Driving financial growth of an orthopedic surgery clinic chain

Axis had built a strong operating business, but the timing of collections made the financial picture harder to manage than the headline numbers suggested. The company was profitable, but the delay between clinical activity and cash receipt created uncertainty around expansion, hiring, and capital commitments.

Management needed more than a backward-looking view of revenue and profit. Before committing further capital, the board wanted to understand clinic by clinic how services performed, how receivables were likely to convert into cash, and whether the business could fund its next stage of growth without putting liquidity under pressure.

1. Building a receivables-driven cash flow view

We started by combining two core data sets: detailed treatment records from the clinics and several years of collections history by payer. Using those inputs, we built a receivables-driven forecasting model that translated clinical activity into expected cash inflows over time.

This showed that although near-term liquidity was tight, the business had a substantial volume of already-earned receivables expected to convert steadily over the following 18 to 24 months. That gave management and shareholders a much clearer understanding of the underlying cash profile and more confidence in planning beyond the immediate quarter.

2. Testing the next growth path

Once the cash profile was clearer, the next question was where growth should come from. In monthly management reviews, we helped management assess whether to continue opening more orthopedic sites or expand into pain-management services within the existing footprint.

We modelled both paths, comparing revenue potential, margin profile, capital requirements, and timing of cash commitments. The analysis showed that pain management offered the stronger next step, with faster payback, higher margins, and lower incremental build-out costs than opening additional clinics immediately.

3. Structuring the expansion and financing it appropriately

Pain-management expansion required new equipment, so we assessed different financing options including term debt, leasing, and vendor financing. The work focused on matching the structure of financing to the expected timing of collections so growth could be funded without putting unnecessary strain on working capital.

This gave the board a clearer basis for approving a debt facility that could be serviced through future cash inflows while allowing the business to add pain-management capacity in a more controlled way.

4. Using monthly reviews to course-correct execution

Once the new service line launched, monthly management reviews quickly became an important decision-making tool. Early results showed revenue coming in below target, and the review process helped identify the reason: the marketing team was still being rewarded primarily for orthopedic cases rather than pain-management volume.

We helped redesign incentives so the commercial team was aligned with the new strategy. With that change in place, volumes improved and execution moved closer to plan.

5. Planning capacity around liquidity

As the business matured, the founding surgeon also began planning for a reduced day-to-day operating role. We incorporated physician hiring into the cash flow model and identified the earliest points at which additional full-time doctors could be added without putting liquidity at risk.

This created a practical roadmap for expanding clinical capacity in step with collections, helping the business avoid hiring ahead of what the cash profile could support.