Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 67% of modeled bridge. Strengths: Occupancy Rate. Risks: Bed Count. Risk-adjusted uplift: $23.6M (vs $35.5M 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 | $13.5M | $13.5M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $13.0M | $371K | $13.4M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $2.1M | $6.1M | $8.2M | $25.9M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $432K | $432K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 26.4% 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 | $3.4M | $6.7M | $10.1M | $13.5M | $13.5M | $13.5M | $13.5M |
| Denial Rate Reduction | $0 | $3.3M | $6.7M | $10.0M | $13.4M | $13.4M | $13.4M | $13.4M |
| A/R Days Reduction | $0 | $2.7M | $5.5M | $8.2M | $8.2M | $8.2M | $8.2M | $8.2M |
| Clean Claim Rate | $0 | $216K | $432K | $432K | $432K | $432K | $432K | $432K |
| Cumulative | $0 | $9.7M | $19.3M | $28.8M | $35.5M | $35.5M | $35.5M | $35.5M |
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 $35.5M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 58% / 9.8x | 62% / 11.2x | 66% / 12.7x | 68% / 13.4x | 70% / 14.1x |
| 9.0x | 53% / 8.3x | 57% / 9.6x | 61% / 10.9x | 63% / 11.6x | 65% / 12.2x |
| 10.0x | 48% / 7.2x | 53% / 8.3x | 57% / 9.5x | 59% / 10.1x | 61% / 10.7x |
| 11.0x | 44% / 6.2x | 49% / 7.3x | 53% / 8.3x | 55% / 8.9x | 57% / 9.4x |
| 12.0x | 40% / 5.4x | 45% / 6.4x | 49% / 7.4x | 51% / 7.8x | 53% / 8.3x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 20% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 5.2x, adding 3.2 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 | $57.0M | — | $57.0M | 8.4% |
| Year 1 | $58.7M | +$23.7M | $82.3M | 12.2% |
| Year 2 | $60.4M | +$35.5M | $95.9M | 14.2% |
| Year 3 | $62.2M | +$35.5M | $97.7M | 14.5% |
| Year 4 | $64.1M | +$35.5M | $99.6M | 14.8% |
| Year 5 | $66.0M | +$35.5M | $101.5M | 15.1% |
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 | $6.7M | $10.1M | $13.5M | $16.2M |
| Denial Rate Reductio | $6.7M | $10.0M | $13.4M | $16.0M |
| A/R Days Reduction | $4.1M | $6.2M | $8.2M | $9.8M |
| Clean Claim Rate | $216K | $324K | $432K | $518K |
| Total | $17.7M | $26.6M | $35.5M | $42.6M |
Peer Context — Where This Hospital Sits
Key metrics vs 20 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 8.4% | -4.9% | -0.6% | 6.8% | P75 |
| Net-to-Gross | 23.3% | 16.3% | 23.4% | 26.4% | P45 |
| Occupancy | 64.7% | 57.7% | 65.7% | 80.9% | P40 |
| Rev/Bed | $1.3M | $1.3M | $1.6M | $2.1M | P20 |
| Exp/Bed | $1.1M | $1.1M | $1.4M | $1.8M | P25 |
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.