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: Bed Count, Occupancy Rate. Risk-adjusted uplift: $23.3M (vs $37.3M 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 | $14.2M | $14.2M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $13.7M | $390K | $14.1M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $2.2M | $6.5M | $8.6M | $27.2M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $454K | $454K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 25.8% 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 | $3.5M | $7.1M | $10.6M | $14.2M | $14.2M | $14.2M | $14.2M |
| Denial Rate Reduction | $0 | $3.5M | $7.0M | $10.5M | $14.1M | $14.1M | $14.1M | $14.1M |
| A/R Days Reduction | $0 | $2.9M | $5.8M | $8.6M | $8.6M | $8.6M | $8.6M | $8.6M |
| Clean Claim Rate | $0 | $227K | $454K | $454K | $454K | $454K | $454K | $454K |
| Cumulative | $0 | $10.2M | $20.3M | $30.3M | $37.3M | $37.3M | $37.3M | $37.3M |
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 $37.3M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 68% / 13.3x | 72% / 15.1x | 76% / 17.0x | 78% / 17.9x | 80% / 18.8x |
| 9.0x | 63% / 11.5x | 67% / 13.1x | 71% / 14.7x | 73% / 15.6x | 75% / 16.4x |
| 10.0x | 58% / 10.0x | 63% / 11.5x | 67% / 12.9x | 69% / 13.7x | 70% / 14.4x |
| 11.0x | 54% / 8.8x | 59% / 10.1x | 63% / 11.5x | 65% / 12.1x | 67% / 12.8x |
| 12.0x | 51% / 7.8x | 55% / 9.0x | 59% / 10.2x | 61% / 10.8x | 63% / 11.5x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 38% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.0x, adding 4.4 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 | $33.8M | — | $33.8M | 4.8% |
| Year 1 | $34.8M | +$24.9M | $59.7M | 8.4% |
| Year 2 | $35.9M | +$37.3M | $73.2M | 10.3% |
| Year 3 | $37.0M | +$37.3M | $74.3M | 10.5% |
| Year 4 | $38.1M | +$37.3M | $75.4M | 10.6% |
| Year 5 | $39.2M | +$37.3M | $76.5M | 10.8% |
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 | $7.1M | $10.6M | $14.2M | $17.0M |
| Denial Rate Reductio | $7.0M | $10.5M | $14.1M | $16.9M |
| A/R Days Reduction | $4.3M | $6.5M | $8.6M | $10.4M |
| Clean Claim Rate | $227K | $341K | $454K | $545K |
| Total | $18.7M | $28.0M | $37.3M | $44.8M |
Peer Context — Where This Hospital Sits
Key metrics vs 57 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 4.8% | -17.0% | 2.8% | 12.6% | P54 |
| Net-to-Gross | 12.4% | 13.4% | 18.3% | 25.8% | P21 |
| Occupancy | 48.0% | 65.6% | 73.7% | 80.4% | P4 |
| Rev/Bed | $1.2M | $1.2M | $1.4M | $1.8M | P25 |
| Exp/Bed | $1.1M | $1.0M | $1.5M | $1.9M | P37 |
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.