-ARPOB in Cayman has been maintained and Revenue has grown 24%. Margin has come down because margins are dependent on types of procedures we undertake. Sometimes they have higher end procedures, types of procedure end up deciding procedures. Margins were affected due to this.
-Sustainability of Margins in Caymans:- coming up with an oncology facility. Some amount of investments they will make in the near time for creating infra and hiring consultants. Current margin will soften for next few quarters, until full facility comes up and scale up happens.
-They haven’t opted for 25% tax rate, as there are some brought forward losses. Once we cross it, we will opt for 25% tax rate.
-In the middle of pandemic, they have taken a call not to create a pricing differential between domestic and international patients. Once international patients do come back, will lead to higher yielding patients. Won’t change the numbers materially in a short period of time.
-EBITDA was 10.2 million in Cayman. ALOS has been high due the nature of cases that came in.
-There was a one off in Q2 ebitda(refund of deposits from unit in Whitefield). Excluding that, inspite of a seasonal quarter. They Have improved Ebitda QoQ.
-Delhi Cluster:- Impacted by Seasonality.
-Construction period at Cayman in two periods:- First oncology block (1 year), and 1 year after that surgery room, cap labs etc. Temporary margin % dilution. Topline will increase due to this once utilization increases.
-As international increases, it will lead to increase in overall average ARPOB.
-Long term growth trajectory: on Capex plans
1.Long term outlook is positive.
2.Capex in Cayman. Opportunities in exploring adjacent countries on a small scale.
3.In India, opportunity will be greenfield in the same city, brownfield and Acquisition.
4.Most obvious:- Brownfield at little cost, after this greenfield in the same city like Bangalore or Kolkata, Inorganic are few and far in between. Will only do inorganic when valuation is favourable. Inorganic has to add something different to our unit. We will be trimming some low yield beds and add higher yielding beds.
5.Opportunities in Caribbean Islands:- eg govt hospital O&M of St Lucia. A lot of challenges in Bangladesh, wasn’t really working out. Decided not to renew our contract.
6.Setting up oncology centres in Ahmedabad and Jaipur. Adding bed capacity in Howrah (bengal). Ahmebdad, have bought some nearby units in Kolkata and small pieces of land for Radiation oncology. Opportunity to get a landlord, to build an OPD plaza next door to main health city in Bangalore, on rental basis. Dharamshila, in discussions with the partner to add few beds in bone marrow and ICU. In Gurugram, if permission is given.Can add two more floors here. In Mysore, will be adding 30 beds. In Shimoga (Karnataka). Will be adding radiation oncology.
7.In nearly every hospital, will do some efficiency improvement, oncology and minor capacity additions.
-53% Occupancy in India and 52% in Cayman islands on the revenue generating beds.
-Cardiac has increased in speciality profile:- Typically yes the margins are higher. Higher profitability in this particular mortality.
-Average revenue per patient has decreased due to covid impact. In Q1 we had a lot of covid patients.
-Dharamshila they have started generating positive Ebitda. In Gurgaon, due to seasonality Ebitda decline. In 6-9 months, they will turn around Gurgaon into a positive Ebitda market. Next year, they expect full and proper break even. It is still relatively new, anything less than 10 years is relatively new.
-Sequential decline in ARPOBs because of general seasonality impact.
-If they don’t even invest in infrastructure, just through efficiencies we can manage volumes for next 2-3 years.
Disc: Invested. Not SEBI registered.
