Latest news with #outpatient
ABC News
24-05-2025
- Health
- ABC News
A pilot program brought down waiting times for paediatric patients, but its future is in doubt
A pilot program designed to reduce paediatric wait times in Tasmania was abruptly ended six months early, according to one of the doctors involved. The General Practitioners with Special Interest (GPwSI) project was part of a broader strategy to address wait times in outpatient clinics across the state. The idea was to place doctors with a specific interest in a range of outpatient clinics like antenatal, cardiology and mental health services to come up with new models of care. The GPs would be working between half a day to two days a week. According to the Health Department, the funding for the entire program was equivalent to employing two full-time GPs for two years. The ABC has been told that while doctors were offered shorter contracts, some were led to believe the pilot program would run for two years, until June 2025, and were shocked when it ended sooner than expected. Tim Jones is one of the doctors who was employed as part of the pilot in mid-2023. He was placed at the Royal Hobart Hospital (RHH) paediatric clinic. "Because of my natural scope being more linked to younger kids, I prioritised seeing any child of seven or under who was on our waitlist here in southern Tasmania," Dr Jones said. While not a fully qualified paediatrician, Dr Jones was able to provide broader assessments, looking at the child's environment, family and school and then linking them up with the support they needed. "We could tease out which kids needed which layer of support," he said. "That meant the kids that did need to go through and have a full formal ADHD [or autism] assessment, we could screen them out and make sure they then got that assessment, whereas kids who needed other pathways, we made sure they got timely access to those services." Often, Dr Jones said, the primary problem was not attention deficit hyperactivity disorder (ADHD) or autism, but things like poor sleep patterns, inadequate supports in school and dyslexia. By managing to filter out those who could be assisted by other services, it meant children who needed more complex assessments could see a paediatrician in a more timely manner. Then in November, Dr Jones was told his position could no longer be funded, and his contract would not be extended and would end in January. Dr Jones said he had been told from the beginning, including during the interview, that the program would run until the end of June this year. The ABC understands other GPs with specific interests were told similar things. "What we found was that a lot of the GPs were able to …integrate well with the systems and start to deliver some outcomes, so it came as a shock to all of us that we received limited notice that the funding was not to be continued past the 18 month mark," DrJones said. According to the Health Department, wait times in Tasmania for a non-urgent patient to see a public paediatrician can last close to two years. That varies depending on where in the state the person is. The private system is no better, as Anna Nottage knows. When her daughter Lottie was aged two, she tried to get her into a paediatrician, concerned about her delayed development. She was referred to a private clinic and the public one at the Royal. Both had extensive waitlists. In the meantime, Ms Nottage and Lottie were able to see Dr Jones, who was working at the developmental clinic at the RHH. While Lottie turned out to be one of the complex cases who did need to be seen by a paediatrician, Ms Nottage said being able to discuss her concerns with Dr Jones was reassuring. "He was a great support," she said. Labor's Shadow Health Minister Ella Haddad said it was disappointing for Tasmanian families waiting in that system that the program had ended. "This is a program that was actually having a tangible effect on [those long waitlists]," she said. "For that to be cut, we know the wait times are just going to get longer and harder for Tasmanians who already need these services early. In April, the state government opened a specialist service for children and young people with suspected ADHD in the south, and there are plans to expand statewide. It also includes funding for two GPs with special interests in ADHD. But that service will not help kids like Lottie, who was eventually diagnosed with autism and is now seeing one of the new paediatricians at a private clinic. "There are a lot of parents probably going through the same thing," Ms Nottage said. "They haven't got a paediatrician and need that stopgap for children with behavioural or developmental needs. In a statement, a Health Department spokesperson said they acknowledged the positive impact the GPwSI model of care pilot had caused for "some patients, particularly in paediatrics". The spokesperson said an evaluation of the broader pilot was being finalised, which would provide guidance on how the department "can best utilise the state's highly-skilled GPwSI and rural generalist workforce across our health service".
Argaam
18-05-2025
- Business
- Argaam
SMC Healthcare executes largest hospital expansion in Northern Riyadh: CEO
Bassam Chahine, CEO of SMC Healthcare, said the company is executing one of the largest private expansion programs in the Kingdom, adding over 698 beds. In an interview with Argaam, Chahine said the company currently has three new hospitals, SMC 3, 4, and 5, at different stages of development, all located in high-growth Northern Riyadh districts. At the same time, SMC seeks to open over 60 new outpatient clinics by the end of Q2 2025. These long-term care beds are part of our strategic shift toward outpatient services. The improvement SMC saw in 2024, from 22.7% to 23.1% in EBITDA margin and from 12.3% to 13.8% in recurring net income margin, reflects the strength of our operating model, Chahine noted. Here are details of the interview: Q: SMC reported solid growth for the full year 2024. What were the key drivers of this performance? A: '2024 was a strong year for SMC, marked by both strategic and financial progress. Our revenues grew by over 5% year-on-year, demonstrating the resilience of our business model and the effectiveness of our strategic direction. On the inpatient side, we continued our transition toward high-performing acute specialties. Despite a decline in inpatient volumes (as we operated the full fourth quarter without long-term care beds, which were being repurposed into outpatient clinics as well as acute beds) we delivered growth in inpatient revenue. This reflects a notable increase in average revenue per inpatient, underlining the effectiveness of our continued focus on high-performing acute specialties and the transition away from LTC patients to acute patients generating higher revenues per bed. At the same time, we are progressively expanding our outpatient footprint (part of a broader shift toward more accessible and diversified care delivery). Outpatient visits rose by nearly 10%, and revenues grew by over 15%. This momentum is also being driven by the strategic repurposing of former long-term care space, which is now being utilized to roll out over 60 new outpatient clinics across our facilities. These developments underscore our ability to adapt to changing healthcare dynamics while continuing to deliver growth and value. Importantly, this translated into improved profitability, with EBITDA margins expanding from 22.7% to 23.1%, and recurring net profit margins increasing from 12.3% to 13.8% year-on-year. Notably, this margin improvement was achieved despite the significant reduction on LTC related revenue in Q4 and the increased costs related to the rollout of the new outpatient clinics.' Q: How do you see the company's performance over the coming years? A: We expect margin expansion to continue over the medium term. The improvement we saw in 2024, from 22.7% to 23.1% in EBITDA margin and from 12.3% to 13.8% in recurring net income margin, reflects the strength of our operating model, as well as the early benefits of our shift toward high-performing acute specialties and outpatient services, both of which are expected to support improvements in our margin profile. This strategic shift along with the transition away from long term patients has already begun to translate into tangible profitability gains. Looking ahead, as new clinics ramp up and our upcoming hospitals gradually come online, we anticipate further operating leverage. We've already built out our central functions (ranging from RCM, HR and procurement to finance and IT) so there's no duplication of overhead as we scale. Additionally, these new facilities will follow our outpatient-focused strategy, supporting structurally higher margin contribution over time. This structure allows us to absorb growth efficiently and drive margin uplift as volumes increase and new facilities mature. While there may be some short-term dilution during early commissioning phases, our experience with SMC 2 demonstrated our ability to ramp up quickly. Over time, we expect the margin trajectory to remain positive, supported by volume growth, mix optimization, and disciplined cost management. Q: The fourth quarter of 2024 was somewhat softer compared to last year. What explains this performance? A: While Q4 2024 net revenue may appear softer when viewed in isolation, it is important to highlight that overall performance remained solid. Both inpatient and outpatient segments continued to grow at the gross revenue level during the quarter. This underscores the strength of our core operations, even during periods of transition. The softer net revenue was largely driven by two temporary and expected factors. First, the quarter included the clearing of a review backlog from 2023, which led to a one-time increase in claim rejections and higher contractual obligations. This technical adjustment affected revenue recognition but does not reflect any weakness in operational performance. Second, Q4 marked the phase-out of our inpatient long-term care beds as part of our strategic shift toward outpatient services. These LTC floors, which were still operating in previous quarters, are now being repurposed into more than 60 new outpatient clinics. Most of these clinics are scheduled to open by the end of Q2 2025, meaning the temporary drop in inpatient volumes was not yet offset by the corresponding outpatient ramp-up. This transition will begin to positively impact our results in the second half of 2025. Overall, we remain confident in the strength of our fundamentals. Demand remains healthy, our care model is evolving in line with market needs, and the steps we're taking today are laying the groundwork for sustained growth and improved margins moving forward. Q: How will the implementation of the DRG system affect SMC's business and what adjustments have you made operationally? A: While the broader sector is anticipating the introduction of DRG with some concern and expectations that margins will come under pressure, we believe that SMC is well-positioned to manage the transition as we expect to remain well-insulated due to our early preparation and the strength of our operating model. We took early action to prepare for the transition by fully integrating coding protocols, claim validations, and automation tools within our systems. Operationally, we are already aligned with many of DRG's core principles. Moreover, DRG applies only to inpatient services, which today represent less than 50% of our revenue. Our outpatient-driven model, demonstrated by the rollout of new clinics, combined with efficient inpatient practices such as short lengths of stay and a readmission rate of around 1 percent, has positioned us well under the new framework. So while we view DRG as a positive step toward value-based care, it will have a limited financial impact on our business. Q: Could you share an update of the company's expansion projects? How you are managing the associated financing / leverage? A: Our expansion strategy is central to our long-term vision and to reinforcing our position as one of the leading private healthcare providers in Riyadh. We currently have three new hospitals, SMC 3, 4, and 5, at different stages of development, all located in high-growth Northern Riyadh districts where healthcare capacity remains limited. SMC 3 has completed excavation works, and construction is set to commence within the next several weeks. SMC 4 is in the final design phase, with construction expected by Q3 2025, while SMC 5 has secured its site and is in early planning. Together, these facilities will more than double our inpatient bed count and significantly expand our outpatient network, aligning with Riyadh's urban expansion and growing demand for insured healthcare services. Importantly, while we are pursuing ambitious expansion plans over the medium to long term, our short-term growth is very much de-risked. The new outpatient clinics we are currently rolling out, over 60 in total, require minimal capex and are being launched in locations with strong patient footfall. The specialties have been carefully selected based on existing demand patterns within our network. As such, any temporary impact from the LTC transition between Q4 2024 and Q2 2025 is expected and already budgeted for. We are confident that this outpatient-led growth will begin to reflect in our financial performance from the second half of 2025 onward. The funding strategy for these projects is already in place, with approximately 80% of the expansion expected to be financed through debt. At the same time, we are actively using internal cash flows wherever possible to limit reliance on external funding. We fully recognize that leverage will increase during the construction phase, but we are committed to maintaining a net debt to EBITDA ratio below 3 times. To support this target, we will manage our dividend distributions with flexibility, using them as a toggle if necessary to ensure we remain within our leverage thresholds. Q: Given rising competition and capacity additions in the Riyadh market, how is SMC positioning itself competitively in the healthcare landscape? A: Despite rising competition, SMC Healthcare holds a distinct position in Riyadh's healthcare landscape. We are one of the few operators serving the full breadth of the mid-to-high insured segment, currently the fastest-growing segment in the market. This positioning allows us to cater to a broad and expanding patient base, compared to the VIP-focused offerings of many of our peers. Crucially, we are one of the few healthcare players offering direct exposure to Riyadh's real growth story. We are Riyadh-focused, and our expansion is concentrated in Northern Riyadh, where the city is rapidly expanding and demand for quality healthcare services continues to rise. While others in the market are exploring multiple geographies or service verticals, which often comes with execution challenges, our roadmap is built on deep market insight and a targeted expansion plan that prioritizes scale and tangible growth potential in the capital's most dynamic area. We are doubling down on Northern Riyadh with a clearly defined, outpatient-led strategy designed to capture the fastest-growing segment in the Kingdom's new up and coming urban zone. Our network is already strategically distributed across Riyadh, and we are now executing one of the largest private expansion programs in the Kingdom, adding over 698 beds, with a clear focus on Northern Riyadh. This region is undergoing one of the most ambitious urban transformations in the Kingdom, anchored by giga-projects such as New Murabba, Diriyah Gate, and the upcoming Riyadh Expo 2030, alongside major residential developments led by the National Housing Company (NHC). These projects are drawing in a growing base of residents and expatriates, driven by Vision 2030 initiatives and Riyadh's rising global profile. Northern Riyadh alone is expected to welcome over 1.5 million new residents by 2035. Northern Riyadh is where much of the city's future growth is concentrated, yet healthcare infrastructure remains underpenetrated. And while new capacity is coming online, it is still not enough to meet the scale of current and future demand. With state-of-the-art facilities under development, SMC will operate in areas with limited direct competition or where competition is targeting a different insurance segment, allowing us to capture a meaningful share of this rapidly growing market. Q: Looking ahead to FY 2025, what are the key priorities for the company both operationally and financially? A: In 2025, our focus will be on disciplined execution across several fronts. Operationally, we will continue expanding our outpatient footprint, with over 60 new clinics expected to become operational across our network. We are also moving ahead with our expansion pipeline, ensuring steady progress on SMC 3 and initiating construction of SMC 4. At the same time, we are strengthening our systems and teams to support this growth while maintaining our clinical and service standards. Financially, we expect further improvement in margins, supported by higher outpatient volumes and a continued shift toward more profitable high-performing acute specialties. At the heart of our financial strategy is a commitment to maintaining a healthy leverage profile. We are targeting sub-3x net debt to EBITDA, even at the peak of our construction cycle. We are also focused on sustaining strong cash flow generation to fund growth internally and ensure financial flexibility as we scale.
