Robbie Marcus

Robbie Marcus sought clarification on whether Enovis' Q4 2025 performance miss was solely due to a selling day misforecast or if product performance was also a factor, given that other orthopedic peers did not report similar impacts. He also questioned the conservatism of the 2026 guidance, considering 2025 ended at the low end of its initial range, and asked about the key drivers for reaching the high versus low end of the new guidance.

Answer

Damien McDonald, Chief Executive Officer, admitted the Q4 miss was due to execution and a miscalculation of selling days, emphasizing it was segment, geography, and product agnostic. He stated the 2026 guidance is conservative due to the dynamic environment, highlighting upside potential from Nebula in hips, shoulder compatibility, OUS hip products (Optimys stem, RM Cup) coming to the U.S., and PNR tailwinds in cold therapy, OA, and Manafuse for Bone Stim.

Robbie Marcus from JPMorgan Chase & Co. sought clarification on Enovis's Q4 2025 performance, questioning if the selling day impact was solely responsible for the miss, especially as peers did not report similar issues. He also asked about the conservatism of the 2026 guidance, given 2025 ended at the low end, and the specific factors that could drive performance to the high or low end of the new range.

Answer

Damien McDonald (CEO) confirmed Q4 was an execution miss related to selling days, not product performance, and acknowledged the need for improved discipline. He described the 2026 guidance as conservative, citing upside potential from Nebula, shoulder compatibility, U.S. launch of Optimys stem and RM Cup, and PNR tailwinds, while noting general market uncertainty as a downside risk.

Robbie Marcus asked about the drivers of the expected Q1 2026 softness and the subsequent acceleration in Q2-Q4, seeking insight into the cadence of improvement throughout the year. He also followed up on the components contributing to the implied year-over-year decline in Q1 2026 operating margins.

Answer

Raul Parra, Chief Financial Officer and Treasurer, declined to provide a detailed quarter-by-quarter breakdown but pointed to the typical seasonality of the business, with Q1 and Q3 generally being lower growth quarters and Q2 and Q4 being the strongest. For Q1 2026 margins, he cited the impact of tariffs (approximately 80 basis points or $3 million gross margin impact, as they were not in effect in Q1 2025), a larger expense base on a smaller revenue quarter due to seasonality, and one-time events like the global sales meeting.

Robbie Marcus followed up on the Q1 2026 guidance, asking about the drivers of acceleration in Q2 through Q4 and the expected cadence of improvement throughout the year. He also inquired about the components contributing to the implied lower operating margins in Q1 2026.

Answer

CFO Raul Parra stated that Q1 and Q3 are typically lower revenue and growth quarters due to seasonality, with Q2 and Q4 being the strongest. He did not provide detailed quarter-by-quarter guidance beyond Q1. Regarding Q1 operating margins, he explained that tariffs, which started in April 2025, represent an 80 basis point or $3 million gross margin impact year-over-year. He also cited a larger expense base on a smaller revenue quarter due to seasonality, and increased expenses from events like the first-ever global sales meeting, as factors contributing to the lower Q1 operating margin.

Robbie Marcus inquired about new patient start trends in the U.S. and internationally, focusing on the sustainability of Type 2 growth in the U.S. and maintaining international market share.

Answer

Ashley McEvoy (President and CEO) confirmed record new customer starts in both the U.S. and OUS. She emphasized that Insulet drives about 65% of market growth, primarily by converting people from multiple daily injections (MDI). McEvoy discussed the significant growth opportunities in Type 1 (40% AID penetration) and Type 2 (5% AID penetration) markets, highlighting Insulet's strong value proposition, clinical science, and commercial strategy focused on clinical outcomes.

Robbie Marcus inquired about the trends in new patient starts, both in the U.S. and internationally, and how Insulet plans to sustain and grow its leadership in new patient acquisition, particularly in Type 2 diabetes and new international geographies.

Answer

Ashley McEvoy, President and CEO, confirmed record new customer starts in both the U.S. and internationally, noting that Insulet drives approximately 65% of market growth, primarily from people transitioning from multiple daily injections (MDI). She discussed continued growth in U.S. Type 1, driven by strong ADA guidelines and the gap between AID and CGM penetration. For Type 2, she highlighted the nascent 5% penetration, strong clinical outcomes, and a strategic pivot to emphasize proven clinical performance through the company's large sales force.

Robbie Marcus asked about the key drivers behind Omnipod 5's continued success and market leadership, despite increasing competition and market noise, inquiring if it's due to form factor, algorithm, or easier onboarding.

Answer

Ashley McEvoy, President and CEO, explained that Omnipod 5's success is due to broad-based, balanced growth, strong science, a beloved and differentiated form factor, superior access and affordability, a resilient supply chain, and the flexibility of Insulet's balance sheet to invest in innovation.

Robbie Marcus asked about the factors driving Omnipod 5's market success, inquiring whether its form factor, algorithm, or ease of onboarding are key differentiators, and what gives management confidence in sustained strong results amidst increasing market competition.

Answer

Ashley McEvoy (President and CEO) highlighted broad-based, balanced growth, strong science (SECURE-T2D, RADIANT trials, real-world evidence), a beloved and differentiated form factor, unique access and affordability, a resilient supply chain built with over $1 billion in investment, and balance sheet flexibility for innovation.

Robbie Marcus asked for high-level drivers for Medtronic to achieve high single-digit EPS growth in fiscal year 2027, considering ongoing investments in Hugo, renal denervation, tibial spend, and CAS. He also questioned if the Street's 8.5% EPS growth estimate is a suitable midpoint.

Answer

EVP and CFO Thierry Piéton outlined drivers including accelerated growth, improving gross margins from CAS mix shift and diabetes separation, and SG&A leverage despite R&D and sales/marketing investments. He noted headwinds from interest rates and tax, and mentioned that the Street's 8.5% estimate might not fully embed temporary dilution from diabetes separation and M&A.

Robbie Marcus, a Managing Director at JPMorgan Chase & Co., asked about the high-level drivers for Medtronic to achieve high single-digit EPS growth in fiscal year 2027, considering significant investments in Hugo, renal denervation, tibial spend, and CAS. He also questioned if the Street's 8.5% EPS growth estimate aligns with Medtronic's midpoint.

Answer

EVP and CFO Thierry Piéton outlined drivers including accelerated growth, improved gross margins from CAS mix and diabetes separation, and SG&A leverage from G&A efficiencies offsetting R&D and sales/marketing investments. He noted headwinds from interest expenses and tax pressure stabilizing, but highlighted potential temporary dilution from the diabetes separation (between IPO and split) and M&A, suggesting the Street's 8.5% might not fully embed these dilutive factors.

Robbie Marcus questioned Medtronic's strategy for reinvesting in SG&A and materially increasing R&D, asking where these funds are being allocated, the expected cadence of investment, and how the company plans to grow operating margin despite higher spending. He followed up by asking about the current environment for tuck-in M&A, identifying interesting segments, and how board committees are facilitating speed.

Answer

CFO Thierry Piéton detailed investment allocation to growth drivers (CAST, Ardian, AltaViva, Hugo) and maintaining technology leadership in key franchises (CRM, CST). He projected SG&A leverage in H2 and operating profit leverage in FY27, driven by gross margin improvements and overhead leverage. CEO Jeff Martha added that improved pricing and cost-down opportunities provide "oxygen" for these investments. For M&A, Martha stated a focus on tuck-ins in higher-growth segments like cardiology and neuroscience, leveraging board committees for speed. Piéton also mentioned an active ventures arm for early-stage investments.

Robbie Marcus asked about Medtronic's strategy for reinvesting in SG&A and R&D, including where these dollars are allocated, the expected cadence of increased investment, and the ability to grow operating margin despite higher spending. He also followed up on the company's focus on tuck-in M&A, the current environment, and specific areas of interest.

Answer

CFO Thierry Piéton stated that investments are directed towards maximizing growth drivers (CAST, Ardian, AltaViva, Hugo) and maintaining technological leadership in key franchises (CRM, CST). He expects SG&A leverage in the second half of the year and a leveraged P&L on operating profit in fiscal 2027, driven by sustainable gross margin improvements and overhead leverage. Chairman and CEO Jeff Martha added that improved pricing and cost-down opportunities provide oxygen for these investments. Regarding M&A, Martha emphasized a focus on tuck-ins in higher-growth segments like cardiology and neuroscience, ideally for early-stage or near-market products, with Medtronic Ventures also actively feeding the pipeline.

Robbie Marcus of JPMorgan Chase & Co. asked about Dexcom's OpEx guidance for 2026, noting an apparent 100 basis points of deleverage after a strong year of expense control in 2025, and sought clarification on the specific spending priorities.

Answer

Jereme Sylvain, CFO of Dexcom, clarified that the goal isn't necessarily to delever OpEx, but rather for gross margin to drive P&L leverage in 2026, with OpEx as a percentage of revenue remaining flat. He attributed the OpEx profile to significant investments in the Ireland manufacturing facility, including hiring, staffing, depreciation, and expensing validation samples, which will shift to COGS in Q4 2026.

Robbie Marcus questioned the 2026 OpEx guidance, noting an apparent 100 basis points of deleverage after a strong year of expense control in 2025, and asked about the specific areas of increased spending.

Answer

Jereme Sylvain, Chief Financial Officer, clarified that the goal is not deleverage but to keep OpEx flat as a percentage of revenue, with leverage primarily flowing through gross margin. He attributed the OpEx profile to a significant investment in the Ireland manufacturing facility, including hiring, staffing, depreciation, and expensing validation samples, which will shift to COGS in Q4 2026.

Robbie Marcus questioned where Dexcom is seeing the most new patient growth, specifically if it's shifting from Type 1 and Type 2 intensive to basal and non-intensive, and if market strategies need to adapt for these new patient groups.

Answer

Jereme Sylvain, CFO, stated that growth remains strong across all Type 2 markets (intensive, basal, non-insulin), with Type 1 naturally seeing slower growth due to higher penetration. He confirmed that Dexcom's teams continuously evaluate go-to-market strategies, including sales force focus and marketing channels, to drive uptake in these increasingly important patient groups, highlighting significant opportunities.

Robbie Marcus inquired about the primary drivers of new patient growth, asking if it's slowing in Type 1 and Type 2 intensive, and increasingly coming from basal and non-intensive segments. He also asked if market strategies need to adapt for these new patient groups.

Answer

Jereme Sylvain, CFO, stated that strong performance is observed across all Type 2 markets, including intensive, basal, and non-insulin, while Type 1 growth naturally slows due to higher penetration. He confirmed that Dexcom's teams are continuously adapting market strategies, including call points and marketing channels, to effectively drive uptake in these increasingly important patient groups, highlighting the significant opportunity with existing coverage.

Robbie Marcus of JPMorgan Chase & Co. inquired about the utilization, reorder rates, and patient trends for Type 2 non-intensive and basal patients, both for insured and cash-pay users.

Answer

CEO Kevin Sayer and CFO Jereme Sylvain responded, noting very good retention and utilization in these populations, especially when reimbursed. Sayer highlighted that Stelo users are reordering regularly. Sylvain added that while utilization is lower for non-covered patients, Stelo is seeing strong uptake in that group.

Robbie Marcus followed up on the TSA runoff, asking if Baxter anticipates earnings growth in 2027 as the majority of TSAs conclude. He also sought a bridge from Q4 2025 gross and operating margins to the 2026 guide, requesting more specific details on the expected cadence for Q1 2026.

Answer

EVP and CFO Joel Grade stated that while specific 2027 guidance isn't provided, he anticipates growth, noting that the majority of TSAs fall off in early 2027. For Q1 2026, Grade reiterated it would be the most challenging quarter due to normal seasonality, an unfavorable Q1 2025 comparison for ITT (due to a one-time distributor bill), continued uncertainty around Novum returns, likely lower drug compounding growth, absorption headwinds from higher-cost inventory, and increased interest expense.

Robbie Marcus asked if Baxter anticipates growing earnings in 2027 as the TSA agreements roll off. He also requested a bridge from the fourth quarter 2025 gross and operating margins to the 2026 guidance, seeking more clarity on the expected cadence, particularly for the first quarter.

Answer

CFO Joel Grade stated that while specific 2027 guidance is not being issued, he anticipates growth, noting that the majority of TSAs will fall off in early 2027. For the 2026 margin bridge, Mr. Grade reiterated that Q1 is expected to be the most challenging due to normal seasonality, an unfavorable year-over-year comparison in ITT (due to a prior-year distributor build), continued uncertainty around Novum returns, unsustainable Drug Compounding growth, absorption headwinds from higher manufacturing costs, pressured bottled margins, and incremental interest expense.

Robbie Marcus from JPMorgan Chase & Co. inquired about CEO Andrew Heider's initial vision for Baxter, the perceived health and trajectory of the business, and any anticipated future changes to 'right the ship.' Marcus also asked for insights into the lower Q4 outlook and the potential for top and bottom-line growth in 2026, considering the Q3 EPS was boosted by a favorable tax rate.

Answer

President and CEO Andrew Heider outlined three key focus areas: stabilizing the business through improved execution, strengthening the balance sheet for future investment and shareholder value, and driving a culture of continuous improvement via the new Growth and Performance System (GPS). Heider confirmed an Investor Day in 2026 for a deeper dive into long-term strategy and financial outlook, and expressed anticipation for growth in 2026, aiming to outpace markets.

Robbie Marcus asked Andrew Heider about his vision for Baxter, initial learnings, the health and trajectory of the business, and expected future changes. He also inquired about the implications of the lower Q4 outlook for 2026, specifically regarding potential positive top and bottom-line growth.

Answer

President and CEO Andrew Heider outlined his focus on stabilizing the business through improved execution, strengthening the balance sheet for future investment, and driving a culture of continuous improvement with the new GPS system. He deferred detailed strategic insights to a 2026 Investor Day but anticipated growth, aiming to outpace markets.

Robbie Marcus questioned the comfort level with the 2026 revenue guidance range of 4%-10% growth, especially given the expectation of a flat Q1 and the potential for a 50% cut with the -52 modifier. He asked if the guidance assumes future improvements or if it's achievable if current conditions persist.

Answer

Tim Herbert, Chairman and CEO, stated that the models for guidance considered the percentage of salary-based versus private practice surgeons and the timing of -52 modifier implementation, expressing comfort with the range. Matt Osberg, CFO, reiterated that the low end of the outlook contemplates a 50% discount, while the high end contemplates a 10% discount, with the outcome depending on how things play out in the coming months. Herbert added that the -52 modifier's full impact hasn't kicked in yet, and Q1 is affected by WISeR logistics.

Robbie Marcus questioned the company's comfort level with the 4%-10% revenue guidance for 2026, especially given the flat Q1 expectation and the wide range of potential -52 modifier impacts. He asked if the guidance assumes an improvement in conditions or if it's achievable if current circumstances persist.

Answer

Tim Herbert (Chairman and CEO) stated that the guidance range is based on models considering different surgeon compensation structures and the timing of -52 modifier implementation. He expressed confidence in the range and the ability to reach the higher end by minimizing the reduction. He noted that the range reflects the variable impact of the -52 modifier, with Q1 also affected by WISeR logistics.

Robbie Marcus inquired about the strong 10.6% TAVR growth, asking if it indicated market share gains beyond the Boston Scientific exit, and requested clarification on regional differences and the volume-versus-sales delta. He also asked for details on the increased Q4 market access spending, its allocation, and whether it was a one-time cost.

Answer

CEO Bernard Zovighian attributed TAVR's strong performance to compelling clinical evidence (Early TAVR, PARTNER 3 & 2 data) and renewed focus on the SAPIEN platform. Dan Lippis, Global Leader of TAVR, confirmed share gains and pricing contributed to the growth, noting stickiness from Boston Scientific's exit and strong SAPIEN 3 Ultra RESILIA adoption. CFO Scott Ullem explained the Q4 SG&A step-up ($112M year-over-year) was intentional for patient access initiatives (asymptomatic amplification, AHA partnership, field force reinforcement), with some spending delayed from earlier in 2025. He indicated a more moderated operating expense growth for 2026.

Robbie Marcus asked about the strong TAVR growth, potential market share gains excluding Boston Scientific's exit, regional differences, and the volume versus sales delta. He also inquired about the substantial increase in Q4 SG&A spending for market access initiatives, its allocation, and whether it's a one-time cost.

Answer

Bernard Zovighian, CEO, highlighted the compelling evidence from PARTNER 3 and EARLY TAVR as drivers of TAVR growth and SAPIEN platform focus. Dan Lippis, Global Leader of TAVR, confirmed share gain and pricing contributed to growth, with share largely from Boston Scientific's exit and strong SAPIEN 3 Ultra RESILIA adoption. Scott Ullem, CFO, explained the Q4 SG&A increase was planned for strategic investments like EARLY TAVR education, AHA partnership, and field force reinforcement, with some spending delayed from earlier quarters. He noted moderated operating expense growth is planned for 2026. Dan Lippis further detailed European guideline amplification programs and U.S. patient/referrer education efforts.

Robbie Marcus asked two clarification questions: first, whether the strong Q4 performance in U.S. large joints included any one-time items or above-normal sales; and second, for guidance on the Q1 and first-half cadence for both top and bottom line, bridging expectations from the 5% exit rate to the 1-3% full-year guide.

Answer

Ivan Tornos, Chairman, President, and CEO of Zimmer Biomet, attributed the strong Q4 U.S. growth primarily to new product acceleration, with some benefit from additional capital sales and a modest uptick in ASC sales. He noted that international knee revenue in Q4 included some revenue shifted from Q3. Suky Upadhyay, CFO and EVP of Finance, Operations, and Supply Chain, Zimmer Biomet, stated that top-line growth is expected to be roughly consistent quarter-to-quarter in 2026, reflecting the Salesforce optimization and international go-to-market changes. Operating margins are projected to be down about 50 basis points for the full year. Q1 operating margins are expected to be down approximately 100 basis points year-over-year due to Paragon 28 not yet being anniversaried, higher commercial investments, and lower gross margins, with a sequential step-up of about 100 basis points in Q2.

Robbie Marcus sought clarification on the strong Q4 performance in U.S. large joints, asking if there were any one-time items, and requested guidance on the Q1 and first-half cadence for top and bottom line, bridging expectations from the 5% exit rate to the 1-3% full-year guide.

Answer

Ivan Tornos, Chairman, President, and CEO, confirmed Q4 U.S. large joint growth was driven by new product acceleration, with some capital sales and ASC uptick, but no major one-time items. Suky Upadhyay, CFO and EVP of Finance, Operations, and Supply Chain, stated top-line growth would be consistent quarterly. Operating margins are expected down ~100 bps year-over-year in Q1, then up ~100 bps sequentially in Q2, and in line with 2025 in H2.

Robbie Marcus asked for clarification on the 2% revenue growth guidance for fiscal Q2, considering it has the easiest year-over-year and two-year stack comparisons. He also inquired about any one-time considerations, such as TSAs or MSAs, that might affect the 25% adjusted operating margin target.

Answer

Vitor Roque, Senior Vice President and Interim Chief Financial Officer, explained that Q2's 2% growth is consistent with full-year guidance, with slight timing changes in Pharma Systems and MMS. He confirmed no specific one-time factors are expected for the 25% operating margin, which is driven by BD Excellence and a favorable mix from strategic investments. Tom Polen, Chairman, CEO and President, added that margin performance benefits from a higher gross margin in innovation and commercially invested areas, 8% productivity improvements from BD Excellence, and a significantly simplified manufacturing network (under 50 plants from over 90).

Robbie Marcus asked for clarification on the Q2 revenue guidance of approximately 2%, given it represents the easiest year-over-year and two-year stack comparisons. He also inquired about any one-time considerations, TSAs, or MSAs that should be factored into models for achieving the 25% operating margin target.

Answer

Vitor Roque, Senior Vice President and Interim CFO, explained that nothing fundamentally changed for Q2, with core growth drivers continuing, and slight timing shifts in Biopharma systems and MMS. He confirmed no specific one-time factors for the 25% operating margin, attributing it to strong BD Excellence execution and a favorable mix. Tom Polen, Chairman, CEO and President, added that innovation and commercial investments are focused on higher-margin areas, and BD Excellence has driven 8% productivity improvements, alongside network simplification from over 90 to under 50 manufacturing plants.

Robbie Marcus asked about the expected 100 basis point headwind from Alaris in fiscal 2026, its benefit in fiscal 2025, and the normalized run rate. He also questioned how BD plans to achieve operating margin expansion with low organic growth.

Answer

Chris DelOrefice, Executive Vice President and Chief Financial Officer, and Tom Polen, Chairman, CEO, and President of BD, explained that Alaris's successful relaunch contributed significantly to FY25, with Q1 FY26 facing the hardest comp. They confirmed the 100 basis point headwind for FY26 and noted that beyond FY26, it would be a 200 basis point headwind before normalizing. They attributed operating margin expansion to the power of BD Excellence, driving gross margin improvement, G&A leverage, and the announced cost-out program, despite absorbing significant tariff impacts, allowing for reinvestment in the business.

Robbie Marcus questioned the over 100 basis point headwind from Alaris in fiscal year 2026, asking about its benefit in fiscal year 2025 and the normalized run rate, and how BD plans to achieve operating margin expansion despite low organic growth.

Answer

EVP and CFO Chris DelOrefice explained that Alaris's relaunch success meant Q1 2026 would be the hardest comp, with a 100 basis point headwind for the full year. Chairman, CEO, and President Tom Polen added that BD would pivot to share gains and leverage the sales team for new launches like Pyxis Pro. Chris DelOrefice further detailed that BD Excellence drives gross margin improvement, offsetting tariffs, and enables reinvestment in the business, leading to underlying operating margin expansion.

Robbie Marcus (represented by Allen) asked about GE HealthCare's assumptions for China's market performance in 2026 and the potential for EPS upside relative to street expectations. He also sought clarification on the drivers behind the 2026 EPS guidance range and how the company anticipates achieving upside to initial targets.

Answer

Jay Saccaro (VP and CFO) and Peter Arduini (President and CEO) stated that China's Q4 2025 performance aligned with expectations, being the most challenging quarter. They adopted a cautious approach for 2026 guidance, anticipating a decline in China, despite observed improvements in VBP win rates and the imaging funnel. For 2026 EPS, Jay Saccaro explained the midpoint's $0.45 growth would be driven by $0.30 from volume and $0.30 from cost/productivity initiatives, offset by strategic investments in SG&A and R&D.

Robbie Marcus asked about Stryker's pricing expectations for both its capital and implant businesses in 2026, as well as the outlook for the capital equipment environment in both the U.S. and internationally. He also sought more color on the strong performance of Mako, Endoscopy, and Instruments, contrasting it with softer results in Trauma & Extremities and Vascular, inquiring about any stocking or destocking impacts.

Answer

Chair and CEO Kevin Lobo indicated that pricing in 2026 is expected to be similar to 2025, reflecting continued focus and muscle developed in price gains. VP of Finance and Head of Investor Relations Jason Beach confirmed a strong capital environment with an elevated backlog. Kevin Lobo attributed strong performance to Mako 4, camera innovation in Endoscopy, and power tools in Instruments. He noted Trauma & Extremities faced tough prior-year comps but has new product launches like Incompass Total Ankle, while Vascular's ischemic sector was challenging, offset by strong hemorrhagic business and new product launches like the Broadway catheter.

Robbie Marcus asked about global procedure volumes, the health of the equipment market, and the specific puts and takes on capital equipment globally, noting strong ortho and CapEx but some medical softness.

Answer

Kevin Lobo, Chair and Chief Executive Officer, confirmed healthy procedure volumes and strong capital markets, citing robust MEKO purchases. He noted variability in Medical's quarterly performance but expected a strong full year despite ongoing supply chain disruptions in emergency care. Preston Wells, CFO, explained the expected Q4 margin step-up, driven by higher sales and continued margin improvement, partially offset by increased tariff impacts.

Robbie Marcus asked about global procedure volumes, the health of the equipment market, and capital equipment trends, specifically noting some softness in the medical segment.

Answer

Kevin Lobo (Chair and CEO, Stryker) confirmed healthy procedure volumes and strong capital markets, highlighting significant Mako purchases. He explained that variability in the medical segment is normal, with a strong Q4 expected despite ongoing supply chain disruptions in emergency care. Preston Wells (CFO, Stryker) detailed the Q3 to Q4 margin step-up, attributing it to higher sales and continued margin improvement efforts, partially offset by second-half weighted tariff impacts.

Robbie Marcus inquired about the discrepancy in organic revenue numbers between the J.P. Morgan conference and current slides, and the drivers behind the orthopedic segment's outperformance and general surgery's underperformance in Q4 2025, along with the outlook for both in 2026.

Answer

Todd Garner, EVP and CFO, clarified that the organic revenue numbers are now more precise due to final 2025 figures. Patrick Beyer, President and CEO, attributed orthopedic strength to committed sales, an improving supply chain, BioBrace momentum, and new European clinical solution approvals. General surgery's decline was due to portfolio management, exiting minor products, and focusing on direct smoke business, particularly impacting U.S. OEM sales.

Robbie Marcus asked for clarification on the organic revenue numbers presented, noting a difference from a previous healthcare conference, and sought details on the drivers behind the strong orthopedic performance and weaker general surgery results in Q4 2025.

Answer

Todd Garner, Executive Vice President and Chief Financial Officer, clarified that the updated organic revenue numbers reflected more precise final 2025 figures. Patrick Beyer, President and Chief Executive Officer, attributed orthopedic strength to an improving supply chain, BioBrace momentum, and new product approvals internationally. General surgery's U.S. decline was due to portfolio management and a focus on direct smoke business over OEM.

Representing Robbie Marcus, Lily from JPMorgan Chase & Co. asked about the drivers behind softer-than-expected capital sales and potential impacts from hospital budgets. She also questioned ConMed's orthopedic market share position given ongoing supply disruptions.

Answer

President & CEO Patrick Beyer explained that while general hospital capital demand is strong, ConMed's results were impacted by tough prior-year comparisons and internal supply chain challenges. He acknowledged a loss of orthopedic market share due to these constraints but highlighted that innovation like BioBrace keeps the company well-positioned for a recovery.

An analyst on behalf of Robbie Marcus questioned if 2025 would be the year for a return to accelerated top-line growth and asked for an update on the previously mentioned smoke evacuation quality issue.

Answer

CEO Curt Hartman deferred specific 2025 growth guidance to the January call but highlighted strong underlying Q3 performance in adjusted EPS, cash flow, and leverage reduction. EVP and CFO Todd Garner confirmed the smoke evacuation quality issue was a transitory Q2 event that is now resolved, with Q3 showing improvement but not a full return to normal trends.

Robbie Marcus asked for more detail on Intuitive's gross margin and operating expense (OpEx) assumptions for 2026, specifically how the ramp-up of da Vinci XIR and trade-ins might impact margins, and what factors contribute to the high and low ends of the OpEx guidance. He also sought an update on the competitive landscape in China, including the impact of new reimbursement programs favoring local competition and the latest tender results.

Answer

CFO Jamie Samath explained that gross margin dynamics include higher trade-ins, a greater mix of da Vinci 5 (not yet at target product costs), procedure guidance, product cost reductions, leveraged facility depreciation, and an incremental 50 basis points impact from tariffs in 2026 (total 120 bps). He noted XIR pricing would be lower than new Xi but with healthy margins. The 11-15% OpEx range reflects the impact of going direct in Italy, Spain, and Portugal, and the procedure range. CEO Dave Rosa addressed China, noting increasing local robotic competitors with similar architectures to Xi, leading to intense pricing in tenders. Intuitive competes with locally manufactured Xi systems and a strong local team. Jamie Samath added that 273 systems remain in the current quota, and the Q4 tender win ratio was lower, though 2025 overall was slightly higher.

Robbie Marcus sought further color on the gross margin and operating expense (OpEx) assumptions for 2026, specifically how da Vinci XIR ramps, trade-ins, and other factors impact margins, and what is assumed at the high and low ends of the OpEx guidance. He also asked about increased price and competition in China, new reimbursement programs favoring local competitors, Intuitive's competitive position, and updates on the latest tender.

Answer

CFO Jamie Samath detailed gross margin dynamics, including higher trade-ins, a greater mix of da Vinci 5 (not yet at target cost), product cost reductions, and increased tariffs (120 basis points in 2026 vs. 65 basis points in 2025). He noted XIR margins are healthy despite lower pricing. The 11-15% OpEx range reflects the direct acquisition in Italy, Spain, and Portugal, and the procedure range. CEO Dave Rosa addressed China, acknowledging increasing local robotic competitors and intensified pricing in tenders. He affirmed Intuitive's strong position with the Xi system, local manufacturing, and team. Jamie Samath added that 273 systems remain in the current quota, and the Q4 tender win ratio was lower, though 2025's overall ratio was slightly higher than the prior year.

Robbie Marcus inquired about the impressive 20% procedure volume growth, its sustainability, and the extent to which Da Vinci 5's introduction contributed to this uptick in both U.S. and international markets. He also asked about the strategy for refurbished Xi systems, their potential to open new channels and countries, and where client interest is highest for these units in 2026 and beyond.

Answer

Jamie Samath, CFO, detailed the U.S. Da Vinci procedure growth trends, noting strong performance in after-hours surgery, acute care, and specific benign general surgery procedures, while acknowledging anecdotal evidence of procedure acceleration in July/August. Dave Rosa, CEO, added that Da Vinci 5's design intent for ease of learning and use is being validated by customer adoption, supporting utilization. Samath further specified 67,000 Da Vinci 5 procedures in Q3. Regarding refurbished Xi systems, Dave Rosa, CEO, explained their role in expanding the portfolio for cost-sensitive customers and alternative sites of care, both domestically and internationally. Jamie Samath, CFO, mentioned 20 refurbished Xi systems sold to date and highlighted their flexibility for segmentation, including U.S. ambulatory surgery centers.

Robbie Marcus asked for an updated perspective on continuous glucose monitoring (CGM) growth expectations for 2026, specifically if a low-to-mid teens growth rate is appropriate, and Abbott's position within the broader market. He also inquired about the magnitude and drivers of margin expansion for 2026.

Answer

Chairman and CEO Robert Ford confirmed expectations for low-to-mid teens CGM growth in 2026, emphasizing that consistent $1 billion annual growth signifies robust performance, not slowing. He highlighted significant penetration opportunities across all patient segments (intensive, basal, non-insulin users) globally, noting progress on U.S. non-insulin user reimbursement and the potential for the dual glucose-ketone sensor to drive market share and expansion. Executive Vice President, Finance and CFO Phil Boudreau added that Abbott aims for 50-70 basis points of operating margin improvement annually, driven by gross margin expansion and P&L leverage.

Robbie Marcus asked about the expected CGM growth for 2026, anticipating low to mid-teens, and sought an update on market growth and Abbott's competitive position. He also inquired about the magnitude and drivers of margin expansion contributing to double-digit EPS growth.

Answer

CEO Robert Ford confirmed expectations for approximately $1 billion in annual CGM sales growth, translating to low teens percentage growth. He emphasized significant penetration opportunities across intensive, basal, and non-insulin users globally, noting progress on U.S. non-insulin user reimbursement. He also highlighted the upcoming dual glucose-ketone sensor as a key opportunity for market share conversion and expansion. CFO Philip Boudreau stated that Abbott is committed to margin expansion, targeting 50-70 basis points of operating margin improvement annually through gross margin expansion and P&L leverage, which underpins the double-digit earnings forecast.

Robbie Marcus inquired about Abbott's diabetes business, specifically U.S. versus international growth dynamics, the impact of the ketone sensor, and potential CMS coverage for non-intensive type 2 diabetes. He also asked for an update on the Volt PFA catheter's early feedback in Europe and its expected ramp in the U.S. for electrophysiology.

Answer

Robert Ford, Chairman and CEO, clarified that U.S. diabetes growth was 19% in Q3, with year-to-date at 25%, attributing earlier higher growth to shelf restocking. He expects strong U.S. growth in 2026 driven by the dual analyte sensor and continued basal segment penetration (currently 20% U.S., <5% international). Ford sees potential for CMS coverage of type 2 non-insulin next year but it's not in the 2026 forecast. For EP, he noted accelerating growth, positive European feedback for Volt PFA (efficacy, safety, N-Site integration enabling conscious sedation), and Abbott's comprehensive portfolio (PFA and LAA) positioning it well for 2026.

Robbie Marcus inquired about the preliminary outlook for 2025, asking if the current Wall Street consensus for high single-digit revenue growth and 10% EPS growth is a reasonable starting point.

Answer

Robert Ford, Chairman and CEO, agreed that the consensus estimates for 2025 are a 'very reasonable starting point.' He highlighted that Abbott enters 2025 with strong momentum, attractive market positions, a productive pipeline, and the benefit of not having the 'COVID cloud' to obscure underlying base business growth, which should support continued margin expansion.

Robbie Marcus from JPMorgan Chase & Co. inquired about the Boston Scientific WATCHMAN device's role as a primary growth driver, seeking insights into expected growth trajectory and financial contribution, particularly in light of positive CHAMPION trial data and increasing concomitant procedure adoption.

Answer

Chairman and CEO Mike Mahoney highlighted WATCHMAN as a "gem" for Boston Scientific, emphasizing its market-creating clinical evidence and strong future portfolio. He noted that concomitant procedures continue to exceed expectations, with 25% of WATCHMAN procedures anticipated to be concomitant by year-end 2025, driven by the trusted FARAPULSE and WATCHMAN combination. Mahoney reiterated confidence in a 20% market CAGR over the long-range plan, supported by an underserved patient population, global expansion (including China's FLX Pro approval), and ongoing investment in portfolio enhancements and clinical evidence.

Robbie Marcus asked about Watchman's role as a key growth driver, the acceleration from concomitant procedures and Option data, and the expected growth and dollar contribution, especially with the upcoming Champion data and the market's low penetration.

Answer

Chairman and CEO Mike Mahoney highlighted Watchman as a 'gem' for Boston Scientific, driven by strong clinical evidence, a robust future portfolio, and the Champion trial readout in H1 2026. He noted concomitant procedures are exceeding expectations, projected to reach 25% of Watchman procedures by year-end 2025, and reiterated a comfortable 20% market CAGR over the long-range plan due to the underserved patient population and globalization efforts, including the Watchman Flex Pro approval in China. Chief Medical Officer Dr. Ken Stein added that the 20% growth projection is 'conservative' given the underpenetrated indicated population and clarified that the Closure AF trial is not a strong read-through for Champion, while Alone AF/OCEAN data supports Therapulse growth without materially impacting concomitant Watchman procedures.

Robbie Marcus sought to understand the lowered guidance, asking how much was based on results seen so far versus future expectations or conservatism. He also asked about the margin progression for the remainder of the year on the lower revenue guide.

Answer

President & CEO Albert White explained the guidance revision is a combination of actual market data (4% growth in calendar Q1), observed channel inventory pressure, and a degree of conservatism. CFO Brian Andrews added that the margin improvement story remains intact, expecting gross and operating margins to be up year-over-year in the second half due to efficiency gains and disciplined cost management.

On behalf of Robbie Marcus, an analyst asked why the consistent top-line sales upside throughout the year has not translated into raised adjusted EBITDA guidance.

Answer

CEO Brenton L. Saunders and CFO Osama Eldessouky both explained that the lack of EBITDA flow-through is a direct result of a strategic decision to make significant investments during what they termed an 'investment year.' These funds are being used to support the most robust launch cycle in the company's history, including products like Miebo, Xiidra, new IOLs, and Daily SiHy lenses, to ensure their long-term success.

Questioned the optimism for 2025 performance, asking why newer reps and the current portfolio would drive improvement, and inquired about the timeline and plan to achieve positive cash flow.

Answer

The company expects 2025 to improve due to territory expansion with newly promoted reps, continued ramping of the SI joint business, and the start of the IPG replacement cycle. Achieving positive cash flow is delayed by the lower revenue outlook, but they believe they are not far off and need more revenue growth.