Pulmonx Corporation (LUNG) Earnings Call Transcript & Summary

Hello, everybody. We are moving to the next session with the team of Pulmonx. I'm still Joanne Wuensch, and I'm still the Medical Technology Analyst here at Citibank. Anyway, we have CEO, Steve Williamson; and CFO, Mehul Joshi, here today. Thank you, both of you, for joining us.

Thanks for having us. Appreciate it.

So here's the big question. I know. We're going to start big. The two of you have been at Pulmonx. I think you're about a month or two away from that anniversary date. And a lot has changed. And so walk us through how you have grabbed the reins of the business, looked to move it in direction? And how you're feeling about a year under your belt?

Sure. I'll jump in and then maybe hand it off to Mehul. So we did start about a year ago. And I think when I look back at that year, the thing that I'm most proud of is if you look at the results for that year. We came in, there was questions about guidance. Are we going to bring down guidance? We said, no. We're going to deliver what we told investors we're going to deliver. We delivered at the high end. So we had 22% growth year-over-year. At the same time, Mehul and his team drove excellent operating leverage. So we had 6% OpEx growth year-over-year. So I'm very proud about that. But at the same time, I think I'm more proud about the foundations we put in place for the future, and there's a number of those. We started out with what we call our acquire, test and treat strategy now. So it's patient acquisition, how do we get the patients to know about our product. There's a huge, huge underserved patient population here. We've got about 500,000 patients in the United States that could benefit from valves, yet there'll be 5,000 patients done this year. So we're only really touching 1% of this potential market. So how do we acquire more patients and activate them? And then once we get them activated, how do we make the testing process easier? So we've done a lot there, and we put several initiatives under that, that kind of blanket. And then treatment, how do we treat more patients? What can we do to broaden this? And that gets into AeriSeal and some of the others. I think as far as the foundational structure of our strategy, we've put good growth initiatives in every area of that. From a marketing perspective, I think we really did a lot there. We were able to -- I mean we drove 54,000 patients to our website, 54,000. There's 5,000 patients were done in the United States. Actually, we had 54,000 potential patients, came into our website and either took a quiz where they came in and talked about their breathlessness and their -- or they called our call center, which is another thing that we stood up last year. We didn't have that in the past. So they can actually call and talk to a respiratory therapist, that respiratory therapist will tell them if valves are a good thing for them or not, and then can actually transfer them to a local treating physician, stay on the phone and then give the handoff there. So really proud about what that team has been able to do. Peer-to-peer education, we doubled our peer-to-peer education. So I'm a big firm believer in physicians talking to physicians is a good way to get the message out, and we've been successful with that. So we'll continue to do more of that this year. So the foundations for long-term growth, I guess one more I have to add in there, I'm sorry. I'm just very proud of the children this year. Our OUS business, we did quite a bit. We grew 42% year-over-year in Q4. Now that's not a new jumping-off point for us, but what we've done is found that in the major markets across the globe. We've made some changes to leadership, we've made some changes in strategies in those places to more emulate what we've seen work in the United States. And in our major markets, we're seeing growth. We went from a direct model in China to a distributor model. We took a little bit of hit on gross margin. But on operating margin, it was accretive for us. And never mind what it's done for revenue there. So we've seen a big pickup in revenue there as well. So I think we're pulling a lot of levers right now and I think long-term growth. Mehul, anything you want to add to that?

Yes. A few things. A few things, and I'm sure Joanne is going to ask about LungTraX later. But one of the things I'm really proud of is that we accelerated the launch of the software, Connect and Detect. And I think that is really setting us up for growth later in '25, but also beyond that. So that's a very impressive launch that we initiated in software, had worked in other software companies before or med device companies who launched software. So that was a really big accomplishment for us. I guess the other two things I would say, Steve talked about hitting the top end of the guidance and building operating leverage. But what I'm very proud about and confident in now is that our ability to get to cash flow breakeven with the cash we have on hand. In terms of what we've done with burn in '24, how we're going to manage burn over the next few years and continue to invest in revenue-generating opportunities. So I feel very good about that and very confident in that. And then lastly, I'd say is we used to get a lot of questions around sales team turnover when we joined and other functions turning over, but our retention rates have been super high. I think the team, especially the commercial team, is more energized than ever because Steve has carried the bag before. But also all the initiatives that we're investing in, they see the light at the end of the tunnel that there are ways we can embellish our acquire, test and treat strategy through all the initiatives that we're investing in.

Before we get more into the [indiscernible]. I do need to knock out some big picture questions I'm asking everybody today. There's a lot coming out of Washington, whether it has to do with tariffs, Medicaid cuts, FDA, NIH funding. Any of those given what we know and don't know that you think we should be focused on for Pulmonx?

Well, I haven't listened to the news in the last hour. So I don't know what's changed. But we're monitoring and assessing the impact of U.S. and international trade regulations and laws including tariffs. It's still early days. We're, as you know, Joanne, we have an international business and our supply chain is also global. So there could be potential implications. But all of our manufacturing is done in the U.S. And so we are sheltered a little bit by that, but we'll just continue to monitor and assess it and see what happens.

Okay. Nothing on NIH funding, FDA?

Really, no.

Excellent. We can move on. One of the things that has struck me over time as watching the Pulmonx evolution is that you really don't have competition when I think about it. So maybe just to get -- sort of level set us. How do you think about the market opportunity? How do you think about -- let's start with the U.S., but we'll get to OUS later. Think about that.

In the U.S., we've got, as I mentioned, about 500,000 patients. So if you whittle down this 3.2 million COPD patients and you break it down into those patients that suffer from severe emphysema, there's about 500,000 that are eligible for our product. As I said, we're barely scratching the surface there. So there's huge opportunities from a -- from not only a patient awareness perspective, but one of the things we don't talk about as much, and it's something that we talked about on our earnings call, the community physicians, the ability -- their awareness of the treatment is very low. So 96% of these community physicians know about valves, they're aware of the technology, yet only 34% of them are aware of what patient would benefit from the procedure, and significantly fewer than that are actually referring patients. So I was -- I'll give you a good example. Yesterday, I was out in the field with a local rep and we went in, we were talking to this pulmonologist, this group of pulmonologists. And they said, "Oh my gosh, thank you so much for doing that, at dinner that you did. We learned so much." And since it had been 3 months, they had sent in 13 patients. So 13 patients that just would have not have had a treatment, they had run out of options for them. They sent them in. Now all 13 didn't get treated. There's -- but the fact that they have 13 just kind of coming through their practice that they're seeing every 1 to 2 months right now and then being able to give them an option, they were elated and like, "We don't know why we didn't know about this before." And it's like, it's on us. We have to educate people. And so I think there's a huge, huge opportunity for us to get at this broader patient population. I talked to you quite a bit about how we do this direct-to-patient advertising right now. We've got 54,000 patients come in, and they've hit -- either taken the quiz or called our site. When we try to transfer them, sometimes they'll say, "I've got to talk to my doctor first. I want to talk to my doctor. I trust my doctor." And so making sure that we've educated those doctors across the country is very important. So what we've done in these major markets where we have good treatment [indiscernible], hired what you call almost like a pharma level rep, it's a junior rep that's not allowed in the hospital. We won't let them in the hospital. We just want them knocking on doors of community pulmonologists every day, talking about valves and what patients would benefit, what the workup is so that we can get this 30% back up to 80%, 90% of these physicians that know about it. So we started in 7 different territories, and we'll see how it works. We'll track StratX coming out of that and then get those StratX move on to procedures. And assuming that, that works, then we'll broaden that out.

So was this work not being done or was it being done, but maybe not at this kind of level?

I think that they were working on different things. There were different focuses that they -- I mean the company was in a different stage then, really I think Glen was exceptionally good at driving clinical data and pushing clinical trials, and we've got 150 published pieces of data right now. We've got 4 randomized controlled trials. We're in the gold guidelines. We are standard of care. And that's what his strength is. Ours is kind of sales and marketing and innovation. So that's where we've been focused.

Okay. So is that -- I used the term on the earnings call and our note that we wrote about it, building the base. Like it just strikes me that what you've really taken on in the last 12 months and going forward is the education, the patient, the physician, and because you have the clinical data and you have -- it's a reimbursed procedure.

So we've got these centers, right? We have centers of excellence that are set up now. Now it's like, okay, let everybody know they're open for business, make sure that patients know they can go in there. And by the way, you're going to go in, you're going to go through a workup. And when you're done, you're going to go sit on the table and there's a great chance that when you wake up, you're going to take the first breath that you've taken in 10 years. I mean it's really that amazing when you see, I was in Europe and actually got to meet a patient that had just had the procedure done and he says, "I want to buy you a pint." He says, I have not felt like this in so long. I heard about a patient the other day that's doing push up the next day. It's like it just -- it felt great. But just like don't do that. Give them a couple of days, give them a couple of days. Exactly, exactly. So yes. The patient stories have been great. There's this big population out there. We've got the referring centers. I think if you do the math, we have about 300 centers that are ordering each quarter, and that's about 75% of our total accounts. So there's some that just cyclical ordering patterns, but we could probably -- we'll get more centers coming on. I think one of the things that we've done a nice job on, and maybe we can talk a little bit about this is, as we bring these centers on, we see them coming up to speed faster. We've got higher clinical requirements to get them on board so that when they come on, they're not dabblers. They're coming in, they're doing procedures. They've got 3 patients set up. They're ready to go. And so we've seen a faster pick up there.

Yes. Bringing on new centers, if they're not productive, it isn't beneficial to the patient population in that community or for us. So we've really accelerated how we're driving training and supporting these new centers to come up to speed faster. We're seeing about a 33% benefit relative to 23 of centers becoming more productive or becoming productive once they sign on for us.

So is this a question of more doctors, more centers? Or is this a question of more doctors in the centers that are already trained doing more procedures? Can be both, too.

I'd say, I think it's both. So it's definitely more centers, with new centers with new physicians and what we talk about, the 10 to 15 a quarter. But we want better qualified centers coming in. But then the more important growth driver is really productivity in existing centers that have programs and that have capacity. And if they need -- part of the reason LungTraX, we developed LungTraX and rolled it out is it really helps with the workflow of those centers who have those patients coming in. So it doesn't take as long to get to treatment.

Okay. I think you have a number of different screening mechanisms. You have StratX. You've introduced LungTraX Connect and Detect. For those new to the story, what are those?

What do they do? How do they work?

What is it. Yes.

It's all actually tied in. Oh, you definitely -- well, you don't even have to ask for one and we can get it for you. It's kind of cool. Yes. So StratX, we'll go through when we take a CT scan and often we do a write-up to a doctor on how well that patient is with valves. And so we show them target areas, we show them destruction scores, we show them residual volume and really set out a target plan for them to go. That's StratX. StratX is now part of the LungTraX platform. So what we found with StratX, in order to get that report from us, which you needed for every patient that you're going to do, in order to get that report, you would go down, a nurse coordinator or a clinical coordinator would go down, they would grab a CD from radiology. They would burn a CD in radiology. They would go back up to their department. They would find a place to place -- I don't know if any of you -- your computers play CDs, mine doesn't. So they've got to find the right computer that will play a CD. They put it in. They upload it to the cloud. We do the StratX report on it. It comes back down to them and they need a [ decoder ring ] because now it's just an MR number. It doesn't have a patient's name or anything on it. So they've got to get that and then they just start working through their checklist of what this patient. So what we decided was with LungTraX Connect, we were going to connect directly to the PAC system. So they don't need to burn a CD. It's like, how big of a deal is that? I was talking to one of the nurse coordinators at a big hospital in Boston, and she was, "It's a 1-mile round trip walk for me to burn a CD. I hate it. It's a huge pain to my butt. Can you please make it so that I don't need to do this." So it was a real big deal. I kind of blew it off and then she's like, "No, please fix this." So anyway, so LungTraX Connect goes into the PAC system, takes the image, sends it out to the cloud. We do the StratX on it. It comes back through. It does have PHI on it. So there's no more need for a [ decoder ring. ] And then when it comes back, it actually comes back with a workflow for that patient so they can actually track the patient through that process. One of the things that we found is probably the leakiest part of that pipe as patients are working through is the workflow. It's the process, the testing process that I talked about in our acquire, test and treat strategy. And so by making it easy to follow for each of these patients with everything tied together, it just -- it made sense for us. So that's LungTraX Connect. What we found after we launched LungTraX Connect is that the engineers have done a really nice job on the next generation of that product, and they were kind of sitting on it a little bit. And I said, "Well, let's put it out there. Let's go. Let's use it." And so LungTraX Detect, imagine LungTraX Connect is one tab on an Excel spreadsheet. Add another tab on it that says Detect, and what that does is it goes through the PAC system. So that's where all the images are kept for the hospital. It goes into the PAC system, and we'll screen all low-dose chest CTs or whatever you set the parameters to be, it can be all CTs if they want, through an AI algorithm and detect patients that have potential emphysema. So they have radiographic emphysema. That comes up on another work stream and it's like, "Oh my gosh. There's all these patients that we didn't even know about." There was a paper published at CHEST in Boston last year. And they found that 10% to 15% of the patients that are in your lung nodule programs also suffer from severe emphysema. So there's this huge overlap because you've got big smoker populations that overlap. It's typically the same patient. But they were undiagnosed emphysematic patients that were diagnosed with Detect. We put this into our first account in December; and in January, they did their first case. So it's been exciting. I talked to a lot of physicians around here about it. They're like, "Why wouldn't we do it?" There's no downside for the hospital. There's no downside to the patients.

They get paid for it?

And they get paid for the procedure, yes.

Okay. But they're not paid for the LungTraX?

Correct. They're not. Now that's -- it's a passive scanning that's done as well. So they don't actually have to do anything. So there's no real association.

Okay. But is there hardware that goes into [indiscernible] screening? Is it software?

It's software. It's just software.

It's cloud-based software that's integrated into their PAC system. So it takes a little bit of time to do that because you have to go through hospital legal organization to sign contracts and then the IT function for cybersecurity and things like that. But it's a 1-day integration into your PAC system, and you can have Connect and Detect up and running.

The training and the launch are 1 day combined, less than 1 day.

And for you, this runs through R&D, COGS? I mean there's a cost to you to do this.

Yes. It will -- it was developed and ran through R&D, it will run through COGS going forward. But it's a nominal cost, and we expect to recover that nominal cost by charging the hospital systems who purchase Detect and Connect. And it's not worth modeling because it's...

Yes. I have it in line in my model.

Yes. It's not worth modeling because it's nominal. It's really our way of enabling the hospitals to identify patients that can drive procedure growth and revenue for us.

Okay. And so the patients. You now made it easier to identify the patients and to [indiscernible]. And then what is the step to taking them to have a procedure, a Zephyr procedure?

So we -- as we've gone through the testing process, it's making sure that we've got enough treatment centers out there. It's making sure that they've got time. Typically, we fall back on nurse coordinators to make sure that the scheduling is in place. I think as we talk about the ability and time, OR time that it takes, it's not that long of a procedure. The procedure itself, the work up takes quite a while, but the procedure itself, you don't need that much OR time. But still, it's hard to get OR time sometimes. So what we've done is started engaging the C-suite of the hospitals and the administrative people to show that there is an economic value to doing this procedure, that there is a humanitarian benefit to doing this procedure where you don't have patients that are suffocating, that you can actually -- they'll be able to breathe. The clinical, we are the gold standard. We are the standard of care. And so everything kind of ties together. It's like so we should make time for this procedure. And that's been received well. And so we'll continue to drive that to make sure that more patients get through the table.

I want to spend a little time on OUS. To your point, OUS was up 42%. That's a new growth rate level I haven't seen. So what is driving that? And how much of your revenue -- multi-part question. How much of your revenue is coming from which regions?

Right. So I'll answer by saying that all of our major markets in international grew substantially. Europe has the bigger base of business. And so all those major markets grew very well in Q4 of last year as well as throughout the year based on some of the changes we've made relative to personnel, bringing practices from the U.S. to the international markets and so on. So that is starting to pay dividends. That 42% and the annual 20% was also impacted by our business in China. So I'll start that one by saying China is a distributor, and our distributor business is less than 5% of our total revenue. So just for materiality purposes. But if you think about China, we engaged a distributor in Q2 of last year. So we had 3 quarters of distributor revenue versus direct revenue, which we had in 2023. They have invested in sales reps, opened up new centers, working on market access. So they've done really well for their business and our business. So our growth rate in China was high because you went from one model to the other, right? What I'd say in '25, it won't be as -- the growth won't be as high as '24, but it will be significant. But again, from a materiality point of view, it's a smaller part of our business, but a lot of it is severe emphysema patients and we expect that to grow over time. But the European business and some of our Asian markets also grew very well based on some of the things we've done, and we expect that going forward. So we likely won't hit 42% on a quarter-over-quarter basis. I hope I'm surprised, but we do expect good growth in the international markets in '25. And then as we get in beyond '25 with Japan coming on board thereafter, as well as some of the screening initiatives that are going on in Europe, we would expect growth to continue in international markets.

You went straight to my next question on Japan. Where are you on that and what does it take? You have to set up a similar infrastructure there?

We have an infrastructure in place in Japan. We're direct there. We've got a couple of sales reps and a whole marketing folks and a, well, leader over there. As far as the post-approval study goes, it's 140 patients. We expect we'll complete in 2026. Once we do that, there's no submission or anything that allows us to go beyond that. We can just start selling in the marketplace. Well, we have to submit it. But once we've completed the 40, we've met the -- we're not waiting for an approval. We've already got the approval. It's just study, send it in and then you can broaden and start selling commercially. We've learned some stuff through this process. It's a conservative culture. We've expected to see back-end the majority of the enrollment come there. But we continue to progress. We've got a number of initiatives in place. And I think what's been great is as we've learned through this process, it's helping set us up so that we have a more efficient and effective commercial launch across the whole country when the time comes.

How large is the TAM?

So it's 100,000 patients. So it's about 1/5, the size of the United States.

AeriSeal, for those who don't know it, why should we love it?

You should love it because it's like a hyper TAM expander. You love those words, right? Hyper TAM, that's good stuff. We should trademark that. So 20% of the time, when a patient goes on valves, they've gone through this whole testing process. They get their -- their StratX comes back, says that they've got a complete fissure. And fissure is really the line between 2 lobes of the lung. What we do is the way that our product works is we put valves in that are one-way valves. So it allows air to suck out of that part of the lobe and it closes that down so that, that lobe, which is hyperinflated, gets smaller. Imagine if you were trying to suck the air out of this room, you could suck the out of this room. But if somebody opened the door -- the window over there, you could -- you would just be pulling air in from somewhere else. Well, what AeriSeal does is it closes that window for you. And it does it by -- it's a foam that's injected or implanted through bronchoscope. It's put in where the fissure is, and it will close down that fissure, the line between the 2 lungs so that, that window is closed and now we've got a positive that does not have any collateral ventilation. So now 20% of the time, that's 20% of the patients that actually go in for our procedure don't get it. It's a bummer for them. Sometimes it's a bummer for their referring physicians. But imagine a world now where it's, hey, you're going to go to sleep and when you wake up, you will either have valves to put in or we will do AeriSeal. And you'll need to come back in 45 days to get your valves put in. So this patient that's already gone through this whole testing process that I've been talking about where it's the leaky part of the funnel, they've actually already made it to the end and then they fall out now. We'll be able to pick up 20% of those patients who will be able to come in and get AeriSeal. So then that's an additional procedure. And at the same time and more importantly, they're going to get the valves that they need so that they can be treated.

And are those procedures done at the same time or is one done first and the other is done the second?

So one is done and then 45 days later or approximately 45 days later, they would come in and have the second valve procedure done.

What about the open window?

When you -- with Chartis. So you go in and to start the procedure, we actually go down with a small balloon. And it's put right at the base of the lobe of the lung, and we put air in and we measure the air flow coming in and out of that lobe of the lung. If there's a leak, if that open window is there, then we'll see that the air is flowing out of this rather than seeing the pressure that we need to see. And so that's how we can tell if the patient has collateral ventilation right now. If they do have collateral ventilation, we call them CV positive, so collateral ventilation positive, and they don't get the procedure. Now they can go off to surgery to have a fissure closure procedure done or they can go do something else. But typically, they kind of fall out of the process. So our ability to go in with a bronchoscope. So a lot of these patients are frail. They're very sick. And so if we can go in with a bronchoscope, there's no incisions and place this -- the AeriSeal in place, then we'll be able to go and do the valves a couple months later.

So big picture, is the leading indicator to Zephyr valve placement Chartis or is it StratX?

It would definitely be StratX. So Chartis is happening, I mean, at the time of the procedure.

Have you thought about sharing how StratX procedures are building as a leading indicator?

Yes. We've talked about it a little bit. It's really interesting because sometimes, I don't want to see our StratX go up if I know that the StratX patients that are coming in are better patients. So if I've got a new center that's set up and they're just sending in good patients rather than sending in old comers, I'll actually see a decrease in my overall StratX volume. But I know that -- but you look at the procedure volume, my hit rate is higher because I've got better quality coming through. So it's kind of -- and you guys aren't good with that stuff.

I won't take that personally.

No, it's -- there's a lot of people who make assumptions on that stuff, and it's like, so we look at it and we can dig into, okay, this facility is -- this has new referrers here, and they're kind of referring to everybody in. And this one has been doing it for a while, and they know exactly who's going to do well. Mehul, anything to add to that or no?

No, I think you got it. But Joanne, part of our sales optimization plan is hirings, lower level of reps who call on COPD clinicians, physicians, right? And so if we're able to call on those physicians, train them better, they understand a better qualified patient. And when they start sending those better qualified patients, so StratX are also better. And so our sales process and the people we're bringing on will help with that. So it doesn't -- as Steve said, StratX just going up for the sake of going up is not really relevant. It's the quality of the StratX, and we're trying to really hit that upstream.

Let's spend just a little bit of time in our remaining time talking about the numbers. And what -- the gross margins, in particular, I thought were notable in the quarter. And how do you continue to drive those margins? And I'm going to ask the next question at the same time. How do you think about operating expense? We started this whole conversation just a mere half hour ago with you saying, you are increasingly confident in the ability to get to cash flow breakeven on hand. Those are your questions.

Yes. Okay. Remind me if I forget to answer one. So on gross margins, we feel really good about the guidance, the 74% that we've provided. And that's really driven by a combination of things. One is increasing procedure volume. So as we build more valves and catheters, our fixed costs in the factory get taken by more volume and more units. So that always helps as our procedures grow. The other thing is geographic mix helps gross margin. The U.S. is slightly more profitable than the international markets for a number of reasons. But as the U.S. grows faster than international, that will also help our gross margins. And then the third thing is we have a number of cost optimization initiatives where we're continuing to improve our productivity in the factories, looking at supply chain, looking at how we're managing our software development and all of that. And so as we do all those things, that will also take costs out over the long term. So albeit we've guided to 74%, but over the longer term, I see gross margins going up higher than that.

Okay. That was the question [indiscernible].

Number one. Operating -- yes. So as Steve mentioned earlier, as did I, our operating leverage in '24 was really good, 22% revenue growth, 6% OpEx growth. And that's why we continue to invest in some of these revenue-generating initiatives. The dynamic there was CONVERT, which was the initial study that was done, and that was ramping down, and CONVERT II was starting to ramp up, but they were not on the same slope. So we got some extra leverage as a result of that. As enrollment increases in 2025 and into '26, R&D expenses will increase as enrollment goes up. So we won't get a lot of leverage in R&D, but we will get leverage in SG&A. So that's how we'll continue to drive leverage on a percentage basis in terms of cash utilization. If you just look at guidance, and I think you're going there, it does not appear that we'll continue to gain a lot of leverage. But we have a number of initiatives. When they come to fruition, we will continue to get leverage. And managing burn is top of mind for me and operating leverage is a key strategic initiative for the company. So we're across it and watch it every day just like we do revenue.

And my last question. Cash flow.

So we ended the year with $101.5 million in cash. We burned $6.3 million in Q4 and $30 million for the year. So that was a very strong performance from a cash management point of view. As I said, we'll continue to do that in 2025, gain some leverage while we're investing in some of our growth initiatives. And I feel very good about it because if you just say we're going to continue to spend or burn $30 million a year, we have almost 3.5 years of cash. But as revenue grows and our leverage initiatives come into play, that should extend our cash burn for more than 3.5 years, right? And so we feel very confident about getting to cash flow breakeven with the cash we have today.

Can you mention when you might be cash flow breakeven or adjusted EBITDA positive?

We have not really disclosed that in terms of revenue levels or timing. We may do so in the future.

Aeris Therapeutics was purchased in 2015. And that's where you've got AeriSeal from, I believe. How are you thinking about building out the portfolio growth? Not that you don't have enough going on, but...

Yes. We get asked about this quite a bit. It's like, are you like acquisitive? Are you looking at any M&A? I think we probably -- we have such an opportunity in front of us. I don't spend much time looking at it. Now people will come to us and opportunistically say, hey, we should get together. Maybe there's some kind of an opportunity to do partnerships or whatever. I'll look at those. But really, we've got to focus. We're going to go acquire more patients. We're going to test them better and faster, and then we're going to get them treated. And that's where we've been uniquely focused. I think if we were looking at kind of any M&A, it would be, okay, where does it fit in, in that strategy? I think finding another product is probably -- there's -- it's not for us right now. Now I'm not saying never. But right now, we've got a hill that we're climbing and I think we're doing a good job. We're showing some progress, and I don't want to do anything to derail that. One of the assets of this company is that we've got this interventional pulmonology sales force that there's not a lot out there. And so we've got a group of reps. There's probably, call it, 75 in the United States, 75 to 80. We've got 35 outside the United States. But it's not just sales, we also have marketing as well. And so we've got a good strong marketing infrastructure globally. And that's a real asset in a specific pulmonary space that doesn't have a lot of device innovation.

So now my favorite question. When we're together -- I know, you're startled. When we're together a year from now, what do you think we're going to be talking about?

Hopefully, for me, it's we sit down and say, "Hey, we delivered what we said we were going to deliver plus some." That's kind of upfront for me. I'm expecting that we're going to be talking about LungTraX Detect and what we're seeing in the market. There's a lot of innovation going on. You guys, if you see on LinkedIn or whatever, there's a lot of discussion around lung cancer screening initiatives. And I don't know about you, but what I hear is that people don't want to go in for lung cancer screening because they might find out they have cancer. But if you go in for lung health screening, it's a little bit different. It's a different term. And as these interventional pulmonologists start to broaden the tools that they offer, the patients that are in the market, they can actually broaden the way that they talk to them. And now we've got technology that says, hey, just take that CT scan you did, and we'll actually run the test on it and put it through the process. So you don't have to run them through a whole lot of extra workup, and you get these patients under your roof right now that you're already -- you've got medical record numbers on, they're already in your process. And they've already done the arterial blood gas. They've already done an echo. They've already done these things as part of their cancer workup. We can just push them right into the process. And so I think we're going to start to see more and more benefit from that and more and more uptake. That's in the U.S. Outside the United States, one of the things that Mehul mentioned are TLHC, targeted lung health care program. So this is smokers 55 to 75 years old, go in and they're offered a CT scan by the government. They just send them letters in the mail. And it's like, you are eligible to get a CT. Now a lot of smokers are not going to go get a CT scan. But what they do is they drive around in vans at the grocery store, at the hardware store, at the football match. So they show up to all of these different events.

American football?

No. British football.

It's in the U.K.

Yes. In the U.K., yes. I wanted to make sure I didn't mess that up. So unless I was going to call it soccer, but I don't want to get in trouble. So they will actually drive around these vans, perform the CT scans there. And they're finding that there's this -- actually, so they're doing them for lung cancer, but they also test them for emphysema. So they get an emphysema read on it. At the same time, they do what's called an MRC test, which is a questionnaire that they go through. It's about 4 or 5 questions and they go through and determine, are they breathless? So this patient now has been diagnosed with radiographic emphysema. Never said they had a problem, but they are breathless. They just never -- they thought it was okay. They thought it was normal. Like, hey, I'm getting old and I smoke, I'm not supposed to be able to tie my shoes. Yes, you are. You're supposed to be able to tie your shoes. You're supposed to be able to go to the mailbox. You're supposed to be able to go upstairs. You go to bed. You're breathless, we can fix that, and there's a reason for it. And so we're seeing this big pickup. And so some data is going to come up this year on this, I believe. And hopefully, we start to see this real pickup in not only the U.K., but there's 9 different -- there's a consortium of 9 countries in Europe that are together on this, plus Australia is kicking off. And so a lot of excitement. And when I think about it, it's kind of like what we're doing with LungTraX here in the U.S., but it's just on a more global scale. So it's really interesting. So hopefully, we're talking a lot about that.

Steve and Mehul, thank you so much for joining us today.

Thanks, Joanne. It's always great to see you. Appreciate your time.