InfuSystem Holdings, Inc Q4 FY2025 Earnings Call

Good day, and welcome to InfuSystem Holdings, Inc. Reports Fourth Quarter Fiscal Year 2025 Financial Results Conference Call. Please note this event is being recorded. I would now like to turn the conference over to Glenn Axelrod. Please go ahead.

Good morning, and thank you for joining us today to review InfuSystem Fourth Quarter 2025 Financial Results ended December 31, 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 will open the call for questions. Before we begin with prepared remarks, I would like to remind everyone 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 the Risk Factors in the 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, Glenn, and good morning, everyone. Welcome to InfuSystem's Fourth Quarter Fiscal Year 2025 Earnings Call. Thank you all for joining us today. I will provide a fourth quarter overview, highlighting key initiatives, outlining our strategic priorities, and providing our outlook for 2026. Then Barry will provide a detailed summary of our financial results. I will then come back for some closing comments before opening the line to questions. During the fourth quarter, we closed out the 2025 reporting period by delivering solid top line growth of 7% with full year adjusted EBITDA expanding 24% to $31.5 million and strong operating cash flow of $7.1 million. We further strengthened our balance sheet with net debt declining 30% year-over-year while returning capital to our shareholders through our share repurchase program, retiring 137,000 shares in the fourth quarter and 1.3 million shares for the full year. We continue to make advances on key initiatives that are expected to help us accelerate our growth rate of net revenue, adjusted EBITDA, and operating cash flows during 2026. We completed the migration of our Wound Care business to the new revenue cycle application that we obtained in conjunction with the acquisition of Apollo Medical during the second quarter of 2025. This includes advanced wound care, negative pressure wound therapy devices, and our latest product category, pneumatic compression devices. This important initiative allows us to reduce processing costs and expand our volume capacity, thereby opening the door to increased revenue volume. This leaves our Oncology business, by far the largest in our Patient Services segment, as the final therapy left to migrate. In addition, we obtained new accreditations for additional home healthcare DME products that we plan to add to our patient services product portfolio. We are currently working with the manufacturers of some of these products with the goal of repeating the speed and success of our latest PCD product launch. We feel positive about the current progress and look forward to providing more details on these products in the near future. We also restructured our field-based biomedical services team of technicians to better align with our reduced volume expectations for 2026 and to better position our capabilities to bring on smaller, more profitable client engagements. Finally, we made significant progress on our project to replace and upgrade our main information technology business application, which we plan to complete during the first quarter of 2026. At project completion, we will reduce the current spending rate for the project and begin focusing on capturing productivity improvements that the new application enables within several departments. As we announced during our review of the 2025 third quarter, we are focused on driving value creation through profitable growth, which led us to restructure our largest biomedical services contract. Consequently, we are starting 2026 at a reduced revenue volume by $7.1 million or 5.5% annually. This was a necessary change that will have an immediate favorable impact on our reporting earnings and cash flow since we expect an even larger reduction in our expenses. After adjusting for this decrease on a pro forma basis, we are expecting annual revenue growth in a range of 6% to 8%. Additionally, we anticipate that our adjusted EBITDA margin will continue in the mid- to low 20% range. This is inclusive of the impact of costs related to our ongoing information technology system upgrade, which are expected to decrease after the first quarter. We are excited about the opportunities ahead and look to update and refine our guidance as we move throughout the year. Now I'll turn it over to Barry for a detailed review of the fourth quarter financial results.

Thank you, Carrie, and thank you, everyone, on the call for joining us today. I'm going to give details for the current quarter's results, provide a few insights on the 2026 outlook, and I'll update you on our current financial position and how it changed during the quarter. Now let me start with our financial results for the period. During the fourth quarter of 2025, our net revenue totaled $36.2 million, representing a $2.4 million or 7% increase from the prior year fourth quarter. Both the Patient Services and the Device Solutions segments contributed to the improvement. Patient Services net revenue increased by $1.1 million or 5.4% and included increased patient treatment volumes in Oncology and Wound Care. Oncology net revenue increased by approximately $500,000 or 2.8%, and wound care treatment volume revenue grew by nearly $900,000, which represented an increase of over 160%, driven largely by pneumatic compression devices, which launched in the previous quarter. Device Solutions net revenue increased by $1.3 million or 9.7%. This increase was primarily attributable to $1 million in higher sales of medical equipment and just over $600,000 in higher revenue volume in biomedical services revenue. The equipment sales included some rental buyouts from a large customer, and the biomedical services increase came from a more diverse group of smaller customers. Partially offsetting these increases for Device Solutions was a $400,000 reduction in equipment rental revenue. Gross profit for the fourth quarter of 2025 was $20.4 million, which was a $2.2 million or 12% increase over the prior year fourth quarter. Our gross margin percentage at just over 56% increased by 2.6% from the prior year amount, demonstrating our focus on profitable growth. This 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 maintenance and disposable expenses. Selling, general and administrative expenses for the fourth quarter of 2025 totaled $14 million and was $865,000 or 6.5% higher than the prior year fourth quarter amount. Part of this increase was attributable to $689,000 in expenses associated with our project to upgrade our main enterprise resources planning software, which was $196,000 higher than the spend for the prior year fourth quarter. This project is now in the final phase with a go-live launch expected during the current quarter, after which quarterly implementation costs are expected to decrease significantly. Other increases for the fourth quarter were related to additional headcount and revenue cycle and other personnel needed to support the higher revenue volume, offset partially by a lower accrual for short-term incentive compensation, portions of which were already capped and fully accrued due to performance metrics being already met at the end of the third quarter. Adjusted EBITDA during the 2025 fourth quarter was $8.8 million, which represented an increase of just over $1.3 million or 17% from the prior year fourth quarter adjusted EBITDA. This represented a 24.3% of net revenue for 2025, which was above the prior year rate of 22.2%. It also was an all-time quarterly record. These amounts included the spending on the ERP project, which again is expected to start to decrease by the second quarter here in 2026. For the full year of 2025, adjusted EBITDA totaled $31.5 million, representing a margin of 21.9%, an increase of 3.1% from 18.8% in 2024. This reflects a significant year-over-year improvement of $6.2 million or 24.3% despite a $1.8 million increase in ERP project expenses. The improvements are another example of how our focus on profitable revenue growth and operational efficiency is yielding meaningful results. Turning now to our outlook for 2026. As Carrie mentioned, we are forecasting an increase in our net revenues of 6.8% for 2026 on a pro forma basis after adjusting for the GE Healthcare contract restructuring. The low end of this range is achievable through initiatives we have put in place or have high visibility to, such as new customers that have already started in our Oncology business, and new products such as PCDs that have already been launched. The high end of the range will be possible when we are successful launching just a few of the new opportunities we are currently focusing on but have not yet started. These include new customers and products whose impact for 2026 will depend on our success rate and launch timing. Now a few points on our financial position and capital reserves. For 2025, we generated operating cash flow totaling over $24.4 million. This amount was nearly $4 million or 19% higher than the amount realized during 2024. This increase was due to the higher adjusted EBITDA offset partially by a use of cash for working capital. Our net capital expenditures were $6.8 million in 2025, which represented a significant decrease from $13.2 million spent during 2024. This decrease was attributable to overall capital spending requirements being lower as compared to amounts in prior years as the sources of our revenue growth have been more weighted towards less capital-intensive revenue sources. We expect these lower requirements to continue in 2026. We remain well positioned 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 $6.9 million during 2025. We were able to do this despite purchasing $9.9 million of our common stock during the year through our stock repurchase authorization. Our available liquidity continues to be strong and totaled nearly $58 million as of December 31, 2025. At that time, our ratio of net debt to adjusted EBITDA was a modest 0.52x. Our debt consists of $20 million in borrowings on our revolving line of credit with no term payment requirements. During the third quarter of 2025, 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 the $20 million of our outstanding borrowings at a below-market rate of 3.8% until April of 2028.

Thanks, Barry. As I reflect back on efforts made during fiscal year 2025, the updates that we've shared with you today, and what we are currently focused on as we head into 2026, I hope that you will agree that we have been diligent in pursuing the strategic priorities we laid out for you during 2025. 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.

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

Maybe starting with the top line guidance, 6% to 8% for the year. Can you talk a little bit about how we should anticipate the growth rates within each segment, Patient Services and Device Solutions to trend? Would we anticipate a continuation of maybe higher percent growth in Device Solutions like you saw in Q4 versus Patient Services? Any color here would be appreciated.

Yes. I'll throw a couple of thoughts out there, Kyle. Definitely, the patient services is where we see our growth mainly coming from. Even Oncology, we see some success there, but Wound Care is our main focus right now for driving further volume through the PCDs that we launched last year and other products we might bring online. That's not to say that we don't see growth in Device Solutions; we definitely do. We're going to give some revenue back because we restructured the GE contract, but we see lots of opportunities for us to take that team and grow the base at much better returns for the company.

Got it. Appreciate that. And on the adjusted EBITDA margin guidance of mid- to low 20s, of course, it includes the planned reduction of the expenses from the ERP program. Any sense as to kind of the go-forward adjusted EBITDA rate for, call it, like Q2 through Q4, just since we'll be kind of working off of the new base of expenses after Q1?

Yes. I want to share some general thoughts on our margins. We have worked hard this past year to improve our margins from historically low levels, and we believe we can maintain this progress. We are optimistic about this. The restructuring in the biomed sector is actually beneficial for our margins. However, we do face some challenges, such as rising healthcare costs and other inflationary effects. We believe we will overcome these challenges through the growth of new products. While we don’t anticipate significant increases in margins as we move forward, we are confident that we will maintain these much higher levels. Does that make sense to you?

Yes. No, it does. I appreciate that. And then maybe just one more. On the revenue cycle application that has been successfully integrated. It sounds like that's been very helpful in driving reduction in lead times, et cetera. Wound Care delivered 160% revenue growth in the last quarter, albeit off of a lower base. Anything to call out here in Wound Care going forward and kind of how you anticipate the revenue cycle application to really help drive volume?

Yes, I'll take that, Barry. The revenue cycle system that we have implemented obviously took a little bit of time to get going. We've entered most of our business, all of the Wound Care business, PCD into that. We are looking forward to in probably the second half of the year, really starting our Oncology business into that as well, but it does allow us to take on some more volume and ramp in a more productive way and manner, both from a PCD and then any new product that will be going through that system. So it's been helpful.

Your next question comes from Anderson Schock with B. Riley.

So the ERP is expected to go live this quarter. I guess what's the remaining spend to completion? And when should we expect to see the net maintenance cost savings to fully materialize?

We anticipate that the number will be slightly higher in the upcoming quarter as we enter the final launch phase, with significant activity underway to prepare for this transition. We are receiving additional support from our consultants as we implement real transactions and transition over. This initial increase in costs is expected in the first quarter, but it should taper off afterward, although it won't drop to zero. Over an annualized basis, when we compare the periods of ERP implementation to the future when the system is fully operational, we expect approximately $2 million in annual savings. This reflects the ongoing expenses, including higher maintenance costs for the new system. The net difference between the implementation phase and future operation is about $2 million in savings. We expect to start realizing benefits sometime in 2026 or beyond into 2027 as we become more proficient with the new application and begin to see efficiencies across the teams affected. It's important to note that we initiated the ERP project because our previous system was being phased out by Microsoft, necessitating this transition. However, we do expect to see a return on our investment in terms of improved efficiencies and productivity that will offset the costs of the new system.

Okay. Got it. And then are there any other costs associated with the transition of the RCM platform from Apollo to expand it into the oncology business?

No, no additional costs. Again, that system is up and running. We're just defining those processes to get oncology over there. We use several systems today for the oncology work. So we're excited to get it moved into that new system, but no additional costs.

Yes. Okay. Got it. And then finally, do you have any updates on the ChemoMouthpiece billing code approval or timing there?

I do. Unfortunately, I don't have any updates, meaning it was approved or not approved. What I would say is that we're in touch with them very frequently. We have weekly calls regarding kind of the momentum that we see and the interest in the product. We are seeing devices that are shipped out on a weekly basis. They don't have any new information based on their December 17 meeting with CMS, but they continue to be encouraged. Again, there's product interest, and we're looking forward to. They were looking forward to maybe a February information back with approval or whatnot, but we haven't heard an update yet.

I would just like to add to that, Carrie. The ChemoMouthpiece piece, we kept that any revenue out of the low end of our guidance range. So it will definitely be one of the things that will help us get higher in the guidance range.

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

You mentioned that the expense reduction related to the renegotiated GE contract will be greater than the $7.1 million in revenue reduction. Where will that show up on the income statement? Will we see that mostly in the gross margin?

Yes, it's gross margin. We restructured the team, so we had to take some team members out of the program and things like we'd have to pay for the parts for repairs, at least not in the field. So there's a lot of costs that come out of the cost of sales line as we see the revenue come down.

All right. Additionally, I believe you mentioned that expenses are expected to decrease by about $2 million due to the ERP completion. On an annual basis, these expenses should drop by around $2 million. In 2025, you had certain expenses associated with the CEO transition, which are expected to disappear by 2026, correct?

That's correct. Yes. Those are added back for EBITDA, but obviously not added back for our operating income or net income. Correct.

Okay. And so your cash flow generation has been getting stronger over the past couple of quarters, and it seems like it's going to continue to improve. You've been paying down debt so far. Is that really the plan for cash? Or do you have any other options that you think you might use your cash for in 2026 and 2027?

Yes, our capital allocation priorities remain unchanged. We have a share buyback program that we approach opportunistically, looking to repurchase shares when we have strong free cash flow and when the trading price is below our assessment of intrinsic value. This strategy will continue. Additionally, paying down debt is flexible for us due to our revolving facility, allowing us to borrow again without losing commitments. We also aim to invest in the business and focus on top-line growth. We've engaged in mergers and acquisitions in the past and may do so in the future. Overall, our priorities are consistent with what they have been.

Your next question comes from Matt Hewitt with Craig-Hallum.

This is Tollef Kohrman on for Matt Hewitt. So kind of just general here, are there any other low-margin businesses you're considering exiting or just opportunities to drive more efficiency?

I don't believe there are any other low-margin areas we are currently considering. We will continue to explore opportunities in the biomed field, but with a smaller nationwide team of technicians, we plan to limit our work in this area to regional projects unless we find favorable pricing that justifies broader travel. Otherwise, there are no low-margin areas we are looking to exit.

Your next question comes from Benjamin Haynor with Lake Street Capital Markets.

First off for me, I know the subject has been already touched on a bit but I was just curious on the Wound Care cost efficiency and maybe how you see that tracking throughout the year.

I would say that the new system is helping us increase volume and is much more efficient compared to the multiple systems we used before. This improvement allows us to bring in more products. We also experienced significant benefits from PCDs, which we managed to ramp up quickly. We anticipate continued growth throughout the year as we introduce new products.

Yes. I would add to that, Carrie, by just saying that the wound care hasn't been a lot of cost actually in our P&L. The cost that we see in order to grow it has been a barrier, and we've been able to move that barrier out of the way. So you won't see necessarily a decrease in our cost because we didn't go and incur them, but now we'll be able to grow the wound care at a more efficient pace, if that makes sense.

Okay. That's helpful. And then just lastly for me on the DME new products. Can you share what categories those are in at all? Or is that something we should be staying tuned for?

I would say from an accreditation standpoint, I'm happy to share we were accredited for a few new products. One is called the Defender Boot, one is called HidraWear in the ostomy category. So we got accredited for some of those codes. We see some interest in some of those products. We've been approached by some folks with some of those products. I would say as a whole, we typically would not love to share. We want to prove out what we're doing before we set expectations on that. We really want to prove out that it's working for us. Reimbursement is working. So we are working with some companies here to take a look at this, see if it's going to be a good opportunity for us. As we are successful in those areas, we'll continue to share more information.

Congrats on the quarter and progress.

Thank you. 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, everyone, for joining today's call. We look forward to speaking with you again on our first quarter call, where we will provide an update on our results and progress.

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