Rick Buchholz: Yes. Hi, Lei. Sure. First, we haven’t quantified the strength in Q4. We’ve mentioned before some of the procedures did not get scheduled or completed in Q3, but we haven’t quantified it. There’s some procedures done in the fourth quarter, and some will carry into first and second quarter of 2024. Regarding the outside the U.S., we had mentioned before that we would — we could see a $4 million headwind in the fourth quarter. That’s about what we saw, roughly in the fourth quarter. Will we see that come through in the first quarter? Probably not. That will be — that will take a few quarters to clear that. So there won’t be a bolus in the first or second quarter. But we’ll work through that. As Tim mentioned, most recently, we did get Germany derogation. We had to work through some logistics and on the labeling for that. And so that really started in late January, but we are now shipping there. But again, we won’t see that come through in a bolus amount.
Unidentified Analyst: Okay. That’s super helpful. Thank you. And my follow-up question relates to Inspire V. Can you clarify, are you still planning to file in early 2024, so tapped in Q1? Is that how you think about early 2024? And talk about your confidence level in getting it approved in 2024. Are we still talking Q2, Q3? I think I heard the comment about later 2024. Thank you.
Tim Herbert: Yeah. Thanks, Lei. I think that we have confidence in our development of the technology and the team is working on the final submissions. We’re not putting out the specific data on when that submission is going in as we work with the FDA, but the submission will include both the Inspire V neurostimulator, the patient program or software changes, the physician program or software changes, it’s a full system-level submission and we do not only want to have approval in 2024, but we want to do a limited launch in 2024 as well. So our — we’re pretty consistent with the targets that we laid out previously.
Unidentified Analyst: Okay. Thank you. So no additional color on the Q3 versus — sorry, Q2 versus Q3 timing on the approval, whether how the clock is reset?
Tim Herbert: Yeah, we’re going to continue to work with the FDA to drive the review process and FDA has their time to review. So yeah, we’ll be careful about putting any more color into that.
Unidentified Analyst: Fair enough. Thank you.
Tim Herbert: Thank you.
Operator: Thank you. And I show our next question comes from the line of Jon Block from Stifel. Please go ahead.
Jon Block: Thanks, guys and solid quarter, Rick and Tim. Maybe just two for me. Rick, for 1Q 2024 US revs to be down mid- to high teens Q-over-Q, I need to get 1Q 2024 year-over-year utilization down 2% to 3% year-over-year. And that would be the first down year-over-year utilization since arguably the throes of COVID, and now you’ve got broader labels, you’ve got the pediatric opportunity in some of those facilities. I think you said you could even see some 3Q 2023 ongoing flop into 1Q 2024. So can you just explain why we would see sort of that level of a falloff in utilization, the down low single digits, again, to sort of put back to your sequential decline of down mid- to high teens?
Rick Buchholz: Yeah. I mean, you have to look back — thanks for the question, Jon. You have to look back in the first quarter of 2023, remember, we had a 400 basis point benefit in our growth last year from the delayed orders that when we introduced the siliconeleads in the US last year. So there’s some of that at play. But we are excited for 2024 with the guidance that we set forth and we’re going to strive to increase utilization. And we talked about a lot of the different areas that we’re going to focus on. So that’s our plan — is to achieve that.
Jon Block: Okay. That’s helpful. Thank you. And then to shift gears, Tim, just for a small amount of us say, I think I heard you correctly before, where it seems to be like a 50% AHI reduction, you think could be beneficial for the business. And I believe you laid out the reasons why. Just to push you there, like what’s not beneficial. In other words, is it a 60% reduction? Is it 65%, 60%, rough numbers, your AHI goes from 50 down to 20? United’s cutoff is 20 not 15. Just to take a step back, are there any levels of AHI reduction where you step away and say this might not be a TAM expander at the end of the day. Thanks for your time guys.
Tim Herbert: In the end, Jon, we don’t care about AHI. What we care about is mechanism of action. And what we believe the mechanism that the GLP act upon is reducing the lateral wall collapse. And we know that we stimulate the hypoglossal nerve that moves the base of the tongue forward, that’s very difficult for our patients to be able to get that level of reduction in AHI, but we want the patient to lose weight, have relaxation of the lateral wall. So that is not a contributing factor to AHI and a patient with a higher AHI can obviously get a higher percent reduction because they can lose weight, lose neck circumference and have a relaxation of the lateral wall collapse, thereby, presenting as tongue-based collapse, which is the majority of the lower BMI patients.
If you’re a low BMI, it’s very difficult to have a significant AHI reduction. So I think you’re going to see a variable reduction in AHI, as you go from low BMI to high BMI. Again, we’re more focused on the GLP-1s, helping the patients lose weight, reduce their neck circumference and relieve the lateral wall collapse, thereby, presenting as a tongue-based colapse for which Inspire can treat them.
