Strengthen Valuation Confidence and Reveal True Earnings Potential

A Quality of Earnings (QoE) review is the most critical component in evaluating the true financial performance of a healthcare organization. Unlike a traditional audit, Coker’s Quality of Earnings review assesses the sustainability, quality, and underlying drivers of earnings—helping you understand the normalized financial picture before moving forward.

Our healthcare-focused team combines financial analysts, valuation experts, and operational specialists to analyze the operational realities behind the numbers. We provide a defensible foundation for valuation and deal structuring grounded in clinical and regulatory reality.

Trusted by healthcare organizations nationwide

  • 35+ years of healthcare consulting experience
  • Specialized expertise in EBITDA normalization and pro forma considerations.
  • Trusted by buyers, sellers, and investors to pinpoint financial risks before closing. 

  • Integrated expertise across valuation, forecasting, and due diligence

"I would be very happy to recommend Coker to any physician group or healthcare group considering compensation or employment structure changes. Coker displayed business acumen and understanding that would be applicable to almost any situation."

- Derek C. Welch, M.D., PathGroup

 

35+

Years of healthcare industry experience

120+

   Nationwide consultant network

80+

Books written and published

When Earnings Quality Defines Deal Certainty

Healthcare transactions face constant pressure to validate earnings and mitigate hidden risks. Even small oversights in payer mix or non-recurring expenses can lead to overvaluation and unexpected liabilities post-close.

Coker’s Quality of Earnings team combines financial and healthcare-specific expertise to help you strengthen transaction integrity. We don’t just identify historical accuracy; we deliver the insights and normalization adjustments that help you navigate complex negotiations and prepare for long-term success.

 

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Our Key Quality of Earnings Services

Buy-Side Quality of Earnings
Independent analysis to validate normalized EBITDA, identify hidden liabilities, and assess the durability of revenue streams for prospective buyers.

Sell-Side Readiness & Pre-Diligence
Proactive reviews for sellers to address normalization adjustments early, strengthen negotiation positions, and streamline the buyer's diligence process.

EBITDA Normalization & Pro Forma Analysis
Identifying non-recurring revenue, one-time expenses, and run-rate adjustments to establish a defensible financial baseline for valuation.

Net Revenue & Payer Mix Analysis
Evaluating reimbursement trends, volume shifts, and revenue cycle performance to determine the reliability of future cash flows.

  • Healthcare-Specific Insight

    QoE findings grounded in clinical operations, regulatory risk, and reimbursement nuances that generalist firms miss.

  • Data-Driven Accuracy

    Rigorous analysis of trial balances, general ledgers, and claim data to establish a reliable financial narrative.

  • Risk Mitigation

    Early identification of financial and operational dependencies that could impact deal structure or post-close stability.

  • Strategic Negotiation Support

    Defensible, clear reporting that empowers deal teams to address issues early and minimize valuation retrades.

Trusted Advisors in Financial Analysis

Coker brings more than 35 years of financial advisory experience to every engagement. Our team combines technical transaction expertise with a deep understanding of operations, compliance, and strategy, ensuring that every QoE review we deliver is both defensible and practical for real-world decision-making.

Regulatory Expertise

Our analysts focus exclusively on healthcare, ensuring normalization adjustments reflect the complexities of the industry.

Integrated Advisory Team

We coordinate with valuation and operational specialists to provide a unified perspective on transaction risk.

Independent and Defensible

Objective, data-supported reports that withstand the scrutiny of buyers, sellers, and financial institutions.

Proven Track Record

For over three decades, Coker has been a trusted partner in validating the financial health of the nation’s leading healthcare organizations.

A Proven, Transparent QoE Process

Our process is designed to deliver both confidence and clarity. We follow a structured, transparent approach that helps you understand every driver of deal performance before you commit.

  1. Financial Scoping & Data Analysis

    We evaluate historical financial statements, revenue streams, and expense drivers to identify key areas for normalization.

  2. Earnings Normalization & EBITDA Adjustment

    Our experts identify non-recurring items and pro forma considerations to establish a repeatable financial baseline.

  3. Revenue Cycle & Payer Mix Review

    We analyze reimbursement trends, denials, and volume shifts to assess the sustainability of current revenue levels.

  4. Definitive QoE Reporting & Insight

    Coker delivers clear, data-supported findings that help deal teams address risks, refine deal structures, and close with confidence.