Good morning, everyone. Suraj Kalia, Senior Medical Device Analyst at Oppenheimer. Pleased to have you guys join us in person, and also to those listening later on. This morning, we are pleased to have Jim Cunniff, CEO, and Brad Nagel, CFO of Electromed, present to us their story. Jim, it's a pleasure to have you. I'll let you take the floor here. Folks, to those of you listening, in case you have any questions, you know the drill. Just send me an email or my juniors an email. I'll put it in the chat box. We'd be more than happy to resurface at the end of the presentation and ask questions. Again, Jim, the floor is yours.
Suraj, thank you for that introduction. Good morning, everybody, and welcome. I'm Jim Cunniff. I'm the CEO of Electromed. With me, as Suraj had mentioned, is Brad Nagel. He's my partner in crime, who's the CFO. We're really excited this morning to share with you the Electromed story. As you can see here, we're an innovative leader in airway clearance technology. This is the standard disclosures, which I won't go through. A little bit about Electromed. Our focus is we're a single product company. Our focus is really on airway management, and I'll show you how we do that in a minute. We're based here in New Prague, Minnesota. We're about an hour southwest of the Twin Cities. We're a 30+ year-old company. We generate about $60 million in revenue.
Our market cap is around $210 million as of the opening of the market this morning. We manufacture all of our products in the United States, which I think is great. We get a lot of questions from investors. You know, do we have exposure to the tariffs that are being introduced? The short answer is we have nominal exposure to the tariffs, which puts us in a really good spot. As I mentioned before, we're a single product company. The mechanism of action of our product is called high-frequency chest wall oscillation. Again, I'll walk you through that in a little bit more detail. A couple of other highlights about the company is, as you can see here, relative to the financials, you know, we're growing, we're profitable. We are a leader in the airway clearance market.
As I mentioned, the mechanism of action of our SmartVest product is called high-frequency chest wall oscillation, or HFCWO, which is what I'll refer to it as. The other thing that makes us, I think, unique, and I'll spend a little bit more time on this later on in the presentation, is unlike a lot of other manufacturers in the home care space, we have a direct-to-patient and provider model. A consequence of that is we have very strong gross profit margins in the mid-70%. We're a growing company. We're profitable. We're generating cash. We have no debt, which I think makes us really kind of an outlier for a company our size. Let me talk just a few minutes about the disease state that we serve. It's called bronchiectasis, which is a bit of a mouthful. Essentially, this is a chronic irreversible lung condition.
Essentially, what ends up happening is patients' lungs, their airways expand, and they get repeated episodes of pulmonary inflammation, which leads to infection, which leads to mucus accumulating within the airways. The problem with that is, as you can imagine, if you have too much mucus in your airways, you start to kind of drown and you can't breathe. What our product really does is it helps to remove that mucus from the airways so that those patients can breathe easier. We feel like this is a great market to be in because this disease is misdiagnosed. Many of the patients that go in to see a pulmonologist are usually diagnosed with asthma or with COPD. We think that there's a great market development opportunity to increase the awareness of bronchiectasis. This disease is underdiagnosed. Obviously, as a consequence of that, HFCWO is underprescribed.
We feel like that's changing. There's some interesting dynamics that are happening in the market right now that we believe are tailwinds to further growth. To that end, I know it's a lot to unpack here. Here's kind of our iceberg slide. We show this in every investor presentation. Let me orient everybody to this slide. At the exposed end of this iceberg, there's 824,000 patients in the U.S. who have been diagnosed with bronchiectasis. Of that, only 127,000 of those patients have adopted our technology or one of our competitors' technologies. Of the remaining 700,000 U.S. bronchiectasis diagnosed patients, only about 230,000 of them are actively seeing a pulmonologist. A pulmonologist is really our sweet spot. That's our call point for our sales reps.
If every one of those patients that has this disease got prescribed HFCWO, that's a $2.3 billion market opportunity for us. We feel like there's a lot to explore in unpacking that and taking advantage of it. That does not even include, at the lower end of this iceberg, the 4.1 million patients in the United States that have COPD bronchiectasis overlap. That's just another opportunity for us to unpack in time. How is bronchiectasis treated? Today, you basically, with our Clearway device, you basically clear the mucus from the airways. The pulmonologist treats the infection with antibiotics, and then they want to reduce the inflammation that the patient has. Again, the more inflammation, the more mucus can build up.
are some exciting new drugs that are coming into the marketplace, most notably at the end of this calendar year, that will address the inflammation side of this treatment paradigm. We feel like the first step in that paradigm is really clearing the mucus from the airways. This is kind of a depiction of what our product actually does. Essentially, the patient wears a vest. That vest is attached to a hose. That hose is then attached to a generator. That generator really introduces air into the vest. It releases that air that is in the bladders of that vest. That mechanism of action of that oscillating treatment is really what forces the mucus out of the bronchial airways so that the patient can either cough that up or swallow the mucus and, again, breathe easier.
Since this is a chronic irreversible condition, the patient needs to be on this treatment really twice a day. Usually, the sessions run about 30 minutes per session. They do this really for the rest of their lives, so seven days per week. You know, we've got, I think, the best-in-class product in the marketplace today, as you can see. Great industrial design on the product. This is a product which is used in the patient's home.
It is very attractive. It is not cumbersome. It is lightweight. It is easy to use. There are no on/off buttons on this technology. It is all through a touchscreen. We have made it that way because one of the key elements of patient success is having adherence. We want to have a product that is comfortable. We feel like the vest that we manufacture is the most comfortable in the market. We have Velcro enclosures.
Many of our competitors have snaps, which are difficult for patients who have arthritis to use. The other thing that I would just comment on is the fact that we have reimbursement both from CMS as well as most private payers in the country for this technology. The other thing that we do that is unique to Electromed is we want to make sure that not only does the patient have a great experience with the product, but we can also show that their quality of health is actually improving. One of the things that we do, and this is a very high-touch portion of the Electromed story, is after we deliver the product to the patient's home, we do an initial assessment as to what is their baseline. Five days later, we go through and see if they're improving after using our technology.
We document all of that. We follow up again 30 days later. We provide all of that back to our providers in the form of what we call Smar Notes. This is an indication that, A, the technology that the prescriber has prescribed is actually doing what it is supposed to. That is really improving the quality of life for these patients. Again, bronchiectasis is chronic. It is irreversible. We do not cure bronchiectasis, but what we do is we improve those patients' quality of life. To that end, one of the things that we want to do, and obviously, I think most everyone on this call understands the cost of hospitalizations. What we have found is when patients get put on this technology, there is a 57% reduction in antibiotic prescriptions, a 59% decrease in hospitalizations, and a 75% decrease in ED visits.
That is really important because, you know, especially if that patient was formally admitted into a hospital, then gets discharged. If they come back to the hospital for the same condition, that is a never event and a big expense to the hospital. We want to keep these patients out of the hospital. We want their treatment to occur in the home. This product enables that to happen. Yeah, I mentioned before about our direct-to-patient model. I think this slide does a really good job of depicting really how things operate in the home market. Most manufacturers will distribute their product through a durable medical equipment distributor. That DME are really the ones who are generating a lot of the demand for the technology in this market. They are the ones who work with the patient for reimbursement coverage. Our model is a little bit different.
We do, on a selective basis, go through some DMEs, but the majority of our revenue really comes from our direct-to-patient model. We work with pulmonologists who provide us with referrals for patients. We then work with the patient to make sure that they can get financial coverage either through Medicare or through private payers. Much like a DME, we just deliver the product to the patient's home and do their training. This is where our revenue comes from. We do have a nascent piece of our business, both internationally as well as in the hospital market. I would say that we feel like the hospital market in the near term is a great kind of greenfield for us. Most of our revenue, 94%, comes from home care patients. About half of our payer coverage comes from Medicare.
We do not feel like this technology and our product in particular is something that has exposure to competitive bidding. In fact, we typically get about a 2%-3% reimbursement increase from Medicare every year. As you can see, I have been talking about bronchiectasis, and that is the preponderance of the diseases that we treat. We also know this technology is appropriate and gets reimbursed for CF and also neuromuscular diseases as well. How will we increase our market share? There are really four primary competitors in this market, including us. One of our secret sauce, I think, has been that we have shrunk our sales reps' territory. We are going to continue to add sales reps to expand our footprint. We also have a really solid direct-to-consumer digital presence.
As you can imagine, if you've got this disease that's chronic and irreversible and it's compromising your quality of life, many of these patients are going online to find different solutions. Many of them find us. We've got respiratory therapists on staff that can work with those patients to better understand their disease state and then get them to a physician that can help them get access to our technology. As I mentioned before, this is an underdiagnosed disease that we serve. We feel like there's a great opportunity through market development to expand education for not only patients, but also providers. Not only are we doing that, but there are other competitors in the market that are investing in that. I think a consequence of that is all boats will rise. We'll be getting some really nice tailwinds in treating bronchiectasis patients.
We also have what we call SmartAdvantage. We think not only do we have a best-in-class technology, but we also think we've got best-in-class customer care and support. This is not only for the patients, but also the clinics which are working with those patients to make their burden in prescribing our technology easier. We feel like we've got not only technology, but also documentation support that helps them. Lastly, an e-prescribing capability. This is something we've had great success with this year. It's basically instead of a clinic sending a prescription to us through a fax, which is kind of the norm, they do that digitally. It does a couple of things. It makes sure that when they do it digitally, we have all the documentation we need to be able to deliver this technology to our patients.
It also helps with not only private payers, but also Medicare in making sure that we have all the documentation necessary for us to get paid. Our long-term objectives as a company, we do not give guidance, but we have been successful in growing our business double digits. We expect that to continue in the near term. I think one of the other things that has been really exciting about the Electromed story is the fact that not only have we been able to grow the top line, but we also have been able to get expanded operating leverage. We expect that to continue as well. Why invest in us? We have a large expanding disease state that we are serving. We have clinically proven technology. As I have mentioned, we have great payer coverage that is only getting better.
In fact, we've made investments this year, this fiscal year, in additional resources to help mine the payer contracts that we have, not only to see if we can get increased reimbursement for our technology, but also to expand our payer coverage in certain markets where we've got some white space. We are growing. We are not only growing, but we are doing it profitably. We are generating cash. We have no debt. In fact, we just announced a week ago that we are doing a stock repurchase program of $5 million. We feel like today our stock's a little undervalued. We feel like that's a good use of our cash going forward. The other thing I wanted to mention before we open things up for questions is the fact that my incentive compensation as well as management's incentive compensation.
When I started, management had incentive compensation based not only on financial results, but also on MBOs. We have flipped that to make sure that our incentive compensation is really aligned with investors. On the bonus side of the equation for us, we need to increase our revenue and also our earnings. If we do that successfully, people will get their incentive compensation. If we do not, they do not get that incentive cap, which I think aligns with what our investors are expecting from a company. We also feel like we have an attractive valuation. When you look at whether it is sales growth or gross profit margin or operating margin relative to the Russell Medical Index, as you can see, we are kind of head and shoulders above other people within that index. We feel like this is a really good investment opportunity for folks.
Suraj, with that, I will open it up for questions. I think we did okay time-wise. The floor is yours, sir.
Jim, I have one question from my side. I know a couple of questions have come in from clients. Let me go with a dumb question that I have first, okay? I'll leave the smart ones for later. Jim, let's say Suraj comes in, right? He has more subcutaneous fat. Let's say somebody else has more visceral fat. Is there basically one algorithm for both in terms of high-frequency chest wall? Let's say the mucus burden, everything is the same. Does it need to apply a certain pressure for a certain duration? The mucus unloading would be equivalent, or should we think differently in terms of titration?
No, it's a very good question. I think you should.
It would be consistent whether or not you're someone who's overweight or someone who's thin. One of the things that we find, though, Suraj, is most of the patients that have bronchiectasis, ironically, they're over 65 years of age. Many of them are female. Actually, they're relatively frail. One of the things that's nice about our product is we've got a really lightweight vest. It's very comfortable. As you mentioned, relative to the titration, even if you have a little bit more skin on the bone, we've got different size vests to accommodate different size patients. We have different pressure settings that we can apply to patients that accommodate the different body types.
Got it. Got it. Fair point. Jim, I'm just reading a question from a client. What are the price versus unit volume dynamics in the high-frequency chest wall oscillation market?
I guess the way I see it is one for you guys and one for the broader market. Maybe you can just kind of characterize how it's playing out.
Yeah, I'll take a stab at this. Brad, you may want to jump in also. Just to kind of level set everyone. I think what's really—I have been in the medical technology market for over 30 years. I have never worked with a company where, outside of when we sell a product to, say, a hospital or a distributor, predominantly outside of the United States with our distributor team that we have there, our pricing is pretty well set. We have fixed contracts for the most part with our commercial payers. The same thing with Medicare.
With Medicare, in particular, the reimbursement rate that they have for us, as well as all of our competitors, is static. There is really not—one of the questions that I know came up when we first introduced Clearway, which is our most recent technology, is, "Are you guys going to get a price bump?" A lot of times, medical technology companies, when they have new innovation, they get the luxury of getting a price increase on that. The short answer is no. I mean, outside of the Medicare increase that we get every year, that is pretty much what the set price is for the technology. You have the price component, which is a bit of a fixed rate. The way in which we increase our revenue is obviously through gaining market share and expanding the market and getting more unit volume.
Suraj, did that answer your question?
No, fair enough. Fair enough. Jim, next question. I'll tack on my sub-question to this. This one is, "What are the pluses and minuses of direct-to-consumer versus DME-based sales?" If I could tack on to this line question, Jim, you mentioned an interesting point, which when I looked at it, I was like, "This is really neat." The high-touch part of the model where you showed the SmartVest patient report, which is invaluable for payers, for performance, reimbursements, so on and so forth. I guess my part of the question is also, does a high touch, as good as it is, does it also reduce leverage for you guys over time?
Two great questions. On the direct-to-consumer side, really what's nice about that is the fact that these patients, as I've mentioned before, they're really looking for solutions.
When they go online, they find us. They can communicate with us either through chat, or they can request a packet, which they can do electronically, which we will then send to them. If they've got follow-on questions as well, we have respiratory therapists on staff that can actually consult with those patients. What's nice about that is we're not going to get a prescription directly through that interaction. What happens is those patients go, there's a solution for this disease I have. I'm going to go talk to my pulmonologist and see if SmartVest is right for me. We feel like that's been just a terrific channel for us to generate awareness and to also transition patients from a prospect into a referral. That's been great. Relative to our SmartNotes, you're right.
That does not necessarily translate into leverage for us. We feel like it is a really important component of making sure that the provider feels like this pretty expensive technology is actually delivering the results it should. I also think that is important for the patient as well. One of the things that we want to make sure happens is the patient does have compliance because they are not going to get all of the benefits in day one. They will get the benefits usually after a week. They will certainly get huge benefits after the course of 30 days. Since this is an irreversible chronic condition, we do not want patients to go, "Gosh, I feel better than I have in years. I am going to stop using the technology." We want them to continue to be vigilant in using the technology. You are right. It is expensive.
We feel like, relatively speaking, when you look at the price of our technology, we feel like it's an investment worth making. We can get leverage in other parts of our reimbursement team to offset that expense. One last point on that, which I'll mention, is we have SmartConnect, which is a more passive monitoring for the patient. It does require the patient to do some technology things with their device. What we found is the adherence to that was so low that we really pivoted to this with SmartNotes to kind of offset the adoption rate of SmartConnect.
Got it. Got it. Jim, final question from my side. That iceberg slide that you presented, two parts to this question. Obviously, there are three or four key players in the space. And 127,000 current penetration, less than 20% penetration.
What would you say is the primary reason for such a large prevalence of undiagnosed patients or lack of knowledge or visibility or whatever? That would be question number A. Question number B, let's say you all were to join forces with someone else, acquire someone else, or someone else acquires you. Does 1+1= 2.5? Or is it really 2 or less than 2? How should we think about that?
Yeah, that's a great question. I think on the, how do you further penetrate that iceberg? I think there's a couple of things. This is a big educational component, Suraj, as I mentioned. There are new drugs that are coming to the market. I think the good to address inflammation. I think the good news with that is these drug companies have very deep pockets.
They are spending a lot of money on training, education for not only the patients, but also providers. There is a lot more awareness to bronchiectasis than there has been in the past. I think what ends up happening is most human beings fall into habits. I think these pulmonologists who are seeing upwards of 50 patients per day, they see a patient, they think they have got asthma, or they have been diagnosed with asthma once upon a time, and they want to treat that condition. It is an easy button, or they have got COPD. Many times, they do not think, "Well, what is really within that COPD umbrella? What else might they have?" What else they might have is bronchiectasis. Creating that awareness, I think, is going to result in more patients getting diagnosed with bronchiectasis and then getting onto our technology.
Does that make sense?
Yep. Fair enough. Fair point.
Relative to 1+1=2.5 , I think there's a there there. I think a lot of it has to do with structure. If we are to join forces with somebody else, I also think this is still highly a clinical sale. You have to have the feet on the street that are helping the providers in identifying patients and then working with the clinics to actually walk them through the reimbursement journey as well. I do not think you just get a bunch of generalists and hope that 1+1=2.5 . I think there still needs to be some specialization on this.
Fair point. All fair points. Gentlemen, always a pleasure connecting with you guys. Jim, congrats on all the progress.
I look forward to you guys beating and raising again. Thank you so much for taking the time this morning. To everyone on the call, we do appre ciate it. Thank you.
Thanks, Suraj.