The Weekly Checkup: Week of April 13-17, 2026

Issue #2 | Week of April 13-17, 2026

Welcome back, and welcome to everyone who joined after Issue #1.

41 announced transactions this week, a bit lighter than last week's 48 but with a notably different composition: Technology 22, Services 19, and just 2 platform deals versus 39 add-ons. That platform-to-add-on ratio is the tightest we've seen in a few weeks, and it's worth watching. When platform creation slows, it usually means either (a) buyers are sitting on dry powder waiting for rate or policy clarity, or (b) existing platforms are absorbing available supply at lower multiples than sellers want. I think it's more the former right now, but the answer will be clearer in six weeks.

A few things caught my attention. Avanos Medical announced a take-private at a number that deserves to be unpacked properly (and is, below). CareDx carved out its lab products business at a revenue multiple that should inform anyone looking at life sciences tools assets. Southern Orthodontic Partners announced two orthodontic deals in two states on consecutive days, the same "structured roll-up" behavior we saw from Bridge Dental last week. CPIhealth bought a pain management physician practice and an ambulatory surgery center on the same day, which is a specific and tax-aware structure that buyers in pain management should pay attention to. And Eli Lilly wrote another biotech check, the second in as many weeks.

I'm also introducing a new recurring sections this week. "From the Vault" pulls one older deal out of the Scope database and walks through what the source documents actually showed.

Deal value: $1.27 billion | EV / Revenue: 1.81x | EV / EBITDA: 14.65x

American Industrial Partners announced the acquisition of Avanos Medical for $25 per share, representing a transaction value of approximately $1.27 billion. Avanos generated FY2025 revenue of $701.2 million and EBITDA of $86.8 million (a 12.4% margin).

My take: The 14.7x EBITDA multiple on a modestly profitable medical device business is the headline number, and it's instructive. At face value, 14.7x looks rich for a mid-cap device company trading with a low-teens EBITDA margin. But that multiple reflects a few things that matter for anyone valuing a similar business: AIP is buying a platform with two distinct segments (pain management and enteral feeding) that likely trade at different multiples on a sum-of-the-parts basis, the revenue multiple of 1.81x is far more defensible than the EBITDA multiple in isolation, and public medical device companies with clean cap tables and identifiable operational improvement levers have been commanding premiums to historical device comps all year. The more useful read for sellers and advisors: if you're valuing a profitable specialty device business right now and using a blended 10-12x EBITDA, this transaction gives you cover to push higher, particularly if your target has margin expansion opportunity and a clear operational thesis. For buyers, the same transaction is a warning about how competitive the mid-cap device auction environment has become.

Deal value: $170 million cash | EV / Revenue: 3.51x

CareDx announced the divestiture of its lab products business to EuroBio Scientific for $170 million in cash. The lab products division generated $48.4 million of annualized 2025 revenue, up from $40.8 million in 2024 and $33.5 million in 2023.

My take: Three things worth noting. First, the 3.5x revenue multiple on a life sciences tools carve-out is consistent with what we've been seeing across the broader tools space this year, and it's a useful comp for anyone advising a seller with a similar revenue profile. Second, the growth story matters here: revenue grew from $33.5M to an implied $48.4M in two years, roughly 20% CAGR. A tools business growing at 20% trades materially differently than one growing at 5%, and the revenue multiple reflects it. Third, and probably most important for deal professionals, this is a carve-out rather than a whole-company sale. Carve-outs typically trade at a discount to whole-company comps because of TSA complexity, separation costs, and customer overlap concerns. The fact that EuroBio paid 3.5x revenue on a carve-out basis suggests whole-company comps for clean tools assets are materially above that. Plan your valuations accordingly.

Southern Orthodontic Partners announced the acquisition of an Arkansas orthodontic practice on Thursday and a Minnesota orthodontic practice on Wednesday. Both were add-ons.

My take: Second week in a row we've seen this "announce multiple deals in the same category in the same week" pattern, following Bridge Dental Group's Foothill / Peak double last week. The behavior is worth flagging for sellers in mature DSO and MSO categories: platforms are structuring close schedules to batch press releases, which means your timeline to close may be faster or slower than you expect depending on what else the buyer is working on. If you're in active discussions with a roll-up platform and they suddenly go quiet for two or three weeks, the most likely explanation isn't that they lost interest. It's that they're working to close an adjacent deal first. Orthodontic practices specifically continue to trade at premium DSO multiples because of their cash-pay mix and predictable treatment cycles, and the consolidation in that subsegment still has meaningful runway.

CPIhealth announced the acquisition of Midwest Interventional Spine Specialists (a pain management physician practice) and Serenity Surgical Center (a pain management ASC) on the same day.

My take: This is a structure worth dissecting because pain management is one of the trickiest physician specialties to value and consolidate. Pain management generates a high percentage of revenue from procedures performed in ambulatory surgery centers, and the economics look very different depending on whether the ASC revenue is captured inside the physician practice's P&L, inside a separately owned ASC, or split between the two. Buying the physician practice and the ASC on the same day, presumably from related sellers, lets CPIhealth consolidate both revenue streams under one roof from day one and apply MSO economics to the practice side while keeping the ASC as a separate entity for reimbursement and ownership-structure reasons. The same logic applies in gastroenterology, orthopedics, and ophthalmology. If you own a physician practice that sends procedures to an ASC you also own, the highest-value exit typically involves selling both, structured correctly, to a buyer who can articulate why they belong together. The valuation work on these transactions is rarely a single number; it's an allocation exercise, and it's a meaningful part of what we do at HealthFMV.

Second week in a row Lilly has announced a biotech acquisition. CrossBridge Bio brings dual-payload ADC technology.

My take: The pattern continues. Cash-strapped biotech with de-risked clinical data in a strategic indication equals acquisition candidate, and Lilly is clearly working through a list. If you advise early or mid-stage biotech sellers in any of Lilly's focus areas (cardiometabolic, obesity, neuro, oncology), the window to have the strategic conversation is now. The ADC thread is also worth watching: Gilead bought Tubulis last week, Lilly just picked up CrossBridge, and Stryker acquired Amplitude Vascular Systems on Monday for a next-generation IVL platform. Advanced delivery and payload technologies, whether in drugs or devices, are where the strategic premium is landing right now.

I tracked 36 additional transactions this week, including notable activity in digital health (Axtria / Conexus, Planview / OZMOSI, Foundation Medicine / SAGA Diagnostics), home health exits (Advanced Care Partners exit from Afterburner / Council Capital), mid-market hospital M&A (Baptist Health / Magnolia Regional, and the unusual Westchester General / nursing home operator group transaction in Miami-Dade), and revenue cycle (TELCOR / Sample Healthcare). The complete list, with the financial detail Scope is known for, will be available to premium subscribers when that tier launches.

Deal value: $71.9 million (100% EV) | EV / Revenue: 0.90x | EV / EBITDA: 7.00x

A Vault deal each week pulls something from the Scope database and walks through what the underlying documents actually said. The goal is to show the kind of detail we surface on the roughly 2,900+ healthcare transactions in our valuation database, and to give subscribers a useful comparable they can act on.

This week: SSM Health's acquisition of a 64% interest in Oklahoma Spine Hospital from Medical Facilities Corporation in February 2026.

What the press release said: SSM paid $46 million for a 64% ownership interest, implying a 100% enterprise value of roughly $71.9 million. The release also reported that, for the fiscal year ended December 31, 2024, and excluding government stimulus income, Oklahoma Spine Hospital generated facility service revenue of $76.4 million and income from operations of $6.7 million.

What the financial statements and cost reports added: Medical Facilities Corporation files detailed MD&A disclosures as a Canadian public company, and those filings allowed us to build a cleaner last-twelve-months view than the press release alone provides. Using the MFC Q3 2025 MD&A and financial statements, and triangulating depreciation using the Medicare cost reports Oklahoma Spine files annually, we arrived at an LTM revenue figure of $79.6 million and LTM EBITDA of $10.3 million (a 12.9% margin). That's the denominator that produces the 7.0x EBITDA multiple and the 0.90x revenue multiple.

Why it matters: Specialty surgical hospitals, particularly spine and orthopedic, don't trade publicly and don't appear in the usual M&A databases with meaningful financial detail. The 7.0x EBITDA multiple on a physician-owned specialty hospital with a 13% margin is a useful data point for any practitioner valuing a similar facility. It's also a reminder that the denominator matters: depending on which trailing period and which adjustments a buyer uses, the EBITDA multiple on this same deal could be presented anywhere from 6x to 11x. The source documents tell the real story. The press release only tells part of it.

Scope Research's valuation database has approximately 2,900+ healthcare M&A transactions with disclosed or derived revenue and EBITDA multiples going back to 2010. The underlying source documents, including cost reports, CON filings, bond disclosures, and audited financials, are what make those figures reliable.

Location: Orlando, FL | Asking Price: $8.5M | Revenue: $4.9M | Cash Flow: $1.6M | CF Margin: 32% | Price / Revenue: 1.7x | Price / Cash Flow: 5.4x

Single-site Orlando rheumatology practice in a 6,500 square foot medical office. Full clinical and diagnostic line-up under one roof: consultations, biologic infusions, X-ray, bone density scanning, nerve studies, and phlebotomy. 2024 revenue of $4.9M and SDE of $1.6M.

My take: The in-house infusion is the most valuable asset here and it fundamentally changes how this practice should be valued. Rheumatology biologic infusions (Remicade, Orencia, Rituxan, and the rapidly growing biosimilar market) generate buy-and-bill economics that look very different from routine office visits, and a practice that captures the infusion margin internally rather than referring it to an outside infusion center is worth a meaningful premium. The 5.4x cash flow ask is at the low end of where infusion-equipped specialty practices have been trading, and there are now multiple PE-backed rheumatology platforms (and several infusion-focused platforms with rheumatology arms) actively rolling up assets like this one. The diligence priorities are payer mix on the infusion side (Medicare Part B vs. commercial vs. Medicare Advantage carve-outs), the drug reimbursement methodology (ASP plus, white-bagging exposure), and the specific biologic mix relative to the biosimilar transition curve. A rheumatology consolidator could likely justify 7x to 8x cash flow on this asset with appropriate diligence. For a non-strategic buyer, the operational complexity of running an in-house infusion suite is a genuine barrier and a reason to pause.

Location: Austin, TX | Asking Price: $2.75M | Revenue: $9.0M | Cash Flow: $3.6M | CF Margin: 40% | Price / Revenue: 0.31x | Price / Cash Flow: 0.77x

Founded 2023. 550+ patients, 4,000+ in-home visits since inception. Mobile wound care delivered in patient homes, assisted living facilities, and long-term care settings. Revenue doubled from 2024 to 2025. 18 employees.

My take: A 0.77x cash flow ask on a profitable, growing healthcare business deserves immediate skepticism. Three things explain prices this far below market. Either the cash flow figure isn't what it appears to be, or the business has structural risk that a sophisticated buyer has flagged and the seller has accepted, or the listing is meaningfully wrong. In mobile wound care specifically, there are real reasons a buyer might run away from a business that looks profitable on paper. Wound care reimbursement (particularly Medicare and Medicare Advantage) has been under significant scrutiny over the last 36 months, with multiple OIG and DOJ enforcement actions targeting specific billing practices around skin substitutes, debridement coding, and cellular and tissue products. A 40% cash flow margin in mobile wound care, in a business founded in 2023 with revenue that doubled in a single year, is exactly the profile that shows up in those enforcement matters. None of this means the business is doing anything wrong, but a serious buyer needs a thorough reimbursement and coding audit, a specific look at the CTP and skin substitute mix, and a review of any RAC, ZPIC, or UPIC activity before committing. If the business survives that diligence, the ask is a steal. If it doesn't, no price is low enough.

Location: West Florida | Asking Price: $4.0M | Revenue: $3.5M | Cash Flow: $500K | CF Margin: 14% | Price / Revenue: 1.14x | Price / Cash Flow: 8.0x

Three-site urgent care platform in West Florida. Walk-in with extended hours. Diversified payer mix (commercial, self-pay, Medicare, workers' comp). On-site CLIA-certified labs and X-ray at all sites.

My take: Three locations is the smallest configuration that qualifies as a platform rather than a collection of practices, and the ability to amortize back-office, billing, and management across three sites is what justifies platform multiples. The 8.0x cash flow ask is at the higher end of where small urgent care platforms have been trading, but the per-location economics tell the real story. $1.17M revenue per location is below the $2M to $3M benchmark for mature urgent care sites, and the 14% cash flow margin suggests the platform is running below its potential. For a buyer, the question is whether the three sites are mature and structurally constrained (which would put the right price at 5x to 6x) or whether they're underperforming and have margin upside (which would justify the 8x ask if the buyer can execute). Diligence priorities: visit volumes per site relative to local market benchmarks, the specific payer mix and contract rates with the major Florida MCOs (Florida Blue, UnitedHealthcare, Aetna, Humana), staffing model and physician compensation structure, and the CON status of any planned additional sites if the buyer's thesis includes expansion. Florida is not a CON state for urgent care, which simplifies that piece.

Location: The Villages, FL (Sumter County) | Asking Price: $8.0M | Cash Flow: $3.5M | Price / Cash Flow: 2.3x

GI group practice serving The Villages and Leesburg, Florida. Revenue not disclosed in the listing.

My take: A 2.3x cash flow ask on a GI practice in The Villages is structurally interesting because The Villages is one of the most concentrated geriatric markets in the United States and GI procedure volume per capita in that geography is exceptional. The lack of disclosed revenue is a significant gap. Without revenue, a buyer can't underwrite the practice's ASC mix (GI practices that own their endoscopy revenue stream trade very differently from those that refer it out), the procedure mix between screening colonoscopy and therapeutic procedures, the payer mix, or the per-physician productivity. The "no middle broker" framing usually signals an unrepresented seller, which can mean either a clean deal at a sensible price or a seller who hasn't been advised on what the practice is actually worth. GI is one of the most heavily consolidated physician specialties in the United States, with major PE-backed platforms (GI Alliance, US Digestive Health, GI Specialists Group, and others) actively acquiring. For any of those platforms, a Villages-area practice is potentially a strategic asset because of the demographics. The 2.3x ask is meaningfully below where strategic GI buyers have been pricing comparable practices, which means either the cash flow figure includes substantial non-recurring items or owner compensation that won't normalize, or the practice has structural issues (referral concentration, ASC ownership questions, succession risk). A serious buyer should request a complete financial package and a procedure-level revenue breakdown before any further conversation.

Location: Kansas City Metro, KS | Asking Price: $4.0M | Revenue: $2.2M | Cash Flow: $1.0M | CF Margin: 46% | Price / Revenue: 1.8x | Price / Cash Flow: 4.0x

Regenerative medicine clinic providing non-surgical joint pain solutions through a mix of insurance-reimbursed and cash-pay therapies including PRP, stem cell, and exosome treatments. Fluoroscopic guidance, custom bracing protocols.

My take: Regenerative medicine occupies a regulatory and reimbursement gray zone that materially affects how this practice should be valued. PRP (platelet-rich plasma) is generally not covered by Medicare or commercial payers and is almost entirely cash-pay. Stem cell therapy for orthopedic indications is similarly cash-pay because most of these therapies do not have FDA approval for the specific indications being marketed and treatments fall outside reimbursement. Exosome therapy is more complicated still, with the FDA having issued specific warnings about exosome products for orthopedic and other indications. The 46% cash flow margin is consistent with a heavily cash-pay business model where the revenue is high-margin but volatile. For a buyer, the diligence priorities are different than for a typical physician practice: marketing dependence (cash-pay regenerative medicine practices live or die by their marketing engine), actual versus advertised clinical evidence (FDA enforcement risk on health claims), provider credentialing (the clinical staffing model needs scrutiny because nurse practitioners and physician assistants performing some of these procedures may be operating outside their state scope of practice), and the insurance-reimbursed portion of the practice (typically fluoroscopy-guided injections and bracing, which trade at very different multiples than the cash-pay book). The 4.0x cash flow ask is appropriate for a cash-pay heavy practice with these structural questions, and arguably generous if the regulatory backdrop tightens. A more conservative valuation would split the practice into the insurance-reimbursed book (worth perhaps 3x to 4x cash flow on that portion) and the cash-pay book (worth perhaps 2x to 3x on that portion given the volatility and marketing dependence).

That's it for Issue #2.

See you next Tuesday.

Will Hamilton, CVA Founder, Scope Research and HealthFMV

The Weekly Checkup is published every Tuesday morning. It is written for general informational purposes. Engagements through Scope Research or HealthFMV require a separate agreement.