SSH - MIAMI
1. Target Overview & Investment Thesis
SSH - MIAMI is a 47-bed community hospital in MIAMI-DADE, FL with $26.1M in net patient revenue and a 8.1% operating margin. The hospital serves a payer mix of 49.6% Medicare, 0.0% Medicaid, and 50.4% commercial.
Thesis: Turnaround. Our ML models identify $1.9M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 8.1% to 15.5% (+736bps).
| Net Revenue HCRIS | $26.1M |
| Current EBITDA COMPUTED | $2.1M |
| Operating Margin COMPUTED | 8.1% |
| Occupancy HCRIS | 81.8% |
| Revenue / Bed COMPUTED | $555K |
| Net-to-Gross HCRIS | 12.2% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
FL has 261 Medicare-certified hospitals with a median operating margin of 3.2%. The target's margin of 8.1% places it above the state median. Among 88 size-comparable peers (24-94 beds), the median margin is 2.6%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (24-94), prioritizing same-state peers. 88 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SSH - MIAMI (Target) | FL | 47 | $26.1M | 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% |
| OVIEDO MEDICAL CENTER | FL | 64 | $110.9M | 7.4% |
| HCA FLORIDA POINCIANA HOSPITAL | FL | 94 | $108.5M | 18.9% |
| ASPIRE HEALTH PARTNERS INC | FL | 90 | $102.5M | -0.3% |
| SANTA ROSA MEDICAL CENTER | FL | 86 | $101.4M | 17.1% |
| ST. CLOUD REGIONAL MEDICAL CEN | FL | 84 | $97.1M | 1.2% |
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% | $548K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $522K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $516K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $317K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $17K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $2.1M |
| + RCM Uplift | +$1.9M |
| Pro Forma EBITDA | $4.0M |
| Current Margin | 8.1% |
| Pro Forma Margin | 15.5% |
| 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 | $3.3M | $33.1M | 10.19x | 59.1% |
| Base (11x exit) | 10.0x | 11.0x | $3.3M | $37.5M | 11.54x | 63.1% |
| Bull Case | 9.0x | 11.0x | $2.9M | $44.9M | 15.34x | 72.7% |
| Bull (12x exit) | 9.0x | 12.0x | $2.9M | $49.8M | 17.03x | 76.3% |
| Bear Case | 11.0x | 10.0x | $3.6M | $22.5M | 6.29x | 44.4% |
| Bear (11x exit) | 11.0x | 11.0x | $3.6M | $25.9M | 7.24x | 48.6% |
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
- 88 hospitals with 24-94 beds
- Same-state prioritization (n=89)
- Comp margins: P25=-16.8% / P50=2.6% / P75=11.8%
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 27, 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.