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, Bed Count. Risks: Net-to-Gross Ratio. Risk-adjusted uplift: $0.9M (vs $1.3M 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 | $492K | $492K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $474K | $14K | $488K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $76K | $224K | $300K | $944K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $16K | $16K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 50.6% 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 | $123K | $246K | $369K | $492K | $492K | $492K | $492K |
| Denial Rate Reduction | $0 | $122K | $244K | $366K | $488K | $488K | $488K | $488K |
| A/R Days Reduction | $0 | $100K | $200K | $300K | $300K | $300K | $300K | $300K |
| Clean Claim Rate | $0 | $8K | $16K | $16K | $16K | $16K | $16K | $16K |
| Cumulative | $0 | $353K | $705K | $1.1M | $1.3M | $1.3M | $1.3M | $1.3M |
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 $1.3M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 57% / 9.6x | 62% / 11.1x | 66% / 12.5x | 68% / 13.2x | 69% / 13.9x |
| 9.0x | 52% / 8.2x | 57% / 9.5x | 61% / 10.7x | 63% / 11.4x | 64% / 12.0x |
| 10.0x | 48% / 7.0x | 52% / 8.2x | 56% / 9.3x | 58% / 9.9x | 60% / 10.5x |
| 11.0x | 44% / 6.1x | 48% / 7.2x | 52% / 8.2x | 54% / 8.7x | 56% / 9.2x |
| 12.0x | 40% / 5.3x | 44% / 6.3x | 49% / 7.2x | 50% / 7.7x | 52% / 8.2x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 19% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 5.3x, 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 | $2.2M | — | $2.2M | 8.8% |
| Year 1 | $2.2M | +$864K | $3.1M | 12.5% |
| Year 2 | $2.3M | +$1.3M | $3.6M | 14.5% |
| Year 3 | $2.4M | +$1.3M | $3.7M | 14.8% |
| Year 4 | $2.4M | +$1.3M | $3.7M | 15.1% |
| Year 5 | $2.5M | +$1.3M | $3.8M | 15.4% |
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 | $246K | $369K | $492K | $591K |
| Denial Rate Reductio | $244K | $366K | $488K | $585K |
| A/R Days Reduction | $150K | $225K | $300K | $360K |
| Clean Claim Rate | $8K | $12K | $16K | $19K |
| Total | $648K | $972K | $1.3M | $1.6M |
Peer Context — Where This Hospital Sits
Key metrics vs 30 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 8.8% | -10.3% | -3.4% | 7.6% | P76 |
| Net-to-Gross | 100.0% | 19.7% | 36.7% | 50.7% | P92 |
| Occupancy | 74.0% | 14.7% | 35.0% | 52.6% | P87 |
| Rev/Bed | $1.5M | $812K | $1.4M | $2.0M | P50 |
| Exp/Bed | $1.4M | $1.1M | $1.6M | $3.1M | P43 |
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.