DX / Differentials / ORTHOPEDIC & MSK
D-05 — PREPARING FOR SALE · ORTHOPEDIC & MSK
Growth has to read as a system — orthopedic and MSK
Visits are documented and the case pipeline is not
PRESENTATION — WHAT THE OPERATOR SEES
A process is in view and the group is measured on visits while a buyer will price cases and referral durability. The work here is to make the pipeline legible and the referral base look like a system rather than a set of friendships.
DIFFERENTIAL — LIKELY CAUSES, MOST LIKELY FIRST
- 01
The referral base is a set of personal relationships
If the referrals follow a surgeon rather than the group, they are portable, and a buyer knows it. Concentration in a small number of referring practices is priced the same way customer concentration is priced in any other business.
Referral volume by referring practice and by receiving surgeon, twenty-four months, with concentration shown, is a query the group can run on itself first.
No published distribution — ADMEN source register, /sources/
NOT THIS IF — Referral volume is distributed across many practices and does not follow individual surgeons.
- 02
The pipeline from visit to case has never been drawn
A buyer pricing an ambulatory surgery centre wants to see how a clinic visit becomes a case. If that pipeline has never been measured, the growth story is a revenue line without a mechanism behind it.
Visit to consult, consult to scheduled case, scheduled to performed — four counts, one definition set, applied identically across clinics and surgeons.
No published distribution — ADMEN source register, /sources/
NOT THIS IF — The pipeline is measured monthly on one definition set and reconciles to the case log.
- 03
Growth came from adding providers rather than from a repeatable system
Volume that grew because two surgeons were hired is not the same asset as volume that grew because demand generation and access improved. Both are real; only one is re-runnable by a buyer.
Decompose growth into provider additions, session additions and same-provider volume change. The third component is the one that carries a multiple.
No published distribution — ADMEN source register, /sources/
NOT THIS IF — Same-provider, same-session volume grew materially over the period.
- 04
Access, the group's biggest operational lever, is undocumented
A buyer with an operating thesis will want the levers. Access time is the strongest one in this category, and a group that cannot show what it is or how it moved has nothing to hand over.
A trailing history of time to next available appointment per clinic, with what changed and when, is both a diligence artefact and an operating instruction.
No published distribution — ADMEN source register, /sources/
NOT THIS IF — Access has been measured and reported for at least a year with a documented history.
HOW TO TELL THEM APART
How to tell these apart in your own numbers
Each of these is a measurement you can run yourself, without us.
01 · The referral base is a set of personal relationships
Referral volume by referring practice and by receiving surgeon, twenty-four months, with the share held by the top ten practices and the top three surgeons.
CONFIRMS IF
A small number of practices or one surgeon carries a disproportionate share.
EXCLUDES IF
Volume is distributed and does not track individual surgeons.
02 · The pipeline from visit to case has never been drawn
Build the four-count pipeline for twenty-four months on one definition set and reconcile the last count to the case log.
CONFIRMS IF
It cannot be built from source systems, or it does not reconcile.
EXCLUDES IF
It reconciles and has been reported monthly.
03 · Growth came from adding providers rather than from a repeatable system
Decompose revenue growth into provider additions, session additions and same-provider change, thirty-six months.
CONFIRMS IF
Almost all of the growth is in the first two components.
EXCLUDES IF
Same-provider volume carried a meaningful share.
04 · Access, the group's biggest operational lever, is undocumented
Produce a trailing twelve-month history of time to next available appointment per clinic, with the operational changes that moved it.
CONFIRMS IF
No such history exists.
EXCLUDES IF
It exists and is already in the reporting pack.
WHAT RESOLVES EACH
What resolves this, and how you will know it resolved
| The referral base is a set of personal relationships | Rx 05 · preparing for sale → | A growth narrative that separates provider additions from same-provider growth, with referral concentration answered before a buyer asks. |
| The pipeline from visit to case has never been drawn | Rx 04 · marketing attribution → | The visit-to-case pipeline drawn on one definition set across clinics and surgeons, reconciled to the case log monthly. |
| Growth came from adding providers rather than from a repeatable system | Rx 05 · preparing for sale → | Growth decomposed in the narrative rather than asserted, so the component that is re-runnable is visible and the component that is not is not oversold. |
| Access, the group's biggest operational lever, is undocumented | Rx 04 · marketing attribution → | Access instrumented, reported and historised — the operating lever handed over as a documented instrument rather than as a claim. |
WHAT "RESOLVED" LOOKS LIKE — Referral concentration, and share of growth from same-provider volume
MEDIAN
Not published for this category.
TOP DECILE
Not published, and a modelled multiple is a model rather than a comparable.
TARGET
Twenty-four months on one definition set, a pipeline that reconciles to the case log, referral volume distributed rather than concentrated, and a documented access history.
No published distribution — ADMEN source register, /sources/
HOW THIS DIFFERS BY SCALE
How this differs by scale
| Single site | A single-surgeon practice sells the surgeon. Referral portability is the entire conversation. |
| Group | Referral concentration and definition drift between clinics are the two findings that most often reprice a group. |
| Platform | With an ambulatory surgery centre, the buyer prices the case pipeline rather than the visit count — the two-sided measurement orthopedic platform operators should already be running. A pipeline that has never been drawn is priced as risk. |
OTHER PRESENTATIONS — ORTHOPEDIC & MSK
- Cost per new patient is rising and the two halves of the business are being averaged
- New patient visits are short and the schedule is the reason
- Visits are flat and the cases are where the money is
- One playbook, and clinics that behave nothing alike
A differential narrows the field. It does not replace the examination — that is what the six weeks are for. Every figure above is an industry reference range, not a client's numbers; those stay sealed. Sources are set out at /sources.
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