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spk05: Good afternoon, ladies and gentlemen, and welcome to the Zynex first quarter 2022 earnings conference call. At this time, all participants are in listen-only mode. A question and answer session will follow the formal presentation. As a reminder, this conference is being recorded. I would now like to turn the conference over to Louisa Smith from the Gilmartin Group. Please go ahead.
spk00: Thank you, Joe, and good afternoon, everyone. Earlier today, Zynex released financial results for the first quarter 2022. A copy of the press release is available on the company's website. Joining me on today's call are Thomas Sangard, Chairman, President, and Chief Executive Officer, Dan Moorhead, Chief Financial Officer, Anna Lukczak, Chief Operating Officer, and Donald Gregg, Vice President of Zynex Monitoring Solutions. Before we begin, I'd like to remind you that during this conference call, the company will make projections and forward-looking statements regarding future events. We encourage you to review the company's past and future filings with the SEC, including without limitation, the company's 2021 Form 10-K and subsequent Form 10-Qs, which identify the specific factors that may cause actual results or events to differ materially from those described in these forward-looking statements. These factors may include, without limitation, statements regarding product development, product potential, the regulatory environment, sales and marketing strategies, capital resources, or operating performance. With that, I'll now turn the call over to Thomas.
spk02: Thank you, Louisa, and good afternoon, everyone. Thank you for joining us today for the first quarter 2022 earnings call. We had another solid quarter of growth and profitability. Our total revenue was $31.1 million for the quarter, an increase of 29% year over year, all generated in our pain management division. Our earnings for the quarter were $0.03 per share, up from $0.02 per share loss a year ago, and adjusted EBITDA was $3.1 million. Our order growth continues, with the month of March recording the highest number of orders in the company's history. Several months ago, we announced a $10 million share buyback program to signal our confidence in the long-term success and growth of Sinex. We have always been committed to delivering shareholder value, and we believe purchasing shares at these prices creates value for our long-term shareholders. The first quarter performance was a reflection of a company's capacity to execute operationally and strategically, and we remain on track for our 2022 annual revenue guidance of $150 to $170 million. During the first quarter, the monitoring division completed the integration of Kestrel Labs and its laser-based pulse oximetry products. In the quarters, In the first quarter, we also added a significant amount of engineering and clinical research personnel to the division and are gearing up for manufacturing and sales of the CM1600, our second-generation blood and fluid monitor. We anticipate these things to take place during the third quarter of the year, pending FDA clearance, obviously. As our audience may recall earlier, The first-generation product, CM1500, is already cleared by the FDA. I will now turn the call over to Anna Luxorg, our Chief Operating Officer.
spk09: Thank you. As Thomas mentioned, we received more orders during March than any other month in record. We've continued to see our sales force becoming more efficient, and revenue per sales rep in Q1 grew by 50% compared to Q1 last year. Sales rep productivity remains an area of emphasis, and we continue to be very selective in hiring new reps and also scrutinizing existing reps, ensuring they're producing at a high level, not only in the quantity of orders, but the quality as well. We ended 2021 with about 400 reps, and at the end of March, the number was approximately 430. Historically, January and February represent the lowest revenue numbers of the calendar year as insurance deductibles reset. This seasonality was no exception this year, but we still achieved $31 million in revenue and $3.1 million in adjusted EBITDA. Additionally, cash collections remain strong, evidence that we are not seeing a dip in numbers based on in or out of network coverage with various insurance providers. Our newest product portfolio offering, BOA Knee Brace, has received significant market interest and is already contributing to revenue growth since its release in January. The next wave, our electrotherapy device prescribed for pain management and rehabilitation, continues to be our top revenue generator and number one prescribed product. Its prescription strength technology has no side effects and is an important first line of defense for doctors in the midst of the opioid epidemic. We've maintained effective inventory management throughout the global supply chain challenges and have sufficient inventory to accommodate our order growth in the coming months. We've seen longer lead times from our manufacturers, but for the most part have been shielded from the macroeconomic complications facing other businesses on the supply side. I'll now ask Don Gregg, Vice President of Xynex Monitoring Solutions, to speak to the business updates related to that division.
spk01: Thank you, Anna. The Xynex Patient Monitoring Division includes a product portfolio and pipeline to address hemodynamic monitoring issues. laser-based pulse oximetry, and sepsis monitoring. These represent a market of over $3.7 billion annually, and we are looking forward to bringing to market a variety of new products and tools to achieve improved patient care. As you may recall, Zynex acquired Kestrel Labs in late 2021, and Zynex Monitoring Solutions has officially completed the integration of this acquisition in the first quarter as planned. We are adding key personnel to build out these laser-based products to include the NECO co-oxymeter, a multi-parameter device, and Hemox, a total hemoglobin oximeter that enables continuous arterial blood monitoring. We plan to submit the NECO oximeter to the FDA for clearance in the next 12 to 18 months. Additionally, the non-invasive CM1600 wireless blood and fluid monitor which was submitted to the FDA in December of 2021, is progressing as planned. As Thomas mentioned, we are awaiting clearance, and the correspondence with the FDA has been positive to date. ZMS is also prioritizing data collection with multiple ongoing studies and clinical trials. We've completed clinical validation trials for the hemodynamic monitor at Yale Medicine and DaVita Kidney Care, both yielding positive results. The Yale study tracks reductions in blood volume and recovery, as well as the vasoconstriction and vasodilation of the relative index. The DaVita study characterizes changes in the relative index during a dialysis procedure, and Wake Forest study was completed this quarter in order to detect postoperative patient fluid status in the PACU, and a peer-reviewed publication is expected to be published in the next few months. We have several additional controlled studies starting in Q2 and Q3 to focus specifically on other complex clinical scenarios to bolster future market adoption of these novel products. With that, I will now turn the call over to Dan Moorhead, Chief Financial Officer, to discuss our operating results.
spk08: Thanks, Don. Please refer to our press release issued earlier today for a summary of our financial results for the first quarter. Orders grew 3% year over year, and net revenue grew 29% to $31.1 million from $24.1 million in 2021. Q1 revenue decreased sequentially compared to Q4, but this is expected as deductibles reset at the beginning of each calendar year. Device revenue increased 6% to $6.7 million compared to $6.4 million in Q1 last year. Supplies revenue increased 37 percent year-over-year to $24.4 million from $17.8 million. Gross margins were 78 percent for the first quarter compared to 76 percent a year ago. Sales and marketing expenses were $14.4 million in the first quarter of 2022 compared to $13.8 million in the same period in 2021. G&A expense was $7.8 million in the first quarter of 2022 which was flat compared to Q4 and up compared to $5.5 million in the same period in 2021. The increase year-over-year was primarily due to our growth in Zynex monitoring and our new headquarters facility. And finally, net income grew 296% year-over-year to $1.4 million this and produced $0.03 per diluted share in the first quarter of 2022 and adjusted EBITDA grew 897% to $3.1 million. Tax expense as a percentage was higher than normal as new regulations were passed related to R&D activities and caused the effective rate to grow to 30% from our prior average of 24% to 25%. We ended the quarter with $39.2 million in cash, down $3.4 million from Q4 due to making the dividend payments of $3.6 million and debt service payments of $1.4 million, including interest. Cash flows from operation in the quarter increased 133% or $7.1 million to a positive $1.8 million compared to cash used in operating activities of $5.3 million last year. With that, I'll turn the call back over to Thomas.
spk02: Thank you, Dan. Turning to the outlook for 2022, our total revenue estimate remains in the range of 150 to 170 million, representing growth of 15 to 30% over the previous year. Adjusted EBITDA for 2022 is estimated to come in between 25 and $35 million. For the second quarter of 2022, we estimate revenue to come in between 35 and $38 million, with adjusted EBITDA between 4 and 6 million. This really reflects our most recent assessment of the current labor environment that puts some restrictions on the pace as to which we can hire additional sales reps and additional employees for the corporate headquarters, and continuing uncertainty related to the evolving impact of the COVID-19 pandemic. We look forward to maintaining our financial health as a key differentiator among our microcap peers, and we still anticipate high growth and profitability in the upcoming quarters. With that, operator, please open the call up for questions.
spk05: We will now begin the question and answer session. To ask a question, you may press star, then one on your telephone keypad. If you are using a speakerphone, please pick up your handset before pressing the keys. To withdraw your question, please press star, then two. At this time, we will pause momentarily to assemble our roster. The first question comes from Matt O'Brien with Piper Sandler. Please go ahead.
spk04: Good afternoon, everyone. It's Adam on for Matt, and thanks for taking the questions here. Maybe just wanted to start with just a little bit more detail on the procedure environment and the recovery that you saw over the course of Q1. It sounds like you had record order volumes, and Mark showed, I mean, is that organic in your mind, or do you think there was some catch-up there from the prior months that were impacted by Omicron? Maybe just talk about any impact to volumes from knee braces, and then would be curious if you could just talk a little bit about how things have trended thus far through April. And then I had a couple follow-ups. Thanks.
spk02: Yeah, I'll take this one. This is Thomas. So to your question about the order growth, there was – We don't really see there was any pent-up demand from previous quarters. This is more what we consider organic growth and organic increased productivity by our sales force. To your question about April, the order growth continues and is at least as good, if not slightly better than what we saw overall in the first quarter.
spk04: Okay, thanks, Thomas. And I gave you a multi-part question, so just maybe trying to tick the last box there. Yeah, did I miss? Impact on knee braces, impact from knee braces. Oh, yeah, that's right, yeah. And anything in terms of, like, revenue contribution from knee braces, and then I had a couple more follow-ups for you. Thanks.
spk02: Yeah, it's slowly beginning to kick in. We've had, you know, About three months after we have initially introduced it to our sales force, especially the OA, osteoarthritis, knee braces have taken off very well with our sales reps. And probably after the next wave, closely followed by, I think, cervical traction, our second or third best results. selling product already so it's nice to see a little bit of diversification in our product revenue and we are seeing the same reimbursement from insurance companies that we expected to see before we introduced this product which was part of our planning and decision to go into this product area so that's very healthy as well
spk04: Okay, thanks for the color there. And then maybe just the next one is on device sales. It looks like there was a pretty healthy sequential decline. So just anything to note or call out on the device business in Q1?
spk08: There isn't.
spk02: It's really just part of the normal.
spk08: Sorry, Thomas. Yeah, no, it's really just part of the normal. you know, seasonality of the business. And if you looked at prior years, you'd kind of see the same thing as a percentage. So, you know, it's pretty normal.
spk04: Okay. Understood. And then maybe I'll just ask one more on the full-year guidance. So, the guidance ranged 150 to 170 implies a nice ramp in the back half maybe just talk about what's contemplated at the low and high end of the range do you think you need to deliver against that 500 salesforce headcount number to to kind of hit you know the top end of the range or are there other levers that you can pull and is there anything contemplated in the guidance from the monitoring business thanks so much for taking the questions
spk02: At this point, we have not added anything from the monitoring business into our guidance. And obviously, the revenue number is more derived from an estimate of we expect to come in around $160 million, and the tolerance of plus minus $10 million on that reflects that. So there's really nothing to interpret in what would the lower number mean and what would the higher number mean. it would basically be a result of the sales productivity here in the first, second, and to some degree third quarter of the year as those orders eventually turn into gross billings to insurance companies and we start seeing some cash. So the revenue for this year is pretty much set as we get get well into the third quarter of the year because any new reps that get added, as you said, we're trending towards the end of the year be at least close to 500 sales reps. And what new reps in the fourth quarter, for instance, might contribute is certainly not going to add to the revenue this year. That will be revenue next year. So a lot of it is really based on how orders are coming in right now.
spk04: Okay, thanks again for taking the questions.
spk02: Thank you.
spk05: Our next question comes from Mark Weissenberger with B Reilly. Please go ahead.
spk07: Yep, thanks. Good afternoon. Appreciate you taking the questions. Just following up on some of the earlier questions, with regard to the device revenue, what percentage was actually NextWave?
spk08: Total device? I don't think we reported, but I think it's it's North. It's probably, you know, it's high eighties or low nineties as a percentage of the total. So, but that's not something we put out, but that's just, you know, off the top of my head. I'm that's pretty close. I think.
spk07: Got it. Okay. And can you remind us kind of what percentage of, of next wave prescriptions are tied to surgical procedures versus kind of more chronic pain management? And, and I guess that kind of, goes to, we've heard a lot about elective procedures picking back up, so I'm wondering if kind of that record March might have seen some impact from that.
spk02: We normally don't at least talk about it, but we don't really record the data that way, because when we receive a prescription, we get a number of diagnosis codes from from the clinic. It could be anywhere between one or two diagnosis codes. Sometimes there's more than 10 diagnosis codes. And they all get entered in our system. Some of those may not actually be relevant for exactly what the device is used for. Others are. So it's hard to get a clear picture. We can see what type of physicians that are prescribing. And we know a little over 20% of our prescribers are orthopedic surgeons and then there's a number of many other specialties that prescribe it. So that still tells you that this is being used a lot post-op surgery and primarily used to speed up the healing and get people back for instance back to work or getting fully recovered much faster than if they were not using the next wave. In many cases Our cold therapy device that we distribute is also added to it, and that even further speeds up the healing.
spk07: Understood. And to that kind of point, have you seen any change in the duration of treatment for patients? And then what have your interactions been with UnitedHealth, and has that changed really at all or no real impact on the business?
spk02: We haven't seen any change in terms of how products are prescribed or being used. Maybe, Anna, you can speak to how we still collect pretty well, if not better, from UnitedHealthcare after we're not in network anymore.
spk09: Right. We have seen a positive change after becoming out of network with United. We see much faster payments from them and more consistency.
spk07: Got it. Hopeful. It looks like you are, in terms of your open positions, it looks like you may be prioritizing some new geographies relative to the past. So wondering if there's any specific factors impacting that or how your strategy on sales rep expansion might have evolved.
spk02: No, we still have 800 territories mapped out, as we've had for several years now. And we have 430 of those populated right now, hopefully about 500 by the end of the year. And it really, sometimes our focus on what territories we are advertising for and therefore interviewing and hiring for depends a little bit if, for instance, we had parted ways with a regional sales manager And if there's either a vacant region, we have 15 regional sales managers, and if there's a vacancy there or someone that has just been hired and is getting up to speed, we typically go slow in terms of hiring for that region. But other than that, we're literally hiring all over the country and obviously pruning our sales force to make sure it's only the the productive sales reps that stays on board long-term, that's pretty much equal throughout the country. And I expect we'll continue to treat pretty much all territories the same way until we get up to 800 sales reps.
spk07: Got it. And then just the last one from me. I wonder if you could talk about any digital initiative you're working on to increase the efficiency and the reach of physicians and prescribers. There's been a rise of these kind of digital points of care solutions that companies are leveraging either to reduce the sales force or at least increase efficiency. So wondering what, if at all, you guys are doing on that front. Thank you.
spk02: No, none of that. I believe we're growing fast enough and our focus is hiring very high quality sales reps rather than then activities that potentially could be distracting for the way things are developing right now. Okay. Thank you very much.
spk05: Our next question comes from Jeffrey Cohen with Leidenberg Thalmann. Please go ahead.
spk03: Hi, Thomas, Dan, and Donald. How are you?
spk02: Good. How are you?
spk03: Just fine. So are you?
spk02: I'm good.
spk03: Dan, I guess I'll start with you on, could you give us a guesstimate on current share count, either or basic or diluted?
spk08: See, we're running, it's about 41 million is diluted.
spk03: Got it. Okay. That's helpful. Anna, can you talk about the, I know you briefly talked about the two knee braces, the OA and the post-op. Any commentary specific to the Aspen Horizon?
spk09: I'm not sure I understand the question. So the Aspen Horizon is the back brace that we distribute?
spk03: Yep. Were there revenues from this prior quarter, from Q1?
spk08: For sure. Yeah, no, it's a big piece of the business as well. So it's, you know, of all the products we distribute, as Thomas mentioned, I think cervical traction is the highest. You know, LSOs or back braces are kind of second. And then, as he mentioned, the knee braces are gain and fast.
spk09: So they're... Yeah, so I would say the OA knee brace and the back brace are probably at the same percentage at this point. And then post-op... We rolled it out a little bit later, so it's not picking up as fast, but we're also seeing traction with that as well.
spk03: Okay, got it. And I may have missed some of the commentary on the BVM-1600. Did you talk about a, I think I heard a submittal in the coming 16 months?
spk01: Let me clarify two things on that. So we submitted the CM-1600 to the FDA in December. We received a response and we're replying back to them. Communications have been good. The NECO product, which is the non-invasive co-oximeter, we are submitting in the next 12 to 18 months to the FDA.
spk03: That's it. Okay. So that was my question. Any commentary in particular to call out on margins from this quarter going forward? you still kind of have a strong feeling of high 70s for the balance of this year?
spk08: Yeah, we, you know, generally Q1 is the worst quarter of the year, so 75 to 80 is still a good range, and we expect to be in the higher 70s, like you said.
spk03: Got it. And then lastly for us, as far as R&D expense, Is most of that going through the G&A line or the sales and marketing line? I'm assuming mostly G&A.
spk08: It is G&A, yeah. And there was just some new regulations that came out on the tax side that anything related to G&A, you have to capitalize from a tax perspective and amortize over, I think it's five years. And so we're working on the back end on an R&D credit study. It's just going to take us a quarter or two to get that in place. so that we can offset some of that increase.
spk03: Okay, got it. And then lastly, I hate to keep beating on the size of the commercial force, but it's sounding like somewhat linear, we should anticipate, for lack of any more detail through the balance of this year, as far as an increase.
spk08: Yeah, I think we kind of look at it on a linear basis, kind of evenly spread across the year, I would agree.
spk03: Okay, got it. And it didn't look like the full year was unchanged on the adjusted EBITDA range as well, right, the 25 to 35? Correct.
spk08: Yeah, all the annual guidance remained the same.
spk03: Okay, perfect. That does it for us. Thanks for taking the questions.
spk05: Thank you. Our next question comes from Yi Chen with HC Wainwright. Please go ahead.
spk06: Thank you for taking my questions. Previously, you mentioned that it is hard to hire additional sales reps under the current market conditions. Have these conditions improved recently?
spk02: Yes, they have improved slightly compared to January and up until now. It's very marginal. So we do see more applicants and among those, obviously, we do see a few more that have the quality that we end up deciding to hire. It's certainly not back to where it was before COVID. And hopefully the trend continues, but it's only slowly we see an improvement.
spk06: And your target is 500 reps by the end of 2022?
spk02: By the end of the year, yeah. So 70 more over the next, that'll be, seven, eight months. So a net addition of 10 should be possible for us.
spk06: Okay.
spk02: Yes, 10 a month.
spk06: Yeah. With respect to CM1600 or CM1500, are there going to be any data published during the remainder of this year, or are And also regarding the FDA response, is there any possibilities you anticipate to conduct any additional clinical trials?
spk01: Yeah, let me take the first question. So we finished the Wake Forest trial, and we presented a poster at the IARS conference. We are working on a peer-reviewed publication. It's in draft right now that we're working on with Dr. Khanna, and that should be publishing... We're targeting a clinical journal, and that should be publishing within a few months. Given that it's peer-reviewed, it takes a bit of time to get that out into the public. The last question about the – I think your question was about the FDA. Is that correct?
spk06: Yes, FDA response and any possibility to conduct additional trials.
spk01: So we have several trials planned. These are controlled trials. The targets with these trials are in various areas around cardiac and non-cardiac surgery and specific others for what we call our whole blood study and a few others around certain shock assessments and things like that, specifically with the 1600. The reason what we've done with much of the trials to date is to validate the relative index and to work through simulations of that around the specific areas to be ready to go into those more difficult surgical procedures and expand that.
spk06: Do you need to complete those trials before securing clearance from the FDA?
spk01: We do not need to complete those trials prior to clearance. Our claims as part of this are back to the 1500. This is a wireless version of that that has got an improved efficacy and so forth on the relative index and specific procedures. So we are adding some claims to it that the trial data that we've already completed supports.
spk06: Got it. Thank you.
spk01: You're welcome.
spk05: This concludes our question and answer session. I would like to turn the conference back over to the founder, chairman, and CEO, Thomas Sengard for any closing remarks.
spk02: Yes, thank you. Thank you for joining us today. We're excited by the momentum that CYNEX is experiencing and look forward to providing meaningful updates on our progress in both divisions in the coming quarter. Enjoy your evening. Thank you.
spk05: The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.
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