Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 69% of modeled bridge. Strengths: Revenue per Bed, Bed Count. Risk-adjusted uplift: $3.5M (vs $5.0M 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 | $1.9M | $1.9M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $1.8M | $52K | $1.9M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $293K | $868K | $1.2M | $3.7M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $61K | $61K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 44.4% 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 | $477K | $954K | $1.4M | $1.9M | $1.9M | $1.9M | $1.9M |
| Denial Rate Reduction | $0 | $472K | $945K | $1.4M | $1.9M | $1.9M | $1.9M | $1.9M |
| A/R Days Reduction | $0 | $387K | $774K | $1.2M | $1.2M | $1.2M | $1.2M | $1.2M |
| Clean Claim Rate | $0 | $31K | $61K | $61K | $61K | $61K | $61K | $61K |
| Cumulative | $0 | $1.4M | $2.7M | $4.1M | $5.0M | $5.0M | $5.0M | $5.0M |
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 $5.0M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 52% / 8.1x | 56% / 9.3x | 60% / 10.6x | 62% / 11.2x | 64% / 11.9x |
| 9.0x | 47% / 6.8x | 51% / 8.0x | 55% / 9.1x | 57% / 9.6x | 59% / 10.2x |
| 10.0x | 42% / 5.8x | 47% / 6.8x | 51% / 7.8x | 53% / 8.3x | 55% / 8.8x |
| 11.0x | 38% / 5.0x | 43% / 5.9x | 47% / 6.8x | 49% / 7.3x | 51% / 7.8x |
| 12.0x | 34% / 4.3x | 39% / 5.2x | 43% / 6.0x | 45% / 6.4x | 47% / 6.8x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 6% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 6.1x, adding 2.4 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 | $12.8M | — | $12.8M | 13.4% |
| Year 1 | $13.2M | +$3.3M | $16.6M | 17.3% |
| Year 2 | $13.6M | +$5.0M | $18.6M | 19.5% |
| Year 3 | $14.0M | +$5.0M | $19.0M | 19.9% |
| Year 4 | $14.4M | +$5.0M | $19.5M | 20.4% |
| Year 5 | $14.9M | +$5.0M | $19.9M | 20.8% |
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 | $954K | $1.4M | $1.9M | $2.3M |
| Denial Rate Reductio | $945K | $1.4M | $1.9M | $2.3M |
| A/R Days Reduction | $581K | $871K | $1.2M | $1.4M |
| Clean Claim Rate | $31K | $46K | $61K | $73K |
| Total | $2.5M | $3.8M | $5.0M | $6.0M |
Peer Context — Where This Hospital Sits
Key metrics vs 42 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 13.4% | -15.6% | 4.8% | 14.5% | P71 |
| Net-to-Gross | 25.9% | 23.0% | 30.4% | 44.4% | P26 |
| Occupancy | 49.7% | 44.6% | 52.7% | 74.6% | P43 |
| Rev/Bed | $2.2M | $473K | $780K | $1.9M | P83 |
| Exp/Bed | $1.9M | $450K | $1.1M | $1.8M | P74 |
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.