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SEGMENT REPORTING
 9 Months Ended
Sep. 30, 2024
Segment Reporting [Abstract]  
SEGMENT REPORTING SEGMENT REPORTING
Our chief operating decision makers ("CODM") previously identified the following three operating and reportable segments: RCM, EHR, and Patient Engagement. In May 2024, the Company made a number of changes to its organizational structure and management system to better align the Company's operating model with its strategic initiatives. As a result, the Company changed from three operating and reportable segments of (i) RCM, (ii) EHR and (iii) Patient Engagement to two operating and reportable segments of (i) EHR and (ii) RCM. These two segments are distinct business units with unique market dynamics and opportunities. They represent the components of the Company for which separate financial information is available and is utilized on a regular basis by the CODM in assessing segment performance and in allocating the Company's resources. The Patient Engagement segment results were transitioned into the EHR segment for all periods presented.
During the Company’s realignment the reportable segments naming convention was updated. The previously reported RCM segment has been updated to Financial Health and the former EHR segment is now referred to as Patient Care. There were no additional changes to the composition of the Company’s reportable segments in connection with the name changes. The financial statements and accompanying footnotes have been updated with the new segment names.
Management evaluates the performance of the segments based on revenues and adjusted EBITDA1. Management believes adjusted EBITDA is a useful measure to assess the performance and liquidity of the Company as it provides meaningful operating results by excluding the effects of expenses that are not reflective of its operating business performance. Our CODM group is comprised of the Chief Executive Officer, Chief Operating Officer, and Chief Financial Officer. Accounting policies for each of the reportable segments are the same as those used on a consolidated basis.
Adjusted EBITDA consists of GAAP net income (loss) as reported and adjusts for (i) depreciation expense; (ii) amortization of software development costs; (iii) amortization of acquisition-related intangibles; (iv) stock-based compensation; (v) severance; (vi) other non-recurring charges; (vii) interest expense and other, net; and (viii) the provision (benefit) for income taxes. There are no intersegment revenues to be eliminated in computing segment revenue.
The CODM do not evaluate operating segments nor make decisions regarding operating segments based on assets. Consequently, we do not disclose total assets by reportable segment.
The following table presents a summary of the revenues and adjusted EBITDA of our two operating segments for the three and nine months ended September 30, 2024 and 2023:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2024202320242023
Revenues by segment:
Financial Health$54,271 $46,582 $161,417 $142,973 
Patient Care
Recurring revenue
Acute care26,584 29,068 80,726 88,420 
Post-acute care— 3,594 597 11,230 
Total recurring Patient Care revenue26,584 32,662 81,323 99,650 
Non-recurring revenue
Acute care2,975 3,118 8,996 9,869 
Post-acute care— 350 70 1,075 
Total non-recurring Patient Care revenue2,975 3,468 9,066 10,944 
Total Patient Care revenue$29,559 $36,130 $90,389 $110,594 
Total revenues$83,830 $82,712 $251,806 $253,567 
Adjusted EBITDA by segment:
Financial Health$9,562 $4,623 $23,767 18,205 
Patient Care4,260 5,099 12,083 17,388 
Total adjusted EBITDA$13,822 $9,722 $35,850 $35,593 

The following table reconciles net income to adjusted EBITDA:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2024202320242023
Net loss, as reported$(9,809)$(3,562)(17,374)(3,315)
Depreciation expense279 297 1,079 1,392 
Amortization of software development costs3,057 2,194 11,779 5,506 
Amortization of acquisition-related intangibles3,126 4,014 9,379 12,043 
Stock-based compensation1,398 1,038 3,698 2,162 
Severance and other non-recurring charges4,018 7,392 12,449 15,313 
Interest expense3,777 2,847 11,826 7,719 
Change in fair value of contingent consideration(1,044)— (1,044)— 
Loss on disposal of property and equipment1,648 — 1,648 117 
Gain on sale of AHT28 — (1,221)— 
Provision (benefit) for income taxes7,344 (4,498)3,631 (5,344)
Total adjusted EBITDA$13,822 $9,722 $35,850 $35,593 
Certain of the items excluded or adjusted to arrive at adjusted EBITDA are described below:
•Amortization of software development costs – Software development costs amortization expense is a non-cash expense arising from the costs incurred for capitalized internally developed software. We exclude software development costs amortization expense from adjusted EBITDA because we believe (i) the amount of such expenses in any specific period may not directly correlate to the underlying performance of our business operations and (ii) such expenses can vary significantly between periods as a result of new capitalized software development costs and full amortization of previously capitalized software development costs.
•Amortization of acquisition-related intangibles - Acquisition-related amortization expense is a non-cash expense arising primarily from the acquisition of intangibles in connection with acquisitions or investments. We exclude acquisition-related amortization expense from adjusted EBITDA because we believe (i) the amount of such expenses in any specific period may not directly correlate to the underlying performance of our business operations and (ii) such expenses can vary significantly between periods as a result of new acquisitions and full amortization of previously acquired intangible assets.
•Stock-based compensation - Stock-based compensation expense is a non-cash expense arising from the grant of stock-based awards. We exclude stock-based compensation expense from adjusted EBITDA because we believe (i) the amount of such expenses in any specific period may not directly correlate to the underlying performance of our business operations and (ii) such expenses can vary significantly between periods as a result of the timing and valuation of grants of new stock-based awards, including grants in connection with acquisitions.
•Severance and other non-recurring charges - We exclude severance expenses (primarily related to costs associated with our recent business transformation initiative) and other non-recurring charges (such as interest income, service charges, and other (income)/loss, and foreign currency (gain)/loss) from adjusted EBITDA because we believe (i) the amount of such expenses in any specific period may not directly correlate to the underlying performance of our business operations and (ii) such expenses can vary significantly between periods.
•Interest expense - Interest expense represents (i) interest incurred on our term loan and revolving credit facility and (ii) non-cash interest expense. We exclude interest expense from non-GAAP financial measures because we believe these amounts relate to specific transactions and, as such, may not directly correlate to the underlying performance of our business operations.
•Change in fair value of contingent consideration - The purchase agreement for our acquisition of Viewgol in 2023 contained contingent consideration, or “earnout,” provisions whereby the previous shareholders of Viewgol would receive additional consideration depending on the achievement of certain performance metrics. After the initial measurement period, U.S. GAAP requires that any adjustments to the estimated fair value of this contingent liability, including upon final determination of amounts due, should be recorded in the relevant period’s earnings. We exclude gains on contingent consideration from non-GAAP financial measures because we believe (i) the amount of such gains in any specific period may not directly correlate to the underlying performance of our business operations and (ii) such gains can vary significantly between periods.
•Loss on disposal of property and equipment - Loss on disposal of property and equipment represents the excess of book value of assets sold over the proceeds received in connection with the sale of property and equipment sold during the period. We exclude loss on disposal of property and equipment from non-GAAP financial measures because we believe (i) the amount of such gains gain or loss in any specific period may not directly correlate to the underlying performance of our business operations and (ii) such gains gain or loss can vary significantly between periods.
•Gain on sale of AHT - Gain on sale of AHT represents the excess of proceeds received over the net assets sold from our sale of AHT, our previously wholly-owned post-acute business, in January 2024. We exclude gain on sale of AHT from non-GAAP financial measures because we believe the amount relates to a specific transaction and, as such, may not directly correlate to the underlying performance of our business operations