Siemens Healthineers AG (SHL) Earnings Call Transcript & Summary

Good morning, ladies and gentlemen, and welcome to Siemens Healthineers Conference Call. As a reminder, this conference is being recorded. Before we begin, I would like to draw your attention to the safe harbor statement on Page 2 of the Siemens Healthineers presentation. This conference call may include forward-looking statements. These statements are based on the company's current expectations and certain assumptions and are, therefore, subject to certain risks and uncertainties. At this time, I would like to turn the call over to your host today, Mr. Marc Koebernick, Head of Investor Relations. Please go ahead, sir.

Thank you, operator. Good morning from Erlangen, the analysts and investors. Our CEO, Bernhard Montag; and our CFO, Jochen Schmitz, will be taking you through the details of our Q3 results for the fiscal year '23 this morning. The Q3 2023 results were published this morning at 7:00 a.m., and you can find all the relevant documents as well as a recording of this call on the Investor Relations section of the Siemens Healthineers website. After the presentations, there will be a chance to ask questions. Let me just remind you of our 2-question rule for the Q&A. And now I will pass the word to our CEO, Bernd Montag. Bernd, the floor is yours.

Thank you, Marc. Good morning, dear analysts and investors. Thanks for listening in and for your continued interest in Siemens Healthineers. As usual, I will kick it off by giving a brief summary of the financial performance in the quarter. We again achieved an excellent double-digit revenue growth of 10% ex-antigen. Including antigen, it was also positive at 3.6%. Our order intake was at a very good level as well. We are happy with the 1.11 equipment book-to-bill that means we booked notably more orders this quarter than we posted revenue in a quarter with excellent revenue. We achieved this very good level despite the absence of a large deal that we signed only a few days after closing the quarter. Jochen will dive a bit deeper in his part. We see a healthy global market environment and continuous strong demand for our products and solution broad-based. Strongest driver of our excellent group revenue growth this quarter was the Imaging segment with 15% growth. While this was on a somewhat weaker comp, I am nevertheless very pleased about this impressive growth and, of course, also about the strong margin of almost 22%. Diagnostics revenue declined by 20% in Q3 as this move was essentially due to the antigen contribution tailing off, the business ex-antigen grew by 2%. This and also the return of the core margin into positive territory, i.e., excluding transformation costs and excluding antigen proof that we are on a good track. Varian grew with 7%, which is below the annual guidance range, but also was on strong comps. I feel comfortable about the double-digit growth dynamic for the full fiscal year, which was again underpinned by a strong order intake. On the margin, which was only 12.1% in Q3, we are experiencing a phase of temporary weakness. Several factors come together here, most importantly, missing conversion this quarter from temporary logistics challenges and the benefit from the pricing measures kicking in later at Varian. Advanced Therapies had a further strong quarter in terms of growth as well as profitability. The segment grew by 12% and achieved a 15.3% adjusted EBIT margin, which is almost a doubling of last year's weaker level. In light of the broad-based good developments in terms of profitability, we were able to deliver a good quarterly EPS number of EUR 0.53. The 24% growth in EPS was supported by a low tax rate. Excluding antigen and the impact of transformation cost, EPS growth was even higher at an impressive 69%. On the back of this good quarter, we confirm our outlook for fiscal year '23. We are expecting to be in the upper half of our 6% to 8% range for revenue growth ex-antigen and are confirming to come in at the lower end of the range for EPS. Jochen will explain the moving parts with regards to this in detail. However, before he takes over, I will give you my take on the segment's Q3 highlights in the next few minutes, starting with Imaging. Q3 was a strong quarter for Imaging in terms of growth and profitability. At the same time, we have been able to increase the very strong and healthy backlog for the Imaging segment again. The demand for our products and services is clinically driven and the virtuous wheel of innovation keeps turning fast for our Imaging business. Our strength allows us to invest more than our competitors in R&D and, at the same time, increase our sector-leading margins. With this, we ensure to be at the forefront when it comes to innovations, consistently growing at above market rates and therefore, further taking share in expanding markets. This is the secret sauce for our ability to grow so strongly and at the same time, expand our sector-leading margins. Our successful pricing initiatives as a reaction to the current inflationary environment are the additional element that will keep this nice margin dynamic are key in terms of further sequential improvement also in the fourth quarter. Hence, we are well on track for our segment guidance on growth and margin. An example of -- one example of many is a deal for 6 photon-counting cities with SCAPIS, Swedish Cardiopulmonary Bioimaging Study. This countrywide study is designed to identify early stage of coronary artery disease and COPD with unprecedented precision and low radiation exposure for patients to initiate and monitor preventive therapies. This deal is not only a proof point for our innovation strength, but also will show that Photon Counting CT has the potential to change how diagnosis and treatment decisions are done in the future. And this potential is even enhanced by our leading position in digitalization, data and AI with more than 1.5 billion curated images, which are the basis to develop our portfolio of AI-enhanced products. Our AI offerings range from scan automation, EG, how the patient is automatically best positioned in the isocenter of the CT for his respective exam to shortening MR exams, for example, with deep resolve, which provides tremendous acquisition time reductions, especially in depiction of dynamic processes or moving organs like cardiac images, and the pre-analyzing of images with leading assistance for the radiologist with our AI-Rad companion family. Turning the page now to Diagnostics, where we also can report good progress on important steps of our transformation. This was an important quarter for the Diagnostics Business next to the promising green shoots in terms of P&L developments, which I have already briefly commented, I would like to highlight quite a few promising -- a very promising developments. Let me start with the maybe most important positive news. We have received the FDA clearance for the Atellica CI Analyzer, the instrument we used to refer to as CI 1900. This is an important step for us. Firstly, the Atellica CI Analyzer was the missing puzzle piece in completing the Atellica ecosystem. And secondly, the U.S. market is by far most important, therefore -- by far, most important single market for our diagnostics business. Hence, being able now to offer the most competitive complete offering for IACC settings in the core lab, be it for the mega lab for hub-and-spoke settings and for low and mid-throughput labs, it is a very crucial step in the diagnostics transformation. This comes at a point in time when we have already been noticing a nice commercial momentum. We have been signing many deals of different sizes and see more in the pipeline, strong proof points of our portfolio strength. Also, in the sentiment of the AACC, the largest trade show in the diagnostic space, which took place last week was very positive. Firstly, it proved to us that the market is in a healthy growth mode and secondly, that the customer resonance to our product portfolio is extremely positive. In terms of our own P&L, this is proven by the fact that the Atellica franchise has been growing strongly throughout 2023. So the commercial momentum for our new and complete portfolio is clearly strong. Also, with regards to the cost side, the past months were important. Thanks to the completion of the portfolio on the IACC side, we could advance in terms of portfolio simplification. Five ‘End-of-Sale’ dates for legacy systems have been communicated to our customers as well as 2 End-of-Life dates, ramping down legacy systems is a process that takes time. We need to take each step carefully considering the impact for our customers. However, walking this path is extremely important in order to reduce complexity and to increase efficiency in so many dimensions over time. So our transformation program is in full execution and cost savings are kicking in. In Q3, we already saw some EUR 20 million of effective savings. This is the first proof point that the transformation is effective and that we are on track to reach our targeted savings of EUR 300 million in 2025. On this positive note, I would like to move to another exciting story. Varian sees a continued order momentum and is supported by the latest addition to the Varian portfolio HyperSight, which is creating lots of traction. You might remember, we launched HyperSight last autumn. It offers substantially improved image quality at an increased speed and allows for substantially improved cancer treatment planning capability right in the treatment room. And it is a showcase of imaging and therapy coming together. The integration of Varian is progressing well, and this is what we also can see when it comes to the synergies ramping up. In the field of AI-based planning and adaptive therapy Varian is at the forefront and underlines this with more than 76,000 online adaptive sessions since market introduction. The excitement this creates with our customers manifests itself in continued strong order momentum quarter-by-quarter. Revenue growth in Q3, however, was held back somewhat by outbound logistics challenges, which we clearly perceive as temporary. Still Varian is with its year-to-date growth rate of more than 9%, well on track for the upper end of the 9% to 12% growth guidance in fiscal year '23, especially having in mind that Q4 last year was rather a weak comp. The pushed out revenue in Q3, of course, did lead to some missing conversion. There is still a noticeable margin compression, which is of temporary nature. At the same time, we continue to invest into R&D to achieve future revenue synergies. Also, it takes longer than in Imaging and Advanced Therapies till the cost challenges from the current inflationary environment can be compensated by our pricing measures, which brings me to Advanced Therapies. Similar to Imaging, Advanced Therapies delivered a very strong revenue growth of 12% at expanding margins. Since the launch of the ARTIS icono biplane for neurovascular interventions, we were able to sell more than 1,000 ARTIS icono. We are leading in the neuro interventional space, and we're able to continue enhance -- continuously enhance the ARTIS icono portfolio since the launch by adding further versions to the portfolio. For example, the biplane version for cardiovascular interventions as well as a ceiling version for precise tumor embolization. The pioneering integration of ARTIS icono ceiling and CT in the Nexaris suite for the OR played a big part in closing a multimodality deal with one of the leading cancer centers in the U.S. The lead to this deal was given by the Varian team, having a strong presence from a collaboration and research perspective, and this really helped to leverage our value proposition, combining Imaging, Varian and Advanced Therapies equipment. Further momentum in the Advanced Therapy segment was added by the collaboration with Intuitive Surgical in the field of endobronchial pulmonology, integrating Siemens Healthineers Cios Spin mobile imaging system enhances the Intuitive Surgical Ion's lung biopsy workflow. Our unique capabilities make us the attractive partner for our other health care companies as much as for our customers. And let me briefly remind you of these 3 unique capabilities. The foundation of our success is the combination of Patient Twinning, Precision Therapy and Digital Data and AI. They fuel our present and future growth and make us the holistic partner of choice for our customers everywhere. They are the source of a constant stream of innovations and pioneering breakthroughs to continuously gain share and expanding accessible markets. And with this, I hand it over to you, Jochen.

Thanks, Bernd and good morning to everyone also from me. Let me take you through the financials of our third quarter of fiscal '23. I would like to start by giving some color on equipment orders. We refer to equipment orders, which relate to Imaging, Varian and Advanced Therapies without service orders and obviously without Diagnostics. Q3 equipment order intake was at a very good level despite the absence of one large deal that we signed only a few days after closing the quarter. Equipment orders were again notably above equipment revenues in Q3. The positive equipment book-to-bill of 1.11 further increased our very healthy order book across the board again. The prior year quarter had very strong equipment book-to-bill of 1.31. Equipment order this quarter were on the same level as the very strong prior year quarter on a comparable basis, which had mid-teens growth back then. I will give more insight on the order book dynamics later in this presentation. By the way, we do see our strong order book reflected in our Q3 revenue growth. Excluding antigen sales, we again posted very strong comparable revenue growth of 10%, another strong quarter after Q2 with 11%. This was based on excellent equipment revenues as well as an accelerated service revenue growth. The strong revenue was converted into strong earnings expansion as you see on the right side of the chart. Adjusted basic earnings per share increased year-over-year by 24%. When looking at the year-over-year comparison, it is important to take into account the antigen accretion from last year's quarter. In the prior year quarter, we booked around EUR 300 million in antigen revenues, which lifted earnings per share by around EUR 0.11. As mentioned already in the Q2 earnings call, antigen sales are tailing off in 2023 as anticipated. In Q3, there was no material impact from antigen. Let me give you some more color on the development of the adjusted EBIT margin in Q3. The adjusted EBIT margin came in at 14.2%, slightly below the prior year quarter. However, excluding the effects of antigen and the transformation costs in Diagnostics, we saw more than 250 basis points underlying margin expansion, primarily driven by better operational performance. Foreign exchange tailwind of around 100 basis points was partially offset by cost increases for increased procurement costs year-over-year. In addition, we saw year-over-year headwinds from a normalized level of incentive preservations in this quarter compared to the unusual low level in prior year. Below EBIT line Financial income net came in at negative EUR 52 million. This is a slight sequential increase of around EUR 5 million versus Q2, which is partially a function of higher interest rates coming through. In Q3, we saw an exceptionally low tax rate positively impacted by several discrete items. I mean discrete items obviously have a kind of a onetime character. One last comment on cash before we look at the segments. Free cash was at EUR 285 million, below the level of prior year quarter. Last year, we also had very positive effects from the antigen business. In this quarter, we increased our inventory levels to ensure our ability to deliver to customers in the upcoming fourth quarter. Bear in mind that we had a strong revenue quarter in Q2 and in Q3 and expect Q4 to be very strong again in absolute terms as always. In the appendix, you will find the free cash conversion bridge. Now let us have a look at the segment performance in detail, starting with Imaging and Diagnostics. Imaging reported a very strong 15.2% comparable revenue growth, growing well across all modalities. On the margin side, Imaging showed strong margin expansion year-over-year, driven by a healthy conversion from the very strong revenue growth. And as expected, we saw the pricing measures contributing to the healthy conversion. Not much to add in a very strong quarter for Imaging. Over to Diagnostics. Due to the tailing off on antigen sales from around EUR 300 million in Q3 last year, Diagnostics saw a notable revenue decline this quarter. Excluding antigen, we saw the core business returning to growth as expected. Looking at the margin. In the core business, as you know, the core excludes antigen and transformation costs. Diagnostics achieved a breakeven margin, driven by the stabilization in the top line and lower logistic cost. Outside of the core margin, we saw transformation costs amounting to EUR 12 million. Please bear in mind that these transformation costs are not falling under our adjustment definition, which means they are reflected in the adjusted EBIT figure. As Bernd has stated before, we also saw the first cost savings from the transformation program coming in. Now let's look at Varian Advanced Therapies on the next slide. On a comparable basis, Varian posted strong revenue growth of 7% this quarter. Although this is below the target range, we feel very confident with the overall growth dynamic for the following reasons. Q3 saw growth in all regions, particularly strong in EMEA and the Americas. Also, Q3 had a relatively tough comp, which will become easier in Q4. And most important, we see the strong order momentum at Varian continuing. We'd expected to book even more revenues in Q3, but were held back by temporary challenges in outbound logistics, which we expected to be solved in Q4. These held back revenues lead to missing conversion in Q3, but at the same time we continue to invest into R&D for future growth. Together this temporarily compress the margins to 12.1% in Q3. When looking at the Q3 margin year-over-year, please bear in mind that the prior year quarter had the highest margin fiscal year '22, 18.1% versus 15.9% for the full fiscal. Compared to this high-margin quarter, we saw year-over-year headwinds from increased procurement cost and foreign exchange. In addition, pricing measures are taking longer compared with Imaging and Advanced Therapies to take effect for Varian due to the longer lead times between order and revenue in this business. Advanced Therapies continued its healthy momentum with very strong comparable revenue growth of 11.9%. On the adjusted EBIT, we saw a very high year-over-year margin expansion. However, compared to a very low margin quarter in 2022. Even if Q3 2022 would have had a normalized margin, we would still have seen a decent margin expansion this quarter, driven by a very healthy conversion from the very strong revenue growth. And as expected, we saw also here the pricing measures contributing to the healthy conversion. The Endovascular Robotics business continued to dilute margins in Q3 by around 300 base points as we are still in the process of ramping down the activities of the cardiology solution. But compared to somewhat elevated levels in the prior year quarter, the quarterly dilution was less than prior year. As said before, Q1 of fiscal year '24 onwards, we expect to see significantly less margin dilution on an ongoing basis from the endovascular robotics investments in neuro solutions only. Related to this, we booked minor charges of EUR 17 million in Q3 for the additional buybacks from customer sites. As in Q2, these charges are adjusted, and we do not expect further charges related to this topic. Now let us have a closer look at the orders and book-to-bill development. Let me start with a great win. We signed and booked a 10-year contract with SSM Health in early July. SSM Health is a large provider with 23 hospitals over 300 physician offices and other facilities in the Midwest of the United States, making it one of the largest integrated providers in the United States. The contract includes equipment from Imaging, Advanced Therapies and Varian, which is another proof point that the combination with Varian is working and is beneficial for our customers. The deal adds revenues for the next 10 years, adding to our resilience for the long term, like the many other value partnerships that we have signed. A quick word on the timing. We signed the deal on July 5, right after Independence Day with the 1st and 2nd of July being a weekend. So because of 1 working day in the United States, the booking of the deal moved from Q3 to Q4. If you would have booked it in Q3, equipment orders would have not been on the same level, but it would have even grown by around mid-single digits. Just an other anecdotal evidence that equipment order growth in a single quarter can be lumpy, which does not create any problem as future revenue growth does not depend on order intake in a single quarter and single quarterly order growth numbers are not an indicator about the health state of our business. However, future revenue growth is, of course, substantiated by the order backlog which brings me to the right side of the chart. We continuously had positive equipment book-to-bill in the last years. And to date, also this year with 1.15 even excluding the SSM Health deal I was referring to beforehand. This means our equipment order bookings are consistently above our revenue bookings further building up our large and healthy backlog. This constantly growing backlog and the accelerated service revenue substantiates very well our revenue growth for the future. Speaking of the future, let us now move to the outlook. We confirm our outlook for fiscal year 2023. We continue to expect the fiscal year clearly in the upper half of the range of 6% to 8%, growing excluding antigen of the minus 1 to plus 1 growth, including antigen. In terms of adjusted EPS, we continue to expect to finish the fiscal year at the low end of our EUR 2 to EUR 2.20 per share outlook. Essentially, we are at the lower end because of foreign exchange effects, which have turned against our initial assumption in the course of the year. As communicated in early May, the foreign exchange impacts are accumulating to more than EUR 0.10 headwinds on EPS compared to when we initially gave this guidance in November 2022. Let us now have a look how this outlook comes together from the bottom up via the segment performances, starting with comparable revenue growth. For the segments, Imaging, Varian and Advanced Therapies, we continue to expect to end the fiscal year at the upper end of the respective ranges for comparable revenue growth. Based on strong revenue growth in the first 9 months, very strong backlog and high recurring revenue share from the service business. In Diagnostics, we are well on track to end the year within the growth range given in May. Over to margins. Both Imaging and Advanced Therapies have shown good margin momentum in the first 9 months. Diagnostics has also shown the expected recovery in Q3. So for those 3 segments, we are on track to end the year well within the respective margin ranges. For Varian, we lowered the margin range to 14% to 15% for this year due to the temporarily challenged margin performance. And now to the line items below the adjusted EBIT. For financial income net, we are lowering our guidance to minus EUR 175 million to minus EUR 185 million this year, so around EUR 20 million more than the old midpoint of minus EUR 160 million to the new midpoint of minus EUR 180 million. Despite the majority of our debt being fixed and rising, interest rates still find their way into the interest expense. We had the loans, which had floating rates and through partial refinancing. Our working capital facility for short-term financing is obviously also exposed to current rates. The EUR 50 -- or the minus EUR 52 million financial income we saw this quarter is probably a very normal quarter for financial income and assuming a similar level for Q4 brings you to the new guidance range for 2023. Beyond this, we need to prepare for some more refinancing to do, which at the current interest rates, should all other things equal, lead to some additional upward pressure in terms of the interest results. On tax, on the other hand, we have not seen a normal quarter. We have seen an extraordinary low tax rate of 13% this quarter, driven by several discrete items that positively impacted the tax rate in Q3. Together with the also very low tax rate in Q1, we now lower the tax rate guidance to 20% to 22% for fiscal year 2023. Please bear in mind that the tax rates in Q3 and Q1, were both positively impacted by discrete items that we cannot expect to repeat themselves in the future. We expect the Q4 tax rate to be a notch above the previous fiscal year guidance of 26% to 28%, which was indicating normal levels. This then brings you to the new range of 20% to 22% for fiscal year '23. So summarizing, quite a few moving pieces, but at the end, the confirmation of our group guidance for comparable revenue growth as well as group EPS in turbulent times. And now I would like to hand it over to Marc for some words on our plans on the IR front in the second half of the calendar year and then obviously, Q&A.

Thank you, Jochen. We have quite a program of IR activities planned for the second half of the calendar year. We will obviously be on the road after this reporting virtually in the U.K. and the U.S. and we'll be taking part in several conferences in person in September. And then we are going to report Q4 results on the 8th November and will enrich this reporting with a strategic and financial update in a format that you might remember, we already had also in 2019. This will be followed by in-person roadshows to all major locations and we will then finalize the IR year with a great in-person event at our premises in Forchheim, where we invite you for the Meet The Management on December 7th. On that day, you will get to look behind the scenes, also in a very interesting tour of our experience center and the CT factory during the morning and in the afternoon, you can meet the management of our 4 segments, including presentations and Q&A sessions. And if you have not signed up for this event, I do encourage you to do so. A reminder of the invitation should be in your inboxes in the course of the day to day. And with that, I get to close today's presentation part and hand over to the operator to remind you of our Q&A instructions.

[Operator Instructions]

Okay. Thank you, operator. We start the session today with Hassan from Barclays. So Hassan, should be live.

I have 2, please. Firstly, Jochen, when we spoke last in mid-June, you talked about low single-digit to mid-single-digit growth in orders for the second half as a fair assumption. I appreciate the commentary around timing on SSM, but has anything changed on an underlying basis? And do you expect Q4 to compensate for this weakness in Q3 and for Q4 to be, say, in the mid-single-digit to high single-digit range in growth terms? And then secondly, on Varian. Could you talk about some of these temporary logistics issues and whether they've been solved so far this quarter? And do you still consider the 2025 margin targets of greater than 20% here as realistic? And if so, should we expect linear phasing from here?

Yes. Hassan, on the -- thanks for the order question, I think we -- hopefully, we made it very clear that how satisfied we are with the development in the markets. The markets are in general, extremely healthy. And the explanation on SSM deal showed you how lumpy this order growth can be. But importantly for us is that we see with 1.11, a very, very healthy addition to our order book at a rate, which is very, very promising for what we can expect from a revenue growth in the future. And I'm also not worried about our market development in the coming quarter.

Then Hassan, on the Varian side. This is outbound logistics, where the team is -- has quite a turbulent year. I mean, as you know, we have made up a great deal in the last -- in Q2 with 47% equipment growth here with the original inbound hiccup we had still the -- getting all the linacs out here, which is, in a way, a nice problem here because of the high growth here is, at some point, a challenge to achieve at exactly a given date. And this is what happened here that a couple of 20-ish linacs, yes, didn't make it to a complete delivery at the customer side at the cutoff date at the end of Q3, which was basically the -- to give some color on what the reason here was. But in the end, yes, it is recovering from the kind of turbulences we had on the inbound side and now making up for it in this -- with this huge order backlog we have, and I'm very happy about this one. And also this on the back of a pretty strong Q3 in the last year. So the absolute revenue target has been very high. You asked about Q4. I'm very optimistic that I think on the one hand, what has -- what didn't make the cutoff here in Q3 will definitely show up in Q4, and I'm very, very optimistic that the team gets into more -- or into less turbulent, more laminar territory. I think also here, André will be of great help with his experience from the MR side. And also bear in mind here that Q4 last year was not very strong comp, which is why I'm very optimistic that we -- that Varian will end up at the upper end of the growth guidance we have given of 9% to 12%. I mean you asked about the Varian margin for the years -- or for the midterm. I mean, on a positive side and the growth momentum, yes, and this is really super exciting, is intact, you see -- or more than intact. It's a vibrant business within Healthineers, the strongest order momentum and also strongest revenue growth momentum. So the growth is very much intact and underpinned by the strong order book achieving the 20% in '25 is still possible, but probably an optimistic case, but I'm optimistic that we are getting close to it.

That's very helpful. Jochen, if I could just follow up on orders. Maybe to ask it another way. Can we get your confidence around 2024 and 2025 revenues that you expect around high single digit given what we've seen and what you expect on the order front so far?

Hassan, thanks for the follow-up question, which is really heading towards where we always wanted to head to from our communication standpoint. Our strong order book with, I would say, 9 months, 1.15, means 15% more orders on equipment than revenue, combined with accelerated service growth, gives us a lot of confidence for our midterm outlook on the revenue line. And therefore, we feel very good about this. And therefore, we are not concerned in getting to what we have guided for in November '21 for Imaging, for Varian and for Advanced Therapies and with the update we did on Diagnostics.

Thanks, Hassan. So we turn over now to Veronika Dubajova from Citi. Veronika, you should be live now.

Excellent. I have also 2 and they will be along very similar lines to Hassan. My first one is on Varian and I guess the margin progression as we think about fiscal '24 and fiscal '25, given that we have a lower starting point in fiscal '23, I think Jochen if I look at consensus, the expectation for next year is going to 18% margin. Do you still think that's possible? And maybe just related to that, what did you do to help the organization avoid issues such as what we have seen today, in the future? Are there any changes that are happening? So sort of 2-parter to that Varian question. And then my second question is just on the portfolio and the structure of the company. Just wanted to get your temperature on obviously, post some of the Corindus changes, whether there are any other parts of the business across all the divisions that you think is noncore and therefore, at this stage, might end up being divested and disposed off or closed off?

Thanks, Veronika. I do start with the Varian one, and I will support the statement of Bernd here, which is always good here if you do this in a public call. But let me start differently. I would say on the top line, we feel extremely well positioned. We gain market share in this business. We have very, very healthy book-to-bill ratios. We have a very healthy order backlog. We see, with regard to margin, as Bernd pointed out, achieving the 20% in 2025 is still possible, but as Bernd said, it's probably the more optimistic case. And I mean the starting point we are currently at didn't make it easier. On the other hand, we are in a very strong position and what is fundamentally weighing on margins that we have not -- that we are not yet back to the economic equation we were used to in this business, out of price and cost. Because of the long cycle nature of the business, and I believe that we still have good opportunities to work on this. And this will give us tailwind for margin expansion in the next 2 years. And I think with this, we feel good about the messages we gave that the 20% is still in reach. But as we said, it is more the optimistic case.

Yes, Veronika on the portfolio side. I mean, first of all, I'm very happy and convinced that we have a very, very rational portfolio. And we also worked on it to be rational. And when I keep speaking about this triangle of Patient Twinning, Precision Therapy and Digital Data and AI, it shows really where we see medicine going when it comes to addressing the noncommunicable diseases, when it comes to overcoming staff shortage and creating access to care. And this is what makes this -- and this story is extremely strong for the combination of Imaging, Advanced Therapies and Varian. This is why Varian got this extra boost in growth. This is also what makes us win the value partnerships because in addition to the medical progress we are driving, we are covering many critical departments in one, in a hospital or health system which allows us to then be also an attractive partner for the C level. So this part of the portfolio is extremely rational and something which also a logic which we want to build on further. Now I'm coming back to the word core. Yes, so to be clear, what is my definition of core means, core means that a business is benefits super strong from being part, being under one roof with the other businesses. Or when you take a business away, the other businesses suffer. So this is clearly the case on the one hand when it comes to Advanced Therapies, Imaging and Varian, this is one core. You can say that Diagnostics is, in a way, a separate entity in this logic, which doesn't have the same -- it doesn't have the same strong interdependency to the other businesses. So you can see that after the -- since the IPO with the Varian acquisition and with all the efforts we are doing on digitalization, value partnerships and so on, so it -- we are more a company over 2 -- with 2 cores, so to say, with a diagnostics business with its own logic and the 3 other businesses. We don't see current any topics like where we need to streamline the portfolio within these 2 stories, so to say.

That's very helpful. If I can just maybe a quick follow-up on Varian. I guess you guys had outlined some really compelling margin expansion path when you did the deal. And it seems like we're diverging further and further away from that. Is there anything else that's going wrong in the business? Are the synergies harder to realize? I mean it doesn't sound like it from the conversation? Or is your impression very much the challenges are sort of self-imposed and easily fixable such as logistics? Just want to get your thoughts on that.

Veronika, I think what we need to see is when -- I mean, when we talked about the -- when we laid out the margin trajectory, it was in November 2021, when we had our Capital Market Day, the world, when it comes to inflationary environment hasn't become easier, so -- and that is what we see currently with an additional aspect of how do we manage the growth here and how much kind of special efforts we currently need to invest before the supply chain is completely streamlined. And I think this current deviation from the path is driven by the change in the cost environment. But we see it as a temporary top year, as Jochen talked about, we will see what we currently see on the imaging side, nicely. The pricing measures making -- starting to visibly making up for the cost pressures, which we saw in the quarters before, we will see similar easing on the Varian side plus more and more benefits from an overall improvement of the supply chain where Varian will benefit here from the know-how, which is there in the rest of Siemens Healthineers.

We head over to Graham from UBS. Graham, you should be live just about now.

Just 2 for me. Just firstly on China, because it's been a source of strength. I wonder if you could give us an update on the dynamics in how you think the environment is developing from an order perspective into the second half calendar year just because we obviously had the rolling over of the fiscal stimulus from the government. So it would be good to get a sense of how impactful that was and sort of what the underlying demand is like there? And then maybe if you could get an update on how you're thinking about labor costs in particular over the next sort of 12 months, just to get a sense of what we should be baking in for inflation there.

So Graham, on the China side, I mean, first of all, underlying demand is super strong. And I think this is how we always, always need to look at this. And China is definitely a business part or a region in which we can achieve growth in the high single digits or low double digits in the -- from an underlying perspective. Then there is an overlay, I mean, in the beginning of the year, there was or, let's say, overlay of some government actions, which have impacts when it comes -- maybe which take them 1 or 2 quarters. So there was a little bit of a held back topic when it comes to -- when it came to the COVID restrictions, then there was a stimulus, then the stimulus ran out currently, there is a little bit of a hesitation in China -- of hospitals to take orders because there are some -- there's a special government focus on procurement practices. But all these things typically -- or have always returned to normal. We will see or we saw in China a little bit of held back orders but, we will see that coming back in the quarters to come. And typically, these topics always compensate.

Graham, on the labor cost side for next year, we expect to see, I would say, a similar merit increase level as we have seen from 2022 to 2023. So I would say in the ballpark on average globally of 5%, which is still a bit decelerated to what we normally would expect, which is more a 3%, 3% to 4%, where we have baked this into our assumptions for the midterm and when we adjusted them with regard to our pricing environment, yes. So I think that is not surprising us going forward.

Thanks, Graham. Brings us to the next one on the line, that will be David Adlington from JPMorgan. David, go ahead.

So just firstly, on market conditions. You sort of mentioned sort of high level in terms of a healthy environment for capital equipment across hospitals. Maybe just a little bit of further color by region because we have had some different commentary from some of your peers. And then secondly, just in terms of diagnostics, just on the margins. So maybe you can give us some kind of path from here, particularly into next year and how you're thinking about the margin improvement or trajectory for Diagnostics would be great?

David, on the markets, we see, in general, I would say, a very, very healthy situation in general. I mean, Bernd referred to China before and nothing to add here. China is in an ongoing build out health care system, which will lead with certain lumpiness based on government incentives or government -- other government programs by quarter, but we see an ongoing trend of investment into the health care system, which should give us a good, good momentum in China. We see the United States also, in general, very, very healthy, which translates in the classical equipment markets to growth rates, which are in the low to mid-single digits. And as we have pointed out since quite a while is that we have seen a very, very strong market environment in EMEA throughout the pandemic, which is now stabilizing on a very high level relative to the past and also now turning back to normal growth environments, which are in the lower single digits on the classical equipment. On the other hand, when you look at our growth profile, I mean we have built up significant installed base over the years, we have still, as I highlighted, a very, very healthy backlog, which will drive our revenue growth on the equipment side, further fueling our service growth, which is currently in levels which we have not seen in the past north of 7%, very, very healthy. Therefore, we feel very, very confident about the prospects with regard to revenue for our business based on healthy markets globally. Sorry, what was the second question?

Diagnostics margins.

Diagnostics margins progression when we are, in general, on track, where we see us on track to achieve the guided margin band for 2025. The transformation is starting to pay off. That's what we have seen. We believe that we have seen trough in Q2. We saw the first signs of light in the Q3, we expect to stay on the growth path also in Q4 and in the positive territory in the core margin -- in the core business in Q4. And then uplifting the margins as the savings, the transformation savings kicking in. And then what will be, so say, the icing on the cake, and the question is how much I icing, is depending on the growth trajectory we are able to achieve. And I mentioned that before, and that was also the reason why we had a relatively broad band communicated 8% to 12% because depending on the success in the marketplace means the growth trajectory, we either and depending on, I would say, less successful, more at the lower end, more successful more to the upper end. And this has not changed.

Thanks, David. We hand over to Odysseas from Berenberg.

So one and a half on Varian please. So just to better quantify the impact of the outline -- on the logistics issue. On the 20-ish linacs, you mentioned didn't make it to complete delivery by the end of Q3. Is it fair to assume around the EUR 2 million price on average? And on the timing of the price increases here, outbound logistics issues aside, would it be sensible to assume some margin expansion this quarter already from price increases? Or is the lead time more of a delta than just the quarter compared to Imaging? And secondly, also I want to ask about the Alzheimer's opportunity following the CMS proposal on covering PET scans for better AMOLED like a couple of weeks back. How are you positioned against competition for this one? And would you think it could help sustaining above digital market growth for the next couple of years?

Odysseas, I had issues to understand your second -- or to hear your second question, but maybe the others could. But I start with Varian. I'll start with Varian first, and then you might repeat the second question. On the Varian side margins, the 12% margin we saw in Q3 is below what we expect for the full fiscal year of 14% to 15%. And when we lose the contribution of 20-plus systems, I think that you can -- that is a sizable amount. But I would say we would be maybe on a normalized case, more at the lower end of the full year guidance range for the fiscal year -- for Q3. In Q4, we expect, obviously, based on the fiscal year guidance, a higher margin level, significantly higher margin level than in Q3. And this is driven clearly, by the expected volume in Q4. As you know, Q4 is, like in Imaging, like in Advanced Therapies, also in Varian normally the quarter with the highest volume in absolute terms and with the best margin levels. So the majority of margin uptick quarter-over-quarter will come from volume, yes. But we will also see on a continuous basis, but not to a large extent yet, better pricing kicking in here. The speed of this is slower than in Imaging and Advanced Therapies. But obviously, Q4 is benefiting more than Q3 from better pricing, but still on a lower extent. And as I said, the vast majority of the margin expansion in Q3 to Q4 comes from volume. With this, I hand over to Bernd.

Yes. Odysseas, can you repeat the second question? It was acoustic, a little bit hard to understand.

Yes, of course. So I wanted you to provide some color on the Alzheimer's opportunity and your competitive position for PET scans here, given the CMS proposal of coverage a couple of weeks back?

So I mean, this definitely plays to our strength there because we are not only the market leader in MR, but also the market leader in PET. And we are, which is mainly not known everywhere, also the market leader in the U.S. when it comes to distribution of PET markers, so that these are -- there's a special topic here, the so-called radiopharmacies, maybe you heard that. So we are with the daughter company, PETNET, the leading provider here. So there's basically no way to around us. And when there is progress in dealing with neurodegenerative diseases, particular Alzheimer's, we definitely benefit. It -- where I would not be too -- let's say, this is not so easy to now derive what is an additional units or so coming from this. I would more use this as one very visible example of what I often say the world innovates for us. So whenever there is a new therapy, Siemens Healthineers benefits, whether it's a new stent or a new watchman device or whatever in the interventional piece side, we benefit by having the Imaging in the right workplace delivered by AT. When it comes to new insights or new drugs, whether it is an anti-fibrosis agent for Crohn's disease or whether it is dealing with Alzheimer's, Siemens Healthineers is the leader, the clear leader in diagnostic imaging benefits. And this is what's driving the growth. Yes, I have a lot of respect for the order discussion here. But this is the real growth driver, and that is why I really like the question. And take this Alzheimer's focus, which currently is there, is just one example of, I am maybe exaggerating, hundreds of how medical progress in other fields is driving our growth.

So we have still quite a few on the line. I think we will not make it through the whole list. But I would say we now take Robert Davies from Morgan Stanley, and then we see if we have time for 1 more afterwards.

My first one was just on your -- coming back to the Varian business, your comments over the midterm outlook. I guess if these are sort of bottleneck challenges or relatively temporary issues, what's kind of changed your view on the medium-term margin potential for that business? That was my first question.

I mean, as we said, we are optimistic when it comes to the -- very optimistic when it comes to the growth. The topic is trust rebalancing, I mean, what we internally call the economic equation of the cost in the supply chain, the labor cost and so on, which is why we are with that growth, which is why the -- we see the 20% still in reach here, but as an optimistic case.

And then my follow-up question is just, I guess, looking into 2024 and the current expectations just in consensus. I know you had a lower tax guide this year. But can you just walk us through the sort of relative moving parts because obviously, you upped your financial expenses guidance for this year, moved the tax rate around. I'd just be kind of curious what your thought process is on some of those line items heading into 2024? Because there seems to be quite a big step-up now particularly, given you're guiding to the low end of the EPS range for this year.

We have a clear guidance in place for the midterm, which is quite -- is a per annum guidance, 6% to 8%; 12% to 15% growth on EPS, and we are currently in the midst of our own budgeting process. And I do not see any reason to deviate from this at this point in time. And as I said before, we feel very good about the growth momentum we see in the businesses because based on what we see on the order book side, on the accelerated service growth. Therefore, we feel very good about the top line development. And again, coming back to our midterm guidance, which we still have in place, which is 6% to 8% growth on the top line revenue, and 12% to 15% adjusted EPS growth.

Okay. Thank you. I think this brings us to the end of today's call. We have a few names left. We will contact you separately from the IR side to finalize your questions. And I would say thank you for the discussion today, and see you on the road or at latest then when we report Q4. Bye-bye. Back to the operator here.

That will conclude today's conference call. Thank you for your participation, ladies and gentlemen. A recording of this conference call will be available on the Investor Relations section of the Siemens Healthineers website.