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: Revenue per Bed, Bed Count. Risks: Occupancy Rate, Net-to-Gross Ratio. Risk-adjusted uplift: $1.7M (vs $2.6M 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 | $963K | $28K | $990K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $153K | $455K | $609K | $1.9M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $32K | $32K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 64.0% 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 | $250K | $500K | $750K | $1.0M | $1.0M | $1.0M | $1.0M |
| Denial Rate Reduction | $0 | $248K | $495K | $743K | $990K | $990K | $990K | $990K |
| A/R Days Reduction | $0 | $203K | $406K | $609K | $609K | $609K | $609K | $609K |
| Clean Claim Rate | $0 | $16K | $32K | $32K | $32K | $32K | $32K | $32K |
| Cumulative | $0 | $717K | $1.4M | $2.1M | $2.6M | $2.6M | $2.6M | $2.6M |
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 $2.6M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 136% / 73.3x | 141% / 81.8x | 146% / 90.3x | 148% / 94.6x | 151% / 98.8x |
| 9.0x | 130% / 64.8x | 135% / 72.4x | 140% / 79.9x | 142% / 83.7x | 145% / 87.5x |
| 10.0x | 125% / 58.0x | 130% / 64.8x | 135% / 71.6x | 137% / 75.0x | 139% / 78.4x |
| 11.0x | 121% / 52.4x | 126% / 58.6x | 130% / 64.8x | 132% / 67.9x | 135% / 71.0x |
| 12.0x | 117% / 47.8x | 122% / 53.5x | 126% / 59.1x | 128% / 62.0x | 130% / 64.8x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 87% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 0.8x, adding 7.6 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 | $283K | — | $283K | 0.6% |
| Year 1 | $291K | +$1.8M | $2.0M | 4.1% |
| Year 2 | $300K | +$2.6M | $2.9M | 5.9% |
| Year 3 | $309K | +$2.6M | $2.9M | 5.9% |
| Year 4 | $318K | +$2.6M | $2.9M | 5.9% |
| Year 5 | $328K | +$2.6M | $3.0M | 5.9% |
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 | $500K | $750K | $1.0M | $1.2M |
| Denial Rate Reductio | $495K | $743K | $990K | $1.2M |
| A/R Days Reduction | $304K | $457K | $609K | $730K |
| Clean Claim Rate | $16K | $24K | $32K | $38K |
| Total | $1.3M | $2.0M | $2.6M | $3.2M |
Peer Context — Where This Hospital Sits
Key metrics vs 50 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 0.6% | -13.8% | -5.6% | 3.0% | P70 |
| Net-to-Gross | 60.9% | 38.4% | 49.6% | 64.0% | P66 |
| Occupancy | 37.3% | 21.8% | 31.3% | 53.1% | P58 |
| Rev/Bed | $2.3M | $776K | $1.8M | $3.1M | P60 |
| Exp/Bed | $2.3M | $906K | $1.9M | $3.0M | P60 |
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.