Every Dollar of EBITDA Is Worth
Eight to Ten at Exit.

Most EBITDA optimization engagements run 60–90 days from kickoff to completed valuation deliverable. Larger multi-site practices may take 90–120 days depending on data availability.

No. Many clients engage us 2–4 years before a planned exit specifically to have time to implement improvements and let them season into the financial statements. Others use our work for partnership restructuring, bank financing, or simply to understand the business better.

Primarily 3 years of P&Ls, your payer contracts, billing system reports (denials, AR aging, CPT volume), and a physician compensation schedule. Our team manages the rest.

Yes. Our normalized EBITDA analysis and valuation memo are prepared to institutional standards and are regularly used in DSO, private equity, and bank financing processes.

For clients who proceed to a transaction, the EBITDA work becomes the foundation of the sell-side process — giving buyers confidence in the financials and maximizing competitive tension among potential acquirers.

EBITDA stands for Earnings Before Interest, Taxes, Depreciation, and Amortization. For physician practices, it represents the true operating earnings of the business — the number buyers and private equity groups use to determine purchase price. In healthcare transactions, practices typically sell at 8 to 10 times EBITDA, which means every additional dollar of EBITDA improvement is worth $8 to $10 at exit. Understanding and optimizing your EBITDA before a transaction is one of the highest-return activities a physician can undertake in preparation for a sale or partnership.

Ideally, 2 to 4 years before a planned exit. EBITDA improvements need time to season into the financial statements — buyers typically want to see 2 to 3 years of normalized financials. Payer contract renegotiations take 6 to 12 months to implement and reflect in collections. Revenue cycle improvements need at least 12 months of data before a buyer will give them full credit. Starting early also gives you optionality: if the market conditions are favorable, you can move sooner. Starting 90 days before a sale leaves most of the value on the table.

A normalized EBITDA adds back one-time, non-recurring, and owner-specific expenses to produce a run-rate earnings figure that reflects what the business will generate under new ownership. Common addbacks include physician compensation above fair market value, personal expenses run through the business, one-time legal or consulting fees, non-recurring equipment purchases, and expenses related to a specific physician who will not continue post-transaction. Normalized EBITDA is the number buyers and their lenders use to determine enterprise value and debt capacity.

The most common issues are rates that have not been renegotiated in 3 or more years, missing CPT codes that are not covered under an existing contract, carve-outs for new procedures that were added to your practice after the original contract was signed, and fee schedule tiers that the practice never advanced beyond despite volume growth. Our CPT-level benchmarking compares your actual contracted rates against current market rates by code, quantifying the gap and identifying the highest-priority contracts for renegotiation based on dollar impact.

Yes. Practice valuations are regularly used for partnership buy-ins and buyouts, divorce proceedings, estate planning, SBA and bank loan applications, hospital employment negotiations, and benchmarking practice performance against specialty peers. A formal, defensible valuation document prepared by advisors with healthcare transaction experience carries significantly more weight in these contexts than an informal estimate or a generic business valuation from a non-healthcare firm.