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Ian Munro
imunro@ccz.com.au
+61 (0) 3-8605 7902
2013E
61.7
7.7
3.5
0.9
44.8%
25.2
0.45
2.0%
13.9x
2014E
85.5
12.7
5.8
1.4
49.1%
16.9
0.75
3.3%
8.0x
2015E
90.8
15.4
7.6
1.8
30.5%
12.9
1.00
4.3%
6.2x
$0.08
$0.04
$0.00
The MDI diagnostic imaging group acquisition settled on 1 May 2013, for an enterprise valuation of c$15m.
We expect MDI to contribute $0.5m profit before tax (PBT) for FY13, out of the total $5m group PBT forecast.
The EPS accretion is forecast to be 22% in FY14 and 32% in FY15. Productivity gains (i.e. 10% shorter
consultation times) within MDI under new ownership could generate an additional $0.76m EBITDA or +6% to
our FY14 EPS, on top of $0.6m of synergies already in our forecasts. We expect EPS growth of 49% during FY14,
above company guidance of a 25%+ EPS increase. General trading conditions have been solid during 3Q13.
CAJ acquired 11 MDI Clinics, comprising 5 large full service clinics and 6 smaller sized clinics. Clinics are
located in the S/SE suburbs of Melbourne with a hub and spoke model, similar to the Capitol Health structure
and importantly two fully licensed MRI machines. MDIs larger clinics include an out of pocket charge on c40%
of scans, providing a template for how the charging structure may change within some of the 15 larger Capitol
Health clinics. Only c20% of scans include out of pocket charges, within the Capitol branded clinics. We expect
average pricing pressure of 3%-4% and volume growth of 4%-5% on scans within large clinics during FY14-FY15.
The Federal Budget re-affirmed that from Nov 2013 GPs will be able to refer scans and request Medicareeligible MRIs for patients over the age of 16 for a set of clinically approved indications. The Budget allows
additional program expenses of c$582m for each of the next 4 years and permits an additional 10 MRI machines
in that period(currently c130 MRI machines are fully licensed Australia-wide). These measures are consistent
with our theory of restricted supply of radiology, higher out of pocket charges and growing GP awareness and
referral rates of MRIs (70% of all Capitols scans are referred by GPs) and likely pressure on competitors who
cannot substitute CTs with MRI.
Valuation: Our valuation has risen to $0.27 per share, with a 100% weighting to DCF. BUY Recommendation.
Next Catalysts: further uplift in demand for MRI scans and potential for higher out of pocket charges, new clinic
and MRI license acquisitions. FY13-FY15 forecasts assume volume/price growth in scans but no new clinics.
Disclaimer: CCZ acted as lead manager to the $7.3m capital raise, executed in March 2013 and received a fee for
providing this service. The author of this report holds a beneficial interest in CAJ shares.
CCZ EQUITIES PTY LIMITED LEVEL 24, 9 CASTLEREAGH STREET, SYDNEY NSW 2000
GPO BOX 5045, SYDNEY NSW 2001 TEL: 61 2 9238 8238 FAX: 61 2 9231 0822 EMAIL: CCZ@CCZ.COM.AU
This is a research publication of CCZ Equities Pty Limited ABN 97 085 277 881 as a Corporate Authorised Representative
reference number 273728 of CCZ Statton Equities Pty Ltd ABN 16 104 843 370 AFS Licence 239946.
imunro@ccz.com.au
27 May 2013
imunro@ccz.com.au
9MFY13 unaudited PBT of $3.3m (+27%), including 3Q13 PBT of $1.2m. PBT growth is likely being
driven by the mixture of volume growth in the number of scans in Capitals larger clinics (statistics
provided by Medicare Australia on diagnostic imaging grew by 5% between 2012 and 2013 and 6%
between 4Q11and 4Q12). Capitols volume growth is also likely being assisted by IT efficiencies and
improvements to patient management.
Price inflation on MRI & CT scans is also a positive driver. Demand for MRI scans has likely tightened,
post the changes to referral structure, allowing GPs to refer child patients (< 16 years old) directly to
diagnostic imaging centres and the associated costs coming under the bulk billing framework.
Average number of scans per MRI machine per day have likely increased to c13/14 scans in 3Q13
from c8/9 per day pre the MRI referral changes in 1Q13. The real kicker here is still on track for
November 2013, when the adults come under the Medicare rebate and direct GP referral structure,
predicating an expected increase in MRI utilisation > 20 scans per machine per day and potentially
triggering an increase to out of pocket charges.
ROE accretion with MDI: Revenue still skewed to the larger Capitol Health clinics.
ROE
19%
17%
15%
6 small MDI
clinics , 2
5 large MDI
clinics , 21
3 nuc med
capitol
clinics, 6
13%
11%
15 large
Capitol
clinics , 49
21 small
large
Capitol
clinics , 7
9%
7%
2012
2013e
2014e
2015e
MDI Acquisition
Expected synergies of $0.6m between FY13-FY15, based on finance synergies of $0.45m and
operating synergies (Telco/Insurance/Systems) of $0.15m. There will be zero cost of attaining these
synergies and the finance synergies will be realised in year 1. There arenil staff synergies included in
the $0.6m total synergy forecast and none included in the assumption of EPS accretion.
Higher staff productivity has the potential to double our synergy assumptions, although these are
difficult to gauge during the early stages. A 10% improvement in productivity / reduction in average
consultation times could potentially add a further $0.76m EBITDA or 6% to group earnings in FY14.
IT platforms and staff arrangements and employment contracts will be largely left alone during
FY13e in order to maintain the existing profitable structure and patient volumes and not open CAJ up
to unnecessary levels of integration risk. Key radiologist staff have been retained on long term
employment contracts.
CCZ Forecast uplift in ROE from c11% in FY13e to c19% in FY15e, from margin uplift and EPS accretion.
CCZ forecast CAJ will continue maintaining a dividend payout ratio of 50%-55% of reported EPS.
27 May 2013
imunro@ccz.com.au
Capitol runs a bulk billing, referral based community services model and aims to be the lowest cost in
the industry. MRI, by contrast, has a far higher proportion of out of pocket charges (almost 40% of
scans include out of pocket charges), providing Capitol a template to use in pricing imaging scans in
appropriate demographics.
MDI adds a premium, higher value scan (CT/MRI) and more out of pocket charge based model
$/scan
260
240
130
220
120
110
200
Capitol Ave
Scans/Day/Clinic
100
80
180
MDI ave
Scans/Day/Clinic
90
160
140
70
120
60
100
50
80
40
2012a
2013e
2014e
2012a
2015e
2013e
2014e
2015e
Volume growth across the larger Capital (15 large clinics) and MDI (5 large clinics) imaging centres is
likely to track at 4%-5% volume growth between FY13-FY15, in line with industry growth.
Some cannibalisation of CTs may occur during this time, however this will be compensated by higher
MRI demand, potential to charge out of pockets in Capitol clinics on MRIs and also, the notion that
Capitol clinics have another 2-3 years of industry growth rates levels, to reach full scan capacity on
existing machines.
There is potential for larger clinic opening hours to be extended beyond 9-5:30, as far as 8:00-19:30
in some to capture unfilled MRI demand.
Historical earnings growth in the MDI business has been tracking in the single digits at the PBT line,
driven by c5%-6% volume growth in scans and upward trajectory of scan charges, based on out of pockets
on CT & MRI.
Finance Synergies
(based on MDI debt position on acquisition)
27 May 2013
$m
2.80
0.24
0.17
0.07
4.2
0.44
-0.36
0.08
4.10
0.30
0.30
0.45
$m synergies to
Combined MDI & CAJ Cost Base FY13e $m run rate
be captured FY14(based on annualising 1H13 results) (pre-synergy)
FY15
Total Operating Expenses FY13e
-64.26
-0.15
Employment
-45.67
0
Telephone
-1.36
-0.025
Equipment costs & servicing
-3.62
-0.05
Technical & Medical Supply
-3.85
-0.05
Insurance
-0.63
-0.025
imunro@ccz.com.au
Out of pockets an industry trend: Revenue share from MRI c20% by FY15 (from 5% in 1H13)
100
90
MRI
5%
Services
3%
X-Ray
24%
80
CT Scan
30%
70
Ultrasound
34%
60
50
40
Mar '07 Sep '07 Mar '08 Sep '08 Mar '09 Sep '09 Mar '10 Sep '10 Mar '11 Sep '11 Mar '12 Sep '12 Mar '13
27 May 2013
imunro@ccz.com.au
450
400
30%
380
400
350
480
1,600,000
1,400,000
1,200,000
300
300
220
250
20%
250
1,000,000
800,000
200
150
100
45
60
90
110
10%
no. of scans/qtr in and out of
hospital rhs
50
0
MRI
low
cost
MRI
high
cost
CT
CT X-Ray X-Ray Ultras Ultra Nuc Nuc
Scan Scan low high Sound Sound Med Med
low high cost cost low high low high
cost cost
cost cost cost cost
600,000
400,000
200,000
0%
Mar Sep Mar Sep Mar Sep Mar Sep Mar Sep Mar Sep Mar
'07 '07 '08 '08 '09 '09 '10 '10 '11 '11 '12 '12 '13
At 31 Dec 2012 there was a gap in receivables of $1.3m to be collected vs. payables of $4.3m. This is
due to the timing of payments from debtors and to creditors. The shortfall is actually Debtor
collections which on average turn around in 2-3 days as monies are received by patients via credit
cards for the full amount plus out of pocket (the patient then gets bulk billed the claimable amount
from Medicare). This means that at a point in time, the level of receivables is very low as the revenue
is received and the cash follows in 2-3 days on average, clearing the balance sheet carrying item.
On the payables side, creditor terms for CAJ on average are < 30 days. CAJ payables include outgoings
in tax to the ATO, GE Finance for machine leases, Property Leases, Staff and Payroll, Cleaners etc. With
c$25m of cash costs incurred during 1H13, including $17m of employee costs, carrying $4.3m worth of
payables is a reasonable position at 31 Dec 2012. CAJ has transitioned payables to direct debit
wherever possible, in order to minimise the carrying value and shorten the working capital cycle. In
many cases, such as rental outgoings, payments are generated 3 months in advance.
Under current circumstances, the shortfall of current assets to current liabilities will likely wind
down to zero in 12-24 months as revenue & cash collected increases over a relatively fixed cost base.
Current liabilities are also partially inflated by c$1.6m of forward 12 month finance lease obligations
aggregated as liabilities, when the income associated with these machines is collected on a monthly
basis over those 12 months. If the Income/EBITDA from these machines was theoretically aggregated
on the current asset side, this would add c$14m to current assets and alleviate the imbalance.
27 May 2013
imunro@ccz.com.au
Share
Price
Cap $m
2570.3
5847.8
98.8
EV/
EV/
EV/
NPAT
EPS % EPS % EPS % EPS % P/E P/E P/E
EBITDA EBITDA EBITDA
'13e $m
'12a '13e '14e '15e '12a '13e '14e
'13e '14e '15e
150.9
382.4
3.1
9.3
11.4
13.9
10.4
34%
EBITDA
P/E Yield Yield
P/ CFPS ROE %
margin
'15e '12a '13e
'12a FY13e
'13e
8.7
8.3 44% 30% 11% 9% 22.2 17.0 15.3 14.1 2% 3% 26.2% 12.0 5.6%
10.6 9.8 8% 2% 9% 9% 18.2 17.7 16.3 14.9 4% 4% 18.9% 11.9 13%
8.0
6.2 116% 45% 49% 31% 36.5 25.2 16.9 12.9 2% 2% 12.7% 13.4 11%
9.7
9.0
20.2 17.4 15.8 14.5
17.4 12%
-18% -31%
80% 45% 7% -11%
-23% -11%
The discount for size is overdone: CAJ trades at an EV/EBITDA discount of 18% and 31% respectively to
peer group in FY14e and FY15e.
We forecast CAJ earnings to accelerate strongly in FY15, as they will include a full 12 months of the
adult MRI regulatory changes, MDI synergies, improved critical mass, efficiency and margin expansion,
plus an evident squeeze on other industry players without the capacity to offer MRI.
Company History
Capitol Health model- CAJ invests in the relationship between the referrer (70% GPs) and the radiologist,
providing close consultation with referrers and sharing resources for bone, prostate etc specialists in
Melbourne by sending scans across the IT network. Capitol takes a partnership approach with the 30
radiologist employees, providing flexible work arrangements where possible and a mix of
performance/base packages and part/full time and management responsibility.
Competition- The top 6/7 players in radiology control c50% of the domestic market, unlike pathology
where the top 3 control 90% of the market. Industry evidence suggests that there are 4 hour waits for an
MRI in many Primary hospitals. Medicare/Childcare is not means tested. Primary has introduced incentive
based remuneration schemes to its radiologists, which may encourage competition for patients. Outside of
Primary, DCA and Capitol Health/MDI in Victoria, the employment opportunities for radiologists drop away
significantly. The MDI ownership model (with 7 partners) was unique across the industry; the balance of
smaller players each have 2-3 clinics and typically the same number of partners. The field drops off
significantly after Capitol Health in Melbourne.
Management & Register Structure- 4-person board, including the MD & CFO and 2 non-executive
directors (none of whom are currently independent, although this may change). Between them, the board
own 47.5m shares or 13% of issued capital. Of the register, 25% is owned by founders, 30% by institutions,
25% by retail, 10% by directors and 10% by radiologists.
Clinton Athaide recently joined the Capitol Health management team. As a former MDI partner with
extensive diagnostic imaging and community health industry experience, Clinton strengthens the
management structure around MD John Conidi. He is ideally suited to help drive the MDI integration and
MRI/out of pocket strategy.
27 May 2013
imunro@ccz.com.au
Regulatory risk: sensitivity to Federal Government regulation and bulk billing levels as stipulated
within the MBS and Federal Budget in May 2013.
The number of scans (full or partial) covered within the new MRI license arrangements from MBS:
elbow, head, shoulders, hands, feet are the most likely categories to be licensed.
Attracting and retaining high quality radiologists on reasonable employment conditions
Availability and cost of equipment finance and credit.
Fleet upgrades (less of a risk as the average useful life of MRI/CT/US and X-Ray is between 10-15
years) and all of the Capitol Health machines are run on operating lease agreements, with straight line
charges. It is likely that the MDI machines will also be transitioned from finance lease to operating
lease, once upgrades occur.
Capitol & MDI Geographic Footprint: Excellent hub and spoke coverage.
27 May 2013
imunro@ccz.com.au
$ 0.23
$ 0.27
Recommendation
BUY
RETURN ANALYSIS
Year End
98.8m
429.5m
30-Jun
20.7%
2011A
2012A
2013E
2014E
2015E
0.29
22%
329.0
0.32
32%
0.63
116%
338.2
0.67
112%
0.91
45%
382.8
0.81
20%
1.36
49%
429.5
1.36
68%
1.78
31%
429.5
1.78
31%
PE on adj EPS
PE - Market
PE Relative
78.7x
14.7x
435.2%
36.5x
13.6x
168.0%
25.2x
14.6x
72.4%
16.9x
13.2x
28.0%
12.9x
12.2x
6.1%
0.00
100.0%
0.0%
0.0%
0.40
100.0%
1.7%
59.5%
0.45
100.0%
2.0%
55.6%
0.75
100.0%
3.3%
55.1%
1.00
100.0%
4.3%
56.3%
26.9x
51.5x
77.6x
8.6%
4.5%
4.8%
7.7%
18.2x
29.2x
34.4x
11.0%
6.8%
8.7%
12.9%
13.9x
19.1x
21.4x
12.7%
9.2%
10.5%
16.0%
8.0x
10.7x
12.1x
14.9%
11.1%
16.0%
23.5%
6.2x
8.1x
8.7x
17.0%
12.9%
18.9%
30.9%
EV/EBITDA
EV/EBIT
EV/PBT
EBITDA/Sales
EBIT/Sales
ROE
ROFE
VALUATION SUMMARY
Models (AUD/share)
DCF
DDM
PE
Weighted Avg
0.27
0.13
0.20
0.27
Valuation Weighting
DCF
DDM
PE
100.0%
0.0%
0.0%
27 May 2013
13.3%
13.5%
2013E
90.0%
99.5%
0.11
0.00
0.11
2014E
90.0%
94.8%
0.16
0.01
0.17
40.5%
4.3%
2015E
90.0%
90.4%
0.20
0.01
0.20
2011A
2012A
2013E
2014E
2015E
45.6
(41.7)
3.9
(1.9)
2.0
(0.7)
1.4
0.0
(0.4)
1.0
1.0
25.0%
8.0%
8.0%
100.0%
100.0%
52.2
(46.6)
5.7
(2.1)
3.5
(0.5)
3.0
0.0
(0.8)
2.1
2.1
14.5%
44.9%
73.0%
120.6%
121.8%
61.7
(53.9)
7.7
(2.1)
5.6
(0.6)
5.0
(0.4)
(1.5)
3.1
3.5
18.1%
36.9%
59.1%
67.5%
45.1%
85.5
(72.8)
12.7
(3.2)
9.5
(1.1)
8.4
0.0
(2.5)
5.8
5.8
38.7%
64.0%
68.7%
67.2%
88.8%
90.8
(75.5)
15.4
(3.6)
11.7
(0.8)
10.9
0.0
(3.3)
7.6
7.6
6.2%
21.1%
23.7%
30.5%
30.5%
imunro@ccz.com.au
2011A
1.2
1.2
0.0
0.4
2.8
2012A
1.7
1.3
0.0
0.8
3.8
2013E
5.1
2.5
0.0
1.1
8.7
2014E
8.2
2.1
0.0
1.1
11.5
2015E
11.1
2.3
0.0
1.1
14.5
9.4
20.9
0.6
30.9
33.7
8.7
23.4
1.0
33.2
37.0
17.1
26.9
2.7
46.6
55.4
15.4
28.8
2.7
46.9
58.4
13.8
28.8
2.7
45.2
59.7
Creditors
Short term debt & finance leases
Current tax liability
Employee Benefits
Current Liabilities
5.1
1.9
0.1
0.7
7.7
4.6
2.1
0.8
0.9
8.5
4.9
3.5
0.4
2.8
11.6
7.5
3.5
0.4
2.8
14.2
8.0
3.5
0.4
2.8
14.6
5.5
0.3
13.5
3.5
0.5
12.5
10.0
0.5
22.2
7.0
0.5
21.7
4.0
0.5
19.2
20.2
24.5
24.5
26.3
33.2
38.1
36.6
35.4
40.5
33.4
(0.00)
20.7%
0.00
1.1x
0.2
0.00
0.00
7.3%
0.01
0.3x
0.5
0.00
0.01
15.5%
0.01
0.6x
0.8
0.00
0.02
(3.8%)
0.02
(0.1x)
1.2
0.00
0.03
(21.6%)
0.03
(0.5x)
1.6
0.00
CASHFLOW (AUD'm)
2011A
2012A
2013E
2014E
2015E
4.5
(0.7)
(1.8)
2.0
4.8
(0.5)
(1.5)
2.8
7.1
0.9
(1.4)
6.6
9.1
(3.0)
(1.5)
4.6
11.3
(0.3)
(2.0)
9.0
0.6
37.7x
1.0x
2%
0.8
27.6x
0.7x
3%
1.7
13.4x
0.7x
7%
1.1
21.5x
0.5x
5%
2.1
11.0x
0.6x
9%
2011A
34
13
104
100
35.0
2012A
37
15
108
101
39.7
19
10.2
22
11.8
2013E
48
15
113
103
45.5
5.0
68
222
3.3
28
12.0
2014E
48
15
118
106
48.7
5.0
71
228
21.2
28
15.2
2015E
48
15
122
110
52.0
5.0
74
233
22.5
28
15.9
Interim Results
Revenue
EBITDA
NPAT
EPS (c)
1H13a
28.5
3.2
1.4
0.4
2H13e
33.2
4.6
1.7
0.5
Fixed Assets
Intangibles
Other
Non-Current Assets
Total Assets
SUBSTANTIAL SHAREHOLDERS
Shareholder (post capital raise)
1. Idinoc (J Conidi)
2. Ms Stella Ha
3. Peter & Janet Hunt
4. Bond Street Custodians (Bkohn)
5. Gia Chau Pty Ltd
27 May 2013
Holding
7%
4%
6%
6%
DPS (c)
0.30
0.15
4%
EBITDA margin %
Free Cash Flow $m
11.1%
1.1
13.8%
5.4
10
imunro@ccz.com.au
Contact List
CCZ Statton Equities
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02 9238 8237
rahmed@ccz.com.au
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02 9238 8222
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Equity Analyst
03 8608 8983
imunro@ccz.com.au
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Research Sales
02 9238 8224
icameron@ccz.com.au
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Research Sales
02 9238 8230
ccaskey@ccz.com.au
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02 9238 8225
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Senior Stockbroker
02 9238 8227
jpeisley@ccz.com.au
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Research Sales
02 9238 8226
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Institutional DTR
02 9238 8231
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Institutional Sales
02 9238 8232
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Research Sales
03 8608 8984
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Office Manager
02 9238 8223
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Retail Assistant
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Administration
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Retail
This is a research publication of CCZ Equities Pty Limited (CCZ Equities) ABN 97 085 277 881 as a Corporate Authorised Representative reference
number 273728 of CCZ Statton Equities Pty Ltd ABN 16 104 843 370 AFS Licence 239946 (CCZ Statton Equities) and is issued on the basis that it is
only for the information of the particular person(s) or organisation(s) to whom it is provided. This document is being distributed to wholesale clients
as defined in section 761G(7) of the Corporations Act 2001. This research publication may not be reproduced, redistributed or published by any
recipient for any purpose unless otherwise agreed in writing by CCZ Equities beforehand. Any recommendations contained herein are unsolicited
general information only. Recommendations are based on consideration of the securities alone, and as such are conditional and must not be relied
upon without specific advice from your securities adviser as to their appropriateness to you given your individual investment objectives, financial
situation and particular needs. Under no circumstances is this research publication to be used or considered as an offer to sell, or a solicitation of an
offer to buy. The information herein has been obtained from, and any opinions herein are based upon, sources believed reliable, but CCZ Equities
makes no representation as to its accuracy or completeness and should not be relied upon as such. All opinions and estimates herein reflect the
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27 May 2013
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