← Throughline · holding view Deep analysis ↗ Q4 FY26
ASTERDM Aster DM Healthcare · Other Q4 FY26 · concall
Pattern: arpp ip congo t

Kerala recovered from decline to record revenue.

4 weak · 16 clean — pushback across 4 of 20 Q&A turns

Focused evidence 4 of 20

Damayanti Kerai · weak

ARPOB and IP volume trends — key initiatives to continue momentum, and headroom on CONGO-T contribution?

Sunil: Aster Q4 IP growth ~7%, includes -8% in K&M from de-empanelment of low-yield Aster Aadhar schemes; ex-that, K&M growth turns positive 3%. Growth drivers: strengthening doctor engagement programs, OP-to-OP and OP-to-IP conversion, call center management. Doctor acquisition primary: added 36+ new doctors in last 6 months alone. Alisha: CONGO mix at 55% blended — can take it to 60% and then 65%.

Siddharth Negandhi · weak

AI implementations within Aster or QCIL?

AI is more academic than ground-reality. We've started on four tiers: patient safety, operating world, financials, clinical. Early successes: AI-enabled CDSS, AI call center support, AI-pre-populating EMR for doctor time savings. Asia's first AI-enabled radiotherapy platform — first Elekta EOP platform sold in India/Asia. CRM/call center AI improving conversion ratios — IP volumes 10% growth, OP double-digit. Mindful that newer AI tech is huge cost with unclear ROI.

Amey Chalke · weak

Hyderabad cluster — INR 500 cr investment status, and CAPEX guidance for QCIL next two years?

Don't know where INR 500 cr number is from. We're turning every asset around — Banjara enhancing oncology (radiation, OPD-to-IPD building); Hitech growing 65-70% YoY; Nampally being spruced up. INR 1,700 odd beds will be added, INR 2,000 cr expense. 1,500 of 1,700 beds are brownfield (revenue accretive), only 200 greenfield. CAPEX run-rate: 5% of annual revenue — 3% refresh, 2% incremental. KIMS-Care procurement synergy boosting effective spend power.

Vivek Sethia · weak

QCIL EBITDA margin we report ~20-21% vs annual report 17-18% — reconciliation?

There is one-time impact broadly around the merger and consultants work to enhance productivity. All one-time. Can provide breakup if desired later.

▸ Other Q&A (16)
Tausif Shaikh · BNP Paribas

Where does the industry stand on common-insurance empanelment with private insurers (uniform pricing) — is Aster or QCIL onboarded, and is this a threat to private hospital chains?

The empanelment piece has been in play for a while; QCIL hasn't signed up and large-tier hospitals haven't either. Two industry concerns: data privacy across hospitals and transparency. It cannot be done unilaterally; it's only feasible if private hospitals accept. There are benefits (could save empanelment costs if done right) but in current avatar, my sense is no, it's not coercive.

Tausif Shaikh · BNP Paribas

Kerala MVT despite Ramadan — give colour; have UAE/Middle East patient flows resumed?

Kerala has done well — MVT 41% YoY growth. Attraction from Middle East, Maldives, African countries. Recently from Oman and UAE less patient inflow, but we kept the boat steady via Maldives and focus on African countries — steady flow happening. Trying to mitigate losses through expanded coverage. Maldives contributing more now.

Tausif Shaikh · BNP Paribas

Kerala nurses' strike status — total Kerala nurses count and INR 20,000 minimum-wage exposure?

Strike started mid-March 2026. UNA demanded the Government release the gazette notification (GO) for basic pay (5-year cycle). Aster has ~4,300 nurses in Kerala, paid basic per government notification. Interim GO issued; UNA continued strike demanding INR 40,000 basic per nurse. Private hospital association negotiated on April 13; the court directed private hospitals to mediate; settlement reached. The strike is called off.

Tausif Shaikh · BNP Paribas

Quantify final wage settlement impact?

Even though demand was INR 40,000 basic, we concluded with a small increase. Total impact in Kerala will be INR 5-6 crores. Increments offered: Calicut INR 3,500 per nurse, Kochi INR 4,000, remaining places INR 3,250. All nurses are back.

Damayanti Kerai ·

What's helping you attract clinical talent in competitive markets like Bangalore, and what's the retention strategy?

Ramesh: Star clinicians joined because Aster has a bigger vision and Bangalore expansion to 5 units; high-end procedures (robotic transplants), CONGO leadership in neurosciences and oncology growing. Brand and clinical excellence pathway attractive. Varun (QCIL): Four-five elements — relationships and transparency; ClinIQ model with clinical independence; technology investments; commercial competitiveness. Our ability to connect, forge alliances is better than anybody else.

Kunal Randeria ·

QCIL mature units grew 14% (vs focused units) — what drives forward growth: case mix or expansion?

Mature growing 13.5-14% top, 20%+ bottom, 30%+ EBITDA. Still enhancing complexity; at ~59% CONGO-T mix, will grow that, especially oncology which is under-leveraged. Significant growth in oncology volume in network over next two years. Emerging/focused at sub-20% EBITDA still have long runway — bringing 'golden few' clinical talent; ethics/integrity brand pull; Hyderabad EBITDA grew 66% YoY.

Kunal Randeria ·

Synergies — INR 85cr in QCIL pre-merger — is similar happening in Aster, and what's incremental post-merger?

The INR 85 cr synergies are pre-Aster QCIL merger — within QCIL we are merging three companies (Care, Evercare Bangladesh, KIMS Trivandrum/Tamil Nadu). Synergies from procurement, food insourcing, AMC etc. Aster QCIL synergies haven't started — they will start to flow in post-merger.

Kunal Randeria ·

Aster Greenfield expansion — cost profile and margin impact over next couple of years?

Last year Kasargod started October; FY26 margin impact only 60 bps — closed 20.4 including Kasargod, ~21% ex-Kasargod (Kasargod loss INR 19-20 cr). FY27: two brownfield expansions already commenced — Whitefield Block D and Ongole 75 beds in April; brownfield is EBITDA accretive (Kannur example: added 100 beds, margin expanded 400 bps from 18.5 to 22.5). Trivandrum commencing H2; underpenetrated, expect to do well. Even with new-unit losses, EBITDA margin should only grow. With merger, synergies coming from Q1FY27 — no margin dilution expected, year-on-year margin growth.

Siddharth Negandhi ·

Karnataka 3% IP volume vs group 8-9% — why low? Was Aster Aadhar a negative-margin scheme? Chemo/dialysis share within Onco/Nephro? AI/robotics implementations?

K&M 3% IP from de-empanelment of low-yield government schemes — ARPOB <50% of cash market. Aadhar at 75% occupancy, exited to optimize for cash/TPA. Whitefield ramped to INR 44 cr/month in <2 years (CMI took 6+ years); now mature so growth tapered to 10-11%. Competition intensity in north Bangalore, one general surgery team left Q3 came back Q4 — strong clinical ecosystem. 3% is one-off, not structural; doctors now in stability — expect bounce in 1-2 quarters. Onco: medical oncology 50-60%, surgical 30-35%, radiation 10-15%; within medical 60% chemo / 40% immunotherapy & targeted.

Siddharth Negandhi ·

K&M capacity utilization — is there a bottleneck elsewhere apart from Aadhar (Kolhapur)?

K&M has capacity: Aster CMI 60%+ occupancy, Aster RV 69%, Aster Whitefield 55%+ (post 150-bed addition). Great runway to add beds. Sarjapur in next year, Yeswanthpur in three more years — very good runway.

Amey Chalke ·

Top-line ~16-17% and ~150bps margin expansion in FY26 — can this growth+margin trajectory continue next two years?

Yes I do — gone to solid start, margin expansion as well as top-line growth will continue. Strategy is firing. Strategies aren't made for a year — what we started is the right thing. Team is rock solid, very committed.

Amey Chalke ·

Whitefield occupancy YoY and profitability — and EBITDA addition potential next 2 years?

Whitefield occupancy 60% (Block A/B/C); Block D adds 159 beds; empty 50 beds being integrated. Aster CMI 56% occupancy, 100-bed expansion in 1+ year. Aster RV 66% occupancy, no oncology — can go 75-80%. Whitefield current margin in high teens; with Block D ramp expect to reach mid-20s.

Vivek Sethia ·

A&T cluster — what steps drove the outperformance and what's sustainable revenue/margin?

Three main hospitals: Ramesh Hospitals (largest), Aster Prime Hyderabad (150 beds), Narayanadri Tirupati (150 beds). Narayanadri (3 yrs old) 46% revenue / 75%+ EBITDA growth — underserved market, good clinicians, will convert wards to single rooms for ARPOB lift. Ramesh stagnant 2 years, lost doctors Q1-Q2, added clinicians in Nephro/Pediatrics/Ortho/Cardio (their stronghold) — post-Dec strong momentum (4 months + April trends similar), 32% revenue growth. EBITDA growing on low base + operating leverage (not hiring more manpower).

Vivek Sethia ·

QCIL expansion plan by cluster, and per-bed capex for brownfield vs greenfield?

Per bed ~INR 1-1.1 crores blended. Bhubaneswar and Raipur this year (capability + bed expansion); FY28 Banjara/Hyderabad significant capacity + capability; Nagercoil expansion ~100 beds (asset at 28-29% EBITDA); Nampally 28 beds. Beyond — Malakpet, Chattogram, Vizag. Of 1,500 brownfield + 200 greenfield total: greenfield Indore only. Brownfield per-bed INR 0.8-1.1 crores; greenfield INR 1.5-1.6 crores.

Vivek Sethia ·

Minority share as % of total profit, going-forward assumption?

Aster ~8% (two units: Aster MIMS 20% minority, Ramesh Hospital 30%). QCIL ~15-20%. Post-merger blended ~10-15%.

Vivek Sethia ·

ROCE calculation reconciliation — my number differs from your presentation?

Aster: we exclude revaluation reserve (land, book entry from IGAP→IndAS transition) and CWIP (asset not deployed). QCIL: we exclude intangibles (Bangladesh acquisitions, KIMS brand/goodwill). Happy to share calculation offline.

▸ Prepared remarks (5 blocks)
As we move closer to completing the proposed merger with Quality Care, I would like to thank our shareholders for their continued confidence and support in approving the scheme. With this milestone behind us, the transaction now awaits final approval from the NCLT. Even ahead of formal completion, the combined proforma performance provides a very useful view of the potential scale and operating profile of the two organizations together. Coming to the quarter's performance on a combined proforma basis, the revenues have grown 18% year-on-year to INR 2,361 crores for the quarter, supported by a 12% increase in total patient volumes and an 8% improvement in ARPP IP. Operating EBITDA has outpaced the revenue growth, increasing by 25% to INR 517 crores. This operating leverage translated into margins of 21.9% and a ROCE improvement of 293 basis points to 21.1%. For FY26, the combined platform has delivered revenue of INR 9,273 crores, growing 14% year-on-year. Operating EBITDA growing at 21% to INR 2,013 crores and margins expanded by 116 basis points now to 21.7%. Over the past three years, the combined entity has delivered revenue CAGR of 14.5% and an Operating EBITDA CAGR of nearly 20%. Over the past year, we have added 373 beds, taking the combined capacity to 10,620+ beds across 28 cities. Our pipeline includes 4,445 additional beds, which will take our total capacity beyond 15,000 beds through a balanced mix of greenfield and brownfield expansions. During the quarter, the merger received overwhelming approval from shareholders and creditors, with 96.7% of shareholder votes cast in favor. The merger application was subsequently filed with the NCLT on December 11, 2025. With the shareholder and creditor approvals also now in place, the matter is currently before the NCLT for the final approval. The next hearing is expected in May, and upon receipt of the order, the merger will become effective. Based on current timelines, we expect the process to be completed within this quarter. Turning towards Aster's performance for the final quarter of the year. Despite macro headwinds, we delivered strong double-digit growth across our core hospitals, clinics, and labs businesses, driven by robust patient volumes and a continued shift towards higher-acuity care. Revenue from operations stood at INR 1,182 crores, reflecting an 18% year-on-year increase. This growth was supported by a 15% increase in total patient volumes, a 9% improvement in ARPP IP, and the contributions from the recently operationalized Kasargod hospital. If you look at cardiology revenues, those grew by 25% year-on-year, with contribution increasing to 15% in Q4 FY26 from 14% last year, while oncology revenues have grown 23%, contributing 11% to the overall mix. Alongside this, the MVT segment maintained strong momentum, growing 41% year-on-year on the back of increased international patient footfall.
Within Kerala, MVT revenues grew 51%, with stronger inflows from Maldives helping offset macro-related softness from the middle east. In our ancillary businesses, labs continued to scale steadily, with revenues increasing 18% year-on-year. Operating EBITDA for the quarter stood at INR 244 crores, growing 26% year-on-year, with margins at 20.7% despite the addition of new capacity. Core hospitals and clinics delivered particularly strong performance, with operating EBITDA growing at 32% and margins at 23.1%. Normalised PAT grew by 32% Year-on-year in Q4FY26 with margins up by 120 basis points. Excluding Kasargod, revenue and operating EBITDA grew 17% and 31% year-on-year respectively, with margins expanding by 239 basis points to 21.7%. Within core hospitals and clinics, excluding Kasargod, operating EBITDA grew 36%, with margins improving to 24.3%, reflecting a 345 basis point expansion. The labs segment saw a sharp increase in profitability, with operating EBITDA growing 181% and margins expanding to 14.7% from 6.2% last year. Kerala continues to anchor stability and profitability despite a temporary and modest impact from the nurses' strike. Inpatient volumes grew 11% year-on-year. Excluding Kasargod, revenues grew nearly 18% year-on-year, while operating EBITDA margins remained strong at 25.6%. In the Karnataka and Maharashtra cluster, operating performance continued to improve, with revenue growing 11% year-on-year. Operating EBITDA grew 25%, with margins expanding by ~270 basis points. The Andhra Pradesh and Telangana cluster delivered strong performance, with revenues growing 30% year-on-year. Operating EBITDA more than doubled during the quarter, with margins expanding significantly by 700 basis points to 18.3%. Over the past year, we added 290 beds, taking Aster's total capacity to 5,449 beds as of March 31, 2026, and expanding our India network to 20 hospitals, including Kasargod. As part of this roadmap, we launched 159 beds at Block D in Aster Whitefield in April 2026 — a dedicated women and childcare facility that strengthens our specialized capabilities in Bengaluru. In the same month, we also operationalized 75 beds at Ramesh Ongole. Looking ahead, we plan to add nearly 2,500 beds over the coming years through a balanced mix of greenfield and brownfield expansions, which will take our total capacity to over 8,150 beds. This includes planned brownfield expansion of 150 beds in MIMS Calicut as well as 130 beds in MIMS Kannur. In the Newsweek World's Best Hospitals Rankings 2026, our facilities secured prominent positions in India, with Aster CMI Hospital ranked #12 and Aster Medcity ranked #28.
I am pleased to report that this quarter is yet another testament to the power of disciplined strategic execution and operational focus across the Quality Care India Limited. This quarter, we are proud to report a double-digit volume growth across the company, with several of our key markets delivering even stronger results. We are making deliberate and measurable progress on enhancing clinical complexity, positioning QCIL as the destination of choice for advanced and high-acuity care. Our work on CONGO-T is progressing well, and we are seeing the early fruits of that focus reflected in our operational metrics. KIMS Health strengthened its position in Transplants, performing its first Heart Transplant in Q4 FY26. Care Banjara installed a Cardiac Laser, which is the first of its kind in the QCIL system. Q4 FY26 witnessed a strong growth overall with a Revenue growth by 18% year-on-year to INR 1,178 crores. EBITDA grew 23% year-on-year to INR 272 crores. The EBITDA Margin expanded by 103 basis points Year-on-year to 23.1%. Revenue growth was driven by an increase in IP and OP volumes. QCIL treated and discharged 10% more patients in Q4 FY26, over the same period last year, serving 62,598 In-Patients. OP footfalls grew by 9% to ~8.8 lakhs patients in that period. ARPP grew 7.4% to ~INR 135k. Our efforts to strengthen clinical offerings and clinical teams has resulted in a 97 basis points increase in CONGO-T revenue, which now forms 58% of total revenue, CONGO-T revenue grew ~20% in Q4 FY26 over Q4 FY25. Payor mix moved favorably to 79% from 'cash + insurance' up 98 basis points Year-on-year. Focus units contribute to ~29% of our revenue, delivered a major turnaround this year. Focus units recorded a double-digit revenue growth of 21%, all while improving efficiency to post a robust EBITDA growth of 66.6% Year-on-year resulting in a 422 basis points EBITDA margin expansion to 15.4%.
In Q4 FY26, ~<strong>59% of revenue</strong> comes from the mature units and that delivered a 13.5% revenue growth Year-on-year, along with a 20.7% EBITDA growth Year-on-year. The resulting EBITDA Margin witnessed an expansion of 198 basis points Year-on-year to reach 33.2%. Emerging units which are the newer units that we have, they contribute ~7% of our revenue. They ramped up strongly, 62.4% year-on-year revenue growth and 44% Quarter on trailing Quarter EBITDA growth. QCIL registered a 17% revenue growth year-on-year to INR 4,630 crores. CONGO-T revenue increased 23%, CONGO-T mix improved 270 basis points to 58.7% of total revenue. QCIL recorded an EBITDA of INR 1,066 crores, first time ever breaching the INR 1,000 crores mark, which represents a growth of 24.1% year-on-year. EBITDA Margin for the year stood at 23.0%, which is a 136 basis points expansion over the previous year. EBITDA growth was bolstered by activities to realize synergies across all our units including procurement centralization which contributed to INR 85 crores to the bottom-line. KIMS performed its first Cardiac Transplant, on a 10-year-old girl. In this quarter, KIMS Health has conducted 2 dual-organ transplants. Among CONGO-T specialties – Orthopedics, Neurology and Gastroenterology had an accelerated ramp-up this year, with each growing minimum 25% for FY26. Robotic procedures more than doubled in FY26 and moved to 1,300+ procedures for the year, which is a 152% growth. We have upgraded our near-term to mid-term expansion plans and intend to invest close to INR 2,000 crores to add over 1,700 beds in the next 3-4 years. We plan to add ~1,300 of these ~1,700 beds in nonmetro markets. Of the total, ~1,500 beds are planned to be added through brownfield expansions while the balance ~200 will come from greenfield projects.
In Q4 FY26, the cluster reported revenues of INR <strong>604 crore</strong>s, reflecting a healthy 21% year-on-year growth, despite the nurse strike during the quarter, the impact of which was limited. Excluding Kasargod, revenues grew 18% year-on-year to INR 587 crores. Growth was significantly bolstered by a 51% year-on-year surge in MVT. While the macro headwinds led to a decline in MVT from the UAE, this loss was efficiently neutralized by business from Maldives and African markets. Operating EBITDA grew by 27% year-on-year while excluding Kasargod, EBITDA increased 35% year-on-year, with margins expanding by 330 basis points to 25.6%. With ~3,000 beds and an expansion pipeline of over 800 beds, including recent brownfield additions of 130 beds at MIMS Kannur and 150 beds at MIMS Calicut, Kerala is well poised to sustain the growth momentum. Revenue for the K&M cluster reached INR 394 crores in Q4 FY26, representing an 11% year-on-year growth fueled by robust realization.
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