What's Really Driving Deal Value in Home Health & Hospice M&A

Maximizing Value in Today's M&A Market [Free Webinar]

Home health and hospice deal activity is picking back up, but getting a transaction across the finish line has never taken more preparation.

That was the core message from our latest webinar, Maximizing Value in Today’s M&A Market, where Maxwell TEC COO Jay Duty sat down with Mark Kulik, Senior Managing Director at The Braff Group, and Kristopher Novak, Managing Director at The Braff Group, to talk through what's shaping the current M&A landscape and what agencies need to have in order before they go to market.

Read on to get the highlights from their recent conversation.

The M&A Market Is Turning a Corner in Home Health & Hospice

After a five-year pullback from the 2021 peak, certified home health deal volume is finally trending up again, and hospice has been climbing since mid-2025. Private equity platform activity is a big part of the story: new platform deals in 2026 are already outpacing 2021, historically a leading indicator of the add-on activity that follows.

Novak pointed to two pieces of good news for home health that the sector hasn't seen together in over a decade: the moratorium that took effect in May, which is capping the supply of new providers and limiting de novo strategies, and a positive rate update. Add in recent private equity moves into home health, and the sector has real momentum, even though Medicaid-focused organizations are still working through a slower funding environment.

Why So Many M&A Deals Still Don't Close

Kulik was direct about a dynamic that the transaction data doesn't capture: the deals that never make it to the finish line. In his view, three forces are converging right now:

• Sellers are still anchored to the high valuations of the COVID years.
• Regulatory oversight and fraud, waste, and abuse scrutiny are at levels he's never seen in 25 years in the sector.
• Buyers, facing higher price tags, want proof of value before they'll pay for it.

That combination produces a due diligence environment that goes well beyond what a state survey covers. Buyers aren't just checking conditions of participation anymore. They're digging into conditions of payment, and that's where deals fall apart.

Kulik shared a few examples that stuck with attendees:

• One buyer walked away from a deal after finding that physician assessment notes were copied directly from nurse notes in the EMR, a red flag the seller hadn't even noticed.
• Another buyer backed out of a transaction after visiting three locations and finding that every patient chart had identical timestamps across admission dates, sign-offs, and hospice certifications, so consistent that the buyer suspected automated compliance rather than real documentation.
• In a third case, a business lost a deal over 5500 filings that hadn't been submitted on time, an issue entirely outside day-to-day operations.

The takeaway: a clean state survey isn't the bar anymore. Buyers want evidence, not assurances, and the burden of proof sits with the seller.

What Buyers Are Actually Scoring

Novak, who previously ran M&A for a publicly traded acquirer, laid out the framework buyers use to triage a pipeline of potential deals:

• Financial performance and reporting accuracy. Owners who can speak to census and their bank balance aren't enough anymore. Buyers want KPIs tracked and understood well before diligence starts.
• Compliance history. Due diligence checklists now commonly run 15 tabs deep, with 100 to 250 questions per tab, and clinical documentation quality is under more scrutiny than ever. Kulik noted this has accelerated sharply in just the last two to three months, as government use of AI to flag billing and coding anomalies has ramped up.
• Operational efficiency. Buyers want to see centralized, streamlined back-office functions, not disparate processes stitched together across locations.
• Technology adoption and ROI. A modern tech stack matters, but only if it's driving measurable results. Both Kulik and Novak cautioned against treating new technology, especially AI tools, as a checkbox. Buyers want to see that a platform is fully adopted and that its ROI shows up in performance, not just in a pitch deck.
• Leadership and culture. A stable, scalable leadership team correlates with better outcomes and higher growth, which makes it one of the more valuable, if less tangible, assets a seller can bring to the table.

Novak also flagged referral source concentration and integration risk as recurring diligence points, particularly for buyers evaluating how disruptive a transition will be for clinicians and staff.

Quality of Earnings: the Report That Sets Valuation

Kulik walked through why a seller-commissioned quality of earnings report has become standard practice rather than a nice-to-have. Tax filings, cost reports, and year-end financials are all snapshots in time. A quality of earnings report answers a different question: will this business keep performing at this level going forward? That forward-looking view is what buyers use to anchor their valuation, and they'll commission their own version regardless of what a seller provides.

Getting ahead of it lets a seller understand their own EBITDA before a buyer's consultant does, giving their advisor a factual basis to push back on any figures a buyer gets wrong. Novak added that GF Data has been tracking private transactions and found that sellers who complete a quality of earnings report in advance consistently land higher multiples.

Kulik put a number on the investment: agencies typically spend $100,000 to $500,000 on this kind of preparation and see four to ten times that back through added turns on their multiple.

The Advice That Ties It Together: Start Early

The single strongest theme from both leaders at The Braff Group was timing. Getting compliance, documentation, financial reporting, and operations in order isn't something to start once a letter of intent is signed. It takes months, sometimes years, and the payoff isn't just a smoother close. It's a materially higher valuation and a faster path through diligence.

Kulik and Novak also urged owners to bring a financial planner into the conversation early. Knowing the actual number needed to retire comfortably, fund a next venture, or support family goals gives a seller a real threshold to evaluate offers against, rather than a vague sense of wanting "the most."

And notably, both advisors made the case that this work pays off even for agencies not currently planning to sell. Strong financial controls, clean documentation, and a well-adopted tech stack are simply what it takes to run a high-performing agency today, whether or not a transaction is on the horizon.

Is Your Agency Deal-Ready?

Whether a sale is on your roadmap this year or several years out, the experts from The Braff Group and Maxwell TEC agreed: the agencies commanding premium valuations are the ones that got ahead of diligence—not the ones who scrambled to catch up.

Maxwell TEC offers comprehensive M&A services designed from home health, hospice, and care at home. From Seller Agency Health Checks, Due Diligence, to Integration, our team will walk you through where your agency stands today and what it would take to close the gap between your numbers and a buyer's expectations.