ABMD

Greetings Warriors,

Being a relative newcomer here, I’m not sure if this company has ever been discussed. If so, it must have
been determined as unworthy, since it appears to be off the radar of most, at least in the last year.

Late last year, after screening several hundred companies and looking for relatively unknown fast-
growers I ran across ABMD, read what information I could find, liked what I found, and decided to give it
a 5% position in my ports with the intention of learning while holding, which is my most productive
learning method as it tends to keep me focused on my holdings and learning as much as possible. So far,
so good. Since I bought in on 11/29/17, ABMD is up approximately 15%.

Like all my holdings except 1 (FB, IMO) Abiomed isn’t cheap by any metrics except those that factor in
very high growth. So the issue for me is to determine what kind of sales growth the company may
realistically be able to obtain in the near future, and to determine if that rate would support a price
considerably higher than my cost of entry. While I choose not to divulge the assumptions or forecasts
made (a simple exercise anyone can easily perform on their own) I assume it’s obvious that my conclusion
was positive.

Abiomed

In simple terms, Abiomed is a medical device manufacturer that produces a device (“pump” for
us layfolk) that assists the heart of patients with hearts with muscles too weak to maintain a proper
supply of blood flow to the body. The device is implanted inside the patient’s heart and does not
replace the human organ, but assists it when needed.

Selected Financial Items (Percent Change) source: Stock Investor Pro (Reuters)

				
**Metric. . . . . . . . . 	2017	2016	2015	2014**
Sales. . . . . . . . . . . 	35.1%	43.1%	25.4%	16.1%
Gross Income. . . . . . . . 	34.3%	46.6%	30.1%	15.7%
Research and Development. . 	33.3%	38.3%	17.3%	19.9%
Net Income. . . . . . . . . 	36.7%	-66.5%	1436.5%	-50.7%
Shares Outstanding. . . . . 	2.5%	3.9%	3.3%	0.6%
Total Cash from Operations. 	49.9%	77.4%	84.3%	-11.0%
Free Cash Flow per Share. . 	6.6%	52.8%	78.0%	-12.3%
Accounts Receivable. . . . 	26.4%	34.6%	30.3%	6.6%
Inventory. . . . . . . . . 	30.7%	58.9%	20.9%	-6.7%
Total Assets. . . . . . . . 	29.8%	25.3%	64.8%	20.8%
Long-Term Debt*. . . . . . 	0.0%	0.0%	0.0%	0.0%
Common Stock Equity. . . . 	22.6%	26.5%	73.2%	22.8%
Total Liabilities and Equity	29.8%	25.3%	64.8%	20.8%
Book Value per Share. . . . 	19.7%	21.7%	67.8%	21.9%

  • LT Debt = 15M (change = 0/0/0/0%)

Rather than write a book about the company, allow me to just list a few relevant points
while trying to balance positive and negative attributes.

Pros
? Market Cap: 9.1b, plenty of room for growth.
? 1-Product Company: Easy to understand, relatively simple accounting.
? Moat: Currently no direct competitors, no known immediate threats to monopoly.
? TAM: 221,000 patients annually (US) and 75,000 (Japan & Germany)**
? Penetration of TAM: 7.0%**
? Qualify for Medicare & Medicaid coverage.
? Product is inserted by catheter rather than open-heart surgery.
? Dilution is reasonable for the industry.
? One of the board members is also an official of United Health.
? Debt is minimal and stable.
** Source: Abiomed

Cons
? 1-product company – if the reputation of the product would be harmed for any reason, the moat
and the company’s company prospects would likely suffer.
? High risk product – Any negative future patient outcomes could threaten viability of the product
and, if serious enough, the company.
? Without new products, the investing opportunity may be of short duration (<5 years?)
? Revenue is non-recurring, although institutional acceptance does lead to repeat sales.

My Personal Conclusion
I believe Abiomed is just beginning to slide into the sweet spot for its niche market. The device is gaining
acceptance by the medical experts as indicated by increasing sales. Profit is rising faster than sales.
Increasing R&D should help maintain quality control and may provide new products. And unfortunately,
our collective heart health does not seem to be improving. Also, when on the receiving end, I do enjoy
the occasional monopoly. I can see a possible near-term path to fast-grower status, little competition
and high risk. Just what the doctor ordered. (So maybe not the high risk, but we’re getting used to it.)

Thoughts & opinions encouraged.

Dan
Disclosure: Long 1 organic heart, 3 cardio stents and a few shares of ABMD

32 Likes

My sister is a nurse in a critical cardiac unit. She text me asking if I’d ever heard of ABMD, this was about a year ago. She noted that their heart pump was all the rage amongst cardiologists in her unit. I hadn’t, but I typed it into a MF service and low and behold, it was a pick a bit before she recommended it.

I think all the points you make are great ones, they have a very unique product that decreases the mortality rate in critical cardiac patients. Their global expansion is just beginning with Japan and Germany and I think their technology IP is fairly well protected for now. So far in just over a year it’s a 2 bagger for me. Over on the RB boards there’s a cardio doctor that found their technology so much better, years ago that he invested. I believe he’s well over a 10 bagger now.

Anyhow, I think the long term prospect for ABMD is quite bright!

Patrick

9 Likes

Thanks, Patrick.

The very best consequence of any discussion is to gain someone’s personal experience with the topic.
I’m embarrassed to say I just discovered this week that ABMD was a Rule Breakers rec. I have several
“innovative” ways to find some of these companies when I guess I should look closer to home first. This
is still my first year in RB but for me TMF has so many recs from so many services that I can’t make
myself read them all. I guess it’s my loss, at least until I discover the same companies myself. I
think that makes me a slow learner. Better slow learning than no learning. Well, maybe. :slight_smile:

Dan

1 Like

Dan - yes actually this was a Saul stock a few years ago. I stuck with it and it’s a multi bagger for me as you will have seen from my port reviews. I’ve sold twice - at 130 about 2 years ago and about 180 or something. I still have a tranche.

Their performance really kicked up a few years ago when their head to head stiff competition failed to publish trial results and then was shown that its solution was hackable and a security risk. Since then it’s been winner takes all. Annoyingly they seem to just focus on Germany and JP outside US.

Ant

2 Likes

I use the Impella all the time. If anyone has any questions, feel free to ask. Great device, life-saving with expanded FDA indications for use in the last 2 years. My main concern with ABMD would be the lack of something new so far and is why I haven’t pulled the trigger on a buy.

MC

10 Likes

re ABMD
beautiful chart 3,6,12 months. I won’t buy anything that can’t manage to go up in a great bull Market And note that they beat analyst estimates in the last 2 quarters, a sign that maybe something new is going on. Analysts by training are essentially backward looking.
ABMD is exceedingly expensive

So we might need to see them have new indications, new products, or sales beyond present geographical limits to justify the price.

I use the Impella all the time. If anyone has any questions, feel free to ask.

Thanks, Doc, I was hoping you would reply. And now, you asked for it. :slight_smile:

  1. Do you have any idea why they have R&D?
  2. Are they trying for new product development, or just refining Impella?
  3. Have there been any significant changes in the product in the last few years?
  4. Any idea what the hospital pays for one? The patient?

I’m just getting into the company’s history. I would like to know more about litigation, if any, and I
need to find out more about plans for future product goals. Without more knowledge, it begs the question
of whether the company is resting on its laurels.

Even if one were inclined to invest, the charts say it isn’t the best timing. But it said the same thing
when I bought too. That seems to often be the case with the fast growers, you pay to play. A healthy-
sized price dip would be nice.

Don’t strain yourself digging for answers to my questions, I’m not lazy and will find them eventually;
I’m just a little time constrained these days (and enjoy discussing companies.)

Dan

4 Likes

beautiful chart 3,6,12 months. I won’t buy anything that can’t manage to go up in a great bull Market
And note that they beat analyst estimates in the last 2 quarters, a sign that maybe something new is
going on.

Agreed. Increasing sales is the only catalyst I’ve seen so far. Healthy but not earthquake territory.

ABMD is exceedingly expensive

No doubt. This makes it high risk for sure. I wish I could have found it a long time ago, but it is
what it is now.

So we might need to see them have new indications, new products, or sales beyond present geographical
limits to justify the price.

Agree again. As I mentioned, a healthy price dip would be nice. For now I’m just bringing the company
back into the board’s radar range just in case there is new news, while laying out a few reasons for my
buy for the benefit of anyone interested and of course, to clarify my thoughts for myself.

Dan

beautiful chart 3,6,12 months. I won’t buy anything that can’t manage to go up in a great bull Market And note that they beat analyst estimates in the last 2 quarters, a sign that maybe something new is going on. Analysts by training are essentially backward looking.
ABMD is exceedingly expensive

Yes, it has been a great company and great chart. Unfortunately the proper chart buy point was $200.38, so now the risk is higher. (Proper = a quality basing pattern after a run up of at least 20%, with strong volume on the breakout and good fundies).

look here
http://stockcharts.com/freecharts/gallery.html?abmd
and notice the base that started on Nov 27 with a high of $200.28. Then the reasonably strong move above that around Dec 8. That was you “chart” opportunity.

here is the old “New America” article on ABMD, I think that was about the time this board was investigating. https://www.investors.com/research/the-new-america/impella-h…

Here are current IBD fundamentals:
It is ranked second in its stock group, behind ALGN which just broke out from $266.51 and is still within the 5% buy range. Anyway:

Rating
Composite Rating 98 Pass
EPS Rating 98 Pass
RS Rating 96 Pass
Group RS Rating A- Pass
SMR Rating A Pass
Acc/Dis Rating A+ Pass

ALGN ratings, even better
Rating
Composite Rating 99 Pass
EPS Rating 97 Pass
RS Rating 98 Pass
Group RS Rating A- Pass
SMR Rating A Pass
Acc/Dis Rating A- Pass

you can see the chart here and why ALGN buy point is 266.51
http://stockcharts.com/freecharts/gallery.html?algn

IBD wants to see breakout vol 40% above average, which does not look to be the case here, but Stockcharts has removed their Vol Moving Avg on their free charts. Jerks.

Don’t worry that ALGN has faded a tiny bit since the breakout, many stock return to test that point, making a new buy opportunity.

Recent ALGN article
https://www.investors.com/research/ibd-stock-analysis/breako…

ALGN first appeared in the IBD New America in 2012, here it is
https://www.investors.com/research/the-new-america/align-tec…

pete

8 Likes

…why Germany concentration
In 2005, ABMD bought Impella Cardio Systems AG, a German company.
In 2014, ABMD bought Entwicklungsgessellschaft (ECP) and Aachen Innovative Solutions (AIS), both German companies.

Important to note: Impella is a Platform, not just a Device. Dr Thorsten Siess from ECP became CTO of ABMD at the time of acquisition. Thorsten 7-minute video (May 17) speaking about the platform: https://tinyurl.com/y9yjmhap

cautiousone

3 Likes

…why Germany concentration

Would you rather have a German made impeller, or a Greek made one?

1. Do you have any idea why they have R&D?
2. Are they trying for new product development, or just refining Impella?

My assumption, without listening to the conf calls, would be improvement of existing devices. Mostly, making them smaller without compromising efficacy. The larger the device, the more vascular complications that will arise from their use. Most of this will be motor technology and software advancements I presume. The device is pretty simple from an engineering perspective, it’s cramming all that into a very small package that has been the coup. Currently the motor on the CP device is 14 French. That means the hole you have to put it through is about the size of a standard ball point Bic pen.

They also developed a right ventricular device. I have yet to use this particular device but it’s not much different from the others.

3. Have there been any significant changes in the product in the last few years?

The CP is the newest change. Same profile as the 2.5 but gives us more output than the 2.5 at the same access site sheath size so we don’t use the 2.5 as much anymore. Size matters, in this case, smaller is better.

4. Any idea what the hospital pays for one? The patient?
I do not, I used to when we first decided to get them but that was several years ago and that is much different now I would assume. Also, that price likely changes by thousands of dollars with different hospitals.

One anecdote for you about the device and that is really works. About 2-3 years ago a guy came in with an acute MI (heart attack). Emergency case requiring multiple stents. Guy was SAS (sick as $h!t) and went into a fatal heart rhythm (Vfib) 69 times and he needed to be shocked every single time to bring him back. I gave him every medication on the planet to try to stop it but nothing worked. It got to the point that one nurse’s job in the room was just to sit next to the defibrillator and shock him… that is literally all she did for about 20-30 minutes. I decided to put in an Impella (it was almost impossible to do because he kept dying on me) and as soon as the device was in and working the rhythm issues resolved completely. The guy lived and I see him once a year now. I’ve been a believer ever since…

MC

19 Likes

This is reminding me of another heart company - Edwards Lifesciences (EW). Heart valves; anything else? Their products are also supposed to be very good.

MC,

I’m curious about their growth, particularly since they seem like a one trick pony.Is it just more awareness of their product? Expanded usage (ie, post arrest cath?) … What moves the needle for them, say, in a year or two?

As for meds, no luck with esmolol? I’ve had reasonable success in (witnessed) VF arrests and has become a go to for us if >3 shocks. Small amount of data, but better than any data for amio or lido.

MC
Really happy you are here, your expertise is priceless on this board.
So off topic, kind of. What is the best coarse in life to never meeting you at work?
Bruce

Looking at past earnings ABMD has been on a roll the last 5 quarters going from 20cents to 53cents earning per share. Yet analysts seem to not show any significant anticipated earnings up tick over the next two quarterly reports.
If earnings are to continue like they did in the past ABMD may be worth the high P/E. If they are flat , probably not.?
Would buying now be buying a year too late?
Raptor D2 gave a nice review ofthe positives, Thanks
The device is gaining acceptance by the medical experts as indicated by increasing sales. Profit is rising faster than sales
so why are analysts predicting flat earnings? What do we know that analysts don’t?

no position in ABMD so far . Just questions

1 Like

I’ve been invested for a couple years now. Part of my conviction before was the belief that they could grow into more indications as their safety profile improved. I hope they will be able to get the size down to something like 10 French or maybe even smaller for a less powerful pump. There’s a lot more access site complications at 14 French. if they could make it smaller then all the cardiologists who focus mainly on regular coronary catheterizations would feel more comfortable (they can do a lot though just a 4 French sheath).

ISRG has done pretty well with just one device that gradually expanded its indications. Many others just get bought out.

@Bruce in my experience the one single thing anyone can do to avoid the cardiologist (among other specialities) is to quit smoking, or never start it.

2 Likes

IRDOC,

I appreciate the smoking advice, but if I can ask a question- how do you feel about occasional cigar smoking (say- one a week) and cardio risk?

Sorry to digress from investment discussion.

Thanks! -Bob

When I say everything, I mean everything… ischemic hearts that are acutely revascularized are the worst, especially a large dominant RCA which is what this was…

MC

1 Like

Eat right, don’t smoke, exercise for 30 minutes 5 days a week and take a moderate dose statin and your chances are pretty good we will only meet outside of the hospital.

MC

3 Likes