Q1 2026 Myomo Inc Earnings Call
Speaker #2: The words "anticipate," "believe," "estimate," "expect," "intend," "guidance," "outlook," "confidence," "target," "project," and other similar expressions are typically used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and may involve and are subject to risks, uncertainties, and other factors that may affect MYOMO's business, financial condition, and operating results.
Speaker #2: These risks, uncertainties, and other factors are discussed in MYOMO's filings with the Securities and Exchange Commission. Actual outcomes and results may differ materially from what's expressed in or implied by these forward-looking statements.
Speaker #2: Furthermore, except as required by law, MYOMO undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this call today, May 7th, 2026.
Speaker #2: It's now my pleasure to turn the call over to MYOMO CEO, Paul Gudonis. Paul, please go ahead.
Speaker #3: Thanks, Bruce. Well, good afternoon and thank you all for joining us today. We remain very excited about the opportunity in front of us to improve lives and grow our company.
Speaker #3: The product arm upper limb paralysis is an underserved medical condition, and each year stroke leaves hundreds of thousands of Americans with lasting arm impairments, and when you add in spinal cord injury, traumatic brain injury, and brachial plexus injuries, the addressable US population reaches into the millions and globally millions more.
Speaker #3: For most of these patients, the standard of care has been a passive brace, ongoing physical therapy with diminishing returns, or resignation to permanent loss of function.
Speaker #3: Our MYOPRO is the only commercially available powered arm orthosis in the US that uses noninvasive EMG sensors to detect the patient's own muscle signals and amplify them into functional movements.
Speaker #3: Thereby permitting paralyzed individuals to feed themselves, carry objects, return to work, and reclaim independence at home. That's not an incremental improvement on existing care.
Speaker #3: It's really an entirely different category of device, and MYOMO owns it. Let me start with a quick real-life story. Our staff just helped Mike, who lost the use of his right arm due to a brachial plexus injury from a motorcycle accident when he was just 17 years old, and now some 50 years later, he's using both arms again with the help of a MYOPRO.
Operator: Good day, and welcome to the Myomo Q1 2026 financial results conference call. I would now like to turn the conference over to Bruce Voss of Alliance Advisors. Please go ahead.
Operator: Good day, and welcome to the Myomo Q1 2026 financial results conference call. I would now like to turn the conference over to Bruce Voss of Alliance Advisors. Please go ahead.
Speaker #3: He's carrying objects safely around his home, and he's doing household tasks such as mowing his lawn. Our MYOPRO has improved the quality of life for Mike and for his wife, reducing the burden of care from his impairment, and that's what this is all about.
Speaker #3: But several positive factors are converging right now to drive MYOMO's success. Reimbursement, distribution, and technology. Reimbursement by CMS and a new Medicare Part B benefit category with HIPAA codes for the MYOPRO has opened access to Medicare populations of tens of millions and removed the single largest historical barrier to adoption.
Bruce Voss: Thank you and good afternoon, everybody. This is Bruce Voss with Alliance Advisors IR. Welcome to the Myomo Q1 2026 financial results conference call. With me on today's call are Myomo's Chief Executive Officer, Paul Gudonis, and Chief Financial Officer, Dave Henry. Before we begin, I'd like to caution listeners that statements made during this call by management other than historical facts are forward-looking statements. The words anticipate, believe, estimate, expect, intend, guidance, outlook, confidence, target, project, and other similar expressions are typically used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and may involve and are subject to risks, uncertainties, and other factors that may affect Myomo's business, financial condition, and operating results. These risks, uncertainties, and other factors are discussed in Myomo's filings with the Securities and Exchange Commission.
Bruce Voss: Thank you and good afternoon, everybody. This is Bruce Voss with Alliance Advisors IR. Welcome to the Myomo Q1 2026 financial results conference call. With me on today's call are Myomo's Chief Executive Officer, Paul Gudonis, and Chief Financial Officer, Dave Henry. Before we begin, I'd like to caution listeners that statements made during this call by management other than historical facts are forward-looking statements. The words anticipate, believe, estimate, expect, intend, guidance, outlook, confidence, target, project, and other similar expressions are typically used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and may involve and are subject to risks, uncertainties, and other factors that may affect Myomo's business, financial condition, and operating results. These risks, uncertainties, and other factors are discussed in Myomo's filings with the Securities and Exchange Commission.
Speaker #3: New clinical studies and in-network contracts with a growing number of commercial payers have significantly increased market access for patients covered by these plans, where transitioning our go-to-market strategy with the distribution system based on recurring patient sources from rehab hospitals and OMP providers to reduce our customer acquisition costs and to build the foundation for accelerated growth going forward.
Speaker #3: And our investments in technology are increasing the value to patients and clinicians while reducing our operating costs as we scale the business to sustain profitability.
Speaker #3: Earlier this year, we established four success pillars for 2026: recurring revenue, market access, operating leverage, and innovation. With strong progress against each, first quarter revenue and profitability exceeded our targets.
Bruce Voss: Actual outcomes and results may differ materially from what's expressed in or implied by these forward-looking statements. Furthermore, except as required by law, Myomo undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this call today, 7 May 2026. It's now my pleasure to turn the call over to Myomo's CEO, Paul Gudonis. Paul, please go ahead.
Bruce Voss: Actual outcomes and results may differ materially from what's expressed in or implied by these forward-looking statements. Furthermore, except as required by law, Myomo undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this call today, 7 May 2026. It's now my pleasure to turn the call over to Myomo's CEO, Paul Gudonis. Paul, please go ahead.
Speaker #3: To measure our progress against these four success pillars, so let's review each of them. Number one, the shift to recurring patient sources. We launched the MYOConnect program in mid-2025 to encourage therapists and physicians at rehab hospitals, stroke clinics, and other healthcare facilities to refer prospective MYOPRO patients to us or to a local OMP partner.
Speaker #3: These channels not only provide recurring referrals but they also carry lower acquisition costs and higher conversion rates versus direct-to-patient marketing. With Medicare coverage in place and the new MYOPRO 2X introduced last year, it was the right time to bring the benefits of the MYOPRO to the incidence population of patients who are currently in outpatient therapy expanding our target market beyond the individuals with chronic arm paralysis and the large prevalence population.
Paul Gudonis: Thanks, Bruce. Well, good afternoon, thank you all for joining us today. We remain very excited about the opportunity in front of us to improve lives and grow our company. Chronic arm upper limb paralysis is an underserved medical condition. Each year, stroke leaves hundreds of thousands of Americans with lasting arm impairments. When you add in spinal cord injury, traumatic brain injury, and brachial plexus injuries, the addressable US population reaches into the millions and globally millions more. For most of these patients, the standard of care has been a passive brace, ongoing physical therapy with diminishing returns or resignation to permanent loss of function.
Paul Gudonis: Thanks, Bruce. Well, good afternoon, thank you all for joining us today. We remain very excited about the opportunity in front of us to improve lives and grow our company. Chronic arm upper limb paralysis is an underserved medical condition. Each year, stroke leaves hundreds of thousands of Americans with lasting arm impairments. When you add in spinal cord injury, traumatic brain injury, and brachial plexus injuries, the addressable US population reaches into the millions and globally millions more. For most of these patients, the standard of care has been a passive brace, ongoing physical therapy with diminishing returns or resignation to permanent loss of function.
Speaker #3: We reoriented our field clinical team and added sales specialists and conducted numerous in-service educational sessions at these rehab locations and I'm pleased to report that now more than 150 rehab facilities are now referring candidates to us.
Paul Gudonis: Our MyoPro is the only commercially available powered arm orthosis in the US that uses non-invasive EMG sensors to detect the patient's own muscle signals and amplify them into functional movements, thereby permitting paralyzed individuals to feed themselves, carry objects, return to work, and reclaim independence at home. That's not an incremental improvement on existing care. It's really an entirely different category of device, and Myomo owns it. Let me start with a quick real-life story. Our staff just helped Mike, who lost the use of his right arm due to a brachial plexus injury from a motorcycle accident when he was just 17 years old. Now, some 50 years later, he's using both arms again with the help of a MyoPro. He's carrying objects safely around his home, and he's doing household tasks such as mowing his lawn.
Paul Gudonis: Our MyoPro is the only commercially available powered arm orthosis in the US that uses non-invasive EMG sensors to detect the patient's own muscle signals and amplify them into functional movements, thereby permitting paralyzed individuals to feed themselves, carry objects, return to work, and reclaim independence at home. That's not an incremental improvement on existing care. It's really an entirely different category of device, and Myomo owns it. Let me start with a quick real-life story. Our staff just helped Mike, who lost the use of his right arm due to a brachial plexus injury from a motorcycle accident when he was just 17 years old. Now, some 50 years later, he's using both arms again with the help of a MyoPro. He's carrying objects safely around his home, and he's doing household tasks such as mowing his lawn.
Speaker #3: The OMP channel is another source of recurring referrals and our OMP revenue group, 79% year over year, as we train and certify additional CPOs and jointly implemented outreach programs.
Speaker #3: Earlier this week, we announced that we've been working with Autobox US clinical operations to certify them as MYOPRO centers of excellence, and we recently conducted training for over 20 clinical specialists from around the country as part of their national rollout.
Speaker #3: Autobox is the world's largest provider of OMP products and clinical services, and we're very pleased to be working so closely with them. In Germany, we have more than 100 OMP practices working with us to provide the MYOPRO to their patients.
Speaker #3: The insurance environment in Germany is highly favorable, and our international revenues reached a Q1 record of approximately $2 million. We continue to expand our sales and clinical staff in Germany and later this month we'll be attending the OT World Conference in Leipzig to engage with additional OMP clinics.
Paul Gudonis: Our MyoPro has improved the quality of life for Mike and for his wife, reducing the burden of care from his impairments, and that's what this is all about. Several positive factors are converging right now to drive Myomo's success. Reimbursement, distribution, and technology. Reimbursement by CMS in a new Medicare Part B benefit category with HCPCS codes for the MyoPro has opened access to a Medicare population of tens of millions and removed the single largest historical barrier to adoption. New clinical studies and in-network contracts with a growing number of commercial payers has significantly increased market access for patients covered by these plans. We're transitioning our go-to-market strategy with a distribution system based on recurring patient sources from rehab hospitals and O&P providers to reduce our customer acquisition costs and to build the foundation for accelerated growth going forward.
Paul Gudonis: Our MyoPro has improved the quality of life for Mike and for his wife, reducing the burden of care from his impairments, and that's what this is all about. Several positive factors are converging right now to drive Myomo's success. Reimbursement, distribution, and technology. Reimbursement by CMS in a new Medicare Part B benefit category with HCPCS codes for the MyoPro has opened access to a Medicare population of tens of millions and removed the single largest historical barrier to adoption. New clinical studies and in-network contracts with a growing number of commercial payers has significantly increased market access for patients covered by these plans. We're transitioning our go-to-market strategy with a distribution system based on recurring patient sources from rehab hospitals and O&P providers to reduce our customer acquisition costs and to build the foundation for accelerated growth going forward.
Speaker #3: This conference is the largest OMP event in Europe. As a result of these efforts, we're tracking extremely well against our targets at consistently increasing revenue from recurring patient sources.
Speaker #3: Pillar number two that's the second success pillar is to increase market access for patients by signing additional payer contracts. As discussed in March, we signed a national arrangement with Elevance which manages a number of Anthem Blue Cross Blue Shield plans in 2017 states, including large ones like Texas, Ohio, Virginia, and California, but we've been entering into these payer contracts to secure MYOMO as an in-network provider with case-by-case coverage determinations and an agreed-upon price for the MYOPRO.
Speaker #3: As a result, we're now seeing a significantly higher authorization rate from these payers' Medicare Advantage and commercial plans. And over the next several months, I expect we'll sign additional state contracts under the Elevance national arrangements.
Paul Gudonis: Our investments in technology are increasing the value to patients and clinicians while reducing our operating costs as we scale the business to sustain profitability. Earlier this year, we established four success pillars for 2026: recurring revenue, market access, operating leverage, and innovation. With strong progress against each, Q1 revenue and profitability exceeded our targets. We measure our progress against these four success pillars, so let's review each of them. Number one, the shift to recurring patient sources. We launched the MyoConnect program in mid-2025 to encourage therapists and physicians at rehab hospitals, stroke clinics, and other healthcare facilities to refer prospective MyoPro patients to us or to a local O&P partner. These channels not only provide recurring referrals, but they also carry lower acquisition costs and higher conversion rates versus direct-to-patient marketing.
Paul Gudonis: Our investments in technology are increasing the value to patients and clinicians while reducing our operating costs as we scale the business to sustain profitability. Earlier this year, we established four success pillars for 2026: recurring revenue, market access, operating leverage, and innovation. With strong progress against each, Q1 revenue and profitability exceeded our targets. We measure our progress against these four success pillars, so let's review each of them. Number one, the shift to recurring patient sources. We launched the MyoConnect program in mid-2025 to encourage therapists and physicians at rehab hospitals, stroke clinics, and other healthcare facilities to refer prospective MyoPro patients to us or to a local O&P partner. These channels not only provide recurring referrals, but they also carry lower acquisition costs and higher conversion rates versus direct-to-patient marketing.
Speaker #3: And since we secured Medicare coverage in April of 2024 and added various commercial and Medicare Advantage contracts, we've gone from just $9 million covered lives to $158 million lives currently.
Speaker #3: Pillar number three is to demonstrate operating leverage and the path to profitability. We demonstrated early operating leverage in the first quarter with revenue up 3% while OPEX was down 1% year over year.
Speaker #3: We also expanded gross margin by 100 basis points and the combination of these accomplishments resulted in a 20% improvement in adjusted EBITDA. And pillar four is to continue to invest in product development and clinical research.
Speaker #3: At the end of March, we launched a new mobile app which allows clinicians, patients, and caregivers to use their smartphones to adjust the MYOPRO device settings, display their muscle movements in EMG signals, and collect usage data that could be used by therapists and physicians.
Paul Gudonis: With Medicare coverage in place and the new MyoPro 2x introduced last year, it was the right time to bring the benefits of the MyoPro to the incidence population of patients who are currently in outpatient therapy, expanding our target market beyond the individuals with chronic arm paralysis and the large prevalence population. We reoriented our field clinical team, added sales specialists, and conducted numerous in-service educational sessions at these rehab locations. I'm pleased to report that now more than 150 rehab facilities are now referring candidates to us. The O&P channel is another source of recurring referrals, and our O&P revenue grew 79% year-over-year as we trained and certified additional CPOs and jointly implemented outreach programs.
Paul Gudonis: With Medicare coverage in place and the new MyoPro 2x introduced last year, it was the right time to bring the benefits of the MyoPro to the incidence population of patients who are currently in outpatient therapy, expanding our target market beyond the individuals with chronic arm paralysis and the large prevalence population. We reoriented our field clinical team, added sales specialists, and conducted numerous in-service educational sessions at these rehab locations. I'm pleased to report that now more than 150 rehab facilities are now referring candidates to us. The O&P channel is another source of recurring referrals, and our O&P revenue grew 79% year-over-year as we trained and certified additional CPOs and jointly implemented outreach programs.
Speaker #3: The app also eliminates the need to ship a laptop with our proprietary software to each user reducing our MYOPRO material costs by about 10%.
Speaker #3: You'll see this benefit flowing through to gross margin beginning in the second quarter. Another R&D investment is a randomized control trial being conducted by the University of Utah Rehabilitation Hospital.
Speaker #3: After successful pilot last year, the university's IRB approved the study, which will compare the outcomes of users with the MYOPRO against those who received the current standard of care of occupational therapy.
Speaker #3: We've enrolled 18 of the 50 subjects to date and when completed, and assuming similar results to our pilot last year, this clinical evidence is expected to support increased reimbursement of the MYOPRO.
Paul Gudonis: Earlier this week, we announced that we've been working with Ottobock Care to certify them as MyoPro Centers of Excellence. We recently conducted training for over 20 clinical specialists from around the country as part of their national rollout. Ottobock is the world's largest provider of O&P products and clinical services. We're very pleased to be working so closely with them. In Germany, we have more than 100 O&P practices working with us to provide the MyoPro to their patients. The insurance environment in Germany is highly favorable. Our international revenues reached a Q1 record of approximately $2 million. We continue to expand our sales and clinical staff in Germany. Later this month, we'll be attending the OTWorld Conference in Leipzig to engage with additional O&P clinics. This conference is the largest O&P event in Europe.
Paul Gudonis: Earlier this week, we announced that we've been working with Ottobock Care to certify them as MyoPro Centers of Excellence. We recently conducted training for over 20 clinical specialists from around the country as part of their national rollout. Ottobock is the world's largest provider of O&P products and clinical services. We're very pleased to be working so closely with them. In Germany, we have more than 100 O&P practices working with us to provide the MyoPro to their patients. The insurance environment in Germany is highly favorable. Our international revenues reached a Q1 record of approximately $2 million. We continue to expand our sales and clinical staff in Germany. Later this month, we'll be attending the OTWorld Conference in Leipzig to engage with additional O&P clinics. This conference is the largest O&P event in Europe.
Speaker #3: Finally, development of the MYOPRO 3 next-generation platform is progressing with a focus on enhanced functionality and increased processing power to support future software-driven innovations.
Speaker #3: The progress on each of our four success pillars is tracking with our targets and we're excited to keep on delivering. On the marketing front, we added a new marketing executive and engaged a new digital ad agency in Q1.
Speaker #3: As a result, we've also refined our marketing strategy with a new approach to digital channels and data-driven targeting. We're also expanding the use of social media to engage directly with healthcare providers and to introduce the MYOPRO in geographies with payer contracts.
Speaker #3: These initiatives are already improving lead quality, which has resulted in more pipeline ads per lead generated and reduced patient acquisition costs, and we expect further efficiency gains as these programs scale throughout 2026.
Paul Gudonis: As a result of these efforts, we're tracking extremely well against our targets of consistently increasing revenue from recurring patient sources. Pillar number 2, that's the second success pillar, is to increase market access for patients by signing additional payer contracts. As discussed in March, we signed a national arrangement with Elevance, which manages a number of Anthem Blue Cross Blue Shield plans in 27 states, including large ones like Texas, Ohio, Virginia, and California. We've been entering into these payer contracts to secure Myomo as an in-network provider with case-by-case coverage determinations and agreed upon price for the MyoPro. As a result, we're now seeing a significantly higher authorization rate from these payers' Medicare Advantage and commercial plans. Over the next several months, I expect we'll sign additional state contracts under the Elevance national arrangements.
Paul Gudonis: As a result of these efforts, we're tracking extremely well against our targets of consistently increasing revenue from recurring patient sources. Pillar number 2, that's the second success pillar, is to increase market access for patients by signing additional payer contracts. As discussed in March, we signed a national arrangement with Elevance, which manages a number of Anthem Blue Cross Blue Shield plans in 27 states, including large ones like Texas, Ohio, Virginia, and California. We've been entering into these payer contracts to secure Myomo as an in-network provider with case-by-case coverage determinations and agreed upon price for the MyoPro. As a result, we're now seeing a significantly higher authorization rate from these payers' Medicare Advantage and commercial plans. Over the next several months, I expect we'll sign additional state contracts under the Elevance national arrangements.
Speaker #3: With that overview, I'll turn the call over to our CFO, Dave Henry, to walk through the financial results in more detail.
Speaker #1: Thank you, Paul. And good afternoon, everyone. As Paul just discussed, we've been busy executing against the success pillars we introduced earlier this year and I'm pleased to report on the progress we've made.
Speaker #1: Our revenue for the first quarter of 2026 was $10.1 million, up 3% versus the prior year period. The increase was driven by a higher average selling price, or ASP, partially offset by a slightly lower number of revenue units.
Speaker #1: ASP in the first quarter was $58,800, up 9% versus the prior year due to higher Medicare Part B and Medicare Advantage reimbursement amounts, reflecting beginning-of-year fee updates.
Paul Gudonis: Since we secured Medicare coverage in April 2024 and added various commercial and Medicare Advantage contracts, we've gone from just 9 million covered lives to 158 million lives currently. Pillar number 3 is to demonstrate operating leverage and the path to profitability. We demonstrated early operating leverage in Q1, with revenue up 3%, while OPEX was down 1% year over year. We also expanded gross margin by 100 basis points, and the combination of these accomplishments resulted in a 20% improvement in adjusted EBITDA. Pillar 4 is to continue to invest in product development and clinical research.
Paul Gudonis: Since we secured Medicare coverage in April 2024 and added various commercial and Medicare Advantage contracts, we've gone from just 9 million covered lives to 158 million lives currently. Pillar number 3 is to demonstrate operating leverage and the path to profitability. We demonstrated early operating leverage in Q1, with revenue up 3%, while OPEX was down 1% year over year. We also expanded gross margin by 100 basis points, and the combination of these accomplishments resulted in a 20% improvement in adjusted EBITDA. Pillar 4 is to continue to invest in product development and clinical research.
Speaker #1: As well, there's a positive channel mix including higher international and Medicare Advantage revenues. We delivered $172 MYOPRO revenue units during the quarter. Looking at payer mix, Medicare Part B patients in our direct billing channel represented 51% of revenue in the first quarter, which was down 12% in dollar terms compared with the prior year.
Speaker #1: Medicare Advantage patients in our direct billing channel represented 19% of first quarter revenue, and in dollar terms was up 11% compared with the prior year quarter.
Speaker #1: As many healthcare providers are seeing the macro environment for Medicare Advantage plans continues to be challenging. To mitigate the impact, we are focusing on in-network patients obtained through our contracting efforts for early results are showing higher authorization rates compared with non-contracted payers.
Paul Gudonis: At the end of March, we launched a new mobile app, which allows clinicians, patients, and caregivers to use their smartphones to adjust the MyoPro device settings, display their muscle movements and EMG signals, and collect usage data that can be used by therapists and physicians. The app also eliminates the need to ship a laptop with our proprietary software to each user, reducing our MyoPro material cost by about 10%. You'll see this benefit flowing through to gross margin beginning in Q2. Another R&D investment is a randomized controlled trial being conducted by the University of Utah Rehabilitation Hospital. After a successful pilot last year, the university's IRB approved a study which will compare the outcomes of users with the MyoPro against those who receive the current standard of care of occupational therapy.
Paul Gudonis: At the end of March, we launched a new mobile app, which allows clinicians, patients, and caregivers to use their smartphones to adjust the MyoPro device settings, display their muscle movements and EMG signals, and collect usage data that can be used by therapists and physicians. The app also eliminates the need to ship a laptop with our proprietary software to each user, reducing our MyoPro material cost by about 10%. You'll see this benefit flowing through to gross margin beginning in Q2. Another R&D investment is a randomized controlled trial being conducted by the University of Utah Rehabilitation Hospital. After a successful pilot last year, the university's IRB approved a study which will compare the outcomes of users with the MyoPro against those who receive the current standard of care of occupational therapy.
Speaker #1: The direct billing channel represented 71% of revenue in the first quarter compared with 79% in the prior year quarter. Direct billing revenue declined as we continue transitioning our business toward recurring patient sources.
Speaker #1: Revenue from recurring patient sources represented 49% of first quarter revenue, up from 25% in the prior year. As you can see, we have made significant progress in shifting toward recurring patient sources at a lower patient acquisition cost compared with advertising-driven much higher cost to acquire.
Paul Gudonis: We've enrolled 18 of the 50 subjects to date, and when completed, and assuming similar results to our pilot last year, this clinical evidence is expected to support increased reimbursement of the MyoPro. Finally, development of the MyoPro 3 next generation platform is progressing. We're focused on enhanced functionality and increased processing power to support future software driven innovations. Progress on each of our four success pillars is tracking with our targets, and we're excited to keep on delivering. On the marketing front, we added a new marketing executive and engaged a new digital ad agency in Q1. As a result, we've also refined our marketing strategy with a new approach to digital channels and data-driven targeting. We're also expanding the use of social media to engage directly with healthcare providers and to introduce the MyoPro in geographies with payer contracts.
Paul Gudonis: We've enrolled 18 of the 50 subjects to date, and when completed, and assuming similar results to our pilot last year, this clinical evidence is expected to support increased reimbursement of the MyoPro. Finally, development of the MyoPro 3 next generation platform is progressing. We're focused on enhanced functionality and increased processing power to support future software driven innovations. Progress on each of our four success pillars is tracking with our targets, and we're excited to keep on delivering. On the marketing front, we added a new marketing executive and engaged a new digital ad agency in Q1. As a result, we've also refined our marketing strategy with a new approach to digital channels and data-driven targeting. We're also expanding the use of social media to engage directly with healthcare providers and to introduce the MyoPro in geographies with payer contracts.
Speaker #1: Breaking down the recurring patient sources approximately 20% of first quarter revenue is generated by direct billing referrals, another 20% was generated by the international channel, 8% from the USOMP channel and the rest was from VA payers.
Speaker #1: International revenue is up 53% year over year and the USOMP channel was up 79% year over year. As of March 31, 2026, the pipeline stood at $1,680 patients.
Speaker #1: An increase of 10% sequentially and 13% year over year. During the first quarter, we added $723 patients to the pipeline, which is up 7% sequentially and 3% year over year.
Speaker #1: 11% of first quarter pipeline ads were generated from direct billing referrals, demonstrating the traction so far with the MYOConnect program. 62% of first quarter revenue units were from intrafill revenue units, which is up 45%, which is up from 45% of revenue units a year ago and demonstrates our increased velocity in fulfilling orders.
Paul Gudonis: These initiatives are already improving lead quality, which is resulting in more pipeline adds per lead generated and reducing patient acquisition costs. We expect further efficiency gains as these programs scale throughout 2026. With that overview, I'll turn the call over to our CFO, Dave Henry, to walk through the financial results in more detail.
Paul Gudonis: These initiatives are already improving lead quality, which is resulting in more pipeline adds per lead generated and reducing patient acquisition costs. We expect further efficiency gains as these programs scale throughout 2026. With that overview, I'll turn the call over to our CFO, Dave Henry, to walk through the financial results in more detail.
Speaker #1: 16% of first quarter orders came from direct billing referrals. We exited the quarter with a backlog of 226 patients. Gross margin for the first quarter of 2026 was $68.2%, up from $67.2% a year ago driven by a higher ASP and material cost reductions partially offset by higher labor and travel costs needed to fit patients on site.
Dave Henry: Thank you, Paul. Good afternoon, everyone. As Paul just discussed, we've been busy executing against the success pillars we introduced earlier this year, and I'm pleased to report on the progress we've made. Our revenue for Q1 2026 was $10.1 million, up 3% versus the prior year period. The increase was driven by a higher average selling price, or ASP, partially offset by a slightly lower number of revenue units. ASP in Q1 was $58,800, up 9% versus the prior year due to a higher Medicare Part B and Medicare Advantage reimbursement amounts reflecting beginning of year fee updates, as well as a positive channel mix, including higher international and Medicare Advantage revenues. We delivered 172 MyoPro revenue units during the quarter.
David Henry: Thank you, Paul. Good afternoon, everyone. As Paul just discussed, we've been busy executing against the success pillars we introduced earlier this year, and I'm pleased to report on the progress we've made. Our revenue for Q1 2026 was $10.1 million, up 3% versus the prior year period. The increase was driven by a higher average selling price, or ASP, partially offset by a slightly lower number of revenue units. ASP in Q1 was $58,800, up 9% versus the prior year due to a higher Medicare Part B and Medicare Advantage reimbursement amounts reflecting beginning of year fee updates, as well as a positive channel mix, including higher international and Medicare Advantage revenues. We delivered 172 MyoPro revenue units during the quarter.
Speaker #1: Operating expenses for the first quarter of 2026 were $10.1 million, down 1% over the prior year quarter. Decrease was driven primarily by lower R&D and G&A expenses, partially offset by higher sales clinical and marketing expenses.
Speaker #1: Operating loss for the first quarter of 2026 was $3.2 million, which narrowed from an operating loss of $3.5 million in the prior year quarter.
Speaker #1: Adjusted EBITDA for the first quarter of 2026 was a negative 2.3 million, compared with a negative 2.8 million in the prior year quarter. The improvement was driven by a lower operating loss I just mentioned and higher ad backs were depreciation expense and stock-based compensation.
Dave Henry: Looking at payer mix, Medicare Part B patients in our direct billing channel represented 51% of revenue in Q1, which was down 12% in dollar terms compared with the prior year. Medicare Advantage patients in our direct billing channel represented 19% of Q1 revenue, and in dollar terms was up 11% compared with the prior year quarter. As many healthcare providers are seeing, the macro environment for Medicare Advantage plans continues to be challenging. To mitigate the impact, we are focusing on in-network patients obtained through our contracting efforts, where early results are showing higher authorization rates compared with non-contracted payers. The direct billing channel represented 71% of revenue in Q1 compared with 79% in the prior year quarter. Direct billing revenue declined as we continued transitioning our business toward recurring patient sources.
David Henry: Looking at payer mix, Medicare Part B patients in our direct billing channel represented 51% of revenue in Q1, which was down 12% in dollar terms compared with the prior year. Medicare Advantage patients in our direct billing channel represented 19% of Q1 revenue, and in dollar terms was up 11% compared with the prior year quarter. As many healthcare providers are seeing, the macro environment for Medicare Advantage plans continues to be challenging. To mitigate the impact, we are focusing on in-network patients obtained through our contracting efforts, where early results are showing higher authorization rates compared with non-contracted payers. The direct billing channel represented 71% of revenue in Q1 compared with 79% in the prior year quarter. Direct billing revenue declined as we continued transitioning our business toward recurring patient sources.
Speaker #1: First quarter non-operating income includes a mark-to-market gain from the change in fair value of derivative liabilities partially offset by cash and non-cash interest expense under the avenue capital term loan.
Speaker #1: Net loss for the first quarter of 2026 was $3 million, or 7 cents per share, as compared with the net loss of $3.5 million, or 8 cents per share, in the prior year quarter.
Speaker #1: Turning now to our balance sheet and cash flow, as of March 31, 2026, cash-cash equivalents and short-term investments were $15.7 million. Deflected over the improvement in adjusted EBITDA, our use of cash was 2.7 million in the first quarter compared with $3.2 million used in the first quarter of 2025.
Dave Henry: Revenue from recurring patient sources represented 49% of Q1 revenue, up from 25% in the prior year. As you can see, we have made significant progress in shifting toward recurring patient sources at a lower patient acquisition cost compared with advertising-driven direct patient revenues, which carry a much higher cost to acquire. Breaking down the recurring patient sources, approximately 20% of Q1 revenue was generated by direct billing referrals. Another 20% was generated by the international channel, 8% from the US O&P channel, and the rest was from VA payers. International revenue was up 53% year over year, and the US O&P channel was up 79% year over year. As of 31 March 2026, the pipeline stood at 1,680 patients, an increase of 10% sequentially and 13% year over year.
David Henry: Revenue from recurring patient sources represented 49% of Q1 revenue, up from 25% in the prior year. As you can see, we have made significant progress in shifting toward recurring patient sources at a lower patient acquisition cost compared with advertising-driven direct patient revenues, which carry a much higher cost to acquire. Breaking down the recurring patient sources, approximately 20% of Q1 revenue was generated by direct billing referrals. Another 20% was generated by the international channel, 8% from the US O&P channel, and the rest was from VA payers. International revenue was up 53% year over year, and the US O&P channel was up 79% year over year. As of 31 March 2026, the pipeline stood at 1,680 patients, an increase of 10% sequentially and 13% year over year.
Speaker #1: Let me conclude my remarks with our forward-looking guidance. As you just heard, we are making tremendous progress on our 2026 objectives. In the first quarter, we achieved higher year-over-year revenue and improved gross margin and lower operating expenses resulting in improved adjusted EBITDA.
Speaker #1: Our transition of the business toward recurring patient sources is running ahead of plan. In addition, the marketing changes we initiated are beginning to take effect.
Speaker #1: As a result, we expect second quarter revenue to be in the range of $10.3 to $10.8 million, which is up 7 to 12% year over year and up 2% to 7% sequentially.
Speaker #1: We expect gross margin in the second quarter to be higher year over year but lower sequentially due primarily to channel mix. We expect operating expenses to increase slightly versus the first quarter reflecting a modest increase in advertising spending.
Speaker #1: For the full year, we are reiterating our revenue guidance in the range of $43 million to $46 million and we affirm our full year operating leverage expectation to limit the growth of operating expenses in 2026 to about one-half the growth of revenue.
Dave Henry: During Q1, we added 723 patients to the pipeline, which is up 7% sequentially and 3% year over year. 11% of Q1 pipeline adds were generated from direct billing referrals, demonstrating the traction so far with the MyoConnect program. 62% of Q1 revenue units were from intra-fill revenue units, which is up from 45% of revenue units a year ago, demonstrates our increased velocity in fulfilling orders. 16% of Q1 orders came from direct billing referrals. We exited the quarter with a backlog of 226 patients.
David Henry: During Q1, we added 723 patients to the pipeline, which is up 7% sequentially and 3% year over year. 11% of Q1 pipeline adds were generated from direct billing referrals, demonstrating the traction so far with the MyoConnect program. 62% of Q1 revenue units were from intra-fill revenue units, which is up from 45% of revenue units a year ago, demonstrates our increased velocity in fulfilling orders. 16% of Q1 orders came from direct billing referrals. We exited the quarter with a backlog of 226 patients.
Speaker #1: With that financial overview, I'll turn the call back to Paul.
Speaker #2: Thanks, Dave. While we summarize, we're keenly focused on implementing our four success pillars to grow MyoPro volume and revenues while improving key financial metrics including gross margin, adjusted EBITDA, and cash usage.
Speaker #2: Our technology is making a dramatic difference in the lives of patients who are suffering with this chronic arm paralysis. And now, Dave and I are ready to take your questions.
Dave Henry: Gross margin for Q1 2026 was 68.2%, up from 67.2% a year ago, driven by a higher ASP and material cost reductions, partially offset by higher labor and travel costs needed to fit patients on site. Operating expenses for Q1 2026 were $10.1 million, down 1% over the prior year quarter. Decrease was driven primarily by lower R&D and G&A expenses, partially offset by higher sales, clinical, and marketing expenses. Operating loss for Q1 2026 was $3.2 million, which narrowed from an operating loss of $3.5 million in the prior year quarter. Adjusted EBITDA for Q1 2026 was -$2.3 million, compared with -$2.8 million in the prior year quarter.
David Henry: Gross margin for Q1 2026 was 68.2%, up from 67.2% a year ago, driven by a higher ASP and material cost reductions, partially offset by higher labor and travel costs needed to fit patients on site. Operating expenses for Q1 2026 were $10.1 million, down 1% over the prior year quarter. Decrease was driven primarily by lower R&D and G&A expenses, partially offset by higher sales, clinical, and marketing expenses. Operating loss for Q1 2026 was $3.2 million, which narrowed from an operating loss of $3.5 million in the prior year quarter. Adjusted EBITDA for Q1 2026 was -$2.3 million, compared with -$2.8 million in the prior year quarter.
Speaker #2: Operator?
Speaker #3: Thank you. We will now begin the question-and-answer session. To join in the question queue, please press star, then 1 on your touchtone phone. If you are using a speakerphone, please pick up your handset before pressing any keys.
Speaker #3: If at any time your question has been addressed and you'd like to withdraw your question, please press star, then 2. At this time, we will pause momentarily to assemble our roster.
Speaker #2: While we're waiting for the first question, I'd like to mention that in May, we'll be participating in the CDOTI, a virtual investor conference, and AGP's annual healthcare company showcase.
Speaker #2: And on June 23, 2024, we'll be presenting at the iAccess Alpha Select virtual conference and holding one-on-one meetings with investors. Operator, let's take the first question whenever you're ready.
Speaker #3: Our first question comes from Chase Knickerbocker of Craig Hallam. Please go ahead.
Dave Henry: The improvement was driven by a lower operating loss I just mentioned and higher add backs for depreciation expense and stock-based compensation. Q1 non-operating income includes a mark-to-market gain from the change in fair value of derivative liabilities, partially offset by cash and non-cash interest expense under the Avenue Capital term loan. Net loss for Q1 2026 was $3 million, or $0.07 per share. This compares with a net loss of $3.5 million or $0.08 per share in the prior year quarter. Turning now to our balance sheet and cash flow. As of 31 March 2026, cash equivalents, and short-term investments were $15.7 million.
David Henry: The improvement was driven by a lower operating loss I just mentioned and higher add backs for depreciation expense and stock-based compensation. Q1 non-operating income includes a mark-to-market gain from the change in fair value of derivative liabilities, partially offset by cash and non-cash interest expense under the Avenue Capital term loan. Net loss for Q1 2026 was $3 million, or $0.07 per share. This compares with a net loss of $3.5 million or $0.08 per share in the prior year quarter. Turning now to our balance sheet and cash flow. As of 31 March 2026, cash equivalents, and short-term investments were $15.7 million.
Speaker #4: Good afternoon. Thanks for taking the questions. Maybe just first on the ASP increase, could you just go into a little bit more detail as far as what drove that?
Speaker #4: As far as kind of the mix specifically that you were referring to, and kind of the drivers within that mix—higher or lower with an ASP.
Speaker #4: And then I guess the next question is just how sustainable is that? How should we be thinking about kind of ASP sequentially through the year?
Speaker #4: Thanks.
Speaker #2: Yeah, sure. So the ASP was $58,800. The increase was due in part to the fee increase that the beginning that happens at the beginning of every year with CMS.
Dave Henry: Reflective of the improvement in adjusted EBITDA, our use of cash was $2.7 million in Q1, compared with $3.2 million used in Q1 2025. Let me conclude my remarks with our forward-looking guidance. As you just heard, we are making tremendous progress on our 2026 objectives. In Q1, we achieved higher year-over-year revenue, improved gross margin and lower operating expenses, resulting in improved adjusted EBITDA. Our transition of the business toward recurring patient sources is running ahead of plan. In addition, the marketing changes we initiated are beginning to take effect. As a result, we expect Q2 revenue to be in the range of $10.3 to 10.8 million, which is up 7% to 12% year-over-year and up 2% to 7% sequentially.
David Henry: Reflective of the improvement in adjusted EBITDA, our use of cash was $2.7 million in Q1, compared with $3.2 million used in Q1 2025. Let me conclude my remarks with our forward-looking guidance. As you just heard, we are making tremendous progress on our 2026 objectives. In Q1, we achieved higher year-over-year revenue, improved gross margin and lower operating expenses, resulting in improved adjusted EBITDA. Our transition of the business toward recurring patient sources is running ahead of plan. In addition, the marketing changes we initiated are beginning to take effect. As a result, we expect Q2 revenue to be in the range of $10.3 to 10.8 million, which is up 7% to 12% year-over-year and up 2% to 7% sequentially.
Speaker #2: That also affected the Medicare Advantage payers as well. So both Medicare and Medicare Advantage, those were about 70% of revenues in the first quarter, and those were all subject to that fee increase.
Speaker #2: Also, international revenues, we get some foreign currency benefit from that. So international is our second largest channel in terms of both revenues and ASP, and they were 20% of revenues.
Speaker #2: So those are the reasons why and then in terms of sustainability, I do expect that the ASP will come down a bit due to channel mix.
Speaker #2: In the second quarter, and I think it's still prudent to assume maybe around a 55,000 or so ASP on a more longer-term basis.
Dave Henry: We expect gross margin in Q2 to be higher year over year, but lower sequentially due primarily to channel mix. We expect operating expenses to increase slightly versus Q1, reflecting a modest increase in advertising spending. For the full year, we are reiterating our revenue guidance in the range of $43 million to $46 million, we affirm our full year operating leverage expectation to limit the growth of operating expenses in 2026 to about one half the growth of revenue. With that financial overview, I'll turn the call back to Paul.
David Henry: We expect gross margin in Q2 to be higher year over year, but lower sequentially due primarily to channel mix. We expect operating expenses to increase slightly versus Q1, reflecting a modest increase in advertising spending. For the full year, we are reiterating our revenue guidance in the range of $43 million to $46 million, we affirm our full year operating leverage expectation to limit the growth of operating expenses in 2026 to about one half the growth of revenue. With that financial overview, I'll turn the call back to Paul.
Speaker #4: Understood. Maybe just on the advertising efficiency side, can you just kind of break down what the percentage kind of benefit was in the quarter from MyoConnect?
Speaker #4: Was the majority of kind of that decrease in cost per pipeline ad driven by MyoConnect, or was there some improvements that you are seeing on the digital marketing side?
Speaker #2: Just in terms of the metrics, the 11% of the pipeline ads in the quarter were MyoConnect, and those come at a low-cost-per-pipeline ad, but we're not advertising to get those.
Paul Gudonis: Thanks, Dave. Well, to summarize, we're keenly focused on implementing our four success pillars to grow MyoPro volume and revenues while improving key financial metrics, including gross margin, adjusted EBITDA, and cash usage. Our technology is making a dramatic difference in the lives of patients who are suffering with this chronic arm paralysis. Now Dave and I are ready to take your questions. Operator?
Paul Gudonis: Thanks, Dave. Well, to summarize, we're keenly focused on implementing our four success pillars to grow MyoPro volume and revenues while improving key financial metrics, including gross margin, adjusted EBITDA, and cash usage. Our technology is making a dramatic difference in the lives of patients who are suffering with this chronic arm paralysis. Now Dave and I are ready to take your questions. Operator?
Speaker #2: So that's a big part of it. And plus, just some of the efficiencies we're seeing as Paul mentioned, we are seeing sort of a lower-cost or more pipeline ads per lead that we're generating.
Speaker #2: Through some of these efforts that we're making.
Operator: Thank you. We will now begin the question and answer session. To join the question queue, please press star then one on your touch tone phone. If you are using a speakerphone, please pick up your handset before pressing any keys. If at any time your question has been addressed and you'd like to withdraw your question, please press star then two. At this time, we will pause momentarily to assemble our roster.
Operator: Thank you. We will now begin the question and answer session. To join the question queue, please press star then one on your touch tone phone. If you are using a speakerphone, please pick up your handset before pressing any keys. If at any time your question has been addressed and you'd like to withdraw your question, please press star then two. At this time, we will pause momentarily to assemble our roster.
Speaker #5: Yeah, we're finding that the quality of the leads, which was an issue a year ago, Chase has really turned around. And now we're getting more of the leads that are generating.
Speaker #5: We're engaging with those patients, and they're medically qualified. So they're moving into the pipeline. We redid our TV advertising as well with a new 120 seconds slot.
Speaker #5: And that's paid off really well. Good cost per call. And the patients that see that or their caregivers are really engaged. So those couple of factors have reduced our cost per pipeline ad.
Paul Gudonis: While we're waiting for the first question, I'd like to mention that in May we'll be participating in the Sidoti Virtual Investor Conference and AGP's Annual Healthcare Company Showcase. On 23rd and 24th June, we'll be presenting at the iAccess Alpha Select Virtual Conference and holding one-on-one meetings with investors. Okay, operator, let's take the first question whenever you're ready.
Paul Gudonis: While we're waiting for the first question, I'd like to mention that in May we'll be participating in the Sidoti Virtual Investor Conference and AGP's Annual Healthcare Company Showcase. On 23rd and 24th June, we'll be presenting at the iAccess Alpha Select Virtual Conference and holding one-on-one meetings with investors. Okay, operator, let's take the first question whenever you're ready.
Speaker #4: And so you had kind of mentioned ramping some of the marketing spend as we go through the year here into Q2. Is that kind of driven by seeing some improvement on that side of things, or maybe just talk me through kind of the drivers behind that kind of reinvestment?
Operator: Our first question comes from Chase Knickerbocker of Craig-Hallum. Please go ahead.
Operator: Our first question comes from Chase Knickerbocker of Craig-Hallum. Please go ahead.
Chase Knickerbocker: Good afternoon. Thanks for taking the questions. Maybe just first on the ASP increase. Could you just go into a little bit more detail as far as what drove that, as far as kind of the mix specifically that you were referring to and kind of the drivers?
Chase Knickerbocker: Good afternoon. Thanks for taking the questions. Maybe just first on the ASP increase. Could you just go into a little bit more detail as far as what drove that, as far as kind of the mix specifically that you were referring to and kind of the drivers?
Speaker #2: Yeah, I would say that is the case. And it's also something that we do typically every year. Second and third quarters are typically our the highest spending for advertising.
Speaker #2: Then it comes back down again in the fourth quarter just because of the efficiencies that happened during the fourth quarter where the inefficiencies, I should say, that happened in the fourth quarter.
Chase Knickerbocker: Within that mix, you know, higher or lower within ASP. I guess the next question is just how sustainable is that? How should we be thinking about kind of ASP sequentially through the year? Thanks.
Chase Knickerbocker: Within that mix, you know, higher or lower within ASP. I guess the next question is just how sustainable is that? How should we be thinking about kind of ASP sequentially through the year? Thanks.
Speaker #5: And also due to the revenue cycle, which could be four to six months or a longer depending on the patient's insurance, advertising now builds a good pipeline and backlog for Q3 and Q4 revenue.
Dave Henry: Yeah, sure. The ASP was, you know, $58,800. The increase was due in part to the fee increase that happens at the beginning of every year with CMS. That also affected the Medicare Advantage payers as well. Both Medicare and Medicare Advantage, those were about 70% of revenues in Q1, and those were all subject to that fee increase. Also, you know, international revenues, we get some foreign currency benefit from that. International is our second-largest channel in terms of both revenues and ASP, and they were 20% of revenue. Those are the reasons why.
David Henry: Yeah, sure. The ASP was, you know, $58,800. The increase was due in part to the fee increase that happens at the beginning of every year with CMS. That also affected the Medicare Advantage payers as well. Both Medicare and Medicare Advantage, those were about 70% of revenues in Q1, and those were all subject to that fee increase. Also, you know, international revenues, we get some foreign currency benefit from that. International is our second-largest channel in terms of both revenues and ASP, and they were 20% of revenue. Those are the reasons why.
Speaker #4: And then just last from me, guidance assumes a step up in growth in the second half. Guidance has reiterated; the mix on a per-quarter basis was a little bit different than what we kind of expected.
Speaker #4: Can you just kind of walk us through what the top end of your guidance assumes and the bottom end as far as kind of the moving pieces and the assumptions in there?
Speaker #4: Thank you.
Speaker #2: I think the top end of the guidance, I think, would reflect more from the direct billing channel, particularly as it relates to more success on the referrals side of things.
Dave Henry: In terms of sustainability, I do expect that the ASP will come down a bit through the channel mix in Q2. I think, you know, I think it's still prudent to assume maybe around a, you know, a $55,000 or so ASP on a more, you know, longer term basis.
David Henry: In terms of sustainability, I do expect that the ASP will come down a bit through the channel mix in Q2. I think, you know, I think it's still prudent to assume maybe around a, you know, a $55,000 or so ASP on a more, you know, longer term basis.
Speaker #2: MyoConnect, I think, is probably the biggest swing factor in terms of our guidance. Good news and good traction with that, which so far we're seeing would lead us to trend towards the higher end of our guidance.
Speaker #2: And if for some reason that were to some of those results would begin to flatten out or going down, that would drive us toward the lower end of our guided range.
Chase Knickerbocker: Understood. Maybe just on the advertising efficiency side, can you just kinda break down, you know, what the percentage kinda benefit was in the quarter from MyoConnect? Was the majority of kinda that decrease in cost per pipeline ad driven by MyoConnect, or was there some improvements that you are seeing on the digital marketing side?
Chase Knickerbocker: Understood. Maybe just on the advertising efficiency side, can you just kinda break down, you know, what the percentage kinda benefit was in the quarter from MyoConnect? Was the majority of kinda that decrease in cost per pipeline ad driven by MyoConnect, or was there some improvements that you are seeing on the digital marketing side?
Speaker #4: Understood. Thank you.
Speaker #3: Our next question comes from Edward Wu of Ascendant Capital. Please go ahead.
Dave Henry: Just in terms of the metrics, you know, the 11% of the pipeline ads in the quarter were MyoConnect, and those come at a, you know, a low cost per pipeline ad, but we're not advertising to get those. That's a, you know, that's a big part of it. Plus, you know, just some of the, some of the efficiencies we're seeing, as Paul mentioned, we are seeing, sort of a lower cost, or more, more pipeline ads per lead that we're generating, through some of these efforts that we're making.
David Henry: Just in terms of the metrics, you know, the 11% of the pipeline ads in the quarter were MyoConnect, and those come at a, you know, a low cost per pipeline ad, but we're not advertising to get those. That's a, you know, that's a big part of it. Plus, you know, just some of the, some of the efficiencies we're seeing, as Paul mentioned, we are seeing, sort of a lower cost, or more, more pipeline ads per lead that we're generating, through some of these efforts that we're making.
Speaker #5: Yeah, congratulations on the quarter. My question is on international. Once again, you had another very strong quarter, very good growth, record revenue. How much potential can the German market have?
Speaker #5: And is there ability to accelerate the growth in the near term?
Speaker #2: Well, you look at the German market, over 80 million population, compared to, say, 330 here in the US. So it's about 25 to 30 percent of the total size of the US market.
Paul Gudonis: Yeah. We're finding that the quality of the leads, you know, which was an issue a year ago, Chase Knickerbocker, has really turned around. Now we're getting more of the leads that are generating, we're engaging with those patients and they're medically qualified, so they're moving into the pipeline. We redid our TV advertising as well with a new 120-second slot. That's paid off really well. A good cost per call, and the patients that see that or their caregivers are really engaged. Those couple factors have reduced our cost per pipeline ad.
Paul Gudonis: Yeah. We're finding that the quality of the leads, you know, which was an issue a year ago, Chase Knickerbocker, has really turned around. Now we're getting more of the leads that are generating, we're engaging with those patients and they're medically qualified, so they're moving into the pipeline. We redid our TV advertising as well with a new 120-second slot. That's paid off really well. A good cost per call, and the patients that see that or their caregivers are really engaged. Those couple factors have reduced our cost per pipeline ad.
Speaker #2: So you can see that there is definitely upside potential there. Also, as we've seen, because of the statutory health insurance, social court rulings over there, we're getting good traction with the insurance companies there.
Speaker #2: So that's why we're continuing to add resources, which is the way to grow that German business. I'll be there later this month in Leipzig, Germany, for the OT World Conference to recruit more O&P providers.
Speaker #2: We'll also start looking at some other international markets.
Speaker #5: That sounds good. You mentioned other international markets. I know you previously have said that the German market was kind of unique from other European markets, or would it be possibly markets in other areas?
Chase Knickerbocker: You had kind of mentioned, ramping some of the marketing spend as we go through the year here into Q2. Is that kind of driven by seeing some improvement, on that side of things? Or maybe just talk me through kind of the drivers behind that, kind of reinvestment.
Chase Knickerbocker: You had kind of mentioned, ramping some of the marketing spend as we go through the year here into Q2. Is that kind of driven by seeing some improvement, on that side of things? Or maybe just talk me through kind of the drivers behind that, kind of reinvestment.
Speaker #5: And any updates on the Chinese market?
Speaker #2: Well, probably the other European markets where we can get the reimbursement relatively quickly. So, we'll be talking to some O&P providers in these other countries to see what they feel about the reimbursement environment, so that— and we always look at where I'm going to invest another euro.
Dave Henry: Yeah. I would say that is, that is the case, but it's also something that we do typically every year. You know, Q2 and Q3 are typically our, the highest spending for advertising, then it comes back down again in Q4 just because of the, you know, the efficiencies that happen during Q4 or the inefficiencies, I should say, that happen in Q4.
David Henry: Yeah. I would say that is, that is the case, but it's also something that we do typically every year. You know, Q2 and Q3 are typically our, the highest spending for advertising, then it comes back down again in Q4 just because of the, you know, the efficiencies that happen during Q4 or the inefficiencies, I should say, that happen in Q4.
Speaker #2: Where's the best place to put it? And so far, the best return has been in Germany. And also staying in Europe would help us leverage the infrastructure we have over there.
Speaker #2: In China, we continue conversations with China Lead Ventures, which was one of the major investors in the joint venture. We've had regular conversations to introduce new potential partners, medical device manufacturers, and investment partners into the JV.
Paul Gudonis: Also due to the revenue cycle, which could be 4 to 6 months or longer, depending on, you know, the patient's insurance. Advertising now builds a good pipeline and backlog for Q3 and Q4 revenue.
Paul Gudonis: Also due to the revenue cycle, which could be 4 to 6 months or longer, depending on, you know, the patient's insurance. Advertising now builds a good pipeline and backlog for Q3 and Q4 revenue.
Speaker #2: But nothing's been finalized over there as far as the next step with the JV.
Chase Knickerbocker: Just last from me. Guidance assumes a step up in growth in H2. You know, guidance has reiterated, the mix on a per quarter basis was a little bit different than what we kind of expected. Can you just kind of walk us through what the top end of your guidance assumes, and the bottom end as far as kind of the moving pieces and the assumptions in there? Thank you.
Chase Knickerbocker: Just last from me. Guidance assumes a step up in growth in H2. You know, guidance has reiterated, the mix on a per quarter basis was a little bit different than what we kind of expected. Can you just kind of walk us through what the top end of your guidance assumes, and the bottom end as far as kind of the moving pieces and the assumptions in there? Thank you.
Speaker #5: Great. Well, thanks for answering my questions. And I wish you guys good luck. Thank you.
Speaker #2: Thank you, Ed.
Speaker #3: Our next question comes from Jeremy Perlman of Maxim Group. Please go ahead.
Speaker #4: Yeah, thank you for taking my question. Firstly, I want to talk about the MyoConnect. You've mentioned that you had roughly 150 rehab facilities that are referring patients currently.
Dave Henry: I think the, you know, the top end of the guidance, I think would reflect, you know, more from the, you know, more from the direct billing channel, particularly as it relates to more success on the referrals side of things. You know, MyoConnect, I think is probably the biggest swing factor in terms of our guidance. You know, like, you know, good news and good traction with that, which so far we're seeing, would lead us to trend towards the higher end of our guidance. If for some reason that were to, you know, some of those results would begin to flatten out or going down, that would, you know, drive us toward the lower end of our guided range.
David Henry: I think the, you know, the top end of the guidance, I think would reflect, you know, more from the, you know, more from the direct billing channel, particularly as it relates to more success on the referrals side of things. You know, MyoConnect, I think is probably the biggest swing factor in terms of our guidance. You know, like, you know, good news and good traction with that, which so far we're seeing, would lead us to trend towards the higher end of our guidance. If for some reason that were to, you know, some of those results would begin to flatten out or going down, that would, you know, drive us toward the lower end of our guided range.
Speaker #4: How extensive do you think that runway is? How many more rehab clinics are in the pipeline to convert to this MyoConnect?
Speaker #2: Well, we've had that's tremendous results in just the first nine months. Jeremy, since we started that in mid-2025, and I expect we're going to add new clinics every month.
Speaker #2: I'd love to get to the point where we have several hundred by the end of this year. There are about 1,500 stroke clinics in the United States.
Speaker #2: Plus, many other major hospitals that treat stroke patients. And then on top of that, we're finding a lot of success with these smaller private rehab clinics.
Speaker #2: There are therapists out there who have their own clinic and they are referring myopro patients to us. So our goal is to grow the number of rehab facilities to a couple of hundred by the end of the year.
Chase Knickerbocker: Understood. Thank you.
Chase Knickerbocker: Understood. Thank you.
Operator: Our next question comes from Edward Woo of Ascendiant Capital Markets. Please go ahead.
Operator: Our next question comes from Edward Woo of Ascendiant Capital Markets. Please go ahead.
Speaker #2: And also see what I call same-store sales growth where after referring that first patient, they'll refer a couple of others. And that should grow not only this year, but well into next year.
Edward Woo: Yeah, congratulations on the quarter. My question is on international. Once again, you had another very strong quarter, very good growth, record revenue. How much potential can the German market have, and is there ability to accelerate the growth on near term?
Edward Woo: Yeah, congratulations on the quarter. My question is on international. Once again, you had another very strong quarter, very good growth, record revenue. How much potential can the German market have, and is there ability to accelerate the growth on near term?
Speaker #2: And that's why I see we're laying the foundation for accelerated growth next year if you can imagine hundreds of these clinics then growing the number of patients they refer next year plus new clinics that come online next year as MyoConnect partners.
Paul Gudonis: Well, you look at the German market, over 80 million population compared to, let's say, 330 here in the US. It's, you know, about 25% to 30% of the total size of the US market. You could see that there is definitely upside potential there. Also, as we've seen, because of the statutory health insurance, social court rulings over there, we're getting good traction with the insurance companies there. That's why we're continuing to add resources, which is the way to grow that German business. I'll be there later this month in Leipzig, Germany for the OTWorld Conference to recruit more O&P providers. We'll also start looking at some other international markets.
Paul Gudonis: Well, you look at the German market, over 80 million population compared to, let's say, 330 here in the US. It's, you know, about 25% to 30% of the total size of the US market. You could see that there is definitely upside potential there. Also, as we've seen, because of the statutory health insurance, social court rulings over there, we're getting good traction with the insurance companies there. That's why we're continuing to add resources, which is the way to grow that German business. I'll be there later this month in Leipzig, Germany for the OTWorld Conference to recruit more O&P providers. We'll also start looking at some other international markets.
Speaker #2: And plus, you have more and more O&P providers coming on that we just announced Autobot. They've got over 50 locations in the US. We just trained 20 some of their clinicians around the country that are going to be spreading the word within their territories.
Speaker #2: We've got other major national accounts lined up for similar type of training going on.
Speaker #4: Okay, that's great. And then, just to follow up—you mentioned that you hope this is laying the foundation for accelerated growth. You're referring to, hopefully, these clinics—once they refer the first patient, they'll refer more.
Speaker #4: Is it too early to tell? Have you seen that play out with the rehab clinics that are already using the MyoConnect program, that they've once they refer the first patient, they've does that give you confidence that in 2027, we could see a big uptick?
Edward Woo: That sounds good. You mentioned other international markets. I know you previously have said that the German market was kind of unique. Other European markets or would it be possibly markets in other areas? Any, any updates on the Chinese market?
Edward Woo: That sounds good. You mentioned other international markets. I know you previously have said that the German market was kind of unique. Other European markets or would it be possibly markets in other areas? Any, any updates on the Chinese market?
Speaker #2: We starting to see those sort of green shoots. Remember that most of these have just come online maybe their first referral in December or January.
Speaker #2: And the patient has to go through the insurance process, has to get fit with the device. Then goes to that clinic for therapy services.
Paul Gudonis: Well, probably the other European markets where we can get the reimbursement relatively quickly. We'll be talking to some OT providers in these other countries to see what they feel about the reimbursement environment so that, you know, we always look at where I'm going to invest another euro, where is the best place to put it. So far, the best return has been in Germany. Also staying in Europe would help us leverage the infrastructure we have over there. In China, we continue conversations with China Lead Ventures, which was one of the major investors in the joint venture.
Paul Gudonis: Well, probably the other European markets where we can get the reimbursement relatively quickly. We'll be talking to some OT providers in these other countries to see what they feel about the reimbursement environment so that, you know, we always look at where I'm going to invest another euro, where is the best place to put it. So far, the best return has been in Germany. Also staying in Europe would help us leverage the infrastructure we have over there. In China, we continue conversations with China Lead Ventures, which was one of the major investors in the joint venture.
Speaker #2: Then they see the outcome. So it may be six months from the time they make their first referral till we make the second. But I'm confident in the way our device performs for these patients, that we'll get these ongoing referrals.
Speaker #4: Okay, understood. And then also just related to the last question related to the MyoConnect, do a higher percentage of the patients that are referred through this program convert eventually to the backlog or to a paying customer?
Speaker #4: Or is it similar to let's say your legacy advertising direct-to-consumer marketing that pulls in the patients where a certain percentage drops off and then only and then whatever percentage goes to the final?
Paul Gudonis: We've had regular conversations to introduce new potential partners, medical device manufacturers and investment partners into the JV, nothing's been finalized over there as far as the next step with the JV.
Paul Gudonis: We've had regular conversations to introduce new potential partners, medical device manufacturers and investment partners into the JV, nothing's been finalized over there as far as the next step with the JV.
Speaker #2: Yeah, that's a good observation. It's a very good observation because these patients are better in two respects. One, we've trained the clinicians that are referring to pre-qualify these patients for us.
Edward Woo: Great. Well, thanks for answering my questions, and I wish you guys good luck. Thank you.
Edward Woo: Great. Well, thanks for answering my questions, and I wish you guys good luck. Thank you.
Speaker #2: So they are sending us better-quality patients, meaning they are more likely to benefit from a myopro in terms of their medical qualifications. So that's a plus.
Paul Gudonis: Thank you, Ed.
Paul Gudonis: Thank you, Ed.
Operator: Our next question comes from Jeremy Pearlman of Maxim Group. Please go ahead.
Operator: Our next question comes from Jeremy Pearlman of Maxim Group. Please go ahead.
Jeremy Pearlman: Yeah. Thank you for taking my question. Firstly, I wanted to talk about the MyoConnect. You've mentioned that you had roughly 150 rehab facilities that are referring patients currently. You know, how extensive do you think that runway is? How many more rehab clinics, you know, is in the pipeline to convert to this MyoConnect?
Jeremy Pearlman: Yeah. Thank you for taking my question. Firstly, I wanted to talk about the MyoConnect. You've mentioned that you had roughly 150 rehab facilities that are referring patients currently. You know, how extensive do you think that runway is? How many more rehab clinics, you know, is in the pipeline to convert to this MyoConnect?
Speaker #2: They're a higher-quality patient than what comes in from the general advertising. And number two, because these clinicians know that Medicare will cover this, they're sending us a higher percentage of Medicare than in the general population.
Speaker #2: So it's almost like a double win from these referrals from the MyoConnect program.
Paul Gudonis: Well, you know, we've had tremendous results in just the first 9 months, Jeremy, you know, since we started that in mid-2025. You know, I expect we're gonna add, you know, new clinics every month. You know, I'd love to get to the point where we have several hundred by the end of this year. There are about 1,500 stroke clinics in the United States, plus many other major hospitals that treat stroke patients. On top of that, you know, we're finding a lot of success with these smaller private rehab clinics. You know, there are therapists out there who have their own clinic, they are referring MyoPro patients to us. Our goal is to grow the number of rehab facilities to a couple hundred by the end of the year.
Paul Gudonis: Well, you know, we've had tremendous results in just the first 9 months, Jeremy, you know, since we started that in mid-2025. You know, I expect we're gonna add, you know, new clinics every month. You know, I'd love to get to the point where we have several hundred by the end of this year. There are about 1,500 stroke clinics in the United States, plus many other major hospitals that treat stroke patients. On top of that, you know, we're finding a lot of success with these smaller private rehab clinics. You know, there are therapists out there who have their own clinic, they are referring MyoPro patients to us. Our goal is to grow the number of rehab facilities to a couple hundred by the end of the year.
Speaker #4: Okay, that's great. Understood. And then just, last question. I know you mentioned on the last year, your Investor Day, a big part of there was a section about adjudicating denied claims.
Speaker #4: I just wonder, any follow-up maybe—how has the success rate of that, is that steady? Has it been improving? Maybe anything you could talk about, that would be great.
Speaker #2: Yeah, we are continuing to do these AOJ hearings. Still running about that same success rate. However, as we mentioned, where we have contracts with these various plans, we have a much higher authorization rate right up front.
Speaker #2: And so we don't even have to go to the hearings.
Paul Gudonis: Also see what I call same store sales growth, where after referring that first patient, they'll refer a couple of others, and that should grow not only this year but, well into next year. That's why I see we're laying the foundation for accelerated growth next year. You can imagine hundreds of these clinics, you know, then growing the number of patients they refer next year, plus new clinics that come online next year as MyoConnect partners. Plus, you have more and more O&P providers coming on. We just announced Ottobock. They've got over 50 locations in the US. We just trained 20 some of their clinicians around the country. They're gonna be spreading the word within their territories. We've got other major national accounts, you know, lined up for similar type of training going on.
Paul Gudonis: Also see what I call same store sales growth, where after referring that first patient, they'll refer a couple of others, and that should grow not only this year but, well into next year. That's why I see we're laying the foundation for accelerated growth next year. You can imagine hundreds of these clinics, you know, then growing the number of patients they refer next year, plus new clinics that come online next year as MyoConnect partners. Plus, you have more and more O&P providers coming on. We just announced Ottobock. They've got over 50 locations in the US. We just trained 20 some of their clinicians around the country. They're gonna be spreading the word within their territories. We've got other major national accounts, you know, lined up for similar type of training going on.
Speaker #4: Okay, that's great. All right. Thank you for taking my questions. I'll hop back in the queue.
Speaker #2: Yeah, thank you.
Speaker #3: Once again, if you have a question, please press star, then one. This concludes our question and answer session. I would like to turn the conference back over to Paul for any closing remarks.
Speaker #2: Well, thanks, operator. And thank you all for joining us today and for your questions. And we look forward to seeing and hearing from you in the coming months.
Speaker #2: So thanks again. And have a good evening.
Jeremy Pearlman: Okay, that's great. To just, you know, to follow up, you mentioned that you hope this is laying the foundation for accelerated growth. You know, hopefully they'll refer these clinics. Once they refer the first patient, they'll refer more. Is it too early to tell? Have you seen that play out with the rehab clinics that are already using in the MyoConnect program, once they refer the first patient, Does that give you confidence that in 2027 we could see a big uptick?
Jeremy Pearlman: Okay, that's great. To just, you know, to follow up, you mentioned that you hope this is laying the foundation for accelerated growth. You know, hopefully they'll refer these clinics. Once they refer the first patient, they'll refer more. Is it too early to tell? Have you seen that play out with the rehab clinics that are already using in the MyoConnect program, once they refer the first patient, Does that give you confidence that in 2027 we could see a big uptick?
Paul Gudonis: You know, we are starting to see those sort of green shoots. You know, remember that, you know, most of these have just come online. They made their first referral in December or January, then the patient has to go through the insurance process, has to get fit with the device, then goes to that clinic for therapy services, then they see the outcome. It may be 6 months from the time they make their first referral till we make the second. I'm confident that in the way our device performs for these patients, that we'll get these ongoing referrals.
Paul Gudonis: You know, we are starting to see those sort of green shoots. You know, remember that, you know, most of these have just come online. They made their first referral in December or January, then the patient has to go through the insurance process, has to get fit with the device, then goes to that clinic for therapy services, then they see the outcome. It may be 6 months from the time they make their first referral till we make the second. I'm confident that in the way our device performs for these patients, that we'll get these ongoing referrals.
Jeremy Pearlman: Okay. Understood. Also just related, the last question related to the MyoConnect. Do a higher percentage of the patients that are referred through this program convert eventually to the backlog into a paying customer? Or is it similar to, you know, that's your legacy advertising direct to consumer marketing that pulls into patients where, you know, this certain percentage drops off and then only whatever percentage goes to the funnel?
Jeremy Pearlman: Okay. Understood. Also just related, the last question related to the MyoConnect. Do a higher percentage of the patients that are referred through this program convert eventually to the backlog into a paying customer? Or is it similar to, you know, that's your legacy advertising direct to consumer marketing that pulls into patients where, you know, this certain percentage drops off and then only whatever percentage goes to the funnel?
Paul Gudonis: Yeah, that's a good observation. That's a very good observation because these patients are better in 2 respects. One, we've trained the clinicians that are referring to pre-qualify these patients for us. They are sending us better quality patients, meaning they are more likely to benefit from a MyoPro in terms of their medical qualifications. That's a plus. They're a higher quality patient than what comes in from the general advertising. Number 2, because these clinicians know that Medicare will cover this, they're sending us a higher percentage of Medicare than in the general population. It's almost like a double win from these referrals from the MyoConnect program.
Paul Gudonis: Yeah, that's a good observation. That's a very good observation because these patients are better in 2 respects. One, we've trained the clinicians that are referring to pre-qualify these patients for us. They are sending us better quality patients, meaning they are more likely to benefit from a MyoPro in terms of their medical qualifications. That's a plus. They're a higher quality patient than what comes in from the general advertising. Number 2, because these clinicians know that Medicare will cover this, they're sending us a higher percentage of Medicare than in the general population. It's almost like a double win from these referrals from the MyoConnect program.
Jeremy Pearlman: Okay, that's great. Understood. Just last question. I know you mentioned on the last, you know, last year, your Investor Day, a big part of there was a section about adjudicating denied claims. I just wonder any follow-up, maybe how is that, the success rate of that? Is that steady? Has it been improving? Maybe anything you could talk about that would be great.
Jeremy Pearlman: Okay, that's great. Understood. Just last question. I know you mentioned on the last, you know, last year, your Investor Day, a big part of there was a section about adjudicating denied claims. I just wonder any follow-up, maybe how is that, the success rate of that? Is that steady? Has it been improving? Maybe anything you could talk about that would be great.
Paul Gudonis: Yeah. We are continuing to do these ALJ hearings. Still running about that same success rate. However, as we mentioned, where we have contracts with these various plans, we have a much higher authorization rate right up front, and so you don't even have to go to the hearings.
Paul Gudonis: Yeah. We are continuing to do these ALJ hearings. Still running about that same success rate. However, as we mentioned, where we have contracts with these various plans, we have a much higher authorization rate right up front, and so you don't even have to go to the hearings.
Jeremy Pearlman: Okay. That's great. All right. Thank you for taking my questions. I'll hop back in queue.
Jeremy Pearlman: Okay. That's great. All right. Thank you for taking my questions. I'll hop back in queue.
Paul Gudonis: Yeah. Thank you.
Paul Gudonis: Yeah. Thank you.
Operator: Once again, if you have a question, please press star then one. This concludes our question and answer session. I would like to turn the conference back over to Paul for any closing remarks.
Operator: Once again, if you have a question, please press star then one. This concludes our question and answer session. I would like to turn the conference back over to Paul for any closing remarks.
Paul Gudonis: Well, thanks, operator. Thank you all for joining us today and for your questions, and we look forward to seeing and hearing from you in the coming months. Thanks again. Have a good evening.
Paul Gudonis: Well, thanks, operator. Thank you all for joining us today and for your questions, and we look forward to seeing and hearing from you in the coming months. Thanks again. Have a good evening.
Operator: This concludes today's conference call. You may now disconnect your lines. Thank you for participating and have a pleasant day.
Operator: This concludes today's conference call. You may now disconnect your lines. Thank you for participating and have a pleasant day.
