Rick Buchholz: Yes. Hey, David, I’d just further comment on a quarterly basis, given the dynamics of 2023, our growth rates have been a little lumpy, if you will, in the international markets. But on an overall basis, as we go forward, we still expect outside the US revenue to be right around 3% roughly of our overall worldwide revenue.
David Rescott: Okay. That’s helpful. And then just maybe on the profit piece. I know I appreciate the kind of commentary around second half 2024 being this sustained profit level. When you think about where you are from a penetration standpoint and then some of the investments over the next several years, DTC getting more targeted, is there any reason to think that this sustained level of profit in the second half of 2024 shouldn’t be kind of a jumping off point as you go into 2025 and beyond?
Rick Buchholz: Yes. I mean we provide guidance on an annual basis, but we’re excited about the leverage that we demonstrated in the fourth quarter and the confidence we have in our revenue number for 2024. We have demonstrated leverage. We’re going to lose some of that leverage with our more pronounced seasonality in Q1, but then we’ll return to that. And our comment was that we’ll be profitable for the second half of 2024 but we’re not giving any long-term guidance, but we’re continuing to build leverage on an annual basis, as you’ve seen.
David Rescott: All right. Thanks for taking the questions.
Rick Buchholz: Thank you.
Operator: Thank you. And I show our next question comes from the line of Anthony Petrone from Mizuho Group. Please go ahead.
Anthony Petrone: Thanks. Tim and Rick, congrats to the strong start — strong end to the year and solid guidance that you put out earlier at JPMorgan. Maybe one just on utilization, tackling it a different way. Our math shows that you got to just north of two implants per center per quarter here exiting December. So just wondering, is two a right number now to jump off for the rest of the year? Or will that just remain a little bit lumpy depending how patient flow comes in? And then I’ll have one quick follow-up on UnitedHealthcare.
Rick Buchholz: Sure. Thanks for the question. So just over two, just to clarify that, that’s two procedures per center per month.
Anthony Petrone: That’s correct, yes. Sorry.
Rick Buchholz: Yeah, we just had just over two and just under two a year ago in the fourth quarter. Again, as we continue to add more centers, we’re up to 1,180 centers, it gets more difficult to move the needle on utilization, but we’ve continued to do that on a year-over-year basis. If you look at each quarter, that’s one of — that’s our goal for 2024 and beyond. We think there’s a lot of room to improve that utilization, but it does — it’s more difficult to move the needle on that. On an annual basis, if you look at our growth, 70% of our growth came from existing centers and 30% of our growth came from new centers. So that kind of signifies a healthy business, and that’s consistent with 2022. So if we can maintain that, continue to add new implanting centers, move that utilization. If you look at our top quartile, they’re doing well north of two procedures per month. And so we want to move all those buckets up if you will. So that’s a real focus for us.
Anthony Petrone: And the follow-up was on United. Positive announcement earlier in the year, Jan 1. They’re basically in line with FDA on AHI and BMI thresholds, but they put the Mandibular turn style in there, if you will, maybe to slow it down a bit. But net-net, it looks like a huge positive. So maybe what do we expect from UnitedHealthcare patient flow, and is there anything from other payers that you’re hearing out there? Thanks.
Tim Herbert: Yeah. Thank you very much. We don’t think it’s going to really affect UnitedHealthcare. They had some regional policies to actually deal with Mandibular devices or oral appliances in the past. We’re very careful to educate the centers when the physicians are preparing their notes and the sites prepared their prior authorization documentation, that they include information and there in regards to the patient’s qualifications, and if they have the right anatomy or severity to be able to qualify for our oral appliance. So we have a little bit of practice dealing with UnitedHealthcare on this subject. All the patients are prior authorized, so we make sure that we put the necessary information are provided from the centers into the submissions such that when we get the prior authorization approvals, we can just move forward.
So we don’t see that from any other payers that’s kind of a unique UnitedHealthcare. But to your point, it is a significant win for the patients in that the expansion to a high AHI to 100 and the BMI warning to 40, and let’s make sure we highlight the pediatric population with Down Syndrome. So, it’s in there, we continue to work with UnitedHealthcare and we’ll continue to push back on them on that. But we don’t see it being really disruptive in the year.
Anthony Petrone: Thank you.
Tim Herbert: Thank you.
Operator: Thank you. And I show our next question comes from the line of Brett Fishman from KeyBanc. Please go ahead.
Brett Fishman: Hey Tim and Rick, thank you so much for taking the questions. Just like to start off over the past month, we had a competitor announced their objective to launch a competitive Hypoglossal nerve stem device later in 2024. So, I was just hoping for a bit of an update from you guys about how you’re thinking about potential future competition in the US market? And then if you think you might have to do anything outside of the normal practices, just to protect that market share in the event that this does actually happen on time?
