COMANCHE COUNTY HOSPITAL
1. Target Overview & Investment Thesis
COMANCHE COUNTY HOSPITAL is a 12-bed community hospital in COMANCHE, KS with $5.5M in net patient revenue and a -21.8% operating margin. The hospital serves a payer mix of 82.2% Medicare, 0.0% Medicaid, and 17.8% commercial.
Thesis: Turnaround. Our ML models identify $413K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -21.8% to -14.3% (+757bps).
| Net Revenue HCRIS | $5.5M |
| Current EBITDA COMPUTED | $-1.2M |
| Operating Margin COMPUTED | -21.8% |
| Occupancy HCRIS | 14.9% |
| Revenue / Bed COMPUTED | $455K |
| Net-to-Gross HCRIS | 110.1% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
KS has 152 Medicare-certified hospitals with a median operating margin of -17.7%. The target's margin of -21.8% places it below the state median. Among 60 size-comparable peers (6-24 beds), the median margin is -18.9%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (6-24), prioritizing same-state peers. 60 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| COMANCHE COUNTY HOSPITAL (Target) | KS | 12 | $5.5M | -21.8% |
| KANSAS CITY ORTHOPAEDIC INSTIT | KS | 17 | $86.3M | 21.1% |
| NEWMAN REGIONAL HEALTH | KS | 23 | $73.9M | -15.6% |
| NEOSHO MEMORIAL REGIONAL MED C | KS | 21 | $53.8M | -13.0% |
| CITIZENS MEDICAL CENTER | KS | 23 | $49.5M | -13.9% |
| WILLIAM NEWTON MEMORIAL HOSPIT | KS | 23 | $42.2M | -20.3% |
| MANHATTAN SURGICAL HOSPITAL | KS | 13 | $42.0M | 13.1% |
| CLARA BARTON HOSPITAL ASSOCIAT | KS | 18 | $35.1M | -8.2% |
| SUSAN B. ALLEN MEMORIAL HOSPIT | KS | 20 | $32.6M | -18.5% |
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: $413K (757bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $115K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $113K | +208bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $109K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $66K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +18bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-1.2M |
| + RCM Uplift | +$413K |
| Pro Forma EBITDA | $-779K |
| Current Margin | -21.8% |
| Pro Forma Margin | -14.3% |
| WC Released (1x) | $209K |
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 | $-1.8M | $-3.7M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-1.8M | $-4.7M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-1.7M | $-3.9M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-1.7M | $-4.8M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-2.0M | $-5.2M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-2.0M | $-6.4M | 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 | Heavy Medicare dependence | Medicare comprises 82.2% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 14.9%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
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
- 60 hospitals with 6-24 beds
- Same-state prioritization (n=64)
- Comp margins: P25=-31.6% / P50=-18.9% / P75=-10.2%
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 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.