Guide to Selling a Urgent Care Practice in Missouri

The market for urgent care in Missouri is more active than ever. With significant growth and a fragmented landscape creating numerous transaction opportunities, many practice owners like you are considering a sale. But a successful exit is more than just finding a buyer; it’s about understanding market dynamics, preparing your practice correctly, and navigating a complex process to maximize your final value. This guide provides key insights to help you begin that journey.

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

Market Overview

The decision to sell your practice doesn’t happen in a vacuum. It is important to understand the landscape. For urgent care owners in Missouri, the current market presents a unique combination of growth and opportunity.

Strong Local Growth

The demand for on-demand care is surging. Missouri has seen its number of urgent care centers climb from 202 in 2019 to 248 in 2023. This growth is fueled by younger patients, with Gen Z and Millennials increasingly using urgent care instead of a traditional primary care physician. This trend signals a durable and expanding patient base for well-positioned practices.

A Fragmented, Active Market

Unlike other healthcare sectors, the urgent care market is not dominated by a few large players. No single business holds more than 5% of the market share. This fragmentation creates a highly active M&A environment, with dozens of transactions taking place every year. For a seller, this means a diverse pool of potential buyers, from private equity to hospital systems, are actively looking for acquisition opportunities.

Key Considerations

While the Missouri market is favorable, buyers look for specific signs of a healthy and scalable practice. Before you decide to sell, it’s wise to assess your operations from a buyer’s perspective. Are you consistently seeing over 30 patient visits per day? This is often seen as a key threshold for profitability and attractiveness. How does your payor mix look? Strong contracts with commercial insurers are highly valued, whereas a heavy reliance on Medicaid can be a concern for some buyers due to lower reimbursement rates. In some urban areas, a rise in competition means that demonstrating a clear competitive advantage or a loyal patient base is more important than ever. Answering these questions honestly is the first step in positioning your practice for a premium valuation.

Market Activity

The high level of M&A activity in Missouri is driven by several types of buyers, each with a distinct motivation. Understanding what they’re looking for can help you position your practice and find the right strategic fit. We see two main groups very active in the market right now.

1. Private Equity (PE) Firms: These buyers are primarily focused on growth and return on investment. They look for practices with strong EBITDA (typically 10-20% margins), a scalable operational model, and the potential to expand into new locations or add service lines. They are buying for a future “exit” of their own, so they will pay a premium for a practice that can serve as a strong platform for growth.

2. Hospitals and Health Systems: These buyers are often more concerned with strategic footprint and patient flow. They may acquire an urgent care to relieve pressure on their emergency departments, expand their market presence, and create a reliable referral source for their network of specialists. For them, your practice’s location and existing referral patterns can be just as valuable as its profitability.

Sale Process

Selling a medical practice is not like selling a house. It is a structured process that, when managed correctly, protects you and maximizes your outcome. It generally begins with creating a clear strategy and preparing your financial and operational documents. From there, we work with you to confidentially market the practice to a curated list of qualified buyers. After initial offers are received, the most intensive phase begins: due diligence. This is where the prospective buyer deeply inspects every aspect of your business, from your financials and billing compliance to your employee contracts and IT systems. Many deals encounter trouble at this stage if the practice is not properly prepared. Successfully navigating due diligence leads to final negotiations and the closing of the sale.

Valuation

One of the first questions any owner has is, “What is my practice worth?” In medical M&A, value is rarely based on a simple multiple of revenue. Instead, sophisticated buyers value your practice based on its Adjusted EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization). This metric represents the true cash flow and future earning potential of the business. The multiple applied to that EBITDA can vary significantly based on your practice’s size, growth trajectory, and overall risk profile. Larger, more profitable practices command higher multiples because they are seen as more stable investments.

Here are typical valuation ranges based on a practice’s annual revenue:

Getting an accurate, professional valuation is the foundation of a successful exit strategy.

Post-Sale Considerations

Signing the sale agreement is a major milestone, but it is not the end of the journey. The structure of your deal has long-term implications for your finances, your legacy, and your staff. A well-advised seller plans for the post-sale period during the negotiation, not after.

Here are three key areas to consider:

1. Your Future Role: Do you want to leave immediately, or are you willing to stay on for a transition period? Many deals include a 1-3 year employment agreement. Understanding your role and compensation is critical.
2. Deal Structure & The Second Bite: Is a portion of the sale price tied to future performance (an “earnout”)? Are you “rolling over” some of your equity to partner with the new owner? This can provide a “second bite at the apple” if the new entity is sold again in the future, but it also carries risk.
3. Protecting Your Legacy: The transaction needs to be structured to protect your staff and ensure a smooth transition of care for your patients. This also includes ensuring all legal and compliance aspects, like Stark Law and Anti-Kickback statutes, are properly handled to prevent future liabilities.