UNIVERSITY HOSPITALS AVON REHAB HOSP
1. Target Overview & Investment Thesis
UNIVERSITY HOSPITALS AVON REHAB HOSP is a 50-bed suburban community hospital in LORAIN, OH with $17.7M in net patient revenue and a 21.4% operating margin. The hospital serves a payer mix of 61.3% Medicare, 1.7% Medicaid, and 36.9% commercial.
Thesis: Turnaround. Our ML models identify $1.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 21.4% to 28.8% (+736bps).
| Net Revenue HCRIS | $17.7M |
| Current EBITDA COMPUTED | $3.8M |
| Operating Margin COMPUTED | 21.4% |
| Occupancy HCRIS | 50.8% |
| Revenue / Bed COMPUTED | $355K |
| Net-to-Gross HCRIS | 57.6% |
| Distress Probability ML | 52.9% |
2. Market Context & Competitive Position
OH has 235 Medicare-certified hospitals with a median operating margin of -0.3%. The target's margin of 21.4% places it above the state median. Among 109 size-comparable peers (25-100 beds), the median margin is -1.5%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (25-100), prioritizing same-state peers. 109 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| UNIVERSITY HOSPITALS AVON REHA (Target) | OH | 50 | $17.7M | 21.4% |
| KNOX COMMUNITY HOSPITAL | OH | 64 | $196.0M | -16.7% |
| CRYSTAL CLINIC ORTHOPAEDIC CEN | OH | 59 | $173.3M | -14.9% |
| OBLENESS MEMORIAL HOSPITAL | OH | 67 | $160.9M | 29.9% |
| MEMORIAL HOSPITAL OF UNION COU | OH | 51 | $151.0M | 8.0% |
| FISHER-TITUS MEDICAL CENTER | OH | 78 | $148.3M | -6.9% |
| WESTERN RESERVE HOSPITAL | OH | 83 | $147.6M | -9.3% |
| GRADY MEMORIAL HOSPITAL | OH | 60 | $146.7M | 16.5% |
| ST. LUKES HOSPITAL | OH | 99 | $144.3M | -27.7% |
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: $1.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $373K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $355K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $351K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $216K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $11K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $3.8M |
| + RCM Uplift | +$1.3M |
| Pro Forma EBITDA | $5.1M |
| Current Margin | 21.4% |
| Pro Forma Margin | 28.8% |
| WC Released (1x) | $680K |
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 | $5.8M | $38.1M | 6.52x | 45.5% |
| Base (11x exit) | 10.0x | 11.0x | $5.8M | $43.8M | 7.50x | 49.6% |
| Bull Case | 9.0x | 11.0x | $5.3M | $50.0M | 9.51x | 56.9% |
| Bull (12x exit) | 9.0x | 12.0x | $5.3M | $56.1M | 10.67x | 60.6% |
| Bear Case | 11.0x | 10.0x | $6.4M | $29.7M | 4.62x | 35.8% |
| Bear (11x exit) | 11.0x | 11.0x | $6.4M | $34.7M | 5.41x | 40.1% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Heavy Medicare dependence | Medicare comprises 61.3% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| High | Elevated distress probability | Model estimates 52.9% 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
- 109 hospitals with 25-100 beds
- Same-state prioritization (n=110)
- Comp margins: P25=-13.9% / P50=-1.5% / P75=9.8%
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.