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AMERICAN SHARED HOSPITAL SERVICES (AMS) Q1 2025 Earnings Summary

Executive Summary

  • Q1 2025 revenue rose 17% year over year to $6.11M, driven by Direct Patient Services ($3.10M) and the new LINAC operations; however gross margin fell to $0.94M and the quarter posted a net loss of ($0.10) per diluted share .
  • Bold miss vs estimates: Revenue $6.11M vs S&P Global consensus $8.63M*; EPS (-$0.10) vs $0.04* — driven by lower Gamma Knife volumes (contract expirations, upgrade downtime) and lower proton therapy volumes .
  • Mix shift continues toward direct patient services; LINAC revenue reached $2.4M (from $0 in Q1 2024), reflecting diversification beyond leasing .
  • Management cites April volume increases and expects a stronger H2 2025; catalysts include the Guadalajara Esprit Gamma Knife start-up “late 2025” and Rhode Island CON approvals for Bristol (RT center) and Johnston (proton center) .

What Went Well and What Went Wrong

What Went Well

  • Direct Patient Services revenue surged 224% YoY to $3.10M, reflecting Rhode Island center integration and Puebla, Mexico launch .
  • LINAC revenue reached $2.40M in Q1 2025 (from $0 in Q1 2024), exemplifying progress in the diversification strategy beyond equipment leasing .
  • Management tone: “We have already begun to see an increase in treatment volumes in April and expect to see further recovery into the back half of this year.” — Ray Stachowiak .

What Went Wrong

  • Gamma Knife revenue fell 18% to $2.10M; procedures declined 24% to 208 due to two contract expirations (Dec-2024, Feb-2025) and downtime for an Esprit upgrade .
  • Proton beam therapy revenue declined 38% to $1.60M; fractions fell 35% to 831 amid lower volumes .
  • Gross margin dropped to $0.94M (from $2.14M YoY), reflecting higher staffing, tech investments, lower GK volumes, and the lower-margin profile of direct patient services; operating loss widened to ($1.30M) .

Financial Results

Consolidated Performance vs Prior Periods

MetricQ1 2024Q3 2024Q4 2024Q1 2025
Revenues ($USD)$5,216,000 $6,999,000 $9,069,000 $6,112,000
Gross Margin ($USD)$2,143,000 $1,370,000 $3,204,000 $942,000
Adjusted EBITDA ($USD)$1,745,000 $1,366,000 $3,464,000 $949,000
Net (Loss) Income ($USD) attributable to AMS$119,000 ($207,000) ($1,308,000) ($625,000)
Diluted EPS ($USD)$0.02 ($0.03) ($0.20) ($0.10)

Estimates vs Actuals (S&P Global consensus)

MetricPeriodConsensusActual
Revenue ($USD)Q1 2025$8,630,000*$6,112,000
Primary EPS ($USD)Q1 2025$0.04*($0.10)
# of Estimates (Revenue)Q1 20251*—
# of Estimates (EPS)Q1 20251*—

Values marked with * retrieved from S&P Global.

Segment and Sub-Segment Breakdown

Segment / Sub-SegmentQ1 2024Q1 2025
Direct Patient Services Revenue ($USD)$963,000 $3,100,000
Equipment Leasing Revenue ($USD)$4,300,000 $3,000,000
Gamma Knife Revenue ($USD)$2,600,000 $2,100,000
Proton Beam Therapy Revenue ($USD)$2,600,000 $1,600,000
LINAC (Radiation Therapy) Revenue ($USD)$0 $2,400,000

KPIs

KPIQ1 2024Q1 2025
Gamma Knife Procedures (count)273 208
Proton Therapy Fractions (count)1,276 831
Cash, Cash Equivalents & Restricted Cash ($USD)$11,275,000 (12/31/2024) $11,491,000 (3/31/2025)
Shareholders’ Equity, excl. NCI ($USD)$25,183,000 (12/31/2024) $24,647,000 (3/31/2025)

Guidance Changes

MetricPeriodPrevious GuidanceCurrent GuidanceChange
Treatment Volumes2025None provided“Increase in April” and “stronger back half of 2025” Directional recovery expected
Guadalajara Esprit Gamma Knife Go-LiveLate 2025N/AStart treating patients and generating revenue towards end of 2025 New milestone timing reiterated
Rhode Island Expansion (Bristol RT center, Johnston proton center)Multi-yearN/ACON approvals obtained; expansion plans reaffirmed Expansion affirmed
Financial Guidance (Revenue/Margins)2025None providedNo quantitative guidance; focus on efficiencies and profitability over time Maintained: no formal numeric guidance

Earnings Call Themes & Trends

TopicPrevious Mentions (Q3 2024)Previous Mentions (Q4 2024)Current Period (Q1 2025)Trend
International expansionPuebla launch; pipeline momentum JV signed for Guadalajara; strong expected volumes in Peru/Ecuador Guadalajara to start late 2025; continued momentum in Ecuador/Peru Advancing
Rhode Island footprint & staffingRI acquisition integration; efficiency initiatives Brown University staffing agreement; synergies with Care New England & Prospect CharterCare Continued staffing optimization; expect steady volume growth as fully staffed Improving
Equipment upgradesGK downtime/upgrades impacting GK volumes Portfolio upgrades to enhance uptime Esprit upgrade downtime cited; LINACs on service agreements for dependability Ongoing
Volume trends (GK/Proton)GK volumes down; proton up modestly in Q3 GK/proton down in Q4 amid contract expirations and macro/local effects GK/proton down in Q1; April volumes trending up Near-term recovery
Reimbursement/MacroNot highlightedNot highlightedMedicaid exposure viewed as limited; primary payers are private/Medicare Low direct risk
Business mix shift to Direct Patient ServicesRetail growth noted Transition toward direct patient care emphasized Retail revenue +224% YoY; LINAC $2.4M Accelerating

Management Commentary

  • “We have already begun to see an increase in treatment volumes in April and expect to see further recovery into the back half of this year.” — Ray Stachowiak .
  • “This will be the only Esprit Gamma Knife in a country of 130 million people… an untapped growth engine for us.” — Gary Delanois (Guadalajara JV) .
  • “The decline [in GK volumes] was primarily due to the expiration of 2 contracts… and downtime to upgrade a third customer to new Elekta Esprit.” — Scott Frech .
  • “Our linear accelerators [are] on service and maintenance agreements… higher uptime for better patient service.” — Gary Delanois .

Q&A Highlights

  • Reimbursement risk: Management views Medicaid changes as low risk given limited Medicaid exposure; primary payers are private insurers and Medicare .
  • Fixed cost absorption: As the Rhode Island footprint expands, AMS expects greater influence over activities/relationships to grow patient volumes under a fixed-cost model .
  • Closing tone: Leadership emphasized strategic confidence and near-term recovery momentum with multiple growth milestones (RI expansion, Guadalajara) .

Estimates Context

  • Consensus coverage is limited (one estimate each for revenue and EPS). Q1 2025 EPS was a miss: ($0.10) actual vs $0.04 consensus; revenue missed: $6.11M actual vs $8.63M* consensus .
  • The miss reflects lower GK and proton volumes (contract expirations, upgrade downtime) and the lower-margin direct care mix — factors likely to prompt near-term estimate revisions until volume recovery is evident .
    Values marked with * retrieved from S&P Global.

Key Takeaways for Investors

  • Mix shift is real: Direct Patient Services is scaling (LINAC $2.4M; retail +224% YoY), but carries lower gross margin, requiring volume leverage to expand profitability .
  • Near-term headwinds in GK/proton volumes caused a notable consensus miss; watch monthly volumes (April cited up) and H2 trajectory for confirmation .
  • Structural catalysts: Guadalajara Esprit start-up (late 2025), RI Bristol RT center, and Johnston proton center should add capacity and strategic presence .
  • Operational execution matters: Staffing optimization (Brown University agreement), service contracts for LINAC uptime, and physician engagement are key to driving volumes .
  • Balance sheet supports expansion: $11.49M cash and $24.65M equity provide flexibility for tuck-ins and growth investments .
  • Estimate sensitivity: With limited coverage and a new mix, consensus may lag execution; strong evidence of volume recovery could re-rate sentiment.
  • Focus on volume ramps and contract pipeline; contract expirations and upgrade downtimes were transitory drivers of Q1 weakness .

Additional primary sources reviewed for context:

  • Q1 2025 press release and 8-K furnishing the press release -.
  • Prior quarters’ materials: Q4 2024 press release and call - -; Q3 2024 press release -.

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