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Narayana Hrudayalaya Ltd>
  • CMP : 1,242.5 Chg : 3.95 (0.32%)
  • Target : 750.0 (17.19%)
  • Target Period : 12-18 Month

01 Jun 2022

Decent numbers amid headwinds; new capex cycle…

About The Stock

NHL operates a chain of multispecialty, tertiary & primary healthcare facilities that initially focused on cardiac & renal but expanded to cancer, neurology, neurosurgery, orthopaedics & gastroenterology facilities.

  • NHL’s network comprises 21 hospitals (including two managed hospitals), four       heart centres, 18 primary care facilities (including clinics and information centres) and a multi-speciality hospital in Cayman Islands)
  • Revenue mix FY22 – India: ₹ 2965.5 crore; (Bangalore:31%, Southern Peripheral:7%, Kolkata:27%, Eastern Peripheral: 5%, Western: 16%, Northern: 13%); Cayman Islands: US$91.9 million
Q4FY22

NHL reported in line numbers amid Omicron wave and subsequent recovery in India business in March aided by traction in Caymans.

  • Revenues were up 12.3% YoY to ₹ 940.7 crore
  • EBITDA was at ₹ 175.1 crore, up 23.8% YoY with margins at 18.6%
  • Adjusted PAT was at ₹ 68.9 crore (up 1.3% YoY)
What should Investors do?

NHL’s share price has grown by ~2.1x over the past five years (from ~₹ 296 in May 2017 to ~₹ 640 levels in May 2022).

  • We maintain BUY due to 1) pick-up for elective surgeries in India post third Covid wave, 2) consistent performance at Cayman Islands and 3) judicious plan to expand at existing hospitals nearing full utilisation
Target Price Valuation

We value Narayana at an SOTP of ₹ 750 by valuing matured India & Cayman hospitals at 14x FY24E EV/EBITDA, new hospitals at 2x and other business at 1x FY23E EV/sales.

Key Triggers for future price performance
  • With Covid in backdrop, increase in footfalls is expected to lead flagship hospitals on a steady growth path amid better returns
  • New hospitals (SRCC, Gurugram, Dharamshila) are likely to see reduction in losses and turn profitable in near term with ramp up in occupancies
  • Improvement in numbers on the back of judicious case mix identification (more focus on oncology, transplants and non-invasive procedures)
  • Expansion at Cayman Islands in oncology while being margin dilutive in near term is likely to provide significant additional operating leverage
New Stock Ideas

Apart from NHL, in our healthcare coverage we like Apollo.

  • Apollo Hospitals is an integrated healthcare provider undergoing an optical transformation towards creating an omni-channel healthcare platform while turning the new hospitals profitable on the back of a judicious case mix
  • BUY with a target price of ₹ 5480

Key Financial Summary

Particulars FY19 FY20 FY21 FY22 5 Year CAGR(FY17-FY22) FY23E FY24E 2 Year CAGR (FY22-FY24E)
Revenues 2,860.9 3,127.8 2,582.3 3,700.4 14.5 4,241.9 4,736.9 13.1
EBITDA 287.9 422.9 182.1 652.6 23.3 789.1 923.8 19.0
EBITDA Margins (%) 10.1 13.5 7.1 17.6 - 18.6 19.5 -
Adjusted PAT 59.3 129.8 -14.3 341.9 32.3 386.3 440.8 13.5
EPS (|) 2.9 6.4 -0.7 16.7 - 18.9 21.6 -
PE (x) 220.3 100.7
EV to EBITDA (x) 47.9 32.7 75.0 20.7 - 17.6 14.8 -
Price to book (x) 12.1 11.5 11.7 8.8 - 7.0 5.7 -
RoE (%) 5.5 11.4 -1.3 23.0 - 20.8 19.4 -
RoCE (%) 7.7 11.0 1.2 20.5 - 18.8 19.5 -
Source: Company, ICICI Direct Research

Key takeaways of recent quarter & conference call highlights

Q4FY22 Results: Robust performance continues

  • Narayana’s quarterly result was in-line with I-direct estimates. Revenues grew 12% YoY to | 941 crore. On the EBITDA front, margins improved 173 bps YoY to 18.6% while EBITDA grew 24% YoY to | 175 crore. Profit for the quarter was flat YoY at | 69 crore. Delta vis-à-vis EBITDA was mainly due to higher tax expense in the quarter
  • Narayana’s Indian operations posted was impacted due to third Covid wave induced disruptions and resulted in sequential decline in Q4, which historically is a strong quarter for Narayana. Q4 was aided by strong recovery in India operations in March,2022 and continued momentum in operations at Cayman Islands and hospital project management at St. Lucia. The margin performance has improved on the back of lower consumable expense. The improvement in numbers over the last few quarters is on the back of judicious case mix identification (more focus on oncology, transplants and non-invasive procedures). We continue to believe in the long term prospects of the company on the back of an asset-right model and affordability philosophy

Q4FY22 Earnings Conference Call highlights

  • Indian operations in Q4FY22 were affected by Omicron wave while March saw strong recovery. Indian operations adjusted for vaccines grew 6.1% YoY while declining 3.3% QoQ. There was sequential decline in cardiac sciences (              Q4FY22: 34.3%, FY22: 36.7%)
  • Occupancy FY22: 50-55%. International patient mix was at 4.6% in Q4FY22 and 3.7% for FY22.
  • EBITDA margins for NH’s three flagship hospitals was at 26.9% in Q4FY22 while at 23.1% in FY22. Other hospitals (ex-Jammu) margins at 17.1% in Q4FY22 while 15.4% in FY22, adjusted for vaccines
  • Three new hospitals loss reduced in FY22 to | 16.7 crore vs. | 42.2 crore in FY21.
  • Cayman Islands – Operating revenue Q4FY22: US$24.4 million (US$91.9 million in FY22). EBITDA for Cayman in Q4FY22: US$10.4 million and US$39.7 million in FY22. St. Lucia contributed | 132 million EBITDA in Q4FY22 and | 374 million in FY22.
  • The management has identified new growth levers –
    • Significant capex into large hospitals for better technology and larger capacity. Kolkata (will buy land, put up new hospital of ~1000 beds) will be greenfield while Bangalore (Cardiac building and additional space for multi-specialty work), Raipur (additional land acquisition) has scope for expansion. NH has maxed out capacities in these hospitals and revenues growth possible only through expansions. In other places, only departments will be added while management indicated at inorganic opportunities
    • Inpatients contribute ~ 80% while management wants to bring it to 50% levels through investment in day care and clinics.
    • Software analytics and shared services for better management
    • Investment in international market to increase presence in Caribbean and North America (including US as market)
  • No significant beds are likely to be commissioned in FY23 while capex guidance for ~ | 1000 crore.
  • Tax rate was higher in Q4 due to repatriated dividend from Cayman and tax paid on that, India business to be taxed at ~ 35% while effective tax would be lower in FY23 as company is carrying forward losses and effective tax on Cayman is nil. Shift to new regime from FY24.
Variance Analysis

  Q4FY22 Q4FY22E Q4FY21 YoY (%) Q3FY22 QoQ (%)   Comments
Revenue 940.7 951.2 837.8 12.3% 959.6 -2.0%   QoQ decline as Indian operations were significantly impacted due to the third wave induced disruptions
Raw Material Expenses 219.9 234.3 206.9 6.3% 236.4 -7.0%    
Employee Expenses 196.1 190.8 169.6 15.6% 192.5 1.9%    
Other Expenditure 349.7 355.0 319.8 9.3% 355.8 -1.7%    
Operating Profit (EBITDA) 175.1 171.1 141.4 23.8 175.0 0.1    
EBITDA (%) 18.6% 18.0% 16.9% 173 bps 18.2% 38 bps   YoY improvement was aided by Cayman Islands and hospital project management at St. Lucia
Interest  16.3 16.3 18.2 -10.8% 16.3 -0.2%    
Depreciation 46.8 46.1 44.5 5.1% 46.1 1.4%    
Other Income 9.8 6.8 8.5 14.4% 6.9 42.2%    
PBT before EO & Forex 121.8 115.5 87.2 39.7 119.5 2.0    
Forex & EO 0.0 0.0 0.0 0.0 0.0 0.0    
PBT after Exceptional Items 121.8 115.5 87.2 39.7 119.5 2.0    
Tax  50.3 29.5 17.2 191.6 19.6 156.0   YoY increase due to tax paid on dividend from Cayman
PAT before MI 71.5 86.1 70.0 2.2 99.8 -28.3    
MI 0.0 0.0 0.0 -23.1 0.0 -37.5    
Adjusted Net Profit 68.9 84.1 68.0 1.3 97.5 -29.3   YoY Delta vis-à-vis EBITDA mainly due to higher tax 
Key Metrics                
 Owned/Operated Hospitals  900.1 915.2 800.1 12.5% 919.9 -2.2%   YoY improvement mainly due to strong numbers led by flagship hospitals 
 Heart Centres  29.8 30.5 21.0 42.1% 30.9 -3.3%   YoY improvement due to easing of travel restrictions
                 

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