Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 66% of modeled bridge. Risks: Occupancy Rate, Commercial Payer %. Risk-adjusted uplift: $7.1M (vs $10.9M 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 | $4.1M | $4.1M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $4.0M | $113K | $4.1M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $633K | $1.9M | $2.5M | $7.9M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $132K | $132K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 34.7% 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 | $1.0M | $2.1M | $3.1M | $4.1M | $4.1M | $4.1M | $4.1M |
| Denial Rate Reduction | $0 | $1.0M | $2.0M | $3.1M | $4.1M | $4.1M | $4.1M | $4.1M |
| A/R Days Reduction | $0 | $837K | $1.7M | $2.5M | $2.5M | $2.5M | $2.5M | $2.5M |
| Clean Claim Rate | $0 | $66K | $132K | $132K | $132K | $132K | $132K | $132K |
| Cumulative | $0 | $3.0M | $5.9M | $8.8M | $10.9M | $10.9M | $10.9M | $10.9M |
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 $10.9M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 49% / 7.3x | 53% / 8.5x | 58% / 9.7x | 59% / 10.3x | 61% / 10.9x |
| 9.0x | 44% / 6.2x | 48% / 7.2x | 53% / 8.3x | 54% / 8.8x | 56% / 9.3x |
| 10.0x | 39% / 5.2x | 44% / 6.2x | 48% / 7.1x | 50% / 7.6x | 52% / 8.1x |
| 11.0x | 35% / 4.5x | 40% / 5.3x | 44% / 6.2x | 46% / 6.6x | 48% / 7.0x |
| 12.0x | 31% / 3.8x | 36% / 4.6x | 40% / 5.4x | 42% / 5.8x | 44% / 6.2x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline -1% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 6.6x, adding 1.9 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 | $37.6M | — | $37.6M | 18.2% |
| Year 1 | $38.7M | +$7.2M | $46.0M | 22.3% |
| Year 2 | $39.9M | +$10.9M | $50.7M | 24.6% |
| Year 3 | $41.1M | +$10.9M | $51.9M | 25.2% |
| Year 4 | $42.3M | +$10.9M | $53.2M | 25.8% |
| Year 5 | $43.6M | +$10.9M | $54.4M | 26.4% |
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 | $2.1M | $3.1M | $4.1M | $5.0M |
| Denial Rate Reductio | $2.0M | $3.1M | $4.1M | $4.9M |
| A/R Days Reduction | $1.3M | $1.9M | $2.5M | $3.0M |
| Clean Claim Rate | $66K | $99K | $132K | $158K |
| Total | $5.4M | $8.1M | $10.9M | $13.0M |
Peer Context — Where This Hospital Sits
Key metrics vs 53 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 18.2% | -7.1% | 6.2% | 18.2% | P74 |
| Net-to-Gross | 19.9% | 23.8% | 28.3% | 34.7% | P13 |
| Occupancy | 43.0% | 46.9% | 57.2% | 68.3% | P19 |
| Rev/Bed | $1.6M | $512K | $1.6M | $2.1M | P45 |
| Exp/Bed | $1.3M | $508K | $1.5M | $1.9M | P36 |
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.