FISHER COUNTY HOSPITAL DISTRICT
1. Target Overview & Investment Thesis
FISHER COUNTY HOSPITAL DISTRICT is a 13-bed community hospital in FISHER, TX with $7.3M in net patient revenue and a -41.4% operating margin. The hospital serves a payer mix of 57.1% Medicare, 0.0% Medicaid, and 42.9% commercial.
Thesis: Turnaround. Our ML models identify $546K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -41.4% to -33.9% (+749bps).
| Net Revenue HCRIS | $7.3M |
| Current EBITDA COMPUTED | $-3.0M |
| Operating Margin COMPUTED | -41.4% |
| Occupancy HCRIS | 11.0% |
| Revenue / Bed COMPUTED | $561K |
| Net-to-Gross HCRIS | 74.0% |
| 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 -41.4% places it below the state median. Among 148 size-comparable peers (6-26 beds), the median margin is -20.6%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (6-26), prioritizing same-state peers. 148 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| FISHER COUNTY HOSPITAL DISTRIC (Target) | TX | 13 | $7.3M | -41.4% |
| CORYELL MEMORIAL HOSPITAL | TX | 25 | $305.9M | -1.5% |
| TEXAS SPINE AND JOINT HOSPITAL | TX | 20 | $147.3M | 30.3% |
| NORTH CENTRAL SURGICAL HOSPITA | TX | 24 | $143.6M | 32.0% |
| SCOTT AND WHITE HOSPITAL TAYLO | TX | 25 | $139.7M | -47.5% |
| BAYLOR ORTHOPEDIC AND SPINE HO | TX | 24 | $133.8M | 39.8% |
| 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% |
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: $546K (749bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $153K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $149K | +204bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $146K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $89K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +13bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-3.0M |
| + RCM Uplift | +$546K |
| Pro Forma EBITDA | $-2.5M |
| Current Margin | -41.4% |
| Pro Forma Margin | -33.9% |
| WC Released (1x) | $279K |
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 | $-4.6M | $-14.4M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-4.6M | $-17.4M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-4.2M | $-17.1M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-4.2M | $-19.9M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-5.1M | $-15.7M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-5.1M | $-18.9M | 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 | Heavy Medicare dependence | Medicare comprises 57.1% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 11.0%, 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
- 148 hospitals with 6-26 beds
- Same-state prioritization (n=155)
- Comp margins: P25=-47.8% / P50=-20.6% / P75=6.0%
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.