InfuSystem (INFU) 10-Q10 Nov 142014 Q3 Quarterly reportFinancial data

Company Profile

Document_and_Entity_Informatio

Document and Entity Information	9 Months Ended
Document and Entity Information	Sep. 30, 2014	Nov. 05, 2014
Document And Entity Information [Abstract]	'	'
Document Type	'10-Q	'
Amendment Flag	'false	'
Document Period End Date	30-Sep-14	'
Document Fiscal Year Focus	'2014	'
Document Fiscal Period Focus	'Q3	'
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	'	22,284,589

Condensed_Consolidated_Balance

Condensed Consolidated Balance Sheets (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Sep. 30, 2014	Dec. 31, 2013
Current Assets:	'	'
Cash and cash equivalents	$1,902	$1,138
Accounts receivable, less allowance for doubtful accounts of $5,287 and $4,774 at September 30, 2014 and December 31, 2013, respectively	11,505	10,697
Inventory	1,589	1,234
Other current assets	621	518
Deferred income taxes	2,296	2,296
Total Current Assets	17,913	15,883
Medical equipment held for sale or rental	2,365	3,664
Medical equipment in rental service, net of accumulated depreciation	17,662	14,438
Property & equipment, net of accumulated depreciation	2,370	872
Deferred debt issuance costs, net	1,349	1,817
Intangible assets, net	24,461	24,182
Deferred income taxes	14,696	16,300
Other assets	208	217
Total Assets	81,024	77,373
Current Liabilities:	'	'
Accounts payable	4,570	4,736
Current portion of long-term debt	4,238	5,118
Other current liabilities	3,303	3,187
Total Current Liabilities	12,111	13,041
Long-term debt, net of current portion	23,631	21,609
Total Liabilities	35,742	34,650
Stockholders' Equity:	'	'
Preferred stock, $.0001 par value: authorized 1,000,000 shares; none issued	0	0
Common stock, $.0001 par value: authorized 200,000,000 shares; issued and outstanding 22,400,743 and 22,203,053, respectively, as of September 30, 2014 and 22,158,041 and 21,960,351, respectively, as of December 31, 2013	2	2
Additional paid-in capital	90,020	89,783
Retained deficit	-44,740	-47,062
Total Stockholders' Equity	45,282	42,723
Total Liabilities and Stockholders' Equity	$81,024	$77,373

Condensed_Consolidated_Balance1

Condensed Consolidated Balance Sheets (Parenthetical) (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, except Share data, unless otherwise specified	Sep. 30, 2014	Dec. 31, 2013
Statement of Financial Position [Abstract]	'	'
Accounts receivable, allowance for doubtful accounts	$5,287	$4,774
Preferred stock, par value	$0.00	$0.00
Preferred stock, shares authorized	1,000,000	1,000,000
Preferred stock, shares issued	0	0
Common stock, par value	$0.00	$0.00
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	22,400,743	22,158,041
Common stock, shares outstanding	22,203,053	21,960,351

Condensed_Consolidated_Stateme

Condensed Consolidated Statements of Operations and Statements of Comprehensive Income (USD $)	3 Months Ended		9 Months Ended
In Thousands, except Share data, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Net revenues:	'	'	'	'
Rentals	$14,505	$14,493	$44,150	$41,556
Product Sales	2,108	1,247	6,077	3,547
Net revenues	16,613	15,740	50,227	45,103
Cost of revenues:	'	'	'	'
Cost of revenues - Product, service and supply costs	3,221	2,750	9,024	8,174
Cost of revenues - Pump depreciation and disposals	1,662	1,650	5,474	4,836
Gross profit	11,730	11,340	35,729	32,093
Selling, general and administrative expenses:	'	'	'	'
Provision for doubtful accounts	1,266	1,795	4,811	4,782
Amortization of intangibles	622	648	1,876	1,972
Selling and marketing	2,483	2,391	7,762	7,281
General and administrative	4,916	4,583	14,723	14,622
Total selling, general and administrative	9,287	9,417	29,172	28,657
Operating income	2,443	1,923	6,557	3,436
Other income (expense):	'	'	'	'
Interest expense	-752	-838	-2,355	-2,636
Other income (expense)	3	-7	26	329
Total other expense	-749	-845	-2,329	-2,307
Income before income taxes	1,694	1,078	4,228	1,129
Income tax expense	-842	-429	-1,907	-324
Net income	852	649	2,321	805
Net income per share:	'	'	'	'
Basic	$0.04	$0.03	$0.10	$0.04
Diluted	$0.04	$0.03	$0.10	$0.04
Weighted average shares outstanding:	'	'	'	'
Basic	22,203,053	21,891,041	22,108,143	21,851,798
Diluted	22,511,159	22,075,532	22,364,999	22,043,998
Comprehensive Income	'	'	'	'
Net income	852	649	2,321	805
Comprehensive income	$852	$649	$2,321	$805

Condensed_Consolidated_Stateme1

Condensed Consolidated Statements of Cash Flows (USD $)	9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013
Statement of Cash Flows [Abstract]	'	'
NET CASH PROVIDED BY OPERATING ACTIVITIES	$4,204	$4,765
INVESTING ACTIVITIES	'	'
Purchase of medical equipment and property	-7,168	-3,396
Proceeds from sale of medical equipment and property	5,193	2,808
NET CASH USED IN INVESTING ACTIVITIES	-1,975	-588
FINANCING ACTIVITIES	'	'
Principal payments on revolving credit facility, term loans, and capital lease obligations	-49,101	-27,912
Cash proceeds from revolving credit facility	47,814	22,395
Common stock repurchased to satisfy statutory withholding on employee stock based compensation plans	-178	-78
NET CASH USED IN FINANCING ACTIVITIES	-1,465	-5,595
Net change in cash and cash equivalents	764	-1,418
Cash and cash equivalents, beginning of period	1,138	2,326
Cash and cash equivalents, end of period	$1,902	$908

Basis_of_Presentation_Nature_o

Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 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
	The terms “InfuSystem”, “the Company”, “we”, “our” and “us” are used herein to refer to InfuSystem Holdings, Inc. and its subsidiaries. InfuSystem Holdings, Inc. is a leading provider of infusion pumps and related services. The Company services hospitals, oncology practices and other alternative 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 unaudited 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 unaudited consolidated financial statements should be read in conjunction with the audited 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 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	9 Months Ended
Medical Equipment and Property	Sep. 30, 2014
Text Block [Abstract]	'
Medical Equipment and Property	'
	2	Medical Equipment and Property
	Medical equipment consisted of the following as of September 30, 2014 and December 31, 2013 (in thousands):


			September 30,			December 31,
			2014			2013
	Medical Equipment in rental service		$	40,930		$	37,252
	Medical Equipment in rental service - pump reserve			(115	)		(87	)
	Accumulated depreciation			(23,153	)		(22,727	)
	Medical Equipment held for sale or rental			2,365			3,664

	Total		$	20,027		$	18,102

	Depreciation expense for medical equipment for the three and nine months ended September 30, 2014 was $0.9 million and $2.4 million, respectively, compared to $1.3 million and $3.8 million for the same prior year periods, 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 extended 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 $0.4 million and $1.4 million in less depreciation expense for the three and nine months ended September 30, 2014, respectively, than otherwise would have been recorded. After-tax impact to net income would have been lower by $0.2 million and $0.8 million for the three and nine months ended September 30, 2014 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 for the three and nine months ended September 30, 2014 was $0.1 million and $0.2 million, respectively, consistent with the same prior year periods. This expense was recorded in general and administrative expenses.
	At December 31, 2013, medical equipment held for sale or rental included approximately $0.8 million of pre-owned equipment received from a financial institution when such equipment came off lease. Under the Company’s former arrangement with the financial institution, the Company did not pay for the equipment until it was sold. The liability for this equipment was included in other current liabilities for a similar amount. The Company assumed risk of loss and accounted for the disposition of such equipment as a sale. In June 2014, the Company bought out the remaining equipment from the financial institution for $0.5 million and payment was made in July 2014. As such, the Company no longer has any liabilities relating to this transaction.

Intangible_Assets

Intangible Assets	9 Months Ended
Intangible Assets	Sep. 30, 2014
Goodwill and Intangible Assets Disclosure [Abstract]	'
Intangible Assets	'
	3	Intangible Assets
	The carrying amount and accumulated amortization of intangible assets as of September 30, 2014 and December 31, 2013, are as follows (in thousands):


			September 30, 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		14,207		18,658
	Non-competition agreements			848		740		108
	Software			5,065		1,370		3,695

	Total nonamortizable and amortizable intangible assets		$	40,778	$	16,317	$	24,461


			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 and nine months ended September 30, 2014 was $0.6 million and $1.9 million, respectively, compared to $0.6 million and $2.0 million for the same prior year periods. Expected annual amortization expense for intangible assets recorded as of September 30, 2014, is as follows (in thousands):


	10/1-		2015		2016		2017		2018		2019 and
	12/31/14		2015		2016		2017		2018		thereafter
	$ 749		$	2,832	$	2,745	$	2,583	$	2,191	$	11,361

Debt

Debt	9 Months Ended
Debt	Sep. 30, 2014
Debt Disclosure [Abstract]	'
Debt	'
	4	Debt
	On November 30, 2012, the Company entered into a credit agreement with Wells Fargo Bank, National Association (“Wells Fargo”), as Administrative Agent and Wells Fargo and funds managed by PennantPark Investment Advisors, LLC (“PennantPark”) as Lenders (the “Credit Agreement”). 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”).
	On May 19, 2014, the Company entered into the Second Amendment to the Credit Agreement with Wells Fargo and PennantPark. This amendment lowers both the effective floating rate and the effective fixed rate by 150 basis points each. As of September 30, 2014, interest on the Credit Facility is payable at the Company’s choice of LIBOR plus 6.75% (with a LIBOR floor of 1.0%, for an effective fixed rate of 7.75%) or the Wells Fargo prime rate plus 4.75% (with a prime rate floor of 3.0%, for an effective floating rate of 8.0%).
	The availability under the Revolver is based upon the Company’s eligible accounts receivable and eligible inventory and is broken down as follows (in thousands):


			September 30,			December 31,
			2014			2013
	Revolver:
	Gross Availability		$	6,685		$	5,900
	Outstanding Draws			(2,974	)		—
	Letter of Credit			(161	)		—

	Availability on Revolver		$	3,550		$	5,900

	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 September 30, 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. The required ratio as of September 30, 2014 was 1.50:1.

		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 had 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. The required ratio as of September 30, 2014 was 1.75:1.

		c)	The Credit Facility includes an annual limitation on Capital Expenditures, as defined in and in accordance with the Credit Agreement, 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 September 30, 2014 as follows (in thousands):


			Remainder			2015		2016		2017				Total
			of 2014			2015		2016		2017				Total
	Term Loans		$	600		$	2,400	$	17,688	$	—			$	20,688
	Revolver			—			—		2,974		—				2,974
	Capital Leases			453			1,846		1,454		454				4,207

	Total		$	1,053		$	4,246	$	22,116	$	454			$	27,869

	The following is a breakdown of the Company’s current and long-term debt (including capital leases) as of September 30, 2014 and December 31, 2013 (in thousands):


	September 30, 2014									December 31, 2013
			Current			Long-Term		Total				Current				Long-Term		Total
			Portion of			Debt						Portion of				Debt
			Long-Term									Long-Term
			Debt									Debt
	Term Loans		$	2,400		$	18,288	$	20,688	Term Loans		$	4,064			$	19,931	$	23,995
	Revolver			—			2,974		2,974	Revolver			—				—		—
	Capital Leases			1,838			2,369		4,207	Capital Leases			1,054				1,678		2,732

	Total		$	4,238		$	23,631	$	27,869	Total		$	5,118			$	21,609	$	26,727

	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.

Income_Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2014
Income Tax Disclosure [Abstract]	'
Income Taxes	'
	5	Income Taxes
	Income tax expense was $0.8 million and $1.9 million for the three and nine months ended September 30, 2014. The Company recorded tax expense of $0.4 million and $0.3 million, respectively, for the same prior year periods. In computing its income tax provision, the Company estimates its effective income tax rate for the full year and applies that rate to income earned through the reporting period. The effective income tax rate was 49.8% and 39.8% for the three months ended September 30, 2014 and 2013, respectively. For the nine months ended September 30, 2014 the effective tax rate was 45.1% compared to 28.7% for the same prior year period. This effective tax rate was higher than the U.S. Federal rate of 34% primarily due to the impact of state and local taxes and Canadian income tax on the Company’s Canadian operations.

Commitments_Contingencies_and_

Commitments, Contingencies and Litigation	9 Months Ended
	Sep. 30, 2014
Commitments and Contingencies Disclosure [Abstract]	'
Commitments, Contingencies and Litigation	'
	6	Commitments, Contingencies and Litigation
	The Company is from time to time involved in legal proceedings arising out of the ordinary course and conduct of our business, the outcomes of which may not be determinable at a particular time. We have insurance policies covering potential losses where such coverage is cost effective. Currently, there are no legal proceedings that management believes would have a material adverse effect on the Company’s consolidated financial condition, results of operations or cash flows.

Earnings_Per_Share

Earnings Per Share	9 Months Ended
Earnings Per Share	Sep. 30, 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				Nine Months Ended
			September 30				September 30
			2014		2013		2014		2013
	Numerator:
	Net income (in thousands)		$	852	$	649	$	2,321	$	805
	Denominator:
	Weighted average common shares outstanding:
	Basic			22,203,053		21,891,041		22,108,143		21,851,798
	Dilutive effect of non-vested awards			308,106		184,491		256,856		192,200

	Diluted			22,511,159		22,075,532		22,364,999		22,043,998
	Net income per share:
	Basic		$	0.04	$	0.03	$	0.1	$	0.04
	Diluted		$	0.04	$	0.03	$	0.1	$	0.04

	For the three and nine months ended September 30, 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	9 Months Ended
	Sep. 30, 2014
Subsequent Events [Abstract]	'
Subsequent Event	'
	8	Subsequent Event
	The Company has evaluated subsequent events through the date of issuance for the condensed consolidated financial statements.

Recent_Accounting_Pronouncemen

Recent Accounting Pronouncements and Developments	9 Months Ended
	Sep. 30, 2014
Accounting Changes and Error Corrections [Abstract]	'
Recent Accounting Pronouncements and Developments	'
	9	Recent Accounting Pronouncements and Developments
	In May 2014, the Financial Accounting Standards Board issued a comprehensive new standard, which amends revenue recognition principles and provides a single set of criteria for revenue recognition among all industries. The new standard provides a five step framework whereby revenue is recognized when promised goods or services are transferred to a customer at an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. The standard also requires enhanced disclosure relating to revenue recognition in both the interim and annual periods. The standard is effective for interim and annual periods beginning after December 15, 2016 and allows for adoption using a full retrospective method, or a modified retrospective method. We are currently assessing the method of adoption and the expected impact the new standard has on our financial position and results of operations.
	In August 2014, the FASB issued guidance requiring management to perform interim and annual assessments of an entity’s ability to continue as a going concern within one year of the date of issuance of the entity’s financial statements. Entities must provide certain disclosures if “conditions or events raise substantial doubt about the entity’s ability to continue as a going concern.” The disclosure requires identifying the principal conditions and events contributing to the “doubt” to continue as a going concern, as well as management’s evaluations and plans to try to alleviate these uncertainties. This guidance is effective for annual reporting periods, within those annual periods ending after December 15, 2016. The Company is currently evaluating the impact of adopting ASU 2014-15 to determine the impact, if any; it may have on its current practices.
	In April 2014, the FASB issued Accounting Standards Update No. 2014-08, Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity (“ASU 2014-08”), which provides guidance regarding the definition of a discontinued operation and the required disclosures. The new guidance defines a discontinued operation as a component or group of components that is disposed of or is classified as held for sale and represents a strategic shift that has (or will have) a major effect on an entity’s operations and financial results. A strategic shift could include a disposal of (1) a major geographical area of operations, (2) a major line of business, (3) a major equity method investment, or (4) other major parts of an entity. In addition, having significant continuing involvement with a component after a disposal or failing to eliminate the operations or cash flows of a disposed component from an entity’s ongoing operations will no longer preclude presentation as a discontinued operation. There will be new disclosures required related to discontinued operations and to disposals of individually significant components that do not qualify as discontinued operations. ASU 2014-08 is effective for reporting periods beginning after December 15, 2014. Early adoption is permitted, but only for disposals (or classifications as held for sale) that have not been reported in financial statements previously issued or available for issuance. ASU 2014-08 applies prospectively to new disposals of components and new classifications as held for sale and is not expected to have a significant impact on the presentation of the Company’s financial statements or disclosures.

Recent_Accounting_Pronouncemen1

Recent Accounting Pronouncements and Developments (Policies)	9 Months Ended
	Sep. 30, 2014
Accounting Changes and Error Corrections [Abstract]	'
Recent Accounting Pronouncements and Developments	'
	In May 2014, the Financial Accounting Standards Board issued a comprehensive new standard, which amends revenue recognition principles and provides a single set of criteria for revenue recognition among all industries. The new standard provides a five step framework whereby revenue is recognized when promised goods or services are transferred to a customer at an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. The standard also requires enhanced disclosure relating to revenue recognition in both the interim and annual periods. The standard is effective for interim and annual periods beginning after December 15, 2016 and allows for adoption using a full retrospective method, or a modified retrospective method. We are currently assessing the method of adoption and the expected impact the new standard has on our financial position and results of operations.
	In August 2014, the FASB issued guidance requiring management to perform interim and annual assessments of an entity’s ability to continue as a going concern within one year of the date of issuance of the entity’s financial statements. Entities must provide certain disclosures if “conditions or events raise substantial doubt about the entity’s ability to continue as a going concern.” The disclosure requires identifying the principal conditions and events contributing to the “doubt” to continue as a going concern, as well as management’s evaluations and plans to try to alleviate these uncertainties. This guidance is effective for annual reporting periods, within those annual periods ending after December 15, 2016. The Company is currently evaluating the impact of adopting ASU 2014-15 to determine the impact, if any; it may have on its current practices.
	In April 2014, the FASB issued Accounting Standards Update No. 2014-08, Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity (“ASU 2014-08”), which provides guidance regarding the definition of a discontinued operation and the required disclosures. The new guidance defines a discontinued operation as a component or group of components that is disposed of or is classified as held for sale and represents a strategic shift that has (or will have) a major effect on an entity’s operations and financial results. A strategic shift could include a disposal of (1) a major geographical area of operations, (2) a major line of business, (3) a major equity method investment, or (4) other major parts of an entity. In addition, having significant continuing involvement with a component after a disposal or failing to eliminate the operations or cash flows of a disposed component from an entity’s ongoing operations will no longer preclude presentation as a discontinued operation. There will be new disclosures required related to discontinued operations and to disposals of individually significant components that do not qualify as discontinued operations. ASU 2014-08 is effective for reporting periods beginning after December 15, 2014. Early adoption is permitted, but only for disposals (or classifications as held for sale) that have not been reported in financial statements previously issued or available for issuance. ASU 2014-08 applies prospectively to new disposals of components and new classifications as held for sale and is not expected to have a significant impact on the presentation of the Company’s financial statements or disclosures.

Medical_Equipment_and_Property1

Medical Equipment and Property (Tables)	9 Months Ended
Medical Equipment and Property (Tables)	Sep. 30, 2014
Text Block [Abstract]	'
Summary of Medical Equipment	'
	Medical equipment consisted of the following as of September 30, 2014 and December 31, 2013 (in thousands):


		September 30,			December 31,
		2014			2013
	Medical Equipment in rental service	$	40,930		$	37,252
	Medical Equipment in rental service - pump reserve		(115	)		(87	)
	Accumulated depreciation		(23,153	)		(22,727	)
	Medical Equipment held for sale or rental		2,365			3,664

	Total	$	20,027		$	18,102

Intangible_Assets_Tables

Intangible Assets (Tables)	9 Months Ended
Intangible Assets (Tables)	Sep. 30, 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 September 30, 2014 and December 31, 2013, are as follows (in thousands):


		September 30, 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		14,207		18,658
	Non-competition agreements		848		740		108
	Software		5,065		1,370		3,695

	Total nonamortizable and amortizable intangible assets	$	40,778	$	16,317	$	24,461


		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 September 30, 2014, is as follows (in thousands):


	10/1-	2015		2016		2017		2018		2019 and
	12/31/14	2015		2016		2017		2018		thereafter
	$ 749	$	2,832	$	2,745	$	2,583	$	2,191	$	11,361

Debt_Tables

Debt (Tables)	9 Months Ended
Debt (Tables)	Sep. 30, 2014
Debt Disclosure [Abstract]	'
Summary of Revolver Based upon Company's Eligible Accounts Receivable and Inventory	'
	The availability under the Revolver is based upon the Company’s eligible accounts receivable and eligible inventory and is broken down as follows (in thousands):


		September 30,			December 31,
		2014			2013
	Revolver:
	Gross Availability	$	6,685		$	5,900
	Outstanding Draws		(2,974	)		—
	Letter of Credit		(161	)		—

	Availability on Revolver	$	3,550		$	5,900

Summary of Future Maturities of Loans and Capital Leases	'
	The Company had approximate future maturities of loans and capital leases as of September 30, 2014 as follows (in thousands):


		Remainder			2015		2016		2017				Total
		of 2014			2015		2016		2017				Total
	Term Loans	$	600		$	2,400	$	17,688	$	—			$	20,688
	Revolver		—			—		2,974		—				2,974
	Capital Leases		453			1,846		1,454		454				4,207

	Total	$	1,053		$	4,246	$	22,116	$	454			$	27,869

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 September 30, 2014 and December 31, 2013 (in thousands):


	September 30, 2014								December 31, 2013
		Current			Long-Term		Total				Current				Long-Term		Total
		Portion of			Debt						Portion of				Debt
		Long-Term									Long-Term
		Debt									Debt
	Term Loans	$	2,400		$	18,288	$	20,688	Term Loans		$	4,064			$	19,931	$	23,995
	Revolver		—			2,974		2,974	Revolver			—				—		—
	Capital Leases		1,838			2,369		4,207	Capital Leases			1,054				1,678		2,732

	Total	$	4,238		$	23,631	$	27,869	Total		$	5,118			$	21,609	$	26,727

Earnings_Per_Share_Tables

Earnings Per Share (Tables)	9 Months Ended
Earnings Per Share (Tables)	Sep. 30, 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				Nine Months Ended
		September 30				September 30
		2014		2013		2014		2013
	Numerator:
	Net income (in thousands)	$	852	$	649	$	2,321	$	805
	Denominator:
	Weighted average common shares outstanding:
	Basic		22,203,053		21,891,041		22,108,143		21,851,798
	Dilutive effect of non-vested awards		308,106		184,491		256,856		192,200

	Diluted		22,511,159		22,075,532		22,364,999		22,043,998
	Net income per share:
	Basic	$	0.04	$	0.03	$	0.1	$	0.04
	Diluted	$	0.04	$	0.03	$	0.1	$	0.04

Medical_Equipment_and_Property2

Medical Equipment and Property - Summary of Medical Equipment (Detail) (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Sep. 30, 2014	Dec. 31, 2013
Medical Equipment And Property [Abstract]	'	'
Medical Equipment in rental service	$40,930	$37,252
Medical Equipment in rental service - pump reserve	-115	-87
Accumulated depreciation	-23,153	-22,727
Medical equipment held for sale or rental	2,365	3,664
Total	$20,027	$18,102

Medical_Equipment_and_Property3

Medical Equipment and Property - Additional Information (Detail) (USD $)	1 Months Ended	3 Months Ended			9 Months Ended		12 Months Ended
In Millions, except Per Share data, unless otherwise specified	Jun. 30, 2014	Sep. 30, 2014	Mar. 31, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013	Dec. 31, 2013
Property, Plant and Equipment [Line Items]	'	'	'	'	'	'	'
Depreciation expense for medical equipment	'	$0.90	'	$1.30	$2.40	$3.80	'
Estimated useful life of medical equipment	'	'	'7 years	'	'	'	'5 years
Change in estimated useful lives, decrease in depreciation	'	0.4	'	'	1.4	'	'
Change in estimated useful lives, decrease in net income after tax	'	0.2	'	'	0.8	'	'
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	0.2	0.2	'
Payment for remaining equipment	0.5	'	'	'	'	'	'
Pre-Owned Equipment [Member]	'	'	'	'	'	'	'
Property, Plant and Equipment [Line Items]	'	'	'	'	'	'	'
Medical equipment held for sale or rental - financial institution	'	'	'	'	'	'	0.8

Intangible_Assets_Summary_of_C

Intangible Assets - Summary of Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets (Detail) (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Sep. 30, 2014	Dec. 31, 2013
Indefinite Lived And Finite Lived Intangible Assets [Line Items]	'	'
Total nonamortizable and amortizable intangible assets, Gross Assets	$40,778	$38,620
Total nonamortizable and amortizable intangible assets, Accumulated Amortization	16,317	14,438
Total nonamortizable and amortizable intangible assets, Net	24,461	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	14,207	12,564
Amortizable intangible assets, Net	18,658	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	740	621
Amortizable intangible assets, Net	108	227
Software [Member]	'	'
Indefinite Lived And Finite Lived Intangible Assets [Line Items]	'	'
Amortizable intangible assets, Gross Assets	5,065	2,907
Amortizable intangible assets, Accumulated Amortization	1,370	1,253
Amortizable intangible assets, Net	3,695	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		9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Goodwill and Intangible Assets Disclosure [Abstract]	'	'	'	'
Amortization of intangible assets	$622	$648	$1,876	$1,972

Intangible_Assets_Schedule_of_

Intangible Assets - Schedule of Expected Annual Amortization Expense for Intangible Assets (Detail) (USD $)	Sep. 30, 2014
In Thousands, unless otherwise specified	Sep. 30, 2014
Goodwill and Intangible Assets Disclosure [Abstract]	'
Amortization expense for remaining fiscal year, 2014	$749
Amortization expense, 2015	2,832
Amortization expense, 2016	2,745
Amortization expense, 2017	2,583
Amortization expense, 2018	2,191
Amortization expense, 2019 and thereafter	$11,361

Debt_Additional_Information_De

Debt - Additional Information (Detail) (USD $)

0 Months Ended

9 Months Ended

0 Months Ended

9 Months Ended

Sep. 30, 2014

19-May-14

Apr. 11, 2014

Sep. 30, 2014

Dec. 31, 2012

Sep. 30, 2014

Nov. 30, 2012

Sep. 30, 2014

Dec. 31, 2013

Nov. 30, 2012

LIBOR [Member]

Prime Rate [Member]

Credit Facility [Member]

Term Loan A [Member]

Term Loan B [Member]

Revolving Credit Facility [Member]

Minimum [Member]

Maximum [Member]

Line of Credit Facility [Line Items]

Line of credit facility

$12,000,000

$14,500,000

$10,000,000

Credit facility, maturity date

30-Nov-16

Decrease in effective floating and fixed interest rate

-1.50%

Effective fixed interest rate

7.75%

Interest on the credit facility, description

'LIBOR plus 6.75% (with a LIBOR floor of 1.0%, for an effective fixed rate of 7.75%) or the Wells Fargo prime rate plus 4.75% (with a prime rate floor of 3.0%, for an effective floating rate of 8.0%).

Effective floating interest rate

8.00%

6.75%

4.75%

Debt instrument floor rate

1.00%

3.00%

Minimum fixed charge coverage ratio

1.25

Fixed charge coverage ratio for the remainder period

1.5

1.25

Maximum leverage ratio

2.5

Leverage ratio for remainder period

1.75

2.5

Credit Facility subject to limitation on Capital Expenditures

1,250,000

6,685,000

5,900,000

Credit Facility subject to limitation on Capital Expenditures in year one

5,500,000

Credit Facility subject to limitation on Capital Expenditures in year two

5,500,000

Credit Facility subject to limitation on Capital Expenditures in year three

5,500,000

Credit Facility subject to limitation on Capital Expenditures in year four

5,500,000

Repayment of credit facility

$1,600,000

Debt_Summary_of_Revolver_Based

Debt - Summary of Revolver Based upon Company's Eligible Accounts Receivable and Inventory (Detail) (Revolving Credit Facility [Member], USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Sep. 30, 2014	Dec. 31, 2013
Revolving Credit Facility [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Gross Availability	$6,685	$5,900
Outstanding Draws	-2,974	'
Letter of Credit	-161	'
Availability on Revolver	$3,550	$5,900

Debt_Summary_of_Future_Maturit

Debt - Summary of Future Maturities of Loans and Capital Leases (Detail) (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Sep. 30, 2014	Dec. 31, 2013
Line of Credit Facility [Line Items]	'	'
Remainder of 2014	$1,053	'
2015	4,246	'
2016	22,116	'
2017	454	'
Total	27,869	26,727
Term Loans [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Remainder of 2014	600	'
2015	2,400	'
2016	17,688	'
2017	0	'
Total	20,688	23,995
Revolving Credit Facility [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Remainder of 2014	0	'
2015	0	'
2016	2,974	'
2017	0	'
Total	2,974	0
Capital Lease Obligations [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Remainder of 2014	453	'
2015	1,846	'
2016	1,454	'
2017	454	'
Total	$4,207	$2,732

Debt_Summary_of_Companys_Curre

Debt - Summary of Company's Current and Long-Term Debt (Including Capital Leases) (Detail) (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified	Sep. 30, 2014	Dec. 31, 2013
Line of Credit Facility [Line Items]	'	'
Current portion of long-term debt	$4,238	$5,118
Long-Term Debt	23,631	21,609
Total	27,869	26,727
Term Loans [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Current portion of long-term debt	2,400	4,064
Long-Term Debt	18,288	19,931
Total	20,688	23,995
Revolving Credit Facility [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Current portion of long-term debt	0	0
Long-Term Debt	2,974	0
Total	2,974	0
Capital Lease Obligations [Member]	'	'
Line of Credit Facility [Line Items]	'	'
Current portion of long-term debt	1,838	1,054
Long-Term Debt	2,369	1,678
Total	$4,207	$2,732

Income_Taxes_Additional_Inform

Income Taxes - Additional Information (Detail) (USD $)	3 Months Ended		9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Income Tax Disclosure [Abstract]	'	'	'	'
Income tax expense (benefit)	$842	$429	$1,907	$324
Effective income tax rate	49.80%	39.80%	45.10%	28.70%
U.S. Federal rate	'	'	34.00%	'

Earnings_Per_Share_Numerators_

Earnings Per Share - Numerators and Denominators of Basic and Diluted Income (Loss) Per Share (Detail) (USD $)	3 Months Ended		9 Months Ended
In Thousands, except Share data, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Numerator:	'	'	'	'
Net income	$852	$649	$2,321	$805
Weighted average common shares outstanding:	'	'	'	'
Basic	22,203,053	21,891,041	22,108,143	21,851,798
Dilutive effect of non-vested awards	308,106	184,491	256,856	192,200
Diluted	22,511,159	22,075,532	22,364,999	22,043,998
Net income per share:	'	'	'	'
Basic	$0.04	$0.03	$0.10	$0.04
Diluted	$0.04	$0.03	$0.10	$0.04

Earnings_Per_Share_Additional_

Earnings Per Share - Additional Information (Detail) (Vested Stock Options [Member])	3 Months Ended	9 Months Ended
In Millions, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2014
Vested Stock Options [Member]	'	'
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]	'	'
Shares with anti-dilutive effect	0.1	0.1