Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 91% of modeled bridge. Strengths: Occupancy Rate. Risks: Bed Count. Risk-adjusted uplift: $31.5M (vs $34.7M 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 | $13.2M | $13.2M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $12.7M | $363K | $13.1M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $2.0M | $6.0M | $8.0M | $25.3M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $423K | $423K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 25.2% 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 | $3.3M | $6.6M | $9.9M | $13.2M | $13.2M | $13.2M | $13.2M |
| Denial Rate Reduction | $0 | $3.3M | $6.5M | $9.8M | $13.1M | $13.1M | $13.1M | $13.1M |
| A/R Days Reduction | $0 | $2.7M | $5.4M | $8.0M | $8.0M | $8.0M | $8.0M | $8.0M |
| Clean Claim Rate | $0 | $211K | $423K | $423K | $423K | $423K | $423K | $423K |
| Cumulative | $0 | $9.5M | $18.9M | $28.2M | $34.7M | $34.7M | $34.7M | $34.7M |
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 $34.7M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 87% / 23.1x | 92% / 26.0x | 96% / 29.0x | 98% / 30.4x | 100% / 31.9x |
| 9.0x | 82% / 20.2x | 87% / 22.8x | 91% / 25.4x | 93% / 26.7x | 95% / 28.0x |
| 10.0x | 78% / 17.8x | 82% / 20.2x | 86% / 22.5x | 88% / 23.7x | 90% / 24.9x |
| 11.0x | 74% / 15.9x | 78% / 18.1x | 82% / 20.2x | 84% / 21.2x | 86% / 22.3x |
| 12.0x | 70% / 14.3x | 75% / 16.3x | 79% / 18.2x | 81% / 19.2x | 82% / 20.2x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 62% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 2.5x, adding 6.0 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 | $14.2M | — | $14.2M | 2.2% |
| Year 1 | $14.6M | +$23.2M | $37.8M | 5.7% |
| Year 2 | $15.1M | +$34.7M | $49.8M | 7.5% |
| Year 3 | $15.5M | +$34.7M | $50.3M | 7.6% |
| Year 4 | $16.0M | +$34.7M | $50.7M | 7.7% |
| Year 5 | $16.5M | +$34.7M | $51.2M | 7.8% |
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 | $6.6M | $9.9M | $13.2M | $15.9M |
| Denial Rate Reductio | $6.5M | $9.8M | $13.1M | $15.7M |
| A/R Days Reduction | $4.0M | $6.0M | $8.0M | $9.6M |
| Clean Claim Rate | $211K | $317K | $423K | $507K |
| Total | $17.4M | $26.1M | $34.7M | $41.7M |
Peer Context — Where This Hospital Sits
Key metrics vs 89 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 2.2% | -10.5% | 4.5% | 14.7% | P43 |
| Net-to-Gross | 24.0% | 12.4% | 18.1% | 25.2% | P66 |
| Occupancy | 224.4% | 64.2% | 69.6% | 79.0% | P99 |
| Rev/Bed | $1.5M | $1.1M | $1.4M | $1.7M | P63 |
| Exp/Bed | $1.5M | $936K | $1.3M | $1.8M | P55 |
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.