Tactile Systems Technology (TCMD) 10-K 18 Feb 25 2024 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2024	Feb. 14, 2025	Jun. 28, 2024
Document and Entity Information
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2024
Document Transition Report	false
Entity File Number	001-37799
Entity Registrant Name	Tactile Systems Technology, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	41-1801204
Entity Address, Address Line One	3701 Wayzata Blvd, Suite 300
Entity Address, City or Town	Minneapolis
Entity Address, State or Province	MN
Entity Address, Postal Zip Code	55416
City Area Code	612
Local Phone Number	355-5100
Title of 12(b) Security	Common Stock, Par Value $0.001 Per Share
Trading Symbol	TCMD
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction [Flag]	false
Entity Shell Company	false
Entity Public Float			$ 283,247,975
Entity Common Stock, Shares Outstanding		23,585,175
Entity Central Index Key	0001027838
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	FY
Amendment Flag	false
Auditor Name	GRANT THORNTON LLP
Auditor Firm ID	248
Auditor Location	Minneapolis, Minnesota

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Current assets
Cash	$ 94,367	$ 61,033
Accounts receivable	44,937	43,173
Net investment in leases	14,540	14,195
Inventories	18,666	22,527
Prepaid expenses and other current assets	5,053	4,366
Total current assets	177,563	145,294
Non-current assets
Property and equipment, net	5,603	6,195
Right of use operating lease assets	16,633	19,128
Intangible assets, net	42,789	46,724
Goodwill	31,063	31,063
Accounts receivable, non-current		10,936
Deferred income taxes	18,311	19,378
Other non-current assets	5,962	2,720
Total non-current assets	120,361	136,144
Total assets	297,924	281,438
Current liabilities
Accounts payable	5,648	6,659
Note payable	2,956	2,956
Accrued payroll and related taxes	17,923	16,789
Accrued expenses	7,780	5,904
Income taxes payable	270	1,467
Operating lease liabilities	2,980	2,807
Other current liabilities	3,147	4,475
Total current liabilities	40,704	41,057
Non-current liabilities
Note payable, non-current	23,220	26,176
Accrued warranty reserve, non-current	1,209	1,681
Income taxes payable, non-current	239	446
Operating lease liabilities, non-current	15,955	18,436
Total non-current liabilities	40,623	46,739
Total liabilities	81,327	87,796
Stockholders' equity:
Preferred stock, $0.001 par value, 50,000,000 shares authorized; none issued and outstanding as of December 31, 2024 and December 31, 2023
Common stock, $0.001 par value, 300,000,000 shares authorized; 23,883,475 shares issued and outstanding as of December 31, 2024; 23,600,584 shares issued and outstanding as of December 31, 2023	24	24
Additional paid-in capital	180,719	174,724
Retained earnings	35,854	18,894
Total stockholders' equity	216,597	193,642
Total liabilities and stockholders' equity	$ 297,924	$ 281,438

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2024	Dec. 31, 2023
Consolidated Balance Sheets
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized	50,000,000	50,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized	300,000,000	300,000,000
Common stock, shares, issued	23,883,475	23,600,584
Common stock, shares, outstanding	23,883,475	23,600,584

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Total revenue	$ 292,984	$ 274,423	$ 246,785
Total cost of revenue	76,296	79,290	70,809
Gross profit	216,688	195,133	175,976
Operating expenses
Sales and marketing	112,009	107,119	106,418
Research and development	8,832	7,823	7,088
Reimbursement, general and administrative	71,135	62,074	60,796
Intangible asset amortization and earn-out	2,531	76	14,432
Total operating expenses	194,507	177,092	188,734
Income (loss) from operations	22,181	18,041	(12,758)
Interest Income	3,384	1,874	60
Interest expense	(2,085)	(4,147)	(2,788)
Other income	9	2	13
Income (loss) before income taxes	23,489	15,770	(15,473)
Income tax expense (benefit)	6,529	(12,745)	2,393
Net income (loss)	$ 16,960	$ 28,515	$ (17,866)
Net income (loss) per common share
Basic	$ 0.71	$ 1.24	$ (0.89)
Diluted	$ 0.7	$ 1.23	$ (0.89)
Weighted-average common shares used to compute net income (loss) per common share
Basic	23,883,729	22,925,497	20,067,969
Diluted	24,138,244	23,176,169	20,067,969
Sales revenue
Total revenue	$ 256,012	$ 239,493	$ 211,345
Total cost of revenue	64,815	66,713	59,619
Gross profit	191,197	172,780	151,726
Rental revenue
Total revenue	36,972	34,930	35,440
Total cost of revenue	11,481	12,577	11,190
Gross profit	$ 25,491	$ 22,353	$ 24,250

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Common Stock	Additional Paid-In Capital	Retained Earnings (Accumulated Deficit)	Total
Balances at the beginning at Dec. 31, 2021	$ 20	$ 119,962	$ 8,245	$ 128,227
Balances at the beginning (in shares) at Dec. 31, 2021	19,877,786
Increase (Decrease) in Stockholders' Equity
Stock-based compensation		9,600		9,600
Exercise of common stock options and vesting of performance and restricted stock units		153		153
Exercise of common stock options and vesting of performance and restricted stock units (in shares)	225,282
Common shares issued for employee stock purchase plan		1,286		1,286
Common shares issued for employee stock purchase plan (in shares)	149,609
Net income (loss) for the period			(17,866)	(17,866)
Balances at the end at Dec. 31, 2022	$ 20	131,001	(9,621)	121,400
Balances at the end (in shares) at Dec. 31, 2022	20,252,677
Increase (Decrease) in Stockholders' Equity
Stock-based compensation		7,547		7,547
Exercise of common stock options and vesting of performance and restricted stock units	$ 1	13		14
Exercise of common stock options and vesting of performance and restricted stock units (in shares)	283,624
Sale of common stock from follow-on public offering, net of offering expenses	$ 3	34,622		34,625
Sale of common stock from follow-on public offering, net of offering expenses (in shares)	2,875,000
Common shares issued for employee stock purchase plan		1,541		1,541
Common shares issued for employee stock purchase plan (in shares)	189,283
Net income (loss) for the period			28,515	28,515
Balances at the end at Dec. 31, 2023	$ 24	174,724	18,894	193,642
Balances at the end (in shares) at Dec. 31, 2023	23,600,584
Increase (Decrease) in Stockholders' Equity
Stock-based compensation		7,819		7,819
Exercise of common stock options and vesting of performance and restricted stock units		24		24
Exercise of common stock options and vesting of performance and restricted stock units (in shares)	317,443
Share repurchases		(3,508)		$ (3,508)
Share repurchase (in shares)	(195,518)			(195,518)
Common shares issued for employee stock purchase plan		1,660		$ 1,660
Common shares issued for employee stock purchase plan (in shares)	160,966
Net income (loss) for the period			16,960	16,960
Balances at the end at Dec. 31, 2024	$ 24	$ 180,719	$ 35,854	$ 216,597
Balances at the end (in shares) at Dec. 31, 2024	23,883,475

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Cash flows from operating activities
Net income (loss)	$ 16,960	$ 28,515	$ (17,866)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization	6,792	6,539	6,268
Deferred income taxes	1,067	(19,378)	(32)
Stock-based compensation expense	7,819	7,547	9,600
Loss on disposal of property and equipment and intangibles	308	3	20
Change in fair value of earn-out liability		(2,475)	11,850
Changes in assets and liabilities, net of acquisition:
Accounts receivable	(1,764)	11,653	(5,348)
Net investment in leases	(345)	1,935	(3,648)
Inventories	3,861	597	(3,907)
Income taxes	(1,404)	(721)	2,270
Prepaid expenses and other assets	(3,929)	72	(950)
Right of use operating lease assets	187	71	168
Accounts receivable, non-current	10,936	12,125	(10,214)
Accounts payable	(1,087)	(3,853)	4,961
Accrued payroll and related taxes	1,134	(311)	4,961
Accrued expenses and other liabilities	120	(6,464)	7,076
Net cash provided by operating activities	40,655	35,855	5,209
Cash flows from investing activities
Purchases of property and equipment	(2,392)	(2,324)	(1,780)
Proceeds from sale of property and equipment	12		11
Intangible assets expenditures	(117)	(157)	(140)
Net cash used in investing activities	(2,497)	(2,481)	(1,909)
Cash flows from financing activities
Proceeds from issuance of note payable		8,250
Payments on earn-out		(10,575)	(5,000)
Payments on note payable	(3,000)	(3,000)	(6,000)
Payments on revolving line of credit		(25,000)
Payments of deferred debt issuance costs		(125)	(39)
Proceeds from exercise of common stock options	24	14	153
Proceeds from the issuance of common stock from the employee stock purchase plan	1,660	1,541	1,286
Payments for repurchases of common stock	(3,508)
Proceeds from issuance of common stock at market		34,625
Net cash (used in) provided by financing activities	(4,824)	5,730	(9,600)
Net increase (decrease) in cash	33,334	39,104	(6,300)
Cash - beginning of period	61,033	21,929	28,229
Cash - end of period	94,367	61,033	21,929
Supplemental cash flow disclosure
Cash paid for interest	2,106	4,560	2,186
Cash paid for taxes	6,848	5,815	44
Capital expenditures incurred but not yet paid	$ 76	$ 528	$ 38

Nature of Business and Operatio

Nature of Business and Operations	12 Months Ended
	Dec. 31, 2024
Nature of Business and Operations
Nature of Business and Operations	Note 1. Nature of Business and Operations Tactile Systems Technology, Inc. (“we,” “us,” and “our”) manufactures and distributes medical devices for the treatment of patients with underserved chronic diseases at home. We provide our Flexitouch Plus, Entre Plus and Nimbl systems, which help control symptoms of lymphedema, a chronic progressive medical condition, through our direct sales force for use in the home and sell or rent them through vascular, wound and lymphedema clinics throughout the United States. On September 8, 2021, we acquired the assets of the AffloVest airway clearance business. AffloVest is a portable, wearable vest that treats patients with chronic respiratory conditions. We sell this device through home medical equipment and durable medical equipment (“DME”) providers throughout the United States. We were originally incorporated in Minnesota under the name Tactile Systems Technology, Inc. on January 30, 1995. During 2006, we established a merger corporation and subsequently, on July 21, 2006, merged with and into this merger corporation, resulting in us being reincorporated as a Delaware corporation. The resulting corporation assumed the name Tactile Systems Technology, Inc. In September 2013, we began doing business as “Tactile Medical.” On August 2, 2016, we closed the initial public offering of our common stock, which resulted in the sale of 4,120,000 shares of our common stock at a public offering price of $10.00 per share. We received net proceeds from the initial public offering of approximately $35.4 million, after deducting underwriting discounts and approximately $2.9 million of transaction expenses. On February 27, 2023, we closed on a public offering of 2,875,000 shares of our common stock at a public offering price of $13.00 per share. We received net proceeds from this offering of $34.6 million after deducting underwriting discounts, commissions, and offering expenses. Our business is affected by seasonality. In the first quarter of each year, when most patients have started a new insurance year and have not yet met their annual out-of-pocket payment obligations, we experience substantially reduced demand for our products. We typically experience higher revenue in the third and fourth quarters of the year when patients have met their annual insurance deductibles, thereby reducing their out-of-pocket costs for our products, and because patients desire to exhaust their flexible spending accounts at year end. This seasonality applies only to purchases and rentals of our products by patients covered by commercial insurance and is not relevant to Medicare, Medicaid or the Veterans Administration, as those payers either do not have plans that have declining deductibles over the course of the plan year and/or do not have plans that include patient deductibles for purchases or rentals of our products.

Basis of Presentation

Basis of Presentation	12 Months Ended
	Dec. 31, 2024
Basis of Presentation
Basis of Presentation	Note 2. Basis of Presentation Our accompanying consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) and pursuant to the rules and regulations of the SEC. The results for the year ended December 31, 2024, are not necessarily indicative of results to be expected for any future year. Principles of Consolidation Our accompanying consolidated financial statements include the accounts of Tactile Systems Technology, Inc. and its wholly owned subsidiary, Swelling Solutions, Inc. All intercompany balances and transactions have been eliminated in consolidation. Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and to disclose contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting period. Actual results could differ from those estimates. ​

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2024
Summary of Significant Accounting Policies
Summary of Significant Accounting Policies	Note 3. Summary of Significant Accounting Policies Cash Cash consists of all cash on hand and deposits. Our cash was held primarily in checking accounts and an Institutional Insured Liquid Deposit demand account as of December 31, 2024 and 2023. Equity Investments Equity investments (including equity securities) with readily determinable fair value are reported at fair value, with unrealized gains and losses included in the determination of net income (loss). For equity investments with no readily determinable fair value, we measure these investments at cost less impairment, if any, plus or minus changes resulting from observable price changes in orderly transactions for the identical or a similar investment of the same issuer. Such observable price changes may include instances where the investee issues equity securities to new investors, thus creating a new indicator of fair value, as an example. As of each of December 31, 2024 and 2023, the total carrying value of our equity investments, with no readily determinable fair value, was $0.3 million, and are included in other non-current assets on our Consolidated Balance Sheets. On an annual basis, we perform a qualitative assessment considering impairment indicators to evaluate whether these investments are impaired and also monitor for any observable price changes. During the years ended December 31, 2024 and 2023, we did not have any impairment loss on these investments. Accounts Receivable The majority of our accounts receivable and revenue are from commercial insurance payers and government payers, such as Medicare, the Veterans Administration and Medicaid. Accounts receivable are recorded based on management’s assessment of the expected consideration to be received, based on a detailed review of historical pricing adjustments and collections. Management relies on the results of the assessment, which includes payment history of the applicable payer as well as historical patient collections, as a primary source of information in estimating the collectability of our accounts receivable. We update our assessment on a quarterly basis, which to date has not resulted in any material adjustments to the valuation of our accounts receivable. We believe the assessment provides reasonable estimates of our accounts receivable valuation, and therefore we believe that substantially all accounts receivable are fully collectible. A portion of claims to Medicare are initially denied and enter the appeals process, where many are ultimately reviewed by an Administrative Law Judge. After final adjudication of all claims, approximately 90% of the claims submitted are approved (this is on a number of claims, not a dollars claimed, basis across all our products). The appeals process can be lengthy, lasting more than a year in most cases. Accordingly, we classify a portion of our Medicare accounts receivable as non-current based on our experience with Medicare collections. Inventories Inventories are valued at the lower of cost (first-in, first-out method) or net realizable value. Property and Equipment Property and equipment are stated at cost and are depreciated using the straight-line method over their estimated useful lives of three Major expenditures for property and equipment are capitalized. Maintenance, repairs and minor renewals are expensed as incurred. When assets are retired or otherwise disposed of, their costs and related accumulated depreciation are removed from the accumulated depreciation accounts and the resulting gains or losses are included in income. Software Costs Revenue Recognition We derive revenue from the sales and rentals of our Flexitouch Plus, Entre Plus and Nimbl systems, and from the sales of our AffloVest product. Flexitouch Plus, Entre Plus and Nimbl We recognize revenue when control of the product has been transferred to our customer, in the amount of the expected consideration to be received for the product. In general, revenue from the sale or rental of a product is recognized upon shipment, unless circumstances dictate that control has not yet passed to the customer. We provide a warranty for these products against defects in material and workmanship for a period of one one We commercially distribute these products directly to patients who are referred to us by physicians, therapists or nurses. In most cases, there is a third-party payer, such as a commercial insurer, Medicare or the Veterans Administration, involved with the transaction. Our contractual relationship resides with the patient when the third-party payer is either a commercial insurer or Medicare and with the Veterans Administration if the patient is covered under their services. Revenue is recognized from such sales upon transfer of control of the product to the customer at a transaction price determined by collection history. As a result, the transaction price is impacted by multiple factors, including the terms and conditions contracted by various third-party payers, and therefore payments from third-party payers typically are less than our standard charge and represent an implicit price concession, resulting in variable consideration. As most contracts are with each individual sale to a patient, we have elected the portfolio approach to determine the transaction price, and ultimately the expected consideration. The portfolios used to determine transaction price are at the payer level, with pricing for each payer assessed based on the underlying similar characteristics. For any of our products sold to patients covered by private payers, such as commercial insurance companies, revenue is recognized upon shipment. A product is not shipped until we have received a prescription from a physician for our products and, as applicable, receipt of prior authorization from payers. At shipment, we invoice the payer for the total product price, and we recognize revenue in the amount of cash consideration anticipated to be received based on the transaction price. After the insurance payer has remitted payment, we separately invoice the patient for their portion of the payment obligation, such as copayments and deductibles. The transaction price is determined based on the payment history of the applicable payer drawn from actual write-off and collections experience from the payer over a rolling 12-month period, as well as historical patient collections. For our products sold to Medicare patients, we recognize revenue from such sales upon shipment of our products, which can occur only after we have received a prescription from a physician and all applicable patient documentation is obtained. The transaction price for our Entre Plus and Nimbl systems is determined based on the payment history using the same methodology as our private insurers. A portion of claims for payment for our Flexitouch Plus system are initially denied, and enter the appeals process, which can be lengthy. We assess the variable consideration for each of these claims as a percentage of the total invoice price based on ultimate approval and collection history. For our products sold to the Veterans Administration on behalf of the patient, our contract is with the Veterans Administration rather than the patient. We enter into individual sales contracts with the Veterans Administration on behalf of each patient. These contracts determine the amount of consideration, which is typically paid in full within 2 We incur incremental costs that directly relate to the sales of our products; however, as the amortization period would be less than one year, we have elected the practical expedient to expense these costs as incurred. We sell and rent these products either directly to patients or the Veterans Administration on behalf of patients, who are referred to us by physicians, therapists or nurses. We bill private insurers and other payers, Medicare, and the Veterans Administration directly for purchases or rentals of our product on behalf of a patient and bill patients directly for their cost-sharing amounts, including any portion of an unsatisfied deductible and any copayments or co-insurance obligation. A portion of our revenue is derived from patients who obtain our products under multiple-month rental arrangements. We bill these patients’ insurance payers monthly over the duration of the rental term. Title to these products passes to the patients at the end of the rental period. Rental agreements are recorded as sales-type leases in accordance with Accounting Standards Update (“ASU”) No. 2016-02, “Leases” (Topic 842) (“ASC 842”). Accordingly, as sales-type leases, the transaction price for the entire rental term is recognized upon transfer of control. AffloVest The AffloVest device is sold through durable medical equipment providers. Revenue is recognized when control of the promised goods or services is transferred to the distributors, in an amount that reflects the consideration we expect to be entitled to in exchange for transferring those goods or providing services. We account for a contract when it has approval and commitment from both parties, the rights of the parties are identified, payment terms are identified, the contract has commercial substance and collectability of consideration is probable. When determining whether the distributor has obtained control of the goods or services, we consider any future performance obligations. Generally, there is no post-shipment obligation on products sold other than warranty obligations in the normal and ordinary course of business. Consequently, revenue from the sale of the AffloVest product is recognized at shipment, unless circumstances dictate that control has not yet passed to the distributor. Certain of our contracts include volume-based incentives which involve rebates that are negotiated at or prior to the time of sale with the customer and are redeemable only if the customer achieves a specified cumulative level of sales or sales increase. Under these incentive programs, at the time of sale, we determine the most likely amount of the rebate to be paid based on forecasted sales levels. These forecasts are updated at least quarterly for applicable customers, and the transaction price is reduced for the anticipated cost of the rebate. If the forecasted sales for a customer change, the accrual for rebates is adjusted to reflect the new rebates expected to be earned by the customer. Amounts billed to customers for shipping and handling activities after the customer obtains control are treated as a promised service performance obligation and recorded in revenue in the accompanying Consolidated Statements of Operations. Shipping and handling costs incurred for the delivery of goods to customers are considered a cost to fulfill the contract and are included in cost of revenue sold in the accompanying Consolidated Statements of Operations. We provide a warranty for the AffloVest products against defects in material and workmanship for a period of five years. In accordance with applicable accounting guidance, we have determined these were assurance warranties and therefore not considered a performance obligation. In addition, we did not evaluate immaterial promised goods or services in the context of the contract. As a result, the sale of these products represents a single performance obligation that is satisfied at a point in time and is short-term in nature. Research and Development Costs We expense research and development costs as incurred, including expenses associated with clinical research studies and development. Shipping and Handling Costs Amounts billed to customers for shipping and handling activities after the customer obtains control are treated as a promised service performance obligation and recorded in total revenue in the accompanying Consolidated Statements of Operations. Shipping and handling costs incurred for the delivery of goods to customers are considered a cost to fulfill the contract and are included in cost of revenue in the accompanying Consolidated Statements of Operations. Product Warranty We provide a warranty for our products against defects in material and workmanship for a period of one Impairment of Long-Lived Assets We review long-lived assets, including property and equipment and patents, for impairment whenever events or changes in business circumstances indicate that the carrying amount of an asset may not be fully recoverable. We will assess long-lived assets used in operations for impairment indicators, including when undiscounted cash flows estimated to be generated by those assets are less than the assets’ carrying amount (see Note 8 – “Goodwill and Intangible Assets”). Goodwill Goodwill represents the excess of the purchase price paid over the estimated fair value of the net assets acquired and liabilities assumed in the acquisition of a business. Goodwill is not amortized, but is tested for impairment at least annually or on an interim basis if an event occurs or circumstances change that would more likely than not reduce the fair value of a reporting unit below its carrying value. We perform our annual assessment of goodwill for impairment as of July 1st of each fiscal year. See Note 8 – “Goodwill and Intangible Assets” for additional information. Stock-Based Compensation We provide stock-based compensation in the form of various types of equity-based awards, including time-based restricted stock units, performance-based restricted stock units, stock options, and through our Employee Stock Purchase Plan (“ESPP”). Stock-based compensation expense is based on the estimated fair value of the award on the grant date for equity awards, or on the first date of the ESPP purchase period for shares under the ESPP, and recognized over the requisite service periods on our Consolidated Statements of Income using the straight-line expense attribution approach. The estimated fair value of time-based and performance based restricted stock units is based on the closing price of our common stock on the grant date. Stock options and ESPP shares are valued using the Black-Scholes option-pricing model. The Black-Scholes valuation model requires the input of highly subjective assumptions. The assumptions include the expected term of the option or ESPP shares, the expected volatility of the price of our common stock, expected dividend yield and the risk-free interest rate. These estimates involve inherent uncertainties and the significant application of management’s judgment. If factors change and different assumptions are used, our stock-based compensation expense could be materially different in the future (see Note 13 – “Stockholders’ Equity”). Income Taxes Income taxes are accounted for under the liability method. Deferred income taxes are provided for temporary differences between the financial reporting and the tax basis of assets and liabilities. If we determine in the future that it is more likely than not that we will not realize all or a portion of the deferred tax assets, we will record a valuation allowance in the period the determination is made (see Note 15 – “Income Taxes”). Changes in tax rates are reflected in the tax provision as they occur. Net Income (Loss) Per Common Share Business Segments The Company operates as one operating segment. The Company's Chief Operating Decision Maker ("CODM") is its Chief Executive Officer, who reviews financial information presented on a consolidated basis. The CODM uses consolidated net income (loss) as the measure of segment profit or loss. Significant segment expenses are those expenses reported in the Consolidated Statement of Operations. The CODM assesses performance for the segment, allocates resources and monitors budget versus actual results using consolidated revenue and net income (loss) which is reflected in the Consolidated Statement of Operations. Accounting Pronouncement Not Yet Adopted In November 2024, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2024-03, “Income Statement – Reporting Comprehensive Income – Expense disaggregation Disclosures (Subtopic 220-40): Disaggregation of Income Statement Expenses” which requires entities to disclose additional information about specific expense categories in the notes to financial statements on an annual and interim basis. The guidance is effective for annual periods beginning after December 15, 2026, and interim periods beginning after December 15, 2027, with early adoption permitted. The Company is currently evaluating the effect that this standard will have on its consolidated financial statements and related disclosures. In December 2023, the FASB issued ASU No. 2023-09, “Income Taxes (Topic 740): Improvements to Income Tax Disclosures” which requires entities to enhance disclosures around income taxes. The guidance is effective for annual periods beginning after December 15, 2024, with early adoption permitted. The Company is currently evaluating the effect this standard will have on its consolidated financial statements and related disclosures. Recently Adopted Accounting Pronouncement In November 2023, the FASB issued ASU No. 2023-07, “Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures” which requires entities to enhance disclosures around segment reporting. The guidance is effective for annual periods beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. The Company adopted ASU 2023-07 with respect to the year ended December 31, 2024. As a result, we have enhanced our segment disclosures in this report. The adoption of this ASU affects only our disclosures, with no impacts to our financial condition and results of operations.

Acquisitions

Acquisitions	12 Months Ended
	Dec. 31, 2024
Acquisitions
Acquisitions	Note 4. Acquisitions On September 8, 2021, we entered into an Asset Purchase Agreement (“AffloVest APA”) to acquire the AffloVest therapy business from International Biophysics Corporation (“IBC”). Under the terms of the AffloVest APA, we agreed to pay IBC a total of up to $100.0 million for the purchase of substantially all of the assets related to its branded high frequency chest wall oscillation vest therapy business, other than specifically identified excluded assets. We acquired AffloVest to further expand our position as a leader in treating patients with underserved chronic conditions in the home. The acquired assets included inventory, tooling, intellectual property, permits and approvals, data and records, and customer and supplier information. At closing, $80.0 million of the purchase price was paid, of which a total of $0.5 million was deposited into an escrow account at closing for purposes of satisfying certain post-closing purchase price adjustments and indemnification claims. Subsequent to closing, $0.2 million was returned to us as a result of working capital adjustments and the remaining $0.3 million was released to IBC. The AffloVest acquisition was funded through a combination of cash on hand and proceeds from borrowings. On November 4, 2022, we entered into an Amendment to the AffloVest APA, the “Amendment” with IBC, which modified the terms of the earn-out arrangement under the AffloVest APA, as follows: ​ ● Initial Earn-Out: The AffloVest APA provided for an initial earn-out equal to 1.5 times the amount by which the AffloVest U.S. revenues in the period from October 1, 2021 to September 30, 2022 (the “Initial Earn-Out Period”) exceed a specified amount; provided that in no event will the payment exceed $10.0 million. o The APA Amendment provides that the calculated amount of the initial earn-out payment is $10.0 million, of which the Company paid $5.0 million on November 28, 2022, and $5.0 million, plus an imputed interest payment of $250,000 , on May 25, 2023. ​ ● Second Earn-Out: The AffloVest APA provided for a second earn-out equal to 1.5 times the amount by which the AffloVest U.S. revenues in the period from October 1, 2022 to September 30, 2023 exceed the revenues recognized during the Initial Earn-Out Period; provided that in no event will the payment exceed $10.0 million. o The APA Amendment changes the 1.5 times multiplier to 3.0 times, but still provides that in no event will the second earn-out payment exceed $10.0 million. o Subsequent to September 30, 2023, it was determined that the calculated amount of the second earn-out payment was $5.6 million, which was paid by the Company on November 28, 2023 (see Note 17 – “Fair Value Measurements”). ​ The fair value of the earn-out as of the acquisition date was $6.4 million. The fair value of the earn-out, reflecting management’s estimate of the likelihood of achieving these targets, was determined by employing a Monte Carlo Simulation model. This amount and the current versus non-current allocation was remeasured at the end of each reporting period until the payment requirement ended, with any adjustments reported in income from operations (see Note 17 – “Fair Value Measurements”).

Accounts Receivable

Accounts Receivable	12 Months Ended
	Dec. 31, 2024
Accounts Receivable.
Accounts Receivable	Note 5. Accounts Receivable

Inventories

Inventories	12 Months Ended
	Dec. 31, 2024
Inventories
Inventories	Note 6. Inventories Inventories consisted of the following: ​ ​ ​ ​ ​ ​ ​ ​ (In thousands) At December 31, 2024 At December 31, 2023 Finished goods ​ $ 6,149 ​ $ 7,979 Component parts and work-in-process ​ 12,517 ​ 14,548 Total inventories ​ $ 18,666 ​ $ 22,527 ​

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2024
Property and Equipment
Property and Equipment	Note 7. Property and Equipment Property and equipment consisted of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ At December 31, (In thousands) 2024 2023 Equipment ​ $ 5,108 ​ $ 4,459 Tooling ​ 4,652 ​ 4,555 Furniture and fixtures ​ 2,095 ​ 2,068 Leasehold improvements ​ 3,466 ​ 1,529 Demonstration equipment ​ ​ 1,106 ​ ​ 896 Construction in progress ​ ​ 152 ​ ​ 1,271 Subtotal ​ 16,579 ​ 14,778 Less: accumulated depreciation ​ (10,976) ​ (8,583) Property and equipment, net ​ $ 5,603 ​ $ 6,195 ​ Depreciation expense was $3.0 million, $2.7 million and $2.5 million for the years ended December 31, 2024, 2023 and 2022, respectively.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	12 Months Ended
	Dec. 31, 2024
Goodwill and Intangible Assets
Goodwill and Intangible Assets	Note 8. Goodwill and Intangible Assets Goodwill In the third quarter of fiscal 2021, we completed the AffloVest acquisition. The purchase price of the AffloVest business exceeded the net acquisition-date estimated fair value amounts of the identifiable assets acquired and the liabilities assumed by $31.1 million, which was assigned to goodwill. Intangible Assets Our patents and other intangible assets are summarized as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted- ​ At December 31, 2024 ​ ​ Average ​ Gross ​ ​ ​ ​ ​ ​ Amortization ​ Carrying ​ Accumulated ​ Net (In thousands) Period ​ Amount ​ Amortization ​ Amount Definite-lived intangible assets: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Patents ​ 12 years ​ $ 1,148 ​ $ 333 ​ $ 815 Defensive intangible assets ​ < 1 year ​ ​ 1,125 ​ ​ 1,065 ​ ​ 60 Customer accounts ​ — ​ ​ 125 ​ ​ 125 ​ ​ — Customer relationships ​ 10 years ​ ​ 31,000 ​ ​ 7,896 ​ ​ 23,104 Developed technology ​ 8 years ​ ​ 13,000 ​ ​ 3,913 ​ ​ 9,087 Subtotal ​ ​ ​ ​ 46,398 ​ ​ 13,332 ​ ​ 33,066 Unamortized intangible assets: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Tradenames ​ ​ ​ ​ 9,500 ​ ​ — ​ ​ 9,500 Patents pending ​ ​ ​ ​ 223 ​ ​ — ​ ​ 223 Total intangible assets ​ ​ ​ $ 56,121 ​ $ 13,332 ​ $ 42,789 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted- ​ At December 31, 2023 ​ ​ Average ​ Gross ​ ​ ​ ​ ​ ​ Amortization ​ Carrying ​ Accumulated ​ Net (In thousands) Period ​ Amount ​ Amortization ​ Amount Definite-lived intangible assets: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Patents ​ 12 years ​ $ 1,018 ​ $ 248 ​ $ 770 Defensive intangible assets ​ 1 year ​ ​ 1,125 ​ ​ 920 ​ ​ 205 Customer accounts ​ — ​ 125 ​ 125 ​ — Customer relationships ​ 11 years ​ ​ 31,000 ​ ​ 5,511 ​ ​ 25,489 Developed technology ​ 9 years ​ ​ 13,000 ​ ​ 2,731 ​ ​ 10,269 Subtotal ​ ​ ​ ​ 46,268 ​ ​ 9,535 ​ ​ 36,733 Unamortized intangible assets: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Tradenames ​ ​ ​ ​ 9,500 ​ ​ — ​ ​ 9,500 Patents pending ​ ​ ​ ​ 491 ​ ​ — ​ ​ 491 Total intangible assets ​ ​ ​ $ 56,259 ​ $ 9,535 ​ $ 46,724 ​ Amortization expense was $3.8 million for each of the years ended December 31, 2024, 2023 and 2022, of which $1.3 million in each of the years ended December 31, 2024, 2023 and 2022, were recorded in cost of sales revenue. Future amortization expenses are expected as follows: ​ ​ ​ ​ ​ (In thousands) ​ ​ ​ 2025 $ 3,714 2026 ​ ​ 3,650 2027 ​ 3,641 2028 ​ 3,638 2029 ​ 3,633 Thereafter ​ 14,790 Total ​ $ 33,066 ​ The weighted-average remaining amortization period for these intangible assets was 9.2 years as of December 31, 2024.

Accrued Expenses

Accrued Expenses	12 Months Ended
	Dec. 31, 2024
Accrued Expenses
Accrued Expenses	Note 9. Accrued Expenses Accrued expenses consisted of the following: ​ ​ ​ ​ ​ ​ ​ ​ (In thousands) At December 31, 2024 At December 31, 2023 Warranty ​ $ 1,784 ​ $ 2,357 Legal and consulting ​ ​ 1,318 ​ ​ 611 Travel ​ ​ 1,120 ​ ​ 1,038 In-transit inventory ​ ​ 1,013 ​ ​ 401 Sales and use tax ​ ​ 802 ​ ​ 183 Clinical studies ​ ​ 304 ​ ​ 363 Other ​ 1,439 ​ 951 Total ​ $ 7,780 ​ $ 5,904 ​

Warranty Reserves

Warranty Reserves	12 Months Ended
	Dec. 31, 2024
Warranty Reserves
Warranty Reserves	Note 10. Warranty Reserves The activity in the warranty reserve during and as of the end of the years presented was as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ December 31, (In thousands) 2024 2023 2022 Beginning balance $ 4,038 ​ $ 4,212 ​ $ 4,959 Warranty provision 2,677 ​ 4,611 ​ 2,047 Processed warranty claims (3,722) ​ (4,785) ​ (2,794) Ending balance $ 2,993 ​ $ 4,038 ​ $ 4,212 ​ ​ ​ ​ ​ ​ ​ ​ ​ Accrued warranty reserve, current $ 1,784 ​ $ 2,357 ​ $ 2,005 Accrued warranty reserve, non-current ​ 1,209 ​ ​ 1,681 ​ ​ 2,207 Total accrued warranty reserve $ 2,993 ​ $ 4,038 ​ $ 4,212 ​

Credit Agreement

Credit Agreement	12 Months Ended
	Dec. 31, 2024
Credit Agreement
Credit Agreement	Note 11. Credit Agreement On April 30, 2021, we entered into an Amended and Restated Credit Agreement (the “Restated Credit Agreement”) with the lenders from time to time party thereto, and Wells Fargo Bank, National Association, as Administrative Agent. The Restated Credit Agreement amended and restated in its entirety our prior credit agreement. On September 8, 2021, we entered into a First Amendment Agreement (the “Amendment”), which amended the Restated Credit Agreement (as amended by the Amendment, the “Credit Agreement”) with the lenders from time to time party thereto and Wells Fargo Bank, National Association, as administrative agent. The Amendment, among other things, added a $30.0 million incremental term loan to the $25.0 million revolving credit facility provided by the Restated Credit Agreement. The term loan is reflected on our consolidated financial statements as a note payable. The Credit Agreement provides that, subject to satisfaction of certain conditions, we may increase the amount of the revolving loans available under the Credit Agreement and/or add one or more term loan facilities in an amount not to exceed $25.0 million in the aggregate, such that the total aggregate principal amount of loans available under the Credit Agreement (including under the revolving credit facility) does not exceed $80.0 million. On September 8, 2021, in connection with the closing of the AffloVest acquisition, we borrowed the $30.0 million term loan and utilized that borrowing, together with a draw of $25.0 million under the revolving credit facility and cash on hand, to fund the purchase price. ​ On February 22, 2022, we entered into a Second Amendment Agreement (the “Second Amendment”), which further amended the Credit Agreement. The Second Amendment modified the maximum leverage ratio, the minimum fixed charge coverage ratio and the minimum consolidated EBITDA covenants under the Credit Agreement, and added a minimum liquidity covenant, through the quarter ended June 30, 2023. The Second Amendment also increased the applicable margin for LIBOR rate loans under the Credit Agreement during the period commencing on the date of the Second Amendment and ending on the last day of the fiscal quarter ending June 30, 2023. Pursuant to the Second Amendment, we made a mandatory principal prepayment of the term loan of $3.0 million on February 22, 2022. ​ On June 21, 2023, we entered into a Third Amendment Agreement (the “Third Amendment”) that replaced the interest rate benchmark under the Credit Agreement from LIBOR to the term Secured Overnight Financing Rate (“SOFR”). All tenors of term SOFR are subject to a credit spread adjustment of 0.10% (“Adjusted Term SOFR”). ​ Following the Third Amendment, the term loan and amounts drawn under the revolving credit facility bear interest, at our option, at a rate equal to (a) the highest of (i) the prime rate, (ii) the federal funds rate plus 0.50% and (iii) Adjusted Term SOFR for a one-month tenor plus 1% (the “Base Rate”) plus an applicable margin or (b) Adjusted Term SOFR for an interest period of one, three or six months, at our option, plus the applicable margin. The applicable margin is 0.75% to 2.25% on loans bearing interest at the Base Rate and 1.75% to 3.25% on loans bearing interest at Adjusted Term SOFR, in each case depending on our consolidated total leverage ratio; except that, pursuant to the Second Amendment and the Third Amendment, during the period commencing on February 22, 2022 and ending on the last day of the fiscal quarter ending June 30, 2023, the applicable margin for LIBOR rate loans and Adjusted Term SOFR loans, as applicable, was 3.50%. At December 31, 2024, all outstanding borrowings were subject to interest at a rate calculated at Adjusted Term SOFR plus an applicable margin, for an interest rate of 6.42%. ​ On August 1, 2023, we entered into a Fourth Amendment Agreement (the “Fourth Amendment”), which further amended the Credit Agreement. The Fourth Amendment, among other things, decreased the commitment fees payable under the revolving credit facility under the Credit Agreement such that the undrawn portions of the revolving credit facility are subject to an unused line fee at a rate per annum from 0.125% to 0.200%, depending on our consolidated leverage ratio, and eliminated the language providing that the applicable margin for Adjusted Term SOFR loans was 3.50%, such that the interest rates are in effect as set forth in the above paragraph. The Fourth Amendment also eliminated the liquidity financial covenant and modified the remaining financial covenants to reflect the termination of the temporary covenant relief period that was in place until June 30, 2023 pursuant to the Second Amendment, such that the financial covenants now include a maximum consolidated total leverage ratio covenant, a minimum consolidated EBITDA covenant and a minimum fixed charge coverage ratio covenant. In addition, the Fourth Amendment provided for an additional term loan in the amount of $8.25 million, which we used for a paydown of the revolving credit facility. The Fourth Amendment also extended the maturity date of the term loans and revolving credit facility under the Credit Agreement from September 8, 2024, to August 1, 2026. On November 1, 2024, we entered into a Fifth Amendment Agreement (the “Fifth Amendment”), which further amended the Credit Agreement. The Fifth Amendment permits the Company to make payments to repurchase shares of its common stock, as long as the Company is not in default before and after giving effect to such repurchases, and as long as such repurchases do not exceed $30.0 million. On December 21, 2023, we made a payment of $16.8 million to repay in full the outstanding balance on the revolving credit facility. ​ As of December 31, 2024, we had outstanding borrowings of $26.3 million under the Credit Agreement, comprised entirely of the term loan. The principal of the term loan is required to be repaid in quarterly installments of $750,000 . Maturities of the term loan for the next three years as of December 31, 2024, were as follows: ​ ​ ​ ​ ​ (In thousands) Amount 2025 ​ $ 3,000 2026 ​ ​ 23,250 Total ​ ​ 26,250 Less: Deferred financing fees ​ ​ (74) Net Note Payable ​ ​ 26,176 Less: Current portion of note payable ​ ​ (2,956) Non-current portion of note payable ​ $ 23,220 ​ Our obligations under the Credit Agreement are secured by a security interest in substantially all of our and our subsidiary’s assets and are also guaranteed by our subsidiary. As of December 31, 2024, the Credit Agreement contained a number of restrictions and covenants, including that we maintain compliance with a maximum consolidated total leverage ratio, a minimum fixed charge coverage ratio and a minimum consolidated EBITDA covenant. As of December 31, 2024, we were in compliance with all covenants under the Credit Agreement.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2024
Commitments and Contingencies
Commitments and Contingencies	Note 12. Commitments and Contingencies Lease Obligations We lease property and equipment under operating leases, typically with terms greater than 12 months, and determine if an arrangement contains a lease at inception. In general, an arrangement contains a lease if there is an identified asset and we have the right to direct the use of and obtain substantially all of the economic benefit from the use of the identified asset. We record an operating lease liability at the present value of lease payments over the lease term on the commencement date. The related right of use (“ROU”) operating lease asset reflects rental escalation clauses, as well as renewal options and/or termination options. The exercise of lease renewal and/or termination options are at our discretion and are included in the determination of the lease term and lease payment obligations when it is deemed reasonably certain that the option will be exercised. When available, we use the rate implicit in the lease to discount lease payments to present value; however, certain leases do not provide a readily determinable implicit rate. Therefore, we must estimate our incremental borrowing rate to discount the lease payments based on information available at lease commencement. We classify our leases as buildings, vehicles or computer and office equipment and do not separate lease and nonlease components of contracts for any of the aforementioned classifications. In accordance with applicable guidance, we do not record leases with terms that are less than one year on the Consolidated Balance Sheets. None of our lease agreements contain material restrictive covenants or residual value guarantees. Buildings We lease certain office and warehouse space at various locations in the United States where we provide services. These leases are typically greater than one year with fixed, escalating rents over the noncancelable terms and, therefore, ROU operating lease assets and operating lease liabilities are recorded on the Consolidated Balance Sheets, with rent expense recognized on a straight-line basis over the term of the lease. The remaining lease terms vary from approximately one We entered into a lease (“initial lease”) in October 2018, for approximately 80,000 square feet of office space for our new corporate headquarters in Minneapolis, Minnesota. In December 2018, we amended the initial lease to add approximately 29,000 square feet of additional office space, which is accounted for as a separate lease (“second lease”) in accordance with ASU No. 2016-02, “Leases” (Topic 842) (“ASC 842”). In December 2019, we further amended the lease which extended the expiration date of the initial lease, extended the expiration date of and added approximately 4,000 square feet to the second lease, as well as added approximately 37,000 square feet of additional office space, accounted for as a separate lease (“third lease”) in accordance with ASC 842. The portion of the space covered under the initial lease was placed in service in September 2019. The portion of the space covered under the second lease commenced in September 2020. Finally, the portion of the space covered under the third lease commenced in September 2021. The three portions were recognized as an operating lease and included in the ROU operating lease assets and operating lease liabilities on the Consolidated Balance Sheets. Computer and Office Equipment We also have operating lease agreements for certain computer and office equipment. The remaining lease terms as of December 31, 2024, ranged from less than one year to approximately four years with fixed monthly payments that are included in the ROU operating lease assets and operating lease liabilities. The leases provide an option to purchase the related equipment at fair market value at the end of the lease. The leases will automatically renew as a month-to-month rental at the end of the lease if the equipment is not purchased or returned. Lease Position, Undiscounted Cash Flow and Supplemental Information ​ The table below presents information related to our ROU operating lease assets and operating lease liabilities that we have recorded: ​ ​ ​ ​ ​ ​ ​ ​ (In thousands) At December 31, 2024 At December 31, 2023 Right of use operating lease assets ​ $ 16,633 ​ $ 19,128 ​ ​ ​ ​ ​ ​ ​ Operating lease liabilities: ​ ​ ​ ​ ​ ​ Current ​ $ 2,980 ​ $ 2,807 Non-current ​ 15,955 ​ 18,436 Total ​ $ 18,935 ​ $ 21,243 ​ ​ ​ ​ ​ ​ ​ Operating leases: ​ ​ ​ ​ ​ ​ Weighted average remaining lease term ​ 5.8 years ​ ​ 6.7 years Weighted average discount rate ​ ​ 4.4% ​ ​ 4.3% ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2024 ​ 2023 ​ 2022 Supplemental cash flow information for our operating leases: ​ ​ ​ ​ ​ ​ ​ ​ ​ Cash paid for operating lease liabilities ​ $ 3,566 ​ $ 3,453 ​ $ 3,575 Non-cash right of use assets obtained in exchange for new operating lease obligations ​ $ 390 ​ $ 293 ​ $ 49 ​ ​ The table below reconciles the undiscounted cash flows under the operating lease liabilities recorded on the Consolidated Balance Sheets for the periods presented: ​ ​ ​ ​ ​ (In thousands) ​ ​ ​ 2025 $ 3,736 2026 ​ ​ 3,808 2027 ​ 3,311 2028 ​ 3,275 2029 ​ 3,309 Thereafter ​ 3,692 Total minimum lease payments ​ ​ 21,131 Less: Amount of lease payments representing interest ​ ​ (2,196) Present value of future minimum lease payments ​ ​ 18,935 Less: Current obligations under operating lease liabilities ​ ​ (2,980) Non-current obligations under operating lease liabilities ​ $ 15,955 ​ Operating lease costs were $3.5 million, $3.6 million and $3.8 million for the years ended December 31, 2024, 2023 and 2022, respectively. Major Vendors We had purchases from one vendor that accounted for 20% of our total purchases for the year ended December 31, 2024, and purchases from one vendor that accounted for 25% of total purchases for the year ended December 31, 2023. Purchase Commitment We issued purchase orders in 2024 totaling $22.8 million for goods that we expect to receive within the next year. Retirement Plan We maintain a 401(k) retirement plan for our employees to which eligible employees can contribute a percentage of their pre-tax compensation. We recorded an expense related to our discretionary contributions to the 401(k) plan of $2.2 million, $1.5 million and $1.5 million for the years ended December 31, 2024, 2023 and 2022, respectively. Legal Proceedings From time to time, we are subject to various claims and legal proceedings arising in the ordinary course of business. Regardless of outcome, litigation can have an adverse impact on us because of defense and settlement costs, diversion of management resources and other factors. On May 24, 2022, a stockholder derivative lawsuit was filed in the United States District Court for the District of Minnesota, purportedly on behalf of the Company against certain of our present and former officers and directors and the Company (as a nominal defendant), captioned Jack Weaver v. Moen, et al., File No. 0:22-cv-01403-NEB-BRT (the “Weaver Lawsuit”). The Weaver Lawsuit generally arose out of the same subject matter as a previously settled securities class action captioned Brian Mart v. Tactile Sys. Tech., Inc., et al., File No. 0:20-cv-02074-NEB-BRT (D. Minn.) (the “Mart Lawsuit”), which alleged, inter alia, that we and eight of our former officers and directors made materially false or misleading statements about our business, operational and compliance policies. The Weaver Lawsuit alleged the following claims under the Exchange Act and common law: (1) that the director defendants made materially false or misleading public statements in proxy statements in violation of Section 14(a) of the Exchange Act; (2) that the director defendants’ stock and option awards should be rescinded under Section 29(b) of the Exchange Act; (3) that the officer defendants’ employment contract compensation should be rescinded under Section 29(b) of the Exchange Act; (4) that certain officer defendants are liable for contribution arising out of any liability incurred in the Mart Lawsuit, under Sections 10(b) and 21D of the Exchange Act; (5) that the individual defendants breached their fiduciary duties; and (6) that the individual defendants were unjustly enriched. The Weaver Lawsuit sought unspecified damages. In August 2022, the matter was transferred to the United States District Court for the District of Delaware by order granting the Parties Stipulation to Transfer. On February 10, 2023, we filed a motion to dismiss the action. The plaintiff filed an Amended Complaint on March 3, 2023. On March 31, 2023, we filed a motion to dismiss the Amended Complaint. On July 31, 2023, the plaintiff filed a Joint Notice of Preliminary Settlement indicating that the parties had reached a non-binding settlement-in-principal on most of the material terms that would resolve all claims between the parties and requested that the Court temporarily stay all deadlines, hearings, and conferences while the parties continued to finalize settlement. On June 6, 2024, the parties entered into a Stipulation of Settlement in the Weaver Lawsuit. On June 7, 2024, the plaintiff filed an unopposed motion for preliminary approval of the settlement. On June 27, 2024, the Court entered an order granting the motion for preliminary approval of the settlement. The final settlement hearing occurred on August 28, 2024, and on September 4, 2024, the Court entered its order approving the settlement, including the agreed upon attorneys’ fees and expense awards to plaintiffs’ counsel and service awards to the shareholder plaintiffs. Pursuant to the settlement, we adopted and maintain certain corporate governance reforms. The attorneys’ fees and expense award of approximately $0.5 million was covered by insurance and has been paid. The settlement does not constitute an admission of liability or wrongdoing by us or any of our current or former directors or officers. This matter is now concluded. On October 25, 2024, the United States District Court, District of Massachusetts (Boston) unsealed two qui tam complaints against us, and we were served with these complaints on January 14, 2025 and January 21, 2025. The United States has indicated that it is not intervening in either matter at this time. The first complaint is captioned United States ex. rel. Benjaman Scarborough vs. Tactile Systems Technology, Inc., Case No. 1:21-cv-10813-IT, and was filed under seal on May 17, 2021, on behalf of the United States by a former employee (the “Scarborough Complaint”). The Scarborough Complaint alleges that we submitted false claims and made false statements in connection with the Medicare programs, in violation of the Federal False Claims Act. The second complaint is captioned United States ex. rel. Jackie Gorham, an individual, and Dustin Gast, an individual, vs. Tactile Systems Technology, Inc. Case No. 1:21-cv-11809-IT, and was filed under seal on September 1, 2021, on behalf of the United States by two former employees (the “Gorham Complaint”). The Gorham Complaint alleges that we submitted false claims and made false statements in connection with the Medicare, Medicare Advantage plans, Medicaid and other government payers, in violation of the Federal False Claims Act and submitted false claims resulting from kickbacks in violation of the Federal False Claims Act and the Federal Anti-Kickback Statute. Both complaints seek damages, statutory penalties, attorneys’ fees, and costs. We will defend the actions as they proceed.

Stockholders' Equity

Stockholders' Equity	12 Months Ended
	Dec. 31, 2024
Stockholders' Equity
Stockholders' Equity	Note 13. Stockholders' Equity We completed an initial public offering of our common stock on August 2, 2016, in which we sold 4,120,000 shares of our common stock at a public offering price of $10.00 per share. Immediately prior to the completion of the initial public offering, all then-outstanding shares of our Series A and Series B preferred stock were converted into 5,924,453 shares of our common stock. Our Series A preferred stock converted to common stock at a ratio of 1-for-1.03 and our Series B preferred stock converted to common stock at a ratio of 1-for-1. In addition, immediately prior to the completion of the initial public offering, we issued 2,354,323 additional shares of our common stock that our Series A and Series B preferred stockholders were entitled to receive in connection with the conversion of the preferred stock, and we issued 956,842 shares of our common stock to pay accrued dividends on our Series B preferred stock. We also paid $8.2 million in cumulative accrued dividends to our Series A convertible preferred stockholders in connection with the initial public offering, including $0.1 million of dividends paid to the holders of the common restricted shares. On February 27, 2023, we closed on a public offering of 2,875,000 shares of our common stock at a public offering price of $13.00 per share. We received net proceeds from this offering of $34.6 million after deducting underwriting discounts, commissions, and offering expenses. Share Repurchase Program On November 4, 2024, we announced that our board of directors authorized a program to repurchase shares of our common stock in the open market or in privately negotiated purchases, or both, in an aggregate amount not to exceed $30.0 million. The share repurchase program became effective on October 30, 2024 and expires on October 31, 2026. Upon purchase of the shares, we reduce our common stock for the par value of the shares with the excess cost applied against additional paid-in capital. We made share repurchases under the share repurchase program as follows, which include the market price of the shares, commissions and excise tax: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ ​ ​ December 31, (In thousands, except share and per share data) ​ ​ 2024 ​ ​ 2023 Number of shares repurchased ​ ​ 195,518 ​ ​ — Total share repurchased cost ​ $ 3,508 ​ $ — Average total cost per repurchased share ​ $ 17.94 ​ $ — ​ As of December 31, 2024 $26.5 million of authorized share repurchases were remaining under the share repurchase program. The timing and amount of future repurchases will be determined based on an evaluation of market conditions and other factors. Repurchases will be funded through available cash balances and ongoing business operating cash generation and may be suspended or discontinued at any time. Shares of stock repurchased under the program are immediately retired. Repurchases under our share repurchase program reduce the weighted-average number of shares of common stock outstanding for basic and diluted earnings per share calculations. Stock-Based Compensation Our 2016 Equity Incentive Plan (the “2016 Plan”) authorizes us to grant stock options, stock appreciation rights, restricted stock, stock units and other stock-based awards to employees, non-employee directors and certain consultants and advisors. There were up to 4,800,000 shares of our common stock initially reserved for issuance pursuant to the 2016 Plan. The 2016 Plan provides that the number of shares reserved and available for issuance under the 2016 Plan will automatically increase annually on January 1 of each calendar year, commencing in 2017 and ending on and including January 1, 2026, by an amount equal to the lesser of: (a) 5% of the number of common shares of stock outstanding as of December 31 of the immediately preceding calendar year, or (b) 2,500,000 shares; provided, however, that our Board of Directors may determine that any annual increase be a lesser number. In addition, all awards granted under our 2007 Omnibus Stock Plan and our 2003 Stock Option Plan that were outstanding when the 2016 Plan became effective and that are forfeited, expire, are cancelled, are settled for cash or otherwise not issued, will become available for issuance under the 2016 Plan. Pursuant to the automatic increase feature of the 2016 Plan, 1,180,019 shares were added as available for issuance thereunder on January 1, 2024. Our Board of Directors exercised its prerogative to forego the automatic increase on January 1, 2025 and January 1, 2023. As of December 31, 2024, 6,475,903 shares were available for future grant pursuant to the 2016 Plan. ​ Upon adoption and approval of the 2016 Plan, all of our previous equity incentive compensation plans were terminated. However, existing awards under those plans continue to vest in accordance with the original vesting schedules and will expire at the end of their original terms. ​ We recorded total stock-based compensation expense of $7.8 million, $7.5 million and $9.6 million for the years ended December 31, 2024, 2023 and 2022, respectively. This expense was allocated as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ December 31, (In thousands) 2024 2023 2022 Cost of revenue $ 365 ​ $ 420 ​ $ 367 Sales and marketing expenses ​ 2,413 ​ ​ 2,985 ​ ​ 4,060 Research and development expenses ​ 157 ​ ​ 133 ​ ​ 226 Reimbursement, general and administrative expenses ​ 4,884 ​ ​ 4,009 ​ ​ 4,947 Total stock-based compensation expense $ 7,819 ​ $ 7,547 ​ $ 9,600 ​ Stock Options Stock options issued to participants other than non-employees typically vest over three or four years and typically have a contractual term of seven or ten years . Stock options are settled in new shares of our common stock. Stock-based compensation expense included in our Consolidated Statements of Operations for stock options was $0.2 million, $0.9 million and $2.5 million for the years ended December 31, 2024, 2023 and 2022, respectively. The total grant date fair value of options vested during the year was $0.6 million, $1.9 million and $3.3 million for the years ended December 31, 2024, 2023 and 2022, respectively. At December 31, 2024, there was approximately $29 thousand of total unrecognized pre-tax stock option expense under our equity compensation plans, which is expected to be recognized on a straight-line basis over a weighted-average period of 0.9 years. The fair value of each option grant is estimated on the date of grant using the Black-Scholes option pricing model. Annually, we make predictive assumptions regarding future stock price volatility, dividend yield, expected term and forfeiture rate. We estimate our forfeiture rate based on an analysis of our actual forfeitures and will continue to evaluate the appropriateness of the forfeiture rate based on actual forfeiture experience, analysis of employee turnover behavior and other factors. The dividend yield assumption is based on expected annual dividend yield on the grant date. To date, no dividend on common stock has been paid by us. Expected volatility for grants issued in and prior to the first fiscal quarter of 2021 was estimated using the average historical volatility of public companies of similar size and industry over a similar period as the expected term assumption used for our options. Beginning in the second fiscal quarter of 2021, we had sufficient historical data to transition to utilizing our average historical volatility over a similar period as the expected term assumption used for our options as the expected volatility. We use the "simplified method" to determine the expected term of the stock option. The risk-free interest rate is based on the yields of U.S. Treasury securities with maturities similar to the expected term of the options for each option group. There were no stock options granted in the years ended December 31, 2024 or 2023. The following table sets forth the estimated fair value of our stock options granted in the year indicated, and the assumptions on which the fair value was determined: ​ ​ ​ ​ ​ 2022 Expected term 4.5 years Expected volatility 59.2% Risk-free interest rate 4.3% Expected dividend yield 0% Fair value on the date of grant $ 8.11 ​ Our stock option activity for the ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted- ​ Weighted- ​ ​ ​ ​ ​ ​ ​ Average ​ Average ​ Aggregate ​ ​ Options ​ Exercise Price ​ Remaining ​ Intrinsic (In thousands except options and per share data) ​ Outstanding ​ Per Share (1) ​ Contractual Life ​ Value (2) Balance at December 31, 2021 ​ 915,224 ​ $ 39.33 ​ 5.0 years ​ $ 2,068 Granted ​ 47,280 ​ $ 6.17 ​ ​ ​ ​ ​ Exercised ​ (90,878) ​ $ 1.68 ​ ​ ​ $ 916 Forfeited ​ (92,981) ​ $ 36.28 ​ ​ ​ ​ ​ Cancelled/Expired ​ (163,338) ​ $ 37.65 ​ ​ ​ ​ ​ Balance at December 31, 2022 ​ 615,307 ​ $ 43.25 ​ 4.7 years ​ $ 164 Exercised ​ (4,625) ​ $ 2.97 ​ ​ ​ $ 98 Forfeited ​ (25,045) ​ $ 47.54 ​ ​ ​ ​ ​ Cancelled/Expired ​ (155,677) ​ $ 50.72 ​ ​ ​ ​ ​ Balance at December 31, 2023 ​ 429,960 ​ $ 40.74 ​ 3.8 years ​ $ 223 Exercised ​ (2,571) ​ $ 9.40 ​ ​ ​ $ 18 Cancelled/Expired ​ (32,518) ​ $ 43.63 ​ ​ ​ ​ ​ Balance at December 31, 2024 ​ 394,871 ​ $ 40.70 ​ 2.8 years ​ $ 309 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Options exercisable at December 31, 2024 ​ 386,990 ​ $ 41.36 ​ 2.8 years ​ $ 238 ​ (1) The exercise price of each option granted during the periods shown was equal to the market price of the underlying stock on the date of grant. (2) The aggregate intrinsic value of options exercised represents the difference between the exercise price of the option and the closing stock price of our common stock on the date of exercise. The aggregate intrinsic value of options outstanding represents the difference between the exercise price of the option and the closing stock price of our common stock on the last trading day of the period. Options exercisable of 386,457 at December 31, 2023, and 435,363 at December 31, 2022 had weighted average exercise prices of $41.53 and $43.83, respectively. The following summarizes additional information about our stock options: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ ​ December 31, Number of: ​ 2024 ​ 2023 Non-vested options, beginning of the year ​ ​ 43,503 ​ ​ 179,944 Non-vested options, end of the year ​ ​ 7,881 ​ ​ 43,503 Vested options, end of the year ​ ​ 386,990 ​ ​ 386,457 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ ​ December 31, Weighted-average grant date fair value of: ​ 2024 ​ 2023 Non-vested options, beginning of the year ​ $ 13.57 ​ $ 16.24 Non-vested options, end of the year ​ ​ 4.23 ​ ​ 13.57 Vested options, end of the year ​ ​ 16.52 ​ ​ 16.51 Forfeited options, during the year ​ ​ — ​ ​ 18.36 ​ Time-Based Restricted Stock Unit s We have granted time-based restricted stock units to certain participants under the 2016 Plan that are stock-settled with common shares. Time-based restricted stock units granted under the 2016 Plan vest over one to three years . Stock-based compensation expense included in our Consolidated Statements of Operations for time-based restricted stock units was $ 5.9 million, $5.1 million and $ 5.8 million for the years ended December 31, 2024, 2023 and 2022, respectively. As of December 31, 2024, there was approximately $6.1 million of total unrecognized pre-tax compensation expense related to outstanding time-based restricted stock units that is expected to be recognized over a weighted-average period of 1.8 years. Our time-based restricted stock unit activity for the ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted- ​ ​ ​ ​ ​ Average Grant Aggregate ​ ​ Units ​ Date Fair Value ​ Intrinsic (In thousands except unit and per unit data) ​ Outstanding ​ Per Unit ​ Value (1) Balance at December 31, 2021 ​ 259,147 ​ $ 42.32 ​ $ 4,932 Granted ​ 539,525 ​ $ 15.03 ​ ​ ​ Vested ​ (123,528) ​ $ 43.20 ​ ​ ​ Cancelled ​ (84,602) ​ $ 26.91 ​ ​ ​ Balance at December 31, 2022 ​ 590,542 ​ $ 19.42 ​ $ 6,779 Granted ​ 398,698 ​ $ 15.52 ​ ​ ​ Vested ​ (270,651) ​ $ 20.18 ​ ​ ​ Cancelled ​ (129,447) ​ $ 19.79 ​ ​ ​ Balance at December 31, 2023 ​ 589,142 ​ $ 16.35 ​ $ 8,425 Granted ​ 541,547 ​ $ 13.82 ​ ​ ​ Vested ​ (281,917) ​ $ 17.38 ​ ​ ​ Cancelled ​ (120,346) ​ $ 14.78 ​ ​ ​ Balance at December 31, 2024 ​ 728,426 ​ $ 14.33 ​ $ 12,478 ​ (1) The aggregate intrinsic value of time-based restricted stock units outstanding was based on our closing stock price on the last trading day of the period. Performance-Based Restricted Stock Units We have granted performance-based restricted stock units (“PSUs”) to certain participants under the 2016 Plan. These PSUs have both performance-based and time-based vesting features. The PSUs granted in 2021 were earned if and to the extent performance goals based on revenue and adjusted EBITDA were achieved in 2022. The PSUs granted in 2022 will be earned if and to the extent performance goals based on revenue change and adjusted EBITDA margin are achieved in 2023. The number of PSUs earned under these grants will depend on the level at which the performance targets are achieved and can range from 50% of target if threshold performance is achieved and up to 150% of target if maximum performance is achieved. One-third two-thirds one-third one-third Stock-based compensation expense included in our Consolidated Statements of Operations for PSUs was $1.2 million, $0.9 million and $0.5 million for the years ended December 31, 2024, 2023 and 2022, respectively. The stock-based compensation expense for the year ended December 31, 2024 reflects an expense of $0.5 million related to the PSUs granted in 2024, an expense of $0.4 million related to the PSUs granted in 2023 and an expense of $0.3 million related to PSUs granted in 2022. The stock-based compensation expense for the year ended December 31, 2023 reflects an expense of $0.5 million related to the PSUs granted in 2023 and $0.4 million related to PSUs granted in 2022. As of December 31, 2024, there was approximately $1.3 million of total unrecognized pre-tax compensation expense related to outstanding PSUs that is expected to be recognized over a weighted average period of 2.0 years. ​ Our PSU activity at the estimated payout of 100% of target for the years ended December 31, 2024, 2023 and 2022, was as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted- ​ ​ ​ ​ ​ Average Grant Aggregate ​ ​ PSUs ​ Date Fair Value ​ Intrinsic (In thousands except unit and per unit data) ​ Outstanding ​ Per Unit ​ Value (1) Balance at December 31, 2021 ​ 54,317 ​ $ 50.22 ​ $ 1,034 Granted ​ 131,710 ​ $ 18.54 ​ ​ ​ Vested ​ (4,407) ​ $ 12.31 ​ ​ ​ Cancelled ​ (26,002) ​ $ 42.53 ​ ​ ​ Balance at December 31, 2022 ​ 155,618 ​ $ 25.05 ​ $ 1,786 Granted ​ 123,575 ​ $ 15.28 ​ ​ ​ Vested ​ (13,842) ​ $ 42.70 ​ ​ ​ Cancelled ​ (67,119) ​ $ 21.50 ​ ​ ​ Balance at December 31, 2023 ​ 198,232 ​ $ 18.93 ​ $ 2,785 Granted ​ 223,762 ​ $ 13.76 ​ ​ ​ Vested ​ (44,162) ​ $ 27.31 ​ ​ ​ Cancelled ​ (104,913) ​ $ 14.14 ​ ​ ​ Balance at December 31, 2024 ​ 272,919 ​ $ 15.19 ​ $ 4,675 ​ (1) The aggregate intrinsic value of performance-based restricted stock units outstanding was based on our closing stock price on the last trading day of the period Employee Stock Purchase Plan Our ESPP, which was approved by our Board of Directors on April 27, 2016, and by our stockholders on June 20, 2016, allows participating employees to purchase shares of our common stock at a discount through payroll deductions. The ESPP is available to all of our employees and employees of participating subsidiaries. Participating employees may purchase common stock, on a voluntary after-tax basis, at a price equal to 85% of the lower of the closing market price per share of our common stock on the first or last trading day of each stock purchase period. The ESPP provides for six-month purchase periods, beginning on May 16 and November 16 of each calendar year. A total of 1,600,000 shares of common stock was initially reserved for issuance under the ESPP. This share reserve will automatically be supplemented each January 1, commencing in 2017 and ending on and including January 1, 2026, by an amount equal to the least of (a) 1% of the shares of our common stock outstanding on the immediately preceding December 31, (b) 500,000 shares or (c) such lesser amount as our Board of Directors may determine. Pursuant to the automatic increase feature of the ESPP, 240,780 shares were added as available for issuance thereunder on January 1, 2025 and 236,003 shares were added as available for issuance thereunder on January 1, 2024. Our Board of Directors exercised its prerogative to forego the automatic increase on January 1, 2023. As of December 31, 2024, 1,444,905 shares were available for future issuance under the ESPP. We recognized $0.5 million, $0.6 million and $0.8 million in stock-based compensation expense related to the ESPP for the years ended December 31, 2024, 2023 and 2022, respectively. ​

Revenue

Revenue	12 Months Ended
	Dec. 31, 2024
Revenue.
Revenue	Note 14. Revenue We derive our revenue from the sale and rental of our products to our customers in the United States. The following table presents our revenue, inclusive of sales and rental revenue, disaggregated by product: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ ​ December 31, (In thousands) ​ 2024 ​ 2023 ​ 2022 Revenue ​ ​ ​ ​ ​ ​ ​ ​ ​ Lymphedema products ​ $ 259,361 ​ $ 241,721 ​ $ 212,266 Airway clearance products ​ ​ 33,623 ​ ​ 32,702 ​ ​ 34,519 Total ​ $ 292,984 ​ $ 274,423 ​ $ 246,785 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Percentage of total revenue ​ ​ ​ ​ ​ ​ ​ ​ ​ Lymphedema products ​ 89% ​ 88% ​ 86% Airway clearance products ​ ​ 11% ​ ​ 12% ​ ​ 14% Total ​ 100% ​ 100% ​ 100% ​ Our revenue by channel, inclusive of sales and rental revenue, for the years ended December 31, 2024, 2023 and 2022, are summarized in the following table: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ ​ December 31, (In thousands) ​ 2024 ​ 2023 ​ 2022 Private insurers and other payers ​ $ 175,432 ​ $ 148,901 ​ $ 139,087 Veterans Administration ​ ​ 30,890 ​ ​ 27,003 ​ ​ 25,507 Medicare ​ ​ 53,039 ​ ​ 65,817 ​ ​ 47,672 Durable medical equipment distributors ​ ​ 33,623 ​ ​ 32,702 ​ ​ 34,519 Total ​ $ 292,984 ​ $ 274,423 ​ $ 246,785 ​ Our rental revenue is derived from rent-to-purchase arrangements that typically range from three to ten months . As title transfers to the patient, with whom we have the contract, upon the termination of the lease term and because collectability is probable, under ASC 842, these are recognized as sales-type leases. Each rental agreement contains two components, the controller and related garments, both of which are interdependent and recognized as one lease component. The revenue and associated cost of revenue of sales-type leases are recognized on the lease commencement date and a net investment in leases is recorded on the Consolidated Balance Sheet. We bill the patients’ insurance payers monthly over the duration of the rental term. We record the net investment in leases and recognize revenue upon commencement of the lease in the amount of the expected consideration to be received through the monthly payments. Similar to our sales revenue, the transaction price is impacted by multiple factors, including the terms and conditions contracted by various third party payers. As the rental contract resides with the patients, we have elected the portfolio approach, at the payer level, to determine the expected consideration, which considers the impact of early terminations. While the contract is with the patient, in certain circumstances, the third party payer elects an initial rental period with an option to extend. We assess the likelihood of extending the lease at the onset of the lease to determine if the option is reasonably certain to be exercised. As the lease is short-term in nature, we anticipate collection of substantially all of the net investment within the first year of the lease agreement. Completion of these payments represents the fair market value of the equipment, and as such, interest income is not applicable. ​ Rental revenue for the years ended December 31, 2024, 2023 and 2022, was primarily from private insurers. Sales-type lease revenue and the associated cost of revenue for the years ended December 31, 2024, 2023 and 2022, was: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, (In thousands) ​ ​ 2024 ​ 2023 ​ 2022 Sales-type lease revenue ​ ​ $ 36,972 ​ $ 34,930 ​ $ 35,440 Cost of sales-type lease revenue ​ ​ 11,481 ​ 12,577 ​ 11,190 Gross profit ​ ​ $ 25,491 ​ $ 22,353 ​ $ 24,250 ​

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2024
Income Taxes
Income Taxes	Note 15. Income Taxes The provision (benefit) for income tax expense consisted of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, (In thousands) 2024 2023 2022 Current income taxes, Federal ​ $ 4,304 ​ $ 5,045 ​ $ 1,838 Current income taxes, State ​ ​ 1,365 ​ ​ 1,440 ​ ​ 637 ​ ​ ​ 5,669 ​ ​ 6,485 ​ ​ 2,475 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Deferred income taxes, Federal ​ 702 ​ (19,046) ​ (32) Deferred income taxes, State ​ ​ 365 ​ ​ (332) ​ ​ — ​ ​ ​ 1,067 ​ ​ (19,378) ​ ​ (32) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Unrecognized tax benefit, Federal ​ (207) ​ 148 ​ (50) Unrecognized tax benefit, State ​ ​ — ​ ​ — ​ ​ — ​ ​ ​ (207) ​ ​ 148 ​ ​ (50) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total provision (benefit) for income taxes ​ $ 6,529 ​ $ (12,745) ​ $ 2,393 ​ The components of our deferred tax assets and liabilities were as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ At December 31, (In thousands) 2024 2023 Deferred tax assets: ​ ​ ​ ​ ​ ​ Operating lease liability ​ $ 4,755 ​ $ 5,394 Net operating loss carryforwards ​ ​ 1 ​ ​ 50 Accounts receivable and inventory reserves ​ ​ 5,406 ​ ​ 7,065 Stock-based compensation ​ ​ 5,818 ​ ​ 5,144 Accrued liabilities ​ 1,766 ​ 2,056 Warranty reserves ​ ​ 752 ​ ​ 1,025 Intangible assets ​ ​ 875 ​ ​ 1,645 Business credits ​ ​ 761 ​ ​ 630 R&D expenses ​ ​ 3,253 ​ ​ 2,189 Other ​ 342 ​ 309 Total deferred tax assets ​ ​ 23,729 ​ ​ 25,507 ​ ​ ​ ​ ​ ​ ​ Deferred tax liabilities: ​ ​ ​ ​ ​ ​ Right of use operating lease assets ​ (4,177) ​ (4,799) Fixed assets ​ ​ (877) ​ ​ (975) Prepaid expenses ​ ​ (209) ​ ​ (232) Other ​ ​ (155) ​ ​ (123) Total deferred tax liabilities ​ ​ (5,418) ​ ​ (6,129) ​ ​ ​ ​ ​ ​ ​ Net deferred tax assets ​ $ 18,311 ​ $ 19,378 ​ A reconciliation of income tax expense (benefit) to the statutory federal tax rate is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ 2024 ​ 2023 ​ 2022 Tax expense at statutory rate 21.0 % ​ 21.0 % ​ 21.0 % State income taxes, net of federal benefit ​ 4.7 ​ ​ 5.2 ​ ​ 4.1 ​ Executive compensation ​ 1.1 ​ ​ 0.9 ​ ​ — ​ Meals and entertainment ​ 1.7 ​ ​ 2.1 ​ ​ — ​ Employee Stock Purchase Plan ​ 0.4 ​ ​ 0.9 ​ ​ (1.0) ​ Federal business credits ​ (1.5) ​ ​ (1.5) ​ ​ 1.6 ​ Valuation allowance ​ — ​ ​ (113.3) ​ ​ (37.4) ​ Return to provision ​ (0.5) ​ ​ 0.5 ​ ​ (0.2) ​ Deferred reprice - state 0.9 ​ 0.2 ​ 0.9 ​ Unrecognized tax benefits ​ 0.3 ​ ​ 0.3 ​ ​ (0.3) ​ Excess benefit on non-qualified stock options and RSUs ​ 0.7 ​ ​ 2.3 ​ ​ (3.7) ​ Interest and penalties ​ — ​ ​ 0.1 ​ ​ — ​ 162(m) write down ​ — ​ ​ 1.6 ​ ​ — ​ Other (1.0) ​ (1.1) ​ (0.5) ​ Net effective rate 27.8 % ​ (80.8) % ​ (15.5) % ​ A reconciliation of unrecognized tax benefits (“UTB”) is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, (In thousands) 2024 2023 2022 Balance beginning of the year ​ $ 702 ​ $ 612 ​ $ 522 Gross changes — tax positions in prior year ​ ​ (272) ​ ​ — ​ ​ — Gross changes — tax positions in current year ​ ​ 117 ​ ​ 90 ​ ​ 90 Balance end of the year ​ $ 547 ​ $ 702 ​ $ 612 ​ Deferred income taxes result from temporary differences between the reporting of amounts for financial statement purposes and income tax purposes. These differences relate primarily to different methods used for income tax purposes including depreciation and amortization, warranty and vacation accruals, and deductions related to allowances for doubtful accounts receivable, and inventory reserves. As of December 31, 2024, the Company had approximately $1 thousand of state net operating loss ("NOL") carryforwards. A portion of the state NOL carry forward amounts have begun to expire in the current year. The Company is subject to income tax examinations in the U.S. federal jurisdiction as well as in various state jurisdictions. U.S. federal and state tax years prior to 2021 are closed to examination. In the event of any future tax assessments, we have elected to record the income taxes and any related interest and penalties as income tax expense on our Consolidated Statement of Operations. The Company is not under exam in any jurisdictions. The effective tax rate for the twelve months ended December 31, 2024, was an expense of 27.8%, compared to a benefit of 80.8% for the twelve months ended December 31, 2023. The primary driver of the change in our effective tax rate was the fact that we did not have a release of a valuation allowance on our deferred tax assets for 2024, while in 2023 there was a release of a valuation allowance to recognize the full value of our deferred tax assets. We recorded an income tax expense of $6.5 million and an income tax benefit of $12.7 million for the twelve months ended December 31, 2024 and 2023, respectively. We recognize the financial statement benefit of a tax position only after determining that the relevant tax authority would more likely than not sustain the position following an audit. For tax positions meeting the more likely than not threshold, the amount recognized in the consolidated financial statements is the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement with the relevant tax authority. Management assesses the available positive and negative evidence to estimate whether sufficient future taxable income will be generated to permit use of the existing deferred tax assets. On the basis of this evaluation, all deferred tax assets are expected to be realizable. The amount of the deferred tax asset considered realizable, however, could be adjusted if estimates of future taxable income during the carryforward period are reduced or increased or if objective negative evidence in the form of cumulative losses is no longer present and additional weight is given to subjective evidence such as our projections for growth.

Net Income (Loss) Per Common Sh

Net Income (Loss) Per Common Share	12 Months Ended
	Dec. 31, 2024
Net Income (Loss) Per Common Share
Net Income (Loss) Per Common Share	Note 16. Net Income (Loss) Per Common Share The following table sets forth the computation of our basic and diluted net income (loss) per share: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ December 31, (In thousands, except share and per share data) 2024 2023 2022 Net income (loss) $ 16,960 ​ $ 28,515 ​ $ (17,866) Weighted-average shares outstanding ​ 23,883,729 ​ ​ 22,925,497 ​ ​ 20,067,969 Weighted-average shares used to compute diluted net income (loss) per share ​ 24,138,244 ​ ​ 23,176,169 ​ ​ 20,067,969 Net income (loss) per share - Basic $ 0.71 ​ $ 1.24 ​ $ (0.89) Net income (loss) per share - Diluted $ 0.70 ​ $ 1.23 ​ $ (0.89) ​ The following common stock equivalents were excluded from the computation of diluted net income (loss) per common share for the periods presented because including them would have been anti-dilutive: ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ December 31, ​ 2024 2023 2022 Restricted stock units 313,458 ​ 337,202 ​ 590,542 Common stock options 360,246 ​ 389,229 ​ 615,307 Performance stock units 53,791 ​ 17,392 ​ 155,618 Employee stock purchase plan 83,598 ​ — ​ 100,506 Total 811,093 ​ 743,823 ​ 1,461,973 ​

Fair Value Measurements

Fair Value Measurements	12 Months Ended
	Dec. 31, 2024
Fair Value Measurements
Fair Value Measurements	Note 17. Fair Value Measurements We determine the fair value of our assets and liabilities based on the exchange price that would be received for an asset or paid to transfer a liability (exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value maximize the use of observable inputs and minimize the use of unobservable inputs. We use a fair value hierarchy with three levels of inputs, of which the first two are considered observable and the last unobservable, to measure fair value. The fair value hierarchy gives the highest priority to quoted prices in active markets for identical assets or liabilities (Level 1). The next highest priority is based on quoted prices for similar assets or liabilities in active markets or quoted prices for identical or similar assets or liabilities in non-active markets or other observable inputs (Level 2). The lowest priority is given to unobservable inputs (Level 3). As of December 31, 2023, our obligations under the AffloVest earn-out arrangements had been paid in full. Prior to the determination of the actual amount of the earn-out, the earn-out liability was valued by employing a Monte Carlo Simulation model in a risk-neutral framework, which is a Level 3 input. The underlying simulated variable included recognized revenue. The recognized revenue volatility estimate was based on a study of historical asset volatility for a set of comparable public companies. The model included other assumptions including the market price of risk, which was calculated as the weighted average cost of capital less the long-term risk-free rate. The earn-out liability was adjusted to fair value at each reporting date until the end of the earn-out period, which was September 30, 2023. Changes in fair value were included in intangible asset amortization and earn-out expenses in our Consolidated Statements of Operations. ​ Changes in the earn-out liability measured at fair value using Level 3 inputs were as follows: ​ ​ ​ ​ ​ (In thousands) ​ ​ Earn-out liability at December 31, 2022 ​ $ 13,050 Payments on earn-out ​ ​ (10,575) Fair value adjustments ​ ​ (2,475) Earn-out liability at December 31, 2023 ​ $ — ​ On May 25, 2023, the Company paid $5.0 million, plus an imputed interest payment of $250,000 , relating to the initial earn-out. Subsequent to September 30, 2023, it was determined that the calculated amount of the second earn-out payment was $5.6 million, which was paid by the Company on November 28, 2023. ​ The carrying amounts of financial instruments such as accounts receivable, other assets, accounts payable, accrued expenses and other liabilities approximate their related fair values due to the short-term maturities of these items. Non-financial assets, such as equipment and leasehold improvements, and intangible assets are subject to non-recurring fair value measurements if they are deemed impaired.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Pay vs Performance Disclosure
Net Income (Loss)	$ 16,960	$ 28,515	$ (17,866)

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Dec. 31, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Cybersecurity Risk Management a

Cybersecurity Risk Management and Strategy Disclosure	12 Months Ended
	Dec. 31, 2024
Cybersecurity Risk Management, Strategy, and Governance [Line Items]
Cybersecurity Risk Management Processes for Assessing, Identifying, and Managing Threats [Text Block]	Risk Management and Strategy We recognize the critical importance in developing, implementing and maintaining robust cybersecurity measures and processes that are designed to safeguard our information systems and to assess, identify and manage material risks from cybersecurity threats. The fundamental controls of our cybersecurity program are based around the National Institute of Standards and Technology (NIST) Cybersecurity Framework (CSF). We engage qualified third-party consultants and advisors to conduct risk and vulnerability assessments to evaluate our systems and to advise us on cybersecurity risk management processes. We maintain a robust vulnerability-management program to evaluate our systems on a monthly basis, and we prioritize remediation efforts based on risk level and criticality of the system or data. We conduct comprehensive penetration testing with external consultants on our enterprise environment and our own products on at least an annual basis. Cybersecurity risk management is an integral part of our technology modernization program. It is integrated into our business, as well as the broader software and digital environment. Our technology modernization program will move many of our core applications to industry-specific healthcare cloud solutions that offer robust HIPAA compliant, data security capabilities and tools. Our modernization plans revolve around simplifying our technology estate to reduce technical debt, automate security functions, and enable applications to take full advantage of best-practice, cloud security capabilities. Our cybersecurity risk management process includes assessment of third-party service providers, suppliers and other business partners’ ability to maintain compliance with our cybersecurity requirements, including review of Service Organization Control Type 2 (“SOC 2”) reports and security controls. Our onboarding process for any third-party service provider includes execution of a business associate agreement that defines the service provider’s responsibility to notify us in the event of any known or suspected cyber incident. We maintain a thorough business continuity and resilience program designed to ensure our operations will withstand significant disruption and minimize impact on our patients and employees in the face of a significant challenge. Using standards developed by Disaster Recovery Institute International (DRII), we regularly conduct a business impact analysis to determine risk level, assess impact severity and prioritize business processes based on company needs. As part of our monitoring process, we perform tabletop exercises at least annually to test our current plans. These cross-functional exercises involve employees from multiple departments and are designed to gain perspective, collect feedback and validate plan effectiveness. The information obtained from the business impact analysis, exercises and testing is utilized to update contingency plans for each department. While we have experienced cybersecurity incidents and expect to continue to be subject to such incidents, to date, we have not experienced any cybersecurity incidents that have materially affected our business strategy, results of operations or financial condition. However, we are subject to ongoing risks from cybersecurity threats that could materially affect us, including our business strategy, results of operations, or financial condition, as further described in Part I, Item 1A, "Risk Factors" of this Annual Report on Form 10-K.
Cybersecurity Risk Management Processes Integrated [Flag]	true
Cybersecurity Risk Management Processes Integrated [Text Block]	Cybersecurity risk management is an integral part of our technology modernization program. It is integrated into our business, as well as the broader software and digital environment. Our technology modernization program will move many of our core applications to industry-specific healthcare cloud solutions that offer robust HIPAA compliant, data security capabilities and tools. Our modernization plans revolve around simplifying our technology estate to reduce technical debt, automate security functions, and enable applications to take full advantage of best-practice, cloud security capabilities.
Cybersecurity Risk Management Third Party Engaged [Flag]	true
Cybersecurity Risk Third Party Oversight and Identification Processes [Flag]	true
Cybersecurity Risk Materially Affected or Reasonably Likely to Materially Affect Registrant [Flag]	false
Cybersecurity Risk Board of Directors Oversight [Text Block]	Governance The Audit Committee of the Board of Directors oversees our cybersecurity and risk management programs, and receives updates from our Information Security and Compliance teams regarding the effectiveness of these programs on a quarterly basis. These reports include descriptions of security incidents and observed trends in threat activity, new programs and tooling designed to address developing areas of risk, and performance reporting of third-party testing, including security awareness training and cybersecurity assessments. The full Board of Directors has general oversight of the Company’s risk management programs, which include cybersecurity risks, and the Audit Committee provides regular reports to the full Board of Directors related to cybersecurity matters and related risk oversight. The Company’s Director of Information Security reports to our Chief Information Officer. Our Director of Information Security is responsible for our cybersecurity program, develops and publishes security policies and procedures, and reports to the Audit Committee on the effectiveness of our security program. Our Director of Information Security has 25 years of technology leadership experience, including 19 years directly overseeing cybersecurity programs in the healthcare device manufacturing industry, and holds the Certified Information Systems Security Professional (CISSP) certification. Our Director of Information Security is responsible for the Company’s Information Security Awareness Program, which includes security training for new hires and ongoing education for all staff, including annual refresher training and periodic bulletins regarding security risks. Security awareness email testing is performed on a monthly basis, with employee performance reported to management for inclusion in performance evaluations. Our Director of Information Security also performs risk assessments of third-party partners, including reviews of SOC 2 reports.
Cybersecurity Risk Board Committee or Subcommittee Responsible for Oversight [Text Block]	Audit Committee
Cybersecurity Risk Process for Informing Board Committee or Subcommittee Responsible for Oversight [Text Block]	The Audit Committee of the Board of Directors oversees our cybersecurity and risk management programs, and receives updates from our Information Security and Compliance teams regarding the effectiveness of these programs on a quarterly basis. These reports include descriptions of security incidents and observed trends in threat activity, new programs and tooling designed to address developing areas of risk, and performance reporting of third-party testing, including security awareness training and cybersecurity assessments. The full Board of Directors has general oversight of the Company’s risk management programs, which include cybersecurity risks, and the Audit Committee provides regular reports to the full Board of Directors related to cybersecurity matters and related risk oversight.
Cybersecurity Risk Role of Management [Text Block]	The Company’s Director of Information Security reports to our Chief Information Officer. Our Director of Information Security is responsible for our cybersecurity program, develops and publishes security policies and procedures, and reports to the Audit Committee on the effectiveness of our security program. Our Director of Information Security has 25 years of technology leadership experience, including 19 years directly overseeing cybersecurity programs in the healthcare device manufacturing industry, and holds the Certified Information Systems Security Professional (CISSP) certification. Our Director of Information Security is responsible for the Company’s Information Security Awareness Program, which includes security training for new hires and ongoing education for all staff, including annual refresher training and periodic bulletins regarding security risks. Security awareness email testing is performed on a monthly basis, with employee performance reported to management for inclusion in performance evaluations. Our Director of Information Security also performs risk assessments of third-party partners, including reviews of SOC 2 reports.
Cybersecurity Risk Management Positions or Committees Responsible [Flag]	true
Cybersecurity Risk Management Positions or Committees Responsible [Text Block]	Company’s Director of Information Security reports to our Chief Information Officer
Cybersecurity Risk Management Expertise of Management Responsible [Text Block]	Our Director of Information Security has 25 years of technology leadership experience, including 19 years directly overseeing cybersecurity programs in the healthcare device manufacturing industry, and holds the Certified Information Systems Security Professional (CISSP) certification
Cybersecurity Risk Process for Informing Management or Committees Responsible [Text Block]	The Company’s Director of Information Security reports to our Chief Information Officer. Our Director of Information Security is responsible for our cybersecurity program, develops and publishes security policies and procedures, and reports to the Audit Committee on the effectiveness of our security program. Our Director of Information Security has 25 years of technology leadership experience, including 19 years directly overseeing cybersecurity programs in the healthcare device manufacturing industry, and holds the Certified Information Systems Security Professional (CISSP) certification.
Cybersecurity Risk Management Positions or Committees Responsible Report to Board [Flag]	true

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2024
Summary of Significant Accounting Policies
Basis of Presentation	Our accompanying consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) and pursuant to the rules and regulations of the SEC. The results for the year ended December 31, 2024, are not necessarily indicative of results to be expected for any future year.
Principles of Consolidation	Principles of Consolidation Our accompanying consolidated financial statements include the accounts of Tactile Systems Technology, Inc. and its wholly owned subsidiary, Swelling Solutions, Inc. All intercompany balances and transactions have been eliminated in consolidation.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and to disclose contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting period. Actual results could differ from those estimates. ​
Cash	Cash Cash consists of all cash on hand and deposits. Our cash was held primarily in checking accounts and an Institutional Insured Liquid Deposit demand account as of December 31, 2024 and 2023.
Equity Investments	Equity Investments Equity investments (including equity securities) with readily determinable fair value are reported at fair value, with unrealized gains and losses included in the determination of net income (loss). For equity investments with no readily determinable fair value, we measure these investments at cost less impairment, if any, plus or minus changes resulting from observable price changes in orderly transactions for the identical or a similar investment of the same issuer. Such observable price changes may include instances where the investee issues equity securities to new investors, thus creating a new indicator of fair value, as an example. As of each of December 31, 2024 and 2023, the total carrying value of our equity investments, with no readily determinable fair value, was $0.3 million, and are included in other non-current assets on our Consolidated Balance Sheets. On an annual basis, we perform a qualitative assessment considering impairment indicators to evaluate whether these investments are impaired and also monitor for any observable price changes. During the years ended December 31, 2024 and 2023, we did not have any impairment loss on these investments.
Accounts Receivable	Accounts Receivable The majority of our accounts receivable and revenue are from commercial insurance payers and government payers, such as Medicare, the Veterans Administration and Medicaid. Accounts receivable are recorded based on management’s assessment of the expected consideration to be received, based on a detailed review of historical pricing adjustments and collections. Management relies on the results of the assessment, which includes payment history of the applicable payer as well as historical patient collections, as a primary source of information in estimating the collectability of our accounts receivable. We update our assessment on a quarterly basis, which to date has not resulted in any material adjustments to the valuation of our accounts receivable. We believe the assessment provides reasonable estimates of our accounts receivable valuation, and therefore we believe that substantially all accounts receivable are fully collectible. A portion of claims to Medicare are initially denied and enter the appeals process, where many are ultimately reviewed by an Administrative Law Judge. After final adjudication of all claims, approximately 90% of the claims submitted are approved (this is on a number of claims, not a dollars claimed, basis across all our products). The appeals process can be lengthy, lasting more than a year in most cases. Accordingly, we classify a portion of our Medicare accounts receivable as non-current based on our experience with Medicare collections.
Inventories	Inventories Inventories are valued at the lower of cost (first-in, first-out method) or net realizable value.
Property and Equipment	Property and Equipment Property and equipment are stated at cost and are depreciated using the straight-line method over their estimated useful lives of three Major expenditures for property and equipment are capitalized. Maintenance, repairs and minor renewals are expensed as incurred. When assets are retired or otherwise disposed of, their costs and related accumulated depreciation are removed from the accumulated depreciation accounts and the resulting gains or losses are included in income.
Software Costs	Software Costs
Revenue Recognition	Revenue Recognition We derive revenue from the sales and rentals of our Flexitouch Plus, Entre Plus and Nimbl systems, and from the sales of our AffloVest product. Flexitouch Plus, Entre Plus and Nimbl We recognize revenue when control of the product has been transferred to our customer, in the amount of the expected consideration to be received for the product. In general, revenue from the sale or rental of a product is recognized upon shipment, unless circumstances dictate that control has not yet passed to the customer. We provide a warranty for these products against defects in material and workmanship for a period of one one We commercially distribute these products directly to patients who are referred to us by physicians, therapists or nurses. In most cases, there is a third-party payer, such as a commercial insurer, Medicare or the Veterans Administration, involved with the transaction. Our contractual relationship resides with the patient when the third-party payer is either a commercial insurer or Medicare and with the Veterans Administration if the patient is covered under their services. Revenue is recognized from such sales upon transfer of control of the product to the customer at a transaction price determined by collection history. As a result, the transaction price is impacted by multiple factors, including the terms and conditions contracted by various third-party payers, and therefore payments from third-party payers typically are less than our standard charge and represent an implicit price concession, resulting in variable consideration. As most contracts are with each individual sale to a patient, we have elected the portfolio approach to determine the transaction price, and ultimately the expected consideration. The portfolios used to determine transaction price are at the payer level, with pricing for each payer assessed based on the underlying similar characteristics. For any of our products sold to patients covered by private payers, such as commercial insurance companies, revenue is recognized upon shipment. A product is not shipped until we have received a prescription from a physician for our products and, as applicable, receipt of prior authorization from payers. At shipment, we invoice the payer for the total product price, and we recognize revenue in the amount of cash consideration anticipated to be received based on the transaction price. After the insurance payer has remitted payment, we separately invoice the patient for their portion of the payment obligation, such as copayments and deductibles. The transaction price is determined based on the payment history of the applicable payer drawn from actual write-off and collections experience from the payer over a rolling 12-month period, as well as historical patient collections. For our products sold to Medicare patients, we recognize revenue from such sales upon shipment of our products, which can occur only after we have received a prescription from a physician and all applicable patient documentation is obtained. The transaction price for our Entre Plus and Nimbl systems is determined based on the payment history using the same methodology as our private insurers. A portion of claims for payment for our Flexitouch Plus system are initially denied, and enter the appeals process, which can be lengthy. We assess the variable consideration for each of these claims as a percentage of the total invoice price based on ultimate approval and collection history. For our products sold to the Veterans Administration on behalf of the patient, our contract is with the Veterans Administration rather than the patient. We enter into individual sales contracts with the Veterans Administration on behalf of each patient. These contracts determine the amount of consideration, which is typically paid in full within 2 We incur incremental costs that directly relate to the sales of our products; however, as the amortization period would be less than one year, we have elected the practical expedient to expense these costs as incurred. We sell and rent these products either directly to patients or the Veterans Administration on behalf of patients, who are referred to us by physicians, therapists or nurses. We bill private insurers and other payers, Medicare, and the Veterans Administration directly for purchases or rentals of our product on behalf of a patient and bill patients directly for their cost-sharing amounts, including any portion of an unsatisfied deductible and any copayments or co-insurance obligation. A portion of our revenue is derived from patients who obtain our products under multiple-month rental arrangements. We bill these patients’ insurance payers monthly over the duration of the rental term. Title to these products passes to the patients at the end of the rental period. Rental agreements are recorded as sales-type leases in accordance with Accounting Standards Update (“ASU”) No. 2016-02, “Leases” (Topic 842) (“ASC 842”). Accordingly, as sales-type leases, the transaction price for the entire rental term is recognized upon transfer of control. AffloVest The AffloVest device is sold through durable medical equipment providers. Revenue is recognized when control of the promised goods or services is transferred to the distributors, in an amount that reflects the consideration we expect to be entitled to in exchange for transferring those goods or providing services. We account for a contract when it has approval and commitment from both parties, the rights of the parties are identified, payment terms are identified, the contract has commercial substance and collectability of consideration is probable. When determining whether the distributor has obtained control of the goods or services, we consider any future performance obligations. Generally, there is no post-shipment obligation on products sold other than warranty obligations in the normal and ordinary course of business. Consequently, revenue from the sale of the AffloVest product is recognized at shipment, unless circumstances dictate that control has not yet passed to the distributor. Certain of our contracts include volume-based incentives which involve rebates that are negotiated at or prior to the time of sale with the customer and are redeemable only if the customer achieves a specified cumulative level of sales or sales increase. Under these incentive programs, at the time of sale, we determine the most likely amount of the rebate to be paid based on forecasted sales levels. These forecasts are updated at least quarterly for applicable customers, and the transaction price is reduced for the anticipated cost of the rebate. If the forecasted sales for a customer change, the accrual for rebates is adjusted to reflect the new rebates expected to be earned by the customer. Amounts billed to customers for shipping and handling activities after the customer obtains control are treated as a promised service performance obligation and recorded in revenue in the accompanying Consolidated Statements of Operations. Shipping and handling costs incurred for the delivery of goods to customers are considered a cost to fulfill the contract and are included in cost of revenue sold in the accompanying Consolidated Statements of Operations. We provide a warranty for the AffloVest products against defects in material and workmanship for a period of five years. In accordance with applicable accounting guidance, we have determined these were assurance warranties and therefore not considered a performance obligation. In addition, we did not evaluate immaterial promised goods or services in the context of the contract. As a result, the sale of these products represents a single performance obligation that is satisfied at a point in time and is short-term in nature.
Research and Development Costs	Research and Development Costs We expense research and development costs as incurred, including expenses associated with clinical research studies and development.
Shipping and Handling Costs	Shipping and Handling Costs Amounts billed to customers for shipping and handling activities after the customer obtains control are treated as a promised service performance obligation and recorded in total revenue in the accompanying Consolidated Statements of Operations. Shipping and handling costs incurred for the delivery of goods to customers are considered a cost to fulfill the contract and are included in cost of revenue in the accompanying Consolidated Statements of Operations.
Product Warranty	Product Warranty We provide a warranty for our products against defects in material and workmanship for a period of one
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets We review long-lived assets, including property and equipment and patents, for impairment whenever events or changes in business circumstances indicate that the carrying amount of an asset may not be fully recoverable. We will assess long-lived assets used in operations for impairment indicators, including when undiscounted cash flows estimated to be generated by those assets are less than the assets’ carrying amount (see Note 8 – “Goodwill and Intangible Assets”).
Goodwill	Goodwill Goodwill represents the excess of the purchase price paid over the estimated fair value of the net assets acquired and liabilities assumed in the acquisition of a business. Goodwill is not amortized, but is tested for impairment at least annually or on an interim basis if an event occurs or circumstances change that would more likely than not reduce the fair value of a reporting unit below its carrying value. We perform our annual assessment of goodwill for impairment as of July 1st of each fiscal year. See Note 8 – “Goodwill and Intangible Assets” for additional information.
Stock-Based Compensation	Stock-Based Compensation We provide stock-based compensation in the form of various types of equity-based awards, including time-based restricted stock units, performance-based restricted stock units, stock options, and through our Employee Stock Purchase Plan (“ESPP”). Stock-based compensation expense is based on the estimated fair value of the award on the grant date for equity awards, or on the first date of the ESPP purchase period for shares under the ESPP, and recognized over the requisite service periods on our Consolidated Statements of Income using the straight-line expense attribution approach. The estimated fair value of time-based and performance based restricted stock units is based on the closing price of our common stock on the grant date. Stock options and ESPP shares are valued using the Black-Scholes option-pricing model. The Black-Scholes valuation model requires the input of highly subjective assumptions. The assumptions include the expected term of the option or ESPP shares, the expected volatility of the price of our common stock, expected dividend yield and the risk-free interest rate. These estimates involve inherent uncertainties and the significant application of management’s judgment. If factors change and different assumptions are used, our stock-based compensation expense could be materially different in the future (see Note 13 – “Stockholders’ Equity”).
Income Taxes	Income Taxes Income taxes are accounted for under the liability method. Deferred income taxes are provided for temporary differences between the financial reporting and the tax basis of assets and liabilities. If we determine in the future that it is more likely than not that we will not realize all or a portion of the deferred tax assets, we will record a valuation allowance in the period the determination is made (see Note 15 – “Income Taxes”). Changes in tax rates are reflected in the tax provision as they occur.
Net Income (Loss) Per Common Share	Net Income (Loss) Per Common Share
Business Segments	Business Segments The Company operates as one operating segment. The Company's Chief Operating Decision Maker ("CODM") is its Chief Executive Officer, who reviews financial information presented on a consolidated basis. The CODM uses consolidated net income (loss) as the measure of segment profit or loss. Significant segment expenses are those expenses reported in the Consolidated Statement of Operations. The CODM assesses performance for the segment, allocates resources and monitors budget versus actual results using consolidated revenue and net income (loss) which is reflected in the Consolidated Statement of Operations.
Accounting Pronouncement Not Yet Adopted	Accounting Pronouncement Not Yet Adopted In November 2024, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2024-03, “Income Statement – Reporting Comprehensive Income – Expense disaggregation Disclosures (Subtopic 220-40): Disaggregation of Income Statement Expenses” which requires entities to disclose additional information about specific expense categories in the notes to financial statements on an annual and interim basis. The guidance is effective for annual periods beginning after December 15, 2026, and interim periods beginning after December 15, 2027, with early adoption permitted. The Company is currently evaluating the effect that this standard will have on its consolidated financial statements and related disclosures. In December 2023, the FASB issued ASU No. 2023-09, “Income Taxes (Topic 740): Improvements to Income Tax Disclosures” which requires entities to enhance disclosures around income taxes. The guidance is effective for annual periods beginning after December 15, 2024, with early adoption permitted. The Company is currently evaluating the effect this standard will have on its consolidated financial statements and related disclosures.
Recently Adopted Accounting Pronouncement	Recently Adopted Accounting Pronouncement In November 2023, the FASB issued ASU No. 2023-07, “Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures” which requires entities to enhance disclosures around segment reporting. The guidance is effective for annual periods beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. The Company adopted ASU 2023-07 with respect to the year ended December 31, 2024. As a result, we have enhanced our segment disclosures in this report. The adoption of this ASU affects only our disclosures, with no impacts to our financial condition and results of operations.

Inventories (Tables)

Inventories (Tables)	12 Months Ended
	Dec. 31, 2024
Inventories
Schedule of inventories	​ ​ ​ ​ ​ ​ ​ ​ (In thousands) At December 31, 2024 At December 31, 2023 Finished goods ​ $ 6,149 ​ $ 7,979 Component parts and work-in-process ​ 12,517 ​ 14,548 Total inventories ​ $ 18,666 ​ $ 22,527 ​

Property and Equipment (Tables)

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2024
Property and Equipment
Schedule of components of property and equipment	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ At December 31, (In thousands) 2024 2023 Equipment ​ $ 5,108 ​ $ 4,459 Tooling ​ 4,652 ​ 4,555 Furniture and fixtures ​ 2,095 ​ 2,068 Leasehold improvements ​ 3,466 ​ 1,529 Demonstration equipment ​ ​ 1,106 ​ ​ 896 Construction in progress ​ ​ 152 ​ ​ 1,271 Subtotal ​ 16,579 ​ 14,778 Less: accumulated depreciation ​ (10,976) ​ (8,583) Property and equipment, net ​ $ 5,603 ​ $ 6,195

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2024
Goodwill and Intangible Assets
Schedule of finite lived intangible assets	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted- ​ At December 31, 2024 ​ ​ Average ​ Gross ​ ​ ​ ​ ​ ​ Amortization ​ Carrying ​ Accumulated ​ Net (In thousands) Period ​ Amount ​ Amortization ​ Amount Definite-lived intangible assets: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Patents ​ 12 years ​ $ 1,148 ​ $ 333 ​ $ 815 Defensive intangible assets ​ < 1 year ​ ​ 1,125 ​ ​ 1,065 ​ ​ 60 Customer accounts ​ — ​ ​ 125 ​ ​ 125 ​ ​ — Customer relationships ​ 10 years ​ ​ 31,000 ​ ​ 7,896 ​ ​ 23,104 Developed technology ​ 8 years ​ ​ 13,000 ​ ​ 3,913 ​ ​ 9,087 Subtotal ​ ​ ​ ​ 46,398 ​ ​ 13,332 ​ ​ 33,066 Unamortized intangible assets: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Tradenames ​ ​ ​ ​ 9,500 ​ ​ — ​ ​ 9,500 Patents pending ​ ​ ​ ​ 223 ​ ​ — ​ ​ 223 Total intangible assets ​ ​ ​ $ 56,121 ​ $ 13,332 ​ $ 42,789 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted- ​ At December 31, 2023 ​ ​ Average ​ Gross ​ ​ ​ ​ ​ ​ Amortization ​ Carrying ​ Accumulated ​ Net (In thousands) Period ​ Amount ​ Amortization ​ Amount Definite-lived intangible assets: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Patents ​ 12 years ​ $ 1,018 ​ $ 248 ​ $ 770 Defensive intangible assets ​ 1 year ​ ​ 1,125 ​ ​ 920 ​ ​ 205 Customer accounts ​ — ​ 125 ​ 125 ​ — Customer relationships ​ 11 years ​ ​ 31,000 ​ ​ 5,511 ​ ​ 25,489 Developed technology ​ 9 years ​ ​ 13,000 ​ ​ 2,731 ​ ​ 10,269 Subtotal ​ ​ ​ ​ 46,268 ​ ​ 9,535 ​ ​ 36,733 Unamortized intangible assets: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Tradenames ​ ​ ​ ​ 9,500 ​ ​ — ​ ​ 9,500 Patents pending ​ ​ ​ ​ 491 ​ ​ — ​ ​ 491 Total intangible assets ​ ​ ​ $ 56,259 ​ $ 9,535 ​ $ 46,724
Schedule of future amortization expense	​ ​ ​ ​ ​ (In thousands) ​ ​ ​ 2025 $ 3,714 2026 ​ ​ 3,650 2027 ​ 3,641 2028 ​ 3,638 2029 ​ 3,633 Thereafter ​ 14,790 Total ​ $ 33,066

Accrued Expenses (Tables)

Accrued Expenses (Tables)	12 Months Ended
	Dec. 31, 2024
Accrued Expenses
Schedule of accrued expenses	​ ​ ​ ​ ​ ​ ​ ​ (In thousands) At December 31, 2024 At December 31, 2023 Warranty ​ $ 1,784 ​ $ 2,357 Legal and consulting ​ ​ 1,318 ​ ​ 611 Travel ​ ​ 1,120 ​ ​ 1,038 In-transit inventory ​ ​ 1,013 ​ ​ 401 Sales and use tax ​ ​ 802 ​ ​ 183 Clinical studies ​ ​ 304 ​ ​ 363 Other ​ 1,439 ​ 951 Total ​ $ 7,780 ​ $ 5,904 ​

Warranty Reserves (Tables)

Warranty Reserves (Tables)	12 Months Ended
	Dec. 31, 2024
Warranty Reserves
Schedule of warranty reserves	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ December 31, (In thousands) 2024 2023 2022 Beginning balance $ 4,038 ​ $ 4,212 ​ $ 4,959 Warranty provision 2,677 ​ 4,611 ​ 2,047 Processed warranty claims (3,722) ​ (4,785) ​ (2,794) Ending balance $ 2,993 ​ $ 4,038 ​ $ 4,212 ​ ​ ​ ​ ​ ​ ​ ​ ​ Accrued warranty reserve, current $ 1,784 ​ $ 2,357 ​ $ 2,005 Accrued warranty reserve, non-current ​ 1,209 ​ ​ 1,681 ​ ​ 2,207 Total accrued warranty reserve $ 2,993 ​ $ 4,038 ​ $ 4,212 ​

Credit Agreement (Tables)

Credit Agreement (Tables)	12 Months Ended
	Dec. 31, 2024
Credit Agreement
Schedule of maturities of the term note payable	​ ​ ​ ​ ​ (In thousands) Amount 2025 ​ $ 3,000 2026 ​ ​ 23,250 Total ​ ​ 26,250 Less: Deferred financing fees ​ ​ (74) Net Note Payable ​ ​ 26,176 Less: Current portion of note payable ​ ​ (2,956) Non-current portion of note payable ​ $ 23,220

Commitments and Contingencies (

Commitments and Contingencies (Tables)	12 Months Ended
	Dec. 31, 2024
Commitments and Contingencies
Summary of lease-related assets and liabilities	​ ​ ​ ​ ​ ​ ​ ​ (In thousands) At December 31, 2024 At December 31, 2023 Right of use operating lease assets ​ $ 16,633 ​ $ 19,128 ​ ​ ​ ​ ​ ​ ​ Operating lease liabilities: ​ ​ ​ ​ ​ ​ Current ​ $ 2,980 ​ $ 2,807 Non-current ​ 15,955 ​ 18,436 Total ​ $ 18,935 ​ $ 21,243 ​ ​ ​ ​ ​ ​ ​ Operating leases: ​ ​ ​ ​ ​ ​ Weighted average remaining lease term ​ 5.8 years ​ ​ 6.7 years Weighted average discount rate ​ ​ 4.4% ​ ​ 4.3% ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2024 ​ 2023 ​ 2022 Supplemental cash flow information for our operating leases: ​ ​ ​ ​ ​ ​ ​ ​ ​ Cash paid for operating lease liabilities ​ $ 3,566 ​ $ 3,453 ​ $ 3,575 Non-cash right of use assets obtained in exchange for new operating lease obligations ​ $ 390 ​ $ 293 ​ $ 49 ​
Summary of undiscounted cash flows	​ ​ ​ ​ ​ (In thousands) ​ ​ ​ 2025 $ 3,736 2026 ​ ​ 3,808 2027 ​ 3,311 2028 ​ 3,275 2029 ​ 3,309 Thereafter ​ 3,692 Total minimum lease payments ​ ​ 21,131 Less: Amount of lease payments representing interest ​ ​ (2,196) Present value of future minimum lease payments ​ ​ 18,935 Less: Current obligations under operating lease liabilities ​ ​ (2,980) Non-current obligations under operating lease liabilities ​ $ 15,955

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	12 Months Ended
	Dec. 31, 2024
Schedule of share repurchase program	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ ​ ​ December 31, (In thousands, except share and per share data) ​ ​ 2024 ​ ​ 2023 Number of shares repurchased ​ ​ 195,518 ​ ​ — Total share repurchased cost ​ $ 3,508 ​ $ — Average total cost per repurchased share ​ $ 17.94 ​ $ —
Schedule of allocation of total stock-based compensation expense	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ December 31, (In thousands) 2024 2023 2022 Cost of revenue $ 365 ​ $ 420 ​ $ 367 Sales and marketing expenses ​ 2,413 ​ ​ 2,985 ​ ​ 4,060 Research and development expenses ​ 157 ​ ​ 133 ​ ​ 226 Reimbursement, general and administrative expenses ​ 4,884 ​ ​ 4,009 ​ ​ 4,947 Total stock-based compensation expense $ 7,819 ​ $ 7,547 ​ $ 9,600
Schedule of estimated fair values and assumptions for stock options granted	​ ​ ​ ​ ​ 2022 Expected term 4.5 years Expected volatility 59.2% Risk-free interest rate 4.3% Expected dividend yield 0% Fair value on the date of grant $ 8.11
Schedule of stock option activity	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted- ​ Weighted- ​ ​ ​ ​ ​ ​ ​ Average ​ Average ​ Aggregate ​ ​ Options ​ Exercise Price ​ Remaining ​ Intrinsic (In thousands except options and per share data) ​ Outstanding ​ Per Share (1) ​ Contractual Life ​ Value (2) Balance at December 31, 2021 ​ 915,224 ​ $ 39.33 ​ 5.0 years ​ $ 2,068 Granted ​ 47,280 ​ $ 6.17 ​ ​ ​ ​ ​ Exercised ​ (90,878) ​ $ 1.68 ​ ​ ​ $ 916 Forfeited ​ (92,981) ​ $ 36.28 ​ ​ ​ ​ ​ Cancelled/Expired ​ (163,338) ​ $ 37.65 ​ ​ ​ ​ ​ Balance at December 31, 2022 ​ 615,307 ​ $ 43.25 ​ 4.7 years ​ $ 164 Exercised ​ (4,625) ​ $ 2.97 ​ ​ ​ $ 98 Forfeited ​ (25,045) ​ $ 47.54 ​ ​ ​ ​ ​ Cancelled/Expired ​ (155,677) ​ $ 50.72 ​ ​ ​ ​ ​ Balance at December 31, 2023 ​ 429,960 ​ $ 40.74 ​ 3.8 years ​ $ 223 Exercised ​ (2,571) ​ $ 9.40 ​ ​ ​ $ 18 Cancelled/Expired ​ (32,518) ​ $ 43.63 ​ ​ ​ ​ ​ Balance at December 31, 2024 ​ 394,871 ​ $ 40.70 ​ 2.8 years ​ $ 309 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Options exercisable at December 31, 2024 ​ 386,990 ​ $ 41.36 ​ 2.8 years ​ $ 238 ​ (1) The exercise price of each option granted during the periods shown was equal to the market price of the underlying stock on the date of grant. (2) The aggregate intrinsic value of options exercised represents the difference between the exercise price of the option and the closing stock price of our common stock on the date of exercise. The aggregate intrinsic value of options outstanding represents the difference between the exercise price of the option and the closing stock price of our common stock on the last trading day of the period.
Schedule of non-vested stock options	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ ​ December 31, Number of: ​ 2024 ​ 2023 Non-vested options, beginning of the year ​ ​ 43,503 ​ ​ 179,944 Non-vested options, end of the year ​ ​ 7,881 ​ ​ 43,503 Vested options, end of the year ​ ​ 386,990 ​ ​ 386,457 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ ​ December 31, Weighted-average grant date fair value of: ​ 2024 ​ 2023 Non-vested options, beginning of the year ​ $ 13.57 ​ $ 16.24 Non-vested options, end of the year ​ ​ 4.23 ​ ​ 13.57 Vested options, end of the year ​ ​ 16.52 ​ ​ 16.51 Forfeited options, during the year ​ ​ — ​ ​ 18.36
Time-Based Restricted Stock Units
Schedule of stock-settled restricted stock unit activity	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted- ​ ​ ​ ​ ​ Average Grant Aggregate ​ ​ Units ​ Date Fair Value ​ Intrinsic (In thousands except unit and per unit data) ​ Outstanding ​ Per Unit ​ Value (1) Balance at December 31, 2021 ​ 259,147 ​ $ 42.32 ​ $ 4,932 Granted ​ 539,525 ​ $ 15.03 ​ ​ ​ Vested ​ (123,528) ​ $ 43.20 ​ ​ ​ Cancelled ​ (84,602) ​ $ 26.91 ​ ​ ​ Balance at December 31, 2022 ​ 590,542 ​ $ 19.42 ​ $ 6,779 Granted ​ 398,698 ​ $ 15.52 ​ ​ ​ Vested ​ (270,651) ​ $ 20.18 ​ ​ ​ Cancelled ​ (129,447) ​ $ 19.79 ​ ​ ​ Balance at December 31, 2023 ​ 589,142 ​ $ 16.35 ​ $ 8,425 Granted ​ 541,547 ​ $ 13.82 ​ ​ ​ Vested ​ (281,917) ​ $ 17.38 ​ ​ ​ Cancelled ​ (120,346) ​ $ 14.78 ​ ​ ​ Balance at December 31, 2024 ​ 728,426 ​ $ 14.33 ​ $ 12,478 ​ (1) The aggregate intrinsic value of time-based restricted stock units outstanding was based on our closing stock price on the last trading day of the period.
Performance-based stock-settled restricted stock units
Schedule of stock-settled restricted stock unit activity	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted- ​ ​ ​ ​ ​ Average Grant Aggregate ​ ​ PSUs ​ Date Fair Value ​ Intrinsic (In thousands except unit and per unit data) ​ Outstanding ​ Per Unit ​ Value (1) Balance at December 31, 2021 ​ 54,317 ​ $ 50.22 ​ $ 1,034 Granted ​ 131,710 ​ $ 18.54 ​ ​ ​ Vested ​ (4,407) ​ $ 12.31 ​ ​ ​ Cancelled ​ (26,002) ​ $ 42.53 ​ ​ ​ Balance at December 31, 2022 ​ 155,618 ​ $ 25.05 ​ $ 1,786 Granted ​ 123,575 ​ $ 15.28 ​ ​ ​ Vested ​ (13,842) ​ $ 42.70 ​ ​ ​ Cancelled ​ (67,119) ​ $ 21.50 ​ ​ ​ Balance at December 31, 2023 ​ 198,232 ​ $ 18.93 ​ $ 2,785 Granted ​ 223,762 ​ $ 13.76 ​ ​ ​ Vested ​ (44,162) ​ $ 27.31 ​ ​ ​ Cancelled ​ (104,913) ​ $ 14.14 ​ ​ ​ Balance at December 31, 2024 ​ 272,919 ​ $ 15.19 ​ $ 4,675 ​ (1) The aggregate intrinsic value of performance-based restricted stock units outstanding was based on our closing stock price on the last trading day of the period

Revenue (Tables)

Revenue (Tables)	12 Months Ended
	Dec. 31, 2024
Revenue.
Summary of revenue disaggregated by product	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ ​ December 31, (In thousands) ​ 2024 ​ 2023 ​ 2022 Revenue ​ ​ ​ ​ ​ ​ ​ ​ ​ Lymphedema products ​ $ 259,361 ​ $ 241,721 ​ $ 212,266 Airway clearance products ​ ​ 33,623 ​ ​ 32,702 ​ ​ 34,519 Total ​ $ 292,984 ​ $ 274,423 ​ $ 246,785 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Percentage of total revenue ​ ​ ​ ​ ​ ​ ​ ​ ​ Lymphedema products ​ 89% ​ 88% ​ 86% Airway clearance products ​ ​ 11% ​ ​ 12% ​ ​ 14% Total ​ 100% ​ 100% ​ 100% ​
Summary of revenue by channel	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ ​ December 31, (In thousands) ​ 2024 ​ 2023 ​ 2022 Private insurers and other payers ​ $ 175,432 ​ $ 148,901 ​ $ 139,087 Veterans Administration ​ ​ 30,890 ​ ​ 27,003 ​ ​ 25,507 Medicare ​ ​ 53,039 ​ ​ 65,817 ​ ​ 47,672 Durable medical equipment distributors ​ ​ 33,623 ​ ​ 32,702 ​ ​ 34,519 Total ​ $ 292,984 ​ $ 274,423 ​ $ 246,785
Sales-type lease revenue and the associated cost of goods sold	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, (In thousands) ​ ​ 2024 ​ 2023 ​ 2022 Sales-type lease revenue ​ ​ $ 36,972 ​ $ 34,930 ​ $ 35,440 Cost of sales-type lease revenue ​ ​ 11,481 ​ 12,577 ​ 11,190 Gross profit ​ ​ $ 25,491 ​ $ 22,353 ​ $ 24,250 ​

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2024
Income Taxes
Schedule of provision (benefit) for income tax expense	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, (In thousands) 2024 2023 2022 Current income taxes, Federal ​ $ 4,304 ​ $ 5,045 ​ $ 1,838 Current income taxes, State ​ ​ 1,365 ​ ​ 1,440 ​ ​ 637 ​ ​ ​ 5,669 ​ ​ 6,485 ​ ​ 2,475 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Deferred income taxes, Federal ​ 702 ​ (19,046) ​ (32) Deferred income taxes, State ​ ​ 365 ​ ​ (332) ​ ​ — ​ ​ ​ 1,067 ​ ​ (19,378) ​ ​ (32) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Unrecognized tax benefit, Federal ​ (207) ​ 148 ​ (50) Unrecognized tax benefit, State ​ ​ — ​ ​ — ​ ​ — ​ ​ ​ (207) ​ ​ 148 ​ ​ (50) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total provision (benefit) for income taxes ​ $ 6,529 ​ $ (12,745) ​ $ 2,393
Schedule of components of our deferred tax assets and liabilities	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ At December 31, (In thousands) 2024 2023 Deferred tax assets: ​ ​ ​ ​ ​ ​ Operating lease liability ​ $ 4,755 ​ $ 5,394 Net operating loss carryforwards ​ ​ 1 ​ ​ 50 Accounts receivable and inventory reserves ​ ​ 5,406 ​ ​ 7,065 Stock-based compensation ​ ​ 5,818 ​ ​ 5,144 Accrued liabilities ​ 1,766 ​ 2,056 Warranty reserves ​ ​ 752 ​ ​ 1,025 Intangible assets ​ ​ 875 ​ ​ 1,645 Business credits ​ ​ 761 ​ ​ 630 R&D expenses ​ ​ 3,253 ​ ​ 2,189 Other ​ 342 ​ 309 Total deferred tax assets ​ ​ 23,729 ​ ​ 25,507 ​ ​ ​ ​ ​ ​ ​ Deferred tax liabilities: ​ ​ ​ ​ ​ ​ Right of use operating lease assets ​ (4,177) ​ (4,799) Fixed assets ​ ​ (877) ​ ​ (975) Prepaid expenses ​ ​ (209) ​ ​ (232) Other ​ ​ (155) ​ ​ (123) Total deferred tax liabilities ​ ​ (5,418) ​ ​ (6,129) ​ ​ ​ ​ ​ ​ ​ Net deferred tax assets ​ $ 18,311 ​ $ 19,378
Schedule of reconciliation of income tax expense (benefit)	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ 2024 ​ 2023 ​ 2022 Tax expense at statutory rate 21.0 % ​ 21.0 % ​ 21.0 % State income taxes, net of federal benefit ​ 4.7 ​ ​ 5.2 ​ ​ 4.1 ​ Executive compensation ​ 1.1 ​ ​ 0.9 ​ ​ — ​ Meals and entertainment ​ 1.7 ​ ​ 2.1 ​ ​ — ​ Employee Stock Purchase Plan ​ 0.4 ​ ​ 0.9 ​ ​ (1.0) ​ Federal business credits ​ (1.5) ​ ​ (1.5) ​ ​ 1.6 ​ Valuation allowance ​ — ​ ​ (113.3) ​ ​ (37.4) ​ Return to provision ​ (0.5) ​ ​ 0.5 ​ ​ (0.2) ​ Deferred reprice - state 0.9 ​ 0.2 ​ 0.9 ​ Unrecognized tax benefits ​ 0.3 ​ ​ 0.3 ​ ​ (0.3) ​ Excess benefit on non-qualified stock options and RSUs ​ 0.7 ​ ​ 2.3 ​ ​ (3.7) ​ Interest and penalties ​ — ​ ​ 0.1 ​ ​ — ​ 162(m) write down ​ — ​ ​ 1.6 ​ ​ — ​ Other (1.0) ​ (1.1) ​ (0.5) ​ Net effective rate 27.8 % ​ (80.8) % ​ (15.5) %
Schedule of unrecognized tax benefits ("UTB")	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, (In thousands) 2024 2023 2022 Balance beginning of the year ​ $ 702 ​ $ 612 ​ $ 522 Gross changes — tax positions in prior year ​ ​ (272) ​ ​ — ​ ​ — Gross changes — tax positions in current year ​ ​ 117 ​ ​ 90 ​ ​ 90 Balance end of the year ​ $ 547 ​ $ 702 ​ $ 612

Net Income (Loss) Per Common _2

Net Income (Loss) Per Common Share (Tables)	12 Months Ended
	Dec. 31, 2024
Net Income (Loss) Per Common Share
Schedule of computation of the basic and diluted net income per share	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ December 31, (In thousands, except share and per share data) 2024 2023 2022 Net income (loss) $ 16,960 ​ $ 28,515 ​ $ (17,866) Weighted-average shares outstanding ​ 23,883,729 ​ ​ 22,925,497 ​ ​ 20,067,969 Weighted-average shares used to compute diluted net income (loss) per share ​ 24,138,244 ​ ​ 23,176,169 ​ ​ 20,067,969 Net income (loss) per share - Basic $ 0.71 ​ $ 1.24 ​ $ (0.89) Net income (loss) per share - Diluted $ 0.70 ​ $ 1.23 ​ $ (0.89)
Schedule of potentially dilutive securities outstanding	​ ​ ​ ​ ​ ​ ​ ​ Year Ended ​ December 31, ​ 2024 2023 2022 Restricted stock units 313,458 ​ 337,202 ​ 590,542 Common stock options 360,246 ​ 389,229 ​ 615,307 Performance stock units 53,791 ​ 17,392 ​ 155,618 Employee stock purchase plan 83,598 ​ — ​ 100,506 Total 811,093 ​ 743,823 ​ 1,461,973 ​

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	12 Months Ended
	Dec. 31, 2024
Fair Value Measurements
Schedule of changes in the earn-out liability	​ ​ ​ ​ ​ (In thousands) ​ ​ Earn-out liability at December 31, 2022 ​ $ 13,050 Payments on earn-out ​ ​ (10,575) Fair value adjustments ​ ​ (2,475) Earn-out liability at December 31, 2023 ​ $ —

Nature of Business and Operat_2

Nature of Business and Operations (Details) - USD ($) $ / shares in Units, $ in Thousands			12 Months Ended
	Feb. 27, 2023	Aug. 02, 2016	Dec. 31, 2023
Nature of Business and Operations
Proceeds from Issuance of Common Stock			$ 34,625
IPO
Nature of Business and Operations
Number of shares of common stock sold		4,120,000
IPO price per share (in dollars per share)		$ 10
Net proceeds from the initial public offering		$ 35,400
Expense Relating To Initial Public Offering		$ 2,900
Follow-On Public Offering
Nature of Business and Operations
Number of shares of common stock sold	2,875,000
Stock price	$ 13
Proceeds from Issuance of Common Stock	$ 34,600

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Details) $ in Millions	12 Months Ended
	Dec. 31, 2024 USD ($) segment	Dec. 31, 2023 USD ($)
Equity Securities
Equity security without readily determinable fair value | $	$ 0.3	$ 0.3
Accounts Receivable
Percentage of claims	90%
Revenue Recognition
Medicare receivables period of time	1 year
Revenue for practical expedient	true
Product Warranty
Number of operating segment | segment	1
Minimum
Property and Equipment
Useful life	3 years
Revenue Recognition
Period for consideration payment after shipment date	2 days
Maximum
Property and Equipment
Useful life	7 years
Revenue Recognition
Period for consideration payment after shipment date	3 days
Garments | Minimum
Product Warranty
Product Warranty	1 year
Garments | Maximum
Product Warranty
Product Warranty	5 years
Controllers | Minimum
Product Warranty
Product Warranty	1 year
Controllers | Maximum
Product Warranty
Product Warranty	2 years
AffloVest
Product Warranty
Product Warranty	5 years

Acquisitions (Details)

Acquisitions (Details)	Nov. 28, 2023 USD ($)	Nov. 04, 2022 USD ($)	Sep. 08, 2021 USD ($)	May 25, 2023 USD ($)	Nov. 28, 2022 USD ($)
AffloVest APA | Second earn-out amendment
Acquisitions
Contingent consideration	$ 5,600,000
AffloVest APA
Acquisitions
Purchase price			$ 80,000,000
Escrow account			500,000
Working capital adjustments			200,000
Amount released to IBC			300,000
Business revenue to exceed base revenue, Multiplier		1.5
Earn-out liability			$ 6,400,000
Earn-out liability, asset acquisition		$ 10,000,000
AffloVest APA | Earn-out period exceed Base Revenues from October 1, 2021 to September 30, 2022
Acquisitions
Business revenue to exceed base revenue, Multiplier			1.5
AffloVest APA | Earn-out period exceed Base Revenues from October 1, 2022 to September 30, 2023
Acquisitions
Business revenue to exceed base revenue, Multiplier			1.5
AffloVest APA | Earn-out period on or before November 28,2022
Acquisitions
Earn-out liability, asset acquisition					$ 5,000,000
AffloVest APA | Earn-out period on or before May 26, 2023
Acquisitions
Earn-out liability, asset acquisition				$ 5,000,000
Imputed interest payment				$ 250,000
AffloVest APA | Second earn-out amendment
Acquisitions
Business revenue to exceed base revenue, Multiplier		3
Earn-out liability, asset acquisition		$ 10,000,000
AffloVest APA | Maximum
Acquisitions
Total consideration transferred			$ 100,000,000
AffloVest APA | Maximum | Earn-out period exceed Base Revenues from October 1, 2021 to September 30, 2022
Acquisitions
Earn-out liability			10,000,000
AffloVest APA | Maximum | Earn-out period exceed Base Revenues from October 1, 2022 to September 30, 2023
Acquisitions
Earn-out liability, asset acquisition			$ 10,000,000

Accounts Receivable (Details)

Accounts Receivable (Details) - item	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Accounts Receivable
Number of insurers	2	2
Insurer One | Customer Concentration Risk | Accounts Receivable
Accounts Receivable
Percentage of concentration	23%	36%
Insurer One | Customer Concentration Risk | Revenue
Accounts Receivable
Percentage of concentration	18%	24%
Insurer Two | Customer Concentration Risk | Accounts Receivable
Accounts Receivable
Percentage of concentration	12%	14%
Insurer Two | Customer Concentration Risk | Revenue
Accounts Receivable
Percentage of concentration	2%	1%

Inventories (Details)

Inventories (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Inventories
Finished goods	$ 6,149	$ 7,979
Component parts and work-in-process	12,517	14,548
Total inventories	$ 18,666	$ 22,527

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Property and Equipment
Subtotal	$ 16,579	$ 14,778
Less: accumulated depreciation	(10,976)	(8,583)
Property and equipment, net	5,603	6,195
Depreciation expense	3,000	2,700	$ 2,500
Equipment
Property and Equipment
Subtotal	5,108	4,459
Tooling
Property and Equipment
Subtotal	4,652	4,555
Furniture and Fixtures
Property and Equipment
Subtotal	2,095	2,068
Leasehold improvements
Property and Equipment
Subtotal	3,466	1,529
Demonstration equipment
Property and Equipment
Subtotal	1,106	896
Construction in progress
Property and Equipment
Subtotal	$ 152	$ 1,271

Goodwill And Intangible Asset_2

Goodwill And Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Sep. 30, 2021
Goodwill and Intangible Assets
Goodwill	$ 31,063	$ 31,063
Definite-lived intangible assets:
Weighted Average Amortization Period	9 years 2 months 12 days
Gross Carrying Amount	$ 46,398	46,268
Accumulated Amortization	13,332	9,535
Total	33,066	36,733
Unamortized intangible assets:
Total intangible assets (Gross)	56,121	56,259
Total intangible assets (Net)	42,789	46,724
Amortization expense	3,800	3,800	$ 3,800
Future Amortization
2025	3,714
2026	3,650
2027	3,641
2028	3,638
2029	3,633
Thereafter	14,790
Total	33,066	36,733
Tradenames
Unamortized intangible assets:
Gross Carrying Amount, Indefinite	9,500	9,500
Patents pending
Unamortized intangible assets:
Gross Carrying Amount, Indefinite	$ 223	$ 491
Patents pending
Definite-lived intangible assets:
Weighted Average Amortization Period	12 years	12 years
Gross Carrying Amount	$ 1,148	$ 1,018
Accumulated Amortization	333	248
Total	815	770
Future Amortization
Total	$ 815	$ 770
Defensive intangible assets
Definite-lived intangible assets:
Weighted Average Amortization Period	1 year	1 year
Gross Carrying Amount	$ 1,125	$ 1,125
Accumulated Amortization	1,065	920
Total	60	205
Future Amortization
Total	$ 60	$ 205
Customer accounts
Definite-lived intangible assets:
Weighted Average Amortization Period	0 years	0 years
Gross Carrying Amount	$ 125	$ 125
Accumulated Amortization	$ 125	$ 125
Customer relationships
Definite-lived intangible assets:
Weighted Average Amortization Period	10 years	11 years
Gross Carrying Amount	$ 31,000	$ 31,000
Accumulated Amortization	7,896	5,511
Total	23,104	25,489
Future Amortization
Total	$ 23,104	$ 25,489
Developed technology
Definite-lived intangible assets:
Weighted Average Amortization Period	8 years	9 years
Gross Carrying Amount	$ 13,000	$ 13,000
Accumulated Amortization	3,913	2,731
Total	9,087	10,269
Future Amortization
Total	9,087	10,269
Cost of revenue.
Unamortized intangible assets:
Amortization expense	$ 1,300	$ 1,300	$ 1,300
AffloVest APA
Goodwill and Intangible Assets
Goodwill				$ 31,100

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Accrued Expenses
Warranty	$ 1,784	$ 2,357	$ 2,005
Legal and consulting	1,318	611
Travel	1,120	1,038
In-transit inventory	1,013	401
Sales and use tax	802	183
Clinical studies	304	363
Other	1,439	951
Total	$ 7,780	$ 5,904

Warranty Reserves (Details)

Warranty Reserves (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Movement in Standard Product Warranty Accrual [Roll Forward]
Beginning balance	$ 4,038	$ 4,212	$ 4,959
Warranty provision	2,677	4,611	2,047
Processed warranty claims	(3,722)	(4,785)	(2,794)
Ending balance	2,993	4,038	4,212
Accrued warranty reserve, current	1,784	2,357	2,005
Accrued warranty reserve, non-current	1,209	1,681	2,207
Total accrued warranty reserve	$ 2,993	$ 4,038	$ 4,212

Credit Agreement (Details)

Credit Agreement (Details) - USD ($)						12 Months Ended
	Dec. 21, 2023	Aug. 01, 2023	Jun. 21, 2023	Feb. 22, 2022	Sep. 08, 2021	Dec. 31, 2024	Nov. 04, 2024	Nov. 01, 2024
Credit Agreement
Line of credit, threshold contingent increase in borrowing capacity					$ 25,000,000
Credit agreement, total aggregate principal amount					80,000,000
Credit facility outstanding amount					25,000,000
Basis spread (as a percent)			0.10%
Amount of authorized shares to repurchase						$ 26,500,000	$ 30,000,000
SOFR
Credit Agreement
Basis spread (as a percent)			3.50%
Revolving credit facility
Credit Agreement
Line of credit					25,000,000
Debt instrument periodic payment	$ 16,800,000
Amount of authorized shares to repurchase								$ 30,000,000
Revolving credit facility | Federal Funds
Credit Agreement
Basis spread (as a percent)			0.50%
Revolving credit facility | Base Rate
Credit Agreement
Basis spread (as a percent)			1%
Revolving credit facility | SOFR
Credit Agreement
Basis spread (as a percent)		3.50%				6.42%
Revolving credit facility | Maximum
Credit Agreement
Unused line fee (as a percent)		0.125%
Revolving credit facility | Maximum | Base Rate
Credit Agreement
Basis spread (as a percent)			2.25%
Revolving credit facility | Maximum | SOFR
Credit Agreement
Basis spread (as a percent)			3.25%
Revolving credit facility | Minimum
Credit Agreement
Unused line fee (as a percent)		0.20%
Revolving credit facility | Minimum | Base Rate
Credit Agreement
Basis spread (as a percent)			0.75%
Revolving credit facility | Minimum | SOFR
Credit Agreement
Basis spread (as a percent)			1.75%
Term Loan
Credit Agreement
Debt instrument face amount					30,000,000
Long-term debt					$ 30,000,000	$ 26,176,000
Principal prepayment of term loan				$ 3,000,000
Increase in term debt		$ 8,250,000
Debt instrument frequency of periodic payment						quarterly
Debt instrument periodic payment						$ 750,000

Credit Agreement - Maturities o

Credit Agreement - Maturities of Debt (Details) - Term Loan - USD ($) $ in Thousands	Dec. 31, 2024	Sep. 08, 2021
Maturities of notes payable
2025	$ 3,000
2026	23,250
Total	26,250
Less: Deferred financing fees	(74)
Net Note Payable	26,176	$ 30,000
Less: Current portion of note payable	(2,956)
Non-current portion of note payable	$ 23,220

Commitments and Contingencies -

Commitments and Contingencies - Lease Obligations (Details) - ft²	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2019	Dec. 31, 2018	Oct. 31, 2018
Minimum
Commitments and Contingencies
Lease terms	12 months
Building | Minimum
Commitments and Contingencies
Lease terms	1 year
Building | Maximum
Commitments and Contingencies
Lease terms	7 years
Equipment
Commitments and Contingencies
Option to renew	true
Equipment | Minimum
Commitments and Contingencies
Lease terms	1 year
Equipment | Maximum
Commitments and Contingencies
Lease terms	4 years
Initial lease
Commitments and Contingencies
Area of office space				80,000
Second lease
Commitments and Contingencies
Area of office space			29,000
Additional office space added to the lease		4,000
Third lease
Commitments and Contingencies
Additional office space added to the lease		37,000

Commitments and Contingencies_2

Commitments and Contingencies - Lease related assets and liabilities (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Lease-related assets and liabilities
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Right of use operating lease assets	Right of use operating lease assets
Right of use operating lease assets	$ 16,633	$ 19,128
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Operating lease liabilities, Current	Operating lease liabilities, Current
Operating lease liabilities, Current	$ 2,980	$ 2,807
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Operating lease liabilities, non-current	Operating lease liabilities, non-current
Operating lease liabilities, non-current	$ 15,955	$ 18,436
Present value of future minimum lease payments	$ 18,935	$ 21,243
Weighted average remaining lease term	5 years 9 months 18 days	6 years 8 months 12 days
Weighted average discount rate	4.40%	4.30%
Cash paid for operating lease liabilities	$ 3,566	$ 3,453	$ 3,575
Non-cash right of use assets obtained in exchange for new operating lease obligations	$ 390	$ 293	$ 49

Commitments and Contingencies_3

Commitments and Contingencies - Undiscounted cash flows (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Undiscounted cash flows
2025	$ 3,736
2026	3,808
2027	3,311
2028	3,275
2028	3,309
Thereafter	3,692
Total minimum lease payments	21,131
Less: Amount of lease payments representing interest	(2,196)
Present value of future minimum lease payments	18,935	$ 21,243
Less: Current obligations under operating lease liabilities	(2,980)	(2,807)
Non-current obligations under operating lease liabilities	$ 15,955	$ 18,436

Commitments and Contingencies_4

Commitments and Contingencies - Lease commitments and operating lease cost (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Commitments and Contingencies
Operating lease cost	$ 3.5	$ 3.6	$ 3.8

Commitments and Contingencies_5

Commitments and Contingencies - Major Vendors (Details) - item	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	May 24, 2022
Vendor One
Commitments and Contingencies
Number of vendors	1	1
Purchases | Vendor | Vendor One
Commitments and Contingencies
Total purchases (in percentage)	20%	25%
The "Weaver Lawsuit"
Commitments and Contingencies
Number of vendors			8

Commitments and Contingencies_6

Commitments and Contingencies - Purchase Commitments (Details) $ in Millions	Dec. 31, 2024 USD ($)
Purchase commitments
Purchase orders issued	$ 22.8

Commitments and Contingencies_7

Commitments and Contingencies - Retirement Plan (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
401(k)
Retirement Plan
Discretionary contributions	$ 2.2	$ 1.5	$ 1.5

Commitments and Contingencies_8

Commitments and Contingencies - Legal Proceedings (Details) $ in Millions	Sep. 04, 2024 USD ($)
Commitments and Contingencies
Attorneys' fees and expense	$ 0.5

Stockholders' Equity - Stock-Ba

Stockholders' Equity - Stock-Based Compensation (Details) $ in Thousands				12 Months Ended
	Jan. 01, 2025 shares	Jan. 01, 2024 shares	Aug. 02, 2016 USD ($) shares	Dec. 31, 2024 USD ($) shares	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Nov. 04, 2024 USD ($)	Apr. 27, 2016 shares
Stock-based compensation
Amount of authorized shares to repurchase				$ 26,500			$ 30,000
Compensation expense				$ 7,819	$ 7,547	$ 9,600
Conversion of preferred stock to common stock (in shares) | shares			5,924,453
Number of new stock issued relating to the IPO that Series A and Series B preferred stockholders are entitled to receive | shares			2,354,323
Employee Stock Purchase Plan
Stock-based compensation
Increase in number of shares reserved and available for issuance | shares	240,780	236,003
Shares available for future issuance | shares				1,444,905				1,600,000
Compensation expense				$ 500	600	800
Series B Preferred Stock
Stock-based compensation
Preferred stock to common stock conversion ratio			1
Number of new stock issued to pay accrued stock dividends relating to initial offering price | shares			956,842
Series A Preferred Stock
Stock-based compensation
Preferred stock to common stock conversion ratio			1.03
Payment of dividends			$ 100
Cumulative accrued dividends			$ 8,200
Cost of revenue.
Stock-based compensation
Compensation expense				365	420	367
Sales and marketing expenses
Stock-based compensation
Compensation expense				2,413	2,985	4,060
Research and development expenses
Stock-based compensation
Compensation expense				157	133	226
Reimbursement, general and administrative expenses
Stock-based compensation
Compensation expense				$ 4,884	4,009	4,947
2016 Plan
Stock-based compensation
Number of shares authorized | shares				4,800,000
Automatic annual increase to the number of shares reserved and available for issuance as a percentage of outstanding common stock (as a percent)				5%
Automatic annual increase to the number of shares reserved and available for issuance | shares				2,500,000
Increase in number of shares reserved and available for issuance | shares		1,180,019
Shares available for future issuance | shares				6,475,903
Employee Stock Option [Member]
Stock-based compensation
Compensation expense				$ 200	$ 900	$ 2,500

Stockholders' Equity - Share Re

Stockholders' Equity - Share Repurchase Program (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Nov. 04, 2024
Stockholders' Equity
Repurchase shares of common stock in aggregate amount	$ 26,500	$ 30,000
Share repurchase (in shares)	195,518
Total share repurchased cost	$ 3,508
Average total cost per repurchased share	$ 17.94

Stockholders' Equity - Stock Op

Stockholders' Equity - Stock Options and Restricted Stock (Details) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($) item $ / shares shares	Dec. 31, 2023 USD ($) $ / shares shares	Dec. 31, 2022 USD ($) $ / shares shares	Dec. 31, 2021 USD ($) $ / shares shares
Stock-based compensation, general disclosures.
Stock-based compensation expense | $	$ 7,819	$ 7,547	$ 9,600
Weighted-average period over which unrecognized compensation cost is expected to be recognized	10 months 24 days
Dividends paid to date | $	$ 0
Aggregate Intrinsic Value
Restricted stock unit awards, Average Intrinsic Value | $			6,779	$ 4,932
Shares repurchased to cover taxes from restricted stock award vesting (in shares) | shares	195,518
Employee Stock Option
Stock-based compensation, general disclosures.
Stock-based compensation expense | $	$ 200	900	2,500
Total unrecognized pre-tax compensation expense related to nonvested stock option awards | $	29
Total grant date fair value of options vested during the period | $	$ 600	$ 1,900	$ 3,300
Estimated fair values and assumptions for stock options granted
Expected term			4 years 6 months
Expected dividend yield (as a percent)			0%
Options Outstanding
Outstanding at beginning of period | shares	429,960	615,307	915,224
Granted | shares	0	0	47,280
Exercised | shares	(2,571)	(4,625)	(90,878)
Forfeited | shares		(25,045)	(92,981)
Cancelled/Expired | shares	(32,518)	(155,677)	(163,338)
Outstanding at end of period | shares	394,871	429,960	615,307	915,224
Weighted Average Exercise Price Per Share
Outstanding at beginning of period	$ 40.74	$ 43.25	$ 39.33
Granted			6.17
Exercised	9.4	2.97	1.68
Forfeited		47.54	36.28
Cancelled/Expired	43.63	50.72	37.65
Outstanding at end of period	$ 40.7	$ 40.74	$ 43.25	$ 39.33
Other information
Options exercisable number of shares exercisable | shares	386,990	386,457	435,363
Options exercisable, weighted-average exercise price	$ 41.36	$ 41.53	$ 43.83
Weighted average remaining contractual life (in years)	2 years 9 months 18 days	3 years 9 months 18 days	4 years 8 months 12 days	5 years
Options exercisable, weighted-average remaining contractual life	2 years 9 months 18 days
Aggregate Intrinsic Value, Options outstanding | $	$ 309	$ 223		$ 2,068
Aggregate Intrinsic Value, Exercised | $	18	$ 98	$ 916
Aggregate Intrinsic Value, Options exercisable | $	$ 238		$ 164
Number of:
Non vested options beginning of the year | shares	43,503	179,944
Non-vested options end of the year | shares	7,881	43,503	179,944
Vested options end of the year | shares	386,990	386,457
Weighted-average grant date fair value of:
Non-vested options beginning of the year	$ 13.57	$ 16.24
Non-vested options end of the year	4.23	13.57	$ 16.24
Vested options end of the year	$ 16.52	16.51
Forfeited options during the year		$ 18.36
Employee Stock Option | Minimum
Stock-based compensation, general disclosures.
Vesting period (in years)	3 years
Term (in years)	7 years
Estimated fair values and assumptions for stock options granted
Expected volatility (as a percent)			59.20%
Risk-free interest rate (as a percent)			4.30%
Fair value on the date of grant (in dollars per share)			$ 8.11
Employee Stock Option | Maximum
Stock-based compensation, general disclosures.
Vesting period (in years)	4 years
Term (in years)	10 years
2023 PSUs
Stock-based compensation, general disclosures.
Stock-based compensation expense | $	$ 500	$ 500
2022 PSUs
Stock-based compensation, general disclosures.
Stock-based compensation expense | $		400	$ 300
2016 Plan | Time-Based Restricted Stock Units
Stock-based compensation, general disclosures.
Stock-based compensation expense | $	5,900	$ 5,100	$ 5,800
Total unrecognized pre-tax compensation expense related to nonvested stock option awards | $	$ 6,100
Weighted-average period over which unrecognized compensation cost is expected to be recognized	1 year 9 months 18 days
Units Outstanding
Restricted stock unit awards outstanding at the beginning of the period (in shares) | shares	589,142	590,542	259,147
Granted (in shares) | shares	541,547	398,698	539,525
Vested (in shares) | shares	(281,917)	(270,651)	(123,528)
Cancelled (in shares) | shares	(120,346)	(129,447)	(84,602)
Restricted stock unit awards outstanding at the end of the period (in shares) | shares	728,426	589,142	590,542	259,147
Weighted Average Grant Date Fair Value Per Unit
Restricted stock unit awards outstanding at the beginning of the period (in dollars per share)	$ 16.35	$ 19.42	$ 42.32
Granted (in dollars per share)	13.82	15.52	15.03
Vested (in dollars per share)	17.38	20.18	43.2
Cancelled (in dollars per share)	14.78	19.79	26.91
Restricted stock unit awards outstanding at the end of the period (in dollars per share)	$ 14.33	$ 16.35	$ 19.42	$ 42.32
Aggregate Intrinsic Value
Restricted stock unit awards, Average Intrinsic Value | $	$ 12,478	$ 8,425
2016 Plan | Time-Based Restricted Stock Units | Minimum
Stock-based compensation, general disclosures.
Vesting period (in years)	1 year
2016 Plan | Time-Based Restricted Stock Units | Maximum
Stock-based compensation, general disclosures.
Vesting period (in years)	3 years
2016 Plan | Performance-based stock-settled restricted stock units
Stock-based compensation, general disclosures.
Stock-based compensation expense | $	$ 1,200	$ 900	$ 500
Total unrecognized pre-tax compensation expense related to awards | $	$ 1,300
Weighted-average period over which unrecognized compensation cost is expected to be recognized	2 years
Number of performance awards under share-based payment arrangement | item	3
Units Outstanding
Restricted stock unit awards outstanding at the beginning of the period (in shares) | shares	198,232	155,618	54,317
Granted (in shares) | shares	223,762	123,575	131,710
Vested (in shares) | shares	(44,162)	(13,842)	(4,407)
Cancelled (in shares) | shares	(104,913)	(67,119)	(26,002)
Restricted stock unit awards outstanding at the end of the period (in shares) | shares	272,919	198,232	155,618	54,317
Payout percentage	100%	100%	100%
Weighted Average Grant Date Fair Value Per Unit
Restricted stock unit awards outstanding at the beginning of the period (in dollars per share)	$ 18.93	$ 25.05	$ 50.22
Granted (in dollars per share)	13.76	15.28	18.54
Vested (in dollars per share)	27.31	42.7	12.31
Cancelled (in dollars per share)	14.14	21.5	42.53
Restricted stock unit awards outstanding at the end of the period (in dollars per share)	$ 15.19	$ 18.93	$ 25.05	$ 50.22
Aggregate Intrinsic Value
Restricted stock unit awards, Average Intrinsic Value | $	$ 4,675	$ 2,785		$ 1,034
Restricted stock unit awards deferred and unissued, Average Intrinsic Value | $			$ 1,786
2016 Plan | Performance-based stock-settled restricted stock units | Minimum
Stock-based compensation, general disclosures.
Performance goals revenue change and adjusted EBITDA margin	25%
Units Outstanding
Percentage to earn or vest the performance-based stock-settled restricted stock units	50%
2016 Plan | Performance-based stock-settled restricted stock units | Maximum
Stock-based compensation, general disclosures.
Performance goals revenue change and adjusted EBITDA margin	175%
Units Outstanding
Percentage to earn or vest the performance-based stock-settled restricted stock units	150%
2016 Plan | Tranche one | Performance-based stock-settled restricted stock units
Stock-based compensation, general disclosures.
Award vesting percentage	33.33%
2016 Plan | Tranche one | 2023 PSUs
Stock-based compensation, general disclosures.
Award vesting percentage	33.33%
2016 Plan | Tranche two | Performance-based stock-settled restricted stock units
Stock-based compensation, general disclosures.
Award vesting percentage	66.67%
2016 Plan | Tranche two | 2023 PSUs
Stock-based compensation, general disclosures.
Award vesting percentage	33.33%

Stockholders' Equity - Employee

Stockholders' Equity - Employee Stock Purchase Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Apr. 27, 2016
Stockholders' Equity
Stock-based compensation expense	$ 7,819	$ 7,547	$ 9,600
2016 Plan
Stockholders' Equity
Shares reserved	6,475,903
Employee Stock Purchase Plan
Stockholders' Equity
Purchase price of common stock under plan (as a percent)	85%
Offering period (in months)	6 months
Shares reserved	1,444,905			1,600,000
Incremental share increase (as a percent)	1%
Incremental share increase (in shares)	500,000
Stock-based compensation expense	$ 500	$ 600	$ 800

Revenue (Details)

Revenue (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Revenue
Revenue	$ 292,984	$ 274,423	$ 246,785
Percentage of total revenue (in percent)	100%	100%	100%
Revenue from sale type lease
Sales-type lease revenue	$ 36,972	$ 34,930	$ 35,440
Cost of sales-type lease revenue	11,481	12,577	11,190
Gross profit	$ 25,491	22,353	24,250
Minimum
Revenue from sale type lease
Rental period of rent-to-purchase arrangements	3 months
Maximum
Revenue from sale type lease
Rental period of rent-to-purchase arrangements	10 months
Private insurers and other payers
Revenue
Revenue	$ 175,432	148,901	139,087
Veterans Administration
Revenue
Revenue	30,890	27,003	25,507
Medicare
Revenue
Revenue	53,039	65,817	47,672
Durable medical equipment distributors
Revenue
Revenue	33,623	32,702	34,519
Lymphedema products
Revenue
Revenue	$ 259,361	$ 241,721	$ 212,266
Percentage of total revenue (in percent)	89%	88%	86%
Airway clearance products
Revenue
Revenue	$ 33,623	$ 32,702	$ 34,519
Percentage of total revenue (in percent)	11%	12%	14%

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Taxes
Current income taxes, Federal	$ 4,304	$ 5,045	$ 1,838
Current income taxes, State	1,365	1,440	637
Current income taxes	5,669	6,485	2,475
Deferred income taxes, Federal	702	(19,046)	(32)
Deferred income taxes, State	365	(332)
Deferred income taxes	1,067	(19,378)	(32)
Unrecognized tax benefit	(207)	148	(50)
Total provision (benefit) for income taxes	6,529	(12,745)	$ 2,393
Deferred tax assets:
Operating lease liability	4,755	5,394
Net operating loss carryforwards	1	50
Accounts receivable and inventory reserves	5,406	7,065
Stock-based compensation	5,818	5,144
Accrued liabilities	1,766	2,056
Warranty reserves	752	1,025
Intangible assets	875	1,645
Business credits	761	630
R&D expenses	3,253	2,189
Other	342	309
Total deferred tax assets	23,729	25,507
Deferred tax liabilities:
Right of use operating lease assets	(4,177)	(4,799)
Fixed assets	(877)	(975)
Prepaid expenses	(209)	(232)
Other	(155)	(123)
Total deferred tax liabilities	(5,418)	(6,129)
Net deferred tax assets	$ 18,311	$ 19,378
Effective Income Tax Rate Reconciliation, Percent
Tax expense at statutory rate	21%	21%	21%
State income taxes, net of federal benefit	4.70%	5.20%	4.10%
Executive compensation	1.10%	0.90%
Meals and entertainment	1.70%	2.10%
Employee Stock Purchase Plan	0.40%	0.90%	(1.00%)
Federal business credits	(1.50%)	(1.50%)	1.60%
Valuation allowance		(113.30%)	(37.40%)
Return to provision	(0.50%)	0.50%	(0.20%)
Deferred reprice - state	0.90%	0.20%	0.90%
Unrecognized tax benefits	0.30%	0.30%	(0.30%)
Excess benefit on non-qualified stock options and RSUs	0.70%	2.30%	(3.70%)
Interest and penalties		0.10%
162(m) write down		1.60%
Other	(1.00%)	(1.10%)	(0.50%)
Net effective rate	27.80%	(80.80%)	(15.50%)
Reconciliation of unrecognized tax benefits
Balance beginning of the year	$ 702	$ 612	$ 522
Gross changes - tax positions in prior year	(272)
Gross changes - tax positions in current year	117	90	90
Balance end of the year	547	702	612
Domestic Tax Jurisdiction
Income Taxes
Unrecognized tax benefit	(207)	$ 148	$ (50)
State and Local Jurisdiction
Deferred tax assets:
Net operating loss carryforwards	$ 1

Net Income (Loss) Per Common _3

Net Income (Loss) Per Common Share - Basic and Diluted Net income Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Net Income (Loss) Per Common Share
Net Income (Loss)	$ 16,960	$ 28,515	$ (17,866)
Weighted-average shares outstanding	23,883,729	22,925,497	20,067,969
Weighted-average shares used to compute diluted net income (loss) per share	24,138,244	23,176,169	20,067,969
Net income (loss) per share - Basic	$ 0.71	$ 1.24	$ (0.89)
Net income (loss) per share - Diluted	$ 0.7	$ 1.23	$ (0.89)

Net Income (Loss) Per Common _4

Net Income (Loss) Per Common Share - Antidilutive Securities Excluded From Computation of Earnings Per Share (Details) - shares	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Net Income Per Share
Antidilutive securities excluded from computation of earnings per share	811,093	743,823	1,461,973
Restricted stock units
Net Income Per Share
Antidilutive securities excluded from computation of earnings per share	313,458	337,202	590,542
Common stock options
Net Income Per Share
Antidilutive securities excluded from computation of earnings per share	360,246	389,229	615,307
Performance stock units
Net Income Per Share
Antidilutive securities excluded from computation of earnings per share	53,791	17,392	155,618
Employee stock purchase plan
Net Income Per Share
Antidilutive securities excluded from computation of earnings per share	83,598		100,506

Fair Value Measurements - Earn

Fair Value Measurements - Earn out liability (Details) - USD ($) $ in Thousands			12 Months Ended
	Nov. 28, 2023	May 25, 2023	Dec. 31, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Payments on earn-out	$ (5,600)	$ (5,000)	$ (10,575)	$ (5,000)
Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Earn-out liability, beginning balance			13,050
Payments on earn-out			(10,575)
Fair value adjustments			$ (2,475)
Earn-out liability, ending balance				$ 13,050

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value Hierarchy (Details) - USD ($)			12 Months Ended
	Nov. 28, 2023	May 25, 2023	Dec. 31, 2023	Dec. 31, 2022
Fair Value Measurements
Earn-out liability payment	$ 5,600,000	$ 5,000,000	$ 10,575,000	$ 5,000,000
Imputed interest payment		$ 250,000