LEHIGH REGIONAL
1. Target Overview & Investment Thesis
LEHIGH REGIONAL is a 53-bed suburban community hospital in nan, FL with $41.3M in net patient revenue and a 6.6% operating margin. The hospital serves a payer mix of 21.0% Medicare, 3.0% Medicaid, and 76.0% commercial.
Thesis: Turnaround. Our ML models identify $3.0M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 6.6% to 14.0% (+736bps).
| Net Revenue HCRIS | $41.3M |
| Current EBITDA COMPUTED | $2.7M |
| Operating Margin COMPUTED | 6.6% |
| Occupancy HCRIS | 49.7% |
| Revenue / Bed COMPUTED | $779K |
| Net-to-Gross HCRIS | 13.2% |
| Distress Probability ML | 46.3% |
2. Market Context & Competitive Position
FL has 261 Medicare-certified hospitals with a median operating margin of 3.2%. The target's margin of 6.6% places it above the state median. Among 89 size-comparable peers (26-106 beds), the median margin is 4.6%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (26-106), prioritizing same-state peers. 89 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| LEHIGH REGIONAL (Target) | FL | 53 | $41.3M | 6.6% |
| ADVENTHEALTH PALM COAST | FL | 99 | $285.7M | 8.1% |
| ASCENSION SACRED HEART EMERALD | FL | 80 | $187.9M | 16.1% |
| VIERA HOSPITAL INC | FL | 84 | $162.9M | 16.9% |
| GULF BREEZE HOSPITAL | FL | 65 | $121.8M | 12.8% |
| MELBOURNE REGIONAL MEDICAL CEN | FL | 96 | $120.2M | 7.3% |
| LOWER KEYS MEDICAL CENTER | FL | 99 | $119.5M | 27.1% |
| OVIEDO MEDICAL CENTER | FL | 64 | $110.9M | 7.4% |
| HCA FLORIDA POINCIANA HOSPITAL | FL | 94 | $108.5M | 18.9% |
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: $3.0M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $868K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $826K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $818K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $503K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $26K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $2.7M |
| + RCM Uplift | +$3.0M |
| Pro Forma EBITDA | $5.8M |
| Current Margin | 6.6% |
| Pro Forma Margin | 14.0% |
| WC Released (1x) | $1.6M |
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 | $4.2M | $48.4M | 11.54x | 63.1% |
| Base (11x exit) | 10.0x | 11.0x | $4.2M | $54.6M | 13.01x | 67.1% |
| Bull Case | 9.0x | 11.0x | $3.8M | $66.0M | 17.48x | 77.2% |
| Bull (12x exit) | 9.0x | 12.0x | $3.8M | $73.1M | 19.36x | 80.9% |
| Bear Case | 11.0x | 10.0x | $4.6M | $31.8M | 6.90x | 47.1% |
| Bear (11x exit) | 11.0x | 11.0x | $4.6M | $36.5M | 7.91x | 51.2% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| 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
- 89 hospitals with 26-106 beds
- Same-state prioritization (n=90)
- Comp margins: P25=-12.3% / P50=4.6% / P75=12.8%
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.