Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 66% of modeled bridge. Risks: Bed Count. Risk-adjusted uplift: $14.2M (vs $21.6M 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 | $8.2M | $8.2M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $7.9M | $226K | $8.1M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $1.3M | $3.7M | $5.0M | $15.7M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $262K | $262K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 27.5% 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 | $2.1M | $4.1M | $6.2M | $8.2M | $8.2M | $8.2M | $8.2M |
| Denial Rate Reduction | $0 | $2.0M | $4.1M | $6.1M | $8.1M | $8.1M | $8.1M | $8.1M |
| A/R Days Reduction | $0 | $1.7M | $3.3M | $5.0M | $5.0M | $5.0M | $5.0M | $5.0M |
| Clean Claim Rate | $0 | $131K | $262K | $262K | $262K | $262K | $262K | $262K |
| Cumulative | $0 | $5.9M | $11.8M | $17.5M | $21.6M | $21.6M | $21.6M | $21.6M |
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 $21.6M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 68% / 13.4x | 73% / 15.3x | 77% / 17.2x | 78% / 18.1x | 80% / 19.0x |
| 9.0x | 63% / 11.6x | 68% / 13.2x | 72% / 14.9x | 73% / 15.7x | 75% / 16.5x |
| 10.0x | 59% / 10.1x | 63% / 11.6x | 67% / 13.1x | 69% / 13.8x | 71% / 14.6x |
| 11.0x | 55% / 8.9x | 59% / 10.2x | 63% / 11.6x | 65% / 12.3x | 67% / 12.9x |
| 12.0x | 51% / 7.9x | 56% / 9.1x | 60% / 10.4x | 61% / 11.0x | 63% / 11.6x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 39% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.0x, adding 4.5 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 | $19.2M | — | $19.2M | 4.7% |
| Year 1 | $19.8M | +$14.4M | $34.2M | 8.3% |
| Year 2 | $20.4M | +$21.6M | $41.9M | 10.2% |
| Year 3 | $21.0M | +$21.6M | $42.6M | 10.4% |
| Year 4 | $21.6M | +$21.6M | $43.2M | 10.5% |
| Year 5 | $22.3M | +$21.6M | $43.8M | 10.7% |
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 | $4.1M | $6.2M | $8.2M | $9.8M |
| Denial Rate Reductio | $4.1M | $6.1M | $8.1M | $9.7M |
| A/R Days Reduction | $2.5M | $3.7M | $5.0M | $6.0M |
| Clean Claim Rate | $131K | $197K | $262K | $315K |
| Total | $10.8M | $16.2M | $21.6M | $25.9M |
Peer Context — Where This Hospital Sits
Key metrics vs 21 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 4.7% | -7.3% | -0.0% | 8.3% | P62 |
| Net-to-Gross | 32.8% | 16.4% | 21.7% | 27.4% | P90 |
| Occupancy | 51.5% | 56.5% | 64.5% | 77.0% | P10 |
| Rev/Bed | $1.4M | $959K | $1.5M | $1.6M | P43 |
| Exp/Bed | $1.3M | $959K | $1.4M | $1.6M | P43 |
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.