管理層發言
Greetings. Welcome to the Viemed Healthcare Second Quarter 2026 Earnings Conference Call. Operator provided instructions. Please note, this conference is being recorded. I will now turn the conference over to Trae Fitzgerald, CFO. Thank you, Trae. You may begin.
Thank you, and good morning, everyone. 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. 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, which could cause actual results or events to vary from those indicated in forward-looking statements. 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. Because of these risks and uncertainties, investors should not place undue reliance on forward-looking statements. 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. The second quarter financial supplement and financial news release as well as the related financial statements are available on the SEC's website. With that, I'll now turn the call over to our Chief Executive Officer, Casey Hoyt.
Okay. Thank you, Trae. Good morning, everyone, and thank you for joining us. I want to begin by recognizing the people responsible for our impressive Q2 results. As of June 30, we've got 1,453 employees that made up the Viemed team. Each day, our folks care for our patients, support our referral partners and improve how we operate. I appreciate the work, compassion and dedication they bring to serving our patients and our mission here at Viemed. The second quarter combined renewed growth in ventilation with continued expansion across the broader business. We ended June with the highest active ventilator patient count in our history, set new records in other service lines and generated record quarterly revenue. Ventilation remains the clinical and economic foundation for Viemed. For investors who are newer to the company, our vent patients live with complex chronic respiratory conditions and benefit from receiving high acuity care in the home. We combine respiratory therapy, ongoing clinical engagement and connected technology to help physicians manage those patients outside the hospital while improving their quality of life. We added 546 ventilator patients during the quarter and ended June with 12,635 active patients. The active patient count increased in each month of the quarter before accelerating in June, producing sequential growth of approximately 4.5%. Q2 produced the second highest quarterly ventilator setup volume in our history and usage compliance improved by more than 25% compared with last June. Higher setup activity brought more patients into the base and our compliance initiatives helped more patients remain on therapy. The results reinforce what we have communicated through the implementation of the new CMS national coverage determination for home mechanical ventilation. The underlying clinical need and referral demand remains substantial. Our teams have adapted to the new qualification, documentation and utilization standards, and the second quarter results show that we can grow under the new coverage framework. Several quarters under the new framework have brought greater clarity across the care continuum. Physicians and referral sources better understand the documentation required to qualify a patient and patients and caregivers receive clear education about the utilization expectations associated with therapy. We continue to refine our qualification, documentation support, patient education and compliance processes as the framework matures. The addressable clinical need for at-home ventilation remains much larger than the population receiving treatment today. Growth during the quarter extended well beyond ventilation. Q2 was a record quarter for PAP setups. Sleep therapy patients increased approximately 5% from the first quarter and 44% from the prior year. Resupply patients increased approximately 10% sequentially and 47% year-over-year. Each new PAP patient also expands the population that can develop into a recurring resupply relationship over time. Maternal health also reached a new quarterly high for breast pump deliveries with activity through legacy Viemed markets increasing approximately 9% sequentially. The early expansion illustrates the strategy behind the Lehan acquisition: connect the proven capability to the payer relationships, referral channels and operating infrastructure already in place across the Viemed platform to accelerate growth. Our service lines reach different patient populations, but they rely on many of the same core capabilities, including payer relationships, intake, reimbursement expertise, clinical support and fulfillment. During the quarter, we continued expanding the technology and fulfillment capacity supporting maternal health with the goal of extending those services into additional markets around the country. We also spent a lot of time during the quarter enhancing our sales organization. This effort led to defining and refining more leadership roles, divisional expansion, market coverage and further clinical support. We took the time to reset on the Viemed culture and paint a clear picture of how folks advance through our organization. While these sales reorganizations come with a heavy operational lift, they are always evolving and necessary for setting the stage to achieve the next level of growth. Developments across the broader industry continue to reinforce the value of secure and stable technology, scalable technology, disciplined payer relationships, a focused portfolio, prudent capital allocation and a balance sheet that preserves strategic flexibility. These have been long-standing priorities for Viemed, and they remain central to how we are building the company. At the midpoint of the year, Viemed is larger and more diversified than ever. Ventilation is growing under the new coverage framework, sleep and resupply continue to expand and maternal health is beginning to benefit from our broader platform. We are investing in the capabilities needed to support that demand with clear expectations for productivity and returns. We entered the second half with multiple sources of growth, a larger patient base and the financial capacity to continue investing in the business. Todd will now review our financial performance, capital allocation and outlook for the balance of this year.
Thank you. All right. Thanks, Casey, and good morning, everyone. All figures today are in U.S. dollars, and our full results have been filed with the SEC. And I'll refer to information included in the quarterly financial supplement, which is also available on our Investor Relations website. The second quarter was another record quarter for Viemed. Revenue reached $78.1 million, increasing approximately 24% from the prior year and approximately 4% from the first quarter. Ventilator rental revenue was $36.4 million, an increase of approximately 8% from the prior year quarter. Other rental revenue increased approximately 19% to $16.4 million. Impressively, equipment sales nearly doubled to $19 million with growth across sleep resupply and the maternal health business lines and service revenue increased approximately 7% to $6.3 million. Ventilator rental revenue represented approximately 47% of total revenue compared with approximately 54% in the prior year quarter. Total rental revenue represented approximately 68% of second quarter revenue compared with approximately 76% a year ago. The change reflects faster growth in resupply and maternal health, not a contraction of the rental base, which increased approximately 11% year-over-year. The growing contribution from product and service revenue creates a different margin and capital profile for the company. These offerings generally carry lower adjusted EBITDA margins than our rental business, but they also require substantially less capital. We evaluate that mix based on its combined contribution to the revenue growth, cash generation and capital efficiency. Gross profit was $45 million or approximately 57.7% of revenue compared with 58.3% in the prior year quarter. Gross margin improved from 56.8% in the first quarter. The year-over-year comparison primarily reflected the revenue mix and temporary distribution and inventory costs in our maternal health business as we manage record volume and transition supply arrangements. Our team maintained service levels throughout that growth, and we expect the new arrangements to provide a more efficient foundation as the business scales. SG&A increased as we added the capabilities required to support a substantially larger company. The primary drivers included compensation associated with higher patient setup activity, phantom stock revaluations resulting from the appreciation in our share price, technology and implementation work, additional operating capacity and temporary duplication as we bring portions of our sleep and resupply operations in-house. These were deliberate decisions to support continued organic growth, which remains our first priority for capital deployment. We are in a growth phase, and we are investing accordingly. We are expanding our product and service offerings and adding the technology, talent, operating capacity and sales capabilities needed to reach more patients and enter new markets. We are already seeing how these capabilities can increase productivity and support additional volume. With the implementation of our new intake workflow partner, Tenor, we reduced the time from receipt of a PAP order to qualification review from days to less than an hour and shortened the time incomplete orders remain in the pipeline by several days. During the quarter, we increased PAP setups by approximately 16% sequentially without a corresponding increase in fulfillment infrastructure. These are early examples of how better systems can expand capacity and improve efficiency as volume grows. We have just completed the integration of this system into our complex respiratory business, which will have a positive impact on our ability to effectively onboard patients and also gives a meaningful ability to scale the business in the future. Net income attributable to Viemed was $2.8 million or $0.07 per diluted share. Adjusted EBITDA was $13.7 million, representing a margin of approximately 17.6% compared with 22.7% in the prior year quarter. The year-over-year adjusted EBITDA comparison included an approximately $1.2 million swing in equipment disposal activity, driven primarily by the nonrecurring gains from the ventilator return program in the prior year's quarters. Excluding that prior year gain, adjusted EBITDA increased year-over-year. For the quarter, operating cash flow was $15.9 million, free cash flow was $8.6 million and net CapEx was $7.3 million or approximately 9.3% of revenue. For the first 6 months of 2026, operating cash flow increased to $24 million from $15.1 million last year, and free cash flow increased to $11.2 million from $4.9 million. On a trailing 12-month basis, free cash flow was $34.4 million or approximately 11.4% of revenue. Our capital allocation priorities remain consistent. Organic growth comes first. Acquisitions must fit the operating platform and meet our return requirements. Share repurchases remain an option when we believe the price warrants an attractive use of capital, and we will always have the ability to pay down the limited debt we carry on the balance sheet. During the quarter, we repaid approximately $2.2 million of debt and repurchased and canceled approximately 531,000 shares for $5.1 million. We ended June with $10.7 million of cash, more cash than total debt and substantial unused capacity under our credit facilities. Turning to our outlook. First half performance and operating trends across the ventilation and broader platform increased our confidence in the full year revenue result. We are raising the low end of our net revenue guidance and now expect full year revenue of $314 million to $320 million compared with the previous range of $312 million to $320 million. The outlook contemplates continued sequential growth through the second half. We are also revising our full year adjusted EBITDA guidance to a range of $64 million to $68 million compared with the previous range of $65 million to $69 million. At the same time, we are lowering our net CapEx outlook to between 8.5% and 10% of revenue compared with the previous range of 9% to 10.5%. The revised guidance reflects the growing contribution from less capital-intensive product and service revenue. Across the current guidance ranges, we expect to deliver a full year adjusted EBITDA margin of at least 20% while generating solid free cash flow and funding continued growth. We intend to sustain the renewed growth in ventilation, continue expanding sleep in the broader platform, complete the operation transitions already underway and generate greater productivity from the capabilities we have added. We feel very good about where the business is headed. Viemed has a strong financial foundation, a broader platform and a team that has demonstrated it can execute. We are proud of the growth our team is producing and confident in our ability to build on it. That completes our prepared remarks, operator, and we would like to open it up for questions.
分析師問答
Operator provided instructions. Our first question comes from Dave Storms with Stonegate.
Just maybe I want to start at the top there. I think you mentioned that you've kind of done a revamp of the sales organization. I was hoping you could spend maybe a little bit more time below the leadership roles, maybe the boots on the ground. What are you seeing in terms of getting people in the door, their time to ramp? I'm sure there's a learning curve once you guys get them in the door. Anything of that nature?
Yes. So the big change is that we added a fourth division. We had the way that we were currently structured before, we had three sales directors and underneath them, roughly 12 managers spread out throughout different regions in the country. Those managers are responsible for leadership, coaching, mentoring, field rides, things of that nature. So we elevated one of our teams into a sales directorship, and that created a lot more room for growth from a geographic standpoint for expansion into different markets and across the territories throughout the country. So we're setting up for growth is number one. Number two, it becomes training the next level of leadership and making sure these folks are delivering the right message. A lot of these people are also tasked with recruiting and finding talent throughout the country. So we want to make sure that they're finding the right folks. Ultimately, we went through a big reorg last year. We intend to probably go through another one next year just because of the way that we're growing. It's something that is always happening and always evolving. It also creates a corporate ladder for growth for our people at the bottom, so they can see that they can make it to different levels throughout the organization and advance within as we grow.
That's great commentary. I appreciate that. And then maybe just turning that into some of the strong growth that you've seen on a patient level. How much of that can be attributed to some of this revamp that you've done? Or is this all organic and can we maybe expect that to take another leg as this revamp really starts to take hold?
Yes. It's all organic in terms of the complex respiratory growth with NIV and really sleep as well. But it's twofold. It's finding new reps and making sure these reps are trained properly and up to speed much sooner rather than later. We've got a strong training program that really works now, and it's been revamped over the last two years, but it's clicking on all cylinders. So we're getting a lot of new hires ramping up sooner rather than later. The other piece is compliance. Our respiratory therapists out in the field have been heavily focused, as a result of the new NCD and all the regulations, on keeping folks on therapy and making sure that they're using the therapy, and that really translates into retention of patients. So we keep patients billing for longer. Both of those things are contributing to our ventilator growth and will continue to contribute in the future. We're not done yet with our NCD overhaul and measuring compliance and getting better at what we do in the field. Many of our RT managers are spending time with ride-alongs and doing their coaching the same way that the sales managers are coaching their teams. So we still have some opportunities to be even better. But we do believe we are best-in-class as it relates to keeping patients on therapy and finding them. There's a lot more room to improve.
That's great commentary. If I could sneak maybe just one more in. You mentioned in your guidance, a lot of the adjustments seem to be largely driven by the growth in the product and service revenue and the margin profile associated with them. As we're thinking about that growth between resupply versus maternal, do you see either one of them having more outsized growth that may be driving the guidance adjustment? How should we compare those two end markets for you?
Clearly, from a percentage basis, maternal is expected to grow at a faster percentage than the sleep resupply, but that doesn't discount how much the resupply growth has outpaced the core ventilator rental revenue. We expect both of those lines to continue to grow. We don't have an exact percentage to give for each product line at this time. The maternal business is new to us— we're one year in. We're taking it throughout the country to other contracts where Viemed is set up, and we have good payer relationships. We have been setting the organization up to be able to scale that business. That includes processes in the back office and how we fulfill these products around the country. There's been a lot of planned disruption to get ready for continued growth. Regarding sleep resupply, we brought the resupply call center in-house where we now manage that day-to-day in our own offices, which was another big change, and we needed to do that to be able to continue to drive the scalability we want to see in those business lines. So both will have significant growth. It's fair to say maternal likely outpaces resupply in percentage terms, but we're extremely excited about growing both product lines and what that does to our financial profile.
Our next question comes from Ilya Zubkov with Freedom Brokers.
So my first is related to the ventilator patient count. I see that it has recovered in Q2 with more than 500 net additions during the quarter. I'm just wondering, was the increase partially related to the insurers approving patients who had previously been denied following the NCD changes?
Yes, that makes up a part of it. The largest piece is new orders coming through. Undoubtedly, having formulary rules has given us the ability to onboard more patients within Medicare Advantage plans or private insurance companies now that we actually have those rules. So that definitely helps. The new sales structure and having effective salespeople is a big part of it. The compliance piece that Casey mentioned is also a big part of it. In the second quarter, we also came through what we would call insurance change season, so we have more patients billing and fewer patients on billing holds. All of those factors combined gave us the ability to have that growth. I would say that's about as good of a quarter as we may have ever seen from an active patient growth standpoint, and we're excited to keep that momentum going into the second half of the year.
Great. And one more question on the respiratory therapist headcount. It increased meaningfully in Q2 after declining through much of last year. I assume this partially reflects the needs of a growing patient base. Could you elaborate on whether the revised NCD requirements have changed the effective capacity of your respiratory therapist workforce?
It's early to say that we'll have a new patients-per-RT ratio. Right now, we're allocating resources to make sure patients are properly educated, seen very often and given every opportunity to get education from our RTs. I don't see a meaningful change in patients per RT in the near future, but we'll monitor it. Some of the headcount increase could be due to the sleep business growing dramatically and the remote setup that some RTs support, so not all RTs are ventilation RT service providers. It's something we're keeping an eye on. If we need a few more RTs to keep patients compliant, that's our commitment to patient care, and we would be okay with that.
And I'll just add to that. Anecdotally, some of our highest patient-count RTs are also some of the best performers in compliance. We are keeping a watchful eye on that, using them as champions, and they're helping others by teaching what they're doing and how their systems are working. We stay tuned to that. But as Todd said, it's a little too early to tell if that's going to move significantly.
Okay. And the last one on the EBITDA margin. It remains under pressure in the first half of 2026 while SG&A grew faster than revenue in Q2. Could you discuss the main sources of operating leverage you expect in the second half of the year that could move adjusted EBITDA margin towards the guided 20% level?
In general, last year the back half of the year carried stronger EBITDA margins, and we would expect the back half of this year to be somewhat in line with that. The first half typically carries a lower margin due to patient holds and cost timing. We're clearly diversifying the company and changing its revenue composition, and we are comfortable with that because if product and service lines have structurally lower EBITDA margins but require less CapEx, net income margins can ultimately expand. As for operating levers, the distribution capabilities I mentioned earlier are key. We have signed with a new national distributor for the maternal health business, and that will translate into other business lines as a scalable process. The new intake workflow will help us scale without hiring as many back-office personnel. Bringing the resupply call center in-house makes that function more scalable to drive revenue in the business line. Additionally, some duplication of cost occurred in Q2 while we were transitioning into new investments and still running old processes. You should see some of that ease up in the back half of the year as we realize the investments made in Q2. We're not concerned about the short-term pressure on EBITDA. If you look at the first six months of this year versus the first six months of last year, and exclude the prior Trilogy gains, we're in line with where we need to be and excited about the diversification we've proven out over the last few years.
We have reached the end of the question-and-answer session. I would like to turn the floor back over to management for closing comments.
Okay. Thanks, everyone, for your trust in Viemed. We appreciate all the new investors and look forward to continuing to add value and make smart decisions here. We're here if you need us. Take care.
This concludes today's teleconference. You may disconnect your lines at this time. Thank you for your participation.