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. Risks: Revenue per Bed, Commercial Payer %. Risk-adjusted uplift: $1.2M (vs $1.7M 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 | $651K | $651K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $626K | $18K | $644K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $100K | $296K | $396K | $1.2M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $21K | $21K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 37.1% 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 | $163K | $325K | $488K | $651K | $651K | $651K | $651K |
| Denial Rate Reduction | $0 | $161K | $322K | $483K | $644K | $644K | $644K | $644K |
| A/R Days Reduction | $0 | $132K | $264K | $396K | $396K | $396K | $396K | $396K |
| Clean Claim Rate | $0 | $10K | $21K | $21K | $21K | $21K | $21K | $21K |
| Cumulative | $0 | $466K | $932K | $1.4M | $1.7M | $1.7M | $1.7M | $1.7M |
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 $1.7M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 78% / 18.1x | 83% / 20.5x | 87% / 22.9x | 89% / 24.0x | 91% / 25.2x |
| 9.0x | 74% / 15.7x | 78% / 17.8x | 82% / 19.9x | 84% / 21.0x | 86% / 22.1x |
| 10.0x | 69% / 13.8x | 74% / 15.7x | 78% / 17.6x | 79% / 18.6x | 81% / 19.5x |
| 11.0x | 65% / 12.3x | 70% / 14.0x | 74% / 15.7x | 75% / 16.6x | 77% / 17.5x |
| 12.0x | 62% / 11.0x | 66% / 12.6x | 70% / 14.2x | 72% / 14.9x | 74% / 15.7x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 53% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 3.1x, adding 5.4 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 | $972K | — | $972K | 3.0% |
| Year 1 | $1.0M | +$1.1M | $2.1M | 6.6% |
| Year 2 | $1.0M | +$1.7M | $2.7M | 8.4% |
| Year 3 | $1.1M | +$1.7M | $2.8M | 8.5% |
| Year 4 | $1.1M | +$1.7M | $2.8M | 8.6% |
| Year 5 | $1.1M | +$1.7M | $2.8M | 8.7% |
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 | $325K | $488K | $651K | $781K |
| Denial Rate Reductio | $322K | $483K | $644K | $773K |
| A/R Days Reduction | $198K | $297K | $396K | $475K |
| Clean Claim Rate | $10K | $16K | $21K | $25K |
| Total | $856K | $1.3M | $1.7M | $2.1M |
Peer Context — Where This Hospital Sits
Key metrics vs 18 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 3.0% | -17.3% | -12.0% | -6.1% | P94 |
| Net-to-Gross | 44.0% | 27.1% | 32.0% | 37.1% | P82 |
| Occupancy | 80.5% | 58.5% | 66.1% | 71.7% | P89 |
| Rev/Bed | $332K | $1.8M | $2.2M | $2.4M | P0 |
| Exp/Bed | $322K | $1.9M | $2.2M | $2.7M | P0 |
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.