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. Risk-adjusted uplift: $6.5M (vs $9.2M 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 | $3.5M | $3.5M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $3.4M | $97K | $3.5M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $539K | $1.6M | $2.1M | $6.7M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $113K | $113K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 33.7% 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 | $879K | $1.8M | $2.6M | $3.5M | $3.5M | $3.5M | $3.5M |
| Denial Rate Reduction | $0 | $870K | $1.7M | $2.6M | $3.5M | $3.5M | $3.5M | $3.5M |
| A/R Days Reduction | $0 | $713K | $1.4M | $2.1M | $2.1M | $2.1M | $2.1M | $2.1M |
| Clean Claim Rate | $0 | $56K | $113K | $113K | $113K | $113K | $113K | $113K |
| Cumulative | $0 | $2.5M | $5.0M | $7.5M | $9.2M | $9.2M | $9.2M | $9.2M |
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 $9.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 115% / 46.3x | 120% / 51.8x | 125% / 57.4x | 127% / 60.1x | 129% / 62.9x |
| 9.0x | 110% / 40.8x | 115% / 45.7x | 119% / 50.6x | 121% / 53.1x | 123% / 55.5x |
| 10.0x | 105% / 36.4x | 110% / 40.8x | 114% / 45.2x | 116% / 47.4x | 118% / 49.6x |
| 11.0x | 101% / 32.8x | 106% / 36.8x | 110% / 40.8x | 112% / 42.8x | 114% / 44.8x |
| 12.0x | 97% / 29.8x | 102% / 33.5x | 106% / 37.1x | 108% / 39.0x | 110% / 40.8x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 80% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 1.3x, adding 7.2 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 | $1.6M | — | $1.6M | 0.9% |
| Year 1 | $1.7M | +$6.2M | $7.9M | 4.5% |
| Year 2 | $1.7M | +$9.2M | $11.0M | 6.3% |
| Year 3 | $1.8M | +$9.2M | $11.0M | 6.3% |
| Year 4 | $1.9M | +$9.2M | $11.1M | 6.3% |
| Year 5 | $1.9M | +$9.2M | $11.2M | 6.3% |
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 | $1.8M | $2.6M | $3.5M | $4.2M |
| Denial Rate Reductio | $1.7M | $2.6M | $3.5M | $4.2M |
| A/R Days Reduction | $1.1M | $1.6M | $2.1M | $2.6M |
| Clean Claim Rate | $56K | $84K | $113K | $135K |
| Total | $4.6M | $6.9M | $9.2M | $11.1M |
Peer Context — Where This Hospital Sits
Key metrics vs 90 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 0.9% | -21.2% | -8.2% | 5.1% | P66 |
| Net-to-Gross | 25.2% | 21.2% | 25.7% | 33.7% | P46 |
| Occupancy | 64.2% | 39.2% | 53.1% | 68.9% | P68 |
| Rev/Bed | $1.4M | $580K | $980K | $1.6M | P66 |
| Exp/Bed | $1.4M | $581K | $1.1M | $1.7M | P66 |
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.