Best Physician Practice M&A Advisors (PPM and Specialty Groups) in 2026

Best Physician Practice M&A Advisors (PPM and Specialty Groups) in 2026

Last updated: September 2026 · Last verified: September 2026

TL;DR. Physician practice M&A in 2026 is a specialty-by-specialty market with one structural gate. The gate is CPOM clearance: the proposed final judgment and permanent injunction California's Attorney General filed against Carbon Health on June 24, 2026 (Los Angeles County Superior Court, Case No. 26STCV19242, subject to court approval) would permanently enjoin three MSO terms, an MSA giving the manager complete authority over payor negotiations, equipment and clinician hiring, firing and compensation; any MSO ownership interest or assignable option in the professional corporation; and an exclusive above-market MSO credit line, with $4.4 million in penalties on the entities and $100,000 on the co-founder, subject to court approval (California AG). Around it sit the state notice clocks: California 90 days, Washington 60, Minnesota 60 or 30, New York 30, Oregon a 30-day preliminary and 180-day comprehensive review. The tape: Provident's Multisite Provider Services count fell from 60, 59 and 64 deals a quarter in Q3 2024 through Q1 2025 to 32, 39 and 31 in Q4 2025 through Q2 2026, with PPM the largest subsector at 18 deals, 16 of them financial buyers; no dated primary report published a physician-practice multiple this pass, and I quote none. Ranked on 28 dated 2025-26 adviser-of-record credits: Physician Growth Partners (18), Provident Healthcare Partners (6), Westcove Partners (3), then Cain Brothers, Cross Keys Capital, Capstone Partners (1), VMG Health as the valuation seat, Edgemont Partners, VERTESS and Skytale Group. I run Peony, the data room 6,800+ customers run processes like these in; we are not an adviser.

Why is "physician practice M&A" a specialty-by-specialty market, and who is this guide for?

Because the buyer for a dermatology group is not the buyer for a cardiology group, and neither is the buyer for a 35-clinic primary care network, so the adviser bench splits along the same lines. I'm Sean Yu, co-founder of Peony, a data room company. I have built and watched thousands of data rooms across my career — about 1,000 of those when I was an investor at two funds with a combined $6.3 billion in AUM, and the rest across the 6,800+ teams Peony serves today. This guide is for the managing partner of an independent physician group, five to a hundred physicians, deciding between a sponsor-backed physician practice management (PPM) platform, a health system and staying independent. It goes deeper than the one-section treatment in our best healthcare M&A advisors hub in three ways: a dated adviser-of-record ledger for physician deals only, a corporate-practice-of-medicine gate verified from a 2026 stipulated judgment filed for court approval, and a state notice table read from the statutes.

A physician practice M&A advisor is an investment bank or sell-side boutique that runs the sale or recapitalization of a physician group on the owners' behalf: normalizing physician compensation into an EBITDA a buyer will underwrite, building the list of platforms already active in the specialty, structuring the friendly-PC and MSO arrangement a corporate buyer needs, and managing the state notice calendar that, in a growing number of states, sets the closing date. The sibling spokes cover what this one does not: dental, behavioral health, the medical office building under the practice and the imaging center beside it.

The ranking standard is the Adviser-of-Record Ledger the sibling spokes use: a firm earns its position only where I could read its role in a primary source with a date; undated tombstones and pre-2024 credits are said to be so, and rank below fewer dated ones. On that standard the physician bench is honest and thin: three firms carry 27 of the 28 dated 2025-26 credits I could open, and several firms the hub lists in PPM carry none.

How does the corporate practice of medicine affect a practice sale, and what is the CPOM-Clearance Gate?

In a corporate-practice-of-medicine state a sponsor cannot own your practice, so the deal is a management services organization buying the non-clinical assets and a management fee while a physician-owned professional corporation keeps the clinical practice; what changed in June 2026 is that a stipulated judgment, filed with a court for approval, now names which terms in that structure cross the line. On June 26, 2026, California Attorney General Rob Bonta announced a settlement his office called "first-of-its-kind" with Carbon Health Technologies, Inc., its affiliated medical groups and co-founder and former CEO Eren Bali "for violating California's ban on the corporate practice of medicine" and other healthcare and consumer-protection laws (press release; proposed final judgment). Carbon Health "operates over 80 clinics across eight states, including 54 in California," and, in the AG's words, its contracts "unlawfully gave Carbon Health Technologies the power to replace the physician-owner of the clinics with a physician of its choosing, while preventing the physician-owner from replacing the MSO without risking losing ownership of the medical practice."

The proposed judgment is the useful document; it is captioned "[Proposed] Final Judgment and Permanent Injunction," was electronically received by the Los Angeles County Superior Court on June 24, 2026 (Case No. 26STCV19242), and takes effect only once the court enters it. It enumerates: the defendants would be permanently enjoined from the corporate practice of medicine as prohibited by Business and Professions Code sections 2052(a) and 146(a), "including but not limited to" three terms. I call the list the CPOM-Clearance Gate, a Peony-original frame, because a buyer's counsel now runs your structure against it before the LOI is priced:

The remedy is structural: "Carbon Health must change its organizational structure so that a non-medical management company can no longer control or have ownership interests in physician-owned medical practices. Physicians must have independent control over medical decisions and how the practices operate." The money is $4,400,000 in civil penalties on the Carbon Health entities, allowed as claims in their Chapter 11 cases in the Southern District of Texas, filed "while the Attorney General's investigation was ongoing," plus $100,000 on Mr. Bali, and the settlement is "subject to court approval." The same release records an April 2026 amicus brief defending the prohibition and a May 2026 settlement with Aspen Dental over the corporate practice of dentistry, so California's posture is a program, not a case. None of this is legal advice; the point for a seller is that the three struck terms are now the three diligence questions, and an adviser who has the answers before launch protects both the price and the calendar.

Do I need to notify the state before selling my medical practice?

In a growing list of states, yes, before signing or before closing depending on the state, and the clock is written into the statute. The table carries only regimes I read from the statute or the agency's own page; where a dollar threshold sits in a regulation I could not open, I say so. Call it the Notice-Clock Ladder, and build the calendar backward from the longest rung that applies.

Three reading notes. California's noticing entity is the buyer side, and the 90 days run to entering into the agreement, not to closing, which is why California processes sign later than anywhere else; the same chapter defines a physician organization as a group "comprised of 25 or more physicians" or a smaller high-cost outlier. Oregon is a review regime, and its own numbers show what review means: 52 notices since the program launched March 1, 2022, 23 approved, 13 approved with conditions, 7 voluntarily withdrawn and none disapproved, 11 involving private equity firms; the conditions OHA uses include "Ensuring providers retain clinical decision-making authority" and restricting physician non-competes, and the pending list includes a preliminary review of The Oregon Clinic-Northwest Gastroenterology Clinic. The Ninth Circuit upheld the program on July 3, 2025, as our hub records. Oregon also enacted Senate Bill 951 in 2025, widely described in press coverage as restricting MSO control of medical practices; I did not open the enrolled bill and quote none of its terms. New York's regime is notice-only as its page stands in August 2026. VMG Health's September 1, 2026 read: "States like New York and Minnesota have expanded pre-close notification and review of healthcare transactions, and in January this year, California enacted similar oversight of private equity in medicine—raising the diligence bar and lengthening timelines for deals involving management services organizations." The federal layer is unchanged from our hub: the FTC, DOJ and HHS request for information of March 5, 2024, and HSR review above a threshold that was about $126.4 million for 2025. Confirm every row with counsel before the LOI.

Which advisers actually closed the physician practice deals on the tape, 2024-26?

Twenty-eight dated closes, and 27 of them belong to three firms. Every row is a transaction where I could read the adviser's role in the adviser's own dated release or a counterparty's; status is closed unless noted, and "unnamed strategic" means the adviser's release did not name the buyer, so neither do I. PR Newswire rows are Physician Growth Partners' own releases; the providenthp.com, westcove.com and capstonepartners.com pages are linked in the Sources section.

Bottom line: the dated physician evidence is concentrated and specialty-shaped. Physician Growth Partners' 18 rows are single-specialty groups sold to the platform consolidating that specialty: four dermatology groups to Forefront, two to DermCare, three ENT and allergy groups to Align, one eye group to PRISM, one orthopedic group to Sequel, one urology group to Unio, one medical spa to MD Esthetics. Provident's six are broader by buyer type: two health-system or hospital-affiliate buyers, two unnamed strategics, one oncology recapitalization and one cardiology platform (US Heart & Vascular). Westcove's three are two plastics groups to one Webster platform and the largest independent cardiology group in the country to a Lee Equity platform. Behavioral (PGP's GBCC Behavioral Health and Oasis to Orchard Mental Health Group, February 6, 2025) and dental (Skytale's MFD Dental to Smile Partners USA, undated) are routed to their own spokes.

What the ledger does not show is most of the market. Provident counts 27 add-on acquisitions in Q2 2026 alone across 25 unique buyers; most platform add-ons are announced by the platform, if at all, with no adviser named. A list that says a firm "advised on" a physician deal without a dated release, a filing or a counterparty's statement is asserting, not reporting. GI and physical therapy have no dated adviser-of-record close on this bench; The Oregon Clinic-Northwest Gastroenterology Clinic sits in OHA's preliminary review with no adviser named.

Who are the 10 physician practice M&A advisors on this bench, and how are they ranked?

By dated physician adviser-of-record evidence first, and by relevance to an owner-physician seller second: dated credits outrank undated tombstones, which outrank a sector page; repeat evidence in the specialties this guide's readers sell in outranks a single credit at platform scale; and a valuation house that a CPOM structure needs anyway earns a labelled seat. Ten firms, not padded, and I say which four carry no dated 2025-26 physician tombstone.

1. Physician Growth Partners: the deepest dated single-specialty record on the bench

Physician Growth Partners was founded in Chicago in 2017 by Michael Kroin and Ezra Simons, with Robert Aprill as Partner, and its 2025-26 releases carry a Boston dateline: on July 27, 2026 it added Steven Grassa, ten years at Provident, as Managing Director in Boston and said that team "will double its office footprint this August." It describes itself as "a nationally recognized investment bank exclusively focused on healthcare" with "over 90 completed transactions" across physician services, outpatient and ambulatory care, dental, post-acute and behavioral health, and outsourced services (July 2026), and its December 2025 boilerplate, citing the LevinPro HC data platform, calls it "the most active M&A Advisor to independent physician groups by deal volume since its founding in 2017, having advised more than 70 practices in successful transactions." The 18 ledger rows are the evidence; the Golden Gate Urology release calls that deal "PGP's 10th completed urology engagement," including practices "operating in highly regulated states such as California," and the hub's UroPartners, Urology America and Keystone Urology credits sit behind them. Registration: the releases state no broker-dealer and the SEC search returns nothing for the brand, so I assert none. Verdict: first on dated evidence by a wide margin, and the call for a single-specialty group whose buyer is the platform consolidating that specialty.

2. Provident Healthcare Partners: the broadest buyer set and the cleanest registration chain

Provident Healthcare Partners, One Financial Center, Boston, with offices in Minneapolis and New York, is founder-owned and sell-side, and its footer states "Securities offered through PCF Capital Markets, LLC, Member FINRA/SIPC," CRD 290765. Six dated physician credits in the first half of 2026: Florida Heart Associates to Lee Health (June 10; Eric Major); Cardiovascular Clinic of North Georgia to US Heart & Vascular (June 25; Provident advised the clinic, not Cardiology of Atlanta, which partnered alongside it); Avecina Medical's 18 urgent-care centers to MD Now, an HCA Healthcare affiliate, taking MD Now "to over 110 Florida locations" (April 23); The Urology Group of Virginia to an unnamed strategic while the practice was separating from a larger organization (March 17; Kevin Palamara); Palmetto Primary Care Physicians, "one of the largest independent primary care groups in the Southeast," 35 clinics, to an unnamed strategic (March 10; Craig Sager); and Chesapeake Oncology-Hematology Associates' recapitalization with Chesapeake Urology, a United Urology Group affiliate of OneOncology (January 4). Provident publishes the quarterly Multisite Provider Services Update this guide's market section relies on, and was "Again Recognized as a Leading Healthcare Investment Banking Firm at the 2025 Annual M&A Atlas Awards" (its December 19, 2025 post). Verdict: the call for a cardiology, primary care, urgent care or multi-specialty group where the buyer may be a health system rather than a sponsor, and for any deal with rollover where you want the registered entity named up front.

3. Westcove Partners: the founder-operator boutique with the year's Deal of the Year

Westcove Partners, Los Angeles by every release dateline, describes itself as "a highly specialized investment bank"; its footer states "Securities are offered through Finalis Securities LLC Member FINRA / SIPC," CRD 305908. Three dated physician credits: Cardiology Consultants of Philadelphia, "the largest independent cardiology group in the United States" with "over 90 cardiologists, 50 advanced practitioners, and nearly 700 total employees across more than 30 locations," to Cardiovascular Logistics, a Lee Equity Partners platform (April 18, 2025); NYBRA Plastic Surgery, Great Neck, five shareholder physicians, to ARSA, a Webster Equity Partners platform (August 27, 2025); and Regional Plastic Surgery Center & Spa, Texas, to ARSA (March 27, 2025). The cardiology transaction won "U.S.A. Deal of the Year" at the 18th Annual M&A Atlas Awards Americas, which also named Westcove "Boutique Healthcare Investment Bank of the Year," per its July 30, 2026 release; its clinical-research closes are not in the ledger. Verdict: the call for a large independent cardiology group or a plastics practice, and the only boutique here whose largest credit is the largest group in its specialty.

4. Cain Brothers, a division of KeyBanc Capital Markets: the platform-scale seat

Cain Brothers (New York) runs, as our healthcare hub puts it, the broadest dedicated healthcare-services platform of any bank, paired with KeyBanc's balance sheet; the hub's verified credits are the US Fertility recapitalization, an L Catterton-led transaction in 2025, and the FHN affiliation with Mercyhealth, closed December 31, 2025. US Fertility is a physician-practice platform, which is why Cain sits on this bench; I opened no new physician tombstone this pass, key.com being unreadable to a fetch, and Cain Brothers & Company, LLC (CRD 13649) has a record under its own name whose current registration status I did not confirm; the business operates as a division of KeyBanc Capital Markets Inc. Verdict: the seat for a $100 million-plus platform recapitalization or a sponsor-to-sponsor secondary; below that scale, the bank across the table.

5. Cross Keys Capital: the widest specialty map, undated on its own site

Cross Keys Capital, Fort Lauderdale, states it has "successfully completed more than 200 transactions" over "almost two decades"; "Securities related transactions are conducted through Sundial Group, LLC, member of FINRA & SIPC," CRD 158367. Our hub verified the franchise: 20-plus specialties including ophthalmology, anesthesiology, dermatology, ENT, orthopedics, urology and pain, typically on private-equity recapitalizations, with co-founder Bill Britton anchoring healthcare. The latest homepage tombstone is "exclusive financial advisor to SEPA Pain & Spine, in its partnership with DxTx Pain & Spine," six locations, two surgical centers and seven physicians in southeastern Pennsylvania, and it carries no date; the transactions page is JavaScript-rendered and returned nothing to a fetch, and the one dated 2026 credit I found in the press is home health (Chambers Home Health & Hospice to Lucent Health Group, June 2026). Verdict: the broadest PPM specialty map on the bench, ranked fifth because I could not date a single 2025-26 physician close; ask for the last five with dates and buyers.

6. Capstone Partners: one dated dermatology close, bank-owned

Capstone Partners, Boston, owned by Huntington since 2022, is a generalist middle-market bank with a healthcare team, and its one dated physician credit is a good one: Wilmington Dermatology Center, a North Carolina "physician-owned cosmetic dermatology, medical spa, and plastic surgery provider," to DermCare Management, a portfolio company of Hildred Capital ("$3.5 billion in AUM"); "The transaction closed in February 2026, and terms of the deal were not disclosed," led by Michael Goldman, Managing Director, Healthcare. Older physician tombstones are Commonwealth Eye Care Associates to EyeCare Partners (2022) and Nevada Heart and Vascular Center's recapitalization with A&M Capital and Oaktree (2021). Verdict: a credible generalist option for a dermatology, eye or cardiology group that wants a bank-owned platform and a research desk; not a physician specialist.

7. VMG Health: the fair-market-value and Stark-clearance seat, not a banker

VMG Health, "Celebrating 30 Years," is a healthcare consulting and valuation firm, and it sits on the bench as a labelled seat because a CPOM-compliant structure needs its product before any banker's: transaction advisory, valuation, coding audit and compliance, and "Physician Enterprise & Medical Group Solutions," with Kevin McDonough heading valuation and transaction advisory and Lukas Recio, CPA, on financial due diligence. It calls itself "the leading provider of ophthalmology and eyecare consulting solutions." It is not an investment bank, states no broker-dealer and returns nothing in the SEC search, as expected; I do not state its headquarters city because I did not verify it. Its September 1, 2026 note, "Private Equity in Physician Practices: Physician Practice Management Is Changing," is the market commentary quoted throughout this guide. Verdict: the firm you retain for the fair-market-value opinion on the management fee and the earn-out, the sell-side quality of earnings and the physician compensation model, alongside the banker, not instead of one.

8. Edgemont Partners: the hospital-based physician services map, last dated in 2023

Edgemont Partners, 787 Seventh Avenue, New York (CRD 122572 and 155143 on file for its two registered entities), runs a physician and provider services practice whose sector page names "anesthesia, dermatology, radiology, ophthalmology, gastroenterology, urology, psychiatry, cardiology, dental services, veterinary, and orthopedics," with bankers Jeff Swearingen, Brett Skolnik and Melvyn Threatt-Peters II, and testimonials from Wolverine Anesthesia and Florida Emergency Physicians on their sales to TeamHealth. Its dated physician tombstones are real, and the latest is August 2023: True Dermatology to AQUA Dermatology (Gryphon and GTCR), First Coast Cardiovascular Institute to Cardiovascular Logistics (Lee Equity, April 2023), Michigan Institute of Urology to Solaris (January 2022), Tennessee Retina to Retina Consultants of America (Webster, September 2021) and Spine Nevada to HOPCo (April 2021). Verdict: the deepest map for hospital-based specialties, anesthesia, emergency medicine and radiology, ranked eighth because no physician close on its own page is dated after August 2023.

9. VERTESS: the operator-led option below $25 million

VERTESS, headquartered in Dallas-Fort Worth, was Axial's number 1 lower-middle-market healthcare sell-side advisor for 2024, and its managing directors are operators as well as bankers, covering urgent care and dental among the coverage areas our hub lists. I found no physician-specialty tombstone at VERTESS this pass; its dated 2025-26 closes in the hub are home care, DME and behavioral. Verdict: the honest option for a small urgent-care or primary-care operator whose buyer is regional, not a platform; not the call for a specialty group.

10. Skytale Group: the med-spa and aesthetics boutique, undated

Skytale Group lists "Physician Practice Management (PPM)," "Medical Aesthetics," "Plastic Surgery," "Dental," "Women's Health," "Endocrinology" and "Wellness and Longevity" among its sectors, and Skytale Group MB, LLC is CRD 333389 in the SEC search. Its transactions page carries eight sell-side tombstones, seven of them aesthetics, undated on its site, among them Glow Medispa to Founders Beauty Group, MD Esthetics' platform investment from New Harbor Capital, Revitalize SkinMD to Empower Aesthetics (Shore Capital) and Tribeca Medspa to AYA Med Spa (Eagle Merchant Partners), plus MFD Dental to Smile Partners USA, routed to the dental spoke. I do not state its headquarters city because I did not verify it. Verdict: the boutique for a med-spa or cash-pay plastics practice whose buyer is one of the aesthetics platforms named above, carried tenth because none of its tombstones is dated.

How do I check whether a physician practice M&A adviser is FINRA-registered?

Search the broker-dealer named in the firm's footer, not the brand on the door. I ran the bench through the SEC's adviserinfo.sec.gov firm search on September 16, 2026, and the physician-practice boutiques mostly run securities through a third-party broker-dealer, the BrokerCheck Gap our consumer products spoke frames: the record lives under a name you have to read off the website.

An empty result is the market's normal shape: most lower-middle-market practice sales are asset sales, and many intermediaries operate under the federal M&A-broker exemption. It stops being academic when the deal includes rollover equity into a platform holding company, a securities transaction, which is why the fee section asks which registered entity receives the success fee. One trap: "PCF" also returns PCF Provident Capital Markets, Inc. (CRD 42442), a different firm; type the CRD.

Who did we leave off, and why?

Every firm below is real or was; what is missing is a dated physician credit I could see, or a working website. Ziegler is the senior-living and not-for-profit specialist our hub places correctly: its fourteen most recent releases through September 2026 are senior-living financings, a pediatric therapy investment (Therapy 2000 by Avesi Partners, June 24, 2026) and a seniors-housing sale, with no physician-practice tombstone. Coker Capital's site failed to connect twice and the bank page that once hosted it returns nothing, so I could not verify its current brand, owner or a dated physician close. Healthcare Transaction Advisors resolves to a parked landing page. Bailey Southwell & Co. serves a "Launching Soon" placeholder with a 2024 copyright, a possible rebrand I could not confirm; a holding page is not a track record. Houlihan Lokey's transactions page is unreadable to a fetch, and the two healthcare tombstones visible by feed (CareNet to EQT, January 2026; abeo and DuvaSawko to Parthenon, June 2025) are healthcare-services businesses (physician revenue-cycle management in the abeo and DuvaSawko case), not practices. Harris Williams, Lincoln International, Piper Sandler and William Blair carry no dated physician-practice adviser-of-record credit I could open. And the names on every "top PPM advisor" list because they are on every tombstone are buyers, not advisers: Webster Equity Partners, Lee Equity Partners, Hildred Capital, Triton Pacific, Shore Capital, Gryphon, GTCR, L Catterton, New Harbor Capital, NexPhase Capital and Eagle Merchant Partners are the sponsors behind the platforms in the ledger, and the platforms themselves, Forefront, DermCare, Align, PRISM, Sequel, Unio, ARSA, Cardiovascular Logistics and US Heart & Vascular, are the counterparties your adviser negotiates against.

What are physician practices selling for in 2026?

The honest number is that no dated primary report published a physician-practice EV/EBITDA multiple I could open this pass, so I quote none; what I can cite is one all-sector reference, Provident's volume and buyer-mix series, and the market's own read on why the platform-versus-add-on spread exists. The reference point: Capstone Partners' Middle Market M&A Valuations Index puts the average middle-market multiple across all sectors at 9.8x EV/EBITDA in 2025, up from 9.4x in 2024, as our industrial advisors guide records; it is not a physician comp and I do not present it as one.

The volume series is Provident Healthcare Partners' Multisite Provider Services count, which excludes transactions under $5 million of revenue. Its quarterly chart, financial plus strategic buyers, runs from 60, 59 and 64 transactions in Q3 2024 through Q1 2025 to 32, 39 and 31 in Q4 2025 through Q2 2026 (Provident's chart totals; 49 in Q2 2025 and 42 in Q3 2025 between), so the direction is firm: multisite provider-services deal count roughly halved in eighteen months. By subsector, PPM was the largest in Q2 2026 at 18 transactions, 16 by financial buyers and 2 by strategics, ahead of dental (5), infusion (3), aesthetics and wellness (2), physical therapy (2) and primary care (1); in Q4 2025 PPM was 25. Provident's Q2 2026 summary for all of healthcare services: "Q2 2026 transaction volume remained steady at 170 deals, roughly in line with 177 in Q1 2026 and 187 in Q2 2025," with "pockets of PPM" reflecting "a 'good house in a bad neighborhood' dynamic, where sector headwinds or misaligned valuation expectations suppress otherwise attractive assets."

That buyer mix is the pricing mechanism. Sixteen of eighteen PPM transactions in a quarter were sponsor-backed platforms buying add-ons, so the price a single-specialty group receives is a function of that platform's own entry multiple, leverage and cost of capital, not of a market clearing price; the platform premium goes to the rare group large enough to be a platform's founding practice, as Women's HealthFirst was for Nova Women's Health Partners. VMG Health's September 1, 2026 note explains the ceiling on the other end: "Investment hold periods are stretching well beyond investor expectations, regulatory scrutiny is increasing, and the act of exiting is more complex." "Platforms built to sell within three to five years are finding a thinner pool of ready buyers, even as the underlying businesses keep scaling," and "the traditional sponsor-to-sponsor exit is becoming harder to execute as buyers grow more selective and financing costs remain elevated. More financial sponsors are using alternative structures to create liquidity without a full sale," which is what Provident's secondary-transaction line counts. For a seller the arithmetic runs one way: a platform that cannot exit pays for add-ons with the same equity you are being asked to roll into, so the add-on price and the rollover value are the same question. At platform scale the same tape shows SignatureMD, a Blue Sea Capital concierge-medicine company supporting 250-plus physicians in 35 states, acquired by L Catterton in Q1 2026.

What does the CY2026 Medicare Physician Fee Schedule do to a practice's EBITDA bridge?

It adds a small amount to 2026 and subtracts from 2027, and a buyer's quality-of-earnings model does both at once. The CY2026 final rule, CMS-1832-F, was published in the Federal Register on November 5, 2025 at 90 FR 49266 and is "effective on January 1, 2026" (Federal Register). Three mechanics matter to a practice sale, and I frame them as the One-Year Bump, a Peony-original reading of the rule's own arithmetic.

Anesthesia has its own conversion factors, 20.5998 qualifying and 20.4976 nonqualifying. Two honesty notes: I do not name the statute behind the 2.50 percent increase because the rule's text says only "established by statute," and I quote no specialty-level impact percentages because the rule's impact table did not render as text. The consequence for a procedural group, dermatologic surgery, GI endoscopy, orthopedics, ophthalmic and urologic procedures, is that the buyer's bridge from your 2026 collections to its 2027 underwriting carries both the expired bump and the efficiency adjustment, so your adviser should present a code-level model before the buyer builds a worse one.

Can an earn-out be tied to referrals or collections without a Stark or anti-kickback problem?

Not to referrals, and the mechanics of an earn-out sit awkwardly with the Stark exception written for practice sales, which is why counsel keys physician earn-outs to non-referral metrics and papers a fair-market-value opinion. The Stark exception for isolated transactions, 42 CFR 411.357(f), covers "a one-time sale of property or a practice" only if the remuneration is "Consistent with the fair market value" and "Not determined in any manner that takes into account the volume or value of referrals by the referring physician," is "commercially reasonable even if the physician made no referrals," and is followed by "no additional transactions between the parties for 6 months," except "commercially reasonable post-closing adjustments that do not take into account the volume or value of referrals" (eCFR). The definition in 411.351 is the catch: an isolated financial transaction is "a one-time transaction involving a single payment" or installment payments where "The total aggregate payment is fixed before the first payment is made and does not take into account the volume or value of referrals" (eCFR). Call it the Isolated-Transaction Test: an earn-out whose total is not fixed before the first payment is not an isolated financial transaction under that definition; it has to be defended as a commercially reasonable post-closing adjustment under 411.357(f)(3), or fit another exception. Stark is strict liability, and it bites wherever the selling physician will refer designated health services, lab, imaging, physical therapy, durable medical equipment, to the buyer entity after closing, which in a platform deal with ancillaries is most of the time.

The anti-kickback sale-of-practice safe harbor, 42 CFR 1001.952(e), protects a payment "by another practitioner where the former practitioner is selling his or her practice to the latter practitioner" only if the sale completes within one year of the first agreement and the seller "will not be in a professional position to make referrals to, or otherwise generate business for, the purchasing practitioner" after that year, with a separate hospital prong tied to health professional shortage areas (eCFR). It is written for a doctor retiring and selling to a doctor. A sponsor recapitalization in which the physician stays, takes rollover and keeps referring fits no prong of it, so that deal relies on fair-market-value and commercial-reasonableness facts rather than safe-harbor protection; the anti-kickback statute is intent-based, which is why the facts matter. Practitioner reading, not legal advice: earn-outs keyed to provider retention or the platform's consolidated EBITDA survive diligence; earn-outs keyed to the seller's own collections invite the question of whose referrals generated them; and the fair-market-value opinion on the price, the management fee and the earn-out is the document a buyer's counsel asks for first, the VMG Health seat on this bench.

Is the PPM model in distress in 2026, and what does it mean for a seller?

Parts of it are, in the primary data. Gibbins Advisors, a Nashville healthcare restructuring firm, released its Interim 2026 Healthcare Bankruptcy Report on July 20, 2026, counting Chapter 11 filings by healthcare companies with more than $10 million in liabilities since January 2019 (Gibbins). The aggregate is stable: "the pace of filings in H1 2026 sits around the quarterly average of ~12.5 since 2019, with 12 filings in Q1 2026 and 14 filings in Q2 2026." The mix is not: "By subsector, Clinics/Physician Practice bankruptcies comprised almost 30% of healthcare filings in H1 2026, with the subsector's activity levels in 2026F on pace to reach their highest level since 2019," and the "$10 million–$50 million in liabilities" cohort is on pace "to finish the year 57% higher than 2025, from 23 filings in 2025 to 36 in 2026F." Not a record; the report says highest since 2019, on a dataset that starts in 2019 and counts only companies above $10 million of liabilities. Ronald Winters, Principal: "There is a lot bubbling under the surface that will ultimately need to be resolved in some form of restructuring, though not all will be resolved in court." The report's cited drivers are Public Law 119-21, signed July 4, 2025, the lapse of enhanced ACA premium tax credits, and rising claim denials.

The case that ties distress to structure is the one in the gate: Carbon Health, an 80-plus-clinic MSO, filed Chapter 11 in the Southern District of Texas while California's corporate-practice investigation was ongoing, and its $4.4 million penalty is now a claim in that case. For a seller the consequences are two. Diligence the buyer. A platform's leverage, its lender, its hold-period position and its exit plan are your rollover's collateral; VMG Health's line that "Platforms built to sell within three to five years are finding a thinner pool of ready buyers" is a statement about the equity you are being offered. Value rollover as platform equity, not practice proceeds. The paper share of a platform deal is worth what the platform's next transaction says it is; your adviser should model it at the platform's entry multiple and debt, and your counsel should read the put, tag and drag terms before you sign.

Who is buying physician practices in 2026: sponsors, platforms or health systems?

Sponsor-backed platforms by count, and health systems by direction. Provident's Q2 2026 subsector count is unambiguous on the first, 16 financial buyers to 2 strategics in PPM, and the ledger agrees: every dermatology, ENT, eye, orthopedic and urology close on it went to a consolidating platform, most of them sponsor-backed, and the sponsors the releases name behind those platforms, Webster, Lee Equity, Hildred and Triton Pacific, together with the sponsors behind older credits such as Gryphon and GTCR, are the buyer universe your adviser's list must actually reach. The direction is the second story. Three 2026 closes on the ledger went to health systems or hospital affiliates, Florida Heart Associates to Lee Health, Garden OB/GYN to Northwell Health and Avecina Medical to MD Now, an HCA affiliate, and two more went to strategics Provident's releases did not name. VMG Health's September 2026 note sets out the three strategic-buyer categories it sees coming for sponsor-owned practices, "Distributors and supply chain acquirers," "Payers and payer-aligned platforms" and "Health systems," and adds: "It's that last category—health systems—where private equity may find its next strategic buyer."

What each buyer prices is different, and the Buyer-Universe Depth Test in our hub applies. A sponsor platform prices your group on the platform's next exit: physician productivity, ancillary capture, the depth of its existing footprint in your geography, and how much of the price you will take as rollover. A health system prices service-line strategy, referral capture and employment economics, usually with no rollover and with the state notice regime's "provider organization" definitions squarely in play. A distributor or payer prices supply-chain or medical-cost economics you cannot see from inside the practice. The adviser who has closed with more than one column can run them against each other; on this bench that is Provident, with PGP the deeper call when the column that matters is the sponsor platforms in one specialty.

What do physician practice M&A advisers charge?

A retainer plus a success fee, and not one firm on this bench publishes a fee percentage, searched September 16, 2026. Below platform scale the conventions in our M&A advisor fees guide apply: a monthly retainer credited against the success fee, a scaled or flat percentage of enterprise value with a stated minimum, a tail period and exclusivity, all in writing. Three physician-specific terms decide what you actually pay. The fee base: whether the percentage applies to enterprise value with rollover equity and the earn-out at face value, or to cash at close, because a platform deal can put a large share of the headline into paper whose value depends on the platform's next exit. Conflicts: what the adviser, or the broker-dealer it runs securities through, has been paid by the buyer or its sponsor in the past two years, in the engagement letter. The registered entity: rollover equity is a security, so ask which entity, if any, receives the success fee and advises on that leg; on this bench the disclosed broker-dealers are PCF Capital Markets (Provident), Finalis Securities (Westcove) and Sundial Group (Cross Keys). Budget the fair-market-value opinion on the management fee, purchase price and earn-out as a separate engagement with a valuation house, before the LOI, because the buyer's counsel will ask for it after.

What should the data room look like when the bidders are the platforms consolidating your specialty?

Built for the fact that your bidders already know your partners, and that the two documents a buyer's counsel reads first, the physician compensation model and the MSA, are the ones a leak would hurt most; in a specialty roll-up, confidentiality is the partnership's survival before it is the deal's. The file a physician-practice buyer pulls: the MSA, succession agreement and intercompany credit terms, read against the three struck terms of the proposed Carbon Health judgment; the fair-market-value opinion on the management fee and any earn-out, tested against 42 CFR 411.351 and 411.357(f); the state notice file; the payor contract and conversion-factor exposure, including how much 2026 EBITDA rides on the one-year 2.50% increase; and the practitioner items with no published source, ours rather than a statistic: physician employment and non-compete terms by state, ancillary and ASC interests, credentialing and enrollment status, and the coding audit a buyer runs on any group with in-office procedures. Then the room itself, staged so each bidder sees what its bid has earned:

• A separate data room per bidder, with visitor groups walling a health system off from the sponsor platforms inside one process, so no party sees another's tranche, activity or Q&A.
• Staged disclosure: the teaser and a de-identified productivity summary first; the quality of earnings, payor-contract and ancillary-revenue schedules in the middle; the physician compensation model by name, the MSA and the succession agreement last, after a bid you believe.
• NDA gates before the room opens: Simple NDA on Business and up, a signed NDA with a countersigned PDF on Data Room and up; one-click revoke on Business and up; link expiry and password-protected links on every tier including Free.
• Per-viewer dynamic watermarks on every rendered page, Data Room plan and up, so a forwarded compensation schedule traces to one reader; view-only and screenshot protection on Business and up.
• Page-level analytics, on every tier, showing which platform's counsel spent an hour on the MSA, the one running the Carbon Health checklist, and which bidder never opened the payor schedule.
• Redaction and archive download on the Deal Team plan for schedules that still carry a patient or payor identifier, plus auto-indexing, structured Q&A and the security layer.

Peony is not an M&A advisor and does not place deals; the firms above do that. We are the confidential room the process runs in: pick your advisor first, then stand up the room. Peony serves 6,800+ customers on exactly this layer, rated 4.8 on G2 and 4.9 on Capterra, and signs a Business Associate Agreement on request; the room is a document-handling control, not a CPOM, Stark or state-notice compliance opinion, which comes from counsel. The Data Room plan is $52 per admin per month billed annually, the tier a sell-side process wants: dynamic watermarking, signed NDA, custom domain, per-file permissions and unlimited rooms. Business is $30 per admin per month billed annually; Deal Team is $64 per admin per month billed annually; a Free tier exists (pricing). The build is in our M&A data room playbook and how to write a CIM; the real estate under the practice, if you own it, is a separate room and a separate buyer, covered in our medical office building data room guide.

So which physician practice M&A adviser should you hire?

The one whose dated evidence sits in your specialty and with your buyer type. A dermatology, ENT, eye, orthopedic or urology group whose likely buyer is the platform consolidating that specialty: Physician Growth Partners, on 18 dated closes, most of them to exactly those platforms, with Cross Keys Capital as the second call if it can date its last five. A cardiology group: Westcove for a large independent group, on the Cardiology Consultants of Philadelphia credit, and Provident for a group a health system may want, on Florida Heart Associates to Lee Health. A primary care, urgent care, pediatric or OB/GYN group where the buyer may be a system: Provident, with PGP's Northwell affiliation as the counter-example. A plastics or med-spa practice: Westcove for plastics, Skytale for aesthetics once it dates its tombstones. A $100 million-plus platform: Cain Brothers. And in every case, a valuation house for the fair-market-value opinion the CPOM structure and the earn-out need, which is the VMG Health seat. Before you sign an engagement letter, ask for the last five closes in your specialty with dates and buyers, the broker-dealer that will receive the fee, and the buyer-side payments of the last two years, in writing.

Related resources

• Best healthcare M&A advisors, the hub this spoke deepens, and the sibling spokes: best dental M&A advisors, best behavioral health M&A advisors, medical office building data room and imaging center M&A data room.
• City guides where physician-practice demand currently lands: best M&A advisors in Boston, best M&A advisors in Charlotte and best M&A advisors in Nashville.
• Best M&A advisors, M&A advisor fees and M&A advisor vs broker vs investment bank.
• M&A data room, how to write a CIM, quality of earnings, sell-side due diligence and best HIPAA-compliant data rooms.
• Pricing and the M&A, due diligence and private equity solution pages.

Frequently asked questions

Who are the best physician practice M&A advisors?

Ten firms, ranked on dated 2025-26 physician adviser-of-record evidence, and 27 of the 28 dated credits belong to three of them. Physician Growth Partners (Chicago-founded, with a growing Boston office) carries 18 dated physician-specialty tombstones on PR Newswire from January 2025 to July 2026 across dermatology, ENT and allergy, eye care, orthopedics, urology, OB/GYN, plastics, pediatrics and one medical spa. Provident Healthcare Partners (Boston; securities through PCF Capital Markets, LLC, CRD 290765) carries six from the first half of 2026, including two cardiology groups, a urology group and a 35-clinic primary care group. Westcove Partners (Los Angeles; Finalis Securities LLC, CRD 305908) carries three, including Cardiology Consultants of Philadelphia to Cardiovascular Logistics. Capstone Partners closed Wilmington Dermatology Center to DermCare Management in February 2026. Cain Brothers is the platform-scale seat; Cross Keys Capital, Edgemont Partners and VERTESS carry physician-services franchises and no dated 2025-26 physician tombstone I could open; VMG Health is the fair-market-value seat, not a banker; Skytale Group is the aesthetics boutique, with undated tombstones on its site.

Which advisors sell dermatology, ophthalmology or orthopedic groups to PPM platforms?

The adviser follows the specialty, because the buyers do. Dermatology: Physician Growth Partners advised six dermatology sales between March 2025 and January 2026, four to Forefront Dermatology, one to DermCare Management and one to DOCS Dermatology Group, and Capstone Partners advised Wilmington Dermatology Center's sale to DermCare, closed February 2026. Ophthalmology: PGP advised Spokane Eye Clinic, 25-plus specialists with an ASC, on its December 2025 partnership with PRISM Vision Group; Edgemont's Tennessee Retina to Retina Consultants of America dates from 2021. Orthopedics: PGP advised Fox Valley Orthopedics on its November 2025 transaction with Sequel Ortho; Edgemont's Spine Nevada to HOPCo is 2021. Urology: PGP's Golden Gate Urology to Unio Specialty Care (July 2026) was its tenth urology engagement; Provident advised The Urology Group of Virginia (March 2026). ENT and allergy: PGP's three sales to Align ENT & Allergy. Cardiology: Westcove (Cardiology Consultants of Philadelphia) and Provident (Florida Heart Associates to Lee Health; Cardiovascular Clinic of North Georgia to US Heart & Vascular). Cross Keys Capital lists 20-plus specialties including ophthalmology and orthopedics, but its tombstones are undated on its site.

Is Physician Growth Partners or Provident Healthcare Partners the better call for a single-specialty group?

PGP on dated single-specialty depth, Provident on buyer breadth and registration. PGP's 18 dated 2025-26 tombstones are almost all single-specialty groups sold to the platforms consolidating their specialty (Forefront, DermCare, Align, PRISM, Sequel, Unio), and it describes itself, citing LevinPro HC data, as the most active M&A adviser to independent physician groups by deal volume since 2017; its releases state no broker-dealer, so I assert none. Provident's six dated 2026 credits include two health-system or hospital-affiliate buyers (Lee Health; HCA's MD Now), its footer names PCF Capital Markets, LLC, Member FINRA/SIPC (CRD 290765), and it publishes the Multisite Provider Services data. For a dermatology, ENT, eye or urology group whose buyer is the platform consolidating that specialty, PGP; for a cardiology, primary care or urgent care group a health system may bid for, and for any deal with rollover where you want the registered entity named, Provident. Ask each for its last five closes in your specialty, with dates.

How does the corporate practice of medicine affect a practice sale?

In a corporate-practice-of-medicine state a non-physician buyer cannot own the medical practice, so the sale is structured as a management services organization buying the non-clinical assets for a management fee while a physician-owned professional corporation keeps the clinical practice. The proposed final judgment and permanent injunction the California Attorney General filed against Carbon Health on June 24, 2026 in Los Angeles County Superior Court (Case No. 26STCV19242), subject to court approval, decides how much control that structure may carry. Once entered it would permanently enjoin three terms: a management services agreement giving the MSO complete authority over advertising, payor negotiations, selection of medical equipment and the hiring, firing and compensation of licensed medical professionals; any MSO ownership interest in the professional corporation, including an assignable option to acquire it; and a revolving credit agreement requiring the PC to borrow exclusively from the MSO at above-market rates. It expressly permits a first-priority lien on PC assets with conventional lender restrictions. Carbon Health pays a $4,400,000 civil penalty and its co-founder $100,000, subject to court approval. A buyer's counsel now reads your MSA, your succession agreement and your intercompany credit line against that list before the LOI is priced. This is not legal advice; retain healthcare regulatory counsel.

What did the Carbon Health settlement change for MSO-backed practices?

It gave every MSO-backed practice a published checklist, in a stipulated judgment filed June 24, 2026 that is subject to court approval. On June 26, 2026, California Attorney General Rob Bonta announced what his office called a first-of-its-kind settlement with Carbon Health Technologies, its affiliated medical groups and co-founder Eren Bali for violating the state's ban on the corporate practice of medicine. Carbon Health operates over 80 clinics in eight states, 54 in California, through a "friendly professional corporation" model whose contracts gave the MSO the power to replace the physician-owner while preventing the physician-owner from replacing the MSO without risking ownership of the practice. The remedy is structural: a non-medical management company can no longer control or hold ownership interests in the physician-owned practices. Penalties are $4.4 million on the entities, allowed as claims in Carbon Health's Chapter 11 case in the Southern District of Texas, and $100,000 on Mr. Bali, subject to court approval. The three struck terms are now the diligence questions.

Do I need to notify the state before selling my medical practice?

In a growing list of states, yes, and the clock is set by statute. California: a private equity group, hedge fund, MSO or newly formed acquisition entity must give the Office of Health Care Affordability written notice at least 90 days before entering into the agreement (Health and Safety Code 127507(c)(3), as amended by AB 1415, signed October 11, 2025); OHCA's dollar thresholds sit in regulations I did not open. Oregon: the Health Care Market Oversight program reviews deals involving medical groups, MSOs and private equity firms, 30 days for a preliminary review and 180 for a comprehensive review unless extended, with revenue thresholds in OAR 409-070. Washington: written notice to the Attorney General not less than 60 days before the effective date of a material change involving a provider organization (RCW 19.390.030). Minnesota: 60 days' notice to the Attorney General and the health commissioner at average revenue of $80 million or more (Minn. Stat. 145D.01), and 30 days' data to the commissioner between $10 million and $80 million (145D.02). New York: 30 days' notice to the Department of Health for material transactions that raise in-state gross revenue by $25 million or more, expressly including MSO agreements (Public Health Law Article 45-A, effective August 1, 2023). Indiana: 90 days' notice to the Attorney General at or above $10 million, effective July 1, 2024, amended July 1, 2025 to exclude practitioner-majority-owned groups. Massachusetts requires a Notice of Material Change to the Health Policy Commission before closing; I quote no day count. Confirm the current rule with counsel.

How long does it take to sell a physician practice when a state notice is on the critical path?

Six to nine months from kickoff to close is the generic healthcare range our hub carries, and in a notice state the statute, not financial diligence, usually sets the closing date. California's 90-day clock runs to entering into the agreement, Washington's 60 days and Minnesota's 60 or 30 run to the effective or completion date, and New York's 30 days run to closing, so file as soon as the definitive terms can be described. Oregon's clocks are review periods, 30 days preliminary and 180 comprehensive unless tolled; its 2025 annual report counts 52 notices since March 2022, 23 approved, 13 approved with conditions, 7 withdrawn and none disapproved. VMG Health's September 2026 note says the state regimes are "raising the diligence bar and lengthening timelines for deals involving management services organizations." Build the calendar backward from the longest clock that applies and do the CPOM structure work in month one.

What are physician practices selling for in 2026?

Nobody published a verified physician-practice EV/EBITDA multiple in a dated primary report I could open this pass, so any platform-versus-add-on ladder you are quoted is an adviser's opinion, not a citable number. The only dated reference is Capstone Partners' Middle Market M&A Valuations Index, an all-sector average of 9.8x EV/EBITDA in 2025, not a physician comp. What is dated for physician services is volume and buyer mix: Provident Healthcare Partners' Q2 2026 Multisite Provider Services update counts 4 platform investments, 27 add-on acquisitions, 3 secondary transactions and 25 unique buyers, its quarterly chart totals fall from 60, 59 and 64 deals a quarter in Q3 2024 through Q1 2025 to 32, 39 and 31 in Q4 2025 through Q2 2026, and PPM was the largest subsector in Q2 2026 at 18 transactions, 16 financial buyers and 2 strategic. The platform premium rests on the scarcity of platform-forming groups; the add-on price rests on the platform's own cost of capital. VMG Health's September 1, 2026 note: hold periods are "stretching well beyond investor expectations" and platforms built to sell in three to five years are "finding a thinner pool of ready buyers."

Should I sell to a PE-backed platform or a health system in 2026?

Both are on the 2026 tape, and the health system is back as a real bidder in the specialties it wants. Provident's Q2 2026 count still shows financial buyers dominating physician practice management, 16 of 18 PPM transactions, and every dermatology, ENT, eye, orthopedic and urology close on the ledger went to a consolidating platform, most of them sponsor-backed. But three 2026 closes went the other way: Florida Heart Associates to Lee Health (Provident, June 2026); Garden OB/GYN into a strategic affiliation with Northwell Health (PGP, January 2026); and Avecina Medical's 18 urgent-care centers to MD Now, an HCA Healthcare affiliate (Provident, April 2026). VMG Health's September 2026 analysis explains why: the sponsor-to-sponsor exit "is becoming harder to execute as buyers grow more selective and financing costs remain elevated," and health systems are where private equity "may find its next strategic buyer." A sponsor prices your group on the platform's next exit and asks for rollover; a system prices service-line strategy and employment terms, usually without rollover. Run both columns; on this bench the adviser that has closed with both is Provident.

Are PPM platforms going bankrupt, and does that change who buys my practice?

Physician-practice bankruptcies are rising, and it changes who you sell to and how you value rollover equity. Gibbins Advisors' Interim 2026 Healthcare Bankruptcy Report (July 20, 2026), which counts Chapter 11 filings by healthcare companies with more than $10 million in liabilities, found that clinics and physician practices comprised almost 30% of healthcare filings in the first half of 2026, on pace for the subsector's highest level since 2019, inside an overall pace of 12 filings in Q1 and 14 in Q2 against a quarterly average of about 12.5 since 2019; the $10 million to $50 million liability cohort is projected to finish 2026 57% higher than 2025. Carbon Health, the MSO in California's June 2026 CPOM settlement, filed Chapter 11 in the Southern District of Texas while the Attorney General's investigation was ongoing. For a seller: diligence the platform buying you, its leverage, lender and exit plan, as hard as it diligences you, and value your rollover as equity in that platform, not as a share of your own practice's price.

What does the 2026 Medicare fee schedule do to my practice's EBITDA?

It moves 2026 up slightly and the 2027 bridge down, and a buyer reads both. The CY2026 Physician Fee Schedule final rule (90 FR 49266, published November 5, 2025, effective January 1, 2026) introduced two conversion factors: $33.5675 for qualifying alternative payment model participants, up 1.2% from $32.3465, and $33.4009 for everyone else, up 0.7%, each including a one-year 2.50% increase for CY 2026 established by statute. First, the 2.50% is a one-year increase, so a buyer underwriting 2027 strips it out of run-rate EBITDA. Second, the rule finalized a 2.5% efficiency adjustment, a downward adjustment for non-time-based services such as procedures, radiology services and diagnostic tests, which lands on procedural specialties while evaluation-and-management-heavy primary care is untouched; it also cut the portion of facility practice-expense RVUs allocated on work RVUs to half the non-facility amount, which favors office-based practices. I quote no specialty-level impact percentages because the rule's impact table did not render as text. Model your own code mix.

Can my earn-out be tied to referrals or collections without a Stark problem?

Not to referrals, and collections only with care. The Stark exception for a one-time sale of a practice (42 CFR 411.357(f)) requires remuneration consistent with fair market value and not determined in any manner that takes into account the volume or value of referrals, and 42 CFR 411.351 defines an isolated financial transaction as one where the total aggregate payment is fixed before the first payment is made. An earn-out whose total is not fixed at signing cannot rely on that definition; it must be defended as a commercially reasonable post-closing adjustment under 411.357(f)(3) that does not take referrals into account, or fit another exception. Stark is strict liability and bites wherever the physician refers designated health services, such as lab, imaging or physical therapy, to the buyer entity. The anti-kickback sale-of-practice safe harbor (42 CFR 1001.952(e)) is written for practitioner-to-practitioner sales completed within a year where the seller stops being in a position to refer, which a sponsor recapitalization where the physician stays and refers does not fit, so that deal rests on fair-market-value and commercial-reasonableness facts rather than safe-harbor protection. That is why counsel keys earn-outs to provider retention or platform-level EBITDA and papers a fair-market-value opinion. This is not legal advice.

What do physician practice M&A advisors charge?

A retainer plus a success fee, and not one firm on this bench publishes a percentage, searched September 16, 2026. The conventions in our M&A advisor fees guide apply: a monthly retainer credited against the success fee, a scaled or flat percentage with a stated minimum, a tail period and exclusivity. Three physician-specific terms decide what you actually pay. The fee base: enterprise value with rollover equity and earn-out at face value, or cash at close. Conflicts: what the adviser or its broker-dealer has been paid by the buyer or its sponsor in the past two years, in writing. The registered entity: rollover equity is a security, so ask which entity receives the fee; on this bench the disclosed broker-dealers are PCF Capital Markets (Provident), Finalis Securities (Westcove) and Sundial Group (Cross Keys). A fair-market-value opinion on the MSO fee or earn-out from a valuation house such as VMG Health is a separate engagement, worth budgeting before the LOI.

How do I check whether a physician practice M&A advisor is FINRA-registered?

Search the broker-dealer named in the firm's footer, not the brand on the door. I ran the bench through the SEC's adviserinfo.sec.gov firm search on September 16, 2026; the physician-practice boutiques mostly run securities through a third-party broker-dealer, so a search on the adviser's own name returns nothing. Provident Healthcare Partners discloses PCF Capital Markets, LLC (CRD 290765); Westcove Partners discloses Finalis Securities LLC (CRD 305908); Cross Keys Capital discloses Sundial Group, LLC (CRD 158367). Edgemont Capital Partners, L.P. (CRD 122572), Edgemont Advisors, LLC (CRD 155143) and Skytale Group MB, LLC (CRD 333389) have records under their own names. Physician Growth Partners' releases state no broker-dealer and I assert none; VMG Health is a consultancy. An empty result is not a scandal, because most lower-middle-market practice sales are asset sales; it stops being academic when your deal includes rollover equity in a platform holding company, a securities transaction. Ask, in writing, which registered entity will receive the success fee.

How do I run a confidential process when the bidders are the platforms my partners already know, and where does the data room fit?

Run it out of a room you control, one per bidder, and stage what each sees. In a specialty roll-up the bidders are the platforms your partners have already met at conferences, and a leaked physician compensation schedule or MSO agreement can end a partnership before it ends a deal. For a 20-physician dermatology group running four sponsor platforms and one health system, I would open a separate Peony data room per bidder so no party sees another's tranche, activity or Q&A; stage disclosure so the teaser and a de-identified productivity summary open first, the quality-of-earnings and payor-contract schedules in the middle, and the physician compensation model, the MSA and the succession agreement last, after a bid you believe; put an NDA gate in front of anything that opens, Simple NDA on the Business plan and a signed NDA on Data Room; use per-viewer dynamic watermarks on the Data Room plan so a forwarded page traces to the reader; and read page-level analytics to see which platform spent an hour on the MSA. Password-protected links, link expiry and analytics are on the Free tier; view-only, screenshot protection and revocation on Business and up; dynamic watermarks, signed NDA and a custom domain on Data Room and up; redaction and archive download on Deal Team. The Data Room plan is $52 per admin per month billed annually, Business is $30, Deal Team is $64, and a Free tier exists; Peony serves 6,800+ customers on exactly this layer, rated 4.8 on G2 and 4.9 on Capterra. The room is a document-handling control, not a CPOM or Stark compliance opinion, which comes from counsel.

Sources

• California Attorney General, Carbon Health settlement press release, June 26, 2026, and proposed final judgment (filed June 24, 2026, Case No. 26STCV19242). https://oag.ca.gov/news/press-releases/attorney-general-bonta-announces-first-its-kind-settlement-carbon-health-and-its ; https://oag.ca.gov/system/files/attachments/press-docs/CH%20Judgment.pdf
• CMS, CY 2026 Physician Fee Schedule final rule, CMS-1832-F, 90 FR 49266, November 5, 2025. https://www.federalregister.gov/documents/2025/11/05/2025-19787/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other
• 42 CFR 411.351, 411.357 and 1001.952 (eCFR, September 2026). https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-411/subpart-J/section-411.357 ; https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-411/subpart-J/section-411.351 ; https://www.ecfr.gov/current/title-42/chapter-V/subchapter-B/part-1001/section-1001.952
• California AB 1415, Chapter 641, Statutes of 2025. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202520260AB1415
• Oregon Health Authority, HCMO program page and 2025 Annual Report. https://www.oregon.gov/oha/HPA/HP/Pages/Health-Care-Market-Oversight.aspx ; https://www.oregon.gov/oha/HPA/HP/HCMOPageDocs/2025-HCMO-Annual-Report.pdf
• RCW 19.390.030; Minn. Stat. 145D.01 and 145D.02; New York DOH material transactions page (revised August 2026). https://app.leg.wa.gov/RCW/default.aspx?cite=19.390.030 ; https://www.revisor.mn.gov/statutes/cite/145D.01 ; https://www.revisor.mn.gov/statutes/cite/145D.02 ; https://www.health.ny.gov/facilities/material_transactions/
• Provident Healthcare Partners transaction releases (January to June 2026), Q1 2026 Multisite Provider Services Update (April 15, 2026) and Q2 2026 Market Update (July 29, 2026). https://www.providenthp.com/expertise/florida-heart-associates/ ; https://www.providenthp.com/expertise/cardiovascular-clinic-of-north-georgia/ ; https://www.providenthp.com/expertise/avecina-medical/ ; https://www.providenthp.com/expertise/the-urology-group-of-virginia/ ; https://www.providenthp.com/expertise/palmetto-primary-care-physicians/ ; https://www.providenthp.com/expertise/chesapeake-oncology-hematology-associates/ ; https://www.providenthp.com/wp-content/uploads/2026/04/Q1-2026-Newsletter_Multisite-Provider-Services.pdf ; https://www.providenthp.com/wp-content/uploads/2026/07/Q2-2026-Newsletter.pdf
• Physician Growth Partners releases on PR Newswire, January 2025 to July 2026, including Golden Gate Urology (July 29, 2026) and Spokane Eye Clinic (December 9, 2025). https://www.prnewswire.com/news-releases/pgp-acted-as-exclusive-financial-advisor-to-golden-gate-urology-in-its-transaction-with-unio-specialty-care-302837964.html ; https://www.prnewswire.com/news-releases/physician-growth-partners-strengthens-eye-care-ma-track-record-advises-spokane-eye-clinic-in-partnership-with-prism-vision-group-302636669.html
• Westcove Partners releases: Cardiology Consultants of Philadelphia (April 18, 2025), Regional Plastic Surgery Center (March 27, 2025), NYBRA Plastic Surgery (August 27, 2025) and the July 30, 2026 awards release. https://www.westcove.com/cardiology-consultants-of-philadelphia-partners-with-cardiovascular-logistics/ ; https://www.westcove.com/regional-plastic-surgery-center-partners-with-arsa/ ; https://www.westcove.com/nybra-plastic-surgery-partners-with-arsa/ ; https://www.westcove.com/westcove-partners-is-the-recipient-of-three-industry-honors-for-firm-and-transaction-excellence/
• Capstone Partners, Wilmington Dermatology Center to DermCare Management. https://www.capstonepartners.com/transactions/capstone-partners-advised-wilmington-dermatology-center-on-its-sale-to-dermcare-management/
• Edgemont Partners, physician and provider services transactions. https://www.edgemont.com/transactions/sector/physician-and-provider-services/
• VMG Health, "Private Equity in Physician Practices: Physician Practice Management Is Changing," September 1, 2026. https://vmghealth.com/insights/blog/private-equity-in-physician-practices-physician-practice-management-is-changing/
• Gibbins Advisors, Interim 2026 Healthcare Bankruptcy Report, July 20, 2026. https://gibbinsadvisors.com/research/healthcare-bankruptcy-filings-stabilize-in-the-first-half-of-2026-but-medicaid-and-policy-reforms-are-set-to-intensify-financial-pressure
• SEC Investment Adviser Public Disclosure firm search (adviserinfo.sec.gov), queried September 16, 2026, for the CRD numbers cited.