NORTHEASTERN NEVADA REGIONAL HOSPITA
1. Target Overview & Investment Thesis
NORTHEASTERN NEVADA REGIONAL HOSPITA is a 59-bed suburban community hospital in ELKO, NV with $84.2M in net patient revenue and a 15.5% operating margin. The hospital serves a payer mix of 42.7% Medicare, 20.2% Medicaid, and 37.1% commercial.
Thesis: Turnaround. Our ML models identify $6.2M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 15.5% to 22.8% (+736bps).
| Net Revenue HCRIS | $84.2M |
| Current EBITDA COMPUTED | $13.0M |
| Operating Margin COMPUTED | 15.5% |
| Occupancy HCRIS | 22.8% |
| Revenue / Bed COMPUTED | $1.4M |
| Net-to-Gross HCRIS | 33.8% |
| Distress Probability ML | 59.0% |
2. Market Context & Competitive Position
NV has 58 Medicare-certified hospitals with a median operating margin of 0.4%. The target's margin of 15.5% places it above the state median. Among 16 size-comparable peers (30-118 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 (30-118), prioritizing same-state peers. 16 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| NORTHEASTERN NEVADA REGIONAL H (Target) | NV | 59 | $84.2M | 15.5% |
| NORTHERN NEVADA MEDICAL CENTER | NV | 88 | $150.8M | 10.5% |
| RENOWN SOUTH MEADOWS MED CTR | NV | 78 | $91.0M | 4.0% |
| DIGINTY HEALTH ST ROSE DOMINIC | NV | 32 | $61.5M | 12.2% |
| KINDRED HOSPITAL LAS VEGAS | NV | 118 | $52.3M | -10.6% |
| HORIZON SPEC HOSPITAL-LAS VEGA | NV | 100 | $44.1M | -2.2% |
| DIGNITY HEALTH REHABILITATION | NV | 60 | $41.4M | 12.1% |
| PAM SPECIALTY HOSPITAL OF LAS | NV | 70 | $37.9M | 10.1% |
| PAM REHAB HOSP OF CENTENNIAL H | NV | 44 | $35.7M | 29.1% |
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: $6.2M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $1.8M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $1.7M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $1.7M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.0M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $54K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $13.0M |
| + RCM Uplift | +$6.2M |
| Pro Forma EBITDA | $19.2M |
| Current Margin | 15.5% |
| Pro Forma Margin | 22.8% |
| WC Released (1x) | $3.2M |
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 | $20.0M | $147.8M | 7.38x | 49.1% |
| Base (11x exit) | 10.0x | 11.0x | $20.0M | $169.1M | 8.44x | 53.2% |
| Bull Case | 9.0x | 11.0x | $18.0M | $196.1M | 10.88x | 61.2% |
| Bull (12x exit) | 9.0x | 12.0x | $18.0M | $219.2M | 12.16x | 64.8% |
| Bear Case | 11.0x | 10.0x | $22.0M | $110.4M | 5.01x | 38.0% |
| Bear (11x exit) | 11.0x | 11.0x | $22.0M | $128.6M | 5.83x | 42.3% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Low occupancy | At 22.8%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
| High | Elevated distress probability | Model estimates 59.0% 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
- 16 hospitals with 30-118 beds
- Same-state prioritization (n=17)
- Comp margins: P25=-1.9% / P50=4.5% / P75=12.1%
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.