Nine Percent: The Readiness Gap Almost Every Practice Owner Shares — and Why It Isn't Your Fault

By Jacob Lynch, Managing Director, Healthcare Capital Advisors

A survey landed this summer that quietly makes the case we make to owners every week — except now the argument is coming from someone else's data.

Ensora Health surveyed more than 1,100 licensed therapists for its 2026 Practice Success Report. Ninety-five percent of practice leaders agreed that all five domains of practice health matter. Seven percent actually track all five. Only 18% called their practice “thriving.” And the single domain that the fewest owners could call a clear strength — the one they were least confident about and least likely to measure — was financial health, at nine percent.

Nine percent. Which means that if you run a behavioral health practice and your finances don't feel buyer-ready, you are not the exception. You are the overwhelming rule.

Here's the part worth sitting with, because it reframes the whole thing. The reason your numbers aren't ready for a buyer isn't that you're bad at running a practice. It's that almost nothing in clinical training, licensure, or the daily work of delivering care ever required you to measure the things a buyer will ask about. You were trained to treat patients and keep a business alive — not to produce an accrual-based quality-of-earnings package. The gap is structural, and it's nearly universal, which is exactly why closing it is such an advantage.

The survey points at the one number that translates most directly into money. Practices that track nothing reported missed billing opportunities at 44%; practices tracking even one domain reported 31%. That thirteen-point gap is revenue that never becomes EBITDA — and no diligence process recovers it after the fact, because a buyer prices what you actually collected, not what you should have earned. Missed billing isn't a rounding error. It's the clearest dollars-and-cents argument for why preparation starts twelve to eighteen months before a sale rather than at the letter of intent.

The good news buried in the same data: the fix isn't dramatic. The owners who close that gap didn't hire a CFO or install an enterprise system. They picked a small number of metrics — the ones a buyer will ask about — and started tracking them on a set day each week. The distance between the 44% and the 31% is mostly the distance between measuring nothing and measuring something.

Two honest caveats, because this is a survey about practice health, not just money. Two of Ensora's five domains are about whether clinicians and clients are being looked after — and the report's finding there is telling: owners want to know and lack a reliable way to see it. Sixty-eight percent had no dependable way to learn why a client left treatment early. That's not a financial failing; it's the same measurement gap showing up on the clinical side. And credit where it's due — this is Ensora's research, and it's a genuinely useful piece of work.

The reason we point owners to it is simple. The instinct, when you read a statistic like “nine percent,” is to feel behind. The more accurate reaction is relief. Almost everyone is in the same position, for reasons that have nothing to do with how good an operator you are — and the small, unglamorous act of starting to measure is what separates the practice that's ready when the right buyer appears from the one that isn't.

If you want to know where you stand across the specific areas buyers scrutinize — strategic clarity, financial readiness, operational strength, and risk — that's exactly what the HCA Readiness Scorecard is for. Five minutes, no cost, and it's just for you.

Healthcare Capital Advisors works exclusively with behavioral and mental health companies on sell-side representation, buy-side strategy, and pre-transaction readiness.  Preparation. Process. Performance.