Kovai Medical Center and Hospital - Health and Wealth

Stock Opportunities Untested - but worth a good look
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Kovai Medical Center and Hospital (KMCH), the 657-bed Multi-disciplinary advanced Super specialty hospital located in a clean, serene 20 acre plot in Coimbatore offers total and comprehensive health solution for various diseases. Comprehensive infrastructure, cutting edge technology, latest Hi â Tech medical equipments in all specializations and committed medical experts make KMCH trusted brand. The hospital has pioneered several techniques like the steroid free kidney transplantation, GDC coiling and clipping for brain aneurysms which save lives, improve patient comfort and minimize side effects.

The hospital has 20 operation theatres and modern equipments including state of the art Varian Trilogy Linear Accelerator, worldâs most advanced PET-CT Scan, 3T MRI, 500 slice volume CT scanner, Endo Bronchial Ultra sound (EBUS), 4D Ultra Sound Scanner, Flat Panel Cath Lab, Cardiac Electro-physiology Lab, Bone Mineral Densitometer, Mammography, Laser equipments, Video Endoscope, Operating Microscope, Auto analyzer, Computer Assisted Navigation for hip and knee replacements, ESWL for the removal of urinary stones.

Super specialty procedures like Open heart surgeries, Valve replacements, Kidney transplants, Hip and Knee replacements, Complex Brain surgeries and Advanced Spine surgeries are done regularly at the hospital.

At KMCH, the latest edition has been the state of the art Comprehensive Cancer Center. The hospital offers 24 hrs end to end services in cancer care from prevention to early detection, comprehensive treatment to palliative care under one roof.

The Comprehensive Cancer center equipped with the worldâs most advanced PET-CT Scanner-True-point enabled Siemens Bio graph 6 for the first time in Coimbatore & Western Tamil Nadu. This unique instrument; PET-CT Scanner makes KMCH one of the few centers in the world to provide this form of cutting edge technology for cancer care. Cancer treatment requires accurate staging of the disease by demonstrating its spread in the human body. The therapies of cancer differ from patient to patient and cure is possible only with perfect staging. World over the whole body PET-CT is the gold Standard for cancer staging. A PET-CT not only stages cancer but it is the current choice for evaluating treatment response and disease recurrence in Oncology.

Highly Qualified and experienced team of professionals in KMCH offers advanced radiation treatment for Cancer control and cure. This hospital provides Rapid Arc therapy with IMRT, image Guided Radio Therapy, SRS, 4D gated Radiotherapy & SBRT.

The Hospital has over 150 internationally renowned full time specialists and over 250 post graduate medical professionals assisting them. With more then 1500 medical, Paramedical, patient relations and administrative staff, the hospital offers total care for patients.

Continuing Medical Education programs update skill sets of the doctors and paramedical staff and keep them abreast of the latest developments in their field. The services are integrated by a state of the art Hospital Management System to provide effortless patient movement.

There are three satellite centers attached to KMCH :

City Center (Ram Nagar)
Erode Speciality Hospital (100 bed)
Erode Center (100 bed) with both in-patient and out patient facilities It has a rural health center at Veeriampalayam to serve the rural community and the under privileged.

Financials:

Yearly Expected Expected
Mar-08 Mar-09 Mar-10 Mar-11 Mar-12 Mar-13 Mar-14
Sales 87.54 110.36 130.07 174.64 222.37 300 330-360
Operating Profit 14.42 18.33 25.75 37.07 43.76 80 90-100
Interest 3.82 4.5 5.68 12.16 16.96 30
Depreciatin 3.85 3.92 4.69 6.63 12.13 15
PBT 8.14 11 17.24 19.48 16.24 35
tax 2.89 3.89 5.75 7.43 4.29 12
NP 5.25 7.14 11.59 12.1 11.95 23 30-40
Quarterly
Dec-12 Sep-12 Jun-12 Mar-12 Dec-11
Sales 79.3
75.3
 68.2 60.14 57.61
Operating Profit 21.87
19.11
 16.18 10.95 12.53
Interest 7.02
6.91
 7.23 4.37 4.84
Depreciatin 3.93
3.77
 3.7 3.54 3.03
PBT 10.92
8.43
 5.25 3.03 4.66
tax 3.79
2.64
 1.67 0.73 1.27
NP 7.12
5.79
 3.58 2.3 3.39
Cash Flows
Mar-08 Mar-09 Mar-10 Mar-11 Mar-12
Operating cash flow 12.52 14.8 23.9 41.2 55.9

Stock Price: 175, P/E:10 Mcap: 191, P/E(FY13): 8 ,

D/E: 3+, D/E(FY13) = 2+

Compounded Sales Growth
10 Years: 23.04%
5 Years: 24.59%
3 Years: 26.31%
1 Year: 31.21%
Compounded Profit Growth
10 Years: 39.43%
5 Years: 12.54%
3 Years: 18.90%
1 Year: 5.54%
Return on Equity
10 Years: 23.87%
5 Years: 25.74%
3 Years: 26.15%
1 Year: 21.37%

Investment Theme:

Recession proof, Growing business (Industry growuth 14%) and sustainable services for cash business. No inventories. No Debtors. No Worries.

PE rerating is a possibility as other listed players like Apollo command P/E:40.

IMO, Expecting a 3-5 bagger in2-4 years in a bull market situation

Negatives: High Debt and capital intensive.

Requesting senior valuepickers opinion.

Disc: Invested a small amount.

5 Likes
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Looks interesting since on a MCAP per bed basis they are at deep discount to other players. I think it would take at least 1500 cr to build a greenfield 700 bed facility. They did complete a 210cr capex last yr so debt/equity looks high. Fixed costs are high in the hospital business & typically it would take 4-5 yrs to recover initial investments. Good thing is that OPM is high and ROE has been maintained at high levels. I think management is key for hospital business where one has to execute high capex at right location & returns will only accrue over the long term. Demand is not an issue as oppurtunity size is massive.

Disclosure: Hold from lower levels.

Investment Theme:

**PE rerating **is in2-4

Negatives:

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One thing I have learned in my 1+ year of investing, High debt can kill you in way many way than you can think of. To me seems like a high-risk kind of investment, with change of high erosion of one’s invested capital.

Few red flags I see is poor ROCE ratio of ~12. Low NPM of ~5% (that too decreasing y-o-y). Promoter shareholding is <50%.

I won’t pay a such high pe of 12.73 for a such low ROCE, high DE stock.

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@subash,

Agreed. Debt is a major issue.

Other red flags, please look from the perspective of FY13.

ROCE~ 20% , NPM~ 8% . Promoter is continuously buying shares from open market.

And PE (consideringDec - 12 results) is 10. Money control didnt update 3rd quarter results.

FY13 year-end PE may be around 8.

<50%.

I won’t pay a such high pe of 12.73 for a such low ROCE, high DE stock.

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I studied this couple of months back and did not invest because of the high debt.

What had attracted me was size of opportunity, promoter purchases, modern techniques (read news reports about use of smart cards to allocate ward boys, use of special system for conveying medicines and supplies etc )

But high debt was a problem and it would continue to be an issue because hospitals is a capital intensive business.

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I think these kind of stocks offer returns only if there is some M&A action and the company gets taken over by some other company.

Having said that the company has shown exemplary growth in sales and profits. Debt though high should be taken in context of nature of business and would in all likelihood remain high going forward also.

Valuations though not too expensive are neither too cheap.

As a business I dont think hospital business is a great business due to capital intensive nature of business. The ancillary business of pharmaceuticals is where all the cream lies.

2 Likes
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Hi Hitesh bhai,

I have been studying this co for last few days and felt its very interesting. Yes, the negative is that its capital intensive but at the same time if its run well, it can be a cash cow for several years.Plus the best thing here could be that the loans could get repaid over coming times.

Its something like a infrastructure once created can payback for several years. AlsoCoimbatoreseems to be becoming a hospital hub in south.

As there is a negative opinion from you, would like to do more homework here. In the meanwhile, can you get some industry updates…as to how is the reputation and standing of the hospital. Is something really good and modern happening here?

Thanks & Regards,

Ayush

1 Like
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Hi… I am from Erode… 100 Kms from Coimbatore… There are 2 branches of KMCH in erode too…

One thing, this area is mushroomed with Hospitals Left, right & center. Where ever you turn you see only Hospitals, Hospitals & Hospitals, so there is too much supply. Also the attrition levels of doctors is very high, and remember this is a business which is solely dependent on doctors a good/bad doctor can make/break a hospital. I dont know about attrition levels in coimbatore but in Erode it is too high.

Also KMCH doesnt specialise in any specific sector, it is like a general purpose hospital, good name, brand, etc… but even in coimbatore there are different hospitals which have their own specialities and these are the primary choices of any patient looking for specific treatments…

Also I have reasons to believe that a lot of money(cash payments) are not accounted for. but i think their cancer department is good, I dont have any inputs from any patients or anything just a feel when I attended their facility…

1 Like
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One thing though… Their facilities are at prime locations everywhere Coimbatore, Erode(2) & Perundurai… That is a very big plus in this company… but looking at the black money in real estate i dunno if we should consider this part in India… need to look if this land bank is property of the company/promoter/leased…

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ayush,

I have quite a few friends working with a lot of big hospitals. The common opinion is that in case of big hospitals the biggest beneficiaries are doctors.

And as mentioned earlier, attrition rates are quite high. Each doctor that leaves the hospital after creating a sort of reputation tends to take his flock of patients with him if he opens up his own practice nearby.

I tend to view hospital business as only slightly higher than airline sector in investment worthiness.

Another such stock with high dividend yield which has gone nowhere all these years is indraprastha medical.

Will still look into more details and let you know more.

regards

hitesh.

1 Like
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@Balkrishna: Good to know that their locations are good and the hospital is well know.

@Hitesh: Yeah, agree on the attrition part etc. However, one thing which is changing in bigger cities is that bigger hospitals are being able to build sort of corporate/brand name…as every person doesn’t has the knowledge of the doctors their experience etc. Also going forward, due to medical insurance, healthcare will be a big area.

Have tracked Indraprastha hospital and the problem for stagnancy there is different. I think the reason is in ownership (govt is part owner and apollo group doesn’t has high stake) and conditions of govt (free medical service, court cases etc)

In kovai few points which i liked are:

1). Consistent growth - the sales have grown from 34 Cr in 2003 to 222 in 2012 and this year they may end up with close to 290-300.

2). ROE has always been good at about 25% so if they are not going for much capex ahead…then it can be a very good situation.

3). Promoters are increasing stake consistently

The above is just on the basis of work of couple of days. So look forward to your views.

Ayush

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Ayush…

I believe your thought on people ignoringspecializationsare misplaced… thespecializationsare again by big hospitals only… Let me give you a example for coimbatore itself,

For Stomach related troubles --> Gem

For casualty and anything related to bones --> Ganga

For Heart --> Im forgetting the name.

All these are big groups. As I mentioned for cancer KMCH stands out no doubt.

The growth is going to be there with life style of peopledeterioratingeveryday along with higher medical awareness the sales are only to grow. Also with improving insurance done by people and higher billing from these hospitals we can expect growth to be clock work type. I think they run high level of empty beds so they do have much room for growth.

Regards,

Krishna.

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For Hospital business cashflows, pricing power and competitive intensity are significantly better than an airline business. Similarities are there as you say in the capital intensive nature of business & need for proper management of capex. I don’t think there are enough large hospital stocks listed to judge ability to generate returns. Apollo is too big & in a different league, Fortis is mostly growing inorganically while Indraprastra has its own issues as Ayush mentioned. PE players have been very active in the recent past in picking stakes(at high valuations) in unlisted chains in NCR region like Rockland, Moolchand etc.

http://www.dealcurry.com/20120511-Sequoia-Capital-To-Invest-R100Cr-In-Moolchand-Healthcare.htm

regards

hitesh.

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@Balakrishna: I meant what you have written above - that in case of superspecialtyhospital, the name of the hospital does become a pull over the years.

One possible major concern to look into is - the risk of technologicalobsolescence. Like in the case of Kovai, they have spent very big amounts on cancerequipment…what if they become outdated in 3 years…while the co is depreciating them over a longer period.

Ayush

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just 1 observation when we all know hospital business is a capital intensive business where brand name, doctors reputation etc matters and there is a vast area hospital industry still needs to cover… for thos they would require medical equipments and for replacement purpose also… so we have polymedicure or something else we can unearth… wouldnt that provide us much more wealth creation…

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In case of koval it is most important can they replicate this hospital model in other city/state?

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One thing I mentioned about increasing demand due to various factors like long life, more halth awareness, etc… but forgot to consider a important thing in the equation the supply… the increase in supply outmatches the increase the demand…

@Gaurav nice question. As of now they have not been able to replicate v.succefully… They are not bad either for example in Perundurai which is a large village/small town this is the only decent hospital… In Erode they are the best for primitive ailments but anything a little big is only referred to the coimbatore branch… so in a way they have not been able to replicate the same story & the primary reason for that is high levels of attrition in doctor level…

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Hi everyone,

I feel like Indraprastha medical is the top pick from healthcare industry, considering the dividend yield & promoters background.

regards,

Shanid V H

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Did a blogpost recently:

BSE:523323| NSE:KOVAI

CMP:Rs.165| Market Cap:175 Cr| PE ratio:9.50| BV:71
Screener link|**Company Website**

Kovai Hospital

**Kovai Medical Centre and Hospital (KMCH)**is a 691 bed multi-disciplinary super speciality hospital located in Coimbatore. The company has two satellite centres at Ramnagar, Coimbatore (10 beds) and Erode (65 beds). In addition the company through its subsidiary aIdhayam Hospitala operates another speciality hospital (58 beds) in Erode.Coimbatore has emerged as one of the major medical centre in South and is attracting a lot of medical tourism.

KMCH had undertaken a major capex of Rs 269 Cr for increasing the number of beds from 320 in 2008 to 691 beds, completed in phases till Aug, 2012. The company has been reporting very good results in recent quarters.Healthcare industry is an evergreen industry and due to health insurance and medical tourism, the sector should see consistent growth.

Interesting Points:

  • In a period of just 2 decades, the promoters have built one of the biggest and renowned hospital of Coimbatore, specializing in over 50 medical disciplines
  • The company has had a very good consistent growth a the company has grown from just 34 Cr turnover in 2003 to 300 Cr expected this yearKovai trend
  • The last phase of the project involving addition of 210 beds in the dedicated cancer block was made available from March, 12. Since then, the company has been delivering good growth along with significant improvement in margins
  • The company has some excellent figures on capacity utilization and patient handling. The hospital has had bed utilization of 90% and has treated more than 2.61 Lac patients during FY 2012.Utilization rate
  • The hospital also has a pharmacy division which is also quite profitable. In 2012, the division did a turnover of 45 Cr and contributed 10 Cr towards profits.
  • The company has excellent cash flows.
  • Promoters regularly buy from open market to increase stake.

Trigger:

To undertake the above expansion, the company had to take a significant debt of 225 Cr. The debt equity ratio shot upto 3.40 as on March, 2012. With the successful completion of expansion and no significant expansion announced as of now, there is a chance that the cash flows might be utilized to bring down debt to comfortable levels. If done, there could be a significant saving in the interest costs (currently 35% of operating profits) and hence a quicker improvement in bottom-line.

Risks:

Hospital is a highly capital intensive and competitive business. If the company again plans a major expansion without bringing down the current debt, then the bottomline may not grow for few years and with high debt, it will be a risky company.

Views Invited

Ayush

1 Like
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Hi Ayush,

I think they also have a medical college in its charitable trust. Any take on that.

Had looked into this couple of years back traded from 90-100 to 180. My concern at that time was the promoters are not interested in shareholders. They might be more inclined towards charity.

Seeing the promoters buying is what is making it interesting. Because it implies management is interested in the stock.

Needs a deeper study. Problem with such companies is they do not catch up soon. Another one is PTL enterprises.