Ladies and gentlemen, good morning and welcome to the Max Healthcare Institute limited Earnings Conference Call. As a reminder, all participant lines will remain in the listen-only mode, and there will be an opportunity for you to ask questions after the presentation concludes. Should you need assistance during the conference call, please signal the operator by pressing star, then zero on your touch-tone telephone. Please note that this conference is being recorded. I now hand the conference over to Suraj from CDR India for opening remarks. Thank you, and over to you.
Thank you, Ran. Good morning, everyone, and thank you for joining us on Max Healthcare Q4 and FY2025 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 begin, 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. Thank you, and over to you, Ran.
Good morning, everyone, and thank you for joining us on Max Healthcare's fourth quarter and full-year FY2025 earnings call. This year has been a pivotal one for us, fueled by focused strategic decisions, disciplined execution on ground, and significant milestones that have set new benchmarks. After acquiring hospitals in Nagpur and Lucknow in the last quarter of previous year, FY2024, we acquired the 500-bed marquee Jaypee Hospital in Delhi NCR this year. As part of our asset-light expansion strategy, we commissioned Max Dwarka and signed up contracts for build-to-suit hospitals to be set up by our partners in Mohali, Thane, and Pritampura, Delhi . During the year, in what could have been a year of moderate growth otherwise, we initiated multiple long-term growth plans, including the announcement made last week regarding acquisition of approximately one-acre land parcel adjoining a fully occupied 400-bed hospital in Vaishali.
Our recent acquisitions, Max Lucknow, Max Nagpur, and Max Noida, played a key role in accelerating top-line and EBITDA growth. Our overall financial performance for FY 2025 reflected this momentum, with a year-on-year growth of 26% in revenue and 22% in EBITDA. Notably, Max Lucknow demonstrated year-on-year growth of 56% in revenue and 102% in EBITDA, while Max Nagpur reported a year-on-year growth of 23% in revenue and 86% in EBITDA in the first year since acquisition. Max Noida is being integrated into our network and reported a gross revenue of INR 228 crore, with an operating EBITDA of INR 48 crore, at a margin of 21% post-acquisition since October 2024. Additionally, our newly operationalized asset-light hospital in Dwarka achieved EBITDA break-even in six months, a new record.
The hospital clocked a revenue of INR 171 crore and an EBITDA loss of INR 29 crore for the entire year FY25 since becoming operational in July 2024. It exited the year with a revenue of approximately INR 30 crore per month and 73% occupancy on the 235 beds in March, with balance 68 beds yet to be opened. We are already looking forward to embark on the next phase of expansion of 200 beds at this facility. These results demonstrate the resilience of our operating model and the caliber of our team. It reinforces our confidence as we prepare to commission three new brownfield towers at Max Nanavati and Mohali Hospital within the next three months and complete our greenfield facility in Gurgaon by the end of this year, adding approximately 1,500 beds in total.
Among the year's other standout achievements, we are proud to have been ranked amongst the top 20 companies in the S&P BSE 100 index and recognized under the next leader's category for corporate governance excellence by Institutional Investor Advisory Services, India's largest proxy advisory. This recognition underscores our unwavering commitment to the highest standards of transparency, accountability, and integrity in corporate governance. On that note, we would like to highlight that we continue to undertake corporate actions to simplify the holding structure, improve governance, and optimize cash flows. To that effect, we have concluded merger of two wholly owned subsidiaries as Hospital Ltd. and Max Hospital and Allied Services Limited. We have also filed an application with the NCLP for merger of Cross Clear Remedies Limited and Jaypee Healthcare Limited ., which will, in effect, reduce our outflow on the acquisition by INR 200 crore-INR 225 crore.
Now, coming to the performance highlights of the fourth quarter, which is the 18th consecutive quarter of year-on-year growth, our average occupancy for the network stood at 75% versus 74% in Q4 last year, and at similar levels in the trailing quarter, whilst the occupied bed days grew by 30% year-on-year and 2% quarter-on-quarter. Do note that the network occupancy stood at 78% if we exclude Max Noida, which is still being integrated into the network, something which we completed the acquisition of in November 2024. Average revenue per occupied bed for the quarter stood at INR 77,100, remaining relatively flat year-on-year and growing 2% quarter-on-quarter. Like for like, our ARPOB for the existing units grew by 7% year-on-year and 2% quarter-on-quarter. Network gross revenue was INR 2,429 crore, compared to INR 1,888 crore in Q4 last year and INR 2,381 crore in the previous quarter.
This reflects an increase of 29% year-on-year and 2% versus the trailing quarter. Of this, new units reported a gross revenue of INR 353 crore, while existing units register a year-on-year growth of 12% in revenue, driven by 6% growth in occupied bed days and 7% growth in average revenue per occupied bed. The international patient revenue stood at INR 202 crore, registering a growth of 28% year-on-year, despite contraction in patient footfalls from Bangladesh and Yemen due to continuing political unrest. Network operating EBITDA stood at INR 632 crore, reflecting a growth of 26% year-on-year and 2% quarter-on-quarter. This includes INR 67 crore EBITDA contribution from new units. Network operating EBITDA margin stood at 27.2% for the quarter. Existing units reported an EBITDA margin of 28.5%. Annualized EBITDA per bed for the network stood at INR 7.4 million.
Like-for-like bed EBITDA per bed for existing units stood at INR 8.4 million, reflecting a growth of 7% year-on-year. Profit after tax, excluding exceptional items and one-off tax gains, was INR 3.76 billion versus INR 3.11 billion in the fourth quarter last year and INR 3.72 billion in the previous quarter, reflecting a growth of 21% year-on-year. There was an exceptional item of INR 740 million towards CIS charges paid to Yeda for seeking permission for change in shareholding of Jaypee Healthcare Limited. prior to acquisition and one-off gains in tax costs of INR 180 million, consequent to voluntary liquidation of a wholly owned step-down subsidiary in the third quarter FY 2025. Overall, free cash flow was INR 4.22 billion during the quarter. INR 3.90 billion was deployed towards ongoing capacity expansion projects and upgradation of facilities at acquired hospitals.
Consequently, net debt for the network came down by INR 32 crore to INR 1,576 crore at the end of March 2025. Continuing our effort to support the local community, we treated approximately 36,500 outpatients and 1,200 inpatients from economically weaker sections of society, entirely free of charge, worth INR 53 crore as hospital tariff. Both our strategic business units continued to report significant growth in their revenue and profitability. Max at Home reported a top line of INR 56 crore, reflecting a robust growth of 22% year-on-year. It offers 15 specialized service lines across 15 cities, with over 50% repeat transactions. Max Lab reported a revenue of INR 46 crore, reflecting a strong growth of 19% year-on-year. It provides services in over 50 cities through its network of more than 1,200 selection centers and active partners. Now, coming to the status of our expansion project. 268 beds at Nanavati in phase one.
The interior work is in progress, and we expect to commission this facility within 90 days. 155 beds at Mohali. Finishing work is underway, and we expect to commission this facility within 90 days as well. Plans to add an additional 45 more beds through internal reconfiguration will be initiated once the new tower is completed within 90 days. 400 beds at Max Saket Complex. Interior work and MEP fit-out works are ongoing, and we expect to commission this facility latest by second quarter FY2026. At Max Lucknow, we have added 128 beds on floors 9 to 12, as communicated previously. Through internal reconfiguration, we have added 35 beds in May and plan to add 39 more beds in the next 12 months. We expect to complete the Onco block here by the second quarter this year. 500 beds at Sector 56 Gurgaon. Structural work is in progress.
We expect to commission the facility by end of this calendar year. At Dwarka, the Onco block is expected to be commissioned by the third quarter this year. All of these are on schedule, and we will see significant ramp-up in our capacity over the next 12 months. 127 beds at Max Nagpur. 12 beds have been added in October 2024. For the balance beds on additional floors, we are awaiting EC approval, that's environmental clearance approval, while the bill of quantities detailing has started. We expect to complete this project within 24 months. 397 beds at Patparganj. We already received the environmental clearance. The tendering work is in progress. The project continues to be largely on schedule. 550 beds at Max Vikrant . We are still awaiting the clearance from the Forest Department for tree transplantation.
All other statutory approvals are already in place, and we expect to complete the project by 2028. 400 beds at Zirakpur Mohali. Our partner is currently awaiting EC approval and has initiated the tendering process, detailing the contractors, etc. The project is expected to be completed within the next 30 months. 140 beds at Vaishali. As announced earlier, we have acquired the land adjoining to Max Vaishali and will be initiating drawings, detailing, etc., in the next couple of months. We expect to complete this brownfield project in the next 30 months as well. Presently, the Vaishali hospital is operating at an 83% capacity utilization. Finally, moving on to the overview of the company's performance for the full year ending March 2025, network gross revenue stood at INR 9,065 crore, reflecting a growth of 26% year-on-year. New units contributed INR 938 crore to the gross revenue.
Overall network operating EBITDA grew by 22% year-on-year to INR 2,319 crore, reflecting a margin of 26.8%, while EBITDA per bed stood at INR 70 lakh. Existing units reported an EBITDA margin of 27.9% and EBITDA per bed of INR 80 lakh. During the full year, we generated INR 1,447 crore of free cash flow from operations after interest, tax, working capital changes, and routine capex. INR 1,182 crore was deployed towards ongoing expansion projects and upgradation of facilities at acquired hospitals. INR 146 crore was distributed as dividend, and INR 1,716 crore net of cash at Jaypee Healthcare Ltd. was used for the Jaypee acquisitions. With this, I would like to open the floor for any questions and answers.
Thank you. Ladies and gentlemen, we will now begin the question and answer session. Anyone who wishes to ask a question may press star and one on their touchstone telephone. If you wish to remove yourself from the questioning session, you may press star and two. Participants are requested to use their handsets while asking a question. Ladies and gentlemen, we will wait for a moment while the question queue assembles. The first question comes from the line of Amey from JM Financial. Please go ahead.
Thank you so much for taking my question. Congrats on the management and good numbers. The first question I have is, we can give information on the profitability of the acquired units like Nagpur, Noida, Lucknow for the quarter?
Like I mentioned, as I mentioned in the speech, as far as Lucknow Hospital is concerned, we had a 56% growth in revenue and 102% growth in EBITDA. Nagpur has reported a 23% growth in revenue, 86% growth in EBITDA.
The Noida Hospital, which we completed the acquisition in November, has a gross revenue of INR 228 crore, and we had a INR 48 crore EBITDA at 21% margin. I think with respect to, have you given the exact numbers of the?
No, so not even the. I think this year, this quarter onwards, because of the fact that two of these hospitals were acquired in quarter four last year, for example, the electricians were acquired in February, and Lucknow was acquired in March. That is the reason why we do not, because it is very tough to now separate the last year number into two parts and this is without that, etc. That is the reason why we have not put the numbers there. I think nevertheless, you have the overall numbers with you. We have 67 total built out of new units, which is 19.4%.
Now, if I take out Dwarka, you know Dwarka has just broken even in December, and even this quarter also there is a small kind of a bit from that hospital in quarter four. If I take out Dwarka, our EBITDA margin is 24.9% in the new units.
The reason I wanted to ask was how much margin expansion still can happen in these units, except Dwarka obviously, which is recently commissioned. The other three units, how much margin expansion scope is there for the next one to two years?
Significant. I mean, this is the first year of acquisition. As you, by the time you put your building blocks in place, you must appreciate that takes some time.
I think clearly in terms of bed utilization, in terms, I mean, just to give you an example, although you had in Lucknow, you had expansion of EBITDA by 106%, yet there is no radiation oncology there. There is no bunker, right? That bunker is going to come into play at the end of H1 this year. Once that happens, the oncology business, which even currently is not anywhere near the oncology business of the rest of the hospitals, there is a major move up over there. If you look at Nagpur, for example, we are already now approaching very high capacity utilization. The teams are coming in play and so on and so forth. We are already looking at the next phase, which is adding another 160, 150 beds over there.
Once that happens, that gives you a major flip because you do not have any capacity left over there. As far as Max Noida is concerned, you are operating at, you bought a unit which is operating at less than 50% occupancy. You have 50% more occupancy, higher sort of ARPOB, as well as all the clinical programs that are coming. Typically, when you do these acquisitions, right, the first year you will have less of a sort of improvement curve in terms of absolute value. Maybe in percentage terms, you are operating on a smaller base. The second year is when you are going to have that. Each one of these, whether it is Jaypee, whether it is Nagpur, as well as Lucknow, also affords significant further brownfield expansion. I mean, you will have years coming out here, years to come.
Also, an important question is to say that we have very respectable margins. For example, Lucknow margin is more than 30%, right? Nagpur margin is around 22%, probably more. Jaypee will also be in the same range. I think the main thing is that we want EBITDA per bed to improve now, which means that we have to put medical programs at a higher end. Just to say the new units, overall the EBITDA per bed is 54% of the rest of the network, which means we have to really grow that number. That is how you will find that, and that is one of the reasons why you find that the revenue growth and EBITDA growth are EBITDA growth is a bit deflated compared to revenue growth because the share of new hospitals is going up, and their EBITDA per bed is lower than the rest of the network.
Going forward, you're going to see that the EBITDA growth will outstrip revenue growth there. Not that the revenue growth is going down. I think there's still more than enough fuel over there.
The second question I have on that is because we have said that 1,500 beds of brownfield expansion will happen in next year. This year, we have seen a lot of acquisitions. What are the objectives next year? Is it a brownfield focus here, or do you think the M&A would still be there?
No, I think it's not one at the cost of the other. I think the brownfield is already under construction. It's already been built. If you look at Mohali Hospital, it's operating at 80%-85% kind of occupancy levels. Okay?
You're really that number of beds which are coming in, which should be very, very quickly taken up. That's the whole purpose of brownfields. Now, similarly, if I look at Mumbai, right, in the next 90 days, again, you're going to have these beds come up, but that solves the problem of the Mumbai hospitals, right? I mean, then Max Saket, again, is at a very, very high occupancy, and that's our main hub. I mean, we're really crying for space and more beds over there. I think those beds don't, I mean, and the balance sheet is something which is completely different. Here are three brownfields we are doing. Gurgaon, Sector 56, as you're aware, Gurgaon for us is the highest ARPOB, the highest EBITDA per bed market.
Again, with this new hospital, which is very, very well located over there at Sector 56, we are looking to do the same sort of encore, have the same sort of results as we had in Dwarka. That has nothing to do with our balance sheet and our capabilities of doing other things. We will continue seeking acquisition opportunities also. Like I said, we have to be able to touch base on or clear two of our filters. One is the 20%-25% ROCE within four to five years, as well as in markets where at least we have one or two of our peers. If these two conditions are met, we are happy to look at acquisitions. Let me continue to pursue them.
Sure. Thank you so much. I will join the session.
Thank you. The next question comes from the line of Damyanti Kerai from HSBC. Please go ahead.
Hi. Good morning, and thank you for the opportunity. My first question is on your fair situation at new hospitals. If I look at your institutional bed share, you mentioned it went up to, say, 33% in Q4. Is it because you are putting more of these key patients to really move up in the occupancy, cover up the fixed cost, and then I think can you please comment on it?
That is absolutely right. I mean, if you look at typically when you open a new hospital, Dwarka, for example, you kind of fill it with all payer groups because really the first focus is to get the occupancy up, and then you start turning it.
If I look at Nagpur, for example, it was operating at sub 60; it was operating at 50%-odd occupancy prior to acquisition, but we took up the business over there for institutional business in order to ramp up the occupancy. The occupancy now is, I mean, it is like almost full up. It is full up. What that does is it helps you occupy your idle beds and yet cover fixed cost or at least a part of it, and it all trickles down to EBITDA. From our standpoint, so long as contribution is positive from any payer group which has idle capacity, it makes sense to do that. We continue to do that, and that is what is paying us the ease and returns as well. I mean, there is no sense in keeping beds idle.
If you have any idle beds, you must do institutional business over there. We continue with that strategy.
Sure. At what occupancy do you choose to optimize between institutional or CP patients? Say you ramp up to 40-45%, or what level do you take that decision?
See, look, we can go up to, let's say, about 80% occupancy, right? Till I get to 80% occupancy effectively, I can't take institutional patients. If I suppose I have 60% occupancy other than institutional, then for the balance 20%, I'll take institutional. I will not have an idle bed.
I can take it the other way around. As long as we are not recruiting cash patient or insurance patient, we like to do the institutional patient.
That's right. Any growth in cash and insurance patient will be accommodated first.
Okay. Got it then. My second question is on international patient revenue. I remember a few quarters back, we were talking about initiative or incentive provided by the government to ease flow of the medical international tourists in India. On the back of that, have you seen any incremental, or I say any meaningful pickup in your international patient business? If I see, I think it's still like 9% of your hospital revenue, although on a bigger base, but any significant or notable push which you might have seen from these initiatives?
It will be 9%, but please understand we will increase capacity. We will increase capacity by 30%, right? The growth in that business this quarter has been 29%, which is a significant increase. I mean, I won't entirely put it down to government window because that's a slow move.
But as the image of the country sort of improves, you have certain setbacks, right? I mean, you also have geopolitical unrest. We had that issue with Bangladesh. We had it with Yemen, etc. We most recently had this with the Pakistan issue where the airspace has been closed. Some of these have those, but you will always be two steps forward, one step back. If you were to draw a line, I think we've had more than 25% growth in this business for a long period of time, and 29% is acceleration in spite of these setbacks.
Got it. My last question is, if I look at your ARPOB on a network basis, including new and existing units, it is somewhere around INR 75,000 for FY2025.
What kind of growth should we look at for this parameter given now, going ahead, also we will be having a mix of existing plus new beds on a consistent basis?
It is relevant what the ARPOB is, right? I mean, by the overall ARPOB is. I mean, today if I acquire something for $100 and it gives me $25 of EBITDA, it's a 25% ROCE. I don't worry about whether what it's producing is lower ARPOB or higher ARPOB. Overall, I mean, what we have to look at is what is happening to overall EBITDA, what is happening to overall EBITDA per bed, what is happening to vis-à-vis what we are deploying.
Got it. Okay. Thank you.
If I look at the ARPOB growth of existing facilities going up by 7.5%, but when I buy something with lower ARPOB, okay, that drags it down. The fact is, should I not be acquiring something with lower ARPOB, even if it's very, very high on ROCE, even if I'm getting it very, very cheap? Answer to that can never be don't acquire. Answer to that always has to be, yes, you must. We are in the, I mean, so long as I can deploy money at a 25%, 20% ROCE is pretty high, 25% overall.
Yes, that's clear. Thank you.
Thank you.
Thank you. The next question comes from the line of Neha Manpuria from Bank of America. Please go ahead.
Yeah. Thanks for taking my question. I think in the presentation, we mentioned that the IP growth at 3.5% was impacted due to, I think, lower footfall in internal medicine, pediatrics. Is there something to read into this? Because it isn't as much as a seasonal quarter. Just trying to understand the reason for this weakness.
Also, typically, when you compare quarter-on-quarter, quarter three happens to have more internal medicine patients, and quarter four happens to have less internal medicine patients. I think that impact of nativity comes in. I think that's what we're trying to explain there because the share of internal medicine coming down.
The fourth quarter, okay, so the drop you're talking is on a quarter-on-quarter. Even if I were to look at a year-on-year, it's just a 3% IP volume growth. Hence, I was wondering if there is anything one of the quarters.
There's a lot of daily patients that come up. Sometime it happens in October, sometime it goes into quarter four. That's probably the change that we referred to there.
Okay. Got it.
Lastly, if I recall, October had a significant amount of dengue patients, particularly in places like Mohali and Gurugram, etc., where we had massive dengue. For some strange reason, it went into October. This year, there wasn't, so I guess.
Yeah. I was thinking about March versus March. I understand that there could be.
Yeah. Yeah. Nothing to read into it. I mean, it could also be, I mean, if you look at some of the new facilities, etc., that we acquired, they weren't there last year. Now they are. They may have a lower level of feeds than internal medicine and so on.
I mean, but there's nothing to, I mean, none of our signs are showing any. If I look at the number of OPDs overall, there's been a significant increase, I think, because, yeah.
But even IP number versus last year, they've grown by 6% existing quarter to quarter. Nearly also about 5%.
No, OPDs in internal medicine, specifically. Internal medicine.
In the fourth quarter, technical sector business comes as far as the volumes goes up.
Year on year.
Year on year.
No, it'll be basically transition of the new hospital versus the old hospital.
That's right. That's right. Okay. Got it. The second question is on Dwarka. I think in the presentation, we mentioned that Dwarka achieved breakeven in December quarter. Based on the loss number, if I were to calculate, I still see there is a loss in Dwarka in the quarter.
It's still making EBITDA loss. Is that correct, or am I missing something here?
No, there is no loss. After breakeven, we have not made a loss. We continue on a, I mean, it's obviously lower profit, but it's definitely ever since. It's not as if December we broke even and then January, February, or March, any of the months that we've lost money. We haven't. Since then, till date, we've not lost money. We have only occupancy moved up. Your flow through the bottom line has improved since then.
Okay. Have we ramped up more beds in Dwarka from the 140 that we'd commissioned, and what's the plan for the ramp-up of the rest of the beds?
No, we already had 235 beds, and we have an occupancy of 73%. That is March.
Okay. Okay.
We have INR 30 crore of revenue coming from that single hospital in the month of March, which I mentioned. You have a 73% in 235 beds. We are expecting now anytime to be opening 68 additional beds.
Got it. Okay. This is helpful.
I mean, we basically already, we just sort of stopped them as the occupancy increases. You know what I mean?
Understood. Yeah. Yeah. Makes sense. Thank you.
Thank you.
Thank you. The next question comes from the line of Prashant Nair from Ambit Capital. Please go ahead.
Yeah. Thanks. Good morning, everyone. Just had a question on the expansion plan since there is no slide on that in this quarter's presentation. The 1,400 odd beds that you were planning to add in financial year 2026, that remains on course. Would it roughly be the same range?
That's right. I mean, usually I have an investor presentation, not on the quarterly presentation. If you see the investor's presentation, it continues to be the same. We expect in the next 90 days, both within 90 days, both Nanavati 260 beds, Mohali 160, 155 beds. I think by second quarter, you will have Smart. By end of calendar year, you will have the Gurgaon facility. In the midst, we are also adding in Lucknow and other places. You will be hitting 1,500 beds, not 1,400 beds. In fact, probably northwards of 1,500 beds by the end of the year. By end of the year.
Okay. Of these, I mean, how many would you operationalize this year? If you can just give an approximate range. I imagine the bigger projects would have not all been operational from the beginning. How do you calibrate?
No, no. We will ramp up. We'll be operationalizing. And there's a ramp-up sort of this thing, etc. Of course, like Dwarka, for example, we didn't commission all 300 beds, although they're ready, right? What we commissioned is as per occupancy. We started with in July, okay? By March, like I said, we're already at 73%. By April, May, it should theoretically be further. I mean, going forward, we are opening another. When we have 75% plus occupancy in any set of beds, that's the time we open the next lot. Now we're opening the final lot in Dwarka. I mean, roughly within the year, we've been able to occupy all the beds. That is a greenfield. Majority of the beds that are coming up are brownfields. Yeah. Gurgaon should have the same trajectory as Dwarka, whereas the brownfield is much faster, right?
The uptake is almost immediate.
Right. That is what I was trying to figure out. For the greenfield, for example, for Saket, would the rule of thumb be that you initially operationalize, say, 50%, and then once that hits 75% occupancy, you add the next block? Is that how one could think about it?
You can think of it like that, but the only difference is that in a greenfield, you take six months to break even, right? By the time you get to 75% occupancy, it probably takes you a year. In a brownfield, you do it almost in months, like in a month or two, or whatever. You would just be ramping up capacity, so your take-up is much faster.
Understood. Thanks. Just one, when you categorize into existing and new units, new units would include all the acquired hospitals plus just the greenfield ones, or would you also include some of the brownfield?
All acquired plus Dwarka. All acquired means plus Dwarka.
Yeah. On a going forward basis also, it is the greenfield plus the acquired.
That's correct.
Thank you. Thank you very much. That's it from me.
Thank you. The next question comes from the line of Vivek Agrawal from Citig roup. Please go ahead.
Thanks for the opportunity. If you look at EBITDA, right, this year, the company has done quite well, right? We have seen expansion and expanding EBITDA margin in the existing units, and even the new units, acquired units, that division worked quite well. Now we are seeing another, I think, 1,400-1,500 beds coming up this year.
It would be great, actually, if you can just give some qualitative color how to look at overall EBITDA growth margins for the next couple of years. Thank you.
Also, I think brown fields normally give you higher EBITDA margins, right, in percentage terms as well as everything else because your fixed cost is already incurred. Primarily, the brown fields coming with, I think, close to 1,000 beds, they should throw out significantly higher EBITDA margins. I'm not going to give you any forward-looking statements, but theoretically, they should give you higher EBITDA margins compared to your existing business. I think that is even if you are sort of occupying those beds with institutional business and whatever else, even then they give you higher EBITDA margins. That's what we've sort of analyzed from all our previous brown fields that we've done.
I think that should work out well for us. Again, you have literally increased capacity by 30% last year. Dwarka, of course, most of the year for the first six months was operating at a loss, and after that, it has been profitable. You will see the full strength of Dwarka coming into the current year. You will look at the momentum of both Lucknow and Jaypee sort of snowball in the current year. On top of that, you have got three brownfields which are coming. The one greenfield which comes at the end of the year may produce some operating loss, like a startup like Dwarka did, but it should more than get cut off or absorbed by what we are doing on the brownfield and the momentum of others. That is where we are.
I mean, I think we are probably going to be entering, if I was to look at it or make a forward-looking statement, the strongest year in the last five years that we had.
Thank you for this comprehensive. Just one more question. I think there is a significant capacity expansion on the year as well as the year. How should you look at the situation as far as supply of doctors, medical cells, nurses, etc.? Thank you.
I mean, look, the brownfield capacity additions do not typically require massive increase or increase in senior level commissions. It does not because if the existing doctors, they increase their footprints within those hospitals and so on because they are the ones who are seeking these beds to start with. I think other than that, I do not see massive capacity expansion literally happening.
Other than one more hospital other than us in the current financial year in Delhi NCR, or maybe one and a half hospitals, really nobody else is coming in the current financial year and thereafter. We have a very strong presence in Delhi NCR. We've got about 14 or 15 facilities there. We tend to pick the best of what is available. If I look at Mohali, it's not as if any new hospitals are coming. We're just expanding capacity. Mumbai, no new hospitals are coming right now. We're just expanding our brownfield capacity. I really don't see, but again, you have to keep in mind that in India, there is the need for quality healthcare, and new greenfields are required, greenfields, brownfields, and so on and so forth.
All the senior units over the next years or a decade who are going to emanate are going to be emanating from current set of MBBS doctors, etc., that you have. Even today, the cost of MBBS receiving the salary is about INR 45,000 or INR 50,000 a month. Your demand supply shows up in the salary standards as well, right? I mean, I do not foresee shortage in senior physicians.
Thank you for that comment.
Thank you. The next question comes from the line of Piyush Kumar from Magnus Hathaway Investment. Please go ahead.
Yeah. Am I audible?
Yes.
Yeah. My question is, can we see the average revenue per occupied bed going to the territory of INR 80,000 plus in the coming quarter? And if yes, what specialty could be the main contributing factor?
I think all the specialties which have been growing take you there.
I mean, we had a 7% growth in the erstwhile kind of hospitals. The present hospitals are growing at a higher sort of district, etc.
Maybe at INR 77,000 ARPOB, right? INR 77,000 ARPOB is the current ARPOB. I'm not sure what is INR 77,000 you're saying. Yes, there's a gap between the new units and the existing units, right? Obviously, we have to, as I mentioned, we don't have a traditionality, for example, in Dwarka, even in Lucknow. Once we start that, then obviously that will add to the ARPOBs. We obviously want to shorten the gap, but there should be a gap between a Nagpur ARPOB and a Delhi ARPOB, right? We can't really be so exact. There will be some difference, but I think we will, I would say, shorten the gap. INR 80,000. Your target of INR 80,000.
The second part is that all the places coming up are in like Mohali, Saket Complex, Smart, Gurgaon, Mumbai, a nd I am distance balling it, but the numbers have a higher ARPOB in the current mix. Sir, my second question is regarding the stock price. In the last six months, the stock price has ranged down over INR 1,200 levels. Any comment on that, sir?
You have to tell me. I have no idea how stock prices work. Okay. Thank you. Thank you. It depends on options and financials and balance sheet, but markets have their own territory.
Thank you.
Thank you. The next question comes from the line of Tushar Manudhane from Motilal Oswal Financial Services. Please go ahead.
Yeah. Thanks for the opportunity, sir. If you could share for FY2025 ARPOB, maybe like pair-wise institutional ARPOB, international patient ARPOB, and cash ARPOB.
We typically do not share the ARPOB separately, but we do mention what the various parameters are. Typically, the international ARPOB is 1.x the cash this time in this quarter. The institutional is around 40% lower than the cash. That is the parameter that is coming to this quarter, right? It changes from quarter to quarter depending on the constitution of patients, ARPOB from international, and also the institutional. Institutional ARPOB has begun a bit. It has begun by around 3%-4% within this quarter compared to the previous quarter. I think that is the movement, which is, I would say, there is nothing changed directionally in any of these ARPOBs.
On a full year basis, we have to think about in terms of either growth or decrease, if you could share that.
No, I would say similar trends as we see, but I think the recent trends are more important than the full year trends. I would say that is what we see. Let's say the cash is 100. The international would be anything between 1.3-1.5, depending on which quarter you talk about, right? The PSU would be, in some quarters, it is 52% of that 100, or sometimes it is 57% of that 100, so that is the area that you have. CPA, it would be 8%-9% lower than the cash. I think that is what it kind of works out.
Thank you. Thank you. Thank you so much.
Thank you. The next question comes from the line of Kunal Lakhan from CLSA. Please go ahead.
Hi. Hi. Good morning. Abhay, you said earlier during the call that because of the brownfield expansion, the margins should improve, or rather it's accretive to the margins. Our existing units are operating at about 28.5% margin and EBITDA of INR 84 lahk per bed. There is an upside potential to this going ahead. That's what we said.
That's right. That's the whole, I mean, I want to guide you to that. Your brownfields have a higher EBITDA per bed, have a higher EBITDA margin. Because your management cost and your senior commission cost is already incurred by the existing hospital, right?
Any incremental beds that you have, even if you were to fill them with lower ARPOB businesses like institutional, etc., still give you a higher EBITDA per bed as well as EBITDA margins below.
Sure. As and when this incremental brownfield capacity stabilizes, where do you think these ARPOBs, or rather EBITDA margins or EBITDA per bed would settle?
I'm not going to give you a forward-looking statement.
No worries. Secondly, on the free cash flow side that we are generating some serious free cash flow from operations, and going by your newer assets are also reaching EBITDA break-even faster, any upfronting of your long-term guidance of, say, adding or doubling your capacity over the next four years? Any upfronting of that guidance?
No, sir. Look, what we do is any guidance that we give, right, is based on us already having acquired the asset, okay, breaking ground or permissions or whatever else it is. It is not a blue sky kind of thing. What I do not tell you is that, look, my belief is over the next five years, I will generate, let's say, INR 15,000 crore, so I will look at tripling my capacity or whatever else it is. No, that is not how we sort of guide either. What I can tell you is that, look, we have guided that we are happy going up to 2.5x net to EBITDA. We have very, very little leverage on our balance sheet, on our books. We are going to be funding all of sort of our expansion mostly through internal accruals, okay?
I mean, we have more than spare room to kind of acquire, and I mean, last year we did three acquisitions, right? Yeah. What is very difficult for me to do is guide, okay, in terms of till the transaction is closed at what we are doing. Now, there are other places that we are looking at expanding, putting up facilities, etc., but till I have that time, I can't sort of this thing. I am sort of cognizant of the fact that at 2.5x net to EBITDA, we get money at 8%-8.25%, and we're able to deploy it at 24%, 25%. As and when the deals happen, we'll announce, and that number on a rolling basis will only go up. I mean, today I'm guiding you, right?
2028, I may have 9,000 beds, but I'm pretty sure one year down the line, that number would have moved up.
Understood. Understood.
So availability of cash is not a constraint for the capacity addition, right? But it's not only cash. It is the balance sheet. We have enough room in the balance sheet.
Correct. Correct. Understood. Lastly, bookkeeping question. Can you give me occupancy numbers in Q4 for the newer units individually? Nagpur, Lucknow, Noida.
Dwarka, I've told you, is 73%. The older units were 78%. The Chitta and Jaypee actually completed in November. I think that's 46, 47. So 46 on average. 46%. 42% in Jaypee Noida and 26% in Chitta, right? And Chitta is a really small unit. And we obviously didn't pay anything much because we didn't have any EBITDA to start with.
Sorry, and how much you said for Lucknow and Nagpur?
Lucknow is 65% with the additional beds that we opened, right? Lucknow operating capacity has gone up. In fact, in this quarter, again, we go up to 430 beds. It was 324 beds in last quarter. We added beds in Lucknow. On the additional beds that we added, the overall capacity was 65%. On the operating capacity that we bought was what? Yeah. That means 209 beds on 234 beds, right? It is 90%. There was 90% occupancy on the beds that we bought.
Understood. Understood.
After that, we keep ramping up the beds. I mean, if you look at the end number of beds today, then it is 67%. Okay, but this is basically the beds that we added over there, right? Yeah. Some beds we got only this quarter. In quarter four. Yeah.
Let's note Nagpur is 81%+ . Nagpur is 81%+ .
Okay. Very helpful, sir. Thank you so much and all the best.
Yeah. Thank you.
Thank you. The next question comes from the line of [Rajith Agarwal from Neelkanth Investment Managers]. Please go ahead.
Good morning, sir. First up, congratulations on good share of results and the overall growth achieved during the year. I just had two very quick questions. This is not a concern exactly. The interest cost has been going up quarter on quarter. Just for how to model it, should we assume the current quarter as the run rate going forward, or is it expected to go up even further?
No, we don't expect any material change in the number. I think this went up since the October quarter because we borrowed money for the Jaypee acquisition of INR 1,000 crore.
We also taken INR 600 crore loan for the [SARA] acquisition in March 2024, right? These are the end-to-end acquisitions that we have, INR 1,572 crore at the end of March, which means that these are the two, primarily, these are the two term loans that we've taken, which is actually reflecting in the net debt. Unless we really do any major acquisitions, I don't think any major change expected in the interest cost as such. Similar run rate for the remaining quarters. If we do an acquisition, then it will change, right? Yeah. I mean, yes, sir. Yeah. Absolutely. Absolutely.
Second question, while Mr. Abhay touched upon this on the supply side, on the competition side, but specifically given that a peer of yours is coming up with the same number of beds in Gurgaon and at the similar premium location, do you think that is going to impact your numbers or the overall scenario for the next one to two years?
No. I'm not seeing any impact on my decision. We have a very large network in Delhi NCR. I mean, we've got, like I said, we've got 14 or 15 hospitals. Today, in terms of number of locations, we have twice the number of locations that our next three peers, okay, have put together. In terms of number of beds, we are equal to or more than the number of beds all of them have put together in NCR. We've got 35,000 healthcare workers, of which 20,000 live in Delhi NCR.
Out of our 6,500 senior clinicians, about 4,000 live in Delhi NCR. We are the largest home care business, only profitable one in the country, entirely focused, almost entirely focused on Delhi NCR. We have the third largest lab over there. In terms of brand, it's a much sort of good thing. Like I said, what we are doing over there today, I mean, we have a facility in Delhi NCR, okay, but it performs far better than the flagship of any other hospital chain that you heard of over there. I mean, in terms of occupancy, in terms of ARPOB, in terms of EBITDA per bed. Even yeah. For me, I'm solving my own need. I don't see a distinction. I don't think the other hospital is the same size either. Probably half the size. Okay.
They're sharing the same number, but yeah, you would know, I think you would know much better.
Anyhow, thanks. Thanks for speaking.
Thank you. Thank you.
Thank you. The next question comes from the line of Dheeresh K. Pathak from White Oak Capital. Please go ahead.
Yes. Thank you for the opportunity. For the Noida asset, what is the total SSI potential and how much has been used currently?
I mean, it's 18 acres of land for Noida, and I think we can add another 1,000+ beds. I don't think, and the present facility is operating at 50%. There's tremendous potential over there. I mean, keep adding. I don't think we have a problem in the next decade at least.
Okay. Understood. Thank you.
Thank you. The next question comes from the line of Tarun Bhatnagar from Tribeca Investment Partners. Please go ahead.
Yeah. Hi. Thank you for your time. My question is on Gurgaon specifically. Now, Gurgaon gets a lot of international patients. Should we assume that once Gurgaon comes up, then your international numbers will increase? You mentioned on the competition that you have some strength. Any particular competitor who you think can be a very tough competitor for you in Gurgaon, or you think that you have much better right to win in that region? Thank you.
Look, every hospital of ours in every micro market, okay, and we have 22 now, is the best-performing hospital, okay, with respect to perhaps every line item, including occupancy. Significantly higher occupancy. We operate at maybe 75%, and next closest competitor is at 65%. It is a function of the value proposition we put together. Now, Delhi NCR also, coincidentally, happens to be our backyard.
I am quite confident about what we are going to be doing over there. It is nothing which is sort of moving our competitive intensity or what we believe would have been the outcome. Yeah, that is where we are as far as Gurgaon is concerned.
Okay. International numbers seem to increase once Gurgaon comes up?
Sorry? International numbers. Yeah. Sorry. I forgot that. No, honestly, it is a destination for international business, but it is very similar to Delhi. I do not give it a significantly higher sort of this thing. In the overall scheme of things, I do not think it is going to really move the needle for us. At the enterprise level, will it significantly increase medical tourism? Answer is no. In any case, in the first year or so, you are going to be taking in all sorts of occupancies, right?
Not only international business, but institutional, otherwise, so on and so forth, like we've done in Dwarka. I don't see day one majority of the beds being filled up with international patients. It also takes time to do that, to mature that business for that particular hospital. No, I don't think it'd be a major move.
Thank you.
Thank you. The next question comes from the line of Rishi Modi from Marcelus Investment Managers. Please go ahead.
Yeah. Hi, guys. Can you hear me?
Yes.
Yeah. I'm just looking at your capacity beds. It's around 5,100 beds. And our operational bed count is around 4,654, which comes to a ratio of 90% operationalization. This has been the ratio for the last couple of quarters. Just wanted to understand, historically, we used to do around 95% of our capacity beds were operationalized.
Are we going to get to that 95%, or is it there's a theoretical capacity, but we are using the space for something else, and hence the operational bed count on the existing infrastructure will remain the same?
No, sir. I mean, if I take the example of the last two acquisitions that we did, we acquired Jaypee Hospital, and along with it, so basically, there was a hospital in Chitta and Dullanshere, which has come. They have a 200-bed capacity, and it's operating at 26%. So that leaves out about 150 beds there and then.
26% on 100 beds?
Or 26% on 100 beds?
We haven't opened the 100 bed yet.
Okay. So that's one. Nevertheless, it's basically 150 beds over there out of your 5,100. Then you have the Jaypee Hospital, which is acquired, which is a capacity of 500 beds. 500 beds operating at 377. Sorry?
We opened only 377.
Yeah.
Let me just, so your question is about the operational capacity and available capacity. I think there are three, four hospitals where we haven't opened all the beds. For example, Jaypee and Noida. The hospital has the capacity to go up to 500 beds. We have opened only 377 beds. There is some spend to be done to bring that 377 capacity to 500. We're planning for the spend. Knowing that the occupancy on that 377 beds is 52% only, we are not really fast tracking that. Similarly, Chitta Hospital, 200 beds hospital, only 100 beds opened. We don't plan on that 100 beds. Also, we have only 26% occupancy. There's no plan to open the balance 100 beds. That will also require some spend. Dwarka Hospital, as I mentioned, we opened only 35 beds.
The capacity is around 303 beds. We will open another 70 beds. Some of them have already been opened as we speak. We have a 200-bed Bathinda hospital where we opened only 100 beds. This is the capacity. I think Bathinda and probably Chitta, I mean, leaving these two, the others will open in the future of time. I mean, Bathinda, we have not seen the demand, so we do not plan to really open the other 100 beds. That is all will be on board, I would say, in another 8-9 months' time. Also to the point, all the capacities are real. These are not theoretical capacities, and they do not bring down to operational because of them not being available. They are the outcome of the business plan.
We don't make them live because the business, in some facts, may not survive at that point.
Okay. Got it. In practicality, if the demand is there, you can open up 5,100 beds?
That's right. Yeah.
That's not a concern.
Okay. That's right. That's right.
I think I wanted to understand ALOS, right? I'm comparing existing to existing. It's around 4.2 days. I just wanted to understand, are we taking any structural efforts to bring ALOS further down on at least the existing infrastructure, or it's more like now we have optimized to a level, and hence the fluctuations will remain on account of seasonality?
It's ongoing. It is seasonal, and it is ongoing. It also depends on your clinical program. You can't even compare any two hospitals across the board.
You have to do it on an absolute basis because no two hospitals have the same clinical program. ALOS by itself is not a bad thing. It depends on what programs you're running. Just to give you an example, a higher-end business, which is an international business, and a higher-end surgical program, which is, let's say, transplant, will always have a higher ALOS, but will have a higher EBITDA per bed per day as well. I think that is what we should be focusing on rather than purely that, unless you have a huge capacity constraint. At this point in time, we have that. I think the teams do work on discharge and so on and so forth to hasten the discharges, etc., etc., etc., to turn around the beds faster.
But if you have capacity, then it becomes theoretical simply because if you, whether I have, let's say, I had one bed for 365 days, whether I have 365 patients on one per day or I had one patient staying for the whole year, what matters to me is what is the EBITDA per bed, purely from a financial perspective.
Okay. All right. Finally, I think on the Nanavati piece, you mentioned you've got one block upcoming. And post that, I think we're going to demolish some 260-bed block and then build up a new one to replace it, which net net we'll have a higher bed amount. Just wanted to understand still what period on those 260 beds at Nanavati, which will be demolished, will be the usage revenue?
No, we are not building 260. We are breaking 160 beds. Okay. 160.
Almost these 160 beds are typically a large amount of them are the ones that are not fully occupied. We're adding 268 right now. For a period of two years, these 160 will not sort of this thing. Then we come back with another 280 beds. 280 beds. Right? You'll have 280, 168, plus another, I think, 150, right? Approximately beds. Yeah.
Okay. If I understand it correctly, the current 160 beds, which will go under demolition two years out, which means the next by 2028. Is that correct?
Currently, we have a 300-bed hospital. We are activating 280 beds approximately now at phase one.
You get to 600 then.
After the 580, after the 580, minus 160. Minus 160. We'll be activating another 275 to 280 beds at phase two. The 160 deactivation is happening in FY2026 or FY2028?
Please go. You have new beds coming. Another 280 beds coming. For two years, you'll have 400 beds when we deactivate 160.
These 160 you're saying are not that occupied. I'm just trying to understand, the return revenue will come in to the beds or it will be lower?
Most of these 160 beds are wall structures and lower occupancy beds. They are the old economy beds. The idea was to utilize them any which way. We got a chance to utilize them in a much better fashion to add a new tower altogether on that area, on that footprint.
Okay. All right. Okay. Thank you.
Thank you. The next question comes from the line of Alankar Garude from Kotak Institutional Equities. Please go ahead.
Yeah. Just one small clarification. Had you booked some cost in Dwarka in the first quarter before commencing operations, which are contributing to the full year EBITDA loss of INR 29 crore?
Yes, we did. You know that this hospital startup was delayed, right? We are planning for quarter one. We had higher manpower, and that even we could ramp it up faster. There was some loss in quarter one. I think it is around INR 5 crore-INR 6 crore, which was also reported. We actually mentioned about it also in the earnings updates.
I understood. Yeah, that is it from my side. Thank you.
Thank you. Ladies and gentlemen, as there are no further questions, I will now hand the conference over to the management for their closing comments.
Thank you once again. We will hear from you next quarter. Appreciate all your time. Thank you.
On behalf of Max Healthcare Institute Limited, that concludes this conference. Thank you for joining us, and you may now disconnect your line.