Nabil Shabshab
Analyst · William Blair. Please proceed with your question
Thank you, Jason. Good afternoon and thank you for joining our second quarter 2021 conference call. We saw sequential growth of 16.8% in total revenue from the first quarter of 2021 and growth of 41.7% in total revenue from the second quarter of 2020. Overall demand and average selling prices for our products were strong in the second quarter of 2021. However, due to supply chain constraints and an effort to optimize financial results, we intentionally focused supply capacity on our direct-to-consumer and international business-to-business sales channels, which you will see reflected in those results. We were pleased by our strong rental revenue growth and our improved direct-to-consumer sales revenue in the second quarter of 2021 sequentially versus the first quarter of 2021 and versus the second quarter of 2020. Direct-to-consumer sales increased due to higher demand, which lead to improved sales representative productivity and higher average revenue per order sequentially versus the first quarter of 2021 and versus the second quarter of 2020, when these metrics had seen the declines from prior periods associated with the COVID-19 pandemic. We believe that the improved metrics we saw in direct-to-consumer sales were primarily due to higher vaccination rates within our patient population leading to increased desire for mobility, concurrent with the relaxation of closure orders related to the COVID-19 Public Health Emergency or PHE, as well as improved consumer confidence. With that, I will now provide details of our second quarter 2021 revenues by channel. For the second quarter of 2021, we generated record total revenue of $101.6 million, compared to $71.7 million in the second quarter of 2020, an increase of 41.7% over the comparative period in 2020. Domestic business-to-business sales in the second quarter of 2021 increased 27.8% to $27.6 million, compared to $21.6 million in the second quarter of 2020. We believe this increase was primarily due to greater demand for portable oxygen concentrators or POCs for both traditional long-term oxygen therapy patients and secondarily due to COVID-19 patients upon hospital discharge, as well as higher reseller demand. International business-to-business sales in the second quarter of 2021 increased by 57.3% or 47.8% on a constant currency basis to $21.8 million compared to $13.9 million in the second quarter of 2020. We believe the increase was primarily driven by improving COVID-19 vaccination rates and increased ambulation of patients in Europe, increased operational capacity of certain European respiratory assessment centers, and increased sales in India associated with the spike in COVID-19 cases in that market. International business-to-business sales in the second quarter of 2021 included $2 million in sales to our distributor in India versus no sales in the second quarter of 2020. Direct-to-consumer sales increased 35.6% to $40.9 million in the second quarter of 2021 from $30.2 million in the second quarter of 2020. We believe the increase was primarily driven by increased demand for POCs due to higher COVID-19 vaccination rates within our patient population and the relaxation of closure orders related to the COVID-19 PHE leading to increased ambulation, as well as improved consumer confidence. This increased demand was partially offset by lower average inside sales representative headcount, which was down approximately 18% from the comparative period as attrition outpaced hiring, primarily due to increased competition for sales professionals in 2021, along with reduced hiring of new sales representatives in 2020 due to the COVID-19 pandemic. We continue to look to add new sales representatives, while maintaining our hiring standards and being mindful of the technology and constrains we are facing. Our rate of hiring increased in the second quarter of 2021, with headcount up slightly as of June 30, 2021, as compared to December 31, 2020. We expect minimal net new hires in the near term due to the size and quality of the candidate pool and expected attrition. We are pleased with the performance of our inside sales teams in the second quarter, as we saw improved direct-to-consumer sales productivity and increased average revenue per order versus the first quarter of 2021. Rental revenue in the second quarter of 2021 increased 85.2% to $11.3 million from $6.1 million in the same period in 2020, primarily due to increased patients on service, higher billable patients as a percent of total patients on service, and higher Medicare reimbursement rates. As of June 30, 2021, we had approximately 37,100 patients on service, which was up 6.9% sequentially compared to March 31, 2021, and up 40.5% compared to June 30, 2020. The increase in patients on service was primarily driven by greater utilization of patient leads for rental opportunities and physician facing initiatives to increase prescriber awareness by our sales force as well as the relaxed Medicare criteria for oxygen therapy reimbursement due to the COVID-19 PHE. We are still cautiously optimistic that our performance both in the direct-to-consumer sales and rental channels is a positive indicator for improving market conditions for our products overall. I would also like to talk about the supply-chain disruptions we are currently experiencing. While we are proud of the fact that we were able to avoid significant impact to our business in terms of supply availability in 2020, we have seen supply chain disruptions in 2021 primarily associated with the semiconductor chips used in our portable oxygen concentrators and batteries. This semiconductor chip shortage being experienced across many industries placing additional pressure on existing supplies. While we have been hard at work to mitigate the impact of the supply shortage, it has and will likely have a negative impact on our ability to manufacture products, as these chips are used across all of our portable oxygen concentrators in both batteries and printed circuit boards. We are continuing to work with our OEM partners and exploring other open market avenues to purchase necessary semiconductor chips. But these products are facing extremely demand and we expect continued challenges in terms of supply constraints and pricing inflation until supply meets demand and prices stabilize. The acquisition cost of these chips from third parties has trended significantly higher in the third quarter of 2021 than the standard purchase price, and is expected to continue to increase if and to the extent supply is available during the shortage. As a result, we expect these inflated costs will increase our cost of goods sold starting in the first quarter of 2021 and continuing until supply meets demand and prices stabilize. We believe based on our assessment and industry feedback that these supply shortages may continue through the second quarter of 2022. While we expect to be supply constrained and unable to meet full customer demand for our products in the interim, we are planning on partially offsetting these rising costs by implementing price increases across our products as of September 1, 2021. Now turning to the latest from CMS; on July 2, 2021, CMS announced a proposed change to the home use of oxygen national coverage determination and proposed removing of the national coverage determination for home oxygen use to treat cluster headache. If approved, these new policies would allow the Medicare administrative contractors to make coverage determinations regarding the use of home oxygen and oxygen equipment for cluster headache. Additionally, CMS proposed to expand patient access to oxygen and oxygen equipment in the home by allowing oxygen use for acute or short-term needs, including cluster headaches or COVID-19, instead of limiting coverage to chronic hypoxemia. CMS also proposed removing the requirement for alternative treatment measures before dispensing of oxygen therapy and removing the requirements to patients be in a chronic stable state when tested for oxygen therapy. CMS is also proposing to remove the limited list of conditions for which oxygen may be covered to respiratory-related diseases and allow physicians flexibility to make the needed determination. In addition, CMS proposed to define exercise more broadly to include functional performance of the patient and to give flexibility on pulse oximetry readings to reduce racial disparities in care. Lastly, CMS proposed to reduce provider burden by removing the oxygen certificate of medical necessity. CMS is seeking comments to these proposed decisions and respond to public comments in the final decision memorandum. We are supportive of these proposed changes and believe that expanded coverage for patients, who would benefit from oxygen therapy, reduced administrative burdens and greatest physician decision making authority on proper patient care can improve access for patients who are in need of oxygen therapy. As I look ahead, while we have some near-term challenges, the underlying demand for our offerings is strong and I'm confident about Inogen's commitment and focus on increasing the POC market penetration and improving patient access. To that effect, we remain focused on expanding physician and patient awareness of the POC modalities for oxygen therapy and [indiscernible] offerings in this space. We are committed to working through the ongoing supply challenges, while we continue to invest in our infrastructure and elevate our investment in clinical evidence and R&D to strengthen our market leadership position in oxygen therapy. While we are still early in these efforts, I believe that we are on the right path to create long-term sustainable and profitable growth. Lastly, I'm happy to have expanded the senior leadership team and in the last couple of months with two new roles, Chief Medical Officer held by Stan Glezer and General Counsel held by Jason Somer. I look forward to Stan's contributions in medical affairs clinical research and regulatory affairs and Jason's contributions to our legal and compliance functions. With that, I will now turn the call to our CFO at Ali Bauerlein. Ali?