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Increase your enterprise value with this business scorecard through boosting profitability, retention and practice worth
By Thanh Mai, OD, FSLS
May 14, 2026
Last year, I went to Las Vegas and visited Alex Hormozi. He’s an accomplished entrepreneur who has written numerous books I’ve loved over the years like “100M Leads” and “100M Offers.” His posts on social media really resonated with me in terms of how to scale and grow a business.
Learning from Alex completely changed how I think about optometry practices. Most optometrists track the wrong scorecard.
We celebrate: “We’re busy.”
“Our schedule is full,” or “We had our best month ever.”
But sophisticated CEOs focus on something entirely different: Enterprise value.
And that comes down to understanding a few key numbers and reducing risk. This isn’t strictly important if you are buying or selling a business. Making a business more valuable inherently is a better business for you to own even if you intend to keep it.
The Business Scorecard
Focus on these six areas.
1. Revenue
Revenue tells you the size of the business. It’s the most reliable indicator of the value of a business. The more revenue you generated means you were great at getting more patients in the door, having them spend money and having them come back more often. Do all three of those well and your revenue will grow and also an indirect way of demonstrating how many lives you’ve improved.
2. Earnings Before Interest, Taxes, Depreciation and Amortization (EBITDA)
One of the most important metrics investors look at is EBITDA. In simple terms: It measures the profitability of the actual business operations.
This is huge because buyers don’t buy revenue. They buy cash flow. Two practices can collect the exact same amount and have dramatically different valuations depending on operational efficiency. If I were to buy your practice, I need EBITDA or profit in order to pay down the loan I might take to buy your practice.
3. Revenue Growth %
A business that is growing 10%+ per year consistently for 10 years is a great sign. A practice that is slowly shrinking needs a darn good reason why. Otherwise, it’s like trying to catch a falling dagger.
Predictable growth lowers risk. And lower risk increases valuation multiples. Sometimes a practice owner tries to sell potential, but a flat lining practice is telling a story that there might not be any potential otherwise the current owner would have realized it already.
4. Yearly Revenue Retention
This is massively overlooked in optometry.
- How much revenue stays year after year?
- Do patients return?
- Do they continue treatment?
- Do they buy again?
- Do they refer friends and family?
Retention creates stability.
The best businesses don’t constantly start over every year trying to find new patients.
They build long-term relationships. Looking at their google and yelp reviews can give you a quick glimpse on the patient experience.
5. EBITDA Margin
This measures efficiency.
How much profit do you keep from every dollar earned? High-performing businesses obsess over operational efficiency:
- Staff productivity
- Delegation
- Exam lane utilization
- Optical capture
- Systems
- Automation
Because growth without operational discipline eventually becomes chaos.
6. LTV/CAC Ratio
This may have been the most important concept discussed.
The best businesses aim for an LTV/CAC ratio of at least 3:1.
LTV = Lifetime Value (how much revenue and profit a patient generates over the lifetime of their relationship with your practice).
CAC = Customer Acquisition Cost (how much it costs to acquire that patient, including marketing, advertising, promotions, referral programs, staff labor and social media).
For example: If it costs you $300 to acquire a patient, but that patient generates $3,000 over time through exams, optical, dry eye treatment, specialty lenses, aesthetics or referrals… That’s an incredible business.
The strongest companies create systems where the lifetime value dramatically exceeds acquisition cost.
Most practices never calculate this. Elite businesses track it obsessively. Many optometrists obsess over whether or not they should take vision plans.
But when I look at my most successful colleagues—the ones with large practices, multiple locations, high revenues and strong enterprise value—I notice that almost all of them take vision plans.
Why? Because they understand LTV/CAC.
Patient Value Beyond The First Exam
They understand that every patient walking through the door has value far beyond the first exam. Most practice owners only evaluate the immediate transaction.
Elite operators evaluate the lifetime relationship.
That patient may start with a routine vision exam, but over time they may become:
- A dry eye patient
- A myopia management patient
- A specialty lens patient
- A medical eye care patient
- A premium optical buyer
- A referral source for family and friends
Sophisticated business owners understand that patient acquisition is hard and expensive.
So when someone walks through your doors, regardless of how they got there, that relationship has enormous long-term value if your systems and retention are strong.
The best practices don’t think: “How much did we make today?”
They think: “What is the lifetime value of this patient over the next 10 years?”
That mindset changes everything.
Then There’s Risk
This was another major lesson from Alex’s team: Valuation isn’t just about growth.
It’s also about reducing risk.
Key Man Risk
If the owner disappears tomorrow, does the business survive?
Most practices are overly dependent on one doctor for seeing patients, driving culture, making decisions, producing revenue and solving problems.
That lowers valuation. I am now very leery when I look to purchase a practice if the owner was the CEO, COO and seeing patients five days a week. It’s not a real business but an owner stuck with a bunch of jobs. Even if you aren’t looking to sell your business, you should create a real one. A real one has the right people in the right seats that have the capacity and want to do their job.
The more dependent the business is on one human, the riskier it becomes. Delegate appropriately and you are growing a real enterprise that is healthier to stay in and healthier to sell if you decide to.
Key Client Risk
If one referral source, one vision plan, one employer contract or one associate drives too much revenue, the business becomes fragile.
Sophisticated buyers hate concentration risk.
Healthy businesses diversify revenue streams. Ideally you offer multiple services.
Single-channel Risk
Some practices rely entirely on one acquisition channel such as Google reviews, insurance directories, social media or one referral relationship. That’s dangerous.
If the channel disappears, growth disappears.
Strong businesses develop multiple predictable ways to acquire patients.
Market Risk
This one matters more than most doctors realize. Is your segment of optometry growing? Or is it shrinking like the LASIK market?
Is it becoming commoditized? If you needed soft contact lenses to survive and your market deems them a commodity, you need to diversify your income streams.
Routine insurance-based exams are getting squeezed.
Meanwhile, myopia management, dry eye, specialty lenses, medical optometry and premium patient experience are rapidly growing.
Practices aligned with growing markets command higher valuations.
Data Risk
This one hit hard. Many practices make decisions based on feelings instead of data. I’ve worked with many that don’t post insurance payments or even post payments in their EMR but rely on just what hits the bank. Many owners have:
- No dashboards
- No KPI tracking
- No acquisition metrics
- No retention metrics
- No financial visibility
That’s risky. Businesses without good systems become difficult to scale and difficult to value.
Business owners need a strong data dashboard that measures things like how many new patients they are generating, capture rate, revenue per patient, etc.
Use The Scorecard To Evaluate Your Practice Worth
Most optometrists think their primary role is seeing patients. But once you own a practice, your role changes. You are no longer just the doctor.
You are the CEO. And one of the CEO’s primary responsibilities is increasing enterprise value over time.
That means:
- Growing revenue
- Improving EBITDA
- Increasing retention
- Building scalable acquisition systems
- Expanding margins
- Reducing operational risk
- Creating systems that grow beyond the founder
Doing all these things well is an indication that you are changing the lives of more patients. Which is why we decided to practice optometry in the first place.
Read more insights from Dr. Mai here.
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Thanh Mai, OD, is the co-founder and CEO of Insight Vision, a multiple location optometric group. To contact him: tmai@visionsource.com |
