EASTERN PLUMAS HEALTH CARE
1. Target Overview & Investment Thesis
EASTERN PLUMAS HEALTH CARE is a 9-bed community hospital in nan, CA with $37.8M in net patient revenue and a -0.7% operating margin. The hospital serves a payer mix of 82.5% Medicare, 0.0% Medicaid, and 17.5% commercial.
Thesis: Turnaround. Our ML models identify $2.8M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -0.7% to 6.6% (+736bps).
| Net Revenue HCRIS | $37.8M |
| Current EBITDA COMPUTED | $-276K |
| Operating Margin COMPUTED | -0.7% |
| Occupancy HCRIS | 24.5% |
| Revenue / Bed COMPUTED | $4.2M |
| Net-to-Gross HCRIS | 81.6% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
CA has 414 Medicare-certified hospitals with a median operating margin of -4.9%. The target's margin of -0.7% places it above the state median. Among 21 size-comparable peers (4-18 beds), the median margin is -10.2%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (4-18), prioritizing same-state peers. 21 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| EASTERN PLUMAS HEALTH CARE (Target) | CA | 9 | $37.8M | -0.7% |
| PORTERVILLE DEVELOPMENTAL CENT | CA | 17 | $193.6M | -6.0% |
| SOUTHERN MONO HEALTH CARE DIST | CA | 17 | $99.1M | 4.1% |
| JEWISH HOME FOR THE AGED | CA | 13 | $88.0M | -48.0% |
| MEE MEMORIAL HOSPITAL | CA | 13 | $67.6M | 3.3% |
| JOYCE EISENBERG KEEFER MEDICAL | CA | 10 | $52.9M | 18.8% |
| MAYERS MEMORIAL HOSPITAL | CA | 16 | $41.7M | -1.3% |
| WEST COVINA MEDICAL CENTER | CA | 13 | $40.6M | 55.3% |
| MEE MEMORIAL HOSPITAL | CA | 13 | $36.3M | -23.4% |
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: $2.8M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $795K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $757K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $749K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $461K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $24K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-276K |
| + RCM Uplift | +$2.8M |
| Pro Forma EBITDA | $2.5M |
| Current Margin | -0.7% |
| Pro Forma Margin | 6.6% |
| WC Released (1x) | $1.5M |
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 | $-425K | $26.0M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-425K | $28.5M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-383K | $37.6M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-383K | $40.9M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-468K | $12.2M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-468K | $13.3M | 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 | Heavy Medicare dependence | Medicare comprises 82.5% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 24.5%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
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
- 21 hospitals with 4-18 beds
- Same-state prioritization (n=27)
- Comp margins: P25=-48.0% / P50=-10.2% / P75=3.3%
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.