Thank you for standing by, and welcome to the Integral Diagnostics IDX FY twenty-four results conference call. All participants are in a listen-only mode. There will be a presentation, followed by a question and answer session. If you do wish to ask a question, you will need to press the star key, followed by the number one on your telephone keypad. Thank you. I would now like to hand the conference over to Dr. Ian Kadish, CEO. Thank you. Please go ahead.
Thank you very much, Jody, and good morning, everybody, who's called in this morning. My name is Ian Kadish. I'm the Managing Director and Chief Executive Officer of Integral Diagnostics. I'm joined here this morning by Craig White. Craig is our Chief Financial Officer. We're privileged to be discussing with you this morning the financial year twenty-twelve results for Integral Diagnostics. We're proud that we delivered on our values in financial year twenty-four. We delivered excellent patient net promoter scores of plus 84 in Australia and plus 86 in New Zealand. We served more than a million patients this year and performed more than 2.5 million exams. We also invested nearly AUD 24 million in CapEx, including investment in new and upgraded equipment across the fleet.
We employed 243 reporting radiologists this year, and importantly, we grew our teleradiology business, IDXT, to provide more services to more external as well as internal clients. We have 1,977 employees across our group, and we continued to progress on delivering our ESG strategy in financial twenty-four. Importantly, we look to create value for all stakeholders, including shareholders, by increasing revenue by 6.6% to AUD 469.7 million. We increased our operating EBITDA by 7.4% to AUD 191.5 million. Importantly, we reduced our leverage by 0.3 turns to 2.6 times.
We also declared a fully franked final dividend of 3.3 cents per share, and we've just announced or we announced during the year our transformational proposed merger with Capitol Health Limited. We undertook a restructure in late calendar year 2023 due to some cost inflation and cost pressures that we experienced across the group. We broadened our referrer base in New Zealand to combat the non-arm's length referral practices that we're seeing emerge in that market. I'll move now to our financial highlights for financial 2024. Solid revenue growth of 6.6% and operating EBITDA growth of 7.4%. We also improved our EBITDA margins to 19.5% from 19.3% in the prior comparable period.
Our statutory net profit after tax shows a loss of AUD 60.7 million, driven predominantly by the impairment that we took in New Zealand at the end of last calendar year. We increased our net profit after tax by 1.3% to AUD 18.1 million. We increased operating EBITDA by 7.4% to AUD 91.5 million, and we increased our operating diluted earnings per share to AUD 0.077 on the back of an increase in revenue of 6.6% to AUD 469.7 million. We also improved our free cash flow by 5.5% to AUD 56 million and reduced our net debt to EBITDA on a pre-AASB 16 basis to 2.6 times.
Our results are consistent with the guidance that we provided on the twentieth of February 2024. The revenue growth of 6.6% was driven by the 3.6% increase, effective 1 July 2023 from Medicare, and an additional 0.5%, effective 1 November 2023. Both of those excluded nuclear medicine. We also annualized the FY 2024 out-of-pocket fee increases, the gap payments, that we took in most of our businesses across the group, and we continued to see a favorable mix impact during the course of the year as patients and referrers moved to more of the higher value, more intensive modalities.
Prolonged cost pressures during the course of the first six months, particularly the high labor costs, driven by inflation and labor market supply constraints, together with the high interest funding costs, precipitated our move to undertake various key operational initiatives where we contained and reduced costs across the group. We announced the impairment loss at the end of the first half of AUD 71.6 million in the New Zealand division, reflecting the changes in the patient referral patterns, and that drove the statutory net loss of AUD 60.7 million for the year. After taking into account the impairment losses, transaction restructuring and integration cost, amortization of customer contracts, net of tax of AUD 78.8 million. Our free cash flow reflects the increased operating EBITDA, and also improvements in our working capital profile and lower replacement capital expenditure in financial 2024.
Our net debt to EBITDA on a pre-AASB 16 basis of 2.6 times compares favorably, both to the number on the 30th of June, 2023 of 2.9, and to the 3.0 number at the 31st of December, 2023, and continues to trend down to the group's target ratio of 2.5 times or less over time. We also declared a fully franked final dividend of AUD 0.033 per share, with total dividends declared for financial 2024, representing 74.4% of our FY 2024 operating net profit after tax. I'll move to the next page, where importantly, we provide a comparison of the second half to the first half, demonstrating the materially stronger second half in financial 2024.
Particularly, the group EBITDA margin, which improved by one hundred and fifty basis points to 20.3% for the second half, compared to the 18.8% that was delivered in the first half. In addition to that, we reduced the leverage by zero point three turns to 2.6 times at the thirtieth of June, 2024. The organic revenue growth in Australia was 2.5% higher in the second half than the first half, and importantly, New Zealand, the second half was 7.9% stronger than it was in the first half. We saw some labor cost growth in the second half of 1.8%, but below the group revenue growth of 3.1%, half on half.
We also reduced other operating expenditure by about AUD 0.5 million over the course of the two halves. Lifting our focus a little on the next page to the industry results. We're looking here at industry disbursements, both on the top line, reflecting disbursements revenue disbursements or costs that are paid by Medicare to the diagnostic imaging industry in Australia, going back to June of 2015, and the bottom line represents the tests that Medicare paid for over the period. In addition to the strong comeback we've seen since the end of December 2022, we've also seen a continued widening between the two lines, which represents the increased proportion of high-value tests, the higher acuity tests, that Medicare is paying for in the industry.
The tests like the PET scans, the MRIs, and the high-speed CTs, which are a lot more expensive and a lot more valuable, and you do fewer of those tests than those tests have increased proportionately more than the increase we've seen in the basic X-ray and ultrasounds. Looking at our shareholder returns on the next page, we can see that the 7.4% increase demonstrated in operating EBITDA between financial 2023 and financial 2024, from a total of AUD 85.2 million in 2023 to AUD 91.5 million in 2024, AUD 48.3 million of which was delivered in the second half. And we also see our dividends this year of AUD 0.033 in the second half and AUD 0.025 in the first half.
I'll hand over now to Craig to take us through some of the financials.
Thanks very much, Ian, and good morning, everybody. Just turning to page 9 of the investor presentation, I'd like to just take you through the results for FY 2024 in a little bit more detail. So you can see that our revenue of AUD 470 million was up a solid 6.6% over the year. Operating EBITDA of AUD 91.5 million was up slightly higher by 7.4%, leading to an expanded EBITDA margin of 19.5% versus 19.3% in the prior year. Operating NPAT of 18.1 was also slightly up versus prior year of 17.9, and that was despite a roughly AUD 4 million increase in interest expense relating to higher interest rates over the year.
Operating diluted EPS was also up slightly at 7.7 cents per share, versus 7.6 in the prior year. Pleasingly, free cash flow was also up a solid 5.5% at AUD 56 million. As Ian referenced, we've worked hard to reduce our leverage across the group in FY 2024, and you can see that net debt reduced by AUD 11 million, with leverage at 30 June 2024 being 2.6 times versus 2.9 times at 30 June 2023. Whilst not on the page, it was three times at 31 December 2023. I'd like to just take you through a little more detail of some of the key lines. Turning to the next slide, 10, to talk about revenue.
If you look at the 6.6% growth, it was effectively driven by Medicare indexation, the annualization of out-of-pocket fee increases that we took across the group, and importantly, the continued favorable mix impact towards higher-end modalities for patient scans. Looking at the split between Australia and New Zealand, organic operating revenue grew 7.2% across the year, adjusted for working days. When you look at IDX compared to Medicare over a two-year period, we saw a gain of 0.6% in revenue market share over the two years, end of 30 June 2024, compared to Medicare, which was 6.7% across that period.
And the reason why we've looked at it across two years is because effectively, IDXT was growing off a higher base in the prior year than Medicare, and therefore, I think, appropriate to look at it across a two-year period in terms of what's happening to market share. In terms of average fees per exam, they increased in Australia by 7.7% against revenue growth of 7.2%, and that was primarily a function of both the Medicare indexation, but also particularly the shift towards higher-end modalities. And that was a real feature of the underlying result. In New Zealand, we also saw across the year, revenue growth of 5.3%, but as Ian referenced, we saw much stronger growth in New Zealand in the second half.
A lot of that driven by work from the DHBs, District Health Boards in New Zealand. Turning to the next slide, 11, and looking at operating expenditure, you can see that when you look at operating expenditure as a % of revenue, consumables are slightly higher, just reflecting the higher modality mix. Labor costs, pleasingly, were slightly lower despite inflation and despite radiologist demand versus supply cost pressures, which I think most of you know are present in the industry, and we've worked very hard to really control our management of labor costs across FY 2024, and that continues. Equipment costs, you can see, were slightly lower.
Occupancy costs increased by 30 basis points, but effectively, that was driven by the fact that in the prior period, we had a write-back of a make-good provision where we were effectively over-provided in FY 2023. So the underlying growth was much smaller and would have reflected the impact of CPI increases. You can see also this year, we've split out technology costs from other expenses, which, as you can see, are very significant in FY 2024 at AUD 15.4 million. We felt it was important to give you visibility of the magnitude of those costs and the importance of technology in our business, and the investment that we've made across the business, not only in clinical and corporate platforms, but also around cybersecurity.
And then when you look at other expenses, excluding technology costs, you can see they actually decreased by 70 basis points, and that really is consistent with the focus that we've had through the year of being as disciplined as we possibly can around cost control. And again, that continues into FY 2025. In terms of capital management, I won't spend too much time on this slide, but we've talked about the fact that it was pleasing to see that leverage came down from 2.9 at 30 June in the prior year to 2.6 times at the end of June 2024.
You can see also just in the balance sheet, the impact of the impairment that we took in New Zealand, obviously, non-cash, but, that is reflected in the balance sheet and the carrying value of the intangible assets going forward. And just turning to slide 13 and having a look at cash flow and cash conversion. Again, it was pleasing to see that free cash flow increased by 5.5%, despite a very big, very favorable movement we had in working capital in FY 2023, which largely just reflected a timing around payments to suppliers.
In terms of capital expenditure on slide 14, you can see that overall across the year, we invested just under AUD 24 million, split between AUD 14.6 million in replacement CapEx across the group, just maintaining the existing fleet, and then AUD 9.3 million of growth CapEx. Which effectively, from a clinical point of view, was invested across four main projects: the Smith Street expansion up on the Gold Coast, which is scheduled to open in the next month. We've also partially completed the expansion of the Ocean Grove site at Lake Imaging in Victoria, and we've also partially completed the Noosa greenfield up on the Sunshine Coast. And finally, in New Zealand, we had an additional PET operational at our Cavendish site, which opened in February 2024.
You can see there that the additional investment that we put into IT of AUD 4.7 million, so on that note, I'll hand back to Ian to talk to the regulatory update.
Thank you very much, Craig. On the fourteenth of May this year, the federal government announced that from one July twenty twenty-five, any practice location that holds a current license, whether it's a partial or a full license, will receive a practice-based license that provides full Medicare eligibility to all MRIs located at that practice. So in effect, what this means is that practices that currently have a partial license will be upgraded to a full license on the first of July next year, and practices that are busy enough to warrant a second MRI at that site would also be able to have a second MRI installed at that site, which would become licensed as it's operating out of the same site.
It does provide opportunities, for practices that do have partial or full licenses to look at investing in those practices that are doing very well, and being able to bill Medicare, immediately from those, you know, from any new MRIs installed on, at those sites. On the first of July, 2027, two and a half years from now, all comprehensive diagnostic imaging practices that have an MRI, will be able to get their MRI upgraded to receive full Medicare eligibility. The other key Medicare changes that have occurred this year, or during financial twenty-four and, influenced the twenty-four results, were the indexation of 3.5% on all DI services, excluding nuclear medicine, that were received on the first of July last year, and then the additional, 0.5% that we received in November of 2024.
In November of 2023. In terms of 2024, we're looking at indexation of 3.5% in all diagnostic imaging services, excluding nuclear medicine from the July that just passed, and on the first of November this year, we will receive a one-off fee increase of 3.5%, followed by annual indexation from 1 July onwards for nuclear medicine as well. We will also get a reduction of 2% for CT services on the first of November this year. In New Zealand, there's only limited indexation of pricing, but we have received price increases, CPI-related price increases from the majority of our private health insurers, and we continue to negotiate with some of the other funders.
The regulatory authorities in New Zealand determined that non-arm's length referral practices by referrers who have interest in radiology practices is acceptable, and as a result of that, we have diversified our referrer base in New Zealand. So we've included more general practitioners, and are working with our GP referrers to more comprehensively work up their patients prior to the specialist referral. And you would have seen in the second half of this past year of twenty twenty-four, how New Zealand has improved, revenue compared to the first half by 7.9%, as the new strategy takes hold.
In both Australia and New Zealand, we've seen international medical graduates, both radiologists, but also importantly, referring doctors and other clinicians like sonographers, nuc med technologists, and other clinical specialists, slowly returning to New Zealand and also to regional Australia, and helping to alleviate the skills shortage we have in those areas. Turning now to our strategy update. At IDX, we believe that good medicine is good business. We look at both growing our existing business and margin, as well as at strategic mergers and acquisition opportunities. In terms of the existing business and margin, we will continue to drive organic earnings growth through focusing on execution of the key operational initiatives that we announced at the end of last year. We will also continue to accelerate the use of teleradiology, digital and AI, to improve the experience for patients and referrers.
We will continue to drive our ESG strategy and to lead through our values. As our balance sheet capacity permits, we will consider accretive mergers and acquisitions that represent a strong clinical, cultural, and strategic fit. We believe that the fundamentals of the essential radiology industry are strong. Our industry benefits from being at that interface between major global trends on the demographic side, as well as the technological side. Demographically, the aging of the population and the increased prevalence of chronic disease and earlier detection opportunities will continue to drive demand for diagnostic services. As technology advances, digitization and the growth of teleradiology and AI is expected to improve the quality and the efficiency of the care that we deliver. We expect to continue seeing the structural shift occurring to higher acuity modalities, as is seen around the world.
IDX is a specialist-focused, quality provider of diagnostic services, and we're strategically well positioned to benefit from these trends and to grow our services nicely going forward. In twenty-five and beyond, the company's focused on executing on these drivers of our strategy and growing our business. We expect to implement the transformational proposed merger with Capitol Health in the fourth quarter of calendar year twenty-four, subject to satisfaction of the conditions precedent to the merger. The combination of our two complementary diagnostic imaging businesses is expected to realize significant benefits for our combined patients, our doctors, and our shareholders. IDX achieved mid-teens revenue growth in July, which includes two extra working days versus the prior corresponding period, in line with Medicare for the states in which IDX operates.
In FY 2025, replacement and growth CapEx, CapEx for IDX, excluding capital, is expected to be between AUD 40 million and AUD 45 million. I'm going to briefly review the last few pages in the deck, which provide a little more detail on our strategy. Our focus remains on the execution of the key operational initiatives that we announced at the end of last year, improving the patients and referrer experience through things like the online appointments platform, strengthening referral relationships through our priority service lines to referrers, and our enhanced e-referral platforms, and also educating patients and referrers on selected diagnostic tests, like high-resolution chest CT for all smokers and cardiac CTs for patients at risk of cardiac disease.
With regard to workforce development, we're in continuing to enhance our clinical productivity through the use of technology like our integrated work list and artificial intelligence. We've grown our sonographer training program to address the workforce shortages in that area, and we're continuing to work very hard and more closely aligning staffing levels to match demand at each clinic. We've also increased our regional radiologist training positions at the IDX sites. We will continue to improve productivity and efficiency to drive our non-labor cost efficiencies and to grow teleradiology so that we can cost effectively balance our workload. We'll continue working on increasing our asset utilization by focusing on improving utilization of the existing installed machine base, and targeting more capital-light teleradiology tenders, like the New South Wales tender that we secured earlier in this calendar year.
We've highlighted on the next page our teleradiology and artificial intelligence arms, as they are material, not just in terms of saving lives, but also in terms of improving efficiency across the group. Our teleradiology business was launched in August of twenty twenty, and since then, it has grown more than any other business unit within IDX. It provides flexibility for radiologists to report at a time and a place that they select, and it also is based on a variable reimbursement model, so that we pay at a consistent percentage of billings to the reporting radiologists. We serve some large state contracts in Western Australia, Queensland, and Victoria, and secured our first one in New South Wales earlier this year.
We've also been early adopters of artificial intelligence, starting at the Apex Radiology Clinic in Western Australia in February 2019, and now utilized across almost all businesses in the IDX fleet. The AI shortens the time for cases that are detected by AI to be abnormal, and allows these cases to be reported next by the reporting radiologist, much improving patient care, but also improving efficiencies because radiologists tend to spend less time on studies that have been declared by the AI system to be disease-free. AI accounts for more than 5% of our IDX volumes and is growing, and we've been working very closely with Aidoc, which is an international radiology AI provider, and we've been working with them now for several years in terms of growing the algorithms that we use across our fleet.
Moving to our ESG initiatives, we're continuing to develop and implement our ESG strategy aligned to our values, to ensure that we comply with the proposed climate-related disclosure standards in Australia and we will be providing more detail on our ESG initiatives when we publish our FY 2024 ESG report later this year. I'll touch on the next two pages on the transformational merger with Capital Health. Our vision is to be the leading ANZ provider in diagnostic imaging, and we'll do that by achieving the optimal healthcare outcome for our patients and referrers, through delivering best-in-class clinical service technology and capabilities, and providing the leading platform that will attract and retain the best of the best in terms of the radiologists and key professionals. The acquisition terms are compelling.
They've been unanimously accepted by the Capitol Board, recommended by the Capitol Board, and it's the highest synergistic combination with significant and ongoing value creation potential. The strategic rationale and financial benefits are laid out on the following page, the final page of the presentation. Importantly, our scale will now be significantly enhanced with a nationwide footprint of 155 clinics, supported by more than 350 radiologists and about 3,000 employees.... It gives us a platform to drive the best-in-class clinical outcomes for our patients, our doctors, and our referrers. Gives us an opportunity to offer increased training, fellowship, and research opportunities to radiologists, so we can retain and train the leading radiologists within our group, so we can continue to provide the high-end services that the market is looking to, is growing faster.
It's a financially attractive opportunity. Our confirmatory due diligence reaffirmed more than AUD 10 million of anticipated annual pre-tax net cost synergies, and the majority of those are expected to be realized within the first year after implementation. We expect to deliver double-digit pro forma FY 2025 EPS accretion to Integral shareholders, including the cost synergies. We also expect additional upside to administrative and revenue synergies that will occur over time. It positions us well for further growth. It gives us an increased ability to invest in the more costly, higher-end modalities like MRI and PET/CT. It gives us a good opportunity to grow teleradiology volumes, not only by offering Integral's leading platform, IDXT, to Capital Health radiologists, but also load balancing using teleradiology across the entire group. It puts us in a stronger financial position to pursue further value accretive investments, including potential M&A.
We'll hand over now to questions, and if I can hand back to you, Jody, to take us through the first questions, please.
Certainly. Thank you. If you do wish to ask a question, please press the star key, then one on your telephone and wait for your name to be announced. If you wish to cancel your request, please press the star key, then two. If you are on a speakerphone, please pick up the handset to ask your question. Thank you. Your first question is from Saul Hadassin, from Barrenjoey. Go ahead, thank you.
Yeah, good morning, Ian, and good morning, Craig. Thanks for taking my questions. Just two from me, if I could. Maybe starting the first question, Ian, just looking at the incremental margins that you generated on revenues in FY twenty-four. If I look at the margin, the EBITDA margin, I think I get about 22% roughly for the additional revenues that you generated in the year. So I just want- the question is really: What do you think maybe held back some of that margin expansion in the year, considering that you're talking to both benefits of price and mix and high modality services? Is the issue here that the cost to deliver those high modality services is actually higher than what we might think? Is the issue scalability?
Just some comments on that, incremental EBITDA that you generated in FY 2024 would be great.
Thanks, Saul. The inflationary impact on consumables, for instance, in modalities, in the expensive modalities like the PET/CTs, did impact our margin on, you know, some of those modalities. So we did see, you know, high inflation at the beginning, in the beginning of FY 2024 and some of those radionuclides and also some of the contrast media we used and some of those non-labor expenditures in addition to the, you know, labor CPI that we experienced at the beginning of the year. Going forward, though, we would expect inflation to come down, both wage inflation, which we've seen, you know, lower this year, than it was at the beginning of last year, and also inflationary costs will continue to come down over the period.
There are some areas where we have seen fairly significant cost increases, contrast media, for instance. But most of that should, over time, taper off in the same way as inflation would. I'll ask Craig if you want to add anything to the margin answer, Craig.
Sure. Saul, I think, just, in addition to what Ian's mentioned, I mean, I think obviously we've worked hard on the labor side to contain that and reduce that as percent, as a percentage of revenue, but there's no doubt those pressures still exist, both in terms of inflation and shortage of supply. So we probably would have liked to seen a, you know, an even bigger reduction had it not been for those factors. But the other key thing I'd probably just talk about is the... And you can really see it on slide five, is the increase in spend in technology. You know, we've been investing heavily, particularly in the clinical, side of the business and around cybersecurity. And you can see that, you know, half on half, we had about a 16% increase in technology costs.
and that's probably suppressed the second half margin, you know, a little more than might otherwise have been the case.
Thank you. And then, if I could, Craig, just one other. I think at the half year, the guide had been for CapEx to be in the vicinity of AUD 30-AUD 40 million for FY 2024. It came in around AUD 24 million. Just wondering for the guide into 25, were there projects that were effectively canceled in terms of any greenfield site developments, or is effectively the spend just being pushed in or fallen into FY 25? Thanks.
...Yeah, I think definitely, you know, there's a case of, you know, I think overall, we've, we've looked to manage CapEx as, as tightly as we can. I think there's definitely some projects where timing of spend has shifted. So for example, the Smith Street site up on the Gold Coast, which is a big comprehensive site, due to open in September, you know, just around construction and, and all that sort of thing has led to a few months delay. So I think that, that significant spend, which was originally thought would occur in FY twenty-four, didn't, and will slip into FY twenty-five. And so there's probably a few other examples like that.
And, you know, the range that we're guiding to 40 to 45, I think is essentially, you know, obviously based around the budget. I think historically, if you look at it, we've typically probably spent at the lower end of that range, and that's usually a function of, you know, even though things are planned, there are, you know, often delays around construction, you know, getting the various certification that you need and so on. So, my sense is that, you know, I'd be probably guiding to the lower end of that 40, 40 to 45 range.
Great. Thanks, Ian. Thanks, Craig. Thanks.
Thank you. Your next question is from Steve Wayne, from Jarden. Go ahead, thank you.
Yes, good morning. I just had a question around, Craig, you mentioned the administrative synergies that might emerge that haven't been taken up or accounted for in your overall ten million figure. Could you just give an idea of what administrative synergies that represents? And then the second part of this is, now that your gearing has come down a bit in the year, the aggregation of the two businesses, what sort of benefit could you expect to see with further lowering of that gearing? I'm just trying to understand the sensitivity to your spread as you move or become less geared over the next sort of twelve months.
Yeah. So, I think probably two questions there, Steve. So firstly, look, we-- you know, when we talk about administrative synergies, I think we're probably talking about process improvement, particularly around billing. You know, I think there are some practices that we have internally within IDXT, that I think can be applied across the capital business that are likely to lead to an improvement in the efficiency of that process. So that, that's what I'm referring, what we're referring to there. I think in terms of gearing, look, a couple of comments.
Clearly, as you say, you know, when you, you know, you look at our gearing now, 2.6, and Capital's gearing, and assuming the merger goes ahead later on this year, yeah, consistent with what was said earlier about the merger, the merged group gearing is lower. I would say that we are in the process of effectively looking to refinance, you know, the facility for the enlarged group, and the intent at this stage is that we will put that new facility in place concurrent with the implementation of the merger, or very close, shortly thereafter.
And I think, you know, it's therefore very difficult for me at this point to give you a sort of a precise answer, but I think, you know, the expectation is on the enlarged business, we will achieve, you know, better pricing overall as a, you know, on a relative basis. And then obviously at lower gearing, you would expect to, you know, have a lower margin applied to the base rate, as gearing comes down. So, you know, I think those are two key things. I think the other thing I'd probably just call out is in refinancing. You know, we currently have some New Zealand dollar debt. You'll see in the annual report that our average effective interest rate across the year was 7.03%.
That splits about 6.6% average in Australia and 8.1% in New Zealand. So you can see that financing in New Zealand is about a percent and a half higher. And I think the intent is that we would probably look to finance the group in AUD going forward, which will yield a further benefit at the interest line.
Excellent. That's clear. Second question I had is, I'm just trying to understand, particularly on the Australian side, your revenue growth. It was below Medicare, as you pointed out, for the FY 2024 year, and it also was weaker than a lot of the, your peers that have reported this reporting season. I'm just trying to understand what-- how would you explain your relative underperformance at the revenue line, relative to some of your peers?
Thanks, Steve. I think a big part of that is the cost pressures that families have been facing across the country and looking for, you know, bulk billing alternatives rather than having to pay gap payments. So I think you know, looking broadly at the areas where we would have underperformed the market, would have been areas where we did put fairly material gaps in place to counter the inflationary impacts we were seeing. And in those areas, it's yeah, you know, it's the bulk billing competitors that really did benefit as patients shopped around a lot more. So I think that that's probably the single biggest driver for that shift.
If we look at it on a state basis, most of that shift occurred in areas like Victoria, where at Lake Imaging we do charge gaps, and we did see some work go over to competitors who do far more bulk billing. And it happened on a similar basis in areas of Queensland, where we do have bulk billing competitors, versus some other areas where, you know, everyone in the market is charging gaps. We didn't see that kind of market share movement.
Got it. Sorry, could I just probe that a little bit further? Just on the regional exposure that you have, are you still facing shortages of radiologists that might be capacity constraining your volumes as well? Is that another sort of potential explanation for that, perhaps weaker relative to peers' revenue growth?
I don't think that's the case, Steve, but our radiologists, where we are short, are covered nicely by IDXT. I mean, IDXT is a you know terrific strategic lever we have to load balance across practices quite nicely. So, you know, where there is a shortage of radiologists, and there is nationwide, in fact, worldwide, there's a shortage of radiologists. But the shortage is covered by IDXT. And, you know, when we monitor our waiting list, it's not really the radiologist reporting that's driving the increased waiting lists. So, it's. I mean, it would be more related to a decreased patient demand because of the gaps that patients are being asked to fill. We still have capacity at IDXT.
You would've seen in this presentation where we call that 80 radiologists now work at IDXT, compared to, I think it was 65, you know, the last time we put those numbers out into the market. So the teler adiology business, the IDXT business, is growing nicely and covers the radiologists' shortfall quite nicely. But yeah, you know, there is that gap, and you know, what your question does highlight as well is that you know, the biggest impediment to growth for the industry really is the access to those kind of skilled professionals.
In regional areas, it was more acute than it is now, because, you know, international medical graduates come in, they are required to work in regional areas in Australia for up to ten years before they can move to the metro area. So we do see, you know, that shortage, that difference in the regional areas, the relative shortage in the regional areas, the metro areas, not you know, it's not as acute as what it was a year ago.
Great. Thanks, Ian. One final one, if I could. Sorry, this is the last. Technology costs. Just wondering, you know, given your comments just now, whether or not that going into FY twenty-five, whether you're expecting those costs to continue to go up year on year?
Steve, I'll take that. I think, you know, don't want to sort of give specific guidance around these costs, but I think, you know, I would expect that they're gonna continue to be an important feature of the investment that we make in the business. But I do think that there's probably been an increase in spend to establish a new level. And certainly, we would be looking to sensibly control those costs and get the right balance going forward. So, you know, I think over the last probably two years, there's been a significant investment, particularly around cybersecurity, for obvious reasons. And, you know, one would hope that that'll sort of stabilize and grow at more normal levels going forward.
Fantastic. Thanks for answering those questions.
Thanks, Steve.
Thank you. Your next question is from David Stanton from Jefferies. Go ahead, thank you.
Good morning, team, and thanks very much for taking my questions. Look, in terms of EBITDA margin longer term, you were at circa 21% pre-COVID and pre-AASB 16. To get back to pre-COVID margins, post AASB 16 implies an EBIT margin of about 24%. Are you still sort of looking to that as a longer-term target? And if so, you know, approximately what year are you looking at? Thank you.
Yeah, David, thanks for your question. Again, you know, I don't think we're providing any guidance here, but certainly I think, you know, the aspiration to continue to expand margin is there, consistent with, you know, what we've said on previous calls. And I think, you know, as we grow in size and scale, then clearly, you know, I think the merger with Capital, as it proceeds, should help underpin that margin expansion. You know, as the group grows, we deliver the synergies, and all those sort of things. I think that will be a real enabler, and probably consistent with some of the things we've talked about before, I think scale will be a you know, determining factor of margin expansion going forward.
Thank you. That's it from me.
Thanks, sir.
Thank you. Your next question is from Craig Wong-Pan from RBC. Go ahead, thank you.
Thanks. Just on the IDXT revenues, could you share how much comes from internal services versus external work?
Yeah, I can provide you perspective on that. I mean, I think the majority is internal. We are utilizing that platform to load balance across the group. You know, and I think, you know, it's an important tool, if you like, for us to be able to load balance in an environment where there are obviously constraints on supply of radiologists. So the majority would be internal, but we are increasingly winning external contracts as well. And Ian, I think, talked to the most recent of those, which was the mid-New South Wales North Coast.
Yeah, and that was coming to my sort of second question, just those upcoming tenders. Could you share kind of the possible size of those, or just to put in kind of context, you know, the potential, if you were to win some of those, what that could mean for the business?
It's very difficult to generalize, to be honest. I mean, you know, they go from small to, you know, potentially quite large. You know, there are a number of opportunities we're looking at right now as that platform grows, and, you know, I think it's well-respected in the marketplace. I think, relative to some of the alternatives that people might be able to use, so we're certainly looking to grow it going forward. Yeah.
IDXT today is one of the top three teleradiology providers in the country, and probably the fastest growing of those, given the external contracts we've won. And we are, you know, actively competing for contracts as they come up from both the incumbents, as well as new contracts, as people realize the advantages that having scale in teleradiology in particular offers. Because with teleradiology, you can justify having radiologists around the clock. It does give you an ability to help our practices that do have after-hours work, but, you know, don't have that at the kind of scale that warrants having their own radiologists on standby.
And if I could just push a little bit- [crosstalk]
Yeah, see, I guess the other part of the answer as well is that even some of the internal teleradiology work we do is for large external clients that we've been servicing for a long time. For instance, in Western Australia and in Central Queensland.
And if we could just push a little bit on what you consider like a large contract, like a large teleradiology contract. Is that sort of in the tens, like AUD 20 million, AUD 30 million dollars, or what gives you a large contract to be?
No, I think, Craig, I wouldn't be thinking 10-20, although I wouldn't say that's impossible. But, you know, I think, you know, anything in that sort of AUD 3-5 million is a nice add-on for the business at the marginal level.
Okay.
And then-
My last question, just on the changes to MRI licenses, could you share what your thoughts are, how that affects your business?
Yeah, they're quite exciting, I think, particularly for incumbent providers over the next couple of years, because practices that we have, like the Citi Scan practice in central Brisbane, in the Brisbane CBD, for instance, that currently has a partial license. We'll see that upgraded to a full license on the first of July next year. And we have the potential there to even add another MRI, depending on the, you know, increase in demand that we see, that will then be able to, you know, service that area of Central Brisbane specialists, because, you know, there are a lot of specialists in that CBD area. And, you know, if we were to put a second MRI at that site, that MRI would be, you know, immediately licensed. So that's a business case we'd be looking at right now.
There are other similar business cases in other places across the group, but that's sort of the obvious one that stands out.
But on a net basis, the ability for you to get full licenses and get greater reimbursement, is that kind of on a net basis a benefit, or do you think there'll be more competition as well, that could take share potentially from your clinics?
Based on the analyses we've done so far, over the next two years, we should see a net benefit, a nice net benefit from this. Particularly from the six partial licenses we have that now get upgraded to full licenses. Like the one, you know, in the Brisbane CBD, for instance, and five other partials that get upgraded to full.
Okay.
But you know, where we will see a lot more competition would be starting the first of July 2027, when we would be able to see other practices who don't currently have licenses, that may have MRIs or may wish to purchase MRIs, you know, be able to compete with the licensed providers. So we would see, you know, a lot more benefit, I would think, over the course of the next two and a half years, without as much competition as what we would see coming about in 2027. Importantly, though, this is critically important, in Australia, our patient population is less serviced by MRIs than most other countries in the OECD.
So if we look at MRI utilization rates in most of the OECD, including New Zealand, Western Europe, Canada, the U.K., we see MRI utilization materially higher than Australia in terms of MRI scans per thousand population. In the region of, you know, 50% higher MRI utilization in those countries. If you look at the U.S., they're almost twice what we are in terms of MRI utilization per thousand. So part of that difference has been because of the MRI licensing regime that Australia's had for the past several years. And as that changes, we would expect our utilization of MRIs to become much more similar to the rest of the developed world, and at that point, even though there will be additional MRIs in the market, the demand for MRIs will be higher, too.
Great. Thank you.
Thank you. Your next question is from Leanne Harrison, from Bank of America. Go ahead, thank you.
Yeah, good morning, Ian and Craig. I might come back to labor costs again. So in the second half, when we're talking about labor as a percentage of revenue, obviously, the work you've done around managing that has paid off. In terms of percentage of revenue, it's down to 62.1%. Can we expect further labor cost out and efficiency in 2025, and see that percentage of revenue reduce further? Or do we think that, you know, where you exited 2024, given increase in labor inflation and the like, is likely to stay at that sort of level?
Leanne, good morning. I'll try to answer that question. I mean, I think for IDXT on a standalone basis, you know, we did have to reduce some headcount, which I think, you know, we did last October, November. So there are no other programs for a similar sort of restructuring at this stage. What I would say, though, is, you know, we, we will certainly even on a standalone basis, be looking for some operating leverage in terms of, you know, as revenues grow, trying to contain those non-clinical costs across the business. So we would certainly be aiming to bring that percentage down further on a standalone basis.
But obviously, you know, as we, you know, proceed with the merger and assuming that goes ahead, you know, we've talked about the fact that of the AUD 10 million of synergies that we've called out, you know, the majority of those are around, you know, eliminating duplicated roles. So, you know, when you look at it on a combined basis, you would expect that some of that synergy benefit's gonna flow through on the revenue line, sorry, on the labor line.
Okay, thank you. And one other question on GAP. So, understanding what you're saying about, you know, a little bit of volume elasticity there, with some patients moving to bulk billing practices. But, you know, you had GAP increases probably about two years ago, nothing really in 2024, given the MBS fee increases. What's your thoughts on further increases to GAP payments in 2025?
We'll continue to monitor the markets, market by market, and that for us is essentially, you know, each region independently, each city independently. So we do price differently, Leanne, in, you know, Geelong to Ballarat, for instance. And we price based on the supply-demand dynamics in that particular market. It's hard to say at this point what the GAP changes are going to be. Obviously, in those markets where, you know, we've noticed some falloff in volume because of GAPs, we'd be a little more cautious in terms of increasing GAPs. And in some markets we may even look at removing the GAPs entirely because, you know, we feel that the volume benefits from doing that would be worthwhile.
So we do run detailed analyses in each market, and we do monitor this on an ongoing basis. But you're right, the kind of, you know, wholesale gap increases that we instituted at the beginning of the, you know, when we first saw the impacts of inflation roughly 18 months ago, we implemented probably the largest of those. We don't expect that kind of, you know, large increase to come by again, given that, you know, indexation has been reasonable.
Okay, thank you very much. I'll leave it there.
Thank you. Your next question is from Tom Godfrey from Ord Minnett. Go ahead, thank you.
Oh, good morning, Ian and Craig. I'll try and keep it brief. Can I just ask around the cost out you guys took at the back half of first half 2024? Is, is, is that annualizing into 2025? And if so, can you sort of help us with the benefit there incrementally?
... Yeah, Tom, so I think the answer to that question is yes, you will see, you know, a benefit, probably worth about five months' worth, because most of that restructure took place in October, November last year. Look, we haven't called out a specific number, so I don't really want to put a number on it now, but you certainly will see some benefit in this first half.
Okay, thanks, Craig, and a lot of talk around investment in technology costs. Like, when do you expect to see the benefits of the operational efficiencies coming through from the tech investments?
Yeah, I think, you know, it's important to realize that I think some of those investments are necessary. You know, I've talked about cybersecurity. You know, it's not a discretionary spend, and I think anybody who's not investing in that space is probably exposed. But in terms of some of the other investments that we've made, they're both on the clinical and the corporate side, you know, some of that investment has gone into enabling and, you know, our teleradiology business. So you'll certainly see benefits going forward from that. And on the corporate side, you know, increasingly, you know, we've got enterprise-wide systems now that, again, as the merger with Capital Health proceeds, we would see that being a key enabler of getting some of that operating leverage in terms of technology cost.
Got it. That's clear. And just last one from me, just on the outlook slide, you called out mid-teens growth for July. Just sort of wondering if the movements in working days, whether it's pretty consistent in August?
Yeah, I think if you were to adjust for the working days, August would not be dissimilar.
Great! That's helpful. Thank you.
Thanks, Tom.
Thank you. Your next question comes from Andrew Paine from CLSA. Go ahead, thank you.
Yeah, morning, guys. I'll be quick. Craig, just wondering if there's any guidance you can give us on interest, net debt, and tax expense into FY twenty-five?
Andrew, I think, you know, I'd point you obviously to the supplementary slides we've included at the back of the investor presentation, so I'm talking about slide 29. I think, you know, we haven't provided specific guidance, so I'm not gonna give you specific numbers, but I'd encourage you probably just to have a look at those FY 2024 numbers, and I'm sure you can sort of probably apply some estimates, particularly based on some of the earlier comments I made around debt refinance. Of course, you know, the other thing is, you know, assuming the merger proceeds, then that's obviously going to impact all these numbers as well.
Yeah, okay. So if we look at, like, two half exit rates and then, yeah, add your comments on top, that'd be better?
Yeah. I think so.
Fine.
You'll certainly see when the scheme booklet comes out. You'll see pro forma historical financials prepared, and that'll probably provide you a guide as well.
Okay, that's great. And just, like, one on, I know you've touched on this, but just looking at the second half growth in Australia, revenues were up about 5.9%, but that benefited from, you know, pretty good indexation plus the additional 0.5%, that came through in November. So, you know, backing all that out and kind of making some adjustments there, you might be looking at about 2.5%, give or take, mix volume as the growth driver there. You know, it seems kind of pretty weak, and I know you've touched on it, but you know, is that all in relation to people, you know, cost of living pressures and moving away to bulk billing facilities?
You know, again, is that something you expect in 2025?
Yeah, I think that what we've seen also is an increased tendency for referrers to refer patients directly to the higher value modalities, and not build up the same way as they did in the past. So historically, the way it generally worked is referrers would refer patients for an X-ray or an ultrasound, and if that came back and it was not definitive, they would then refer the patient on for a CT or an MRI. What we're seeing increasingly now is the referral coming in directly for the CT, or directly for the MRI, and bypassing those lower value-added studies initially.
So that's also impacting volume somewhat by, you know, increasing the revenue we get from the higher value modalities, but reducing the number of tests and the number of patients that present to the clinics, 'cause they'd be presenting once, not twice.
Yeah, and I think the other thing I'd probably just mention, just to take you back to slide 10 and the average fees per exam, you know, which in Australia over the year were up 7.7%, which is pretty solid. You know, obviously, the Medicare indexation contributes to that. There was some annualization of price increases, but you know, there's probably a good sort of three and a half percent modality mix benefit in that number. So probably a little stronger than the numbers you mentioned, Andrew.
Okay, so 3.5% modality, so then you've got volume plus you've got price. Like, where's the issue? Like, is that then that implies volumes went backwards.
Yeah, I think, I mean, I think it'd be fair to say, yeah, I mean, you can see that the average fee per exam increased by 7.2 against overall revenue growth, seven. Oh, sorry. Average fees per exam grew by 7.7 against organic revenue growth of 7.2. So volumes did decline overall by 0.5%, and that was a function of the movement in mix towards, you know, MRI, CT, PET, and so on.
Okay, sure. Look, I'll, I'll leave it there. Thanks.
Thanks.
Thank you. Your next question comes from Gretel Janu from E&P. Go ahead, thank you.
Thanks. Just one question for me. Just in terms of New Zealand, we could just see the revenue line picking up in the second half. Just wondering now, what are the expectations for the contribution of New Zealand going forward, and particularly to margin here? Thanks.
Yeah, thanks, Gretel. I mean, New Zealand contributes about probably 12-13% of revenue, a little higher in terms of margin, given the EBITDA margins, a little in excess of 30%. So, you know, I think we would be sort of looking for, you know, continued solid growth, both in Australia and New Zealand going forward. So I wouldn't see that overall mix shift between geographies being, you know, sort of a major issue.
Great. That's all I had. Thanks.
Thanks, Gretel.
Thank you. Your next question comes from Andrew Goodsall from MST. Go ahead, thank you.
Thanks very much. I'm down to one as well. But just thinking forward to the deregulation in twenty twenty-seven, I guess there's two things in our minds. Is there a sort of risk that there's a bit of an arms race to close out any underserviced areas? And secondly, with that level of competition, what does that do, in your mind, to the opportunity to seek a co-payment?
Thanks, Andrew. The increased competition that we will see from 2027 onwards will make it a little more challenging in some areas to put gap payments in place. But by the time we get to 2027, though, we would've seen, you know, MRI utilization in Australia catch up a lot more to be more similar to the rest of the world. So I would see demand for MRIs continuing to increase, and I would see practices in areas where we can provide that premium service, where we have access to that subspecialty radiologist reporting in those areas, and patients that are referred by specialists, where they've been paying gap payments to those specialists, continue to, you know, pay gaps in radiology as well.
But we'll obviously monitor market by market to determine, you know, where we can put the gaps in place. And in 2027, there'll be, you know, more competition, and competition from other areas that you know, we're not gonna see for the next two and a half years. So it's yeah, 2027's quite a way out. I would expect the way that MRI utilization around the world is increasing, that even if there is an arms race to bring in more machines, I would see that the demand for MRI continue to, you know, match that increased supply coming in.
It's just such a useful modality, and it's being used more and more, and it's changing the, you know, treatment patterns, you know, for some very high volume conditions, for knee pathology, for instance. And I would see, you know, Medicare and other payers being pressurized really to open up a lot more indications for MRI, because these indications, there's just evidence based for MRI utilization to continue to go up. So a good example of that is MRIs of the knee for patients over fifty, who are the patients who need it, knee MRIs. Medicare used to pay for that a few years ago. They've not paid for that for patients over fifty.
It's been taken off the Medicare benefit schedule over the past few years, but, you know, I'm sure that when they are reflecting on the data now, they would've seen, you know, knee procedures undertaken by orthopedic surgeons going up a lot more because GPs don't have access to MRI of the knee for patients over 50, the way that they did, you know, back in 2018 and earlier. So I would see MRI indications continuing to grow. Cardiac MRI is becoming more and more important. Breast MRI, prostate has been a, you know, high growth area for us for some time, and should continue to see growth. So yes, there will be a lot more supply in 2027, a little more supply in 2025.
but it's, you know, it doesn't, it's not a concern at this point, certainly not in twenty twenty-five, when the competition would still be limited. It's a very sensible expansion path that Medicare has embarked on, by allowing the existing practices with licenses to expand for additional licenses before, you know, before allowing an arms race, like the one you allude to, to begin, and I think that by the time that that does start, you know, the market will be seeing a lot more demand for MRI.
That's, that's terrific. Thank you. Comprehensive. Thank you.
Thank you. There are no further questions at this time. I will now hand back to Dr. Kadish for closing remarks.
Thank you very much, and thank you all for your attendance. The session really was engaging, and we appreciate the questions that were asked. We are particularly excited at this point, both in terms of you know, what we're seeing in the industry overall, and what we're seeing in our business, and the potential for, you know, increasing the scale of our business through this transformational merger that we've proposed with Capital Health, that we expect to be completed towards the end of the calendar year. So it's it is a particularly exciting time. We do appreciate the support that we have and do get from our shareholders, and thank you for your interest this morning.
Thank you. That does conclude our conference for today. Thank you all for attending. You may now disconnect your lines.