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Transaction advisory for healthcare practices

Buying, selling, merging, or bringing in a partner — modeled after tax, before you are negotiating against someone who does this professionally.

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CPA-led · Nationwide & fully remote · Flat monthly fees
Two analysts reviewing financial charts and running numbers on a calculator

Works with the tools you already use

Valuation analysisQuality of earningsDeal structureBuy-in modelingExit readiness
The Problem

The other side has done this a hundred times. You are doing it once.

DSOs, consolidators, and private equity groups have full-time transaction teams. The owner across the table has a practice to run and an offer letter they were given a week to answer.

Valuation you did not set

A multiple of EBITDA sounds objective until you see how EBITDA was calculated. We rebuild it and show which add-backs are defensible and which are being used against you.

Structure decides the tax

Asset versus stock sale, earnout terms, and rollover equity change the after-tax outcome more than the headline price does. Two offers at the same number are rarely worth the same.

Nobody modeled the after

Post-transaction you may be an employee of the buyer for three to five years. What that compensation actually looks like belongs in the analysis, not in the surprise column.

What You Get

Everything your practice needs behind the front desk

One integrated, CPA-led team handles the entire business side, so your energy stays on care.

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  • ✓ Practice valuation and EBITDA normalization
  • ✓ Quality of earnings review of your own numbers
  • ✓ Buy-side diligence when you are acquiring
  • ✓ Deal structure and after-tax proceeds modeling
  • ✓ Associate and partner buy-in design
  • ✓ Earnout and rollover equity analysis
  • ✓ Exit readiness planning years ahead of a sale
  • ✓ Coordination with your attorney and lender through close
What You Get

What transaction advisory includes

Financial representation through the largest event of your professional life, from first offer through close.

01

Assess

A free deep-dive into your books, entity, comp, and pain points.

02

Build

We clean up the books, set your chart of accounts, and stand up the compliance calendar.

03

Run

Monthly financials, payroll, and tax filings delivered like clockwork.

04

Grow

Quarterly strategy, benchmarking, and proactive tax planning.

A worked example

What a buyer actually adjusts

The gap between your P&L and your purchase price is a list. This is the list.

Adjusted EBITDA bridgeIllustrative
Net income per the books$412,000
Interest, taxes, depreciation and amortisation$96,000
Reported EBITDA$508,000
Owner compensation above market$180,000
Personal expenses run through the practice$34,000
One-time legal and build-out costs$41,000
Below-market related-party rent, normalised($58,000)
Deferred maintenance the buyer will fund($22,000)
Adjusted EBITDA$683,000

What this tells you

  • Why the add-backs need supportEvery one of these is a number you assert and the buyer tests. Undocumented add-backs are the first thing struck in diligence, and each dollar struck comes off at the multiple.
  • The rent adjustment surprises peoplePaying yourself below-market rent inflates profit. A buyer normalises it to market and your EBITDA falls. Better to know before you are negotiating.
  • When to startTwelve to twenty-four months before you intend to sell. Clean books and a defensible bridge are built, not produced on demand.

Illustrative example showing the structure of a quality-of-earnings bridge. Figures are not those of any client and are not a valuation.

Questions

How a transaction engagement runs

No, but earlier is materially better. Before you respond we can rebuild the valuation and model the after-tax outcome, which is usually enough to change how the negotiation goes.
No. We handle the financial and tax side and work alongside your healthcare transaction counsel, who handles the legal documents. Both roles are necessary and they are not the same job.
Two to three years out. Clean books, defensible add-backs, and a practice that is not wholly dependent on the owner are what move a multiple, and none of them can be manufactured in the final quarter.
The Difference

No equity. No percentage of your growth.

Most management services organizations charge for your back office by taking ownership or a share of every dollar you collect. One costs you control. The other costs you more each year you succeed.

Equity MSOs take ownership

A DSO or private-equity group provides the back office in exchange for a stake. You get infrastructure. You also get a board, a budget you no longer set, and an exit on their timeline.

Percentage MSOs tax your growth

A fee set as a share of collections does not stay flat. Running your back office is not twice the work when revenue doubles, but the fee is. Every good year costs you more.

We take neither

A flat monthly fee for a defined scope. No equity, no share of collections, no right of first refusal if you sell. Grow the practice and the upside stays with you.

Why our model is different →

Get Started

Ready to see what your practice is really worth?

Book a free assessment. We will review your financials, normalize your earnings, and give you an honest valuation range before anyone else does.

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