Annual results at the end of June 2020

Rapport Financier Par Ramsay Santé, le

Resilient results impacted by the Covid crisis, a crisis in which Ramsay Santé has been a key player in patient care in Continental Europe.

Annual results at the end of June 2020

Resilient results impacted by the Covid crisis, a crisis in which Ramsay Santé has been a key player in patient care in Continental Europe.

  • More than 7,000 Covid patients treated in intensive care and medicine during the first wave of the crisis in France, Sweden and Italy.
  • Turnover reached €3,746.2 million, up 10.1%, primarily due to the full year of contribution of Capio.
  • High exceptional additional costs arising from the treatment of Covid patients.
  • EBITDA was up 65.3% to €546.8 million, including the positive impact of the first-time application of IFRS16 amounting to €203.5 million. Adjusted for this effect and at constant consolidation scope and exchange rates, the EBITDA/revenue margin was 9.7%, exactly at the level same as last year, with the benefit in France from the revenue guarantee scheme introduced by the government, for an amount of €136.7 million.
  • Current operating profit at 30 June 2020 amounted to €184.7 million, an improvement of 17.7% over the previous year. Excluding the positive impact (€38.1 million) of the first-time application of IFRS 16, it was down 6.6%.
  • Group share of net earnings was €13.4 million compared with €8.2 million at end-June 2019.
  • The value of the property portfolio (ex-RGdS scope) now stands at €899 million, up 15.1% year-on-year.
  • Net financial debt amounted to €3,372.5 million, including €2,163.5 million in IRFS 16 liabilities, and €330 million refundable cash advances from the French social security bodies at the end of June 2020.
  • A process of integration of the Capio Group is almost complete.

Pascal Roché, Managing Director of Ramsay Santé, says : 

"After satisfactory half-yearly results, with improving financial indicators, the second half of the year has been deeply impacted by the admission and treatment of Covid patients. This has been our major objective in all six countries in which we are operating and, thanks to the exceptional work of our teams, we are very proud to have played a role for patients and with the various governments that has gone well beyond our market share, and has been recognised as such by the various regulatory authorities. As a result, more than 7,000 intensive care and medical patients have been treated in France, Sweden and Italy. More specifically, in France, almost 10% of all Covid patients hospitalised have been treated in a Ramsay Santé facility. In the meanwhile, we have endeavoured to maintain a high level of investment, of more than €168.7 million this year, in order to constantly reinforce the quality of care and strive for efficiency, in line with our strategy as the European leader in the provision of integrated care, caring for 7 million patients".

The Board of Directors, meeting on 20 October 2020, approved the consolidated financial statements for the financial year ending 30 June 2020. The audit procedures have been carried out and the audit report will be issued after the review of the management report.

The accounts and reports will be available to the public when the company's registration document is published at the end of October 2020.

Synthetic results

In €M

From 1 July 2019 to 30 June 2020

Variation

from 1 July 2018 to
30 June 2019

 

IFRS 16

 

IAS 17

Turnover

3,746.2

+10.1%

3,401.1

EBITDA

546.8

+65.3%

330.8

Current Operating Result

184.7

+17.7%

156.9

As a % of Turnover

4.9%

+0.3 point

4.6%

Operating Result

176.2

+48.3%

118.8

Net income, Group share

13.4

+63.4%

8.2

Earnings per share (in €)

0.12

+20.0%

0.10

Note: the above table presents financial data based on different accounting standards. The first-time application of IFRS 16 to the financial year beginning 1 July 2019 resulted in an improvement in EBITDA of €203.5 million and an increase in depreciation and amortisation charges of €165.4 million for a net impact on recurring operating income of €38.1 million. The impact of the implementation of IFRS 16 on Group share of net profit amounted to an additional charge of €21.9 million over the year.

Breakdown of revenue by operating segment

In €M

from 1 July 2019 to
30 June 2020

from 1 July 2018 to
30 June 2019

Variation

Île-de-France

932.7

942.3

-1.0%

Auvergne-Rhône-Alpes

508.1

384.8

+32.0%

Nord - Pas de Calais - Picardie

352.8

376.9

-6.4%

Provence Alpes Côte d'Azur

155.5

159.3

-2.4%

Bourgogne Franche Comté

99.2

107.6

-7.8%

Other regions

563.2

329.3

+71.0%

Other activities

53.0

---

N/A

« Nordics »

1,081.7

---

N/A

Capio

---

1,100.9

N/A

Published Turnover

3,746.2

3,401.1

+10.1%

 

 

 

 

Including :
- Revenue on a like-for-like basis and at constant exchange rates


3,166.0


3,374.7


-6.2%

 - Changes in scope of consolidation and exchange rates

580.2

26.4

N/A

Note: the table above details the contributions of the various operating segments to the Group's consolidated revenue. The work carried out during the financial year led to the recognition, in the French operating segments, of the contribution of the Capio France entities previously grouped under the heading "Capio". The latter also included the revenues of the Scandinavian and German entities, which are now isolated under the "Nordics" heading.

Significant events of the financial year :

Pandemic-related health crisis COVID 19

The financial year ended June 30, 2020 was marked by the health crisis linked to the global COVID 19 pandemic.

In France, private hospitals have actively participated in the national plan to combat the Covid 19 epidemic in conjunction with and in support of public hospitals. In compliance with ministerial directives, relayed by the Regional Health Agencies, private clinics and hospitals have cancelled (at the height of the crisis and particularly during the period of containment imposed at national level from 16 March 2020) all their non-emergency medical and surgical activities that did not result in a loss of opportunity for patients in order to free up capacity in hospital accommodation and technical platforms to meet local health needs. Staff and private doctors have been mobilised and integrated into the plans to prevent and combat the epidemic.

As the health situation has evolved, and in particular the process of deconfinement, the activity of private hospitals has been able to resume under more normal conditions, but still under constraints, in compliance with government or regional directives and depending on local health conditions.

The financial impacts are diverse and variable depending on the specific situation of each institution. They mainly concern

  • Loss of earnings (loss of healthcare turnover and/or ancillary income) due to deprogramming and the drop in activity.
  • Additional costs incurred to deal with the crisis, including the following:
    • Medical purchases (medicines and medical devices),
    • Payroll (carers) and incidental expenses (travel expenses, expense reports, staff protection costs, etc.),
    • Investments or rental of equipment.

a) Cash advances :

To provide short-term support to healthcare institutions and to avoid any cash shortages, a system of repayable advances was set up in March 2020 as an exceptional and transitional measure. Thus, at their request, private health care institutions can benefit from a reimbursable advance on subsequent billings to the social security bodies.

This advance is based on the average monthly level of revenues (excluding fees) invoiced in 2019. 

At the same time, a transitional advance system was also set up in June 2020 to cover the part of the financing relating to user participation (moderating tickets and daily rates) that is obligatorily covered by supplementary health insurance contracts.

At 30/06/2020, advances received by the Group are recorded as liabilities on the balance sheet, under liabilities, for a total amount of €330 million.

b) Revenue guarantee scheme :

Mechanism :

Order n°2020-309 of 25 March 2020 / Order of 6 May 2020 / ATIH technical notice.

This guarantee is put in place for all activities carried out by all health care institutions, which are normally financed in whole or in part on the basis of activity output.

The guarantee covers revenues for the period March 2020 to December 2020. The principle is to guarantee health care institutions, for this period, a minimum revenue (from the compulsory insurance scheme) at least equal to the revenue received for 2019 activity (reduced over 10 months to have a comparable period).

The scope of the guarantee concerns :

  • Medicine Surgery and Obstetrics (MSO): health insurance receipts (excluding fees) on hospitalisation services in accordance with article R.162-33-1 (DRG, daily supplements, GHT, ATU, SE...), remuneration of salaried doctors invoiced by the establishment, treatment of patients benefiting from State Medical Aid and Emergency Care,
  • Follow-up and rehabilitation care (FCR): health insurance receipts from hospitalisation benefits under Article R.162-31-1 and the remuneration of salaried doctors invoiced by the establishment (“Dotation Modulée à l'Activité” has its own guarantee mechanism) excluding the fees of private practitioners,
  • Mental Health: health insurance receipts on hospitalisation benefits under Article R.162-31-1 and the remuneration of salaried doctors invoiced by the establishment, excluding the fees of private practitioners.

The guarantee level is calculated on the basis of 2019 revenues (excluding IFAQ grant quality funding) and takes into account :

  • the unfreezing of the prudential coefficient, retroceded to healthcare institutions, at the end of 2019
  • specific situations (grouping of establishments, transfer of activities, etc. of certain establishments whose 2019 activity may have been impacted),
  • price effects :
    • MSO +0.2% excluding External Consultation Acts
    • Hospitalisation at Home (HAD) +1.1%.
    • FCR +0.1%.
    • Mental health +0.5%.

The guaranteed amount (annual 12-month basis and monthly basis) was communicated to the establishments by the Regional Health Agencies (ARS) on which they depend in June 2020.

The final regularisation will be determined in March 2021 (in order to have exhaustive information on the activity carried out between March and December 2020).

Impact on the financial statements at 30 June 2020 :

At June 30, 2020, the amount of the financing guarantee recognised by the Group takes into account the activity carried out and the amount guaranteed for the period March-June 2020, as well as business forecasts for the period July to December 2020.

The financing guarantee for the financial year ended June 30, 2020 amounts to €136.7 million and is recognised in the income statement under "Other operating income" and in the balance sheet under "Other current assets".

c) Subsidies for additional costs Covid :

In parallel with the funding guarantee scheme, the government has also planned to adapt the levels of allocations usually paid to health institutions in order to compensate for the additional costs related to the COVID-19 crisis that would not otherwise be covered.

At June 30, 2020, the system was still too imprecise as to the scope of the additional costs that would be covered, their amount and any compensation mechanisms that might be put in place. In this context, it is impossible for the Group to assess the impact and it has been decided that all sums received to finance additional costs (Contractualisation Assistance or Regional Intervention Fund) will be considered as advances on the liabilities side of the balance sheet. 

d) Impacts outside France :

Outside France, the Group's establishments actively took part in patient care and screening, in support of public institutions and in close collaboration with the guardians. Nevertheless, business was logically strongly impacted by the effects of the health crisis. Indeed, scheduled, non-emergency surgical operations had to be cancelled from mid-March 2020. In Sweden, the Group's major hospital at Sankt Göran, operated by the Group in Stockholm, played a key role in managing the epidemic, with more than 150 beds dedicated to Covid patients and an almost threefold increase in its intensive care capacity. 

While in Norway and Denmark no accompanying measures have been implemented, our establishments in Sweden and Germany have benefited from subsidies covering additional operating costs, the provision of nursing staff and beds. Sankt Göran Hospital has been allocated a specific compensation package in view of its involvement. In total, the amount of aid received by our establishments in Scandinavia and Germany amounts to €28 million at the end of June 2020. 

Scope

Following the acquisition of Capio on 7 November 2018, the valuation of the identifiable assets acquired and liabilities assumed at their fair value on the acquisition date in the financial statements was finalised during the first half of the financial year. Goodwill relating to the Capio acquisition thus amounts to 950.0 million euros at 31 December 2019.

Application of IFRS 16

IFRS 16 - Leases has been applied as of July 1, 2019.

The implementation of IFRS 16 in the financial statements at the end of June 2020 translates into: 

  • 2,163.5 million in lease liabilities;
  • A right of use of 2,106.8 million euros;
  • An improvement in EBITDA of 203.5 million euros;
  • A deterioration in net profit for 21.9 million euros. 

The Group has opted for the simplified retrospective method as from 1 July 2019. In accordance with the transitional provisions of IFRS 16, the comparative period has not been restated.

Comments on the annual accounts

Activity and turnover :

In the financial year ended June 2020, Ramsay Santé Group recorded published consolidated revenue of €3,746.2 million, compared with €3,401.1 million for the period from 1 July 2018 to 30 June 2019, up 10.1%. For information, the financing guarantee scheme in the Group's financial statements has no impact on published revenue as it is recognised in the income statement under "Other operating income".

On a like-for-like basis and at constant exchange rates, the Group's sales decreased by 6,2% with one additional working day. 

Changes in the scope of consolidation are almost entirely explained by the integration of the Capio Group, since 7 November 2018. Its incremental contribution to the Group's annual revenue amounted to €557.8 million.

At the end of June 2020, the total activity of Ramsay Santé's French entities excluding Capio, strongly impacted by the consequences of the Covid crisis and the cancellation of all scheduled medical and surgical activities, fell sharply by 13.9% in terms of admissions (excluding emergencies). The breakdown by business line is as follows:

  • -12.5% in Medicine, Surgery and Obstetrics
  • -19.5% in follow-up and rehabilitation care
  • -14.3% in mental health

As part of its public service missions, the Group also recorded a sharp 9% drop in the number of emergencies over the past year, with around 565,000 visits to the emergency services in our establishments. 

In addition, organic growth in the Group's Nordic activities for the financial year ended 30 June 2020 was +2.7% compared with last year.

Results :

EBITDA reached €546.8 million for the financial year ended 30 June 2020, up 65.3% on a reported basis. Group EBITDA at end-June includes €136.7 million related to the revenue guarantee scheme described in the paragraph "Significant events of the financial year" above. It also includes the positive impact of the first-time application of IFRS 16 in the amount of €203.5 million. On a like-for-like basis, at constant consolidation scope, exchange rates and accounting standards, EBITDA decreased by 2.1% over the period. 

The EBITDA margin as a percentage of sales was 14.6%, up from 9.7% for the same period last year on a reported basis, but stay flat at constant scope, exchange rate and accounting standards. 

Current operating result amounted to €184.7 million between 1 July 2019 and 30 June 2020 (or 4.9% of revenue), up 17.7% over the previous financial year, including a €38.1 million favourable impact of the first-time application of IFRS 16.

Other non-current income and expenses represent a net expense of €8.5 million for the period ended 30 June 2020, consisting mainly of restructuring costs. From 1 July 2018 to 30 June 2019, other non-current income and expenses represented a net expense of €38.1 million. 

The cost of net financial debt amounted to €130.2 million for the financial year ended 30 June 2020, compared with €66.9 million the previous year. It comprises interest on the Senior debt and, in accordance with IFRS 16, the Group recorded an additional financial interest expense of €71.6 million related to the lease debt.

Group’s share of net income reached €13.4 million at 30 June 2020 versus €8.2 million for the period from 1 July 2018 to 30 June 2019. The impact of the application of IFRS 16 on the Group's net profit resulted in an expense of €21.9 million.

Indebtedness :

Net financial debt at 30 June 2020 increased sharply to €3,372.5 million compared with €1,641.7 million at 30 June 2019. Net debt includes €1,730.5 million in non-current borrowings and €24.8 million in current borrowings, offset by €538.2 million in positive cash.

The application of IFRS 16 to operating leases resulted in an increase of €2,163.5 million in net financial debt at June 30, 2020, including €1,973.8 million in non-current lease debt and €189.7 million in current lease debt.

The Group complies with all commitments relating to the financial documentation in place. The application of IFRS 16 has no effect on the methods used to calculate the financial aggregates referred to in these debt agreements.

ISIN code and Euronext Paris: FR0000044471
Website: www.ramsaygds.fr

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