Key Financial Highlights
• Record Revenue: INR 13,410 million, an 8.7% year-on-year increase.
• Consolidated EBITDA: INR 3,274 million, with margin improvement.
Operational Updates
• New Hospital Inauguration: Successful launch in Camana Bay.
• Digital Transformation: Ongoing initiatives including AI-driven patient management systems.
Expansion Plans
• Capital Expenditure:
• Kolkata Greenfield project: Estimated at INR 950 crores for 350 beds.
• Bengaluru expansion: Estimated at INR 500 crores.
• New Facility in Cayman: Focus on short-stay surgeries; initial operational losses expected.
Performance Insights
• Inpatient Volume Trends: Stagnation in India; growth plateau in Cayman due to market dynamics.
• Insurance Launch: Narayana Health Insurance commenced in Mysore; focus on simplifying claims process.
Challenges and Strategies
• Stagnant Inpatient Numbers: Attributed to recent elections; focus on improving revenue quality.
• Occupancy Issues: Addressing challenges at the Cayman facility; potential bed count reduction if occupancy does not improve.
Future Outlook
• Growth Expectations: Tied to new hospital openings and infrastructure improvements over the next three years.
• Capex Financing: 80% of projected capex to be financed through debt; no immediate equity raises needed.
Additional Discussions
• Performance Assessment: Balanced evaluation of hospital administrators based on various operational metrics.
• ARPOB Insights: Average Revenue Per Occupied Bed noted at 16.6 million for Q1 FY25.
Conclusion
• The call concluded with a focus on ongoing projects, expected expansions, and strategies for enhancing growth and operational efficiency.

Narayana Hrudayalaya Limited Q4 FY24 Earnings Call Summary
Key Financial Highlights
• Record Revenue and Profitability:
• Consolidated revenue of INR 12,794 million for Q4, a 4.7% YoY increase.
• EBITDA margin of 24.9%.
Business Performance
• Overseas Subsidiary Success:
• Strong performance from HCCI Cayman.
• Patient Discharges:
• Decline noted, but improvements in average revenue per patient.
• Anticipated normalization post-infrastructure upgrades.
Growth Prospects
• India Business Growth:
• Current growth at 4-5%, down from 14-15%.
• Optimism for double-digit growth through operational efficiencies.
Expansion Plans
• Bed Expansion:
• INR 1,000 crores projected for FY25, focusing on Bangalore and Kolkata.
• New Facilities:
• Significant construction planned, with new facilities expected in three years.
Investments and Subsidiaries
• Samyat Healthcare Private Limited:
• Aimed at optimizing supply chain management and tax efficiency.
• Rajarhat Project:
• Estimated capital of INR 1,000 crores for 1,000 beds, with a break-even expected in 2-3 years.
Operational Insights
• Average Revenue Metrics:
• Focus on Average Revenue Per Patient (ARPP) over Average Revenue Per Occupied Bed (ARPOB).
• Insurance Business:
• Expected launch next quarter, focusing on core geographies.
Challenges and Strategies
• Capacity Constraints:
• Current growth limited by capacity rather than demand.
• Outpatient Growth:
• Addressing challenges through new outpatient clinics.
Financial Management
• Capital Expenditure Funding:
• 20% from internal accruals, 80% via debt, leading to projected gross debt of INR 2,400 crores.
• Cash Management:
• Exploring overseas opportunities while considering repatriation despite potential losses.
Future Outlook
• Ancillary Services Growth:
• Limited current revenue prospects but promising for the future.
• Operational Efficiency:
• Continuous focus on enhancing patient throughput and reducing waiting times.
Conclusion
• The company remains committed to growth through strategic investments and operational improvements, with a focus on expanding both inpatient and outpatient services.

Earnings Performance
• Date of Call: February 16, 2024
• Consolidated Revenue: INR 12,036 million
• Year-on-Year Growth: 6.7%
• Quarter-on-Quarter Decline: 7.8% (seasonal factors)
• EBITDA Margin: Decreased to 24.7%
• Strong Overseas Performance: Noted alongside a solid balance sheet with net cash position.
Clinical Achievements
• Successful organ transplants and advancements in digital initiatives.
• Ongoing efforts to enhance payor mix and overall performance.
Regional Performance Insights
• North Region: Underperformance primarily in Gurugram and Jaipur units.
• Capex Timeline: Cayman hospital nearing completion; Bangalore and Kolkata projects taking 2-3 years.
Insurance and Operational Updates
• Insurance License: Received in January; operations planned for Karnataka next year.
• ARPOB Trends: Fluctuations attributed to seasonal variations; improved payor mix noted.
Expense Management
• Decrease in other expenses due to one-time costs and strategic spending slowdown.
• Clarification on unspent expenses and lease modifications affecting other income.
Cost Management and Revenue Growth
• Rising manpower costs (10-12% year-on-year) influenced by wage policies.
• Focus on operational efficiencies and digital initiatives to manage costs.
Future Growth Strategies
• Ongoing efforts to optimize throughput without adding beds.
• Long-term capital allocation strategy focused on expanding market share in Bangalore and Kolkata.
Clinical Service Expansion
• Focus on expanding services beyond oncology and cardiology to include orthopedics, spine, and critical care.
• Emphasis on minimally invasive procedures to reduce hospital stays.
Capital Expenditure Plans
• Planned capex of INR 1100 crores for FY24 and INR 1200 crores for FY25.
• Funding sourced from bank borrowings, NCDs, and internal accruals.
Patient Satisfaction and Operational Efficiency
• Average Google review rating of 4.8 indicating positive service feedback.
• Hospital construction costs estimated at 1.5 to 2 crores per bed.
Conclusion
• Management expressed optimism about strategies to enhance cash flow and operational performance amidst economic fluctuations.

Narayana Hrudayalaya Limited Q2 FY24 Earnings Call Summary
Key Financial Highlights
• Consolidated Revenue: INR 13,052 million (14.3% YoY growth)
• EBITDA: INR 3,265 million with improved margins
• Record Revenue: Reported from Cayman units
• Accreditation: JCI Enterprise Accreditation achieved
Operational Updates
• Expansion Plans:
• Brownfield projects in Bangalore and Kolkata
• Addition of 110 beds in Howrah by Q4, with plans for 700 more in 3-4 years
• Digital Transformation: Advancements noted in clinical achievements and operational efficiency
Management Insights
• Future Growth: Confidence expressed in sustaining growth and commitment to ESG goals
• Margin Expansion: Focus on patient throughput and operational efficiency
• Revenue Growth: Emphasis on increasing patient intake with existing infrastructure
Performance Metrics
• Average Length of Stay (ALOS): Reduced from 4.8 to 4.4 days
• Average Revenue Per Patient (ARPP): Increased in Cayman Islands due to outpatient classification
• Inpatient ARPP: Decline attributed to high base last year, overall trend remains positive
Challenges and Considerations
• Inflation and Regulatory Challenges: Potential impacts on margins discussed
• Tax Rate: Estimated around 10% for the current year, 25% for the next year
• Staffing Concerns: New doctor additions despite decreased expenses; lower attrition in Cayman Islands
Future Outlook
• Cayman Islands Operations: Competition from local hospitals acknowledged; U.S. insurance coverage confirmed
• CapEx Plans: Funding through debt without significantly impacting debt-to-EBITDA ratio
• Market Dynamics: Anticipated challenges from inflation and government actions ahead of elections
Conclusion
• Overall Discussion: Focused on capacity expansion, operational efficiency, and investment strategies to sustain growth amidst challenges.

Narayana Hrudayalaya Limited Q4 FY23 Earnings Call Summary
Key Financial Highlights
• Q4 FY23 Revenue: INR 12,216 million (29.9% YoY growth)
• Fiscal Revenue: INR 45,248 million (22.2% growth)
• Consolidated EBITDA: INR 2,904 million (23.8% margin)
Significant Developments
• Operationalization of a new Bone Marrow Transplant Wing
• Advancements in cardiac care
• Implementation of a new Lab Information System for improved lab efficiency
Healthcare Accessibility Initiatives
• Transitioning to a managed care approach to enhance patient outcomes
• Establishment of Narayana Health Integrated Care (NHIC) for clinic asset management
New Hospital Performance
• Mumbai hospital reached breakeven; Dharamshila achieved a 16% margin
• Launch of an oncology block in the Cayman Islands
Revenue Model and Strategy
• New healthcare initiative to include subscriptions, medicine sales, lab tests, and consulting fees
• Focus on improving Average Revenue Per Occupied Bed (ARPOB) through operational efficiency
Capacity and Operational Efficiency
• Adequate capacity in India hospitals; improvements needed in internal processes
• INR 150 crores allocated for greenfield expansions, including land acquisition in Calcutta
Oncology Department in Cayman
• Expected to attract patients seeking radiotherapy, previously traveling to Miami
• High margins anticipated due to low operating costs
Market Dynamics and Challenges
• Potential impact of revised CGHS rates on operations and international patient flow
• Ongoing cost headwinds affecting overall margins despite improved hospital utilizations
Future Growth and Investments
• No immediate plans for adding beds; focus on operational efficiencies
• Successful integration of Sparsh Hospital with over 200 procedures monthly
Conclusion
• Emphasis on balancing operational efficiency with patient satisfaction for long-term sustainability
• Ongoing discussions for potential contracts to contribute to future earnings