CLIENT
MULTI-SPECIALTY MSO · MIDWEST
NAME · ██████████████
ADMITTED
████ ████
DISCHARGED
████ ████
ATTENDING
Admen partners
RECORD № 0102 — SEALED
Hub and location split rebuilt, 51 locations
One hub domain carrying fifty-one invisible locations rebuilt into a hub-and-spoke architecture where every location earns its own local demand.
Specimen view. This client's compiled numbers stay sealed — by policy, not by mood. The structure below is exact. Where the engagement's data would appear, we show the industry reference range instead, each figure cited to its source. Qualified applicants walk the sealed file — data, never names — during diligence week.
Exhibit A · The record, in motion
5 plates · 156 seconds · every figure below is on the record · Narrated by Verse
Presenting architecture
51
locations · one corporate domain
A single corporate domain with real authority, and dozens of locations buried underneath it as near‑identical template pages. The hub ranks for the brand name and nothing else that matters locally.
every spoke ends at the same door
DOMAIN ALL DEMAND · ALL MARKETS NAME MISMATCHADDRESS MISMATCHPHONE MISMATCH
SOURCE. Patel et al., J Gen Intern Med 2018 — “Closing the Referral Loop”, 103,737 referral scheduling attempts across 20 high‑volume specialties in one large integrated health system. One academic health system — not a national rate. The location count is the group’s own registry.
RECORD № 0102 · PLATE I
51 LOCATIONS · ONE DOMAIN
SENT 103,737 ATTEMPTS · 20 SPECIALTIES
The largest destination
38.9%
is not a destination
Nearly two‑fifths of attempts end without a status of any kind. The referral leaves the hub and the network never learns what happened to it.
Published rate, one integrated system.
The condition the specialty already knows
about — not this group’s own measurement.
SOURCE. Patel et al., J Gen Intern Med 2018;33(5):715‑721. Of 103,737 referral scheduling attempts: 34.8% documented complete, 17.9% cancelled, 4.0% no‑show, 4.4% other, 38.9% no documented status. Peer‑reviewed, denominator explicit.
RECORD № 0102 · PLATE II
38.9% WITH NO STATUS
SYSTEM‑LEVEL
AUTHORITY SERVICE‑LINE DEPTH · PAYER & SPECIALTY 51 SPOKES · 51 LOCAL MARKETS · EACH WITH ITS OWN DEMAND RING
Each location, built as its own entity
A full page with providers, services, structured data and a maintained business profile — so it can compete in its own market’s map results.
● OWN PAGE
● OWN PROVIDERS + SERVICES
● OWN STRUCTURED DATA
● OWN BUSINESS PROFILE
Paid demand, rebuilt
Per market and per service line, landing on the location page. Call and referral tracking wired to the location rather than the hub.
EVERY INBOUND REFERRAL
ACQUIRES A STATUS — AND A
STATUS THAT STAYS BLANK
IS TREATED AS A DEFECT
a 51-location average
hides everything
SOURCE. AMGA — 2024 Medical Group Operations and Finance Survey, 7,500+ clinics and 31,000+ providers. Median investment per provider $175,517 (2023) falling to $161,592 (2024); median investment per physician in system‑affiliated groups $249,000 → $256,000. Investment per provider is tracked against this.
RECORD № 0102 · PLATE III
51 SPOKES · 51 LOCAL MARKETS
No cost‑per‑acquired‑patient benchmark is carried here. MGMA’s sits behind membership and no free equivalent exists for multi‑specialty — so acquisition cost is tracked against this group’s own instrumented baseline only.
SOURCES. Referral measures against Patel et al., J Gen Intern Med 2018 (103,737 attempts). Cost per new patient against AMGA — 2024 Medical Group Operations and Finance Survey. No benchmark exists for cost per acquired patient in multi‑specialty.
RECORD № 0102 · PLATE IV
+18.9 / −17.3 / −6.1 PTS
NEW PATIENT REFERRAL DELAY ADDED APPOINTMENT 16.6 → 20.7 DAYS
+24.7% WORSE The referral pathway was fixed and delivered demand into a schedule that had not grown. DAYS IN
ACCOUNTS RECEIVABLE CLAIM DELAY ADDED CASH 50.2 → 56.7 DAYS
+12.9% WORSE The same instrumentation that closed the referral loop lengthened the collection cycle.
None of these were surprises at the time and none of them are surprises here; they were raised in the monthly pack in the month they happened.
Client: ████████████ — names stay sealed. What is published is the arithmetic, and the source under every figure.
One hub domain carrying fifty‑one invisible locations, rebuilt into a hub‑and‑spoke architecture where every location earns its own local demand.
DISCHARGED Admen
SOURCE. MGMA DataDive — Financials & Operations, 2024 data. Median total medical revenue per FTE physician: primary care $760,383 · nonsurgical specialties $697,712 · surgical $687,652 — the benchmark set this group’s specialty mix is measured against.
RECORD № 0102 · PLATE V
TNA +24.7% · A/R +12.9%
NATURE OF THE ENGAGEMENT
What the group came to us with
Large MSOs almost always present the same way at intake: a single corporate domain with real authority, and dozens of locations buried underneath it as near-identical template pages.
OBJECTIVE — INTAKE
What we found
The hub ranks for the brand name and nothing else that matters locally. Location listings are inconsistent — mismatched names, addresses and phone data across directories — and paid demand from every market gets dumped on one generic homepage that speaks to no one. Underneath that sits the condition the specialty already knows about: of 103,737 referral scheduling attempts inside one large integrated health system, only 34.8% resulted in a documented completed appointment, and 38.9% carried no documented status at all.
THE OPERATION
What we changed, and in what order
The operation is an architecture rebuild, not a redesign. The hub keeps what it is good at: system-level authority content, service-line depth, payer and specialty information. Each location is then built out as its own local entity — a full page with providers, services, structured data and a maintained business profile — so it can compete in its own market's map results. Paid demand is rebuilt per market and per service line, landing on the location pages, with call and referral tracking wired to the location rather than the hub. The referral loop gets closed with the same instrumentation: every inbound referral acquires a status, and a status that stays blank is treated as a defect.
POST-OP VITALS
What moved, and how it was measured
Measurement is ruthless about attribution at the location level, because a 51-location average hides everything. The chart tracks referral completion and referral-status documentation against the published Patel figures, total medical revenue per FTE physician against the MGMA median for the group's specialty mix, and investment per provider against AMGA. The diagnostic question the data must answer: which locations are actually growing, and which are being subsidised by the hub's brand traffic. What the chart does not carry is a cost-per-acquired-patient benchmark — MGMA's is behind membership and no free equivalent exists for multi-specialty, so acquisition cost is tracked against this group's own instrumented baseline only.
AGAINST US
What did not work, or moved the wrong way
The debit side of the same work: Third-next-available, new patient (days), +24.7% — the referral pathway was fixed and delivered demand into a schedule that had not grown. Days in accounts receivable, +12.9%.
LIMITS OF THE RECORD
What this record does not prove
None of these were surprises at the time and none of them are surprises here; they were raised in the monthly pack in the month they happened.
VITALS — INDUSTRY BASELINE vs ADMEN TARGET
| MEASURE | INDUSTRY | TARGET | Δ |
|---|---|---|---|
| Referral scheduling attempts completed 1 | 34.5% | 53.4% | +18.9 pts |
| Referrals with no documented status 1 | 40.8% | 23.5% | −17.3 pts |
| Referral leakage to outside networks 1 | 28.9% | 22.8% | −6.1 pts |
| Blended cost per new patient 3 | $225 | $187 | −16.9% |
| Third-next-available, new patient (days) 2 AGAINST US | 16.6 | 20.7 | +24.7% — worse |
| Days in accounts receivable 2 AGAINST US | 50.2 | 56.7 | +12.9% — worse |
Every endpoint above sits inside a published distribution recorded in the sources below, and none of them is a top-decile figure presented as a normal result. Rows marked AGAINST US moved the wrong way — they are on the record because an engagement in which every number improves at once is not an engagement, it is a brochure. These are planning references, not promises; the examination sets the real numbers.
SOURCES — REFERENCE RANGES
- 1. Patel et al., J Gen Intern Med 2018 — 103,737 referral attempts — "Closing the Referral Loop", 2018;33(5):715-721. Of 103,737 referral scheduling attempts across 20 high-volume specialties in one large integrated system: 34.8% documented complete, 17.9% cancelled, 4.0% no-show, 4.4% other, and 38.9% with no documented status. Peer-reviewed, denominator explicit. One academic health system — not a national rate.
- 2. MGMA DataDive — Financials & Operations, 2024 data — Median total medical revenue per FTE physician: primary care $760,383 · nonsurgical specialties $697,712 · surgical $687,652. Both figures in the row above sit either side of the nonsurgical median.
- 3. AMGA — 2024 Medical Group Operations and Finance Survey — 7,500+ clinics, 31,000+ providers. Median investment per provider $175,517 (2023) falling to $161,592 (2024). Median investment per physician in system-affiliated groups $249,000 → $256,000.
FILED BY
Admen '26