DDx — MULTI-SPECIALTY MSO
MSOs: the five ways this presents
Each presentation below lists what could be causing it, ranked, with the finding that tells the causes apart and what resolution actually looks like. 25 causes, 25 tests, each cited to a primary source for this specialty rather than borrowed from another one.
Nothing on these pages describes a client or an engagement.
PRESENTATIONS
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Patient acquisition cost is climbing
Every encounter costs more to deliver than it did three years ago, the subsidy per physician keeps climbing, and someone on the board has asked for the group's cost per new encounter against an industry benchmark. There is no honest industry benchmark to give …
5 CAUSES · 5 TESTS
WORK IT THROUGH → -
New patient volume is short of plan
Primary care is referring. The specialists say their schedules are not full. When someone asks what happened to last month's referrals, the answer takes two weeks to assemble and comes back partial. The instinct in the room is to generate more demand — before …
5 CAUSES · 5 TESTS
WORK IT THROUGH → -
Growth has plateaued
Production is climbing and the schedule reads full, but total medical revenue per FTE physician has not moved in two years and the operating margin per physician is worse than it was. Everyone in the group is working harder than they were in 2023. The board wa…
5 CAUSES · 5 TESTS
WORK IT THROUGH → -
Performance varies by location
Same brand, same compensation model, same EHR, same playbook, and the per-physician economics at the best site are multiples of the worst. Site leadership at the underperformers asks for more staff. The group has already checked, and the staffing ratios are ro…
5 CAUSES · 5 TESTS
WORK IT THROUGH → -
Preparing for sale
A process is twelve to eighteen months out. The growth story on the page is real, but most of it came from tuck-ins, and the same-store line underneath is thin. Someone has asked what the group's referral capture rate is and the honest answer is that nobody ha…
5 CAUSES · 5 TESTS
WORK IT THROUGH →
WHICH ONE
How to tell which one you have
These five overlap, and two or three usually apply at once. The order to read them in is set by which number actually moved. If cost per new patient moved, start there. If demand held and bookings did not, start with the volume page. If nothing moved at all, start with the plateau page — and if the group total looks acceptable while one site keeps coming up in conversation, read the variance page first, because a pooled number is structurally incapable of showing you what you are looking for.
Every cause on every page above carries a measurement you can run in your own systems, with the finding that confirms it and the finding that rules it out. Run two or three before you brief anybody. If the tests tell you this is not a marketing problem, that is the correct answer and it cost you nothing.
RESOLUTION
What resolves each, and what resolved looks like
Each presentation resolves to a different part of the work, and the pages say which: reporting and attribution where the finding is a measurement error, conversion and desk work where the loss is between the inquiry and the admission, acquisition where the demand genuinely is not there, and pre-sale work where the question is whether growth can be re-run by somebody else.
Each also carries what resolved looks like as a number — the measure, the published median, the top decile where an honest one exists, and a target range — with the source in the row. Where no credible distribution is published, the page says so instead of borrowing one from an adjacent specialty. That absence is itself a finding: it means your own trailing history is the only benchmark worth measuring against.
WHERE YOU STAND
Reference ranges for multi-specialty groups and MSOs
See also where you stand and what decides the outcome before any of this is treated.
A differential narrows the list. It does not close it — that is what the examination is for.
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