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: Revenue per Bed. Risks: Occupancy Rate, Commercial Payer %. Risk-adjusted uplift: $12.3M (vs $18.5M 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 | $7.0M | $7.0M | $0 | 12mo |
| Denial Rate Reduction | 12.0% DEFAULT | 6.5% BENCHMARK | $6.8M | $194K | $7.0M | $0 | 12mo |
| A/R Days Reduction | 52.00 DEFAULT | 38.00 BENCHMARK | $1.1M | $3.2M | $4.3M | $13.5M | 9mo |
| Clean Claim Rate | 88.0% DEFAULT | 96.0% BENCHMARK | $0 | $225K | $225K | $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 | $3.5M | $5.3M | $7.0M | $7.0M | $7.0M | $7.0M |
| Denial Rate Reduction | $0 | $1.7M | $3.5M | $5.2M | $7.0M | $7.0M | $7.0M | $7.0M |
| A/R Days Reduction | $0 | $1.4M | $2.9M | $4.3M | $4.3M | $4.3M | $4.3M | $4.3M |
| Clean Claim Rate | $0 | $113K | $225K | $225K | $225K | $225K | $225K | $225K |
| Cumulative | $0 | $5.0M | $10.1M | $15.0M | $18.5M | $18.5M | $18.5M | $18.5M |
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 $18.5M is added at exit.
| Entry \ Exit | 9.0x | 10.0x | 11.0x | 11.5x | 12.0x |
|---|---|---|---|---|---|
| 8.0x | 61% / 10.7x | 65% / 12.3x | 69% / 13.8x | 71% / 14.6x | 73% / 15.4x |
| 9.0x | 56% / 9.2x | 60% / 10.5x | 64% / 11.9x | 66% / 12.6x | 68% / 13.3x |
| 10.0x | 51% / 7.9x | 56% / 9.2x | 60% / 10.4x | 62% / 11.0x | 63% / 11.6x |
| 11.0x | 47% / 6.9x | 52% / 8.0x | 56% / 9.2x | 58% / 9.7x | 59% / 10.3x |
| 12.0x | 43% / 6.1x | 48% / 7.1x | 52% / 8.1x | 54% / 8.6x | 56% / 9.2x |
Covenant Headroom (at 10x Entry, 6.5x Max Leverage)
Pro forma EBITDA can decline 26% before the 6.5x covenant trips. RCM uplift reduces leverage from 8.5x to 4.8x, adding 3.6 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 | $24.7M | — | $24.7M | 7.0% |
| Year 1 | $25.5M | +$12.4M | $37.8M | 10.7% |
| Year 2 | $26.2M | +$18.5M | $44.8M | 12.7% |
| Year 3 | $27.0M | +$18.5M | $45.6M | 12.9% |
| Year 4 | $27.8M | +$18.5M | $46.4M | 13.2% |
| Year 5 | $28.7M | +$18.5M | $47.2M | 13.4% |
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 | $3.5M | $5.3M | $7.0M | $8.5M |
| Denial Rate Reductio | $3.5M | $5.2M | $7.0M | $8.4M |
| A/R Days Reduction | $2.1M | $3.2M | $4.3M | $5.1M |
| Clean Claim Rate | $113K | $169K | $225K | $271K |
| Total | $9.3M | $13.9M | $18.5M | $22.2M |
Peer Context — Where This Hospital Sits
Key metrics vs 34 size-matched peers. Low percentile on margin/efficiency metrics = more room for improvement = larger bridge opportunity.
| Metric | Hospital | P25 | P50 | P75 | Percentile |
|---|---|---|---|---|---|
| Op Margin | 7.0% | -12.3% | 0.8% | 7.2% | P72 |
| Net-to-Gross | 38.1% | 28.4% | 33.1% | 38.1% | P73 |
| Occupancy | 45.7% | 47.3% | 59.3% | 64.4% | P18 |
| Rev/Bed | $2.0M | $1.1M | $1.8M | $2.6M | P61 |
| Exp/Bed | $1.9M | $1.3M | $1.8M | $2.6M | P56 |
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.