CLEARFIELD HOSPITAL
1. Target Overview & Investment Thesis
CLEARFIELD HOSPITAL is a 40-bed rural/critical access in CLEARFIELD, PA with $42.7M in net patient revenue and a -2.6% operating margin. The hospital serves a payer mix of 42.7% Medicare, 1.1% Medicaid, and 56.2% commercial.
Thesis: Turnaround. Our ML models identify $3.1M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -2.6% to 4.7% (+736bps).
| Net Revenue HCRIS | $42.7M |
| Current EBITDA COMPUTED | $-1.1M |
| Operating Margin COMPUTED | -2.6% |
| Occupancy HCRIS | 25.6% |
| Revenue / Bed COMPUTED | $1.1M |
| Net-to-Gross HCRIS | 30.6% |
| Distress Probability ML | 53.8% |
2. Market Context & Competitive Position
PA has 225 Medicare-certified hospitals with a median operating margin of -4.4%. The target's margin of -2.6% places it above the state median. Among 81 size-comparable peers (20-80 beds), the median margin is 1.8%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (20-80), prioritizing same-state peers. 81 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CLEARFIELD HOSPITAL (Target) | PA | 40 | $42.7M | -2.6% |
| THE GETTYSBURG HOSPITAL | PA | 76 | $341.8M | 18.4% |
| UPMC HANOVER | PA | 73 | $200.8M | 18.2% |
| MEMORIAL HOSPITAL | PA | 80 | $184.5M | 13.1% |
| UPMC CARLISLE | PA | 72 | $165.0M | 19.5% |
| OSS ORTHOPAEDIC HOSPITAL | PA | 30 | $149.4M | -5.0% |
| WELLSPAN SURGERY AND REHAB HOS | PA | 25 | $120.2M | 2.8% |
| UPMC LITITZ | PA | 36 | $114.5M | 14.2% |
| MINERS MEMORIAL MEDICAL CENTER | PA | 49 | $107.7M | 12.4% |
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: $3.1M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $897K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $854K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $845K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $520K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $27K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-1.1M |
| + RCM Uplift | +$3.1M |
| Pro Forma EBITDA | $2.0M |
| Current Margin | -2.6% |
| Pro Forma Margin | 4.7% |
| WC Released (1x) | $1.6M |
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 | $-1.7M | $24.0M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-1.7M | $25.8M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-1.6M | $35.6M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-1.6M | $38.4M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-1.9M | $8.8M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-1.9M | $9.1M | 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 | Low occupancy | At 25.6%, 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 53.8% 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
- 81 hospitals with 20-80 beds
- Same-state prioritization (n=82)
- Comp margins: P25=-12.8% / P50=1.8% / P75=9.1%
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.