Good afternoon, everyone, and thank you for waiting. Welcome to the video conference of the release of results for the fourth quarter of 2021 of Dasa. So that you can use the simultaneous translation, it is available on the platform. To use it, just click on the button Interpretation with the globe icon on the bottom of your screen and choose your preferred language, Portuguese or English. We inform that this video conference is being recorded and will be made available on the IR site of the company, on the IR site of the company, under the area of Results. I would like to remind you that our considerations include also prospective declarations, which could differ substantially from those contemplated in these declarations and perspectives of the company. That means that these results may be significantly different, which are defined in the earnings release today in our financial reports.
Among these files, any future declarations during this call are based on hypotheses starting on this date. We have no obligation to update this information as new information appears. During the presentation of the company, all of the participants will have their microphones turned off. We will now start the questions and answers section at the end. To participate, click on the Q&A icon on the bottom of your screen and leave your question. The solicitation to turn on your microphone will appear on the screen, and you can then open your mic to make questions. We would like to ask you to make your questions just once. Thank you. Please do not repeat questions. We now pass it over to Andy Campbell, Director of Investor Relations of Dasa.
Thank you very much. Welcome to everyone. We will be starting our presentation from Pedro Bueno, followed by Felipe Guimarães, Financial Director. We also have with us General Director of Hospitals and Oncology, Sérgio Ricardo Santos, Director of Strategy and SG&A, and next to her, General Director of Products, Marketing and Experience, and Carlos de Barros , General Director of Outpatient Care, Diagnostics and Formation of Care. They will be available to answer your questions during the Q&A session right after the end of our presentation. I would like to pass the microphone over to Pedro.
Thank you, Andy. Good morning to everyone, and welcome to our results call in the fourth quarter of 2021. We are now going to look at slide three. I would like to initiate our presentation reiterating our mission and our vision. Dasa has been integrating a network, a health network to be the health that the people want and that the world needs. In many aspects, 2021 was a year of transformation for us. We dealt with the biggest wave of COVID of the whole pandemic. We did our IPO, we launched our new brand, and we had a huge advance in our strategy.
The execution was based on strengthening our core business, expanding our high growth initiatives, and growing exponentially in our digital platform, which was launched just one year ago and has already brought benefits of involvement with an increase in revenue, validating our thesis. Beyond that, it was a very busy year in acquisitions, with the acquisition of more than 1,500 beds and more than five diagnostics and oncology companies. We are specialized in integration, and we have built our playbook, which shows relevant gains in the assets which are more advanced in our integration plan. All that is not to say we had an easy year.
We had many days of difficult discussions, decisions, and adjustments in the team, but the desire to create an integrated company and put the users first. As I can say for myself and all of the incoming, we're all very excited about everything that we did in 2021, and we've learned a lot, and we're ready to deliver in 2022 with a lot of excellence, growth, and profitability. Looking at slide number four, please. We're going to talk about six topics during our comments today. First, I'll speak about our highlights from 2021 with a summary of our consolidated results. After that, I'll talk about the development of our core business, the hospitals and diagnostics, and then talk about our high growth initiatives with the coordination of care and other companies.
I'm going to talk about the development of the Nav, our digital platform, and then I'll pass it back over to Felipe to talk about our numbers and our balance sheet. Slide five, please. Now to talk about the highlights and our conquests in 2021, I'd like to give attention to four points. First, 2021 was an excellent year for the development of our core business for diagnostics. We had a huge growth, an increase in revenue of 40% compared to 2020, and almost doubling our EBITDA during the year. In the diagnostics segment, in which we are market leaders, we were the company that most gained share during this year. The result of our excellence of execution with our focus on technology experience, and at the same time increasing the satisfaction of users and guarantee higher levels of efficiency.
This year, we went forward in several levers of growth with this objective, and we'll continue impacting positively our revenue and margins during 2022. In the hospital segment, we're focused on preparing the business to arrive at new levels of revenue and profitability. We started to implement the same playbook that we used in the diagnostics in 2015, when we started the turnaround of Dasa. We focused on people and culture, definition of operational model, and using the best practices already existing in the different hospitals, and creating support areas such as the command center, which supports the managers to maximize their assets with more profitability. In 2021, we almost doubled our number of beds through acquisitions and construction of a greenfield hospital.
When we receive our pro forma revenue for these acquisitions, we're very close to a balance between hospitals and oncology on one side, and outpatient care and diagnostics on the other. A very important advance in our ecosystem strategy. Finally, the two businesses continue to give the best experience to our users, which was reflected in the highest NPS in the history of the company, both in diagnostics as well as in hospitals. In diagnostics, we increased our NPS by 3 points compared to the fourth quarter of 2020, arriving at 77 points. In hospitals, we went up by 2 points, arriving at 71.3. Number two, in second place, I would like to point out that our high growth initiatives within the business unit of outpatient care, diagnostics, and coordination of care. We increased the revenue from our genomic companies, and we also grew by 86% in 2021.
These opportunities reflect the power of our ecosystem to use data and involvement and engagement and capacity of navigation to supply new business fronts and accelerate these ramp-ups. All of our businesses are created with the objective of integrating more fluid experiences for the users and, at the same time, efficiency for the operators. We are very optimistic with the growth of these initiatives for 2022. Specifically in our business of coordinate care, we had a good behavior in contracts and performance, showing our expertise in management, healthcare management, and the use of data, as you will see going forward. The third highlight of 2021 was our advance in digital strategy. We relaunched Nav in April of 2021 as a new brand, which registered exponential growth in users, going from 125,000 to 1.8 million users in 2021. A platform of quality.
The app got a 4.8 out of 5 rating, and these are important. The doctors who use Nav have an uplift in their revenue of 9% in relation to the control group, when we look at the growth of these two groups. In telemedicine, one of the applications available in the Nav, the number of visits went up by 4x in 2021. In fourth place, in 2021, we took an important step to create a culture and values which permeate the entire company. Looking at our 50,000 employees, we continue to advance in our desire to create a healthy environment. Looking at people and culture, as I mentioned previously, we invested in a new management team for our hospitals, making eight important hires for the levels of vice president and directors. We are well-structured to empower our growth and a strong growth in profitability in 2022.
Now go to slide number six, please, to talk about our consolidated results. Since the beginning of the pandemic in the second quarter of 2020, our revenue has grown at a fast and consistent rate. In 2021, the gross revenue grew by 40%, representing a gain in share for Dasa. Inside of our core, the two core businesses had a strong growth in 2021. In outpatient care and diagnostics and coordination, revenue grew by 39%, even with no contributions from acquisitions. It is also worth mentioning that Alta, our premium brand, grew by 60% its revenue during the year. In the oncology hospitals, grew by 81%. Look at the resilience of our rate of occupations increased 8.4%, even though we had lost the COVID beds in the second half of the year. Our initiatives for high growth had a spectacular year in terms of operational metrics.
The home care coordination of care of the oncology companies already made an important contribution to our results of the year. Let us talk a little about each one of these business units going forward. Now we look at the next slide, please. In 2021, our EBITDA margin grew by more than 5 percentage points, a movement which has gained continuity in 2022. In the fourth quarter, there was an adverse impact of several impacts, which reduced momentarily our EBITDA margin to 12.4%. The temporary fall in margin was 8.5% when compared to the same quarter of the previous year, and is concentrated principally in the oncology hospitals and our administrative expenses. We observed in the fourth quarter as an atypical quarter, and the behavior of our business since December validated our diagnosis that the fourth quarter had a four strong one-off component.
To explain the results of the fourth quarter, we point out the following important factors and their relevance for the reduction of 8.5 percentage points in margin during the fourth quarter of 2020. We had a revolution in the revenue from COVID. In the beginning of the fourth quarter, it impacted our two business units, but principally hospitals and oncology. In October, this fall off in revenue was not compensated immediately by a recovery of elective surgeries. We had the return of patients with demands for these services. Without this revenue, and due to our strong fixed cost structure, we had a worse result than we expected with impact on our margins.
This impact coincided with the seasonal effect that was higher in the fourth quarter of 2021, when people naturally tend to mark less elective surgeries and periodic surgeries, in contrast with the previous year when the seasonality was inverted, had a very strong in the fourth quarter of 2020 due to the pandemic. When we put these two factors together, the seasonality, this explained more than 2 percentage points in margin compared to last year. On the positive side, we operated quickly with our initiatives, revenue-generating initiatives, and we saw a recovery in the second quarter of November. This recovery has sustained itself during the first two months of this year. The second factor which impacted the fourth quarter was a growth in revenue from acquired hospitals.
In the first moment, these revenues tend to have lower margins in relation to existing businesses, diminishing our profitability in the short term. We estimate that the effects of these integration of these assets with lower margins explains 1.7 percentage points of reduction in our margin compared to the fourth quarter of 2020. Our playback of integration has been delivering robust results in organic revenue and savings on materials and administrative expenses. As we advance on these different cohorts of hospitals acquired, we hope that these margins will converge to the same level as our mature hospitals. This tendency, which has already been confirmed in the first two months of 2022. The next factor which impacted our profitability was our business unit of hospitals and oncology, where we had an atypical expense in the purchase of materials.
In the first case, after reevaluating our processes at the end of the year, we drew down our stocks. We wrote down our stocks, especially for robotics, which is non-recurring and had no cash effect. In the second case, seeking to maximize the long-term returns, we finished two contracts with specific suppliers, generating rescission expenses to migrate to other suppliers who have lower costs. While the impact of these costs did not have the same relevance as the other previously mentioned factors, the one-off impact of these explains another 1 percentage point of lost margin versus the fourth quarter of 2020. In fourth place, we made a decision to postpone from October of 2021 until January of 2022, a readjustment in prices together with some of our clients in exchange for commercial conditions which are more favorable, such as higher levels of readjustments and other procedures such as oncology.
These were implemented and have already started to have a positive impact in the first quarter of 2022. The impact of the postponement of these readjustments had an impact of approximately 1 percentage point in our margin when compared to the fourth quarter of 2020. Finally, we took the decision at the end of the third quarter to maintain, and in some cases, accelerate our investments in technology, innovation, aimed at the strategy of the Navigation platform. We are leaders in technology in the healthcare sector, and we are accelerating the ramp-up of our digital platform and the interoperability of data through our business to grow even faster in the future. Part of this development is related to the acceleration of the construction of Nav and also the acceleration of the digitization of process with gains of efficiency.
Behind that, we decided to seniorize and increase our team of hospital management to advance with quality and profitability and the challenge of integrating, which we will see this year in 2022. These expenses had an impact of more than 2% of EBITDA margin when compared to the fourth quarter of 2021, because we decided to invest instead of anticipating gains of scale of our G&A. During 2022, we will capture part of these gains, which have already been identified and will simplify our management structure. With the fourth quarter of 2021 in the past, we started 2022 a great deal better, with results in January and February following our budget for the year, and with profitability closer to what we had in the first quarters of 2021 prior to the fourth quarter, even considering the impact of the integrated hospitals in the first quarter of 2022.
We are also optimistic with our results for this year, especially when we consider the huge increase in the number of surgeries in 2022 in the first months, and also the success of the integration of our hospitals, increase in prices with specific contracts, and a continued improvement of the development of our digital platform, among other factors already mapped out or under execution. Now I would like you to move to slide eight, please. The hospital and oncology unit registered positive results for the year of 2021, with growth of net revenue of 42.8% and gross margin improvement. Our rate of occupation has been very resilient and has maintained at 75% during the fourth quarter, even considering acquisitions, and our hospitals by COVID-19. In the first part of the year, this participation reached pre-COVID, pre-pandemic levels.
In the fourth quarter, nonetheless, we observed the effects of a very weak October, with the smallest contribution to revenue related to COVID. At the same time, due to the lower presence of other conditions, which is already underway. When we added these factors together with the higher cost of material due to an accounting write-downs in our stock and suppliers, we had a shrinking of the gross margins compared to the previous year. This was also partly explained by the consolidation of the acquired assets and higher material costs. Looking at the future, we are optimistic with the perspective of this business unit, and also with the reflection with a high level of knowledge of the hospital unit and also the health sector overall. Many times we have a one-hour in the costs for 2022.
For the consolidated results, our playbook is an instrument for the improvement of these things. Looking at the next slide, we are going to talk more about that on slide number nine. Our recent acquisitions are in a process of optimization and integration into the Dasa ecosystem. As we mentioned in the last quarter, our playbook of M&A consists of three phases, which happen in parallel. They are not sequential, but they do have different maturities. In relation to the recently acquired assets, the Hospital da Bahia and São Domingos are executing phase I, which consists in reinforcing the management team of the hospital when necessary, renegotiating contracts with the objective of reducing the prices from our suppliers and expenses, as well as standardizing the medical protocols. We had a gain of margins from 2%-5% starting from that phase already in the first months of post-acquisition.
Leforte already went through phase I and is already receiving some of the benefits of phase II. We focus on procedures, more complex procedures, better clinical efficiency, and a playbook of IT. We see a gain of 5-7 percentage points in our margin for the hospitals during this phase, during the 12- 18 months to mature 100%. In the case of Leforte, which was the biggest hospital we bought this year, we see concrete results of our initiatives. In the month of January, for instance, in spite of the inferior seasonality, the revenue of Leforte was already substantially above the average of the asset in the third quarter of 2021. It was right after Dasa took over the control with a closing that happened in September.
This increase of organic revenue, added to the costs and expenses in the first phase, resulted in more relevance and it beats the margin for Leforte during the first two months of this year and should continue during all of 2022. As far as phase III, we have already done a complete revision of any opportunities, brownfield opportunities, which are part of this stage for all of our hospitals, and a huge opportunity for expansions. This week, for instance, we inaugurate a new wing with an expansion of 100 beds in the São Domingos hospital in São Luís, raising it from 370 to 470 beds in the total of that hospital. For the next years, we are also expecting an expansion in the Grupo Carmo in Rio, with the addition of at least 85 beds, which represents a relevant increment of growth.
In relation to the new hospital in the ABCD region in São Paulo, the brownfield opportunity is even bigger in terms of beds, 150 beds. The brownfield expansion usually offers a very attractive with a short period of return. There are no regulatory questions, and you have the question of the fixed costs within the hospital structure. Continuing our discussion of the core, we will go to page 10 to talk about our other business unit. Our business unit of outpatient care, diagnostics, and coordination of care registered robust growth in gross revenue of 38% in 2021, signaling gains of share for Dasa. In 2021, the gross margin increased well by 37.8% and exceeded the pre-COVID levels of 2019. In the fourth quarter of 2021, the net revenue of this business unit registered a growth of 2.5%, in spite of all the adverse factors which impacted it during that quarter.
First of all, the revenue from COVID diminished, which this represented 15% of the business unit's revenue in 2020, while during the same period of 2021, it represented only 6.8%. As I mentioned previously, October was an atypical month, different from the historical patterns, both in the COVID and non-COVID areas. The second was the postponement, a momentary postponement of certain contracts, as we mentioned, with the adjustments changed from October to January. These readjustments have already been implemented and are already positively impacting our results. At the same time, we observe an adverse seasonal effect in the last quarter of the year. While the fourth quarter of 2020 had an anomaly without the usual seasonal effects, we now have a more challenging base for the fourth quarter of 2021.
Within that context, we consider the increase in revenue positive when compared to the fourth quarter of 2020, even though all of the factors in this sector impacted us strongly in October. Another point of revenue of reference is the increase of 38% in this business unit when compared to the fourth quarter of 2019, and a quarter that was pre-COVID, eliminating any distortions brought in 2020 during the pandemic. Looking forward, we're investing to make our leadership in the diagnostic market. We continue to invest in technology with the idea of perfecting the user experience. Just as an example, in 2021, our web check-in registry was officially launched, and it already added up more than 330,000 accesses, permitting the users to have a faster and more efficient attendance in our service center. This has generated a reduction in time for service and gains in productivity in these units.
The increase in the number of services per person will translate into web check-ins into a reduction in fixed costs for our units, and especially in the reception area, one of the principal costs of our units. Now let's go to slide 11 to look at the high growth initiatives. Looking in the same business unit, we had relevant results in our initiatives of high growth. These initiatives will continue to be a focus for Dasa in 2022 in the measure that it diversifies our revenue, potentializes our gains of scale, and gives us a desirable return, improves our contact with patients. Just to speak briefly about our initiatives, Dasa Empresas, our solutions for corporate clients, had a growth of more than 1 million lives in 2021. Our home collection unit has grown at an accelerated rate with a higher level of satisfaction from the clients.
The revenue grew by 47% in 2021, and we still see a huge opportunity for this model of attendance. Our genetics unit, which is a Genera leader in tests of this type, had growth of 87% or 86% in 2021. The coordination of care had important advances last year, beyond growing more than 42% in the number of users in the period we improved and in the question of managed portfolios. We brought a case study here of this business. To illustrate the potential that we see in this segment, we can cite a concrete example when we had it with an individual portfolio. It's a very complicated portfolio to manage in 2021. We had a division of 25,000 lives involved in the coordination of Dasa, all by volunteers. We took over this responsibility during the first eight months, of which we have the information from the operator.
We saw a reduction of 30% in claims for medical care compared to a control group of the same portfolio in the same period. Since this contract was based on performance, this value generated by our management was shared between the operator and Dasa. However, more important, this case shows our expertise in healthcare management, engagement, and the use of data to generate the best possible experience for our users, as well as efficiency for the healthcare plan operators. With cases like this, it makes us even more interested in coordinating data with other portfolios even bigger for 2022. Next slide, please. In the fourth quarter, we had an inflection and an exponential inflection point for the Nav, our digital platform. We had reached more than 1 million users in just one quarter. We went over the total number of users in the previous period of the previous nine months.
The acceleration of new users corresponded in the same time when we observed an improvement in the evaluation of the experience by the user. In July of 2021, the Nav was 3.705. In the fourth quarter of 2021, Nav reached 4.7%, a very high score. With that, we confirmed our investments which were done to improve the experience of our users. Beyond the patients, we saw a huge number of users, a huge jump in Nav Pro, our interface for doctors, with more than 10,600 different users just in the fourth quarter of 2021, compared to 2,400 in the third quarter. The increase in the number of medical users has been accompanied by an increase in revenue coming for these doctors, reflecting a higher level of engagement.
We identified an uplift in the growth of revenue coming from the doctors that are connected of 9% when compared to a control group who were not connected during the same period. Considering the vast universe of doctors with whom we interact regularly, this is an important advance as we advance a growing number of doctors in our platform. And of course, once again, we will be focused on the engagement of the user and as the value proposition continues to evolve. In that case, the app Nav has become more and more important as a channel of connection between patients and doctors, improving the user experience and bringing more patients into the Dasa ecosystem. Today, I will pass the word over to Felipe, who's going to speak about our M&A initiatives and our numbers. Slide 14, please, where we present an update on the M&A initiatives.
During the fourth quarter, we advanced even more in our ecosystem strategy within the principal markets. At the beginning of last year, Hospital da Bahia and Hospital São Domingos, totaling The Hospital da Bahia contributed to our results. This hospital represents a significant advance of the company in the strengthening of our position in the market in Salvador, and at the same time impulse our navigation strategy in the northeast. Hospital São Domingos complements our laboratory operations in Maranhão with strong financial gains. It exercised impact in 2021, but will contribute in the first semester of 2022. Beyond that, we concluded the acquisitions of Hospital Paraná in the first part of 2022 without impacting the impacts of fourth quarter 2021. We consolidated all of the acquisitions of hospitals and oncology services announced in 2021. We are now going to slide 15. We will comment on our financial results.
In 2021, we had a growth of gross revenue of 39.5%, pushed by strong growth in both business units. The adjusted EBITDA doubled in relation to 2020. The results in 2021 included the acquisitions acquired from each acquisition, and during 2021, if we had been consolidated in the whole year instead of a part of a year, would have contributed another BRL 270 million of EBITDA. Instead of BRL 1.7 billion reported, these are pro forma numbers. We cannot look at all the synergies since these assets are now becoming part of the Dasa ecosystem. Looking at slide 16, we will talk about our debt, our cash position. We closed the fourth quarter with a net debt of 2x EBITDA, a reflection of our balance sheet and our financial position. When we consider the reported EBITDA, including non-recurring expenses, our level of leverage goes to 3.2x.
Even though we made payments in different acquisitions in Bahia and São Domingos, our cash position during the fourth quarter of 2021 increased due to the issuance of BRL 2 billion in debentures, which extended the profile of our debt. We registered BRL 3.6 billion in cash equivalent. At the closing of 2021, we closed an emission of BRL 2 billion in commercial paper, which gives us more flexibility attending to our needs and our obligations in the execution of our investment plans for the year. The continuity of seeking opportunities in the sector. We believe the company is well positioned in organic and inorganic, and generate value for our business.
We will now begin the question- and- answer period. If you have any questions, to make a question, to participate, just click on the Q&A button on the bottom of your screen and send your question. We will open your microphone so that you can make your question live. The first question comes from Pedro Oliveira, a sell-side analyst from BTG Pactual. Pedro, we are going to open your microphone so you can speak. So you can make your question. Pedro, please go ahead.
Thank you for taking my question. From our side, we have two questions. The first is in relation to CapEx. We observed an important volume in the fourth quarter. I want to understand if that comes from any pent-up demand from 2021, which all wound up was held back due to the pandemic? Or what was the principal motive of this large CapEx volume in that quarter? What should we expect for 2022 if nominally we will continue with this high CapEx? The second question is related to the strategy of tickets in the hospital vertical.
We had a fall-off in this semester, and the M&As had an important impact. I want to understand what is your strategy to adopt if it is increase of complexity in these assets which have been acquired, or if we should expect a ramp-up over the next years, or if some of them, in fact, will have a ticket which is structurally lower. Thank you.
You are on mute. I am sorry, he is on mute. We cannot hear him. He is on mute. He is on mute. I am sorry, but the speaker. There you go. Okay. Yeah. Okay.
Sorry about that. I was speaking alone here. My microphone was turned off. Thank you for the question, Pedro. I am going to take the CapEx, and then I am going to pass over to Emerson, who is going to talk about the hospital's average tickets. Going directly to the point, we do not expect to maintain this level of CapEx for 2022. 2022, we see a level a little bit below the accumulated of 2021.
Very focused on the area of technology and on the part of navigation and information security, and also in brownfield operations in our hospitals. In this fourth quarter, we had a consolidation with the investment, the acceleration of the navigation due to our initiatives, and we've seen very good results as we've accelerated these, and also because we've made a strong investment in information security in relation to IT in some hospitals and medical equipment.
Pedro, as far as the average ticket of the hospitals, there are two effects here. The first, we have the entrance of the acquired companies in the fourth quarter pressuring us, downward pressure, and we've had our stock when they've gone on a better, higher level than Dasa at the beginning of the year. The impact of COVID. We had strong COVID previously. In the fourth quarter, it fell off, and so less COVID and low complexity COVID. The Omicron spent only 2 days in the hospital. When we saw in the second and the third wave, we saw more than 10 days average hospital stay. The impact of COVID was relevant in the acquired cost hospitals. Nothing structural about our business.
Thank you. Next question comes from Gustavo Miele, sell-side analyst from Goldman Sachs. We'll open your audio so you can go ahead and make your question. Gustavo, go ahead. Go ahead.
Hi. Thank you for the presentation. Two quick questions from our side. First is in relation to the conversations with the payers. We think that in relation to Leforte, you're in the stage of adding more complexity since you've been integrated, but how are your conversations with the payers to line up once you may go into more microservices? Also, on the same subject, if you expect that the transactions that we have seen with SulAmérica could impact your relationship with other payers if they have sought to talk with you about trying to strengthen your commercial relationship with them.
The second question is about Salvador. What do you expect in the competitive environment for 2022? We saw relevant movements there from other players in the sector in that city. You're making an interesting move of verticalization in oncology after the acquisition of Clínica AMO. Do you think that the verticalization of oncology could be good for you and bring some competitive advantages in that city? Those two points, relationship with payers and the dynamic in Salvador. Thank you.
Okay, Gustavo, thank you for your questions. I'm going to start off with the first part, and then I'll pass it to Emerson to talk about Salvador. The relationship with the payers, I would say, is very positive. Everything that we've been building in Dasa is in the sense of bringing a better value proposition for the patient as well as for the operators, the payers, in relation to costs in the individual portfolios. Our hospitals, even though we've been gaining complexity in average ticket, we've invested a lot in clinical efficiency. When an operator compares the average ticket for a certain complexity in our hospital with competitor, many times we have the benefit of total cost, not just as necessarily in price, but in total cost, because we use medical protocols for clinical efficiency.
As the second part of your question, you commented about the merger that recently happened, and this generates a goodwill for the other payers. We are opening conversations with several other payers about increasing the partnership registries so that we can have reciprocal benefits, reduction of costs for the payers, and growth of volume and of revenue for Dasa.
In the specific case of Leforte, I would say, as I mentioned at the opening, we saw an important growth of revenue in Leforte from January when compared to the average month of the third quarter, even though in spite of that seasonality, which plays against, but it did not involve any readjusting in price. It was just bringing better medical teams, reforms in the surgical centers, bringing more complexity to the hospital. There is still the upside of the readjustment, which will happen now this year. In 2022, we have the expectation of in the consolidated of Dasa, the two business units, to be able to pass through inflation with the payers. I am going to pass it off to Emerson to talk about the situation in Salvador.
As you mentioned, Salvador has a competitive scenario, which is challenging, but we have a big opportunity there. The interaction between AMO and the other hospital in Bahia was very low. Today we have the migration of the surgical teams from AMO who were in other hospitals in Salvador, migrating to our Hospital da Bahia. Beyond that, we also have a migration of small procedures that were done in the day hospital and in other hospitals of the competition, which are now migrating to our operation.
Since oncology is a specialty which is very relevant in our business, it is part of our strategy. In Salvador, specifically due to the potential and the size that it has, this is without a doubt a strategic lever. Beyond that, we have the image clinic in Salvador, Leme, which is the best operator in Salvador, completing our Dasa ecosystem. We have the same tools and capture and navigation of patients who make a precocious diagnosis of cancer in Salvador for AMO and then for the Hospital da Bahia. It is one of the assets in-house which we are using to ramp up more quickly the Bahia hospital.
Thank you, Pedro and Emerson, for your answers.
Next question come from Carlos, sell-side analyst from Condor Insider. We are opening your microphone so you can go ahead and make your questions. Go ahead. Carlos, go ahead.
Good afternoon to everyone. I have three questions to ask. First, for 2022, what will be your investment in CapEx on the maintenance and openings of the current units? Second question, with the new level of interest rates and inflation, should we expect that 2022 more complicated by getting the maximum synergies from the acquired hospitals, acquired units, or are you open for new opportunities? Three, do you plan to utilize the resources in cash to pay debts that will come due in 2022, about 28% of the total debt, or will you be opening new lines of financing to lengthen this horizon? If so, what will be the rates on the new negotiations? Thank you very much.
Thank you for your question. Carlos, starting with the CapEx, as I commented, our CapEx for 2022 will be focused on two fronts, the technology to support our expansion and our strategy, as well as in the area of information security and in the hospital brownfield area with these items being acquired. In relation to your second question, the focus of this year is in fact to integrate the assets that we acquired during 2021, even though we believe there are still opportunities to continue consolidating, perhaps at a lower level than we did in 2021, but we still have a year of new acquisitions where these things will occur.
Finally, your question about cash. We're going to continue to roll these debts over. Recently, we just did BRL 4 billion of new borrowings in the last five months at the average cost of CDI plus 1.5 , which helps us to an increase in the duration of our debts and the horizon of our debts.
Okay. Thank you.
Next question from Fred Mendes, sell-side analyst of Bank of America. Fred, go ahead. We're opening your microphone to make your questions. Fred, you can now start.
I have two important questions from my side. First is, if you could explain a little bit in the call, if I was to rank the principal objectives, this is a year in which we can expect something like more relevant revenue. If this is not the moment to think about NPS and other metrics, this would be the first. The second, in the area of diagnostics, as you mentioned, the representatives of COVID. In the first quarter, there will be some positive COVID effects, but after that, it will be close to zero. So what can you expect for 2022, that even without this so-called benefit of the COVID patients, we can think about a margin expansion for the whole year? Thank you very much.
Andréa.
Good afternoon. In listening to Nav, we're going to have three principal focuses this year. The first is to improve the NPS. We already have an important score, but we wanted to increase all the services of Nav. The second, it is better engagement. We've been working strongly on the engagement of users, and with the idea of generating revenue from each per navigation, an important revenue, as Pedro mentioned in his presentation. We also observe 9 percentage points of improvement for doctors who are involved in the Nav program. The object is to generate more doctors and more users on the platform, and therefore, more transaction and more services. Finally, we see an increase in the first two months in the number of these clinical operations.
Thank you, Fred. This is a good question. We're being very consistent and not to take off too fast. We want to gain experience and knowledge from our users. Any platform that you look at, it took five years to be built. So we've gained a huge number of hours at the end. If we look at the first number from the first quarter, it's much higher than in the closing of last year, but also less important to gain users and revenue, but to gain revenue and confidence. Obviously, we can monetize this in parallel, but this ramp-up of the monetization will only happen in the third and fourth year. I'll pass it over to Carlos.
T hank you, Fred, for the question. Speaking a little bit about the business of 2022, what do we think is going to continue to happen? First of all, as you mentioned, the revenue from COVID, yes, heads towards zero. It's what we hope because we all want this pandemic to end. What we have seen in the first quarter of this year, and with January and February, due to the Omicron, there was a small peak, but now in March, this has already fallen off strongly. What we expect for the rest of the year is the continuity of what we saw in 2021, which is to continue gaining share.
When we look at the full year of 2021, and we compare it with the principal competitors and the information that we have about the health market in 2021, we expect to continue gaining share in 2022. Some things supporting us and being the reasons for this to continue to happen. First, the effects of the fourth quarter have been reverted. We've already seen our first quarter much stronger.
Secondly, our high growth initiatives continue at a very accelerated rate, both Alta and home collection and company businesses. All of this continued in the first semester, and all this combined with the digitalization of the service, the reduction of time of 25%, arriving at even 50% in some cases, and some people waiting in front of the receptionist, the principal levers we have for 2022 give us a lot of confidence in the area of 2022. We're going to continue to grow and taking share.
Very well. Thank you. Thank you very much.
Pedro, Andréa, Carlos, thank you very much. Next question comes from Vinicius Figueiredo, sell-side analyst for Itaú BBA. Vinicius, we're opening your audio. Please go ahead and make your question. Go ahead.
Good afternoon to everyone. For taking my question. My first question is in relation to the low stocks which were previously seen. I wanted to understand, was it just a certain operation that you acquired recently, or was it in your operation organically? If I could add just one more question. If you have seen an environment for better negotiations with suppliers in 2022. If I can make one more, complementing the first question of our colleague. Revenue coming from COVID has lost importance, but I wanted to understand in the area of readjustments and costs. No matter how much we have off in the area of COVID cases, we should also have protocols more demanding in the hospitals. What do you imagine with these items for 2022, these cost items for 2022?
Hi Vinicius. Thank you. Basically, it was in our organic operation, the process of lowering the robotics, where we made a revision of our analysis of our processes, and we hope that this won't happen again. In relation to the negotiation world, it's been very difficult. The negotiations are very tough, but we have a much bigger scale, which gives us an advantage, especially when we're looking for oncology medications, etc .
Together with that, we have an internal movement for standardization of our protocols to concentrate volumes and those medications, and to be able to gain scale and gain negotiation power. Finally, you talked about COVID, the costs of COVID. In this sense, I think that we've seen. Look at it positively, both in consumption as well as in price. The principal costs related to COVID are related to people, whether they're in the hospitals or in the units, and related to APIs. Both are reducing quite a bit.
Today, we have small and modest spaces dedicated to COVID, which diminished the numbers of people dedicated to that, and also the APIs, which have been reduced, that cost, especially in the area of costs, masks, gowns, gloves, have prices that are much less inflated than they were in previous periods. So this curve is going down. In the first, we just had a new bid, which also came in with a newly reduced price.
Perfect. Super clear. Thank you.
Very well. Very clear. Thank you very much. Next question comes from Ricardo, the sell-side analyst of Safra. We are opening up your microphone so you can make your question. Go ahead.
Good afternoon, everybody. Thank you for taking my question. My first question is just a clarification about the accounting write-down, if you could quantify a bit, because it covers several lines. But if there is a way for us to look at that in a more normalized way of cost, that would help. The second question is in relation to the increment that you mentioned of the medical revenue. It was a good opening. Can you clarify about the levers and how it affected the performance of the doctors who are in the platform, the Nav platform, who are more engaged? What is bringing this performance? Of course, it is the platform to be able to have this, but also within the platform, what are the principal levers that have raised the performance of the doctors, increased the performance of the doctors?
As far as the P&Ls, I am going to talk about that, and then I am going to pass to Andréa. We estimated BRL 26 million in my impact during the quarter.
[Non-English content], Ricardo. The southern margin on that platform is executive the convenience which it offers for the professionals through the Nav Pro, which is the version for professional of the Nav. So he has access to all of the results of the laboratory exams and images, as well as clinical insights which help in the care of his patients. We have already been observing this as well as other services, convenience services, ease and access to our medical assistants. And with that, we observe an increase in the utilization of the services and a gain of share in the Dasa.
Thank you. If you could also mention a little bit if you've noticed any of these points pushing the growth of the other, such as the ecosystem, where you have more doctors involved, you have more users and more patients. Today, do you see one of these pushing this growth more than another, or are you still in initial stage where this type of analysis, network effect is not yet appearing in a more significant way?
Our objective is the network effect. Today, we observe this a bit of a nine points in a smaller grow in our other patients as well. So we measure both ends, but it's more towards the professionals because of the number of services and accesses that we have made available to the medical professionals for the patients. But looking at the roadmap of this year is we're looking at several clinical insights and services, conveniences, and also which have already been tested, and which are now by digitalizing them, it'll be faster, easier to scale them up of these services for our patients.
Thank you. Thank you very much.
Our section's question- and- answer is now closing. I'm going to pass the microphone over to Pedro Bueno for the final considerations. Pedro, please go ahead.
Thank you. So thank you very much for the participation. We're here satisfied with the numerous structural advances that we made in 2021. Of course, the fourth quarter was differently than we hoped, but as you see, it's all mapped out. The one-offs will no longer, the first quarter is coming much stronger in line with our budget, so we're very excited about the construction here of 2022. And you have our commitment and our dedication focused on the execution this year to be able to increase this profitability, expanding our high growth initiatives, and continue expanding the Nav, our platform. If you have any more questions, our team is at your service. Thank you all very much