Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 59% of modeled bridge. Strengths: Bed Count, Net-to-Gross Ratio. Risks: Occupancy Rate, Commercial Payer %. Risk-adjusted uplift: $0.8M (vs $1.4M 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 | $527K | $527K | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $507K | $14K | $521K | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $81K | $240K | $320K | $1.0M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $17K | $17K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 55.1% 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 | $132K | $263K | $395K | $527K | $527K | $527K | $527K |
| Denial Rate Reduction | $0 | $130K | $261K | $391K | $521K | $521K | $521K | $521K |
| A/R Days Reduction | $0 | $107K | $214K | $320K | $320K | $320K | $320K | $320K |
| Clean Claim Rate | $0 | $8K | $17K | $17K | $17K | $17K | $17K | $17K |
| Cumulative | $0 | $377K | $755K | $1.1M | $1.4M | $1.4M | $1.4M | $1.4M |
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 $1.4M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 76% / 17.0x | 81% / 19.2x | 85% / 21.5x | 87% / 22.6x | 88% / 23.7x |
| 9.0x | 71% / 14.7x | 76% / 16.7x | 80% / 18.7x | 82% / 19.7x | 83% / 20.7x |
| 10.0x | 67% / 12.9x | 71% / 14.7x | 75% / 16.5x | 77% / 17.4x | 79% / 18.3x |
| 11.0x | 63% / 11.5x | 67% / 13.1x | 71% / 14.7x | 73% / 15.6x | 75% / 16.4x |
| 12.0x | 59% / 10.2x | 64% / 11.7x | 68% / 13.2x | 69% / 14.0x | 71% / 14.7x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 50% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 3.2x, adding 5.2 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 | $862K | — | $862K | 3.3% |
| Year 1 | $888K | +$924K | $1.8M | 6.9% |
| Year 2 | $915K | +$1.4M | $2.3M | 8.7% |
| Year 3 | $942K | +$1.4M | $2.3M | 8.8% |
| Year 4 | $971K | +$1.4M | $2.4M | 8.9% |
| Year 5 | $1000K | +$1.4M | $2.4M | 9.1% |
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 | $263K | $395K | $527K | $632K |
| Denial Rate Reductio | $261K | $391K | $521K | $626K |
| A/R Days Reduction | $160K | $240K | $320K | $385K |
| Clean Claim Rate | $8K | $13K | $17K | $20K |
| Total | $693K | $1.0M | $1.4M | $1.7M |
Peer Context — Where This Hospital Sits
Key metrics vs 156 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 3.3% | -47.2% | -19.9% | 6.5% | P69 |
| Net-to-Gross | 15.7% | 25.8% | 39.5% | 55.2% | P6 |
| Occupancy | 2.4% | 11.9% | 21.2% | 40.2% | P3 |
| Rev/Bed | $1.9M | $456K | $790K | $1.4M | P82 |
| Exp/Bed | $1.8M | $620K | $1.1M | $1.7M | P76 |
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.