Let’s talk about a dirty little secret in multi-site healthcare. It’s called same-store growth. You know, that boring, unsexy thing where you actually make your existing locations…better.
I know, I know…where’s the thrill in that? Why focus on maximizing the value of what you already own when you could be out there gobbling up more practices like a PE-backed Pac-Man with a spreadsheet addiction?
And hey, it worked. Until it didn’t.
That’s how we ended up with all these DSO’s puffed up on fairy dust and “strategic add-backs” so ridiculous they made WeWork look frugal. They overpaid, overpromised, and then—surprise!—ended up parked in a lender sidecar, stuck watching from the sidelines because their bank covenants waved the white flag.
Here’s the truth: Buying practices isn’t growth. It’s shopping. And no matter how many logos you add to the website or how many ribbon-cuttings you post on LinkedIn, you’re not scaling, you’re just hoarding.
Real growth…the kind that matters when the music stops, is in same-store performance. That’s what turns your roll-up into a platform, your spreadsheet into a sustainable business, and your exit into something someone actually wants to pay for.
But too many leadership teams avoid it. Why? Because it’s hard. It’s not a headline. It’s process improvement. Training. Scheduling optimization. Tracking capacity and no-show rates. Fixing leaky ops. Empowering managers. Holding people accountable. You know, work.
Same-store growth is where your culture, operations, and leadership get exposed. And for some groups, the numbers aren’t pretty.
Here’s what happens when you don’t focus on it:
- Burnout goes up.
- Retention goes down.
- Revenue per location plateaus (or worse, declines).
- You keep buying just to cover the fact that your house is leaking.
You can’t grow your way out of poor performance. Eventually, someone’s going to look at that EBITDA margin and realize half your locations are just along for the ride.
So, if you’re a CEO, operator, investor, or deck-slinging M&A junkie, here’s your new KPI: What’s the average revenue growth per location over the last 12 months, without any acquisitions? If the answer makes you uncomfortable, good. That’s where the work starts.
