AVAIL HOSPITAL LAKE CHARLES
1. Target Overview & Investment Thesis
AVAIL HOSPITAL LAKE CHARLES is a 10-bed community hospital in CALCASIEU PARISH, LA with $11.1M in net patient revenue and a -45.5% operating margin. The hospital serves a payer mix of 29.5% Medicare, 0.0% Medicaid, and 70.5% commercial.
Thesis: Turnaround. Our ML models identify $825K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -45.5% to -38.1% (+740bps).
| Net Revenue HCRIS | $11.1M |
| Current EBITDA COMPUTED | $-5.1M |
| Operating Margin COMPUTED | -45.5% |
| Occupancy HCRIS | 18.8% |
| Revenue / Bed COMPUTED | $1.1M |
| Net-to-Gross HCRIS | 10.0% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
LA has 212 Medicare-certified hospitals with a median operating margin of -3.5%. The target's margin of -45.5% places it below the state median. Among 36 size-comparable peers (5-20 beds), the median margin is 5.0%. 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. 36 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| AVAIL HOSPITAL LAKE CHARLES (Target) | LA | 10 | $11.1M | -45.5% |
| SPECIALISTS HOSPITAL OF SHREVE | LA | 15 | $79.1M | 21.3% |
| PARK PLACE SURGERY CENTER | LA | 10 | $51.6M | 15.4% |
| SURGICAL SPECIALTY CENTER BATO | LA | 16 | $49.8M | 16.9% |
| LAFAYETTE SURGICAL SPECIALTY H | LA | 20 | $48.9M | 9.1% |
| REEVES MEMORIAL MEDICAL CENTER | LA | 15 | $34.0M | 64.5% |
| MONROE SURGICAL HOSPITAL | LA | 10 | $25.8M | -11.9% |
| DOCTORS HOSPITAL OF SLIDELL LL | LA | 10 | $20.7M | 21.0% |
| UNION GENERAL HOSPITAL INC. | LA | 20 | $20.4M | 2.2% |
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: $825K (740bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $234K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $223K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $223K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $136K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +9bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-5.1M |
| + RCM Uplift | +$825K |
| Pro Forma EBITDA | $-4.2M |
| Current Margin | -45.5% |
| Pro Forma Margin | -38.1% |
| WC Released (1x) | $427K |
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 | $-7.8M | $-25.2M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-7.8M | $-30.3M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-7.0M | $-30.1M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-7.0M | $-34.9M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-8.6M | $-26.8M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-8.6M | $-32.3M | 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 | Low occupancy | At 18.8%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
| 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
- 36 hospitals with 5-20 beds
- Same-state prioritization (n=38)
- Comp margins: P25=-3.9% / P50=5.0% / P75=17.1%
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.