Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 61% of modeled bridge. Strengths: Bed Count. Risks: Occupancy Rate, Revenue per Bed. Risk-adjusted uplift: $0.4M (vs $0.7M 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 | $246K | $246K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $237K | $8K | $245K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $38K | $112K | $150K | $472K | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $10K | $10K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 50.9% 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 | $61K | $123K | $184K | $246K | $246K | $246K | $246K |
| Denial Rate Reduction | $0 | $61K | $122K | $184K | $245K | $245K | $245K | $245K |
| A/R Days Reduction | $0 | $50K | $100K | $150K | $150K | $150K | $150K | $150K |
| Clean Claim Rate | $0 | $5K | $10K | $10K | $10K | $10K | $10K | $10K |
| Cumulative | $0 | $177K | $355K | $527K | $650K | $650K | $650K | $650K |
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 $650K is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 113% / 44.0x | 118% / 49.3x | 123% / 54.5x | 125% / 57.2x | 127% / 59.8x |
| 9.0x | 108% / 38.8x | 113% / 43.5x | 117% / 48.1x | 119% / 50.5x | 121% / 52.8x |
| 10.0x | 103% / 34.6x | 108% / 38.8x | 112% / 43.0x | 114% / 45.1x | 116% / 47.2x |
| 11.0x | 99% / 31.1x | 104% / 35.0x | 108% / 38.8x | 110% / 40.7x | 112% / 42.6x |
| 12.0x | 95% / 28.3x | 100% / 31.8x | 104% / 35.3x | 106% / 37.0x | 108% / 38.8x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 79% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 1.3x, adding 7.1 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 | $123K | — | $123K | 1.0% |
| Year 1 | $126K | +$433K | $560K | 4.6% |
| Year 2 | $130K | +$650K | $780K | 6.3% |
| Year 3 | $134K | +$650K | $784K | 6.4% |
| Year 4 | $138K | +$650K | $788K | 6.4% |
| Year 5 | $142K | +$650K | $792K | 6.4% |
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 | $123K | $184K | $246K | $295K |
| Denial Rate Reductio | $122K | $184K | $245K | $294K |
| A/R Days Reduction | $75K | $112K | $150K | $180K |
| Clean Claim Rate | $5K | $7K | $10K | $12K |
| Total | $325K | $488K | $650K | $780K |
Peer Context — Where This Hospital Sits
Key metrics vs 230 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 1.0% | -14.0% | 0.2% | 11.7% | P51 |
| Net-to-Gross | 22.6% | 19.7% | 31.0% | 50.9% | P28 |
| Occupancy | 24.0% | 32.2% | 56.1% | 74.0% | P20 |
| Rev/Bed | $224K | $326K | $544K | $1.0M | P13 |
| Exp/Bed | $221K | $339K | $495K | $1.1M | P10 |
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.