Driving financial growth of an orthopedic surgery clinic chain

Axis was founded when a leading orthopedic surgeon—fresh off a successful exit—partnered with a prominent local family office. Over five years the group opened five clinics, posting strong gains in both revenue and profit. Yet cash always felt tight. In U.S. healthcare, payments arrive from dozens of insurers and government programs on unpredictable schedules. For Axis that meant receivables could take anywhere from three to eighteen months to clear, leaving the business rich on paper but occasionally short of cash.

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Why Axis Brought in Alehar

The board asked Alehar to trace every service logged in the clinic‑management system, link those services to historical payment patterns, and build a forecast that would show—clinic by clinic—when the cash would actually arrive. They wanted clarity before committing fresh capital for further expansion. They also wanted us to analyze and review the business for them on a monthly basis so that they could make the key decisions necessary to scale.

1. Building a Receivables‑Driven Cash‑Flow Model

Our team ingested two data sets: detailed treatment records from the clinics and five years of collections history by payer. We calibrated payment curves for each payer, then projected inflows month by month for the next two years.

The model revealed that although cash was tight in the current quarter, a large wave of receivables—already earned—would land steadily over the following 18–24 months. That insight gave the shareholders confidence to keep scaling rather than pull back.

2. Choosing the Next Growth Vector

At the next monthly management review meeting, management’s big question was whether to open more orthopedic clinics or broaden into pain‑management services inside the existing sites. We modeled both paths, weighing revenue growth, margin impact, capital outlays, and timing of cash commitments. Pain management proved the clear winner: faster payback, higher margin, and lower incremental build‑out costs.

3. Financing the Expansion

Pain management required new equipment, so we analysed term loan, lease, and vendor‑financing structures, matching each to the projected surge in receivable collections. The board approved a debt facility that would be serviced comfortably by future cash inflows, allowing Axis to install pain‑management suites without stressing working capital.

4. Course‑Correcting Early Results

After the first month of pain‑management, the monthly management review meeting showed that revenue came in below target. A deep dive showed the marketing team was still rewarded mainly for sourcing orthopedic surgeries, not pain‑management cases. We designed a revised incentive plan that paid equally for both service lines, and volumes rebounded within six weeks.

5. Planning for a Scalable Clinical Team

As the business matured, the founding surgeon wanted to step back from day‑to‑day operating lists. We layered a physician‑hiring schedule onto the cash‑flow model, identifying the earliest dates the group could add full‑time doctors without jeopardising liquidity. This roadmap now guides recruitment, ensuring capacity grows in step with receipts.

Axis monitors cash on a rolling twenty‑four‑month horizon, confident that incoming receivables will service debt and finance continued growth. Marketing incentives align with the new strategy, doctor hiring follows the cash forecast, and each monthly management review drives timely, data‑based decisions. Alehar remains embedded, running the MMRs, refining forecasts, and advising on capital moves, proving that disciplined reviews and sustained partnership can transform a volatile revenue stream into a dependable engine for scale.