PIKES PEAK REGIONAL HOSPITAL
1. Target Overview & Investment Thesis
PIKES PEAK REGIONAL HOSPITAL is a 13-bed rural/critical access in TELLER, CO with $26.3M in net patient revenue and a -9.3% operating margin. The hospital serves a payer mix of 44.1% Medicare, 9.1% Medicaid, and 46.8% commercial.
Thesis: Turnaround. Our ML models identify $1.9M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -9.3% to -1.9% (+736bps).
| Net Revenue HCRIS | $26.3M |
| Current EBITDA COMPUTED | $-2.4M |
| Operating Margin COMPUTED | -9.3% |
| Occupancy HCRIS | 21.5% |
| Revenue / Bed COMPUTED | $2.0M |
| Net-to-Gross HCRIS | 27.0% |
| Distress Probability ML | 54.8% |
2. Market Context & Competitive Position
CO has 108 Medicare-certified hospitals with a median operating margin of -3.6%. The target's margin of -9.3% places it below the state median. Among 35 size-comparable peers (6-26 beds), the median margin is -5.1%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (6-26), prioritizing same-state peers. 35 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| PIKES PEAK REGIONAL HOSPITAL (Target) | CO | 13 | $26.3M | -9.3% |
| NATIONAL JEWISH HEALTH | CO | 13 | $150.4M | -50.0% |
| ASPEN VALLEY HOSPITAL DISTRICT | CO | 25 | $130.1M | 0.4% |
| HEART OF THE ROCKIES REG MED C | CO | 25 | $117.5M | 5.4% |
| GRAND RIVER HOSPITAL DISTRICT | CO | 25 | $85.2M | -30.8% |
| CENTURA ST. THOMAS MORE HOSPIT | CO | 25 | $83.7M | 18.4% |
| SOUTHWEST MEMORIAL HOSPITAL | CO | 23 | $74.6M | -4.5% |
| GUNNISON VALLEY HOSPITAL | CO | 20 | $63.3M | 2.8% |
| FAMILY HEALTH WEST HOSPITAL | CO | 25 | $62.6M | 6.4% |
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: $1.9M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $552K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $526K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $521K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $320K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $17K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-2.4M |
| + RCM Uplift | +$1.9M |
| Pro Forma EBITDA | $-506K |
| Current Margin | -9.3% |
| Pro Forma Margin | -1.9% |
| WC Released (1x) | $1.0M |
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 | $-3.8M | $3.3M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-3.8M | $2.4M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-3.4M | $7.5M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-3.4M | $7.2M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-4.1M | $-5.2M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-4.1M | $-7.1M | 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 21.5%, 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 54.8% 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
- 35 hospitals with 6-26 beds
- Same-state prioritization (n=38)
- Comp margins: P25=-24.1% / P50=-5.1% / P75=2.9%
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.