PALM BAY HOSPITAL
1. Target Overview & Investment Thesis
PALM BAY HOSPITAL is a 120-bed suburban community hospital in BREVARD, FL with $153.6M in net patient revenue and a 9.5% operating margin. The hospital serves a payer mix of 28.5% Medicare, 1.9% Medicaid, and 69.6% commercial.
Thesis: Turnaround. Our ML models identify $11.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 9.5% to 16.9% (+736bps).
| Net Revenue HCRIS | $153.6M |
| Current EBITDA COMPUTED | $14.6M |
| Operating Margin COMPUTED | 9.5% |
| Occupancy HCRIS | 77.1% |
| Revenue / Bed COMPUTED | $1.3M |
| Net-to-Gross HCRIS | 18.8% |
| Distress Probability ML | 40.2% |
2. Market Context & Competitive Position
FL has 261 Medicare-certified hospitals with a median operating margin of 3.2%. The target's margin of 9.5% places it above the state median. Among 123 size-comparable peers (60-240 beds), the median margin is 4.7%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (60-240), prioritizing same-state peers. 123 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| PALM BAY HOSPITAL (Target) | FL | 120 | $153.6M | 9.5% |
| MOFFITT CANCER CENTER | FL | 218 | $1.91B | 16.0% |
| WEST KENDALL BAPTIST HOSPITAL | FL | 127 | $361.6M | 18.5% |
| HCA FL FT WALTON-DESTIN HOSP | FL | 231 | $361.3M | 38.1% |
| ADVENTHEALTH WESLEY CHAPEL | FL | 169 | $360.1M | 17.0% |
| ORLANDO HEALTH SOUTH LAKE HOSP | FL | 167 | $331.8M | 7.2% |
| ADVENTHEALTH PALM COAST | FL | 99 | $285.7M | 8.1% |
| ADVENTHEALTH SEBRING | FL | 204 | $279.7M | -3.1% |
| HOMESTEAD HOSPITAL | FL | 159 | $270.4M | -11.1% |
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: $11.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $3.2M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $3.1M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $3.0M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.9M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $98K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $14.6M |
| + RCM Uplift | +$11.3M |
| Pro Forma EBITDA | $25.9M |
| Current Margin | 9.5% |
| Pro Forma Margin | 16.9% |
| WC Released (1x) | $5.9M |
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 | $22.5M | $209.4M | 9.32x | 56.3% |
| Base (11x exit) | 10.0x | 11.0x | $22.5M | $237.7M | 10.58x | 60.3% |
| Bull Case | 9.0x | 11.0x | $20.2M | $282.3M | 13.96x | 69.4% |
| Bull (12x exit) | 9.0x | 12.0x | $20.2M | $313.9M | 15.52x | 73.1% |
| Bear Case | 11.0x | 10.0x | $24.7M | $145.6M | 5.89x | 42.6% |
| Bear (11x exit) | 11.0x | 11.0x | $24.7M | $168.2M | 6.80x | 46.7% |
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
- 123 hospitals with 60-240 beds
- Same-state prioritization (n=124)
- Comp margins: P25=-6.3% / P50=4.7% / P75=14.7%
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.