WILLIS-KNIGHTON HEALTH SYSTEMS
1. Target Overview & Investment Thesis
WILLIS-KNIGHTON HEALTH SYSTEMS is a 686-bed large academic medical center in CADDO PARISH, LA with $1.02B in net patient revenue and a 6.9% operating margin. The hospital serves a payer mix of 33.5% Medicare, 0.9% Medicaid, and 65.6% commercial.
Thesis: Platform Growth. Our ML models identify $74.9M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 6.9% to 14.3% (+736bps).
| Net Revenue HCRIS | $1.02B |
| Current EBITDA COMPUTED | $70.1M |
| Operating Margin COMPUTED | 6.9% |
| Occupancy HCRIS | 64.7% |
| Revenue / Bed COMPUTED | $1.5M |
| Net-to-Gross HCRIS | 27.1% |
| Distress Probability ML | 45.4% |
2. Market Context & Competitive Position
LA has 212 Medicare-certified hospitals with a median operating margin of -3.5%. The target's margin of 6.9% places it above the state median. Among 564 size-comparable peers (343-1372 beds), the median margin is -4.5%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (343-1372), prioritizing same-state peers. 564 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| WILLIS-KNIGHTON HEALTH SYSTEMS (Target) | LA | 686 | $1.02B | 6.9% |
| ST. LUKES HOSPITAL | PA | 633 | $8.94B | 87.9% |
| STANFORD HEALTH CARE | CA | 657 | $6.76B | 3.7% |
| CLEVELAND CLINIC HOSPITAL | OH | 1326 | $6.38B | -17.7% |
| VANDERBILT UNIVERSITY MEDICAL | TN | 1084 | $5.44B | -15.9% |
| UCSF MEDICAL CENTER | CA | 834 | $5.44B | -5.4% |
| UT MD ANDERSON CANCER CENTER | TX | 721 | $4.90B | -0.8% |
| UNIV OF MI HOSPITALS & HLTH CT | MI | 951 | $4.62B | -1.4% |
| MEMORIAL HOSPITAL FOR CANCER A | NY | 514 | $4.34B | -32.5% |
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: $74.9M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $21.4M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $20.3M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $20.1M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $12.4M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $651K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $70.1M |
| + RCM Uplift | +$74.9M |
| Pro Forma EBITDA | $145.0M |
| Current Margin | 6.9% |
| Pro Forma Margin | 14.3% |
| WC Released (1x) | $39.0M |
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 | $107.9M | $1.21B | 11.22x | 62.2% |
| Base (11x exit) | 10.0x | 11.0x | $107.9M | $1.37B | 12.67x | 66.2% |
| Bull Case | 9.0x | 11.0x | $97.1M | $1.65B | 16.98x | 76.2% |
| Bull (12x exit) | 9.0x | 12.0x | $97.1M | $1.83B | 18.82x | 79.9% |
| Bear Case | 11.0x | 10.0x | $118.7M | $801.9M | 6.76x | 46.5% |
| Bear (11x exit) | 11.0x | 11.0x | $118.7M | $920.6M | 7.76x | 50.6% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Standard execution risk | RCM improvement requires management buy-in and 12-18 month implementation timeline |
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
- 564 hospitals with 343-1372 beds
- Same-state prioritization (n=7)
- Comp margins: P25=-14.4% / P50=-4.5% / P75=4.7%
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.