Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 66% of modeled bridge. Strengths: Net-to-Gross Ratio. Risks: Bed Count, Revenue per Bed. Risk-adjusted uplift: $9.1M (vs $13.8M 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 | $5.2M | $5.2M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $5.0M | $144K | $5.2M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $805K | $2.4M | $3.2M | $10.1M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $168K | $168K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 35.1% 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 | $1.3M | $2.6M | $3.9M | $5.2M | $5.2M | $5.2M | $5.2M |
| Denial Rate Reduction | $0 | $1.3M | $2.6M | $3.9M | $5.2M | $5.2M | $5.2M | $5.2M |
| A/R Days Reduction | $0 | $1.1M | $2.1M | $3.2M | $3.2M | $3.2M | $3.2M | $3.2M |
| Clean Claim Rate | $0 | $84K | $168K | $168K | $168K | $168K | $168K | $168K |
| Cumulative | $0 | $3.8M | $7.5M | $11.2M | $13.8M | $13.8M | $13.8M | $13.8M |
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 $13.8M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 125% / 57.6x | 130% / 64.3x | 135% / 71.1x | 137% / 74.5x | 139% / 77.9x |
| 9.0x | 119% / 50.8x | 124% / 56.8x | 129% / 62.8x | 131% / 65.8x | 133% / 68.8x |
| 10.0x | 115% / 45.4x | 119% / 50.8x | 124% / 56.2x | 126% / 58.9x | 128% / 61.6x |
| 11.0x | 110% / 41.0x | 115% / 45.9x | 119% / 50.8x | 121% / 53.3x | 123% / 55.7x |
| 12.0x | 106% / 37.3x | 111% / 41.8x | 115% / 46.3x | 117% / 48.6x | 119% / 50.8x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 84% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 1.0x, adding 7.4 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 | $1.9M | — | $1.9M | 0.7% |
| Year 1 | $2.0M | +$9.2M | $11.2M | 4.3% |
| Year 2 | $2.0M | +$13.8M | $15.8M | 6.0% |
| Year 3 | $2.1M | +$13.8M | $15.9M | 6.1% |
| Year 4 | $2.2M | +$13.8M | $16.0M | 6.1% |
| Year 5 | $2.2M | +$13.8M | $16.0M | 6.1% |
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 | $2.6M | $3.9M | $5.2M | $6.3M |
| Denial Rate Reductio | $2.6M | $3.9M | $5.2M | $6.2M |
| A/R Days Reduction | $1.6M | $2.4M | $3.2M | $3.8M |
| Clean Claim Rate | $84K | $126K | $168K | $201K |
| Total | $6.9M | $10.3M | $13.8M | $16.6M |
Peer Context — Where This Hospital Sits
Key metrics vs 27 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 0.7% | -1.7% | 5.5% | 14.4% | P27 |
| Net-to-Gross | 11.7% | 24.6% | 29.0% | 35.2% | P0 |
| Occupancy | 54.1% | 60.7% | 73.5% | 81.3% | P7 |
| Rev/Bed | $874K | $1.5M | $1.8M | $2.2M | P4 |
| Exp/Bed | $868K | $1.4M | $1.6M | $2.0M | P4 |
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.