Intuitive Surgical, Inc. (NASDAQ:ISRG) Q3 2023 Earnings Call Transcript

Jamie Samath: Just one other element. We are in-sourcing a high-volume accessory on the multiport side as part of in-sourcing that there’s some differential automation in the line there. And so ramping that, there’s some work to get that to be at our targets.

Travis Steed: Great. Helpful. And coming into this year, on the procedures, some of the swing factors were China, staffing pressures and COVID. And I imagine like going into ’24, there’s bariatrics in China, some of the swing factors. Maybe you could just talk about some of the swing factors on 2024 procedures, pluses and minuses and do you think China and bariatrics are still going to be growing and adding to the growth in procedures in ’24?

Brian King: Travis, this is Brian. I guess thinking of 2024, nothing really to share at this point. Clearly, I think when we get into January, we’ll be able to give you a bit more insight. But I guess I’ll just leave it at that for now.

Gary Guthart: Let me just pick up two topics you hit. On the China side, I think the procedure demand side remains robust. I think there’s some government policy activity that’s putting a little bit of a chill in the market. Some of that is economics, so price caps and value-based pricing and some of it is in any corruption probe that is giving hospitals some pause moving forward with other new programs. We’ll see. I think the China side is likely to — some pressure on the China side is likely to persist for several quarters. On the bariatric side, I think we’ll find a new normal in the next few quarters. It’s hard to predict exactly when that will happen. We’ll see that play out in the marketplace.

Travis Steed: Great. Thanks a lot.

Operator: We go to next line, Larry Biegelsen, Wells Fargo. Please go ahead.

Larry Biegelsen: Good afternoon. Thanks for taking the question. Gary, your usage-based leasing program has gotten some scale. Can you talk about the utilization rates on those systems relative to the average? And any other themes you could share?

Gary Guthart: Sure. I will turn to Jamie here on kind of utilization rates. So why don’t you kick that off?

Jamie Samath: Yes. There’s two ways to look at it, Larry, what is the absolute utilization rate compared to a regular leasing compared to a purchase arrangement. They are very similar. Actually, the tightness on the mean between those three structures is very tight. Within those arrangements, you generally have a target procedure level that reflects success of the program for the customer and the economic objectives that we have. And if you accumulate again, the portfolio they run at slightly above the targeted procedure levels that we have embedded in the contracts. So they have run very well so far, and it’s one of the reasons why we and the customer have expanded those so quickly in recent times.

Larry Biegelsen: That’s helpful. And leasing in the U.S., where do you see that going? I mean, it was almost — it was over 70 this quarter and last quarter. Have we plateaued? Or does that continue to go higher?

Jamie Samath: On a global basis, we expect the proportion of placements that are leased to continue to find. U.S. is pretty high, as you pointed out, Larry, 70% this quarter, 78% last quarter. There will be some larger IDNs that just routinely prefer to purchase just because of how that affects the metrics that are important to them. But even in the U.S., I think there’s some room for that to continue to creep up a little bit, obviously, running out of room. We found a number of U.S. customers have really appreciate that as a way to manage through what are totally managed capital budgets.

Larry Biegelsen: Thank you.

Operator: Next, we have Brandon Vazquez, William Blair. Please go ahead.