Florida Gastroenterology Practice with In-House Endoscopy Lab, Sole County GI Provider

$1.8M

Revenue

$989K

SDE

5.0x

Multiple

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Full Editorial Writeup

This is an established gastroenterology practice operating in a Florida county for more than a decade, notable for being the sole GI provider in its market. It runs from a purpose-built 5,400 SF medical/surgical facility that houses an in-house Office-Based Endoscopy Lab (OBL), letting the practice capture both the consultation fees and the higher-margin procedure revenue that would otherwise flow to an outside ambulatory surgery center. The practice serves an estimated 6,000 to 8,000 active patients with entrenched physician and healthcare referral relationships and carries roughly a two-month appointment backlog.

The economics are attractive for a healthcare deal: three-year average revenue of $1.818M against three-year average SDE of $989K, a margin north of 50 percent that reflects the OBL's procedure leverage and a lean six-person staff. The asking price of $5.0M is split explicitly into a $3.245M operating practice and $1.755M of medical real estate, and the deal is SBA pre-qualified, which matters because a physician-buyer can finance the going concern rather than paying all cash.

The standout dynamic is capacity headroom. The owner deliberately cut the clinical schedule to four days a week in 2025 as part of retirement planning, so a successor inherits a two-month backlog and an OBL that is not running at full utilization. Restoring a five-day schedule, increasing procedure throughput, and adding a second GI provider are all near-term levers a motivated operator can pull without needing to win a single new referral source.

Why we like it

Earnings quality is strong for a solo practice: $989K SDE on $1.818M revenue is a 54 percent margin, driven by the in-house OBL capturing procedure revenue that most GI offices hand off to a surgery center. A two-month backlog means demand is not the constraint, physician time is, which is a high-class problem for a buyer.
The moat is real and rare: this is the SOLE GI provider in its county with 6,000 to 8,000 active patients and long-tenured referral relationships built over more than a decade. In healthcare, being the only game in town for a specialty procedure gives durable pricing power and near-guaranteed patient flow from primary-care referrals.
GI services are as recession-proof as it gets. Colonoscopies, endoscopies, and treatment for chronic digestive conditions are medically necessary, largely insurance-reimbursed, and an aging Florida population only increases demand regardless of the economic cycle.
The operator advantage is unusually clean: the seller intentionally throttled the practice to four days a week for retirement, so the growth is sitting in plain sight. A buyer who simply restores a five-day schedule and better utilizes the OBL captures upside without new marketing spend or new locations.

How to improve it

Restore the five-day clinical schedule immediately. The owner cut to four days in 2025 for retirement, so recovering that fifth day recaptures roughly 20 percent of clinical capacity against an existing two-month backlog, with essentially no incremental fixed cost.
Recruit a second GI provider or an advanced-practice provider to work the backlog and expand OBL procedure volume. With demand already outstripping capacity, added clinical hours convert almost directly into high-margin procedure revenue in the underutilized facility.
Maximize OBL procedure utilization by scheduling endoscopy blocks more densely and reducing gaps between cases. Every colonoscopy and upper endoscopy performed in-house rather than referred out keeps the facility fee inside the practice.
Expand into the underutilized facility space referenced in the listing. Adding infusion services, additional exam rooms, or ancillary diagnostics leverages fixed rent and staff against new revenue lines.
Audit and optimize the payer mix and coding. GI reimbursement varies widely by procedure and payer, and a fresh review of contracts, prior authorizations, and CPT coding accuracy can lift collections on the existing volume.
Formalize and deepen referral relationships with local primary-care physicians and hospitals. Documenting these relationships and adding a light-touch outreach cadence protects the sole-provider position and insulates against a competitor entering the county.
Build a recall and screening-reminder system to systematically bring back patients due for surveillance colonoscopies. Screening intervals create predictable, repeatable procedure volume that a disciplined recall program captures rather than losing to attrition.

Diligence notes

Scrutinize the payer mix and reimbursement trends. A GI practice's economics hinge on Medicare and commercial rates for endoscopy and OBL facility fees, so pull the last three years of collections by payer and by CPT to confirm the SDE is sustainable and not propped up by a favorable one-time contract.
Verify the physician transition risk carefully. This is a solo practitioner practice where the owner IS the revenue, so confirm that referral relationships, patient loyalty, and payer credentialing will transfer to a successor and that 8 weeks of training is realistically enough for a new GI to hold the panel.
Confirm the OBL's licensing, accreditation, and reimbursement status. Office-Based Endoscopy Labs are subject to state and payer rules, and any lapse in accreditation or a shift in how the OBL facility fee is reimbursed could materially change the procedure margin.
Separate the real estate valuation from the operating multiple. The asking price bakes in $1.755M of medical real estate, so the operating business is really priced at $3.245M against $989K SDE (about 3.3x), and a buyer should independently appraise the 5,400 SF facility to confirm that real estate value.
Test the durability of the sole-provider moat. Verify there is no incoming competitor, hospital-employed GI, or telehealth GI encroaching on the county, and understand how defensible the referral base is if a larger system decides to enter the market.
Validate the backlog and active-patient figures. Confirm the two-month appointment backlog and the 6,000 to 8,000 active patient count against the practice management system, since these numbers drive the growth thesis and should not be taken on the broker's word.

Source

Originally listed on BizBuySell. View original listing →