Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 75% of modeled bridge. Strengths: Occupancy Rate, Commercial Payer %. Risks: Revenue per Bed, Net-to-Gross Ratio. Risk-adjusted uplift: $1.5M (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 | $745K | $745K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $717K | $20K | $737K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $114K | $339K | $453K | $1.4M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $24K | $24K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 85.7% 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 | $186K | $372K | $559K | $745K | $745K | $745K | $745K |
| Denial Rate Reduction | $0 | $184K | $369K | $553K | $737K | $737K | $737K | $737K |
| A/R Days Reduction | $0 | $151K | $302K | $453K | $453K | $453K | $453K | $453K |
| Clean Claim Rate | $0 | $12K | $24K | $24K | $24K | $24K | $24K | $24K |
| Cumulative | $0 | $533K | $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 | 49% / 7.5x | 54% / 8.7x | 58% / 9.8x | 60% / 10.4x | 62% / 11.0x |
| 9.0x | 44% / 6.3x | 49% / 7.3x | 53% / 8.4x | 55% / 8.9x | 57% / 9.4x |
| 10.0x | 40% / 5.3x | 44% / 6.3x | 49% / 7.2x | 50% / 7.7x | 52% / 8.2x |
| 11.0x | 35% / 4.5x | 40% / 5.4x | 44% / 6.3x | 46% / 6.7x | 48% / 7.1x |
| 12.0x | 31% / 3.9x | 36% / 4.7x | 41% / 5.5x | 43% / 5.9x | 44% / 6.3x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 0% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 6.5x, adding 2.0 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 | $6.4M | — | $6.4M | 17.2% |
| Year 1 | $6.6M | +$1.3M | $7.9M | 21.2% |
| Year 2 | $6.8M | +$2.0M | $8.8M | 23.5% |
| Year 3 | $7.0M | +$2.0M | $9.0M | 24.1% |
| Year 4 | $7.2M | +$2.0M | $9.2M | 24.6% |
| Year 5 | $7.4M | +$2.0M | $9.4M | 25.2% |
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 | $372K | $559K | $745K | $894K |
| Denial Rate Reductio | $369K | $553K | $737K | $885K |
| A/R Days Reduction | $227K | $340K | $453K | $544K |
| Clean Claim Rate | $12K | $18K | $24K | $29K |
| Total | $980K | $1.5M | $2.0M | $2.4M |
Peer Context — Where This Hospital Sits
Key metrics vs 21 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 17.2% | -13.3% | -4.1% | 0.4% | P94 |
| Net-to-Gross | 69.2% | 77.1% | 82.8% | 85.7% | P12 |
| Occupancy | 85.8% | 62.9% | 69.9% | 79.0% | P75 |
| Rev/Bed | $503K | $736K | $1.5M | $1.9M | P12 |
| Exp/Bed | $417K | $407K | $1.2M | $2.1M | P29 |
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.