RADY CHILDRENS HOSPITAL - SAN DIEGO
1. Target Overview & Investment Thesis
RADY CHILDRENS HOSPITAL - SAN DIEGO is a 401-bed large academic medical center in SAN DIEGO, CA with $1.82B in net patient revenue and a 14.8% operating margin. The hospital serves a payer mix of 0.3% Medicare, 35.6% Medicaid, and 64.0% commercial.
Thesis: Platform Growth. Our ML models identify $134.2M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 14.8% to 22.2% (+736bps).
| Net Revenue HCRIS | $1.82B |
| Current EBITDA COMPUTED | $269.8M |
| Operating Margin COMPUTED | 14.8% |
| Occupancy HCRIS | 70.4% |
| Revenue / Bed COMPUTED | $4.5M |
| Net-to-Gross HCRIS | 50.4% |
| Distress Probability ML | 48.4% |
2. Market Context & Competitive Position
CA has 414 Medicare-certified hospitals with a median operating margin of -4.9%. The target's margin of 14.8% places it above the state median. Among 145 size-comparable peers (200-802 beds), the median margin is -4.5%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (200-802), prioritizing same-state peers. 145 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| RADY CHILDRENS HOSPITAL - SAN (Target) | CA | 401 | $1.82B | 14.8% |
| STANFORD HEALTH CARE | CA | 657 | $6.76B | 3.7% |
| UC DAVIS MEDICAL CENTER | CA | 666 | $3.28B | -11.5% |
| UCSD MEDICAL CENTER | CA | 718 | $3.06B | -7.2% |
| RONALD REAGAN UCLA | CA | 446 | $2.62B | -6.8% |
| LUCILE PACKARD CHILDRENS HOSPI | CA | 394 | $2.39B | -0.8% |
| LOS ANGELES GENERAL MEDICAL CE | CA | 596 | $1.96B | 10.2% |
| UCI MEDICAL CENTER | CA | 397 | $1.90B | -2.5% |
| CITY OF HOPE NATIONAL MEDICAL | CA | 217 | $1.83B | -10.7% |
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: $134.2M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $38.3M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $36.5M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $36.1M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $22.2M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $1.2M | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $269.8M |
| + RCM Uplift | +$134.2M |
| Pro Forma EBITDA | $404.0M |
| Current Margin | 14.8% |
| Pro Forma Margin | 22.2% |
| WC Released (1x) | $69.9M |
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 | $415.1M | $3.12B | 7.52x | 49.7% |
| Base (11x exit) | 10.0x | 11.0x | $415.1M | $3.57B | 8.60x | 53.8% |
| Bull Case | 9.0x | 11.0x | $373.6M | $4.15B | 11.10x | 61.8% |
| Bull (12x exit) | 9.0x | 12.0x | $373.6M | $4.63B | 12.40x | 65.5% |
| Bear Case | 11.0x | 10.0x | $456.6M | $2.32B | 5.07x | 38.4% |
| Bear (11x exit) | 11.0x | 11.0x | $456.6M | $2.70B | 5.90x | 42.6% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Elevated Medicaid exposure (35.6%) | Medicaid reimburses below cost in most states. Mitigant: denial reduction lever has highest impact on Medicaid claims |
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
- 145 hospitals with 200-802 beds
- Same-state prioritization (n=146)
- Comp margins: P25=-15.8% / P50=-4.5% / P75=3.7%
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.