Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 62% of modeled bridge. Strengths: Net-to-Gross Ratio. Risks: Occupancy Rate, Revenue per Bed. Risk-adjusted uplift: $1.7M (vs $2.8M 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 | $1.1M | $1.1M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $1.0M | $29K | $1.0M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $162K | $481K | $643K | $2.0M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $34K | $34K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 30.3% 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 | $264K | $529K | $793K | $1.1M | $1.1M | $1.1M | $1.1M |
| Denial Rate Reduction | $0 | $262K | $523K | $785K | $1.0M | $1.0M | $1.0M | $1.0M |
| A/R Days Reduction | $0 | $214K | $429K | $643K | $643K | $643K | $643K | $643K |
| Clean Claim Rate | $0 | $17K | $34K | $34K | $34K | $34K | $34K | $34K |
| Cumulative | $0 | $758K | $1.5M | $2.3M | $2.8M | $2.8M | $2.8M | $2.8M |
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 $2.8M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 319% / 1285.6x | 328% / 1428.8x | 336% / 1572.0x | 340% / 1643.6x | 343% / 1715.2x |
| 9.0x | 309% / 1142.4x | 318% / 1269.7x | 326% / 1397.0x | 329% / 1460.7x | 333% / 1524.3x |
| 10.0x | 300% / 1027.8x | 309% / 1142.4x | 317% / 1257.0x | 320% / 1314.3x | 324% / 1371.5x |
| 11.0x | 293% / 934.1x | 301% / 1038.3x | 309% / 1142.4x | 313% / 1194.5x | 316% / 1246.6x |
| 12.0x | 286% / 856.0x | 294% / 951.5x | 302% / 1046.9x | 305% / 1094.7x | 309% / 1142.4x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 99% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 0.0x, adding 8.4 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 | $16K | — | $16K | 0.0% |
| Year 1 | $16K | +$1.9M | $1.9M | 3.5% |
| Year 2 | $17K | +$2.8M | $2.8M | 5.3% |
| Year 3 | $17K | +$2.8M | $2.8M | 5.3% |
| Year 4 | $18K | +$2.8M | $2.8M | 5.3% |
| Year 5 | $18K | +$2.8M | $2.8M | 5.3% |
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 | $529K | $793K | $1.1M | $1.3M |
| Denial Rate Reductio | $523K | $785K | $1.0M | $1.3M |
| A/R Days Reduction | $322K | $483K | $643K | $772K |
| Clean Claim Rate | $17K | $25K | $34K | $41K |
| Total | $1.4M | $2.1M | $2.8M | $3.3M |
Peer Context — Where This Hospital Sits
Key metrics vs 48 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 0.0% | -8.3% | 1.1% | 13.1% | P45 |
| Net-to-Gross | 16.8% | 15.6% | 19.2% | 30.4% | P34 |
| Occupancy | 31.5% | 41.1% | 66.2% | 76.9% | P19 |
| Rev/Bed | $485K | $468K | $920K | $1.3M | P27 |
| Exp/Bed | $485K | $384K | $684K | $1.2M | P29 |
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.