Integral Diagnostics Limited (IDX) Earnings Call Transcript & Summary

Thank you for standing by, and welcome to the Integral Diagnostics First Half Fiscal Year '26 Results Call. [Operator Instructions] I would now like to hand the conference over to Dr. Ian Kadish, CEO. Please go ahead.

Thank you very much, Alicia, and good morning, all. My name is Ian Kadish. I am the Chief Executive and Managing Director of Integral Diagnostics. I'm joined this morning by Craig White, who is our Chief Financial Officer. We're pleased this morning to be able to deliver another strong set of results for Integral Diagnostics for the first half of financial year '26 with solid revenue growth and improved margins on all earnings lines. We saw strong revenue growth of 55.6% to $393.5 million, which included the 6-month contribution from Capitol. We've also delivered an improved operating EBITDA margin of 20.6%, which is up 230 basis points versus the first half of financial '25. We delivered strong growth in operating diluted earnings per share and an interim dividend per share of 66.2% and 32%, respectively. The Capitol merger annual synergies of more than $14 million have already been achieved, materially above the $10 million that we estimated at the time of the merger. We ended the year with a strong balance sheet with a reduced leverage of 2.5x at the 31st of December 2025 versus 2.8x on the 31st of December 2024, with 51% of our gross debt hedged effective late December at a favorable interest rate versus the BBSY. The strategic mergers from -- the strategic benefits from the Capitol merger continue to be realized across teleradiology, group procurement, and employee engagement. We're now nicely positioned to support government initiatives to improve outcomes for patients and to deliver solid revenue growth and further margin expansion, driven by the government initiatives of MRI deregulation, the National CT Lung Cancer Screening Program, and the $8 billion GP Bulk Billing Incentive Program. We're delivering excellent outcomes for our patients. Our Net Promoter Score for patients is at 82, and we have strong radiologists and referrer engagement. Moving to the strategic overview and a key progress update in the 3 major areas. The integration with Capitol is now well advanced. We're exceeding the annual synergies of $14 million and expect to continue to drive additional synergies going forward in areas like group procurement and teleradiology. We're continuing to focus also on driving organic growth in the -- across the whole business and operational efficiencies and continue our strategic focus on radiologist recruitment, productivity, and efficiency to support the growing demand for services by patients and an enhanced focus on teleradiologist recruitment to grow IDX's industry's leading teleradiology platform called IDXt, to drive further operational efficiency and margin improvement. IDXt now has 124 teleradiologists on 31 December 2025. This is up from 93 at the same time last year. And we do continue to evaluate and implement incremental greenfields and inorganic growth opportunities. We will be opening 3 new greenfield sites in the last quarter of this financial year, including a new clinic at the Eastwood Private Hospital in South Australia, a new clinic in Wangaratta, and also in Wangaratta, Victoria and in Maroochydore in Queensland. And we relocated our facility in Launceston to a new state-of-the-art facility in the city. We continue to evaluate M&A opportunities as they arise. IDX today has 144 sites across Australia and New Zealand with 485 radiologists and about 3,000 staff. We have a GP and a specialist referral network in both metro and regional areas. IDX historically was more concentrated in the regional areas after merger with Capitol, we're almost equally spread across both regional and metropolitan areas because of Capitol's strong footprint in Metro Melbourne. We have built a strong platform to continue to improve clinical outcomes and growth and continue to develop our sub-specialist reporting capabilities, both to report to capitalize on our specialist expertise, but also to make use of enhanced AI screening and detection algorithms that are available. We continue to focus on radiologist recruitment, productivity, and on efficiency, and we use IDXt and AI to improve operational efficiency as well. And we've been leveraging the scale advantages we have now in procurement, in IT, in recruitment, and in property to generate operational efficiencies. We continue to deliver on our values in the first half of financial '26. Patients first is always our first value. We have an excellent average NPS score of 82. We serve 1 million patients with about 2 million exams in the first half. And we also invested $24.9 million in CapEx, including $8 million in new growth initiatives. We employed 485 radiologists and a significant number of these radiologists are shareholders in IDX. And we continue to grow IDXt's teleradiology platform, both within IDX, where we service the legacy IDX and all the legacy Capitol businesses as well, as well as growing teleradiology services externally with external clients, too. We have about 3,000 employees, and we've undertaken a structured program over the 6 months over the past year, in fact, to create One Team focusing on what unites us, providing better care together. Our annual culture survey demonstrated continued strong engagement scores, and we continue to deliver value for all stakeholders, including shareholders, increasing revenue by 55.6%, increasing operating EBITDA by 75.6% and increasing operating NPAT by 154% to $22.3 million. We continue to focus on our ESG strategy. And in terms of our final value of embracing change, we've rationalized and are rationalizing -- we are rationalizing clinical and nonclinical systems across the larger group. I'm going to hand over to Craig now to take us through some of the financial detail.

Thanks, Ian, and good morning, everybody. Thank you for joining us this morning. Just turning to Page 7, I'd like to just take you through the financial results in some more detail. I think as Ian called out, we're really pleased that we've seen strong growth across all earnings lines and that growth getting stronger as you come down the P&L down to operating NPAT. So with revenue growth at 55.6%, EBITDA growth at 75.6%, EBITA growth at 108.2%, and operating NPAT growth at 154.6% has meant that we've seen margins expanding on all key earnings lines. In particular, the operating EBITDA margin was pleasingly up 230 basis points to 20.6%, up from 18.3% in prior half. Operating diluted EPS is also up strongly by 66.2% at $0.059 per share and the interim dividend also up 32% at $0.033 per share. In terms of cash flow, operating cash flow was also strong, up just under 65%, and I'll talk to that in a little bit more detail later on. As Ian called out, our net debt-to-EBITDA gearing ratio is down from 2.8x to 2.5x, so 0.35 -- sorry, 0.3x turn. Net debt being up slightly, a function of basically the transaction restructuring and integration costs. I'd like to just turn to Page 8 and, I guess, set the scene in terms of laying out pro forma P&L comparing first half FY '26 to first half FY '25. For those of you who had a look at this chart at the last half, we would have shown pro forma EBITDA for 1H FY '25 at $73.1 million. What we've tried to do here is present the first half results for FY '26 on a like-for-like basis with the first half for FY '25, particularly in light of the work that we've done in terms of all the purchase price accounting and discovery, I suppose, through the period following the merger. So that you can see that we've adjusted for a few items, one being a small amount relating to repairs and maintenance costs that were previously capitalized by Capitol, which should have been expensed. Capitol also excluded or put below the line a number of their management costs of about $800,000, which we put above the line. There are 4 clinics that were closed and 1 clinic sold in Melton. So excluding that, there's a $0.5 million impact. And then adjusting for the 2% reduction in CT Medicare indexation, which was implemented on 1 November 2024 has about an $800,000 impact. So what that means is on a like-for-like basis, the operating EBITDA for first half FY '26 of $81.1 million compares to the prior corresponding period of $70.9 million or that represents 14.4% growth. Put differently, when we look at it in margin terms, the first half operating EBITDA margin for FY '26 of 20.6% compares to 19.3% in the PCP. If we just turn to Page 9, I'll just go through some of the other key lines of the P&L in more detail. You can see that while headline revenue growth was 5.7%, if you adjust for the closed clinics, the 4 closed clinics I referenced, the 1 sold site being Melton and also put New Zealand on to a constant currency basis, then that 5.7% and 6.9%. If you look at the split between -- in Australia between the legacy IDX business, the legacy Capitol business, you can see that the legacy IDX business has grown at 8.5%, legacy Capitol business at 5.4%, which on a combined basis meant that Australia grew by 7.4% compared to Medicare growth of 9.1%. The IDX legacy business was strong, driven by both the underlying business as well as the impact of MRI deregulation and the introduction of the National Lung Cancer Screening Program, both that were effective from 1 July 2025. The growth in the Capitol business, legacy Capitol business was a little bit lower, just reflecting a lack of growth in GP attendances and referrals, but we certainly expect that to improve over time as the GP Bulk Billing Incentive Program kicks in and also as we build out the referral base for the Capitol business away from GPs towards specialist referrers. Organic revenue growth in New Zealand was a little lower at 2% on a constant currency basis, largely reflecting pricing pressures in that market, particularly reductions in private health insurance reimbursements, but underlying volume growth in New Zealand was strong. Turning to Slide 10 and just having a look at operating expenditure. You can see that we've achieved a pleasing reduction in our labor costs of 1.4% or 140 basis points. That really reflects the synergies across the group following the integration of Capitol and IDX workforces together with increased use of IDXt, our teleradiology business. And that's despite the fact that we obviously see an ongoing shortage of clinical staff and some labor cost inflation, especially in regional Australia. In terms of some of the other lines on the expense lines, consumables were up about 20 basis points. That largely just reflects a shift in the modality mix towards higher-end modalities as well as price increases for radiopharmaceuticals and contrast that's used in those high modality studies. Equipment costs were 20 basis points lower, and that is starting to reflect some of the procurement benefits that we're seeing with our larger size and improved negotiation of equipment service agreements and the maintenance profile of capital equipment. Just turning to Slide 11 and touching on cash flow. As I called out, operating cash flow -- operating free cash flow was strong, growing about 65%. The operating free cash flow conversion was down slightly relative to the PCP, so 65% versus 76.9%. However, I think it's worth noting that, first of all, in the PCP, the operating EBITDA of $46.2 million, included a $600,000 loss for Capitol for the 10-day period following the merger on the 20th of December 2024 through to 31 December 2024. So that naturally inflates the prior period cash flow conversion. In terms of this half, you can see that the changes in working capital have certainly been a driver of the slightly lower free cash flow conversion. But really, that's a function of probably 2 things. One is higher prepayments of $4.1 million, you can see that on the balance sheet slide, as well as reduced accounts payable of around $9 million. Nothing particularly unusual. I think probably fair to say that the accounts payable balance at 31 December 2024 was probably higher. There was a lot going on in the business. Obviously, the merger took place on the 20th of December. So I think the -- what you're seeing in terms of the working capital movement for accounts payable is more an aberration in the prior period than anything unusual in the current half. And I would expect that that will normalize going forward other than obviously reflecting growth in the business over time. In terms of capital expenditure, Ian touched on a couple of elements here, but we had a total of $24.9 million of CapEx, split $16.9 million on replacement CapEx and $8 million in growth CapEx. We've called out some of the larger spends, in particular the new greenfield of Eastwood Private Hospital in South Australia, Wangaratta in Victoria, a new MRI machine at John Flynn Hospital in Queensland, and the new site in Launceston, Tasmania. Regardless of whether the CapEx is replacement or growth, the reality is that we're investing in our equipment fleet, and that over time is obviously enhancing the ability to service our patients. Just turning to Page 13 on the balance sheet. A couple of key points I'd just like to call out here. As I mentioned earlier, net debt to EBITDA is down from 2.8x to 2.5x. It's probably a touch higher than we forecast at the time of the merger. At the time of the merger, we forecast pro forma leverage at 2.4x. But that's really, as you can see in the footnotes on that page, a function of 2 things. One was a $3.7 million tax payment for the stub periods for Capitol, which we didn't know about at the time of the merger. And the other one was $5.4 million of additional CapEx that we've invested into MRIs ahead of MRI deregulation. So those MRIs went into John Flynn Hospital in Queensland, as I mentioned, as well as other sites like IOP, Imaging @ Olympic Park in Melbourne and so on. So we're pleased to see that net debt to EBITDA has come down to 2.5x. That's now at the top end of our target range and fully expect that that will continue to trend down over time. We retained significant liquidity headroom under our facilities, about $115 million. Pleasingly, our interest funding costs over the half have come down about 2%. That's a function of the renegotiation of the financing facilities at the time of the merger on 20th December 2024 as well as just the cash rate coming down across that period. We have also now hedged just over 51% of our gross debt, which is effective late December, and that was at a favorable rate versus the current BBSY rate in the order of, I would say, if you look at the rate we've hedged at relative to current BBSY, we're around 0.5% favorable to that current rate and certainly favorable to the 2-year swap rate. I'll now hand back to Ian to take you through the industry and regulatory update.

Thank you very much, Craig. These are exciting times for radiology as we harness the power of technology to materially improve our diagnostic capabilities and patient outcomes. IDX is very well positioned to capitalize on the positive industry fundamentals. The aging population and the earlier detection of disease drives increasing demand for diagnostic services, especially in the high acuity end where IDX is strong. Medicare DI benefits and services are growing consistently above the long-term growth rate, and I'll go through that in a little more detail on the following slide. Medicare indexation was effective from 2.4% from 1 July '25. And the structural shift to the higher modalities is propelled further by government initiatives like the MRI deregulation program and the National Lung Cancer Screening Program. The MRI deregulation at the end on the 1st of July 2027, MRIs will be further deregulated on 1 July 2029. IDX today holds 42 licensed MRIs in Australia compared to 23 licensed MRIs in the prior corresponding period. The National Lung Cancer Screening Program is driving growth in screening CTs, but also driving growth -- follow-up growth in interventional work and in PET-CTs, and we expect that will continue as more patients join the lung cancer -- participate in the Lung Cancer Screening Program. The Health Department has committed $264 million to the CT screening program over the next 4 years. Technological advancements at IDX means that about 10% of our scans today are processed through an AI algorithm, which enhances the quality of care and improves labor productivity. And this percentage increases steadily. And teleradiology today across both the IDX and Capitol groups combined is running at about 15% of all our scans, and this enhances labor productivity. The $8 billion GP Bulk Billing Incentive Programs for all Australians that only began the 1st November 2025, is driving increased GP visits and increased radiology referrals because the more patients that the GP face, the more patients will go on to access radiology. The expedited specialist pathway for radiologists from the U.K. and Ireland is currently expected to be implemented sometime in this half of financial year '26. It's administered by the Medical Board of Australia and by AHPRA, noting that the expedited special pathways were recently expanded to include general medicine and pediatrics in January of this year. And the government has also pledged new funds for 400 new nursing scholarships and 2,000 more GPs. Turning to the chart on Page 16. The chart has 2 lines. The top line indicates the Medicare outlays and the Medicare benefits paid and the bottom line shows the Medicare services that relate to those benefits. The reason that the 2 lines have been diverging is that the proportion of the high acuity scans, the more valuable scans, the MRIs, the CTs, and the nuclear medicine, especially PET-CTs have been growing faster than the basic x-rays and ultrasound. And this is just a function of the aging population, the changing in the demographics of disease and it's a trend that we see across the world, across developing -- across the developed countries in the world where more and more referrers are turning to the more valuable scans like the CTs and the MRIs and using proportionately fewer of the entry-level scans. If we look at the industry growth rates on a 12-month rolling basis, they continue to track ahead of the 10-year average, and that's driven by Medicare indexation, but also this modality mix, driven by the structural demographic trends. And then MRI deregulation and National Lung Cancer Screening are further driving growth in MRI and CT. Turning now to our strategy, our priorities, and outlook. Good medicine is good business. In radiology, if we do the right thing for our patient, we invariably do the right thing for the business as well. Our strategy is to continue to grow the existing business and margin and then to continue to explore strategic M&A. We're driving organic earnings growth, including a relentless focus on radiologist recruitment and productivity together with operational efficiencies. We continue to accelerate the use of teleradiology, digital platforms, and AI to improve the patient and referrer experience and doctor efficiency. We continue to drive our ESG program to lead to our values. And we are completing now the integration of IDX and the Capitol merger, including ongoing realization of additional synergies and continue to evaluate further M&A growth opportunities in a consolidating market. Our outlook for FY '26 and beyond is that IDX, including Capitol, achieve a 7.8% constant currency revenue growth rate in January 2026, adjusted for working days and on a like-for-like basis. We expect continued revenue growth and operating EBITDA margin is also expected to expand further over time with FY '26 operating EBITDA margin forecast to be around 21%, consistent with the guidance that we gave at the AGM and driven by the ramp-up of the new greenfield sites and brownfield investments, scale benefits, including the use of IDXt teleradiology, both internally and externally, and together with further procurement efficiencies and then supported by further deregulation of MRI and growth of the National Lung Cancer Screening Program, partially offset by ongoing clinical labor shortages and cost pressures. Our group FY '26 replacement and growth CapEx is expected to be between $45 million and $55 million. And our group net debt-to-EBITDA ratio of 2.5x on 31 December 2025, down from 2.8x at 31 December 2024 is in line with the group's target ratio of 2.5x or less and projected to continue to trend down further over time. We'll turn now to questions and answers. So over to the operator for any questions.

[Operator Instructions] Your first question comes from David Stanton with Jefferies.

First question on seasonality. As you look at the business now, the combined business, can you talk to seasonality you see first half versus second half across the business, please?

Thank you, David. The seasonality that we're expecting in the second half is fairly similar to what we have seen in previous years. So we would expect to see roughly a 47-53 split between the first half to the second half, which is consistent with what we've seen in previous years.

Understood. And perhaps a question or 2 for Craig. Can you perhaps talk to, firstly, D&A that you expect second half versus first half and potentially NRIs that we should be thinking about for the second half of '26, please?

Yes, sure, David. Firstly, just on depreciation, I'll probably take you to Slide 24 of the investor pack that sets out both depreciation and the financing costs. And obviously, you've got a split there between normal depreciation, all interest, and then the AASB 16, right of use depreciation and finance costs. So let me just talk to each of those elements. You can see that normal depreciation of PP&E was down $800,000 across the halves. That is fundamentally driven by obviously new CapEx coming in, but also as part of the merger, we've looked at the whole useful lives of all of the equipment across the business. And in a number of cases, there are instances where we've upgraded machines to ensure that they still qualify for capital sensitivity, but we didn't adjust the depreciation. So effectively, what you're seeing here is a benefit of that. I would expect that the number you see there in the first half of $19.8 million, call it $20 million, is a pretty good proxy for what we would see in the second half. In terms of the right of use depreciation of $14 million, again, I think that's probably a pretty good proxy of what you'll see in the second half. Again, it is down slightly on the PCP by $1.3 million. That's probably a function of a number of things, but bearing in mind that there are 4 clinics that we closed and 1 that we sold. So obviously, the leases associated with those clinics have been taken out of these numbers in the current half. You didn't specifically ask about financing costs. I might just pass on that for the moment. But in terms of, I think you referenced NRIs, the non-recurring items. I think we just go back to Slide 23 of the pack. Maybe let me just talk to first half FY '26, and I'll give you a view on second half FY '26. So obviously, the big item remains the transaction restructuring and integration costs of $10.3 million. There's really 3 items that make up that number. The bulk of it, as you would expect, would relate to the merger with Capitol. That was just under $7 million in that category. And that was a function of labor costs that we've specifically incurred related to integration as well as some of the run-off costs for previous management in the business that have been part of the rationalization process and part of the synergies that we've realized. So just under $7 million in there for, relating to the merger. The second big item is about $2 million relating to an enterprise-wide systems implementation that we have been working on for a couple of years now that we've been rolling out across Capitol. So that's the implementation of Workday, which we have implemented in the legacy IDX business been rolling out across Capitol, but we've also rolled out in addition to the financials and the adaptive planning modules, we've also rolled out the HCM or human capital management module as well. So that's a big transformational project, which will conclude around 30 June this year. And then there's probably about $1 million relating to what I'd call business development. So think of that as M&A. There's obviously a lot of activity in this space, not at liberty to talk about who we have been talking to, but there's about $1 million of M&A costs there. So that makes up roughly the $10 million. The other significant items there, we mentioned the contingent consideration liabilities. That relates to the earn-out at Capitol, in particular, IFP. And then the share-based expenses of $1.4 million. Again, that relates to both historical share-based expenses relating to the doctor loan share program as well as the impact of the rationalization of management at Capitol as part of the merger. So that's first half FY '26. I think if you look at it going forward, obviously, the contingent consideration liabilities, we would expect a similar amount in the second half, so about $4.5 million probably for the full year. The share-based expenses, I would expect that's probably going to be in the order of a similar amount. And then within the $10.3 million, as I said, most of the Workday implementation will be done. So that's about $10 million. There might be a little bit of residual below-the-line spend for that finalization of some of the back-end systems that integrate into Workday HCM in the first half next year, but that will be much reduced. I think the business development M&A is very much based on what we may choose to look at. And then as far as the merger goes, which is obviously the big bucket, we would expect that we'll probably see that come down, I would say, from just under $7 million to around $5 million, I would say, in the second half, and then obviously continue to reduce into FY '27. So I think it's important just to put this into context as well, we've obviously -- with the merger with Capitol as a transformational merger, those transaction restructuring implementation costs in FY '25 amounted to just under $35 million. So the numbers that we're now looking at are much, much smaller, and we would expect them to continue to reduce over time. So hope that answers your question, David.

Yes. I mean just for the dummies like me, if you add it all up, it sounds like it's about $12 million for the second half pretax. Would that be reasonable?

I think that's a good number, yes. If you look at all of them combined, they were $14 million pretax, take a couple of million off that, about $12 million, that's about right.

Our next question comes from the line of Saul Hadassin with Barrenjoey.

First question, can you just touch on the performance of the revenues of the Capitol sites that you touched, that you mentioned in that lower rate of growth versus the IDX sites? And you talked to GP referrals. I'm just wondering, if you take out Olympic Park from the Capitol base, it does suggest that those sites have indeed seen pretty limited rate of growth. So is this just the mix that you referred to in terms of where those referrals are coming from? To what extent do you think that revenue growth will recover with the bulk billing centers? And do you intend to rationalize any more of those Capitol sites?

Thank you, Saul, for the question. There are a couple of questions in there. But the -- I guess, the trend that you're referring to is the lower growth of the Capitol in the Capitol clinics than at IDX and especially lower if you include -- if you exclude the sites like Imaging Olympic Park, which is growing quite strongly. There are 2 reasons, 2 major reasons for that difference. And the biggest by far is the fact that Capitol depends a lot more on GP referrals and GP visitations were fairly low, almost flat in the first couple of months and pick up -- have picked up a bit towards the end, especially with the GP Bulk Billing Incentive coming through, but that was right at the end of the half, so November, December because it was only implemented in November. And we had overestimated, I think, in terms of the Capitol MRIs being able to pick up specialist work because a lot of those specialist referral patterns do take time to change. And we don't benefit as much from the full license MRIs when the GPs are referring, we benefit a lot more from specialists referring. But we have seen continued increases, continued -- more specialists referring to those MRIs, and we expect that that growth will continue, which has been a factor of changing those practice patterns, which don't change overnight and taken a little longer than we expected, but they are changing. The second driver of the lower Capitol results has not been as much in Victoria as in South Australia, where there's been a fairly structural change at a large Capitol site that we have in South Australia, where we're seeing some challenges with regard to radiologist recruitment in particular. We had relied a lot on international medical graduates at that site. We're no longer able to use international medical graduates at the site and have been quite limited at that site in Adelaide, which has been a good growth driver in the previous year. We do have strategies in place in South Australia to look at changing that going forward, improving and getting back to where we were. The other parts of the Capitol business, Tasmania has been doing nicely and holding its own and Western Australia has been integrated now into the IDX business in Western Australia, which was the much larger business there and now falls under the apex umbrella in Western Australia. But we have seen lower growth, and that's where the Capitol clinics had been closed. In fact, I think of the 4 closures that Craig referred to, I think 2 or 3 of them were in Western Australia, 1 or 2 in Victoria. That's really it in terms of your questions, I suppose. So the important thing going forward, I suppose, is that we are seeing the growth come back in the Capitol side. We were constrained also with the clinical workforce in Victoria and the Victorian Capitol sites, specifically sonographies. So there is a shortage of sonographers countrywide, but it seems to be more acute in some of the areas in Melbourne where we were having some difficulty attracting and retaining the full sonography workforce we have. But we've got strategies in place. We have a training school in place, and we're steadily improving the access to sonographers in Capitol. I think that those are the major drivers really to talk to regarding the lower Capitol growth rate year-on-year compared to IDX.

Yes. Thanks for that, Ian. And if I could just ask you one more question. Not much reference to New Zealand in the presentation outside of the 2% organic revenue growth. I guess to what extent does that remain a key part of the business? I'm assuming that costs were not necessarily able to grow at that rate or maybe they were. But I guess to the extent that it's now becoming a drag on earnings growth, to what extent do you want to continue to allocate capital to that region? And are you assessing the potential for any type of strategic moves there?

Thanks, Saul. We are open to any strategic moves that can be shown to be in the benefit of our shareholders. New Zealand for us is not nearly as exciting a market as it was 5 or 6 years ago. And it's been challenged, in particular, in the first half of this year by some of the private health insurers that have cut back on their reimbursement rates. And because of the overall economic conditions in New Zealand, we've seen some switching from the better private health insurance plans to the plans that don't cover as much, which has had an impact on us because remember that in New Zealand, private health insurance pays for outpatient as well as inpatient radiology treatment. So we've definitely been impacted by that in New Zealand. We're still impacted a little by the specialist owned MRIs in that market. And the New Zealand market has consolidated very quickly since we've moved into that market. In fact, probably the -- looking at the 6 largest operators in New Zealand right now, that probably account for roughly, we'd be estimating close to 90% of New Zealand radiology. So the market has consolidated quickly, but we think that in a place like Greater Auckland, which is where we are one of the largest, if not the largest operator, there'd be room for at least one more wave of consolidation that would make sense in that market. So we'd be open to looking at it to the extent it make sense for shareholders.

Our next question comes from the line of Steven Wheen with Jarden.

I just wanted to ask about, you keep talking to the synergies from the Capitol transaction exceeding $14 million. Just wonder if you'd quantify what that sort of level is and what further you can do with regards to the procurement of teleradiology side? What sort of upside they might be able to provide?

Steve, hello, it's Craig. Let me perhaps take your question on synergies and then Ian can comment on teleradiology. I think in terms of synergies, look, it's hard to put a definitive number on it because we're continuing to sort of see these synergies emerge over time. Fundamentally, they're all really within the procurement area. And we're seeing them across a number of IT contracts as those IT contracts either come up for renewal or we assess them where it makes sense to exit them early. We're seeing further procurement benefits in the service agreements that we're negotiating with equipment suppliers over time as we renew the fleet. We're seeing some procurement synergies in the consumables line, again, largely based on the volumes we're now procuring. So I think this is just going to be a feature going forward over the next 12 to 18 months as we look to procure better. We now have a group procurement function. I think it's something I've talked to in previous results. And that team is doing a great job of continuing to find procurement benefits. But we're talking probably within this half in the order of $0.5 million to $1 million, but we think there's probably another 1 or 2 still out there to capture over time.

The best way, Steve, to think about quantifying the additional benefits that can still come from teleradiology is to look at our teleradiology penetration at IDX and at Capitol. So we called out roughly 15% penetration rate across the whole business, that's made up of about 20% in the IDX legacy practices and about 7% or 8% in the legacy practices of the Capitol Group. There's no reason that Capitol would not get -- perhaps not quite to the IDX level of 20%, but a lot more closer to that level. And as that teleradiology penetration rate improves, increases in the Capitol business, we'll see an improvement in margin at the same time. So that takes a bit of time to happen and develop to get the system ingrained in terms of using teleradiology for after hours and using teleradiology for the management of the overflow work. But it's happening more and more, and we expect that we'll continue to see the overall teleradiology rate getting closer to the IDX legacy rate of 20%, and then continuing to grow after that.

Yes, that's clear. The penetration that Capitol Group has with teleradiology, is that being constrained somewhat by the number of teleradiologists that you have? I'm just wondering, I might have missed this, but have you indicated how many more you've signed on or how many more are in the pipeline?

Yes, Steve, it's right. So we are still constrained. It still is a rate-limiting constraint, but we have increased the number of teleradiologists today to around 120 from 93 a year ago. So we've increased the number quite substantially and continue to see a pipeline. I think the pipeline now of teleradiologists is running between 20 and 30 teleradiologists coming into the pipeline and still a lot of additional interest. So we will continue to be constrained, I suppose, by the number of radiologists, but we're growing the business. We're growing the number of radiologists in that business by more than 30% year-on-year.

Yes. And I think importantly, Steve, obviously, as that percentage grows, we essentially see about a 4% to 5% margin pickup basically because it's just more -- it's easier for radiologists to report through teleradiology. So productivity is better. So there is about a 4% to 5% EBITDA margin pickup relative to that scan being read in clinic.

And just in terms of a more accurate number, Steve, we have 124 teleradiologists today compared to 93 by 31 December '24.

Or put differently, it's up by 10 since 30 June. So we're 114 at 30 June and now 124.

That's clear. Can I just quickly ask about -- I mean, typically, in first half, in your history, the West Australian reporting contract has been a bit of a problematic one in terms of the effect on the half. I'm just wondering, you were able to reset that. I'm just wondering what sort of effect, if any, there was with that with regards to that contract in the first half of '26.

Steve, I mean, I think the growth rate in the first half for both the Western Australian Country Health Service, the WACHS contract and also Central Queensland Health Service, where we also have a large reporting contract. The growth rates are below where they were at the same time last year, but still elevated relative to the overall group growth rate of 7.4% for Australia. So they are coming down. But importantly, the GP Bulk Billing incentives was only brought in effect 1 November 2025. And the expectation is that as that kicks in, that you should see a reduction in the number of patients going through the emergency departments and public hospitals back into the GP channel. So we would expect that that growth rate will continue to trend down. But I don't think we would say it had a material impact on this half result.

Okay. A material adverse impact in gross margin, I guess.

Correct. Yes.

And then just last one, just the 3 new greenfield sites, just what sort of timing you'd expect them to be starting to contribute from a profitable point of view as they ramp up?

All 3 of these that are coming on board will only make meaningful contributions in the FY '27 financial year because they'll be opening up right towards in the last quarter of this financial year. The contribution will be negligible initially, but will pick up over the course of next year. I think it's worth pointing out, Steve, just in reference to the last question that you were asking about the public hospital growth rates is that the overall Medicare growth rate is very high. And when you look at our growth rate and even at Sonic's growth rate and other figures that have come out around private growth, is the private growth has generally been below those Medicare numbers, which suggests that the high growth that we're seeing in Medicare has been driven by those public hospital EDs. And that's the big reason why the bulk billing program was put into place. And we would expect that those growth rates, those abnormally high growth rates in those public hospital EDs will come down over time, especially now when the bulk billing -- GP Bulk Billing Program starts getting traction, because patients will be attending their GPs rather than ramping up at the ED. And we will then see the public and the private growth rates being a lot more similar to what they have been in recent years. And that will help us in terms of the Western Australian contract and in terms of the Central Queensland contract.

Our next question comes from the line of Craig Wong-Pan with RBC.

Just on that 7.8% growth that you saw in January, could you split that out between Australia and New Zealand?

Craig, I would say that you should assume very similar profile of what we've seen in the first half, right? So Australia is obviously most of that. New Zealand would be another sort of 2% growth on PCP. There hasn't been a significant change.

What we do expect to see going forward, Craig, is that within the second half, so not in January or February, but sometime between March and June, there will be additional revenue that will be pumped into the New Zealand District Hospital Board, the DHBs, that will be coming to -- will be directed at diagnostic imaging. So the government announced a fairly substantial program a few months ago that they will be spending over the course of this financial year. They announced an investment of about $64 million in both diagnostic imaging and in gastroenterology, but we expect that the majority of it would come into diagnostic imaging. And we're likely to get our fair share of that over time. And it's an investment that they've made that would need to be done before the end of this year because they're looking to reduce their waiting list. So I do expect that New Zealand will grow more in the second half than in the first.

The other thing I would probably just add is, Craig, of that 7.8%, that is a constant currency number, the stronger Aussie against the New Zealand is -- if you looked at it on a reported basis, 7.8% becomes 7.6%. So it has had a bit of an impact.

Next question, just on the comment made about rationalizing clinical and nonclinical systems. Just wanted to understand on the clinical side, is there kind of costs involved with that? Or is there a benefit and just the timing for when that could be completed?

It's a good question. And we are in the process of standardizing clinical systems within the state, within each state. And in Victoria, we're consolidating our clinical systems, our radiology information systems down to 2. So in Western Australia, by the end of this financial year, we will have consolidated to 1 system across both Capitol and IDX, that conversion is well in progress with a couple of clinics still to go. And in Victoria, it's also in progress and we expect to complete around the middle of the calendar year as well. We're down to one radiology information system in Queensland. We finished -- we completed that standardization a little while ago and similarly in Tasmania and South Australia.

So it doesn't sound like there's much cost involved with that?

There is some cost involved. And the benefits will come down the line when all of Capitol in Victoria, for instance, has only 1 radiology information system as opposed to the 3 that Capitol in Victoria are running right now.

And then just last question on the cash flow conversion. I know you called out a few items that led to the PCP being a bit stronger than this year. But just your expectations for the second half, like is that cash flow conversion given the timing of payments and working capital, I'm assuming that unwinds in the second half. Are you expecting a much higher cash flow conversion in second half?

Yes, Craig, I mean, I think I said, called out that it's probably more a function of the working capital at 31 December 2024 when accounts payable were higher than probably normal. So I don't think we'll see that accounts payable balance rise at the full year. The other driver was the prepayments of about $4-odd million. Those will unwind. So look, it's difficult to say exactly. I can't give you an exact number or percentage. But, look, suffice to say, we're very focused on cash flow. And generally, the growth is strong and the conversion is strong, I think.

Our next question comes from the line of Andrew Paine with CLSA.

Look, just coming back to the seasonality that you were speaking about before and that kind of historical split of 47% in the first half. Just running that through and marrying that up to your expectation of around 21% EBITDA margins for the full year. So if we put it through that type of split, it's pretty hard to get towards that 21%. So just trying to understand your views on the machination for second half and the full year.

Yes, Andrew, maybe I can comment. I'm a little first to hear what you say, I mean, I think if you were to take that 47-53 split as a guide, and that's something we've seen for the last 3 years that at a 21% margin overall probably brings you out at around $172-odd million of EBITDA for the full year, thereabouts.

Well, yes, it depends on what you have for revenue growth, obviously. But yes, that's -- but that would be probably more 21.5% on our numbers. I'm just trying to understand, is that a less 21%?

Yes. Well, we've -- look, it's not too precise. I think you'll see that there is a little squiggle beforehand, which is approximately 21%. And look, we'd like to think that we can achieve at least 21%, we don't want to be below.

Yes. No, that's fine. And then just also just your gearing ratio is obviously down to 2.5. And you've mentioned the available debt facilities. So generally, when you're at that level, you feel comfortable looking at M&A. And I know you mentioned it in your outlook slide, but is that part of the near-term strategy? Or is there still a focus on bedding down the Capitol merger in the near term?

I mean I think it depends on, obviously, opportunities in the market. But I think fair to say that really 1 year on from the merger, we're looking at both, both just finishing the integration, which is well advanced and any good opportunities that come along.

So you feel comfortable bringing on new businesses where you are with Integral and Diagnostic -- Integral and Capitol as the merged business?

As you would have seen, Andrew, there's a lot of activity in the market, and the market will continue to consolidate because like we've demonstrated in the Capitol integration, the benefits of scale in this industry are compelling. So we will participate in that continued consolidation, but we'll do so strategically and in a sensible way.

Anything in particular you're looking at, what type of businesses?

No, there's nothing that we can really call out beyond that or beyond what's called out in terms of our strategy. We would look at businesses that are strategically aligned, that are clinically aligned with the businesses we're in and businesses that can really add value from the perspective of every one of IDX's levers that we can bring to bear, so teleradiology, the system consolidation we've had, anything that is value accretion for our shareholders.

Our next question comes from the line of Sacha Krien with Evans & Partners.

Different way of asking Andrew's question again. Just wondering, is the January growth rate of 7.6% a reasonable estimate for the second half? Or do you expect that to improve with the bulk billing changes? And just wondering on that, are you cycling any Queensland weather impacts in the PCP?

Yes. I mean I think, Sacha, in terms of an outlook, the 7.6% reported is not dissimilar to the 7.4% we saw in the first half, slightly stronger. I think you should be thinking similar levels. I don't think we're looking for huge acceleration. It'd be nice if it came, but we're not forecasting it at this stage. To your point on, are we cycling weather events, there was the cyclone up in Queensland, but there was a reasonable insurance recovery for that. So I don't think that would be significant. So I think thinking around that sort of 7.5% is probably a good number.

And just in terms of the bulk billing incentive, I think you stated -- been commenting that there has been some improvement. Are you seeing any of that early improvement in the Capitol growth rate coming through?

I think it's just too early to call, Sacha. If you look at the Medicare data for GP attendances, July to October, it was flat. November and December average was around 3.5% growth, right? So you have to assume that that GP Bulk Billing incentive kicking in for those last 2 months has seen a lift in GP attendances. But is that then flowing through the increased volumes for us? It's just too early to tell. But you would expect over time, it will be.

Logically, it would be.

Yes. And just on the Capitol growth, can you share maybe volume and yield growth within that 5.4%? I guess I'm just trying to understand, is it really just soft volumes that's causing the weakness at the moment? Or is there some fee compression in the market with the partial metro MRI deregulation?

Capitol have always had a bulk billing policy. We did experiment with charging for some ultrasounds, pelvic ultrasound and [ weekend ] ultrasound. But we reversed that policy after experimenting with at some of the Capitol clinics and not really seeing the benefits carry through. In fact, we lost volume to competitors. At the time, we took advantage of the fact that we had changed that billing policy, which had been long-standing. So we did reverse back to the Capitol policy that has been long-standing in terms of bulk billing.

So mainly volumes then?

Yes.

Our last question comes from the line of David Low with UBS.

Just one on teleradiology. So Craig, if you could just clarify that 4% to 5% margin pickup. I presume you just mean that it lifts by a point or so in terms of percentage margin. And then perhaps for Ian, just 15% of work is coming through teleradiology, I think you've said and you've given us a breakdown. What's possible? Where do you think that can get to? And how much benefit is that likely to be for margins this year, next year?

So maybe I'll just answer the first one, David. Essentially, when we say margin pickup, if you really look at the differential and the cost of the radiologists reporting a scan in clinic versus the cost of radiologists reporting that scan via teleradiology, there's about a 4% to 5% of revenue difference. And that's what I'm referring to in terms of margin pickup. So as the mix changes over time, we should see that reflected in the margin. I'll let Ian answer the second question.

So over the next several...

When you say revenue difference, so effectively, you're getting paid the same, I presume, for the read of that result.

We mean as a...

As a percentage of revenue. So the radiologists cost as a percentage of revenue is about 4% to 5% lower by teleradiology.

And then we would expect that teleradiology over the course of the next several years, so we're talking over a 3 to 4 year time frame, should approach 30% overall in the group. We think that 30% is an overall sustainable, attainable goal for teleradiology. We think looking at some of our regional clinics that are already at that level, we think that that's a level that we can most efficiently run clinics and run the business overall. But it will take time to get there. We've seen Capitol is a lot lower than IDX right now. It's taken IDX a few years to reach the 20%. It will take Capitol some time to get up to IDX levels. And IDX will continue to do more teleradiology amongst the legacy businesses as well. But over the course of the next year, we shouldn't expect too much of an increase. There will be an increase. There will continue to be that increase, but it will be a few percent a year into the 20s as we approach 30% in 3 or 4 years' time. I think that 30% is the optimal mix between in-clinic radiology and teleradiology, both in terms of patient service, quality, and referral interaction on site and the efficient use of teleradiology resources, which as Craig pointed out, comes at a 4% to 5% cost advantage.

Just one other question, going back to Dr. Stanton's questions about the nonrecurring items. What's the philosophy going forward? Because clearly, those items more than halved profit in the first half and another $12 million to come in the second half. I mean what sort of level of spending are you going to break out this way, do you think, going forward?

Yes, David, I mean, I think, firstly, we have a strict policy on what is regarded as a nonrecurring item, right? And for that, it has to genuinely be nonoperating. And we've just done a big transformational merger and these are sort of the costs associated with that. The other thing I would say is, I mean, there are a number of these items that are noncash in nature, right? So I'll give you an example. I mean, things like the -- we have an amortization of a brand intangible relating to one of the brands that we assessed it having a 5-year life. So that's being amortized through the P&L. It's a noncash item and that's going to impact below the line for the next 5 years. But it all relates to the acquisition. It doesn't have anything to do with operating, it is noncash. So I think absent further M&A, the direction is absolutely downwards. But anything that is in the nature of nonoperating or related to M&A, I think is a legitimate nonrecurring item.

And I agree on the restructuring and the M&A. I mean when I see something like the $2.3 million for one-off systems implementation, I guess, what I'm asking is, what should we be thinking about outside of M&A as an ongoing sort of cost below the line?

Yes. Well, I think, as we said at the time of the merger that we expected integration to take place over 2 years. I mean I think it's happened a lot faster than that. We're on this reporting period, effectively 1 year on from the merger. We'll see this rundown in integration costs continue over this next 6 to 12-month period. The systems implementation on -- of Workday will be, as I said, essentially complete by 30 June. So I can't give you a specific number, but the direction is down absent further M&A.

I'd now like to pass the call back to Dr. Kadish for any closing remarks.

Thank you very much. And I am a little surprised to see the relatively muted reaction in the market to what is a very strong result. Revenue increase is solid. Our margin increase on every earnings line is substantial, 230 basis points in EBITDA is a good increase over the prior comparable period. So it has been at all surprising to see the relatively muted reaction. And also the number of questions around the below-the-line costs. The merger that we undertook with Capitol was a transformational merger by any measure. And we did call out at the time of the merger, that was transformational. We did expect below-the-line costs to be coming through for up to 2 years after the merger. We've seen those costs come down in each half, and they'll continue to come down. But transformational mergers like that take place very, very seldom. We are very pleased with where we are. Radiology today is a great place to be invested. It is the sweet spot of healthcare investment, there is no doubt. And at IDX, we're really ideally positioned to capitalize on the kind of growth that we will be seeing in radiology in Australia, similar to what has been seen globally in terms of radiology around the world. It's an area where we benefit both from technology advancements as well as the demographic change in the population as the population becomes older and the increase in the prevalence of chronic disease and the ability of radiology to detect disease early. And the new wellness medicine craze where there's a lot of radiology tests that are now undertaken to prevent disease before it occurs and to pick up disease very, very early. And I think that radiology will benefit a lot more from wellness over the next few years as well. So I think that in terms of investment, radiology is an excellent place to be. In terms of investing within radiology, IDX is currently the only listed investment opportunity on the ASX for radiology investment. And we think it's a really exciting place to be. The market will continue to consolidate. IDX would be expected to play a part in that. But applying that only in terms of ensuring that every move we make, every acquisition we undertake would be earnings accretive to our shareholders. And we'll continue to explore opportunities as those opportunities arise as we have done in the past. So thank you all for your time this morning and look forward to meeting with you over the course of the next week or 2.

That does conclude our conference for today. Thank you for your participation. You may now disconnect.