Greetings, and welcome to the Viemed Fourth Quarter 2023 Earnings Call. [Operator Instructions] As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Todd Zehnder, Chief Operating Officer. Thank you. You may begin.

All right. Good morning, everyone. Please note that our remarks in this conference call may include forward-looking statements under the U.S. federal securities laws or forward-looking information under applicable Canadian securities legislation, which we collectively refer to as forward-looking statements. Such statements reflect the company's current views and intentions with respect to future results or events and are subject to certain risks and uncertainties, which could cause actual results or events to vary from those indicated in forward-looking statements. Examples of such risks and uncertainties are discussed in our disclosure documents filed with the SEC or the securities regulatory authorities in certain provinces of Canada. Because of these risks and uncertainties, investors should not place undue reliance on forward-looking statements. The forward-looking statements made in this conference call are made as of today and the company undertakes no obligation to update or revise any forward-looking statements, except as required by law. The fourth quarter and year-end financial results news release, including the related financial statements are available on the SEC's website. Now I'll turn it over to Casey to get things started.

Okay. Thank you, Todd, and good morning, everyone. Welcome to our fourth quarter 2023 earnings call. I'm thrilled to share the exciting developments and achievements that highlight our quarter and overall year. First and foremost, I want to thank our Viemed family made up of over 1,000 healthcare professionals treating patients in all 50 states. Our people signify the collective strength, passion and expertise required to improve life. Each member of our team plays a pivotal role in our ability to enhance the lives of our patients and produce positive outcomes for physicians and payers alike. Our growing workforce fueled by our best-in-class HR department and staffing division enables us to extend our reach to a broader community. The commitment to our employees is reflected in the investment we make in their development, well-being and job satisfaction. This fosters a positive work culture that separates us from our competition and is most certainly the cornerstone for our success. Moving on to the quarter. Perhaps some of the most significant work we accomplished in the fourth quarter was our efforts surrounding the restructuring of our sales force, recognizing the need for more localized training and management infrastructure, we reorganized the country to create a more regional and localized approach to help with training and work-life balance for our people. Our new structure, which launched in early 2024, and paved the way for multiple territory sales manager and National Sales directorship promotions. This expansion and fortification of our team is driven by the vision of accommodating the growth trajectory of our organization. By leveraging the strength of our top-performing sales personnel, we are not only strengthening the leadership of our sales force, but also fostering a culture of excellence and continuous development. These leaders and trainers play a crucial role in shaping…

All right. Thanks, Casey. In reviewing the financial results, all figures are in U.S. dollars and the full results have been made available on the SEC website as well as SEDAR. Our core business generated net revenue of $50.7 million during the fourth quarter of 2023 as compared to net revenues of $37.5 million in the fourth quarter of 2022, which equates to a 35% increase. Our sequential growth for the core business was 3%, which is a good sign that the integration of the HMP acquisition, along with our organic growth continued in line with our historical norms. Our revenue for the year ended December 31, 2023, came in at $183 million, which is a 32% increase over 2022. We continue to stay optimistic that we will be able to continue our high organic growth rates as well as continue our evaluation of inorganic opportunities. Our fourth quarter revenue from vents was approximately 58% of our revenue as compared to 66% in the fourth quarter of 2022. Our gross and EBITDA margins are still strong and improving as we are focused on both margin and diversification. We have been very successful in managing our cost structure this year, and it is showing in both gross and EBITDA contribution. As is typical, we want to point out the rapid notional growth of our margins but are also proud of the increase in the percentages over the last six months. Our gross and EBITDA margins during the quarter came in at 63.3% and 25.3%, respectively. Our fourth quarter gross and EBITDA amounts came in at $32.1 million and $12.8 million, respectively. Both gross and EBITDA margin and margin percentages grew sequentially and continues our theme of profitable growth, both organically and inorganically. Our full year EBITDA for 2023 was $43.1 million,…

Okay. Thank you, Todd. After looking back on Viemed's journey, I was reflecting on some of the financial milestones our company has achieved. Since our initial public listing, we have grown adjusted EBITDA to nearly equal the total revenue for this spin out year in 2017. Along the way, we have achieved this incredible growth while doing so as a profitable company in every single year. Viemed's financial success and consistent track record is a testament to the resilience strategic acumen and unwavering commitment of our entire team. The aging population continues to be a significant factor in our industry dynamics. Simultaneously, technological advancements and increased awareness for shaping the adoption of our specialized home medical services. We believe the home medical equipment markets hold promising opportunities for continuous expansion, and we stand ready to leverage our expertise in navigating this landscape. The fourth quarter of 2023 stands as a testament to Viemed Healthcare's unwavering dedication to excellence in growth. Our growth is propelled by strong relationships with suppliers, seamlessly integrated proprietary technology and a commitment to innovation. The Engage Care Manager, our innovative clinical management technology exemplifies our dedication to operational excellence, providing transformative benefits for our respiratory therapists and enhancing patient care. The expansion in the new geographies, diversification of product and payer mix and targeted acquisition initiatives underscore our commitment to reaching more patients. In closing, Viemed Healthcare enters the future with confidence, guided by a resilient team, a strong financial foundation and a commitment to delivering exceptional respiratory care. The positive regulatory environment supports our growth initiatives, allowing us to strategically strengthen our sales force and make investments that position Viemed for sustained success. As we build towards the future, the strategic addition of leaders and trainers, coupled with our commitment to exploring innovative partnerships reflects our patients- reflects our dedication to not just keep pace with the industry but to set new standards of excellence. As we look ahead, the path is clear for Viemed. We will continue to expand our footprint and refine our offerings. The combination of these activities, coupled with our ability to track our success translates into an unparalleled ability to drive value for payers. We thank all of our shareholders who have placed their trust in Viemed and look forward to telling our story to more shareholders as our company continues to expand across the country. This concludes our prepared remarks. Thank you, and we'll now open up for further questions.

[Operator Instructions] And our first question comes from Brooks O'Neil with Lake Street Capital Markets. Please state your question.

Thank you very much. Good morning, guys. I thought perhaps I had jumped on the wrong conference call when I heard Casey talking about all that high-tech stuff, but it's pretty impressive.

Yes, very excited on our technology advancements. But what's your question, Brooks?

All right. So my first question, I'm just- I hate to betray my ignorance here, but give us just a little background on the 75-25 blended Medicare rate? How much impact do you think that might have add in 2023? And from what you're seeing in terms of the outlook for 2024. It sounds like might go at.

Yes, Brooks, this is Todd. I'll take that one. During the- there were several concessions obviously made by CMS during that time. And one of them was to give some rate relief to former competitive bid products. So when we're talking about it, it specifically relates to- in our stance, it relates to the sleep and oxygen business. And long story short, they had given rate relief by making it a little bit less weighted towards the competitive bid area rates and more to the rural rates. So with the expiration of that and it really comes down to the only way it's going to get brought back is through a congressional bill, I guess, on the budget that would give us the relief. It has now gone back to former rates. I don't have a 2023 number, but what we can tell you is it's roughly about a $3 million impact on an annual basis to our company for 2024. You can think about it at $750,000 plus or minus for the first quarter that we are not factoring in. I mean we have lowered our guidance, assuming that is not going to happen. So it's not super material but something that we would much rather have these higher rates because it's a value-added service for these people in those smaller cities around the country.

Sure. That's extremely helpful. I really appreciate that color. Let me just ask you this. It sounds like things just broadly are going well. I know that in over the last several years, maybe RT availability has been a bit of a headwind. How are you feeling about that situation today?

We're not seeing any holdbacks on finding our RTs right now. The staffing division is pretty much clicking on all cylinders from finding our folks. I think what I'm talking a lot about in the script about the restructuring of the sales force and what's interesting is that we're have support more clinical support behind our head sales folks that are really developing into veteran productive areas. And so just the landscape of the type of personnel, the type of RT that we're looking for has evolved a little bit. It's more of your support role. But we still look for our sales roles as well, but not having any issues trying to finding our respiratory therapist at this Tom, to answer your question.

All right. That's great. Let me just add a little technical question about my model. I noticed that the tax rate this quarter was a little bit higher than I have been modeling. Is that a rate somewhere in the very low 30% range that you think is likely to play out in 2024?

I think it will probably go back down some, Brooks. I think this had to do with some permanent differences, and I'll probably reserve the right for you to talk to Trae later on. But I think it has something to do with some permanent differences that we had to take the expense forward during the fourth quarter really related to future periods.

Okay. Well, that's very helpful. I think that does it for me. I'm excited to hear about all the progress and the opportunity and the incredible results you delivered last year. So I know '24 is going to be another great year.

Thanks Brooks.

Our next question comes from Doug Cooper with Beacon Securities. Please state your question.

Good morning, guys. Congrats on another nice quarter. I just want to talk about organic growth. By my calculations, I guess, excluding the impact of HMP organic growth year-over-year in quarter four was about 16%. Is that in the ballpark?

Yes, that sounds about right.

Okay. So, and then the Q1 guidance, again, excluding if I compare Q1, your guidance midpoint to Q1 last year, which obviously didn't have HMP in there, it looks about 10% and then sequentially about flat. So maybe just talk a little bit about what you're seeing on the growth side?

Yes. As it relates to 1Q over 4Q, the main thing- or 1Q over last year's we do have more of our business coming from what I would consider the sleep products, which has- is it probably a little bit more susceptible to deductibles and seasonality. And truthfully, as more of our patients hit insurance changes, it's becoming more common that people are swapping around on insurances and it puts patients on hold. We don't lose the patient, but we just maybe miss a bill or two that is seeming to have a little bit higher impact on us. As it relates to the 16%, I mean, I think that's- it's a really good growth year for us. It's not as high as our historical rates, but we've always been clear that say that as we get bigger, the ability to grow 25% and 30% is getting harder just because the notional amounts are getting larger. I think the one important thing to think about as it relates to sequential is our new patient starts are as high or higher than we've ever seen in the first couple of months. So the fix is there. We just got to get more patients to see their doctors to get paperwork submitted and we're on track with what is setting up to be a really good 2024.

And then just- so you talked about would say that's going to set up well for the resupply business. Can you give us some actual metrics of the resupply business in quarter 4.

In Q4 or for '24.

No. For Q4.

I want to say that Q4 resupply made up about of our revenue base as a company. That's- I don't have that number right in front of me, but I think that that's probably pretty close to where we are. And if you think about it, and now that's including both Viemed and HMP think about where that was probably a year ago, that would have been at best 3%. So the resupply, I mean like we've talked about, our own organic Viemed sleep growth, the end game is to get more and more patients on that resupply program, obviously, continue to set up new patients for the- to add to the funnel. But that's what we brought in with H&P, our own business. So when I referenced several times in the script about transactional revenue and being able to generate free cash flow, the fact that we have that number upwards of, call it, gaining on double digits is a major milestone for us.

And are you seeing sort of roughly $600 annualized per patient on the resupply? Is that a piece of number to use?

I'm sorry, Doug, what was that?

The revenue per resupply patient? Is it sort of annualized run rate about $600? Is that the number that makes sense?

Yes. I would say we're about $200 to $215 per order. And it just- I mean, if you want to say that 3x that, that might be a little high for us. I want to say we're somewhere in the 2.5 orders per patient per year, but it may be gaining on that. So somewhere between $550 and $650 per patient per year.

Okay. And what percentage of your sleep patients will be on the resupply program today?

As far as our active sleep patients, like the active PAP rental patients all SP-3 I mean everybody that meets compliance on the resupply program. So if we end up we're setting up 1000- about 1,500 on a consolidated basis a month. Our resupply program is more probably in the 30,000 patients. So it's obviously a lot bigger because the PAP caps out.

Okay. And I guess just as my final one. The actual vent patients, 10,327 to end the year, up marginally from the 10,244- can you just talk about your outlook for actual vent patient growth this year?

Yes. Look, I mean, we're going to continue to say that our expectation is to grow that patient count, call it 100 a month. We didn't get there in the fourth quarter. We'll see if we get there in the first quarter. Obviously, as we get larger, the attrition is higher. You start out with- I mean our average length of stay- is staying at 17 months. So we're losing more patients just due to expiration, unfortunately. But some of the stuff that Casey talked about where a lot of new sales initiatives, and we're obviously out there trying to get new regions and new contracts. We still show up every day, expecting to grow that on a net basis about 100 a month. Some quarters, we do it, some we don't. We're still very confident that vent growth is going to continue. And once again, I'm very pleased with where we're seeing new patient setups in the first quarter.

Okay, great. That's it for me. Thank you, guys.

Thanks, Doug.

[Operator Instructions] Our next question comes from Nick Corcoran with Acumen. Please state your question.

This is Megan on the line for Nick this morning. Nick had a question regarding the vent patient growth and respiratory illnesses this winter. Have respiratory illnesses as when to temper your patient expectations at all? Or has it been pretty usual for the season.

Well, I mean, we- I don't have the specific number on respiratory illnesses. It's not something that we watch on a daily basis, but you're seeing our bit growth in terms of total VIP patients that we were just talking about on the rise. So we're optimistic that there's plenty of patients out there for 2024. It's just a matter of getting our people trained and up and running and producing in an efficient manner, which is what the restructuring is focused on.

Okay. Thank you.

And our next question comes from Eric Coldwell with Baird. Please state your question.

Thank you, and good morning. I wanted to ask two questions. The first is on Philips and their decision to stop selling equipment in the U.S. Just what kind of knock-on effects have you seen? And is there any lingering impact of their recalls and their regulatory issues and now their decision to extricate themselves from the U.S. marketplace. Thank you.

Yes. I'll take it. I'll split it up into two products because it really affects PAPs and vents more than items. On the PAPs side, it really got an impact us outside of the fact that in the event that we have patients that are on a Philips product, they might want a different product. I don't think- we're not seeing that in any large scale or really any scale for that matter. So it shouldn't impact the sleep business anymore. It did in the past when we had to get all of those patients set up on new equipment, be it either a new Philips device that was FDA compliant or some of our other vendors. This has been going on for a few years now. And so the good news is we have adequate sleep providers or other manufacturers who are able to fulfill all of our needs at this point. So no issues there. As it relates to the events, the recall is still in place, and I know that Philips and the FDA are working on a remediation. It's very minor, in our opinion, a very minor remediation but one that has taken a long time to get done. The ability for us to continue to service patients with those ventilators remains, and we are still servicing patients and have been reworking devices. So the ability for us to continue with that is not at risk in our opinion. At some point, they won't be in the market of making parts down the road and so forth, but we are planning effectively for that. I think the best thing though, Eric, is that it's been going on for three years, and we diversified our fleet at this point. And there are three other very competent vent manufacturers out there, and we're probably up to roughly 50% of our fleet being non-Philips at this point and only getting larger every month.

Perfect. Second topic, you alluded to this in the prepared remarks. I've been focused on it. The CMS final rules are actually, I think, a set of three of them in total, one that went live in January, one that goes live and another one that goes live in 2026. But in general, we're seeing CMS really rein in these Medicare Advantage and managed Medicaid plans for things like improper denials unnecessary and improper prior authorizations. Also CMS forcing these plans to fully cover everything that's covered under fee-for-service, which was not always the case in the past, providing faster appeals, resolution transparency. A lot of good things for the DME industry. I believe I'm curious, you mentioned it could be a good guy. I'm just curious, do you have any statistics or analysis that might suggest how these tighter rules around the MCOs could actually quantitatively impact you? Is that something that is available? And have you seen any impact at this point given the last rule went into effect a couple of months ago?

Yes. I mean we've seen a little bit of a behavior shift. Everything I have is really anecdotal in terms of stories and approvals. I don't have a number right here in front of me, but I can circle back with you, Eric, what we're seeing. I predict that the behavior is going to change here with all these final rules now in place. And it's not material at this moment in time, but check back in Q2, and we might have some metrics there that hopefully we see some metrics that are side of life for improvement on authorizations and they're following Medicare guidelines, which is all they really need to do. So.

Oh, go ahead, please. Sorry.

No, no, we're just optimistic about what's going to happen.

Yes, it can't hurt. I think it's the way we look at it. Last one, just maybe a bit of a reach and a derivative of something that's happening nationally with this Change Healthcare cyber-attack. Have you seen any have you seen any impact in the last 2-plus weeks regarding this in terms of any form of patient challenge or customer behavior shift in the marketplace. It's getting a lot of headlines. I think most of our companies are saying it's probably not going to be a material knock-on effect, but I am curious if you've seen any ripple effect from the challenges that United is having with Change Healthcare and then therefore, a number of providers are having challenges as well.

Yes, I'll take that. I mean, the beginning part of your question is the part that we can definitively say we're thankful nothing has happened. Patient care has not been compromised at all. And so that's the most important thing. I know- two weekends ago, the pharmaceutical benefits were some issues, and I think that was the first thing they tackled. So they got that stood up and things are good. So we can definitively say we've been able to take care of patients and continue to get authorizations in a timely manner. What will happen is the submission of claims is getting slowed down. We- anything that's going through change has been halted for about the last 10 days. We have proactively worked to get through two phases to go ahead and reroute some of our largest carriers to other clearing houses so that we can keep the- really the cash flow coming in. It's really a delay more than anything. But yes, it's a disruption to the industry for sure. We applaud and support their efforts to make sure that it's secure going forward because we take security very seriously around here. So they need to do the right thing. I know they are, in the interim, we are taking the time to go ahead and just reroute payers to make sure we're not negatively impacted from a cash standpoint.

Are you willing to share who you're rerouting to? What other payer switches you're using?

I mean, currently, our- I don't mind saying that currently, the largest reroute is going to waste or slashes our med. I think it's one and the same, but- that's probably our second largest. And then all of our federal monies are directly with CMS, so that's not impacted.

So you're not anticipating a notable impact on cash flow this quarter, which I think is the knock-on effect that most of our supply chain coverage is focused on, but it doesn't sound like it's a material concern in whatever it is, is likely transitory?

Yes, assuming that all of our efforts that are ongoing come through that cash flows are as we are expected, we shouldn't see a material impact. It may slow down some cash for a little while, but nothing that's going to hamper our ability to continue to do anything around here.

Perfect. Let me add my congrats to a nice continued performance. Good talking to you guys. Thanks very much.

Thanks Eric. Have a good day, man.

Thank you. And there are no further questions at this time. I'll hand the floor back to management for closing remarks. Thank you.

Yes. We want to thank everybody for your interest in Viemed today. And if there are any follow-ups, just reach out to us. Have a great day.

Thank you. This concludes today's conference. All parties may disconnect.