PHYSICIANS SURGICAL HOSPITAL
1. Target Overview & Investment Thesis
PHYSICIANS SURGICAL HOSPITAL is a 40-bed community hospital in POTTER, TX with $100.7M in net patient revenue and a 36.7% operating margin. The hospital serves a payer mix of 30.1% Medicare, 0.0% Medicaid, and 69.9% commercial.
Thesis: Turnaround. Our ML models identify $7.4M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 36.7% to 44.1% (+736bps).
| Net Revenue HCRIS | $100.7M |
| Current EBITDA COMPUTED | $37.0M |
| Operating Margin COMPUTED | 36.7% |
| Occupancy HCRIS | 12.2% |
| Revenue / Bed COMPUTED | $2.5M |
| Net-to-Gross HCRIS | 29.2% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
TX has 583 Medicare-certified hospitals with a median operating margin of -0.7%. The target's margin of 36.7% places it above the state median. Among 286 size-comparable peers (20-80 beds), the median margin is -2.9%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (20-80), prioritizing same-state peers. 286 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| PHYSICIANS SURGICAL HOSPITAL (Target) | TX | 40 | $100.7M | 36.7% |
| WISE HEALTH SYSTEM - PARKWAY | TX | 36 | $361.0M | -15.5% |
| CHILDRENS MEDICAL CENTER OF PL | TX | 72 | $336.7M | 20.9% |
| CORYELL MEMORIAL HOSPITAL | TX | 25 | $305.9M | -1.5% |
| BAYLOR HEART AND VASCULAR HOSP | TX | 53 | $255.0M | 30.0% |
| TEXAS ORTHOPEDIC HOSPITA | TX | 42 | $237.8M | 46.3% |
| LAKE GRANBURY MEDICAL CENTER | TX | 53 | $181.6M | 38.5% |
| METHODIST HOSPITAL FOR SURGERY | TX | 32 | $178.4M | 22.8% |
| BAYLOR MEDICAL CENTER AT FRISC | TX | 68 | $161.1M | 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: $7.4M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $2.1M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $2.0M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $2.0M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.2M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $64K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $37.0M |
| + RCM Uplift | +$7.4M |
| Pro Forma EBITDA | $44.4M |
| Current Margin | 36.7% |
| Pro Forma Margin | 44.1% |
| WC Released (1x) | $3.9M |
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 | $56.9M | $318.2M | 5.59x | 41.1% |
| Base (11x exit) | 10.0x | 11.0x | $56.9M | $368.5M | 6.47x | 45.3% |
| Bull Case | 9.0x | 11.0x | $51.2M | $411.4M | 8.03x | 51.7% |
| Bull (12x exit) | 9.0x | 12.0x | $51.2M | $463.9M | 9.06x | 55.4% |
| Bear Case | 11.0x | 10.0x | $62.6M | $262.6M | 4.19x | 33.2% |
| Bear (11x exit) | 11.0x | 11.0x | $62.6M | $309.2M | 4.94x | 37.6% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Low occupancy | At 12.2%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
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
- 286 hospitals with 20-80 beds
- Same-state prioritization (n=287)
- Comp margins: P25=-23.7% / P50=-2.9% / P75=10.3%
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.