Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 74% of modeled bridge. Strengths: Revenue per Bed, Occupancy Rate. Risk-adjusted uplift: $3.8M (vs $5.1M 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 | $2.0M | $2.0M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $1.9M | $54K | $1.9M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $300K | $889K | $1.2M | $3.7M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $63K | $63K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 63.2% 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 | $489K | $977K | $1.5M | $2.0M | $2.0M | $2.0M | $2.0M |
| Denial Rate Reduction | $0 | $484K | $967K | $1.5M | $1.9M | $1.9M | $1.9M | $1.9M |
| A/R Days Reduction | $0 | $396K | $793K | $1.2M | $1.2M | $1.2M | $1.2M | $1.2M |
| Clean Claim Rate | $0 | $31K | $63K | $63K | $63K | $63K | $63K | $63K |
| Cumulative | $0 | $1.4M | $2.8M | $4.2M | $5.1M | $5.1M | $5.1M | $5.1M |
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 $5.1M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 104% / 35.3x | 109% / 39.6x | 113% / 43.9x | 115% / 46.0x | 117% / 48.1x |
| 9.0x | 99% / 31.0x | 103% / 34.8x | 108% / 38.6x | 110% / 40.5x | 112% / 42.4x |
| 10.0x | 94% / 27.6x | 99% / 31.0x | 103% / 34.4x | 105% / 36.1x | 107% / 37.9x |
| 11.0x | 90% / 24.8x | 95% / 27.9x | 99% / 31.0x | 101% / 32.6x | 103% / 34.1x |
| 12.0x | 86% / 22.4x | 91% / 25.3x | 95% / 28.2x | 97% / 29.6x | 99% / 31.0x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 75% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 1.7x, adding 6.8 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 | $1.3M | — | $1.3M | 1.3% |
| Year 1 | $1.3M | +$3.4M | $4.7M | 4.8% |
| Year 2 | $1.3M | +$5.1M | $6.5M | 6.6% |
| Year 3 | $1.4M | +$5.1M | $6.5M | 6.7% |
| Year 4 | $1.4M | +$5.1M | $6.5M | 6.7% |
| Year 5 | $1.4M | +$5.1M | $6.6M | 6.7% |
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 | $977K | $1.5M | $2.0M | $2.3M |
| Denial Rate Reductio | $967K | $1.5M | $1.9M | $2.3M |
| A/R Days Reduction | $595K | $892K | $1.2M | $1.4M |
| Clean Claim Rate | $31K | $47K | $63K | $75K |
| Total | $2.6M | $3.9M | $5.1M | $6.2M |
Peer Context — Where This Hospital Sits
Key metrics vs 14 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 1.3% | -8.3% | -1.9% | 0.4% | P79 |
| Net-to-Gross | 52.4% | 47.2% | 52.3% | 63.2% | P50 |
| Occupancy | 65.6% | 46.3% | 47.8% | 57.5% | P86 |
| Rev/Bed | $3.9M | $1.8M | $2.9M | $3.5M | P79 |
| Exp/Bed | $3.9M | $1.8M | $3.0M | $3.8M | P79 |
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.