HCA HOUSTON HEALTHCARE TOMBALL
1. Target Overview & Investment Thesis
HCA HOUSTON HEALTHCARE TOMBALL is a 205-bed suburban community hospital in HARRIS, TX with $214.9M in net patient revenue and a 2.4% operating margin. The hospital serves a payer mix of 19.9% Medicare, 3.0% Medicaid, and 77.1% commercial.
Thesis: Undervalued. Our ML models identify $15.8M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 2.4% to 9.7% (+736bps).
| Net Revenue HCRIS | $214.9M |
| Current EBITDA COMPUTED | $5.1M |
| Operating Margin COMPUTED | 2.4% |
| Occupancy HCRIS | 55.8% |
| Revenue / Bed COMPUTED | $1.0M |
| Net-to-Gross HCRIS | 9.8% |
| Distress Probability ML | 44.5% |
2. Market Context & Competitive Position
TX has 583 Medicare-certified hospitals with a median operating margin of -0.7%. The target's margin of 2.4% places it above the state median. Among 148 size-comparable peers (102-410 beds), the median margin is 4.9%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (102-410), prioritizing same-state peers. 148 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| HCA HOUSTON HEALTHCARE TOMBALL (Target) | TX | 205 | $214.9M | 2.4% |
| CHILDRENS MEDICAL CENTER OF DA | TX | 377 | $1.56B | 10.3% |
| DELL CHILDRENS MEDICAL CENTER | TX | 262 | $901.9M | 25.5% |
| DOCTORS HOSPITAL AT RENAISSANC | TX | 394 | $847.8M | 9.2% |
| ASCENSION SETON MEDICAL CENTER | TX | 391 | $702.5M | 12.6% |
| DRISCOLL CHILDRENS HOSPITAL | TX | 215 | $694.3M | 29.4% |
| ROUND ROCK HOSPITAL | TX | 165 | $681.4M | 8.7% |
| METHODIST SUGAR LAND HOSPITAL | TX | 337 | $679.6M | 12.6% |
| METHODIST WILLOWBROOK HOSPITAL | TX | 346 | $661.8M | 10.8% |
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: $15.8M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $4.5M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $4.3M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $4.3M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $2.6M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $138K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $5.1M |
| + RCM Uplift | +$15.8M |
| Pro Forma EBITDA | $20.9M |
| Current Margin | 2.4% |
| Pro Forma Margin | 9.7% |
| WC Released (1x) | $8.2M |
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 | $7.8M | $191.6M | 24.58x | 89.7% |
| Base (11x exit) | 10.0x | 11.0x | $7.8M | $213.3M | 27.36x | 93.8% |
| Bull Case | 9.0x | 11.0x | $7.0M | $268.0M | 38.20x | 107.2% |
| Bull (12x exit) | 9.0x | 12.0x | $7.0M | $294.4M | 41.97x | 111.1% |
| Bear Case | 11.0x | 10.0x | $8.6M | $110.0M | 12.83x | 66.6% |
| Bear (11x exit) | 11.0x | 11.0x | $8.6M | $123.7M | 14.43x | 70.6% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| 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
- 148 hospitals with 102-410 beds
- Same-state prioritization (n=149)
- Comp margins: P25=-7.1% / P50=4.9% / P75=13.4%
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.