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. Risks: Revenue per Bed. Risk-adjusted uplift: $2.0M (vs $2.7M 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 | $1.0M | $1.0M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $994K | $28K | $1.0M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $158K | $470K | $628K | $2.0M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $33K | $33K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 35.5% 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 | $258K | $516K | $774K | $1.0M | $1.0M | $1.0M | $1.0M |
| Denial Rate Reduction | $0 | $256K | $511K | $767K | $1.0M | $1.0M | $1.0M | $1.0M |
| A/R Days Reduction | $0 | $209K | $419K | $628K | $628K | $628K | $628K | $628K |
| Clean Claim Rate | $0 | $17K | $33K | $33K | $33K | $33K | $33K | $33K |
| Cumulative | $0 | $740K | $1.5M | $2.2M | $2.7M | $2.7M | $2.7M | $2.7M |
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 $2.7M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 118% / 49.2x | 123% / 55.0x | 127% / 60.9x | 130% / 63.8x | 132% / 66.7x |
| 9.0x | 113% / 43.4x | 117% / 48.5x | 122% / 53.7x | 124% / 56.3x | 126% / 58.9x |
| 10.0x | 108% / 38.7x | 113% / 43.4x | 117% / 48.0x | 119% / 50.4x | 121% / 52.7x |
| 11.0x | 103% / 34.9x | 108% / 39.1x | 113% / 43.4x | 115% / 45.5x | 117% / 47.6x |
| 12.0x | 100% / 31.7x | 104% / 35.6x | 109% / 39.5x | 111% / 41.4x | 113% / 43.4x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 81% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 1.2x, adding 7.3 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 | $452K | — | $452K | 0.9% |
| Year 1 | $465K | +$1.8M | $2.3M | 4.4% |
| Year 2 | $479K | +$2.7M | $3.2M | 6.2% |
| Year 3 | $494K | +$2.7M | $3.2M | 6.2% |
| Year 4 | $508K | +$2.7M | $3.2M | 6.2% |
| Year 5 | $524K | +$2.7M | $3.2M | 6.3% |
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 | $516K | $774K | $1.0M | $1.2M |
| Denial Rate Reductio | $511K | $767K | $1.0M | $1.2M |
| A/R Days Reduction | $314K | $471K | $628K | $754K |
| Clean Claim Rate | $17K | $25K | $33K | $40K |
| Total | $1.4M | $2.0M | $2.7M | $3.3M |
Peer Context — Where This Hospital Sits
Key metrics vs 172 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 0.9% | -19.8% | -3.7% | 4.3% | P66 |
| Net-to-Gross | 27.5% | 18.2% | 23.5% | 35.5% | P59 |
| Occupancy | 82.1% | 43.9% | 57.0% | 73.7% | P84 |
| Rev/Bed | $538K | $506K | $950K | $2.1M | P26 |
| Exp/Bed | $533K | $591K | $1.1M | $2.2M | P23 |
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.