Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 76% of modeled bridge. Strengths: Occupancy Rate, Commercial Payer %. Risks: Net-to-Gross Ratio, Revenue per Bed. Risk-adjusted uplift: $1.2M (vs $1.5M 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 | $584K | $584K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $562K | $16K | $578K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $90K | $266K | $355K | $1.1M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $19K | $19K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 54.8% 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 | $146K | $292K | $438K | $584K | $584K | $584K | $584K |
| Denial Rate Reduction | $0 | $144K | $289K | $433K | $578K | $578K | $578K | $578K |
| A/R Days Reduction | $0 | $118K | $237K | $355K | $355K | $355K | $355K | $355K |
| Clean Claim Rate | $0 | $9K | $19K | $19K | $19K | $19K | $19K | $19K |
| Cumulative | $0 | $418K | $836K | $1.2M | $1.5M | $1.5M | $1.5M | $1.5M |
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 $1.5M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 46% / 6.6x | 50% / 7.7x | 54% / 8.8x | 56% / 9.3x | 58% / 9.9x |
| 9.0x | 41% / 5.5x | 45% / 6.5x | 49% / 7.5x | 51% / 7.9x | 53% / 8.4x |
| 10.0x | 36% / 4.6x | 41% / 5.5x | 45% / 6.4x | 47% / 6.8x | 49% / 7.3x |
| 11.0x | 31% / 3.9x | 36% / 4.7x | 41% / 5.5x | 43% / 5.9x | 45% / 6.3x |
| 12.0x | 27% / 3.3x | 32% / 4.0x | 37% / 4.8x | 39% / 5.1x | 41% / 5.5x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline -10% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 7.1x, adding 1.3 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 | $8.2M | — | $8.2M | 28.0% |
| Year 1 | $8.4M | +$1.0M | $9.5M | 32.4% |
| Year 2 | $8.7M | +$1.5M | $10.2M | 35.0% |
| Year 3 | $8.9M | +$1.5M | $10.5M | 35.9% |
| Year 4 | $9.2M | +$1.5M | $10.7M | 36.8% |
| Year 5 | $9.5M | +$1.5M | $11.0M | 37.8% |
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 | $292K | $438K | $584K | $701K |
| Denial Rate Reductio | $289K | $433K | $578K | $694K |
| A/R Days Reduction | $178K | $266K | $355K | $426K |
| Clean Claim Rate | $9K | $14K | $19K | $22K |
| Total | $768K | $1.2M | $1.5M | $1.8M |
Peer Context — Where This Hospital Sits
Key metrics vs 2738 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 28.0% | -17.3% | -4.8% | 6.2% | P97 |
| Net-to-Gross | 86.1% | 28.3% | 40.1% | 54.8% | P97 |
| Occupancy | 97.5% | 23.3% | 41.3% | 63.9% | P99 |
| Rev/Bed | $730K | $445K | $882K | $1.8M | P44 |
| Exp/Bed | $525K | $459K | $997K | $1.9M | P30 |
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.