Ladies and gentlemen, good day, and welcome to Rainbow Children's Medicare Limited Q1 FY25 Earnings Conference Call, hosted by IIFL Securities Limited. As a reminder, all participant line 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 touch tone phone. Please note that this conference is being recorded. I now hand the conference over to Mr. Rahul Jeewani from IIFL Securities Limited. Thank you, and over to you, sir.
Yeah. Hi, good morning, everyone. I welcome you all to the first quarter earnings conference call of Rainbow Hospitals, hosted by IIFL Institutional Equities. From Rainbow, we have with us Dr. Ramesh Kancharla, Chairman and Managing Director, Mr. Sanjeev Sukumaran, Group Chief Operating Officer, Mr. Vikas Maheshwari, Group CFO, and Mr. Saurabh Bhandari, Head Investor Relations and Group Business Analyst. Over to you, sir, for your opening comments.
Thank you, Rahul. So good morning, everyone. So I'm delighted to extend a warm welcome to the earnings call for the first quarter of financial year FY 25. Our quarterly performance reflects our commitment to expanding footprint, operational excellence, and our continued investment in technologies that enhance patient care and higher efficiency. This quarter, we have delivered a robust financial and operational performance. We have remained focused on optimizing our processes, ensuring that our services run seamlessly and efficiently to enhance the network effect of our hub-and-spoke model. In the last quarter, we marked a significant milestone by commissioning three new hospitals, one each in Hyderabad, Bangalore and Chennai, adding total of 280 beds. This brings our total capacity to over 2,000 beds, including managed beds in New Delhi.
We delivered an incredible 15% revenue growth in a seasonally weak quarter. We have seen progressive growth across all operational metrics, compared to the previous year. Our outpatient footfalls, inpatient admissions and deliveries are all showing significant improvement. We are optimistic about maintaining and surpassing this growth in the coming quarters. Our EBITDA growth has been slightly muted, primarily due to the costs associated with our newly opened hospitals. The trajectory of the operations at our new hospitals is as per our expectations and showing growth month-on-month. For the Q1 FY 25, our revenue registered a growth of 15%, amounting to INR 330.2 crores.
Similarly, our EBITDA increased by 7%, reaching to INR 93.7 crores, while the PAT was down by 4.2% to INR 39.7 crores due to the higher depreciation and finance costs, mainly as it's affected. Our overall occupancy rates for the quarter was 42.4%, with the mature hospitals achieving 50% occupancy and the new hospitals, including the recently commissioned hospitals, recording a 27.6% occupancy rate. So these figures indicate that we have a sufficient headroom for growth in the coming quarters. During the quarter, we have launched a pilot project, an Adult Vaccination Outreach program, which we named it as AVON, with the top five vaccine manufacturing companies to cater to the immunization needs of the families.
AVON initiative will cover influenza vaccines, including influenza, the HPV, pneumococcal vaccine, and the shingles. The progress on IVF has been promising and has garnered good traction. We expect to keep up the momentum on IVF, IVF side to... and grow in the coming quarters. Our ongoing investments in the technology has achieved tangible results. By leveraging advanced digital tools, we have been able to significantly impact the patient experience, from streamlining the appointments to the faster and more accurate diagnostics. These innovations not only enhance the patient satisfaction, but also contribute to the operational efficiencies. In addition to this enhancing of the operational capabilities, we have made a significant strides in data and cybersecurity.
Recognizing the clinical importance of safeguarding patient data, we have invested in robust security measures that keep us ahead of potential threats. This proactive approach ensures that our patients' information is secure and reinforcing their trust in our services. Highlighting the projects' status, the development of our new regional spoke, which is in Rajahmundry of 100 beds, the work is in progress, and also the Hennur, Bangalore, 60 beds of spoke is progressing well. Both are expected to commence operations in Q4 FY 25. The project for the regional hub hospital in Coimbatore of 130 beds has just started and is expected to complete in 24 months' time. We have registered the land parcels in Gurgaon at Sector 44 and 56.
For Sector 44, we have submitted the drawings to HSVP for building sanction approvals. Further, for the Sector 56, we will be submitting the drawings to HSVP in the coming weeks. Beyond our growth plans, I would like to highlight some significant achievements that underscore our dedication to pediatric and maternal healthcare excellence. A 15-year-old child was actually being treated elsewhere for a seizure disorder for the last 12 years, with a normal neuroimaging and also EEG on several occasions by various doctors, including neurologists. When the child finally reached Rainbow, our pediatric nephrologist carefully evaluated and discovered the child is having a very low heart rate and also has a partial hearing loss. So he then kind of referred the child to our pediatric cardiologist, suspecting some genetic disorder, there may be heart involvement.
The cardiologist performed the ECG and an echocardiogram and detected there's a long QT interval on ECG, which is known to cause bradycardias and arrhythmias. The genetic test confirmed it has a confirmed the long QT intervals as a part of Jervell and Lange-Nielsen syndrome, which is a very, very rare condition. And in this particular condition, the children will have a long QT on ECG. They are prone to have bradycardias and sometimes arrhythmias and death. So in this case, the child was actually being treated, unfortunately, for 12 long years with the antiepileptics without diagnosis. The simple, I think, the great clinical acumen of our pediatric neurologist and clinched the diagnosis, and the child was treated with a very simple medicines called beta blockers and mexiletine to treat for on long-term basis.
Now, in another case, we had a 32-year-old lady with a complex medical history of ischemic heart disease and a stent in place, with a chronic renal failure and diabetes, was advised not to become pregnant because of her multiple comorbidities. However, the lady accidentally became pregnant and sought our help to continue the pregnancy. Our perinatal team responded very positively and included adult cardiology and the renal physicians team, and followed up pregnancy very closely and optimized her care time to time, and ensured the pregnancy sails as smooth as possible. And eventually, an elective C-section planned and delivered a healthy baby, and mother was so happy with that, to become a mother. So these cases emphasize that importance of a multidisciplinary approach for tertiary and quaternary care patients to achieve better outcomes.
As we celebrate silver jubilee of Rainbow in the in providing world-class children's healthcare in India, I extend my heartfelt gratitude to our doctors, nurses, and the entire Rainbow family, along with our valued stakeholders and end parents who have contributed to this incredible journey. As we look ahead, we remain committed to the maintaining our leadership in the pediatric and perinatal healthcare through continuous innovation, leadership development, operational excellence, and an unwavering focus on patient care. We are confident that our strategic investments will continue to drive our growth and deliver long-term value to our stakeholders. With this, I will now pass the mic to our Group CFO, Mr. Vikas Maheshwari, to take you through the financial update. Thank you once again for joining joining us today. We look forward to your questions and insights as we move forward.
Thank you. Very good morning to all of you, and thank you for attending this early conference. I am pleased to brief you on the financial performance and the key developments of the Rainbow hospitals for the first quarter of FY 25. Our operating revenue for the quarter stood at INR 330 crores, reflecting a 15% growth compared to the corresponding quarter of the previous financial year. Our EBITDA for the first quarter amounted to INR 93.7 crores, marking a 6.9% growth compared to the same period last year, with an EBITDA margin of 28.4%.
The profit after tax for the quarter is INR 39.7 crore, representing a 4.2% decline compared to the corresponding quarter of the last financial year, mainly due to increased depreciation and interest expenses related to our new units. In terms of operational performance, outpatient and inpatient growth was very healthy at 12% and 10% respectively for the quarter compared to the last year. Delivery volume also showed an impressive growth of 10% year-on-year growth. For the quarter, our non-annualized ROC is at 5.2% and are expected to rise as the new units ramp up their operations. Our payer mix continues to be robust and balanced, with 52% of the revenue coming from the insurance segment and the remaining 48% from the cash patients.
Additionally, our international business accounted for 2.9% of our total revenue for the first quarter, amounting to INR 9.4 crore. Our balance sheet remains strong, with net cash position of INR 518 crore as of June 30th, 2024, which will support our ongoing capital expenditure plans. Given our current cash flow and anticipated internal accruals in the coming years, we are confident in our ability to complete all managed capital expenditures through internal accruals without acquiring debt financing. During the quarter, the company invested roughly INR 56.7 crore in ongoing capital expenditures. I am happy to share that we successfully conducted our AGM on July 30th, 2024, with all the resolutions passed by the shareholders, and the company has paid the dividend on the same day. With these insights, I conclude my financial update.
I now invite questions and suggestions from the participants. Thank you.
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 touch tone telephone. If you wish to remove yourself from the question queue, you may press star and two. Participants are requested to use handsets while asking a question. Ladies and gentlemen, we will wait for a moment while the question queue assembles. The first question is from the line of Pritesh Chheda from Lucky Investment. Please go ahead, sir.
Yeah, so on the existing hospitals, what was the revenue growth and the margin profile on a YY basis, if you could share that because looking at the presentation, you've given all the other data points except like-to-like comparison?
So Lucky, I think, so on the mature units, the revenue growth has been healthy. It has been at around 7%-8% growth year-on-year basis. And, we expect this growth to, you know, go further up as we enter into the season. Typically, the quarter first remains very muted. Still, we could show some growth of 7.3% year-on-year basis. And, as we enter into the season, which is September and December, you'll see more healthy growth in the double digits going forward.
But when we are comparing on a YY basis, which is a like-to-like quarter, why shouldn't the growth be... Why is the growth single digit?
No, your point is correct. We have no points on this. The last quarter has been very, you know, is a very heated heat, and the people have taken- And the elections were there, whether many people have gone, you know, the different places, et cetera. That may be the reasons where we have seen this slightly, you know, less growth in terms of, revenue growth.
Okay. And at the 7% growth, what is the margin profile there? Is there any erosion in margin?
We are not seeing any margin erosion. In fact, you know, in the mature hospital, we operate on the operating leverage, so any incremental revenue growth will always, you know, improve the EBITDA or EBITDA margins.
Okay, but at 7% growth, will the margin be a similar number only in the current motion?
It should be same. It's not changed.
Yeah.
It is slightly improved on only.
Okay.
We are not seeing any sign of the EBITDA margin impact year-over-year basis.
My second question is that on the newer hospital, usually what is the trajectory of occupancy that, you know, year one, year two, year three, usually you budget at what level of occupancy usually these hospitals break even?
No, it depends on Lucky. It depends on where these hospitals are. Usually in Hyderabad, we expect it to be kind of a break even within the first year itself.
At what occupancy, sir?
Usually about 35% occupancy, we break even.
Okay.
Yeah, 30%-35% occupancy, we break even. A place like Bangalore, yeah, it will take about 12-15 months time. Chennai might take about 15-18 months time. That's how we look at it. Based on the maturity of the hub-and-spoke model, we tend to kind of plow that way.
So your prime market, Hyderabad, has year 1 of breakeven, and everywhere else is less than 2 years, basically, anywhere between 1.5-2.
Yeah.
At the same overall of 35% or less?
I think more or less, 35% occupancy.
Okay, done, sir. Thank you very much.
Thank you.
Thank you. To ask a question, please press star and one now. The next question is from the line of Damayanti Kerai from HSBC. Please go ahead.
Hi, good morning, and thank you for the opportunity. My first question is on costs related to new units. So just want to understand whether the first quarter numbers reflect most of the costs which you have incurred or you, like, you expect to incur on an ongoing basis for the new units? Or, like, do you have plan to add on more doctors, more people, et cetera, there? So some color on that will be helpful.
Damayanti, I think with the quarter first, what are the cost structure we have seen for our new units which we started, I think more or less settled there. Obviously, we started these units in second of the March quarter, right? So the doctors have started joining April, May, and June. So you will see some incremental cost may come for the new units, but more or less, I think 90%-95% is settled there.
Okay.
As we grow these units and new clinical sites join, there may be some impact, but not major, not major. So it's more or less what you are seeing is more or less settled there.
Understood. So in terms of margin, we understand your September and December quarter are very healthy. But on an annual basis, how should we think about improvement or change from the FY 24 level?
I think, Damayanti, we just to anticipate that now growth is probably for this year will be kind of a late teens. When you do a late teens growth, I think, overall, most of the operating metrics and financial metrics will be pretty healthy.
Understood. My next question is, in Hyderabad market, your competitors are getting more aggressive in mother and child care segment. What are your thoughts on the competitive scenario, and have you seen any impact in terms of, say, loss of clinical talent, et cetera?
I mean, Rainbow is a very, very large and strong forte. I mean, I don't think we will not be kind of impacted directly through the loss of clinical talent because the brand drives the business here and not the individuals. Second important thing is, of course, when there are a lot of doctors, hospitals have started coming in the similar space, certainly, there definitely some competition will come. But I mean, with our kind of credibility in Hyderabad city, we may not kind of impact on the long-term basis.
Okay. It might not-
It's not, not something new to us. We have been seeing this competition almost like, more than a decade.
Sure. And my last question is, you mentioned your IVF program is picking up momentum. So if you can just, update us on, like, how do you plan to take it up? And, very broadly, like, over the next two to three years, how do you want to grow this business, and how critical this is for your existing offering?
Okay. Well, we had three in the past, one in Bangalore, Vijayawada, and Hyderabad. Now we've got about 11 total. So now I think all of them are commissioned, all the embryo services have started, and the doctors have been recruited, business plan being laid out. And I think the whatever the early footfalls, what we are seeing, and which are pretty impressive, which are pretty organic. What we are seeing is, what we expected is to have kind of a Rainbow to drive the organic footfalls, I mean the direct footfalls, which is happening, and they are quite impressive numbers. And as we...
I think we'll have to see that, how this number is going to translate to the cycles, and it will take about probably at least couple of quarters for us to kind of have a better comprehension on that.
So how much you have invested so far?
The investment is not too much because we have expanded into our own hospitals only. So it is the equipment and the space, furniture, fixtures, that's all. That is not very significant. It's very small, minimal.
Okay.
They're not standalone. They're all within the existing hospital. Either new hospitals or existing hospitals, we have included them under our Birthright parent services.
Okay. Thank you. I'll get back in touch with you.
Thank you.
Thank you very much. The next question is from the line of Mr. Mahesh from Atal Investment Managers. Please go ahead.
Sir, just wanted to know the, the new hospitals that we have just added, like, I could see that last few quarters, we are still at that occupancy levels of 27%, 28% there. So what are we doing? I mean, where? I mean, the ARPOB in the new hospitals is somewhere around 52,000 something. Is it because of, you know, high cost that these hospitals are not showing the occupancy on these areas? Or you are? I mean, it is, I mean, it is going as per your plan. How exactly do you see these new hospitals, you know? Because, the earlier guide you told that 35, 35% it will be a break even, so we are still at 27% for the new hospitals.
When do you see these break-even levels reaching, if you can take this question back?
Yeah, Mahesh, I've already earlier stated about the timelines of the breakeven. So I think that we are in a children's healthcare space and also the maternal services. These are organic businesses. These are not aggregation businesses like multispecialties, right? A lot of sales-driven, those things. It will take its own time because we do recruit doctors on a full-time basis. I mean, medical teams have to settle, set, and people have to recognize, and then I think kind of it starts growing organically. Why we say about Hyderabad, we probably are kind of doing the first year breakeven within the first year, and that's because of the redistribution of the patients and also the huge brand reputation momentum. You say there's a Rainbow, then people automatically goes there.
So to an extent, that also happens in Bangalore, and Chennai is just kind of, the traction will takes a little longer time. This is how we work. So generally, that acquisition of the practices are much less in pediatric side, and this is more of organic drive. So the timelines, what we see, what we kind of. We're quite happy with what our timelines about, 12-18 months' time are the spoke hospitals to break even, at 35% occupancy. And one other thing is that, now, we will take at least about 6 months' time to get all the insurance sorted out. So that's again, big. They're not going to, you know, give you the insurance power. The TPA is, they recognize, as soon as you start the hospitals, it's always challenging.
So we are kind of still waiting for some more permissions, some more insurance tie-ups, and those things. They all happen kind of, 6-9 months' time it takes. So these are all things which actually, takes its own time to kind of, settle.
All right. So just my, educate, I mean, our knowledge base, just wanted to know, what do we do to attract this polyclinic that you have in the Hyderabad region? But you know, the spread of polyclinics is huge. I mean, the clinics where, you know, they, they don't have this beds and all, but they are, you know, doing it on a very lower scale. How do you - How are you reaching out to those people? And, I mean, in terms of, working from their side, how do you see that thing coping up in future? Because I see Hyderabad is, I mean, currently in Hyderabad, there are a lot of polyclinics operating. So how do you see that particular thing?
I mean, you see the polyclinics for the children's healthcare, we can do that since we are already there, almost 7 hospitals in Hyderabad, and we have, you know, starting to do one more. I think almost we are very close to kind of most of the geographies. In addition, doing polyclinic, now recently, we just kind of contemplating to do one more polyclinic in Attapur area. So I think the polyclinics are important, but at the same time, they have to be driven by our own doctors. We can't recruit non-aligned doctors to do a polyclinic. That won't kind of convert patients to you. This is our experience when we look at the other hospitals, multi-specialty hospitals, when they run the polyclinics.
Now, whatever we do, it has to be in our control. It has to be a kind of, within the network.
I was asking about more about the polyclinics which are, you know, not in the Rainbow's umbrella. Polyclinics which are operating independently, how you are reaching out to them? How you are getting referrals from their side?
No, of course, you know, teams, they will, they will coordinate with them. We have a large doctors network who refers patients to us, and the patient reference happens only when there's complexity and when they require the them to send it to Rainbow Hospital for particular, you know, intensive care or specialty. I mean, we have, that way, a huge connect with our doctors across Hyderabad, Telangana, and Andhra Pradesh.
My last question would be on this Haryana thing, sir. I mean, it's been like, you know, taking us a very long time because it's almost more than a year that we kind of, I mean, we went ahead with that project, and it's taking a long time. Can you please throw some light on what exactly is happening on the ground there and why it's taking so much time? Is it because of bureaucracy or some change of, you know, government or something like that, I mean, what exactly?
I think it's just a pace of government, nothing else, actually. So we know the CEO, despite knowing the CEO of HSPT, still that it takes that much of time because we just you know how the systems work. And also, Haryana has got two, one is Gurgaon offices and Panchkula. So between those two offices, it takes its own time, and yeah, finally, I think it we got the permissions. We got land registered, which is more important. Now we apply for the permissions. Hopefully, they won't take much longer. There's some more clearances need to be done. Then post that is our project team, how aggressively we're going to do that.
Once you have all the permissions on board, I think it'll take, should take, shouldn't take more than two years, plus or minus few months.
Okay. So, 2026, 2027, as you reported in your presentation, that's, that's when we are going to get that.
Yeah, maybe six months, we have to give additional time.
All right. All right, sir. Oh, thank you so much.
Thanks, Mahesh. Thank you.
Thank you very much. The next question is from the line of Harsh Bhatia from Bandhan AMC. Please go ahead.
Yeah, morning. Am I audible?
Yes, sir, you're audible.
Thank you. So just one clarification. Apologies if this is repetitive, but on this ARPOB move on a year-on-year basis, I understand the LOS has also moved up, and which is why there could be a case of ARPOB moving down. But this has been the case for both the new hospitals as well as the old hospitals. So if you could help us understand, like, what exactly is happening across both the units?
Yeah, yeah, Harsh. See, even I was wondering that what kind of a dynamics of this actually is, trying to look at it. What I could actually look into conclude myself is that ARPOB guidance, whatever we have given the last, if you go to last 3-4 earnings calls, our ARPOB guidance has always been 55,000-60,000 is probably a right ARPOB for our business. And sometimes it goes up because of the case mix change. When you have a lot of season, do a lot of pediatric business, then ARPOBs tend to go down, and you do same thing, you clock higher revenues and better profitability also.
So now with the current, when you look at the ARPOBs today, with the, slightly lower, which, and the ALOS is slightly higher, I think compared to kind of a year-to-year, the change of the business, that's what is actually, it is only about, if you look at an average of per, ALOS is only four hours has increased. And, that could be a kind of a little change in the case mix than anything else. And, there is the last year, dominantly, we kind of a business was obstetrics and lots of pediatric surgeries. That took the lead, therefore, the ARPOBs are lower, and there were, the ARPOBs are higher, and the ALOS have gone lower.
If you go back and see the last four quarters, usually our ALOS was about 2.65-2.7. Somewhere around that is usually the ALOS. I'm not very sure that ALOS s of less than 2.5 is may happen occasionally, but not on regular. Our ALOS will probably stand somewhere between a 2.6-2.8. This is actually of a proper business mix resulting in our ALOS. This is how I look at it.
So Mahesh, if I, if I can add. So, since sir has explained about the ARPOB and ALOS, so if you just multiply with this, you will get the average revenue per patients, right? Irrespective of their ALOS, et cetera. If you see that, that has gone up, so that shows that we are getting the high complex cases at our hospital, and that has gone up on year-on-year basis by 6% and quarter-on-quarter basis also. So I think INR 107,000 is, ARPP, which has gone up by 7%, which is a healthy sign. ALOS is the factor which depends on, you know, critical cases which you get, whether you are getting quaternary care, more cases or tertiary care. Based on that, the ALOS keeps changing.
But being in industry, we feel that what is more important is the ARPP, what type of cases we are getting. So we are happy with the ARPP growth of 6%-7%, which we have seen in our case, both year-on-year and quarter-on-quarter.
Okay, so simply, it is just about the cases, so overall case mix becoming more and more complex to a certain extent.
Correct. Correct. So the more complex cases, you know, the patients intend to stay, you know, longer period at the hospital. So that may impact the ARPOB. But what is more important is ARPP. Obviously, ARPOB is very important because it's a key metric, how we drive our occupancy and then revenue. But that is also one of the key metrics which we should look at.
Just in terms of this volume growth, the double-digit volume growth that you are telling her, again, my understanding might be very limited and might be inaccurate in a certain way, but would we continue to see this double-digit volume growth going for the next few quarters on a year-on-year basis? Because FY 24 was also the year where we saw first quarter being a double-digit growth on a year-on-year basis, but then the volume growth was very mixed picture for the next 9 months of FY 24. So would that be the case this year as well, or would we expect to see FY 25 remaining quarters to be a double-digit volume growth?
This year, kind of largely, many things remains very positive because we are looking at overall, there's nothing major. Now the elections been over, and there's, the monsoons are kind of right on time. I think they're going in a right on track. I think the overall, even, even the first quarter itself, we sensed that, you know, there is a positive trajectory for, for the year. So I would expect that the year kind of, be a kind of a late-teen growth for Rainbow.
Sure. And you would continue to feel that that would entirely flow through at the bottom line as well, given the incremental cost that we have seen in the first quarter, irrespective?
Correct. Correct, Mahesh.
Yeah. Let's see how the case mix and what kind of pathology, how we're going to deal with that. So revenues are derivatives. It depends on how, what we are going to do in the next nine months' time in terms of, as a, as a hospital, that results in a kind of a revenue generation. And, I'm sure when you do about, late-teen growth, you will definitely do a, an impressive, show also as well in the, the financial side.
Sure. Thank you.
Thank you very much. Before we take the next question, we would like to remind participants that you may press star and one to ask a question. The next question is from the line of Bansi Desai from J.P. Morgan. Please go ahead.
Hi, thanks for the opportunity. So just philosophically, checking, is demand in this industry sensitive to pricing? So I assume that, you know, probably for our newer units, you know, we would have competitive pricing, and probably that also could have had some bearing on ARPOGs. So maybe, you know, just your thoughts on these.
You're absolutely right, Mansi. I think in the newer units, always there are two, three things which plays out in the newer units. One is that now, so you want it to be attractive to the patients. Generally, any new hospital, people see it as how expensive it is. First thing is, reaction is: you don't want to get that in a bad name. So that's, you will definitely price it up, attractively in the beginning. Second, the important thing is you may not have the insurances, all those things, so that some of the patients kind of may not come into the hospital because there's no cashless. So which will take about six to eight months, nine months' time to kind of settle down all the insurances coming. So this factor certainly will play, and you're absolutely right.
Okay, that's helpful, sir. And you know, from a longer term perspective, when we think about expansion, besides whatever, you know, you have shared, you know, where do you think you have, you know, opportunities if you think from slightly longer term perspective? You know, would it be these existing cities, locations, or you think there is promise, probably newer markets, newer cities? And if at all, you know, you want to call out where you probably see that opportunity for us?
Yes, Mansi, the one is, we have actually absolute clarity about what Rainbow's plan is for the next 4, 5 years' time, 3, 4 years' time. So what we have done in Hyderabad, I think we're would be closer to 1,000 beds. And definitely the, we are in the, in the business with the expansion in Bangalore to kind of becoming a kind of the largest player in Bangalore. We are already there. And Chennai is the same way, and also regional spokes in Andhra Pradesh and Tamil Nadu. This will continue. I think this is where the Rainbow is a household name. This is where the demand continue to be there. This is what kind of a patronage of the brand is very significant.
We'll continue to play our dominance in the south, which within the cities and also connecting regional spokes. That will continue to expand. And while we do that, and also we are exploring other opportunities, other opportunities. Of course, Delhi is a, the NCR is a larger play. And also the opportunities we're looking at seriously are for acquisitions, which I think, you know, we are quite optimistic about. If something comes, which is philosophically aligned to us, we'll definitely go for it. I think this is how we look at it. I mean, there's a constant, you know, research going on what are the new cities, how do we enter.
One thing we are not very sure of, or we are not going to do, is that do about 50 beds or 100 beds into one large city and going around putting our dots in multiple places. I don't think that's the efficient way. If we get into the city, we will address the city needs of children's healthcare in a larger on a long-term basis. And also, we do a kind of hub-and-spoke model to include the larger part of the city into our network. This is our game plan.
Thank you, sir. That's very clear. And Vikas, just one clarification. You know, on the cost side, you know, for this quarter, the other expenses have declined sequentially. So anything to read there? I see, you know, increase in professional fees, and you highlighted that's probably because of the newer units coming in. But why would have other expenses decline, and should we see this as a sustainable trend?
So Mansi, there is a, you know, accounting standard, this ECL provision, which keeps coming. So based on that, the other expenditure, which is the one part there, gets little bit adjusted. So I think whatever the numbers we have shown, should be stand there right now. Because it's a clean quarter, there is no ECL impact, et cetera, in this quarter.
Okay, thanks a lot.
So if you look at the Quarter Three and the Quarter Two, it's more or less on the same range, but the Quarter Four was slightly got impacted because of the ECL. I think, the numbers which we are showing for the quarter for us is a clean quarter. That is the number which we should see there. Is it clear, Mansi? Mansi?
Yes. Yes, understood. Thanks.
Yeah.
Thank you very much. The next question is from the line of Rahul Jeewani from IIFL Securities Limited. Please go ahead, sir.
Yeah. So you indicated in terms of the breakeven timelines for our new hospitals in Hyderabad being within 12 months, and for other hospitals being 18-24 months. So can you please also talk about the timelines for breakeven for these four new hospitals, which we commissioned in fourth quarter of last year? Because one of those was a brownfield expansion at Hydernagar, and I'm assuming that the brownfield hospital would achieve EBITDA breakeven faster than some of your other newer hospitals.
That is actually, Rahul, an expansion. It's an additional block which we built adjacent to the Hydernagar Hospital. Earlier, it used to be about 85 , 80-plus beds. Now, that's become kind of 110, 120 beds now. The new block, actually, we dedicated more to the perinatal services because we do a large number of deliveries in that hospital. We just made it a completely kind of a the women's block. So that is an additional, additional beds, which is for demand we have done it. That unit does very well anyway, and it deserved that expansion. We have done it. We are very happy with that. IVF therapy business also are actually going very well.
The next one is that we have done in Himayat Nagar in Hyderabad city, which is actually central part of the Hyderabad city. It's the competitive area of Hyderabad city. So I think now, about 5-6 months ago, I think it's tracking pretty well. And it's all a new team completely, and they are doing well. It's going well. It is within the first year itself that will break even. And in Bangalore, Sarjapur, I think it's also going very well. It takes probably about 12-15 months to break even. That I think we're quite happy with the way it's going.
Chennai is a large facility, new area, with a very new set of doctors. It will take it about 15-18 months' time for its break even because it's a little high-cost unit, because we have put a lot of money into that, because it is one of the areas, the difficult area to get a land or building or anything, which is called Anna Nagar area. So we managed to get it and run the hospital, and it will take... In the long term, that is a great area to be in.
Sure, sir. So then potentially the Hydernagar, Himayat Nagar, and the Sarjapur hospital should achieve EBITDA breakeven by end of this year. And Chennai, you are possibly targeting breakeven in first half of next year?
Yeah, exactly. Yeah.
Sure, sir.
Next year, next year, probably next year's season, right? For next year's season, it should be fine.
Sure, sir. Sure. And given that this year, obviously, with the drag from these four new units, which would impact our margins this year, by end of this year, we would again be commissioning, let's say, 160 incremental beds across Rajahmundry and Hennur. So next year, do you think that, given that, this year already, we would have seen the impact of these new hospitals, FY 26 should see a margin improvement for us, despite incremental capacity addition, in fourth quarter of FY 25?
You're right. You're right, Rahul. That's what actually our thought is.
Sure, sir. Sure, sure. That's it from my side. Thank you.
Rahul, to add one more point, you know, it shows the resilience of our business model. We have opened three new hospitals and one expansion. And still, you know, we have been able to deliver a very healthy EBITDA margin. And the trajectory of the breakeven, as [Sanjeev] sir has explained, I think is well poised for the next leg of the growth. And by the year end, once these hospitals get opened, I think two and a half of our hospital, including this expansion which we did, I think it is doing very well. So I think we are well, you know, poised for the next leg of the growth in terms of both margin and the revenue growth and the EBITDA.
Sure, sir. Thank you. Thank you.
Thanks, Rahul.
Thank you very much. To ask a question, please press star and one. Now, the next question is from the line of Alankar Garude from Kotak Institutional Equities. Please go ahead, sir.
Yeah. Hi, good morning, everyone. So first question, we have eight hospitals in Hyderabad now, with 110 new beds commencing operations in the past few months alone. You also spoke about possibly adding another hospital in the coming years. So just wanted to understand, how are you thinking about the impact of cannibalization in Hyderabad?
Well, yeah, it's interesting. We always see some degree of cannibalization because the nature of the book, the patients which are on the kind of a board within the two hospitals, will settle down to a new hospital. But we have always seen that the growth opportunity is much larger. This cannibalization would not be really significant for... Because the other hospitals have always kind of been in demand for the beds and those things. So in a way, that works better when you have a kind of a the new hospital network, some degree of adjustments between the both the units of the occupancies would help us in the long term to create more beds for that geography.
Understood, sir. The second question was, any color on the performance of, the Madhukar Hospital in this quarter? You had mentioned about a pickup in performance in this fiscal. So any thoughts on, how's the performance been in the first quarter?
Madhukar, definitely there's an uptick in the performance and overall shape of the Madhukar Hospital, and traction seems to well, perinatal services are pretty good, and the education services are picking up. I think a number of footfalls have increased significantly. These are all very positive signs. And also that, you know, the cost structures also, we've been constantly working on the cost structures and which is also kind of we are seeing some tangible results of our operation teams working on the cost side. And I think by towards the kind this year, I will probably have a much better opportunity to go to good, good EBITDA for Madhukar as well as Rosewalk, both of them.
So, I think, FY 24, we were at higher single-digit EBITDA margins in Madhukar. So would it be fair to assume, maybe a mid-teens kind of a, low- to mid-teens kind of a number in FY 25, and possibly higher going forward in FY 26?
I think what we are looking at, Alankar, is that right now, it's a pretty... I think it's a double-digit EBITDA. That's what I am aiming at. I'm not sure where I would end up, whether it is early teens or just teens or mid-teens. I'm not very sure at the moment. So definitely, I think achieving double-digit EBITDA in that kind of a structure of, you know, is satisfying, to be honest with you.
Understood. And maybe a quick, follow-up there, what's the outstanding amount, from the trust?
It remains same from the March. Whatever we have seen, it is same. So, you know, as the year progresses, we expect that INR 3 crore-INR 4 crore to further come down, Anant. So it's more or less same status.
Okay, understood. And one final question from my side. When it comes to Gurgaon, construction has not started yet at both the hub as well as the spoke hospitals. So just wanted to get a sense, are we seeing any delays in both these hospitals?
It's not saying, I mean, we have still said about 27, right? Mid of 27. We are in the middle of. So I think there may be a kind of a 4-6 months delay, likely, because we didn't expect about a year long to get to the register, the land parcels, and also now we applied for the permissions. Hopefully, this phase of the permissions phase, if we can kind of cut short 2-3 months time with all the permissions, then we should be kind of right on the track, maybe have a 3-4 months leeway. We've already kind of onboard the head of the project, and we are actually working on the drawing phase, other things.
So I think we are also trying to see that some innovative ways of to cut short the timelines in terms of core construction, in terms of going a hybrid way, the multiple things we are exploring it. And I think from our side, we are gearing up to try to kind of bridge some gaps.
So sir, if we, if we assume, say, you get an approval in the next, say, couple of months, how much time do you think would it need to construct the spoke as well as the hub hospital?
Once, once you start groundbreaking, it will probably take about two years' time, if in the modern ways of constructions. If you have got everything else finalized, you go the turnkey basis, or you try to work on a with a great executive teams.
Understood, sir. That's it from my side. Thank you, and all the best.
Thanks. Thanks, Anant.
Thank you very much. The next question is from the line of Anand Mishra from Phillip. Please go ahead, sir.
Hello.
Sir, we can hear you.
Yeah. So I have just a couple of questions on your Gurgaon expansion. So do we have any broad CapEx number for the whole project?
I think, we do have a broadly, but once we have a kind of a BOQ stages and those things, we'll have a lot more clarity about it.
Okay. Just quickly, I mean, on the competitive side, right? So I think the Gurgaon market is fairly competitive, given the density of hospitals there. So, I mean, what is our go-to-market strategy there? So are we looking at maybe being a premium player, or are we looking at being a mid-market player? If you could give us some color on that.
I think our Gurgaon flagship hospital is going to be a national referral hospital for entire North India. So that's the positioning what we're going to base it hospital. The spoke hospital of 100+ beds is going to be kind of a local Gurgaon high-end hospital. And
Okay.
I think that these hospitals are actually going to be a, probably a very, very well built and, very futuristic.
But, is it fair to assume our CapEx per bed in the range of INR 1.5 crores-INR 2 crores? I mean, how would that be on the higher end or something around?
I think it will be around 1.5. Yeah, sure. For sure.
Okay, great. Thanks. That answers my question. Thank you.
Thank you very much. Ladies and gentlemen, that was the last question. I now hand the conference over to the management for closing comments.
Yeah, thanks. We would like to thank you all for joining today's conference call. Your participation and insightful questions are invaluable as we continue to navigate our strategic path forward. The support and engagement are crucial, as we appreciate the time and effort you have invested in understanding our business and the future plans. We look forward to our continued partnership and are excited about opportunities ahead. For any queries, please reach out to investors@rainbowhospitals.in or Mr. Saurabh Bhandari. Thank you very much.
Thank you.
Thank you.
Thank you.
On behalf of IIFL Securities Limited, that concludes this conference. Thank you for joining us, and you may now disconnect your lines.
Thank you.