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Vivos Therapeutics, Inc. (VVOS)·Q1 2025 Earnings Summary

Executive Summary

  • Q1 2025 revenue was $3.02M, down 12% year over year and below Wall Street consensus; EPS was -$0.45 and EBITDA -$3.74M, both weaker than estimates as the company pivoted away from VIP service revenue to direct-to-patient product sales through provider alliances and pending acquisitions . Revenue consensus was $3.67M*, EPS consensus -$0.40*, EBITDA consensus -$2.60M*; revenue and EBITDA missed, EPS slightly missed. Values retrieved from S&P Global.
  • Product revenue grew 8% YoY and appliances shipped nearly doubled (3,736 arches vs. 1,996), but gross margin compressed to 50% (57% prior year) due to reduced high-margin VIP service revenue .
  • Liquidity declined as cash and equivalents fell to $2.34M (from $6.26M at 12/31/24); cash used in operations increased to $3.8M as contract liabilities and accruals declined .
  • Strategic catalyst: definitive agreement to acquire The Sleep Center of Nevada (SCN) for up to $9M; management expects revenue accretion and potentially cash-flow positive operations by Q3 2025, contingent on closing and financing (senior loan + equity) .

What Went Well and What Went Wrong

What Went Well

  • Product momentum: product revenue +8% YoY; arches shipped +87% YoY (3,736 vs. 1,996), reflecting growing pediatric guide volumes and direct patient focus .
  • Operating discipline: operating expenses down 5% YoY to $5.43M amid continued sales/marketing and G&A cost cuts supporting the pivot .
  • Strategic progress: signed $9M SCN acquisition; management highlighted accretive revenue potential, 3,000+ monthly patient flow, and expected contribution margins ≥50% .
    • “We’re on the cusp of seeing our strategic pivot come to fruition.” – CEO Kirk Huntsman .
    • “We expect… net contribution margins for SCN revenue… 50% or better.” – CEO .

What Went Wrong

  • Top-line and margin pressure: total revenue fell 12% YoY to $3.02M; gross margin dropped to 50% (57% prior year) as VIP service revenue declined per strategy .
  • Consensus miss: revenue $3.02M vs. $3.67M* consensus; EBITDA -$3.74M vs. -$2.60M* consensus; EPS -$0.45 vs. -$0.40* consensus. Values retrieved from S&P Global.
  • Liquidity strain: cash fell to $2.34M (from $6.26M at YE) and operating cash burn rose to $3.8M due to lower contract liabilities and reductions in accruals/payables; financing needed to close SCN and bolster liquidity .
    • CFO: “We are actively seeking financing to close the SCN transaction and bolster our cash position.”

Financial Results

Core Financials (quarterly)

MetricQ3 2024Q4 2024Q1 2025
Revenue ($USD Millions)$3.86 $3.70*$3.02
EPS (Basic & Diluted, $USD)-$0.40 -$0.39*-$0.45
Gross Margin (%)60% 56.7%*50%
EBITDA ($USD Millions)-$2.50*-$2.66*-$3.74*
Cash & Equivalents ($USD Millions)$6.31 $6.26 $2.34

Values marked with * retrieved from S&P Global.

Revenue Mix and Margins

MetricQ1 2024Q3 2024Q1 2025
Product Revenue ($USD Millions)$1.67 $1.96 $1.81
Service Revenue ($USD Millions)$1.75 $1.90 $1.20
Gross Profit ($USD Millions)$1.94 $2.33 $1.51
Gross Margin (%)57% 60% 50%

KPIs (YoY and operational)

KPIQ1 2024Q1 2025
Oral Appliance Arches (units)1,996 3,736
Product Revenue ($USD Millions)$1.67 $1.81
Service Revenue ($USD Millions)$1.75 $1.20
Operating Expenses ($USD Millions)$5.72 $5.43
Net Loss ($USD Millions)-$3.76 -$3.86
Cash & Equivalents ($USD Millions)—$2.34

Guidance Changes

MetricPeriodPrevious GuidanceCurrent GuidanceChange
Operating cash flow breakeven2025 timeline“Positive cash flow from operations by mid-2025” “Eliminate burn; cash-flow positive as early as Q3 2025” Accelerated
SCN acquisition closeQ2–Q3 2025Close later this quarter or in Q3, subject to financing Close in next 1–2 months; nonbinding $7.5M senior loan + ≥$1.5M equity targeted Maintained timeline; financing plan detailed
Revenue accretion from SCNQ3 2025—Immediate accretion with diagnostic/therapeutic services; revenue-to-cash conversion in Q3 New
Operating expenses trendQ3–Q4 2025Continued cost reductions (historical) OpEx to tick up near-term due to SCN staffing/doctors; revenue to outpace spend Raised near-term OpEx
Contribution margin (SCN)Ongoing~50% contribution margin in model ≥50% net contribution margins expected at SCN Maintained

Earnings Call Themes & Trends

TopicQ3 2024 (two quarters prior)Q4 2024 (prior quarter)Q1 2025 (current)Trend
Business model pivot to medical alliances/MSOEarly stage; initial Rebis alliance; transition quarter ahead Detailed pivot economics; 70%+ case acceptance in pilots; $4,500 per case; target 2,500+ sleep labs Execution update; SCN definitive agreement; accretive plan; operational ramp Strengthening and executing
Patient acceptance vs CPAPStrong initial conversions; expanding to 2 more CO locations 70%+ acceptance in pilots; pediatric FDA clearance supports adoption 71% acceptance at Rebis cohort cited; plans to replicate at SCN Positive, validating thesis
Reimbursement/CPT codesAMA CPT codes effective Jan 2025; impact TBD Working with payers; value proposition to reduce cost of care Seeking reimbursement levels; payer engagement underway In progress
Financing/liquidityRaised capital; cash $6.3M at 9/30/24 $17.9M raised in 2024; cash $6.26M YE Seeking $7.5M debt + ≥$1.5M equity to close SCN; cash $2.34M; ops cash burn up Tight near-term; financing key
M&A pipelineTargeting 6–8 centers; telemedicine scale Negotiating providers treating ~8,500 OSA patients/month SCN signed; active negotiations nationwide Building
Revenue mix shiftProduct share rising; VIP enrollment fading Product 52% of FY sales vs. 48% services Product up YoY; service down in Q1 Toward products/direct-to-patient
Pediatric FDA clearanceAnnounced Sept 2024; marketing build Highlighted as strategic advantage Pediatric guides helped volume; family cross-pollination Supportive demand driver

Management Commentary

  • “The acquisition and integration of SCN will showcase our transformation… we’re at the forefront of a transformational opportunity” – CEO Kirk Huntsman .
  • “We expect… simple math tells the story… solve our cash burn and generate significant positive cash flows and profits by the end of 2025… even if we cut the above forecast figures in half.” – CEO on SCN economics .
  • “The revenue will more than offset… having doctors as employees… there’s a huge advantage for Vivos in this model.” – CFO on MSO economics .

Q&A Highlights

  • Rebis alliance performance and learnings: Slower-than-expected volumes due to partner issues, but ~71% patient selection of Vivos validates thesis; informed tighter operational controls in future alliances .
  • SCN accretion timing and mechanics: Expect immediate diagnostic revenue and Q3 accretion; built-out facility and >100 patients booked starting early June; plan to “hit the ground running” .
  • Operating expenses outlook: Near-term OpEx increases for staffing and doctors to support SCN; management expects revenue growth to outpace spending quickly .
  • Deal structure/valuation: $9M consideration ($6M cash, $1.5M stock upfront; $1.5M contingent stock); valuation driven by patient volume capture and economics of direct-to-patient model .
  • Guidance tone: Confidence in closing SCN within 1–2 months with $7.5M debt plus ≥$1.5M equity; objective to eliminate burn and turn cash-flow positive in Q3 .

Estimates Context

MetricQ1 2025 ConsensusQ1 2025 Actual
Revenue ($USD Millions)$3.67*$3.02
EPS ($USD)-$0.40*-$0.45
EBITDA ($USD Millions)-$2.60*-$3.74*
EPS – # of Estimates2*—
Revenue – # of Estimates2*—

Values marked with * retrieved from S&P Global.

Implication: The quarter was a revenue and EBITDA miss versus consensus (driven by the deliberate reduction in VIP service revenue during the pivot), with EPS slightly below expectations. Street models likely need to reflect lower near-term service revenue and margin compression, offset by higher product volume and potential Q3 SCN accretion .

Key Takeaways for Investors

  • Near-term numbers reflect strategic pivot: expect continued service-revenue headwinds and margin compression until alliance/acquisition-driven diagnostic and direct product revenues scale; product volumes are already growing .
  • Liquidity and financing are the gating factors: closing SCN depends on securing a $7.5M senior loan plus ≥$1.5M equity; monitor financing milestones closely .
  • SCN is the catalyst: management targets accretive revenue and potentially cash-flow positive operations by Q3; watch for closing timing and early conversion metrics (case acceptance, contribution margin) .
  • OpEx will rise near-term for ramp: staffing and salaried doctors will lift expenses, but management expects revenues to outpace spending quickly under the MSO model .
  • Reimbursement progress could unlock upside: CPT codes are in place; payer coverage levels are being pursued and could meaningfully improve economics over time .
  • Pediatric demand and guide volumes are supportive: FDA pediatric clearance and family “cross-pollination” may sustain appliance unit growth .
  • Model updates: Analysts should reduce VIP service assumptions and raise product/direct-to-patient revenue growth, with a step-up in Q3 from SCN accretion; margin mix improves post-close given contribution margin expectations ≥50% .

Values retrieved from S&P Global where marked with *.