SI-BONE, Inc. - 1781346 - SI-BONE INC

All righty. Thank you so much, everybody, for joining. Really appreciate it. Obviously, Patrick on the U.S. MedTech team, last session of the day, and very excited. Savanchil is Chief Financial Officer here from SI Byrne. Thanks so much for agreeing to come to do this. Thanks for having us here. You guys have a lot going on. And before I dive into the specific questions. I'd love to just get a state of the union for you, how you feel about the business. A lot has changed in the last few years. No particular direction, just how does it feel? So when you think about our business over the last several years, we started with being an anatomy-specific company within the pelvis, and we built a franchise there with SI Joint dysfunction. Then we went into pelvic fixation and pelvic trauma. The common thread there was we were focused on unmet clinical needs, which is where SI-joined dysfunction play in, and or areas where the current standard of care was very poor and you had high failure rates, which is when pelvic fixition came into play and pelvic drama came into place. We've seen a great amount of success there, and I'm happy to walk through some metrics in a minute on that. But since that, what we've been very focused on is saying, what is our core competency as we look at the future of the company? And our core competencies revolve around being able to fix and fuse low-density bone. So that was number one. Number two was the biomechanical and 3D printing expertise, design expertise that we had developed. Number three was being able to, since you were going after unmet clinical needs, being focused on clinical evidence. And number four, when you're building out the market, making sure you had a level of reimbursement that could support the economics for the healthcare system while also improving the outcomes, which in the long run actually reduces the cost of the healthcare system. As we looked at that, you know, we started to broaden our aperture and started looking at opportunities within compromised bone, which generally would be patients with osteoporosis, osteopenia, or other sort of bone-compromising disease states. And that really has allowed us to widen the level of opportunities we can go after. And Onyx was the first product that we put out there. That was our first product outside the pelvis. And it's a very exciting opportunity for us, as you heard on our earnings call. But there's more to come. We've called ourselves being on an innovation super cycle start of the year. We launched a couple products already this year. And we are on this flywheel of continuing to launch products at the regular cadence going forward, at least one, maybe two products a year, each targeting a new SAM. Again, the reason I use the word SAM is because we're going after unmet or disease states that have poor outcomes, these are well-defined TAMs. And what we don't want to do is be a me-too product company. And by focusing on specific failure rates, we're actually going after markets that we can own and that we can define. I'd love to start, actually, with Onyx. It seems like the obvious thing to jump into. Maybe just to level set everybody, because there might be some people in the room who are less familiar. Can you just give a quick overview of OnyX as a platform and what you're doing there? Sure. So, again, if you think about what we've been able to do in the last few years with, I'll start with Granite, but our overall innovation cycle has been focused on where can we improve outcomes for patients and reduce failure rates. We started with granite in complex fusion. That was about four years ago. That was going at the base of deformity and degen constructs that end at the pelvis. There was a 24% failure rate for those procedures. Granite, we believe, is starting to become the standard of care. It was our first breakthrough device. We recently put out a clinical study, Paula that actually showed the revision rate went down from 24% to around 3% in cases where granite was used. What we did was we leveraged that same technology and said, okay, what else can we address within the spine fusion space or complex fusion space for our customers? The next failure opportunity that we wanted to go after was UIV and LIV, which is upper instrumented vertebra, lower instrumented vertabra. Simplistically, think about it as the top of the construct and the bottom with the construct. Literature would tell you there's about a 27% failure rate in those procedures, so it's quite high. It's actually even more elevated for patients that have osteoporosis just because you don't have the bone to fuse or bite into and fix into. So Onyx is going off of that need. So it's a massive opportunity for us. Our best estimate is around 200,000 annual procedures would benefit from OnyX, and about a quarter of that is in the deformity space. The remainder of that is in the DGEN space. It's a very attractive opportunity. It's the same call point that today uses Granite. It's within the same commercial channel that today sells Granite, and it's got a lot of reimbursement frameworks already set up, especially when you think about complex fusion procedures, which are seven or more level. They'll be able to benefit from the new DRGs that were effective October 1st. Because it's another breakthrough device, this is our third breakthrough device. We've also filed for NTAP, which, if approved, would go effective October 1st, 2027. So a great opportunity with a well-known issue from our customers. Bits within the channel has the infrastructure that we worked on to build over the last four years to really drive growth acceleration for the business. You guys flagged on the Q3 call the encouraging alpha launch from the start of it. What did you learn about patient selection and surgeon demand from that alpha launch? Yeah, so we got FDA clearance at the end of September, and we did our first case then, and we've been in alpha launch since then, which is a small group of surgeons that we're going out and working with right now just to make sure that we've really simplified the workflow that fits with them and everything is working as it should. We basically had three metrics that we were tracking to define the success of onyx number one is is onyxx being used in cases with granite because the same call point a lot of times the same procedure the answer to that is yes uh number two was not all cases that we work on with granit not all of the cases go to the pelvis right there's about 400 plus thousand fusion procedures there's around 50 000 or 40 to 50 3,000 deformity procedures. And on the deformity side, we think all of them should go to the pelvis. On the fusion side, in DGEN, not all of whom do go to their pelvis. So our second metric was physicians that do not use granite in all the cases, will they use onyx? The answer to that was yes. So that allows us to get more cases per physician. And then the third aspect of our success was physicians who today don't use granate at all because they don't go to the pelvis, mostly in the legion side. Can we see success with Onyx? And the answer to that is yes. So if you think about the three big metrics for us, one is can we get higher procedure ASP? In month one, we are seeing that. Number two is can we get more cases per physician? We are seeing dat. And number three, can we continue to attract new physicians who today do not use granite to be able to use OnyX? So the answer that is, yes, as well. But it's month one. It is an alpha launch. We are going to do a beta launch as we go throughout the quarter, and then we'll do full launch in Q1 and then continue to roll out surgical capacity throughout the first half of the year. So really pleased with what we see. And the other benchmark, and we talked about this during our earnings, Granite has been a great success for us, and it's been one of the fastest-scaling platforms for us in the last four years. When we compare Granite in their first month of Alpha launch to Onyx in this first month of Alpha Launch, OnyX has actually done really well compared to Granite as well. So it gives us a lot of confidence that we have a great product. It's fitting the workflow. It's training light. And so it should be very exciting going into 27 and 28. You have two hats. You've got a CRO hat and a CFO hat. one hat tends to be quite optimistic the other tries usually often to be pessimistic is the wrong word but realistic maybe or that's probably too British a way to phrase it but you know when you're thinking of the launch of Onyx on the one hand you don't want people to get ahead of themselves but on the other hand you have a very established commercial throughput to a lot of these docs and a big unmet need. How do you think about that ramp and that adoption curve maybe not for putting in numbers but just as a conceptual framework? So I think there's two aspects to it. One is just the commercial framework, and the other is ramping up the surgical capacity to make sure you have the capacity to support the volume that we expect Onyx to generate. So on the commercial frame work side, OnyX actually benefits a lot from all the work we did on Granite. Granite, when it came out in 2022, we had close to 700 physicians that we worked with. and we had, say, around 50 agents that we worked with, and we weren't in all the KOLs and weren't in all of the academic centers in the U.S. and had to work through the VAC committee approvals to get the product on the approved product list as well, which can be a very heavy lift. Onyx actually benefits from all that work because the surgeons who use Granite, as I said earlier, are the prime customers for OnyX initially. and that's the low-hanging fruit we're going after. The commercial channel, because Onyx does not compete or cannibalize any existing solution, it is truly going after a known failure rate. It fits within the commercial channel as well. From a VAC committee approval standpoint, because we've done a lot of work with Granite already, this is priced the same way as Granite is. It's filling into the line extension channel, and so the VAC approvals should work out really well as well, So I think from a commercial ramp standpoint, we're pretty optimistic that there is demand, the framework exists, and we should see a pretty nice ramp as we go into 2027, 2028. On the surgical capacity side, we'll continue to bring that on. We learned from how Granite did and how quickly it ramped, so we're continuing to work on that. But as with everything else, it's going to take time to get the capacity online. will continue to roll out capacity in the fourth quarter, the first quarter, second quarter, to be ready for the back half of the year when you start really seeing the ramp and actually being ready for also when the NTAP goes effective, which is October 1st, 2027. How critical in your mind is that NTAP for driving the incremental adoption relative to the economics without the NTAB? So if you think about ONIX, our view is ONIX demand will be driven by the fact that it is solving a clinical need. and we believe that's going to be the biggest driver of demand. The NTAP is going to be valuable, but if you think about where ONIX is going to be used initially, our target population is going to be deformity cases, which in a lot of cases, either they're using granite, so they should be able to tap into the existing new DRGs, or if they're doing seven more levels, which is where high-complex cases go in that fit the same DRG, ONIX should beable to benefit from that as well. So we don't think reimbursement is going to be the gating factor for adoption of phonics. It's the clinical evidence, the clinical problem that's solving, and also the fact that it fits into DRGs. The NTAP will be helpful once it comes out in late 2027. But even when you think about the benefit of NTAP that Granite had when Granite was around on the NTAP program before the DRGs came out, 60% of my granite volume was actually commercial, which did not benefit from NTAP. And the reason it was 60% or why it did not get impacted by NTAP was granite was solving a clinical known issue as well. So surgeons want to use solutions that solve their problem, that reduces revision rates and improves outcomes. So I think we are solving that, and that should allow us to gain traction. I guess if you're taking revision rates from 24, 27% down to those simple digits, you're saving so much money out of the system anyway. Right. So it's more about the long-term benefit. And true to our culture, we are going to be doing a clinical study as well. For Onyx, we just completed a clinical two-year study for Paula for Granite, and we saw the revision rates go down from 24 to 3%, and we actually parsed the data. Granite-specific revision was less than 1%. So we know what Granite can do. We feel great about what Onyx has the potential to do, but we are going to back it up with clinical data, and we should be launching that study in the near future. How much do you think clinical studies are driving decision-making here? They're helpful to prove to the clinician what's going on, but for OnyX, do you need that clinical data to drive more meaningful adoption, or can you get a big chunk of the curve first? Yeah, I'd say if you break down your physician group, you can break it down into three buckets. The first one is the early adopters, the ones who really understand the clinical challenges and want to adopt the newest technologies. We got, with Granite, a huge group of physicians who want to do that. So I think we have a very good install base to go after with Onyx. Then you've got some people who are going to want to use OnyX and see how their patients do. And then you're going to be a third bucket of physicians who are going to say, I'm going to use Onyx, but I would like to get additional clinical data to more regularly use Onynx. And I think we can service all the three buckets, but the first bucket is so big and such a big low-hanging fruit for us that we think that should drive a lot of growth from OnyX in the early days. but with clinical data, I think we could build it out too. And again, like I said, for granite too, we started selling granite in 2022 and Paula came out in 2026 and the adoption really continued to ramp throughout that time period. How should we think about the Onyx, the number of Onyxes used procedure and how that ASP mix works? Yeah. So when we think the SAM or TAM for OnyX, we break it down into two buckets. The first one is the deformity side, which is around 40,000 cases. We think like with granite, this should be used in all deformity cases. Generally, you're going to have four onyx used in that case, two on the top, two in the bottom, and then you could use granite if you go to the pelvis. So in some of those cases, we see sort of six to eight implants being used in a case. But for onyxx, it's about four in that. And at $3,000 an implant, that's $12,000 just for Onyx. Then you go outside of deformity and you look at the rest of fusion procedures, there's around 400,000, 450,000 procedures. If you look at literature, whether you look at patients that have osteoporosis or UIV, LIV failures, coincidentally, both of them are between 27% and 30%, that would give you about 150,000 cases. Now, because they're shorter concept cases, we think you're going to use two implants generally at the top of the case, and that would be two implants at $3,000 an implant, so that would be $6,000. So very similar to the Granite framework. Right, right. And on the Granit framework, you know, new reimbursement classifications came in through in October, which is kind of awesome. How should we think about the benefit of that? Yeah, so, that was something that we've been working on for years. For a few years, the NTAP was about to expire at the end of last year, so a year prior to that, we were working on it. So, we're really pleased that the new DRGs were put in place, and for a pelvic fixation, they're pretty specific to granite, sort of highlights the problem statement that we're solving, the good clinical evidence that we were able to provide to CMS as well as part of that discussion. Just to provide people a perspective, the reimbursement increases are anywhere between $20,000 on the low end and $50,000 on the high end, so it's quite meaningful. Now, what does it do? For us, it's the following. One, especially for new sites where granite is still not fully penetrated, it actually allows us to take economics as a cause of friction off the table because of the reimbursement being as well-defined as it is. That's number one. Number two is physicians or hospitals that were being selective on when to use granite, even though 60% of our volume from granite came from commercial, it's still a very small subset of our business today. With these new DRGs, which are permanent, they're not limited to Medicare only. Over time, in the next 12 months, you'll see commercial coverage pick up on these DRGs. So that opens up the opportunity for physicians to consistently use granite. So that's number two. And then number three is biomechanically, we've always said you want to use two implants on either side. But a lot of times, cost can be a gating factor where physicians are like, look, I'm just going to be able to use one because that's all I can afford right now. And that argument goes away as well. So it's an opportunity to actually be able sell more product per case. So those are the three big advantages for us. That product per-case flip, surgeons already using Granite. So is there any reason that wouldn't inflect fairly quickly once that made aware of the new economics? I think, so we're doing our bit to make people aware of the economics. We actually held a webinar with the hospital coders and we had several hundred dial in. So there's growing awareness. It's actually much simpler than billing to an NTAP because when you're billing to an NTOP, you actually have to assign an ICD-10X code and that's a workflow. And most people in these hospital systems aren't used to doing that for spine procedures. on these DRG changes is actually a lot more seamless. It's a lot more permanent. You just have to make sure you're billing to the right DRGs. So, you know, how quickly will it have an impact? It's really hard for me to say that today because it went effective in what is traditionally the busiest quarter of the year for us. So are we seeing any uptake on the pelvic fixation side because it's specific to granite demand? Is it because it is DRGs? Is because of, you know, the pull-through that we're seeing with Onyx as well for physicians. So there's a lot of good things going on for Granite, so I can't pinpoint to one. But what it should tell you is, more importantly than the fourth quarter going into 2027, it should bode well for the complex Fusion franchise. The portfolio is broadening. You mentioned innovation super cycle. As that happens, to your mind, how much runway do we still have on the core SR joint business? and what's the remaining constraint today is it like diagnosis is it referrals or payer access yes so when you when you think about the business effigy and dysfunction still as a standalone is the biggest ham for us at 280 000 procedures close to three billion dollar to an hour billion dollar tam um i'll bucket that into my minimally invasive procedure bucket where i put trauma as well. That business remains the largest revenue contributor for us today. The growth in that business is coming from not just the surgeon side, though, which remains the vast majority of the business, but it is coming From the strategic shift that we did a few years ago by also engaging interventional spine physicians. And the reason we did that was we've been working with interventional spinal physicians since the inception of the company. But it was more from a referral pattern standpoint. But what we were seeing in the last few years is there is a growing interest in interventional spine physicians to be able to do SI joint dysfunction procedures, but they wanted minimally invasive procedures. So we had TORC. We started with TORc with them, and that gained traction. But we very quickly started to build out our intra-platform, which is our Allograft solutions, as well as our intra TI product that launched earlier this year. So when you think about runway, there's a lot of runway there, both in terms of surgeons and interventional. What we have now is a very comprehensive solution set that was specific to surgeons, but in the last three years have built a platform that's very specific to interventional as well with the allograft and the metal that we launched earlier this year. And then you've got a backdrop on the reimbursement side that's also become favorable. you've got two different codes that you can build to 27278, which is mostly being used by interventionists for in-office and ASCs, which are where a lot of our growth has been. And we talked about that in the third quarter. We really saw that inflect on the interventional side. That side of service, because the reimbursement is lower, that does impact your ASP, but we do see a lot of volume, opportunity in that market. And then more recently, last week, CMS did finalize the reimbursement for our code CPT27279 to also be able to perform that in an in-office setting at a $20,000 reimbursement. So when you think about the reimbursements, reimbursement backdrop, it's well set up. It's across all sites of service. And what we've done in the last three years is we've made sure that we can support a physician, whether it's a surgeon or an interventionalist, whether that's done in an outpatient ASC or an in-office, whether it's done on a patient that wants an allograft solution or a metal solution, we are the one-stop shop for that. And so I think there's good opportunity there to continue to accelerate volume growth. You might have a new patient by the sounds of the banging. I feel like You're going to have some deformity there. If we think about intra and we think about the ASC and the mixed side, how do you guys think about ASC pool growing so quickly? How much of that is just like extra patients relative to some moving, just moving side of care? Yeah, so when we went to the interventionals market, we were very deliberate in our strategy where we were focused on markets where surgeons were not doing these procedures or interventional spine physicians weren't recommending patients or referring patients to surgeons. So, for us, it was always an incremental opportunity. We also know, if you look at the interventional market as a whole, interventionalists generally don't perform surgical procedures in hospitals. So our focus was how do we service them at the site of service where they can perform procedures, and it was either ASCs or in office. Not all interventional spine physicians have ASCs, but they all have office-based labs. And so our focus was, how do we make sure we have the solution set to service them in those markets? So I would say it's all incremental. It was a known strategy for us from a pricing standpoint. And this is the one piece I think was missed on our earnings call, where we saw a big spike in volumes because of the traction we're getting on the interventional side. The ASP was lower, but the cost profile of a product is lower because the gross margin was still very stable. So I think we've deliberately planned and strategized on the different sites of service and how do we attack each one of them and continue to do it profitably. Your reps have got a lot going on, right? You've got all this out of the bag. You've got all these reimbursement changes. You got sites of care. How are they doing? How's attrition? Are you able to add new reps? I mean, they always like working at companies that are growing quickly, but what's the health of the sales force in general? So I'd say, and we've said it for a long time, we probably have the best sales force in the industry. And the reason they're best at what they do is because they lead with education and evidence. And not many companies in our space do that. So we're really proud of what they doing. Yes, they're really busy, but they're also excited with all the opportunities they have, whether it's on the interventional side, being able to grow there, whether it's in the complex fusion side. Where we've been very deliberate is how do we make sure we can focus and maximize opportunities. So earlier this year, we entered a collaboration with Smith & Nephew to make sure that we were not distracting our reps in the trauma side because we only have one solution in trauma today, and we did not want to have a sales force being at level one, level two trauma sides for that one case. So we did that. that was a deliberate move to focus them on what we knew was good growth opportunities on the interventional side and the surgeon side with Onyx coming on. So I think that's playing out really well. You're starting to see green shoots on the trauma side, and the fact that you saw the growth on the interventional site that you showed, that's again driven by focus. The other thing that we've done very well since we launched Granite was build out the hybrid sales force. And part of that was also making sure that our reps were spending more time hunting and building relationships and going deeper with the call point versus spending eight hours in an OR where they were only going to get two implants. Now with Onyx, that changes because they could get six implants or even more in some cases. So that agent network has really freed up our reps' time as well to focus on building relationships. And then the last piece is we're being very targeted and thoughtful about how we expand our sales force. There's a lot of opportunity for us, and we're looking at it market by market where we see great opportunities where can we add another rep? Can we add a couple more junior reps to provide the senior reps some more bandwidth? So it's a very surgical approach doing things, and I think we've got a great leadership team who's done this well. And what you're going to see is productivity is going to improve, but despite us adding more reps, but that's because we see opportunities where we can add more reps. I actually should know this, but I don't. How frequently are the reps supporting many of these procedures? I mean, hip and knee, it's like a massive number, obviously. But how much time is supporting the existing wallet versus hunting for new? So I would say, by and large, there's somebody in the case every time. Now, the reason we did the hybrid network sales force was exactly to address what you just raised as a concern where we want our reps to be in the OR because they want to build the relationships with the physicians and the hospital staff. And I think that's really important. What we also wanted to do was make sure they had the bandwidth, especially with all these new opportunities and untapped hams that we have out there to continue to build relationships and drive deeper dialogue. And if you look at our productivity metric, which is around 2.3 million, it's grown consistently. It was about less than a million four years ago. When you look at our top line growth, it shows that this hybrid model is actually working. And when you think about the operating leverage in the business that we're able to get, because a lot of times for these hybrid models, there is no fixed cost. It's effectively think about it as case coverage cost is what you pay. And it works well for us because it frees up our reps time who can then go sell. It works for some of these agents because they're already in those cases. So there's no increment. I appreciate we're not in 2027 yet, but we sort of touched on a bit on the call. Given all of these different pathways and things, is there a world where 2027 growth actually ends up looking better than 2026, which so far looks like it should have been a great year? Right. So, again, you're right. I'm not going to comment on 2027 guidance or expectations. But when you think about us as a business, you've got reimbursement tailwinds in terms of a new DRG that just went effective, which is a meaningful increase. You've got reinforcement changes on the SI joint dysfunction side with the addition of in-office for 27279, which would be really good for the SI join business. You've Got the potential for NTAP with ONIX that goes effective in Q4 of 2027. So that's on the reimbursement side. And then you think about the call point growth that we're seeing, both on the interventional side and the surgeon side, that's going to be a good tailwind for the business. And then, you layer on top of that, the new product like Onyx, which we believe will do really well. So, there's a lot of good things to get excited about going into 2027, but we also want to make sure that a lotof these tailwinds are relatively new. We want to see how they perform in the fourth quarter, how they performance going into the first quarter of next year before we comment on expectations. What's actually very important is for everybody to appreciate that these tailwinds are not one-off. The DRGs are permanent and durable. The commercial pickup on those will be durable. The OBL in office for 7-9 is durable. The NTAP will have quite a bit of runway when it comes out. These new products have a lot durability because there is a massive opportunity of untapped ham for those products. So I know everybody's excited about 2027, but what excites me is looking at 27, 28, 29 and what impact this could have over the next three years. And then you think about all the other opportunities within Compromise Bone that we want to bring to market over the same time period, which would be on top of these tailwinds so it's exciting to be us but it's also uh the entire company is heads down starting with commercial team all the way into operations everybody's heads down let's execute let's end the fourth quarter strong let's get into next year and then think about next year in 2028 at that point one step at a time the you have quite an expanded role right because you're you're both the cfo and the coo role how do you split your time and how doyou think about you know doing those things simultaneously um they're actually quite interlinked i would actually say to to be an effective cfo running operations is actually being uh it's actually been great simply because um from a cfo perspective you're focused on revenue in the middle of the pnl and as a ceo you'refocused on revenue and the line right beneath revenue which is cogs and supply chain and how do you balance the two where you're getting the right supply in the right place at the right time to make sure you're maximizing utilization becomes really important. When you're putting out new products, how do you scale that product? How do you get the cost out of the product as it gets bigger becomes really importante because we like our industry-leading gross margins. We want to be able to maintain our industry leading gross margins, we know when you put out a new product, it leads to a little bit of dilution because of non-cash depreciation, but our team's focused on how do we offset that non-cast depreciation by getting cost out, by being more efficient, by getting better turns in the field. These are things that, from a CFO standpoint, are metrics. But when you become the CEO, you're actually owning those metrics. And so it's kind of fun to see those play out. And what you've seen us do is you've had very stable gross margins at close to 80%, 79.3% to be accurate. And what we said externally is with new product launches, you can see the gross margins go down to about 78%. But at the same time, we're very focused on saying, what other activities can we do to get that gross margin up back to close to 80%. And I think we have a good roadmap to be able to do that. So how do I spend my time? I think I spend a lot of my time on how do we maximize growth opportunities? How do we optimize opportunities on asset efficiency? And then how do We reinvest back in growth through R&D so that we can keep the fly wheel going? Because if you think about our profitability outcome, it's all being growth driven. The growth has been linear to how we've gone from negative EBITDA to positive EBITda to now cash flow break even. So you've got scrappage rates and yields and all that good stuff. Fun stuff. Kind of fun stuff. I think you do a good amount of these meetings. You have capital markets experience before, and you speak to a lot of investors on that side. What are people not focused on externally but matters a lot internally or flipped another way gets a lot of attention externally that actually internally like this isn't a thing or just where there's a disconnect of any kind i would say there's an increasing appreciation now for si bone being a technology platform versus a single disease state platform and i would Say that's been the biggest change in how investors are thinking about us you know for the longest time we get questions on, hey, you have this triangle patent that's expiring in 2026, now it's 2028, how should we think about it? I have three docs that use that product. And everybody else has moved on to modern technology. But more importantly, I think that appreciation of this is a company that has continued to look for unmet needs, disrupt those markets, build their own terms, do it in a very thoughtful way, be very targeted and not being a me-too product, maintain high gross margins, maintain the asset-light model, inflect on cash flow. I think three years ago, people would have questioned all of those. At this point, people actually recognize that this management team and this company is capable of doing that and then more. So I do think that the narrative has shifted from a single product to a technology platform, one call point to a multi-call point, from subscale to a scalable infrastructure. Nice. You're finally being recognized for it in the stock price, too. Yeah, no, I mean, look, there's a lot to do, all right? And I think we're very excited about it. We're very excited about what 2027 holds, what 2028 holds. We'RE excited about the R&D pipeline that we're working on. And a lot of times people wonder why we don't want to talk about what's on the come, but part of that is because we're going after unmet needs, we want to hold it close to our vest. But because we're going after unmet needs, by the time we talk about it or start talking about it, we're two years into the journey of developing it. So when we say we're going to put out a couple products in any given year, we are feeling pretty good about that trajectory. That's why I didn't try and drill you on other areas of compromised bone. I'll let you keep your secrets. Yeah. The compromised bone has really opened up the aperture for us for multiple opportunities to go after. And it's really given us a nice roadmap over the next five years for innovation. Anshul, thank you so much. Thank you.