Document and Entity Information
Document and Entity Information - shares | 6 Months Ended | |
Jun. 30, 2019 | Jul. 26, 2019 | |
Document And Entity Information [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Jun. 30, 2019 | |
Document Fiscal Year Focus | 2019 | |
Document Fiscal Period Focus | Q2 | |
Trading Symbol | IRTC | |
Entity Registrant Name | iRhythm Technologies, Inc. | |
Entity Central Index Key | 0001388658 | |
Current Fiscal Year End Date | --12-31 | |
Entity Filer Category | Large Accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Common Stock, Shares Outstanding | 24,851,931 | |
Entity Current Reporting Status | Yes | |
Entity Shell Company | false | |
Entity File Number | 001-37918 | |
Entity Tax Identification Number | 208149544 | |
Entity Address, Address Line One | 650 Townsend Street | |
Entity Address, Address Line Two | Suite 500 | |
Entity Address, City or Town | San Francisco | |
Entity Address, State or Province | California | |
Entity Address, Postal Zip Code | 94103 | |
City Area Code | 415 | |
Local Phone Number | 632-5700 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands | Jun. 30, 2019 | Dec. 31, 2018 |
Current assets: | ||
Cash and cash equivalents | $ 16,154 | $ 20,023 |
Short-term investments | 43,240 | 58,320 |
Accounts receivable, net | 29,137 | 21,977 |
Inventory | 2,774 | 2,062 |
Prepaid expenses and other current assets | 3,669 | 4,100 |
Total current assets | 94,974 | 106,482 |
Property and equipment, net | 12,618 | 9,158 |
Operating lease right-of-use assets | 94,326 | |
Goodwill | 862 | 862 |
Other assets | 4,515 | 3,208 |
Total assets | 207,295 | 119,710 |
Current liabilities: | ||
Accounts payable | 3,628 | 2,284 |
Accrued liabilities | 23,304 | 26,570 |
Deferred revenue | 1,199 | 1,243 |
Accrued interest, current portion | 139 | 139 |
Operating lease liabilities, current portion | 7,384 | |
Total current liabilities | 35,654 | 30,236 |
Debt | 34,927 | 34,899 |
Deferred rent, noncurrent portion | 153 | |
Operating lease liabilities, noncurrent portion | 88,106 | |
Total liabilities | 158,687 | 65,288 |
Commitments and contingencies (Note 6) | ||
Stockholders’ equity: | ||
Preferred stock, $0.001 par value – 5,000,000 shares authorized at June 30, 2019 and December 31, 2018; and none issued and outstanding at June 30, 2019 and December 31, 2018 | ||
Common stock, $0.001 par value – 100,000,000 shares authorized at June 30, 2019 and December 31, 2018; 24,836,171 and 24,368,073 shares issued and outstanding at June 30, 2019 and December 31, 2018, respectively | 23 | 23 |
Additional paid-in capital | 271,551 | 257,955 |
Accumulated other comprehensive income (loss) | 35 | (41) |
Accumulated deficit | (223,001) | (203,515) |
Total stockholders’ equity | 48,608 | 54,422 |
Total liabilities and stockholders’ equity | $ 207,295 | $ 119,710 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) (Unaudited) - $ / shares | Jun. 30, 2019 | Dec. 31, 2018 |
Statement Of Financial Position [Abstract] | ||
Preferred stock, par value | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized | 5,000,000 | 5,000,000 |
Preferred stock, shares issued | 0 | 0 |
Preferred stock, shares outstanding | 0 | 0 |
Common stock, par value | $ 0.001 | $ 0.001 |
Common stock, shares authorized | 100,000,000 | 100,000,000 |
Common stock, shares issued | 24,836,171 | 24,368,073 |
Common stock, shares outstanding | 24,836,171 | 24,368,073 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations (Unaudited) - USD ($) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2019 | Jun. 30, 2018 | Jun. 30, 2019 | Jun. 30, 2018 | |
Income Statement [Abstract] | ||||
Revenue | $ 53,331,000 | $ 35,469,000 | $ 100,545,000 | $ 66,034,000 |
Cost of revenue | 12,825,000 | 9,490,000 | 24,555,000 | 18,101,000 |
Gross profit | 40,506,000 | 25,979,000 | 75,990,000 | 47,933,000 |
Operating expenses: | ||||
Research and development | 8,639,000 | 4,564,000 | 15,395,000 | 8,583,000 |
Selling, general and administrative | 43,189,000 | 33,094,000 | 79,894,000 | 61,671,000 |
Total operating expenses | 51,828,000 | 37,658,000 | 95,289,000 | 70,254,000 |
Loss from operations | (11,322,000) | (11,679,000) | (19,299,000) | (22,321,000) |
Interest expense | (440,000) | (861,000) | (849,000) | (1,719,000) |
Other income, net | 310,000 | 334,000 | 689,000 | 717,000 |
Loss before income taxes | (11,452,000) | (12,206,000) | (19,459,000) | (23,323,000) |
Income tax provision | 15,000 | 0 | 27,000 | 0 |
Net loss | $ (11,467,000) | $ (12,206,000) | $ (19,486,000) | $ (23,323,000) |
Net loss per common share, basic and diluted | $ (0.46) | $ (0.51) | $ (0.79) | $ (0.99) |
Weighted-average shares, basic and diluted | 24,724,808 | 23,747,131 | 24,600,250 | 23,614,281 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Comprehensive Loss (Unaudited) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2019 | Jun. 30, 2018 | Jun. 30, 2019 | Jun. 30, 2018 | |
Statement Of Income And Comprehensive Income [Abstract] | ||||
Net loss | $ (11,467) | $ (12,206) | $ (19,486) | $ (23,323) |
Other comprehensive income (loss): | ||||
Net change in unrealized losses on available-for-sale securities | 33 | 47 | 76 | 27 |
Comprehensive loss | $ (11,434) | $ (12,159) | $ (19,410) | $ (23,296) |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2019 | Jun. 30, 2018 | |
Cash flows from operating activities | ||
Net loss | $ (19,486) | $ (23,323) |
Adjustments to reconcile net loss to net cash used in operating activities: | ||
Depreciation and amortization | 1,292 | 1,105 |
Stock-based compensation | 11,745 | 7,323 |
Amortization of debt discount and issuance costs | 31 | 125 |
Accretion of discounts on investments, net | (419) | (350) |
Provision for doubtful accounts and contractual allowances | 10,683 | 6,440 |
Amortization of operating lease right-of-use assets | 5,061 | |
Changes in operating assets and liabilities: | ||
Accounts receivable | (17,844) | (11,197) |
Inventory | (712) | (485) |
Prepaid expenses and other current assets | (27) | 46 |
Other assets | (1,174) | 625 |
Accounts payable | 1,025 | 106 |
Accrued liabilities | (3,187) | 497 |
Deferred rent | 61 | |
Deferred revenue | (45) | (596) |
Operating lease liabilities | (3,724) | |
Net cash used in operating activities | (16,781) | (19,623) |
Cash flows from investing activities | ||
Purchases of property and equipment | (4,468) | (2,226) |
Purchases of available-for-sale investments | (44,976) | (42,616) |
Maturities of available-for-sale investments | 60,550 | 73,004 |
Net cash provided by investing activities | 11,106 | 28,162 |
Cash flows from financing activities | ||
Repayment of debt | (1,500) | |
Proceeds from issuance of common stock, net | 5,409 | 5,069 |
Tax withholding upon vesting of restricted stock awards | (3,557) | (1,538) |
Other | (46) | |
Net cash provided by financing activities | 1,806 | 2,031 |
Net increase in cash, cash equivalents, and restricted cash | (3,869) | 10,570 |
Cash, cash equivalents and restricted cash beginning of period | 20,023 | 8,671 |
Cash, cash equivalents and restricted cash end of period | 16,154 | 19,241 |
Supplemental disclosures of cash flow information | ||
Interest paid | 836 | 1,748 |
Non-cash investing and financing activities | ||
Property, plant and equipment costs included in liabilities | $ 284 | $ 218 |
Condensed Consolidated Statem_4
Condensed Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Thousands | Total | Common Stock | Additional Paid-in Capital | Accumulated Other Comprehensive Income (Loss) | Accumulated Deficit |
Beginning balance at Dec. 31, 2017 | $ 23 | $ 236,184 | $ (65) | $ (156,589) | |
Proceeds from issuance of common stock, net | 5,070 | ||||
Stock-based compensation expense | 7,323 | ||||
Tax withholding upon vesting of restricted stock awards | (1,538) | ||||
Net change in unrealized losses on available for sale securities | $ 27 | 27 | |||
Net loss | (23,323) | (23,323) | |||
Cumulative effect of accounting changes | 1,355 | ||||
Ending balance at Jun. 30, 2018 | 68,467 | 23 | 247,039 | (38) | (178,557) |
Beginning balance at Dec. 31, 2018 | 54,422 | 23 | 257,955 | (41) | (203,515) |
Proceeds from issuance of common stock, net | 5,408 | ||||
Stock-based compensation expense | 11,745 | ||||
Tax withholding upon vesting of restricted stock awards | (3,557) | ||||
Net change in unrealized losses on available for sale securities | 76 | 76 | |||
Net loss | (19,486) | (19,486) | |||
Ending balance at Jun. 30, 2019 | $ 48,608 | $ 23 | $ 271,551 | $ 35 | $ (223,001) |
Organization and Description of
Organization and Description of Business | 6 Months Ended |
Jun. 30, 2019 | |
Accounting Policies [Abstract] | |
Organization and Description of Business | 1. Organization and Description of Business iRhythm Technologies, Inc. (the “Company”) was incorporated in the state of Delaware in September 2006. The Company is a digital healthcare company redefining the way cardiac arrhythmias are clinically diagnosed by combining wearable biosensing technology with cloud-based data analytics and deep-learning capabilities. The Company commenced commercial introduction of its products in the United States in 2009 following clearance by the U.S. Food and Drug Administration. The Company is headquartered in San Francisco, California, which also serves as a clinical center. The Company has additional clinical centers in Lincolnshire, Illinois and Houston, Texas and a manufacturing facility in Cypress, California. In March 2016, the Company formed a wholly-owned subsidiary in the United Kingdom. The Company manages its operations as a single operating segment. Substantially all of the Company’s assets are maintained in the United States. The Company derives substantially all of its revenue from sales to customers in the United States. |
Summary of Significant Accounti
Summary of Significant Accounting Policies | 6 Months Ended |
Jun. 30, 2019 | |
Accounting Policies [Abstract] | |
Summary of Significant Accounting Policies | 2. Summary of Significant Accounting Policies Basis of Presentation The accompanying financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America, or U.S. GAAP, and applicable rules and regulations of the Securities and Exchange Commission, or SEC, regarding interim financial reporting. As permitted under those rules, certain footnotes or other financial information that are normally required by GAAP have been condensed or omitted, and accordingly the balance sheet as of December 31, 2018, and related disclosures, have been derived from the audited consolidated financial statements at that date but does not include all of the information required by GAAP for complete consolidated financial statements. These unaudited condensed consolidated financial statements have been prepared on the same basis as the Company’s annual consolidated financial statements and, in the opinion of management, reflect all adjustments (consisting only of normal recurring adjustments) that are necessary for the fair statement of the Company’s condensed consolidated financial information. Certain prior period amounts in the accompanying consolidated financial statements have been reclassified to conform to current period presentation. The results of operations for the six months ended June 30, 2019 are not necessarily indicative of the results to be expected for the year ending December 31, 2019 or for any other interim period or for any other future year. The accompanying interim unaudited condensed consolidated financial statements and related financial information should be read in conjunction with the audited financial statements and the related notes thereto for the year ended December 31, 2018 included in the Company’s annual report on Form 10-K, filed with the SEC on March 4, 2019. Accounts Receivable, Allowance for Doubtful Accounts and Contractual Allowance Accounts receivable consists of amounts due to the Company from institutions, third-party payors, government and commercial payors and their related patients, as a result of the Company's normal business activities. Accounts receivable is reported on the condensed consolidated balance sheets net of an estimated allowance for doubtful accounts and a contractual allowance. The Company establishes an allowance for doubtful accounts for estimated uncollectible receivables based on its historical experience and recognizes the provision as a component of selling, general and administrative expenses. The Company establishes a contractual allowance when it estimates that consideration to be received will be lower than the contracted rate based on its historical experience and recognizes the provision as a reduction to revenue. The following table presents the changes in the allowance for doubtful accounts (in thousands): Six Months Ended June 30, Year Ended December 31, 2019 2018 Balance, beginning of period $ 4,851 $ 3,568 Add: provision for doubtful accounts 3,358 5,826 Less: write-offs, net of recoveries and other adjustments (3,537 ) (4,543 ) Balance, end of period $ 4,672 $ 4,851 The following table presents the changes in the contractual allowance (in thousands): Six Months Ended June 30, Year Ended December 31, 2019 2018 Balance, beginning of period $ 10,601 $ 7,444 Add: allowance for contractual adjustments 7,325 9,392 Less: contractual adjustments (3,557 ) (6,235 ) Balance, end of period $ 14,369 $ 10,601 The following table presents the impact of allowance for doubtful accounts and contractual allowance on accounts receivable (in thousands): Six Months Ended June 30, Year Ended December 31, 2019 2018 Gross accounts receivable $ 48,178 $ 37,429 Less: allowance for doubtful accounts (4,672 ) (4,851 ) Less: contractual allowance (14,369 ) (10,601 ) Net accounts receivable $ 29,137 $ 21,977 The Company reviews and updates its estimates for the allowances for doubtful accounts and contractual allowance periodically to reflect its experience regarding historical collections. If management were to make different judgments or utilize different estimates in the allowances for doubtful accounts and contractual allowance, differences in the amount of reported selling, general and administrative expenses and revenue could result, respectively. Concentrations of Risk Credit Risk Financial instruments that potentially subject the Company to a concentration of credit risk consist primarily of cash and cash equivalents, investments and accounts receivable. Cash, cash equivalents, and investments are deposited in financial institutions which, at times may be in excess of federally insured limits. Cash equivalents are invested in highly rated money market funds. The Company invests in a variety of financial instruments, such as, but not limited to, United States Government securities, corporate notes, commercial paper and, by policy, limits the amount of credit exposure with any one financial institution or commercial issuer. The Company has not experienced any material losses on its deposits of cash and cash equivalents or investments. Concentrations of credit risk with respect to accounts receivable are limited due to the large number of customers comprising the Company’s customer base and their dispersion across many geographies. The Company does not require collateral. The Company records an allowance for doubtful accounts when it becomes probable that a receivable will not be collected. Federal government agencies, including Centers for Medicare and Medicaid Services (“ Revenue Recognition The Company’s revenue is generated primarily from the provision of its cardiac rhythm monitoring service, the Zio XT service. The Zio XT is a cardiac rhythm monitoring service that has a patient wear period of up to 14 days and is billable when the monitoring reports are delivered to the healthcare provider, which is also when the service is complete and the Company recognizes revenue. The time from when the patient has the Zio XT device applied to the time the report is posted is generally around 18 days. The Company accounts for contract revenue with a customer when there is a legally enforceable contract between the Company and the customer, the rights of the parties are identified, the contract has commercial substance, and collectability of the contract consideration is probable. The Company's revenue is measured based on consideration specified in the contract with each customer. A unique aspect of healthcare is the involvement of multiple parties to the service transaction. In addition to the patient, often a third-party, for example a commercial or governmental payor or healthcare institution, like a hospital or clinic, will pay the Company for some or all of the service on the patient’s behalf. Separate contractual arrangements exist between the Company and third-party payors that establish amounts the third-party payor will pay on behalf of a patient for covered services rendered and should be conside red in determining collectability and the transaction price for services provided to a patient covered by that third-party payor. The Company recognizes revenue on an accrual basis based on estimates of the amount that will ultimately be realized. These estimates require significant judgment by management. In determining the amount to recognize for a delivered report, the Company considers factors such as claim payment history from both payors and patient out-of-pocket costs, payor coverage, whether there is a contract between the payor or healthcare institution and the Company, historical amount received for the service, and any current developments or changes that could impact reimbursement and healthcare institution payments. A summary of the payment arrangements with third-party payors and healthcare institutions is as follows: • Contracted third-party payors – The Company has contracts with negotiated prices for services provided for patients with commercial healthcare insurance carriers • CMS – The Company has received independent diagnostic testing facility approval from regional Medicare Administrative Contractors and will receive reimbursement per the relevant Current Procedural Terminology (“CPT”) code rate for the services rendered to the patient covered by CMS. • Non-contracted third-party payors: Non-contracted commercial and government payors often reimburse out-of-network rates provided under the relevant CPT codes on a case-by-case basis. The transaction price is based on factors including an average of the Company’s historical collection experience for non-contracted services. This rate is reviewed at least quarterly. • Healthcare institutions – Healthcare institutions are typically hospitals or physician practices in which the Company has negotiated amounts for its monitoring services, including certain governmental agencies such as the Veteran’s Administration and Department of Defense. The Company is utilizing the portfolio approach practical expedient under ASC 606 for revenue recognition. The Company accounts for the contracts within each portfolio as a collective group, rather than individual contracts. Based on history with these portfolios and the similar nature and characteristics of the patients within each portfolio, the Company has concluded that the financial statement effects are not materially different than if accounting for revenue on a contract-by-contract basis. For healthcare institutions, the Company has historical experience of collecting substantially all of the negotiated contractual rates and determined at contract inception that these customers, and or their related third-party payor that pays the Company on their behalf, have the intention and ability to pay the promised consideration. As such, the Company is not providing an implicit price concession but, rather, has chosen to accept the risk of default, and any subsequent impairment of the related receivable are recorded as bad debt expense. For contracted and CMS portfolios, the Company is providing an implicit price concession because, while the Company has a contract with the underlying payor, the Company expects to accept a lower amount of consideration when claims are adjudicated and allowable claims are determined by the commercial payor. The implicit price concession is recorded as variable consideration to the transaction price and recorded as an adjustment to revenue as a contractual allowance. Historical cash collection indicates that it is probable that substantially all of the allowable claim amount will be received, and hence this amount is recorded as revenue. Any subsequent impairment of the related receivable is recorded as bad debt expense. For non-contracted portfolios, the Company is providing an implicit price concession because the Company does not have a contract with the underlying payor, the result of which requires the Company to estimate transaction price based on historical cash collections utilizing the expected value method. Subsequent adjustments to the transaction price are recorded as an adjustment to revenue and not as bad debt expense. Disaggregation of Revenue The Company disaggregates revenue from contracts with customers by payor type. The Company believes these categories aggregate the payor types by nature, amount, timing and uncertainty of its revenue streams. Disaggregated revenue by payor type and major service line for three and six months ended June 30, 2019 was as follows (in thousands): Three Months Ended Six Months Ended June 30, 2019 June 30, 2019 Commercial Payors $ 27,631 $ 51,978 Centers for Medicare & Medicaid 14,747 27,493 Healthcare Institutions 10,953 21,074 Total $ 53,331 $ 100,545 Contract Liabilities ASC 606 requires an entity to present a revenue contract as a contract liability when the Company has an obligation to transfer goods or services to a customer for which the Company has received consideration from the customer, or an amount of consideration from the customer is due and unconditional (whichever is earlier). Certain of the Company’s customers pay the Company directly for the Zio XT service upon shipment of devices. Such advance payments, or contract liabilities are recorded as deferred revenue on the Condensed Consolidated Balance Sheets and revenue is recognized when reports are delivered to physicians. Total revenue recognized during each of the three and six months ended June 30, 2019 that was included in the contract liability balance at the beginning of 2019, was $0.1 million and $1.2 million, respectively. The total revenue recognized during the three and six months ended June 30, 2018 that was included in the contract liability balance at the beginning of 2018 was less than $0.1 million and $1.2 million, respectively. Contract Costs Under ASC 340, the incremental costs of obtaining a contract with a customer are recognized as an asset. Incremental costs of obtaining a contract are those costs that an entity incurs to obtain a contract with a customer that it would not have incurred if the contract had not been obtained. The Company’s current commission programs are considered incremental. However, as a practical expedient, ASC 340 permits the Company to immediately expense contract acquisition costs, as the asset that would have resulted from capitalizing these costs will be amortized in one year or less. Leases Identifying a lease The Company determines whether a contract contains a lease at the inception of a contract. If the contract conveys the right to control the use of an identified asset for a period of time in exchange for consideration, the Company considers the contract to contain a lease. The Company determines whether a contract conveys the right to control the use of an identified asset for a period of time if the contract contains both of the following terms: • The right to obtain substantially all of the economic benefits from use of the identified asset • The right to direct the use of the identified asset Discount rate for leases On January 1, 2019, the rate implicit in the Company’s leases was not readily determinable. As such, the Company used its incremental borrowing rate to calculate its right-of-use assets and lease liabilities. The Company determined the appropriate incremental borrowing rate by utilizing the interest rate obtained in connection with the Third Amended and Restated Loan and Security Agreement with Silicon Valley Bank (“Third Amended and Restated SVB Loan Agreement”) On October 4, 2018, the Company entered into an office lease (“San Francisco Lease”) to rent approximately 117,560 rentable square feet in San Francisco, California, which will become the Company’s new headquarters. The San Francisco Lease commenced on May 13, 2019 and the Company determined that the interest rate associated with the Third Amended and Restated SVB Loan Agreement could not be utilized as the incremental borrowing rate associated with the San Francisco Lease due to the term of the lease, as well as annual rental payments. The Company determined the appropriate incremental borrowing rate by using a synthetic credit rating which was estimated based on an analysis of outstanding debt of companies with similar credit and financial profiles. Lease term The lease term is generally the minimum noncancelable period of each lease. The Company does not include option periods in determining the right-of-use asset and right-of-use liability unless it is reasonably certain that the Company will exercise the option at inception or when a triggering event occurs. As of June 30, 2019, no renewal options were included in the determination of lease terms. Lease Modification The San Francisco Lease is in the same building with the same landlord as the lease for the Company’s current headquarters in San Francisco (“existing lease”). Upon the commencement of the San Francisco Lease, the existing lease which had an original expiration date of February 2020, was modified to expire in September 2019. Recently Adopted Accounting Guidance In February 2016, the Financing Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2016-02, Leases (“Topic 842”), which requires lessees to recognize lease liabilities and corresponding right-of-use assets on the consolidated balance sheet for all leases. For finance leases, the lessee would recognize interest expense and amortization of the right-of-use asset and, for operating leases, the lessee would recognize a straight-line lease expense. Topic 842 also changes the definition of a lease and expands the disclosure requirements of lease arrangements. The Company has no embedded leases with suppliers. Upon adoption of Topic 842 on January 1, 2019 using the modified retrospective method, the Company recognized right-of-use assets of $10.4 million and lease liabilities of $10.2 million. There was no cumulative-effect adjustment recorded on January 1, 2019. The Company adopted the following practical expedients allowed under Topic 842: • The package of three practical expedients, which allows entities to make an election that allows them not to reassess (1) whether existing or expired contracts contain embedded leases under Topic 842, (2) lease classification of existing or expiring leases, and (3) indirect costs for existing or expired leases • Combining lease and non-lease components practical expedient, which allows lessees, as an accounting policy election by class of underlying asset, to choose not to separate non-lease components from lease components and instead to account for each separate lease component and the non-lease components associated with that lease component as a single lease component; and • Comparative reporting practical expedient, which allows entities to initially apply Topic 842 at the adoption date and recognize a cumulative-effect adjustment to the opening balance of retained earnings in the period of adoption For further details, refer to Note 6. Commitments and Contingencies |
Cash Equivalents and Investment
Cash Equivalents and Investments | 6 Months Ended |
Jun. 30, 2019 | |
Cash Equivalents And Investments [Abstract] | |
Cash Equivalents and Investments | 3. Cash Equivalents and Investments The fair value of securities, not including cash at June 30, 2019 and December 31, 2018, were as follows (in thousands): June 30, 2019 Amortized Gross Unrealized Estimated Cost Gains Losses Fair Value Money market funds $ 9,748 $ — $ — $ 9,748 U.S. government securities 33,023 35 — 33,058 Corporate notes 1,999 — — 1,999 Commercial paper 8,183 — — 8,183 Total available-for-sale marketable debt securities $ 52,953 $ 35 $ — $ 52,988 Classified as: Cash equivalents $ 9,748 Short-term investments 43,240 Total cash equivalents and investments $ 52,988 December 31, 2018 Amortized Gross Unrealized Estimated Cost Gains Losses Fair Value Money market funds $ 10,606 $ — $ — $ 10,606 U.S. government securities 9,976 — (1 ) 9,975 Corporate notes 16,514 3 (18 ) 16,499 Commercial paper 36,331 — — 36,331 Total available-for-sale marketable debt securities $ 73,427 $ 3 $ (19 ) $ 73,411 Classified as: Cash equivalents $ 15,091 Short-term investments 58,320 Total cash equivalents and investments $ 73,411 The following table summarizes the fair value of the Company’s cash equivalents, short-term and long-term marketable securities classified by maturity (in thousands): June 30, December 31, 2019 2018 Due within one year $ 52,988 $ 73,411 Due after one year through three years — — Total available-for-sale marketable debt securities $ 52,988 $ 73,411 As of June 30, 2019, the Company had no available-for-sale securities in an unrealized loss position. The following table presents the Company's available-for-sale securities that were in an unrealized loss position as of December 31, 2018 (in thousands): December 31, 2018 Less than 12 months 12 Months or Greater Total Assets Fair Value Unrealized Loss Fair Value Unrealized Loss Fair Value Unrealized Loss U.S. government securities $ 5,977 $ (1 ) $ — $ — $ 5,977 $ (1 ) Corporate notes 11,521 (10 ) 2,993 (8 ) 14,514 (18 ) Total $ 17,498 $ (11 ) $ 2,993 $ (8 ) $ 20,491 $ (19 ) Available-for-sale securities held as of June 30, 2019 had a weighted average 93 days |
Fair Value Measurements
Fair Value Measurements | 6 Months Ended |
Jun. 30, 2019 | |
Fair Value Disclosures [Abstract] | |
Fair Value Measurements | 4. Fair Value Measurements The Company discloses and recognizes the fair value of its assets and liabilities using a hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability (an exit price) in an orderly transaction between market participants at the reporting date. The hierarchy gives the highest priority to valuations based upon unadjusted quoted prices in active markets for identical assets or liabilities (Level 1 measurements) and the lowest priority to valuations based upon unobservable inputs that are significant to the valuation (Level 3 measurements). The guidance establishes three levels of the fair value hierarchy as follows: Level 1 - Inputs are unadjusted quoted prices in active markets for identical assets or liabilities at the measurement date. Level 2 - Inputs (other than quoted market prices included in Level 1) are either directly or indirectly observable for the asset or liability through correlation with market data at the measurement date and for the duration of the instrument’s anticipated life. Level 3 - Inputs reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date. Consideration is given to the risk inherent in the valuation technique and the risk inherent in the inputs to the model. Assets and liabilities measured at fair value are classified in their entirety based on the lowest level of input that is significant to the fair value measurement. The Company’s assessment of the significance of a particular input to the fair value measurement in its entirety requires management to make judgments and consider factors specific to the asset or liability. The corporate notes, commercial paper and government securities are classified as Level 2 as they were valued based upon quoted market prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active and model-based valuation techniques for which all significant inputs are observable in the market or can be corroborated by observable market data for substantially the full term of the assets. The fair value of the Company’s outstanding interest-bearing obligations is estimated using the net present value of the payments, discounted at an interest rate that is consistent with market interest rates, which is a Level 2 input. The carrying amount and the estimated fair value of the Company’s outstanding interest-bearing obligations at June 30, 2019 are $34.9 million and $35.4 million, respectively. The carrying amount and the estimated fair value of the Company’s outstanding interest-bearing obligations at December 31, 2018 were $34.9 million and $34.9 million, respectively. The Company had no transfers between levels of the fair value hierarchy of its assets measured at fair value. The following table presents the fair value of the Company’s financial assets and liabilities determined using the inputs defined above (in thousands). June 30, 2019 Level 1 Level 2 Level 3 Total Assets Money market funds $ 9,748 $ — $ — $ 9,748 U.S. government securities — 33,058 — 33,058 Corporate notes — 1,999 — 1,999 Commercial paper — 8,183 — 8,183 Total $ 9,748 $ 43,240 $ — $ 52,988 December 31, 2018 Level 1 Level 2 Level 3 Total Assets Money market funds $ 10,606 $ — $ — $ 10,606 U.S. government securities — 9,975 — 9,975 Corporate notes — 16,499 — 16,499 Commercial paper — 36,331 — 36,331 Total $ 10,606 $ 62,805 $ — $ 73,411 |
Balance Sheet Components
Balance Sheet Components | 6 Months Ended |
Jun. 30, 2019 | |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
Balance Sheet Components | 5. Balance Sheet Components Inventory Inventory and Printed Circuit Board Assemblies (“PCBAs”), which are recorded as other assets as they are used many times over a period longer than one year on average, consisted of the following (in thousands): June 30, 2019 December 31, 2018 Raw materials $ 1,974 $ 1,028 Finished goods 4,543 3,565 Total $ 6,517 $ 4,593 Classified as: Inventory $ 2,774 $ 2,062 Other assets 3,743 2,531 Total $ 6,517 $ 4,593 Amounts reported as other assets are comprised of the PCBA costs that are included in both raw materials and finished goods totals above. Property and Equipment, Net Property and equipment, net consisted of the following (in thousands): June 30, December 31, 2019 2018 Laboratory and manufacturing equipment $ 3,830 $ 2,750 Computer equipment and software 1,062 1,062 Furniture and fixtures 925 925 Leasehold improvements 2,146 726 Internal-use software 11,177 8,925 Total property and equipment, gross 19,140 14,388 Less: accumulated depreciation and amortization (6,522 ) (5,230 ) Total property and equipment, net $ 12,618 $ 9,158 Depreciation and amortization expense was $0.7 million and $1.3 million for the three and six months ended June 30, 2019, respectively, and $0.6 million and $1.1 million for the three and six months ended June 30, 2018, respectively. Accrued Liabilities Accrued liabilities consisted of the following (in thousands): June 30, December 31, 2019 2018 Accrued vacation $ 3,646 $ 2,825 Accrued payroll and related expenses 13,338 18,188 Accrued professional services fees 895 1,243 Claims payable 3,220 2,374 Other 2,205 1,940 Total accrued liabilities $ 23,304 $ 26,570 |
Commitments and Contingencies
Commitments and Contingencies | 6 Months Ended |
Jun. 30, 2019 | |
Commitments And Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | 6. Commitments and Contingencies Lease Arrangements The Company leases office, manufacturing, and clinical centers under non-cancelable operating leases which expire on various dates through 2031. These leases generally contain scheduled rent increases or escalation clauses and renewal options. Operating lease right-of-use assets and lease liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. The operating lease right-of-use assets also include any lease payments made to the lessor at or before the commencement date as well as variable lease payments which are based on a consumer price index. The Company is also subject to variable lease payments related to janitorial services and electricity which are not included in the operating lease right-of-use asset as they are based on actual usage. The Company recognizes operating lease expense on a straight-line basis over the lease period. The total operating lease cost recognized during the six months ended June 30, 2019 was $4.1 million and cash paid for operating leases during the six months ended June 30, 2019 was $2.8 million. On October 4, 2018, the Company entered into an office lease (“San Francisco Lease”) to rent approximately 117,560 rentable square feet in San Francisco, California, which will become the Company’s new headquarters. The term of the San Francisco lease began on May 13, 2019, and expires on August 31, 2031. . The Company has obtained a standby letter of credit in the amount of $6.9 million, which may be drawn down by the landlord to be applied for certain purposes upon the Company’s breach of any provisions under the San Francisco Lease. As of June 30, 2019, maturities of operating lease liabilities were as follows (in thousands): Period Ending December 31: 2019 (remainder of year) $ 1,743 2020 11,757 2021 11,760 2022 11,317 2023 11,639 Thereafter 100,764 148,980 Less: imputed interest (53,490 ) Total lease liabilities $ 95,490 Minimum future lease payments previously disclosed in the 2018 10-K and under the previous lease accounting standard, which includes annual rental payments for the San Francisco Lease which commenced May 13, 2019, for the year ended December 31, 2018 are as follows (in thousands): Period Ending December 31: 2019 $ 8,135 2020 10,669 2021 10,828 2022 11,150 2023 11,483 Thereafter 98,209 Total $ 150,474 The weighted average remaining lease term of the Company’s operating leases as of June 30, 2019 was 11.9 years. The weighted average discount rate of the Company’s operating leases is 7.33% as of June 30, 2019. Legal Proceedings From time to time, the Company may become involved in legal proceedings arising from the ordinary course of its business. Management is currently not aware of any matters that could have a material adverse effect on the financial position, results of operations or cash flows of the Company. Indemnifications In the ordinary course of business, the Company enters into agreements that may include indemnification provisions. Pursuant to such agreements, the Company may indemnify, hold harmless and defend an indemnified party for losses suffered or incurred by the indemnified party. Some of the provisions will limit losses to those arising from third-party actions. In some cases, the indemnification will continue after the termination of the agreement. The maximum potential amount of future payments the Company could be required to make under these provisions is not determinable. The Company has also entered into indemnification agreements with its directors and officers that may require the Company to indemnify its directors and officers against liabilities that may arise by reason of their status or service as directors or officers to the fullest extent permitted by California corporate law. The Company currently has directors’ and officers’ insurance. The Company has never incurred material costs to defend lawsuits or settle claims related to these indemnification provisions, and believes that the estimated fair value of these indemnification obligations is not material and it has not accrued any amounts for these obligations. |
Debt
Debt | 6 Months Ended |
Jun. 30, 2019 | |
Debt Disclosure [Abstract] | |
Debt | 7. Debt Pharmakon Loan Agreement In December 2015, the Company entered into a Loan Agreement with Biopharma Secured Investments III Holdings Cayman LP (the “Pharmakon Loan Agreement”). The Pharmakon Loan Agreement provides for up to $55.0 million in term loans split into two tranches as follows: (i) the Tranche A Loans are $30.0 million in term loans, and (ii) the Tranche B Loans are up to $25.0 million in term loans. The Tranche A Loans were drawn on December 4, 2015. The Tranche B Loans were available to be drawn prior to December 4, 2016. No additional draw was taken. The Tranche A Loans bear interest at a fixed rate equal to 9.50% per annum that is due and payable quarterly in arrears. During the first eight calendar quarters, 50% of the interest due and payable was added to the then outstanding principal. In December 2015, the Company used the proceeds from the Pharmakon Loan Agreement to repay $4.9 million of bank debt to Silicon Valley Bank (“SVB”). The issuance costs and debt discount have been netted against the borrowed funds on the balance sheet. On October 23, 2018, the Company repaid the principal amount of the Tranche A Loan of $30.0 million and related accrued interest of $3.3 million. The Company incurred a $3.0 million loss in connection with the early extinguishment of the Pharmakon Loan Agreement which included a prepayment premium fee of $1.0 million and additional consideration related to the prepayment of $1.5 million. Bank Debt In December 2015, the Company entered into a Second Amended and Restated Loan and Security Agreement with SVB, (the “SVB Loan Agreement”). Under the SVB Loan Agreement, the Company may borrow, repay and reborrow under a revolving credit line, but not in excess of the maximum loan amount of $15.0 million, until December 4, 2018, when all outstanding principal and accrued interest becomes due and payable. Any principal amount outstanding under the SVB Loan Agreement shall bear interest at a floating rate per annum equal to the rate published by The Wall Street Journal as the “Prime Rate” plus 0.25%. The Company may borrow up to 80% of its eligible accounts receivable, up to the maximum of $15.0 million. In August 2016, the Company obtained a $3.1 million standby letter of credit pursuant to the SVB Loan Agreement in connection with a lease for its San Francisco office. In October 2018, the Company entered into the Third Amended and Restated Loan and Security Agreement with SVB (“Third Amended and Restated SVB Loan Agreement”). This Agreement amends and restates the Second Amended and Restated Loan and Security Agreement between the Company and SVB dated December 4, 2015, as amended by the First Loan Modification Agreement between the Company and SVB dated August 22, 2016. Pursuant to the Third Amended and Restated SVB Loan Agreement, the Company obtained a term loan (“SVB Term Loan”) for $35.0 million. Total proceeds from the SVB Term Loan were used to pay off the loan agreement with Biopharma Secured Investments III Holdings Cayman LP (“Pharmakon”), totaling $35.8 million. The Company will make interest-only payments through October 31, 2020, followed by 36 monthly payments of principal plus interest on the SVB Term Loan. Interest charged on the SVB Term Loan will be the greater of (a) a floating rate based on the “Prime Rate” published by The Wall Street Journal minus 0.75%, or (b) 4.25%. Under the Third Amended and Restated SVB Loan Agreement, the Company may borrow, repay, and reborrow under a revolving credit line, but not in excess of the maximum loan amount of $25.0 million, which includes an $11.0 million standby letter of credit sublimit availability. In October 2018, a $6.9 million standby letter of credit was obtained in connection with a lease for the Company’s San Francisco headquarters. Any principal amount outstanding under the Third Amended and Restated SVB Loan Agreement revolving credit line shall bear interest at an amount that is the greater of (a) a floating rate per annum equal to the rate published by The Wall Street Journal as the “Prime Rate” or (b) 5.00%. The Company may borrow up to 75% of eligible accounts receivable, up to the maximum of $25.0 million. As of June 30, 2019, no amount was outstanding under the revolving credit line. The Third Amended and Restated Loan Agreement requires the Company to maintain a minimum consolidated liquidity ratio or minimum adjusted Earnings Before Interest, Tax, Depreciation, and Amortization during the term of the loan facility. In addition, the SVB Loan Agreement contains customary affirmative and negative covenants and events of default. The Company was in compliance with loan covenants as of June 30, 2019. The obligations under the Third Amended and Restated Loan Agreement are collateralized by substantially all assets of the Company. California HealthCare Foundation Note In November 2012, the Company entered into a Note Purchase Agreement and Promissory Note with the California HealthCare Foundation (the “CHCF Note”), through which the Company borrowed $1.5 million. The CHCF Note accrued simple interest of 2.0%. The accrued interest and the principal was to mature in November 2016. In partial consideration for the issuance of the CHCF Note, the Company issued warrants to purchase 22,807 shares of the Company’s Series D convertible preferred stock. In June 2015, the Company amended the CHCF Note to extend the maturity date to May 2018. The CHCF Note was subordinate to other debt. In May 2018, the Company repaid the principal amount of $1.5 million and related $0.2 million in accrued interest on the CHCF Note. |
Income Taxes
Income Taxes | 6 Months Ended |
Jun. 30, 2019 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | 8. Income Taxes The Company recorded a tax provision related to its U.K. entity during the three and six months ended June 30, 2019. The Company did not record a provision or benefit for income taxes during the three and six months ended June 30, 2018, as it reported losses in each period which are not more likely than not to be realized. Due to the uncertainties surrounding the realization of deferred tax assets through future taxable income, the Company has provided a full valuation allowance and, therefore, no benefit has been recognized for the net operating loss carryforwards and other deferred tax assets. |
Stockholders' Equity
Stockholders' Equity | 6 Months Ended |
Jun. 30, 2019 | |
Equity [Abstract] | |
Stockholders' Equity | 9. Stockholders’ Equity Common stock The Company’s amended and restated certificate of incorporation dated October 25, 2016, authorizes the Company to issue 100,000,000 shares of common stock with a par value of $0.001 per share and 5,000,000 shares of preferred stock with a par value of $0.001 per share. The holders of common stock are entitled to receive dividends whenever funds and assets are legally available and when declared by the board of directors , subject to the prior rights of holders of all series of convertible preferred stock outstanding The Company had reserved shares of common stock for issuance as follows: June 30, December 31, 2019 2018 Options issued and outstanding 1,715,389 2,094,137 Unvested restricted stock units 886,404 547,891 Common stock warrants issued and outstanding 4,857 4,857 Shares available for grant under future stock plans 6,763,074 5,607,014 Total 9,369,724 8,253,899 |
Stock Incentive Plans
Stock Incentive Plans | 6 Months Ended |
Jun. 30, 2019 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |
Stock Incentive Plans | 10. Stock Incentive Plans Equity Incentive Plan Activity A summary of share-based awards available for grant under the 2016 Plan is as follows: Awards Available for Grant Balance at December 31, 2017 4,034,152 Additional awards authorized 1,168,865 Awards granted (666,913 ) Awards forfeited 124,478 Awards withheld for tax purposes 56,710 Balance at December 31, 2018 4,717,292 Additional options authorized 1,218,402 Awards granted (532,551 ) Awards forfeited 103,561 Awards withheld for tax purposes 38,148 Balance at June 30, 2019 5,544,852 The following table summarizes stock option activity under the 2006 and 2016 Plans: Options Outstanding Options Outstanding Weighted- Average Exercise Price Per Share Weighted- Average Remaining Contractual Life (years) Aggregate Intrinsic Value (in thousands) Balance at December 31, 2017 2,601,181 $ 12.24 7.17 $ 113,958 Options granted 366,928 $ 68.32 Options exercised (798,424 ) $ 7.19 Options forfeited (75,548 ) $ 34.30 Balance at December 31, 2018 2,094,137 $ 23.20 7.02 $ 97,976 Options granted 20,010 $ 82.77 Options exercised (357,321 ) $ 9.12 Options forfeited (41,437 ) $ 54.96 Balances at June 30, 2019 1,715,389 $ 26.06 6.57 $ 91,452 Options exercisable – June 30, 2019 1,173,390 $ 15.74 5.95 $ 74,322 Options vested and expected to vest – June 30, 2019 1,687,960 $ 25.57 6.54 $ 90,783 The aggregate intrinsic values of options outstanding, exercisable, vested and expected to vest were calculated as the difference between the exercise price of the options and the closing price of the Company’s common stock. During the six months ended June 30, 2019 and 2018, the Company granted options with a weighted-average grant date fair value of $38.29 and $30.80 per share, respectively. |
Stock-Based Compensation
Stock-Based Compensation | 6 Months Ended |
Jun. 30, 2019 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |
Stock-Based Compensation | 11. Stock-Based Compensation Employee Stock Options Valuation The fair value of employee and director stock options was estimated at the date of grant using a Black-Scholes option valuation model with the weighted average assumptions below. Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Expected term (in years) 6.1 6.1 6.1 6.1 Expected volatility 45.0 % 46.2 % 45.0 % 45.9 % Risk-free interest rate 2.36 % 2.77 % 2.39 % 2.72 % Dividend yield 0.0 % 0.0 % 0.0 % 0.0 % Stock-Based Compensation The following table summarizes the total stock-based compensation expense included in the statements of operations and comprehensive loss for all periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Cost of revenue $ 137 $ 21 $ 225 $ 138 Research and development 1,278 781 2,151 1,357 Selling, general and administrative 5,915 3,274 9,369 5,828 Total stock-based compensation expense $ 7,330 $ 4,076 $ 11,745 $ 7,323 As of June 30, 2019, there was total unamortized compensation costs of $11.7 million, net of estimated forfeitures, related to unvested stock options which the Company expects to recognize over a period of approximately two years, $47.8 million, net of estimated forfeitures, related to unrecognized restricted stock unit (“RSU”) expense, which the Company expects to recognize over a period of 2.5 years, and $1.9 million unrecognized ESPP expense, which the Company will recognize over one year. Performance based RSUs (“PRSU”) In February 2019, the Company granted PRSUs to key executives of the Company. The performance equity program has a 2-year performance period measuring target revenue compound annual growth rate (“CAGR”) achievement for fiscal year 2020 compared to fiscal year 2018. There is a minimum performance threshold of 75% to earn 50% of target, and a maximum threshold of 125% achieved to earn 200% of target. The exact number of earned shares will be determined based on linear interpolation using the actual revenue CAGR as it falls between the minimum and maximum thresholds outlined above. The fair value of the PRSUs will range from $0 to $19.5 million, depending on the actual achievement relative to the performance target . |
Net Loss Per Common Share
Net Loss Per Common Share | 6 Months Ended |
Jun. 30, 2019 | |
Earnings Per Share [Abstract] | |
Net Loss Per Common Share | 12. Net Loss Per Common Share As the Company had net losses for the three and six months ended June 30, 2019 and 2018, all potential common shares were determined to be anti-dilutive. The following table sets forth the computation of the basic and diluted net loss per share attributable to holders of common stock (in thousands, except share and per share data): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Numerator: Net loss $ (11,467 ) $ (12,206 ) $ (19,486 ) $ (23,323 ) Denominator: Weighted-average shares used to compute net loss per common share, basic and diluted 24,724,808 23,747,131 24,600,250 23,614,281 Net loss per common share, basic and diluted $ (0.46 ) $ (0.51 ) $ (0.79 ) $ (0.99 ) The following outstanding shares of potentially dilutive securities have been excluded from diluted net loss per common share for the six months ended June 30, 2019 and 2018, because their inclusion would be anti-dilutive: Six Months Ended, June 30 2019 2018 Options to purchase common stock 1,715,389 2,384,798 PRSUs and RSUs issued and unvested 886,404 575,585 Warrants to purchase common stock 4,857 4,857 Total 2,606,650 2,965,240 |
Summary of Significant Accoun_2
Summary of Significant Accounting Policies (Policies) | 6 Months Ended |
Jun. 30, 2019 | |
Accounting Policies [Abstract] | |
Basis of Presentation | Basis of Presentation The accompanying financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America, or U.S. GAAP, and applicable rules and regulations of the Securities and Exchange Commission, or SEC, regarding interim financial reporting. As permitted under those rules, certain footnotes or other financial information that are normally required by GAAP have been condensed or omitted, and accordingly the balance sheet as of December 31, 2018, and related disclosures, have been derived from the audited consolidated financial statements at that date but does not include all of the information required by GAAP for complete consolidated financial statements. These unaudited condensed consolidated financial statements have been prepared on the same basis as the Company’s annual consolidated financial statements and, in the opinion of management, reflect all adjustments (consisting only of normal recurring adjustments) that are necessary for the fair statement of the Company’s condensed consolidated financial information. Certain prior period amounts in the accompanying consolidated financial statements have been reclassified to conform to current period presentation. The results of operations for the six months ended June 30, 2019 are not necessarily indicative of the results to be expected for the year ending December 31, 2019 or for any other interim period or for any other future year. The accompanying interim unaudited condensed consolidated financial statements and related financial information should be read in conjunction with the audited financial statements and the related notes thereto for the year ended December 31, 2018 included in the Company’s annual report on Form 10-K, filed with the SEC on March 4, 2019. |
Accounts Receivable, Allowance for Doubtful Accounts and Contractual Allowance | Accounts Receivable, Allowance for Doubtful Accounts and Contractual Allowance Accounts receivable consists of amounts due to the Company from institutions, third-party payors, government and commercial payors and their related patients, as a result of the Company's normal business activities. Accounts receivable is reported on the condensed consolidated balance sheets net of an estimated allowance for doubtful accounts and a contractual allowance. The Company establishes an allowance for doubtful accounts for estimated uncollectible receivables based on its historical experience and recognizes the provision as a component of selling, general and administrative expenses. The Company establishes a contractual allowance when it estimates that consideration to be received will be lower than the contracted rate based on its historical experience and recognizes the provision as a reduction to revenue. The following table presents the changes in the allowance for doubtful accounts (in thousands): Six Months Ended June 30, Year Ended December 31, 2019 2018 Balance, beginning of period $ 4,851 $ 3,568 Add: provision for doubtful accounts 3,358 5,826 Less: write-offs, net of recoveries and other adjustments (3,537 ) (4,543 ) Balance, end of period $ 4,672 $ 4,851 The following table presents the changes in the contractual allowance (in thousands): Six Months Ended June 30, Year Ended December 31, 2019 2018 Balance, beginning of period $ 10,601 $ 7,444 Add: allowance for contractual adjustments 7,325 9,392 Less: contractual adjustments (3,557 ) (6,235 ) Balance, end of period $ 14,369 $ 10,601 The following table presents the impact of allowance for doubtful accounts and contractual allowance on accounts receivable (in thousands): Six Months Ended June 30, Year Ended December 31, 2019 2018 Gross accounts receivable $ 48,178 $ 37,429 Less: allowance for doubtful accounts (4,672 ) (4,851 ) Less: contractual allowance (14,369 ) (10,601 ) Net accounts receivable $ 29,137 $ 21,977 The Company reviews and updates its estimates for the allowances for doubtful accounts and contractual allowance periodically to reflect its experience regarding historical collections. If management were to make different judgments or utilize different estimates in the allowances for doubtful accounts and contractual allowance, differences in the amount of reported selling, general and administrative expenses and revenue could result, respectively. |
Concentration of Credit Risk | Concentrations of Risk Credit Risk Financial instruments that potentially subject the Company to a concentration of credit risk consist primarily of cash and cash equivalents, investments and accounts receivable. Cash, cash equivalents, and investments are deposited in financial institutions which, at times may be in excess of federally insured limits. Cash equivalents are invested in highly rated money market funds. The Company invests in a variety of financial instruments, such as, but not limited to, United States Government securities, corporate notes, commercial paper and, by policy, limits the amount of credit exposure with any one financial institution or commercial issuer. The Company has not experienced any material losses on its deposits of cash and cash equivalents or investments. Concentrations of credit risk with respect to accounts receivable are limited due to the large number of customers comprising the Company’s customer base and their dispersion across many geographies. The Company does not require collateral. The Company records an allowance for doubtful accounts when it becomes probable that a receivable will not be collected. Federal government agencies, including Centers for Medicare and Medicaid Services (“ |
Revenue Recognition | Revenue Recognition The Company’s revenue is generated primarily from the provision of its cardiac rhythm monitoring service, the Zio XT service. The Zio XT is a cardiac rhythm monitoring service that has a patient wear period of up to 14 days and is billable when the monitoring reports are delivered to the healthcare provider, which is also when the service is complete and the Company recognizes revenue. The time from when the patient has the Zio XT device applied to the time the report is posted is generally around 18 days. The Company accounts for contract revenue with a customer when there is a legally enforceable contract between the Company and the customer, the rights of the parties are identified, the contract has commercial substance, and collectability of the contract consideration is probable. The Company's revenue is measured based on consideration specified in the contract with each customer. A unique aspect of healthcare is the involvement of multiple parties to the service transaction. In addition to the patient, often a third-party, for example a commercial or governmental payor or healthcare institution, like a hospital or clinic, will pay the Company for some or all of the service on the patient’s behalf. Separate contractual arrangements exist between the Company and third-party payors that establish amounts the third-party payor will pay on behalf of a patient for covered services rendered and should be conside red in determining collectability and the transaction price for services provided to a patient covered by that third-party payor. The Company recognizes revenue on an accrual basis based on estimates of the amount that will ultimately be realized. These estimates require significant judgment by management. In determining the amount to recognize for a delivered report, the Company considers factors such as claim payment history from both payors and patient out-of-pocket costs, payor coverage, whether there is a contract between the payor or healthcare institution and the Company, historical amount received for the service, and any current developments or changes that could impact reimbursement and healthcare institution payments. A summary of the payment arrangements with third-party payors and healthcare institutions is as follows: • Contracted third-party payors – The Company has contracts with negotiated prices for services provided for patients with commercial healthcare insurance carriers • CMS – The Company has received independent diagnostic testing facility approval from regional Medicare Administrative Contractors and will receive reimbursement per the relevant Current Procedural Terminology (“CPT”) code rate for the services rendered to the patient covered by CMS. • Non-contracted third-party payors: Non-contracted commercial and government payors often reimburse out-of-network rates provided under the relevant CPT codes on a case-by-case basis. The transaction price is based on factors including an average of the Company’s historical collection experience for non-contracted services. This rate is reviewed at least quarterly. • Healthcare institutions – Healthcare institutions are typically hospitals or physician practices in which the Company has negotiated amounts for its monitoring services, including certain governmental agencies such as the Veteran’s Administration and Department of Defense. The Company is utilizing the portfolio approach practical expedient under ASC 606 for revenue recognition. The Company accounts for the contracts within each portfolio as a collective group, rather than individual contracts. Based on history with these portfolios and the similar nature and characteristics of the patients within each portfolio, the Company has concluded that the financial statement effects are not materially different than if accounting for revenue on a contract-by-contract basis. For healthcare institutions, the Company has historical experience of collecting substantially all of the negotiated contractual rates and determined at contract inception that these customers, and or their related third-party payor that pays the Company on their behalf, have the intention and ability to pay the promised consideration. As such, the Company is not providing an implicit price concession but, rather, has chosen to accept the risk of default, and any subsequent impairment of the related receivable are recorded as bad debt expense. For contracted and CMS portfolios, the Company is providing an implicit price concession because, while the Company has a contract with the underlying payor, the Company expects to accept a lower amount of consideration when claims are adjudicated and allowable claims are determined by the commercial payor. The implicit price concession is recorded as variable consideration to the transaction price and recorded as an adjustment to revenue as a contractual allowance. Historical cash collection indicates that it is probable that substantially all of the allowable claim amount will be received, and hence this amount is recorded as revenue. Any subsequent impairment of the related receivable is recorded as bad debt expense. For non-contracted portfolios, the Company is providing an implicit price concession because the Company does not have a contract with the underlying payor, the result of which requires the Company to estimate transaction price based on historical cash collections utilizing the expected value method. Subsequent adjustments to the transaction price are recorded as an adjustment to revenue and not as bad debt expense. Disaggregation of Revenue The Company disaggregates revenue from contracts with customers by payor type. The Company believes these categories aggregate the payor types by nature, amount, timing and uncertainty of its revenue streams. Disaggregated revenue by payor type and major service line for three and six months ended June 30, 2019 was as follows (in thousands): Three Months Ended Six Months Ended June 30, 2019 June 30, 2019 Commercial Payors $ 27,631 $ 51,978 Centers for Medicare & Medicaid 14,747 27,493 Healthcare Institutions 10,953 21,074 Total $ 53,331 $ 100,545 |
Contract Liabilities | Contract Liabilities ASC 606 requires an entity to present a revenue contract as a contract liability when the Company has an obligation to transfer goods or services to a customer for which the Company has received consideration from the customer, or an amount of consideration from the customer is due and unconditional (whichever is earlier). Certain of the Company’s customers pay the Company directly for the Zio XT service upon shipment of devices. Such advance payments, or contract liabilities are recorded as deferred revenue on the Condensed Consolidated Balance Sheets and revenue is recognized when reports are delivered to physicians. Total revenue recognized during each of the three and six months ended June 30, 2019 that was included in the contract liability balance at the beginning of 2019, was $0.1 million and $1.2 million, respectively. The total revenue recognized during the three and six months ended June 30, 2018 that was included in the contract liability balance at the beginning of 2018 was less than $0.1 million and $1.2 million, respectively. |
Contract Costs | Contract Costs Under ASC 340, the incremental costs of obtaining a contract with a customer are recognized as an asset. Incremental costs of obtaining a contract are those costs that an entity incurs to obtain a contract with a customer that it would not have incurred if the contract had not been obtained. The Company’s current commission programs are considered incremental. However, as a practical expedient, ASC 340 permits the Company to immediately expense contract acquisition costs, as the asset that would have resulted from capitalizing these costs will be amortized in one year or less. |
Leases | Leases Identifying a lease The Company determines whether a contract contains a lease at the inception of a contract. If the contract conveys the right to control the use of an identified asset for a period of time in exchange for consideration, the Company considers the contract to contain a lease. The Company determines whether a contract conveys the right to control the use of an identified asset for a period of time if the contract contains both of the following terms: • The right to obtain substantially all of the economic benefits from use of the identified asset • The right to direct the use of the identified asset Discount rate for leases On January 1, 2019, the rate implicit in the Company’s leases was not readily determinable. As such, the Company used its incremental borrowing rate to calculate its right-of-use assets and lease liabilities. The Company determined the appropriate incremental borrowing rate by utilizing the interest rate obtained in connection with the Third Amended and Restated Loan and Security Agreement with Silicon Valley Bank (“Third Amended and Restated SVB Loan Agreement”) On October 4, 2018, the Company entered into an office lease (“San Francisco Lease”) to rent approximately 117,560 rentable square feet in San Francisco, California, which will become the Company’s new headquarters. The San Francisco Lease commenced on May 13, 2019 and the Company determined that the interest rate associated with the Third Amended and Restated SVB Loan Agreement could not be utilized as the incremental borrowing rate associated with the San Francisco Lease due to the term of the lease, as well as annual rental payments. The Company determined the appropriate incremental borrowing rate by using a synthetic credit rating which was estimated based on an analysis of outstanding debt of companies with similar credit and financial profiles. Lease term The lease term is generally the minimum noncancelable period of each lease. The Company does not include option periods in determining the right-of-use asset and right-of-use liability unless it is reasonably certain that the Company will exercise the option at inception or when a triggering event occurs. As of June 30, 2019, no renewal options were included in the determination of lease terms. Lease Modification The San Francisco Lease is in the same building with the same landlord as the lease for the Company’s current headquarters in San Francisco (“existing lease”). Upon the commencement of the San Francisco Lease, the existing lease which had an original expiration date of February 2020, was modified to expire in September 2019. |
Recently Adopted Accounting Guidance | Recently Adopted Accounting Guidance In February 2016, the Financing Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2016-02, Leases (“Topic 842”), which requires lessees to recognize lease liabilities and corresponding right-of-use assets on the consolidated balance sheet for all leases. For finance leases, the lessee would recognize interest expense and amortization of the right-of-use asset and, for operating leases, the lessee would recognize a straight-line lease expense. Topic 842 also changes the definition of a lease and expands the disclosure requirements of lease arrangements. The Company has no embedded leases with suppliers. Upon adoption of Topic 842 on January 1, 2019 using the modified retrospective method, the Company recognized right-of-use assets of $10.4 million and lease liabilities of $10.2 million. There was no cumulative-effect adjustment recorded on January 1, 2019. The Company adopted the following practical expedients allowed under Topic 842: • The package of three practical expedients, which allows entities to make an election that allows them not to reassess (1) whether existing or expired contracts contain embedded leases under Topic 842, (2) lease classification of existing or expiring leases, and (3) indirect costs for existing or expired leases • Combining lease and non-lease components practical expedient, which allows lessees, as an accounting policy election by class of underlying asset, to choose not to separate non-lease components from lease components and instead to account for each separate lease component and the non-lease components associated with that lease component as a single lease component; and • Comparative reporting practical expedient, which allows entities to initially apply Topic 842 at the adoption date and recognize a cumulative-effect adjustment to the opening balance of retained earnings in the period of adoption For further details, refer to Note 6. Commitments and Contingencies |
Summary of Significant Accoun_3
Summary of Significant Accounting Policies (Tables) | 6 Months Ended |
Jun. 30, 2019 | |
Accounting Policies [Abstract] | |
Schedule of Changes in Allowance for Doubtful Accounts | The following table presents the changes in the allowance for doubtful accounts (in thousands): Six Months Ended June 30, Year Ended December 31, 2019 2018 Balance, beginning of period $ 4,851 $ 3,568 Add: provision for doubtful accounts 3,358 5,826 Less: write-offs, net of recoveries and other adjustments (3,537 ) (4,543 ) Balance, end of period $ 4,672 $ 4,851 |
Schedule of Changes in Contractual Allowance | The following table presents the changes in the contractual allowance (in thousands): Six Months Ended June 30, Year Ended December 31, 2019 2018 Balance, beginning of period $ 10,601 $ 7,444 Add: allowance for contractual adjustments 7,325 9,392 Less: contractual adjustments (3,557 ) (6,235 ) Balance, end of period $ 14,369 $ 10,601 |
Schedule of Impact of Allowance for Doubtful Accounts and Contractual Allowance on Accounts Receivable | The following table presents the impact of allowance for doubtful accounts and contractual allowance on accounts receivable (in thousands): Six Months Ended June 30, Year Ended December 31, 2019 2018 Gross accounts receivable $ 48,178 $ 37,429 Less: allowance for doubtful accounts (4,672 ) (4,851 ) Less: contractual allowance (14,369 ) (10,601 ) Net accounts receivable $ 29,137 $ 21,977 |
Disaggregated Revenue by Payor Type and Major Service | The Company disaggregates revenue from contracts with customers by payor type. The Company believes these categories aggregate the payor types by nature, amount, timing and uncertainty of its revenue streams. Disaggregated revenue by payor type and major service line for three and six months ended June 30, 2019 was as follows (in thousands): Three Months Ended Six Months Ended June 30, 2019 June 30, 2019 Commercial Payors $ 27,631 $ 51,978 Centers for Medicare & Medicaid 14,747 27,493 Healthcare Institutions 10,953 21,074 Total $ 53,331 $ 100,545 |
Cash Equivalents and Investme_2
Cash Equivalents and Investments (Tables) | 6 Months Ended |
Jun. 30, 2019 | |
Cash Equivalents And Investments [Abstract] | |
Schedule of Fair Value of Securities, not Including Cash | The fair value of securities, not including cash at June 30, 2019 and December 31, 2018, were as follows (in thousands): June 30, 2019 Amortized Gross Unrealized Estimated Cost Gains Losses Fair Value Money market funds $ 9,748 $ — $ — $ 9,748 U.S. government securities 33,023 35 — 33,058 Corporate notes 1,999 — — 1,999 Commercial paper 8,183 — — 8,183 Total available-for-sale marketable debt securities $ 52,953 $ 35 $ — $ 52,988 Classified as: Cash equivalents $ 9,748 Short-term investments 43,240 Total cash equivalents and investments $ 52,988 December 31, 2018 Amortized Gross Unrealized Estimated Cost Gains Losses Fair Value Money market funds $ 10,606 $ — $ — $ 10,606 U.S. government securities 9,976 — (1 ) 9,975 Corporate notes 16,514 3 (18 ) 16,499 Commercial paper 36,331 — — 36,331 Total available-for-sale marketable debt securities $ 73,427 $ 3 $ (19 ) $ 73,411 Classified as: Cash equivalents $ 15,091 Short-term investments 58,320 Total cash equivalents and investments $ 73,411 |
Schedule of Fair Value of Short-term and Long-term Marketable Securities Classified by Maturity | The following table summarizes the fair value of the Company’s cash equivalents, short-term and long-term marketable securities classified by maturity (in thousands): June 30, December 31, 2019 2018 Due within one year $ 52,988 $ 73,411 Due after one year through three years — — Total available-for-sale marketable debt securities $ 52,988 $ 73,411 |
Schedule of Available-for-Sale Securities Unrealized Loss Position | As of June 30, 2019, the Company had no available-for-sale securities in an unrealized loss position. The following table presents the Company's available-for-sale securities that were in an unrealized loss position as of December 31, 2018 (in thousands): December 31, 2018 Less than 12 months 12 Months or Greater Total Assets Fair Value Unrealized Loss Fair Value Unrealized Loss Fair Value Unrealized Loss U.S. government securities $ 5,977 $ (1 ) $ — $ — $ 5,977 $ (1 ) Corporate notes 11,521 (10 ) 2,993 (8 ) 14,514 (18 ) Total $ 17,498 $ (11 ) $ 2,993 $ (8 ) $ 20,491 $ (19 ) |
Fair Value Measurements (Tables
Fair Value Measurements (Tables) | 6 Months Ended |
Jun. 30, 2019 | |
Fair Value Disclosures [Abstract] | |
Schedule of Fair Value of Company's Financial Assets and Liabilities | The following table presents the fair value of the Company’s financial assets and liabilities determined using the inputs defined above (in thousands). June 30, 2019 Level 1 Level 2 Level 3 Total Assets Money market funds $ 9,748 $ — $ — $ 9,748 U.S. government securities — 33,058 — 33,058 Corporate notes — 1,999 — 1,999 Commercial paper — 8,183 — 8,183 Total $ 9,748 $ 43,240 $ — $ 52,988 December 31, 2018 Level 1 Level 2 Level 3 Total Assets Money market funds $ 10,606 $ — $ — $ 10,606 U.S. government securities — 9,975 — 9,975 Corporate notes — 16,499 — 16,499 Commercial paper — 36,331 — 36,331 Total $ 10,606 $ 62,805 $ — $ 73,411 |
Balance Sheet Components (Table
Balance Sheet Components (Tables) | 6 Months Ended |
Jun. 30, 2019 | |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
Components of Inventory and Printed Circuit Board Assemblies ("PCBAs") | Inventory and Printed Circuit Board Assemblies (“PCBAs”), which are recorded as other assets as they are used many times over a period longer than one year on average, consisted of the following (in thousands): June 30, 2019 December 31, 2018 Raw materials $ 1,974 $ 1,028 Finished goods 4,543 3,565 Total $ 6,517 $ 4,593 Classified as: Inventory $ 2,774 $ 2,062 Other assets 3,743 2,531 Total $ 6,517 $ 4,593 |
Components of Property and Equipment, Net | Property and equipment, net consisted of the following (in thousands): June 30, December 31, 2019 2018 Laboratory and manufacturing equipment $ 3,830 $ 2,750 Computer equipment and software 1,062 1,062 Furniture and fixtures 925 925 Leasehold improvements 2,146 726 Internal-use software 11,177 8,925 Total property and equipment, gross 19,140 14,388 Less: accumulated depreciation and amortization (6,522 ) (5,230 ) Total property and equipment, net $ 12,618 $ 9,158 |
Components of Accrued Liabilities | Accrued liabilities consisted of the following (in thousands): June 30, December 31, 2019 2018 Accrued vacation $ 3,646 $ 2,825 Accrued payroll and related expenses 13,338 18,188 Accrued professional services fees 895 1,243 Claims payable 3,220 2,374 Other 2,205 1,940 Total accrued liabilities $ 23,304 $ 26,570 |
Commitments and Contingencies (
Commitments and Contingencies (Tables) | 6 Months Ended |
Jun. 30, 2019 | |
Commitments And Contingencies Disclosure [Abstract] | |
Schedule of Maturities of Operating Lease Liabilities | As of June 30, 2019, maturities of operating lease liabilities were as follows (in thousands): Period Ending December 31: 2019 (remainder of year) $ 1,743 2020 11,757 2021 11,760 2022 11,317 2023 11,639 Thereafter 100,764 148,980 Less: imputed interest (53,490 ) Total lease liabilities $ 95,490 |
Schedule of Minimum Future Lease Payments under Previous Lease Accounting Standard | Minimum future lease payments previously disclosed in the 2018 10-K and under the previous lease accounting standard, which includes annual rental payments for the San Francisco Lease which commenced May 13, 2019, for the year ended December 31, 2018 are as follows (in thousands): Period Ending December 31: 2019 $ 8,135 2020 10,669 2021 10,828 2022 11,150 2023 11,483 Thereafter 98,209 Total $ 150,474 |
Stockholders' Equity (Tables)
Stockholders' Equity (Tables) | 6 Months Ended |
Jun. 30, 2019 | |
Equity [Abstract] | |
Schedule of Common Stock Shares Reserved for Future Issuance | The Company had reserved shares of common stock for issuance as follows: June 30, December 31, 2019 2018 Options issued and outstanding 1,715,389 2,094,137 Unvested restricted stock units 886,404 547,891 Common stock warrants issued and outstanding 4,857 4,857 Shares available for grant under future stock plans 6,763,074 5,607,014 Total 9,369,724 8,253,899 |
Stock Incentive Plans (Tables)
Stock Incentive Plans (Tables) | 6 Months Ended |
Jun. 30, 2019 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |
Summary of Share-based Awards Available for Grant under 2016 Plan | A summary of share-based awards available for grant under the 2016 Plan is as follows: Awards Available for Grant Balance at December 31, 2017 4,034,152 Additional awards authorized 1,168,865 Awards granted (666,913 ) Awards forfeited 124,478 Awards withheld for tax purposes 56,710 Balance at December 31, 2018 4,717,292 Additional options authorized 1,218,402 Awards granted (532,551 ) Awards forfeited 103,561 Awards withheld for tax purposes 38,148 Balance at June 30, 2019 5,544,852 |
Summary of Stock Option Activity Under 2006 and 2016 Plans | The following table summarizes stock option activity under the 2006 and 2016 Plans: Options Outstanding Options Outstanding Weighted- Average Exercise Price Per Share Weighted- Average Remaining Contractual Life (years) Aggregate Intrinsic Value (in thousands) Balance at December 31, 2017 2,601,181 $ 12.24 7.17 $ 113,958 Options granted 366,928 $ 68.32 Options exercised (798,424 ) $ 7.19 Options forfeited (75,548 ) $ 34.30 Balance at December 31, 2018 2,094,137 $ 23.20 7.02 $ 97,976 Options granted 20,010 $ 82.77 Options exercised (357,321 ) $ 9.12 Options forfeited (41,437 ) $ 54.96 Balances at June 30, 2019 1,715,389 $ 26.06 6.57 $ 91,452 Options exercisable – June 30, 2019 1,173,390 $ 15.74 5.95 $ 74,322 Options vested and expected to vest – June 30, 2019 1,687,960 $ 25.57 6.54 $ 90,783 |
Stock-Based Compensation (Table
Stock-Based Compensation (Tables) | 6 Months Ended |
Jun. 30, 2019 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |
Schedule of Fair Value of Employee and Director Stock Options Estimated Using Weighted Average Assumptions | The fair value of employee and director stock options was estimated at the date of grant using a Black-Scholes option valuation model with the weighted average assumptions below. Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Expected term (in years) 6.1 6.1 6.1 6.1 Expected volatility 45.0 % 46.2 % 45.0 % 45.9 % Risk-free interest rate 2.36 % 2.77 % 2.39 % 2.72 % Dividend yield 0.0 % 0.0 % 0.0 % 0.0 % |
Summary of Total Stock-Based Compensation Expense Included in Statements of Operations and Comprehensive Loss | The following table summarizes the total stock-based compensation expense included in the statements of operations and comprehensive loss for all periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Cost of revenue $ 137 $ 21 $ 225 $ 138 Research and development 1,278 781 2,151 1,357 Selling, general and administrative 5,915 3,274 9,369 5,828 Total stock-based compensation expense $ 7,330 $ 4,076 $ 11,745 $ 7,323 |
Net Loss Per Common Share (Tabl
Net Loss Per Common Share (Tables) | 6 Months Ended |
Jun. 30, 2019 | |
Earnings Per Share [Abstract] | |
Computation of Basic and Diluted Net Loss per Share Attributable to Common Stock holders | The following table sets forth the computation of the basic and diluted net loss per share attributable to holders of common stock (in thousands, except share and per share data): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Numerator: Net loss $ (11,467 ) $ (12,206 ) $ (19,486 ) $ (23,323 ) Denominator: Weighted-average shares used to compute net loss per common share, basic and diluted 24,724,808 23,747,131 24,600,250 23,614,281 Net loss per common share, basic and diluted $ (0.46 ) $ (0.51 ) $ (0.79 ) $ (0.99 ) |
Schedule of Anti-dilutive Securities Excluded from Diluted Net Loss per Common Share | The following outstanding shares of potentially dilutive securities have been excluded from diluted net loss per common share for the six months ended June 30, 2019 and 2018, because their inclusion would be anti-dilutive: Six Months Ended, June 30 2019 2018 Options to purchase common stock 1,715,389 2,384,798 PRSUs and RSUs issued and unvested 886,404 575,585 Warrants to purchase common stock 4,857 4,857 Total 2,606,650 2,965,240 |
Summary of Significant Accoun_4
Summary of Significant Accounting Policies - Schedule of Changes in Allowance for Doubtful Accounts (Details) - USD ($) $ in Thousands | 6 Months Ended | 12 Months Ended |
Jun. 30, 2019 | Dec. 31, 2018 | |
Receivables [Abstract] | ||
Balance, beginning of period | $ 4,851 | $ 3,568 |
Add: provision for doubtful accounts | 3,358 | 5,826 |
Less: write-offs, net of recoveries and other adjustments | (3,537) | (4,543) |
Balance, end of period | $ 4,672 | $ 4,851 |
Summary of Significant Accoun_5
Summary of Significant Accounting Policies - Schedule of Changes in Contractual Allowance (Details) - USD ($) $ in Thousands | 6 Months Ended | 12 Months Ended |
Jun. 30, 2019 | Dec. 31, 2018 | |
Receivables [Abstract] | ||
Balance, beginning of period | $ 10,601 | $ 7,444 |
Add: allowance for contractual adjustments | 7,325 | 9,392 |
Less: contractual adjustments | (3,557) | (6,235) |
Balance, end of period | $ 14,369 | $ 10,601 |
Summary of Significant Accoun_6
Summary of Significant Accounting Policies - Schedule of Impact of Allowance for Doubtful Accounts and Contractual Allowance on Accounts Receivable (Details) - USD ($) $ in Thousands | Jun. 30, 2019 | Dec. 31, 2018 |
Receivables [Abstract] | ||
Gross accounts receivable | $ 48,178 | $ 37,429 |
Less: allowance for doubtful accounts | (4,672) | (4,851) |
Less: contractual allowance | (14,369) | (10,601) |
Net accounts receivable | $ 29,137 | $ 21,977 |
Summary of Significant Accoun_7
Summary of Significant Accounting Policies - Additional Information (Details) | May 13, 2019 | Oct. 04, 2018ft² | Jun. 30, 2019USD ($) | Jun. 30, 2018USD ($) | Jun. 30, 2019USD ($)Lease | Jun. 30, 2018USD ($) | Dec. 31, 2018 | Jan. 01, 2019USD ($) |
Summary Of Significant Accounting Policies [Line Items] | ||||||||
Total revenue recognized that was included in contract liability | $ 100,000 | $ 1,200,000 | $ 1,200,000 | |||||
Number of embedded leases with suppliers | Lease | 0 | |||||||
Cumulative effect adjustment | $ 0 | |||||||
Operating lease right-of-use assets | 94,326,000 | $ 94,326,000 | ||||||
Operating lease liabilities | $ 95,490,000 | $ 95,490,000 | ||||||
Topic 842 | ||||||||
Summary Of Significant Accounting Policies [Line Items] | ||||||||
Operating lease right-of-use assets | 10,400,000 | |||||||
Operating lease liabilities | $ 10,200,000 | |||||||
Office Lease | San Francisco | ||||||||
Summary Of Significant Accounting Policies [Line Items] | ||||||||
Lease rentable area | ft² | 117,560 | |||||||
Lease expiration date | Feb. 29, 2020 | Aug. 31, 2031 | Sep. 30, 2019 | |||||
Maximum | ||||||||
Summary Of Significant Accounting Policies [Line Items] | ||||||||
Total revenue recognized that was included in contract liability | $ 100,000 | |||||||
Maximum | Zio XT service | ||||||||
Summary Of Significant Accounting Policies [Line Items] | ||||||||
Equipment wear period | 14 days | |||||||
Revenue | Customer Concentration Risk | Federal Government Agencies | ||||||||
Summary Of Significant Accounting Policies [Line Items] | ||||||||
Concentration of credit risk | 36.00% | 38.00% | 36.00% | 38.00% | ||||
Accounts Receivable | Accounts Receivable Concentration Risk | Federal Government Agencies | ||||||||
Summary Of Significant Accounting Policies [Line Items] | ||||||||
Concentration of credit risk | 21.00% | 18.00% |
Summary of Significant Accoun_8
Summary of Significant Accounting Policies - Disaggregated Revenue by Payor Type and Major Service (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2019 | Jun. 30, 2018 | Jun. 30, 2019 | Jun. 30, 2018 | |
Disaggregation Of Revenue [Line Items] | ||||
Revenue | $ 53,331 | $ 35,469 | $ 100,545 | $ 66,034 |
Commercial Payors | ||||
Disaggregation Of Revenue [Line Items] | ||||
Revenue | 27,631 | 51,978 | ||
Centers for Medicare and Medicaid | ||||
Disaggregation Of Revenue [Line Items] | ||||
Revenue | 14,747 | 27,493 | ||
Healthcare Institutions | ||||
Disaggregation Of Revenue [Line Items] | ||||
Revenue | $ 10,953 | $ 21,074 |
Cash Equivalents and Investme_3
Cash Equivalents and Investments - Schedule of Fair Value of Securities, not Including Cash (Details) - USD ($) $ in Thousands | Jun. 30, 2019 | Dec. 31, 2018 |
Schedule Of Available For Sale Securities [Line Items] | ||
Amortized Cost | $ 52,953 | $ 73,427 |
Gross Unrealized Gains | 35 | 3 |
Gross Unrealized Losses | (19) | |
Estimated Fair Value | 52,988 | 73,411 |
Cash equivalents | 9,748 | 15,091 |
Short-term investments | 43,240 | 58,320 |
Total cash equivalents and investments | 52,988 | 73,411 |
Money Market Funds | ||
Schedule Of Available For Sale Securities [Line Items] | ||
Amortized Cost | 9,748 | 10,606 |
Estimated Fair Value | 9,748 | 10,606 |
U.S. Government Securities | ||
Schedule Of Available For Sale Securities [Line Items] | ||
Amortized Cost | 33,023 | 9,976 |
Gross Unrealized Gains | 35 | |
Gross Unrealized Losses | (1) | |
Estimated Fair Value | 33,058 | 9,975 |
Corporate Notes | ||
Schedule Of Available For Sale Securities [Line Items] | ||
Amortized Cost | 1,999 | 16,514 |
Gross Unrealized Gains | 3 | |
Gross Unrealized Losses | (18) | |
Estimated Fair Value | 1,999 | 16,499 |
Commercial Paper | ||
Schedule Of Available For Sale Securities [Line Items] | ||
Amortized Cost | 8,183 | 36,331 |
Estimated Fair Value | $ 8,183 | $ 36,331 |
Cash Equivalents and Investme_4
Cash Equivalents and Investments - Schedule of Fair Value of Short-term and Long-term Marketable Securities Classified by Maturity (Details) - USD ($) $ in Thousands | Jun. 30, 2019 | Dec. 31, 2018 |
Marketable Securities [Abstract] | ||
Due within one year | $ 52,988 | $ 73,411 |
Total available-for-sale marketable debt securities | $ 52,988 | $ 73,411 |
Cash Equivalents and Investme_5
Cash Equivalents and Investments - Additional Information (Details) $ in Thousands | 6 Months Ended | |
Jun. 30, 2019USD ($)Investment | Dec. 31, 2018USD ($) | |
Cash Equivalents And Investments [Abstract] | ||
Debt securities, available-for-sale unrealized loss | $ | $ 0 | $ 20,491 |
Available-for-sale securities, weighted average maturity of days | 93 days | |
Number of unrealized loss position in investments | 0 | |
Number of unrealized loss position for more than 12 months in investments | 0 |
Cash Equivalents and Investme_6
Cash Equivalents and Investments - Schedule of Available-for-Sale Securities Unrealized Loss Position (Details) - USD ($) $ in Thousands | Jun. 30, 2019 | Dec. 31, 2018 |
Schedule Of Available For Sale Securities [Line Items] | ||
Available-for-sale securities, unrealized loss position, Less than 12 months, Fair Value | $ 17,498 | |
Available-for-sale securities, unrealized loss position, Less than 12 months, Unrealized Loss | (11) | |
Available-for-sale securities, unrealized loss position, Greater than 12 months, Fair Value | 2,993 | |
Available-for-sale securities, unrealized loss position, Greater than 12 months, Unrealized Loss | (8) | |
Available-for-sale securities, unrealized loss position, Total, Fair Value | $ 0 | 20,491 |
Available-for-sale securities, unrealized loss position, Total, Unrealized Loss | (19) | |
U.S. Government Securities | ||
Schedule Of Available For Sale Securities [Line Items] | ||
Available-for-sale securities, unrealized loss position, Less than 12 months, Fair Value | 5,977 | |
Available-for-sale securities, unrealized loss position, Less than 12 months, Unrealized Loss | (1) | |
Available-for-sale securities, unrealized loss position, Total, Fair Value | 5,977 | |
Available-for-sale securities, unrealized loss position, Total, Unrealized Loss | (1) | |
Corporate Notes | ||
Schedule Of Available For Sale Securities [Line Items] | ||
Available-for-sale securities, unrealized loss position, Less than 12 months, Fair Value | 11,521 | |
Available-for-sale securities, unrealized loss position, Less than 12 months, Unrealized Loss | (10) | |
Available-for-sale securities, unrealized loss position, Greater than 12 months, Fair Value | 2,993 | |
Available-for-sale securities, unrealized loss position, Greater than 12 months, Unrealized Loss | (8) | |
Available-for-sale securities, unrealized loss position, Total, Fair Value | 14,514 | |
Available-for-sale securities, unrealized loss position, Total, Unrealized Loss | $ (18) |
Fair Value Measurements - Addit
Fair Value Measurements - Additional Information (Details) - USD ($) $ in Millions | Jun. 30, 2019 | Dec. 31, 2018 |
Carrying amount | ||
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items] | ||
Outstanding interest-bearing obligations | $ 34.9 | $ 34.9 |
Estimated fair value | Level 2 | ||
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items] | ||
Outstanding interest-bearing obligations | $ 35.4 | $ 34.9 |
Fair Value Measurements - Sched
Fair Value Measurements - Schedule of Fair Value of Company's Financial Assets and Liabilities (Details) - USD ($) $ in Thousands | Jun. 30, 2019 | Dec. 31, 2018 |
Assets | ||
Total financial assets | $ 52,988 | $ 73,411 |
Level 1 | ||
Assets | ||
Total financial assets | 9,748 | 10,606 |
Level 2 | ||
Assets | ||
Total financial assets | 43,240 | 62,805 |
Money Market Funds | ||
Assets | ||
Total financial assets | 9,748 | 10,606 |
Money Market Funds | Level 1 | ||
Assets | ||
Total financial assets | 9,748 | 10,606 |
U.S. Government Securities | ||
Assets | ||
Total financial assets | 33,058 | 9,975 |
U.S. Government Securities | Level 2 | ||
Assets | ||
Total financial assets | 33,058 | 9,975 |
Corporate Notes | ||
Assets | ||
Total financial assets | 1,999 | 16,499 |
Corporate Notes | Level 2 | ||
Assets | ||
Total financial assets | 1,999 | 16,499 |
Commercial Paper | ||
Assets | ||
Total financial assets | 8,183 | 36,331 |
Commercial Paper | Level 2 | ||
Assets | ||
Total financial assets | $ 8,183 | $ 36,331 |
Balance Sheet Components - Comp
Balance Sheet Components - Components of Inventory and Printed Circuit Board Assemblies ("PCBAs") (Details) - USD ($) $ in Thousands | Jun. 30, 2019 | Dec. 31, 2018 |
Inventory [Line Items] | ||
Total inventory and printed circuit board assemblies | $ 6,517 | $ 4,593 |
Inventory | 2,774 | 2,062 |
Other assets | 4,515 | 3,208 |
Printed Circuit Board Assemblies | ||
Inventory [Line Items] | ||
Other assets | 3,743 | 2,531 |
Raw Materials | ||
Inventory [Line Items] | ||
Total inventory and printed circuit board assemblies | 1,974 | 1,028 |
Finished Goods | ||
Inventory [Line Items] | ||
Total inventory and printed circuit board assemblies | $ 4,543 | $ 3,565 |
Balance Sheet Components - Co_2
Balance Sheet Components - Components of Property and Equipment, Net (Details) - USD ($) $ in Thousands | Jun. 30, 2019 | Dec. 31, 2018 |
Property Plant And Equipment [Line Items] | ||
Total property and equipment, gross | $ 19,140 | $ 14,388 |
Less: accumulated depreciation and amortization | (6,522) | (5,230) |
Total property and equipment, net | 12,618 | 9,158 |
Laboratory and Manufacturing Equipment | ||
Property Plant And Equipment [Line Items] | ||
Total property and equipment, gross | 3,830 | 2,750 |
Computer Equipment and Software | ||
Property Plant And Equipment [Line Items] | ||
Total property and equipment, gross | 1,062 | 1,062 |
Furniture and Fixtures | ||
Property Plant And Equipment [Line Items] | ||
Total property and equipment, gross | 925 | 925 |
Leasehold Improvements | ||
Property Plant And Equipment [Line Items] | ||
Total property and equipment, gross | 2,146 | 726 |
Internal-Use Software | ||
Property Plant And Equipment [Line Items] | ||
Total property and equipment, gross | $ 11,177 | $ 8,925 |
Balance Sheet Components - Addi
Balance Sheet Components - Additional Information (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2019 | Jun. 30, 2018 | Jun. 30, 2019 | Jun. 30, 2018 | |
Property Plant And Equipment [Abstract] | ||||
Depreciation and amortization expense | $ 700 | $ 600 | $ 1,292 | $ 1,105 |
Balance Sheet Components - Co_3
Balance Sheet Components - Components of Accrued Liabilities (Details) - USD ($) $ in Thousands | Jun. 30, 2019 | Dec. 31, 2018 |
Payables And Accruals [Abstract] | ||
Accrued vacation | $ 3,646 | $ 2,825 |
Accrued payroll and related expenses | 13,338 | 18,188 |
Accrued professional services fees | 895 | 1,243 |
Claims payable | 3,220 | 2,374 |
Other | 2,205 | 1,940 |
Total accrued liabilities | $ 23,304 | $ 26,570 |
Commitments and Contingencies -
Commitments and Contingencies - Additional Information (Details) | May 13, 2019 | Oct. 04, 2018USD ($)ft² | Jun. 30, 2019USD ($) |
Lessee Lease Description [Line Items] | |||
Operating lease, cost | $ 4,100,000 | ||
Cash paid for operating leases | $ 2,800,000 | ||
Operating leases, weighted average remaining lease term | 11 years 10 months 24 days | ||
Operating leases, weighted-average discount rate | 7.33% | ||
Office Lease | San Francisco | |||
Lessee Lease Description [Line Items] | |||
Lease rentable area | ft² | 117,560 | ||
Lease commencement date | May 13, 2019 | ||
Lease expiration date | Feb. 29, 2020 | Aug. 31, 2031 | Sep. 30, 2019 |
Renewal term of lease | 5 years | ||
Office Lease | San Francisco | Standby Letters of Credit | |||
Lessee Lease Description [Line Items] | |||
Proceeds from line of credit | $ 6,900,000 | ||
Office Lease | San Francisco | Maximum | |||
Lessee Lease Description [Line Items] | |||
Tenant improvement allowance | $ 2,400,000 |
Commitments and Contingencies_2
Commitments and Contingencies - Schedule of Maturities of Operating Lease Liabilities (Details) $ in Thousands | Jun. 30, 2019USD ($) |
Operating Lease Liabilities Payments Due [Abstract] | |
2019 (remainder of year) | $ 1,743 |
2020 | 11,757 |
2021 | 11,760 |
2022 | 11,317 |
2023 | 11,639 |
Thereafter | 100,764 |
Total lease payments | 148,980 |
Less: imputed interest | (53,490) |
Total lease liabilities | $ 95,490 |
Commitments and Contingencies_3
Commitments and Contingencies - Schedule of Minimum Future Lease Payments under Previous Lease Accounting Standard (Details) $ in Thousands | Dec. 31, 2018USD ($) |
Operating Leases Future Minimum Payments Due [Abstract] | |
2019 | $ 8,135 |
2020 | 10,669 |
2021 | 10,828 |
2022 | 11,150 |
2023 | 11,483 |
Thereafter | 98,209 |
Total | $ 150,474 |
Debt - Additional Information (
Debt - Additional Information (Details) | Oct. 23, 2018USD ($) | Oct. 31, 2018USD ($) | May 31, 2018USD ($) | Dec. 31, 2015USD ($)Tranche | Jun. 30, 2015 | Nov. 30, 2012USD ($)shares | Jun. 30, 2019USD ($) | Aug. 31, 2016USD ($) |
Pharmakon Loan Agreement | ||||||||
Debt Instrument [Line Items] | ||||||||
Maximum borrowing capacity | $ 55,000,000 | |||||||
Number of tranches for loans | Tranche | 2 | |||||||
Loss in connection with early extinguishment of debt | $ 3,000,000 | |||||||
Prepayment premium fee | 1,000,000 | |||||||
Additional consideration for prepayment of debt | 1,500,000 | |||||||
Repayment of debt | $ 35,800,000 | |||||||
Pharmakon Loan Agreement | Silicon Valley Bank | ||||||||
Debt Instrument [Line Items] | ||||||||
Repayment of debt | $ 4,900,000 | |||||||
Pharmakon Loan Agreement | Tranche A Loans | ||||||||
Debt Instrument [Line Items] | ||||||||
Maximum borrowing capacity | $ 30,000,000 | |||||||
Debt instrument, fixed interest rate | 9.50% | |||||||
Debt instrument, periodic payment | quarterly | |||||||
Debt instrument, interest due and payable | 50.00% | |||||||
Repayment of debt | 30,000,000 | |||||||
Payment of accrued interest on debt | $ 3,300,000 | |||||||
Pharmakon Loan Agreement | Tranche B Loans | ||||||||
Debt Instrument [Line Items] | ||||||||
Maximum borrowing capacity | $ 25,000,000 | |||||||
SVB Loan Agreement | ||||||||
Debt Instrument [Line Items] | ||||||||
Maximum borrowing capacity | $ 15,000,000 | |||||||
Credit facility expiration date | Dec. 4, 2018 | |||||||
Borrowing capacity description | The Company may borrow up to 80% of its eligible accounts receivable, up to the maximum of $15.0 million | |||||||
SVB Loan Agreement | Maximum | ||||||||
Debt Instrument [Line Items] | ||||||||
Percentage of eligible accounts receivable for borrowings | 80.00% | |||||||
SVB Loan Agreement | Prime Rate | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument interest rate spread | 0.25% | |||||||
SVB Loan Agreement | Standby Letters of Credit | ||||||||
Debt Instrument [Line Items] | ||||||||
Line of credit | $ 3,100,000 | |||||||
Third Amended and Restated SVB Loan Agreement | Standby Letters of Credit | ||||||||
Debt Instrument [Line Items] | ||||||||
Maximum borrowing capacity | 11,000,000 | |||||||
Proceeds from line of credit | 6,900,000 | |||||||
Third Amended and Restated SVB Loan Agreement | SVB Term Loan | ||||||||
Debt Instrument [Line Items] | ||||||||
Maximum borrowing capacity | $ 35,000,000 | |||||||
Last interest only payment date | Oct. 31, 2020 | |||||||
Number of monthly payments of principal and interest | 36 months | |||||||
Debt instrument, interest rate terms | Interest charged on the SVB Term Loan will be the greater of (a) a floating rate based on the “Prime Rate” published by The Wall Street Journal minus 0.75%, or (b) 4.25%. | |||||||
Third Amended and Restated SVB Loan Agreement | SVB Term Loan | Minimum | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, interest rate | 4.25% | |||||||
Third Amended and Restated SVB Loan Agreement | SVB Term Loan | Prime Rate | ||||||||
Debt Instrument [Line Items] | ||||||||
Basis spread deduction on variable rate | 0.75% | |||||||
Third Amended and Restated SVB Loan Agreement | Revolving Credit Facility | ||||||||
Debt Instrument [Line Items] | ||||||||
Maximum borrowing capacity | $ 25,000,000 | |||||||
Line of credit | $ 0 | |||||||
Debt instrument, interest rate terms | Any principal amount outstanding under the Third Amended and Restated SVB Loan Agreement revolving credit line shall bear interest at an amount that is the greater of (a) a floating rate per annum equal to the rate published by The Wall Street Journal as the “Prime Rate” or (b) 5.00%. | |||||||
Third Amended and Restated SVB Loan Agreement | Revolving Credit Facility | Minimum | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, interest rate | 5.00% | |||||||
Third Amended and Restated SVB Loan Agreement | Revolving Credit Facility | Maximum | ||||||||
Debt Instrument [Line Items] | ||||||||
Percentage of eligible accounts receivable for borrowings | 75.00% | |||||||
CHCF Note | ||||||||
Debt Instrument [Line Items] | ||||||||
Repayment of debt | $ 1,500,000 | |||||||
Payment of accrued interest on debt | $ 200,000 | |||||||
Proceeds from long-term debt, net of issuance costs | $ 1,500,000 | |||||||
Debt instrument accrues simple interest rate | 2.00% | |||||||
Debt instrument maturity date | May 31, 2018 | Nov. 30, 2016 | ||||||
CHCF Note | Series D Convertible Preferred Stock | ||||||||
Debt Instrument [Line Items] | ||||||||
Warrants issued to purchase shares | shares | 22,807 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Details) - USD ($) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2019 | Jun. 30, 2018 | Jun. 30, 2019 | Jun. 30, 2018 | |
Income Tax Disclosure [Abstract] | ||||
Provision (benefit) for income taxes | $ 15,000 | $ 0 | $ 27,000 | $ 0 |
Benefit recognized for net operating loss carryforwards | 0 | 0 | ||
Benefit recognized for other deferred tax assets | $ 0 | $ 0 |
Stockholders' Equity - Addition
Stockholders' Equity - Additional Information (Details) - USD ($) | 6 Months Ended | |
Jun. 30, 2019 | Dec. 31, 2018 | |
Equity [Abstract] | ||
Common stock, shares authorized | 100,000,000 | 100,000,000 |
Common stock, par value | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized | 5,000,000 | 5,000,000 |
Preferred stock, par value | $ 0.001 | $ 0.001 |
Dividends declared | $ 0 |
Stockholders' Equity - Schedule
Stockholders' Equity - Schedule Of Common Stock Shares Reserved For Future Issuance (Details) - shares | Jun. 30, 2019 | Dec. 31, 2018 |
Class Of Stock [Line Items] | ||
Total number of shares reserved for future issuance | 9,369,724 | 8,253,899 |
Common stock warrants issued and outstanding | ||
Class Of Stock [Line Items] | ||
Total number of shares reserved for future issuance | 4,857 | 4,857 |
Options Issued and Outstanding | ||
Class Of Stock [Line Items] | ||
Total number of shares reserved for future issuance | 1,715,389 | 2,094,137 |
Unvested restricted stock units | ||
Class Of Stock [Line Items] | ||
Total number of shares reserved for future issuance | 886,404 | 547,891 |
Shares Available for Grant Under Future Stock Plans | ||
Class Of Stock [Line Items] | ||
Total number of shares reserved for future issuance | 6,763,074 | 5,607,014 |
Stock Incentive Plans - Summary
Stock Incentive Plans - Summary of Share-based Awards Available for Grant under 2016 Plan (Details) - 2016 Plan - shares | 6 Months Ended | 12 Months Ended |
Jun. 30, 2019 | Dec. 31, 2018 | |
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | ||
Awards Available for Grant, Beginning balance | 4,717,292 | 4,034,152 |
Additional awards authorized | 1,218,402 | 1,168,865 |
Awards Available for Grant, Awards granted | (532,551) | (666,913) |
Awards Available for Grant, Awards forfeited | 103,561 | 124,478 |
Awards withheld for tax purposes | 38,148 | 56,710 |
Awards Available for Grant, Ending balance | 5,544,852 | 4,717,292 |
Stock Incentive Plans - Summa_2
Stock Incentive Plans - Summary of Stock Option Activity Under 2006 and 2016 Plans (Details) - USD ($) $ / shares in Units, $ in Thousands | 6 Months Ended | 12 Months Ended | |
Jun. 30, 2019 | Dec. 31, 2018 | Dec. 31, 2017 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |||
Options Outstanding, Beginning balance | 2,094,137 | 2,601,181 | |
Options granted | 20,010 | 366,928 | |
Options exercised | (357,321) | (798,424) | |
Options forfeited | (41,437) | (75,548) | |
Options Outstanding, Ending balance | 1,715,389 | 2,094,137 | 2,601,181 |
Options exercisable | 1,173,390 | ||
Options vested and expected to vest | 1,687,960 | ||
Options Outstanding, Weighted Average Exercise Price Per Share, Beginning Balance | $ 23.20 | $ 12.24 | |
Options Outstanding, Weighted Average Exercise Price Per Share, Options granted | 82.77 | 68.32 | |
Options Outstanding, Weighted Average Exercise Price Per Share, Options exercised | 9.12 | 7.19 | |
Options Outstanding, Weighted Average Exercise Price Per Share, Options forfeited | 54.96 | 34.30 | |
Options Outstanding, Weighted Average Exercise Price Per Share, Ending Balance | 26.06 | $ 23.20 | $ 12.24 |
Options Outstanding, Weighted Average Exercise Price Per Share, Exercisable | 15.74 | ||
Options Outstanding, Weighted Average Exercise Price Per Share, vested and expected to vest | $ 25.57 | ||
Options Outstanding, Weighted- Average Remaining Contractual Life (years) | 6 years 6 months 25 days | 7 years 7 days | 7 years 2 months 1 day |
Options exercisable, Weighted- Average Remaining Contractual Life (years) | 5 years 11 months 12 days | ||
Options vested and expected to vest, Weighted- Average Remaining Contractual Life (years) | 6 years 6 months 14 days | ||
Options Outstanding, Aggregate Intrinsic Value | $ 91,452 | $ 97,976 | $ 113,958 |
Options exercisable, Aggregate Intrinsic Value | 74,322 | ||
Options vested and expected to vest, Aggregate Intrinsic Value | $ 90,783 |
Stock Incentive Plans - Additio
Stock Incentive Plans - Additional Information (Details) - $ / shares | 6 Months Ended | |
Jun. 30, 2019 | Jun. 30, 2018 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | ||
Weighted-average grant date fair value of options | $ 38.29 | $ 30.80 |
Stock-Based Compensation - Sche
Stock-Based Compensation - Schedule of Fair Value of Employee and Director Stock Options Estimated Using Weighted Average Assumptions (Details) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2019 | Jun. 30, 2018 | Jun. 30, 2019 | Jun. 30, 2018 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | ||||
Expected term (in years) | 6 years 1 month 6 days | 6 years 1 month 6 days | 6 years 1 month 6 days | 6 years 1 month 6 days |
Expected volatility | 45.00% | 46.20% | 45.00% | 45.90% |
Risk-free interest rate | 2.36% | 2.77% | 2.39% | 2.72% |
Dividend yield | 0.00% | 0.00% | 0.00% | 0.00% |
Stock-Based Compensation - Summ
Stock-Based Compensation - Summary of Total Stock-Based Compensation Expense Included in Statements of Operations and Comprehensive Loss (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2019 | Jun. 30, 2018 | Jun. 30, 2019 | Jun. 30, 2018 | |
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items] | ||||
Total stock-based compensation expense | $ 7,330 | $ 4,076 | $ 11,745 | $ 7,323 |
Cost of Revenue | ||||
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items] | ||||
Total stock-based compensation expense | 137 | 21 | 225 | 138 |
Research and development | ||||
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items] | ||||
Total stock-based compensation expense | 1,278 | 781 | 2,151 | 1,357 |
Selling, general and administrative | ||||
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items] | ||||
Total stock-based compensation expense | $ 5,915 | $ 3,274 | $ 9,369 | $ 5,828 |
Stock-Based Compensation - Addi
Stock-Based Compensation - Additional Information (Details) - USD ($) $ in Millions | 1 Months Ended | 3 Months Ended | 6 Months Ended |
Feb. 28, 2019 | Jun. 30, 2019 | Jun. 30, 2019 | |
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||
Total unamortized compensation costs, net of estimated forfeitures related to unvested stock options | $ 11.7 | $ 11.7 | |
Unamortized compensation costs related to unvested stock options, expected period of recognition | 2 years | ||
Restricted Stock Units ("RSUs") | |||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||
Unamortized compensation costs related to unvested stock options, expected period of recognition | 2 years 6 months | ||
Total unamortized compensation costs, net of estimated forfeitures related to restricted stock unit | 47.8 | $ 47.8 | |
Performance Based Restricted Stock Units ("PRSU") | |||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||
Performance period | 2 years | ||
Cumulative expenses | 1.7 | $ 1.7 | |
Performance Based Restricted Stock Units ("PRSU") | Minimum | |||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||
Performance threshold | 75.00% | ||
Performance target to be earned at performance threshold | 50.00% | ||
Fair value of shares granted | $ 0 | ||
Performance Based Restricted Stock Units ("PRSU") | Maximum | |||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||
Performance threshold | 125.00% | 125.00% | |
Performance target to be earned at performance threshold | 200.00% | ||
Fair value of shares granted | $ 19.5 | ||
ESPP | |||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||
Total unamortized compensation costs, net of estimated forfeitures related to unvested stock options | $ 1.9 | $ 1.9 | |
Unamortized compensation costs related to unvested stock options, expected period of recognition | 1 year |
Net Loss Per Common Share - Com
Net Loss Per Common Share - Computation of Basic and Diluted Net Loss per Share Attributable to Common Stock holders (Details) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2019 | Jun. 30, 2018 | Jun. 30, 2019 | Jun. 30, 2018 | |
Numerator: | ||||
Net loss | $ (11,467) | $ (12,206) | $ (19,486) | $ (23,323) |
Denominator: | ||||
Weighted-average shares used to compute net loss per common share, basic and diluted | 24,724,808 | 23,747,131 | 24,600,250 | 23,614,281 |
Net loss per common share, basic and diluted | $ (0.46) | $ (0.51) | $ (0.79) | $ (0.99) |
Net Loss Per Common Share - Sch
Net Loss Per Common Share - Schedule of Anti-dilutive Securities Excluded from Diluted Net Loss per Common Share (Details) - shares | 6 Months Ended | |
Jun. 30, 2019 | Jun. 30, 2018 | |
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items] | ||
Anti-dilutive securities excluded from diluted net loss per common share | 2,606,650 | 2,965,240 |
Options to Purchase Common Stock | ||
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items] | ||
Anti-dilutive securities excluded from diluted net loss per common share | 1,715,389 | 2,384,798 |
PRSUs and RSUs Issued and Unvested | ||
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items] | ||
Anti-dilutive securities excluded from diluted net loss per common share | 886,404 | 575,585 |
Warrants to Purchase Common Stock | ||
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items] | ||
Anti-dilutive securities excluded from diluted net loss per common share | 4,857 | 4,857 |