Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 65% of modeled bridge. Risks: Bed Count. Risk-adjusted uplift: $13.7M (vs $21.2M 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 | $8.1M | $8.1M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $7.7M | $221K | $8.0M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $1.2M | $3.7M | $4.9M | $15.4M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $258K | $258K | $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 | $2.0M | $4.0M | $6.0M | $8.1M | $8.1M | $8.1M | $8.1M |
| Denial Rate Reduction | $0 | $2.0M | $4.0M | $6.0M | $8.0M | $8.0M | $8.0M | $8.0M |
| A/R Days Reduction | $0 | $1.6M | $3.3M | $4.9M | $4.9M | $4.9M | $4.9M | $4.9M |
| Clean Claim Rate | $0 | $129K | $258K | $258K | $258K | $258K | $258K | $258K |
| Cumulative | $0 | $5.8M | $11.5M | $17.2M | $21.2M | $21.2M | $21.2M | $21.2M |
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 $21.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | Loss | Loss | Loss | Loss | Loss |
| 9.0x | Loss | Loss | Loss | Loss | Loss |
| 10.0x | Loss | Loss | Loss | Loss | Loss |
| 11.0x | Loss | Loss | Loss | Loss | Loss |
| 12.0x | Loss | Loss | Loss | Loss | Loss |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 0% before the 6.5x covenant trips. RCM uplift reduces leverage from 99.0x to 99.0x, adding 0.0 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 | $-144.0M | — | $-144.0M | -35.8% |
| Year 1 | $-148.3M | +$14.1M | $-134.2M | -33.3% |
| Year 2 | $-152.7M | +$21.2M | $-131.6M | -32.7% |
| Year 3 | $-157.3M | +$21.2M | $-136.1M | -33.8% |
| Year 4 | $-162.0M | +$21.2M | $-140.9M | -35.0% |
| Year 5 | $-166.9M | +$21.2M | $-145.7M | -36.2% |
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 | $4.0M | $6.0M | $8.1M | $9.7M |
| Denial Rate Reductio | $4.0M | $6.0M | $8.0M | $9.6M |
| A/R Days Reduction | $2.4M | $3.7M | $4.9M | $5.9M |
| Clean Claim Rate | $129K | $193K | $258K | $309K |
| Total | $10.6M | $15.9M | $21.2M | $25.4M |
Peer Context — Where This Hospital Sits
Key metrics vs 155 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | -35.8% | -15.9% | -4.3% | 3.5% | P8 |
| Net-to-Gross | 25.6% | 17.5% | 22.6% | 28.9% | P63 |
| Occupancy | 50.5% | 54.3% | 65.4% | 73.8% | P19 |
| Rev/Bed | $1.1M | $1.3M | $1.9M | $2.6M | P18 |
| Exp/Bed | $1.5M | $1.5M | $2.0M | $2.7M | P29 |
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.