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: Revenue per Bed, Bed Count. Risks: Occupancy Rate, Net-to-Gross Ratio. Risk-adjusted uplift: $4.8M (vs $7.0M 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 |
|---|---|---|---|---|---|---|---|
| Net Collection Rate | 93.5% DEFAULT | 97.0% BENCHMARK | $2.0M | $0 | $2.0M | $0 | 18mo |
| Cost to Collect | 4.5% DEFAULT | 2.5% BENCHMARK | $0 | $1.9M | $1.9M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $1.8M | $52K | $1.9M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $290K | $860K | $1.2M | $3.6M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $60K | $60K | $0 | 6mo |
| 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 |
|---|---|---|---|---|---|---|---|---|
| Net Collection Rate | $0 | $331K | $662K | $993K | $1.3M | $2.0M | $2.0M | $2.0M |
| Cost to Collect | $0 | $473K | $945K | $1.4M | $1.9M | $1.9M | $1.9M | $1.9M |
| Denial Rate Reduction | $0 | $468K | $936K | $1.4M | $1.9M | $1.9M | $1.9M | $1.9M |
| A/R Days Reduction | $0 | $383K | $767K | $1.2M | $1.2M | $1.2M | $1.2M | $1.2M |
| Clean Claim Rate | $0 | $30K | $60K | $60K | $60K | $60K | $60K | $60K |
| Cumulative | $0 | $1.7M | $3.4M | $5.0M | $6.3M | $7.0M | $7.0M | $7.0M |
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 $7.0M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 51% / 8.0x | 56% / 9.2x | 60% / 10.4x | 62% / 11.1x | 63% / 11.7x |
| 9.0x | 46% / 6.7x | 51% / 7.8x | 55% / 8.9x | 57% / 9.5x | 59% / 10.0x |
| 10.0x | 42% / 5.7x | 46% / 6.7x | 50% / 7.7x | 52% / 8.2x | 54% / 8.7x |
| 11.0x | 37% / 4.9x | 42% / 5.8x | 46% / 6.7x | 48% / 7.2x | 50% / 7.6x |
| 12.0x | 33% / 4.2x | 38% / 5.0x | 42% / 5.9x | 44% / 6.3x | 46% / 6.7x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 5% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 6.2x, adding 2.3 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 | $18.7M | — | $18.7M | 19.8% |
| Year 1 | $19.3M | +$4.6M | $23.9M | 25.3% |
| Year 2 | $19.9M | +$7.0M | $26.8M | 28.4% |
| Year 3 | $20.5M | +$7.0M | $27.4M | 29.0% |
| Year 4 | $21.1M | +$7.0M | $28.0M | 29.6% |
| Year 5 | $21.7M | +$7.0M | $28.7M | 30.3% |
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% |
|---|---|---|---|---|
| Net Collection Rate | $993K | $1.5M | $2.0M | $2.4M |
| Cost to Collect | $945K | $1.4M | $1.9M | $2.3M |
| Denial Rate Reductio | $936K | $1.4M | $1.9M | $2.2M |
| A/R Days Reduction | $575K | $863K | $1.2M | $1.4M |
| Clean Claim Rate | $30K | $45K | $60K | $73K |
| Total | $3.5M | $5.2M | $7.0M | $8.3M |
Peer Context — Where This Hospital Sits
Key metrics vs 12 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 19.8% | -35.1% | -25.8% | -5.1% | P89 |
| Net-to-Gross | 60.1% | 36.0% | 53.3% | 60.1% | P67 |
| Occupancy | 40.0% | 43.0% | 55.7% | 85.2% | P17 |
| Rev/Bed | $3.9M | $1.4M | $3.9M | $4.9M | P44 |
| Exp/Bed | $3.2M | $649K | $2.2M | $5.0M | P58 |
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.