If you do have a question, you can type that into the button at the bottom of the screen. With that out of the way, it's all yours, Jim.
Hey, thanks so much, Jim, for the introduction. Thank you, everybody, for participating in this presentation. We're excited to share with you the Electromed story. With that, let's get started. This is the normal disclosures, which I'm not going to read through. I did want to share with you the Electromed story and a little bit about who we are. We are a medical device company. We're really focused on airway management in the respiratory care space. I think many of you may find this kind of shocking, but we've actually been doing this for over 30 years. We're based in New Prague, Minnesota, which is about an hour southwest of the Twin Cities. We generate about $60 million in revenue, 210 market cap as of today. All of our manufacturing is done in Minnesota also. We're a U.S.-based manufacturer.
Quite candidly, most of our componentry that we use within the assembly of our product is sourced within about a 100-mile radius of our manufacturing facility. We do not have great exposure to tariffs, and we are in a really good spot as a company. Also, on the financial side of the business, we have got a great story to tell. We are growing. We are profitable. We are in a large market, which I am going to talk more about in a minute, that is expanding. The technology that we manufacture, it is called high-frequency chest wall oscillation. I will be referring to that as HFCWO throughout the presentation. I will also share with you what that mechanism of action is. We have got a really attractive direct-to-patient model, again, which I will talk more about in detail, and a great financial profile. We are growing. We are profitable. We are generating cash, and we have no debt.
The primary disease state that we treat is called bronchiectasis, which is a bit of a mouthful. It is important to note that it is an irreversible chronic lung condition that is really characterized by abnormal widening of one or more of your airways. Essentially, what ends up happening is that mucus builds up within the airways, which really prevents the patient or the individual from having a great quality of life because they are compromised in their breathing. This is a disease which is misdiagnosed. It is underdiagnosed. As a consequence, our technology, HFCWO, is underprescribed. The market for this is large. It is growing. It is underpenetrated. I know there is a lot on this slide, but I will try to unpack this iceberg for you. Let us just start at the top. Today, there are about 824,000 patients in the United States that have been diagnosed with bronchiectasis.
Of that, about 127,000 are on our technology or one of our competitors' technologies. If you back that out of the 824, of that remaining 740,000 patients, there are about 230,000 of them that are actually being seen by a pulmonologist. As a direct-to-patient model, our sales reps call on pulmonologists. If all 230,000 of those patients were put on HFCWO therapy, the total addressable revenue is $2.3 billion. Really great market opportunity for us. As you can see, also, the prevalence of diagnosis is growing about 12% annually. How is bronchiectasis treated? We have introduced a new campaign in the last several months. It is called Triple Down on Bronchiectasis. This is really our thrust at not only educating providers, which are the prescribers of our technology, but also patients on what are their treatment options for this disease state.
Today, if you've got bronchiectasis, as I mentioned before, you have mucus that's building up in your airways, which is really preventing you from getting a deep breath. It all starts with clearing the airways. You clear the airways with our technology. Many of those patients also have an infection, which is treated with antibiotics. In the future, there are going to be drugs that are coming out to address the inflammation. The three elements that you see here on the treat infection, reduce inflammation, clear the airway, that's really the triple-down elements that a patient needs to go through to improve their quality of life. This gives you an idea on this slide as to really our mechanism of action. As you can see on the left, there's a vest that's attached to a hose that's attached to a generator.
That vest basically gently squeezes and releases the patient. That mechanism of action, that oscillation, is what forces the mucus into the major airways. The patient can either cough that up or swallow their mucus. Again, they can take a deep breath, and they can have an improved quality of life. Since this is a chronic, irreversible condition, the patient is going to be doing this therapy usually two times per day. The therapy sessions are usually 30 minutes at a time. Again, since it is chronic, irreversible, they are going to be doing this seven days a week. We are really excited because a little over two years ago, we came out with the newest HFCWO device, SmartVest Clearway. We are really excited about this product because it really is best in class. We have got the lightest weight vest on the market.
We have Velcro enclosures to help adhere that to the patient. That's important because many of these patients are elderly, and having to manage clips is difficult if you have arthritis. Also, having a heavyweight vest is difficult because it puts strain on the body. We are the only single hose device on the marketplace. The ergonomics are great. As you can see, we are really proud of the industrial design. We have no on/off buttons. Everything is utilized through a touchscreen. The compliance rates are really terrific on this. In addition to that, we do have really robust payer coverage, both with CMS as well as with private payers. We have over 270 million contracted lives that can take advantage of this technology.
The other thing that we do, in addition to manufacturing a product, delivering it to the patient, doing the education and the in-servicing on the product, is we actually look at their progress. How are they actually progressing and using this technology? Upon delivery of the product and after training, we do an initial assessment of that patient's quality of life. We come back and do a second assessment after five days. We follow up 30 days later to do a subsequent assessment. This is really valuable because what we want to be able to provide to the clinician is how is their patient actually progressing on this device. This is just a great way to show that patient progression for the prescribing physician. The evidence is clear.
Not only do our patients love using this product, as you can see on the left here, 95% would recommend SmartVest to others, but also our clinical evidence is very robust. At a time when most health systems would like their patients to be treated at the home and out of the hospital, this product, when used properly and consistently, has shown a 57% reduction in antibiotic use, which is great, a 59% decrease in hospitalizations, and 75% fewer ED visits. All important attributes, especially if the patient was initially admitted into a hospital, the last thing that the hospital wants is for that patient to be readmitted, which is a never-event for the health system. I mentioned before that we have a direct-to-patient model. Let me depict what that really means.
In the home space, most manufacturers like us, they make the product, but then they distribute that product through a durable medical equipment distributor, who then is the one who's responsible for generating demand with the patient. They're the ones who have the payer contracts. They're the ones who deliver the product to the patient and do the in-servicing. As a consequence, they need to share their margin with that DME. In our model, even though we do go through a select group of DMEs, most of our revenue is generated by going direct to the patient. We're not only the manufacturer, but we also have payer contracts. Our sales teams call directly on the providers to get prescriptions for our product. We deliver our product to the patient home, and then we help the patient with their insurance needs as well. Where is our revenue coming from?
Most of it is in the home setting. We have a nascent international and hospital business. Our hospital business actually is thriving, and we feel like that's white space for us. We are continuing to lean into that. We also feel like that's an avenue to the home. We feel like that's a nice referral source for us. As you can see, also from a reimbursement standpoint, about half of our reimbursement comes from Medicare. Also, as I've been talking about in this presentation, though we do cover other disease states, the primary one that we focus on are those patients who have bronchiectasis. How are we going to grow? We've had a great strategy of shrinking territories and continuing to expand our feet on the street. That's been a winning strategy for us, and we're going to continue doing that.
We also have a very robust direct-to-consumer and physician marketing. Why that's important is because these patients, again, have a chronic, irreversible condition, and they're looking for solutions. Because this is an underdiagnosed condition, we also want to make sure that the clinicians have all the information that they need on this disease state to better identify patients who might have bronchiectasis. Our direct-to-consumer model is one in which we do outreach to physicians as well as patients. This has been a terrific referral source for us because we have patients who can then interact with our respiratory therapists who are on staff to help direct those patients to pulmonologists that they can see to find out more about our product and if it's appropriate to treat their condition.
Because also there's not a great deal of awareness, we've also invested in a lot of market development, and that's been a great tailwind for us. The good news, as I mentioned before, is there's also drugs that are entering the space. Pharma too has been doing a terrific job in further educating providers and patients on bronchiectasis. I think a consequence of that is that all boats are going to rise in this market segment. We also, because we're not only a manufacturer, but a DME, we have what's called SmartAdvantage. This is to help not only the clinics that we serve, but also the patients in helping make sure that they have insurance coverage for our product. This has really been a really neat leverage point for us.
The norm within our market, when we get a prescription, it's sent through a fax, believe it or not. We have introduced an e-prescribe solution, excuse me, where we can basically get all of the patients' notes. We can identify that they have all the criteria for reimbursement. It's just been not only a great benefit to the clinics that we serve and time savings, but also it's been a great efficiency benefit for us. A consequence of that is once we have all the right documentation and we know we're going to get payer coverage, we can get this therapy to the patients sooner rather than later. Our long-term objective, we are a publicly traded company. We don't give guidance, but we've been successful, and we continue to believe that we can generate double-digit top-line growth.
In the last 18 months- 24 months, we've done also a really good job of not only growing the top line, but driving efficiencies internally, which has helped us expand our operating margin. We expect that double whammy of revenue growth coupled with better operating leverage to continue in the near term. Why invest in us? As I mentioned before, we have a large expanding disease state that we are covering. We've got clinically proven technology that's best in class, great payer coverage that's only getting better. We've added resources into our reimbursement team to engage with our private payers in particular to not only expand that pool of payers, but also to look at getting better reimbursement. We've got terrific top-line growth, and we're profitable. We're generating cash, and we have no debt.
The other thing I wanted to share with everybody is that management's incentives are aligned with our investors. My incentive compensation, Brad's incentive compensation, management team's compensation is not a combination of driving financial results and subjective KPIs. Our incentives are based on driving investor value through revenue growth and earnings growth. If we're not successful in doing that, we don't achieve our incentive compensation goals. We feel like that's aligned with our investors. Likewise, if we do well on both of those metrics, hopefully, we'll be generating better shareholder value, which we will then benefit from as well. Looks like this is such a great slide. We're staying on it. Let's try it. Yeah, we're trying to advance the slide here.
I guess the last thing I would share with you as we're waiting is the fact that, and really, here we are, is we're an attractive valuation. When you take a look at Electromed versus the Russell Medical Index, as you can see, whether it's sales growth, margin, both gross profit and operating margin, we're head and shoulders above what the averages are in the Russell Medical Technology Index. We feel like we've got a very good investment story to tell. Jim, with that, that's the end of my presentation, and we'd love to open it up for some questions.
Great. Great. Start off with some for me. Nice presentation. To me, I think the clearest way to grow is to increase awareness.
I go back to that iceberg slide you had at the beginning, where there seems to be a lot of potential patients, but not very many actually getting treated. What is the best way to increase awareness? Is it talking to doctors, talking to patients? What do you think the best way to do that is?
Jim, I think it's a combination of both those things. As I mentioned, part of our D2 C strategy has been to educate both providers and patients. Obviously, our sales reps, as a single product company, are engaging with pulmonologists on a daily basis to help them identify bronchiectasis patients. We feel like that's still a winning strategy for us because this is still very much a clinical sale. Having experts in the field talking to clinicians helps.
The other thing that we're excited about is that we're anticipating that the Chest Society sometime this year is going to be introducing treatment guidelines for bronchiectasis patients. Believe it or not, in the United States, there has never been United States-based treatment protocols for treating bronchiectasis. We believe, although we do not have overwhelming insights into this, we have been told that part of that paradigm is going to be having airway clearance as part of that treatment protocol. Those are just a combination of things that we see are really important.
Do you have physicians talking to other physicians or presenting at conferences, letting them know about treatments or is that part of the strategy?
Yeah, we participate in all the respiratory care conferences, both as a supplier as well as on the podium.
We do have a clinical team, and they present on bronchiectasis and airway clearance. I think that's another mechanism by which we get the word out. The other thing that we've done really successfully in the past 12 months is we've introduced CEU courses, continuing education courses for physicians. Part of that is focused on airway clearance. We feel like that's another way just to spawn that area of knowledge for them. Because many times what's happening is these physicians are seeing patients, and they're identifying them with bronchiectasis, but there's also many of these have overlap with, excuse me, COPD, and they have overlap with bronchiectasis. Just illuminating that in their eyes, I think, is important because if they have bronchiectasis, you certainly want to get them on airway clearance.
That's part of what's going to help them breathe easier and have a better quality of life.
Right. Another way to grow, it may not be as easy, is to gain share in the marketplace. I know you came out with SmartVest two years ago. How is that doing? Do you think you've picked up some share?
Oh, absolutely. Unequivocally. Yeah, there are four players that are in this market. Two of us are publicly traded companies, so you can see what our financials are. Between the two of us that you see, where you can see the granular financial data, we've been growing at about 10 times their rate. We feel like we're at, excuse me, 5-10 times their rate on the top line. You don't do that without taking share.
The other thing that we do is we do pull reimbursement data. Unfortunately, the data that we have is a bit stale, mainly because of the Change Healthcare data breach that happened last year. We are still looking at mining that data, but we do believe that the growth rates that we've had in the last two years, we are gaining share. We also have a couple of competitors that are a bit distracted. Two of our primary vest competitors, where they have a vest and a hose that's attached to a generator, they have a broader bag than we do. Their reps are focused on other products within their portfolio. We have another competitor that, unfortunately, has had some quality issues and are under an FDA consent decree. They have other distractions of their own, and they've been letting off staff as well.
We think that that's actually been an opening for us, predominantly within the hospital market.
Should we expect another generation product over the next few years? Is that something that you started?
Yeah, we do. I don't anticipate it's going to be in the next couple of years, though, Jim. The life cycle on this technology is a lot longer than a lot of other med tech technologies. It's usually five to seven years versus every two to three years. We feel like that's right. We've introduced a new generator. When you think about it, unlike a lot of other medical devices where they're typically used within a hospital, ours are used in a patient's home. In addition to the individual getting the care, they may have other family members that are using that product. Our product has to be really robust.
In addition to that, we have a lifetime warranty on our product. When a patient gets a SmartVest, we guarantee that for life. That includes the hose, and it includes the vest that comes with the generator. We do not have to have a new device every two to three years.
Right. I guess the third way to grow, which is probably even harder, is to add products to the portfolio. As we talked about a little while ago, you have pretty impressive infrastructure with regards to being able to obtain reimbursement to code properly. That is a pretty valuable asset. Are you considering that as an option? Are there other therapies that you think you could sell and put through your reimbursement, your revenue cycle management process?
First off, it is a great insight. It is a great question.
You're preaching to the choir here because we're always looking at what else could we add to our sales reps' bag. I mean, we've got two really valuable, three valuable assets. We've got a best-in-class product. We've got what we believe is a best-in-class sales team that only has one product. If we could put another product within that channel, that would be a victory for us as long as it's not a distraction to our high-value, high-margin product. We also, to your point, have a great reimbursement team. We don't take for granted the payer contracts we have, the efficiencies we've gained with that team. Certainly, Jim, I mean, I'm always on the lookout if there's a technology that's out there where it might not be in the pulmonary space, but it might be in an adjacency. It's a best-in-class technology.
One of the missing components is having the reimbursement team that could dovetail into what we're doing. We're certainly always looking at those types of opportunities.
Right now, the balance sheet's in very good shape. I mean, would you consider leveraging it a little bit in order to get into a new business?
We would. Right now, though, to the question you asked before, when you take a look at that iceberg that I've shared with you, we just feel like there's so much runway in the market that we're serving right now, especially as we continue to invest in awareness campaigns and expand our sales team. We've demonstrated we have a best-in-class technology. We still feel like we've got runway to grow and great tailwinds. Certainly, back to your previous question, we are generating cash. We've been providing investor value by doing share buybacks.
We did one in September. We just introduced another one a couple of weeks ago for $5 million worth of share repurchases. If we can't find the right M&A opportunity, we'll certainly look at other means in which we can provide value to our investors. Yes, I mean, we would take on debt if the appropriate asset was out there. In the meantime, we want to make sure that we're being good stewards of the cash that we have and investing back in the business and then providing value to our investors where it makes sense.
Right. There are a couple of questions from the audience. Are there any headwinds and tailwinds because of the new administration with regard to the VA or tariffs, that type? I think we're a bit you never know.
I mean, the landscape has changed so much in the last two months. I hate to look into the crystal ball that would be foggy in two minutes. As I mentioned at the onset of our presentation, the good news is we have very little OUS exposure on the revenue side. Tariffs will not impact us on that side. Most of our raw materials that we source are sourced domestically, and we do all of our manufacturing here in Minnesota. We are pretty sheltered from tariffs on that side as well. Most of our revenue is here in the United States. We are in good shape there.
Relative to the VA, quite candidly, our hospital business, and that's really where we would get referrals for veteran patients, is just such a small portion of our total revenue that we don't feel like that's a big impact, nor if there's any changes that happen with bundled payments to hospitals, that that's going to be a big negative for us. In fact, what it could be is a big positive because, as I mentioned before, if you've got a respiratory patient that you've admitted and then discharged, and they have bronchiectasis, and they were on an HFCWO device while they were in the hospital, if they could get on our device when they're at the home, which prevents them from getting readmitted into the hospital or going to the emergency department, that's going to lower the overall cost of care and the reimbursement.
I assume right now, the primary source of revenue is CMS-based Medicare reimbursement.
About 50% of our revenue comes from CMS. The other half is from private pay.
Okay. All right. Another question from the audience about the share price. You've done very, very well the last, I'd say, nine months, but then you were down significantly last month. This was most of the names I cover. Do you have any context for what happened?
Brad, do you want to jump in on this?
Sure. I'll add color. Yeah, absolutely. For us, the share price is always about controlling what we can control, which is primarily executing and delivering earnings. Jim talked about in the presentation the fact that we've had a focus on both growing revenue, but also expanding operating leverage.
It does feel a bit like our expanded operating leverage was growing so quickly over the past year where when we've tried to set the expectation, double-digit top-line growth and marginally better operating income growth or bottom-line growth, we had so much low-hanging fruit over the last year that there were times where our earnings were growing 60%, 70%, 100% in some of those quarters. I think with that came the valuation side of the equation. We saw our PE get to the point where it's really higher than our historical valuation. I feel like right now we're right back in line with what we've seen historically. Again, that's part of the story as we come back into the market repurchasing shares. We do see the value there and are putting our money where our mouth is.
Are you happy with the size of the sales force right now? I know you've kind of shrunk some of the territories to add a few more. Do you think you're at a good spot with that, or do you think there's still room to add sales reps across the country?
No, our intent is to continue to add. We have to be really deliberate. Jim, I think you and I have talked about this before. I think for the folks that are on the call right now, I think it's important to note we're a single-product company. We want to be really deliberate. Our sales reps, a big part of their incentive compensation is predicated on getting referrals. Anytime, having been a former salesperson myself, somebody shrinks your territory, especially mid-cycle, that adds to some angina.
We typically determine what the territory expansions are going to be on an annual basis and then make determinations as to when we actually execute against that. We are in a great spot right now with the feet on the street that we have right now. As the year progresses, we are not on the calendar year. Our year ends at the end of June. As we head into July, we will certainly be adding new territories for our next fiscal year.
How long does it typically take a new salesperson to get up to speed? The norm for us has been around six months.
One of the things that we've done, I think, better with the recruitment of the talent that we have, coupled with expectations, coupled with our training regimen, is that we've brought that cycle down from about six months down to around three months where we're seeing productivity.
All right. We have just about a minute left. Do you want to make any closing comments before we sign off?
First off, again, Jim, it's always good to see you. Thanks for the time today. Thanks for all of you who have joined this call. I think the last thing I would leave you with is I think it's important to reiterate that as a company, we have a cascade of customers. We've got prescribing physicians. We have the patients that we serve, but also we have investors.
One of the things that Brad and I are very conscious of, as well as the rest of the management team, is we want to make sure that we're delivering great performance for you. As Brad had mentioned, relative to our stock price, we get stock price appreciation. That is what we're expecting to continue to do.
Great. Appreciate you presenting today. I know we kept you busy with meetings. Appreciate you taking the time to do that too. Hope to hear from you again soon, get another update.
Super. Thanks, Jim. Thanks, everyone. Take care.