PUSHMATAHA HOSPITAL
1. Target Overview & Investment Thesis
PUSHMATAHA HOSPITAL is a 42-bed rural/critical access in PUSHMATAHA, OK with $6.1M in net patient revenue and a -23.7% operating margin. The hospital serves a payer mix of 66.5% Medicare, 12.8% Medicaid, and 20.7% commercial.
Thesis: Turnaround. Our ML models identify $457K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -23.7% to -16.2% (+754bps).
| Net Revenue HCRIS | $6.1M |
| Current EBITDA COMPUTED | $-1.4M |
| Operating Margin COMPUTED | -23.7% |
| Occupancy HCRIS | 15.7% |
| Revenue / Bed COMPUTED | $144K |
| Net-to-Gross HCRIS | 32.6% |
| Distress Probability ML | 61.4% |
2. Market Context & Competitive Position
OK has 147 Medicare-certified hospitals with a median operating margin of -8.8%. The target's margin of -23.7% places it below the state median. Among 92 size-comparable peers (21-84 beds), the median margin is -9.0%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (21-84), prioritizing same-state peers. 92 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| PUSHMATAHA HOSPITAL (Target) | OK | 42 | $6.1M | -23.7% |
| STILLWATER MEDICAL CENTER | OK | 52 | $270.2M | -9.9% |
| ST ANTHONY SHAWNEE HOSPITAL | OK | 57 | $169.2M | -6.1% |
| MCBRIDE CLINIC ORTHOPEDIC HOSP | OK | 68 | $166.9M | -5.0% |
| OKLAHOMA HEART HOSPITAL SOUTH | OK | 43 | $148.5M | -0.6% |
| OKLAHOMA SURGICAL HOSPITAL | OK | 74 | $146.2M | 17.7% |
| COMMUNITY HOSPITAL | OK | 45 | $143.9M | 21.7% |
| NORTHEASTERN HEALTH SYSTEM | OK | 80 | $134.6M | -9.6% |
| INTEGRIS HEALTH EDMOND | OK | 77 | $119.4M | -3.8% |
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: $457K (754bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $127K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $125K | +206bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $121K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $74K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +16bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-1.4M |
| + RCM Uplift | +$457K |
| Pro Forma EBITDA | $-982K |
| Current Margin | -23.7% |
| Pro Forma Margin | -16.2% |
| WC Released (1x) | $233K |
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 | $-2.2M | $-4.9M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-2.2M | $-6.1M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-2.0M | $-5.3M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-2.0M | $-6.4M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-2.4M | $-6.5M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-2.4M | $-7.9M | 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 | Heavy Medicare dependence | Medicare comprises 66.5% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 15.7%, 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 61.4% 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
- 92 hospitals with 21-84 beds
- Same-state prioritization (n=93)
- Comp margins: P25=-23.3% / P50=-9.0% / P75=3.3%
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.