OUACHITA COUNTY MEDICAL CENTER
1. Target Overview & Investment Thesis
OUACHITA COUNTY MEDICAL CENTER is a 82-bed under-performing / distressed in OUACHITA, AR with $30.2M in net patient revenue and a -27.2% operating margin. The hospital serves a payer mix of 29.4% Medicare, 13.5% Medicaid, and 57.1% commercial.
Thesis: Turnaround. Our ML models identify $2.2M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -27.2% to -19.8% (+736bps).
| Net Revenue HCRIS | $30.2M |
| Current EBITDA COMPUTED | $-8.2M |
| Operating Margin COMPUTED | -27.2% |
| Occupancy HCRIS | 14.4% |
| Revenue / Bed COMPUTED | $368K |
| Net-to-Gross HCRIS | 26.6% |
| Distress Probability ML | 59.5% |
2. Market Context & Competitive Position
AR has 108 Medicare-certified hospitals with a median operating margin of -7.6%. The target's margin of -27.2% places it below the state median. Among 34 size-comparable peers (41-164 beds), the median margin is 0.0%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (41-164), prioritizing same-state peers. 34 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| OUACHITA COUNTY MEDICAL CENTER (Target) | AR | 82 | $30.2M | -27.2% |
| ARKANSAS HEART HOSPITAL | AR | 112 | $205.9M | 1.2% |
| NATIONAL PARK MEDICAL CENTER | AR | 126 | $118.8M | 2.6% |
| BHMC-CONWAY | AR | 108 | $94.7M | -15.6% |
| ST. MARYS REGIONAL MEDICAL CEN | AR | 137 | $94.3M | 6.7% |
| SALINE MEMORIAL HOSPITAL | AR | 130 | $91.4M | -8.0% |
| NORTH ARKANSAS REGIONAL MEDICA | AR | 120 | $89.1M | -13.9% |
| SILOAM SPRINGS MEMORIAL HOSPIT | AR | 64 | $85.0M | 8.4% |
| ARKANSAS SURGICAL HOSPITAL | AR | 47 | $75.1M | 11.7% |
4. Predicted Improvement Opportunities
Improvement targets set at P75 of comparable peers with 60% gap closure assumption. Coefficients calibrated to published research bands. Total EBITDA uplift: $2.2M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $633K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $603K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $597K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $367K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $19K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-8.2M |
| + RCM Uplift | +$2.2M |
| Pro Forma EBITDA | $-6.0M |
| Current Margin | -27.2% |
| Pro Forma Margin | -19.8% |
| WC Released (1x) | $1.2M |
6. Returns Analysis — Scenario Matrix
5-year hold, 5.5x leverage, 3% organic growth, 10%/yr debt paydown. Base case uses 100% of predicted RCM uplift. Bull case: 130% uplift at lower entry. Bear case: 50% uplift at higher entry.
| Scenario | Entry | Exit | Equity In | Equity Out | MOIC | IRR |
|---|---|---|---|---|---|---|
| Base Case | 10.0x | 10.0x | $-12.6M | $-31.8M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-12.6M | $-39.1M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-11.3M | $-35.8M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-11.3M | $-42.5M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-13.9M | $-38.8M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-13.9M | $-47.2M | 0.00x | -100.0% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| High | Negative operating margin | RCM uplift bridge shows clear path to profitability; working capital release provides near-term cash cushion |
| Medium | Low occupancy | At 14.4%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
| High | Elevated distress probability | Model estimates 59.5% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
8. Data Sources & Methodology Appendix
Data Sources
- CMS HCRIS Cost Reports (Medicare-certified hospitals)
- CMS Medicare Utilization (DRG-level volumes)
- CMS Chronic Conditions (county-level disease prevalence)
- HCRIS multi-year trend data (financial time series)
Comparable Selection
- 34 hospitals with 41-164 beds
- Same-state prioritization (n=35)
- Comp margins: P25=-15.2% / P50=0.0% / P75=10.8%
Bridge Methodology
- Targets: P75 of comparable peers (60% gap closure)
- Denial: avoidable share = 35% of delta × NPR
- AR: bad debt coefficient = $0.65 per day per $1K NPR
- NCR: 60% coefficient on collection rate improvement
- CDI: 0.75% of Medicare revenue per 0.01 CMI point
Returns Assumptions
- Leverage: 5.5x entry (84.6% debt / 15.4% equity)
- Organic growth: 3% annual EBITDA growth
- Debt paydown: 10% of principal per year
- Hold period: 5 years
Generated by SeekingChartis on April 26, 2026. All predictions use public data only. Confidence intervals calibrated via split conformal prediction (90% coverage target). This memo is for informational purposes and does not constitute investment advice.