Ladies and gentlemen, good day, and welcome to the Q4 FY23 and FY23 post-results conference call of Fortis Healthcare Limited. As a reminder, all participant lines will be in the listen-only mode, and there will be an opportunity for you to ask questions after the session concludes. Should you need assistance during the conference call, please signal an operator by pressing star then zero on your touch-tone phone. I now hand the conference over to Mr. Anurag Kalra, Senior Vice President, Investor Relations at Fortis Healthcare Limited. Thank you, and over to you, Mr. Kalra.
Thank you, Zico. Very good morning and good afternoon, ladies and gentlemen, and welcome to Fortis Healthcare's Q4 FY23 and FY23 results call. We have on the call today, Dr. Ashutosh Raghuvanshi, our Managing Director and CEO. With him we have Mr. Vivek Goyal, the Chief Financial Officer of Fortis. From SRL, we have Mr. Anand, the CEO of SRL, and with him is Mangesh Shirodkar, the Chief Financial Officer of SRL.
We will start the presentation by some opening comments by Dr. Raghuvanshi, followed by some highlights of the operational diagnostics business that Anand will take you through, and then we can open the floor for question and answers. I do hope all of you have got a chance to look at our investor presentation and press release. I just wanted to also state that, the discussion today will be subject to the forward-looking disclaimers that we have, as we mentioned in both the press release and the presentation. With that, I hand over to Dr. Ashutosh Raghuvanshi.
Thank you, Anurag. A very good morning and good afternoon, everyone. Thank you for taking time to join us on our Q4 financial year 2023 earnings call. I hope all of you are doing well. Before I delve into quarter four and the full financial year results, I'm pleased to inform you that our board has recommended a maiden dividend of INR 1 per share, 10% of face value, subject to the approval of shareholders. This signifies the transformational journey that the company has undergone in last few years, and as a result, the healthy operational and financial performance that we have witnessed in our business. Coming to the performance of the company, I shall comment on the year as a whole and then move on to quarter four.
For the financial year 2023, consolidated revenues for the company stood at INR 6,298 crores compared to INR 5,718 crores in financial year 2022, a growth of 10%. Our hospital business revenue for the year have grown 19.8% to INR 5,107 crores from INR 4,264 crores in financial year 2022. Our diagnostic business has witnessed a muted performance with a significant decline in COVID volumes. Revenue for the diagnostic business recorded a decline of 16% to reach INR 1,347 crores in financial year 2023. Our consolidated EBITDA stood at INR 1,163 crores compared to INR 1,096 crores in financial year 2022.
This translates into a margin of 18.5% in financial year 2023 versus 19.2% in financial year 2022. Our hospital business margin has strengthened from 15.8% in financial year 2022 to 18.1% in financial year 2023, clocking an EBITDA of INR 922 crores. Margins in the diagnostic business were at 19.5% versus 26.5% in financial year 2022, a drop of almost 700 basis points impacting our overall consolidated margins. Consolidated profit before tax, before exceptional items, was INR 740 crores compared to INR 673 crores in financial year 2022.
Largely contributed by the performance of the hospital business, consolidated profit after tax before exceptional items stood at INR 559 crores versus INR 475 crores in financial year 2022, a growth of 18%. On the quarterly performance, we recorded a consolidated top line of INR 1,643 crores in quarter four, a growth of 19.2%. The hospital business revenue grew a robust 29.7% to INR 1,351 crores compared to INR 1,041 crores. The diagnostic business revenue declined 10.8% to INR 332 crore in quarter four of financial year 23.
Our consolidated EBITDA was at INR 285 crores versus INR 227 crore in quarter four of financial year 2022, translating into a margin of 17.3% versus 16.5% in financial year 2022. EBITDA for the hospital business stood at INR 230 crores compared to INR 144 crores in quarter four of financial year 2022, with EBITDA margins at 17% versus 13.8% in quarter four of financial year 2022. EBITDA for the diagnostic business stood at INR 55 crores compared to INR 84 crores, with margins at 16.5% versus 22.5% in quarter four of financial year 2022, primarily due to the fall in COVID volumes.
Consolidated PBT before exceptional items was INR 173 crores in quarter four of financial year 2023, an increase of 37% compared to quarter four of financial year 2022. Our profit after tax before exceptional item increased 47% to INR 128 crores in quarter four of financial year 2023. On the balance sheet side of things, we have a healthy net debt to EBITDA of 0.29 versus 0.6 over the corresponding previous period, that is quarter four of financial year 2022. Our net debt stands at INR 330 crores as of 31st of March 2023, compared to INR 549 crore as on 31st March 2022. Our finance costs are also lower by 12%, both as a result of debt reduction and lower rate of borrowing.
I shall now take you through some qualitative highlights of our hospital business for financial year 2023. Our hospital business had an average occupancy of 67% compared to 63% in financial year 2022. Our ARPOP witnessed a growth of 11.5% to INR 2.01 crore in financial year 2023 versus INR 1.8 crore in financial year 2022. The growth in ARPOP was led by a healthy increase in our revenues from key focus specialties such as oncology, cardiac sciences, neurosciences, renal sciences, gastroenterology, and orthopedics, which cumulatively grew 31% in financial year 2023. The other important driver of ARPOP was the higher contribution from surgical volumes seen in financial year 2023, which stood at 59% versus 53% in financial year 2022.
In addition to the above, there was strong traction from our international business revenue, which grew 98% in financial year 2023 to INR 425 crores. Revenue contribution of international business stood at 8.3% in financial year 2023 versus 5% in financial year 2022. Our focus on strengthening our clinical programs continued through the year across all our facilities in terms of investing in high-end medical infrastructure and onboarding medical talent. The year witnessed addition of several eminent clinicians across various specialties like cardiac sciences, oncology, neurosciences, gastroenterology, and orthopedics. Some of the key medical equipment that we installed during the year included LINACs, PET/CT, da Vinci surgical robots, cath labs, neuro navigation systems, and orthopedic robots.
Just to put some numbers in context for this, out of total CapEx spend of about INR 300 crores in financial year 2023, approximately INR 200 crore has been incurred for medical equipment. Amongst the other key strategic growth initiatives that we have spoken of before is our brownfield bed expansion plan. We have added approximately 140 beds across our key facilities, including FMRI, BG Road, Mulund, Mohali, Ludhiana, and Nagarbhavi in Bangalore. Our plans to add close to 1,300-1,400 beds over the next 4 to 5 years are on track. As we have said before, our growth would comprise not only of our brownfield expansion, but also efforts to expand our size and scale through inorganic efforts.
This is evidenced in our signing of a definitive agreement with the VPS Group for the acquisition of hospital asset of Medeor Hospital in Manesar, Gurgaon, which could potentially add 350 beds to our network. We further expanded our presence with the launch of a 200-bedded multi-specialty hospital in Greater Noida under an O&M arrangement. In addition, we also commissioned a state-of-the-art cancer daycare center at Defense Colony in New Delhi. On our digital transformation initiatives, one of the key highlights in financial year 2023 was the launch of an electronic medical record system that we believe would eventually transform the way patient health records and databases are stored and shared and accessed by relevant stakeholders. This has the potential to significantly enhance our patient experience and service parameters. With respect to costs, we have achieved reasonable traction.
Cost optimization initiatives primarily related to drug and consumables and consumption optimization have also contributed to the hospital business margin improvement. Like I have said before, cost optimization across functions and expense line is an ongoing process, and we are actually conscious that this can be an important contributor to our profitability going forward. Some thoughts on our diagnostic business. An important highlight was that while our overall diagnostic business saw a decline, our non-COVID business revenue grew 12%, both for the quarter and financial year 23 respectively. The diagnostic business environment remains challenging at present, but SRL continues to work towards expanding its customer touchpoints, have added more than 1,100 customer touchpoints in financial year 23. This takes the total number of customer touchpoints to approximately 3,500+ as on date.
The business conducted 39.1 million tests during financial year 2023, as against 44.2 million tests in financial year 2022. Anand will take you through further details on the performance for the year and the quarter. With that, I would now like to conclude my comments. Thanks. Thank you all for your continuing support. On behalf of my team and I, want to assure you that we remain committed to our growth objectives and would ensure that all efforts are made to better our business performance going forward. I shall now hand over to Anand for his thoughts on SRL.
Thank you, Ashutosh Raghuvanshi. A very good morning and good afternoon to everyone on the call. Thank you for joining us today. On behalf of SRL Diagnostics, I warmly welcome you all for our Q4 FY 2023 results conference call. During the quarter, we reported a revenue of INR 332 crores, with 97% of our revenues coming from non-COVID testing. Our reported EBITDA stands at INR 54.7 crores with a margin of 16.5% for Q4 FY 2023. We conducted 9.8 million tests and serviced 4 million patients during the quarter. Non-COVID revenue has posted a growth of 12% over Q4 of 2022 and 41% growth over Q4 of 2020.
Revenue from genomics showed 36% growth in Q4 of 2023 versus Q4 of 2022, while our preventive testing portfolio has grown by 27% in Q4 of 2023 versus Q4 of 2022. For the financial year FY 2023, SRL reported net revenue of INR 1,347 crores. The company's reported EBITDA for the year stood at INR 263 crores, representing a margin of 19.5%. The business served a total of 16.6 million patients and completed 39.1 million tests during the year. Our preventive portfolio revenues showed a growth of 29%, and the genomics revenues showed a growth of 41% in FY 2023 compared to FY 2022. We have added 1,100+ CTPs and 53 new laboratories during this year. The B2C, B2B revenue mix stands at 54 to 46 in FY 2023 compared to 55/45 in FY 2022.
The business continues to have a well-diversified geographical mix with no overdependence on any region, allowing it to capitalize on the pan-India network optimally. Our workforce of over 7,000+ employees across our network are the pillars of our strength. One of the company's core areas of emphasis is learning and development. In the recent years, SRL has advanced to provide a variety of specialized competency enhancement programs. About 5,200 man days were logged by the company in learning and development initiatives during FY 2023. We rolled out the Future Ready Leadership Development Program and Strength-Based Leadership Development Program for SRL's identified high-potential employees. We continually expand our test menu in a way that it not only meets the needs of diagnostic options for the present, but also keeps us future ready.
We are happy to have added over 200 new tests to our test menu in FY23. We have also launched an online directory of services on the website that helps patients and doctors get the necessary information on our test menu with a simple search. Digital transformation has been one of our priority areas in FY23. Our app install numbers have grown by 8 lakhs, and our website recorded 8 million visits in the year. Our customer NPS improved from 74 in FY22 to 80 in FY23. Apart from delivering accurate and timely test reports, we have also built a convenient customer experience process at our centers for home visits and across our mobile app and website. SRL operates one of the largest accredited network of laboratories in the country.
43 of our labs are accredited by NABL, and 3 of our labs are recognized under the NABL MELT Program . We also have 2 CAP-accredited laboratories in Mumbai and Dubai. Being prepared for the future is one of our corporate goals. The transition to next-generation diagnostics, digitalization of diagnostics along the value chain, and the customer demand for omni-channel and on-demand services, in our opinion, are the 3 major themes that will shape the diagnostic industry's midterm future.
By enhancing our expertise in next-generation diagnostics, we are staying ahead of the curve. We are also optimizing our processes through digitization during sample collection and logistics, laboratory automation at pre-analytical phase, and in reporting. The current trend inclines towards consumer choices, consumer empowerment, and consumer wellness, and we are cognizant of this ever-changing landscape and are making the right strides in this direction. Finally, I take this opportunity to thank you all for your trust in SRL. I would like to hand over the call now to Mr. Anurag Kalra, Head of our Investor Relations.
Thank you, Anand. Ladies and gentlemen, we shall now open the floor for question and answers. May I request the moderator, please.
Thank you very much. We will now begin the question and answer session. Anyone who wishes to ask a question may press star and one on their touchtone telephone. An operator will take your name and announce your turn in the question queue. Participants are requested to only use handsets while asking a question. Ladies and gentlemen, we will wait for a moment while the question queue assembles. Our first question is from the line of Kunal Randeria from Nuvama. Please go ahead.
Good morning. sir, firstly, on SRL, some of your peers have taken price increases on some of the tests in their portfolio. Have you taken it? If so, how much, and on what % of your portfolio?
Thanks, Kunal. We have still not taken any price increase on our portfolio so far. We are evaluating the options and probably look at it during the mid-year.
Mid-year. Sure. sir, I mean, if I look at the SRL business as a whole, your realization seem to be holding steady. If I were to compare to pre-COVID years, there's been a very sharp margin compression. At the same time, some of your peers have been able to maintain margins. It seems that cost structure might be a bit bloated. just want to understand what are some of the operations changes that maybe you would like to get to the SRL business?
No. On our margins, what you're asking is the pre-COVID margins are different from. What is that? I didn't get what you're asking.
I mean, in FY19 or even FY20, you used to clock somewhere around 20%-21% kind of margins. Now, in Q4 of this year, it's fallen to 16.5%. Your realizations are fairly steady. Just want to understand, you know, what SRL has done differently to some of the peers who seem to have largely maintained some of the margin trends.
In FY 2019, we were at about 20%, and in FY 2020 we were at 18% of margins. In FY 2023, our margins are now at about 19%. The Q4 had some exceptional items which could have caused that drop in that particular quarter. We also have to note that, you know, we have grown our infrastructure and, you know, we are working on all the aspects to make sure that we continue to grow on the margins as well. I guess you want to add. Okay.
If I can add here. Q4, Kunal, I had the CSR for the entire year of INR 5 crore. Secondly, we had taken this was one of the HP PPP, the government contract. We had taken a provision, this is as per ECL method of around INR 6.5 crore in this quarter. These are the two one-offs in this quarter. Though we are confident of getting the payment from HP government. However, on a conservative basis, as per ECL method, we have provided for this. These are the two abnormals in the quarter because of which the percentage, the margins may look lower.
Yeah. Okay. Fair enough. Would you like to call out that number?
INR 6.5 CR as Provision for Doubtful Debts in HP, and INR 5.1 CR is CSR.
And just one more on the hospital side, in the last few quarters, your margins seemed to have steadied around between 16.5%-17.5% kind of levels. I think now the way forward could either be, you know, some of the less than 10% kind of hospitals start ramping up. Just want to understand, what should we expect in the next 18-24 months, you know, in this business.
Yeah. Yeah, Kunal, I can answer this question. As you rightly said, our margins are steadily moving forward actually, and we have achieved now 17% margin for this financial year. Our aim is to quickly move to 20% margin. It is now a question of whether we will able to achieve this year or next year.
I understand your guidance, but what I'm trying to understand is where will it come from? That 300 basis points margin expansion, so I'm not even holding on to FY 2024, it could be even 2025. I'm just asking where it will come from?
Yeah. There will be different, you know, levers for margin improvement. One is obviously, improvement in the payer mix and the specialty mix. Payer mix, as I was mentioning earlier also, we have government patients of course around 20%. We are working towards, you know, improving that payer mix slowly. It will happen gradually. That will give us improvement in the ARPOB. Second lever is of course the specialty mix. Some of the specialties are the more focused specialty for us, like onco and neuro and cardio, of course. The third lever is of course the cost lever. We are working constantly to reduce the cost structure and, you know, optimize the cost structure. That should also help us in improving the margin.
All three lever will add. Fourth, fourthly is on the expansion side. As Dr. Raghuwanshi mentioned in his initial comments, we are expanding our brownfield expansion bed capacity. This way we will able to achieve, you know, the economy of scale, which will help us in improvement in the margin. Lastly, you know, on the portfolio rationalization side, there are certain units which we have discussed in past, which are on which we are trying to rationalize our portfolio, where, you know, we feel there is very little chance to improve by us. That's why we those loss-making unit, we are planning to divest, and that will further give a boost to the EBITDA margin.
Sure. Sure. If we can just follow up on the point that you made on payer mix. Interestingly, because, say, I mean, if I were to see a payer mix today, around 18%, 19% would be coming from government, CGHS and, you know, ECHS. Even 4, 5 years back, the mix was fairly similar. You're confident that you can reduce your footprint over here going forward. Is my understanding correct?
Yeah. No, there is some improvement, and it need to be seen unit-wise because there are units who are operating, for example, at 60% occupancy level. There's no reason why we should be, you know, reducing our government payer there. There are certain units, especially in NCR region, where the payer mix, you know, the occupancy level is at around 80%. There, you know, we feel there is opportunity to rationalize this payer mix to the extent possible. As I said in the beginning, it may not be very prompt. Lastly, on the payer mix, the unit where we are going for expansion, and we know that there will be substantial capacity we'll be adding. There we are going slightly slow on the, on this, shifting because, you know, quick ramp up of those brownfield expansion programs.
Got it, sir. Thank you very much and all the best.
Thank you.
Thank you. Ladies and gentlemen, in order to ensure that the management is able to address questions from all participants in the conference, please limit your questions to one or two questions per participant. Should you have a follow-up question, we would request you to rejoin the queue. Thank you. Our next question is from the line of Shyam Srinivasan from Goldman Sachs. Please go ahead.
Yeah. Good morning, and thank you for taking my question. Just the first one on the growth we have witnessed in the hospital business and what's the outlook for, say, fiscal 2024 over 2023? About 20% growth we have seen. How should we look at fiscal 2024 revenue growth? If you could disaggregate that into either utilization, ARPOB has grown 11.5%. Just wanna understand the outlook on your revenue growth for the hospital business for 2024?
Yeah. Shyam, sorry. Shyam, on this question, last year, means 2022, was affected because of COVID, and that's why, you know, you have seen this 20% type of growth rate. I don't think so we will able to achieve that type of number. A double-digit growth, we are aiming for 2024, and we are quite confident we'll be able to achieve that. To your second question, We are expecting a ARPOB growth of around 6%-7% in the current year because, you know, ARPOB level has settled at a, you know, we have seen a significant increase in the ARPOB in last couple of years. We feel there will, the ARPOB increase, maybe, you know, limited.
The third lever for growth will be, you know, the occupancy ramp up. We are at a 67% occupancy level, so we are targeting at all our hospital level, we should be achieving at 70% occupancy level, and that should give us the major growth, plus, you know, the additional bed capacity we are adding. All put together, I think we are targeting around 11%-12% growth rate for 2024.
Got it. Vivek, that's very helpful. If I were to look at the surgical mix, 59% of hospital revenues, can we see this go further up? You think in some of the key therapies that you've been tracking and then there's a nice table that you've given now on what is the individual therapy level growth. Which are the areas that you can see further expansion in, say, next year?
Yeah. Shyam, as far as, you know, the mix is concerned, I don't expect a dramatic shift this year. However, there is definitely a phenomena where hospitals such as ours are attracting more of quaternary care kind of work, so that is why the surgical numbers are growing. As far as specialties are concerned, we are seeing quite a significant growth on the oncology side. In the oncology surgery component, we are expecting that we would see a similar kind of increase happening this year as well. Overall, as far as the ratios are concerned, it would probably not change too dramatically.
Got it. If you can quickly squeeze in last one on non-COVID volumes. I know there is a degrowth on the overall headline number for volume growth. Anand, if you could help us understand what's happening on the non-COVID volume. I know value is 12% growth, but just disaggregating that into volume and realization, what's happening there? Thank you. All the best.
On the non-COVID volume, Shyam, on a like-to-like basis, if you look at it, we have seen about 15% growth in the non-COVID volume. Because of we had in the last year, we had the HP PPP, which was a high contributor to the volume. That contract was not there in this year, in FY23. That has led to some shrinkage in the volume because of that. If you take like-to-like, there is a 15% growth in volume.
Anand, we are not this contract is not coming, right? 2024 will have complete. When did we lose this contract or stop this contract?
This was in May of, you know, May of FY 22, which, sorry, FY 23. Which means that May 2022, up to May 2022, we had this contract. Only two months of FY23 has revenues of this contract, whereas in FY24, it will not be there completely.
Got it. Yeah. Thank you, and all the best.
Thank you.
Thank you. Our next question is from the line of Agarwal from DAM Capital. Please go ahead.
Hi. Thanks for taking my question. On the expansion plans for the hospitals, I mean, A, if you can just probably help us understand more about the Manesar asset that you've acquired, what opportunities you see for that asset, you know, and given the fact that it is a further down in Gurgaon, I mean, Is it a very different catchment area versus, for example, an FMRI sort of hospital? Secondly, you know, on a going forward basis, what are the kind of, you know, expansion plans do we have in mind apart, you know, you highlighted some of the bed expansion thoughts, but if you can elaborate more about how we're thinking about expansion for the next couple of years.
As far as Manesar is concerned, it is a upcoming area, and there is lot of new residential developments as well as infrastructure development which is happening. There is a new highway, which is expressway, which is connecting Delhi to the national highway. That is almost nearing completion. As a result of that, the uptake of the residential apartments in the vicinity in that area, being more affordable is happening quite rapidly. We see that this area will be quite a prime area in next few years, because of the physical infrastructure of the highways and et cetera, which is developing and is getting ready.
That's why it is an important position for us to take within the Gurgaon micro market, having these two positions are very important. One is present and the other is future. It is a brownfield acquisition. Once we have concluded the closure of the deal, within 12 months, we should be able to get the hospital going with about 150 beds in first phase, we will take it to 350 beds. This is a full service hospital, it serves a lot of hinterland of Rewari, et cetera, as well. It is not a small market, it is a large market which is growing very rapidly. That is why we are very excited about this.
Similarly, the brownfield expansions which we are doing, some of that is almost ready. As we had said that this would take 3 to 5 years to do the about 1,300 to 1,400 beds. This is very much on track in various stages of operationalizing. So in Mumbai, for instance, the beds, about 100 beds are ready, and part of that, about 45 beds have already been commissioned. As a matter of fact, we inaugurated that floor just last week. Similarly, in NCR, in the Noida facility, the construction has begun about a few months back, and it is absolutely on track. Faridabad, the construction has been on for about a year, and we expect to complete that within next 6 months.
The capacity should get added by the end of this year. Similarly, we have the finalization or we have the construction which is started in FMRI facility itself, and that would add about 180 beds. This would take about 2 years or 2 and a half years, I would say, to complete. Similar is the timeframe for Shalimar Bagh where we are in the process of getting our plans approved, and that is almost in the final stages. Very soon we expect to begin that construction as well. All these are very much on track. Similarly, the last one I would like to add is about 100 beds, which we would commission in Kolkata are physically ready.
Just some last mile permissions, et cetera, are due. The moment all that is done, those beds will be commissioned as well. These, this would mean about a 200 or 250 beds within this year other than Manesar. Bangalore also, we have some expansion facility, where we have, approximately about another 150 beds, which we will be adding over a period of next 2 years. As the occupancy levels over there have been slightly lower, that's why we have not commissioned that number of beds there. We expect that in next two years we should be able to absorb that capacity as well.
Thanks. Thanks, Dr. Raghuvanshi. On the hospitals, just continuing the hospitals part, you know, we've had a pretty reasonable growth in the hospital business revenues through the, through the last, three or four quarters. Intuitively one would have thought that EBITDA margin should have expanded, you know, with the increase in revenues through the quarter. Through, I mean, when I'm talking about from Q1 to Q4 of FY2023. Any reasons why, you know, despite probably having the best revenues in the year, for the quarter, we've had, slightly lower margins for this quarter?
If I can answer this question. There are a couple of reasons for this. One is of course, the CSR expenses as booked in this quarter, which is around 9 crore for the hospital business. Number two is there are certain, you know, expenses which we have booked in this quarter, which are a sort of one-off. Like, you know, the Anandapur facility we are getting the approval, and for that, we have to pay certain fees. Similarly, for the Mohali facility, the adjacent land parcel, we have provided for certain, you know, penalties which are imposed for non-construction. There are certain legal costs which has been provided for t hese are the some one-off. If we exclude those one-off, there is a margin improvement actually.
What will the aggregate amount of these one-offs, if you can just call that out?
It is around on EBITDA level it is not impacting much, because certain income also has been added. Just explain this in slightly more detail. Certain provisions and advances have also been written back. That's why, you know, the revenue has gone up by INR 35 crore approximately, and around a similar number has been, you know, the one-off expense item has been booked. Net-net there is no major impact, but because the revenue has increased by INR 35 crore because of this one-off, the margin has been impacted.
Lastly, you talked about closing certain non-viable operations. How many such operations which, probably potentially we could be considering for closure?
We always discuss about these two, three facilities which are, you know, dragging sort of our numbers. Two facilities are in Chennai. One actually we have disclosed in our financial, we have classified as asset held for sale, which is the Arcot Road facility. That facility, you know, we are exploring to, you know, dispose off. As you might be knowing, this is a loss-making facility, and we are incurring around 3 crores per month EBITDA loss on this entity, and that's why we finally decided to hive it off . Another facility in that category, I will not say, we have not advanced to that extent, but the Malar facility , we are again exploring various options, which may include divestment also.
Okay. Thank you very much.
Thank you. Our next question is from the line of Amit Khetan from Laburnum Capital . Please go ahead.
Hi, good morning, and thank you for taking my question. First a follow-up on the Medeor acquisition. How many beds... you mentioned you plan to operationalize about 150 beds in the first phase. What is the amount of CapEx that we need to incur to bring this up to our network standards?
If I can answer this question. As you might be knowing, INR 225 crore we have paid, or we will be paying for acquiring this, plus there will be another INR 15 crore-INR 20 crore GST. Apart from that, because this facility is not running for last one year, so there will be some expenditure on the for bringing the facility in a running state. That will require another INR 25 crore approximately, and balance INR 75 crore is for the medical equipment side. Another INR 100 crore we will be spending on this facility to bring it up to
Understood. Secondly, on pricing, can you quantify the impact of the price hikes, the scheme price hikes announced by the government on our business? Have we taken any price hike on the non-scheme business, you know, starting April?
This is a, I will say, a sort of regular exercise which the operational team do. The normal price increase we do to we take is in the range of 3%-4% at one time, and it happens at two times in a year. Plus the CGHS price increase impact will also be there. I think overall level we will, we should able to achieve this time or at least 2% price increase on a overall basis.
Got it. Lastly, for this year, can you share the CapEx numbers, both maintenance as well as expansion for this for FY 24?
Yeah. Maintenance CapEx will be in the range of INR 250 crore-INR 300 crore because there are certain equipment which are due for renewal, replacement. Plus there is a CapEx, as we have said, the Greenfield expansion we have opened at 4 sites. Some expenditure will come from that. In my view, the cash expenditure will be coming to the extent of INR 600 crore-INR 700 crore in this financial year.
INR 600-INR 700 includes the maintenance CapEx, right?
Yeah. Maintenance CapEx of around INR 250 crore-INR 300 crore, which include IT CapEx also.
Got it. Thank you, and all the best.
Thank you.
Thank you. Our next question is from the line of Nikhil Mathur from HDFC Mutual Fund. Please go ahead.
Hi, good morning. My first question is on the ARPO divergence that we see between your different facilities in the same region as well, Delhi NCR. Now I understand that FMRI obviously has a lot of international patients. The case mix and everything would be amongst the best. But still the divergence versus, let's say, Shalimar Bagh or Fortis Escorts Heart Institute has kind of increased in FY23. Looking forward, what should we expect for the ARPOs of these assets which are lagging massively versus FMRI? I mean, would this divergence increase? Would this divergence reduce? If you can give some color on what should we expect from some of these assets in Delhi NCR, which seems to be pretty lucrative, at least on the occupancy front when I see the second chart.
I think, when you compare the unit with FMRI, you will see, you know, the substantial gap. The reason for FMRI ARPO increases, as you rightly said, is the international patient flow, which has increased tremendously. Because there is certain facilitator fees is also, you know, included in there. That's why in the gross level, the ARPO level is high. Having said that, if you see, you might have seen the chart which we have shown in, on our investor presentation. In almost all the facilities, the ARPO has increased. That is a very good sign. This lead to, you know, this is coming from the better specialty mix as well as, you know, some improvement in the payer mix also.
Should we expect that in some of these facilities, the ARPO increase can be reasonably higher versus FMRI in the coming 2-3 years? Also, occupancy is quite good, right? I mean, FEHI is at 71%, Shalimar is at 75%.
I don't think you should expect that the ARPO in all these facilities would be at similar level, and certainly not at FMRI level, because of the difference in the nature of these hospitals. Like, for example, in FMRI, there is no beds which are given for EWS. Whereas in Delhi hospitals, that is the case, especially in Escorts, for example. That's why even at the higher occupancy there, ARPO seems low because 10% of the beds are free. That's some kind of differences like that you would see. We can expect a good healthy ARPO growth in Shalimar Bagh, Noida, Faridabad, et cetera. Not so much at FEHI. Definitely there will be a differential between FMRI and these hospitals because of the addressing communities.
Okay. Understood. Sir, circling back to the EBITDA margin expectation of from 17% to 20%. If I look at the three or four levers that you have, increasing ARPO, occupancy, and closure of couple of facilities, if these three happen, only then will you achieve 20% or 20% is achievable even if there are some misses and hits on some of these aspects?
I think 20% EBITDA margin we are reasonably sure, and I think if we're able to divest these assets. Without divestment, let me put this way, we should achieve 20% EBITDA margin. If we're able to achieve the divestment, that will further boost the EBITDA margin by 1%-2%.
Understood. Is there some explicit cost control which you are expecting and hence this confidence of 20% EBITDA margin?
Yeah. One is, you know, as I said, because of the expansion program, you know, the brownfield expansion and the ramp up of the occupancy level. That, that is the major lever for the margin improvement, followed by the adding certain more facilities and, you know, the payer mix change. Plus, you know, cost side, you know, we are doing continuous efforts by better negotiation, by optimizing our cost structure, by, you know, improving the productivity to the extent possible. All those measures, we are taking to, you know, improve the margins.
Understood. One final question I had on the Medeor acquisition. Now I think, INR 320 odd crore is the total CapEx that is likely to be incurred for 350 beds. Unless you achieve the current EBITDA per bed, which is roughly INR 33 lakh-INR 34 lakh, it will be, I think, difficult for you to make 20% ROC in this particular facility because, I mean, the CapEx will be roughly around INR 90 lakh-INR 95 lakh per bed in the next year or so. Going by your comments that there are new highways coming up, Faridabad is a catchment area and those areas, I'm not too sure if this is likely to get achieved in one or two years. Can you give some thoughts on what is the target ROC that you're looking from this investment and in how much time frame is that possible to achieve that target ROC?
You know, this is for all practical purpose, this is a sort of new facility because this hospital is not in operation. As Dr. Raghuvanshi mentioned earlier, it will take one year time for us to start this hospital and then to reach a particular occupancy level. That's why, you know, the return on capital metrics will follow, you know, the occupancy ramp up we're able to achieve. Having said that, if we able to ramp up the capacity for the ROC will be faster. We are targeting at least.
How much ROC?
17%, 18% ROC by fourth, fifth year, we are targeting to achieve at 17%, 18% of ROC level for this facility. It means too we'll be able to achieve ramp up faster.
Right. Just one associated question here. Will there be some shared costs with FMRI? I mean, FMRI is not very close by to this facility, but still, it's not very far off as well. Would there be some shared costs between the two units?
I think there will be operational synergies. In terms of costs, I don't think there would be too much of sharing. Definitely there will be lot of synergies on the operational side, and that will help to have a quick ramp up as years is.
Do doctors at FMRI have bandwidth to kind of attend to, this hospital as well whenever it's up and running?
Yes, of course. We have second line of clinicians which is ready to take further responsibilities. We have seen that, you know, just the announcement that we are intending to complete this transaction, we have seen lot of interest from many other clinicians as well. That is certainly no challenge at all.
Understood, sir. Very clear. Thank you so much.
Thank you. Our next question is from the line of Bino Pathiparampil from Elara Capital. Please go ahead.
Hi. Good morning. Most items answered. Just one clarification on SRL. If I look at the 4 Q margins, obviously YOY it is, it is looking bad because of the high COVID volume of the prior year. Even if I compare sequentially to Q3, there is a major contraction in EBITDA margin, even if you adjust for some sort of seasonality that used to be there. Could you explain that please?
Yes. I had explained to an earlier caller as well. This is because of some one-off expenses which have happened in Q4. The two if you adjust that, the EBITDA is at 20%. The two adjustments are CSR. The CSR for the whole year is accounted in this quarter. Which is to the tune of INR 5.1 crores. And there is a PFD for our HP PPP, which we have taken on a conservative basis. Which is at INR 6.5 crores. Both if you take together, you have adjusted margin will be 20%.
Understood. Okay. Thank you.
Thank you. Our next question is from the line of Saurabh Kapadia from Sundaram Mutual Fund. Please go ahead.
Yeah. Thanks for the opportunity. Just one clarification. The INR 100 crore CapEx on Manesar is for 350 beds?
Sorry, your voice is breaking. Can you speak again?
Yeah. I was asking the INR 100 crore CapEx of Manesar is for 350 beds.
No, no. INR 150 is the additional expenditure we have to put in the equipment and for upkeeping this facility to bring the facility to full operational level. Apart from that, there is around INR 240 crore total acquisition cost. All put together it will be around INR 340 crore, all, you know, total investment for Manesar facility for 350 beds.
Okay. Secondly, if you can now provide the revenue and EBITDA or the EBITDA loss for the Arcot Hospital for 2023.
EBITDA loss was around INR 36 crore. The revenue was INR 151 crores.
Sorry, 51?
Yeah.
INR 51 crores.
Okay. Growth now for next year, what you are saying double digit would excluding the Arcot number, right?
Yeah. Arcot still is in our port. We are in the process of finalizing the deal. I think it will take another two months' time for us to close this transaction. Till that time, this loss will continue.
Oh, okay, sir. Thank you.
Thank you. Our next question is from the line of Abdulkader Puranwala from ICICI Securities. Please go ahead.
Yeah, hi. Thank you for the opportunity. Just one question on your hospital margin. If I look at the segmental breakup, and if I compare the whole of FY 2023, I know the start of the year we had close to 4 facilities with EBITDA margin upwards of 25%. Where we ending in, you know, FY 2023 is just having 2 facilities. Just wanted to understand, you know, through the revenues across Mohali, Shalimar Bagh and FMRI has grown consistently over the quarters. What would explain this kind of a dip into the EBITDA margin?
Abdul, when you look at this chart, I think there are a couple of highlights that we want to share with you. One, if you look at the top 3 brackets, which is the EBITDA margin range from 15, 20% to going up to 25%. Almost the revenue contribution in FY 2022 from just these 3 margin brackets was about 69% in FY 2022, and that's actually gone up to 78% in FY 2023. Not to mention, when you also look at these, the ARPOB numbers as well as the occupancy numbers have also increased significantly. To your specific question on, you know, the more than 25% margin, which were 3 facilities in FY 2022 have gone down to 2. That was just a smaller facility, Kalyan, which has now fallen below.
Kalyan did very well during COVID times now, but it's a small, 50-odd bed facility which is now gone below. Other than that, I think all our facilities, whether it's FMRI, whether it's Shalimar Bagh, whether it is, you know, Mohali, they are all in the 20-25 and 25+ brackets. When you look at FY 2023, Mohali, BG Road, Shalimar Bagh, Mulund, Anandapur, Ludhiana, and a couple of more are all in that bracket. You have to look at this holistically and how the overall number of facilities are moving towards the higher end of the bracket.
Sure. Got it. Just final one on the diagnostic side. I mean, you know, going ahead, what is the kind of volume growth we should peg in for the non-COVID business? On, on the price increase as well. A couple of your peers have indicated, I know that they are starting to taking some price increase. In our portfolio, have we started that evaluation and, you know, what could be the quantum ahead?
You're not very clear, Abdul, but from what I understand, you are asking about any price increase. Price increase, as I was telling the earlier caller also that we have not done any price increase so far. We are contemplating an increase probably during the middle of the year. As of now we have done no price increase. The volume growth on a like-to-like basis will be about 12%. Our ARPT growth is 0. That is the actual growth because we have to remove the HP PPP, which is a high volume business which we had in FY 2022, which has only 2 months of component in FY 2023.
Understood, sir. Thank you.
Thank you. Our next question is from the line of Saion Mukherjee from Nomura Securities. Please go ahead.
Yeah. Thank you. Thank you for taking my question. Sir, on SRL, would you like to give some guidance on growth or margin, let's say, for the next year or maybe even for the medium term?
I think, as we all know, the industry is expected to grow at about 10% CAGR over the next 3 years. I think SRL will be around 1 or 2 basis points higher than that. That would be the expectation.
Okay.