When they're most prone to going in and out of the hospital and burdening the payer with cost and the hospitals with readmissions and so on and so forth. We manage that in the home and prevent it from happening. On top of the complex respiratory service offering, we've also bolted on a sleep platform, a maternal health, and staffing divisions, and we'll get into the details of all those divisions here in the presentation. We've got over 172,000 patients in our care, under our care across 50 states. Probably, you know, got decent coverage in 37, 38 states. There's still plenty of room to densify and grow throughout the country.
We use technology that we place in the home and couple it with human touch to ultimately drive down these costs for the healthcare system and drive quality of care. The company has been growing since its public inception on a 26% CAGR, and we generated $28 million of free cash flow in 2025 with no net debt. This is a look at our management team. We've got, you know, over 80 years of public company experience across this team. Myself and Michael Moore are the original founders of the business. We've been at it for 20 years. Todd and Trae here at my left and right have been with us for 10 years. The insiders represent roughly 20% of insider ownership in the company.
I mean, this investor deck's a little bit dated as of whenever we had to post it, but I think we're right around, what, $350 million market cap ballpark right now where we sit today. There's multiple catalysts that are driving our growth. We're in a massively underserved population of patients that need our care in the home. I'll get into it in the coming slides about how we look at the COPD market and it being underserved. Roughly 10% market penetration for COPDers for this service. We've got the sleep business that's 20% or less, you know, under-penetrated. The same goes for oxygen therapy as well. Viemed serves as this vital link between the payers, the providers, and the patients, providers being the physicians.
We kinda navigate that patient through the system, hold their hand, make sure that they get the care in the home. It's a proven growth platform with a broadening service mix. We've been diversifying the business pretty heavily over the past five, six years, and I'll explain more on that in the coming slides. There's also regulatory tailwinds that favor our model, ultimately just being driven by the aging population of the, you know, folks in the country with baby boomers turning 65 every day. We've got about 10,000 of those guys turning 65 every day, and that trend is gonna continue through 2030. This is a deeper dive on the core business. Our complex respiratory model is supported by a ventilator product that we manage in the home.
You can see this graph shows the quarter-by-quarter vent active patient growth since 2020. The monthly reimbursement for a vent, we get about $1,050 from Medicare, and most private insurance is in that same reimbursement model. As I mentioned, the average length of stay is 17 months, but the reimbursement is an uncapped rental, meaning that if we keep them alive for three years, we can bill for those 36 months. But oftentimes, we might lose a patient in the first three months. It's a bundled rate that includes the 24/7 respiratory care in the home, all the supplies, and all the equipment that's needed to manage the patient. Medicare and private insurance pay for the majority of these services. This is a deeper dive into the COPD massively underserved population.
We got about 25 million COPDers inside of the country. About 10% of those patients, 2.5 million, are at the most severe level of the disease state. You know, that's whenever they're most prone to having their lungs fail them. Whenever they reach chronic respiratory failure, that's roughly half of those guys, that's when they become a candidate for complex respiratory. We got 1.25 million of those patients in the Medicare system right now, and we've only treated, as an industry, 70,000 Medicare beneficiaries. This, this right here represents a 6% market penetration for Medicare. When you bolt on private insurance, you're probably at the sub-10% market penetration number. Viemed's the third-largest provider in the space. We represent about 14% of the overall market share.
There's really not that many companies that are out there doing complex respiratory service at least that well. The top 10 providers make up 62% of the overall market share. We use technology that we built here in-house to go into the home to assist our RTs and provide a better patient experience. She's holding a tablet right now that will connect to the vent, connect to all the equipment in the home, give us readings from afar. It's got a telehealth feature that will go back and forth with the respiratory therapist. That way, when folks have shortness of breath attacks and, you know, they're struggling, they can have a real-time interaction with our respiratory therapist.
On the back end of all the technology, we're capturing data, we're capturing outcomes that we can report back to the physician and to the payer to just be a more collaborative partner. We've completed three studies in the space. I'm not gonna go through every single detail on this slide, but there's some general themes. You know, we have a 43% in relative mortality reduction, a 39% relative reduction in all-cause mortality over the course of seven years. It's, you know, and these studies show that we do prevent ER visits, we prevent hospitalizations from happening. Naturally, that's where you're generating the cost savings that are shown on the study to the left. We get 'em on therapies sooner rather than later. We could save north of $5,400 per patient per year.
Our operating model is very unique and lean and scalable. We don't typically require your traditional DME infrastructure, meaning, you know, a retail store or a brick-and-mortar facility to offer our services. We've got therapists that have inventory in the trunks of their car. They're trained to stop and go at a moment's notice for whatever the patient needs. It's a mobile workforce, backed by the data. You know, when we decide to go somewhere, we're looking at COPD prevalence, we're looking at hospital bed readmissions, and we're targeting these COPD needy rich environments to go to the next spot. At the end of the day, it's a very lean market entry, and we can scale pretty darn fast across the country.
Some of our product offerings beyond ventilation is airway clearance, which is, you know, a percussion vest or an airway clearance device designed to clear the airway and allow the patient to produce coughs. We have stationary and portable oxygen concentrators that are in place to treat the Stage 1, 2, and 3, the earlier disease state phases of COPD. Sleep CPAP therapy, the CPAPs designed to treat sleep apnea, and the resupply that goes with it, which is typically your mask, your tubing, your filters, and your consumables that are repeat and residual income with the patient. The last one is breast pumps. We did purchase a company in July 1 of last year, Lehan's Medical in Illinois. That was 60% maternal health and 40% respiratory.
We're in the process now of adding breast pumps to the mix, maternal health's becoming material part of the business, and we look forward to expand it here in 2026 and beyond. Outside of the current national model, while we do have full line DME offerings, and that helps us get hospital joint venture contracts and things of that nature, it's not really a fundamental part of our expansion plans to go full line DME throughout the entire country. We just have certain little pockets where we'll do so. Six years later, these numbers tell the story of our diversification efforts over the past six years.
You can see in this chart that in 2019, we were 87% a ventilator company, and we had some initiatives and strategic goals to really change that and flip the script. You can see we're pretty proud of the fact that we're now a 48% ventilator company, well more diversified. 8% of our business, oxygen. Airway clearance represents 7%. Sleep, probably one of the fastest-growing sectors of our business right now, is now up to 21%. Maternal health's at 6%, and a staffing component that we bolted on post-COVID, it was a two-pronged approach. We wanted to find our folks with the staffing division during a clinical labor shortage and also be helpful to our hospital partners who were looking for contract nursing at that time, post-COVID.
That business has since morphed into doing state-by-state contracts and providing different types of staffing. Primarily, 80% of the business now has a behavioral health component where we're placing licensed clinical social workers in certain pockets to manage different projects on a state-by-state basis. The last piece, it just shows you on the far right-hand side how we diversified our payer mix as we diversified the business along the way. Ventilation's primarily heavily reliant on Medicare reimbursement, and so that's gone down since 2019. As I mentioned, sleep is the clearest example of our fastest-growing division. You can see how we've grown it since 2023 on a quarter-by-quarter basis. Last year, we grew CPAP growth by 62%. Resupply grew 49%.
As of 4Q 2025, it was 21% of our net revenue. We're pretty proud of the sleep growth, and we'll continue to double down on that here in 2026. There's multiple tailwinds behind sleep. Some of them come from our acquisition of HMP and Lehan's. We bought a handful of sleep patients through those transactions. We've also accelerated our growth with our sales reps in different pockets throughout the country. The name of the game for us is just finding good people and placing them in target-rich environments to where they capture this business. The addressable market on sleep is over 30 million patients in the U.S. right now. This is a better look at the different product sectors, the percentage of revenue that they represent.
Oxygen represents 8%. Our growth rate was 8% in 2025. Airway clearance was 7% of the revenue with a growth rate of 18% in 2025. Women's health, 6%. 2025 growth rate of 100%. We were able to really help our new acquisition grow their maternal health business through leveraging the Viemed contracts that are throughout the country, and we'll continue to do that as well. Healthcare staffing represents 8% and had a growth rate of 12% in 2025. All divisions growing and on track here, so we have a lot of positive momentum with Viemed as we sit here today. Getting in a little bit to the growth strategy, I mean, I mentioned that we're a 26% CAGR growth company.
The majority of that really is coming from our organic growth model, and you know, it's, there's lots of opportunities to still continue to hit that underserved population. Our plan is to densify in the markets that we are and then certainly expand into new territories like we have been for many years now. Excuse me. Then inorganic growth, we've got companies that are teed up in the pipeline. We're pretty picky on who we bring into the fold. Our M&A strategy, we're not really your typical roll-up story because we're growing so rapidly organically, but we look for companies with great management teams that are in position to springboard our organic growth engine.
That was the description of HMP, which was done in June 2023, and East Alabama Medical Center joint venture done in 2024, and then Lehan done in 2025. The operational leverages that we're tugging on, I mean, we're using AI tools throughout almost every single department across Viemed right now. It's been super helpful. We're growing, so we haven't had to fire a bunch of people, but we're probably going to be hiring less at a slower rate, if you will, in the future just with utilizing some of these tools. We'll continue to do that. We've got a declining CapEx intensity, and it's a very capital-light business in order to grow. Then, as I mentioned, favorable free cash flow margin mix. The shared infrastructure reduces incremental cost per service.
I talked a little bit about all three of these, but you know, just to focus a little bit on HMP, their product mix was 20% complex respiratory and 80% sleep when we found them. It was a good acquisition for us with a great team. We were able to teach them how to expand their complex respiratory and still help them grow their sleep business, and it ended up being in a coverage gap that we had in around Tennessee, North Alabama, North Mississippi. We took advantage of a geographical strategy expansion. East Alabama Medical Center was our first joint venture that we pulled off with this hospital. We acquired a company called Home Med that was owned by East Alabama Medical Center.
Basically came in, really taught them how to do complex respiratory and higher margin business a little bit more efficiently, and it's been a win-win for both parties through that transaction. The last one, as I mentioned, and it's been talked about, is Lehan's, so I won't dig in on that. Lots of runway and opportunity for this company. I mean, the CMS is obviously signaling that we need to be treating more patients in the home. They've been very supportive of our industry. We just had a kind of flip it over to the stable regulatory environment. They have announced that competitive bidding, which is a program designed for us to all establish fair market value and pricing. The products that Viemed has today will be excluded from competitive bidding. Lots of our investors were focused on this.
We weren't terribly afraid of competitive bidding, but it's one less distraction that we have to deal with and offers a lot more stability for the future. Of course, the aging population. The hospital cost pressure goes back to length of stay management. I mean, what we do for the hospital is we get patients out of there at the right time. You know, if we can get them out of there two days sooner, that frees up a bed for the next patient, which is a heavy focus right now on hospital management. We're very helpful in helping them achieve their length of stay goals. This is a deeper dive into the regulatory stability. You know, over the years, we've received bumps from Medicare reimbursement through the CPI rates. As mentioned, competitive bidding is excluded.
Most recently in June, they established a new vent NCD, which is a pretty hot topic for all of our investors to understand. NCD is a National Coverage Determinations. Basically, the rules that we have to follow for navigating the vent business. We were asking for more rules, and we got them. The competitive advantage here is that there's no more ambiguity in between what we have to do in order to treat a vent patient, and it really is a signal to the MA plans. As Medicare has initiatives that hold them accountable to the same clinical standards, we can now prevent denials from MA plans because we have these concrete rules in place with this new NCD. We're already seeing that behavioral shift from payers, so that's been a positive tailwind for us.
Finally, I'm gonna swing over and let Todd get it.
All right. Just touching on 2025, I think the easiest way to describe it is writing press releases is pretty fun right now for Viemed. We're pretty much hitting new records every quarter. We ended last year with just over $270 million of revenue and over $60 million of EBITDA. Like Casey just mentioned, all product lines are growing, and we really don't have a set percentage that we're looking for. As long as everything is growing and growing profitably, that's all that we really care about, and let the chips fall where they will. We remain debt-free on a net basis. We have about as much cash as debt. We've been paying that down since the Lehan's acquisition.
As mentioned, we have put another buyback in place where we just executed our third buyback last year. We bought back 5% of the equity, and as I'll talk about, we put a new one in place. Casey mentioned it, but the green number on here is the one that we're getting most excited about. We grew 21% last year and still generated $28 million of free cash flow, which gives us the optionality to build the coffers for more M&A or continue to buy back shares when the valuation presents itself as an opportunity. This just shows you a few years of growth from 2023 through 2025, and then where our guidance is.
Not by design, but it looks like we're basically growing about $40 million -$45 million of gross revenue a year, and you can see the EBITDA that follows along with that. Gross margins are compressing slightly over time, and that's really a product of the diversification within the product lines. The EBITDA margins are relatively stable, and net income is continuing to stay relatively stable to maybe up slightly on, like, maybe 20 to 50 bps a year. I didn't say it, but we've been positive net income every year since our public existence, which is something we're very proud of. Sometimes when you're in growth mode, you sacrifice profitability for that, and we understand that sometimes.
We've been able to grow this company, you know, 26% on a CAGR basis and stay positive net income throughout the whole time. This shows that growth over time. Obviously, growing when you're a $40 million company like we were when we spun ourselves out, we were growing 40% and 50% a year. Now the growth rate is tempered to, I think it was 21%. The midpoint of guidance this year has us growing 17%. What's most impressive, and Casey kinda touched on it, is from the $40 million to $300 million or $270 million that we did last year, all but roughly $50 million of that has been organic. So in that $270 million , acquired revenue would be about $50 million. The rest is organic.
I mean, sales-driven organization, finding new salespeople, finding new therapists in pockets of underserved communities is what we do and what we do best. Finding revenue synergy M&A is the new part of the growth strategy, if you will. This lays out where we are for guidance this year, $310 million-$320 million of revenue and EBITDA of $65 million-$69 million. The growth in EBITDA slightly drags compared to revenue, really as a function of last year we had some gains as a result of a vent buyback program that we took advantage of. There was a few million dollars of kinda, if you wanna call it, one-time gains in last year's numbers. Once again, still maintaining healthy EBITDA and healthy net income margins.
As you see, the CapEx intensity, Casey briefly mentioned this, is really coming down because the maturity of the vent business, which has always been our highest CapEx business, is showing signs as we're sitting here around 12,000-13,000 active patients. We're not having to buy as many new vents going forward. Such rapid growth coming from the sleep resupply business, which is a CapEx zero product line. The new business line from maternal health is very, very low CapEx as well. As the vent business has matured and we've identified and brought in more material product lines that don't have as much CapEx, it gives us the confidence to say we are gonna continue to grow free cash flow.
We don't guide it 'cause it's a tough number to guide, but we feel comfortable that the $28 million will be grown upon this year. Capital allocation, you've heard us talk about organic growth. It is what we wake up and drive ourselves to do every day. We are an organic growth company. We do like the M&A optionality, and as we sit here and build the balance sheet up and have the free cash flow, we want to do more M&A. We're very disciplined in our M&A. As Casey mentioned, we don't just roll up a bunch of companies just to pack revenue into the P&L.
We look for management teams that we can keep on board and either have them help us grow their product lines around the country, like the maternal health, or teach people how to do more complex respiratory as we feel like we're best in class when it comes to ventilation, which we've done on both of our acquisitions to this point. Lastly, we're always looking to return capital to shareholders, really through buybacks. We've entertained dividends in the past, but buybacks have been the most efficient to this point. As I mentioned, we've already completed three buybacks. We've bought back 4.5 million shares at an average price of $5.79, which today we're trading a little bit north of $9, $9.50, and so it's been a good use of our capital over time.
We just launched another buyback, I guess last week. We will continue to use that as a prong of growing value for shareholders. And last, kinda why own the company. We have a proven model. We are up to +170,000 patients around the country. We continue to grow that every month. It's a matter of finding new pockets to go put salespeople around the country and deliver value. Ultimately, if we put the patient first, we've proven that physicians like to refer patients to us, and we can make a successful business out of it. The regulatory stability that Casey talked about is extremely important. While we don't fear competitive bidding, it does give overhang to the stock because it's uncertainty that is behind us at this point for some period of time.
The vent NCD that came out really is impactful to us because it gives us a set of rules and clarity that we can go and conduct business for the foreseeable future without, you know, sort of backwards looking audit potential. The financial performance is something we're always proud of. The balance sheet is best in class, the growth rates are best in class, and the profitability is there. Now, like I've mentioned a couple of times, the free cash flow puts us in an extremely enviable position to where we just have to determine what's the best use of that capital on an annual basis. The M&A optionality is there. We've done three deals. They've all been accretive. Pretty sure in the first quarter we closed them. They're definitely all accretive over time, and that's something we're extremely proud of.
Our M&A team has done a good job of bringing good opportunities, and we've been patient and diligent, and we will continue to do that. Capital allocation is always something we are very in tune to. As I think Casey mentioned, we own 20%-25% of the beneficial ownership out there, so we show up every day aligned with our shareholders on the street. We're in this for the long haul, and we're having a lot of fun doing it.
That concludes our prepared remarks at this time. Jim, I think we will open it up to any questions.
Okay. We don't have much time, but you know, the one thing that always gets me when I watch a presentation is that slide on the sleep apnea growth. You know, when GLP-1s came out, you know, everybody thought that market was gonna fall apart. You guys, I think you grew 60% last year, and it sounds like you're you know expect some pretty good growth this year. You know, what's the secret to growing that business?
You know, there's a massive demand for sleep apnea treatment right now throughout the country. For us, we're a really good sales organization with a clinical focus. It's been expanding that offering out to all of our sales force throughout the country. You know, when we first expanded Viemed, it was complex respiratory only, and then once we had our contracts in place, we chased the sleep business. It was a little bit of a late start for sleep for us. Some of that growth you're seeing is because we haven't been at it for 20 years or for, you know, 14 years like we have been with complex respiratory.
Nevertheless, wherever we go, we see opportunity. We're usually able to beat out the competitor with a more creative offering, with home sleep and sleep coaching and holding the hand of a patient in a more careful manner. That's why we're winning right now.
The overall reimbursement environment, can you just you know, how has it trended the past couple of years, especially on the vent side? You know, where do you think that's headed?
Yeah, I mean, I think we've seen over the last few years, it's just been CPI bumps. They've been at historic levels. You know, coming out of COVID, we saw some 5%, some 8% CPI bumps. This year, like we have in that slide, it was 2%-2.8%, depending upon the product and what zip code the product is in. That's our current expectation. I mean, the only thing on the reimbursement environment would be competitive bidding. Again, another positive that our products were excluded. That again would take place, you know, for the affected products, for continuous glucose monitoring and some other products.
Those will be 2028, but other than that, our expectation is this year what we already know, the 2%-3% CPI bump, and we'll likely get another one, if not a little bit higher, here going into 2027.
All right. Great. Hey, well, we are out of time. I appreciate, though, that you did take the time to present today and to do meetings with us and wanna thank all the investors who are tuning in as well. Thank you.
Thanks for having us.
Thanks for having us, Jim.
Appreciate it.
Bye-bye.