Not really, as my thesis (explained elsewhere) is that iTrack...

Not really, as my thesis (explained elsewhere) is that iTrack Advance is superior to stents and other MIGS procedures (primarily due to not tearing or stenting but other factors as well), and that doctors will choose this procedure before going for the more invasive stenting procedures. Combo procedure was never something I thought much about as a driver, I don’t believe it’s that common of a procedure yet and was only practiced by the more innovative doctors experimenting in their practices. There’s also still nothing stopping people from coming back a few days, weeks, months or years later to get an additional procedure (funded by Medicare). I also know ophthalmologists celebrated the news when the MACs announced it, it was seen as a win and they did not seem concerned that it would impact their ability to practice the way they wanted to do. Whilst it removed a more niche procedure (ie the mixed procedure), it has essentially guaranteed long term reimbursement for all procedures.

It makes a lot of sense to try with the less invasive, stent free and tear free option (iTrack Advance), especially now with the 30% increase in reimbursement, and then if that doesn’t quite do the trick add a stent. This is a fairly conventional approach to treatment, start with the least invasive procedure and only go more invasive if necessary. It’s not a one and only approach, patients are currently told these are treatments not cures and that they should expect to come in again. Most do, and they’ll want to try something different when they come in again. All the reimbursement change will block is unnecessary double dipping at the same time, which I don’t really think was common place regardless except for the experimentations of a few of the more innovative doctors. It won’t stop patients getting multiple MIGS treatments over the course of their lives.

The company was quite bullish on further growth and especially profitablility going forward, and have proved that with the recent investments in the marketing expansion, so given that and a lack of criticism of it in the ophthalmology community and by the company (both the company and the doctors want the same things - more money), I’d say that the 30% increase in reimbursement will be more significant.

I do agree, it would be great for them to say how big or small mixed procedures are as a percentage of total revenue, but I’m not really sure if they have this data. They sell the same device for every type of use, it’s up to the doctor to decide how they use it. Same issue when I tried to find out how many iTrack procedures were done ab externo, only the insurers have the numbers on how procedures are used.

I’m also not sure of the percentage between ASC and hospitals, but part of the appeal of MIGS compared to traditional surgery is that they can be done in an ASC setting compared to hospital, so I’d say it’s a high one.