Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 67% of modeled bridge. Strengths: Net-to-Gross Ratio, Bed Count. Risks: Commercial Payer %. Risk-adjusted uplift: $2.8M (vs $4.2M 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 | $1.6M | $1.6M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $1.5M | $44K | $1.6M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $246K | $731K | $977K | $3.1M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $51K | $51K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 44.1% 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 | $401K | $803K | $1.2M | $1.6M | $1.6M | $1.6M | $1.6M |
| Denial Rate Reduction | $0 | $397K | $795K | $1.2M | $1.6M | $1.6M | $1.6M | $1.6M |
| A/R Days Reduction | $0 | $326K | $651K | $977K | $977K | $977K | $977K | $977K |
| Clean Claim Rate | $0 | $26K | $51K | $51K | $51K | $51K | $51K | $51K |
| Cumulative | $0 | $1.2M | $2.3M | $3.4M | $4.2M | $4.2M | $4.2M | $4.2M |
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 $4.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 92% / 26.1x | 97% / 29.4x | 101% / 32.6x | 103% / 34.3x | 105% / 35.9x |
| 9.0x | 87% / 22.9x | 92% / 25.8x | 96% / 28.7x | 98% / 30.1x | 99% / 31.6x |
| 10.0x | 83% / 20.2x | 87% / 22.9x | 91% / 25.5x | 93% / 26.8x | 95% / 28.1x |
| 11.0x | 78% / 18.1x | 83% / 20.5x | 87% / 22.9x | 89% / 24.1x | 91% / 25.2x |
| 12.0x | 75% / 16.3x | 79% / 18.5x | 83% / 20.7x | 85% / 21.8x | 87% / 22.9x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 66% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 2.2x, adding 6.3 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 | $1.5M | — | $1.5M | 1.8% |
| Year 1 | $1.5M | +$2.8M | $4.3M | 5.4% |
| Year 2 | $1.6M | +$4.2M | $5.8M | 7.2% |
| Year 3 | $1.6M | +$4.2M | $5.8M | 7.3% |
| Year 4 | $1.7M | +$4.2M | $5.9M | 7.3% |
| Year 5 | $1.7M | +$4.2M | $5.9M | 7.4% |
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 | $803K | $1.2M | $1.6M | $1.9M |
| Denial Rate Reductio | $795K | $1.2M | $1.6M | $1.9M |
| A/R Days Reduction | $488K | $733K | $977K | $1.2M |
| Clean Claim Rate | $26K | $39K | $51K | $62K |
| Total | $2.1M | $3.2M | $4.2M | $5.1M |
Peer Context — Where This Hospital Sits
Key metrics vs 110 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 1.8% | -9.4% | 5.0% | 12.8% | P42 |
| Net-to-Gross | 10.5% | 15.7% | 24.5% | 44.1% | P10 |
| Occupancy | 48.7% | 50.9% | 64.1% | 81.3% | P21 |
| Rev/Bed | $1.3M | $239K | $506K | $1.0M | P86 |
| Exp/Bed | $1.2M | $280K | $533K | $969K | P84 |
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.