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SEGMENT REPORTING
 12 Months Ended
Dec. 31, 2024
Segment Reporting [Abstract]  
SEGMENT REPORTING SEGMENT REPORTING
Our chief operating decision makers ("CODM") previously identified the following three operating 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 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 in May 2024 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.
The CODM evaluates the performance of the segments based on revenues and Adjusted EBITDA1, as well as the expenses within each segment including cost of sales, product development, sales and marketing, and general and administrative. The CODM considers revenue, Adjusted EBITDA, and the related expenses to allocate resources for each segment during the annual budgeting and forecasting process. Monthly, the CODM considers forecast-to-actual variances for each of these performance measures to assess the performance for each segment. 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 the Company’s operating business performance. Our CODM group is comprised of the Chief Executive Officer, Chief Operating Officer, and Chief Financial Officer. As of December 31, 2024, the Chief Operating Officer’s employment with the Company terminated and, as such, the CODM group will be comprised of the Chief Executive Officer and Chief Financial Officer going forward. 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 intangible assets; (iv) stock-based compensation; (v) severance; (vi) other non-recurring charges; (vii) interest expense and other, net; (viii) impairment of goodwill; (ix) impairment of trademark intangibles; (x) gain on contingent consideration; (xi) loss on disposal of property and equipment; (xii) gain on sale of AHT; and (xiii) 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 years ended December 31, 2024, 2023, and 2022:
Year Ended December 31,
(In thousands)202420232022
Revenues:
Financial Health$217,672 $192,325 $179,870 
Patient Care124,974 143,630 146,778 
Total consolidated revenues342,646 335,955 326,648 
Less:
Financial Health expenses:
Cost of sales (excluding depreciation and amortization and stock compensation expense)$116,494 $108,498 $96,793 
Product development8,197 9,362 6,609 
Sales and marketing17,138 17,261 13,752 
General and administrative expenses39,680 34,008 27,497 
Total Financial Health expenses$181,509 $169,129 $144,651 
Patient Care expenses:
Cost of sales (excluding depreciation and amortization and stock compensation expense)$51,316 $65,116 $68,939 
Product development25,352 27,878 25,290 
Sales and marketing9,223 10,795 13,379 
General and administrative expenses18,676 18,941 18,490 
Total Patient Care expenses$104,567 $122,730 $126,098 
Total segment expenses$286,076 $291,859 $270,749 
Adjusted EBITDA by Segment:
Financial Health36,163 23,196 35,219 
Patient Care20,407 20,900 20,680 
Total Adjusted EBITDA$56,570 $44,096 $55,899 
The following table reconciles net income to adjusted EBITDA:

Year Ended December 31,
(In thousands)202420232022
Net income (loss), as reported
$(20,439)$(48,434)$15,867 
Deferred revenue and other acquisition-related adjustments— — 109 
Depreciation expense1,346 1,946 2,443 
Amortization of software development costs15,122 8,096 3,484 
Amortization of acquisition-related intangibles12,505 16,426 17,403 
Stock-based compensation5,520 3,271 5,173 
Severance and other non-recurring charges15,442 22,186 4,504 
Interest expense and other, net15,517 11,659 5,267 
Impairment of goodwill— 35,913 — 
Impairment of trademark intangibles— 2,342 — 
Gain on contingent consideration(1,044)— (565)
Loss on disposal of property and equipment3,895 117 — 
Gain on sale of AHT(1,529)— — 
Provision (benefit) for income taxes
10,235 (9,426)2,214 
Total adjusted EBITDA$56,570 $44,096 $55,899