 8% to 11% on the guide. A lot of that is really tied to volumes through hospitals because the range, really, we're assuming kind of a normal low single-digit census inpatient admission growth. And I think with our strong contracting, we feel very good coming into this year in kind of delivering strong growth. But it's also dependent on what's going on in the market. And I think those are some things where -- that's why we have a range on revenues is because if it's a 1%, you could be closer to the lower end; if it's a 3% or better, you're towards the high end. So census has a lot to do with it, and it will be interesting to see how that plays out for this year. But we're coming off a strong year in terms of hospital patient volumes and growth. I think last year was 3%, 4% growth. So that was a strong year.

We are at time here. So Micah, Eli, thank you so much. The breakout will be downstairs in Amarante 1. All right.

Thank you.