NORTHERN CALIFORNIA REHAB HOSPITAL
1. Target Overview & Investment Thesis
NORTHERN CALIFORNIA REHAB HOSPITAL is a 56-bed community hospital in SHASTA, CA with $43.3M in net patient revenue and a 10.0% operating margin. The hospital serves a payer mix of 59.1% Medicare, 0.0% Medicaid, and 40.9% commercial.
Thesis: Turnaround. Our ML models identify $3.2M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 10.0% to 17.4% (+736bps).
| Net Revenue HCRIS | $43.3M |
| Current EBITDA COMPUTED | $4.3M |
| Operating Margin COMPUTED | 10.0% |
| Occupancy HCRIS | 60.4% |
| Revenue / Bed COMPUTED | $773K |
| Net-to-Gross HCRIS | 10.9% |
| 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 10.0% places it above the state median. Among 114 size-comparable peers (28-112 beds), the median margin is -5.9%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (28-112), prioritizing same-state peers. 114 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| NORTHERN CALIFORNIA REHAB HOSP (Target) | CA | 56 | $43.3M | 10.0% |
| RANCHO LOS AMIGOS NATL.REHAB.C | CA | 83 | $512.6M | 41.9% |
| USC NORRIS CANCER HOSPITAL | CA | 60 | $468.7M | 19.1% |
| KFH - FREMONT | CA | 100 | $296.2M | -6.6% |
| MERCY HOSPITAL OF FOLSOM | CA | 106 | $287.8M | 17.0% |
| MARSHALL HOSPITAL | CA | 111 | $286.0M | -5.9% |
| LLUMC MURRIETA | CA | 111 | $276.7M | -20.3% |
| ADVENTIST HEALTH SONORA | CA | 84 | $274.3M | -7.4% |
| CPMC-R.K. DAVIES MEDICAL CENTE | CA | 105 | $243.7M | 24.6% |
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: $3.2M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $909K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $866K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $857K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $527K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $28K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $4.3M |
| + RCM Uplift | +$3.2M |
| Pro Forma EBITDA | $7.5M |
| Current Margin | 10.0% |
| Pro Forma Margin | 17.4% |
| WC Released (1x) | $1.7M |
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 | $6.7M | $60.5M | 9.06x | 55.4% |
| Base (11x exit) | 10.0x | 11.0x | $6.7M | $68.7M | 10.29x | 59.4% |
| Bull Case | 9.0x | 11.0x | $6.0M | $81.4M | 13.55x | 68.4% |
| Bull (12x exit) | 9.0x | 12.0x | $6.0M | $90.6M | 15.07x | 72.0% |
| Bear Case | 11.0x | 10.0x | $7.3M | $42.4M | 5.77x | 42.0% |
| Bear (11x exit) | 11.0x | 11.0x | $7.3M | $49.0M | 6.67x | 46.2% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Heavy Medicare dependence | Medicare comprises 59.1% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Low | Low net-to-gross ratio | Large contractual allowances suggest pricing discipline issues. Mitigant: payer renegotiation is an additional upside lever |
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
- 114 hospitals with 28-112 beds
- Same-state prioritization (n=115)
- Comp margins: P25=-21.2% / P50=-5.9% / P75=1.9%
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.