Good morning to everyone. Welcome to the Results Conference call of the fourth quarter of 2024 of Rede D'Or. We have here with us in the call, Mr. Paulo Moll, President; Rodrigo Davino, CEO of Hospitals; Otávio Lazcano, VP of Finance and IR; and Raquel Reyes, CEO of Health and Dental of SulAmérica. We inform that the event will take place for 60 minutes, and the recording will be available at the website of IR of the company. After the initial presentation, we're going to start the Q&A. You will receive further instructions before continuing. We would like to clarify that any statements that might be done during the earnings call regarding business perspectives of Rede D'Or, projections, operational goals, and financial goals are based on beliefs and premises of the board of directors based on information currently available. Forward-looking statements are not guarantees of performance.
They involve risks and uncertainties. They refer to events that may or may not take place. Investors should understand that macroeconomic conditions and industry conditions and other operational factors may affect the performance of the company and may lead to results that are different from those stated from the forward-looking statements of today. Now, I'd like to give the floor to Paulo Moll. He will start the earnings call. Please, the floor is yours.
Thank you. Let's start with a few highlights of our operation in 2024. We had results very solid, and this reinforces the combination of business that we have of Rede D'Or SulAmérica that happened two years ago, the M&A. There are a few numbers that I would like to highlight that show the resilience and the solid growth that we've had, even in a healthcare market that is still very challenging.
We see this in the sector. The gross revenue, we had a growth of 10%, 9.6%. The EBITDA got to BRL 8.5 billion, a growth of 33.3%, with a consolidated margin of 16.5%. If we look at the adjusted EBITDA by the results, finance of the technical reserves of health at SulAmérica, we would have a margin of EBITDA 18.4% and a total EBITDA of BRL 9.5 billion, with a growth of 29% year- on- year. The net income, BRL 3.9 billion, very strong growth, 81.6% in regards to 2023. This net income would have been BRL 4.1 billion if we exclude the accounting amortization of the portfolios of SulAmérica. The data of SulAmérica, I am going to let Raquel go over them. I wanted to talk about looking at our numbers on the cash generation and cash allocation. We had a conversion of over 100% of our EBITDA at the cash flow.
We are deleveraging the company. Our net debt/EBITDA finished the year 1.9 times. It's a drop of 0.4 times in regards to 2023, even with a payment of BRL 1.45 billion in interest over capital and BRL 946 million in repurchasing the shares, BRL 2.1 billion in CAPEX in 2024. This shows the rigor, discipline, financial discipline of the company, good finance management that we have, and a good operational performance. The year was very important for our expansion. We had five new hospitals, Memorial Star Guarulhos, Alphaville, Macaé Alliance Star, and a new tower of Villanova Star. The number of beds, total beds, has grown in the year, 11.2%, getting to 13,000 total beds. Operational beds, we get to 9,852, a growth of 259 beds. It's important to highlight this. We had an impact that is important throughout the year in the continuity of operators that we delisted.
We were exposed on a contract. At the end of the year, we had a closing of beds. That is natural, given the reduction that we have of demands. It was higher than expected, even though it's normal within the seasonality. We had, on the 13th of November, when we did the last call for the earnings call, that we had 9,981 operational beds. We imagined that at the end of the year, we would have a total number of beds that would be lower, but we reduced 124 beds. It's larger than our expectation. We would like to highlight that we are recovering. We're opening operational beds all throughout 2025, January and February of 2025. They were not especially strong in regards to 2024.
Remember that in 2024, we had a frequency that was very high in the emergencies because of dengue fever and respiratory syndrome, and we had a canceling of the contract with Unimed FEJ, a client with a relevant volume at Rio de Janeiro. Regardless, we start the month of March above 10,000 operational beds. Today, we have 10,097 operational beds. It shows our capacity and the capacity of the company as a whole of growing with a basis of clients and good partners, a sustainable base, and a consistent and quality-based base. Going back to 2024, we closed the year with 79.6% of occupancy throughout the year, record numbers. I would also like to talk about the perspectives for 2025. We're going to have the continuity of our organic expansion, the utilization of the operations. We have, for example, 13 implementations of hospital systems.
Obviously, once they are implemented, we will have more standardization with our processes. We want to continue to strengthen our JAV, Atlântica D'Or, with the Bradesco Group. This is an important vector of growth. The hospitals have done a strong ramp-up on the launched hospitals, and we're going to continue to do good opportunities on cash allocation. We have a strong cash position, very comfortable with leveraging a lot of cash generation. We're going to continue paying attention to the good projects that we can add to the company, whether they are organic or inorganic. Once again, I would like to highlight the strength of the business combination that we have between Rede D'Or and SulAmérica.
We can bring a lot of possibilities of growth and a great symbiosis amongst the operations and the reduction, obviously, of the risk of execution and the expansion of beds with Rede D'Or and SulAmérica. We end up having a number of opportunities that are very big with the consolidated company, with the cash allocation, with return rates that are very attractive. Regardless of the size of the business, we continue to see a level of growth that is high because of the amount of opportunities that we have for the growth and the cash allocation opportunities. We have a dynamic of conversion of EBITDA and generation of free cash flow that we have to highlight.
Very few companies in our sector have the capacity to convert 100% or more than 100% of the EBITDA in cash, and with the position that we have with the leverage, a good problem, which is the generation of excess cash. We're going to be paying attention with a lot of care and discipline to the best capital allocation for the company. Lastly, we would like to say that we have a natural hedge of the results. Given that the operation of service provision, the operators and the operation that they have similar scales, the drop of frequency that we observed in the fourth quarter or in other moments because of an epidemic or a high frequency, high utilization, we end up having a neutral effect within our consolidated operation with the consolidated numbers.
This compensates the other side, and we have a stability of results with the perspective of continuity of growth that is very strong. Now, I will give the floor to Raquel, and I will be with you during the Q&A.
Thank you, Paulo. Good morning. It's a pleasure to be with you. Let's talk about the main highlights of SulAmérica. I want to talk not only about the quarter, but the full year of 2024, which was very good in terms of achievements. Continuing with the reduction in the claims in 2024, we have an operational result that was negative in 2022 to continue to be in the blue and contribute with relevant numbers, consolidated numbers to the company as a whole. We are growing the base of beneficiaries in 153,000 lives net in health and 216,000 in dental.
We go over the 5.3 million total number of beneficiaries. We also evolved substantially in the combat of fraud and abuses, an agenda that you've heard for some quarters, contributing with the conscientious use of the resources of health that affects the claims also. We increased our breadth with the launch of new products, 29 new products launched in different regions of the country, more intelligent, more modern, and more sustainable. The index of administrative expenses also has to be highlighted below 6%, much more healthy now. We continue to improve continuously the services to our beneficiaries with more and more technologies, our apps. They are the best evaluated of the company, of the sector, and strategies implemented according to the profile.
The consolidation of our Concierge Line with services that are absolutely differentiated, exposing every day as a manager of our company, as a manager of health, in fact. At the same time, we start a natural process of reduction of the readjustment index after a difficult period, but absolutely necessary of strong adjustments in the portfolios. All of this is the result of a lot of work, consistent work, and I would like to thank the commitment of our 4,000 employees. All of that is based on a long-term strategy. This trajectory, as you know, started two years ago, and little by little, we and our companies are gathering the fruits of our labor. That's it. I am certain that we will continue with the same rhythm in 2025 with the same objective of achieving sustainable growth. Thank you.
Now I will give the floor to Davino.
Good morning. Very good to be with you today. I would like to highlight a few points that Paulo already mentioned. Regardless of everything that we lived in 2024 with the delisting and rearrangements that were necessary, we managed to grow the volume of the patient day year on year, 2.3% almost. As Paulo has said, our average rate of occupancy is about 79.6%, which is a rate of occupancy very good. We have not had it, the annual occupancy rate. We have not had it for a long time in these numbers. Now talking about the growth of occupancy rate in the patient day, we managed to keep the volumes of surgeries and complex surgeries. We increased them as well. It is a big challenge because that brings us possibilities in the different geographies that we work with.
We can work with the teams and show the patients the safety of our hospitals and how that surely can bring benefits for the patient. Regardless of the growth that we've been having, regardless of what we had in terms of loss, we also want to use rationally the healthcare system. That has to be in a balance to avoid waste, and we can continue with a system that is more adequate. Changing the page. Without trying to be repetitive with the hospital beds, Paulo already mentioned, we've grew with the operational beds, and we always try to work in an optimized fashion. We grew a lot in the total beds. We grew almost 11% year on year on total beds, but operational beds, they also grew. We have to work optimized so we can continue to bring resources for the company.
In the lines of Raquel and the other ones, we would like to thank the 75,000 employees that we have, plus the 50,000 physicians that work every day in our hospitals. Without them, obviously, this company would not have delivered the results of 2024. The challenges that we have for 2025, not only with the employees, and we have an executive group also that backs up the growth. Now I will give the floor to Otávio.
Thank you, Davino. Once again, good morning, everyone. On page number eight of the presentation, the gross revenue and average ticket of these hospital services started with a graph on the left. The company reported the gross revenue for the segment in the fourth quarter of 2027, BRL 1.904 billion, a growth of 12.6% in regards to the fourth quarter of 2023.
A small drop of 2.1% facing the quarter, the third quarter of 2024, an increase in the average ticket of 1.2% and a drop of volume of 3.4%. At the center of the page, the company reported a gross total revenue of BRL 31 billion 293 million, the growth of 10.1%, the result of an increase of the average ticket of 6.8%, and the volumetry of 3%. On the right, we have the annual evolution of the average ticket since 2017. Next page. Now we are talking about oncology, always starting with the graph on the left.
The company reported the gross revenue of BRL 829 million in the fourth quarter of 2024, a growth of 16% facing the fourth quarter of 2023, a growth of 0.8% if you compare it to the third quarter 2024, a result of the increase of the ticket of 1.8% and a drop in the volume of 1.3%. In the center of the page, gross revenue total of oncology in 2024, BRL 3 billion 197 million, 16.8% higher than the one verified in 2023, the result of the increase of the average ticket of 12.1% and an increase of volume of 4.1% in the same way. In the graph on the right, we have the evolution annual of the average ticket since 2017. Page 10, cost and expenses, hospital services.
On your left, the company reported the total costs of BRL 5.594 billion in the fourth quarter of 2024, a growth of 16.5% if you compare it to the fourth quarter 2023. In the center of the page, the company reported the total cost in 2024 of BRL 21.270 billion, an increase of 9.9% facing 2023. On your right, we have the general and administrative expenses. There is a small one-off positive in the first quarter of 2024 regarding the victory that the company had in a dispute that had some historical expenses, but we verified a stability in the SG&A of this segment of the business throughout time, totally stable and something close to 3.7% of the gross revenue of the company.
On your right, far right, the company reported the administrative costs general in 2024, BRL 1 billion 211 million of growth of 13.7% if you compare it to the FY 2023. On page 11, EBITDA and net income. On your left, a company reported for the segment of hospital services an EBITDA in the first quarter of BRL 1 billion 532 million, a growth of 7.6% if you compare it to that reported of the fourth quarter of 2023, a margin of EBITDA of 21.8%. At the center of the page, the company reported an EBITDA of the segment of hospital services once again in 2024 of BRL 7 billion 168 million, a margin of EBITDA of 25.8%. On your right, the company reported net income consolidated, adjusted for the fourth quarter of 2024, the FY of 2024 of BRL 932 million and BRL 4 billion 146 million, respectively.
Next one, some data on SulAmérica. Starting on the graph on the top left, net revenues in the fourth quarter of 2024, BRL 7.861 billion, 12.7% higher than the one verified in the fourth quarter of 2023. On the full year, the net revenue of SulAmérica, BRL 30.023 billion, is 11.3% higher than the one verified in 2023. In the clockwise fashion, on the top right, the consolidated loss ratio of 2024 of 80.2% in the fourth quarter is 4.9 percentage points lower than 2023. On the right, we have 4.4 less percentage points in the full year for 2024 in comparison to 2023. Here, there is an evolution of the beneficiary basis, health and dental beneficiaries, 5.3 million beneficiaries in the fourth quarter of 2024.
On the left and below, an adjusted EBITDA of SulAmérica in the fourth quarter of 2024 of BRL 726 million, which is 141% higher than the fourth quarter of 2023. In a year, the EBITDA adjusted of SulAmérica of BRL 2.3 billion is 131.5% higher than the full year of 2023. The consolidated EBITDA of the company and the consolidated and adjusted by the financial revenue of the guaranteeing assets of the company is BRL 8.479 billion and BRL 9.468 billion, respectively, in the full year of 2024. Page 13, that profile, the company is extremely well capitalized, very a lot of liquidity. We have over BRL 102 billion of total assets at the end of full year 2024, including a position, cash position equivalent of BRL 40 billion.
Excluding the technical provisions, even so, a position of cash net of BRL 19.85 billion, a gross debt of BRL 37.6 billion, a net debt of BRL 17.8 billion, a net debt EBITDA in the more conservative reading of 1.9 times. When we include the provisions for insurance reserves, we get to a relationship of net debt of 1.3 times. The company today has the ratings attributed by S&P and Fitch with above the sovereign risk. This is extremely relevant for a company that doesn't have assets abroad and doesn't have revenues in dollars or euros. At the center of the page, we have a cost of capital, cost of debt in CDI plus 3% with a 5.6 average term in years. On the debt amortization schedule, the main until the exhaustion of the debt.
Last page, managerial cash flow, reconciling the EBITDA that was reported by the company with a variation of cash, always moving to the right, starting with the EBITDA of BRL 8 billion 479 million. Thereafter, we have a positive variation of working capital of over BRL 3.5 billion. On the right, other balance sheet items, negative BRL 253 million. The leasing expenses, BRL 731 million, the payment of taxes in the amount of BRL 1.2 billion, the financial activities cash flow negative in BRL 601 million, the cash flow that stems from the investments negative in BRL 2.1 billion, we get to a variation of cash of BRL 7 billion 56 million. On the right, we have graphically the evolution of the average days receivables, DIO and DPO of hospital services. I close now the presentation and I open for the Q&A. Thank you.
We're going to start the Q&A session. For investors and analysts, if you want to ask a question, please click on raise hand. If your question has been answered, you can drop your hand. Due to the limitation of time of this earnings call, we ask that the analysts ask a maximum of two questions so that more people can take place. Our first question is from Andres Sales, UBSPB. Please, the floor is yours.
Good morning, everyone. Thank you for the opportunity to ask questions. I have two. First, about the new projects in 2025. Do you have an expectation of new centers for beds? 900 beds, but could we have some color on the timing of the launching of the new beds, new projects?
Should we see launches on the first semester, or is it going to be focused on the third and fourth quarter? Second question is about SulAmérica. Considering the new products being launched, how should we look at the evolution of the consolidated loss ratio of SulAmérica long term after 2025? Would it be reasonable to think about the consolidated loss ratio that is eventually less than what we observed in the pre-pandemic?
Thank you, Andrea. I'm going to ask the first question, the second question to Raquel. The best information about the investments of the company is the one that is in the reference form, that there is a lot of information there. We last year gave more granularity on the information. On the last version of May of last year, we consolidated more of the information because of strategic issues, but the projects are ongoing.
I'm going to tell you two examples of works that are advanced. São Lucas in Aracaju, Sergipe, and the works of expansion of Asunción Hospital in São Paulo. The best information for you and for the investors and the readers of our balance sheets is the one that is in the reference form.
Hi, Andrea, this is Raquel. Thank you for the question. In regards to the consolidated loss ratio, I cannot give you another answer than the one that we perceive of continuous improvement. That's going to be always our focus. I'm not going to mention any specific points, but I would like to say that the products that were launched not only in 2024, we are with the strong rhythm of launching products since 2023 when we launched another 2024, if I'm not incorrect.
Understanding the profile of each place, of each geography, understanding the competitors of a region, what is the profile of co-participation, the product that is being sold, launching the products with the service providers and other service providers depending on the region, and remembering the maxim that our desire is to have a consolidated loss ratio and claims control and one that presents an improvement, but always doing lower readjustments as well that increases, broadens the base of beneficiaries without a shadow of a doubt. Another point, besides the intelligent products, I would like to highlight the issue of our fight that continues in regards against frauds and abuses. We had a reduction that was extremely relevant in the representativeness of the reimbursement for the total payment of claims. It's dropping to less than half. Today, reimbursement is less than 8% of our claims.
We do not have a silver bullet. There is a series of actions that we have to take into consideration in terms of this consolidated loss ratio, but this is happening. Another point that I see a strong trend, and I see it in the entrepreneurial, but now I see it for the wholesale, is the co-participation. In the small and medium companies, we have over 22% of the entirety of the base of the stock of these SMEs with co-participation and the sales, the sales in over 44% in co-participation in the entrepreneurial that was 50% of the stock and 86% in the sales. We have to add all this and not forget the point of synergies that Paulo has mentioned in his initial speech.
That we can prove at this moment with all the synergies with the hospitals, we can have a differentiated position of highlight that leads us to a better improvement of consolidated loss ratio and costs that are lower when comparing to the markets. Thank you for the question.
Thank you, Raquel, Otávio, Gavina.
Next question. I said Rafael Elagi from XP. The floor is yours.
Good morning. Thank you for taking our two questions. First question is in regards to the issue of the operational beds at the end of last year. You mentioned yourself an effect that is lower than what was expected, but I wanted to understand, do you foresee any other factors that are not, for example, seasonality or another factor that is not so expected and even something that is acute that happened last year?
That would be the first question, and then maybe would have had an extension to the beginning of this year. Second question, trying to explore the dynamic of the growth of the base of SulAmérica. In the third quarter of last year, you had that growth that was more robust in regards to the other quarters of the year. The data of ANS, the National Agency of Supplementary Healthcare, signal an interesting growth at the beginning of this year that we have a strategy of growth. Can you give us more details on that? Also thinking on the values that we saw last year and the growth of Rio de Janeiro, we saw some growth there. We know of the presence of the company in this geography. However, the dynamic of growth of this geography is more difficult in terms of the number of beneficiaries.
If you can discuss this, that would be great. Thank you.
I'm going to start with the first question about the operational beds. Two factors. The listings that we've done and we continue to do all throughout last year and an effect of seasonality that I think that it was stronger. We expect a December that is weaker, but this year it was more intense. When we did the last call on November 13 that we had the 9,981 beds, we didn't have the expectation of closing 124 beds, knowing that something we would close to keep the efficiency of the hospitals and the rate of occupancy of the hospitals to keep the results. At the beginning of the year, there was another factor. At the end of last year, we do the listing of Unimed, and we stopped to service on February 18.
We had to deal with this first quarter in the loss of these volumes. As I mentioned, we can leave this behind in the past, and we are at a threshold that is above 10,000 beds, 10,097 beds without Unimed FEJ at the base and ready to have a rhythm of growth that is interesting with a ramp-up of our units and, of course, getting into the months of higher demand and more frequency. I'll give the floor to Raquel.
Thank you for the question. In regards to the strategy of growth of our base of beneficiaries at SulAmérica, it's a challenge for 2024 of objectives for the team. The challenge was very high, and 2025 is still high challenges. What I wanted to make clear is that the responsible pricing conscientious, those that planned good will reap the results for their good portfolios.
Still in the strategy of growth, there isn't just a focus in one type of portfolio, one type of group, one type of geography. No, we continue to focus on the retail and in the regions that are obvious. We cannot leave São Paulo, Rio de Janeiro, the big capitals, and now getting into Rio de Janeiro. We still have a strong strategy, and we have opportunities that are born there from the need of certain beneficiaries, and having a network that we can complete today is very relevant. Of course, because of the issue of the relevance of the amount of beds by Rede D'Or. We continue as one of our main priorities. Maturation, when we discuss the big negotiations, the maturation of this type of business is lower, so slower.
There are some contracts that we take one year for the beginning of the negotiation and the implementation itself. We continue to work firmly. Some of these contracts were implemented in 2024, some in 2025. We continue with a lot of good stuff in negotiation. I would like to highlight the regions that are not obvious, that we are always talking about the obvious ones, but we have also the last product that we have launched was in Parauapebas. We continue to observe opportunities regardless of the geographic limitations. Thank you.
Thank you. Next question. Gustavo Miele, Goldman Sachs. The floor is yours.
Good morning to everyone. Thank you for the presentation. I have two questions. Still within the context of hospital services, I wanted to hear about personnel.
In the cost, but also if you can do an analysis, adding DNA and to avoid classification in between the lines. There is a small pressure in personnel you are looking year on year. Is that due to the addition of capacity that the company has delivered over the last 12 months, or eventually, is there any extemporaneous factor that we should take into consideration when we are modeling personnel for 2025? Maybe do you foresee a space for the dilution in the first quarter, given that, as Paulo commented at the beginning of the call, a lot of the beds are starting to be operational from this start in 2024? The first question. The second question, looking at EBITDA, we have had the questions on what would be an aliquot of recurring cost of income in 2025.
We look at a print of the fourth quarter of 2024, which is stronger than we imagined. We wanted to understand what is recurrent, what is not, looking at the recomposition of tax income and the interest over capital. If you can talk about this.
Hi, this is Otávio. I'm going to answer both. As Paulo has said, we lost some operational leverage, seasonality, the listing that Paulo mentioned in the fourth quarter of 2024. When we look at the records, the relevance of personnel with the percentage of the gross revenue of the company, we are obtaining gains of productivity that are very significant. In 2019, just representing 27.7% of ROI. 2020, the most difficult years in the pandemic, it was 29.1%. For 2021, it dropped to 24.6, 2023, 23.9, and 2024, 24.1. It seems to be something acute and not structural.
Of course, with the advance of the works and the opening of the beds, the enterprises that we have in ramp-up from the harvests and the reduction of additional costs will let us verify all of these investments and the return on the company. On the second question, on the effective aliquot for 2025, it's very difficult to give guidance. The company is very conservative in the communication. We don't give guidance for the market to avoid any mistake in the communication. I'm going to tell you qualitatively, SulAmérica is presenting itself as a business that is more lucrative. Theoretically, it takes the effective aliquot of the company as a whole. On the other hand, the company has a set of tools that we've exercised all throughout the years to keep the effective aliquot under control.
I would like to say the base negative of CSLL, the income tax that we pay, and we accept the claims and the provision of the accounts receivable. When we accept this, we have another PIS and COFIN. We have a set of tools that allows us to understand that the effective aliquot of the company will be under control for many years. The amortization also is another tool that we have. Everything is described on the explanatory note on number 17. If you take a look at it, you will have a good idea on how we handle all of these tools to keep the effective aliquot of the company under control. Okay? Thank you.
Thank you for the questions. Next question. Flavio Yoshida, Bank of America. Please.
Good morning. Paulo, Rodrigo, Otávio, Raquel, thank you for the opportunity. I have two questions on my side.
The first one is in regards to the consolidated loss ratio of SulAmérica. We understand that it's improving, but at the same time, the level of technical provision is increasing a lot. We understand that you adopt a certain conservative position in the provisions, but I wanted to understand up until when do you get the conservative? How do you see the technical provision levels in which the company finds itself today? The second question is in regards to the ramp-up of the hospitals of Atlântica D'Or. In general, we have a perception of a new hospital that starts with low complexity.
In that sense, I wanted to understand if the ramp-up of the Atlântica D'Or hospitals today starts with a level of complexity that is higher, and if because of that, the ramp-up of margins is given in a more accelerated way when comparing to a hospital that is outside of Atlântica. Thank you.
I'm going to start by the second question, and then I will give the floor to Raquel. In fact, the ramp-up of the hospitals of Atlântica is more accelerated than the average of the greenfields of Rede D'Or. We've had two out of the three hospitals getting in the second month of operation break-even, operational break-even. You know the numbers, the records of the company. We usually took about four to six months to reach the operational break-evens.
This is because we are in places with an important population that is covered by SulAmérica and Bradesco that has been serviced since the first day, and we registered other operators, and this has made the ramp-up more accelerated than the records. Four to six months to reach operational break-even is an achievement when you compare to the greenfields that are done in Brazil, but outside of Brazil. Usually, the hospital is a type of asset that takes longer to mature. Therefore, we can reach quicker to higher profitability levels. Of course, we do not expect that for the two first quarters of operation, but I would like to say that for the second semester of operation, we can see these hospitals with an interesting level of margin and even with margins aligned with the numbers of the company. Now I will give the floor to Raquel.
Thank you for the question. Your reading is correct. We are reinforcing this in a very clear way in the call and the individual conversations of a position, a provision that is more conservative and more aligned with what we believe. This rhythm has been kept since the beginning of 2023 until the end of 2024. There is no type of intention of changing this. We wanted to show you that with numbers. In December of 2023, we had 3,780, and in December of 2024, 5,218, plus BRL 100 million in the long term. Your reading is correct. We can present an improvement with a change in the format of the provision, a provision that is more conservative. If that change had not occurred, the consolidated loss ratio would have been lower, but nothing changes because this is effectively what we believe that we should do. Thank you.
Our next question is from Vinicius Figueiredo from Itaú BBA. Please continue.
Good morning. Thank you for taking my question. I wanted to start my question, which is a follow-up of the previous question in regards to the conservative provisions. When we look at our model, the biggest difficulty within SulAmérica is to project PIONA. Now looking at the deficits of ANS and the individuals that you publish at SulAmérica, we can observe that we still have a constitution that is strong from PIONA specifically, and this helps us understand this very strong conversion of EBITDA to cash. I wanted to understand now that looking at the number of the intercompany eliminations Rede D'Or being more relevant within SulAmérica, you're improving all the processes, the network being more streamlined. Shouldn't we have that constitution of PIONA decelerating regardless of the conservativeness?
Eventually, we can see a gap between the consolidated loss ratio decreasing this gap. Another point that I wanted to try and explore is it's very clear in regards to the break-even of Atlântica D'Or of these hospitals, but I just wanted to understand and to do a cross-check with these number of operational beds. When we look, usually we're talking about greenfield hospitals opening 40-50 operational beds at the beginning and then getting to the 80 in 12 months. Does it make sense here that these hospitals within Atlântica D'Or can reach the 80 beds in less time? Just to try and understand what has been observed with Macaé, Alphaville, etc.
Thank you, Vinicius. I'm going to start with the end. The answer is yes, of course. We're reaching the break-even in the second month of operation. We are ramping up the beds quicker.
That rule that we've given as the average in the IPO, the opening of 80 beds per year with a greenfield, we're doing that quicker. We have hospitals with 120 beds at launch and with 90% occupancy, and we are increasing the beds. We have situations such as this that is a result of this registration of the two insurance companies since the beginning and the regions with the lack of reference beds in those operations. Now, going to the provisions, we are doing the provisions in a way that is conservative, that we understand that are adequate. We are still going to have the posture that is as conservative as possible, but within a context that is technical. Raquel can talk about this better than myself, but of course, backed up by the technical group within SulAmérica. Our posture will be as conservative as possible.
This is the type of operation that we are well provisioned, and it's important for any future oscillation. We are always going to, within the technical limit and whatever we can make in decisions, we are always going to be as conservative as possible. To add something else, Paulo, it's important to highlight that we report in this way with the PIONA because of the regulatory issues, but our calculation that involves TSL that is under review for the liquidation. Vinicius, I give you a lot of comfort in how that is calculated, looking at the lags between occurrences and the payment effectively observing the issue of the claims that are generated within Rede D'Or. The communication is more fluid, so this provision is very much adjusted. The word conservative is giving you an impression that we have excesses.
No, we are conservative as the insurance activity requires, and we are comfortable looking at all these times, all the lags, and also the participation of Rede D'Or within this.
Thank you. Very clear.
Thank you. Next question, Samuel Alves, BTG Pactual, please.
Good morning, Paulo, Raquel, Gavina. Two questions. First question, once again, about operational beds. Paulo has given us a great context on the first quarter and the effects of the delisting, how that was compensated. I wanted to ask about 2025. Do you change your mindset for 2025, seeing these delistings that happen at the end of the year? Or intuitively, can we think of a ramp-up of operational beds that is very important? If you can give us some color on the quantitative, if it can be the double than the ramp-up of beds that we've seen in the last year. And that's the first question.
The second question is more about the margin of hospitals for the year. You were commenting on these launches for the hospitals, and it ends up that we have a recent record of launching of hospitals that naturally hurt the margin in the beginning, but Paulo commented that the hospitals within Atlântica D'Or are maturing quicker. I wanted to understand how do you see the margin of the hospitals in the year? Can you seek a growth in margin throughout the year? Once again, if you can share the quantitative number on the budget, that would be great.
Thank you, Samuel. I am going to start with the operational beds.
We do not give the guidance for 2025, exact number, but we have the expectation that 2025 is going to be very much stronger than 2024 in the opening of beds, given that we have the ramp-up of several hospitals that we launched, and we have other delistings important that happened, São Luiz Campinas, and we have the new Barra D'Or, which was transferred from one side to the other, and they're going to do the ramp-up throughout the year. We have a good expectation of growth than the last year, even though we don't have the exact number for you.
In regards to the margin of the hospitals, we have obviously the seasonality, natural seasonality, but looking at the closed year of 2025, mainly stemming from this expansion that we will have of beds and the dilution and leveraging, this will be much more intense in the second quarter than the first quarter. We hope and we see space to have an operational leveraging of margin when we look at the full year, but making it clear that this will happen gradually. Naturally, the biggest benefits are in the second quarter because we are going to see a lot of these hospitals operating with margins that are similar or some superior to the average of the company.
Thank you, Paulo. Next question, Joseph Giordano from JP Morgan.
Good morning, everyone. Good morning, Paulo, Otávio, Gavina. Thank you. I'm going to focus on the hospital side.
I wanted to explore one point. The cash generation is very robust given all the investments, but I wanted to explore within this context of delistings, the best sources for payment. How should we think about the math of the receivables from now on? It was stable 120-122 days. Do you foresee any space to unlock some cash flow in that front?
Hello. This movement that we've done, they protect the quality of our receivables. We are at ease with the quality of the receivables that we have. Obviously, we have internally, when we look at the average of the company is 122 days, we have hospitals with better performances than others, and we are always looking for things that are within reach, and they do not depend on renegotiation. It's gain of efficiency, internal efficiency, and of course, we have goals and expectations of getting reductions.
I wouldn't say that in the consolidated that is very representative. The expansion that we had in the past of another seven, eight days, some of them were renegotiations on our model of delivery of accounts. You don't deliver the accounts every day, you deliver it twice a month. This is definitive, and I don't have the expectation of this is going to be a daily delivery for these operators. SulAmérica was one of them. There is the expansion in the number of days, which is negotiations that we understood that were reasonable to do within the important operators for Rede D'Or. We have the opportunity of improving processes and trying to bring some hospitals that have a worse performance than the others to bring a process that is more efficient. I talked about the implementation of systems in 13 hospitals.
These hospitals go within the system, and on average, we can get a cost of days receivable that is less with systems that we know better that are more efficient and in other actions and processes. I do not want to commit to you with a reduction. It is an internal goal for us, and for modeling, we are stable in that days receivable, and that is what I would suggest to you.
Thank you. Next question, Mauricio Zepeda, Morgan Stanley.
Paulo, Raquel, Gavina, Otávio, thank you for the opportunity. Two questions regarding SulAmérica and regarding the sector of operators. First one, if you can give us a regulatory update on how the sectorial discussions on the set of norms that ANS has suggested at the end of the year, how are these discussions?
Also in the same front, in a more institutional, how has the sector fought the excessive judicialization, if you can give us an update? The second question, looking at the performance of SulAmérica, what do you believe has been the biggest commercial differential, and is that sustainable for the next years? Because I see that this performance is very good.
Paulo Zepeda, so I'm going to start thanking you. We, in fact, agree SulAmérica has positioned ourselves in a very highlighted way in the sector as a whole. We do not have a silver bullet to reduce the claims and the consolidated loss ratio. All the products that were launched in 2023 and 2024, there is observation by the area of products and opportunities and regions that are not obvious. We are going to launch a product in a certain region that can add 3,000 lives a year.
It's a market. We have done this deep dive so we can understand the opportunities, whatever they are. Our commercial area, I think that deserves a specific talk, working with the other areas of the company. We have an internal maxim that we are all commercial. Regardless of the area that you are, you have the obligation of finding business opportunities. You have the obligation of finding synergies with commercial partners and service providers in general. I can say that we have seized these opportunities a lot. It is a bit of everything and being in the market every day. On the regulatory side and judicialization, Zepeda, I believe that we have seen this with concern as is not different. The regulatory framework that guides us is from 20 years ago.
The intergenerational impact, which is the younger that pay for the older and even the productive age of people when they stop. Our age for pricing, it stops at 59 years of age. Fifty-nine, 60, 70, there is a lot of people that are productive. There is a lot of things in the middle that I, as the whole sector, support a more complete review. What we cannot have is to have this done too quickly. These are revisions and studies that are important that lack an evaluation of regulatory impact. We cannot have another change of rules as it was the limitation of the removal of limitations of the therapies, for example, that was not done on an evaluation of previous regulatory impact that we did not have directive of utilization, for example. We have to study this, but the issues are too big.
These issues, they have to be sliced, and we have to have time to evaluate each of them with consultancies, entities that represent the consumer, with the judiciary powers, and the regulatory agency and so on. The idea is, yes, we saw it with concern, and we are trying with the agency to keep this dialogue open and getting our standpoint and the sector. Now, I'm talking, I work at Financial Saúde, and this is a common concern of the sector. We have to have time and do not take any decision too quickly that might affect the sector. Very important. There is co-participation, selling online, the technical review of individual plans, a series of things that bring impacts that can be very detrimental to the productive chain as a whole.
Absolutely everything that is a part of this, whether it's consumers or operators, they manifest it in the same way. We expect to have this agenda open with ANS to work with this in a calmer fashion. Judicialization was and still is a concern. We defend the active participation and the active consultation of the judges to the technical core systems. It is difficult for a judge to receive a demand on Friday for a surgery, with the physician saying that it is an urgent surgery, that the person is going to die, and this is a bariatric surgery. It might be because of the release, but if we had an opinion, if the core of technical support was really used, you would know that there is not an obesity surgery that is urgent. A lot of these entries could drop.
This is regarding the awareness of the beneficiaries and the consumers. 80% of the plans are entrepreneurial plans, and we have an agenda of awareness with the HR and entities that represent the executive class of the country. Thank you.
Thank you for the clarity on the responses.
Next question, Ricardo Boyatti, Banco Safra. Please. Your microphone is open. Next one, and then we go back. Next question, Leandro Bastos from Citibank. Please.
Thank you. Just to follow up on the part of the receivables of the hospitals that you commented, we realized that over the last quarter, there was a drop of the receivables. It was stable. These are the two questions. First, understand what was that movement concentrated in the fourth quarter, and how do you see the level of provisioning for this scenario of delisting? What do you see in this part? That's it.
Hi, this is Otávio. About the provisioning in general, we think that the level of provisioning for the company for the receivables is absolutely comfortable facing the scenario that we have today and the market conditions. Specifically about the billings claims, we have the cash generating unit looking at the experience over the last five years. After two years of the titles expiring, we drop the accounts receivable against the provision of the claims one to one. It's not that we're not trying to get the values of those expired over the two years. Besides that, at a company's convenience and seeking to keep the effective aliquot under control and observing the company number, per company number, we also accept the claims, medical billings, rejections. When you accept that, I take back 3.4%, 3.5% of PIS and COFINS. We do that company by company.
Theoretically, companies that are more lucrative, I have more incentives to do this quicker. Companies that are less lucrative, I have less incentives of doing this quicker. Companies with accumulated base negative of CSL, I do not have any incentive for this, and I am just limited to the compensation. In the fourth quarter, we had more claims accepted, however, because of these reasons that I just presented.
Thank you. Next question. Carlos Moscarini, Santander, please.
Question for Paulo. When you see the portfolio of hospitals, do you think that the quality of this portfolio is where you would like, or is there any adjustment, any delisting that should be done over the next months? A question on SulAmérica. I want to understand if SulAmérica is seizing the new hospitals to launch new products in these regions: Alphaville, Guarulhos. I would like some color on that. Thank you.
Thank you, Caio. Good. Obviously, this is very dynamic, and we are always analyzing and evaluating our relationships, and eventually, we might have some delisting. With a base of contracts and relationships, there is nothing that will bring a lot of concerns once we have overcome this contract with Unimed FEJ. That one was the one that we communicated that was a point for us of concern if we were going to have that continuity a long time. We ended up taking this decision at the end of the year, and we stopped servicing on February 18th. When we look at the base of clients, there is nothing that we have a prediction of discontinuing. The relationships are good. They are balanced, but this is very dynamic, and this can change. Should we start to have some larger difficulties on the receivables or the relationship with a specific operator?
Once again, nothing outside of the expectation. Now I will give the floor to Raquel. Of course, we are seizing, obviously, this opening of the hospitals from moment zero, the availability in our network, activating with sales, doing the link with the commercial side that we're having. We have regions that maybe we wouldn't have a lot of participation in sales, such as Guarulhos. All of them are available. Thank you.
The Q&A session is adjourned. We'd like to give the floor to Mr. Paulo Moll for the closing of the session.
Thank you very much to all that took part on our call. We will see you briefly. Thank you.
The earnings call for the tour is closed. Thank you for your participation. Have a wonderful day.