Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 58% of modeled bridge. Strengths: Commercial Payer %, Bed Count. Risks: Occupancy Rate, Revenue per Bed. Risk-adjusted uplift: $0.5M (vs $0.8M 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 | $307K | $307K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $296K | $8K | $304K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $47K | $140K | $187K | $589K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $10K | $10K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 41.1% 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 | $77K | $154K | $230K | $307K | $307K | $307K | $307K |
| Denial Rate Reduction | $0 | $76K | $152K | $228K | $304K | $304K | $304K | $304K |
| A/R Days Reduction | $0 | $62K | $125K | $187K | $187K | $187K | $187K | $187K |
| Clean Claim Rate | $0 | $5K | $10K | $10K | $10K | $10K | $10K | $10K |
| Cumulative | $0 | $220K | $440K | $655K | $808K | $808K | $808K | $808K |
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 $808K is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 72% / 15.1x | 76% / 17.1x | 80% / 19.1x | 82% / 20.1x | 84% / 21.2x |
| 9.0x | 67% / 13.0x | 72% / 14.8x | 76% / 16.6x | 77% / 17.6x | 79% / 18.5x |
| 10.0x | 63% / 11.4x | 67% / 13.0x | 71% / 14.7x | 73% / 15.5x | 75% / 16.3x |
| 11.0x | 59% / 10.1x | 63% / 11.6x | 67% / 13.0x | 69% / 13.8x | 71% / 14.5x |
| 12.0x | 55% / 9.0x | 59% / 10.3x | 63% / 11.7x | 65% / 12.3x | 67% / 13.0x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 44% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 3.6x, adding 4.9 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 | $601K | — | $601K | 3.9% |
| Year 1 | $619K | +$539K | $1.2M | 7.5% |
| Year 2 | $638K | +$808K | $1.4M | 9.4% |
| Year 3 | $657K | +$808K | $1.5M | 9.5% |
| Year 4 | $676K | +$808K | $1.5M | 9.7% |
| Year 5 | $697K | +$808K | $1.5M | 9.8% |
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 | $154K | $230K | $307K | $369K |
| Denial Rate Reductio | $152K | $228K | $304K | $365K |
| A/R Days Reduction | $93K | $140K | $187K | $224K |
| Clean Claim Rate | $5K | $7K | $10K | $12K |
| Total | $404K | $606K | $808K | $970K |
Peer Context — Where This Hospital Sits
Key metrics vs 69 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 3.9% | -11.0% | -1.0% | 10.3% | P59 |
| Net-to-Gross | 33.7% | 20.7% | 30.7% | 41.1% | P58 |
| Occupancy | 6.6% | 25.6% | 35.9% | 53.5% | P0 |
| Rev/Bed | $314K | $472K | $844K | $1.3M | P9 |
| Exp/Bed | $301K | $472K | $961K | $1.3M | P10 |
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.