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EB

EKSO BIONICS HOLDINGS, INC. (EKSO)·Q4 2024 Earnings Summary

Executive Summary

  • Record Q4 revenue and improved gross margins, but losses persisted: Q4 revenue reached $5.09M (company record) with gross margin ~53%, up 400 bps YoY, while net loss was $(3.41)M, or $(0.14) per share .
  • Operational levers turned positive: supply chain and service-cost efficiencies drove margin gains; OpEx fell YoY on lower headcount and discretionary spend .
  • Personal channel build-out advanced: management paused new Medicare claim submissions in Q4 to retool process, engaged Pria Healthcare, built a backlog of 25+ Medicare candidates, and named National Seating & Mobility (NSM) exclusive CRT distributor for Indego Personal, positioning for 2025 acceleration .
  • Estimate context: The company did not provide guidance, and we did not find a published S&P Global consensus for EKSO this quarter in company materials; therefore, no vs-consensus comparison is included.

What Went Well and What Went Wrong

What Went Well

  • Record revenue and higher gross margin: “Record Q4-2024 revenue of $5.1 million” with gross margin ~53% (+400 bps YoY) driven by supply chain savings and reduced service costs .
  • Cost discipline: Sales & marketing ($1.9M), R&D ($0.845M), and G&A ($2.2M) all declined YoY, reflecting lower headcount and discretionary payroll/consulting .
  • Strategic channel progress: Exclusive NSM CRT distribution for Indego Personal announced; management emphasized this expands access and leverages NSM’s 180+ locations and payer relationships . Quote: “We are excited to expand the distribution of the Ekso Indego Personal device through this strategic commercial partnership with NSM.” – CEO Scott Davis .

What Went Wrong

  • Losses continue and widened sequentially vs Q3: Q4 net loss $(3.41)M vs $(2.07)M in Q3; EPS $(0.14) vs $(0.10) in Q3 .
  • Personal Medicare ramp slower than hoped: After first reimbursement in July, subsequent claims moved to appeals; company “elected not to submit additional claims” in Q4 while retooling the process with Pria .
  • Europe tailwind set to normalize: Exceptional 2024 growth tied to French hospital systems is expected to taper back to “normal growth” in 2025, muting a recent regional boost .

Financial Results

Quarterly P&L progression (oldest → newest)

MetricQ2 2024Q3 2024Q4 2024
Revenue ($USD Millions)$4.950 $4.129 $5.090
Gross Profit ($USD Millions)$2.637 $2.209 $2.714
Gross Margin (%)53% 53.5% ~53%
Total Operating Expenses ($USD Millions)$4.972 $4.848 $4.944
Loss from Operations ($USD Millions)$(2.335) $(2.639) $(2.230)
Net Loss ($USD Millions)$(2.416) $(2.072) $(3.413)
EPS (Basic & Diluted, $)$(0.13) $(0.10) $(0.14)
Operating Cash Flow (Use) ($USD Millions)n/an/a$(1.4)

YoY Q4 comparison

MetricQ4 2023Q4 2024
Revenue ($USD Millions)$4.847 $5.090
Gross Profit ($USD Millions)$2.369 $2.714
Gross Margin (%)49% ~53%
Total Operating Expenses ($USD Millions)$5.818 $4.944
Loss from Operations ($USD Millions)$(3.449) $(2.230)
Net Loss ($USD Millions)$(3.214) $(3.413)
EPS (Basic & Diluted, $)$(0.22) $(0.14)
Operating Cash Flow (Use) ($USD Millions)$(1.6) $(1.4)

KPIs (disclosed)

  • Devices sold (EksoHealth): Q2 2024 = 37 units ; Q3 2024 = 33 units ; Q4 2024 not disclosed.
  • Cash & restricted cash: Dec 31, 2024 = $6.5M .

Segment disclosure

  • Ekso operates as one operating and reportable segment with two markets (Enterprise Health and Personal Health); no segment revenue breakout provided .

Guidance Changes

Metric/TopicPeriodPrevious Guidance/CommentaryCurrent Guidance/CommentaryChange
Enterprise Health multi-unit orders2025“Normalize… procurement cycles with Integrated Delivery Networks near-term” (Q3 PR) Expect to be back in standard procurement cycles; anticipate more multi-unit orders in 2025 (NA) Qualitative positive update
CMS Medicare claims (Indego Personal)Next 6–9 monthsQ3: initial CMS reimbursement; “growing… claim submissions… pipeline” (no count) Built backlog of 25+ Medicare candidates; anticipate submitting claims over next 6–9 months (cannot guarantee payment) Greater specificity; execution-focused
Gross margin trajectory2025Q3: GM ~53.5% amid cost efficiencies GM may vary q/q but expected to trend up through 2025 Positive qualitative
Formal financial guidance (revenues/EPS)n/aNone providedNone provided Maintained (none)

Earnings Call Themes & Trends

TopicPrevious Mentions (Q-2 and Q-1)Current Period (Q4 2024)Trend
CMS reimbursement & go-to-market (Indego Personal)Q2: Initial Medicare claims pending reimbursement . Q3: Received initial CMS reimbursement; growing submission pipeline .Paused new Q4 submissions; engaged Pria Healthcare; backlog 25+ Medicare candidates; plan submissions over next 6–9 months .Building infrastructure; near-term pause → structured scale-up
Distribution partnershipsQ2/Q3: Focus on IDNs and DME partners .NSM named exclusive CRT distributor for Indego Personal in the U.S. .Expanded channel reach
Regional trendsQ2/Q3: International activity ongoing .Europe exceptional in 2024 due to French hospital systems; expect taper to normal growth; APAC growth to continue; potential personal device opportunity via existing reimbursement programs .Europe normalization; APAC steady-to-improving
Supply chain & marginsQ2: GM 53% on ASP and cost improvements . Q3: GM 53.5% on supply chain/service cost savings .Q4 GM ~53%, improvements from supply chain and service cost reductions; 2025 GM trending up .Sustained efficiency gains
Enterprise Health demandQ2/Q3: Off-cycle IDN procurement in 2024; normalization expected near-term .Expect multi-unit orders as procurement cycles return in 2025 .Positive setup for 2025
AI/technologyQ4: AI-for-Good webinar keynote on AI-powered exoskeletons (Nov) .Management emphasizes clinical and mobility innovation; no specific Q4 AI product KPI disclosed .Thought leadership; early ecosystem engagement

Management Commentary

  • “We are pleased to close out 2024 with record fourth quarter revenue, improved gross margin and growing interest in our unrivalled portfolio of Enterprise Health and Personal Health devices.” – CEO Scott Davis .
  • “One of these key changes was engaging Pria Healthcare… we anticipate submitting [25+] claims to CMS over the next 6 to 9 months… we didn’t have that confidence without them. Thus, our reluctance to submit Medicare claims in the fourth quarter.” – CEO Scott Davis .
  • “This marks our first entrance into the large and growing CRT space… we believe NSM is ideally suited to help us expand the distribution of Indego Personal through this new strategic partnership.” – CEO Scott Davis ; see also NSM press release .
  • “Operating expenses… were $4.9 million, a 15% decrease [YoY]… due to a decrease in headcount, discretionary payroll and consultant costs.” – CFO Jerome Wong .

Q&A Highlights

  • Enterprise multi-unit orders: 2024 was off-cycle for major IDNs; 2025 expected to be back on standard procurement cycles, supporting more multi-unit orders, especially in North America .
  • Medicare claims volume: Company identified ~25 Medicare beneficiaries for Indego Personal and plans submissions over 6–9 months with Pria’s assistance; private payer strategy expected to follow after establishing consistent Medicare success .
  • Patient qualification: Prioritizing SCI patients who meet FDA indications, appropriate health screening, and “pure Medicare” coverage; broader pools (Medicare Advantage/private) cultivated for future reimbursement expansion .
  • Regional outlook: APAC growth expected to continue; Europe to revert to normal growth post-2024 surge tied to French hospital adoption .
  • NSM partnership: NSM seen as best-in-breed CRT partner with payer experience; complements ongoing O&P DME pilots .

Estimates Context

  • No formal guidance provided by the company for revenues or EPS .
  • We did not find a published S&P Global consensus for EKSO in company materials; thus, versus-consensus comparisons are omitted.

Key Takeaways for Investors

  • Q4 delivered record revenue with structurally higher gross margins from supply chain and service-cost efficiencies; operating losses narrowed YoY but widened sequentially vs Q3, reflecting mix and other P&L items .
  • The personal channel is the 2025 swing factor: pause in Q4 submissions was strategic; Pria engagement, NSM exclusive CRT distribution, and a 25+ Medicare backlog create clearer line of sight to reimbursement-driven growth as processes mature .
  • Enterprise Health could re-accelerate as IDN procurement cycles normalize in 2025, supporting potential multi-unit orders and providing a steadier base of revenue .
  • Regional dynamics: Europe’s exceptional 2024 likely normalizes; APAC remains a steady growth vector, with potential for personal device uptake where reimbursement exists .
  • Margin trajectory constructive: management expects gross margin to trend up through 2025, aided by supply chain and production efficiencies; watch mix and distribution shifts .
  • Liquidity: Cash and restricted cash stood at $6.5M at year-end; operating cash burn improved YoY in Q4; monitor working capital and claim collection cadence as personal channel scales .
  • Execution watchlist for 1H25: timing/approval of Medicare claims, NSM-driven funnel conversion, and visibility on private payer pathways after establishing consistent Medicare outcomes .