Start a Specialty-Practice MSO Roll-Up Playbook Advisory

1. 1

   Codify the oncology MSO playbook

   The starting asset is a clear grasp of the oncology consolidation template: MSO owns operations and contracts with a physician-owned practice, management fees commonly structured at 30 to 50 percent of pre-close compensation over 20-to-30-year terms. Those figures are documented context to benchmark against, not promises. Codifying this into a repeatable framework is the advisory's product.

2. 2

   Map which specialties fit the template

   Physician-owned specialties with fragmentation, succession pressure, and ancillary revenue (dermatology, gastroenterology, ophthalmology, cardiology, and others) are natural roll-up candidates. Assess each specialty's economics against the oncology template. Knowing where the playbook transfers well and where it does not is the core insight you sell.

3. 3

   Adapt the structure to each specialty's economics

   Each specialty has different reimbursement, ancillary mix, and regulatory nuances, so the playbook must be adapted, not copied blindly. Tailor fee structures, terms, and integration plans to the specialty. This adaptation is where the advisory earns its fee over a generic M&A shop.

4. 4

   Advise consolidators and physician groups

   Buyers are private-equity consolidators seeking new specialty platforms and physician groups weighing a roll-up, and you can advise either side. Position clearly to avoid conflicts. Both sides need the structural and benchmarking expertise you carry from oncology.

5. 5

   Handle compliance and licensing

   MSO structures implicate corporate-practice-of-medicine, Stark, and anti-kickback law in every specialty, and transaction advice may trigger securities-licensing obligations. Work with healthcare and securities counsel. Compliance is central to credible advisory, not an add-on.

6. 6

   Price on retainer and success fees

   Advisory typically blends retainers with transaction success fees, aligning you with executed roll-ups. The transferable-playbook angle lets you build a multi-specialty practice rather than a single-vertical one. This complements the oncology-specific M&A advisory and practice-management cards in this file.

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