PIEDMONT MACON NORTH HOSPITAL
1. Target Overview & Investment Thesis
PIEDMONT MACON NORTH HOSPITAL is a 79-bed under-performing / distressed in BIBB, GA with $59.1M in net patient revenue and a -5.7% operating margin. The hospital serves a payer mix of 25.7% Medicare, 5.7% Medicaid, and 68.6% commercial.
Thesis: Turnaround. Our ML models identify $4.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -5.7% to 1.6% (+736bps).
| Net Revenue HCRIS | $59.1M |
| Current EBITDA COMPUTED | $-3.4M |
| Operating Margin COMPUTED | -5.7% |
| Occupancy HCRIS | 20.0% |
| Revenue / Bed COMPUTED | $748K |
| Net-to-Gross HCRIS | 12.0% |
| Distress Probability ML | 54.0% |
2. Market Context & Competitive Position
GA has 165 Medicare-certified hospitals with a median operating margin of -2.8%. The target's margin of -5.7% places it below the state median. Among 68 size-comparable peers (40-158 beds), the median margin is -0.3%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (40-158), prioritizing same-state peers. 68 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| PIEDMONT MACON NORTH HOSPITAL (Target) | GA | 79 | $59.1M | -5.7% |
| TANNER MEDICAL CENTER-VILLA RI | GA | 58 | $289.8M | 33.3% |
| PAULDING MEDICAL CENTER | GA | 112 | $288.5M | 9.0% |
| EMORY JOHNS CREEK HOSPITAL | GA | 154 | $269.1M | 3.5% |
| SHEPHERD CENTER | GA | 130 | $254.9M | -20.8% |
| PIEDMONT ROCKDALE HOSPITAL | GA | 141 | $217.4M | -4.1% |
| DOUGLAS HOSPITAL | GA | 112 | $217.2M | -0.8% |
| NORTHSIDE HOSPITAL - DULUTH | GA | 87 | $193.2M | -3.1% |
| ADVENTHEALTH GORDON | GA | 69 | $188.5M | -3.4% |
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: $4.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $1.2M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $1.2M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $1.2M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $719K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $38K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-3.4M |
| + RCM Uplift | +$4.3M |
| Pro Forma EBITDA | $957K |
| Current Margin | -5.7% |
| Pro Forma Margin | 1.6% |
| WC Released (1x) | $2.3M |
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 | $-5.2M | $21.1M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-5.2M | $21.5M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-4.7M | $34.2M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-4.7M | $35.9M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-5.7M | $1.1M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-5.7M | $-695K | 0.00x | -100.0% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| High | Negative operating margin | RCM uplift bridge shows clear path to profitability; working capital release provides near-term cash cushion |
| Medium | Low occupancy | At 20.0%, 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 54.0% 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
- 68 hospitals with 40-158 beds
- Same-state prioritization (n=69)
- Comp margins: P25=-12.9% / P50=-0.3% / P75=8.9%
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.