Prepared for lenders, CDCs, and federal agencies to SBA SOP 50 10 8, USDA 7 CFR Part 5001, and conventional underwriting standards. Fiduciary duty runs to the lender and the agency, never the borrower. 4,000+ engagements since 1998 covering $41.2 billion in evaluated project value. So far in 2026: 41 engagements and $1.54 billion evaluated — 17 SBA, 11 USDA.
Inpatient hospice houses and palliative-care facilities are census businesses with a defined reimbursement frame: the Medicare hospice benefit dominates payment, level-of-care rules govern what inpatient days the benefit covers, and the census flows from the sponsoring agency's home-hospice population and community referral relationships. The study sizes demand from mortality and hospice-utilization data in the service area, models the inpatient census the sponsoring agency's caseload can actually support, and tests the facility's economics at the benefit's rates with the general-inpatient and respite criteria applied honestly.
Census modeling from service-area mortality, hospice penetration, and the sponsor's caseload, payer modeling at Medicare hospice rates by level of care, staffing at the clinical ratios inpatient hospice requires, and philanthropy treated as documented support rather than assumed subsidy.
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. Nonprofit sponsors reach USDA Community Facilities and philanthropic-leveraged conventional structures; the sponsoring agency's operating history is the core credit fact.
The engagement extends the firm's community-facility and senior-care record into end-of-life care's specific reimbursement architecture. 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.
A feasibility study for an inpatient hospice house or palliative care facility is not a general healthcare market report. Every section is built around the Medicare hospice benefit's reimbursement architecture, the sponsoring agency's existing caseload, and the clinical staffing ratios that inpatient care legally requires. The study moves from population data to projected census to a fully modeled income statement, and every link in that chain is documented and auditable.
Demand for inpatient hospice beds is not measured by population headcount alone. The analysis begins with mortality — specifically, the number of deaths in the defined service area that occur from diagnoses historically associated with hospice enrollment — and then applies hospice penetration rates drawn from Medicare program data and state health department vital-statistics files. Those rates vary materially by geography, and the study uses the rates actually observed in the service area, not national averages.
The sponsoring agency's Medicare cost reports and state licensure filings provide the factual foundation for the caseload side of the model. Average daily census, the share of patient days that qualify as general inpatient under the Medicare criteria, and the frequency of respite admissions are all drawn from the agency's own filed records rather than industry benchmarks. Competitive supply is inventoried from state health facility licensing registries, certificate-of-need databases where the state maintains them, and Medicare provider enrollment records, which identify every certified hospice and every licensed inpatient unit operating in the market. Planned supply — facilities in development or under CON review — is identified through state agency public notices and, where applicable, USDA Community Facilities obligation lists. The result is a demand picture anchored in documented evidence at every step, with no layer of the analysis resting on an assumed penetration improvement or an unverified referral commitment.
Hospice & palliative care facility feasibility studies are sensitive to a small number of inputs that carry most of the financial weight. Identifying those inputs, sourcing them honestly, and stress-testing them across a defined range is the analytic core of the engagement. A study that presents only a base case without showing how the coverage ratio moves when key assumptions shift is not useful to a credit officer.
Each financing channel raises a distinct set of questions, and a study prepared for one program is not automatically acceptable to another. Understanding what each reviewer is actually testing allows the study to answer those questions directly rather than leaving gaps for underwriters to fill with conservative assumptions.
SBA lenders reviewing a hospice facility under SOP 50 10 8 require a feasibility study from an independent third party when the project is a startup or an expansion that materially changes the borrower's revenue base. The study must demonstrate 1.15x operating debt-service coverage and 1.00x global coverage from documented cash flows, not from philanthropy treated as operating income. The GIP utilization assumption receives particular scrutiny because it drives revenue per day.
USDA Community Facilities is the most common agency channel for nonprofit hospice sponsors. RD Staff Instruction 5001 requires an independent feasibility study and places weight on the sponsoring organization's operating history, existing caseload depth, and community need documentation — all of which map directly to the demand methodology described above. The agency also evaluates whether the facility duplicates services already available in the community, making the competitive-supply inventory a compliance requirement, not merely a market observation.
Conventional lenders typically require 1.20x coverage and focus on the sponsor's balance sheet, the concentration of Medicare revenue, and the facility's ability to service debt if census runs below projection. Ratio analysis benchmarked against RMA and IBISWorld data provides the peer context lenders use to evaluate whether the projected margins are credible.
The engagement begins with a fixed, quoted fee returned within one business day of inquiry. No fee is contingent on the study's finding, and the determination is not revised under pressure. That structure is not incidental — it is the condition that makes the study credible to a lender or agency reviewer who knows the sponsor has a financial interest in a favorable conclusion.
Once the engagement is confirmed, a data room checklist is issued. For a hospice facility, the data room typically includes the sponsor's Medicare cost reports, state licensure filings, average daily census records by level of care, any signed philanthropy commitments, the proposed site or lease, construction cost estimates, and the proposed debt structure. Standard delivery is 10 to 15 business days from a complete data room. Rush delivery is available when a loan committee deadline requires it.
The deliverable is a bound narrative report and a fully linked Excel financial model. The model publishes to a secure client portal where it stays live: a reviewer can change any input — census, rate, staffing ratio, interest rate — and watch every downstream calculation update in real time. There are no hardcoded values. The narrative includes an explicit statement of conditions that identifies the assumptions on which the favorable or unfavorable determination rests, so any party reading the study knows exactly what would have to be true for the conclusion to hold. Wert-Berater, Inc. has completed 4,000+ engagements representing $41.2 billion in evaluated project value since 1998.
The fee is fixed and quoted within one business day of inquiry. It does not vary with the study's finding, and no portion is contingent on loan approval or a favorable determination. Because scope drives cost, the quote is based on the project's complexity — number of beds, financing programs involved, and whether the sponsor is a startup or an established agency with filed cost reports.
Standard delivery is 10 to 15 business days from receipt of a complete data room. Rush delivery is available when a lender or agency deadline requires a shorter window. The most common cause of delay is an incomplete data room; sponsors who assemble Medicare cost reports, census records, and philanthropy documentation before engagement begins consistently receive studies on the faster end of the standard window.
Revenue per patient day swings significantly depending on the share of days that qualify as general inpatient under the Medicare hospice benefit versus routine home care. That utilization rate is difficult to project for a new facility and is the assumption underwriters challenge most often. A credible study sources the GIP rate from the sponsor's own filed cost reports and stresses it across a defined range rather than holding it flat at an optimistic level.
The two programs share a requirement for an independent third-party study but differ in what they emphasize. USDA Community Facilities places particular weight on community need documentation and competitive-supply analysis as compliance elements, not just market context. A study built specifically to RD Staff Instruction 5001 addresses those elements explicitly; a study prepared only to SBA SOP 50 10 8 may leave gaps that a USDA reviewer will flag.
Yes, and USDA Community Facilities is specifically structured to accommodate philanthropic leverage alongside agency debt. The feasibility study treats confirmed grant awards and signed pledge commitments as documented support. Unconfirmed or anticipated philanthropy is excluded from the base-case revenue and coverage calculation and may be shown separately as upside in the sensitivity analysis.
The core data room includes Medicare cost reports for the sponsoring agency covering at least three filed years, average daily census records broken out by level of care, state licensure filings, any signed philanthropy or grant commitment letters, a proposed site description or executed letter of intent, construction cost estimates, and the proposed debt structure including loan amount, term, and proposed rate.
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