MEDICAL CITY GREEN OAKS HOSPITAL
1. Target Overview & Investment Thesis
MEDICAL CITY GREEN OAKS HOSPITAL is a 124-bed suburban community hospital in DALLAS, TX with $36.9M in net patient revenue and a -16.2% operating margin. The hospital serves a payer mix of 8.5% Medicare, 0.3% Medicaid, and 91.2% commercial.
Thesis: Undervalued. Our ML models identify $2.7M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -16.2% to -8.8% (+736bps).
| Net Revenue HCRIS | $36.9M |
| Current EBITDA COMPUTED | $-6.0M |
| Operating Margin COMPUTED | -16.2% |
| Occupancy HCRIS | 84.2% |
| Revenue / Bed COMPUTED | $298K |
| Net-to-Gross HCRIS | 27.4% |
| Distress Probability ML | 39.7% |
2. Market Context & Competitive Position
TX has 583 Medicare-certified hospitals with a median operating margin of -0.7%. The target's margin of -16.2% places it below the state median. Among 172 size-comparable peers (62-248 beds), the median margin is 2.3%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (62-248), prioritizing same-state peers. 172 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| MEDICAL CITY GREEN OAKS HOSPIT (Target) | TX | 124 | $36.9M | -16.2% |
| DRISCOLL CHILDRENS HOSPITAL | TX | 215 | $694.3M | 29.4% |
| ROUND ROCK HOSPITAL | TX | 165 | $681.4M | 8.7% |
| HILLCREST BAPTIST MEDICAL CENT | TX | 236 | $464.8M | -6.7% |
| THE HEART HOSPITAL BAYLOR PLAN | TX | 109 | $464.6M | 25.7% |
| METHODIST RICHARDSON MEDICAL C | TX | 247 | $449.2M | 14.6% |
| DELL SETON MEDICAL CENTER AT T | TX | 225 | $438.6M | -4.2% |
| UNITED REGIONAL HEALTH CARE SY | TX | 244 | $422.1M | 3.3% |
| COVENANT CHILDRENS HOSPITAL | TX | 181 | $410.3M | 15.5% |
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: $2.7M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $775K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $738K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $731K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $449K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $24K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-6.0M |
| + RCM Uplift | +$2.7M |
| Pro Forma EBITDA | $-3.3M |
| Current Margin | -16.2% |
| Pro Forma Margin | -8.8% |
| WC Released (1x) | $1.4M |
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 | $-9.2M | $-12.3M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-9.2M | $-16.5M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-8.3M | $-10.5M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-8.3M | $-13.9M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-10.1M | $-22.9M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-10.1M | $-28.4M | 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 |
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
- 172 hospitals with 62-248 beds
- Same-state prioritization (n=173)
- Comp margins: P25=-8.6% / P50=2.3% / P75=12.5%
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.