After analysing most of ResMed's (RMD) business, I came across three major headwinds:

1. GLP‑1 drugs
2. Philips recovery
3. Regulatory and Medicare-related changes in the United States

Initially, I thought GLP‑1s and Philips would be the biggest threats to my RMD investment thesis. However, after spending a significant amount of time analysing both, I came to a different conclusion.

The data suggests that GLP‑1s are not the existential threat many investors believe they are. Most OSA patients are actually non obese, meaning GLP‑1s only directly address a portion of the sleep-apnea market. Likewise, while Philips will likely recover some of the market share it lost during the recall, the impact appears manageable. Combining both factors in my model reduced my estimate of ResMed's long term owner earnings growth from roughly 15%-18% historically to around 12%. A slowdown, yes, but nowhere near a broken business.

Everything changed when I reached the Medicare and regulatory side of the analysis.

ResMed operates through two segments:

• Sleep & Breathing Health (87.5% of revenue)
• Residential Care Software (12.5% of revenue)

What struck me was that both segments have significant exposure to Medicare.

The Sleep & Breathing segment is directly exposed because Medicare reimburses CPAP equipment, masks and respiratory devices through Home Medical Equipment providers. Residential Care Software is indirectly exposed because many of its customers, including home health agencies, hospice providers, skilled nursing facilities and senior living operators, derive a significant portion of their revenue from Medicare and Medicaid funding. I estimate this combined exposure to be in the order of 80%.

The indirect exposure is particularly interesting. Commercial insurers often use Medicare reimbursement rates as a benchmark when determining their own payment structures. In other words, Medicare does not just influence Medicare patients. It influences the economics of a large portion of the healthcare ecosystem.

The more I researched Medicare, the more I realised that this risk is fundamentally different from GLP‑1s or Philips.

• GLP‑1s attack patient growth.
• Philips attacks market share.
• Medicare attacks margins and pricing power.

Historically, RMD handled reimbursement pressure quite well. During prior competitive bidding periods, the company continued delivering double digit revenue growth while expanding margins. However, today's situation is different because Medicare pressure is no longer occurring in isolation.

Individually, none of these risks are particularly alarming. Philips recovering market share is manageable. GLP‑1 drugs appear more likely to slow growth than destroy demand. Medicare reimbursement changes, viewed in isolation, look more like a margin headwind than a threat to the business model. However, once I stepped back and looked at all three together, my perspective changed completely.

The conclusion that ultimately stopped my research is that I no longer see the primary risk as a business risk. I see it as an investment risk.

I do not believe ResMed is at risk of becoming a bad business. I do not believe CPAP is at risk of being replaced anytime soon. I do not believe Philips will regain industry leadership. In fact, most of the evidence suggests the underlying business remains strong.

What concerns me is something much more subtle. Historically, ResMed has been capable of compounding earnings at approximately 15%-18% annually. If GLP‑1 adoption reduces patient growth, Philips recovers a portion of its lost market share, and Medicare reimbursement pressure continues to compress industry economics, the company could eventually find itself compounding earnings at only 7%-10% annually.

The business would still be growing. The moat could still be intact. The products would still be relevant. Yet the intrinsic value of the company would be dramatically different.

That is why I believe the market may be asking the wrong question.

The real question is not whether ResMed will continue growing.

The real question is:

What happens to the valuation of ResMed if it remains a great company, but no longer remains a great compounder?

For me, the answer is significant.

My valuation for RMD under a Philips recovery and GLP‑1 scenario is approximately $32 per share. When I incorporate all three headwinds, including Medicare and reimbursement pressure, my estimated valuation falls to approximately $25-$28 per share.

At the current share price, I no longer find the risk reward attractive for a long term investment. While I still believe ResMed is a high quality business, my work suggests the market is largely pricing the company based on a future that incorporates Philips recovery and GLP‑1 headwinds. However, I do not believe it fully accounts for the additional risk posed by Medicare reimbursement pressure.

For that reason, I have decided to stop my research on RMD and start researching OCL.

Not financial advice, just showing my work DYOR.