SSM HEALTH ST ANTHONY HOSPITAL - MID
1. Target Overview & Investment Thesis
SSM HEALTH ST ANTHONY HOSPITAL - MID is a 126-bed safety-net/medicaid heavy in OKLAHOMA, OK with $98.7M in net patient revenue and a -24.3% operating margin. The hospital serves a payer mix of 30.2% Medicare, 26.1% Medicaid, and 43.7% commercial.
Thesis: Undervalued. Our ML models identify $7.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -24.3% to -16.9% (+736bps).
| Net Revenue HCRIS | $98.7M |
| Current EBITDA COMPUTED | $-24.0M |
| Operating Margin COMPUTED | -24.3% |
| Occupancy HCRIS | 59.4% |
| Revenue / Bed COMPUTED | $783K |
| Net-to-Gross HCRIS | 9.0% |
| Distress Probability ML | 49.9% |
2. Market Context & Competitive Position
OK has 147 Medicare-certified hospitals with a median operating margin of -8.8%. The target's margin of -24.3% places it below the state median. Among 32 size-comparable peers (63-252 beds), the median margin is -3.8%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (63-252), prioritizing same-state peers. 32 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SSM HEALTH ST ANTHONY HOSPITAL (Target) | OK | 126 | $98.7M | -24.3% |
| OKLAHOMA HEART HOSPITAL | OK | 97 | $342.0M | -2.8% |
| COMANCHE COUNTY MEMORIAL HOSPI | OK | 201 | $304.2M | -7.9% |
| INTEGRIS SOUTHWEST MEDICAL CEN | OK | 169 | $267.6M | -13.5% |
| HILLCREST HOSPITAL SOUTH | OK | 152 | $218.9M | 4.9% |
| SAINT FRANCIS HOSPITAL SOUTH | OK | 104 | $198.3M | 34.4% |
| SAINT FRANCIS HOSPITAL MUSKOGE | OK | 236 | $196.5M | 11.6% |
| MCBRIDE CLINIC ORTHOPEDIC HOSP | OK | 68 | $166.9M | -5.0% |
| MERCY HOSPITAL ARDMORE | OK | 140 | $158.8M | -1.1% |
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: $7.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $2.1M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $2.0M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $2.0M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.2M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $63K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-24.0M |
| + RCM Uplift | +$7.3M |
| Pro Forma EBITDA | $-16.7M |
| Current Margin | -24.3% |
| Pro Forma Margin | -16.9% |
| WC Released (1x) | $3.8M |
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 | $-36.9M | $-85.4M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-36.9M | $-105.9M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-33.2M | $-93.9M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-33.2M | $-112.3M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-40.6M | $-109.8M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-40.6M | $-133.9M | 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 | Elevated Medicaid exposure (26.1%) | Medicaid reimburses below cost in most states. Mitigant: denial reduction lever has highest impact on Medicaid claims |
| 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
- 32 hospitals with 63-252 beds
- Same-state prioritization (n=33)
- Comp margins: P25=-15.2% / P50=-3.8% / P75=6.0%
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.