How much does a quality of earnings report cost for a medical practice?

QoE pricing is a function of three variables: practice scale, complexity, and the scope of the engagement. For practical ranges, a sell-side QoE on a single-location outpatient practice with $1.5M to $4M in EBITDA typically costs in the $35,000 to $55,000 range. A multi-location practice with $5M to $10M in EBITDA, more complex payer mix, and historical acquisitions typically runs $55,000 to $90,000. Platform-stage businesses (multiple locations, $10M+ EBITDA, rollup activity, multi-state operations) regularly exceed $100,000. The work behind the fee is substantial. A real QoE includes monthly proof-of-revenue and proof-of-cash testing for the trailing 24 to 36 months, line-by-line normalization of EBITDA add-backs (owner compensation in excess of fair market value replacement, owner personal expenses run through the practice, one-time legal or settlement costs, non-recurring projects), working capital normalization to support a fair peg in the transaction, customer concentration analysis (payer mix, top referrers, top patient concentration if relevant), revenue cycle metric analysis (denial rate, days in AR, collection rate trends), and identification of risks that will surface in buy-side diligence anyway. A weak QoE prepared by an inexperienced provider, often the practice's existing CPA who has never sold a business, frequently costs the seller more than the fee saved. Buyers reverse-diligence sloppy add-backs, push back on aggressive normalizations, and use the resulting credibility gap to chip purchase price. A strong sell-side QoE, prepared by a healthcare-experienced transaction advisory provider, accomplishes three things. First, it surfaces and fixes problems before the buyer finds them, including bookkeeping errors, missing reconciliations, undocumented related-party transactions, and unsupported add-backs. Second, it gives the seller defensible adjusted EBITDA, which directly drives purchase price (every $100K of defensible add-back multiplied by the deal multiple is real money). Third, it accelerates the transaction. Buyers see a credible QoE and shorten their own diligence, which reduces the window in which deals fall apart. For a practice contemplating a sale in the next 12 to 24 months, the QoE engagement should typically begin at least three to six months before going to market, with enough time to remediate any findings before bringing the deal to buyers. Practices that wait until the buy-side QoE finds problems pay for them at the closing table.