ML Analysis — CITY HOSPITAL INC.
CCN 510008 | Clustering + Distress + RCM Opportunity
🛡️ Public data only — no PHI permitted on this instance.
Investability Score
Buy — solid fundamentals with identifiable value creation levers. Proceed to detailed diligence.
65
/ 100 (B)
Financial Health12/25
RCM Upside18/25
Market Position15/20
Demand Defensibility13/15
Operational Efficiency6/15
Entry Multiple: 9.5x – 11.5x
Est. MOIC: 2.3x
Risk Factors:
- Negative operating margin
Catalysts:
- RCM optimization could add 3-5pp margin
- Strong commercial payer base protects revenue
- Limited competition supports pricing power
Margin Prediction (Trained Ridge Model)
2.9%
R²=0.34 | n=4,907 | Grade B | Actual: -2.8%
Ridge regression trained on 4,907 HCRIS hospitals. 90% CI: [-25.4%, 31.1%]. P69 nationally.
| Driver | Value | Effect | Explanation | |
|---|---|---|---|---|
| Revenue/Bed | 1866401.939 | +0.0401 | Higher Revenue/Bed increases predicted margin | |
| Expense/Bed | 1917996.693 | -0.0321 | Higher Expense/Bed decreases predicted margin | |
| State Peer Margin | -0.003 | +0.0316 | Higher State Peer Margin increases predicted margi | |
| Bed Utilization Value | 1443116.598 | +0.0189 | Higher Bed Utilization Value increases predicted m | |
| Log(Beds) | 5.094 | +0.0167 | Higher Log(Beds) increases predicted margin |
Turnaround: 55%Turnaround possible (55%) but uncertain. Margin improvement depends on Revenue/Bed.
Suburban Community Hospit
Archetype
42.6%
Distress Risk
$2.4M
RCM Opportunity
D
Opportunity Grade
-2.0%
Projected Margin
Cluster: Suburban Community Hospital
Percentile within cluster: P5. Community hospitals — the largest PE deal category. Focus on RCM improvement and cost optimization at 9-11x.
Nearest Peers
| Hospital | State | Beds |
|---|---|---|
| CLARA MAASS MEDICAL CENTER | NJ | 259 |
| PRESENCE SAINTS MARY & ELIZABETH MED | IL | 266 |
| ADVENTIST HEALTH BAKERSFIELD | CA | 254 |
| BRISTOL REGIONAL MEDICAL CENTER | TN | 244 |
| HOLSTON VALLEY HOSP & MED CTR | TN | 286 |
| SPRINGFIELD REGIONAL MEDICAL CENTER | OH | 230 |
Distress Analysis
Risk: Elevated
National distress rate: 49.3%
WV distress rate: 41.7%
Model AUC: 0.629
| Factor | Value | Contribution | Direction |
|---|---|---|---|
| Occupancy Rate | 0.773 | -0.230 | ▼ risk |
| Medicaid Day Pct | 0.064 | -0.025 | ▼ risk |
| Revenue Per Bed | 1866401.939 | -0.017 | ▼ risk |
| Net To Gross Ratio | 0.377 | +0.004 | ▲ risk |
| Medicare Day Pct | 0.308 | -0.003 | ▼ risk |
| Beds | 163.000 | +0.002 | ▲ risk |
RCM Improvement Opportunity
Total (risk-adjusted): $2.4M
Current margin: -2.8%
Projected margin: -2.0%
Grade: D
Comps: 16
Gap analysis vs P75 peers with 60% closure assumption. Confidence-weighted by lever implementation difficulty.
| Lever | Current | Benchmark | Gap | Impact | Confidence | Timeline |
|---|---|---|---|---|---|---|
| Payer Mix Optimization | 0.628 | 0.765 | 13.7% | $2.1M | 50% | 24mo |
| Occupancy Improvement | 0.773 | 0.825 | 5.2% | $344K | 55% | 24mo |
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 | 25.0 | [25.0, 75.0] | P0 | 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. |