Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 63% of modeled bridge. Strengths: Commercial Payer %. Risks: Occupancy Rate, Revenue per Bed. Risk-adjusted uplift: $1.5M (vs $2.4M 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 | $919K | $919K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $885K | $25K | $910K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $141K | $418K | $559K | $1.8M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $29K | $29K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 31.7% 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 | $230K | $460K | $689K | $919K | $919K | $919K | $919K |
| Denial Rate Reduction | $0 | $227K | $455K | $682K | $910K | $910K | $910K | $910K |
| A/R Days Reduction | $0 | $186K | $373K | $559K | $559K | $559K | $559K | $559K |
| Clean Claim Rate | $0 | $15K | $29K | $29K | $29K | $29K | $29K | $29K |
| Cumulative | $0 | $658K | $1.3M | $2.0M | $2.4M | $2.4M | $2.4M | $2.4M |
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 $2.4M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 63% / 11.4x | 67% / 13.1x | 71% / 14.7x | 73% / 15.5x | 75% / 16.3x |
| 9.0x | 58% / 9.8x | 62% / 11.2x | 66% / 12.7x | 68% / 13.4x | 70% / 14.1x |
| 10.0x | 53% / 8.5x | 58% / 9.8x | 62% / 11.1x | 64% / 11.8x | 65% / 12.4x |
| 11.0x | 49% / 7.4x | 54% / 8.6x | 58% / 9.8x | 60% / 10.4x | 61% / 11.0x |
| 12.0x | 46% / 6.5x | 50% / 7.6x | 54% / 8.7x | 56% / 9.2x | 58% / 9.8x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 30% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.6x, adding 3.9 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 | $2.9M | — | $2.9M | 6.2% |
| Year 1 | $2.9M | +$1.6M | $4.6M | 9.9% |
| Year 2 | $3.0M | +$2.4M | $5.4M | 11.8% |
| Year 3 | $3.1M | +$2.4M | $5.5M | 12.0% |
| Year 4 | $3.2M | +$2.4M | $5.6M | 12.2% |
| Year 5 | $3.3M | +$2.4M | $5.7M | 12.5% |
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 | $460K | $689K | $919K | $1.1M |
| Denial Rate Reductio | $455K | $682K | $910K | $1.1M |
| A/R Days Reduction | $280K | $419K | $559K | $671K |
| Clean Claim Rate | $15K | $22K | $29K | $35K |
| Total | $1.2M | $1.8M | $2.4M | $2.9M |
Peer Context — Where This Hospital Sits
Key metrics vs 34 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 6.2% | -16.8% | -4.7% | 1.5% | P79 |
| Net-to-Gross | 20.4% | 10.6% | 22.2% | 31.7% | P42 |
| Occupancy | 29.8% | 26.3% | 40.3% | 53.9% | P29 |
| Rev/Bed | $489K | $339K | $584K | $926K | P39 |
| Exp/Bed | $459K | $369K | $614K | $1.1M | P38 |
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.