Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 70% of modeled bridge. Strengths: Bed Count, Occupancy Rate. Risk-adjusted uplift: $2.8M (vs $4.0M 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 | $1.5M | $1.5M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $1.4M | $41K | $1.5M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $231K | $685K | $916K | $2.9M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $48K | $48K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 44.0% 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 | $377K | $753K | $1.1M | $1.5M | $1.5M | $1.5M | $1.5M |
| Denial Rate Reduction | $0 | $373K | $746K | $1.1M | $1.5M | $1.5M | $1.5M | $1.5M |
| A/R Days Reduction | $0 | $305K | $611K | $916K | $916K | $916K | $916K | $916K |
| Clean Claim Rate | $0 | $24K | $48K | $48K | $48K | $48K | $48K | $48K |
| Cumulative | $0 | $1.1M | $2.2M | $3.2M | $4.0M | $4.0M | $4.0M | $4.0M |
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 $4.0M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 62% / 11.2x | 66% / 12.8x | 70% / 14.4x | 72% / 15.2x | 74% / 16.0x |
| 9.0x | 57% / 9.6x | 62% / 11.0x | 66% / 12.4x | 67% / 13.2x | 69% / 13.9x |
| 10.0x | 53% / 8.3x | 57% / 9.6x | 61% / 10.9x | 63% / 11.5x | 65% / 12.2x |
| 11.0x | 49% / 7.2x | 53% / 8.4x | 57% / 9.6x | 59% / 10.2x | 61% / 10.8x |
| 12.0x | 45% / 6.4x | 49% / 7.5x | 53% / 8.5x | 55% / 9.1x | 57% / 9.6x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 28% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.7x, adding 3.8 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 | $4.9M | — | $4.9M | 6.5% |
| Year 1 | $5.0M | +$2.6M | $7.6M | 10.2% |
| Year 2 | $5.2M | +$4.0M | $9.1M | 12.1% |
| Year 3 | $5.3M | +$4.0M | $9.3M | 12.3% |
| Year 4 | $5.5M | +$4.0M | $9.4M | 12.5% |
| Year 5 | $5.6M | +$4.0M | $9.6M | 12.7% |
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 | $753K | $1.1M | $1.5M | $1.8M |
| Denial Rate Reductio | $746K | $1.1M | $1.5M | $1.8M |
| A/R Days Reduction | $458K | $687K | $916K | $1.1M |
| Clean Claim Rate | $24K | $36K | $48K | $58K |
| Total | $2.0M | $3.0M | $4.0M | $4.8M |
Peer Context — Where This Hospital Sits
Key metrics vs 82 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 6.5% | -12.5% | 1.7% | 9.0% | P64 |
| Net-to-Gross | 16.4% | 21.7% | 31.7% | 44.0% | P12 |
| Occupancy | 55.2% | 27.9% | 46.8% | 69.3% | P60 |
| Rev/Bed | $1.9M | $414K | $841K | $1.8M | P75 |
| Exp/Bed | $1.8M | $391K | $963K | $1.5M | 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.