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Summary of Significant Accounting Policies (Tables) | 12 Months Ended
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Dec. 31, 2021
Accounting Policies [Abstract] |
Sales Revenue Disaggregated by Sales Channel and Geographic Region | The following table sets forth the Company’s sales revenue disaggregated by sales channel and geographic region:
(amounts in thousands) |  | Years ended December 31, |
Revenue by region and category |  | 2021 |  |  | 2020 |  |  | 2019 |
Business-to-business domestic sales |  | $ | 91,371 |  |  | $ | 96,423 |  |  | $ | 106,428 |
Business-to-business international sales |  |  | 79,460 |  |  |  | 62,147 |  |  |  | 77,960 |
Direct-to-consumer domestic sales |  |  | 140,899 |  |  |  | 121,619 |  |  |  | 156,158 |
Total sales revenue |  | $ | 311,730 |  |  | $ | 280,189 |  |  | $ | 340,546 |
Summary of Fair Value Assets Measured on Recurring Basis for Cash, Cash Equivalents and Marketable Securities | The following table summarizes fair value measurements by level for the assets measured at fair value on a recurring basis for cash, cash equivalents and marketable securities:
|  | As of December 31, 2021 |
|  |  |  |  |  | Gross |  |  |  |  |  |  | Cash |  |  |  |  |
|  | Adjusted |  |  | unrealized |  |  |  |  |  |  | and cash |  |  | Marketable |
(amounts in thousands) |  | cost |  |  | gains |  |  | Fair value |  |  | equivalents |  |  | securities |
Cash |  | $ | 48,817 |  |  | $ | — |  |  | $ | 48,817 |  |  | $ | 48,817 |  |  | $ | — |
Level 1: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Money market accounts |  |  | 186,707 |  |  |  | — |  |  |  | 186,707 |  |  |  | 186,707 |  |  |  | — |
Level 2: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Corporate bonds |  |  | 9,988 |  |  |  | 1 |  |  |  | 9,989 |  |  |  | — |  |  |  | 9,989 |
Total |  | $ | 245,512 |  |  | $ | 1 |  |  | $ | 245,513 |  |  | $ | 235,524 |  |  | $ | 9,989 |
|  | As of December 31, 2020 |
|  |  |  |  |  | Gross |  |  |  |  |  |  | Cash |  |  |  |  |
|  | Adjusted |  |  | unrealized |  |  |  |  |  |  | and cash |  |  | Marketable |
(amounts in thousands) |  | cost |  |  | gains (losses) |  |  | Fair value |  |  | equivalents |  |  | securities |
Cash |  | $ | 52,812 |  |  | $ | — |  |  | $ | 52,812 |  |  | $ | 52,812 |  |  | $ | — |
Level 1: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Money market accounts |  |  | 159,150 |  |  |  | — |  |  |  | 159,150 |  |  |  | 159,150 |  |  |  | — |
Level 2: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Corporate bonds |  |  | 11,549 |  |  |  | (1 | ) |  |  | 11,548 |  |  |  | — |  |  |  | 11,548 |
U.S. Treasury securities |  |  | 4,107 |  |  |  | — |  |  |  | 4,107 |  |  |  | — |  |  |  | 4,107 |
Agency mortgage-backed securities |  |  | 3,601 |  |  |  | 1 |  |  |  | 3,602 |  |  |  | — |  |  |  | 3,602 |
Total |  | $ | 231,219 |  |  | $ | — |  |  | $ | 231,219 |  |  | $ | 211,962 |  |  | $ | 19,257 |
Summary of Estimated Fair Value of Company's Investments in Marketable Securities Classified by Contractual Maturity Date | The following table summarizes the estimated fair value of the Company’s investments in marketable securities, classified by the contractual maturity date of the securities:
|  | December 31, |
(amounts in thousands) |  | 2021 |
Due within one year |  | $ | 9,989 |
Due in one year through five years |  |  | — |
Total |  | $ | 9,989 |
Summary of Components of Accumulated Other Comprehensive Income (Loss) | The components of accumulated other comprehensive income (loss) were as follows:
| As of December 31, 2021 |
| Foreign |  |  | Unrealized |  |  | Unrealized |  |  | Accumulated |
| currency |  |  | gains |  |  | gains (losses) |  |  | other |
| translation |  |  | on marketable |  |  | on cash |  |  | comprehensive |
(amounts in thousands) | adjustments |  |  | securities |  |  | flow hedges |  |  | income |
Balance as of December 31, 2020 | $ | 1,128 |  |  | $ | — |  |  | $ | (653 | ) |  | $ | 475 |
Other comprehensive income (loss) |  | (800 | ) |  |  | 1 |  |  |  | 1,793 |  |  |  | 994 |
Balance as of December 31, 2021 | $ | 328 |  |  | $ | 1 |  |  | $ | 1,140 |  |  | $ | 1,469 |
| As of December 31, 2020 |
| Foreign |  |  | Unrealized |  |  | Unrealized |  |  | Accumulated |
| currency |  |  | gains (losses) |  |  | losses |  |  | other |
| translation |  |  | on marketable |  |  | on cash |  |  | comprehensive |
(amounts in thousands) | adjustments |  |  | securities |  |  | flow hedges |  |  | income (loss) |
Balance as of December 31, 2019 | $ | 271 |  |  | $ | 6 |  |  | $ | (364 | ) |  | $ | (87 | )
Other comprehensive income (loss) |  | 857 |  |  |  | (6 | ) |  |  | (289 | ) |  |  | 562 |
Balance as of December 31, 2020 | $ | 1,128 |  |  | $ | — |  |  | $ | (653 | ) |  | $ | 475 |
Summary of Quantitative Information about Level 3 Inputs for Fair Value Measurement of Earnout Liability | The following table provides quantitative information about Level 3 inputs for fair value measurement of the earnout liability as of December 31, 2021 and December 31, 2020. Significant increases or decreases in these inputs in isolation could result in a significant impact on our fair value measurement:
|  | As of |  |  | As of |  |
Simulation input |  | December 31, 2021 |  |  | December 31, 2020 |  |
Revenue volatility |  |  | 15.00 | % |  |  | 35.00 | % |
WACC |  |  | 10.50 | % |  |  | 12.00 | % |
20-year risk free rate |  |  | 2.02 | % |  |  | 1.45 | % |
Market price of risk |  |  | 2.68 | % |  |  | 8.00 | % |
Summary of Reconciliation of Earnout Liability Measured and Carried Fair Value on a Recurring Basis | The reconciliation of the earnout liability measured and carried at fair value on a recurring basis is as follows:
(amounts in thousands) |  |  |  |
Balance as of December 31, 2019 |  | $ | 26,559 |
Change in fair value |  |  | 1,053 |
Balance as of December 31, 2020 |  | $ | 27,612 |
Change in fair value |  |  | (11,596 | )
Balance as of December 31, 2021 |  | $ | 16,016 |
Summary of Cash, Cash Equivalents and Short-term Investments | Cash, cash equivalents, and marketable securities consist of the following:
(amounts in thousands) |  | December 31, |
Cash and cash equivalents |  | 2021 |  |  | 2020 |
Cash |  | $ | 48,817 |  |  | $ | 52,812 |
Money market accounts |  |  | 186,707 |  |  |  | 159,150 |
Total cash and cash equivalents |  | $ | 235,524 |  |  | $ | 211,962 |
Marketable securities |  |  |  |  |  |  |  |
Corporate bonds |  | $ | 9,989 |  |  | $ | 11,548 |
U. S. Treasury securities |  |  | — |  |  |  | 4,107 |
Agency mortgage-backed securities |  |  | — |  |  |  | 3,602 |
Total marketable securities |  | $ | 9,989 |  |  | $ | 19,257 |
Schedule of Net Accounts Receivable Balance Concentrations by Major Category | Net accounts receivable (gross accounts receivable, net of allowances) balance concentrations by major category as of December 31, 2021 and December 31, 2020 were as follows:
|  | As of |  |  | As of |
(amounts in thousands) |  | December 31, 2021 |  |  | December 31, 2020 |
Net accounts receivable |  | $ |  |  | % |  |  | $ |  |  | % |
Rental (1) |  | $ | 6,011 |  |  |  | 24.6 | % |  | $ | 3,794 |  |  |  | 12.8 | %
Business-to-business and other receivables (2) |  |  | 18,441 |  |  |  | 75.4 | % |  |  | 25,923 |  |  |  | 87.2 | %
Total net accounts receivable |  | $ | 24,452 |  |  |  | 100.0 | % |  | $ | 29,717 |  |  |  | 100.0 | %
(1) | Rental includes Medicare, Medicaid/other government, private insurance and patient pay.
(2) | Business-to business receivables included one customer with an accounts receivable balance of $5,945 and $7,044 as of December 31, 2021 and December 31, 2020, respectively. The customer received extended payment terms through a direct financing plan offered. The Company also has a credit insurance policy in place, which allocated up to $10,000 in coverage as of December 31, 2021 and December 31, 2020 for this customer with a $400 deductible and 10% retention.
Schedule of Percentage Breakdown of Net Accounts Receivable by Aging Category by Invoice Due Date | The following table sets forth the percentage breakdown of the Company’s net accounts receivable by aging category by invoice due date as of December 31, 2021 and December 31, 2020.
|  | As of |  |  | As of |
(amounts in thousands) |  | December 31, 2021 |  |  | December 31, 2020 |
Net accounts receivable by aging category |  | $ |  |  | % |  |  | $ |  |  | % |
Held and Unbilled |  | $ | 848 |  |  |  | 3.5 | % |  | $ | 298 |  |  |  | 1.0 | %
Aged 0-90 days |  |  | 22,194 |  |  |  | 90.8 | % |  |  | 28,604 |  |  |  | 96.2 | %
Aged 91-180 days |  |  | 888 |  |  |  | 3.6 | % |  |  | 560 |  |  |  | 1.9 | %
Aged 181-365 days |  |  | 450 |  |  |  | 1.8 | % |  |  | 230 |  |  |  | 0.8 | %
Aged over 365 days |  |  | 72 |  |  |  | 0.3 | % |  |  | 25 |  |  |  | 0.1 | %
Total net accounts receivable |  | $ | 24,452 |  |  |  | 100.0 | % |  | $ | 29,717 |  |  |  | 100.0 | %
Schedule of Allowances for Accounts Receivable | The following table sets forth the accounts receivable allowances as of December 31, 2021 and December 31, 2020:
|  | As of |  |  | As of |
(amounts in thousands) |  | December 31, 2021 |  |  | December 31, 2020 |
Allowances - accounts receivable |  | $ |  |  | % |  |  | $ |  |  | % |
Doubtful accounts |  | $ | 52 |  |  |  | 0.2 | % |  | $ | 52 |  |  |  | 0.2 | %
Rental revenue adjustments |  |  | — |  |  |  | 0.0 | % |  |  | 396 |  |  |  | 1.3 | %
Sales returns |  |  | 810 |  |  |  | 3.1 | % |  |  | 742 |  |  |  | 2.4 | %
Total allowances - accounts receivable |  | $ | 862 |  |  |  | 3.3 | % |  | $ | 1,190 |  |  |  | 3.9 | %
Breakdown of Company's Revenue from U.S. and Non-U.S. Sources | A portion of revenue is earned from sales outside the United States. Approximately 74.1%, 73.6% and 70.2% of the non-U.S. revenue for the years ended December 31, 2021, 2020 and 2019, respectively, were invoiced in Euros. A breakdown of the Company’s revenue from U.S. and non-U.S. sources for the years ended December 31, 2021, 2020 and 2019, respectively, is as follows:
| Years ended December 31, |
(amounts in thousands) | 2021 |  |  | 2020 |  |  | 2019 |
U.S. revenue | $ | 278,543 |  |  | $ | 246,340 |  |  | $ | 283,983 |
Non-U.S. revenue |  | 79,460 |  |  |  | 62,147 |  |  |  | 77,960 |
Total revenue | $ | 358,003 |  |  | $ | 308,487 |  |  | $ | 361,943 |
Schedule of Inventories | Inventories that are considered current consist of the following:
| December 31, |
(amounts in thousands) | 2021 |  |  | 2020 |
Raw materials and work-in-progress | $ | 21,909 |  |  | $ | 22,318 |
Finished goods |  | 12,116 |  |  |  | 3,743 |
Less: reserves |  | (2,152 | ) |  |  | (1,246 | )
Inventories, net | $ | 31,873 |  |  | $ | 24,815 |
Computation of Depreciation and Amortization using Straight Line Method Over Estimated Useful Lives of Assets | Property and equipment are stated at cost. Depreciation and amortization are calculated using the straight-line method over the assets’ estimated useful lives as follows:
Rental equipment | 1.5-5 years
Manufacturing equipment and tooling | 3-5 years
Computer equipment and software | 2-3 years
Furniture and equipment | 3-5 years
Leasehold improvements | Lesser of estimated useful life or remaining lease term
Summary of Depreciation and Amortization Expense of Rental Equipment and Other Property and Equipment | Depreciation and amortization expense related to rental equipment and other property and equipment are summarized below for the years ended December 31, 2021, 2020 and 2019, respectively.
| Years ended December 31, |
(amounts in thousands) | 2021 |  |  | 2020 |  |  | 2019 |
Rental equipment | $ | 8,860 |  |  | $ | 5,695 |  |  | $ | 6,253 |
Other property and equipment |  | 3,993 |  |  |  | 3,882 |  |  |  | 3,421 |
Total depreciation and amortization | $ | 12,853 |  |  | $ | 9,577 |  |  | $ | 9,674 |
Summary of Property Plant and Equipment and Rental Equipment with Associated Accumulated Depreciation | Property and equipment and rental equipment with associated accumulated depreciation is summarized below as of December 31, 2021 and 2020, respectively.
(amounts in thousands) |  | December 31, |
Property and equipment |  | 2021 |  |  | 2020 |
Rental equipment, net of allowances of $1,290 and $575, respectively |  | $ | 59,073 |  |  | $ | 46,953 |
Other property and equipment |  |  | 31,522 |  |  |  | 27,071 |
Property and equipment |  |  | 90,595 |  |  |  | 74,024 |
Accumulated depreciation |  |  |  |  |  |  |  |
Rental equipment |  |  | 33,355 |  |  |  | 30,283 |
Other property and equipment |  |  | 18,314 |  |  |  | 15,511 |
Accumulated depreciation |  |  | 51,669 |  |  |  | 45,794 |
Property and equipment, net |  |  |  |  |  |  |  |
Rental equipment, net of allowances of $1,290 and $575, respectively |  |  | 25,718 |  |  |  | 16,670 |
Other property and equipment |  |  | 13,208 |  |  |  | 11,560 |
Property and equipment, net |  | $ | 38,926 |  |  | $ | 28,230 |
Computation of Earnings Per Share | The computation of EPS is as follows:
| Years ended December 31, |
(amounts in thousands, except share and per share amounts) | 2021 |  |  | 2020 |  |  | 2019 |
Numerator—basic and diluted: |  |  |  |  |  |  |  |  |  |  |
Net income (loss) | $ | (6,333 | ) |  | $ | (5,829 | ) |  | $ | 20,950 |
Denominator: |  |  |  |  |  |  |  |  |  |  |
Weighted-average common shares - basic common stock (1) |  | 22,490,027 |  |  |  | 21,980,326 |  |  |  | 21,821,104 |
Weighted-average common shares - diluted common stock |  | 22,490,027 |  |  |  | 21,980,326 |  |  |  | 22,241,064 |
Net income (loss) per share - basic common stock | $ | (0.28 | ) |  | $ | (0.27 | ) |  | $ | 0.96 |
Net income (loss) per share - diluted common stock (2) | $ | (0.28 | ) |  | $ | (0.27 | ) |  | $ | 0.94 |
Denominator calculation from basic to diluted: |  |  |  |  |  |  |  |  |  |  |
Weighted-average common shares - basic common stock (1) |  | 22,490,027 |  |  |  | 21,980,326 |  |  |  | 21,821,104 |
Stock options and other dilutive awards |  | 166,258 |  |  |  | 64,471 |  |  |  | 419,960 |
Weighted-average common shares - diluted common stock |  | 22,656,285 |  |  |  | 22,044,797 |  |  |  | 22,241,064 |
Shares excluded from diluted weighted-average shares: |  |  |  |  |  |  |  |  |  |  |
Stock options |  | 151,344 |  |  |  | 467,378 |  |  |  | 53,888 |
Restricted stock units and restricted stock awards |  | 167,237 |  |  |  | 292,795 |  |  |  | 169,305 |
Shares excluded from diluted weighted-average shares |  | 318,581 |  |  |  | 760,173 |  |  |  | 223,193 |
(1) | Unvested restricted stock units and restricted stock awards are not included as shares outstanding in the calculation of basic earnings per share. Vested restricted stock units and restricted stock awards are included in basic earnings per share if all vesting and performance criteria have been met. Performance-based restricted stock units and restricted stock awards are included in the number of shares used to calculate diluted earnings per share as long as all applicable performance criteria are met, and their effect is dilutive. Restricted stock awards are eligible to receive all dividends declared on the Company’s common shares during the vesting period; however, such dividends are not paid until the restrictions lapse.
(2) | Due to net losses for the years ended December 31, 2021 and December 31, 2020, diluted loss per share is the same as basic.

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