Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 60% of modeled bridge. Strengths: Net-to-Gross Ratio. Risks: Bed Count, Occupancy Rate. Risk-adjusted uplift: $20.8M (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 | 35.8% 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 | $3.3M | $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 | 49% / 7.3x | 53% / 8.4x | 57% / 9.6x | 59% / 10.2x | 61% / 10.8x |
| 9.0x | 44% / 6.1x | 48% / 7.1x | 52% / 8.2x | 54% / 8.7x | 56% / 9.2x |
| 10.0x | 39% / 5.2x | 44% / 6.1x | 48% / 7.0x | 50% / 7.5x | 51% / 8.0x |
| 11.0x | 34% / 4.4x | 39% / 5.2x | 44% / 6.1x | 46% / 6.5x | 47% / 7.0x |
| 12.0x | 30% / 3.8x | 35% / 4.5x | 40% / 5.3x | 42% / 5.7x | 44% / 6.1x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline -2% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 6.6x, adding 1.8 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 | $124.7M | — | $124.7M | 18.9% |
| Year 1 | $128.5M | +$23.2M | $151.6M | 23.0% |
| Year 2 | $132.3M | +$34.7M | $167.1M | 25.3% |
| Year 3 | $136.3M | +$34.7M | $171.0M | 25.9% |
| Year 4 | $140.4M | +$34.7M | $175.1M | 26.5% |
| Year 5 | $144.6M | +$34.7M | $179.3M | 27.2% |
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 12 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 18.9% | -2.8% | 1.7% | 16.1% | P73 |
| Net-to-Gross | 10.6% | 26.8% | 31.6% | 35.8% | P9 |
| Occupancy | 41.2% | 71.2% | 74.8% | 81.1% | P0 |
| Rev/Bed | $963K | $1.6M | $2.3M | $2.7M | P0 |
| Exp/Bed | $781K | $1.5M | $2.0M | $2.7M | P0 |
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.