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00:06 Good day, and welcome to the Assure Holdings Third Quarter Twenty Twenty One Earnings Conference Call. All participants will be in listen-only mode. [Operator Instructions] Please note event is being recorded. 00:41 I would now like to turn the conference over to Scott Kozak. Please go ahead..

00:45 Hello everyone, thank you for participating in today's conference call to discuss Assure Holdings' financial results for the third quarter ended September thirty, twenty twenty one. On the call today are Executive Chairman and CEO, John Farlinger and CFO John Price.

After the market closed this afternoon, the company issued a press release announcing its results for the third quarter of twenty twenty one. The release in investors presentation are available in the investor section of our website.

Before we begin the prepared remarks, I would like to remind you that some of the statements made will be forward-looking and are made under the Private Securities Litigation Reform Act of Nineteen Ninety Five. Actual results may differ materially from those projected or implied due to a variety of factors.

We refer you to Assure's recent filings with the SEC, including its quarter word on Form 10-Q for the third quarter for a more detailed discussion of the risks that could impact the company's future operating results and financial condition.

Also on today's call, management will reference certain non-GAAP financial measures, which we believe provide useful information for investors.

01:47 For a reconciliation of these non-GAAP measures, please consult the most recently filed 8-K associated with the filing of the earnings release for the three months ended June thirtieth, twenty twenty one, which is available on the SEC website. In addition, please note that Assure reports in U.S.

dollars and all amounts to be expressed today are in U.S. currency. 02:05 Finally, I would like to remind everyone that this call will be recorded and made available for replay via link on the company's website. Now I would like to turn the call over to the Executive Chairman and CEO of Assure Holdings, John Farlinger.

John?.

02:20 Thank you, Scott, and hello, everyone. when we dialled the call by telephone? You may want to join our webcast or download our third quarter twenty twenty one earnings presentation on Assure’s investor Relations site. Found at ir.assureneuromonitoring com. Again, that is ir.assureneuromonitoring.com.

And this will allow to see the slides that I were obviously. 02:50 Today, we'll provide an update on our drivers for success and discuss our vision for sustained rapid growth over the next several years. I'll start with an update on our third quarter results. This was a very active quarter for sure.

We secured an agreement with Premier, the country's second largest group purchasing organization. And through that, we became a sole contracted provider of the operative neuromonitoring services for its network of forty four hundred hospitals. 03:29 Additionally, we ramped our high margin remote neurology services platform.

We organically expanded into two new states, and we completed our optimistic onto Nasdaq.

In terms of financial flexibility, Assure completed a small surgical private placement transaction, which we announced today, raising just enough funds from institutional investors as well as support from our board management team to view our most promising growth initiatives in twenty twenty two or at the same time in minimizing dilution.

04:08 Key financial metrics in the third quarter were sharply positive, including a notable increase in revenue to eight point five million dollars. We showed a net profit of one hundred thousand dollars and adjusted EBITDA rose to one point two million dollars.

Our adjusted EBITDA improvement really stands out as it occurred during the quarter, in which we had had a heavy focus on Century integration and building out infrastructure. Going forward, we will continue to focus on minimizing cash burn and generating positive EBITDA while striving to deliver rapid growth.

04:52 Share reiterate our guidance to perform seventeen thousand managed procedures in twenty twenty one. In fact, we expect to exceed seventeen thousand and deliver a record fourth quarter in terms of managed procedures. All this happening despite the lingering impact of COVID-19.

I also want you outline that we are guiding towards twenty five thousand manage procedures in twenty twenty two. And I want to be clear of this target of twenty five thousand managed procedures excludes any growth generated from premier relationship. It also excludes any growth coming out of further M&A.

05:45 We manage procedure growth from premier or M&A activity would add to this target of twenty five thousand managed procedures that we are forecast for twenty twenty two. We will talk much more about why she was growing so rapidly, while a significant majority of our industry peers. Are their stagnant or in many cases shrinking.

06:12 Next, I'm going to jump on to slide four. And I'll talk about how our Assure is pivoting away from our historical model. Our Assure’s bread butter has long been providing a highly trained board certified technologist in the operating room and pairing that with a contractor providing remote neurology services.

For one to one pairing and this one to one model we've established matched an Assure technologist with a surgeon in the operating room, which is illustrated in blue in the diagram on the left. 06:47 Assure Technologies typically performed approximately two hundred surgeries per year.

This prepayable revenue structure has served as a basis for our success to date. Remote neurology services, which is featured in orange on the right side of the slide in the one to mini model. And as a result has a different financial profile.

Physicians provide remote neurology services from an off-site location, each one having the ability to handle two thousand five hundred or more procedures annually. Early this year, Assure began transitioning surgeries from our remote neurology contractors to Assure utilized physicians.

07:36 As summarizes pivot in a nutshell, Assure Technologies that create a baseline for our business Assure neurologist are simply consuming the volume created by this relationship. At this point, it's simply a matter of scheduling and delivery because the patient volume has already established.

Our focus in Q4 and twenty twenty two is on controlling the quality of our neurology service and driving that cost of delivery lower. 08:10 As we move on to slide five, You see one remote neurology professional working from an off-site location, and you see them reviewing multiple screens and managing multiple surgeries simultaneously.

While we continue that source function to trusted partners in certain geographies as we ramp, Assure has begun delivering the service ourselves. In our largest markets, including Texas and Colorado. This accomplished as a number of key positives and objectives for the company.

Firstly, we would be able to oversee quality of service for providing remote neurology services. This commitment to quality supports our efforts to sign newly network agreements and facility wide agreements with hospitals.

09:03 Secondly, by bringing the neurologist function in house, we will be able to significantly reduce cost of delivery, allowing the company to improve our profitability on every case we performed going forward, Our objective is to cut costs and delivery from remote neurology services by over fifty percent going forward.

Additional scale will serve a catalyst for margin improvement in the future. 09:34 Thirdly, we're driving top line benefits. The mostly cases we performed remote neurology services represents a creation of a new revenue stream.

Fourth, our integrate offering wide significant value for each and new market and every new M&A opportunity we pursue going forward. Fifth, fifth and finally, providing remote neurology services for Island M opens the door for new opportunities in adjacent markets where similar remote neurology services are utilized.

10:10 I want to be clear that our shift to providing remote neurology is simple and straightforward. We've already built that platform. We already have the patient volume.

We are simply replacing contractors with Assure control physicians to absorb the volume, the result will be higher margins a new revenue stream and turning cash over much more quickly. 10:39 On slide six we take a closer look at the trajectory of our remote neurology business.

I want to emphasize this is not something we are planning this is something we are doing. In September, the two Assure arrears working on our team recorded a record three thirty remote neurology procedures.

With a third position reader showing the organization, in mid-November, and four starting at the end of November, the number of cases we are performing will only continue to accelerate. 11:17 We are guiding to a range of one twelve hundred low neurology procedures in the fourth quarter of twenty twenty one.

I want to get amplify because we consider Assure’s telehealth neurology offering to be one of the company's most important growth opportunities. 11:41 On slide seven, focused by comments on the platform, we spent the last two years building and what it means for future growth and development.

Assure’s platform is summarized in the center of the circle in blue and includes the following. Firstly, maintaining exceptional clinical operations. Automating, our revenue cycle management function and collecting cash faster. Boosting managed care, which refers to deciding more in network agreements.

Minimizing the bottlenecks in business operations, particularly around onboarding and credentially. We instituted an ongoing training and development program for clinical staff, and we've successfully executed our M&A strategy. In a highly fragmented market that has led to three accretive transactions over the last two years.

12:38 This platform was built with the intent of having these functional areas support interoperative neuro monitor. And you see those of verticals on the left, spine neurosurgery vascular, ENT and orthopedic. And indeed, it was done, and I believe we've done a good job in supporting those verticals.

As we transition to becoming a provider of remote neurology services, we expect that our expertise in their operating are monitoring will assist us to enter adjacent markets in which our Assure neurologist can also provide patient services.

13:17 We are planning and hoping to be able to provide services into such new verticals as EEG, epilepsy, sleep study, stroke. By leveraging our existing key competencies, which we have focused on building over the past twenty four months. 13:37 Next, we'll jump on to Slide eight and look at our geographic footprint.

The twelve states in Green represent our current operations. Service expanded into four new states in twenty twenty one alone. Missouri in Kansas view the acquisition of Century Neuromonitoring, Nebraska and most recently Nevada to organic growth.

14:00 Previous bought went Nevada for a second We signed an agreement to provide either operative neuromonitoring services for eight hospitals in the state. And we are currently ramping Those procedures up and hope could be able to get to a run rate of almost two thousand procedures annually.

In addition, we see further expansion to add at least one more state by the end of twenty twenty one. 14:28 Our expansions has been supported by the build of our distributor. Partnerships with medical devices distribution should absolutely to share open new markets in Nevada and Nebraska and extended our reach in Texas. Just within the last few months.

The other catalyst for Assure’s expansion is the winning of a system wide hospital facility contract. I'm pleased to report a very big win of that which we believe will be a game changer for Assure.

15:01 Specifically, on slide nine, I'm referring to a system wide contract we secured with Premier, the second largest group purchasing organization or GPO in the United States.

Over the life of the three year agreement, Assure will serve as the sole contracted with supplier get operate neuromonitoring services to previous alliance of approximately forty four hundred U. S. Hospitals. And two hundred and twenty five thousand other providers. We were honored to be chosen by premier.

Following an RFP process that include our largest competitors in the industry. 15:41 Our selection provides Assure with a hunting license, to pursue other opportunities within this network.

It also underscores Premier’s Recognition of the Assure’s established a reputation we delivering high quality service at a competitive price and has the capacity to scale and support coverage for the second largest GPO in the U. S.

This agreement is consistent with our strategy to build a platform that enables hospitals and medical facilities to outsource interop we are monitoring services with thousands of cases enabling. We'll be building resources and significant resources to make sure that it Assure harness us the substantial premier opportunity. 16:29 Next on slide ten.

I'm going to note another key milestone. Assure began trading on Nasdaq in September. Assure is a first interoperative neuromonitoring focused company trading on a major U. S. Exchange.

We believe that assurance has reached the level of maturity in necessary to take advantage of the accelerating benefits and opportunities that the Nasdaq listing can provide, including enhancing Assure’s visibility, industry profile and market liquidity.

17:03 Before handing off the call, I just wanna highlight a few additional updates among our twenty twenty one corporate objectives listed in front of on slide eleven. We already talked quite a bit how Assure’s expanding scale.

So, I will just quickly add that we anticipate if buyers’ market for high quality interoperative neuromonitoring assets in twenty twenty two as many of our competitors continue to struggle with that of network billing, recollections, we continued the impact of COVID-19 and the general inability to raise the capital sufficient to capitalize their businesses.

17:45 To those points, we now have approximately thirty percent of our total commercial insurance volume in contractual rates either directly with payers or indirectly through third party administrators and anticipate expanding this to more than fifty percent by the end of twenty twenty two.

We recently signed an agreement with multiple, but we believe has significant potential for Assure. 18:11 The multi deployment agreement will provide network access to help plan members who access multiplans national primary and complementary networks.

More than one union healthcare providers participate in multiplans network, and sixteen million health plan members have access to the company's services.

18:34 Assure believes the multiplan group will improve network utilization for the companies that are operated their commodity claims and attract a substantially higher proportion of eligible claims to our contracted rates.

Another catalyst on the horizon that could significantly change our landscape for network agreements if the no surprises at federal legislation. 18:59 This bill was for the first – allowed us for the first time, companies like ours to arbitrary. At a batch level cases where we are not being paid.

To date, our only remedies non-payment have in litigation. We're going to state regulators. Going forward, we believe that the speed resolution process will help us get paid as many claims as possible and also force many insurance companies to strike fair any network agreements with companies like ourselves.

19:36 Before turning the call over to John Price, I want to reiterate that I believe this is the best position that Assure been in. From a capitalization perspective from a platform perspective and a business catalyst perspective, the opportunities ahead of us with Premier for remote neurology services, organic growth in new states and M&A.

We'll be keeping us very busy over the next six to twelve months and beyond. 20:03 Now, I'll turn the meeting over to Assure’s CFO, John Price, to go through the company's financials.

John?.

20:09 Thank you, John. Hello, everyone and thank you for joining us today. I will start by calling out highlights from Assure’s third quarter twenty twenty one financial results. Sure experienced strong revenue and improved profitability in the quarter as illustrated on slide twelve.

Managed case volumes increased as we anticipated related to the acquisition of Century, which we completed on April thirty, transitioning cases from remote neurology contractor to Assure’s readers and seasonality, which typically improves over the course of the year as patients schedule surgical procedures to align with their meeting – with meeting their health insurance deductibles.

20:53 Our revenue accrual rate was stable overall. Seeing a bit deeper, that stability reflects some revenue per case compression on a technical bill balanced to get some improvement on a remote neurology professional rate.

We continue to see improvement in collections as a greater proportion of our commercial insurance volume become set like contracted in network rates with payers, we expect to add more stability in revenue. 21:21 From Q2 to Q3, our managed case volume increased seventeen percent.

On a year-over-year basis, our Q3 twenty twenty one managed cases increased by eighty six percent from two thousand six hundred and eighty five during the third quarter of twenty twenty.

Adjusted EBITDA was a profit of approximately one point two million dollars compared to a loss of zero point seven million dollars in the second quarter of twenty twenty one.

21:49 The positive EBITDA result and transition to profitability we achieved in the third quarter reflected faster improvement driven driven primarily by delivering on remote neurology services.

On a sequential basis, our operating expenses decreased to three point seven million dollars compared to four point five million dollars The company second quarter operating expenses included several one-time costs such as legal expenses to support our Nasdaq application, start-up costs associated with our remote neurology business, It investments to support data analytics initiatives infrastructure costs to support anticipated growth and one stock based compensation.

22:32 On slide thirteen we'll review balance sheet and cash flow. Our cash collections in the third quarter were impacted by an uncharacteristically slow July that we believe was an industry wide issue. Since July, our monthly collections have returned to normalized levels.

Looking forward, we anticipate collections to improve in the fourth quarter, and into twenty twenty two driven by our investments in automation and the benefit of in network contracting in our remote neurology billing.

We ended the quarter with zero point nine million dollars in cash compared to four point four million dollars at the end of twenty twenty However, our cash position is substantially different today.

The company strength its balance sheet with the closing of an institutional investor led private placement of approximately five million dollars providing additional financial flexibility, liquidity and capital to execute our twenty twenty two initiatives.

23:36 The company's accounts receivable increased to twenty two point seven million dollars during the third quarter. This was primarily due to the eighty six percent increase in year over year managed case volume, including additional volume from acquisitions and several million dollars of the cost receivable from our remote neurology business.

Further, there was no meaningful adjustment to our provision for bad debt. 24:01 From my financial strength of a liquidity perspective, I think it is useful to highlight our nearly ten to one current ratio as of September thirty, which has been further strengthened with the closing of approximately five million dollars of additional financing.

24:17 Next, I want to highlight our financial goals of tightly managing expenses while continuing to improve cash collections. During Q3, we reduced our cost profile by reducing operating expenses eighteen percent sequentially which we anticipate will continue during the fourth quarter of twenty twenty one.

Taking a step back, Assure’s overall financial strength has greatly improved, and our current capitalization is the best we've ever had at Assure. 24:46 Before concluding, I want to note that John Farlinger and I has spoken with many of our investors in recent months.

24:52 During these discussions, we have heard a desire to better streamline how Assure presents the business investors to help facilitate a better understanding of our volume, mix and business catalysts. We are working to realign how we present the business model to make it more adjustable.

We anticipate setting the business performance for fiscal twenty one and the outlook for twenty two and a more streamlined fashion during our fourth quarter call. And with that, I'll turn the call back over to our operator for Q&A..

25:30 Thank you. We will now begin the question-and-answer session. Today’s question, you may [Operator Instructions] Our first question comes from Jim Sidoti with Sidoti and Company. Please go ahead..

26:05 Good afternoon. Thanks for taking the question. I cover couple of different companies that are involved in and final procedures and almost all the other ones have had the lower guidance in twenty twenty one because of the recent surge in the Delta Variant.

So to what extent it Delta variant impacting you?.

26:35 Hey, James. Listen great question. We're still seen and lingering effects of COVID this morning we did a quick assessment. As you probably know, Colorado has went through another surge. We're seeing a slowdown in some cases in parts of Western Colorado there's still a lingering impact in Texas and to a lesser degree in Louisiana.

But for the most part, It's kind of just a lingering noise at the business rather than a complete slowing down of the business like we experienced twenty twenty. And we getting guidance earlier that we felt we would be at seventeen thousand procedures. 27:23 We would have been higher than that statement except for the impact of COVID.

But we are expecting a record fourth quarter in procedures and obviously we're pathway through the quarter. 8 So we have some perspective on how we think it's going to end up. The other thing is surgeons are very creative. hey, went through this exercise in April, May and June of twenty twenty where their business models got shut down.

They have been very adaptable and are moving, in certain markets, more and more business to ASCS or able to surgery centers in advance of hospitals are slowed down by COVID. And that's really not forced us to be at the mercy of what could have been probably having a larger impact on our business in Q3 and Q4..

28:20 Yes I think that that answered it. As you look into the fourth quarter, typically the fourth quarter is the higher quarter in terms of procedure volumes.

What does that mean for you though? In terms of revenue mix, do you think you'll have more of a commercial business in the fourth quarter or more of the government insured business and what is the impact on margins?.

28:52 Great question. It's funny just when through we're going through our planning exercise right now for twenty twenty two. And we just went through this analysis something to let our CFO, John price respond to you with the assessment of mix and the seasonality Impacting on our business..

29:12 And Jim, based on some of our prior discussions we've had with you, one, we really see the mix change over the course of the year. The first part of the year, it's really focused more from a government perspective. And as we get further into Q3 we've seen this in September, the mix really starts to accelerate and change.

Basically moving to the high 50s as we wrap up the year from a commercial payer perspective, with the residual piece being government oriented. And the other part of the two we also start to see that hockey stick in just pure case volume as well in Q4. So Jim, just to summarize, we kind of go through and reset every every year.

Legally the Q1 makes shifts higher propensity of government cases, probably in the high fifties and slower margins.

30:13 And then we kind of sequentially progress higher volume, higher margins as it shifts to Q4 where it's the complete opposite you're almost at sixty percent in terms of commercial dominance because of the race to get a light of procedures study in Q4. And we've seen that pretty much every year the last couple of years..

30:37 And when you look at the business today, what do you think the primary growth drivers are because you can expand geographically, you can add more technicians you can add more neurologist.

These M&A opportunities, which one gets the highest priority, which initiatives?.

31:03 Well, short term. We're very focused on really two or three of initiatives. Number one is ramping up our remote neurology services. And we're demonstrating what we're doing in Q3.

That will have a significant impact on our business both our existing business, new states and M&A opportunities, and it will drive more margin and the focus there is really to deliver higher quality of service with a lower cost of delivery hence making all parts of our business more valuable.

And we've been pretty transparent our plans were to have for full time all onboard by the end of this fiscal year. They are hires we’re ramping. And then as we go into next year, we'll continue that progression in cadence of moving be more business onto to our platform.

31:54 Secondly, we've got to be able to ramp up on the corporate development side to support the premier opportunity. It's a significant milestone for us in willingness contract and we don't want to step here. So we are wrapping, we're planning now as that is all happening real time.

32:17 The third thing is really just execution opening up probably at least one more state before the end of the year and then just delivering on the business we've got in front of us. To your point upon M&A, we'll turn our attention M&A probably in Q1. We're looking we're always active we're always looking for opportunities.

They're buying opportunities out there. But right now for the balance of the year, it's simply execution of remote neurology, delivering on the premier contract ramping up our corp debt function and opening up at least one more state..

32:53 And when you do turn to M&A, do you think there'll be more deals like Century out there or is there possibly another type of target that you'd be looking at?.

33:06 Great question. We're active now. Our plan is to always be active. And We believe there will be buying opportunities. They're buying opportunities now, it's just with a small team more taxed delivering on the business in front of us. But going into Q1 we're in in position. We can offer people in that Nasdaq currency.

And by currency was critical to getting the century deal done and offering stock back to the founders where they may didn't get the price they want upfront, but they probably will get it over the medium with the appreciation the value of our currency. I think going into Q1 as you look at our trajectory next year.

33:54 We laid out kind of a cadence of getting the twenty five thousand managed procedures. We'd like to that as we did this year with additional M&A, but like this past year and we want to be patient and look for buying opportunities..

34:11 Now this morning, you announced raised some money to a private placement.

Why now?.

34:23 Well, we needed capital to expand our remote neurology service. The premier opportunity needs bodies. We need a corporate debt team, we want to be able to get access to data there are host of things that we need to integrate with premier. And then we’re hiring more economics. We've announced Nevada.

We need to hire more people there and we're hoping that in our state. 34:51 And I think we just wanted to make sure that we were capitalized to take advantage of the growth opportunities in front of us right now.

And we were conscious of dilution the price of our stock, and we didn't want to raise a lot of money we wanted to raise just enough money, deliver and execute in the business in front of us..

35:15 Right. A couple more. You mentioned the no surprises act in your script.

What do you think the impact of that actual will be on your business and your ability to sign more in network agreements?.

35:32 it's going to be a significant catalyst for driving behavior. We see it I know Paul Webster listing on the call, I believe he's on it. Paul is working pretty much extensively on positioning us to be able to operate three cases starting in the first quarter of twenty two. But no surprise that gives you on.

Why this is important for companies flight hours? Is that date we if we're not paid by a major insurer, the only option we've been available is to litigate or go into to the state regulators. Neither of those usually work out.

36:17 In the new order with the no surprise Act in stage four there was no state legislation, we can now and batch claims in arbitration and that coins in arbitration. We just went through our first exercise of batching for arbitratory. We are this goal is able to successfully arbitrated against the insurance company, so we believe we can.

That then forces the discussion around network contracting. Right? And we believe ultimately this will be a catalyst for driving more of our business into a network rates.

Right now, we kind of held off wanting to go in network and taking rates that were probably lower than we felt we had to take them a short term because we're kind of doubling you down in our ability to and the get successful results in Q1 and then push for in network rates as we start to win some of these arbitration cases.

37:22 And the arbitration numbers are predicated based upon a formula, which is typically an average of average collections by payers on a state level and federally..

37:36 All right. And then last one from me on the balance sheet. You're accounts, I think about four million in the quarter, is access related to the increase.

This rapid increasing in procedures or is there anything else we driving at and are you confident you'll be able to collect that revenue?.

38:02 John, do you want to answer that, you this went through a friendly detailed analysis of all the IR..

38:08 Yes. We kinda of, we talked about this a bit on the script as well. One it's really driven by the increase in volume and the balance was really in line with our expectations. When you take a look at the volume on a year over year basis, we've grown volume eighty six percent, So we were expecting some growth in accounts receivable.

The other aspect of this just on a quarter to quarter sequential basis, the good portion of accounts receivable I'd say in excess of two million dollars is really related to our remote neurology services. And some of additional volume that we had this quarter in comparison in Q2.

38:50 And just the last thing Jim to note is that again, we've did a deep dive in our allowance with doubtful accounts and during the quarter, we had no additional meaningful write offs which is critical for us. Really, I think it's showing the benefit of us being in network..

39:12 And do you expect accounts receive while the pickup again in the fourth quarter and then maybe start to market itself down in Q1?.

39:22 Yes. I would expect Q4 to be up again. Again, we're expecting volumes to increase quite significantly in Q4. Going to continue to move more volume onto to our remote neurology platform, and that obviously is going to continue to drive higher billing because it's at a higher rate a professional basis..

39:41Then we'll see kind of a drop in the AR numbers going into Q1 and Q2. As volumes taper off, the other thing is we are speeding up the rate at which cash is collected on the file, so which we're being paid. It's just we've had nearly six percent lift in volume, you have to expect an increasingly and the size of the AR..

40:04 And do you think within money you raised through the private replacement, you'll be able to fund this this rapid rise in procedure growth and are there any steps you can do now to manage cash, So you don't have to go back right away to get two raise more?.

40:28 Well, obviously numbers are kind of highlighting you had the numbers are kind of highlighting. We've been pretty focused on running leaders. And during Q3 we reduced our workforce by over eight percent with the intent I understand our biggest model share. We're moving from a minute operator we a monitoring focused business. In her low neurology.

So you're going to see a migration of spending from the traditional core business in the remote neurology. And our focus has really been. We've been saying in every quarter, it's all about automation. It's all about data.

It's all with analytics and our but are planning now is around being seventy five thousand procedures in building a platform that allows us to scale without a linear increase in staff.

And right now the biggest need for spending is really around robotics, technologies to deliver more interop in our monitoring business, some additional all that we expect to probably hire in twenty and twenty two and then additional staff to support growth. But I think right now we're with this infusion capital work.

And as you can see, we were even the positive in the quarter. So The spending right now will be investment in spending around, again getting to a higher level of volume, which has been our goal all the way around in twenty twenty one.

Do you have any other questions?.

42:11 Sorry. I think that's it for me. Thank you..

42:17 Our next question comes from Bill Sutherland with the Benchmark Company. Please go ahead..

42:24 Thank you. Congrats all the progress. I wanted to talk a little bit about the premier relationship.

Are the member health systems that you're going to be going to currently using another third party for their monitoring?.

42:51 Yes, a number of them are. That third party, their contract ended on October thirty one So Bill will be going through we're really going through a process now we're gathering data. Starting discussions with some hospitals who already reached out.

And then we're getting we've spent out giving contractual data on the pricing of that competitor has been using, and now we're going to start now rich program. Starting with various hospitals..

43:24 Did you, so, so this was, I didn't realize this was they saw contract prior to you when a yours.

So did they, what degree that they have that entire universe of members? Premium members?.

43:40 But we don't have data yet on the penetration numbers they have, but they had the exclusive relationship we believe as well over a three year period..

43:50 Is it your guess that the rest of it would be more or less greenfield? Or is it I mean, is it safe to assume that you even if they didn't use that vendor? They have got some relationship in place?.

44:07 Yes, I think the safe does still bad..

44:10 Yes.

So You're going to bring remote neurology to these deals as well aren't you?.

44:22 We'll be augmenting the operating monitor expansion with remote neurology. Going back to the slide in the presentation, it's now supporting all of our [Indiscernible] growth and we have plans to expand that by vertical in twenty twenty two..

44:46 Is the limitation neurologists or just just the pace of being able to the contracting process?.

44:57 As it relates to pre year, limitation right now is just we people, we are building a core team to support this opportunity, which we believe is significant. We know the prior competitor had meaningful success in delivering on the contract with premier. Despite five territories. we're now ramping up and trying to gather data.

We're into our first month in the dealer of start November one, so we’re still only more incur here, but we're moving quickly, part of the funding that we brought in, which really to help ramp that up..

45:37 Because you're going to need to geographically expand on share?.

45:41 We are and that have that have capabilities across the entire United States. Now obviously for in twelve states now, there'll be slower overlap. And we've already started some of the outreach states where we have currently operated. But again, we need to capital to really start to aggressively to go after this business..

46:08 And is your push with remote neurology changing your M&A focus in terms of what you want to emphasize?.

46:20 Good question. I think as it relates to core business, a quarter or operator of the reminder, does it change our valuation? Well, it potentially makes both acquisitions were valuable to us..

46:33 Right. And hopefully it doesn't change to a pricing decision on our part. But well, for example, the century transaction, if we were providing remote neurology at that point in time we acquired Century, it would have affected our valuation of the business, no doubt. So, it's only made that acquisition more valuable in hindsight.

Because they were using third parties, they were paying a premium and now by bringing it in house in our own proprietary model where we are able to preserve and keep margin, it just makes that book of business more viable to us..

47:16 Sure. Makes sense.

And you'd be looking as suppose M&A as a weighted speed up the pace so they're getting into an adjacent yet under the own?.

47:30 Yes. Yeah, didn't I don't want really go down on that path yet. I think from our standpoint, in the medium term, we're focused on ramping up and we have a couple of directions we're taking, both focused on improving quality of service and lowering cost of delivery.

And frankly, as we bring it in house, we're looking at a thirty five percent to forty percent reduction over the gate through our own delivery team and through negotiating contracts with existing vendors.

48:04 So again, we expect margins to improve as we scale out business and as we continue to drive our operating the monitoring business because are operative and monitoring is driving the remote neurology platform and generating more margin..

48:19 Right. And then last I did also as the prior analyst noticed very impressive ability to take your case your managed procedure target, given the surge.

I was thinking what portion of cases are in ASCS or short state surgical facilities?.

48:47 As well as varies a little bit based upon the level of COVID, ballpark probably thirty percent or ASPS right now. However, last year it shifted as the hospitals were faced with issues, with surgeons migraine board of their business ASCs [Indiscernible]..

49:09 Obviously, that's a pretty good a pretty good portion of your business in the ASC, so that's that's help. Okay. Exciting times. Thanks, guys. Appreciate it..

49:25 Thanks, Bill..

49:26 Thanks, Bill..

49:28 Our next question comes from David Schechter with Perspective Capital Management. Please go ahead..

49:38 Hi, John. Hi, Scott. And John again, congratulations on all the great stuff that's going on there. As you look at a year from now, and assuming things go as you hope they will, breaking IONM cases away from neurology cases, what kind of profit per case and again, I understand there's different states and there's different types of surgeries.

Is there any way for an outsider or to model? What kind of profit on a per case basis we you think you should have perhaps a year from now or two years from now, whatever you think is the right time timeframe?.

50:29 John, you want to respond that?.

50:33 Yes, David yes it's been really a primary focus since I joined the company and as we discussed on script there, We've met with a number of investors and we're trying to streamline the way that we're presenting the business. I would say for Q4 and taking a look out, for twenty twenty two.

We'll be in a better position to give you a bit of an outlook say, historically, we really haven't discussed our margins or rates on a per case basis. Historically. And as we kind of roll out this new model in the way we're presenting the business hoping give a little more transparency to help you with your own independent models..

Yeah, it would be very helpful because you do forecast a total case number next year albeit without premier or acquisition to twenty five thousand cases, but that's part to translate into some kind of sequential profit number or even a revenue number without at least some guidance towards the modeling?.

51:54 Yeah. David, I completely understand and it’s like I said I'm anticipating that we'll have disclosure on those various elements, it's going to allow you to ahead and kind of put you monthly….

52:07 Montly Q4 earnings call..

52:08 Yeah for year end..

52:10 All right. So thank you very much for all..

52:15 Yeah. David would just give us something back in the next quarter it's kind of a moving target. You can probably take our existing numbers extrapolate that over twenty five thousand procedures.

But frankly, the upside year significant upside in the remote neurology side and getting additional margin off of that business going forward, even extra two dollars to two hundred fifty dollars a procedure has a significant impact on profitability next year.

Separately, we're going to do an assessment probably as early as January, February around other M&A targets. And again, it's not in that twenty five thousand But I'm not the belief it will have an impact on growth next year as it did this year.

We think they going be buying opportunities again, and we wntto be selective and we want to be active in the part of next year..

53:11 Look forward to that. One last quick question in the financing that just closed in the press release you mentioned that management and the Board would be buying up to another seven hundred thousand dollars of the securities one would you expect that deal led additional maybe even consider a kind of a green shoe for the management and board.

When do you expect that to close?.

53:40 Over the the next couple of days. Management and the board wanted the market to be able to react to the funding and the earnings before pricing are around to our corporate guidelines around insiders and that's operating news to allow the market to react. See the results and then we would participate after that in the public domain.

I appreciate that. Thank you very much..

54:15 Thanks, David..

54:18 Our next question comes from [Indiscernible] with Bank Equity. Please go ahead..

54:23 Yes. Thank you for taking my question. Congratulations on the quarter, guys.

Can you maybe expand upon the multiplan agreement and how that impacts the acceleration of your end network revenue stream?.

54:39 Yeah. Happy to.

Paul are you, are you on the line right now you Paul Webster?.

54:47 Yes.

Can you hear me?.

54:49 Yeah, I want you just walk me through the opportunity that's developed through multiplan, and the effect and the impact is happening in our business..

55:01 Sure. So we had an agreement with multi planned previously, which was a different kind of structured plan. It was a discount arrangement. This is a true network PPO network agreement and we've included all of our provider entities across all of our states in this new agreement.

And couple of things, we focused on pricing this agreement so that it would be more attractive to payers and participation. The initial structure was based on percent of build charges. This one is various multiples of the Medicare fee schedule.

And so, with that pricing arrangement, it was multi belief and is our belief that there will be a higher participation in processing claims through those discount range it's thereby increasing in network participation..

56:05 And we're seeing a Paul and you could share we're seeing a material impact all that plan already. And by bringing you onto our platform..

56:19 Right. And, to provide some context for the effectiveness of this contract so far. The effective data the agreement was August fifteenth that is the affected date, dates of service. So, obviously, there's some timing where the claim has to go through adjudication and payment so forth.

So we start seeing the impact of the agreement in late September, early October now that we're into mid November. We can see a fairly material impact. I would hesitate to give you any numbers at this point only because it's early in the process. And the communication of multi plan outs of their partners and clients is still underway.

And so we have what we've seen so far is encouraging, but it's by no means where we expect be we think it will improve over time..

57:20 Got it, that makes sense?.

57:24 Yeah..

57:25 This concludes our question-and-answer session. I would like to turn the conference back over to John Farlinger for any closing remarks..

57:37 Thank you. [Indiscernible] Assure team, we'd like to thank everyone for listening to today's call. Before concluding I'd like to have a few last comments. I want to summarize what we believe our Assure’s greatest opportunities and the areas of focus in the near term. There follows.

Again, just reiterate, number one, expanding our remote neurology services platform, two taking a full advantage of our position, as the sole contracted provider of interop and their monitoring services for the premier network. Three, Organic growth extends our reach with existing states and helps us expand into new states.

Four, opportunistic M&A that leverages our public company Nasdaq currency at advantage none of our interoperative neuro monitoring focus competitors and duplicate. 58:34 Definitely, we'll continue to focus on using data, analytics and automation to strengthen revenue cycle management and to facilitate signing of new and network agreements.

With that, revenue cycle management and managed care we're essentially contracting with a network providers will continue to be a focus for us going into early twenty twenty two.

With that I'm going to conclude, we thank all of you for your participation today We look forward to speaking to you again on our fourth quarter earnings call twenty twenty two. Thank you..

59:18 The conference is now concluded. Thank you for attending today's presentation. You may now disconnect..