Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 76% of modeled bridge. Strengths: Occupancy Rate, Revenue per Bed. Risks: Bed Count. Risk-adjusted uplift: $143.6M (vs $189.2M 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 |
|---|---|---|---|---|---|---|---|
| Net Collection Rate | 93.5% DEFAULT | 97.0% BENCHMARK | $54.0M | $0 | $54.0M | $0 | 18mo |
| Cost to Collect | 4.5% DEFAULT | 2.5% BENCHMARK | $0 | $51.4M | $51.4M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $49.5M | $1.4M | $50.9M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $7.9M | $23.4M | $31.3M | $98.6M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $1.6M | $1.6M | $0 | 6mo |
| 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 |
|---|---|---|---|---|---|---|---|---|
| Net Collection Rate | $0 | $9.0M | $18.0M | $27.0M | $36.0M | $54.0M | $54.0M | $54.0M |
| Cost to Collect | $0 | $12.9M | $25.7M | $38.6M | $51.4M | $51.4M | $51.4M | $51.4M |
| Denial Rate Reduction | $0 | $12.7M | $25.4M | $38.2M | $50.9M | $50.9M | $50.9M | $50.9M |
| A/R Days Reduction | $0 | $10.4M | $20.9M | $31.3M | $31.3M | $31.3M | $31.3M | $31.3M |
| Clean Claim Rate | $0 | $823K | $1.6M | $1.6M | $1.6M | $1.6M | $1.6M | $1.6M |
| Cumulative | $0 | $45.8M | $91.7M | $136.7M | $171.2M | $189.2M | $189.2M | $189.2M |
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 $189.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x |
| 9.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x |
| 10.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x |
| 11.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x |
| 12.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x | -100% / 0.0x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 888% before the 6.5x covenant trips. RCM uplift reduces leverage from 99.0x to -51.2x, adding 150.2 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 | $-162.4M | — | $-162.4M | -6.3% |
| Year 1 | $-167.3M | +$126.1M | $-41.1M | -1.6% |
| Year 2 | $-172.3M | +$189.2M | $16.9M | 0.7% |
| Year 3 | $-177.5M | +$189.2M | $11.8M | 0.5% |
| Year 4 | $-182.8M | +$189.2M | $6.4M | 0.3% |
| Year 5 | $-188.3M | +$189.2M | $962K | 0.0% |
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% |
|---|---|---|---|---|
| Net Collection Rate | $27.0M | $40.5M | $54.0M | $64.8M |
| Cost to Collect | $25.7M | $38.6M | $51.4M | $61.7M |
| Denial Rate Reductio | $25.4M | $38.2M | $50.9M | $61.1M |
| A/R Days Reduction | $15.6M | $23.5M | $31.3M | $37.5M |
| Clean Claim Rate | $823K | $1.2M | $1.6M | $2.0M |
| Total | $94.6M | $141.9M | $189.2M | $227.1M |
Peer Context — Where This Hospital Sits
Key metrics vs 10 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | -6.3% | -23.2% | -6.3% | -5.6% | P44 |
| Net-to-Gross | 38.5% | 35.0% | 38.5% | 42.9% | P44 |
| Occupancy | 91.3% | 71.1% | 77.6% | 84.6% | P80 |
| Rev/Bed | $4.7M | $1.9M | $2.4M | $2.5M | P89 |
| Exp/Bed | $5.0M | $2.0M | $2.3M | $3.0M | P89 |
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.