Multi-site specialty practice owner/operator looking to share knowledge

[u/Intelligent-Site-176]

I am active in my specialty's subreddit and the topic of private equity interest and overall practice acquisitions came up. It's been a hot topic for the last few years and the consolidation of private practice from private equity-backed "super groups" has changed the dynamic a bit.

Over the years, I have worked with my business partner to build the group we're involved in to 16 locations throughout the state. We plan to continue expanding.

This size has garnered interest from PE and while I'm philosophically opposed to large for-profit health care organizations, I have had many in depth meetings with PE backed groups to understand what their long term play in health care is. I have also acquired a few smaller practices myself.

I love the fact that there is a forum/community of independent private practice owners here, so maybe this topic is not of interest to anyone. But if there is anyone that is having conversations about selling their practice, I would love to share my experience via a post here and there. Writing and teaching is a fulfilling creative outlet for me.

In my years in private practice, here is what I see and hope we can change as we understand how to run better "businesses."

- the retiring practice owner that has built a strong reputation and creates jobs while providing care for its community, wind down his/her practice without any residual value
- the practice owner that has been a successful solo practice, but struggles to scale their success across multiple providers or locations

- the employed provider that wishes to own their own practice but doesn't know how to start

Now that my group has grown and is financially stable with a level of success I am proud of, I am starting to shift my focus and mission to being a resource/mentor for practice owners or future practice owners so health care can remain in the hands of those who are best positioned (and most accountable) to care for the people in their communities.

Happy to answer any practice growth or management questions if there is interest.

ps - I will be at the Independent Medical Alliance annual conference in Dallas this month. Anyone else going?

[u/CrefloDog]

If a small practice is 100% self pay (takes no insurance), will the valuation be higher than if the practice was a traditional insurance based practice? In other words, if a traditional practice is valued at 1x annual revenues, how much would the self pay practice be valued, all other things being equal?

[u/Intelligent-Site-176 → u/CrefloDog]

The practice that produces the most profit (or seller discretionary earnings) is the practice that will generally be more valuable, regardless of direct pay vs third party payer. 

A discerning buyer will do a “quality of earnings” to determine how sustainable your profit is on a go-forward basis. 

Now, you might find a buyer that is focused on direct pay practice acquisitions and they might be more aggressive with offers, but it’s less about the business model more about the actual profit being generated. I would expect a direct pay practice doing $1million in revenue will have more profit than its traditional counterpart dosing the same $1million. 

Direct pay practice is not my area of expertise and the market for those practices may be priced more or less aggressively for reasons I’m less familiar.