TRINITY HEALTH LIVINGSTON
value-creation walk.
7-lever RCM bridge from current EBITDA to pro-forma — denial / underpay / DAR / coding / contract / cost discipline / cash acceleration. Each lever shows current vs benchmark target with data provenance.
Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 78% of modeled bridge. Strengths: Occupancy Rate, Revenue per Bed. Risk-adjusted uplift: $8.2M (vs $10.5M 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 | $4.0M | $4.0M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $3.9M | $110K | $4.0M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $615K | $1.8M | $2.4M | $7.7M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $128K | $128K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 46.5% 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 | $1.0M | $2.0M | $3.0M | $4.0M | $4.0M | $4.0M | $4.0M |
| Denial Rate Reduction | $0 | $992K | $2.0M | $3.0M | $4.0M | $4.0M | $4.0M | $4.0M |
| A/R Days Reduction | $0 | $813K | $1.6M | $2.4M | $2.4M | $2.4M | $2.4M | $2.4M |
| Clean Claim Rate | $0 | $64K | $128K | $128K | $128K | $128K | $128K | $128K |
| Cumulative | $0 | $2.9M | $5.7M | $8.6M | $10.5M | $10.5M | $10.5M | $10.5M |
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 $10.5M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 51% / 7.8x | 55% / 9.0x | 59% / 10.2x | 61% / 10.8x | 63% / 11.4x |
| 9.0x | 46% / 6.5x | 50% / 7.6x | 54% / 8.7x | 56% / 9.2x | 58% / 9.8x |
| 10.0x | 41% / 5.5x | 46% / 6.5x | 50% / 7.5x | 52% / 8.0x | 53% / 8.5x |
| 11.0x | 37% / 4.8x | 41% / 5.6x | 46% / 6.5x | 47% / 7.0x | 49% / 7.4x |
| 12.0x | 33% / 4.1x | 37% / 4.9x | 42% / 5.7x | 44% / 6.1x | 46% / 6.5x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 3% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 6.3x, adding 2.2 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 | $30.6M | — | $30.6M | 15.2% |
| Year 1 | $31.5M | +$7.0M | $38.5M | 19.2% |
| Year 2 | $32.4M | +$10.5M | $43.0M | 21.4% |
| Year 3 | $33.4M | +$10.5M | $43.9M | 21.9% |
| Year 4 | $34.4M | +$10.5M | $44.9M | 22.4% |
| Year 5 | $35.4M | +$10.5M | $46.0M | 22.9% |
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% |
|---|---|---|---|---|
| Cost to Collect | $2.0M | $3.0M | $4.0M | $4.8M |
| Denial Rate Reductio | $2.0M | $3.0M | $4.0M | $4.8M |
| A/R Days Reduction | $1.2M | $1.8M | $2.4M | $2.9M |
| Clean Claim Rate | $64K | $96K | $128K | $154K |
| Total | $5.3M | $7.9M | $10.5M | $12.7M |
Peer Context — Where This Hospital Sits
Key metrics vs 75 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 15.2% | -12.4% | -3.3% | 8.3% | P91 |
| Net-to-Gross | 27.2% | 31.4% | 37.3% | 46.5% | P15 |
| Occupancy | 76.0% | 17.4% | 36.4% | 55.1% | P88 |
| Rev/Bed | $4.8M | $646K | $1.4M | $2.3M | P99 |
| Exp/Bed | $4.0M | $617K | $1.5M | $2.3M | P99 |
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.