Thank you for standing by and welcome to Integral Diagnostics 1H FY 2022 Results Call. All participants are in a listen-only mode. There will be a presentation followed by a question and answer session. If you wish to ask a question, you will need to press the star key followed by the number one on your telephone keypad. I would now like to hand the conference over to Dr. Ian Kadish, CEO and Managing Director. Please go ahead.
Thank you very much, Lexi. My name is Ian Kadish. I'm Chief Executive Officer and Managing Director of Integral Diagnostics. I'm joined this morning by Craig White. Craig is our Chief Financial Officer. It's our privilege this morning to be talking to you about our H1 FY 2022 results. We also have the privilege of discussing with you an exciting acquisition that we announced this morning together with its associated capital raise. We plan to spend 15-20 minutes on the H1 results, given that these results were in the main released on the Australian Securities Exchange on 27th of January when we posted a market update. We're going to spend about 20 minutes discussing the acquisition and associated capital raise, and then have 20 minutes at the end for questions [audio distortion].
Our vision at Integral Diagnostics is to improve the healthcare world, and the way we do this is by delivering the best health outcome for every patient we serve. We always put our patients first. We demonstrate medical leadership by improving outcomes with evidence-based care. At Integral Diagnostics, everyone counts. We work safely and collectively and respect each other. We ensure that we create value not just for shareholders, but for all stakeholders. We embrace change, and we've never had to do this more than in the last two years, where everyone has faced this worldwide pandemic. We served 484,000 patients last year. We adapted to changing COVID-19 variants, initially during the Delta wave and then later during the Omicron wave. We continue to invest in creating safe environments for our patients and our staff.
We invested AUD 13.6 million in new capital expenditure last year, building a new center at Benowa on the Gold Coast, which accounted for almost half of our gross capital expenditure during the first half. We continue to develop and deploy technology to enhance our patient and referrer experience. Prior to the acquisition, we have 232 reporting radiologists. 152 of our radiologists are employees of IDX, 78 are contractors, and importantly, 98 of our current radiologists are shareholders in the business. We continued the development of IDXT, which is Integral Diagnostics' teleradiology reporting platform. We provide services to external clients as well as internal clients. The external clients are a new service provided by IDXT during the first half of this year. As telemedicine became more important, teleradiology has become an integral component of telemedicine.
We commenced the development of group-wide subspecialty reporting to capitalize on the specialist expertise we have within IDX. We continued our focus during the half of delivering our ESG strategy. We implemented an employee recognition program, and we invested heavily in supporting our people during the many COVID-19 mandated outages. We conducted a temperature check survey with our employees in October to follow up with a survey that was conducted in July, and we demonstrated improvement in employee engagement scores. Our operating NPAT unfortunately declined by 21.7% to an AUD 13.0 million profit in the first half. Our operating diluted earnings per share declined by 22.8% to AUD 0.064 per share. We have declared a first half 2022 fully franked dividend of AUD 0.04 a share.
We commenced the integration of the X-Ray Group acquisition in Albury/Wodonga on the first of November last year. We also continued integration of Ascot Radiology over in Auckland, New Zealand. We invested more than AUD 10 million in growth initiatives in the first half, including the development of three new sites. We managed workflows and personnel systems as we continue to operate in a COVID-19 environment, and we continued to be active in voicing our opinion and working with the industry and in-industry bodies in New Zealand to address the non-arm's length referral practices that had developed in Auckland. We also were fortunate to appoint our Chief Financial Officer, Craig White, who commenced with us on 24th of January. Craig came to us from GenesisCare, where he was the CFO there for some time.
It's terrific that we have been able to secure a Chief Financial Officer with healthcare as well as financial expertise. Moving to the financial highlights for the first half of 2022. We grew our revenue by 5.7% despite the challenging COVID-19 environment. Our earnings lines were declined by 48.7% in terms of statutory NPAT to AUD 10.4 million in earnings. Our operating NPAT after tax declined to AUD 13 million, by 21.7%. Our EBITDA declined by 7.1% to AUD 39.5 million. We saw a decline in our operating earnings per share by 22% to AUD 0.064 per share. Our free cash flow also declined by about 25%.
Our net debt to last 12 months EBITDA on a pre-AASB 16 basis was at 2.5 x at the end of the first half. We were principally affected by COVID-19 across all the geographic areas which we serve. Impacted specifically by the restrictions on elective surgery, by patients' reluctance or inability to obtain healthcare services, and importantly, by staff shortages, which required us to sometimes close sites or reduce operations. Our employee costs increased due to the increased leave, increased use of sick leave, most significantly, a reduction in annual leave taken in large part to replace those who were on sick leave. Border restrictions impacting staffing, and which particularly impacted our businesses in Western Australia and Auckland that are dependent on the ability to source cross-border staff.
Also our border practices on the Gold Coast, and in Queensland where we cross the Queensland-New South Wales border, and in our new practice in Albury/Wodonga, where we again straddle the New South Wales-Victorian borders, and border closures are particularly disruptive in these practices where both staff and patients are used to seamlessly crossing the state line. Increased consumable costs due to ongoing use of personal protective equipment.
We saw supply chain disruptions for equipment delivery and repairs and caused delays in some of our organic growth initiatives and also increased the downtime of some of our equipment. As a company, we're fully committed to maintaining and supporting our excellent team of radiologists and related medical specialists and technical staff through COVID-19, continue the delivery of high-quality services to our patients as demand returns. We declared a fully franked dividend of AUD 0.04 a share.
It's down from AUD 0.055 per share last year this time, but it remains consistent with our historical payout ratio of 70% of our statutory net profit after tax. Moving on to the next page of investor presentation on the first half. We have produced a slide on outlays over the course of the past several years. What's very evident in the slide is that the Medicare outlays have come back strongly in the calendar year, in calendar year 2021 on a 12-month rolling basis. The industry is recovering from the depths of the COVID-19 impacts early in 2020, and we're seeing that kind of recovery come back in the industry expectedly and quite nicely.
Our shareholder returns demonstrate a strong track record of a fully franked interim dividend, that has been growing for the past several years. It declined this year to AUD 0.04 a share. Important to note that we have remained in line with a payout ratio of 70% of statutory NPAT. Our dividend record date is the 2nd of March 2022, and the payment date will be the 5th of April 2022. I'm gonna hand over now to Craig White, our Chief Financial Officer, to take us through the financial performance.
Thanks, Ian, and good morning, everybody. I'm just taking you to slide eight of the pack headed Results for First Half of 2022. Ian's already touched on some of these. I think, you know, the key additional point I'd like to make is that the results are essentially in line with the market update announcement we provided on the 27th of January. Despite the COVID-19 impact on the first half result, it's pleasing to see that we saw 5.7% growth in operating revenue. Our free cash flow remains solid at around AUD 25 million. Clearly that's helpful in contributing to funding our growth initiatives. As Ian mentioned, on a pre-AASB 16 basis, leverage at the end of December 2021 sat at 2.5 x.
Post the acquisition of Peloton and the AUD 90 million capital raising, that leverage does reduce to 1.9x. If we just turn to the next slide on revenue, to take you through in a bit more detail here. The 5.7% growth in operating revenue was essentially driven by three items. AUD 3.5 million of organic growth. AUD 3.9 million attributable to the acquisition of Ascot Radiology, where we have additional two months contribution. AUD 2.4 million from the X-Ray Group where we had a few months' contribution, following that acquisition. In terms of organic growth, it was pleasing to see that we saw 5% organic growth in Australia, against an industry of 4.7%. Both those numbers obviously impacted by COVID.
I think it's also important to note that IDX's growth rate is off a higher base than that for the industry because of the more regional nature of IDX's operations, which were less impacted by COVID-19 in the prior year. In New Zealand, we've called out an 18.1% organic revenue decline, principally driven by COVID, and really reflects the absence of any COVID-19 impact in the first half of FY 2021, so the prior corresponding period. In line with historic trends, we've seen average fee per exam increase across the group by 4.4% in the first half FY 2022, and that really reflects a continued mix shift to higher value modalities such as MRI, CT, and PET scans. Turning to slide 10 on operating expenditure.
Fundamentally driven by the decline in revenue that's been affected by COVID-19, we've seen a 2.9% increase in operating expenditure as a percentage of revenue. Principally, as Ian called out, driven by employee costs and in particular, reduced annual leave as staff and doctors have not been able to take leave in a COVID-19 environment, a significant increase in additional sick leave, and increased costs of staff allowances as we sought to ensure that our various practices were properly staffed despite some of the border restrictions that Ian referenced earlier. In terms of consumables, we've seen a 0.3% increase as a percentage of revenue, driven by two factors. One, the mix shift towards higher-end modalities, but also an increased use of PPE due to COVID-19.
You would expect that over time to reduce. We've seen a small increase in depreciation reflecting additional growth capital investment and also the extra two months of the Ascot Radiology and The X-Ray Group acquisitions. Certainly linked to the acquired acquisitions, finance costs across the group have gone up to AUD 0.7 million. Moving to the next slide on capital management. Integral Diagnostics continues to have a very strong balance sheet. We have significant liquidity headroom available under the group's debt facilities of AUD 100 million headroom. That excludes an additional AUD 105 million, which is available to us under an accordion facility as part of our overall club facility.
As I mentioned, leverage on a pre-AASB 16 basis stood at 2.5 x at 31 December 2021, but reduces to 1.9 following the Telus acquisition and the AUD 90 million capital raising. Just one other point I'd like to call out on this page, and that is that the balance sheet reflects the provisional accounting for the X-Ray Group, and that will be finalized within the required 12-month period from date of acquisition. Just turning to cash flow and cash conversion on slide 12. Previously calling out the fact that the group continues to generate strong free cash flow to support growth initiatives.
If we look at free cash flow conversion, net of replacement CapEx on a pre-AASB 16 basis, then cash conversion sits at around 90%. Obviously, as mentioned earlier, we have continued to invest in growth CapEx, which is about AUD 6.8 million higher in the first half FY 2022 versus first half FY 2021. Ian, I think, I'll hand back to you now to talk through CapEx and some of the growth initiatives.
Thank you very much, Craig. As Craig indicated, we are investing for growth again. You'll notice on the page of capital expenditure, we have committed AUD 10.4 million to grow CapEx. This is relative to the AUD 3.6 million that was committed last in this prior comparable period. It's a significant increase, and it demonstrates the confidence that we have in the business in terms of our greenfield and brownfield investments. Our most significant greenfield investment, as I mentioned earlier, is the Benowa greenfield in the Gold Coast. We have invested almost half of our growth capital during the first half. It's an AUD 4.5 million investment. It's an exciting development for us on the Gold Coast, and it complements our existing offerings on the Gold Coast very, very nicely.
It's a full comprehensive clinic with MRI, CT, and the functional services. We also invested in a greenfield in Perth for the first time. It's our O'Connor greenfield, and that's a $1.2 million capital investment for us. Moving on to the regulatory environment, which we see as stable in both Australia and New Zealand. As at today's presentation, there are no further licenses or plans for the deregulation of MRI licenses that have been announced. Licenses are sometimes announced during a federal election year. In the budget last year, we did receive a 0.9% indexation increase from Medicare. This was lower than what we had anticipated, given the fact that CPI for the period was 2.8%, and in fact, health CPI was higher at 4.8%.
Indexation applies to all items except for the MRI and PET items. As of this year, indexation will be applied to MRI items as well, starting from the 1st of July 2022. However, at the same time, Medicare has reduced the bulk billing incentive for MRI to 95% of the Medicare Benefits Schedule from the 10% that it was at previously. Medicare do expect to deliver AUD 107 million savings over the four-year forward estimate. FDG PET for the early detection and diagnosis of Alzheimer's disease was introduced onto the MBS on the 1st of November. This test is expected to be an exciting development, not just for us, but for all patients and their families that are impacted by Alzheimer's disease.
The ability to detect the disease earlier and to treat disease with the new treatments that are available should make a real difference to patients and to providers like ourselves who have the ability to make an early diagnosis. In New Zealand, annual adjustment is provided across all the contracts that we do have. We do see CPI-type adjustments in all of the contracts we have in New Zealand. We expect that the DI market in New Zealand will continue to grow, driven by aging demographics and the adoption of new technologies that improve patient outcomes, like the PET technology just referenced. There has also been an emerging market practice in New Zealand over the past six or eight months or so, where referrers are acquiring ownership interest in radiology practices.
This has the potential to change the competitive dynamics, as referrers will then have a vested interest in the facilities that they refer to. IDX expects that the regulators and payers in New Zealand will review these practices against their own guidelines, and will take the necessary actions to ensure that patient interests are protected, that patient choice is retained, and that patients and payers are not subject to over-servicing and unnecessary imaging. We're working with the industry body in New Zealand to ensure that our voice and the patient voice is heard. We're working with a body called the New Zealand Institute of Independent Radiologists. Management strategy remains consistent. Good medicine is good business. Our organic and inorganic growth strategy, and our focus remains the same despite COVID-19 impacting our near-term performance.
Our drivers of strategy are organic growth, business integration and further efficiency gains to accelerate the use of digital and AI technology to improve the experience of patients and referrers, to drive our ESG agenda, to nurture and develop a leadership culture across our business, and to evaluate and continue to execute on further strategic acquisitions. The company is fully committed to maintaining and supporting our excellent team of radiologists and related medical specialists and technical staff through COVID-19 to continue to deliver high quality services to our patients as demand returns. Prior experience operating in a post-COVID-19 restricted environment has seen a return to historical levels of operations and a period of catch-up of pent-up demand, which has resulted in higher volumes of exams for some months.
Maintaining our workforce and infrastructure to ensure that IDX is well-positioned to service this increased demand when it returns remains a priority for us. The company also maintains its focus on executing both our organic and inorganic growth strategy in line with our values to deliver the best health outcomes for patients. We believe that the underlying fundamentals of the radiology industry remain strong. The company is confident that patient volumes and historical growth patterns will, over time, return to pre-COVID-19 levels, and that the continued investment in our workforce and infrastructure is going to position us well. Our second half performance to date continues to be impacted by COVID-19. There are some early signs that patient volumes are returning, especially in our Queensland operations, albeit that the impact of COVID-19 on the second half still isn't certain.
I will move on now to discuss our recent acquisition and our capital raise, and I will then open up for questions. We announced this morning that we have acquired Peloton Radiology for AUD 66. 5 Million. Payable is 90% in cash and 10% in new ordinary IDX shares. In addition, there is a retention-based earn-out of AUD 4 million, which will be subject to Integral's achieving certain retention and integration objectives, and is payable in tranches. AUD 3 million on the 1st of July 2023, and AUD 1 million on the 1st of July 2024. The acquisition multiple is 8.8x pro forma FY 2022 EBITDA, including the upfront consideration and the earn-out. It's funded by a fully underwritten entitlement offer and IDX shares.
We expect to deliver low single-digit pro forma FY 2022 EPS accretion before ongoing synergies and one-off integration costs. The completion of the acquisition is expected in calendar year 2022, subject to the satisfaction of conditions precedent, including ACCC approval. Peloton Radiology is a scale provider of diagnostic imaging services with a strategic presence from Brisbane up to the Sunshine Coast in that high growth corridor of Southeast Queensland. It's a highly diversified practice with a high-end modality mix that includes nuclear medicine, CT, and partially licensed MRI. It comprises nine wholly-owned clinics with good locations that complement our clinics that are further up the Sunshine Coast and joins us to the Peloton clinics down in Moreton Bay and Brisbane itself. Peloton brings with it an experienced team of 12 radiologists and 190 employees.
It enhances our presence in that high-growth corridor in Southeast Queensland. It provides us with several more centers of excellence in areas like breast imaging and women's diagnostic services. It also meets our investment criteria, not just for EPS accretion, but also meeting our return on capital hurdles, as well as being a strong clinical and cultural fit. The group has a strong clinical leadership record and a track record of delivering good patient outcomes. We're excited about the acquisition and looking forward to discussing the acquisition with the market. Funding for the acquisition is via a fully underwritten entitlement offer to raise about AUD 90 million offered at AUD 3.44 per new ordinary share. The offer price for the entitlement offer.
New IDX shares issued to Peloton Radiology vendors at AUD 3.44 per share will be issued at the completion of the acquisition. The new shares will not be eligible for the interim dividend in the sense of share relating to the first half that ended on the 31st of December. The offer price of AUD 3.44 represents a 10% discount to the theoretical ex-rights, ex-rights price of AUD 3.82 and represents an 11.1% discount to the dividend-adjusted closing price of IDX shares on Tuesday the 22nd of February. The offer provides us with additional balance sheet flexibility to support investment in identified bolt-on M&A opportunities that are aligned with our strategy. The net debt to last twelve months pro forma adjusted EBITDA is expected to reduce to 1.9x on a pre-AASB 16 basis.
IDX shares will be issued to certain Peloton Radiology non-radiology vendors as consideration for the acquisition, and will be subject to escrow arrangement for up to two years. Importantly, the acquisition is subject to conditions precedent, including a confirmation of the relevant regulatory approvals, including the Australian Competition and Consumer Commission, consent to assignment of material property leases, confirmation that Peloton Radiology holds all the required licenses and no material risks change in Peloton Radiology. I'm going to go through some of the personal details of the acquisition clinic over the next few slides. Just to provide an overview of the assets and the business that we're acquiring. Peloton has a high quality, well-invested fleet of three MRIs, and all of these MRIs have a partial license.
Partial licenses are good and appropriate for most, if not all, GP referrals, and can also be used for some specialist referrals too. They have 18 GP machines. They have 190 employees across the Peloton—nine Peloton clinics. Twelve long-tenured radiologists comprise the Peloton Radiology staff and complement. The radiologists have skills in a broad range of specialties, including musculoskeletal and sports imaging, head and neck, urological imaging, angiography and interventional radiology, breast, abdominal, nuclear medicine, and cardiac imaging. The brand has good reputation for excellent quality care in the Southeast Queensland corridor. The next page outlines some of the reasons that we consider Peloton to be an attractive strategic acquisition for us. It enhances our presence in that high-growth corridor in Southeast Queensland.
The Sunshine Coast population is projected to grow by 167,000 people between 2021 and 2041. That's an increase of almost 50% over the current population in the area. We see numerous additional growth initiatives through the combined group, both Peloton and ourselves, in areas where Peloton has been doing a lot of work on, in their gastroesophageal reflux studies, in breast AI, and in general premium breast care technologies that they offer. In increasing capacity, equipment capacity in Southeast Queensland, where we can load balance between the MRIs and CTs that we have in our fleet and the MRIs and CTs in Peloton's fleet. We expect that the acquisition will deliver low single-digit pro forma FY 2023 EPS accretion, with more ongoing synergies and one-off integration costs.
The group is a good, strong cultural fit, focused on clinical excellence in diagnostics and on delivering good patient outcomes. The leadership team of Peloton have a combined 50 years of experience managing the business. The Peloton radiologists currently report more than 230,000 reports every year on the Sunshine Coast and in North Brisbane and in the Brisbane CBD. Moving on to page 12 of the acquisition deck. You can see that Peloton Radiology comprises four major businesses. The largest business within the group and the keystone business of the group are the X-ray and imaging clinics. They have clinics along the Sunshine Coast from Caloundra, Coolum, Currimundi, Kawana, Maroochydore, and Buderim. The CitiScan clinic in the Brisbane CBD.
The DIFW, or the Diagnostic Imaging Centre for Women, co-located with the CitiScan practice next to the Queen Street Mall in the Brisbane CBD, an excellent location for both practices. The Lime Radiology in Margate, in the Moreton Bay region of southeast Queensland. The elderly population, which is our target market as a radiology business, our target market is the population 65+ or even 85+, which are the highest users of our services. It's that population that is expected to grow the most. It's expected to grow in the Sunshine Coast 21% for the population 65 and over, versus 15% for the general Australian population above the age of 65 across Australia.
Importantly, the population above the age of 85 is expected to grow by 2.5%, which is materially above the 2% expected in the general Australian population above the age of 85. The average age on the Sunshine Coast is 42 versus an average age of 38 in the general population. It satisfies IDX investment criteria, as you can see on page 13, and we also have identified multiple future growth avenues. These include optimizing our equipment and capacity utilization across the combined IDX and Peloton fleet, using our call centers to direct patients to the most appropriate services. Utilizing the IDX key teleradiology support centers for the after-hours and subspecialty expertise that can be provided to the Peloton Group to assist in their growth. To utilize the buying power that IDX has, particularly with the large multinational network.
To integrate our platforms and IT support across the businesses. To expand some of the successful offerings that Peloton has into the rest of the IDX offering. Offerings like their gastroesophageal reflux disease studies, as well as the breast diagnostic services. Then to offer Peloton radiologists the ability to do subspecialty reporting from the IDX hospital and specialist networks. We believe that the evaluation that we've taken to this business has been very disciplined. It's an acquisition multiple of 8.8 x their pro forma FY 2023 EBITDA. The synergies utilize IDX's cost structure across areas such as equipment service contracts, medical consumables, and IT software to deliver the identifiable synergies. We have an integration plan that we have discussed with vendors and agreed. It minimizes disruption to operations.
It ensures that we retain the best of both businesses in terms of the key people. It involves clear lines of leadership and communication, and establishes a clear and demonstrable path to optimizing the network benefit for the combined group and to establish the synergies. Radiologists have been incentivized, in terms of an offer that we have put to key radiologists, and we'll be meeting with more, so that their interests are aligned with ours. We have commenced these negotiations. On completion of the acquisition, certain of the Peloton Radiology ventures and some of the non-vendor radiologists will be receiving escrowed IDX shares to ensure that their interests are aligned with the interests of other IDX shareholders. The Peloton radiologists will gain access to IDX's share plan, so we can further enhance our alignment with them over the medium and long term.
The earn-outs are designed to align the interests of the vendors, the radiologists in the Peloton Group and IDX. We'll also be, on the operational side, aligning our radiology information systems and our picture archive and clinical systems or PACS systems. We will be streamlining our accounting software and recording processes across both businesses, consolidating some of the back office processes around risk management, insurance, human resources, and IT. We will be aligning our clinical leadership and governance of Peloton Radiology with Peloton Radiology to form a part of the Integral Diagnostics leadership team. We will be utilizing IDX's cost structure across areas such as equipment, service contracts, medical consumables, and IT software to deliver these identifiable synergies. After the acquisition, we will continue to operate in six key geographic markets because Peloton is an extension of our current market on the Sunshine Coast down into Brisbane.
It aligns nicely with the Sunshine Coast practice that we already have and gets closer to joining the two practices we have up in Queensland, the two current practices in Queensland, being the Imaging Queensland business we have and the South Coast Radiology business. It takes our total number of employees at IDX up to 1,582 and employed radiologists up to 160. We will now have seven partial MRIs in addition to our 14 full MRIs once we add the two partial licensed MRIs that the Peloton Group brings.
We have a total of 36 MRIs across the group, bearing in mind that the MRIs in New Zealand do not need Medicare licenses to operate. In Australia, we also operate some MRIs that do not have licenses where we charge privately for the services provided on those segments. I'll hand over now to Craig to take us through some of the details of the entitlement offer.
Thanks, Ian. I'll just turn to page 17 of the presentation. The entitlement offer is structured as a one for 7.75 pro rata accelerated non-renounceable entitlement offer. As we've mentioned previously, we're looking to raise AUD 90 million. New shares will be issued at a share price of AUD 3.44. As Ian mentioned previously, which represents 10% discount to TERP or 11.1% discount to the adjusted closing price of IDX shares on 22 February 2022 of AUD 3.87. Proceeds from the entitlement offer will obviously be used to partially fund the acquisition of Peloton Radiology, but will also provide additional balance sheet flexibility to support investment in identified bolt-on M&A opportunities that are continually aligned with IDX's strategy.
When we think of the AUD 90 million total capital raise, the net proceeds net of transaction costs will be about AUD 85 million. AUD 60 million of that AUD 85 million will go towards the acquisition of Peloton Radiology, with AUD 25 million staying in the balance sheet to support future growth initiatives, including identified bolt-on opportunities. The institutional component of the offer is open until midday tomorrow, Thursday the 24th of February. The retail component of the offer will open at 10 A.M. on Tuesday, the 5th of March. You'll see on the following slide that the entitlement offer timetable is outlined there. I won't go through that in detail, but that's there for your reference. With that, Ian, I'll pass back to you. Thanks.
Thank you very much, Craig. I'll ask Lexi, if you're still there, Lexi, to open up a line for questions, please.
Thank you. If you wish to ask a question, please press star one on your telephone, and wait for your name to be announced. If you wish to cancel your request, please press star two. If you're on speakerphone, please pick up a handset to ask your question. Your first question comes from Lyanne Harrison from Bank of America. Please go ahead.
Good morning, Ian. Good morning, Craig. I'm gonna start with Peloton, given that we ended there. You spoke of, you know, synergies and integration costs. Can you give us some indication of the magnitude of synergies and over what time period? Also, you know, what kind of integration costs you've been factoring against that?
Thanks for your question, Lyanne. We haven't called out the synergies that we're expecting to generate, but I think it's fair to say that when we make acquisitions like this, we do expect synergies along the lines as we've spoken about earlier. We just haven't quantified them for the market because we would need to do a little more work to ensure that some of those synergies are realizable and when they're realizable. You know, I mean, it's a fairly wide range of synergies that we've looked at. We're confident that we will deliver synergies, but we just don't have enough detail yet to provide any numbers around it.
Okay. Thank you. Craig?
I was just going to add, Lyanne, I think one of the areas that we're giving a specific number. I think we certainly see some opportunities in terms of revenue and the way that Peloton Radiology currently go about their billing and just ensuring that, you know, the billing is in line with what we're entitled to bill for the services provided. I think that would certainly be one area that we've looked at and see opportunity.
Okay, thank you very much. If I could move on to first half trading, and you know, certainly wanting to understand better in terms of as we come out of or different regions have come out of COVID lockdown, what you're witnessing there in terms of the recovery of activity. I guess you mentioned Queensland patient activity was returning. Can you also talk to that with other geographies as well?
Sure. Happy to do that. Queensland volumes are returning nicely. Queensland was impacted the most by the Omicron variant of COVID-19 in mid-December, late December, and then that impact continued into January. We've seen volumes coming back nicely in Queensland over the past few weeks. We're still waiting on the impact, if any, of Omicron in Western Australia particularly. We have seen impact in New Zealand from Omicron as well. We've not seen a bounce back in those areas yet, although Western Australia is not really down much. New Zealand was down in the first half. In Victoria, we were not impacted in calendar year 2020.
When we look at our calendar year 2021 numbers, because we were relatively unimpacted the previous year, we have not seen as much of an improvement year-over-year than what businesses that would be more oriented to Melbourne would see. Our businesses in Victoria are regional for the most part. We're in Ballarat, Geelong, in Melton, in Sunbury and in Warrnambool. Those regional areas were impacted this year by Omicron, but were relatively unimpacted in calendar year 2020 or the first half of 2021 financial year.
Okay.
Not much more we can really do geographically, but that's probably a rundown of each area.
Are you able to give us some indication, particularly, I guess Victoria, Queensland and New Zealand? Previously, for New Zealand, you called out in previous announcements whether it was, you know, x% below normal. Are you able to share any of that with us today?
No, we're not giving any more detail than what we did call out already. We have called out New Zealand revenue was down in the first half this year compared to last year. And that's down predominantly due to Omicron. Omicron has impacted our New Zealand operations quite significantly. We were given instruction by the Ministry of Health in New Zealand that we were not allowed to scan except if life or limb was threatened for a big chunk of the first half, September, October, November kind of timeframe. Our New Zealand businesses were impacted significantly by Omicron in the first half. And then to a significantly lesser extent, we were also impacted by the opening of a referrer-owned practice in Auckland. The referrers have an incentive to refer to their own practice.
That did impact our numbers, but to a much less extent than COVID did.
Okay. Just one last question from me on cost pressures. Obviously saw cost pressure in employee costs. How are you know, I guess addressing that in the coming, you know, six-nine months around managing those cost pressures going forward?
Yeah, Lyanne, I'll comment on that. I mean, I think the first thing is that we would largely see these cost pressures being transitory. You know, the reduced annual leave, the increased sick leave, the increased allowances for staff to move staff around to properly resource our practices. I think, you know, as Omicron and COVID pass, those cost pressures should abate. I think the other thing I'd call out is, you know, we do have, you know, reasonably high fixed costs in the business. You know, costs for staff do flex to some extent with revenue, but there is still a big fixed cost portion there.
We experience that sort of negative operating leverage on the way down. As we recover from Omicron and COVID, we would expect the reverse to be true. You should see that positive operating leverage come through. You know, for improvement on the revenue line, we would expect a much greater improvement on the profit line. Hopefully that gives you a bit of a sense of how we're thinking about it.
Thank you very much. I'll leave it there.
Thanks.
Thank you. The next question comes from Craig Wong-Pan from Royal Bank of Canada. Go ahead.
Morning. First question just on CapEx. I was wondering whether your existing guidance for AUD 20 million-AUD 24 million of growth CapEx in fiscal 2022 still stands. If you could just kind of how much you're looking to spend this year.
That's correct. Yeah, there hasn't been a significant change in that.
Yeah. Okay, great. Just on Peloton, based on Lyanne's question on integration costs, could you share how much you expect to incur on the back of that?
This is specifically in relation to Peloton Radiology?
Yeah.
Look, I think I don't think that's something that we've sort of disclosed. We treat it obviously as a below EBITDA line item. You know, I think we've sought to make sure that we're properly resourced to make sure that the integration of the acquisition is successful. You know, I think probably a good guide is you know, the sort of integration costs we've incurred in regards to prior acquisitions. You know, we spent around AUD 2.8 million below the line in the first half. I think I'd probably use that as a guide.
Okay. Last question on Peloton. Can you say how much revenue that business has and what type of growth rate it was achieving prior to COVID?
We haven't disclosed the revenue or growth rate numbers for Peloton historically. Suffice to say that its margins are better than ours, so its margins are slightly stronger than what our margins are, and that the business is in a high growth area.
Okay. Thank you.
Thank you. Your next question comes from John Campbell from Citi. Please go ahead.
Thank you. Ian, just on Peloton, why haven't you disclosed the revenue? I mean, is that a secret?
Hi, John. We don't disclose revenue for any of the acquisitions we've done, John. We haven't disclosed revenue in the past. The only exception to that has been for New Zealand, just because we report New Zealand separately as part of our annual reporting. Otherwise, we report our earnings, and we don't share the margin or revenue information.
When you say the margin will be higher than your historic, does that mean the pro forma FY 2022 Peloton margin is higher than your historic margin or your current margin, which is depressed because of COVID? Can you just give us a little more color?
Sure. I'd be happy to do that. Peloton's margins are slightly higher than ours in both a COVID environment and a non-COVID environment. They've been impacted by COVID, but less so than what we've been impacted by COVID. Their margins are slightly higher than our margins, both during COVID. In fact, there's more of a difference during COVID because their business is. They have less operational leverage in their business than what we do. In other words, a lot of their radiologists are paid as a percentage of revenue compared to our radiologists that are paid salaries.
During periods of downtime like COVID, they're less impacted than what we are. During periods where the demand comes back and where we service the pent-up demand, that's where we see our operational leverage come to the fore, and that's where a business like Peloton's margins would not increase as much as our margins would when demand comes back. I hope that helps you.
No, that's helpful. Just maybe a little history on Peloton. Who did you buy it from, and how long has it been going for?
We bought Peloton from a family office, private equity vendor consortium, plus some radiologists and others in the medical field who had invested in radiology businesses in Southeast Queensland. They initially invested in the business five or six years ago, maybe a little more. They acquired initially the X-Ray & Imaging group on the Sunshine Coast, and then expanded into Brisbane with the acquisition of the CitiScan group right next to the Queen Street Mall in the Brisbane CBD.
They subsequently acquired the Diagnostic Imaging Centre for Women and moved that practice to co-locate that right next to the CitiScan practice in the Brisbane CBD. More recently, they acquired Lime Radiology in Moreton Bay. So those are the practices that comprise the group. Some of those practices, Lime, for example, we have previously looked at ourselves, because we see those practices as attractive practices, and you know had some knowledge of those practices prior to their acquisition by Peloton.
Right. It's been a recent kind of consolidation of the practices over a five-year period. I guess that's-
Over a five-six-year period. Yeah.
Yeah. Thank you. Can I just clarify on New Zealand? You know, you've made comments about that, and I'm not sure I fully understand what you're talking about, because obviously historically in Australia, medical practices have bought imaging practices with varying degrees of success. Obviously, some have both and Healius did until they sold the medical business. I'm just trying to understand how important this could be in the New Zealand market and why the industry body would or what authority they would have to try and stop this from happening.
Thanks. It's difficult to say at this stage the kind of impact that it would have. The difference it has from the kind of integrated offerings we see at Healius and Sonic Healthcare in our market is that the practice here is limited to orthopedic surgeons who are referring specifically for MSK MRI procedures, which are well reimbursed in New Zealand. If they have a direct ownership in the practice themselves, then there is an incentive for them to refer to the practice because they're getting a benefit from each referral that they make themselves. The practice for us, this kind of practice for us does not make sense because it takes away the professional requirement that all doctors have to always do what's best for the patient.
Here there is a risk that the choice is removed from the patient, that there is a risk of over-servicing as referrers refer more to their own practices because they're essentially getting some reimbursement back from every referral they make to their practice. That's why we'd like to stop this in New Zealand using you know the regulatory and the industry bodies and working with them to ensure that everything is done in the best interest of the patient. Australia and the U.S., and most countries in the OECD have very stringent anti-kickback legislation in place.
The Stark anti-kickback provisions in the U.S., for instance, the private health insurance laws here in Australia that prevent referrers from receiving any kind of inducement for referrals that they make. New Zealand does not have that kind of regime in place. Each one of the major players in New Zealand who have in their guidelines wording similar wording to what exists in our Private Health Insurance Act here in Australia or the Stark and Anti-Kickback provisions in the U.S. We're just working with these payers to do what their guidelines say that they should be doing.
Thanks, Ian. Just finally back to Craig. I just want to clarify, if possible, you've confirmed the CapEx number. With all the moving parts, maybe you can give us some guidance for depreciation and amortization and potentially interest for the FY 2022 year, maybe ex the Peloton acquisition.
Yeah. I mean, I think in terms of depreciation, John, you know, we think it's the replacement CapEx has been roughly in line with depreciation. Obviously you've got to add on the depreciation coming from growth CapEx, so that'd be sort of through organic initiatives or inorganic, like the acquisitions. You know, I think if we just exclude Peloton, you can see through the sort of depreciation. I don't think you can see a material change in that number in the second half, as a rough guide. Okay?
You know, in terms of financing costs, again, in terms of how you'd be thinking about that, clearly a lot depends on when the Peloton Radiology acquisition finally completes, and we actually draw on the funds that we're raising through the capital raise. To be honest, it's a little bit difficult to be too specific on that. I think it's fair to say you'd probably take first half interest expense, and then assume we're going to get some saving from having raised capital, and perhaps, you know, completion will occur in the last quarter of FY 2022.
That's helpful. Thank you very much.
Thank you. The next question comes from Steve Wheen from Jarden. Please go ahead.
Yeah, good morning.
Morning, Steve.
Just wanted to understand the pro forma EBITDA that you've used for Peloton versus what's happening with IDX. IDX is obviously experiencing COVID-related pressures and as a result, that's sort of flagged in your sort of to the second half of the year, and yet the pro forma is not factoring in any COVID-related impact. Could you just sort of explain why there is that difference of stance between the two?
I can perhaps comment on that, Steve. I think you know, obviously if we just think about the AUD 8 million that we're calling out for pro forma EBITDA for Peloton Radiology, we have got actuals in there for the seven months. Those actuals were probably most affected in December and January by COVID, you know, being a Queensland-based business. Ian talked earlier about the you know, the spread of Omicron as the border opened up. We've also talked about the fact that, you know, we're seeing some green shoots and recovery in our Queensland business, particularly SCR, which is close to the New South Wales/Queensland border.
I guess when you take those two together and you look at the five-month forecast that's assumed in that AUD 8 million, we're assuming that we are going to be returning to a more normal environment, in terms of trading without further impact of COVID.
Yeah. No, that does. It is your expectation that the COVID impact is not going to. I mean, I guess it does surprise me would be impacted. I guess where this is headed is, does this mean that the chance of you having to pay the earn-out is probably reduced?
No. The earn-out is paid based on some integration criteria and on the retention of radiologists. It's not based on earnings. But we've looked at, Steve, their earnings on a consistent basis to what we've booked for ours. You know, their impact of COVID to date and our impact of COVID to date and the trajectory that both companies have of seeing through COVID and coming out of COVID over the next few months, which we believe to be the case for both businesses. We've looked at it consistently as we see the EBITDA projections. And so that rapid recovery that you're seeing in Queensland, is there any reason you wouldn't expect to see that elsewhere?
We would also expect to see that kind of recovery in Victoria too. Western Australia and New Zealand are a little different in that they've not really experienced an Omicron wave the way the rest of us, or the way the rest of the country has, the way the rest of Australia has. New Zealand has started to see Omicron. They have over the past several weeks, but it's not been nearly as severe as it was in Queensland in December and January, for instance. Western Australia is only recently seeing Omicron coming through the border.
We are less exposed, though, in Western Australia to Omicron than what we would be in other parts of the country because our practices in Western Australia are largely based at large public hospitals and doing a lot of public work in Western Australia that's not impacted nearly as much by COVID as what the private clinics are.
That's clear. Can I just move on to the margin comment of Peloton, obviously saying it's slightly above what you're seeing. Is that the reason, therefore, that the synergies that Craig mentioned are probably more likely to be only revenue synergies as opposed to cost synergies?
That's partly true, but there are cost synergies as well, but there would not be as many cost synergies as we would see in a less efficiently run business.
Somewhat related, there was a bit of a focus by the Australian government on co-claiming activities among MRI scans. I just wondered if you've seen any sort of further sort of finalization of that of those sort of restrictions required by the government.
We're not in any finalization of it, but we are aware that Medicare still has some of those investigations ongoing. At IDX, we're less exposed and less affected than what some of our competitors are.
The approach from Peloton to co-claiming is consistent with the way IDX approaches it?
It is consistent. To the extent that it hasn't been in the past, that's been for the vendor's account.
Yep. Got it. Okay. I just also wanted to pick up on some of the license renewals, or sorry, contract renewals that were underway sort of at the last result, so in particular Pindara. Has there been an outcome to that recontracting?
There's not been a long-term outcome, but we have secured with Ramsay, and are speaking to Ramsay about a longer term contract at all five Queensland facilities we have. The contract currently is extended until January of next year, and we're in discussions with Ramsay around longer periods.
Okay. That would then fold in additional hospitals to your business. Is that right? Or are they existing contracts with the same Ramsay Hospitals?
We currently have five Ramsay Hospitals in Queensland that we're providing services to. One of them we have a long-term contract with, and the other four, we're in discussions extending the contract at all of them. They're all under contract for the future span.
Okay. Just a few more questions from me, if I can. Given this has come out of private equity, any expectation around additional CapEx for the Peloton business that you think that will be necessary?
We've looked at this in some detail together with the previous vendors of the business and together with the radiologists that are working in the business now, and we have identified some CapEx expenditures that will be required, and we've factored that into our growth calculation going forward.
Okay. Can you quantify what that CapEx might look like?
We haven't talked about this.
Is it material?
No, it's not out of line with what would be expected for similar businesses, single businesses of ours. To the extent that we do invest more CapEx, and we may in one or two areas, it would be for growth.
Understood. I'll leave my last question. That's all from me. Thanks very much.
Thank you. This question comes from Chris Cooper from Goldman Sachs . Please go ahead.
Hi. Morning. Thank you. Ian, just to follow up on your comments on the trading conditions in Victoria, please. I was just a little confused by the statement you made suggesting there was no negative impact in calendar 2020. Did I misunderstand the comment? I, you know, I appreciate there's some big differences to Queensland here, but just struggling to see why you're not seeing a quicker rebound in Victoria than you currently are.
Chris, simply because in Victoria, we're in the regional areas that were not impacted in the prior comparable period the same way as Melbourne was. If we look at the, you know, few practices, we have very few in Melbourne itself, North Melbourne, West Melbourne. Those practices were significantly impacted in the prior comparable period and in this period. We did see an improvement over the low base that they had in these West Melbourne practices. When we look at the bulk of IDX's business in Victoria, it's in cities like Geelong and Ballarat and regional areas of Melbourne that in the prior comparable period were not impacted.
The improvement that we would see this year would be less because we're comparing it to a much higher base that was not impacted in the prior comparable period, if that's making sense. Essentially what I'm saying in Victoria, for those competitors of ours that have predominantly Melbourne businesses, you would expect to see better growth, whereas for businesses like ours that are more regional, we've not seen the same kind of growth. We've experienced organic growth of about 5% across all our Australian businesses. That organic growth would have been higher had we been impacted more in Victoria during calendar year 2020, the same way as other people were.
Perhaps just asking a slightly different way. Rather than looking at sort of year-over-year comp in percentages, is there any reason why in terms of volume terms, Victoria doesn't recover to where it was pre-COVID in the way that it turns out Queensland is?
Victoria is recovering. I mean, on the revenue side, you know, the whole of Australia in the first half, for us generated 5%, which we're happy with. It's slightly above industry growth of 4.7% in Australia over the same period. Some of that's generated in Victoria. You know, a lot of it in Queensland, given that, you know, Queensland comprises such a large proportion of our business. We're seeing that 5% growth overall in our Australian practices, 5% organic growth. That's pure organic growth. From a revenue side, it's there is the growth year-on-year. What impacted us during Omicron specifically was the amount of sick leave we had, particularly in Victoria, particularly in Queensland.
For all the sick leave we had, we had to replace those on sick leave by using up the annual leave that, you know, others would have been on annual leave, which had to be canceled to use up their sick leave. Essentially, it was a double whammy for us to cover all that sick leave. On some days in, you know, mid, late December, in Queensland alone, there were more than 100 people away on sick leave in our business.
Okay. That's good. Just one on employee expenses. I mean, clearly we saw a mix shift last year. I think that was very well flagged and you told us in August the majority of that would be permanent. Craig, I believe you said on this call a third of it will also be considered transitory. Could you just help clarify my understanding there, and maybe just give us some guidance around employee expenses? I think it's gonna be a really important line for us to focus on.
Yeah, sure, Chris. I mean, I think just to reiterate from Ian's comment, I think the piece that we see as transitory is the reduced annual leave, the increased sick leave, and the increase in staff allowances. You know, as borders open, movement of staff gets easier, and Omicron recedes, then all those costs could normalize in the piece. I think I did also talk about the fact that obviously we did have a you know, significant fixed cost element to the business, and I'm not sure what was said at the full year. If Ian had made any comments around the full year, it would have related to that fixed cost portion. Does that you know, clarify things for you?
It does. In terms of modeling this, going forward here, I mean, is there reason to assume a sort of mid-single digit growth in employee expenses for the next couple of years, or should we be thinking about something a bit different?
Well, I think, to be honest, Chris, I don't wanna sort of be giving forward guidance here. I think we'd be disappointed if we saw mid-single digit growth. That's all I would say, probably.
Okay. Thank you. Just final one, just a clarification on the excess with the raise. I believe we're talking about potentially AUD 25 million excess above what intended spending on Peloton. So is the assumption that all of this is going to [ audio distortion ] or are you gonna be looking to hold some back for sort of internal CapEx programs or maybe a bit of deleveraging?
There are additional opportunities that we see that we have raised funds to be able to execute on. It's a lot easier to execute on acquisitions when you have funds sitting and are not subject to having to do another capital raise.
I think I would probably add to that, Chris. I think the way to probably think about that additional AUD 25 million is really in terms of making sure that the capital structure of the group is appropriate. When we talk about the fact that post Peloton leverage comes from 22.5x at 31 December 2021 down to 1.9x. You know, I think as a group, we probably think of leverage in the range of 2-2.5x as being where we might want to be. We've got that additional equity, and we've also got significant debt service to ensure that we've got, you know, an appropriate capital structure for the group.
Yeah. Okay. Thank you.
Thank you. The next question comes from Thomas Hugh from Barrenjoey. Go ahead.
Hi. Thanks for taking my question. Just one from me. In terms of the Medicare bulk billing center changes on MRI in FY 2023, I believe the initial assessment of the impact was about AUD 300,000-AUD 400,000. Just, is there more clarity on how material or immaterial the impact is?
No, I think that number still holds. I think that the impact would probably be in that kind of range. We are looking at billing policies. We did expand our bulk billing policies during COVID to help the communities in which we operated and also to ensure that we're utilizing the capacity we had. We did start doing more bulk billing. We will move more towards normalized pricing policies as the impacts of COVID abate. As we move more towards a normalized pricing for ourselves by implementing private and gap bills where we have in the past, we'll see impacts like the impact that you're talking about on bulk bill MRI incentives abated. Because that incentive exists, but only for bulk bill MRIs, not for MRIs where you're charging a gap in any event.
Yep. Understood. Maybe just a follow-up. Is there any discussion in terms of what indexation will be like in FY 2023? I understand that currently it's about compared to CPI of like 33%-40%.
I would hope that it would be closer to where CPI is. We expected that last year as well, and it came in well below CPI and even further below healthcare CPI. Hoping this year to look closer.
Okay. Thank you.
Thank you. Once again, if you wish to ask a question, please press star one on your telephone and wait for your name to be announced. Your next question comes from Rod Gilliss from Rimor Equity Research. Please go ahead.
Hi, Ian. Hi, Craig. Thank you very much for your time and for taking my question. I might just immediately follow on from the last question to start with. Given that level of indexation, although it's great that we now have it, but was so low, is there any sort of clarity on what the decision process of what the level of indexation will be in any given year? Is there any sort of mathematical calculation that you are privy to that you can share with us? Or are you literally just sitting there going, "Well, we have no idea what it will be going forward.
It's supposed to be similar to what we experience in terms of wage inflation, but it was a lot lower than that last year. Either there's a catch-up, which will happen this year, or it's related to something that we're not across or not as across. We were surprised, as was I think most people in the industry, by in fact, not just radiology, but healthcare. Because the increase pertained to all the Medicare's expenditures, doctor-related expenditures. We were surprised at the 0.9% increase when inflation rate was so much higher and when healthcare CPI in particular was so much higher.
Absolutely. Would your expectation be if something like happened, that happened again, that there would be some strong lobbying that then would take place?
Yes.
If I can quickly come back to Peloton, and I apologize. I did miss a portion of the Q&A. If these questions have been asked already, I apologize. Firstly, I just wanted to double check. I mean, you referred to the 8.8x EBITDA multiple for the acquisition price. I presume given that it wasn't said otherwise, that that is a post-AASB 16 EBITDA number. If that is the case, I was just wondering, are you able to give us some-
Sorry, just to be clear, Rod, that was pre-AASB 16.
Oh, perfect. Thanks. That makes the rest of my question completely invalid then. I'll move on. Thank you. Craig, you did kind of hint that you felt there was some under-billing taking place at Peloton versus what Peloton is potentially entitled to. Are you able to expand on what that means? Is that versus actual Medicare codes that could be used that aren't used?
There's not much more I would say, Rod. I think, you know, the point really was just about the fact that Peloton Radiology is providing services to patients, and we just want to make sure that the billing for that is in line with what the company is entitled to bill.
Yeah. The Medicare code is complex and, you know, businesses like ours are able to invest the kind of expertise we need to understand the code well and to bill efficiently and according to the Medicare benefits.
Okay, great. Also on Peloton, I just want to come back to the fixed versus variable remuneration for radiologists. I mean, my understanding is that the Integral Diagnostics model historically has been, as you suggested, a fixed plus remuneration with the potential for radiologists to become equity holders, and therefore, they're very closely aligned to shareholders in terms of the overall business doing well. It sounds like from what you said that Peloton has operated on this variable as a portion of revenue remuneration for presumably at least senior radiologists. Is that something that you will look to change within Peloton given that it sits slightly differently from the current model?
No, we would not be changing the radiologist reimbursement mechanisms. We're working with the radiologists to ensure that our interests and their interests are aligned and have undertaken not to make any changes to their current work practices or reimbursement mechanisms for the duration of, you know, for the next several years.
Okay.
The Peloton model works very well as we just saw in times that revenue does come down like during COVID. Whereas when revenue comes back and is strong, then there is this operational leverage at IDX that, you know, businesses like Peloton that revert their radiologists on a percentage basis don't see that kind of operational leverage coming back.
Sure. Okay. If we then look at the relationship between Imaging Queensland and Peloton, do you think there is a competitive incentive between those two businesses versus where you've made other add-on acquisitions where there's some geographic overlap?
We think that the businesses are aligned in a lot of ways. The areas where there is overlap in the practice, there are opportunities to expand services to patients and to make it easier for patients to access radiology services. For instance, if we manage to improve our capacity utilization, it will reduce waiting lists in both practices. By implementing a call center that can help patients find the most appropriate facility close to where they are, where waiting list is shorter, will be beneficial to patients and will ensure that we're using our capacity optimally.
We've seen that work very well in other areas where we have a fair number of practices, like the Gold Coast, for instance. Where we're able to help patients find the most appropriate facility closest to them that can provide them with the kind of specialized service they need.
Absolutely. Can I take that to say, anything you can do to manage capacity effectively between those two practices is ultimately a benefit to the radiologist, whatever the remuneration profile that they're on?
Yes. To improve access, to improve patient access, helps radiologists, it helps patients, it helps the business. To reduce waiting lists similarly, you know, helps everyone.
Absolutely. Okay. Can I just jump in on and looking at what's happening in New Zealand with regard to the new competition in Auckland. You know, obviously in that Auckland area, you have some historically pretty high margin, highly specialized business with some pretty highly qualified radiologists. Are you able to expand on what specialties are seeing the competition arise from the specialists who have put in place their own radiology services? And I guess to add on to that question, have you actually lost any radiologists to this new competition?
Certainly. We've not lost radiologists to the new competition, and the new competition is limited to MSK type services, the kind of services that orthopedic surgeons and spinal surgeons refer to. We don't expect it's going to expand much beyond those two specific areas. If it's not in a material way.
Yep. Okay. All right. My last one, and I know this is in some ways not directly relevant to you, but on the Sonic conference call, they were talking about their acquisition in Melbourne of, sorry, Epworth Imaging. The way they described it and what they want to do with that business, it felt like that they feel that they have a hub in the Epworth business which is underutilized and is therefore not generating the level of margin that I think the business should. Therefore, they're looking at to expand. My reading of what they're saying is they're looking to expand spokes into community imaging from that hub to hopefully make good use of that hub. When...
Now, I know that's not directly competing with the scope of your Victorian business, but I'm just interested in when a company makes the decision to take that route, how easy is it to actually win business when you are really putting in some greenfields operations in areas that are presumably already well-serviced? You know, has anyone really been successful in that model of trying to take business? Sorry, I'm not asking the question well. I guess it really comes back to how sticky are referrers with their current providers?
Referrers are fairly sticky to their current providers, and what we have found is that if we can meet all the needs of a referrer in a particular area, the referrer becomes more sticky. To the extent that you can provide all the services so that the referrer does not need to think of where to send the patient, the referrer ultimately only needs your referral pad on his desk or her desk and your app open on their computer. That's where you'd ultimately like to be. That's why the hub and spoke methodology for us works very well, and that's why providing referrers with a comprehensive service works very well. A service that has everything from basic X-ray and ultrasound through to CT, MRI, and nuclear medicine.
The referrer knows that whatever he or she's referring to, most services can be provided by us, and that we have enough clinics in the area that makes it convenient for their patients. We have found that to be a key ingredient to our success over the years and, you know, if that's what Sonic are looking to do, then they're looking to emulate something which we've shown works quite well. I believe that there is enough growth in radiology generically to support additional greenfields to go around surrounding hub-like sites. Remember that our industry grows at 7% a year, and it's done that historically for many years. Going forward, we don't see any reason that top-line growth trajectory should change.
In fact, a lot of exciting developments in radiology and nuclear, and nuclear medicine today that argue for that kind of growth to continue up on the top line. That means that, you know, we will continue to see development of greenfield and brownfield type developments in the market to accommodate the increase in demand over time.
That's great. That's all for me. Thank you very much.
Thank you. There are no further questions at this time. I'll now hand back to you, [audio distortion] Kadish, for closing remarks.
We have gone well over time, but I think it's been very well worthwhile and much appreciated from the engagement from everyone on this call, and we do look forward to meeting with you all over the next couple days. Thank you all very much.
Thank you. That does conclude our conference for today. Thank you for participating and please disconnect.