Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 69% of modeled bridge. Strengths: Occupancy Rate. Risks: Bed Count. Risk-adjusted uplift: $15.7M (vs $22.9M 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 | $8.7M | $8.7M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $8.4M | $239K | $8.6M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $1.3M | $4.0M | $5.3M | $16.7M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $278K | $278K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 30.0% 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 | $2.2M | $4.4M | $6.5M | $8.7M | $8.7M | $8.7M | $8.7M |
| Denial Rate Reduction | $0 | $2.2M | $4.3M | $6.5M | $8.6M | $8.6M | $8.6M | $8.6M |
| A/R Days Reduction | $0 | $1.8M | $3.5M | $5.3M | $5.3M | $5.3M | $5.3M | $5.3M |
| Clean Claim Rate | $0 | $139K | $278K | $278K | $278K | $278K | $278K | $278K |
| Cumulative | $0 | $6.2M | $12.5M | $18.6M | $22.9M | $22.9M | $22.9M | $22.9M |
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 $22.9M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 66% / 12.6x | 70% / 14.4x | 74% / 16.1x | 76% / 17.0x | 78% / 17.9x |
| 9.0x | 61% / 10.8x | 65% / 12.4x | 69% / 14.0x | 71% / 14.8x | 73% / 15.5x |
| 10.0x | 57% / 9.4x | 61% / 10.8x | 65% / 12.2x | 67% / 13.0x | 69% / 13.7x |
| 11.0x | 53% / 8.3x | 57% / 9.6x | 61% / 10.8x | 63% / 11.5x | 65% / 12.1x |
| 12.0x | 49% / 7.3x | 53% / 8.5x | 57% / 9.7x | 59% / 10.2x | 61% / 10.8x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 35% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.2x, adding 4.2 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 | $22.7M | — | $22.7M | 5.2% |
| Year 1 | $23.4M | +$15.3M | $38.6M | 8.9% |
| Year 2 | $24.1M | +$22.9M | $47.0M | 10.8% |
| Year 3 | $24.8M | +$22.9M | $47.7M | 11.0% |
| Year 4 | $25.5M | +$22.9M | $48.4M | 11.1% |
| Year 5 | $26.3M | +$22.9M | $49.2M | 11.3% |
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 | $4.4M | $6.5M | $8.7M | $10.4M |
| Denial Rate Reductio | $4.3M | $6.5M | $8.6M | $10.3M |
| A/R Days Reduction | $2.6M | $4.0M | $5.3M | $6.4M |
| Clean Claim Rate | $139K | $209K | $278K | $334K |
| Total | $11.4M | $17.2M | $22.9M | $27.5M |
Peer Context — Where This Hospital Sits
Key metrics vs 88 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 5.2% | -18.2% | -8.7% | -1.0% | P85 |
| Net-to-Gross | 33.1% | 16.8% | 23.1% | 30.0% | P80 |
| Occupancy | 59.9% | 52.9% | 61.8% | 76.7% | P44 |
| Rev/Bed | $1.9M | $832K | $1.2M | $1.6M | P85 |
| Exp/Bed | $1.8M | $821K | $1.2M | $1.7M | 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.