Teleflex Incorporated (TFX) Earnings Call Transcript & Summary

Thank you for joining us this morning. I'm Matt Taylor, the U.S. medical supplies and devices analyst here at Jefferies, and pleased to be joined here by the management team from Teleflex. To my right is Liam Kelly, the CEO. And we also have Larry Keuschd, who runs Investor Relations and strategy for the company. And so we have about 25-minute session here for a fireside chat.

So can we start just high level and talk a little bit about Teleflex, how the company is positioned in the health care landscape and give investors a sense for your different focus areas and, ultimately, how that translates into your growth algorithm?

Yes. So ultimately, Teleflex is a critical care company. So our core focus is in the hospital side to serve as -- we like that space because it's incredibly stable, and we've seen procedure volumes very stable over the last period of time. Our key areas of focus are in Interventional Access, so within the cath lab; our Vascular business is really focused on the intensive care unit; and our Surgical business, obviously focused within the surgical area. Most of our procedures are emergent care, and our emergency medicine portfolio is also within the hospital setting in the emergency room. Our biggest exposure to deferrable procedures would be in the area of the UroLift product, which is used to treat benign prostate hyperplasia. Our end markets are pretty stable, growing at around 3%, but we're also in higher growing -- higher growth end markets. So obviously, Interventional Access is a higher growth area for us. Rectal spacing for the treatment of prostate cancer is a higher growth space for us. Large-bore closure is a higher growth end market for us as a company. And we continue to execute in those specific areas. So all in all, we see the environment has been very stable, both in the U.S. and internationally. We do about 23% of our revenues in Europe, 12% in Asia Pacific, and we continue to expand in both of those geographies.

Great. And maybe just talk a little bit more about the fundamentals of your business and the outlook for them. Could you talk about the environment for hospital census and growth there? There's been a strong capital and hospital environment this year. Do you see next year as more of a continuation of that? Or do you think anything is going to change?

So I see the environment has been pretty stable, as I said a little bit earlier. We're not a capital equipment company per se. The vast majority of our products are consumable, and they are single-use products. The one exposure that we have to capital is our intra-aortic balloon pump business, and that is seeing a robust growth for a different dynamic rather than hospital budgets. But if we do a quick tour around the world, the Americas, I would see, is incredibly stable from a procedural perspective. We're a critical care company, an emergent care company. So we didn't see a big bolus of pent-up demand out the other side of COVID. We're not in orthopedics where things were getting postponed. Maybe a little bit on the surgical side of our business. But all in all, pretty stable, and we just see the U.S. environment as being robust from the point of view of procedures getting done. Then if you come to Europe, Europe has got different little pockets within it. But all in all, it's pretty stable. We do see the -- that some of the geographies are working diligently to control their hospital spending budgets a little bit in the U.K. But outside of the U.K., we see a robust environment in Italy, Germany, France and Spain. And we continue to launch new products within those geographies, in particular in the higher growth areas. MANTA continues to do very well in Europe. Our hemostatic portfolio does well. Our intraosseous portfolio does well. And then if you go to Asia, yes, the growth in there has always been pretty, pretty robust for companies like Teleflex. Very stable in places like Australia, which is very like the U.K., but also getting growth in places like Korea. Stable environment there. Outside of the doctor strike, you have to recall that this year, the doctor strike in Korea caused a little bit of a headwind in the second half of the year. But that should normalize when you get into next year. And China for us has been a fairly robust area as well. And with UroLift as a product, for example, we're seeding the market there with UroLift and beginning to do some work there. And in China, it's as many times you're bringing -- you're selling old as new. A product that was a new product in the United States 4 years ago is now a new product in that part because of the time it takes to get it registered.

And maybe we can talk a little bit about capital allocation. So over time, the company has created a lot of value through M&A. Could you talk about your capital allocation priorities today and how you're balancing M&A opportunities with other options?

So capital allocation all begins with cash flow. So we have a robust cash flow generation. This year, cash flow from operations should be in the region of around $500 million, with net cash flow being approximately $400 million. Our net leverage right now is about 1.7x. So we have solid cash flow and flexibility with -- on our balance sheet. Our priorities for cash flow -- for capital allocation has been, first of all, to invest in our current business. We want to invest in areas to continue to grow our company internally, in R&D and infrastructure and in the high-growth portfolio. Second use of capital has been for inorganic opportunities to continue to pursue really strategic, disciplined M&A. Thirdly, we want to return capital to shareholders. We believe that there is an opportunity for us to continue to return capital to shareholders. On -- in our Q2 earnings call, we announced a -- we got an approval for a $500 million share repurchase plan, and we executed on it -- and began executing on a $200 million ASR. That should be complete as -- in this quarter. We had a bulk of it through at that stage. And if I spend a couple of minutes on M&A and what we're looking for on M&A, I think that's an important aspect to cover. So we're looking for something within our existing verticals. We believe that we're broad enough as a portfolio as a company. We're acutely looking for top line acceleration of growth, and we want to bring in assets that are going to grow above our company average. We also want assets that will leverage our gross margin and operating margin and continue to add value to Teleflex. Right now, we're obviously aware of EPS dilution, so we'd like to bring in assets that would not be diluted in the first year. From a financial metrics, I think we're looking for assets that will get above our internal cost of capital at a minimum of year 5. And if you look at the transactions that we've done since I became CEO in 2018, in 2018, we did a small little tuck-in, MANTA, which continues to penetrate the large bore market area. In -- we followed that up in 2019 as we went into -- with Z-Medica. Z-Medica, a hemostatic portfolio, accretive margins to Teleflex, accretive top line growth, has continued to perform exceptionally well. We did a tuck-in then, HPC, for our OEM business. It brought our OEM business into thin-walled microcatheters, an area that we hadn't been, and it gave us access to higher growth markets for our OEM business. So in neurovascular, EP, faster-growing end market segments. We then executed on the Titan stapler for bariatric surgeries. In the first year, it was impacted by GLP-1s. But in this year, it has returned to strong double-digit growth and will continue to be a growth driver for Teleflex over the years and again will be accretive to our gross margin. And in -- then the final transaction that we did was to execute on a transaction with Palette Life Sciences. And as you know, Palette Life Sciences has performed really well in the first year that we've had it as a company. So in -- since 2018, we've done 2 transactions over $500 million, and that's kind of the cadence you should expect from Teleflex. We'll be disciplined. We'll bring in an appropriate asset at the appropriate time. And because of our very strong cash flow generation, now, we have the flexibility to augment that really good M&A with share repurchases. And it would be our expectation that we'd utilize the other $300 million of the share repurchase methodically over the next period of time.

Great. So I wanted to go back to -- you touched on a couple of the high-growth areas, how they're doing. You've gone to this way of describing our business where you have the durable core in the higher growth areas. And previously, I talked about kind of mid-single-digit growth for the durable core, 4% to 5%, double-digit growth for the high-growth areas. Is that still the right way to think about your business? And maybe you could expand on how some of the different areas within those segments are doing.

Yes. So we outlined the high-growth portfolio that will grow 12% to 13%. So that was our goal for our high-growth portfolio, and if you look at what's within that high-growth portfolio, obviously, Barrigel within the Interventional Urology business is in there. And again, it's accretive to Teleflex gross margins and is performing exceptionally well. You have our PICC portfolio within the high-growth portfolio. We're taking share there because our coating technology. Our hemostatic portfolio, the Z-Medica acquisition that I spoke about just moments ago, that is a -- we continue to expand indications in that and continue to augment the growth within the hemostatic portfolio. Our intraosseous portfolio in the emergency medicine room does well there. And we have MANTA that we spoke about earlier that penetrates the large bore closure. It is the only single-shot large bore closure product out there in the market. And of course, Titan returning to double-digit growth this year is the final element within the high-growth portfolio. So all aspects within that, that I outlined are performing in line with expectations. And the durable core, which is the 2/3 of Teleflex, is that we also expect it to grow 5% and have been performing at that level. Within that, you would have our Interventional Access portfolio. A large portion of that, excluding MANTA, would be part of the durable core. And obviously, Asia Pacific, a lot of the products within the Asia Pacific portfolio are also within that durable core segment, and we continue to see opportunities to continue to have that as a very stable 5% grower over the longer term.

Great. And as that rolls into your long-range plan, I want to talk about some of the goals there. You had previously set out these goals to grow about 6% or 7% and also increase operating margins 200 to 300 basis points through 2025. So maybe talk about where we are relative to those goals and how you view Teleflex's goals going forward in that context.

Yes. So we outlined our 3-year plan and, just remind everybody, in early 2023 and it was to run through 2025. And the goals were to expand our top line revenue growth by 6%; our gross margins by 250 basis points, which would get you to around 61.7% gross margins; our operating margins by 200 basis points, which would get you to approximately 29% operating margins; and then to drive good solid earnings growth and cash generation as a result of that. If you can look at the first year of our LRP, which is 2023, on the revenue side, we were ahead of that. We came in at 6.5%. On our guidance for this year, you can see we'll be slightly below that 6%. So a little bit of work to do next year to get that CAGR within that. Making good progress on the gross margin side, where we're in line with our expectations on the gross margin side. And a little bit of work also to do on the operating margin side, just with the inflation that we saw as we went through '23. And again, this year in '24, a little bit of work to do there on the operating margin side. But we still continue to execute against those goals. And obviously, we'll get to guidance in the final year in the end of February of 2025.

Great. And I wanted to double click on some of the key growth areas that you outlined. One of the things I wanted to start with was this balloon pump opportunity. So investors have been very interested in this. For context, one of your competitors set some challenges and had some warnings about using their product in the U.S. So talk about the opportunity to gain share in the U.S. and internationally, how that's different and what you've baked in so far.

Yes. So just to remind the investors of what the opportunity is, so it's the intra-aortic balloon pump market is the market that we're talking about. It's a duopoly ourselves and one other company in this space. We have approximately a 1/3 market share. The overall market is $250 million, and it's roughly split 50-50 between the capital, which is the pump and the disposable that gets used with that pump, which is the catheter. The -- we have approximately a 1/3 market share in that space, and the U.S. market is approximately 1/3 of that overall market. So that's the backdrop, just to give people who aren't familiar with Teleflex some context. In May of this year, the competitor -- the FDA issued a noticed to the competitor and to the customers of that competitor saying that they should seek an alternative if one is available. Obviously, the alternative is the Teleflex balloon pump that's on the market today. So we immediately ramped up our manufacturing capacity of pumps to take maximum benefit of this opportunity. And following that, we saw an uptick in quote volume from customers within the United States. That quote volume continued through Q3, and I sit here into Q4, we've seen that quote volume continue to flow in. So we upped our guidance in Q2, the majority of it based on this opportunity to capitalize on this balloon pump opportunity. And we still expect to shift those pumps. We expect our competitor will be off the U.S. market for Q1 and Q2 of next year. And we're focused on this as being a U.S. opportunity, that 1/3 of the market. As we go into Q4, we're also ramping up our capacity on catheters to support those pumps when we put them into the marketplace. So by Q1 of next year, we will also have capacity -- additional capacity on catheters to support those pumps over the lifetime of the product. The company -- the competitor also had their CE mark withdrawn, and that was supposed to come back in September of 2024. But the removal of that was then extended through the first half of next year, so through July of 2025. We don't anticipate a big pickup in Europe simply because that it's just a different market dynamics. You sit in the United States and you watch TV, and this class action lawsuit, lawyers putting up advertisements on left, right and center. But I grew up in Ireland and I never saw an advertisement for a class action lawsuit. You don't see them in Europe. So people aren't going to get sued for using a product that has a CE mark withdrawn. It's just the nature of the business. So we don't anticipate to have a significant uptick in Europe as -- and the base of this. And then within Asia Pacific, like I said, where we sell old as new, the pump that we sell in Asia is seen as a new product. And so, therefore, we've always -- we've been taking share for the last few years, and we expect that to continue over the next number of years in that market. So our goal is to maximize the opportunity. Our goal is to ensure that the catheter volume will follow the pump for the next 8 to 9 years when the pump gets used. And our goal is to sell as many pumps as possible in Q4 and Q1, Q2 next year and to hold on to that market share then longer term. Just on the margins on those products, just to clarify that. I'm sure people are interested. The pump gross margin is slightly below the corporate average and the catheter margin is slightly above the corporate average. So in its totality, it's equal to the margin of the company. And obviously, we're investing some of the benefit to accelerate the growth, but we would envision that a portion of -- a big proportion of that would drop through to earnings to shareholders.

Is there anything that could change relative to your assumption in Europe that could make that a bigger opportunity for you? Could there be another communication from the regulatory agencies or something else that could happen?

So I think that our expectation is that they're going to come back in the second half of the year, the competitor, in both the U.S. and get their CE mark back in Europe. That's an unknown. Only the competitor can tell you whether that's actually going to happen or not. If that doesn't happen, then, obviously, that would extend the opportunity in the United States. And it would also then bring a heightened sense of urgency to the European customers because there would just be doubt as to whether it's going to return to the market or not. For me, it's really important that the share that we take -- that we keep that share. And it's also really important that the catheter volume for the next 8 years stays with that pump. And I just want to touch on a slight nuance between catheters. So can you use our catheter and the competitor pump and vice versa? Yes, you can. So you can swap them over and back. Most customers, and particularly in the United States, want to use fiber optic. It basically -- all that means is the catheter senses because what the catheter is doing is keeping the patient alive. These are critically ill patients, and it's beating, it's doing the work at the heart. That's in essence what it's doing. So if you have a fiber optic option, the synchronization between the heartbeat and the catheter doing its job is at its ultimate. So -- but our products work differently. Our fiber optic sensor is on the tip of the catheter. The competitor's is within the pump. So if you attach our catheter to their pump and lose the fiber optic capability and vice versa, if you attach their catheter to our pump, you also lose that fiber optic capability. So that's why there's an incredibly high attachment rate to a Teleflex pump using a Teleflex catheter and a competitor pump using a competitor catheter.

Great. So we have a few minutes, but I want to cover a couple of other areas. One is -- let's talk about UroLift trends a bit. So you called out continued pressure in the office setting with UroLift and it's declining this year. I guess, when can we expect some more stabilization on UroLift growth trends?

Yes. So as we went through this year, our expectation was that UroLift would be -- the decline we expect in the first half of the year was in line. In Q3, it was also broadly in line with what we expected as we went through Q3. But what we expected within Q3, because in the first half of the year, we were actually training the UroLift reps on the Barrigel product that we acquired through Palette Life Sciences. And what we anticipated was in the third quarter and as you got to the back end of the third quarter, you would see an uptick because those reps are back out there being productive. And we spoke in the past about the halo effect that having reps selling 2 products, you might get a halo effect on the UroLift product. We did get a halo effect, but it wasn't on the UroLift product. It was on the Barrigel product. We've seen that accelerate ahead of our expectations in Q3 and the expectation for Q4. So we revised -- and also early in the fourth quarter, what we saw was an impact from the storms and also from the saline shortage. Saline is used pretty heavily for urology procedures because you actually have to use saline to fill the bladder. And as you're doing these procedures, it flushes through, so that the surge you can see what they're actually doing. Regarding the stabilization, we haven't seen stabilization yet. It's been difficult to call the bottom of this. But I can tell you, we have not sat in our hands, Matt. We have initiated a rebate program for urologists in the office side and service. This year, we had an accelerated rebate based on volume. And the good news is that the surgeons that took up the volume rebate showed a much smaller decline. But nonetheless, the decline in the office continued because it accelerated in the cohort that did not accept that. We've supported the product with clinical studies to eliminate the argument about retreatment rates, and that argument is now pretty much gone. We have put in a preauthorization for the surgeon in the office, so that if they do the procedure, they know that they'll get paid. And we've made some structural changes within the business unit. The President that came over from the Palette acquisition is now leading the whole business. We've also brought in a VP of Marketing, who is coming from a market leader in minimally invasive -- a company within the urology space and BPH space. We've also changed out the VP of Sales. So we've made a lot of changes as well in order to augment this. But we haven't seen the bottom, and we haven't seen it in 2024. And we're continuing to run different programs to support the office. But the change in reimbursement has definitely had an impact on the product, that is for sure.

Is the hospital environment still growing for UroLift? And what is the percentage mix now of office versus hospital?

So the office has obviously become a much smaller part of it. It's gone down to 20%. We continue -- and it's really all about the office, Matt. The reimbursement has had an impact in the office, and that's what's really driving the decline. So we're continuing, as I said, to put programs in place trying to secure that. But to your point, it's becoming a much smaller part now of the pie. And to answer your question specifically, it's now below 20% of the overall volumes.

So we just have time for one more. Maybe just because it was a recent change, I wanted to ask you about the OEM customer issue. So maybe you could cover that and talk about what happened there and how it's going to impact financials going forward.

Yes. This was unfortunately a surprise to us. We were not expecting this within the third quarter. It was a customer vertical integration of a product we've been making for them for a long period of time. It was a little bit unique in so far as that it was a 10-year-old product and not that complex. The vast majority of our OEM business very complex, thin wall, wired extrusion and complex vertical extrusions. It had an impact within the quarter of approximately $7 million. The bulk of the $7 million was this integration. There was some inventory management within that number as well. We expect another $7 million in Q4. And we also anticipate that will be with us for the first half of next year. It is transitory. And once it's -- we're through the -- into the second half of next year, that vertical integration will be in the rearview mirror. It is unique and it is not something we have seen in many, many years within the OEM business. And we don't anticipate that this should happen again just based on the age of the product, the lack of complexity. The majority of what we do is really difficult for customers to move in-house. And therefore, we'll monitor through this through the first half of next year and obviously closely monitor the inventory levels within our other customer base. But our OEM business will return to a more normalized level once this is flushed through, and we definitely see this as transitory for that business.

Great. I think we had to end there. We did pretty good for 25 minutes. Thanks so much for your time. Thanks for your interest in Teleflex. Thank you.