Established Multi-Specialty Medical Practice, 3 Wyoming Locations

$13.0M

Revenue

$558K

SDE

2.7x

Multiple

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Full Editorial Writeup

This is a 50-plus year old multi-specialty medical practice operating across three locations in Wyoming, serving a growing and relatively underserved regional market. The practice generates roughly $13M in gross revenue with 59 full- and part-time staff, and carries deep community trust built over generations of patient relationships. The diversified specialty mix spreads revenue across multiple service lines, which lowers single-specialty concentration risk and keeps patient flow steady.

The financial story is unusual for a practice of this size. On $13M of revenue it reports $558,000 of cash flow (SDE) and only $258,000 of EBITDA, implying a low single-digit operating margin. That is the central question in this deal: either the practice is loaded with physician compensation and administrative drag that a sharper operator can fix, or the economics are genuinely thin and the revenue number is inflated by pass-through costs. The $1.5M asking price against $13M of revenue (roughly 0.12x revenue) tells you the market is pricing this on earnings, not top line.

What makes it notable is the seller setup. The physician-owners explicitly want to stay on and continue practicing for several years, offloading only the administrative burden. For a buyer that means clinical continuity and retained patient relationships from day one, which is the single biggest risk in buying a medical practice. The real estate is owned (not disclosed as included), the seller will carry 10%, and the deal is positioned as an operations-and-admin play on an established, essential-service business.

Why we like it

Multi-specialty medical care is as essential and recession-resistant as it gets, and a 50-year-old practice with three locations has a returning patient panel that generates revenue without re-winning each sale. Patients come back for ongoing care, insurance reimburses the bulk of it, and demand does not evaporate in a downturn.
The physician-owners want to STAY and keep practicing for years, which removes the biggest landmine in buying a practice: losing the doctors and the patients who follow them. You are buying the administrative upside while clinical production and relationships stay locked in place.
At $1.5M against $558K of SDE, this is a 2.69x cash flow multiple, cheap for an essential healthcare business with 50 years of goodwill. The seller carrying 10% signals some confidence and gives you a modest alignment hook to negotiate against.
Wyoming is a genuinely underserved healthcare market with limited competition and steady, moderate growth. Three established locations give you existing footprint to add providers, specialties, and ancillary revenue rather than building from scratch.

How to improve it

Attack the margin immediately. On $13M of revenue the practice throws off only $258K of EBITDA, which is a sub-2% operating margin, so the first 90 days should be a line-by-line teardown of payer mix, coding accuracy, and physician compensation to understand where the money goes. If billing and coding are leaking, that is the fastest path to real profit.
Renegotiate payer contracts and tighten revenue cycle management. A 50-year-old practice often runs on stale reimbursement rates and slow collections, so benchmark contracted rates against regional norms and bring in modern RCM to cut days-in-AR and denials.
Add high-margin ancillary services across the three locations. In-house labs, imaging, physical therapy, or pharmacy capture revenue that currently leaks to outside providers, and the existing patient flow makes utilization immediate rather than speculative.
Professionalize the administrative function the owners want to shed. Install a strong practice administrator and modern scheduling, billing, and EHR workflows so you capture the exact value the sellers are handing off: freeing physicians to produce while admin runs tight.
Lock in the physicians with multi-year employment and comp agreements tied to production. Their stated willingness to stay is the whole thesis, so paper it properly with non-competes and retention incentives before close, and build a provider recruiting pipeline for future expansion.
Evaluate the owned real estate as a separate value lever. If the practice occupies owned buildings, structure a sale-leaseback or clarify whether the property transfers, because the facilities could be a meaningful asset or an additional acquisition that affects your true all-in multiple.

Diligence notes

Reconcile the margin gap. $13M revenue producing only $258K EBITDA and $558K SDE is the headline risk, so obtain tax returns and detailed P&Ls to confirm whether revenue is gross billings before heavy pass-throughs, whether physician comp is swallowing the margin, or whether the business is genuinely low-profit.
Scrutinize the payer and specialty mix. Pull the breakdown of Medicare, Medicaid, commercial, and self-pay, plus revenue by specialty and by provider, to understand reimbursement exposure and concentration risk if any single physician or specialty carries the practice.
Verify the physician retention commitment in writing. The deal depends on the owners staying, so confirm their actual timeline, compensation expectations, credentialing, and whether patient relationships are personal to them or institutional, then paper employment and non-compete terms before close.
Clarify the real estate. The listing shows real estate as owned but not disclosed as included, so determine whether the three facilities transfer, require a lease, or must be purchased separately, since that materially changes your total capital outlay and the effective multiple.
Review the EBITDA versus SDE reconciliation and FF&E. Only $50K of FF&E is included on a $13M practice, which is low for three medical locations, so confirm what equipment conveys, what is leased, and what capex the sites will need in the first two years.
Audit billing, compliance, and malpractice history. In a multi-specialty practice this old, check coding compliance, any payer audits or clawbacks, licensing status of all providers, and the malpractice claims history across every location before committing.

Source

Originally listed on BizBuySell. View original listing →