Guide to Selling a Dialysis & Nephrology Practice in Portland, OR

An overview of the market, valuation, and process for practice owners considering a transition.

Selling your Dialysis & Nephrology practice in Portland is a significant decision, and the timing has never been more interesting. The market is defined by strong market demand and a powerful trend towards strategic consolidation by larger groups. For independent owners, this presents both a unique opportunity and a complex landscape to navigate. This guide provides a clear overview of what you need to know to position your practice for a successful sale.

Curious about what your practice might be worth in today’s market?

The Portland Nephrology Market: A Tale of Growth and Consolidation

Understanding the environment you’re selling in is the first step. For nephrology practices, the market is dynamic both nationally and right here in Portland.

A Growing National Tide

The demand for dialysis services is strong and getting stronger. The U.S. market is projected to grow from over $35 billion in 2024 to more than $66 billion by 2034. This growth has attracted large, for-profit companies like DaVita and Fresenius, as well as private equity investors. They are actively consolidating the market, which means they are constantly looking for well-run practices to acquire. This creates a competitive environment for buyers, which can benefit sellers.

Portland’s Unique Currents

Locally, you’re familiar with established groups like the Oregon Kidney & Hypertension Clinic, OHSU, and U.S. Renal Care. These organizations, along with national players, are shaping the Portland landscape. A key trend influencing buyers is the shift toward value-based care (VBC) models. A practice that can demonstrate efficiency and positive patient outcomes under these new payment structures is immediately more attractive to a potential partner or acquirer.

What Buyers Look for in a Portland Practice

When a potential buyer evaluates your practice, they look beyond the surface. They are buying future cash flow and strategic value. Here is what they focus on:

1. Financial Health. This is the most important factor. Buyers will want to see several years of clean financial statements. They’ll analyze your revenue, expenses, and profitability. For reference, a 2016 report noted average net profit margins for dialysis clinics around 18%, so demonstrating stable or growing profitability is key.
2. Stable Patient Base and Referrals. A loyal patient base with low turnover is a major asset. Equally important is a strong, diverse network of referring physicians from the Portland area. Demonstrating these relationships with data adds significant value.
3. Quality of Your Team. An experienced and stable team, from physicians to nurses and support staff, is highly valuable. A buyer sees a strong team as a sign of a well-run practice and reduced transition risk.
4. Operational Strength. This includes your day-to-day processes, your technology (like a modern EHR), and compliance record. Efficient operations suggest that the practice can be integrated smoothly and continue to perform well post-sale.

A comprehensive valuation is the foundation of a successful practice transition strategy.

Who is Buying Practices Today?

The market is not just active. It is competitive. Two main types of buyers are shaping the acquisition landscape in nephrology.

The Rise of Private Equity

Private equity (PE) firms have a strong appetite for nephrology practices. They see the industry’s stable demand and growth potential. PE buyers are often looking for a “platform” practice to build upon, or smaller “add-on” practices to merge with an existing platform. They bring business expertise and capital, but it’s important to find a partner whose goals align with yours. We specialize in finding a partner that fits, often structuring deals that allow physicians to retain clinical control and even share in future growth.

Strategic Hospital and Health System Acquirers

Large, established healthcare organizations and other dialysis providers are also active acquirers. Their goal is often to expand their geographic footprint in the Portland area or to build a more integrated care network. Selling to a strategic buyer can offer different benefits, such as access to a larger patient population and established hospital relationships.

What a Professional Sale Process Looks Like

Selling your practice isn’t like listing a house. To protect confidentiality and maximize value, the process is highly structured. A misstep at any stage can jeopardize the outcome.

1. Preparation. This is where the most important work is done. It starts with a comprehensive valuation to understand what your practice is truly worth. We then work with you to prepare financial documents and craft a compelling narrative that highlights your practice’s strengths for potential buyers. Most practices are undervalued until this work is done.
2. Confidential Marketing. Your practice is never publicly listed. Instead, we identify and discreetly approach a curated list of qualified financial and strategic buyers. This creates a competitive environment without alerting your staff, patients, or competitors.
3. Due Diligence. Once offers are received and a lead buyer is selected, they will begin a deep dive into your practice. This is an intense period of reviewing financials, contracts, and operational data. Being thoroughly prepared is critical to keep the process smooth and prevent buyers from lowering their price.
4. Closing. The final stage involves negotiating the definitive legal agreements and planning for a smooth transition for you, your staff, and your patients.

Preparing properly for buyer due diligence can prevent unexpected issues.

How is a Nephrology Practice Valued?

Valuing a medical practice is equal parts math, market, and mindset. Buyers don’t just buy your past profits; they buy your future potential. The core formula is straightforward: Adjusted EBITDA x a Valuation Multiple.

Adjusted EBITDA is a measure of your true cash flow. It starts with your net income and adds back interest, taxes, depreciation, and amortization. We then “normalize” it by adjusting for any one-time expenses or owner-specific perks (like a car lease or above-market salary) to show a buyer the real profitability.

The multiple is where the story comes in. It’s not a fixed number. It changes based on risk and growth potential, as seen by the buyer.

Planning for Life After the Sale

A successful transition is defined by what happens after the documents are signed. The best deals are structured with the future in mind, protecting both your financial outcome and your legacy. Planning for these elements upfront is critical.

1. Your Role in the Transition. What do you want your role to be? Some owners wish to retire immediately, while others prefer to continue practicing for a few years. This is a key point of negotiation that should reflect your personal and financial goals.
2. Protecting Your Staff. Your team is a core asset of the practice and a key part of your legacy. A good buyer will want to retain your staff. We help structure agreements that include protections and incentives for your key employees, ensuring a stable transition.
3. Understanding Your Proceeds. The final number is often more complex than cash at close. Many deals include an “earnout,” where you receive additional payments for hitting future performance targets, or “rollover equity,” where you retain a minority stake in the new, larger company. This gives you a potential second financial win when the larger entity is eventually sold.

Your legacy and staff deserve protection during the transition to new ownership.

Every practice sale has unique considerations that require personalized guidance.