CORAL GABLES HOSPITAL
1. Target Overview & Investment Thesis
CORAL GABLES HOSPITAL is a 245-bed suburban community hospital in MIAMI-DADE, FL with $114.5M in net patient revenue and a 0.4% operating margin. The hospital serves a payer mix of 21.6% Medicare, 2.5% Medicaid, and 75.9% commercial.
Thesis: Undervalued. Our ML models identify $8.4M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 0.4% to 7.7% (+736bps).
| Net Revenue HCRIS | $114.5M |
| Current EBITDA COMPUTED | $445K |
| Operating Margin COMPUTED | 0.4% |
| Occupancy HCRIS | 19.9% |
| Revenue / Bed COMPUTED | $467K |
| Net-to-Gross HCRIS | 10.1% |
| Distress Probability ML | 53.8% |
2. Market Context & Competitive Position
FL has 261 Medicare-certified hospitals with a median operating margin of 3.2%. The target's margin of 0.4% places it below the state median. Among 112 size-comparable peers (122-490 beds), the median margin is 3.2%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (122-490), prioritizing same-state peers. 112 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CORAL GABLES HOSPITAL (Target) | FL | 245 | $114.5M | 0.4% |
| MOFFITT CANCER CENTER | FL | 218 | $1.91B | 16.0% |
| MAYO CLINIC FLORIDA | FL | 304 | $1.09B | 21.6% |
| MOUNT SINAI MEDICAL CENTER OF | FL | 481 | $904.2M | 12.2% |
| TALLAHASSEE MEMORIAL HOSPITAL | FL | 483 | $871.6M | -4.8% |
| SHANDS JACKSONVILLE MEDICAL CE | FL | 481 | $861.4M | -7.1% |
| NICKLAUS CHILDRENS HOSPITAL | FL | 259 | $769.3M | 5.5% |
| MEMORIAL HOSPITAL WEST | FL | 486 | $741.4M | 5.2% |
| SOUTH MIAMI HOSPITAL | FL | 375 | $688.4M | 11.6% |
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: $8.4M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $2.4M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $2.3M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $2.3M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.4M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $73K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $445K |
| + RCM Uplift | +$8.4M |
| Pro Forma EBITDA | $8.9M |
| Current Margin | 0.4% |
| Pro Forma Margin | 7.7% |
| WC Released (1x) | $4.4M |
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 | $685K | $87.2M | 127.30x | 163.6% |
| Base (11x exit) | 10.0x | 11.0x | $685K | $96.2M | 140.36x | 168.8% |
| Bull Case | 9.0x | 11.0x | $617K | $124.2M | 201.42x | 188.9% |
| Bull (12x exit) | 9.0x | 12.0x | $617K | $135.7M | 220.02x | 194.1% |
| Bear Case | 11.0x | 10.0x | $754K | $44.9M | 59.52x | 126.4% |
| Bear (11x exit) | 11.0x | 11.0x | $754K | $49.6M | 65.79x | 131.0% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Low occupancy | At 19.9%, 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 53.8% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
| 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
- 112 hospitals with 122-490 beds
- Same-state prioritization (n=113)
- Comp margins: P25=-5.3% / P50=3.2% / P75=16.9%
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.