ML Analysis — BOULDER CITY HOSPITAL
CCN 291309 | Clustering + Distress + RCM Opportunity
🛡️ Public data only — no PHI permitted on this instance.
Investability Score
Hold / Selective — investigate specific opportunities but be prepared for execution risk.
46
/ 100 (C)
Financial Health5/25
RCM Upside19/25
Market Position9/20
Demand Defensibility7/15
Operational Efficiency6/15
Entry Multiple: 8.0x – 10.0x
Est. MOIC: 1.9x
Risk Factors:
- Negative operating margin
- Small facility (<50 beds) — limited scale
- Low occupancy (<30%) — demand risk
- Expenses exceed revenue
Catalysts:
- Strong commercial payer base protects revenue
Margin Prediction (Trained Ridge Model)
-9.8%
R²=0.34 | n=4,907 | Grade B | Actual: -13.8%
Ridge regression trained on 4,907 HCRIS hospitals. 90% CI: [-38.1%, 18.5%]. P37 nationally.
| Driver | Value | Effect | Explanation | |
|---|---|---|---|---|
| Revenue/Bed | 1226298.600 | -0.0493 | Lower Revenue/Bed decreases predicted margin | |
| State Peer Margin | 0.004 | +0.0369 | Higher State Peer Margin increases predicted margi | |
| Expense/Bed | 1395601.200 | +0.0322 | Higher Expense/Bed increases predicted margin | |
| Reimbursement Quality | 0.305 | -0.0298 | Higher Reimbursement Quality decreases predicted m | |
| Log(Beds) | 3.219 | -0.0268 | Lower Log(Beds) decreases predicted margin |
Turnaround: 33%Turnaround possible (33%) but uncertain. Margin improvement depends on improving Revenue/Bed.
Under-Performing / Distre
Archetype
55.5%
Distress Risk
$2.9M
RCM Opportunity
C
Opportunity Grade
-4.2%
Projected Margin
Cluster: Under-Performing / Distressed
Percentile within cluster: P46. Deeply negative margins signal severe distress. Evaluate asset-level acquisition at 4-6x normalized EBITDA.
Nearest Peers
| Hospital | State | Beds |
|---|---|---|
| HOLY FAMILY MEMORIAL INC | WI | 58 |
| MIDDLESBORO ARH | KY | 46 |
| ATRIUM HEALTH NAVICENT BALDWIN | GA | 86 |
| BON SECOURS COMMUNITY HOSPITAL | NY | 98 |
| ADVANCED SPECIALTY HOSP. OF TOLEDO | OH | 40 |
| COMMUNITY HEALTH CENTER BRANCH | MI | 75 |
Distress Analysis
Risk: High
National distress rate: 49.3%
NV distress rate: 37.5%
Model AUC: 0.629
| Factor | Value | Contribution | Direction |
|---|---|---|---|
| Occupancy Rate | 0.217 | +0.286 | ▲ risk |
| Medicaid Day Pct | 0.002 | -0.087 | ▼ risk |
| Net To Gross Ratio | 0.465 | +0.043 | ▲ risk |
| Revenue Per Bed | 1226298.600 | +0.021 | ▲ risk |
| Beds | 25.000 | -0.017 | ▼ risk |
| Medicare Day Pct | 0.343 | +0.003 | ▲ risk |
RCM Improvement Opportunity
Total (risk-adjusted): $2.9M
Current margin: -13.8%
Projected margin: -4.2%
Grade: C
Comps: 16
Gap analysis vs P75 peers with 60% closure assumption. Confidence-weighted by lever implementation difficulty.
| Lever | Current | Benchmark | Gap | Impact | Confidence | Timeline |
|---|---|---|---|---|---|---|
| Occupancy Improvement | 0.217 | 0.612 | 39.4% | $2.6M | 55% | 24mo |
| Net-to-Gross Ratio Improvement | 0.465 | 0.562 | 9.6% | $345K | 65% | 18mo |
Predicted RCM Performance (Public Data Only)
A
RCM Grade
Strong RCM profile — likely low-risk from an operations perspective. Focus diligence on growth thesis.
| Metric | Predicted | 90% CI | Percentile | Assessment |
|---|---|---|---|---|
| Denial Rate | 2.0% | [2.0%, 25.0%] | P0 | Strong — predicted denial rate is in the top third nationall |
| Days in AR | 31.1 | [25.0, 75.0] | P65 | Strong — predicted days in ar is in the top third nationally |
| Clean Claim Rate | 98.0% | [80.0%, 98.0%] | P0 | Strong — predicted clean claim rate is in the top third. |
| Net Collection Rate | 99.5% | [90.0%, 99.5%] | P8 | Strong — predicted net collection rate is in the top third. |