Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 70% of modeled bridge. Strengths: Occupancy Rate, Bed Count. Risks: Revenue per Bed. Risk-adjusted uplift: $0.5M (vs $0.7M 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 | $254K | $254K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $245K | $8K | $253K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $39K | $116K | $155K | $487K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $10K | $10K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 56.0% 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 | $64K | $127K | $191K | $254K | $254K | $254K | $254K |
| Denial Rate Reduction | $0 | $63K | $126K | $190K | $253K | $253K | $253K | $253K |
| A/R Days Reduction | $0 | $52K | $103K | $155K | $155K | $155K | $155K | $155K |
| Clean Claim Rate | $0 | $5K | $10K | $10K | $10K | $10K | $10K | $10K |
| Cumulative | $0 | $183K | $366K | $544K | $671K | $671K | $671K | $671K |
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 $671K is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 63% / 11.6x | 68% / 13.3x | 72% / 14.9x | 74% / 15.7x | 75% / 16.6x |
| 9.0x | 58% / 10.0x | 63% / 11.4x | 67% / 12.9x | 69% / 13.6x | 70% / 14.4x |
| 10.0x | 54% / 8.6x | 58% / 10.0x | 62% / 11.3x | 64% / 11.9x | 66% / 12.6x |
| 11.0x | 50% / 7.6x | 54% / 8.8x | 58% / 10.0x | 60% / 10.6x | 62% / 11.2x |
| 12.0x | 46% / 6.7x | 51% / 7.8x | 55% / 8.9x | 57% / 9.4x | 58% / 10.0x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 31% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.5x, adding 3.9 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 | $769K | — | $769K | 6.1% |
| Year 1 | $792K | +$447K | $1.2M | 9.8% |
| Year 2 | $815K | +$671K | $1.5M | 11.7% |
| Year 3 | $840K | +$671K | $1.5M | 11.9% |
| Year 4 | $865K | +$671K | $1.5M | 12.1% |
| Year 5 | $891K | +$671K | $1.6M | 12.3% |
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 | $127K | $191K | $254K | $305K |
| Denial Rate Reductio | $126K | $190K | $253K | $303K |
| A/R Days Reduction | $77K | $116K | $155K | $185K |
| Clean Claim Rate | $5K | $7K | $10K | $12K |
| Total | $336K | $503K | $671K | $805K |
Peer Context — Where This Hospital Sits
Key metrics vs 58 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 6.1% | -24.8% | -1.3% | 7.9% | P69 |
| Net-to-Gross | 20.6% | 19.6% | 29.0% | 56.0% | P33 |
| Occupancy | 63.1% | 37.5% | 56.8% | 80.8% | P57 |
| Rev/Bed | $397K | $253K | $505K | $749K | P31 |
| Exp/Bed | $373K | $393K | $537K | $1.1M | P22 |
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.