Prepared for lenders, CDCs, and federal agencies to SBA SOP 50 10 8, USDA RD Instruction 5001, and conventional underwriting standards. Fiduciary duty runs to the lender and the agency, never the borrower. More than 4,000 studies since 1998 covering $40.2 billion in evaluated project value.
Dialysis feasibility is census-driven and demographically anchored: end-stage renal disease prevalence in the service area, the nephrology referral base that directs patients, and station capacity arithmetic against treatment schedules. The study sizes the patient census from prevalence data and the local nephrology landscape, models station utilization across shifts, and prices treatments through the payer reality the category lives with — Medicare's bundled rate dominating volume while commercial patients carry the margin, a mix the pro forma must state explicitly rather than blend.
Census modeling from ESRD prevalence and referral analysis, station-capacity mathematics — patients per station across treatment shifts — payer-mix yield with the commercial share's outsized margin contribution quantified, and staffing builds at the nurse-and-technician ratios the modality requires.
Every Wert-Berater financial model is fully linked with no hardcoded values, so any reviewer can stress any input. Deliverables comprise a complete narrative report and the linked Excel model, with ten-year pro forma, sensitivity analysis at ±5, 10, and 15 percent, interest-rate stress from +0.5 to +3.0 percent, and ratio analysis benchmarked against RMA and IBISWorld data.
SBA engagements are prepared to SOP 50 10 8, including its debt-service-coverage minimums of 1.15x operating and 1.00x global. USDA engagements follow RD Staff Instruction 5001 across the Business & Industry, Community Facilities, REAP, and Value-Added Producer Grant programs. Conventional engagements are built to the lender's stated coverage standard, typically 1.20x. Independent and physician-affiliated centers fit SBA structures; the specialized buildout — water treatment, medical gas, generator — takes special-purpose treatment in collateral analysis across all programs.
The firm's clinical-facility practice supplies the specialized-infrastructure costing — water systems and redundancy engineering — the modality demands. Independence is non-negotiable: determinations follow the evidence and are not revised under pressure, and studies are built to pass lender, agency, and third-party review without exception items.
Qualify a project. Tell us about the project and the program. We will tell you the truth about it — scope, timeline, and fee confirmed before work begins.
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