Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 71% of modeled bridge. Strengths: Occupancy Rate, Payer Diversity. Risks: Bed Count, Commercial Payer %. Risk-adjusted uplift: $31.6M (vs $44.2M modeled).
EBITDA Bridge — 7 RCM Levers
Each bar shows the annual EBITDA impact at full run-rate. Revenue levers increase top-line; cost levers reduce operating expense; cash acceleration releases working capital. Calibrated to published research bands (Denial 12%→5% = $8-15M on $400M NPR).
Lever Detail
Each value shows its data source. SELLER = seller data room, DEFAULT = model default, BENCHMARK = P75 peer benchmark.
| Lever | Current | Target | Revenue | Cost | EBITDA | WC | Ramp |
|---|---|---|---|---|---|---|---|
| Cost to Collect | 4.5% DEFAULT | 2.5% BENCHMARK | $0 | $16.8M | $16.8M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $16.2M | $462K | $16.6M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $2.6M | $7.6M | $10.2M | $32.2M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $537K | $537K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 31.7% BENCHMARK | $0 | $0 | $0 | $0 | 18mo |
| CDI / Case Mix Index | 135.0% DEFAULT | 142.0% BENCHMARK | $0 | $0 | $0 | $0 | 18mo |
Implementation Timing Curve
Linear ramp to full run-rate per lever. Month 0 = close date. Partners should expect 60-70% of total uplift realized by month 12.
| Lever | M0 | M3 | M6 | M9 | M12 | M18 | M24 | M36 |
|---|---|---|---|---|---|---|---|---|
| Cost to Collect | $0 | $4.2M | $8.4M | $12.6M | $16.8M | $16.8M | $16.8M | $16.8M |
| Denial Rate Reduction | $0 | $4.2M | $8.3M | $12.5M | $16.6M | $16.6M | $16.6M | $16.6M |
| A/R Days Reduction | $0 | $3.4M | $6.8M | $10.2M | $10.2M | $10.2M | $10.2M | $10.2M |
| Clean Claim Rate | $0 | $269K | $537K | $537K | $537K | $537K | $537K | $537K |
| Cumulative | $0 | $12.0M | $24.1M | $35.8M | $44.2M | $44.2M | $44.2M | $44.2M |
Returns Sensitivity (IRR / MOIC)
5-year hold, 5.5x leverage, 3% organic growth, 10%/yr debt paydown. Green = exceeds 20% IRR hurdle. Amber = 15-20%. Red = below hurdle or loss. RCM uplift of $44.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 64% / 11.9x | 68% / 13.6x | 72% / 15.3x | 74% / 16.1x | 76% / 16.9x |
| 9.0x | 59% / 10.2x | 64% / 11.7x | 68% / 13.2x | 69% / 13.9x | 71% / 14.7x |
| 10.0x | 55% / 8.9x | 59% / 10.2x | 63% / 11.6x | 65% / 12.2x | 67% / 12.9x |
| 11.0x | 51% / 7.8x | 55% / 9.0x | 59% / 10.2x | 61% / 10.8x | 63% / 11.4x |
| 12.0x | 47% / 6.8x | 51% / 8.0x | 55% / 9.1x | 57% / 9.7x | 59% / 10.2x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 32% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.4x, adding 4.0 turns of cushion.
5-Year Value Creation Waterfall
EBITDA trajectory: 3% organic growth + RCM uplift ramp (full run-rate at month 18).
| Base EBITDA | RCM Uplift | Total | Margin | |
|---|---|---|---|---|
| Entry | $48.5M | — | $48.5M | 5.8% |
| Year 1 | $49.9M | +$29.4M | $79.4M | 9.5% |
| Year 2 | $51.4M | +$44.2M | $95.6M | 11.4% |
| Year 3 | $53.0M | +$44.2M | $97.1M | 11.6% |
| Year 4 | $54.5M | +$44.2M | $98.7M | 11.8% |
| Year 5 | $56.2M | +$44.2M | $100.3M | 12.0% |
Achievement Sensitivity
What if we only achieve a fraction of each lever? 50% = conservative, 75% = base management case, 100% = plan, 120% = stretch.
| Lever | 50% | 75% | 100% | 120% |
|---|---|---|---|---|
| Cost to Collect | $8.4M | $12.6M | $16.8M | $20.1M |
| Denial Rate Reductio | $8.3M | $12.5M | $16.6M | $19.9M |
| A/R Days Reduction | $5.1M | $7.7M | $10.2M | $12.3M |
| Clean Claim Rate | $269K | $403K | $537K | $645K |
| Total | $22.1M | $33.1M | $44.2M | $53.0M |
Peer Context — Where This Hospital Sits
Key metrics vs 28 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 5.8% | -10.0% | -4.6% | 1.0% | P86 |
| Net-to-Gross | 48.4% | 10.9% | 21.3% | 31.7% | P96 |
| Occupancy | 77.4% | 52.1% | 66.3% | 77.9% | P68 |
| Rev/Bed | $2.4M | $710K | $917K | $1.2M | P96 |
| Exp/Bed | $2.3M | $776K | $984K | $1.3M | P96 |
Bridge Methodology
Coefficients calibrated to published research bands: denial 12%→5% = $8-15M on $400M NPR. Current metrics estimated from HCRIS public data and ML predictions. Target metrics set at P75 peer benchmarks with 60% gap closure assumption. Revenue levers use NPR × delta × avoidable share. Cost levers use claims volume × cost per reworked claim. Working capital from AR reduction is one-time cash (not included in recurring EBITDA). Returns assume 5.5x leverage, 3% organic growth, 10%/yr debt paydown.