Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 70% of modeled bridge. Strengths: Occupancy Rate, Net-to-Gross Ratio. Risk-adjusted uplift: $8.3M (vs $11.7M 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 | $4.5M | $4.5M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $4.3M | $123K | $4.4M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $685K | $2.0M | $2.7M | $8.6M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $143K | $143K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 29.2% 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 | $1.1M | $2.2M | $3.3M | $4.5M | $4.5M | $4.5M | $4.5M |
| Denial Rate Reduction | $0 | $1.1M | $2.2M | $3.3M | $4.4M | $4.4M | $4.4M | $4.4M |
| A/R Days Reduction | $0 | $905K | $1.8M | $2.7M | $2.7M | $2.7M | $2.7M | $2.7M |
| Clean Claim Rate | $0 | $71K | $143K | $143K | $143K | $143K | $143K | $143K |
| Cumulative | $0 | $3.2M | $6.4M | $9.5M | $11.7M | $11.7M | $11.7M | $11.7M |
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 $11.7M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x |
| 9.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x |
| 10.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x |
| 11.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x |
| 12.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 148% before the 6.5x covenant trips. RCM uplift reduces leverage from 99.0x to -3.1x, adding 102.1 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 | $-3.1M | — | $-3.1M | -1.4% |
| Year 1 | $-3.2M | +$7.8M | $4.6M | 2.1% |
| Year 2 | $-3.3M | +$11.7M | $8.4M | 3.8% |
| Year 3 | $-3.4M | +$11.7M | $8.3M | 3.7% |
| Year 4 | $-3.5M | +$11.7M | $8.2M | 3.7% |
| Year 5 | $-3.6M | +$11.7M | $8.1M | 3.6% |
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 | $2.2M | $3.3M | $4.5M | $5.4M |
| Denial Rate Reductio | $2.2M | $3.3M | $4.4M | $5.3M |
| A/R Days Reduction | $1.4M | $2.0M | $2.7M | $3.3M |
| Clean Claim Rate | $71K | $107K | $143K | $171K |
| Total | $5.9M | $8.8M | $11.7M | $14.1M |
Peer Context — Where This Hospital Sits
Key metrics vs 210 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | -1.4% | -16.9% | -4.3% | 4.4% | P60 |
| Net-to-Gross | 13.8% | 18.1% | 22.3% | 29.2% | P10 |
| Occupancy | 66.0% | 46.1% | 59.3% | 72.6% | P61 |
| Rev/Bed | $1.4M | $722K | $1.4M | $2.2M | P51 |
| Exp/Bed | $1.4M | $782K | $1.5M | $2.4M | P45 |
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.