CANTON-POTSDAM HOSPITAL
1. Target Overview & Investment Thesis
CANTON-POTSDAM HOSPITAL is a 94-bed suburban community hospital in SAINT LAWRENCE, NY with $231.6M in net patient revenue and a -5.7% operating margin. The hospital serves a payer mix of 26.8% Medicare, 3.5% Medicaid, and 69.7% commercial.
Thesis: Turnaround. Our ML models identify $17.0M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -5.7% to 1.6% (+736bps).
| Net Revenue HCRIS | $231.6M |
| Current EBITDA COMPUTED | $-13.2M |
| Operating Margin COMPUTED | -5.7% |
| Occupancy HCRIS | 72.3% |
| Revenue / Bed COMPUTED | $2.5M |
| Net-to-Gross HCRIS | 45.6% |
| Distress Probability ML | 42.7% |
2. Market Context & Competitive Position
NY has 196 Medicare-certified hospitals with a median operating margin of -17.5%. The target's margin of -5.7% places it above the state median. Among 69 size-comparable peers (47-188 beds), the median margin is -17.1%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (47-188), prioritizing same-state peers. 69 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CANTON-POTSDAM HOSPITAL (Target) | NY | 94 | $231.6M | -5.7% |
| ROSWELL PARK CANCER INSTITUTE | NY | 142 | $772.3M | -40.1% |
| MARY IMOGENE BASSETT HOSPITAL | NY | 160 | $529.1M | -31.6% |
| SARATOGA HOSPITAL | NY | 171 | $431.9M | -12.3% |
| NORTHERN WESTCHESTER HOSPITAL | NY | 162 | $416.0M | -4.5% |
| OUR LADY OF LOURDES MEMORIAL H | NY | 175 | $411.8M | -24.9% |
| PHELPS MEMORIAL HOSPITAL CENTE | NY | 135 | $360.4M | -20.4% |
| CAYUGA MEDICAL CENTER AT ITHAC | NY | 107 | $302.3M | -13.1% |
| PECONIC BAY MEDICAL CENTER | NY | 130 | $294.3M | -9.3% |
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: $17.0M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $4.9M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $4.6M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $4.6M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $2.8M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $148K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-13.2M |
| + RCM Uplift | +$17.0M |
| Pro Forma EBITDA | $3.8M |
| Current Margin | -5.7% |
| Pro Forma Margin | 1.6% |
| WC Released (1x) | $8.9M |
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 | $-20.4M | $83.2M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-20.4M | $84.9M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-18.3M | $134.5M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-18.3M | $141.3M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-22.4M | $4.5M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-22.4M | $-2.3M | 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 |
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
- 69 hospitals with 47-188 beds
- Same-state prioritization (n=70)
- Comp margins: P25=-29.1% / P50=-17.1% / 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.