Thank you, Neerav. Good morning, everyone, and thank you for joining us on Max Healthcare's Q4 and FY 2026 earnings conference call.

We have with us Mr. Abhay Soi, Chairman and Managing Director; Mr.

Yogesh Sareen, Senior Director and Chief Financial Officer; and Mr. Keshav Gupta, Senior Director - Growth, M&A and Business Planning.

We will begin the call with opening remarks from the management, following which we will have the forum open for an interactive Q&A session. Before we begin, I would like to point out that some statements made today may be forward-looking in nature, and a disclaimer to this effect has been included in the earnings presentation shared with you earlier.

I would now like to invite Abhay to make his opening remarks. Thank you, and over to you, Abhay.

Good morning, everyone, and thank you for joining us on Max Healthcare's earnings call for fourth quarter and full year ended March 2026. Let me begin by highlighting that over the last two quarters, we have rolled out phased commissioning of more than 20% additional brownfield capacity across our hospitals in Mohali, Nanavati Mumbai, and Nanavati Mumbai and Max Smart in Delhi.

All the beds will be ready to be operationalized over the next two to three months. Further, we expect to add another 10% capacity once our 500-bed greenfield hospital in Gurgaon is commissioned during the year.

We have already onboarded clinical and non-clinical talent for these capacities and expect significant operating leverage to come through as operations progressively ramp up. We are also pleased to share that we have completed the acquisition of a controlling stake in Kalinga Hospital Limited this month.

Kalinga owns and operates a 250-bed hospital on a prime 10-acre land parcel in the heart of Bhubaneswar, which also allows us for future brownfield expansion at that facility. The acquisition marks our entry into Eastern India and provides us a strong platform with established clinical programs and significant potential for future expansion at the existing site.

We have firmed up plans to revamp and expand the facility. Further, the board has approved an investment of ₹1,400 crores for the construction of a 700-bed greenfield hospital at Shaheed Path, Lucknow.

This investment reflects our continued confidence in the region where we have seen encouraging momentum since the acquisition of our existing facility. The proposed hospital will add meaningful bed capacity and position us to serve the growing demands for high-quality healthcare services in one of North India's important healthcare markets.

With respect to the fourth quarter performance, the network delivered its 22nd consecutive quarter of year-on-year growth, with the revenue increasing by 10% and operating EBITDA by 8%. As we move into FY 2027, our priorities remain focused on scaling the recently commissioned capacities, integrating Kalinga Hospital into the network, and progressing our outlined expansion projects, including the Sector 56 Gurgaon hospital.

At the same time, our existing hospital operations continue to provide a steady foundation supported by strong clinical capabilities and consistent execution across the network. This positions us well to deliver sustained growth while maintaining capital discipline.

Now coming to the fourth quarter performance highlights. Average occupancy for the network continued to be more than 75% despite increase in operational bed capacity, with most of the units operating at near optimal capacity.

Occupied bed days were up by 8% year-on-year and 4% quarter-on-quarter. Average length of stay was temporarily higher by 9% compared to Q4 last year, characteristic spurt due to multi-location capacity rollout simultaneously.

Average revenue per occupied bed for the quarter stood at ₹77,900. This was after absorbing the impact of higher average length of stay and discontinuation of select high-value chemotherapy drugs for institutional patients.

Network gross revenue stood at ₹2,664 crores compared to ₹2,429 crores in Q4 last year and ₹2,608 in the previous quarter. This reflects an increase of 10% year-on-year and 2% quarter-on-quarter.

Due to discontinuation of select high-value chemotherapy drugs for institutional patients, share of oncology in patient revenues dropped by 21% from 26% in Q4 FY 2025 and 24% in Q3 FY 2026. Excluding oncology, gross revenue grew by 15% year-on-year and 5% quarter-on-quarter.

International patient revenue was 2,200—sorry, was ₹227 crores, registering a growth of 12% year-on-year and accounting for a 9% of the revenue from hospitals. Digital revenue from online marketing activities, web-based appointments, and digital lead management was ₹838 crores, accounting for approximately 31% of overall revenue.

Website traffic crossed 90 lakh sessions during the quarter, growing by 39% year-on-year. Network operating EBITDA stood at ₹682 crores, reflecting a growth of 8% year-on-year, 5% quarter-on-quarter.

Network operating EBITDA margin was 26.8% for the quarter compared to 27.2% in fourth quarter FY 2025 and 26.1% in the trailing quarter. Annualized EBITDA per bed for the network stood at ₹73 lakhs versus ₹74 lakhs in FY 2025 and ₹71 lakhs in the previous quarter.

This was also reflective of the higher average length of stay. Profit after tax for the network was ₹387 crores against ₹376 crores in Q4 last year and ₹344 crores in the previous quarter.

The network generated free cash flows of ₹581 crores during the quarter. Rupees—during the quarter, ₹328 crores was deployed towards ongoing capacity expansion projects and facility upgrades at newer facilities.

Net debt for the network stood at ₹1,908 crores compared to ₹2,166 crores at the end of December 2025, and the net debt to EBITDA ratio continues to be less than one. Continuing our efforts to support the local communities, we provided free treatment to approximately 42,000 patients from economically weaker sections of society worth ₹59 crores at hospital tariff.

Both our strategic business units continued to deliver steady growth in revenue and profitability. Max@Home reported revenues of ₹73 crores, reflecting a 30% year-on-year growth.

It offers 16 specialized service lines across 15 cities with over 56% repeat transactions. Max Lab reported a revenue of ₹52 crores, reflecting 14% year-on-year growth.

It provides services in over 60 cities and served nearly 6 lakh patients during the quarter. Now moving on to the status of our expansion projects coming on stream in the next two to three years.

Max Lucknow, the current capacity of the hospital stands at 426 beds, and we expect this to increase to 570 beds over the next two quarters. 500 beds at Sector 56 Gurgaon, the interior and facade works have started.

We are targeting to commission this facility by the end of this year. 100 beds at Max Nagpur, project work continues to be on track, and we expect commissioning by FY 2028.

400 beds at Zirakpur, Mohali, structural work is ongoing, and we are on schedule to commission the hospital in FY 2028. 260 beds at Max Dwarka, building plan admission is underway, and the project is expected to take 24 months to complete.

200 beds at Max Vaishali, we are awaiting building plan approvals while all other clearances in place. Project is expected to take 24 months post receipt of approvals.

400 beds at Max Patparganj, D-wall work construction has started, and we expect commissioning by FY 2029. Finally, coming to the overview of the company's performance for the full year ended March 2026, during the year, we have initiated phased commissioning of nearly 20% additional brownfield capacity across the network.

Network gross revenue stood at ₹10,538 crores, reflecting a growth of 16% year-on-year. Overall network operating EBITDA grew by 14% year-on-year to ₹2,638 crores, translating to a margin of 26.2% and EBITDA per bed of ₹72 lakhs.

Profit after tax for the network increased to ₹1,631 crores compared to ₹1,336 crores in FY 2025, registering a growth of 22%. During the year, we generated ₹1,541 crores of free cash from operations after interest, tax, working capital changes, and routine capex.

Further, ₹1,627 crores was deployed towards ongoing expansion projects and facility upgrades at newer units, ₹131 crores towards land purchases at Vaishali, and ₹146 crores was distributed as dividend. With this, we open the floor for any questions you may have.

Thanks for taking my questions. My first question is on the brownfield beds that we've added.

When do we start seeing them contributing to EBITDA more meaningfully? Did I hear it correctly that all of these brownfield beds will be commissioned in the next two quarters?

Second quarter, third quarter is when they should start showing up more meaningfully on your EBITDA?

No, they're already contributing to EBITDA. It's not any form of negative contribution really.

What happens is that you get the better end of things as you go along. Because right now, out of the total 1,000-odd beds, we've initiated lesser amount.

It's a phased rollout. Let's say if you have 400 beds at Max Smart which are being rolled out in a phased commissioning, you would have started with about less than 100 beds, about 100 beds over there.

As you open up the balance beds over the next two, three months, etc., the next couple of quarters, you'll see the entire operating leverage as the balance beds get occupied. Because your costs related to even the brownfields are not linear effectively.

Okay. Is it fair to assume, Abhay, that the occupancy in these ramping up should not be a problem?

We should get to a fairly good level of occupancy as soon as we start these beds. That should not be a problem, right?

That would be a fair assumption.

Yes. It's a two-way this thing.

You don't open beds if you don't have occupancy. What we've seen is a very good ramp-up of that occupancy.

Therefore, you've seen in spite of new beds opening up, okay, occupancy remains high. Having said that, I must also point out what is embedded within it is also higher ALOS.

What tends to happen is, you're just a little more efficient when you don't have the beds. When you open up the new beds, there's a tendency for the ALOS to increase.

I daresay it's slightly temporary in nature. We tighten it again.

You've seen the ALOS has gone up by about 8%, 9%. The impact of that is that shows up in both your ARPOB and occupancy.

Although the occupancy sort of sounds a little higher, your ARPOB comes through a little lower.

Understood. My second question is on Gurugram.

Did I hear you correctly that we are now expecting a Gurugram commissioning by the end of this fiscal year? I'm not sure if I picked that up correctly.

And Sorry, Abhay.

Is that right?

Not audible. We're

expecting commissioning by the end of the year, yeah.

Okay. We shouldn't be expecting any further delay on that because that's been pushed out a few times now.

That's right. That's right.

Okay. Sorry, one last question if I may, on the Bhubaneswar asset that we have acquired.

This will start integrating from first quarter itself, or is there any approval, etc., that we require before closing this?

No, first quarter. We've already acquired the majority stake.

We will be consolidating.

Got it. I have a few more questions, but I'll get back in the queue.

Thank you.

Yes.

Thanks for the opportunity. Just again on Gurgaon, how should we think about the operationalization of beds?

Assuming we commission towards the end of fiscal '27, what will be the phase one operationalization? What is the count that we should expect in fiscal '28?

I think in fiscal '28, we would be looking at breaking even within the year. It's a greenfield, as you're aware.

Having said that, our experience with the Dwarka greenfield, we operationalized it. We guided to a one-year breakeven.

We actually broke even in six months. We had an operating loss, a consolidated loss in the first six months of, I think, about ₹35, ₹40 crores, but by the end of the year, I think it was less than ₹10 crores that we sort of.

Even if that number is more or less in this case, it's not a meaningful change to perhaps what the projections are going to be.

In terms of beds, are we expecting a phase-wise manner of operationalization here? Because it's a 500-bed

Yes. You always do it even tactically you do it in that manner.

Physically beds come out in phases, but also tactically. Because if you have 500 beds, day one you're not going to have occupancy of 500 beds.

You don't operationalize or staff all the 500 beds. If I take the example of Dwarka where we had 300 beds, we started with 140 beds.

We ramped up occupancy, broke even with the 140. The balance beds sort of start yielding as you go along.

You're seeing a similar sort of story play out in the brownfields right now. With respect to even the greenfield at Gurgaon, you're going to start with let's say about 200-odd beds.

Once you kind of break even within that, then you start rolling out the balance beds.

Understood, that's clear. My second question is on the onco share decline that we've seen in Q4.

While clearly the reason highlighted is discontinuation of chemo drugs, but it still feels a bit sharp, given we had quantified onco drug impact to be about ₹80-odd crores. If you could help us understand what has happened here and by when do we expect this to reverse?

I think there are two things. You have onco drugs because this is daycare, right?

You have onco drugs margins which were coming out a little perverse to us. Discontinuation of these high-value drugs not only impacts your top line, but also impacts your related OBDs, occupied bed days, which are related to it because some of the patients which are coming for this thing are also admitted at night.

It has a knock-on effect on that as well. Your OBDs have sort of come down by about 5% to 6%, which is related to this.

Do we have a plan in place? How do we replace this?

What alternative protocols would you have? Bansi,

basically, some of this is permanent because we know that we will not be able to do this kind of a business on the minus margin basis. As you also seen even in this quarter, although the OBDs have degrown by 6% in oncology, but we have overall grown the OBDs, right?

That means the other specialties were able to kind of compensate for it. I think that's the plan even going forward that we don't expect the share of oncology to come back to 25%, 26% as it was earlier.

It will continue to be hover around 21%, 22%. We will then have the other specialties fill up that tube.

Got it. The CGHS rate revision benefits, has that started to flow through in Q4?

All except the superspecialty rates. I think a very large part is already in, but there's a small part which is left out, which is around ₹25, ₹30 crore per annum.

That phased out over the year in this year. I think in two hospitals it's started to come, but balance is still pending.

That's all in this quarter.

We're expecting that to be in the next few months, yeah.

Thank you.

Hi. Thank you for the opportunity.

My first question is clarification. Abhay, you mentioned you are rolling out beds in a phased manner even for say facility like Smart.

Help me to understand this better. In the past, whenever you have opened or commissioned brownfield facilities, I understand the ramp-up happened much faster than what we are seeing right now.

According to you, anything has changed since then? That's why you are going for more gradual, phased way of operationalizing beds?

No, we've always opened brownfield in a phased manner. Brownfield or greenfield, it's always been opened in a phased manner.

It is opened in a phased manner because as soon as any part of a new facility, any floors are ready, okay, there's always a tearing need for those floors. You've seen that play out in the occupancy as well.

We try to put it to work as soon as possible. Whichever floors are ready, and it's the same at Nanavati, it's the same at Mohali, it's the same at Smart.

It's been this same in the past at Shalimar Bagh or Vaishali or every facility we've rolled out, it's been rolled out in this manner.

We mentioned in the speech also, our available capacity, operational beds have gone up by 8%, has OBDs gone up by 8%. As and when the beds are ready, they are being taken up.

In context also Smart is that this is a 26th, 27th month of project starting, right? Typically a project of this size takes about 36 months.

Because we are taking up projects to operations within a shorter time, floor by floor, and hence they are being taken up floor by floor.

Sure. When it comes to ramp-up of some of the newer facilities, you mentioned about Dwarka.

Similarly, can you update on the status of Noida unit, how it is ramping up in terms of occupancy, etc.? Last quarter, if I remember correctly, you mentioned there are some issues which you are trying to resolve.

If some update you can share on Noida unit.

You're talking about Noida or Dwarka?

Noida one.

Noida.

Yeah.

All right.

The Noida has ramped up well now in this quarter. Right?

The occupancies is around 64%, 65%. Right?

There's further room to grow. I think on the revenue side, it's done well compared to last quarter.

We see there has been hiring of doctors also in that hospital. I would say we're happy with where we are with respect to Noida when it comes to quarter-on-quarter growth.

I think it's pulled around very well. In terms of EBITDA growth also, it's a substantial growth that we've seen over there.

It's well on its way.

It's in line with your expectations, right? It's not falling short.

Yes. Yes.

Yes.

Yes. Absolutely.

Okay.

I'm very encouraged by the last quarter and more.

Okay. It can very well go to the network-level occupancy of say 75% or so?

No, absolutely.

Absolutely. I think very shortly We'll need to do a brownfield over there and add more beds as well.

Okay. Good to hear.

My second question is actually clarification on discontinuation of oncology drugs. You mentioned 5% to 6% OBD got knocked off because of it.

I just wanted to understand, these drugs are high in terms of ticket size, etc. Were they meaningful contributor at the EBITDA level also?

Yes, would have. Because earlier they were given at MRPs, and we had 15%, 16% margin on those.

That used to flow to the EBITDA.

It used to be 16% margin because you have to give a 30% discount to MRP. We sort of discontinued these, right?

Earlier there was contribution

to EBITDA. That is the reason when we gave you the price impact of the CGHS, we netted that also.

To that extent, it's absorbed through the price increase. We had suggested I think it's a 200% ₹200 crore net benefit.

140 after GST. After

GST, it was 140. The CGHS rate revision, we got higher rates, but you got capped out on this high-value drug.

From a CGHS standpoint, the net benefit was ₹200 crores. There was also, I think, a impact of GST, which was a separate this thing.

Net of it was ₹140-odd crores would be the net benefit.

Okay. That is no longer there, right?

That post-GST number that

Sorry?

₹200 crore, you mentioned, is the gross number. Then when you include the GST impact, etc., ₹140 crore is the number which was coming through.

That's right. Of which ₹30 crores, as I mentioned, is superspecialty rates, which is not yet flowed in.

That means about 100, ₹110 has flowed in, about 30 to 40 is yet to flow in, yeah. These are all annual numbers, right?

Sorry, just to clarify, another ₹30 crore would flow out from here?

These are annualized numbers. Out of 140, 30 to ₹40 crores is yet to flow in.

About 100 to ₹110 crores has already flown in on an annualized basis.

Okay. Got it.

I think my last question is on the pipeline projects which you indicated which are coming up say in '28 or so. Is any facility there where we are seeing some delays, etc., in terms of approvals or it's just completion of the facility which should be done as per your indicated timeline?

Is there any regulatory clearances or any other clearances which are due? No, nothing.

No regulatory clearance is pending over and above what has been anticipated. In the past, there's been delays because of GRAP-3.

We've had delays because of shortage of manpower because there's been LPG crisis and there's been no sort of gas at this thing, there's been shortage of manpower from that standpoint. Forest approval because there was a issue with respect to Delhi tree transplantation where the Supreme Court had taken cognizance of, I think, the Lieutenant Governor versus Supreme Court contempt of court matter because of which it got stalled.

These are not typically regulatory approvals which have sort of this thing. I think we've had issues and incidents with respect to pollution and shutdowns of construction or tree transplantation or Iraq War causing shortage of LPG, and therefore, manpower not showing up at site.

Okay. That's helpful.

Thank you. I'll get back in the queue.

Thank you for taking my question. The first question is with respect to doctor costs.

We see that our doctor costs have gone up, and we've hired in advance. Just wanted to get a sense for which all expansions have we hired and which are the hospitals where further doctor additions are still pending which might hit the cost line item in the next one to two quarters?

I think they

Okay, I think it's a very good question. There are two things.

End of '24, 2024, we essentially added close to 25% to 30% more capacity. This was through whether it was Dwarka, whether it was the JP acquisition, Sahara done sometime before that, or Alexis in Nagpur.

This year, we've, already started a phased rollout of 20%-plus more capacity, which includes Mohali, Punjab, Nanavati Mumbai, Smart Saket, as well as, we added more beds in Lucknow as well. We've seen a meaningful, somebody asked me a question before this about Noida, and we've seen meaningful improvement over there because we've expanded our doctor base.

That is one place. We've seen the same in Lucknow where we are ramping up.

We've seen the same in in in Smart. We've seen the same in Nanavati Mumbai.

We've seen the same in Mohali. All of these new ones which are coming, we've added added doctors.

Even Dwarka, now it's operating at 80%, 85% capacity. Through the year, it had, through the last quarter, we had added some more people over there as well.

Yes, I think it's been pretty much quite secular across the portfolio because we've been it's it's multi-locational there's been addition of this. You're going to see the same thing in in Bhubaneswar now because we will add manpower over there.

Although it's should not move the overall needle simply because, that's just one hospital. The minute you're doing it at four or five multi-locations at at one point of time, you're going to see a little bit of lumpiness.

Got it.

That there is that Even an acquisition, the reason I mentioned in end of '24 when we kind of this thing, because when you do some acquisition, it's not as if you are able to do all your hiring in the next six months or 12 months or whatever. It takes time.

It also moves in a phased manner. Particularly if there's competition in those areas.

Got it. Just to better understand, this ₹435 crore number for doctor fees in Q4, that should not materially change going forward, at least for the next few quarters.

Is that the fair way to think about it?

Yes, you start getting operating leverage, in fact. My belief is that marginally all of this percentage start coming down.

Got it. This Kalinga Hospital, any startup losses or what about breakeven timelines?

How should we think about it?

It's already profitable. I think it does about 10-odd crores of EBITDA.

You're not starting with a negative.

₹10 crore per quarter?

Annual.

Annual. Got it.

Unlike some other places where we had to discontinue businesses, right, because we wanted to streamline practices, all those things have been taken care of, and even after that, we should be able to maintain broadly that EBITDA run rate. No chance of it going into negative, that's what I'm trying to No,

let me just correct you. Even in the other places where we corrected the business behaviors, to say, even there it didn't go into negative.

We just made less profit. None of these acquisitions have been loss-making or even after taking over, when we did whatever actions we took, it did not go into negative territory.

Got it. Thanks for the clarification.

Even in this case, ₹10 crores positive and we've just done the acquisition, you're going to this thing. God forbid, you're taking some action, you still won't see meaningful negative numbers or anything like that.

Got it. The last question would be with respect to the new units, whatever we've operationalized in the last 12 to 15 months, how have their overall revenue and margin trajectory look like?

Any color there will be helpful.

The 12 to 15 months, okay, I would basically, before rolling out this 20%, 25% capacity rollout that we've recently done over the last, let's say, three to five months, yeah, the previous generation for about 12 months or 13 months, we did not really add any capacity. We added it before that, okay, again which was a little lumpy.

We did Lucknow, we did Nagpur, we did Dwarka, and we did JP, right? Are those the four you're referring to?

Yes,

yes. I think all four have done significantly well.

I can tell you Lucknow, for example, is doing pretty much 5x of EBITDA of what we acquired it for. There's meaningful addition in Nagpur, in Noida also we've seen that.

Dwarka is not only operating at 80%, 85% capacity utilization, but we already planning a brownfield over there of another 200-plus beds. In fact, oncology bunker over there, and the oncology center over there in Dwarka is yet to start, which is going to start by next month.

That should reap even further sort of benefits. We're seeing those benefits come through.

Got it. Helpful.

Thanks.

You're seeing it, you're going to see a bit of a hockey stick there because when you move from let's say in a Noida, right, when you move from that 65% to that 75%, 80%, you see at 50%, 55% you break even, right, most units. At 60%, 65% you start doing very well.

The real juice starts coming from that 60%, 65% up to that 80-odd percent occupancy that we do.

Thanks for the opportunity. This was more on the Lucknow side.

While we have very decent land bank as far as Sahara Hospital is concerned, and of course, in history, we see Shaheed Path land was also acquired more or less at the similar time, I think. How are we evaluating in terms of which land bank to sort of set up?

I understand board has given sort of approval for Shaheed Path, but if you could help understand how are we going to sort of utilize both the land banks and build up the Lucknow sort of hospital network?

I think it's a very good question. We have a land bank, it's about 27 acres of land in Shaheed Path, okay, which is right in the heart of Gomti Nagar.

27 acres at Gomti Nagar.

Yeah. No, 27 acres is Gomti Nagar, which is right in the heart of Lucknow, and 5-plus acres which is on Shaheed Path.

We are expanding our capacity over the next few months. You'll see a capacity of Gomti Nagar go up to about 570 beds.

What we intend to do is we intend to start another hospital, okay. We want to have a multi-locational strategy of about 700 beds in Shaheed Path, which we'll be operating in a phased manner, which should take about three years to build it.

Simultaneously, we believe we'll be running out of capacity at Lucknow at Gomti Nagar as well, we'll be adding another 200 to 300 beds over there. You're going to have a multipronged strategy.

I think one doesn't have much to do with the other because these are two locations, which means we will have two sets of doctors and clinicians. It allows you to do that.

You see if you have one, in terms of the bench strength of senior clinicians, you have one chairman cardiology, one chairman oncology, one chairman this thing, and it becomes a choke point for other sort of senior personnel coming in. When you have multiple locations, it allows you to do that.

We've seen that advantage play out for us in Delhi, in other places, etc. We like that whole cluster approach.

You have benefits of brownfield, but it's also beneficial to have a cluster approach and then have brownfields emerging in multiple locations.

Understood. This is not so much more sort of a cannibalizing given that it's hardly a 12, 15 km distance.

It would be more like multi-location playing out.

No, no, absolutely. Absolutely.

Tushar, also on this Shaheed Path, the capacity can go up to roughly 850 beds, right? There's more which we can build there after even after this 700 beds.

It reflects the kind of confidence you have on this Lucknow as a location, building up such a strong almost it would be what 1,000 1,000 In fact, more than 1,000-plus sort of a bed size eventually. Not immediately, but over a period of time.

No, no, absolutely. Absolutely.

Let me put it this way. I see over the next decade even probably Gomti Nagar, okay, going close to, perhaps close to 2,000 beds, just that one location.

We're going to do it in a phased manner. We have the land bank over there.

The kind of ramp-up we're seeing is because our clinical programs are very strong over there.

Understood. That was one.

Second, sir, are you seeing this risk of this medicines being taken directly by the let's say health scheme or CGHS in other therapies?

No, firstly, because of being in Delhi, we have a larger amount of institutional business which was coming to our Delhi sort of hospitals. This impacts that largely.

What they basically said is that, look, you have to provide it at 30% discount to MRP, right? It's not they haven't selected the drugs.

They said all medicines at 30% discount to MRP. Now what happens is any medicines or alternatively, CGHS patient can get the medicine from CGHS.

From a hospital standpoint, if your margins are less than 30%, then you'll probably discontinue it because it becomes loss-making. The patient has the alternative or option of buying it from the CGHS dispensary.

Our present margins and our present this thing on a drug-on-drug basis also is reflective of that action. It's not a government action, it's a CGHS price revision.

You get some and you lose some, I guess. The net benefit is ₹200 crores.

After GST, which is a separate sort of hit that we got, it becomes a ₹140 crore benefit. No,

no, I got you, sir. Sir, just a clarification, this is onco's therapy specific, or this is more between CGHS doing it across the therapy?

No, this is across the board. Across the board, all medicines.

Sorry, onco medicines. Chemo therapies,

yeah. Chemo.

Chemotherapies. Which is why I was trying to ask that is this getting expanded to other therapies for the patients covered under CGHS?

No,

no, no.

This is the first time they've made any changes on the price listing in 14 years, right?

Understood. Practically, is CGHS able to provide the medicines on timely basis or you think the patient will come back to the hospital pharmacy or the hospital?

The answer to that.

Tushar, there's obviously tardy. I think there's a lot of noise amongst the CGHS pensioners, etc., on this.

We've been given to understand that they're reconsidering it. Again, one doesn't know because there has been a lot of representation made even by patients on this, right?

Got it.

One of the problems is that this also applies to ECHS, for example, and other PSUs. Whilst CGHS has its dispensary to dispense this, ECHS and other PSUs don't have the dispensary, and they cannot access CGHS dispensary.

The problem is some of these drugs are then not accessible to them.

Right. Effectively, this should sort of start getting reflected back probably in maybe sometime in future.

Sorry, it should get reversed, you're saying?

Yeah.

It stands to reason.

Understood.

Otherwise, you'll have servicemen who are not able to access these, which is presently the case.

Got it, sir. Just lastly, this Gurgaon, we were to sort of start second half.

Is it now we are indicating end, few months sort of taking some time? Is that the way to think about?

No, that is right. We were saying second half, and now when we send second half, we meant middle of second half, and now it's end of this thing.

I think it's been two issues over here. One was a lot of labor goes back during elections, particularly Bengal elections.

It's a bit of a festive season from them from that standpoint. We had a lot of reduction in manpower at the sites.

Second is also the LPG issue. Most labor, they cook their own food and etc., we had disruption over there because the labor did not have LPG.

We've started serving lunches and meals for all labor at our sites now in order to surpass that. Because this labor is not on our books, they're the contractor's labor.

There's a particular method that you have to sort of follow to even initiate that because literally we've got about 1,100 to 1,200 people on the Gurgaon site working. Our kitchens are supplying to the 1,100 to 1,200 people, their meals and so on and so forth.

I think these are issues which have caused delay of a couple of months.

Thanks for that clarification. Just lastly, if I may, just one more if I may squeeze in with respect to doctor talent cost.

Given that the kind of bed addition and starting of hospitals by multiple corporates probably over last maybe couple of years and subsequently over next four to five years, are you seeing this doctor talent cost sort of or the negotiating power moving to doctor from corporates?

I think there are two things. Firstly, it's not a new phenomenon that hospitals come up in locations where there are existing hospitals.

It's not as if in any micro market it's that you've got five hospitals and three more have come up or four more have come up. It's pretty much been one here and one there and so on.

When that happens, your own clinicians tend to negotiate their own sort of compensations and they does go up from that standpoint. Having said that, it does sort of even out, and it is transferred over a period of time to the patients.

Because eventually you're still a 10%, 12% PAT margin business. It's capital intensive, you're reinvesting, etc.

It's a natural phenomenon. It gets a little lumpy sometimes.

It's not as if it's not passed through. You will see this normalize across the board.

I'm not just saying it for sort of Max, I would believe for the entire industry.

Got it, sir. This is helpful, sir.

Thanks a lot.

Hi. Thank you for the opportunity.

Excuse my confusion, but regarding the discontinuation of chemo drugs due to MOU conditionalities, this is specific to Max Healthcare in a region or this is industry-wide pan-India? If I understood it correct, it had a knockoff negative impact on revenue to the tune of ₹130 crores, and they had around 16%, 17% EBITDA margins.

If you can help me clarify that.

Firstly, no, this is industry-wide phenomenon. Secondly, as a proportion of its business, Max perhaps does the maximum amount of oncology business.

Then within that, if you actually see, we probably do the maximum amount of institutional business, which is CGHS, ECHS, etc. Although it's industry-wide phenomenon, the impact would be felt maximum at Max for these reasons.

The overall impact of these discontinuations is ₹200 crores in the drug billing. Top line.

Your top line reduces by ₹200 crores basis this.

Got it. This was the quarterly number?

Annual number,

yeah. Sorry, I couldn't get it.

It's an annual number. Annual billing of chemotherapy drugs will come down by ₹200 crores because of these discontinuations.

Got it, sir. Thank you.

Thanks for the clarification.

Yeah. Hi, sir.

Thanks for the opportunity. Just a follow-up on this CGHS part only.

If I see the contribution from CGHS, it's barely moved the needle. Whereas our onco revenues have seen a sizable dip.

Within that, if you could help us understand that what portion of your CGHS revenues actually comes from oncology and how should we look at ahead as well? No,

obviously, there's less impact on the beds for this. As chemotherapies are billed in the daycare, when you discontinue these drug billing or providing these drugs to the patient, right, there's a impact on the revenue, but there's no impact on the beds.

Nevertheless, there are some of these patients who also then avail surgeries in the network and also some of these patients are also get admitted in the hospital. To that extent, the OBDs, the occupied bed days for oncology patients have come down by 6% Y-o-Y, right?

Now your question is that within the overall CGHS business, how much in oncology? I think that would be around probably around 35%, 40%, yeah.

It used to be 50 earlier, it's reduced to 40% now.

Understood, sir. Sir, then on your existing network, that is prior to any bed additions what you have done, in terms of the steady-state revenue and EBITDA growth, sir, how should we look at it?

In terms of your say bed network, what you had till FY 2025 or say till '26. The levers of growth, would it be more ARPOB-driven, yeah, is there some element of case mix as well which can help to at least post a single-digit kind of a growth?

I think basically, there are two elements which make the revenue grow up. One is the ARPOB, other is the OBDs, the occupied bed days.

Now that even in the existing hospitals, we are adding more beds, right? There's a brownfield expansion that we're talking about in Mohali, in Nanavati, even Lucknow and Max Smart.

I think that question is not really, our role is to make sure that wherever we have 80%, 85% occupancies and we add more beds there and try and ensure that there is a OBD growth also, right? If we don't have OBD growth, then you only growth would be the ARPOB growth, right, which will be let's say 6%, 7% of the revenues.

Our role is to ensure that wherever we find this situation coming up there, then we add more beds.

Understood. Sir, last one from my end.

Would it be possible to quantify the EBITDA drag with the new hospitals would have had in Q4 and for the full year '26?

No, it's very tough to do it now, nah? Because once you can do it maybe probably first month or first two months.

Then the patients start to mingle, right? When you put another brownfield tower, you won't be able to separate the revenues or EBITDAs of tower one and tower two, right?

Because what you also, for example, do is move certain specialties into A tower versus B tower. When you move those specialties, then wherever you move it from, those beds get occupied by other specialties, and where you move, that gets this thing, etc.

Let's say if I move oncology into a new tower, and that becomes an onco tower. In the previous place where it was occupying those beds, those beds get occupied by other specialties.

Whereas in the new tower, okay, you'll have largely oncology, you'll have different ARPOBs and different this thing, etc. Yeah.

Understood.

On a consolidated basis, what we've seen is there's no real pressure on margins.

Effectively, I think Got it.

Hello. Thank you for the opportunity, sir.

Just a clarification on chemo drugs again, sorry. Here, we are losing out on OPD also.

If it's only the dispensary and the drugs, to whom are to whom we are losing the OPD patients in general, the 5% to 6% impact on OPD? Clarification on that will be great.

Q1, for until now we are seeing a full full impact of this chemo drugs at least, right?

That's correct. Quarter four has already had the full impact.

We started to stop this in October last year. To that extent, quarter four has the full impact of all this chemo drugs.

I think what we haven't got is the full impact of the price gain on the CGHS side, which will come about starting this quarter. As I said, two of the hospitals have got the superspecialty rates, and during the course of the year, we'll have more hospital also getting those rates.

On the other question that you have on the OBDs, where are we losing to? Well, The smaller nursing homes who are able to manipulate their invoices, etc.

We believe they're able to do that or whatever. Whatever the practices, they go to perhaps the disorganized sector or smaller nursing homes.

Got it. Here, do we expect any resolution, or this is going to be there for next couple of quarters and until the base of Q3?

Like it will start to Look, I think like I said earlier, it doesn't seem to stand to reason, right? It's not as if, the because it's not as if our margins are any different from the price, at which perhaps the government is buying it.

These are medicines like Keytruda, which is, the largest and the fastest-growing oncology medicine in the world. They don't make any exceptions for anybody in terms of what the margins are, for example.

One is that. Secondly, the CGHS and CGHS rates apply to the other public sector undertakings and other, sort of panels like ECHS, which is ex-servicemen, and so on.

Whilst CGHS patients have an option of, procuring the drugs directly from the CGHS dispensary or their pharmacy, the ECHS and the PSUs don't have that option because they don't have those pharmacies. Of course, a lot of people are complaining.

A lot of patients are complaining to because, they're unable to access these directly Keytruda and, they have to sort of move to other medicine. It's not necessarily Look, every patient is different, right?

For some patients, it is necessary for having this in their I mean they I guess they're finding it difficult to to source this. We are facing finding a lot of complaints, and I'm sure so is the CGHS and this thing.

We are hoping that they will reconsider this. They should, but, you are asking for timelines, and, it's difficult to pin that down.

Got it. Just a clarification, ECHS and the PSU patients are seeing disruption to the treatment for last six months, or they are moving out to other medicines, whatever is alternate available?

No, same thing, right? They've got to behave the same way as the CGHS.

There are other alternatives to some of these medicines, yeah.

Okay. Got it.

Thank you.

It's not there're no alternatives to it, there are alternatives, okay, but they may not be preferred alternatives from a clinical standpoint. The question is efficacy.

If a doctor believes that this particular branded drug has more efficacy for a particular patient, may not be for B patient, but for a particular patient.

Got it. Thank you so much, sir.

Yeah. Each one of us affects differently to different paracetamol, affects sort of differently to even a different antibiotic, let alone chemo.

Hmm.

Thank you, everyone, for joining us today. We appreciate all your time and look forward to interacting with you again next quarter.

Thank you.