Insights
Perspectives from the practice. Written by practitioners, not content teams.
Building on a Rate You Don't Set
CMS proposed a 6.4 percent home health cut for 2026 and finalized 1.3 percent. Owners budgeted through months of not knowing. When most of your revenue is a number someone else can reprice, planning for the press release is how agencies get caught.
The Price on the Term Sheet Is Not the Price
Owners spend months arguing about the multiple and almost no time on the words underneath it. The structure decides how much of the headline is real, how much is a promise, and how long you wait to learn the difference.
Busy Is Not the Same as Full
A shop can feel slammed and still be leaving output on the floor. The gap between how busy you feel and how much you actually ship is worth finding.
Utilization and Pricing Are the Two Numbers You Run on Feel
Two numbers decide whether a services firm makes money: how much of your people's time you sell, and what you charge for it. Most owners set both by instinct and hope they were close.
The Real Cost of a Machine Hour
The operating cost your dealer quotes is the smallest number in the equation. The one that decides whether a machine makes money is the one you have to build yourself.
A Sales Engine That Does Not Depend on You Being in the Room
In most lower middle market companies, the owner is the sales process. That works until it caps the business, and it always caps the business. Here is how to build the engine instead.
The Revenue Mix That Decides What You Are Worth
Commercial plans pay about double what Medicare pays for the same service. So your payer mix, more than your patient volume, quietly sets your margin and what the practice is worth.
Your Crews Are Paid to Drive, and Nobody Measures It
Route density decides your maintenance margin more than anything on the price sheet, and almost no one tracks the one number that shows it: how much of a paid day the crew spends between stops instead of on them.
The Questionnaire That Decides Your Contract
A spreadsheet from your biggest customer's procurement team asks about your energy, emissions, and waste. It reads like paperwork. It's a condition of keeping the account.
The Software Stack Nobody Decided To Build
Nobody sat down and designed the software your company runs on. It accumulated, one reasonable subscription at a time, until no single person could name it all.
Count the Cash You Can't Spend
You can quote your revenue to the dollar and still have no idea how much of your own money is frozen in inventory and idle machines. The number has a name, and it's usually about 4 months long.
Why Turnarounds Stall in Month Six
The plan is usually fine. What breaks is capacity: the same handful of people are asked to run the business and change it at the same time, and something has to give.
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