M&A Uncovered: Insider Lessons from Real Healthcare Practice Acquisitions

Introduction

Closing a medical practice acquisition is exciting—but as any seasoned dealmaker will tell you, the difference between a win and a regret is what’s uncovered before the ink dries.

Inside the Due Diligence Vault: Lessons from the Field

What do hundreds of real-world due diligence projects reveal? The story is rarely found in the top-line numbers. Instead, deal success emerges in the details others might miss.

• Delayed Metrics: The inability to get timely, actionable operational data post-close is one of the top reasons integrations fail and issues fester.
• AR Surprises: AR over 120 days and “off-balance” contract disputes are usually the largest sources of hidden loss.
• Coding/Compliance Blind Spots: Small gaps can become significant losses if Medicare rules or audits shift.
• Team or Process Gaps: Practices lacking clear billing/RCM ownership or facing frequent staff turnover see the most post-close churn.
• Reliance on Spreadsheets: If ongoing reporting depends on spreadsheets, you don’t have a real handle on performance.

Protect EBITDA and Find Consistent Upside Opportunities

• Contract Improvement: Benchmark payer rates and don’t hesitate to renegotiate as a deal lever.
• Service Line Margins: Often, overlooked ancillary services are the highest-margin and fastest growth areas after close.
• Quick Wins: Proactive AR follow-up or regular coding reviews often pays for itself quickly, especially when you refocus your best talent on true productivity—instead of on endless rework.

Wins (and losses) are nearly always tied to operational drivers—not headline financials.

5 Actionable Tips Before Your Next Acquisition

1. Demand AR Detail by Age and Payor
2. Audit Coding Practices
3. Interview Billing, Operations, and Tech Staff Directly
4. Evaluate Policy Manuals for Real-World Relevance
5. Scenario-Plan for Key Staff Departures