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Case study 02 · Healthcare, greenfield hospital

Ayushyaman Hospital

A hospital from an empty plot to full service

Clinicians know medicine. Almost nobody sets out knowing bed mix, payer economics, biomedical waste authorisation and insurance receivable cycles at the same time. We worked with Ayushyaman Hospital from the first feasibility question through to the day every department was running.

Engagement type
Greenfield project
Scope
Concept to full service
Sector
Private healthcare
Role
End to end advisory

What changed

Before, and after

Before After
Starting point Empty plot and a clinical plan Fully operational hospital
Funding Promoter capital only Structured term and working capital
Compliance Nothing in place All statutory approvals obtained
Revenue channels Cash patients only Cash, insurance, TPA and scheme

The starting point

Where the business actually was.

A hospital is one of the most capital-intensive businesses an entrepreneur can start, and one of the few where the money arrives months after the service is delivered. Equipment is bought before a single patient walks in. Insurance and scheme payments settle long after treatment. Between those two facts sits a working capital requirement most promoters do not see coming.

The promoters behind Ayushyaman Hospital had clinical capability and a clear intent. What they did not have was a project structure: how many beds, which specialities first, what to buy on day one and what to defer, how it would be funded, and what would still be legally required six months after opening.

Getting any of those wrong is expensive. Getting the equipment plan wrong is expensive for a decade.

The decision that mattered

The core discipline in a hospital project is refusing to build the hospital everyone wants on day one. Equipment bought ahead of demand does not sit idle quietly. It sits idle while depreciating, while the loan against it is repaid, and while the interest accrues. Our first job was to separate what the hospital needed to open from what it could add once occupancy justified it.

The work

Phase by phase, in order

The order matters more than any individual step. Most of what goes wrong in a project like this is sequencing, not effort.

01 Phase one

Catchment, demand and payer mix

Before any drawing was finalised we established who the hospital would actually serve, what they would be treated for, and critically, who would be paying. Payer mix drives the entire financial structure, because a cash patient and a scheme patient are the same treatment with completely different cash timing.

  • Catchment population, access and travel time analysis
  • Existing hospitals and specialities already served in the area
  • Case mix estimate by department
  • Payer mix: cash, private insurance, TPA and government scheme
  • Realistic occupancy build-up over the first three years
02 Phase two

Project planning and phasing

The plan was built in stages rather than as one launch. Departments that generate early occupancy open first. Capital-heavy equipment waits until the volume that justifies it is visible rather than projected.

  • Bed count and speciality mix matched to demand, not ambition
  • Civil, interior and equipment cost estimated separately
  • Equipment list tested against forecast utilisation and payback
  • Phase one and phase two split defined explicitly
  • Manpower plan with clinical and non-clinical cost
03 Phase three

Funding the project and the gap after it

Most hospital funding proposals cover construction and equipment and then run out. The months between opening and the first insurance settlements are where new hospitals get into difficulty, so that gap was funded deliberately rather than discovered later.

  • Detailed project report prepared for lenders
  • Cost of project and means of finance with promoter contribution defined
  • Term loan structuring against realistic occupancy build-up
  • Working capital assessed for insurance and scheme receivable cycles
  • CMA data and projections in bank format
  • Support through sanction, queries and disbursement
04 Phase four

Licensing and statutory compliance

A hospital carries more statutory obligations than almost any other business of its size, and several of them must be in place before a single patient is admitted. We mapped every requirement and managed the sequence.

  • Clinical establishment registration
  • Biomedical waste authorisation and disposal contract
  • Fire safety no objection certificate
  • Pollution control board consent
  • Pharmacy licence and drug storage compliance
  • Radiology and imaging equipment regulatory approval
  • Statutory registrations for a diagnostic facility where applicable
  • Building, lift and electrical safety clearances
05 Phase five

Empanelment and revenue channels

A hospital that only accepts cash patients has limited its own market. Empanelment widens the catchment considerably, but it also lengthens the collection cycle, so it has to be built into the working capital plan rather than added afterwards.

  • Insurance company and TPA empanelment applications
  • Government health scheme empanelment where eligible
  • Tariff structure set by department and procedure
  • Documentation standards to reduce claim rejection
  • Receivable ageing and follow-up process established
06 Phase six

Running it properly, from day one

The systems that tell a hospital whether it is making money are almost impossible to retrofit. We put department-wise costing in place before opening, so profitability was visible from the first month instead of being reconstructed a year later.

  • Department-wise costing framework with overhead allocation
  • Occupancy, case mix and average revenue per bed tracking
  • Monthly management information pack for the promoters
  • Receivable and claim rejection monitoring
  • Quarterly review against the original project assumptions

Approvals and compliance

Everything that had to be in place

Each of these has prerequisites. Applied in the wrong order they do not simply delay a project, they reset parts of it.

  • Clinical establishment registration
  • Biomedical waste authorisation
  • Fire safety NOC
  • Pollution control consent
  • Pharmacy licence
  • Imaging equipment approval
  • Building and lift clearances
  • Insurance and TPA empanelment

Orina coordinates and prepares these applications. Where a filing must legally be made or certified by a chartered accountant, company secretary, advocate or licensed professional, that person signs it and we work alongside them.

Where it stands

The result.

The hospital opened with the departments its catchment actually needed, funded through a structure that accounted for the receivable gap rather than assuming it away.

Every statutory approval was in place before admission of patients, and empanelment widened the accessible population well beyond cash-paying patients.

Department-wise costing was operating from the first month, which means the promoters have always known which parts of the hospital earn and which are carried. That is unusual, and it is the difference between managing a hospital and reacting to it.

If you are considering the same

Five things we would tell you first

01

Build for opening, not for year five

Equipment bought ahead of demand depreciates and services debt while standing still. Phase it deliberately.

02

Payer mix is a finance decision

Who pays determines when you are paid. Empanelment expands the market and lengthens the cash cycle at the same time.

03

Fund the gap after opening

Construction finance ends at commissioning. The difficult months come afterwards, waiting on first settlements.

04

Licences are sequential

Several approvals depend on others being in place. Applied out of order they do not just delay opening, they can stop it.

05

Install the costing before the patients

Department profitability is very hard to reconstruct backwards. Set it up before the first admission.

Services involved

What this engagement drew on

03 Project reports, DPR & CMA data Bank-ready project reports, detailed project reports and CMA data, built on real assumptions your banker can check. Read more 02 Financial review & profitability Fix margins, free up working capital, shorten the cash cycle, and restructure debt so the business can breathe. Read more 01 Business strategy & growth planning A written plan for where the business goes next: which markets, which products, which investments, and in what order. Read more

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