Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 71% of modeled bridge. Strengths: Occupancy Rate. Risks: Bed Count. Risk-adjusted uplift: $32.0M (vs $45.4M 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 | $17.2M | $17.2M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $16.6M | $474K | $17.1M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $2.6M | $7.8M | $10.5M | $33.1M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $552K | $552K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 32.0% 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 | $4.3M | $8.6M | $12.9M | $17.2M | $17.2M | $17.2M | $17.2M |
| Denial Rate Reduction | $0 | $4.3M | $8.5M | $12.8M | $17.1M | $17.1M | $17.1M | $17.1M |
| A/R Days Reduction | $0 | $3.5M | $7.0M | $10.5M | $10.5M | $10.5M | $10.5M | $10.5M |
| Clean Claim Rate | $0 | $276K | $552K | $552K | $552K | $552K | $552K | $552K |
| Cumulative | $0 | $12.4M | $24.7M | $36.8M | $45.4M | $45.4M | $45.4M | $45.4M |
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 $45.4M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 56% / 9.4x | 61% / 10.8x | 65% / 12.2x | 67% / 12.9x | 68% / 13.6x |
| 9.0x | 51% / 8.0x | 56% / 9.2x | 60% / 10.5x | 62% / 11.1x | 64% / 11.7x |
| 10.0x | 47% / 6.8x | 51% / 8.0x | 55% / 9.1x | 57% / 9.7x | 59% / 10.2x |
| 11.0x | 43% / 5.9x | 47% / 7.0x | 51% / 8.0x | 53% / 8.5x | 55% / 9.0x |
| 12.0x | 39% / 5.2x | 44% / 6.1x | 48% / 7.0x | 50% / 7.5x | 51% / 8.0x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 17% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 5.4x, adding 3.1 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 | $80.2M | — | $80.2M | 9.3% |
| Year 1 | $82.6M | +$30.2M | $112.8M | 13.1% |
| Year 2 | $85.1M | +$45.4M | $130.4M | 15.1% |
| Year 3 | $87.6M | +$45.4M | $133.0M | 15.4% |
| Year 4 | $90.2M | +$45.4M | $135.6M | 15.7% |
| Year 5 | $93.0M | +$45.4M | $138.3M | 16.0% |
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 | $8.6M | $12.9M | $17.2M | $20.7M |
| Denial Rate Reductio | $8.5M | $12.8M | $17.1M | $20.5M |
| A/R Days Reduction | $5.2M | $7.9M | $10.5M | $12.6M |
| Clean Claim Rate | $276K | $414K | $552K | $662K |
| Total | $22.7M | $34.0M | $45.4M | $54.4M |
Peer Context — Where This Hospital Sits
Key metrics vs 760 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 9.3% | -14.5% | -4.3% | 5.1% | P83 |
| Net-to-Gross | 25.1% | 19.0% | 25.5% | 32.0% | P48 |
| Occupancy | 83.4% | 64.1% | 73.5% | 81.6% | P80 |
| Rev/Bed | $1.5M | $1.2M | $1.7M | $2.2M | P40 |
| Exp/Bed | $1.4M | $1.2M | $1.7M | $2.3M | P33 |
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.