Good morning, ladies and gentlemen. Welcome to the earnings call for the second quarter at Mater Dei. Today, we have Mr. José Henrique Salvador and Rafael Cordeiro, our CFO and Investor Relations Director. This earnings call is being recorded and will be available on the Investor Relations website after its completion. To activate the simultaneous translation option, just select the globe icon on the bottom. The presentation will be available on the IR website, on the Mater Dei network website. We'd like to let you know that possible statements about future events are subject to risks and uncertainties that could make such expectations not become complete or differ from what is expected. These expectations are based on information currently available, and the company is not liable for their actual results.
So if you'd like to open up and submit a question, please raise your hand or if you'd rather, you can also send your question by chat. I'll pass the floor on to Mr. José Salvador, so that we can begin the presentation. Good morning, everyone. Thank you so much for your time and attention today, so that we can explain a bit of our earnings for the second quarter of 2024, and also a bit of the earnings for the first half of 2024. We can move on, please. So just a few reflections here on this quarter and the other quarters. This was probably a quarter where we had growth in our revenue of 8.3% in regards to the second half of 2023. So we can demonstrate that the company continues to keep up with its growth process.
But this quarter had some results we were not satisfied with and with what we've seen in our day-to-day, and some of these factors explain what happened. So the first point that's worth mentioning is that this quarter had less levels of complexity. So this is because of the effects or after effects of one of the biggest dengue fever epidemics, which is very atypical when you consider to other recent periods in the company. So also in May and in June, we had atypical months related to respiratory diseases.
It was a year that was a lot warmer than last year's, and some of our structures in the hospital are prepared for patients that are clinical and that have these respiratory diseases because of this period in the year, especially for those units that have big pediatric units and intensive units. This year was really a different year compared to other years, which basically reflected in the results in the month of June, which is where we have a level of revenue. Normally, that's a lot stronger, but this year specifically, we had a month where we didn't really achieve the same levels of revenue that we had already observed in other years. Along with lower complexity and expectation for more patients, made us have a month of June with lower occupation rate, which definitely influenced our levels of profitability.
So the positive point here is that in July, we had already seen a perspective that was really unique compared to what we had seen in June. We're going to also talk about this up ahead. So besides this, it was a quarter where we had the payment in our main units of the second most relevant installment of the nursing bill. So we had decided to negotiate this in each unit, and we decided to take the forefront and try to have negotiations that could be fair for the company. And now what we can do is share with you about how the impact of the nursing bill is very close to the end and reflecting our numbers at the net, at the network.
So almost 90% of the final effects are already reflected in our numbers and the numbers we had presented actually in this quarter, which brought an impact that is besides what above 1.1 percentage points in our results. Since we are still at this moment where... Well, this is unfortunately an impact that goes up on an elevator and comes down on a stairway. We still don't have the power to offset this effect in our numbers. So the third important factor are those related to claims and our NPLs as well. This is mainly due to some operational factors, where we have a claims rate, a non-payment rate, and NPL that's higher than what we had presented in previous years. So about two percentage points, approximately, of our results.
We've been working intensely on solving our revenue base, actually, and cleaning up our revenue base to be able to reflect the actual levels of expectation for cash conversion that we would like to achieve in the company. And up ahead, Rafael will be able to present this with greater clarity, and the main reasons for the effects we had observed in this quarter related to the NPL. So besides this, we've also had opportunities that we've observed in the work done in medical materials to reduce this line and what it represents as costs for the company. And we've also done some relevant work in this sense, which is also why I would like to talk about these perspectives.
So after a very crucial moment in this company, which was basically the solving this issue at Porto Dias, which is something we'd already brought to the public, we have a lot more positive perspectives. First of all, in regards to July, we've already had a month that was very different than what was observed in June and also what was observed on average in this last quarter. So in Salvador, we had 39% growth, and when we compare June and July, and then we had a general surgical growth of almost 15% also. And in the metropolitan region, in the same way, we've also had relevant growth in our surgery volumes, which are also about 13% compared to what we had presented in the last month.
So besides all of this, we've had stronger advances, and we're gonna see this effect in the second semester of our sustainability project for the supply chain. It's such a robust project we've implemented here in our chain and in our network. That was expected for the second semester, and our expectation is that in the next 12 months, with the supplies project, we'll be able to really offset the impact that the nursing bill has been bringing to the company. So our objective is that with this work, we'll really be able to offset what we've had as an impact for the nursing bill we've already presented. So besides this, you have a shift in quarters between this quarter and the next, which has led to a good perspective for good negotiations we were able to work on in some specific hubs.
So in these hubs, from companies we acquired, where we had a bigger difficulty to present the growth and results, we were able to have some relevant negotiations when it comes to the price charts with the operators and the payers, over double digits in these negotiations. Besides this, you have the adjustments with the main payers, and this took place in this quarter. We've also been able to attract new customers, demonstrating the credibility of some of these new acquisitions and units that of doctors and other movements we've been working on to attract new physicians to each of these defined hubs.
So we've been working on major efforts also to conversion of some of the values we have into cash, and this is mainly due to two important initiatives with the reduction of operational losses and non-payments in the company. So we've seen significant changes in the end of this quarter, but also work with the payers, so that we can really get back some values that were pending from the past, that help us with a stronger cash position, and also help us with a conversion in our economic results through the returns on these values to the company. Another important perspective as well, that we have for the next two weeks, is the opening of the Nova Lima Mater Dei, a new hospital that's very modern, in a region that has levels of growth, populational growth, that's above 40%.
So it's the highest income per capita in Brazil, and now on the 23rd of August, we'll be opening this unit. And as we've mentioned before, it is a unit that brings quite a bit of synergy with the units in the metropolitan region, in Belo Horizonte. And due to the way that the payers have been receiving this, and the medical teams have been receiving this unit, we believe it's gonna ramp up even quicker than what we had budgeted originally. So for this specific unit, we have many new teams that are references in our region, and teams that are here to be part of the Mater Dei network, and also come along to bring in new patients that hadn't been using our hospitals before.
Besides this, we have important advances in our Mater Dei Santana project in the northern region of São Paulo. This is a project that advanced quite a bit, and the negotiations with Atlântica and BSP advanced significantly, and we have the opportunity to try to anticipate as much as possible the beginning of the construction phase of this project, so that we can open up the hospital, as we mentioned, in 2028. So now getting into the specific presentation, we cannot say this was a quarter that was challenging. We cannot disregard the fact that it was very challenging because of the negotiations and the divestments of Porto Dias. We had a big focus on this, and a lot of our attention was really connected to negotiations related to the project specifically.
Now, with the resolution and the closure of the operation, we'll be focusing even more on the existing operations and projects we have in-house to unleash even more value for the company. We can move on. Besides this, in this quarter, we celebrated two years of the hospital in Salvador, and this was a very important period because the unit in Salvador was never so robust as it is in these two years, attracting a lot of attention from teams that are considered important to the market there, teams that are important to Bahia. These are teams that also have a national presence in their specialties.
A lot of teams have been contacting us and integrating the Mater Dei Salvador teams in the end of this last quarter, and this also brings an important expectation for growth, and a bit of this is reflected in our results in July. But we can already notice that this team is responsible for this impact in our unit. So besides this, many of the operators in the region also have relevant trends and movements to be able to concentrate their volume of patients in our unit. It's worth mentioning that June is a very unique month in the Northeast and in Brazil, because that's where you have the big parties, the São João parties, traditional parties, and that's why the results were impacted.
But now we've seen that July also has this recovery and beginning of August as well, with a big volume in our units. Another point that's really important that took place in the last quarter was the incorporation of a new executive team. Lara Salvador Jacob came back from her training, and you saw a bit of the governance and family training processes here, and Lara's coming back to take on the position for innovation and patient experience, and we have many projects we plan to accelerate with her arrival that will also bring in major potentials for growth. And we've talked about this with some projects with A3Data and some other initiatives as well, in parallel, that bring in synergies with our business, and we plan to accelerate these with Lara's arrival back into the management team.
We also had an accelerated pace of investments in the companies acquired, and each of our hospitals intends to really be... Well, the reference is not only in the locations where they're placed, but in the regions where they are, and these investments in this quarter had a bigger, a quicker pace than what we had done previously, and these are investments that we intend to strengthen a lot, with the position of these hospitals as the main hospitals in each of these regions. As we work with the plan, with the companies acquired, that are levels higher than what we had seen in previous quarters, and the perspectives for the next quarters are really important.
But we had many different ICUs that were referenced as UTI Top Performer, and this is a relevant seal or certificate in our market that demonstrates the commitment to relevant quality of care in each of our units. We've also, in this quarter, had a second issuance of debentures at a cost that was below what we had for our debt levels in the company, which helps us have a cash position that is even higher than what would have been projected, despite this operation in Porto Dias and this separation of the Mater Dei network. And this was super important because it helped position us in a safer way and also for seeing possible new movements in the company's pipeline.
So in regards to Mater Dei Nova Lima, as I mentioned previously, we're just days away from the opening of this hospital, and as I mentioned, this is gonna be incorporating a lot of value in our metropolitan region. So this includes value in the short term, with the growth of the level of services provided in our region, but also strategic value, as we are very well-positioned in a very relevant region for our state. We can move on, and with that, after we go over this quick summary of what happened in this quarter and our main lessons learned and perspectives, but I wanted to show Rafael so he could explain the numbers a bit and how these perspectives were reflected in the numbers for this quarter. Okay, thank you, José Henrique.
Good morning, everyone, and this is a really important moment for the company. I think, José Henrique's message is really in line with what we've been doing internally ever since the perception of what we'd seen in May and June of our results. But we've intensified many of these initiatives, which are very fundamental to complete the results we expected, and we're really focused on reaching what we have committed to indirectly and internally to have profitability that's a lot better than what we had last year. Some projects we had already expected in our budget for the second semester. These are not simple projects. They're really important structural projects, and that's where we see the seasonality issue that's pretty different than that in other years, as José Henrique mentioned.
So I'm going to show you first a bit of slide 5 with the occupation rate. So we had a drop in the occupation rates, and I believe this is the first point for deviation of what we would like to operate with, which is close to 80%, and this makes us have a bit more costs with personnel and payroll than what we would like to have. And so this is the first point. Of course, this is operating a hospital is not simple, and you don't want to be changing your team too much because there's a big expectation for the historical seasonality, with June and July being very strong for surgeries, and that didn't happen, so... As well as ICUs for intensive care. So this pressure makes us have to act quickly.
And so from an organizational perspective, as José Henrique mentioned, we see a recovery in July, which is where we are able to fight a bit of the seasonality, and we still. Well, we operate in certain regions, like Minas Gerais, that was really affected by dengue, and maybe other chains also, and networks have a bit more of a regional revenue distribution, and so maybe the impacts are not the same. But anyways, we continued with about 80% on our target or radar, and when we look at the amount of patients per day compared to last year, you can see the same growth we had in the first quarter, also compared to the second quarter.
With the dengue pandemic was very strong, and we had very strong growth in the first quarter, but then we had a pretty constant revenue for the second quarter. So moving on to slide 6, this lower complexity for this activity we found within the patient profile made us have a constant ticket compared to the first quarter, which is a base growth of 0.6%-2.20%. And we had a growth of 0.7% compared to 6 months last year, the first six months last year and the first 6 months this year. So in regards to the net revenue, there's some stability also in regards to the first quarter, BRL 583 million in the first quarter, compared to BRL 585 million in the second quarter.
But from a semestral vision, with the first six months, the first half, we can see a growth of 8%. So our objective is to have a growth level that is double digits, and we're still below this. And so when you look at this from... Then you have a bit of the structuring projects we have, right? One of them is the issue with the revenue cycle. So when we look at the gross revenue, we've grown about 10%. We're closer to what we would like to perform in the year, but we had 8.2 worse than last year when it comes to our loss rate and NPL.
So in the end of last year, we were able to adjust the year of 2023 as a whole, including a perception that had already been worsening in the first and second quarter last year. But since this was accounted for in the fourth quarter, comparatively, the first quarter last year still had a lower rate of losses and NPL. So that's where you can see a lower rate. But that's pretty much a bit of the reason for the drop in the EBITDA. So these values, we've been able to see a bit of an improvement in the results this year, and we believe that over time, we'll be able to have a slight reversal in regards to these values.
Because as we negotiate with the payers, we can have some revenue kind of reversed with some values that will help us to reestablish our revenue in the second semester. So our projection for the revenue cycle is that we hired a specific consultant to perform all of the diagnosis, and it's going to be fundamental, the initiatives in the second semester and where the growth will come from, and that's one of the initiatives where we are really focused on. So the explanation between the net revenue and the gross revenue is pretty much due to this loss, and then we're pretty much flat in regards to the net revenue.
So when we move on to slide 7, we cannot in any way ignore, when me and José Henrique speak, we recognize that we have the obligation to explain this, but not to justify or try to provide some comfort zone for ourselves with the results we achieved. We're just explaining this from our perspective, that we will get into action, and we are getting into action in the company, to be able to recover the margins we had last year in the recent past, not only in the metropolitan region, but margins that are greater than what we had performed with last year. So when it comes to costs, in our first half, we had a loss of two percentage points, and the main reason here is the nursing bill, and we have two percentage points here.
In the first semester, it was 1.5, but in the run rate, we'll have about two percentage points loss in the margin. So we have some other projects to offset. We had already discussed a higher occupation rate, some adjustments in the costs for payers, and all of this work that we're doing, that is capable of offsetting this lower result. So in the quarter, we have 3.2, and this is where we actually have this revenue period that is very different than what we had in the first quarter, where medical materials are more important than the first quarter. We're not satisfied with these results, and we're working towards this with many different initiatives, but it's important to highlight the main points that were offending factors here.
Then when it comes to maintenance, it's still in line with the sustainability project for the supply chain we're working on, where we have maybe one of the biggest companies in the consulting in the world. So when it comes to expenses, we have an important comparison factor. So the first semester last year affects the and it affects us a lot in the quarter, and we had a labor reversal of BRL nine million. So when you compare this, you see we have a number that was way below, but that's because of the reversal issue from a comparison perspective, so it helps the last year be better, basically.
Then this year, you have another point which helps, which is this issue, which is we have an accounting rule to place this as an NPL, but we highlight that this is related to the cost of the cycle of the revenue. So this is basically because of the actual cycle, which you have some accounts that have a difficulty in their cycles, and they're identified in the last year. This problem that we noticed in some of the turnarounds in the systems, we kind of pay for this cost and in the first year or semester. So the perspectives are that this is not recurring, and that's where with the initiatives we've implemented in the chain for the revenue cycle, that this will be providing some amortization.
Part of this, we believe we'll be able to recover. The payers know the service is provided, but we also have a better cycle mapped out, and so this is an offending factor of 1.5-two points. So just from the revenue cycle, we're talking about three-3.5 percentage points of losses in our profitability when we start looking at the EBITDA margin. So it's important for you guys to get a feel of this, because sometimes the accounting certifies something for a specific moment, but that sometimes comes from initiatives or reflects from the past that are not compromised in the future, but that we have to explain where the actual accounting for that is not related to the production in the quarter.
So this is important to get to know, because this is the work we've been discussing many times in our one-on-ones and meetings and conferences, where we expect future improvements and reversal for the past, but then, of course, also facing all of this in a more direct manner. So moving on to slide eight, you can see the effects of all of this work, which is reflected in our EBITDA margins, which are low, way below our expectations. We had a drop of 3.3 percentage points. I'm on slide eigt now. So 3.3 percentage points, and 3.7 percentage points if you compare from the first half with the first halves.
So then you can see the main reasons for this are the nursing bill in Brazil and the revenue cycles and the opportunity for a better covenant when it comes to buying inputs and materials, as I mentioned in our sustainability project for the supply chain. One important point I want to highlight here, another point actually, is that quarterly, from the BRL 90 million we have, where the EBITDA is worse than last year, half of this result comes from the Porto Dias operation. This year, Porto Dias had BRL 10 million worse than last year, mainly due to the losses and where they had to kind of hold on to the revenue, but because of the problems we've already mentioned to you, and that's what made us actually make the decision of selling the asset.
When it comes to adjustments, the Porto Dias sales reflects on our results with BRL 644 million in losses due to the drops in the Porto Dias asset. The transaction, in our perspective, should take place in this month of August. But since we announced this on the 31st of May, within the quarter, we have to perform a new assessment of this asset and compared to what was accounted for and what we consider fair value, because the announcement is sometimes a little more updated than the asset. So BRL 744 million, we have a small adjustment in the pre-operational costs in Nova Lima that should be open in two weeks, by the 23rd of August, this year. Moving on to slide nine, we had a growth of BRL two million in our net income.
Part of this result is due to the lower financial results for the reductions in Selic rate, which improves our results, and that, of course, affected our net income. We had some adjusted and net income as well that we're recovering here in Porto Dias. We had BRL 115 million with 9.9% or 10% net margin. So we can see 8.8% in margins, 2.2 percentage points worse than the first quarter, which makes us have 51 against 64 million. Here is to have an adjustment until August. We'll probably have this, depending on the closing of Porto Dias, and this will be about BRL 18 million. So moving on to cash flow on page nine, we started the year with BRL 319 million in our cash position.
We had a cash generation of BRL 136 million, and that was already deducted from the working capital with all the pressure we have in the chain for receipts, and that's already discounted here. It's important to mention that from the BRL 136 million for operational cash generation, BRL 15 million come from Porto Dias, which is about close to 10% or 11% of this generation. To a company that will generate maybe only 30% of the profit. So you can see that in the operational cash generation, it doesn't really reflect.
Although we think these economic results are excellent, they base a lot of decisions, but cash position is what really makes the company grow and invest and make decisions to reinvest, and they're only responsible for 11% of the cash generation, even with the initiatives we had implemented in the last year. So this low cash generation compared to this revenue is really the justification for the main decision-making process, where we had a big effort in the second quarter to be able to confirm this negotiation and a big focus now, without deviating our attention to things that we weren't able to solve before. So we can face all of the operational aspects, and then we have a focus on all of the executive management team distributed between different projects and actions.
We had BRL 91 million in interests and on income and social contributions, and the biggest is BRL 84 million in Nova Lima. We had BRL 13 million in EMEC, too. This is a city where we operate with an occupation rate that's really high, and there's a high demand. So at the adequate moment, we should develop some project to increase the amount of beds there. We also had BRL seven million in investments in Salvador. We had the payment of the purchase, which was BRL 30 million, approximately, and BRL 29 million on maintenance CapEx. That represents 2.2 percentage points compared to the in regards to the revenue, in line with what we expect as maintenance for the units. We had some units required that required investments, improvements, and flows to be able to service our patients better.
So we had the debentures that we fundraised in the month of June, CDI + 0.95%, and are within the health sector, with all of the challenges we have been going through, as well as the in a more one-off manner. We have a solid cash generation, and this has been our the company's rating was repeated also in this process. So the issuance is below 1% spread with the extension of the debt. So this is an important movement for the company. And so you have BRL 200 million as fundraising initiatives that came in. And for main numbers that deduct from this line, we have the payment of dividends and the purchase of BRL 14 million in treasury shares, which is also a cash exit.
We had the amortization of BRL 20 million from other debts that we have, especially from the BNDES, and BRL 19 million also from leases. BRL two million, which makes us reach BRL 325 million in our cash position by the end of the semester. In regards to the PMR and PMP, we have clearly seen a reduction. If we were to look at a management perspective in regards to our results without Porto Dias, we would basically, in this methodology, and of course, each one does this according to what they have available. But in our methodology, we look at the last 12 months, we have 110 days without Porto Dias, and you can see that the operations are really healthy.
We've already mentioned that with the project we have for the improvement in our cash cycle and revenue cycle, we would like to bring these 110 to closer to 100. It's not something short term, but, it's something that we could do this year, and it'll probably reflect the results next year. This is super important because of all the aspects I mentioned previously. In regards to the payments, we had a drop of payment days to suppliers, because in the first quarter, we had this purchase strategy before we had the CMG increase, and then we have more pay suppliers to pay, and we have less of a cash exit. We buy less, and that and we use up part of the stock. So even from our perspective, the stock was pretty constant, which demonstrates that we were prepared.
Now in July, with this growth, as Joaquin mentioned, in Salvador, of 39%, compared to June, and 13%-15% general increase in all the units with the surgery volumes, and we're going to have a consumption of the stock to reduce and also help improve our cycle. Moving on to slide 10, the last slide here in our presentation, we have, with the fundraising, the increase of our gross debt, we had an increase in our cash position as well, and with the last twelve month and the EBITDA a bit below what we expected, we had a covenant, which was 2.2 times EBITDA. In regards to the schedule, with the new fundraising, we were able to increase the average terms.
We went to 4.7 years, and 55% is about 3-5 years, and from this amount, BRL 700 million referred to debentures that we took on in November 2021, and the amortization is in 2027 and 2028. In the long term, we have BNB and the debentures we fundraised now in 2024, which will be expiring in 2030 and 2031. Within the cost structure and strategy, we operated this financial cost below CDI, CDI minus half, and the hedge, or the swap we had in the operation for BNB.
And with this, we have a CDI + 4.5, and then the distribution is almost 95% of our debt as CDI, and we have part of this in TJLP, which basically makes us not have everything indexed according to Selic-CDI in our debt level. So we're kind of a bit frustrated with the results achieved, but we have a lot of energy and focus on improving this. So I want to wrap up now and thank you all once again for your presence, and I will get into Q&A. So Filipe Amancio from Itaú BBA. Hi, guys. Good morning. Thanks for taking my questions. We have two questions on my side. First, about receivables. So I want to get an update on this topic. We've seen a very stressed scenario.
You had talked about the pressure at Porto Dias, but how is the working capital dynamic in the more mature operations? Have you guys been able to observe some marginal improvements? Is the scenario still challenging or uncertain? And the second question is maybe a little more focused on strategy. We've seen in the last quarter that there's been a scenario where the health plans have been moving a lot to reduce claims rates, de-credentialing, reducing new products, reducing specialties, and losing the accreditation from the main hospital. So what's been the net effect in the main areas you guys are in? Do you guys notice that there's a closer proximity from other payers that stopped working with other hospitals, et cetera? Well, I'll start off with this answer, and then after, I'll pass it on to Rafael.
Thanks for the question, and we'll talk about the receivables. So the second part of your question, Filipe, really, the thing we notice is a really close relationship with the operators in regards to our operations, and we've just mentioned, or we've just reported a bit of the results we've seen in June. And this is something we're super convinced about, because this drop in volumes is not in any way related to any kind of noise with payers. Actually, some payers have been working towards stronger initiatives related to decreditations on certain of certain networks and hospitals, and they've contacted Mater Dei to use as a safety to receive these patients, especially in some regions where you see notorious movements in this direction and where these payers have been doing this.
It's a really important opportunity for us to take advantage of, as long as they are healthy and as long as they have price ranges that are well negotiated and conditions as well that are accepted by Mater Dei and that do not pressure ticket. And it's important to make this very clear. So in our growth strategy, there's not a strategy to de-deteriorate tickets in exchange of certain volumes or movements, and we think these need to always be healthy negotiations. But having said that, we have pretty good negotiations and perspectives for the growth in our revenue in certain specific regions with the payers.
So, actually, for New Nova Lima specifically, when we take a look at the main payers nationally that sell plans, and that are not connected to any specific groups, we have at least two of these big payers that are already credited. They have already included Nova Lima as well in their base, and two other payers also included the Salvador unit for another 20,000 lives, which demonstrates the close relationship that the payers have had with Mater Dei, and how they've really recognized our excellence in our operations. So basically, in regards to these negotiations on receivables, I'll pass the floor on to Rafael, and the perspective is even more positive than what it had been in previous months, because the negotiations are a lot more intense, and you have negotiations on what are the values that should be received.
And it's than what we had before, if we would or not have a receipt value or if you would postpone these negotiations. So once again, all of these negotiations are win-win scenarios, where we sit down with the payers, and we try to identify what could have happened and how we can get back to those values, but in a more positive scenario than what we had experienced in previous semesters. Well, Filipe, thank you for your question, and I think that this answer needs to have a bit more analysis. So I would say that we've already stopped getting worse, and we have the perspective for improvement. That's probably the why. But why?
Because the numbers we reflect on in the accounting processes are, we have this thermometer that's more up to date for the statements in the month, and we can notice a reduction in the gross losses, which is due to the work we've done in the revenue cycle. So every month, we gain more and more, so we can recover the levels that we had before, which is pretty much the size we've had in the initial rate, so with losses. So we have some work to recover these loss rates, but if we don't reduce the size of the initial loss rate, we're not going to be so effective after you recover this, because you leave a lot of money on the table, which kind of puts you in a fragile position.
So solving the overall cycle, ever since the process where we leave the discharge of the patient, perform the correct audit, send this correctly to the payer, solve the administrative aspects, and don't wait to up ahead, where we have to fight this, which really stresses the relationship with the payer. So what we've noticed is that there's a reduction in this, and we expect to recover these, as they will help us with the net numbers. But what we would like to also mention is that these adjustments with the payers are adjustments in operations we acquired, and that we bought an asset in a certain situation with not too much of a local relationship.
After two years of operation, we gained credibility with the clinical team as they see how serious we are in our operations, but also with other local payers to demonstrate how important we are for them to sell products, to have good levels of health in the region. What we've been able to achieve is that where you see this profile of plans, it's a little different than the profile of the metropolitan region about its own GE, and that's where we've seen adjustments that are way above inflation. We're not saying we're making money on behalf of the payer, but we're just reestablishing their capacity to be coherent in receiving what they deliver to the patient, what they invest in the hospital.
So it's been a very important process, and in the payers where we have a mature relationship, which are more like the national payers that are including this profile for the metropolitan region, we've been able to have adjustments in line with the inflation, and we have some important points for the second semester, which will also help because the costs are not going to wait for twelve months. You always have some news every month on our cost base, and you always have to have this analysis. So this is a bit of a longer answer here to show you where we are in this movement to improve the cycle for revenue. Okay, perfect. Thanks, guys. Thank you for the answers. Very clear. Thank you. Our next question is from Gustavo Miele from Goldman Sachs. Hey, good morning, José Henrique, and Rafael.
Thanks for the presentation. I wanted to explore three quick topics, please. First, which is maybe more of a fiscal topic, I wanted to understand if you guys have performed any assessments on how this impairment of BRL 744 million could impact the tax payments up ahead. You had talked about this in the release, and this amount was maybe a little higher than the profit reserves the company has. So I wanted to understand if there's any accumulated losses you're expecting for up ahead. And so I wanted to understand how you guys are thinking about this topic. That's the first question, and the other two points that are more like operationally direct. I wanted to get your comments on medical materials.
Rafael talked about the agendas in the company to optimize procurement and increase the platform, but I wanted to know if the pressure of about 1 percentage point year-over-year, and the cost line is due to some other, one-off effect, or if it's more of a, operational leverage, it's maybe a little lower. And a third point to wrap up, which is more about the occupation dynamic, because quarter-over-quarter is maybe a little worse than seasonality would suggest or what you expected, but maybe market to market would be interesting to get your perspective. But in other markets, you guys had seen maybe a worse or better dynamic than the average of occupation you've seen. So these are the three points. Well, thanks, Miele, and I'm gonna leave this part here to Rafael and get into the operational aspect.
About MatMed, we did not have any relevant impacts when it comes to negotiation. What I wanna say is we didn't have a big change in our charts that were relevant, that could explain for this worsening we've had, from one percentage point, approximately in regards to the net revenue quarter-over-quarter. But what we've noticed, especially, was the mix issue, as we've mentioned, in this quarter, specifically, and we've also got a bit more of a ramp up in some units that don't have the same specific mix. What's important to say is that each of these points related to medical materials are already mapped out by the company, and they're already under treatment through this project we're working on, and they have very positive perspectives.
So we can't get into specific details about each negotiation, but the format for negotiation has really been related to concentrating purchases with suppliers that are more relevant and a greater national integration, providing more volume, especially when it comes to medical materials, as you mentioned. And then to make this value easy, our objective that we've been pursuing with optimism is that in the impact you guys are gonna observe in the nursing bill, that will really have this kind of synergy and saving in the medical material line specifically. So when it comes to occupation seasonality, just giving you an overview here on our units. We have the Northeast hub and Bahia hub with a lower occupation because of the seasonality with the São João parties.
It was an opportunity to reduce credits on hours that employees had accumulated, and also reduce other liabilities that could exist for the company in other moments. We worked on this and really focused on this in this month, and we had an atypical reduction due to seasonality in the metropolitan region of Belo Horizonte, because of the reasons we explained. We know the impact that the metropolitan region has and results, and that's pretty much what happened. Without any... Besides these explanations we had, without any change in the fundamentals in regards to the growth and performance that these units have in the metropolitan region, and the perspectives are very positive.
So the good news is that in July and August, we've already seen some improvements that are really significant at these levels, when it comes to the amount of procedures and also the occupation. So I'll pass this floor on to Rafael to discuss a bit of the impairment with Corporate M&As. So thanks for this. I think it's great to explain these points. And we had about a BRL 1 billion rise in the goodwill in this operation, which, if you look at this, it's about 34% of the goodwill, could be used, and BRL 340 million, where you can use this. And at the time when we looked into all of this, PPA process, we defined the use in 60 months.
If we were to count how many months we were considering in the month of August, 55% of these already have been over. So 55% of this, the BRL 340 million, which is a good cash value to take advantage of and pay less taxes, are BRL 187 million. The other BRL 153 million reais stop being something that is recurrent every month, and they set up a fiscal tax loss, which gets into the rule where you're gonna take advantage of 30% of each bit of the future profit in the company. So I'll be using this in the next years to understand about BRL 150 million reais. So in the models, you'll see the future profit coming deducted from what was left behind.
So if you have any other questions, let me know. But about the reserves, you mentioned we had a loss of BRL 491 million. We had the profit, which was BRL 79 million in the operation, which makes us have a sales operation plus the recurring operation of BRL 422 million. From this, we have to, first of all, look at the reserves and the accumulated profit, which is at about BRL 396 million. So you have BRL 25 million, where if we were to end the year today, we would look at against the capital reserve.
So since we already have the operation for the third and fourth quarters, all of the profits will add on, and if we have over 25% profit, we won't have to go against the capital reserves, we'll set up another profit reserve in the future. So the effect in this is that we'll have a reduction, a total reduction or a lower reduction, a lower reserve, but then the information on the distribution of dividends in the next years will be a decision made by the company, and to be able to really fulfill those 25% of the profits. So then it's a matter of separating the operational profit from the non-operational profit that comes from sales. So I hope to have answered, and let me know if you still have any questions, and I'll explain.
No, that was super clear, Rafael. Thank you so much, José Henrique. Good morning. Our next question comes from Yan Cesquim from BTG. Well, good morning, José Henrique, and Rafael, Ovida, and everyone else. Two questions here. The first one is like a follow-up of some of the questions from our colleagues, which basically approach the negotiations with the payers and perception of the procedure mix. I think it was very clear that the logic for these renegotiations that have gone on in the change in the semester were really favorable.
You even mentioned that the objective is to transfer the inflation on average in these contracts, but I wanted to understand if when you observed July and August, this, mix in the procedures, on average, is already linked to the base effect that kind of hindered the procedure mix for the second, quarter. Do you have this perception as well? And the second question is about the stability in this, effect of the nursing law. So I wanted to understand, how much time you expect to achieve this stability for the comparative basis effects, but also understand if, well, when it comes to budget, how much time you expect to be able to offset these effects. So that's pretty much it, guys. Thank you. Thank you, Yan, and thanks for the question. I'm gonna start off here.
Specifically related to the mix, which is the most important part of your first question. So yes, we've already seen July and August having a mix that's a lot better than what we had observed in the second quarter, specifically. So it's a mix where we were able to have a very relevant growth in the surgeries, which is super important when it comes to profitability and revenue in our operations, and also greater predictability of what actually generates this from a profitability perspective. So the mix in July and the beginning of August has been a lot more favorable than what we had observed, especially in May and June, and especially in June, where we had this very atypical month, as I mentioned.
In the relationship with the payers, we have the effects of the readjustments, and most of them happened in this shift in the semester. And also, not only negotiations related to adjustments in prices, but also, as I mentioned previously, some other negotiations that we consider important in regions that are selected. So regions where we've identified that besides the opportunities operationally, that we had already set out, and the operational improvements in the units, that it would be important to also speak with our main partners and demonstrate to them that those units really needed to have a more relevant revenue recognition process. And that's happened in this shift from July to August, and that's where we already start off with a level of prices for some of these units that are better.
So we're not talking about the IPCA or other adjustments we had initially looked at, but we're talking about a reestablishment in the price ranges for some of these units. And then about stability in the nursing minimum wage law or bill. It's also the role of the company to be very transparent and have a lot of clarity in how we present this. So we explained to you quarter-over-quarter, and in our conferences, what had been our strategy, and also our observations in regards to the mandatory need to fulfill these. And we had the negotiations, they reflected in the results, and we have about 90% of the size of the impact that this would generate to our units.
So to reach the stability and really be able to talk about more and more on how we expect this result to not be perpetuated over time, this work especially is what we've been putting into course, so that in the next 12 months, we can have we can achieve, as we mentioned, the possibility to offset the impact that this has been generating to the company. So not sure if this is clear, but it's the work we've been doing in the more robust lines for supplies to improve not only the impact of medical materials on net revenue, but that this impact can be sufficient to also cover the impact of the nursing bill on our numbers. Yeah, very clear, guys. Thank you so much. And the last question is from Stella Stern from J.P. Morgan.
Hey, guys.
Good, good day, and thanks for taking my question. It's about the operations acquired with Mater Dei. Could you give us an overview on how this ramp-up process has been taking place for the acquired hospitals, like Santa Genoveva, Premium, et cetera? Exploring the occupation rate dynamic, the relationship with the payers and the tickets and all of that, is that more in line with the legacy operations that Mater Dei has, or what's missing, and what's the development of this ramp-up process itself? Thanks. Thank you, Stella. I'll quickly go over this. As I mentioned, in a specific hub, we were able to have a relevant negotiation, which reflects on the results in the next months. These are units that are...
Well, especially Santa Genoveva, Santa Clara, and EMEC, they are units where we already have a relevant booming operation and an occupation, an installed capacity in these units that is already an occupation that is already pretty relevant in some of these. The work has been done in Uberlândia to make both units, Santa Clara and Santa Genoveva, work in a more synergistic way, and that we can improve efficiency and make these two units work together and demonstrate to the main payers in the market the importance that these hospitals have. Of course, this would help with the recovery of the values we have. Premium continues also on a ramp-up that's really important. The hospital makes already changed a lot ever since we performed the acquisition, and now there's a lot more complexity.
The mix of the payers in the hospital also changed a lot. We have very relevant growth with an insurance company that's growing a lot in that region, a historical partner for us, and it's a hospital that's been working 100% of its current capacity, installed capacity. Of course, we can work on some adjustments, but this is a project that already demonstrates some hope in the short term, so that we can expand even more and provide some concrete results to this expansion project we have in Goiânia. And then specifically, after many changes we implemented, EMEC is the hospital that gets back to growing. There's pretty good perspectives for growth in the hospitalization lines and also the outpatient lines.
So we've been working specifically on growing the revenues that are, complementary and that are so important to the growth also of a hospital unit, and this is what's been going on, specifically at EMEC. In the second semester this year, we have good expectations for an improvement in our margins for these units. Thank you. That was very clear.
Good morning. Thank you. Now we will end this call, and José Henrique will share his last remarks. Thank you so much. Thank you all so much for your time and attention. I think we were able to share, the main points with you, clearly, and I hope this gives you the a view of the main impacts in this quarter and our main initiatives as well.
Of course, possibly we'll have a month or another where we will have maybe some negative effects or surprises, but we've really kept our eyes open to this, and we have kind of the skin in the game to get the changes implemented in the necessary timing. So these changes in the perspectives we're presenting are changes we are very confident about because we've already done these before in the past, and they're gonna be reflected in the results in the next quarter. But thank you so much for your time and attention, and we'll be available if you guys have any other questions. Thank you so much. Have a great day.