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BioTelemetry Inc (BEAT)
Q3Â 2018 Earnings Conference Call
Oct. 30, 2018, 5:00 p.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
Good afternoon. Thank you for joining us for the BioTelemetry Third Quarter 2018 Earnings Conference Call. Certain statements during the conference call and question-and-answer period to follow, may relate to future events and expectations and as such constitute forward-looking statements within the meaning of the Private Securities and Litigation Act of 1995. Such statements involve known and unknown risks, uncertainties and other factors, which may cause the actual results, performance or achievements of the company in the future to be materially different from the statements that the company's executives make today. These risks are described in detail in our public filings within the Securities and Exchange Commission, including our latest periodic report on Form 10-K or 10-Q. We assume no duty to update these statements. At this time, all participants have been placed on a listen-only mode. The floor will be opened for questions and comments following the presentation.
It is now my pleasure to turn the floor over to your host, Mr. Joseph Capper. Sir, you may begin.
Joseph Capper -- President & Chief Executive Officer
Thank you, operator, and good afternoon everyone. I'm Joe Capper, President and CEO of BioTelemetry. I'm joined by Heather Getz, our Chief Financial Officer. I'll start with a recap of our third quarter performance and other key developments. Heather will take you through a more detailed review of our financial results. I will then provide commentary on how we see the business progressing, as we close out the year and transition into 2019. After our prepared remarks, we'll open up the call for questions.
I am extremely excited to share details with you this afternoon on another record setting quarter for BioTelemetry, during which we once again exceeded all of our expectations. During the quarter, we achieved 18% organic revenue growth, surpassing the $100 million mark for the second consecutive quarter. We also achieved new all-time highs in EBITDA, hitting $30 million for the first time and EBITDA margin. This performance is particularly noteworthy given that the third quarter is seasonally our most challenging of the year and considering that our markets have not been growing anywhere near 18%. Our business is really firing on all cylinders.
Since I have been with the company, we've had an unwavering commitment to being at the forefront of advancing connected solutions capable of meeting today's healthcare challenges. That focus has enabled us to achieve our 25th consecutive quarter of sustained year-over-year revenue growth, with excellent performance across the entire company.
In the remote cardiac monitoring segment, we have brought a steady stream of customer-focused products and enhancements to the market. Over the years, our commitment to innovation has produced the most technologically advanced and extensive portfolio in the industry. As a result, BioTelemetry is the far in a way leader in this market as our results indicate.
In our Research division, we have -- we made a determination that expanding service offerings would result in accelerated growth. Since adding imaging capabilities a few years ago, that thesis has been resoundingly validated. In addition to dramatically improve growth, we now compete for business that was previously out of reach. As a result, our backlog is building and we are converting it to revenue at a record pace. Our Research business has tremendous momentum and we are highly encouraged by its many opportunities for growth.
And as many of you know, we are busy leveraging our wireless platform and proprietary technology to develop new opportunities for future growth in digital population health and other areas. The field is wide open for companies like us, who possess the experience and technology to remotely monitor and transmit data. We are extremely optimistic about the future of population health, given the magnitude of the market and the need for the healthcare industry to migrate to such solutions.
As a result of our exceptional year-to-date performance and our confidence about the future, we are once again increasing guidance for the remainder of the year, which Heather will detail in her upcoming comments. But first, I want to share with you some key metrics and thoughts about our performance in the third quarter.
During the period, revenue grew by 23% to $100 million, exceeding the upper-end of our expectations by $2 million. As mentioned, organic revenue growth was an impressive 18%. Overall margins continue to improve as quarterly EBITDA grew by 72% to $30 million, again far exceeding our expectations. We ended the quarter with $63 million in cash, up nearly $24 million in the quarter.
MCT volume was up 13% organically. Our Research services team continued to expand backlog and finished the quarter with a remarkable 45% year-over-year revenue growth rate. We continued efforts to expand our digital population health management business through key partnerships and internal investments. And with most of the LifeWatch integration behind us, we were able to devote more time to explore in future growth initiatives, where we can leverage BioTelemetry's core capabilities. We believe there will be massive opportunity for companies that can reliably deliver data from remote locations in a timely and cost efficient manner.
Taking a closer look at the healthcare services business, we continue to see exceptionally positive trends. In early Q3, we analyzed the LifeWatch acquisition. At the outset, we committed to $30 million in synergies and stated our intent to maximize customer retention. After a full year of integration, it is clear that process has been resounding success. Having met or exceeded all expectations.
Not only that we achieved our synergy objective, we had continued growth in our largest and most important accounts. It was extremely gratifying to get this stamp of approval from our customers, which helped push pro forma healthcare revenue growth to 15% in the quarter. This growth continues to be fueled by the tremendously successful launches of our latest generation MCT and extended wear Holter. In fact, MCT volume growth accelerated in the quarter to 13%, driven by the further release and wide market acceptance of this new system. This marks the fifth consecutive quarter of double-digit pro forma MCT growth, a remarkable achievement during the major integration.
As a reminder, not all MCT is of the same. Our new system incorporate our unparalleled arrhythmia detection capability in a product that can be configured as a patch, or use lead wires when patients prefer not to wear a patch. As I mentioned on our last call, we are seeing increased same-store growth in account to convert to this new system and our extended wear Holter product continue to gain share as well with incredibly high market penetration rates. This product is shaping up to be a nice complement to the new MCT system in a accounts that prefer more than one monitoring option at the disposal.
As it's well-established, our extensive product portfolio includes the most accurate and advanced technology in the marketplace, generating the highest yield and the fastest turnaround times with the more than 30,000 physicians, who prescribe our product each month. It's fitting that the most advanced technology is supported by the most capable sales organization in the remote cardiac monitoring market. We feel by wide margin the most productive sales team in the market. We are also in the process of adding additional sales personnel to augment this team. As I have stated in the past, given our market strength and clear technology advantage, I would not want to compete against this team.
As mentioned, the research services team also posted another remarkable quarter with year-over-year revenue growth of 45%. This is their fourth consecutive record setting period with at least 20% growth, which is more than twice that of the industry. Additionally, team continues to build pipeline and convert it to revenue at a record pace.
There are two other recent trends involving the research segment that are worth mentioning. First, we continue to experience an increase in dual service studies. As I mentioned on the last call, these awards are up 75% since the start of the year. This rapid increase in studies that include both cardiac and imaging requirements reinforces our intention to expand service offerings, as a key element of our strategic growth plan. Also we are starting to have success incorporating our proprietary ePatch monitor as a critical element of new cardiac studies, creating cross segment top-line synergies. These trends bode extremely well for the future of this important division.
With the healthcare and research services division, which account for over 95% of the company's revenue, growing at double digits, we have the luxury of spend a bit more time on resources developing additional opportunities for revenue growth. Last quarter, we announced the commercial introduction of our latest generation cell-enabled blood glucose monitor powering our digital population health service. This latest system includes an innovative touch screen user interface enabling patients to easily test blood glucose levels, while capturing additional personal health data.
Clinicians can access and track their patients data through the Bio Telcare cloud and can provide immediate feedback directly to their patients via the new monitors messaging feature. The new Bio Telcare meter also features the ability to consolidate data from other connected health devices, uniquely positioning us to move beyond diabetes and into the management of other chronic conditions, at some point in the future.
More recently, we acquired certain assets of a commercial partner, which was having financial difficulties. This addition will expand our reach into several key customers. As we move into 2019, we will allocate more business development resources into this segment and expected to become a meaningful contributor later next year. Using a combination of internal and external expertise, we continue to evaluate numerous connected health technologies and solutions to better understand, where we can best leverage our capabilities.
We are also developing other opportunities to current and potential partnerships with the Apple Heart Study being a prime example. These are just a few of the many exciting prospects that lie ahead for the company. Expect BioTelemetry to continued to lead these market development efforts, as no other company is as well-positioned to capitalize on such opportunities.
To sum up, we are obviously very pleased with the company's exceptional performance this quarter. The benefits of acquiring LifeWatch are readily apparent and we've done a number of transactions, I learned a long time ago that the success of any acquisition can be largely attributed to the work that is done before the deal is even announced.
Our senior leadership team did an exceptional job identifying the enormous value of combining BioTelemetry and likewise, and then seamlessly integrating the two organizations to a better than expected outcome. Not surprisingly that the same theme is the driving force behind our strong organic growth.
We really do have all the key elements for continued success. A proven and experienced management team, market leading products, exceptional sales and service and a solid financial foundation, a broad market acceptance of our latest MCT and extended wear Holter continues to surpass expectations.
Our Research segment growth rate is outpacing the market by a tremendous margin and we are making further strides with our digital population health management business. Our future is filled with an abundance of opportunity.
With that, I'll turn the call over to Heather for detailed financial review of the quarter. Heather?
Heather Getz -- Executive Vice President and Chief Financial Officer
Thank you, Joe. And good afternoon everyone. As Joe just announced, the third quarter of 2018 marked our 25th consecutive quarter year-over-year revenue growth, with total revenue reaching $100 million. This represents a 23% increase as compared to the third quarter of 2017 and resulted from robust overall organic growth of 18%, the full period impact of the acquisition of LifeWatch, which occurred in early July 2017, as well as higher Research revenue.
Healthcare revenue was remarkable with an increase of $14.7 million, or 21%. On a pro forma basis, the Healthcare segment grew by 15% with significant increases in both MCT and extended wear Holter. Our Research revenue increased 45% or $4.2 million, largely due to a higher volume of studies in both imaging and cardiac with both new and existing customers. Other revenue was up 8 %.
Moving to gross profit margin and adjusted EBITDA. Our gross profit margin for the third quarter of 2018 were 62.7% versus 60.6% in the prior year period. Our third quarter adjusted EBITDA was $30.1 million, our highest quarterly adjusted EBITDA in the company's history and represented a 30% return on revenue.
The increases in our margins were primarily due to volume related efficiencies largely driven by the higher patient volume, synergies from the acquisition of LifeWatch as well as favorable products and payer mix. To extend on the synergies from LifeWatch, we announced previously that we've specifically identified $30 million of savings. And as of last quarter, we had met that target with $7.5 million of realized synergies in Q2, getting us to the $30 million on an annualized basis.
Going forward, now that we have reached our synergy target and past the one year anniversary of the acquisition, to the extent there are additional benefits achieved through further enhancements to our processes. We will talk about those benefits and efficiencies as opposed to additional synergies.
As for tax rate, as you may remember, last year, the only cash taxes that the company paid were for state taxes, because of the use of federal NOLs. This year the company continued to pay only state taxes, again due to the use of NOLs as well as income tax benefits, resulting from certain large discrete deductions taken during the first three quarters of this year. As a result of these factors, we now expect our full-year GAAP tax rate to be about 2% with actual cash taxes of about $1.2 million.
Moving to the balance sheet. We ended the quarter with $63 million in cash and $201 million of indebtedness. Year-to-date, we generated $44 million in cash from operations. As previously mentioned, during 2018, we did a several one-time cash outlays totaling approximately $10 million for integration related activities. In addition, we used $17.5 million for capital expenditures, driven by the additional devices placed into service for our Healthcare business. Free cash flow was $27 million.
Shifting gears, I will now touch on the outlook for the full-year of 2018. To review, we initially guided to 2018 full-year revenue of over $380 million and EBITDA of over $90 million. This represented a 10% organic growth rate on the top-line and EBITDA return of about 24% to 25%. Then at the end of Q2, we raised this guidance to $392 million to $395 million of revenue and adjusted EBITDA margin of approximately 26%.
I am pleased to announce that we are raising our guidance for a second time this year. As such, we are now projecting annual revenue to be in the range of $397 million to $400 million with an adjusted EBITDA return of approximately 28%. This represents approximately 14% organic revenue growth over 2017 and a 500 basis point improvement in EBITDA margin. This increase in guidance is the result of the strong revenue growth from the recent promotional launches of our MCT and extended wear Holter patch products, the introduction of our products into the legacy LifeWatch accounts, the positive impact of synergies as well as strength in our Research business.
To summarize, the company remains in a strong financial position with modest leverage and additional capacity, if needed. We just posted our 25th consecutive quarter of year-over-year revenue growth and realized our highest quarterly adjusted EBITDA and EBITDA margin in the history of the company. We achieved the high-end of our synergy target of $30 million ahead of schedule and in less than one year post acquisition. We grew pro forma revenue by over 18%, while driving a 1200 basis point improvement in our EBITDA return. These results and consistent growth have provided and will continue to provide the financial strength and flexibility to execute on our key growth initiatives.
And with that, I will turn the call back over to Joe.
Joseph Capper -- President & Chief Executive Officer
Thanks, Heather. As you have just heard, we had another outstanding quarter, in which we exceeded all of our expectations. As we close out this record setting year and prepare for 2019, the company is benefiting from excellent momentum across the enterprise. Our strategy is yielding results better-than-expected and we continue to broaden our opportunities. The LifeWatch acquisition has advanced our growth plans by several years, allowing for the reallocation of more time and resources toward new initiatives, which will be powerful growth drivers for the future.
To ensure continued success throughout the remainder of the year, we will focus on completing the remaining elements of the LifeWatch integration, expanding our comprehensive approach with the ongoing promotion of our new patch products, both MCT and extended wear Holter, continuing to grow our research backlog and convert it to revenue at the accelerated rate, we are now experiencing, building out our digital population health management business and expanding on key partnerships we have developed.
Our consistent performance has positioned BioTelemetry as one of the most influential connected health platforms in today's market. Our dominated cardiac monitoring and clinical research businesses have the potential to provide solid growth for years to come, while affording us the flexibility to commercialize additional innovative connected health solutions. We expect a strong finish to 2018, as evidence by our increased full-year guidance. More importantly, we anticipate continued above market performance well into the future. While we are pleased with how far the company has evolved, I firmly believe our best days are still ahead.
When we closed out 2018, we will have monitored an excess of 1 million patients in the year, providing thousands of doctors with lifesaving information with which to treat their patients. We must never lose sight of the fact that people's lives will literally depend on the work that we do every day. I would again, like to thank those of you, who helped to deliver our 25th consecutive growth quarter, and I look forward to discussing number 26th next quarter.
With that, we'll now pause and open the call to questions. Operator, we're ready for our first question.
Operator
(Operator Instructions) And our first question comes from the line of Bruce Nudell of SunTrust. Your line is now open.
Bruce Nudell -- SunTrust -- Analyst
Thanks very much and congratulations on a very, very strong quarter. Heather or Joe, last quarter you helped break up the Healthcare business into chunks. And I was wondering now that you're disclosing the growth rate in extended Holter, if you could just kind of give us an approximation for the quarter in terms of the percent of healthcare this MCT event, extended Holter and traditional Holter?
Heather Getz -- Executive Vice President and Chief Financial Officer
So, Bruce, at this point in time, we're not breaking out the extended versus traditional, but I can tell you that MCT was about 73% of healthcare with event being about 16% and both extended and traditional Holter at about 11%.
Bruce Nudell -- SunTrust -- Analyst
Okay. Thank you very much. And Joe, you guys are very buttoned down in the cardiac monitoring realm. You've extended that capability into research. And I was just wondering from your perspective, are there kind of bite size digital population health opportunities that can be secured and exploited without dilution of management effort and perhaps very, very a large investment?
Joseph Capper -- President & Chief Executive Officer
Yeah. It's a very good question, Bruce. I think that there are some smaller capabilities that we could acquire that would really complement our current service offering. As you know, up until maybe three weeks ago, valuations were a little bit in outer space. But we think that people would like to join a company like us and we think that acquiring these capabilities will become more plausible over time.
I don't know that there's a big giant one in the space that we've discovered yet that makes a whole lot of sense for us. But I do think that there's some small ones that would be very complementary to the service offering we are currently providing.
Bruce Nudell -- SunTrust -- Analyst
And I guess my follow-up on that is, should we be thinking about kind of regional or payers specific initiative, not the whole country, you know, just something more circumspect. And you know just on a broader level, why won't the, in your view, the Googles, the Apples enter into the medical grade space as opposed to the consumer space? Thanks so much.
Joseph Capper -- President & Chief Executive Officer
Yeah, I don't know that we would restrict ourselves to thinking about additional capabilities regionally. I think it would really depend on the opportunity, obviously when they are small, we don't have the reach to expand into all the geographic zones you'd like to see, do that kind of on an organized growth fashion -- in a organized growth fashion
The second part of your question about the consumer and consumer device oriented companies entering into the space in terms of offering pinnacle great products. I don't know that I would say it would never happen, but you know obviously they don't have those core competencies within their organizations. And so I think the more probable path would be to look for folks like us to partner with. I can't get inside their heads in terms of what they're thinking strategically to get how they approach the market. But clearly I think we're an interesting partner for anyone looking to get into this space.
Bruce Nudell -- SunTrust -- Analyst
Thanks again. And congratulation on a great quarter.
Joseph Capper -- President & Chief Executive Officer
Thanks Bruce.
Heather Getz -- Executive Vice President and Chief Financial Officer
Thanks Bruce.
Operator
Our next question comes from the line of Brooks O'Neil of Lake Street Capital. Your line is now open.
Brooks O'Neil -- Lake Street Capital -- Analyst
Good afternoon, and congratulations on a terrific quarter and positive outlook. I was hoping guys, you might be willing to describe your sense of your market share, your penetration in the cardiac services space. You mentioned that your 14%, 15% organic growth rate exceeded, what you perceive to be the growth rate of the overall market. But maybe you could just say sort of how much more room you see for yourself in cardiac services as we think about the future of the core business.
Joseph Capper -- President & Chief Executive Officer
Yeah I would -- it depends on how you're defining the remote cardiac monitoring business. If you're including all the service lines that we typically do, meaning Holter, extended wear Holter event and MCT. We're probably somewhere in that 25% market share range you know estimating obviously we're a little bit disadvantaged in terms of not having great market data. But I would say based on the market data we do have, we can probably -- we can probably back into around a 25% share. If you look at MCP, we're probably 2X plus that we are probably somewhere in the 50% to 60% range is my guess.
Brooks O'Neil -- Lake Street Capital -- Analyst
So, you would say, you still see significant room for growth in the core business?
Joseph Capper -- President & Chief Executive Officer
Absolutely, for several reasons. One I think the market is growing at a pretty decent rate. Number two, we have plenty of opportunity to grow our market share within that space take our unfair share of the growth, or unfair of the market. Why do I think that? For all the reasons we talked about. We have the best technology by a long shot. We have the most capable sales organization by a long shot. We have a great financial position. We have probably more insurance contracts than any other participant in the market.
So, when you look at all of those elements that go into making a formidable competitor, there is nobody it's really close to us. The ones that are behind us are really just the second and third. So, I think yes, we can take more market share and I think as the market grows, we're going to benefit from that. We've done very little outside the US there's opportunities for us to look beyond our own borders.
So, I do think there's going to be a lot of opportunity. We're starting to see, I think I've mentioned this on previous calls utilization of our MCT technology in new areas of healthcare. We used to not -- we used to not use our technology in places like neurology market, we are starting to use it now in emergency department discharges, they are starting to start few more usage of product there. So, all of those things I think bode well for our essential growth in the future.
Brooks O'Neil -- Lake Street Capital -- Analyst
That's great, Joe. Thank you for that color. Secondly, I was reading somewhere about increased use of a remote patient monitoring in the Research services sphere, specifically I think in the home testing. Have you see that and do you see that as an opportunity for BioTelemetry there in the short term or the longer term?
Joseph Capper -- President & Chief Executive Officer
We do. In fact, you know, obviously we're restricted by naming, who the partners are, but very large pharmaceutical partner launched the study using us as their partner and using our ePatch products in that study. So, I mentioned that in my talking points that we're starting to see those opportunities, which are driving potential for top-line kind of cross segment revenue synergies. But yes, we are starting to see it. And within the research market we are hearing people talk more and more about virtual studies, where people are able to participate from home and provide information from home and not necessarily to center based studies.
Brooks O'Neil -- Lake Street Capital -- Analyst
That's great. Would you say you need to add any capabilities to take advantage of that opportunity, or are you pretty well positioned to date?
Joseph Capper -- President & Chief Executive Officer
I think we're well positioned in terms of our ability to grow within -- with the services we have today. I do think that there are other services that make a lot of sense for us to add to the portfolio or partner with other companies, who have those services to make us a more attractive competitor, more attractive partner to the sponsors that we currently serve.
Brooks O'Neil -- Lake Street Capital -- Analyst
Great. And then I know you mentioned the diabetes situation and your opportunity there. But could you elaborate just a little bit more about, where you think you are in terms of pursuing a real business in diabetes monitoring? And what you see in the marketplace today?
Joseph Capper -- President & Chief Executive Officer
I think we're very early stage. And I talked about that this past year. We focused -- obviously we focus a lot of our time and attention on the LifeWatch integration. And in terms of what we did with the pop health business was really investing in new technology and building that platform. So, it's scalable for future growth, as we move into '19 we'll start to allocate more business development resources. And then I believe we'll start to see more greater market penetration. We know there is demand for the service, it's just a matter of getting our -- getting out in the market and getting our voice heard.
Brooks O'Neil -- Lake Street Capital -- Analyst
That's great. As you know I've been involved with you since 2015, and I share your enthusiasm. I think you're just getting going. So, keep it up.
Joseph Capper -- President & Chief Executive Officer
Thanks. Thanks Brooks. I appreciate the continued support. There's times when we call you are good luck charm and other times, when you're a bad penny on those bad days.
Bruce Nudell -- SunTrust -- Analyst
Right. You're right.
Operator
Thank you. And our next question comes from the line of Marco Rodriguez of Stonegate Capital. Your line is now open.
Marco Rodriguez -- Stonegate Capital Markets -- Analyst
Good afternoon. Thanks for taking my questions. I was wondering, Joe, maybe you could talk a little bit more in regard to the PHM market and the particular opportunities you might be looking at? And how you're thinking about the allocation of capital, as we move into fiscal '19?
Joseph Capper -- President & Chief Executive Officer
Yeah. So, let's talk about pop health kind of just in general, what does it all mean right. We're talking about using a technology to enable a service, where you can effect some change typically in the larger product markets. So, we selected diabetes, given its size, epidemic proportions in the US and its growth. And because that's one disease state, where individuals, patients, participants are conditioned to taking information from their bodies on a daily basis. So, the challenge for us would be how do you collect that information remotely, centralize it and then use that information in a behavioral modification program to improve the disease state of those individuals and ultimately improve outcome and drive down total costs of care. That's it in a nutshell. That's what pop health is all about. And that market makes -- that makes a lot of sense.
Again, I can tell you there is tremendous demand for these types of services, not just in diabetes, but in hypertension, CHF and respiratory sleepness. There's a lot of different opportunities here. So, our challenge would be not to go too crazy for that again and collect a bunch of assets that are unrelated and we can't market them in a coherent fashion. We want to be get good at diabetes and build our technology then expand from there. And make sure that we're proven along the way that we can affect the outcome. We can drive down a A1Cs and we can drive down total costs of care. We've had some excellent studies that have validated that thesis. And again, it's just a matter of getting those dev resources in place and getting our voice heard in the marketplace.
Marco Rodriguez -- Stonegate Capital Markets -- Analyst
Understood. And in terms of that the movement, because I believe you said in your prepared remarks you were thinking there might be some significant movement from that segment if you will in the latter part of fiscal '19. First off, did I hear that correctly? And second -- I'm sorry, go ahead.
Joseph Capper -- President & Chief Executive Officer
Yeah, I think, we'll start to see some meaningful contribution in the second half year, at least that's what we're sort of planning for. It's going to take a while to really build it up to the point where we're going to start seeing something that matters.
Marco Rodriguez -- Stonegate Capital Markets -- Analyst
Got you. And will that flows through your patient services revenue area?
Joseph Capper -- President & Chief Executive Officer
Right now, it does not. We'll determine whether or not it needs to be broken out or rolled up into different segments some point in the future.
Heather Getz -- Executive Vice President and Chief Financial Officer
It's sitting over in other right now.
Marco Rodriguez -- Stonegate Capital Markets -- Analyst
Got you. Next question here just kind of focusing on the operating expenses here in the quarter, came in a little bit lower than we were anticipating. Just kind of wondering if there were some one-time items that positively impacted G&A and sales and marketing, or how should we think about that kind of trending going forward?
Heather Getz -- Executive Vice President and Chief Financial Officer
Yeah. The only real one-time item in the quarter that we had was the adoption of the stock-comp for non-employees, which was about $500,000 in the quarter with a catch up for the year. But other than that, we just had some higher items in Q2 as it relates to sales and marketing. But I think that this is a pretty -- pretty reasonable run rate as far as G&A and sales and marketing are concerned. We do still have a fair number of open positions throughout the company as we grow and we talked about that last quarter that we have not been able to keep pace with our hiring, with our growth. So, we will be adding some hedge as we progress, but we will also be gaining efficiency at the same time.
Marco Rodriguez -- Stonegate Capital Markets -- Analyst
Got you. And just to confirm those additional positions, those were at the cost of service line item, or they're going to be spread also into, maybe sales and marketing?
Heather Getz -- Executive Vice President and Chief Financial Officer
You're going to see most of them up in cost of sales, but we are as Joe indicated in his remarks, adding additional sales and marketing resources as well.
Marco Rodriguez -- Stonegate Capital Markets -- Analyst
Right. And then in terms of the sales and marketing additions, I mean, how should we think about that progression as we look in to fiscal '19, this to be maybe just a one-time event or you are going to layering in additional heads throughout the whole year?
Heather Getz -- Executive Vice President and Chief Financial Officer
Yeah. You're going to see a come in throughout the year. As we talked about, we don't have a specific number, like, we're not saying we're going to hire 25 people. We look at each territory strategically and determine whether or not it makes sense to add additional heads there, combined territories or split them.
Marco Rodriguez -- Stonegate Capital Markets -- Analyst
Got it. Thanks a lot guys. I appreciate your time.
Heather Getz -- Executive Vice President and Chief Financial Officer
No problem. It's OK.
Operator
Thank you. And our next question comes from the line of Dennis Ding of Raymond James. Your line is now open.
Dennis Ding -- Raymond James -- Analyst
Hi, this is Dennis on for Jayson Bedford. Thanks for taking the questions. I've a couple of questions on extended Holter. Last quarter you mentioned that you rolled -- you rolled out your extended Holter product to around 50% of your installed base. I was wondering, if that roll-out continued, if you roll that out to 100% of your base set?
And my follow-up to that would be the impact on -- the impact of extended Holter on the rest of your business meaning, have you seen any cannibalization of Holters, or event monitors? Thanks.
Joseph Capper -- President & Chief Executive Officer
So, just to clarify, I don't believe we -- if we did say 50% of our accounts now had access, or we had penetrated 50% of our accounts with extended wear Holter that was misinformation. What I think we said was -- what we intend to say was about 50% of our MCT accounts had been -- had the new MCT introduced to them. So, we really haven't put out a number of accounts or a percentage of our accounts, where extended wear Holter has penetrated or have been introduced and is currently being utilized.
So, what we have said is, we're seeing really rapid market uptick and because it's so fast and because it's so early, it didn't make a lot of sense for us to start put those numbers out and then projecting what that growth is going to look like in the coming quarters. So, for us we were just trying to buy a little bit more time.
Overall, the Holter segment is growing. What we have seen is rapid growth in extended wear and low or flat or flat to maybe even a slight decline in what we call the traditional Holter, meaning the 24, 48-hour services. So, we're seeing flat to declining traditional Holter, flat to declining event. We're seeing growth in extended wear Holter and growth in MCT. So, one can assume that we have some cannibalization. You probably have event, this is migrating in MCT. You probably have traditional Holter business migrating to extended wear Holter, if that makes sense to you? And then we're seeing obviously growth above and beyond our own account base as we bring in new customers.
Dennis Ding -- Raymond James -- Analyst
Okay, got it. Thanks for the color.
Joseph Capper -- President & Chief Executive Officer
Sure.
Operator
And our next question comes from the line of Gene Mannheimer of Dougherty & Company. Your line is now open.
Eugene Mannheimer -- Dougherty & Company -- Analyst
Thanks. Good afternoon and congrats on the great quarter and outlook.
Heather Getz -- Executive Vice President and Chief Financial Officer
Thanks, Eugene.
Eugene Mannheimer -- Dougherty & Company -- Analyst
Question on pricing. Can you comment at all about how pricing might have impacted some of those strength you saw this quarter and for your outlook and maybe what CNS might be thinking about with respect to their next fee schedule adjustment?
Heather Getz -- Executive Vice President and Chief Financial Officer
Yeah. So in the quarter, Eugene, we saw some favorable payer mix. So, I would necessarily consider that pricing favorability as much as it would just favorable payers in the quarter. That was not a huge number, but it did benefit us.
As far as the CMS rate, they have not been finalized yet for this year. We expect that to come out at some point in early November. But the proposed rate has a slight decline in the MCT rate and we would expect if that were to go into effect in 2019, it impact us by about 2%. That being said, we don't expect it to be implemented.
Joseph Capper -- President & Chief Executive Officer
So, let's comment on that just a little bit. We never know right, when the final rates come out, but it will be up November. We were able to kind of unbundle the proposed rate and found that the consultants were hired by CMS were using information that really wasn't relevant to the code and we were able to meet with them and explain our position and it seem like it was understood and accepted.
That doesn't mean that we had any direction from the group. It was just -- I thought it was very positive dialogue. So, Heather's comment that were -- we don't expect it to be implemented, I would side with her on that, but I want to be careful that we're not -- we're not forecasting that.
Heather Getz -- Executive Vice President and Chief Financial Officer
Sure.
Eugene Mannheimer -- Dougherty & Company -- Analyst
Sure. Makes sense. Thanks for that and with respect to the cash flow in the quarter was very strong. I think you said $27 million free cash flow. So, that probably puts -- that's year-to-date, OK. So, how are you with respect to your $50 million full-year free cash flow target?
Heather Getz -- Executive Vice President and Chief Financial Officer
So, we are -- we are pretty much on track for that. We may come in slightly under. We actually have a higher investment in CapEx than we expected going into the year because of the higher growth rate. So, that's actually a good thing. But we're looking pretty close to that $50 million.
Eugene Mannheimer -- Dougherty & Company -- Analyst
That's terrific. Thank you. (Multiple Speakers) Okay. $45 million you said.
Heather Getz -- Executive Vice President and Chief Financial Officer
Yeah.
Eugene Mannheimer -- Dougherty & Company -- Analyst
Okay, great. And then last thing, just in terms of the strength you're seeing overall, is it, you're seeing more momentum across large hospital networks versus independent practices and how to -- maybe you can share with us, how your business -- on your healthcare business breaks out across those two categories?
Joseph Capper -- President & Chief Executive Officer
I cannot do that, cannot do the latter. I would tell you that we would -- we are seeing growth across the Board in our healthcare segment. I do think it's natural to conclude that we're seeing more growth in the larger systems and larger accounts.
We are very good at positioning ourselves within those large accounts from an EMR integration standpoint. Once you're integrated, you tend to have a stronger position relative to your competition. And so that seems to help us and obviously it's the larger systems that tend to do those first and we have a number of those integrations completed across the US. So, I'd say that we'll probably get more growth there, as a result of that focus.
Eugene Mannheimer -- Dougherty & Company -- Analyst
That's terrific. Thanks again. Appreciate it.
Heather Getz -- Executive Vice President and Chief Financial Officer
Thanks, Gene.
Operator
(Operator Instructions) Our next question comes from the line of Bill Sutherland of Benchmark Company. Your line is now open.
Bill Sutherland -- Benchmark Company -- Analyst
Thanks. Hey, Joe and Heather.
Joseph Capper -- President & Chief Executive Officer
How are you?
Bill Sutherland -- Benchmark Company -- Analyst
How are you? Good. So, the remarkable lift here in EBITDA margin, how should we think about this as, I mean, how should we think about your sustainable margin at this point, just based on what you got in place going forward?
Heather Getz -- Executive Vice President and Chief Financial Officer
Hey, sure. So, for the full year, Bill we guided to 28% EBITDA return and that would imply about a 28% EBITDA return for Q4. As I mentioned, we did have some benefits in the quarter having some open positions and things like that, that did flow through to the bottom line, as well as some favorable mix. So, for the year, we're looking at about 28%.
We have not yet guided into 2019, but as we've mentioned in the past that we are looking to make additional investments, but also looking to continue to expand our EBITDA return. So, stay tuned. We'll give some additional guidance on that number as we go.
Joseph Capper -- President & Chief Executive Officer
And I would say too, Bill, we've been kind of pleasantly surprised by margin accretion with scale in this business. And obviously it's not always easy to see that until you get there.
Heather Getz -- Executive Vice President and Chief Financial Officer
Right.
Joseph Capper -- President & Chief Executive Officer
So, while we anticipate resource in the business at higher level, as we move forward, we don't know what kind of operational efficiencies we'll get as the company continues to grow. They seem to come a bit faster than our incremental spend has grown.
Bill Sutherland -- Benchmark Company -- Analyst
Right. I know you can't -- you can't anticipate some of the investments you're going to be making. But it just feels like the model has kind of just shifted up, you know, asking anything dramatic like that. And then the other thing, I'm wondering how to think about is research revenue growth, which is such a lift. Is there any way to frame like, what you believe is reasonable or same with there?
Joseph Capper -- President & Chief Executive Officer
Yeah, I think I would just, kind of, guide you back to our overall guidance and not focus on breaking it out. And we're comfortable with kind of double-digit growth as we move forward and we'll talk more about that on success of quarters. But they had tremendous growth in the quarter. And as you know, we've talked about this business as being kind of choppy in the past. We had -- we would guided toward like 15% to 20%, when we came into the year. We had a 20% quarter, 30% quarter and a 45% quarter. That's a result of the team doing excellent work in '17 and into '18 building up their pipeline, building up their backlog, converting that backlog. It's a revenue with low cancellation rate.
So, that's how you got there. That's way, way above market growth. I would think it's safe to say that we're not going to grow it 45% that's a business every quarter for the foreseeable future. But I think we're comfortable with sort of the overall guidance for the company being around the double-digit range.
Bill Sutherland -- Benchmark Company -- Analyst
Okay. Couple of specifics, Heather, what is the CapEx you think you're going to have for the year?
Heather Getz -- Executive Vice President and Chief Financial Officer
So, we'll end up just north of $20 million, in the $20 million to $22 million range.
Bill Sutherland -- Benchmark Company -- Analyst
Okay. And remind me what Holter as a percent of revenue was last year for you guys?
Heather Getz -- Executive Vice President and Chief Financial Officer
So, last year, it was around 8%.
Bill Sutherland -- Benchmark Company -- Analyst
8%.
Heather Getz -- Executive Vice President and Chief Financial Officer
I'm sorry, last year -- last year third quarter was about 8%. Yeah.
Bill Sutherland -- Benchmark Company -- Analyst
That was -- that's kind of level it's been at, right?
Heather Getz -- Executive Vice President and Chief Financial Officer
Yeah. Yeah. I mean it have been moving up a little bit, but yeah.
Bill Sutherland -- Benchmark Company -- Analyst
Real good. Great report. Thanks everybody.
Heather Getz -- Executive Vice President and Chief Financial Officer
Thanks.
Joseph Capper -- President & Chief Executive Officer
Thanks.
Operator
And I'm showing no further questions at this time. I would now like to turn the call back to Mr. Joseph Capper for any further remarks.
Joseph Capper -- President & Chief Executive Officer
Thank you, Operator. Thanks again everyone for your continued support and interest in the company. We will speak to you after our next quarter. Operator, that concludes today's call. Thank you.
Operator
If you joined the conference late today, you may listen to the conference call via a digital replay, which will be available through the Investor Information section of the BioTelemetry website at www.gobio.com until November 13, 2018.
Duration: 49 minutes
Call participants:
Joseph Capper -- President & Chief Executive Officer
Heather Getz -- Executive Vice President and Chief Financial Officer
Bruce Nudell -- SunTrust -- Analyst
Heather Getz -- Executive Vice President and Chief Financial Officer
Brooks O'Neil -- Lake Street Capital -- Analyst
Marco Rodriguez -- Stonegate Capital Markets -- Analyst
Dennis Ding -- Raymond James -- Analyst
Eugene Mannheimer -- Dougherty & Company -- Analyst
Bill Sutherland -- Benchmark Company -- Analyst
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