Question-and-Answer Session
Operator
[Operator Instructions]. And our first question comes from the line of Tao Levy with Deutsche Bank. Please proceed.
Unidentified Analyst
Yes, good morning. This is Seth [ph] in for Tao. Congrats on a good quarter.
Catherine M. Burzik - President and Chief Executive Officer
Thank you.
Unidentified Analyst
So Cathy, just a couple of questions. First on the domestic V.A.C. competitive landscape, so have you felt any competitive pricing pressures for the V.A.C. or have you... and I guess have you won any big contracts that have helped drive the V.A.C. business domestically?
Catherine M. Burzik - President and Chief Executive Officer
Sure. Let me talk a little bit about that. We have not seen any increased competitive pressures on the domestic front associated with V.A.C. therapy, so that'll be the answer to that. I believe in the last call we talked a little bit about our position with Premier. We got a very good position with Premier, very recently associated with V.A.C. and we are certainly cashing in on that now.
Unidentified Analyst
Okay. Second, I guess coming on to the analysts meeting you talked about, a lot about low hanging fruit. I assume some of that pushed through to the margin line, the rental margin line this quarter. So one, is there any additional leverage on that rental profit margin line? And two, when new manufacturing facility comes on, is that going to negatively impact the margins, if I heard correctly appreciation just helped a little bit and noticing out to the opposite direction?
Catherine M. Burzik - President and Chief Executive Officer
Maybe I'll turn that question over to Marty.
Martin J. Landon - Sr. Vice President, Chief Financial Officer
Yes. We did have good margins. We have said historically that we believe there is leverage in the model and as I said in my comments, we are going to manage that to make sure that we make the kind of investments necessary to continue the top line growth. So while there is leverage in the model, we will moderate that a little bit of long lines of what we told people in the past, look for 50 to 100 basis points of margin expansion, some of them at the gross profit line, some of that at the operating profit line. I don't think that's changed. In terms of the Irish manufacturing facility, certainly we think that we have got other activities going on, as we look at those kinds of things we look to, to manage our margins. So I wouldn't expect a significant margin squeeze as a result of that coming online.
Unidentified Analyst
Okay. And Marty, should we model in any future tax, lowering of the tax line from this manufacturing facility and when?
Martin J. Landon - Sr. Vice President, Chief Financial Officer
Certainly Ireland has a lower tax structure than what we see in other parts of the world and so I would expect that over time as we produce product there, we would have an opportunity to lower our effective tax rate. I think that that will be measured but we do see that coming down over time.
Unidentified Analyst
And when does this come online?
Martin J. Landon - Sr. Vice President, Chief Financial Officer
We'll start full production in the first quarter of 2008.
Unidentified Analyst
Okay. Thank you very much. Congrats.
Catherine M. Burzik - President and Chief Executive Officer
You're welcome.
Operator
Our next question comes from the line of Michael Weinstein with J.P. Morgan. Please proceed.
Unidentified Analyst
Thanks. It's Taylor [ph] here for Mike. So, Cathy congrats on nearing anniversary number one and Marty on a few more than that.
Catherine M. Burzik - President and Chief Executive Officer
Thank you, Taylor.
Unidentified Analyst
First question is, let's talk about the U.S. V.A.C. business and the components of growth there. Can you split that out for us roughly between units, pricing and payor mix, etcetera?
Martin J. Landon - Sr. Vice President, Chief Financial Officer
Yes, I would... this is Marty, Taylor, and thanks for recognizing the longevity. Yes, so primarily unit driven, business continues to be driven by increased units and market penetration. We do see as we've mentioned in our commentary, improved revenue realization so we have seen at least stable pricing if not a slight increase in overall pricing related to our ability to build and collect particularly in the home. Mix does have an impact and has had a negative impact overall, because we see more growth particularly in Medicaid, which has a lower rate. So that kind of offsets a little bit of the revenue realization. But I think from a modeling standpoint, if you think of the revenue growth as primarily driven by units, you are in a good place.
Unidentified Analyst
Okay. So if we compare it to the second quarter, which... second quarter surprised us with the reacceleration of U.S. V.A.C. but it seemed like that was driven... you had a fairly stable unit growth rate in the 20% to 21% range, this was my impression with the fluctuations around that being pricing, mix. So this quarter if we... as we go from 22% in the second quarter to 17% in the third quarter, did unit growth stay in that 20% to 21% or was it fluctuations again in pricing and mix?
Martin J. Landon - Sr. Vice President, Chief Financial Officer
It was closer to the revenue line, so we actually saw unit growth that was down a little bit from what we saw in the second quarter on a percentage basis year-on-year.
Unidentified Analyst
Okay, so unit growth was closer to the 17%?
Martin J. Landon - Sr. Vice President, Chief Financial Officer
Correct.
Unidentified Analyst
Okay. And is there anything to attribute that to, any particular care setting?
Martin J. Landon - Sr. Vice President, Chief Financial Officer
If I had to pick a care setting, I would generally scribe that to the acute care environment where we have seen lower senses, we have seen some things where they are getting squeezed a little bit from a reimbursement standpoint, but nothing on market I would say in terms of that change. I think you just see a number of factors. There are... as you grow the business, there are natural points of resistance in the business both in the U.S. and Internationally, and as I said in my comments, we saw growth that varied by geography and as you think about that environment getting homecare reimbursement becomes important as you move forward because this becomes a fairly significant line item in certain institutions and you get to a point where you not only have to do the clinical sale, which we are very good at but you also have to do the economic sale to keep pushing through. And those are things that we've dealt with in the past and so the expectation here is that we will move through those as well.
Unidentified Analyst
Okay. And does that affect your... as we think about the fourth quarter guidance, which based on the full year guidance implies I think sales growth of 9% to 14%, which would certainly represent a deceleration from what you have done so far in the year. I know you talked about the surfaces business expecting lower revenue growth there but is there an expectation for deceleration in the V.A.C. business as well?
Catherine M. Burzik - President and Chief Executive Officer
Taylor, this is Catherine. Let me just comment a little bit about that. As Marty indicated in his comments, we've had four quarters now of very strong growth and that growth rate began at fourth quarter of 2006, so one of the things to take into account here is the comparison this quarter to last quarter. That's said this global healthcare reimbursement environment that Marty spoke a little bit about has created some cost pressures both domestically and internationally. In the domestic area, I will give you for example the fact that Medicare has reduced the reimbursement for the long-term acute care facility, so they are really struggling right now on how best to move forward. And so we obviously have to... have to work through that and deal through that. We've done that successfully in the past.
In international, we see some additional health technology assessments and these health technology assessments come from various countries within Europe that are actually trying to understand what is the effectiveness of negative pressure wound therapy versus moist wound therapy, and so we have to work through these on a case-by-case basis. The good news here is, KCI as you know has a large volume of evidence associated with the clinical and the economic effectiveness of V.A.C. We have shown time and again that we can put that evidence forward and work through these kind of situations both domestically and internationally, and we certainly intend to do that but I thought it was prudent to try to factor in what we think the impact that those are going to be in Q4.
Unidentified Analyst
Okay, great. And then just last question and then I'll drop. Gross margin was very strong, can you just go through the reasons for that again and how much of that is sales force productivity driven?
Catherine M. Burzik - President and Chief Executive Officer
There is certainly a piece of that gross margin is sale force productivity driven, which you see on the top line results were pieces [ph]. Our service organization productivity driven in there as well as you starting to see some of the benefits associated with our globalization efforts. That said I want to just repeat something that Marty indicated. You know as we look to that kind of growth margin, we definitely want to take some of that margin going forward and invest it particularly in our international sales organization where we look to build capability in Japan going forward as well as growth in certain European countries. We also want to invest this in a number of marketing programs as we go forward here for Info-V.A.C. and Acti-V.A.C. So we have places that we want to invest that money.
Unidentified Analyst
Okay. Thanks a lot.
Martin J. Landon - Sr. Vice President, Chief Financial Officer
Thanks Taylor.
Operator
Our next question comes from the line of Mark Richter with Jefferies & Company. Please proceed.
Mark Richter - Jefferies & Co.
Yes, good morning guys and great quarter.
Catherine M. Burzik - President and Chief Executive Officer
Thank you, Mark.
Martin J. Landon - Sr. Vice President, Chief Financial Officer
Thank you, Mark.
Mark Richter - Jefferies & Co.
Few questions first, so excluding the $0.06 one-time financing charges, you would have done $0.88, you know, first closed at $0.79 and analysts were sort of mixed in terms of some taking out the charge or some including it on their estimates for the quarter, so first call was a little bit nebulous. That said you posted a great EPS number, can you give us a bit of more color on what drove the dramatic upside?
Catherine M. Burzik - President and Chief Executive Officer
Well, I will comment a little bit and then Marty may also want to comment but thank you for the compliment. Yes, we are definitely proud of the quarter. I mean we are focusing a lot on the internal management of the business and I think you see some of the fruits of that coming in this quarter. I just talked a bit about the gross margin piece and what drove that gross margin, so you see a lot of it coming from, actually from the gross margin line leveraged on to the bottom line. And as we said that, it comes from both certainly sales force productivity but also improved efficiency facilitated with our service organization. And then also, we think that we could spend more in the marketing area than we have spent, so some of that comes from what I would call an under spend in the area of marketing.
Martin J. Landon - Sr. Vice President, Chief Financial Officer
Yes, I think the global alignment efforts have been effective to this point, Mark, and I think they have eliminated some redundancies in terms of people repeating processes and that's helped. Certainly, we have had good strong revenue growth and we have had stable pricing that helps pricing always results in better margins. I think that we have put in place programs that were just not rolling out in terms of new products and so those types of things have helped us generate higher margins. We look forward and we say, look you got to have those marketing programs for these new products that you go forward. You got to expand the work force as you look forward and so that is why we are saying that this is a very solid margin growth, but don't get carried away. We are going to manage this as we invest for the future.
Mark Richter - Jefferies & Co.
Perfect. And just on the gross margin topic, where do you see sort of peak gross margins coming on?
Catherine M. Burzik - President and Chief Executive Officer
Peak gross margins?
Mark Richter - Jefferies & Co.
Yes, peak gross margins, correct.
Martin J. Landon - Sr. Vice President, Chief Financial Officer
Oh, hard to say. I mean... as I said, we think that we have an ability to expand margins as we go forward. Our expectation in the short-term is that we will be higher than where we have been but again, we will measure that. Could we get above 50%, I think that as you think about a pattern of expanding margins, it's not inconceivable to think that you would get there at some point but that is dependent upon a number of factors including reimbursement, including product innovations, etcetera, etcetera. So I'd hate to predict that, but we do think there's leverage in the model.
Mark Richter - Jefferies & Co.
Okay, perfect. And then, can you give us a sense of timing for your swims product. You talked about using that for prophylactic use during your analyst day and earlier in the call, in the surgical suite, but can you give us a sense of timing of the launch and maybe any anecdotal feedback from Wake Forest where they are already using V.A.C. for this use?
Catherine M. Burzik - President and Chief Executive Officer
Sure. The product is under development as we talked about in our analyst day. I want to be careful here about predicting market availability because we have got to get the product finished, and then we also have to get it through regulatory approval. So you can assume that it is a product probably in the 2009, 2010 kind of timeframe most likely. So it's not an imminent product, but it's a product that we feel very good about and expanding into what I'll called over 2 million surgical wounds that today are treated, and quite often some of those wounds today are even treated with V.A.C. and that is exactly what Wake Forest your question is doing? Wake Forest is... from my understanding and talking to Dr. Ajanta uses V.A.C. prophylactically with just about every surgery that they do. So you do find some physicians that are already doing this even though we think V.A.C. today works in that vein, we do think that our improved product, which is really going to be earmarked specifically for surgery is going to be a better product for that application.
Mark Richter - Jefferies & Co.
Okay, perfect. And then the last question is, so I am just... your strategy for global expansion sounds like it's progressing very well. Can you give us a sense of what the next countries we can expect approval and/or your sort of focus on?
Catherine M. Burzik - President and Chief Executive Officer
Sure. And yes, we are definitely focused a lot on global expansion and that includes both strengthening the penetration within Europe to the point that Marty made around investing in our international sales organization will be a key thing that we move forward with in 2008. This includes for example, we are strong today in Germany and we are working towards a potential for homecare reimbursement in Germany, but we are also investing on sales force expansion in France and in Spain, if you look beyond and perhaps in the U.K. if we can get some additional reimbursement for home use in the U.K.
If you look into Asia, this is going to be a key area for us going forward in 2008 and 2009. Particularly in Japan, where as I commented in my comments; we are really pleased that we were able to accelerate the whole enrollment and the completion of our clinical trials in Japan. And the results to-date look good so far and we are putting together now our strategy here for getting regulatory and reimbursement approval in Japan. As we go forward and bring on... ahead of Asia Pacific then we are close to being able to announce that individual, we will give that person some priorities here associated with expanding from Japan and to really understanding what the market opportunity would be for China and India. So those will be key focuses for us as we move into Asia.
Mark Richter - Jefferies & Co.
Great, very helpful and again, great quarter. Thanks guys.
Catherine M. Burzik - President and Chief Executive Officer
Thank you. Thanks Mark.
Operator
Our next question comes from the line of Mark Mullikin with Piper Jaffray. Please proceed.
Mark Mullikin - Piper Jaffray
Good morning. I'd just like to get a little more color on the nature of the health technology research assessment. Which countries have you received those and does that have any immediate impact on your ability to place V.A.C. systems.
Catherine M. Burzik - President and Chief Executive Officer
Sure Mark. I'd be happy to provide some color on that. These... our health technology assessments are things that I know that KCI has dealt with for the last several years, but more recently in the last several months, we have gotten technology assessments request from the Netherlands and from Belgium, and from the U.K. I think those are the three major countries that we have them in. And they take several different flavors. Generally, there is not an immediate impact, although some times there is. Generally, there is not an immediate impact but you have some time to work with the government to provide the evidence about the overall clinical and economic outcomes associated with V.A.C. So we work through this on a case-by-case basis that I said. In some cases, I'll tell you in particular of the case that happened in the Netherlands, this was a little bit of a different one. In the Netherlands, we did see an immediate impact as a result of that because in the Netherlands, although really in the homecare environment, no longer allowing that to be placed until we can get through that assessment with them.
Mark Mullikin - Piper Jaffray
Okay. And then on the competitive front, two of your competitors have signed agreements with Universal Hospital Services, commonage rentals of their devices and I was just wondering, what differentiates your model from a model like that in terms of just how the customer interfaces with you?
Catherine M. Burzik - President and Chief Executive Officer
Yes. I understand and yes, I am aware of those two competitors that have signed, one in services and one in the area of V.A.C. I have a pretty strong perceptive about this. I am very proud of the capability that KCI has to directly distribute and service our product and interact with our customer, and I've traveled enough now to interact with many of our customers around the world and understand that it is the combination of our sales organization, our distributional organization, our service organization and ability that we have to do collection and billing directly that it is really... I mean, I call it part of this KCI clinical advantage. So I think it is a key advantage that we have and it's a model that KCI put together some time ago. We execute that model globally. I mean, we intend to continue to do that.
Mark Mullikin - Piper Jaffray
Okay. And then just one last one, have you seen any competitive phone-based systems out in the field?
Catherine M. Burzik - President and Chief Executive Officer
We have not seen any competitive phone-based systems out in the field.
Mark Mullikin - Piper Jaffray
Okay. Thank you very much.
Catherine M. Burzik - President and Chief Executive Officer
You're welcome.
Martin J. Landon - Sr. Vice President, Chief Financial Officer
Thanks Mark.
Operator
Our next question comes from the line of Michael Watson with Wachovia [ph]. Please proceed.
Unidentified Analyst
Hi, thanks for taking my question. I guess just with regards to Japan, can you remind us how much follow-up is going to be required there? And then secondly, what is the number of wounds in that market you think you can treat? And then finally, are there any other types of... maybe gauze-based NPWT systems on the market there?
Catherine M. Burzik - President and Chief Executive Officer
Sure, so... we started this clinical trial in Japan last December and the trial is now totally enrolled. The patients are not totally through it but they are close to being totally through it, and then we will put that data together and work with what's called the, pharmaceutical manufacturing distributional organization, PMDA in Japan and the Ministry of Health in Japan to obtain reimbursement. The reason why the Japanese market is attractive... an attractive market for us is it's known that the length of stay in Japan is quite long. That's the Japanese philosophy of healthcare. They like to keep the patients in the hospital for a longer period of time than they do for example in the U.S. or in Europe. We think that V.A.C. will be uniquely suited to treat wounds in the Japanese market. When we look at the acute-care space alone, we think that it's 200,000 type of annual wound opportunity in Japan. And so a major piece of work that Woody Staub and his team will work on during the course of this year is starting to develop the commercial capability for us to go-to-market in Japan. Did that answer the question?
Unidentified Analyst
For the most part but are there any competitive --
Catherine M. Burzik - President and Chief Executive Officer
Oh yes, you question about competitive. Yes, to my knowledge there are no competitive negative pressure wound therapy systems in Japan. My understanding is to do wound drainage. They do sometimes use valve suction, valve suction counts, which is common I know around the world to do that. But as far as the whole mechanism of action and the healing that one gets not just draining the wound but the healing of the wound as far as I am aware and I have been over there now a few times. I am not aware of any other NPWT company on the market there.
Unidentified Analyst
All right. And then you talked a little bit about expecting some reimbursement pressure and I think that from what we have seen... that is kind of common, just generally across medical device industry but specifically with regards to negative pressure, how do you think that will manifest itself. Do you think that that will lead to slower unit growth for your V.A.C. systems or maybe pricing pressure or more of these healthcare assessments types of things?
Catherine M. Burzik - President and Chief Executive Officer
It's all the way. Let me just give you my philosophy on that and maybe Marty will want to comment on this too. But as the dollars... V.A.C. is such a fabulous treatment alternative that cost little [ph]. I was recently at the American Association of Trauma Surgeons and they complimented us on creating the V.A.C. and they said that we revolutionized their ability to treat patients... to treat patients that they could never heal before. And so with that comes a lot of growth and with the growth, the numbers get larger, different levels of administration become more and more aware. I mean that's like what's happened at CMS where it becomes a large number and it becomes... the insurance companies become aware of this and the administration becomes aware of this.
I think it is incumbent on KCI to be able to provide the evidence about the overall cost effectiveness and clinical outcomes of V.A.C. and if you net out all of our clinical trials, the answer here is that you have 35% reduction of wound healing time. And you have a 25% reduction in the overall cost... I'm sorry, 25% of the overall cost of treating the wound. That's been now proven to many different clinical trials. We have to package all that information together in our leadership changes in these different hospitals, leadership changes in government and we have to continue to sell the story. I think the comment I will also make is that there is obviously no other participant in the NPWT space that could possibly have the body of evidence that KCI has. So we are truly advantage as we go forward. But the reality is that we are breaking into a new category. We're developing a whole new category in our healthcare. So as a result of that... as the size of the category grows, certain individuals become concerned about the overall dollar spend.
Martin J. Landon - Sr. Vice President, Chief Financial Officer
Yes. And Mike, the only thing I'd add to that is I think that... I'm not sure exactly how it ends up manifesting itself. But anything where you have a restricted reimbursement, those things that get better outcomes that reduce treatment times or cost of care are going to work favorably. So logically in my mind, I think it actually has the opportunity for us to drive demand because we have a product that gets good positive outcomes. You think back to 1983 in the surfaces business when DRGs came out, right, and there was a fixed payment reimbursement. Well, actually our unit volume went up and the reason it did is because we were getting patients... keeping them from getting pneumonia, keeping them from getting pressure sores, things that would increase the cost of care and I see this somewhat similarly as reimbursement continues to get constrained, those products that bring real effective outcomes actually are advantaged.
Unidentified Analyst
All right. And then are there any updates that you can provide on your business development activities and in your acquisition strategy?
Catherine M. Burzik - President and Chief Executive Officer
Mike, it's the same thing that we always say here. We are actively involved in a number of potential things here that we are looking at. I think it's important for us to go forward in the areas that we talked about at the analyst day that we continue to look at and to build by capability. So I think that's probably all that I really want to say about the business development at this point.
Unidentified Analyst
All right, that's all I have got. Thanks a lot.
Catherine M. Burzik - President and Chief Executive Officer
You're welcome.
Operator
[Operator Instructions]. Our next question comes from the line of Randy Heck with Grownow [ph] Investment Group. Please proceed.
Randall Heck - Goodnow Investment Group
That's Goodnow. Hi, good morning. My question is on Japan and it was pretty much answered, but maybe I will ask one other question about Japan. What is the timeframe now, your best estimate of timeframe?
Catherine M. Burzik - President and Chief Executive Officer
Okay, Randy. Thank you for asking the question. We are putting together the results of the clinical trial as we speak here, and would anticipate in the first part of next year interacting with the right government agencies in Japan to cement for regulatory approvals. And we will shortly after that begin the reimbursement approval process and we will start to build commercial capability next year. My organization in Japan continues to tell me that in 2010 is when they will be on the market and I continue to push V.A.C. and try to get them to start thinking about 2009. So we will see whether we are able to get some on the market in 2009, but I certainly would see that we would be with key opinion leaders, we would be with key universities. We should have some major placements with beta sites, etcetera, I would say by the end of '08 and certainly then into '09.
Unidentified Analyst
Okay, okay. That's all I had.
Catherine M. Burzik - President and Chief Executive Officer
Okay. Thank you, Andy.
Operator
And our last question comes from the line of Spencer Nam with Summer Street Research. Please proceed.
Spencer Nam - Summer Street Research
Good morning, Cathy and everyone. Thanks for taking my call. Just a couple of quick questions. On this lawsuit that was filed by the ITI, any comments you guys can provide on what... where that is and what you guys want to do with that?
Catherine M. Burzik - President and Chief Executive Officer
Hi Spencer. How are you? I am going to turn the question over to Steve. You know that we don't provide very much color on these kind of things but we are certainly aware of the ITI suit.
Stephen D. Seidel - Sr. Vice President, General Counsel and Secretary
Yes, Spencer, on the public filings there in Delaware, you can see that we have now filed a responsive motion which is a motion to dismiss. This is actually a device [ph] that we haven't seen... at least haven't seen to date in the marketplace. We don't even know the product specifications of it. So we filed a motion to dismiss kind of stating that we view that as a premature filing at this point. And the judge may rule. But again, this is a product that we haven't seen. It hasn't been introduced as far as we can tell out in the marketplace yet and we will see how it develops from there. We will probably know more a quarter from now as to how that's going to proceed.
Spencer Nam - Summer Street Research
Great. I appreciate that. And then second question is just on your current conversations or relationship with CMS whether you guys are in conversations with them on various issues with respect to the negative pressure space in the V.A.C. and how the CMS is responding or viewing the overall product... the different data that you have presented over the past years?
Catherine M. Burzik - President and Chief Executive Officer
So, I will give a few comments on that, Spencer. We continue to work with CMS. We also continue to work with the FDA and other areas of helping human services here to tell the overall V.A.C. story. My emphasis in going forward and I personally spent a lot of time now with CMS, my emphasis here in going forward will be through our Chief Medical Officer and kind of the health economics and reimbursement part of our organization. I think there is wonderful opportunity that KCI has at this point with the approval of Info-V.A.C. and Acti-V.A.C. for home use, which no other NPWT provider has to go back to CMS and try to explain to CMS the huge amount of data that we had to provide to the FDA in order to get that clearance, which I think really separates us from any other providers in the state. And so I think that is the really important part of the work of Dan Ciaburri and his team, and they have already started a plan relative to meeting with the individuals that we need to meet within CMS to begin to tell that story. So that clearly is part of it as well as the overall new data that we have from our diabetic foot ulcer trial that we just talked about in the last earnings call is also very compelling data about the overall effectiveness of V.A.C. versus moist wound therapy. So I think those are important things for us to go back to CMS and tell the story. Did that help somewhat?
Spencer Nam - Summer Street Research
That sounds good. It was very helpful. Thank you.
Catherine M. Burzik - President and Chief Executive Officer
Okay. You're welcome.
Operator
I would now like to turn the call back over to management for closing remarks.
David Holmes - Director of Investor Relations
Thank you, Lacy. This concludes our third quarter earnings call. We appreciate your questions and participation and on behalf of the KCI team, thank you and have a great week.
Operator
Thank you for your participation in today's conference. This concludes your presentation. You may now disconnect. Good day.
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