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: Commercial Payer %, Bed Count. Risks: Occupancy Rate, Revenue per Bed. Risk-adjusted uplift: $0.2M (vs $0.4M 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 |
|---|---|---|---|---|---|---|---|
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $135K | $8K | $143K | $0 | 12mo |
| Cost to Collect | 4.5% DEFAULT | 2.5% BENCHMARK | $0 | $140K | $140K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $22K | $64K | $85K | $269K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $10K | $10K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 51.1% 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 |
|---|---|---|---|---|---|---|---|---|
| Denial Rate Reduction | $0 | $36K | $72K | $107K | $143K | $143K | $143K | $143K |
| Cost to Collect | $0 | $35K | $70K | $105K | $140K | $140K | $140K | $140K |
| A/R Days Reduction | $0 | $28K | $57K | $85K | $85K | $85K | $85K | $85K |
| Clean Claim Rate | $0 | $5K | $10K | $10K | $10K | $10K | $10K | $10K |
| Cumulative | $0 | $104K | $208K | $307K | $378K | $378K | $378K | $378K |
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 $378K is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 49% / 7.2x | 53% / 8.4x | 57% / 9.6x | 59% / 10.2x | 61% / 10.8x |
| 9.0x | 44% / 6.1x | 48% / 7.1x | 52% / 8.2x | 54% / 8.7x | 56% / 9.2x |
| 10.0x | 39% / 5.2x | 44% / 6.1x | 48% / 7.0x | 50% / 7.5x | 51% / 8.0x |
| 11.0x | 34% / 4.4x | 39% / 5.2x | 44% / 6.1x | 45% / 6.5x | 47% / 6.9x |
| 12.0x | 30% / 3.8x | 35% / 4.5x | 40% / 5.3x | 42% / 5.7x | 44% / 6.1x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline -2% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 6.6x, adding 1.8 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 | $1.4M | — | $1.4M | 19.5% |
| Year 1 | $1.4M | +$252K | $1.7M | 23.7% |
| Year 2 | $1.5M | +$378K | $1.8M | 26.1% |
| Year 3 | $1.5M | +$378K | $1.9M | 26.7% |
| Year 4 | $1.5M | +$378K | $1.9M | 27.4% |
| Year 5 | $1.6M | +$378K | $2.0M | 28.0% |
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% |
|---|---|---|---|---|
| Denial Rate Reductio | $72K | $107K | $143K | $172K |
| Cost to Collect | $70K | $105K | $140K | $168K |
| A/R Days Reduction | $43K | $64K | $85K | $102K |
| Clean Claim Rate | $5K | $7K | $10K | $12K |
| Total | $189K | $284K | $378K | $454K |
Peer Context — Where This Hospital Sits
Key metrics vs 96 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 19.5% | -14.5% | 4.3% | 11.8% | P90 |
| Net-to-Gross | 60.0% | 15.8% | 28.7% | 51.1% | P78 |
| Occupancy | 41.2% | 46.8% | 60.6% | 81.5% | P19 |
| Rev/Bed | $140K | $245K | $502K | $940K | P13 |
| Exp/Bed | $113K | $299K | $518K | $933K | P3 |
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.