This article first appeared on GuruFocus .
Release Date: November 04, 2026
For the complete transcript of the earnings call, please refer to the full earnings call transcript .
Positive Points
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Total revenue increased 12.5% year-over-year to $42 million, driven by strong Greenbrook performance.
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Greenbrook revenue grew 20.1% year-over-year to $26.2 million, reflecting revenue cycle management improvements and Spravato growth.
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Gross margin expanded to 52.2% from 45.9% in the prior year quarter, due to go-to-market strategy and RCM gains.
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Operating expenses decreased 12.6% to $21.3 million, leading to income from operations of $0.5 million versus a $7.3 million loss last year.
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Adjusted EBITDA turned positive at $1.9 million, a $6.6 million improvement, and cash flow from operations and investing was positive $0.8 million.
Negative Points
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NeuroStar session revenue declined year-over-year, and management expects it to continue trending slightly downward.
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NeuroStar total revenue grew only 1.8% year-over-year, with capital sales offsetting session weakness.
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Cash balance decreased to $27.9 million from $34.1 million at year-end 2025, reflecting ongoing cash utilization.
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Full-year 2026 cash flow from operating and investing is projected negative $10 million to $12 million.
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Greenbrook clinic occupancy remains low, ranging from 25% to 75%, with the bottom quartile needing improvement.
Q & A Highlights
Q: How much of Greenbrook's Q3 growth came from pricing/revenue cycle gains versus patient volume, and what is the current unused capacity? A: CEO Dan Rivers said growth was a combination of revenue cycle management improvements and Spravato growth, which he described as more durable due to the maintenance phase patients enter. On occupancy, he noted a wide range from roughly 25% at the low end to 75% for top performers, and said moving the bottom quartile up is a key focus behind the go-to-market changes expected to impact 2027.
Q: How durable are the revenue cycle management improvements, and can they carry into 2027? A: CEO Dan Rivers said most changes are quite durable, citing the deployment of Skypoint, an AI-enabled coding tool, which drove a low double-digit improvement in first-month collections and reduced back-office headcount that was redirected to other roles. He cautioned future gains will be more modest as "we keep climbing higher on the tree," but sees more runway. CFO Nir Now added that gross margin improvements versus prior year are mostly durable, with the exception of some prior-period RCM catch-ups.
Q: What is the rationale for shifting direct-to-consumer ad spend toward expanding the Greenbrook field sales team, and what is the cost impact? A: CEO Dan Rivers said the company plans to add eight reps to its base of 20, reaching 28 by sometime in Q1, with no incremental cost since dollars are being repurposed from DTC advertising. He said field reps deliver better returns because they use pharma data to target prescribers treating patients with two or more MDD drugs, yielding better-qualified referrals, whereas DTC patients often don't qualify and can clog intake teams. New reps are expected to contribute meaningfully by mid-2027.
Q: How much of the record NeuroStar system sales were capital/lease conversions of existing session customers versus new accounts, and did installed-base treatment volume grow in Q3? A: CEO Dan Rivers said the mix continues moving toward capital and lease, with over half of all units sold in Q3 being capital or lease units, which benefits ASP and gross margin. He clarified these are new boxes/chairs, not recognition of existing customers paying off contracts. Session volume grew modestly among existing customers, and the expanded go-to-market is reaching larger multi-site and national accounts that don't need the same support services as private practices.
Q: How significant is the AdvancedMD EHR integration as a competitive advantage, and what is the timeline for additional EHR integrations? A: CEO Dan Rivers called the AMD-Trackstar integration an important first step, noting AMD is the largest of a fragmented EHR landscape and is also used at Greenbrook clinics. The integration eliminates duplicate documentation entry and enriches Trackstar's data pool. He said the company will monitor results with the AMD user base before sequencing second and third EHR partners from a prioritized list, using AMD as a predicate to demonstrate value.
Q: What drove the strong clinic margin improvement beyond efficiency and workflow gains, and will the incremental sales rep investment be absorbed into margins? A: CEO Dan Rivers said most Greenbrook margin improvement came from better revenue cycle management rather than mix, while NeuroStar margin benefited from more than half of units going out as premium-priced capital or lease purchases. On rep costs, he reiterated the eight added reps carry no incremental cost due to DTC ad spend repurposing, and expects better yield from field sales given access to prescriber data and better-qualified patient referrals.
Q: How should investors think about steady-state NeuroStar gross margin given the shifting capital and session mix? A: CEO Dan Rivers said he wouldn't predict dramatic swings in NeuroStar gross margin, noting the mix is settling into a more predictable future state and recent levels reflect what that margin might look like. He said it continues to depend on adoption rates of the company's offerings, but he doesn't expect dramatic swings either way from recent results.
Q: Could the published data on treatment gaps and missed days alter how providers think about TMS regimens and expand patient flexibility? A: CEO Dan Rivers highlighted the TMS Journal publication analyzing over 6,400 real-world NeuroStar patients, which found no statistically significant difference in outcomes for patients who missed treatment days, with up to 13 days of missed treatment not reducing effectiveness. He said this serves as a "welcome mat" for reluctant patients and referral sources, especially around holidays, with the message being to start therapy now rather than wait.
Q: How is the Compass Pathways collaboration pilot being structured, how many clinics are involved, and what needs to be true before a network-wide rollout? A: CEO Dan Rivers said the number of initial sites hasn't been shared, but the company will likely start with a hub-and-spoke model, aiming to be in each MSA rather than every one of its 84 Spravato clinics. Current focus is on training programs for caregivers and sales teams, targeted HCP outreach, and benefit investigation/payer relations readiness. He noted single case agreements will likely rule early days until coverage matures, and the company is "downstream with our mitts open and ready to catch."
Q: Has the number of Spravato sites changed from 84, and is J&J's reported 36% year-over-year Spravato growth a good proxy for Neuronetics' growth? A: CEO Dan Rivers did not confirm a specific site count or quantify Spravato's dollar contribution, but said the company has seen double-digit growth in Spravato. He described the growth as a ladder approach, with patients entering the network and continuing on a maintenance phase, and expects that growth to remain quite durable.
For the complete transcript of the earnings call, please refer to the full earnings call transcript .
