Q3 2024 Viemed Healthcare Inc Earnings Call
Speaker Change: Greetings and welcome to VIMED's third quarter 2024 earnings conference call. At this time all participants are on a listen-only mode.
A question and answer session will follow the formal presentation.
Speaker Change: If anyone should require operator assistance during the conference, you can press star zero on your telephone keypad.
Speaker Change: As a reminder, this conference is being recorded. I would now like to turn the conference over to your host, Todd Zehnder, COO. Thank you. You may begin.
All right. Thank you, Rob.
Todd Zehnder: Good morning everyone. We appreciate you joining us today. Please note that our remarks in this conference call may include forward-looking statements under the U.S. federal securities laws or forward-looking information under applicable Canadian securities legislation, which we collectively refer to as forward-looking statements.
Speaker Change: Such statements reflect the company's current views and intentions with respect to future results or events and are subject to certain risks and uncertainties.
Speaker Change: which could cause the actual results or events to vary from those indicated in forward-looking statements.
Speaker Change: Examples of such risks and uncertainties are discussed in our disclosure documents filed with the SEC or the security regulatory authorities in certain provinces of Canada.
Speaker Change: Because of these risks and uncertainties investors should not place undue reliance on forward-looking statements.
Speaker Change: The forward-looking statements made in this conference call are made as of today, and the company undertakes no obligations to update or revise any forward-looking statements except as required by law.
Speaker Change: The third quarter financial news release, including the related financial statements, are available on the SEC's website. I'll now turn it over to ViMed CEO Casey Hoyt to get things started.
Casey Hoyt: Okay, thank you, Todd, and good morning, everyone. We appreciate you joining us today.
Casey Hoyt: The third quarter results exceeded both our projections and expectations, driven by continued organic growth in our core businesses, as well as continued growth from recent M&A activity, leading to strong year-over-year and sequential growth in net revenue.
Casey Hoyt: Our third quarter net revenue established yet another company record of $58 million exceeding the top end of our guidance and establishing a pathway to a strong finish in 2024.
Casey Hoyt: I want to acknowledge and thank our incredible VyMed family, which now numbers more than 1,150 employees.
Casey Hoyt: You've heard us talk about earning a trusted place in the home for some time. I want to drill down on that a bit more this morning and why it matters.
Casey Hoyt: ViMed is substantially differentiated from HME providers to the point that we believe that even the description, home medical equipment, doesn't fully capture exactly what we're doing in the home and the value we're proving out every day to patients, providers, and payers.
Casey Hoyt: It's clear that there is a trend of providing clinical care in the home. Patients want to be treated in the comfort and safety of their home. Hospitals and health systems want to avoid readmissions, and payers know that costs are lower in the home versus an institutional setting.
Casey Hoyt: Improving outcomes, patient satisfaction, and operational efficiency are the pillars for delivering care in the home.
Speaker Change: Biomed has been a leader since day one with our high-touch, high-technology care model.
Casey Hoyt: What's become clear to us is that in today's environment, patient satisfaction is more critical than ever. A focus on patient outcomes and personalized care, not to mention offering support to address patient concerns, becomes increasingly important, particularly when it comes to patient compliance.
Casey Hoyt: Utilizing advanced tools such as our proprietary Engage platform can boost provider communication and care coordination. These solutions need to be scalable to streamline operations and provide the accurate data ultimately needed for value-based care.
Speaker Change: This isn't a future state we're talking about at Vymed. This is the model that we have been deploying with our RTs at the center of everything we do in the home.
Casey Hoyt: It's the reason why we've allocated capital investments in technology, recruiting, training, and the provision of social services we offer to our patients.
Casey Hoyt: We're ready for where the industry should be going and we expect to continue to lead it.
Casey Hoyt: On the regulatory front, we're seeing some positive signs and support for the industry.
Casey Hoyt: BiMed has been a leading advocate for the reconsideration of NCD280.1, emphasizing objective and comprehensive coverage policies for NIV therapy.
Casey Hoyt: We believe that the request for the NCD is another signal we've seen from CMS that they are serious about holding MA plans accountable for appropriate guidelines to deliver clinical care.
Casey Hoyt: The majority of comments submitted on the NCD have been positive, and we think this is a real opportunity for the industry to serve those in need and facilitate continued expansion.
Casey Hoyt: The reason we've been proactive on the NCD is that establishing clear and consistent guidelines will create a stable business environment for providers and reduce uncertainty for patients.
Casey Hoyt: The research supports the efficacy of NIV, resulting in significant reductions in costs, hospitalizations, and improved patient outcomes.
Casey Hoyt: And the data exhibits there is medical necessity for putting patients on the device immediately and improving their quality of life.
Casey Hoyt: We've submitted our comments on the NCD and have sponsored or supported much of the research cited in other comments.
Casey Hoyt: We'll continue to provide a leadership role through VyMed and through the Industry Trade Associations.
Casey Hoyt: I'd also like to highlight that there has been some recent movement on the 75-25 reimbursement relief.
Casey Hoyt: Recall that this rate adjustment for certain products in certain areas would increase Medicare reimbursements for providers serving those areas.
Casey Hoyt: This isn't dead by any means. It adds positive momentum with some recent legislative support. And it should be backed up for consideration at the end of the year.
Casey Hoyt: As we've noted before, restoration of this relief would be positive for the financial performance in 2025.
Casey Hoyt: Let me now turn to some brief updates on the business. The continued strength of our vent business was on display again this quarter with a 4.3% sequential increase in active vent patients.
Casey Hoyt: That sequential growth is usually a leading indicator for future quarters and reinforces the positive outlook we have on the business.
Casey Hoyt: The 400-plus increase in vet patients we've experienced in both Q2 and Q3 is as good as we've produced in a number of years.
Casey Hoyt: One of the reasons our vent growth has been so strong is the operational overhaul we completed earlier in the year. Those efforts resulted in internal processes driving higher vent utilization and vent patient billings.
Casey Hoyt: The new sales structure we put in place and discussed last quarter is having an impact as well.
Casey Hoyt: With an 18% increase in average monthly setups per sales rep, compared with what they were producing prior to the implementation, we've been accelerating the recruitment of sales reps to maintain our industry-leading organic growth.
Casey Hoyt: We expect to have more to report on this effort in Q4.
Casey Hoyt: In our sleep business, all I can say is what a difference a quarter makes in terms of the overall narrative around GLP-1 drugs.
Casey Hoyt: Based on what we've seen from ResMed and others so far, we believe it's pretty conclusive that GLP-1s are not impeding the growth of the sleep business. As we noted before, in fact it appears to be bringing more patients into treatment for sleep apnea and other disorders as they lose weight.
Casey Hoyt: Despite the increasing use of GLP-1 therapies for weight loss, both obesity and sleep apnea rates continue to climb. For patients with moderate to severe obesity-related sleep apnea, research consistently shows that combining PAP therapy with weight loss provides greater benefits than either treatment alone.
Casey Hoyt: Real-world data reveals that OSA patients prescribed GLP-1 medications are 10.8% more likely to start PATH therapy with significantly higher adherence rates evidenced by increased PATH resupply orders at one and two years post setup.
Casey Hoyt: The improvement in sentiment and the increasing amount of published research lines up with what we're seeing in our business. We're seeing sequential growth in CPAP units, patients, resupply orders, and home sleep tests.
Casey Hoyt: Even though Sleep is currently contributing 17% of our total revenue as of Q3, we believe we've only scratched the surface of what this business can contribute to our overall growth.
Casey Hoyt: We're still on track with our East Alabama joint venture integration, but we made incremental progress each of the last two quarters, and as this is our test case for future JVs like this, we are easing our way into our growth plans.
Casey Hoyt: We outlined a plan for annualized revenue of approximately $4 million when we made this acquisition, and that's the path we're on. We expect to have more to report out on the JV at the year-end.
Casey Hoyt: Our M&A pipeline remains robust, with a focus on adding complementary services that could expand our core businesses.
Casey Hoyt: These new opportunities could also build on the strong relationships we've already earned with patients and could enhance our value to providers and payers through greater scale and efficiencies.
Casey Hoyt: Overall, I'm pleased with how we've executed throughout this quarter. We've regularly challenged our team to hit our strategic goals and they've delivered.
Casey Hoyt: With record-breaking quarters in 2024, on top of our highest EBITDA quarter ever in Q3, we have built up a lot of positive momentum for the fourth quarter that will feed into 2025.
Casey Hoyt: The increasing vent patient and sleep patient growth, together with our sleep resupply business, provide a strong base for organic growth.
Casey Hoyt: We have no intention of letting up. We are laser-focused internally on finishing on a strong note, which will provide the exit velocity for a stronger year in 2025.
Speaker Change: For more on our operational and financial results for the quarter, I'll turn the call back over to Todd.
Todd Zehnder: All right. Thanks, Casey. In reviewing the financial results, all figures are in US dollars, and the full results have been made available on the SEC website. I'll focus my prepared comments on providing some additional color behind our strong performance.
Todd Zehnder: You'll notice we added some new disclosures this quarter around our sleep therapy patient count and sleep resupply orders.
Todd Zehnder: Based on feedback we've received from the investment community, we've been exploring some incremental disclosures that can assist in measuring our performance.
Todd Zehnder: Our goal is to build on these disclosures over the next couple of quarters.
Todd Zehnder: The new company record for revenue this quarter and the 17% increase was driven almost entirely by organic growth with organic or acquired revenue accounting for 1.1 billion of that year-over-year increase.
Todd Zehnder: Our revenue increased 6% on a sequential basis with inorganic or acquired revenue accounting for only $327,000.
Todd Zehnder: The organic growth story at ViMed is alive and well and in our mind provides a high level of predictability of growth in a very capital-efficient manner.
Todd Zehnder: Our core business events accounted for 55% of the revenue this quarter with sleep increasing to 17%.
Todd Zehnder: Our oxygen and staffing businesses continue to grow as well with those each contributing roughly 10% of this quarter's revenue.
Todd Zehnder: We're also making incremental improvements with the East Alabama Medical Center JV.
Todd Zehnder: Gross margin was fairly consistent with the last two quarters at 59.3%.
Recall that down year-over-year due to
Todd Zehnder: as sleep, oxygen, and staffing continue to grow at a faster rate.
Todd Zehnder: Slightly above and below the 60% mark is where this current business mix should be.
Todd Zehnder: The EBITDA margin for the quarter was 24.1%, which is up from 23.3% in the second quarter, and compares favorably with 24.5% a year ago.
Todd Zehnder: We've made substantial improvement each quarter, and we're aiming for another strong performance in the fourth quarter.
Todd Zehnder: We've done a really good job of managing SG&A with these expenses down to 46% of revenue this quarter, compared with 48% in the second quarter and 48% a year ago.
Todd Zehnder: We are investing in new sales talent, improving and improving our patient experience in the home.
Todd Zehnder: The continued reduction in SG&A as a percentage of revenue is a reflection of good cost controls, but also the leverage we're getting from better productivity and efficiencies from operational and process improvements that have been put in place.
Todd Zehnder: As expected, our gross capex this our strategic acceleration of the Vent Exchange Initiative.
Todd Zehnder: For the quarter, we invested approximately $11 million on CapEx, primarily on various respiratory equipment for our patients.
Todd Zehnder: Offsetting these purchases was approximately six million dollars of related sales and exchange proceeds.
Todd Zehnder: putting our net cash capex for the quarter at approximately $5 million.
Todd Zehnder: We expect to sell more events over the next several quarters, but the pace and amount will be determined by the remediation process established by Philips and the related governmental agencies.
Todd Zehnder: We've once again funded our CapEx out of discretionary cash flow and continue to manage the business in order to drop free cash flow onto the balance sheet.
Todd Zehnder: Our percentage of net capex to EBITDA was at 36% this quarter compared with 64% in the second quarter and 58% a year ago.
Todd Zehnder: We will continue to update our free cash flow disclosure on an annual basis.
Todd Zehnder: Similar to last quarter, we recorded a small gain of 0.5 million dollars that was primarily driven by the Trilogy Return Program.
Todd Zehnder: We would expect to continue reporting these gains until the project is completed, likely next year.
Todd Zehnder: The balance sheet remains in great shape as we paid down our line of credit by $2 million during the quarter, giving us $55 million available on our credit facilities, along with a $30 million accordion if needed for an attractive use of proceeds.
Todd Zehnder: We built up cash by $2.5 million to $11.3 million as of quarter-end and improved working capital to $11.3 million.
Todd Zehnder: The tremendous opportunity we have to upgrade our vent fleet through the Phyllis buyback is enabling us to prioritize investing in our organic growth.
Todd Zehnder: The increased liquidity also gives us the flexibility to consider additional M&A in the future that can be complementary to our growth.
Todd Zehnder: The momentum in the business is demonstrated in our outlook for the fourth quarter.
Todd Zehnder: We are anticipating net revenue in the range of $59.7 million to $60.9 million.
Todd Zehnder: The midpoint of that range implies sequential growth of 4.0% and a year-over-year increase of 18.9%.
This outlook is based on sequential
Todd Zehnder: continued contribution from our sleep business, along with the anticipated growth in our other products.
Todd Zehnder: There aren't too many moving parts for us coming into the fourth quarter.
Todd Zehnder: Without assuming any material diversion from the margin profile we've experienced most of this year and the typical liquidity ramp we see during the fourth quarter, we believe it's realistic to expect a solid adjusted EBITDA finish to the year as well.
Todd Zehnder: With the improvement we've made every quarter this year from operational and sales efficiencies, driving organic growth.
self-funding CapEx through cash flow, and improving the balance sheet.
Todd Zehnder: It's critical to maintain that momentum and operational excellence during the fourth quarter.
Todd Zehnder: We're confident that we will, which should position us very well for a good year in 2025.
Thank you for joining us today. This
Thank you.
Speaker Change: Thank you. At this time, we'll be conducting a question and answer session. If you'd like to ask a question, please press star 1 on your telephone.
Speaker Change: A confirmation tone will indicate your line is in the question queue. You may press star 2 if you'd like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys.
One moment please while we poll for questions.
Speaker Change: Our first question comes from Brooks O'Neill with Lake Street Capital Markets. Please proceed with your question.
Speaker Change: Thank you very much and good morning guys. Congratulations on the terrific progress you're making.
To be honest, you...
Todd Zehnder: You guys provided such a great overview. I only have one significant question.
Todd Zehnder: I probably should know the answer to this before I even ask it, but Casey provided a nice overview of the positive shift in the regulatory environment.
I'm curious if
Todd Zehnder: What they're talking about involves any increased reimbursement or maybe I should say any change in reimbursement or is it just clarifying some of the usage guidelines and whatnot?
Thank you.
Speaker Change: No problem. There's two regulatory, not issues, but things that I commented on. 7525 is a rate relief reimbursement fluctuation.
Todd Zehnder: I'm not sure if you recall, but back during COVID, we've got rate relief, and what they did at the beginning of last year is they recalled that relief, and so the 7525 movement was a rural
Todd Zehnder: demographic mix split that they were going back and looking at the area that we received relief.
Todd Zehnder: We can get that recalled, basically. That's not dead. There's a lot of movement behind it.
Todd Zehnder: It's about a 140 million lift for CMS to recall that, which is not that big.
Todd Zehnder: we represent less than 2% of the CMS Medicare spend in the industry so
Todd Zehnder: We got some legislative support behind us and, you know, we'll be hopeful at the end of the year to maybe recover that, but that would just be a net win for us.
The other is the NCDs.
comment that's that's
No relation to any kind of reimbursement shift, but
Todd Zehnder: It's just good policy to develop clear clinical guidelines. CMS is kind of acknowledging that they're a little too vague right now. It's allowing MA to make up their own rules, for lack of a better description. And so they're honing in on that to where...
Todd Zehnder: MA follows their clinical guidelines and in order to do that they got to go into a comment period and ask for all comments which there was no better time to have all the research buttoned up that we've invested into over the last five to seven years.
Todd Zehnder: to be able to kind of comment through the lens of data and publish research and rather than our opinion as a as event provider it was extremely powerful and we saw a lot of our peers and industry associations follow suit to our comments and latch on to them as well so you know the industry was reasonably aligned with all of their commentary
Todd Zehnder: as it related to this. So CMS should have some powerful data to write some clear guidelines here in the future, which would be a major win for our entire industry.
Speaker Change: Great. Fantastic. Thanks a lot. Congratulations again on the terrific progress.
Speaker Change: As a reminder, if you'd like to ask a question, please press star one on your telephone keypad. One moment while we poll for questions.
Speaker Change: Our next question comes from Doug Cooper with Beacon Securities. Please proceed with your question.
Speaker Change: Good afternoon guys, it's a nice quarter. Todd, I just wanted to focus in on the, I guess, the increased disclosure around the sleep business. I just want to make sure I got...
Todd Zehnder: I understand the disclosure here. So I guess it's the fourth bullet point in your press release.
Todd Zehnder: The company increased its sleep therapy patient count by 11% sequentially to 19,478. And then the company also increased its resupply orders by 9.7% sequentially to 22,143.
Speaker Change: So there's, let's call it just round figures, 20,000 patients in your sleep program today and then but there's 22,000 it looks so almost like there's more people in the resupply program than you have actual patients. How should I read that?
Speaker Change: Those are mutually exclusive, Doug. So the sleep therapy patients are the ones that are on pap therapy, like we're actually renting them the machine right now. The resupply process developed over the last, call it five to 10 years, and so they're no longer in their, generally what, 13 month cap period? And so they're just.
Speaker Change: They're just on resupply. So you should add those together effectively to get to what the patients that we served during the quarter, which was roughly 42,000.
$42,000.
Speaker Change: Okay and then so the resupply order that's that's 22,000 is that three times a year?
Speaker Change: I think on average we're a little, we're probably closer to two, two and a half times per year. It depends on insurance companies and it just depends on patient you know, reference on how often they reorder, but ours is between two and two and a half as a total company.
Speaker Change: Okay and just on when I relate it back to your financials I see the line item other durable medical equipment rentals of 12.5 million that's directly related to the 42,000 patients
Speaker Change: that would have the 22,000 patients or excuse me the 20,000 patients that are renting the machine
Speaker Change: The resupply would be service revenue, but additionally on the other rentals, you would have your oxygen patients, everything else, vests, sterilizers, just the whole continuum of products.
Speaker Change: Okay and then finally just the other equipment sales that would be the resupply program the 8.4 million? Yes. Is there anything else in that number other than the resupply program?
or is that predominant?
It's primarily resupply, but there is other things in there.
Speaker Change: Okay, okay, and then to your point Casey, the 469 patients you added in the VENT program, I think I went back and looked, this might be...
In fact, it's...
Speaker Change: It might be the biggest lift I've seen on an absolute basis, maybe, well, I went back five years. There might have been one quarter where you added more than that, and it was $4.55 in the prior quarter, too. What do you attribute to...
Speaker Change: You pick it, is it just to, you know, increase sales or are the referring docs, are they becoming more comfortable with the program?
Speaker Change: I really attribute it to our training program and our restructure of the sales force. We're doing more with less.
Speaker Change: And these guys are extremely productive, they're polished, they're more educated. We have the right people in the right spots throughout the country. It wasn't an easy movement, we moved 12 folks into middle management and just restructured the entire sales force.
Speaker Change: I would say that we still, and we started talking about this at the beginning of the year,
Speaker Change: But we've yet to really benefit from the recruiting, the localized recruiting benefits that are on the ground, just because we've been so laser focused on training our folks up. But that's the next phase of the sales restructure is really.
recruiting people and localize in their backyards and
Speaker Change: We have the recipe now for training, we have the recipe right now for finding the right people. Now it's 2024 and beyond, Q4 and 2025, it's going to be about recruiting and finding these guys and incrementally growing. So we're super excited about where we sit right now.
Speaker Change: Okay, and just finally on the M&A side you said it's the pipelines looking pretty robust
Any color on what?
Speaker Change: you know, is it in the sleep? I'm assuming it wouldn't be vents, but would it be sleep? Would it be outside of the respiratory space? Maybe just one more more color and kind of size of the companies you might be looking at.
Speaker Change: And we're always going to be leaning toward the respiratory dove. We're not exclusive to that. I mean we will look at other businesses. We look at other businesses.
Speaker Change: We generally have said that the size of the HMP acquisition was just a really good size, which was that $25-30 million range, but we'll do smaller deals as necessary or we'll look at larger deals.
Speaker Change: So, we've got a little bit of everything in there right now, but it just feels like we're getting more inbound calls over the last, call it three months, than we had the prior couple of years.
Right, right.
Speaker Change: Okay, that's it for me guys. Terrific work. All right, Doug. Thanks. Thank you.
Speaker Change: Our next question is from Ilya Zubkov with Freedom Broker. Please proceed with your question.
Yeah, good afternoon and thank you for taking my question.
So, my first question is on the EBITDA margin expansion.
Speaker Change: adjusted a bit. The margin is expanding from quarter to quarter this year and I was wondering
If the primary driver
for that is.
Speaker Change: If yes, could it be in effect next year as well?
Speaker Change: Yeah, I mean, generally our EBITDA margins do get stronger as the year goes on. If you look at it, just quarter over quarter, we generally see higher margins. But the answer is yes, we do see some efficiencies that have come with scale.
slightly smaller percentage of our revenue.
Speaker Change: It's a challenge to keep our margins flat, but we were pretty close with that, and that just shows that everything across the board is getting a little bit more efficient with scale, and we get the leverage of becoming a bigger company.
Speaker Change: A lot of moving parts and pieces, but we're extremely excited about
Speaker Change: The overall metric is why, in my prepared remarks, I talked about SG&A as a percentage of revenue, because the gross margin is very product-driven. The G&A is something that we have more control over and the scalability that you're referring to.
Speaker Change: So, I see that CAPEX is growing, and I wanted to ask if you expect further increase in CAPEX in nearest quarters, and what is the expected timing for full replacement of recalled ventilators?
Speaker Change: Yeah, I mean, like I said in the earlier part, we definitely saw an increase this quarter, but we're starting to measure it on a net capex because the third quarter was where we really got into a groove of
Speaker Change: selling or Distributing our vents back to fill us in obviously our vent patient count is growing So we have to replace those vents with cat bags. It's why you saw as very deliberately disclosed net cat bags
Speaker Change: And we're very proud that I think the Net Cap X as a percentage of EBITDA is probably the lowest it's ever been in our corporate history. I would expect that number to continue to be very large this quarter, and very likely it will stay like that through at least the middle of next year.
Speaker Change: We're kind of waiting on Phillips and the FDA and anybody else that is going to be needed to make a decision of when they can actually remediate some of their events versus us just selling them back to them.
Speaker Change: And we'll be working in conjunction with them to see how that all shapes out to determine whether we keep selling at the rate that we are right now, or maybe we send some back to be able to stay on patience and so forth. So it's a little early for us to say how long it will take us to finish, but it'll definitely go into next year because we still have a pretty significant fleet out there.
All right. Thank you very much.
Thank you.
Speaker Change: We have reached the end of the question and answer session. I'd now like to turn the call back over to management for closing comments.
Speaker Change: Alright, we want to thank everybody for listening in and if you have follow-up questions please reach out to us and we look forward to talking to everyone. Have a great day.