NxStage Medical 10-Q 3 Nov 16 2016 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2016	Oct. 31, 2016
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2016
Document Fiscal Year Focus	2,016
Document Fiscal Period Focus	Q3
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		64,756,107

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Current assets:
Cash and cash equivalents	$ 60,817	$ 59,065
Accounts receivable, net	30,581	25,195
Inventory	46,877	38,391
Prepaid expenses and other current assets	5,875	6,254
Total current assets	144,150	128,905
Property and equipment, net	65,004	66,711
Field equipment, net	20,450	20,744
Deferred cost of revenues	33,972	33,068
Intangible assets, net	10,202	11,744
Goodwill	42,710	42,710
Other assets	2,623	2,992
Total assets	319,111	306,874
Current liabilities:
Accounts payable	14,755	10,767
Accrued expenses	29,335	27,266
Current portion of long-term debt	330	315
Other current liabilities	4,105	4,394
Total current liabilities	48,525	42,742
Deferred revenues	50,969	51,362
Long-term debt	1,445	1,664
Other long-term liabilities	16,829	17,367
Total liabilities	117,768	113,135
Commitments and contingencies
Noncontrolling interests subject to put provisions	116	219
Stockholders’ equity:
Undesignated preferred stock: par value $0.001, 5,000,000 shares authorized; no shares issued and outstanding as of September 30, 2016 and December 31, 2015	0	0
Common stock: par value $0.001, 100,000,000 shares authorized; 65,638,390 and 64,873,038 shares issued as of September 30, 2016 and December 31, 2015, respectively	65	64
Additional paid-in capital	626,040	612,487
Accumulated deficit	(406,004)	(402,830)
Accumulated other comprehensive loss	(4,328)	(4,031)
Treasury stock, at cost: 922,630 and 822,059 shares as of September 30, 2016 and December 31, 2015, respectively	(15,827)	(13,864)
Total NxStage Medical, Inc. stockholders' equity	199,946	191,826
Noncontrolling interests not subject to put provisions	1,281	1,694
Total stockholders' equity	201,227	193,520
Total liabilities and stockholders’ equity	$ 319,111	$ 306,874

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 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)	65,638,390	64,873,038
Treasury stock, shares (in shares)	922,630	822,059

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Loss - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Statement of Comprehensive Income [Abstract]
Revenues	$ 91,951	$ 86,521	$ 273,365	$ 246,319
Cost of revenues	52,770	51,803	159,244	150,611
Gross profit	39,181	34,718	114,121	95,708
Operating expenses:
Selling and marketing	16,024	14,445	47,394	43,511
Research and development	8,278	6,752	23,393	19,248
Distribution	7,063	6,514	21,131	19,140
General and administrative	7,792	8,642	24,334	26,139
Total operating expenses	39,157	36,353	116,252	108,038
Income (loss) from operations	24	(1,635)	(2,131)	(12,330)
Other expense:
Interest expense, net	(244)	(312)	(773)	(795)
Other (expense) income, net	(346)	235	(987)	536
Total other expense	(590)	(77)	(1,760)	(259)
Net loss before income taxes	(566)	(1,712)	(3,891)	(12,589)
Provision for income taxes	324	290	1,007	870
Net loss	(890)	(2,002)	(4,898)	(13,459)
Less: Net loss attributable to noncontrolling interests	(724)	(315)	(1,724)	(787)
Net loss attributable to stockholders of NxStage Medical, Inc.	$ (166)	$ (1,687)	$ (3,174)	$ (12,672)
Net loss per share, basic and diluted (in dollars per share)	$ 0	$ (0.03)	$ (0.05)	$ (0.20)
Weighted-average shares outstanding, basic and diluted (in shares)	64,638	63,528	64,414	63,215
Other comprehensive loss, net of tax	$ (78)	$ (829)	$ (297)	$ (1,759)
Total comprehensive loss	(968)	(2,831)	(5,195)	(15,218)
Less: Comprehensive loss attributable to noncontrolling interests	(724)	(315)	(1,724)	(787)
Total comprehensive loss attributable to stockholders of NxStage Medical, Inc.	$ (244)	$ (2,516)	$ (3,471)	$ (14,431)

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015
Cash flows from operating activities:
Net loss	$ (4,898)	$ (13,459)
Adjustments to reconcile net loss to net cash flow from operating activities:
Depreciation and amortization	23,974	23,240
Stock-based compensation	7,688	9,590
Other	(886)	748
Changes in operating assets and liabilities:
Accounts receivable	(5,501)	(6,560)
Inventory	(22,026)	(10,977)
Prepaid expenses and other assets	621	(85)
Accounts payable	3,930	(613)
Accrued expenses and other liabilities	3,015	(64)
Deferred revenues	(924)	(204)
Net cash provided by operating activities	4,993	1,616
Cash flows from investing activities:
Proceeds from sales of marketable securities	0	403
Cash paid for acquisitions, net of cash acquired	(513)	0
Purchases of property and equipment	(6,796)	(7,153)
Net cash used in investing activities	(7,309)	(6,750)
Cash flows from financing activities:
Issuance of shares under stock incentive plans, net of payroll taxes paid	3,677	3,643
Investment by noncontrolling interest holder	1,210	471
Proceeds from loans and lines of credit	0	1,275
Repayments on loans and lines of credit	(225)	(60)
Repayments on capital leases	(1,153)	(1,051)
Net cash provided by financing activities	3,509	4,278
Foreign exchange effect on cash and cash equivalents	559	(720)
Increase (decrease) in cash and cash equivalents	1,752	(1,576)
Cash and cash equivalents, beginning of period	59,065	52,884
Cash and cash equivalents, end of period	$ 60,817	$ 51,308

Nature of Operations, Basis of

Nature of Operations, Basis of Presentation and Principles of Consolidation	9 Months Ended
	Sep. 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 September 30, 2016 and December 31, 2015 and for the three and nine months ended September 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	9 Months Ended
	Sep. 30, 2016
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary 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 September 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 371 Usage (393 ) Balance at September 30, 2016 $ 367 Intangibles and Other Long-Lived Assets Intangible assets are carried at cost less accumulated amortization. For assets with determinable useful lives, amortization is recognized using the straight-line method over the estimated economic lives of the respective intangible assets, ranging from eight to fourteen years . Long-lived assets, including intangible assets, are tested for recoverability whenever events or circumstances indicate that their carrying value may not be recoverable. Recoverability of these assets is measured by a comparison of the carrying value of an asset or asset group to the future undiscounted cash flows over the asset’s remaining depreciable life. If an asset or asset group is considered impaired, the impairment recognized is the amount by which the carrying value of the long-lived asset(s) exceeds the fair value of the long-lived asset(s), which is determined using estimated discounted cash flows to be generated from such assets or other methods, if appropriate. During the three and nine months ended September 30, 2016 and 2015 , no significant impairment was recognized. Future events and circumstances may indicate that certain long-lived tangible assets in the Services segment, primarily leasehold improvements at our NxStage Kidney Care dialysis centers, may not be recoverable. As of September 30, 2016 , our estimate of future undiscounted cash flows indicated that such carrying amounts were expected to be recovered. However, it is reasonably possible that the estimate of undiscounted cash flows may change in the near term resulting in the need to recognize an impairment at the clinic level for at least some portion of those assets. Estimating future net cash flows requires significant estimates and judgment. Changes in market conditions, including delays in CMS certification, slower than expected patient growth or unfavorable payor mix would negatively impact our estimated future net cash flows in the near term, which could result in impairment charges. 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 2014-09: “Revenue from Contracts with Customers.” The standard provides that revenue should be recognized when an entity transfers promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. In addition, the standard requires disclosure of the nature, amount, timing and uncertainty of revenue and cash flow arising from contracts with customers. The FASB has issued several amendments and updates to the new revenue standard, including how an entity should identify performance obligations. As amended, the new guidance is effective for us beginning January 1, 2018, with early adoption permitted no earlier than the original effective date of the standard, which is the first quarter of fiscal 2017 for us. The new guidance allows for full retrospective adoption applied to all periods presented or a modified retrospective adoption with the cumulative effect of initially applying the new guidance recognized at the date of initial application. We are continuing to evaluate the future impact and method of adoption of ASU 2014-09 and related amendments for our consolidated financial statements and related disclosures. We intend to adopt ASU 2014-09 and related amendments effective January 1, 2018. 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 intend to adopt this standard as of January 1, 2019. 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 intend to adopt this standard as of January 1, 2017. 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	9 Months Ended
	Sep. 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): September 30, December 31, Purchased components $ 16,595 $ 15,294 Work in process 12,209 10,080 Finished goods 18,073 13,017 Total $ 46,877 $ 38,391

Property and Equipment and Fiel

Property and Equipment and Field Equipment	9 Months Ended
	Sep. 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 $45.5 million and $36.9 million at September 30, 2016 and December 31, 2015 , respectively. Accumulated depreciation on field equipment was $47.2 million and $44.1 million at September 30, 2016 and December 31, 2015 , respectively.

Intangible Assets

Intangible Assets	9 Months Ended
	Sep. 30, 2016
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets Accumulated amortization of intangible assets was $24.4 million and $22.9 million at September 30, 2016 and December 31, 2015 , respectively.

Net Loss per Share

Net Loss per Share	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2016 2015 2016 2015 Options to purchase common stock 1,096 631 682 756 Unvested restricted stock units 382 411 359 350 Total 1,478 1,042 1,041 1,106

Accrued Expenses, Other Current

Accrued Expenses, Other Current Liabilities and Other Long-Term Liabilities	9 Months Ended
	Sep. 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): September 30, December 31, Payroll, compensation and related benefits $ 14,186 $ 14,061 Distribution expenses 4,107 3,465 General and administrative expenses 2,448 2,309 Other manufacturing costs 2,307 2,097 Other 6,287 5,334 Total $ 29,335 $ 27,266 The components of other current liabilities are as follows (in thousands): September 30, December 31, Capital lease obligations $ 2,041 $ 2,184 Deferred revenue, current portion 1,273 1,363 Other 791 847 Total $ 4,105 $ 4,394 The components of other long-term liabilities are as follows (in thousands): September 30, December 31, Capital lease obligations $ 10,862 $ 10,815 Lease incentive obligations 3,247 3,743 Benefit plan obligations 1,804 1,681 Other 916 1,128 Total $ 16,829 $ 17,367

Segment Disclosures

Segment Disclosures	9 Months Ended
	Sep. 30, 2016
Segment Reporting [Abstract]
Segment Disclosures	Segment Disclosures We have three reportable business segments: System One, In-Center, and Services, as well as 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 September 30, 2016 Revenues from external customers $ 70,011 $ 14,493 $ 3,601 $ 3,846 $ — $ 91,951 Intersegment revenues 1,930 — — — (1,930 ) — Revenues 71,941 14,493 3,601 3,846 (1,930 ) 91,951 Segment profit (loss) 19,828 2,463 (15,676 ) (6,384 ) (207 ) 24 Depreciation and amortization 5,578 500 1,134 1,113 — 8,325 Three Months Ended September 30, 2015 Revenues from external customers $ 61,910 $ 19,440 $ 3,418 $ 1,753 $ — $ 86,521 Intersegment revenues 910 — — — (910 ) — Revenues 62,820 19,440 $ 3,418 1,753 (910 ) 86,521 Segment profit (loss) 16,036 3,762 (15,567 ) (5,866 ) — (1,635 ) Depreciation and amortization 5,129 551 1,222 865 — 7,767 Nine Months Ended September 30, 2016 Revenues from external customers $ 205,538 $ 47,990 $ 9,190 $ 10,647 $ — $ 273,365 Intersegment revenues 5,553 — — — (5,553 ) — Revenues 211,091 47,990 9,190 10,647 (5,553 ) 273,365 Segment profit (loss) 55,997 8,155 (46,332 ) (19,354 ) (597 ) (2,131 ) Depreciation and amortization 16,033 1,489 3,361 3,091 — 23,974 Nine Months Ended September 30, 2015 Revenues from external customers $ 179,760 $ 55,870 $ 7,122 $ 3,567 $ — $ 246,319 Intersegment revenues 2,060 — — — (2,060 ) — Revenues 181,820 55,870 $ 7,122 3,567 (2,060 ) 246,319 Segment profit (loss) 42,528 9,094 (46,233 ) (17,719 ) — (12,330 ) Depreciation and amortization 15,627 1,571 3,641 2,401 — 23,240 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 September 30, Nine Months Ended September 30, 2016 2015 2016 2015 DaVita 21 % 20 % 20 % 20 % Fresenius 18 % 16 % 18 % 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	9 Months Ended
	Sep. 30, 2016
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Significant commitments and contingencies at September 30, 2016 are consistent with those discussed in Note 10 to the consolidated financial statements in our 2015 Annual Report.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2016
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The provision for income taxes of $0.3 million during both the three months ended September 30, 2016 and 2015 , and $1.0 million and $0.9 million during the nine months ended September 30, 2016 and 2015 , respectively, relates to the profitable operations of certain foreign subsidiaries. As of September 30, 2016 , we had a liability for unrecognized tax benefits included in the balance sheet of approximately $0.5 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 nine months ended September 30, 2016 .

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2016 2015 2016 2015 Cost of revenues $ 314 $ 227 $ 1,056 $ 734 Selling and marketing 781 1,127 2,562 3,657 Research and development 344 427 1,148 1,355 General and administrative 855 1,219 2,922 3,844 Total $ 2,294 $ 3,000 $ 7,688 $ 9,590 Stock Options and Restricted Stock Units The Company granted options to purchase 20,351 shares of common stock during the three months ended September 30, 2016 and options to purchase 1,334,351 and 1,061,554 shares of common stock during the nine months ended September 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 nine months ended September 30, 2016 and 2015 was $5.89 and $6.13 per option, respectively. The Company awarded 23,380 and 34,660 restricted stock units during the three months ended September 30, 2016 and 2015 , respectively, and 219,846 and 173,841 restricted stock units during the nine months ended September 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 nine months ended September 30, 2016 and 2015 was $17.34 and $16.59 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	9 Months Ended
	Sep. 30, 2016
Equity [Abstract]
Stockholders' Equity	Stockholders' Equity We received 100,571 and 43,506 shares of common stock that were surrendered in payment for the exercise of stock options during the nine months ended September 30, 2016 and 2015 , respectively.

Noncontrolling Interest

Noncontrolling Interest	9 Months Ended
	Sep. 30, 2016
Noncontrolling Interest [Abstract]
Noncontrolling Interest	Noncontrolling Interest As of September 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 September 30, 2016 and December 31, 2015 , total assets of our VIEs were $12.5 million and $11.0 million , and total liabilities and noncontrolling interests of our VIEs were $10.9 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. At September 30, 2016 the Company's noncontrolling interests subject to put provisions were $0.1 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 nine months ended September 30, 2016 and 2015 (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2016 2015 2016 2015 Balance at beginning of period $ 1,722 $ 1,087 $ 1,694 $ 1,088 Capital contributions by noncontrolling interest 231 — 531 263 Sales of noncontrolling interests — — 679 208 Net loss attributable to noncontrolling interest in consolidated subsidiary (672 ) (315 ) (1,623 ) (787 ) Balance at end of period $ 1,281 $ 772 $ 1,281 $ 772

Derivative Instruments and Hedg

Derivative Instruments and Hedging	9 Months Ended
	Sep. 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 September 30, 2016 and December 31, 2015 , the notional amount of our outstanding contracts that are designated as cash flow hedges was $23.0 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 September 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 nine months ended September 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 September 30, 2016 Foreign exchange forward contracts $ (386 ) $ (381 ) Cost of revenues Nine Months Ended September 30, 2016 Foreign exchange forward contracts $ (1,338 ) $ (1,430 ) Cost of revenues Three Months Ended September 30, 2015 Foreign exchange forward contracts $ (1,093 ) $ (547 ) Cost of revenues Nine Months Ended September 30, 2015 Foreign exchange forward contracts $ (1,824 ) $ (1,231 ) Cost of revenues

Accumulated Other Comprehensive

Accumulated Other Comprehensive (Loss) Income	9 Months Ended
	Sep. 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 (1,338 ) (389 ) (1,727 ) Loss reclassified to earnings (1) 1,430 — 1,430 Total other comprehensive income (loss) 92 (389 ) (297 ) Balance, net of tax, as of September 30, 2016 $ (1,391 ) $ (2,937 ) $ (4,328 ) (1) Reclassifications of gains (losses) on derivative instruments are included in cost of revenues on the condensed 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	9 Months Ended
	Sep. 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 nine months ended September 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): September 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) $ 34,793 $ — $ — $ 34,793 Foreign exchange forward contracts (2) — 59 — 59 Liabilities Foreign exchange forward contracts (2) $ — $ 1,024 $ — $ 1,024 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 September 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 condensed 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	9 Months Ended
	Sep. 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): Nine Months Ended September 30, 2016 2015 Noncash Investing and Financing Activities: Transfers from inventory to field equipment $ 14,629 $ 11,776 Transfers from field equipment to deferred cost of revenues 10,396 9,251 Payment of corporate bonus in common stock — 1,103 Market value of shares received in payment for exercise of stock options 1,963 745 Construction-in-process financed by construction liability 187 1,332 Property and equipment acquired under capital lease 127 354

Summary of Significant Accoun23

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2016
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying condensed consolidated financial statements as of September 30, 2016 and December 31, 2015 and for the three and nine months ended September 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.
Intangibles and Other Long-Lived Assets	Intangibles and Other Long-Lived Assets Intangible assets are carried at cost less accumulated amortization. For assets with determinable useful lives, amortization is recognized using the straight-line method over the estimated economic lives of the respective intangible assets, ranging from eight to fourteen years . Long-lived assets, including intangible assets, are tested for recoverability whenever events or circumstances indicate that their carrying value may not be recoverable. Recoverability of these assets is measured by a comparison of the carrying value of an asset or asset group to the future undiscounted cash flows over the asset’s remaining depreciable life. If an asset or asset group is considered impaired, the impairment recognized is the amount by which the carrying value of the long-lived asset(s) exceeds the fair value of the long-lived asset(s), which is determined using estimated discounted cash flows to be generated from such assets or other methods, if appropriate. During the three and nine months ended September 30, 2016 and 2015 , no significant impairment was recognized. Future events and circumstances may indicate that certain long-lived tangible assets in the Services segment, primarily leasehold improvements at our NxStage Kidney Care dialysis centers, may not be recoverable. As of September 30, 2016 , our estimate of future undiscounted cash flows indicated that such carrying amounts were expected to be recovered. However, it is reasonably possible that the estimate of undiscounted cash flows may change in the near term resulting in the need to recognize an impairment at the clinic level for at least some portion of those assets. Estimating future net cash flows requires significant estimates and judgment. Changes in market conditions, including delays in CMS certification, slower than expected patient growth or unfavorable payor mix would negatively impact our estimated future net cash flows in the near term, which could result in impairment charges.
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 2014-09: “Revenue from Contracts with Customers.” The standard provides that revenue should be recognized when an entity transfers promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. In addition, the standard requires disclosure of the nature, amount, timing and uncertainty of revenue and cash flow arising from contracts with customers. The FASB has issued several amendments and updates to the new revenue standard, including how an entity should identify performance obligations. As amended, the new guidance is effective for us beginning January 1, 2018, with early adoption permitted no earlier than the original effective date of the standard, which is the first quarter of fiscal 2017 for us. The new guidance allows for full retrospective adoption applied to all periods presented or a modified retrospective adoption with the cumulative effect of initially applying the new guidance recognized at the date of initial application. We are continuing to evaluate the future impact and method of adoption of ASU 2014-09 and related amendments for our consolidated financial statements and related disclosures. We intend to adopt ASU 2014-09 and related amendments effective January 1, 2018. 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 intend to adopt this standard as of January 1, 2019. 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 intend to adopt this standard as of January 1, 2017. We are currently evaluating the method of adoption and the potential impact this standard will have on our financial statements and related disclosure.
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.
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.

Summary of Significant Accoun24

Summary of Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 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 371 Usage (393 ) Balance at September 30, 2016 $ 367

Inventory (Tables)

Inventory (Tables)	9 Months Ended
	Sep. 30, 2016
Inventory Disclosure [Abstract]
Components of Inventory	The components of inventory are as follows (in thousands): September 30, December 31, Purchased components $ 16,595 $ 15,294 Work in process 12,209 10,080 Finished goods 18,073 13,017 Total $ 46,877 $ 38,391

Net Loss per Share (Tables)

Net Loss per Share (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2016 2015 2016 2015 Options to purchase common stock 1,096 631 682 756 Unvested restricted stock units 382 411 359 350 Total 1,478 1,042 1,041 1,106

Accrued Expenses, Other Curre27

Accrued Expenses, Other Current Liabilities and Other Long-Term Liabilities (Tables)	9 Months Ended
	Sep. 30, 2016
Payables and Accruals [Abstract]
Components of Accrued Expenses	The components of accrued expenses are as follows (in thousands): September 30, December 31, Payroll, compensation and related benefits $ 14,186 $ 14,061 Distribution expenses 4,107 3,465 General and administrative expenses 2,448 2,309 Other manufacturing costs 2,307 2,097 Other 6,287 5,334 Total $ 29,335 $ 27,266
Components of Other Current liabilities	The components of other current liabilities are as follows (in thousands): September 30, December 31, Capital lease obligations $ 2,041 $ 2,184 Deferred revenue, current portion 1,273 1,363 Other 791 847 Total $ 4,105 $ 4,394
Components of Other Long-term Liabilities	The components of other long-term liabilities are as follows (in thousands): September 30, December 31, Capital lease obligations $ 10,862 $ 10,815 Lease incentive obligations 3,247 3,743 Benefit plan obligations 1,804 1,681 Other 916 1,128 Total $ 16,829 $ 17,367

Segment Disclosures (Tables)

Segment Disclosures (Tables)	9 Months Ended
	Sep. 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 September 30, 2016 Revenues from external customers $ 70,011 $ 14,493 $ 3,601 $ 3,846 $ — $ 91,951 Intersegment revenues 1,930 — — — (1,930 ) — Revenues 71,941 14,493 3,601 3,846 (1,930 ) 91,951 Segment profit (loss) 19,828 2,463 (15,676 ) (6,384 ) (207 ) 24 Depreciation and amortization 5,578 500 1,134 1,113 — 8,325 Three Months Ended September 30, 2015 Revenues from external customers $ 61,910 $ 19,440 $ 3,418 $ 1,753 $ — $ 86,521 Intersegment revenues 910 — — — (910 ) — Revenues 62,820 19,440 $ 3,418 1,753 (910 ) 86,521 Segment profit (loss) 16,036 3,762 (15,567 ) (5,866 ) — (1,635 ) Depreciation and amortization 5,129 551 1,222 865 — 7,767 Nine Months Ended September 30, 2016 Revenues from external customers $ 205,538 $ 47,990 $ 9,190 $ 10,647 $ — $ 273,365 Intersegment revenues 5,553 — — — (5,553 ) — Revenues 211,091 47,990 9,190 10,647 (5,553 ) 273,365 Segment profit (loss) 55,997 8,155 (46,332 ) (19,354 ) (597 ) (2,131 ) Depreciation and amortization 16,033 1,489 3,361 3,091 — 23,974 Nine Months Ended September 30, 2015 Revenues from external customers $ 179,760 $ 55,870 $ 7,122 $ 3,567 $ — $ 246,319 Intersegment revenues 2,060 — — — (2,060 ) — Revenues 181,820 55,870 $ 7,122 3,567 (2,060 ) 246,319 Segment profit (loss) 42,528 9,094 (46,233 ) (17,719 ) — (12,330 ) Depreciation and amortization 15,627 1,571 3,641 2,401 — 23,240
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 September 30, Nine Months Ended September 30, 2016 2015 2016 2015 DaVita 21 % 20 % 20 % 20 % Fresenius 18 % 16 % 18 % 17 %

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2016 2015 2016 2015 Cost of revenues $ 314 $ 227 $ 1,056 $ 734 Selling and marketing 781 1,127 2,562 3,657 Research and development 344 427 1,148 1,355 General and administrative 855 1,219 2,922 3,844 Total $ 2,294 $ 3,000 $ 7,688 $ 9,590

Noncontrolling Interest (Tables

Noncontrolling Interest (Tables)	9 Months Ended
	Sep. 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 nine months ended September 30, 2016 and 2015 (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2016 2015 2016 2015 Balance at beginning of period $ 1,722 $ 1,087 $ 1,694 $ 1,088 Capital contributions by noncontrolling interest 231 — 531 263 Sales of noncontrolling interests — — 679 208 Net loss attributable to noncontrolling interest in consolidated subsidiary (672 ) (315 ) (1,623 ) (787 ) Balance at end of period $ 1,281 $ 772 $ 1,281 $ 772

Derivative Instruments and He31

Derivative Instruments and Hedging (Tables)	9 Months Ended
	Sep. 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 September 30, 2016 Foreign exchange forward contracts $ (386 ) $ (381 ) Cost of revenues Nine Months Ended September 30, 2016 Foreign exchange forward contracts $ (1,338 ) $ (1,430 ) Cost of revenues Three Months Ended September 30, 2015 Foreign exchange forward contracts $ (1,093 ) $ (547 ) Cost of revenues Nine Months Ended September 30, 2015 Foreign exchange forward contracts $ (1,824 ) $ (1,231 ) Cost of revenues

Accumulated Other Comprehensi32

Accumulated Other Comprehensive (Loss) Income (Tables)	9 Months Ended
	Sep. 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 (1,338 ) (389 ) (1,727 ) Loss reclassified to earnings (1) 1,430 — 1,430 Total other comprehensive income (loss) 92 (389 ) (297 ) Balance, net of tax, as of September 30, 2016 $ (1,391 ) $ (2,937 ) $ (4,328 ) (1) Reclassifications of gains (losses) on derivative instruments are included in cost of revenues on the condensed 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)	9 Months Ended
	Sep. 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): September 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) $ 34,793 $ — $ — $ 34,793 Foreign exchange forward contracts (2) — 59 — 59 Liabilities Foreign exchange forward contracts (2) $ — $ 1,024 $ — $ 1,024 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)	9 Months Ended
	Sep. 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): Nine Months Ended September 30, 2016 2015 Noncash Investing and Financing Activities: Transfers from inventory to field equipment $ 14,629 $ 11,776 Transfers from field equipment to deferred cost of revenues 10,396 9,251 Payment of corporate bonus in common stock — 1,103 Market value of shares received in payment for exercise of stock options 1,963 745 Construction-in-process financed by construction liability 187 1,332 Property and equipment acquired under capital lease 127 354

Nature of Operations, Basis o35

Nature of Operations, Basis of Presentation and Principles of Consolidation (Details)	Sep. 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) $ in Millions	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2016USD ($)	Sep. 30, 2015USD ($)	Sep. 30, 2016USD ($)customer	Sep. 30, 2015USD ($)	Dec. 31, 2015customer
Accounting Policies [Line Items]
Asset impairment recognized | $	$ 0	$ 0	$ 0	$ 0
Minimum
Accounting Policies [Line Items]
Useful life of intangible assets			8 years
Maximum
Accounting Policies [Line Items]
Useful life of intangible assets			14 years
Customer Concentration Risk | Accounts Receivable
Accounting Policies [Line Items]
Number of significant customers | customer			0		1
Customer Concentration Risk | Accounts Receivable | Customer One
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	9 Months Ended
	Sep. 30, 2016USD ($)
Movement in Standard and Extended Product Warranty Accrual, Increase (Decrease) [Roll Forward]
Balance at beginning of period	$ 389
Provision	371
Usage	(393)
Balance at end of period	$ 367

Inventory - Components of Inven

Inventory - Components of Inventory (Details) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Inventory Disclosure [Abstract]
Purchased components	$ 16,595	$ 15,294
Work in process	12,209	10,080
Finished goods	18,073	13,017
Total	$ 46,877	$ 38,391

Property and Equipment and Fi39

Property and Equipment and Field Equipment - Additional Information (Details) - USD ($) $ in Millions	Sep. 30, 2016	Dec. 31, 2015
Property And Equipment Excluding Field Equipment
Property, Plant and Equipment [Line Items]
Accumulated depreciation	$ 45.5	$ 36.9
Field Equipment
Property, Plant and Equipment [Line Items]
Accumulated depreciation	$ 47.2	$ 44.1

Intangible Assets - Additional

Intangible Assets - Additional Information (Details) - USD ($) $ in Millions	Sep. 30, 2016	Dec. 31, 2015
Goodwill and Intangible Assets Disclosure [Abstract]
Accumulated amortization of intangible assets	$ 24.4	$ 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		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 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)	1,478	1,042	1,041	1,106
Options to purchase common stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common stock equivalents excluded from computation of earnings per share (in shares)	1,096	631	682	756
Unvested restricted stock units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common stock equivalents excluded from computation of earnings per share (in shares)	382	411	359	350

Accrued Expenses, Other Curre42

Accrued Expenses, Other Current Liabilities and Other Long-Term Liabilities - Components of Accrued Expenses (Details) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Payables and Accruals [Abstract]
Payroll, compensation and related benefits	$ 14,186	$ 14,061
Distribution expenses	4,107	3,465
General and administrative expenses	2,448	2,309
Other manufacturing costs	2,307	2,097
Other	6,287	5,334
Total	$ 29,335	$ 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	Sep. 30, 2016	Dec. 31, 2015
Payables and Accruals [Abstract]
Capital lease obligations	$ 2,041	$ 2,184
Deferred revenue, current portion	1,273	1,363
Other	791	847
Total	$ 4,105	$ 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	Sep. 30, 2016	Dec. 31, 2015
Payables and Accruals [Abstract]
Capital lease obligations	$ 10,862	$ 10,815
Lease incentive obligations	3,247	3,743
Benefit plan obligations	1,804	1,681
Other	916	1,128
Total	$ 16,829	$ 17,367

Segment Disclosures - Additiona

Segment Disclosures - Additional Information (Details)	9 Months Ended
	Sep. 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		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Segment Reporting Information [Line Items]
Revenues	$ 91,951	$ 86,521	$ 273,365	$ 246,319
Segment profit (loss)	24	(1,635)	(2,131)	(12,330)
Depreciation and amortization	8,325	7,767	23,974	23,240
System One
Segment Reporting Information [Line Items]
Revenues	71,941	62,820	211,091	181,820
Segment profit (loss)	19,828	16,036	55,997	42,528
Depreciation and amortization	5,578	5,129	16,033	15,627
In-Center
Segment Reporting Information [Line Items]
Revenues	14,493	19,440	47,990	55,870
Segment profit (loss)	2,463	3,762	8,155	9,094
Depreciation and amortization	500	551	1,489	1,571
Services
Segment Reporting Information [Line Items]
Revenues	3,846	1,753	10,647	3,567
Segment profit (loss)	(6,384)	(5,866)	(19,354)	(17,719)
Depreciation and amortization	1,113	865	3,091	2,401
Operating Segments | System One
Segment Reporting Information [Line Items]
Revenues	70,011	61,910	205,538	179,760
Operating Segments | In-Center
Segment Reporting Information [Line Items]
Revenues	14,493	19,440	47,990	55,870
Operating Segments | Services
Segment Reporting Information [Line Items]
Revenues	3,846	1,753	10,647	3,567
Other
Segment Reporting Information [Line Items]
Revenues	3,601	3,418	9,190	7,122
Segment profit (loss)	(15,676)	(15,567)	(46,332)	(46,233)
Depreciation and amortization	1,134	1,222	3,361	3,641
Intersegment Elimination
Segment Reporting Information [Line Items]
Revenues	(1,930)	(910)	(5,553)	(2,060)
Segment profit (loss)	(207)		(597)
Intersegment Elimination | System One
Segment Reporting Information [Line Items]
Revenues	$ 1,930	$ 910	$ 5,553	$ 2,060

Segment Disclosures - Summary47

Segment Disclosures - Summary of Customers Who Individually Make Up Greater than 10% of Total Revenues (Details) - Sales Revenue, Net - Customer Concentration Risk	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
DaVita
Revenue, Major Customer [Line Items]
Percentage of revenues	21.00%	20.00%	20.00%	20.00%
Fresenius
Revenue, Major Customer [Line Items]
Percentage of revenues	18.00%	16.00%	18.00%	17.00%

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Income Tax Disclosure [Abstract]
Foreign tax expense	$ 0.3	$ 0.3	$ 1	$ 0.9
Liability for unrecognized tax benefits	$ 0.5		0.5
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		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation expense	$ 2,294	$ 3,000	$ 7,688	$ 9,590
Cost of revenues
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation expense	314	227	1,056	734
Selling and marketing
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation expense	781	1,127	2,562	3,657
Research and development
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation expense	344	427	1,148	1,355
General and administrative
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation expense	$ 855	$ 1,219	$ 2,922	$ 3,844

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Details) - $ / shares	1 Months Ended	3 Months Ended		9 Months Ended
	Mar. 31, 2016	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Options to purchase common stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, grants in period (in shares)		20,351		1,334,351	1,061,554
Weighted-average fair value of options granted (in dollars per share)				$ 5.89	$ 6.13
Options to purchase common stock | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period				1 year
Options to purchase common stock | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period				4 years
Unvested restricted stock units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, grants in period (in shares)		23,380	34,660	219,846	173,841
Weighted-average fair value of restricted stock granted (in dollars per share)				$ 17.34	$ 16.59
Unvested restricted stock units | Performance Based Plans
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				3 years
Unvested restricted stock units | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period				3 years
Unvested restricted stock units | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period				4 years

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Details) - shares	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015
Equity [Abstract]
Shares delivered or surrendered in payment for the exercise of stock options (in shares)	100,571	43,506

Noncontrolling Interest - Addit

Noncontrolling Interest - Additional Information (Details) $ in Thousands	Sep. 30, 2016USD ($)entity	Dec. 31, 2015USD ($)
Noncontrolling Interest [Abstract]
Number of VIEs | entity	7
Total assets of variable interest entities	$ 12,500	$ 11,000
Total liabilities and noncontrolling interest of variable interest entities	10,900	10,200
Noncontrolling interests subject to put provisions	$ 116	$ 219

Noncontrolling Interest - Sched

Noncontrolling Interest - Schedule of Changes in Noncontrolling Interest (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest [Abstract]
Balance at beginning of period	$ 1,722	$ 1,087	$ 1,694	$ 1,088
Capital contributions by noncontrolling interest	231	0	531	263
Sales of noncontrolling interests	0	0	679	208
Net loss attributable to noncontrolling interest in consolidated subsidiary	(672)	(315)	(1,623)	(787)
Balance at end of period	$ 1,281	$ 772	$ 1,281	$ 772

Derivative Instruments and He54

Derivative Instruments and Hedging - Additional Information (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Dec. 31, 2015
Hedging Transactions And Derivative Financial Instruments [Line Items]
Period of cash flow hedges	12 months
Gain (loss) on ineffectiveness in earnings	$ 0	$ 0
Foreign exchange forward contracts | Cash Flow Hedges
Hedging Transactions And Derivative Financial Instruments [Line Items]
Notional amount of outstanding contracts	23		$ 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 - Cost of revenues - Cash Flow Hedges - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Derivative Instruments, Gain (Loss) [Line Items]
Gain (Loss) Recognized in OCI (Effective Portion)	$ (386)	$ (1,093)	$ (1,338)	$ (1,824)
Gain (Loss) Reclassified from OCI into Income (Effective Portion)	$ (381)	$ (547)	$ (1,430)	$ (1,231)
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		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Beginning balance, net of tax			$ 193,520
Total other comprehensive income (loss)	$ (78)	$ (829)	(297)	$ (1,759)
Ending balance, net of tax	201,227		201,227
Unrealized gain (loss) on derivative instruments
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Beginning balance, net of tax			(1,483)
Other comprehensive loss before reclassifications			(1,338)
Loss reclassified to earnings			1,430
Total other comprehensive income (loss)			92
Ending balance, net of tax	(1,391)		(1,391)
Other
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Beginning balance, net of tax			(2,548)
Other comprehensive loss before reclassifications			(389)
Loss reclassified to earnings			0
Total other comprehensive income (loss)			(389)
Ending balance, net of tax	(2,937)		(2,937)
Total
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Beginning balance, net of tax			(4,031)
Other comprehensive loss before reclassifications			(1,727)
Loss reclassified to earnings			1,430
Total other comprehensive income (loss)			(297)
Ending balance, net of tax	$ (4,328)		$ (4,328)

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 - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Foreign exchange forward contracts
Assets
Foreign exchange forward contracts	$ 59	$ 51
Liabilities
Foreign exchange forward contracts	1,024	1,192
Foreign exchange forward contracts | Quoted Prices in Active Markets for Identical Assets (Level 1)
Assets
Foreign exchange forward contracts	0	0
Liabilities
Foreign exchange forward contracts	0	0
Foreign exchange forward contracts | Significant Other Observable Inputs (Level 2)
Assets
Foreign exchange forward contracts	59	51
Liabilities
Foreign exchange forward contracts	1,024	1,192
Foreign exchange forward contracts | Significant Unobservable Inputs (Level 3)
Assets
Foreign exchange forward contracts	0	0
Liabilities
Foreign exchange forward contracts	0	0
Money market funds
Assets
Money market funds	34,793	34,776
Money market funds | Quoted Prices in Active Markets for Identical Assets (Level 1)
Assets
Money market funds	34,793	34,776
Money market funds | Significant Other Observable Inputs (Level 2)
Assets
Money market funds	0	0
Money market funds | Significant Unobservable Inputs (Level 3)
Assets
Money market funds	$ 0	$ 0

Supplemental Cash Flow Inform58

Supplemental Cash Flow Information - Summary of Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015
Noncash Investing and Financing Activities:
Transfers from inventory to field equipment	$ 14,629	$ 11,776
Transfers from field equipment to deferred cost of revenues	10,396	9,251
Payment of corporate bonus in common stock	0	1,103
Market value of shares received in payment for exercise of stock options	1,963	745
Construction-in-process financed by construction liability	187	1,332
Property and equipment acquired under capital lease	$ 127	$ 354