Medical Practice Valuations | Physician Practice Appraisals

When Physicians Need a Valuation

The Five Triggering Events I See Most Often

A medical practice rarely gets valued for fun. There's usually a deadline, a counterparty, and a specific report standard the engagement has to satisfy. Here's where I come in most often.

Divorce & Equitable Distribution

Determining practice value as of the relevant dates and separating personal from enterprise goodwill. The bulk of my courtroom work.

Partner Buy-Ins & Buy-Outs

An incoming partner needs a defensible price; a departing partner needs a supported, arm's-length number prepared to the standard their CPA, attorney and the IRS apply. Many physician partnership agreements call for a third-party appraiser — that's the role I fill.

Sale to a Hospital System or PE Platform

Establishing fair market value before negotiations begin, so the parties are negotiating against a supported number. Includes carve-outs for ancillary lines, real estate, and personal goodwill.

Estate & Gift Tax Filings

Practice interests transferred to a spouse, children, or a successor partner generate IRS scrutiny. The report has to anticipate every position the IRS valuation engineer will take — including the discounts for lack of control and lack of marketability.

Bankruptcy & Wind-Down

A struggling practice has different valuation problems than a healthy one — going-concern versus liquidation premise, executory contract treatment, professional licensure value, and the receivables haircut. I am retained by trustees, debtors and secured creditors, and the analysis is the same in each.

Shareholder Disputes & Buy-Sell Triggers

Disability, retirement, death, or a deadlock that activates the buy-sell agreement. Many agreements call for an independent credentialed appraiser and specify the standard of value. That's the engagement I take.

Specialties Served

Fifteen Medical Specialties — and Counting

Healthcare valuations are not interchangeable. The economics of an ABA therapy practice look nothing like a multi-specialty surgical center, and a chiropractic clinic looks nothing like a compounding pharmacy. Here's the practical inventory of specialties I've valued.

Primary Care & Internal Medicine

Family medicine, internal medicine, primary care groups

Surgical Specialties

General surgery, surgical centers, multi-specialty surgical associates

Dermatology & Aesthetics

Dermatology practices, medical spas, laser & aesthetics centers

Dental & Oral Health

Dental groups, multi-location dental practices, dental labs

Ophthalmology & Vision

Ophthalmology practices, eye institutes, optometry practices

Podiatry

Foot & ankle specialists, podiatry practices

Behavioral Health

Applied Behavior Analysis (ABA) therapy, behavioral care centers

Pain Management

Pain management centers, pain & primary care combinations

Chiropractic

Individual and multi-location chiropractic practices

Prosthetics & Orthotics

Durable medical equipment, P&O practices

Pulmonary Medicine

Pulmonary medical practices, lung associates

Audiology

Hearing aid & audiology centers

Veterinary Medicine

Veterinary clinics, animal hospitals

Hospital Transactions

Community hospital acquisitions

Compounding Pharmacies

Specialized compounding operations

What Makes Medical Different

Healthcare Valuations Are Not Interchangeable with Generic Business Valuations.

Medical practice economics differ from general industrial economics in ways a generic approach does not capture. A defensible medical practice valuation has to account for four things that generic valuations miss.

Personal goodwill versus enterprise goodwill The split between personal and enterprise goodwill varies widely; I measure it case by case with the 16-factor model and show the evidence for each factor. Personal goodwill is treated differently in divorce, in a sale, and in estate and gift filings. I separate personal from enterprise goodwill and support the allocation; the legal characterization of that allocation is for counsel and the court. Separating it is the entire ballgame.
Reimbursement & payor-mix risk A practice with 70% Medicare and Medicaid revenue is fundamentally different from one with 70% commercial and self-pay. CPT-code reimbursement schedules, MIPS exposure, prior-authorization friction, and payor concentration all flow into the discount rate.
Stark, Anti-Kickback & corporate practice of medicine Federal and state regulation restricts who can own a medical practice, what kinds of compensation arrangements are permitted, and how ancillary income streams can be structured. A valuation that ignores these constraints will overstate transferability, which is a reliability defect I address directly in the report.
Capacity utilization & provider-bench depth A solo practice running at 95% utilization has zero growth runway. A four-physician group with one underutilized provider has obvious upside. The benefit-stream forecast has to reflect what the practice can actually produce, not what last year's revenue happened to be.

Medical team of physicians and clinical staff in a clinic setting — representing the multi-provider practices Ameri-Street Advisory values.

Selected Engagements

A Sample of Medical Practice Engagements

Drawn from the public CV. Client names are confidential — case venue, year, and engagement context are reported here so attorneys and physicians can see the actual mix of work.

Practice Type	Venue	Context
Medical Practice	Fifth Judicial Circuit, FL — Citrus County	Family Law
Dentist Medical Practice	Pinellas County Circuit Court, FL	Family Law
Medical Practice	Fifth Judicial Circuit, FL	Family Law
Chiropractic Clinic	Marion County Circuit Court, FL	Family Law
Medical Practice	Fifth Judicial Circuit, FL	Family Law
Medical Billing Company	Miami, FL	Partner Dispute
Medical Practice	Dagsboro, DE	Family Law
Chiropractic Clinic	Brooksville, FL	Family Law
Dental Lab	Tampa, FL	Family Law
Dental Practice	Lakeland, FL	Bankruptcy
Optometry Practice	Tampa, FL	Business Sale

Earlier engagements and the full litigation log appear in the CV — available on request.

Common Questions

What Physicians and Their Attorneys Ask First

Why is a medical practice harder to value than a regular business?

Three reasons. First, the receivables age and collect very differently than other industries — payor mix, reimbursement schedules, and the prior-authorization pipeline all matter. Second, regulation (Stark, Anti-Kickback, corporate practice of medicine, state licensure) restricts who can own the practice and how revenue can be earned, which directly limits transferability and therefore value. Third, personal goodwill is treated differently in divorce, in a sale, and in estate filings. The split between personal and enterprise goodwill varies widely; I measure it case by case with the 16-factor model and show the evidence for each factor. A generic appraiser misses one of these and the report falls apart at trial.

Do you separate personal goodwill from practice (enterprise) goodwill?

Yes — and this is one of the most important pieces of any medical practice report. I use a 16-factor multi-attribute utility model (MUM) that weighs eight personal-goodwill indicators against eight enterprise-goodwill indicators to produce a defensible allocation. The MUM analysis is explained in plain language in the report body and supported by an exhibit so the trier of fact can see exactly how the allocation was reached.

Will the report meet hospital, PE platform, or strategic-buyer due-diligence standards?

That is the standard the report is built to. The report is structured as a NACVA Conclusion of Value with full income, market, and asset-approach development — the standard institutional buyers and their investment banks expect. It includes a normalized benefit stream, comparable transaction analysis (BizComps and IBA databases), and a fully supported discount rate build-up. The CBA designation is one of the very few U.S. business-appraisal credentials that require peer review of completed reports as a condition of certification, which institutional buyers recognize.

Can you value a partial interest — for example, one partner buying out another?

Yes. Partial-interest valuations are a substantial portion of my medical practice work. The engagement applies a discount for lack of control (DLOC) and a discount for lack of marketability (DLOM) on top of the pro-rata enterprise value. Both discounts are supported with empirical evidence — DLOC from the difference between the controlled and non-controlled benefit streams together with control-premium and minority-interest data, and DLOM from a factor analysis carried out separately at the entity level and at the shareholder level, supported by the restricted-stock and pre-IPO studies. The buy-sell agreement language usually drives the standard of value (fair market value, fair value, or contractually defined), and I conform the report to whatever the agreement specifies.

What information do you need to start?

For most engagements: three to five years of practice tax returns, the most recent year-to-date P&L and balance sheet, the most recent payor-mix and CPT-distribution report, a copy of the lease and any applicable buy-sell or partnership agreement, a fixed-asset schedule, the physician's employment or compensation arrangement, and a brief management interview (usually 60–90 minutes by Zoom). I send a tailored information request once I've talked through the triggering event with you and we've fixed the valuation date and standard of value.

How long does a medical practice valuation take?

From engagement letter signed to draft report typically four to six weeks, assuming the documents arrive in a reasonable batch and the management interview can be scheduled inside the first two weeks. Litigation timelines can compress this if there's a court deadline. Phase I diagnostic engagements (a calculation engagement producing a calculated value, before committing to a full valuation engagement) run two to three weeks.

What does a valuation cost?

It depends on the situation: what triggered the need, the size and complexity of the business, and whether testimony is likely. That is exactly why the first conversation is free. After we talk, I will tell you what I think you need and what it will cost before any work begins.

Do you testify in court?

Yes. The CV documents 14 court testimony appearances, 11 deposition appearances, and 3 mediations. In two divorce matters in which I was the valuation expert, the trial court's judgment was affirmed on appeal.

Meet the Appraiser

Salvatore B. Urso, CBA

"Every report has my name and my signature. I do the work, I take the deposition, I sit in the chair."

Medical practice valuations sit at the intersection of personal goodwill, regulatory complexity, and physician-specific economics. I am the appraiser who will personally complete your engagement, sit through deposition, and take the stand if the case goes to trial. No junior staffer, no rotating team.

The CBA designation I hold is one of the very few U.S. business-appraisal credentials that require peer review of completed reports as a condition of certification — fewer than 400 appraisers nationwide hold it. In two matters in which I was the valuation expert, the trial court's judgment was affirmed on appeal by the Florida appellate courts.

800+

Valuations

80+

Sales Facilitated

100%

Personally Authored

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Defensible Valuations for Physician Practices, Dental Groups, and Healthcare Entities