PHD#1 DBA SKAGIT VALLEY HOSPITAL
1. Target Overview & Investment Thesis
PHD#1 DBA SKAGIT VALLEY HOSPITAL is a 137-bed suburban community hospital in SKAGIT, WA with $414.3M in net patient revenue and a -17.9% operating margin. The hospital serves a payer mix of 32.2% Medicare, 3.1% Medicaid, and 64.7% commercial.
Thesis: Undervalued. Our ML models identify $30.5M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -17.9% to -10.6% (+736bps).
| Net Revenue HCRIS | $414.3M |
| Current EBITDA COMPUTED | $-74.4M |
| Operating Margin COMPUTED | -17.9% |
| Occupancy HCRIS | 85.2% |
| Revenue / Bed COMPUTED | $3.0M |
| Net-to-Gross HCRIS | 27.5% |
| Distress Probability ML | 37.3% |
2. Market Context & Competitive Position
WA has 104 Medicare-certified hospitals with a median operating margin of -10.3%. The target's margin of -17.9% places it below the state median. Among 32 size-comparable peers (68-274 beds), the median margin is -9.7%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (68-274), prioritizing same-state peers. 32 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| PHD#1 DBA SKAGIT VALLEY HOSPI (Target) | WA | 137 | $414.3M | -17.9% |
| VIRGINIA MASON MEDICAL CENTER | WA | 222 | $1.11B | -23.2% |
| ST. JOSEPH MEDICAL CENTER | WA | 208 | $750.0M | 1.9% |
| HARRISON MEDICAL CENTER | WA | 238 | $653.4M | 2.2% |
| CENTRAL WASHINGTON HOSPITAL | WA | 176 | $550.9M | -2.0% |
| YAKIMA VALLEY MEMORIAL HOSPITA | WA | 208 | $522.3M | -10.4% |
| LEGACY SALMON CREEK HOSPITAL | WA | 178 | $479.7M | -5.2% |
| SWEDISH MEDICAL CENTER CHERRY | WA | 181 | $463.4M | -15.0% |
| ST. JOHN MEDICAL CENTER | WA | 122 | $335.0M | -4.4% |
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: $30.5M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $8.7M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $8.3M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $8.2M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $5.0M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $265K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-74.4M |
| + RCM Uplift | +$30.5M |
| Pro Forma EBITDA | $-43.9M |
| Current Margin | -17.9% |
| Pro Forma Margin | -10.6% |
| WC Released (1x) | $15.9M |
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 | $-114.4M | $-185.5M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-114.4M | $-241.3M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-103.0M | $-177.8M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-103.0M | $-224.3M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-125.8M | $-300.9M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-125.8M | $-371.8M | 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
- 32 hospitals with 68-274 beds
- Same-state prioritization (n=33)
- Comp margins: P25=-21.4% / P50=-9.7% / P75=-1.9%
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.