Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 65% of modeled bridge. Strengths: Net-to-Gross Ratio. Risks: Occupancy Rate. Risk-adjusted uplift: $4.8M (vs $7.3M 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 | $2.8M | $2.8M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $2.7M | $77K | $2.8M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $428K | $1.3M | $1.7M | $5.3M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $89K | $89K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 29.8% 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 | $697K | $1.4M | $2.1M | $2.8M | $2.8M | $2.8M | $2.8M |
| Denial Rate Reduction | $0 | $690K | $1.4M | $2.1M | $2.8M | $2.8M | $2.8M | $2.8M |
| A/R Days Reduction | $0 | $566K | $1.1M | $1.7M | $1.7M | $1.7M | $1.7M | $1.7M |
| Clean Claim Rate | $0 | $45K | $89K | $89K | $89K | $89K | $89K | $89K |
| Cumulative | $0 | $2.0M | $4.0M | $5.9M | $7.3M | $7.3M | $7.3M | $7.3M |
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 $7.3M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 68% / 13.3x | 72% / 15.2x | 76% / 17.0x | 78% / 17.9x | 80% / 18.8x |
| 9.0x | 63% / 11.5x | 67% / 13.1x | 71% / 14.7x | 73% / 15.6x | 75% / 16.4x |
| 10.0x | 58% / 10.0x | 63% / 11.5x | 67% / 12.9x | 69% / 13.7x | 71% / 14.4x |
| 11.0x | 54% / 8.8x | 59% / 10.1x | 63% / 11.5x | 65% / 12.1x | 67% / 12.8x |
| 12.0x | 51% / 7.8x | 55% / 9.0x | 59% / 10.2x | 61% / 10.8x | 63% / 11.5x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 38% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.0x, adding 4.4 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 | $6.6M | — | $6.6M | 4.8% |
| Year 1 | $6.8M | +$4.9M | $11.7M | 8.4% |
| Year 2 | $7.0M | +$7.3M | $14.4M | 10.3% |
| Year 3 | $7.3M | +$7.3M | $14.6M | 10.5% |
| Year 4 | $7.5M | +$7.3M | $14.8M | 10.6% |
| Year 5 | $7.7M | +$7.3M | $15.0M | 10.8% |
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 | $1.4M | $2.1M | $2.8M | $3.3M |
| Denial Rate Reductio | $1.4M | $2.1M | $2.8M | $3.3M |
| A/R Days Reduction | $848K | $1.3M | $1.7M | $2.0M |
| Clean Claim Rate | $45K | $67K | $89K | $107K |
| Total | $3.7M | $5.5M | $7.3M | $8.8M |
Peer Context — Where This Hospital Sits
Key metrics vs 194 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 4.8% | -18.3% | -3.9% | 4.7% | P75 |
| Net-to-Gross | 9.1% | 17.8% | 22.4% | 29.8% | P5 |
| Occupancy | 40.9% | 45.0% | 58.0% | 72.3% | P18 |
| Rev/Bed | $1.1M | $619K | $1.1M | $2.1M | P47 |
| Exp/Bed | $1.0M | $676K | $1.4M | $2.4M | 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.