Xtant Medical - Earnings Call - Q4 2024

Transcript

Operator (participant)

Good day, everyone, and welcome to the Xtant Medical Q4 and year end 2024 earnings. At this time, all participants have been placed on a listen-only mode. If you have any questions or comments during the presentation, you may press star one on your phone to enter the question queue at any time, and we will open the floor for your questions and comments after the presentation. It is now my pleasure to turn the floor over to your host, Brett Maas with Hayden IR. Sir, the floor is yours.

Brett Maas (Managing Partner)

Thank you, Operator. Joining me today is Sean Browne, President and Chief Executive Officer, and Scott Neils, Chief Financial Officer. Today's call is being webcast and will be posted on the company's website for playback. During the course of this call, management may make certain forward-looking statements regarding future events and the company's expected future performance. These forward-looking statements reflect Xtant's current perspective on existing trends and information and can be identified as such words by expect, plan, will, may, anticipate, believe, stood, intends, and other words with similar meaning. Such forward-looking statements are not guarantees of future performance and involve risks and uncertainties, including those noted in the risk factor section of the company's annual report on Form 10-K filed this afternoon with the SEC and in subsequent SEC reports and press releases. Actual results may differ materially.

The company's financial results press release and today's discussion include certain non-GAAP financial measures. Please refer to the non-GAAP and GAAP reconciliations which appear in our press release and are otherwise available on our website. Note that our Form 8-K filed with the financial results press release provides a detailed narrative that describes our use of such measures. For the benefit of those who may be listening to the replay of this call, it was held and recorded on 6 March 2024 at approximately 4:30 P.M. Eastern Time. The company declines any obligation to update its forward-looking statements except as required by applicable law. Now, I'd like to turn the call over to Sean Browne. Sean, the floor is yours.

Sean Browne (CEO)

Thank you, Brett, and good afternoon, everyone. I am pleased to announce record Q4 revenue of $31.5 million and for the full year, $117.3 million. This is our first full quarter, a consistent year-over-year comparison with the Surgalign business incorporated into our revenue, which amounts to a 12% growth quarter-over-quarter and a 28% year-over-year growth. From a profitability perspective, we again delivered positive adjusted EBITDA of $438,000 in the Q4. This accomplishment was achieved despite an inventory write-off of $1.5 million related to the Surgalign acquisition, as Scott will explain later. In summary, 2024 was a challenging year on many fronts with the integration of the various Surgalign businesses and the ambitious challenge of vertically integrating Xtant's biologics offering. I'm thrilled to say that as a team, we have come out leaner and better prepared to create a self-sustaining, growing, and profitable company.

Operationally, we continue to look at opportunities to leverage the Xtant and Surgalign platforms to improve efficiency. Through this work, we were able to generate cash flows from operations in Q4 of over $500,000 for the first time since 2022. Since August and through the current Q1 of 2025, we have reduced our operating expenses by approximately $5 million. A portion of this cost savings was achieved through headcount reductions of more than 13%, most of which was tied to the closing of the Greenville facility and other acquisition-related integration activities. Recall, we acquired our Greenville facility when we acquired the nanOss production operations from RTI Surgical in October 2023. We recently moved the production of our nanOss products to our Belgrade facility.

As we continue to vertically integrate our biologics business, we believe we will realize additional operating efficiencies tied to greater throughput and improved processes. From a hardware perspective, we continue to rationalize old and redundant lines. This is a good example of where we have chosen to give up some top-line revenue due to the capital required to maintain a hardware line. Furthermore, as we bring more lines into our main distribution facility in Belgrade, we believe there will be additional savings compared to using a third-party logistics company in 2024 that is not as efficient as our own operations. From a commercial perspective, our biologics business grew 21% for the quarter, while our hardware took a 10% hit.

Two main drivers for the growth in biologics were, first and foremost, our new stem cell offering branded as OsteoVive Plus, which has done very well for us out of the gate. The second driver was our new Amnion product line. Conversely, our hardware drop-off was tied to two significant issues. First, to a very strong previous-year comparison that included several rationalized Surgalign fixation lines. These were lines that Surgalign had discontinued prior to our acquisition. Secondly, our international business continued to fight through E.U. supply chain issues that impacted their sales again in this quarter. From a new product development perspective, we anticipate four new biologics products scheduled to launch this year. The primary release will be our own growth factor product, which we are excited about because it will complete the targeted vertical integration of our current offering.

Two of our new products will be upgraded DBM-based products that should drive higher revenue and gross profit. The last of these new product lines will expand our surgical wound care offering. Our surgeons currently use all of these products, and our independent agent partners have requested them for quite some time. This year, we expect to pick up a solid growth in our OEM business. These OEM opportunities serve two purposes. First, it is a great channel for us to leverage manufacturing capacity to grow profitably. Second, it serves as a means for Xtant to learn more about adjacent markets such as foot and ankle, trauma, surgical, wound care, and other relevant markets that we can serve now with our current expanded offerings of products, which many of these serve these adjacent markets.

With that as a backdrop, in January 2025, we licensed another Q code for our single-layer Amnion product. This brought us an upfront licensing fee of $1.5 million and production minimums for an OEM partner. However, most of these minimums will not continue if the local coverage determination, or LCD for skin substitute, takes effect as planned on 13 April 2025. Looking ahead to 2025, we are continuing our pursuit of achieving self-sustainability. Our corporate direction moving forward has been prioritizing profitability ahead of revenue growth. We plan to leverage our cost-cutting measures to return our business to sustainable cash-flowing business. In fiscal year 2025, we expect mid-double-digit revenue growth in biologics and to stay consistent to modestly down revenue year-over-year in hardware. From a hardware perspective, we continue to look at rationalizing lines to optimize both our offering and our management of cash.

From a profitability perspective, our goal is to be sustainably cash-flowing by the end of the year. From a guidance perspective for full year 2025, we expect revenue in the range of $126 million to 130 million, which is an 8% to 11% growth, which together with our anticipated cost savings, we project that we will not need to raise additional capital. With that, I will turn the call over to Scott for a more detailed review of our financial results.

Scott Neils (CFO)

Thank you, Sean, and good morning, everyone, or good afternoon, rather. Total revenue for the Q4 of 2024 was $31.5 million compared to $28.1 million for the same period in 2023. The 12% increase is attributed primarily to 21% or $3.2 million year-over-year growth in our biologics product family, exclusive of the impact of $1.5 million of licensing revenue during the Q4 of 2024. This increase was partially offset by a 10% or $1.3 million year-over-year reduction in spinal implant sales. Gross margin for the Q4 of 2024 was 50.8% compared to 61% for the same period in 2023. Throughout the course of 2024, we worked to verify the existence of inventory associated with our acquisition of Surgalign Holdings' hardware and biologics business.

These procedures were completed during the Q4, resulting in a $1.5 million inventory charge, which adversely affected gross margin by 680 basis points compared to the same period a year ago. Additionally, gross margin was adversely affected by 570 basis points during the Q4 of 2024 compared to the same period in 2023 for reduced yields and throughput as Amnion stem cell production was optimized. Q4 2024 operating expenses were $17.9 million compared to $21 million in the same period a year ago. As a percentage of total revenue, operating expenses were 56.8% compared to 74.5% in the same period a year ago. Sequentially, operating expenses declined $2.2 million and declined as a percentage of revenue compared to Q3 2024 by 15.5 points.

General and administrative expenses were $5.7 million for the three months ended 31 December 2024, compared to $8.9 million for the same period in 2023. This decrease is primarily attributable to the $2.1 million reduction to various compensation plans, as well as reductions in professional fees totaling $1 million. Sales and marketing expenses were $11.7 million for the three months ended 31 December 2024, compared to $11.6 million for the same quarter last year. This increase is primarily due to higher commission expenses, $0.7 million related to increased sales, partially offset by reductions in salaries and wages totaling $500,000. Research and development expenses were $522,000 for the three months ended 31 December 2024, an increase from $492,000 in the Q4 of 2023.

Net loss in the Q4 of 2024 was $3.2 million or $0.02 per share, compared to a net loss of $4.3 million, or $0.03 per share in the comparable 2023 period. Adjusted EBITDA for the Q4 of 2024 was $438,000, compared to an adjusted EBITDA loss of $695,000 for the same period in 2023. Beginning in the Q4 of 2024, we are no longer including the phasing of the bargain purchase gain on our sell-through of inventory acquired as part of our purchase of Surgalign Holdings' Hardware and Biologics Business in our calculation of adjusted EBITDA, and prior periods have been recast to conform to the current calculation. The related effect on adjusted EBITDA was a reduction of $1.4 million in the Q4 of 2023 to arrive at the recast amount.

Turning now to our full year financial results, total revenue for 2024 was $117.3 million compared to $91.3 million for 2023, an increase of 28%. This increase is primarily attributable to additional sales from our acquisition of the Surgalign Holdings' Hardware and Biologics Business, higher independent agent sales, and $1.5 million of upfront licensing revenue related to our SimpliMax product and associated trademarks. Gross margin for 2024 was 58.2% compared to 60.8% for 2023. Of this decrease, 220 basis points were due to product mix, and 200 basis points were due to reduced production throughput. 2024 operating expenses were $80.3 million, or 68.5% of total revenue, compared to $65.6 million, or 71.9% of total revenue in 2023. General and administrative expenses were $28.7 million for the year ended 31 December 2024, compared to $25.9 million for 2023.

This increase is primarily attributable to an increase in stock-based compensation, severance expense, additional hardware and software expense, and additional amortization expense, which were partially offset by reductions in various compensation plans. Sales and marketing expenses were $49.2 million for 2024, compared to $38.4 million for 2023. This increase is primarily due to higher commission expenses related to increased sales, as well as higher professional service fees. Research and development expenses were $2.4 million for the year ended 31 December 2024, an increase from $1.3 million from the prior year. This increase is primarily due to additional personnel added with our acquisitions. Net loss in 2024 was $16.4 million, or $0.12 per share, compared to net income of $660,000 or $0.01 per share in 2023. Note that 2023 net income included an $11.7 million gain on bargain purchase related to our acquisition of the Surgalign Hardware and Biologics Business.

Adjusted EBITDA for 2024 was a loss of $2.3 million compared to a loss of $1.4 million for 2023. As previously noted, we are no longer including the phasing of the bargain purchase gain on our sell-through of inventory acquired as part of our purchase of Surgalign Holdings' Hardware and Biologics Business in our calculation of adjusted EBITDA. The related effect on adjusted EBITDA was a reduction of $2.3 million in 2023 to arrive at the recast amount. As of 31 December 2024, we had $6.2 million of cash, cash equivalents, and restricted cash. Net accounts receivable was $20.7 million, inventory was $38.6 million, and we had $4.2 million available under revolving credit facilities as of the end of 2024. Operator, you may now open the line for questions.

Operator (participant)

Certainly. Everyone at this time will be conducting a question-and-answer session. If you have any questions or comments, please press star one on your phone at this time. We do ask that while posing your question, please pick up your handset if you're listening on speakerphone to provide optimum sound quality. Once again, if you have any questions or comments, please press star one on your phone. Your first question is coming from Chase Knickerbocker from Craig-Hallum. Your line is live.

Chase Knickerbocker (Senior Research Analyst)

Good afternoon. Thanks for taking the questions. Congrats on the quarter here. I guess just to start on—

Sean Browne (CEO)

Thanks, Chase.

Chase Knickerbocker (Senior Research Analyst)

Biologics, if we think about kind of sequential growth there, it sounds like it was largely driven by the VBM launch. Is the majority of that white label, or was there any pull-through on your internally developed product in Q4 through your distribution channel?

Sean Browne (CEO)

Yes. Primarily white label. We were finishing off the last bits of our, so literally like the middle of December, we finished off the last of the distributed products. We saw a little bit of pickup on our own label product, but it was mostly the white label.

Chase Knickerbocker (Senior Research Analyst)

As we enter the year, is that a pretty meaningful portion of that kind of mid-teens growth that you're kind of accounting for? Is there a way for us to think about it from a standpoint of kind of expanding those current relationships on the white label side, or are you ramping kind of new ones? Just kind of walk us through how that's kind of worked for VBM and your ultimate expectations for it in 2025.

Sean Browne (CEO)

Four months ago, I would have told you that a big part of the growth was going to be mostly on the white label side. Not mostly, but a good chunk of it was on the white label side. Our funnels right now look very, very good for our Xtant branded product. What I'd tell you is that the VBM product is going to be a big part of our growth this year. As I look at it today, it's probably going to be about a 50/50% split.

Chase Knickerbocker (Senior Research Analyst)

As far as white label and the next Xtant branded.

Sean Browne (CEO)

It's white label product, yeah.

Chase Knickerbocker (Senior Research Analyst)

Yeah. Yeah. And then on the growth factor side, kind of any expectations on when we could have that launched? Is that a pretty material contributor to 2024 to 2025?

Sean Browne (CEO)

Yeah. Two things to that. First of all, the product is to be finished this quarter. We're excited about the product being done. We still have another three months or so of our current product line that we'll be working through. From there, what we are looking at is a couple of things. With our current product line, there are some limitations to where we can sell it. We're hoping that we can now start being able to open up this product line a lot more. As to the second half of this year, we should certainly see a pickup from a margin perspective.

Secondarily, we hope to see at least the revenue begin to climb after we have basically got to take out the last line and make sure that we keep that business, but then also grow it from there.

Chase Knickerbocker (Senior Research Analyst)

Scott, sorry if I missed it, but what were the exact impacts to gross margin in Q4 from those inventory write-offs?

Scott Neils (CFO)

The one related to our inventory cleanup or the inventory charge related to the Surgalign inventory was just under 700 basis points. It's actually 680 basis points. And then the difference in throughput was about 570 basis points.

Chase Knickerbocker (Senior Research Analyst)

Got it. If we think about 2025, I mean, any color you can give towards gross margins, we should see some improvement, I would imagine, as VBM starts to sell through the direct channel in a bigger sense as well. Any thoughts on gross margin for 2025?

Sean Browne (CEO)

Right. We finished the year for the full year at 58.2%. I think as we walk through the course of 2025, by the time we get to Q4 of 2025, I think we pick up four or five points to that as we see the impact of VBM and some of the other new product introductions we'll be rolling out.

Chase Knickerbocker (Senior Research Analyst)

Great. Thanks, guys.

Operator (participant)

Thank you. Your next question is coming from Ryan Zimmerman from BTIG. Your line is live.

Hi, Sean. Hi, Scott. This is Izzy on for Ryan. Thank you for taking the questions.

Sean Browne (CEO)

Hello, Izzy. How are you?

Good. Thank you. Just to start with 2025 guidance, I was hoping if you could speak to some of your assumptions around pacing and what would get you to the low and high ends of the guide.

Scott, you want me to jump in, or you want to jump in on this?

Scott Neils (CFO)

Yeah. Maybe I'll set the stage for it. If you want to add any color to it, feel free to jump in, Sean.

Sean Browne (CEO)

Sure.

Scott Neils (CFO)

I think from a phasing perspective on top line, I think we look for seasonality that directionally is consistent with what we saw in 2024. That said, I do not expect to see as dramatic an increase in sales transitioning from Q1 to Q2, really only because of the impact of some of what we will see on the annual licensing side here in Q1. As we move down into OPEX, having covered gross margin with Chase, turning to the OPEX front, I think we pick up maybe a point on the G&A side during the course of the year. I think we pick up significant leverage in sales and marketing. We are probably picking up four to five points as a percentage of revenue on that side of things. I think R&D, we look to stay largely flat during the course of the year.

Sean Browne (CEO)

Does that give you some good color, Izzy?

Yeah, that's helpful. Thank you. Is there anything that would allow for any outperformance in 2025 that we should keep in mind?

Sure. One of the big ones is if the LCD gets pushed in any way. Additionally to that point, if you think about the way the LCD for the wound care side is set up, it really only covers diabetic foot ulcers and venous leg ulcers. When I listen to the gentleman from Organogenesis as well as MIMEDX, that makes up about 57% of that total market. Some of that OEM revenue that we have, or at least licensing revenue, could certainly pick up in that realm. There are other things too that from one of the things that I want to make sure of that when we bring on an OEM player for any of our products that we can reliably supply them, we have been on the wrong side of that ourselves.

As we create more capacity within our plant, which is some of the things we're working on as we speak, we think that there's, quite frankly, we've got plenty of demand. It's a matter of getting the donors, having the clean rooms, and all the things available so that we can produce what we need to produce to really knock this number out. I feel good about the top line side of this thing. It's just a matter of making sure that we don't outkick our coverage, so to speak.

Understood. I heard your comments around that guidance is not going to require any additional capital. Curious if you guys are holding back spend in any other areas that would potentially allow for growth if you had it on hand.

Oh, that's a great question. Like anything. I mean, I'll tell you, back in the dot-com days, right? You had enough money, you could just keep buying or buying business, basically. Yeah, this is certainly a way to buy business, no question about it. What we are trying to build is really something sustainable. To that end, we wouldn't be doing anything that would be that detrimental to our growth engine. It's just that there's certain things, like for instance, hardware is a great example. We have certain product lines that are pretty old for us, where we might have, say, 10 doctors out there that are using 10 different sets of, say, a pedicle screw line, an old pedicle screw line.

If we wanted to upgrade those lines and bring them up to, say, if we had to buy brand new ones, we have to buy 20 new sets altogether, even though we only have 10 sets being used. Yeah, we could be buying stuff like that on the come, but it's just, and hardware is one of those things where you could put a lot of money into hardware, and before you know it, you have outstripped all of your profitability through CAPEX. That's just something we want to keep an eye on.

Got it. Last one for me, I was just curious how quickly we should start seeing some of the cost savings move into the P&L. Thanks for taking the questions.

Great. Scott, I'll throw that over to you. I can tell you right now, we're already immediately starting to see some of it already in the Q4, but you'll see a significant amount here in the Q1. Scott, I'll let you add to that.

Scott Neils (CFO)

Right. I think that's exactly right. We've put the wheels in motion on those. To the extent we've needed to reduce headcount, we've done so. We've put the spend reductions in place where necessary. Those are locked and loaded heading into 2025.

Thanks for taking the questions.

Sean Browne (CEO)

Great. Thanks, Izzy.

Operator (participant)

Thank you. That concludes our Q&A session. I'll now hand the conference back to President and Chief Executive Officer Sean Browne for closing remarks. Please go ahead.

Sean Browne (CEO)

Thank you, Operator. First, I'd like to thank our hardworking Xtant team members and their dedication to our mission of honoring the gift of donations so that our patients can live as full and complete a life as possible. Secondly, I'd like to thank all of you who have joined us today. We greatly appreciate your support, and we're really excited about our self-sustaining year of 2025. Thank you.

Operator (participant)

Thank you. Everyone, this concludes today's event. You may disconnect at this time and have a wonderful day. Thank you for your participation.