Bridge Realization Estimate
ML model predicts what fraction of the bridge is achievable (accuracy: 60%, n=5,839)
Expected realization: 63% of modeled bridge. Strengths: Occupancy Rate. Risks: Bed Count. Risk-adjusted uplift: $57.4M (vs $91.2M 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 | $34.7M | $34.7M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $33.4M | $954K | $34.3M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $5.3M | $15.8M | $21.1M | $66.5M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $1.1M | $1.1M | $0 | 6mo |
| Net Collection Rate | 93.5% DEFAULT | 31.5% 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 | $8.7M | $17.3M | $26.0M | $34.7M | $34.7M | $34.7M | $34.7M |
| Denial Rate Reduction | $0 | $8.6M | $17.2M | $25.7M | $34.3M | $34.3M | $34.3M | $34.3M |
| A/R Days Reduction | $0 | $7.0M | $14.1M | $21.1M | $21.1M | $21.1M | $21.1M | $21.1M |
| Clean Claim Rate | $0 | $555K | $1.1M | $1.1M | $1.1M | $1.1M | $1.1M | $1.1M |
| Cumulative | $0 | $24.8M | $49.7M | $74.0M | $91.2M | $91.2M | $91.2M | $91.2M |
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 $91.2M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 183% / 182.8x | 190% / 203.5x | 195% / 224.2x | 198% / 234.5x | 200% / 244.9x |
| 9.0x | 177% / 162.2x | 183% / 180.6x | 188% / 198.9x | 191% / 208.1x | 193% / 217.3x |
| 10.0x | 171% / 145.6x | 177% / 162.2x | 182% / 178.7x | 185% / 187.0x | 187% / 195.2x |
| 11.0x | 166% / 132.1x | 171% / 147.1x | 177% / 162.2x | 179% / 169.7x | 182% / 177.2x |
| 12.0x | 161% / 120.8x | 167% / 134.6x | 172% / 148.4x | 174% / 155.3x | 177% / 162.2x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 95% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 0.3x, adding 8.1 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 | $3.8M | — | $3.8M | 0.2% |
| Year 1 | $3.9M | +$60.8M | $64.7M | 3.7% |
| Year 2 | $4.0M | +$91.2M | $95.2M | 5.5% |
| Year 3 | $4.1M | +$91.2M | $95.3M | 5.5% |
| Year 4 | $4.2M | +$91.2M | $95.4M | 5.5% |
| Year 5 | $4.4M | +$91.2M | $95.6M | 5.5% |
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 | $17.3M | $26.0M | $34.7M | $41.6M |
| Denial Rate Reductio | $17.2M | $25.7M | $34.3M | $41.2M |
| A/R Days Reduction | $10.5M | $15.8M | $21.1M | $25.3M |
| Clean Claim Rate | $555K | $832K | $1.1M | $1.3M |
| Total | $45.6M | $68.4M | $91.2M | $109.5M |
Peer Context — Where This Hospital Sits
Key metrics vs 295 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 0.2% | -14.9% | -4.3% | 4.1% | P63 |
| Net-to-Gross | 23.5% | 20.5% | 26.6% | 31.5% | P33 |
| Occupancy | 64.1% | 68.5% | 77.3% | 84.7% | P13 |
| Rev/Bed | $1.8M | $1.5M | $1.9M | $2.6M | P47 |
| Exp/Bed | $1.8M | $1.5M | $2.0M | $2.8M | P43 |
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.