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, Revenue per Bed. Risks: Bed Count, Commercial Payer %. Risk-adjusted uplift: $23.8M (vs $35.1M 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 | $13.4M | $13.4M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $12.9M | $367K | $13.2M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $2.0M | $6.1M | $8.1M | $25.6M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $427K | $427K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 30.1% 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 | $3.3M | $6.7M | $10.0M | $13.4M | $13.4M | $13.4M | $13.4M |
| Denial Rate Reduction | $0 | $3.3M | $6.6M | $9.9M | $13.2M | $13.2M | $13.2M | $13.2M |
| A/R Days Reduction | $0 | $2.7M | $5.4M | $8.1M | $8.1M | $8.1M | $8.1M | $8.1M |
| Clean Claim Rate | $0 | $214K | $427K | $427K | $427K | $427K | $427K | $427K |
| Cumulative | $0 | $9.6M | $19.1M | $28.5M | $35.1M | $35.1M | $35.1M | $35.1M |
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 $35.1M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 76% / 16.9x | 81% / 19.2x | 85% / 21.4x | 86% / 22.6x | 88% / 23.7x |
| 9.0x | 71% / 14.7x | 76% / 16.7x | 80% / 18.7x | 81% / 19.7x | 83% / 20.7x |
| 10.0x | 67% / 12.9x | 71% / 14.7x | 75% / 16.5x | 77% / 17.4x | 79% / 18.3x |
| 11.0x | 63% / 11.4x | 67% / 13.1x | 71% / 14.7x | 73% / 15.5x | 75% / 16.3x |
| 12.0x | 59% / 10.2x | 64% / 11.7x | 68% / 13.2x | 69% / 14.0x | 71% / 14.7x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 50% 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 | $21.9M | — | $21.9M | 3.3% |
| Year 1 | $22.6M | +$23.4M | $46.0M | 6.9% |
| Year 2 | $23.2M | +$35.1M | $58.4M | 8.7% |
| Year 3 | $23.9M | +$35.1M | $59.1M | 8.8% |
| Year 4 | $24.7M | +$35.1M | $59.8M | 9.0% |
| Year 5 | $25.4M | +$35.1M | $60.5M | 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 | $6.7M | $10.0M | $13.4M | $16.0M |
| Denial Rate Reductio | $6.6M | $9.9M | $13.2M | $15.9M |
| A/R Days Reduction | $4.1M | $6.1M | $8.1M | $9.7M |
| Clean Claim Rate | $214K | $320K | $427K | $513K |
| Total | $17.6M | $26.3M | $35.1M | $42.1M |
Peer Context — Where This Hospital Sits
Key metrics vs 58 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% | -6.8% | 0.0% | 6.1% | P67 |
| Net-to-Gross | 20.6% | 21.2% | 26.8% | 30.1% | P20 |
| Occupancy | 57.2% | 52.3% | 62.4% | 75.9% | P38 |
| Rev/Bed | $2.1M | $1.2M | $1.5M | $2.0M | P78 |
| Exp/Bed | $2.0M | $1.1M | $1.5M | $2.1M | P71 |
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.