Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 57% of modeled bridge. Strengths: Bed Count. Risks: Occupancy Rate, Revenue per Bed. Risk-adjusted uplift: $0.3M (vs $0.5M 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 |
|---|---|---|---|---|---|---|---|
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $170K | $8K | $178K | $0 | 12mo |
| Cost to Collect | 4.5% DEFAULT | 2.5% BENCHMARK | $0 | $177K | $177K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $27K | $80K | $107K | $339K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $10K | $10K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 45.7% 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 |
|---|---|---|---|---|---|---|---|---|
| Denial Rate Reduction | $0 | $45K | $89K | $134K | $178K | $178K | $178K | $178K |
| Cost to Collect | $0 | $44K | $88K | $132K | $177K | $177K | $177K | $177K |
| A/R Days Reduction | $0 | $36K | $72K | $107K | $107K | $107K | $107K | $107K |
| Clean Claim Rate | $0 | $5K | $10K | $10K | $10K | $10K | $10K | $10K |
| Cumulative | $0 | $129K | $259K | $383K | $472K | $472K | $472K | $472K |
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 $472K is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 67% / 12.9x | 71% / 14.8x | 75% / 16.6x | 77% / 17.4x | 79% / 18.3x |
| 9.0x | 62% / 11.2x | 66% / 12.8x | 70% / 14.3x | 72% / 15.2x | 74% / 15.9x |
| 10.0x | 58% / 9.7x | 62% / 11.2x | 66% / 12.6x | 68% / 13.3x | 70% / 14.0x |
| 11.0x | 54% / 8.5x | 58% / 9.8x | 62% / 11.2x | 64% / 11.8x | 66% / 12.5x |
| 12.0x | 50% / 7.5x | 54% / 8.8x | 58% / 9.9x | 60% / 10.6x | 62% / 11.2x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 37% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.1x, adding 4.3 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 | $447K | — | $447K | 5.1% |
| Year 1 | $460K | +$315K | $775K | 8.8% |
| Year 2 | $474K | +$472K | $946K | 10.7% |
| Year 3 | $488K | +$472K | $960K | 10.9% |
| Year 4 | $503K | +$472K | $975K | 11.0% |
| Year 5 | $518K | +$472K | $990K | 11.2% |
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% |
|---|---|---|---|---|
| Denial Rate Reductio | $89K | $134K | $178K | $214K |
| Cost to Collect | $88K | $132K | $177K | $212K |
| A/R Days Reduction | $54K | $81K | $107K | $129K |
| Clean Claim Rate | $5K | $7K | $10K | $12K |
| Total | $236K | $354K | $472K | $566K |
Peer Context — Where This Hospital Sits
Key metrics vs 56 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 5.1% | -14.0% | -0.8% | 9.2% | P64 |
| Net-to-Gross | 26.6% | 20.2% | 29.8% | 45.7% | P39 |
| Occupancy | 3.5% | 21.2% | 35.4% | 69.7% | P2 |
| Rev/Bed | $353K | $401K | $536K | $950K | P18 |
| Exp/Bed | $335K | $355K | $573K | $1.0M | P18 |
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.