Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 75% of modeled bridge. Strengths: Occupancy Rate, Revenue per Bed. Risks: Bed Count. Risk-adjusted uplift: $53.1M (vs $70.3M 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 | $26.7M | $26.7M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $25.7M | $735K | $26.5M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $4.1M | $12.2M | $16.3M | $51.3M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $856K | $856K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 34.7% 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 |
|---|---|---|---|---|---|---|---|---|
| Cost to Collect | $0 | $6.7M | $13.4M | $20.1M | $26.7M | $26.7M | $26.7M | $26.7M |
| Denial Rate Reduction | $0 | $6.6M | $13.2M | $19.9M | $26.5M | $26.5M | $26.5M | $26.5M |
| A/R Days Reduction | $0 | $5.4M | $10.8M | $16.3M | $16.3M | $16.3M | $16.3M | $16.3M |
| Clean Claim Rate | $0 | $428K | $856K | $856K | $856K | $856K | $856K | $856K |
| Cumulative | $0 | $19.2M | $38.3M | $57.0M | $70.3M | $70.3M | $70.3M | $70.3M |
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 $70.3M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 67% / 13.2x | 72% / 15.0x | 76% / 16.8x | 78% / 17.7x | 79% / 18.6x |
| 9.0x | 62% / 11.3x | 67% / 12.9x | 71% / 14.6x | 73% / 15.4x | 75% / 16.2x |
| 10.0x | 58% / 9.9x | 62% / 11.3x | 66% / 12.8x | 68% / 13.5x | 70% / 14.2x |
| 11.0x | 54% / 8.7x | 58% / 10.0x | 62% / 11.3x | 64% / 12.0x | 66% / 12.7x |
| 12.0x | 50% / 7.7x | 55% / 8.9x | 59% / 10.1x | 61% / 10.7x | 62% / 11.3x |
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 4.1x, 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 | $65.0M | — | $65.0M | 4.9% |
| Year 1 | $66.9M | +$46.9M | $113.8M | 8.5% |
| Year 2 | $68.9M | +$70.3M | $139.3M | 10.4% |
| Year 3 | $71.0M | +$70.3M | $141.3M | 10.6% |
| Year 4 | $73.1M | +$70.3M | $143.5M | 10.7% |
| Year 5 | $75.3M | +$70.3M | $145.6M | 10.9% |
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 | $13.4M | $20.1M | $26.7M | $32.1M |
| Denial Rate Reductio | $13.2M | $19.9M | $26.5M | $31.8M |
| A/R Days Reduction | $8.1M | $12.2M | $16.3M | $19.5M |
| Clean Claim Rate | $428K | $642K | $856K | $1.0M |
| Total | $35.2M | $52.8M | $70.3M | $84.4M |
Peer Context — Where This Hospital Sits
Key metrics vs 21 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 4.9% | -0.5% | 1.7% | 14.8% | P55 |
| Net-to-Gross | 34.5% | 24.9% | 31.1% | 34.7% | P70 |
| Occupancy | 97.5% | 70.8% | 74.9% | 82.0% | P95 |
| Rev/Bed | $2.8M | $1.5M | $1.8M | $2.4M | P90 |
| Exp/Bed | $2.7M | $1.2M | $1.6M | $2.2M | P86 |
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.