Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 67% of modeled bridge. Strengths: Occupancy Rate, Payer Diversity. Risks: Revenue per Bed, Commercial Payer %. Risk-adjusted uplift: $0.3M (vs $0.4M 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 | $137K | $8K | $146K | $0 | 12mo |
| Cost to Collect | 4.5% DEFAULT | 2.5% BENCHMARK | $0 | $143K | $143K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $22K | $65K | $87K | $274K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $10K | $10K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 56.4% 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 |
|---|---|---|---|---|---|---|---|---|
| Denial Rate Reduction | $0 | $36K | $73K | $109K | $146K | $146K | $146K | $146K |
| Cost to Collect | $0 | $36K | $71K | $107K | $143K | $143K | $143K | $143K |
| A/R Days Reduction | $0 | $29K | $58K | $87K | $87K | $87K | $87K | $87K |
| Clean Claim Rate | $0 | $5K | $10K | $10K | $10K | $10K | $10K | $10K |
| Cumulative | $0 | $106K | $212K | $313K | $385K | $385K | $385K | $385K |
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 $385K is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 54% / 8.6x | 58% / 9.9x | 62% / 11.2x | 64% / 11.9x | 66% / 12.6x |
| 9.0x | 49% / 7.3x | 53% / 8.5x | 57% / 9.6x | 59% / 10.2x | 61% / 10.8x |
| 10.0x | 44% / 6.2x | 49% / 7.3x | 53% / 8.3x | 55% / 8.9x | 57% / 9.4x |
| 11.0x | 40% / 5.4x | 45% / 6.3x | 49% / 7.3x | 51% / 7.8x | 52% / 8.2x |
| 12.0x | 36% / 4.7x | 41% / 5.5x | 45% / 6.4x | 47% / 6.8x | 49% / 7.3x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 11% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 5.8x, adding 2.7 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 | $834K | — | $834K | 11.7% |
| Year 1 | $859K | +$256K | $1.1M | 15.6% |
| Year 2 | $885K | +$385K | $1.3M | 17.8% |
| Year 3 | $911K | +$385K | $1.3M | 18.2% |
| Year 4 | $938K | +$385K | $1.3M | 18.6% |
| Year 5 | $967K | +$385K | $1.4M | 18.9% |
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% |
|---|---|---|---|---|
| Denial Rate Reductio | $73K | $109K | $146K | $175K |
| Cost to Collect | $71K | $107K | $143K | $171K |
| A/R Days Reduction | $43K | $65K | $87K | $104K |
| Clean Claim Rate | $5K | $7K | $10K | $12K |
| Total | $192K | $288K | $385K | $461K |
Peer Context — Where This Hospital Sits
Key metrics vs 127 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 11.7% | -21.2% | -4.1% | 4.8% | P87 |
| Net-to-Gross | 68.9% | 31.6% | 42.9% | 56.4% | P91 |
| Occupancy | 62.0% | 21.5% | 46.4% | 64.9% | P69 |
| Rev/Bed | $188K | $277K | $445K | $856K | P7 |
| Exp/Bed | $166K | $269K | $447K | $965K | P6 |
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.