An optometry practice owner keeps a close eye on practice performance metrics. Photo generated by Gemini.
Most practice owners can’t say what their practice is worth. The reason isn’t carelessness—it’s that the things drive the number never show up in the day-to-day.
By Erich H. Mattei, MBA, CVA
July 30, 2026
I’ll ask a practice owner what their practice is worth, and there’s almost always a pause. Then a number that starts with “probably.”
I’ve stopped being surprised by it. These are sharp people who can tell you last month’s collections to the dollar, what their top three codes are and how many exams they did last Tuesday. Ask them the worth question, and the confidence drains out of the room. Not because they don’t care. Because nobody’s ever been watching the thing you’d need to watch to answer it.
And here’s the part that matters: For most owners, the practice is the single biggest asset they have. It’s the retirement plan, whether or not they think of it that way. It’s the thing a bank, a buyer or a partner is going to put a number on someday. And it just sits there in the background, quietly changing value every year, with nobody keeping an eye on it.
WHY THE NUMBER HIDES
The reason you can’t see your practice’s value isn’t the valuation itself. A good valuation is math you can learn. The reason it hides is that the things driving it don’t announce themselves. They move slowly, underneath a practice that feels completely fine.
Think about how a normal year goes. Patients come in. Bills get paid. The staff shows up. Nothing is on fire. By every signal an owner actually feels day-to-day, things are working. So nobody stops to ask the harder question: Is this practice actually growing, or is it just holding steady? Because those two feel identical from the inside and they are worth completely different numbers.
A practice that’s genuinely growing—revenue trending up, margin holding or improving, the owner making deliberate moves—is worth a great deal more than one that’s coasting at the same revenue. Same collections, same chairs, same patient count, wildly different valuations. The difference is trajectory, and trajectory is invisible if you’re only ever looking at it this month.
THE HANDFUL OF THINGS THAT ACTUALLY MOVE IT
If you want to start seeing the number, you start by watching the things underneath it. There aren’t many, and none of them require a valuation to track.
Revenue trend, not revenue.
The number that matters isn’t what you collected this year. It’s the direction over three. A practice at $700K and climbing is a different asset than a practice at $700K that’s been flat since 2022, even though they look identical in a single year’s tax return. Nobody buys a snapshot. They buy a direction.
| Fair Market Value (FMV) of Growing Revenue with Identical Collections and Cost Structure | ||
| Flat | Growing | |
| Gross Revenue | $700,000 | $700,000 |
| Growth | 0% | 5% |
| Margin | 30.6% | 30.6% |
| COGS | ($192,500) | ($192,500) |
| Payroll | ($171,500) | ($171,500) |
| Occupancy | ($51,800) | ($51,800) |
| Overhead | ($70,000) | ($70,000) |
| Optometric Net | $214,200 | $214,200 |
| Range of FMV | $298,000 | $416,500 |
Margin, over time.
Most owners know their revenue cold and their margin barely at all. Margin is where value quietly leaks—a point lost to a new hire that didn’t pay off, a point to a lease that crept up, a point to supply costs nobody renegotiated. None of it hurts at the moment. All of it compounds into what your practice is worth.
| FMV of Strong Margin with Identical Collections and Growth Rate | ||
| Weak | Strong | |
| Gross Revenue | $700,000 | $700,000 |
| Growth | 5% | 5% |
| Margin | 21.6% | 37.1% |
| COGS | ($224,000) | ($175,000) |
| Payroll | ($189,000) | ($157,500) |
| Occupancy | ($51,800) | ($51,800) |
| Overhead | ($84,000) | ($56,000) |
| Optometric Net | $151,200 | $259,700 |
| Range of FMV | $244,364 | $615,562 |
Who’s steering?
This is the one that doesn’t show up on a spreadsheet at all, but a buyer feels it immediately. Is this practice being actively driven toward something, or is it running on momentum? A practice with a plan is worth more than a practice on autopilot, even at the same numbers, because the buyer is buying the future, not the past.
| FMV of Actively Driving with Identical Collections and Growth Rate, Utilizing Percentage Cash Pay as Proxy for Actively Driving the Practice | ||
| Gross Revenue | $700,000 | $700,000 |
| Growth | 5% | 5% |
| Margin | 30.6% | 30.6% |
| COGS | ($192,500) | ($192,500) |
| Payroll | ($171,500) | ($171,500) |
| Occupancy | ($51,800) | ($51,800) |
| Overhead | ($70,000) | ($70,000) |
| Optometric Net | $214,500 | $214,500 |
| Percentage Cash Pay | 10% | 50% |
| Range of FMV | $329,728 | $468,562 |
FINE IS THE DANGEROUS PLACE
The trap in all of this is that “fine” feels safe. A coasting practice doesn’t hurt. There’s no crisis, no red flag, no month where you sit up and realize something’s wrong. It just runs. And because it runs, nobody asks the question, the value drifts sideways for years while the owner assumes it’s climbing.
Then one day it stops being abstract. Someone makes an offer. A partner wants to buy in or out. A health event forces a decision. Retirement stops being a someday. And suddenly the number you never tracked is the only number that matters. You’re trying to learn it under a deadline, in a negotiation, across the table from someone who valued you months ago never told you.
That’s the whole case for looking early. Not because you’re planning to sell tomorrow—most owners reading this aren’t—but because the number is moving right now, in a direction you can influence, and you can only influence what you can see. An owner who’s been watching revenue trend, margin and whether the practice is actually being driven has a very different set of options than one who finds out where they stand the week they need to.
You don’t need a formal valuation to start. You need to stop measuring where you are and start measuring which direction you’re moving. The worth question gets a lot less intimidating once you’re watching the things that answer it.
So here’s the version of the question worth sitting with, whether or not you’re anywhere near a decision: Are you driving this thing, or just running it? Most owners have never actually stopped to ask. It’s worth the pause.
 |
Erich H. Mattei, MBA, CVA, is a Certified Valuation Analyst and President of Akrinos, where he works with independent optometry practice owners on valuation, growth and long-term strategy. To contact him: erich@akrinos.com |
