Good afternoon. Thanks for being with us here today at LD Micro. Our next presenter of the day is James Cunniff, Electromed. Take it away, James.
Thank you, Megan. Thank you, everyone, for your interest in Electromed and for being here today. I know we've had a really busy day at the conference, so I'll jump right into it. This is a forward-looking statement. Obviously, I'm not going to go through our disclosures here, and we'll kick right into it. Who is Electromed? I'm not sure how many of you are familiar with who we are, what our story is. We're a medical device company that's really focused on airway clearance. During the course of the presentation, I'll share with you a little bit more about what our technology does and where our focus is specifically. We're headquartered in New Prague, Minnesota, which is about an hour southwest of the Twin Cities. We're not a newbie. We do about $600 million in revenue.
All of our products are manufactured in Minnesota. Most of our product components are actually sourced about 100 miles from our facility. With all the churn that's been happening relative to tariff activity, we're really pretty immune from that, which is really good. A couple of the other financial highlights is, and I think this is exciting, as a micro-cap company, as I mentioned, we're about $60 million in revenue. We are the leader in the expanding airway clearance market. I'll share with you a little bit more about what that is and how we address this market. The technology that we have, there's about four of us in this market that really address the disease state, which is called bronchiectasis. We do it with what's called high-frequency chest wall oscillation. That's really the mechanism of action of how our product works.
We've got a really attractive to-the-home market direct-to-patient model, which, again, I'll share a little bit more details on. I think what's really exciting is the fact that we're growing, we're profitable, we have no debt, and we've got about $14 million in cash. Most recently, in September of this previous year, we did a $5 million stock repurchase, and we just announced another $5 million stock repurchase. What is bronchiectasis? This is the primary disease state that we serve. It's really an irreversible lung condition, and it's characterized by a widening of one or more of the bronchia. That's basically your airways. There's a vicious cycle that occurs where a patient has an infection, they have inflammation, mucus buildup within their airways, and the patient really has a hard time breathing.
This disease state that we serve is misdiagnosed, is underdiagnosed, and as a consequence, high-frequency chest wall oscillation, or HFCWO, is underprescribed. The prevalence rate of patients that have COPD and underlying bronchiectasis is about 54%. You will see, basically, on this next slide, why that is important. Because if you take a look at the top half of this iceberg, there are about 824,000 patients in the United States who have actually been diagnosed with bronchiectasis. Of that, about 127,000 are actually on our technology or one of our competitors' technology. The remaining 700,000 patients, about 230,000 of them are actually being seen by a pulmonologist. That is really where our sales are focused. We are focused on pulmonology clinics. With an average sale price of our product of $10,000 per unit, that is about a $2.3 billion market value for you.
That is just to address the 230,000 patients who are being seen by pulmonologists who have this disease state. If you go into the lower half, you have COPD patients and underlying bronchiectasis. That is really what this 4.1 million patients represent. A huge market opportunity. These are people who have the disease, but they have not been diagnosed. One of the things that we are doing is we are tripling down on bronchiectasis. Cycle where they have inflammation, they then have an infection that then gets treated typically by antibiotics. These patients still need to clear their airways because if you have mucus built up in your lungs, you cannot breathe. Also, that mucus is the fuel for future infections. We are part of the treatment protocol and really the first line of defense.
We want to clear the lung so that the patients can get back and have a more active lifestyle. How is bronchiectasis treated? As I mentioned before, on the infection, it's antibiotics. There are some treatments underway for inflammation, but this is a chronic, irreversible condition. If you have this condition, you might have a mechanism to actually clear the lungs. That mechanism of actuation is high-frequency chest wall oscillation. The way it works, if you can take a look at that cartoon depiction that's on the left, is that we have a generator that's attached to a hose that then is attached to a vest. That vest gently squeezes, releases the patient's torso. What that mechanism of action does is it actually forces the mucus into the larger airways so that the patient can cough it up or they can swallow it.
On the right, we can get a sense of what the real device looks like on a patient. We've got a really terrific technology. It's best in class. We've got great information both on the clinical side as patient satisfaction, which I'll share in a minute. One of the questions we always get asked is, "Okay, this is a chronic, irreversible condition. Once somebody gets on the device, how often do they have to use it?" They typically have to use it two times per day. The sessions that they... and seven days a week. We did introduce one of the newest products in the marketplace about two years ago, which is our Clearway device. We're really excited about this device. We've had great market adoption for this product. We feel like we've really cracked the code relative to the industrial design.
This is something which is going to be used in patients' home, whether it's in their living room or in their bedroom. We also are the only HFCWO provider that actually has a one-hose design. What's important about that is most of our competitors have two hoses. This is really ergonomic. We have the lightest weight vest that's in the market. Also, the enclosures for our vest are Velcro. They're not snaps. That's important because many of our patients that we serve are over 65 years of age. They typically have underlying different disease states, and many of them are arthritic. We want to have something that's lightweight, which drives compliance, but we also want to have something which is easy to put on and take off.
One of the other things that we do, which is very unique in the home care space, is bill the payer to make sure that we don't have to share the product margin with another company. As a consequence, gross-profit margin is much lower. We are much more profitable. Where's most of our revenue coming from? As you can see here, it's really home care-based. About 94% of our revenue is in the home. We do have a nascent hospital business, so we do sell our product as capital equipment into the hospital. We do get trailing disposables in the vest, the hose that comes with the product in the hospital market. About half of our reimbursement comes from Medicare and the other half from commercial payers.
One of the questions we always get asked is, "Do you have any concerns about Medicare maybe reducing your rate?" I think the good news is we have had a history with CMS where they have actually increased our reimbursement rate every year based on their urban CPI increase. That averages around 3% per year. On the referral source, most of it, as I have mentioned during this presentation, comes from patients who have bronchiectasis. There are other conditions where we have reimbursement criteria, most notably cystic fibrosis and some neuromuscular diseases. Because the bronchiectasis cohort of patients is so large, that is really where our reps are focusing their time, and we as an organization are focusing ours. What is our growth strategy? We have got a great algorithm where if we add sales reps, we increase our revenue. We are going to continue doing that.
One of the big challenges, as you saw in that iceberg slide, is just how do we move these patients who have bronchiectasis to where they actually get a prescription for this technology? A lot of that has to do with awareness, both with the pay provider, the physician themselves, as well as the patient. We've invested quite a bit in direct-to-consumer marketing to get the word out. A lot of these patients are looking for solutions online, and we're a great source for that. We also have respiratory therapists on staff who will take questions from patients and speak with them directly. We don't give prescriptions, but we can actually share with the patient who they can go to to get access to this technology.
Market development, as I've mentioned, not only are we doing a lot of market development work that's related to provider education, patient education. The good news is providers. In the past, probably two to three years ago, if we were at a respiratory care conference, no one would be talking about bronchiectasis. Now they are. That's a really great sign. We feel like there's terrific tailwinds for more patients to get on this technology. We also have what we call SmartAdvantage. Not only do we have a great product, not only do we have terrific salespeople, but it's the support that we provide the clinic to make it really easy for them. They're dealing with a lot of different patients. They're dealing with a lot of different payers.
We try to be an easy button for them to get our technology that the patient paid. We also have an e-prescribe solution. Believe it or not, in the year 2025, most of our prescriptions come in via fax. We have an e-prescribe solution, so we can get all the documentation from the clinics electronically. That is both a savings for the clinic in time, but it is also a savings for us in processing these prescriptions. What are our long-term objectives? We are a publicly traded company. We do not give guidance, but what we have been successful doing and what we have communicated is we expect to continue to grow our top-line double digits and get continued operating leverage. We have had great success doing that in the last 18 months, and we expect to continue to do that. Why invest?
As you can see through this presentation, we're in a large expanding market in airway clearance. We've got great clinically proven technology with backed-up studies for that. We've got broad payer coverage. We have over 285 million lives in the United States. We have coverage from both Medicare as well as with private payers. We have consistent double-digit organic growth. I want to emphasize too, for a company our size, one of the things that's. The other thing I want to leave you with is the fact that my incentives, as well as Brad Nagel, who's our CFO, who's with me today, as well as the entire management team, our incentive compensation is predicated not on just increasing our financial performance or subjective MBOs. They're all focused on financial objectives. I don't get paid. Brad doesn't get paid.
The management team doesn't get paid unless we improve our revenue performance and our earnings performance. We think that's aligned with investors. The last slide I'll leave you with is we think that we're an attractive valuation. This is a bit dated. This was the trailing 12 months as of December 31. As you can see, our performance, ELMD versus the Russell Medical Index, really we're head and shoulders, whether it's sales growth, gross margin, or average operating margin. We're head and shoulders over the average within that index. I think we've got some time remaining, Megan, for some questions. Again, I appreciate everyone's time and attention. With that, we'll open it up for any questions folks might have. Yes, sir.
I was thinking if you did an expensive review to send somebody out initially, the specification of a 5-day to a 30-day delay would impact them more. Yeah. The question was, what's the cost impact of having to send somebody out to actually consult with a patient? Is the how they're progressing? Was that? Yeah. It's basically, when we deliver the product to the patient, we actually contract with 1099 respiratory therapists to do that. On that aspect of our business, we actually outsource that. It's a pretty nominal expense for them to go out initially. We also contract with the telehealth service to actually follow up with that patient on day five and then day 30. They collect those SmartNotes for us. It's a pretty nominal expense.
Really, when you take a look at our P&L, one of the big benefits that we've had really within the last probably 18 months is the fact in the past, when we would have a sales rep, we almost had to add a commensurate person who was in our back office to support that sales rep. Today, even though our biggest expense is our sales expense, we've been able to really do a good job, whether it's through process improvement or technology enhancements that we've implemented, to reduce that one-to-one ratio between what we do on the front-end with sales and what we do to support them on the back-end. We've been able to do that also with some of those telehealth services. It's a great question. Anything else? Any other questions for folks? Yes.
More on the buyback versus, I guess, just making that money and adding more sales reps? Yeah. We think we can do both. One of the things that's unique about our company and the question was, instead of doing buybacks, why don't you just increase your sales, your feet on the street? We're very focused on continuing to expand our sales team, but we have to do it judiciously. Our reps have a base salary, plus they get paid commissions. We want to make sure that when we add reps because we don't have another product within their bag outside of SmartVest, is that if you're a sales rep during the middle of the year, as an example, that can be really disengaging. We are really thoughtful about where we expand our sales coverage.
Every year, we add four to five sales reps within the United States for coverage. In the absence of an M&A opportunity, in the absence of investing in other areas of our business near term, we feel like since we're generating cash, we think that doing buybacks is probably the best use of cash near term. Yes, sir. What is the proportion of the razor-to-razor blade? Yeah. The question is, what's the proportion of razor-to-razor blade? We're really more of a razor-and-blade model. Basically, the way that it works is that when we have a patient that gets on the product, the reimbursement cycle is anywhere from 10-13 months with the payers. We get that revenue stream from the payers during that period of time. That includes the generator, the hose, and the vest.
One of the things that's also a competitive advantage for us is that we have a lifetime warranty on our product. A lot of our patients get on this technology late within their disease state. If they have to have their hose replaced, if they have to have their vest replaced, we do that for them. The return on investment for the payer and for the patient is outstanding because this is a product they're going to use for the rest of their lives. The only area where we have a razor-to-razor blade model is in the hospital. In the hospital, part of the—what happens is in a clinic space where we're getting a prescription that's for a specific patient, the sales cycle is a lot shorter. The time to revenue is a lot shorter.
In the hospital business, we may get a bolus of bigger amounts of orders, but it's a capital equipment sales. There's a lot more decision-makers involved in the process. The time from starting the process to revenue takes a lot longer. Once we get the capital within that hospital, they do have to replace their hoses. They do have to replace their wraps. They have to replace their vest to accommodate different patients. Great question. Any other questions? All right. Thank you for your time and attention. Thank you for your interest. I know it's late in the day, and really appreciate it. Thank you so much.