Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 70% of modeled bridge. Strengths: Occupancy Rate, Payer Diversity. Risks: Commercial Payer %, Revenue per Bed. Risk-adjusted uplift: $1.3M (vs $1.9M 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 | $706K | $706K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $679K | $19K | $699K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $108K | $321K | $429K | $1.4M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $23K | $23K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 34.6% 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 | $176K | $353K | $529K | $706K | $706K | $706K | $706K |
| Denial Rate Reduction | $0 | $175K | $349K | $524K | $699K | $699K | $699K | $699K |
| A/R Days Reduction | $0 | $143K | $286K | $429K | $429K | $429K | $429K | $429K |
| Clean Claim Rate | $0 | $11K | $23K | $23K | $23K | $23K | $23K | $23K |
| Cumulative | $0 | $505K | $1.0M | $1.5M | $1.9M | $1.9M | $1.9M | $1.9M |
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 $1.9M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 44% / 6.2x | 48% / 7.2x | 53% / 8.3x | 54% / 8.8x | 56% / 9.3x |
| 9.0x | 39% / 5.1x | 43% / 6.0x | 47% / 7.0x | 49% / 7.4x | 51% / 7.9x |
| 10.0x | 34% / 4.3x | 39% / 5.1x | 43% / 6.0x | 45% / 6.4x | 47% / 6.8x |
| 11.0x | 29% / 3.6x | 34% / 4.4x | 39% / 5.1x | 41% / 5.5x | 43% / 5.9x |
| 12.0x | 25% / 3.0x | 30% / 3.7x | 35% / 4.4x | 37% / 4.8x | 39% / 5.1x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline -15% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 7.5x, adding 1.0 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 | $14.5M | — | $14.5M | 41.1% |
| Year 1 | $14.9M | +$1.2M | $16.2M | 45.8% |
| Year 2 | $15.4M | +$1.9M | $17.2M | 48.9% |
| Year 3 | $15.8M | +$1.9M | $17.7M | 50.2% |
| Year 4 | $16.3M | +$1.9M | $18.2M | 51.5% |
| Year 5 | $16.8M | +$1.9M | $18.7M | 52.9% |
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 | $353K | $529K | $706K | $847K |
| Denial Rate Reductio | $349K | $524K | $699K | $838K |
| A/R Days Reduction | $215K | $322K | $429K | $515K |
| Clean Claim Rate | $11K | $17K | $23K | $27K |
| Total | $928K | $1.4M | $1.9M | $2.2M |
Peer Context — Where This Hospital Sits
Key metrics vs 49 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 41.1% | -11.0% | -3.4% | 10.3% | P96 |
| Net-to-Gross | 57.6% | 18.5% | 28.3% | 34.6% | P88 |
| Occupancy | 72.8% | 26.5% | 47.7% | 61.5% | P86 |
| Rev/Bed | $436K | $426K | $971K | $1.5M | P27 |
| Exp/Bed | $257K | $423K | $1.0M | $1.5M | 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.