SSH - MIAMI LAKES
1. Target Overview & Investment Thesis
SSH - MIAMI LAKES is a 60-bed suburban community hospital in MIAMI-DADE, FL with $38.3M in net patient revenue and a 10.3% operating margin. The hospital serves a payer mix of 39.7% Medicare, 1.1% Medicaid, and 59.2% commercial.
Thesis: Turnaround. Our ML models identify $2.8M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 10.3% to 17.7% (+736bps).
| Net Revenue HCRIS | $38.3M |
| Current EBITDA COMPUTED | $4.0M |
| Operating Margin COMPUTED | 10.3% |
| Occupancy HCRIS | 97.6% |
| Revenue / Bed COMPUTED | $638K |
| Net-to-Gross HCRIS | 16.2% |
| Distress Probability ML | 36.4% |
2. Market Context & Competitive Position
FL has 261 Medicare-certified hospitals with a median operating margin of 3.2%. The target's margin of 10.3% places it above the state median. Among 105 size-comparable peers (30-120 beds), the median margin is 4.8%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (30-120), prioritizing same-state peers. 105 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SSH - MIAMI LAKES (Target) | FL | 60 | $38.3M | 10.3% |
| ADVENTHEALTH PALM COAST | FL | 99 | $285.7M | 8.1% |
| ASCENSION SACRED HEART EMERALD | FL | 80 | $187.9M | 16.1% |
| LAKEWOOD RANCH MEDICAL CENTER | FL | 120 | $171.1M | 10.4% |
| HCA FLORIDA LAKE CITY HOSPITAL | FL | 113 | $168.8M | 34.4% |
| VIERA HOSPITAL INC | FL | 84 | $162.9M | 16.9% |
| PALM BAY HOSPITAL | FL | 120 | $153.6M | 9.5% |
| ADVENTHEALTH NEW SMYRNA BEACH | FL | 109 | $152.7M | -6.5% |
| SARASOTA MEMORIAL HOSPITAL VEN | FL | 110 | $134.6M | -29.5% |
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: $2.8M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $804K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $766K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $758K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $466K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $24K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $4.0M |
| + RCM Uplift | +$2.8M |
| Pro Forma EBITDA | $6.8M |
| Current Margin | 10.3% |
| Pro Forma Margin | 17.7% |
| WC Released (1x) | $1.5M |
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 | $6.1M | $54.3M | 8.92x | 54.9% |
| Base (11x exit) | 10.0x | 11.0x | $6.1M | $61.7M | 10.13x | 58.9% |
| Bull Case | 9.0x | 11.0x | $5.5M | $73.0M | 13.32x | 67.8% |
| Bull (12x exit) | 9.0x | 12.0x | $5.5M | $81.2M | 14.82x | 71.5% |
| Bear Case | 11.0x | 10.0x | $6.7M | $38.2M | 5.71x | 41.7% |
| Bear (11x exit) | 11.0x | 11.0x | $6.7M | $44.2M | 6.60x | 45.9% |
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
- 105 hospitals with 30-120 beds
- Same-state prioritization (n=106)
- Comp margins: P25=-10.3% / P50=4.8% / P75=13.2%
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.