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What were the key takeaways from Neuronetics’s earnings call?

- **Revenue momentum**: Q3 revenue $37.3M (+11% pro forma YoY), driven by 25% Greenbrook clinic growth and 40 NeuroStar systems shipped
- **SPRAVATO optimization**: 86% A&O mix in Q3, with B&Bill expanded to 5 states for margin optimization
- **Cash flow progress**: Sequential improvement to $0.8M Q3 use, targeting Q4 positivity
- **Strategic partnerships**: 3-year Elite DNA agreement to be sole TMS provider for 30+ Florida clinics
- **CEO transition**: Keith Sullivan to retire in June 2026 after 5+ years leading $147M+ revenue business

**【CEO Summary Section】**
- Total revenue reached $37.3 million, up 11% on a pro forma basis year-over-year, driven by Greenbrook clinic growth (25% adjusted pro forma increase) and strong NeuroStar system sales (40 systems shipped). 
- NeuroStar treatment session utilization grew 11% YoY, with SPRAVATO volumes up sequentially and 84/89 eligible clinics now offering the therapy.
- Operational improvements include: 
  - $0.8 million cash used in operations (vs. $17M Q1), with full-year cash flow positivity targeted
  - Kiosk adoption reducing front desk bottlenecks and improving collections
  - Streamlined organizational structure reducing management layers
- Strategic partnerships with Elite DNA and Transformations Care Network expand TMS access, with 3-year agreement to be sole provider for 30+ Florida clinics.
- New York State Medicaid now covers NeuroStar TMS for 5M+ members, broadening patient access.

**【CFO Financial Commentary】**
- Q3 2025 revenue: $37.3M (101% YoY growth, 11% pro forma)
- NeuroStar system revenue: $3.5M (30+ ASP above target)
- Clinic revenue: $21.8M (25% YoY growth)
- Gross margin: 45.9% (down from 75.6% YoY due to Greenbrook integration)
- Operating expenses: $24.4M (12% YoY increase)
- Cash position: $34.5M (including $10M debt draw)
- Q4 2025 guidance: $40-43M revenue
- Full-year 2025 guidance: $147-150M revenue (down from prior $149-155M due to SPRAVATO Buy & Bill optimization)

**【Q&A Highlights】**
- **Greenbrook vs. NeuroStar dynamics**: Greenbrook clinics driving 28% YoY growth, while NeuroStar utilization growth (11%) not yet translating to revenue due to 2024 inventory buildup
- **Gross margin challenges**: 70bp Q3 margin decline due to capital sales mix, SPRAVATO A&O shift, and one-time Compass revenue
- **SPRAVATO strategy**: 86% A&O mix in Q3 (vs. 56% Q2), with B&Bill expanded to 5 states where economics favorable
- **Cash flow progress**: Sequential improvement from $3.5M Q2 burn to $0.8M Q3 use, targeting Q4 positivity
- **2026 outlook**: Normalized NeuroStar inventory levels, continued SPRAVATO optimization, and automation investments (e.g., patient text alerts, intake process digitization)

Neuronetics, Inc. (STIM) Q3 2025 Earnings Call Transcript

- **Revenue growth accelerates**: Q2 2025 revenue of $38.1 million (+18% YoY) driven by Greenbrook clinic ($23M, 23% sequential) and NeuroStar session growth (+13%).
- **Strategic momentum**: BMP program sites treat 3x more patients, SPRAVATO buy-and-bill expanded to 77/83 clinics, and adolescent patient starts up 25% YTD.
- **Cash flow progress**: Q2 cash used in operations improved to $3.5M (vs. $17M in Q1), targeting breakeven in Q3 and positive in Q4.
- **Gross margin dynamics**: 46.6% in Q2 (down from 74% YoY) due to Greenbrook mix, with 2025 guidance of 48-50% reflecting ongoing optimization.
- **Key risks**: SPRAVATO reimbursement variability and operational integration complexity, offset by disciplined expansion and claims process improvements.

**【CEO Summary Section】**
- Total revenue for Q2 2025 was $38.1 million, an 18% year-over-year increase on an adjusted pro forma basis, driven by strong Greenbrook clinic performance and NeuroStar treatment session growth.
- Key strategic priorities: 
  1. Greenbrook growth strategy (e.g., RAM program, SPRAVATO buy-and-bill expansion)
  2. BMP program expansion (395 active sites, 3x patient volume per site)
  3. Operational efficiency improvements (e.g., self-check-in kiosks, claims collection process)
- Adolescent patient growth: 25% increase in new patient starts YTD 2025 vs. 2024, supported by expanded insurance coverage.
- Q2 marked the strongest Greenbrook clinic revenue quarter in company history, with $23 million in clinic revenue.

**【CFO Financial Commentary】**
- GAAP net loss: $9.8 million ($0.15 per share), improved from $9.8 million ($0.33 per share) in Q2 2024.
- Gross margin: 46.6% (down from 74% in Q2 2024 due to Greenbrook integration and SPRAVATO mix).
- Operating expenses: $25.8 million (25% increase vs. Q2 2024, driven by Greenbrook G&A costs).
- Cash used in operations: $3.5 million (vs. $17 million in Q1 2025, reflecting operational efficiency gains).
- Updated 2025 guidance:
  - Total revenue: $149-$155 million
  - Gross margin: 48-50%
  - Operating expenses: $100-$105 million
  - Cash flow from operations: breakeven in Q3, positive in Q4

**【Q&A Highlights】**
- **Greenbrook vs. traditional NeuroStar growth**: CEO noted 13% growth in NeuroStar despite shifting marketing focus to provider referrals, expecting long-term efficiency gains.
- **SPRAVATO buy-and-bill strategy**: CFO emphasized selective expansion based on reimbursement rates, targeting 83 eligible clinics by year-end.
- **Adolescent patient outreach**: Leveraging Provider Connection Program to educate primary care physicians on TMS benefits.
- **Cash collection improvements**: 10% increase in first-month collections in Q2 vs. Q1, with $5.5 million in aged AR being reworked.
- **2026 gross margin outlook**: Potential for margin improvement through clinic efficiency and SPRAVATO optimization, though mix-dependent.


Neuronetics, Inc. (STIM) Q2 2025 Earnings Call Transcript

- **Revenue Surge**: Q1 2025 revenue of $32 million (+84% YoY) driven by Greenbrook acquisition, with BMP sites treating 3x more patients.
- **SPRAVATO Momentum**: 75% of clinics now offer SPRAVATO, with Buy & Bill treatments generating 3x higher revenue.
- **Adolescent Growth**: Adolescent TMS utilization up 38% YoY, exceeding 2023 totals.
- **Cash Flow Target**: On track for Q3 2025 cash flow positivity, supported by $18.9 million follow-on offering.
- **Guidance Update**: Full-year revenue $149-155 million, with Q2 forecast $36-38 million.

**【CEO Summary Section】**
- **Revenue Growth**: Total revenue reached $32 million in Q1 2025, up 84% YoY, driven by the Greenbrook acquisition. Pro forma revenue increased 7% compared to Q1 2024.
- **Greenbrook Integration**: Clinic revenue rose 41% YoY to $18.7 million, with NeuroStar TMS revenue up 8% on a same-clinic basis. SPRAVATO is now available in 75% of Greenbrook clinics, with Buy & Bill treatments generating 3x the revenue of the administer-and-observe model.
- **BMP Program Expansion**: Over 385 active BMP sites treat 3x more patients per quarter than non-BMP sites. Adolescent TMS utilization grew 38% YoY, surpassing 2023 full-year totals.
- **Cash Flow Outlook**: On track for cash flow positivity in Q3 2025, supported by $18.9 million from a February follow-on offering.

**【CFO Financial Commentary】**
- **Financial Results**: GAAP net loss of $12.7 million (-$0.21 per share) vs. $7.9 million (-$0.27) in Q1 2024. EBITDA improved to -$10.1 million from -$6.3 million.
- **Gross Margin**: 49% in Q1 2025 (vs. 75% in Q1 2024) due to lower-margin Greenbrook clinic business.
- **Operating Expenses**: $26.8 million (+35% YoY), driven by Greenbrook integration costs. Q2 OpEx expected to stabilize at $23-24 million.
- **Guidance**: Full-year revenue of $149-155 million, with gross margin ~55% and OpEx $90-98 million. Q2 revenue forecast $36-38 million.

**【Q&A Highlights】**
- **BMP Site Utilization**: BMP sites treat 3x more patients than non-BMP sites, with 110 sites in process of meeting program standards.
- **Greenbrook Performance**: SPRAVATO revenue up 50% YoY, with Buy & Bill conversions on track for full rollout by end-2025.
- **Cash Flow Management**: Q1 cash burn of $17 million due to one-time expenses (vendor payments, bonus payouts). Q2 cash usage expected <$5 million, with year-end cash >$20 million.
- **Leadership Transition**: CFO Steve Furlong to retire in March 2026, with search underway for successor.

Neuronetics (STIM)-6 May 25-2025 Q1 Earnings call transcript

- **Revenue Growth**: Q4 2024 revenue $22.5M (+11% YoY), driven by Greenbrook acquisition and BMP expansion.
- **BMP Success**: 350+ sites treating 3x more patients; 125+ new sites pending Q2 2025 compliance.
- **2025 Outlook**: $145M-$155M revenue, 55% gross margin, Q3 cash flow breakeven with SPRAVATO buy-and-bill and BMP scale.
- **Greenbrook Synergies**: 90%+ of $22M cost savings realized; 35+ clinics using SPRAVATO buy-and-bill for 3x revenue growth.
- **Adolescent Expansion**: 18% increase in sites treating teens; 78% of adolescents achieve meaningful improvement.


**【CEO Overview】**
- **2024 Key Achievements**: Acquired Greenbrook TMS, expanded BMP program to 350 sites, secured FDA clearance for adolescent TMS, refinanced debt, and raised $18.9M in Q4 2024.
- **BMP Program Success**: Sites in BMP treat 3x more patients quarterly; 125+ new sites pending standards compliance for Q2 2025.
- **2025 Growth Drivers**: Scale BMP to 500+ sites, optimize Greenbrook clinics, and expand SPRAVATO buy-and-bill to 35+ clinics by year-end.

**【CFO Financial Highlights】**
- **Q4 2024 Results**: Total revenue $22.5M (+11% YoY), GAAP net loss $12.1M, EBITDA (-$10.5M) due to $10.6M one-time acquisition costs.
- **2025 Guidance**: Revenue $145M-$155M, gross margin 55%, operating expenses $90M-$98M, cash flow breakeven Q3 2025.
- **Greenbrook Synergies**: 90%+ of $22M annualized cost savings realized by end-2024; targeting 35% clinic gross margin in 2025.

**【Q&A Key Takeaways】**
- **Greenbrook Integration**: 90%+ cost synergies captured; Q3 2025 cash flow positive with BMP and SPRAVATO rollout.
- **SPRAVATO Expansion**: 35 clinics using buy-and-bill (3x revenue vs. admin/observe); 120-day payer terms manageable with $18.9M capital raise.
- **Patient Flow Efficiency**: BMP implementation cuts referral-to-treatment time 40%; 63 Greenbrook clinics now offer SPRAVATO.
- **Adolescent Market Growth**: 18% increase in sites treating adolescents; 78% of teens achieve clinically meaningful improvement.


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