Fleury SA
BOVESPA:FLRY3
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Fleury SA
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Good morning, everybody. I would like to welcome you to the Grupo Fleury Results Conference Call for the first quarter '22. We have with us today, Ms. Jeane Tsutsui, the company's CEO; Jose Filippo, the CFO and IR Officer; and Renato Braun, IR Director. I would like to inform you that this event is being recorded, and we are making available simultaneous translation into English. We will initially present the company results. And ensuing this, we will go on to the question-and-answer session. At the end of that session, Ms. Tsutsui will offer her closing remarks.
All of the figures mentioned here are compared to the same period in 2021, except when specified otherwise, and they have been rounded to the closest thousands. Before proceeding, we would like to clarify that this presentation may have some forward-looking statements. Now they do not only refer to historic data, but they refer to the desires and expectations of the company. The words believes, plans, estimates, projects, desires and similar words would like to identify forward-looking statements that involve known and unknown risks. And of course, this will include uncertainties that are not impacted to the competitiveness of prices and services.
Among certainties, we have the services in the market transactions of the company, competitors, regulatory approval changes in the mix of services offered as well as other risks that are described in the company reports.
I would now like to turn the floor over to Mrs. Tsutsui, who will begin the presentation. You have the floor.
Good morning to all of you. First of all, I would like to thank you for your presentation here. Before highlighting the results of the first quarter '22, I would like to speak about our strategy in a broader way. We continue to build an integrated health care ecosystem for those who accompanied our presentation in March, you have already had contact with Slides #3 and 4, and we'll acknowledge them.
Slide 3 shows how diagnostic medicine permeates the health journey of our patients. The offers in diagnostic medicine are at the top of the graph with our brands. And the health journey appears below beginning with prevention, checkup services, vaccination services and genomics. We then go on to primary care, our telemedicine service and clinical consultations. We then have consultations in medical specialties that we call secondary care. And finally, tertiary care, which are the low complexity surgeries carried out in outpatient centers. The Fleury Group has been acting with different services in all of these stages and the patient's health journey is complemented with diagnostic medicine offering support to the physicians at all stages of care.
It is with this integrated strategy that we focus on the 3 avenues of growth for the Fleury Group that you see on Slide #4, diagnostic medicine, new links and the health platform in the first quarter of 2022, we underscore the importance of this strategy. We are determined moving forward in our trajectory, and we have attained a record performance in the group.
Let us go to the highlights in Slide #5, the revenues were BRL 1.2 billion, a record for the [indiscernible]. We expanded all business lines and grew 21.7% vis-a-vis the same period last year. If we don't take into account revenues for COVID test, we had a growth of 26% vis-a-vis the first quarter '21. Our organic growth that does not include acquisitions carried out last year was 11.8%. And this shows the strength of diagnostic medicine in all of our brands, and the acknowledgment that they have in terms of quality and excellence of products and services offered by the group. If we compare the revenues of the first quarter '22 and that of the first quarter '23 of the pandemic, we had a growth of 52.3%. We're operating at a new level of revenues. And therefore, we're showing that the strategy that I just mentioned is bringing us the results we expected.
An example of this is clients home care, representing 21% of the revenues of the group with a growth of 26% vis-a-vis the same period last year. In the opposite direction, we see that COVID exams have decreased their share in our revenues. They corresponded to 9.7% of revenues in 2021. This has dropped to 6.2%. Our EBITDA in the first quarter was BRL 326.6 million, a record quarterly figure 14.4% higher than the first quarter '21. Even with the acquisitions, our margin was 30% for the quarter.
We recorded net revenues of BRL 110.4 million with a margin of 10.1%. We reinforced our strategy of growing through acquisitions. And this quarter, we concluded the acquisition of Marcelo Magalhaes, and we announced the acquisition of the Saha Group in Sao Paulo, which I will detail very soon.
Before giving the floor to Filippo to speak about financial results, I would like to refer to the 2 acquisitions that reinforce our integrated health ecosystem. We have just concluded the acquisition of the Marcelo Magalhaes laboratory on Wednesday.
In Slide 6, you can see that they have 3 units. Home care, it has 64 years of history, and it is a reference in clinical analysis in the premium segment in the metropolitan region of [indiscernible]. This acquisition reinforces our strategy to speed up the growth of the company in diagnostic medicine expanding our strategic presence in the Northwest and increasing [indiscernible] to 30 PSCs in [indiscernible]. It also strengthens our capacity to process clinical analysis exams in the region, complementing our service offer through a+ Pernambuco and Diagnóstico brands.
Yesterday, we announced the acquisition of the Saha Hospital in Sao Paulo, as you can see on Slide 7. They specialize in infusion of medication and immunobiologics and have a surgical low complexity center. The Saha Hospital is located in the region of Bela Vista also has another unit in Osasco, and it works with most of the payment sources for surgeries and day hospitals as something that the Fleury Group has already done. Additionally, the acquisition of the Saha Hospital will strengthen our positioning as one of the main medication infusion centers in the metropolitan region of Sao Paulo, where we already have the set, the infusion center in Pernambuco and immunobiological medication infusion in the Fleury brand.
So besides presenting consistent results that point to the sustainability of our business were determined in the execution of our strategy in the growth avenues that we have identified. I would now like to give the floor to Jose Filippo, Executive CFO and IRO Officer, who will speak about our financial performance.
Thank you, Jeane, and a good day to all of you. I will continue on with the presentation offering greater detail. In Slide #8, we can see that once again, the quarterly revenues were a record BRL 1.2 billion with a growth of 21.7% vis-a-vis the same period last year. If we discount the effect of COVID tests, its figure increases to 26.3%. Although we don't include the acquisitions, the organic growth was 11.8%, reflecting the strength of diagnostic medicine in all of our brands, acknowledge for their services and quality. Home care had an expansion of 27.3%, representing 8.1% of the revenues of the year, and we have 5 PSC units.
In Slide #9, we see the participation of COVID tests in our revenue since the beginning of the pandemic. Initially, they -- sorry, in this quarter, they corresponded to 6.2% of the revenues. These figures have been at the same level since the third quarter '21. Now if we don't take into account the share of COVID test, we had a growth of 26.3%, which means that returning to normal operation conditions, less impacted by the pandemic is happening positively in all segments, as we will show you in the coming slides.
We go on to Slide #10. In the first quarter of '22, the gross revenues of the PSCs had a growth of 17.9% vis-a-vis the same period last year, reaching BRL 921.8 million. If we consider only organic growth, the increase of gross revenue was 13.6%, showing you the strength of diagnostic medicine in all of our brands. I would like to highlight the Fleury brand growth, 18.6% showing the consolidation and preference for this brand for elective exams.
On Slide 11, we will speak about new links and health platform. We had a fivefold growth if we compare this quarter with the same quarter of 2021. In the first quarter of 2022, the revenues reached BRL 79.3 a growth of 471.9%, representing 6.8% of the group revenues. The growth of 18x of new links in the quarter reflects the acquisitions carried out and the expansion of existing services. Now the health platform registered 272,000 teleconsultations, a growth of 45.2% when compared to the first quarter of '21. And the revenue totaled BRL 7.3 million for the period.
In Slide #11, we had a quarterly record gross revenue of BRL 324.7 million. Despite the challenges of the inflationary pressure and the strong base of comparison still held back with the cost of 2021, we were able to limit the impact of price transfers carried out at the beginning of the year.
We go on to Slide 13, and we see that in the first quarter, operating revenues had a reduction of 24 basis points, representing 9.7% of net revenues. We also had a strong control of expenses despite the strong base of comparison last year. And -- what we did was to integrate acquisitions and business units.
In Slide #14, we highlight the growth of 14.4% of recurring EBITDA that reached BRL 326.6 million with a 30% margin. As mentioned, this result is due to regular conditions that have been resumed and a very judicious management of costs and expenses. There were no recurring effects this quarter. Now in terms of net income, we totaled BRL 110.4 million compared to BRL 118.6 million in the first quarter '21, impacted by higher financial expenses due to the increase in interest rate.
In Slide 16, we show you our operating cash generation, BRL 62.7 million with -- impacted with deferred taxes and the payment of PLL that had not happened the last quarter. Now the average term of receivables was reduced by 1 day and the average term of payment increased by 5 days.
In Slide #17, a CapEx totaled BRL 66.5 million with an expansion of 29.6% compared to the previous year. These are investments in IT to increase the efficiency and enhance the client experience. We have renewed equipment and maintained our equipment.
In Slide 18, the net debt at the end of March reached BRL 1.5 million, an increase of 9.5% compared to the close of the previous payment. Leverage was 1.4% below the limit of 3x set forth by our debt instruments. We have the seventh issuance of debentures in April, totaling BRL 700 million. The resources obtained will be used for general corporate users, reinforcing working capital and lengthening the company debt. The return on invested capital without things reached 21% and -- excuse me, 46%. Now when we follow up on the net promoter score, the consolidated figure was 72.3%.
In Slide 20 and coming close to the end of the presentation, I would like to highlight the Fleury agenda for the coming months. This is also available in the IR side of the company. Before we go on to questions and answers, I would like to return the floor to Jeane.
Thank you, Filippo. We began the year 2022 stronger, and this is the achievement of 13,000 workers and the 3,000 physicians of the group that devote themselves intensely to the health and well-being of our customers. I would like to thank the work of our teams and the confidence of our customers and partners at Fleury Group. Thank you very much. We are now at your entire disposal for questions and answers.
Good morning. This is Renato Braun. I would like to reinforce the channels for you to post questions. [Operator Instructions] The first question comes from Fred from Bank of America.
Now you already mentioned this at the beginning, and you seem to be ever more motivated. I would like to understand your growth pillars. And if this would perhaps be your main opportunity.
The second question with the practical end of COVID, if you expect a reduction in the home care or if this is something that is here to stay and will continue on as part of your services.
When it comes to the Day Clinic, you have brought up a very important point. We see the opportunity to grow in terms of ambulatory surgery, where we have greater efficiency, we can carry out lower complexity procedures. And these are models that can be expanded. We have this day clinic model of ambulatory surgeries at our orthopedic center in Joanopolis. We also carry out surgeries in the Marcelo Cunha Ophthalmological Center and in the fertility center, where we carry out surgeries relating to women's health.
With the acquisition of Saha, we can add another surgical center with 5 rooms to carry out these procedures. Now this is one of the growth avenues. But as new links, we have included the part of orthopedics medication infusion and fertility as well as ophthalmology, there are opportunities. We observed, Fred, that this combination is of the utmost importance to fulfill the journey of care, all of the preventive part consultations, the diagnostics part and the ambulatory outcome through therapies by carrying out these lower complexity surgeries in the hospital.
This will complete their journey, increase loyalty, and we will be able to come to a good outcome. We have grown to -- we have spoken about avenues of new links that include consultations and treatment. And you are right, the day clinic model is very interesting for our growth journey.
When it comes to home care, we believe that there has been a change in the behavior of our customers. During the pandemic, we had a significant expansion. We had growth quarter-on-quarter. Now once again, we show you a growth of 27.6%. We have expanded the number of procedures, and this is a service, a lever where we still detect opportunities for growth. So we believe that this home care because of the level of satisfaction, it has caused it has a very high Net Promoter Score and the opportunity of going beyond the cities where we are.
Of course, this type of care goes beyond. It is an interesting model for us, and it continues to grow. It represents 8.1% of our total revenues. We had an increase of 95% in the routes. And today, it is very significant in all of the regions where we act. Last year, it was stronger in the metropolitan region of Sao Paulo. Nowadays, it is an important lever in all regions.
I draw your attention to Marcelo Magalhaes that we had just acquired. They also have this home care and it will strengthen our positioning in [indiscernible]. Thank you, Fred.
If you allow me, I have another question. Does it make sense for you to carry out partnerships with hospitals, perhaps to improve the situation of their emergency centers or would it be very difficult to think along those lines simply to get a better understanding of what could happen?
Thank you, Fred. In a certain way, we work very closely with hospitals. We do carry out diagnostic medicine in some hospitals. And in the fourth quarter, we announced a joint venture with Einstein in specific areas. Through time because of the ecosystem, this partnership seems to make sense. It's a win-win situation to carry out low complexity surgeries in a day hospital means you're allowing for more space for the larger complexity surgeries in hospitals. And throughout this ecosystem, part of the procedures depending on the clinical conditions of the patient will require an environment with greater complexity.
Theoretically, of course, Fred, all of this makes sense.
[Operator Instructions] Our next question comes from Mauricio Cepeda from Credit Suisse.
Jeane, Filippo and Renato. I do have a question here. The first of which refers to investments. And I would like to know what is happening with the strategy between the brands. You do have very strong growth between the brands with a good margin. So are you thinking of new strategies in terms of diversification? And another question now the entire system is undergoing pressure. And I would like to know if you foresee a pressure that would perhaps be abnormal for the rest of this year.
A third question, perhaps an unheard of question. The weight of nursing basically, if you are ready to face this, if you understand the impact that this would have on you and the mix of the professionals that you need to work with immunobiological material. And of course, this extends to the nursing staff.
Thank you, Cepeda, for the questions. I will begin with the first question on growth. As you have mentioned, we have had a very healthy organic growth of 11.8%. We have a percentage of COVID revenues in the first quarter of '21, that is higher than the first quarter of 2022. If we eliminate COVID from this comparison, basically organic growth would reach 15.1%. When you mentioned the branded, Cepeda, I would like to try your attention to the growth of the number of beneficiaries.
In supplementary health, we have approximately BRL 40 million. There has been growth, but it is not homogeneous growth. In Sao Paulo, we had a greater growth. And in Rio, for example, the Fleury brand has significant growth of 18.6%. And this growth results from all of the activities that we have mentioned to increase market share, and they relate to differentiating the experience in the Fleury brand. The home care is also important.
Now even in the Fleury brand, if we take away home care, that growth of 18.1% will continue. And the creation of the new links surrounding the Fleury brand which has also helped to enhance customer loyalty and bring diagnostic medicine for a premium brand. In a plus, we also have healthy growth of 17%. We have had significant growth in the home care and for mice. So very generally, we can see that the strategy of bringing together inorganic and organic growth through the service units acquired has been a very healthy move, and we're satisfied with the results that we observed.
Pretti Bioclinico and Espirito Santo, which is a new market. Now regarding the ticket, everybody has discussed the issue of the sustainability of the health sector as Fleury Group, we have taken a stance, offering solutions to the operators, be it through new products and the more preventive medicine. The earlier on, you carry out a diagnosis, the better for the system, you avoid cases of greater complexity.
Now with the claims, there has been an increase, and we know that through time, we will have to face a negotiation. Now most of our negotiations have already taken place in the second quarter. And we now see an impact in the price readjustment of our growth. Now when it comes to pressure for negotiation, we see that ever more diagnostic medicine represents 20% of the total amount of supplementary health. We have been working very closely with the health operators offering solutions. And of course, we're open to work together.
Now to go on to your last question, I would like to remind you that Filippo mentioned how disciplined we have been regarding our cost and expenses with several initiatives to enhance productivity in a year where we will have inflationary pressure to ensure that we continue to grow and maintain the group profitability. Regarding the question about nursing, we know that the nursing professionals need to be valued. And now if this project has a final approval, I remind you, it has been approved by the House of Representatives. It still has to be debated at the Senate and the government is debating funding forms.
The impact on SUS and philanthropic hospitals will be significant. And of course, all of this will have an impact on private health systems as an ambulatory health group, perhaps we will have a lesser impact because the makeup of our associates is a mix. And to respond to your question objectively, for those who work in collection, they have a different profile. We can have laboratory technicians. And as part of our associates, we have room aids that are not nursing professionals.
We have biomedics, chemists and in diagnostic medicine, especially the ambulatory diagnostic medicine, the makeup of associates is more heterogeneous, and we do not have a very high percentage of nursing professionals or nursing aids. When we look at medium and high complexity environments, this percentage will tend to be higher. The second issue is the gap that we have between what these professionals receive and which would be a floor. Now this gap is higher in some regions.
Our greatest operation is in the Southeast where the gap is lower compared to the Northeast. It's also important to consider this when we speak about an impact. And as I mentioned previously, we do have several issues in terms of ways of mitigating and being very disciplined regarding our cost to maintain the lowest impact possible in our results.
Thank you, Jeane. The next question has come in through the webcast from the JPMorgan Bank. I will read the question. Thank you for the presentation. Which is your outlook on the profitability of the new businesses, the health platform and the new links? Which is your vision for the medium and long term?
Thank you for the question. I will begin Filippo, please also participate. We have said that these new links are businesses with a margin structure that is somewhat different from that of diagnostic medicine orthopedics, ophthalmology, they have a mix of clinical consultations and procedures and where in a structural way, the margin tends to be lower than in diagnostic medicine.
I draw your attention to our strategy to continue to grow in diagnostic medicine. This is our core. We have the ability to gain synergy and maintain profitability levels through time or improve them and also have the growth of new links where structurally, the margin tends to be lower, that as part of the mix will end up being very healthy. It helps us to increase the revenues for diagnostic medicine. We can see what happened in the first quarter.
In the second semester of last year, we had acquisitions in new links. We grew significantly. And through time, we have been able to maintain a margin of 30% in the first quarter. Filippo, I don't know if you would like to add something.
Yes, Jeane, and thank you for the question. An additional point is that our growth in new links has happened inorganically as well as organically. We're beginning to build a portfolio today that can carry out measurements of organic growth. Now structurally, when we compare this with diagnostic medicine, the margins tend to be lower. Our goal is that through time and with an integration of these activities with the arrival of new links and new acquisitions in the system, we will be able to have the gain of efficiency that we're seeking and that this margin will increase. It will always be lower than diagnostic medicine. It is something complementary in the health journey, as we mentioned.
So we do have a significant outlook for growth. We begin to have critical mass, the presence of new links in the business with a good future outlook. Now as new links grow, they bring us more activity and diagnostic medicine. Now the share of new links in the total revenue of the group's portfolio will always be absorbed by the organic growth of the group as a whole. Through time, we hope to be able to add new activities, new links with greater efficiency and increase the margin gaining experience in terms of the management of this activity.
Our next question comes from Vinicius Figueiredo from Itau BBA.
First of all, I would like to refer to new links. We have observed quarter-on-quarter, a somewhat different behavior vis-a-vis what we expected, which is the seasonality of new links. The first quarter should be weaker than the fourth quarter or if there is a specific effect that could justify this drop. And to think about Saha that you have just acquired, can we imagine new units being inaugurated in the coming years?
And if you allow me to touch upon another topic regarding working capital year-on-year, we don't observe great changes, but there is a greater cash burn, cash consumption. Is this due to a more difficult negotiation with the payment sources. Are they requesting longer terms, what will happen going forward?
Thank you, Vinicius, for the questions. Regarding the new links, you brought up an interesting point. Yes, there is seasonality in the first quarter, at the beginning of the year, especially in January. We have a large number of physicians and patients that go on vacations. There is seasonality where you have lower growth in the first quarter. This is what we have observed.
In the first quarter, the revenues move sideways compared to the fourth quarter because we have orthopedics and ophthalmologists that go on vacation. And we made the most of this period to renovate some units, the [indiscernible] unit clinic, we carried out an interesting retrofit. And presently, we see that the movement has enhanced its space. We do have a plan for the growth of new units and organic growth. And the expectation is to open 7 new units for diagnostic medicine, not only in Sao Paulo, but also in Rio de Janeiro.
Last year, we also had openings at the end of the year. We opened up units in Viman as well as in Sao Paulo. Now besides the 7 units of diagnostic medicine, we do have an organic expansion plan for orthopedics. We have acquired Vita. We have Vita care units for physical therapy and the plan presently is to increase this by 6 units more for Vita and Vita care in 2022.
Now this organic expansion is very important associated to inorganic growth through acquisitions. Regarding working capital, I will give the floor to Filippo.
Regarding accounts receivable that we have seen in our growth, they are highly associated to the growth of revenues. They do not reflect any change in stance or positioning on the part of our customers. What happened, and this is something I would like to underscore. We had a change of 1 day when we speak about the average term of receivables. It's not an issue of change or a change in stance of the payment centers. It's only due to a growth in revenue.
I would like to make a comment regarding the cash generation for the quarter. Now we have shared this information with you. We have some extraordinary situations that do not have an impact. The cash generation for the year is within what we expected. It is aligned with the market projections. We had a payment -- a tax payment that was deferred in 2021. We also paid for PLR, which refers to our payroll, and this has not happened the previous year.
Now these are some factors that have an impact on the cash generation in the first quarter. These are extraordinary effects that will not have an effect for the rest of the year. This is what happened in cash management -- generation, excuse me, and working capital for the year.
Our next question comes from Gustavo Miele from Goldman Sachs.
I have a few points of discussion. The first refers to the benefits that could be offered by the acquisition of Saha. Based on the description that you gave us, this situation is more of a hospital situation. Perhaps is focused on infusions. And will this cause any problem with your sources of payment? These are figures that are still under pressure vis-a-vis what we saw in 2021. This is the first question.
The second question does not refer to guidance, but to the creation of new units, new businesses, which is the process for a potential accreditation of these new units?
And the third question, how can you explain the huge share that you had in the Fleury brand from 46% to 52%? Is this due to the donation of share for other larger players and is most of this coming from the hospital niche? These are my 3 questions.
Thank you, Gustavo, for the questions. Regarding the first benefit of Saha and renegotiation with the payment sources. Saha has a positioning that is different from CIP. It is interesting because we end up by expanding the offers to our customers. Saha has significant revenue because of the immunobiological medication. Although it may seem to be a hospital. We are speaking of ambulatory centers for infusion, very similar to CIP in Osasco and Bela Vista.
And besides having a greater breadth of plants that have been accredited, we see a very large benefit when it comes to negotiations with suppliers. We're working with medication, and pharma has developed new molecules. There's a pipeline of development with immunobiologics. And because of the volume, we practically doubled our revenues of infusion of medication, and we're able to have a better negotiation with suppliers.
In terms of the potential opening of new units, you have brought about a very important point. We're very attentive to this. We spoke about accreditation. But first of all, the opening of the orthopedic units offer a significant revenues from the private group in Vita and Vita care, and we don't foresee difficulties.
In terms of accrediting these services that are still very fragmented in Sao Paulo, we carried out a very precise geomarketing survey, and we have the opportunity of expanding the software for an audience that wants greater capillarity especially in physical therapy, we're speaking about frequent sessions, and it's very good to be close to your end consumer. In diagnostic medicine, we're also bringing in new contracts at the end of the year. We spoke about a very large contract with more than 400,000 lives.
And in fact, we need to expand our units to service those customers. We're quite calm when it comes to accreditation. We have carried out an expansion in the regions where we have a very high volume in our units and were part of the accreditation already exists.
Now regarding the reconciliation of the share gain of the Fleury brand, the Fleury brand is 96 years. It is very acknowledged and it has a very high share. You mentioned the number of lives. Now these lives do not grow very much in this segment, and we have had expressive growth with a gain in share. We don't look at our competitors, but what we do observe ever more is a vision of the integration of the journey that ends up causing loyalty for the customers in the ambulatory environment. This is interesting for the operators as well as for the customer who will have a complete journey.
And from the operational viewpoint, we have carried out all of the processes to capture the customer who goes for an ophthalmological or orthopedic consultation. 60% of the customers of Vita also carry out their diagnostic exempts with us, with the Fleury brand, and this is a win-win in terms of the experience, reduction of waste and offering physicians a very quick solution. The results are in the physician's hands [indiscernible] that they can make their clinical decisions.
We have received 3 e-mails with very similar questions. I will put them together. The first comes from Walter Pereira. How is the growth of diagnostic medicine?
The second link to this topic comes from [ Saolo Toledao ]. Which is the evolution of the margins of diagnostic medicine?
And the third question, which will be the impact of Marcelo Magalhaes on the company results? The last question was asked by [ Claucia Martins ].
Thank you for the questions, and I will try to respond to the 3. The first regarding the growth in diagnostic medicine. I would like to emphasize structural data and data of our activities in all of our brands. First, regarding the epidemiological part. I repeat that Brazil is one of the countries where we have one of the highest aging rates of the population, people with ages higher than 60 years of age, do have chronic diseases. They will require more medical services and diagnostic medicine goes through all of the stages of care, prevention, diagnostics and treatment as well. So there is an epidemiological trend in Brazil with the potential for growth for diagnostic medicine.
Now the second part, in fact, we have carried out several activities in diagnostic medicine with the launch of new products and through medical relationship. To give you an idea, we have a team that periodically visit physicians, clarifying issues, offering medical education and speaking about the portfolio. We visit 12,000 physicians every year -- month, excuse me. Through this team, we also offer consultancy. And we have spoken about the growth of home service, the differentiation of units, the care that we have with the reception of our customers and inorganic growth.
Now given that through time, we have an increase in volume. In the first quarter, we grew in terms of volume exam, 23%. We have the opportunity of capturing synergy not only through a greater volume in clinical analysis, there is a possibility of gaining synergy with an increase in productivity, which means that the margins of diagnostic medicine through time will continue to be very healthy. And even with the different mix of brands, we do have a good margin for diagnostic medicine.
Now to go on to the last question regarding Marcelo Magalhaes. This is a traditional brand, a benchmark in [indiscernible]. They have 3 patient service centers and home care. They're focused on clinical analysis in the premium sector. They have high margins. And with the acquisition of Marcelo Magalhaes, we have captured synergies. We already carry out clinical analysis with Amais in Pernambuco and images in Amais Pernambuco.
There is the opportunity of capturing synergy. In technical areas, for example, the processing of clinical analysis, and we have the opportunity of expanding our imaging services as well with a differentiated positioning. All of this will bring about benefits when it comes to negotiations with operators and suppliers. And we're very thankful for that. We're very happy with the closing of Marcelo Magalhaes.
Our next question through audio comes from Ricardo Boiati from Safra Bank.
Jeane, Renato, Filippo, and other participants. I do have some questions which in truth are more follow-up questions. The first, to go back to the organic growth more specifically. Jeane, you gave us several insights and points that have been very useful in your adjusted growth, which I believe was 15% in March. If you could rank which are the main factors that we look at is the recovery of health plans due to the crisis generated by the pandemic. This has been a recurring theme.
Patients are beginning to visit physicians more beginning new treatments. Was this an important factor in this resumption of organic growth at a very sound level in this quarter? There are other factors such as marketing, market share for the sector, cross-selling with some new links. If you could perhaps put in order, which are the main factors, they can help us think better going forward. And if we can think of a sustainable growth of 2 digits in organic growth for diagnostic medicine. This is a very broad question.
A second question referring to capital allocation. You have given us some clues, but to gain a better understanding, which is the size of the opportunity that you have to continue to work with small or medium-sized acquisitions in the core part in diagnostic medicine or in new links where you still have many opportunities for acquisitions, not only Saha and Marcelo Magalhaes, for example, and the growth potential with this profile of M&A and if the company is assessing something larger?
And as part of that context, which will be the company balance? The company does not have a very high leverage. You may have a gradual increase in your indebtedness. So which would be the company balance, enabling you to continue allocating capital for growth?
Thank you for your questions. Regarding organic growth, we have already spoken about this. Let me bring in some new elements. First of all, we have grown 17% in clinical analysis, laboratory exams and 12% in imaging exams. Now when we perceive what is happening in the growth sector, there are some factors. The increase in chronic diseases is one. And there's a greater awareness among people on the need of carrying out a follow-up of chronic diseases. We do have that relationship with colleagues who are in clinics, and the pandemic has brought about a greater awareness.
We spoke about patients with chronic diseases that had higher mortality. And during the pandemic, several patients stopped following up on their diseases, they have now resumed this. Now this lack of follow-up or lack of treatment exacerbates diseases. We have factors, and we know that patients with post-COVID are faced with chronic situations that are there to stay. And we have put all of our strategy to work to capture patients.
Generally, we see that people are more concerned with their health. We have a greater number of chronic diseases of chronic patients and the fact that there is greater awareness on the need to care for your health will take people to follow up with their physicians and carry out diagnostic exams even though they are in good health. Now all of this is very positive. And early diagnosis will avoid cases with greater complexity.
Now regarding capital allocation, I will give the floor to Filippo. I remind you that we have been extremely disciplined in-house, as we mentioned and in terms of our capital allocation, this is an important factor. We have a sequence of internal analysis but Filippo will speak about this in greater detail regarding the opportunities that we have for acquisitions and an adequate capital allocation.
Yes, without a doubt. Thank you, Jeane, and thank you for your question. We have already mentioned here our commitment with our discipline, but our growth will come from a combination of inorganic and organic growth. We have already observed this. The acquisition of Marcelo Magalhaes has just been concluded and reflects this prospection activity. We have an M&A area that has been reinforced with expertise to be able to analyze cases.
Now our goal is not to do business that is not aligned with our goal. Now of course, this will pose a challenge in terms of our hit rate. We do have to comply with the parameters that we set forth. And we do have room in terms of leverage, but this room is limited. It's not infinite. We're going to use this combination to our favor. We are at the end of the quarter with 1.4x net debt EBITDA ratio. And there are situations where we could get to 2x, we would still be very far from the 3x, which would be a technical limit because of our debt instruments, but this is something that we manage on a daily basis.
So this combination of parameters will enable us to continue on successfully. Now the targets and our acquisitions already bring in EBITDA. And of course, this is positive. We're working with something that is established, that brings in synergies and efficiency gains. They reinforce the company. And of course, all of this will contribute to this combination where we will continue on.
You speak about the opportunity for more transformational larger movements. Well, these would be very specific situations. We're speaking about that prospection pipeline that we have, that quest of a combination of inorganic and organic growth, which is sustainable and can continue on with our trend.
The next question comes from BTG Pactual. Mr. Cesquim, you may proceed.
Jeane, and all the rest. We do have some questions here. The first is a follow-up on Fred's question on home care. Have you observed an effect of the substitution of demand for this year? And if you could perhaps reduce the units that you have because of the mobile care that you have.
The second question refers to orthopedic therapeutic services. You have spoken about several new units, and I would like to understand the impact of this, if this changes your outlook for the year.
Thank you, Yan, for the questions. Now regarding home care, mobile care, we follow up on the indicator that you mentioned, how many patients used to go to the units and are now being serviced through home care. Now home care services customers at that point in time where they have clinical analysis, when they have a combination of ultrasound or MRI, they will have to go to a unit. There is no significant replacement of demand of units in terms of the home care.
Now when this happens, it's not negative for us. We have made the most of our square meters to expand our growth in terms of imaging exams and other services. We have spoken about making the most of our units for primary care, for the infusion of medication. And in our vision, we follow up on the indicator of revenues per square meter, and we have increased the revenues in a very healthy fashion. We don't need to eliminate some units. We have better used our units in the Fleury brand when we carry out a retrofit, we're expanding the offer of services, increasing the number of ultrasound for the Fleury brand so much so that we're going to have to open new units this year.
In a very controlled fashion, there will be 7 units of diagnostic medicine and the expansion of orthopedic services. Now these units for orthopedic services, we have a combination of units. We have a broader portfolio, which includes physical therapy and other units where the focus is physical therapy to be closer to the customer. The CapEx of these units is not very significant. It is part of our CapEx projection for this year.
Last year, CapEx was somewhat higher. It offset the CapEx that we had held back on in 2020. So this CapEx is fully under control. And through time, there is an indicator of return on capital invested, and we're very confident in this strategy. We remind you that in this model of creating orthopedic service units, we do have that vision of working very closely with the diagnostic medicine unit to complete the customers' journey and to capture the demand for diagnostic medicine.
[Operator Instructions] Our next question comes from Vinicius Ribeiro from UBS.
We have 2 topics we would like to discuss with you. First of all, remaining with the Fleury brand, when we think about the ticket revenue that is consolidated, we will see that the ticket ends up being flat. Now you have spoken about the gain of market share. What does this relate to? And once again, speaking about the Fleury brand, the gross margin dynamic, does it refer to the fact that the Fleury brand is growing more and above and beyond other brands?
The second topic is to speak about Saude iD. The revenues albeit not being significant, have had a resumption. And you mentioned the number of active users. Now is this revenue resumption associated to consultations, associated to Omicron? Or do they refer to growth of active users? And if this is what we should expect going forward.
Thank you, Vinicius, for the questions. Now regarding the ticket that you mentioned, the growth of the Fleury brand is very healthy. And the growth of the ticket in the premium sector is higher. When you mention that there was a revenue due to exams and there was a reduction, I recall that this is due to the mix between clinical images -- clinical analysis and images. We have grown more in clinical analysis, vis-a-vis images. And on the average, we have a reduction of the ticket. But this is very healthy. We have grown 25.6% in number of exams, 17% in clinical analysis and 12% in terms of images.
This ticket that has a drop here is due to the fact that the number of clinical analysis exams is higher than the number of imaging exams. Of course, there are several negotiations. And through time, we work very closely with the operators. It's interesting to bring in ever more volume. When processing clinical analysis with a higher volume, we can reduce our cost because of the synergy gains. But generally, the negotiations are at a very healthy pace.
Now what you mentioned was very interesting. The Omicron moment leads to an increase in medical teleconsultations, we had 272,000 medical consultations during the quarter. And of course, this relates to the increase in the Omicron cases. The number of customer service by Saúde iD does have a variation, and it depends on waves on moments and the number of acute cases. We have a baseline that is growing where we follow up on chronic patients, but the Omicron wave did lead to an enormous increase, especially in January.
Now regarding the number of customer service in the first quarter of 2022, we had 173,000 a number that was higher than what we had previously corresponding to 15.6% of the total lives of the group. Now why don't we speak about this constantly? There is a natural fluctuation in Saúde iD. It fluctuates with COVID wave, for example, or acute cases. Very generally, we are following our strategy of Saude iD with new partners and by offering new products. Thank you very much, Vinicius.
As we have no further questions, at this point, we would like to conclude the question-and-answer session. We return the floor to Ms. Tsutsui for her closing remarks.
I would like to thank everybody who participated in our conference call for the first quarter 2022. We are very confident in our strategy for an integrated health ecosystem. It contributes a great deal to health. We are determined to continue on with our discipline, and we want to build an ever stronger Fleury Group. Thank you very much.
The conference call for the Fleury Group ends here. Thank you very much for your participation. Have a good afternoon.