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: Revenue per Bed, Bed Count. Risks: Occupancy Rate. Risk-adjusted uplift: $1.9M (vs $3.0M 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 | $1.2M | $1.2M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $1.1M | $32K | $1.1M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $177K | $524K | $700K | $2.2M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $37K | $37K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 39.9% 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 | $288K | $576K | $863K | $1.2M | $1.2M | $1.2M | $1.2M |
| Denial Rate Reduction | $0 | $285K | $570K | $855K | $1.1M | $1.1M | $1.1M | $1.1M |
| A/R Days Reduction | $0 | $233K | $467K | $700K | $700K | $700K | $700K | $700K |
| Clean Claim Rate | $0 | $18K | $37K | $37K | $37K | $37K | $37K | $37K |
| Cumulative | $0 | $825K | $1.6M | $2.5M | $3.0M | $3.0M | $3.0M | $3.0M |
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 $3.0M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 73% / 15.4x | 77% / 17.5x | 81% / 19.5x | 83% / 20.6x | 85% / 21.6x |
| 9.0x | 68% / 13.3x | 72% / 15.2x | 76% / 17.0x | 78% / 17.9x | 80% / 18.8x |
| 10.0x | 63% / 11.7x | 68% / 13.3x | 72% / 15.0x | 74% / 15.8x | 75% / 16.6x |
| 11.0x | 59% / 10.3x | 64% / 11.8x | 68% / 13.3x | 70% / 14.1x | 71% / 14.8x |
| 12.0x | 56% / 9.2x | 60% / 10.6x | 64% / 11.9x | 66% / 12.6x | 68% / 13.3x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 46% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 3.5x, adding 4.9 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 | $2.2M | — | $2.2M | 3.8% |
| Year 1 | $2.2M | +$2.0M | $4.3M | 7.4% |
| Year 2 | $2.3M | +$3.0M | $5.3M | 9.3% |
| Year 3 | $2.4M | +$3.0M | $5.4M | 9.4% |
| Year 4 | $2.5M | +$3.0M | $5.5M | 9.5% |
| Year 5 | $2.5M | +$3.0M | $5.6M | 9.6% |
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 | $576K | $863K | $1.2M | $1.4M |
| Denial Rate Reductio | $570K | $855K | $1.1M | $1.4M |
| A/R Days Reduction | $350K | $525K | $700K | $840K |
| Clean Claim Rate | $18K | $28K | $37K | $44K |
| Total | $1.5M | $2.3M | $3.0M | $3.6M |
Peer Context — Where This Hospital Sits
Key metrics vs 39 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 3.8% | -22.0% | -4.3% | 5.1% | P68 |
| Net-to-Gross | 36.0% | 24.7% | 32.7% | 39.9% | P61 |
| Occupancy | 23.2% | 32.5% | 43.8% | 67.5% | P15 |
| Rev/Bed | $2.3M | $545K | $1.4M | $2.0M | P79 |
| Exp/Bed | $2.2M | $618K | $1.4M | $2.1M | P77 |
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.