Hidden within Myomo's recent earnings calls lies a fascinating trend, one that might have slipped under the radar of even the most seasoned analysts: the company's explosive growth in Germany. While Myomo's U.S. business has certainly grabbed headlines, fueled by the recent CMS reimbursement victories, their German expansion has been quietly outpacing even their ambitious domestic projections.

In the first quarter of 2024, international revenue, largely driven by German sales, accounted for a staggering 25% of Myomo's total revenue. This is particularly remarkable when considering the significant growth of their U.S. business, spurred by the long-awaited Medicare Part B coverage. This begs the question: could Myomo's German success be the company's secret weapon, poised to propel them to even greater heights?

Let's delve deeper. Myomo's approach in Germany mirrors their initial strategy in the U.S., focusing on establishing a robust network of orthotics and prosthetics (O&P) clinics. They've successfully recruited over 100 O&P clinics in Germany, a network comparable in size to their direct billing team in the U.S. These clinics, already familiar with stroke patients and accustomed to navigating the German healthcare system, have proven to be highly effective in advocating for MyoPro coverage and facilitating patient access.

This O&P-centric strategy in Germany offers valuable insights into Myomo's long-term potential. As they ramp up their O&P channel in the U.S., they can leverage the lessons learned from their German success. The German experience suggests that O&P clinics, with their established patient relationships and expertise in navigating insurance systems, can be a powerful force in driving MyoPro adoption.

The numbers tell a compelling story. In the fourth quarter of 2023, international revenue represented 23% of total revenue, a figure that climbed to 25% in the first quarter of 2024. This upward trend suggests that Myomo's German operation is accelerating, even as their U.S. business experiences a surge of its own.

International Revenue Growth

The chart below illustrates the growth of Myomo's international revenue, highlighting its increasing contribution to the company's overall revenue.

Extrapolating from these figures, we can hypothesize a scenario where Germany, with a population roughly 20% that of the U.S., could eventually account for a similar proportion of Myomo's total revenue. Imagine a future where Myomo's international business, spearheaded by Germany, generates hundreds of millions of dollars annually, rivaling their U.S. operations.

Myomo's German success is not just a testament to their strategic execution; it also highlights the universality of their product's value proposition. The MyoPro addresses a fundamental human need: the desire to regain lost function and reclaim independence. This need transcends borders and cultures, offering Myomo a global market ripe for expansion.

While the spotlight shines brightly on Myomo's recent Medicare triumphs, it's crucial to remember that their German operation is quietly laying the groundwork for a global medical robotics powerhouse. As Myomo's German gambit unfolds, it's clear that their success story is only just beginning.

"Key Highlights from Myomo's Q1 2024 Earnings: Revenue Growth: 9% year-over-year, reaching $3.8 million. International Revenue: Accounted for 25% of total revenue, driven primarily by German sales. Record Backlog: 275 units, up 56% year-over-year. Expanding Patient Pipeline: Over 1,100 candidates in process, a 30% increase from the previous year. Medicare Part B Reimbursement: MyoPro claims are being approved and processed at the published lump-sum rates. O&P Channel Momentum: Growing interest from O&P clinics in providing MyoPro to patients, building on German success."

"Fun Fact: The word "myoelectric" combines "myo" (meaning muscle) and "electric," reflecting the technology's core principle of using muscle signals to control prosthetic or orthotic devices. Myomo's MyoPro truly embodies this concept, empowering individuals to regain control of their limbs through their own muscle activity."