Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 65% of modeled bridge. Strengths: Payer Diversity. Risks: Commercial Payer %, Revenue per Bed. Risk-adjusted uplift: $1.3M (vs $2.0M 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 | $765K | $765K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $737K | $21K | $758K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $117K | $348K | $466K | $1.5M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $24K | $24K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 42.7% 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 | $191K | $383K | $574K | $765K | $765K | $765K | $765K |
| Denial Rate Reduction | $0 | $189K | $379K | $568K | $758K | $758K | $758K | $758K |
| A/R Days Reduction | $0 | $155K | $310K | $466K | $466K | $466K | $466K | $466K |
| Clean Claim Rate | $0 | $12K | $24K | $24K | $24K | $24K | $24K | $24K |
| Cumulative | $0 | $548K | $1.1M | $1.6M | $2.0M | $2.0M | $2.0M | $2.0M |
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 $2.0M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 44% / 6.1x | 48% / 7.1x | 52% / 8.2x | 54% / 8.7x | 56% / 9.2x |
| 9.0x | 38% / 5.1x | 43% / 6.0x | 47% / 6.9x | 49% / 7.4x | 51% / 7.8x |
| 10.0x | 33% / 4.2x | 38% / 5.1x | 43% / 5.9x | 45% / 6.3x | 46% / 6.7x |
| 11.0x | 29% / 3.5x | 34% / 4.3x | 38% / 5.1x | 40% / 5.4x | 42% / 5.8x |
| 12.0x | 24% / 3.0x | 30% / 3.7x | 34% / 4.4x | 36% / 4.7x | 38% / 5.1x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline -16% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 7.6x, adding 0.9 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 | $17.0M | — | $17.0M | 44.4% |
| Year 1 | $17.5M | +$1.3M | $18.8M | 49.2% |
| Year 2 | $18.0M | +$2.0M | $20.0M | 52.4% |
| Year 3 | $18.6M | +$2.0M | $20.6M | 53.8% |
| Year 4 | $19.1M | +$2.0M | $21.1M | 55.2% |
| Year 5 | $19.7M | +$2.0M | $21.7M | 56.7% |
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 | $383K | $574K | $765K | $919K |
| Denial Rate Reductio | $379K | $568K | $758K | $909K |
| A/R Days Reduction | $233K | $349K | $466K | $559K |
| Clean Claim Rate | $12K | $18K | $24K | $29K |
| Total | $1.0M | $1.5M | $2.0M | $2.4M |
Peer Context — Where This Hospital Sits
Key metrics vs 43 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 44.4% | -10.1% | 0.7% | 10.3% | P98 |
| Net-to-Gross | 85.9% | 18.0% | 27.8% | 42.7% | P98 |
| Occupancy | 54.0% | 40.8% | 52.9% | 65.5% | P53 |
| Rev/Bed | $348K | $420K | $971K | $1.5M | P21 |
| Exp/Bed | $193K | $390K | $1.0M | $1.5M | P5 |
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.