KIOWA DISTRICT HOSPITAL
1. Target Overview & Investment Thesis
KIOWA DISTRICT HOSPITAL is a 10-bed community hospital in BARBER, KS with $6.8M in net patient revenue and a -38.8% operating margin. The hospital serves a payer mix of 72.5% Medicare, 0.0% Medicaid, and 27.5% commercial.
Thesis: Turnaround. Our ML models identify $509K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -38.8% to -31.3% (+750bps).
| Net Revenue HCRIS | $6.8M |
| Current EBITDA COMPUTED | $-2.6M |
| Operating Margin COMPUTED | -38.8% |
| Occupancy HCRIS | 28.8% |
| Revenue / Bed COMPUTED | $679K |
| Net-to-Gross HCRIS | 108.1% |
| 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 -38.8% places it below the state median. Among 41 size-comparable peers (5-20 beds), the median margin is -20.3%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (5-20), prioritizing same-state peers. 41 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| KIOWA DISTRICT HOSPITAL (Target) | KS | 10 | $6.8M | -38.8% |
| KANSAS CITY ORTHOPAEDIC INSTIT | KS | 17 | $86.3M | 21.1% |
| 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% |
| CLAY COUNTY MEDICAL CENTER | KS | 20 | $30.5M | -14.5% |
| SALINA SURGICAL HOSPITAL | KS | 16 | $28.3M | 20.9% |
| MIAMI COUNTY MEDICAL CENTER | KS | 18 | $28.0M | -17.2% |
| ANDERSON COUNTY HOSPITAL | KS | 12 | $27.8M | -15.4% |
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: $509K (750bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $143K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $139K | +205bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $136K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $83K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +14bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-2.6M |
| + RCM Uplift | +$509K |
| Pro Forma EBITDA | $-2.1M |
| Current Margin | -38.8% |
| Pro Forma Margin | -31.3% |
| WC Released (1x) | $260K |
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 | $-4.0M | $-12.3M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-4.0M | $-14.8M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-3.6M | $-14.4M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-3.6M | $-16.8M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-4.5M | $-13.5M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-4.5M | $-16.3M | 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 72.5% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 28.8%, 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
- 41 hospitals with 5-20 beds
- Same-state prioritization (n=45)
- Comp margins: P25=-34.9% / P50=-20.3% / P75=-9.2%
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.