DDx — PE-BACKED PLATFORMS
PE Platforms: 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
Blended CAC across the platform is up and payback has stretched. Nobody can tell the operating partner whether that is mix, market, media price, or conversion — because CAC is computed once, at the top, on a site set that changes every quarter. The cohort view…
5 CAUSES · 5 TESTS
WORK IT THROUGH → -
New patient volume is short of plan
Inquiry volume is healthy at the platform level. What reaches the schedule, survives to the appointment and converts to treated work is a fraction of it, and every site names a different culprit. The pipeline the board reviews and the production the income sta…
5 CAUSES · 5 TESTS
WORK IT THROUGH → -
Growth has plateaued
Total revenue is up and the board deck looks fine, because six add-ons closed in eighteen months. Same-store is flat or negative and nobody can say which sites are carrying it. The sponsor sees a platform that is buying its growth rather than compounding it — …
5 CAUSES · 5 TESTS
WORK IT THROUGH → -
Performance varies by location
Every site runs the same playbook and the results are not close. Site-level margin spans double digits, the top and bottom sites are in comparable markets, and the answer changes depending on who is asked. It is the question diligence asks first and the one pl…
5 CAUSES · 5 TESTS
WORK IT THROUGH → -
Preparing for sale
Twelve to eighteen months from a process. The bankers want a growth narrative and diligence will want the mechanism underneath it. Right now the honest version of the story is that the platform bought well — and a buyer pays for a buying record differently tha…
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 PE-backed platforms
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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