InfuSystem (INFU) 10-K 22 Mar 19 2018 FY Annual report Financial data

Document And Entity Information

Document And Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2018	Mar. 08, 2019	Jun. 30, 2018
Document Information [Line Items]
Entity Registrant Name	InfuSystem Holdings, Inc
Entity Central Index Key	0001337013
Trading Symbol	infu
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Well-known Seasoned Issuer	No
Entity Emerging Growth Company	false
Entity Small Business	true
Entity Common Stock, Shares Outstanding (in shares)		19,577,024
Entity Public Float			$ 60,990,253
Entity Shell Company	false
Document Type	10-K
Document Period End Date	Dec. 31, 2018
Document Fiscal Year Focus	2018
Document Fiscal Period Focus	FY
Amendment Flag	false

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Current assets:
Cash and cash equivalents	$ 4,318	$ 3,469
Accounts receivable, net	9,593	11,284
Inventories	2,254	1,764
Other current assets	1,372	1,150
Total current assets	17,537	17,667
Medical equipment for sale or rental	1,601	1,567
Medical equipment in rental service, net of accumulated depreciation	23,488	23,369
Property & equipment, net of accumulated depreciation	1,445	1,633
Intangible assets, net	19,865	24,514
Other assets	137	131
Total assets	64,073	68,881
Current liabilities:
Accounts payable	7,091	5,516
Capital lease liability, current	33	505
Current portion of long-term debt	4,903	3,039
Other current liabilities	2,763	3,414
Total current liabilities	14,790	12,474
Long-term debt, net of current portion	28,842	25,352
Capital lease liability, long-term		33
Deferred income taxes		62
Other long-term liabilities		7
Total liabilities	43,632	37,928
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 23,095,513 and 19,577,024, as of December 31, 2018, respectively, and issued and outstanding 22,978,398 and 22,780,738, as of December 31, 2017, respectively.	2	2
Additional paid-in capital	83,167	92,584
Retained deficit	(62,728)	(61,633)
Total stockholders’ equity	20,441	30,953
Total liabilities and stockholders’ equity	$ 64,073	$ 68,881

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - $ / shares	Dec. 31, 2018	Dec. 31, 2017
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, authorized (in shares)	200,000,000	200,000,000
Common stock, issued (in shares)	23,095,513	22,978,398
Common stock, outstanding (in shares)	19,577,024	22,780,738

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Net revenues:
Rentals	$ 56,584	$ 61,085
Product sales	10,554	9,992
Net revenues	67,138	71,077
Cost of revenues:
Cost of revenues — Product, service and supply costs	19,332	18,367
Cost of revenues — Pump depreciation and disposals	8,788	9,349
Gross profit	39,018	43,361
Selling, general and administrative expenses:
Third-party payor provision for doubtful accounts		5,615
Amortization of intangibles	4,649	5,560
Asset impairment charges		993
Selling and marketing	9,107	9,779
General and administrative	24,847	25,226
Total selling, general and administrative	38,603	47,173
Operating income (loss)	415	(3,812)
Other expense:
Interest expense	(1,420)	(1,332)
Other expense	(37)	(113)
Total other expense	(1,457)	(1,445)
Loss before income taxes	(1,042)	(5,257)
Provision for income taxes	(53)	(15,450)
Net loss	$ (1,095)	$ (20,707)
Net loss per share:
Basic and diluted (in dollars per share)	$ (0.05)	$ (0.91)
Weighted average common shares outstanding:
Basic and diluted (in shares)	21,417,628	22,739,651

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, 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)				(100,000)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		(58)			$ (58)
Net loss			(20,707)		$ (20,707)
Common stock repurchased as part of Repurchase Program (in shares)					0
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
Stock based shares issued upon vesting - gross (in shares)	103,000
Stock based shares issued upon vesting - gross
Stock-based compensation expense		957			$ 957
Employee stock purchase plan (in shares)	44,000				43,433
Employee stock purchase plan		91			$ 91
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares)	(29,000)				(100,000)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		(70)			$ (70)
Net loss			(1,095)		$ (1,095)
Common stock repurchased as part of Repurchase Program (in shares)				(3,320,000)	(3,300,000)
Common stock repurchased as part of Repurchase Program		(10,395)			$ (10,395)
Balances (in shares) at Dec. 31, 2018	23,096,000			(3,518,000)
Balances at Dec. 31, 2018	$ 2	$ 83,167	$ (62,728)		$ 20,441

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands		12 Months Ended
		Dec. 31, 2018	Dec. 31, 2017
OPERATING ACTIVITIES
Net loss		$ (1,095)	$ (20,707)
Adjustments to reconcile net loss to net cash provided by operating activities:
Provision for doubtful accounts		6,104	5,641
Depreciation		6,659	6,963
Loss on disposal of medical equipment		434	207
Gain on sale of medical equipment		(1,340)	(1,662)
Amortization of intangibles		4,649	5,560
Asset impairment charges			993
Amortization of deferred debt issuance costs		33	28
Stock-based compensation expense		957	682
Deferred income tax benefit (expense)		(62)	15,389
Changes in Assets - (Increase)/Decrease:
Accounts receivable		(4,413)	(5,344)
Inventories		(490)	402
Other current assets		(222)	(201)
Other assets		(6)	119
Changes in Liabilities - Increase/(Decrease):
Accounts payable and other liabilities		183	(352)
NET CASH PROVIDED BY OPERATING ACTIVITIES		11,391	7,718
INVESTING ACTIVITIES
Purchases of medical equipment		(8,022)	(2,652)
Purchases of property and equipment		(281)	(104)
Purchases of intangible assets			(192)
Proceeds from sale of medical equipment		3,319	3,866
NET CASH (USED IN) PROVIDED BY INVESTING ACTIVITIES		(4,984)	918
FINANCING ACTIVITIES
Principal payments on term loans and capital lease obligations		(6,319)	(37,466)
Cash proceeds from bank loans and revolving credit facility		11,162	28,866
Debt Issuance Costs		(27)	(38)
Cash Proceeds - Stock Plans		91	131
Common stock repurchased as part of Repurchase Program		(10,395)
Common stock repurchased to satisfy taxes on stock based compensation		(70)	(58)
NET CASH USED IN FINANCING ACTIVITIES		(5,558)	(8,565)
Net change in cash and cash equivalents		849	71
Cash and cash equivalents, beginning of year		3,469	3,398
Cash and cash equivalents, end of year		4,318	3,469
SUPPLEMENTAL DISCLOSURES
Cash paid for interest		1,383	1,200
Cash paid for income taxes		159	139
NON-CASH TRANSACTIONS
Additions to medical equipment and property	[1]	998	549
Medical equipment acquired pursuant to a capital lease			$ 137
[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, 2018 and 2017, 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, 2018
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 five 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. and Moog Medical Devices Group each supply 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 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, 2018
Notes to Financial Statements
Significant Accounting Policies [Text Block]	2. Summary of Significant Accounting Policies Reclassifications Certain prior period reclassifications were made to conform with the current period presentation. These reclassifications had no Presentation in the Consolidated Statements The Company rents and sells medical equipment. The Company purchases medical equipment directly for sale as well as medical equipment that is purchased for either rental or sale and that is unallocated at the time of purchase (“Unallocated Assets”). Management believes that the predominant source of revenues and cash flows from the Unallocated Assets is from rentals and most equipment purchased is likely to be rented prior to being sold. Additionally, during the year ended December 31, 2018, 230: Statement of Cash Flows, Classification of Certain Cash Receipts and Cash Payments 230” two 230, 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 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, 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 judgments 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 two Accounts Receivable and Allowance for Doubtful Accounts Amounts billed that have not 606, not December 31, 2018. 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 December 31, 2018 2017, Medical Equipment Medical Equipment (“Equipment”) consists of equipment that the Company purchases from third 1 2 seven not $0.5 December 31, 2018 2017, 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 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 previous acquisitions. The Company amortizes the value assigned to the physician and customer relationships on a straight-line basis over the period of expected benefit, which ranges from 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 for trade names with indefinite lives through the royalty relief income valuation approach. The Company performed its annual impairment analysis as of October 2018 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 not December 31, 2018 $0.2 December 31, 2017. $2.3 2018 $3.1 2017. 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 not In 2017, December 2017, $1.0 2017. 2018, none Operating and Capital Leases Leases 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 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 3.5% December 31, 2018. Revenue Recognition On January 1, 2018 606 606” two 606 605 606 ASC 606 606 not The Company has two 606. no The Company generates the majority of its revenue from the rental of infusion pumps to its customers and a minority of its revenue from product sales. For the rental service performance obligation, revenue is based on its standalone price, determined by using reimbursement rates established by third not The Company employs certain significant judgments to estimate the dollar amount of revenue, and related concessions, allocated to the rental service and sale of products. These judgments include, among others, the estimation of variable consideration. Variable consideration, specifically related to the Company’s third no Net revenues are adjusted when changes in estimates of variable consideration occur. Changes in estimates typically arise as a result of new information obtained, such as actual payment receipt or denial, or pricing adjustments by payors. Subsequent changes to estimates of transaction prices are recorded as adjustments to net revenue in the period of the change. Subsequent changes that are determined to be the result of an adverse change in the payors ability to pay are recorded as an allowance for doubtful accounts. Cost of Revenues Cost of revenues include the costs of servicing and maintaining pumps, products sold, shipping and other direct and indirect costs related to net revenues. Shipping and handling costs incurred after control over a product has transferred to a customer are accounted for as a fulfillment cost. 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 2018 2017, 7% 6% third 2018 2017, 4% 2018 2017 We also contract with various other third no 7% third Income Taxes The Company recognizes deferred income tax liabilities and assets based on: ( 1 2 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 not not 50% Treasury Stock The Company periodically repurchases shares of its common stock. These repurchases take place either as part of a board-authorized program, which may may 10b5 1 Share Based Payments The determination of the fair value of stock option awards, restricted stock 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 and marketing 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, 2018 2017 Earnings Per Share The Company reports its earnings per share in accordance with the “Earnings Per Share” topic of FASB 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): 2018 2017 Numerator: Net loss (in thousands) $ (1,095 ) $ (20,707 ) Denominator: Weighted average common shares outstanding: Basic 21,417,628 22,739,651 Dilutive effect of restricted shares, options and non-vested share awards - - Diluted 21,417,628 22,739,651 Stock options of 0.1 0.5 not December 31, 2018 2017, Fair Value of Financial Instruments The carrying amounts reported in the consolidated balance sheets as of December 31, 2018 2017 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 that are not Level III significant inputs to the valuation model are unobservable. Recent Accounting Pronouncements and Developments In January 2017, No. 2017 04, 350 2 December 15, 2019 ( January 1, 2020 January 1, 2017. not In February 2016, No. 2016 02, 842 842, 842 842 December 15, 2018, July 2018, 2018 10, 842, July 2018, 2018 11, 842 January 1, 2019 not not not 842 842 not In June 2016, No. 2016 13, 326 326 not 326 January 1, 2020. 326 In August 2016, 230, eight not December 15, 2017. January 1, 2018, $0.3 December 31, 2018 $0.1 December 31, 2017.

Note 3 - Revenue Recognition

Note 3 - Revenue Recognition	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Revenue from Contract with Customer [Text Block]	3 . Revenue Recognition Adoption of ASC 606 Except for the changes related to the adoption of ASC 606, not 606 December 31, 2018 ( 2018 As Reported Adjustments Pro-Forma as if Previous Accounting Guidance Was in Effect (Unaudited) Net revenues: Net rental revenues $ 56,584 $ 6,319 $ 62,903 Net revenues 67,138 6,319 73,457 Gross profit 39,018 6,319 45,337 Selling, general and administrative expenses: Provision for doubtful accounts - 6,319 6,319 Total selling, general and administrative 38,603 6,319 44,922 The following table presents disaggregated revenue by offering type: 2018 Third-Party Payor Rentals 47.6% Direct Payor Rentals 36.7% Product Sales 15.7% Total - Net revenues 100.0%

Note 4 - Medical Equipment

Note 4 - Medical Equipment	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Medical Equipment and Property Disclosure [Text Block]	4 . Medical Equipment Equipment consisted of the following as of December 31 2018 2017 Medical Equipment for sale or rental $ 1,601 $ 1,567 Medical Equipment in rental service 61,429 57,928 Medical Equipment in rental service - pump reserve (530 ) (482 ) Accumulated depreciation (37,411 ) (34,077 ) Medical Equipment in rental service - net 23,488 23,369 Total $ 25,089 $ 24,936 Depreciation expense for the years ended December 31, 2018 2017 $6.2 $6.5

Note 5 - Property and Equipment

Note 5 - Property and Equipment	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Property, Plant and Equipment Disclosure [Text Block]	5 . Property and Equipment Property and equipment consisted of the following as of December 31 2018 Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 3,717 $ (3,257 ) $ 460 Automobiles 118 (95 ) 23 Leasehold improvements 2,219 (1,257 ) 962 Total $ 6,054 $ (4,609 ) $ 1,445 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 Depreciation expense for each of the years ended December 31, 2018 2017 $0.4 $0.5

Note 6 - Intangible Assets

Note 6 - Intangible Assets	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Intangible Assets Disclosure [Text Block]	6 . Intangible Assets The carrying amount and accumulated amortization of intangible assets as of December 31, 2018 2017 2018 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 (24,175 ) 12,359 Non-compete agreements 1,136 (1,136 ) - Software 11,230 (5,724 ) 5,506 Total nonamortizable and amortizable intangible assets $ 50,923 $ (31,058 ) $ 19,865 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 The weighted average remaining lives of physician and customer relationships, non-compete agreements and software were 4 0 2 December 31, 2018. In 2017, December 2017, $1.0 2017. 2018, none Amortization expense for intangible assets for the years ended December 31, 2018 2017 $4.6 $5.6 five December 31, 2018 2019 2020 2021 2022 2023 2024 and thereafter Amortization expense $ 4,402 $ 4,285 $ 3,930 $ 2,051 $ 548 $ 2,649

Note 7 - Debt

Note 7 - Debt	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Debt Disclosure [Text Block]	7 . Debt On July 31, 2018, March 23, 2015 ( 2.8 second not $8.6 not $6.4 no December 31, 2019 1.25:1.0 1.15:1.0. December 6, 2021, December 31, 2024. As of December 31, 2018, 2018, fifth 13 10 The net availability under the revolving credit facility under the Credit Agreement (the “Revolver”) is based upon the Company’s eligible accounts receivable and eligible inventory and was comprised as follows (in thousands): December 31, December 31, 2018 2017 Revolver: Gross Availability $ 9,973 $ 10,000 Outstanding Draws - - Letter of Credit (750 ) (750 ) Landlord Reserves (70 ) (45 ) Availability on Revolver $ 9,153 $ 9,205 The Company had future maturities of loans as of December 31, 2018 2019 2020 2021 2022 2023 and thereafter Total Term Loan A $ 3,584 $ 3,584 $ 16,143 $ - $ - $ 23,311 Term Loan C 1,229 1,229 5,528 - - 7,986 Equipment Line 128 512 512 512 898 2,562 Unamortized value of debt issuance costs (38 ) (38 ) (38 ) - - (114 ) Total $ 4,903 $ 5,287 $ 22,145 $ 512 $ 898 $ 33,745 The following is a breakdown of the Company’s current and long-term debt as of December 31, 2018 December 31, 2017 ( December 31, 2018 December 31, 2017 Current Portion Long-Term Portion Total Current Portion Long-Term Portion Total Term Loan A $ 3,584 $ 19,727 $ 23,311 $ 3,067 $ 25,444 $ 28,511 Term Loan C 1,229 6,757 7,986 - - - Equipment Line 128 2,434 2,562 - - - Unamortized value of debt issuance costs (38 ) (76 ) (114 ) (28 ) (92 ) (120 ) Revolver - - - - - - Total $ 4,903 $ 28,842 33,745 $ 3,039 $ 25,352 28,391 As of December 31, 2018, 30 2.00% 3.00% 2.50%, 1.00% 0.25%. December 31, 2018 5.13% 2.38% 2.75% December 31, 2018 5.50% 5.50%

Note 8 - Income Taxes

Note 8 - Income Taxes	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Income Tax Disclosure [Text Block]	8 . Income Taxes The following table summarizes loss before income taxes for the years ended December 31 ( 2018 2017 U.S loss $ (1,138 ) $ (5,419 ) Non-U.S. income 96 162 Loss before income taxes $ (1,042 ) $ (5,257 ) The following table summarizes the Company’s components of the consolidated provision for income taxes for the years ended December 31 2018 2017 U.S Federal income tax benefit (expense) Current $ - $ 73 Deferred 62 (13,830 ) Total U.S. Federal income tax benefit (expense) 62 (13,757 ) State and local income tax expense Current (84 ) (45 ) Deferred - (1,560 ) Total state and local income tax expense (84 ) (1,605 ) Foreign income tax expense Current (31 ) (88 ) Total income tax expense $ (53 ) $ (15,450 ) The following table summarizes activity related to the Company’s valuation allowance for the years ended December 31 ( 2018 2017 Valuation allowance at the Beginning of Period $ (11,435 ) $ - Income tax expense - (11,435 ) Release of valuation allowance 65 - Valuation allowance at the End of Period $ (11,370 ) $ (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: 2018 2017 Income tax expense at the statutory rate 21.0% 34.0% State and local income tax expense (14.0%) 4.6% Foreign income tax (2.2%) (1.2%) Permanent differences (9.4%) (8.3%) Increase in valuation allowance (0.3%) (217.5%) Impacts related to the 2017 Tax Act 0.0% (106.0%) Other adjustments (0.1%) 0.4% Effective income tax rate (5.0%) (293.9%) The following table summarizes the temporary differences and carryforwards that give rise to deferred tax assets and liabilities as of December 31 ( 2018 2017 Deferred Federal tax assets – Bad debt reserves $ 1,178 $ 1,375 Stock based compensation 393 305 Net operating loss 8,025 7,319 Accrued compensation 218 249 Inventories 27 18 Accrued rent 31 30 Goodwill and intangible assets 2,507 3,323 Research & development credits 533 533 Other credits 25 5 Other 114 103 Total deferred Federal tax assets 13,051 13,260 Less: valuation allowance (9,724 ) (9,599 ) Net deferred tax assets 3,327 3,661 Deferred Federal tax liabilities – Depreciation and asset basis differences (3,335 ) (3,672 ) Other 8 (51 ) Total deferred Federal tax liabilities (3,327 ) (3,723 ) Net deferred Federal tax assets (liabilities) - (62 ) Net deferred state and local tax assets 1,646 1,836 Less: valuation allowance (1,646 ) (1,836 ) Net deferred tax assets (liabilities) $ - $ (62 ) As of December 31, 2018 2017, $38.2 $34.9 The Company’s federal net operating loss carryforwards of approximately $34.8 2028 2038 $3.4 $1.3 5 20 2019, 2019 2038. At December 31, 2018, not no The Company had no December 31, 2018 2017. 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 2015 2018 four 2014 2018 The 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 $4.7

Note 9 - Commitments and Contin

Note 9 - Commitments and Contingencies	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	9 . Commitments and Contingencies From time to time in the ordinary course of its business, the Company may may not not, not not The Company is not

Note 10 - Leases

Note 10 - Leases	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Leases of Lessee Disclosure [Text Block]	10 . Leases The Company leases office space, service facility centers and equipment under non-cancelable capital and operating lease arrangements. The Company periodically enters into capital leases to finance the purchase of ambulatory infusion pumps (“Pump Assets”). The Pump Assets 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 3.5% December 31, 2018. Future minimum rental payments pursuant to leases that have an initial or remaining non-cancelable lease term in excess of one December 31, 2018 Capital Leases Operating Leases Total 2019 $ 33 $ 1,866 $ 1,899 2020 - 1,717 1,717 2021 - 1,107 1,107 2022 - 1,016 1,016 2023 - 1,040 1,040 Thereafter - 5,599 5,599 Total require payments $ 33 $ 12,345 $ 12,378 Less amounts representing interest (3.5%) - Present value of minimum lease payments 33 Less current maturities (33 ) Long-term capital lease liability $ - At December 31, 2018 2017, $0.6 $1.7 $0.2 $0.5 The Company had minimum future operating lease commitments, mainly related to its leased facilities. Related rental expense for facilities and other equipment from third $1.5 $1.0 December 31, 2018 2017,

Note 11 - Share-based Compensat

Note 11 - Share-based Compensation	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Disclosure of Compensation Related Costs, Share-based Payments [Text Block]	1 1 . 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 (“RSUs”), 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 five ten four 2018, three 1 one may In 2007, 2007 2.0 May 27, 2011, 3.0 December 31, 2018, no fourth 2018. On April 23, 2014, 2014 “2014 2014 2014 2014 2007 2.0 July 19, 2018, 1.0 December 31, 2018, 0.1 2014 The Company granted stock options under the 2014 December 31, 2018 2017, Shares Forgone to Satisfy Minimum Statutory Withholdings During the years ended December 31, 2018 2017, December 31, 2018 2017, 0.1 Stock Appreciation Rights (“SARs”) As of December 31, 2018, 0.2 ( 1 0.1 December 31, 2018, March 31, 2019, $3.00 ten 10 January 1, 2018, December 31, 2018; ( 2 0.1 December 31, 2018, March 31, 2019, ninety 90% 2018 As of December 31, 2018, $0.3 The following table summarizes SARs share activity for the years ended December 31: Weighted average grant Number of date fair Aggregate shares value fair value Unvested at December 31, 2016 - $ - Granted 200,000 1.26 $ 60,000 Vested - - Vested shares forgone to satisfy minimum statutory withholding - - Forfeitures - - Unvested at December 31, 2017 200,000 1.26 $ 60,000 Granted - - Vested (1) (200,000 ) 1.26 $ 288,000 Vested shares forgone to satisfy minimum statutory withholding - - Forfeitures - - Unvested at December 31, 2018 - $ - $ - ( 1 December 31, 2018 December 31, 2018 March 31, 2019 Restricted Shares During the year ended December 31, 2018, 0.1 December 31, 2017, 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, 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 Granted 125,000 1.37 Vested (4,116 ) 2.60 $ 13,749 Vested shares forgone to satisfy minimum statutory withholding (2,134 ) 2.60 $ 4,695 Forfeitures (1,626 ) 2.60 Unvested at December 31, 2018 129,583 $ 1.42 As of December 31, 2018, $0.1 2021. 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, 2018, 251,430 December 31: 2018 2017 Compensation expense $ 33,874 $ 49,150 Shares of stock sold to employees 43,433 68,958 Weighted average fair value per ESPP award $ 2.45 $ 2.21 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, 2018, 0.8 0.2 five 12 December 31, 2017, 1.1 0.3 five 12 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, 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 Granted - - Exercised (33,576 ) 1.96 162,134 Exercised shares forgone to satisfy minimum statutory withholding (14,255 ) 1.96 Cashless exercise (65,501 ) 1.96 Forfeited (20,000 ) 1.93 Outstanding at December 31, 2018 - $ - - $ - Exercisable at December 31, 2018 - $ - 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, 2016 1,249,999 $ 2.80 4.26 $ - 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 Granted 825,000 3.14 3.64 Exercised (10,953 ) 2.15 12,159 Exercised shares forgone to satisfy minimum statutory withholding (5,134 ) 2.15 Cashless exercise (33,079 ) 2.15 Forfeited (514,167 ) 2.62 Outstanding at December 31, 2018 2,224,167 $ 2.67 3.01 $ 1,719,584 Exercisable at December 31, 2018 1,101,910 $ 2.52 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, 2016 800,000 $ 2.25 2.26 $ 240,000 Granted - - - - Exercised - - - - Forfeited (800,000 ) - - - Outstanding at December 31, 2017 - $ - - $ - Granted 125,000 2.55 5.42 111,250 Exercised - - - - Forfeited - - - - Outstanding at December 31, 2018 125,000 $ 2.55 5.42 $ 111,250 Exercisable at December 31, 2018 - $ - Aggregate Intrinsic Value = Excess of market value over the option exercise price of all in-the-money stock options. ( 1 The following table summarizes information about stock options outstanding at December 31, 2018: 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 1,519,167 2.48 $ 2.41 1,040,243 $ 2.48 $3.01 - $4.00 705,000 3.39 $ 3.22 61,667 $ 3.18 Outstanding at December 31, 2018 2,224,167 3.01 $ 2.67 1,101,910 $ 2.52 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: 2018 2017 Expected volatility 35% to 49% 30% to 69% Risk free interest rate 2.43% to 2.88% 0.69% to 2.05% Expected lives at date of grant (in years) 3.83 3.93 Weighted average fair value of options granted $1.00 $2.09 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 ( 2018 2017 Restricted share expense $ 78 $ 48 Stock option and SARs expense 879 634 Total stock-based compensation expense $ 957 $ 682 Share Repurchase Program On March 12, 2018, one million not may may may 10b5 1 During the year ended December 31, 2018, 0.5 2.1 0.7 3.3 15% December 31, 2017. December 31, 2017, not Stock Purchase and Settlement Agreement and Stock Purchase Agreement On July 31, 2018, 2.2 $3.10 $6.7 not three third 2018 2.1 36,000 third 7 10 On July 31, 2018, 0.7 $3.10 $2.1 third 2018. 7 10

Note 12 - Employee Benefit Plan

Note 12 - Employee Benefit Plans	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Pension and Other Postretirement Benefits Disclosure [Text Block]	1 2 . Employee Benefit Plans The Company has a defined contribution plan in which the Company makes matching contributions for a certain percentage of employee contributions. For each of the years ended December 31, 2018 2017, $0.6 not

Note 13 - Subsequent Events

Note 13 - Subsequent Events	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Subsequent Events [Text Block]	13. Subsequent Events On February 5, 2019, fifth 1 2 December 31, 2018 2019, 3 December 31, 2019 4 5 December 31, 2018 December 31, 2019.

Significant Accounting Policies

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Reclassification, Policy [Policy Text Block]	Reclassifications Certain prior period reclassifications were made to conform with the current period presentation. These reclassifications had no
Presentation in Consolidated Statements [Policy Text Block]	Presentation in the Consolidated Statements The Company rents and sells medical equipment. The Company purchases medical equipment directly for sale, as well as, medical equipment that is purchased for either rental or sale and that is unallocated at the time of purchase (“Unallocated Assets”). Management believes that the predominant source of revenues and cash flows from the Unallocated Assets is from rentals and most equipment purchased is likely to be rented prior to being sold. Additionally, during the year ended December 31, 2018, 230: Statement of Cash Flows, Classification of Certain Cash Receipts and Cash Payments 230” two 230,
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 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, 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 judgments 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 two
Trade and Other Accounts Receivable, Policy [Policy Text Block]	Accounts Receivable and Allowance for Doubtful Accounts Amounts billed that have not 606, not December 31, 2018.
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 December 31, 2018 2017,
Medical Equipment [Policy Text Block]	Medical Equipment Medical Equipment (“Equipment”) consists of equipment that the Company purchases from third 1 2 seven not $0.5 December 31, 2018 2017,
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 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 previous acquisitions. The Company amortizes the value assigned to the physician and customer relationships on a straight-line basis over the period of expected benefit, which ranges from 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 for trade names with indefinite lives through the royalty relief income valuation approach. The Company performed its annual impairment analysis as of October 2018 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 not December 31, 2018 $0.2 December 31, 2017. $2.3 2018 $3.1 2017.
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 not In 2017, December 2017, $1.0 2017. 2018, none
Lessee, Leases [Policy Text Block]	Operating and Capital Leases Leases 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 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 3.5% December 31, 2018.
Revenue from Contract with Customer [Policy Text Block]	Revenue Recognition On January 1, 2018 606 606” two 606 605 606 ASC 606 606 not The Company has two 606. no The Company generates the majority of its revenue from the rental of infusion pumps to its customers and a minority of its revenue from product sales. For the rental service performance obligation, revenue is based on its standalone price, determined by using reimbursement rates established by third not The Company employs certain significant judgments to estimate the dollar amount of revenue, and related concessions, allocated to the rental service and sale of products. These judgments include, among others, the estimation of variable consideration. Variable consideration, specifically related to the Company’s third no Net revenues are adjusted when changes in estimates of variable consideration occur. Changes in estimates typically arise as a result of new information obtained, such as actual payment receipt or denial, or pricing adjustments by payors. Subsequent changes to estimates of transaction prices are recorded as adjustments to net revenue in the period of the change. Subsequent changes that are determined to be the result of an adverse change in the payors ability to pay are recorded as an allowance for doubtful accounts.
Revenue Recognition, Cost of Revenue [Policy Text Block]	Cost of Revenues Cost of revenues include the costs of servicing and maintaining pumps, products sold, shipping and other direct and indirect costs related to net revenues. Shipping and handling costs incurred after control over a product has transferred to a customer are accounted for as a fulfillment cost.
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 2018 2017, 7% 6% third 2018 2017, 4% 2018 2017 We also contract with various other third no 7% third
Income Tax, Policy [Policy Text Block]	Income Taxes The Company recognizes deferred income tax liabilities and assets based on: ( 1 2 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 not not 50%
Treasury Stock, Policy [Policy Text Block]	Treasury Stock The Company periodically repurchases shares of its common stock. These repurchases take place either as part of a board-authorized program, which may may 10b5 1
Share-based Compensation, Option and Incentive Plans Policy [Policy Text Block]	Share Based Payments The determination of the fair value of stock option awards, restricted stock 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 and marketing 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, 2018 2017
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 FASB 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): 2018 2017 Numerator: Net loss (in thousands) $ (1,095 ) $ (20,707 ) Denominator: Weighted average common shares outstanding: Basic 21,417,628 22,739,651 Dilutive effect of restricted shares, options and non-vested share awards - - Diluted 21,417,628 22,739,651 Stock options of 0.1 0.5 not December 31, 2018 2017,
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, 2018 2017 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 that are not Level III significant inputs to the valuation model are unobservable.
New Accounting Pronouncements, Policy [Policy Text Block]	Recent Accounting Pronouncements and Developments In January 2017, No. 2017 04, 350 2 December 15, 2019 ( January 1, 2020 January 1, 2017. not In February 2016, No. 2016 02, 842 842, 842 842 December 15, 2018, July 2018, 2018 10, 842, July 2018, 2018 11, 842 January 1, 2019 not not not 842 842 not In June 2016, No. 2016 13, 326 326 not 326 January 1, 2020. 326 In August 2016, 230, eight not December 15, 2017. January 1, 2018, $0.3 December 31, 2018 $0.1 December 31, 2017.

Note 2 - Summary of Significa_2

Note 2 - Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	2018 2017 Numerator: Net loss (in thousands) $ (1,095 ) $ (20,707 ) Denominator: Weighted average common shares outstanding: Basic 21,417,628 22,739,651 Dilutive effect of restricted shares, options and non-vested share awards - - Diluted 21,417,628 22,739,651

Note 3 - Revenue Recognition (T

Note 3 - Revenue Recognition (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of New Accounting Pronouncements and Changes in Accounting Principles [Table Text Block]	2018 As Reported Adjustments Pro-Forma as if Previous Accounting Guidance Was in Effect (Unaudited) Net revenues: Net rental revenues $ 56,584 $ 6,319 $ 62,903 Net revenues 67,138 6,319 73,457 Gross profit 39,018 6,319 45,337 Selling, general and administrative expenses: Provision for doubtful accounts - 6,319 6,319 Total selling, general and administrative 38,603 6,319 44,922
Disaggregation of Revenue [Table Text Block]	2018 Third-Party Payor Rentals 47.6% Direct Payor Rentals 36.7% Product Sales 15.7% Total - Net revenues 100.0%

Note 4 - Medical Equipment (Tab

Note 4 - Medical Equipment (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Medical Equipment [Table Text Block]	2018 2017 Medical Equipment for sale or rental $ 1,601 $ 1,567 Medical Equipment in rental service 61,429 57,928 Medical Equipment in rental service - pump reserve (530 ) (482 ) Accumulated depreciation (37,411 ) (34,077 ) Medical Equipment in rental service - net 23,488 23,369 Total $ 25,089 $ 24,936

Note 5 - Property and Equipme_2

Note 5 - Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Property, Plant and Equipment [Table Text Block]	2018 Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 3,717 $ (3,257 ) $ 460 Automobiles 118 (95 ) 23 Leasehold improvements 2,219 (1,257 ) 962 Total $ 6,054 $ (4,609 ) $ 1,445 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

Note 6 - Intangible Assets (Tab

Note 6 - Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets [Table Text Block]	2018 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 (24,175 ) 12,359 Non-compete agreements 1,136 (1,136 ) - Software 11,230 (5,724 ) 5,506 Total nonamortizable and amortizable intangible assets $ 50,923 $ (31,058 ) $ 19,865 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
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block]	2019 2020 2021 2022 2023 2024 and thereafter Amortization expense $ 4,402 $ 4,285 $ 3,930 $ 2,051 $ 548 $ 2,649

Note 7 - Debt (Tables)

Note 7 - Debt (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Line of Credit Facilities [Table Text Block]	December 31, December 31, 2018 2017 Revolver: Gross Availability $ 9,973 $ 10,000 Outstanding Draws - - Letter of Credit (750 ) (750 ) Landlord Reserves (70 ) (45 ) Availability on Revolver $ 9,153 $ 9,205
Schedule of Maturities of Long-term Debt [Table Text Block]	2019 2020 2021 2022 2023 and thereafter Total Term Loan A $ 3,584 $ 3,584 $ 16,143 $ - $ - $ 23,311 Term Loan C 1,229 1,229 5,528 - - 7,986 Equipment Line 128 512 512 512 898 2,562 Unamortized value of debt issuance costs (38 ) (38 ) (38 ) - - (114 ) Total $ 4,903 $ 5,287 $ 22,145 $ 512 $ 898 $ 33,745
Schedule of Debt [Table Text Block]	December 31, 2018 December 31, 2017 Current Portion Long-Term Portion Total Current Portion Long-Term Portion Total Term Loan A $ 3,584 $ 19,727 $ 23,311 $ 3,067 $ 25,444 $ 28,511 Term Loan C 1,229 6,757 7,986 - - - Equipment Line 128 2,434 2,562 - - - Unamortized value of debt issuance costs (38 ) (76 ) (114 ) (28 ) (92 ) (120 ) Revolver - - - - - - Total $ 4,903 $ 28,842 33,745 $ 3,039 $ 25,352 28,391

Note 8 - Income Taxes (Tables)

Note 8 - Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Income before Income Tax, Domestic and Foreign [Table Text Block]	2018 2017 U.S loss $ (1,138 ) $ (5,419 ) Non-U.S. income 96 162 Loss before income taxes $ (1,042 ) $ (5,257 )
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]	2018 2017 U.S Federal income tax benefit (expense) Current $ - $ 73 Deferred 62 (13,830 ) Total U.S. Federal income tax benefit (expense) 62 (13,757 ) State and local income tax expense Current (84 ) (45 ) Deferred - (1,560 ) Total state and local income tax expense (84 ) (1,605 ) Foreign income tax expense Current (31 ) (88 ) Total income tax expense $ (53 ) $ (15,450 )
Summary of Valuation Allowance [Table Text Block]	2018 2017 Valuation allowance at the Beginning of Period $ (11,435 ) $ - Income tax expense - (11,435 ) Release of valuation allowance 65 - Valuation allowance at the End of Period $ (11,370 ) $ (11,435 )
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]	2018 2017 Income tax expense at the statutory rate 21.0% 34.0% State and local income tax expense (14.0%) 4.6% Foreign income tax (2.2%) (1.2%) Permanent differences (9.4%) (8.3%) Increase in valuation allowance (0.3%) (217.5%) Impacts related to the 2017 Tax Act 0.0% (106.0%) Other adjustments (0.1%) 0.4% Effective income tax rate (5.0%) (293.9%)
Schedule of Deferred Tax Assets and Liabilities [Table Text Block]	2018 2017 Deferred Federal tax assets – Bad debt reserves $ 1,178 $ 1,375 Stock based compensation 393 305 Net operating loss 8,025 7,319 Accrued compensation 218 249 Inventories 27 18 Accrued rent 31 30 Goodwill and intangible assets 2,507 3,323 Research & development credits 533 533 Other credits 25 5 Other 114 103 Total deferred Federal tax assets 13,051 13,260 Less: valuation allowance (9,724 ) (9,599 ) Net deferred tax assets 3,327 3,661 Deferred Federal tax liabilities – Depreciation and asset basis differences (3,335 ) (3,672 ) Other 8 (51 ) Total deferred Federal tax liabilities (3,327 ) (3,723 ) Net deferred Federal tax assets (liabilities) - (62 ) Net deferred state and local tax assets 1,646 1,836 Less: valuation allowance (1,646 ) (1,836 ) Net deferred tax assets (liabilities) $ - $ (62 )

Note 10 - Leases (Tables)

Note 10 - Leases (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Future Minimum Lease Payments for Capital and Operating Leases [Table Text Block]	Capital Leases Operating Leases Total 2019 $ 33 $ 1,866 $ 1,899 2020 - 1,717 1,717 2021 - 1,107 1,107 2022 - 1,016 1,016 2023 - 1,040 1,040 Thereafter - 5,599 5,599 Total require payments $ 33 $ 12,345 $ 12,378 Less amounts representing interest (3.5%) - Present value of minimum lease payments 33 Less current maturities (33 ) Long-term capital lease liability $ -

Note 11 - Share-based Compens_2

Note 11 - Share-based Compensation (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Share-based Compensation, Stock Appreciation Rights Award Activity [Table Text Block]	Weighted average grant Number of date fair Aggregate shares value fair value Unvested at December 31, 2016 - $ - Granted 200,000 1.26 $ 60,000 Vested - - Vested shares forgone to satisfy minimum statutory withholding - - Forfeitures - - Unvested at December 31, 2017 200,000 1.26 $ 60,000 Granted - - Vested (1) (200,000 ) 1.26 $ 288,000 Vested shares forgone to satisfy minimum statutory withholding - - Forfeitures - - Unvested at December 31, 2018 - $ - $ -
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, 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 Granted 125,000 1.37 Vested (4,116 ) 2.60 $ 13,749 Vested shares forgone to satisfy minimum statutory withholding (2,134 ) 2.60 $ 4,695 Forfeitures (1,626 ) 2.60 Unvested at December 31, 2018 129,583 $ 1.42
Schedule of Share-based Compensation, Employee Stock Purchase Plan, Activity [Table Text Block]	2018 2017 Compensation expense $ 33,874 $ 49,150 Shares of stock sold to employees 43,433 68,958 Weighted average fair value per ESPP award $ 2.45 $ 2.21
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, 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 Granted - - Exercised (33,576 ) 1.96 162,134 Exercised shares forgone to satisfy minimum statutory withholding (14,255 ) 1.96 Cashless exercise (65,501 ) 1.96 Forfeited (20,000 ) 1.93 Outstanding at December 31, 2018 - $ - - $ - Exercisable at December 31, 2018 - $ - 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, 2016 1,249,999 $ 2.80 4.26 $ - 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 Granted 825,000 3.14 3.64 Exercised (10,953 ) 2.15 12,159 Exercised shares forgone to satisfy minimum statutory withholding (5,134 ) 2.15 Cashless exercise (33,079 ) 2.15 Forfeited (514,167 ) 2.62 Outstanding at December 31, 2018 2,224,167 $ 2.67 3.01 $ 1,719,584 Exercisable at December 31, 2018 1,101,910 $ 2.52 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, 2016 800,000 $ 2.25 2.26 $ 240,000 Granted - - - - Exercised - - - - Forfeited (800,000 ) - - - Outstanding at December 31, 2017 - $ - - $ - Granted 125,000 2.55 5.42 111,250 Exercised - - - - Forfeited - - - - Outstanding at December 31, 2018 125,000 $ 2.55 5.42 $ 111,250 Exercisable at December 31, 2018 - $ -
Schedule of Share-based Compensation, Shares Authorized under Stock Option Plans, by Exercise Price Range [Table Text Block]	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 1,519,167 2.48 $ 2.41 1,040,243 $ 2.48 $3.01 - $4.00 705,000 3.39 $ 3.22 61,667 $ 3.18 Outstanding at December 31, 2018 2,224,167 3.01 $ 2.67 1,101,910 $ 2.52
Schedule of Share-based Payment Award, Employee Stock Purchase Plan, Valuation Assumptions [Table Text Block]	Stock Options: 2018 2017 Expected volatility 35% to 49% 30% to 69% Risk free interest rate 2.43% to 2.88% 0.69% to 2.05% Expected lives at date of grant (in years) 3.83 3.93 Weighted average fair value of options granted $1.00 $2.09
Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Table Text Block]	2018 2017 Restricted share expense $ 78 $ 48 Stock option and SARs expense 879 634 Total stock-based compensation expense $ 957 $ 682

Note 1 - Basis of Presentatio_2

Note 1 - Basis of Presentation and Nature of Operations (Details Textual)	12 Months Ended
	Dec. 31, 2018
Number of Operating Locations	5
Concentration Risk, Percentage of Raw Material Purchases from Suppliers, Minimum Threshold	10.00%

Note 2 - Summary of Significa_3

Note 2 - Summary of Significant Accounting Policies (Details Textual) $ in Thousands, shares in Millions	1 Months Ended	12 Months Ended
	Oct. 31, 2018USD ($)	Dec. 31, 2018USD ($)shares	Dec. 31, 2017USD ($)shares
Number of Operating Segments		1
Number of Financial Institutions		2
Inventory Valuation Reserves, Ending Balance		$ 100	$ 100
Medical Equipment in Rental Services, Useful Life		7 years
Medical Equipment Held for Sale or Rental Reserves		$ 500	500
Impairment of Intangible Assets, Indefinite-lived (Excluding Goodwill)	$ 0
Capitalized Computer Software, Net, Ending Balance		0	200
Capitalized Computer Software, Amortization		2,300	3,100
Impairment of Long-Lived Assets Held-for-use		0	$ 1,000
Accounting Standards Update 2016-15 [Member]
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification		300
Accounting Standards Update 2016-15 [Member] | Year Ended December 31, 2017 [Member]
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification		$ 100
Employee Stock Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount | shares		0.1	0.5
Sales Revenue, Product Line [Member] | Customer Concentration Risk [Member]
Concentration Risk, Percentage		15.70%
Sales Revenue, Product Line [Member] | Customer Concentration Risk [Member] | National Association 2 [Member] | Oncology Business [Member]
Concentration Risk, Percentage		7.00%	6.00%
Sales Revenue, Net [Member] | Customer Concentration Risk [Member] | National Association 2 [Member]
Concentration Risk, Percentage		4.00%	4.00%
Capital Leases [Member]
Debt, Weighted Average Interest Rate		3.50%
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 Significa_4

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, 2018	Dec. 31, 2017
Numerator:
Net loss (in thousands)	$ (1,095)	$ (20,707)
Weighted average common shares outstanding:
Basic (in shares)	21,417,628	22,739,651
Dilutive effect of restricted shares, options and non-vested share awards (in shares)
Diluted (in shares)	21,417,628	22,739,651

Note 3 - Revenue Recognition -

Note 3 - Revenue Recognition - Impact of ASC 606 On the Condensed Consolidated Statements of Operations (Unaudited) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Net revenues:
Rentals	$ 56,584	$ 61,085
Net revenues	67,138	71,077
Gross profit	39,018	43,361
Selling, general and administrative expenses:
Provision for doubtful accounts
Total selling, general and administrative	38,603	$ 47,173
Difference between Revenue Guidance in Effect before and after Topic 606 [Member]
Net revenues:
Rentals	6,319
Net revenues	6,319
Gross profit	6,319
Selling, general and administrative expenses:
Provision for doubtful accounts	6,319
Total selling, general and administrative	6,319
Calculated under Revenue Guidance in Effect before Topic 606 [Member]
Net revenues:
Rentals	62,903
Net revenues	73,457
Gross profit	45,337
Selling, general and administrative expenses:
Provision for doubtful accounts	6,319
Total selling, general and administrative	$ 44,922

Note 3 - Revenue Recognition _2

Note 3 - Revenue Recognition - Disaggregated Revenue by Revenue Stream (Details) - Customer Concentration Risk [Member]	12 Months Ended
	Dec. 31, 2018
Third-Party Payor Rental Revenue [Member]
Revenue	47.60%
Director Payer Rentals [Member]
Revenue	36.70%
Sales Revenue, Product Line [Member]
Revenue	15.70%
Revenue from Contract with Customer [Member]
Revenue	100.00%

Note 4 - Medical Equipment (Det

Note 4 - Medical Equipment (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Depreciation Expense Related to Medical Equipment	$ 6.2	$ 6.5

Note 4 - Medical Equipment - Su

Note 4 - Medical Equipment - Summary of Medical Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Medical Equipment for sale or rental	$ 1,601	$ 1,567
Medical Equipment in rental service	61,429	57,928
Medical Equipment in rental service - pump reserve	(530)	(482)
Accumulated depreciation	(37,411)	(34,077)
Medical Equipment in rental service - net	23,488	23,369
Total	$ 25,089	$ 24,936

Note 5 - Property and Equipme_3

Note 5 - Property and Equipment (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Depreciation, Nonproduction	$ 0.4	$ 0.5

Note 5 - Property and Equipme_4

Note 5 - Property and Equipment - Property and Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Gross Assets	$ 6,054	$ 6,129
Accumulated Depreciation	(4,609)	(4,496)
Total	1,445	1,633
Furniture and Fixtures [Member]
Gross Assets	3,717	3,824
Accumulated Depreciation	(3,257)	(3,277)
Total	460	547
Automobiles [Member]
Gross Assets	118	118
Accumulated Depreciation	(95)	(85)
Total	23	33
Leasehold Improvements [Member]
Gross Assets	2,219	2,187
Accumulated Depreciation	(1,257)	(1,134)
Total	$ 962	$ 1,053

Note 6 - Intangible Assets (Det

Note 6 - Intangible Assets (Details Textual) - USD ($) $ in Thousands	12 Months Ended		24 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2018
Amortization of Intangible Assets, Total	$ 4,649	$ 5,560
Physician and Customer Relationships [Member]
Finite-Lived Intangible Assets, Remaining Amortization Period	4 years
Noncompete Agreements [Member]
Finite-Lived Intangible Assets, Remaining Amortization Period	0 years
Computer Software, Intangible Asset [Member]
Finite-Lived Intangible Assets, Remaining Amortization Period	2 years
Impairment of Intangible Assets, Finite-lived		$ 1,000	$ 0

Note 6 - Intangible Assets - Su

Note 6 - Intangible Assets - Summary of Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Amortizable intangible assets, accumulated amortization	$ (31,058)	$ (26,409)
Total nonamortizable and amortizable intangible assets, gross assets	50,923	50,923
Total nonamortizable and amortizable intangible assets, net	19,865	24,514
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	(24,175)	(21,801)
Amortizable intangible assets, net	12,359	14,733
Noncompete Agreements [Member]
Amortizable intangible assets, gross assets	1,136	1,136
Amortizable intangible assets, accumulated amortization	(1,136)	(1,125)
Amortizable intangible assets, net		11
Computer Software, Intangible Asset [Member]
Amortizable intangible assets, gross assets	11,230	11,230
Amortizable intangible assets, accumulated amortization	(5,724)	(3,460)
Amortizable intangible assets, net	5,506	7,770
Trade Names 1 [Member]
Nonamortizable intangible assets	$ 2,000	$ 2,000

Note 6 - Intangible Assets - Ex

Note 6 - Intangible Assets - Expected Annual Amortization Expense for Intangible Assets (Details) $ in Thousands	Dec. 31, 2018USD ($)
Amortization expense, 2019	$ 4,402
Amortization expense, 2020	4,285
Amortization expense, 2021	3,930
Amortization expense, 2022	2,051
Amortization expense, 2023	548
Amortization expense, 2024 and thereafter	$ 2,649

Note 7 - Debt (Details Textual)

Note 7 - Debt (Details Textual) $ in Thousands, shares in Millions	Jul. 31, 2018USD ($)shares	Jul. 30, 2018	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)
Stock Repurchase Agreement, Shares to be Repurchased | shares	2.8
Long-term Debt, Total			$ 33,745	$ 28,391
Equipment Line [Member]
Long-term Debt, Total			2,562
Term Loan C [Member]
Long-term Debt, Total			$ 7,986
Credit Facility [Member]
Fixed Charge Coverage Ratio	1.15	1.25
Credit Facility [Member] | Equipment Line [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 6,400
Credit Facility [Member] | Term Loan C [Member]
Long-term Debt, Total	$ 8,600
Credit Facility [Member] | Eurodollar Loan [Member]
Debt Instrument, Interest Rate, Effective Percentage			5.13%
LIBOR Rate			2.38%
Credit Facility [Member] | Eurodollar Loan [Member] | London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate			2.75%
Credit Facility [Member] | Eurodollar Loan [Member] | Minimum [Member] | London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate			2.00%
Credit Facility [Member] | Eurodollar Loan [Member] | Maximum [Member] | London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate			3.00%
Credit Facility [Member] | CB Floating Rate Loan [Member]
Debt Instrument, Interest Rate, Effective Percentage			5.50%
Lender Prime Rate			5.50%
Credit Facility [Member] | CB Floating Rate Loan [Member] | London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate, Before Margin Rate			2.50%
Credit Facility [Member] | CB Floating Rate Loan [Member] | Minimum [Member] | Greater of Prime Rate or LIBOR Plus 2.5% [Member]
Debt Instrument, Basis Spread on Variable Rate			(1.00%)
Credit Facility [Member] | CB Floating Rate Loan [Member] | Maximum [Member] | Greater of Prime Rate or LIBOR Plus 2.5% [Member]
Debt Instrument, Basis Spread on Variable Rate			0.25%

Note 7 - Debt - Summary of Revo

Note 7 - Debt - Summary of Revolver Based Upon Borrowers' Eligible Accounts Receivable and Inventory (Details) - Revolving Credit Facility [Member] - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Gross Availability	$ 9,973	$ 10,000
Outstanding Draws
Letter of Credit	(750)	(750)
Landlord Reserves	(70)	(45)
Availability on Revolver	$ 9,153	$ 9,205

Note 7 - Debt - Summary of Futu

Note 7 - Debt - Summary of Future Maturities of Loans (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
2020	$ 5,287
2021	22,145
2022	512
Total	898
Long-term Debt, Total	33,745	$ 28,391
Unamortized value of the debt issuance costs, 2019	(38)
Unamortized value of the debt issuance costs, 2020	(38)
Unamortized value of the debt issuance costs, 2021	(38)
Unamortized value of the debt issuance costs, 2022
Unamortized value of the debt issuance costs, 2023 and thereafter
Unamortized value of the debt issuance costs, Total	(114)	(120)
2019	4,903
Equipment Line [Member]
2019	128
2020	512
2021	512
2022	512
Total	898
Long-term Debt, Total	2,562
Term Loan A [Member]
2019	3,584
2020	3,584
2021	16,143
2022
Total	23,311
Long-term Debt, Total	23,311	28,511
Term Loan C [Member]
2019	1,229
2020	1,229
2021	5,528
2022
Total	7,986
Long-term Debt, Total	$ 7,986

Note 7 - Debt - Summary of Comp

Note 7 - Debt - Summary of Company's Current and Long-term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Current portion of long-term debt	$ 4,903	$ 3,039
Long-term debt	28,842	25,352
Total	33,745	28,391
Unamortized value of the debt issuance costs, current portion of long-term debt	(38)	(28)
Unamortized value of the debt issuance costs, long-term debt	(76)	(92)
Unamortized value of the debt issuance costs, Total	(114)	(120)
Equipment Line [Member]
Current portion of long-term debt	128
Long-term debt	2,434
Total	2,562
Term Loan A [Member]
Current portion of long-term debt	3,584	3,067
Long-term debt	19,727	25,444
Total	23,311	28,511
Term Loan C [Member]
Current portion of long-term debt	1,229
Long-term debt	6,757
Total	$ 7,986

Note 8 - Income Taxes (Details

Note 8 - Income Taxes (Details Textual) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Unrecognized Tax Benefits, Ending Balance	$ 0	$ 0
Net Operating Loss Carryforwards Limitation on Use	1,800
Remaining Preownership Net Operating Loss Carryforwards	$ 4,700
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, Total	$ 38,200	$ 34,900
Operating Loss Carryforwards with Indefinite Life	$ 3,400
Domestic Tax Authority [Member] | Internal Revenue Service (IRS) [Member]
Open Tax Year	2015 2016 2017 2018
State and Local Jurisdiction [Member]
Operating Loss Carryforwards, Total	$ 1,300
Foreign Tax Authority [Member] | Canada Revenue Agency [Member]
Open Tax Year	2014 2015 2016 2017 2018

Note 8 - Income Taxes - Summary

Note 8 - Income Taxes - Summary of (Loss) Income Before Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
U.S loss	$ (1,138)	$ (5,419)
Non-U.S. income	96	162
Loss before income taxes	$ (1,042)	$ (5,257)

Note 8 - Income Taxes - Summa_2

Note 8 - Income Taxes - Summary of Components of Consolidated Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
U.S Federal income tax benefit (expense)
Current		$ 73
Deferred	62	(13,830)
Total U.S. Federal income tax benefit (expense)	62	(13,757)
Current	(84)	(45)
Deferred		(1,560)
Total state and local income tax expense	(84)	(1,605)
Current	(31)	(88)
Total income tax expense	$ (53)	$ (15,450)

Note 8 - Income Taxes - Changes

Note 8 - Income Taxes - Changes in Valuation Allowance (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Valuation allowance at the Beginning of Period	$ (11,435)
Income tax expense		(11,435)
Release of valuation allowance	65
Valuation allowance at the End of Period	$ (11,370)	$ (11,435)

Note 8 - Income Taxes - Reconci

Note 8 - Income Taxes - Reconciliations of Effective Income Tax Rate to Federal Statutory Rate (Details)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Income tax expense at the statutory rate	21.00%	34.00%
State and local income tax expense	(14.00%)	4.60%
Foreign income tax	(2.20%)	(1.20%)
Permanent differences	(9.40%)	(8.30%)
Increase in valuation allowance	(0.30%)	(217.50%)
Impacts related to the 2017 Tax Act	0.00%	(106.00%)
Other adjustments	(0.10%)	0.40%
Effective income tax rate	(5.00%)	(293.90%)

Note 8 - Income Taxes - Summa_3

Note 8 - Income Taxes - Summary of Temporary Differences and Carryforwards That Give Rise to Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Less: valuation allowance	$ (11,370)	$ (11,435)
Net deferred Federal tax assets (liabilities)		(62)
Less: valuation allowance	(11,370)	(11,435)
Net deferred tax assets (liabilities)		(62)
Domestic Tax Authority [Member]
Bad debt reserves	1,178	1,375
Stock based compensation	393	305
Net operating loss	8,025	7,319
Accrued compensation	218	249
Inventories	27	18
Accrued rent	31	30
Goodwill and intangible assets	2,507	3,323
Research & development credits	533	533
Other credits	25	5
Other	114	103
Total deferred Federal tax assets	13,051	13,260
Less: valuation allowance	(9,724)	(9,599)
Net deferred tax assets	3,327	3,661
Depreciation and asset basis differences	(3,335)	(3,672)
Other	8	(51)
Total deferred Federal tax liabilities	(3,327)	(3,723)
Net deferred Federal tax assets (liabilities)		(62)
Net deferred state and local tax assets	13,051	13,260
Less: valuation allowance	(9,724)	(9,599)
Net deferred tax assets (liabilities)		(62)
State and Local Jurisdiction [Member]
Total deferred Federal tax assets	1,646	1,836
Less: valuation allowance	(1,646)	(1,836)
Net deferred state and local tax assets	1,646	1,836
Less: valuation allowance	$ (1,646)	$ (1,836)

Note 10 - Leases (Details Textu

Note 10 - Leases (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Operating Leases, Rent Expense, Net, Total	$ 1.5	$ 1
Pump Assets [Member]
Capital Leased Assets, Gross, Total	0.6	1.7
Capital Leases, Lessee Balance Sheet, Assets by Major Class, Accumulated Depreciation	$ 0.2	$ 0.5
Capital Leases [Member]
Debt, Weighted Average Interest Rate	3.50%

Note 10 - Leases - Schedule of

Note 10 - Leases - Schedule of Future Minimum Rental Payments Pursuant to Capital and Operating Leases (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
2019, capital leases	$ 33
2019, operating leases	1,866
2019	1,899
2020, capital leases
2020, operating leases	1,717
2020	1,717
2021, capital leases
2021, operating leases	1,107
2021	1,107
2022, capital leases
2022, operating leases	1,016
2022	1,016
2023, capital leases
2023, operating leases	1,040
2023	1,040
Thereafter, capital leases
Thereafter, operating leases	5,599
Thereafter	5,599
Total required payments, capital leases	33
Total required payments, operating leases	12,345
Total required payments	12,378
Less amounts representing interest (3.5%), capital leases
Present value of minimum lease payments, capital leases	33
Less current maturities, capital leases	(33)	$ (505)
Long-term capital lease liability, capital leases		$ 33

Note 10 - Leases - Schedule o_2

Note 10 - Leases - Schedule of Future Minimum Rental Payments Pursuant to Capital and Operating Leases (Details) (Parentheticals)	Dec. 31, 2018
Capital lease interest	3.50%

Note 11 - Share-based Compens_3

Note 11 - Share-based Compensation (Details Textual) - USD ($)

Jul. 31, 2018

Jul. 19, 2018

Sep. 07, 2016

May 27, 2011

May 31, 2014

Mar. 31, 2019

Sep. 30, 2018

Dec. 31, 2018

Dec. 31, 2017

Mar. 12, 2018

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

251,430

Treasury Stock, Shares, Acquired

3,300,000

0

Percentage of Reduction in Shares Outstanding from Repurchases

15.00%

Share Repurchase Program [Member]

Stock Repurchase Program, Number of Shares Authorized to be Repurchased

1,000,000

Treasury Stock, Shares, Acquired

500,000

First Stock Purchase Agreement [Member]

Stock Repurchase Program, Number of Shares Authorized to be Repurchased

2,200,000

Treasury Stock, Shares, Acquired

2,100,000

Stock Repurchase Program, Authorized Amount, Per Share

$ 3.10

Stock Repurchase Program, Authorized Amount

$ 6,700,000

Stock Repurchase Program, Period the Sellers Agree Not to Purchase Shares

3 years

Stock Repurchase Agreement, Number of Shares Sold By Sellers to Third Parties on the Open Market

36,000

Second Stock Purchase Agreement [Member]

Stock Repurchase Program, Number of Shares Authorized to be Repurchased

700,000

Stock Repurchase Program, Authorized Amount, Per Share

$ 3.10

Stock Repurchase Program, Authorized Amount

$ 2,100,000

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, Grants in Period, Gross

2014 Amended and Restated Stock Incentive Plan [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Number of Additional Shares Authorized

1,000,000

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

825,000

1,087,500

Employee Stock Option [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period

1 year

1 year

Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross

800,000

1,100,000

Employee Stock Option [Member] | Chief Executive Officer [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross

200,000

300,000

Employee Stock Option [Member] | Minimum [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period

5 years

Employee Stock Option [Member] | Maximum [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period

10 years

Restricted Stock Units (RSUs) [Member] | Awards Granted in 2018 [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period

3 years

Restricted Stock Units (RSUs) [Member] | Maximum [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period

4 years

Stock Appreciation Rights (SARs) [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other Than Options, Vested and Outstanding

200,000

Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period

200,000

[1]

Allocated Share-based Compensation Expense, Total

$ 300,000

Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period

200,000

Stock Appreciation Rights (SARs) [Member] | Vesting Upon Closing Public Market Price Reach 3 or More for 10 Consecutive Trading Days [Member] | Scenario, Forecast [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period

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] | Scenario, Forecast [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period

100,000

Stock Appreciation Rights (SARs) [Member] | Maximum [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period

1 year

Restricted Stock [Member]

Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period

4,116

15,730

Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period

125,000

0

Employee Service Share-based Compensation, Nonvested Awards, Compensation Not yet Recognized, Share-based Awards Other than Options

$ 100,000

[1]

SARs were vested on December 31, 2018 and can be exercised during the period beginning on December 31, 2018 and ending on March 31, 2019

Note 11 - Share-based Compens_4

Note 11 - Share-based Compensation - Summary of Stock Appreciation Rights Activity (Details) - Stock Appreciation Rights (SARs) [Member] - USD ($)	12 Months Ended
	Dec. 31, 2018		Dec. 31, 2017
Unvested, number of shares (in shares)	200,000
Unvested, weighted average grant date fair value (in dollars per share)	$ 1.26
Unvested, aggregate fair value	$ 60,000
Granted, number of shares (in shares)			200,000
Granted, weighted average grant date fair value (in dollars per share)			$ 1.26
Granted, aggregate fair value			$ 60,000
Vested, number of shares (in shares)	(200,000)	[1]
Vested, weighted average grant date fair value (in dollars per share)	$ 1.26	[1]
Vested, aggregate fair value	$ 288,000	[1]
Vested shares forgone to satisfy minimum statutory withholding, number of shares (in shares)
Vested shares forgone to satisfy minimum statutory withholding, weighted average grant date fair value (in dollars per share)
Forfeitures, number of shares (in shares)
Forfeitures, weighted average grant date fair value (in dollars per share)
Unvested, number of shares (in shares)			200,000
Unvested, weighted average grant date fair value (in dollars per share)			$ 1.26
Unvested, aggregate fair value			$ 60,000
[1]	SARs were vested on December 31, 2018 and can be exercised during the period beginning on December 31, 2018 and ending on March 31, 2019

Note 11 - Share-based Compens_5

Note 11 - 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, 2018	Dec. 31, 2017
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
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period	125,000	0
Granted, weighted average grant date fair value (in dollars per share)	$ 1.37
Vested, number of shares (in shares)	(4,116)	(15,730)
Vested, weighted average grant date fair value (in dollars per share)	$ 2.60	$ 0.88
Vested, aggregate fair value	$ 13,749	$ 83,003
Vested shares forgone to satisfy minimum statutory withholding, number of shares (in shares)	(2,134)	(20,811)
Vested shares forgone to satisfy minimum statutory withholding, weighted average grant date fair value (in dollars per share)	$ 2.60	$ 2.80
Vested shares forgone to satisfy minimum statutory withholding, aggregate fair value	$ 4,695	$ 51,304
Forfeitures, number of shares (in shares)	(1,626)	(8,333)
Forfeitures, weighted average grant date fair value (in dollars per share)	$ 2.60	$ 2.60
Unvested, number of shares (in shares)	129,583	12,459
Unvested, weighted average grant date fair value (in dollars per share)	$ 1.42	$ 2.61

Note 11 - Share-based Compens_6

Note 11 - Share-based Compensation - Summary of Activity Relating to Company's ESPP Program (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Compensation expense	$ 33,874	$ 49,150
Shares of stock sold to employees (in shares)	43,433	68,958
Weighted average fair value per ESPP award (in dollars per share)	$ 2.45	$ 2.21

Note 11 - Share-based Compens_7

Note 11 - Share-based Compensation - Summary of Stock Option and Inducement Stock Option Activity (Details) - USD ($)		12 Months Ended
		Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Inducement Stock Options [Member]
Outstanding, number of authorized shares (in shares)	[1]		800,000
Outstanding, weighted average exercise price (in dollars per share)			$ 2.25
Outstanding, weighted average remaining contractual term (Year)		5 years 153 days		2 years 94 days
Outstanding, aggregate intrinsic value		$ 111,250		$ 240,000
Granted, number of authorized shares (in shares)	[1]	125,000
Granted, weighted average exercise price (in dollars per share)		$ 2.55
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]	125,000		800,000
Outstanding, weighted average exercise price (in dollars per share)		$ 2.55		$ 2.25
Exercisable, number of authorized shares (in shares)	[1]
Exercisable, weighted average exercise price (in dollars per share)
Granted, weighted average remaining contractual term (Year)		5 years 153 days
Granted, aggregate intrinsic value		$ 111,250
2007 Stock Incentive Plan [Member]
Outstanding, number of authorized shares (in shares)		133,332	488,332
Outstanding, weighted average exercise price (in dollars per share)		$ 1.99	$ 2.31
Outstanding, weighted average remaining contractual term (Year)				91 days
Outstanding, aggregate intrinsic value			$ 40,716	$ 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)		(33,576)	(25,037)
Exercised, weighted average exercise price (in dollars per share)		$ 1.96	$ 1.51
Exercised, aggregate intrinsic value		$ 162,134	$ 86,900
Exercised shares forgone to satisfy minimum statutory withholding, number of authorized shares (in shares)		(14,255)	(13,245)
Exercised shares forgone to satisfy minimum statutory withholding, weighted average exercise price (in dollars per share)		$ 1.96	$ 2.32
Cashless exercise, number of authorized shares (in shares)		65,501	(71,718)
Cashless exercise, weighted average exercise price (in dollars per share)		$ 1.96	$ 2.32
Forfeited, number of authorized shares (in shares)		(20,000)	(245,000)
Forfeited, weighted average exercise price (in dollars per share)		$ 1.93	$ 2.83
Cashless exercise, number of authorized shares (in shares)		(65,501)	71,718
Outstanding, number of authorized shares (in shares)			133,332	488,332
Outstanding, weighted average exercise price (in dollars per share)			$ 1.99	$ 2.31
Exercisable, number of authorized shares (in shares)
Exercisable, weighted average exercise price (in dollars per share)
2014 Amended and Restated Stock Incentive Plan [Member]
Outstanding, number of authorized shares (in shares)		1,962,500	1,249,999
Outstanding, weighted average exercise price (in dollars per share)		$ 2.44	$ 2.80
Outstanding, weighted average remaining contractual term (Year)		3 years 3 days	3 years 65 days	4 years 94 days
Outstanding, aggregate intrinsic value		$ 1,719,584
Granted, number of authorized shares (in shares)		825,000	1,087,500
Granted, weighted average exercise price (in dollars per share)		$ 3.14	$ 2.09
Exercised, number of authorized shares (in shares)		(10,953)
Exercised, weighted average exercise price (in dollars per share)		$ 2.15
Exercised, aggregate intrinsic value		$ 12,159
Exercised shares forgone to satisfy minimum statutory withholding, number of authorized shares (in shares)		(5,134)
Exercised shares forgone to satisfy minimum statutory withholding, weighted average exercise price (in dollars per share)		$ 2.15
Cashless exercise, number of authorized shares (in shares)		33,079
Cashless exercise, weighted average exercise price (in dollars per share)		$ 2.15
Forfeited, number of authorized shares (in shares)		(514,167)	(374,999)
Forfeited, weighted average exercise price (in dollars per share)		$ 2.62	$ 2.61
Cashless exercise, number of authorized shares (in shares)		(33,079)
Outstanding, number of authorized shares (in shares)		2,224,167	1,962,500	1,249,999
Outstanding, weighted average exercise price (in dollars per share)		$ 2.67	$ 2.44	$ 2.80
Exercisable, number of authorized shares (in shares)			955,868
Exercisable, weighted average exercise price (in dollars per share)			$ 2.69
Granted, weighted average remaining contractual term (Year)		3 years 233 days	3 years 47 days
2014 Amended and Restated Stock Incentive Plan [Member] | 2007 Plan (Options) [Member]
Exercisable, number of authorized shares (in shares)		1,101,910
Exercisable, weighted average exercise price (in dollars per share)		$ 2.52
[1]	Represents inducement stock options to purchase shares of the Company's Common Stock to executive level managers.

Note 11 - Share-based Compens_8

Note 11 - Share-based Compensation - Schedule of Stock Options Outstanding (Details) - 2014 Amended and Restated Stock Incentive Plan [Member]	12 Months Ended
	Dec. 31, 2018$ / sharesshares
Options outstanding, number of shares outstanding (in shares) | shares	2,224,167
Options outstanding, weighted-average remaining contractual life (Year)	3 years 3 days
Options outstanding, weighted-average exercise price (in dollars per share)	$ 2.67
Options exercisable, number of shares exercisable (in shares) | shares	1,101,910
Options exercisable, weighted-average exercise price (in dollars per share)	$ 2.52
Range 1 [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	1,519,167
Options outstanding, weighted-average remaining contractual life (Year)	2 years 175 days
Options outstanding, weighted-average exercise price (in dollars per share)	$ 2.41
Options exercisable, number of shares exercisable (in shares) | shares	1,040,243
Options exercisable, weighted-average exercise price (in dollars per share)	$ 2.48
Range 2 [Member]
Exercise price, lower range (in dollars per share)	3.01
Exercise price, upper range (in dollars per share)	$ 4
Options outstanding, number of shares outstanding (in shares) | shares	705,000
Options outstanding, weighted-average remaining contractual life (Year)	3 years 142 days
Options outstanding, weighted-average exercise price (in dollars per share)	$ 3.22
Options exercisable, number of shares exercisable (in shares) | shares	61,667
Options exercisable, weighted-average exercise price (in dollars per share)	$ 3.18

Note 11 - Share-based Compens_9

Note 11 - Share-based Compensation - Schedule of Share-based Compensation Expense Based on Fair Value of Options (Details) - $ / shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Expected lives at date of grant (in years) (Year)	3 years 302 days	3 years 339 days
Weighted average fair value of options granted (in dollars per share)	$ 1	$ 2.09
Minimum [Member]
Expected volatility	35.00%	30.00%
Risk free interest rate	2.43%	0.69%
Maximum [Member]
Expected volatility	49.00%	69.00%
Risk free interest rate	2.88%	2.05%

Note 11 - Share-based Compen_10

Note 11 - Share-based Compensation - Stock-based Compensation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Restricted share expense	$ 78	$ 48
Stock option and SARs expense	879	634
Total stock-based compensation expense	$ 957	$ 682

Note 12 - Employee Benefit Pl_2

Note 12 - Employee Benefit Plans (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Defined Benefit Plan, Plan Assets, Contributions by Employer	$ 0.6	$ 0.6