Teleflex Incorporated (TFX) Earnings Call Transcript & Summary

All right. Good morning. Thanks so much for joining us. Matt O'Brien, analyst here at Piper. I'm very fortunate to have the management team from Teleflex with us from the company, we've got Liam, who's the CEO; and then Larry, who's the Head of Investor Relations. Gents, thanks so much for coming. Really appreciate it.

Thanks for having us.

So maybe let's start a little bit. I won't get into the guidance question that Larry will shut down yet, but let's just get into the different components, first of the business. Palette, that deal that you just did there. I thought was pretty interesting. Just closed it. I know it's early. But that's a product that is similar to Spacer from Boston and it's done really well at Boston. So just how do we think about Palette in terms of integrating it into the business and then obviously on a global basis, really trying to make it a much bigger product?

Yes. So what I like about Palette is the obviousness of it. It fits into that urology call point. And it opens up another call point for radiation oncology. About 80% of the procedures are done within the urology call point. And right now, we have just shy of 4,000 urologists that we've trained and that are using UroLift today. As we -- we're very thoughtful about integrating this, and we've also taken into account that additional call point. So we'll have 20 of our staff specifically dedicated to doing the training and the radiation oncologists. And that will obviously open up another call point for us that we're pretty excited about where there's a lot of fast growth. For me, I think it's more about expanding the market and taking share in our fairness math. So I think Boston Scientific can rest easy. The market is big. It's a $320 million market, and they've done a great job in the beginning of the development of that market. But we look at our core base of urologists users, UroLift users. And we see that only 20% of them use barrigel today, only 40% of them use any type of spacing. So we're going to after that 60% white space in the United States. And we believe that there is a potential even though we haven't built it into our model, that it will also have a halo effect for UroLift. Specifically to the product, the product has some unique attributes that I think make it pretty unique in the spacing world. First and foremost, the product is [indiscernible]. Now when you're trying to protect the other organs as you're going through increased refractionation and radiation therapy and you're doing hyperfractionation, you're using higher doses of radiation therapy. So the risk of ancillary damage grows exponentially. And you want to cover the whole area around the prostration. And the beauty about this product is it can get -- it can be molded. You don't have a time constraint of 20 seconds to inject it and get it to set. You can actually go in. It's very visible. You can see what's going on, and you can mold it, so you're covering that entire area. And I think urologists really like that aspect of it. Rad Onc love that aspect of it. It also lasts a little bit longer. It lasts up to 6 months. So what oftentimes happens as you go through hyperfractionation, after you have your hyperfractionation, you go back for a couple of tests. And you might have to go back and have another couple of doses. So this will last longer. So the health care economics of it work well. It's well reimbursed. So therefore, we believe that it's got legs over a multiyear period. And we expect the asset in entirety of this year to do about $56 million, and we expect it to grow high teens, low double digits. So this will be a growth driver for Teleflex for many years to come. So -- and again, I just love the obviousness of it and how it fits right into the Teleflex bag and can help drive long-term growth. The only other aspect that I'd mention on it is the margin profile of it. It is accretive to UroLift margins. So from that standpoint as well, and as you know, UroLift margins are in the high 70s. So this is a nice margin drop in for that organization.

Got it. Okay. I appreciate that. That 60% of folks that don't use any kind of spacer today. What's been the gating factor? Has it been the fact that it's not a moldable product and something you got to do pretty quickly with spacer or is there something else that's really kept them from using? Is that cost? So -- as I think about that low double digits to teens growth you're expecting, how much of that is really penetrating that group versus other ways to grow the business?

So spacing is so a new math. That -- so we're just going through the early adopters with spacing in general. So you have to think about it that the spacing has only been in the market since around 2018 really when it started to build some momentum. So we're only a few years into spacing as a concept in general. The other thing that has happened is that hyperfractionation has really gained momentum in Europe for us. This is an odd 1 because Europe kind of adopted this new technique before the United States, but it's growing rapidly as a methodology within the United States and that is hyperfractionation. And what that means is you get higher doses, more concentrated, but for the patient, it's fewer visits to have that radiation therapy done. That's also growing within the United States. And as that grows, there is an increasing need for using spacing. And I think that it's just education, just making people aware, spacing is here, what it does, how it protects. The fact that, again, ours doesn't set too quick, you don't have to dissect to put it in. And there aren't 14 steps to getting it set up. It's just a range. You basically a syringe and a needle and you're able to mold and it gives excellent covered to prospects.

Got it. Okay. Okay. I think it's going to be a really good one for you guys. What have you seen as far as it's the ability to help you on the UroLift side of things? And I'll get into the UroLift questions here in a second. But what are you seeing from that perspective?

6 weeks in.

Yes. I mean, 6 weeks in, so it feels that good.

But look, I think, as I alluded to, we haven't built a halo effect UroLift into this. But I think ultimately, it has a significant potential to have a halo effect for UroLift as group that are using UroLift. But there's a -- there's 9,000 urologists in the United States -- there's 12,000 in the United States, 9,000 that do BPH. 97% of urologists that do BPH also do prostate cancer. It's the #2 reason that a man will go to the urologist. So the synergies here are massive. And there are urologists that feel that if I don't cut, I'm not actually doing anything to the prostate. So this will now allow us to engage in a conversation with that group and say, I know you believe that unless you cut you don't, but let's start with the smaller prostates. Let's go for the 50-gram prostate, and let's use UroLift for that. And now, of course, we have a plethora of clinical evidence that show that the -- using the UroLift for all size of the prostate below 100 grams is very effective. And I think there could potentially be a halo effect given we're going to have more salespeople in this call point with a jewel bag. And it also sends a really strong signal to the urology community. Teleflex is committed to urology as a call point. And I think that the halo effect is something that could happen, and we haven't built it into the deal model. We never build in our own revenue synergies to our deal models, but I think it is a potential. Too early to see it yet, Matt, in all transparency. It's only 6 weeks in, and we're working through the integration.

Got it. And I'm going to get into the M&A side of things a little more in a second. But just quickly on the urology side, I mean that seems like a really good area. There seems like there's some other areas of urology that potentially you could get into, like stones. And you said, "Hey, we want stuff that's not deferrable". If it somebody that's had a kidney stone, I would tell you that's not deferrable. So I mean, is the urology a real focus area for Teleflex going forward from continuing to fold in assets?

So it's 1 of the areas of focus for us. For sure. We've always said that the urology call point is a good 1 for us. Interventional is a significant call point for us. The intensive care unit, a significant call point for us, emergency medicine. All of those areas are areas we would look to do M&A are in an aligned space to any of those areas. Tuck-ins and surgical and OEM, nothing has changed in our perspective on that. But there's been no or very little innovation in the area of kidney stones, to your point, for the last 20 years. There's been very little innovation in the area of erectile dysfunction in the last 20 years. So these are segments within urology that come to mind that are ripe for disruption. And there are some interesting technologies and some of them that are ripe for disruption with the right technology.

And did the BPH docs, and do they do -- obviously, they're doing prostate cancer as well, but do they do other kidney stones and things like that as well?

So if you think about it, you're a [ block ], you go on to the urologists, you've got a prostate, females don't have that, spacing is for the prostate, erectile dysfunction is a male condition. Kidney stones goes both ways, but I think most urologists that we would deal with, I think the #3 reason that a man will go to the urologist for kidney stones ironically and #4 is erectile dysfunction.

Got it. Okay. I appreciate that. So let's go to UroLift. We talked about -- I talked to Larry in the follow-up call after the Q3 results that you didn't get any questions on UroLift this quarter, which was amazing. That business was 1 that has had a great trajectory and obviously slow down because of some reimbursement changes, et cetera. Where are we in terms of trying to reaccelerate growth of that business domestically? I think it sounds like things in China and Japan are going pretty well. But what about domestically reaccelerating the business?

Yes. So domestically, really for a number of quarters now and through the 3 quarters this year, we've seen growth in the hospital side of service. And it's ironic because in the hospital, that's where all the competition. The area that has been challenged candidly has been the office site of service. But if you look at the overall revenue for UroLift Q1, Q2, Q3, it's been amazingly stable this year so far. And I think if you look at that and you roll into next year, now you're up against that comparable with a very stable, the halo effect that could come from the Palette acquisition being integrated. And I think that for us, getting the office to stabilize for is going to be key. If the office stabilizes, UroLift will grow. The international markets you mentioned, are going really, really well. Japan is tracking right where we said it would be at 1/3 of the growth in the United States market. So we're really positive on that. We're early days in China. We are now seeding a couple of the key markets to get it on to the government tenders so that we can actually start to develop that market. That will get some revenue in China in '24, but the real year for China will be '25 as we get it across the board and the tenders. We're doing work in Taiwan. We're doing work in other parts of Southeast Asia and in India. So I think getting the office side of service to stabilize will be important to us. Now it is important also for investors to realize, we don't need UroLift to grow in order to hit our 6% LRP. I'm not saying it's not going to grow, but we don't need it to grow to hit our 6% LRP. And another thing, I think, should be -- people should be aware of, UroLift was way ahead of its deal model for the first 3.5 years and way ahead. It's been a little bit behind, obviously, for the last couple of years. But it generates -- that business unit generates a lot of cash that is really important for Teleflex. So from a cash generation, that's an important asset for us.

Got it. Okay. Appreciate that. Let's move over to Standard Bariatrics just for a few minutes there, because you gave us a lot of good detail on the call as far as why GLPs are not really going to hurt you that badly. Just maybe talk a little bit about your updated expectations for that business. In the next couple of years because I know it's probably not going to hurt massively long term, but maybe more acutely in like a year, it could have more of an impact or a year or 2? Is that the right way to think about it? Or no, look, like the market is big enough, we can still penetrate a lot of it over the asset nicely?

So I think it's probably not going to get to our deal model in year 4 or year 5. But we're also not going to pay $300 million for the assets. It was a contingent consideration of around $130 million. So that's why you put contingent consideration in place is to protect yourself against the revenue growth in case it doesn't arrive. And in this instance, the GLP-1s have been somewhat disruptive. But just to level set, our total Bariatric revenue is 50 basis points of Teleflex. We thought it was going to add around $15 million a year, probably won't add that. The market -- the total market for Bariatrics is probably not $300 million. Let's say, it's -- let's take the worst-case scenario. We've heard anything from 10% reduction to 25% reduction. Is it an air pocket? Is it not an air pocket? Will it come back? It could potentially. But let's take the worst case, it's 25% less. That's a $230 million market for us to grow into. We never bought this company because the market, the market was growing at 8%. We bought this company to penetrate. The Titan stapler is working really, really well. There is anecdotal evidence that it shaves at least 15 minutes after the procedure. That anecdotal evidence will be turned into real life evidence. We have a clinical trial ongoing right now that we believe we'll be able to demonstrate that time saving, and that's going to be really important. I think the other aspect is that we will have buttress. We're trialing it at the moment, 60% of bariatric surgeons use buttress. And what buttress is when you do the line of staples, it's almost like having super glue between the staples. It just seals them just a little bit better. And I think that even though technically, our product doesn't need buttress because it does a full line of staples in one go, 60% of surgeons use it. And it helps them sleep at night. So having buttress for our portfolio in Q1. So maybe, Matt, it won't grow at $15 million a year. But if it grows at $7 million, we were a $3 billion company in the whole scheme of things, it's still going to be a growth driver for Teleflex over a multiyear period.

Got it. Okay. Appreciate that. I haven't heard much about Z-Medica recently. How is that going versus the deal model? And then I know a big part of Z-Medica was really U.S. where are we at as far as growing OUS?

Z-Medica is doing exceptionally well. That was an excellent, excellent acquisition for Teleflex. And for people who don't -- are not familiar with Teleflex, who don't what Z-Medica is, it's basically a [indiscernible] that helps to -- for the blood to coagulate and for it to clause after a traumatic event. So the market for this product is $600 million. And it's broken into 2 subsegments. This $300 million of the market is external bleeding, which is gunshot wound, stabbed wound, military application for similar for the troops that are now probably engaging in other parts of the world as we see it. And the other part of it is internal bleeding. And for internal bleeding, it's again a traumatic event, a road traffic accent or something like that, patient ends up into the operating room, their triage pretty quickly into surgery. It allows you to stop bleeding very, very quickly and get to the source and be able to help that. And we have a unique indication. We are the only product that is a unique indication for use in internal bleed administration. And we just got a cardiac indication, which also helps solidify that $600 million market. And I think that the margins on this product as well are accretive to Teleflex and a nice opportunity for Teleflex. Dollar growth in Z-Medica is a really good opportunity for Teleflex.

Got it. Okay. I'm going to get to the margin comment in a second. But you guys did raise guidance for the full year coming out of Q3. What was it as far as the progression in Q4 that you were seeing? Obviously, the Q3 results, but the progression into Q4 that you were seeing that gave you the confidence to raise it for the full year?

Yes. So I think when we chatted at the beginning of the year, the goal in Teleflex was every quarter to at least achieve our revenue numbers. We're slightly displaced right now, and that's fine. But I think the best way to get it replaced is just to continue to beat and raise and beat and raise, in particular on the revenue line. So this is the third quarter in a row where we've been -- had the opportunity to beat our revenue and raise our revenue. And if you take a step back and you look at the lower end of our guidance at the beginning of the year, it was 4.7%. And roll forward into where we are today, the low end of our guidance is from 4.7% to 6.4%. So the environment that we're in right now, if you're in the hospital, it's a really positive place to be, especially with our portfolio that's focused on that acute patient within the hospital. And the reason we were able to raise our guidance was because of what we've seen through the 3 quarters and what our expectation was for the fourth quarter. I can tell you, Matt, as I sit here today, I feel equally as confident in that updated guidance as I did a month ago from what I've seen in the markets to date. So we feel solid on our full year guidance. And I think it's the first year of our LRP. And as you know, our LRP was to grow 6%. And as my mother God rest her, used to say, a good start is half the battle. This is a good start. 6.5% applying growth in an LRP that had a CAGR of 6% over a 3-year period. So I think that we feel good as we sit here today. And the reason that we're able to raise our guidance is because of the performance that we saw with an interventional access. The APAC performance has been incredibly solid. OEM has done well. Surgical will anniversary. The standard bariatrics in the fourth quarter. So that will probably take a little bit of a step back. But the anesthesia team will be through the recall. So that will probably take a step up. Vascular will probably take a little bit of a step-up in the fourth quarter. So I feel good about where we are right now, Matt, from this year, but also heading into next year.

So speaking of next year, you talked about the LRP, we're talking 6% or 7%, I think what you committed to last year on the top line over the 3-year period?

Yes, we modified it to 6%.

Yes, 6%. The Street is modeling 4% for next year. I mean, is the Street being way too conservative? Or is there something that we need to be thinking about that like, I don't know if it's an FX thing or something else that the Street is just not getting right?

So I think that our goal is to have a CAGR of 6% through the LRP, and that's what we're executing towards. The current environment that we're in, I can tell you the procedures are really back to the pre-pandemic levels, and I feel comfortable with where we're at. I think there's a number of -- and this is why you have a portfolio of products within your basket. Obviously, we're going to anniversary standard bariatrics in the fourth quarter. We're going to exit the MSA in the month of December. So you're going to lose $70 million of revenue, but it's low margin revenue. So I know you want to get the margins, but it will help margins. You're also going to have Palette in our wheelhouse. That's going to add -- we've got about $12 million in this year. That will add about $55 million. So whatever guidance we give for the year, I think the investment community should be aware that the organic growth is about 50 basis points above that because there is about 50 basis points of an organic headwind built in just to that dynamic. FX will be what FX is in the ultimate time frame. And I think that we'll get to guidance when we get to guidance. Larry doesn't have to kick me. So I'm going to do it to myself. But we'll get the guidance when we get to guidance. But where I sit today, I think that the portfolio of Teleflex products focused on the acute segment, nondeferrable procedures for the most part, has been on a really strong trajectory all year this year, and I think we look forward to carrying that momentum into next year and the year after.

Okay. Got it. The next piece of that is the bottom line because there's a lot of stuff going on next year. Obviously, the MSAs, the Palette solution, the FX. Can EPS grow next year? I mean how do we think about all the EPS dilution you're absorbing next year?

Yes. So we would expect EPS grow next year even with all of those factors. So let's deal with the known knowns. You've mentioned the bulk of them. So Palette, will lose of around $0.35. The MSA will be dilutive around $0.25. I would have thought that FX would have been -- I was talking to you 6 weeks ago when the euro was at 105, I would have thought it would have been a big headwind, that 110, we'll see where it is when we get to February when we give guidance. But if you take those 2 elements of the knowns, our tax rate is going to go up a little bit as well because of teller 2, you would expect that. But if you just take those 2 knowns, that's about 5% of earnings power. That's roughly what that is. So -- but taking that into account, and you know that we've pre-pandemic, we were a high single, low double-digit earnings grower fairly consistently. So you take 5% of that, that without getting into guidance, I think we'll see earnings horsepower in '24. Then you roll into '25, of course, Palette then starts to lever starts to give you some earnings horsepower inflation starts to continue to modulate. We've got our restructuring programs. So we would expect to see a more normalized EPS growth in 2025.

And you don't have the dilution from MSA.

MSA, right? That's correct.

So a big snapback then '25 or is it more kind of what you've guided to historically of kind of the low double digits?

So we'll see when we get there, but it will definitely be an improvement in '25 over '24, I think, and a good solid positive improvement on '25 over '24. And I do think that '24 will be an improvement over this year '23.

Okay. I appreciate that. Last one, we've got about a minute left. It's just on the M&A side of things. Liam, I know we've talked about this maybe a couple of years ago, you were spending -- you spent quite a bit of time. It was 40% of your time, something like that on M&A targets. Are you still doing that? And then is the interest rate environment changing your deal models or your appetite for deals?

So I think that I still spend a fair time on M&A. You look at Palette Life Sciences, the first time that we met them was in 2020. We didn't consummate until 2023. It takes a lot of upfront work getting to know a business, getting to know the management teams feeling confident in the business and the management team before you're in a position to consummate it. I mean, we've got -- we're at 2.1x levered right now, pro forma. So we've got lots of firepower. We're cognizant of the interest rate environment. We're cognizant of our leverage, and we'll keep in mind our leverage. It's -- we're going to pay down the revolver. And I think it should be a really strong signal to the investment community. We didn't term out the Palette debt. We left it on the revolver. That just over a year's free cash flow. So we'll have that paid off in quick order. So we have firepower. You've got to be thoughtful, and we'll continue to be thoughtful on the assets we'll acquire. We're looking for assets that are accretive to our top line, accretive to gross margins right out of the gate, a little bit of dilution in the shorter term. But we're also looking at assets that will be accretive. I think that's important as well. Investors are putting a lot of focus on earnings horsepower as well as we are, and we always have.

Got it. Okay. Unfortunately, we're all out of time left to cut it off there. But Liam and Larry, thank you so much for the time. I appreciate it.

Matt, thank you very much.

Thank you,. Appreciate it.