Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 59% of modeled bridge. Strengths: Net-to-Gross Ratio. Risks: Occupancy Rate, Revenue per Bed. Risk-adjusted uplift: $3.5M (vs $6.0M 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 | $2.3M | $2.3M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $2.2M | $63K | $2.3M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $351K | $1.0M | $1.4M | $4.4M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $73K | $73K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 20.9% 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 | $573K | $1.1M | $1.7M | $2.3M | $2.3M | $2.3M | $2.3M |
| Denial Rate Reduction | $0 | $567K | $1.1M | $1.7M | $2.3M | $2.3M | $2.3M | $2.3M |
| A/R Days Reduction | $0 | $464K | $929K | $1.4M | $1.4M | $1.4M | $1.4M | $1.4M |
| Clean Claim Rate | $0 | $37K | $73K | $73K | $73K | $73K | $73K | $73K |
| Cumulative | $0 | $1.6M | $3.3M | $4.9M | $6.0M | $6.0M | $6.0M | $6.0M |
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 $6.0M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 153% / 104.1x | 159% / 116.1x | 164% / 128.0x | 166% / 134.0x | 169% / 139.9x |
| 9.0x | 147% / 92.2x | 153% / 102.8x | 158% / 113.4x | 160% / 118.7x | 162% / 124.0x |
| 10.0x | 142% / 82.7x | 147% / 92.2x | 152% / 101.8x | 154% / 106.5x | 157% / 111.3x |
| 11.0x | 137% / 74.8x | 142% / 83.5x | 147% / 92.2x | 149% / 96.5x | 152% / 100.9x |
| 12.0x | 133% / 68.3x | 138% / 76.3x | 143% / 84.2x | 145% / 88.2x | 147% / 92.2x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 91% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 0.6x, adding 7.9 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 | $445K | — | $445K | 0.4% |
| Year 1 | $459K | +$4.0M | $4.5M | 3.9% |
| Year 2 | $473K | +$6.0M | $6.5M | 5.7% |
| Year 3 | $487K | +$6.0M | $6.5M | 5.7% |
| Year 4 | $501K | +$6.0M | $6.5M | 5.7% |
| Year 5 | $516K | +$6.0M | $6.5M | 5.7% |
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 | $1.1M | $1.7M | $2.3M | $2.7M |
| Denial Rate Reductio | $1.1M | $1.7M | $2.3M | $2.7M |
| A/R Days Reduction | $697K | $1.0M | $1.4M | $1.7M |
| Clean Claim Rate | $37K | $55K | $73K | $88K |
| Total | $3.0M | $4.5M | $6.0M | $7.2M |
Peer Context — Where This Hospital Sits
Key metrics vs 113 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 0.4% | -5.2% | 2.8% | 16.9% | P41 |
| Net-to-Gross | 10.1% | 10.0% | 14.5% | 20.9% | P26 |
| Occupancy | 19.9% | 52.9% | 64.4% | 75.3% | P0 |
| Rev/Bed | $467K | $825K | $1.2M | $1.4M | P8 |
| Exp/Bed | $466K | $739K | $970K | $1.3M | P8 |
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.