Ladies and gentlemen, good day, and welcome to Max Healthcare Institute Limited Earnings Conference Call. As a reminder, all participant lines will be in the listen-only mode, and there will be an opportunity for you to ask questions after the presentation continues. Should you need assistance during this conference call, please signal an operator by pressing star, then zero on your touch-tone phone. Please note that this conference is being recorded. And now, I hand the conference over to Mr. Suraj Digawalekar from CDR India. Thank you, and over to you, sir.
Thank you, Neeraj. Good morning, everyone, and thank you for joining us on Max Healthcare's Q1 FY 2025 earnings conference call. We have with us Mr. Abhay Soi, Chairman and Managing Director, Mr. Yogesh Sareen, Senior Director and Chief Financial Officer, and Mr. Keshav Gupta, Senior Director, Growth, M&A, and Business Planning. We will begin the call with opening remarks from the management, following which we will have the forum open for an interactive Q&A session. Before we start, I would like to point out that some statements made in today's call may be forward-looking in nature, and a disclaimer to this effect has been included in the earnings presentation shared with you earlier. I would now like to invite Abhay to make his opening remarks.
A very good morning to all, and a warm welcome to Max Healthcare's earnings call for the first quarter of fiscal year 2025. It has been a very promising start to this financial year. I'm pleased to share that we have operationalized Max Super Speciality Hospital, Dwarka on July 2nd, located in the heart of South Delhi. It is a 303-bed hospital equipped with the latest high-end technology and currently has 125 doctors and 480 nurses, paramedics, and support staff. The hospital is seeing good traction since the launch. Presently, the hospital team is engaged on various fronts, including patient outreach, empowerment with insurance companies, clinical accreditation, et cetera. Yesterday, we announced a build-to-suit transaction for setting up a 250-bed hospital in Mohali. This 275,000 sq ft building with attendant parking will be constructed by the developer as per our requirement and specifications.
This is a long-term lease extendable up to 50 years at our option, and we expect to commission the facility before FY 2028. The hospital will cater to surrounding areas of Himachal Pradesh, Punjab, and Haryana. This is in line with our asset line strategy, which allows us to expand while insulating against development risks. Further, in strong demonstration of our turnaround capabilities, both Lucknow and Nagpur hospitals that we acquired at end Q4 last year are ramping up well. With an average occupancy hovering around 60% for Q1, these hospitals contributed INR 99 crores to the revenue and INR 18 crores to the operating EBITDA, reflecting a year-on-year growth of 21% and 64%, respectively. More importantly, this was done within the first three months of us acquiring these facilities. Collectively, their ARPOB stood at INR 45,300 and annualized EBITDA per bed of about close to INR 30 lakhs.
A large part of the post-merger integration activity has been completed now, the results of which will be more visible in the quarters to come and further augmented as new clinical teams join and infrastructure is upgraded there. Now, coming to the Q1 performance, this is our 15th consecutive quarter of year-on-year growth. Overall, network gross revenue stood at INR 2,028 crores, registering a growth of 18% year-on-year and 7% quarter-on-quarter. Network operating EBITDA was INR 499 crores, net of one-time charge of INR 6 crores towards pre-launch costs at Max Dwarka. This reflects a growth of 14% year-on-year and a marginal decline of 1% quarter-on-quarter. Profit after tax stood at INR 295 crores compared to INR 291 crores in Q1 last year and INR 311 crores in the previous quarter.
While we expect substantial improvements during the course of this year, we are also infusing equity in the Lucknow subsidiary to bring down the finance costs. All numbers from here on are going to be now shared for a like-for-like basis, excluding new hospitals. Our average occupancy for the network increased to 77% from 74% in Q1 last year and 75% in the trailing quarter, while occupied bed days grew by around 5% year-on-year and 2% quarter-on-quarter. Average revenue per occupied bed ARPOB for the quarter improved to INR 80,100, growing by 7% year-on-year and 3% quarter-on-quarter. Year-on-year improvement in ARPOB was largely due to growth in oncology, orthopedics, and renal sciences, as well as an increased number of robotic procedures. This was coupled with tariff revisions for self-pay insurance and institutional segments.
Network gross revenue was INR 1,929 crores compared to INR 1,719 crores in Q1 last year and INR 1,847 crores in the previous quarter. This reflects an increase of 12% year-over-year and 4% growth versus the trailing quarter. The international patient revenue stood at INR 158 crores. There was a temporary impact on patient flows from some countries due to political situations and credit risk management-related actions taken by us, which accounted for the muted growth in this segment. Network operating EBITDA stood at INR 487 crores, reflecting a growth of 12% year-over-year while declining by 2% quarter-over-quarter. Operating EBITDA margin stood at 26.5% for the quarter. Growth in EBITDA was impacted due to annual merit increase, GST on variable management fee, and drop in footfall for immigration health checks owing to change in visa regulations by some countries, particularly Canada and U.K.
Annualized EBITDA per bed stood at INR 74.7 lakhs, clocking a growth of 6% year-on-year. Profit after tax was INR 316 crores versus INR 291 crores in Q1 last year and INR 322 crores in the previous quarter. Free cash flow from operations was INR 258 crores. Of this, INR 213 crores was deployed towards the ongoing capacity expansion projects and upgradation of facilities at new hospitals. Consequently, net cash position stood at INR 66 crores at the end of June 2024. Continuing our efforts to support the local communities, we treated approximately 36,800 patients in OPD and 1,150 patients in IPD from economically weaker sections of society, entirely free of cost or free of charge. Both our strategic business units continued to report significant growth in their revenue and profitability. Max at Home reported a top line of INR 49 crores, reflecting a strong growth of 23% year-on-year and 6% quarter-on-quarter.
This SBU offers 14 service lines over 10 cities and continues to experience a very high rate of repeat transactions. Max Lab, the non-captive pathology vertical, now offers its services in nearly 50 cities and has a network of over 1,100 collection centers and active partners. This strategic business unit reported a gross revenue of INR 41 crore, reflecting a strong growth of 21% year-on-year and 6% quarter-on-quarter. Now, coming to the status of expansion projects. For the 590 beds at Lucknow Hospital, the work on refurbishing the existing facility is underway. Finishing work for operationalizing additional 140 beds has started. We have also received the environmental clearance approval for setting up a new 450-bed tower on this site, and we expect to complete the development of the new tower within 48 months, sorry, within 24 months.
For 140 beds at Nagpur Hospital, work has been initiated to add around 25 beds through internal reconfiguration by Q3 FY 2025, and environmental clearance application for adding 115 beds on two additional floors has been filed. We expect approval over the next 2-3 months and the project completion by in the next 24 months as well. For 241 beds at Nanavati, Phase 1, the hospital structure will be up in this month, and the project completion is expected by end of this fiscal year, as communicated earlier. The project continues to be on schedule. 375 beds at Max Smart at Saket Complex. The project was fast-tracked in Q4, and we expect its completion by Q1 FY 2026. This is a steel structure building, and the installation of columns has already started. The site is fully mobilized, and we don't expect any further delays.
For 155 beds at Mohali, work on the second-floor slab is underway. While the work on ramp area is reaching ground level, all high-side equipment has been ordered, and the project was on schedule. We expected completion by Q1 FY 2026. For 300 beds at Sector 56, Gurgaon, basement slabs are nearing completion, and the project is progressing as per plan. Orders for all long-lead items have been placed. We expect completion for the first phase by Q2 FY 2026. For 250 beds at Patparganj, Phase 1, post-issuance of the no-objection certificate by the Fire and Water Department, we have submitted the drawings for approval, and the tendering process for this project is on. For 415 beds at Max Vikrant Saket, the environmental clearance and consent to establish has been received. The barricading and D-walls, et cetera, have started. We have applied for forest approval and are still awaiting the same.
We expect some delay due to ongoing litigation involving DDA and Delhi government regarding cutting of trees in the eco-sensitive zone near Asola and the Ridge areas without approval. With this, we open the floor for Q&A.
Thank you very much. We will now begin the question and answer session. Anyone who wishes to ask the question may press star and one on their desktop phone. If you wish to remove yourself from the question queue, you may press star and two. Participants are requested to use handsets while asking a question. Ladies and gentlemen, we will wait for a moment while the question queue assembles. Participants, you may press star and one to ask the question. Participants, you may press star and one to ask the question. First question is from the line of Amey Chalke from JM Financial. Please go ahead.
Yeah, thank you for taking my question. The first question I have is in Lucknow Sahara unit. I understand that we have planned to expand units to 550 beds, and then there is another tower which could come up. But what is the near-term action plan for the existing units of the 250-bed unit in terms of the specialty addition, et cetera? The ARPOB, I believe, was substantially low. So what would be the driver going ahead for this unit to improve ARPOB's function?
The clinical program is clearly one. Adding doctors is the other, and that's how you sort of achieve clinical programs. Improvement in infrastructure. So we are expecting to refurbish the entire, I mean, the present infrastructure as well as add the 140 beds by end of this calendar year. I think as far as clinical programs are concerned, oncology represents less than 2% of the total revenue in Lucknow, so that's a major driver for us. You know, it is a high sort of ARPOB business as well as contributes more than 24%-25% to our overall revenues. So if you look at sort of implying that over there, you'll see a major flip in ARPOB.
I think, like I mentioned, we've had in the first three months, literally, I mean, we got there, we acquired it end of March, and April, May, June, compared to April, May, June last year, there's been a 60, 60-odd% increase in EBITDA, and this has largely come through all the sort of low-hanging fruit, et cetera, which is there. The real changes that we may have made, you're going to have all of those sort of pay dividends in the quarters to come. Also, you know, typically, we have a higher proportion of surgical business that we do in our hospitals and a lower proportion of medical business, whereas in both Nagpur as well as Lucknow, the situation is the other way around.
I mean, it's a higher sort of, so when your surgical mix moves up with respect to the medical mix, you see higher ARPOBs in any case. So there are plenty of levers, so I'm not sort of concerned about that. And frankly, I think the kind of traction that we are getting, the kind of, you know, the early wins that we've been able to demonstrate over there, it gives me a lot of confidence that we should be able to ramp up both ARPOB as well as profitability there.
This oncology addition, et cetera, should we expect it in the current existing unit, or it will happen when the expansion for the bed addition happens?
No, the existing unit, we already have bunkers for radiation, et cetera, which are non-operational. We will just operationalize this. You know, the 140 beds that we are adding, as well as this thing that we are doing, is going to happen by the end of the year. Actually, even the new tower that we are building is going to be done over the next 24 months because, you know, it's 27 acres of land. We don't have to do so many basements and so on and so forth, you know, similar to what we've done at Max Smart and some of the other things that we're looking at. But yes, the oncology business should ramp up in the current year itself. I mean, it will not ramp up to 25%, but you'll see ramp-ups in the quarters to come immediately, as well as the surgical business, right?
Sure. Thank you.
And even after we sort of take over these, when we start adding doctors, when we give doctors letters of intent and, you know, they sign up with us to join us, they have a 2-3-month notice period. So it takes them kind of time to join us. And as the infrastructure sort of, you know, the equipment has been ordered, the new equipment, and so on and so forth, as that comes through, you see more and more teams coming up, right? Now, all the technology, all the equipment is being replaced and so on and so forth, right?
Sure. The second question I have, you know, the Dwarka unit, which has been recently commissioned, if you can provide some timeline over where how the ramp-up will happen and in terms of the specialty, is it at par at present with the other units, or you think the improvement will happen over a period of time? Thank you.
No, sir, in terms of the infrastructure is concerned, it is at par. I think the bunker is not ready as yet. That is going to be ready in due course. But other than that, I think as far as infrastructure and technology is concerned, not only is it at par, but it's the new generation. So I would say it's perhaps one or two steps ahead of the existing infrastructure. We have again seen very, very good traction over there. It is a massive facility. It's the best infrastructure of its kind in the region of Dwarka. You know, there's a huge amount of, again, fantastic traction is what we've seen in the first month itself, and I think this should continue. You know, you should have a break even no more within, you know, six to eight months.
Sure. Thanks for having joined us.
Thank you. Next question is from the line of Lindi Tan, from Lion Global Investors. Please go ahead.
Yes.
Lindy, sorry, we're not audible. I mean, you're not audible. Can you speak through the handset? Lindi Tan, can you hear us? Lindi Tan, your audio is not clear. Can I request you to speak through the handset?
I don't think he's talking to us. Why don't you take the next?
Sure. Next question is from the line of Rishi Mody for Marcellus Investment Managers. Please go ahead.
Yeah, hi. Abhay, can you hear me?
Yes.
Yeah. So Abhay, just on the Mohali hospital that you're planning to add four years out, right, are we going to be, is this going to be firstly an O&M agreement the way we have with Devki Devi and those kind of hospitals, or is it an outright rental sort of a model that we see in retail where we don't incur a CapEx? We are just put in a security deposit and we start operating on it?
So it is the latter. It is, we are leasing it. It's an outright rental/lease model where somebody else is putting the infrastructure and has invested in the land, making a built-to-suit. It's a 50-year lease agreement. The only difference is normally you have, you know, commercial leases for 9 or 15 years or whatever, but here there's pretty much a 50-year lock-in. So yeah, it's a 50-year lease agreement that we will have.
Okay. Just from a broader conceptual point of view, right, are we seeing incremental interest from, say, the builder or real estate community towards having these sort of models, or like if you can just share your observations from across North India or rest of the country?
You see, it depends on the tenant. Today, if you tell a builder that you please make a bill-to-suit, and I will give you 8, 8.5% yield, and I'll give you whatever, 3, 4%, you know, increment every year. I mean, that is what the market is, right, as far as commercial real estate is concerned. So as far as the builders are concerned, developers are concerned, they're happy to do it for commercial real estate, for retail real estate, or for hospitals. The question is how many hospital chains can offer this? Your own ROCEs have to be significantly higher than what you're paying out over there. So I think, you know, in our situation, we are able to take up these hospitals because our ROCEs are significantly higher. And so the bill-to-suit kind of model works for us.
It may not be the case, I mean, it certainly works for the developers. They are taking, you know, a punt on our balance sheet effectively, and that is where they're getting the listing that, look, we'll be around for 50 years, and, you know, they'll be able to, after even making that particular hospital or that listing and dedicating it to us for 50 years. Because do remember, this is built-to-suit. So it's not, it's as per our design. So if somebody's building something, you know, under certain specs and is leasing it out to you for 50 years, he has to sort of be very confident that you will be around for 50 years and your balance sheet will be able to hold it. Now, I think that's a punt a developer needs to take because eventually you're tenants.
But you are a tenant for 50 years, it's not as if you can move this hospital and you start, you know, using it for a mall or give it for some other purpose or hotel or whatever else it is.
Right. All right. Secondly, just I think you went through the capacity addition plans and updates pretty quickly, but just on an overall basis versus Q4, any delays or any preponement, just if you could highlight that piece?
Not really. So we're not expecting any delays or preponements. I think you're going to have, except for Vikrant, I think, which is the last one, which in any case was a 2028 generation hospital, which we're expecting maybe a couple of quarters of delay on that one. Other than that, we're not expecting any delays. So you should have Mumbai, Mohali, as well as Saket up by Q4, Q1.
Okay. Got it. Yogesh, I had a question for you on the tax rate piece. So I'm seeing our tax rate for this quarter has come up to 26%. Just wanted to understand because I'm under the impression that we have a tax benefit in the BLK and the Nanavati and now with the Dwarka unit. So is my understanding correct? And this is just a factor of the profitability for these two charitable hospitals. If you could just help me understand the tax piece for y'all.
That's right. So this is Yogesh. Yeah. So overall rate is 22.8%, right? This quarter, the rate has gone up because we have losses in the new entities, mainly this Sahara hospital entity. You know, this Sahara hospital transition was INR 993 crore. We funded this by INR 840 crore of loan into the entity. And as I mentioned, that Abhay alluded to in his speech that we are changing the capital structure in the company. So since we have losses in the company, we don't, you know, do the DTA as per our policy till such time the company is profitable, right? So that means you have these losses, but you have the tax loss on the other entity. So that is the reason why the rate has gone up. But otherwise, the rate was the same as in Q4.
Q4 was 21.8, and we do think that, you know, going forward, we will be around 22% rate.
Okay. But so just if I take a calculation, right?
Also, on the BLK, the whole, you know, the agreement is that whatever is the net profit, 98% of the profit comes to us, right? So the moment we withdraw that money from there, there are two taxes on that. One is there is GST, and also the other is that when the money comes on this side, then we have to pay tax on it, right? So to that extent, BLK doesn't allow me any tax shield. We don't park money in trust. We sort of take it, we pay full tax on it.
Okay. So for example, now BLK, there's no capacity expansion plan, so you're taking the money, repatriating it to the holding company. But Nanavati, we have a plan of expansion, hence we are not repatriating. But once that expansion is done, it will also become like BLK. Is my understanding correct?
That's right. But also this formula is on cumulative basis, right? So what happened is that the BLK wiped out their losses on a cumulative basis last year, quarter two. So the withdrawal has happened from quarter three onwards, right? So similar thing will happen for Nanavati. The withdrawal will happen, but that will happen once the cumulative profits are made in that entry, in that trust.
Okay. So maybe 1, 2 years down the line, it will start paying off?
Yes. Yes.
All right. Okay. Understood. Yeah. That's it from my end. Thank you.
Thank you. Next question is from the line of Damayanti Kerai from HSBC. Please go ahead.
Hi. Thank you for the opportunity. My first question is on the margin contraction, which we have seen in first quarter. Can we attribute most of that for the new facility cost or between Q4 and June quarter? Have you seen like any major change in the business mix in terms of medical and surgical volumes which are coming to your facilities?
We've clearly seen a change in the clinical mix. It's moved to a higher-end clinical mix. And like I've mentioned in the past, when you do higher-end surgeries, you do more robotics and more oncology and so on, they typically have low margins, lower margins in percentage terms, but higher margins in value terms. So, you know, while you see a flattening of EBITDA margins, you don't, you see an increase in EBITDA per bed on the existing hospitals as well. So I think the takeaway should be that what is the increase in EBITDA per bed? Because eventually we have two things. We've got inventory and we've got number of days in a year.
And it's really, you know, you'd rather do a 50%, you'd rather do a 20% margin on a INR 10 lakh surgery than do a 50% margin on a INR 2 lakh surgery, right? So I think percentage is relevant. I think we should look at sort of the other thing is that we had a reduction in OPDs, like I mentioned, in the current year. And these OPDs were largely from the immigration because of disruption in visas from Canada and from U.K. and a little bit in Australia. We've had reduction in OPDs, and this is the immigration income that we had. So that has had a couple of percentage point sort of impact.
Okay. That's clear. My second question is, a couple of your hospitals are scheduled to start in another, say, 6-12 months, if I may say, Nanavati, Smart, yeah, Mohali.
6-8 months, that's right.
Yeah. So just want to understand when you, like, when you are about to start a new facility, when do you start your pre-launch activities and what kind of cost you are anticipating for these upcoming units?
So look, unlike Dwarka, which is a, you know, it's a new facility. So what you have to do is you have to actually have a minimum amount of doctors and staff, et cetera, which is pretty much you need to staff the entire hospital, okay, in that case, before you apply for even a nursing home license, right? So you're sitting fully staffed, okay, then you make the application for the nursing home license, okay, and then you need to sort of promote the facility by advertising it and so on and so forth, by onboarding doctors and, you know, getting new, getting all the insurance companies and TPAs onboarded, by getting institutional sort of this thing, by public, you know, corporate tie-ups and so on and so forth. So you're really starting ground zero.
All of the facilities that you've sort of alluded to right now, be it Nanavati, Mohali, as well as the Max Healthcare, they're all existing facilities. So I don't need to promote existing facilities. There are enough people waiting in Mumbai over there waiting for beds, right? And it's going to be very similar to what happened in Shalimar Bagh. In Shalimar Bagh, we didn't have to have any pre-op expenses really or, you know, promote those facilities or even wait to get these. So all the contracts, everything is already pretty much signed up. So you won't see any pressure on margins over there. I think, you know, almost, almost day one, you're sort of good to go.
Okay. Understood. My last question is on claritY-on-Your Mohali planned hospital. So you said it's a 50-year-long lease, and it's a built-to-suit premises which you'll be getting. So there will be no CapEx once you get the facility leased. It's just, let's say, equipment and then people's costs which will be going towards this unit.
That's right. That's right. So we will be providing the medical equipment and, you know, other than the deposit again, which is interest-bearing and loose furniture, you know, the entire project cost is incurred, including the land and building, et cetera. And more importantly, any delays, any cost, time overruns, everything are to their account.
Okay. Understood. Thank you.
I mean, this is very similar to what we've done in Dwarka, right?
Okay. So the way, like, Dwarka, it's an O&M facility which you got into your network, but.
This is not an O&M. This is a lease. But the same listing as Dwarka in the sense that, you know, developer develops it, and he incurs the project cost. We bring in the equipment and so on, okay? And, you know, I mean, whether you look at O&M or a lease, the commercials are pretty much the same. That's it, right? That's it, right?
Okay. Thank you. Thank you for your answers.
Thank you. Next question is from the line of Kunal Randeria from Axis Capital. Please go ahead.
Hi. Good morning. In the last few quarters, the number of your institutional beds is standing, it's around 29%. Do you see headroom for some improvement over here?
We do see headroom for improvement here, but, you know, first quarter and usually the third quarters are weaker quarters. So compared to a fourth quarter, what you take your foot off the accelerator, you know, there's not the time sort of this thing because your occupancy level is subdued at that point in time. So if you want to kind of, this is, and you're not going to churn your patients. Typically, you'll see churn happening in the second quarter and the fourth quarter.
Right. Okay. So because even I think in last quarter, it was somewhere around 29%, right? So, you know, I thought it's just in the last five or six quarters, somewhere in this range.
But that's at Q4, right? The fourth quarter is a strong quarter. So if you see Q3 versus Q4, there may have been some change. But if you look at Q4 versus Q1, you won't have a change. So typically now, again, from Q1 to Q, sorry, Q1 to Q2, you'll see a change, but Q2 to Q3, you won't see a change. I would also say there's a change that you don't see. That change is in the ARPOB of the business, right? So we do the PSU business, but while you may see the same beds, but the throughput of those beds has gone up. If I see the improvement in the ARPOB, it's Y-on-Y, it's a 10% improvement in the ARPOB of the PSU. So which means that we are within that beds, we are trying to do high-end work, right?
Sure. Got it. Just second question about.
Yeah. Yeah. This question. Yeah.
Yeah. Sure. Second question on ARPOB, this quarter saw around 7% growth on your, you know, existing units. So is this the new normal that we should expect going forward?
No, I think, you know, we've had a, because of immigration and visas, okay, that's had a, you know, maybe a couple of 2-3 percentage point impact on ARPOB. That is something we had last year, but this year there's been some disruption because of Canada not issuing visas, U.K. immigration visas have been sort of this thing, and we've seen the same with Australia as well. We believe it's a temporary phenomenon, and, you know, that business is sort of this thing. But if it doesn't, then we kind of repurpose that space to put more IPD beds and so on and so forth. We'll catch that up, but yeah. So I think seven would be a little muted compared to perhaps what we had in the past.
Sure. Got it. Sorry, when you say this, I'm assuming the new units that are coming in, or it's only for the existing units?
Sorry? Which is?
So when you mentioned that your growth should be higher than 7%, so does it include all the beds or just the new units? It has the existing units.
New units will be a significantly higher ARPOB growth, right? I mean, new units are starting at a low base. So if you combine the two, then your growth should be more.
Okay. Okay. Okay. Okay. For example, I mean.
I mean, you had a revenue growth of 21% in the new units, right?
Okay. Okay. Because so you are saying that maybe Lucknow and Nagpur, whose ARPOBs are lower, should grow at a much faster pace than your existing hospitals?
And Dwarka.
Dwarka. Okay. Sure.
Right? So I mean, your percentage growth, the absolute base is lower. They're starting on a lower ARPOB.
Sure. Sure. So okay. So.
Had a 21% and 64% growth in Lucknow and Nagpur on sort of revenue and EBITDA alone. So you can imagine a huge amount of growth comes from that, right?
Sure. Sure. Just one, you know, I think Lucknow seems to be like a go-to spot for a lot of your peers also. Do you think that so many beds coming up in that area, there is enough medical talent available, both from a doctor as well as from a nursing perspective?
Actually, I don't know of any other hospital coming up there. I mean, besides Medanta, which has been there for a while and a smaller, smaller Mukholo facility, which has again been there for five, six years. And this was also an existing facility. And other than that, we've only bought the land, you know, in Shaheed Path, which is opposite Medanta, but I don't, I haven't heard of any other hospital really coming up there. But nevertheless, we don't, we see an abundant supply of talent there. In fact, the doctors that we employ are daily, and a lot of them are from SGPGI, you know, Lucknow. So to that end, you know, we don't see, we haven't really had.
So you know, historically, Lucknow has been the place where we've got most doctors. I mean, 25%-30% of our daily doctors are from Lucknow. Historically, Lucknow has had medical colleges and government medical hospitals, et cetera, and so a big, big sort of base of doctors there.
Right. Right. Okay. Got it. Thank you. And all the best.
Thank you.
Thank you. Next question is from the line of Dheeresh from WhiteOak Capital Management. Please go ahead.
Yeah. Thank you for the opportunity. Sir, which quarter do we take the annual increments? Is it this quarter or?
First of April.
First of April. Okay. For the Mohali asset that we mentioned, it would be possible for you to share how much the partner, the listed partner, is investing in the land and building for the 250-bed?
I can't share that. He already, you know, he owns the land, so he would have.
We have a fixed rental.
Specifications and have BOQs, you know, then they don't sort of share what they are spending. But usually, land and building will cost, but the building alone will cost about 80% of the total project cost if we were to do it.
The line for the participant drop. We move on to the next participant. Next question is from the line of Adrit Chaturvedi from Nomura. Please go ahead.
Hi. So I have a question specifically regarding the improvement business. So you reported this quarter around INR 1,600 crore of.
Sorry to interrupt you. Voice is coming muffled. Can you speak through the handset, please? Hello?
Hello.
Yeah. Yeah.
Yeah. Yeah. Yeah. So my question is specifically regarding the inpatient business. So you've reported around INR 1,600 crore of IP revenue. So that's around 21% YY growth. And also, the volumes have grown by roughly 17%. So that translates to about like 3.5% growth in realization. Now, this 3.5% is sort of one of the lowest in the preceding quarters. But at the same time, the volumes are like highest in the preceding quarters. So is this the sort of sort of business profiling that we should come to expect as you grow and you expand, that your realization per patient on the IP business is going to be around 3%-4%, but you're going to focus more on volumes?
No, because you are looking at the overall number, which includes the new facilities, right? So you should compare the number on Y-on-Y basis for the existing hospital separately because the new hospital ARPOB is obviously lower, right? And also, you know, so to that extent, you find a volume increase, but not, you know, the increase in the revenues because of the ARPOB issue. As I mentioned, that, you know, as we have changed the mix of the business in those new hospitals, we also put in oncology there and have more talent there. Slowly, the ARPOB will inch up, right? So there's a difference of INR 80,000-INR 45,000. The new hospitals have an ARPOB of INR 45,000, and our existing hospitals have an ARPOB of INR 80,000, right? So we think that INR 45,000 will, you know, surely come up fast.
It should be, you know, anything between 60-65,000, let's say in a year's time. That's how this will catch up, right? Then you'll find that the number increase and the overall revenue increase will kind of, you know, start to have lesser differences.
Okay. So the backdrop, so the backdrop also on the levers for these realizations, right? So like if we look at the sum of shares of oncology, cardiac sciences, orthopedics, neuroscience, and renal, like the sum, the share has come down this quarter on a YY basis. And that's a first in a while. And even, even.
Because you are including the new hospital. Because you included the new hospital, which has less than 2% oncology share, right? So it will, right?
So, what's the?
Because the new hospital's share is very different from what we have in the existing hospitals.
Right. So when do you suspect, like as the expansion ramps up, that we would have a sort of a resting rate where, as you said, ARPOB grows at roughly 9%-10%? So I guess the realizations grow at 8%.
No, no, no. It doesn't work like that. So please understand, okay? What are we, what is it that we focus on? We focus on acquiring facilities, okay, turning them around, see that this thing, get higher ROCEs over a period of time, but you look at it on an incremental basis, right?
Got it. Okay.
Now, all of, if we bought something, okay, with a lower EBITDA, you know, lower ARPOB, okay, and we are demonstrating an increase in that ARPOB, it may or may not get to, you know, a Nagpur hospital will not have the same ARPOB, okay, eventually, but that a Delhi hospital does.
Okay. Yeah. So yeah.
Nor may it have the same EBITDA per bed. What you have to see is, okay, vis-à-vis what you paid for it, okay, what is the sort of return you're going to get, and so on and so forth. Yes, the levers for doing all of that, and what we are seeing is that levers for doing all of that is going to be better critical mix, you know, doing more surgical work, less sort of this thing, et cetera, higher oncology business, and so on and so forth.
Okay.
Now, you may get to that mix of 25% or 24% oncology, okay, but you may not get to the ARPOB because, you know, the rates over there are cheaper. I'm not even chasing the Delhi ARPOB with it, right?
Yeah. No, I understand. So just lastly, so a lot of your peers have mentioned that they're sort of translating a lot of the lower ALOS businesses to like daycare. And right now, your IP business is roughly 80% of overall. So you don't give any separate numbers there. So do you have like any kind of qualitative color regarding what's the OPD margin profiling as versus daycare and how it helps your margins if you sort of translate a lot of those lower ALOS to daycare and census beds, non-census beds?
Also, look, I think if you, the lower ALOS business to this thing has its own sort of tenets with it, okay, because currently insurance companies don't cover businesses which are where you don't spend the night in the hospital, right? So you need to spend the night for insurance companies. So daycare business may not be covered by the insurance companies. That itself is a kind of this thing. So, you know, by squeezing a lower ALOS business and doing a daycare, I mean, of course, if you can, a daycare's a procedure, okay, the longer you stay in the hospital, the hospital loses money, loses money, right? I mean, the surgical part is what makes money. So if you can translate anything into a daycare, get a person in the morning, do the procedure, and have him out by the evening, okay, your yield is significantly higher.
The question is, why is it that you can't do it? Because for a lot of the procedures, or for most of the procedures, you need to stay the night in the hospital to claim insurance.
Okay. So on the cash patients, like the cash patients, is there a targeted strategy there to like move a lot of these lower ALOS to daycare? Or is it something that's not the focus right now in terms of your non-IP business?
We do that as hygiene, right?
Okay.
I don't know exactly what you're seeking. If you're able to articulate a little better, then perhaps I can answer you for this question. I think for us, the ARPOB is the one that we go for, right? We will obviously, and you know, this daycare procedure will be all run-of-the-mill procedure, right? Our focus is to, you know, go up the value chain, right? So we'll be pursuing liver transplant, oncology, neuro, cardiology, cardiac surgeries. I think those are the procedures that we pursue, right? So while we'll obviously, there'll be shift of some daycare procedure, you know, one day stay, can you do it in daycare? Yes, we can. We do. But I think that's not the focus of the hospital administration to really, you know, go after, right? And really, it depends what your proportion is, right?
I mean, everybody's ALOS is sort of different because their clinical programs are different. But if you do a liver transplant, okay, your EBITDA per bed, per day, your ARPOB is higher, your EBITDA per bed is higher, right? But the fact of the matter is the patient stays much longer. Now, would I replace that with a dengue patient which has maybe a lower ALOS, but, you know, higher percentage margin, but lower sort of EBITDA per bed? No.
Okay. Thanks, sir . Thank you.
Thank you. Next question is from the line of Prashant Nair from Ambit Capital. Please go ahead.
Yeah. Good morning. Just one question on your, so as your new projects now start coming on stream over the next few years, so if we take some of your larger brownfield projects like Saket or Nanavati, when the new beds come online, would they have similar case mix, payer mix, ARPOB, et cetera, as the older beds, or would they start at slightly different levels and then match up to how the existing hospital beds are?
So you're going to have a different sort of mix to start with because, you know, first and foremost, what you do is you try to ramp up occupancy over there in the new beds. And, you know, when you do that, then you're not kind of very strict on the payer mix as well as the clinical mix, okay? You are going to take, and, you know, people who may not be getting priority today because that's a lower-end payer mix or a lower-end clinical mix, right? You kind of open your doors to it. So ARPOB from the incremental beds is lower. Having said that, having said that, the EBITDA per bed is higher. Your profitability because you get a huge amount of operating leverage over there as well, right? Because your main costs and, et cetera, associated costs, everything is already being incurred by existing hospital.
Sure. And second question, in these projects, you know, would the investment in the beds follow a similar pattern? So say a new greenfield project, you front-load everything, right? So in brownfield beds, is there a period maybe after the first year, second year, when you have to step up either investment in people or equipment so that these beds are not ramped up, or are they all done at the beginning?
They're all done in the beginning. So you don't have to step up anything. I think brownfields, as I understand, you're pretty much, yeah, you're operating with the same set of people, the same majority of the equipment is already there, you know? So yeah.
The line for the participant dropped. We move on to the next participant. Next question is from the line of Tushar Manudhane from Motilal Oswal, please go ahead.
Yeah. Thanks for the opportunity, sir. So just from this international patient ARPOB, if you could just, you know, help us understand like how much drop the ARPOB, I mean, declining the ARPOB that has happened because of these issues related to business? Maybe year-over-year or a quarter-on-quarter growth.
Also, international business has got nothing to do with immigration business. These are two separate streams altogether. The immigration business is where people come for visas, they have to get themselves tested and so on and so forth in our immigration departments, right? The international business is the incoming business that you have. I mean, immigration business is the people who have to, if you have to relocate to Canada, then you have to get your medical sort of tests and all done, right?
The OP business.
It's OP business. The international medical tourism is people who are coming to India. They're two separate business streams.
Amazing. So as far as international business, just to understand what kind of ARPOB growth rates came over the last two, three quarters?
No, so Prashant, typically the ARPOB in the international business is 1.5 times of the overall ARPOB, right, in growth. So international business growth on ARPOB would be 7%-10%, right, if you see the last year. So, and also it changes, right? Quarter-on-quarter depends on what the provider of the patient is that you're getting. But that would be the, so it'll be overall growth because these tariffs are linked to the, you know, self-pay tariff.
Largely similar to that of the domestic patient in terms of growth, not in terms of value, but in terms of growth, we are largely similar in both international as well as domestic patients. Is that the right way to understand?
Big change, yeah. So the pricing change is, yeah, price is linked to the self-pay, right? So we charge a premium on that, but then it's linked to self-pay.
I understand. I understand. How much of your OpEx at Dwarka? Like as an operation cost, when we say breakeven within 6-8 months, so if you could share how much OpEx, you know, and how much of that is already into the P&L? Given that you said that we need to get the licenses and also you need to have doctors and nurses already on board, so does it mean that the OpEx is already in 1Q ?
No, so Prashant, basically in this quarter, we have INR 6 crore of pre-launch costs. You know, these are the costs of the doctors and the staff that we had hired. You know, before you get the nursing home license, you're supposed to have people on your rolls, right? So you have to demonstrate to the department, to the Delhi Health Department, to say that, you know, we have, you know, so many people available for treating patients. So that is the cost. We haven't had any revenue from the hospital in quarter one, right? These costs will obviously get built, right? This is a cost which is for the quarter, but obviously if you take June month, June month, the cost will be higher than the average, right? INR 6 crore is not for the full quarter. Not for the full quarter.
So if I take, let's say, June, if I take July, you will have further increase in the cost because we're adding more people. So we opened 94 beds at this point of time. And I know I can't give you a P&L statement in terms of what the cost would be, but we do think that by 8-9 months, we should be on a breakeven state, which means that, you know, it should be in the Q4 that we start to see breakeven numbers at EBITDA level for our hospitals.
Well, so is there, I mean, primarily just trying to understand in that time how much drag will be there on the existing EBITDA of, say, INR 500 crore? From that perspective, just to understand.
Tushar, we said Q4 is breakeven, right? So that means the drag will happen till Q4. So in Q4, you'll see that, you know, loss becoming kind of breakeven for Dwarka.
Sure. How much further investment would be required in Lucknow for these 450 beds once the EC approval is there?
I think this will be around INR 700 crore+. 450 beds investment. Yeah.
Got it, sir. Thanks. That's it from my side. Thank you, sir.
Thank you. Next question is from the line of Amit Kadam from Canara Robeco Mutual Fund. Please go ahead.
Yeah. Hi, sir. Am I audible?
I am. Yes, yes.
Yeah. Hi, sir. And hi, team. So my question is, like, I'm just reading the slide number 10, and I'm trying to refer the outpatient growth, what we have seen, the fourth chart, where it shows that 4.5% has been the growth for the like-to-like or the existing hospitals. Whereas when I compare it for the quarter one FY 2024, a year back, this run rate was like almost 13%-14% growth rate. What, how do I read this particular thing, 14% versus 4.5% right now?
No, so the OpEx has come down. I think I will allude that to in your speech also that we had immigration business, which is down by around 48%, right? There's a large immigration, you know, so we have 3 centers for immigration, right? 2 in Punjab and 1 in Delhi. Now the footprints have come down by 48% there, right? So obviously that has impact in these numbers because that's all OPD business. So we do think that this impact will go until quarter three. And from, you know, because Q4 was a normal quarter because we have this change in the visa regulation from first of January this year. So there'll be some impact of that that we will have.
But the good part is this is not the OPD business which leads to admissions or IPD, right? I mean, this is purely, this is always, you know, immigration business. OPD people come to the consult, they go out. They don't get translated. Normally, a reduction in OPD business or in outpatient footfalls, okay, would be concerning because what that means is that you're going to have lower in-patients going forward. But this is not the category of people which converts to in-patients.
Shalimar Bagh, which is about 3% of 3% of Shalimar Bagh.
Last year, yeah. Also, also last year, I think we opened Shalimar Bagh, and so 3% of that was because of the capacity expansion, like you just pointed out. That was last year. So it was new capacity which opened in this month last year, in that quarter.
So, like, the kind of capacities what we are going to see in next one or year, what is the metrics or what number you would like to see? Because for a kind of a run rate in terms of volume, what we want to see, and partly driven by ARPOB, but partly driven by volume, this number should be high single digit. That's what could be a number for maybe a steady-state growth.
Are you talking about the existing hospitals or the new hospitals or combined?
Yes, sir. Because combined, you are, it may not be a correct reference, but like when I just see that inpatient and outpatient both, and you say that partly would be the international, but then I'm just like a little confused that international patient coming off may not have a much so much impact.
The material part is the in-patient.
Yeah. So inpatient is 5.5. That's what I, that's the second part of the question is. Then what is the run rate I need to see in this particular number to maintain our steady-state growth rate of this as a tracking point?
So I think, so I'll just give you an example of what happened in Shalimar Bagh, right? This is a hospital where we added 43% bed capacity. And the moment you have the capacity available, the capacity got filled up. The IPD volume and the occupancies went up by 34%-35%. The OPDs and the IPD footfalls went up by, you know, 34%-35%, right? So that's the same thing we expect here, to the extent that if there's a brownfield expansion and we add in, let's say, in a 300-bed hospital, we add in 150 beds, we plan to open all those 150 beds in one row, and to that extent, we will find that the volume will expand, you know, within, you know, 2-3 quarters, we should be on a normal occupancy of.
But if you wanted to do apples to apples, like you added Shalimar Bagh capacity last year, same time, this year you'll add Lucknow and Nagpur. And then see what the overall growth is. That's why I asked you the specific question. Because if you're not doing apples to apples, right? If you look at existing hospitals last year, then you have to look at existing hospitals sans the, without the Shalimar Bagh expansion.
But sir, this is a volume count, right? So it is irrespective of what hospitals I'm trying to count, because even I give that benefit of Shalimar also now part, where I'm like in like existing part, and if it is 5.5.
No, I mean, that's a significant difference here, right? So let's say last year, okay, so you had 3,400 beds, and then you add, let's say, 200 beds to it, because you've done a brownfield. Now you move to 3,600 beds, right? You're not comparing the 3,400 to the existing beds today. You're comparing the 3,600 to the existing today. But you had that jump of 200 beds last year. Likewise, if you take a jump of 900 beds this year, okay, then you need to look at overall footfall.
So I think let me just turn it the other way around. Just explain this. So basically, you know, we have the highest occupancy among our peer group, right? Which means that we don't have, we don't have more IPD patients, right? So what comes first? You have to have capacity to have more IPD patients.
So what, so that means to the extent we are limited by the number of beds that we have. And the example that I gave to you for Shalimar Bagh was that the moment we added beds, the volume went up. So as the capacity will get added, we do think this volume will materially change. We do think the volume will materially change. Because we don't have beds, right? How can I?
If we don't come up with brownfields, we don't come up with capacity addition, we're already operating at 77% occupancy. I don't have room for my bed occupancy to go up. Marginally only, right?
Yeah. This, this explains that particular thing, because maybe on the flip side, I was maybe trying to say, is there a shortfall in terms of whatever the demand expectation?
No, no, no. I mean, there's a shortfall of supply. There's a supply shortfall, and that's why we're doing all these Brownfields, right?
Okay.
That's where the Shalimar Bagh example fitted, right?
Right. You mentioned that inpatient and outpatient doesn't have, like, a high correlation with that particular thing.
No, no, no. It has a very high correlation. Okay. But the outpatient business, which is reduced, is the immigration, visa immigration business.
Okay.
If you're going to Canada, you have to come to get your blood test done so you get your, you know, certificate from this thing that you're medically fit, right? So let's say if you immigrate to Canada, you will come to a hospital and get that this thing because, you know, we were accredited with the Canadian embassy. Now that person was not going into an inpatient. He will not be getting admitted for a procedure.
Right.
So, the visa policy or right now, Canadian government is not giving visas, so people are not coming for that medical certificate.
If you would have added that, if you would have added that missing part, it would have, what run rate, this number of 4.5 would have been? It would be in the.
The same. It would be the same. Inpatient would be the same.
Not inpatient, outpatient then, sir? That 4.5 would have jumped up?
Yeah. Then that would have gone up. Yeah.
Okay. Fair enough, sir. I won't take further questions. I'll just, I'll drop off this. Thank you. Thank you.
Thank you. Next question is from Lorna Samin Gupta from Centrum Broking.
Hey, hi. Am I audible?
Yeah. Yeah.
Yeah. Hi. Thank you for the opportunity. So just want to understand on the bed share mix. So basically, from the existing units, bed share has remained majorly between 29%-30% for the institutional segment. So, and however, overall institutional bed share mix has come down to 27%. So, so how do you see it going forward over the next 2-3 years once all the facilities get integrated and they are in full steam?
So I think the two aspects, you know, so far, like we said, that, you know, quarter one is a weaker quarter. Okay, you have less demand. So you don't, you know, put your foot on the accelerator and start driving out institutional business. You accept and accommodate because you want to fill your beds. Normally, you see this happening in Q3 and Q4, where you have reduction in institutional business. Having said that, like I mentioned, when you come up with new capacity, new brownfield, then you take in, you know, occupancy is the criteria, not the caliber of clinical mix as well as the sort of payer mix. So we will be at that stage taking more institutional. But having said that, even on institutional business, the EBITDA per bed which you're able to eke out is significantly higher than what it is for existing beds.
That has been experienced in Shalimar Bagh also, right? So when we opened the new beds, you saw the ARPOB of the incremental ARPOB of the new beds come down because you were taking institutional as well as sort of lower payer mix, et cetera. But the EBITDA per bed pertaining to those incremental beds were higher than the EBITDA per bed of the previous hospital or the existing hospital.
Okay. Okay. Understood, sir. And for the international patients also, you see like this bed share mix going upwards or remaining at the same level? And how do you see this international business going forward?
We see it, I mean, the growth in that business has been outstripping growth in other businesses. Percentage incrementally going up.
Yeah. So I think Q1 is an aberration there. But we do think that there will be growth with the come back. It has come back, I mean, as we speak. And I think there's some temporary blip because of, you know, Bangladesh situation and situation in Yemen, Somalia, et cetera.
But nevertheless, as long as your growth in international business is more than growth in your other business, you know, you'll have the bed share only go up.
Sure, sir. Thank you.
Thank you. Next question is from the line of Alankar Garude from Kotak Institutional Equities. Please go ahead.
Hi. Thank you for the opportunity. Sir, we have added two new cities to our network in the past six months. Now, other than these two, our focus seems to be on growing in the existing market, at least over the next four to five years. So the question is, beyond what we have already announced so far on the expansion front, is it fair to expect a relatively higher expansion announcement coming through towards the newer markets?
Look, I think, you know, growth in our existing hospitals is not a focus. Growth in our existing hospitals is a necessity. Because we've run out of capacity, we're already operating 77%. I need to increase bed strength in my existing hospitals. And that's why you're seeing this incremental kind of this thing. And this is something we embarked on, you know, 2, 3 years ago. And so they've been in construction and so on and so forth. And over the next, you know, maybe between the next 8 to the next 15 months, or 20 months, you're going to see, or 20 months, you're going to see a lot of that capacity come through. Now, having said that, we still have a balance sheet. You know, you know all the expansion is being incurred through internal accruals. So we are intending to go to other markets.
You know, there are high ROCE markets, high opportunity markets. Frankly, I mean, you can imagine whatever multiple I've made for these two hospitals has already come down by 60-odd%, simply because, you know, we moved the EBITDA by this much in the first three months. So we see opportunities in other markets as well, and we are focusing on them. And that's where the focus is going to be. It doesn't mean that you don't look at metros. The point is that in metros, it's going to be that much more difficult to be able to acquire hospitals or to acquire land because, you know, it's not available.
Fair enough, Abhay. So maybe linked to that one, how are you looking at this expansion from an operational standpoint? I mean, any need to beef up the senior management team? Can senior management bandwidth be increasingly an issue going forward?
On the contrary, I think, you know, if you actually see the number of locations that we've added in the last 5 years or 6 years, right, is essentially 3. One is Dwarka, which is open. One is Lucknow, and one is Nagpur. So from maybe 17 locations, we've gone to 20 locations. Now, everybody wants career progression, right? I mean, we've got close to 30,000 people who work for us. And, you know, if it's one unit head, he also wants over 5 or 6 years, you know, his area of influence to increase. You know, he's handling one hospital; he wants to handle two. The person who's handling two wants to handle three or four or whatever. So I think, you know, providing that growth, providing that segue for people's career path, you know, it's a necessity today. Even in 5 years to have 3 more locations.
Essentially, if you make a brownfield, I mean, you know, a lot of our expansion is a brownfield. Now, you know, if I increase 800 beds by another 400 beds in Saket, you know, nobody, I mean, it's the same location. It's just you're doing a little more of the same thing. You're not really operating another facility. So from 200 beds in Mohali, you know, you go to 355 beds. You don't require management bandwidth for it. I mean, you're just doing more of the same, effectively. Then 85% of our growth has come, or is coming through going forward, is 90% is coming through brownfields. So it's your existing capacity you're increasing.
So look, I think, you know, from a leadership standpoint or down the thing, I mean, the 3 locations on top of 17 which have been added, I don't think it's, you know, on the project side, of course, we've you know, augmented the teams because, you know, when we embarked upon all of these kind of expansions, you need to sort of fortify those teams. So that's what we focused on. Other than that, not really. I mean, of course, we've strengthened the teams, et cetera, but that happens through due course. I don't see bandwidth issues. Because frankly, the expansion hasn't been that much in terms of locations.
Fair enough. So maybe that question becomes more relevant as we go beyond these 20 cities. Okay. So the second one then, Abhay, is we have been increasingly hearing about resistance from insurance companies on rising healthcare tariffs. Over a period of time, do you expect any change in the balance of power when it comes to negotiations between corporate hospital chains like us and insurance companies?
Look, I think, you know, insurance companies, by the end of the day, okay, piggyback on what your schedule of charges are, right? What your rate list is for cash-paying patients. And frankly, I think, you know, you have the most democratic system over here because no hospital has a monopoly. You know, patients are choosing to go where they want based on the value proposition they're able to get. Okay, it's not as if people are not kind of, you know, reducing their prices to get more patients and so on and so forth. Everybody does that. None of the big chains, none of the big guys, okay, are price makers. We are all price takers. Eventually, 90% of all healthcare is provided by smaller nursing homes and so on and so forth. Every year, they have no what the inflation is.
They come up with a particular price, and when we seek price data, okay, that is the basis on which we increase our rate. So I think, you know, from our standpoint, you keep in mind, I mean, our EBITDA per bed is still 55% better than the second best player in the industry. Our ARPOBs are maybe 20% better than the second best player in the industry. Okay. So I mean, if there is price negotiation, that sort of comes down. Then, you know, I frankly think even insurance companies are a lot more fragmented.
Understood. That's it from my side. Thank you.
Thank you. Next question is from the line of Shubham from Purnartha Investment.
Hi, sir. I want to know how many nursing seats you have across hospital?
What?
Nursing seats.
Nursing colleges?
Nursing seats.
Yeah. You mean nursing colleges?
Yeah. I mean, so do you have some nursing seats in Lucknow? I think so.
We have one nursing college in Lucknow, and that's about it.
Yeah. That's around 100 seats.
100 seats.
Okay. And do you want to increase that or something like plan is there?
We have tied up with many nursing hospitals, nursing colleges.
Okay. And how many beds operationalized in Dwarka?
94 beds at this point. So it's a 300-bed hospital, 294 beds.
Yeah.
As we speak here.
Okay. Thanks.
Thank you very much. Ladies and gentlemen, I now hand the call over to the management for closing comments.
So thank you, everyone, for joining us for the first quarter FY 2025 earnings call. We look forward to catching up again next quarter. Thank you.
Thank you very much. On behalf of Max Healthcare Institute Limited, this conference, thank you for joining us, and we now disconnect. Thank you.