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.
Urgent care is retail medicine: visit volume is a function of trade-area population, drive-time convenience, payer acceptance, and competing access points — other urgent cares, retail clinics, emergency departments, and same-day primary-care capacity. The study sizes annual visits from population and documented use rates, nets the competitive set honestly, prices the visit through the payer mix the location will actually draw, and tests the staffing model — provider hours are the dominant cost — against the volume curve by daypart and season.
Visit modeling from per-capita urgent-care utilization benchmarks, competitive census including retail and telehealth alternatives, payer-yield analysis by contract status, seasonality from respiratory-season patterns, and breakeven stated in visits per day — the operating statistic every operator and underwriter shares.
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. Owner-operator clinics fit SBA structures naturally; franchise affiliations are evaluated on system economics; multi-site operators route conventional with site-level reporting.
The engagement applies the firm's retail-site discipline — traffic, visibility, drive-time — to clinical volume economics. 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 urgent care center is not a generic healthcare pro forma. It is a site-specific, operator-specific document built around the clinical and financial variables that determine whether a particular location, at a particular volume, with a particular payer mix, can service the proposed debt. The narrative report addresses trade-area definition, population and demographic profile, competitive supply, projected visit volume, revenue per visit by payer class, staffing configuration, and a plain-language conclusion on financial viability.
Demand for urgent care is not inferred from regional healthcare spending trends. It is counted from the ground up, starting with the population that can reach the site within a competitive drive time and working forward through utilization rates, competitive subtraction, and payer yield. Each step relies on a specific, verifiable source rather than an assumed growth rate.
Population and demographic data come from current census estimates and licensed demographic databases that report age distribution, household income, and insurance-coverage rates at the block-group level. Age structure matters because urgent-care utilization skews toward pediatric and working-age adults; a trade area heavy in seniors shifts volume toward primary care and emergency departments. State health department licensing registries and certificate-of-need filings, where applicable, identify permitted and pipeline competitors that do not yet appear in commercial directories. Traffic-count data from state DOT sources and third-party mobility datasets inform visibility and access scoring for the specific parcel. Retail-clinic footprints are tracked through publicly available corporate real-estate disclosures and franchise development announcements. Telehealth penetration is assessed through insurer network filings and published plan documents, which indicate whether virtual visits are positioned as a substitute for low-acuity in-person care in the relevant market. The competitive supply figure that enters the model is a documented count, not an estimate, and each competitor is classified by service scope, payer acceptance, and hours of operation.
Four inputs account for the majority of variance in projected debt-service coverage for an urgent care center. A credible study does not pick a single value for each and move on; it documents the basis for the base-case value, tests the range, and states the visit-per-day threshold at which coverage falls below the applicable minimum. Lenders and agency reviewers will stress these inputs independently; the model is built so they can.
Every assumption is sourced, every source is cited, and the model recalculates when any value changes.
Underwriting concerns for urgent care centers differ from those for other medical facilities because the revenue model is transactional rather than subscription-based. There is no census, no long-term patient contract, and no guaranteed referral stream. Each of the three primary lending channels approaches that exposure differently.
SBA lenders operating under SOP 50 10 8 require an independent feasibility study when the project involves a start-up or a significant expansion. The study must support a debt-service-coverage ratio of at least 1.15x on an operating basis and 1.00x on a global basis. For urgent care, SBA reviewers focus on whether the payer-mix assumption is achievable given the operator’s current contract status and whether the competitive displacement estimate is conservative. Franchise affiliations require evaluation of system-level economics alongside site-level projections.
USDA Business & Industry and Community Facilities lenders, governed by RD Staff Instruction 5001, encounter urgent care projects most often in rural and underserved markets where the competitive set is thin but so is the insured population. The study must address Medicaid and self-pay concentration risk explicitly, because those payer classes carry the lowest net yield per visit.
Conventional lenders typically require 1.20x coverage and place additional weight on operator track record across existing sites. Multi-site operators are evaluated with site-level reporting that isolates the proposed location’s performance from the consolidated entity. In all channels, the breakeven visit count — stated in visits per day — is the figure underwriters return to most often.
The engagement follows a defined sequence so that both the sponsor and the lender know what to expect and when. The fee is fixed and quoted in writing within one business day of receiving the project description; it does not change based on the finding, and no portion is contingent on a favorable conclusion. Fiduciary duty runs to the lender and the reviewing agency.
Work begins when the data room is complete. A complete data room for an urgent care engagement includes the site address and lease or purchase terms, the operator’s existing payer contracts and credentialing status, historical volume and revenue data for any operating locations, the proposed staffing plan, and the project’s capitalization structure. Incomplete submissions extend the timeline; the engagement clock does not start until all required materials are received.
Standard delivery is ten to fifteen business days from a complete data room. Rush delivery is available and is quoted at the time of engagement. The deliverable set — bound narrative report, fully linked Excel model, sensitivity tables, interest-rate stress, ratio analysis benchmarked against RMA and IBISWorld data, and statement of conditions — is published to a secure client portal. The Excel model remains live in the portal and recalculates when any input is changed, so a lender’s credit officer or an agency reviewer can run their own stress scenarios without requesting a revised report. Determinations are not revised under pressure; if project parameters change materially, a scope-change process applies.
The fee is fixed and quoted in writing within one business day of receiving the project description. It does not vary based on the outcome of the study, and no portion is contingent on a favorable finding. Because scope varies by project complexity, payer-mix detail required, and whether SBA, USDA, or conventional compliance is needed, a specific figure is provided after a brief intake conversation.
Standard delivery is ten to fifteen business days from receipt of a complete data room. Rush delivery is available and is quoted at the time of engagement. The timeline does not begin until all required materials — site information, payer contracts, operator financials, staffing plan, and capitalization structure — are received. Incomplete submissions are the most common cause of delays.
Revenue is transactional: there is no patient census, no long-term contract, and no guaranteed referral stream. Net revenue per visit swings materially with payer mix, and payer mix depends on contracts that may not yet be executed at the time of underwriting. Competitive displacement is also harder to quantify than in most healthcare sectors because retail clinics, telehealth, and same-day primary care all compete for the same low-acuity visit.
Not automatically. SBA engagements are structured to SOP 50 10 8, including its 1.15x operating and 1.00x global debt-service-coverage minimums. USDA engagements follow RD Staff Instruction 5001, which carries its own documentation and analytical requirements. Studies intended for USDA Business & Industry or Community Facilities review are scoped and formatted to those standards from the outset, not adapted after the fact.
A complete data room includes the site address and lease or purchase terms, the operator’s existing payer contracts and credentialing status, historical volume and revenue data for any operating locations, the proposed staffing model, and the full capitalization structure including proposed loan amount and terms. Franchise operators should also provide the franchise disclosure document and any system-level benchmarking data the franchisor makes available.
Where a sponsor is evaluating an emergency department or a licensed inpatient component alongside ambulatory care, the analysis moves beyond urgent-care economics into a hospital market and demand study covering inpatient discharges, admitter relationships and the licensure pathway.
The fully linked Excel model is published to a secure client portal and remains live after delivery, so any reviewer can change an input and see the effect on coverage ratios immediately. If the project itself changes materially — a different site, a revised capitalization structure, or a significantly different payer mix — a scope-change process applies. Minor sensitivity testing is built into the standard deliverable and does not require a new engagement.
An urgent care service area follows the road network and the patient's choice set, not a simple radius. Drive-time catchments are assessed by direction and time of day, with attention to congestion, physical barriers, interchange movements and the routes connecting homes, schools and workplaces. A parcel may appear central on a map yet lose practical access because patients must make a difficult turn or pass another clinic first. The analysis distinguishes a primary catchment, where convenience supports routine use, from a secondary area that may contribute visits but should not carry the core forecast.
Population analysis considers where people live and when they are present. Age profile, household composition, daytime activity, housing development and population change help describe the addressable patient base. Payer mix is evaluated as a market and operator concept rather than applied as a national template. Local coverage characteristics are considered alongside the operator's executed contracts, credentialing status, network participation and experience at comparable centres. Coverage in the community does not automatically become collectible revenue for the project if the operator is outside a network or enrolment remains incomplete.
Site convenience is tested at the parcel level. Visibility must be considered from the patient's direction of travel, not just from the frontage; signage rights, lighting, parking, public transport where relevant, ingress and egress, turning movements and co-tenancy all affect capture. An urgent care centre also needs a workable clinical layout, accessible entry, separation of public and staff functions, safe specimen handling and enough flexibility to manage peaks without creating a waiting-room bottleneck. A lower rent does not compensate for a site that suppresses visits or requires expensive remedial work.
The competitive inventory includes independent and hospital-affiliated urgent care centres, retail clinics, freestanding emergency departments, hospital emergency departments and primary-care practices offering same-day appointments. Telehealth can substitute for some low-acuity encounters, while emergency departments compete for patients who are uncertain about severity or influenced by established hospital relationships. Each competitor is classified by hours, service scope, age restrictions, imaging or laboratory capability, appointment policy, payer acceptance, affiliation and ease of access. A count of clinic pins without these distinctions overstates some substitutes and understates others.
Hospital affiliation changes both market position and economics. A health-system brand may provide patient recognition, shared records, access to contracted networks and a defined pathway for escalation. It can also direct lower-acuity traffic from an emergency department. An independent operator may compete through convenience, customer experience and occupational-health relationships but cannot assume referrals merely because it is near a hospital or physician campus. The study examines documented arrangements and existing behaviour; an unsigned affiliation, informal conversation or hoped-for referral stream is not treated as base-case volume.
Competitive response is also relevant. An established system can extend hours, add online scheduling, reposition a primary-care site or open a retail-format clinic. A new entrant may trigger more advertising or a stronger effort to retain low-acuity visits within an existing network. Pipeline research reviews licensing and planning records, health-system announcements, property activity and visible construction, then assigns timing and confidence to each potential opening. The forecast does not assume the present access landscape remains static through the subject's ramp.
Visit volume is built from the catchment population, observed or supportable utilisation behaviour, the competitive choice set, the operator's service proposition and the site's expected capture. The calculation is reconciled from more than one direction: market demand allocated among credible access points, and an operating build-up based on opening hours, provider capacity and the pace at which awareness develops. This prevents a theoretically available market from producing a forecast that the staffing plan or premises could not physically serve.
The ramp begins with credentialing, pre-opening outreach and the practical date on which all intended services can be delivered. Awareness, repeat use, search visibility, employer relationships and physician familiarity develop at different speeds. Monthly projections recognise that initial curiosity does not equal durable demand and that new-patient acquisition eventually overlaps with repeat visits. The model also examines daypart and day-of-week patterns because an annual total can conceal periods when provider capacity is idle and other periods when waiting times push patients elsewhere.
Urgent care acuity and visit reasons are seasonal. Respiratory illness may increase demand in one part of the year, while injuries, school and sports requirements, travel-related needs or occupational services follow different patterns. Weather can alter both illness and patients' willingness to travel. Seasonality affects more than total visits: it changes testing, supplies, staffing pressure and the mix of services provided. The cash-flow forecast therefore avoids converting a peak month into a year-round run rate and tests whether liquidity can carry quieter periods.
Gross charges are not the same as net patient-service revenue. The model separates payer classes conceptually and applies the operator's actual contractual and collection circumstances where support is available. Commercial contracts may differ by plan and service; government programme participation follows its own enrolment and billing rules; self-pay collections depend on payment policy and patient behaviour. Occupational medicine may add another revenue stream, but employer relationships, pricing and service scope must be evidenced rather than assumed.
Timing matters as well as yield. Claims can be delayed by credentialing, coding errors, eligibility questions, documentation deficiencies, denials and patient-responsibility balances. The study considers the lag between a visit and collected cash, expected rework and bad debt, and whether working capital is adequate during ramp. It does not resolve legal billing questions or promise a reimbursement outcome. Its role is to ensure the financial case is based on collectible revenue under supportable contracts and processes, not on a fee schedule that the operator may never realise.
Changes in payer mix are tested against staffing and debt service because volume and yield can move in opposite directions. A centre may gain visits while generating less cash than planned, or it may secure attractive network access later than the opening schedule assumes. Sensitivity cases therefore separate visit shortfall, collection delay and weaker realised revenue rather than treating every downside as the same generic sales reduction.
The clinical staffing model starts with intended hours, service scope, state practice requirements and the operator's supervision and governance plan. Physician, advanced-practice provider, nursing, medical-assistant, radiology, laboratory, registration and management functions are mapped to the workload they support. The analysis distinguishes coverage that must be present whenever the doors are open from labour that can flex with demand. It also recognises recruitment lead time, agency or temporary coverage, benefits, training, leave, turnover and administrative time outside direct patient contact.
Provider productivity is constrained by acuity, documentation, procedures, testing and room turnover. A simple average of visits per hour can hide unsafe or operationally unrealistic peaks. The model tests whether the planned rooms, staff and diagnostics can process the projected daypart demand while maintaining workable waiting times. It also identifies the volume threshold at which another clinical team or support role is needed, because revenue does not always grow smoothly when staffing must be added in blocks.
Other operating costs are connected to the chosen service scope: medical and testing supplies, waste handling, laundry, information systems, billing, malpractice and general insurance, maintenance, quality programmes, marketing and administrative support. Lease costs are read with common-area charges, taxes, utilities, escalations and landlord responsibilities. The resulting expense structure distinguishes fixed occupancy and opening-hour commitments from visit-driven costs, which is essential to understanding downside performance.
Licensure and accreditation pathways vary by state, ownership model and the services offered. The study identifies the applicable sequence in general terms: entity formation and professional governance, land-use and building approvals, facility or laboratory permissions where applicable, pharmacy and controlled-substance arrangements where relevant, payer enrolment, inspections, policies, training and any voluntary or contract-driven accreditation. Project counsel and qualified clinical advisers confirm the legal requirements. The financial schedule allows for dependencies, because construction completion alone does not mean the centre can bill every planned service.
Capital cost review covers shell and tenant build-out, design and professional fees, plumbing and electrical work, clinical rooms, reception and staff areas, information and security systems, furniture, signage, diagnostic and laboratory equipment, medical supplies, permitting, contingency and pre-opening expense. Equipment choices are tied to the clinical scope; a service that depends on imaging or point-of-care testing carries space, staffing, maintenance and quality-control consequences as well as purchase cost. Landlord allowances and financed equipment are reconciled to their timing so they are not counted twice or mistaken for a reduction in total project cost.
Opening readiness is tested as a coordinated schedule. Certificate of occupancy, staff recruitment, training, equipment commissioning, supply delivery, insurer credentialing and marketing must converge. A delay in one critical item can leave the borrower paying rent and debt service without the expected revenue mix. The model therefore considers both the planned opening and a delayed or partially credentialed case.
Stabilisation means the centre has developed a repeatable pattern of visits and collections under a normal operating schedule. It is not simply the first month that reaches a selected visit level. The monthly model carries visits, payer-related collection timing, staffing steps, occupancy cost, working capital and debt service through the ramp. It identifies operating breakeven, cash breakeven and the point at which coverage becomes durable, then tests how those dates change under slower awareness, delayed contracts, lower collections or higher labour cost.
Lenders underwrite execution risk as much as market demand. Principal concerns include an overly broad catchment, understated hospital or retail competition, unexecuted payer contracts, credentialing delay, dependence on an undocumented referral source, provider recruitment difficulty, a staffing plan that cannot flex, cost overruns, insufficient opening liquidity and a lease term or renewal structure that does not align with the debt. Operator experience and performance at existing centres can inform the assessment, but a successful location is not transferred mechanically to a site with different access, competition or payer circumstances.
The coverage case shows the relationship among collected revenue, operating cost, capital structure and required debt service. Downside tests isolate the assumptions that consume the margin first and show the additional liquidity or operating change that would be needed. This gives a lender a transparent basis for structuring reserves, conditions and covenants without presenting the feasibility conclusion as a guarantee of clinical, regulatory or credit outcomes.
Groups comparing several parcels can begin with a healthcare site selection analysis, while a broader hospital and outpatient market report can document service-area demand and competitive capacity before a project-specific feasibility engagement. If the transaction also needs an opinion of property value, that is addressed through a separate commercial real estate appraisal. Lending scopes can be coordinated with SBA feasibility-study review or USDA Community Facilities analysis when the lender, CDC or Agency determines that work is appropriate. Each service answers a different underwriting question and remains separately scoped.
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Wert-Berater, Inc. is an independent provider of feasibility studies and other related services. The firm does not provide financing or equity investment advice, and does not arrange, broker, or place debt or equity capital of any kind.
All appraisal assignments are performed by Bruce E. Jones, MAI, ASA-GC, BCA, CMEA, a member of the Appraisal Institute since 2006, a staff member of Wert-Berater, Inc. and owner of Special Purpose Realty Valuation.