Free cash flow remains highly volatile, with a -2.2% margin in 2026Q1, indicating that the company has yet to establish a sustainable path toward cash-flow neutrality despite low capital intensity with CapEx/Revenue ratios consistently below 2%.
| Cash from Operations | -21.81M | -24.59M | -26.54M | -36.31M | -61.76M | -32.68M | 508K | 3.62M |
| Operating CF Margin % | - | -4.89% | -6.75% | -11.2% | -24.46% | -16.1% | 0.27% | 2.33% |
| Operating CF Growth % | -1574.44% | 7.35% | 26.92% | 41.2% | -88.97% | -6533.07% | -85.95% | - |
| Net Income | -43.51M | -60.61M | -53.01M | -83.07M | 152K | -10.93M | -14.32M | -4.02M |
| Depreciation & Amortization | 3.25M | 6.94M | 6.29M | 5.87M | 4.41M | 3.34M | 3.18M | 2.94M |
| Stock-Based Compensation | 1.82M | 4.55M | 0 | 17.81M | 27.68M | 24.54M | 151K | 94.01K |
| Deferred Taxes | 0 | -32K | 0 | -76K | -263K | -1.24M | -1.34M | 824.76K |
| Other Non-Cash Items | -21.73M | 23.23M | 2.12M | 20.79M | -73.2M | -33.9M | 11.85M | 326.93K |
| Working Capital Changes | -876K | 1.32M | 18.06M | 2.36M | -20.54M | -14.49M | 992K | 3.45M |
| Change in Receivables | -11.73M | -12.58M | -5.77M | -4.5M | -19.66M | -2.99M | -6.76M | -4.44M |
| Change in Inventory | -11.98M | -6.84M | 3.64M | -4.38M | -1.73M | -1.84M | -465K | -1.13M |
| Change in Payables | 19.19M | 19.64M | 9.21M | 5.06M | -6.19M | 2.92M | 3.76M | 5.53M |
| Cash from Investing | -3.91M | -3.07M | 46.21M | 62.64M | -131.61M | -12.15M | -8.84M | -1.2M |
| Capital Expenditures | -2.71M | -3.2M | -3.79M | -4.57M | -5.53M | -2.85M | -1.19M | -1.2M |
| CapEx % of Revenue | 0.5% | 0.64% | 0.96% | 1.41% | 2.19% | 1.4% | 0.64% | 0.78% |
| Acquisitions | -126K | 0 | 0 | -4.46M | -8.58M | -9.11M | -150K | 0 |
| Investments | - | - | - | - | - | - | - | - |
| Other Investing | -1.08M | 0 | 0 | 0 | 0 | -200K | -7.5M | 0 |
| Cash from Financing | 16.27M | 11.56M | -3.49M | -6.85M | 92.21M | 154.01M | 11.89M | -1.81K |
| Debt Issued (Net) | -36K | -20.04M | -39K | -101K | 109.94M | -7.25M | 12.18M | -1.81K |
| Equity Issued (Net) | 16.49M | 32.63M | 75K | -1.02M | -9M | 20M | 0 | 0 |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Share Repurchases | 0 | 0 | 0 | -1.02M | -9M | 0 | 0 | 0 |
| Other Financing | -184K | -1.04M | -3.53M | -5.73M | -8.74M | 141.26M | -293K | 0 |
| Net Change in Cash | -9.46M | -16.1M | 16.18M | 19.48M | -101.16M | 109.18M | 3.55M | 2.41M |
| Free Cash Flow | -25.73M | -27.79M | -30.33M | -40.88M | -67.28M | -35.73M | -686K | 2.41M |
| FCF Margin % | -4.71% | -5.53% | -7.71% | -12.61% | -26.65% | -17.6% | -0.37% | 1.55% |
| FCF Growth % | -34.35% | 8.38% | 25.82% | 39.24% | -88.33% | -5108.02% | -128.46% | - |
| FCF per Share | -0.03 | -0.03 | -0.40 | -0.55 | -0.83 | -0.54 | -0.01 | 0.04 |
| FCF Conversion (FCF/Net Income) | 0.59x | 0.41x | 0.41x | 0.44x | -406.29x | 2.99x | -0.04x | -0.90x |
| Interest Paid | 878K | 0 | 0 | 4.51M | 224K | 275K | 227K | 3.38K |
| Taxes Paid | 0 | 0 | 0 | 403K | 150K | 1.73M | 207K | 61.27K |
Insufficient liquidity for expansion
As reported in recent financial filings, TOI exhibits a persistent disconnect between net losses and operating cash flow, with the OCF/NI ratio fluctuating significantly, reaching 0.89 in 2026Q1, which suggests that accounting accruals and non-cash adjustments are masking the underlying cash burn of the business.
The volatility in the relationship between net income and operating cash flow indicates that the company's reported earnings are heavily influenced by non-cash items and working capital swings. Investors should monitor whether this conversion gap narrows as the company attempts to scale its value-based care model, as current figures suggest that cash generation remains decoupled from accounting profitability.
Based on the provided cash flow data, TOI's free cash flow trajectory remains highly inconsistent, with margins swinging from -17.7% in 2024Q2 to a brief positive 2.4% in 2024Q4, indicating that the company has yet to establish a sustainable path toward positive cash flow generation.
The erratic nature of free cash flow suggests that the business is highly sensitive to timing differences in payer reimbursements and operational expenditures. This lack of a stable trajectory warrants further investigation into whether the current cost structure can support long-term cash self-sufficiency without recurring external financing.
According to quarterly cash flow statements, working capital changes have served as a primary, albeit inconsistent, driver of liquidity, with a notable $12.7M inflow in 2024Q4 followed by subsequent outflows, highlighting the company's reliance on timing shifts to manage its immediate cash requirements.
The reliance on working capital fluctuations to offset operating losses suggests that the company's core operations are not yet generating sufficient internal cash to fund its expansion. This dynamic appears to create a fragile liquidity profile where any delay in collections could exacerbate the existing cash burn.
As indicated by the reported financial data, TOI maintains a relatively low capital intensity, with CapEx/Revenue ratios consistently below 2% across the last ten quarters, suggesting that the company's primary cash drain is operational overhead rather than heavy investment in physical infrastructure or equipment.
The low capital intensity implies that the company's expansion strategy is primarily driven by clinical labor and administrative costs rather than significant property, plant, and equipment outlays. This may indicate that the business model is inherently scalable, provided that the company can eventually achieve the necessary operating leverage to cover its fixed costs.
Quick answers to the most common questions about buying TOI stock.
The Oncology Institute, Inc. (TOI) generated $-24.6M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
The Oncology Institute, Inc. (TOI) reported negative free cash flow of $27.8M in 2025, indicating capital requirements exceeded cash from operations.
The Oncology Institute, Inc. (TOI) spent $3.2M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.