Earnings Call Transcript - EKSO Q2 2025

Stephen Kilmer, Investor Relations

Thank you, operator, and good afternoon, everyone. Earlier today, Ekso Bionics released financial results for the second quarter ended June 30, 2025. A copy of the press release is available on our website. I would like to point out that management will make statements during this call that include forward-looking statements within the meaning of the federal securities laws, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements made during this call that are not statements of historical facts should be deemed to be forward-looking statements. All forward-looking statements, including statements regarding our business strategy, future financial or operational expectations, our ability to close on delayed customer sales, our expectations of the regulatory landscape governing our products and operations are based upon management's current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements. For a list and description of the risks and uncertainties associated with the company's businesses, please see its filings with the Securities and Exchange Commission. Ekso disclaims any obligation, except as required by law, to update or revise any financial or operational projections, its regulatory outlook or other forward-looking statements, whether because of new information, future events or otherwise. Any forward-looking statements made on this call speak only as of the date of this call. Representing Ekso Bionics today are Scott Davis, our Chief Executive Officer; Jerome Wong, our Chief Financial Officer; and Jason Jones, our Chief Operating Officer. With that said, I will now turn the call over to Jerome.

Jerome Wong, CFO

Thank you, Steve. Good afternoon, everyone, and welcome to our second quarter 2025 conference call. On behalf of the management team and everyone at Ekso Bionics, I would like to thank you for your interest in our company. And for those of you who are shareholders, we appreciate your support. For the benefit of those who are new to the Ekso Bionics story, I would like to take a moment to summarize our business. Ekso designs, develops and markets exoskeleton products that augment human strength, endurance and mobility. The primary end market for our exoskeleton technology is health care, where our technology primarily serves people with physical disabilities or impairment in both physical rehabilitation and mobility. We operate as one operating and reportable segment with 2 markets, Enterprise Health and Personal Health. Our legacy Enterprise Health product consists mainly of our EksoNR device, which is a wearable robotic exoskeleton specifically designed to be used in a rehabilitation setting to assist individuals recovering from both acute and chronic conditions. And our newer Ekso Indego Personal device is a wearable lower extremity powered exoskeleton that enables certain individuals living with spinal cord injuries with the ability to stand and walk independently. Both products also include the sale of support and maintenance contracts. I will turn this call over to Scott in a moment for an update on our commercial activities and growth plans. However, before I do, I would like to provide a brief summary of our financial results. To streamline things, all of the numbers I will refer to have been rounded, so they are approximate. As we mentioned in today's press release, we experienced abnormal weakness in the second quarter of 2025. The company recorded revenue of $2.1 million for the period compared to $5 million for the second quarter of 2024. This was primarily driven by what we believe are short-term delays in completing certain multi-device Enterprise Health sales and was offset partially by higher Ekso Indego Personal device sales. As Scott will discuss shortly, we are working to get back on track for the second half of the year and beyond. Gross profit for the second quarter was $800,000, representing a gross margin of approximately 40%, compared to a gross profit of $2.6 million and a gross margin of 53% for the same period of 2024. The change in gross profit was driven by a decrease in revenues associated with our Enterprise Health devices, partially offset by an increase in revenues associated with Ekso Indego Personal devices and a reduction in service costs. The decrease in gross margin was primarily driven by fixed cost of goods in relation to the decrease of Enterprise Health device sales, lower margin sales related to increased volume through distribution and an increase in shipping costs, partially offset by improved margins in service. Operating expenses for the second quarter of 2025, which consists of R&D, G&A and sales and marketing expenses were $4.8 million, a 4% improvement from $5 million for the second quarter of 2024. Net loss applicable to common stockholders for the 2025 second quarter was $2.7 million or $1.24 per basic and diluted share, compared to a net loss of $2.4 million or $1.99 per basic and diluted share for the same period of 2024. As of June 30, 2025, the company had cash and restricted cash of $5.2 million. That is it for my summary of our second quarter 2025 results. Please see our Form 10-Q filed earlier today for further details regarding the results. I'll now turn the call over to Scott.

Scott G. Davis, CEO

Thank you, Jerome, and good afternoon, everyone. I'll cut to the chase. Our second quarter revenues were disappointing. But as Jerome noted, we believe this was a temporary setback, driven mostly by short-term delays in completing 2 significant multiunit Enterprise Health device sales that were anticipated in the quarter. As we discussed on our last call, we've also had a small percentage of U.S. customers impacted by loss of federal grants and/or concerns related to economic uncertainties who have pushed their purchases into later 2025 or early 2026. Nevertheless, we don't believe the second quarter revenue shortfall truly reflects the health of our current business nor our prospects for the future. Several reasons are bolstering our confidence that we can get back on track for the second half of the year and beyond. First, we're confident that we will be able to close a significant portion of the deferred multi-device Enterprise Health sales prior to year-end. At the same time, we are capitalizing on continued Enterprise Health customer demand by recently signing a master subscription agreement with another major integrated delivery network. And to help support that, we are constantly looking for ways to help us raise awareness, acceptance and adoption of our exoskeleton technology within the market. A good recent example is our launch of eksoUniversity, a new virtual platform providing continuing education courses to physical therapists and physical therapist assistants across the country. While we believe eksoUniversity can generate incremental revenue for us, the greater value is represented through the program's ability to educate the neurological/physical therapy community on a wide range of relevant topics and ever-evolving patient treatment options. I'm happy to share that we have already delivered our first official CEU certification to a Connecticut-based PT coincidentally via a course entitled Benefits of a Personal Exoskeleton. In addition, the general trend of lower but steady growth in our more mature legacy Enterprise Health business is being increasingly counterweighted by the growth in Personal Health from sales of the Ekso Indego Personal. To put that into perspective, despite total revenues for the first 6 months of 2025 being down 38% compared to the same period in 2024, Personal Health product revenues grew by more than 50%. As I've said in the past, while the majority of our revenue in 2025 is expected to still come from Enterprise Health, we believe that we will continue to see increasing contributions from our Personal Health products during the remainder of the year and beyond. There are a few things driving that. First, as we've discussed in the past, CMS established pricing determination for our Indego Personal Exoskeleton in Q2 2024. This regulatory change created a significant opportunity to help Medicare enrollees living with spinal cord injury by removing what has historically been a primary barrier to accessing our exoskeleton. Accordingly, we immediately set out to establish a go-to-market strategy aimed at notifying as many early physician and provider adopters as possible of the new CMS benefit category redetermination and fee schedule listing. Additionally, we began working closely with our extensive network of neuro rehabilitation partners across the country, focused on educational efforts and on appropriate patient selection and process for patients prescribed an Ekso Indego Personal for the home and community setting. With that early work largely completed, we then shifted our primary focus from building awareness and providing customer education to advancing our scalable go-to-market strategy for the personal channel. One of the important changes we made was to engage PRIA Healthcare, one of the leaders in market access services, which has been instrumental in the successful commercialization of over 300 medical devices. We are confident we made the right choice in partnering with PRIA. PRIA has been providing us with invaluable strategic guidance, leveraging its expertise to help us navigate the complexities of coding, coverage and payment, thereby allowing us to more effectively put Ekso Indego Personal within reach of individuals who need this potentially life-changing mobility-enhancing technology. On the distribution front, I'm pleased to report that in the second quarter, we received the first order from National Seating & Mobility, or NSM, our exclusive Ekso Indego Personal device distributor within the complex rehabilitation technology or CRT industry in the United States. Also in Q2, we named Bionic P&O, a leading national provider of prosthetic and orthotic solutions as our first O&P distributor. We're excited that they submitted an additional 3 patient claims for the Indego Personal exoskeleton to Medicare in the second quarter. Altogether, with Ekso's focused marketing efforts, we've now developed a pipeline of more than 45 Medicare beneficiaries that we believe are qualified candidates for Ekso Indego Personal in 2025. That's up more than 200% from where we were at the end of 2024. As a reminder, factors considered for the candidates to be represented in our pipeline include, among other things, Medicare enrollment, an appropriate indication for use and medical necessity. And we again caution that we cannot guarantee that all of our pipeline will result in new claims submissions occurring before the end of this year or ultimately be paid. Finally, we continue to innovate. In mid-May, we announced that Ekso joined a select group of medical device companies in the NVIDIA Connect program. NVIDIA Connect brings together emerging and established technology companies to accelerate product development and increase cost efficiency. Members gain specialized training, priority engineering support and exclusive access to NVIDIA's advanced development kits, GPU platforms and global ecosystem, helping facilitate the program members' ability to deliver next-generation solutions in AI and high-performance computing. While we believe our advanced exoskeleton technology platforms are already state-of-the-art, we're working to use the valuable tools and resources provided through this prestigious NVIDIA program to support a new strategic initiative to build a proprietary foundation model for human motion and physical rehabilitation, and to help develop and integrate related new AI capabilities across our portfolio of enterprise healthcare and personal health devices. This aligns squarely with our mission of improving health and quality of life with advanced robotics designed to enhance, amplify and restore human function. And we are walking the talk. Indeed, just 34 calendar days after announcing our acceptance into the NVIDIA Connect program, we revealed initial proof of concept in the form of a new AI voice agent designed for intelligent control of our legacy EksoNR device. Ekso Voice Agent is being implemented on NVIDIA Jetson Orin Nano hardware developed with the NVIDIA JetPack SDK and OpenAI tools for voice recognition. The proof of concept is configured as an edge AI system, which can run with or without connection to the cloud. While this initial proof of concept was with the EksoNR, integration of new AI-powered capabilities into both our enterprise and personal health devices is a key pillar of our growth strategy. We are in the fortunate and enviable position of already having a repository consisting of approximately 350,000 patient sessions and over 15 million step-by-step data points, and that is growing by an additional 60,000 patient steps on average every day. The aim is to develop AI tools designed to leverage this proprietary data in order to help transform human-robot interaction. In other words, while the AI hardware is coming from NVIDIA and others and much of the software is open-sourced, we believe our large and growing database sets us apart, making us uniquely positioned to utilize AI to advance exoskeleton technology platforms. In summary, the second quarter was abnormally weak from a revenue perspective, and that was primarily due to what we believe are short-term delays in completing some multi-device Enterprise Health sales, and we're working diligently to get back on track for the second half of the year and beyond. At the same time, as we work to capture deferred sales and capitalize on anticipated customer demand in the legacy enterprise health market, we are continuing to build and execute on a scalable go-to-market strategy for Indego Personal, supported by established and new industry-leading DME, O&P and market access partners that is driving an increased contribution from our Personal Health products, which grew by more than 50% year-over-year in the first half of 2025. Finally, we've launched a strategic initiative aimed at building a proprietary foundation model for human motion and physical rehabilitation, and to help develop and integrate related new AI capabilities across our portfolio of enterprise health and personal health devices. We believe AI is a necessary component to enable broader adoption of exoskeletons for personal use. This ends our prepared remarks for today. And with that, we are happy to take any questions you might have.

Benjamin Charles Haynor, Analyst

First off for me on the deferred sales that you guys have on the Enterprise Health side, it sounds like a lot of them are potentially going to fall into the current quarter. Can you quantify how much is deferred there? How much you expect kind of the back half of the year?

Scott G. Davis, CEO

Ben, thank you for your question. We had two multiunit device sales that did not occur in Q2. To clarify, one was an international order delayed due to regulatory issues that we anticipate resolving this calendar year, and we believe it will happen in 2025. The other was a significant multiunit order from a North American IDN, which included both renewals and new hospitals expected to take place in the current third quarter. That order is in the $1 million range, while combined, the two orders total approximately $1.4 million.

Benjamin Charles Haynor, Analyst

Okay, that's definitely helpful. Regarding the Indego Personal, I understand it is growing faster than you anticipate the Enterprise Health business will and that it will eventually surpass it. Do you have any insight on when that transition might occur?

Scott G. Davis, CEO

That's a great question and something that we've been working really hard on as a management team, as a company. All of the work that we've done internally with our own resources as well as working with PRIA Healthcare, the onboarding of our 2 new distribution partners in the space for scalable go-to-market strategy, the work we've done to increase the marketing efforts to continue to increase leads and build pipeline demand as well as the business development work we continue to do looking for other national O&P providers to work with. We're already beginning to see the positive impacts of that work. And in addition to that, we're doing a lot of work within the VA systems to increase those opportunities as well as workers' compensation. So as we're looking at that sort of blended ecosystem, and we look back at 2024, that represented approximately 10% of our revenue for the company. And as we're looking at 2025, we believe that that will be closer to 25% contribution to our total revenue. And as we move forward and cross into 2027, we believe that it will begin to overtake what we're seeing on enterprise.

Benjamin Charles Haynor, Analyst

Okay. So a couple of years out, maybe 18 months from today. That's good. I'm just thinking about PRIA and I'm curious. It seems like you've really nailed down the patient profile. How is the process of nailing that down coming along? Have you been before any more ALJs and learned anything new that's worth noting? Anything on that front?

Scott G. Davis, CEO

Yes. I mean that remains an area of focus for us as we work through the appeals process. We have a couple of patient claims that will go before ALJ in Q3. In Q2, we had one that went before ALJ that was remanded to a lower level in CMS and ultimately approved. So we are seeing positive outcomes. The important part here is that we are being reaffirmed that these are medically necessary. So they are getting reimbursed when we're able to get in front of these administrative law judges, they can really understand this a bit better. And again, this is a ramp-up period. So what we're being very cautious with in working with our DME partners and O&P partners is to ensure that we're level setting expectations with patients and health care providers and ensuring that we're putting forth the best claims possible so that we can pave a way to these happening on a more routine basis. But with any new process, it takes a little time to ramp up, but we believe that we're starting to make some good progress.

Benjamin Charles Haynor, Analyst

Okay. Got it. And then lastly for me on eksoUniversity. Is that going to be something that is solely focused on exoskeletons? Or are there additional modules or content that we're going to be putting in there?

Scott G. Davis, CEO

Yes, that's a great question. We view this as a significant opportunity to concentrate on neuro rehabilitation. Our initial courses will primarily focus on exoskeleton technology, but we anticipate that they will cover a wide range of the latest neuro rehabilitation techniques and methods available. We have a strong network of neuro physical therapists who contribute to the development of these materials, providing us with valuable insights as we create these courses. Our main goal is education. If we can demonstrate and introduce more people to the possibilities presented by various types of technology, we believe that will benefit the entire industry.

Swayampakula Ramakanth, Analyst

Sorry, I've been on the call intermittently. I would like to know about the new collaborations you've established to facilitate the commercialization of the personal devices. How are those efforts progressing? Also, when do you anticipate that growth will become significant based on these new partnerships, specifically regarding the personal devices before we discuss the enterprise side? I have a couple of questions related to that.

Scott G. Davis, CEO

Sure. Thanks, RK. As we discussed today and as I previously mentioned, we're working hard with our industry partners, PRIA, to navigate the complexities of market access and work with CMS. This effort not only supports us but also serves as a resource for our distribution partners, whether in CRT or O&P, assisting with the appeals process and helping us build this new path step by step. This collaboration has been incredibly beneficial. The partnerships we've formed with Bionic P&O, NSM, and other significant O&P providers are progressing each quarter. What begins slowly with initial discovery and the first patients getting through to initial claims submitted is now leading to increased claims in subsequent quarters. We're seeing steady growth, moving from one patient to several more each quarter through these partners. Many of the leads we've developed have originated from Ekso, but we're noticing a shift within the ecosystem where, during our training sessions and onboarding at different rehabilitation sites, existing customers who have previously used our technology are identifying new patients. Our distribution partners are also contributing leads through their networks, signaling the emergence of a promising lead source. We truly believe this scalable approach, collaborating with top-tier providers, will effectively deliver our technology to those who need it the most.

Swayampakula Ramakanth, Analyst

Okay. Great. Regarding enterprise sales, what immediate actions do you think are necessary to return to growth, and what is your estimate for how long that might take?

Scott G. Davis, CEO

Yes, we are disappointed with the results of Q2. However, there is positive news as we still have several devices and two significant deals, particularly in North American integrated delivery networks, that are still in play, including one deal worth over $1 million in Q2, which we believe has the potential for even more in Q3. We are optimistic about bringing this deal in for Q3, viewing it not as a lost opportunity but rather as deferred. We are actively working on our robust pipeline built over the years to assist enterprise customers facing budget interruptions, whether due to losing federal grants or budget concerns. We are collaborating to find alternative options for onboarding technology that do not rely on capital budgets or grants. Additionally, we are partnering with a new third-party financial provider to help these organizations integrate this into their operational and capital budgets. We are making every effort to support enterprise customers who wish to utilize this technology to treat patients, ensuring they have the means to do so despite concerns regarding their 2025 budgets.

Swayampakula Ramakanth, Analyst

My final question is about the potential enterprise clients affected by the loss of federal grants. How many of our current enterprise clients are using federal grants, and how confident are we that these grants will be extended in the upcoming contract period?

Scott G. Davis, CEO

Yes. So in general, we don't have a magic number on how many hospitals go for federal grants for this technology. I think if we look historically, from a pure revenue standpoint in North America, I would approximate 10% of our enterprise customers rely on federal or outside grants to fund their technology. And I think that's a conservative estimate. Thank you, operator, and thank you to everyone for joining us today. We look forward to updating you as we continue to progress.

Operator, Operator

Our first question comes from the line of Ben Haynor with Lake Street. Thank you. This concludes today's conference, and you may disconnect your lines at this time. Thank you for your participation. Have a great day.