Good day, ladies and gentlemen, and welcome to this NeoGenomics, Inc. fourth quarter and full year 2018 financial results conference call. As a reminder, today's meeting is being recorded. All lines have been placed on a listen-only mode. The floor will be open for your questions and comments following the presentation. If you should require assistance throughout today's call, please press star zero. Now at this time, for opening remarks and introductions, I am pleased to turn the floor over to Mr. Douglas Van Oort. Please go ahead, sir.
Thank you, Operator, and good morning, everyone. I'd like to welcome everyone to NeoGenomics' fourth quarter 2018 conference call. Joining me from our Fort Myers headquarters is Sharon Virag, our chief financial officer, Robert Shovlin, President of our Clinical Services division, George Cardoza, President of our Pharma Services division, and Bill Bonello, Chief Strategy and Corporate Development Officer and Director of Investor Relations. Before we begin our prepared remarks, Bill Bonello will read the standard language about forward-looking statements.
This conference call may contain forward-looking statements which represent our current expectations and beliefs about our operations, performance, financial condition, and growth opportunities. Any statements made on this call that are not statements of historical fact are forward-looking statements. These statements, by their nature, involve substantial risks and uncertainties, certain of which are beyond our control. Should one or more of these risks or uncertainties materialize, or should the underlying assumptions prove incorrect, actual outcomes and results could differ materially from those indicated in the forward-looking statements. Any forward-looking statements speak only as of today, we undertake no obligation to update any such statements to reflect events or circumstances after today.
Before turning it back to Doug, I want to let everyone know that we will be making a copy of our transcript for this morning's prepared remarks available on the investor relations section of our website shortly after the call is completed. We also want to let everyone know that we are going to limit the number of questions to two per person in order to give more people a chance to ask questions within the one hour that has been allocated for this call. Doug?
Thank you, Bill. For today's call, I will briefly review some quarter four highlights and then turn the call over to Sharon Virag for a more detailed review of the financial results. After that financial review, I will comment on several of our growth initiatives and investments that we're making to drive both near-term and long-term growth. We will then have time for questions and answers. Let's begin with the quarter four highlights. We were very pleased with our quarter four financial performance. We reported record revenue and adjusted EBITDA with 25% top-line growth and 30% adjusted EBITDA growth. Those results included 20 days of Genoptix results, and when excluding the impact of Genoptix, organic revenue growth was 17% and adjusted EBITDA was up 27%. In the Clinical Services division, we continued to achieve good results from our efforts to improve both revenue and cost per test.
Excluding the impact of Genoptix, we actually increased average revenue per test by 6% year-over-year, and we lowered cost per test by 3%. Obviously, the resulting impact was an expansion of our margins. Clinical test volume growth was a little bit lower than normal as we were up against an exceptionally strong prior year comparison. Clinical test volume increased 13% year-over-year with Genoptix and 9% year-over-year excluding Genoptix. Volume growth was unusually low in November, but has returned to historical levels in both December and year to date in 2019. Pharma Services revenue grew 33% year-over-year to a record $10.6 million. We signed $15 million of new contracts during the quarter, and our backlog was up 44% year-over-year to $99 million.
The quarter's record levels of profitability were achieved even as we continued to make significant investments for future growth, and adjusted EBITDA margin reached an all-time high of 17%. Importantly, service levels were excellent and customer retention levels were outstanding. Cash collections were very strong and also reached a record level for the quarter. On the strategic front, we completed our acquisition of Genoptix on December 10th. Now that we've had two months of ownership, we are even more excited about the acquisition today than we were at the time we announced the deal. This combination of NeoGenomics and Genoptix sets our company apart with unprecedented reach to all customer segments, including hospitals, pathologists, and community oncology practices. It also allows us to be even more competitive by leveraging best practices and offerings from each company and unifying cancer care among oncologists, pathologists, hospitals, payers, and patients.
I will provide a more detailed update on the Genoptix integration activities later in this call. The strong fourth quarter results capped an eventful year for our company, which included good quarterly performance, a new strategic partnership with PPD, our redemption of the preferred stock owned by GE and GE's subsequent exit from their ownership position in Neo stock and a $135 million secondary offering, followed by our acquisition of Genoptix. We feel very good about 2018 and are even more excited about our opportunities in 2019. Before we talk about those opportunities, I would like to turn the call over to our Chief Financial Officer, Sharon Virag, for a more detailed review of fourth quarter financial results.
Thank you, Doug. Our fourth quarter revenues were $76.5 million, a 25% increase from last year. Clinical Services revenue increased 23% to $65.9 million, and Pharma Services revenue increased 32.6% to $10.6 million. Clinical volume increased 13% to 198,000 tests, and average revenue per test increased 9% to $333. Excluding the impact of Genoptix, revenue increased 17% to $71.8 million. Volume grew 9%, and average revenue per test increased 5.5% to $323. As we discussed last quarter, we are optimistic that we are beginning to see less downward pressure on price per test than we've experienced over the past several years. Also impacting revenue per test are improvements in our cash collections. Gross profit increased by $10.3 million to $37.1 million, up 39% from the prior year. This increase represents a 69% contribution on the $15.1 million of revenue growth.
Gross margin improved by 495 basis points year-over-year to 48.5%. This improvement was driven by productivity gains, cost efficiencies, and improved revenue per test. Genoptix had a modestly positive impact on gross margin during the quarter. G&A expenses increased by $9.1 million or 55% year-over-year to $25.7 million. Approximately $2.3 million of this increase is related to one-time, non-recurring acquisition-related transaction costs. These expenses are counted as non-GAAP adjustments in our calculation of adjusted EBITDA, adjusted net income and adjusted EPS. The balance of the increase is primarily attributable to the addition of Genoptix, higher professional fees, and increases in payroll and payroll-related costs. Excluding one-time costs and the impact of Genoptix, G&A expenses were 24% higher than last year. This increase reflects key investments made in the company's G&A infrastructure to support our continued growth.
Sales and marketing costs increased by 37% year-over-year to $8 million, primarily due to the Genoptix acquisition. Excluding the impact of Genoptix, sales and marketing expenses were 24% higher than last year. Similar to G&A, this increase reflects important investments made in the company's sales and marketing team to support top-line growth. Fourth quarter GAAP net income attributable to common shareholders was $353,000, compared to net income of $1.9 million in the fourth quarter of 2017, and diluted income per share was zero versus diluted income per share of $0.02 in the prior year. We believe that in order to compare the net income related to the true operation of the company on a more consistent basis across periods, it's appropriate to adjust GAAP net income or loss available to common shareholders to exclude certain non-cash items and, if applicable, one-time costs.
We refer to this measure as adjusted net income and on a per-share basis, adjusted diluted earnings per share, and we have included a table with how these are calculated in our earnings release. Adjusted EBITDA was $13 million, an increase of 30% year-over-year. The marginal adjusted EBITDA contribution on revenue growth, excluding Genoptix, was 26%, which is within our long-term guidance of 25%-35%. As we've mentioned in the past, the 25%-35% guidance is in a range that we expect to fall into on average, with some quarters above and some quarters below that range. In the fourth quarter, adjusted net income was $5.5 million, compared to $3.2 million in the prior year. Adjusted diluted EPS was $0.06 versus $0.04 in quarter four 2017.
Cash collections were strong in the quarter, with clinical DSOs improving seven days sequentially to 77 days, excluding the impact of Genoptix. Cash flow from operations increased 148% for the full year to $44.8 million. Capital expenditures for the year were $21.9 million, with $14.3 million of cash CapEx and the remainder under lease financing. We ended the quarter with $10 million of cash and $112 million of total debt, including capital leases. During the quarter, we completed the acquisition of Genoptix for approximately $125 million in cash and 1 million shares of common stock. We finished the fourth quarter with 1,475 full-time equivalent employees, contract doctors and temps, including 359 legacy Genoptix employees. Versus 1,078 as of September 30, 2018, and 980 as of December 31st, 2017.
On a consolidated full-year basis, we finished 2018 with $276.7 million in revenues, representing 15.2% year-over-year growth, and test volumes increased 14.1% compared to 2017. We also saw revenue per test improve 1.2% and experienced a decrease in cost per test of 4.6%. This corresponded to a 360 basis point gross margin improvement year-over-year. Additionally, we posted 2018 adjusted EBITDA of $43.6 million, which represents 29.6% growth year-over-year, and our adjusted EBITDA margin expanded 170 basis points versus 2017 to 15.7%. We are issuing full-year 2019 revenue and earnings guidance. We expect consolidated revenue to be in the range of $379 million-$395 million and adjusted EBITDA to be in the range of $49 million-$53 million.
This guidance assumes $80 million-$85 million of revenue from Genoptix, approximately 10% volume growth on legacy NeoGenomics business, low single-digit declines in legacy NeoGenomics Clinical Services revenue per test, and approximately 20% growth in Pharma Services revenue. I want to address an anticipated question about our volume growth expectations. As many of you know, we have historically guided to mid-teens volume growth. We continue to believe that we can grow the business at that rate on a long-term basis and in a normal operating year. However, 2019 is an integration year. It's our goal not to lose a single customer during that integration. The top priority for our sales team will be customer retention. Thus, while we are encouraged by the growth opportunities in front of us, it seems prudent to forecast slightly lower than normal volume growth this year.
Finally, I want to take just a minute to discuss our plans for reporting 2019 results. This quarter, we quantified the impacts that Genoptix had on certain results and metrics. We did this because our 2018 revenue and EBITDA guidance and most analyst estimates excluded the impact of Genoptix acquisition on our fourth quarter results. Going forward, we will not be quantifying the impact of Genoptix on specific results. We expect that our integration activities will progress at a rapid clip, and it would be both impractical and counterproductive to segregate Genoptix results from the rest of our business. That said, we will keep you apprised on how we are tracking with basic assumptions such as cost synergies and revenue compression. I'll now turn the call back over to Doug to provide some additional commentary on our key 2019 initiatives and opportunities.
Thank you, Sharon. I'd like to begin with an update on Genoptix and our integration activities. We're very excited about this opportunity to combine the best of Genoptix with the best of NeoGenomics. Virtually everything we have seen and heard since closing the acquisition on December 10th reaffirms our conviction that this combination makes a lot of sense for patients, providers, payers, employees, and shareholders. As a privately held company for many years, Genoptix focused on building its business with community-based oncologists. The company developed outstanding products and services for this market segment and developed an excellent reputation for quality of testing and reporting that remains a gold standard in our industry. I'm happy to report that we're moving forward at a rapid pace with integration activities and are very much on schedule.
Rob Shovlin is leading the commercial and operational integration, and Sharon Virag is leading the financial aspects of the integration process. Most of our NeoGenomics team now has experience with complex integrations, and we're applying our learnings to this integration. We're moving as deliberately and quickly as possible. We're making very good progress. Our estimates of synergy have been verified, and we feel that our plans are on track. Several Genoptix leaders have assumed key leadership positions in our commercial operations and finance teams, and we're working to fill a number of new growth positions with highly qualified people from Genoptix. Since finding great people is a constraint to growth, this is a welcome relief. Shortly after closing the deal, a number of us met with each member of the Genoptix sales team.
After significant review and analysis, we developed and rolled out a complete integrated sales organization and new territory alignment, all within 6 weeks after closing. Just last week, we held a very successful national sales meeting. We now have 80 sales professionals in our Clinical Services division and nine in our Pharma Services division. Counting our marketing and managed care teams, we now have approximately 100 people in our commercial organization. We have found a very high level of experience, commitment, and enthusiasm across all departments at Genoptix, including the medical team, lab operations, and corporate support functions. On the medical team, a strong group of Genoptix pathologists and PhDs have added to our existing team, which now combines to total approximately 80 MDs and PhDs. I believe we now have one of the largest and most capable team of medical and scientific professionals for cancer diagnostics in the country.
In operations, in particular, Genoptix has an excellent molecular lab, and the combination of our molecular teams and capabilities is going to be extremely beneficial to our operations and future strategies. Former molecular leaders at Genoptix are now part of the current molecular leadership for our combined company. In operations, we have already worked to consolidate test menus and identify best practices, which we will standardize on. The broader NeoGenomics solid tumor test menu has allowed for tests formerly sent out by Genoptix to nearly immediately be performed internally at our lab in Aliso Viejo. Internalizing send-out testing is both a cost reduction and an improvement in service and turnaround time for clients and patients.
Although we purposefully did not include revenue synergy in our deal models, we have come to believe that there is a good opportunity to increase business with existing customers over time by leveraging our comprehensive test menu and large portfolio of managed care and GPO contracts. Genoptix sales representatives have confirmed that many customers were sending solid tumor work to other labs because Genoptix was not actively trying to win that business. The reps also believe that they missed out on a significant amount of business because they did not have contracts to serve as an in-network provider with a large number of managed care plans that NeoGenomics does have contracts with. We hope to leverage our large test menu and portfolio of payer contracts to gain revenue synergy over time. As we work through the integration, our top priority is customer retention.
Obviously, maintaining high service levels and turnaround time is critical to customer retention, as is a long list of other aspects of superior service. NeoGenomics is laser-focused on client satisfaction. We are quite proud that with approximately 2,000 responses to our customer surveys during 2018, our Net Promoter Scores ranged from 59 to 60. We understand what it takes to satisfy customers, and we will try to maintain those throughout the integration process. While successfully integrating Genoptix is our most important job this year, we do have a lot of other exciting growth initiatives underway. There are four that warrant an explanation. First, we continue to sign contracts with commercial payers, group purchasing organizations, integrated delivery systems, large hospital networks, and large oncology practices. This activity is a direct result of our scale and strong ability to serve providers and payers on a national basis.
In addition to recently announced agreements with Cigna and Premier, we added several important new contracts in the fourth quarter to further expand our access to referring physicians and patients. Once contracts are awarded, they typically take several months before beginning and then several more months to fully transition. As a result, we have some good visibility to volume growth beginning in the next several months. Second, we continue to make progress with our proactive measures to address revenue per test. We have enhanced our analysis of existing reimbursement trends, identified areas where we are being underpaid, and implemented a plan for improvement. These activities include securing coverage for non-covered tests, improving our billing process to avoid denials, and working denials more effectively when they do occur. We are also evaluating our fee schedules to identify tests that are not appropriately priced.
Our recent results suggest that we are seeing some initial benefits from these efforts. A third area of growth is in our exciting Pharma Services division. You may have noticed that our revenue grew nicely on a sequential and year-over-year basis each quarter during 2018. That revenue growth is driven by our strong backlog of signed contracts, which totaled nearly $100 million at year-end. We believe this growth is fueled by strong market demand for oncology clinical trials and also to our unique capabilities. One of those capabilities, the ability to help sponsors with a complementary biomarker or companion diagnostic, and then be able to immediately offer that test commercially upon drug approval, is becoming of increasing interest to our pharma clients. We continue to invest in our capabilities to serve pharma clients, including a build-out of our global infrastructure.
We're beginning to see projects roll through our lab in Switzerland. We are slated to open our Singapore lab in just two weeks, and we are in the planning stages for China as well. We also continue to be excited about our global partnership with PPD. We have a handful of early wins and a number of bids outstanding with pharma and biotech companies today. We expect the pace of activity to increase over time, especially as we add capabilities in Asia. Fourth, we continue to make progress with our FDA initiative. As we have discussed on previous calls, we are in the process of seeking FDA approval for a large multi-gene next-generation sequencing panel.
We believe that an FDA-approved next-generation sequencing test offering will benefit both our Pharma Services and Clinical Services divisions by further differentiating us from other oncology labs, helping to drive reimbursement for our multi-gene panel, and increasing our attractiveness to pharma companies for clinical trials involving companion diagnostics. After we closed the Genoptix deal and reviewed our plans in detail with our new broader team, we decided to make some additions to our assay, and we are quite excited about it. Even with these revisions, we expect to submit the assay to the FDA late in the third quarter or in the fourth quarter of this year. In summary, we are excited about the strength of our business, our position in the market, and our near-term and long-term growth opportunities.
Sophisticated laboratory testing plays an increasingly critical role in identifying appropriate care protocols for cancer patients, ultimately improving quality of care and saving lives. We're pleased to play an important role in this vital segment of our healthcare system and believe that our services are creating value for patients, employees, customers, and for our investors. I'll now hand the call over to Bill to lead us through questions and answers.
At this point, we'd like to open it up for questions. Incidentally, if you're listening to this conference call via webcast only and would like to submit a question, please feel free to email us at bill.bonello@neogenomics.com during the Q&A session, and we will address your questions at the end if the subject matter hasn't already been addressed by our call-in listeners. As mentioned at the beginning of this call, we would like to ask each person to limit their questions to two so that we may hear from everyone and still keep within the hour allocated for this call. Operator, you may now open the call for questions.
Thank you. Ladies and gentlemen, the floor is now open for your questions. If you do have a question and would like to ask it, please press star one on your telephone keypad. Again, that is star and one on your telephone keypad. Also, if you're using a speakerphone today, we ask that while posing your question, you pick up your handset to provide the most favorable sound quality. Again, ladies and gentlemen, if you do have a question or comment, please press star one on your telephone at this time. We'll take just a moment to allow everyone a chance to signal. We'll take our first question today from Drew Jones with Stephens Inc. Please go ahead.
Thanks. Good morning, guys.
Good morning.
Just wanted to start quickly on the volume growth. Doug, could you maybe tell us what was it in November that maybe slowed things? Then just given the commentary around the improved trajectory year-to-date, how that factored into the decision to be a little more conservative with the guidance on volume growth for 2019?
Sure, Drew. The volume growth was surprisingly low in November. We don't really have a great explanation for it, to be honest. We didn't lose any clients. We had a slight reduction in ordering from a lot of different clients. It bounced back really completely in December and has been strong year-to-date. We believe that the volume projections and pipelines are pretty strong for us as we look forward. We are cautious. We are going through an integration year. We thought that our guidance volume growth was responsible in light of that.
Okay. Maybe moving on to something that looks pretty positive. Can the momentum on price per test and improvements that you showed there, how much runway is left in some of these initiatives that you guys have been enacting? Maybe is there a way to quantify the opportunity with non-covered tests on existing volume to kind of support the outlook there?
Let me try to make a few comments. Then I'll turn it over to Sharon. I would say the improvements that we're making in reimbursement per test is not because we're raising prices necessarily. It's just that we're being more efficient about getting paid for the work that we already do. We've put a lot of tools in place to try to get reimbursement. You know that we've worked with a number of managed care plans. We continue to add to our list of managed care plans, and that certainly helps. We're also implementing tools in our billing process generally, which I think will continue to help us to offset the natural kind of decline that we're seeing in the marketplace. Sharon, you have anything to add?
Yeah, I would just add, as all of the opportunity that we've had on these GPO contracts and everything, they come with volume, which means that we might be willing to be flexible on price. What all of these efforts that we're doing, basically, we're trying to hold serve against that. People shouldn't expect to see us be able to hold that forever in light of the way in which our contracting is moving. If we can stay flat, I would be happy for this year. We did project just a little bit of a decrease in it in the numbers and the guidance that we've given you. I'd be happy if we stayed flat.
Thank you, guys.
Thank you, Drew.
Again, to our audience, it is star 1 if you would like to ask a question. We'll go now to Kevin Ellich with Craig-Hallum. Please go ahead, sir.
Good morning. Thanks for taking the questions. A lot of discussion, Doug, on the Genoptix acquisition and integration. Just a couple questions there. The $80 million-$85 million in revenue that you guys called out in your guidance for the year, just wondering, it seems like that's a slight decrease relative to what you guys had expected when you first announced that deal, and just wondering if there's any seasonality, early findings you can give us on how that deal's going.
All right. On the revenue compression in particular, we went back once we had full visibility. As you know, we had to use third parties because we were competitors during diligence. We went back after we had full access, everything that we thought was confirmed, which is great. I think there is the revenue compression that we thought. The contracts do line up the way they do, where they're out of network, we're in-network. There's going to be a change for that, and we reflect that in that range. We also discontinued a small piece of their business where the margins weren't what we would want to have in what's called urine cytology. That's gone, that's why you see that range come off of 85 and a little bit lower because of that discontinued piece.
We feel really comfortable that with time, we are going to be able to see some revenue synergies, but that's not going to happen immediately, so we wanted to make sure that the range was something that was very realistic for an integration year. Doug?
I would just add one thing, and that's that so far, the Genoptix volume has pretty well stabilized, and it was declining last year. It was declining when we completed the acquisition, but it's stabilized, and we feel pretty good about what we're seeing so far.
That's helpful. Doug, just quickly on the PPD partnership or collaboration, you talked about early wins in your prepared remarks and existing bids. Just wondering if you can give any more color on the size of those wins, are you still on track for that $10 million in run rate revenue by year-end, or is there potentially some upside there? Thanks.
Kevin, I'm going to turn that over to George Cardoza, who's here with us.
Yeah. For competitive reasons, we really can't give out revenue for a particular customer. We are happy with the alliance. We have had some early wins. We presented at their national sales meeting a few weeks ago to their entire team, and we're actually traveling next week over to Asia with them. Things continue to be on track. We have a lot of joint bids out there, and we remain very excited about the alliance.
Thank you.
Thanks, Kevin.
Our next question will come from Puneet Souda with Leerink Partners. Please go ahead.
Yeah. Hi, Doug. Thanks for the question. First, just briefly, again, touching on volume, I just wanted to make sure I'm understanding it correctly, that your guide is implying you obviously have overall sales rep and commercial organizations that's larger. Genoptix is moving in network. Solid tumor volumes are coming in internally, and you have good visibility here. I just want to make sure that the volume guidance decline is due to the discontinued pieces overall, or is there something else that's just making you a little bit more conservative here? Just wanted to understand that correctly. Thank you. I have two more follow-ups.
Hey, Puneet, it's Bill. I'll take that one. Again, we're talking about 10% volume growth on the legacy NeoGenomics business, which is a little bit lower than our historical mid-teens long-term guidance. The entire reason for that being a little bit lower than our long-term guidance is the fact that we're integrating Genoptix, and we know that our sales force is going to be focused on customer retention above all else. Our number one objective is to not lose a single customer, and that's more important than going out and winning a new customer. Ideally, you'll be able to do both. That's it. We're just being prudent.
We're very excited by the opportunities that are in front of us, as you pointed out, we know the reality of what can happen during a big integration project, it makes sense from a guidance standpoint to project conservatively. Not conservatively, but prudently.
Okay. Appreciate that. If I could touch a little bit on the end client or the customer. You have had conversations with them so far. What's your feedback overall from the oncologists and pathologists about the integration? Usually customers are either pleased or have comments on one or two aspects of the business maybe they're excited about as a result of the integration. Could you give us some color there? Just any sense of using the gold standard COMPASS reports, how are you going to integrate those across NeoGenomics now? Last one that you have to do in IT for some of that integration. Thanks.
Puneet, so far the customers that we talk with, and we're out there a lot, are quite pleased about what we're going through and the combination of NeoGenomics and Genoptix. I think the Genoptix customers are pleased about the opportunity to access a broader menu, particularly on the solid tumor side. We're already seeing some early wins in terms of tests that were previously sent out by Genoptix are now being performed internally at turnaround times that are superior to what they were offering before. On the NeoGenomics customer side, I think, there's not a lot of change, frankly. I think over time. We had no negative reaction from the pathologists that we've talked with. In fact, I think they are also feeling good about our expanded service and offerings.
In terms of COMPASS, we intend to offer the COMPASS product, which, as you know, is a gold standard for oncologists, broadly to oncologists across the Neo network. That's one of the things that we're programming in our systems right now, and we will offer as a result of the completion of the integration efforts.
Great. Thank you. I'll jump back in the queue.
Once again, ladies and gentlemen, that is star and one if you would like to ask a question. We'll go next to Brian Weinstein with William Blair.
Hey, guys. Thanks for taking the questions, and good morning. A couple things. First, I just want to go back on this notion of the integration here. You say, obviously, you're laser-focused on this, but I'm just trying to understand, what is the kind of legacy NeoGenomics rep doing differently in 2019 versus 2018 that gives kind of any concern about losing revenue? Given that we're kind of dealing with a bit of a different customer base, just trying to understand why you think that there's some risk there, Doug. I think you just said that there's not a lot of change in these customers and that these customers feel good about the offerings. Just kind of help me understand that a little bit.
Yeah. I'm going to turn it over to Robert Shovlin to address that, if you don't mind, Brian.
Yeah. Hi, this is Rob. We pretty quickly integrated our commercial organization within six weeks of the close. We now have NeoGenomics reps and legacy Genoptix reps that are one sales organization, and we've redrawn the territory boundaries. Each of these sales reps are now introducing themselves to new clients, the legacy Genoptix or the legacy Neo clients. They need to spend time getting acclimated with their new clients and their new restructured territory. Then as we move forward with integration items, we'll need to educate our clients on any changes based on the integration. There's some of those, what we would call distractions, where they're not aggressively selling new clients, but managing the existing base in their territories.
I would probably add to that. If you think about it, we're moving, for example, we're bringing the systems together, and they're going to have to be coming on that one system, including, for example, billing. Just moving these customers from one billing system, if they're with Genoptix, over to our billing system, for example, there's education that has to happen. There's resetting up those connections that have to happen, and those can all be distractions. We want to make sure the sales folks are participating in those with their customers.
I will just correct or just comment on one thing you said, Brian. You talked about losing customers. Our retention rate of customers is in the very high 90s. We don't expect to lose customers as a result of this.
No, totally understand that. Thanks for the clarification. Thinking about some of the investments that you've made, I think you talked about G&A and sales and marketing were up somewhere, I think, 24% in the quarter. Can you be a little bit more specific on some of the investments that you've made here for future growth? Should we expect those types of investments to continue? Thanks.
You should expect our investments to continue, but not at that pace, I would say, of year-over-year increase. The investments that we're making include investments in the FDA assay process, for example. We've added a number of people to comply with the FDA submission process. We've added facilities globally. You know that we've added people and facilities in Europe, in Singapore. We're exploring facilities in China. We're investing in our technology, in IT, in science generally. There's a lot of great things happening technologically. We intend to make sure that our test menu is the most up-to-date, scientifically advanced menu out there. That has been an area of investment as well. I would say that we're investing for growth. All of these activities are growth-related, and some of these are being made because we have some visibility to growth that we expect to see in 2019.
I think we feel pretty good about the investments that we've made, even though the number looks like it's a little bit higher than it normally would be.
Last question for me, if I could sneak one more in here. It's just on pacing, given that we haven't heard or we don't really know kind of all the details there. I just want to make sure any comps that might be difficult for Genoptix as we think about quarterly pacing going forward, things that you would kind of call out, either about that side of the business or on the legacy side, just as we think about the quarters here. Thanks.
I don't think there's anything unusual, Brian, about the quarterly pacing at Genoptix. The revenue seasonality would mirror that of legacy NeoGenomics. What we're seeing so far is a stabilization of the volume. In the past, if you've looked at the SEC filings, you can see that Genoptix volume had declined in 2018 and previously. Now that's stabilized. There are no unusual trends that I would alert you to.
I think one thing just to think about is synergies will come over time, right? We have a great plan, and we're really excited about it. Those will unfold over time. There will be a little bit of a trend related to those that's towards the back end. Revenue compression, the bad news on this deal was that we expect to start really quickly, and we're already seeing our contracted payers interested in moving the Genoptix business over. That happens immediately versus when the synergies will kick in. You'll see a little bit of trending for those two that are on the different tracks. We hope that they meet as early as possible, compression will start earlier than synergies.
Great. Very helpful. Thank you guys so much.
Thank you, Brian.
Our next question comes from the line of John Hsu with Raymond James. Please go ahead, sir.
Good morning. Just a couple from me. Just on Genoptix, unless I missed this, do you have a specific cost synergy target for 2019? You were obviously very helpful, Sharon, in providing some of the details around that there would be pacing of synergies throughout the year. Just how do we think about maybe the run rate exiting 2018? Maybe along with that, since you've now closed the deal and have made progress on the Salesforce integration, any changes to your expectations for timelines for the integration process? Do we expect that the integration could be largely complete in 2019 or moving into 2020? Just help us think about the cost synergy targets for this year as well as timelines. Thank you.
Yeah. Over the three-year period, we're still looking at $25 million. Some of that is a little bit back-loaded because some big things have to happen, and mostly system rationalization has to happen. That takes time. There is some portion of that in this year. We're not giving out the exact amount, but it's not exactly straight-lined over the three years. It's not off that far. If you think about the revenue compression, it was $15 million originally calculated, with about half of that covered by their existing EBITDA. Our first task this year to get to flat EBITDA is to recognize enough synergies to offset that, and that gets us back to zero EBITDA on the Genoptix business. You could think of that as our target for the year, and we're working towards that goal.
Yeah. The bottom line, John, is we haven't seen anything which changes our original synergy estimates that we discussed before, and we're feeling like everything is on track.
Yeah. I think the timing is as we expected as well, right?
Yeah.
To get to your timing question.
Okay, great. Just one more from me, just on M&A. Can you just speak to your appetite for M&A at this point? You've obviously talked about wanting to continue to grow the Pharma Services side of the business. Maybe you could just give us your updated thoughts and any color on the pipeline.
We remain very interested in growing our Pharma business, both organically and through M&A. We are out there looking at deals. We are not currently looking to acquire in the Clinical business. We've got our hands full right now with the Genoptix integration. We are looking at Pharma deals, and we intend to continue to build that business through acquisition as well as organically.
Great. That's all for me. Thank you so much.
Once again, ladies and gentlemen, that is star and one if you would like to ask a question. We'll go next to Joe Munda with First Analysis.
Good morning. Can you hear me okay?
We can, Joe. Thanks.
Real quick, two quick questions here. First, in terms of 2019, with the integration of Genoptix and the volume growth expectations that you're putting out there, I was wondering if you could give us some color or some granularity on what your thoughts with test mix would look like in 2019. Then a follow-up in regards to the Pharma Services business. Can you give us some color on what the mix looks like in terms of stage of trial, or is Pharma Services, the backlog there, heavily weighted towards one phase of the trial or another? Thanks.
Sure, Joe. I will start by addressing the test mix question and then turn it over to George to talk about the Pharma Services backlog. In terms of test mix, because of Genoptix, we are seeing more of a mix in 2019 to gene testing as opposed to solid tumor. We are also seeing, as we have in the past, more growth in molecular testing, particularly the next-generation sequencing panels. Other than that, I think that what we're seeing is similar kinds of trends in terms of test mix as we've had before. In terms of Pharma, George?
We've really gone across. We do quite a bit of research and discovery or pre-phase 0, if you would, and up to phase I, II and III. What we did see in 2018 is sort of a shift to more longer trials, the phase II and III. That's really one of our objectives is to be large enough and at the scale to be able to handle a clinical trial, all the way through the discovery of the molecule, all the way through the FDA approval process. The flip side of that is having those phase II and III trials that can be a little bit longer in terms of the revenue recognition in our backlog. We're happy that obviously we're able to take these trials all the way through now.
Okay. Thank you.
Next, we'll go to Paul Knight with Janney Montgomery.
Hi, Doug. Two things. One is, the pricing environment for the core business, excluding Genoptix, seems to be better and better. What are your thoughts this year? That would be my first question for you.
Thanks, Paul. I would say the pricing environment is not necessarily better. It's always very competitive in our part of the market. I would say that PAMA, which is impacting the industry at large, is not as significant an impact on NeoGenomics. We're seeing some stabilization on the Physician Fee Schedule. As we engage in larger and larger GPOs and these kinds of contracts, there is some very modest price decline that we sometimes see as we gain volume, by entering into these agreements. I think the guidance that we've generally laid out there of 1%-3% kind of decline still seems appropriate to us. The days of having the significant declines that we've experienced years ago, we think for now, are behind us.
The other, Doug, would be regarding the PPD collaboration. Are you seeing that backlog build due to PPD, or is it separate from that? Can we get an update on that JV?
Yeah, we really can't call out specific clients in a backlog. Again, we are pleased with the alliance. We continue to make progress. We're both very committed to it. Both sides have worked together, and we've actually made some significant bids together. We've also had a few wins cross the finish line. We're pleased with the alliance, but we really can't call out specific numbers on it.
Thanks.
Thank you, Paul.
Next we'll go to Bruce Jackson with The Benchmark Company. Please go ahead, sir. Your line is open.
Good morning. Nice quarter. I've got a two-part question. On the quoted Genoptix revenue number, did that include any solid tumor revenue? Then can you just talk a little bit more about the synergy opportunity from the community oncology market, and do you think it can increase your solid tumor business there?
Yeah, Bruce, the Genoptix numbers do include some solid tumor, but most of that business coming from Genoptix is on the heme side. We do expect that there will be some revenue synergy, which we did not include in our original deal model, as a result of being able to provide solid tumor testing to the Genoptix customer base. As we met with all of the representatives at Genoptix, we learned that Genoptix was not actively pursuing solid tumor testing. As you know, we have a very strong solid tumor business at NeoGenomics, we are able to provide that kind of testing to those customers. We think that's a revenue synergy.
Great. Thank you.
You're welcome.
Ladies and gentlemen, once again, that is star and one, if you would like to ask a question or need clarification on anything covered in today's meeting. We'll pause just for a few more moments to allow everyone a final opportunity to signal us with star and one. It appears we have no signals from the group. Mr. Van Oort, I will turn it back to the group for any additional or closing remarks or perhaps if we received any web questions.
We have received no web questions. Thank you.
Okay. Thanks, Bill, and thank you, Jim. Before we end the call, I would like to recognize the approximately 1,475 NeoGenomics team members around the world for their dedication and commitment to building a world-class cancer genetics testing company. On behalf of our NeoGenomics team, I want to thank everyone for their time joining us this morning. For those of you listening who are investors or are considering an investment in NeoGenomics, we thank you for your interest in our company. Goodbye.
Ladies and gentlemen, this does conclude today's teleconference, and we do thank you all for your participation. You may now disconnect your lines and enjoy the rest of your day. Thank you.