EASTERN IDAHO REGIONAL MEDICAL CENTE
1. Target Overview & Investment Thesis
EASTERN IDAHO REGIONAL MEDICAL CENTE is a 233-bed safety-net/medicaid heavy in nan, ID with $370.5M in net patient revenue and a 42.0% operating margin. The hospital serves a payer mix of 23.6% Medicare, 31.0% Medicaid, and 45.5% commercial.
Thesis: Platform Growth. Our ML models identify $27.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 42.0% to 49.3% (+736bps).
| Net Revenue HCRIS | $370.5M |
| Current EBITDA COMPUTED | $155.6M |
| Operating Margin COMPUTED | 42.0% |
| Occupancy HCRIS | 63.3% |
| Revenue / Bed COMPUTED | $1.6M |
| Net-to-Gross HCRIS | 21.6% |
| Distress Probability ML | 50.5% |
2. Market Context & Competitive Position
ID has 51 Medicare-certified hospitals with a median operating margin of -3.5%. The target's margin of 42.0% places it above the state median. Among 1770 size-comparable peers (116-466 beds), the median margin is -3.8%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (116-466), prioritizing same-state peers. 1770 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| EASTERN IDAHO REGIONAL MEDICAL (Target) | ID | 233 | $370.5M | 42.0% |
| RONALD REAGAN UCLA | CA | 446 | $2.62B | -6.8% |
| LUCILE PACKARD CHILDRENS HOSPI | CA | 394 | $2.39B | -0.8% |
| MAYO CLINIC HOSPITAL | AZ | 315 | $2.25B | 1.4% |
| RAINBOW BABIES & CHILDRENS HOS | OH | 231 | $2.22B | -5.0% |
| EASTERN MAINE MEDICAL CENTER | ME | 352 | $2.05B | 48.1% |
| ARTHUR G JAMES CANCER HOSPITAL | OH | 356 | $1.95B | 21.0% |
| MOFFITT CANCER CENTER | FL | 218 | $1.91B | 16.0% |
| UCI MEDICAL CENTER | CA | 397 | $1.90B | -2.5% |
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: $27.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $7.8M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $7.4M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $7.3M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $4.5M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $237K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $155.6M |
| + RCM Uplift | +$27.3M |
| Pro Forma EBITDA | $182.8M |
| Current Margin | 42.0% |
| Pro Forma Margin | 49.3% |
| WC Released (1x) | $14.2M |
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 | $239.3M | $1.30B | 5.43x | 40.2% |
| Base (11x exit) | 10.0x | 11.0x | $239.3M | $1.51B | 6.29x | 44.5% |
| Bull Case | 9.0x | 11.0x | $215.4M | $1.67B | 7.77x | 50.7% |
| Bull (12x exit) | 9.0x | 12.0x | $215.4M | $1.89B | 8.77x | 54.4% |
| Bear Case | 11.0x | 10.0x | $263.3M | $1.08B | 4.12x | 32.7% |
| Bear (11x exit) | 11.0x | 11.0x | $263.3M | $1.28B | 4.86x | 37.2% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Elevated Medicaid exposure (31.0%) | Medicaid reimburses below cost in most states. Mitigant: denial reduction lever has highest impact on Medicaid claims |
| High | Elevated distress probability | Model estimates 50.5% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
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
- 1770 hospitals with 116-466 beds
- Same-state prioritization (n=6)
- Comp margins: P25=-13.7% / P50=-3.8% / P75=5.9%
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.