Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 60% of modeled bridge. Strengths: Bed Count, Commercial Payer %. Risks: Occupancy Rate, Revenue per Bed. Risk-adjusted uplift: $0.7M (vs $1.2M 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 | $448K | $448K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $431K | $12K | $443K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $69K | $204K | $272K | $858K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $14K | $14K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 61.5% 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 | $112K | $224K | $336K | $448K | $448K | $448K | $448K |
| Denial Rate Reduction | $0 | $111K | $222K | $332K | $443K | $443K | $443K | $443K |
| A/R Days Reduction | $0 | $91K | $182K | $272K | $272K | $272K | $272K | $272K |
| Clean Claim Rate | $0 | $7K | $14K | $14K | $14K | $14K | $14K | $14K |
| Cumulative | $0 | $321K | $641K | $955K | $1.2M | $1.2M | $1.2M | $1.2M |
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 $1.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 170% / 142.4x | 175% / 158.6x | 181% / 174.8x | 183% / 182.9x | 186% / 191.0x |
| 9.0x | 163% / 126.2x | 169% / 140.6x | 174% / 155.0x | 177% / 162.2x | 179% / 169.4x |
| 10.0x | 158% / 113.3x | 163% / 126.2x | 168% / 139.2x | 171% / 145.7x | 173% / 152.1x |
| 11.0x | 153% / 102.7x | 158% / 114.5x | 163% / 126.2x | 166% / 132.1x | 168% / 138.0x |
| 12.0x | 148% / 93.9x | 153% / 104.7x | 159% / 115.5x | 161% / 120.8x | 163% / 126.2x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 93% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 0.4x, adding 8.0 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 | $63K | — | $63K | 0.3% |
| Year 1 | $65K | +$785K | $849K | 3.8% |
| Year 2 | $67K | +$1.2M | $1.2M | 5.6% |
| Year 3 | $69K | +$1.2M | $1.2M | 5.6% |
| Year 4 | $71K | +$1.2M | $1.2M | 5.6% |
| Year 5 | $73K | +$1.2M | $1.2M | 5.6% |
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 | $224K | $336K | $448K | $537K |
| Denial Rate Reductio | $222K | $332K | $443K | $532K |
| A/R Days Reduction | $136K | $204K | $272K | $327K |
| Clean Claim Rate | $7K | $11K | $14K | $17K |
| Total | $589K | $883K | $1.2M | $1.4M |
Peer Context — Where This Hospital Sits
Key metrics vs 94 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 0.3% | -14.5% | -8.3% | -3.1% | P87 |
| Net-to-Gross | 52.5% | 47.2% | 53.5% | 61.5% | P46 |
| Occupancy | 13.3% | 14.6% | 20.6% | 32.9% | P21 |
| Rev/Bed | $895K | $906K | $1.3M | $1.8M | P24 |
| Exp/Bed | $893K | $971K | $1.4M | $2.1M | P20 |
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.