The Level Market Monitor
HealthcareWhat the biggest healthcare services companies tell us about your practice
These five public companies aren’t your peers — they’re what an exit looks like at scale. PE firms use their financials as the starting comp set when they value your practice.
Updated quarterly · Last update: April 2026 · All data from SEC filings
$14.8B
Combined Revenue
5 public healthcare companies (FY2025)
142K+
Combined Employees
Across all facilities
9.5x
Median EV/EBITDA
What the market pays
7
Acquisitions Tracked
Major deals since 2024
Industry Scorecard
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
A 5-location PT practice won’t trade at 13x EBITDA. But these public multiples set the ceiling for the entire healthcare services industry. Private practices in the $3–30M range typically trade at 4–10x EBITDA. The gap is explained by size, payer contract quality, provider retention, and compliance infrastructure. Understanding the ceiling helps you understand what to work toward.
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 cash they actually take home. When a PE firm or buyer looks at your books, these are the metrics they dig into.
| Metric | EHC | ADUS | SGRY | USPH | ACHC |
|---|---|---|---|---|---|
Collection SpeedHow many days before you get paid | 48 days | 50 days | 43 days | 38 days | 49 days |
Supplier Payment SpeedHow many days you take to pay vendors | 32 days | 22 days | 35 days | 18 days | 20 days |
Short-Term LiquidityCan you cover bills due in 12 months? | 1.08x | 1.85x | 1.80x | 1.05x | 1.55x |
Cash Actually Generated% of revenue that becomes real cash | 12.6% | 9.5% | 6.2% | 9.6% | -13.3% |
Equipment & Vehicle SpendTrucks, tools, facilities as % of revenue | 10.8% | 0.7% | 3.1% | 1.3% | 17.3% |
Return on Owner’s InvestmentProfit per dollar invested in the business | 26.2% | 10.5% | -3.2% | 8.2% | -43.9% |
Overhead RateNon-job costs as % of revenue | 4% | 21.5% | 3.6% | 9% | 4.6% |
Click any row to see what the metric means for your businessand where private healthcare practices typically stand.
The revenue cycle gap
Public healthcare companies collect in 38–52 days (DSO) and pay suppliers in 18–35 days (DPO). Many private practices run 55–90 day DSO with 10–15% denial rates — that’s cash stuck in payer limbo. At $5M revenue and 8% cost of capital, a 30-day DSO improvement frees up $33K per year. Multiply that across a multi-location practice and the impact compounds.
The Valuation Bridge
From public multiples to your exit number
PE firms start with public company valuations as the ceiling, then adjust down. Here’s how the math works.
Public Companies (8–14x EBITDA)
EHC, ADUS, SGRY, USPH, ACHC — range reflects scale, growth trajectory, and payer mix quality. EHC and USPH trade at premiums on growth. ACHC and SGRY trade at discounts on margin/profitability concerns. These multiples set the ceiling for healthcare services valuations.
PE Platform Companies (8–12x EBITDA)
Professionalized healthcare groups at $50M–$500M revenue with centralized billing, compliance infrastructure, multi-payer contracts, and professional management.
Private Practices (4–8x EBITDA)
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)
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
A 5-location PT practice is one bad lease renewal from trouble. A 780-clinic platform like USPH has geographic diversification and negotiating leverage with every payer. Size reduces risk, and buyers pay for reduced risk.
Payer Mix Quality
Commercial payer mix commands premium multiples. A practice that's 70% commercial insurance gets a higher multiple than one that's 70% Medicaid. USPH runs 64.2% commercial payers. EHC runs 82% Medicare + Medicare Advantage — which is stable but rate-capped. Payer diversification and managed care contract quality are the biggest multiple drivers.
Provider Retention & Recruitment
If 3 therapists leave and take their patients, what happens to your revenue? Public companies invest heavily in culture, compensation, and career paths. Every healthcare CEO on this page cited staffing as a growth constraint. Provider retention is the healthcare equivalent of a contractor's workforce moat.
Revenue Cycle & Billing Infrastructure
Clean claims, fast collections, low denial rates. Public companies have dedicated revenue cycle teams that collect in 38–50 days. Many private practices still run 60–90 day AR with 15%+ denial rates. PE discounts for billing chaos.
Compliance & Regulatory Infrastructure
Healthcare is the most regulated industry in the country. Practices with documented compliance programs, proper credentialing, and clean survey histories command higher multiples. A single compliance issue can kill a deal. ACHC's 2025 margin compression is partly tied to state-level Medicaid rate changes — regulatory risk is real.
Recurring Patient Relationships
Chronic care management, ongoing therapy protocols, and long-term patient relationships create predictable revenue. Practices with strong patient retention and referral networks are worth more than those dependent on new patient acquisition.
Multiple arbitrage: why PE keeps buying healthcare practices
This is the same mechanic driving healthcare consolidation: PE buys your practice at 5–7x EBITDA, professionalizes the back office, bolts it onto a platform with better payer contracts and billing infrastructure, and exits the combined entity at 10–13x. UnitedHealth paid 13.4x for Amedisys. Kinderhook is paying 10.3x for Enhabit. Your practice's EBITDA becomes worth 2x inside the right platform. That spread is why PE has poured billions into healthcare services since 2020 — even as some public names (ACHC, SGRY) have compressed.
What private healthcare practices sell for (by revenue tier)
| Revenue Tier | Typical Multiple | Typical Buyer | Key Drivers |
|---|---|---|---|
| Under $3M revenue | 2–5x SDE / 3–5x EBITDA | Individual practitioners, small MSOs, SBA loans | Provider dependence, payer mix, patient volume stability, referral relationships |
| $3M–$15M revenue | 5–8x EBITDA | Regional MSOs/DSOs, lower middle-market PE | Provider retention, commercial payer %, billing quality, compliance history, geographic density |
| $15M–$50M revenue | 7–10x EBITDA | PE platforms, strategic acquirers (USPH, SGRY, ACHC) | 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) | Scale, diversification, management depth, value-based care capabilities, technology infrastructure, audit-ready financials |
Company Profiles
Inside each company’s financials
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 — the gold standard for post-acute care at scale.
$5.9B
Revenue
21.4%
EBITDA Margin
9.5x
EV/EBITDA
42,000
Employees
Why healthcare practice owners should care
Encompass Health grew revenue 10.5% to $5.94B and adjusted EBITDA 14.9% in 2025 — proving that healthcare facilities can be high-margin businesses at scale. They added 517 licensed beds (8 new hospitals + expansions) and hit a 21.4% EBITDA margin. If you run a rehab clinic, PT practice, or home health agency, EHC sets the ceiling for what operational excellence looks like in post-acute care.
“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)
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
Why healthcare practice owners should care
Addus grew 23% to $1.42B and expanded EBITDA 28% in 2025 — the first full year of the Gentiva personal care acquisition. They're proving the home care rollup model works: pay $350M for a regional platform, fold it into central operations, and harvest margin expansion. If you run a home health or personal care agency doing $5M+, Addus and its competitors are still actively looking for tuck-ins.
“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)
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 Largest home health/hospice deal ever. DOJ required divestiture of 164 locations before close. | $3.3B | ~13.4x | Aug 2025 |
| Ascension Health | AMSURG (Envision surgery centers) 250+ ambulatory surgery centers across 34 states. Announced deal — not yet closed. Expected to expand Ascension from 58 to 300+ centers when completed. | ~$3.9B (reported) | N/A | Announced Jun 17, 2025; pending close |
| Kinderhook Industries (PE) | Enhabit Home Health & Hospice Take-private of 249 home health + 117 hospice locations across 34 states at $13.80/share. | $1.1B | ~10.3x (implied) | Announced Feb 23, 2026; expected to close Q2 2026 |
| Astrana Health | Prospect Medical Systems Physician network: 3,000 PCPs, 10,000 specialists, 610K members. Value-based care platform. | $708M | ~8.7x | Jul 2025 |
| Addus HomeCare | Gentiva Personal Care (full-year impact in 2025) Personal care operations across 7 states. First full year of integration drove ADUS to 23% revenue growth in 2025. | $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. | Undisclosed | N/A | Jan 2025 |
| Cardinal Health / Specialty Alliance | Solaris Health Largest urology MSO — 750+ providers, 250+ locations, 14 states. | $1.9B | N/A | Aug 2025 |
Sources: Company IR press releases, SEC filings, Reuters. Deal values and multiples as disclosed by buyers. “N/A” where terms were not publicly disclosed.
What the CEOs Are Saying
Key themes from recent earnings calls
Payer-owned platforms are reshaping healthcare M&A
UnitedHealth/Optum paid $3.3B for Amedisys. SCA Health (also Optum) acquired U.S. Digestive Health. Payers are buying the care delivery infrastructure — and they're paying strategic premiums to do it. This changes the buyer universe for every independent practice: your future acquirer might be an insurance company, not just PE.
Sources: Amedisys proxy filing; SCA Health/USDH industry reports
Home health consolidation accelerating — ADUS proves the rollup works
Addus's 23.2% revenue growth in 2025 was the first full year of Gentiva integration. Adjusted EBITDA grew 28%. That's the PE playbook executing perfectly: buy a regional platform for ~10x, integrate, harvest margin. Kinderhook is taking Enhabit private for $1.1B at 10.3x. Scale in home health now means survival — small agencies can't absorb PDGM billing complexity.
Sources: ADUS FY2025 10-K; Enhabit take-private announcement (Feb 2026)
Surgery center same-facility growth decelerating but still outperforming
Surgery Partners grew 6.2% in 2025 (down from 13.5% in 2024) with 4.9% same-facility growth — 1.4% rate / 3.4% volume. The outpatient shift continues, but case mix shifts and payer pressure are compressing revenue-per-case growth. ASC operators with higher-acuity capabilities (orthopedics, spine) still command premium valuations, but the easy gains have been harvested.
Sources: SGRY FY2025 10-K and earnings release (Mar 2026)
Behavioral health demand is strong — but margins are under siege
Acadia's 2025 told the harder truth: revenue grew 5% to $3.3B but adjusted EBITDA dropped $100M+ to $609M. Net loss of $(12.16) per share. Clinical labor cost, state Medicaid rate pressure, and compliance remediation are structural challenges even when demand is strong. For private behavioral health practices, this is a reminder: demand doesn't protect margin if staffing and payer contracts move the wrong way.
Sources: ACHC FY2025 10-K; 2026 guidance call (Feb 2026)
PT rollup still the hottest subsegment — USPH up 16% on acquisitions
USPH grew 16.3% in 2025 to $781M, ended the year at 780 clinics, and guided to $102–106M adjusted EBITDA for 2026. They also announced two 10-year strategic hospital alliances in January 2026 expected to add $7.3M annualized EBITDA. This is the model every PE firm in PT is chasing. If you own 3–10 PT clinics with clean books, the buyer universe has never been deeper.
Sources: USPH FY2025 10-K; Q4 earnings release (Feb 2026)
Provider recruitment is still the #1 growth constraint
Every CEO in this group cited staffing as their primary growth constraint. USPH opened clinics but churned some. Encompass Health added 517 beds but was gated by nursing recruitment. Acadia's margin compression was largely clinical labor cost. The practices that solve provider recruitment and retention will outperform. It's the healthcare equivalent of the skilled trades shortage.
Sources: All 5 FY2025 10-K filings; earnings call commentary
Get the full report: Level Healthcare Market Monitor Q1 2026
All 5 company profiles, operating benchmarks, M&A deal tracker, valuation bridge, and private practice multiple ranges. Free PDF.
Financial data sourced from SEC EDGAR filings (10-K) and company earnings releases. Market valuations from publicly available data. Updated quarterly.
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Methodology & Sources
Financial Data
All company financials sourced from SEC EDGAR filings (Form 10-K) and official company earnings releases. Revenue, margins, and employee counts are as reported by each company for their most recent completed fiscal year.
Valuations & Multiples
Enterprise value and EV/EBITDA multiples use publicly available market data. Private healthcare practice multiple ranges are sourced from M&A advisory reports and disclosed transaction terms. 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 — FY2025 10-K (filed Feb 26, 2026); FY2025 earnings release (Feb 5, 2026)
- ADUS — FY2025 10-K (filed Feb 24, 2026); FY2025 earnings release (Feb 2026)
- SGRY — FY2025 10-K (filed Mar 2026); FY2025 earnings release (Mar 2, 2026)
- USPH — FY2025 10-K (filed Feb 27, 2026); FY2025 earnings release (Feb 25, 2026)
- ACHC — FY2025 10-K (filed Feb 26, 2026); FY2025 earnings release (Feb 25, 2026); 8-K CEO transition (Jan 20, 2026)
Frequently Asked Questions
Why should a small healthcare practice care about billion-dollar public companies?
Because these companies set the valuation ceiling for the entire healthcare services industry. When PE evaluates your practice, they start with public company multiples and adjust down for size, payer mix, and operational risk. Understanding the ceiling tells you what's possible — and what you need to build to get there.
What EBITDA multiple can a private healthcare practice realistically expect?
It depends on size, specialty, and quality. Under $3M revenue: 3–5x EBITDA. $3–15M: 5–8x. $15–50M: 7–10x. $50M+ platforms: 9–13x+. The biggest drivers are payer mix (more commercial = higher multiple), provider retention, billing efficiency, and compliance history. A 10-location PT practice with 65%+ commercial payer mix and clean books can command the top of its range.
How is healthcare M&A different from other industries?
Three things make healthcare unique: (1) Regulatory complexity — compliance history, licensing, and credentialing all affect deal value. (2) Payer relationships — managed care contracts often have change-of-ownership clauses. (3) Provider retention — the value walks out the door every night. Buyers price all three of these factors, which is why professional management and documented processes command premium multiples.
Why did Acadia (ACHC) have a bad 2025 if demand is strong?
Clinical labor cost inflation, state Medicaid rate pressure (especially for specialty facilities), and goodwill impairment tied to legacy assets. Revenue grew 5% but adjusted EBITDA dropped $100M+ and Acadia posted a net loss of $(12.16) per share. The lesson for private behavioral health operators: demand doesn't protect margin if staffing costs and payer mix move the wrong way.
How often is this data updated?
We update the Market Monitor quarterly, after each earnings season. All financial data is sourced directly from SEC filings (10-K and 10-Q) and company earnings releases. Market valuations reflect publicly available data at the time of update.
Is this investment advice?
No. The Level Market Monitor is for educational purposes — helping healthcare practice owners understand the capital markets context around their industry. We are not a registered investment advisor. All financial data is sourced from public filings and is presented as-is.
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