Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 61% of modeled bridge. Strengths: Bed Count, Payer Diversity. Risks: Occupancy Rate, Commercial Payer %. Risk-adjusted uplift: $0.9M (vs $1.5M 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 | $588K | $588K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $566K | $16K | $583K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $90K | $268K | $358K | $1.1M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $19K | $19K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 48.9% 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 | $147K | $294K | $441K | $588K | $588K | $588K | $588K |
| Denial Rate Reduction | $0 | $146K | $291K | $437K | $583K | $583K | $583K | $583K |
| A/R Days Reduction | $0 | $119K | $239K | $358K | $358K | $358K | $358K | $358K |
| Clean Claim Rate | $0 | $9K | $19K | $19K | $19K | $19K | $19K | $19K |
| Cumulative | $0 | $421K | $843K | $1.3M | $1.5M | $1.5M | $1.5M | $1.5M |
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 $1.5M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 59% / 10.0x | 63% / 11.5x | 67% / 13.0x | 69% / 13.7x | 71% / 14.5x |
| 9.0x | 54% / 8.6x | 58% / 9.9x | 62% / 11.2x | 64% / 11.8x | 66% / 12.5x |
| 10.0x | 49% / 7.4x | 54% / 8.6x | 58% / 9.7x | 60% / 10.3x | 61% / 10.9x |
| 11.0x | 45% / 6.4x | 50% / 7.5x | 54% / 8.6x | 56% / 9.1x | 57% / 9.6x |
| 12.0x | 41% / 5.6x | 46% / 6.6x | 50% / 7.6x | 52% / 8.1x | 54% / 8.6x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 21% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 5.1x, adding 3.4 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 | $2.4M | — | $2.4M | 8.0% |
| Year 1 | $2.4M | +$1.0M | $3.5M | 11.7% |
| Year 2 | $2.5M | +$1.5M | $4.0M | 13.7% |
| Year 3 | $2.6M | +$1.5M | $4.1M | 14.0% |
| Year 4 | $2.6M | +$1.5M | $4.2M | 14.3% |
| Year 5 | $2.7M | +$1.5M | $4.3M | 14.5% |
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 | $294K | $441K | $588K | $706K |
| Denial Rate Reductio | $291K | $437K | $583K | $699K |
| A/R Days Reduction | $179K | $269K | $358K | $430K |
| Clean Claim Rate | $9K | $14K | $19K | $23K |
| Total | $774K | $1.2M | $1.5M | $1.9M |
Peer Context — Where This Hospital Sits
Key metrics vs 76 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | -50.0% | -8.0% | -3.0% | 4.4% | P0 |
| Net-to-Gross | 22.5% | 33.6% | 43.0% | 48.9% | P3 |
| Occupancy | 21.8% | 19.1% | 27.6% | 42.3% | P34 |
| Rev/Bed | $949K | $993K | $1.4M | $2.0M | P22 |
| Exp/Bed | $2.6M | $1.2M | $1.5M | $2.0M | P89 |
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.