Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 65% of modeled bridge. Strengths: Bed Count, Commercial Payer %. Risks: Occupancy Rate, Net-to-Gross Ratio. Risk-adjusted uplift: $0.8M (vs $1.2M 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 | $452K | $452K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $435K | $12K | $448K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $69K | $206K | $275K | $867K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $14K | $14K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 64.1% 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 | $113K | $226K | $339K | $452K | $452K | $452K | $452K |
| Denial Rate Reduction | $0 | $112K | $224K | $336K | $448K | $448K | $448K | $448K |
| A/R Days Reduction | $0 | $92K | $183K | $275K | $275K | $275K | $275K | $275K |
| Clean Claim Rate | $0 | $7K | $14K | $14K | $14K | $14K | $14K | $14K |
| Cumulative | $0 | $324K | $648K | $964K | $1.2M | $1.2M | $1.2M | $1.2M |
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 $1.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 56% / 9.3x | 61% / 10.7x | 64% / 12.0x | 66% / 12.7x | 68% / 13.4x |
| 9.0x | 51% / 7.9x | 56% / 9.1x | 60% / 10.3x | 61% / 11.0x | 63% / 11.6x |
| 10.0x | 47% / 6.8x | 51% / 7.9x | 55% / 9.0x | 57% / 9.5x | 59% / 10.1x |
| 11.0x | 42% / 5.8x | 47% / 6.9x | 51% / 7.9x | 53% / 8.4x | 55% / 8.9x |
| 12.0x | 38% / 5.1x | 43% / 6.0x | 47% / 7.0x | 49% / 7.4x | 51% / 7.9x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 16% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 5.5x, adding 3.0 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 | $2.2M | — | $2.2M | 9.5% |
| Year 1 | $2.2M | +$793K | $3.0M | 13.3% |
| Year 2 | $2.3M | +$1.2M | $3.5M | 15.4% |
| Year 3 | $2.4M | +$1.2M | $3.5M | 15.7% |
| Year 4 | $2.4M | +$1.2M | $3.6M | 16.0% |
| Year 5 | $2.5M | +$1.2M | $3.7M | 16.3% |
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% |
|---|---|---|---|---|
| Cost to Collect | $226K | $339K | $452K | $542K |
| Denial Rate Reductio | $224K | $336K | $448K | $537K |
| A/R Days Reduction | $138K | $206K | $275K | $330K |
| Clean Claim Rate | $7K | $11K | $14K | $17K |
| Total | $595K | $892K | $1.2M | $1.4M |
Peer Context — Where This Hospital Sits
Key metrics vs 88 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 9.5% | -12.9% | -3.1% | 2.8% | P95 |
| Net-to-Gross | 62.5% | 52.0% | 59.3% | 64.1% | P69 |
| Occupancy | 35.9% | 15.7% | 30.7% | 41.6% | P62 |
| Rev/Bed | $1.4M | $1.1M | $1.8M | $2.7M | P40 |
| Exp/Bed | $1.3M | $997K | $1.7M | $2.6M | P36 |
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.