Good morning, ladies and gentlemen, and welcome to the earnings call for the fourth quarter of 2022 of Rede Mater Dei de Saúde. We have Dr. Henrique Salvador, our CEO, and Rafael Cordeiro, our CFO and investor relations director. This earnings call is being recorded and will be available on the IR website for the company after its closing. To activate the simultaneous translation option, just select the icon of the globe at the bottom part of your screen. The presentation will be available on the company's investment relations website. Before we proceed, we want to mention that any possible statements about future events are subject to risks and uncertainties that can make certain expectations not become complete or differ materially from expectations. These represent opinions at the moment they are made, and the company is not forced to deliver them. After the presentation, we will begin the Q&A session.
If you would like to submit a question, please raise your hand and we will open up your mic. Or if you would prefer, you can send the question through chat, and we would ask you to submit your name and company. I will pass the floor on to Dr. Henrique Salvador to begin the presentation.
I am going to quickly introduce this, and then I will pass the floor on to Rafael Cordeiro, our CFO, to talk about the operational highlights in the quarter. First of all, I would like to say that in 2022, we consolidated our strategy for expansion and especially for the creation of the geographic hubs, which is really the strategy we adopted when we began our IPO. We completed the acquisition of four hospital units, one diagnostic center.
One hospital in Uberlândia, a diagnostic center, one in Goiânia, and one in Feira de Santana, and after, one more in Uberlândia. We also started our unit in Salvador, a very robust project with 370 beds. We ended the year with 1,500 operational beds approximately. This growth provided for financial results that were all-time highs. A net revenue close to BRL 1.8 billion, an increase of 72% compared to the year of 2021. Also an increase in the average ticket in the last quarter of about 5% compared to the previous quarter. I think these numbers reflect our execution that has been very consistent in this growth strategy, and they also strengthen our relationship with the payers in all the various payers where we are present.
For 2023, we have a plan to continue with our integration process of the acquired units, and we would also be executing our organic growth plan. We really trust that we will find this balance point between growth and profitability with some units that are still being delivered and integrated, and they will be improving their performance in next quarters. We do plan to continue to deliver results that are consistent. We also opened our medical center in Salvador in February. This is an important step towards our project in Bahia, especially in Salvador. This medical center has the capacity for 73 offices. We are also going to be starting a human reproduction center, a hemodialysis center, and a blood transfusion center as well in the same development.
What is important is that the opening of this medical center will allow us to have the integration of care as well, benefiting patients, increasing the speed of the services and the quality of the services offered, also allowing for the offering of products that are coordinated and integrated for the different payers and health plans through primary, secondary, and tertiary care. This medical center also has a convention center that is very modern to perform conferences and organize events, which is an important attractiveness for the overall community and physicians that always organize symposiums, scientific events, and this becomes a big, important center to promote scientific activity.
In 2022 still, as we moved along with the market trends, we started working with A3Data to be able to introduce these new compensation models that I referred to in a bit, along with the payers that are our partners, creating models where you have more predictability and lower variability for the operators with the global daily fees and packages with compensation models that are better. This movement also led to a significant increase in our generated revenue through these compensation models. This is important at this moment because we can demonstrate the flexibility that Mater Dei has and how it is really in line with the new trends in the market. These new models are beneficial for all parties and based on sharing risks.
The structuring of this data in a very safe and precise way with A3Data allows us to make decisions through a simulator, which was created together with A3Data, offering results that are a lot closer to what we consider precise and more assertive, allowing for the pricing of products in a more objective way. In the same way, A3Data also has allowed for other projects to add value to the digital strategy of the Mater Dei network. In the last national conference for private hospitals, we also presented some experiences about this kind of model. These digital products can be scalable, of course, and they are based on data analytics and artificial intelligence. Then we created within A3Data, a split so that we can have a health vertical that is really looking at the different opportunities that exist in the health sector.
We already completed, for example, a very relevant product for an increased productivity in our units through sharing the hours of our employees within the units and neighboring units even, such as the Belo Horizonte hub and the Mater Dei Santo Agostinho in Contorno, even in Uberlândia with Hospital Santa Genoveva and Hospital Santa Clara. So another important point also that we should mention is the investment in modernizing our surgical centers and adding new floors in the Hospital Premium in Brasília. We had a constant concern in improving the structures of the units acquired so we could offer a very good service that is more compatible with the kind of public we work with.
We are advancing in the Hospital Premium with the opening of new specialties to be able to work in surgical centers, outpatient centers, and emergency rooms, of course, anchored on a closer relationship with our payers. Another important movement that took place recently was the renewal of our GPTW seal, the Great Place to Work, and we received the acknowledgment as an excellent company to work at after an organizational climate survey in all of our units. It is the first time where we were able to receive this seal involving the entire Mater Dei network. Another important step that was concluded and is actually in progress is an update of our IT systems, our ERP, at the Hospital Santa Genoveva , and also soon at the Hospital Santa Clara.
The strategy is that we will be able to integrate all of the hospitals in the same ERP, with the exception of the Hospital Português, will continue to operate with CASSI because it really is an operation that is very complex, and it operates very well with the system. The idea would be to integrate this in the MV platform, all of these units. It is important to remember that whenever we have a turnaround in our system, we have some stress and instability in the operations, but we start noticing a return to normality in the first operations that have already gone through this kind of migration process. I think these were the main highlights I had to share as an introduction, and I will be available also to clarify any other questions that may appear after Rafael Cordeiro also presents the financial highlights and operational highlights.
Thank you, Dr. Henrique. Good morning, everyone. As we complete this year of 2022 with many challenges, we still feel very motivated towards 2023 as we already have all of the units that were acquired, integrated, and now we have the perspective and perception that the operations are a lot more in line with our capacity for assessment to be able to have the year of 2023 that is very positive. We will move on to the highlights. On page four, we start off with the operational aspects. We had a small drop in our occupancy rates. We moved on to 77% in the quarter, 79% in 2022, with about 68.3% in the previous year. We will have some units also that recently entered and helped with the opening of the beds. We have some adjustments that are already being addressed in the first quarter of 2023.
We start off with the company and the IPO with 580 beds. But now we have 1,500 beds that are operational, but we have the capacity for over 2,500 beds that will allow us to still have growth without needing to perform other acquisitions or resources to acquire more beds. The impact of the growth in beds is substantial when it comes to patients per day, almost doubling the amount. It is a growth of about 88% compared to the fourth quarter of 2021, when we started our first unit, Hospital Português, integrated into our consolidated base for the Mater Dei network. We added this slide now at the end of the year, which is a relatively new slide we are using in our presentations to give you a bit more color on the overall metropolitan region plus Salvador, which is important to highlight.
The controller has Salvador included, and the consolidation would be for the units acquired. We consider this to still be very robust in Belo Horizonte with an operation that has margins above market levels. Even with the beginning in Salvador in May, which was a detractor for our margins in the first year of the operation as expected, we were able to have a very robust year, and the last quarter also showed this kind of growth. In 2023, we expect Salvador, which is having a smoother operation with better coverage in beds, more physicians and an NPS above the average we have in the Mater Dei network. We ended the year with BRL 1 billion 773 of net revenue, BRL 1 billion 52 coming from the controller and BRL 611 from the consolidations.
When it comes to the fourth quarter, we ended the quarter with BRL 502 million, BRL 293 from the controller and BRL 219 from the consolidation. When it comes to margins, we had a consolidated margin of 26.1%. The consolidations helped with 24%, BRL 171 million in EBITDA, and the controller contributed with BRL 290 million, 27.6% EBITDA margin. In the quarter, you can see that the controller had 27.9% with a growth, even with a quarter where we had a salary adjustment in Belo Horizonte. Belo Horizonte had a salary adjustment in April of 7%, which pressured our costs a bit, as they were a bit higher than what we expected. This was due to the inflation that was so high in 2022. Even so, we were able to have a quarter that was better than in the full year. We have good perspectives for 2023.
We had some adjustments operationally in the consolidations. As Dr. Henrique mentioned, we are exchanging some of the systems. We are changing some of the mixes, bringing in some new physicians, and we have adjustments that are still, well, there are still operations that do not have such a big history of operations. Quarterly assessments with the seasonality from region to region are normal impacts and effects that take place in the operation. We also ended with our best EBITDA in a quarter, BRL 122 million, and we did not have any M&A adjustments in this quarter. As I mentioned, this is a growth. Now we are going to page six, but it is a net revenue with a growth of 72%, which reflects our strategy for growth organically and inorganically in the operation in Salvador. We had a growth quarterly of 8%.
The fourth quarter is the first quarter where we have all of the operations, and we had BRL 512 million, which places us in a position where if we multiply by four, we are a company with over BRL 2 billion in net revenue. We went from BRL 750 million in net revenue back then, before we started the expansion. The ticket has been growing gradually. We have many impacts with the mix and new negotiations, new compensation models, as well as a quarter with all of the operations. What is important is that we have been able to have some discussions with the payers in each market, and we have been able to have the pass-through of the inflation. It is a mix.
It's not just about a negotiation directly with the payer, but as Dr. Henrique mentioned, we need to understand the demands they have and demands we have so that we can evolve and not have a margin loss over time due to the average ticket issue. The ticket in the year was BRL 2.09 and in the quarter, BRL 2.19 per bed. Moving on to page seven, we have an increase in our costs and our expenses when you look at this on an annualized basis. We have new operations, of course, that we're consolidating. These are more expensive operations that throughout the year were improved so that we could improve the cost of acquisition for the inputs, reduction of people, and bringing in some activities in our shared service center.
This is some work that's underway with this integration, and we've been able to have good results in our synergies. However, it is within that time frame of 12 - 18 months, and we're able to complete our first unit, which is the Português unit with 12 months of operation. We have a unit that has only three months of existence, so it's within the pace we were expecting for integration. Of course, we have regional difficulties that are occasional that we have to operate and navigate through, but we've been able to achieve the planned numbers in our synergy expectations. We ended the quarter with BRL 340 million of cost for services provided and BRL 81 million of net operational expenses adjusted. This represents 66.4% from our net revenue, and the expenses represent 15.7%. We need to work with this during 2023.
The numbers are presented in a consolidated way, but we know that we have individualized work and hospitals that still don't have the correct number of employees per bed that we operate with as a standard. We have some work we're addressing to be able to reach these results and be able to reduce the cost of the operation and achieve the expected dilution in the operational expenses. As we move on to slide eight, this is a reflection which is in our EBITDA. In the year, we have an adjustment of BRL 33 million. These adjustments are non-recurring in the year. To give you a comparison, 2021, these are stock option adjustments plus M&A, and the non-operational, pre-operational costs in Salvador, which were BRL 33 million in the year, which in a normalized operation would be BRL 461 million of EBITDA in 2022. So a margin of 26.1%.
When it comes to a quarterly view, you have a first quarter where you do not have any adjustments. We are not adjusting these stock options. We don't adjust any other types of activities. We stopped some of the M&As. We finished them. We already had BRL 123 million compared to the third quarter where we had about 25.3%. The fourth quarter is a quarter where, as you all know very well, we're kind of going back in time here. We had the World Cup. We had challenges operationally, especially in the years where you had matches with Brazil, and also the normal seasonality of the last 15 days in the year where we have a drop in surgeries, and this, of course, impacts in the results and the margins, which are a fruit of certain surgeries, which are really our main option in the Mater Dei network.
On the next page, we get into the net income and net margin. We had a quarter that was below expectations. We have interest rates that are higher despite our financial costs being below CDI. But these are challenges that we have as we operate with lower cash level, and it is normal for us to have a financial cost that is a little higher, financial expense that is higher. But what is important is that, and we are going to highlight this, is that our debt profile and our exposure is very much controlled, and especially if you look at the average in the markets of companies we compare with, we have a pretty good situation. And this is a fruit of the strategy.
When we perform the acquisitions, we always thought of where we would reach with this debt because we needed to have space to be able to have other transactions that were structuring our future and not have a rope on our neck. In our net income, we have BRL 216 million in the year. We have adjustments reflected here, including those that are in our EBITDA, as well as the ones for the income tax, which is the fruit of the goodwill with the Hospital Português acquisition.
In the quarter, we have BRL 36 million of net income, BRL 18 million which are recurring and BRL 18 million with the adjustments. So a 7% net margin with a drop of 5.4% compared to the third quarter of 2022. And when it comes to the cash flow, we ended the year with BRL 378 million in cash, with a cash operational flow of BRL 111 million.
With taxes and interest, we had BRL 173 million, and the biggest exit for our cash position were the investments we made overall in the last two years. We invested approximately BRL 2 billion in improving the operations and the acquisitions, the construction in Salvador. So it is a very robust growth, and we are going to reap the fruits of this in the operations in the next years. Moving on to page 10, when we get into our debt, we ended the fourth quarter and the year with a covenant of net debt to EBITDA of 1.9, and our covenant is up to 3.5. As I mentioned in the previous slide, it is a financial situation that is very controlled, comfortable with possibilities to, if there is an opportunity, still have some kind of growth inorganically.
We ended with BRL 1 billion 203 million of total debt and a cash of BRL 378 million, which leads us to achieve BRL 850 million of net debt. Our average term of debt is long, 5.7 years, so we do not have any problems with refinancing or debts maturing in a short term. So it is long, 5.7 years, and 51% of our debt is above five years and 38% in the fourth and fifth years. So we have 89% of our debt with over four years maturity.
And the profile of the debt is 93% in CDI minus 0.95% below CDI. We apply our cash position at CDI, so we have a carryover that is positive, and 7% of the debt we have from BNDES for the construction of the Mater Dei Betim-Contagem unit, which is considered a TJLP rate plus 318%, which is 7% of our total debt. This is the profile of our debt and a bit of our presentation here. We tried to cover the main points and the highlights strategically as well as the operational and financial aspects.
Now we will open up to Q&A. I am looking at the queue here, and our first question is from Gustavo Miele. Gustavo, you may open your mic, please.
Good morning, Rafael and Dr. Henrique. Thank you for the presentation. I have two questions on the ticket, please. First, we noticed that this healthy increase of the ticket quarter-over-quarter is still connected naturally to a cash consumption in the receivables when we look at the working capital. I would like to know if you could share a bit of how this dual term and price ratio is with the negotiations with the payers.
Does it make sense to assume that the structural term for payments with the main customers of the clients of the company reached a whole new level? If you look at the overall sector during 2023, with cost pressures still quite high due to high frequency, could you talk about this, please? Thank you. The second question is a little more related to complexity.
I want to know about if this main force towards a better mix in this quarter is a elective surgery backlog issue that is being addressed, or did you actually notice that there is an opening for new operational fronts that are a little more complex in the acquired companies? Understanding if the better mix is more of a supply issue or if it is more of a demand issue for services that are a little higher or more expensive from a ticket perspective. These are the two points. Thanks, guys.
Thank you, Miele. I am going to start off here, and after Dr. Henrique can contribute as well on the strategy aspects. About the average ticket, despite the fact that we have all of our operations in place in the fourth quarter, we still have some variations between the beds in different units. One issue we have considered during 2023 is the growth in Salvador within the overall base, and this growth helps the ticket. It is an operation that is in a market with a higher ticket than Belo Horizonte. Growth in Salvador helps with the composition of this ticket. Here in BRL you have a sum of plus and negative aspects in the operations. As mentioned in the one-on-one conversations and conferences with you guys, we all know we have a challenge, right?
In the new units because sometimes they are limited towards a few procedures because there is not attractiveness for the clinical team or all the necessary equipment to perform the operations and surgeries, and you have a challenge with registering these new activities as well and specialties in the hospitals. If we were to deep dive here, you have a bunch of factors, but the point is that we notice that in a sustainable way, we have an improvement in the units when it comes to comparing with when we bought them. We bring the profile of Mater Dei and the units, Português has been around for 12 months. They have a lot of interaction with us, with making them more of a surgical hospital and a little bit less clinical, which helps the ticket. We have oncology also that we are adding in the units, which also helps.
We have growth in Salvador. There are some issues, and of course, you also have the strategy for readjustments in the company, where we have to face difficulties, of course, because our sector is not going through a very glamorous moment. We are going through a moment of quite a bit of tightening in line with the economic and political tightening phase and fiscal phase. These situations reflect on our operation. But we have been able to, throughout the years, really after 43 years of history, we have always had a very open, transparent relationship with our payers. I think both sides kind of place their cards on the table, and we have been able to reflect and adjust price in this average ticket, but it is not the main and only aspect. We have many different aspects involved.
About the issue with the terms, we believe that there is a term for receipt that is not varying that much. What we have noticed is that there is a little bit more of tightening towards contractual conditions and really following what is agreed upon or what is in the contract, which in the past had some more flexibility operationally, but now the payers have demanded or requested that we are a little more faithful to our agreements, and we have adapted our operation to this. This is their right, of course, to demand this because on their side, they have also gone through a moment of quite a lot of difficulty. We hope that in 2023, we will be able to continue to move towards increasing this. We have no objective of growing beyond IPCA in the renegotiations.
What we could see is that maybe we are changing the mix, then we have a hospital profile with a higher ticket, searching for greater profitability. Miele, I hope that question is clear. Any other questions?
No, very clear. Thank you, Rafael.
All right.
We have Luca Marchesini in the queue. Please, you can open up your mic.
Hi, good morning, guys. Good morning, Dr. Henrique and Rafael. Thanks for taking our question. About the cost line, we have seen an increase of cost with personnel. You mentioned that this was mainly due to the acquisitions and the integrations. Could you tell us about your expectation for this line in 2023? Should we continue to see an increase during the quarters? I think that would help us a lot. Thank you.
Well, thanks for that. We do not like talking about perspectives or guidance. If you look at a bit of the sentiment for the operation, is that really the worst has passed. You have this perspective that the inflation is lower, inputs are a little more controlled. We had a salary adjustment that was very significant in our operation in Belo Horizonte. At the end of the year, it was a pretty high 7% adjustment. We have different factors. The cost factor that you are looking at from a consolidated perspective. You have operations where the costs are higher and the margins are lower. Due to the integration, you have an inflation that we have seen that is a little bit more controlled from the perspective of our employees and also our suppliers for inputs. We believe that we can work towards reducing this and that the worst has passed.
We are not experiencing a moment where we are skyrocketing, where we have a big change. Our segment has gone through many adjustments, so we have challenges up ahead, but the perspectives are positive. I will pass the floor on to Dr. Henrique.
Luca Marchesini, you can be sure that this is a constant point of attention for us due to the relevance of the investments in personnel and our costs. We are now currently working with A3Data to provide to the network, and we are going to provide this to the market as well, this solution that can be scalable with this tool called Compartilha, which allows you to rationalize the amount of hours, sharing employees within the units. What is interesting is you have a satisfaction level that is very good from the management perspective and even from the employees that can go from one unit to another.
This is a culture we have always had at Mater Dei. We grew with this kind of culture and we are sharing this with the other units as well, where we are present, of course. This is where we have more control, but we have less control over issues related to collective union agreements for salaries and other issues that are legal that are impacting our performance. When it comes to investments in productivity and investments in hours we have worked, we do have a very incisive work based on this.
We have another point also that I forgot to mention, which is that the operations are going through a downsizing process. We have a switchover in our personnel, which increases a bit of the costs with temporary dismissals, and these adjustments, of course, impact our results.
For the next year, with the exception of Santa Clara, we carry on a bit of the weight of this, and we already have a unit that is pretty smooth without these costs. The trend is positive because we cannot make a measure now and have a reflection on the numbers today. We have something that is quite healthy for the year of 2023. This is a point that we look at closely really because we have to have a very critical analysis of this and what needs to be moved from a corporate perspective as well as what can be canceled in the units. We have this very precise look towards the integrations. It is very much concentrated on these opportunities.
Very clear, guys. Thank you so much.
Thank you.
Our next one comes from Ian from BTG. Ian, please.
Good morning, Dr. Henrique. Good morning, Rafael. Two questions on my side. The first one is that I would like to know about if you would give us some indication of what you have already noticed when it comes to frequency for the beginning of 2023, and if you see a strong volume of hospital frequency surgeries and the maintenance of the level of complexity for the first quarter, considering what you have already seen about the numbers. The second question is if you could zoom in a bit more into the operational results of the controller. More specifically, I would like to understand what was the print of operational beds when you look at Belo Horizonte, Salvador in the fourth quarter and how this is going to be evolving now in the beginning of 2023. That is pretty much it, guys. Thank you so much.
Well, about the first question, I am going to answer this, and then after I will pass the phone to Rafael Cordeiro. Well, Ian, really what we have noticed is that we have a growth in our units, a high occupation rate. We just opened in Salvador another hospitalization floor and more beds in Mater Dei Betim-Contagem. Hospital Premium also opened up another 2 floors. We noticed that the level of complexity should remain at a very similar level as what we had been operating in the last quarter.
The hospitals are really going to be more relevant and the production is going to be growing. It is kind of in line with what we have noticed and I believe that this is going to be the trend also for 2023, really anchored upon some new registration processes for some units. We brought in the IPSEMG to some units in Minas Gerais.
We also took Cassi to the units and some other insurance players also that are moving on to some of our units that did not have these accreditation processes. Actually, we have some work that is pretty much orchestrated around attracting more physicians, offering compensation models that are providing greater predictability to the payers and registering new units with specialties that were not registered. We have this ongoing process and we are diversifying our portfolio of insurances in Porto Seguro. I am giving you some examples, but we can notice a growing production and complexity that should be kept with what we have noticed in the last quarter. All right, Ian, is that clear?
Yes, that is clear. Rafael Cordeiro, I just wanted to know about the second question on the operational beds in Belo Horizonte and Salvador.
Well, Dr. Henrique Salvador has already mentioned that we had beds open in Salvador and it is an operation that has been gaining greater traction within what was planned. We expect to continue with this trend in 2023. In Belo Horizonte, what we see in the metropolitan region, we have talked about with very defined strategies in all 3 units, specific registrations and attracting new physicians. We are in the fine-tuning of the operation. We also were getting into the level of the physicians and specialties, and we can know where we can gain market share and provide these specific physicians. It is not like from night to day where we are going to have the full disclosure of these beds, but we believe that this strategy has been moving along, and we have been able to open up beds in these operations.
Of course, we must remember that we are moving on to the fourth quarter, and we are experiencing the first quarter, which are the 2 quarters that have the biggest challenge when it comes to seasonality. The end of the year, the holiday period. In Salvador, for example, Carnival is a moment where we have a very specific reduction in operations. These are characteristics, and we are going through a seasonality moment that is a little more difficult with the robustness Dr. Henrique Salvador mentioned. Even in these moments, we notice this growing volume in our hospitals. What we have noticed also is that these lungs that our hospitals in Belo Horizonte have give us a lot of flexibility.
When you look at the pandemic, for example, at a moment with a lot of stress, we didn't close our emergency rooms during any days because we had the option to have a whole floor in the hospital and make it into pediatric ward, where we were able to absorb all of the pediatric demands. Then another opportunity, we were able to transform another floor into a COVID unit, which allowed us to have more flexibility after the more critical phase of the pandemic. Then we deactivated this unit. This allowed us to offer to our customers some services that are less stressed and have higher quality as well.
Perfect, guys. Thank you so much.
Thank you.
Now we'll move on to Ricardo Boiati. He's from Safra.
Good morning, Rafael and Dr. Henrique and other participants. I'd like to go back to the issue with costs. When we look at the disclosure of the margins with the controller and the acquired companies, we see the gap in the performance was bigger in the fourth quarter, where the margins of the acquired companies was a lot lower than the average in the year compared to the controller. I think this was already explained quite a bit, that you have the restructuring impacts, a turnaround in the systems.
We have this impression that there are a lot of one-off factors that are now recurring in the margins of the acquired companies, especially in the fourth quarter. Rafael, could you maybe quantify this a little more? That would help everyone to get a better perspective on how the recurring margin has evolved in the acquired operations. I think that for forecasts, this would help us a lot.
If you don't mind quantifying this, that's the first part of my question. The second part is related to the evolution of the alternative compensation or payment models that you mentioned. Now that you have this kind of model gaining a lot more traction in the company, what kind of changes have you noticed when it comes to economics? If the average ticket is lower than the average ticket.
Sorry, I think we just had a technical issue. Oh, no, Boiati just had connection issues, but I think we were able to get most of his question. We'll be able to start answering it already meanwhile. I think this is a challenge we have in the interactions with you guys, which is the questions you have requiring some more disclosure operation by operation.
It's not the company's objective to have this kind of disclosure, because I think this kind of exposes the regional operations we have. I think some of the points we could maybe look at here, specifically, we had a switch in our systems recently. We still have some variations in the number analysis that could impact a bit of the quarters, not in the sense that the operation is different or that there's a one-off, but more related to the fact that we have a bigger trust in the consolidation of the numbers of the operation in a single base for our system from an operational perspective to be able to have the analysis and also from a financial perspective. We also have an issue with the full consolidation for three months at Santa Clara.
Santa Clara was in the last quarter, starting off with one month, and then in the third and fourth quarter, there was three months. It is a hospital that started off with a base zero in the margin, and we have a challenge where you need to adjust this. You come in to be able to, you start seeing some beds that do not have an occupation rate at the level we operate with. You have to hold this kind of cost, understand the dynamic, and this, of course, affects our numbers occasionally. As we mentioned, these are not operations that have recurring results. We are still experiencing these external factors a bit. But we already have a consolidation from the perspective of about 18% this quarter, which was lower than the previous quarter.
It is a quarter where we already have different initiatives, and we have the perspective for an improvement from now onwards with these initiatives implemented and structured. There is nothing very specific that you would have to look at and just set a number, and that will be the main cause for the margins being lower. This is part of the integration process, so sometimes you have some costs, as you mentioned, with the dismissal of some people or some other specific factors, or maybe old inventory stock that you do not have the full purchases to be able to have an average cost.
Quarter over quarter, we will move along, and by the end of next year, when we have the operation of 12 months for all the operations, we will be able to have a better vision on the seasonality from a regional perspective, the results and earnings and stability of these earnings. But we do believe that 18% acquisition with a batch of about six to eight months, when you add this to the average, is really a portfolio of acquisitions that is very robust and very promising for the future. The second part of his question. Are you back, Ricardo Boiati?
Yes, I was able to get back. Sorry, guys, I had an issue with my connection, but thank you. I think your answer is very clear. The second question is about the new payment models or compensation models and how this impacts the economics, the tickets, and if maybe the frequency could be bigger because of this, if the contribution margin per patient is very different. I think now you already have a pretty good volume to be able to analyze this in greater detail. Any kind of input towards this would be very interesting. Thank you.
The perspective we have on these new compensation models is very positive because these are decisions that are very structured through a lot of predictive analysis in our hospitals to be able to move in this direction. We work on something that is positive for our partners and operators, so you have risk-sharing.
When it comes to a reflection of this in our statements, we need to have the actual agreements become results or earnings. Since they are recent agreements, we still do not have the weight or significance in our actual numbers at the end of the day. When we reach a better level of maturity, we will be able to share this with you. But within our perspective, we believe that it is something that can generate the margins, and we have improvement opportunities for operation as the fruit of operational excellence and management that we have to be able to serve through these opportunities. Of course, this is not easy. It is a shift in mindsets, but we have what it takes to be able to have better results in 2023.
No doubt at all, Ricardo Boiati. These new compensation models are certainly, at the end of the day, first of all, they work with the issue that has always been a very important agenda in the sector, which is reducing waste. It also allows for an increase in the volumes and scale-up on production. Quite frequently, at the end of the day, they contribute to an increase in our revenue in the units. We understand that on our side, as a provider, as long as these products are built with responsibility and the support of tools that allow us to have a lot of safety as we take on these risks, this is a beautiful opportunity for increasing revenue.
Great, guys. Thank you so much.
Now I will pass the floor on to Giselle from Bank of America.
Good morning, Rafael. Good morning, Dr. Henrique Salvador. Thank you for taking my question. I just have one question here, which is if you could talk about the synergies. You already talked about this a lot in the call, but I want to understand what would be 2023. You talked about integration in the systems. You talked about personnel. But what do you think would be the next step? In 2023, my focus is system integration that represents this amount of synergies that we expect, just so we can understand a bit of a pipeline on synergy capturing for the year and where we can possibly expand margins. Thank you.
Giselle, thank you for the question. I think that we cannot get into the numbers here, because we do not think it is good to place expectations about synergies on the table and then generate some frustration. We think this is dangerous for the company, and what is important is really to see how this reflects on the margins and how they are sustainable over time. But from a strategic perspective, we address this part initially, which is the financial part, where we exchange the debts and the capital structure. We have a systems issue where we identify this to be able to have greater accuracy in the numbers and monitor this with greater safety in the level of information. We have another issue, which is costs. One of the first waves we have also between people and inputs.
Then we have the second wave, which is where we have a big challenge for 2023, in my opinion, which is the second and third wave, where we need to look at attracting new clinical teams and specialties that also demand some more commercial work, so that we can have the renegotiation and work with the local payers. This is a second and third wave because you need to have a relationship, you need to have interactions and a bit of a track record, and this has happened. In January, for example, we organized a roadshow in different cities where we operate. This was our full C-level team interacting with physicians and payers. We think that this is a big driver in 2023 so that we can go through these possible synergies and specialties, revenues, physicians, and provide more robustness to our balance sheet.
Excellent. Thank you so much.
These are some initiatives. Because for costs, we hope to reap the fruits of these different initiatives in 2023.
Very clear. Thank you very much.
Thank you, Giselle.
Now we will pass the floor on to Estela from JPMorgan.
Hi, guys. Good morning. A quick question on my side. What is the company's mindset towards M&A? I know the environment is not very easy right now, but are you looking at some assets in the market still, especially now that the company has already integrated all of the previous M&As? Another question is if you could provide some details on the organic expansion plan for each region, especially in Pará, where the company was planning to open up some beds as well. Thank you.
Good morning, Estela. How is it going? The issue with the integrations is really in progress, as Rafael Cordeiro mentioned. 2023 is the year that is very important for us so we can really fulfill the integration agenda that we have ahead of us. Actually, we have this movement we are working on now, which is through a specialized consulting company to review the culture of the network at this moment, which has been a very interesting trend and movement, which will allow us to be able to really make sense of all of these integrations when it comes to personnel, when it comes to culture. But of course, Estela, we are always keeping our eyes open on opportunities. But of course, they will be more occasional in 2023 if they occur.
At this moment, actually, considering the moment the country is going through and the cost of capital, as well as the stability and the leverage that the Mater Dei network has at this moment, we will only have these movements if they really make sense. They could even be major transformational movements, but they need to make sense, in line with what brought us all the way here, which is a safer perspective on all of this. This is applicable to Pará as well. We have really been analyzing opportunities there, and we are analyzing the timing as well to be able to put into operation new beds and maybe some expansion that we can work on there as well. This is valid for there, but also all of the other regions where we are present.
Very clear. Thank you so much.
You are welcome.
Now, since we do not have any other questions, in the chat or on the list, we will end this call for the year of 2022. We want to thank you all for your presence. Soon we will meet again because we have our earnings in the first quarter in a very short timing as well. Thank you so much. Have a great day, everyone. Good day, everyone. Bye.