Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 68% of modeled bridge. Strengths: Commercial Payer %, Bed Count. Risks: Revenue per Bed. Risk-adjusted uplift: $0.2M (vs $0.3M 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 |
|---|---|---|---|---|---|---|---|
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $108K | $8K | $116K | $0 | 12mo |
| Cost to Collect | 4.5% DEFAULT | 2.5% BENCHMARK | $0 | $112K | $112K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $17K | $51K | $68K | $216K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $10K | $10K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 59.8% 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 |
|---|---|---|---|---|---|---|---|---|
| Denial Rate Reduction | $0 | $29K | $58K | $87K | $116K | $116K | $116K | $116K |
| Cost to Collect | $0 | $28K | $56K | $84K | $112K | $112K | $112K | $112K |
| A/R Days Reduction | $0 | $23K | $46K | $68K | $68K | $68K | $68K | $68K |
| Clean Claim Rate | $0 | $5K | $10K | $10K | $10K | $10K | $10K | $10K |
| Cumulative | $0 | $85K | $170K | $250K | $307K | $307K | $307K | $307K |
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 $307K is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 83% / 20.6x | 88% / 23.2x | 92% / 25.9x | 94% / 27.2x | 95% / 28.5x |
| 9.0x | 78% / 17.9x | 83% / 20.3x | 87% / 22.7x | 89% / 23.8x | 90% / 25.0x |
| 10.0x | 74% / 15.8x | 78% / 17.9x | 82% / 20.1x | 84% / 21.1x | 86% / 22.2x |
| 11.0x | 70% / 14.1x | 74% / 16.0x | 78% / 17.9x | 80% / 18.9x | 82% / 19.9x |
| 12.0x | 66% / 12.7x | 71% / 14.4x | 74% / 16.2x | 76% / 17.1x | 78% / 17.9x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 58% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 2.7x, adding 5.7 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 | $146K | — | $146K | 2.6% |
| Year 1 | $150K | +$205K | $355K | 6.3% |
| Year 2 | $155K | +$307K | $462K | 8.2% |
| Year 3 | $160K | +$307K | $467K | 8.3% |
| Year 4 | $164K | +$307K | $471K | 8.4% |
| Year 5 | $169K | +$307K | $476K | 8.5% |
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% |
|---|---|---|---|---|
| Denial Rate Reductio | $58K | $87K | $116K | $140K |
| Cost to Collect | $56K | $84K | $112K | $135K |
| A/R Days Reduction | $34K | $51K | $68K | $82K |
| Clean Claim Rate | $5K | $7K | $10K | $12K |
| Total | $153K | $230K | $307K | $368K |
Peer Context — Where This Hospital Sits
Key metrics vs 130 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 2.6% | -14.8% | -2.1% | 6.3% | P62 |
| Net-to-Gross | 55.5% | 33.1% | 46.2% | 59.8% | P68 |
| Occupancy | 52.6% | 20.5% | 46.4% | 69.8% | P56 |
| Rev/Bed | $234K | $288K | $460K | $881K | P14 |
| Exp/Bed | $228K | $276K | $445K | $961K | P14 |
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.