Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 76% of modeled bridge. Strengths: Occupancy Rate, Commercial Payer %. Risks: Revenue per Bed. Risk-adjusted uplift: $0.5M (vs $0.6M 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 | $240K | $240K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $231K | $8K | $239K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $37K | $109K | $146K | $460K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $10K | $10K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 61.4% 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 | $60K | $120K | $180K | $240K | $240K | $240K | $240K |
| Denial Rate Reduction | $0 | $60K | $119K | $179K | $239K | $239K | $239K | $239K |
| A/R Days Reduction | $0 | $49K | $97K | $146K | $146K | $146K | $146K | $146K |
| Clean Claim Rate | $0 | $5K | $10K | $10K | $10K | $10K | $10K | $10K |
| Cumulative | $0 | $173K | $346K | $514K | $634K | $634K | $634K | $634K |
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 $634K is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 47% / 6.8x | 51% / 7.9x | 55% / 9.0x | 57% / 9.5x | 59% / 10.1x |
| 9.0x | 41% / 5.7x | 46% / 6.6x | 50% / 7.6x | 52% / 8.1x | 54% / 8.6x |
| 10.0x | 37% / 4.8x | 41% / 5.7x | 46% / 6.5x | 48% / 7.0x | 49% / 7.4x |
| 11.0x | 32% / 4.0x | 37% / 4.8x | 41% / 5.7x | 43% / 6.1x | 45% / 6.5x |
| 12.0x | 28% / 3.4x | 33% / 4.2x | 37% / 4.9x | 39% / 5.3x | 41% / 5.7x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline -8% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 7.0x, adding 1.5 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 | $3.0M | — | $3.0M | 25.2% |
| Year 1 | $3.1M | +$423K | $3.5M | 29.5% |
| Year 2 | $3.2M | +$634K | $3.8M | 32.1% |
| Year 3 | $3.3M | +$634K | $3.9M | 32.9% |
| Year 4 | $3.4M | +$634K | $4.0M | 33.7% |
| Year 5 | $3.5M | +$634K | $4.1M | 34.5% |
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 | $120K | $180K | $240K | $288K |
| Denial Rate Reductio | $119K | $179K | $239K | $287K |
| A/R Days Reduction | $73K | $109K | $146K | $175K |
| Clean Claim Rate | $5K | $7K | $10K | $12K |
| Total | $317K | $476K | $634K | $761K |
Peer Context — Where This Hospital Sits
Key metrics vs 107 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 25.2% | -14.1% | -1.8% | 7.7% | P94 |
| Net-to-Gross | 48.6% | 35.2% | 48.0% | 61.4% | P51 |
| Occupancy | 90.2% | 21.1% | 48.9% | 69.5% | P98 |
| Rev/Bed | $666K | $290K | $544K | $1.0M | P57 |
| Exp/Bed | $498K | $280K | $536K | $1.1M | P48 |
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.