Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 73% of modeled bridge. Strengths: Occupancy Rate, Net-to-Gross Ratio. Risks: Bed Count. Risk-adjusted uplift: $23.3M (vs $32.1M 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 | $12.2M | $12.2M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $11.7M | $336K | $12.1M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $1.9M | $5.6M | $7.4M | $23.4M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $390K | $390K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 28.9% 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 | $3.1M | $6.1M | $9.2M | $12.2M | $12.2M | $12.2M | $12.2M |
| Denial Rate Reduction | $0 | $3.0M | $6.0M | $9.1M | $12.1M | $12.1M | $12.1M | $12.1M |
| A/R Days Reduction | $0 | $2.5M | $4.9M | $7.4M | $7.4M | $7.4M | $7.4M | $7.4M |
| Clean Claim Rate | $0 | $195K | $390K | $390K | $390K | $390K | $390K | $390K |
| Cumulative | $0 | $8.7M | $17.5M | $26.0M | $32.1M | $32.1M | $32.1M | $32.1M |
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 $32.1M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 55% / 8.9x | 59% / 10.3x | 63% / 11.7x | 65% / 12.3x | 67% / 13.0x |
| 9.0x | 50% / 7.6x | 54% / 8.8x | 58% / 10.0x | 60% / 10.6x | 62% / 11.2x |
| 10.0x | 45% / 6.5x | 50% / 7.6x | 54% / 8.7x | 56% / 9.2x | 58% / 9.8x |
| 11.0x | 41% / 5.6x | 46% / 6.6x | 50% / 7.6x | 52% / 8.1x | 54% / 8.6x |
| 12.0x | 37% / 4.9x | 42% / 5.8x | 46% / 6.7x | 48% / 7.1x | 50% / 7.6x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 14% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 5.6x, adding 2.9 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 | $63.2M | — | $63.2M | 10.4% |
| Year 1 | $65.1M | +$21.4M | $86.5M | 14.2% |
| Year 2 | $67.0M | +$32.1M | $99.1M | 16.2% |
| Year 3 | $69.0M | +$32.1M | $101.1M | 16.6% |
| Year 4 | $71.1M | +$32.1M | $103.2M | 16.9% |
| Year 5 | $73.2M | +$32.1M | $105.3M | 17.3% |
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 | $6.1M | $9.2M | $12.2M | $14.6M |
| Denial Rate Reductio | $6.0M | $9.1M | $12.1M | $14.5M |
| A/R Days Reduction | $3.7M | $5.6M | $7.4M | $8.9M |
| Clean Claim Rate | $195K | $293K | $390K | $469K |
| Total | $16.0M | $24.1M | $32.1M | $38.5M |
Peer Context — Where This Hospital Sits
Key metrics vs 167 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 10.4% | -15.0% | -3.6% | 4.5% | P85 |
| Net-to-Gross | 11.0% | 17.3% | 22.6% | 28.9% | P7 |
| Occupancy | 79.5% | 53.7% | 65.4% | 75.3% | P83 |
| Rev/Bed | $1.9M | $1.3M | $1.7M | $2.5M | P55 |
| Exp/Bed | $1.7M | $1.3M | $1.9M | $2.6M | P41 |
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.