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. Risks: Occupancy Rate. Risk-adjusted uplift: $1.1M (vs $1.7M 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 | $658K | $658K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $634K | $18K | $652K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $101K | $300K | $401K | $1.3M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $21K | $21K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 49.9% 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 | $165K | $329K | $494K | $658K | $658K | $658K | $658K |
| Denial Rate Reduction | $0 | $163K | $326K | $489K | $652K | $652K | $652K | $652K |
| A/R Days Reduction | $0 | $134K | $267K | $401K | $401K | $401K | $401K | $401K |
| Clean Claim Rate | $0 | $11K | $21K | $21K | $21K | $21K | $21K | $21K |
| Cumulative | $0 | $472K | $943K | $1.4M | $1.7M | $1.7M | $1.7M | $1.7M |
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 $1.7M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 76% / 16.7x | 80% / 19.0x | 84% / 21.2x | 86% / 22.3x | 88% / 23.4x |
| 9.0x | 71% / 14.5x | 75% / 16.5x | 79% / 18.5x | 81% / 19.4x | 83% / 20.4x |
| 10.0x | 66% / 12.7x | 71% / 14.5x | 75% / 16.3x | 77% / 17.2x | 78% / 18.1x |
| 11.0x | 62% / 11.3x | 67% / 12.9x | 71% / 14.5x | 73% / 15.3x | 74% / 16.1x |
| 12.0x | 59% / 10.1x | 63% / 11.6x | 67% / 13.0x | 69% / 13.8x | 71% / 14.5x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 49% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 3.3x, adding 5.2 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 | $1.1M | — | $1.1M | 3.3% |
| Year 1 | $1.1M | +$1.2M | $2.3M | 7.0% |
| Year 2 | $1.2M | +$1.7M | $2.9M | 8.8% |
| Year 3 | $1.2M | +$1.7M | $2.9M | 8.9% |
| Year 4 | $1.2M | +$1.7M | $3.0M | 9.0% |
| Year 5 | $1.3M | +$1.7M | $3.0M | 9.1% |
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 | $329K | $494K | $658K | $790K |
| Denial Rate Reductio | $326K | $489K | $652K | $782K |
| A/R Days Reduction | $200K | $300K | $401K | $481K |
| Clean Claim Rate | $11K | $16K | $21K | $25K |
| Total | $866K | $1.3M | $1.7M | $2.1M |
Peer Context — Where This Hospital Sits
Key metrics vs 62 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 3.3% | -17.7% | -9.7% | -0.7% | P81 |
| Net-to-Gross | 24.5% | 33.3% | 39.7% | 49.9% | P8 |
| Occupancy | 33.5% | 20.5% | 32.8% | 53.1% | P50 |
| Rev/Bed | $1.3M | $573K | $987K | $1.7M | P65 |
| Exp/Bed | $1.3M | $661K | $1.0M | $1.8M | P63 |
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.