Aster DM Healthcare Limited (NSE: ASTERDM) Q3 2026 Earnings Call dated Feb. 02, 2026
Corporate Participants:
Alisha Moopen — Managing Director & Group Chief Executive Officer
Puneet Maheshwari — Investor Relations
Varun Khanna — Group Managing Director, Quality Care India Limited
Ramesh Kumar — Chief Operating Officer
Sunil Kumar — Chief Financial Officer
Analysts:
Unidentified Participant
Presentation:
Puneet Maheshwari — Investor Relations
Good morning everyone. I welcome you to the Astradeum Healthcare Earnings Conference call for the third quarter of FY26. Today with us we have the Senior management of astradium healthcare, namely Ms. Alisha Mopin, Deputy Managing Director, Mr. T.J. wilson, Non Executive Director, Mr. Ramesh Kumar, Chief Operating Officer, Mr. Sunil Kumar, Chief Financial Officer and Mr. Hitesh Dadda, Chief Investor Relations and MND Officer. We are also delighted to have Mr. Varun Khanna Group MD of Quality Care. Mr. Khanna is here solely in the capacity of a representative of Quality Care to give insights into the business and future plans of Quality Care, the entity which is in process to get merged with Astadium Healthcare.
It is to be noted that merger is subject to further regulatory approvals. All external attendees will be in listen only mode for the duration of the entire call. We will start the call with the opening remarks by management followed by an interactive Q and A session. Certain forward looking statements in this meeting involve risk and uncertainties as Stadium assumes no responsibility for actions based on these statements and undertakes no obligation to update them for future events. With this I will now request Ms. Alicia Mopin to start with opening remarks. Over to you, Ms. Alicia.
Alisha Moopen — Managing Director & Group Chief Executive Officer
Thank you Puneet. Good morning everyone. Thank you for joining us as this is our first call in 2026. Wishing everyone a Happy New Year. As we move through the final phase of the regulatory process of the proposed merger with Quality Care, we believe it is increasingly becoming useful to discuss our performance through the lens of the combined platform we are in the process of building. At the same time, we remain fully mindful that the transaction is still subject to shareholder and NCLT approvals while the merger process is yet to be consummated. Combined performance of the platform reflects how the two organizations are already operating at scale with complementary footprints, similar clinical philosophies and consistent operating disciplines, and provides a clearer view of the earnings, capacity and capital efficiency of the platform for the coming years.
Over the coming few months, wherever relevant, we intend to continue providing this combined pro forma perspective to help investors better assess the underlying economics of this platform. With that context and keeping the medium to long term lens in mind, I will begin by discussing the combined pro forma performance of Aster and Quality Care before moving to Aster’s results, we are very encouraged by the operating performance of the combined entity this quarter which demonstrates consistent and broad based growth driven by continued focus on clinical excellence and improving case mix and efficient cost management. On a combined pro forma basis, the platform delivered revenue growth of 15% year on year to 2,366 crores supported by 9% growth in total patient volumes and 8% growth in inpatient ARPP.
This was also accompanied by the Congo mix increase by approximately 150 basis points to 54.4% in Q3 FY26. Operating EBITDA grew faster than revenue, increasing 22% year on year to 503 crores, translating into an operating EBITDA margin of 21% and a ROCE of 21%. This performance is not limited to a single quarter. The combined PROFOMA performance of ASTER and QSIL has demonstrated strong performance across the first 3/4 of FY26 supported by steady patient volume growth in the 8 to 9% range and sequential improvement in patient realizations, with inpatient ARPP increasing in the range of 8 to 10% year on year each quarter over the same period.
This reflects not just top line growth but continued investments in operating quality driven by higher clinical complexity and improving case mix and sustained cost discipline across the combined platform. As a result, revenues and operating EBITDA have grown at healthy double digit rates across all three quarters while operating margins have remained stable about 20% despite ongoing capacity additions and business seasonality. Supporting this momentum, we continue to pursue measured capacity expansion aligned with long term demand. Over the past year we have added 560 beds, taking combined capacity to 10,620 beds across 28 cities. Our pipeline includes over 4,000 additional beds which will take the total capacity to 14,710 beds through a balanced mix of GREENFIELD and Brownfield expansion.
This disciplined and balanced approach allows us to scale capacity while preserving capital efficiency and returns. Both ASR and Quality Care have independently demonstrated strong execution across cost management and clinical productivity. Initiatives such as procurement centralization, insourcing of key services and strengthening of clinical talent have again supported operating efficiencies as well as margin delivery. This provides confidence in operating alignment and execution discipline ahead of integration as we continue to progress through the merger process. Coming to the update on the merger, A notable development during the quarter was the continued and structured progress on the proposed merger with Quality Care in the Limited.
The transaction has advanced through the key regulatory and procedural steps to date. Following the receipt of the CCI approval and no objection letters from the NSC and BSE with no adverse observations, the Company has filed a merger application with the NCLT on December 11, 2025 as directed by the NCLT. The shareholders meeting is to consider and approve the merger scheme is expected to be conveyed between February 27, 2026 and March 13, 2026. Subject to shareholder approval. The NCLT will thereafter review the application and upon receipt of its sanction, the merger will become effective. Based on the current process timelines, the merger is expected to be completed in Q1 FY27.
Now, having reviewed the trajectory of the combined platform, let’s turn into Aster’s performance for the quarter. During the quarter, ASTER delivered steady and broad based growth supported by improving case mix, disciplined execution and continued momentum across its core clusters. A key development during the period was the commissioning of the Kasarkur Hospital which marked an important expansion milestone and contributed to overall revenue growth. Aster’s revenue from operations stood at 1,186 crores representing a 13% year on year increase driven by 10% growth in total patient volumes and a 9% improvement in inpatient ARPP. This improvement was supported by a richer specialty mix with the Congo mix increasing meaningfully during the quarter.
Alongside continued focus on operational efficiency, this performance reflects a continued shift towards complex high value care. Oncology revenues grew by 27% year on year with contribution increasing to 11% in Q3FY26 which is up from 10% same time last year. The medical value Travel segment grew 41% year on year led by higher international patient footfall in Kerala where Mvt revenues grew 64% year on year. In our ancillary businesses, the lab revenues increased by 17% year on year to 39 crores reflecting continued scale up at the operating level. Performance remained stable despite the addition of new capacity.
Operating EBITDA stood at 224 crores, up 11% year on year with a margin at 18.9%. Core hospitals and clinics delivered 12% growth in operating EBITDA with margin of 21.4% reflecting steady execution across established assets. While reported margins reflect the impact of recently commissioned capacity, the core operating performance of the mature network continued to demonstrate strong operating leverage. If you exclude the newly commissioned Kastel Code, hospital revenue and operating EBITDA grew by 12% and 17% year on year respectively, with the operating EBITDA margins expanding by 90 basis points to 20.2%. This like for like comparison and performance reinforces the strength of the established hospital portfolio and the predictability of the maturity curve across the network.
Core hospitals and clinics delivered 18% growth in operating EBITDA with margins improving to 22.8%. Excluding CASA code, the normalized path grew 22% year on year reflecting improved profitability. Normalized PAT excludes the impact of provisions related to the recently revised labor code. Sunil will explain more about this later in the call. Within this overall performance, the Kerala Cluster continues to anchor stability and profitability, reflecting the maturity and the depth of the network. Following its turnaround, inpatient volumes grew 11% year on year and 8% excluding KASR code, indicating healthy underlying demand. Revenues grew nearly 20% year on year while operating EBITDA margins remained strong at 25.4%.
Led by cost efficiencies as well as operational leverage, Kerala remains a key earnings and cash generation anchor for the platform, absorbing growth investments elsewhere while maintaining high operating discipline. The Karnataka and Maharashtra cluster saw a relatively softer performance during the quarter, primarily due to a temporary volume moderation from seasonality, some scheme rationalization that was done and a few clinician movements. Proactive hiring and retention initiatives are underway to strengthen the clinical depth and execution capabilities. With these measures in place, the Karnataka and Maharashtra Cluster is well positioned to deliver improved performance and accelerated growth in the coming quarters.
Overall, ASTER continues to deliver consistent earnings, quality and operating discipline, reinforcing its role as a key engine within the combined platform. Moving to CAPEX and Expansion Our growth strategy continues to balance near term operating performance with long term capacity creation with a clear focus on discipline expansion and return led cap deployment. Over the past year we added more than 320 beds taking ASTA’s total capacity to 5,451 beds as of 12-31-2025. This includes the recent commissioning of new capacity including Castler Code which expanded our India network to now 20 hospitals. Since commissioning, the Castle Code hospital has demonstrated a steady and encouraging ramp up with outpatient footfall averaging around 400 patients per day, rising inpatient admissions and over 120 doctors onboarded, establishing a strong clinical and operational foundation right from the onset.
Beyond Kasirkod, ASDA plans to add over 2,300 beds over the coming years through a balanced mix of brownfield expansion and greenfield projects, taking our total capacity to over 7,800 beds. This pipeline is phased and aligned with demand visibility, ensuring growth remains disciplined and capital efficient. We also increased our stake in Aster Aadar Hospital by 12%, taking our total ownership now to 99% and we are in advanced stages of acquiring full ownership, further strengthening the operational control and integration within the platform. During the quarter, ASTA continued to receive strong external recognition across leadership, clinical excellence and innovation, reinforcing the depth and quality of this platform that we are building.
Dr. Azad Mopan, our Founder Chairman, was honored with a Lifetime Achievement award by Mount Judy Ventures and recognized as a Visionary leader in Healthcare at the Elliott’s Healthcare Innovation Summit. At the same summit A Healthcare was awarded the best Hospital Chain of the year with Asta RV recognized as the best multi specialty hospital and Aster White Field receiving awards for excellence in Cardiology, Pulmonology as well as Urology. Aster Hospital also received top rankings at the Weak India Health Summit 2025 with Asta MIMS Callican ranked as the number one special multi speciality hospital, Astamid City Kochi ranks second among multispeciality hospital and Asta CMI Bangalore recognized as the second best emerging multispeciality hospital.
In addition, the group was recognized amongst India’s top 500 value creators by Dunn and Bradford and Asta Digital India received their Innovation New Initiatives award at the 24th Data Center Summit and Awards to conclude, ASTA has delivered a resilient and well balanced performance during this quarter supported by steady growth across the core hospitals and improving case mix, disciplined cost management and continued strengthening of clinical talent and leadership depth across the network. Our consistent approach to operating execution, steady progress on capacity expansion and focused investments in people and systems have further reinforced the stability and scalability of our regional platforms.
As we move towards the final stages of the regulatory process for the proposed merger with Quality Care, our focus remains firmly on execution, excellence, capital efficiency and building a clinically strong and scalable organization while continuing to deliver consistent operating performance. By deepening leadership capabilities and attracting high quality medical talent, we believe we are well positioned to deliver accessible high quality healthcare at scale and create sustainable long term value for all our stakeholders. I will now invite Mr. Varun Khanna to take you through the Quality Care performance.
Varun Khanna — Group Managing Director, Quality Care India Limited
Thank you, thank you Alicia. Good morning and wish you all a very happy 2026. This quarter demonstrates continued growth, momentum and value creation from disciplined execution of initiatives launched earlier during the quarter. We’ve strengthened our micro market leadership through focused investments in clinical capabilities and infrastructure while maintaining rigor in our approach to bed capacity expansion. Overall performance in Q3 was strong with revenue rising 17.3% YoY to 1181 crores and post indise EBITDA increased 32% YoY to INR 279 crores. The post indice EBITDA margin expanded 265 basis points YoY to 23.7% in QY FY26 Q3 FY26 revenue growth during the quarter was driven by increase in IP and op volume 8% yoy for both improvement in specialty mix with Congo T share increasing by 60bps to 57.6% and a very favorable shift in the pair mix as the share of cash and insurance business rose further by 100 basis points to 80.1%.
Total RPOB increased 12.2% year on year to INR 47k in this quarter from INR 42k in the same quarter previous year driven by improvements in specialty mix, pair mix and a 3.4% reduction in alos to 3.9 days. EBITDA growth also reflects the early success of key synergy initiatives including procurement, new clinical talent hiring implemented in the first half for FY26, continued focus on clinical talent recruitment and management, along with the strong ramp up of the Nagarcoil unit launched in October 24 which has already started contributing very profitably in this quarter. During the quarter the mature units which is approximately 60% of our revenue, delivered a 12.9% YoY revenue growth and 18.8% YoY EBITDA growth again achieving a margin of 32.8%, an expansion of 160bps over last year.
Emerging units which is about 7% of the revenue continue to scale up well recording a 15.6% quarter in trailing quarter EBITDA growth and a margin of 13.3% reflecting 140bps quarter and trailing quarter expansion. EBITDA improved YOY increasing from a loss of 1 crore last year to a profit of 10 crores this year. For this category. Focus units which is 29% of the total revenue, delivered a robust 19.1% YoY growth and 68.1% YoY ETA growth and achieved a margin of 17.8% representing 520bps. Yuu expansion driven by sustained emphasis on operating excellence across the business. We continue to draw top tier talent from across the healthcare ecosystem and over the past few months we built out a strong leadership bringing a wealth of experience from across the industry.
Given our leaders experience and expertise, we feel well placed as we enter our next phase of growth in excellence and care. We have continuously been advancing our doctor hiring models in a very structured way. We’ve onboarded over 100 clinicians across the network during this year. While these initiatives were launched a few quarters ago, this quarter has shown significant progress with the monthly recurring revenue from the newly hired clinician cohorts reaching 24 crores this quarter. Moreover, these new hires have been instrumental in driving a shift towards higher equity care with our Congo T share increasing the by 60 basis points to 57.6%.
Our commitment to advancing clinical excellence has driven several notable milestones. We performed the first matched unrelated donor MUD transplant at KIMS and carried out the first cadaveric transplant in Aurangabad, earning recognition as an authorized cadaveric transplant center. Additionally, our surgical oncology and urology teams at NAGAR Coil successfully executed a very rare and complex laparoscopic dissection of a large retroperitoneal tumor in an 11 year old boy, demonstrating our commitment to bringing the highest quality of care in tier 2 and tier 3 markets. We also reduced RA loss by 3.4% to 3.9 days YoY to further enhance our clinical programs, we have committed to invest in in advanced future ready technologies to enhance clinical outcomes and expand the access to specialized care.
Through our partnership with Elekta, we are deploying five linear accelerators across our network along with the network’s first advanced central planning system in oncology. This strengthens clinical decision making, standardizes care delivery and enables technology driven collaboration with expert clinicians. In parallel, we are strategically scaling our robotic program through a newly established partnership with Intuitive Surgical. With the planned acquisition of five robotic systems, we are in the first organization to implement robotic surgery at this scale across the tier 2 markets. This initiative is our effort to democratize access to cutting edge surgical care. Ensuring patient benefit from the latest advancements in gastro and general surgery and gynaec expansion continues to be a key strategic priority.
We remain committed to strengthening our presence in existing markets and entering new ones through brownfield expansions, strategic M and A and greenfield developments. Our enhanced near to medium term growth plan includes investment of around 2000 crores to add over 1700 beds in the next three to four years. In line with our mission to improve accessibility to high quality care. 1300 of these 1700 beds will be added in non metro tier 2 markets. Our efforts continue to get recognized in the industry. Some key accolades we received during the quarter include the Visionary Healthcare Leadership Award at the AHPI Annual Conference.
Kim’s Health Trivandrum received the Kerala Health and Medical Tourism Award from cii. AHPI conferred the best emerging hospital to Kim’s Hospital Nagar Koil. Thank you yet again and I’ll pass it to Ramesh. Thank you.
Ramesh Kumar — Chief Operating Officer
Thank you. Thank you Mr. Varun and good morning everyone. So I’ll take a few minutes to walk you through the performance of each of our cluster I think this quarter and share an update on our operational priorities and team strengthening processes. Let me begin with Kerala which was a clear standout cluster this quarter and continues to anchor the company’s performance the cluster delivered a strong year on year performance Q3FY26 with a revenue of 629 crores growing 20% year on year. Excluding Kasar goat the revenue increased 19% year on year to 619 crores highlighting the sustained strength of the core hospitals and the ability to grow on an elevated base established earlier in the year.
Performance during the quarter reflected the continued momentum post recovery with the underlying demand remaining stable. Revenue growth was also driven by a strong growth in Mvt revenue growing 64% year on year led by a higher international patient footfall from Maldives, Oman and other Middle east markets. This is complemented by a sustained growth in oncology revenue and the initial ramp up of the newly operationalized Castle Road Hospital. Inpatient grew by 11% year on year while the ARPP IP increased 7% supported by an improved case mix led by higher share of complex procedures particularly in oncology. From a profitability standpoint of view, operating EBITA increased 18% year on year 144 crores excluding Castle Road operating EBITA grew 28% year on year to 157 crores with the margins expanding by 190 basis points to 25.4% margin expansion.
It was purely driven by operating leverages across mature assets, continued the reduction of alloys and disciplined cost management across manpower and overheads even as oncology led growth resulted in a higher material intensity with the close to 3,000 capacity of beds, a stable leadership structure and a clear expansion Runway. The Kerala cluster means well polished, poised to sustain momentum compound growth over the medium term and deliver the best in class profitability. Turning to the K and M cluster, revenue grew by 7% year on year to 383 crores in Q3FY26 supported by a strong 17% increase. In inpatient ARPP despite a 9% year on year decline in patient volume.
Volume softness was largely due to the discontinuation of the state scheme at ASAD Aadhar and a few clinician movement due to the heightened competitive intensity in Bengaluru micro markets. The operating EBITDA grew by 55% year on year with a margin of 21.9% despite higher material costs linked to oncology. Furthermore, proactive hiring and retention initiatives are being implemented to strengthen the depth and the execution capabilities. With these measures in place, the KN cluster is well positioned to drive improved performance and accelerated growth in the coming quarter. Turning to ANT Cluster revenue grew by 13% year on year to 137 crores in Q3 FY26 driven by 4% increase in patient volume at a 10% improvement in AirPP IP reflecting a better case mix and a pricing discipline.
From a profitability perspective, operating EBITDA increased 7% year on year with margins at 13.2% despite increase in clinical manpower cost. However, there has been a sequential margin improvement from 7.9% in quarter one FY26 to 13.2% in quarter three FY26. Overall, the quarter reflects a steady execution across clusters with Kerala continuing to anchor growth and profitability and KM and ANT making progress on revenue quality and operational discipline. With focused intervention underway and a balanced growth strategy, the platform remains well positioned to sustain momentum and deliver consistent performance in the coming quarter. Thank you and I’ll now hand it over to Sunol for a detailed review of the financial performance.
Sunil Kumar — Chief Financial Officer
Thank you Mr. Ramesh. Good morning everyone. For the quarter ended 31st December 25th our excluding our newly launched Kasar Gold Hospital revenues increased to 1,176 crores up by 12% in quarter 3 FY25 and operating EBITDA has increased to 237 crores with a margin of 20.2 percentage compared to 2 not 2 crores in quarter 3 FY25 with a growth of 17%. Normalized PAT normalizing the recent changes in the labor code and post NCI for the quarter 3 FY26 is at 98 crores compared to 81 crores in quarter 3 FY25 with the growth of 22% YoY. Similarly, for the nine months ended 31st December 25th India revenues have increased to 3451 crores up by 10% from 9 months FY25 and operating EBITDA has increased to 715 crores with a margin of 20.7% compared to 613 crores in 9 months FY25 with a growth of 17% normalized PAT post NCI and also the Labor Code changes which recently happened for 9 months FY26 is 298 crores compared to 251 crores in 9 months FY25 and growth of 19%.
Yoyo our PAT for the quarter was impacted by one time exceptional expenses related to implementation of new labor code amounting to 27.9 crores. This includes a provision of 26.3 crores towards gratuity and 1.6 crores towards compensated absences. Moving to segmental performance, our hospital segment continued to deliver consistent and strong performance during the quarter excluding Caster growth revenues grew by healthy 14% YoY while the EBITDA grew by 18% leading to an 80bps improvement in margins. Importantly, performance was consistent across hospitals at different stages of maturity. Our matured hospitals above 7 years delivered 14% growth and 17% EBITDA growth, operating at robust ROC of 36.2.
Percentage hospitals in 3 to 7 year maturity bracket recorded 10% revenue growth and strong 28% growth in EBITDA with ROG improving by 470bps to 25.7%. Our new RSATs which are less than 3 year old, saw revenue growth of 19%. Turning to our diagnostic business, I’m pleased to share that Asilabs has successfully delivered a turnaround. Since the start of FY25 ETO margins have expanded from minus 7.6 in FY24 to positive 7.6 in FY25 to 12.2% in YTD FY26 driven by robust 35% year on year growth in external business, enhanced operating leverage and improved material cost efficiencies.
This turnout has translated a healthy ROC of 27%, a remarkable recovery from a negative levels a year ago. On the wholesale pharmacy front, we took a strategic call last year to outsource the loss making part of this segment. While this decision led to a reduction in reported revenues, it has materially improved profitability. For the first nine months, EBITDA margins improved to 1.8% compared to negative margins in the same period last year. Importantly, this improvement is sustaining with the segmented delivering ebitda margins of 2.2% in the most recent quarter and moving to positive RO for the first time.
As of 9 months FY26, our total capital expenditure stood at 406 crores with nearly 50% allocated to our expansion projects. We continue to maintain a robust liquidity position with cash and cash equivalents of 1255 crores while our gross debt remains moderate at 631 crore. Additionally, we have given significant improvement. We have seen significant improvement in ROC which has increased by 260bps from 19.5 last year same time to 22.1. With this we have laid a solid foundation for future growth. As we move into the future, we are confident of building on this momentum with the same discipline and focus.
On that note, I conclude my remarks and hand it over to Puneet to begin the Q and A session. Thank you.
Questions and Answers:
operator
Thanks. Dear participants, during the Q and A session you will get a chance to ask a question by raising your hand through the raise Hand icon in zoom application at the bottom of your window we will call out your name after which your line will be unmuted and you will be able to ask a question. I would also like to request to all the participants if you have if you can introduce yourself with your name and company that you are associated with before asking the question. If you are not associated with any company and you are an individual investor, you can highlight that as well.
Moving on to the Q and A session now the first question is from Mr. Toseif. Mr. Tosif, can you please unmute yourself and ask the question? Thanks Punit.
Unidentified Participant
I’m audible. Yes, you’re audible. Hi, this is Tori from BNP Paribas. My first question is to Ramesh on. The performance of Kerala Kerala flagship hospital. As a med city we have seen. A 20 more than 20 growth this quarter. Can you give us more color on this performance? Especially how much Delta has been driven. By the MVT volumes and this whether. This growth in the MVT is sustainable or not and the overall Kerala business. I mean seeing the volume increase for the overall mt or is it just about Astra Team Healthcare?
Ramesh Kumar
Yeah, thank you to for that question. And I’m sure you rightly highlighted about the flagship of Aster. It has really grown well if you really look at the performance of some few months back, we always had the issue of sometimes the leadership issue and the MVT growth. So you have rightly pointed out all this has been taken care. We have a solid leadership there at the ground level we are able to build on, add more clinicians to the system. That has also brought in a lot of the top line revenue and certain programs like the robotic program have taken off very well.
In fact there are months that around 80 to 90 surgeries of robotic program has been done. So the overall performance consistently it has been doing around 90 crores and above for the last five, six months. So that’s been the performance of the flagship and since you touched upon the MVT, MVT it’s grown by 64%. So that clearly shows that we are back on MVT and especially from Maldives and Oman is what our patients are flowing in. I think this is definitely sustainable because there was a temporary setback for these patients not coming back and I think we have started driving them back and we have a proper engagement with both Maldives and Omani patients as well.
So that’s where it stand and I’m sure it will continue. Flagship will definitely contribute and other units of Kerala has also started doing exceedingly well including Mims Calicut and the new unit added is also performing very well. Kasar good. So entire Kerala cluster will sustain and you can see a significant growth and with very good margins. It has given 25.2 25.5% margin operating margins as well.
Unidentified Participant
That’s helpful. My second question is on a Karnataka cluster this quarter we have seen occupancy dip to 55% from 60% earlier. While you have highlighted there is some. Movement of clinicians but can you give us more color means in which segment the clinicians had moved out. Have we able to fill in the. Gaps and when we can expect a normalized business.
Ramesh Kumar
Great. So KDM cluster as we look at you know let me tell the good news is that the ARPP has grown by 17. That really clearly says that we are in a strong footing in in Karnataka the especially when it comes to the Congo T mix and especially in that oncology and neurosciences have been contributing very well and of course our facility Whitefield facility continued to contribute 14% of the growth. So it clearly says that we are on a strong footing.
Unidentified Participant
Yes.
Ramesh Kumar
Coming to the other two unit Aster RV and the two micro markets one is south and one is the other as the CMI north.
Unidentified Participant
Yes.
Ramesh Kumar
Here as you rightly mentioned there is we have been performing with the Congo T again I’m talking on oncology has been doing very well across all the units and and of course transplant as well in these two units. So the market has I mean even though there have been a lot of competition in the market and there is some attrition of clinicians we are able to replace all those clinicians and most of them are either intensivist anesthetists or even for that matter every generating doctors as well. But if if I say for example in as a CMI if you have if I would have had the pediatric thing moving out we have onboarded some of the best clinicians best well renowned pediatric team on board.
So the replacement has also been happening in a fashion that we hire the best of the clinician on board. So that’s where I think we’ll be not only replacing, we’ll also be adding new clinicians. Way forward we are and the good news is there are some clinicians who have already left us. There’s also rejoining Aster that clearly shows that we have been our mantra which we said that we will treat you well and most of the clinicians happy rejoining as well. That’s very good news. So way forward our plans are to hire more clinicians enter, ensure that we have the right clinicians and well renowned clinicians on board to contribute and have a steady growth happening for Bangalore.
Unidentified Participant
Just the last one on the RPOP levels of Bangalore clusters means have we reached optimal level of case mix in Bengaluru and what is the sustainable level of RPAP level? One could see whether one can assume 75,000 and from there, whatever the industry growth of 6 to 7%.
Ramesh Kumar
Yeah, there is a headroom for growth. As, as I rightly said, you know, we if once we start progressing well with a Congo T which is, which will be our focus for Bangalore as well, the RPOB would also, you know, which should move to another. From whatever 77,000 to further mode it can add another 6 to 7% more is what I foresee in the coming days. But for a mature hospital Bengaluru, 75,000. To 80,000 would be the current levels. Right. To look out for.
Unidentified Participant
Sorry, I didn’t get you.
Ramesh Kumar
For the most of the mature hospitals. In Bengaluru, the levels would be 75,000 to 80,000. Right?
Unidentified Participant
Yeah, yeah, it should be 75,000. Thanks, I’ll get back in the queue.
operator
Yeah, thanks. The next question, who is asking from Mr. Ame, can you please unmute yourself and ask the question please?
Unidentified Participant
Yeah, am I audible?
Ramesh Kumar
Yes, you’re audible.
Unidentified Participant
Yeah. Thank you. Thank you for giving me an opportunity and congrats to the management for good numbers. So the first question I have on the QCIL front, we have shown really good improvement this quarter on the margin front, is it driven solely by the QCIL efforts on each of these assets or is there also impact of synergies which we have started seeing in qcr? Thank you so much.
Ramesh Kumar
First of all. Thank you. Yes, the numbers look good. I think the question, as I understand we do have synergies. I told you previously as well, we do have synergies, but that’s not the QCL aster synergies. Those synergies will only play out post the merger, post the regulatory approvals come in. We had, even in QCI we had synergies that played out between teams and care and Evercare. Those synergies are playing out. We started working on them about a year back and that’s led to a significant upside. We’ve. We’ve also had significant business improvements. I touched upon it, but let me emphasize them again.
Our pear mix is getting better. We’ve actually moved to 80 plus percent pear mix now. And just to give you a sense, I think a few years back this was 76, 77. So there’s a very significant shift that is happening. Our Congo tea continues to get significantly improved. I alluded to the fact that we’ve been hiring a lot of clinicians. Almost 100 odd clinicians have been hired in the last three quarters. The monthly impact of these new clinicians coming on board is about 24 crores which is sizable and we’ve been able to restrict any consultant leaving.
So the good part is that anything that we are hiring today is accretive. I also give you a sense by various categories as you know that you know we’ve always emphasized categories that we work on. Mature, emerging, underperforming, in focus. Our mature continues to grow very well and we’ve seen about 18, 19% kind of EBITDA growth rate on that. The other categories are firing as well. So wherever we had some challenges, wherever EBITDA wasn’t looking good, for instance we had the focus units where our EBITDA wasn’t looking very good and which is why they got categorized in focus units and there was a reasonable number, 28, 29% of the value of our business was coming from there there we’ve seen 19% growth on the top line and the bottom line has grown about 70% which also means it translates into 550 bits of improvement on the EBITDA percentage and that is largely led by the value growth or the top line growth and the initiatives that we’ve taken.
So I hope that answers your question.
Unidentified Participant
Sure. So basically the synergies led by the combined procurement, pharmacies, etc that is likely to play out only post mer what. You mean to say?
Ramesh Kumar
Absolutely. So if you are again if you are alluding to synergies between QCL and Aster, those synergies will only play out post. So there are no, no synergy impacts of the proposed merger in the the QCL results.
Unidentified Participant
Sure.
Unidentified Participant
And what could be the quantum for these synergies? The reason I’m asking this because the next year if you look at for a combined entity we are adding on almost 900 beds of which 700 beds are greenfield where only UCL is only adding 200 beds which I suppose are brownfield. This number has cut down sizably from last quarter. So the next year seems to be a high Greenfield year where there would be a losses to recoup. So will these synergies will be able to recoup these losses?
Alisha Moopen
Well, let me take a part of it and pass on the part to Sunil to handle. So we will, we will see some bed growth which is coming in and the bedroom that we’re looking at essentially may not be margin diluted because a large part of these beds are coming in Bhubaneswar, which is a facility for us that does very well. We are maxed for capacity so we can really take more patients. It’s a highly profitable asset for us. And we are also adding to the equity. We are adding oncology there. So I don’t think these will be dilutive on margins is one part of it.
Some of the beds that are getting added in Raipur will also not be margin diluted. We will be able to enhance again equity there because one of our linear accelerators coming there. So that too doesn’t seem to be a concern. If that’s the question on the the margin piece for the blended or the merged entity, I’m going to pass this question.
Ramesh Kumar
Thank you. See, with respect to next year, what we are expecting is that because one of the things which has changed is this Sajapur Road Hospital, right. So what has happened is that it took us some time to get the drawing approvals and all on construction has just started basically the interiors and everything. So it should come mostly the faggot of FY27. That’s where we moved it to beginning of FY28. That means to say we’ll have only two projects next year. And also if you’ve seen the merger date also. Right. We are expecting sometime in quarter one.
So for sure, you can be very sure on the how when the operations will happen of these two green field because the out of the Hyderabad and the Trivandrum. Trivandrum is expected operationalized first and sometime in the beginning of H2. Right. I’m hoping that before that the merger should happen. And second is that is related to the Hyderabad hospital which is women children care. And that should happen sometime in the second half of the H2 of next year. So we’ve keeping that in mind the timeline, I don’t think so. It will have a very considerable impact for the financial year.
It’ll be very similar to Kasarguri starting only in the second half. And you’ll see it’s not going to impact you on a full year margins. And also it’s very, very important Amai to note that both in Trivandrum and you know like in Trivandrum or Hyderabad, we have the QCL assets already there. Right. We can get the network benefit which is a very, very important thing. And Triventrum we have called out previously also it’s very, very underprinted From a corporate, you know, private quality bets per se. Kims has been the leader there and we’re expecting to get the network benefit in Trivantrum to have a very, very good launch, attract the good clinicians locally and we’re able to drive the ramp up and that’s what we’ve shown in a, in a, in a city which is only 1.5 million.
We are talking about wrapping up to within three months, 400 patients, op patients per day, 50 to 60 occupancy beds in a day. And same thing in Hyderabad also. Hyderabad is what the very care has got good assets and our asset, women, children is very much strategically situated in IT geography. So and we expect it to do really, really well. So just I just want to add.
Alisha Moopen
Here that as you saw the combined. Number, more than 50% of the beds are actually coming in nature. Right. Plus the synergy element that we have. Guided that, you know, we expect 10. To 15% of EBITDA coming in form of synergies over next two to three years. Putting all of that in perspective, you know, we don’t want to guide you on every quarter. I think for us what’s important is do we reach to those 24, 25% threshold in years. The answer is probably yes, that we intend to do that. And I think we see that moving forward. I, I mean there’ll be few quarters that you will see because of new capacities coming in. You’ll see that excluding those project the momentum continues but there will be some impact because of those new projects coming in.
Right. But I think it’s important to have clarity on that. We are looking for a 24 with a sizable expansion in capacity volumes as well as top line as we move forward. Sure. Thank you so much. That answers the questions. This last question, if I can squeeze in on Bangladesh because there has been a lot of concerns from the investor side how this unit cluster is performing for QCI over last nine months since there have been a lot of social issues there and any thoughts on the, the minority stake as well in that entity. Thank you so much.
I will join.
Alisha Moopen
Magnificent. Thank you. So Bangladesh has also done well for us and is in line with our overall performance. So the top line growth for Bangladesh for the year and I think that is the question that you had, you didn’t ask for a quarter, you actually asked for YTD is at about 21 odd percent. And I’ve said this earlier, Bangladesh does get influenced by certain external factors. But the fact of the matter is that we happen to be the best place for patients in Bangladesh and therefore we spring back our volumes very, very quickly. So yeah, that’s, you know, the strength of Bangladesh continues.
Unidentified Participant
Sure. And any thoughts of the minority interest? Are we going to buy back this minority interest or how it’s going to stay?
Ramesh Kumar
Thank you, Amir. Thanks for the question, but I think we don’t want to give a very leading comment on this. We will keep you posted as and when we have a decision on this.
Unidentified Participant
Sure. Thank you.
operator
So thanks Amit. The next participant who is asking the question is Ms. Damianti, if you can unmute yourself and ask the question.
Unidentified Participant
Yeah, hi. Thank you for the opportunity and I hope I’m audible. So my first question is on your. Castlegod unit which just started. So how do you see the trajectory for scale up of this unit and when we should be expecting unit to turn cost neutral? So that’s my first point. And then I have some other questions on the new units. I’ll come back.
Alisha Moopen
Sunil, do you want to go ahead?
Sunil Kumar
Yeah, yeah. So yeah, I think I called out on the caster good unit. It has done really, really well as I said in the third month because the R Pops are quite lower, being a tireless city. Right. So ARPO is only in 31,000. With that we are able to ramp up to 50, 55 beds only in the third month with more than 400 patients. Right. So losses have drastically reduced to only around 2, 2 and a half crores per month. So if the trend continues, the growth what we had in the first, you know, three months.
So I think within the next one quarter, I think we should be able to break you. Okay, so you’re comfortable about covering up all the cost in short term, right? Yeah, because we already added all the key clinicians. We added more than 100 plus clinicians with more than 40 to 50 rgds. And also look at the Congo teamings there already. Congo teamings for new hospitals, more than 46 percentage. That’s really good. Okay, that’s I think helpful. My second question is on your women and child hospital in Hyderabad where I believe we had seen some shift in the timeline and now you’re indicating that.
To start in the second half. So if you can just, you know, update, you know, it’s like 2h the time when you are confident about launching the unit and in preparation of entering that space, what kind of hiring or other, other preparations are currently underway.
Alisha Moopen
Ramesh, would you go ahead?
Ramesh Kumar
Yeah. So as you see that, you know it’s a women and child project, broad specialty. What I mean to say it is sorry it is a multi specialty of women and child. Multi specialty means we are going to have all specialty of women especially to start with oncology, not only maternity cases, gynecolog cases. We are also looking at other super specialization of women alone and also the children, the all subspecialties of children as well. So as far as that’s the concept of the hospital. So we have actually we wanted to add a bunker now in between.
So that’s where the timeline got shifted a little bit. But nevertheless, as projected timelines we will be, we will be commissioning and side by side we are looking into the talent pool as well. And since the concept is all there, we are also looking at which talent can be hired and how to kick start. So all the plans are in place and sure short we will be coming up at the at the given timeline.
Alisha Moopen
So Ms. Daventy, just to add to what Ramesh is saying, we’ve had other women and children at Kotakal before as well as within Whitefield Hospital there is a women and children block. So we have done this before. The delay has been slightly because we wanted to change the configuration of how many beds are for women compared to how many for children and also work with sort of the QSIL team on how do we kind of leverage this network that Quality Care has in Hyderabad. And exactly like you said, there’s a lot of review happening in terms of onboarding of the right clinical talent for a specialized care for the women’s hospital largely in Hyderabad.
So the preparation. Thanks Alicia.
Unidentified Participant
So just want to understand of the total capacity which you are planning for this facility, how much will be for the pediatrician part and how much will be for women care?
Alisha Moopen
So more than the majority will be for women. So I don’t want to give exactly the number because we still have some flexibility, but sort of more than 60% will be for women’s care. Okay, my last question is on the.
Unidentified Participant
Talent movement in Karnataka cluster which we already discussed and you mentioned you are preparing some strategy to retain the best doctors in your team, etc. So if you can highlight a bit. About, you know, how the competition is shaping up in terms of getting the. Best talent as we see more competitors. Coming into this market, especially Bangalore and. What, what are your key strategies to retain your core doctor team there?
Alisha Moopen
Yeah, so I think I have again called out, but still I would like to repeat the same one. We are as rightly we are looking at how to retain existing clinicians. So that is of course many of them are quite happy and contented with the aster itself they they don’t want to because as we go by our you know what do you call the tagline we will treat you well. They’re quite happy with the culture of astro so many of the senior clinicians are quite happy to be with us only. So Andy, those who have I and I did mention about that some of them, few of them who had left they would like to come back so that is also one good thing what we see now further we are looking at what are the best talent available in Bangalore.
We look into the top 1, 2, 3 for example what in the Congo team makes we want to see who are the top 1, 2, 3 clinicians and we would like to onboard them, engage them. We are putting all the efforts and shortly you would hear some you know that some of the very big what do you call names would also be associated with us. So that is. That’s the way forward plan. We are trying to get the best of the clinicians on board.
Unidentified Participant
Sure. Thank you team. I’ll get back in the queue.
operator
Thanks Namayanti. I would like to put a reminder to all the attendees would like to ask a question Please raise your hand and ask the question with this now we have next participant Mr. Kunal Rendiria. Kunal, can you please unmute yourself and ask the question foreign.
Unidentified Participant
Good morning everyone. So my question is around your expansion. Plans and you know just I would. Like a few clarifications. So in Kasar goat for example you. Have 264 bed expansion but those are bed capacity right? So how many beds will be operational? Because you have 80 census beds for now so when will the remaining come. And how much could should be the. Total operational beds there.
Alisha Moopen
So thanks Kunal for that question. See we said that 264 bits is the total you know or capacity bits out of that census bids is approximately 183 to 185 census beds and balance around 80 bits is a non census bit. Okay that’s a broad breakup on it. When you talk about the operational C usually nonsense bits gets operational very quickly because there you’re talking about emergency daycare and few other pre op post op beds right? That’s mostly usually get operated in the operation in the first year but mainly it takes time for the census beds to get operational.
As I said currently we are at 80 beds. Now question is that how fast we can ramp up to a 180 beds. So what we always seen is that even when you looked at Kandur previously because that Was the first hospital is in that micro market. We were able to ramp up very very quickly. If the current trend of quarter one does and I think within a, you know very quickly we should be able to ramp it up the 180 bits.
Unidentified Participant
Right. So fair enough.
Alisha Moopen
And for the remaining 750 bets that you’re going to add in 27 in Hyderabad and Trivandrum, will the ratio be approximately the same? See usually 75 to 80 percentage, around 70% is the census bets and 25% is the nonsense bits. That’s a mix you should keep in mind whenever you’re doing your modeling. Sure, but, but, but then just for.
Unidentified Participant
A modeling purpose how many bets would be you know the census beds coming.
Alisha Moopen
On stream in FY27. See usually always we start between. Between 75 to 80 beds. That’s the usual start like what you did in Castle board. Also it all depends on the ramp up. Whenever you on the operationalized best you hit between 60 to 65% occupancy you start adding 30 beds. Right. So usually what we have seen is that wherever the micro market is very strong like a tire 2 city, right. We have seen the ramp up to happen to a complete capacity between again see if it’s a 500 bed hospital you’re looking at five to six years.
But if it’s a micro market as strong as Bangalore, it may take another two to three years longer. That’s a broad guidance what I can give you that.
Unidentified Participant
That’s very helpful, thank you. My second question is on Kerala now. Obviously you know since the last one. Year there’s been a. I think a. Massive change in how you know this. This has spanned out earlier. The occupancy used to be very high. R pops used to be depressed. So I understand the discounting and all would have come off. But now we are seeing very sharp r pop growth. So what is it that’s that’s changed? Have you added a lot of specialties in your hospital that’s driving your growth? Because for an asset that’s been mature.
Alisha Moopen
And you know this being a sea of change in one year itself. So just, just want to kind of understand how much of this is sustainable. You know. I’ll ask Ramesh to come in after I had a very on a technical part of it. So if you Kunal, if you look at growth in Kerala but majority of that is coming because of alos, right? Loss is almost 7 percentage. If you remove that RP level, ARPP level it’s around 8 to 9 percentage. But when you go to the ERPP IP that’s around 7 to 7 and a half percentage.
So I don’t think so. 7 to 7% is a very matured growth for a. You know, so with the 2500 beds or 2800 bits what we have today. So even that’s what I think we, you know, previously also we’ve given that understanding that very important to know in Kerala is that Kerala almost, you know, north of Kerala, 75 to 80% is a cash patients. Still the insurance penetrations is quite less. But as compared to a central Kerala where where we have the flagship hospital, Kochi still the cash patients almost 60 percentage. Keeping that in mind, you can continue to expect the AIR pp better not to track the air R pop because there will always a movement on the, you know, the.
Because of the case mix, on the procedure mix or the specialty mix changing. You always see our, you know, yellows going up and down better. That’s a more of a misnomer better to control on the RPIP. RPIP I think in the future between 6 to 8% is a growth in a midterm. I’m talking about around three to four years is something you can expect in Kerala for sure. And the most important thing why it will also drive is that I told you about the peer mix. In addition to that you also seen the competition coming in, right? With competition coming in, a lot of these changes will happen and that will expect you to drive the RPOC growth.
In addition to that I think Mr. Ramesh called out. We added more than across Kerala itself. We added more than 2025 clinicians in the Congo T broad specialties. That’s also expecting, you know, basically elevating our RP growth over a period of time.
Unidentified Participant
Right, right, right. This is very helpful.
operator
Thanks Kunal. We would like to highlight that we’ll be giving preferences to attendees who have not asked a question before. So in that line the next question is from Mr. Vivek. Sit here. Vic, can you please unmute yourself and ask the question?
Unidentified Participant
Yeah, sure. Thanks for the opportunity. So I have a couple of questions with regards to qsil. So firstly just wanted to understand the breakdown of your expansion plan for QSil. Right. In terms of Greenfield and Brownfield expansion year wise I see that you have provided for the merged entity provide same for QSIL and along with the capex earmarked on a year on year basis.
Alisha Moopen
So Vivek, we’ve given some color but let me, let me give you the image and number. So we’re Adding Bhubaneswar, Raikpur and Kotam for FY27 and that will be 155 and you know, about 190 beds which is coming in FY27. Now all of these are existing facilities. So there’s a ramp up of beds that is happening. All of these are census beds. So that is one piece. I can tell you. We’re looking at FY28 at about 780 beds. And again a large part of this is actually all of it is brownfield. Right. So it’s addition happening to our existing properties.
And therefore capacity expansion is how I’m going to put these beds as FY29 and beyond is another 750 odd beds. So if that answers your question, just.
Unidentified Participant
To add in all the expansion that. Varun mentioned in QCL, almost 89, 90% of the expansion is brownfield in nature that QCL is having. Sure, sure, that helps. Secondly, just wanted to understand, like we’ve seen the Congo mix for both ASTER and QSIL sort of improving on a quarterly basis going forward on a steady state basis. Where do you see the case mix for Aster as well as for the merged entity going?
Varun Khanna
So let me take the QCL side of it. Is that okay if I answer for qcl? So QCL is currently sitting and is able to see 57.6 odd percent. I think the endeavor is to continue doing this. I told you that our investments, a large part of our investments for QCL is going to oncology. Oncology is still under dialed when it comes to qcr. So the fact that we are investing into linear accelerators, the fact that we are adding Oncoblox in five different facilities over the next two years, needless to say that this will enhance the contribution of CONGO T as we go forward.
So I don’t think 57.6 is going to be where it is from a mature number standpoint. It’s continued to grow. I don’t know, I can’t really put a number to where it will end up. But my sense is that you’ll be in mid-60s over a period of time. So I don’t want to draw when, but the how is known to us. I don’t think the when is a fair answer. Is that, okay, maybe I can pass out.
Ramesh Kumar
Yeah, so just to add to that Astra side, you know, somewhere mid-50s is what we are having. Congo T mix, I think it will steadily start growing. As rightly mentioned, even the new units have started doing exceedingly well in the Congo Tea like the Castle Gold one. So we are also looking I mean a steady growth and the focus as we rightly said especially in tier 1 city in Bangalore and of course all the tier 2 and tier 3 cities also are focused. We are looking at the dedicated cancer care centers. Rightly said Onco can give us a real growth.
We are looking at having relax and make it as a complete comprehensive. So oncology will be one major contribution followed by cardiology. We have started doing a lot of transplants for heart transplants as well. Even the new Calicut unit has opened account as med city. We are focusing Bangalore is doing exceedingly well in the transplants for heart transplants. So I think the way forward focus would be anyway as rightly mentioned by Mr. Varun we would be we would look at 60 plus somewhere around 60 to 65 is what we are looking at to achieve the numbers.
Alisha Moopen
And Vivek, one of the other things I have to tell you maybe I’m just adding to what Rameshal said and this is less to do with our network. This is more to generalize our comment as we get into tier 2 tier 3 hospitals, the need for complexity there is very high currently or given the fact that this is how healthcare has developed in the country. People have moved various cities but the need to travel can be limited if the capability is available which is where getting more Linux which is where getting robotic systems into various cities, expansion of talent that I spoke about earlier.
I think all of this is helping us grow our Congo tea mix. I spoke about the complexity that we are enhancing. I think adding transplants into tier 23 cities today is becoming a norm. So all of that will continue to enhance the group’s focus and performance on comfort to you.
Unidentified Participant
Thank you, that helps. Just one last question with regards to the pharmacy business. It’s a two part question. Firstly just wanted to understand what is the size of the pharmacy business for QCEL and its margins. The second part is in the previous couple of calls you had mentioned that you know we are making sort of a strategic exit from loss making units in the pharmacy business. I guess this was more pertaining to Aster. So just wanted you to shed some light as to how that’s panning out for for the merged entity as a whole. So Vivek, it’s very important to know that QCL doesn’t have any pharmacy business whatever pharmacy.
It’s more of IP and op pharmacy within the hospitals. What we have is two parts. One is the wholesale pharmacy. We have wholesale pharmacy which gets consolidated. Then there is a retail pharmacy where we have 49% investment where the share of equity gets, you know, adjusted at the PAT level. Right. That’s a two different parts. Now the wholesale pharmacy level, what used to happen is that this is the asset which we bought in the, in the local Bangalore market. And in addition to that we added, you know, the second business unit to supply to a retail pharmacy which didn’t work out really well due to logistics and reverse logistics and the fill rates and a lot of other things.
That is the reason I think a year back we tried to move out of that and ensure that we come back to the one which we acquired and that’s where we were able to bring out of the negative margin a year back to a positive margin, the wholesale pharmacy. And going forward also wholesale pharmacy, we don’t expect to do major growth because it’s. You can’t expect more than three to three and a half percentage margin considering it’s a low margin business. So we’ll try to keep at that level. In terms of retail pharmacy where I said we only own 14% and balance is owned by a resident individuals.
Here we have around two, not three pharmacies where we have, you know, lent our brand to drive the business. Right. That’s where we have, you know, brand licensing has been arrangement has been done here and there. I think it’s two, not three pharmacies. It’s paired over Telangana, Karnataka and Kerala that’s doing well. That’s expected to break even in another year or two. I hope that helps.
operator
Thanks. Yeah. I would like to request all the participant if you can raise your hand and ask the question in this we have next. Mr. Harith, Mr. Harith, can you please unmute yourself and ask the question.
Unidentified Participant
Hi, good afternoon. Thanks for the opportunity on QCELL EBITDA that you’ve disclosed which is the operating EBITDA. It’s around 800 crores for the nine month FY26 period. So is there a minority share out of this 800 crores that you can share? A rough number is what I’m looking at because there are quite a few units of ours where there’s a decent minority shareholding like for instance the Kim sales part of it. So any approximate number that you can share. So approximate minority for qcl is roughly 20%. You know, you can use that as a base and we can probably, you know, send the exact number separately.
All right, that’s helpful. And between the operating EBITDA and the reported post in days, EBITDA for QSIL is There a major difference. Like we haven’t asked her a few, you know, ESOP items and you know, the fair value movements, etc. So for QSil as well, is there a similar adjustment between operating EBITDA and reported ebitda?
Ramesh Kumar
Well, there will be, but we will share that number with you. I think it’s about 15 to 17 crores is what I remember offhand.
Unidentified Participant
Okay. And for the new units that we are expecting in, in FY2728 which are mainly Trivandrum, Hyderabad and Sarjapur Attaster, I’m talking referring only to the Greenfield units. What’s the kind of, you know, EBITDA. Losses In the first 12 months that.
Ramesh Kumar
We should be penciling in? You know, all these are in different markets and you should be looking at different numbers. But any ballpark guidance will be helpful. Yeah, I think previously called out, it’s very difficult to give you the number because it’s all in different micro market. Right. Sajapur. Anyway, it’s going to come in the beginning of FY28 but the next year we are only talking about in the second half. The first one should be a Trivandrum and the second should be the Hyderabad women children. But the good thing is that in both the cases I called out saying that it’s not a new geography.
Hyderabad you already present care is present. That should help us in driving the growth and attracting the key clinicians. Same is the case in the Trivandrum, but usually what we’ve always seen on average. Right. Again, this is something very broadly for your modeling. I’m talking about it could be anywhere on a monthly average. Right. And again I’m talking about the first six months could be between two and a half to four crores per month. Usually that’s a broad burn which you expect. All right. And the last one, more of an observation. When I look at the, you know, total operational beds at a astral level, excluding QCI, the breakup between census and non census, the 24 share of non census beds seems to be a bit higher than what we typically see at your peers.
And then even at QCL, I think this is a lower number. Around 15 to 16% of beds being non census. So is there a reason, is there something different about our model or network that’s leading to this higher number of non census beds? Is it because, you know, some of our units are smaller? Right, thank you. So see in the industry there is no confusion when you get to the census beds. We all know that any bed which you try to occupy for the patient on the midnight basis. You take it as census bed in case of nonsense.
But there is no industry wide agreed standard. Everyone takes it very, very differently. In our case it’s higher because we count everything. And also see for example usually it includes your emergency beds where there is no admission, happens overnight or say daycare beds. Right, that’s one bit of it. Third one is also your pre op, post op beds or we also look at dialysis beds. There are a lot of these things where some of the institutions may count in the nonsenses and some institutions like us, and we have been very consistent, you know, over a period of time, last 10, 12 years, we’ve been including it and we not changed any formula.
But also it’s important to note that we are also looking at now going forward because there are a lot of short stay procedures and the daycare, specifically oncology. In case of oncology you are, you know, more than 50 to 60% of the revenue comes from chemo and it’s a daycare. Right. You don’t see a patient staying overnight. And we have been converting most of the time sometimes from sensitive nonsense beds. So as long as you’re going forward. We are. And that’s also another reason why our alos is also going down drastically. You’ve seen from one year back we’ve been reducing last four quarters or five quarters, we’re going down by more than 5 to 6 percentage.
So it’s more to do with the short step procedures and more daycare patients which we are using. Otherwise there is nothing much to talk about there. That’s helpful sir. I’ll get back. Nikki, thank you.
operator
Thanks. Arith, I would request you to please limit your question to two, but not more than three per participant at the time. The next question is from Nancy. Nancy, if you can, you know, unmute yourself and ask the question.
Unidentified Participant
Sorry, am I audible? Congrats on a strong team. I’m just trying to piece a few things together and trying to understand. So you know, we see that there’s. A margin dip from the previous quarter and while I understand that Q3 is. Generally, you know, a slightly weaker quarter for entirety of healthcare and some of. The margin drag is also coming from the Kasarbourd hospital that we’ve started. But still, you know, there’s about 200 bips despite the Kasarbour hospital adjustment that’s lesser from the previous quarter. So I’m just trying to understand that. Is this totally accountable to seasonal seasonality or you know, are there any other. Factors that are also playing out here.
Ramesh Kumar
Yeah, thank you, Nancy. See there are two, three things we need to look into it. So year on year if you remove the Casar gold, right Then you’re talking about 22 going down to 20.2 percentage. And when you look at the revenue and all you’re Talking about or 21, 22 crores revenue tip from quarter on quarter to wherein EBITDA it’s impacting almost 26 crores, right? If that’s the right number, yes. And if you look at the dip almost for 60 to 65% is impacting due to the revenue, right. If in 22 revenue, crores revenue comes down naturally, 62% of that impacts on this one.
Second thing which is really happening is more of investment which you’re doing in the clinical talent which Ramesh talked about. Right. And I also spoke about saying that Kerala itself, you look at Iran year quarter to quarter three, it’s the same revenue, right? 619 roads excluding Kasar gold. But still the margin you can see a slight dip. It’s because of investment what you’re doing. And it’s very, very important that an organization like us, which we talked about again Ramesh talked about the Congo team mix and growth we are looking at because we got, we, we can get a major leverage in the how we converting, you know, mix we can improve year on year.
We already improved by more than 240 pips and we expect to go beyond 60. So our we are very, very clear that we want to add more and more clinical talent. And that’s exactly what’s happening. So it’s important to note that this is an investment, we need to think it as investment so that once the new doctors who have come on board start ramping up over three to four quarters, you will see the benefits in the volume, benefits in the margin. Right? That’s one thing. That’s the first important thing. Second also one thing which has happened between the quarter to quarterly is that I also told in the last quarter in the similar earnings call that year on year the medical specialties basically the vector bone diseases is reduced by almost 70 percentage.
And when you look at and because of which last quarter two we have seen a dip of almost 12% in the internal medicine, pulmo and children’s specialty. Same thing has happened in quarter three also in this quarter three, when you compare to the last quarter three, you have seen a dip of almost 12 percentage in internal medicine, pulmonology and children cases. So that’s also another reason why it is Impacted at the same time. What’s also happening is that irrespective of this, our oncologist growth is great. For example, when you talk about oncology in this only in the quarter three our both our cardiology has grown by more than 22 percentage and oncology is grown by 27 percentage.
Both these specialties carry a high material cost unlike other specialties. That’s one of the reason our metal cost has gone up on from year on year this one and that is also impacting our you know, margins. But as I said this is not a structural issue. You have always seen quarter to quarter three, it always slows down. But again with the investment what you made, you can expect a good ramp up and steady ramp up in our volumes going forward.
Unidentified Participant
Understood sir, that was super helpful. Thank you.
operator
Thank you Nancy. The next question is from Mr. Kashish. Kashish, can you please unmute yourself and ask the question?
Unidentified Participant
Hi, thank you for the opportunity. So just two questions on the ancillary business. One is on the Ester labs. So we have seen the margins improve sharply to 12%. So at what scale do we see these margins stabilize and what can we expect going forward? And secondly is towards the wholesale pharma business. Sorry Kashish, we didn’t get your second part of the question.
Alisha Moopen
Oh actually. First one on the labs laps I think even I even called out in my speech how from a negative beta it has gone to positive. But in FY25 and in FY26 we on a YTD basis we already gone to 12.2% margins. You know and here the most important thing for the margins to further drive up is important that our non captive business which is currently at 30 to 31 percentage of our astral as revenue, how to drive it more than 50 percentage. So that’s exactly the sales strategy which we are internally working it. And also you’ll see very soon there will be a dedicated labs app will be launching.
Not linked to our hospitals but dedicated retail app will be launching. That’s going to really help us in driving the non captive business. Once we’re able to get a non captive up from 30% to more than 50 percentage that’s when you will see our gross margin improvement in a very drastic way. And if that happens then you can look at more than 20 plus margins. And again question is all about how fast we move in this one. And again you’ve seen the year on year growth also more than 20% or 30% on the external business.
What we are talking about I think next two to three years you can see more than 20 percentage margin gaslapse. And also margin labs is always a, you know, it’s a high margin business and we expect to do really well. Understood, thank you. And second question was after outsourcing the wholesale pharma business, how much margin drag has been removed? Sorry, how much margin drag, drag, drag, margin losses has been removed from here. What we’re talking about is that on a monthly basis around 1 to 2 crores every month. That’s the number which you have removed because you know, right Kashish, in the wholesale, it’s a distribution business, actual margin what you get is 8 percentage.
But with so much of discounts being given to the retailers and other trade business, the gross margin further from 8% dipstore on 5 to 6 percentage and with other manpower and overheads put together the max you can hit is around three, three and a half percentage, not more than that. And also you need a scale to drive this margin. And currently as I said on the quarter three already we moved to 2.2 percentage and we’re consistent to continue to keep it positive and try to drive beyond 3 percentage there. But I think again Kashish, I called very clearly we are not looking at increasing this business in a very drastic manner.
We want. Because you can always drive this business but you not get the quality business. We want to ensure that. What business is that? You know, it’s a high margin business. What we’re getting it and we don’t want to drive the top line at the cost of my margin. So the main idea is to even though my revenue dips, you know, year on year, I want to keep it consistent and drive the margins up. Understood sir. Thank you. And just, just completing the loop. Do we.
operator
Sorry Gashish, we are not able to hear you properly. I would request you to please come in the queue.
Unidentified Participant
Sure.
operator
I would request everyone to limit your questions to two considering the time. The next question is from Mr. Siddharth. Siddharth, can you please unmute yourself and ask the question. Hi, thanks for the opportunity. On, on the alos, one sees a.
Alisha Moopen
Significant difference between the alos QCL versus Aster. ASER is among the lowest in the industry. Given what you mentioned on you know. Encore being largely daycare and that being a focus area for you, should we. Expect this to stay at this level or even drop further? That was question one. Question two was in terms of you. Know, AI initiatives or technology initiatives. Given that a large part of the network is in tier 2 and tier 3 cities. Right. Are there any remote diagnostics or AI initiatives that you’ve been taking that could possibly keep, you know, availability of challenge being a, availability of talent being a lower challenge in, in those centers? Mr. Ramesh, you want to pick up the yellow question.
Alisha Moopen
So as far as you know, as rightly mentioned, it is all about oncology daycare more of a targeted therapy has been done. So daycare has been improving day, day by day. Chemo daycare is more number of patients have been there in chemo day care. So that’s one, one impact. Second is we have also not many of key procedures, keyhole procedures and we have been using a lot of, I mean, I mean sorry, soft tissue robo also for you know, various other procedures. And as sometime back I mentioned, you know, in a place like Med City we have, we do around 80, 85 to 90 Davinci, sorry your robotic procedures and and of course lab surgeries are gone up.
So there’s a significant reduction in average length of say if you ask me will there be a further reduction? I mean it’s very, very difficult to say. But I’m sure this is the best. What we are in this is that shift which has been happening too a lot of procedural different procedures which we have taken up. I’m sure this would all be the, the best. And the length of stay is also to do with you know, your quality parameters like you know, infection control practices and thereby the length of stay is high. So we have one of the best quality parameters closely monitoring by all the chief of medical services.
So all these factors are contributed to a reduced iOS.
Unidentified Participant
Right. And Mr. Kana, if you could just give us a sense on, you know, whether from where you are at 3.9 given post the merger learnings and synergies, do you expect there to be a reduction?
Varun Khanna
So Siddharth, thanks for the question. So let me add to this. I think the reason you see the differential is also the mix of specialties. So what QCL does in terms of enhanced revenues, enhanced revenue mix is a high mix on account of orthopedics, cardiothoracic, neurosciences. So when you do complex work around neuro, orthopedics and cardiothoracic, you will then tend to get a higher a loss. Our alos currently is sub 4 and largely driven by the mix part of it. We will continue to see improvement in this as well as we go robotic and oncology because that will bring in a lower ALOS patient into the system which is a high yielding patient as well.
So we’ll have a favorable impact to RPOB on account of value and also a loss reduction which is inversely proportional to the RPOB as well, if that answers your question. I think the second part that you touched upon is more on the AI, is that, could you be more specific? What kind of response are you seeking?
Unidentified Participant
Okay, so what I want to understand is given that both at QCL and Aster, you are essentially looking at a lot more of your capacity being in. Non metro towns where talent availability, I’m assuming, will be a relatively higher challenge. And in that context, is there any technology initiatives that you’re taking where certain operations can be done remotely or what. You may in order to reduce your talent dependence? That’s, that’s really the question. Or any other initiatives in which, you. Know, technology helps sort of improve the. Improve the ability to service patients in those towns better?
Ramesh Kumar
Yeah, fair question, Siddharth. There’s a lot happening on tech and AI in our industry. So let me first start with responding to your first part of the question in terms of dearth of talent. So I don’t think we are seeing dearth of talent, at least on the QCL side. And having heard what Alisha and Sunil mentioned around Kasargod, I don’t think we’re seeing dearth of talent. So these are tier two, tier three cities. And I just heard Alicia talk about 120 clinicians in Kasar God. And I just told you about the complexity work that we are doing in Aurangabad and Nagar Coil.
I don’t see that dearth of talent. So even for the complex work, the second part that I alluded to, I mean, today you can do transplants in 100 odd cities in the country. So it’s not limited to the 5, 6 metros that we know of. So that’s 1, 2 AI. Essentially we are looking at, we are looking at a lot of AI, but not certainly emanating from a need because of dearth of talent. So let me rule that out clearly. We are seeing, in fact, I spoke about eop, which is the first centralized solution that our group is looking at on radiation.
And that will be AI enabled, that will be tech enabled. And the idea to do that is not really, again, talent efficiency in some of these markets. But how is it that you can scale up the decision making, make it more speedier, make it more robust, make it more consultative? I think some of those are playing out. The third and the most important part that’s playing out for some of these investments is efficiency. We are Getting significant efficiency through some of the work that we are doing through AI. For instance, getting centralized call centers, getting pre recorded voice calls now with the consumer before they come into the hospital so that the EMR is enabled with the input parameters and the time between the OPD time can actually be reduced or the consultation time can be reduced.
So some of that is being played out. And by the way, these initiatives also help the consumer because the consumer is able to iterate a lot more to a chatbot or a chat or you know, they can choose their medium of communication. So all of that is certainly play out and that will be to drive efficiency. I hope that answers your question.
Unidentified Participant
Yes, thanks. And the last question was on the AP cluster in terms of inpatient volumes that’s sort of been flat for the nine months. If you could just throw some light. On how one should think about that. This question is I’m assuming is directed to.
Alisha Moopen
Yes.
Unidentified Participant
Yeah. Okay. So if you can elaborate a bit here. You would like to know about AP Telangana performance, is that correct? AP Telangana. If I just look at the inpatient volume, right. And, and maybe I will tell you. The specific slide that maybe I may. Have then not looked at it correctly. I’m looking at slide 40 of your. Presentation where you know, in, in Q3. You’Re continuing to see the inpatient volume even in AP Telangana being flat. Right. I mean 400 inpatient visits extra. So. So that’s the one that I wanted some understanding.
Alisha Moopen
Yeah. So if one looks at it on a nine month basis, which I’m seeing right there also it’s sort of been. Been slower growth. So. Yeah, so. So we have, especially when it comes to Telangana, sorry, ap, AP part. We have Vijayawada, Guntur and Angola. The three units what we have. Whereas anthropathy also we have Tirupati is doing exceedingly well. If you really look at that is one unit which is consistently performed very well and average around, you know, 130 or 140% of the budget achievement. And whereas in Vijayawada, the. The Vijaywada is a major center for especially the case mixes cardiology. And some of the clinicians are there. We had attrition as far as Vijayawada and Guntur is concerned. So now they, now we have replaced these clinicians.
Thereby the volumes are picking up. Guntur also volumes have started picking up. So you will find a steady growth happen coming in the next few months. We have replaced all the clinicians wherever attrition was there. Ungol had certain several also had the competition, you know, Where a few of the doctor clinicians have left to the competition but all have been replaced and ongoal is also bounced back in last two months achieving their budgets and volumes are also there has been a significant growth. So it was a temporary setback and I think we have taken action on that and you can see a steady growth in coming days.
Unidentified Participant
Thank you.
operator
Thanks dad. In the interest of the time I would like to take the final question for the management. Mr. Sheena Ryan, can you please ask the question?
Unidentified Participant
Hi, thanks for the opportunity. Hope I’m audible. Can you hear me? Hello?
operator
Yes, we can hear you.
Unidentified Participant
Okay. Yeah. So my first question was in the material cost. So if we see year on year. Adjusted for wholesale pharmacy seats it’s up. 50Bps now how much of it can be attributed to higher material costs coming from oncology and cardiology. So yeah, thanks for the question. So on the 50% 50 pips what you’ve seen I would say 60 percentage of that should be attributed to oncology and another 20 percentage due to neuro because we’ve been good amount of DBS cases Also our DBS actually have doubled year on year and mostly unbalance another 20% issue attribute to the robotic procedures also. So we’ve been doing almost now 300 robotic procedures every month. It’s 100 growth yoy out of that more than 60% of the robotic processors are the soft tissue and balance. 40% is Ortho. So I think the we are been doing a lot of because see we’ve been treated more like a quaternary care and we’ve been a referral center in all our key hospitals like cmi Mid City and Calicut where you get a lot of high end referral patients.
That’s where we do TAVI DBS robotic procedures and specifically oncology and oncology. 60% of its Medum wherein the material cost usually it’s around 45 percentage in that 40 to 50% is my immunotherapy and target therapy their margins literally there’s no margins for my mara, you know the materials and usually for every patient the average yield goes between 4 lakhs to 7 lakhs and out of that as I said 70% is your material cost there. So the question what we are now looking is that again as I said whatever the metal cost because already whatever you you looked at last three years we have been able to drive the metal cost from 25.5 to below 21 last year closing at 20.9.
And that has changed little bit in the current Year because of the case mix. But what we are also seeing is that as Mr. Ramesh called out, we have been adding more, you know, the clinicians in the other Congo mix also. So that’s going to help us to drive the overall Congo mix and also ensure that there is a good growth equivalent to what we’re seeing in encore. As I said, in Congo we’ve grown by more than 240bips. Yoy. But out of the new look at the all the Congo specialty breaker, the highest has been the oncology at 27% only in quarter three that is the highest.
And second highest would be our cardio and third highest would be neuro. Right. So I expect once we’re able to, I would say neutralize more or less the growth and I think we will be able to get it down below 21 going forward.
Alisha Moopen
Okay. But then as a target mix of revenue, where do we see oncology in medium term, two, three years and how would that, you know, impact our material. Cost over so yeah, that’s another good question. And I think we’ve been calling out saying that we’ve been doing very heavy investment in oncology and oncology has been the fastest grower in all our specialties. Two years back we used to be around 8, 9 percentage. Now we have moved to an 11% contribution on revenue. And the way it’s going, I don’t know, another four to five years, we expect it to be in high teens. Right. That’s a growth engine which we are looking at. But at the same time that’s also been part of our Congo growth.
Right. Because on a blended we would be around 53, 54. And with that as Varun called out, we are looking at more than 60% plus and oncology will be the major driver growth. But I think metal cost, we should not get too much worry on the metal cost because oncology also gives you a good EBITDA per bed growth. That is something which we need to always watch out for.
Unidentified Participant
Thanks. If I may ask one last question. Okay. Please. Yeah. So on slide 48 of the presentation, there are a few synergies that we have highlighted. So you know which of these is most sensitive to delivering the EBITDA upside. Potential of 10 to 15%. So which is your top priority after the merger? Say you want to get this done in six to 12 months, first thing. Which you want to do and which if it is not done, has the. Highest impact on your EBITDA margin expansion.
Varun Khanna
If I want to jump in Sinan the the quick answer will be the material. Right. Today I have thousand crores purchased as an aster and QCell has got 100,000 crores. Imagine bringing the two things together and negotiating a 2,000 crore procurement and also getting the best of the both worlds on the formula mix. And I think that’s a no brainer. That’s going to be there first target and I think we should be able to do really well on that.
Unidentified Participant
Okay. Okay. Thank you so much. That answers my question.
operator
All the best. Thank you everyone. Thanks to the management. There is no more question to the management. Now. This concludes the earnings call for this quarter of Astradium Healthcare. I thank the management and all the attendees for joining us today. If you have any other further questions or queries, please do get in touch with us. Thank you.
Alisha Moopen
Thank you everyone.
Ramesh Kumar
Thank you.
Varun Khanna
Thank you.