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. Risk-adjusted uplift: $8.9M (vs $11.7M 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 | $4.4M | $4.4M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $4.3M | $122K | $4.4M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $681K | $2.0M | $2.7M | $8.5M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $142K | $142K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 35.9% 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 | $1.1M | $2.2M | $3.3M | $4.4M | $4.4M | $4.4M | $4.4M |
| Denial Rate Reduction | $0 | $1.1M | $2.2M | $3.3M | $4.4M | $4.4M | $4.4M | $4.4M |
| A/R Days Reduction | $0 | $900K | $1.8M | $2.7M | $2.7M | $2.7M | $2.7M | $2.7M |
| Clean Claim Rate | $0 | $71K | $142K | $142K | $142K | $142K | $142K | $142K |
| Cumulative | $0 | $3.2M | $6.4M | $9.5M | $11.7M | $11.7M | $11.7M | $11.7M |
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 $11.7M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 59% / 10.2x | 63% / 11.7x | 67% / 13.1x | 69% / 13.9x | 71% / 14.6x |
| 9.0x | 54% / 8.7x | 58% / 10.0x | 62% / 11.3x | 64% / 12.0x | 66% / 12.7x |
| 10.0x | 50% / 7.5x | 54% / 8.7x | 58% / 9.9x | 60% / 10.5x | 62% / 11.1x |
| 11.0x | 45% / 6.5x | 50% / 7.6x | 54% / 8.7x | 56% / 9.2x | 58% / 9.8x |
| 12.0x | 42% / 5.7x | 46% / 6.7x | 50% / 7.7x | 52% / 8.2x | 54% / 8.7x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 22% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 5.1x, adding 3.4 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 | $17.3M | — | $17.3M | 7.8% |
| Year 1 | $17.8M | +$7.8M | $25.6M | 11.5% |
| Year 2 | $18.4M | +$11.7M | $30.0M | 13.5% |
| Year 3 | $18.9M | +$11.7M | $30.6M | 13.8% |
| Year 4 | $19.5M | +$11.7M | $31.1M | 14.0% |
| Year 5 | $20.1M | +$11.7M | $31.7M | 14.3% |
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 | $2.2M | $3.3M | $4.4M | $5.3M |
| Denial Rate Reductio | $2.2M | $3.3M | $4.4M | $5.3M |
| A/R Days Reduction | $1.3M | $2.0M | $2.7M | $3.2M |
| Clean Claim Rate | $71K | $106K | $142K | $170K |
| Total | $5.8M | $8.8M | $11.7M | $14.0M |
Peer Context — Where This Hospital Sits
Key metrics vs 108 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 7.8% | -21.1% | -5.8% | 8.1% | P72 |
| Net-to-Gross | 12.5% | 17.5% | 27.0% | 35.9% | P4 |
| Occupancy | 83.5% | 39.5% | 58.5% | 76.7% | P86 |
| Rev/Bed | $2.3M | $416K | $704K | $1.3M | P92 |
| Exp/Bed | $2.1M | $415K | $856K | $1.4M | P94 |
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.