ROXBURY PSYCHIATRIC HOSPITAL
1. Target Overview & Investment Thesis
ROXBURY PSYCHIATRIC HOSPITAL is a 112-bed suburban community hospital in FRANKLIN, PA with $18.4M in net patient revenue and a 25.2% operating margin. The hospital serves a payer mix of 1.7% Medicare, 0.4% Medicaid, and 97.9% commercial.
Thesis: Turnaround. Our ML models identify $1.4M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 25.2% to 32.6% (+736bps).
| Net Revenue HCRIS | $18.4M |
| Current EBITDA COMPUTED | $4.6M |
| Operating Margin COMPUTED | 25.2% |
| Occupancy HCRIS | 78.2% |
| Revenue / Bed COMPUTED | $164K |
| Net-to-Gross HCRIS | 34.9% |
| Distress Probability ML | 41.7% |
2. Market Context & Competitive Position
PA has 225 Medicare-certified hospitals with a median operating margin of -4.4%. The target's margin of 25.2% places it above the state median. Among 101 size-comparable peers (56-224 beds), the median margin is -6.5%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (56-224), prioritizing same-state peers. 101 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ROXBURY PSYCHIATRIC HOSPITAL (Target) | PA | 112 | $18.4M | 25.2% |
| ST LUKE HOSPITAL ANDERSON CAMP | PA | 193 | $433.0M | 20.6% |
| THE GETTYSBURG HOSPITAL | PA | 76 | $341.8M | 18.4% |
| ST. JOSEPH MEDICAL CENTER | PA | 132 | $334.8M | 13.2% |
| EPHRATA COMMUNITY HOSPITAL | PA | 115 | $291.8M | 3.8% |
| EINSTEIN MEDICAL CENTER MONTGO | PA | 175 | $276.3M | 6.9% |
| THE GOOD SAMARITAN HOSPITAL | PA | 145 | $269.5M | -5.0% |
| WILKES-BARRE GENERAL HOSPITAL | PA | 188 | $262.1M | -13.0% |
| UPMC ST MARGARET | PA | 185 | $248.5M | -21.3% |
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: $1.4M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $387K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $368K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $364K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $224K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $12K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $4.6M |
| + RCM Uplift | +$1.4M |
| Pro Forma EBITDA | $6.0M |
| Current Margin | 25.2% |
| Pro Forma Margin | 32.6% |
| WC Released (1x) | $706K |
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 | $7.1M | $44.2M | 6.18x | 44.0% |
| Base (11x exit) | 10.0x | 11.0x | $7.1M | $50.9M | 7.13x | 48.1% |
| Bull Case | 9.0x | 11.0x | $6.4M | $57.7M | 8.98x | 55.1% |
| Bull (12x exit) | 9.0x | 12.0x | $6.4M | $64.9M | 10.09x | 58.8% |
| Bear Case | 11.0x | 10.0x | $7.9M | $35.1M | 4.46x | 34.9% |
| Bear (11x exit) | 11.0x | 11.0x | $7.9M | $41.1M | 5.24x | 39.2% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Standard execution risk | RCM improvement requires management buy-in and 12-18 month implementation timeline |
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
- 101 hospitals with 56-224 beds
- Same-state prioritization (n=102)
- Comp margins: P25=-19.1% / P50=-6.5% / P75=7.1%
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.