Global Markets Research

Fortis Healthcare FOHE.NS FORH IN 13 November 2022

EQUITY: HEALTH CARE & PHARMACEUTICALS

2QFY23: Strong hospital business Rating

Remains Buy

Quick Note Target price

Remains INR 319
Closing price
Fortis Healthcare reported 2QFY23 results on 11 November 2022. Revenue was largely in 11 November 2022 INR 282
line with our expectation. EBITDA/PAT beat our estimates by 2%/43%. The beat on PAT
was on account of an exceptional gain of INR 5,160mn recognized during the quarter. It
pertains to the reversal of an impairment charge on investment in an associate company, Research Analysts
Lanka Hospitals Corporation PLC (LHCL SL, not rated; 28.6% stake) on account of
India Pharmaceuticals
favorable movement in its share price.
Saion Mukherjee - NFASL
Overall revenue grew 9.9% y-y and 8% q-q in 2Q. Hospital revenue (81% of consolidated [email protected]
revenue) recorded 18% y-y and 9% q-q growth on the back of a seasonally strong quarter. +91 22 403 74184
Occupancy rate improved 500bp q-q to 70%. Average revenue per operating bed Aneesh Deora - NFASL
(ARPOB) was at a historical high of INR 19.7mn (annualized) and grew 5.4%y-y. EBITDA [email protected]
+91 022 40374102
margin recorded a strong 152bps rise y-y to 18.2% and EBITDA CAGR was strong at
22.4% over 2QFY20-23.
The diagnostics business declined 15% y-y on account of declining COVID-related
revenue and grew 5% q-q. The contribution of COVID-related revenue was 5% in
2QFY23, vs. 22% in 2QFY22. Ex-COVID-19 tests revenues increased 3.8% y-y, slightly
lower than peers. EBITDA margin was 21.4%, an improvement of 181bp from the previous
quarter. The company continues to aggressively add to its network of collection centres
which we think should drive volumes going ahead.
Net debt marginally increased toINR 5,650mn as on 30 Sept 2022 vs INR 5490mn as on
31 March 2022.
We maintain our Buy rating and target price of INR319 (13% implied upside). Our target
price is based on a DCF valuation, implying an EV/EBITDA of 22.7x on our FY24F
estimates [adjusting for SRL’s (unlisted) minority EBITDA). The stock is currently trading
at 20.3x EV/EBITDA on our FY24F estimates [adjusting for SRL’s (unlisted) minority
EBITDA].

Hospital business: Strong EBITDA margin

1. Most of the key operating metrics have shown a positive movement in 2QFY23.

2. The occupancy rate was 70% in the quarter, up from 65% in 1QFY23 on the back of a
seasonally strong quarter. COVID-19 revenue was only 0.6% of sales in the quarter.

3. ARPOB was at a historical high of INR19.7mn (annualized) and grew 5.4%y-y.

ARPOB marginally improved by 0.5% sequentially despite a fall in surgical
contribution (59% in 2QFY23 vs 61% in 1QFY23). The q-q improvement in ARPOB
could be due to a better specialty mix and higher international patient contribution, in
our view. Oncology contribution increased from 12.1% to 13.1% q-q. International
patients contributed 8% to revenue, up from less than 5% in the past two years and
7% in the previous quarter. Also, ARPOB was up 28% from 1QFY20 levels (8.6%
CAGR in 2QFY20-23), primarily driven by a better case mix.

4. 30% of the operating beds recorded EBITDA margin in excess of 25% in 2QFY23.
This is compared with only 12% of operating beds delivering 25%+ EBITDA margin in
FY20 (pre-COVID-19).

5. Hospital EBITDA margin at 18.2% was up 151bp y-y and EBITDA recorded a CAGR Production Complete: 2022-11-13 22:31 UTC

See Appendix A-1 for analyst certification, important disclosures and the status of non-US analysts.
Nomura | Fortis Healthcare 13 November 2022

of 22.4% over 2QFY20-23.

Diagnostics business; slow ex-COVID-19 y-y growth

1. There is continued momentum in network expansion. 210 new collection centers were
added during the quarter. The network grew to 2,955 collection centers vs.
1,948 collection centers as of 2QFY22, a 52% increase in collection centers over the
past 12 months. On the back of this expansion, CC (collection centres) to lab ratio
increased to 18.6 vs. 12.1 a year back, thus closing in on the gap vs peers in terms of
network presence.

2. Realization per test was at INR349 and recorded a healthy increase q-q from INR334
in the previous quarter. Average realization per patient also improved to INR 805 from
INR774 in the previous quarter. Number of tests conducted per patient remained flat
q-q at 2.31.

3. Specialised test contribution was 39% this quarter, vs. ~30% in pre-COVID times.
Realization per test also increased by 4.5% from the pre-COVID average of ~INR334.

4. B2C contribution continued at 55% in the quarter. Prior to the acquisition of DDRC in
1QFY22, B2C contribution was ~45%.

5. We note that the sequential q-q increase of 5% in diagnostics revenues has mainly
come from improvement in realization per test. Test volumes remained flat q-q at
9.97mn.

6. The y-y growth ex-COVID-19 tests recorded 3.8% growth y-y. EBITDA margin was at
21.4% compared to pre-COVID-19 2QFY20 level of 26.6%.

Fig. 1: Segment-wise revenue and EBITDA

Q-Q Y-Y 2QFY23 vs. Nom

INR mn 2QFY22 1QFY23 2QFY23
Chg (%) Chg (%) Nom ests (%)
India Hospital business
Sales 10,985 11,924 12,970 9% 18% 12,719 2%
EBITDA 1,839 1,933 2,367 22% 29% 2,211 7%
- margin 16.7% 16.2% 18.2% 17.4%
SRL Diagnostics business
Sales 3,640 2,955 3,102 5% -15% 3,498 -11%
EBITDA 1,005 578 663 15% -34% 757 -12%
- margin 27.6% 19.6% 21.4% 21.6%
Total India
Sales 14,625 14,879 16,072 8% 10% 16,217 -1%
EBITDA 2,844 2,511 3,030 21% 7% 2,968 2%
- margin 19.4% 16.9% 18.9% 18.3%
Consol Revenue (incl OOI) 14,624 14,879 16,072 8% 10% 16,217 -1%

Consol EBITDA 2,844 2,511 3,030 21% 7% 2,968 2%

Source: Company data, Nomura research

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Nomura | Fortis Healthcare 13 November 2022

Fig. 2: P&L

Q-Q Y-Y 2QFY23 vs. Nom

INR mn 2QFY22 1QFY23 2QFY23
Chg (%) Chg (%) Nom ests (%)
Revenue 14,625 14,879 16,072 8.0% 9.9% 16,217 -1%
EBITDA 2,844 2,511 3,029 21% 7% 2,968 2%
Other Income 80 207 155 -25% 94% 80 94%
Depreciation 745 743 769 4% 3% 750 3%
Interest Expense 403 312 328 5% -19% 315 4%
PBT 1,775 1,663 2,087 26% 18% 1,983 5%
Provision for Tax 514 420 496 18% -4% 506 -2%
Minority Interest 237 121 139 15% -42% 120 16%
Associate income 42 100 75 -25% 77% 75 0%
Extraordinary items (3) - (516) - - - -
PAT 1,069 1,223 2,044 67% 91% 1,433 43%
Q-Q Y-Y vs. Nom
Chg (bps) Chg (bps) (bps)
EBITDA margin 19.4% 16.9% 18.8% 197 (60) 18.3% 54

Source: Company data, Nomura estimates

Fig. 3: Hospitals – EBITDA margin Fig. 4: Occupancy rate

EBITDA margin has improved Occupancy rate has increased

Source: Company data

Source: Company data

Fig. 5: ARPOB Fig. 6: Surgical contribution

ARPOB is at a historical high Surgical revenue contribution is at an all-time high

Source: Company data

Source: Company data

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Nomura | Fortis Healthcare 13 November 2022

Fig. 7: Hospitals – EBITDA margin split Fig. 8: Payor mix

30% of operational beds contributed >25% EBITDA margin Contribution of international patients has increased
% of operational beds Payor mix FY19 FY20 FY21 FY22 1QFY23 2QFY23
EBITDA margin
FY19 FY20 FY21 FY22 1QFY23 2QFY23 Cash domestic 46.0% 41.2% 40.4% 39.2% 36.1% 35.1%
>25% 11% 12% 0% 17% 31% 30% International 11.0% 10.1% 4.0% 4.8% 7.1% 8.0%
20% - 25% 13% 22% 19% 39% 14% 25% Govt. and institutional 14.0% 17.9% 18.4% 17.2% 19.4% 19.5%
15% - 20% 27% 21% 23% 7% 23% 19% TPAs 27.0% 28.9% 35.9% 37.7% 36.4% 36.5%
10% - 15% 14% 18% 19% 7% 13% 8% Others 2.0% 1.9% 1.3% 1.1% 1.0% 0.9%
<10% 35% 26% 39% 29% 18% 18%
Source: Company data
Source: Company data

Fig. 9: Diagnostics – EBITDA margin Fig. 10: Realization per test

Realization per test is above pre-COVID levels

Source: Company data

Source: Company data

Fig. 11: Number of collection centers

Aggressive network expansion evident

Source: Company data

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Nomura | Fortis Healthcare 13 November 2022

Appendix A-1
Analyst Certification
We, Saion Mukherjee and Aneesh Deora, hereby certify (1) that the views expressed in this Research report accurately reflect
our personal views about any or all of the subject securities or issuers referred to in this Research report, (2) no part of our
compensation was, is or will be directly or indirectly related to the specific recommendations or views expressed in this
Research report and (3) no part of our compensation is tied to any specific investment banking transactions performed by
Nomura Securities International, Inc., Nomura International plc or any other Nomura Group company.

Issuer Specific Regulatory Disclosures

The terms "Nomura" and "Nomura Group" used herein refer to Nomura Holdings, Inc. and its affiliates and subsidiaries, including Nomura
Securities International, Inc. ('NSI') and Instinet, LLC ('ILLC'), U. S. registered broker dealers and members of SIPC.

Materially mentioned issuers

Issuer Ticker Price Price date Stock rating Sector rating Disclosures
Fortis Healthcare FORH IN INR 282 11-Nov-2022 Buy N/A

Fortis Healthcare (FORH IN) INR 282 (11-Nov-2022) Buy (Sector rating: N/A)
Rating and target price chart (three year history)
Date Rating Target price Closing price
22-Nov-21 Buy 266.90
17-Nov-21 319.00 286.20
27-May-21 Neutral 226.25
27-May-21 245.00 226.25
29-Oct-20 164.00 126.85

For explanation of ratings refer to the stock rating keys located after chart(s)

Valuation Methodology We arrive at Mar'23F target price of INR319/sh for FORH using DCF valuation. The benchmark index
for this stock is Nifty 50
Risks that may impede the achievement of the target price Key risks: 1) Lower-than-estimated volume growth in hospitals
and slower than estimated recovery from COVID-19 disruptions; 2) weaker-than-expected price realization; 3) adverse
regulatory action by the government; 4) slower-than-estimated growth in diagnostics; 5) negative verdict on open offer by the
Supreme Court of India

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