Ladies and gentlemen, good day, and welcome to the Q4 and FY 2024 earnings conference call of Healthcare Global Enterprises Limited. This conference call may contain forward-looking statements about the company, which are based on the beliefs, opinions and expectations of the company as on date of this call. These statements are not the guarantees, the future performance of the company, and it may involve risks and uncertainties that are difficult to predict. 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 presentation concludes. Should you need assistance during the conference call, please signal an operator by pressing star then zero on your touchtone phone. Please note that this conference is being recorded. I now hand the conference over to Dr. B.S. Ajaikumar, Executive Chairman of Healthcare Global Enterprises Limited. Thank you, and over to you, sir.
Thank you very much, and, good morning to everyone. A warm welcome to the present Q4 and FY 2024 earnings conference call for Healthcare Global Enterprises. I am joined today by Mr. Raj Gore, our CEO, and Ruby Vatalia, CFO, and my senior management team, along with the SGA, our investor relations advisor. The past year has been another remarkable chapter in our growth history. We are proud to have positively impacted the lives of those who have entrusted us with their well-being. Their achievements have been made possible through efforts and tireless dedication of our doctors, nurses, staff, and other stakeholders. Having spent decades in cancer care industry, both in U.S. and in India, needless to say, there's a contrast, stark contrast between the Western countries and India.
You know, in the beginning, we used to see a lot of patients with advanced diseases, but today I'm happy to say in big cities, we are seeing patients in early stage, and we are seeing good quality of, treatment as well as very good. Given the population of India and more recognition of cancer and lifestyle disease, it is definitely going to be a rising incidence of cancer in the coming decade. With a reported incidence, 2.2 million annually, the actual incidence is expected to be much higher, maybe 1.5x-3x higher, and the statistics are definitely alarming. At HCG, we are seriously fighting the war against cancer. We are the only organized cancer care chain in the country, with a state-of-the-art operation extending to Tier 1 and Tier 2 cities.
Thanks to our state-of-the-art technology, including digital PET scans, digital pathology, precision radiation therapy, cutting-edge robotic surgery system, we deliver the highest standard of care to our patients. We recently added [robotic Plus X], which will transform the precision medicine in the era of genomics. We believe precision medicine is the future, targeted therapy is the future, and genomic evaluation is going to play a major role. And having done genomic analysis over several thousand patients, we have certainly become leaders in the targeted therapy based on the genomics. We plan to introduce MR-Linac radiation therapy in Bangalore, which will be a notable addition to the vastly superior radiation treatment offering at HCG, which will help us revolutionize radiation therapy in the state. This cutting-edge technology integrates magnetic resonance imaging with linear accelerator to improve the clinical outcome, reduce side effects, and reduce treatment spanning.
There are several clinical milestones we have achieved during the year. To mention a few, we have performed record number of minimal access gynecologic surgeries at our Center of Excellence in Bangalore. We have administered one of the rare procedure called NeuroSAFE, a nerve-sparing prostatectomy. We have done robotic-assisted [breast axillo-pectoralectomy], which is the first of its kind in, in Mumbai. We have also done significant number of 3D planning, large tumor resection in our Bangalore division, with having an engineering department for the same. We are happy to report that our mortality rate, as we measure, while we are one of the few measuring it, has now come under 1% over the years. The feat we are immensely proud of and definitely meeting or beating the global standards. Research and development is an integral part of HCG DNA.
Our clinical trials and research initiatives are paving the way for new and improved treatment modalities. We've established an institutional research committee to fund investigator-initiated trials, which is one of a kind in the Indian private health sector. This commitment to R&D nurtures innovation and leads to industry-leading academic excellence in HCG. We continue to collaborate with market companies on projects like predictive analysis and analytics, computational work, and the initial design support system by leveraging our AI ML technology. We have the best-in-class medical talents from around the world, ensuring that our patients benefit from the expertise by some of the best minds in oncology.
Our commitment to improving cancer care in India remains steadfast. We are dedicated to raising awareness, enhancing early detection, and providing advanced treatment options to transform the perception and reality of cancer care and make cancer care a chronic disease. Together, we will continue to strive for better outcome and a brighter future for those affected by this disease. I will now hand over the call to our CEO, Mr. Raj Gore, for his observations and strategies going forward, and also the summary of the operational performance for the quarter gone by. Raj?
Thank you, Dr. Ajaikumar. Good morning, everyone. A very warm welcome to all the participants on the call. We are very proud to report a strong performance during quarter four, 2024, with all-time high annual revenue, which grew 12%, with EBITDA growth of 21%, translating to 19% EBITDA margin. This exceptional growth serves as a testament to our enduring commitment to excellence in cancer care. HCG has positioned itself as the destination for cancer care, with superior clinical outcomes underpinned by advanced technology and commanding market-leading positions across 16 of 18 cities. The company has decoded the oncology business model in India with robust performance both in metros and non-metros. We continue our dominance in key existing markets like Bangalore, Ahmedabad, and Cuttack, along with turnarounds for centers like Nagpur, Jaipur, Borivali, and now Kolkata.
Furthermore, there is a massive potential across the key established and emerging centers that still remain untapped, with potential to grow faster than the market over the next few years, which would help us to improve our return metrics going forward. For the fiscal year 2024, ROCE performance for the company has been 10%, whereas our established centers operate at much superior ROCE of 21%. Based on vintages, we see that the nascent centers, although have low or negative ROCE currently, they can significantly improve ROCE to operate in line with longer vintage centers. With the Kolkata center generating positive EBITDA, our conviction on delivering strong returns has only increased. There are multiple levers in place to keep dominating the oncology market in India, which we have captured in the last couple of slides in the first section of our investor presentation.
Now, I would like to briefly talk about some of the key strategic initiatives. Over the years, we have taken multiple steps to enhance our operations and improve our profitability. To point out key strategic initiatives during the year, after consistently achieving organic growth for three, four years now, we are now poised to expedite HCG's expansion through strategic acquisitions. In addition to our expansion efforts in Indore, we are committed to further strengthen our presence in Bangalore. We are currently in the process of establishing two hospitals with total 125 beds in North Bangalore and Whitefield area, slated to be operational in the next 12-15 months. These state-of-the-art facilities will enhance our capacity to cater to the growing cancer needs of the region.
Furthermore, to enhance the patient experience and streamline access to healthcare services, we have introduced HCG Care Smart App Suite, including a patient app exclusively designed for unique needs of cancer patients. This innovative platform provides patients with seamless access to treatment options and their medical records with a click, anytime, from anywhere. In addition, the app would also, also help us consistently engage with our patients to monitor adherence to treatment plan and post-treatment follow-up to improve long-term outcomes. Already, the Smart App Suite has benefited over 56,000 outpatients with active participation from more than 300 doctors on this digital platform. Our digital revenue has grown 75% year-on-year in FY 2024, and will continue to be an important driver of growth in future. With this, I hand over to Ms. Ruby, our CFO, for financial highlights.
Good morning, everyone. In reviewing our performance for the quarter, I am pleased to report 12% year-over-year growth, culminating in a top-line figure of INR 495 crores. For the full year of FY 2024, the revenue stood at INR 1,912 crores, witnessing a growth of 13% year-over-year. Our operating metrics, key indicators of our performance, have shown substantial all-round improvement in this quarter. Chemotherapy sessions increased by [14%], OPD footfall rose by 19%, and while our radiation experienced healthy growth, the decline in capacity utilization from 65% to 61% is due to proactive expansion and the incorporation of four new linear accelerators. Our for the quarter stood at 42,700 as compared to 39,700, registering a growth of 8% on a YOY basis.
The revenue of our established centers experienced an 11% year-on-year growth, and revenue from emerging centers grew by 16% on a YOY basis, with EBITDA for emerging centers growing at 117% on a YOY basis. We are observing a consistent uptick in our emerging centers, marked by increased footfall across various cancer treatment modalities. Our two prominent emerging centers in Mumbai and Kolkata have demonstrated robust performance. Specifically, our Kolkata center had an impressive year, year-on-year growth of 20%, while our South Mumbai center achieved 37% growth.
Additionally, our Nagpur center has outperformed expectations, recording a remarkable 48% year-on-year growth. On the EBITDA front, our EBITDA grew by 21% YOY and stood at INR 94 crores for the quarter. But for this quarter, stood at INR 21.3 crores, as compared to INR 8 crores in the previous, year's same quarter. Our CapEx for the 12-month period stood at INR 187 crores, and net debt excluding leases stood at INR 358 crores as on March 2024. This includes acquisition of Nagpur, Kolkata, and Indore, and we have spent INR 115 crores towards our growth CapEx, mainly on our 2 facilities, Ahmedabad and Whitefield. As we speak, Ahmedabad construction is almost complete, and we will be transitioning very soon. We have also given bifurcation of our EBITDA across matured and emerging centers. I would request participants to refer the investor presentation for the further details. With this, I would like to open the floor for question and answers.
Thank you very much. We will now begin the question- and- answer session. Anyone who wishes to ask question may press star and one on the touchtone telephone. If you wish to remove yourself from question queue, you may press star and two. Participants are requested to use handsets while asking a question. Ladies and gentlemen, we'll wait for a moment while the question queue assembles. First question is from the line of Nishit from ChrysCapital. Please, go ahead.
Hi, thank you. So, I just wanted to ask, the revenue growth drivers for FY 2025 between new beds, ARPO, or/and occupancy? Hello?
Hi. If I've understood your question, you're asking about what revenue drivers for next year, right? The current year.
Yes, between, you know, new bed additions, ARPO, or occupancy load.
Yeah. So look, our revenue growth in last few years is primarily driven by 2/3 by volume growth, and it will continue the same trend going forward. It will be largely driven by volume. While we've seen some improvement in ARPO, as you know, during the year, we have deployed bed capacity, linear accelerator capacity, OT capacity. We have added clinicians and, you know, strengthened our go-to-market efforts. We are also, in this year, moving to a larger facility in our center of excellence in Ahmedabad. So we've deployed, you know, additional capacity. We have, you know, increased our clinical bandwidth. We've strengthened our go-to-market, which will continue to help us, you know, get more patient footfalls and therefore grow, at a healthy rate, which is better than the market growth rate.
Okay. And, you know, just wanted some color on, you know, outlook on margin for FY 2025 and beyond. Our EBITDA margin overall for the company in Q4 is around 19%, whereas for FY 2024 is 17.8%. So is Q4 the new normal for margin? And what will drive margin improvement, if at all?
Yeah. So if I can just take you back. Look, first half of the year, we, you know, communicated that, you know, our margins were subdued because investment in clinical bandwidth, and then, you know, downtime, transition time to add, you know, our linear accelerators. Throughout this year, subsequently, you have seen improvement in our EBITDA margin. The EBITDA margin that we see in Q4 is on account of better service mix and a payer mix, and operating leverage due to a strong revenue growth. We expect that to continue going forward, and as I mentioned earlier, there are lots of revenue growth levers to drive volume-led revenue growth going forward. Our, you know, utilizations, as Ruby mentioned in her presentation, on beds it's about 56%, on linear accelerators, 61%.
So I think we are very well poised to drive revenue growth, and that will help us, you know, to get operating leverage. The strongest point or one of the strongest, you know, performance is, you know, our emerging centers. As you heard, Kolkata has turned, you know, started contributing positive EBITDA. It will continue to grow going forward. South Mumbai has reduced the losses, and is expected to, you know, start breaking even sometime in the middle of the year. These two were earlier EBITDA drag due to losses. And now going forward, as they start contributing to the EBITDA margin, we are very confident that we'll continue our EBITDA margin journey in a positive direction going forward.
Understood. So even the emerging EBITDA, which is in Q4, is 14%, you're saying is sustainable, right? Because is fiscal year is somewhere close to 9%.
Yeah. So, just to recap, we have many centers in this bucket. You know, most of the centers have been contributing EBITDA and have been growing. The two youngest, you know, hospitals, the Kolkata and South Mumbai, was a drag on our EBITDA margin in the past. Q4, Kolkata in Q3 and Q4, has started contributing positively, and will continue to reduce the losses in South Mumbai and break even in the middle of the year. So as a result, emerging center bucket will start moving, you know, in the right direction throughout this year.
Okay. And could you share how Indore has panned out for us?
Yeah. So look, as we said, Indore was our strategic acquisition in a new market, Madhya Pradesh. Central India has one of the lowest penetration or lowest density of comprehensive cancer care center per million population. It's about 45-50 lakh population, you have one cancer care center, versus about 16-17 lakh population per cancer care center in our southern region. So we made this acquisition in the second half, starting with the second half. Our first priority was to integrate it on HCG's platform, in every possible way, and invest in this asset to bring it to HCG quality care. We have upgraded, you know, we had started the construction work, or renovation work.
We've upgraded ICU facilities. We've upgraded private rooms. We have invested in medical equipment, invested in upgrading OT equipment. We have started empaneling, you know, more TPAs. Our go-to-market initiative has been strengthened. It's on the right track, so far, as per our integration plan, and we'll, you know, we'll continue to share the progress going forward. So far, so good, in terms of our progress on integration of this new asset.
Got it. So, and any thoughts on inorganic acquisition? Bernard.
Yeah, so, you know, we've been saying that after three, four years of consolidation and a consistent quarterly performance, strong performance, few quarters ago, we said that we will look at acquisition as a strategic, you know, lever to grow or expand the company. We've already done Indore acquisition. At any point of time, we are evaluating, you know, several key assets. And as and when we get to concrete concluding stage, we will be happy to share with everyone.
Okay, thank you. That's all from my side. Thank you.
Thank you. Ladies and gentlemen, you may press star and one to ask question. The next question is from the line of Dhara Patwa from SMIFS Limited. Please go ahead.
Thank you for the opportunity, and congratulations on the good set of numbers. I just have three questions. One is, what is your bed expansion strategy for the next two, three years? And suppose if you want to develop a new hospital, so what is your criteria to select the geography for that expansion? Yeah, that's my first question.
So, thank you for asking that question. See, over the years, we have created a dominating presence in our current 18, 19 locations. Our first priority is to invest in these assets and create capacity in terms of beds, OPs, linear accelerators, so we continue to dominate our presence and continue to grow our market share in our current locations. We have already announced and shared with you that in Ahmedabad, you know, we are moving from below 100 beds to 200-bed capacity, newly built to our specifications, a very premium advanced cancer care center in next month. So we're doubling our capacity there. We have added, you know, about 20 beds and two OPs in last year in our center of excellence in Bangalore.
We have announced two new projects in Bangalore market, one in East Bangalore in Whitefield with 25 beds, a comprehensive cancer care center, and one in North Bangalore, about 100 beds, comprehensive cancer care center, which will become operational in about another 12-15 months. So we're doubling down in our both strong markets. In total, you know, across our current hospitals, we are looking at adding about 350-400 beds in our existing hospitals in next 4-5 years. Most of that will get completed in next year. So that's the plan on our current brownfield expansion in our current market. As I mentioned, that we continue to look at M&A opportunities.
In the past, we've had a brilliant track record in acquiring cancer care centers and creating value. So we continue to look at it. We started our journey last year with Indore. We are looking at opportunities. We are looking at, you know, basically our criteria for that is we're looking at, you know, comprehensive cancer care centers in markets which are attractive markets in terms of cancer incidence, affordability, household income, density of comprehensive cancer care centers. These assets are usually 70-80 beds. We are looking at assets which, you know, preferably are EBITDA creative from right in the beginning, and we can acquire it at a good valuation. So that's the criteria for our M&A. In markets where we do not see M&A opportunities, but we feel that they are markets of strategic importance. We may look at greenfield, you know, especially in our current states where we dominate, like, you know, Maharashtra, Gujarat. So as and when we have something concrete plan on that front, we'll share with you.
Just to add, in addition to 300 we also have about 200 additional installed bed capacity, which we have not deployed. So along with adding new capacity, we will also be deploying the existing installed capacity where the capacity is already spent.
Yeah. So, you know, if you look at our current occupancy is about around 65%-67% on our operational beds. Our capacity on capacity beds, including the 200-odd beds, as you mentioned, which we've not made operational, is about 56%. So we have, you know, in all capacity parameters, we have enough headroom in our current hospitals to continue to grow for next five years.
Sure, sir. This is pretty insightful. My second question was: What is the average life of a LINAC machine and the replacement cost for the same?
Sorry, are you asking about average life of a LINAC machine?
Yeah. Like, how much is the duration that we could use it? It is 12 years, 15 years, something like that.
Yeah, the linear accelerators are normally there for about 14 years, 10-14 years. Most of the new technology has been in the software upgradation. The basic hardware platform has remained the same in the last 10 years or so. As the new technology evolves, as you know, with AI and high technology, more and more it will be software upgradation, so the basic unit may remain the same with upgradation. So our thinking at this time is it will last anywhere between 12-15 years, the average linear accelerator hardware. Of course, the software and all can even last longer, but we are in the transition process as far as the linear accelerator is concerned, because we are talking about adaptive therapy, precision therapy, MR-Linac. So many new things are happening, so it is undergoing a tremendous change. A s an oncologist, I do believe this will last for a long time.
Yeah, sure. And lastly, on what will be the effective tax rate for FY 2025?
Sorry, can you ask that question again?
Effective tax rate for FY 2025, ETR.
Between 35%-39%.
35%. Sure. That's it from my side. Thank you.
Thank you. A reminder to all participants, you may press star and one to ask question. The next question is from the line of Shyam Srinivasan from Goldman Sachs. Please go ahead.
Good morning. Thank you for taking my question. Just the first one, on the opening remarks around the whole, you know, aspiration to grow faster than the industry. So we have done, about 12%, 13% this year, in terms of top line growth. When I look at some of the large NCR-based players who report oncology separately, they have grown 21%-25%. I know they may be an outlier, but some of their relative absolute sizes of, revenue have now reached almost very close to us. So just want to understand what's the reason why, why we may be actually growing slower than some of these peers? Is it just that they are in expansion phase and we have not, or just want to understand some of the competitive dynamics.
Yeah. So good morning, Shyam. Thank you for that question. We have grown about 12% year-on-year. However, I want to just point out that in last couple of quarters ago, we have announced that we're gonna scale down our shop and shop, large shop and shop center in North Bangalore, MSR. So that business has not been with us for last six months. If we adjust for that, we have grown about 14% year-on-year in the current, in the last year. That is above the you know, market growth rate, which is about 12% you know, on an average oncology market. Now, obviously, year-on-year growth rate is also a function of the base that you have.
I think many players, multi-specialty players, have started focusing on oncology recently. And therefore, you know, their year on year growth is a function of their existing base that they had. We have a large presence. We've been in this business for a long time, and therefore our base is much higher. Some players have, you know, very high concentration in specific markets, right? So if they're, you know, the realization plays a larger role in growth versus volume-led growth. I think as a, as a strategy, we want to continue to focus on volume-led growth, which is a sustainable growth, while continue to improve realization, but primarily volume-led growth. So, you know, look, I, as a leading oncology player, we have enough levers to, you know, and enough, you know, as I explained, our plan is robust to maintain our leadership position, which is volume-led growth, and we will continue on that path. More than that, you know, I mean, I can't comment on, you know, other, play ers. Yeah.
Well, Shyam, as you rightly mentioned, they have been on an expansionary path. We have been in a consolidation phase. We started deploying additional capacities in some of our key centers, like Ahmedabad. So Ahmedabad, Kolkata center, the other centers, large centers, we have started deploying capital, increasing the capacity, which has been done. And we should start seeing growth momentum from these centers, which will rub on the overall growth of the company as well. Yeah.
Thank you, Raj. Yeah, understood. That's helpful. Just a second question, you know, actually a related question to question number one: in terms of doctor attrition, because some of your competitors are expanding, have you seen attrition or any of those parameters that you look at from an HR or a retaining our key talent perspective? Has that seen an uptick or a change, or what are we doing to retain our, our top talent?
Shyam, as you know, this is Dr. B.S. Ajaikumar. As you know, HCG has always been very proud of our doctor group, and our top doctor attrition is very low, less than 5%. So we have been very proud, and even today, because of the way we empower the doctors, the way we are involved in academics and research, our attrition has not been a major issue, and we don't expect it to be an issue at all. And another thing I want to tell you is we are also in training. We have our own training programs and fellowship programs, residency program, and because of that, we have significant number of doctors coming out of the training in medical oncology, radiation, surgical oncology. Because of that, and we are an institution, and I always like to compare it to where I trained, M.D. Anderson.
You know, wherever you went in U.S., you found doctors trained in MD Anderson. And it is a proud thing that doctors are there working in different institutions trained by that. So similarly, where we go now, we see doctors are trained in HCG are there. So we don't have any issues, doctors who want to even sometimes leave, because we have an internal training mechanism. And because we brand HCG more than doctor, and we collaborate with doctors and work, we don't see that as a foreseeable issue at all. And the people come to it for HCG to HCG as a quality institution, as a destination. So that is how we have been able to grow and maintain our status of the leader, and we will continue to do that. We are very clear that most of the major doctors have been with us for a long time and will continue to be there, and we don't see any issues on that.
Helpful, sir. Thank you. Just my second question is on if you could double-click on both the, I think the case studies that you have presented in the investor presentation are very helpful. But I just wanted to go through, like, South Mumbai, what's the, you now are looking at international medical tourism as a, as an avenue. So just want to understand, what's the size there? What are the plans for further enhancing our, at South Mumbai? What's been the response, even from local patients? That is my second question.
Yeah. So, Shyam, as you know, South Mumbai, South Bombay Hospital, is a premium hospital at a very good location. We have a differentiated technology there. It is still the only hospital in Western India with a CyberKnife and Tomotherapy under one roof. As mentioned earlier, we have invested in our clinical talent. We have, you know, a medical oncologist who focuses on breast oncology. He used to be director of breast oncology program in U.K., in Nottingham Hospital. We have a breast surgeon who's come back after getting trained in Memorial Sloan Kettering. So we have a very good talent on medical side, surgical side. Radiation, we were always strong in that department.
So we have a product now, which is a premium product, differentiated technology, and clinicians with full-time clinicians with a very high pedigree. And Mumbai is more connected to the rest of the world in most cities in India. So this is a perfect recipe to attract international patients. You know, and just to explain, CyberKnife gives lot of advantage in terms of treating, you know, cancer patients, which cannot be treated by other modality, other linear machines. But one of the biggest advantage of CyberKnife, when an international patients travels to India, you can treat the patient in with a hypofractionation.
You know, I generally, in linear accelerator, you will go through 25-30 fractions, and you have to stay 6-8 weeks for that. Whereas CyberKnife can do it in matter of days, and therefore the length of stay for international patients in India becomes much lesser, and therefore, out-of-pocket expenses goes down. So not only you have a superior outcome, but your out-of-pocket expenses go down. So we are, you know, it's well positioned to target international patients. We've been working on, you know, our go-to-market efforts in certain markets like Middle East, Oman, and East Africa. We have seen currently 30%-35% of our center revenue coming from international.
At the same time, because of these differentiated products, we are targeting a wider geography, not just South Mumbai, but a Greater Mumbai, Maharashtra, and, you know, strategically connected locations to Mumbai, who historically, drain into Mumbai, like, you know, Northeast is there, some of the cities in, central India. So we continue to spread our net wider in terms of go-to-market to get the right segment for our right, for, the products that we have in this. It's, we've significantly reduced our losses this year, in this center, and we are expecting it to, break even sometime middle of this year.
That's helpful, sir. My last, last two questions, if I may. Sorry, I'm asking many questions, but, similarly, if on Borivali, your presentation talks about positive EBITDA in fiscal 2024, and revenue going at a CAGR of 22%. So all the changes regarding, I think we have made management changes as well. So how is this, that, seeing fruition now, when I look at Borivali? Any numbers you want to share at this point of time, given that we have now reached, probably some scale there?
Yeah. So look, Borivali, you know, has been a well-performing asset. Actually, you know, it exactly follows our unit economics. Last year, we have added one more linear accelerator to augment our radiation capacity there. We added robotic, you know, our robot there, surgical robot. We have created a vertical specialization in surgical team. We have onboarded surgical talent. It had shown 20%+ growth. It delivers, you know, mid-20 EBITDA margin, and we have enough spare capacity on all modalities there. So I think, you know, we are perfectly poised to gain market share, you know, from others and continue to grow at a very aggressive growth rate going forward in Borivali in Mumbai.
Got it. My last question is just on the balance sheet. In terms of our debt, I know debt went up year-over-year in fiscal 2024, but what are the plans going forward? Will we use this dry powder to, you know, kind of do M&A like we may have hinted, but just want to understand how should we look at any plans for debt reduction? Thank you.
Hi, thanks, thanks for that question. So the current levels we are very comfortable with, with all our banking covenants we have in our schedule. We are exploring, looking at, inorganic growth, and that Raj talked about, and we will be looking at those. In terms of funding requirements for that, we will be funding it through both internal accruals as well as external debt funding.
Sure, and all the best. Thank you.
Thank you. Ladies and gentlemen, you may press star and one to ask question. The next question is from the line of Ankit Pande, from InCred Asset Management. Please go ahead.
Yeah, hi, good morning, and so congratulations on the great set of numbers. I have a few questions. Starting with on the CapEx fund, what will be the organic CapEx for the next one to two years?
So, on CapEx, I mean, as far as the maintenance CapEx is concerned, we have always guided that our maintenance CapEx will be around INR 65-70 crore, and INR 70 crore is the number which you saw, for FY 2024 as well. On the growth CapEx, we have largely any new project which is coming up, we have been presenting it before you. So other than what we have laid out in Ahmedabad and Whitefield in Bangalore, we also announced North Bangalore center. And North Bangalore, the total CapEx we estimated is around INR 90 crore. This largely will be spent in the current year and a portion of it in the next financial year.
Okay. I think you have even mentioned that, you know, in some of the centers you'll be doing adding more capacity over there. So, in FY 2025 and 2026, how much, how many brownfield capacity expansion can we expect, apart from that, the Ahmedabad and the Bangalore that has already been announced?
I think other than Ahmedabad, I mean, that's primarily the brownfield capacity increase that will come this year. Rest will probably follow in the year after that. Majority, I mean, we are doing some bed and OT expansion in our existing centers. Say, in our [Kalgymala center] in Vizag, we are doing expansion in Cuttack. So there are bed or associated, you know, infrastructure addition which is happening in couple of centers, and large one would probably happen in next financial year in Cuttack.
Okay. So that will be roughly how many beds that will be increasing?
Sorry?
How many beds capacity will be increasing in the brownfield?
That's in Whitefield. In Whitefield, we are, I mean, in Bangalore we are adding about 125 beds, but that won't come this year. That will be next financial year. So in both projects, between both projects, North Bangalore and Whitefield, will be added about 125 beds, which will get commissioned in the following financial year, FY 2026.
Sure. Sir, can you just talk about your inorganic CapEx also inorganic plans that you acquisition that you'll be doing? Which region and how much you'll be invest in the inorganic opportunities?
Yeah. So look, I mean, I think we are uniquely poised to be a consolidator in this state. You know, there are some active comprehensive cancer care centers across the country. While from a management bandwidth, we would prefer them in existing markets or adjacent to our markets. We will be opportunistic if we get a good acquisition target in a newer state. So, you know, with M&A, you have to be opportunistic. I can't tell you, you know, if our investment in these assets will be proportionate to the size of the asset. So, you know, we'll be able to tell you, you know, as and when we have something concrete. So it's difficult to comment on the size of the acquisition. Just to add, you know, it will depend on obviously the availability of the target and we are managing of the debt level which we can sustain. And we have our internal guidance on the debt levels. We will be using that.
Right. So one more question on the tax rate. If I look at your cash tax, the tax that you pay, and it is visible on the cash flow statement. Last year, on a PBT of INR 45 crore, we paid INR 22 crore tax, INR 23 crore tax, that's 50% of PBT. And this year, on a PBT of INR 68 crore, we have paid INR 47 crore of tax, that's like 70% of our PBT. And then, you know, on the P&L, we are guiding for effective tax rate of 35%-39%. I thought the corporate India tax rate has fallen to 25% a few years back. So what is it that is keeping our cash tax and our PNL tax so high? I mean, 70% tax rate on a cash tax basis seems unreal. Can someone explain to us why our cash tax rate tends to be, like, 60%-70%?
Yeah. Yeah, sure. So, we have various entities under which our businesses . There are entities separately where we incur losses, and since they are separate entities, we don't get that benefit at a consolidated level, and we don't recognize deferred tax asset on that. That is the reason why our effective tax rate is higher. You're absolutely right that we are moving towards 25% at the corporate level. However, there will be a journey. Once these entities becomes profitable, we will start seeing a reduction in our effective tax rate.
So I get it. So on the entities which are profitable, are we paying exactly 25% tax?
Yes, that is right. We are paying 25% tax. We have about INR 47 crores of losses that is letting off our overall profitability.
Oh, so in other terms, if I calculate-
Ultimately, we are paying 25%. Sorry, again, please.
Yeah, yeah, yeah. So what I was asking was that, if I take the INR 47 crore of tax paid in FY 2024, and I multiply it by 4, that gives me almost INR 180 crore of profit before tax on our profitable entity. Would that be correct?
So, see, we have for the year, entities making around INR 15 crores of profit, on which we have gross paid of 24%, which becomes INR 27 crores profit, and we have INR 47 crores of loss-making entities where, there are no tax credits taken. So, if we adjust for, the INR 47 crores, it would be at to 20, 27%. Right now, we are at 39% because we are not taking the tax rate of INR 47 crores. You can do the math.
No, no, I, so I am not following the math here. I'm sorry. I'll have to drill a bit more on this. So INR 67-68 crores of consolidated profit, right? Add back INR 47 crores of losses that you are saying is included in this profit. So that gives me 120-odd crores of profit. On a, even on 120-odd crores of profit-making entities, we are paying INR 48 crores of tax. So that's 40% tax. Is that correct?
INR 27 crore of tax. You see the net tax.
Yeah, net of refunds, the tax. No, net of refunds, the tax is INR 47 crores on your consolidated cash flow. I'm talking about cash tax.
No, no, no. Please, please, that includes the TDS also, which is 10. That is not the tax charge. You should look at the PNL, because the balance sheet includes two things. One is the cash tax as well as the TDS, which gets deducted from the payments that we collect from our credit payers. It does include that.
What is this TDS? Can you again explain?
TDS is tax deducted at source under Section 194J. Whenever we bill our credit payers, while taking the payment, they'll deduct tax at 10% before taking the payment. Or in some places, we have got low TDS, which will be anywhere between 2% and up to 4.5%, but still done the tax deduction, which normally will get refunded in a cycle of 2 to 3 years. So those are not the cash taxes. That does not impact the P&L. That is only a tax issue, which is with the government, with the income tax department, which gets refunded after 2 to 3 years.
Okay. I get it. But this has been going on for the last two, three years, right? So, this INR 22 crores tax that we paid last year also.
Yeah. So it will go on because we have great business, which is about 3% of our total revenue. So it will keep going on like that. So once our tax is 10% of the revenue, you will see negative of that. But right now, we are at 2%-3%, so we have some way to go there.
I get it. Now I understand it. Thank you so much for that clarification. Last question, on the multi-specialty hospitals that we have, Raj, this question is for you. On the three multi-specialty hospitals that we have, what's the strategy now going forward? And what are the current, sort of margins that those facilities are doing for us?
So, Aditya, answer that question. We have been pretty clear on our communication on this front. We have had four multi-specialty hospitals. Above that, Bhavnagar is now, you know, oncology is a dominant specialty. We added a linear accelerator three years ago. We are looking at adding another linear accelerator there. So it will continue to oncology will continue to contribute more and more in Bhavnagar. Rajkot, again, we are currently last year, we started surgical oncology and medical oncology. Currently, we are in process of building a bunker. So on Rajkot will also have a comprehensive cancer care facility, and oncology will become a dominant specialty going forward. In Suchirayu, we are, you know, again, we have a very strong market share there.
It's a very good referral center for North Karnataka. We are currently building a bunker for linear accelerator as well as PET scan next to the Suchirayu Hospital. Eventually, we have an opportunity. We have another comprehensive cancer care center in Hubli. Eventually, when we need to add more capacity, we cannot add that capacity in our existing Hubli Cancer Center. However, this is a planned roadmap for going forward. You know, since we are adding linear accelerator and PET scan next to Suchirayu, we have a growth headroom whenever we need additional capacity, and then, you know, oncology will start becoming a dominant specialty within Suchirayu. The last multi-specialty hospital is in Ahmedabad, Medisurge, which will continue to be a multi-specialty hospital. There is no space there to add oncology in that hospital, yeah.
Understood. Thanks, Raj. Thank you, gentlemen. All the best.
Thank you.
Thank you.
The next question is from the line of Bino Pathiparampil from Elara Capital. Please go ahead.
Hi, good morning. Couple of questions, just following up on earlier questions. In Ahmedabad, where we are adding beds, what is the existing capacity, utilization there or occupancy there? What's your expectation regarding the new 100 beds? Are they going to get filled in six months?
Yeah. So, I wish I can fill 100 beds in six months in any market. But yeah, look, Ahmedabad, again, we've, it's a hospital that we started more than 12, 13 years ago. It has less than 100 beds. The capacity constraint, more than beds, it was ICU beds and OTs. We have had 5 OTs. As you know, this is a surgery-dominant cancer center. We have a very strong team of more than 20 surgical oncologists there, with vertical specialization, and a very high volume, strong robotic surgery center. Since it is a surgery-dominant center, OT capacity and post-op ICU beds became a problem for us or capacity constraint for us, and that's when we decided to invest in a new hospital, which is a 200-bed.
There we have, you know, we'll be moving next, sometime next month. We have to start with, we are doubling the OT capacity from five to 10 OTs, and we have a further headroom to add, OTs whenever we need. Same for ICU. So we are very excited. This is a center that is built to our specification, very premium center. And, you know, because we have all the, clinical bandwidth and are currently the number one market share, I think we are best poised to ramp it up quickly. How fast can we ramp it? Well, we are shooting as fast as we can, but, you know, as stated earlier, we've always said that we will grow at higher than market growth rate in every micro market. Here we have an opportunity now to increase our market share. We are already number one market share with 30%+ market share. So we have an opportunity. So we'll go all out and see. It's difficult to predict how fast we can, you know, fill that at this stage.
Can you give some historical growth rates around that, Raj?
So in FY 2023, another was 10%-20%. In FY 2024, in spite of all the capacity challenges, we grew by 40%. We do expect the growth momentum to continue, and, I mean, this growth probably will get accelerated once we get into the new center. We were capacity challenged, and you can take a guidance from here of the growth rate and, I mean, make a sense of how faster we will fill those beds.
Understood. Thanks for that. I think, you know, typically it takes at least 3 years from plan to operationalizing a new facility or new beds. Okay, after this Bangalore 125 bed addition in FY 26, it looks like you don't have a, you know, plan to grow further our capacity. Do you have anything in mind, even in early stages, where you'll be doing something significant brownfield or a greenfield for addition beyond FY 2026?
Bino, it's difficult to hear you. Is this question about Bangalore?
No. Overall, your bed growth plan, because we don't have a plan in place beyond, beyond FY 2026. Next year, we have 125-bed addition in Bangalore. Beyond that, we don't have a plan in place for the question.
Yeah. So no, we have a plan. We just spoke about it a little while ago. So let me start from the current base. Today, we have 56% utilization on our capacity beds, so we have about 44% beds unoccupied right now in our existing hospitals. So that's number one, first headroom. Then in our strategic markets, like Bangalore, we've added 20 beds, you know, last year. We have a capacity to add, we have a plan to add another 25-30 beds in our existing center in next 2 years. We are also adding 2 more hospitals in Bangalore, one in Whitefield and one in North Bangalore, with total 125 beds. That will get commissioned in FY 2026. Now, that's enough bed capacity for Bangalore to continue to grow for next 5 years.
I would like to point out that we've also have three daycare centers in this market, which have done very well, and we'll continue to add couple of more daycare centers in next 12, 18 months in Bangalore, so that we, you know, penetrate, we have a deeper penetration in greater Bangalore market and grab higher market share. The second key market is Ahmedabad. We just spoke about it, where we are doubling our capacity. So we have a headroom and a runway to continue to grow for next few years. You know, similarly, market by market, you know, we have added 35 beds in Baroda.
We are adding another 25-30 beds in Vizag in next year, and then we have a plan to add another 25-30 beds in Vizag in 2-3 years. Cuttack, we'll be adding about 60-70 beds. The remaining all our hospitals, we have enough current capacity, which is unutilized, which will continue to fuel the growth for next 5 years. We don't see any capacity constraint in our hospitals with this plan baked into our 5-year plan. We don't see any capacity constraint for at least next 5 years. As we ramp up, we will continue to monitor utilization and figure out if we need to add subsequent capacity in any of these markets.
You know, to summarize, today, we have enough capacity to grow. We are clearing the capacity bottleneck, you know, and we'll have a runway to grow for next 5 years. If we feel that, you know, in next, you know, 2, 3 years, we'll continue to monitor it and continue to deploy more capacity in our established centers. These are the centers we have a dominant market share, and we will not let the capacity come between our future growth in future. So if I can just summarize that, so you mentioned the addition, plus 200 beds addition which we have. So we do have visibility within, next 3 years, we'll be deploying 500. We also have done an assessment of which are the centers which probably would go out of capacity after 3 years. That would also need an addition of about another 200 beds. In 5 years' time, we have a visibility of adding about 800-900 beds.
Sorry, 800-900 beds in 5 years. Okay. So these are mostly brownfield, you are saying?
Yeah, I just want to add one thing here. See, in oncology, you should never focus only on beds. As we go forward, oncology is more outpatient, more targeted treatment, and also we should look at the growth in oncology, not clearly just measured by the beds alone. While the beds will be needed, but the proportionate growth of oncology will be more without even considering the beds. The way it has moved in the last few decades, and we continue. Because our average length of stay, as you can see, has come down significantly. More targeted surgeries, more targeted treatment, you know, so all of this, we will have a more footfall is what we have to look at other than the bed strength.
But as you explained, bed strength will increase, but one should not measure only by the bed strength. Because, for example, if you have a breast spoke model, you have more clinics, like what Raj mentioned, you know, outpatient clinics and all. There will be no beds, but it will be still infusion centers, which are contributing to the revenue and the growth. So it has to be looked at in a more analytical way in oncology rather than just the beds.
Yeah. Thank you, Dr. B.S. Ajaikumar, for pointing that out. And as you know, we have added, we have added 3 linear accelerators in last few years. Today, we have 36 linear accelerators. On that, our utilization is about 61%-62%, so there also we have enough headroom to keep going, growing, going forward.
Understood. Thank you very much.
Thank you. Ladies and gentlemen, as that was the last question, I would now like to hand the conference over to the management for closing comments. Over to you, sir.
So once again, thank you so much for your interest in HCG. We've had, you know, as I mentioned my opening remarks, we've had a fantastic performance in quarter four with about 12% year-on-year growth on revenue, 21% on EBITDA. Our margins are sitting 19%. We have, you know, the team has worked very hard to add clinical bandwidth, clear capacity constraints, we, you know, drive our go-to market. We are very optimistic in driving our growth, you know, in the current quarter and in the current year. Looking forward to see you next quarter in on this call. Thank you.
Thank you. On behalf of Healthcare Global Enterprises Limited, that concludes this conference. Thank you for joining us, and you may now disconnect your lines. Thank you.
Thank you, everyone. Good morning, and thank you.