Growth and sale readiness.

Sale-readiness checklist.

• Three years of clean, accrual-basis financials with consistent methodology.
• Defensible EBITDA — owner add-backs documented, recurring vs. one-time costs separated.
• Provider compensation structured to market rates — below-market comp inflates EBITDA but buyers normalize it.
• Payer contracts reviewed, with assignability or renegotiation paths.
• Provider employment agreements with appropriate non-competes and term length.
• Owner work documented and transferable — if the practice runs because of you, it’s worth less.
• Concentration risk — one provider, one payer, one referral source all reduce value.

Whether to grow, stay, partner, or sell.

Most owners want options, not a forced choice. The fix is the same regardless of which option you pick: get the finance function right, get the financials clean, understand the economics. Then the choice can be strategic instead of forced.

Two different conversations.

Growth and sale readiness sound similar but are different problems. Growth is about whether the practice can scale — can you add a provider, a location, or a service line without breaking the operating model? Sale readiness is about whether the practice is buyable — can a strategic acquirer or PE platform diligence it and see clean, defensible numbers? Most practices need both, but the work is sequenced differently.

What buyers look for.

Strategic and financial buyers evaluate medical practices on a small set of factors:

• EBITDA quality. Adjusted, defensible, with reasonable owner add-backs.
• Revenue concentration. Diversified payer mix and patient base preferred.
• Provider retention. Multi-provider groups command higher multiples than solo practices.
• Recurring revenue. Established patient panels and contracts.
• Operating systems. EHR, billing, financial close, KPIs — clean, documented, repeatable.
• Compliance posture. Coding accuracy, credentialing, HIPAA, OIG — clean records.
• Growth runway. Story for why the next owner makes more, not less.

The work that takes 18 months.

Owners who think they can “tidy up” for a sale 90 days before going to market are usually wrong. The work that drives valuation takes 12–18 months:

• Reconstructing a clean financial history (3 years of accurate, adjusted statements).
• Building documented operating procedures and KPI reporting.
• Resolving any payer or compliance issues quietly, before they appear in diligence.
• Tightening the management structure so the practice doesn’t depend on the owner.
• Modeling growth scenarios that a buyer can validate.

Questions practice owners ask.

What multiple do practices sell for? Wide range, specialty-dependent. Primary care typically trades lower than dermatology, ophthalmology, or specialty surgery. Multi-site platforms attract more buyer interest than single locations. Numbers are less useful than understanding what drives the multiple at your practice.

When should we start thinking about this? The day you start the practice, structurally. Three years before you actually want to sell, practically. The buyers will look at three years of history regardless of when you start preparing.

Should we use a banker? For most practices over $2–3M EBITDA, yes. The fee pays for itself in process, competition, and price.