Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 73% of modeled bridge. Strengths: Occupancy Rate, Commercial Payer %. Risks: Revenue per Bed, Net-to-Gross Ratio. Risk-adjusted uplift: $1.4M (vs $1.9M 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 | $712K | $712K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $685K | $20K | $704K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $109K | $324K | $433K | $1.4M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $23K | $23K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 57.6% 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 | $178K | $356K | $534K | $712K | $712K | $712K | $712K |
| Denial Rate Reduction | $0 | $176K | $352K | $528K | $704K | $704K | $704K | $704K |
| A/R Days Reduction | $0 | $144K | $289K | $433K | $433K | $433K | $433K | $433K |
| Clean Claim Rate | $0 | $11K | $23K | $23K | $23K | $23K | $23K | $23K |
| Cumulative | $0 | $510K | $1.0M | $1.5M | $1.9M | $1.9M | $1.9M | $1.9M |
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 $1.9M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 47% / 6.9x | 52% / 8.0x | 56% / 9.1x | 57% / 9.7x | 59% / 10.2x |
| 9.0x | 42% / 5.7x | 46% / 6.7x | 51% / 7.7x | 52% / 8.2x | 54% / 8.7x |
| 10.0x | 37% / 4.8x | 42% / 5.7x | 46% / 6.6x | 48% / 7.1x | 50% / 7.5x |
| 11.0x | 33% / 4.1x | 38% / 4.9x | 42% / 5.7x | 44% / 6.2x | 46% / 6.6x |
| 12.0x | 28% / 3.5x | 34% / 4.2x | 38% / 5.0x | 40% / 5.4x | 42% / 5.7x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline -6% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 6.9x, adding 1.5 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 | $8.4M | — | $8.4M | 23.5% |
| Year 1 | $8.6M | +$1.2M | $9.9M | 27.8% |
| Year 2 | $8.9M | +$1.9M | $10.8M | 30.2% |
| Year 3 | $9.2M | +$1.9M | $11.0M | 31.0% |
| Year 4 | $9.4M | +$1.9M | $11.3M | 31.8% |
| Year 5 | $9.7M | +$1.9M | $11.6M | 32.5% |
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 | $356K | $534K | $712K | $854K |
| Denial Rate Reductio | $352K | $528K | $704K | $845K |
| A/R Days Reduction | $216K | $325K | $433K | $520K |
| Clean Claim Rate | $11K | $17K | $23K | $27K |
| Total | $936K | $1.4M | $1.9M | $2.2M |
Peer Context — Where This Hospital Sits
Key metrics vs 45 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 23.5% | -6.0% | 7.6% | 17.6% | P80 |
| Net-to-Gross | 69.5% | 20.7% | 27.1% | 57.6% | P89 |
| Occupancy | 75.5% | 51.3% | 67.1% | 76.3% | P69 |
| Rev/Bed | $474K | $446K | $732K | $1.7M | P32 |
| Exp/Bed | $363K | $375K | $657K | $1.4M | P20 |
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.