Due Diligence Guide · Dermatology Practice

Dermatology Practice Acquisition Due Diligence Guide

Avoid costly surprises when buying a dermatology practice. Validate physician retention risk, payer contracts, malpractice exposure, and CPOM compliance before you close.

Find Dermatology Practice Acquisition Targets

Acquiring a dermatology practice in the $1M–$5M revenue range requires deep scrutiny of physician dependency, dual revenue streams, and state-specific healthcare regulations. Practices trading at 4–7x EBITDA must justify that multiple with clean billing records, diversified payer contracts, and a clinical team that extends beyond the founding dermatologist.

Dermatology Practice Due Diligence Phases

01

Phase 1: Financial & Revenue Cycle Validation

Verify that reported EBITDA is clean, recurring, and not distorted by owner perks or one-time cosmetic revenue spikes. Separate medical billing from cash-pay aesthetic revenue.

Segment Medical vs. Cosmetic Revenuecritical

Request a 3-year revenue breakdown separating insurance-billed medical dermatology from cash-pay cosmetic services like Botox, fillers, and laser treatments. Verify margins on each stream.

Review Payer Mix and Reimbursement Ratescritical

Audit all active payer contracts. Flag Medicare or Medicaid concentration above 40%. Confirm reimbursement rates are at or above regional benchmarks for key CPT codes.

Analyze Billing and Collections Qualityimportant

Review accounts receivable aging, denial rates, and collections efficiency. High denial rates or aging AR over 120 days may signal systemic billing problems or coding compliance gaps.

02

Phase 2: Clinical Operations & Physician Risk

Assess key-person dependency, provider employment agreements, and the quality of clinical infrastructure. A single-physician practice presents meaningful post-close revenue risk.

Evaluate Physician and Provider Employment Agreementscritical

Review all dermatologist, PA, and NP contracts for term, compensation structure, non-compete enforceability, and termination triggers. Confirm post-close retention commitments from key providers.

Assess Key-Person Revenue Concentrationcritical

Determine what percentage of revenue is driven by the founding physician. If one provider generates over 70% of revenue, model downside scenarios and negotiate earnout provisions accordingly.

Review Patient Volume Trends and Appointment Miximportant

Analyze 24-month appointment data by provider, visit type, and payer. Look for declining medical appointment volume masked by growing cosmetic revenue, and flag elevated no-show rates.

03

Phase 3: Legal, Compliance & Deal Structuring

Healthcare acquisitions require compliance with corporate practice of medicine laws, malpractice review, and proper entity structuring to ensure a legally defensible transaction.

Audit Malpractice History and Insurance Coveragecritical

Obtain a full 10-year malpractice claims history. Confirm whether policies are claims-made or occurrence-based, and establish whether tail coverage is required and who bears that cost.

Confirm CPOM Compliance and Deal Structurecritical

Verify state-specific corporate practice of medicine laws. Most dermatology acquisitions require an MSO structure or physician equity rollover. Engage a healthcare M&A attorney before LOI.

Review Facility Lease, Licenses, and Provider Enrollmentsimportant

Confirm lease term with renewal options and landlord assignment consent. Validate all state licenses, DEA registrations, and Medicare or Medicaid provider enrollment numbers are current.

Dermatology Practice-Specific Due Diligence Items

  • Verify that cosmetic revenue is documented with signed patient consent forms, procedure logs, and itemized invoicing to confirm repeatability and margin quality.
  • Confirm all laser and aesthetic equipment is owned outright, under warranty, and FDA-cleared — equipment liens or outdated devices reduce acquisition value materially.
  • Request state medical board complaint history for all licensed providers, including any prior disciplinary actions, probationary periods, or license restrictions.
  • Evaluate the practice's online reputation and patient review volume across Google and Healthgrades — cosmetic dermatology practices are highly dependent on digital word-of-mouth.
  • Assess whether the EMR and practice management system is scalable or will require costly migration post-close, particularly if integrating into a larger dermatology roll-up platform.

Frequently Asked Questions

What EBITDA multiple should I expect to pay for a dermatology practice?

Independent dermatology practices typically trade at 4–7x EBITDA. Higher multiples apply to practices with strong cosmetic revenue, multiple providers, and diversified payer mix with minimal Medicare concentration.

Can I use an SBA 7(a) loan to acquire a dermatology practice?

Yes. Dermatology practices are SBA-eligible. Most deals combine an SBA 7(a) loan with a seller note covering 10–15% of the purchase price, plus a 12–24 month seller transition period to protect revenue continuity.

How does corporate practice of medicine law affect a dermatology acquisition?

Most states prohibit non-physicians from owning medical practices. Acquirers typically use an MSO structure, separating clinical operations from administrative management, or require physician equity rollover to maintain compliant ownership.

What is the biggest red flag in dermatology practice due diligence?

A single physician generating over 80% of revenue with no succession plan or signed post-close employment agreement. This key-person risk can collapse practice value rapidly if that provider departs after closing.

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