Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 68% of modeled bridge. Strengths: Occupancy Rate. Risks: Bed Count. Risk-adjusted uplift: $37.9M (vs $55.5M 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 | $21.1M | $21.1M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $20.3M | $580K | $20.9M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $3.2M | $9.6M | $12.8M | $40.5M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $675K | $675K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 32.5% 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 | $5.3M | $10.5M | $15.8M | $21.1M | $21.1M | $21.1M | $21.1M |
| Denial Rate Reduction | $0 | $5.2M | $10.4M | $15.7M | $20.9M | $20.9M | $20.9M | $20.9M |
| A/R Days Reduction | $0 | $4.3M | $8.6M | $12.8M | $12.8M | $12.8M | $12.8M | $12.8M |
| Clean Claim Rate | $0 | $338K | $675K | $675K | $675K | $675K | $675K | $675K |
| Cumulative | $0 | $15.1M | $30.2M | $45.0M | $55.5M | $55.5M | $55.5M | $55.5M |
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 $55.5M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 63% / 11.6x | 68% / 13.2x | 72% / 14.9x | 73% / 15.7x | 75% / 16.5x |
| 9.0x | 58% / 9.9x | 63% / 11.4x | 67% / 12.9x | 69% / 13.6x | 70% / 14.3x |
| 10.0x | 54% / 8.6x | 58% / 9.9x | 62% / 11.2x | 64% / 11.9x | 66% / 12.6x |
| 11.0x | 50% / 7.5x | 54% / 8.7x | 58% / 9.9x | 60% / 10.5x | 62% / 11.1x |
| 12.0x | 46% / 6.6x | 51% / 7.7x | 55% / 8.8x | 56% / 9.4x | 58% / 9.9x |
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 4.5x, 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 | $63.9M | — | $63.9M | 6.1% |
| Year 1 | $65.8M | +$37.0M | $102.8M | 9.7% |
| Year 2 | $67.8M | +$55.5M | $123.3M | 11.7% |
| Year 3 | $69.8M | +$55.5M | $125.3M | 11.9% |
| Year 4 | $71.9M | +$55.5M | $127.4M | 12.1% |
| Year 5 | $74.1M | +$55.5M | $129.6M | 12.3% |
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 | $10.5M | $15.8M | $21.1M | $25.3M |
| Denial Rate Reductio | $10.4M | $15.7M | $20.9M | $25.1M |
| A/R Days Reduction | $6.4M | $9.6M | $12.8M | $15.4M |
| Clean Claim Rate | $338K | $506K | $675K | $810K |
| Total | $27.7M | $41.6M | $55.5M | $66.6M |
Peer Context — Where This Hospital Sits
Key metrics vs 19 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 6.1% | -7.0% | -1.2% | 4.5% | P74 |
| Net-to-Gross | 24.6% | 25.0% | 27.7% | 32.5% | P21 |
| Occupancy | 75.8% | 56.8% | 67.1% | 75.4% | P74 |
| Rev/Bed | $1.7M | $1.5M | $1.7M | $1.9M | P53 |
| Exp/Bed | $1.6M | $1.4M | $1.6M | $2.0M | P53 |
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.