$5.6M
$2.8M
2.4x
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Three strategically located Central Florida clinics with in-office procedure rooms and integrated diagnostics (EMG/NCV), reducing external referrals and accelerating care delivery. Board-certified orthopedic surgeons, a neurosurgeon, a chiropractic neurologist/electromyographer, and interventional pain professionals all under one roof. Turnkey in-house billing, AR, and lien administration supported by bilingual staff in English, Spanish, Creole, and French. Referral demand underpinned by multi-decade relationships with high-volume PI attorneys across Central Florida.
Why we like it
- Earnings quality is strong on paper: $2.8M cash flow on $5.6M revenue is a 50% adjusted EBITDA margin, driven by keeping diagnostics (EMG/NCV), procedures, and surgery in-house rather than referring the revenue out. That vertical integration is the difference between a good margin and a great one in this space.
- The moat is the referral network, not the real estate. Multi-decade relationships with high-volume personal-injury attorneys across Central Florida create a durable, relationship-driven pipeline that a competitor cannot buy on the open market. In PI medicine, the attorney relationships are the customer acquisition engine.
- Healthcare demand for orthopedic and injury care is recession-resistant. People get hurt in car accidents and workplace incidents regardless of the economy, and PI cases proceed independent of consumer discretionary spending, so the top line does not evaporate in a downturn.
- The infrastructure is turnkey: in-house billing, AR, and lien administration plus bilingual staff (English, Spanish, Creole, French) serving a diverse Central Florida market. A buyer inherits operating systems and language coverage that would take years and real money to build from scratch.
- The entry multiple is attractive: 2.43x cash flow for a three-location, multidisciplinary healthcare group is well below typical medical practice comps. If the referral base and collections hold up in diligence, the buyer is getting genuine scale at a value price.
How to improve it
- Map and diversify the PI attorney referral base in the first 90 days. Quantify what share of revenue comes from the top five firms, lock in the relationships personally, and begin adding new attorney partners so no single source can crater the practice.
- Tighten lien collections and AR aging. PI revenue is realized on settlement timelines, so a focused push on reducing days-to-collect, negotiating lien resolutions, and cleaning up stale receivables can pull real cash forward without adding a single patient.
- Add or extend high-margin in-house service lines. If any diagnostics, imaging, physical therapy, or interventional pain steps are still being referred out, bringing them in-house captures margin the practice is currently giving away.
- Systematize provider productivity and scheduling across all three clinics. Standardize procedure-room utilization and surgeon block time so capacity is not sitting idle, converting the existing fixed-cost footprint into more billable throughput.
- Build a formal marketing and intake engine for attorney partners. Give referring firms a dedicated liaison, fast turnaround on records and reports, and reporting they value, making this practice the default destination and raising switching costs.
- Recruit and retain the clinical talent post-close. Since surgeons and the neurosurgeon drive both reputation and billing, secure employment agreements and non-competes early so the value does not walk out the door after the seller exits.
- Explore a fourth location or acqui-hire in an adjacent Central Florida market. The operating model, billing, and lien systems are already built, so incremental clinics can leverage the same back office and referral relationships for high-return expansion.
Diligence notes
- Scrutinize referral concentration among PI attorneys. Get a firm-by-firm breakdown of case volume and revenue, and understand how portable those relationships are if a founding provider or the seller departs, because this is the single biggest risk in the deal.
- Stress-test the lien-based collections and AR. Review historical collection rates, write-offs, days-to-settlement, and how the $5.6M revenue converts to actual cash, since PI revenue recognition can look better on an accrual basis than it collects.
- Confirm the 50% adjusted EBITDA margin and what the adjustments are. Ask for reconciliation between reported financials and the $2.8M cash flow figure, and separate owner-provider compensation from true operating profit so you know what is left after replacing clinical labor.
- Validate regulatory and compliance posture. PI medicine invites scrutiny around billing practices, lien arrangements, and self-referral rules, so review coding audits, payer relationships, and any prior investigations or attorney disputes.
- Verify provider contracts, credentialing, and retention. Confirm which physicians are employed versus contracted, their non-compete terms, and whether the surgeons and neurosurgeon are staying, since their absence would materially impair revenue.
- Establish years in business, ownership history, and lease terms for all three clinics. The listing omits founding date and location specifics, so confirm operating history, landlord relationships, and lease renewal risk for each site before pricing the deal.
Source
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