RED RIVER HOSPITAL
1. Target Overview & Investment Thesis
RED RIVER HOSPITAL is a 96-bed suburban community hospital in WICHITA, TX with $21.4M in net patient revenue and a 9.1% operating margin. The hospital serves a payer mix of 7.8% Medicare, 0.5% Medicaid, and 91.6% commercial.
Thesis: Turnaround. Our ML models identify $1.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 9.1% to 16.4% (+736bps).
| Net Revenue HCRIS | $21.4M |
| Current EBITDA COMPUTED | $1.9M |
| Operating Margin COMPUTED | 9.1% |
| Occupancy HCRIS | 77.4% |
| Revenue / Bed COMPUTED | $223K |
| Net-to-Gross HCRIS | 36.3% |
| Distress Probability ML | 42.2% |
2. Market Context & Competitive Position
TX has 583 Medicare-certified hospitals with a median operating margin of -0.7%. The target's margin of 9.1% places it above the state median. Among 196 size-comparable peers (48-192 beds), the median margin is 2.6%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (48-192), prioritizing same-state peers. 196 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| RED RIVER HOSPITAL (Target) | TX | 96 | $21.4M | 9.1% |
| ROUND ROCK HOSPITAL | TX | 165 | $681.4M | 8.7% |
| THE HEART HOSPITAL BAYLOR PLAN | TX | 109 | $464.6M | 25.7% |
| COVENANT CHILDRENS HOSPITAL | TX | 181 | $410.3M | 15.5% |
| COLLEGE STATION HOSPITAL | TX | 135 | $397.7M | -0.9% |
| CHILDRENS HOSPITAL OF SAN ANTO | TX | 174 | $376.5M | -2.8% |
| DECATUR COMMUNITY HOSPITAL | TX | 81 | $361.0M | -15.5% |
| CHILDRENS MEDICAL CENTER OF PL | TX | 72 | $336.7M | 20.9% |
| MEDICAL CITY MCKINNEY | TX | 166 | $302.5M | -0.4% |
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% | $449K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $428K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $423K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $260K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $14K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $1.9M |
| + RCM Uplift | +$1.6M |
| Pro Forma EBITDA | $3.5M |
| Current Margin | 9.1% |
| Pro Forma Margin | 16.4% |
| WC Released (1x) | $820K |
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 | $3.0M | $28.5M | 9.56x | 57.1% |
| Base (11x exit) | 10.0x | 11.0x | $3.0M | $32.3M | 10.84x | 61.1% |
| Bull Case | 9.0x | 11.0x | $2.7M | $38.5M | 14.34x | 70.3% |
| Bull (12x exit) | 9.0x | 12.0x | $2.7M | $42.8M | 15.94x | 74.0% |
| Bear Case | 11.0x | 10.0x | $3.3M | $19.7M | 6.00x | 43.1% |
| Bear (11x exit) | 11.0x | 11.0x | $3.3M | $22.7M | 6.93x | 47.3% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Standard execution risk | RCM improvement requires management buy-in and 12-18 month implementation timeline |
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
- 196 hospitals with 48-192 beds
- Same-state prioritization (n=197)
- Comp margins: P25=-10.6% / P50=2.6% / P75=12.2%
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.