Viemed Healthcare (NASDAQ:VMD) executives used the company’s fourth-quarter and full-year earnings call to highlight a “milestone year” in 2025, pointing to record revenue and Adjusted EBITDA, stronger free cash flow, and continued progress diversifying the business beyond its core ventilator rental franchise.
Management also addressed the industry’s transition to updated Medicare coverage criteria for noninvasive ventilation, describing near-term friction but reporting early signs of improving momentum entering 2026. Alongside the respiratory business, leadership emphasized rapid growth in sleep therapy and resupply, as well as early traction and expansion plans in maternal health following the Lehan’s Medical Equipment acquisition.
2025 financial results: record revenue, stable margins, and higher free cash flow
Adjusted EBITDA for the fourth quarter was $18.2 million. For the full year, Adjusted EBITDA totaled a record $61.4 million, representing a margin of approximately 22.7%. Management said the margin has remained stable and is expected to remain at a similar level entering 2026. Gross margin for the year was just under 58%, and the company said it was not seeing “structural margin deterioration” as the revenue mix shifts.
Cash generation improved substantially. Net cash provided by operating activities was $51.9 million in 2025. After net capital expenditures of approximately $23.8 million, free cash flow was $28.1 million, more than double the $11.6 million recorded in 2024. Free cash flow in the fourth quarter alone was $10.8 million.
On the balance sheet, Viemed ended the year with $13.5 million in cash and about $46 million available under its credit facilities. Long-term debt was $11.3 million, which management characterized as effectively no net debt after cash.
Business mix shifts as sleep and maternal health scale
Management provided detail on the sources of 2025 growth and how the revenue mix is evolving. Equipment and supply sales rose by $19.4 million, or about 63% year-over-year, driven primarily by expansion in sleep resupply and the addition of maternal health products following the Lehan’s acquisition. Ventilator rentals increased $12.2 million, or roughly 10%, reflecting higher patient volumes and what the company described as solid demand.
Other non-vent home medical equipment rentals increased by $9.7 million, or 20%, supported by growth in PAP therapy, oxygen, and airway clearance therapies. Services revenue increased by $4.8 million, or about 24%, driven mainly by continued growth in healthcare staffing.
From a mix perspective, management said ventilation declined from 56% of revenue in 2024 to 51% in 2025, as other categories expanded more quickly. Sleep grew from 16% to 20% of revenue, while maternal health contributed about 3% of 2025 revenue.
Respiratory update: NCD transition creates friction, but early 2026 signals improve
CEO Casey Hoyt said Viemed saw some moderation in ventilator patient growth during the fourth quarter, which he described as largely expected as the industry works through updated National Coverage Determination (NCD) requirements. He cited two drivers: operational effort required to implement new documentation and process requirements, and updated criteria that can disqualify some patients who may have qualified under the prior framework.
Hoyt said the company invested throughout 2025 in infrastructure to navigate the transition, including compliance capabilities, physician education, and internal workflow alignment. He also said Viemed’s proprietary Engage patient platform has been instrumental in providing data to help clinicians manage and report real-time compliance metrics.
While acknowledging short-term friction, management said it supports the move toward more objective criteria, arguing that over time the updated NCD could reduce uncertainty and favor scaled providers with strong documentation. Hoyt said that entering 2026, Viemed is seeing progress, including patients who previously were denied coverage under more subjective Medicare Advantage criteria now qualifying under the new NCD standards.
- Management said the company has had a 100% success rate at the administrative law judge level on appealed Medicare Advantage denials under the new NCD.
- Hoyt also said denials are being resolved earlier in the Medicare Advantage appeals process, improving reimbursement timing and reducing uncertainty.
- He noted that January was one of the strongest new ventilator setup months in the company’s history.
On the regulatory environment more broadly, Hoyt addressed a CMS update on the next round of competitive bidding. Based on the categories identified by CMS, management said it does not expect the announced round to apply to any of Viemed’s current offerings, including ventilators, or to have a material impact on the business.
Sleep and resupply post strong growth; maternal health expansion underway
Management positioned sleep therapy and resupply as a fast-scaling growth pillar. As of Dec. 31, 2025, the company’s PAP therapy patient count reached 34,528, representing 62% year-over-year growth. New sleep patient setups increased 70% during 2025 compared to the prior year, which management said also builds a pipeline for future resupply revenue.
The company ended 2025 serving 36,561 resupply patients, up 49% year-over-year. Hoyt said Viemed still sees room to improve conversion rates and deepen patient engagement, which it views as additional runway into 2026. He also cited tailwinds including underdiagnosis of obstructive sleep apnea and increased screening tied to broader discussions around metabolic health and GLP-1 therapies.
In maternal health, management said Lehan’s has performed well since the acquisition closed on July 1 and has integrated smoothly. The transaction was described as accretive “out of the gate,” generating positive net income contribution in both quarters since closing. Viemed said it began billing its first maternal health claim outside of Lehan’s original footprint late in the third quarter and described early signs as encouraging.
Management said approximately $9 million of 2025 revenue was associated with maternal health products across existing Lehan’s markets and new Viemed markets. The company also emphasized that maternal health broadens payer mix, reduces Medicare concentration, and adds another recurring DME category.
In response to an analyst question about priorities for expanding the Lehan’s platform, management said payer expansion is the top priority, noting reimbursement-rate research and a state-by-state approach. The company also said it is cross-training sales representatives and working to ensure back-office fulfillment and onboarding capacity can support rapid growth. Management added that, on a percentage basis, it expects maternal health to be the fastest-growing product line for the company.
Capital allocation and 2026 outlook
CFO Todd (last name not provided in the transcript) said the board authorized a new share repurchase program for 2026, citing confidence in the durability of cash flows and the long-term outlook. He described the company’s capital allocation approach as balanced across organic growth investments, disciplined and accretive acquisitions, and opportunistic buybacks.
Looking to 2026, Viemed guided for net revenue of $310 million to $320 million and Adjusted EBITDA of $65 million to $69 million. Management said the outlook excludes any contribution from potential acquisitions. The company said 2026 EBITDA growth is expected to trail revenue growth on a percentage basis largely because 2025 Adjusted EBITDA benefited from non-recurring items, including a $2.2 million gain from a ventilator buyback program.
Management also expects quarterly cadence to be uneven: the first quarter is expected to be relatively flat to slightly down sequentially due to ongoing complex respiratory documentation transition and normal seasonality, followed by a return to a more normalized pattern beginning in the second quarter, with sequential growth of approximately 3% to 5% throughout the remainder of the year.
The company reiterated expectations for net capital expenditures in the 10% to 11.5% range for 2026 and said a diversifying revenue base should support lower capital intensity over time. While not providing formal free-cash-flow guidance, management said it expects to continue generating a “significant amount of free cash flow” even after the growth investments embedded in its 2026 outlook.
About Viemed Healthcare (NASDAQ:VMD)
Viemed Healthcare, Inc (NASDAQ: VMD) is a provider of home-based respiratory therapy services, specializing in the management of patients requiring long-term mechanical ventilation and pulmonary support. The company’s offerings encompass invasive and noninvasive ventilation, airway clearance therapies, cough assist devices, and supplemental oxygen. Viemed combines durable medical equipment with clinical care, delivering tailored respiratory treatment plans that are overseen by licensed respiratory therapists and registered nurses.
Founded in the early 2010s and headquartered in Birmingham, Alabama, Viemed has grown its footprint to serve patients across multiple states in the United States.
