InfuSystem (INFU) 10-K 19 Mar 18 2017 FY Annual report Financial data

Document And Entity Information

Document And Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2017	Mar. 02, 2018	Jun. 30, 2017
Document Information [Line Items]
Entity Registrant Name	InfuSystem Holdings, Inc
Entity Central Index Key	1,337,013
Trading Symbol	infu
Current Fiscal Year End Date	--12-31
Entity Filer Category	Smaller Reporting Company
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Well-known Seasoned Issuer	No
Entity Common Stock, Shares Outstanding (in shares)		22,805,775
Entity Public Float			$ 31,478,640
Document Type	10-K
Document Period End Date	Dec. 31, 2017
Document Fiscal Year Focus	2,017
Document Fiscal Period Focus	FY
Amendment Flag	false

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Current Assets:
Cash and cash equivalents	$ 3,469	$ 3,398
Accounts receivable, less allowance for doubtful accounts of $6,514 and $4,989 at December 31, 2017 and 2016, respectively	11,385	11,581
Inventories	1,764	2,166
Other current assets	1,049	949
Deferred income taxes		2,675
Total Current Assets	17,667	20,769
Medical Equipment held for sale or rental	1,567	1,642
Medical equipment in rental service, net of accumulated depreciation	23,369	28,036
Property & equipment, net of accumulated depreciation	1,633	1,997
Intangible assets, net	24,514	31,239
Deferred income taxes		12,436
Other assets	131	225
Total Assets	68,881	96,344
Current Liabilities:
Accounts payable	5,516	5,315
Capital lease liability, current	505	2,938
Current portion of long-term debt	3,039	5,314
Other current liabilities	3,414	2,872
Total Current Liabilities	12,474	16,439
Long-term debt, net of current portion	25,352	26,577
Capital lease liability, long-term	33	2,573
Deferred income taxes	62
Other long-term liabilities	7	66
Total Long-Term Liabilities	25,454	29,216
Total Liabilities	37,928	45,655
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 22,978,398 and 22,780,738, as of December 31, 2017, respectively, and issued and outstanding 22,867,335 and 22,669,675, as of December 31, 2016, respectively.	2	2
Additional paid-in capital	92,584	91,829
Retained deficit	(61,633)	(41,142)
Total Stockholders’ Equity	30,953	50,689
Total Liabilities and Stockholders’ Equity	$ 68,881	$ 96,344

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Accounts receivable, allowance for doubtful accounts	$ 6,514	$ 4,989
Preferred stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Preferred stock, shares authorized (in shares)	1,000,000	1,000,000
Preferred stock, shares issued (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Common stock, shares authorized (in shares)	200,000,000	200,000,000
Common stock, shares issued (in shares)	22,978,398	22,867,335
Common stock, shares outstanding (in shares)	22,780,738	22,669,675

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Net revenues:
Rentals	$ 61,085	$ 62,210
Product sales	9,992	8,287
Net revenues	71,077	70,497
Cost of revenues:
Cost of revenues — Product, service and supply costs	18,367	16,206
Cost of revenues — Pump depreciation and loss on disposal	9,349	9,551
Gross profit	43,361	44,740
Selling, general and administrative expenses:
Provision for doubtful accounts	5,641	5,631
Amortization of intangible assets	5,560	3,849
Asset impairment charges	993
Selling and marketing	9,779	9,657
General and administrative	25,200	24,629
Total selling, general and administrative	47,173	43,766
Operating (loss) income	(3,812)	974
Other (expense) income:
Interest expense	(1,332)	(1,344)
Other (expense) income	(113)	6
Total other expense	(1,445)	(1,338)
Loss before income taxes	(5,257)	(364)
Income tax (expense) benefit	(15,450)	142
Net loss	$ (20,707)	$ (222)
Net loss per share:
Basic (in dollars per share)	$ (0.91)	$ (0.01)
Diluted (in dollars per share)	$ (0.91)	$ (0.01)
Weighted average common shares outstanding:
Basic (in shares)	22,739,651	22,617,901
Diluted (in shares)	22,739,651	22,617,901

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Treasury Stock [Member]	Total
Balances (in shares) at Dec. 31, 2015	22,740,000			(198,000)
Balances at Dec. 31, 2015	$ 2	$ 91,238	$ (40,920)		$ 50,320
Stock based shares issued upon vesting - gross (in shares)	56,000
Stock based shares issued upon vesting - gross
Stock-based compensation expense		462			$ 462
Employee stock purchase plan (in shares)	88,000				88,109
Employee stock purchase plan		204			$ 204
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares)	(17,000)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		(75)			(75)
Net loss			(222)		(222)
Balances (in shares) at Dec. 31, 2016	22,867,000			(198,000)
Balances at Dec. 31, 2016	$ 2	91,829	(41,142)		50,689
Stock based shares issued upon vesting - gross (in shares)	62,000
Stock based shares issued upon vesting - gross
Stock-based compensation expense		682			$ 682
Employee stock purchase plan (in shares)	69,000				68,958
Employee stock purchase plan		131			$ 131
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares)	(20,000)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		(58)			(58)
Net loss			(20,707)		(20,707)
Balances (in shares) at Dec. 31, 2017	22,978,000			(198,000)
Balances at Dec. 31, 2017	$ 2	92,584	(61,633)		30,953
ASU 2016-09 adoption			$ 216		$ 216

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands		12 Months Ended
		Dec. 31, 2017	Dec. 31, 2016
OPERATING ACTIVITIES
Net loss		$ (20,707)	$ (222)
Adjustments to reconcile net loss to net cash provided by operating activities:
Provision for doubtful accounts		5,641	5,631
Depreciation		6,963	6,895
Loss on disposal of medical equipment		207	641
Gain on sale of medical equipment		(1,797)	(1,231)
Amortization of intangible assets		5,560	3,849
Asset impairment charges		993
Amortization of deferred debt issuance costs		28	31
Stock-based compensation expense		682	462
Deferred income tax benefit (expense)		15,389	(240)
Changes in Assets - (Increase)/Decrease:
Accounts receivable		(5,445)	(4,589)
Inventories		402	(250)
Other current assets		(100)	(88)
Other assets		119	166
Changes in Liabilities - Increase/(Decrease):
Accounts payable and other liabilities		(352)	(3,146)
NET CASH PROVIDED BY OPERATING ACTIVITIES		7,583	7,909
INVESTING ACTIVITIES
Acquisitions			(370)
Purchases of medical equipment		(3,299)	(5,101)
Purchases of property and equipment		(104)	(168)
Purchases of intangible assets		(192)	(3,526)
Proceeds from sale of medical equipment		4,648	3,821
NET CASH PROVIDED BY (USED IN) INVESTING ACTIVITIES		1,053	(5,344)
FINANCING ACTIVITIES
Principal payments on term loans and capital lease obligations		(37,466)	(66,999)
Cash proceeds from bank loans and revolving credit facility		28,866	66,892
Debt Issuance Costs		(38)	(7)
Cash Proceeds - Stock Plans		131	204
Common stock repurchased to satisfy taxes on stock based compensation		(58)	(75)
NET CASH (USED IN) PROVIDED BY FINANCING ACTIVITIES		(8,565)	15
Net change in cash and cash equivalents		71	2,580
Cash and cash equivalents, beginning of year		3,398	818
Cash and cash equivalents, end of year		3,469	3,398
SUPPLEMENTAL DISCLOSURES
Cash paid for interest		1,200	1,234
Cash paid for income taxes		139	105
NON-CASH TRANSACTIONS
Additions to medical equipment and property	[1]	549	429
Medical equipment acquired pursuant to a capital lease		$ 137	$ 2,675
[1]	Amounts consist of current liabilities for medical equipment that have not been included in investing activities. These amounts have not been paid for as of December 31, 2017 and 2016, respectively, but will be included as a cash outflow from investing activities for purchases of medical equipment and property when paid.

Note 1 - Basis of Presentation

Note 1 - Basis of Presentation and Nature of Operations	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Basis of Accounting [Text Block]	1. Basis of Presentation and Nature of Operations InfuSystem Holdings, Inc. and its consolidated subsidiaries (the “Company”) are a leading provider of infusion pumps and related products and services for patients in the home, oncology clinics, ambulatory surgery centers, and other sites of care from six The Company ’s core service is to supply electronic ambulatory infusion pumps and associated disposable supply kits to oncology clinics, infusion clinics and hospital outpatient chemotherapy clinics to be utilized in the treatment of a variety of cancers including colorectal cancer, pain management and other disease states. The majority of the Company’s pumps are electronic infusion pumps. Smiths Medical, Inc. supplies more than 10% In addition, the Company sells or rents new and pre-owned pole mounted and ambulatory infusion pumps to, and provides biomedical recertification, maintenance and repair services for , oncology practices, as well as other alternate site settings including home care and home infusion providers, skilled nursing facilities, pain centers and others. The Company also provides these products and services to customers in the small-hospital market. The Company purchases new and pre-owned pole mounted and ambulatory infusion pumps from a variety of sources on a non-exclusive basis. The Company repairs, refurbishes and provides biomedical certification for the devices as needed. The pumps are then available for sale, rental or to be used within the Company’s ambulatory infusion pump management service. The accompanying consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) and the rules and regulations of the U.S. Securities and Exchange Commission (“SEC”).

Note 2 - Summary of Significant

Note 2 - Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Significant Accounting Policies [Text Block]	2. Summary of Significant Accounting Policies Presentation in the Consolidated Statements The Company rents and sells medical equipment. Management believes that the predominant source of revenues and cash flows from this medical equipment is from rentals and most equipment purchased is likely to be rented prior to being sold. Accordingly, the Company has concluded that (i) the assets specifically supporting its two Principles of Consolidation The consolidated financial statements include the accounts of the Company and all wholly owned organizations. All intercompany transactions and account balances have been eliminated in consolidation. Segments The Company operates in one reportable segment based on management’s view of its business for purposes of evaluating performance and making operating decisions. The Company ’s approach is to make operational decisions and assess performance based on delivering products and services that together provide solutions to its customer base utilizing a functional management structure. Based upon this business model, the chief operating decision maker only reviews consolidated financial information. Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates, assumptions and judgments that affect the amounts reported in the financial statements, including the notes thereto. The Company considers critical accounting policies to be those that require more significant judgments and estimates in the preparation of its consolidated financial statements, including the following: revenue recognition, which includes contractual adjustments, accounts receivable and allowance for doubtful accounts, sales return allowances, inventory reserves, long lived assets, intangible assets valuations and income tax valuations. Management relies on historical experience and other assumptions believed to be reasonable in making its judgment and estimates. Actual results could differ materially from those estimates. Business Combinations The Company accounts for all business combinations using the acquisition method of accounting, which allocates the fair value of the purchase consideration to the tangible and intangible assets acquired and liabilities assumed based on their estimated fair values. The excess of the purchase consideration over the fair values of these identifiable assets and liabilities is recorded as goodwill. When determining the fair values of assets acquired and liabilities assumed, management makes significant estimates and assumptions. The Company may third not one Cash and Cash Equivalents The Company considers all highly liquid investments with original maturities of three The Company maintains its cash and cash equivalents primarily with two Accounts Receivable , Allowance for Doubtful Accounts and Contractual Allowances Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenues and accounts receivable at their net realizable value . Accounts receivable are reported at the estimated net realizable amounts from patients, third third third not Due to continuing changes in the health care industry and third ’s estimates could change in the near term, which could have a material impact on the Company’s consolidated business, financial position, results of operations and cash flows. Following is an analysis of the allowance for doubtful accounts for the Company for the years ended December 31 Balance at beginning of Year Charged to costs and expenses Deductions (1) Balance at end of Year Allowance for doubtful accounts — 2017 $ 4,989 $ 5,641 $ (4,116 ) $ 6,514 Allowance for doubtful accounts — 2016 $ 4,737 $ 5,631 $ (5,379 ) $ 4,989 ( 1 Inventories The Company’s inventories consist of disposable products and related parts and supplies used in conjunction with medical equipment and are stated at the lower of cost ( first first $0.1 $0.2 December 31, 2017 2016. Medical Equipment Medical Equipment (“ME”) consists of equipment that the Company purchases from third 1 2 seven not $0.5 $0.6 December 31, 2017 2016. Property and Equipment Property and equipment is stated at acquired cost and depreciated using the straight-line method over the estimated useful lives of the related assets, ranging from three seven Externally purchased information technology software and hardware are depreciated over three five Intangible Assets Intangible assets consist of trade names, physician and customer relationships, non-compete agreements and software. The physician and customer relationships and non-compete agreements arose primarily from the acquisitions of ISI and First Biomedical in 2010 2015. fifteen twenty two five three not Management tests indefinite life trade names for impairment annually or as often as deemed necessary. The impairment test for intangible assets with indefinite lives consists of a comparison of the fair value of the intangible assets with their carrying amounts. If the carrying value of the intangible assets exceeds the fair value, an impairment loss is recognized in an amount equal to that excess. The Company determines the fair value of its intangibles assets with indefinite lives (trade names) through the royalty relief income valuation approach. The Company performed its annual impairment analysis as of October 2017 no Software Capitalization and Depreciation We capitalize certain costs incurred in connection with obtaining or developing internal-use software, including payroll and payroll-related costs for employees who are directly associated with the internal-use software project, external direct costs of materials and services and interest costs while developing the software. Capitalized software costs are included in intangible assets, net and are amortized using the straight-line method over the estimated useful life of three five $0.2 $3.5 December 31, 2017 2016, $3.1 2017 $1.7 2016. Impairment of Long-Lived Assets Long-lived assets held for use, which includes property and equipment and amortizable intangible assets, are reviewed for impairment when events or changes in circumstances indicate that their carrying value may not If an impairment indicator exists, the Company assesses the asset or asset group for recoverability. Recoverability of these assets is determined based upon the expected undiscounted future net cash flows from the operations to which the assets relate, utilizing management’s best estimates, appropriate assumptions and projections at the time. If the carrying value is determined not The Company performed an impairment analysis in December 2017 no not $1.0 December 31, 2017. not December 31, 2016. Operating and Capital Leases L eases for all of our corporate and other operating locations are under operating leases and the Company recognizes rent expense on a straight-line basis over the lease terms. Rent holidays and rent escalation clauses, which provide for scheduled rent increases during the lease term, are taken into account in computing straight-line rent expense included in our consolidated statements of operations. The difference between the rent due under the stated periods of the leases compared to that of the straight-line basis is recorded as a component of other long-term liabilities in the consolidated balance sheets. Landlord funded lease incentives, including tenant improvement allowances provided for our benefit, are recorded as leasehold improvement assets and as deferred rent in the consolidated balance sheets and are amortized to depreciation expense and as rent expense credits, respectively. The Company periodically 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. Under the terms of all such capital leases, the Company does not not 3.6% December 31, 2017. Revenue Recognition The Company recogn izes revenue for selling, renting and servicing new and pre-owned infusion pumps and other medical equipment to oncology practices as well as other alternate site settings including home care and home infusion providers, skilled nursing facilities, pain centers and others, and billing the oncology practice, or the third third third Customer Concentration Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenues and accounts receivable at their net realizable values. Inherent in these estimates is the risk that the estimates will have to be revised or updated as additional information becomes available. Specifically, the complexity of many third may third For 2017, the Company’s largest contracted payor was a national association comprised of multiple members, which in the aggregate, accounted for approximately 24% 13% December 31, 2017, 2017, 6% 6% December 31, 2017, For 2016, the Company’s largest contracted payor was Medicare, which accounted for approximately 21% 13% December 31, 2016, 19% 13% December 31, 2016, We also contract with various other third no 10% third Income Taxes The Company recognizes deferred income tax liabilities and assets based on: ( 1 2 Deferred income tax (expense) benefit results from the change in net deferred tax assets or deferred tax liabilities. A valuation allowance is recorded when, in the opinion of management, it is more likely than not not Provisions for federal, state and foreign taxes are calculated based on reported pre-tax earnings based on current tax law and include the cumulative effect of any changes in tax rates from those used previously in determining deferred tax assets and liabilities. Certain items of income and expense are recognized in different time periods for financial reporting than for income tax purposes; thus, such provisions differ from the amounts currently receivable or payable. The Company follows a two First it evaluates the tax position for recognition by determining if the weight of available evidence indicates that it is more-likely-than- not not 50% Share Based Payments The determination of the fair value of stock option awards and stock appreciation rights (collectively, “Share-Based Awards”) on the date of grant using option-pricing models is affected by the Company’s stock price, as well as assumptions regarding a number of other inputs using the Black-Scholes pricing model. These variables include the Company’s expected stock price volatility over the expected term of the Share-Based Awards, actual and projected employee stock option exercise behaviors, risk-free interest rates and expected dividends. The expected volatility is based on the historical volatility. The Company uses historical data to estimate Share-Based Awards exercise and forfeiture rates. The expected term represents the period over which the Share-Based Awards are expected to be outstanding. The dividend yield is an estimate of the expected dividend yield on the Company’s stock. The risk-free rate is based on U.S. Treasury yields in effect at the time of the grant for the expected term of the Share-Based Awards. All Share-Based Awards are amortized based on their graded vesting over the requisite service period of the awards. Compensation costs are recognized over the requisite service period using the accelerated method and included in selling expenses and general and administrative expenses, based upon the department to which the associated employee or non-employee resides. Deferred Debt Issuance Costs Capitalized debt issuance costs as of December 31, 201 7 2016 Earnings Per Share The Company reports its earnings per share in accordance with the “Earnings Per Share” topic of the Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”), which requires the presentation of both basic and diluted earnings per share on the statements of operations. The diluted weighted average common shares include adjustments for the potential effects of outstanding stock options but only in the periods in which such effect is dilutive under the treasury stock method. Included in our basic and diluted weighted average common shares are those stock options and common stock shares due to participants granted from the 2014 In accordance with this topic, the following table reconciles income and share amounts utilized to calculate basic and diluted net loss per common share (in thousands, except shares): 2017 2016 Numerator: Net loss (in thousands) $ (20,707 ) $ (222 ) Denominator: Weighted average common shares outstanding: Basic 22,739,651 22,617,901 Dilutive effect of restricted shares, options and non-vested share awards - - Diluted 22,739,651 22,617,901 Antidilutive awards: 490,428 90,715 S tock options of 0.5 0.1 not December 31, 2017 2016, Fair Value of Financial Instruments The carrying amounts reported in the consolidated balance sheets as of December 31, 2017 2016 The Company has adopted ASC 820, For financial assets and liabilities measured at fair value on a recurring basis, fair value is the price the Company would receive to sell an asset or pay to transfer a liability in an orderly transaction with a market participant at the measurement date. A three Level I quoted prices in active markets for identical instruments; Level II quoted prices in active markets for similar instruments, quoted prices for identical instruments in markets hat are not of the instrument; and Level III significant inputs to the valuation model are unobservable. Recent Accounting Pronouncements and Developments In May 2017, ) No. 2017 09, 718. December 15, 2017 ( January 1, 2018 not In January 2017, No. 2017 04, 350 2 December 15, 2019 ( January 1, 2020 January 1, 2017. not position, results of operations, cash flows and/or disclosures. In May 2014, 2014 09, 606 605, 605 August 2015, 2015 14, – Deferral of the Effective Date”, which defers the effective date of ASU 2014 09 December 15, 2017, 2016, 2016 08, 2016 10, 2016 12, The Company ’s approach to analyze the impact of the new standard on its revenue contracts included a review of existing contracts with customers for each revenue stream, an evaluation of the specific terms of those contracts and the appropriate treatment under the new standards, and a comparison of that new treatment to its existing accounting policies to identify differences. The Company will adopt the requirements of the new standard on January 1, 2018 The Company identified the same performance obligation under Topic 606 605. The new standard requires the Company to estimate these amounts. The Company anticipates that the timing and measurement of revenue will be consistent with its current revenue recognition although its approach to revenue recognition will now be based on the transfer of control. As a result, there will be no January 1, 2018. The Company has determined the impact of adopting the standard on its control framework and notes minimal, insignificant changes to its system and other controls process. The Company is finalizing the impact of Topic 606 first 2018. In February 2016, No. 2016 02, 842 2016 02” 2016 02, 2016 02 2016 02 December 15, 2018, In March 2016, No. 2016 09, — Stock Compensation (Topic 718 2016 09” December 15, 2016. January 1, 2017, 2016 09. $0.2 $0.2 January 1, 2017 December 31, 2016 ( In June 2016, No. 2016 13, Financial Instruments (Topic 326 2016 13” 2016 13 not 2016 13 January 1, 2020. 2016 13. In August 2016, No. 2016 15, 230 2016 15” 2016 15 December 15, 2017, 2016 15 January 1, 2018 not ’s consolidated financial position, results of operations, cash flows and/or disclosures. In November 2015, No. 2015 17, 740 2015 17” 2015 17 first 2017 may not an initial balance sheet reclassification of $2.7 December 31, 2017, not not no $11.4 December 31, 2017.

Note 3 - Medical Equipment

Note 3 - Medical Equipment	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Medical Equipment and Property Disclosure [Text Block]	3 . Medical Equipment Medical equipment consisted of the following as of December 31 2017 2016 Medical Equipment held for sale or rental $ 1,567 $ 1,642 Medical Equipment in rental service 57,928 59,034 Medical Equipment in rental service - pump reserve (482 ) (551 ) Accumulated depreciation (34,077 ) (30,447 ) Medical Equipment in rental service - net 23,369 28,036 Total $ 24,936 $ 29,678 Depreciation expense for the years ended December 31, 201 7 2016 $6.5 $6.3

Note 4 - Property and Equipment

Note 4 - Property and Equipment	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Property, Plant and Equipment Disclosure [Text Block]	4 . Property and Equipment Property and equipment consisted of the following as of December 31 2017 Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 3,824 $ (3,277 ) $ 547 Automobiles 118 (85 ) 33 Leasehold improvements 2,187 (1,134 ) 1,053 Total $ 6,129 $ (4,496 ) $ 1,633 2016 Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 3,809 $ (3,071 ) $ 738 Automobiles 129 (83 ) 46 Leasehold improvements 2,177 (964 ) 1,213 Total $ 6,115 $ (4,118 ) $ 1,997 Depreciation expense for each of the years ended December 31, 2017 2016 $0.5 $0.6

Note 5 - Intangible Assets

Note 5 - Intangible Assets	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Intangible Assets Disclosure [Text Block]	5 . Intangible Assets The carrying amount and accumulated amortization of intangible assets as of December 31 are as follows (in thousands): 2017 Gross Assets Accumulated Amortization Net Nonamortizable intangible assets Trade names $ 2,000 $ - $ 2,000 Amortizable intangible assets Trade names 23 23 - Physician and customer relationships 36,534 21,801 14,733 Non-compete agreements 1,136 1,125 11 Software 11,230 3,460 7,770 Total nonamortizable and amortizable intangible assets $ 50,923 $ 26,409 $ 24,514 2016 Gross Assets Accumulated Amortization Net Nonamortizable intangible assets Trade names $ 2,000 $ - $ 2,000 Amortizable intangible assets Trade names 23 23 - Physician and customer relationships 36,534 19,427 17,107 Non-compete agreements 1,136 1,064 72 Software 13,745 1,685 12,060 Total nonamortizable and amortizable intangible assets $ 53,438 $ 22,199 $ 31,239 The weighted average remaining lives of physician and customer relationships, non-compete agreements and software are 4 1 2 December 31, 2017. The Company performed an impairment analysis in December 2017 no not $1.0 2017. Amortization expense for intangible assets for the years ended December 31, 201 7 2016 $5.6 $3.8 five December 31, 2017 2018 2019 2020 2021 2022 2023 and thereafter Amortization expense $ 4,649 $ 4,402 $ 4,285 $ 3,930 $ 2,051 $ 3,197

Note 6 - Debt

Note 6 - Debt	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Debt Disclosure [Text Block]	6 . Debt On March 23, 2015, $27.0 $8.0 $10.0 March 23, 2020 The Borrowers drew $27.0 November 30, 2012, April 20, 2015, $8.0 March 23, 2016. On December 5, 2016, not $32 $5 ’s drawings under the revolving credit line under the Credit Facility; (ii) extending the maturity date of the Term Loan and the revolving credit line to December 5, 2021; ( $1.3 2.75 1.0 December 31, 2015 March 31, 2017, 2.50 1.0 March 31, 2017 March 31, 2018 2.25 1.00 March 31, 2018. On March 22, 2017, not 2.75 1.0 December 31, 2015 March 31, 2018, 2.50 1.0 March 31, 2018 March 31, 2019 2.25 1.00 March 31, 2019. As of March 31, 2017, he Company breached a financial covenant under its Credit Facility, which resulted in an event of default under the Credit Facility. Specifically, the Company was not March 31, 2017 2.75 2.96. May 10, 2017, one not No On June 28, 2017, not (i) amendment of the chart within the definition of “Applicable Rate” in Section 1.01 Leverage Ratio CBFR Eurodollar Spread Commitment Level I < 1.5:1.0 - 1.00% 2.00% 0.25% Level II < 2.0:1.0 to 1.0 but > -0.75% 2.25% 0.25% Level III < 2.5:1.0 to 1.0 but > - 0.50% 2.50% 0.25% Level IV < 3.0:1.0 to 1.0 but > 0.00% 2.75% 0.25% Level V ≥ 3.0:1.0 0.25% 3.00% 0.25% and further amend ment of the definition of “Applicable Rate” in Section 1.01 first June 30, 2017.”; (ii) amend ment of the definition of “Fixed Charge Coverage Ratio” in Section 1.01 zero (iii) amend ment of clause (f)(ii) in the definition of “Permitted Acquisition” in Section 1.01 “$10,000,000” “$5,000,000” “$25,000,000” “$12,500,000.”; (iv) add ition of the following definition of “Excess Cash Flow” to Section 1.01 “Excess Cash Flow” means, for any fiscal year of the Company, (a) EBITDA for such fiscal year, minus (b) Capital Expenditures made or incurred during such fiscal year minus (c) Fixed Charges for such fiscal year. (v) amendment of Section 2.08 (b) The Borrowers hereby unconditionally agree that the Term A Loans and the Term B Loans shall be replaced and refinanced in full as of the First Amendment Effective Date with a Term Loan in an aggregate amount equal to $32,000,000 2.01 $30,665,999.98, 2.01 June 30, 2017, September 30, 2017 December 31, 2017 $577,500 2.09 2.16 March, 2018 March, June, September December $766,650 2.09 2.16 not (vi) amendment of Section 2.09 (d) All prepayments required to be made pursuant to Section 2.09 first one first second third first All prepayments required to be made pursuant to Section 2.09 first second one first third first (vii) add ition of a new Section 2.09 (f) Until the latest of the Revolving Credit Maturity Date, the Term A Maturity Date, the Term B Maturity Date or the Term Maturity Date, as the case may 2.09 ten ’s annual audited financial statements for the immediately preceding fiscal year are delivered pursuant to Section 5.01 5.01, seventy-five 75% 2.5 1.0 fifty 50% 2.5 1.0 2.0 1.0 zero 0% 2.0 1.0 (viii) amend ment of Section 6.04 “$5,000,000” “$2,500,000.”; (ix) amendment of Sections 6.12 (a) Leverage Ratio . The Borrowers will not 4.0 1.0 December 31, 2017, ( 3.75 1.0 December 31, 2017 June 30, 2018, ( 3.50 1.0 June 30, 2018 December 31, 2018, 3.00 1.00 December 31, 2018. (b) Fixed Charge Coverage Ratio . The Borrowers will not 1.15:1.0 March 31, 2018, 1.25:1.0 March 31, 2018. As of Decembe r 31, 2017, Simultaneous with the execution of Third Amendment, the Company entered into a Patent and Trademark Security Agreement, which replaces the Patent and Trademark Security Agreement entered into on March 23, 2015 As a result of the changes to the definition of ‘Leverage Ratio” and “Fixed Charge Coverage Ratio” within the Third Amendment, the Company will have increased flexibility. The change to the definition of “Applicable Rate” will effectively increase the Company’s interest rate under the Chase Credit Agreement by 50 To secure repayment of the obligations of the Borrowers, each Borrower has granted to the Lender, for the benefit of various secured parties, a first The availability under the Revolver is based upon the Borrowers ’ eligible accounts receivable and eligible inventory and is comprised as follows (in thousands): December 31, December 31, 2017 2016 Revolver: Gross Availability $ 10,000 $ 10,000 Outstanding Draws - - Letter of Credit (750 ) - Landlord Reserves (45 ) (45 ) Availability on Revolver $ 9,205 $ 9,955 The Company had approximate future maturities of loans as of December 31, 2017 2018 2019 2020 2021 2022 Total Term Loan $ 3,067 $ 3,067 $ 3,067 $ 19,310 $ - $ 28,511 Unamortized value of debt issuance costs (28 ) (30 ) (31 ) (31 ) - (120 ) Total $ 3,039 $ 3,037 $ 3,036 $ 19,279 $ - $ 28,391 The following is a breakdown of the Company ’s current and long-term debt as of December 31, 2017 December 31, 2016 ( December 31, 2017 December 31, 2016 Current Portion of Long-Term Debt Long-Term Debt Total Current Portion of Long-Term Debt Long-Term Debt Total Term Loan $ 3,067 $ 25,444 $ 28,511 Term Loans $ 5,336 $ 26,664 $ 32,000 Unamortized value of debt issuance costs $ (28 ) $ (92 ) (120 ) Unamortized value of debt issuance costs $ (22 ) $ (87 ) (109 ) Revolver - - - Revolver - - - Total $ 3,039 $ 25,352 $ 28,391 Total $ 5,314 $ 26,577 $ 31,891 As of December 31, 2017, 2.00% 3.00% 30 2.50%, 1.00% 0.25%. December 31, 2017 4.32% 1.57% 2.75%

Note 7 - Income Taxes

Note 7 - Income Taxes	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Income Tax Disclosure [Text Block]	7 . Income Taxes In December 2017, “2017 2017 many changes to existing U.S. tax laws that impact the Company, most notably a reduction of the U.S. corporate income tax rate from 35% 21% December 31, 2017. 2017 one September 27, 2017 2018, The Company recognized the income tax effects of the 2017 2017 No. 118, 740, period in which the 2017 2017 740 2017 740 2017 2017 may may may 2017 The changes to existing U.S. tax laws as a result of the 2017 Company’s federal income taxes are as follows: Reduction of the U.S. Corporate Income Tax Rate The Company measures deferred tax assets and liabilities using enacted tax rates that will apply in the years in which the temporary differences are expected to be recovered or paid. Accordingly, the Company ’s deferred tax assets and liabilities were remeasured to reflect the reduction in the U.S. corporate income tax rate from 35% 21%, $5.6 December 31, 2017 $5.6 December 31, 2017. The following table summarizes loss before income taxes for the years ended December 31 ( 2017 2016 U.S loss $ (5,419 ) $ (600 ) Non-U.S. income 162 236 Loss before income taxes $ (5,257 ) $ (364 ) The following table summarizes the Company’s components of the consolidated provision for income taxes for the years ended December 31 2017 2016 U.S Federal income tax (expense) benefit Current $ 73 $ - Deferred (13,830 ) 157 Total U.S. Federal income tax (expense) benefit (13,757 ) 157 State and local income tax (expense) benefit Current (45 ) (58 ) Deferred (1,560 ) 83 Total state and local income tax (expense) benefit (1,605 ) 25 Foreign income tax (expense) benefit Current (88 ) (40 ) Total income tax (expense) benefit $ (15,450 ) $ 142 The following table summarizes activity related to the Company ’s valuation allowance for the years ended December 31 ( 2017 2016 Valuation allowance at the Beginning of Period $ - $ - Income tax expense (11,435 ) - Release of valuation allowance - - Valuation allowance at the End of Period $ (11,435 ) $ - The following table summarizes a reconciliation of the effective income tax rate to the U.S. federal statutory rate for the years ended December 31: 2017 2016 Income tax expense at the statutory rate 34.00 % 34.00 % State and local income tax expense 4.60 % 9.16 % Foreign income tax (1.17 %) (3.79 %) Permanent differences (8.25 %) (38.40 %) Research & development credits 0.00 % 37.81 % Increase in valuation allowance (217.49 %) 0.00 % Impacts related to the 2017 Tax Act (105.95 %) 0.00 % Other adjustments 0.37 % 0.31 % Effective income tax rate (293.89 %) 39.09 % The following table summarizes the temporary differences and carryforwards that give rise to deferred tax assets and liabilities as of December 31 ( 2017 2016 Deferred Federal tax assets – Bad debt reserves $ 1,375 $ 1,710 Stock based compensation 305 668 Net operating loss 7,319 8,184 Accrued compensation 249 280 Alternative minimum tax credit - 73 Inventories 18 69 Accrued rent 30 46 Goodwill and intangible assets 3,323 6,675 Research & development credits 533 534 Other credits 5 5 Other 103 189 Total deferred Federal tax assets 13,260 18,433 Less: valuation allowance (9,599 ) - Net deferred tax assets 3,661 18,433 Deferred Federal tax liabilities – Depreciation and asset basis differences (3,672 ) (4,725 ) Other (51 ) (157 ) Total deferred Federal tax liabilities (3,723 ) (4,882 ) Net deferred Federal tax assets (62 ) 13,551 Net deferred state and local tax assets 1,836 1,560 Less: valuation allowance (1,836 ) - Net deferred tax (liabilities) assets $ (62 ) $ 15,111 As of December 31, 201 7 2016, $0.0 $0.6 third As of December 31, 201 7 2016, $34.9 $24.1 The Company ’s federal net operating loss carryforwards of approximately $34.9 2028. $1.4 5 20 2018, 2018. The Company ’s realization of its deferred tax assets is dependent upon many factors, including, but not December 31, 2017, not not no $11.4 December 31, 2017. The Company had no s for the years ended December 31, 2017 2016. The Company is subject to taxation for Federal and various state jurisdictions in the United States and Canada. The Federal income tax returns of the Company for the years 2014 2017 four 2013 2017 T he Company completed an update to its analysis of past ownership (as defined under Section 382 not December 31, 2010. December 31, 2010 December 31, 2010. $1.8 remaining pre-ownership change net operating loss carryforwards of $4.7

Note 8 - Commitments and Contin

Note 8 - Commitments and Contingencies	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	8 . Commitments and Contingencies From time to time in the ordinary course of its business, the Company may may not the Company, whether meritorious or not, not not On January 29, 2018, the Company received notice that the U.S. District Court for the Central District of California (the “Court”) (Case No. 2:16 08295 November 8, 2016 two June 19, 2017, December 15, 2017, first December 20, 2017, January 19, 2018. January 19, 2018, January 29, 2018. February 28, 2018, 9th The Company is not ’s financial condition, results of operations or cash flows.

Note 9 - Leases

Note 9 - Leases	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Leases of Lessee Disclosure [Text Block]	9 . Leases The Company leases office space, service facility centers and equipment under non-cancelable capital and operating lease arrangements. The Company periodically enter 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 weighted average interest rate under capital leases was 3.6% December 31, 2017. Future minimum rental payments pursuant to leases that have an initial or remaining non-cancelable lease term in excess of one December 31, 201 7 Capital Leases Operating Leases Total 2018 $ 514 $ 1,326 $ 1,840 2019 33 1,225 1,258 2020 - 695 695 2021 - 181 181 2022 - 191 191 Thereafter - 747 747 Total require payments $ 547 $ 4,365 $ 4,912 Less amounts representing interest (3.5%) (9 ) Present value of minimum lease payments 538 Less current maturities (505 ) Long-term capital lease liability $ 33 At December 31, 201 7 2016, $14.0 $13.9 $6.1 $4.2 The Company had minimum future operating lease commitments, mainly r elated to its leased facilities. Related rental expense for facilities and other equipment from third $1.0 December 31, 2017 2016,

Note 10 - Share-based Compensat

Note 10 - Share-based Compensation	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Disclosure of Compensation Related Costs, Share-based Payments [Text Block]	1 0 . Share-based Compensation All stock option awards are amortized based on their graded vesting over the requisite service period of the awards. Compensation costs are recognized over the requisite service period using the accelerated method and included in selling expenses and general and administrative expenses, based upon the department to which the associated employee or non-employee resides. Stock Incentive Plan The Company has various stock option and stock-based incentive plans and agreements whereby stock options , restricted stock awards, and stock appreciation rights (“SARs”) were made available to certain employees, directors and others approved by the Company’s Board of Directors (the “Board) or Compensation Committee. Stock options are granted at, or above, fair market value and generally expire in three ten four 1 one may In 2007, 2007 (the “Plan”) providing for the issuance of a maximum of 2.0 May 27, 2011, 3.0 no 0.1 April 23, 2014, 2014 “2014 2014 2014 2014 2.0 December 31, 2017, 0.1 2014 2014 2007 2.0 T he Company granted stock options under the 2014 December 31, 2017 2016, Shares Forgone to Satisfy Minimum Statutory Withholdings During the years ended December 31, 201 7 2016, December 31, 2017 2016, 0.1 Stock Appreciation Rights (“SARs”) As of December 31, 2017, 200,000 ( 1 100,000 will vest and become exercisable during the period beginning on December 31, 2018, $3.00 ten 10 January 1, 2018, December 31, 2018; ( 2 100,000 will vest and become exercisable during the period beginning on December 31, 2018, ninety 90% 2018 As of December 31, 2017, $0.1 expense was recorded for outstanding SARs. Restricted Shares During the years ended December 31, 2017 2016, not The following table summarizes restricted share activity , excluding the Company’s employee stock purchase plan, for the years ended December 31: Weighted average grant Number of date fair Aggregate shares value fair value Unvested at December 31, 2015 170,832 $ 2.09 Granted - - Vested (64,182 ) 1.74 $ 236,161 Vested shares forgone to satisfy minimum statutory withholding (16,484 ) 2.81 $ 49,592 Forfeitures (32,833 ) 2.18 Unvested at December 31, 2016 57,333 2.21 Granted - - Vested (15,730 ) 0.88 $ 83,003 Vested shares forgone to satisfy minimum statutory withholding (20,811 ) 2.80 $ 51,304 Forfeitures (8,333 ) 2.60 Unvested at December 31, 2017 12,459 $ 2.61 As of December 31, 201 7, $0.1 2020. Employee Stock Purchase Plan In May 2014, October 2014 ( 200,000 15% six September 7, 2016, 350,000 No may $25,000 may December 31, 2017, 294,863 December 31: 2017 2016 Compensation expense $ 49,150 $ 113,531 Shares of stock sold to employees 68,958 88,109 Weighted average fair value per ESPP award $ 2.21 $ 2.73 Stock Options The Company calculates the fair value of stock option awards using the Black-Scholes option pricing model, which incorporates various assumptions including volatility, expected term, risk-free interest rates and dividend yields. The expected volatility assumption is based on historical volatility of the Company’s common stock over the most recent period commensurate with the expected life of the stock option granted. The Company uses historical volatility because management believes such volatility is representative of prospective trends. The risk-free interest rate assumption is based upon observed interest rates appropriate for the expected life of the stock option awarded. The Company determines expected lives as the average of the vesting period and the contractual period. Dividend yields have not not During the year ended December 31, 201 7, 1.1 0.3 five 12 December 31, 2016, 0.6 none December 31: Weighted- Average Number Weighted- Remaining Aggregate of Authorized Average Exercise Contractual Intrinsic 2007 Plan (Options) Shares Price Term (in Years) Value Outstanding at December 31, 2015 488,332 $ 2.31 0.25 $ 118,899 Granted - - Exercised - - Exercised shares forgone to satisfy minimum statutory withholding - - Cashless exercise - - Forfeited - - Outstanding at December 31, 2016 488,332 $ 2.31 0.25 $ 118,899 Granted - - Exercised (25,037 ) 1.51 86,900 Exercised shares forgone to satisfy minimum statutory withholding (13,245 ) 2.32 Cashless exercise (71,718 ) 2.32 Forfeited (245,000 ) 2.83 Outstanding at December 31, 2017 133,332 $ 1.99 - $ 40,716 Exercisable at December 31, 2017 133,332 $ 1.95 Aggregate Intrinsic Value = Excess of market value over the option exercise price of all in-the-money stock options. Weighted- Average Number Weighted- Remaining Aggregate of Authorized Average Exercise Contractual Intrinsic 2014 Plan (Options) Shares Price Term (in Years) Value Outstanding at December 31, 2015 970,000 $ 2.79 3.58 $ 222,200 Granted 600,000 $ 2.76 4.60 Exercised (1,866 ) 2.69 Exercised shares forgone to satisfy minimum statutory withholding (798 ) 2.69 Cashless exercise (12,614 ) 2.69 Forfeited (304,723 ) 2.70 Outstanding at December 31, 2016 1,249,999 $ 2.80 4.26 $ - Exercisable at December 31, 2016 616,597 $ 2.87 Granted 1,087,500 2.09 3.13 Exercised - - Exercised shares forgone to satisfy minimum statutory withholding - - Cashless exercise - - Forfeited (374,999 ) 2.61 Outstanding at December 31, 2017 1,962,500 $ 2.44 3.18 $ - Exercisable at December 31, 2017 955,868 $ 2.69 Weighted- Average Number Weighted- Remaining Aggregate Inducement of Authorized Average Exercise Contractual Intrinsic Options Shares ( 1 ) Price Term (in Years) Value Outstanding at December 31, 2015 800,000 $ 2.25 2.90 $ 616,000 Granted - - - - Exercised - - - - Forfeited - - - - Outstanding at December 31, 2016 800,000 $ 2.25 2.26 $ 240,000 Granted - - - - Exercised - - - - Forfeited (800,000 ) - - - Outstanding at December 31, 2017 - $ - - $ - Exercisable at December 31, 2017 - $ - Aggregate Intrinsic Value = Excess of market value over the option exercise price of all in-the-money stock options. ( 1 800,000 The following table summarizes information about stock options outstanding at December 31, 201 7: Options Outstanding Options Exercisable 2007 Plan (Options): Range of Exercise Prices Number of Shares Outstanding Weighted-Average Remaining Contractual Life Weighted-Average Exercise Price Number of Shares Exercisable Weighted-Average Exercise Price $1.76 - $2.00 91,666 - 1.93 91,666 1.93 $2.01 - $3.00 41,666 - 2.01 41,666 2.01 Outstanding at December 31, 2017 133,332 - $ 2.31 133,332 $ 1.95 Options Outstanding Options Exercisable 2014 Plan (Options): Range of Exercise Prices Number of Shares Outstanding Weighted-Average Remaining Contractual Life Weighted-Average Exercise Price Number of Shares Exercisable Weighted-Average Exercise Price $2.01 - $3.00 1,962,500 3.18 $ 2.44 955,868 $ 2.69 Outstanding at December 31, 2017 1,962,500 3.18 $ 2.44 955,868 $ 2.69 The following is the average fair value per share estimated on the date of grant and the assumptions used for options granted during the years ended December 31: Stock Options: 2017 2016 Expected volatility 30% to 69% 35% Risk free interest rate 0.69% to 2.05% 0.69% Expected lives at date of grant (in years) 3.93 5.01 Weighted average fair value of options granted $2.09 $2.76 Stock-based compensation expense The following table presents the total stock-based compensation expense, which is included in selling, general and administrative expenses for the years ended December 31 ( ): 2017 2016 Restricted share expense $ 48 $ 151 Stock option expense 634 311 Total stock-based compensation expense $ 682 $ 462 Common Share Repurchase Program On March 12, 2018, 1 may may 10b5 1 not may December 31, 2017 2016, not

Note 11 - Employee Benefit Plan

Note 11 - Employee Benefit Plans	12 Months Ended
	Dec. 31, 2017
Notes to Financial Statements
Pension and Other Postretirement Benefits Disclosure [Text Block]	1 1 . Employee Benefit Plans The Company has defined contribution plan in which the Company makes matching contributions for a certain percentage of employee contributions. For the years ended December 31, 2017 2016, $0.6 $0.7 not

Significant Accounting Policies

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2017
Accounting Policies [Abstract]
Presentation in Consolidated Statements [Policy Text Block]	Presentation in the Consolidated Statements The Company rents and sells medical equipment. Management believes that the predominant source of revenues and cash flows from this medical equipment is from rentals and most equipment purchased is likely to be rented prior to being sold. Accordingly, the Company has concluded that (i) the assets specifically supporting its two
Consolidation, Policy [Policy Text Block]	Principles of Consolidation The consolidated financial statements include the accounts of the Company and all wholly owned organizations. All intercompany transactions and account balances have been eliminated in consolidation.
Segment Reporting, Policy [Policy Text Block]	Segments The Company operates in one reportable segment based on management’s view of its business for purposes of evaluating performance and making operating decisions. The Company ’s approach is to make operational decisions and assess performance based on delivering products and services that together provide solutions to its customer base utilizing a functional management structure. Based upon this business model, the chief operating decision maker only reviews consolidated financial information.
Use of Estimates, Policy [Policy Text Block]	Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates, assumptions and judgments that affect the amounts reported in the financial statements, including the notes thereto. The Company considers critical accounting policies to be those that require more significant judgments and estimates in the preparation of its consolidated financial statements, including the following: revenue recognition, which includes contractual adjustments, accounts receivable and allowance for doubtful accounts, sales return allowances, inventory reserves, long lived assets, intangible assets valuations and income tax valuations. Management relies on historical experience and other assumptions believed to be reasonable in making its judgment and estimates. Actual results could differ materially from those estimates.
Business Combinations Policy [Policy Text Block]	Business Combinations The Company accounts for all business combinations using the acquisition method of accounting, which allocates the fair value of the purchase consideration to the tangible and intangible assets acquired and liabilities assumed based on their estimated fair values. The excess of the purchase consideration over the fair values of these identifiable assets and liabilities is recorded as goodwill. When determining the fair values of assets acquired and liabilities assumed, management makes significant estimates and assumptions. The Company may third not one
Cash and Cash Equivalents, Policy [Policy Text Block]	Cash and Cash Equivalents The Company considers all highly liquid investments with original maturities of three The Company maintains its cash and cash equivalents primarily with two
Trade and Other Accounts Receivable, Policy [Policy Text Block]	Accounts Receivable , Allowance for Doubtful Accounts and Contractual Allowances Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenues and accounts receivable at their net realizable value . Accounts receivable are reported at the estimated net realizable amounts from patients, third third third not Due to continuing changes in the health care industry and third ’s estimates could change in the near term, which could have a material impact on the Company’s consolidated business, financial position, results of operations and cash flows. Following is an analysis of the allowance for doubtful accounts for the Company for the years ended December 31 Balance at beginning of Year Charged to costs and expenses Deductions (1) Balance at end of Year Allowance for doubtful accounts — 2017 $ 4,989 $ 5,641 $ (4,116 ) $ 6,514 Allowance for doubtful accounts — 2016 $ 4,737 $ 5,631 $ (5,379 ) $ 4,989 ( 1
Inventory, Policy [Policy Text Block]	Inventories The Company’s inventories consist of disposable products and related parts and supplies used in conjunction with medical equipment and are stated at the lower of cost ( first first $0.1 $0.2 December 31, 2017 2016.
Medical Equipment [Policy Text Block]	Medical Equipment Medical Equipment (“ME”) consists of equipment that the Company purchases from third 1 2 seven not $0.5 $0.6 December 31, 2017 2016.
Property, Plant and Equipment, Policy [Policy Text Block]	Property and Equipment Property and equipment is stated at acquired cost and depreciated using the straight-line method over the estimated useful lives of the related assets, ranging from three seven Externally purchased information technology software and hardware are depreciated over three five
Goodwill and Intangible Assets, Intangible Assets, Policy [Policy Text Block]	Intangible Assets Intangible assets consist of trade names, physician and customer relationships, non-compete agreements and software. The physician and customer relationships and non-compete agreements arose primarily from the acquisitions of ISI and First Biomedical in 2010 2015. fifteen twenty two five three not Management tests indefinite life trade names for impairment annually or as often as deemed necessary. The impairment test for intangible assets with indefinite lives consists of a comparison of the fair value of the intangible assets with their carrying amounts. If the carrying value of the intangible assets exceeds the fair value, an impairment loss is recognized in an amount equal to that excess. The Company determines the fair value of its intangibles assets with indefinite lives (trade names) through the royalty relief income valuation approach. The Company performed its annual impairment analysis as of October 2017 no
Capitalization of Internal Costs, Policy [Policy Text Block]	Software Capitalization and Depreciation We capitalize certain costs incurred in connection with obtaining or developing internal-use software, including payroll and payroll-related costs for employees who are directly associated with the internal-use software project, external direct costs of materials and services and interest costs while developing the software. Capitalized software costs are included in intangible assets, net and are amortized using the straight-line method over the estimated useful life of three five $0.2 $3.5 December 31, 2017 2016, $3.1 2017 $1.7 2016.
Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]	Impairment of Long-Lived Assets Long-lived assets held for use, which includes property and equipment and amortizable intangible assets, are reviewed for impairment when events or changes in circumstances indicate that their carrying value may not If an impairment indicator exists, the Company assesses the asset or asset group for recoverability. Recoverability of these assets is determined based upon the expected undiscounted future net cash flows from the operations to which the assets relate, utilizing management’s best estimates, appropriate assumptions and projections at the time. If the carrying value is determined not The Company performed an impairment analysis in December 2017 no not $1.0 December 31, 2017. not December 31, 2016.
Lessee, Leases [Policy Text Block]	Operating and Capital Leases L eases for all of our corporate and other operating locations are under operating leases and the Company recognizes rent expense on a straight-line basis over the lease terms. Rent holidays and rent escalation clauses, which provide for scheduled rent increases during the lease term, are taken into account in computing straight-line rent expense included in our consolidated statements of operations. The difference between the rent due under the stated periods of the leases compared to that of the straight-line basis is recorded as a component of other long-term liabilities in the consolidated balance sheets. Landlord funded lease incentives, including tenant improvement allowances provided for our benefit, are recorded as leasehold improvement assets and as deferred rent in the consolidated balance sheets and are amortized to depreciation expense and as rent expense credits, respectively. The Company periodically 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. Under the terms of all such capital leases, the Company does not not 3.6% December 31, 2017.
Revenue Recognition, Policy [Policy Text Block]	Revenue Recognition The Company recogn izes revenue for selling, renting and servicing new and pre-owned infusion pumps and other medical equipment to oncology practices as well as other alternate site settings including home care and home infusion providers, skilled nursing facilities, pain centers and others, and billing the oncology practice, or the third third third
Concentration Risk, Credit Risk, Policy [Policy Text Block]	Customer Concentration Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenues and accounts receivable at their net realizable values. Inherent in these estimates is the risk that the estimates will have to be revised or updated as additional information becomes available. Specifically, the complexity of many third may third For 2017, the Company’s largest contracted payor was a national association comprised of multiple members, which in the aggregate, accounted for approximately 24% 13% December 31, 2017, 2017, 6% 6% December 31, 2017, For 2016, the Company’s largest contracted payor was Medicare, which accounted for approximately 21% 13% December 31, 2016, 19% 13% December 31, 2016, We also contract with various other third no 10% third
Income Tax, Policy [Policy Text Block]	Income Taxes The Company recognizes deferred income tax liabilities and assets based on: ( 1 2 Deferred income tax (expense) benefit results from the change in net deferred tax assets or deferred tax liabilities. A valuation allowance is recorded when, in the opinion of management, it is more likely than not not Provisions for federal, state and foreign taxes are calculated based on reported pre-tax earnings based on current tax law and include the cumulative effect of any changes in tax rates from those used previously in determining deferred tax assets and liabilities. Certain items of income and expense are recognized in different time periods for financial reporting than for income tax purposes; thus, such provisions differ from the amounts currently receivable or payable. The Company follows a two First it evaluates the tax position for recognition by determining if the weight of available evidence indicates that it is more-likely-than- not not 50%
Share-based Compensation, Option and Incentive Plans Policy [Policy Text Block]	Share Based Payments The determination of the fair value of stock option awards and stock appreciation rights (collectively, “Share-Based Awards”) on the date of grant using option-pricing models is affected by the Company’s stock price, as well as assumptions regarding a number of other inputs using the Black-Scholes pricing model. These variables include the Company’s expected stock price volatility over the expected term of the Share-Based Awards, actual and projected employee stock option exercise behaviors, risk-free interest rates and expected dividends. The expected volatility is based on the historical volatility. The Company uses historical data to estimate Share-Based Awards exercise and forfeiture rates. The expected term represents the period over which the Share-Based Awards are expected to be outstanding. The dividend yield is an estimate of the expected dividend yield on the Company’s stock. The risk-free rate is based on U.S. Treasury yields in effect at the time of the grant for the expected term of the Share-Based Awards. All Share-Based Awards are amortized based on their graded vesting over the requisite service period of the awards. Compensation costs are recognized over the requisite service period using the accelerated method and included in selling expenses and general and administrative expenses, based upon the department to which the associated employee or non-employee resides.
Deferred Charges, Policy [Policy Text Block]	Deferred Debt Issuance Costs Capitalized debt issuance costs as of December 31, 201 7 2016
Earnings Per Share, Policy [Policy Text Block]	Earnings Per Share The Company reports its earnings per share in accordance with the “Earnings Per Share” topic of the Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”), which requires the presentation of both basic and diluted earnings per share on the statements of operations. The diluted weighted average common shares include adjustments for the potential effects of outstanding stock options but only in the periods in which such effect is dilutive under the treasury stock method. Included in our basic and diluted weighted average common shares are those stock options and common stock shares due to participants granted from the 2014 In accordance with this topic, the following table reconciles income and share amounts utilized to calculate basic and diluted net loss per common share (in thousands, except shares): 2017 2016 Numerator: Net loss (in thousands) $ (20,707 ) $ (222 ) Denominator: Weighted average common shares outstanding: Basic 22,739,651 22,617,901 Dilutive effect of restricted shares, options and non-vested share awards - - Diluted 22,739,651 22,617,901 Antidilutive awards: 490,428 90,715 S tock options of 0.5 0.1 not December 31, 2017 2016,
Fair Value of Financial Instruments, Policy [Policy Text Block]	Fair Value of Financial Instruments The carrying amounts reported in the consolidated balance sheets as of December 31, 2017 2016 The Company has adopted ASC 820, For financial assets and liabilities measured at fair value on a recurring basis, fair value is the price the Company would receive to sell an asset or pay to transfer a liability in an orderly transaction with a market participant at the measurement date. A three Level I quoted prices in active markets for identical instruments; Level II quoted prices in active markets for similar instruments, quoted prices for identical instruments in markets hat are not of the instrument; and Level III significant inputs to the valuation model are unobservable.
New Accounting Pronouncements, Policy [Policy Text Block]	Recent Accounting Pronouncements and Developments In May 2017, ) No. 2017 09, 718. December 15, 2017 ( January 1, 2018 not In January 2017, No. 2017 04, 350 2 December 15, 2019 ( January 1, 2020 January 1, 2017. not position, results of operations, cash flows and/or disclosures. In May 2014, 2014 09, 606 605, 605 August 2015, 2015 14, – Deferral of the Effective Date”, which defers the effective date of ASU 2014 09 December 15, 2017, 2016, 2016 08, 2016 10, 2016 12, The Company ’s approach to analyze the impact of the new standard on its revenue contracts included a review of existing contracts with customers for each revenue stream, an evaluation of the specific terms of those contracts and the appropriate treatment under the new standards, and a comparison of that new treatment to its existing accounting policies to identify differences. The Company will adopt the requirements of the new standard on January 1, 2018 The Company identified the same performance obligation under Topic 606 605. The new standard requires the Company to estimate these amounts. The Company anticipates that the timing and measurement of revenue will be consistent with its current revenue recognition although its approach to revenue recognition will now be based on the transfer of control. As a result, there will be no January 1, 2018. The Company has determined the impact of adopting the standard on its control framework and notes minimal, insignificant changes to its system and other controls process. The Company is finalizing the impact of Topic 606 first 2018. In February 2016, No. 2016 02, 842 2016 02” 2016 02, 2016 02 2016 02 December 15, 2018, In March 2016, No. 2016 09, — Stock Compensation (Topic 718 2016 09” December 15, 2016. January 1, 2017, 2016 09. $0.2 $0.2 January 1, 2017 December 31, 2016 ( In June 2016, No. 2016 13, Financial Instruments (Topic 326 2016 13” 2016 13 not 2016 13 January 1, 2020. 2016 13. In August 2016, No. 2016 15, 230 2016 15” 2016 15 December 15, 2017, 2016 15 January 1, 2018 not ’s consolidated financial position, results of operations, cash flows and/or disclosures. In November 2015, No. 2015 17, 740 2015 17” 2015 17 first 2017 may not an initial balance sheet reclassification of $2.7 December 31, 2017, not not no $11.4 December 31, 2017.

Note 2 - Summary of Significa19

Note 2 - Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2017
Notes Tables
Allowance for Credit Losses on Financing Receivables [Table Text Block]	Balance at beginning of Year Charged to costs and expenses Deductions (1) Balance at end of Year Allowance for doubtful accounts — 2017 $ 4,989 $ 5,641 $ (4,116 ) $ 6,514 Allowance for doubtful accounts — 2016 $ 4,737 $ 5,631 $ (5,379 ) $ 4,989
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	2017 2016 Numerator: Net loss (in thousands) $ (20,707 ) $ (222 ) Denominator: Weighted average common shares outstanding: Basic 22,739,651 22,617,901 Dilutive effect of restricted shares, options and non-vested share awards - - Diluted 22,739,651 22,617,901 Antidilutive awards: 490,428 90,715

Note 3 - Medical Equipment (Tab

Note 3 - Medical Equipment (Tables)	12 Months Ended
	Dec. 31, 2017
Notes Tables
Schedule of Medical Equipment [Table Text Block]	2017 2016 Medical Equipment held for sale or rental $ 1,567 $ 1,642 Medical Equipment in rental service 57,928 59,034 Medical Equipment in rental service - pump reserve (482 ) (551 ) Accumulated depreciation (34,077 ) (30,447 ) Medical Equipment in rental service - net 23,369 28,036 Total $ 24,936 $ 29,678

Note 4 - Property and Equipme21

Note 4 - Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2017
Notes Tables
Property, Plant and Equipment [Table Text Block]	2017 Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 3,824 $ (3,277 ) $ 547 Automobiles 118 (85 ) 33 Leasehold improvements 2,187 (1,134 ) 1,053 Total $ 6,129 $ (4,496 ) $ 1,633 2016 Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 3,809 $ (3,071 ) $ 738 Automobiles 129 (83 ) 46 Leasehold improvements 2,177 (964 ) 1,213 Total $ 6,115 $ (4,118 ) $ 1,997

Note 5 - Intangible Assets (Tab

Note 5 - Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2017
Notes Tables
Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets [Table Text Block]	2017 Gross Assets Accumulated Amortization Net Nonamortizable intangible assets Trade names $ 2,000 $ - $ 2,000 Amortizable intangible assets Trade names 23 23 - Physician and customer relationships 36,534 21,801 14,733 Non-compete agreements 1,136 1,125 11 Software 11,230 3,460 7,770 Total nonamortizable and amortizable intangible assets $ 50,923 $ 26,409 $ 24,514 2016 Gross Assets Accumulated Amortization Net Nonamortizable intangible assets Trade names $ 2,000 $ - $ 2,000 Amortizable intangible assets Trade names 23 23 - Physician and customer relationships 36,534 19,427 17,107 Non-compete agreements 1,136 1,064 72 Software 13,745 1,685 12,060 Total nonamortizable and amortizable intangible assets $ 53,438 $ 22,199 $ 31,239
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block]	2018 2019 2020 2021 2022 2023 and thereafter Amortization expense $ 4,649 $ 4,402 $ 4,285 $ 3,930 $ 2,051 $ 3,197

Note 6 - Debt (Tables)

Note 6 - Debt (Tables)	12 Months Ended
	Dec. 31, 2017
Notes Tables
Schedule of Commitment Fee and Applicable Margin for Eurodollar and CBFR [Table Text Block]	Leverage Ratio CBFR Eurodollar Spread Commitment Level I < 1.5:1.0 - 1.00% 2.00% 0.25% Level II < 2.0:1.0 to 1.0 but > -0.75% 2.25% 0.25% Level III < 2.5:1.0 to 1.0 but > - 0.50% 2.50% 0.25% Level IV < 3.0:1.0 to 1.0 but > 0.00% 2.75% 0.25% Level V ≥ 3.0:1.0 0.25% 3.00% 0.25%
Schedule of Line of Credit Facilities [Table Text Block]	December 31, December 31, 2017 2016 Revolver: Gross Availability $ 10,000 $ 10,000 Outstanding Draws - - Letter of Credit (750 ) - Landlord Reserves (45 ) (45 ) Availability on Revolver $ 9,205 $ 9,955
Schedule of Maturities of Long-term Debt [Table Text Block]	2018 2019 2020 2021 2022 Total Term Loan $ 3,067 $ 3,067 $ 3,067 $ 19,310 $ - $ 28,511 Unamortized value of debt issuance costs (28 ) (30 ) (31 ) (31 ) - (120 ) Total $ 3,039 $ 3,037 $ 3,036 $ 19,279 $ - $ 28,391
Schedule of Debt [Table Text Block]	December 31, 2017 December 31, 2016 Current Portion of Long-Term Debt Long-Term Debt Total Current Portion of Long-Term Debt Long-Term Debt Total Term Loan $ 3,067 $ 25,444 $ 28,511 Term Loans $ 5,336 $ 26,664 $ 32,000 Unamortized value of debt issuance costs $ (28 ) $ (92 ) (120 ) Unamortized value of debt issuance costs $ (22 ) $ (87 ) (109 ) Revolver - - - Revolver - - - Total $ 3,039 $ 25,352 $ 28,391 Total $ 5,314 $ 26,577 $ 31,891

Note 7 - Income Taxes (Tables)

Note 7 - Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2017
Notes Tables
Schedule of Income before Income Tax, Domestic and Foreign [Table Text Block]	2017 2016 U.S loss $ (5,419 ) $ (600 ) Non-U.S. income 162 236 Loss before income taxes $ (5,257 ) $ (364 )
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]	2017 2016 U.S Federal income tax (expense) benefit Current $ 73 $ - Deferred (13,830 ) 157 Total U.S. Federal income tax (expense) benefit (13,757 ) 157 State and local income tax (expense) benefit Current (45 ) (58 ) Deferred (1,560 ) 83 Total state and local income tax (expense) benefit (1,605 ) 25 Foreign income tax (expense) benefit Current (88 ) (40 ) Total income tax (expense) benefit $ (15,450 ) $ 142
Summary of Valuation Allowance [Table Text Block]	2017 2016 Valuation allowance at the Beginning of Period $ - $ - Income tax expense (11,435 ) - Release of valuation allowance - - Valuation allowance at the End of Period $ (11,435 ) $ -
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]	2017 2016 Income tax expense at the statutory rate 34.00 % 34.00 % State and local income tax expense 4.60 % 9.16 % Foreign income tax (1.17 %) (3.79 %) Permanent differences (8.25 %) (38.40 %) Research & development credits 0.00 % 37.81 % Increase in valuation allowance (217.49 %) 0.00 % Impacts related to the 2017 Tax Act (105.95 %) 0.00 % Other adjustments 0.37 % 0.31 % Effective income tax rate (293.89 %) 39.09 %
Schedule of Deferred Tax Assets and Liabilities [Table Text Block]	2017 2016 Deferred Federal tax assets – Bad debt reserves $ 1,375 $ 1,710 Stock based compensation 305 668 Net operating loss 7,319 8,184 Accrued compensation 249 280 Alternative minimum tax credit - 73 Inventories 18 69 Accrued rent 30 46 Goodwill and intangible assets 3,323 6,675 Research & development credits 533 534 Other credits 5 5 Other 103 189 Total deferred Federal tax assets 13,260 18,433 Less: valuation allowance (9,599 ) - Net deferred tax assets 3,661 18,433 Deferred Federal tax liabilities – Depreciation and asset basis differences (3,672 ) (4,725 ) Other (51 ) (157 ) Total deferred Federal tax liabilities (3,723 ) (4,882 ) Net deferred Federal tax assets (62 ) 13,551 Net deferred state and local tax assets 1,836 1,560 Less: valuation allowance (1,836 ) - Net deferred tax (liabilities) assets $ (62 ) $ 15,111

Note 9 - Leases (Tables)

Note 9 - Leases (Tables)	12 Months Ended
	Dec. 31, 2017
Notes Tables
Schedule of Future Minimum Lease Payments for Capital and Operating Leases [Table Text Block]	Capital Leases Operating Leases Total 2018 $ 514 $ 1,326 $ 1,840 2019 33 1,225 1,258 2020 - 695 695 2021 - 181 181 2022 - 191 191 Thereafter - 747 747 Total require payments $ 547 $ 4,365 $ 4,912 Less amounts representing interest (3.5%) (9 ) Present value of minimum lease payments 538 Less current maturities (505 ) Long-term capital lease liability $ 33

Note 10 - Share-based Compens26

Note 10 - Share-based Compensation (Tables)	12 Months Ended
	Dec. 31, 2017
Notes Tables
Schedule of Share-based Compensation, Restricted Stock Units Award Activity [Table Text Block]	Weighted average grant Number of date fair Aggregate shares value fair value Unvested at December 31, 2015 170,832 $ 2.09 Granted - - Vested (64,182 ) 1.74 $ 236,161 Vested shares forgone to satisfy minimum statutory withholding (16,484 ) 2.81 $ 49,592 Forfeitures (32,833 ) 2.18 Unvested at December 31, 2016 57,333 2.21 Granted - - Vested (15,730 ) 0.88 $ 83,003 Vested shares forgone to satisfy minimum statutory withholding (20,811 ) 2.80 $ 51,304 Forfeitures (8,333 ) 2.60 Unvested at December 31, 2017 12,459 $ 2.61
Schedule of Share-based Compensation, Employee Stock Purchase Plan, Activity [Table Text Block]	2017 2016 Compensation expense $ 49,150 $ 113,531 Shares of stock sold to employees 68,958 88,109 Weighted average fair value per ESPP award $ 2.21 $ 2.73
Schedule of Nonvested Share Activity [Table Text Block]	Weighted- Average Number Weighted- Remaining Aggregate of Authorized Average Exercise Contractual Intrinsic 2007 Plan (Options) Shares Price Term (in Years) Value Outstanding at December 31, 2015 488,332 $ 2.31 0.25 $ 118,899 Granted - - Exercised - - Exercised shares forgone to satisfy minimum statutory withholding - - Cashless exercise - - Forfeited - - Outstanding at December 31, 2016 488,332 $ 2.31 0.25 $ 118,899 Granted - - Exercised (25,037 ) 1.51 86,900 Exercised shares forgone to satisfy minimum statutory withholding (13,245 ) 2.32 Cashless exercise (71,718 ) 2.32 Forfeited (245,000 ) 2.83 Outstanding at December 31, 2017 133,332 $ 1.99 - $ 40,716 Exercisable at December 31, 2017 133,332 $ 1.95 Weighted- Average Number Weighted- Remaining Aggregate of Authorized Average Exercise Contractual Intrinsic 2014 Plan (Options) Shares Price Term (in Years) Value Outstanding at December 31, 2015 970,000 $ 2.79 3.58 $ 222,200 Granted 600,000 $ 2.76 4.60 Exercised (1,866 ) 2.69 Exercised shares forgone to satisfy minimum statutory withholding (798 ) 2.69 Cashless exercise (12,614 ) 2.69 Forfeited (304,723 ) 2.70 Outstanding at December 31, 2016 1,249,999 $ 2.80 4.26 $ - Exercisable at December 31, 2016 616,597 $ 2.87 Granted 1,087,500 2.09 3.13 Exercised - - Exercised shares forgone to satisfy minimum statutory withholding - - Cashless exercise - - Forfeited (374,999 ) 2.61 Outstanding at December 31, 2017 1,962,500 $ 2.44 3.18 $ - Exercisable at December 31, 2017 955,868 $ 2.69 Weighted- Average Number Weighted- Remaining Aggregate Inducement of Authorized Average Exercise Contractual Intrinsic Options Shares ( 1 ) Price Term (in Years) Value Outstanding at December 31, 2015 800,000 $ 2.25 2.90 $ 616,000 Granted - - - - Exercised - - - - Forfeited - - - - Outstanding at December 31, 2016 800,000 $ 2.25 2.26 $ 240,000 Granted - - - - Exercised - - - - Forfeited (800,000 ) - - - Outstanding at December 31, 2017 - $ - - $ - Exercisable at December 31, 2017 - $ -
Schedule of Share-based Compensation, Shares Authorized under Stock Option Plans, by Exercise Price Range [Table Text Block]	Options Outstanding Options Exercisable 2007 Plan (Options): Range of Exercise Prices Number of Shares Outstanding Weighted-Average Remaining Contractual Life Weighted-Average Exercise Price Number of Shares Exercisable Weighted-Average Exercise Price $1.76 - $2.00 91,666 - 1.93 91,666 1.93 $2.01 - $3.00 41,666 - 2.01 41,666 2.01 Outstanding at December 31, 2017 133,332 - $ 2.31 133,332 $ 1.95 Options Outstanding Options Exercisable 2014 Plan (Options): Range of Exercise Prices Number of Shares Outstanding Weighted-Average Remaining Contractual Life Weighted-Average Exercise Price Number of Shares Exercisable Weighted-Average Exercise Price $2.01 - $3.00 1,962,500 3.18 $ 2.44 955,868 $ 2.69 Outstanding at December 31, 2017 1,962,500 3.18 $ 2.44 955,868 $ 2.69
Schedule of Share-based Payment Award, Employee Stock Purchase Plan, Valuation Assumptions [Table Text Block]	Stock Options: 2017 2016 Expected volatility 30% to 69% 35% Risk free interest rate 0.69% to 2.05% 0.69% Expected lives at date of grant (in years) 3.93 5.01 Weighted average fair value of options granted $2.09 $2.76
Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Table Text Block]	2017 2016 Restricted share expense $ 48 $ 151 Stock option expense 634 311 Total stock-based compensation expense $ 682 $ 462

Note 1 - Basis of Presentatio27

Note 1 - Basis of Presentation and Nature of Operations (Details Textual)	12 Months Ended
	Dec. 31, 2017
Number of Operating Locations	6
Concentration Risk, Percentage of Raw Material Purchases from Suppliers, Minimum Threshold	10.00%

Note 2 - Summary of Significa28

Note 2 - Summary of Significant Accounting Policies (Details Textual) $ in Thousands	1 Months Ended	12 Months Ended
	Oct. 31, 2017USD ($)	Dec. 31, 2017USD ($)shares	Dec. 31, 2016USD ($)shares	Jan. 01, 2017USD ($)	Dec. 31, 2015USD ($)
Number of Operating Segments		1
Number of Financial Institutions		2
Inventory Valuation Reserves		$ 100	$ 200
Medical Equipment in Rental Services, Useful Life		7 years
Medical Equipment Held for Sale or Rental Reserves		$ 500	600
Impairment of Intangible Assets, Indefinite-lived (Excluding Goodwill)	$ 0
Capitalized Computer Software, Net		200	3,500
Capitalized Computer Software, Amortization		3,100	1,700
Impairment of Long-Lived Assets Held-for-use		$ 1,000	$ 0
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount | shares		490,428	90,715
Retained Earnings (Accumulated Deficit)		$ (61,633)	$ (41,142)
Deferred Tax Assets, Valuation Allowance		11,435
Reclassification From Current Deferred Tax Assets to Noncurrent Deferred Tax Assets [Member]
Current Period Reclassification Adjustment		$ 2,700
Accounting Standards Update 2016-09 [Member]
Deferred Tax Assets, Gross				$ 200
Retained Earnings (Accumulated Deficit)				$ 200
Employee Stock Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount | shares		500,000	100,000
Sales Revenue, Product Line [Member] | Customer Concentration Risk [Member] | National Association 1 [Member] | Oncology Business [Member]
Concentration Risk, Percentage		24.00%
Sales Revenue, Product Line [Member] | Customer Concentration Risk [Member] | National Association 2 [Member] | Oncology Business [Member]
Concentration Risk, Percentage		6.00%
Sales Revenue, Product Line [Member] | Customer Concentration Risk [Member] | Medicare [Member] | Oncology Business [Member]
Concentration Risk, Percentage			21.00%
Sales Revenue, Product Line [Member] | Customer Concentration Risk [Member] | National Association [Member] | Oncology Business [Member]
Concentration Risk, Percentage			19.00%
Sales Revenue, Net [Member] | Customer Concentration Risk [Member] | National Association 1 [Member]
Concentration Risk, Percentage		13.00%
Sales Revenue, Net [Member] | Customer Concentration Risk [Member] | National Association 2 [Member]
Concentration Risk, Percentage		6.00%
Sales Revenue, Net [Member] | Customer Concentration Risk [Member] | Medicare [Member]
Concentration Risk, Percentage			13.00%
Sales Revenue, Net [Member] | Customer Concentration Risk [Member] | Blue Cross/Blue Shield Affiliates [Member]
Concentration Risk, Percentage			13.00%
Capital Leases [Member]
Debt, Weighted Average Interest Rate		3.60%
Computer Software, Intangible Asset [Member]
Finite-Lived Intangible Asset, Useful Life		3 years
Information Technology Software [Member]
Property, Plant and Equipment, Useful Life		3 years
Computer Equipment [Member]
Property, Plant and Equipment, Useful Life		5 years
Minimum [Member]
Property, Plant and Equipment, Useful Life		3 years
Minimum [Member] | Physician and Customer Relationships [Member]
Finite-Lived Intangible Asset, Useful Life		15 years
Minimum [Member] | Noncompete Agreements [Member]
Finite-Lived Intangible Asset, Useful Life		2 years
Minimum [Member] | Software Development [Member]
Property, Plant and Equipment, Useful Life		3 years
Maximum [Member]
Property, Plant and Equipment, Useful Life		7 years
Maximum [Member] | Physician and Customer Relationships [Member]
Finite-Lived Intangible Asset, Useful Life		20 years
Maximum [Member] | Noncompete Agreements [Member]
Finite-Lived Intangible Asset, Useful Life		5 years
Maximum [Member] | Software Development [Member]
Property, Plant and Equipment, Useful Life		5 years

Note 2 - Summary of Significa29

Note 2 - Summary of Significant Accounting Policies - Analysis of Allowance for Doubtful Accounts (Details) - USD ($) $ in Thousands		12 Months Ended
		Dec. 31, 2017	Dec. 31, 2016
Balance at beginning of year		$ 4,989	$ 4,737
Charged to costs and expenses		5,641	5,631
Deductions	[1]	(4,116)	(5,379)
Balance at end of year		$ 6,514	$ 4,989
[1]	Deductions represent the write-off of uncollectible account receivable balances.

Note 2 - Summary of Significa30

Note 2 - Summary of Significant Accounting Policies - Summary of Income and Share Amounts Utilized to Calculate Basic and Diluted Net Income Per Common Share (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Net loss (in thousands)	$ (20,707)	$ (222)
Weighted average common shares outstanding:
Basic (in shares)	22,739,651	22,617,901
Dilutive effect of restricted shares, options and non-vested share awards (in shares)
Diluted (in shares)	22,739,651	22,617,901
Antidilutive awards: (in shares)	490,428	90,715

Note 3 - Medical Equipment (Det

Note 3 - Medical Equipment (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Depreciation Expense Related to Medical Equipment	$ 6.5	$ 6.3

Note 3 - Medical Equipment - Su

Note 3 - Medical Equipment - Summary of Medical Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Medical Equipment held for sale or rental	$ 1,567	$ 1,642
Medical Equipment in rental service	57,928	59,034
Medical Equipment in rental service - pump reserve	(482)	(551)
Accumulated depreciation	(34,077)	(30,447)
Medical Equipment in rental service - net	23,369	28,036
Total	$ 24,936	$ 29,678

Note 4 - Property and Equipme33

Note 4 - Property and Equipment (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Depreciation, Nonproduction	$ 0.5	$ 0.6

Note 4 - Property and Equipme34

Note 4 - Property and Equipment - Property and Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Gross Assets	$ 6,129	$ 6,115
Accumulated depreciation	(4,496)	(4,118)
Total	1,633	1,997
Furniture and Fixtures [Member]
Gross Assets	3,824	3,809
Accumulated depreciation	(3,277)	(3,071)
Total	547	738
Automobiles [Member]
Gross Assets	118	129
Accumulated depreciation	(85)	(83)
Total	33	46
Leasehold Improvements [Member]
Gross Assets	2,187	2,177
Accumulated depreciation	(1,134)	(964)
Total	$ 1,053	$ 1,213

Note 5 - Intangible Assets (Det

Note 5 - Intangible Assets (Details Textual) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Amortization of Intangible Assets	$ 5,560	$ 3,849
Physician and Customer Relationships [Member]
Finite-lived Intangible Asset, Weighted Average Remaining Amortization Period	4 years
Noncompete Agreements [Member]
Finite-lived Intangible Asset, Weighted Average Remaining Amortization Period	1 year
Computer Software, Intangible Asset [Member]
Finite-lived Intangible Asset, Weighted Average Remaining Amortization Period	2 years
Impairment of Intangible Assets, Finite-lived	$ 1,000

Note 5 - Intangible Assets - Su

Note 5 - Intangible Assets - Summary of Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Amortizable intangible assets, accumulated amortization	$ 26,409	$ 22,199
Total nonamortizable and amortizable intangible assets, gross assets	50,923	53,438
Intangible assets, net	24,514	31,239
Trade Names [Member]
Amortizable intangible assets, gross assets	23	23
Amortizable intangible assets, accumulated amortization	23	23
Amortizable intangible assets, net
Physician and Customer Relationships [Member]
Amortizable intangible assets, gross assets	36,534	36,534
Amortizable intangible assets, accumulated amortization	21,801	19,427
Amortizable intangible assets, net	14,733	17,107
Noncompete Agreements [Member]
Amortizable intangible assets, gross assets	1,136	1,136
Amortizable intangible assets, accumulated amortization	1,125	1,064
Amortizable intangible assets, net	11	72
Computer Software, Intangible Asset [Member]
Amortizable intangible assets, gross assets	11,230	13,745
Amortizable intangible assets, accumulated amortization	3,460	1,685
Amortizable intangible assets, net	7,770	12,060
Trade Names 1 [Member]
Nonamortizable intangible assets	$ 2,000	$ 2,000

Note 5 - Intangible Assets - Ex

Note 5 - Intangible Assets - Expected Annual Amortization Expense for Intangible Assets (Details) $ in Thousands	Dec. 31, 2017USD ($)
Amortization expense, 2017	$ 4,649
Amortization expense, 2018	4,402
Amortization expense, 2019	4,285
Amortization expense, 2020	3,930
Amortization expense, 2021	2,051
Amortization expense, 2022 and thereafter	$ 3,197

Note 6 - Debt (Details Textual)

Note 6 - Debt (Details Textual)	Dec. 05, 2016USD ($)	Mar. 23, 2015USD ($)	Dec. 31, 2017USD ($)	Sep. 30, 2017USD ($)	Jun. 30, 2017USD ($)	Mar. 31, 2017USD ($)	Jun. 30, 2017USD ($)	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)	Jun. 28, 2017USD ($)	Jun. 27, 2017USD ($)	Mar. 22, 2017
Long-term Debt			$ 28,391,000					$ 28,391,000	$ 31,891,000
Proceeds from Issuance of Long-term Debt								28,866,000	66,892,000
Debt Instrument, Periodic Payment, Principal			577,500	$ 577,500			$ 577,500
Leverage Ratio						2.96
Debt Instrument, Periodic Payment			766,650	$ 766,650	$ 766,650	$ 766,650
Revolving Credit Facility [Member]
Long-term Line of Credit
The Chase Credit Agreement [Member] | London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate								2.75%
Debt Instrument, Basis Spread on Variable Rate, Before Margin Rate								2.50%
Debt Instrument, Interest Rate, Effective Percentage			4.32%					4.32%
Debt Instrument, Floor Rate								1.57%
The Chase Credit Agreement [Member] | London Interbank Offered Rate (LIBOR) [Member] | Minimum [Member]
Debt Instrument, Basis Spread on Variable Rate								2.00%
Applicable Margin Rate								(1.00%)
The Chase Credit Agreement [Member] | London Interbank Offered Rate (LIBOR) [Member] | Maximum [Member]
Applicable Margin Rate								0.25%
The Chase Credit Agreement [Member] | Eurodollar [Member] | Maximum [Member]
Debt Instrument, Basis Spread on Variable Rate								3.00%
The Chase Credit Agreement [Member] | JP Morgan Chase Bank [Member]
Debt Instrument, Maturity Date		Mar. 23, 2020
The Chase Credit Agreement [Member] | JP Morgan Chase Bank [Member] | Revolving Credit Facility [Member]
Line of Credit Facility, Maximum Borrowing Capacity		$ 10,000,000
First Amended Credit Agreement [Member]
Maximum Permitted Leverage Ratio, Period One	2.75
Maximum Permitted Leverage Ratio, Period Two	2.5
Maximum Permitted Leverage Ratio, Period Three	2.25
Second Amended Credit Agreement [Member]
Maximum Permitted Leverage Ratio, Period One												2.75
Maximum Permitted Leverage Ratio, Period Two												2.5
Maximum Permitted Leverage Ratio, Period Three												2.25
Third Amended Credit Agreement [Member]
Maximum Permitted Leverage Ratio, Period One			4					4
Maximum Permitted Leverage Ratio, Period Two			3.75					3.75
Maximum Permitted Leverage Ratio, Period Three			3.5					3.5
Debt Instrument, Face Amount										$ 2,500,000	$ 5,000,000
Long-term Line of Credit			$ 30,665,999.98					$ 30,665,999.98
Percentage of Excess Cash Flow for Prepayment of Debt, If Leverage Ratio is Greater Than or Equal To 2.5			75.00%					75.00%
Percentage of Excess Cash Flow for Prepayment of Debt, If Leverage Ratio is Less Than 2.5 But Greater Than or Equal To 2.0			50.00%					50.00%
Percentage of Excess Cash Flow for Prepayment of Debt, If Leverage Ratio is Less Than 2.0			0.00%					0.00%
Maximum Permitted Leverage Ratio, Period Four			3					3
Maximum Permitted Fixed Charges Coverage Ratio, Period One			1.15					1.15
Minimum Permitted Fixed Charges Coverage Ratio, Period Two			1.25					1.25
Debt Instrument, Interest Rate, Increase (Decrease)								0.50%
Third Amended Credit Agreement [Member] | Revolving Credit Facility [Member]
Debt Instrument, Face Amount										5,000,000	10,000,000
Third Amended Credit Agreement [Member] | JP Morgan Chase Bank [Member] | Revolving Credit Facility [Member]
Debt Instrument, Face Amount										$ 12,500,000	$ 25,000,000
Term Loan A [Member] | The Chase Credit Agreement [Member] | JP Morgan Chase Bank [Member]
Long-term Debt		27,000,000
Proceeds from Issuance of Long-term Debt		27,000,000
Term Loan B [Member] | The Chase Credit Agreement [Member] | JP Morgan Chase Bank [Member]
Long-term Debt		8,000,000
Proceeds from Issuance of Long-term Debt		$ 8,000,000
Term Loan [Member]
Long-term Debt			$ 28,511,000					$ 28,511,000	$ 32,000,000
Term Loan [Member] | The Chase Credit Agreement [Member]
Long-term Debt	$ 32,000,000
Debt Agreement, Additional Amount Available	5,000,000
Debt Instrument, Periodic Payment, Principal	1,300,000
Term Loan [Member] | First Amended Credit Agreement [Member]
Debt Instrument, Face Amount	$ 32,000,000

Note 6 - Debt - Schedule of App

Note 6 - Debt - Schedule of Applicable Rates and Commitment Fees Percentage (Details) - Third Amended Credit Agreement [Member]	Jun. 28, 2017
Leverage Ratio Level I Less than 1.5:1.0 [Member]
Commitment Fee Rate	0.25%
Leverage Ratio Level II Less than 2.0:1.0 to 1.0 but Greater than or Equal to 1.5:1.0 [Member]
Commitment Fee Rate	0.25%
Leverage Ratio Level III Less than 2.5:1.0 to 1.0 but Greater than or Equal to 2.0:1.0 [Member]
Commitment Fee Rate	0.25%
Leverage Ratio Level IV Less than 3.0:1.0 to 1.0 but Greater than or Equal to 2.5:1.0 [Member]
Commitment Fee Rate	0.25%
Leverage Ratio Level V Greater than or Equal to 3.0:1.0 [Member]
Commitment Fee Rate	0.25%
CBFR Spread [Member] | Leverage Ratio Level I Less than 1.5:1.0 [Member]
CBFR Spread	(1.00%)
CBFR Spread [Member] | Leverage Ratio Level II Less than 2.0:1.0 to 1.0 but Greater than or Equal to 1.5:1.0 [Member]
CBFR Spread	(0.75%)
CBFR Spread [Member] | Leverage Ratio Level III Less than 2.5:1.0 to 1.0 but Greater than or Equal to 2.0:1.0 [Member]
CBFR Spread	(0.50%)
CBFR Spread [Member] | Leverage Ratio Level IV Less than 3.0:1.0 to 1.0 but Greater than or Equal to 2.5:1.0 [Member]
CBFR Spread	0.00%
CBFR Spread [Member] | Leverage Ratio Level V Greater than or Equal to 3.0:1.0 [Member]
CBFR Spread	0.25%
Eurodollar [Member] | Leverage Ratio Level I Less than 1.5:1.0 [Member]
CBFR Spread	2.00%
Eurodollar [Member] | Leverage Ratio Level II Less than 2.0:1.0 to 1.0 but Greater than or Equal to 1.5:1.0 [Member]
CBFR Spread	2.25%
Eurodollar [Member] | Leverage Ratio Level III Less than 2.5:1.0 to 1.0 but Greater than or Equal to 2.0:1.0 [Member]
CBFR Spread	2.50%
Eurodollar [Member] | Leverage Ratio Level IV Less than 3.0:1.0 to 1.0 but Greater than or Equal to 2.5:1.0 [Member]
CBFR Spread	2.75%
Eurodollar [Member] | Leverage Ratio Level V Greater than or Equal to 3.0:1.0 [Member]
CBFR Spread	3.00%

Note 6 - Debt - Summary of Revo

Note 6 - Debt - Summary of Revolver Based Upon Borrowers' Eligible Accounts Receivable and Inventory (Details) - Revolving Credit Facility [Member] - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Gross Availability	$ 10,000	$ 10,000
Outstanding Draws
Letter of Credit	(750)
Landlord Reserves	(45)	(45)
Availability on Revolver	$ 9,205	$ 9,955

Note 6 - Debt - Summary of Futu

Note 6 - Debt - Summary of Future Maturities of Loans (Details) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
2,018	$ 3,039
2,019	3,037
2,020	3,036
2,021	19,279
2,022
Long-term Debt	28,391	$ 31,891
Unamortized value of the debt issuance costs, 2018	(28)
Unamortized value of the debt issuance costs, 2019	(30)
Unamortized value of the debt issuance costs, 2020	(31)
Unamortized value of the debt issuance costs, 2021	(31)
Unamortized value of the debt issuance costs, 2022
Unamortized value of the debt issuance costs, Total	(120)	(109)
2,018	3,039
2,019	3,037
2,020	3,036
2,021	19,279
2,022
Total	28,391	31,891
Term Loan [Member]
2,018	3,067
2,019	3,067
2,020	3,067
2,021	19,310
2,022
Long-term Debt	28,511	32,000
2,018	3,067
2,019	3,067
2,020	3,067
2,021	19,310
2,022
Total	$ 28,511	$ 32,000

Note 6 - Debt - Summary of Comp

Note 6 - Debt - Summary of Company's Current and Long-term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Current portion of long-term debt	$ 3,039	$ 5,314
Long-term debt, net of current portion	25,352	26,577
Total	28,391	31,891
Unamortized value of the debt issuance costs, Current portion of long-term debt	(28)	(22)
Unamortized value of the debt issuance costs, Long-term debt	(92)	(87)
Unamortized value of the debt issuance costs, Total	(120)	(109)
Long-term debt	25,352	26,577
Term Loan [Member]
Current portion of long-term debt	3,067	5,336
Long-term debt, net of current portion	25,444	26,664
Total	28,511	32,000
Long-term debt	$ 25,444	$ 26,664

Note 7 - Income Taxes (Details

Note 7 - Income Taxes (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent		34.00%	34.00%
Income Tax Expense (Benefit), Continuing Operations, Adjustment of Deferred Tax (Asset) Liability		$ 5,600,000
Effective Income Tax Rate Reconciliation, Tax Credit, Research, Amount		0	$ 600,000
Deferred Tax Assets, Valuation Allowance		11,435,000
Unrecognized Tax Benefits		0	0
Net Operating Loss Carryforwards Limitation on Use		1,800,000
Remaining Preownership Net Operating Loss Carryforwards		$ 4,700,000
Minimum [Member]
Operating Loss Carryforwards Expiration Periods		5 years
Maximum [Member]
Operating Loss Carryforwards Expiration Periods		20 years
Domestic Tax Authority [Member]
Operating Loss Carryforwards		$ 34,900,000	24,100,000
Deferred Tax Assets, Valuation Allowance		$ 9,599,000
Domestic Tax Authority [Member] | Internal Revenue Service (IRS) [Member] | Earliest Tax Year [Member]
Open Tax Year		2,014
Domestic Tax Authority [Member] | Internal Revenue Service (IRS) [Member] | Latest Tax Year [Member]
Open Tax Year		2,017
State and Local Jurisdiction [Member]
Operating Loss Carryforwards		$ 1,400,000
Deferred Tax Assets, Valuation Allowance		$ 1,836,000
Foreign Tax Authority [Member] | Canada Revenue Agency [Member] | Earliest Tax Year [Member]
Open Tax Year		2,013
Foreign Tax Authority [Member] | Canada Revenue Agency [Member] | Latest Tax Year [Member]
Open Tax Year		2,017
Scenario, Forecast [Member]
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent	21.00%

Note 7 - Income Taxes - Summary

Note 7 - Income Taxes - Summary of (Loss) Income Before Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
U.S loss	$ (5,419)	$ (600)
Non-U.S. income	162	236
Loss before income taxes	$ (5,257)	$ (364)

Note 7 - Income Taxes - Summa45

Note 7 - Income Taxes - Summary of Components of Consolidated Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
U.S Federal income tax (expense) benefit
Current	$ 73
Deferred	(13,830)	157
Total U.S. Federal income tax (expense) benefit	(13,757)	157
State and local income tax (expense) benefit
Current	(45)	(58)
Deferred	(1,560)	83
Total state and local income tax (expense) benefit	(1,605)	25
Foreign income tax (expense) benefit
Current	(88)	(40)
Total income tax (expense) benefit	$ (15,450)	$ 142

Note 7 - Income Taxes - Changes

Note 7 - Income Taxes - Changes in Valuation Allowance (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Valuation allowance at the Beginning of Period
Income tax expense	(11,435)
Release of valuation allowance
Valuation allowance at the End of Period	$ (11,435)

Note 7 - Income Taxes - Reconci

Note 7 - Income Taxes - Reconciliations of Effective Income Tax Rate to Federal Statutory Rate (Details)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Income tax expense at the statutory rate	34.00%	34.00%
State and local income tax expense	4.60%	9.16%
Foreign income tax	(1.17%)	(3.79%)
Permanent differences	(8.25%)	(38.40%)
Research & development credits	0.00%	37.81%
Increase in valuation allowance	(217.49%)	0.00%
Impacts related to the 2017 Tax Act	(105.95%)	0.00%
Other adjustments	0.37%	0.31%
Effective income tax rate	(293.89%)	39.09%

Note 7 - Income Taxes - Summa48

Note 7 - Income Taxes - Summary of Temporary Differences and Carryforwards That Gives Rise to Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Less: valuation allowance	$ (11,435)
Net deferred Federal tax assets	(62)
Net deferred Federal tax assets		15,111
Less: valuation allowance	(11,435)
Net deferred tax (liabilities) assets		15,111
Domestic Tax Authority [Member]
Bad debt reserves	1,375	1,710
Stock based compensation	305	668
Net operating loss	7,319	8,184
Accrued compensation	249	280
Alternative minimum tax credit		73
Inventories	18	69
Accrued rent	30	46
Goodwill and intangible assets	3,323	6,675
Research & development credits	533	534
Other credits	5	5
Other	103	189
Total deferred Federal tax assets	13,260	18,433
Less: valuation allowance	(9,599)
Net deferred tax assets	3,661	18,433
Depreciation and asset basis differences	(3,672)	(4,725)
Other	(51)	(157)
Total deferred Federal tax liabilities	(3,723)	(4,882)
Net deferred Federal tax assets	(62)
Net deferred Federal tax assets		13,551
Deferred Tax Assets, Gross	13,260	18,433
Less: valuation allowance	(9,599)
Net deferred tax (liabilities) assets		13,551
State and Local Jurisdiction [Member]
Total deferred Federal tax assets	1,836	1,560
Less: valuation allowance	(1,836)
Deferred Tax Assets, Gross	1,836	1,560
Less: valuation allowance	$ (1,836)

Note 9 - Leases (Details Textua

Note 9 - Leases (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Operating Leases, Rent Expense, Net	$ 1	$ 1
Pump Assets [Member]
Capital Leased Assets, Gross	14	13.9
Capital Leases, Lessee Balance Sheet, Assets by Major Class, Accumulated Depreciation	$ 6.1	$ 4.2
Capital Leases [Member]
Debt, Weighted Average Interest Rate	3.60%

Note 9 - Leases - Schedule of F

Note 9 - Leases - Schedule of Future Minimum Rental Payments Pursuant to Capital and Operating Leases (Details) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
2018, capital leases	$ 514
2018, operating leases	1,326
2,018	1,840
2019, capital leases	33
2019, operating leases	1,225
2,019	1,258
2020, capital leases
2020, operating leases	695
2,020	695
2021, capital leases
2021, operating leases	181
2,021	181
2022, capital leases
2022, operating leases	191
2,022	191
Thereafter, capital leases
Thereafter, operating leases	747
Thereafter	747
Total require payments, capital leases	547
Total require payments, operating leases	4,365
Total require payments	4,912
Less amounts representing interest (3.5%), capital leases	(9)
Present value of minimum lease payments, capital leases	538
Less current maturities, capital leases	(505)	$ (2,938)
Long-term capital lease liability, capital leases	$ 33	$ 2,573

Note 10 - Share-based Compens51

Note 10 - Share-based Compensation (Details Textual) - USD ($)		Sep. 07, 2016	May 27, 2011	May 31, 2014	Dec. 31, 2017	Dec. 31, 2016	Mar. 12, 2018	Dec. 31, 2015	Apr. 23, 2014	Dec. 31, 2007
Share-based Compensation Arrangement by Share-based Payment Award, Number of Additional Shares Authorized		350,000
Shares Paid for Tax Withholding for Share Based Compensation					100,000	100,000
Employee Stock Ownership Plan (ESOP), Shares Contributed to ESOP				200,000
Employee Stock Purchase Plan Discount Rate				15.00%
Employee Stock Ownership Plan ESOP Purchase Per Employee Maximum				$ 25,000
Stock Issued During Period Shares Employee Stock Ownership Plan Number of Remaining Shares Available for Future Issuance					294,863
Treasury Stock, Shares, Acquired					0	0
Subsequent Event [Member]
Stock Repurchase Program, Number of Shares Authorized to be Repurchased							1,000,000
2007 Stock Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized										2,000,000
Share-based Compensation Arrangement by Share-based Payment Award, Number of Additional Shares Authorized			3,000,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Number					133,332	488,332		488,332
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross
2014 Amended and Restated Stock Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Number					1,962,500	1,249,999		970,000
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant					100,000				2,000,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross					1,087,500	600,000
Employee Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period					1 year
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross					1,100,000	600,000
Employee Stock Option [Member] | Chief Executive Officer [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross					300,000	0
Employee Stock Option [Member] | Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period					3 years
Employee Stock Option [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period					10 years
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number					12,459	57,333		170,832
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period					0	0
Restricted Stock [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period					4 years
Employee Service Share-based Compensation, Nonvested Awards, Compensation Not yet Recognized, Share-based Awards Other than Options					$ 100,000
Stock Appreciation Rights (SARs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number					200,000
Stock Appreciation Rights (SARs) [Member] | Vesting Upon Closing Public Market Price Reach 3 or More for 10 Consecutive Trading Days [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number					100,000
Stock Appreciation Rights (SARs) [Member] | Vesting Upon Achievement of 90% or More of Corporate Objectives Under the 2018 Employee Incentive Compensation Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number					100,000
Stock Appreciation Rights (SARs) [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period					1 year
Allocated Share-based Compensation Expense					$ 100,000
Inducement Stock Options [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Number	[1]					800,000		800,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross	[1]
Inducement Stock Options [Member] | Former Executive Level Managers [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Number					800,000
[1]	Represents inducement stock options to purchase 800,000 shares of the Company's Common Stock to former executive level managers.

Note 10 - Share-based Compens52

Note 10 - Share-based Compensation - Summary of Restricted Share Activity, Excluding Company's Employee Stock Purchase Plan (Details) - Restricted Stock [Member] - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Unvested, number of shares (in shares)	57,333	170,832
Unvested, weighted average grant date fair value (in dollars per share)	$ 2.21	$ 2.09
Granted, number of shares (in shares)	0	0
Granted, weighted average grant date fair value (in dollars per share)
Vested, number of shares (in shares)	(15,730)	(64,182)
Vested, weighted average grant date fair value (in dollars per share)	$ 0.88	$ 1.74
Vested	$ 83,003	$ 236,161
Vested shares forgone to satisfy minimum statutory withholding, number of shares (in shares)	(20,811)	(16,484)
Vested shares forgone to satisfy minimum statutory withholding, weighted average grant date fair value (in dollars per share)	$ 2.80	$ 2.81
Vested shares forgone to satisfy minimum statutory withholding	$ 51,304	$ 49,592
Forfeitures, number of shares (in shares)	(8,333)	(32,833)
Forfeitures, weighted average grant date fair value (in dollars per share)	$ 2.60	$ 2.18
Unvested, number of shares (in shares)	12,459	57,333
Unvested, weighted average grant date fair value (in dollars per share)	$ 2.61	$ 2.21

Note 10 - Share-based Compens53

Note 10 - Share-based Compensation - Summary of Activity Relating to Company's ESPP Program (Details) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Compensation expense	$ 49,150	$ 113,531
Shares of stock sold to employees (in shares)	68,958	88,109
Weighted average fair value per ESPP award (in dollars per share)	$ 2.21	$ 2.73

Note 10 - Share-based Compens54

Note 10 - Share-based Compensation - Summary of Stock Option and Inducement Stock Option Activity (Details) - USD ($)		12 Months Ended
		Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Inducement Stock Options [Member]
Outstanding, number of authorized shares (in shares)	[1]	800,000	800,000
Outstanding, weighted average exercise price (in dollars per share)		$ 2.25	$ 2.25
Outstanding, weighted average remaining contractual term (Year)			2 years 94 days	2 years 328 days
Outstanding, aggregate intrinsic value			$ 240,000	$ 616,000
Granted, number of authorized shares (in shares)	[1]
Granted, weighted average exercise price (in dollars per share)
Exercised, number of authorized shares (in shares)	[1]
Exercised, weighted average exercise price (in dollars per share)
Forfeited, number of authorized shares (in shares)	[1]	800,000
Forfeited, weighted average exercise price (in dollars per share)
Exercised, number of authorized shares (in shares)	[1]
Forfeited, number of authorized shares (in shares)	[1]	(800,000)
Outstanding, number of authorized shares (in shares)	[1]		800,000	800,000
Outstanding, weighted average exercise price (in dollars per share)			$ 2.25	$ 2.25
Exercisable, number of authorized shares (in shares)	[1]
Exercisable, weighted average exercise price (in dollars per share)
2007 Stock Incentive Plan [Member]
Outstanding, number of authorized shares (in shares)		488,332	488,332
Outstanding, weighted average exercise price (in dollars per share)		$ 2.31	$ 2.31
Outstanding, weighted average remaining contractual term (Year)			91 days	91 days
Outstanding, aggregate intrinsic value		$ 40,716	$ 118,899	$ 118,899
Granted, number of authorized shares (in shares)
Granted, weighted average exercise price (in dollars per share)
Exercised, number of authorized shares (in shares)		25,037
Exercised, weighted average exercise price (in dollars per share)		$ 1.51
Exercised shares forgone to satisfy minimum statutory withholding, number of authorized shares (in shares)		13,245
Exercised shares forgone to satisfy minimum statutory withholding, weighted average exercise price (in dollars per share)		$ 2.32
Cashless exercise, number of authorized shares (in shares)		71,718
Cashless exercise, weighted average exercise price (in dollars per share)		$ 2.32
Forfeited, number of authorized shares (in shares)		245,000
Forfeited, weighted average exercise price (in dollars per share)		$ 2.83
Exercised, number of authorized shares (in shares)		(25,037)
Exercised, aggregate intrinsic value		$ 86,900
Exercised shares forgone to satisfy minimum statutory withholding, number of authorized shares (in shares)		(13,245)
Cashless exercise, number of authorized shares (in shares)		(71,718)
Forfeited, number of authorized shares (in shares)		(245,000)
Outstanding, number of authorized shares (in shares)		133,332	488,332	488,332
Outstanding, weighted average exercise price (in dollars per share)		$ 1.99	$ 2.31	$ 2.31
Exercisable, number of authorized shares (in shares)		133,332
Exercisable, weighted average exercise price (in dollars per share)		$ 1.95
2014 Amended and Restated Stock Incentive Plan [Member]
Outstanding, number of authorized shares (in shares)		1,249,999	970,000
Outstanding, weighted average exercise price (in dollars per share)		$ 2.80	$ 2.79
Outstanding, weighted average remaining contractual term (Year)		3 years 65 days	4 years 94 days	3 years 211 days
Outstanding, aggregate intrinsic value				$ 222,200
Granted, number of authorized shares (in shares)		1,087,500	600,000
Granted, weighted average exercise price (in dollars per share)		$ 2.09	$ 2.76
Exercised, number of authorized shares (in shares)			1,866
Exercised, weighted average exercise price (in dollars per share)			$ 2.69
Exercised shares forgone to satisfy minimum statutory withholding, number of authorized shares (in shares)			798
Exercised shares forgone to satisfy minimum statutory withholding, weighted average exercise price (in dollars per share)			$ 2.69
Cashless exercise, number of authorized shares (in shares)			12,614
Cashless exercise, weighted average exercise price (in dollars per share)			$ 2.69
Forfeited, number of authorized shares (in shares)		374,999	304,723
Forfeited, weighted average exercise price (in dollars per share)		$ 2.61	$ 2.70
Exercised, number of authorized shares (in shares)			(1,866)
Exercised shares forgone to satisfy minimum statutory withholding, number of authorized shares (in shares)			(798)
Cashless exercise, number of authorized shares (in shares)			(12,614)
Forfeited, number of authorized shares (in shares)		(374,999)	(304,723)
Outstanding, number of authorized shares (in shares)		1,962,500	1,249,999	970,000
Outstanding, weighted average exercise price (in dollars per share)		$ 2.44	$ 2.80	$ 2.79
Exercisable, number of authorized shares (in shares)			616,597
Exercisable, weighted average exercise price (in dollars per share)			$ 2.87
Granted, weighted average remaining contractual term (Year)		3 years 47 days	4 years 219 days
2014 Amended and Restated Stock Incentive Plan [Member] | 2007 Plan (Options) [Member]
Exercisable, number of authorized shares (in shares)		955,868
Exercisable, weighted average exercise price (in dollars per share)		$ 2.69
[1]	Represents inducement stock options to purchase 800,000 shares of the Company's Common Stock to former executive level managers.

Note 10 - Share-based Compens55

Note 10 - Share-based Compensation - Schedule of Stock Options Outstanding (Details)	12 Months Ended
	Dec. 31, 2017$ / sharesshares
2007 Stock Incentive Plan [Member]
Options outstanding, number of shares outstanding (in shares) | shares	133,332
Options outstanding, weighted-average remaining contractual life (Year)
Options outstanding, weighted-average exercise price (in dollars per share)	$ 2.31
Options exercisable, number of shares exercisable (in shares) | shares	133,332
Options exercisable, weighted-average exercise price (in dollars per share)	$ 1.95
2014 Amended and Restated Stock Incentive Plan [Member]
Options outstanding, number of shares outstanding (in shares) | shares	1,962,500
Options outstanding, weighted-average remaining contractual life (Year)	3 years 65 days
Options outstanding, weighted-average exercise price (in dollars per share)	$ 2.44
Options exercisable, number of shares exercisable (in shares) | shares	955,868
Options exercisable, weighted-average exercise price (in dollars per share)	$ 2.69
Range 1 [Member] | 2007 Stock Incentive Plan [Member]
Exercise price, lower range (in dollars per share)	1.76
Exercise price, upper range (in dollars per share)	$ 2
Options outstanding, number of shares outstanding (in shares) | shares	91,666
Options outstanding, weighted-average remaining contractual life (Year)
Options outstanding, weighted-average exercise price (in dollars per share)	$ 1.93
Options exercisable, number of shares exercisable (in shares) | shares	91,666
Options exercisable, weighted-average exercise price (in dollars per share)	$ 1.93
Range 1 [Member] | 2014 Amended and Restated Stock Incentive Plan [Member]
Exercise price, lower range (in dollars per share)	2.01
Exercise price, upper range (in dollars per share)	$ 3
Options outstanding, number of shares outstanding (in shares) | shares	1,962,500
Options outstanding, weighted-average remaining contractual life (Year)	3 years 65 days
Options outstanding, weighted-average exercise price (in dollars per share)	$ 2.44
Options exercisable, number of shares exercisable (in shares) | shares	955,868
Options exercisable, weighted-average exercise price (in dollars per share)	$ 2.69
Range 2 [Member] | 2007 Stock Incentive Plan [Member]
Exercise price, lower range (in dollars per share)	2.01
Exercise price, upper range (in dollars per share)	$ 3
Options outstanding, number of shares outstanding (in shares) | shares	41,666
Options outstanding, weighted-average remaining contractual life (Year)
Options outstanding, weighted-average exercise price (in dollars per share)	$ 2.01
Options exercisable, number of shares exercisable (in shares) | shares	41,666
Options exercisable, weighted-average exercise price (in dollars per share)	$ 2.01

Note 10 - Share-based Compens56

Note 10 - Share-based Compensation - Schedule of Share-based Compensation Expense Based on Fair Value of Options (Details) - $ / shares	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Expected volatility		35.00%
Risk free interest rate		0.69%
Expected lives at date of grant (Year)	3 years 339 days	5 years 3 days
Weighted average fair value of options granted (in dollars per share)	$ 2.09	$ 2.76
Minimum [Member]
Expected volatility	30.00%
Risk free interest rate	0.69%
Maximum [Member]
Expected volatility	69.00%
Risk free interest rate	2.05%

Note 10 - Share-based Compens57

Note 10 - Share-based Compensation - Stock-based Compensation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Restricted share expense	$ 48	$ 151
Stock option expense	634	311
Total stock-based compensation expense	$ 682	$ 462

Note 11 - Employee Benefit Pl58

Note 11 - Employee Benefit Plans (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Defined Benefit Plan, Plan Assets, Contributions by Employer	$ 0.6	$ 0.7