Rating Rationale
December 10, 2020 | Mumbai
Fortis Healthcare Limited
  Ratings continues on 'Watch Developing'; Rated amount enhanced
 
Rating Action
Total Bank Loan Facilities Rated Rs.539.8 Crore (Enhanced from Rs.429 Crore)
Long Term Rating CRISIL A (Continues on 'Rating Watch with Developing Implications')
Short Term Rating CRISIL A1 (Continues on 'Rating Watch with Developing Implications')
1 crore = 10 million
Refer to annexure for Details of Instruments & Bank Facilities
Detailed Rationale

CRISIL ratings on the bank facilities of Fortis Healthcare Limited (FHL) continues on 'Rating Watch with Developing Implications'.
 
FHL's operations were impacted by the Covid-19 pandemic and the resultant countrywide lockdown. Occupancy for hospitals suddenly dropped to 29% in April 2020 from an average occupancy of 68% during fiscal 2020 as people deferred elective procedures coupled with lower outpatient department footfall, and fall in medical tourism. Similarly, the diagnostics segment was hit by lower referrals from hospitals, deferment of preventive check-ups, and logistic issues in sample collection because of the lockdown.
 
However, with gradual easing of restrictions and lifting of the lockdown, occupancy levels in hospitals business have witnessed recovery and were at ~66% in October 2020 (including slightly more than 20% occupancy from Covid-19 patients) while the diagnostic business has already exceeded pre pandemic revenues in October 2020.
 
Consolidated operating revenue was Rs 995 crore and earnings before interest, tax, depreciation and amortisation (Ebitda excluding other income) was Rs 120 crore in the quarter through September 2020, compared with consolidated operating revenue of Rs 1,212 crore and Rs 184 crore, respectively, in the corresponding period of the previous fiscal. For the quarter ended June 2020, the corresponding numbers were Rs 606 crore and a loss Rs 99 crore, respectively. Healthy liquidity, estimated more than Rs 500 crore (including consolidated cash and equivalent and unutilised bank lines) at the end of October 2020, aided by positive cash accruals in the quarter through September 2020 should be adequate to support current operations, repayments and capex plans.
 
The ratings continue to remain on watch because of the pending legal issues. The Hon'ble Supreme Court, through its order dated November 15, 2019, had initiated suo moto contempt proceedings against inter alia, FHL with regard to the IHH equity infusion and purchase of RHT Health Trust (RHT) assets. The matter is currently pending before Hon'ble Supreme Court. Also, the Securities and Exchange Board of India and the Serious Fraud Investigation Office are investigating into alleged financial irregularities at FHL. Furthermore, on November 20 2020, SEBI issued a show cause notice inter alia to FHL and its wholly owned subsidiary Fortis Hospitals Ltd. (Rated 'CRISIL A/Watch Developing/CRISIL A1') for alleged involvement in diversion of funds by the erstwhile promoters and misrepresentation of the financials thereby not safeguarding investor interests. The hearing is scheduled in January 2021. The outcome of these matters including any punitive action may have a bearing on company's credit risk profile. CRISIL will remove the ratings from watch and take a final rating action once clarity emerges on these aspects.
 
The ratings reflect FHL's strong market position and healthy financial risk profile. These strengths are partially offset by moderate operating performance and exposure to regulatory risks in the healthcare industry.
 
Moreover, minority shareholders of SRL, holding ~31.5% stake, hold a put option and the liability towards this put option, of around Rs 1,200 crore, has already been provided in the books of FHL. The company is in active discussions for providing extension of the said put option. However, if FHL is required to provide a cash exit to the minority shareholders of SRL, it may significantly impact FHL's liquidity and would, therefore, remain a key rating sensitivity factor.

Analytical Approach

For arriving at its ratings, CRISIL has combined the business and financial risk profiles of FHL and its subsidiaries, joint ventures and associates, because all the entities are under a common management and have strong business and financial linkages.

Please refer Annexure: List of entities consolidated, for details of the entities considered and their analytical treatment for consolidation.

Key Rating Drivers & Detailed Description
Strengths
* Strong market position
FHL (on consolidated basis) operates 27 hospitals (including 4 network hospitals) which provide pan-India coverage. Fortis is a well-known brand in the Indian healthcare space. The company's hospitals (on consolidated basis including network hospitals) include those in Gurugram, Haryana; Mohali, Punjab; Okhla, Delhi; Shalimar Bagh, Delhi; BG Road, Bengaluru; and Mulund, Mumbai. These hospitals offer world class services and attract international patients. SRL has established a strong brand in both retail and business-to-business (B2B) segments, managing over 400 labs (including joint ventures) with 1,400+ collection centres and 7,000+ sample pick-up points in India. FHL's strong market position should sustain over the medium term, given its wide geographical footprint and diverse specialty mix. There is a proposal to change the Fortis and SRL brand names, subject to various requisite approvals, which will remain a monitorable.

* Strong financial risk profile, aided by equity infusion by IHH
Fresh equity infusion of around Rs 4,000 crore by IHH in November 2018 helped FHL reduce its high-cost debt and buy RHT assets. This led to significant improvement in cash accrual and the financial risk profile. While the financial risk profile will be impacted in fiscal 2021 because of lower accrual, this is expected to be temporary. Debt reduced to around Rs 1413 crore as on September 30, 2020, from around Rs 1,505 crore as on June 30, 2020 given the recovery in operating performance, tax refund etc in the second quarter of fiscal 2021. On consolidated basis, gearing, interest coverage and the ratio of net debt to Ebitda are expected to remain below 0.5 time, above 3.5 times, and below 2 times, respectively, over the medium term (excluding FY21 due to adverse impact of pandemic) on a steady state basis. The company is being prudent and proceeding with its capex plans judiciously. Any large, debt-funded capex or investment and its impact on the financial risk profile will remain key monitorables.

Weaknesses:
* Moderate operating performance
FHL reported operating profitability of around 5% in fiscals 2018 and 2019. However, consolidated operating margin improved to 13.1% in fiscal 2020 from 5% in the previous fiscal, primarily because of savings of net business trust cost of around Rs 270 crore annually, which was being paid to RHT prior to acquisition of its assets. Moreover, all operating metrics for the hospitals segment have improved. For instance, average revenue per occupied bed was Rs 1.59 crore and occupancy was 68% in fiscal 2020, against Rs 1.52 crore and 67%, respectively, for the previous fiscal.

After weak operating performance in the first quarter induced by the pandemic, there has been significant recovery in the second quarter of fiscal 2021 in the hospitals business while the diagnostics business has almost reached pre pandemic revenues. Operating revenue in the hospitals business stood at Rs 746 crore with a reported operating Ebitda of Rs 63 crore for the quarter through September 2020, compared with operating revenue of Rs 972 crore with an operating Ebitda of Rs 122 crore in the corresponding period of the previous year, primarily because of constrained occupancy amid the lockdown. Similarly, operating revenue in the diagnostic business stood at Rs 282 crore with a reported operating Ebitda of Rs 64 crore, compared with operating revenue of Rs 277 crore and reported operating Ebitda of Rs 64 crore in the corresponding period of the previous year. Higher COVID testing volumes benefitted company's performance and non COVID business is almost back on track to pre-covid levels. Hospital occupancy has recovered to 66% in October from ~50% in July and ~29% in April 2020. Covid occupancy was slightly above 20% of the total of ~66% occupancy in October 2020. As the average revenue per occupied bed for a Covid bed is almost half compared to a non-Covid bed due to price caps therefore it will continue to have a bearing on overall operating margins of the hospital business.

The hospitals business has been Ebitda positive since July 2020 and the diagnostic business since June 2020. Consolidated operating performance will be subdued in fiscal 2021. Sustained recovery in occupancy (of non-Covid patients and international patients) and profitability will be key monitorables.

* Exposure to regulatory risks
The government policy regarding capping of prices for medical procedures such as for the treatment of Covid-19 and for medical devices such as coronary implants and knee implants impacted players in the healthcare sector. While such price control mechanisms have a direct bearing on players' operating margin through reduction in revenue, they also impact premium patients (including medical tourism) who would prefer getting such procedures done in foreign geographies. Any policy change that may negatively impact FHL's credit risk profile will be closely monitored.
Liquidity Adequate

FHL had cash and equivalent and unutilised limits of Rs 500+ crore as at end of October, 2020, against debt repayment obligation of ~Rs 86 crore for the remainder of fiscal 2021. Bank overdraft/cash credit limits of Rs 398 crore was utilised 78% on average over the 12 months through November 2020. Operations were cash accretive in the second quarter of fiscal 2021. Cost-cutting measures, comfortable debt repayment and prudent incremental capex will help sustain liquidity. FHL also had a dedicated undrawn line for meeting capex requirement of Rs 91 crore at the end of October 2020.

Rating Sensitivity Factors
Upward Factors
* Strong revenue growth and improving profitability, leading to consolidated net debt to Ebitda ratio sustaining below 1.75 times
* Resolution of ongoing litigations and investigations with no adverse impact on the financial risk profile

Downward Factors
* Worsening operating performance with stagnating revenue or declining profitability
* Significant, debt-funded capex or investments, leading to consolidated net debt to Ebitda ratio sustaining above 2.75 times
* Adverse impact of ongoing litigations weakening the financial risk profile.

About the Company

FHL was incorporated in February 1996. The company's first healthcare facility became operational at Mohali in Punjab in 2001.
 
FHL is an integrated healthcare services provider and has presence in hospitals, diagnostics, day care, and specialty facilities. It has both owned and managed hospitals. The diagnostic brand, SRL, is among the leading chains in the country.
 
FHL has entered women and child health and well-being segments through its brand, La Femme. It has four facilities under the brand, one each in Jaipur; Greater Kailash, New Delhi; Bengaluru; and Shalimar Bagh, New Delhi.
 
Fortis has four hospitals accredited to the Joint Commission International (JCI), 18 hospitals accredited to the National Accreditation Board for Hospitals (NABH), 10 NABH-accredited blood banks, and 23 hospitals with NABH-accredited nursing programmes under its umbrella.
 
On February 15, 2018, the shareholding of the erstwhile promoters, Mr Malvinder Mohan Singh and Mr Shivinder Mohan Singh, reduced to less than 1% after the Supreme Court allowed lenders to invoke the pledge against shares of FHL held as security. Thereafter, the search for a new promoter began and bids were invited from investors. IHH was the winning bidder and became the new promoter, investing around Rs 4,000 crore in the company against fresh issuance of ~31.1% stake.

Company's board has provided in principle approval for changing of company's name, brands and logo from Fortis and SRL whose license agreement(s) are expiring in April and May 2021 respectively. This should help reinforce complete disassociation with the erstwhile promoters. There is a proposal to rename the Fortis brand as Parkway which is a strong international brand belonging to IHH Healthcare Berhard (IHH) while a neutral name will be considered for SRL. The said proposal of change in company name, brand and logo for Fortis and SRL are subject to regulatory approvals (including approval from the Hon'ble Supreme Court of India).
 
For the first six months of fiscal 2021, FHL had a net loss of Rs 170 crore and operating revenue of Rs 1,600 crore, against net profit of Rs 202 crore and operating revenue of Rs 2,350 crore for the corresponding period of the previous fiscal.

Key Financial Indicators (Consolidated)
As on/for the period ended March 31 Unit 2020 2019
Reported revenue Rs crore 4632 4469
Reported profit after tax (PAT) Rs crore 91 (224)
Reported PAT margin % 1.97 (0.05)
Adjusted debt/adjusted networth* Times 0.4 0.61
Adjusted interest coverage Times 3.12 2.06
*CRISIL-adjusted numbers. Networth has been adjusted for intangible assets such as goodwill

Any other information: Not applicable

Note on complexity levels of the rated instrument:
CRISIL complexity levels are assigned to various types of financial instruments and are included (where applicable) in the Annexure -- Details of Instrument in this Rating Rationale. For more details on the CRISIL complexity levels, please visit www.crisil.com/complexity-levels.
Annexure - Details of Instrument(s)
ISIN Name of instrument Date of allotment Coupon rate (%) Maturity date Issue size (Rs.Cr) Complexity level Rating assigned with outlook
NA Overdraft* NA NA NA 50 NA CRISIL A/Watch Developing
NA Term Loan NA NA 13-Jun-2024 300 NA CRISIL A/Watch Developing
NA Term Loan NA NA 20-Aug-2026 70 NA CRISIL A/Watch Developing
NA Non-fund-based limits NA NA NA 9 NA CRISIL A1/Watch Developing
NA Overdraft# NA NA NA 50 NA CRISIL A/Watch Developing
NA Term loan NA NA 1-Sept-2025 20.80 NA CRISIL A/Watch Developing
NA Term loan NA NA 1-Sept-2025 40 NA CRISIL A/Watch Developing
*Interchangeable with working capital demand loan and short-term loan
#Interchangeable with working capital demand loan and short-term loan and non fund based limits
 
Annexure - List of Entities Consolidated
Names of entities consolidated Extent of consolidation Rationale for consolidation
Hiranandani Healthcare Pvt Ltd Fully consolidated Consolidated being subsidiary
Fortis Hospotel Ltd Fully consolidated Consolidated being subsidiary
Fortis Health Management Ltd Fully consolidated Consolidated being subsidiary
Hospitalia Eastern Pvt Ltd Fully consolidated Consolidated being subsidiary
International Hospital Ltd Fully consolidated Consolidated being subsidiary
Escorts Heart and  Super Speciality Hospital Ltd Fully consolidated Consolidated being subsidiary
Fortis La Femme Ltd Fully consolidated Consolidated being subsidiary
Fortis Health Management (East) Ltd Fully consolidated Consolidated being subsidiary
Fortis Cancer Care Ltd Fully consolidated Consolidated being subsidiary
Fortis Healthcare International Ltd Fully consolidated Consolidated being subsidiary
Escorts Heart Institute and Research Centre Ltd Fully consolidated Consolidated being subsidiary
Fortis Malar Hospitals Ltd Fully consolidated Consolidated being subsidiary
Fortis Hospitals Ltd Fully consolidated Consolidated being subsidiary
Fortis Global Healthcare (Mauritius) Ltd Fully consolidated Consolidated being subsidiary
Malar Stars Medicare Ltd Fully consolidated Consolidated being subsidiary
Fortis Asia Healthcare Pte. Limited Fully consolidated Consolidated being subsidiary
Birdie & Birdie Realtors Pvt Ltd Fully consolidated Consolidated being subsidiary
Fortis Emergency Services Ltd Fully consolidated Consolidated being subsidiary
Stellant Capital Advisory Services Pvt Ltd Fully consolidated Consolidated being subsidiary
RHT Health Trust Manager Pte Ltd Fully consolidated Consolidated being subsidiary
Fortis Health Staff Ltd Fully consolidated Consolidated being subsidiary
SRL Ltd Fully consolidated Consolidated being subsidiary
SRL Diagnostics Pvt Ltd Fully consolidated Consolidated being subsidiary
SRL Reach Ltd Fully consolidated Consolidated being subsidiary
SRL Diagnostics FZ-LLC Fully consolidated Consolidated being subsidiary
Fortis Healthcare International Pte Ltd Fully consolidated Consolidated being subsidiary
Mena Healthcare Investment Company Ltd Fully consolidated Consolidated being subsidiary
Medical Management Company Ltd Fully consolidated Consolidated being subsidiary
Fortis CSR Foundation Fully consolidated Consolidated being subsidiary
Sunrise Medicare Pvt Ltd Equity method Equity method of consolidation
Lanka Hospital Corporation Plc Equity method Equity method of consolidation
RHT Health Trust Equity method Equity method of consolidation
Fortis Cauvery Equity method Equity method of consolidation
Fortis C-Doc Healthcare Ltd Equity method Equity method of consolidation
DDRC SRL Diagnostics Pvt Ltd Equity method Equity method of consolidation
SRL Diagnostics (Nepal) Pvt Ltd Equity method Equity method of consolidation
Annexure - Rating History for last 3 Years
  Current 2020 (History) 2019  2018  2017  Start of 2017
Instrument Type Outstanding Amount Rating Date Rating Date Rating Date Rating Date Rating Rating
Fund-based Bank Facilities  LT/ST  530.80  CRISIL A/(Watch) Developing  11-09-20  CRISIL A/Watch Developing    --    --    --  -- 
        15-06-20  CRISIL A/Watch Developing               
        17-03-20  CRISIL A/Watch Developing               
        11-03-20  CRISIL A1/Watch Developing               
Non Fund-based Bank Facilities  LT/ST  9.00  CRISIL A1/(Watch) Developing  11-09-20  CRISIL A1/Watch Developing    --    --    --  -- 
        15-06-20  CRISIL A1/Watch Developing               
        17-03-20  CRISIL A1/Watch Developing               
All amounts are in Rs.Cr.
Annexure - Details of various bank facilities
Current facilities Previous facilities
Facility Amount (Rs.Crore) Rating Facility Amount (Rs.Crore) Rating
Non-Fund Based Limit 9 CRISIL A1/Watch Developing Non-Fund Based Limit 9 CRISIL A1/Watch Developing 
Overdraft* 50 CRISIL A/Watch Developing Overdraft* 50 CRISIL A/Watch Developing
Overdraft# 50 CRISIL A/Watch Developing Term Loan 370 CRISIL A/Watch Developing
Term Loan 430.8 CRISIL A/Watch Developing -- 0 --
Total 539.8 -- Total 429 --
*Interchangeable with working capital demand loan and short-term debt
#Interchangeable with working capital demand loan and short-term loan and non fund based limits
Links to related criteria
CRISILs Approach to Financial Ratios
CRISILs Criteria for Consolidation

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