Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 64% of modeled bridge. Strengths: Bed Count, Revenue per Bed. Risks: Occupancy Rate. Risk-adjusted uplift: $1.4M (vs $2.2M 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 | $833K | $833K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $802K | $23K | $824K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $128K | $379K | $507K | $1.6M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $27K | $27K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 63.5% 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 | $208K | $416K | $625K | $833K | $833K | $833K | $833K |
| Denial Rate Reduction | $0 | $206K | $412K | $618K | $824K | $824K | $824K | $824K |
| A/R Days Reduction | $0 | $169K | $338K | $507K | $507K | $507K | $507K | $507K |
| Clean Claim Rate | $0 | $13K | $27K | $27K | $27K | $27K | $27K | $27K |
| Cumulative | $0 | $597K | $1.2M | $1.8M | $2.2M | $2.2M | $2.2M | $2.2M |
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 $2.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 87% / 23.1x | 92% / 26.1x | 96% / 29.0x | 98% / 30.5x | 100% / 31.9x |
| 9.0x | 82% / 20.2x | 87% / 22.8x | 91% / 25.4x | 93% / 26.7x | 95% / 28.0x |
| 10.0x | 78% / 17.9x | 82% / 20.2x | 86% / 22.6x | 88% / 23.7x | 90% / 24.9x |
| 11.0x | 74% / 15.9x | 78% / 18.1x | 82% / 20.2x | 84% / 21.3x | 86% / 22.3x |
| 12.0x | 70% / 14.3x | 75% / 16.3x | 79% / 18.2x | 81% / 19.2x | 82% / 20.2x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 62% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 2.5x, adding 6.0 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 | $895K | — | $895K | 2.1% |
| Year 1 | $922K | +$1.5M | $2.4M | 5.7% |
| Year 2 | $949K | +$2.2M | $3.1M | 7.5% |
| Year 3 | $978K | +$2.2M | $3.2M | 7.6% |
| Year 4 | $1.0M | +$2.2M | $3.2M | 7.7% |
| Year 5 | $1.0M | +$2.2M | $3.2M | 7.8% |
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 | $416K | $625K | $833K | $999K |
| Denial Rate Reductio | $412K | $618K | $824K | $989K |
| A/R Days Reduction | $253K | $380K | $507K | $608K |
| Clean Claim Rate | $13K | $20K | $27K | $32K |
| Total | $1.1M | $1.6M | $2.2M | $2.6M |
Peer Context — Where This Hospital Sits
Key metrics vs 95 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 2.1% | -11.7% | -2.6% | 3.2% | P67 |
| Net-to-Gross | 54.8% | 50.0% | 57.6% | 63.5% | P39 |
| Occupancy | 27.4% | 16.0% | 32.0% | 44.3% | P40 |
| Rev/Bed | $2.1M | $1.1M | $1.8M | $2.7M | P59 |
| Exp/Bed | $2.0M | $1.1M | $1.8M | $2.7M | P59 |
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.