MCCAMEY COUNTY HOSPITAL DISTRICT
1. Target Overview & Investment Thesis
MCCAMEY COUNTY HOSPITAL DISTRICT is a 11-bed community hospital in UPTON, TX with $8.0M in net patient revenue and a -97.0% operating margin. The hospital serves a payer mix of 56.0% Medicare, 0.0% Medicaid, and 44.0% commercial.
Thesis: Turnaround. Our ML models identify $600K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -97.0% to -89.5% (+746bps).
| Net Revenue HCRIS | $8.0M |
| Current EBITDA COMPUTED | $-7.8M |
| Operating Margin COMPUTED | -97.0% |
| Occupancy HCRIS | 14.0% |
| Revenue / Bed COMPUTED | $731K |
| Net-to-Gross HCRIS | 75.9% |
| 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 -97.0% places it below the state median. Among 76 size-comparable peers (6-22 beds), the median margin is -23.3%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (6-22), prioritizing same-state peers. 76 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| MCCAMEY COUNTY HOSPITAL DISTRI (Target) | TX | 11 | $8.0M | -97.0% |
| TEXAS SPINE AND JOINT HOSPITAL | TX | 20 | $147.3M | 30.3% |
| UVALDE MEMORIAL HOSPITAL | TX | 21 | $89.9M | 30.1% |
| BAYLOR MEDICAL CENTER AT TROPH | TX | 21 | $89.7M | 31.5% |
| WEBSTER SURGICAL SPECIALTY HOS | TX | 20 | $85.0M | -2.8% |
| PRESBYTERIAN PLANO CENTER DIAG | TX | 18 | $81.9M | 28.4% |
| BAYLOR SURGICAL HOSPITAL LAS C | TX | 20 | $79.8M | 33.3% |
| THE HEART HOSPITAL BAYLOR DENT | TX | 22 | $79.5M | 28.2% |
| CLEVELAND EMERGENCY HOSPITAL | TX | 16 | $66.9M | 10.2% |
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: $600K (746bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $169K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $163K | +203bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $161K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $98K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +12bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-7.8M |
| + RCM Uplift | +$600K |
| Pro Forma EBITDA | $-7.2M |
| Current Margin | -97.0% |
| Pro Forma Margin | -89.5% |
| WC Released (1x) | $308K |
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 | $-12.0M | $-45.4M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-12.0M | $-53.8M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-10.8M | $-55.8M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-10.8M | $-64.0M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-13.2M | $-44.5M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-13.2M | $-53.3M | 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 | Heavy Medicare dependence | Medicare comprises 56.0% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 14.0%, 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
- 76 hospitals with 6-22 beds
- Same-state prioritization (n=86)
- Comp margins: P25=-48.9% / P50=-23.3% / P75=7.7%
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.