Zynex Inc (ZYXI) 2022 Q2 法說會逐字稿

Good afternoon, ladies and gentlemen, and welcome to the Zynex Second Quarter 2022 Earnings Conference Call. (Operator Instructions) As a reminder, the conference call is being recorded.

I would now like to turn the conference over to Ms. Louisa Smith from the Gilmartin Group. Please go ahead.

Thank you, Chuck, and good afternoon, everyone. Earlier today, Zynex released financial results for the second quarter of 2022. A copy of the press release is available on the company's website. Joining me on today's call are Thomas Sandgaard, Chairman, President and Chief Executive Officer; Dan Moorhead, Chief Financial Officer; Anna Lucsok, 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.

Thank you, Louisa, and good afternoon, everyone. Thank you for joining us today for the second quarter 2022 earnings call. This quarter's revenue and profitability remained exceptionally strong as we continue to execute on our long-term growth plans.

Total revenue was $36.8 million for the quarter, an increase of 18% year-over-year. Both in June and also for the second quarter, we saw the highest number of monthly and quarterly orders in the company's history. Second quarter orders grew 19% sequentially over the first quarter of 2022 and 10% over the second quarter 2021. Earnings for the quarter were $0.08 per diluted share and adjusted EBITDA was $5.5 million, and we are on track for achieving both top and bottom line full year guidance.

Zynex is experiencing consistent growth quarter-over-quarter and are looking forward to continued demonstration of our strong performance. During the second quarter, we completed a $10 million share buyback program and established yet another buyback program for an additional $10 million. We believe this initiative signals to our shareholders how confident we are in delivering value and executing our strategic growth plans.

We ended the second quarter with approximately 400 sales reps. We reiterate the ability of new and existing reps to grow sales more efficiently and strategically as evidenced by consistency in order growth. The current job market makes it difficult to hire a significant amount of new high-quality sales reps. In the second quarter, we achieved record order numbers, demonstrating our ability to continue to grow our top line. Once the job market returns to a more normal cadence, we believe that we will accelerate growth even further and eventually fill all 800 territories across the U.S., of which 400 are still open.

In our Monitoring products division, we continue to hire for engineering and clinical research positions as we keep making progress on our CM-1600 blood and fluid volume monitor, sepsis detection device and our laser-based pulse oximeter. Pending FDA clearance on our second-generation blood and fluid value monitor, we are now gearing up to launch the product commercially during the second half of this year. We expect to see prototypes of the laser-based pulse oximeter also here in the second half of this year, and we are targeting a submission to the FDA mid next year.

I will now turn the call over to Anna Lucsok, our Chief Operating Officer.

Thank you, Thomas. As the monitoring division is still in its ramp-up to commercialization, the Pain Management division remains the primary revenue source for Zynex. As Thomas discussed, we've seen a consistent increase in order growth and revenue over the past several quarters, in large part due to productivity of our sales force.

Revenue per sales rep in Q2 grew by 37% compared to Q2 2021 and 23% over last quarter. Sales force productivity rather than site has developed into the primary driver for high-quality and top line revenue growth. We continue to be very selective of new reps to ensure they are a good fit. On the existing sales force, we're identifying underperformers earlier in their life cycle with the company and are emphasizing efficiency with new and existing reps.

Similarly to other companies facing macroeconomic challenges, we have been impacted by inflation primarily in corporate employee and sales rep wages and incentive pay. Both have increased more than normal over the last 12 to 18 months, which has impacted our bottom line.

Cash collections from payers both in and out of network remains strong, and we have not seen any shift in dynamics throughout the first half of the year. Additionally, we've largely been unaffected by supply chain concerns impacting many others in the med tech space. Our access to components and supplies has not significantly changed year-over-year, and we've built up inventory to account for longer transit times in shipping channels. We have also been able to tap into our secondary manufacturing providers to keep the study handle on necessary materials.

I'll now ask Don Gregg, VP of Zynex Monitoring Solutions, to speak to the business updates related to that division.

Thank you, Anna. The Zynex Patient Monitoring division, otherwise known as ZMS, comprises a multiproduct portfolio and development pipeline, including hemodynamic monitoring, sepsis monitoring and laser-based pulse oximetry. We estimate that ZMS has a total addressable market of approximately $3.7 billion, and we have started to implement an effective growth strategy within the division to capitalize on future market share.

There are two primary programs driving growth of the monitoring division. The first is the development of the NiCO CO-Oximeter and HemeOX products, whose technology Zynex integrated through the Kestrel Lab's acquisition. The second is the noninvasive CM-1600 wireless blood and fluid monitor and its associated commercialization and R&D efforts. The NiCO and HemeOX are laser-based products, which will be used in hospital systems as a multiparameter pulse oximeter and a hemoglobin oximeter that allows for continuous arterial blood monitoring, respectively.

ZMS has been building out the teams and adding critical engineering and clinical personnel, and we remain on track for submission to the FDA in mid-2023. The noninvasive CM-1600 devices, wireless blood fluid monitor, we submitted it to the FDA at the end of 2021 and are in discussions with the agency to provide all additional information requested. We are still confident that clearance is progressing as planned.

As it relates to the CM-1600, ZMS is using this opportunity for the creation of clinical evidence to support the commercialization process. Multiple ongoing and new studies are set to launch in addition to recently completed clinical validation trials, which track blood volume, shock response and recovery in the patient population. Additional enrollments are continuing, and we will examine the new CM-1600 in our ongoing apheresis blood donation study. We look forward to presenting the data in the coming quarters and seizing our market opportunity.

I will now turn call over to Dan Moorhead, Chief Financial Officer.

Thanks, Don. Please refer to our press release issued earlier today for a summary of our financial results for the second quarter and 6 months of 2022.

In the second quarter, orders grew 10% year-over-year and net revenue grew 18% to $36.8 million from $31 million in 2021. Device revenue increased 21% to $9.5 million compared to $7.8 million in Q2 last year.

Supplies revenue increased 18% year-over-year to $27.3 million from $23.2 million. Gross margin was 80% for the second quarter compared to 77% a year ago. Sales and marketing expenses were $16.3 million in the second quarter compared to $13.8 million in the same period in 2021. G&A expenses were $8.8 million in the second quarter, an increase of 42% or $2.6 million year-over-year. $1.4 million of the increase is related to investments in our Monitoring Solutions division and related headcount to launch our new products. The increase in monitoring is in line with previously stated estimates of increased spend.

Tax expense as a percentage was lower than normal at 19% for the quarter due to an additional deduction related to stock options, which were exercised during the quarter.

And finally, net income grew 19% year-over-year to $3.3 million and produced $0.08 per diluted share in the second quarter and adjusted EBITDA grew 16% to $5.5 million.

As for our 6 months results for the first half of 2022, orders grew 6% year-over-year and net revenue grew 23% to $67.8 million from $55.1 million in 2021. Device revenue increased 14% to $16.2 million compared to $14.2 million last year. Supplies revenue increased 26% year-over-year to $51.6 million from $41 million.

Gross margin was 79% year-to-date compared to 76% a year ago. Sales and marketing expenses were $30.7 million for the first half compared to $27.6 million in the same period in 2021. G&A expenses were $16.6 million, an increase of $4.9 million year-over-year. As mentioned earlier, we continue to invest in the Monitoring Solutions division, which accounted for $2.7 million of the increase year-to-date.

And finally, net income grew 125% year-over-year to $4.7 million and produced $0.12 per diluted share in the first half of 2022, and adjusted EBITDA grew 97% to $8.6 million.

Tax expense year-to-date as a percentage was slightly lower than normal at 23% due to additional deductions related to stock options. And as a reminder, we expect tax expense for the remainder of the year to range between 25% and 30% due to changes in the treatment of research and development expenses and other timing differences.

We ended the quarter with $26.9 million in cash, down $12.4 million from Q1 due to outflows of $10.7 million related to our buyback programs, income tax payments of $3.9 million and debt service payments of $1.4 million, including interest. Cash flows from operations for the year increased 137% or $5.9 million to a positive $1.6 million compared to cash used in operating activities of $4.3 million last year.

Before I turn it back over to Thomas, I want to inform analysts and investors that as part of our quarterly reporting process, we plan to discontinue the practice of issuing pre-announcement flash reports beginning in Q3.

And with that, I'll turn the call back over to Thomas.

Thank you, Dan. As noted earlier, we are affirming full year guidance with total revenue estimate in the range of $150 million to $170 million, representing growth of 15% to 30% over the previous year. Adjusted EBITDA for 2022 is estimated to come in between $25 million and $35 million.

And for the third quarter of 2022, we estimate revenue between $40 million and $43 million with an adjusted EBITDA between $7 million and $9 million. These figures reflect our most recent assessment of the current labor environment and continued uncertainty relating to the evolving impact of the COVID-19 epidemic and how that's helped by the government and other macroeconomic factors.

With that, operator, please open the call up for questions.

(Operator Instructions) And the first question will come from Adam Maeder with Piper Sandler.

This is Simran on for Adam. Maybe starting with a little bit more detail on the procedure environment and the progression that you saw over the course of Q2. It sounds like you've had record order volumes in June. So I mean, is that sales force related in your mind? Or do you think there was maybe some pent-up demand from COVID? And then I would be curious if you could just talk about -- a little bit about how things have trended thus far into July?

I think we can safely say that this is all sort of an internal issue more than externally. It's better productivity from our sales force as relatively new reps are becoming more productive and the entire sales force overall rather than it's how the entire medical environment is developing. July is already showing great growth. And as we have alluded to earlier, we'll continue to see strong order growth compared to the same quarters last year. And we are definitely trending right in that direction here in July already.

Okay. And then for net sales force adds in the quarter, could you remind me where you finished in Q2?

Sure. Right around 400.

Okay. So it sounds like there was about an attrition of 30 reps from the prior quarter. So maybe just talk about the hiring environment in general, given some of these macro pressures. I know you guys touched on kind of the inflationary headwinds on wages. And just in general, though, about attracting quality reps as well as your confidence in getting to that 500 rep target by year-end?

Yes. It's obviously difficult. It's -- because we can't really lower the bar in terms of the quality of the reps we hire. We -- you can -- but you can kind of say that we did that in 2020 and where we had to prune a significant amount of those after having been here a year, and maybe it didn't produce as far as you would hope. So we keep the bar at the same high level. It really shows in those we do hire continue to have a steady increase in the first 90-day performance, which is always a very strong indication of the long-term performance.

So per rep, I would say we're building a stronger and stronger sales force. But the amount of reps we are able to handle or to recruit versus the now fairly small attrition we have is not enough to really significantly change the number. So of course, we expect that it will loosen up a little later in the year. And that's why we're talking about increasing the number of reps towards the end. But it's -- the growth is certainly coming from reps becoming more productive. And those we do hire quickly kick in with some significant numbers.

Okay. Perfect. And then if I could just squeeze in one more on the guide. So the full year guide was maintained, and you issued a range of $40 million to $43 million for Q3. So now with the Q2 results in hand, this does imply a pretty hefty ramp in Q4 particularly, I think, about $10 million at the midpoint. So is the expectation of kind of this like continuation of ramp and sales rep productivity without necessarily adding more reps? Or is there a bolus of reps that you're expecting to kind of come through during Q4 that's giving you the comfort in hitting your full year target? And then also, sir...

Two very different things. There's two different kinds of seasonalities. One on the order side and then on the revenue. Throughout the year, we always see an increase of revenue, mostly driven by insurance deductibles that obviously become less towards the end of the year. So we always start revenues at the level that is either at the same or sometimes even a little than the fourth quarter of the previous year. And then you see the overall growth. And by now, we're looking at it with 15% to 30% revenue growth over the year.

So the orders are growing more steadily. Obviously, when doctors are on vacation, it's a little weaker, but that shows a whole different pattern with doctors typically out in January and July because they don't want to get hit by insurance deductibles. But for us, we see the majority of the revenue throughout the year in the third and especially fourth quarter. So it's perfectly natural that we see that. It's not like we've put additional pressure on ourselves to suddenly ramp up revenue. It's just part of the seasonality on the revenue side of our business.

And if you look at the percentages of the total, if you look at last year and this year, they're mirroring almost exactly the same. The Q2 as a percentage of the total $130 million we did last year, Q2 of the kind of the midpoint of the range this year. And then with the guide Q3 as a percentage of total, it's almost exactly the same. So it's nothing that's out of the ordinary.

Got it. And then just real quick, is there anything contemplated in the guide for -- from the monitoring business?

No.

The next question will come from Jeffrey Cohen with Ladenburg Thalmann.

It sounded like you had a 10.7% number there on the buybacks. So does that mean that you've initiated that second piece?

Correct. Yes.

Okay. So the 0.7% was as of the end of the quarter or currently?

That was end of the quarter.

Got it. Okay. I guess we'll get nothing further yet. So I guess the next question is for Donald. If you could talk about the developments, I'm not going to ask about 1600, I've already done that so many times. So when you talk about the NiCO and the HemeOX, you're talking about the platform together. And then maybe talk a little bit about what you're envisioning down the road on the commercial front as far as do it yourself, do it by territories, by regions, distributors. Any thoughts there? Any updates for us to think about?

Yes. First, I'll say that we're on track with our internal development time lines for the laser-based products. The commercialization, we try to think about that upfront as we're designing the product because we want to put things in the devices and in the platform and think about how we actually commercialize and go to market. These devices are planned to be wireless in nature, so they can have connectivity in the hospital and will allow us to collect data and things like that.

With that said, commercialization is a combination of both a direct sales force and an indirect sales force. And I probably can't speak too much more about that except that this is a system sale, and it takes some individuals that understand both the technology and the clinical therapy to sell this device. And so it's a very important way that you will go to market and how we will focus primarily in the hospital market in the beginning. Does that answer your question?

Yes. And Dan, how does it look in the back half? You mentioned $2.7 million for the front half on the G&A for ZMS, back half around the same.

No, it's a little more than that just because we've been ramping. So we spent about $2.5 million last year. We said we were going to spend about $5 million more this year. So somewhere in that 7.5% to 8% range for the full year is about where we'll end up, I think.

Okay. That's helpful. And then lastly, I guess, maybe a question for you, Thomas. When we think about the past number of months and quarters and years of awareness growing out there, how is that reflected currently both on the patient side and both on the physician side when you think about and talk to folks out there about awareness and trends and utilization and prescribers and number of practices that are expanding internally and number of practices, which are being added?

Well, I assume you're talking about the Pain Management division here.

Yes.

Okay. So our business model, I would say, has very little to do with sort of the general awareness also because we're talking about a more than -- it's a $25 billion to $30 billion Pain Management market. And we're still just a drop in the bucket when it comes to that. Everything is driven by the face-to-face interaction between our sales force and the prescribing physicians.

So yes, there's awareness where we have a rep in front of the prescriber. And other than that, yes, occasionally, I hear someone here in Colorado that's seen the Zynex name before. But that's probably more because we are here. It's obviously something that over the past 26 years, we've now been in this industry in this country. We have tested a lot of different things and also seen other companies pretty much break then neck on trying other things, trying to do more of a pull approach instead of a push approach, which you can call having a direct sales force.

And we end up losing a ton of money on any other approach than that. So it's not really something we measure and pay attention to. We measure our productivity in our sales force, and that's going to drive us to, obviously, the end goal of what I believe will be above $800 million in annual revenue on these products.

The next question will come from Marc Wiesenberger with B. Riley Securities.

Of the more than 45,000 orders in the second quarter, I'm wondering if you could give us a rough breakdown of how much of that was NexWave versus other products? And how has that breakdown been trending recently?

I believe in terms of orders, about 82% to 83% of the orders are NexWave. So now obviously, subsequent suppliers that are being sent out or several years after when we received the prescription. That's obviously part of why when we see significant order growth by -- it takes a while before the actual revenue kicks in. So it's gone up. You can call the diversification has improved a little bit, but not substantially.

Understood. And then if you could update us maybe on how many active patients do you currently have and how that maybe trended relative to the prior quarter and last year.

I think we're somewhere approaching 100,000 in active patients. We don't -- that's not a metric we're tracking on a day-to-day basis, but I do get information on that here and there. And that's people that are still known to be treating with the device. Obviously, we don't always know when somebody is treating and not treating. So it's a little bit of a round number, but we think it's somewhere in that area.

Got it. Okay. Great. And then if you could talk about the percentage of the sales and marketing expense that's maybe related to fuel for your reps? And then kind of what percentage maybe is kind of the marketing materials for in-clinic kind of the food and kind of the advertising stuff? And with respect to those kind of costs, I think a lot of them have probably experienced some inflationary dynamics. Wondering if you have taken any actions around that or you're potentially going to take some actions around that stuff to mitigate some of those rising costs.

So with respect to fuel and kind of those in-service or meals that they're providing the clinics at times, those are capped on a per rep basis. So no, I can't say that, that has really affected us because the rep can only spend so much per month, and so they have to allocate their dollars effectively. We haven't increased that since gas has gone up significantly in the last 6 months. And so we haven't seen an increase there.

I would say, as far as rep materials, obviously, as we've continued to grow, that piece has grown significantly as well and we've been able to be more efficient on some of those and bring down the price versus -- in producing them here or outsourcing and we kind of do a mix of both to make that efficient. But I would say, again, that's a pretty small piece of the budget. Most of the budget is obviously going to salaries and the related commissions and that T&E number that I spoke of that capped as a percentage of that as well, but we haven't seen any increases due to the factors you mentioned.

And obviously, we have a relatively large sales force with 400 sales reps. So we have a lot of efficiencies and also flexibility. In all the printed materials we supply to them, that's generated internally. We really have our own -- we call it a very large-scale version of a [King Coast], yes. That is able to customize prescription pads for individual physicians, for instance, and marketing material individualize the sales reps' names on it and how to send in prescriptions, et cetera. All that is customized. And we can switch gears very quickly here by doing all that internally instead of having it done upside because of that. That's fairly inflation-proof, I would say.

Understood. Very helpful. And then just two more for me, and these are going to switch to ZMS. I think I heard you talk about your gearing up for a commercial launch in the second half of this year for potentially the CM-1600 after clearance. Does that mean that you've really kind of finalized a go-alone strategy and you will be building up the sales rep base within that segment, which is obviously going after a completely different market. And if you could remind us how many sales reps you have there now and what's kind of the medium-term goal for the ZMS sales reps.

So the current sales commercialization team is -- we're scheduled to respond to the FDA. Let me just back up and say we're scheduled to return or respond to the FDA. And we will consider building the commercialization team to sell the device. We have a plan in place to bring on a limited number of reps that are direct that will also help manage an indirect channel, and that's a fairly small number in the beginning because we will be ramping over a few quarters of next year.

Monitoring Solutions division, I'm wondering if you could just talk more about that and what kind of capabilities you're envisioning there. And maybe would that kind of provide recurring revenue in terms of software? And any kind of additional details would be helpful.

Yes. So the business model around that is if you look at devices in the medical device industry today, most everything is connected via wireless Bluetooth or some type of communication, whether it be near field, et cetera. There's on-prem solutions in a hospital, and then there's typically a cloud behind that, that provides data, collects data, downloads updates to devices, things like that. We have -- we are building a connected platform to communicate with all of our devices wherever they are in the world. And that platform can download updates that can collect data, it can do some vision to do reporting and some vision to have a SaaS business model behind it. So that way, there are revenues from the capital, from the disposables and from the software.

The next question will come from Yi Chen with H.C. Wainwright.

My first question is, could you give us some general comments regarding whether a recession in the U.S. economy could negatively impact your business going forward?

It's a medical service and a lot of these are paid by insurance and other types of things. So I don't know that we feel there's going to be a direct impact on this. Obviously, with people's discretionary income, you never know with copays and those types of things. But so far, what we've seen or what we expect to see is fairly minimal.

Got it. And given the current environment for hiring new sales reps, how quickly could you achieve the target number once you get the clearance for the monitor to get to the sufficient reps for your team to launch the product?

Reps that sell capital equipment, system-level type equipment will take probably 60 to 90 days to bring on. We've outlined a plan that will bring on, as I mentioned, a limited number of those because we have a strategic approach to what geographies and territories within that geography we want to go after and the types of hospitals, whether they be academic or other types of institutions. There's a ramp to those. And it's also based on the success and the need in the marketplace. And so I think that, that will be spread over a number of quarters based on kind of how we see our launch.

And lastly, can you remind us how long a period did it take to complete the initial $10 million share buyback? And do you expect a similar time frame complete the additional program of $10 million?

The original one, we did in about 60 to 75 days. We would expect this one to go quite a bit slower. So it's out there, and it may change. But right now, it's executing at a much slower pace.

This concludes our question-and-answer session. I would like to turn the conference back over to Mr. Thomas Sandgaard for any closing remarks. Please go ahead.

Yes. Thank you for joining us today. We look forward to maintaining our financial health going forward and anticipate high growth from sales rep productivity in the upcoming quarters. Enjoy your evening, and thanks for your interest in this call and in Zynex. Thank you. Bye.

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