InfuSystem Holdings, Inc Q3 FY2025 Earnings Call

Good day, and welcome to the InfuSystem Third Quarter 2025 Earnings Conference Call. Please note this event is being recorded. I would now like to turn the conference over to Joe Dorame of Lytham Partners. Please go ahead.

Good morning, and thank you for joining us today to review InfuSystem's Third Quarter 2025 Financial Results ended September 30, 2025. With us today on the call are Carrie Lachance, Chief Executive Officer; and Barry Steele, Chief Financial Officer. After the conclusion of today's prepared remarks, we'll open the call to questions. Before we begin with prepared remarks, I would like to remind everyone that certain statements made by the management team of InfuSystem during this conference call constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Except for the statements of historical fact, this conference call may contain forward-looking statements that involve risks and uncertainties, some of which are detailed under Risk Factors in documents filed by the company with the Securities and Exchange Commission, including the annual report on Form 10-K for the year ended December 31, 2024. Forward-looking statements speak only as of the date the statements were made. The company can give no assurance that such forward-looking statements will prove to be correct. InfuSystem does not undertake and specifically disclaims any obligation to update any forward-looking statements, except as required by law. Now I'd like to turn the call over to Carrie Lachance, Chief Executive Officer of InfuSystem. Carrie?

Thank you, Joe, and good morning, everyone. Welcome to InfuSystem's Third Quarter Fiscal Year 2025 Earnings Call. Thank you all for joining us today. I will provide a third quarter overview, highlighting key successes, addressing notable challenges and outlining our strategic priorities as we wrap up 2025 and look forward to 2026. Then Barry will provide a detailed summary of our financial results. I will then come back to some closing comments before opening the line to questions. This morning, we published our third quarter earnings report, which illustrated another strong quarter of financial performance, marked by continued revenue growth, margin expansion, robust cash flow, debt reduction and returning capital to our shareholders. In the report, we shared examples of the activities and initiatives we have underway that have contributed to these improved financial metrics. I'll take a few minutes now to walk through some of them. I'll start by discussing some very important projects driving our Wound Care initiatives. We see an opportunity to leverage strategic competencies present in our Patient Solutions segment beyond our existing therapies of oncology and pain management. A key driver for long-term success in this initiative has been taking steps that will lower the processing cost for each patient referral. This is why we acquired Apollo in May of this year. Integrating this company and its systems not only brought us Wound Care customers, but more importantly, presented a quick and low-cost means to upgrade to a more streamlined billing software that will allow us to process upfront paperwork and insurance claims more quickly and efficiently. During the third quarter, we completed key integration tasks, including connecting the new RCM application to our insurance billing clearinghouse, which effectively plugs in our large portfolio of insurance payers. We are now focused on additional system and process improvements, particularly building out the AI and automation enhancements that the new tool allows and completing the transition of our existing Wound Care volume into the new system. While it's still too early to measure the exact cost reduction benefit, we believe the new system will allow us to process the highly complex Wound Care claims on a cost-efficient basis. The ongoing progress also brings us a few steps closer to onboarding our Oncology and Pain Management billing volume onto the application, further leveraging the investment and improving our overall RCM efficiency. Also in the third quarter, we began accepting patient referrals and booking revenue for pneumatic compression devices, or PCDs, through a new relationship with the device manufacturer. Although the amount of revenue was relatively small, the quickness to launch illustrates not only the strength of our payer portfolio when we bring it to bear on new products, but the significant improvements that the team has made to accelerate the speed at which we bring new products online. For now, we are classifying these revenues in the Wound Care category with hopes they will grow large enough in the future to report them separately. Next, I'd like to note three developments positively impacting our business beyond Wound Care. First, in addition to the new billing system acquired and integrated via the Apollo acquisition during the third quarter, we went live with a machine learning tool focused on our front-end intake process, which is another complicated and time-consuming manual task. This was done even while continuing the implementation of our ERP level software system upgrade that we began in 2024. Second, we secured a significant new contract with a large hospital system for our Oncology business. Our sales team has had tremendous activity, and this win, along with others, increases our market share and will help us to continue to report Oncology revenue growth at levels exceeding expectations, a challenge given our high market share. The contract win resulting in higher volume will, of course, require us to spend capital on pumps, a fair trade, given Oncology is our most accretive revenue source. In addition, I'll note that Oncology revenue for the third quarter reached an all-time record, which is a common accolade for the business. Finally, we secured a multiyear contract extension with one of our largest national insurance payers. This type of event is not normally newsworthy since we routinely extend existing contracts and add new payers to our very extensive portfolio. However, this one stands out as particularly exciting because it provides enhanced service coverage in product areas we are focused on, such as negative pressure wound therapy devices and PCDs. The extension also contains a much appreciated price increase. The accomplishment demonstrates the depth of our contract relationships as a whole and the value our payers see in our capabilities. Before I turn the call over to Barry, I need to provide an update on developments in our biomedical services business. As we mentioned in our last quarterly call, we've been working with our largest biomedical services customer to modify the contract to reflect changes in market economics and developments in the relationship. During the third quarter, we signed a contract amendment that will improve pricing and shift the relationship to reduce device volume and lower service levels on most of the devices remaining on the contract. These changes will result in a reduction in revenue under the contract by an estimate of $6 million to $7 million annually starting in December of this year. However, it is important to note that these changes will also result in an expansion of our operating income by reducing costs and expenses in an amount greater than the revenue decline. We are now focused on resizing and relocating our field-based biomedical technician team to conform to the changes. While we are always disappointed by changes that reduce our revenue, we believe that profitability is a key driver of shareholder value and that these strategic adjustments are essential to our continued progress and will leave us with a very solid core field-based biomedical service business from which to build upon. Now I'll turn it over to Barry for a detailed review of the third quarter financial results.

Thank you, Carrie, and thank you, everyone, on the call for joining us today. I'm going to focus on the main drivers for the current quarter's results, and I'll update you on our current financial position and how it changed during the quarter. And let me start with our financial results for the period. During the third quarter of 2025, our net revenue totaled $36.2 million. This was another record, and it represented a $1.2 million or 3.3% increase from the prior year third quarter. The improvement was applicable to increased net revenue for the Patient Services segment, partially offset by lower revenue from Device Solutions. Patient Services net revenue increased by $1.6 million or 7.6% and included increased patient treatment volumes in Oncology and Wound Care. Oncology net revenue increased by nearly $700,000 or 3.6%, and Wound Care revenue was up by 116%, totaling $2 million, which was mainly driven by volume increases in negative pressure wound therapy treatments related to the Smith & Nephew partnership, increased volume from the Apollo acquisition and first-time revenue for pneumatic compression devices. Device Solutions net revenue decreased by $400,000 or 2.9%. This decrease was primarily attributable to about $400,000 in lower revenue volume in biomedical services and a standout large equipment sale during the prior year to a large rental customer that bought out $1 million in lost pumps from their contract. Partially offsetting these declines was a $600,000 non-recurring benefit to adjust the contract asset related to our largest biomedical services customer. The lower revenue from the biomedical services mainly relates to a remediation contract that benefited the prior year but was nearly completed prior to the current year period. Gross profit for the third quarter of 2025 was $20.8 million, which was also a quarterly record and a $1.8 million or 9.3% increase over the prior year third quarter. Our gross margin percentage at just over 57% increased by 3.1% from the prior year's amount, which was a significant improvement even without the one-time 1.7% boost that we received from the contract asset adjustment. The remaining increase was mainly driven by improved labor efficiency and pricing in biomedical services, improved revenue mix favoring higher-margin revenue such as Oncology, lower procurement costs and lower pump disposal expenses. Selling, general and administrative expenses for the third quarter of 2025 totaled $17 million and was $1.2 million or 7.8% higher than the prior year third quarter amount. More than half of this increase was attributable to $773,000 in expenses associated with our project to upgrade our main enterprise resource planning software. Other increases were related to additional headcount and revenue cycle and other personnel needed to support the higher revenue volume and a higher accrual for short-term incentive compensation. Partially offsetting these increases was a lower sales commissions rate related to shifts in revenue mix. Adjusted EBITDA during the 2025 third quarter was $8.3 million, which represented an increase of just over $400,000 or 5.6% from the prior year third quarter adjusted EBITDA. This represented 22.8% of net revenue for 2025, which was slightly above the prior year rate of 22.3% despite a $500,000 increase in spending on the ERP project. On a trailing 12-month basis, adjusted EBITDA totaled $30.2 million, representing a margin of 21.4%. This demonstrates that our focus on profitable revenue growth and operational efficiency is yielding meaningful results. Now a few points on our financial position and capital reserves. On a year-to-date basis, for the first 9 months, we generated operating cash flow totaling over $17 million. This amount was $4.8 million higher than the amount realized during the prior year-to-date period. This increase was due to the higher adjusted EBITDA, which on a year-to-date basis was also up by $4.8 million. Our net capital expenditures were $3.1 million so far in 2025, which represented a significant decrease from $10 million spent during the first 9 months of last year. The amount during the prior period was focused on infusion pumps needed to support increased volume in the Device Solutions rental business, which grew more significantly during that period. Although we anticipate an increased amount of medical equipment purchases during the next quarter to support some new customers in Oncology, we continue to anticipate that our overall capital spending requirements will remain at moderate levels as compared to amounts in prior years, as the sources of our future revenue growth will continue to be more weighted towards less capital-intensive revenue sources. We continue to be positioned well to fund continued net revenue growth with the growing cash flow from operations backed by significant liquidity reserves available from our revolving line of credit and manageable leverage and debt service requirements. Our net debt decreased by $5.7 million during the third quarter. We were able to do this despite purchasing $2.2 million of our common stock during the quarter under our $20 million stock repurchase authorization. This brings total shareholder capital return under the plan so far this year to $8.6 million. Our available liquidity continues to be strong and totaled nearly $65 million as of September 30, 2025. At that time, our ratio of net debt to adjusted EBITDA was modest at 0.66x. Our debt consists of borrowings on our revolving line of credit with no term payment requirements. Early in the third quarter, we amended our credit agreement, extending the facility for 2 additional years. The facility now expires in July 2030. We continue to benefit from an outstanding interest rate swap, which fixes our interest rate on $20 million of the outstanding borrowings at a below-market rate of 3.8% until April 2028. I'll now turn the call back over to Carrie.

Thanks, Barry. As we close out the year with strong momentum, we are reaffirming our full year outlook, targeting adjusted EBITDA margin to be 20% or greater and revenue growth between 6% to 8%. We are entering 2026 as a stronger and more focused company, well positioned to build on this progress. As I reflect back on the efforts we made during the third quarter, the updates that we've shared with you today and what we are currently focusing on as we close out 2025, I hope you will agree that we've been diligent in pursuing the strategic priorities we laid out for you in early August when we reported the second quarter. Those priorities are to execute with discipline, deliver profitable growth and drive long-term value creation for our shareholders. Operator, we are ready for the Q&A portion of the call.

Our first question comes from Kyle Bauser with ROTH Capital Partners.

Carrie and Barry, glad to see the very nice progress around prioritizing profitable growth and sort of improving the processes to lower cost here. It sounds like you've made some nice strides across the business in relation to this, particularly in Wound Care and Oncology. It seems like Oncology is probably much more streamlined than kind of the growing Wound Care business. Can you maybe talk a little bit more, Carrie, about the additional enhancements you want to make in the Wound Care business kind of around AI and automation enhancements?

Yes, sure. From an AI perspective or an automation perspective, we have our new system that we implemented for the revenue cycle aspect over the past few months. That's working tremendously well. We have a good portion of our business that we're starting to put into that. Our older system didn't have any AI or automation technology that it allowed for. So we're looking forward to plugging even more of the business in, but we can see some efficiencies starting already in those lines of business.

Okay. Got it. And regarding the largest biomedical service contract changes, of course, it sounds like it will be much more profitable moving forward, which is great. Can you speak a little bit more about the level of reduction in this contract from a sales perspective? And then I think you mentioned kind of being able to recoup that in profit. So just any more color there would be appreciated.

I’ll jump in on that. We anticipate a significant adjustment in the revenue from that contract, estimating between $6 million and $7 million for a couple of reasons. Even though we raised our prices, certain locations did not work well for us or the customer, which will lead to a volume reduction of about 40%. The remaining volume will see a lower service level, as we'll only perform preventive maintenance services rather than on-demand repairs, although there is potential for some repairs to return to our facilities from a depot standpoint. We're uncertain about the revenue from those repairs, but we expect to receive some devices we’ve been repairing in the field back at our depots. The positive aspect is that this will help us adjust our cost structure significantly, and the economics of the program should now be favorable. While it’s unfortunate to lose some revenue, we will have a solid foundation to rebuild on. In fact, we’ve already secured additional business with other clients, allowing us to begin rebuilding at a much better margin.

Got it. Appreciate that. And maybe just lastly, kind of related to that, so the 6% to 8% sales growth rate reiterated, which is great. How should we think about kind of the growth profile of Patient Services versus Device Solutions, either for this year or going forward? I guess I'm trying to get at the Device Solutions, what sort of growth profile can we envision there kind of moving forward with the change in this big contract?

Yes. So obviously, that's a pretty big headwind for us for next year just from that one contract adjustment. As you're aware, we do see our growth continuing where we're focused on is in the Wound Care, the Patient Services side with a bunch of different potential therapies and things that we'll look at bringing online. And so I think that will be a little bit slower on the growth side for the Device Solutions side where you see more growth being driven by the Patient Services side as we proceed through the year. The good thing is that the change that we're talking about doesn't take effect until December. And so there'll be a small impact on the current year for the adjustment to the large biomedical services contract.

Our next question comes from Matt Hewitt with Craig-Hallum Capital Group.

This is Tollef on for Matt. Given your focus on profitable growth, how do you balance margin improvement with maintaining revenue momentum across your key segments?

I'll address that. Our business varies significantly in terms of revenue sources and associated margins, as well as the capital needed for growth. We are working on improving areas with lower cash flow and margins, which is evidenced by the notable change in our large biomedical services contract. We are concentrating on leveraging our core competencies in segments where we can enhance profitability without large capital expenditures. To guide our focus, we are considering the return on invested capital. By entering markets or expanding areas with minimal investment requirements that can yield good returns and cash flow, we are prioritizing those opportunities. It’s not solely about the visible margins; it’s also about our ability to operate effectively within a segment and the speed at which we generate cash flow from it.

Yes, we discussed the PCDs, which we had entered a few years ago, but we faced some challenges in that area. However, with the improvements and automation of our back-end systems, we have been able to continue our growth and re-enter the PCD market. Alongside Wound Care, these are two segments we are concentrating on, and we see significant opportunities in both.

Your next question comes from Jim Sidoti with Sidoti & Co.

So Barry, I think I heard you say that the ERP expenses in the quarter was about $733,000. Is that right?

$770,000.

Okay. And you think that will be gone by 2026, right?

No, we'll have spent in the first quarter. We'll be going live during the first quarter. So it will taper off after that. Keep in mind, though, our overall maintenance cost on the new system versus the old system is a little bit higher. So it doesn't all completely go away, but a very large portion of it goes away starting in the second quarter of next year.

Okay. And that's more than the gain you got from renegotiating the pricing on the contract then?

Well, I thought you were discussing the ERP, and now that we are focusing on the medical.

I'm just trying to figure out if this $0.11 if it's a clean EPS number. But it sounds like the one-time benefit was offset by the one-time expense because of the ERP.

That's a good perspective. We made some adjustments to our short-term compensation incentives. As I mentioned earlier, if you exclude the impact of the contract adjustments, which accounted for about $600,000 related to prior services we completed, we still experienced growth in both our gross margin and EBITDA margin. You are correct that there are other offsetting expenses involved that are somewhat unrelated. However, if you removed those factors, the situation would look more favorable.

Okay. All right. And then in terms of the new service agreement, so it sounds like that business went from around $11 million to about $6 million to $7 million in terms of revenue. Is that right?

We believe we are returning between $6 million and $7 million. The exact amount is unclear due to the volume of repairs we conduct in the building. The biomedical services business was previously around $10 million to $12 million, but it will likely be significantly lower. However, we have secured other business that should help offset some of that decline.

Okay. With the $12 million business, can you give us an idea of what the operating profit was for that and what it will be for the smaller business?

I want to illustrate that we weren't achieving the margins we expected under the contract. With the new structure featuring a higher price, we are now able to service in a way that will lead to a significant improvement in our margins, not just in percentage but in actual margin dollars. So, looking back at the volume on the repairs we do in the building...

The impact of the change is that with the operating dollars under this new agreement reduced to around $5 million, you are indicating that you will achieve greater operating profit compared to what you had with a $12 million business.

That's correct.

That's correct. Okay. So...

Our top line will be negatively impacted, and yet the bottom line will be positively impacted.

And I assume now that some of that excess capacity, you'll try and use that for new customers?

I don't believe we'll consider it excess capacity. We will not have regional team members and will instead concentrate our team closer to the devices. This will lower some of our operating costs for getting people on site. However, I believe as we grow, we won't rely heavily on a single customer, especially one with a loss leader contract. Since we're winning additional contracts, we expect to continue expanding intelligently with smaller contracts that are much more advantageous for us. Yes, I think so. There are other opportunities we may consider for mergers and acquisitions, but you'll hear about them if they develop. Since we have positive cash flow and the business is becoming less capital intensive, we have excess cash to return to investors or pay down our relatively low debt. So yes, it will likely be very similar. In the fourth quarter, we will definitely need to acquire pumps for some new customers in Oncology, which means we will increase capital spending in that period.

But it sounds like with this new strategy that the operating cash flow is going to go up, not going to go down over the next couple of years.

Our next question comes from Ben Haynor with Lake Street Capital Markets.

Just a couple for me. First off, on the biomedical services contract, are there going to be any sort of one-time expenses to kind of the transition here, moving team members around? Anything related to that? Or that just kind of they get reallocated relatively easily and not any real expenses associated with the change to the contract?

Yes, there's definitely some costs. They're fairly low, both in some severance conditions and some relocations. But it will be in the fourth quarter, very small, very manageable amount.

Okay. And even with that, you would expect the operating profit dollars to go up?

Yes. The true effect of the revenue and the changes in our cost structure will be felt in the early part of next year since we are still fulfilling the current contract through the end of November. Additionally, December typically does not see much revenue due to preventive maintenance services during the holidays. Therefore, there isn't a significant impact this year. There may be a minor additional expense from some restructuring, but the larger effect will be next year when we anticipate reduced revenue and an even greater reduction in costs. Yes, the price increase is something we see in other contracts as well. This one will be beneficial for us. Most of our contracts are not heavily concentrated, so we would need to see price increases across all of them for the impact to be very noticeable. However, it's important to note that we do not anticipate price decreases in these contracts.

Our next question comes from Matt Hewitt with Craig-Hallum Capital Group.

So from a ChemoMouthpiece, we do actually have some good news; we don't have anything back from CMP as far as their approval for a code, a rate for a code. So that should come by the end of this year. However, we have seen some increased placement in the market. So from a sales perspective, we have started to see the uptake into facilities for placement of the device, which has been a really great start. So again, that approval accreditation kind of code will come up by the end of the year. We're waiting for CMP to announce that. And then the rate for that code should be out midyear next year.

This concludes our question-and-answer session. I would like to turn the conference back over to Carrie Lachance for any closing remarks.

Thank you. I want to thank everyone for participating on today's call, and we look forward to our fourth quarter call when we will update on our results and progress.

The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.