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Why Hospitals Are Not Buying The T2 Biosystems Diagnostic System - $1.50 1-Year Price Target

White Diamond Research profile picture
White Diamond Research
2.52K Followers

Summary

  • T2 Biosystems’ recent Breakthrough Device designation by the FDA isn’t an acknowledgement of the device’s effectiveness or clinical value proposition, only that it diagnoses life-threatening conditions.
  • The T2Dx Instrument adds additional hospital expense but provides little clinical value, hence the miniscule sales numbers.
  • The value of the T2Bacteria test is low because it does not measure bacterial susceptibility to antibiotics and, therefore, does not change clinical practice. Other similar technologies have been flops.
  • In every 2018 quarter, TTOO's unsustainable research revenue was higher than its much more important product revenue.
  • TTOO has $44M in debt, paying interest at an usurious 12.5% rate.

T2 Biosystems (NASDAQ:TTOO) T2 Magnetic Resonance ("MR") technology, powered through their T2Dx Instrument, is a diagnostic system that can do a variety of blood tests from inserted panels. They just had a big launch in mid-2018 for the T2Bacteria which got FDA approved in May 2018 that was supposed to be a "game changer". But it is becoming a commercial flop like other bacteremia (bacteria in the blood) testing diagnostic systems before it. You can see that TTOO still has very meager sales and huge losses every quarter.

We have nothing against progress and early-stage companies attempting to develop breakthrough medical technologies. However, when such a company is not the first mover in its market, they better have a superior product. Unfortunately, for TTOO, it appears that this is not the case. We believe our research shows that TTOO has no real competitive advantage in a crowded space with significant established players. In its 2014 10-K, TTOO listed five competitors and in its 2018 10-K, it listed eight (Becton, Dickinson and Co. (BDX), bioMerieux (OTCPK:BMXXY), Bruker (BRKR), Accelerate Diagnostics (AXDX), Luminex (LMNX), GenMark (GNMK), Cepheid, and Beckman Coulter). There are some big players in this list.

We, at White Diamond Research, are continuing our rampage of exposing mediocre medtech device companies. In the past 8 months, we have exposed the mediocre medical devices of Viveve Medical (OTC:VIVE), TransEnterix (TRXC), Helius Medical (HSDT), and Apyx Medical (APYX). All four of those companies have stock prices that are considerably lower today than when we first published our reports on them.

We interviewed a couple of physicians who are experts in the field of sepsis testing. From the information we collected from them, we realized that TTOO's T2Dx is also a mediocre medical device. We learned why the company is having a hard time selling it

This article was written by

White Diamond Research profile picture
2.52K Followers
We provide deep research and valuable information on small cap stocks to hedge funds and high net worth individuals. We specialize in the technology and healthcare sectors. We have an over 80% success rate, see our reports at whitediamondresearch.com. See the 3rd party verified return on each of our bearish reports over the last 24 months at: https://breakoutpoint.com/as-summary/white-diamond-gvmtg/To inquire about becoming a premium subscriber, send a PM here or email us at research@whitediamondresearch.com.Follow us on twitter @whiteresearch.

Analyst’s Disclosure: I am/we are short TTOO. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.

Additional disclosure: http://whitediamondresearch.com/disclaimer/

Seeking Alpha's Disclosure: Past performance is no guarantee of future results. No recommendation or advice is being given as to whether any investment is suitable for a particular investor. Any views or opinions expressed above may not reflect those of Seeking Alpha as a whole. Seeking Alpha is not a licensed securities dealer, broker or US investment adviser or investment bank. Our analysts are third party authors that include both professional investors and individual investors who may not be licensed or certified by any institute or regulatory body.

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Comments (180)

r
Well,,,, Another shot in the dark --- Looks like Tony has some "tight shoes" to fill --- Who is waiting in the wings to take over and re-organize???
m
Looks like you were far too generous with your buck 50 price target.
j
White Diamond,
What do you think of AXDX?
m
Excellent question. I was just looking into going short AXDX while long TTOO.
White Diamond Research profile picture
We've been silent on AXDX for awhile because we hadn't researched it very much and didn't want to lead anyone the wrong way. We are now researching the company and will give a formal opinion soon.
CR144 Research profile picture
This is nothing more than BS written by short seller.
shinobirastafari profile picture
Care to comment? GE Healthcare seems more bullish on TTOO than you are. To whose opinion should we pay more attention?

www.streetinsider.com/...

T2 Biosystems (NASDAQ: TTOO) disclosed that on March 15, 2019 T2 Biosystems, Inc. (the “Company”) entered into a Catalog Supply Agreement – OEM Retail (the “Agreement”), with GE Healthcare Bio-Sciences Corp. (“GE Healthcare”) for the manufacture and supply by GE Healthcare of its proprietary superparamagnetic particles to be used in connection with the Company’s products. Pursuant to the agreement, GE Healthcare has appointed the Company as a non-exclusive reseller of the particles, solely as part of the Company’s products, in clinical diagnostics and life sciences research around the world. The agreement contains other terms and conditions generally consistent with an agreement for the manufacture and supply of materials or products for use in the development and commercialization of biotechnology products such as the Company’s products, including with respect to ordering, supply of such product in accordance with specifications, and quality assurance and quality control activities. The Company is obligated to meet certain minimum purchase requirements in each contract year of the agreement during the term.

Either party may terminate the Agreement immediately upon the insolvency of the other party, or for uncured breach of the Agreement where termination is effective on receipt by the breaching party of a termination notice not less than 60 days after receipt of written notice of a breach. GE Healthcare may also terminate the Agreement if the Company fails to pay any amounts due within 30 day after receipt of written notice of GE Healthcare’s intent to terminate for non-payment, or if the Company fails to timely pay any such amounts 3 times within a twelve month period. Absent earlier termination, the Agreement will remain in force until March 1, 2027.
Poynter profile picture
I am long TTOO, but this deal has nothing to do with GE being "bullish" on TTOO -- they are simply selling them one of their products!
White Diamond Research profile picture
"GE Healthcare seems more bullish on TTOO than you are. To whose opinion should we pay more attention?"

Here is our track record: breakoutpoint.com/...

If GE can beat that, go with GE.
shinobirastafari profile picture
I'm not going with GE or TTOO or your suggestions. I remember your short article on RLYP, just before they got bought out. I was unimpressed seekingalpha.com/...
my dog profile picture
I have justed watched the t2 presentation to paccarb on you tube anybody invested should watch, very informative, especially the question and answer with the panel. Even brought up company funding and the importance of being nomdilutive.
w
62walt
16 Mar. 2019
There is no particular revenue benefit to the hospital for owning the machine versus the rental platform. The real value proposition is primarily two fold: first, more effective treatment for patients (which is what medicine is all about) and second, significant reduction in health care costs from reducing length of stay.
c
Question: Not as well versed in the industry as most of you. In my experience revenue/income drives adoption (of anything) faster than savings (maybe even lives), does the hospital benefit at all from a revenue perspective since they own the machine? In other words, do they also makes some margin? All reimbursable? thanks.
TradeATM profile picture
They get reimbursed in certain cases in the ED under CPT codes. Otherwise their profit/savings incentives resolve around savings through pharmacy, better patient outcomes, early discharge and others - there’s a whole matrix of metrics that dictate how much a hospital is reimbursed that these tests should improve. Candida has already done so at least.
w
62walt
16 Mar. 2019
An example of the insulated silos, and the effect on the the sales cycle, may be Massachusetts General Hospital. The T2 has yet to refer to any “wins” there, and they may already be a customer, but that is a hospital that has licensed patents to the company, has a royalty agreement on sales, and has co-authored papers with the company. Logic would dictate they should be well along the adoption curve with the likes of Henry Ford Hospital and Lee Memorial Health Systems which have been mentioned on the conference calls. I would think Mass General would want to get out front on this effort if for no other reason than their royalty deal would pay for the costs of its own adoption and then some.
Osmium Research profile picture
Does anyone know if Kaiser Permanente has purchased a system?
w
62walt
15 Mar. 2019
Last comment. I just increased my long position 30%.
Poynter profile picture
@62walt :
well I kind of stand corrected regarding my comment “flying off the shelves” at this point if “the impact of this technology was glaringly obvious”. As you spell out very clearly, there are impediments of the status quo, the difficulty of changing hospital-management minds, etc.

But still, the impact of this technology is not glaringly obvious. As I stated earlier, if there were robust data from a large hospital-patient population which clearly indicated that using T2 instruments (versus current SOC) substantially 1) reduces costs of hospital stays and 2) improves patient outcomes, it would be hard for hospital management to ignore that data -- it would stand out as a win-win for everyone. Yes, there is increased cost, but that can be rationalized as clearly justifiable because of improved patient outcome and reduced cost(patient, insurance, and hospital costs?).

Maybe I'm wrong, but I haven't seen any such data -- if its out there, I would very much like to read it. We know T2 systems dramatically reduce the time to complete a bacterial ID test and that of itself is a huge deal -- I like this stock but until I see more data regarding their product's value in real world hospital settings (as well as the anticipated launch of the T2Resistance tests) I'm just dabbling in the stock for now.
G
The issue is that there is a clear understanding that this can reduce hospital costs, reduce patient bed time and improve patient care and outcomes. But it's not as easy as run the test and reap the rewards, it requires a lot more from the hospital staff and antibiotic stewardship committee.

The hospital has to provide a multi-disciplinary approach based on solid guidelines and clinical algorithms (which are just decision trees/flowcharts) developed by a diagnostic and stewardship group. These algorithms are going to be different for different areas based on the local bacterial epidemiology. It creates more complexity for the physician.

An example hypothetical: Rather than just leave the patient on broad-spectrum antibiotics until blood culture comes back in 2 days (as they used to do) the physician now decides to eliminate two antibiotics and add another based on species identification from T2dx's results available 4 hours after blood draw. They determined to use T2dx on this bacteremia patient by comparing the patient's symptoms and any bio-markers to their clinical algorithm to find out if this was a good candidate. But the physician now has to consult with the pharmacist and clinical microbiologist in following the clinical algorithm to monitor the patient to make sure they aren't dealing with a resistant strain or a multi strain bacteremia. So they test for a couple of additional bio-markers and carefully monitor the patient's progress. If the bio-markers come back as expected and the patient improves, they've bought valuable time and provided better care than simply leaving them on the less effective broad-spectrum antibiotic, exposing them to liver damage. Plus using broad-spectrum antibiotics with poor effectiveness promotes the development of antibiotic resistance, which is a threat to every patient in the hospital. If the patient takes a turn for the worse they'll have to modify antibiotic treatment again per their algorithm. However by carefully screening the patient before deciding to use the T2dx test, they find that the vast majority of patients get much improved care. Now when the blood culture finally arrives a couple of days later, they might tailor the antibiotics further by looking at the susceptibility results it provides.

So it takes a well-organized hospital that isn't broken up into insulated silos to make this work well. It takes a good stewardship committee that keeps up with the field and is aware of the local bacterial epidemiology. As a result some institutions see better results than others.
w
62walt
15 Mar. 2019
Damn, hit send to early. Let me finish my thought picking up from the head of the microbiology making the decision to “blow” their budget by adopting a new higher cost alternative test. That administrator is not thinking about the overall reduction in healthcare cost, they are focused on their budget. It is the infectious disease stewardship committees which are now stepping back and looking at the “big picture” and going out to individual department heads to find out best practices to reduce the risk of sepsis. As the CEO said on the conference call, the more informed the decision maker the more rapid the sale. You can see this tipping point starting to happen by listing to the conference call and seeing the traction they are starting to get as one spreads around the industry.
w
62walt
15 Mar. 2019
@poynter I agree this is a waiting game (clearly!) but I disagree with the premise that the product should be “flying off the shelves” at this point if “the impact of this technology was glaringly obvious”. The important market dynamic you are missing is how difficult it is to penetrate a market where the standard of care (blood culture) has been firmly entrenched for years and is relatively cheap on a per test basis. To understand this market dynamic is to climb into the decision making process within hospitals with historically very siloed management structures and department heads who are fiercely protective of their current operating budget. I have come to understand this dynamic extremely well from a 30 year hospital administration veteran at a very prestigious, world wide venerated institution. The simplest way to describe this is, for example, example of a head of the ER department, or the head of the microbiology lab has to make a decision If investors go through the conference call again this dynamic is clearly highlighted and the company is clearly
r
Look what happened to Whoopi Goldberg
The Auryn profile picture
@roger kidder Wouldn't it be great if she started talking about the company?
Poynter profile picture
I'm watching the rev. numbers -- they will tell the story of how valuable the product is (or is not). This could be a good time to tip-toe in, but there are clearly some unanswered questions about adoption.
I can't agree with all this aggressive "tar-and-feather" talk regarding the author and article. This device certainly has value. Its a matter of whether the value matches up with the cost. If the impact of this technology (on both cost-of-care and patient outcomes) was glaringly obvious --i.e., data from a large patient population in real hospital settings where outcomes with and without the technology were observed, and it was found that costs of hospital stays were down dramatically, and patient outcomes were dramatically superior, these instruments would be flying off the shelves. It's too early to tell right now. I do not believe the poor performance of the SP recently is substantially caused by this one article. Its a wait-and-see approach to buying that is seen here. Let's see what the next couple quarters shows us in terms of boxes and strips sold. I think the new T2Resistance is a missing piece that will greatly increase the technology's value proposition
c
IF SA does not address such articles, it will lead to their demise. No one will follow. If SA wants to be relevant, they will fix.
r
me66 and @chadwick404 --- thank you. SA should be ashamed of themselves
m
@chadwick404, I am sorry to say, that I have to agree with you here. SA should practice some form of editing, fact checking, etc. on these type of articles. I really hate to say that because when SA is working well, it is a tremendously valuable resource, I have learned tons here. Especially from comment threads, that are civil, and where very knowledgable people discuss, debate ideas and exchange information. And FACTS.... This article falls far short of that standard, and then it is elevated to " Editors Pick " status ???? Baffling.

That being said, it did provide me with an entry point, I > my TTOO position 35% this morning. I am happy to take the long side of this trade....

GLTA longs.
chadwick404 profile picture
How is it ethical for SA to promote an obvious "hit" or "shorting" article, regardless of its veracity? Do the editors share the standards or threshold whereby such articles are picked for such designation? Its one thing for a SA contributor to post a piece stating why "GE is going down" or "GE is a missed buying opportunity" as an opinion piece for an investment rationale. But this article appears to pass some sort of editor's bar - what is that bar? How is a contributor's "facts" evaluated, used to discern?
R
RDTguy
09 Mar. 2019
A nice report, WDR -- don't mind the haters. I've worked with more than one company pursuing technologies and products for this area, and you have hit many critical items SPOT ON. Good work.
TradeATM profile picture
It really is amazing the amount of companies that have pursued technological solutions for the delayed results of blood culture. How many companies have been successful? One - T2 Biosystems. Even in your praise of the article you contradict one of the authors points.
Osmium Research profile picture
I'll have to apologize to WDR RDT, I think my brief interactions with the staff at T2 negatively colored my reactions. Nevertheless, I think the comments in this section were of a high quality (myself excluded) and WDR really didn't provide any insight into the complex relationship between the feature set T2 brings to the micro sector and the underlying factors (cost, diagnosis, treatment..) that will influence adoption.
Squabkiller profile picture
Sure a guy with 3 comments took the time to "congratulate" WDR. Good try.
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