On Track to Profitability, Price Target Increased (MST), page-24

Is nobody worried about the MAC/LCD removing reimbursement for mixed MIGS?

We don't know how much of Revenue is canaloplasty/iTrack alone (which will not be affected). It's possible a lot of Revenue is from mixed MIGS. They say it's "partially" mixed MIGS, but that could mean anything (50% of Revenues?).

Why does the company just assume that, when forced to choose, surgeons will opt for iTrack/canaloplasty instead of stents?

The evidence for the efficacy of each method alone looks about the same. This is also true for both combined; the efficacy of Mixed MIGS is statistically insignificant (which is probably why the MACs are fed up of paying for both stents & catheters in the same eye).

It's possible the iTrack results endure for longer; but there is not yet any prospective RCT evidence for iTrack. MAGIC & CATALYST are still recruiting, and look to be a way off yet. This is important if you're expecting medics to rely on iTrack as a singular option when others are available.

The 30% reimbursement increase is only for iTrack in Ambulatory Surgical Centres, and that's the Facility itself. iTrack reimbursement for Hospitals will increase by 4%. Molteno (in either venue) by 3-4%. The surgeons themselves will get paid slightly less in all cases, so you better hope they're not choosing which device to use.

Is it really obvious that facilities will opt for 'iTrack alone' in 2025, or that the price increase will offset for any declines in the Mixed MIGS business?

Shouldn't we know how much of Revenue is: (a) iTrack alone vs Mixed MIGS; (b) ASC vs Hospitals; (c) iTrack vs Molteno ... before we make a judgment on the potential combined effect of the MACs LCD and the CMS price increase?

If I was management, and I was convinced these developments were unthreatening... then I would break these segments out to prove it. I can't see that they do this anywhere. It's all just "glaucoma surgical devices" or geographical segmentation.

There is a potential cliff-edge out there for Revenues... in the very near future.