Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 65% of modeled bridge. Risks: Bed Count, Commercial Payer %. Risk-adjusted uplift: $12.4M (vs $19.2M 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 | $7.3M | $7.3M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $7.0M | $200K | $7.2M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $1.1M | $3.3M | $4.4M | $14.0M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $233K | $233K | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 38.1% 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 | $1.8M | $3.6M | $5.5M | $7.3M | $7.3M | $7.3M | $7.3M |
| Denial Rate Reduction | $0 | $1.8M | $3.6M | $5.4M | $7.2M | $7.2M | $7.2M | $7.2M |
| A/R Days Reduction | $0 | $1.5M | $3.0M | $4.4M | $4.4M | $4.4M | $4.4M | $4.4M |
| Clean Claim Rate | $0 | $116K | $233K | $233K | $233K | $233K | $233K | $233K |
| Cumulative | $0 | $5.2M | $10.4M | $15.5M | $19.2M | $19.2M | $19.2M | $19.2M |
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 $19.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 116% / 47.5x | 121% / 53.2x | 126% / 58.8x | 128% / 61.7x | 130% / 64.5x |
| 9.0x | 111% / 41.9x | 116% / 46.9x | 120% / 51.9x | 122% / 54.5x | 124% / 57.0x |
| 10.0x | 106% / 37.4x | 111% / 41.9x | 115% / 46.4x | 118% / 48.7x | 119% / 50.9x |
| 11.0x | 102% / 33.7x | 107% / 37.8x | 111% / 41.9x | 113% / 44.0x | 115% / 46.0x |
| 12.0x | 98% / 30.6x | 103% / 34.4x | 107% / 38.1x | 109% / 40.0x | 111% / 41.9x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 81% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 1.2x, adding 7.2 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 | $3.3M | — | $3.3M | 0.9% |
| Year 1 | $3.4M | +$12.8M | $16.2M | 4.4% |
| Year 2 | $3.5M | +$19.2M | $22.7M | 6.2% |
| Year 3 | $3.6M | +$19.2M | $22.8M | 6.3% |
| Year 4 | $3.7M | +$19.2M | $22.9M | 6.3% |
| Year 5 | $3.8M | +$19.2M | $23.0M | 6.3% |
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 | $3.6M | $5.5M | $7.3M | $8.7M |
| Denial Rate Reductio | $3.6M | $5.4M | $7.2M | $8.6M |
| A/R Days Reduction | $2.2M | $3.3M | $4.4M | $5.3M |
| Clean Claim Rate | $116K | $175K | $233K | $280K |
| Total | $9.6M | $14.4M | $19.2M | $23.0M |
Peer Context — Where This Hospital Sits
Key metrics vs 25 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 0.9% | -12.3% | 0.9% | 6.0% | P48 |
| Net-to-Gross | 35.6% | 28.4% | 33.5% | 38.1% | P58 |
| Occupancy | 49.8% | 49.8% | 60.5% | 65.9% | P24 |
| Rev/Bed | $1.3M | $1.2M | $1.5M | $2.7M | P29 |
| Exp/Bed | $1.3M | $1.3M | $1.7M | $2.6M | P24 |
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.