SOUTHERN TENNESSEE MEDICAL CENTER
1. Target Overview & Investment Thesis
SOUTHERN TENNESSEE MEDICAL CENTER is a 128-bed suburban community hospital in FRANKLIN, TN with $116.5M in net patient revenue and a 6.3% operating margin. The hospital serves a payer mix of 24.3% Medicare, 22.4% Medicaid, and 53.3% commercial.
Thesis: Turnaround. Our ML models identify $8.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 6.3% to 13.7% (+736bps).
| Net Revenue HCRIS | $116.5M |
| Current EBITDA COMPUTED | $7.4M |
| Operating Margin COMPUTED | 6.3% |
| Occupancy HCRIS | 23.9% |
| Revenue / Bed COMPUTED | $910K |
| Net-to-Gross HCRIS | 19.8% |
| Distress Probability ML | 57.9% |
2. Market Context & Competitive Position
TN has 141 Medicare-certified hospitals with a median operating margin of -0.6%. The target's margin of 6.3% places it above the state median. Among 44 size-comparable peers (64-256 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 (64-256), prioritizing same-state peers. 44 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SOUTHERN TENNESSEE MEDICAL CEN (Target) | TN | 128 | $116.5M | 6.3% |
| COOKEVILLE REGIONAL MEDICAL CE | TN | 212 | $372.5M | 2.1% |
| MAURY REGIONAL HOSPITAL | TN | 244 | $334.0M | -9.7% |
| TENNOVA HEALTHCARE - TURKEY CR | TN | 219 | $326.2M | 8.1% |
| BLOUNT MEMORIAL HOSPITAL | TN | 145 | $326.0M | -8.5% |
| SUMMIT MEDICAL CENTER | TN | 188 | $298.0M | 40.6% |
| BRISTOL REGIONAL MEDICAL CENTE | TN | 244 | $293.9M | 3.2% |
| METRO NASHVILLE GENERAL HOSPIT | TN | 114 | $287.4M | 48.9% |
| WILLIAMSON HEALTH | TN | 203 | $271.4M | -3.3% |
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: $8.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $2.4M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $2.3M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $2.3M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.4M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $75K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $7.4M |
| + RCM Uplift | +$8.6M |
| Pro Forma EBITDA | $16.0M |
| Current Margin | 6.3% |
| Pro Forma Margin | 13.7% |
| WC Released (1x) | $4.5M |
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 | $11.4M | $134.5M | 11.84x | 63.9% |
| Base (11x exit) | 10.0x | 11.0x | $11.4M | $151.6M | 13.35x | 67.9% |
| Bull Case | 9.0x | 11.0x | $10.2M | $183.6M | 17.96x | 78.2% |
| Bull (12x exit) | 9.0x | 12.0x | $10.2M | $203.3M | 19.89x | 81.8% |
| Bear Case | 11.0x | 10.0x | $12.5M | $87.9M | 7.04x | 47.7% |
| Bear (11x exit) | 11.0x | 11.0x | $12.5M | $100.8M | 8.06x | 51.8% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Elevated Medicaid exposure (22.4%) | Medicaid reimburses below cost in most states. Mitigant: denial reduction lever has highest impact on Medicaid claims |
| Medium | Low occupancy | At 23.9%, 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 57.9% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
| 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
- 44 hospitals with 64-256 beds
- Same-state prioritization (n=45)
- Comp margins: P25=-7.4% / P50=1.5% / P75=14.4%
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.