NxStage Medical 10-Q 4 Aug 16 2016 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2016	Jul. 28, 2016
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2016
Document Fiscal Year Focus	2,016
Document Fiscal Period Focus	Q2
Trading Symbol	NXTM
Entity Registrant Name	NxStage Medical, Inc.
Entity Central Index Key	1,333,170
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		64,562,414

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Current assets:
Cash and cash equivalents	$ 58,459	$ 59,065
Accounts receivable, net	30,092	25,195
Inventory	41,309	38,391
Prepaid expenses and other current assets	5,921	6,254
Total current assets	135,781	128,905
Property and equipment, net	66,374	66,711
Field equipment, net	20,978	20,744
Deferred cost of revenues	34,065	33,068
Intangible assets, net	10,714	11,744
Goodwill	42,710	42,710
Other assets	3,074	2,992
Total assets	313,696	306,874
Current liabilities:
Accounts payable	13,583	10,767
Accrued expenses	26,616	27,266
Current portion of long-term debt	324	315
Other current liabilities	4,452	4,394
Total current liabilities	44,975	42,742
Deferred revenues	52,280	51,362
Long-term debt	1,602	1,664
Other long-term liabilities	16,911	17,367
Total liabilities	115,768	113,135
Commitments and contingencies
Noncontrolling interests subject to put provisions	168	219
Stockholders’ equity:
Undesignated preferred stock: par value $0.001, 5,000,000 shares authorized; no shares issued and outstanding as of June 30, 2016 and December 31, 2015	0	0
Common stock: par value $0.001, 100,000,000 shares authorized; 65,443,862 and 64,873,038 shares issued as of June 30, 2016 and December 31, 2015, respectively	65	64
Additional paid-in capital	621,395	612,487
Accumulated deficit	(405,838)	(402,830)
Accumulated other comprehensive loss	(4,250)	(4,031)
Treasury stock, at cost: 901,013 and 822,059 shares as of June 30, 2016 and December 31, 2015, respectively	(15,334)	(13,864)
Total NxStage Medical, Inc. stockholders' equity	196,038	191,826
Noncontrolling interests not subject to put provisions	1,722	1,694
Total stockholders' equity	197,760	193,520
Total liabilities and stockholders’ equity	$ 313,696	$ 306,874

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Jun. 30, 2016	Dec. 31, 2015
Statement of Financial Position [Abstract]
Undesignated preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Undesignated preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Undesignated preferred stock, shares issued (in shares)	0	0
Undesignated preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, shares issued (in shares)	65,443,862	64,873,038
Treasury stock, shares (in shares)	901,013	822,059

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Loss (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Statement of Comprehensive Income [Abstract]
Revenues	$ 92,207	$ 80,316	$ 181,414	$ 159,798
Cost of revenues	53,784	49,452	106,474	98,808
Gross profit	38,423	30,864	74,940	60,990
Operating expenses:
Selling and marketing	16,116	14,518	31,370	29,066
Research and development	7,961	6,622	15,115	12,496
Distribution	7,015	6,255	14,068	12,626
General and administrative	8,511	8,585	16,542	17,497
Total operating expenses	39,603	35,980	77,095	71,685
Loss from operations	(1,180)	(5,116)	(2,155)	(10,695)
Other income (expense):
Interest expense, net	(288)	(242)	(529)	(483)
Other (expense) income, net	(409)	37	(641)	301
Total other expense	(697)	(205)	(1,170)	(182)
Net loss before income taxes	(1,877)	(5,321)	(3,325)	(10,877)
Provision for income taxes	348	273	683	580
Net loss	(2,225)	(5,594)	(4,008)	(11,457)
Less: Net loss attributable to noncontrolling interests	(493)	(267)	(1,000)	(472)
Net loss attributable to stockholders of NxStage Medical, Inc.	$ (1,732)	$ (5,327)	$ (3,008)	$ (10,985)
Net loss per share, basic and diluted (in dollars per share)	$ (0.03)	$ (0.08)	$ (0.05)	$ (0.17)
Weighted-average shares outstanding, basic and diluted (in shares)	64,428	63,288	64,302	63,059
Other comprehensive loss, net of tax	$ (1,280)	$ (154)	$ (219)	$ (930)
Total comprehensive loss	(3,505)	(5,748)	(4,227)	(12,387)
Less: Comprehensive loss attributable to noncontrolling interests	(493)	(267)	(1,000)	(472)
Total comprehensive loss attributable to stockholders of NxStage Medical, Inc.	$ (3,012)	$ (5,481)	$ (3,227)	$ (11,915)

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015
Cash flows from operating activities:
Net loss	$ (4,008)	$ (11,457)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization	15,649	15,473
Stock-based compensation	5,394	6,590
Other	(561)	813
Changes in operating assets and liabilities:
Accounts receivable	(4,980)	(2,315)
Inventory	(12,533)	(8,023)
Prepaid expenses and other assets	150	169
Accounts payable	2,785	(641)
Accrued expenses and other liabilities	276	(2,036)
Deferred revenues	991	(957)
Net cash provided by (used in) operating activities	3,163	(2,384)
Cash flows from investing activities:
Cash paid for acquisitions, net of cash acquired	(513)	0
Purchases of property and equipment	(5,466)	(4,181)
Net cash used in investing activities	(5,979)	(4,181)
Cash flows from financing activities:
Issuance of shares under stock incentive plans, net of payroll taxes paid	1,897	1,974
Investment by noncontrolling interest holder	979	471
Proceeds from loans and lines of credit	0	1,275
Repayments on loans and lines of credit	(156)	(44)
Repayments on capital leases	(803)	(722)
Net cash provided by financing activities	1,917	2,954
Foreign exchange effect on cash and cash equivalents	293	(923)
Decrease in cash and cash equivalents	(606)	(4,534)
Cash and cash equivalents, beginning of period	59,065	52,884
Cash and cash equivalents, end of period	$ 58,459	$ 48,350

Nature of Operations, Basis of

Nature of Operations, Basis of Presentation and Principles of Consolidation	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Nature of Operations, Basis of Presentation and Principles of Consolidation	Nature of Operations, Basis of Presentation and Principles of Consolidation Nature of Operations We are a medical technology company that develops, manufactures and markets innovative products and services for patients suffering from chronic or acute kidney failure. Our primary product, the System One, was designed to satisfy an unmet clinical need for a system capable of delivering the therapeutic flexibility and clinical benefits of traditional dialysis machines in a smaller, portable, easy-to-use form that can be used by healthcare professionals and trained lay users alike in a variety of settings, including patient homes, as well as more traditional care settings such as hospitals and dialysis centers. Given its design, the System One is particularly well-suited for home hemodialysis and a range of dialysis therapies that are more practical to deliver in the home setting, including more frequent hemodialysis and nocturnal hemodialysis. Clinical literature suggests such therapies provide patients better clinical outcomes and improved quality of life. We also operate several recently opened NxStage Kidney Care dialysis centers, independently and in some instances as joint ventures, that treat end-stage renal disease (ESRD) patients directly. Although small in scale, these centers provide us with valuable experience as a service provider to better meet and anticipate the needs of both our customers and patients, while optimizing our product technology. In addition, these centers provide us with the opportunity to innovate and foster new care delivery models to advance the standard of renal care across other markets, including skilled nursing facilities. More specifically, at NxStage Kidney Care we offer a range of treatment options, including home hemodialysis, peritoneal dialysis and in-center hemodialysis, including with our System One. These centers also help us to devise best practices for successful home dialysis programs and provide sites for future clinical trials. We are headquartered in Lawrence, Massachusetts, with manufacturing facilities in Mexico, Germany and Italy. Through our international network of affiliates and distribution partners, patients in over 23 countries have been treated with our products. Basis of Presentation The accompanying condensed consolidated financial statements as of June 30, 2016 and December 31, 2015 and for the three and six months ended June 30, 2016 and 2015 , and related notes, are unaudited but, in the opinion of our management, include all adjustments, consisting of normal recurring adjustments, that are necessary for fair statement of the interim periods presented. Our unaudited condensed consolidated financial statements have been prepared following the requirements of the Securities and Exchange Commission (SEC) for interim reporting. As permitted under these rules, we have condensed or omitted certain footnotes and other financial information that are normally required by U.S. generally accepted accounting principles (GAAP). Our accounting policies are described in the notes to the consolidated financial statements in our Annual Report on Form 10-K for the year ended December 31, 2015 ( 2015 Annual Report) and updated, as necessary, in this Quarterly Report on Form 10-Q. Operating results for any interim period are not necessarily indicative of results for the entire year or future periods. The December 31, 2015 condensed consolidated balance sheet contained herein was derived from audited financial statements, but does not include all disclosures that would be required for audited financial statements under GAAP. For further information, refer to the consolidated financial statements and footnotes thereto included in our 2015 Annual Report. The preparation of our condensed consolidated financial statements in conformity with GAAP requires our management to make estimates and assumptions that affect reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Principles of Consolidation Our condensed consolidated financial statements include the accounts of NxStage Medical, Inc. and our wholly-owned subsidiaries and other entities in which we maintain a majority voting interests or for which we maintain effective control, including variable interest entities (VIEs) for which we are deemed the primary beneficiary. All significant intercompany balances and transactions have been eliminated. Noncontrolling interests represent the proportionate equity interests in the consolidated entities that are not wholly owned by us. Noncontrolling interests of acquired entities are recognized at their initial fair value.

Summary of Significant Accounti

Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	ummary of Significant Accounting Policies Concentration of Credit Risk Concentration of credit risk with respect to accounts receivable is primarily limited to certain customers to whom we make substantial sales. No single customer represented more than 10% of accounts receivable at June 30, 2016 . One customer represented 12% of accounts receivable at December 31, 2015 . Warranty Costs We accrue estimated costs that we may incur under our product warranty programs at the time the product revenue is recognized, based on contractual rights and historical experience. Warranty expense is included in cost of revenues in the condensed consolidated statements of comprehensive loss. The following is a rollforward of our warranty accrual (in thousands): Balance at December 31, 2015 $ 389 Provision 233 Usage (243 ) Balance at June 30, 2016 $ 379 Recent Accounting Pronouncements Recently Implemented Accounting Pronouncements In April 2015, the FASB issued ASU No. 2015-5, Intangibles - Goodwill and Other - Internal-Use Software (Subtopic 350-40): "Customer's Accounting for Fees Paid in a Cloud Computing Arrangement." Under this standard, if a cloud computing arrangement includes a software license, the software license element of the arrangement should be accounted for consistent with the acquisition of other software licenses. If a cloud computing arrangement does not include a software license, the arrangement should be accounted for as a service contract. The update was effective for us beginning January 1, 2016. The adoption of this standard did not impact our financial statements. In September 2015, the FASB issued ASU No. 2015-16, Business Combinations (Topic 805): "Simplifying the Accounting for Measurement-Period Adjustments". The new standard requires that an acquirer recognize adjustments to provisional amounts that are identified during the measurement period in the reporting period in which the adjustment amounts are determined and sets forth new disclosure requirements related to the adjustments. The new standard was effective for us beginning January 1, 2016. The adoption of this standard did not impact our financial statements. Recent Accounting Pronouncements Not Yet Adopted In May 2014, the FASB issued ASU No. 2014-9: “Revenue from Contracts with Customers,” which provides guidance for revenue recognition. The standard’s core principle is that a company will recognize revenue when it transfers promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. The new guidance initially was effective for us beginning January 1, 2017, but on July 9, 2015 the FASB deferred the effective date and, as a result, the new guidance is effective for us beginning January 1, 2018. Companies may adopt the new revenue standard as of the original effective date. We are currently evaluating the method of adoption and the potential impact this standard will have on our financial statements. In July 2015, the FASB issued ASU No. 2015-11, Inventory (Topic 330): "Simplifying the Measurement of Inventory." The update requires that an entity should measure in scope inventory at the lower of cost and net realizable value. Net realizable value is the estimated selling prices in the ordinary course of business, less reasonably predictable costs of completion, disposal, and transportation. The amendments will be effective for us beginning January 1, 2017. The adoption of this update is not expected to have an impact on our financial statements. In February 2016, the FASB issued ASU No. 2016-02: "Accounting for Leases" which amends the existing accounting standards for leases. The new standard requires lessees to record a right-of-use asset and a corresponding lease liability on the balance sheet for all leases with terms longer than twelve months. For lessees, leases will continue to be classified as either operating or financing in the income statement. This ASU is required to be applied with a modified retrospective approach and requires application of the new standard at the beginning of the earliest comparative period presented. The new guidance is effective for us beginning January 1, 2019 and early adoption is permitted. We are currently evaluating the potential impact this standard will have on our financial statements. In March 2016, the FASB issued ASU No. 2016-09, “Improvements to Employee Share-Based Payment Accounting,” which simplifies several aspects of the accounting for employee share-based payment transactions for both public and nonpublic entities, including the accounting for income taxes, forfeitures, and statutory tax withholding requirements, as well as classification in the statement of cash flows. The new guidance is effective for us beginning January 1, 2017 and early adoption is permitted. We are currently evaluating the method of adoption and the potential impact this standard will have on our financial statements and related disclosure.

Inventory

Inventory	6 Months Ended
	Jun. 30, 2016
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory includes material, labor and overhead, and is stated at lower of cost (first-in, first-out) or market. The components of inventory are as follows (in thousands): June 30, December 31, Purchased components $ 14,973 $ 15,294 Work in process 13,255 10,080 Finished goods 13,081 13,017 Total $ 41,309 $ 38,391

Property and Equipment and Fiel

Property and Equipment and Field Equipment	6 Months Ended
	Jun. 30, 2016
Property, Plant and Equipment [Abstract]
Property and Equipment and Field Equipment	Property and Equipment and Field Equipment Accumulated depreciation on property and equipment was $42.6 million and $36.9 million at June 30, 2016 and December 31, 2015 , respectively. Accumulated depreciation on field equipment was $46.3 million and $44.1 million at June 30, 2016 and December 31, 2015 , respectively.

Intangible Assets

Intangible Assets	6 Months Ended
	Jun. 30, 2016
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets Accumulated amortization of intangible assets was $23.9 million and $22.9 million at June 30, 2016 and December 31, 2015 , respectively.

Net Loss per Share

Net Loss per Share	6 Months Ended
	Jun. 30, 2016
Earnings Per Share [Abstract]
Net Loss per Share	Net Loss per Share Basic net loss per share is computed by dividing loss attributable to NxStage Medical, Inc. common stockholders (the numerator) by the weighted-average number of common shares outstanding (the denominator) for the period. The computation of diluted loss per share is similar to basic loss per share, except that the denominator is increased to include the number of additional common shares that would have been outstanding if the potentially dilutive common shares had been issued. The following potential common stock equivalents, as calculated using the treasury stock method, were not included in the computation of diluted net loss per share as their effect would have been anti-dilutive due to the net loss incurred (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 Options to purchase common stock 550 752 529 824 Unvested restricted stock units 335 405 369 368 Total 885 1,157 898 1,192

Accrued Expenses, Other Current

Accrued Expenses, Other Current Liabilities and Other Long-Term Liabilities	6 Months Ended
	Jun. 30, 2016
Payables and Accruals [Abstract]
Accrued Expenses, Other Current Liabilities and Other Long-Term Liabilities	Accrued Expenses, Other Current Liabilities and Other Long-Term Liabilities The components of accrued expenses are as follows (in thousands): June 30, December 31, Payroll, compensation and related benefits $ 12,411 $ 14,061 Distribution expenses 3,525 3,465 General and administrative expenses 2,334 2,309 Other manufacturing costs 2,458 2,097 Other 5,888 5,334 Total $ 26,616 $ 27,266 The components of other current liabilities are as follows (in thousands): June 30, December 31, Capital lease obligations $ 2,058 $ 2,184 Deferred revenue, current portion 1,609 1,363 Other 785 847 Total $ 4,452 $ 4,394 The components of other long-term liabilities are as follows (in thousands): June 30, December 31, Capital lease obligations $ 10,580 $ 10,815 Lease incentive obligations 3,379 3,743 Benefit plan obligations 1,747 1,681 Other 1,205 1,128 Total $ 16,911 $ 17,367

Segment Disclosures

Segment Disclosures	6 Months Ended
	Jun. 30, 2016
Segment Reporting [Abstract]
Segment Disclosures	Segment Disclosures We have three reportable business segments: System One, In-Center, and Services and an Other category. The operating results of NxStage Kidney Care are included in our Services segment. We refer to our System One segment, In-Center segment, and Other category as our products business. We distribute our products in three markets: home, critical care and in-center. Our System One segment includes revenues from the sale and rental of the System One and PureFlow SL dialysate preparation equipment and the sale of disposable products to customers, including NxStage Kidney Care, in the home and critical care markets. The home market is devoted to the treatment of ESRD patients in the home or a home-like setting, while the critical care market is devoted to the treatment of hospital-based patients with acute kidney failure or fluid overload. Some of our largest customers in the home market provide outsourced renal dialysis services to some of our customers in the critical care market. Sales of products to both markets are made primarily through dedicated sales forces and distributed directly to the customer, or the patient, with certain products sold through distributors. Our In-Center segment includes revenues from the sale of blood tubing sets and needles for hemodialysis primarily for the treatment of ESRD patients at dialysis centers and needles for apheresis. Nearly all In-Center products are sold through national distributors. The remainder of our products business, which is included within the Other category, relates to the manufacturing of dialyzers for sale to Asahi Kasei Kuraray Medical Co., Ltd. (Asahi) and research and development and general and administrative expenses that are excluded from the segment operating performance measures. Our Services segment includes revenues from dialysis services provided to patients at our NxStage Kidney Care dialysis centers. Sales of the System One and related products to our NxStage Kidney Care dialysis centers are included in System One segment revenues, which are then eliminated upon consolidation. The accounting policies of our reportable segments are described in Note 2 to the consolidated financial statements included in our 2015 Annual Report and updated, as necessary, in Note 2 to the condensed consolidated financial statements included in this Quarterly Report. Our chief operating decision maker allocates resources to our business segments and assesses segment performance based on segment profit (loss), which consists of revenues less cost of revenues, selling and marketing and distribution expenses. The following summarizes the operating performance of our reportable segments (in thousands): System One In-Center Other Services Intersegment Elimination Total Three Months Ended June 30, 2016 Revenues from external customers $ 67,954 $ 16,731 $ 3,408 $ 4,114 $ — $ 92,207 Intersegment revenues 1,893 — — — (1,893 ) — Revenues 69,847 16,731 3,408 4,114 (1,893 ) 92,207 Segment profit (loss) 17,945 3,133 (16,089 ) (5,949 ) (220 ) (1,180 ) Depreciation and amortization 5,271 495 1,134 1,013 — 7,913 Three Months Ended June 30, 2015 Revenues from external customers $ 58,752 $ 18,563 $ 1,857 $ 1,144 $ — $ 80,316 Intersegment revenues 668 — — — (668 ) — Revenues 59,420 18,563 $ 1,857 1,144 (668 ) 80,316 Segment profit (loss) 13,518 3,155 (15,718 ) (6,071 ) — (5,116 ) Depreciation and amortization 5,208 547 1,208 830 — 7,793 Six Months Ended June 30, 2016 Revenues from external customers $ 135,527 $ 33,497 $ 5,589 $ 6,801 $ — $ 181,414 Intersegment revenues 3,623 — — — (3,623 ) — Revenues 139,150 33,497 5,589 6,801 (3,623 ) 181,414 Segment profit (loss) 36,169 5,692 (30,656 ) (12,970 ) (390 ) (2,155 ) Depreciation and amortization 10,455 989 2,227 1,978 — 15,649 Six Months Ended June 30, 2015 Revenues from external customers $ 117,850 $ 36,430 $ 3,704 $ 1,814 $ — $ 159,798 Intersegment revenues 1,150 — — — (1,150 ) — Revenues 119,000 36,430 $ 3,704 1,814 (1,150 ) 159,798 Segment profit (loss) 26,492 5,332 (30,666 ) (11,853 ) — (10,695 ) Depreciation and amortization 10,498 1,020 2,419 1,536 — 15,473 Substantially all of our revenues are derived from the sale of the System One and related products that cannot be used with any other dialysis system, and from needles and blood tubing sets in the U.S. The following table summarizes the number of customers who individually make up greater than ten percent of total revenues: Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 DaVita 20 % 21 % 20 % 21 % Fresenius 18 % 17 % 17 % 17 % Sales to DaVita HealthCare Partners Inc. (DaVita) and Fresenius Medical Care (Fresenius) are in the System One segment.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2016
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Significant commitments and contingencies at June 30, 2016 are consistent with those discussed in Note 10 to the consolidated financial statements in our 2015 Annual Report.

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2016
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The provision for income taxes of $0.4 million and $0.3 million during the three months ended June 30, 2016 and 2015 , respectively, and $0.7 million and $0.6 million during the six months ended June 30, 2016 and 2015 , respectively, relates to the profitable operations of certain foreign subsidiaries. As of June 30, 2016 , we had a liability for unrecognized tax benefits included in the balance sheet of approximately $0.4 million , including a nominal accrual for interest and penalties of less than $0.1 million . There have been no significant changes to these amounts during the three and six months ended June 30, 2016 .

Stock-Based Compensation

Stock-Based Compensation	6 Months Ended
	Jun. 30, 2016
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-Based Compensation	Stock-Based Compensation Stock-based Compensation Expense The following table presents stock-based compensation expense included in our condensed consolidated statements of comprehensive loss (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 Cost of revenues $ 362 $ 242 $ 742 $ 507 Selling and marketing 951 1,151 1,781 2,530 Research and development 409 423 804 928 General and administrative 1,058 1,047 2,067 2,625 Total $ 2,780 $ 2,863 $ 5,394 $ 6,590 Stock Options and Restricted Stock Units The Company granted options to purchase 141,515 and 147,007 shares of common stock during the three months ended June 30, 2016 and 2015 , respectively, and options to purchase 1,314,000 and 1,061,554 shares of common stock during the six months ended June 30, 2016 and 2015 , respectively, which vest based on continued employment over a period of one to four years. The weighted-average fair value of options granted during the six months ended June 30, 2016 and 2015 was $5.84 and $6.13 per option, respectively. The Company awarded 42,440 and 16,355 restricted stock units during the three months ended June 30, 2016 and 2015 , respectively, and 196,466 and 139,181 restricted stock units during the six months ended June 30, 2016 and 2015 , respectively, which vest based on continued employment over a period of three to four years. The weighted-average fair value of these restricted stock units awarded during the six months ended June 30, 2016 and 2015 was $16.75 and $16.94 per unit, respectively. In March 2016, the Compensation Committee of our Board of Directors approved the grant of up to 434,850 restricted stock units subject to the achievement of certain Company financial performance metrics for the year ending December 31, 2016 . The restricted stock units, if earned, vest over a requisite service period of three years and have an average fair value of $15.57 per unit.

Stockholders' Equity

Stockholders' Equity	6 Months Ended
	Jun. 30, 2016
Equity [Abstract]
Stockholders' Equity	Stockholders' Equity We received 78,954 and 43,506 shares of common stock that were surrendered in payment for the exercise of stock options during the six months ended June 30, 2016 and 2015 , respectively.

Noncontrolling Interest

Noncontrolling Interest	6 Months Ended
	Jun. 30, 2016
Noncontrolling Interest [Abstract]
Noncontrolling Interest	Noncontrolling Interest Noncontrolling interests represent the third-party equity ownership interests in consolidated entities for which we have effective control, including VIEs for which we are deemed the primary beneficiary. We assess the terms of our investment interests to determine if any of our investees meet the definition of a VIE. For any VIEs, we perform an analysis to determine whether our variable interests give us a controlling financial interest in a VIE. The analysis identifies the primary beneficiary of a VIE as the enterprise that has both 1) the power to direct activities of a VIE that most significantly impact the entity’s economic performance and 2) the obligation to absorb losses of the entity or the right to receive benefits from the entity. As of June 30, 2016 , we have 7 VIEs included in our consolidated financial statements all of which are NxStage Kidney Care dialysis centers. We are the managing member or we have a majority seat on the entity’s board of managers, manage these entities through a management services agreement, and, together with our joint venture partners, provide operating and capital funding as necessary for the entities to accomplish their operational and strategic objectives which transfer substantial power over and economic responsibility for the entities to us. The analysis upon which these consolidation determinations rest is complex, involves uncertainties, and requires significant judgment on various matters. At June 30, 2016 and December 31, 2015 , total assets of our VIEs were $11.2 million and $11.0 million , and total liabilities and noncontrolling interests of our VIEs were $9.5 million and $10.2 million , respectively. We have potential obligations to purchase the noncontrolling interests held by third parties in certain of our consolidated subsidiaries. These obligations are in the form of put provisions and are exercisable at the third-party owners' discretion given specific facts and circumstances as outlined in each subsidiary's operating agreement. If these put provisions were exercised, we would be required to purchase all the third-party owners' noncontrolling interests at a fair value at the time of exercise pursuant to the terms of the agreement. For the three and six months ended June 30, 2016 the Company's noncontrolling interests subject to put provisions were $0.2 million and none of the rights were exercisable. The following table sets forth the changes in noncontrolling interest not subject to put provisions for the three and six months ended June 30, 2016 and 2015 (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 Balance at beginning of period $ 1,500 $ 883 $ 1,694 $ 1,088 Capital contributions by noncontrolling interest — 263 300 263 Sales of noncontrolling interests 679 208 679 208 Net loss attributable to noncontrolling interest in consolidated subsidiary (457 ) (267 ) (951 ) (472 ) Balance at end of period $ 1,722 $ 1,087 $ 1,722 $ 1,087

Derivative Instruments and Hedg

Derivative Instruments and Hedging	6 Months Ended
	Jun. 30, 2016
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Instruments and Hedging	Derivative Instruments and Hedging We operate manufacturing and service facilities in Mexico, Germany, and Italy, and we purchase materials and pay our employees at those facilities in pesos and euros, and as such, we are potentially exposed to adverse as well as beneficial movements in currency exchange rates. We enter into foreign exchange forward contracts to minimize the impact of currency exchange rate fluctuations on these peso and euro denominated expenses. These contracts have a duration of up to twelve months and are designated as cash flow hedges. The counterparties to these foreign exchange forward contracts are creditworthy financial institutions; therefore, we do not consider the risk of counterparty nonperformance to be material. As of June 30, 2016 and December 31, 2015 , the notional amount of our outstanding contracts that are designated as cash flow hedges was $21.0 million and $22.1 million , respectively. The fair value of these contracts is recorded on the balance sheet within prepaid expenses and other current assets or accrued expenses depending on the gain (loss) position. The fair value of these contracts was a net liability of $1.0 million and $1.1 million at June 30, 2016 and December 31, 2015 , respectively. The cash flows related to our currency exchange contracts are classified as operating cash flows, which is consistent with the cash flow treatment of the underlying items being hedged. Gains or losses related to hedge ineffectiveness recognized in earnings were not material during the six months ended June 30, 2016 and 2015 . Given the short-term nature of our contracts, any gains or losses recorded within accumulated other comprehensive income (loss) will be recognized in earnings within the next twelve months. The following table presents the effect of these contracts designated as cash flow hedges on our condensed consolidated financial statements (in thousands): Gain (Loss) Recognized in OCI (Effective Portion) Gain (Loss) Reclassified from OCI into Income (Effective Portion) Classification within the Condensed Consolidated Statement of Comprehensive Loss Three Months Ended June 30, 2016 Foreign exchange forward contracts $ (1,135 ) $ (362 ) Cost of revenues Six Months Ended June 30, 2016 Foreign exchange forward contracts $ (952 ) $ (1,049 ) Cost of revenues Three Months Ended June 30, 2015 Foreign exchange forward contracts $ (386 ) $ (206 ) Cost of revenues Six Months Ended June 30, 2015 Foreign exchange forward contracts $ (731 ) $ (684 ) Cost of revenues

Accumulated Other Comprehensive

Accumulated Other Comprehensive (Loss) Income	6 Months Ended
	Jun. 30, 2016
Equity [Abstract]
Accumulated Other Comprehensive (Loss) Income	Accumulated Other Comprehensive (Loss) Income The following additional information is provided with respect to the accumulated other comprehensive (loss) income as presented on the condensed consolidated balance sheets (in thousands): Unrealized gain (loss) on derivative instruments Other (2) Total Balance, net of tax, as of December 31, 2015 $ (1,483 ) $ (2,548 ) $ (4,031 ) Other comprehensive loss before reclassifications (952 ) (316 ) (1,268 ) Loss reclassified to earnings (1) 1,049 — 1,049 Total other comprehensive income (loss) 97 (316 ) (219 ) Balance, net of tax, as of June 30, 2016 $ (1,386 ) $ (2,864 ) $ (4,250 ) (1) Reclassifications of gains (losses) on derivative instruments are included in cost of revenues on the consolidated statement of comprehensive loss. See Note 14 , Derivative Instruments and Hedging for further information. (2) Other includes cumulative translation adjustments and, to a lesser extent, pension benefits.

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2016
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements We have certain financial assets and liabilities measured at fair value on a recurring and non-recurring basis recorded in our condensed consolidated balance sheets. The fair value measurements used are based on quoted prices, when available, or through the use of alternative approaches. The inputs used to determine fair value have been classified as Level 1, 2 or 3. Fair values determined by Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities that we have the ability to access. Fair values determined by Level 2 inputs utilize data points that are observable such as quoted prices, interest rates and yield curves for similar instruments and model-derived valuations whose inputs are observable. Fair values determined by Level 3 inputs utilize unobservable data points for the asset or liability. We measure the fair value of our foreign exchange forward contracts classified as derivative instruments using an income approach, based on prevailing market forward rates less the contract rate multiplied by the notional amount. The product of this calculation is then adjusted for counterparty risk. We did not have any transfers between Level 1 and Level 2 and Level 3 during the six months ended June 30, 2016 . The following table presents assets and liabilities measured at fair value on a recurring basis and their level within the value hierarchy (in thousands): June 30, 2016 Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total Fair Value Assets Money market funds (1) $ 34,785 $ — $ — $ 34,785 Foreign exchange forward contracts (2) — 47 — 47 Liabilities Foreign exchange forward contracts (2) $ — $ 1,058 $ — $ 1,058 December 31, 2015 Quoted Prices in Active Markets for Identical Assets Significant Other Observable Inputs Significant Unobservable Inputs Total Fair Value Assets Money market funds (1) $ 34,776 $ — $ — $ 34,776 Foreign exchange forward contracts (2) — 51 — 51 Liabilities Foreign exchange forward contracts (2) $ — $ 1,192 $ — $ 1,192 (1) Money market funds are included within cash and cash equivalents. (2) Foreign exchange forward contracts are included within prepaid expenses and other current assets or accrued expenses depending on the gain (loss) position. The carrying amount of our long-term debt approximates fair value at June 30, 2016 and December 31, 2015 . The fair value of our long-term debt was estimated using inputs derived principally from market observable data, including current rates offered to us for debt of the same or similar remaining maturities. Within the hierarchy of fair value measurements, these are Level 2 inputs. The carrying amounts reflected in the consolidated balance sheets for cash and cash equivalents (including money market funds), accounts receivable, prepaid expenses and other current and non-current assets, accounts payable and accrued expenses approximate fair value due to their short-term nature.

Supplemental Cash Flow Informat

Supplemental Cash Flow Information	6 Months Ended
	Jun. 30, 2016
Supplemental Cash Flow Elements [Abstract]
Supplemental Cash Flow Information	Supplemental Cash Flow Information The following additional information is provided with respect to the condensed consolidated statements of cash flows (in thousands): Six Months Ended June 30, 2016 2015 Noncash Investing and Financing Activities: Transfers from inventory to field equipment $ 10,267 $ 8,772 Transfers from field equipment to deferred cost of revenues 7,136 6,268 Payment of corporate bonus in common stock — 1,103 Market value of shares received in payment for exercise of stock options 1,470 745 Construction-in-process financed by construction liability — 669 Property and equipment acquired under capital lease — 354

Summary of Significant Accoun23

Summary of Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying condensed consolidated financial statements as of June 30, 2016 and December 31, 2015 and for the three and six months ended June 30, 2016 and 2015 , and related notes, are unaudited but, in the opinion of our management, include all adjustments, consisting of normal recurring adjustments, that are necessary for fair statement of the interim periods presented. Our unaudited condensed consolidated financial statements have been prepared following the requirements of the Securities and Exchange Commission (SEC) for interim reporting. As permitted under these rules, we have condensed or omitted certain footnotes and other financial information that are normally required by U.S. generally accepted accounting principles (GAAP). Our accounting policies are described in the notes to the consolidated financial statements in our Annual Report on Form 10-K for the year ended December 31, 2015 ( 2015 Annual Report) and updated, as necessary, in this Quarterly Report on Form 10-Q. Operating results for any interim period are not necessarily indicative of results for the entire year or future periods. The December 31, 2015 condensed consolidated balance sheet contained herein was derived from audited financial statements, but does not include all disclosures that would be required for audited financial statements under GAAP. For further information, refer to the consolidated financial statements and footnotes thereto included in our 2015 Annual Report.
Use of Estimates	The preparation of our condensed consolidated financial statements in conformity with GAAP requires our management to make estimates and assumptions that affect reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.
Principles of Consolidation	Principles of Consolidation Our condensed consolidated financial statements include the accounts of NxStage Medical, Inc. and our wholly-owned subsidiaries and other entities in which we maintain a majority voting interests or for which we maintain effective control, including variable interest entities (VIEs) for which we are deemed the primary beneficiary. All significant intercompany balances and transactions have been eliminated. Noncontrolling interests represent the proportionate equity interests in the consolidated entities that are not wholly owned by us. Noncontrolling interests of acquired entities are recognized at their initial fair value.
Concentration of Credit Risk	Concentration of Credit Risk Concentration of credit risk with respect to accounts receivable is primarily limited to certain customers to whom we make substantial sales.
Warranty Costs	Warranty Costs We accrue estimated costs that we may incur under our product warranty programs at the time the product revenue is recognized, based on contractual rights and historical experience. Warranty expense is included in cost of revenues in the condensed consolidated statements of comprehensive loss.
Recent Accounting Pronouncements	Recent Accounting Pronouncements Recently Implemented Accounting Pronouncements In April 2015, the FASB issued ASU No. 2015-5, Intangibles - Goodwill and Other - Internal-Use Software (Subtopic 350-40): "Customer's Accounting for Fees Paid in a Cloud Computing Arrangement." Under this standard, if a cloud computing arrangement includes a software license, the software license element of the arrangement should be accounted for consistent with the acquisition of other software licenses. If a cloud computing arrangement does not include a software license, the arrangement should be accounted for as a service contract. The update was effective for us beginning January 1, 2016. The adoption of this standard did not impact our financial statements. In September 2015, the FASB issued ASU No. 2015-16, Business Combinations (Topic 805): "Simplifying the Accounting for Measurement-Period Adjustments". The new standard requires that an acquirer recognize adjustments to provisional amounts that are identified during the measurement period in the reporting period in which the adjustment amounts are determined and sets forth new disclosure requirements related to the adjustments. The new standard was effective for us beginning January 1, 2016. The adoption of this standard did not impact our financial statements. Recent Accounting Pronouncements Not Yet Adopted In May 2014, the FASB issued ASU No. 2014-9: “Revenue from Contracts with Customers,” which provides guidance for revenue recognition. The standard’s core principle is that a company will recognize revenue when it transfers promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. The new guidance initially was effective for us beginning January 1, 2017, but on July 9, 2015 the FASB deferred the effective date and, as a result, the new guidance is effective for us beginning January 1, 2018. Companies may adopt the new revenue standard as of the original effective date. We are currently evaluating the method of adoption and the potential impact this standard will have on our financial statements. In July 2015, the FASB issued ASU No. 2015-11, Inventory (Topic 330): "Simplifying the Measurement of Inventory." The update requires that an entity should measure in scope inventory at the lower of cost and net realizable value. Net realizable value is the estimated selling prices in the ordinary course of business, less reasonably predictable costs of completion, disposal, and transportation. The amendments will be effective for us beginning January 1, 2017. The adoption of this update is not expected to have an impact on our financial statements. In February 2016, the FASB issued ASU No. 2016-02: "Accounting for Leases" which amends the existing accounting standards for leases. The new standard requires lessees to record a right-of-use asset and a corresponding lease liability on the balance sheet for all leases with terms longer than twelve months. For lessees, leases will continue to be classified as either operating or financing in the income statement. This ASU is required to be applied with a modified retrospective approach and requires application of the new standard at the beginning of the earliest comparative period presented. The new guidance is effective for us beginning January 1, 2019 and early adoption is permitted. We are currently evaluating the potential impact this standard will have on our financial statements. In March 2016, the FASB issued ASU No. 2016-09, “Improvements to Employee Share-Based Payment Accounting,” which simplifies several aspects of the accounting for employee share-based payment transactions for both public and nonpublic entities, including the accounting for income taxes, forfeitures, and statutory tax withholding requirements, as well as classification in the statement of cash flows. The new guidance is effective for us beginning January 1, 2017 and early adoption is permitted. We are currently evaluating the method of adoption and the potential impact this standard will have on our financial statements and related disclosure.

Summary of Significant Accoun24

Summary of Significant Accounting Policies (Tables)	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Schedule of Rollforward of Warranty Accrual	The following is a rollforward of our warranty accrual (in thousands): Balance at December 31, 2015 $ 389 Provision 233 Usage (243 ) Balance at June 30, 2016 $ 379

Inventory (Tables)

Inventory (Tables)	6 Months Ended
	Jun. 30, 2016
Inventory Disclosure [Abstract]
Components of Inventory	The components of inventory are as follows (in thousands): June 30, December 31, Purchased components $ 14,973 $ 15,294 Work in process 13,255 10,080 Finished goods 13,081 13,017 Total $ 41,309 $ 38,391

Net Loss per Share (Tables)

Net Loss per Share (Tables)	6 Months Ended
	Jun. 30, 2016
Earnings Per Share [Abstract]
Schedule of Anti-dilutive Net Loss Per Share	The following potential common stock equivalents, as calculated using the treasury stock method, were not included in the computation of diluted net loss per share as their effect would have been anti-dilutive due to the net loss incurred (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 Options to purchase common stock 550 752 529 824 Unvested restricted stock units 335 405 369 368 Total 885 1,157 898 1,192

Accrued Expenses, Other Curre27

Accrued Expenses, Other Current Liabilities and Other Long-Term Liabilities (Tables)	6 Months Ended
	Jun. 30, 2016
Payables and Accruals [Abstract]
Components of Accrued Expenses	The components of accrued expenses are as follows (in thousands): June 30, December 31, Payroll, compensation and related benefits $ 12,411 $ 14,061 Distribution expenses 3,525 3,465 General and administrative expenses 2,334 2,309 Other manufacturing costs 2,458 2,097 Other 5,888 5,334 Total $ 26,616 $ 27,266
Components of Other Current liabilities	The components of other current liabilities are as follows (in thousands): June 30, December 31, Capital lease obligations $ 2,058 $ 2,184 Deferred revenue, current portion 1,609 1,363 Other 785 847 Total $ 4,452 $ 4,394
Components of Other Long-term Liabilities	The components of other long-term liabilities are as follows (in thousands): June 30, December 31, Capital lease obligations $ 10,580 $ 10,815 Lease incentive obligations 3,379 3,743 Benefit plan obligations 1,747 1,681 Other 1,205 1,128 Total $ 16,911 $ 17,367

Segment Disclosures (Tables)

Segment Disclosures (Tables)	6 Months Ended
	Jun. 30, 2016
Segment Reporting [Abstract]
Summary of Operating Performance of Reportable Segments	The following summarizes the operating performance of our reportable segments (in thousands): System One In-Center Other Services Intersegment Elimination Total Three Months Ended June 30, 2016 Revenues from external customers $ 67,954 $ 16,731 $ 3,408 $ 4,114 $ — $ 92,207 Intersegment revenues 1,893 — — — (1,893 ) — Revenues 69,847 16,731 3,408 4,114 (1,893 ) 92,207 Segment profit (loss) 17,945 3,133 (16,089 ) (5,949 ) (220 ) (1,180 ) Depreciation and amortization 5,271 495 1,134 1,013 — 7,913 Three Months Ended June 30, 2015 Revenues from external customers $ 58,752 $ 18,563 $ 1,857 $ 1,144 $ — $ 80,316 Intersegment revenues 668 — — — (668 ) — Revenues 59,420 18,563 $ 1,857 1,144 (668 ) 80,316 Segment profit (loss) 13,518 3,155 (15,718 ) (6,071 ) — (5,116 ) Depreciation and amortization 5,208 547 1,208 830 — 7,793 Six Months Ended June 30, 2016 Revenues from external customers $ 135,527 $ 33,497 $ 5,589 $ 6,801 $ — $ 181,414 Intersegment revenues 3,623 — — — (3,623 ) — Revenues 139,150 33,497 5,589 6,801 (3,623 ) 181,414 Segment profit (loss) 36,169 5,692 (30,656 ) (12,970 ) (390 ) (2,155 ) Depreciation and amortization 10,455 989 2,227 1,978 — 15,649 Six Months Ended June 30, 2015 Revenues from external customers $ 117,850 $ 36,430 $ 3,704 $ 1,814 $ — $ 159,798 Intersegment revenues 1,150 — — — (1,150 ) — Revenues 119,000 36,430 $ 3,704 1,814 (1,150 ) 159,798 Segment profit (loss) 26,492 5,332 (30,666 ) (11,853 ) — (10,695 ) Depreciation and amortization 10,498 1,020 2,419 1,536 — 15,473
Summary of Customers Who Individually Make Up Greater than 10% of Total Revenues	The following table summarizes the number of customers who individually make up greater than ten percent of total revenues: Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 DaVita 20 % 21 % 20 % 21 % Fresenius 18 % 17 % 17 % 17 %

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	6 Months Ended
	Jun. 30, 2016
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Summary of Stock-Based Compensation Expense in Consolidated Statements of Comprehensive Loss	The following table presents stock-based compensation expense included in our condensed consolidated statements of comprehensive loss (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 Cost of revenues $ 362 $ 242 $ 742 $ 507 Selling and marketing 951 1,151 1,781 2,530 Research and development 409 423 804 928 General and administrative 1,058 1,047 2,067 2,625 Total $ 2,780 $ 2,863 $ 5,394 $ 6,590

Noncontrolling Interest (Tables

Noncontrolling Interest (Tables)	6 Months Ended
	Jun. 30, 2016
Noncontrolling Interest [Abstract]
Schedule of Changes in Noncontrolling Interest	The following table sets forth the changes in noncontrolling interest not subject to put provisions for the three and six months ended June 30, 2016 and 2015 (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 Balance at beginning of period $ 1,500 $ 883 $ 1,694 $ 1,088 Capital contributions by noncontrolling interest — 263 300 263 Sales of noncontrolling interests 679 208 679 208 Net loss attributable to noncontrolling interest in consolidated subsidiary (457 ) (267 ) (951 ) (472 ) Balance at end of period $ 1,722 $ 1,087 $ 1,722 $ 1,087

Derivative Instruments and He31

Derivative Instruments and Hedging (Tables)	6 Months Ended
	Jun. 30, 2016
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Effect of Contracts Designated as Cash Flow Hedges on Consolidated Financial Statements	The following table presents the effect of these contracts designated as cash flow hedges on our condensed consolidated financial statements (in thousands): Gain (Loss) Recognized in OCI (Effective Portion) Gain (Loss) Reclassified from OCI into Income (Effective Portion) Classification within the Condensed Consolidated Statement of Comprehensive Loss Three Months Ended June 30, 2016 Foreign exchange forward contracts $ (1,135 ) $ (362 ) Cost of revenues Six Months Ended June 30, 2016 Foreign exchange forward contracts $ (952 ) $ (1,049 ) Cost of revenues Three Months Ended June 30, 2015 Foreign exchange forward contracts $ (386 ) $ (206 ) Cost of revenues Six Months Ended June 30, 2015 Foreign exchange forward contracts $ (731 ) $ (684 ) Cost of revenues

Accumulated Other Comprehensi32

Accumulated Other Comprehensive (Loss) Income (Tables)	6 Months Ended
	Jun. 30, 2016
Equity [Abstract]
Summary of Additional Information on Accumulated Other Comprehensive (Loss) Income	The following additional information is provided with respect to the accumulated other comprehensive (loss) income as presented on the condensed consolidated balance sheets (in thousands): Unrealized gain (loss) on derivative instruments Other (2) Total Balance, net of tax, as of December 31, 2015 $ (1,483 ) $ (2,548 ) $ (4,031 ) Other comprehensive loss before reclassifications (952 ) (316 ) (1,268 ) Loss reclassified to earnings (1) 1,049 — 1,049 Total other comprehensive income (loss) 97 (316 ) (219 ) Balance, net of tax, as of June 30, 2016 $ (1,386 ) $ (2,864 ) $ (4,250 ) (1) Reclassifications of gains (losses) on derivative instruments are included in cost of revenues on the consolidated statement of comprehensive loss. See Note 14 , Derivative Instruments and Hedging for further information. (2) Other includes cumulative translation adjustments and, to a lesser extent, pension benefits.

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2016
Fair Value Disclosures [Abstract]
Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis	The following table presents assets and liabilities measured at fair value on a recurring basis and their level within the value hierarchy (in thousands): June 30, 2016 Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total Fair Value Assets Money market funds (1) $ 34,785 $ — $ — $ 34,785 Foreign exchange forward contracts (2) — 47 — 47 Liabilities Foreign exchange forward contracts (2) $ — $ 1,058 $ — $ 1,058 December 31, 2015 Quoted Prices in Active Markets for Identical Assets Significant Other Observable Inputs Significant Unobservable Inputs Total Fair Value Assets Money market funds (1) $ 34,776 $ — $ — $ 34,776 Foreign exchange forward contracts (2) — 51 — 51 Liabilities Foreign exchange forward contracts (2) $ — $ 1,192 $ — $ 1,192 (1) Money market funds are included within cash and cash equivalents. (2) Foreign exchange forward contracts are included within prepaid expenses and other current assets or accrued expenses depending on the gain (loss) position.

Supplemental Cash Flow Inform34

Supplemental Cash Flow Information (Tables)	6 Months Ended
	Jun. 30, 2016
Supplemental Cash Flow Elements [Abstract]
Summary of Supplemental Cash Flow Information	The following additional information is provided with respect to the condensed consolidated statements of cash flows (in thousands): Six Months Ended June 30, 2016 2015 Noncash Investing and Financing Activities: Transfers from inventory to field equipment $ 10,267 $ 8,772 Transfers from field equipment to deferred cost of revenues 7,136 6,268 Payment of corporate bonus in common stock — 1,103 Market value of shares received in payment for exercise of stock options 1,470 745 Construction-in-process financed by construction liability — 669 Property and equipment acquired under capital lease — 354

Nature of Operations, Basis o35

Nature of Operations, Basis of Presentation and Principles of Consolidation (Details)	Jun. 30, 2016country
Accounting Policies [Abstract]
Number of countries in which entity operates	23

Summary of Significant Accoun36

Summary of Significant Accounting Policies - Additional Information (Details)	12 Months Ended
	Dec. 31, 2015
Customer Concentration Risk [Member] | Accounts Receivable [Member]
Accounting Policies [Line Items]
Percentage of accounts receivable	12.00%

Summary of Significant Accoun37

Summary of Significant Accounting Policies - Schedule of Rollforward of Warranty Accrual (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2016USD ($)
Movement in Standard and Extended Product Warranty Accrual, Increase (Decrease) [Roll Forward]
Balance at beginning of period	$ 389
Provision	233
Usage	(243)
Balance at end of period	$ 379

Inventory - Components of Inven

Inventory - Components of Inventory (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Inventory Disclosure [Abstract]
Purchased components	$ 14,973	$ 15,294
Work in process	13,255	10,080
Finished goods	13,081	13,017
Total	$ 41,309	$ 38,391

Property and Equipment and Fi39

Property and Equipment and Field Equipment - Additional Information (Details) - USD ($) $ in Millions	Jun. 30, 2016	Dec. 31, 2015
Property And Equipment Excluding Field Equipment [Member]
Property, Plant and Equipment [Line Items]
Accumulated depreciation	$ 42.6	$ 36.9
Field Equipment [Member]
Property, Plant and Equipment [Line Items]
Accumulated depreciation	$ 46.3	$ 44.1

Intangible Assets - Additional

Intangible Assets - Additional Information (Details) - USD ($) $ in Millions	Jun. 30, 2016	Dec. 31, 2015
Goodwill and Intangible Assets Disclosure [Abstract]
Accumulated amortization of intangible assets	$ 23.9	$ 22.9

Net Loss per Share - Schedule o

Net Loss per Share - Schedule of Anti-dilutive Net Loss Per Share (Details) - shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common stock equivalents excluded from computation of earnings per share (in shares)	885	1,157	898	1,192
Options to Purchase Common Stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common stock equivalents excluded from computation of earnings per share (in shares)	550	752	529	824
Unvested Restricted Stock Units [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common stock equivalents excluded from computation of earnings per share (in shares)	335	405	369	368

Accrued Expenses, Other Curre42

Accrued Expenses, Other Current Liabilities and Other Long-Term Liabilities - Components of Accrued Expenses (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Payables and Accruals [Abstract]
Payroll, compensation and related benefits	$ 12,411	$ 14,061
Distribution expenses	3,525	3,465
General and administrative expenses	2,334	2,309
Other manufacturing costs	2,458	2,097
Other	5,888	5,334
Total	$ 26,616	$ 27,266

Accrued Expenses, Other Curre43

Accrued Expenses, Other Current Liabilities and Other Long-Term Liabilities - Components of Other Current Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Payables and Accruals [Abstract]
Capital lease obligations	$ 2,058	$ 2,184
Deferred revenue, current portion	1,609	1,363
Other	785	847
Total	$ 4,452	$ 4,394

Accrued Expenses, Other Curre44

Accrued Expenses, Other Current Liabilities and Other Long-Term Liabilities - Components of Other Long-term Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Payables and Accruals [Abstract]
Capital lease obligations	$ 10,580	$ 10,815
Lease incentive obligations	3,379	3,743
Benefit plan obligations	1,747	1,681
Other	1,205	1,128
Total	$ 16,911	$ 17,367

Segment Disclosures - Additiona

Segment Disclosures - Additional Information (Details)	6 Months Ended
	Jun. 30, 2016segmentmarket
Segment Reporting [Abstract]
Number of reporting segments | segment	3
Number of markets product distributed | market	3

Segment Disclosures - Summary o

Segment Disclosures - Summary of Operating Performance of Reportable Segments (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Segment Reporting Information [Line Items]
Revenues	$ 92,207	$ 80,316	$ 181,414	$ 159,798
Segment profit (loss)	(1,180)	(5,116)	(2,155)	(10,695)
Depreciation and amortization	7,913	7,793	15,649	15,473
System One [Member]
Segment Reporting Information [Line Items]
Revenues	69,847	59,420	139,150	119,000
Segment profit (loss)	17,945	13,518	36,169	26,492
Depreciation and amortization	5,271	5,208	10,455	10,498
In-Center [Member]
Segment Reporting Information [Line Items]
Revenues	16,731	18,563	33,497	36,430
Segment profit (loss)	3,133	3,155	5,692	5,332
Depreciation and amortization	495	547	989	1,020
Services [Member]
Segment Reporting Information [Line Items]
Revenues	4,114	1,144	6,801	1,814
Segment profit (loss)	(5,949)	(6,071)	(12,970)	(11,853)
Depreciation and amortization	1,013	830	1,978	1,536
Operating Segments [Member] | System One [Member]
Segment Reporting Information [Line Items]
Revenues	67,954	58,752	135,527	117,850
Operating Segments [Member] | In-Center [Member]
Segment Reporting Information [Line Items]
Revenues	16,731	18,563	33,497	36,430
Operating Segments [Member] | Services [Member]
Segment Reporting Information [Line Items]
Revenues	4,114	1,144	6,801	1,814
Other [Member]
Segment Reporting Information [Line Items]
Revenues	3,408	1,857	5,589	3,704
Segment profit (loss)	(16,089)	(15,718)	(30,656)	(30,666)
Depreciation and amortization	1,134	1,208	2,227	2,419
Intersegment Revenue Elimination [Member]
Segment Reporting Information [Line Items]
Revenues	(1,893)	(668)	(3,623)	(1,150)
Segment profit (loss)	(220)		(390)
Intersegment Revenue Elimination [Member] | System One [Member]
Segment Reporting Information [Line Items]
Revenues	$ 1,893	$ 668	$ 3,623	$ 1,150

Segment Disclosures - Summary47

Segment Disclosures - Summary of Customers Who Individually Make Up Greater than 10% of Total Revenues (Details) - Sales Revenue, Net [Member] - Customer Concentration Risk [Member]	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
DaVita [Member]
Revenue, Major Customer [Line Items]
Percentage of revenues	20.00%	21.00%	20.00%	21.00%
Fresenius [Member]
Revenue, Major Customer [Line Items]
Percentage of revenues	18.00%	17.00%	17.00%	17.00%

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Income Tax Disclosure [Abstract]
Foreign tax expense	$ 0.4	$ 0.3	$ 0.7	$ 0.6
Liability for unrecognized tax benefits	$ 0.4		0.4
Accrued interest and penalties (less than $0.1 million)			$ 0.1

Stock-Based Compensation - Summ

Stock-Based Compensation - Summary of Stock-Based Compensation Expense in Consolidated Statements of Comprehensive Loss (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation expense	$ 2,780	$ 2,863	$ 5,394	$ 6,590
Cost of Revenues [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation expense	362	242	742	507
Selling and Marketing [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation expense	951	1,151	1,781	2,530
Research and Development [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation expense	409	423	804	928
General and Administrative [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation expense	$ 1,058	$ 1,047	$ 2,067	$ 2,625

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Details) - $ / shares	1 Months Ended	3 Months Ended		6 Months Ended
	Mar. 31, 2016	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Options to Purchase Common Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, grants in period (in shares)		141,515	147,007	1,314,000	1,061,554
Weighted-average fair value of options granted (in dollars per share)				$ 5.84	$ 6.13
Options to Purchase Common Stock [Member] | Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period (in years)				1 year
Options to Purchase Common Stock [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period (in years)				4 years
Unvested Restricted Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, grants in period (in shares)		42,440	16,355	196,466	139,181
Weighted-average fair value of restricted stock granted (in dollars per share)				$ 16.75	$ 16.94
Unvested Restricted Stock Units [Member] | Performance Based Plans [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, grants in period (in shares)	434,850
Weighted-average fair value of restricted stock granted (in dollars per share)				$ 15.57
Restricted stock vests over a requisite service period (in years)				3 years
Unvested Restricted Stock Units [Member] | Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period (in years)				3 years
Unvested Restricted Stock Units [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period (in years)				4 years

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Details) - shares	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015
Equity [Abstract]
Shares delivered or surrendered in payment for the exercise of stock options (in shares)	78,954	43,506

Noncontrolling Interest - Addit

Noncontrolling Interest - Additional Information (Details) $ in Thousands	Jun. 30, 2016USD ($)entity	Dec. 31, 2015USD ($)
Noncontrolling Interest [Abstract]
Number of VIEs | entity	7
Total assets of variable interest entities	$ 11,200	$ 11,000
Total liabilities and noncontrolling interest of variable interest entities	9,500	10,200
Noncontrolling interests subject to put provisions	$ 168	$ 219

Noncontrolling Interest - Sched

Noncontrolling Interest - Schedule of Changes in Noncontrolling Interest (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest [Abstract]
Balance at beginning of period	$ 1,500	$ 883	$ 1,694	$ 1,088
Capital contributions by noncontrolling interest	0	263	300	263
Sales of noncontrolling interests	679	208	679	208
Net loss attributable to noncontrolling interest in consolidated subsidiary	(457)	(267)	(951)	(472)
Balance at end of period	$ 1,722	$ 1,087	$ 1,722	$ 1,087

Derivative Instruments and He54

Derivative Instruments and Hedging - Additional Information (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Dec. 31, 2015
Hedging Transactions And Derivative Financial Instruments [Line Items]
Period of cash flow hedges (in months)	12 months
Gain (loss) on ineffectiveness in earnings	$ 0	$ 0
Foreign Exchange Forward Contracts [Member] | Cash Flow Hedges [Member]
Hedging Transactions And Derivative Financial Instruments [Line Items]
Notional amount of outstanding contracts	21		$ 22.1
Fair value of outstanding contracts liability	$ 1		$ 1.1

Derivative Instruments and He55

Derivative Instruments and Hedging - Effect of Contracts Designated as Cash Flow Hedges on Consolidated Financial Statements (Details) - Foreign Exchange Forward Contracts [Member] - Cost of Revenues [Member] - Cash Flow Hedges [Member] - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Derivative Instruments, Gain (Loss) [Line Items]
Gain (Loss) Recognized in OCI (Effective Portion)	$ (1,135)	$ (386)	$ (952)	$ (731)
Gain (Loss) Reclassified from OCI into Income (Effective Portion)	$ (362)	$ (206)	$ (1,049)	$ (684)
Classification within the Condensed Consolidated Statement of Comprehensive Loss	Cost of revenues	Cost of revenues	Cost of revenues	Cost of revenues

Accumulated Other Comprehensi56

Accumulated Other Comprehensive (Loss) Income - Summary of Additional Information on Accumulated Other Comprehensive (Loss) Income (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Beginning balance, net of tax			$ 193,520
Total other comprehensive income (loss)	$ (1,280)	$ (154)	(219)	$ (930)
Ending balance, net of tax	197,760		197,760
Unrealized Gain (Loss) on Derivative Instruments [Member]
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Beginning balance, net of tax			(1,483)
Other comprehensive loss before reclassifications			(952)
Loss reclassified to earnings			1,049
Total other comprehensive income (loss)			97
Ending balance, net of tax	(1,386)		(1,386)
Other [Member]
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Beginning balance, net of tax			(2,548)
Other comprehensive loss before reclassifications			(316)
Loss reclassified to earnings			0
Total other comprehensive income (loss)			(316)
Ending balance, net of tax	(2,864)		(2,864)
Total [Member]
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Beginning balance, net of tax			(4,031)
Other comprehensive loss before reclassifications			(1,268)
Loss reclassified to earnings			1,049
Total other comprehensive income (loss)			(219)
Ending balance, net of tax	$ (4,250)		$ (4,250)

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - Fair Value Measurements, Recurring Basis [Member] - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Foreign Exchange Forward Contracts [Member]
Assets
Foreign exchange forward contracts	$ 47	$ 51
Liabilities
Foreign exchange forward contracts	1,058	1,192
Foreign Exchange Forward Contracts [Member] | Quoted Prices in Active Markets for Identical Assets (Level 1) [Member]
Assets
Foreign exchange forward contracts	0	0
Liabilities
Foreign exchange forward contracts	0	0
Foreign Exchange Forward Contracts [Member] | Significant Other Observable Inputs (Level 2) [Member]
Assets
Foreign exchange forward contracts	47	51
Liabilities
Foreign exchange forward contracts	1,058	1,192
Foreign Exchange Forward Contracts [Member] | Significant Unobservable Inputs (Level 3) [Member]
Assets
Foreign exchange forward contracts	0	0
Liabilities
Foreign exchange forward contracts	0	0
Money Market Funds [Member]
Assets
Money market funds	34,785	34,776
Money Market Funds [Member] | Quoted Prices in Active Markets for Identical Assets (Level 1) [Member]
Assets
Money market funds	34,785	34,776
Money Market Funds [Member] | Significant Other Observable Inputs (Level 2) [Member]
Assets
Money market funds	0	0
Money Market Funds [Member] | Significant Unobservable Inputs (Level 3) [Member]
Assets
Money market funds	$ 0	$ 0

Supplemental Cash Flow Inform58

Supplemental Cash Flow Information - Summary of Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015
Noncash Investing and Financing Activities:
Transfers from inventory to field equipment	$ 10,267	$ 8,772
Transfers from field equipment to deferred cost of revenues	7,136	6,268
Payment of corporate bonus in common stock	0	1,103
Market value of shares received in payment for exercise of stock options	1,470	745
Construction-in-process financed by construction liability	0	669
Property and equipment acquired under capital lease	$ 0	$ 354