Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 75% of modeled bridge. Strengths: Occupancy Rate. Risk-adjusted uplift: $10.6M (vs $14.2M 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 | $5.4M | $5.4M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $5.2M | $148K | $5.3M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $826K | $2.4M | $3.3M | $10.3M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $172K | $172K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 29.4% 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 | $1.3M | $2.7M | $4.0M | $5.4M | $5.4M | $5.4M | $5.4M |
| Denial Rate Reduction | $0 | $1.3M | $2.7M | $4.0M | $5.3M | $5.3M | $5.3M | $5.3M |
| A/R Days Reduction | $0 | $1.1M | $2.2M | $3.3M | $3.3M | $3.3M | $3.3M | $3.3M |
| Clean Claim Rate | $0 | $86K | $172K | $172K | $172K | $172K | $172K | $172K |
| Cumulative | $0 | $3.9M | $7.7M | $11.5M | $14.2M | $14.2M | $14.2M | $14.2M |
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 $14.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 74% / 16.1x | 79% / 18.3x | 83% / 20.4x | 85% / 21.5x | 87% / 22.6x |
| 9.0x | 69% / 14.0x | 74% / 15.9x | 78% / 17.8x | 80% / 18.8x | 82% / 19.7x |
| 10.0x | 65% / 12.2x | 69% / 14.0x | 73% / 15.7x | 75% / 16.6x | 77% / 17.4x |
| 11.0x | 61% / 10.8x | 65% / 12.4x | 69% / 14.0x | 71% / 14.8x | 73% / 15.5x |
| 12.0x | 57% / 9.7x | 62% / 11.1x | 66% / 12.5x | 68% / 13.3x | 69% / 14.0x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 48% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 3.4x, adding 5.1 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 | $9.5M | — | $9.5M | 3.5% |
| Year 1 | $9.8M | +$9.4M | $19.2M | 7.1% |
| Year 2 | $10.1M | +$14.2M | $24.2M | 9.0% |
| Year 3 | $10.4M | +$14.2M | $24.5M | 9.1% |
| Year 4 | $10.7M | +$14.2M | $24.8M | 9.2% |
| Year 5 | $11.0M | +$14.2M | $25.2M | 9.4% |
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 | $2.7M | $4.0M | $5.4M | $6.5M |
| Denial Rate Reductio | $2.7M | $4.0M | $5.3M | $6.4M |
| A/R Days Reduction | $1.6M | $2.5M | $3.3M | $3.9M |
| Clean Claim Rate | $86K | $129K | $172K | $207K |
| Total | $7.1M | $10.6M | $14.2M | $17.0M |
Peer Context — Where This Hospital Sits
Key metrics vs 54 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 3.5% | -12.8% | -0.9% | 6.9% | P65 |
| Net-to-Gross | 29.9% | 16.7% | 23.2% | 29.4% | P75 |
| Occupancy | 87.4% | 59.6% | 75.1% | 84.5% | P76 |
| Rev/Bed | $1.7M | $715K | $1.3M | $1.7M | P77 |
| Exp/Bed | $1.7M | $813K | $1.3M | $1.8M | P72 |
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.