Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 71% of modeled bridge. Strengths: Occupancy Rate. Risk-adjusted uplift: $11.5M (vs $16.3M 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 | $6.2M | $6.2M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $5.9M | $170K | $6.1M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $948K | $2.8M | $3.8M | $11.9M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $198K | $198K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 30.8% 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 | $1.5M | $3.1M | $4.6M | $6.2M | $6.2M | $6.2M | $6.2M |
| Denial Rate Reduction | $0 | $1.5M | $3.1M | $4.6M | $6.1M | $6.1M | $6.1M | $6.1M |
| A/R Days Reduction | $0 | $1.3M | $2.5M | $3.8M | $3.8M | $3.8M | $3.8M | $3.8M |
| Clean Claim Rate | $0 | $99K | $198K | $198K | $198K | $198K | $198K | $198K |
| Cumulative | $0 | $4.4M | $8.9M | $13.2M | $16.3M | $16.3M | $16.3M | $16.3M |
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 $16.3M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 100% / 31.7x | 104% / 35.6x | 109% / 39.5x | 111% / 41.4x | 113% / 43.4x |
| 9.0x | 94% / 27.8x | 99% / 31.3x | 103% / 34.7x | 105% / 36.5x | 107% / 38.2x |
| 10.0x | 90% / 24.7x | 94% / 27.8x | 99% / 30.9x | 101% / 32.5x | 102% / 34.0x |
| 11.0x | 86% / 22.2x | 90% / 25.0x | 94% / 27.8x | 96% / 29.2x | 98% / 30.6x |
| 12.0x | 82% / 20.1x | 87% / 22.6x | 91% / 25.2x | 93% / 26.5x | 94% / 27.8x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 72% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 1.8x, adding 6.6 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 | $4.5M | — | $4.5M | 1.5% |
| Year 1 | $4.6M | +$10.8M | $15.5M | 5.0% |
| Year 2 | $4.8M | +$16.3M | $21.0M | 6.8% |
| Year 3 | $4.9M | +$16.3M | $21.2M | 6.8% |
| Year 4 | $5.1M | +$16.3M | $21.3M | 6.9% |
| Year 5 | $5.2M | +$16.3M | $21.5M | 6.9% |
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 | $3.1M | $4.6M | $6.2M | $7.4M |
| Denial Rate Reductio | $3.1M | $4.6M | $6.1M | $7.3M |
| A/R Days Reduction | $1.9M | $2.8M | $3.8M | $4.5M |
| Clean Claim Rate | $99K | $148K | $198K | $237K |
| Total | $8.1M | $12.2M | $16.3M | $19.5M |
Peer Context — Where This Hospital Sits
Key metrics vs 80 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 1.5% | -9.8% | 0.5% | 7.0% | P53 |
| Net-to-Gross | 26.2% | 21.5% | 26.9% | 30.8% | P43 |
| Occupancy | 67.3% | 49.0% | 57.0% | 71.4% | P70 |
| Rev/Bed | $1.8M | $954K | $1.3M | $1.6M | P78 |
| Exp/Bed | $1.8M | $682K | $1.3M | $1.6M | P78 |
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.