Performance Assessment & Improvement Plan – DSO

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Consulting Services​ - Overview

A multi-specialty DSO with approximately 250 clinics across 6 states was experiencing meaningful growth up until H2’22, when hurricane-related site closures, expense management challenges, new provider hire-ramp up, and challenging labor markets led to a high leverage ratio, resulting in a limited availability of capital. Additionally, wide performance dispersions across certain historical acquisitions and regional markets created further downward pressure on margins. The underperforming sites coupled with the DSO’s suboptimal reporting and analytics program led management to engage SCALE to formalize a performance improvement plan for its lenders.

Clinical Specialties

Clinical Services

Client Profile

Services Deployed


Data Analytics

Strategic Planning and Execution

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SCALE made near-term, mid-term, and long-term recommendations regarding underperforming sites & performance turnaround, cash flow, financial reporting, and determined cost savings opportunities for HR, IT, and RCM. The final report was presented to the client’s private equity sponsors and ultimately received praise for its exhaustive and targeted findings. The assessment resulted in the successful implementation of the change in control, and SCALE has continued to be involved in a PMO role to supervise the implementation of our recommendations.

Key Growth Opportunities

Benchmarking data suggests opportunity to improve rates in key markets, implying an 8-15% uplift to EBITDA across the network

Improving productivity of underperforming GP doctors by improving provider retention, enhancing provider onboarding training and development, increasing Saturday scheduling utilization, and developing Dental Assistant capabilities would represent a 7-9% uplift to EBITDA.

Expanding specialty coverage and productivity in underperforming regions would represent a 4-8% uplift to EBITDA

Improving hygiene coverage and productivity in underperforming sites to get to benchmark represents a 2-3% EBITDA opportunity

Completing 1 to 3 acquisitions in existing markets with strong operational leadership can increase EBITDA by 5-14%

Potential PSC headcount reductions based on 3 year forecast model can increase EBITDA 5-6%

Strategically pursue expansion opportunities to realize an incremental 3-6% uplift in EBITDA

Strategically increase Medicaid coverage in underutilized sites, representing a 1-2% EBITDA uplift opportunity

Total Est. Range of EBITDA Improvement 34% - 63%

Let's SCALE together

SCALE Healthcare is based on the foundation of a singular focus – elevating management performance across healthcare services. We are focused on the entire suite of operational advisory and diligence services exclusively to healthcare service organizations, with local team presence across 10 states.

Unlike the many consulting firms that offer more narrow and often more impractical solutions borne of limited or very general expertise, we rely on our team of 75+ carefully selected senior operational healthcare experts to ensure we provide the most relevant and value added experience across the full range of management disciplines and clinical specialties that fall within healthcare services.

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