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. Risks: Occupancy Rate, Revenue per Bed. Risk-adjusted uplift: $0.3M (vs $0.5M 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 |
|---|---|---|---|---|---|---|---|
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $167K | $8K | $175K | $0 | 12mo |
| Cost to Collect | 4.5% DEFAULT | 2.5% BENCHMARK | $0 | $173K | $173K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $27K | $79K | $105K | $332K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $10K | $10K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 54.5% 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 |
|---|---|---|---|---|---|---|---|---|
| Denial Rate Reduction | $0 | $44K | $87K | $131K | $175K | $175K | $175K | $175K |
| Cost to Collect | $0 | $43K | $87K | $130K | $173K | $173K | $173K | $173K |
| A/R Days Reduction | $0 | $35K | $70K | $105K | $105K | $105K | $105K | $105K |
| Clean Claim Rate | $0 | $5K | $10K | $10K | $10K | $10K | $10K | $10K |
| Cumulative | $0 | $127K | $254K | $376K | $463K | $463K | $463K | $463K |
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 $463K is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 70% / 14.2x | 74% / 16.1x | 78% / 18.1x | 80% / 19.1x | 82% / 20.0x |
| 9.0x | 65% / 12.3x | 70% / 14.0x | 74% / 15.7x | 75% / 16.6x | 77% / 17.4x |
| 10.0x | 61% / 10.7x | 65% / 12.3x | 69% / 13.8x | 71% / 14.6x | 73% / 15.4x |
| 11.0x | 57% / 9.4x | 61% / 10.9x | 65% / 12.3x | 67% / 13.0x | 69% / 13.7x |
| 12.0x | 53% / 8.4x | 57% / 9.7x | 61% / 11.0x | 63% / 11.6x | 65% / 12.3x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 42% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 3.8x, adding 4.7 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 | $377K | — | $377K | 4.4% |
| Year 1 | $388K | +$309K | $697K | 8.0% |
| Year 2 | $400K | +$463K | $863K | 10.0% |
| Year 3 | $412K | +$463K | $875K | 10.1% |
| Year 4 | $424K | +$463K | $887K | 10.2% |
| Year 5 | $437K | +$463K | $900K | 10.4% |
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% |
|---|---|---|---|---|
| Denial Rate Reductio | $87K | $131K | $175K | $210K |
| Cost to Collect | $87K | $130K | $173K | $208K |
| A/R Days Reduction | $53K | $79K | $105K | $126K |
| Clean Claim Rate | $5K | $7K | $10K | $12K |
| Total | $232K | $347K | $463K | $556K |
Peer Context — Where This Hospital Sits
Key metrics vs 16 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 4.4% | -18.4% | -1.1% | 8.0% | P56 |
| Net-to-Gross | 54.0% | 22.0% | 44.4% | 54.5% | P69 |
| Occupancy | 39.5% | 23.0% | 41.3% | 56.0% | P38 |
| Rev/Bed | $361K | $657K | $1.1M | $1.5M | P19 |
| Exp/Bed | $345K | $518K | $1.3M | $1.7M | P19 |
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.