SAINT THOMAS HIGHLAND HOSPITAL
1. Target Overview & Investment Thesis
SAINT THOMAS HIGHLAND HOSPITAL is a 12-bed community hospital in WHITE, TN with $21.5M in net patient revenue and a -11.9% operating margin. The hospital serves a payer mix of 31.5% Medicare, 0.0% Medicaid, and 68.5% commercial.
Thesis: Turnaround. Our ML models identify $1.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -11.9% to -4.6% (+736bps).
| Net Revenue HCRIS | $21.5M |
| Current EBITDA COMPUTED | $-2.6M |
| Operating Margin COMPUTED | -11.9% |
| Occupancy HCRIS | 29.4% |
| Revenue / Bed COMPUTED | $1.8M |
| Net-to-Gross HCRIS | 15.2% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
TN has 141 Medicare-certified hospitals with a median operating margin of -0.6%. The target's margin of -11.9% places it below the state median. Among 12 size-comparable peers (6-24 beds), the median margin is -0.8%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (6-24), prioritizing same-state peers. 12 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SAINT THOMAS HIGHLAND HOSPITAL (Target) | TN | 12 | $21.5M | -11.9% |
| THE CENTER FOR SPINAL SURGERY | TN | 23 | $78.7M | 39.3% |
| TRUSTPOINT HOSPITAL | TN | 18 | $50.8M | -0.8% |
| VANDERBILT BEDFORD COUNTY HOSP | TN | 24 | $49.5M | 1.9% |
| DELTA MEDICAL CENTER MEMPHIS | TN | 10 | $28.4M | 3.4% |
| RIDGEVIEW PSYCHIATRIC HOSPITAL | TN | 16 | $11.7M | -46.4% |
| ST THOMAS DEKALB HOSPITAL | TN | 18 | $10.8M | -32.3% |
| SAINT THOMAS STONES RIVER HOSP | TN | 21 | $9.9M | -30.0% |
| HANCOCK COUNTY HOSPITAL | TN | 10 | $7.2M | -7.9% |
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: $1.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $451K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $430K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $426K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $262K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $14K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-2.6M |
| + RCM Uplift | +$1.6M |
| Pro Forma EBITDA | $-982K |
| Current Margin | -11.9% |
| Pro Forma Margin | -4.6% |
| WC Released (1x) | $824K |
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 | $-3.9M | $-1.1M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-3.9M | $-2.5M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-3.5M | $1.5M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-3.5M | $543K | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-4.3M | $-7.7M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-4.3M | $-9.9M | 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 | Low occupancy | At 29.4%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
| 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
- 12 hospitals with 6-24 beds
- Same-state prioritization (n=15)
- Comp margins: P25=-30.5% / P50=-0.8% / P75=4.6%
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.