Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 66% of modeled bridge. Strengths: Commercial Payer %. Risks: Revenue per Bed. Risk-adjusted uplift: $0.4M (vs $0.6M 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 | $224K | $224K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $216K | $8K | $224K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $34K | $102K | $136K | $430K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $10K | $10K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 37.5% 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 | $56K | $112K | $168K | $224K | $224K | $224K | $224K |
| Denial Rate Reduction | $0 | $56K | $112K | $168K | $224K | $224K | $224K | $224K |
| A/R Days Reduction | $0 | $45K | $91K | $136K | $136K | $136K | $136K | $136K |
| Clean Claim Rate | $0 | $5K | $10K | $10K | $10K | $10K | $10K | $10K |
| Cumulative | $0 | $162K | $325K | $482K | $595K | $595K | $595K | $595K |
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 $595K is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 65% / 12.2x | 69% / 14.0x | 73% / 15.7x | 75% / 16.5x | 77% / 17.4x |
| 9.0x | 60% / 10.5x | 64% / 12.1x | 68% / 13.6x | 70% / 14.3x | 72% / 15.1x |
| 10.0x | 56% / 9.1x | 60% / 10.5x | 64% / 11.9x | 66% / 12.6x | 68% / 13.3x |
| 11.0x | 52% / 8.0x | 56% / 9.3x | 60% / 10.5x | 62% / 11.1x | 64% / 11.8x |
| 12.0x | 48% / 7.1x | 52% / 8.2x | 56% / 9.4x | 58% / 9.9x | 60% / 10.5x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 34% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.3x, adding 4.1 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 | $620K | — | $620K | 5.5% |
| Year 1 | $639K | +$396K | $1.0M | 9.2% |
| Year 2 | $658K | +$595K | $1.3M | 11.2% |
| Year 3 | $678K | +$595K | $1.3M | 11.3% |
| Year 4 | $698K | +$595K | $1.3M | 11.5% |
| Year 5 | $719K | +$595K | $1.3M | 11.7% |
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 | $112K | $168K | $224K | $269K |
| Denial Rate Reductio | $112K | $168K | $224K | $269K |
| A/R Days Reduction | $68K | $102K | $136K | $164K |
| Clean Claim Rate | $5K | $7K | $10K | $12K |
| Total | $297K | $446K | $595K | $713K |
Peer Context — Where This Hospital Sits
Key metrics vs 121 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 5.5% | -8.8% | 2.8% | 12.0% | P57 |
| Net-to-Gross | 44.9% | 14.0% | 20.7% | 37.5% | P81 |
| Occupancy | 48.7% | 49.1% | 62.9% | 77.4% | P23 |
| Rev/Bed | $129K | $304K | $571K | $1.2M | P8 |
| Exp/Bed | $122K | $338K | $624K | $1.1M | 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.