Myomo - Q1 2023
May 10, 2023
Transcript
Operator (participant)
Good afternoon, welcome to the Myomo first quarter 2023 earnings conference call. All participants will be in a listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star then one on your telephone keypad. To withdraw your question, please press star then two. Please note this event is being recorded. I would now like turn the conference over to Kim Golodetz. Please go ahead.
Kim Golodetz (SVP and Principal)
Thank you, operator, and good afternoon, everyone. This is Kim Golodetz with LHA. Welcome to the Myomo first quarter 2023 conference call. Earlier today, Myomo issued a news release announcing financial results for the three months ended March 31st, 2023. If you would like to be added to the company's email distribution list to re-receive future announcements, please register on the company's website at myomo.com or call LHA at 212-838-3777 and speak with Carolyn Curran. With me on today's call from Myomo are Paul Gudonis, Chief Executive Officer, and David Henry, Chief Financial Officer. Before we begin, I'd like to caution listeners that statements made during this conference call by management, other than historical facts, are forward-looking statements.
The words anticipate, believe, estimate, expect, intend, guidance, outlook, confident, target, project, and other similar expressions are typically used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and may involve and are subject to certain risks and uncertainties and other factors that may affect Myomo's business, financial condition and operating results. These and additional risks, uncertainties and other factors are discussed in Myomo's filings with the Securities and Exchange Commission, including the Form 10-Q for the quarter ended March 31, 2023 and subsequent filings. Actual outcomes and results may differ materially from what's expressed in or implied by these forward-looking statements. Except as required by law, Myomo undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this call. It's now my pleasure to turn the call over to Myomo CEO, Paul Gudonis.
Paul, please go ahead.
Paul Gudonis (CEO)
Thanks, Kim. Good afternoon, everyone, and thanks for joining us. As demonstrated by our Q1 financial results, we had a very strong start to the year. The decisions we made about advertising and reimbursement strategies, along with the actions to control costs, have begun to pay off while positioning us well for both top line growth and an improved bottom line in 2023. Product revenue in Q1 2023 was $3.4 million, which met our expectations of 20% year-over-year growth in MyoPro sales. We increased our patient pipeline with more than 400 new candidates entering the process of obtaining a MyoPro. We expanded the use of new digital technologies in the front end of our patient conversion cycle, and we now use an online waiting room where interested patients can be screened via telehealth by our licensed clinicians.
Compared with the first quarter of 2022, this pipeline growth represents a 54% increase in the number of patients with previous payers, those that have reimbursed for the MyoPro in the past. We did this while spending 33% less on direct-to-consumer marketing. In turn, our cost per pipeline add is down 53% from the first quarter of 2022 and down 50% from the fourth quarter of 2022. These metrics are all trending in the right direction. As you may recall, earlier this year we modified our pipeline focus to patients who have insurance from carriers that have paid for the MyoPro in the past. We received 122 authorizations and orders during the quarter, which is up 30% from a year ago.
The backlog also increased to 176 units, representing over $7 million in potential revenue as we complete the deliveries and/or receive payment for these devices. We were able to accomplish these additions to the pipeline, the insurance authorizations and deliveries with a 12% lower headcount, which resulted in improved operational efficiencies. Our international business generated record revenues in the quarter as we continue to add O&P provider locations in Germany and obtain insurance reimbursement, which is largely due to the favorable social court rulings over the past year. We also achieved a major significant milestone in Australia, where the National Disability Insurance Scheme, or NDIS, began paying for MyoPro, and we expect this will lead to future sales in that country.
The other major international development occurred in April when our China joint venture paid the remaining $1.7 million of the initial license fee. As the COVID-19 lockdowns were lifted across China, our partners, Ryzur Medical and Chinaleaf, were able to move forward and launch the JV startup activity for Jiangxi Myomo. We've begun the process of providing technical documentation know-how so that the JV staff can establish its local manufacturing and distribution operations. The JV is also starting the process to obtain regulatory approval from the National Medical Products Administration to begin offering the Myomo product line to rehab hospitals and to patients.
As a reminder, the JV contract calls for more than $10 million in additional license payments over the next decade. Myomo shareholders have a 19.9% equity stake in Jiangxi Myomo, with our Chinese partners putting up all the capital to fund this business. Here in the U.S., we continue to work toward our goal of securing Medicare Part B coverage for MyoPro, ultimately as a lump sum payment. In the interim, more likely as a rental because that's how we're currently classified by the Centers for Medicare and Medicaid Services or CMS. In January 2023, CMS issued a public notice regarding new rulemaking around defining the benefit for neck, arm, leg and back braces and newer technologies.
We see this as a good sign that CMS recognizes the value of new technology-driven braces, and we believe that this new rule, when published next summer, will provide CMS's official response to our benefit category change request. A change in the benefit category, if made, could lead to lump sum reimbursements. In the meantime, we've moved forward as recommended by CMS staff to make the MyoPro accessible to Medicare Part B patients. Last month, we met with the medical directors and staff of the CMS billing contractors, referred collectively as the DME MACs, and we presented new clinical evidence contained in two studies submitted for publication to support the reimbursement of the MyoPro for Medicare beneficiaries. While I can't go into details regarding the research until publication, both studies add to the body of research that supports the safety and the effectiveness of the MyoPro.
We also filed two claims for devices provided to Medicare Part B beneficiaries, and we're now going through the process of having these claims reviewed for payment. To increase these chances for success, these claims are for reimbursing MyoPro as a rental and are being processed by the DME MACs. The claims are being evaluated per Medicare's policy for individual consideration and may result in the payment of the claim or if the initial submission is denied, we file an appeal which triggers a manual review of the patient's medical necessity criteria and their chart notes. In addition, we're in the process of identifying and evaluating four additional Medicare Part B patients, and we plan to submit additional claims in the coming weeks covering all four of Medicare's billing regions.
When we have definitive information on a few of these claims and we begin to see a pattern among the DME MACs or if there's publicly available information from CMS, we will use this to update investors. As I stated during our last call, we expect to have some clarity on reimbursement for Part B patients by the end of June. While there's no specific timeline for the actions by CMS or its billing contractors, we believe that coverage of the MyoPro for Medicare Part B beneficiaries would address the issue of equitable treatment of these seniors since others with Medicare Advantage, VA patients and those covered by various private payers are able to obtain a MyoPro and improve the quality of their life and their health outcomes.
I'll turn the call over to David Henry, Myo's CFO, for more detailed discussion on our financial results. Dave?
David Henry (CFO)
Thank you, Paul. Good afternoon, everyone. Let me start my remarks with a review of our first quarter financial results. Total revenue for the first quarter of 2023 was $3.4 million and was comprised solely of product revenue. This was down 11% from the prior year quarter, which included the $1 million partial payment of the technology license fee from our joint venture partner in China. Excluding that payment, product revenue increased 20% year-over-year. This growth was driven by a higher number of revenue units and a higher average selling price or ASP. We recognized revenue on 80 units in the quarter, which was an increase of 13% over the prior year. ASP was approximately $43,000, up from approximately $40,000 in the fourth quarter of 2022.
The direct billing channel represented 70% of revenue in the first quarter compared with 65% in the prior year quarter and 70% in the fourth quarter of 2022. We realized record international revenue in the quarter, which represented 20% of product revenue. The remaining 10% of revenue was from the VA and domestic O&P channels. Backlog, which represents insurance authorizations and orders received but not yet converted to revenue, was 176 units at quarter end, up 10% compared with the prior year quarter and up 7% sequentially. Our patient pipeline increased to 855 candidates in the first quarter, up 28% from the year ago quarter, which has been revised to reflect only previous payers.
As Paul mentioned, a record 438 patients were added to our pipeline in the first quarter, an increase of 54% over the prior year. The year-ago pipeline additions have also been revised to reflect only previous payers. Our pipeline was more volatile than usual in the first quarter as a large number of patients exited the pipeline. Our new virtual waiting room certainly increased pipeline additions and decreased the cycle time from lead to initial evaluation, but it's unclear if this also contributed to the higher number of pipeline drops. We'll be closely monitoring this metric in the coming months. Gross margin for the first quarter of 2023 was 67% compared with 66.7% for the prior year quarter. This increase was driven by a higher ASP and lower warranty reserves.
I should also note that first quarter a year ago's gross margin was also benefited by the $1 million partial license payment. Operating expenses for the first quarter of 2023 were $5 million, a decrease of 6% compared with the first quarter of 2022. The improvement was primarily driven by our headcount reduction in January, as well as lower advertising expenses. Which decreased 33% compared with the prior year quarter. We're on pace to spend roughly $1 million less on advertising in 2023, which is part of the $2 million in annual operating expense savings we're expecting for the year. As a result of the improved efficiency of our marketing efforts, our cost per pipeline add decreased to $1,579, which is down 53% compared with the prior year quarter and down 55% sequentially.
Operating loss for the first quarter of 2023 was $2.7 million, compared with an operating loss of $2.7 million for the first quarter of 2022, which included the benefit of the partial payment of the initial technology license fee. Net loss for the first quarter of 2023 was $2.6 million, or $0.11 per share, compared with a net loss of $2.8 million or $0.41 per share for the first quarter of 2022. Net loss in the first quarter of 2023 includes the impact of the shares issued in our offering in January. Note that the 6.8 million pre-funded warrants issued in that offering are considered common stock equivalents under GAAP and are included in our weighted average shares outstanding. None of the pre-funded warrants have been exercised as of today.
Adjusted EBITDA for the first quarter of 2023 was -$2.5 million, compared with -$2.4 million in the first quarter of 2022, which again also included the benefit of the partial license fee. Turning to our cash position. Cash and cash equivalents as of March 31st, 2023 were $9.3 million. Cash used in operating activities was $1.8 million for the first quarter of 2023. Looking ahead, as Paul mentioned, we received the remaining initial technology license fee of $1.7 million in April. This amount will be recorded as license revenue in the second quarter. Pro forma for the licensee payment, we entered the second quarter with approximately $11 million in cash. As a result of this payment, we expect record second quarter total revenue.
With the increase in backlog in the first quarter, we're in position to grow second quarter product revenues both year-over-year and sequentially. We continue to believe that product revenue growth for the full year of between 20% and 30% is attainable. With that financial overview, I'll turn the call back to Paul.
Paul Gudonis (CEO)
Thanks, Dave. Well, as I outlined in my recent shareholder letter, this year marks 10 consecutive years of revenue growth for Myo. We expect another year of growth based on the size of our patient pipeline, and we plan to meet growing demand with increased operational efficiency and lower cash burn. Our actions earlier this year to focus on the highest yield candidates in the pipeline to lower the costs of growing the pipeline and to reduce our operating expenses should enable us to reach these financial goals during the course of the year. With that business and financial overview, we're now ready to take your questions. Operator?
Operator (participant)
We will now begin the question and answer session. To ask a question, you may press star, then one on your telephone keypad. If you are using a speakerphone, please pick up your handset before pressing the keys. To withdraw your question, please press star then two. At this time, we will pause momentarily to assemble our roster.
Paul Gudonis (CEO)
Before we take the first question, I want to mention that we'll be participating in the A.G.P. MedTech Conference on May 23rd and 24th, and the Maxim MedTech Conference on June 20th and 21st. We're available for virtual and in-person investor meetings, so please contact LHA Investor Relations to set up a time. Okay, operator, we're ready for the first question whenever you are.
Operator (participant)
Our first question comes from Ben Haynor from Alliance Global Partners. Please go ahead.
Ben Haynor (Managing Director)
Good afternoon, gentlemen. Thanks for taking the question. First off, for me, can you talk a little bit more about the implementation of the virtual waiting room? You know, maybe if I heard you right, you think that there may be some impact to the pipeline drops. Can you, can you kind of explain why or speculate on why that may be?
Paul Gudonis (CEO)
We've been implementing this new technology so that when someone sees one of our ads, whether it's on television or social media, or they go to the website and they reach out to our call center, which is in Texas, we'll have an initial discussion with the patient, understand what their insurance, their diagnosis, and then ask them if they would like to participate in a free, no obligation screening right then. If they say yes, we can send them a link, and then on their laptop or on their cell phone, they can immediately be put into this, we call an online waiting room. We'll have an available clinician, one of our certified prosthetist orthotists, who can immediately conduct a telehealth screening.
was very convenient for patients. It's been convenient for our clinical staff as well. Avoids having to try to set up an appointment, which might be the next day, it might be a week or two later. People can immediately be evaluated, consider whether or not they'd like to be a candidate for the MyoPro. We explain the process they have to go through. They have to go get an appointment with their doctor face-to-face. They have to get their chart notes, a written order, and so on, in order for us to move forward with insurance. A lot of people, candidates have taken advantage of this really convenient approach. We added a lot of candidates to the pipeline
We're trying to assess whether or not people need more time to consider the process. We have to provide them with additional information. We're seeing the trade-off of, you know, the convenience of it versus, you know, the effectiveness of having people in the pipeline. There may be other factors that we're just not aware of. People may have other health issues going on, they may wanna take their time in considering moving forward in the with the MyoPro, so we keep them in our database.
David Henry (CFO)
Yes. The cycle time between lead and that initial telehealth evaluation, decreased pretty substantially in the first quarter. What we're asking ourselves is whether that decrease in cycle time was really time that a patient might use to, you know, that they were using maybe a quarter, two quarters, three quarters ago, to think about whether they wanna go forward, talk to their families, things like that. Because patients always drop out. You know, we used to be able to not get ahold of many patients after their initial contact, and they ended up being pipeline drops that way.
We wonder if we've now just sort of, kinda, you know, increased pipeline assets and each increased drops because patients that haven't had really the time to speak to their families before that initial telehealth evaluation.
Ben Haynor (Managing Director)
Okay. That's helpful and that all makes sense. Have you seen any difference in the mix of the, you know, the patient's diagnosis that, or diagnoses that have come through with the virtual waiting room versus previously? Or is that kinda, it hasn't changed at all?
Paul Gudonis (CEO)
Yeah, Ben, it's been pretty stable. I mean, the majority of the candidates who reach out to us, have hemiparesis, due to a stroke. That remains our number one diagnosis. The next one would be brachial plexus injuries, that's the shoulder nerve. Maybe third would be spinal cord injuries.
Ben Haynor (Managing Director)
Okay. Got it. Then lastly for me on the your discussions with the DME MACs, any additional feedback, any color that you can share on how those meetings went? I understand we're, you know, we're waiting for a month and a half or so for the potential category change. On the DME MAC side, any more color that you can provide there?
Paul Gudonis (CEO)
Well, I would say I thought we had a very good meeting. It was a number of participants from the DME MAC medical director staff from what's called the PDAC, some of their professional staff, including a Certified Prosthetist Orthotist, medical director. We had quite a long discussion. We reviewed the research that I mentioned here, 'cause we wanted to make sure that they understood that this, which is one of the criteria, is that will this device be beneficial for Medicare age beneficiaries? In our patient registry, retrospective research that is underway to be published, we point out that these patients did improve the relevant endpoints by having MyoPro.
These are patients who are seniors who have Medicare Advantage plans, so they fit in that over 65 category, which is important for the DME MACs in making their decision.
Ben Haynor (Managing Director)
Okay. Got it. Well, thanks for taking the questions, gentlemen, I'll jump back to you.
Operator (participant)
Our next question comes from Scott Henry from Roth Capital. Please go ahead.
Scott Henry (Managing Director and Senior Research Analyst)
Thank you. Good afternoon. A couple questions. You know, I'm starting to look at the model through the new funnel of payers with a history of making payment. You know, I'm seeing some different trends, and I'm curious if it's just noise or your thoughts. Not unexpectedly, you're seeing a higher percent of authorizations, which would make sense if it's a higher quality group. I'm also seeing, at least in the first quarter, I saw a higher, you know, assuming I'm looking at these numbers correct, but it looks like I saw a higher percent of backlog dropouts and a higher percent of, you know, lost patients who were in the cumulative reimbursement pipeline. What are your thoughts on those numbers? Albeit very early at this point.
David Henry (CFO)
Yeah. Hi, Scott. It's Dave. How are you? Yeah, you're right. The, the authorization rate did increase. It was expected to increase. We'll see if that, how that trend continues as we move through the other quarters. We were just having a conversation with Ben about sort of the pipeline and why we thought that the churn in the pipeline was higher than normal in the first quarter. That's something, again, that we'll probably be looking to validate ourselves in the coming months here to see if that trend continues. In terms of the backlog, you know, we did have a higher percentage of people drop out of the backlog in first quarter.
We did have a large number of people from the standpoint of their medical conditions changing, which was a reason for the dropouts. We had a few, I won't say it was that many, I'd call it a handful, that dropped out as a result of the change we made in the pipeline because we had a few patients in the backlog that were more older patients in the backlog that were with payers that weren't considered good payers anymore. We decided that to discontinue any efforts that more people were just spending resources trying to or spending their time trying to collect. We dropped a few of those. Those are the primary reasons for the change in the backlog.
You know, aside from that, those handful that dropped that I would say that are directly related to our strategy to only focus on previous payers, the rest of the change was just really due to a higher number of people with medical things going on medically than we'd seen in prior quarters.
Scott Henry (Managing Director and Senior Research Analyst)
I guess, you know, Dave, just to follow up on that, it sounds like a lot of these numbers, you know, once you get used to this new virtual waiting room, should sort of revert back to where they were before. The patients you pick up this quarter because there were shorter throughput, well, you know, next quarter they're not gonna fall in because it was longer throughput. It sounds like it should normalize. Is that fair? Probably all of these metrics should... You know, with the exception, I would expect authorization to be higher, but it sounds like pipeline adds should kind of be where it would be regardless over time. I mean, how do you think about those?
David Henry (CFO)
Yeah. I mean, I think that's correct. I think it would also depend on the, you know, the continued success of the lead generation, if we are trying to adhere to a budget. So we're trying not to spend more than we need to generate leads. So that will be a constraining factor, which I think will help keep the cost of pipeline add down. The question will be is, will the number of adds continue to be, you know, where they've been? So it's we're kind of learning as we go with this new methodology, but we're encouraged by the results so far in first quarter.
Scott Henry (Managing Director and Senior Research Analyst)
Okay. great. Dave, I think you said you're looking for 20% to 30% revenue growth in 2023 off of, I assume a base pulling out the one-time events last year. Does that reflect anybenefit from CMS or, you know, is that more of a 2024 event?
David Henry (CFO)
Yeah, no, I mean, we're not, we're not assuming anything regarding CMS.
Scott Henry (Managing Director and Senior Research Analyst)
Okay. Great. I think that should do it for me right now. Thank you for taking the questions.
David Henry (CFO)
Sure. Thanks, Scott.
Operator (participant)
The next question comes from Jim Sidoti from Sidoti & Company. Please go ahead.
Jim Sidoti (Analyst)
Hi. Good afternoon. Thanks for taking the questions. It seems like you're attacking the reimbursement issue on multiple fronts. With the DME MACs, if you are approved as a rental, do you have any sense on what the length of that rental would be or what the monthly payment would be?
David Henry (CFO)
Typically with DME rentals, those are paid on a monthly basis, for a total of 13 months. At the end of the 13 months, the patient owns the device. We have to make sure that the patient continues to use the device during that period of time, and then we bill monthly. We don't know how much they would pay. That's why we've submitted a couple claims. We're gonna submit a couple more to see, you know, what the results are. I will say this.
Jim Sidoti (Analyst)
Okay.
David Henry (CFO)
Sorry.
Jim Sidoti (Analyst)
Sorry. Go ahead. Sorry, Dave.
David Henry (CFO)
Yeah, I was gonna say that according to the Medicare, you know, their billing manual, what they, you know, what they do under a capital program is they're, you know. If you look at the, you know, the sum total of 13 months of rentals compared to a lump sum payment, they do give a little bit of a bump up, around 5% for rental payments because of, you know, they try to take into account the time value of money.
What, you know, so what you might get in terms of a benefit in terms of the, you know, the 13, you know, the, you know, the patient if they go through all through the 13 months, we have to work to make sure that the patient continues to use the device. That's why we have our, you know, our MyoCare coaches and things like that we, you know, we have people on our staff that follow up with patients post-delivery to try to make sure that their outcomes are maximum.
Jim Sidoti (Analyst)
Okay. That makes sense. Could there possibly be a situation where you could get approved in one region but not in another?
David Henry (CFO)
Yes, that can happen because there are four regions. Each have their own medical directors, and that's why we met with all four medical directors presenting the same data. We're filing claims in all four regions to see if we'll get approved in each one of those regions.
Jim Sidoti (Analyst)
Do they coordinate with regard to the reimbursement amount, or could those vary from region to region as well?
David Henry (CFO)
They could vary from region to region. I know that, my understanding is that these medical directors regularly conference with each other, but I don't know if they may make distinctions between each different region.
Jim Sidoti (Analyst)
Okay. If you do start getting reimbursed from one of the regions, will that help you with the private payers?
Paul Gudonis (CEO)
I think it would be a good demonstration.
To the private payers, especially Medicare Advantage plans that may not be covering the MyoPro to date. That says, "Look, Medicare standard fee for service is covering this. You're obligated to cover this as well." Although we continue to be, this is individual consideration, but we do think that having some payments by under Part D coverage would be a real positive with Medicare Advantage plans.
Jim Sidoti (Analyst)
Okay. All right. Switching to the international sales, 20%, which is, I think the highest I've seen in a while. Is that all from Germany?
Paul Gudonis (CEO)
Most of it's from Germany. We actually talked about the National Disability Insurance Scheme approval. That was revenue in the first quarter. We don't really talk about it, but we did a sale to another European country. It was more from a research standpoint, not one that we're expecting to continue, at least in the near term. More of a one-off. The bulk of the sales are from Germany. We've been expanding our team of business development managers and clinical trainers, and O&P locations, that know the MyoPro in Germany, and that's been working well.
Jim Sidoti (Analyst)
Do you think Australia could be, could ramp up similar to the way Germany did? Or do you think Australia would be a smaller piece of the pie?
Paul Gudonis (CEO)
I think, well, Australia's a smaller country than Germany.
We don't have staff on the ground, in Australia like we do in Germany. I think, you know, that presence that we have, both business development and clinical support, has been a big part of, why the German market has grown so well.
Jim Sidoti (Analyst)
Got it. Got it. Were you surprised at all to receive the $1.7 million payment from the Chinese joint venture? 'Cause I know on the last call, you seemed a little hesitant regarding that one.
Paul Gudonis (CEO)
Surprised, well, I don't think is the right word. I think we were pleased. Yeah, we're glad that, you know, they're, you know, they're finally, you know, able to move forward. I think, you know, I think they just needed, you know. I believe that they needed the government just to. They need the conditions to be right, I think, for them to, you know, start up a new business venture.
Jim Sidoti (Analyst)
Right. Okay. All right. Well, you know, it seems like, you know, revenue's going up, expenses are going down. I mean, it seems like things are moving in the right direction. You know, hopefully that trend, those trends continue.
Paul Gudonis (CEO)
Thanks, Jim.
Operator (participant)
Once again, if you have a question, please press star then one. Our next question comes from Edward Wu from Ascendiant Capital Markets. Please go ahead.
Edward Wu (Equity Research Analyst)
Yeah, thank you for taking my question. On the China joint venture, is there any timeline for the next process? When would you possibly get additional revenue from the joint venture?
Paul Gudonis (CEO)
We are having weekly team calls, you know, of our engineering and operations team, regulatory, clinical team, with the China Joint Venture staff. Their next steps are really to obtain a NMPA approval. That's the equivalent of the Chinese FDA, to be able to market the devices there. We don't know exactly when that would happen. The other key activity in parallel is to establish especially the manufacturing operations and the supply chain. We are working with them to identify the equipment they need to purchase, like 3D printers, test fixtures, assembly equipment. They have to order the various parts, including the motors, the electronics, the batteries and so on. That's what's underway.
Don't have a timeframe when production would start yet, because it's only been about 30 days since we've kicked off this joint venture project. Yeah, It's the key gating item is the NMPA approval. We don't expect that they'll begin risking manufacturing before knowing that they're gonna get NMPA approval to proceed.
Edward Wu (Equity Research Analyst)
Great. My last question is, as a reminder, where does the joint venture have their distribution rights? Is it only in China?
Paul Gudonis (CEO)
It's China, Hong Kong, Taiwan and Macau.
Edward Wu (Equity Research Analyst)
Great. Well, thanks for answering my question. I wish you guys good luck. Thank you.
Paul Gudonis (CEO)
Thanks, Ed.
Operator (participant)
This concludes our question and answer session. I would like to turn the call back to Paul Gudonis for closing remarks. Please go ahead.
Paul Gudonis (CEO)
Thanks, operator. In closing, I just wanna highlight what makes Myomo a special company. We have a large unmet market opportunity to assist these individuals with upper extremity paralysis, and there's a growing awareness among clinicians of the MyoPro's utility. We've combined the use of digital technology with a targeted marketing approach to lower the costs of providing the MyoPro to these patients. Our international sales are growing, as you heard today, helped by the recognition from payers of the use of the MyoPro to improve activities of daily living. We're making good progress with CMS and expect to have more robust reimbursements in the U.S. in the near term, while at the same time, we developed an excellent track record of obtaining reimbursement from other health plans in the U.S.
We continue to innovate in product design and our business processes to operate more efficiently as we scale the business. Again, thanks for your continued interest in Myomo, and have a good rest of your day.
Operator (participant)
The conference is now concluded. Thank you for attending today's presentation. You may now.