Average DRG weight across discharges — a complexity proxy.

Each 0.05 CMI uplift ≈ 0.75% of Medicare revenue. CDI initiatives target this lever.

Σ (DRG weight × discharges) / total discharges. CMS DRG weights are the rate table.

Share of claims accepted on first submission without rework.

High clean-claim rate cuts follow-up FTE cost and shortens AR. Each 1pp lift saves the cost of one rework × claims volume.

Claims accepted first-pass / total claims submitted. Front-end coding + eligibility verification drive this.

Share of total revenue or patient days attributable to commercial (non-government) payers.

Highest reimbursement index (~1.0). Each pp of commercial mix lifts NPR/charge directly. Concentration risk if a single payer >40%.

Commercial revenue / total revenue (or commercial days / total days).

RCM operating cost as a share of net patient service revenue.

Direct EBITDA leverage — every 1pp reduction drops to the bottom line. Above 4% suggests automation upside.

Total RCM cost (FTEs + tech + outsourced vendors + bad debt processing) / NPSR.

How many days of operating expense the hospital can cover from current cash.

<30 days = covenant-trip risk; <15 = restructuring territory. Above 100 = healthy.

Cash + cash equivalents / (annual operating expense / 365).

Average days accounts receivable spends outstanding before collection.

Each day reduction releases ~NPSR/365 of working capital. Long DSO ties up cash and predicts bad debt write-offs.

(AR balance / annual NPSR) × 365. National median ~45 days; >55 = working-capital trapped; <38 = best in class.

Long-term debt as a multiple of net patient service revenue.

>1.0x typically requires above-average margin to service. Drives covenant attention.

Long-term debt / NPSR.

Share of submitted claims initially denied by the payer (before appeals).

Each 1pp reduction recovers ~35% × NPSR in avoidable revenue. Denials drive bad debt and rework cost — the highest-leverage RCM lever.

Denied claims / total claims submitted. Source: HFMA MAP Keys; partner-supplied or predicted from public-data features.

Earnings before interest, tax, depreciation, amortization, divided by NPSR.

PE benchmark for sponsor-quality cash generation. <8% raises questions; >15% is the platform-grade band.

EBITDA / NPSR. EBITDA reconstructed from HCRIS operating income + D&A + lease normalization.

Total operating expense normalized by licensed bed count.

Cost-density benchmark. High expense/bed with low revenue/bed signals labor or supply inefficiency — the synergy diligence target.

Operating expenses / licensed beds. Source: HCRIS Worksheet G-3.

Share of claims paid in full on the first attempt (no resubmission, no appeal).

Catches both denial and underpayment leak. Each 1pp lift saves rework-cost and shortens AR aging.

Claims paid in full first-pass / total claims. Tighter than clean_claim_rate because it tracks payment, not acceptance.

Full-time-equivalent staff per adjusted occupied bed — the canonical staffing intensity metric.

>7.0 = overstaffed (right-sizing opportunity); <4.5 = lean (often a quality risk).

Total FTEs / adjusted occupied beds. Source: HCRIS Worksheet S-3 Part II + S-3 Part I.

EBIT divided by interest expense — how many times over EBIT covers interest.

Below 2.0x is the credit-attention zone; <1.5x raises restructuring discussion.

EBIT / interest expense. From HCRIS G-2 + footnotes.

Total labor cost as a share of net patient service revenue.

>60% is the labor-pressured band. Right-sizing or wage normalization typically takes 1-3pp out.

Total labor cost (Worksheet A col 1+2 + benefits) / NPSR.

Share of total inpatient days attributed to Medicaid beneficiaries.

Lowest reimbursement index (~0.58). High Medicaid % drives DSO + denial rate up.

Medicaid patient days / total patient days.

Share of total inpatient days attributed to Medicare beneficiaries.

Drives reimbursement index — higher Medicare % means lower NPR per gross charge (~0.79 vs 1.00 commercial).

Medicare patient days / total patient days. Source: HCRIS Worksheet S-3 Part I.

Share of net realizable revenue actually collected (after contractual allowances).

Every 1pp lift drops to EBITDA. Below 95% signals process leak; <93% is distressed.

Cash collected / (gross charges − contractual adjustments). Excludes bad debt write-offs.

Patient-service revenue net of contractual allowances and bad debt — the topline line underwriters anchor every multiple to.

Primary scale driver. Multiples (EV/NPR, EV/EBITDA) and lever-impact estimates all flow from NPR. Trend is the leading indicator of demand and pricing power.

Gross charges − contractual allowances − bad debt provision. Source: HCRIS Worksheet G-3 Line 3 or partner-supplied audited financials.

Net patient revenue as a fraction of gross charges — the realization rate.

Payer-mix-driven; highly stable within a hospital. Sudden compression signals contract loss or payer aggression. Wide variance vs peers (>5pp) warrants a contract-by-contract walk.

Net patient revenue / gross charges.

Share of staffed beds occupied — patient days / bed-days available.

Drives fixed-cost absorption. Below 50% the hospital can't cover overhead; above 80% constrains throughput.

Total patient days / bed-days available. Source: HCRIS Worksheet S-3 Part I.

Operating income as a share of net patient service revenue.

The single best summary of asset health. <0% is distressed; >5% is sustainable; >10% is best-in-class for community hospitals.

(Net patient revenue − operating expenses) / net patient revenue. Source: HCRIS Worksheet G-2.

Inverse-Herfindahl concentration index across the payer mix; higher = more diverse, lower = more concentrated.

Concentration is the silent risk: one Medicare Advantage contract renegotiation can move 20% of revenue. Higher diversity = lower contract-renewal risk.

1 − Σ(payer_share²) across the mix. Range 0 (single payer) to ~0.8 (very diverse).

Net patient revenue normalized by licensed bed count.

Captures pricing × throughput in one number. Best-in-class acute hospitals run $1.5-2.5M/bed; lower suggests under-occupancy or weak payer mix; higher suggests outpatient skew or premium markets.

Net patient revenue / licensed beds.

Annual total of inpatient days across all service lines.

Volume baseline for occupancy, payer-mix calculations, and capacity-planning. The denominator most other partner ratios are normalized against.

Sum of daily inpatient census across the fiscal year. Source: HCRIS Worksheet S-3 Part I.