InfuSystem (INFU) 10-Q5 May 142014 Q1 Quarterly reportFinancial data

Company Profile

Document_and_Entity_Informatio

Document and Entity Information	3 Months Ended
Document and Entity Information	Mar. 31, 2014	Apr. 28, 2014
Document And Entity Information [Abstract]	'	'
Document Type	'10-Q	'
Amendment Flag	'false	'
Document Period End Date	31-Mar-14	'
Document Fiscal Year Focus	'2014	'
Document Fiscal Period Focus	'Q1	'
Trading Symbol	'INFU	'
Entity Registrant Name	'InfuSystem Holdings, Inc	'
Entity Central Index Key	'0001337013	'
Current Fiscal Year End Date	'--12-31	'
Entity Filer Category	'Smaller Reporting Company	'
Entity Common Stock, Shares Outstanding	'	22,375,438

Condensed_Consolidated_Balance

Condensed Consolidated Balance Sheets (USD $)	Mar. 31, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Mar. 31, 2014	Dec. 31, 2013
Current Assets:	'	'
Cash and cash equivalents	$496	$1,138
Accounts receivable, less allowance for doubtful accounts of $5,875 and $4,774 at March 31, 2014 and December 31, 2013, respectively	12,099	10,697
Inventory	1,398	1,234
Other current assets	714	518
Deferred income taxes	2,296	2,296
Total Current Assets	17,003	15,883
Medical equipment held for sale or rental	2,955	3,664
Medical equipment in rental service, net of accumulated depreciation	15,405	14,438
Property & equipment, net of accumulated depreciation	915	872
Deferred debt issuance costs, net	1,661	1,817
Intangible assets, net	24,075	24,182
Deferred income taxes	15,998	16,300
Other assets	238	217
Total Assets	78,250	77,373
Current Liabilities:	'	'
Accounts payable	5,153	4,736
Current portion of long-term debt	5,305	5,118
Other current liabilities	2,479	3,187
Total Current Liabilities	12,937	13,041
Long-term debt, net of current portion	21,864	21,609
Total Liabilities	34,801	34,650
Stockholders' Equity:	'	'
Preferred stock, $.0001 par value: authorized 1,000,000 shares; none issued	'	'
Common stock, $.0001 par value: authorized 200,000,000 shares; issued and outstanding 22,195,958 and 21,998,268, respectively, as of March 31, 2014 and 22,158,041 and 21,960,351, respectively, as of December 31, 2013	2	2
Additional paid-in capital	89,925	89,783
Retained deficit	-46,478	-47,062
Total Stockholders' Equity	43,449	42,723
Total Liabilities and Stockholders' Equity	$78,250	$77,373

Condensed_Consolidated_Balance1

Condensed Consolidated Balance Sheets (Parenthetical) (USD $)	Mar. 31, 2014	Dec. 31, 2013
In Thousands, except Share data, unless otherwise specified	Mar. 31, 2014	Dec. 31, 2013
Statement Of Financial Position [Abstract]	'	'
Accounts receivable, allowance for doubtful accounts	$5,875	$4,774
Preferred stock, par value	$0.00	$0.00
Preferred stock, shares authorized	1,000,000	1,000,000
Preferred stock, shares issued	'	'
Common stock, par value	$0.00	$0.00
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	22,195,958	22,158,041
Common stock, shares outstanding	21,998,268	21,960,351

Condensed_Consolidated_Stateme

Condensed Consolidated Statements of Operations and Statements of Comprehensive Income (USD $)	3 Months Ended
In Thousands, except Share data, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013
Net revenues:	'	'
Rentals	$14,850	$13,445
Product Sales	2,392	1,256
Net revenues	17,242	14,701
Cost of revenues:	'	'
Cost of revenues - Product, service and supply costs	2,890	2,579
Cost of revenues - Pump depreciation and disposals	2,276	1,699
Gross profit	12,076	10,423
Selling, general and administrative expenses:	'	'
Provision for doubtful accounts	2,107	1,660
Amortization of intangibles	629	672
Selling and marketing	2,655	2,408
General and administrative	4,909	5,031
Total sales, general and administrative	10,300	9,771
Operating income	1,776	652
Other income (expense):	'	'
Interest expense	-827	-874
Other (expense)/income	-17	312
Total other expense	-844	-562
Income before income taxes	932	90
Income tax expense	-349	-39
Net income	583	51
Net income per share:	'	'
Basic	$0.03	$0
Diluted	$0.03	$0
Weighted average shares outstanding:	'	'
Basic	21,972,739	21,802,515
Diluted	22,456,143	22,238,160
Comprehensive Income	'	'
Net income	583	51
Comprehensive income	$583	$51

Condensed_Consolidated_Stateme1

Condensed Consolidated Statements of Cash Flows (USD $)	3 Months Ended
In Thousands, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013
Statement Of Cash Flows [Abstract]	'	'
NET CASH (USED IN) PROVIDED BY OPERATING ACTIVITIES	($636)	$1,632
INVESTING ACTIVITIES	'	'
Purchase of medical equipment and property	-1,127	-1,777
Proceeds from sale of medical equipment and property	1,252	1,093
NET CASH PROVIDED BY (USED IN) INVESTING ACTIVITIES	125	-684
FINANCING ACTIVITIES	'	'
Principal payments on term loans and capital lease obligations	-14,394	-2,802
Cash proceeds from bank loans and revolving credit facility	14,263	'
NET CASH USED IN FINANCING ACTIVITIES	-131	-2,802
Net change in cash and cash equivalents	-642	-1,854
Cash and cash equivalents, beginning of period	1,138	2,326
Cash and cash equivalents, end of period	$496	$472

Basis_of_Presentation_Nature_o

Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2014
Accounting Policies [Abstract]	'
Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies	'
	1	Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies
	InfuSystem Holdings, Inc. (the “Company”) is a leading provider of infusion pumps and related services. The Company services hospitals, oncology practices and other alternate site healthcare providers. Headquartered in Madison Heights, Michigan, the Company delivers local, field-based customer support, and also operates pump repair Centers of Excellence in Michigan, Kansas, California, Texas, and Ontario, Canada.
	The accompanying consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) for interim financial information. Accordingly they do not include all of the information and notes required by U.S. Generally Accepted Accounting Principles (“GAAP”) for complete financial statements. The accompanying consolidated financial statements include all adjustments, composed of normal recurring adjustments, considered necessary by management to fairly state our results of operations, financial position and cash flows. The operating results for the interim periods are not necessarily indicative of results that may be expected for any other interim period or for the full year. These consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2013 (“2013 Form 10-K”) as filed with the SEC.
	The consolidated financial statements are prepared in conformity with U.S. GAAP, which requires the use of estimates, judgments and assumptions that affect the amounts of assets and liabilities at the reporting date and the amounts of revenue and expenses in the periods presented. We believe that the accounting estimates employed are appropriate and the resulting balances are reasonable; however, due to the inherent uncertainties in making estimates, actual results could differ from the original estimates, requiring adjustments to these balances in future periods.

Medical_Equipment_and_Property

Medical Equipment and Property	3 Months Ended
Medical Equipment and Property	Mar. 31, 2014
Text Block [Abstract]	'
Medical Equipment and Property	'
	2	Medical Equipment and Property
	Medical equipment consisted of the following as of March 31, 2014 and December 31, 2013 (in thousands):


			March 31,			December 31,
			2014			2013
	Medical Equipment in rental service		$	38,544		$	37,252
	Medical Equipment in rental service - pump reserve			(92	)		(87	)
	Accumulated depreciation			(23,047	)		(22,727	)
	Medical Equipment held for sale or rental			2,955			3,664

	Total		$	18,360		$	18,102

	Depreciation expense for medical equipment for the three months ended March 31, 2014 was $0.7 million compared to $1.2 million for the same prior year period, which was recorded in cost of revenues – pump depreciation and disposals, respectively.
	During the first quarter of 2014, the Company reassessed the estimated useful life of certain of its property and equipment. As a result, the estimated useful life of the Company’s medical equipment was changed from five to seven years due to the determination that the Company was using these assets longer than originally anticipated. A major factor in this change was the servicing of such equipment by the Company’s Kansas facility, which was acquired in 2010. As a result, disposal of such equipment has decreased significantly since that acquisition.
	The change in the estimated useful lives of the Company’s pump equipment was accounted for as a change in accounting estimate, on a prospective basis, effective January 1, 2014. The change in estimated useful lives resulted in $0.5 million in less depreciation expense for the quarter ended March 31, 2014 than otherwise would have been recorded. After tax impact, net income would have been lower by $0.3 million, if this change in estimate had not been made. There was no impact to the basic or diluted income per share due to this change in estimate.
	Depreciation expense for property and equipment (other than medical equipment) for both the three months ended March 31, 2014 and 2013 was $0.1 million, respectively, which was recorded in general and administrative expenses.

	Medical equipment held for sale or rental includes approximately $0.8 million of pre-owned equipment received from a financial institution when such equipment came off lease. Under the Company’s arrangement with the financial institution, the Company does not pay for the equipment until it is sold. The liability for this equipment is included in other current liabilities for a similar amount. The Company assumes risk of loss and accounts for the disposition of such equipment as a sale.

Intangible_Assets

Intangible Assets	3 Months Ended
Intangible Assets	Mar. 31, 2014
Goodwill And Intangible Assets Disclosure [Abstract]	'
Intangible Assets	'
	3	Intangible Assets
	The carrying amount and accumulated amortization of intangible assets as of March 31, 2014 and December 31, 2013, are as follows (in thousands):


			March 31, 2014
			Gross				Accumulated				Net
			Assets				Amortization				Net
	Nonamortizable intangible assets
	Trade names		$	2,000			$	—			$	2,000
	Amortizable intangible assets
	Physician and customer relationships			32,865				13,112				19,753
	Non-competition agreements			848				664				184
	Software			3,433				1,295				2,138

	Total nonamortizable and amortizable intangible assets		$	39,146			$	15,071			$	24,075


			31-Dec-13
			Gross				Accumulated				Net
			Assets				Amortization				Net
	Nonamortizable intangible assets
	Trade names		$	2,000			$	—			$	2,000
	Amortizable intangible assets
	Physician and customer relationships			32,865				12,564				20,301
	Non-competition agreements			848				621				227
	Software			2,907				1,253				1,654

	Total nonamortizable and amortizable intangible assets		$	38,620			$	14,438			$	24,182

	Amortization expense for the three months ended March 31, 2014 and 2013 was $0.6 million and $0.7 million, respectively. Expected annual amortization expense for intangible assets recorded as of March 31, 2014, is as follows (in thousands):


	4/1-				2015				2016				2017		2018		2019 and
	12/31/14				2015				2016				2017		2018		thereafter
	$	1,867			$	2,321			$	2,235			$	2,201	$	2,191	$	11,260

Debt

Debt	3 Months Ended
Debt	Mar. 31, 2014
Debt Disclosure [Abstract]	'
Debt	'
	4	Debt
	On November 30, 2012, the Company entered into a credit agreement with Wells Fargo as Administrative Agent and Wells Fargo and PennantPark as Lenders. The credit agreement consists of a $12.0 million Term Loan A (provided by Wells Fargo), a $14.5 million Term Loan B (provided by PennantPark) and a $10.0 million revolving credit facility (the “Revolver”), all of which mature on November 30, 2016, collectively (the “Credit Facility”). Interest on the Credit Facility is payable at the Company’s choice of LIBOR plus 7.25% (with a LIBOR floor of 2.0%) or the Wells Fargo prime rate plus 6.25% (with a prime rate floor of 3.0%). As of March 31, 2014, interest was payable at the Wells Fargo prime rate plus 6.25%, which equaled 9.50%.

	The availability under the revolving Credit Facility is based upon the Company’s eligible accounts receivable and eligible inventory. The Company had revolving loan gross availability of $6.9 million and $5.9 million, respectively, outstanding amounts on the Revolver included $0.6 million at March 31, 2014 and a reserve amount of $0.1 million and $0.0 million, respectively, on a letter of credit at March 31, 2014 and December 31, 2013, leaving approximately $6.2 million and $5.9 million available under the revolving Credit Facility as of March 31, 2014 and December 31, 2013, respectively.
	The Credit Facility is collateralized by substantially all of the Company’s assets and requires the Company to comply with covenants, including but not limited to, financial covenants relating to the satisfaction, on a quarterly and annual basis for the duration of the Credit Facility, of a total leverage ratio, a fixed charge coverage ratio and an annual limit on capital expenditures, including capital leases. As of March 31, 2014, the Company was in compliance with all such covenants and expects to be in compliance over the next 12 months.
	In connection with the Credit Facility, the Company has the following covenant obligations for the duration of the facility:

		a)	The fixed charge coverage ratio is calculated in accordance with the agreement governing the Credit Facility. This covenant was first required to be reported as of March 31, 2013 and has a minimum ratio at that time of 1.25:1. The required ratio varies quarterly for the remainder of the facility duration, from 1.25:1 to 2.00:1.

		b)	The leverage ratio is calculated in accordance with the agreement governing the Credit Facility. This covenant was first required to be reported as of March 31, 2013 and has a maximum ratio at that time of 2.50:1. The required ratio varies quarterly for the remainder of the facility duration, from 2.50:1 to 1.00:1.

		c)	The Credit Facility includes an annual limitation on Capital Expenditures, as defined in and in accordance with the credit agreement for the Credit Facility, which was $1.25 million for the month ended December 31, 2012 and $5.5 million for each year ending December 31, 2013 through 2016.
	The Company occasionally enters into capital leases to finance the purchase of ambulatory infusion pumps. The pumps are capitalized into medical equipment in rental service at their fair market value, which equals the value of the future minimum lease payments and are depreciated over the useful life of the pumps.
	The Company had approximate future maturities of loans and capital leases as of March 31, 2014 as follows (in thousands):


			Remainder		2015		2016		2017				Total
			of 2014		2015		2016		2017				Total
	Term Loans		$	3,464	$	2,400	$	17,636	$	—			$	23,500
	Revolver			—		—		654		—				654
	Capital Leases			928		1,253		823		11				3,015

	Total		$	4,392	$	3,653	$	19,113	$	11			$	27,169


	The following is a breakdown of the Company’s current and long-term debt (including capital leases) as of March 31, 2014 and December 31, 2013 (in thousands):


	March 31, 2014								December 31, 2013
			Current		Long-Term		Total				Current				Long-Term		Total
			Portion of		Debt						Portion of				Debt
			Long-Term								Long-
			Debt								Term Debt
	Term Loans		$	4,064	$	19,436	$	23,500	Term Loans		$	4,064			$	19,931	$	23,995
	Revolver			—		654		654	Revolver			—				—		—
	Capital Leases			1,241		1,774		3,015	Capital Leases			1,054				1,678		2,732

	Total		$	5,305	$	21,864	$	27,169	Total		$	5,118			$	21,609	$	26,727

Income_Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2014
Income Tax Disclosure [Abstract]	'
Income Taxes	'
	5	Income Taxes
	During the three months ended March 31, 2014 and 2013, we recorded income tax expense of $0.3 million and $0.1 million, respectively. The increase is tax expense was primarily due to profitability during the quarter ended March 31, 2014. In computing its income tax provision, the Company estimates its effective tax rate for the full year and applies that rate to income earned though the reporting period. The effective income tax rate was 37.4% and 43.4% for the quarters ended March 31, 2014 and 2013, respectively.

Commitments_and_Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2014
Commitments And Contingencies Disclosure [Abstract]	'
Commitments and Contingencies	'
	6	Commitments and Contingencies
	The Company is currently involved in legal proceedings arising out of the ordinary course and conduct of our business, the outcomes of which are not determinable at this time. We have insurance policies covering potential losses where such coverage is cost effective. In the Company’s opinion, any liability that might be incurred by us upon the resolution of these claims and lawsuits will not, in the aggregate, have a material effect on the Company’s consolidated financial condition, results of operations or cash flows.

Earnings_Per_Share

Earnings Per Share	3 Months Ended
Earnings Per Share	Mar. 31, 2014
Earnings Per Share [Abstract]	'
Earnings Per Share	'
	7	Earnings Per Share
	Basic income per share is computed by dividing net income by the weighted average number of common shares outstanding during the period. Diluted income per share assumes the issuance of potentially dilutive shares of common stock during the period. The following table reconciles the numerators and denominators of the basic and diluted income per share computations:


			Three Months Ended
			March 31
			2014		2013
	Numerator:
	Net income (in thousands)		$	583	$	51
	Denominator:
	Weighted average common shares outstanding:
	Basic			21,972,739		21,802,515
	Dilutive effect of non-vested awards			483,404		435,645

	Diluted			22,456,143		22,238,160
	Net income (loss) per share:
	Basic		$	0.03	$	—
	Diluted		$	0.03	$	—

	For the three months ended March 31, 2014, vested stock options of 0.1 million were not included in the calculation because they were not in-the-money.

Subsequent_Event

Subsequent Event	3 Months Ended
	Mar. 31, 2014
Subsequent Events [Abstract]	'
Subsequent Event	'
	8	Subsequent Event
	On April 11, 2014, the Company repaid $1.6 million on its Credit Facility for its annual Excess Cash Flow sweep as required and defined by the Company’s Credit Agreement dated November 30, 2012.

	Cautionary Statement about Forward-Looking Statements
	Certain statements contained in this quarterly report on Form 10-Q are forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended (the “Securities Act”) and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). The words “believe,” “may,” “will,” “estimate,” “continue,” “anticipate,” “intend,” “should,” “plan,” “expect,” “strategy,” “future,” “likely,” variations of such words, and other similar expressions, as they relate to the Company, are intended to identify forward-looking statements. In connection with the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995, the Company is identifying certain factors that could cause actual results to differ, perhaps materially, from those indicated by these forward-looking statements. Those factors, risks and uncertainties include, but are not limited to, potential changes in overall healthcare reimbursement — including CMS competitive bidding, sequestration, concentration of customers, increased focus on early detection of cancer, competitive treatments, dependency on Medicare Supplier Number, availability of chemotherapy drugs, global financial conditions, changes and enforcement of state and federal laws, natural forces, competition, dependency on suppliers, risks in acquisitions & joint ventures, US Healthcare Reform, relationships with healthcare professionals and organizations, technological changes related to infusion therapy, dependency on websites and intellectual property, the ability of the Company to successfully integrate acquired businesses, dependency on key personnel, dependency on banking relations and covenants, and other risks associated with our common stock, as well as any other litigation to which the Company may be subject from time to time; and other risk factors as discussed in the Company’s annual report on Form 10-K for the year ended December 31, 2013 and in other filings made by the Company from time to time with the Securities and Exchange Commission.

Medical_Equipment_and_Property1

Medical Equipment and Property (Tables)	3 Months Ended
Medical Equipment and Property (Tables)	Mar. 31, 2014
Text Block [Abstract]	'
Summary of Medical Equipment	'
	Medical equipment consisted of the following as of March 31, 2014 and December 31, 2013 (in thousands):


		March 31,			December 31,
		2014			2013
	Medical Equipment in rental service	$	38,544		$	37,252
	Medical Equipment in rental service - pump reserve		(92	)		(87	)
	Accumulated depreciation		(23,047	)		(22,727	)
	Medical Equipment held for sale or rental		2,955			3,664

	Total	$	18,360		$	18,102

Intangible_Assets_Tables

Intangible Assets (Tables)	3 Months Ended
Intangible Assets (Tables)	Mar. 31, 2014
Goodwill And Intangible Assets Disclosure [Abstract]	'
Summary of Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets	'
	The carrying amount and accumulated amortization of intangible assets as of March 31, 2014 and December 31, 2013, are as follows (in thousands):


			March 31, 2014
			Gross				Accumulated				Net
			Assets				Amortization				Net
	Nonamortizable intangible assets
	Trade names		$	2,000			$	—			$	2,000
	Amortizable intangible assets
	Physician and customer relationships			32,865				13,112				19,753
	Non-competition agreements			848				664				184
	Software			3,433				1,295				2,138

	Total nonamortizable and amortizable intangible assets		$	39,146			$	15,071			$	24,075


			31-Dec-13
			Gross				Accumulated				Net
			Assets				Amortization				Net
	Nonamortizable intangible assets
	Trade names		$	2,000			$	—			$	2,000
	Amortizable intangible assets
	Physician and customer relationships			32,865				12,564				20,301
	Non-competition agreements			848				621				227
	Software			2,907				1,253				1,654

	Total nonamortizable and amortizable intangible assets		$	38,620			$	14,438			$	24,182
Schedule of Expected Annual Amortization Expense for Intangible Assets	'
	Expected annual amortization expense for intangible assets recorded as of March 31, 2014, is as follows (in thousands):


	4/1-				2015				2016				2017		2018		2019 and
	12/31/14				2015				2016				2017		2018		thereafter
	$	1,867			$	2,321			$	2,235			$	2,201	$	2,191	$	11,260

Debt_Tables

Debt (Tables)	3 Months Ended
Debt (Tables)	Mar. 31, 2014
Debt Disclosure [Abstract]	'
Summary of Future Maturities of Loans and Capital Leases	'
	The Company had approximate future maturities of loans and capital leases as of March 31, 2014 as follows (in thousands):


		Remainder		2015		2016		2017				Total
		of 2014		2015		2016		2017				Total
	Term Loans	$	3,464	$	2,400	$	17,636	$	—			$	23,500
	Revolver		—		—		654		—				654
	Capital Leases		928		1,253		823		11				3,015

	Total	$	4,392	$	3,653	$	19,113	$	11			$	27,169

Summary of Company's Current and Long-Term Debt (Including Capital Leases)	'
	The following is a breakdown of the Company’s current and long-term debt (including capital leases) as of March 31, 2014 and December 31, 2013 (in thousands):


	March 31, 2014							December 31, 2013
		Current		Long-Term		Total				Current				Long-Term		Total
		Portion of		Debt						Portion of				Debt
		Long-Term								Long-
		Debt								Term Debt
	Term Loans	$	4,064	$	19,436	$	23,500	Term Loans		$	4,064			$	19,931	$	23,995
	Revolver		—		654		654	Revolver			—				—		—
	Capital Leases		1,241		1,774		3,015	Capital Leases			1,054				1,678		2,732

	Total	$	5,305	$	21,864	$	27,169	Total		$	5,118			$	21,609	$	26,727

Earnings_Per_Share_Tables

Earnings Per Share (Tables)	3 Months Ended
Earnings Per Share (Tables)	Mar. 31, 2014
Earnings Per Share [Abstract]	'
Numerators and Denominators of Basic and Diluted Income (Loss) Per Share	'
	The following table reconciles the numerators and denominators of the basic and diluted income per share computations:


		Three Months Ended
		March 31
		2014		2013
	Numerator:
	Net income (in thousands)	$	583	$	51
	Denominator:
	Weighted average common shares outstanding:
	Basic		21,972,739		21,802,515
	Dilutive effect of non-vested awards		483,404		435,645

	Diluted		22,456,143		22,238,160
	Net income (loss) per share:
	Basic	$	0.03	$	—
	Diluted	$	0.03	$	—

Medical_Equipment_and_Property2

Medical Equipment and Property - Summary of Medical Equipment (Detail) (USD $)	Mar. 31, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Mar. 31, 2014	Dec. 31, 2013
Medical Equipment And Property [Abstract]	'	'
Medical Equipment in rental service	$38,544	$37,252
Medical Equipment in rental service - pump reserve	-92	-87
Accumulated depreciation	-23,047	-22,727
Medical equipment held for sale or rental	2,955	3,664
Total	$18,360	$18,102

Medical_Equipment_and_Property3

Medical Equipment and Property - Additional Information (Detail) (USD $)	3 Months Ended		12 Months Ended
In Millions, except Per Share data, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013	Dec. 31, 2013
Property, Plant and Equipment [Line Items]	'	'	'
Depreciation expense for medical equipment	$0.70	$1.20	'
Estimated useful life of medical equipment	'7 years	'	'5 years
Change in estimated useful lives, decrease in depreciation	-0.5	'	'
Change in estimated useful lives, decrease in net income after tax	-0.3	'	'
Change in estimated useful lives, basic and diluted income per share	$0	'	'
Depreciation expense for property and equipment (other than medial equipment) recorded in general and administrative expenses	0.1	0.1	'
Pre-Owned Equipment [Member]	'	'	'
Property, Plant and Equipment [Line Items]	'	'	'
Medical equipment held for sale or rental - financial institution	$0.80	'	'

Intangible_Assets_Summary_of_C

Intangible Assets - Summary of Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets (Detail) (USD $)	Mar. 31, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Mar. 31, 2014	Dec. 31, 2013
Indefinite Lived And Finite Lived Intangible Assets [Line Items]	'	'
Total nonamortizable and amortizable intangible assets, Gross Assets	$39,146	$38,620
Total nonamortizable and amortizable intangible assets, Accumulated Amortization	15,071	14,438
Total nonamortizable and amortizable intangible assets, Net	24,075	24,182
Physician and Customer Relationships [Member]	'	'
Indefinite Lived And Finite Lived Intangible Assets [Line Items]	'	'
Amortizable intangible assets, Gross Assets	32,865	32,865
Amortizable intangible assets, Accumulated Amortization	13,112	12,564
Amortizable intangible assets, Net	19,753	20,301
Non-Competition Agreements [Member]	'	'
Indefinite Lived And Finite Lived Intangible Assets [Line Items]	'	'
Amortizable intangible assets, Gross Assets	848	848
Amortizable intangible assets, Accumulated Amortization	664	621
Amortizable intangible assets, Net	184	227
Software [Member]	'	'
Indefinite Lived And Finite Lived Intangible Assets [Line Items]	'	'
Amortizable intangible assets, Gross Assets	3,433	2,907
Amortizable intangible assets, Accumulated Amortization	1,295	1,253
Amortizable intangible assets, Net	2,138	1,654
Trade Names [Member]	'	'
Indefinite Lived And Finite Lived Intangible Assets [Line Items]	'	'
Nonamortizable intangible assets	$2,000	$2,000

Intangible_Assets_Additional_I

Intangible Assets - Additional Information (Detail) (USD $)	3 Months Ended
In Thousands, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013
Goodwill And Intangible Assets Disclosure [Abstract]	'	'
Amortization of intangible assets	$629	$672

Intangible_Assets_Schedule_of_

Intangible Assets - Schedule of Expected Annual Amortization Expense for Intangible Assets (Detail) (USD $)	Mar. 31, 2014
In Thousands, unless otherwise specified	Mar. 31, 2014
Goodwill And Intangible Assets Disclosure [Abstract]	'
Amortization expense for remaining fiscal year, 2014	$1,867
Amortization expense, 2015	2,321
Amortization expense, 2016	2,235
Amortization expense, 2017	2,201
Amortization expense, 2018	2,191
Amortization expense, 2019 and thereafter	$11,260

Debt_Additional_Information_De

Debt - Additional Information (Detail) (USD $)

3 Months Ended

0 Months Ended

3 Months Ended

In Millions, unless otherwise specified

Mar. 31, 2014

Nov. 30, 2012

Mar. 31, 2014

Dec. 31, 2013

Nov. 30, 2012

Mar. 31, 2014

Dec. 31, 2012

Mar. 31, 2014

LIBOR [Member]

Prime Rate [Member]

Term Loan A [Member]

Term Loan B [Member]

Revolving Credit Facility [Member]

Credit Facility [Member]

Minimum [Member]

Maximum [Member]

Line of Credit Facility [Line Items]

Line of credit facility

$12

$14.50

$6.90

$5.90

$10

Credit facility, maturity date

30-Nov-16

Interest on the credit facility, description

'LIBOR plus 7.25% (with a LIBOR floor of 2.0%) or the Wells Fargo prime rate plus 6.25% (with a prime rate floor of 3.0%)

Interest rate on credit facility

7.25%

6.25%

Debt instrument floor rate

2.00%

3.00%

Interest rate

9.50%

Revolving loan amounts outstanding

0.6

Reserve amount on letter of credit

0.1

Revolving credit facility available

6.2

5.9

Minimum fixed charge coverage ratio

1.25

Fixed charge coverage ratio for the remainder period

1.25

Maximum leverage ratio

2.5

Leverage ratio for remainder period

2.5

Credit Facility subject to limitation on Capital Expenditures

1.25

Credit Facility subject to limitation on Capital Expenditures in year one

5.5

Credit Facility subject to limitation on Capital Expenditures in year two

5.5

Credit Facility subject to limitation on Capital Expenditures in year three

5.5

Credit Facility subject to limitation on Capital Expenditures in year four

$5.50

Debt_Summary_of_Future_Maturit

Debt - Summary of Future Maturities of Loans and Capital Leases (Detail) (USD $)	Mar. 31, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Mar. 31, 2014	Dec. 31, 2013
Line of Credit Facility [Line Items]	'	'
Remainder of 2014	$4,392	'
2015	3,653	'
2016	19,113	'
2017	11	'
Total	27,169	26,727
Capital Lease Obligations [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Remainder of 2014	928	'
2015	1,253	'
2016	823	'
2017	11	'
Total	3,015	2,732
Term Loans [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Remainder of 2014	3,464	'
2015	2,400	'
2016	17,636	'
2017	'	'
Total	23,500	23,995
Revolving Credit Facility [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Remainder of 2014	'	'
2015	'	'
2016	654	'
2017	'	'
Total	$654	'

Debt_Summary_of_Companys_Curre

Debt - Summary of Company's Current and Long-Term Debt (Including Capital Leases) (Detail) (USD $)	Mar. 31, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Mar. 31, 2014	Dec. 31, 2013
Line of Credit Facility [Line Items]	'	'
Current portion of long-term debt	$5,305	$5,118
Long-Term Debt	21,864	21,609
Total	27,169	26,727
Capital Lease Obligations [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Current portion of long-term debt	1,241	1,054
Long-Term Debt	1,774	1,678
Total	3,015	2,732
Term Loans [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Current portion of long-term debt	4,064	4,064
Long-Term Debt	19,436	19,931
Total	23,500	23,995
Revolving Credit Facility [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Current portion of long-term debt	'	'
Long-Term Debt	654	'
Total	$654	'

Income_Taxes_Additional_Inform

Income Taxes - Additional Information (Detail) (USD $)	3 Months Ended
In Thousands, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013
Income Tax Disclosure [Abstract]	'	'
Income tax (expense) income	($349)	($39)
Effective income tax rate	37.40%	43.40%

Earnings_Per_Share_Numerators_

Earnings Per Share - Numerators and Denominators of Basic and Diluted Income (Loss) Per Share (Detail) (USD $)	3 Months Ended
In Thousands, except Share data, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013
Numerator:	'	'
Net income	$583	$51
Weighted average common shares outstanding:	'	'
Basic	21,972,739	21,802,515
Dilutive effect of non-vested awards	483,404	435,645
Diluted	22,456,143	22,238,160
Net income (loss) per share:	'	'
Basic	$0.03	$0
Diluted	$0.03	$0

Earnings_Per_Share_Additional_

Earnings Per Share - Additional Information (Detail) (Vested Stock Options [Member])	3 Months Ended
In Millions, unless otherwise specified	Mar. 31, 2014
Vested Stock Options [Member]	'
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]	'
Shares with anti-dilutive effect	0.1

Subsequent_Event_Additional_In

Subsequent Event - Additional Information (Detail) (Subsequent Event [Member], Credit Facility [Member], USD $)	0 Months Ended
In Millions, unless otherwise specified	Apr. 11, 2014
Subsequent Event [Member] \| Credit Facility [Member]	'
Subsequent Event [Line Items]	'
Repayments on Credit Facility	$1.60