What the biggest healthcare services companies tell us about your practice
These five public companies aren’t your peers, they provide historical references for diligence. Private-company comparisons depend on contract mix, earnings quality and operating scale.
Historical snapshot · Market data: April 2026 · Revenue and growth checked against SEC facts; other fields have separate limits
Five public healthcare services companies, side by side
Company
Revenue
Growth
Gross Margin
EBITDA Margin
Backlog
EV/EBITDA
Rev/Employee
EHCEncompass Health
$5.9B
+10.5%
26.3%
21.4%
N/A
9.5x
$141K
ADUSAddus HomeCare
$1.4B
+23.2%
32.5%
12.7%
N/A
11.3x
$28K
SGRYSurgery Partners
$3.3B
+6.2%
23.1%
15.9%
N/A
8.4x
$207K
USPHU.S. Physical Therapy
$781M
+16.3%
19.2%
12.2%
N/A
13.5x
$89K
ACHCAcadia Healthcare
$3.3B
+5%
22.9%
18.4%
N/A
7.9x
$133K
What this means for you
Payer mix, reimbursement, clinician capacity and ownership interests can move revenue and EBITDA in different directions. A surgery-center rollup is not a like-for-like PT practice. Match parent versus noncontrolling earnings, collection periods and provider retention before applying a multiple. Retained private ranges are planning scenarios, not verified sale prices.
Operating Benchmarks
How these companies manage cash, collections, and overhead
Revenue and margins only tell half the story. These are the numbers that show how efficiently a healthcare business actually runs, how fast they collect from payers, how much they spend on facilities and equipment, and how much operating cash remains after the stated cash capital-spending measure, before debt service and owner distributions. When a PE firm or buyer looks at your books, these are the metrics they dig into.
Metric
EHC
ADUS
SGRY
USPH
ACHC
48 days
50 days
43 days
38 days
49 days
32 days
22 days
35 days
18 days
20 days
1.08x
1.85x
1.80x
1.05x
1.55x
7.4%
7.3%
5.9%
7.8%
-13.3%
12.4%
0.5%
2.4%
1.8%
17.3%
23.2%
8.8%
-4.5%
8.3%
-56.6%
4%
21.5%
3.6%
9%
4.6%
Apply these numbers to your business
Collection Speed (DSO)
Ending or average eligible receivables divided by comparable net revenue, multiplied by period days. State the payer, allowance and patient-balance scope; this ratio is not elapsed time for an individual claim.
Comparison and operating check
Retained public DSO references span 38-50 days with unreproduced definitions. No matched private-practice DSO or denial-rate distribution is supplied. Compare your own service-date cohorts and accepted-claim collections.
Illustrative $5M annual comparable net revenue and a 75-to-45-day DSO change imply $5M / 365 x 30 = about $411K one-time receivable reduction, if revenue and scope stay constant. At an assumed 10% borrowing rate that balance change avoids about $41K yearly interest, not $411K recurring profit. Write-offs can reduce AR without releasing cash.
Supplier Payment Speed (DPO)
Eligible trade payables divided by comparable cost of sales, multiplied by period days. Payroll, lease payments and services may need separate schedules instead of being included as trade payables.
Comparison and operating check
Retained public DPO references are 18-35 days, with unreproduced cost definitions. No private COD or net-10 frequency is measured here. Read each signed supplier term and model the payment due date.
DSO and DPO use different sales and cost denominators; their difference alone is not a cash conversion cycle. Map payer receipts, payroll, vendor payments and inventory separately. Extending supplier terms can move a cash peak without reducing the cost of care.
Cash Actually Generated (FCF Margin)
Matched annual operating cash flow minus cash capital spending on the stated SEC tag basis, divided by revenue. This excludes lease-financed additions and other capitalized costs and is not cash available to the owner after financing or distributions.
Comparison and operating check
ACHC's matched cash-PPE free cash flow is about -13.3%; EHC's continuing-operations cash flow less productive-asset spending gives 7.4%. The ownership and spending scopes differ. Neither is a matched private-practice benchmark.
Bridge operating earnings to working capital, capital spending, leases, debt service and distributions. Positive cash capital-spending free cash flow can still leave insufficient cash for owner payouts or committed expansion. Review the actual due dates before funding growth.
Facility & Equipment Spend (CapEx)
Cash PPE or productive-asset spending divided by matched annual revenue, with issuer-specific tag and scope. Lease-financed additions and acquisition consideration are outside this measure.
Comparison and operating check
Matched values are EHC 12.4%, ACHC 17.3%, SGRY 2.4%, USPH 1.8% and ADUS 0.5%. SGRY's 2.4% alone does not establish a capital-intensive or capital-light model. Separate maintenance, expansion, acquisitions and leased equipment before comparing.
Test how much reinvestment is required to maintain collectible capacity. Delaying replacement can temporarily increase cash while creating future commitments; a low one-year cash PPE ratio does not prove a higher valuation.
Short-Term Liquidity (Current Ratio)
Current assets divided by current liabilities. A value above 1.0 indicates balance-sheet coverage of current liabilities, not proof of solvency or on-time payroll. Collectibility and timing still matter.
Comparison and operating check
Retained public references span 1.05-1.85x with unreproduced calculations. No measured private distribution is supplied. Inspect receivable collectibility and restricted cash rather than inferring a universal safe ratio.
Stress a delayed payer receipt against dated payroll and supplier obligations. Two practices can have the same current ratio and different near-term shortfalls. Use a dated cash forecast and a separately justified liquidity reserve.
Return on Closing Book Equity (ROE)
Matched NetIncomeLoss-tag income divided by closing reported equity. Closing equity, preferred interests and noncontrolling ownership differ from average common equity or the owner's cash investment.
Comparison and operating check
Matched issuer-specific figures include ACHC -56.6% and EHC 23.2%. They are not a private-practice return distribution or evidence that operating discipline caused the difference.
Inspect noncash impairment, leverage, ownership allocation and the equity denominator before comparing. A low book-equity denominator can inflate ROE without increasing operating contribution or owner cash.
Overhead Rate (SG&A)
Reported selling, general and administrative expense divided by revenue. Check where billing, caregiver coordination, provider pay and occupancy are classified before comparing care models.
Comparison and operating check
Retained historical SG&A references include SGRY 3.6% and ADUS 21.5%, with unreproduced classifications. No 20-35% private-practice distribution is supplied. Reclassify comparable functions before treating a spread as removable cost.
Illustrative $5M revenue and a 30%-to-20% overhead change would reduce modeled expense $500K only if revenue, classification and service coverage stay constant. Subtract transition spending, replacement platform fees and required clinical support. The gross difference does not automatically flow to EBITDA or establish an exit multiple.
Click any row to see what the metric means for your business and where private healthcare practices typically stand.
The revenue cycle gap
Public healthcare companies collect in 38-50 days (DSO) and pay suppliers in 18-35 days (DPO). These retained historical public-company ratios are not practice benchmarks. Measure a private practice's net collectible A/R and denial rate from matched payer remittances; gross charges, contractual adjustments and patient balances change the denominator. At illustrative $5M annual net credit revenue, a 30-day DSO improvement releases about $411K of cash once. If it replaces borrowing at an assumed 8%, the annualized interest sensitivity is about $33K while the receivable and borrowing reductions persist. This is a scenario, not a verified collection result. The effect scales with revenue; it does not compound by itself.
The Valuation Bridge
From public multiples to your exit number
Use public company valuations as one reference point, then examine the adjustments and return requirements a buyer would apply.
Public Companies7.9-13.5x EBITDA
PE Platform Companies8-12x EBITDA
Private Practices4-8x EBITDA
Small / Solo Practices2-5x SDE
Public Companies (7.9-13.5x EBITDA)
Retained April 2026 reference observations: EHC 9.5x, ADUS 11.3x, SGRY 8.4x, USPH 13.5x and ACHC 7.9x. EV bases and EBITDA adjustments have not been reproduced. Hospital, home-care and outpatient PT models have different payer, capital and ownership structures; the spread does not isolate a causal growth or payer premium.
PE Platform Companies (8-12x EBITDA)
Illustrative private valuation scenario, not a measured transaction distribution. Professionalized healthcare groups at $50M-$500M revenue with centralized billing, compliance infrastructure, multi-payer contracts, and professional management.
Private Practices (4-8x EBITDA)
Illustrative private valuation scenario, not a measured transaction distribution. Owner-operated practices and facilities at $3M-$50M revenue. The typical entry point for PE acquisitions. Multiple depends heavily on payer mix, provider retention, and owner dependence.
Small / Solo Practices (2-5x SDE)
Illustrative private valuation scenario, not a measured transaction distribution. Under $3M revenue. Often valued on seller's discretionary earnings. Buyer pool is individual practitioners, small groups, and DSO/MSO platforms looking for tuck-ins.
What drives the gap between public and private multiples
Size & Scale
Test the claimed benefit of scale rather than assuming a premium. Count economically owned locations, measure payer and referral concentration, then subtract centralized management cost. A 780-clinic headline that includes managed sites does not tell you the same thing as 780 fully owned clinics.
Payer Mix Quality
USPH's 2025 filing groups 64.2% of revenue from managed care, commercial insurers, workers' compensation and other private sources. That is not 64.2% commercial insurance alone. EHC reports 65.4% Medicare and 16.4% Medicare Advantage, or 81.8% combined; it says traditional Medicare generally pays more than its other payers. A higher commercial share is not automatically a higher margin or valuation. Compare allowed amounts, denial recoveries, patient balances and cost per treated case for the same service.
Provider Retention & Recruitment
Labor availability and cost are operating risks, not a claim that every quoted CEO named staffing as the primary constraint. Trace open provider hours to appointments offered, cancellations, completed visits and collected contribution. Do not count a recruited clinician as productive capacity before credentialing, demand and scheduling are ready.
Revenue Cycle & Billing Infrastructure
Retained public DSO references span 38-50 days, with unreproduced definitions. No matched private denial-rate distribution is supplied. Build a claim-cohort bridge from service date to submission, acceptance, denial, resubmission and cleared cash; separate billed charges, allowed revenue, contractual adjustments and patient responsibility. A lower ending AR balance can reflect write-offs rather than faster collections.
Compliance & Regulatory Infrastructure
Treat licensure, credentialing, exclusion checks, survey findings and any change-of-ownership approvals as specific diligence workstreams. Verify whether approval delay blocks service, billing or collection, and model the resulting timing separately. A clean checklist does not establish regulatory compliance or a valuation premium.
Recurring Patient Relationships
Compare completed care episodes, clinically appropriate follow-up, referral sources and cumulative collected contribution by cohort. Repeat visits can reflect the treatment plan and need not mean automatic contractual recurring revenue. Check reimbursement and clinical appropriateness before projecting retention-driven growth.
Multiple arbitrage: why PE keeps buying healthcare practices
Illustrative acquisition math, not a return forecast: $2M normalized EBITDA at an assumed 6x gives $12M enterprise value. If EBITDA were unchanged and a buyer later applied an assumed 12x, enterprise value would be $24M before debt, transaction costs, integration spending or new investor ownership. The multiple increase is an assumption, not evidence that joining a platform doubles the seller's proceeds. Reconcile clinician compensation, lease commitments, quality-of-earnings adjustments and post-close dilution first.
Planning scenario, not verified private-market pricing. Diligence tests: Provider retention, commercial payer %, billing quality, compliance history, geographic density
$15M-$50M revenue
7-10x EBITDA
PE platforms, strategic acquirers (USPH, SGRY, ACHC)
Planning scenario, not verified private-market pricing. Diligence tests: Multi-site operations, centralized billing, managed care contracts, provider recruitment pipeline, clean compliance
$50M+ / platform
9-13x+ EBITDA
Large PE, public strategics (EHC, SGRY, ADUS), payer-owned platforms (Optum, CVS)
Planning scenario, not verified private-market pricing. Diligence tests: Scale, diversification, management depth, value-based care capabilities, technology infrastructure, audit-ready financials
Company Profiles
Inside each company’s financials
EHC
Encompass Health
The largest owner and operator of inpatient rehabilitation hospitals in the U.S. 173 hospitals across 39 states and Puerto Rico with 11,465 licensed beds, a historical inpatient rehabilitation reference.
$5.9B
Revenue
21.4%
EBITDA Margin
9.5x
EV/EBITDA
42,000
Employees (approx.)
Why healthcare practice owners should care
Encompass Health is an inpatient rehabilitation hospital operator, not a matched outpatient clinic benchmark. Its retained $1,268M adjusted EBITDA divided by verified $5,935M revenue gives 21.4%; the EBITDA adjustments remain unreproduced. Its matched continuing-operations cash flow less productive-asset spending gives a different 7.4% cash-flow margin. For a practice owner, the useful test is whether extra staffed capacity becomes treated visits, collectible revenue and cash after reinvestment. Separate licensed beds from staffed beds, and hospital economics from therapist-clinic economics.
“Our Q4 performance was very strong, capping a stellar 2025. Our 2025 revenue increased 10.5% and Adjusted EBITDA grew 14.9%. The need for the services we provide continues to grow as the U.S. population ages.”
Mark Tarr, CEO, FY2025 Earnings Release (Feb 2026)Retained historical quote; exact wording has not been independently checked.
ADUS
Addus HomeCare
Leading multi-service home care provider, personal care, home health, and hospice. After the $350M Gentiva acquisition closed in Dec 2024, 2025 was Addus's first full year at scale: 23.2% revenue growth to $1.42B.
$1.4B
Revenue
12.7%
EBITDA Margin
11.3x
EV/EBITDA
50,660
Employees (approx.)
Why healthcare practice owners should care
Addus grew revenue 23.2% to $1.42B in the first full year after the retained Gentiva transaction. That headline combines acquired scale and operating results; it does not establish integration returns. For a home-care agency, bridge acquired hours, same-location billable hours, reimbursement per hour and fully loaded caregiver cost before attributing growth to a rollup. Then test whether authorization, payroll and reimbursement stay aligned when a new branch joins. The historical acquisition reference is not a current offer to buy a $5M agency.
“For the full year, we achieved a new annual record of $1.4 billion in net service revenues, an increase of 23.2% compared with 2024. Continued strong demand has supported this impressive growth.”
Dirk Allison, CEO, FY2025 Earnings Release (Feb 2026)Retained historical quote; exact wording has not been independently checked.
Surgery Partners
One of the largest operators of ambulatory surgery centers (ASCs) and surgical hospitals in the U.S. 176 surgical facilities (157 ASCs + 19 surgical hospitals) across 30 states, generating $3.3B in revenue with mid-teens EBITDA margins.
U.S. Physical Therapy
The largest pure-play outpatient physical therapy company in the U.S. 780 total clinics (746 owned + 34 managed), with $781M in revenue (+16.3%). The closest public comp to what a multi-location PT practice looks like at scale.
M&A Deal Tracker
The consolidation wave is real
Major healthcare services acquisitions since 2024. Who’s buying, what they’re paying, and what it means for the industry.
Buyer
Target
Deal Value
Multiple
Date
UnitedHealth / Optum
Amedisys
Retained home health/hospice transaction reference. The historical description reports DOJ-required divestiture of 164 locations before close; it is not a current status check or independently verified deal-size ranking.
Retained transaction reference. A disclosed price is not a disclosed EBITDA multiple. Unless a calculation and primary source are shown, the multiple and target financial estimates have not been independently reproduced. Earnouts, assumed debt and forecast periods can change the ratio.
$3.3B
~13.4x
Aug 2025
Ascension Health
AMSURG (Envision surgery centers)
Retained announcement described 250+ centers across 34 states and expansion from 58 to 300+ centers. Pending-close wording is the April 2026 historical status, not a current closing confirmation.
Retained transaction reference. A disclosed price is not a disclosed EBITDA multiple. Unless a calculation and primary source are shown, the multiple and target financial estimates have not been independently reproduced. Earnouts, assumed debt and forecast periods can change the ratio.
~$3.9B (reported)
N/A
Announced Jun 17, 2025; pending close (historical April 2026 status; not verified October 7, 2026)
Kinderhook Industries (PE)
Enhabit Home Health & Hospice
Take-private of 249 home health + 117 hospice locations across 34 states at $13.80/share.
Retained transaction reference. A disclosed price is not a disclosed EBITDA multiple. Unless a calculation and primary source are shown, the multiple and target financial estimates have not been independently reproduced. Earnouts, assumed debt and forecast periods can change the ratio.
$1.1B
~10.3x (implied)
Announced Feb 23, 2026; expected to close Q2 2026 (historical April 2026 expectation; not verified October 7, 2026)
Retained transaction reference. A disclosed price is not a disclosed EBITDA multiple. Unless a calculation and primary source are shown, the multiple and target financial estimates have not been independently reproduced. Earnouts, assumed debt and forecast periods can change the ratio.
$708M
~8.7x
Jul 2025
Addus HomeCare
Gentiva Personal Care (full-year impact in 2025)
Personal care operations across 7 states. The first full-year contribution overlaps ADUS's 23.2% 2025 growth; these aggregate figures do not isolate acquired revenue, organic growth or integration returns.
Retained transaction reference. A disclosed price is not a disclosed EBITDA multiple. Unless a calculation and primary source are shown, the multiple and target financial estimates have not been independently reproduced. Earnouts, assumed debt and forecast periods can change the ratio.
$350M
~10x (est.)
Dec 2024 close
SCA Health (Optum)
U.S. Digestive Health
149 physicians, 24 ASCs, 1,250 employees, GI-focused platform across PA and DE.
Retained transaction reference. A disclosed price is not a disclosed EBITDA multiple. Unless a calculation and primary source are shown, the multiple and target financial estimates have not been independently reproduced. Earnouts, assumed debt and forecast periods can change the ratio.
Undisclosed
N/A
Jan 2025
Cardinal Health / Specialty Alliance
Solaris Health
Largest urology MSO, 750+ providers, 250+ locations, 14 states.
Retained transaction reference. A disclosed price is not a disclosed EBITDA multiple. Unless a calculation and primary source are shown, the multiple and target financial estimates have not been independently reproduced. Earnouts, assumed debt and forecast periods can change the ratio.
$1.9B
N/A
Aug 2025
Sources and verification limits are linked with each company and deal. Values may be disclosed or reported; a multiple labeled implied is a calculation rather than necessarily a buyer disclosure. Check the price and earnings basis in the source before treating it as a transaction comp. “N/A” or “Not disclosed” means the terms were not publicly disclosed here.
Historical results and operator tests
What the dated results can help you test
Buyer type changes the diligence questions
The retained Optum/Amedisys and SCA/U.S. Digestive Health references broaden the historical buyer list beyond PE. Their transaction amounts and exact status are not a measured premium. Map who controls payer contracts, provider relationships and operating assets before comparing an offer; a payer-owned buyer can have different constraints from a practitioner-owned group.
Acquired growth needs a same-branch economics bridge
ADUS's verified 23.2% 2025 revenue growth overlaps the first full year after the historical $350M Gentiva transaction. It does not prove integration succeeded. Reconcile acquisition contribution and same-branch billable hours, then compare caregiver payroll timing with authorized and collected revenue. Additional branch revenue can widen the cash requirement before reimbursement arrives.
Sources: ADUS annual SEC facts; historical Gentiva reference; operator test
More surgery cases need not create equal contribution
SGRY's retained 4.9% same-facility growth includes reported 1.4% rate and 3.4% cases, rounded and with mix effects possible. A center should compare net collectible contribution and room hours by procedure and payer. More cases can displace higher-contribution work or require costly implants. The aggregate is not a forecast of independent ASC margin or value.
Sources: Retained SGRY FY2025 results; procedure-economics operator test
Behavioral demand and expansion cash move independently
ACHC's 5.0% verified revenue growth sits alongside retained adjusted EBITDA of $609M and matched cash capital-spending free cash flow of about -$440M. Separate the historical $996M noncash goodwill impairment from cash PPE spending. An operator should model staffed occupancy, payer collection and expansion payments on their own dates before funding additional beds.
PT clinic growth must be reconciled to ownership and staffing
USPH's verified 16.3% revenue growth and historical 780 owned-plus-managed clinic count do not measure growth per fully owned site. Compare matched clinics and economically owned contribution. Its retained early-2026 acquisitions and hospital alliances were expected to add $7.3M annualized EBITDA, a forecast not realized contribution. Do not use that forecast as proof of your own exit value.
Sources: USPH SEC annual facts; retained early-2026 outlook
Recruitment matters when it becomes collectible capacity
The retained CEO quotes do not establish a universal primary staffing constraint. Measure the gap between credentialed provider hours, available appointments, attended visits and paid claims. A filled role that lacks credentialing or referral demand can add payroll before collections. Compare this funnel by location instead of assuming headcount growth is patient growth.
Sources: Operator test; no universal CEO attribution or measured private percentile
Get the full report: Level Healthcare Services Benchmarks 2026
Operating benchmarks for private healthcare practices, collection rates, payer mix, labor cost ratios, EBITDA margins, and historical public-company references for private-business diligence. Free PDF.
Q1 2026. Snapshot last updated: April 2026. Financials come from filings and earnings releases; fiscal periods and adjusted earnings definitions vary. Market valuations are historical snapshots, and the report does not promise current prices or automatic quarterly updates.
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Methodology & Sources
Financial Data
Annual revenue and growth have been checked against the linked historical SEC facts. Each profile states its financial period. Other retained margins, headcounts, ratios and quotes have independent evidence limits. This review does not make the April 2026 market-price snapshot current.
Valuations & Multiples
EV/EBITDA values are retained April 2026 historical references with unreproduced EV builds and EBITDA definitions. Private ranges are Level planning scenarios, not a verified transaction distribution. Multiples are point-in-time estimates.
Disclaimer: The Level Market Monitor is for educational and informational purposes only. Level is not a registered investment advisor, broker-dealer, or valuation firm. The information presented does not constitute investment advice, financial advice, or a recommendation to buy or sell securities. All forward-looking statements reflect company guidance and public analyst estimates, not Level projections. Past performance does not guarantee future results.
SEC Filings Referenced
EHC Annual period ended 2025-12-31; SEC filing dated 2026-02-26
ADUS Annual period ended 2025-12-31; SEC filing dated 2026-02-24
SGRY Annual period ended 2025-12-31; SEC filing dated 2026-03-02
USPH Annual period ended 2025-12-31; SEC filing dated 2026-02-27
ACHC Annual period ended 2025-12-31; SEC filing dated 2026-02-27
Frequently Asked Questions
Why should a small healthcare practice care about billion-dollar public companies?
Use these five companies to choose questions, not a formula for your practice's price. The public snapshot spans different care models, ownership and capital structures, and its EV bases remain unreproduced. Compare your payer collection, provider capacity and reinvestment before treating a public multiple as a relevant reference.
What EBITDA multiple can a private healthcare practice realistically expect?
The private ranges shown are illustrative planning scenarios, not verified market percentiles or offers: under $3M revenue 3-5x EBITDA; $3-15M 5-8x; $15-50M 7-10x; $50M+ 9-13x+. A higher commercial payer share does not guarantee a premium. Normalize provider pay, payer allowances, owner dependence, lease obligations and required capital, then test actual buyer terms.
How is healthcare M&A different from other industries?
Check the actual license, credentialing, payer and provider arrangements for the proposed transaction. Some agreements require notices or approvals on ownership changes; applicability depends on the contract and jurisdiction. Trace whether each issue changes permissible care delivery, billable revenue or collection timing. These are diligence questions, not a universal legal rule or guaranteed multiple uplift.
Why did Acadia (ACHC) have a bad 2025 if demand is strong?
Demand and cash generation answer different questions. ACHC's verified revenue grew 5.0%, while its retained adjusted EBITDA fell from $709M to $609M. About $132M matched operating cash flow less $572M cash PPE spending gives -$440M. The $996M retained goodwill impairment is noncash. Review staffing economics, payer collection and expansion obligations separately rather than treating the impairment as cash spending.
How often is this data updated?
This is a retained April 2026 market snapshot, reviewed October 7, 2026. Market prices and deal status have not been refreshed to the review date. Annual revenue and specifically listed financial fields are checked against historical SEC facts. Other ratios, quotes, market prices and estimated deal multiples have independent evidence limits. Market valuations reflect publicly available data at the time of update.
Is this investment advice?
No. This is an educational historical reference. Only the expressly listed matched financial fields are reproduced from SEC facts. Quotes, deals, other ratios and valuation scenarios have separate evidence limits; this page does not verify a current offer, investment return or legal conclusion.