Note: This is a preliminary transcript and may contain inaccuracies. It will be updated with a final, fully-reviewed version soon.
Artemis Medicare Services Ltd (NSE: ARTEMISMED) Q4 2026 Earnings Call dated May. 11, 2026
Corporate Participants:
Devlina Chakravarty — Managing Director
Unidentified Speaker
RUDRA NARAYAN ACHARJEE — Investor Relations
Sanjiv Kumar Kothari — Chief Financial Officer
Analysts:
Himanshu Binani — Analyst
Unidentified Participant
Unidentified Participant
Aditya Chheda — Analyst
Shanskar Singhal — Analyst
Unidentified Participant
Unidentified Participant
Presentation:
Operator
Ladies and gentlemen, good day and welcome to Artemis Medicare Services Limited Q4FY26 earnings conference call hosted by Anvati Shares and Stockbroking Limited. As a reminder, all participant lines will be in the listen only mode and there will be an opportunity for you to ask questions after the presentation concludes. Should you need assistance during this conference call, please signal an operator by pressing Stardom zero on your touchstone phone. Please note that this conference is being recorded.
I now hand the conference over to Mr. Himanshu Bhirani from Managati Shares and Stockbroking Limited. Thank you. And over to you Mr. Binani.
Himanshu Binani — Analyst
Thank you Nirav. Good day everyone and welcome to the fourth quarter and full year FY26 earnings conference call of Artemis Medicare Limited hosted by Anandrati Shares and Stockbroking. From the management we have Dr. Deblina Chakravarti, the Managing Director, Mr. Sanjeev Kothari, the CFO of the company and Mr. Rudra Narayana, the Head Investor Relations. I would like to thank the management for giving us this opportunity to host this call. We’ll begin the call with a brief opening remarks from the management post which we will have a session open for Q and A.
Without further ado, I would like to hand the call to Ms. Devlina. Thank you. And over to you Ma’. Am.
Devlina Chakravarty — Managing Director
Thank you Himanshu. Good morning ladies and gentlemen and we are pleased to share our financial and operational performance for the quarter. As we wrap up FY26, I would like to begin by providing an overview of the healthcare sector and the overall hospital industry. The healthcare landscape continues to evolve driven by both rising demand for specialized services and technological advancements. The healthcare landscape is evolving with a growing preference for high value treatments as patients become more informed and discerning in their choices.
Additionally, government policies and tariff adjustments in health care have introduced certain challenges in the short term. But we are very confident in our ability to navigate these challenges through our operational agility and strategic cost management. For FY26 we delivered a strong performance marking another year of growth despite external challenges. Our consolidated revenue from operations for FY26 was INR 1081 crores reflecting a year on year growth of 15.4%. This growth was primarily driven by strong performance in our core specialties including cardiology, oncology and orthopedics.
Coupled with an improved payer mix and an increase in high complexity procedures. Our EBITDA for the year was INR218 crores with an EBITDA margin of 20.2%. This reflects our focus on operational efficiencies and disciplined cost management across our network of hospitals. Our profit after tax for FY26 was at INR 104 crores showing a year on year increase of 26.2%. Our quarterly performance highlights turning to quarter four FY26 we posted a consolidated revenue from operations of INR 279 crores reflecting a growth of 16.4% compared to the same quarter of last year.
This growth was primarily driven by higher patient volumes, particularly in our high margin specialties. Our EBITDA in The quarter was INR 59 crores with an EBITDA margin of 21.3%. Our quarter witnessed a strong increase in contribution from both domestic and international patients. Profit after tax for quarter 4 FY26 was INR 30 crores representing a growth of 32.1% from corresponding quarter of previous year. This strong PAT growth is a testament to our ability to scale efficiently while maintaining financial discipline.
Operational Highlights Our flagship hospital in Gurugram continues to deliver strong performance with occupancy level reaching 64.6% in quarter four. This reflects sustained demand for specialized and advanced health care services across key therapeutic areas particularly in cardiology, oncology and organ transplant. Our average revenue per occupied bed for quarter four was INR84571 showing a 7.3% increase compared to quarter four of FY25 driven by an enhanced case mixed and higher paying patients.
In line with our commitment to quality and operational excellence, Artemis Medicare received several prestigious certifications in FY26. Most notably we received
Unidentified Speaker
The Platinum Green Building certification while which entities
Devlina Chakravarty — Managing Director
Which entitles US to a 15% increase in SAR at no additional cost. This will allow us to add 100 beds to our Gurugram facility, further enhancing our capacity. Just to make a point here, our international patients despite the West Asia war continues to grow and this financial year showed a growth of 26.39%. The countries that we are witnessing high demand apart from Middle east is Africa CIS reflecting growing trust in our clinical capabilities and our clinical standards. This strong performance highlights our established position in medical value travel segment and the strength of our global brand.
Backed by continued focus on clinical excellence, patient experience and targeted international outreach, we remain well positioned to drive further growth in this segment. We also continue to make steady progress on our expansion initiatives, our 300 bed super specialty hospital in Raipur is on track to commence operations in quarter one of FY27, marking a key milestone in our growth journey. In addition, we are advancing our plans for the 650 bed facility in South Delhi which is expected to be commissioned in FY29, further strengthening our presence in key markets.
On the clinical front, we continue to make achievements in advancing patient care. We have launched several new programs including India’s first private geriatrics and longevity department as well as a collaboration with Kim Hyderabad for advanced heart and lung transplants. These initiatives highlight our commitment to providing cutting edge care to our patients. Our focus on digital transformation remains strong. In FY26, we made significant investment in technology to improve both patient care and operational efficiency.
We successfully implemented AI assisted triad systems across our hospitals which have already started to show positive results in reducing wait times and improving patient flow. Additionally, we are expanding our use of data analytics to optimize patient pathways and support clinical decision making. As part of our ongoing commitment to sustainability, we have taken several steps to reduce our environmental footprint. In addition to the green building certification I mentioned earlier, we have also focused on energy efficient systems across our hospitals and implemented waste reduction programs.
These initiatives are aligned with our long term goal to contribute positively to the environment while continuing to to deliver world class health care services. Looking ahead. Looking ahead in F1 27 FY27 will be an exciting year for Artemis Medicare as we continue to execute on our growth strategy. We remain focused on increasing our bed capacity with plans to expand from our current capacity of 800 beds to 2000 beds by 2029. The commissioning of our Raipur and South Delhi facilities will play a key role in this expansion.
We are confident that these initiatives will drive strong growth in the years to come. We also remain committed to enhancing our digital capabilities, improving patient outcomes and maintaining operational excellence. With the Board’s approval for a fundraising initiative up to INR 700 crores, we are well positioned to support our expansion efforts and continue to deliver value to all our stakeholders. With that, I will now open the floor for any questions. Thank you.
Questions and Answers:
Operator
Thank you very much. We’ll now begin the question and answer session. Anyone who wishes to ask a question may press STAR and one on the Touchstone telephone. If you wish to remove yourself from the question queue, you may press STAR and two participants are requested to use handsets while asking a question. Ladies and gentlemen, we will wait for a moment while the question queue assembles participants. You may press STAR and one to ask the Question. The first question is from the line of Sanjay Shah from KSA Shares and securities.
Please go ahead.
Unidentified Participant
Good morning to all and doctor, thanks for a wonderful explaining the opening on the opening remarks about hospital and healthcare industry in India. And ma’, am, I really appreciate your presentation showing the critical care success story of our hospital. Ma’, am, my question was regarding can you highlight on critical capability of the hospital how we are progressing on that side. So
Unidentified Participant
As you are aware.
Operator
Ma’, am, can you hear us? Participants, please stay connected while we rejoin Dr. Devlina. Ladies and gentlemen, thank you for your patience. We have the line for the. For Dr. Ma’ am reconnected. Ma’, am, please go ahead. Sorry
Devlina Chakravarty
For the drop. Sorry and regret the drop. So Sanjay, you were asking about our critical care. Could you just retrieve the question quickly one more time?
Unidentified Participant
Yeah, yeah, it was. My question was more related to the critical care capability. Whatever we have developed and what we have planned ahead, that includes the whole healthcare ecosystem. Yeah,
Devlina Chakravarty
So you know, critical care I would divide into two types. One is a strong emergency care and the second is the in house critical care. So as you are aware that Artemis is known for our, you know, critical care in Haryana. We are not only treating our own patients but we, you know, we are the vessels center for a large number of critical care patients from across Haryana. So we have one is to three critical care beds and one three critical care beds. And we have a great network of transports which deliver, which delivers patients from secondary, primary and other tertiary care facilities to our hospital.
We have a large team of critical care specialists full time in house and we have various types of critical care. One is like a general critical care. Then we have a surgical critical care. We have critical care for transplants, we have critical care for cardiovascular surgeries, we have critical separate critical care for neurosurgeries, we have critical care for pediatric surgeries. We we have separate NICU and PICU which is level four in terms of critical care. And in terms of our emergency services, we have actually a very AI driven AI emergency facilities wherein we can pick up the patient from their house.
And the AI tool guides our paramedics and our junior doctors in the ambulance and connect them with the ICU and the emergency senior doctors. So actually the treatment starts in the ambulance as such, so that we do not waste any time if you are caught in traffic. There is no delay in patient treatment. So we have progressively and each year we are enhancing our number of critical care beds, our critical care super specialty. So that continues to be a big ticket item for Us in terms of delivery of care being a quaternary care hospital.
Unidentified Participant
Right? Right Dr. So my next question was regarding our international patient. We have been growing in spite of war and uncertain circumstances globally.
Unidentified Participant
Yes. How
Unidentified Participant
We can look our hospital in from by 2029 when we’ll start a geographical diversification to South Africa, from north to other areas a new geography is in India also. And is there any scope of international preparation because we are. We are the highest among the industries. So can you highlight upon so basically
Devlina Chakravarty
So our endeavor would be to remain at the same 30 31% of revenue coming from international patients in irrespective of where we are and how our top line moves. So every year we add more countries to our list. We increase our MOUs with various international governments. So we have a full strategy and we have a separate international team who works only towards that. So our strategy will continue to have 30 to 31% of revenue from the international like we have today.
Unidentified Participant
So doctor, now adding our bed in South Delhi will help us to increase our RPOB from here. Because going to large metros from NCR regions.
Devlina Chakravarty
No. So you know in we are in NCR and we have the highest R POB in NCR we are higher than even Delhi but we have been growing 7 to 8% year on year on our rpob. So that will be the trend if not more. Definitely Delhi is a higher South Delhi is a higher rpob areas. But in Gurgaon we beat even the South Delhi R pops because of our mix of patients, our high end surgeries and our efficiencies of turning the bed around. You know the bed turnaround time and we will continue to do so and increase like how we are doing 7 to 8% year on year.
Unidentified Participant
My last question was regarding can you touch upon our Mauritius bed capacity increase from 80 to 110 and how we are doing over there.
Devlina Chakravarty
So the first hospital is broken even and is making a profit. The second hospital has just started so we are already beginning to get the fee for the second hospital. So we are on a monthly fee for running and doing our so you know giving our expertise to these hospitals and we are pretty much on track. We were pretty much on track with the first hospital and we are pretty much on track with the second hospital which has just started in April.
Unidentified Participant
Thank you very much. Very helpful. Thank you very much.
Devlina Chakravarty
Thank you. Thank you.
Operator
Next question is from the line of Aditya Chera from Inquired Asset Management. Please go ahead.
Aditya Chheda
Hi, good morning. Congratulations on the members. I have two questions. First was on the women’s project Would you be able to share any project details that are outlined with respect to what should be the capex per bed etc. And how the facility will come over in phases. And the second question was about the EBITDA margin profile across the hospital cardiac care and daffable segment and the reason for this is whether the losses from the Raipur facility will impact the EBITDA growth or they will be offset by the Gurdam operating leverage and any losses from daffodils, cardiac etc.
So if you can highlight on these I
Devlina Chakravarty
Will answer the second question first and for the first the KPIX and all I’ll hand over to Rudra to give you a detail for the second question Our this thing is there will be certain some losses in Raipur but if you look at our projections our increase in EBITDA will continue because you know our occupancy in the Gurgaon hospital is increasing. Our mix of cases you know is becoming better. The new towers are reaching their maturity so the EBITDA growth will continue in the coming financial year despite losses in Raipur, Daffodils and cardiac care have are all EBITDA break even and making small profits.
So that’s actually a non issue in this whole piece. Our endeavor would be to offset the Raipur losses with strong growth in EBITDA in our Gurgaon facility. So that’s to answer your second question for the first one the project highlight I can give you that we have already we are in the process of admitting our drawings our plans to the MCD post which the demolition of the old structure is going to start. We are pretty much online in terms of timelines for these actions but in terms of capex so it’s a 650 bedded facility which will start in two phases of 450 and 200.
But the capex and other details I hand over to Rudra to reply to Hi
RUDRA NARAYAN ACHARJEE
Aditya Rudra this side
Shanskar Singhal
For the CAPEX portion aditya there is a two part to it. The first part for around 350 for around 450 beds the capex would be to the tune of 350 crores and for the second 200 beds it would be another 150 to 160 crores total would be 500 crores for 650 beds which will be close to 75 lakhs to 80 lakhs per bed. So that is on the CAPEX part of this. Aditya, any questions regarding this?
Aditya Chheda
This Includes everything, right. Land, equipment, etc. The full project. So
Shanskar Singhal
Land and building is owned by the trust. We have, we have in our portion we had the interiors and the equipment. These include the interiors and the equipments.
Aditya Chheda
Got it. And lastly on the additional far at the Kurgaon facility, would you be adding those in FY27 or it will be in phases.
Devlina Chakravarty
So we are basically looking at both all the options. We have a little pipeline with some other opportunities. So and we have this option of 100 bed facility here. So we are kind of taking that call whether to start this 100 bed facility in the, in the current financial year or to take up another if possible take up another brownfield or a greenfield project if that’s available. So that we will clear in the next few weeks and we’ll continue come back to you and you’ll hear it from us very soon.
Aditya Chheda
Thank you.
Operator
Thank you. Next question is from the line of Adesh Gosalia from Spark. Please go ahead.
Aditya Chheda
Hello. Thank you for the opportunity and congratulations to the management for excellent set of numbers and ending by 26 on such high notes. I had a couple of questions. So firstly on the EBITDA margins we saw our Q4 EBITDA margins inching up to 18 and a half percent the levels we saw in the Q2 of this financial year. So this is, this will be continuing for the next 27, 28. We will be maintaining the like continuing the Gurgaon facility at this at such high margins for the entire year or we should expect some similar trend of FY26.
Devlina Chakravarty
We will not only try to maintain it but we will try to better it with some plans that we have. So you will see this continuous growth in the present financial year also. Yes.
Aditya Chheda
Okay. And on a blended level like after the Raipur comes up. So I think Raipur would be like commercialized in Q1. So the 3/4 of FY27 would see the entire impacts of RIPOs. And I think the break even is expected in 15 to 18 months. If please correct me if I’m wrong over there. So what should be the blended level on the margins that we can expect.
Shanskar Singhal
So Rudra this side. So as Dr. Devlina mentioned, we will be continuing this 21.2 or the 19.4% without the other income for Gurgaon facility. And it will the margins will expand only over the period of time. But having said that like we had indicated earlier there would be close to 18 to 20 crores of losses from Raipur so that we are standing with the same levels 80 to 85 crores of revenue, top line for Raipur for FY27 and 18 to 20 crores of losses. So that overall mix will, will be putting the ebitda maybe a one on one one to 1.5% lower because of these losses.
Aditya Chheda
Okay. Okay, makes sense. Second question was on the operating bits right now we exited FY26 at 544 operational bits. So how are we looking this trend inching upwards from here on or this would be maintained like if you can share some color on this.
Devlina Chakravarty
So 546 beds which you saw this year immediately starts with 200 more beds. There is an option of adding another 100 beds in our facility and or picking up a brown or green seal project. So this bed expansion like our commitment is 2000 beds by 2029. And you will see the beds increasing in phases as we move to 2029 with 2000 plus beds. Definitely by 2029.
Aditya Chheda
Yes, that is, that, that I understood. But I was asking on the operational bit. So from current Gurgaon facility we are, we had an average operational beds of 544 and 526. So on that I was, you know, I wanted a bit of a color that how much, you know, room is there for us to grow this operational beds. And similarly for Ipur also like from 200 beds coming up, how many beds will get operationalized in FY27?
Devlina Chakravarty
Yeah, so for Gurgaon I’ll stick to Gurgaon facilities first. We have the ability to start 100 more beds. But like I had mentioned earlier today, we are at 64.6% occupancy. The moment we have 70% occupancy for a quarter, we are going to be opening 50, then another, another 50 beds. That is to put the Gurgaon in perspective. As we speak our operation, our occupancy is going up. It has moved from 60 because we have opened new towers. Right. It has moved from 60 to 64.6% and we are keeping an eye at 71 quarter we will open 50 more beds and then 50 more.
That’s for Gurgaon. For the 200 beds which we are starting in quarter one of the of FY27 in Raipur. The first phase will see 100 and 50 beds operational and within three to four months we will be adding 50 more beds because we are looking at it as a high volume market. And so I, I think in two quarters you can expect all 300 beds operational.
Aditya Chheda
Okay, that’s, that’s great to Know. And lastly the capex figures that Rudra mentioned regarding the women’s facility. So how much of that. So if you can just share a timeline that how that would be incurred over the next two years.
Shanskar Singhal
So these capex for the. For the capex portion will come after FY27 only because interiors and equipment has to be placed and we are planning to start it by FY29. So the CapEx portion for women’s piece from Artemis side will come into picture after in the mid of FY28 because we have to start the interiors and the. And the equipment for the advanced portion that is there for which is linked to the building milestones that we have started paying it slowly and gradually because the building has to be built and that advance will be adjusted when once the hospital gets operationalized over a period of 8 to 10 years.
Aditya Chheda
Okay, got it. So the FY27 I think the would be a very capex light year for us. Like there won’t be any significant number coming up in the books in F28. The major numbers would be.
Shanskar Singhal
No, no. Only the replacement pays of gur and and splitting of RUR because 50, 60% we have already spent out of 110 crores. So rest 5660 crores. So total would be close to 100 and 100 crores maybe.
Devlina Chakravarty
Yeah, that’s right. In
Aditya Chheda
FY 2700 crores is the capex figure that would be coming in
Shanskar Singhal
Correct? Correct. Correct.
Aditya Chheda
Okay, got it. There are a couple of more questions. I will fall back in the view. Thank you so much.
Devlina Chakravarty
Thank you.
Operator
Thank you so much. Adesh. Next question is from line of Shankar from Iraya Capital. Please go ahead.
Aditya Chheda
Hello. Yeah, hi. Good morning. So I have a couple of questions. First on the can you give a bit more color on how was the growth in international patient in the last quarter which is Q4FY26 and what are the trends that you’re seeing on that front in the current quarter? Q1 FY27.
Devlina Chakravarty
So the. The last, the third month of the last quarter which was in the month of March, we saw a 15 to 18% dip in the international patient which has turned around in the month of April. And the recovery had started in the month of April and as we speak in the month of May we are almost closing onto almost 90% recovery as we speak now.
Aditya Chheda
So. So you’re saying that the impact of war which was seeing in March has been almost subsided in the current quarter and we are on. Almost back on track.
Devlina Chakravarty
Yes. Unless something new happens, we are back on track. Yeah.
Aditya Chheda
Okay, and the countries that you mentioned that you are looking to add going forward, what are the other countries that we are seeing strong demand? We are
Devlina Chakravarty
Not only, we are not only confined to Middle east, we are confined to a lot of comes from Africa, cis, the SARC nations. Now we are also looking to open. Earlier we had only East Africa. Now we have also opened large number of countries in West Africa and the Francophone nations. We are also looking at now at Canada and we are looking at some Nordic countries where patients are coming in for high end treatments. So every year we add a couple of countries, if not more. And so that this exercise and this continuity is maintained and any problem in one region does not affect the overall international flavor for us.
Aditya Chheda
Okay, so if you can share, what is the proportion of Middle east patient in our current international patient? If you can share that color,
Devlina Chakravarty
I would say, I mean, how much is it? 3%? 30%. 30%. Okay, 30%. Yes.
Aditya Chheda
Okay, understood. And you touched upon that you see the case mix improving. So if we are maintaining our international patient at 31, 32%. So how do you see other segments of the case mix in the next three, four years
Devlina Chakravarty
As you keep adding high end facilities, high impacts, you know, case mix not only for international but domestic. So we have seen a surge in our domestic numbers and in, we are also seeing continuously seeing a surge in the high end, you know, patients in the domestic, which is also a very big welcome and that had actually offset some of the international dip which we saw in March of last quarter. So basically, you know, high end surgeries, like whether it is neurosurgeries, cardiac surgeries, oncosurgeries, transplants, we are seeing increase, both domestic, especially domestic, as well as international, in, in these areas, which is, which is a very welcoming trend for us.
Aditya Chheda
Okay, so is it fair to say that you can see government mix going down in the next few years?
Devlina Chakravarty
See, the government mix in terms of percentage might be the same as we’re increasing the number of beds, you know, but in terms of percentage, because sometimes when you’re opening new beds, you want to prevent, I mean, beds which are not occupied, you don’t want a situation like that. But overall, if you look at the businesses, our endeavor continues to have cash, TPA and international more than any empanel business. But the good news is also the government is also, as you’re aware, is revising the rates and we are sometimes, we are cherry picking some of the, you know, the investigations and treatments which are almost close to our rat Rates.
So it’s actually a strategy. But we definitely don’t want the government business to come up and it’s not coming up. But we keep moving around in a manner so that no bed stays empty as we increase capacity. So that’s basically what I wanted to say. Yeah, yeah,
Aditya Chheda
Understood. So my next question is around the Gurugram facility. Can you give any hard code number around the EBITDA margin how you see it going in the next three, four years and mainly what are the improvement drivers for that improvement in the EBITDA margin from Gurugram Facility?
Devlina Chakravarty
So Gurugram Facility will see ebitda northwards of 20% if not more in the coming years. And this will be driven by three factors. The first one is a large number of high end domestic and international patients. Secondly is efficiency in our consumption. We have gotten our consumption down by one and a half, 2% and that endeavor will continue. And third will be basically as we have more specific facilities, the corporate cost is going to get divided amongst the various facility which today sits in Gurgaon alone.
So all these three will contribute to an upward of 20% of EBITDA in Gurgaon.
Aditya Chheda
Okay. Sorry
Operator
To interrupt, Can I request you to please come back for a follow up?
Aditya Chheda
Yeah, sure. Thanks.
Operator
Thank you. Next question is from the land of Anshala Dharwal from MK Global. Please go ahead.
Unidentified Participant
Hi. Thank you for the opportunity and congratulations on a good set of numbers. Thank
Devlina Chakravarty
You.
Unidentified Participant
Could you, could you. Ma’, am, could you please allude on the, on the further scope of sort of improving our occupancy at Gurgaon? I was observing that in the past our occupancies in the Gurgaon has sort of hovered around the 63, 64% range. And now that we add beds, can occupancies go north of 70? Odd percentage here onwards?
Devlina Chakravarty
Yes, yes, absolutely. And that is what we are aiming and that’s when we are also trying to open our new beds. So we are looking and definitely by quarter two of the current financial year we are looking at, to move to touch 70 if not exceed it. And because we have, we have the numbers, we know that it will be reaching at that and our endeavor would be to, at 70, 75% which is optimum for us actually for us for the last couple of years we have been non stop adding beds, one tower, then various floors in a tower, then the second tower, then opening various floors in the tower.
So when you see your base, that is number of beds increasing the occupation occupancy looks more or less the Same because our denominator is gone, becoming higher. But now with all the beds open, we are confident to reach 70 if not more by quarter two of this year. Okay. Okay.
Unidentified Participant
My second question is on the Raipur unit. You. I think Rudra alluded that we are expecting about 18 to 20 crore of losses which should be more than offset by Gurgaon unit. Are there any costs of doctors or. Or any other line item which are sitting in our console business right now? Since you are just about to start this unit.
Devlina Chakravarty
No, no, no. Nothing.
Unidentified Participant
Okay. Only once and we operationalize, Raipur costs will sort of come in.
Devlina Chakravarty
Yes, yes, yes, that’s right. That’s right.
Unidentified Participant
Got it. Also ma’, am, you alluded to certain government tariffs in the healthcare sector which has led to certain. Would you be able to elaborate on this?
Devlina Chakravarty
No, I said some of the government tariffs have gone up. They have given us
Unidentified Participant
The CTHS pricing has improved so that that would be beneficial. So they
Devlina Chakravarty
Have revised for private sectors to take in government patients because there was a large number of rejection from various hospitals. So they have revised it for the better. That’s what I wanted to say.
Unidentified Participant
My apologies. I got that wrong. The. The next question that I had was on our case mix, while you alluded that, you know, our complex. The share of complex care beds or cases has sort of gone up. If I look at our numbers, our Congo mix has sort of slightly dipped. Not meaningfully, but slightly dipped. Whereas our
Sanjiv Kumar Kothari
Peer mix has trended. The Congo mix
Devlina Chakravarty
Is basically the oncology one. And there were two reasons for it. One was there was a pushback from the TPAs for the immunotherapy. You know, the. Because they. There has been a very big fight between the hospitals and insurers on use of immunotherapy which is far more expensive than chemotherapy. So this was a pushback and immunotherapy, of course the margins are less but the cost goes up. The. The top line moves up. So we have now spoken with insurers and we have moderated the use of immunotherapy.
So that is one reason. Secondly, in between a circular had come from the government regarding chemotherapy for government government patients which was not conducive for. For private hospitals. So all private hospitals at that point had stopped chemotherapy for these empanel patients till discussions were concluded and conducive part was found for the hospitals and now we have restarted. So these were basically transit transient and mainly for the oncology piece. And. Well, that’s what I would like to highlight.
Unidentified Participant
Great. All the very Best ma’, am for the coming year. Thank you.
Devlina Chakravarty
Thank you. Thank you.
Operator
Thank you. Next question is from the name of Avnish Tiwari from Micra. Please go ahead.
Aditya Chheda
Hi, can you articulate your outlook on pricing growth in your treatment given that two forces, One is the number of bags which are being added by various hospitals as well as there’s some level of negotiations in health insurance industry including standard operating procedures, reducing the waste and fraud. So maybe if you can just articulate in your ARPOV growth of 7 to 8% what kind of pricing or inflation driven pricing growth you’re looking at.
Devlina Chakravarty
So basically for our pricing, if you look at our competitors, so we are slightly on the lower side as compared to our competitors. This is. But we build on it. We build on our rpob not through our price but through our efficiency and case mix. And we keep ourselves the incremental pricing which is happens year on year. It is, you know, it is in a range of 3 to 5%. Actually 5% which finally comes down to 3% for us because TPAs and insurers have a locking period of three years with the price. So we get a 3% impact only from pricing because government doesn’t change and the TPA doesn’t change.
So only the cash and the international pricings. So we get a 3% but we, rather than increasing the price, we work on Kate’s mix more deeply and in, in terms of efficiency. So whether it is the turnaround time of the beds, whether it is the cost of consumption, you know, quickly, how quickly we can discharge a patient. So we work around those parameters rather than pricing. So to answer your question, we are moderately priced lower than many in our region. I mean the big ones, the big quaternary, we are probably as much as Medanta, but cheaper than a Fortis or a Max.
So that’s where we stand. And we don’t use pricing to drive our business.
Aditya Chheda
Great. And lastly on this health insurance segment, do they then favor you over others to the extent they can influence the traffic or how that negotiation with those guys.
Devlina Chakravarty
So we have, we have a good relation with all our insurance players. Yes, they do promote Artemis as a place, but at the end of the day, a hospital which is 18 years old, a lot of choices are made by the preparations themselves. But definitely the TPAs, the TPA and the insurance business is a large chunk of business for us.
Aditya Chheda
Okay, let’s squeeze one more. This standard operating procedures and everything the GI Council is working on, how is that impacted your business and your previous business? Does it Create an operating advantage for you because you’re more efficient. Right. So
Devlina Chakravarty
I am a part of that council in CII. I had the working group three where which has been kind of moderated now by Mr. Ajay Seth, chairman of IRDA. So I am a very much part of all of this. And I can only tell you there are five working groups working on various aspects. One is categorization of hospitals which will give transparent pricing. Then you know, ethical things between the insurer and the hospital. So there are multiple such five agendas which five working groups. And I can only tell you when all these groups are implemented it will be a huge benefit for the hospitals and also a huge benefit for the insurers.
It’s going to be a win win situation. And luckily we have Mr. State as in the center, the GIC Council. So you know this is going to be winning ticket for all hospitals because then we really don’t have to flog for getting the right price or getting the renewals on time and so on and so forth. Which was. Which has been a problem with the hospitals because the insurers, you know, they continue beyond three years do not give us price revision or they try to sometimes bully us to get low prices. So now there is going to be a huge amount of standardization.
And as far as Artemis is concerned, I can only tell you this will be a new dawn in business for us because I’m very, I’m working very closely with them.
Aditya Chheda
Great, thank you. I wish you very good.
Devlina Chakravarty
Thank you.
Operator
Thank you. Next question is from the line of Aditya from Railwood Capital. Please go ahead.
Aditya Chheda
Good morning everyone. So first of all congrats on the strong performance. I just want to get a better sense of the overall RIPUR and physical market. So RIPUR has seen like meaningful capacity addition over the last year or so. One listed player has entered and few local hospitals have come up. So I just want to understand like do you believe there is sufficient flying demand in ripurance of teliver to absorb these new bed additions without meaningful pressure across occupancies? And when you think of your own ramp up, do you see your growth coming primarily from capturing share from existing players?
Or your thesis is more that overall market is under penetrated and will grow with new supply. And who do you see as key competitors in that market?
Devlina Chakravarty
Okay, so going on to Raipur. Let me tell you Raipur is a market where every tertiary and quaternary private player is looking at. So as we speak, whether it is a Manipal, whether it is a Leelavati, every either they are buying land or signing mous and so on and so forth. And I predict Raipur to become something a mini Lucknow going ahead. Today they don’t have a single, they have large number of hospitals but they do not have a single so called hospital with the right kind of an infrastructure, all medical equipment and the right kind of doctors.
Right. So like you know whether it is these are transplants, whether high end neurosurgeries, neuro interventions, whereas there is a deep penetration of insurance, there is the per capita income of Chhattisgarh, especially Raipur is very high. So our strategy is to create Raipur hospital as a nodal hospital for Chhattisgarh because you know almost 60% of patients from Chhattisgarh come to Bombay and Delhi for treatment. So and they are, they do not get treated in their own state because of paucity of care.
So we are trying to position ourselves and have the first mover advantage to getting all the patients who are moving out of Chhattisgarh to be treated in Chhattisgarh. And everybody’s eyeballs are being grabbed by Raipur now, all other big players. So we are trying to establish a first mover advantage in terms of name, quality of care, transparency in care and so on and so forth. So that’s the gist we had actually before going into Raipur had done a complete market survey through PwC. And also the good news is our partners who own the land and the building are the two most reputed doctors of Raipur.
So there is already. So it’s not like a new territory for or I mean it won’t be a totally an unknown territory, the hospital for the patients. Because our partners are the two topmost doctors of Raipur. So this is basically the gist that I wanted to give you.
Aditya Chheda
Got it. Thanks. Just to follow up, so what is the Capex per bet for the Ripos hospital and what will be the specialty mix and Payer mix as it operationalizes.
Devlina Chakravarty
So it will be between 110 to 120 crores is a capex for a 300 bed facility. And we are doing every. So we are going to be the, every specialty is going to be there in Raipur. We will be the first hospital to have a pet CT scan, you know in the hospital. Apart from that we will have radiotherapy, robotics, transplants, you know, all the things for which the people of Raipur are going out of Chhattiskar or you know, to get their treatment. So we have identified that, we have identified it district wise.
What is the need need so that this can become a central referral center. Referral hospital for Chhattispur.
Aditya Chheda
Got it. One last question. Basically according to my research like there in terms of manpower state like Chhattisar, there is difficulty in basically attaining specialized manpower in terms of doctors, nurses and skilled technicians. So how is the Artemis team going about hiring and basically retaining the specialty? That
Devlina Chakravarty
Was the first deep dive we had done. Apart from the financials of the market. That’s the first deep dive. So Raipur has its own medical college, postgraduate college, three nursing colleges. So all our resource heads of departments, various departments are all in place. So all the letters have been rolled out and they will be joining from first week of June, which is next month. Nurses are all been hired. So you know there is no paucity of medical manpower. Training is ongoing to bring them to our level of expectations.
But they are good quality people. They are doctors who are trained in robotics, who are doctors who are trained in the, you know, very high end cardiac interventions. And they’re all there. So now because of the insert that we are providing, they are happy to join us and they’re all in place.
Himanshu Binani
Sure. Thank you so much and all the best for the future.
Devlina Chakravarty
Thank you. Thank you.
Operator
Thank you. Next question is from line of Pratik Srivastava from Nivesh please.
RUDRA NARAYAN ACHARJEE
Yeah, hello ma’. Am. Ma’. Am. What could be the realistic R FOB from RIPUR facility in long run?
Devlina Chakravarty
So we have looked at 35,000, 33 to 35,000 plus to start with. And then as we start our high end like transplants and others, we expect it to be higher than that.
RUDRA NARAYAN ACHARJEE
If I look at 35,000 which is because of tier 2. Right. And Gurgaon is tier 1 very high. But if I look at your margin and you’re saying that you’ll be able to margin, you’ll be able to maintain the margin. But if I do, there are lots of factors which are working against it. Right. One is as you said, right. The R4 would be lower. Second would be your peer mix. You’re not going to get a lot of international stations. Right. There is the. Then of course the facility takes time. There is fixed cord burden.
There is also you know, Apollo Hospital. Yeah. So my question is that if I look at lot of factors they are working against at least for next one to your structural by the way, you know, because Raipur is a smaller rpob. So structurally anyways it’s a much weaker market for from the EBITDA margin point of view, not just from short Run.
Devlina Chakravarty
So you know you’re forgetting that in these places the cost is also less. And keeping all of that in mind, we have, we have captured around 20 crores of loss and a break even in 18 months time. So what happens is it takes six months, three months for the TPS to come, six months for all the government schemes to come. And almost at the same time we start getting the licenses for transplants and other things. And that’s how you move. Right? So we are starting at 35 000. The cost of running the facility is also lower whether it is food, whether housekeeping, doctors, nurses, paramedics.
So it is, it is lower in that, in that manner. So that is what we have said that in the first 18 months we will have a loss of 18 to 20 crore and then we will ramp these numbers up, you know, post, post getting all the licenses.
RUDRA NARAYAN ACHARJEE
So and so ma’, am, to make up for this
Devlina Chakravarty
Similar story like a large hospital, whether it is a max or a Medanta, they have a facility in, in a tier one and they have a facility in tier two cities right now. The rpobs will always be different in these two cities. When you look at the consolidated P and L, you take into account the high and the low R pops, the high and the low costs of manpower consumptions and so on and so forth. And that’s how you. But it always adds. If you look at the smaller towns, if you look at the standalone, their RPOVs are always, sorry, their EBITDA margins are always higher in terms of percentages than the bigger hospitals.
Because these hospitals though they might have a lower RPOP, they typically function anywhere between 20 and 25% EBITDAs because their other costs are low income. You know. So that’s how these things work out.
RUDRA NARAYAN ACHARJEE
Got it. One on the little larger term view. So this anyways we, you know it’ll take around three to four years for Raipur facility to be, you know completely ramped up to get to around occupancy level. But we have today at Gurgaon now do you see that in that till that term the Gurgaon of course will have to perform much better. But if I just do some simple calculation at least you know, based on the number what you gave. So Gurgaon facility will now today, which, which today is at around 21 EBITDA margin and at around the 230 or something.
Sorry, I don’t have that number but I think it needs to grow.
Unidentified Participant
Yeah,
RUDRA NARAYAN ACHARJEE
Correct. So it needs to accelerate its growth by around 6 to 7% I think crosses your 20% number which we gave earlier. It in my figures it needs to grow at around 23, 24%.
Shanskar Singhal
Hi Pratik, Rudra this side. So if you see Gurugao margins, if you see the Gurgaon revenues, it will grow at 15 to 15 between 15 to 17% year on year. And whatever revenues and you have seen the performance and the margin profile of Q4. So whatever revenue that gets added to the Gurgaon facility right now at least 30% will flow down. So and 18 to 20 crores of losses that I have highlighted for Raipur which would be a drag of 1 to 1.5% in the first year. After that, once the Raipur starts break evening, within 18 to 20 months when it is break even and everything starts starts flowing off in a neutral manner, it will add up to the ability.
So it, it is just a question of one to one and half years when the profile would be down first. Because maybe one, one to one and a half percent, not more than that.
RUDRA NARAYAN ACHARJEE
Yeah, that is what. Yeah, I think that is what even my numbers are saying one to one and a half. So it should not be a big drag. But yeah, some slight drag on the margin calculation
Shanskar Singhal
Would be 20 crores over at 1300 crores revenue that we are expecting is one and a half percent. So that is the overall thing. So one one and a half percent it would be down for around 15 months. Then it would again add up to the Ebitdas. That’s right.
RUDRA NARAYAN ACHARJEE
Yeah. Thank you. Thank you for the excellent answer. That clarifies my doubt. Thank you sir.
Operator
Thank you. Next question is from the line of Satyam Kumar from AAA Holding Trust. Please go ahead.
Aditya Chheda
Hi. Thanks for the opportunity. Actually I have a couple of questions first just wanted to get your thoughts. Like recently some news were flowing that health ministry is like examining margin caps on medical devices amid rising insurance costs and all. So like I think earlier proposal was 65% cap and recent discussion is around 30 to 50%. So do you have any thoughts on this? Anything you’d like to share?
Devlina Chakravarty
Sorry, I missed the question. Could you, could you repeat it? Sorry, I just missed it. I’m sorry.
Aditya Chheda
So recently there were some news flows with regards to that Health ministry is examining putting a margin cap on medical devices. The medical devices which hospital use to treat the patients. Okay. So in past also we have heard something on the similar lines when there were news that around 65% cap will be there. Recent news sources that that around 30 to 50% cap might be death. So is Anything concrete with regards to that the hospitals, for the hospital it can be a negative.
Devlina Chakravarty
No, there is no nothing concrete in this regard. And because I am also members of ciic we haven’t heard this and there is no notification which has come. The last time it happened was for the stent for you know, accident stents and implants and that’s where we are. Nothing new has been added to that list.
Aditya Chheda
Okay, understood. And ma’, am, would you like to give some like guidance for some something longer term like say next three to four years. What kind of top line you are eyeing for. And second like how the RPO of International Patient is growing with respect to domestic patients. So just these two questions.
Devlina Chakravarty
So basically you know and Rudra will give you a little bit more insight and we can’t give a guidance but I can tell you the next three to five years is the next phase of expansion that we are going to see. So not only are we going to consolidate and move bigger and faster in Gurgaon, our facilities in Raipur will start getting matured. Our Delhi facility is going to start. So some we don’t want to give numbers as such because that would be incorrect. But Rudra will be able to give you some kind of a flavor.
So.
Shanskar Singhal
Hi Satyam from our flagship hospitals, if you see we would be adding beds and over a period of three to four years you can take at least 15 to 17% growth on the revenue front and whatever numbers, whatever revenue that gets added to the top line at least 30% percent will flow down to the EBITDA. So that is the overall thing that we have in mind. And apart from that before the RIPUR thing I have already said you that there will be an 18 to 20 crore of loss and then it will start adding up to the overall P L.
So that is for the next two to three years and having. And also we have plans to raise up to 700 crores that we have taken the board approved approval and we will go for the shareholders approval once the assets are finalized. So that portfolio we have to see how the mix is and what gets added over India.
Aditya Chheda
And just one, if you can share insights with regards to how RPAP for International Patient is going compared to domestic patients.
Devlina Chakravarty
It’s one and a half times more, I mean 1.3 times I would say more than domestic patient.
Aditya Chheda
No ma’, am that I understand how the growth is happening. Like domestic how much percentage of price hike you are taking compared to international patient. That’s that aspect. Just wanted to understand
Devlina Chakravarty
15 hike even in the next budget we have taken a 15 hike on our top line and 7030 is the division between domestic and international. So similar hike we are taking in domestic and international business. So the top line we are budgeted with at least minimum of 15% increase in the top line and revenue mix. 70% domestic, 30% international with a 15% overall increase in the business, 15% for domestic and 15% for international.
Aditya Chheda
Thank you.
Devlina Chakravarty
Thank
Operator
You. Next question is from line of Cycaren from Palavarti Finsov. Please go ahead.
Unidentified Participant
Yeah, hi. Thanks for taking my question ma’. Am. Just understanding in terms of capital allocation, if we have to look at the cash flows which the company will generate in the next couple of years and the kind of capex you have articulated for Gurgaon as well as the new South Delhi and Raipur, don’t you think taking the debt itself will be sufficient to fund this? Why we need this kind of a large capital rise of 400 crores.
Shanskar Singhal
So. Hi Sai Kiran, Rudra this side. So for the rifur and including the 650 beds of Delhi the maximum peak debt would be close to 350 crores that we will have to take and currently it is close to around 260 crores. So that is. That will go up to 350 crores max. And we have, we will be generating the internal accruals and that would be enough to fund our existing projects that we have announced.
Devlina Chakravarty
So your question is why
Unidentified Participant
Do
Devlina Chakravarty
We need the fundraise? Is that what is your question
Unidentified Participant
Exactly, ma’? Am. Yes, please. Yes, you got it right. Thank you.
Devlina Chakravarty
Yeah. So basically what is happening is we need the fundraise because in some of these new projects we also have to give them a deposit. So the deposit is cannot be funded through bet. So we have to be. So that’s the reason that we have to kind of.
Unidentified Participant
And
Devlina Chakravarty
These are some of the projects which are in pipeline. So as closer to the time of finalization. So we have a, we have a pipeline which has some brown and green field projects and we should be. We are looking at the next four to six weeks to finalize at least one of them and then go for the raise because this would probably be required for this finalization of this new project.
Unidentified Participant
So in a way what you’re suggesting is that this capital, what you intend to rise will be for the projects beyond the three projects which you already have in place.
Devlina Chakravarty
That’s right. So we, this capital raised is only going to fund our new projects which could be one or which could be two. Yeah.
Unidentified Participant
And the second thing is primarily a simple extension of your capital allocation strategy. Whenever you allocate capital, what are the few things which you look at in terms of ROCs and then how do you think about deploying that capital in terms of the return ratios? If you can just articulate that is really helpful, ma’. Am. Thank you very much.
Sanjiv Kumar Kothari
I’ll ask Sanjeev
Devlina Chakravarty
To talk
Sanjiv Kumar Kothari
About it. Today is the project we basically focused on IRR and roc. IRR and roc and
Devlina Chakravarty
What kind of numbers you look at. Currently our
Sanjiv Kumar Kothari
Roc is around 14.5%
Devlina Chakravarty
And going forward
Sanjiv Kumar Kothari
We are expecting in the range of 16 to 18%.
Devlina Chakravarty
In how much period of time?
Sanjiv Kumar Kothari
In next three to four years time frame.
Unidentified Participant
So this will be the incremental capital when you allocate. That’s how you think about it, sir, 15 to 16% kind of an ROCE is what you intend whenever you take up the project.
Devlina Chakravarty
Yes. So when we take up the project which is with any new capital which is being deployed, we look anywhere between 16 to 18% ROC in the next three to five years. And that’s how we have extrapolated our new projects and when they fit the bill, only then we go ahead with the project.
Shanskar Singhal
Also to add to Dr. Devlina Saikiran, we look at the payback period and we see to it that the payback period is within five to six years of the time. That’s
Devlina Chakravarty
Right. So that
Shanskar Singhal
Is one of the factors that we think and we see the asset turnovers also. And those are few of the factors that we think we look at and then decide upon the new expansion program projects.
Unidentified Participant
Great. It really appreciate this ma’. Am, if I can squeeze in one last question. If you have to benchmark your Gurgaon hospital with the best in the ncr, do you still think that there are certain gaps in terms of the capabilities and then maybe some of the existences still some more what I can say, apnea in the Gurgaon hospital is needed or we are at par with the best in the ncr.
Devlina Chakravarty
So my answer is there is there is no deficiency in this hospital and that is why this hospital is the biggest hospital in terms of Gurgaon referrals. There was a survey done. So now the next phase of growth when the brand becomes popular in other parts of Delhi NCR and in central India. This is going to be a new era. So there is nothing that we do not do. From a heart lung transplant to laser liver transplant, bone marrow neurosurgery, neuro intervention, cyberknife, there Is not one thing that we do not do which is missing from our list.
So we are right at the top. And that’s also a reflection from our patient growth and rpops. You know, if you do not, if you are not in the quaternary space, you will never reach those rpobs.
Unidentified Participant
Thanks a lot. And really efficient. Thank you very much. Thank
Devlina Chakravarty
You. Thank you. Thank you.
Operator
Thank you. Next question is from the line of Anubhav Sangal from Ananwati Shares and securities. Please go ahead.
Aditya Chheda
Hi, good afternoon. My question would be do we have any sort of EWS obligation in the RIPUR and the new Grim Hands facility? And if so, then what would be the extent of it? If you can quantify that.
Devlina Chakravarty
So EWS goes on in every hospital, in every private hospital in Delhi, NCR and otherwise. So in gurma we have 20%. In Delhi we have 10% EWS commitment. And Raipur will be again in the range of 10% which we are not sure, but lesser than 10%. So actually complying to these EWS is not an issue if you know how to do it, how you move your facilities for the ews, how do you create your facility for the ews, how do you manage your supply chain? So you know all of that. So we are in this space for the last 18, 19 years with 20% EWS and we are known to be one of the best in Gurgaon in terms of compliance.
We have never had an issue.
Aditya Chheda
Sure. Thank you.
Operator
Thank you.
Devlina Chakravarty
Next question
Operator
Is from the line of Devang Patel from Samisha Capital. Please go ahead.
Unidentified Participant
Hi, just wanted a quick clarification.
Devlina Chakravarty
Yes, can’t hear you. Hello,
Unidentified Participant
Can you hear me now? Can you hear me now?
Devlina Chakravarty
Yes. Okay,
Unidentified Participant
Wanted to clarify the cash flow from operations for the full year is lower. So are there any one offs in the second half and what kind of EBITDA to cash flow conversions we can expect going forward?
Sanjiv Kumar Kothari
Cash flow from operation for the year, if you see IT, is around 60% of my EBITDA and free cash flow is around percent after netting of CAPEX, there is no one off as such.
Devlina Chakravarty
No one would. Okay, does that answer your question?
Unidentified Participant
Yes, the conversion is particularly lower in the second half and so are these the normal numbers? Because we’ve seen CFO come off for the full year versus last year
Sanjiv Kumar Kothari
Versus last year. We have improved cash flow from operators.
Devlina Chakravarty
Can we just take it offline with Sanjeev and others? Let us check the numbers. Yeah, yeah.
Sanjiv Kumar Kothari
We have cash flow. Free cash flow this year is 88 crore versus 69 crore last year.
Devlina Chakravarty
But any other question we can take it offline. Yeah. Because we’ll have to check these numbers and we don’t want to give a. Yeah, wrong number. Yeah.
Unidentified Participant
Yeah. That is all from my side. Thank you.
Devlina Chakravarty
Okay.
Operator
Thank you very much, ladies and gentlemen. We’ll take that as a last question. I’ll now hand the conference over to the management for closing comments.
Shanskar Singhal
Hi, Neera Gudra this side. So I would like to thank everyone for joining the call. I hope we have been able to respond to all the queries adequately. For further information, I request you to please get in touch with me or the investor relations team. Stay safe, stay healthy, be. And thank you once again for joining us.
Devlina Chakravarty
Thank you very much. Thank you.
Operator
Thank you very much on behalf of Anvati Shares and Stockbroking limited. That concludes this conference. Thank you for joining us. And you may now disconnect your line. Thank you.